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...