Hope

The first day of the brigade a 40 year old woman came in with a chronic ulcer due to severe varicose veins on her right shin. It started as a bug bite, she said. Most patients with this kind of ulcer in the U.S. are in their 70´s and 80´s.

My first question was, How many kids do you have? Six. Multiple pregnancies are the usual cause of severe varicose veins in younger women. (The other leg had no varicose veins at all, which is often the case.)

She’d had it for over a year, and had been treated with antibiotics several times to no avail. The ulcer was slightly inflamed because of the body´s efforts to heal it, but it wasn´t then, and probably hadn´t ever been infected, since she was otherwise healthy and not a diabetic. In any case, antibiotics would only be an adjunct, to clear up the infection, not to heal the ulcer.

The treatment this woman needed was not high tech. She needed a weekly leg wrap with a zinc oxide-impregnated bandage for several weeks to months. The ointment would keep hard scabs from forming and allow new cells to grow into the ulcer. The foot-to-knee wrap would keep blood from pooling in the swollen veins and causing fluid to leak out into the tissues, resulting in swelling that impedes the arterial inflow needed for healing.

At home, I have these patients come in once a week to have the bandage changed by the nurse. Not rocket science. The bandages themselves only cost a couple of bucks. But they do need to be wrapped carefully and they need to stay on continuously between visits.

My heart sank. Even if we could find the bandage and teach her how to wrap it properly, how was it going to stay in place during a week of walking the dusty dirt road up the mountain? Our elderly patients at home can watch TV with the leg up and drive to the office. This lady had to go and stand in the market every day to support her family. Furthermore, even a few bucks was beyond her reach. And even covered with something, that ointment would attract dirt like crazy. It seemed like such a tragedy that there were so many obstacles to something so fundamentally simple. It´s not a heart transplant, after all!

As we talked, she began to cry and express her fear that it would never heal. I was afraid of the same thing. I really felt discouraged and hopeless. I asked her if we could pray, because I felt we needed a miracle. I had tears in my eyes as I prayed that God would heal her body, mind and spirit. Then I was led to pray that he would provide whatever resources were necessary to heal her.

Well, this prayer changed me. The feeling of hopelessness left me, and I went out to confer with the team about what we had on hand. Nurse Ruth soaked the leg and did a beautiful job removing all the dead tissue (anesthetic provided by the dentists!) while I saw a few more patients. The wound was not as deep as I had feared, PTL! We had a small supply of antibiotic ointment in the pharmacy, and an ace bandage provided the means to counteract the elevated hydrostatic pressure in the leg that was preventing adequate blood flow from reaching the wound to heal it.

Since it was the first day, I told her to come back on the last day so we could re-dress it at least once. She left, smiling, with her return ticket in hand.

On the last day she returned and we re-dressed the wound. It was too soon to see any change, but at least the bandage had stayed on reasonably well.

Ruth and I did our best to explain the how and why of the bandages. We strategized about some things she might use when our supply of two whole Ace bandages lost their stretch and the antibiotic ointment ran out. Petroleum jelly and strips of clean cloth would serve the same functions.

I don´t know how much she understood, or whether she could even afford Vaseline - oh, if only I knew how to find a parish nurse in this barrio! But we did our best with the resources we had. I know she felt greatly encouraged by our efforts and attention, and I am trusting that God will take care of the rest.

Organ Recital

Over the years I have noticed that people often come to the doctor with a list of problems. One-stop shopping, I’m sure they are thinking; let’s get everything taken care of at once. I can relate to that.

The trouble is, human beings can’t give full attention to multiple things at once (no, not even doctors!) There is actually a concept in learning theory that explains why the brain can’t work that way (although I can’t remember the term right now!)

And of course, folks don’t always mention the most important or serious thing first, or at all, even if they know which is most serious. I once treated a lady who was having a heart attack, but all she cared about was her headache!

During the medical brigade, the patients could access only one service a day. They had to choose between medical, dental and optical. If they wanted another service,they had to come back another day and wait in line again with no guarantee of getting in. So they had to decide which was most important.

