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9-15-2010 (Wednesday)

This morning I awoke again before the alarm was to go off having checked it a couple times in the hour or so before this. Finally I decided to get up. I did sleep fairly well and felt rested. After the cold shower I felt really refreshed. One can’t be sleepy and have a cold shower and still stay sleepy.

I was thinking about our surgeries from yesterday and what lies before us today. The patient with the myomectomy yesterday illustrates a problem that occurs not only here in Ecuador but in the US as well. This lady had been advised to had a hysterectomy and this was given as her only option. Jane tells me there are “gynecologists” (I use quotation marks to indicate my feelings some) here who have not had good training and all they do is hysterectomies. One that is located in this region of the country is known for doing a hysterectomy for almost any reason. Jane has seen people who should not have been operated on but now live their lives without a uterus and many times without ovaries. The myomectomy offers an alternative to keeping the uterine function intact and still treating the problem. Here in Ecuador there is no good system of accountability on practitioners. I am not a fan of the malpractice situation in the US; however, it does bring on needed accountability. We have developed all sorts of quality assessment protocols to make sure physicians remain accountable to their patients and to their peers. Without a malpractice suit threat, the physicians run amok with unneeded surgery and surgery being done incorrectly. The patient is left with little recourse. Here I have seen people that were mistreated and they just live with the problem now with little relief.

Jane was also telling me that Ecuador has a welfare system but not nearly as helpful as in the US. Here it is called a “bonus” and many people cheat the system just to get a little extra money from the government. Jane knew of one lady who had lied on application forms and presented as needing welfare. Yet she owned a furniture store and made a good amount of money through her business. She said one lady she talked to worked as an investigator for the welfare system. She told Jane that over the years she has investigated thousands of welfare applications and recipients and only found one person who actually qualified for welfare support. The rest were all fraudulent. Recently the president of Ecuador signed into law a bill granting welfare to blind people. The amount per month given to blind people is around $240. With this new law an amazing number of blind people are coming from everywhere. Because the clinic has an eye program there have been people coming in just wanting a certificate stating they are blind so they can obtain this welfare check. They are not blind at all but want to cheat the government. Cheating the government is a common disease world-wide.

Enough of my soapbox for the day. I waited on Jane to round on the patients and missed seeing her go into the albergue. She came out having seen all the patients and said they were all doing quite well. So we move on to breakfast and devotions.

Father, thank You for a new day. I slept well and feel refreshed and ready for another big day. Lord, You covered us with Your grace and mercy for the past two days and I pray for that to continue. Help us to stay focused and not become distracted. Satan wants us to take our eyes off of You, Lord. Help us to avoid those temptations. Lord, I pray for today, for the patients and for the team. Thank You for all that You do here in San Lorenzo.. Father, I pray for my family. Wrap Your arms of love around Phyllis, my children and their spouses and children. I pray also for my extended family as well. Thank You, Lord, for them. Please shower them with Your blessings, Lord. Thank You, Lord! Amen.

We have had some power outages but so far they have occurred when no surgery was ongoing. Last night we had the very noisy generator on for about an hour until the power came back on. It was dark out and no visible moon and when all the lights go out it is really dark. I am glad the power stays on through the night as I sleep with a fan blowing on me continually. Also the white noise generated by the fan drowns out a lot of the traffic noise and I seem to sleep better. The main pump to the new well is not working. Jane only has the old well and cistern. It is dry season so there is not much rain. However, recently the city water has been flowing some and actually has been keeping the cistern full. Surgery week, however, uses a lot of water for all the laundry and scrubbing. So far we have not run low. Lord, please provide the water we need. You have done so in the past and I thank You for that. Thank You, Lord. Amen.

Our devotions prior to breakfast was from Philippians 3:3-11. Here Paul twice states he wants to know Christ better. In knowing Christ one becomes more like Christ.. I found this amazing that this piece of scripture would align so closely with my thoughts about this trip and my personal mission statement. Actually, is there anything more important than knowing God? Think about that. At the end of the day does anything else you have done or have owned in your life matter as much as knowing God?

Our first surgery was L.A., age 64, with an obstructed bile duct. He is ill because of this condition and has stones in his gallbladder and bile duct. Also, on ultrasound preop there was a roundworm in the bile duct. We went in thinking we would be chasing a worm as well. The surgery was difficult because of the inflammation effects of the sick gallbladder. The bile duct has some stones in it but we were able to clear them out. We did not find a worm. The man had been given worm medicine and probably the worm went on to eternity. We were in surgery almost 4 hours and this makes for tired backs, arms and legs. Hopefully, this man will now find his liver function returning to normal and he will feel much better.

Our next patient, M.A., age 51, has fibroids and is bleeding a lot. Her blood count is marginally low. Her blood pressure was up when she was in the clinic last week. Jane gave her some blood pressure medication and told her if the pressure was too high we would not be able to do the surgery. She is overweight and I am sure that has some influence on her pressure. Today, her blood pressure was 233/125. Viviana gave her some medication IV to see if that would bring it down and we decided to delay her surgery for an hour or so to see what her pressure did. So we wheeled her out to the recovery room to observe for the time while we continued with other surgeries. We will then decide whether we can do her surgery depending on what her blood pressure is doing.

