Devotion

I was reading a devotional today (http://www.devotions.com/) and this poem was on the website. Author unknown.

It’s sometimes very difficult

For us to understand

The wisdom and the love behind

The things that God has planned.

But we wouldn’t have the rainbow

If we didn’t have the rain;

We wouldn’t know the pleasure

If we never tasted pain.

We wouldn’t love the sunrise

If we hadn’t felt the night;

And we wouldn’t know our weakness

If we hadn’t sensed God’s might.

We couldn’t have the springtime

Or the yellow daffodil

If we hadn’t experienced

The winter’s frosty chill.

And though the brilliant sunshine

Is something God has made.

He knew too much could parch our souls

So He created shade.

So God’s given us a balance:

Enough joys to keep us glad,

Enough tears to keep us humble,

Enough good to balance bad.

And if you’ll trust in Him you’ll see

Though yesterday brought sorrow,

The clouds will part and dawn will bring

A happier tomorrow.

It is late Friday night, almost Saturday morning here in Rurre. This week was long and tough. Laura, the lady with the three children (11, 5, and 3) died peacefully Monday morning at 230am. She was laid out for two days in the family home with candles, flowers and lots of family and friends surrounding her. It was a sad day for all, but everyone seemed at peace knowing that their friend, daughter, mother, sister, aunt, grand daughter, was no longer suffering. I stopped by the house Thursday afternoon and shared a soda with the mother and grandmother. There grief is coming out in the physical, with shoulder pain, sore throats, coughs and general weakness. I can’t imagine the pain the mother must be going thru losing her daughter.

David (name changed) is 11 years old and has Downs Syndrome. He lives around the corner from the clinic and often I will see him hanging out on the bridge between his house and the clinic. Sometimes, he will stop by to see what’s going on and he always has a smile from ear to ear and a great big hug. David is so full of love and joy. No matter how good or rough the day is going, he always brings a smile to my face too.

Jori (name changed) is the 14 year old who came to the clinic last week and had a positive pregnancy test. The plan was for her to bring her boyfriend (22 years old) to the clinic so we (Dr. Frida and myself) could discuss options with the couple. Today, Jori showed up alone. Her boyfriend had to go to La Paz for a week to visit with his ailing father. Jori was tearful and doesn’t know what she wants. She is 7 weeks pregnant. She does not want to leave her house, but she says she will be kicked out of the house if her parents find out she’s pregnant. Jori is scared. I asked what she was most fearful of right now; being pregnant or her parents finding out. Jori shared that she is terrified of telling her parents because the only way they know how to deal with conflict is with physical contact. Jori is unsure how responsibility her boyfriend will take in caring for the baby. Abortion was discussed, as well as adoption. Recently, I met a woman who works at an orphanage. I am also going to talk with Pastor Jack and Daisy about possible homes for Jori until she gives birth. Jori will return to the clinic next Friday with her boyfriend to discuss the situation. If all goes well (please pray they decide to keep the baby), then we will all sit down with the parents on Saturday to discuss the situation and evaluate if Jori will be safe at home. If anyone has any suggestions, I am open to them.

Marlene is 16. She has a physical handicap and walks with a limp. Two Saturday’s ago, she was on a moto taxi and was flung off and landed on her knee. She had Xrays, but nobody gave the mother the results. It’s two weeks later and nothing has been done. I got my workout today, by carrying her around the clinic and then to the boat that crosses to San Buena Ventura. She was seen by a trauma MD and will have surgery on Monday.

Tonight, I played pool with my friend, Mette. She is a med student from Denmark. I play pool like my dad plays golf!!!! We had lots of fun anyway and I actually won a game.

Well, I am signing off for the night. I am going to bake a chocolate cake with Natalie, a teenage girl who wants to learn how to bake. I had to buy the butter tonight, because the only store that sells real butter is closed tomorrow. stocked up, so I should have enough for a while.

Love and hugs to all.

Life and Death

Three boys on their way home from school, having fun climbing the walls!

