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.

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