Is This the Quiet Week We’ve All Been Hoping For?

We have four patients in the hospital. Yesterday we had seven, but two went home and one was transferred to Hospital Vozandes Quito because he had a heart attack that wouldn’t slow down.

Why are things slow here in Shell? There’s a strike. Strikes in Ecuador don’t just have people with signs walking in a circle, that doesn’t get the attention of the authorities. A strike in Ecuador is not a strike without roadblocks and burning tires. The strikers have found out that the police can pull apart a roadblock of burning tires lined up across the road with long metal poles, so now they use dump truck loads of dirt on the road so no one can pass until they decide to end the strike. Burning tires make great TV shots and blocking the roads brings capitalism to the aid of the strikers. The truckers and bus companies want to travel and make money, so they pressure the authorities to give in to the strikers' demands.

The semi-good thing about a strike for a day or two is that hardly anyone can come to the clinic, which means we don’t operate, which doesn’t affect me, but we also have very few patients in the clinic, which gives me time to catch up on my journal, emails and other important communication.

The bad thing about strikes is that travel gets bogged down. Our ophthalmologist, eye doctor, got stuck about 10 miles away. They let ambulances through, so our ambulance went to get him from the far side of the barricade. He called us to ask the ambulance driver to come get him. Thank goodness for cell phones.

Another bad thing is that the medical student who took the patient having the heart attack to Quito got stuck about 2 am ten miles away from the hospital. She tried to sleep on the gurney in the back of the ambulance, but when the ambulance driver lay down on a bench and started to snore loudly, she didn’t sleep anymore that night. She ended up walking with some patients in the rain, coming from 4 hours away to our fair hospital about 5 am. She is about 22. They are about 70, but because they walk everywhere out in the rural areas, and they have worked at manual labor all their lives, they walked her into the ground and the old folks had to slow down so that the young college student could keep up.

The worst thing is that the patients who need to come to the doctor can’t get here. The ophthalmologist is only here one week per month. Most of the patients who received operations last month can’t get in for their follow ups appointments, and patients who need to come to the clinic can’t get around the barricades. For me, the worst thing is there’s no bread and no Diet Coke in the stores. We missionaries really suffer. (Just kidding.)

Tomorrow, if the strike ends, we will be extra busy. If the strike drags on, patients who early need care won’t get it, and that could be tragic. For now, it’s just a relaxing slow day after a few weeks of horror.

Something about me

Elizabeth tells her story

I grew up in a nominally Catholic home. I also grew up as an expatriate in South America, my father was a businessman, and in my youth I met a number of children of missionaries. I first heard the gospel in an understandable way from missionaries when I was fifteen years old. When I went to college in the US, God brought me to a church where I could learn and grow in my faith.

In college I decided to study nursing specifically so I could do mission work anywhere in the world. A few years out of college I joined a church planting team to start a Hispanic church in Miami, Florida. I began graduate school to become a Nurse Midwife, when I met Jerry at the University of Miami. We married and moved to Tampa for him to start medical school. During the following years I entered a time of serious questioning and exploration of my faith, and at the same time we began having our children. I thank God for this time, as it helped sharpen and mature me, and prepare me for service.

We moved to Tucson AZ in 1996, so Jerry could work at a community health center and help pay back the student loans he owed. We became involved in leading a marriage ministry (and worked on our own marriage as well!). By 2002 all our student debt was paid. We applied to HCJB World Radio after exploring other medical mission’s options at the Yearly Global Medical Missions conference in Kentucky. I remember seeing the tremendous medical need in Africa, yet feeling that we fit better with South America. As I was struggling with that idea, I spoke with a representative of HCJB World Radio Inc. who told me of a great place to work for in Ecuador, but that they were opening doors to Africa, and looking at options in Malawi! I thought, “What a perfect fit, we could get our missionary feet wet in ‘comfortable’ South America, and yet Africa could be in our future some day!”

We have been in Ecuador for four wonderful years. I’ve worked part time in the hospital, begun a health education and community outreach program and started and a pre and post test counseling program for our HIV. I also lead an evangelical Bible study for Ecuadorian women who have had little or no background in the Bible. We have loved living and serving our awesome God here, and don’t feel our time for serving in missions is anywhere near up. Perhaps, If God allows we can continue to serve Him with the needs He puts before us in Malawi.

“My Father is glorified by this, that you bear much fruit…” John 15:8

Elizabeth Koleski

That Time of Year

Well, it's that time of year again.

The first day of fall? No

The baseball pennant races? No

The start of football season? No

The kids are back in school? No

Well, what time of year is it? It's the flying of the ants! Duh!

The flying of the ants is the one or two days each year when the ants fly. They can be found under any street or porch light the following morning.

Last Thursday the Indians who live near our house were out collecting them before school. They had big garbage bags full of them. Elizabeth asked for a few.