The Macaw at Jack's house.

Whew! It is Saturday evening at 10pm and I am just slowing down after two LONG days.

Yesterday, we saw 24 patients at the clinic. On my way to the clinic, I witnessed two women in the middle of the road and a man in between them. One lady had her fists drawn. The women were circling the man. As I got closer, I thought "ok self, do I ignore what I am seeing and just keep walking or do I get involved?" What do you think I did? If you guessed I got involved you are right. As I got closer, I yelled out "hola, como estan" (Hi, how are you) I then walked up to the woman who looked agitated and I put my arm around her and starting chatting with her. As I was talking with her, we continued to walk toward the clinic and the other woman took off. Apparently, the two were fighting over a guy. I asked the woman what would happen if she got in a fight and the police came. She told me it wouldn't be good and I agreed. I think distracting her and talking about the consequences, she realized fighting would get her nowhere. As I arrived at the clinic, she gave me a hug and thanked me.

During a consultation, I heard a loud shreek and lots of screaming and crying. Dr. Frida knew exactly what was going on. She jumped up from her desk, grabbed the ambu bag, told me to take my stethoscope and we both ran down the street. The house on the corner is owned by a young couple. Laura is 26 years old, and married with three young children; 11, 9 and 6. Laura is dying of cancer. I don't know where it started, but it has metasasized throughout her body. Because of all the fires, the air has been thick and Laura was having difficulty breathing. Dr. Frida used the ambu bag and shortly thereafter, Dr. Crispen, from Rurre Hospital arrived with a small oxygen tank. I stayed with the family for a while and tried to console the mother of the 26 year old. I can't imagine how she must feel, losing her daughter. I didn't say much, just let the family know I was there if they needed anything.

Back at the clinic, we had a 14 year old girl come in. Her complaint was a stomach ache. When asked about her menstrual cycle, she told the MD, she hasn't missed. She has a 17 year old boyfriend and is sexually active. We sent her for a urine test (Antonio, our pharmacist does dipsticks), and sure enough, the HCG test came back positive. When Dr. Frida shared the results with the girl, she started to cry uncontrolably. She asked the MD to help her....meaning abort the baby. Thank God, Dr. Frida does not believe in this practice. We are going to meet with the girl and her boyfriend on Monday. The girl is afraid her parents will kick her out of the house... So, for all my prayer warriors out there, please join me in praying for this situation, that God would give us wisdom and guidance on how to address this delicate situation.

As we continued with the consultations, a gentleman came to the door. His wife was seen in the clinic two weeks ago. She is six months pregnant and extremely anemic. Her legs also had 4+ pitting edema. When she was seen by us two weeks ago her hematocrit was 22%, and we sent her by moto taxi to the hospital. Apparently, they did nothing for her and sent her home. Why the husband waited two weeks to come back, I don't know. But, there he was in our clinic asking us to help. "My wife is very weak and can't walk. The hospital sent her home. I am worried about her". After consulting with Dr. Frida, I packed my bag with my stethoscope and a month supply of Ferrous Sulfate with Folic Acid. I told the husband I would follow him to the house. He told me he couldn't go back to the house because he was working (he sells ice cream on the streets). I explained to him I was not that familiar with Rurre and the streets and he would have to show me where he liveed. He reluctantly agreed. When we arrived at his (house), I found the wife sitting on a piece of plastic washing clothes. I gasped, which I know was not the thing to do, but seeing her there was disturbing to me. Thank GOD!!!! I gave the husband 5 Boliviano's for the return trip and left.

I assessed her and took her vitals. She was tachy and pale as could be. Her conjunctiva was white. The gums of her teeth were white. I asked her what had been going on and she told me she fell yesterday and after was vomitting blood. She began crying and was scared. I felt the baby moving and could hear the heartbeat. Without trying to be alarming, but needing to be firm to get my point across to her, I told her she needed immediate medical attention. I helped her to the (bed) and propped her legs up on some rolled up clothes. Her bed was floor level with a bamboo platform and some blankets on top. She didn't have any pillows, just blankets and clothes. We made do with what we had. I told her I was going to talk with the MD. She needed to stay in bed until I returned.

