Guatemala Day 6: Last day of surgeries

Today is our last day of surgeries and I'm going to miss the routine. You kind of get attached to the patients here as they are so trusting and so grateful. When you walk by their beds, they reach out and say "gracias" over and over.

The connection between doctor, nurse and patient is not the same here as it is the US. Back home, the doctors say very few patients would thank them after they just had a hernia operation or a vaginal hysterectomy. But in Guatemala it’s different. They don’t take medical care or our work for granted. They see it as a gift.

SEEING THE BIG PICTURE

“All of you want to do more and you want the people to have more,” Karen Prevatt, our pastor said, during our morning devotional time.

And Karen’s right. We want to give the Guatemalans the same opportunities and level of care that we can provide our patients in the United States.

Our dentist wishes she could save permanent teeth with root canals and other treatments, some of the doctors wish their patients could have follow up treatments with radiation or physical therapy, and our auditory team wishes they had an assortment of hearing aids so they could help more people in their area.

Not being able to give our patients everything we wish is frustrating, but on Thursday, Karen reminded us that we don’t always get to see the big picture.

“You may feel like you are only doing something small, but you may not see the complete effect of your work,” she said.

She reminded us even though we want to do so much more that each day we were making a difference ---not just for the patient, but their family and everyone who knew them.

MAKING THE ROUNDS

Every morning as soon as we arrive at the hospital, the doctors (along with their translators) make their rounds through the wards to see how their patients are doing.

Our children’s area was full today, and the one parent who was allowed to stay with each child overnight looked exhausted. We couldn't afford to feed them as we only had enough food for the patients, but they could sleep in the chair beside the child’s bed to comfort them throughout the night.

Most of them will be going home today including 8-year-old Daniela who had her tonsils out. Devona would also be going home. In her 40s, she had her gallbladder removed and her teenage daughter had been staying by her side while she recovered in the ward.

“I feel much better,” she said. “The doctor is wonderful. Thank you.”

Her doctor was Dr. Richard Bland. Before he left her side that morning, she wanted a photo to remember him. She grabbed his hand tightly and smiled big. She was just so happy.

Heber, a 22-year-old, was also doing well. He had a severe hearing problem and had come in with his older brother the day before.

“Our parents are dead so I take care of him,” said Heber’s brother. “He was hit by a car when he was 4 and after that he couldn’t hear.”

Heber and his brother

Jodi Bova tested his hearing on Wednesday and found he had some fluid behind his eardrum. Rather than sending him home with a hearing aid, the doctors decided to try draining the water. The operation worked. On Thursday we found his hearing had improved so much that he no longer required a hearing aid.

The change in Heber was incredible. During Wednesday’s consultation, he didn’t say a word and relied on his brother to do all the talking. In fact, I wasn't sure he could talk. Today though, he was talking with his brother and asking our translator questions.

Even with the language barrier, we have bonded with both our Guatemalan patients and the hospital staff. Using hand gestures and a combination of the few English words they know and the few Spanish words we’ve picked up while there, we listen as they tell us about their children and families, and we do the same. Somehow we understand each other and are able to share.

THE NUMBERS SAY IT ALL

Over the past six days, we have become the masters of flexibility –whether it was overcoming the issue of having no water (on Thursday we again had water problems - making it 4 days in a row) or accommodating patients who showed up hours, even days, later than their scheduled appointments due to transportation issues.

We also had a number of unscheduled patients. As word spread throughout the region that we were there, families returned with friends, neighbors and relatives hoping for a chance to see our doctors for various treatments.

We tried to accommodate as many as possible in our already tight schedule, and in addition to the scheduled surgeries, we saw over 50 walk-ins over the week. Dr. Maggie Arner and Dr. Mark Hoeplinger were able to help all these extra people with their basic family physician needs.

In Guatemala, nothing runs like clockwork and we’ve accepted you have to take things as they come. And now, just as it seems we had figured out how to do everything, we were finishing up the last of our scheduled surgeries and getting ready to pack everything up. Tomorrow we would be taking the bus to Antigua.

That night we had an amazing meal at Romeo’s restaurant. Romeo had been preparing meals for our team all week and just like our lunches had been wonderful, so was the food that night. It ranged from a beef dish, to rice and pasta dishes, to traditional Guatemalan salads and vegetables, to these incredible desserts. It was a buffet none of us would forget.

What was also incredible was hearing the final number of how many people we had helped that week.

•Audiology did 125 consultants and gave out 42 hearing aids over the week

•Dental saw 95 patients and completed 582 procedures

•Triage patients seen but not scheduled for surgery: EMT- 91, GYN -18, GEN -13

•The GYN team did 18 surgeries and 24 procedures

•The GEN team did 24 surgeries

•The EMT team did 24 surgeries and 26 procedures

In total we did 66 surgeries and performed 74 procedures. If we include all the triage patients, we affected over 300 people and their families over the course of the week. In other words, as a team WE ROCK !