You see our employee Martha preparing them. You take off the wings and the head and cook them. Around here we call them "Jungle Bacon Bits." They have a touch of a lemon taste, plus a bit of a Baco-s taste.

So, next time you see ants on the move, keep in mind that you too can have a high protein, low carb topping for your salad, or give the kids a nutritious after-school snack!
I'm sure they'll be available at Trader Joe's soon.

Yes, We Are Trying to Change Their Culture

At times, people will accuse missionaries of trying to "change the culture." I'm involved in a case now that involves a part of indigenous culture that really needs to be changed.

A month ago, I delivered a baby that almost died during labor. Those types of tragedies happen on occasion, and they are horrible. What makes this situation even more tragic is that the mother is only twelve. (Yes, 12.) She got pregnant when she was eleven.

She told our female chaplain that the 22-year-old man who is the father of the baby gave presents to her parents and her uncles. To show their appreciation for his gifts, her father gave her to him. She then had to live with him. He forced himself on her often and beat her the rest of the time.

The mother of this little girl said she didn't like the situation, but "That's how life is." As a woman, she has no say over what happens to her daughter. The girl, and the mother are the sole property of the father. The "husband" now is the owner of the little girl.

Where does this idea come from that a twelve-year-old girl is ready for marriage and motherhood come from?

The culture states that after a girl's first menstrual period, she is ready to be married and start producing children for her "owner". (Yes, the indigenous people use that word themselves.)

Well, can't the Child Protective Services do something?

Ecuador has very little money to protect anyone, let alone children. There is no justice in the jungle other than "jungle justice". Since the people of the community all agree that a twelve year old girl is marriage material and the property of her father, to trade for stuff like a cow or a chicken, there will be no protection for this little girl.

Well can't you do something?

If the girl wants to run away, leave everyone she has ever known and everything she has ever known, we can help her get to an orphanage in the capital. That means we take a child from the jungle from a community of 150 people maximum and move her to a city of 1.2 million people, where people will take care of her, but her friends, her family and her brain damaged child will never see her again.

I pray that the Holy Spirit will prevail on the people to change their attitudes and their society to treat all people with human dignity and human rights.

Do I want to change the culture of the untouched people? In this case,
YES, I WANT TO CHANGE THE CULTURE!

A culture that treats human beings, and especially children, as property is WRONG. I defy anyone to make a case that this aspect of the "untouched" culture is something that missionaries should not address.

Six-Year-Old Update

David Santi went home a couple of days ago. He is the six-year-old who kept thwarting our efforts to change his bandages. He wore donated clothes as he left because he came to the hospital without a stitch on.

As you can see in the photo, he went home with quite a haul of goodies. He has two cars, each about 4 to 5 inches long, plus a coloring book. Not bad for a naked little boy from the jungle The last few days he was in the hospital, David made himself quite at home. He would sit with the nurses at the nurses' station. He always had candy or gum. He went from a frightened boy in pain to a little pistol.

David's home life is sad. He is an orphan, and his twelve-year-old sister takes care of him and his younger siblings. We can't change everything here, but we can do what we do very well and with great love.

We already miss David.

Blessings,
Jerry and Elizabeth Koleski

Outwitted by a Six-Year-Old

We have been trying to change little David Santi’s bandages for the last two days. David burned himself by spilling hot soup on his back four days ago. Because David is only six and in our hospital all alone from the jungle, we don’t expect him to grin and bear it when we change the bandages, we do it under anesthesia.

There is only one drawback to anesthesia; you can’t eat for a few hours before you get it. That is where one little six-year-old from the jungle has defeated six doctors from the big city. Yesterday the resident wrote the order “Do not feed until after lunch.” The nurses thought that David was to get lunch, then nothing else. David, being a hungry little boy in a strange place, ate what the grown ups gave him. He was finishing lunch just as they were going to take him to the Operating Room to change his bandages. The dressing change had to be put off, because if David vomits from the anesthesia, he could inhale the vomit and give himself a nasty pneumonia.

Today, everyone was told that David was not to eat breakfast, so that the bandages could be changed. Everyone was with the plan, except David. As they were about to take the little guy to the Operating Room, he was finishing the apple he had begged from the nice man across the hall. The doctor asked, “Why did you eat an apple? You weren’t supposed to eat anything.” With brilliant six-year-old logic, David replied, “Nobody gave me any breakfast and I was hungry, so I asked the man for some food and he gave me an apple.”

David will be fine. The burns aren’t very deep and cover less than 10% of his body. He would be fine faster if we could change his bandages and clean his burns more often, but he will be fine anyway. He’s really cute, so when he does what he wants, which is the exact opposite of what we want, it’s impossible to be angry with him. Still, getting outwitted by a six-year-old is embarrassing and frustrating.

