Day 9 – January 15, 2025
Day 9
Day 9 – January 15, 2025
Today we have two gyn surgeries that involve pelvic relaxation with prolapse of the pelvic organs and bladder function problems. These issues are often addressed surgically working through the vagina instead of an abdominal approach.
The team met at 7 for devotions and breakfast. Carmen had fixed the meal for us consisting of scrambled eggs, smashed plantain or green banana and cheese mixed together. We also had watermelon and some slices of mango. For our drink we had tree tomato juice. The tree tomato is a fruit that is common in this area. It obviously grows on trees and has a citrus-like flavor. It is a little tart but is very good.
After breakfast we began our first surgery. This patient had a significant prolapse of the cervix and uterus along with vaginal wall relaxation resulting in a large cystocoele, a dropped bladder, that gave her a lot of incontinence, and also a rectocoele where the rectum bulged anteriorly into the vaginal space. The anatomic distortion creates a challenge in surgery where our goal is to restore normal anatomy and normal function. The control of the bladder is very dependent on the normal anatomy. If the anatomy is distorted from stretching and relaxation, the control of the bladder becomes a major issue for the patient. It is not much of a health risk but socially is becomes a major deterrent to living a normal life.
This surgery took about 2 and a half hours to complete with the anatomic positions of the bladder and bowel now back to normal. My hope is after everything heals she will have a good result with no incontinence and can start living a normal life. These patients are so grateful to have their bladder weakness fixed.
We decided to have lunch before starting our second surgery. Our lunch was encebollado, an Ecuadorian favorite. It is yucca, albacore, onions, cilantro, banana chips, covered with a broth with some hot sauce on top and then a lime squeezed over it to lace it with the juice. Delicious! Loida made it especially for me. She showed us the order of adding the ingredients to make the meal.
The order of ingredients: yucca, then albacore, the sliced onions, then fresh chopped cilantro, then banana chips, then the broth. The orange bowl is hot sauce that has onions, cilantro mixed in. The lime halves that you squeeze in the press and sprinkle the juice over the soup.
Our second surgery had similar problems but much less anatomic distortion. This repair went much more smoothly and time involved was a little over an hour. I kept thinking about out the surgeries scheduled for me tomorrow. Both of those patients have total prolapse with the vagina everted out. These problems are much more difficult to repair as bowel and bladder are inside that pouch as well. The restoration of anatomy is a real challenge as all the tissues have been stretched out and attenuated. I anticipate each case taking at least three hours. It will be a long day. I used to do these surgeries and enjoyed the challenge but now I am older and the standing a long time in one place results in swollen legs and ankles and a lot more fatigue.
Our anesthesiologist also is boarded in family practice. He lives in Esmeraldas and has an office here in San Lorenzo as well as in Esmeraldas. He asked me to see one of his San Lorenzo patients for a problem with urinary incontinence. She came to the clinic about 4 pm. I was surprised to see this police officer in full uniform walking in. She was tall, thin, and had the expression that she meant business. She was wearing sunglasses as well. I talked with her about her incontinence problems and examined her as well. She did not need a surgical correction at this time and feel some exercises to strengthen the pelvic tissues might help her. I told her the approach to these issues is to try conservative measures first before resorting to surgery. She understood and agreed to try muscle strengthening exercises first knowing that it may take three months or more to see if they are helping to control her bladder. If not, surgery might be an option but her physical changes are very minimal and I’m not sure if surgery would possibly give her more problems instead of giving her the help she needs. I would probably ask her to see a urologist as well to make sure she gets the right treatment.
She was embarrassed to undergo an exam by a complete stranger even though she accepted the fact that I was a physician and my practice involved the very problem she had. Damarys helped me by translating for us. The patient told Damarys she appreciated my help and also said it was a relief for her as she realized she would never see my face again.
After that appointment, I met up with Claudia in the dining area and we sat and talked about our spouses who both had similar degenerative neurologic diseases leading to their deaths. She went through a similar process of caring for her husband as I did with my wife. Soon it was time for dinner and Loida put together some rice and chicken using up leftovers and added watermelon, mango juice, and lemonade to drink. I must say, they are taking good care of us and feeding us quite well.
It is bedtime now and soon I will be turning out the lights and settling in for another good sleep. Lord Jesus, I humbly come to You tonight with my heart filled with worship and praise for how You have been so faithful in helping us with our surgical cases as we serve Your people here in Ecuador. They come to us with specific health care needs and we serve them as we serve You. Our hope is they see Jesus when they look at us for we want to present You to them through our witness and help. Thank You for inviting us to come here with You to help Jane and her team in this ministry. Lord, thank You for the help you gave me today in the surgeries I was able to help doing. You gave me clarity of mind and guided me through the process so the patients would receive Your healing power delivered through us. Thank You for allowing us to participate in this miracle of healing. You created us with that power in us to heal our own wounds and illnesses. When that occurs, You receive more glory. Lord, I worship You and am so privileged to walk with You and to participate in Your kingdom building work here in Ecuador. Thank You, Jesus! Amen.
Medical Missions 