2120 W. Laura Street ... come by!

we went (renae and i, to Peoria)
we saw.
i bought.

it's gorgeous inside, original woodwork on floors and moldings, built in 1935, kitchen accented with white and black tile, bright natural lighting everywhere, a lovely yard with a swingset, 3 bedrooms upstairs and a bonus room in the attic. i'm excited to receive this beautiful gift from the LORD!
we walked in 1:23pm and by 1:28 i knew it was perfect. we left the house at 1:43 and by 2pm we were at the realtor's office drawing up the offer. i submitted the offer by 2:30 and the selling agent picked it up at 2:45. at 6:45 i received a call saying that my offer was accepted with no changes and we'll close on June 2nd.

and there's a lilac bush in front. renae prayed for that.

The Vine Trust

so as i've been perusing the web looking for pictures of the Amazon Hope ships, i found a great site for the organization, The Vine Trust. check it out. lots of pictures and more background on what i joined. this is in conjunction with Scripture Union of Peru, the local organization. The Vine Trust in based in the UK. just so good to get my mind off of my own little life and see more of the world.... enjoy, and let me know when you want to join me there...

Some stories from Amazon Hope

the first week:
i was a translator for Dr. Wendy Slater, a 37 year old, spunky physician from Scotland. we had a great time together and i enjoyed being able to facilitate her relationships with the patients and staff as well. it was a strange dynamic being the one to know both Spanish and English (though at times i didn't think i knew English when speaking with the Scottish group.) there were 6 members of the team from the UK - 2 doctors, one dentist, one pharmacist, one nurse and a dental nurse.
In addition to the UK team and me, the Peruvians included 6 crew members and Captain, Luis the chef, John G - lab tech/pastor/general asst., Nimia - nurse/pharmacy/everything else, Dr. Ronald Ramirez, MariLou - midwife, Yodimi - health dept. nurse, John V. - registration/lab/etc. and Fransisco the dentist.

One of the patients that was most difficult to see was a woman in her 30's with a husband and 6 children who was brought to the boat on a stretcher. we were told that she had a vaginal infection - for 2 years. beyond that, we eventually learned that it was actually cancer and that she had an infection on top of that. she was in excruciating pain and had been losing weight - many concerning symptoms indicating that she did not have long to live. John G. (pastor), Dr. Wendy and I met with her and her husband to see how they were doing, knowing that there was no medical treatment we could offer. She told us that she knew Jesus Christ and that she and her family trust Him. We prayed for her, for their family and John spent a while encouraging the husband to love his wife to the very end, to be with her. we gave her Ibuprofen and several antibiotics to treat the infection component. it was humbling and emotionally painful for us to see her leave on the stretcher after her husband carried her up the stairs from the hull of the ship. John reminded Wendy and me that though we could do little to ease her physical condition, we as doctors have something even more important to offer - the hope of eternal life in Christ.

Another group of patients i saw were the elderly, lovely men and women who had cataracts or pterygium (a condition where the tissue on the surface of the eye becomes ridge-like and grows across the eye eventually obscuring vision). these beautiful "ancienos" (in spanish - ancient ones :) ) still work in the fields, eeking out an existence for themselves and their families but can barely see. the most frustrating part of these visits was telling them that though there is surgery to treat both conditions, we were not equipped to do it. however, each time i said this, i asked them to pray with us that Amazon Hope II (see picture, and click on link to see it's progress) would be coming soon and with it, the facilities and staff to do cataract surgery and other general surgeries.










One of the most interesting patients i saw was a woman in her 50's whose concern was a rash on both of her legs. first of all, this was not the first patient i treated for a rash. nearly every patient had some sort of skin complaint. however, this patient was different in that her rash looked much more uniform, less due-to-bad-water, and she had had it for 5 months. Dr. Ronald, my dermatology (and everything else) consultant, had also never seen anything like it. i could see him start to think harder than he usually had to when answering my questions about skin problems. i suggested a possible etiology, which he accepted as within the realm of possibility (for any of you medical people - my thought was a purpuric rash due to thrombocytopenia). we ruled it out with a quick blood test - literally, a prick to see if she bled and bled. she didn't. his next question to the patient was "have you had any change in sensation in your legs?" much to my surprise, she said yes. he tested her sensation by having her lay down on the exam table and asked her to say when she felt his touch on her leg. he scraped one of the lesions with his pen cap (note the sophisitcated medical instruments we used...) and she said nothing. harder. nothing. after a few attempts in different parts of her leg, and her silence continuing, he turned to me and said, "i think it's lepra." or, leprosy. something i had only heard about in the Bible and maybe once in my microbiology class during 2nd year of medical school. we advised her to go to the government hospital in Iquitos where she could be tested for FREE and if found to have leprosy, treated for FREE as well. this is a patient i will never forget. nor will i forget Dr. Ronald's amazing skills in clinical diagnosis.