“Our original work in this region was designed to be surgeries, but it turned out to be much more,” said Dr. Ray Maddox, our team leader. "I thank you for the contributions you made."

Guatemala Day 5: Hump day or Spadadzio

On the bus going to the hospital

Every morning I wake up before 5 a.m. and get ready for our day. It’s still dark outside as my roommate and I walk across the hostel grounds to the place where we have our 5:30 a.m. devotionals and at first it seemed really early...and really strange.

Now things are familiar. There’s that rooster that crows every morning in the distance, the occasional screech from a peacock, and our group gathering in our area and whispering in hushed tones as we pour our morning coffee or tea. It's starting to feel comfortable and even we were talking about how far we had come as a team in such a short time.

“Yesterday went much smoother than the day before. We now know what to do and how to work together,” said Dr. Surendra Sharma from Palm Springs.

Karen Prevatt told us this is because we are “spadadzio”, which means we eagerly push through no matter what comes our way.

"Last night I looked up and saw a big spider over Wanda Kay's bed. We expected the hotel to send up a big man to get the big spider, but instead they sent up up this little woman with a broom," said Karen during the devotional.

She told us this woman was determined to get that spider down. You have to keep in mind, that our rooms at the hostel don't have your average 8-foot ceilings. They must be close to 20-feet high. But that didn't stop this woman. She threw that broom up to the ceiling and eventually was able to get the spider down.

"That woman had spadadzio...and so do you," said Karen. "Where there's a will there's a way and you will find that way."

NO WATER; NO PROBLEM

The fire truck

We needed to be super spadadzio on Wednesday because as soon as we arrived, we discovered we didn’t have water -- again. But we were getting used to this. It was the third day in a row so we knew what to do. We called the fire department at 8 a.m. to bring their tank, but they couldn’t get there until 10:30 a.m. Of course, by now we knew this really meant 11ish, so we improvised.

“The instruments were sterilized last night and we can use our drinking water to scrub up. This way we can do the first two cases,” said RN Liz Pascual.

In the meantime, it was time for the doctors to do their rounds. The little boy with the tumor in his cheek who had to undergo emergency surgery the day before was doing fine. Dr. Mark Hoeplinger even thought the swelling looked a little less severe, which was good news. And our translator who had surgery on his nose was also doing well and would be going home.

Edgar was doing fine after his surgery

“Yesterday I was dizzy and was in Wonderland afterwards, but today I feel wonderful,” said Edgar. "Brad, Char and Dr. Mark totally changed my life."

The other patients were also doing fine and many of them were allowed to leave the hospital that morning including 75-year-old Andres.

He was a sweet man - and very passionate. He grabbed my hand as I walked past his bed and wouldn’t let go. Over and over he repeated, “Gracias, gracias, gracias. I pray for you. I pray for you.”

Apparently, the doctors had removed a hernia from him the day before. He said it used to pulse pain and now it was gone.

AS GOOD AS IT GETS

Andres was so happy his hernia was gone.

The first couple of patients in audiology that morning were in their 80s. Eulogio was 84-years-old and had come with his son. He had not had hearing in his left ear for the last 15 years and had only some hearing his right ear. Jodi and her team fitted him with a hearing aid and the transformation was instant.

It was amazing to see him go from non-responsive to responding to our instructions and talking directly to us. You could see the confidence return to his eyes. And he no longer had to look at his son for confirmation or guidance. He was independent again.

The second patient was the oldest patient of the week. His name was Isodoro and he was 89-years-old. He had hearing loss in both ears. At first Jodi was worried that the hearing aid they had on hand would be too loud, but he was lucky. It worked fine and we had another happy Guatemalan.

But Jodi did wish she could do more and provide better hearing aids.

“Because we only have one type of hearing aid, I can’t adjust the low and high frequencies. I can only make things louder,” Jodi said.

The hearing aids we have for the Guatemalans are analog systems and are great for poverty areas. They are durable and don’t require batteries as they are solar powered. However, they are not custom made and only work for certain types of hearing loss.

“They are one-size-fits-all so sometimes, if the fit isn’t right, they will rub and the person could get a sore in their ear,” said Jodi.

We want to do so much for these people, but we can only give them what we have available. It’s just so hard to accept that this is as good as going to get when you know back home there are many other options available.

THE LONG AND WINDING ROAD

Many of the patients we saw this week came a long way to have their operations done. They had met with one of the Faith in Practice doctors on the village team and then waited until we arrived. Nusli, a 21-year-old school teacher, lives on the other side of the country and traveled 15 hours to get here.

“We came with nine people. I stayed here with Nusli, but the others when on to Antigua,” said Nusli’s mother.

Nusli had her tonsils out and it was taking a while to heal. But even with the pain, they don’t regret their decision to come.

“We definitely would do this again. We were very happy to come here even if it was a long way,” said Nusli’s mother. “Faith in Practice has been wonderful. They have helped so many people.”

Each day we laugh at the lack of air conditioning in the wards, how it doesn't consistently work in the operating rooms and the way we always seem to have some sort of water problem.

