Unceasing Operations

Since 1997, I have been privileged to volunteer on medical/ surgical mission projects with Medical Ministry International (MMI).  I wasn’t even a premedical student at the time, but Dr. Pedro Obregon invited me along with my parents and sister to assist him on a medical mission project in Northwestern Thailand.  My experience on that project caused me to change the course of my studies and to pursue a career in general surgery.  With MMI, I’ve volunteered on 13 teams in six different countries, the last eight in Bolivia.  I can’t even begin to express how important MMI, its employees, field staff, and volunteers have been in my life.

Over the past year, I became aware that MMI was struggling under some financial difficulties.  Providing quality free and low-cost medical care around the globe is an expensive endeavor.  It entails making many difficult financial decisions and a constant effort to raise funds from a variety of sources.  In the end, both continuing projects and servicing their debts became too great a task.  On November 9, 2015, after 48 years and providing over $500,000,000 in medical services to the world’s poorest, MMI’s board communicated their decision to cease operations and close the ministry.  We were on project at the time.  Funding our latest project in Bolivia was MMI’s last effort in the field and I am thankful to the administrators and staff who made it happen, even while knowing they were in their final days on the job.

Since MMI’s announcement went public, many have asked if I will be continuing to take surgical teams to Bolivia.  Other natural questions have also arisen surrounding our team in Bolivia and our warehouse of equipment and supplies.  I was too busy at the time to address these questions, but feel it necessary to do so now as we have all intentions to continue our work there.

The organizational demise of a volunteer-based, nonprofit NGO is a strange event.  While MMI’s closure is in itself a tragedy, it is in no way an end to the work they have been doing.  For a while now, their field staff have operated more or less as independent contracting organizations with assets held and controlled locally.  To the extent of my knowledge, these field workers fully intend to continue their work, and their assets are not subject to seizure/ liquidation.  Likewise their volunteers, myself included, have no intent to stop organizing and carrying out projects in cooperation with these dedicated workers.   It is my prayer that even as this seed appears to fall to the ground and die, that it will ultimately bear much fruit as its many volunteers continue to serve and to seek new venues for service.  Indeed, even as MMI ceased operations, our own team continued to operate (literally) with joy and care.

Our challenge will come in organizing and recruiting for future projects.  We have benefitted much from MMI’s Texas staff as they helped to plan and recruit for projects, clear international credentialing hurdles, and fill gaps from the large pool of volunteers they have accumulated over the years.  While this will present a challenge, I do not think it is insurmountable.  Already, we have a sizeable and growing team who have verbally committed to our next project.  Send Health, inc. (www.sendhealth.org) was created at just the right time to facilitate fundraising activities for our specific projects, and MMI Canada (www.mmicanada.ca) has agreed to assume central organizing responsibilities.  They are already working closely with the MMI Bolivia team to prepare for our projects and many more.

Our next project is scheduled for April 16-30 in San Carlos, Bolivia.  It will be our fourth time there in as many years.  We will have a surgical team as well as an on-site medical, dental, and optometry teams.  We will have an evangelistic team meeting with our patients and families and also participating in our integrated health educational efforts.  We still need volunteers for specific roles, and many of our volunteers could use financial or logistical support in making their participation possible.  Please do not hesitate to contact me at DrCampbell@SendHealth.org if you have any interest in participating, making a donation, or helping in our fundraising efforts.

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The Man Behind the Curtain

In an operating room, once the patient is asleep, prepped (with antiseptic) and draped, the head of the drape is lifted up and clipped to a pair of IV poles. This lifts the drapes off the patient’s head and gives the Anesthesiologist room to work, managing the patient’s breathing, administering medications and fluids, basically keeping them alive through the operation. We call this lifted drape the “curtain” (creative, aren’t we?). The curtain also serves to separate the work of the surgeons from that of the anesthesiologist, for while our work is intimately related, our roles are fundamentally different and they must remain spatially separate if things are to work out well for the patient.

While we as surgeons like to think of ourselves as “captain of the ship,” the reality is that the Anesthesiologist is the one sustaining the patient’s life, literally taking every breath for them during a procedure. There is much that goes on behind the curtain, even if all we hear is a reassuringly steady stream of beeps from the various monitoring devices in use. Sometimes the Anesthesiologist is chatty. Sometimes silent. Some procedures require a lot of communication, others really don’t. The surgeon is kept on a “need to know” basis and we seldom need to know every minute detail of what is going on behind the curtain. Frankly, knowing too much would likely just distract us from our own task at hand.
Of course, the surgeon can make things more exciting for the anesthesiologist. We may encounter an unexpected finding that makes for a longer operation. We may get into bleeding or need adjustments in the patient’s breathing pattern, and sure enough our colleague is on his feet making the necessary adjustments. They might even have anticipated events in advance as they are always paying more attention to the operation than we give them credit for.

