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

Prayer Requests

Here is a "prayer card" for the month ahead:

Prayer Requests

Kate Venable & Julie Fletcher

Hospitals of Hope, Cochabamba

Bolivia -- July 2007

http://www.katevenable.blogspot.com

www.hospitalsofhope.org

• The LORD’s protection
• Willing hearts to serve
• Eyes to see where the LORD is leading, how to serve
• Skill in language
• Unity among believers there, volunteers, Julie and me
• Opportunities to share the gospel
• Continued growth in medical skills
• Encouragement to the Scripture Union missionaries in Iquitos, Peru we will visit (July 2-5)
• That God would be glorified
• Leading and direction for long-term medical missions

we fly out on Sunday, July 1 and return July 27.
I'M SO EXCITED!!!!!!!!!!!!!!!!!!!!!!!

off to Bolivia

seeing as it's about time for my monthly post... i thought i would introduce the next adventure i am blessed and so thankful to anticipate.
i will be going to Bolivia, for the month of July, with my dear friend and colleague, Julie, where we will be working in Hospital of Hope near Cochabamba. the website for it is: http://www.hospitalsofhope.org
i/we will be trying to keep up with some posting during the trip. i don't know what internet access will be, as the hospital is in a rural area. i'll post some prayer requests before i leave.
thanks! i'm so excited...

more on noah

so my little wee nephew has his own website, for anyone who would like to see oodles more pictures of the cuteness! :) i'll get to see him in person tomorrow and for the weekend. so exciting!

a visit with dear old friends

here are some pictures from 2 weekends ago when Brook, Renae and Joie blessed me with a weekend visit to Peoria! thanks again, dear friends. it was such a gift to have you here. come again soon.... and anyone else - visitors are always welcome!

introducing...

Noah Elias Venable
birth day March 24 to Stephen and Karli
my first nephew!

restoring order

i think there's reason that order does the soul good. and the body as well. and today - my home. the LORD is a God of order and not of chaos and we're made in His image.
it's hard to appreciate the newly created order without seeing the previous chaos, but here are some pix to prove that the floor exists in my office... and that my nook where i had hoped to spend time reading the Word actually works... and that the nightstand from Dad and Judy (for Christmas) brings much needed order to my bedroom.

Tis the Season...

well it's high time that i post something, or so i've been hearing from various sources. So i thought i'd add to the blog some festive photos (renae, i actually thought of spelling photos "fotos" to go with "festive"...).

i recently had a Christmas party for my department (Internal Medicine/Pediatrics Combined Residency Program) - residents, families, staff, attendings, even some students who are interested in our program. there were about 30-40 people there throughout the evening. i loved it! an answer to prayer for the use of my home.

i wish you all be here with me in my little home. Caron came this week, with Annabelle and Violet. What a treat that was!! Thank you for coming, girls.



i hope the season is a blessed one for all. Immanuel, God with us. Praise the LORD.

a day in the life...

as i have reflected on my day, i realized - what i've seen and done and heard and felt today is rather amazing, and not a "normal" job.
i stood at a 67 year old man's bedside for almost 2 hours, telling the nurse what to do to keep his blood pressure up, his heart rate down and try to get his heart into a normal, safe rhythm, what medicine and fluid to administer, what tests we needed to order, which bodily fluids we needed to send to the lab for cultures, and what antibiotic to start to keep the infection i was suspicious of from making him any sicker. and he's doing ok now.
i pulled a tube out of a woman's side/chest wall where it had been placed to treat a pneumothorax (when air gets into the space around your lung and the tube sucks it out).
i walked in to my other patient's room to find the floor covered with her bodily fluids (and solids). and then i walked out again.
i watched and listened (and prayed) as my attending doctor told a patient that she has advanced lung cancer, already spread to multiple sites in her body.
and this is what i do every day. what a crazy life! and i love it.

i want to be like Cliff

when i'm 75 (and hopefully sooner...) i want to be like Cliff. I met him last weekend through a friend of a fellow resident who goes to church with Cliff. he took 5 of us girls sailing for an afternoon on the illinois river/lake peoria in his 24 foot sailboat, giving each of us a chance to steer, sharing about sailing, kayaking (he does that too), his faith and his experience of the LORD Jesus in His life. i hope i get to spend more time around this active, youthful, wonderful, joy-filled, godly, reminds-me-of-my-grandfather-ly man. thank you, Cliff!

seeds

so i've had a little box called "Basil Mini Pot" for years. maybe 3, 4 years... ever intending to actually open it and plant the seeds and grow my own basil. i've moved it from my first apartment in Omaha (on Cass) to the Glen Arlo and then to Julie's house... it somehow made it through the nearly 2 years at Julie's house and became a part of the many boxes that joined me here in my own, new house in Peoria, Illinois. it was unpacked, put on my kitchen counter, and left there for me to see daily for several weeks. one day last week i was seized with "i must just plant these stupid seeds!" and stop toting them around from house to house.
skeptical that these small seeds in a plastic packet would actually grow now, after 3 or 4 years, i followed the instructions, put them in their "Mini Pot" and left them on my window sill.

AND THEY GREW!!! little sprouts, pushing up soil, still able to spring to life after years in a plastic packet - without nourishment, light, attention, soil, water... their potential remained.
this gives me hope somehow. that seeds planted in my soul, and not attended for a while, are still capable of growing and bringing forth life with even the smallest amount of overdue attention. may it be!

the transformation

here are some pix of the new look on the inside of my house... enjoy. (sorry about the arrangement of the photos)

a new look

so the blog has a new look! ... for a new season, a new state, a new town, a new job, and all of the news that goes along with such. and just because. sometimes we need things to be changed around, spruced up. so here it is.

my first day of school...

or rather, residency!!
"Hello, I'm Dr. Venable" is getting more and more easy to say after the first few days. at first i kept thinking - i feel like i'm pretending to be my grandfather. but i'm wearing the long coat and the pager and the name badge that says "Katherine Venable, M.D." I've been working with/watching a dermatologist named Dr. Swaminathan for these first 2 weeks, i had my first clinic this morning where i see my "own" patients. My first call night will be next friday, when i work in the hospital and actually admit patients who are sick enough to need inpatient hospital care. that will be a little scary, but i'm looking forward to it. this is such a privilege!

some pictures from the last few weeks

Lou Karre, M.A. in Counseling! from Covenant Theological Seminary. Congratulations, Lou. i'm so proud of you!!! me, Jen Allen and Lou here after her ceremony.






a beautiful, enchanting child at Bethany Beach, DE where i spent memorial day weekend.







Amazon Hope II - in the Baltimore Harbor on a publicity tour, on it's way to Iquitos, ETA July 2006.







Me and my almost-90-year-old Grandma Peg at cousin Jacob's wedding. She's super cool - just returned from a 3 week trip to Germany to visit my aunt.

washing Sammy the cat. though Julie got a bit of a bath as well...

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.