Hospital Closed: On Strike

Kinda crazy, but true.  The government hospitals in Cusco and Abancay (the two nearest cities) are on strike. Probably related to wages or work hours or something along those lines.  It complicates our jobs because when we need specialists or CAT/MRI that’s where we send our patients.  Technically the hospitals are still seeing “emergencies.” (whatever that means).

    I have a patient, Policarpo, who arrived at our hospital Friday with his brother and family friend.  He’s in his 40’s, maybe has some sort of baseline metal delay, but presented almost completely unresponsive.  He’d been admitted at the hospital in Abancay for 3 days with “preseptal celulitis.” (Infection of the superficial area of the eye socket).  His family reported that prior to this illness he was working in the field, but since the onset of this illness he’s been bedbound and incontinent of urine and stool.  According to the discharge papers he was clinically improving so he was sent home on oral antibiotics.  No CT scan was ever done, supposedly.  (Most of our history comes from the family, so culturally you have to ask questions at least 3 times, and sometimes even then they won’t tell you everything or the truth).

  His family says he was throwing up to antibiotic, bedbound and barely responsive so they brought him to us.  He laid on the stretcher nearly dead looking, but if I yelled “What’s your name?” in Quechua, he’d open his eyes a crack and move his mouth as if he was going to answer, but nothing would come out.  His GCS was 9 (a way of measuring neurological responsiveness.  15 is normal. 0 is dead. 8 or less you should probably intubate to protect them against aspirating.)  His labs weren’t super impressive, WBC 8, CRP 10.  But clinically he looked bad.  He still had a red swollen perioribal area on the left with a fluid collection on ultrasound. He needed a CT, but our new one is still stuck in customs in Lima, and we weren’t confidant he’d make it Cusco, especially since they’d spent most of all of their money on their 3 days in the hospital in Abancay. 

                So I admitted him for Orbital Cellulitis on Cetriaxone, Vancomycin (which was a debate, because its expensive and I’m not sure of the prevalence of community acquired MRSA in Peru, though its recommended for patients in the USA), and Metronidazole.  By the next morning his GSC was up to 12. By Sunday he was consistently at 14.  Yesterday he was consistently 15.  But he still continues with profound debility and incontinence.  Since he’s been alert enough to talk, in Quechua he complains of pain when he moves his eye (I say “in quechua”, because once you go through 2 language barriers, I start doubting whether or not we’re talking about the same thing anymore).  He still really needs a CT to rule out abscess or any sort of intracranial process.  We never performed a spinal tap, because we didn’t have a CT first.  He’d received 5 days of IV antibiotics today and the plan was to send him to Cusco for a CT, but after talking it over with Martina, we’re really afraid he’ll get lost in the system because the hospital is still on strike and the family doesn’t have any money.  So we kept him on for a couple more days of IV antibiotics, ambulation and physiotherapy.

                Please pray for Policarpo and his recovery.  Pray for wisdom on when to send him for a CT.  Pray for our CT to be released from customs.  Pray for our X-ray machine which broke 2 weeks ago (we were without x-rays for a week, and now were using old schools films [thank the Lord for them] until the digital machine is fixed).

Luz and and Angel's Kiss

Luz has been one of the Lord’s sweetish blessings to me since I’ve been here in Peru.  For those of you who know Sylvia Park, her personality and spirit are similar to that of Sylvia.  Luz is general medicine doctor from Lima.  Their university/medical school in Peru is 5 years.  The final year is like our intern year of residency.  Afterwards they have to serve in a rural community for a year.  This is Luz’s rural year, and it’s nearly at an end (she finishes in the end of this month). Afterwards if she wants to specialize she can take an exam that is offered once a year in June. Whoever gets the highest score gets first dibs at choosing a speciality/residency spot.  To practice general medicine there is no residency program.  Family Practice doesn’t really exist here.  There is a specialty “family medicine” here, but the doctors are only trained in preventative medicine, not in ob/peds/ inpatient, etc.

