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Monthly Archives: November 2012

Things I’ll Miss

We land in about an hour, and though I will still have the baggage claim and a three hour drive before getting home, this project is essentially complete. It would be great to have a few days to sit at home and process the last couple of weeks, but it’s back to work on Monday. I haven’t yet determined whether or not I will find work to be more or less relaxing than the project. It will be nice to be the surgeon without also having to be the nurse, the tech, the pharmacist, the orderly, the medical director, the cruise director, and Jason Bourne. It will be nice to ask for instruments in English, though I will probably continue to ask for them in Spanish. It will be nice to order a medication without having to rummage through a suitcase to find it. It will be nice use sterile light handles once again, though I will probably forget to reach for them. It will be nice not to sweat like a professional wrestler, but I will miss having a person who’s sole job is to wipe my forehead. It will be nice to have patient monitors that chirp at the appropriate times, and an air-conditoner that doesn’t. It will be nice to have an organized medical records system, but I loathe the notes and dictations I must contribute to that system.

Though it is always nice to return to the amenities of life in the Midwestern United States, that is in part because I will again have that period of time when I don’t take them for granted… when I realize that I don’t need to depend on them since most the world can’t and doesn’t.

I will be glad to have a warm shower without the threat of 240 volts entering my hand from the shower knob. (I did tell the hotel manager about this, and he promptly fixed the problem by wrapping my shower knob with electrical tape).

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I will be glad to flush my toilet paper down the toilet without risking a major public health disaster. It will be nice to brush my teeth with tap water again and to stop using Cipro as an after-dinner mint. I will probably take a break from orange Fanta (these trips amount to a more or less continuous oral glucose tolerance test). It will be nice to walk on a sidewalk, though I will kind of miss the livestock which populate the roadside (of course, it is deer season in our front yard, so all is not lost).  20121104-055706.jpg

I can do without roosters crowing at 2am – though we ate chicken at least twice a day in a futile attempt to cut down on the noise.
I will enjoy eating with my family again, but will miss the daily breakfast with a group of young Bolivian doctors who are dedicating their lives to serving the poorest of the poor. I will miss wearing flip flops, though I’m sure everyone else is looking forward to my once again wearing shoes and socks. It’ll be nice to call home from my cell phone or my office, but I’ll miss the cute little lady with the “phone booth” at the corner vegetable market. It will be nice not to trip over 5 or 6 mangey dogs on the way to breakfast each morning, but I’ll miss having the hotel puppy nibble playfully on my toes (many apologies for that rocking-chair incident, buddy).  20121104-055734.jpg

I will kind of miss the quaint, bare-bulb lighting fixture of the hotel lobby, but I will not miss the lightbulb size bug that would at times hang from it.

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I will miss Yoko, but not the beetles.

Indeed, it will be nice to return home, but I am becoming increasingly aware that I have a home away from home… an extended family that I never would have predicted. I count myself the richest man in the world, though I am leaving some of my riches behind in what they say is the poorest country in South America (and I am not even talking about the 6.6kg of unroasted coffee beans I was unable to bring back). I will cherish my memories, but I also know from experience that memories can be painfully short. Please, feel free to remind me from time to time.

Thanks for reading along. All apologies for any unsavory surgical details, borderline inappropriate humor, cultural insensitivities, and overindulgent verbosity. I covet your prayers as I seek out my next project. If you have interest in volunteering, I’d love to chat with you about it. Much thanks to those who trusted me to take them along… Jean, Bill, Stan, John, Lori, Sarah, and of course Wendy, Emma, and Tessa. Thanks also for those in Bolivia (Francis, Yoko, Reuben, Franz, Sorona, Paola, Sheila, Blanca, Elizabeth, James, Jenny, Ignacio) who served as God’s instruments, oftentimes placed in my hand at the exact moment you were needed most. One could scarcely meet a more joyful group of people, though you have sacrificed much in faith that such joy would await you. It is truly humbling to work alongside you. I sincerely hope we will get to do this together again soon.

