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7/22/2012 (Sunday)

It’s Sunday and the sky is a little overcast.  Rain moved in during the night and I was awakened by rain coming in the window above my bed and hitting my face.  The building is all concrete and there is no sound of rain like we would hear on our roofs.  Then the next awakening was when my internal clock said I had slept over 8 hours and it was time to get up.  I then got up and collected my things and went to the bathroom for my real awakening and another deep inhale in the shower.  Now that I am now fully awake and alert I decided to spend a little time reading.  The quiet time study I am doing led me to Psalm 103 and I must insert that into this journal.  Read it slowly and thoughtfully.

Psalm 103

Praise the Lord, O my soul; all my inmost being, praise his holy name.  Praise the Lord, O my soul, and forget not all this benefits – who forgives all your sins and heals all your diseases, who redeems your life from the pit and crowns you with love and compassion, who satisfies your desires with good things so that your youth is renewed like the eagle’s. 

The Lord works righteousness and justice for all the oppressed.   He made known his ways to Moses, his deeds to the people of Israel: The Lord is compassionate and gracious, slow to anger, abounding in love.  He will not always accuse, nor will he harbor his anger forever; he does not treat us as our sins deserve or repay us according to our iniquities.  For as high as the heavens are above the earth, so great is his love for those who fear him; as far as the east is from the west, so far has he removed our transgressions from us.  As a father has compassion on his children, so the Lord has compassion on those who fear him; for he knows how we are formed, he remembers that we are dust.  As for man, his days are like grass, he flourishes like a flower of the field; the wind blows over it and it is gone, and its place remembers it no more.  But from everlasting to everlasting the Lord’s love is with those who fear him, and his righteousness with their children’s children – with those who keep his covenant and remember to obey his precepts.

The Lord has established his throne in heaven, and his kingdom rules over all.  Praise the Lord, you his angels, you mighty ones who do his bidding, who obey his word.  Praise the Lord, all his heavenly hosts, you his servants who do his will.  Praise the Lord, all his works everywhere in his dominion.  Praise the Lord, O my soul.

How easily it is to forget all the benefits that God gives us!  I think of where I am right now.  I have running water and a toilet.  There are many living within this community who don’t have those amenities.  I have the ability to take a shower every day even if it is cold.  I have a roof over my head.  There is a kitchen here with a refrigerator and freezer and there is ample food.  There are so many benefits that God has provided for me today and I need to take the time and make a mental list of those and thank Him for them.  David in writing this Psalm was talking to himself.  He was reminding himself to dig deep into his memory and to thank God for all the benefits in his life.  It takes mental energy to do this.  It takes thinking and remembering and reflecting on what benefits I have in my life.  It is so easy to take things for granted and just expect them to be there not giving any credit to the fact that these amenities are benefits. 

10:30 am.  I am back from church.  Jane and I strolled over to the ministry building about 8:15 and church began about 8:30.  In the previous years there would be possibly 30 people attend.  Today there were at least 50 to 60 adults in attendance and probably 30 to 40 children.  This church has experienced growth and that, too, is a benefit from God.  When I told Jane about my taking pictures yesterday and finding people in the ministry building praying she said the church has experienced a dramatic growth over the past year or so.  The congregation had developed several cell groups and every Saturday one of the cell groups comes to the ministry building to set up for the Sunday service and then they spend the day fasting and praying for the church.  That’s right, I said “day.”  They were there all day and at dark the lights came on and they had a time of singing and then went home.  The church now has a morning service and an evening service on Sunday.  Many of the new members of the church have come from the neighborhood around the clinic.

It is very difficult for me to understand all that is being said because of the language barrier.  My Spanish is quite limited and I find it difficult to know and follow what the person is saying.  This is especially a problem for me in the church when the pastor is speaking.  The people follow him completely but I don’t know what he is saying.  I wish I knew more Spanish so I could communicate with these people. 

