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2/15/08 (Friday)

6:00 AM.  We have gone about 12 hours without power and without any water.  The power outages have been a real challenge.  I wonder if this is an effort to thwart God’s work here.  It certainly is a distraction that is frustrating.  We can continue to deliver care but why must it be such a struggle?  The patient’s recovering must do so in the dark and without water.  We have a hard time properly doing surgery without the ability to scrub well and to see.  We have alternative sources of light such as flashlights and the generator; however, the generator is not trustworthy.  Fortunately, last night it was running.  Each time it turns on one wonders if that is the last.  Jane commented that it does not sound right as it is running.  It is difficult to maintain your own personal hygiene when there is no water and no electricity.  This level of power disruptions is new to me.  In the times I have been here before, we only occasionally used the generator and then only for a short while.  The rest of the time we had power.  This trip, however, has been about 50/50 it seems.  We have had to depend on the generator for a sizeable portion of our time.  The pump switches for the water system have failed and thus the gravity feed system does not work automatically.  I seem to be complaining and maybe I am.  This week it seems we have had direct efforts at stopping our work by taking out the essential elements of power and water.  Yet, I know and believe that God has not turned His back on us.  He is here and He will show us a way around this to accomplish what He wants us to do.  The surgeries will go on and the care will be delivered.  We have to stay focused on Him and not on our situation.   

Father, this morning my attitude is needing some adjustment.  The problems with the power and available water has been quite stressful for me as well as the rest of the team.  I am frustrated because I want to do quality work for You and for me I need to assure cleanliness and sight.  Please, Lord, help me stay focused on You.  Help me see beyond the barriers and to continue to run the race You have set before me.  Help us finish strong, Lord.  Thank You, Lord.  Amen. 

7:00 AM.  Upon arrival to the operating room area, the anesthesiologist announced that she does not feel we should attempt our surgeries, especially the hysterectomy, with the power down.  We have the headlights and could possibly work with those but she was correct in being hesitant.  The generator was on and parts of the circuits were powered.  Apparently, one phase of the generator was not working and some of the circuits were not live.  This included the operating room.  We talked about running an extension cord from a live circuit in an adjacent room to run the surgical light but she still felt this was too risky.  We were about to talk with the patient when the city power came on and everything was working.  Therefore, we decided to proceed with our schedule.  It was now 8:30 AM by the time we were getting started. 

As we talked about whether to proceed or not, I remembered the question asked of me by a close friend.  Several years ago my close friend and running buddy, Ken Nichols, was facing a tough decision in his life and career.  This decision involved a move of his family from Washington to San Diego.  This move was going to be very costly as well as carry with it other challenges.  He called me asked, “How do you tell the difference between faith and foolishness?”  That question came to mind again today as we looked at our challenge before us.  If we proceed with surgery in the circumstances of the morning, are we exercising faith or foolishness?  Are we working in God’s wisdom or man’s?  God clearly states in His Scripture that His ways are not our ways and His thoughts are not our thoughts.  His wisdom is not our wisdom.  We cannot comprehend how God thinks.  When we face a tough decision, how often do we rely on God’s wisdom?  Many times these decisions are made from man’s perspective and man’s wisdom, not necessarily God’s. 

How far will God take me to totally depend on Him?  Do I thwart His work through my doubt, my unbelief?  All Satan has to do is introduce doubt and my faith starts to unravel.  Eve learned this in the Garden of Eden.  Satan caused Eve to doubt and the rest is history.  Why am I so troubled with doubt?  I wonder how much of God I have missed because I doubted.  Interestingly, when I have been on mission trips and have been stretched beyond my limit, taken beyond my own resources, God then shows me that anything is possible with Him.  He has orchestrated miraculous events that cannot be explained any other way.  He has shown Himself to me over and over in those moments when I am powerless and have to totally depend on Him.  One would think that I should be walking strong with God every step of the way having witnessed Him working in and through my circumstances time and time again.  Yet, I continue to struggle with doubt.  It does not take much doubt to derail the peace, joy and hope that I have walking with God.  In spite of the miracles and the wondrous works that God has allowed me to see and experience, doubt continues to enter the picture.  I really struggle at times trying to decide if I am practicing faith or foolishness.  Today, this struggle again happened.  Should we proceed with surgery placing our total faith in God and let Him worry about the power and water?  Or should we be cautious and not be foolish and place our patient at unnecessary risk?   

Once the power came on and we had good water pressure, we felt we could proceed with our schedule.  Our first patient was a woman with fibroids and having problems with heavy menses and pain.  She came in for an abdominal hysterectomy.  Her surgery went along very well with minimal bleeding.  Compared to the cases earlier this week, this surgery was very easy.  We had no difficulties and no complications. 

Our second patient wanted her IUD removed.  She has had this form of contraception for 18 years and now wants to conceive again.  Wearing and IUD for that long can make it difficult to remove because it tends to migrate into the wall of the uterus.  We did a D&C finding the IUD in the cavity and it came out quite easily.   

