What I'm looking forward to in the US

As much as I’ve loved my time here in Ecuador, I am looking forward to some things in the US. Here’s an incomplete list of what I’m looking forward to in the US:

• Electric lights that turn on every time you flip the switch.
• Toilets that flush every time you push the handle.
• Not having the fear that I will go to jail for a little fender-bender. Here, everyone in or near the accident goes to jail until the judge sorts it out.
• Public restrooms that are clean and have toilet paper.
• Not having the fear that any time you get in a vehicle it could be your last look at Earth. (The drivers here love to pass on 2 lane bridges, blind curves, and going up hills.)
• Pretzels. (There is every kind of junk food available, even Sour Cream and Onion Ruffles, but no pretzels.)
• Diet Dr. Pepper (You can’t even get regular Dr. Pepper here.)
• Tunnels that you can see in, because they have lights.
• The power is on always.
• Not having to change the propane gas tank on the hot water heater to get a warm shower.
• Drinking the water.
• Newspapers and books in English.
• News in English on the radio.
• Autumn leaves.
• Seeing as many of you as possible.

See you soon.
Blessings,
Jerry

Things I'll Miss about Shell, Hospital Vozandes and Ecuador

• · Everything within walking distance.
• · Living across the street from the hospital.
• · Getting into a car maybe once a week or less.
• · Little kiosks where you can interact with a human when you buy something.
• · Serving the very poor.
• · Shaking hands with everyone you meet.
• · Saying hello to everyone every morning and again in the afternoon.
• · So little car traffic that you can walk or jog in the middle of the street.
• · The big crime wave: some lawn chairs stolen from a porch.
• · $1 lunch, $1.30 if you go to the expensive place.
• · Knowing most everyone I deal with daily.
• · Praying at the start of every work day and whenever a patient has a crisis.
• · NO INSURANCE FORMS
• · No malpractice claims, lawyers, or threats.

Born on Third Base

If life were a baseball game, I was born on third base. There's nothing wrong with being born on third base, unless I become proud and think that I got to third base through my own efforts. Honestly, anyone who is reading this was probably born on third base, also.

For those of you who don’t know baseball, think of football (soccer) as being born getting to kick a penalty kick with no goalie trying to block the shot. It’s not a guarantee you’ll make a goal, but the odds don’t get much better.

Why do I say I was born on third base? My parents could read and taught me to read. I was born in the US, where free public education is really free. In some of the countries I have visited, "free public education" means you have to pay for uniforms, buy new textbooks every year, pay special "fees" for the teacher, computers, and miscellaneous rip offs. In the US, public education is really free and quite good.

Why else was I born on third base? Despite claims of reverse discrimination against white males, white males in the US have lots of advantages. Some people are not fond of the US at this point in time, but having a US passport gives lots of advantages throughout the world. When I go to get my Driver's License here, I don't have to pay a bribe like my national friends. Why no bribe? I have a blue passport form the USA.

I could easily have born to a family in the jungle, where my parents could not read and there are no schools, where a man has to kill or be killed, where girls are married off after their first menstrual period. (I really have delivered a baby from a 12-year-old girl from the jungle.) I could have learned a language that is only spoken in a handful of villages and precludes me from getting a job in the money economy. Those are people are born at bat standing at home plate.

For those of you following the football (soccer) analogy, jungle folk were born at the far end of the field, all by themselves, with all eleven players from the other team trying to stop them from scoring a goal. It’s not definite that they won’t make it, but it’s not likely.

I have a friend who was born in Africa to Indian parents. However, both his parents were teachers, taught him to read, instilled in him a love of education and passed on their intelligence genes as well. He didn’t have his mental development destroyed by malaria, malnutrition or military actions. My Indian/African friend was born on second base. (For you soccer fans, that’s a little outside the penalty area.)

So now that we all realize that we were born with multiple privileges… (What? You’re still not convinced?) You have access to a computer. You learned to read from your parents. You aren’t in prison or trying to survive from day to day like the folks in Zimbabwe or the rest of Africa. You can see so that you can read. You have hands that can manipulate a computer mouse. Yes, you have made the most of the opportunities God blessed you with, but you didn’t earn those blessings.

We’ll try again. Now that we all agree that we have blessings we didn’t earn, what do with do with that knowledge? I can’t tell you what God wants you to do with the gifts He has given you, but I can make a couple of suggestions:

• Share. You can share the money you make from what you do with your gifts or you can take the gifts on the road to share them with people who don’t have ready access to those gifts.
• Thank God for the gifts. If you didn’t earn gifts, you can thank the Giver daily for them.
• Avoid pride. If you could just as easily have been born to live you days barefoot in the jungle, don’t feel so smug. Really believe the phrase, “there but for the grace of God go I.”
• Share regularly. If you have money in the bank, or even loose change in your pocket, you are richer than 80% of the people in the world, so share some of that blessing every pay day. Kind of like a tithe. I know we live under the New Covenant, but tithing is one of the best ideas the Old Testament has to offer. God doesn’t need your money, but you need to give it to Him.

So now that we are all on third base, let’s get home well. Now that we are kicking to an open goal, let’s score. God is on His feet, in the stands cheering for us.

Blessings,

Jerry

What I Will Miss about Shell

You can walk on the street anytime before midnight and feel safe.

The kids can walk to their friends’ houses safely.

After 50 years of missionary presence, there is a lot of kindness and care in Shell.