-MC
Location:Seat 30B

Posted by Matt at 1:27 AM

 
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Posted by on November 4, 2012 in Uncategorized

 

Bourne in Bolivia

I am admittedly a fan of the Bourne trilogy of action films starring Matt Damon. Sometimes when abroad, the reality of the narrow urban streets, the third-world traffic “patterns,” and anxiety at customs & immigration starts to meld with my caffeine-warped dreams and I start to fancy myself another Jason Bourne (only less good looking, minus the Parkour and Jujitsu skills, and not exactly multi-lingual). Then I wake up and a guy named Francis picks me up in a minivan and drives me to the airport.

I have now left Bolivian airspace while our beloved anesthesia machine hides somewhere in a warehouse north of Santa Cruz. This was no small feat, as many forces conspired against us. The big blue case did not escape notice upon our arrival – it clearly had not been purchased at the duty free and the new Bolivian customs officials (all of them had been replaced 5 days before our arrival) felt it their duty to keep the behemoth under their watch. Though we were ultimately able to take it with us and use it on the project, I had to agree to bring it back home or pay a hefty duty, though the amount was never specified. They were clearly angling for a bribe, otherwise they would have opened the case, inspected its contents, and assessed its value. As it were, they knew it was valuable to us, which was all that mattered. Francis called their bluff. If they are not bluffing, I will either need to return with the machine, or stay with it.
Through the two weeks that follow, Francis repeatedly tried to negotiate via phone with customs. This resulted in many wasted cell-phone minutes, but never was a ransom named. We drove to Santa Cruz on Friday with hopes of going to the airport and negotiating a deal – the baggage fees alone to return it would be $200, so anything near that figure would be worth it. Unfortunately, it is a national Holiday in Bolivia and nearly everything (except the zoo) was closed – even the souvenir shops where locked up. We would have to wait until the morning of our departure to learn the fate of Dr. Dre (and Dr. Campbell for that matter). The zoo was quite nice, by the way.
We departed for the ViruViru airport at 5:45am hoping to beat the lines. Francis suggested curbside check-in to find out early on if my passport was flagged in any way. He had the big blue case along with our luggage – I do not know what exactly was packed in it. For all I know, it could be the machine, or it could be the massive haul of decorative pan-flutes the Mayor of Santa Rosa had given to us at our last barbecue. My passport scanned without any problems and I was given a boarding pass – so far, so good. Francis, wanting to make sure I would not get stopped further on, still thought it would be a good idea to go down to the customs office and make sure the machine could stay and that I could go. Even though international flights had already arrived and people were entering the country, the customs office was locked and gated – a sign read that they would not open until 10:00am because of the holiday (Holiday’s apparently take precedence over things like national security or customs extortion). Our flight was to leave at 9:10. We would need to make a choice – either check the trunk and bring Dre home, or leave Dre with our Bolivian staff and hope I wouldn’t get stopped later. We chose to leave the machine (or whatever Francis had packed in the case). I checked my other bags and we say our goodbyes to Francis. I hope to see him again soon, but home is on our minds. I not truly rest until the plane is in the air.
We clear security, or at least one round of it – didn’t even have to take off our shoes. We then pass a set of duty free shops and flat screens playing 1980’s music videos. Now more security stations, at least two more hand searches of my carry-on bag, much scrutiny of my passport (They always look sideways at my Burmese visa before finding the Bolvian one. Later, I realize the Burmese visa is indeed sideways). One official takes my picture, scans my passport, then starts shaking his head disapprovingly. I have a moment of internal panic, but I am able to channel my internal Jason Bourne and secrete some endogenous metoprolol. I try not to sweat, but I have been constantly doing so for two weeks – lost cause. Finally, it turns out that the guy was just frustrated with his slow computer (I think he purchased it at the Santa Rosa Internet cafe). He says “No problem” and waves me through. I am now home free, or at least in the duty-free, where I immediately start to shop for over-priced chocolate and feel pressured to buy cologne.
Trying to decide if Jason Bourne would prefer his chocolate bar with or without Brazil nuts (Bolivian Brazil nuts, mind you), I hear my name paged overhead. I’ve seen the movies. Overhead pages are never a good thing. I ask myself WWJBD (what would Jason Bourne do) as I approach the desk. I know the answer, but I am pretty sure a sudden flurry of MMA skills would be ill-advised. The man at the American Airlines desk informs me that I have dangerous-appearing items in my suitcase (darn panflutes) and that I need to accompany him downstairs for an inspection. As we walk down a dark, lonely staircase, I try to determine if this is the part where I get kidnapped or become an organ donor (this would only be just, since I have been removing others’ organs for the past fortnight). We reach the ground level and I am hand an orange vest (don’t chain-gangs wear these?) to wear out onto the Tarmac. A big muscular guy with a gun is standing there with my bags and I am told to open the small side pocket on my rolling duffel. Thankfully, he also has a bible and this makes him seem a little less threatening (though it is open to Judges which I recall being a fairly violent book). He pulls out a laryngoscope and I am asked to safely dismantle the threatening-looking device. I show them the empty battery case and try to explain in Spanglish that it is a flashlight for looking into people’s throats. This involves making some explanatory gestures – I decide to demonstrate on my own larynx rather than on the man with the gun. He seems satisfied. I give him my orange vest and they walk me back up the stairs to the terminal. I return to the duty free and buy my chocolate – both with and without the Brazil nuts. We soon board the flight and I am safely nestled in seat 24F amongst a crowd of softly snoring elderly British bird-watching tourists. My adventure complete, I fall asleep and contemplate selling the movie rights (but only if I am played by Matt Damon).

