Wednesday, April 15, 2015

Nursey Stuff

Well... we have had a very busy 3 surgical days at the hospital.  Monday we had 2 sweet ladies with open cholecystectomies (gall bladders), a bilateral inguinal hernia repair,  and something else I can't remember already.  There is another nurse and I that work the pre-op/recovery room/post-op area.   We basically get the patient from off the OR table, take him to our room, and look after them til they go home or stay overnight.  Today we moved 2 more beds into an already full 4 bed ward.  At one point we had 7 VERY FRESH post-op patients in there.  We started out with a 2 year old circumcision who screamed for pretty much 3 hours, then 4 year old Maria-- inguinal hernia repair who was the sweetest girl ever!  She cried for about 20 seconds once, and while they were putting her under.  Then we moved onto Fabricio, the brave 6 year old with an undescended testicle.  I got a kiss from him when he went home.  Then we also did 2 more inguinal hernia repairs, 2 more gallbladders, and an umbilical hernia repair. I don't know where they are all getting these hernias, but they all seem to want to ride home on a motorbike on 4x4 roads.

All this with a manual BP cuff, since our automatic vitals machine died half way through the day.  No ECG monitoring and one patient who came to us with an airway still in place.  Made for busy times. 3 spinals and 5 general anaesthetics.

My feet are tired, but my heart is full.

Other interesting nursing moments for you nurse types:
- one pair of nasal prongs is all that exists for O2 which comes in a big tank that we haul to whichever bedside needs it (nothing piped in, no suction equipment at the bedside).  I guess everyone has to share nasal germs or go without.  Rewashed our one oxygen mask today.
- the post-op infection rate is really low here considering all that goes on, and MRSA- what's that?
- tomorrow we are doing a colonostomy reversal.  I don't know if it's this guy or someone from last year, but ostomy supplies aren't in abundant supply here, and he basically carries around a Walmart plastic bag to drain his ostomy into.  You can imagine how life changing this surgery could be for someone like this!!
- We made a deal with the anaesthetist to give us some vials of Morphina because 60mg of Ketorolac (ouch kidneys!) and Tylenol are what they basically use post-op for even big hernia repairs. At home they could be on a epidural or PCA for a few days.  So I carry some ampoules in my pocket all day for when we need to use it.  No saline to dilute anything so we just pull it out of the IV "bags"/boxes that we have to cut the tip off to open.
- no handwashing audits here, none of the sinks, if you can find one, have soap.  Hand sanitizer!!
- Privacy?
- the patients can get surgery here but it costs about $1000 and no one can afford it, so they are living with these things often for years.  We charge $40 or something like that so that they can feel responsible but also respected and cared for.  Some will wait til next year when the team returns.
- the first day when we asked for new sheets to change the bed it seemed like we were asking for their first born.  There was visible blood on the bed.

Today was a more calm pace and I ended being trucked home early this afternoon due to a wonderful case of Montezuma's.  I got to nap and enjoy the pool briefly which was much needed.

We had a potential ruptured appendix that came last night and we hydrated and antibiotic-ed overnight so he could be operated on today.  Giving 3 hours in the OR, in case of complications, possible resection or whatever, they went in found an abscess that popped pus everywhere, no appendix in sight, put in a drain and closed him up in 45 minutes (sorry Dawn and Erin if you are reading).  He is lucky 19 year old!!  The family has a lot of spiritual stuff going on, witch doctors etc. that they have tried for the last 2 weeks before bringing him to us.  Our "chaplain" shared the Gospel with him and he gave his life to Jesus this morning and went into the OR with peace on his face, much different than last night.

Thanks for thinking and praying with me!  It's really rewarding to give care to people who are so grateful, hug you when they go home, and being able to pray with patients and love on them is a great experience! So thankful for our awesome translators that we will turn into nurses yet!