Then there was the time we ran out of oxygen because the emergency alarm on the tank wasn't working. Here at the hospital the oxygen tanks are older and haven't been serviced. We also don't have the luxury of having AE Techs on hand to handle technical problems. Thankfully, we had CRNA Christian Cleveland-Peck, aka McGyver. on the team who was able to get everything sorted out.

"We wouldn't be doing all theat we are doing, if it wasn't for what he was doing," said Dr. Maggie Arner.

But even with all these flaws in the system, our hospital was pretty good when compared to Guatemalan standards.

"The public and national hospitals are much worse," said Joanna, our Faith in Practice coordinator.

ON A SAD NOTE

Our team of 31 all came to Guatemala to help people, so when we discovered a situation where we couldn’t, it was disappointing. It wasn’t just heartbreaking for us, but for the patients who had come so far to see us. They had arrived with hope, thinking if anyone can help them it would be us.

Every day audiology had to deal with heart breaking moments like this.

“Yesterday we told one woman we couldn’t help her daughter, she was so upset and didn’t want to accept the news,” said Susana. “It’s so hard giving out news like that.”

The woman’s daughter was 5 years old and had been deaf since birth. The hearing aids we had to offer had no affect on her at all, but the team was determined to give her mother some hope. They spent the afternoon calling around to see if they could find a place that could do a cochlear implant.

“The woman came back today to thank us. She gave us photos of her daughter and brought bananas and limes,” Susana said. “It was so touching that she came all the way back just to thank us.”

You can size of the mass compared to her rib cage.

Dr. Bland had a similar heartbreaking situation. His 25-year-old patient had a massive tumor that expanded from her breast and had spread up over her shoulder. The tumor was so large, it extended close to 6 inches out from the side of her rib cage. He suspected it was cancer, but even if it wasn't, the tumor was so large and intricate that it would be impossible to remove.

All he could do was take a biopsy to confirm the diagnosis.

“In the US, we may have been able to shrink it a bit with chemo and radiation to help prolong her life, but here she doesn’t have that option,” Richard said.

Guatemala Day 4: The Gratitude of the People

The longer I am here the more I learn about our patients’ lives and the role Faith in Practice plays in them. They are starting to recognize me as I walk by and as I sit by them, they try to talk to me using gestures.  Something they give up and just laugh and hug me. I swear, if I do another mission, I'm going to learn more Spanish so I can really communicate with them.

While Monday had a number of obstacles ranging from the lack of water to no air conditioning in the operating rooms (it was really hot in there), it was the gratitude of the people kept the team going.

The first gynecology surgery of the day was one of these times. Petrona, 65, was the cutest little old woman you had ever seen. And I'm not exaggerating when I say little. She was less than 5-feet tall and weighed only 43 kg (95 pounds). She would be getting a vaginal hysterectomy and was shivering from nerves and the cold air in the operating room, but that didn’t stop her from smiling away and giggling.

She had the best smile. At first she didn't want me to take her photo as she didn't have her teeth in, but then she posed for me.  Having no teeth, made her even cuter.

Petrona told me (via a translator) she worked as a maid and this was her second time getting surgery through Faith in Practice. The first time was a few years ago and she said back then she was scared, but she was so delighted at the outcome that she was much more comfortable going into this surgery.

Petrona couldn't read or write so her signature is her fingerprint

Her positive attitude was contagious – especially as she kept making little remarks and laughing. For example, to check to see if her spinal anesthesia was working, we asked if she could feel her feet.

“Yes,” Petrona said. The doctors all paused for just a second. If the spinal AE was working, she should be feeling nothing.

Then she followed with the punchline. “They are sleeping," she said.

She was so cute, you just wanted to hug her.

GRATITUDE AND LOVE

All of the patients at the hospital were nervous before their operations, but they were so grateful to have our team there to help then. Maria Hernadez had come from Totonicapan which was three hours away to have her gallbladder removed. Her surgery was on Monday and she was looking forward to going home the next day.

Juan had a tumer in his cheek.

“I started having pain two years ago, so now it’s good to have it gone,” said Maria Hernadez-Cox via our translator, Ines. “It’s very good to have you and your doctors here. You are good people.”

The father of a 6-year-old boy named Antello had similar things to say. His son had a tumor removed from his pelvic area the day before and was recovery.

“The doctors and the hospital are excellent. We received lots of attention and my son is doing well. He’s in no pain,” said Antello’s father.

Antello and his father had come from Peten which was 15 hours away. They said they had seen a Faith in Practice doctor in the villages who told them to come here for the operation. Because they don’t have a car, they had to take the bus to Antigua and then catch a ride with a friend of a friend. The long ride was worth it as they would not have been able to get the tumor removed where they lived.

One of Guatemalan translators, 16-year-old Edgar, was also going into surgery to fix his broken nose. He said he was thankful the team was here, even though he was a little nervous.

“I’m freaking out right now, but I’m glad I’m getting it done,” said Edgar. “I get nose bleeds and have some nasal problems.”

