Thursday, February 27, 2020

Forty One Tubs



This was going to be a great year for our project to the Dominican Republic. We had 40 participants lined up to go for a one-week project, so we had the potential to take more supplies than ever before.
Each of us on the project can take 2 checked bags and we can usually get all of our clothes and personal supplies in one suitcase or duffel and the second piece of luggage can be 27 gallon yellow and black plastic tub with up to 50 pounds of medication and supplies for our project. We normally collect supplies year-round and then in early September we order medications and then in October we meet and put the surgical packs together for sterilization. The hospital in Winfield has been kind enough and willing to process and sterilize our packs for the last 10 years as only 2 other hospitals in Kansas have the capabilities.


The process for bring medical supplies into the Dominican Republic has always to this point been pretty simple. I collect the supplies and create an inventory of each tub and send it to the country director for MMI, our sponsoring organization, about 3 weeks in advance. He then sends me a letter from the government acknowledging our donation to the people of the DR. Then we just walk thru customs after collecting our bags and tubs. Easy.

Early in the summer I got the word that William Newton Hospital was undergoing renovation of their surgery area including the central supply. That meant that they had to decommission the ethylene oxide (EtO) sterilization system during the work but that it would be up and running by early November. Since we didn’t do the final packing of all our tubs until December 7th, there shouldn’t be a problem…


The process in the DR is a little more complicated than I knew, but I didn’t need to know because it has always gone so easily. Actually, it is a multi-step procedure. First, the participating doctors’ and nurses’ license and credentials are reviewed by the Ministry of Health and they give approval for us to practice in the country for the time of our project. Then the Regional Health Ministry and local hospital sign off on and give us permission to work there. The documents are then taken to Customs and our list of medications and supplies are reviewed and the final signature is given for us to bring the medications and supplies into the country.

Meanwhile, we packed 15 tubs of supplies for sterilization. We were waiting for the okay from Winfield to bring the supplies for them to process. I got word that the renovation was going a little slower that expected and they wouldn’t be done til late November. No problem, we don’t pack the final tubs til December 8th. Since they can’t use the EtO they said they could heat sterilize what ever we had. Unfortunately, we only had 3 of the 15 tubs that could be heat sterilized since the heat would destroy anything with plastic in it. So, we took the 3 tubs and they did them over then next few days. December 8th, we had our packing event and we packed 28 tubs. We always try to split things up so not one tub contains all of any given thing in case it got lost, even though they never have to this point. That way the mission goes on if only one or two tubs don’t make it. This means that I would wait a bit until the last tubs are packed to send the final inventories.



Sometimes things change in the DR from year to year although most things don’t. It seems as if a high ranking official in the DR took office January 1, 2020 and he had this little quirk that he didn’t like having forms and requests from his predecessor around. So, every letter must be addressed to him personally. Didn’t know that. So, our forms and documents were turned in early December and we waited.


Back in Winfield, it’s December 16th and they are getting close but need a filter to be delivered and installed before they can move into the new facilities. Nope, it didn’t come in on the 23rd so it will be after the first of the year. It arrived, was installed but they failed the fire inspection on January 8th. They did pass the next day and they started on our tubs. They finished 5 tubs on January 13th and saw that they were running low in EtO so they ordered more to be shipped but a snow storm in Iowa grounded the transport and they ran out of EtO with 5 more tubs to go on January 21st. Did I mention that we leave the country on January 25th and I still have tubs all over my house? Since we didn’t have many meds to put in the tubs, we packed the tubs at my house and started calling people to come get the tubs. By God’s grace I found out that one of the participant’s daughters was going to Kansas City and would take two tubs there. The participant in Kansas City then took one of them on to a participant in Nebraska. A doc in Wichita, Rob, offered to take another one of the last tubs with the surgery supplies. The last of the tubs gets delivered at 4 am on Saturday morning to the airport to a participant as he was arriving at the airport. A sigh of relief by all was had. 41 tubs, a record amount of supplies for our project right under the wire. And off we go for a relaxing flight to the Dominican Republic.


We left Wichita at 5:40 am for Atlanta, then after an hour or so layover, we were on the flight to Santo Domingo. Arriving on time, we all gathered just inside the door of the airport so we could all process thru customs all together. There were also two other medical teams arriving on our flight going on to different parts of the island. The lines were extremely long thru customs so by the time we got thru having our passports stamped we arrive at the baggage area and all the bags were there.  Each of us got our bag and tub placed on a cart and slowly inched to the custom agent. I went first and gave my letter of donation and my passport to the agent and a new set of problems began. Usually, my rudimentary Spanish, hand signs and documents have allowed us to just walk on by. Not this time. It seemed as if there was a problem. They wanted to open and check everything. All 41 tubs! I called our Dominican director and had him talk to the agent in Spanish. By now it is late afternoon and the airport is packed with people but not with employees. After much back and forth, and something about a missing signature, they said we would have to come back Monday morning to get our supplies.