... back again

i arrived safe and sound in Iquitos on the night of March 25th. the 14 days on Amazon Hope were perhaps one of the most amazing times of my life. seeing, feeling, experiencing, doing things that few people in the world will ever see. we attended to over 2500 patients (medical, dental, immunizations and obstetric visits).
the days that followed were full of last times seeing people, goodbyes, my camera being stolen, getting ready to leave, and much, much travel. i arrived in the USA on March 29th, exhausted, with a sinus infection and intestinal problems where i was met by Caron (with annabelle and violet), Julie, Renae, Joie and Brook. Thank you so much for welcoming me back!
i now have no pictures to post of the boat experience until i track down the people from Scotland who were with us for the first 10 days of our 14 day journey. the rest of the time will only live in my memory and heart. i'll be posting some stories in the days to come. i'm sleeping a lot this week.

As for residency...
i will be joining the staff of the University of Illinois St. Francis Medical Center in Peoria, Illinois starting June 21st! This was somewhat of a surprise, but it is at the Hand of my Sovereign, All-Powerful Heavenly Father whose purposes stand firm forever, who does everything in faithfulness and love for His children. and so it is. my anticipation is growing and i am eager to see what is in store for me there. and to start working as a doctor. finally. the program is well established, primary care focused, family-oriented, involved in the serving the community (especially the underserved because it is a Catholic Hospital), sees a great diversity of people, are interested in preparing me for what i want to do in the future. and as an extra bonus, the financial benefits are amazing. i am thankful that this is where i will be for the next 4 years.

Graduation is May 5-6, 2006. come if you can!
and from thence forth, i'll get to sign my name with an "M.D."

I will cry out to God Most High,
to God who accomplishes all things for me,
to God, who fulfills His purpose for me.
Psalm 57:2

Amazon Hope

tomorrow i leave for 2 weeks on the boat, Amazon Hope. it will hold a crew of 4-5 Peruvians, 8 Scottish medical personnel, 5 peruvian medical personnel, and me, the lone americana who will also be translator for part of the time. and many, many patients. we´ll see patients in the "hull" (if i remember boat anatomy) where there is a "consult room" which will have curtains making it into 3 and a dental room. we are going on the Rio Ucayali to the communities live on its banks. http://en.wikipedia.org/wiki/Ucayali
so i´ll be gone for these 2 weeks without email access or phone so please don´t worry if you don´t see anything on my blog or hear from me for that long.
just pray. pray for safety and health, for strength to see so, so many patients all day, for skill and growing ability in Spanish as i will be translator for the first 8 days (none of the team from scotland speak spanish), and then continued skill as i join Ronald in seeing the 100 patients a day after the group from Scotland leaves. for the people we´ll be serving, pray that they would not only be helped and blessed by the health care, but also know why we do it - because Jesus Christ loves them and we are His hands and feet on earth to show them that.
the boat is quite nice - though old. i´ll have an air conditioned room for sleeping and i´ve been told, very good food all these days. we´ll have the chance to get off and walk around in the communities where we stop, so i won´t be entirely ship-bound for 13 days.
another item is that i won´t be finding out about where i´ll be doing my residency until i return on the night of March 25th. pray for this time of waiting for me.

thank you, thank you.
off to the jungle i go...

if you´d like to help...

i´ve been thinking about how to respond to the comments i´ve received and emails saying... "i wish i could send medicines or supplies..." or "what can i do to help".
today i came upon a way:
we are out of vitamins for kids (who all have anemia)
we are out of cough syrup for kids (and all of them have some viral upper respiratory infection that makes them cough all night and not sleep)
we are out of reading glasses (the kind you buy at the grocery store for $1.75)

SO... to start with, if you are willing, email me at katvenable2006@yahoo.com and let me know if you would like to contribute money, how much and what i should buy "for you" here. you can reimburse me when i return. it is very difficult to send supplies in the mail because of customs issues here. they rarely reach the intended party, unfortunately. so while i´m here, i can at least purchase some of these things for anyone who would like to help. and remember that even a little of our US currency goes a long way here.

thank you.

El Día de la Mujer

today i was greeted with a rose and wishes for "happy day"... the day of the women.
i had no idea this was a holiday. i received many wishes for a happy day. and a little gift. and lots of kisses on the cheek - which is a typical greeting hello and goodbye. but more today than usual. all the women at the clinic recieved a flower and a gift.
a lovely tradition i think we should observe in the USA.
here i am with nimia and melissa who both work at the clinic. they are lovely and sweet and a blessing to work with.