Blessings,
Jerry

Each Heart Knows It's Own Bitterness

What do you do when there are three patients who need a ventilator, and your little hospital in the jungle only has two ventilators? You pray, you put the intern and resident to work ventilating by hand the patient most likely to die, and in a sad way, you hope that the sickest one passes to his final destination before the poor intern and resident stay up all night trying to keep alive a man who lost his pancreas.

What happened to his pancreas? It died. It was dead and black, except for the areas that were filled with abscesses. He survived about a month with a dying pancreas, but he passed away tonight. We went way beyond the call. He came in near death. We saw that he had air in the parts of his abdomen that should not have had air. He was taken to the operating room with the understanding might die during the surgery, but the surgery represented his only hope, as slim as his hope was. When the surgeon found that there was dead tissue and pus where his pancreas should have been, he closed the man's abdomen and took him back to his room.

As soon as the man returned to his hospital room after the "open and close" surgery, his heart stopped. After three minutes of work and medicines, his heart started again. The resident and intern did the work of a breathing machine for about 30 minutes until he started breathing again, but 2 hours later, his heart stopped and did not start again. His wife did nothing for about five minutes, then she started to cry and cry and cry without ceasing.

King Solomon wrote in the book of Proverbs:
Each heart knows its own bitterness,
and no one else can share its joy. (Proverb 14:10)

The husband and wife and their two sons had many moments of joy in their lives together, and everyone's life ends in sadness for those left behind. Tonight the couple's life together ended. She and the boys will know bitterness for a while, and loss forever, but they will have many moments of joy in the future.

After seeing a number of deaths here on the edge of the jungle, I think that we should work at making more joyful moments and work at remembering them more. Bitterness comes pretty easily; joy takes some work.

Malawi, Here We Come

Our son Andrew will finish eighth grade in June 2008. After that date, we will need to look for other ways to educate our children.

We took a trip to Malawi in April. We liked it a lot. We prayed and were convinced that God wants us to go to Malawi. There is a clinic there called Partners in Hope founded by Dr. Perry Jansen. The needs are huge, but God is alive there.

The life expectancy at birth in Malawi is 37 years. 1 in 4 children die by age 5. 15% of adults and 30% of the population is HIV positive. One half of a million children have lost one or both parents to AIDS. There are 2 doctors per 100,000 Malawians. That is 1% of the rate in the United States. There is a joke, that is half funny and half true that there are more Malawian doctors in England than is Malawi.

We pray we will make a difference.

Blessings,
Jerry for the Koleski family

Standing on the Shoulders of Giants

Hospital Vozandes del Oriente has been here in Shell for 49 years. We do some great work with very little, and have a great reputation. We have patients who come 11 hours to see us. People seem partly to trust us because we are gringos, but mostly because we are Christians. We don't recommend surgery because we want the money but because we think it is best for the patient.

We are reaping the good reputation built up over years by great doctors who came here when there was nothing here. Everett Fuller was the first doctor here, even before the hospital existed. He was a surgeon. His wife Dorothy was a nurse. Dr. Fuller had a operating room and a clinic. Before he had completed the hospital, all the patients that needed to be hospitalized were placed on the first floor of a small hotel down the road. After surgery, the patient would be wheeled down the road on a gurney. One of the people pushing the gurney would hold an umbrella over the patients face to shield them from the sun or the rain. It's either sunny or rainy here in Shell.

Dorothy Fuller was Everett's scrub nurse in the Operating Room. In most hospitals, the custodians or the nurses are responsible for cleaning the Operating Room, but not in the early days of Hospital Vozandes del Oriente. Dr. Fuller loves telling the story that when his wife was his "assistant" and he had a particularly bloody surgery, Mrs. Fuller would hand Dr. Fuller a mop and say, "You put the blood on the floor. You need to clean it up!" Dr. Fuller is sure that he is the only surgeon who ever had to mop his own Operating Room floor.

We are living the words of Jesus from the Gospel of John, "Thus the saying 'One sows and another reaps' is true. I sent you to reap what you have not worked for. Others have done the hard work, and you have reaped the benefits of their labor." (John 4:37 & 38)

Jerry

Mud Slide Slim

Since children in the jungle don't get to go sledding on snow, they still can slide down hills. Here, they go mud sliding.

The day started with the kids trying to slide on a large sheet of plastic wet down with spay water. They quickly discovered that the plastic wanted to slide down the hill with them. Since the first try was not fun enough, fast enough or dirty enough for the kids, the kids decided just to slide on the mud. It made a huge mess, grinding mud into their clothes. After they were done, they turned the bathroom into a new mud pit.

The great thing about kids is that they will make their own fun, and are usually more creative than the adults around them.

Blessings,
Jerry and Elizabeth

Premature Baby - It's Good to be Wrong Sometimes

It's good to be wrong sometimes. I thought the premature baby admitted two weeks ago was going to die. Shows how much I know. The baby at first lost weight and needed antibiotics, but now she is growing and getting ready to leave the hospital in the next few days.