Edgar said when he spoke to the doctors, they gave him a choice about whether or not he should do the surgery. He thought about it and decided to go ahead with it.

“The doctors here are the most amazing people I have ever met,” said Edgar.

Edgar’s mom said she’s glad he’s getting the operation.

“I want to thank you for everything you and your friends have done for us. Gracias.”

The parents of 6-year-old Juan agree. Their son had a tumor on his cheek. It had been removed one time before, but grew back so we removed it again on Monday. The boy's face was swollen and he was in a little pain, but still the family was thankful.

Impromtu prayer when Juan had to go into surgery a second time.

“We are glad we came here from Totonicapan. We can’t believe how good the experience has been. The doctors have been wonderful,” said Juan’s father.

Sadly, Juan’s cheek swelled up more during the day and we had to quickly re-operate on him. Our pastor Karen Prevatt prayed with the family outside the operating room while they wept.

It was so sad. This little boy had already found a special place in my heart. I could only imagine what it would be like to have to surrender your 6-year-old to strangers who didn't speak your language.
“We are glad you are here to help us,” said Juan’s father later on.

THE THREE P’S OF DENTISTRY

Not everyone loves to see the dentist and that goes for people living in Guatemala. Lydia, 14, says even though she’s getting a cleaning and doesn’t have any cavities, she’s scared and will be relieved when it’s over. Believe it or not, this was the first time she’s ever had her teeth cleaned.

Christian, 12, was the dental patient before her. He had six teeth removed, which was the most extractions our dentist has to do on one person during this trip. Thankfully, they were all baby teeth. She had his permanent teeth still looked healthy.

“It’s good for him to get this. Now he won’t have any more cavities,” his mother said.

Dentist Christine Heoplinger said all of her patients on this trip are in the 6th grade. She said she is seeing more decay in kids their age on than she would have expected, and much more than the average 12 to 14 year old child in the US.

“It’s not their hygiene. It’s more of a dietary problem. They chew a lot of sugar cane, drink coke and sodas and eat other sugary foods that are causing the decay,” Christine said.

The reason all her patients are all young is because after they finish the 6th grade they are no longer eligible for the dental program. It’s not a Faith in Practice rule, but a Guatemalan government rule. So because of the time constraints and the number of kids to see, Christine is focusing on the 3 P’s of dentistry: Pain, permanent teeth and prevention. However, she wishes she could do much more.

“It would be nice to be able to do some root canals on some of the molars. There is so much that could be done to help them if we had the time and the resources to do it,” said Christine.

THE POWER OF SOUND

“I am profoundly thankful for this group. I will pray God watches over all of you while you do your work. I will also pray for your families. Mucho gracias, gracias, gracias.”

Words like these could be heard over and over throughout the hospital, but these particular ones came from 76-year-old Francisco after Jodi Bova and her team helped improve his hearing with a hearing aid. Being in the auditory room is incredible as you are can see the patients' faces light up when they can hear sound again. They literally go from expressionless to big smiles.

We sometimes forget the impact hearing has in our lives, but that afternoon 82-year-old Julia reminded us. She had not been hearing well for over 23 years. Her sister told us that when we gave her the hearing aid, she was crying she was so happy. Apparently, when her hearing went, she had stopped being social and had lived the last two decades sitting in the corner.

“Her sister told me Julia was so happy yesterday when could hear again. She can go to church now. She can go to the market and barter. She can go by herself and ask what the prices are,” said Susana.

Another overjoyed man told the group that now he could be his own man. Instead of relying on someone else’s ears, his boss could give orders directly to him.

All day long, I heard amazing stories like these.

LOVE IN ACTION

Tuesday was a good day. We did 22 procedures including removing a massive hernia from a man in his 60s. Before the operation his scrotum was approximately 12 inches long and included his large bowel and momentum (the fat that covers the intestines). It was incredible to watch Dr. Richard Bland and his team remove it and repair the damage. I could have watched the surgeries all day long.

While all the operations went well, the day wasn’t without its obstacles. The air conditioning stopped working in some of the operating rooms and by mid-afternoon the surgeons were working in what felt like a sauna. Their scrubs were wet with perspiration, but they never slowed down -- until we ran out of water.

Yup, that's right. For the second day in a row, we didn't have water for a couple hours. This time the problem was human-error. Apparently, the hospital tank's automatic valve system was broken and the staff had to manually open and close it. They forgot to open it.

"It was a hectic day. We worked from 7:30 a.m. until 7:00 p.m. with only a 15 minute lunch. Once, I went out to use the restroom between surgeries and was stopped by someone asking a question. By the time I got back in the operating room, the patient was already on the table and I was scrambling to get the instruments on the tray," said RN Char Schumann.

Don't believe for a minute that these obstacles stopped us. All the hard work and sweat we put in everyday was worth it. The people of Guatemala were so open with their gratitude, it was almost overwhelming. But at the same time they were praising us for our work, we were also thankful for them as they were changing us in their own way. They were love in action.

Our CRNA Christian Cleveland-Peck summed up this up over dinner when he recalled a simple gesture he had witnessed.