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Location:Viru Viru

 
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Posted by on November 3, 2012 in Uncategorized

 

Swimming with the Stars

My earlier post was entitled “Embarassment of Riches” before I got sidetracked by a story about a colostomy. Apologies for the confusion. Ever read one of those books that are so long that you forget what it was about in the first place? It’s kinda like that.

The old adage goes that it is more blessed to receive. The altruist in me wants to agree, but that would contradict another truism I have learned – that whenever one serves on one of these projects, one always manages to receive way more than he could ever hope to give. If it is more blessed to give, then why would God have us receive so much in spite of our best efforts to tilt the balance otherwise?

Well since the beginning of our trip, the town of Santa Rosa has not ceased to make us feel welcome. The mayor has a love for both ceremony and barbecue. His people just like to party.

On Wednesday, after a day of treating parasitic diseases in the village of Loma Alta (I think it means high mountain, but it is actually a flat pasture), we were invited by the people of the village to go swimming. Since that village doesn’t have a pool, we would need to go further offroad to the next village where there apparently is a pool of some sort. Some of the team were not initially keen on the idea, but once the suggestion had been made, the idea of a party started to grow. The vice mayors of these villages got involved, and before you know it there is a formal meal and Gladys, the head nurse at the hospital, is packing her suit. If I have learned one thing on these trips it is that you never turn down an invitation because by the time the invitation is made, the meal has already been cooked. We took Francis’ Land Cruiser (a 1992 named Methuseleh with a broken control rod), Reuben’s truck (a 1986 with no speedometer), and a taxi out past Loma Alta and on to the village of Rincon. The pool, apparently nestled deep within an unlabeled dairy farm, was unfortunately closed as the owner had fallen ill. We then drove on into the “Zona Urbana” of Rincon (a cow was eating grass next to the sign) to a thatch-roofed restaurant where our tables awaited. We were treated to a pig-roast (again confirming that they started cooking the meal even before we had been invited to the party) and other traditional Bolivian fare. No wonder there are so many gallbladders to remove.


Thursday was our last operative day and the clinic team was back working at the main hospital. Dr. Franz gave a noontime lecture on diabetes and hypertension while we ate cheese empanadas and drank orange Fanta. He had run into an old friend from medical school who is apparently living on a nearby dairy farm with her parents and looking for a full time job. She worked with us in the clinic that day. Her name is Cher (her father was apparently a fan). She invited us to go swimming that afternoon in the pool at HER dairy farm (apparently, this is becoming a trend) and, of course, she had already baked a cake for the occasion. Since we had been unable to swim the night before with the village people, we decided to take Cher up on the offer.

Cher picks us up at the hotel Ochotu and we again drive out on a bumpy road into the seemingly eternal Bolivian pastureland. We soon turn at an unmarked barbed wire gate and drive past her fields of cows and calves.


She is apparently in charge of rearing the 80 or so calves while other siblings and in-laws attend to other farm duties. We park next to the farmhouse and are soon picking blackberries (or something similar) from a tree and start fawning over the calves (ironic, I know) as they chew grass and moo at us. Soon, the roosters get in on the action and make their presence known. I agree with Jean, their crowing sounds much more like “Por Favooooor!” than cockadoodle doo.

