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2/08/08 (Friday)

Our day began long before dawn with the loss of our electricity.  You awaken to a change in your environment.  The room is very still and the outside noises are more prominent.  You realize the fan is off and this means the electricity is off.  The outside light is off.  We have lost our power, which occurs periodically here in San Lorenzo.  I don’t know when it occurred but the change to quiet awakened me.  The white noise from the fan was gone.  I went back to sleep and slept off and on until the light of dawn started to enter the room.  I then arose about 6:45 and checked the water to see if we had any water that I could use to at least wash my face.  The water pressure was okay and then I realized that Jane had installed a gravity feed system as a back up for water so she didn’t have to depend totally on a pump and continuous electricity.  This made a shower possible and I was able to start my day a little less smelly and grungy.   

After breakfast of scrambled eggs with onions mixed in, we are off to the clinic.  Nancy also fixed for us a fruit drink called arasha.  This fruit is somewhat white and the drink looked like milk.  It was delicious.  I told Linzy that I was going to alert her to the possibility of intermittent power outages but didn’t realize we would experience it real time before that moment occurred.  Gonzalo started up the generator a little after 7:00 and it makes so much noise that one can hardly hear.  At least we can generate our own electricity until the fuel runs out.  So, this is the start of our day. 

Lord, Thank You for the restful night and this new day with a challenge before us already.  Remind us Lord that You are in charge and our mission is to depend on You for everything.  Help us to understand that, Lord.  Help us to keep our faith strong in You and not be distracted in any way because of simple things like a power outage to major things that could disrupt what we are to do here serving You.  You are in charge, Lord.  This gives me great comfort.  Father, ride with Damarys today as she returns to Quito to be with her family.  Our other team members arrive tomorrow and give them safety as they travel.  Father, thank You for this opportunity to serve You today.  Thank You for my family and please keep them close to You today.  Thank You, Father!  Amen. 

At the start of the clinic we gathered for devotions.  The staff has been studying Psalms.  They were on Psalm 23 today.  They asked me if I knew this Psalm and I said as a child I had memorized this Psalm as part of Sunday School.  They then asked me to recite it as I remembered it.  I was able to go back about 55 to 60 years in the memory bank, pull up this Psalm, and recite it.  Then we talked more about what this Psalm means.  I shared with them a study I did with my physician Bible study group when we studied a book by Charles Swindoll who discussed various Psalms.  This Psalm talks about the shepherd and how he cares for his sheep.  He forces the sheep to lie down and rest otherwise they may not and exhaust themselves.  Sheep will not drink from running water so the shepherd will take them to still water.  The shepherd protects his flock with his rod and staff.  The sheep trust the shepherd with their lives.  When the shepherd leads them into a new pasture, first he will prepare the pasture by seeking out the places where poisonous snakes dwell.  These vipers live in small holes in the ground and when the sheep’s nose comes too close they will strike and inflict a lot of injury to the sheep.  The shepherd pours oil around the hole to keep the snake from being able to come out.  He also anoints the head of the sheep with oil so the snake can’t latch on to the sheep’s head.  We had a good discussion of what a shepherd does and how this relates to our Good Shepherd as He cares for each one of us, His sheep. 

5:55 PM.  We are finished with our clinic for the day.  The day was long, hot and sweaty.  We all suffered from “mucho sudando” (much sweating).  I moved the thermometer into our room and it quickly went to 93 degrees with the humidity moving from 70% to above 96%.  The last number to register is 96% and then it will go to HH, meaning high humidity I suppose, and then to ERR.  The humidity reading was ERR the entire day.  Jane said we had 35 patients scheduled even though she asked the clinic staff to limit our day to 25.  Of the 35 scheduled, we had 20 show.  Out of the twenty, we scheduled 13.  Monday and Tuesday of next week are already full with Wednesday mostly full.  We will see several more patients tomorrow and likely will fill up the rest of the week.   

One woman came in today having given the history that she underwent a surgery 7 years ago for a pregnancy where the placenta was over the cervix.  She said the doctor told her she had a placenta previa and she needed immediate surgery.  She underwent delivery of the baby only to lose this baby.  She said she has had no more menstrual periods since that surgery and she desperately wants to conceive again.  She is currently 36 years old.  Upon more questioning about the event related to the last pregnancy, she stated she had no problems, bleeding or other difficulties at the time the decision was made for surgery.  All she was told was the baby died.  She was in her 7th month of gestation at the time.  Upon examining her, we found she had had a hysterectomy.  Her uterus and cervix were surgically absent.  When we told her our findings, she was very shocked.  What had happened to her 7 years ago was a hysterectomy for a placenta previa with the baby being lost from a very premature delivery.  With my knowledge and experience with placenta previa, this aggressive treatment is not at all indicated, especially if the patient is not bleeding or having any problems.  Placenta previa many times will result in a Cesarean delivery but usually we try to take the patient as close to term as possible so the baby will survive and do well.  We all felt so sorry for this lady who 7 years after the fact learns that her uterus and cervix were removed and she would never be able to conceive again.   

Another woman came in wanting a hysterectomy.  Jane had seen her earlier and found a large mass in her pelvis.  Upon exam, it was clear this woman had and advanced cervical cancer.  I felt this was beyond our ability to manage surgically here.  We arranged for her to go to Quito to be seen and treated with radiation therapy.  She shed some tears as she realized she had a terrible disease and would likely die from it.  This is terrible news to give to anyone.  I cannot imagine the barriers in front of people here who have no money and very little ability to get the care they need.  In the US, these people would get good care regardless of their ability to pay.  It is so sad to see these problems here.   

Our evening is one of just trying to cool down and stop the mucho sudando.  I hope to have some time to read some more and get online to communicate via email.  Just as we were finishing our dinner, the lights went out.  Linzy and I were going to go with Gonzalo to a phone cabin nearby so we could make a couple phone calls home.  Now that the power is out the phone cabin is closed.  Therefore, we will work on making a phone call tomorrow.  This is the second power outage in less than 24 hours.  I hope this is not a trend we will have to endure for the next several days. 

Father, this has been a long and difficult day.  The heat and humidity takes its toll quickly on our stamina, especially mine.  Thank You for being there with us and supporting us throughout. I pray for the women we saw today and the plans for surgery.  Lord, I could sense Your presence as You gave us wisdom and clear thinking about the situations we encountered.  I pray especially for the lady who learned today that she lost her uterus and her child-bearing ability 7 years ago and didn’t know it until now.  Please wrap Your arms of love around her and give her hope.  I pray also for the lady who had cervical cancer that is beyond our ability to manage.  Please give her hope as well.  Lord, touch her and heal her, please.  Thank You, Lord, for Your unconditional and unfailing love!  Please equip us to share this love with those we see tomorrow.  Amen. 

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