3:50 pm.  The day has been slow.  I have been listening to a course I am taking and following the speaker on the course outline on the computer as I listen.  My next item of business for awhile is to study again the information on the fistula repair.  Jane and I have talked about it frequently and reviewed together how we will approach this.  She really wants to accomplish this for this patient to help her and also to gain the experience in doing these surgeries so she can attempt the easier ones by herself in the future.  In this country with many women delivering at home unattended, the incidence of fistula is much higher than what we would ever see in the States.  The fistulas usually occur because of a prolonged labor, many times several days.  In the US we never let that happen.  If labor stalls out a C-section is performed.  Here a C-section would mean travelling some distance to see a doctor in a strange hospital to get this surgery.  I think back of the time I was here and Jane and I went upriver to a village to do pap smears all week.  A young lady was in labor and I was asked to check her and possibly help deliver her.  However, she had been laboring for a couple days and was making no progress.  I recommended a C-section so that meant putting her in a canoe, taking a 4-hour trip down river to catch a bus and then a bumpy 2-hour ride to the hospital in Esmeraldas where she could get this surgery.  I felt really bad for her because of her discomfort and pain and then having at least a 6 hour journey while in labor to get to the hospital.  Back home there would be public outcry over a situation like this and all sorts of regulatory intervention would be planned to prevent another.  However, this is Ecuador and the culture is the way it is.  This is where an older lady comes to our clinic for surgery next week taking 2 days of travel for her to get here.  Our fistula patient lives on the rivers somewhere and I am sure she must travel by canoe and bus for several hours to come to our clinic.  Plus, when she goes home she will need frequent post-op visits to make sure healing has progressed according to plan.  That means more travel to and from for her.  Yet, these people take this right in stride because that is the way it is.  For me I have to deal with the cultural differences to feel comfortable with some of these situations.  If I were here long-term like Jane is I would see things much more through Ecuadorian eyes.

6:00 pm.  Damarys and Loida arrived about 4 pm and have unloaded the car.  They brought with them the Karl, Jody and Owen Needy, a family from Tennessee who have come to work on various projects needing maintenance as well as help us in the OR.  Karl and Jody have come before and have been a big help to Jane.  Jody is in nursing school and works as a lab technician.  Owen, their son came along this time to work with his dad.  Also, Elizabeth, a senior college student who is going on to medical school, came to work with us.  She is from Minnesota.  She will be very helpful in the OR and helping care for our patients.  Elizabeth has been in Ecuador most of the summer.  She spent the month of June here with Jane and then went to Shell to spend some time there.  She returned here for the week and will be travelling back to Quito with Jane and me on Saturday.

8:00 pm.  We all piled into Jane’s car, 10 of us, and went out to eat.  That meant driving into town and stopping at this little restaurant.  We had grilled chicken or pork along with beans and rice.  The food was tasty.   I am always a little cautious about eating local food where I am unsure of how it is prepared.  I especially don’t want to get sick and then not be able to help in surgery.  However, Jane and I have eaten at this place before.  The menu has two options – grilled pork chop or grilled chicken breast.  One lady is standing out on the sidewalk grilling the meat and we have to pass through the smoke to go in to sit down.  There are about 6 tables.  The meal is the grilled meat with beans and rice. 

When we came back to the clinic Gonzalo was there with his wife, Nancy.  Gonzalo works at the clinic and Nancy usually cooks the meals for us.  However, Nancy was walking very slowly and is obviously in a lot of pain.  Jane saw her and drained a perirectal abscess.  Nancy is diabetic and her blood sugar was 400.  Unfortunately, diabetics here don’t get treated as regularly as in the States.  Here a person may not even know he or she has diabetes.  Jane talked with Jody about giving Nancy some insulin and then Gonzalo will take her home for the night.  It will soon be time to call it a day and head to bed.  We have a busy schedule tomorrow with a lot of standing time.  I plan to take breaks between cases so I can put my feet up, especially since my right leg is much more prone to swelling since my knee problem a few months ago.  Before we went out to eat I reviewed again the information on the vesico-vaginal fistula repair. 

Father, Thank You for what You have taught me today.  I have been reminded through David to think about all the benefits You have given to me and to thank You for them.  Lord, so many parts of my life are because of Your grace and mercy and provision.  You grant me the wisdom I need to make decisions and to help Jane deliver care here in San Lorenzo.  You grant me the ability to travel here.  You give me a place to stay with running water, toilet, shower, soap, and a comfortable bed.  Lord, I take these for granted most every day yet I now confess that I have these because of You.  Lord, thank You for giving so much to me.  Thank You, Lord.

Lord, I look at the little church that meets here in the ministry building.  You showed me what happens when people pray and fast and honor You through that.  Lord, I ask You to bless this church, bring more people in and teach them to share Your love in the neighborhood and beyond.  Thank You for the pastor, his wife and the people willing to step up and help lead this church. 

Father, I pray for Nancy.  Please protect her from any serious complications from this abscess and her high blood sugar.  Watch over her tonight, please.

Father, I pray for tomorrow.  I pray that we can all have a good rest and be ready to work in the operating room tomorrow.  I pray for the patients who will have surgery tomorrow.  Please wrap Your arms around them and hold them close to You and protect them.  Thank You, Father for bringing all of us here to serve the people and in the process to bring You honor and glory.  Thank You, Father.  Amen.

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