I think God operates much like an Anesthesiologist. (Disclaimer: PLEASE don’t tell this to any Anesthesiologists/ CRNAs that you know. We wouldn’t want it to go to anyone’s head and we still need them to think that the surgeon is running things). He works behind a curtain of sorts, staying unseen and quiet most of the time. He is constantly at work, mostly in the business of sustaining the universe and all that is happening in it. It is an active, though mostly quiet job, and lest we think He is not paying attention (maybe reading the newspaper or playing sudoku) He is constantly at the ready to intervene as needed. He is paying attention to what we are doing. He may even be preparing in advance for what we think are unanticipated turns of events.
Sometimes we can make God’s job more exciting than maybe He was hoping for it to be. Maybe he is behind his curtain rolling his eyes, for we as humans make for some clutzy surgeons who learn slowly even from our own mistakes. But he stays behind His curtain, doing what only He can do while allowing us to do what only we have been assigned to do. Sometimes he speaks words of encouragement or reassurance. Sometimes he gives constructive advice. Sometimes he demands we stop for a minute, but He seldom reaches over the curtain. He can. He’s God. He can do what He wants. But it seems that He wants to stay behind that thin curtain most of the time, giving us free will and the illusion that we are in control.

I am still trying to wrap my mid around all that has happened on this project. The pace of activity often does not allow for reflection in real-time, yet I was able at times to catch glimpses of what God was doing behind His curtain. These glimpses were enough to let me know that He is there, doing His work, while giving us the privilege and thus the duty to do ours.

The glimpses come in many forms.

• A young boy from a remote village, with both a badly wounded heel and a badly wounded family starts to find healing, comfort, and a renewed intimacy with his struggling father. He had come to the church to watch the Jesus movie (thanks, Ramiro and Warren) when Dr. Schmidt discovered his state of affairs and got him to us before too much gangrene had set in (thanks Gary). Still in a battle to save his foot, he is now at a Children’s hospital where more surgery will be needed. 
• A sick man with Chagas’ disease of his colon requires transfer to a larger hospital where he needs more surgery and critical care than we can do in Santa Rosa. He gets the needed care, and in the process we are building a relationship with a larger hospital to support our efforts with the poor in the region. (Thanks, Dr. Vargas and Hospital San Jose Obrero)
• A surgical patient, previously doubtful that God really loved him, receives that love in tangible form from our compassionate recovery nurses and leaves with a newfound faith in the goodness and grace of his creator and savior. (Thanks, Janet and Freddie)
• A last minute teenage volunteer from Cochabamba fills a critical translating role and starts learning nursing skills before starting nursing school next fall. (Thanks, Alyssa)
  An engineering student from Texas optimizes our instrument resterilization process, allowing us to operate almost uninterrupted and never going without the tools we needed. (Thanks, Carlos).
• A team works through their own illnesses without complaint or conflict to do over 70 procedures on patients too poor afford surgery anywhere else.

I could go on and on (some things never change), but you get the idea.

These glimpses are just that. They are not the whole story. I will probably never really know the whole story of all God has done to pull this project off or what the longer lasting results of the project will be in the lives of the individuals we served. As I said, we are mostly kept informed on a need-to-know basis. But God knows we sometimes need to see these glimpses in order to sustain our faith that His larger plan is still proceeding, and this helps us keep our hands at the tasks set before us without despair.

I would be remiss not to thank our own man behind the curtain, Dr. Jon Klatt, who took every breath for our general anesthesia patients on this project (and three others in the past). So compassionate, caring, impeccably prepared, calm under pressure, a true team player, a master at his trade in austere conditions, AND a great sense of humor. He worked long hours with short breaks yet kept the mood positive for the whole team. I can’t say enough about the privilege and honor it has been to serve with him and that he keeps signing up for more. Thanks, Jon.

 

Cold in Bolivia

I have a cold.  It started on Thursday evening as a dry, scratchy cough and has since progressed through the predictable course of sneezing, runny nose, sore throat, congested sinuses, fatigue, and is just now starting to lift.  It was mild and short-lived.  I probably looked worse than I felt.  Still, it carries with it some degree of anxiety – could it be something worse?  Is it just the prodrome of a more serious viral infection?  Did I take all my malaria pills on time?  Did I drink some unfiltered water?  Or did I scratch the itchy bite of a Reduviid bug, thus introducing a stream of malevolent Trypanosomes into my blood?  Maybe I’m just paranoid.  Then again, I’ve heard that paranoia itself can be an early symptom of some viral encephalopathies.  I did get all my shots, but they don’t have shots for everything.  But it’s probably just a cold, and the project moves on in spite of it.  I was not the first of our team to face some illness and I probably won’t be the last.