“Remember that little old woman from the morning? When we were walking her down the hall for surgery, she passed her husband. She took her false teeth out of her mouth and gave them to her husband who put them in his pocket without hestitation. Now that’s love,” said Christian.

You can call me 'Gringa'

The best part of my Guatemala trip so far has got to be the kids. As soon as they see me they start chanting, “Gringa, Gringa, Gringa!” and then they run over and swarm me with hugs.

Of course, after that they start blabbering away in Spanish and I have no idea what they are saying.

I try to tell them I don’t speak Spanish, but they don’t care. They keep asking “Gringa” questions, but all I hear is “Gringa, blah blah blah blah blah?”

So I bring out my camera to distract them. They hop up and down, shout a little cheer and start posing.

They LOVE getting their photos taken. Really, really, really love it.

I swear, I must have 50 photos of the group of little kids I found playing in this structure behind the hospital. They are hilarious. I have to take a photo and then show it to them. Then they all run over and look through the viewer.

Then, it’s “Gringa, photo, photo!”

Ha! Now they are speaking my language.

 

Guatemala Day 3: Watching a real-live operation

This little boy would let go of his dad.

The vibe on Monday was completely different from the day before. The team was focused on pre-op, surgeries and post-op and it felt like a real hospital. We were geared up and ready to work and there was no time to waste. We had planned to do 16 to 20 operations a day so the schedule was tight.

I got to wear my scrubs for the first time as I would be going into the operating room today. I thought I had picked out ones that would allow me to blend with the surgical team, but apparently I bought very fashion-forward ones (even though they were on sale) as everyone kept commenting on them. My scrubs even became the talk of the dental lab.

Oh well, I can't deny that I am a bit of a fashionista, but back to the mission.

As I walked down the hallway, every family I met looked apprehensive as they waited quietly for their surgery time, and some of the kids were hanging onto their parent’s legs, afraid of what was to come. They would still smile when I greeted them, but it faded quickly and was replaced with worry. However, they weren't the only ones apprehensive. Today would be the first day we would be working as a team and I wasn't the only one who would be in role that were far removed from what we did in back home.

Me in the operating room.

"I'm usually not in the operating room," said RN Mary Sanchez from South Carolina. "I work in intensive care so this is very different for me. I have to remember to stay clear of the sterile field and count the sponges. In intensive care, I know it so well, I can react automatically in an emergency situation. Here, it's not like that."

By 8 a.m. the first patients were being prepped in the pre-op room, but it turned out their wait was going to be a little longer than planned as all of the facets in the hospital were spewing out nothing by air.

Surprise! We had no water. Not even a drop.

“We can’t perform surgeries without water. We can’t scrub up before or wash our equipment,” Dr. Ray Maddox, our team leader said.

The team weighed our options. Should we postpone the surgeries? Should we use our limited drinking water for scrubbing? Finally, after much running around, the fire department came to our rescue and used their truck to fill up our tank. Apparently a tree had fallen and obstructed the flow of water between San Filippe and the hospital. They had to cut around the tree to free the stream.

We breathed a sigh of relief. We may have been behind schedule, but we were back to helping people.

RIGHT ON TRACK

The lack of water didn’t stop audiology from seeing their patients and they were quickly moving through their list. Each person who came in to see them had a story, including their oldest patient of the day.

Patient explaining that an animal went in his ear years ago.

“An animal went into my ear 30 years ago and, after that, I couldn’t hear,” said the 84-year-old man. “I was working at a coffee plantation at the time and it took them a long time to get it out."

He was adorable. If he heard the test beep loud and clear, he raised his hand high, but if it was quiet, he would show us the universal “little bit” sign using his thumb and forefinger.

Our CCCA, Jodi Bova, set him up with a hearing aid and you never saw a brighter smile. He thanked us over and over and gave everyone on the team a big hug.

But not all stories had a happy ending. Five-year-old Angel was born premature and had never spoken. Because he couldn’t understand the instructions, our pastor Karen Prevatt taught him to put a plastic ball into a container every time he heard the sound.

At first we thought perhaps he was hearing something as there were times when Jodi would play the sound and he would drop the ball in the container. Each time, he would make a little proud smile. But our hope was soon dashed when we placed a hearing aid on him.

“Unfortunately, in this case the hearing aid showed no improved response. We didn’t think he would benefit from it,” Jodi said.

It’s always hard to give out bad news, but the team was able to provide the parents with some other options such as the number for the local deaf school. It wasn't much, but it gave the mother some hope for her son's future.

SAVED BY THE GLOVE AND THE UTERUS THAT GREW…AND GREW…AND GREW

Meanwhile, back in surgery another obstacle had crept up.

The glove that saved us.

In the United States, the camera lens used in laposcoptic surgeries such as gallbladders comes sterilized.

It turns out that’s not the case in Guatemala, and the surgeons didn’t feel comfortable having a non-sterilized piece of equipment on the operating table. Instead of risking contamination, they needed a solution – and they needed it quickly.