The milking machine is down and Cher’s sister and brother in law are busy fixing it, but not too busy to show us the milking barn. They eventually get it up and running, which is a good thing since some of the cows looked a bit full (that, or they were bulls with duplicate parts and sizeable hernias). Another brother hooks the cows up to the machine after hosing off their udders. He has a tee shirt on that says “I love my job.”

We eventually settle down by the pool, which is actually quite a nice blue tile-lined pool, though it is only filled about two feet deep at this point. Perfect for lounging around with toddlers, though. Francis has brought his super-cute 2 year old (she keeps grabbing for my toes) and Cher’s daughter Beyonce is swimming with her father, Norman. Norman is a motorcycle adventurer from Germany who was six years into circumnavigating the globe on motorcycle when he fell in love with Cher and settled down in Santa Rosa. A fascinating free-spirit who speaks six languages and has personally modified his own motorcycle to handle everything from the Serengeti to Patagonia.

Yoko, our nutritionist is also along, so I can now honestly say I have sipped coffee, in a pool, at sunset, with the trio of Cher, Beyonce, and Yoko, as well as a motorcycle riding German dairy farmer named Norman – not what I expected on a Thursday afternoon in Bolivia. I even got a goodnight kiss from Beyonce as we left.

Evenings like this are one of the unexpected blessings I encounter on these trips. Every person was a new treasure to enjoy, with stories to hear and uncanny points of commonality to discover. Nothing was rushed.


The sunset was phenomenal. The cake was made with home-grown blackberries and fresh cream from the farm. We are sad to cut things short now, but we have a date with the mayor for yet another municipal celebration (and of course another barbecue).

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Location:somewhere south of Santa Rosa

 
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Posted by on November 2, 2012 in Uncategorized

 

Embarassment of Riches

Many obligatory apologies for my failure to update this blog as often as I had wished. Internet access has been spotty at best and we have had minimal time to even seek it out. To be honest, I am glad that I have not spent much time holed up in a sweaty Internet cafe (minus the cafe part, mind you) as I would have missed out on much of what I have been blessed to experience these two weeks. Starting this post from the balcony at the hotel Ochotu (though I doubt I will finish it there) on a cool, rainy morning. It is 5:30 and my bags are more or less packed. It is the first time that the weather has been cool, so of course this means we are leaving Santa Rosa today.

I will start by attempting to summarize our work on these two weeks, since that is what we came to do. I am told we completed 63 surgical procedures. My count is more around 52, but they tell us 63 because they count things like a bilateral hernia repair as two procedures, or they will count an incidental appendectomy along with the hysterectomy with which it was performed. At least 20 of these were open cholecystectomies (gallbladder removal). There were also a number of hysterectomies (much thanks to Bill Leach) and hernias. The first week we operated like crazy since we had both general surgeons and gynecology scheduling cases in parallel. To schedule a case is to make a promise as these people (underresourced rural Bolivians) only have access to non-emergent surgical care for these two weeks out of the year. We operated past 8pm on three of the five days and the local hospital staff was gracious to stay so late and to work so hard to allow us to care for so many people. We pushed their electricity, water supply, and personnel resources to the brink, and maybe a little bit past it at times. The second week (general surgery only) was a bit more tame and we actually made it to dinner on time 3 out of 4 nights, not that any of us would go hungry. They fed us like pigs on this trip… Actually, they even fed us a pig. A whole one. He was kind of crispy.