I don’t write to gain anyone’s sympathy, nor to appear in some way heroic.  Really, as far as colds go, it was a 1 on a scale of 0-10.  This brief brush with illness does however bring some perspective to our work here as healers.  It helps us to better understand our patients as well as our teammates and thus can even be a blessing in its own right (though not one that I would specifically seek out).

You may have already heard that our project got off to a great start.  20 operations in the first two days, patients getting out the hospital on schedule with only mild pain, smiles on their faces.  We even squeezed in two emergency appendectomies – patients who would normally have had to travel an additional hour to beg for an emergency operation that might take them a year or two to pay off.  The project could not have started off better.

I have a team of joyful, flexible, and gregarious doctors, nurses, and assistants.  I would say we worked tirelessly, but that would be to deny our humanity.  No one is truly tireless, and this is tiresome work.  What impresses me about this team is their willingness to work through fatigue, and to remain joyful, creative, and affable in the process.

Sure enough, by Wednesday, the travel fatigue, dietary alterations, bug bites, and long hours in the OR started to add up.  First it came in the form of rumors.  So-and-so has been vomiting.  Someone else has been spending a lot of time in the bano.  At first, it was hard to tell.  These people, supposedly sick, still had smiles on their faces.  They were still working hard caring for patients, delivering anesthesia, organizing and running for supplies and instruments.  They were just gone for a few minutes here and there.  Really, I only knew because Wendy was apparently medicating them in the break room (she carries quite the pharmacy in her magic backpack apparently).  Had I not been told, I would not have noticed until later.  But seeing others serve through and in spite of their own illness gives strength to serve through one’s own.   It reminds me that we all, in our own small ways, are serving the true wounded healer.  We agreed to slow the pace for the next day or two to allow some breathing room in the schedule.

Thursday was a day of larger cases – we took out quite the bloody 1lb thyroid lobe and also reversed a colostomy.  Both those operations wound up requiring all hands on deck.  In all we only did three cases that day because emergencies in other cities tied up our Bolivian anesthesiologist for most of the afternoon.  Eight more cases on Friday and we actually finished before dark, allowing our recuperating team members to get a much-needed afternoon nap.  It is humbling to serve alongside people like this.

There is so much more to tell.  So  many details I could spend hours describing.  Alas, the day is short, the internet is slow, and there is another week ahead of us.  You might just have to come along to get the full experience (hopefully without colds, stomach flus, or Trypanosomiasis).

 

Hitting the ground running.

I’ll try to give a big-picture update of our experience so far in Santa Rosa.  Will try to give some more in-depth stories when I have time to write over the weekend.

Aside from taking three hours to renew our visas, the action has been non-stop since arriving in Bolivia a few days ago.  I never quite know the overall makeup of our team until we have all arrived – there will always be some old faces and some new ones, both from the US, with MMi-Bolivia, and at the local hospital in Santa Rosa.  What on paper had seemed to be a small team (12 US volunteers spaced across two weeks) has been well supplemented by Bolivian volunteers from Santa Cruz and misisonary families from La Paz and Cochabamba.  We have 37 people here for the first week, filling out the entirety of both hotels in Santa Rosa.  Work began even before everyone had arrived, with the Santa Cruz team setting up our supply room and much of the OR before we arrived.

We got to the hotel around 2pm after languishing in the SLOWEST VISA LINE EVER, but then cruising through customs (praise God) and a safe 2h bus ride to Santa Rosa.  No sooner did we unpack (except for Dr. Margarita Graham, whose suitcase took two more days to arrive) than we began seeing consults (about 20 of them), scheduling operations, and finishing our setup.  The whole team finally converged at dinner with a chance to make acquaintances.  I was shocked at the overall size and capabilities of our team.  We had to assign some to the hospital/ surgical team and others to the outreach clinic (medical, dental, optometry) team – they often travel three hours on dirt roads each day to reach their clinic location.  We stayed up a bit late figuring out who to plug in where, at least for starters.

