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Monthly Archives: April 2016

Lazaro Rises

Apologies for my failure to update my blog but only once during the project.  I meant to write more often, but those plans were waylaid by a wonderful fortnight that simply left little time for blogging or for the reflection I find necessary in order to write a worthwhile post.  Now that I am on an airplane seat flanked by two boring/ snoring businessmen, I have had time to think and get to the task at hand.  I’m going to save a general overall project for another post – we’re still tabulating the statistics and getting feedback and stories from team members, so it’s not quite time for that yet.

In brief, I am told we performed 82 surgical procedures and saw well over a thousand medical, dental, and optometry patients.  To be honest, it really didn’t seem like that much since things ran so smoothly.  Many hands indeed made for short work, and short, efficient work makes for boring and uninspiring blog posts, so maybe that’s why I didn’t write very many.  Now that I have some time to reflect, my mind turns not to the statistics, but to people, their stories, and still the greater story that encompasses us all.  So pardon the verbosity about to ensue, but it’s a long flight and I’ve had some caffeine.

We were a few days into the project and had settled into our groove.  All the moving pieces both inside and outside of the operating room were coming together – the fruit of an experienced and well-prepared team.  It is also the product of a fairly predictable case-load of overdue elective surgical procedures on otherwise healthy patients.  Years ago, in a different context, my dad once told me that while a well-organized plan is very important, the people God most needs us to serve will often present as interruptions to those plans.   Sure enough, just as our well-oiled machine was hitting full-throttle, we started to get consults from the inpatient wards – sicker patients, diagnostic dilemmas, and heartbreaking stories that come from the poorest corners of a broken world.  This time, the interruption came in the look of an unsmiling 14 year old boy.  His name is Lazaro.

Laying on his right side, unable to hold back tears, his left hip was partially flexed and he was either unable to unwilling to move it.  He had high fevers and a high “white count,” serving as sure signs of a severe infection somewhere.  He was tender all over the left side of his body – his abdomen, his flank, his back, his hip, and his thigh, though nothing showed itself on the surface.  He had already been on antibiotics for a couple of days without improvement.  He was so frightened and in so much pain, one could not tell if the infection were in his abdomen (wrong side for appendicitis), his hip joint, or deep in his retroperitoneum (behind the abdominal cavity in an area that makes walking extremely painful).  He would need an operation, but without a CT scan to guide us, it was hard to tell where one should cut.  Lazaro was sick.

Lazaro was also poor.  I’m not sure how far he had to travel to reach the hospital, but it was clear he was from the countryside (the “campo”), and I’m sure the journey was excruciating (he mostly came via motorcycle taxi on roads of mud and dirt).  His grandfather heard surgery and worried about the cost – he could not even afford to continue the antibiotics.  We were able to provide them and to reassure him they would not be charged for the operation.  We booked him for an exploration the next morning.

Not only was Lazaro poor, but he was also lonely.  He lives with his aging grandparents.  His father is dead and his mother, likely struggling with severe mental illness, wants nothing to do with him.  So while his tears and cries spoke of his physical pain, there was a deeper sadness in his eyes that spoke to an abandonment that his grandparents were unable to assuage.  This was despair, or as Kierkegaard would say, “a sickness unto death.”

We took Lazaro to the operating room the next morning.  Based on his exam, I decided to perform a retroperitoneal exploration through a small incision on the lower left side of his abdomen.  If he had an abscess deep in the back of his abdomen, this would allow us to drain it without contaminating his abdominal cavity.  When we were unable to find anything there, the same incision allowed me a good look into his abdomen, which also was quite normal.  0 for 2, but we at least had only made one small incision.  With him under anesthesia, we got a good exam, but could feel nothing else to guide any further incisions.  The exact location of his infection would remain a mystery for now, as I could not bring myself to create more wounds, pain, or suffering.  We would keep him on antibiotics while waiting for the infection to declare itself, hopefully without spreading or doing irreparable damage.

