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9/16/06 (Saturday)

Saturday, September 16, 2006 

6:00 AM.  I awoke earlier in the night during a hard rain storm.  There was lightning and thunder and heavy rain.  The rain went on for an hour or so.  When I got up and showered and dressed, I went out into the kitchen area and looked out at water everywhere.  The grounds which can be a little muddy after some rain were covered with standing water everywhere.  People were coming in to the clinic and were walking through the puddles as they walked to the clinic door to check in.   

Jane and I started seeing patients about 8:00 or so.  One nice event that occurs now every morning is the staff gathers together to have about 15 minutes of devotions.  Jorge is leading them through the book of Proverbs.  Someone will read the selected section, in Spanish of course, and then Jorge will comment and teach.  They then sing some songs and pray together before starting the day.  This is a neat time even though I don’t understand a word they are saying.  One song was the Spanish version of When The Roll is Called Up Yonder and I sang along in English as they were singing in Spanish.  At least I knew what they were singing!   

We saw 18 patients today and scheduled a few more surgeries.  These patients were more time consuming in that some needed some long counseling.  A couple ladies came in for infertility evaluations.  How do you take such a complex topic and explain it to someone who has no idea about human physiology and then try to translate that into Spanish?  They want me to operate and fix their problem.  It just isn’t that simple.  I wish it was.  We tried to explain the basal body temperature chart and how to monitor ovarian function to this one lady.  She didn’t want to spend another three to six months tracking her temperature.  She wanted surgery now to fix it.  Her problem is not surgical and it was hard to convince her that surgery was not needed in her situation.  We spent probably an hour talking to this lady.  We finished our day about 4:00.  The room temperature reached 88 degrees and the humidity reached 83%.  Needless to say, it was uncomfortable. 

One lady came in with an ultrasound desiring surgery to fix her problem so she can conceive.  She has never had a pregnancy.  She was told she has uterine fibroids.  Her ultrasound shows this huge fibroid inside the uterus.  This is an unusual location for one of this size and she not having any bleeding problems with it.  The big question for us was how do we remove it?  We don’t have any hysteroscopic instruments to go up inside the uterus to look at it or attempt to remove it.  It would have to be pulverized almost to get it out of the uterus this way.  That would take us all day.  Going into the abdomen would necessitate cutting the uterus open to get to the mass.  This leaves a scar and a weak area on the uterine wall that places the patient at high risk for uterine rupture if she conceived and carried to term.  She would have to have a C-section for delivery.  How do you monitor a high risk patient out here where prenatal care is so sparse and the travel time to get to a place for a C-section is so long?  Possibly, the lowest risk situation for the patient is to do nothing.  However, that is unacceptable to her.  We also could get into a problem that would necessitate a hysterectomy.  That is also unacceptable to the patient.  We spent a lot of time talking with this lady to get her to understand the complexity of this situation and the risks involved. 

I took pictures of the ultrasound and a diagram the radiologist drew of what the uterus looked like in the ultrasound and sent this via email to a couple of my partners to pick their brains on how to surgically manage this.  Email was great in that I could get an expert opinion and the advice I needed to make the right decisions on this lady’s behalf.

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The diagram shows the mass inside the uterus.  

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The ultrasound images are not good quality but were current.  They showed this mass and it was difficult to interpret exactly where it was.  I could see how the radiologist felt it was inside the uterus but I wasn’t certain that was correct.

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Our surgery schedule now has 27 people for next week and we have a couple patients coming on Monday for evaluation.  These people will likely need surgery also.  Our biggest concern right now is our anesthesia.  We are still waiting on final word about anesthesia for next week.  Paul had indicated he might be able to come for Tuesday through Saturday.  If he comes that would be great but it cuts our schedule by a full day.  That means we shift all these patients into other days making all the days very long and stressful.  However, if Paul doesn’t come, we may not be doing anything at all. 

Damarys and Loita came tonight from Quito to spend a day or so with us.  We will be heading out for dinner tonight and hopefully I can go to a phone cabin and call Phyl.  I would really enjoy talking with her.   

We went out to eat for dinner by going downtown into bustling San Lorenzo to eat at the El Choko restaurant.  While we were eating we received a phone call from one of the anesthesiologists that Jane has worked with in the past.  This lady stated that she and Paul have worked out coverage for us for next week.  She will come for Monday and Tuesday and Paul will come for Wednesday through Saturday.  Paul originally was not available at all because he is taking some classes and had told Jane several weeks ago that he would be unavailable for several months.  Paul was the anesthesiologist who worked with me on the previous times I have been here.  He is very good and I am excited to work with him again.  Our prayers were answered!  We were at the end of our rope and we just had to let go and trust God on this.  He confirmed our calling to be here by working it out and not letting the surgery schedule collapse.  We will be able to be His hands this next week as we touch and treat several people.   

Thank You, Lord, for Your incredible grace and unfailing love!  You called me here and You have placed Jane here to carry out Your ministry to the people in San Lorenzo and surrounding area.  Thank You for answering our prayers and providing anesthesia for us for the entire week.  We can continue with the schedule and not have to turn anyone away.  Lord, this is Your ministry and we so much appreciate the opportunity to participate with You.  Thank You!!  Amen.

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