CRNA Christian Cleveland-Peck came to the rescue, pulling what we fondly refer to as a “McGyver” move.

“To keep everything sterile, he cut out the finger of a rubber glove and ran the lens through it,” said Dr. Cathy Sims. “It was so simple and it worked!”

The 8 lb uterus the doctors removed. Amazing.

As the team quickly set up for their first surgery, over in Operating Room #1, Dr. Gordon Graham, Dr. Surendra Sharma, RN Pat Egerton and RN Mary Shanchez were busy pulling off their own brilliant moves. Their 39-year-old patient had come to the hospital with an enlarged uterus.

“I can’t believe the pain this woman must have been living in,” Mary said. “When he removes it, she will wake up feeling like a new person.”

Mary was right. This poor woman’s uterus had grown to the size of a small watermelon and she looked like she was 30 weeks pregnant. When removed, it weighed 8-pounds and had multiple tumors growing out of it.

“It’s one of the biggest ones I’ve removed,” said Gordon. “In the US, we would have most likely caught it much earlier so it wouldn’t have grown to such a massive size.”

It WAS the biggest one I had ever seen.  This was the first surgery I had ever witnessed and I found the whole experence amazing.  I swear, if I would have seen what I saw today when I was 17 and making career decisions, I would have been a surgeon.  I loved watching them work.

FROM DAWN TO DARK

Monday was the first of many long days. It began in the dark at 5:30 a.m. with devotion lead by Karen and continued long after the sun set. Some of us were able to get back to the hotel by 6:30 p.m., but a few members, including CRNFA Jennifer Curran in recovery, were there until 8:30 p.m. making sure all the patients spending the night were stabilized.

"One little boy asked me if I was going to stay and have a party with him. He was having so much fun at the hospital," said Jen.

All areas in the hospital were non-stop busy including the dental area where Dr. Christine Hoeplinger and a dentist from Guatemala were seeing 14 patients a day.

There was only so much they can do this week so Christine and her team are focused on cleanings, fluoride treatments, fillings and sealants.

“We don’t have all the equipment here to save the teeth. I’d love to be able to do other treatments, but I can't,” Christine said.

In total, we completed 18 surgeries on Monday. They included abdominal hysterectomies, vaginal hysterectomies, cystocele-rectocle repair, myomectomy, herniaplasty, laparoscoptic cholecystectomy, bilateral sphenoildatomy, removing tumors, frenulectomy and tonsillectomies.

These, along with the patients we met, became the talk of the day. We added them all to our list of miracles – including the massive uterus and the rubber glove. They may not be traditional miracles, but they certainly weren’t something you see every day.

Guatemala Day 2: Day of Triage

More than 150 people showed up at the hospital on Sunday to meet with the doctors. I wasn't sure when they arrived, but when we arrived at 7:30 a.m. they had already filled the waiting room and were lined up down the driveway and out onto the grass. But there was no pushing or chaos. Instead they waited patiently and greeted us with happy "Good mornings" in Spanish.

Seeing all these people and their expectant faces got me a little worried.  How in world were the 30 of us going to pull this off in this old hospital?  I didn't even know how helpful I was even going to be.  I didn't speak Spanish and had absolutely no medical skills, but here I was and these people were looking at me with such hope in their eyes.

It was going to be a busy day. The doctors would be scheduling 60 to 65 surgeries to complete over the next four days and our goal was meet all 150 patients who were waiting on Sunday. In addition to the triage, other people on the team were setting up the operating rooms, the pharmacy and the recovery areas.

Before going out, our team leader Dr. Ray Maddox gave some important advice.

“We are all practicing outside our comfort zone… in a third world county and in a different hospital,” said Ray. “We need to be flexible and roll with the punches.”

ONE BY ONE

The advice was well heeded. By 8:30 a.m., the air was already humid and the waiting room was starting to heat up from all the bodies. For those of you who have lived in Texas, imagine that humidity in a room filled with a hundred people. We were hot, hot, hot.

Then the triage began.

“Claudia Lopez!” called out the nurse.

The waiting Guatemalans shouted the name to those in the back of the room who relayed it out to those waiting on the grass, driveway and sidewalk. Before long, Claudia could be seen weaving her way through the crowd, and our work had officially begun.

My role was to help Dr. Gordon Graham in gynecology by escorting in the patients and trying to make the women feel comfortable during their exams. Our first patient of the day was Erika.

Speaking very little Spanish (really, I speak practically none), I couldn’t understand what they were saying, but I could understand the tears and the sadness as her mother explained her symptoms. Erika has been born with a tube around her uterus and had a half developed arm. She now had to go through another surgery and she was afraid.

“I don’t want to do a surgery, but I will do it,” said Erika.

As I led Erika and her mom to the anesthesiology department after the evaluation, I could tell they were a little shell-shocked. Erika would be undergoing her surgery the next day.

Our next patient was a 58-year-old woman with cancer, who greeted me with a kiss on the cheek (so cute that they do this even when meeting you the first time). After her evaluation Dr. Graham told her she would need abdominal hysterectomy.