Prayer requests:
- they are showing the Jesus movie tonight in a nearby neighborhood and then next Wednesday we will show it in the town square so that will be cool
- to top off my day, I had a filling fall out today, so pray I don't get some mouth infection and die in South America. I was able to Skype Kevin and Erin and he phoned our dentist who said it should be OK.
- Doing more kids tomorrow, so that worries me since my peds. experience is so rusty
- some of the team changes on the weekend, some go home and a bunch of OB/Gyn types are coming next week.  Hysterectomies, fibroids, fistulas here we come.  And I really want to see some births!!
- my partner Cindy gets some relief from her allergies and some much needed sleep!

Quote of the day: "No worries about the neighbors trying to steal wifi, when they are crocodilias"

Monday, April 13, 2015

Day 1

Interesting moments/facts from Bolivia I've learned so far:
- it is the 2nd most poor country in the western hemisphere, 50% live in "extreme poverty" and 25% below the poverty line
- the Amboro nature reserve is one of the largest tracts of jungle preserved in South America, has over 900 species of birds, over 100 species of butterflies, more than all of Canada and the US in just 4300 sq. km
- kaka, coca, cocao, and cocoa are all very different things
- tapirs like to drink from the swimming pool
- one set of nasal prongs for oxygen can go a long way
- you can resterile suction tubing when you run out (on day 1)
- if you announce in church that you can have body parts removed, they will come...gall bladders, appendixes, lumps, bumps, lipomas galore ( we only remove when necessary)
-  they have some weird rules about shoes and lab coats in the hallways and in and out of sterile areas.  Had to buy $2 "Crocs" for ease of transferring footwear 100 times/day
- it's really good the AC works in the OR - I drank 3 litres today and only peed one (I know TMI)
- post-op patients in Canada get a lot more pain meds
- La Paz is one of the highest elevation cities in the world.  The airport is on a huge flat plateau that is surrounded by mountains and volcanoes of 22000 ft.
- children are well behaved.. I saw 3 children sit and play in one hallway/ bench for 8 hours without complaining
- planning to ride home for 2 hours on a motor bike with your sister and 3 children(f rom above) post inguinal hernia repair is NOT a good plan.  I made him stay the night :)
- these lovely people are so grateful for any help they can get.
- being told I love you by an ecstatic post op patient made my day  :)
- I'd like to learn more Spanish than the words for pee, poo, blood pressure, pain, nausea, sit up, lay down, bandage, tylenol
- fresh tangerines, pineapple, papayas, watermelon every morning is worth having breakfast at 6:30 am- well not quite but helps
- Working with such a great team who are so committed to serving the poor is very rewarding!  Who wants to come next time!!?

Sunday, April 12, 2015

Football

A few of us took a Sunday morning stroll down some side road.  There seemed to be a lot of action, mostly motor bikes/dirt bikes heading in the direction.  I saw the cleats suing over someone's shoulder and figured it out.  Back in the bush in the middle of nowhere was a soccer field and a boisterous game of football.  Red vs. yellow.  They had to dodge the odd chicken on the field, but definitely had some serious skill.  We watched for a bit and headed back for lunch.

We spent the afternoon unpacking and sorting about 16 suitcases that were full of some essential OR equipment and a lot of donated supplies.  A few of us spent some time setting up the OR and making sure the anaesethetic equipment was working, as well as the ECG and vitals monitoring equipment.  Stuff was divided up into pre-op, OR, post-op and outpatient supplies.  The docs spent some time doing consults to set up the schedule for the next few days.  Sounds like Monday is gall bladders.   Cindy from Wisconsin and I will be responsible to recover the patients and look after the post-op until we leave for the day and the local staff will take over for the night shift.  There is one surgeon here for a large number or people and the back log is severe, as well they do only more simple procedures.  We can't do any orthopedic cases because they don't have an x-ray machine.

Up at 0630 tomorrow, the internet is quite slow so don't know if I can post photos. 

We went to church this evening, and they asked the gringos to get up and sing.  What can you do?  You can't refuse!

