Thursday, February 22, 2018

At the hospital

More to be added later...

Heading home...

More to be added later
The Market in Antigua

Preparing to board in Guatemala City

Processional on the First Sunday of Lent

Colored Sawdust used to create mat

In February, as Lent approaches, the Jacaranda trees which are all around Antigua bloom. Their purple petals are royal in color and set the scene for the season. Antigua is known for it's processionals and on each Sunday in Lent, A processional will begin at a church on the edge of town and wind its way toward the site of the old cathedral at the City's Center. I was blessed to be in Antigua for the first such processional for 2018.  In preparation, large color designs made of flowers and/or colored sawdust, are placed along the route of the processional. 
Flowers are used for this mat

Those with banners lead the processional 
While the processional is still a ways away, young men with banners began to make their way down the street as the music from the band can be heard long before one sees the musicians.

The largest float with the suffering Jesus
As the processional approaches, priests swing censers filling the air with incense.  Immediately my head began to react to the smell and I realize why I could never be a Catholic or Orthodox or Buddhist priests (there's other reasons, but my allergies is at the top of the list). 

The floats are carried on the shoulders of men who wear purple robes.  Those who carry the float are exchanged each block.  As they slowly move forward, the float seems to rock back and forth. Time seems to appear to slow down as the float waddles down the street carried by local men.
The statue of Jesus carrying the cross provides a visual that goes well with the mournful sounds coming from the band.

The band follows the Jesus float, providing a mournful tune to encourage those who are a witness to the processional to reflect on their sins and on our human role in crucifying the Savior.

Following Jesus is a float of the blessed mother of the Savior, Mary.

I think these were statues of Mary and Joseph.

As soon as the processional passed, men were out with shovels and racks to clean up the streets. The vegetation and sawdust was tossed into a front-end loader who would dump the waste into the back of waiting pickup trucks. 

It was over in 30 minutes. Even though my head was clogged, it wouldn't have missed this experience.  It was also beautiful and mysterious.  

Story of San Pedro

Story to be added later
Statue of San Pedro
at the San Francisco Church

Tuesday, February 20, 2018

Wrapping Up our Week

Fuego puffing away on Friday afternoon
We returned to Jalapa after packing up in Monjas, where we enjoyed a hearty feast, our last group meal with everyone.  Each of the individual groups shared a story and everyone received   a certificate. It was a wonderful gathering. Most of us heading to bed early even though we’d been promised a whole half hour more sleep.  

Devotions on Friday morning, Day 8, came a little later, 6 AM (instead of 5:30 AM).  At breakfast, we were given a final count of those seen in each clinic and a total number of people. 

General Medical 743
Pediatrics 285
Audiology 125 with 35 hearing aids given
Gynecology 230
Cervix exams  154 exams with 10 abnormal referrals 
Dental 287
Wheel Chairs 64
Referrals 387

The referral number is especially gratifying as these are people who will be seen and hopefully provided with life-giving surgeries through Faith in Practice surgeons in Antigua. 

We were on the bus and ready to leave at 7:30 AM.  Soon we were heading west toward Guatemala City and Antigua. There were some talking but lots of sleeping. As we were coming through Guatemala City, we noticed that Fuego was active with large plumb of smoke belching from the top. For the rest of my time in country, the mountain would be smoking off and on. 

We arrived back in Antiqua around noon and checked into the Hotel Las Farolas, which is on the southwest side of the city with wonderful views of Fuego.  I headed out with the the pharmacy group for some shopping and lunch (I had curried vegetables).  In the evening, I headed out with a large number within our group to Epicure, for dinner.  A number in our group were leaving really early on Saturday, so everyone headed to bed early.  

Part of the Savannah-area contingent: John, Eric, Wilma,
Fernando, Joy, Howard, JJ , and me. 
On Saturday morning, those of us left had breakfast at the hotel and took some group photos.  I headed off after breakfast with the pharmacy group to visit a Farmacia.  We found one where I picked up some tooth paste as we compared prices with drugs in the United States. I was especially interested in knowing that I could buy a three pack of Lantaus pens (one of two kinds of insulin that I take) for 2300 Q or about $32.  That’s a little over $10 a pen without insurance. While I have to admit that this would be a lot of money on most Guatemalan wages, I still find it strange that even with my copay, I’m paying close to $20 a pen in the States (If I had to buy it without insurance, it would be closer to $100.  