Amy

this is my patient Amy. she´s very sweet and about 6 months old. her mother brought her in because she has had fever for several days, as well as cough and is not well. She is like the other 30 or 40 kids under the age of 2 i´ve seen in 2 days with the same symptoms. it´s an epidemic of some upper respiratory infection running rampant among these people who live so close together in such poor conditions.
Amy, however, i´m pretty sure has pneumonia. i´m only pretty sure because i don´t trust the accuracy of my physical exam skills... because that´s all i have here. in our lab we can´t check to see if her blood shows signs of infection. we can´t do a chest X-Ray. so only my hands, ears, eyes, mind and her mother´s description told me that she has pneumonia.
hopefully, it will be responsive to high doses of Amoxicillin. not the best choice for pneumonia, but again... all we have. i try not to think of the 2 babies i admitted to the hospital in Ecuador with pneumonia who had been treated with Amoxicillin at a different hospital for 7 days before... and had gotten worse. just pray that the LORD will make up for all we lack and bring healing to her little body.

Belén

Some more thoughts and commentary on where i work every day.
Belén means "Bethlehem" and yesterday as i was appalled by the filth and trash and smells and sights, i kept thinking about how a place like this could be called Bethlehem... Bethlehem, that lovely place we think of where Jesus was born, a quaint little town with full inns and a cozy stable with a rustic, straw-filled manger where our Savior, the King of Heaven, was born... where noble wise men-kings and humble shepherds visited, where angels sang and a bright star shone overhead...
How is it that someone named this place Bethlehem?, i kept thinking.
however, as i´ve continued to reflect, Belén is the perfect name for this place, because Bethlehem, beyond our Christmas card images (which are more likely a product of Hallmark than reality), is the place all humanity associates with the miracle of Jesus´birth into this world. and that miracle, at it´s core is that Jesus, King of King and Lord of Lords, humbled Himself to become human so He could sympathize with our weaknesses, save us from our sinful, hopeless life and demonstrate His love for us in that while we were yet sinners, He died for us. and He lived among us - in all our filth and sin and poverty, both spiritual and physical.
"For you know the grace of our LORD Jesus Christ, that though He was rich, yet for your sake He became poor, so that you through His poverty might become rich." (II Corinthians 8:9)

(my taxi driver, Luis)

Hogar de Belén

that´s the name of the clinic where i´ll spend much of the next month. it means "Home of Belen". you can´t imagine (i´ll try to post pictures soon) how true this is. it is distinctly different than all the other buildings there. it is cement, white, clean, solid amidst (literally) a sea of filth, wooden shacks that float, despair and little that is sure or solid.
to get to work today i was picked up (they use one of my favorite verbs for this action - coger - which can mean to catch, to take, to get) by the doctor, Ronald. on his motorcycle. i climbed on behind him - i think that was the first time in my life to have ridden on a motorcycle. it was pretty fun, actually. and an adventure amidst the crazy traffic of mototaxi´s here. we made our way to the "top" of Belén ... where he left his motorcycle in a locked garage of sorts. then we descended the stairs to where the water begins. if you can call this water - it´s filth. sewage. grey and thick-looking. all manner of stuff floating in it. and scores of people everywhere. walking in it, canoeing around it in, living in shacks that float on it. and the ´water´is supposed to rise more this month. this same water is part of the Mighty Amazon.
our taxi to the clinic was a low-riding, wooden canoe. i got in trusting that it would hold all 3 of us - me, Ronald and our "driver" who was a boy of maybe 11 yrs. it did. and he rowed us through the water streets to the steps of the clinic, partly submerged. we pulled up, disembarked, and walked up the dry, solid steps.
a waiting room filled with people, a pharmacy/lab (which can do urine analysis and malaria blood tests, nada más = nothing more), 2 consultation rooms, a dining room where the children´s programs are held including lunch. there are a second and third floor which are being finished.
i saw close to 20 patients today. mostly on my own, consulting with Dr. Ronald when i wasn´t sure what to do or how to diagnose and treat without my usual tools of lab, X-ray, etc. the majority need more than medicine can offer them. so i gave a lot of vitamins, ibuprofen/tylenol, anti-parasite drugs and prayed. prayed for wisdom and understanding in spanish and of their lives. and prayed for food for them. for a day when they have a toilet in their house and clean water. for a day when they don´t have to live in filth. for them to at least be blessed by spending some time in the "Hogar de Belén", hoping they were able to find hope and light and peace there.
after afternoon devotions with the staff, we left. in a canoe, to the water´s edge, and then in a mototaxi to my clean, lovely hostal. the contrast is almost palpable.
i get to go back tomorrow. i can´t believe that this is actually my life. and i can´t believe Belén is actually theirs. i covet your prayers - for them, for me.