Her birth weight and her Bilirubin, the chemical that makes people with Hepatitis look yellow, were horrible. She was born at 32 weeks. We have had babies 33 weeks of age die here. This tiny girl doesn't think much of numbers and statistics, she just keeps on growing and eating. When she was born, she weighed 1900 grams (4 lb 3 oz). During her first week of life, she dropped all the way to 1580 grams (3 lb 7 oz). Now she's almost back to her birth weight. She never developed any of the problems most premies develop, like pneumonia or other infections. She never ended up on a ventilator. I'm amazed.

If she can keep gaining weight and clear up her jaundice, she might get to go home to the jungle in a few days. That would be a great surprise and a time when I'll be very happy I was wrong.

Blessings,
Jerry

Premature Baby

Friday night we admitted a baby from the jungle. She was born at 7 months, 2 months early. She was the color purple, like a nasty bruise, from the waist down. Her skin was almost glassy smooth, not normal for a full 9 month baby. She weighed a little over 4 pounds.

It is a horrible situation. Her odds of survival here are really poor. Even in Quito, her odds of survival are really poor. Mom is 16 and Dad is 20. How do you explain to two children that their first child will probably die? We told them we will do everything we can, which we will, but that the odds of her leaving the hospital alive are less than 10%. Mom cried.

It's a scene we work through often. A baby with no prenatal care is born early. We work our tails off, they looks good for about 3 to 5 days, then they start spiraling down and die in a couple of days later. The whole process usually takes a week.

I find it heart breaking. One of my first questions to God, at least from this side of Heaven, would be, "Why do innocent little babies suffer and die?" I don't know the answer. I don't have any clue.

Someone smarter than me said it is because people are sinners and the wages of sin is death. He assured me that the baby didn't sin, but that because she is human, and humans sin, she suffers unfairly. It is like the students at Virginia Tech who never hurt the crazy kid who shot them, they were just the caught in the crossfire of his sin or mental illness. This baby is an innocent victim of the crossfire of human sin.

So today the little baby from the jungle with a child for a mother is OK. If she survives even a month it will be a miracle, but we have to work as if the miracle is coming, but not get our hopes up too high, so that when the worst happens, we aren't too broken hearted. The thing is, no matter how pessimistic I am, it still kills me when these babies die.

Children dying is the part of missionary medicine that I absolutely hate.

God be with you,
Jerry and Elizabeth
Koleski

Clemencia Puwanchin

Clemencia Puwanchin left the hospital today. She was a 32 year old woman I met on a malaria caravan to the jungle over two months ago. She had been sick for one year and four months; bed bound for the last eight months. She was totally blind - she could see light and dark, but not shapes or human forms in front of the light.

We brought her in with the team that went to the jungle. she had to be helped to walk to the airstrip in the middle of town. Her belly was huge, like a woman pregnant for a year and a half might look. Her community had given her up for dead, but not her husband.

We had no idea what was wrong with Clemencia until we got her to the hospital in Shell. It turned out she had diabetes. For the lack of $1 per day in medicine, she lost her sight and almost died.

We treated Clemencia's diabetes, and she started gaining weight and getting energy, but she still was blind. Our ophthalmologist came from Quito, and he operated on one cataract, and a two days later, she could see. We had to keep Clemencia and her husband at our hospital for two more weeks because her diabetes put her at risk fo infection to the eye, which would have cost her newly gained sight.

Clemencia and Jose went home for two weeks, so she could see the faces of her children, which she hadn't seen in over a year. She just came back, had surgery on her other eye, and now she has the binocular vision we almost all take for granted. She has gained weight, is doing the things she used to do, and is about the happiest patient I have seen for years.

In the Bible, the book of John, chapter 9, God tells a great story:
1As he [Jesus] went along, he saw a man blind from birth. 2His disciples asked him, "Rabbi, who sinned, this man or his parents, that he was born blind?"

3"Neither this man nor his parents sinned," said Jesus, "but this happened so that the work of God might be displayed in his life. ..."

6Having said this, he spit on the ground, made some mud with the saliva, and put it on the man's eyes. 7"Go," he told him, "wash in the Pool of Siloam". So the man went and washed, and came home seeing.

The miracle that Jesus did more than any other in the Bible was to give eyesight to the blind. It's a metaphor for how we are blind to the things that really matter in life, like God, as we chase the brass rings of physical beauty, new cars, new clothes, and all the other idols we think we can't live without. Clemencia saw all that the modern world has to offer; TV, SUVs and the latest fashions, but none of that compared to seeing her own children's faces.

It's really a privilege to have a bit role in a miracle. Here in Shell we get that privilege often. Have you thought how great it is to have two eyes? Have you thanked God for that gift? We thank God for you.

Blessings,
Jerry