As people began to leave, I walked over to Quiana de Las Fore’s, where I would be staying for the next few days.  A new group had flown in to do surgeries at the Herman’s Pedro (Brother Pedro) hospital.  These surgeries would come from those seen by “village teams” like ours, who refer candidates to the hospital.  The team was involved with their orientation/ , which gave me a lazy day to enjoy by the pool and the wonderful grounds at the Quiana de las Flores.

The farm included both enclosed and open growing areas.

Later in the morning, after I came back from the Quiana, a group of us headed off to an organic farm on the Southwestern side of Antigua. As it was Saturday, there were lots of vendors trying to sell their wares as well as a restaurant that served food from the gardens. The farm was irrigated and bountiful.  I purchased some more coffee and sampled a lot of food.  If I lived here, I'm sure I'd be a regular at this market.

 After a final lunch at Las Farolas, Louise, Marty and I took a cab with our suitcases over to the Quiana, where I spent the afternoon hanging out and enjoying their grounds.

Lazy time at "The Quiana"

On Saturday night, I went with a group to have dinner at San Domingo, a place we had visited during our tour of the city.  The dinner was wonderful.  By this time, most of my group had flown home with the exception of a few who were staying longer to enjoy a few days of rest in the city or to volunteer time to working at the hospital. There, at the hospital, I would witness the life-giving work of these surgeons over the next few days. 

Friday, February 16, 2018

Day 7 (second day in Monjas)

Dr. Colm meeting with Mynor (age 12) and his grandmother, Juana (age 59)

Hotel Puente Viejo
We’re staying at the Hotel Puente Viejo in Jalapa which is built around open courtyards in a manner that draws cool air throughout the building. In the afternoon, when it is warm outside, a cooling breeze can be felt in the stairwells and halls. Thanks to this convection of air, as I open the door this morning and step out of my room a little after 5 AM, I am treated to the wonderful smell of bacon whiffing up from the kitchen three stories below. I am sad to learn that there is no bacon at our breakfast but I’m pretty sure the eggs were fried in bacon grease.  We hold devotions at 5:30 AM, followed by a breakfast of fruit, pancakes, eggs, fried beans, and rolls.  

Loading Buses
At 7 AM, we load the buses for the trip over the mountain and into the wide valley upon in which Monjas sits.  At the school, we gather with all the local volunteers for a short prayer and then head out to work. Already a large crowd has gathered.  While those in triage begin their interviews, other providers wait for their first patients. I strike up a conversation with Dr. Mary, a gynecologist from the Mayo Clinic in Rochester, Minnesota, who tells me about a 58 year old woman she examined yesterday.  The woman had a mass in her breast.  Thankfully, with the use of ultrasound, she was able to determine the mass wasn’t cystic, but solid. This was not good. As the mass was almost 3 centimeters, it needs to be biopsied and probably removed. The woman could never afford the surgery, but they were able to arrange for her to travel to Antiqua where they will have it biopsied and then, if cancerous, removed. “Coming here, we get to see the other side of medicine which makes us appreciate what we take for granted at home,” Mary says.
Gynecology Team from left: local volunteer, Interpreter Fran,
Dr. Aileen, translator Mikki, Dr. Eric & Dr. Mary
Fran, a registered nurse and translator from New York State tells me of the women who come into the Gynecology Clinic.  Many are scared and have no understanding of what is happening to their bodies.  They are afraid of cancer. Yet, these are strong and brave women who just have so many difficulties in life. Although the birth rate is falling, many of the older women have had as many as 14 pregnancies.  One patient that came in yesterday had only one child, with severe birth defects. The mother had to care for the child full-time, but the father wanted more children.  Another women with 14 children, who lives with a lifetime of abuse, sought out certain wild plants known to end or prevent pregnancy. Her abusive husband then condemned her for being a bad woman.  It is culturally hard for these women and for the providers who come from other areas of the world and strive to provide care.  But there are good stories, too. The day before, a woman who had been married for several years without children was delighted to discover that she is pregnant.  

