Following and Changing in Yaguate

    We generally tell people who go on a mission trip to a developing country to "Be Flexible" and they usually get it.  But I have found that it is the repeat participants that seem to have more trouble with that flexibility because they were flexible... the first time.  Thereafter, they get used to the new different and then it changes again and we have to be flexible all over again.  We had planned to return to Palenque in January of 2023 for some time but three weeks before we were to leave the US, I got word that we were changing hospitals for the project.  My first thought was "nobody ask or talked to me about this".  Submission is part of the flexibility thing I talked about that I am still working on.  Apparently, the hospital's backup generator was broken, whatever that means.  I should have suspected something since last year, when we were at that hospital, I saw them "jump-start" the hospitals generator with a Honda Accord.    So, we were going to San Gregorio de Yaguate instead of Palenque.

Putting together a Team

    This year we had 37 participants go to the DR.  The process of recruiting a team is both easy and hard.  This was almost the largest group that I have taken to the DR. This is great since we had seen marked decreases in participants since COVID changed the world.  Half to two thirds of the participants are folks who return year after year with us and have become some of my most treasured friends.  Another group are people who have been once or twice before, but don't come every year.  The last group are first timers.  This group is a lot of  fun because they see everything thru new eyes.  The last participant to join us only decided 3 weeks before we left to come.  This year we had 11 physicians, 2 CRNA's, 1 Nurse Practioner, 1 Pharmacist, 12 RNs, 2 Medical Students and 8 general helpers.  Those of us repeaters are constantly talking to others about the mission and I am adding names to my master email list through out the year.  Then, when the project is set I begin by sending out an email to ask people to consider going and begin the planning.  As it turns out this year we had more gynecologist than in years before and that changed the case mix of surgeries we could do.  If we had gone to the original hospital we would have not had the physical room to do all the surgeries that we did.  I had no way of knowing that, but apparently, God did.

Thorns and Roses

   

There are always troubles or difficulties and blessings that present themselves during a mission project and one must be careful to always look closely to see the flower among the Thorns.  We changed our hospital this year because of difficulties with the back up generator at Palenque.  But we didn't anticipate that the "new" hospital would be without running water.  It seems as if there was a problem with their cistern holding water.  That meant that the toilets had to be bucket flushed.

  I was surprised to find that some of our younger participants needed to Google it to learn how (actually we ended up telling them).  That meant that we had to use hand gel for hand cleaning and Avagard for sterile preparation of our hands  for surgery.

    We did have air conditioners in the OR and actually in our sleeping rooms.  Very much a Rose, but the Thorn was that few people came to the Caribbean with a blanket to sleep under.  And when we ran low on gowns toward the end of the week, it was chilly in the ORs. 

    Prior to our arrival on a project, our Dominican director will make site visits to the local community and work out the dates and locations of our surgery and clinic teams.  He will also let them know our team composition and capabilities.  The hospital director then spreads the word to the local people and a list is developed of people that may need our services.  This year they identified 135 people and apparently told them to all show up on the Sunday we arrived to set up so that they could be seen and scheduled for surgery. 

We were able to see 75 patients the afternoon we arrived and we told the rest to return on Monday.  There are many factors that go into scheduling patients for surgery including the number of surgeons, the number of staff members, the number of recovery room beds, the amount of supplies and medications as well as the condition of the patients.  Based on all those factors we anticipated being able to do 100-110 surgeries and ended up at 98 total.  So, the Thorn of having to change hospitals at the last minute became a Rose of  allowing us to do almost 20 more surgeries due to the larger size of the preoperative and postoperative rooms.

    The medical clinics work in the same fashion.  Our director meets with the local sponsor of the project that in this case was a pastor from a local church.  Clinic site locations and dates are picked and then the local pastor spreads the word to the communities and helps arrange the actual locations for the clinic to be held.  Sometimes they meet in a church, sometimes a community center, but this time one was held in a local library. 

    It is an unusual experience for those of us in health care to be welcomed with a "Rose" of applause but not in the DR.  Each morning as we arrive to the clinic and to the hospital all the patients for the day are there with their family. When we are introduced to the crowd, they break into applause. We all begin the day with prayer and a Spanish praise song, Alabare'.  At the hospital, all the patients show up at 8 am for the day and have their preoperative COVID test and then wait their turn for surgery.  When the nurses come to the waiting area to call the next patients name, everyone applauds and congratulates the patient.  There was a long hallway from the OR sites and the postoperative recovery rooms.  In the hospital, people could wait anywhere in the hospital and the waiting area was between the OR and the post op area.  As one young body was being transported from the OR by the waiting area full of people, he was quite sleepy from his surgery but did manage to raise a thumbs up to which the crowd cheered and applauded.