   Luz has a super sweet spirit and she’s everyone’s friend.  She reminds me a Sylvia because she’s way more into fashion then I’ll probably ever be in a million years (I can’t even remember what I wore yesterday), and she takes pictures of food after it’s been made (just like Sylvia).  She loves to cook too.   Anytime she ever tries anything I always know she’ll be asking how to make it before the days over.  One time she had a patient’s family that was giving her a very hard time until she was in tears even though she’d given appropriate medical care.  Even a day or two later she was still really feeling down about the case, so Martina told me that I should do something fun with Luz over the weekend to cheer her up.  So I invited her over for pancakes (which she loves) and Frozen (which will make anyone laugh). I made one pancake in order to show her how and let Luz make the rest (and mine was the worse looking one of the bunch).  To Luz, of course the making of the pancakes was the best part of the night.

   You can be praying for Luz.  She’s a Christian, loves God and desperately wants to do His will; she’s just not sure what it is.  She’ll go home to Lima at the end of this month and has to decide what she “wants to do with her life.” Of course I’m encouraging her to come back and work at Diospi for at least another year or two while I’ll be here  J  I can’t imagine Diospi without her. L

This is a type of Hemangioma called an “Angel’s Kiss”.  You can tell why.  We see a lot of hemangiomas here.  Many much more disfiguring than this.  A hemangioma is an abnormal growth of blood vessels that people are born with.  Sometimes you can operate them, but they often times grow back.  Even in the USA there’s not very good treatment options for this.  This picture is a happy case.  Just a cute birth mark.  The sad cases are the 20 year guy who comes with one leg larger than the other and full of the abnormal blood vessels, who cried out of disappointment and hopelessness because we had been his last hope (unfortunately the Hospital has been marked as the Miracle Hospital.  So all too often people come looking for miracles.  Which is great when God answers our prayers, but kills me when God’s answer is “no” or “not now.”)  Please pray that God continues to work miracles here so that the people can see Him and yearn to know Him personally.

Samana Santa

         

Semana Santa (i.e. the week of Easter) is a big event here due to the huge Catholic influence.  The hospital clinic was closed bother Thursday and Friday so we had a 4 day weekend.  Unfortunately this is a much celebrated time of the year because its time of drinking a lot of alcohol.  The Peruvian church I’m attending in town decided to use this time to have a revival for a church in a small village called Puka Puka (where the members of our church take turns teaching each Sunday).  This village is an hour walk up the mountain that looks down upon Curahuasi.  Puka Puka is known as a community where all the men work all day in the fields and then at night drink and beat their families.  The kids are pretty much on their own.  Each afternoon we had kind of like a VBS for the kids for three hours and then we had something for the adults afterwards.  One night they showed the Jesus film in Quechua.  That night was our biggest turn out of adults.  And afterwards many of the adults committed or recommitted their lives to Christ.

                Several of the kids also gave their lives to the Lord.  We had fun with them and taught them how to throw a Frisbee and attempted to teach them how to play ultimate Frisbee. J

                Seeing how hungry and open the people were to redirection my heart was renewed as well that weekend.  The next week I felt so much more intentional during my patient encounters.  One of my patients came back a couple days ago and said that he and his daughter had been moved by our encounter, had converted from catholic to evangelical (i.e. all non-catholic, non-Mormon, non-Jehovah Witnesses Christians in Peru) and came back to the hospital to ask to be baptized.

                A couple days ago I had a lady come worried about a “wound” on her cervix that she’d had for 3 months.  She’d had a normal colposcopy, pelvic and vaginal ultrasound 2 months earlier by our gynecologist.  After 30 minutes of talking I finally realized that she’d had a spontaneous abortion 3 months ago, and therefore she thought that that had caused the “wound” on her cervix, she’d had a slightly irregular period (likely due to stress), saw some Peruvian Gynecologist who told her that she had a “wound” on her cervix that was growing and now she was scared to death she had a cancer and was going to die (the Peruvians have very unrealistic and irrational fears about cancer, and the young people think they have a cancer.  I’m not sure what propaganda is out there, but it’s probably contributing towards their fears).  When I realized all of these misconceptions she had I was finally able to educate her and calm her fears.

                Please pray that I continue to be renewed and seek God’s guidance to know what patients are really seeking and needing when they walk in my door.