Dr. Eric and Interpreter Fran and Bertila
Bertila is the first patient this morning in the Gynecology Clinic.  A 58 year old woman who had four pregnancies and three children, she had paid 200 Q (about 30 dollars) for an ultrasound, which indicated a cyst. The doctor told her not to worry about it. Dr. Eric, a retired gynecologist from Minnesota and Georgia, decides to do another ultrasound and a pelvic exam to make sure everything is okay. He’s surprised to find a large ovarian cyst on her right ovary.  It needs to be removed. But first, Bertila must have her blood pressure under control.  With a reading of 195/112, she would be in danger from the anesthesia.  He prescribes blood pressure medicine and refers her for a hysterectomy in a couple months, after her blood pressure drops.  
Dr. Joe and Translator JJ discusses recommendations with Angel

In the general medicine clinic, Dr. Joe from Seattle is examining Angel, a 55 year old man who is complaining of pains and a burning sensation in his abdomen.  He had hernia surgery three years earlier and upon examination, it is discovered that he has another hernia.  While this would normally be a simple operation and he is referred to such a procedure, Angel has diabetes which, if not controlled, will complicate the surgery.    

Dr. Colm meeting with Martin and his daughter

Dr. Colm, from Savannah, is checking out Mynor, age 12, and his grandmother, Juana, age 59.  Both appeared to be in good health despite complaints from the grandmother of joint pain and some bruises.  Next is Maria, a 58 year old woman who has a large lump at the base of her neck. She is referred for a biopsy.  His next patient is Martin, an 87 year old man wearing a light brown cowboy hat, who is brought into the clinic by his daughter.  He has had prostrate issues and has been wearing a catheter for a year. Complicating his problems is his diabetes, which should be under control so they can safely address his other needs. 
Dr. Margaret examining Toribio 

Across the room, Dr. Margaret from California is visiting with Toribio, a well-dressed and very polite 38 year old man. He has had problems eating and have had a number of tests, but they haven’t found anything.  He said that last year, he was given medicine from a Faith in Practice team that was helpful.  She again prescribes medicine.  As she talks to him, she learns that he has volunteered before with Faith in Practice and hopes to do it again.  He lives in another town and took the bus here for today’s clinic. His home is in the hills where he has a small farm of 7 manzanas (roughly 12 acres) where he primarily raises coffee.  
Hector and Julissa
Hector and Julissa, two Faith and Practice team members have been working hard at each site to feed the 62 team members (staff, volunteers from the United States and guards).  Much of the food they provide is prepared in Antigua and frozen, but each day there are vegetables to prepare and guacamole to make.  For our group, he peals forty avocados a day just for the guacamole. By the end of the lunch, we’re scraping the bottom.  In addition to the food that Hector brought with him from Antigua, he buys locally the tortillas locally so that they’ll be fresh. In Monjas, a group of women have set up a kitchen behind the school where they prepare tortillas to sell to Hector, as well as providing food for the 50 local volunteers that are helping out with the clinic.  

While eating lunch, I talk to Dr. Aileen, a retired gynecologist from Florida. She tells about a woman of 17 who came into the clinic. She assumed right away that she was nine months pregnant.  She says she last menstruated three months ago, which doesn’t seen right.  Upon examination, they discover a huge fibroid of the uterus, which is very dangerous at this size and could easily rupture and cause death. They make an urgent referral for her to be seen in Antiqua for surgery, which may require a hysterectomy.  Even if they can remove the fibroid without a hysterectomy, she will still have a difficult pregnancy. Surgery can save her life.  
Martin repairing Louis' shoes

As the team blogger, I spend my days at the clinic walking around seeking stories and then retreating into the lab, which is rather quiet.  I set up in a corner, where I comb through my notes and write (using a keyboard and iPad) the stories that I have encountered.  While the lab is quiet, it provides an important work for the other clinics. Mardi and Louise (both from Georgia) spend their days taking blood glucose readings and doing pregnancy and urology tests. The two women obviously enjoy one another and interacting patients. Mardi assures me that she and Louise earn every penny they make, but that doesn’t stop her for advocating for a raise for Louise.  A raise would help Louise afford a new pair of shoes. Her sneakers blew apart earlier in the day and Mardi duct tape them together so that she can make it through the day. 

In the other corner of the Lab, Joy, who’s from Savannah, dispenses reading glasses. Those patients who need glasses are asked to read from a page with various sizes of text to determine which set of glasses would best fit their needs.  Joy is also our team photographer and banker.