“Can I take other medication instead?” Francesca asked.

Like Erika, she was scared and was hoping the doctor would recommend something easier. You can’t blame them for being frightened. Unlike in the US, where you may have a few weeks to prepare for surgery, some of them have only 24 hours. Plus, immediately after hearing the diagnosis, they have to decide whether or not they want to go through with it. If they decide no, they may have to wait months before they have the chance to see the doctor again – and by then it could be too late.

But there was another complication to Francesca’s case that the doctor couldn’t fix.



Ezmereld's mom burst into tears when we gave her bus fare to return.

 “We can do what we can for her here, but they may not be able to get her the radiation she needs after the treatment,” said Gordon. “We can only hope there is no microscopic spread.”

Many Guatemalans, like Francesca’s family are poor. While they know they need the medical help, they can’t afford the trip to the national hospital for the follow up.

Similar of heart-breaking stories were happening in general triage area where Dr. Richard Bland and Dr. Surendra Sharma were evaluating their patients. While many of the patients they had seen that day were hernia and gallbladder cases, Richard told me there was one unusual case -- the woman had a large mass that started under her armpit, encompassed her shoulder and was moving into the clavicle area.

“Sometimes there is nothing we can do here,” said Richard. “She had waited too long before seeing a doctor. All we can do is a biopsy to confirm the diagnosis.”

Other cases were less severe and there were times when the patients chose not to have the surgery at all. One 65-year-old man who had a hernia did just that. After speaking with the doctor, he decided his pain was minor compared to having to through a surgery. He opted to wait a few months to see if got worse.

TEARS, FEARS AND OTHER CASES

Over in EMT, Dr. Mark Hoeplinger, medical student Brad Oriel and RN Char Schumann were busy evaluating their cases.

“We had lots of tonsils, a few broken noses and one case where a little boy had a tumor on his cheek,” Char said.

They were also checking ears for possible hearing loss which seemed to be one of the common problems in the country.

“A lot of times, the people in Guatemala have some hearing loss caused by ear infections that weren’t treated. In some cases, the infection grows and the membrane ruptures,” said Char.

Char said another reason for the increased number of cases was that they have been using unpurified water to clean their ears. While they had good intentions and thought the water would get rid of the infection, the bacteria in the water, actually helped it grow.

But bad water was only one issue.

“We have seen a few people with cotton in their ears. Their ears were most likely hurting, so they put it in and left it there,” said Char. “In many cases, they just need to be educated on what they should do.”

There was one little girl that touched us all.

Her name was Ezmeralda and her family had traveled 80 km to see the doctor. Dr. Hoeplinger tried to clean out her ears in order to check her hearing, but she needed to come back a second day to complete the treatment. She was also malnurished as the family couldn't afford food.

“She’s had a lifelong ear problems and she’s currently draining pus so we want her to come back,” said Mark. “We can give her drops today and do the rest on Tuesday.”

Unfortunately, the family didn't have the 56 quetzals to return (roughly $7 USD). They had used all their money just to get there for today's appointment.

Touched by the little girl and the poverty problem of the her family, the doctor gave them the money. The girl’s mother burst into tears, thanking the group over and over. She hugged us all, and yes, I was holding back the tears.



For them, this little gesture of caring was a miracle.

CAN YOU HEAR ME NOW?

More miracles were happening in the audiology area, which was run by Jodi Bova, Susana Wilson and Karen Prevatt, our pastor. One of their patients was a 14-year-old girl. Her mother told us they first noticed she had a hearing problem when she was 6.

“She answered the phone and said no one was there, but her brother was on the line,” said the girl’s mother via Susana who was translating. “We told her brother to shout really loud and she still heard nothing.”

Jodi placed the headphones on the girl. Then we waited in silence for the girl to respond. We watched as she raised her arm to some of the sounds and did nothing through others. It turned out the girl had no usable hearing in her left ear, but the good news was she did have some hearing in her right ear – making her a good candidate for a hearing aid.

“This was good news. It’s very sad if we have to turn them away,” said Susana. “We had two out of the 16 we saw today where we couldn’t help .”

While helping everyone is rewarding, the audiology group did say they had one incredibly happy moment in the morning.

“We had a 2-year-old boy who had hearing loss. Because he couldn't hear the instructions, we came up with a way for him to test his hearing by putting a plastic piece into a container every time he heard the beep,” Jodi said.
They were able to fit him with a hearing aid and for the first time he was able to hear his mother’s voice.

We left the clinic around 6 p.m. feeling exhausted, but satisfied.

We now had our roster of patients. Tomorrow the surgeries will begin.

Guatamala Day 1: A long day of travel, but worth it

We arrived in Guatemala City in shifts. When I say "we", I mean myself and 30 other people from across the US who had volunteered to work on a weeklong surgical mission in Guatemala.

I know it sounds crazy that I'm using my vacation to work in a third world country, but this was something I've always wanted to do, and finally the dream was coming true -  I was going down as the surgical team's historian.