Back at the clinic, I updated Dr. Frida on my findings. We both agreed she needed immediate medical attention. Dr. Frida wrote a note to the San Buena Ventura Hospital which is across the river. Dr. Frida asked if I would accompany her and I agreed. When I returned to the house, the husband was gone and the wife was back washing the clothes. WHAT ARE YOU DOING, I wanted to scream at her. Deep breath, Deep breath... I am missing something. During my earlier visit, the neighbor told me many people have offered to help, but neither the husband or wife have accepted help. I didn't react. I just asked if I could return when her husband was home and she told me I could come back in the morning. So, this morning, I made my way back to their house. Both the husband and wife were there. Thankfully, the wife was in bed. I talked with both of them and explained that the wife needed to get to the hospital. The husband agreed and I told them I would return in 15 minutes with three moto taxis. I went home, called three moto taxis and they took us to the river. We crossed the river by boat and then took three more moto taxis to the SBV hospital. I am really getting good at side saddeling!!! At the hospital, Dr. Jaimie greeted me and immediately took in the patient to be evaluated. A few minutes later, he come and told me they would be admittng the pt.

Tonight, I was invited to a birthday party and tomorrow I am going horseback riding with Christian and Mette, two medical students from Denmark. I am off to bed! I hope you are all enjoying the pictures. Love and hugs to all

San Pedro

The children of San Pedro, one of the community visits we do. The children heard me say OK as I was getting out of the jeep after our 3 1/2 hour ride and they clung to that. I would be walking into the makeshift clinic and I would hear "OK" in the background. I would turn around and they would all look at each other and giggle! I was seeing pt's with Dr. Frida and the children were standing in the doorway, motioning me to come. I went to see what they wanted and they were holding a flat basketball and invited me to play soccer with them. I explained to them I was in the middle of seeing patients and would play with them when I was done. They agreed, but didn't budge. They all waited for me in the doorway and watched every move I made. Later, we played soccer with a flat basketball. At the end of the day, I attempted to teach them how to make a human pyramid. As you can see, we need a bit more practice!

Don Saul

Don Saul

This is Don Saul. He is a patient at the clinic. Everyday, I pass his house on my way to and from the clinic. He is always sitting in the chair that you see in the picture. If he's not snoozing when I pass by his house in the afternoons, I will often stop and sit and chat with him for a few minutes. He's always asking me on a date, and I remind him he is a married man and I am way too young!!! Wednesday, I was walking home from the clinic and his wife came out to greet me. She sent me on my way with some tamarinda seeds to make tamarinda juice. Ooh it's delicious with ice and a bit of sugar!



Poor Don Saul. As you can see from the picture, Don Saul walks with wooden crutches because he has arthritis so bad. I think it was Monday morning he came to the clinic to get his monthly meds and injection. His house is about 3 blocks from the clinic and he was only half way home twenty minutes after he left us. I was leaving the clinic for siesta when I saw him.

Baby Simba

The circus came to town the last week of August and I was invited to go with Dr. Frida and the health care promoters. During intermission, there was an opportunity to have your picture taken with baby Simba. What do you think, shall I bring one home?

Pictures of Serafim

Serafim

Right thigh abscess. Second day of treatment. My first day of seeing this.

Sunday, Sept. 2nd. Serafim wanted to go back to his community, but I asked him to stay one more day. He returned on Monday for one more dressing change and then I sent him on his way with his promise that he would return the following Sunday. He did. Unfortunately, I don´t have a picture of the ulcer, but it was almost completely healed. Serafim did a great job with his dressing changes at home and really made some great improvements. I promised Serafim I would give him a copy of his picture. I will have to go to La Paz (18 hour drive or I can go by plane). I will get all my pictures in prints in December. That way everyone will have a copy.