John and Scott are our team leaders.  Scott, a pharmacist by training, leads the clinical service department at the University of Kentucky Medical Center. Unable to be a Carolina Tarheel, leading Faith in Practice mission trips is Scott's attempt to do penance for his shortcomings.  In addition to co-leading the team, he also helps pack all the drugs that will be dispensed by the ten village teams that Faith and Practice sends out during the winter and spring of the year.  John is our other leader.  As he is retired, he does a lot of the advance work for the team, beginning in May of each year.   John and his wife, Wilma, started volunteering on mission teams with Faith in Practice in 2003 and have been a part of 20 teams. John has led a team each year for the last eight. Although John isn’t fluent in Spanish, he knows enough of the language to do his job without an interpreter. Wilma is a retired paramedic, is fluent, and serves as interpreter in triage  John laughs, saying they recruited his wife first and he tagged along.  John and Scott are both excellent leaders and help get the job done without being overbearing.  
Local Volunteers after 4 successful days in the village

Wednesday, February 14, 2018

Day 6, Monjas Guatemala

While numbers is not the main measurement of Faith in Practice’s work in Guatemala, our Jalapa Mission Team lead by John Tysse and Scott Kincaid have racked up some incredible numbers. With two days of clinics in El Aguacate, we saw over 1100 patients.  This include 190 pediatric cases, 136 Gynecology cases, 67 visual inspection of cervix to check for cancer, 186 dental patients, and fitted 29 wheel chairs. The team referred 183 patients, many of whom will be having surgical procedures in “Faith in Practice” partnering hospitals. Part of the purpose of these village teams is to find candidates in the countryside that may benefit from surgery. As cervical cancer is a major cause of death among women in Guatemala, the exams found 4 women who need to have lesions removed. These four women will be given a new lease on life.  

School in Monjas
Our third village day begins at 5:30 AM with devotions and, because it is Ash Wednesday, a brief service of the imposition of ashes on those interested in participating. After breakfast, we headed south to the town of Monjas, a city built on a wide plateau with rich agricultural fields that are irrigated with an impressive infrastructure.  Again, we set up in a school which appears to be a better equipped than the school we worked out of in El Aguacate.  Here there are regular bathrooms and not just privies behind the buildings. 
In the Lab:
From Left: Louise, Marti, teacher (in red) and Joy

As we arrive, there was a long line of those seeking treatment along with vendors preparing lunch to sell. In the back of the school, several women set up a small tortilla operation and make rice and salsa. Unlike in Aguacate, in which we set the clinics up on Sunday afternoon before the first day, here we had to set up the clinic. There were boxes and crates to be distributed to the right rooms, partitions to be installed for patient privacy, tables, chairs and beds to be set up.  While we are working several of the teachers come into their rooms and thank us for volunteering.  We arrive before 8 AM, but are unable able to see the first patients until around 9 AM.   
Dr. Cam with Interpreter Lucy
with Baby Daniella and her mother

The second patient Dr. Cam, a pediatrician from Houston, Texas, sees is Daniela, an 18 month old girl who only weighs 13 pounds.  As her 18 year old mother takes off her top for an exam, we all can tell she’s struggling to breath. Her mother says she is always congested and that she eats very little and has a hard time swallowing and often chokes when eating.  Examining her, it becomes obvious that she has a double ear infection, but are  other issues concerning Dr. Cam. The child is extremely underweight.  He wonders if perhaps she had a airway obstruction in the nose and calls for a consult with an oral surgeon.  While waiting for the consult, her mother breast feeds Daniela and another patient was examined. 
Interpreter Lucy with Britney and her mother

Britney is a seven month old girl who weighs two more pounds that Daniela, and is over a year older.  Britany’s the first child for her 24 year old mother.  The mother is concerned that Britany seems not interested in standing. Checking her out, Dr. Cam finds her to be developmentally fine.  She was using her hands.  After asking her mother for permission to photograph, I take her photo on my iPad and show it to the mother. Britany laughs and tries to grab the iPad. She is obviously aware of her surroundings. Dr. Cam reassures her mother and shows her how to help her gain leg strength by holding her arms so she is in an upright position while she attempts to walk.  Britney’s visit was a welcome reprieve as she is an obviously healthy infant.

