Sunday, April 26, 2015

The Foothills of the Andes

Dear Bolivia,

You fill me up and break my heart all at once.  In your thick, green jungles you hold the secrets to joy and contentment, to true riches, and yet tear a hole in my heart.  We have tread lightly and quickly on you.... your red soil.  Come and loved and been so loved by you, and your people.  We are changed by your beauty and the depths of the heart in your people.

You leave us with an aching to be more, do more, create more.  People say we sacrifice by spending our time and our strength and our money, but it is you who sacrifice to open our eyes more fully.  To really see, to be awake, to leave behind the mundane and sameness that life can become.

People say that Westerners have won the lottery on life, that we just got lucky being born where we were, and that is so true.  And yet there is so much emptiness in the hearts here that your people seem to have found, richness that money can't fill.  And yet it's heart breaking to see the orange, fragile hair that comes with kwashiokor and the poverty behind the neatly swept yards and brick houses.  The medical problems that go untreated for years because of the lack.

So to say goodbye is what breaks me.  To not know when I will see you again and experience those real friendships and the lack of self centeredness among my other Bolivian and American servants who share in the same understanding - of the heights of the Andes and the spacious valleys of the Amazon basin, and the love of your people.

To my new and forever friends, thank you for sharing your gifts and your hearts together with me.  For being an inspiration by how you live your lives!  I will forever be changed.  To quote a friend on the trip, "I am truly the richest man alive".  I shall say woman - and I get to come back home to a family that amazes me!

Wednesday, April 22, 2015

Vanishing Grace

Some wonderful, grace filled random memories imprinted on my mind and heart:
  • holding a 4 minute old newborn baby yesterday
  • having some of our sweet patients from last week come back for their follow up visits and stop in to say hi. A sweet 9 year had surgery last week and her Mom was on the slate for today. She stayed around all day and became my little student nurse, making beds and watching us do everything and hugging every time we had a spare second. Then sitting with her Mom at while she woke up. She beamed when we told her what a good nurse she will be one day.
  • Little 8 month old Isaiah at the Nutrition Center next door (where kids with malnutrition go for supplemental care for as long as needed). He has a cleft palate and laughs and laughs with any type of attention and cries when you put him down. Those are some dedicated ladies that work there!
  • The heart of the Bolivian team here who work tirelessly to organize everything for when we come so that we can make best use of our time. I have never heard one of them complain once! And then they stay up all night swimming and laughing!
  • Having a shower with a frog
  • beach volleyball in the pool at night, even with the language barrier there is a lot of laughter
  • getting a smile and hug from so many patients who waited all day long, came from hours away, and sometimes didn't get fed
  • The amazing vision and impact of those who work with this organization long term have had
  • The willingness of the Bolivian night nurses to take on our patients with all kinds of things they have never heard of.
  • Last week I talked about sheets.... how quickly our standards change! After pre-opping 9 patients, caring for 5 left over from yesterday and then receiving 9 new post-ops, we ran out today and because of the rainfall the past 2 days, they couldn't dry the laundry. I don't think one person noticed that they had to lie in someone else's bed. At home that patient load would be covered by 5 RNs, so we are thankful for nothing too serious happening when we couldn't be as vigilant as we want
  • Holy hysterctomies! Gynecology (this week's surgeons speciality) is not my thing! Please just send me a gall bladder
  • One of the locals has a translator app. on his phone that you talk into and it instantly translates verbally and written- very cool
  • why did the chicken cross the road? Or the dog? Or some other creature

I have in my head been creating a post for a long while on why I am a Christian.  To the vast majority of people who haven't maybe grown up in a church, or had an experience with God, I don't know if it is fully understand why someone would choose that path.  Growing up in a Christian family doesn't necessarily mean you will continue to follow the way when you yourself are an adult, but does expose you to what it really means in many more ways when you have good examples in your parents.  The problem is most of us are pretty messed up in our own ways, and don't always give the best example to our own children or others about how to be a Christian, and that is one of the biggest criticisms I hear about the church is the hypocrisy of the people in it. And I can agree with that, everyone has their own story and is on their own journey and that is not to say there isn't a more “holy” standard of living we are aiming for. Nothing drives me more crazy than actions that are fake and not met behind with the right heart.

