the end of week 2

so, the end of the second week has come. and the beginning of some time of travel and vacation with it. to wrap up the time line from before, i'll finish out what these days have looked like:\

16 july - 18 july: the grueling schedule of before stayed with last week. we revised our role to be that of consultants and as needed help overnight. we helped with the more critical patients, did pre-op evaluations as requested by the surgeons, while the Bolivian staff did the majority of management (as they had been prior) still. however, as we had input to give overnight, or with post-op complications, we were able to give it more freely.
i think we learned a lot about the differences in management styles, communication, and practice of medicine through these weeks. i'm still thinking on these issues, trying to sort out what lessons to take away for the future.
we have seen tons of GI problems: gall bladders gallore! in young patients (20's and 30's), and their course post-op has not always been easy. in a 52 year old man who had a laparascopic (camera, minimally invasive) surgery converted to open due to the size of the stone obstructing his bile duct, his post-op course has resulted in the surfacing of an auto-immune disease, we think, that may not allow him to leave the hospital. His name is Raul, he is a pastor, and a dear, dear man of God. Please pray for him - for his family, his ministry/congregation, and his life. He is very, very ill and there is little more that can be done medically (even if we were in the US).
Other "fires" we've been called to put out included issues with pain post-op, pain in a man who had a surgery 1 month ago and had a obstruction in his bowels. it's definitely a challenge when you can't get STAT labs and X-Ray in the middle of the night, not to mention wishing you could send them for a CT scan... so we've done our best with clinical exam, supportive management, calling the surgeons to evaluate patients, and praying a lot.

18 july: julie was very sick (vomiting, nausea, exhausted - lasted for about 24 hrs and she's better) and i took the day to go to a village where some of the team went and set up a clinic. it was the village of Falsuri, up in the mountains north of where we are. beautiful, beautiful! they don't have a doctor there, it's very possible to get into the city/town to see a doctor, but either they are afraid, they don't have money, or lack the education/knowledge to know when it is best to see a doctor. largely the patients i saw were pretty healthy - the usual complaints of "pain all over" (usually arthritis type, or tense muscles due to their very difficult manual labor), gastritis pain (due to diet and it's very common to have H.Pylori infections in the stomach here), "my child doesn't want to eat and has belly pain" (parasites) and dizziness (because they don't drink water and only drink a little juice or soda most of the time.)
so we gave a lot of anti-parasitics, some antiacids, tylenol and ibuprofen, and vitamins. i had the opportunity to pray for a woman who described non-cardiac chest pain whenever she was worried or nervous about things, when she was depressed or sad. it was an honor to ask the LORD for help on her behalf and share with her the hope of Jesus - God with us.

upon my return to the hospital after taking several little mini-van buses back down the mountain and into town, i was met with on of the staff here asking me to attend his wife's delivery. she was on the 'operating table'/delivery table and about to deliver her first any time. so i quickly changed and then waited around a while ... and before too long she delivered a little boy! He was a bit too blue for my comfort initially, and my NICU training compelled me to take action a bit quicker than the nurses there, or general doctor seemed to. after some suction and warming and oxygen, he pinked up - but slowly. someone later wondered aloud if because of the altitude (8500 ft), babies look paler/bluer at first. perhaps. He's doing well now and his name is Ricardo. i'll try to get a picture.

19 july: another clinic in the morning. not as remote a village. lots of vitamins. lots of tylenol and ibuprofen. returned in the afternoon and napped until dinner.

20 july: today. said good bye to the large, large group and then there was silence. the 6 of us that remain are re-grouping, doing some planning for local activities (hiking, eating, seeing things) and resting.

all for now...

Vida en Vinto, Bolivia

"Life in Vinto, Bolivia"

hello all, and apologies for the lack of postings!

to start with, i'll give you an idea of what the days have held since we arrived...

6 july: arrived in Cochabamba (the larger city in the highlands of Bolivia) safely and rather miraculously after getting 2 seats on a "full" flight. We were met at the airport by one of the Hospital Administrators named Paul, wearing a llama sweater and holding a sign saying "Hospitals of Hope". He was a welcome sight. He took us the 30 minutes to the HOH complex outside of a smaller town called Vinto to the HOH guesthouse.

We met our housemates, other volunteers who have been here varying amounts of time, mostly college students (Josh, Stephanie, Stephanie, Jean, Katherine and Pepper), rested, settled. The guest house is beautiful, we have our own room and bathroom. There is a common kitchen and the first night we had a great meal of tacos :) and went to bed exhausted, but well.

7 july: more resting and relaxing, and actually, preparing for the BIG group from the US, Canada and one guy from the UK to arrive in various installments later that day and the next. This is a team from MMI (Medical Ministries, International) composed of surgeons, nurses and a ton of 'general helpers' (more college students, teenagers, older folks). Most are staying in the guest house with us, which makes things very full/tight, with others staying at another house off site. We became part of the welcoming crew and 'house managers' since we had been there all of a day before the others. It's been a blessing, though, to have arrived before them, and to be sort of "independent" from the larger group, as we have more freedom to go about without obligation to the group activities/dynamics.

8 july: Sunday, mostly spent preparing for the week to start, with surgeries and patient care dynamics, etc. The hospital is fully functional with bolivian staff, however the surgery team brought a large influx of patients, with much more complicated issues, and so the preparation and management of this has been tricky, and a challenge for the Hospital staff.

9 july - 13 july: the work schedule here at the Hospital has been grueling, actually. we spent each of these nights (aside from the last, Friday) up all night at the hospital. I thought i'd be getting more rest here than at home ... but last week that was not the case. The LORD certainly has had His designs for us to be here at the same time as the surgery team, because the role of pre and post-operative management has fallen to us. Julie just finished her Internal Medicine residency which makes her perhaps the most qualified one here to manage critically ill patients, of which we have had quite a few. I have had the blessing, joy, and pleasure of working with her to manage these patients, talk through things, and learn learn learn.

We have had some frustrations and challenges working with the Bolivian staff physicians, as their approach to management differs quite a bit on some things, and our US practice of medicine has conflicted with theirs on a number of occasions. Toward the end of the week, a lot of these issues were sorted out (slowly!!!) but it is still a challenge to communicate over another culture and language in addition to the culture of medicine being different here. (Julie has likened it to 1950's medicine in the US).

i'll give some patient stories in the next entry.

14 july - 15 july: 2 glorious days off! we slept, ate great food (out! in the city, with a small group of the 'original' volunteers - so lovely! see pix below), and tried to regroup to sort out what the 2nd week should look like. we spent time in the city shopping, exploring, and trying to learn more about the people and culture here. it's beautiful here. and the people are dear and sweet. they are very proud of their heritage, their city, their country and children.

16 july: Week 2 begins. more of the same in terms of management of patients....

so there's a bit of an update. and at this point i'm only as far as reflecting on what has been happening, more than how i'm feeling about it, or more of my thoughts. i am in need of some time to process and reflect and pray and then i'll be able to share more.

one question i've been asked several times: how is the Spanish going?

it's going. always wish i were able to communicate more freely, more smoothly, with better grammar... but overall, it's going very well. i feel like most days i understand more, and am able to use what i hear to improve my own skills. i am one of few "spanish-speakers" among this large group of americans, so i do a lot of translating. amazing, really. a gift from the LORD.

thanks for your prayers. please continue. this has been a hard 10 days.

some images of Peru