When Dr. David arrives for the consult, he takes a look at Daniela and asks that I bring her and her mother to his clinic where he can have a better look. In the dental clinic, we have the mother lay down in a dental chair holding Daniela. Dr. David checks her out.  Although he doesn’t think she has an obstruction in the nasal passage, he finds her tonsils and adenoids  enlarged.  With the infection and congestion in her head causing her inability to breath through her nose, Daniela also has problems breathing through her mouth. Her condition causes her difficulty eating and sleep apnea.  After consulting with Dr. Cam, they decide to recommend she be urgently seen by an Ear-Nose and Throat specialist. The mother is also given antibiotics for her ear infection.  
Dr. Cam with Oliver David

An older mother with her seven year old son is Dr. Cam’s next patient.  She has seven children and has lost another, a young girl who died when she was a year and a half.  Her son, Oliver David, is 7 years old and complains of pain in his legs.  He only walks a little and because of this, she keeps him from attending school.  Examining his feet, Dr. Cam discovers that his Achilles tendon in his left leg is short and does not extend to where he can put his heel to the ground.  Dr. Cam tells his mother that this shouldn’t keep him from school, but that he will be referred to a orthopedic surgeon who could determine if they can lengthen his tendon and allow him to place his feet flat on the ground.  

Oscar discussing how to take medicine
After a filling lunch prepared by Hector and his crew (beef stew with rice and tortillas), I visit the Farmacia (Pharmacy).  There, six pharmacists work hard, not only filling prescriptions but consulting with physicians as to what medicines they have for certain treatments.  As the week continues, they have run out of certain medicines and must come up with substitutes. As the drugs are being dispensed, Oscar, one of our bus drivers who’s obviously Spanish speaking, help sthe pharmacists explain to the patient (or the patient’s parents) how to administrator the drugs. Most of the drugs were prepackaged in the fall by a team overseen by one of our team leaders, Pharmacist Scott Kincaid.  

The Pharmacy Team (from left): Kyle, Kylie, Nathan, Kirsten,
Heather and the local volunteer 

Denillo informs patients what to expect
to the left, Jessica is at computer making referrals

Next to the Farmacia is the office for referrals.  There, Denillo, a member of the Faith in Practice team from Guatemala, explain what will happen as they are referred to one of two hospitals that partner with Faith in Practice.  While he orients the patients, Jessica, another in-country Faith in Practice worker (she’s from the Netherlands) is busy at her computer arranging schedules and follow-up schedules.

By early in the afternoon, things are slowing down.  As we swap stories, Wilma, an interpreter from Michigan, tells about five people (two couples and a single woman) who travelled from the town of Escuintla, which is over three hours away. They had a series of medical needs,  especially in the gynecology area.  Having heard about the reputation of Faith in Practice, they took the long trip that involved walking and taking buses. 

As we load the buses for the trip back to the hotel in Jalapa, the smeared ash crosses on foreheads on many of the volunteers are still visible. 

Tuesday, February 13, 2018

Day 5: Dentist, Audiologists & Pediatricians

Guatemala Day 5  (second day in the town named for the avocado) 

Dr. David works on Sujeryly as translator Sharon
attempts to comfort
Sujeyly is a three year old with four abscessed teeth and the first patient to enter the dental clinic this morning. Checking her, Dr. David, a pediatric oral surgeon from Boston, says he sees similar things in his practice at home.  He lifts up the girl from the chair and asks her mother to take a seat.  She appears nervous, pointing to her daughter, but when she sits down, Dr. David places the girl on her lap and has her hold her daughter.  Sharon, a translator with a puppet, tries to assure the toddler that it’ll be soon over and her teeth won’t hurt. She gives a shy smile.  Dr. David turns to prepare the novocaine, telling me that at home, he’d use anesthesia and the procedure would go quickly.  “Here,” he says, “there’s going to be a lot of blood and crying but by tomorrow she’ll be fine.”  He takes the syringe and numbs the area around the teeth. The girl begins to wail as the medicine is given.  He has the translator tell the girl and her mother that they will wait a few minutes for the numbing to take place.  He then turns to his next patient, a seven year old girl named Brenda. 