Well, our plan had been to take our tubs to the camp an hour and a half away in Monte Plata. Next, we would unpack our bags and settle in, have orientation and Sunday morning after devotions, we would separate out the medical and surgical supplies. We would then take the surgical supplies to the hospital and set everything up to be able to start surgery early on Monday morning. I tried to explain to the customs agents that this “new” plan of theirs was not acceptable, but my logic was not working on the customs agents. We had no choice but to leave the baggage area with our luggage but not of tubs of supplies and meet our school bus and leave for Monte Plata. We were assured that it would work out fine, but they didn’t seem to understand the gravity of our situation. We brought all the things we HAVE to have to do surgery and run medical clinics. They said it would be okay, but they just don’t know…


As we found there was enough to start on Monday, but it was not OUR STUFF. We did our surgery consults and scheduled the first day of surgery. The clinic went thru the reserve tubs of supplies that had been left over after the previous project and found enough for Monday’s clinic. So, we went to the hospital and started the day with our anesthesia people saying they might not have enough to finish the scheduled cases for the day. Around noon, I received a call from our director, and I was then taken to customs at the airport in the big white truck. We arrived at customs and waited and waited and they finally they told us that they didn’t have the required signature so we would have to come back tomorrow. I was devastated; didn’t they understand? It was their people who would be penalized. We had OUR PLANS and had it under control, but we couldn’t help without OUR STUFF.


We started Tuesday with some reservations, but they said we would be getting our supplies. The clinic found enough to take to the clinic, and we found enough to do the scheduled cases, but they were not confident. We left to go to the airport again in the big white truck only to get there and have them say again the letter had a problem with the description of our host hospital. We begged the lady at the customs office she said if you have any tubs that don’t have medications, she will let us take those. I checked my inventory list and found 11 tubs that were packed late, so they only have the sterilized supplies. They looked in a couple of them and released them to us. The weird thing was that they also released the medications that the other project, one the other side of the island to me??? That made no sense at all. But we took them and then sent them to that project by a tour bus that was going there on Wed. We packed up and took the 11 tubs back and they said maybe tomorrow on the rest. At this point, our people were out of some anesthesia meds but MMI was able to buy some and borrow some of the meds from the local hospital. After going thru the tubs back at camp, one of the tubs was on of Rob’s tubs.


Unknown to me, at the last-minute Rob had bought medication for Parkinson’s disease for a patient that he had been seeing in the DR for several years. Juan was an elderly man who was very immobile and had debilitating tremors without the medications. He had been placed on two long acting pills a day and Rob would usually bring enough for about 6 months and then hope the patient could get enough for the rest of the year. Rob this time brought instead a lower dose that had to be taken three times daily, but that dose was inexpensive enough to get almost 11 months worth. We were not scheduled to go to the El Dean where he lives in, but it was on the way to the village of Don Juan where we were going on Wednesday. So, the medication came right in time.
Upon arrival he found out that Juan had passed away 2 weeks prior to our visit, and the funeral was last week. Rob was very disappointed and saddened. He hugged the daughter and returned to camp. On Thursday, the first patient he saw in Chirino was a lady named Guadalupe who was being seen for an infection, but she had the same symptoms as Juan with the classic tremor and rigidity and flat affect. They didn’t know what she had but to Rob it was an easy diagnosis and the starting dose of medications needed for this condition was exactly what he brought thinking it was for Juan. God knew well in advance that all would work, but it was us who thought we planned for everything that learned the hard lesson.


On Wednesday I returned to customs again and this time the tubs were ready and waiting for us. We don’t know if our directors’ urging had worked, or if it was the intervention of my friend’s, husband’s, best friend’s, uncle’s intervention (that’s a whole different story) or all the prayers going up in the Dominican Republic and the United States or some combination of all. Yes, the tubs had been opened and yes, they found some meds that had been packed that were expired and outside their acceptable date range that they kept but everything else was there. We returned with the remainder of the 41 tubs to surgery with their supplies and the medications for the clinic and there was plenty for all and lots for the next project to use.



There were many lessons that we learned this year. For one, it is God’s project and plans, not ours. That should have been obvious to us early on. MMI has a warehouse in the DR where extra supplies are taken after a project. We generally don’t have to rely on that because we always bring whatever we need or want. We were uncomfortable relying on someone else’s supplies. We always tell our first-time participant that the first rule on a mission trip is to be flexible. They grasp and understand that well. What I realized is that it is those of us who are repeat participants that ended up being the least flexible. We had been flexible the first time we came down and that became the norm.

 When things didn’t go like last year, we became off balance because it required trust and being willing to change. This year allowed us to use up what was there and use the older supplies so that we could resupply with newer medications and supplies so that they are available to be used for such a time as this.
It is said in the Bible that anytime God repeats something, it is to emphasize that and underscore its importance.



 Did I mention that thru the week, due to the gospel being presented, that 41 people came to a saving knowledge of Jesus.  41....coincidence?  I think not.