His fevers subsided, but his pain did not.  By Sunday, it became clear that his pain was centering in the area of his hip.  We were able to get him to move his joint though, which argued against an infection within the joint itself.  We made arrangements to use the hospital’s (ancient) ultrasound machine in the operating room the next day in hopes this would guide a targeted exploration through his thigh muscles.

Needless to say, Lazaro was not excited to see us.  Though despondent and numb, it seemed the only thing that would animate him was his fear of another surgical procedure, but with his abuelo’s consent (and little bit of Versed), he reluctantly allowed us to take him.  With him fully asleep, the ultrasound indeed showed us a poorly defined abnormality three inches deep into his hip musculature.  We made our incision and probed deeply in that direction, but initially found nothing.  This was frustrating.  Too aggressive of an exploration can damage the muscles and tendons, prolonging his recovery or adversely affecting his gait long into the future.  But missing the infection a second time was not an option as life and limb would eventually be in jeopardy.  Stephanie, our 4th year surgery resident, saw something on ultrasound that I could not.  She could my finger was glancing off the side of the target and challenged me to plunge a sharper instrument at a slightly deeper angle.  She was right on.  Pus flowed out of the wound (sorry for those with weak constitutions) as I broke up septations within a large abscess cavity.  Thankfully, it appeared to spare the actual joint space.  We washed him out with lots of sterile fluid and antibiotics before placing a dressing and taking him to the recovery room.

The hardest part for the doctors, finding the infection and getting it drained, was over.  The hardest part for Lazaro, was now to begin.  Damaged by infection, surgery, and days without significant movement, his muscles were in no mood to get moving.  Though his fevers were gone and his wound looked good from day to day, he did not want to get out of bed for long and he would become paralyzed with fear even at the sight of me, not quite believing my reassurances of “no mas cirugia.”  And while he would tell us that his pain was much better, the look on his face told us that he still suffered much.  Lazaro needed to walk.  He also needed a friend and encourager.  But my white coat and my scalpel disqualified me.

This is where our large and varied team comes into play.  Fearing that he might develop full-blown “gringophobia,” I dispatched Yoko, our Bolivian cook/ nutritionist/ evangelist/ and counsellor to spend the morning with Lazaro.  Why Yoko?  If you have to ask, then you have not had the privilege of meeting her.  She personifies compassion and patience.  She knows how to listen, then to encourage, then to challenge those who are hurting, whether they are our patients, their families, or even members of our own team.  At first Lazaro was not pleased to have a visitor, but within an hour they were coloring together and she was reading him stories and listening to him talk about his interest in cars he someday would like to ride in.  That afternoon, he got up and hobbled across the room to the bathroom.

The next day, I asked Michelle, our team’s physical therapist, to come and help Lazaro walk further.  This required her to take a taxi from our clinic location half an hour away and would take her away from those duties for much of the afternoon, but she seemed to relish the opportunity when we told her his story.  She also borrowed a cane from one of our own team members with hip problems of their own.  They were glad to lend it, even if it would make their own day quite a bit more difficult.  We had Yoko warm Lazaro up for a second visitor.  Michelle wore a pink jacket rather than a white coat.  Still, he did not seem excited to have yet another visitor, but he eventually complied and let her help him with his gait.  By the time we were finished with the day’s operations, he had walked up and down the hall three times.  Even still, he agreed to walk a few steps towards me so I could observe.  It wasn’t a smile quite yet, but his mouth showed something new: determination.  To make the moment perfect, the radio down the hall actually played the “Rocky” theme song right as he stood up from his wheelchair. (I promise I am NOT making that up.)

As we arrived at the hospital for what would be our last clinical day and entered the back hallway, the first thing we saw was Lazaro, walking, unassisted – no IV pole, no cane, no helper.  And while he still limped, it was actually his other leg that had stiffened up a bit from bearing the load so much the day before.  Now he was bearing his full weight on his infected leg, and he bore it well.  Lazaro was alone in the hallway, but now his aloneness stood as a sign of victory rather than defeat, and it came as the fruit of loving encouragement rather than abandonment.  Still, he tightens up with fear and anxiety when he sees me.  Still, he does not smile when I beckon.

