Friday, February 16, 2018

Day 7 (second day in Monjas)

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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

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