Iquitos

i arrived on March 1 at 7am. yes, that´s when i arrived. and praise the LORD, i was met by a lovely woman from Scripture Union named Rosi, the wife of an administrator with the organization named Carlos. i spent yesterday resting and meeting several other people and trying to sort out (have yet to figure out how to say that very useful phrase in spanish) my housing situation. we´re trying to find a family for me to live with. currently i´m staying in a room on the 4th floor of a clean, lovely hostel that looks out over the Amazon River. and costs about $7.50 a night.

To give you a word picture of Iquitos... (photos to come)

• people come here by boat or by plane.
• it´s a city of about 1 million people.
• the primary mode of transportation is in a mototaxi (half motorcycle with a seat behind for passengers and a little roof overhead)
• it´s ON the Amazon River
• there are "CyberCafe´s", lots of stores (all kinds - clothes, shoes, electronics, motorcycles, bread/food items/the usual junkfood selection and drinks shops) , major banks and government offices, a government hospital, a dozen hotels-hostals, some restaurants (including a 60´s style burger joint that appeals to the foriegners called Ari´s Burger) several squares, lots of churches, lots of people, lots of noise, lots of mototaxis, lots of heat. today, for about an hour, lots of rain.
  
• the top 3 reasons foreigners come here are... 1. Tourismo de la selva (jungle tours) 2. Tourismo sexual (no translation needed) 3. Tourismo de brujeria(tourism of witch craft)

So that´s where i´m working. More specifically, in an area of the city that i wrote about the last time i came here (Peru trip June 2004 with Zion Church) called Belén. I´ve recently learned in my study of spanish that Belén means Bethlehem. I´m still trying to sort out the spiritual implications of that.
I´m working in a new clinic in Bélen which wasn´t there in 2004. only the foundations. if you´d like to check out the website for Scripture Union Peru, it´s http://www.unionbiblicadelperu.com
search around a little to the Medical tab and if you can switch it to English, or if you can understand enough in Spanish, you can read about the clinic and the work going on here. The medical work is fairly new, as largely this organization helps children who have been abandoned by their parents or whose parents cannot afford to feed them or care for them. hard to imagine, i know.

using "we" instead of "i"

is the theme of the last 9 days. Julie and i (we) had a fantastic time together - seeing, doing, experiencing, talking, talking, talking, listening, eating, hiking, sleeping a little, and just enjoying a grand adventure. i was the primary communicator with anyone who speaks Spanish, and it took a few times to get used to asking questions with the "we" form of all the verbs. one of the hardest things for me in this new language is the conjugation of verbs, but it was a pleasure and delight to get used to using the "we" form for 9 days.
to give an overview of our travels:
Feb 19 julie finally arrived, 12 hours late after being diverted to Guayaquil, Ecuador due to thick cloud cover over Quito. Much rejoicing and a fairly quick turnaround to the bus that took us 5 hours south to Shell. arrived without incident. basically went to bed.
Feb 20-21 my last day on call. and a busy one. julie kept the camera all day and took many photos of me "in action" as well as was an excellent resource for a very complex medicine patient who came in at 2 am. she ended up in the ICU and i don´t know what happened to her yet. we basically didn´t sleep that night and i wrapped things up the next morning at the hospital (see photo - some of the people i worked with and my favorite patient, Darlen with her mom. Darlen was burned badly about 2 months ago and comes now for dressing changes. she sang songs for everyone including my favorite, "arriba doctorita!"). in the afternoon we went to a wildlife preserve and saw some jungle animals. great fun! (see photo of julie with rebecca the monkey on her head).

Feb 22-23 goodbye Shell and off to Baños, small city in Ecuador where i would want to live if i had to pick a place. Baños = Baths. as in thermal springs from "al dentro del volcán" (inside the volcano) which have been channeled into pools where people can go and soak. we went only for about 45 minutes (way too short) and paid $1 each for this fantastic experience. also around Baños we hiked, visited some INCREDIBLE waterfalls and soaked up this charming, quaint little town at the foot of majestic mountains. a highlight of Ecuador for me. (Photos: Pallon del diablo waterfalls, thermal baths at the foot of a waterfall and our dinner entertainment)

Feb 24 goodbye Ecuador... off to Perú. Landed in Lima(so nice to fly with a friend!) and were welcomed warmly by various Peruvians who helped us get to our lovely hotel. We both decided that this busy, loud city of 9 million people was NOT the highlight of the trip, but it served to allow us to travel on to the next adventure: Machu Picchu.