For me, one of the most challenging things about surgery, especially when children are involved, is that we often must inflict suffering in order to heal.  The pain of a procedure almost always precedes its benefits, and children have a harder time understanding or believing this than do (most) adults.  Moreover, the permission to operate is granted by parents or guardians often, over the objections of the patient himself.  While this does not bother me from an ethical standpoint, it does come at a relational cost.  It violates a trust, and this may hamper a patient’s willingness to cooperate with subsequent treatments or therapy.  This is why surgeons need a team – others who have not violated that trust and can thus gain the patient’s active participation in their own healing.  Were it not for Yoko, and then Michelle, Lazaro might still be lying in bed, wondering if he could ever walk or even if it would be worth it to try.

I never did see Lazaro smile, but others tell me they did.   I’ll take it.

 
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Posted by on April 30, 2016 in Uncategorized

 

E Pluribus Unum and the Kingdom of God

“Out of many, one.”

I must confess, these projects stress me out a bit.  They just do.  I remember being taught in junior-high health class that there are both good/productive kinds of stress (eu-stress) and bad/nonproductive kinds of stress (dis-stress).  I tend to experience a lot of both of them as we prepare for and begin these projects.  Each project seems to bring a unique blend of them – new things will serve as the predominant stressors while others become known quantities, adequately contained by good preparation or experienced volunteers. So what has been stressing me out (in both “good” and “bad” ways) this time?  The sheer size of this team.  It is by far the largest project team I have ever directed or participated in.  We have more doctors (6), more nurses (8, plus 2 retired), more general helpers (12), and more Canadians (14) than ever before.  That is a lot of traffic to direct and people to watch out for.

The size of the team had me both excited and anxious for a number of reasons.

  • Over half have not been to this particular location before, and about one third of them are on their first medical mission project anywhere, so while I am excited to introduce them all to this wonderful place and share a life-changing experience with them, I stress out about doing so. What if someone gets sick, or bored, or feels underutilized, under-appreciated, or in over their head?
  • Much of the team is arriving as part of sub-groups who know each other quite well. Some have served together on particular projects before.  Some work together at home and are coming as a group.  We have groups of 5 and 7 from Canada who know each other well from home, but have never been to Bolivia before. All these pre-formed groups can be a good thing, jump-starting team unity and preventing people from getting homesick, but it can also degenerate into cliques or factions as the days get long and the work gets stressful.  Which would be the case this time?
  • The team comes from a broad array of Christian traditions – Baptist, Evangelical Free, Catholic, Anglican, Lutheran, Episcopalian, Unity, and even conservative Mennonite (complete with bonnets and dresses at all times). Though all are here to serve the same God together by serving the same people, they could also choose to focus on their differences or withdraw into their own groups.  Historically, families and fellowships have been broken and wars have been fought over the differences between these groups.  Would it threaten the unity of our team?
  • Though our whole team is to serve at the same location for the first two days, we would be splitting into two groups after that. Ultimately, I have to assign people to one group or the other, taking into account their different skill-sets, interests, and their physical ability to tolerate difficult travel (including hiking and crossing rivers that do not necessarily have bridges).  I would need to balance the desire to give everyone the experience they want with our need to put together the most effective teams to get the work done well.  Would people embrace their assigned roles, or quietly wish I had assigned them elsewhere?

These were the concerns that would sabotage my sleep on the flight from Miami to Santa Cruz (that, and the fact that Star Wars was the in-flight movie).  They were the subject of my prayers (and maybe some of yours) as we prepared for the trip and the team kept growing and growing.  To this point, I can happily say that all these concerns have been allayed and the prayers have been answered far beyond my satisfaction.  This team has been outstanding in every way imaginable.

I will provide a more detailed account of our work below (for those who have not yet fallen asleep), but first must comment on what I have observed from our team; the amazing unity that comes from serving together with one another.  At every meal, people are gravitating to sit next to someone new, to learn about their background, their personality, their faith, and to hear the story of how they wound up volunteering for this team.  Dozens of such conversations continue on our bus trips and in the pockets of down-time which occasionally occur during the project day.  Our Bolivian team members join right in as well.  Everyone is learning and laughing a lot.  E pluribus unum is alive and well down here in Bolivia.