    Monday started briskly – the advance preparations helped us start our first case around 9:00am – much earlier than the usual Monday down here.  We also have a Bolivian anesthesiologiest who can do spinal/ sedation cases, which has let us run a second table (in the same OR) all three days.  Doing surgery by committee, we managed to pull off 9 procedures on Monday, 10 on Tuesday, and 8 on Wednesday.  That’s 28 in 3 days (though my greatest accomplishment may have been my Mr. Miagi moment when I caught a mosquito in the OR with a pair of forceps).   For perspective, on the first project I directed (San Juan, Bolivia in 2012) we only got 28 cases done in the entire two weeks!  It is only possible because of an incredible team – servant hearts, senses of humor, an no one taking their role for granted.  We are having so much fun and so are the patients.  Unfortunately, some of our in-country participants have to start leaving tomorrow – goodbyes are never fun, but we look forward to working with each other again.  

Tomorrow is another busy day.  We have some larger cases (Colostomy reversal, huge thyroid) as well as the usual smattering of gallbladders and hernias.  Hoping for some R&R over the weekend and a visit of the coffee plantation (my home away from home).  Wendy leaves me on Saturday morning, though I have toyed with inciting a road blockade to prevent that from happening.  Will try and update again this weekend.  Hasta luego, folks.

-Matt

 

Packing – A Hate/Love Relationship

I hate packing.  It seriously stresses me out and I truly don’t have the time for it.  If I could pay someone else to pack for me, I would, but frankly, I don’t think I’d be able to trust them.  Then I would be out fifty bucks (or however much one pays for such a service) and STILL wouldn’t have any fresh underwear upon arrival.  [Please, do not mention to Wendy that I have suggested paying someone to pack for me.  She does it for free.  She does it well.  I can’t afford such quality.]

Packing makes me anxious.  With every item I add to the suitcase there is a paradoxical, mounting fear that I am forgetting to add something even more important to the suitcase.  By the time I find this essential (but forgettable) item, the suitcase will inevitably be at weight and now I will have to choose something else to remove.  Upon doing so, I am certain that I will eventually regret having left the relegated item behind.  I hate packing.

Packing unsettles me at home.  If I pack my clothes too early, then I am unable to wear them in the days leading up to my departure.  If I pack my toothpaste, deodorant, or razor too early, then I must unpack them later lest I go unkempt.  So I end up living out of my suitcase even before I must actually live out of my suitcase.  I hate packing.  I hate it so much, I actually left a fully packed suitcase in Bolivia just so I wouldn’t have to pack again for each trip.  But then I forget what I packed in that suitcase.  Did I leave enough underwear? Scrubs?  Coffee filters?  So I wind up packing these items anyways.  I hate packing, and now I am duplicating my misery on a worldwide scale.

Packing makes me triage which items are truly important.  I cannot take all ten books I am currently reading.  I cannot take all the art supplies I know I will not have time to use.  I have closets full of medical supplies and must choose which items are of highest importance or are hardest to obtain in Bolivia.  Each decision comes with some uncertainty and stress.  I hate packing.

But as the suitcases near their weight limit, I also start to realize that this stress over packing is born of the abundance I have been given.  How lucky am I that I get to choose from among my countless pairs of shoes and my closet and dresser stuffed with clothes for all seasons.  I have SIX Buckeye hats and really should only take one or two.   I have travel gadgets galore.  I get to sit on a plane for hours undisturbed and read the books of my choosing.  Packing would be easier if I didn’t have all this stuff.  So even though I hate packing, I’m starting to be thankful that I can hate packing.  

Not only that, but I also start to realize that there have been times when I could not even fill one suitcase with supplies – now I have closets overflowing with donations.  So many patients, thankful to be well once again, have donated their unused supplies.  Sales representatives, whose jobs are to make money SELLING sutures, bowel staplers, hernia mesh, and surgical supplies instead have been incredibly generous with their wares, simply excited to hear that a life can be changed with what they gave.  Supply NGOs, like MAP International and Americares have shipped us boxes of top-quality supplies.  Holy Family Memoral has given thousands of dollars of supplies and medications over the years via their Staff Mission Fund.  School kids have collected more toothpaste and toothbrushes than you can imagine.  And while at times I am forced to choose between urinary catheters or tubes of Kids’ Crest, it brings of waves of gratitude as I recognize the effort someone made to give us these supplies.  Packing would be easier if everyone wasn’t so generous.  I may still hate packing, but this hate is only possible because of others’ love, so maybe I should’t use the word hate so much.  Maybe I actually love packing.  Maybe.

We leave in less than two days.  This packing can only last so much longer.  In Santa Rosa, I’m never sure if I’ll have internet access or not.  If we do, I’ll try to keep the blog updated.  Please follow along and share with others as you feel led.