9/23/06 (Saturday)

Saturday, September 23, 2006

6:50 AM. I have been up for a little while, showered and ready to start my day. We had another rain shower last night. Jane was telling me yesterday that God has provided the water we would need for the surgery week. She said usually in this time of year it is dry and when she has surgery week she needs to buy a tanker of water almost every day to fill the cistern so the clinic could have enough water. She said this week with all the rain, the cistern has remained full and she has not had to purchase water at all. This was a blessing in that it saved the clinic some valuable dollars. She commented that this was just another little provision of a gracious and merciful God.

Lord, thank You for the rain and how precious it is. We take the rain for granted yet this week You allowed it to rain every night with restoration of our water supply. Without adequate water, we would not be able to do the cleaning and scrubbing necessary to maintain surgery. Thank You, Lord, for that component of Your grace. You have sustained us in so many ways, Lord, and now I am reminded of one element of many other that are behind the scenes yet are very important and that You covered them all. Thank You for Your healing power that You have passed on to our patients. Thank You for your unfailing love for all of us. I ask for Your presence again today as we finish our OR schedule. Please equip us to carry out the work before us today. Thank You, Lord! Amen.

4:00 PM. Our surgeries went very well today. They were all minor cases and we were done with 6 surgeries by 2:00. One D&C we did was on a young lady who had had an induced abortion about 5 years ago. She 16 then, I believe. She has not been able to conceive since then. One ultrasound showed something in the uterine cavity and the radiologist stated it was fetal bones. The abortion was in the first few weeks of a pregnancy and the bones would not be calcified by that time. We were not sure what was going on there. I did a D&C to see what the problem was and try to identify this foreign substance in the uterine cavity. Through the curette I felt something that the instrument grated over. It actually felt like the copper wire that is on the copper IUDs. The curette then brought out some fragments of flat, hard material that could be bone but also could be something else. Paul stated that many of the induced abortions he sees were caused by inserting something into the uterus to disrupt the pregnancy. He said he has seen cases where the surgeon took out fragments of wood, rubber catheters and metal objects. These fragments I removed could be calcified wood or possibly fetal bone that remained behind and eventually was calcified by the lining of the uterus. At any rate, the material was probably acting like and IUD in disrupting implantation. By removing these fragments and restoring a normal uterine cavity, I suspect she will now be able to conceive.

I am amazed at the level of “medical care” that the people live with. I say “medical care” that is consistent with things like I just talked about with the induced abortion. Other people have come in with stories of really bizarre treatments being given to them. A couple years ago I took a needle out of a lady’s vaginal opening. That needle had been there for a few years after a surgery had been performed on that area. The lady had pain with intercourse and that needle was in the right place to cause her a lot of difficulty. We did surgery on her this week because of a uterine problem. She also wanted me to repair the vaginal opening where a scar had developed from the needle. I did a hysterectomy and a vaginal repair on her.

This week has been a very challenging and interesting week. I continue to be amazed at the amount of pathology we took care of this time. Previous times here we had hysterectomies and other surgeries. This time, however, the surgeries were all difficult gyn cases, some of the most difficult I have ever experienced. Jane and I work so well together as a team. She understands what I am doing and vice versa. We work like we have been a team for many years. Our actions are complementary and support one another. She has skills I don’t have that help us handle the unusual findings we seemed to encounter time after time. By myself, I would have been really struggling with some of the surgeries. By herself, she would have been struggling too. Yet, God empowered the two of us along with Angelita, Maria Luisa and Paul to work together as a team and deliver high quality care to many people.

We had another rain last night. Jane said this morning that this was most unusual and that God was so good to us by supplying all the water we need. She said usually when she is here for surgery week that she has to buy a tanker or two of water every day because the demand for water is so great. Yet, this week we got our “tanker” every night from the hand of God. Our well stayed full and the cistern remained full and we had enough water to take care of all the needs at the clinic. A tanker of water costs about $10. This may not seem like much but it is a cost that the clinic can barely afford. To have the water plentiful, the money saved could now go for other expenses.

Thank You, Lord, for this week! Thank You for providing us with the skills and supplies we needed to accomplish what we did. Thank You for the water so Jane did not have to purchase water. Lord, You are so wonderful. We felt Your unfailing love day after day. You kept us protected from illness that could have exiled us from you. You kept us in supplies so that we could do all 31 surgeries. You kept us working together as a great team. Thank You, Lord, for your incredible grace and mercy and love!! Amen!

6:30 PM. We just returned from taking Jorge, Angelita and Maria Luisa home. They finished with the clean up of the clinic and will take a day off next week so they all said good bye to me and for me to tell my wife hello for them. As we drove around San Lorenzo there have been some improvements. The current mayor is getting some construction accomplished. A lot of the downtown is now paved and a big sewer project is underway on the road into town. Once that is completed that road is to be paved as well. Jane said this mayor seems to be actually doing something for the people here compared to previous city leaders. Mary Aaland, MD, who comes here to work with Jane at least yearly, said before I came this time that she felt San Lorenzo was developing a middle class. She said there are more cars and more televisions and cell phones compared to previous years’ observations. I would agree with her. There have been some good improvements since last year.