Feb 25-27 Cusco, the Sacred Valley and Machu Picchu. Not having known all that much about this wonder of the world, i was eager to go because it is renown the world over and especially in south america. and i´m here... so i should see it. well my tune has now changed after seeing it: Machu Picchu is a MUST SEE in this world. the price in money and time to get there is completely worth it. proabably the most incredible thing i´ve seen in my life. Julie and i had a grand adventure getting there, complete with multiple modes of transportation: plane to Cusco, little van to Otallantaytamba, train to Aguas Calientes, feet to Machu Picchu, bus back down the mountain. these pictures aren´t going to do it justice, but perhaps give you the itch to visit. it is steeped in history and mystery (and rain when we were there...). incredible, incredible... no tengo palabras sufficiente! (i don´t have sufficient words...) Photos: boarding the train, the mountains from inside the train, Aguas Calientes, Julie starting to ascend the steps to Machu Picchu which we started at 5am using our headlamps, and the ruins.

And that was the way i spent the last 9 days. Fantastic. Julie - thank you so much for coming to a different hemisphere and continent to encourage me and have a fantastic adventure! it was a JOY to spend such great time together in these amazing places.

what i do every day...

i thought after looking back over the last few posts that anyone reading really doesn't have any idea what i do on the days i'm not flying over the jungle, spending time in Makuma (which has been a total of 3.5 days out of this month, notable though they are...) or buying ridiculously cheap, delicious fruit/vegetables at the market. And at one point i had posted a synopsis of my day/night on call (called a "turno") but it has disappeared into the netherworlds of cyberspace and is not on the blog now... if anyone has seen this missing piece of my musings, please return it to it's home here.

So here's a typical day.
7:30 Devotions and Rounds at the hospital - in spanish, a summary of the patients and presentation of any new "ingreso's" (admissions) from the night. such presentations are done by the Intern (of which i am one) on call the night before.
8ish dressing changes on patients already admitted, assisting in surgery for the morning, or taking a spot in the ER to await patients that come in for more urgent issues.
i've spent most of my days in the ER.
some of the things i've seen -

• a lot of pregnant women who are starting to go into labor
• kids with vomiting/diarrhea/fever/cough/pneumonia who have often been brought in by their parents after 8+ days because they live so far away and can't afford to come in for every little bug their kid gets. often, too, these families from "al dentro" (literally, the inside but used when people are from the jungle) speak an indian/tribal language so getting the real story can be tricky or impossible. the other night i admitted 3 infants under the age of 4 months all with pneumonia and one with dehydration, all from "al dentro". they're all doing much better now and their mothers probably saved their lives by bringing them in when they did. much more time with pneumonia and dehydration could have been fatal.
• what else? snake bites. amazing that these are becoming fairly routine for me to handle in the ER. but true. i've seen at least 5 snake bite patients. i have yet, however, to see the snake that did the biting - apparantly sometimes people bring it in too.
• various skin infections.
• stomach pain.
• oh, and the one that i was woken up for at 3 am the other night: "i've had pain in my back and my neck and my arms for 10 years..." how long? (thinking my spanish was a bit shaky at 3am and i hand't heard correctly)... "10 years". and why did you decide to come in ahora? (now) ... i never got a good answer. on exam, he had no pain to any of my palpation and was able to function pretty well, so we gave this dear old man some IV pain medicine and told him to come back in a few hours for a more in-depth evaluation. he and his wife (also very cute) thanked us and went back out into the night.
• fever for a month/weakness/weight loss/pain all over... turned out to be malaria.

so that's what i've been seeing.
midday try to steal away for a quick lunch at home
5pm home, unless on call and then i stay until there are no more patients in the ER.

that's pretty much it. i have another call day monday-tuesday and then that's it. ... off to do a little traveling with dear friend JULIE who is coming tonight!!! and then to Peru. for one more month.

sick

so i've now joined the distinguished ranks of those who have endured sickness in foreign lands... and lived to tell about it.
sue - malaria in zambia
caron - typhoid fever in india
jen caye - some bad GI problem in india
daphne - i'm sure you've had something but i just don't know where or what
brook - same for you in zambia

well my bout started on friday as i was treking, tromping, slurpingthroughmud and hiking in rubber boots up a large, large mountain to get out of the jungle. led by our teenage guide who was being corralled into being our guide by his dad, dan and i made it after 6 hours of the aforementioned journey. wet, dirty - filthy, thirsty, hungry, sore, exhausted, we ended up on the closest thing to a road we had seen in hours. 6 to be exact.
so we found some beverages. and a waterfall. and later a river. and eventually a bus. and then another bus after waiting on the side of some road. which took us to 2 bridges we had to cross on foot over the raging Pastaza River. to another bus. to Shell. at midnight. we started at 9am.