Our third patient was a 14-year-old girl with a left inguinal hernia.  Jane performed with surgery with Barb assisting and I chose to sit out and not scrub.  This surgery went along very smoothly. 

Our fourth patient was a woman requesting a tubal ligation.  I performed this surgery through a mini-lap incision.  The surgery was a little difficult because of the small incision and the uterus lying back in the pelvis, almost out of reach.  Eventually, I was able to move the uterus into the right position and then find the tubes to perform the ligation.  

During the first case Jane went out to see a little boy with an injury to his bottom.  About 10 days ago he was swimming with some other boys and jumped into the water landing on a rock.  He struck the backside of his left thigh just at the hip.  The skin was not broken but the area swelled and became very painful.  His mother brought him in for an exam.  Jane found the area to be swollen and red.  She felt this area had become an abcess so she added him on as our last surgery.  This little boy came in to the operating room and was very brave.  He tolerated the IV insertion like a trooper.  Once he was asleep, Jane examined his left hip more.  The upper leg right at the hip margin was red and swollen tight.  Jane opened the skin over this area and immediately drained a huge amount of pus.  The abcess extended well up into his hip as well as down the leg.  Jane was able to drain the abcess and then put in a drain to promote more drainage as the area healed.  I am sure this relieved a lot of this boy’s pain.  We will keep him overnight and give him antibiotics.  I suspect he will be able to go home in the morning. 

Our first patient of the week came in today because she was running a fever.  She was also complaining of urinary symptoms.  I examined her and felt that she was dealing with a bladder and left kidney infection.  We decided to keep her to give IV fluids and antibiotic.  If she is better in the morning, she should be able to return home. 

Yesterday, Linda was having trouble with diarrhea and some nausea.  She was feeling some better this morning but still a little dizzy.  The anesthesiologist had her lay down and started an IV on her just to give her fluids.  Once she had that in Linda felt so much better.  She was able to function the rest of the day without any problems.  Her diarrhea and nausea disappeared.  I am really glad Linda is now better and that none of the others has had any problems.  I worry about my teammates when they come with me and then fall ill.  The last thing I want to see is a teammate become ill or injured.  God has protected them this week and I praise Him for that. 

After our last surgery, we then had a group photo shoot.  Jane then took us into San Lorenzo so we could walk around and look at the city.  The mayor has spearheaded several improvement projects with paving of the roads, refurbishing the old pier making it a nice place to visit and enjoy the water, and developing a children’s park area with multiple play equipment.  The paving bricks on one of the main streets downtown have been pulled up and the street is being repaved with colored bricks.  This will look very nice when it is completed.   

I have noticed that San Lorenzo has changed a lot since my first visit here.  Cell phone towers have become reality here and now everyone carries a cell phone.  The city has more cars and appears to be better off economically than before.  I am seeing a middle class develop here.  There is still a lot of poverty yet the people are making improvements.  This is quite encouraging.   

While we were out on the town a couple former patients came to the clinic to fix dinner for us.  They had talked with Jane earlier in the week and said they wanted to fix breakfast for us on Saturday.  Since Barb, Linda and Annette will be leaving early in the morning they came and fixed dinner.  When we returned from our little adventure, a hot dinner of fried fish, plantain, and chicken soup was waiting on us.  These gracious women fixed a delicious meal and did so out of the goodness of their heart.  They were thankful for the medical help Jane and I gave to them when I was here on a previous trip and wanted to do something special for us.  We had a good time enjoying the local fare and talking with these women.  The one woman who came up with this plan wanted her picture with me.  I got by camera and Linda took our picture.  When I told her how thankful I was for her act of kindness, she said, “You took more out of me than I gave you here.”  She went on to tell how my surgery, which I presume was a hysterectomy, has changed her life.  She is very grateful for that.  This was a very special moment for me.  This is the paycheck that makes the difference for me.  When I can make a positive difference in someone’s life that makes the work all worthwhile. 

It is now 11:15 PM and time to hit the sack.  I hope that the power will continue to be on through the night so the fan will run.  The sounds of the night are going strong with all sorts of frog noises and other sounds.  It is interesting to hear the chorus.  Add to this the sound of a steady rain on the roof and it will not take much to drift off to sleep.  Barb, Linda and Annette are leaving in the morning to head to Quito.  They plan to stop at Otavalo to shop and also to stop at the Equator Monument outside of Quito.  They leave for the United States on Sunday morning.  I have so enjoyed having them here.  They have been such good help and made our job much easier, especially for Jane.  We have had a great time working together. 

Father, thank You for this day full of challenges.  When we placed our faith in You, everything worked out without any problems.  Lord, help me deal with my doubt.  Help me keep focused on You all the time and not let my wisdom or any doubt enter the picture and derail Your work through me.  Thank You for the work You have accomplished through us this past week here.  Thank You for protecting the patients who underwent surgery.  I ask for Your healing touch on their bodies so they recover fully.  I also ask for Your healing spiritually for them.  I pray for a good night’s sleep for all of us.  Thank You for this great week!  Amen.

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