One interesting addition to the culture is the cell phone. Last year we saw one lady with a cell phone and she was from several hours away. We also ran into a work crew laying cable for cell phones and communication across the mountains when we went to see the hummingbirds at Tony Nunnery’s place. Now, everyone has a cell phone. The people wear them on their belts or are carrying them in their hands. The patients lay in the albergue working their cell phones, sending text messages, making calls. Jane said now the status symbol for San Lorenzo is the cell phone. She said you are considered second class scum if you don’t have a cell phone. The times we have been in town I noticed most everyone walking around is sporting a cell phone. There is a big cell tower about a quarter mile from the clinic. It is interesting to see the change from last year when cell phones were very rare, especially with the patients coming to the clinic.

As we were getting ready to take the team back to their homes, the lady who has the bad cancer came up to Jane and wanted to go inside to talk with her. Maria Luisa and Angelita had been talking with her in the clinic building and walked with her over to the house. Once they went inside the lady dropped to the floor at Jane’s feet and began to cry, almost wailing. She is to travel to Quito tomorrow and to go to the community outreach office at HCJB hospital on Monday to get the paperwork set up for her to be seen at the cancer hospital. Community outreach department has a fund that will help pay for her care if she can’t pay herself. This lady was scared and really struggling with the fact that she had a very serious problem that threatens her life. She kept talking about not wanting to leave her children. She just cried and cried. Finally, Angelita talked with her and told her that we all have problems we have to deal with and she must get up and face what she has too. Angelita was not rude or demanding but did tell her that crying and laying on the floor was not going to do anything for her. The lady got up and they talked a little more and she then walked outside and left the clinic as she headed for home. I can imagine the incredible emotional stress she is dealing with right now. She is very poor and has a life-threatening problem that needs a lot of money, which she doesn’t have, to treat it. Life has turned upside down for her. Angelita and Maria Luisa have been witnessing to her as well, trying to introduce her to Jesus Christ. I am certain that God is not shocked by this lady’s problem. This very problem may be allowed to happen to draw her to Him. He can heal her physically, emotionally and spiritually. She needs to let Him do that. We all have that choice and at times we do our best to resist His helping hand reaching out to us to lift us up and heal us.

Jane and I have been concerned, worried is a better word, about our lady on whom we did the multiple myomectomy. She is now 24 hours post-op and is a little tachycardic. She has had some dizziness when sitting up earlier today. Jane gave her more IV fluids and that has helped a lot. We went to see her a little while ago and she looked fairly good. She is pale and I suspect her blood count may be in the 8 to 10 range. Her pulse is strong at 110 and her blood pressure sitting up is in the 130/90 range. We are concerned that she may have bled some internally but may be stabilizing. At this point we plan to observe her and check her blood count in the morning. To do that the family will have to go to the lab, purchase a blood test tube, and bring it to us. We will draw the blood and they will then take it back to the lab for processing. They will then go later to get the result and bring it to us. Jane and I have talked about the possibility of having to take another look in her abdomen. At this point our anesthesiologist, Paul, is on his way back to Quito. If we had to return to surgery, we might have to do our own anesthesia. I could put in a spinal but I don’t remember the doses. Jane said we could call Paul and he could guide us by phone on the right doses so we could do a spinal and then explore the belly to see what is going on. I hope we don’t have to go that far. We both are concerned yet she is looking better hour by hour. Jane said she is right now only 24 hours post-op and we possibly are expecting more than we should at this point. We will certainly keep a close eye on her tonight.

Lord, please rest Your hand on this lady. Comfort her and support her. If she is bleeding, please stop that so we don’t do more harm by taking her back to surgery. If surgery is needed, make that clear to us and guide us please. Lord, she presents with a tough decision right now and we really need You to stand with us and guide us through this. Please wrap Your arms of love and healing around her, Lord. Also, please help the lady with cancer. She is distraught and in despair. Her life has turned upside down and she appears to have no ability to think clearly right now. Please comfort her and her family. Give her hope and direction. Lord, shelter her and heal her, please. And please be with Phyllis as she travels. I love her so much, Lord, and I want the best for her at all times. Please shelter her with your loving arms and hold her tight. Thank You, Lord, for blessing me by bringing Phyllis into my life. I pray this all in Your precious name, Lord Jesus. Amen.

8:00 PM. Our power just went out as I was working on this journal. The albergue was very hot with all the beds full and about 5 people for every patient milling around in the room. It felt good just to walk outside where it is a little cooler. Right now it is 84 degrees and 71% humidity in my room. I have a fan running all the time. It is warmer in the albergue. I would hate to be recovering from major surgery in a room that is hot like that. However, this is considered a lot better than home living conditions and the patient’s prefer to stay a night or two more just because they have a real mattress to lie on. We now have power via the generator, which is a diesel engine sitting right outside the window to the front room of the house where we sleep. That generator is very, very loud and I certainly don’t look forward to trying to sleep with that thing running. I hope the city power comes back on soon.

The following pictures are of San Lorenzo as we took the team to their homes.

These scenes are of the streets in San Lorenzo. When the dirt is dry there is a lot of dust. When it is wet, there is a lot of mud. Jane really needs her 4-wheel drive just to drive on these streets.

While we were taking Jorge to his home this little boy came running up to Jane to say hello. Jane had operated on him removing a large mass from his neck. He was excited to see her.