so i fell into bed shaking after my hot shower (praise the LORD) and knew that my body was not well. the next day i was on call and tried desperately throughout the day to lay down for a little rest, but kept getting called. and lasted (barely) until about 11:30 pm when my housemates convinced me to own up to how horrible i was feeling and tell the doctor on call with me that i had a fever after 1g of Tylenol and 400mg of Ibuprofen... that i ached all over... that my cough was getting worse and i was feeling weak and dizzy. so i did. my blessed roommate Emily took my calls from Saturday night at 12 midnight until monday morning and i stayed in bed for about 36 hours.
they did all sorts of tests and have given me all sorts of medicines to "cover" whatever it is. not sure entirely, but i did have some intestinal parisites which are soon to be history after i take the second drug to de-worm myself. pleasant, isn't it?
Gracias a Dios, today i have returned to the Land of the Living. i'm praying i'll stay here for quite a while.

Makuma - otra vez

Makuma - again.
this time for 3 days. Dan (another hospital volunteer, a Radiographer from the UK) and i along with some other Ecuadorians were flown in to Makuma's airstrip on Wednesday last week. Upon our arrival, we met Alexandra (another HCJB volunteer from the UK, an engineer leading the water project there) and the Headlands as well as many other Makumans. that afternoon consisted of Alex assessing the status of the "minga" (the work day) and sorting out where Dan and I could best be put to work. We ended up at the "bodega" (a little shop that sells medicines and other items) helping 2 lovely Health Promoters learn to take blood pressures. it is hard enough teaching someone to take a blood pressure reading in english, let alone in Spanish! ... and then what is normal, why it is important to know, and what it can indicate in the whole picture of a person's health. Alex and Dan helped me, and we took turns all taking one person's blood pressure and hopefully getting the same result. they learned quickly and by the next day, Dan reported that they were all getting the same reading each time.

Health Promoters are amazing people - they are volunteers from their community who are being trained by a nurse practitioner or doctor to be more eyes/ears/hands/voices of health to those around them. the often act as nurses to 'triage' patients who may need more medical attention and are educators, in as much as they themselves are educated, on hygiene, nutrition and prevention of illness. Miriam, the nurse practitioner who has been working in this community for 20-some years, is back in the US for a few months, so i did not have the opportunity to work with her.

Screenings at the Colegio (high school more or less)...

• 36 youth.
• 4.5 hours.
• 4 really sick kids. (referred to the new doctor in the community)
• 32 others who don't drink enough water or eat sufficient food for their 30 minute to 2 hour walk to school every day, soccer game each afternoon and same walk home.
• and a marked difference between the children from clean-water communities and no-water-system communities.

i asked the same questions to each of these children all morning long, and with the exception of a gal with 10? days of fever and vomiting, a boy with 2 days of fever and bloody diarrhea, a gal with a nearly-infected decaying tooth, and one girl with some skin problem i didn't have a clue about ... the complaints each one had were: head ache and stomach ache. and after hearing that they only eat yuca (a potato-y type starch) and drink yuca or a bit of water but have few symptoms of parasites or other more serious reasons for either complaint, i gave the same 'prescription' to every one:
start drinking at least 6 cups of the clean water here at school every day
eat more/different than yuca for breakfast (if anything), lunch and dinner

after seeing all these children and making notes about where they live, if there is a water system there, their age and complaints, Alex and i spoke with the director of the Colegio. it was very encouraging to be able to report that the majority of the youth we saw were generally "healthy" - in that only a few were acutely ill... that the problems were not medical but rather environmental and habit-related. the kids from clean water communities are visibly (skin is without rash/bites from bathing in the river) healthier. they aren't used to drinking water because for ages, the water makes you sick if you drink it. she assured us that there ARE other natural or very cheap sources of food than yuca - but that many people just don't know how/what to cook differently so as to have protein in their diet. and that the families who have attended classes on nutrition have been able to make changes in their diet which still fit within their culture and environment.
i met the doctor later that evening and we spoke at length over these issues. he is newly graduated from medical school in columbia and is in Makuma for a year before starting his residency. he agreed that changing habits will effect the greatest change. i was encouraged that this new doctor was eager to educate and help this community grow in understanding how to take care of themselves and their future.

i'm very thankful for the opportunity to visit Makuma again. the people there are lovely.

one more note on the "minga" -
this is a work day for the water project... but not by 'paid workers' to install clean water to people's houses... it is a work day for the people who want water for their houses to get it there. there have been many mingas for this project and will be more. if you or someone from your family doesn't work on a minga day, your family owes $5. this is how the project is being accomplished. it's a fantastic approach to community development. the community really "owns" their system this way. no one has done it for them. by the sweat of their brow and the labor of their hands they will have clean water in their home.