Jesus speaks a lot about this place called “the Kingdom of God.”  It was the first thing he preached about and the thing he preached about most often.  He would describe it with metaphors and parables, and made frequent reference to the prophets of old who had foretold of this magical place.  It was a place where justice would reign, where the sick and lame would be healed, where peace would replace conflict, and where people would help the weak rather than step on or climb over them.  Though these prophets spoke of a place either far away or long in the future, Jesus announced that it was near, or “at-hand.”  Though not yet in its fullness, it would be present whenever His people would live together by its ethos.  So while our time here may not be quite perfect, I think it’s been pretty close to what this Kingdom must be like (except we still can’t drink the water or flush the toilet paper).

Now, some details on our first week in San Carlos:

We are one week in to our project and we are truly firing on all cylinders.  The surgical team has a great mix of experience and adaptability.  Pre-project preparation has resulted in very few equipment or supply shortages.  We are blessed with some hard working and eager translators (Carlos and Alyssa) who are also aspiring to healthcare careers, so they’ll even scrub in and help when needed.   Our team has become quite familiar with the San Carlos OR staff (we love Vasilica and Ignacio), so they have effectively joined our team and even anticipate our needs – we haven’t had to delay a case for instruments even once.  We’ve even added on emergency appendectomies and performed anesthesia for a C-section without substantially interrupting the scheduled cases.  In all, we performed 38 cases in the first five days, but were only late to dinner once.

Likewise, in our “recovery room”, Linda (second project) and Freddie (4th project) have led a great team including some young practical nurses (RPNs) from Canada in assuring our post-op patients are safe and comfortable throughout their stay.  Alyssa (who will be entering nursing school in the fall) has come down from Cochabamba for her second mission with us and has served not just as a translator, but a director of traffic and has championed patient education, making sure our patients can follow their medication instructions and keep their incisions clean and uninfected.  Also translating and assisting in the OR, she has shown remarkable endurance through long, hot days and has an amazing ability to multi-task without getting flustered.  I plan to write the administration of her nursing school to see if they can grant her breaks to come back and join us.  She is truly a badge of honor for her parents.

Outside, our legion of general helpers have found plenty to keep themselves busy.  They register patients and guide them to where they need to go.  They help in the pharmacy, the eye clinic, the dental clinic, and play with the children next door at a child/ infant nutrition center.  They color and play ball with the children while their parents are in surgery or an eye exam.  They have organized our supply room and quickly run items to the surgeons who need everything NOW.  They are eager to learn new skills and to patiently struggle through the language barrier when a translator is not immediately available.  They have truly made everyone feel like a person and not just a task.

Elsewhere, our clinic team has started going to remote/ poorly accessible locations, even crossing rivers in small boats or in monster dump-trucks, reaching people who don’t even have a doctor or nurse they can see once a year.  When the lines are long, they stay late to make sure everyone is seen.  Having never observed their work directly, I hope to join them for a day next week if everything continues to run so smoothly at the hospital or if we run out of gallbladders to remove or hernias to fix.

Wendy and the girls had a great week, working in the pharmacy and with the children around the hospital and nutrition center.  The week flew by faster than they could imagine, and they headed back to Santa Cruz last night and are flying home presently.  It was neat to see the girls cautiously come out of their comfort zones in order to engage some lonely children with play and stories.  They are so tender-hearted and gravitated towards the kids back in the inpatient area and at the nutrition center where the environment is a bit less chaotic.  I enjoyed getting lots of hugs between cases, a luxury I don’t even get at home.  Now they’re headed home to be reunited with their friends and their bunnies and head back to school.  If this week goes by as quickly as the first, I’ll see them again in no time.