Most of them had one or more of about 10 symptoms:

1. Loss of appetite and abdominal pain – diagnosis, parasites
2. Headache – diagnosis, chronic low grade dehydration and heavy physical work, including carrying heavy loads on the head
3. Sore throat, coughs and cold symptoms – mostly viruses and allergies.
4. Pain in the bones – ditto heavy physical work
5. Dizziness – ditto dehydration
6. White blotches on the skin – superficial fungal infection – unsightly, but harmless
7. Skin ‘allergy’ – a non-specific rash that I had no clue about
8. Acid stomach
9. Exertional chest pain and shortness of breath walking up the mountain that Villa Nueva sits on – angina pectoris. Take these baby aspirins until they run out in 30 days and be sure to sit down and rest until the pain goes away. (!!!)
10. Asthma. There’s a lot of wood smoke from cooking in addition to considerable smog.

It was pretty routine to see a mom and a ‘passel’ of kids, and 'laundry lists' of symptoms were the norm. I always started with the baby and worked up to the mom in order to minimize the confusion in my brain. One day I saw a family of 7 – mom, 4 kids, and 2 nephews. Each of them had at least three complaints – some had more. It was late in the afternoon, I was already tired, and the almost-equatorial sun was beating in on us. Fortunately, none of them was really sick. Anti-parasitics, Tylenol and vitamins for all, and they were on their way. Meanwhile, I was toast – cross-eyed with mental fatigue.

So on the next to last day in the afternoon I had already worked through a lot of these families, and another one was in my cubicle. I’d finished with the two or three kids, and mom was giving me her list. Headache, pain in the bones, parasites, dizziness – maybe there was more; it’s all kind of a blur.

And oh! by the way, is there any chance of seeing the dentist? I lost a molar recently and I have a lot of pain, I can’t sleep at night. It just broke off, leaving the root behind.

Believe me, it’s all too easy to tune out towards the end of the list. By the grace of God, that last snapped me out of my fog. Have you had fever? I asked. Yes, she had. I looked in her mouth and winced. The socket was full of pus and the gums red and swollen. We had stopped giving out tickets for the dentists (they pulled hundreds of teeth; the record was 29 from one person), but I was worried about the retained tooth fragment – a wound can’t heal properly with a foreign body in it.

I stepped out to consult with Joe, one of the dentists. He immediately offered to come and look at her. “Oh, yes, that definitely needs attention. I wish she had come earlier in the week so we could load her up with antibiotics beforehand. Give her two grams of ampicillin today and something for pain and have her come back first thing in the morning.”

I was grateful that he was willing to add her to an already full caseload. I begged a dental ticket from Bob and gave her a big bag of horse pills. Shortly thereafter, we finished for the day and I went home and passed out.

The last day was just as busy and exhausting, but when we were done I thought about her again and tracked Joe down to find out what had happened.

Oh yes, he said, it was a good thing she had come, because it wasn’t just an abscess in the soft tissues, but osteomyelitis – infection actually in the bone, from where it can easily get into the bloodstream and cause a catastrophic infection. She could have been dead in two weeks without treatment, he said.

Ay, carumba! It´s a good (God) thing that my numb brain woke up to pay attention to what she was telling me! Those kids definitely did not need to be losing their mama at such a young age.

A Medical Brigade

When I got to Honduras in January, I wanted to contact my friend Rick, but I didn’t have his phone number. So I emailed him and asked him to call me. The next day, feeling stir-crazy, I decided to take a walk around the neighborhood. As I came to the end of the street, I heard an American voice calling my name! Lo and behold, there was Rick! I accompanied him to the Internet café (he had yet to receive my email), where we ran into Sister Patricia, wife of Pastor Rafael whom I had heard of but not met on my previous trip.

Pastor Rafael is also a doctor, and a day or two later Rick introduced me to him. We talked about the medical needs in Honduras for a while, and then he said, about the brigades, “We serve much, but help little.” This articulates very well both my frustration and my commitment.