My Testimony

Each weekday at the hospital begins with a 30 minute chapel service with all the patients, their family, and the hospital staff.  I was asked to give my testimony.  I used to think a testimony was the story of how a person came to Christ.  I've since realized that our testimony is just a declaration about what God is doing and has done in our lives.  So now I have a million testimonies because God's constantly growing me.  So when I give my testimony now I try to pick one that hits home with what my audience is struggling with.  Here's the testimony I gave in Spanish (the English translation is also included):

Me llamo Ari.  Soy de los Estados Unidos.  Yo he sabido del Señor por casi toda mi vida, pero yo conocí al Señor personalmente desde los 15 anos.

                Hay una película nueva de mi pais que es una ilustración perfecta de mi testimonio sobre mi crecimiento en Cristo.  Esta película se llama Congelado o Frozen.  Es la historia de dos hermanas que eran buenas amigas.  La hermana mayor, Elsa, tiene poderes especiales y puede hacer hielo y nieve de la nada. Una vez, cuando era una niña, ella golpeo accidentalmente a su hermana con su magia y casi la mato.  Elsa estaba advertida que pueden salir cosas buenas de su magia, pero si ella no aprendía cómo controlarla, también pueden salir cosas malas.  Después, ella tuvo mucho miedo de hacer daño a su hermana otra vez.  Mientras iba creciendo su vida fue dominada por el miedo.  Cada día ella trataba de controlar su magia y ser “buena persona.”  La incapacidad de controlar su magia causo en ella el miedo a seguir creciendo.  Un día ella perdió el control completamente, y dominada por el miedo empezó a hacer daño a otros sin darse cuenta.  El amor incondicional de su hermana finalmente derritió el corazón de Elsa, y ella aprendió que era capaz de controlar su magia por medio del amor. Cuando más trataba de ser buena, mas estaba su vida controlada por el miedo, y el resultado fue malo.  Pero cuando ella estaba llena de amor para otros, ella era libre y el resultado era bueno.

                Este es mi testimonio.  Cuando era niña, yo asistía a una iglesia, oraba a Dios, leía la Biblia, y creía en el Señor.  Pero, incorrectamente yo pensaba que no podía comprometer mi vida públicamente a Cristo hasta que yo sea lo suficientemente correcta.  Yo luche con toda mi fuerza para ser lo suficientemente buena, pero descubrí que esto estaba fuera de mi control.  Como Elsa, mi vida estaba controlada por el miedo de meterme en problemas, perder el respeto y decepcionar a otros.  No era libre.  Cuando por fin yo di mi vida públicamente a Cristo en bautismo a los 15 anos, mi vida cambio.  Gracias al poder del Espíritu Santo dentro de mí y por medio de otros cristianos que el señor trajo a mi vida, yo aprendí que nunca puedo ser “perfecta” por mi misma.  Solamente por medio del poder del Espíritu Santo podemos ser capaces de agradar a Dios, conocer su voluntad, y desear hacerla.  También aprendí que ser cristiano no se trata acerca de ser bueno.  Se trata acerca de conocer a Dios personalmente.  Se trata de conocerlo tan bien que pueda confiar en El en cada momento de mi vida. Se trata de amarlo tanto que anhelo obedecerle y hacer su voluntad. Se trata acerca de tener una relación tan cercana con El que su amor por cada persona que El creo en el mundo se derrame dentro de mi corazón.  Se trata acerca de mirar e interactuar con gente que no conozco y sentirme emocionada con su amor por ellos.  Y como se dio cuenta Elsa, el resultado de este amor es la perfección que estaba tratando de hacerlo yo sola sin éxito.

                Yo les comparto mi testimonio porque cada día yo hablo tanto con ustedes que me dicen a mi la misma cosa: Ustedes saben Jesús.  Pero sus vidas están controladas por el miedo.  Miedo de enfermedad.  Miedo de perder a sus familiares.  Miedo de falta de trabajo y comida.  Miedo de que no sean lo suficientemente buenos para Dios.  Pero este es mi testimonio a ustedes.  El miedo es lo opuesto del amor, y la evidencia de conocer verdaderamente a Dios es su amor.  Antes yo vivía una vida controlada por el miedo, pero hoy día vivo con la libertad de conocer verdaderamente al Señor y de tener su espíritu santo dentro de mí.  “Mas el fruto del Espíritu es amor, gozo, paz, paciencia, benignidad, bondad, fidelidad, mansedumbre, dominio propio.” Gálatas 5:22-23.

