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6-24-2014 (Tuesday)

Tuesday morning and we awoke to no water.  Last night as I rounded on the patients with Jane we had very low water pressure and Jane had said we were almost out of the water.  The cistern is empty and there was a low level of water in the shallow well.  The deep well is not functioning because of pump problems.  Jane has a tank of water collected from rain run-off of the roofs and she opened this up last night.  This tank contains about 1000 liters of water.  This morning we had no water at all.  The next step is to bring in a tanker truck to refill the cistern.  Without water, we cannot work today.

I got up a little early and rounded with Jane.  The patients are doing very well.  We will be releasing most of them today.  The one lady whose surgery was partially covered by EUMC funds will be coming over to the clinic before she leaves so I can get a picture of her post-op.  Her recovery has gone well and I hope the surgery works without failing again.  As we finished rounds and came to the clinic we were met by M.C., our first surgical patient of the day.  She also is very poor and EUMC funds are helping cover her costs.  She brought a gift for us, a bag of fruit she picked from her home.  The bag contained some large grapefruit, coconuts, and a huge papaya.  This papaya was the biggest one I have ever seen, the size of a large watermelon.  Amazing!  Out of her poverty she gives to us!

M.C. and her offering to us.

M.C. and her offering to us.

Father, I am humbled by this act of generosity.  I am humbled to see her smile and sense the peace she has.  I pray for this lady, Lord.  Please keep her safe and secure during the surgery and afterward.  Thank You for her giving heart and gratitude for what we are doing for her.  Lord, this is all from You.  Thank You, Father.  I pray for Jane and me as we do her surgery this morning.  Please wrap Your hands around ours and help us care for her.  Thank You, Father.  Amen.

At breakfast this morning the tanker truck arrived.  The local fire department brings its tanker and off loads the water into the cistern.  Jane said we will likely need to refill the cistern a couple more times today.

Getting water

Getting water

Being Jesus to someone requires a love for that person that sees beyond their appearance and instead of seeing the filthy rags on the surface you see the person behind those rags and understand the value of that individual.  As dressed up as we can make ourselves we still are covered with filthy rags in God’s sight because we harbor sin.  Yet, Jesus’ mission was to free us from that bondage of sin and make us acceptable before God.  Look at John 8:2-11 for an example of how Jesus teaches us about His approach to the filthy rags of sin.

At dawn he appeared again in the temple courts, where all the people gathered around him, and he sat down to teach them.  The teachers of the law and the Pharisees brought in a woman caught in adultery.  They made her stand before the group and said to Jesus, “Teacher, this woman was caught in the act of adultery.  In the Law Moses commanded us to stone such women.  Now what do you say?”  They were using this question as a trap, in order to have a basis for accusing him.  But Jesus bent down and started to write on the ground with his finger.  When they kept questioning him, he straightened up and said to them, “If any one of you is without sin, let him be the first to throw a stone at her.”  Again he stooped down and wrote on the ground.  At this, those who heard began to go away one at a time, the older ones first, until only Jesus was left, with the woman still standing there.  Jesus straightened up and asked her, “Woman, where are they?  Has no one condemned you?”  “No one sir,” she said.  “Then neither do I condemn you,” Jesus declared.  “Go now and leave your life of sin.”  (NIV)

This woman was obviously guilty of her sin.  However, the important part of this encounter was Jesus did not condemn her.  He reached out to her with forgiveness and acceptance but also instructed her to leave her life of sin and become a new person.  Even though these words are not recorded here I wonder if Jesus included instruction to follow God and to walk with Him from this point on in her life.  This certainly is inferred in how he talked with her and treated her with respect, love and forgiveness.

Even though this situation was set up to trap Jesus by creating a situation where He was put on the spot as to whether He would uphold the Law or not.  Jesus’ teaching seemed to these religious leaders to contradict the Law and they were looking for an opportunity to catch Him in some violation of the Law they so revered.  Jesus handled this masterfully by turning the accusation back on the accusers.  He didn’t accuse them directly but forced each of them to examine their own hearts and see if they qualified for the privilege of casting a stone at this woman.  He simply told them that they had no business of judging another of sin when they themselves were sinners.  Jesus was in total control of this situation and He ministered to all of those present, exposing sin and offering forgiveness.

I find it interesting that the adulterer was not brought before Jesus along with the adulteress.  One wonders if the man involved was one of the crowd.  At any rate, those wishing to condemn this woman did not seem to feel it was necessary to condemn the man involved.  The Law stated that both parties caught in adultery were to be stoned.  I am sure that Jesus would have said the same thing concerning the man.  He would have challenged each accuser to examine himself before throwing any stone of judgment.

If I am to be Jesus to someone today, I must analyze my own heart before I submit to the temptation of judging another person.  I have to look at my hands and see how many stones I am carrying.  I have to depend on God to expose my own sins so I can bring them to God for forgiveness.  We all are like this woman.  We harbor sin and would be unable to stand before God.  We deserve to be stoned, yet God does not approach us with condemnation but love and forgiveness.  He always gives us a chance to confess and be cleansed of our sins.

How many stones are you carrying right now?  Are you throwing them or dropping them?  Search your heart.  Let God reveal to you where you harbor some sin that keeps you from having a full, deep, personal relationship with Him.  His desire is to have that type of relationship with Him.  He wants you to walk with Him and spend every minute of every day in fellowship with Him.  He reaches out to you with forgiveness and acceptance.  His hands carry no stones.