(NOTE: picture is me in the tiny plane over the Pastaza River, i think.)

my first "turno"

In the States we call this "being on call". Well no matter how you call it, it usually involves a lot of hours at the hospital, not much sleep, and needing a day to recover afterward. I had no idea how I'd fare with this first "turno" in a different language, limited hospital resources and diseases/conditions I've never encountered in my brief medical experience.
The way it works here is that the interns (4th year medical students) see each patient first, evaluate them in the ER and then start deciding what needs to be done while consulting with the resident on call. It could also include being called in the middle of the night (la mitad de la noche) for emergency surgery or anything. I live close enough to the hospital that I go home and keep the phone beside my bed, half sleeping, expecting to be called. I'll have a total of 6 turnos, one of those coming next weekend both Saturday and Sunday.
So yesterday/last night, I had a steady stream of patients to evaluate (only about 5 from afternoon until 12:30 am)... and of course here all things take more time.
1. an 8 month old girl who had just had a seizure but was doing fine. Her mother kept saying they didn't have "plata" (money) to see the neurologist in Quito (5 hours and $5 by bus if the buses can get through the land-slide-prone road...). So we gave her some anti-seizure medication to start and insisted she return to the clinic next week.
2. a 45? year old man with sinusitis and a rough throat
3. a 15 year old gal with abdominal pain for 8 days and fever. No diarrhea, no vomiting, but no appetite. The 35+ man who was with her I discovered was her husband. I was just about to try to ask some more sensitive questions (how in Spanish I'm not sure yet...) when the resident came swooping in and got right to the point ... are you pregnant? The test that came back about an hour later revealed the answer: YES. And it showed she had a pretty bad urinary tract infection. They live "adentro" ... meaning in the jungle, more or less.
4. a 41 year old woman came in with her husband who knew nothing of her history because they've been separated, except that she was in the hospital in another city for 3 months with "sickness of her brain"... and that since then she doesn't talk normally, not much more than "yes/no/I can't/I don't know" . And earlier she had had an "ataque" (attack...) of some sort. This sketchy history was confounded by the odd physical findings - some weakness, confusion, and as I listened to her heart, it was very irregular and her oxygen saturation was low as well. She had an elevated white blood count indicating infection - but we don't know where. We ended up admitting her with our list of possibilities being very long. And this morning we still don't know what her difficulty is. We only have so many tests available here.
5. and at 12:00 midnight, an 11 year old boy was brought in by his dad because of leg pain for 2 hours. Dad was worried that he was going to get the same condition as his cousin who has a ? – a degenerative muscular or neurologic condition due to which he doesn't walk now. The boy was happy, strong, walked fine... and on a bit more questioning, he had been playing a lot of soccer lately. So I tried to explain 'growing pains' to this Ecuadorian man and assure him that his son was completely fine. We gave them some Tylenol anyway.

and no calls en la mitad de la noche.

to the jungle

i went on friday with a group of HCJB volunteers/workers to visit a community called Makuma. it was a community first inhabited by missionaries who found it a good place to land a small plane in the jungle and be near several Indian tribes. so we took a MAF (Mission Aviation Fellowship) plane seating 6 including the pilot 35 minutes by air over the jungle to Makuma and landed on a dirt airstrip. i have never been weighed before going on a plane. another new experience. (picture - the two planes coming and going from Makuma)

we spent the day meeting people in the community as well as the missionaries (Jim and Norma Headland) who have been there for 35 years. they are now involved with local members of the community in a massive translation project - translating the Bible from Spanish to Schuar. i was just fascinated by the process and deeply moved by their passion for providing the Word of God in a language the people can understand. Umbato, a man from the area who is the main translator, works tirelessly and shared with us his heart for this work. his hope and prayer is to live to see the completion of this work. the Headlands echo this same prayer, as they are in their 60's and forsee another 10+ years of this project. they are also praying for people to join and continue this work alongside of them in the days ahead.



we learned of the need for health care workers there, as their nurse practitioner has left for several months and there is no doctor nor rural intern available. i am hopeful to have the chance to return there for a few days to do some basic health checks and evaluate if patients need care at the hospital in Shell. if so, this would mean they are taken there by air.
there is also an impressive water project going on lead by an HCJB staff named Alexandra and several of the members of the community. clean water is something i will never again take for granted.