                Todos los días sigue creciendo mi confianza en el Señor.  Estoy aquí en Perú en Diospi hoy día porque tengo confianza que el Señor me llamo aquí para amarlos a ustedes.  Y tengo confianza que El va a cuidar de todas mis necesidades.  Confío en su promesa de Mateo 6:33: “Mas bien, busquen primeramente el reino de Dios y su justicia, y todas estas cosas [por ejemplo, la comida, la ropa, la casa, la salud] les serán añadidas”.  Y nada me da mas gozo que mirar a cada uno de ustedes acercarse a Dios y confiar también en nuestro fiel Salvador. Gracias por su atención.

My name is Ari.  I’m from the USA.  I’ve known (saber) about the Lord most of my life, but I’ve known (conocer) the Lord personally since I was 15.

                There’s a movie that recently came out in the US that illustrates perfectly my testimony about my growth in Christ.  The movie is called Frozen.  It’s about two sisters who had been good friends.  The older sister, Elsa had special powers and could create ice and snow at will.  One time when she was a young child she accidently struck her sister will her powers and nearly killed her.  She was warned at that time that much good could come from her powers, but if she didn’t learn to control her powers, much evil could come from them as well. She became very afraid that she would hurt her sister again.  As she grew up her life was ruled by fear.  She daily tried to control her powers and be “good”.  Her inability to control her power caused her fear to grow and grow.  Until one day she completely lost control, and controlled by fear began to hurt others without realizing it.  The sacrificial love of her sister finally melted Elsa’s heart, and she learned that she was able to control her power through love.  Before the harder she tried to be good, the more her life was controlled by fear, and the product was evil.  But when she was full of love for others, she was free, and the product was good.

                This is my testimony.  When I was young I went to church, prayed to God, tried to read the Bible and believed in the Lord.  But I incorrectly thought I could not publically commit my life to Christ until I was “good enough.”  I tried so hard to be good, but found I was not in control.  Like Elsa my life was ruled by fear of getting in trouble, losing face, and disappointing others.  I was not free.  When I finally gave my life to Christ publicly in baptism at 15 yo my life changed.  Through the power of the Holy Spirit within me and through other Christians the Lord brought into my life, I learned that I can never be “good enough” on my own.  Only through the power of the Holy Spirit are we capable of pleasing God, knowing his will, and desiring to do his will.  I also learned that being a Christian isn’t about being good.  It’s about knowing God personally.  It’s about knowing him so well that I trust him in every aspect of my life.  It’s about loving him so much that I long to obey him and do his will.  It’s about having such a close relationship with him that His love for every single person in the world that he personally designed and created overflows into my heart.  It’s about seeing and interacting with people you don’t know and being overwhelmed with His love for them.  And like Elsa realized, the product of this love is the “good” that I’d been trying unsuccessfully so hard to do on my own.

                I share this testimony with you because every day I talk to so many of you who tell me the same thing.  You know Jesus. But your lives are controlled by fear.  Fear of disease. Fear of loss of relationships.  Fear of lack of job and food. Fear that you’re not good enough.  But this is my  testimony to you.  Fear is the opposite of love, and the evidence of truly knowing God (conocer) is His love.  I used to live a life controlled by fear, but now I daily live in the freedom of truly knowing the Lord and having His Holy Spirit within me.  “ and the fruits (i.e. product/evidence) of the spirit are Love, joy, peace, patience, kindness, goodness, faithfulness and self control.”

Every day I continue grow in my trust of the Lord.  I have left my friends, family, country, job, culture and home to come serve you here in Peru.   I’m here today because I trust that the Lord’s called me here to love you, and that he will take care of all over my needs.  I trust His promise in Matthew 5:… Seek first the Kingdom of God and all these things (food, clothing, housing) will be added unto you.  And nothing gives me greater joy than watching each of you learn to trust our Faithful Savior as well.

[As a footnote, in the Spanish version I use their two different words for "to know".  "Saber" which means "to know" as in book knowledge, but without a personal encounter.   "Conocer" means to know personally; to "know" because you met them or personally went to a place.]