Bolivia Day Zero

This morning after a good 10 hours of sleep, I feel rested and more ready to focus on coherent conversation.  The flight was long, Kelowna, Calgary, LA, Miami, La Paz, Santa Cruz, and then 2 hours by bus to our hotel.  I had 2 hour gaps between most flights, which was not restful, as I was randomly chosen twice for more screening, full body pat down, check my lap top, had to go out, change terminals, stand in line again, re-check baggage, get new boarding passes printed etc.  I had hoped to use my new Starbucks card my students gave me, but didn't even have time to do that in airport.  I arrived and was waved right through customs and the Americans took 2 more hours to come through because they need to have photos taken, get visas, and all our medical supplies and equipment amazingly passed through customs- about 8 large suitcases including medications.



Our hotel is lovely!!!  AC, wifi from some areas, hot water, they keep feeding us, and fresh squeezed orange juice.  Today we had a team meeting this morning.  I amazed at the dedication already of the on site Bolivia MMI team that sets everything up for our arrival.  They include a nurse with a masters degree, a female doctor, an optometrist, some translators, another physician, bus driver and some logistics team members.  And they all look about 30 years old!  So young and dedicated to helping their people receive medical care.

Our North American team consists of an OR nurse, an ICU nurse, an nurse anaesthetist, 3 general surgeons, 3 general helpers and me.   Dr. Matt is our team lead and is a bit ADD, totally hilarious, and can multi- task like nobody. Should be a great week!

Thursday, March 26, 2015

Sweet Sister Friends




I got a short and very sweet e-mail from an old friend today.  I had been thinking lately how crazy and busy everyone's life seems to be at this stage.  Aging parents, and busy career lives, growing teenagers with lives and schedules, and just the general worry of trying to keep everything going.  There have been too many days lately where I haven't been able to connect on a real deep level with those I hold dearest.  I miss the days of being home full time with pre-schoolers and having time for long chats beside the swing sets with girl friends.  So was thinking of the amazing women in my life and ones who I am so blessed to call friends.

This is re-post from an old one, girlfriends - you totally rock!
One of the problems is that some of them are too far away for my liking!!

So I think of the gifts of each one. The things they have taught me. How different we all are and yet so much the same. The ways that we change because of who we've known, and how they have touched our hearts. For those I have known for longer, I am amazed at the different paths and experiences that have changed who we are and where we have gone with our lives. The way God has directed each step...

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

My friend said to me that I am one she wants to know when we are old ladies. That is a great compliment, and so I send her funny old lady cards. She has the gift of inclusion! Everyone is her friend and she knows how to introduce everyone to her BEST friend. I have never met anyone with as much joy and enthusiasm, the ability to entertain a crowd, but draw in just one person into a deep conversation, that is a gift!

She is warm-hearted, consistent and even-keeled, even tempered - even with flaming red hair, always reliable and always caring. Athletic and beautiful, faithful in prayer and never ending in speaking clearly of God's promises and blessing, when they haven't always felt like they have been hers. She has a man just like mine and we understand that part of each other. She is like a sister to me.

She teaches me about being real and true to yourself at whatever the cost. To always say what matters and always ask the tough and deeper questions; to not be content with the same.  She's not afraid to stir the pot and make a difference.  She is about knowing Jesus even when it's hard or doesn't make sense. She is confident and assertive, and easy to talk to. She is creative and feminine and beautiful. We can always pick up right where we left off without a missing a beat, and she is ALWAYS up for a travel adventure!

And another one... my friend can do anything she sets her mind to. She is creative and full of love. She is confident in who she is and always fun to be with. She is a wonderful mother of 5 and the most faithful friend. She never complains, and always looks to the bright side. She can organize better than even I can. With every word that is spoken she has a whisper of encouragement to add. Every occasion is reason to celebrate and there are many. Her hands are skilled and her mind is sharp, but not after 9 pm. Her life is a gift to be shared with many; thankful I am one of them !!

She is a true gift. She who is soft spoken and adored by any who meet her, even though she thinks she is easily forgotten. Who could forget such a warm and loving person? Always a listening ear, a wise word, and strong cup of coffee. I see inside her quiet inner world and noisy outer world full of boys to a place of contentment in her soul. That spontaneous, wild adventurous side lurking beneath the phlegmatic is such a delightful contrast.