I’ve been on a couple of medical brigades in Honduras before now with the University of Cincinnati, but I had very mixed feelings about them. My Spanish wasn’t good enough to really understand what people were saying, and the translators were young teenagers from a different social class, so although they understood the words, I knew they were missing nuances. I didn’t feel I could really connect with the people, and from the medical standpoint, the needs were so great, and our resources so limited, that it was painful.

Anyway, Pastor Rafael invited me to join a brigade in February. This group was from Health Care Ministries of the Assemblies of God and was run by some very seasoned people. Bob McGurty, fresh from surviving the tsunami while on vacation in Thailand after many years in Bangladesh, was our fearless leader. (Basically, he and his family survived because they were visiting him in the hospital after he had had a motorcycle accident! When I met him, he was still moving slowly because of a fractured rib.)

“We’re field-driven,” he told me. “We only come in by invitation from local churches.”

This time they were invited by American missionaries Sam and Evelyn Klingler, who are part of a world-wide Assemblies of God ministry of evangelistic tent meetings. The medical brigade was planned with the evangelical churches of a poor barrio creatively named Villa Nueva (New Town), in conjunction with a two-evening revival at the host church, Gate of Heaven.

Bob and head nurse Peggy Johnson and the team of about 25 doctors, dentists, nurses and pharmacists from all over the US had been at the crematorio (city dump) for a few days before I hooked up with them. They had quite some stories to tell about ministering to the people who live there – like how the folks were in competition with the vultures for the garbage!

Bob oriented me to the system. Preprinted cards were used for charting. At the bottom of each one was a series of checkboxes:
• Under 5 years,
• Believer,
• Saved today,
• Healed, and
• Other.

After the medical evaluation, everyone was directed to the consejeria (counseling area) to talk with the volunteers from the local churches and to receive prayer if desired. Nobody could get their medicine from the pharmacy without passing through the consejeria! (Kind of a no-sparrow-shall-fall approach…)

It was gratifying to know that the whole team was on the same page in wanting not only to provide medical treatment to the best of our abilities and resources, but more importantly to offer the people the chance to get hooked up with Jesus, the only one who can shine light in our darkness and fill the big empty hole we all have inside.

So it was very easy to share the love of Jesus with the patients in words as well as in our actions. My Spanish is now good enough that I can usually understand what is going on, and I mostly worked without a translator. I asked everyone if they knew Jesus and checked the appropriate box. Most said they were believers, but I did pray with a few who were willing to receive Christ. (I know God will forgive the halting way I pray in Spanish – all those petitions are supposed to be in the subjunctive mode – arrrgh!) Others, who wanted prayer for healing, I prayed for in English - tongues, after all!

Our pharmacy consisted of anti-parasitic medications, various antibiotics, acetaminophen, ibuprofen, topical steroids and anti-fungals, vitamins, cold medications, a small supply of antihypertensive and antidiabetic medication, and not much else.

Most of what we see is either so minor as to not really need much treatment, or so major as to be beyond our resources. Although I passed out a lot of antibiotics, probably less than five of the hundred and fifty patients I saw actually needed them. (A really nasty tonsillitis and an infected jawbone are the ones that come to mind.)

The anti-parasitics were probably more widely needed, although of course we didn’t have any diagnostic testing available.

Then there was the diabetic who hadn’t been able to afford insulin for the past six months… not much to do for her, our supplies of medication would only last her a few weeks at most. That’s not going to make much of a dent in a life-long condition…

These folks cannot afford even Tylenol, so they are eager to have the opportunity to receive medications and vitamins. I was very willing to oblige, under the ‘serve much’ principle, but I was relieved on this brigade to be able to routinely and openly access the unlimited healing available through Jesus Christ. It’s easy to forget him when we see our medical treatment working effectively, but for those who are more worried than sick, and those for whom we can do nothing medically, the need is more evident. I’ll be posting some of my divine appointments here, so stay tuned!