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8/14/05 (Sunday)

Today, we saw more patients in the clinic.  We had 5 come from the rivers.  Jane said there are 119 villages along the rivers in this area.  There is a missionary midwife who makes the rounds to these villages to assist the women and is basically la doctora for them.  She is the one who referred the patients to Jane for treatment.  They all traveled for several hours by canoe and bus to get here.  They came prepared to stay overnight so they could have surgery tomorrow.  One lady we saw today had a 14-hour trip coming to get surgery.  She arrived late last night and is staying in our post-op ward until we can do her surgery.  These ladies all are fairly young, 40 or under, and look at least 20 years older.  Their skin is scarred in many places, they generally have few teeth, and most likely have not had any significant medical care.  It is hard to imagine the type of life they have lived. 

One lady came hoping to have a hysterectomy because of excessive bleeding.  Her exam, however, showed an advanced cancer of the cervix.  She is beyond any surgery to help her.  It was hard to inform her she had very bad cancer.  Her only hope, short of a divine miracle, is radiation therapy.  This would involve travel to Quito, which is 5 hours from San Lorenzo in addition to the travel she needs to do just to get here.  She has no money and with no money up front, there is no care in this country.  There is no such thing as medical insurance.  You pay cash and if you can’t pay for your care, you don’t get care.  It was sad to see this lady cry and realize that she was going to die without being able to care for her 4 children.  Her husband is a jerk, he could care less about her or her condition, or even the children.  You see situations here that you don’t see in the US.  That makes it difficult because in our culture you have multiple options and a person like this would get treatment even if she couldn’t pay. 

Phyl will be helping us tomorrow in the instrument room cleaning and wrapping instruments and helping with keeping up with the laundry.  She also will likely be working with the post-op patients taking vital signs and keeping Jane and me updated on the patients’ conditions.  She is learning to communicate with hand signals but is not speaking Spanish yet.  She may be modeling the scrub suits for the ladies tomorrow. J 

Alex, a missionary with HCJB, arrived today to spend the next couple days with us.  He works at the various clinics as the guy who fixes things and keeps the buildings and equipment working properly.  He supervised the building of the wall around this clinic and also took care of the roof our ABF group purchased for the building where the patients stay post-op.  He speaks English and is from New Zealand.  He and Phyl had a good time talking this afternoon while Jane and I saw patients in the clinic.  I think Phyl was glad to have someone to talk with without using hand signals. 

Tomorrow we hope to get an early start in surgery since we have 6 major cases to do.  We will likely be in the operating room for at least 12 hours tomorrow and probably the same amount to time each day through Friday.  We will work until noon on Saturday as our anesthesiologist needs to head back to Quito Saturday afternoon. 

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