Bienvenidos a Ecuador...

(Welcome to ecuador) i arrived safe, sound and very weary on Tuesday afternoon and stayed at a guest house in Quito with HCJB World Radio's ministry base here. lovely people - the riemers - took good care of me and i was able to rest and regroup for the trip south to the jungle. Quito is very modern, busy, big, has no beans or tortillas to speak of, and is set in the Andes at about 9,000 feet. Beautiful but a very different feel from Guatemala. (picture above taken from the plane flying into quito)
On Wednesday, another medical student in her 4th year, Emily, from Indianapolis joined me in navigating the bus on the 7 hr. trip from Quito to Shell (which usually takes 5 h.). The LORD provided a way through a strike 2 days before and a landslide across the ONE road going from Quito to all points south and we made it after a long, long day of travel. the picture is from inside the bus, through the window, of the car in front of us going past the landslide.









my first few hours in shell included getting some groceries at the market for $2.80 and another $.54 for my 4 eggs (in a plastic bag) and 4 rolls. thank you renae for the "Extra Bag!" i take it everywhere now. i settled into my new house for the month with Emily and Elizabeth who is from Ohio who has been here for 5 months working as a nurse-aid/nurse/youth worker and is hoping to go to medical school this fall.
i have my own bedroom and a great bed, a desk and a window that looks out to jungle-ish plants and some houses in the town. a rooster wakes me up every morning at about 3-3:30 am and yet i usually fall back asleep to the rain pouring down. it rains about 6-10 times a day, sometimes a downpour. we cook our own food and have an american-type kitchen with most of the needed utensils and bowls/pans/etc. it's really not hard to live there aside from the occaisonal unwanted guest. like today, i encountered a spider the size of my palm (legs and all) when i opened the door to leave. not my favorite. elizabeth killed it. then i went to work.

the last days in guatemala...

were bittersweet. excitement about moving on toward the next adventure ... but reluctance to leave the dear people in guatemala and things that had become familiar. the weekend prior to leaving, i went with the group to Tikal... a place of mystery and history of the Mayan people. i was amazed by the ruins of these people's temples of worship and their ability to construct such structures having none of the equipment or "technology" we have today. (see if you can find me in the picture!) amazing indeed. it turned out to be a relaxing weekend and i returned to antigua with the group Sunday night to prepare to leave monday noon for guatemala city.


on monday in the morning, i went to a clinic in Chimaltenango (about 40 minutes from antigua) that is aided by my father's regional church organization (the Baltimore Presbytery). Ronaldo and his wife work at the clinic and showed me around and introduced me to various others who work there. they explained the different works going on there - health care, health promotion in neighboring communities, education and leadership development for adults, and a psychology/counseling service. the whole morning was in Spanish, thus a good test of my ability to understand and ask questions. i fared pretty well. the picture is of the room that was built through funds from the baltimore presbytery. (escuela de teologia y tecnica - school of theology and technology)










i said good bye to my host family and to the gals i lived with (philly, carrie and becky - all PA students from UNMC... a lovely group of new friends) and went on my way to la capital (guate city) for an afternoon of rest and puttering around before my 6 am flight to Qutio, Ecuador. i met a Guatemalan friend named Josue there for a late lunch at a wonderful taco place (buena comida en guatemala!!!) and then spent the evening enjoying a bookstore, the Holiday Inn's small exercise room, the pool (outdoors, warm water, under the stars... all to myself... dreamy!) and a phone call to home. my flight left as scheduled and i was on my way to ecuador.
farewell guatemala - i hope to return someday very soon. three weeks was too short!

Carin and Christian

these two people have been dear, sweet blessings to me this week. i met carin outside of a coffee shop on saturday morning last weekend when i was in antigua by myself (without the group... but not alone). i asked her if she was waiting for someone and she told me she was adopting a boy from guatemala and was waiting for the social worker. on monday she and Christian, her 3 year old son, moved to antigua to wait for the necessary paper work to go through. so since wednesday (today is friday) i have seen her and Christian for an hour or so between my classes. i have heard her beautiful story of God´s work in her life and in the life of her family, been blessed to play with and hold her sweet boy, and enjoy learning about the process she has been through to give this beautiful child a home.
his story is that he was left on the street by his mother or father when just a few days old. he was found and taken to an orphanage in Guatemala City where he has lived for the first 3 years of his life. he will soon be going to his new home near minneapolis, mn to join his new family.

... for He sets the lonely in families ...

what a beautiful picture of this promise.