 
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Posted by on April 23, 2016 in Uncategorized

 

Something old, something new

I’ll confess to having writers’ block for about the first time ever.  It’s time to head back to Bolivia, which also means awakening my blog from its biannual torpor, and though I feel more prepared than ever to head for the airport, I am coming up short on a fresh way to report on it.  I guess I’ll concentrate on what’s new this time, then refer you back to previous pre-trip blogposts like this one or this one from recent projects, or this one from what seems like ages ago.  Apparently I have much more to say when I have less time to say it (and maybe that’s why I talk so fast).

While I intend to focus mainly on what is new this time, that will have a bit more meaning if I remind myself of where we started and how we got to this point.  I’ll hit the highlights.

  • 2010 – Signed up on a whim for a one week project in Bolivia because I had an extra week of vacation and I knew the director, Dr. Obregon, my mentor who got me into medicine and surgery in the first place.  I hadn’t travelled with him since 2003.  Had an incredible experience and met Francis Perez – God said I can (and should) work with this man.  I knew I’d be back.
  • 2011 – Dr. Obregon gets sick.  Can’t travel for 6 months.  Gently informs me I should take over directing surgical projects for Bolivia, starting in January.
  • 2012 – Direct my first project, this time to San Juan, Bolivia (a post World-War II Japanese colony in the middle of rural central Bolivia) – find a team of trusting (way too trusting) volunteers willing to come with me.  We experienced awkward in at least three languages.  We ate inland sushi (and took Cipro).  It was awesome.  I also met more young Bolivian volunteers (my brothers and sisters now) who would become the nucleus of our team that continues planning and preparing for our projects year-round.  It was awesome.  I agreed to come back again.
  • 2012-2014 – Develop a pattern of taking teams twice a year – San Carlos in the spring and Santa Rosa in the fall.  Volunteers start signing up again and again, developing their own habit of repeated service and inviting friends of their own to help out.
  • 2014 – Started SendHealth Inc.  – our local nonprofit intended to help volunteers raise and store funds and purchase supplies for use on our projects.
  • 2015 – MMi USA (Texas) ceases operations while we were on project (a long story for another time, but an unfortunate end to an organization I’d been volunteering with since 1997), but the work continued and we are fortunate to be working with Medical Ministry International of Canada who has done a fantastic job recruiting and preparing for our next trip.

And that brings us up to now:  April 2016 in San Carlos – it will be my first project run by MMi Canada and they’ve been wonderful to work with, especially Tracey, our project coordinator.  She has put up with dozens of emails (long ones) and phone calls from a rather hands-on director and has gone above and beyond everything I’ve asked for as we prepare for this trip.  The Canada office has recruited magnificently and we have our largest team ever ready to meet in Miami and take the red eye to Santa Cruz.

We have fourteen volunteers from the US (representing WI, MN, OH, ND, CA, and TX), fourteen from Canada (representing BC, MB, and ON), and 16 Bolivian volunteers from the cities of Santa Cruz, La Paz, Cochabamba, and Montero.  That makes 44 and does not even include the local hospital staff who step it up and work 24/7 to help us care for such a large number of patients.  Of our North American volunteers, about half have volunteered on medical mission projects before (11 have volunteered with SendHealth projects) while the other half will be experiencing this for the first time.  Judging by the size of our Bolivian team, there will be some new faces there as well.

To be frank, the sheer size of the team is rather intimidating, though while working we will seldom all be in the same place at the same time.  I could be nervous about playing “cruise director” for such a large group, but they all seem to be enthusiastic self-starters and our Bolivian team promise me that there is plenty of work to be done.  I believe them.  I’ve experienced many things in Bolivia, but boredom hasn’t been one of them.  Apparently, neither is brevity.  This post is getting longer than I originally intended.  That is not new.

I’ll attempt to post updates periodically while on project – usually every few days if the internet is functioning (and if I am still functioning at the end of the day).  I’ll link to fresh blogposts from Facebook and the SendHealth website, or you can just click up there somewhere to follow the blog formally.  For now, hasta luego, amigos.

 

 

 
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Posted by on April 15, 2016 in Uncategorized