Our first patient, M.C., is 42 and has myomas.  She has had a lot of bleeding that has not responded well to hormone therapy.  Right now she is on the birth control pill and this is not working well.  I do not like her on the pill at her age.  She has run a chronic anemia because of the bleeding.  Our plan is to do a hysterectomy.  Her surgery was a struggle.  She is heavy and the uterus was quite large making exposure of the vessels difficult.  We were able to complete the surgery going slow and methodical and had minimal blood loss.  She also had a rather large umbilical hernia that Jane is fixing as we closed the incision since the incision into the abdomen extended up to the hernia area.  Father, thank You for guiding us through this surgery and giving us the stamina and wisdom needed to do this procedure.  Thank You for keeping away any complicating issues.  Thank You for keeping M.C. safe.  Lord, You certainly were with us helping us all the way.  Thank You.  Amen.

D.Z. came over to the clinic before she went home.  I wanted to get a picture of her to send to EUMC missions committee as funds they sent helped cover the cost of her surgery and of the surgery we just completed on M.C.  It is amazing how these patients recover so quickly.  This type of surgery on D.Z. would involve a several day stay in the hospital in the States.  She is ready to go home today, only 2 days post op.  I got a picture of her with Howard and me as Howard attends Englewood United Methodist Church.

D.Z. ready to go home

D.Z. ready to go home

M.R., the patient we operated on yesterday for a supposed large myoma finding instead a pregnancy with no evidence of myoma had an obstetrical ultrasound this morning.  The ultrasound shows a normal 16 week pregnancy with active fetal movement and no evidence of any myoma.  We are very happy for her.  It is distressing to me to have misleading information that seemed trustworthy and not having the resources to quickly verify this information.  The one problem contributing to this was the refusal to share the previous ultrasound results with us.  All we could go on was what was told the patient.  This led us down the path where we could have destroyed a life.

L.T. is our next surgery.  She has a uterine prolapse along with the bladder creating urinary dysfunction.  She also has a hernia at the incision from a previous appendectomy.  Our plan is to explore the appendectomy incision and repair the hernia and then do a vaginal hysterectomy and anterior repair to fix the prolapse and restore the bladder to its normal position to allow better function.  Lord, I pray for L.T.  Please cover her with Your grace and give her peace.  I ask for Your hands around our hands as we do this surgery.  Lord, I also ask for stamina and knowledge to do the right surgery for L.T.  Bless us with Your presence, Lord.  Thank You.

Our surgery with L.T. went well but took a long time.  We were in the OR for about 3 hours to get all the work accomplished.  She had a spinal but it started to wear off before we were finished and so the anesthesiologist gave her a general anesthetic so we could finish.  Thank You, Lord, for keeping L.T. save and walking with us through the surgery.

Our next patient is M.B.  I operated on her several years ago for multiple fibroids.  She wanted to conceive and we did a multiple myomectomy procedure.  She experienced some internal bleeding post-op which then stopped without the need to return to the operating room.  She was one I would call a miracle.  Our anesthesiologist had left and then M.B. began bleeding.  We had no way to take her back to the OR to see what was going on.  Her blood count dropped steadily and all Jane and I could do was pray, and pray we did.  The next morning M.B. was up walking around and feeling great.  She went home that day.  Jane and I could only praise God for answering our prayers.  Now M.B. is back with more myomas and heavy bleeding with anemia.  She brought some blood transfusions with her so we could use that in surgery.  This time we will be doing a hysterectomy.  Father, please carry M.B. in Your arms through this.  Help us to do the surgery without significant blood loss.  Keep M.B. safe and secure and cover her with Your unfailing love.  Thank You, Father, for always being with us and sustaining us.  

7:00 pm.  We have completed our surgery with M.B.  She had massive fibroids that distorted the uterus significantly making the surgery quite difficult.  She brought two units of whole blood with her and we gave both units during surgery.  Coupled with the large myomas were adhesions from her previous surgery.  This procedure was one of the more difficult ones we have encounterd so far.  But God is good.  He was with us throughout, kept us calm with quiet reassurance, guided our hands gently, and gave us the knowledge and insight to correctly dissect the large vessels out without causing any injury to other structures such as ureter.  M.B. will now be able to recover from her anemia.  I am very happy for her.  Thank You, Father, for being here in the room with us guiding us, protecting M.B. and helping us with a difficult surgery.  Thank You, Lord!

We have one more surgery and then Dahlia, our anesthesiologist will be leaving to drive to Quito for a meeting in the morning.  She holds some positions of responsibility in the social security hospital system as well as teaching residents and medical students.  She won’t be back to San Lorenzo until mid afternoon so tomorrow morning will be some down time for me.  I will be able to get my feet up more and let the ankles reappear.  The swelling fo the lower legs and ankles has been uncomfortable.  This comes from standing all day with little moving around.

8:30 pm.  Our last surgery is complete.  This was on S.O., a 68 year-old man with a mass next to his navel plus under the mass was a small hernia.  Jane was uncertain as to what the mass was.  We opened the skin next to the mass and found a large sebaceous cyst.  Once this was dissected out she found the hernia and repaired this.

Our day is over!  Lots of standing and holding one position that makes the legs swell and ache as well as the back hurt.  Soon we will be gathering for a small meal and then head to bed.  I need to get my feet up for at least 8 hours.

Father, this has been a tough day for us but You were there with us and enabled us to complete the work.  Thank You for that.  Thank You also for covering the patients with Your presence and touching them with Your healing hand.  Lord, we depend on You so much, for everything we do.  Thank You for allowing me to come here to serve You.  Amen.




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