In a round about way that is kind of the whole point of the message though.  We are all messed up and need help, need something or someone bigger than ourselves to make it work for us.  Need Jesus to help us cross that divide between the natural and the holy.  And that is not saying that we can live however we want because we are forgiven later on because of it, but gives me freedom in CHOOSING to serve God, and love Him because I want to, because of all that He had given me, and filled in my own broken heart.  I am just blessed beyond measure in even being allowed to show Jesus to someone else, like in a mirror.

I have been reading the book "Vanishing Grace" by Phillip Yancey and it grabbed me from the first chapter because of the lack of hypocrisy in it, the total openness of his soul into what really is the Good News. I heard him speak and he is a nerdy guy with the worst hair ever and can easily laugh at it.   He talks about how to put aside all the rules that religions build up. Most religions have a set of rules or expectations to follow, that if you do such and such, you are a Muslim, and if the good deeds outweigh the bad you'll make it to heaven. Or Hinduism, if you live well enough, you will be reincarnated as something better next time around. Being a Christian is different because it is nothing about what we can do to get to heaven or make it, but all about what Jesus already did for us because he wants to just love us. That relationship with Him isn't a burden, but as they call it here liberacion. Freedom!

Grace seems to be vanishing from our world in a lot of places and in a lot ways that we treat each other, but I have seen an over abundance of it this week! ( who voluntarily does 5 - 13 hour shifts in a row? And then again the next week) Seen love in action, been blessed to work my butt off for people that can give you nothing back- except a whole lot of love and gratitude- but be way more fulfilled than an all-inclusive trip can give you (a lot more tired of course).  And maybe have some lasting impact on lives. Thankful that my big mess can be used in some small way.

Monday, April 20, 2015

You are Bolivian

     Onto a new week! We had a wonderful, somewhat restful weekend. We could choose to stay back at the hotel or go into Santa Cruz for shopping, dinner and airport pick-up/drop offs. I probably could have used the rest to stay and relax but can never pass up an opportunity to see stuff, get out with people and see a new city. Plus, there were a few things I really needed! I'm sort of falling apart. Forgot to pack underwear, so bought some right off the street in Santa Cruz yesterday, as well, I had a cavity fall out this week, so I'm really turning into a wreck!
     We started the day with a fabulous tour of a coffee plantation which despite the fact that I am a tea snob, I find the whole process fascinating, the smell intoxicating, the whole coffee culture I love, so it was really cool and the scenery phenomenal.
     We said a sad goodbye to 6 of our teammates at the airport. 5 of us are staying on for another week. Then we waited for a few hours for a large group of 15 OB/Gyn people all from the same hospital in Connecticut to clear customs with all their drugs, medical supplies and gear. Bolivia seems to give Americans as hard time, as I was waved through. I rode the “party bus” back from Santa Cruz last night with the Bolivians. The front window had tassels swinging across the windshield, and this nice pulsing strobe light and the same beat music. I slept across the back seats from midnight to 2 am back to the resort despite the Latin party music.
     The new group are super organized and a bit overwhelming, after our tight knit group we had last week. So a real shift in my mind. My Canadian phlegmatic attitude comes out even stronger because I am always a balancer - finding what is missing in a situation and taking that role whether in tasks or personality. If organization or leadership is needed, I can find myself there; if someone calm is needed, I fit there well. When I was sitting in the airport last night, I thought I could easily go home right now to my sweet family, but just need to really take some time to make that shift in my head to move forward, hard when there's a bit of fatigue setting in. I'm looking forward to another great week and having some more nurses to help in pre-op, recovery room, post-op.
     So I pray especially for peace and grace, real bonding with the new team members, and God to do some more miracles in the lives of our patients as well as the team as we serve Him and each other.
I got the best complement today from my new Bolivian friends, they said, “you are now Bolivian”. They love with such amazing servant hearts and open themselves up to new friendships. They are inspiring in their ability to work hard for the sake of their own country and serving in whatever way they can. So that was a real gift!
     I can't wait to have to get my buddy Ramiro (our translator) to translate words like uterus, vagina, cramps, panties :) Gyne is not really my area of expertise or interest, but loving these cute little ladies that I get to take care of is. I say little because they are all about 5 feet tall, and I am towering over them. And they all giggle when I tell them my name (which means pretty in Spanish). I'm sure they think I had some loco parents who named me.

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


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!