Some of the team had come the day before, but many of us left on Friday night via the red eye and met at the airport on Saturday afternoon. After traveling so many hours and landing in new country, it was nice to see all green Faith in Practice t-shirts. Suddenly, I knew wasn't not alone.

But my day of traveling wasn’t over yet. My team still had to take the bus from Guatemala City to the hospital outside of Retalhulea. This would my glimpse of the country I’d be living in for the next seven days.

During the four hour ride, the group got to know each other. Nervous and not sure what to expect, there were a number of us who were first timers to Faith in Practice.

I was glad to hear this as I was worried I would be the only out of their comfort zone.  If you've ever met me, then you know that unless I'm working out or cycling, I'm not exactly the casual-go-without-makeup type. I'm a true city-girl.

But at least I wasn't the only one new.

“I’ve wanted to do this for five years, but there never seemed to be a good time to go,” said Karla, a RN from Portland. “Finally, I just decided to do it.”
Each of the new people had their own reason for joining Faith in Practice, and each had found out about it different ways.

“My physician had gone on the trip and told me about it,” said Susana from Northern California. “I’m a retired social worker and I wondered if there something I could do on the trip.”

There certainly was something that Susana could do. Being fluent in Spanish, she’s one our team’s translation people. She assisted the doctors as they triage patients.

While Susane and Karla were a few of the new people, others were Faith in Practice veterans, such as Maggie. She has been on 14 or 15 trips and this was her third time with a surgical team.

“The last time I was at this location was for a clinic trip. We had people lined up out the door and down the hill,” Maggie said.

OUR FIRST VIEW OF THE HOSPITAL

My team arrived in Retalhulea around 8 p.m. Even though I was hot and tired from traveling, I was still excited to see the hospital I would be working in.

The hospital was old and not at all like the hospitals in North America. It was going to take a little fixing up before we would be able to take in patients. The hospital contained 70 beds for the patients and one of our first jobs in the morning would be to transform the rooms into pre-op and post-op rooms in preparation for the upcoming week.
“We are all very happy you will be working with us this week at the hospital,” said Sergio Lopez, he hospital administrator.

The whole staff was happy to see us and it showed in their faces. Hugs were exchanged with those whose faces they recognized, while the rest of us were greeted with warm smiles.

“Welcome all the new ones and a double welcome to those who have come back,” said Dr. Cesar Joaquin Barrios, Director of the hospital.

In addition to the hospital building was also an area where people could stay if they had come from far away and needed a place to stay before and after their surgery.

“We have room for 30 to 40 people,” Lopez said. “And they can have with them one family member.”

The operating rooms were recently remodeled with the help of Faith in Practice. But the pride of the hospital had to be the brand new dental clinic which was also set up with the help of Faith in Practice.

It contained two dental chairs and could be used to do both evaluations and restorative dentistry. It is also air conditioned which was going to come in handy – they expected 100 patients on Sunday from a nearby school.

I looked around and knew we had a lot of work set out for us in the next week. But the team was ready to take on anything. And how could we not be?

The people were so gracious and so glad that we had come. Their smiles were enough to make the miles between us disappear.

“Welcome. You are the like the light for our people,” said the hospital’s supervisor. See? How could you not want to help?

Jazzed up in Tracy

You know how you should never judge a book by its cover? Well…you should never judge a town by its news coverage.

Working in the media for years, whenever I drive by a new city or an area, the first thing that pops in my head will be “oh, that’s where that fire happened” or “oh, that’s where they found so-and-so.” You know how it is…every place has a story.

So when I had to visit a friend in Tracy, the story that popped in my head was, “The unidentified blue lights of Tracy.” Not that there’s anything wrong with UFOs. They are cool, but I was wondering what else I was going to find there.

My first stop was Helm’s Ale House where they make these incredible pan-fried garlic bread thingies. Yes, that’s correct – the bread is pan-fried and it’s really good. There is also enough garlic on them to scare away any vampires in a hundred mile radius – but I do recommend them.

Helm’s (named after the owner) opened just over a year ago, is family-owned and has excellent service. I have no idea how many ales they have on the menu, but the assortment seemed pretty good and Helm also makes a couple of specialty ale cocktails that are worth a try.

After dinner, the next stop was The Main Street Jazz Café, which is really located on Central Street – not Main. This place is a hidden gem. Maybe it’s not so hidden to those that live in the area, but for a Midtown-grid girl like me, I had no idea this wonderful place existed.

Run by a father and son, I’m going to describe it as a coffee shop/wine bistro as you can get both there. It's filled with comfy sofas, warm mood lighting and intimate little rooms, so the café is like hanging out in someone’s living room – if you happen to know someone who is very cool and has great taste in decor. Plus, they actually do have live jazz and blues bands playing every night. Yay!! Love live music.

The Main Street Jazz Café is also  great place to chill and relax, and the jazz, in case you were wondering, is fantastic.

So will I be going back to Tracy anytime soon? Definitely!!