Dr. Robert with Rosa and her family
In another station, Dr. Robert, also an oral surgeon from Boston, is working between two older children.  Rosa is 11 years old who needs two extractions.  Saul is nine and needs one. They are both brave as he gives them the shot to numb their teeth and neither cry as the teeth are extracted.  At the third station, Dr. Carlos, a dentist from Guatemala is seeing Amanda, age 12, and Celeste, age 2.  All six chairs are filled within minutes of the clinic opening.  He prepares a syringe and gives numbs the area around the teeth, having them to wait before the teeth are pulled.  

Dr. David and Robert both examine Sujeryly

Once Sujeyly’s mouth is numb, Dr. David begins pulling her infected teeth.  As he grabs a tooth and begins to pull, she screams. He drops the tooth into a cup as blood fills her mouth. There is no suction. Using gauze to wipe up the blood, he pulls another tooth. The girl continues to scream as her mother holds her tightly.  In a few minutes it’s over.  The doctor tells her that she felt no pain with her mouth numb. Her mother is given instructions and antibiotics as the girl’s crying wanes.  Blood drools down her mouth.  The translator grabs a gauze and wipes it off her shirt.  It’s been less than thirty minutes. The first patients have all been treated as others are taking their place in the chairs.  

Dr. Jill cleans Venango's ears
Leaving the dental clinic, I head over to the audiology, where it is much quieter.  Dr. Jill, from Buffalo, New York, is cleaning Venango’s ears.  He’s 75 and can’t hear.  Once his ears are cleansed of wax, she has him sit in front of a hearing machine and learns that he is totally deaf in his left ear and has severe loss in the right. The doctor places a hearing aid in his right ear and he smiles and can hear.  She then takes the aid out and adjusts it to better fit his ear.

On the other side of the room, Courtney, an audiologist from Thunder Bay, Ontario, is speaking to the granddaughter of Maria, a 67 year old woman with a hearing aid.  But her aid doesn’t appear to be working.  Both Courtney and Dr. Jill are impressed with the quality of the aid and assume it must have been a used hearing aid donated in the States.  The quality of her aid is much higher than the ones that Faith in Practice can provide.  Courtney tests the aid. It’s working, but needs cleaning. Courtney cleans it and through a translator describes the limitation of such devices as she was wondering why she can’t hear when someone is talking from behind her. The cleaned hearing aid works better and the woman is sent home with a year supply of batteries.  

Interpreter Sharon explains to Venango and
his wife the operation of a hearing aid
Once Venango has been fitted with the hearing aid, he is sent to find his wife.  Dr. Jill wants to assure that someone else can help him maintain the aid. She joins him and to too listen to Sharon, a translator, go through the talking points that Dr. Jill has supplied. They are shown how to install the aid in the ear, how to clean it and replace the battery. They are also reminded of the dangers the batteries pose to small children and animals.  

Audiologist Courtney examines Juan
As Sharon describes the handling of the hearing aid, she is constantly asked to translate for Courtney’s new patient, Juan, a 13 year old boy. He’s there with his father. He has no hearing in his left ear in which he has a malformed ear lobe.  She tests both ears, starting with the right. His hearing is normal. In his left, he is unable to hear but she determines that the nerves which transmits the hearing to the brain are working. This makes Juan a good candidate for surgery, for simple procedure of opening the ear canal will provide Juan with full hearing.  Courtney writes up her notes and sends Juan and his father over to the referral clinic where they will arrange a visit for Juan to one of the partner hospitals where a Faith in Practice volunteer surgeon will reconstruct his ear.

Dr. Ava examines Hian

In the pediatric clinic, Dr. Ava from Syracuse New York is examine Hian, an 18 month old boy.  He has a hernia and it hurts when he coughs or cries.  The child has already had two hernia surgeries and Dr. Ava recommends a third, suggestions they look at a mesh to repair the tear. After Hian and his mother leave for the referral clinic, where volunteers will work to arrange the surgery, Ava comments on how many cases of scabies she’s seen today.
Todd taking roll to make sure everyone is accounted for
before heading back to Jalapa

One of two trucks to haul our equipment 

This is our second and last day in Aquacate. Around 2 PM, most of the clinics are completed and we begin to pack up.  Everything is hauled out to the gate of the school yard by 3 PM, except for the dental clinic which is still seeing patients.  As soon as they finish, they pack up and we haul the gear out.  We’re on the road back to our hotel in Jalapa before 4 PM.

Your humble blogger in the brightest scrubs he could find

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