The hospital really makes a difference. People come from very far because we treat them well and give good medical care.

I have patients who are good friends.

The weather is great.

The fruits and juices are wonderful.

Beautiful birds.

I can pray openly with patients.

We start every day with group prayer.

The medical students and residents are eager to learn.

The missionaries.

Getting a front row seat to see God’s miracles.

No TV, no X-boxes, and no weapons in neighbors’ houses.

The children’s friends’ parents share our values and standards.

We will miss Shell a lot.

Blessings,
Jerry

Big Urine, Little Urine

In Ecuador, especially among indigenous people, big urine is stool, and little urine (la orina chiquita, la orina pequeña) is urine. When people complain of problems urinating, the doctor has to be sure to specify which one.

Humorous story to remember this by: One doctor had an elderly gentleman who came in repeatedly saying, “I can’t urinate.”

The doctor gave him Hytrin, a medicine to help men with prostate trouble pee. He still couldn’t go. Finally, the doctor took him to the Emergency Room to put a Foley catheter in him. He starts to scream, “NO! I just can’t pee!”

The doctor remembered big urine vs. little urine and asked how many days since the gentleman pooped. It had been about 4 days. Milk of Magnesia cured him when a Foley catheter put into his bladder couldn’t.

A Grizzly Day by Mike Hardin, MD

Do you ever wonder if all your life’s training was to prepare you for one moment? In retrospect, Saturday, January 19, 2008 seems like that day.

The setting is our 30-bed mission hospital with a two and a half bed E.R., running on generator power since the electricity was out to our section of the country, with one doctor, one resident, one intern and two nurses on duty on a Saturday morning. At 10:15 AM a bus crashes and overturns on the road winding down from the Andes towards the Amazon, about a 25-minute drive from the hospital.

Six are dead on the scene. Bystanders begin loading other victims into pickup trucks, cars and eventually ambulances to be transported down the road to our hospital or up the road to others.

As soon as we realized the number of wounded arriving (eventually 23), we enacted the finely tuned hospital disaster plan: call everyone related to the hospital and then some and ask them to come help. The hospital ambulance trolled through town to find employees and bring them in.

Broken and bloody body after body came through the door and were placed on stretchers or benches in the hallway. It resembled a scene from a war movie. The amount of blood and gravity of the injuries were overwhelming. We made quick triage decisions as we decided one victim was too far gone to save – we stopped resuscitation and pushed the body to the end of the hallway to free up space for others that could be saved. The number of critical patients quickly outnumbered our medical personnel.

Four with severe head injuries were intubated and placed on our three ventilators. Short one ventilator, a patient’s mother-in-law was quickly briefed on how to keep her son-in-law alive by squeezing the ambu bag and ventilating him while we moved on to other patients. She kept it up for two hours before he was transferred.

Victims were labeled with tags with numbers and brief exam findings. Only later were people identified. Some of the injured had to identify their severely wounded or dead relatives for us.

One scene still plays in my head. A 21-year old Korean American girl wandering through the E.R. door with the entire right side of her face from her nose to her ear hanging off, exposing her skull, the skin held up by her right hand. A missionary took her off for treatment.

Everyone came to help. All of the missionary doctors, various spouses -- even the kitchen, janitorial, maintenance and administrative staff of the hospital were all enlisted in some way. Our administrator’s wife found herself shaving and prepping victims’ heads for suturing. Missionaries and staff donated blood that was immediately transfused into patients -- the closest blood bank was unable to process blood due to the power outage.

A call for help to the nearest hospital brought another five Ecuadorian doctors, among them a much needed orthopedist and general surgeon plus two radiology techs to help with the numerous x-rays.

In all, two patients died, six critical head injury patients were transferred for CT evaluation, several underwent major surgery for internal bleeding or extensive suturing and the remainder had lacerations sutured and fractures splinted or casted.

There were numerous heart-wrenching stories. An injured mother with a one-month old baby identifying her dead husband, her four nephews and nieces severely injured as well, their own mother later found dead at another hospital 45 minutes away. Another mother with her severely injured five-year old son at our hospital, her daughter in another hospital and her husband in even another one two hours away undergoing neurosurgery to remove blood clots from his brain. The American girl, severely disfigured, far from home and alone, in such shock she could only worry about her missing backpack that contained all her research data for her graduate thesis.

And there were bright spots. The incredible spirit of teamwork in a gruesome situation, the accidental transfer of anonymous patients (who ended up being related) to the same hospital, gravely injured patients whose lives were saved. I’m proud of a dedicated staff that freely gave their all to help in a horrendous situation.

The following day we airlifted seven more patients (paid for by the local ministry of health, a miracle in itself) to other hospitals for further treatment and discharged the least of the wounded, an 80-year old woman with a small cut on her forehead.

Missionaries contacted the relatives of the American girl, notified the U.S. Embassy, made lodging and transportation arrangements for the family, arranged for her transfer to a Quito hospital and welcomed her there with hospital visits by English-speakers. Another very determined missionary traveled to two separate towns, three different police stations and the regional transportation office in search of the backpack. She even searched the wreckage of the entire bus and found nothing. Eventually, in a locked storeroom in a ministry of transportation office in a town two hours away she found the backpack, still sealed with all the girl’s research data, cash, credit cards and passport. It arrived in Quito today.

I’m not sure how to end except to ask for your prayers for the numerous victims and their grieving families and for a shocked hospital staff that experienced a lot more than they ever bargained for.

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.