    If there was any question as to whether we were appreciated, it was answered when one happy patient returned the day after his surgery with a pan full of 36 home made empanadas for the whole surgery crew.  They were very good and were made with yucca as the pastry shell.  It is a local favorite as well as some of us.  The hospital staff also served us the last day with a fried Caribbean sea bass and tostones which are twice fried plantain slices.  All were very tasty.  

Earthquake

    I have encountered many different things while in the DR, but this year I was able to add a new experience.  During our teams morning devotional, one of the participants was presenting a devotion on the Hope of God.  In the middle of the presentation, all the people upstairs simultaneously got up from their metal chairs on a tile floor.  It was about that time, I realized that there wasn't anyone upstairs that the building was shaking.  Yes, we experienced an earthquake at exactly 7:11 in the morning.  We were all getting ready to head outdoors when it quit as quickly as it started.  Later, we discovered that a 5.6 earthquake had occurred 30.6 miles away from us. 

Later, I texted my wife and she told me that she had been awakened at 5 am (there is a 2 hour difference between Wichita and the DR) and had felt led to pray for our teams safety at that same time.  What a coincidence! Just kidding.  The scheduled village that day was closer to the epicenter but they didn't see any damage. The school officials had called off school and most everyone stayed home rather that coming out to the clinic. After lunch the people showed up in crowds to be seen.

Struggles of the Patients

    One of the patients needed a hysterectomy because of heavy bleeding. However, her blood count was too low to safely proceed with surgery.  Our doctors recommended that the patient have a transfusion prior to surgery.  For us in the US, that is not a major problem.  But in the DR it is.  The day that she was scheduled for her surgery, she didn't show up.  After we found a number to call her, we were told that she had to travel by moped to another city to buy her blood.  She arrived later (on the moped) with her blood in a Styrofoam dinner container with ice cubes in a plastic bag. We administered the blood to her and then took her to surgery and she was home the next morning. 

    I saw a patient on Monday afternoon as I was filling in the last slots in the schedule.  She was weak and kind of shaky and I ask if she was okay thru the interpreter.  She responded that she hadn't had anything to eat or drink since Saturday in hopes that we would do her surgery.  After we left Sunday and told people to return the next day, she had just stayed at the hospital in hopes to be the seen for sure.  She was willing to do anything to get help.  We gave her some IV fluids and her surgery went well.

    I had a male around his mid 50's who was a neighbor of the hospital director, who arrived late on Tuesday to be seen to see if we could squeeze him on the schedule.  He had an abdominal wall hernia that had been present for 12 years.  I also noticed that he walked with a cane. We saw him and did an evaluation including checking his blood pressure.  We checked it several times and it was 224/129!!  We immediately told him that he couldn't have surgery with that pressure and sent him around the corner to the Emergency Room (yes, it was a room with people in the halls).  As he was going I asked about his limp and he said he has had that since his stroke a year ago, undoubtedly due to high blood pressure.  As we were leaving in the evening, he came by my room and said they got his pressure down with meds to 149/100 and he ask if we could go ahead with the surgery.  The answer was no, as it was still too dangerous to operate in an elective fashion on a non emergent hernia.  We advised him to keep taking his blood pressure medication and to return on our next project to be evaluated.

    It is sometimes not just the patients who are under stress.  For instance, we had two brothers, 2 and 6 years old, that need to be circumcised and their mother wanted them done on the same day.  So, the first one went well and when he was taken to the post operative room mom came in to sit with him until he was ready to go home.  We then did the second boy and when he went to the same room to recover, mom needed help and the boys grandmother came in to help.  When both boys cried we looked over and saw that grandmother had passed out on the second boys bed.  Everything turned out good, but it was a little chaotic in that crowded room for a bit.

Speaking Your Heart

    We had daily devotions during our time in the Dominican Republic beginning on the first day, Sunday morning.  The first day the message highlighted a devotion that I had shared almost 10-15 years ago.  It focused on the concept of doctors needing others around us to make us productive. 

Then another devotion resonated with the person that was sharing that one of us had shared a few years ago.  Neither one of us remembers much of the details that we had shared at that time but it shows how important that it is to share your heart because you never know where people are at the time you share your insights or how important that they are to them.  The devotion times during the projects remain a source of encouragement to each of us and allow us to focus our efforts each day.

"I can do all (these) things"

    Frequently, we hear the verse from Philippians 4:13 quoted and used to encourage us to do anything we want to do.  But, recently I read that this verse must be read in context with the preceding verses, 11 and 12 which go something like this in the NASB. "Not that I speak from need, for I have learned to be content in whatever circumstances I am.  I know how to get along with little, and I also know how to live in prosperity; in any and every circumstance I have learned the secret of being filled and going hungry, both of having abundance and suffering need.  I can do all things through Him who strengthens me."  The "all things"  that he was referring to was the preceding things like being content in any and every circumstance.  That contentment that he learned was thru Him who strengthens me also.  Contentment is what allows us to be strong like these people from the Dominican Republic who don't seem to have a portion of what we materially have but have an abundance of His strength.