If I tell one patient’s story, I will tell you about a man I will call Jaime. With an ever- shrinking world, I have changed his name, though I’m pretty sure they don’t have HIPPA down here (I think they call it Hee-Pah). Jaime is 40 years old. He walked into our consult room with a downward, avoidant countenance. He was with a much younger woman who we would later find to be his daughter. He was gently cradling his right lower abdomen. He didn’t say much. When it came time to examine him, he asked that his family leave the room, a request not made by most of our patients. He then lifted his shirt and showed us why he was here. Jaime had a colostomy, or maybe an ileostomy – we couldn’t quite tell. It was prolapsed by about two feet into a plastic grocery sac secured around it with a rubber band (For non-medical types, this means he had two feet of inside-out intestine protruding from his abdomen into a loose fitting Wal-Mart sac). You could tell by the way he cradled it that it was tender.
Jaime had been stabbed in a bar fight about 7 years ago, perforating his bowel and giving him peritonitis. Fortunately he was able to have life-saving surgery, but the colostomy was necessary to prevent ongoing infection. It could have been reversed a few months after surgery, but Jaime did not have the resources to pay for that procedure. He was likely not even been able to pay the bills from the first hospitalization, so the colostomy stayed. Over the years, the abdominal wall began to weaken and the bowel started to prolapse out further and further. In a country with a paucity of properly fitting colostomy bags, this is a big problem. He constantly smells of excrement and must use one hand to support the weight of the bowel to keep it from prolapsing further. Employment prospects are grim, social stigmatization a given. Moreover, Jaime’s lifestyle (which had resulted in the bar fight in the first place) had resulted in estrangement from his family. Guilt and depression are as evident as his colostomy. In past years, however, he has reconnected with his daughter and ex-wife, and they have helped him make it to Santa Rosa in hopes of having his colostomy reversed.
Though we do not have all the details on his original procedure, it looks feasible to attempt a reversal. Even if scar tissue is severe, we could at least revise the stoma and fix the prolapse. The biggest risk is that the suture likes will leak. If this happens, we would need to reoperate and create the colostomy once again. We are hoping we can perform the procedure through a small incision around the colostomy and avoid re-opening his larger midline scar, but we must be prepared to do so if necessary. He signs the consent, seemingly out of resignation, though he clearly wants the operation. He has no questions. He barely makes eye contact. He doesn’t even seem to have hope in a favorable outcome. Maybe he is afraid to. We will do his case on Monday so we can watch him closely afterwards.
Monday comes and we take Jaime to the OR. Jean puts him to sleep. He is connected to two cardiac monitors and three pulse oximeters, all this in hope that at least one of each will be functioning at any given time as we are operating during peak power usage and there are frequent surges or brief outages. I am able to reduce his prolapse once he is asleep, and for a brief moment, it actually looks like a “normal” colostomy. In the end, the


procedure goes quite well. We are able to complete it through the small incision as we had hoped and with minimal contamination of the wound from the intestinal contents (this operation has about a 30% infections rate). We are pleased. In the recovery room, I am able to guide Jaime’s hand to the site where the colostomy had been. Though tender, he feels its absence and I think I may have seen the beginning of a groggy, hesitant smile.
I should mention that we have had somewhat of a translator shortage during the second week. James and Jenny have returned to Cochabamba, Elizabeth has nursing classes in Santa Cruz, and Yoko is with the clinic team in places where Butch and Sundance haven’t even been. Francis is our only translator, and my Spanish is still apparently so poor that I cannot even ask how to find him without a translator. We later learn that one of his disappearances was while he was on the ward talking at length with Jaime. This is how we came to know much of his story. Francis encouraged Jaime to look at this event as a chance for a new beginning. Just as his colostomy was no longer visible, so also could his pervasive sense of guilt. He had already changed his ways of drunken carousing, but he had yet to live free of the shame which had accompanied that life. Now free from the sight and the smell of his colostomy, he could should also live free of that shame. He has been forgiven by his family, but needed to know that He has also been forgiven by his Creator and can and should learn to forgive himself… to live as a forgiven man.
In Matthew 8, Jesus is approached by a leper. This man too bore a physical ailment that symbolized a sense of shame and filth. He says “Lord, if you are willing you can make me clean.” Jesus simply says “I am willing” as he reaches out and touches the man, not only healing him physically, but also showering unconditional approval on him from God Himself. But He is not finished. The statement of God’s willingness to heal is followed by a charge, maybe even a command: “Be clean.” The man was not to go on living like a leper. He was no longer to be isolated or ashamed. He was even to boldly approach the purveyors of clean and unclean and declare himself a new man, clean and unashamed. So too can and should Jaime live a new life of forgiveness and acceptance. He tells Francis he will do this. They talk and they pray together.

I love it when I cannot find Francis. He is usually doing something like this.

I have so much more to tell, but I would not be surprised if you have already stopped reading by now. Maybe if I find time, I can tell you of our pig-roast with the mayor, or possibly of lounging in a pool at sunset with Cher, Beyonce, and a Germam dairy farmer named Norman (you think I’m kidding, don’t you).

Location:Santa Rosa del Sara and the Zona Urbana

 
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Posted by on November 2, 2012 in Uncategorized