She stands full of grace and beauty. A quiet soul waiting to be discovered. She sees the world through a different lens. There are people that you wonder how they think, and where they possess such ideas and creativity. And thank God He made them, to show the world another kind of beauty and a reality apart from the everyday normal. She never says no to anyone she cares about and I wish she were my auntie.

Cook for a crowd of 100 - no problem, organize a list of 100 things - easy,  crack a sarcastic joke to make teenage boys howl - she's got it.  I love this one!  She is full of heart and helping others, staying focused and being a Mom to many.  She is a true gift and knows what her gifts are, treats her guys like kings and teaches them to be independent and fold their own laundry.  She has a true and sincere heart for serving and has her priorities right, and puts her actions ahead of her words...AND is the most fun in a small package!

So joyful to walk down life's road with you!

My heart is full.....


Wednesday, March 25, 2015

Yellow Fever and other details...

I am so glad I won't be contracting yellow fever and typhoid, but man I can hardly lift my arms today from the immunizations!   I got a bit of sympathy today from my students.  It will be all about details the next couples weeks, til I go.  Anyone who has a BP cuff of any kind they want to lend me would be great!  Also we are taking donations of small toys, school supplies, travel size toiletries, toothbrushes, or reading glasses if anyone feels like helping fill up my suitcase.

The team lead Dr. has been e-mailing me all kinds of information, so I'm getting super excited.  We will be doing a lot of general surgical cases, and also a lot of gyne stuff.  There are 3 general surgeons and 3 OB GYNs going, and a few medical students and 4 RNs and 4 LPNs.

So for you who like details, this is copied from my booklet:
The town we are going to... is one of the poorest counties in Bolivia. It has 25,000 people spread in the main town and other districts. The main activity is agriculture; they grow oranges, rice and cocoa. The land is mainly own by a few families and the rest of the people work for them. The county is also rich in sand and clay for the construction.

In this town (which we aren't supposed to mention on social media), there is one GP Physician per every 3,200 inhabitants. 3 Dentists for the whole population and 2 OB-GYN doctors attends all the calls of the county. There is also a General Surgeon and one Pediatrician. Ongoing prevention programs are not available and the number of preventable deceases is considerably growing. There is 1 Radiologist working half time. The MMI teams have been providing an answer to the backlog of surgical cases, and supplying the need for Dental services, Optometry and healthcare in general.

On this project and by the request of the Municipal Department of Health, we’ll continue to meet the needs for primary care in the surrounding communities, where the physicians get only once every month or less for some communities. Proving medicine to the patient is another way to assure the completion of the prescribed treatment and one of the strength of the project. The surgical component of the project will provide the patients with an opportunity to have access to a surgery in their own community and only contribute with $50.00 to $60.00 instead of $400.00 or more depending on the case; which makes the service impossible to buy for most of the people in the area.

Thursday, March 12, 2015

Finally!!! Bolivia Here I Come!

After lots of thinking and praying and internet searching for different organizations, and a real desire to go serve somewhere in a 3rd world country, I signed up to go on medical trip.  A lot of it had to do with timing, since I have a nice 3 week window in April.  So I applied at the beginning of February, kind of late on my part, and have been waiting.... and waiting....  With not much info. from them yet, and a few e-mails back and forth, and so-and-so is out of town and then the next so-and-so important person was out of town, and now finally today I got my package!  Yay!  I was getting kind of anxious as it in in 1 month!!  In my mind I had given them a deadline of Friday- tomorrow- to get back to me or my organized self was going to deem them incompetent and disorganized and could I trust that someone would pick me up from the airport?  Isn't it always amazing how we have to trust to the last minute.

Bolivia

So I am SUPER excited!!  I haven't really said much to many people, because I wasn't sure it was going to all come together.  I don't yet know exactly what I'm going to be doing, but nursey stuff.  We are going to be just NW of Santa Cruz on the map, elevation of 350m.

So I have appointments lined up for immunizations and booking flights tomorrow!  Hoping to maybe stop over in Dallas (Randi?)  because it looks like a lot of the flights route through there.

I will keep you posted!