Our next patient is from the area of Zapallo Grande on the rivers. A.T., age 50, has a cystocoele (dropped bladder) with some incontinence. I was able to repair this problem easily and this should give her a good result with more normal bladder function.

We then had lunch with fried chicken, salad, fried plantain, and yellow rice. After lunch and a time off the feet, we then rechecked M.A.’s blood pressure. It had dropped to 200/120. This still was way too high to chance anesthesia and surgery on her. The risk of stroke and heart attack is too high in this situation. The surgery was cancelled for now and Jane will continue to work with her to try to get her blood pressure under control.

Our last patient B.B, age 49, is Beatriz, the lady I operated on in 2004 for a very bad cervical cancer. She had been having right lower abdominal pain and we felt we needed to evaluate this more with a look see. Unfortunately, she didn’t understand about having an empty stomach before surgery so she came in right after she ate lunch. We delayed her surgery until 4:30 to give her stomach some time to empty. Beatriz is now 6 years out from the cervical cancer. At the time her cancer was large and bleeding excessively. I operated on her then just to save her from bleeding to death. We did not do what would be the aggressive surgery for this stage of cancer. At the time I did not expect to cure her. However, last year she came to the clinic to visit another patient and I had the chance to meet her again and examine her. She showed absolutely no evidence of any cancer and I was thrilled. This was a cure! Now we are looking again to see what the pain problem is and hoping that there is no cancer.

While we were waiting for Beatriz to empty her stomach a patient I saw in 2006 came in from the rivers. We saw her in Zapallo Grande then and she had a complete eversion of her reproductive organs. The vagina was turned inside out and the uterus hung completely outside the body. We operated on her and repaired the entire prolapse and I was very thrilled to accomplish the return to normal anatomy for her. Once she returned to her village we did not have the opportunity for follow up evaluations. I often thought about her and how she did after the surgery. Today I got my answer. She came in with a complete prolapse of the vagina again. She said this happened about a month after the last surgery, now 4 years ago. She said when she went home she went back to doing all the normal things she would do. She is a widow and lives by herself so she does everything in the way of work to live. Thus, right away after surgery she was lifting heavy things and doing hard work. In talking with her it was clear to me she had no understanding of anything medical and the importance of allowing the surgical area to heal properly. We plan to operate on her tomorrow to try to fix the problem for her. This will give me a little time to try to plan the best repair for her. She said she is a widow and does not ever plan to remarry and is not sexually active nor will be. I told her one option is to do a procedure that completely ablates the vagina. Her tissues are so loose that any repair that leaves the vagina will likely fail again. The only way to assure that she will not deal with this again is to close the vagina completely. She said that would be fine with her. We will think about it overnight.

Beatriz was brought to the OR about 4:30 and we looked in her abdomen with the laparoscope. Her exam again did not reveal any evidence of cancer and Jane and I suspected she had problems with adhesions. When we put the scope in that is exactly what we found, lots of adhesions in the middle to the right of the lower abdomen. We then opened the abdomen and cleaned out all the adhesions. This gave us the opportunity to check lymph nodes and the pelvis to look for any cancer. We found none! I told Jane I remember she and I intensely praying about Beatriz in 2004. I said God heard our prayers and said to us, “Ok, now get out of My way and let Me handle this.” And He certainly did. He brought miraculous healing to this lady. No one can convince me otherwise. Knowing how cervical cancer grows, there is no way our surgery we did in 2004 was close to curative. However, add God to that picture and this is what you get!

Father, thank You so much for this day of surgery. Thank You especially for Beatriz and again showing us Your miracle of healing. We take that for granted a lot and I confess that. You absolutely wowed us with what You did for her. I praise You, Lord. Lord, please help M.A. with her hypertension. It is very high and dangerous for her. Please help her Lord and guide Jane as she treats her medically at this time. Lord, lay Your healing hand on L.A. His gallbladder was in bad condition and he is sick because of the obstruction. Thank You for helping us with his surgery today. Please watch over him as he recovers. Father, thank You for a good day serving You. I pray for wisdom and guidance as we sort out what to do for this lady who came to us from the rivers. Help us, Lord, do the right thing for her. I pray for Your insight and words of encouragement. I pray that I can be the right instrument for You to bring healing to her body. Thank You, Father. Amen.

8:00 PM. I just talked with Phyllis via Skype. We were even able to talk with video for about 30 minutes. That was great. I love her so much and it is really nice to be able to talk with her every day. Jane just left to take the clinic workers home and then we will have our dinner. Usually dinner is some kind of soup and is a light meal. After that I would like to head to bed so I can have a good night’s sleep. Tomorrow is another big day in the OR. We have this lady from the rivers and also another lady with cervical cancer that could be more of a radical hysterectomy. Plus there are a couple more people with prolapse that need some sort of repair surgery.

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Comments»

1. Kent Brower - September 16, 2010

God grant Marv wisdom and ability to do the surgeries ahead!
Kent

2. Rosa and Ken Liston - September 16, 2010

We’re praying for you and the team and thanking God for the success He is giving you!

Thanks for sharing the pictures and stories. I look forward to reading you blog each day.

May God continue to bless your great efforts!

Rejoicing in Him


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