They come in threes---My first Subacute Thyroiditis--- September 2016

THEY COME IN THREEs--- My first case of Subacute  Thyroiditis   

   In Medicine there's a saying, "they come in three's." That's to say when one patient presents with a rare diagnosis, two more similar cases follow.  For me it's God's providence.  How best to learn a wierd uncommon diagnosis but to see it three times in a row close together.  

Last Friday Celestina was sitting in the Emergency room where I was working.  In her hand was a reference from the local health post that had as a diagnosis "Goiter" and a request for a medicine evaluacion.  Celestina, a 37 year old woman from Curahuasi, reported that a painful mass appeared on the front part of her neck a week earlier.  When I examened her she had a pulse of 97 (regularly regular), no tremor, but a soft mass coming off of the right side of her thyroid.  When I tried to place my hand on the mass to examine it she grabbed my hand and fought me so that I would not touch the exquisitly painful mass.

Her ultrasound showed what looked like a goiter with lots of inflamatory lymph nodes.  Her TSH was low, her free T4 was high. Her CRP was 60 and her ESR was 90.  I had my suspicions from the moment I touched the painful mass.  It'd looked up and ordered the recomended tests.  The results came back as expected.  I talked it over on the phone with Will, the other American FP here, for reassurance since it was my first case.  He says, I've seen one  in my life (and he's in his 40's), but it sounds like it.

In the health post Celestina had already received Diclofenac without relief, so I started treatmeant with Prednisone (steroids) and Propranolol (a betablocker to slow the heartrate).  Since Celestina lives in Curahuasi I had the rare luxary of being able to give her an appointment for Monday to see how she'd responded to treatment (most of our patients come from more than 12 hours away and it's costly to return or stay in town).

Monday afternoon Celestina sat in my exam room smiling as I was able to touch her thyroid without her feeling pain (photo above).  

Subacute thyroiditis is an autoimmune attack of the body against the thyroid gland. The first phase the thyroid is clasically very painful and sends excess amounts of thyroid hormone (free T4) into the whole body.  Then the thyroid levels in the body fall low.  And then finally the thyroid recuperates and goes back to normal function.

The treatment is steroids to lower the autoimmune attack (steroids inhibit immune response) and medicines to support symptoms as needed (beta blockers when T4 is high and thyroid hormone when T4 is low).

Wednesday Dr. Martina entered my office to describe to me one of her patients that had the exact same presentation and lab and ultrasound results.  So now we're awaiting number 3!.....

LEARNING ABOUT GOD!

    

(Above: Sophia, one of the many sunday school teachers that pour into the kids of the church each Sunday.)

Sunday school is fun and a blessing but we continue to use the patio the owner of the building where the church meets.  Please pray for a classroom for the children.  The rains have arrived early and will make meeting in an open patio impossible.

The Two Catagories of Sins of Women

Monday nights the women keep coming for crafts, community and a devotional message. We're currently croqueting jackets, making Bonzae trees with plastic beedes and plastic flower beeds (the last photo below they are painting their miniture flowerpots), and some are working on their own separate projects.

We'd been studying the book of Mark but the women have decided that they'd like to do a study about Being Women of Excellence, that I'd done with the womans group a year ago.  But only one woman is the same as the year before, so here we go.  I was inspired by a sermon that talked about the two catagories of the sins of women: comparison and perfectionism.  Most of our insecurities and daily activities fall in these two sins.  They're sins when they're motivated by what the world thinks.  But when they're motivated by what God wants and thinks of us then He is glorified.  Please pray for the work of God in the heart of each woman to put her value in what God thinks of her and not the world as we start and go through this study.

  

FIRST TIME EATING CHIPS AND SALSA

 Our discipleship group is the joy of our lives. Please continue to pray for: Maria Pilar, Andrea, Paola, Christian, Igor, Edy, Ivette, Ingrit, Xiomara, and Angie.  We can see their hunger and thrist to know God more and please him, but we also can see the world pulling at them.  Pray that they keep coming and applying themselves, and that God gives them the strength to resist the pressures of their parents, friends, and the world.  We will finish the first of four books in the Discipleship series tomorrow.

Above they are enjoying a snack of Chips (like Ruffles, it's hard to find tortilla chips even in Cusco) and salsa (homemade) after studying for 1.5 hours.  The time after the lesson eating and walking them home has allowed us to grow closer to them and enter a little into their lives.

AND THE 7th Day HE RESTED

David and I took our first "real" vacation since the honeymoon.  We took a 13 hour bus ride to Huacachina, a natural oasis located next to sand dunes where you can go sand boarding.  Like snowboarding except that you have to rub wax on the bottom of your board each time before you go down so that you slip over the sand.

 

 

DUH-dUH=DUH-duh....

Our good friend Juvenile (who worked before as a nurse in the out patiente clinic and then learned to work the XR and CT machine and moved into the radiology department in Diospi) got married a couple weeks ago.  There's is now the second marriage that has been held in the Diospi Suyana School gym.  He married to another friend of mine from church her in Curahuasi, Rosmery (who's finishing her nursing training).

THE WISE MAN BUILD HIS HOUSE UPON THE ROCK....

We just finished a lession series about "building" with the Lucmos kids.  David was incharge of a "review game" for the story able the Wise and foolish man.  This is a picture of his Wisest Man human pyramids.  His foolish man human pyramid had all little kids and couldn't build even their second level.

LEARNING TO BAKE A CAKE

Most of the homes in Curahuasi don't have ovens. Tradicionally they cook with stoves.  When they want to use an oven the go to "the ovens" and pay someone to cook their guinepig or chicken or  turkey for them.  So it's a special occacion.  In David's class he invites the children's parents to bring a cake for their birthday to share together.  But since no one has an oven, they by one and it isn't very cheap. 
   For various reasons two of David's students had birthdays during vacations and then their parents weren't motivated to send anything with them to school.  They were both sad, so David invited them over to bake their own cake.  I'm always thinking about books like, "When Helping Hurts" because there's already lots of evidence of entitlement from the people recieving so many handouts from the government and missionaries.  So when they come we let them follow the recipe and just supervise them as they make it themselves, so that with pride they serve the cake to their classmates the next day.
  Here is Freddy and Silvana baking a Nestle chocolate cake together.

Thanks for your continued thoughts and prayers!
May God continue richly blessing you!!

Playing Frisbee with arms tied together with Shoelaces?---August 2016

  Playing Frisbee with arms tied together with Shoelaces?

Our group of frisbee was up over 60 youths each week.  Our desire is to have fun but also to share with them about Jesus each week during a 15 minute break halfway through 1.5 hours of play.  The youth don't pay to play, but David said they they'll apply themselves more if there's a little cost.
  So David started weekly Challenges.  The Challenge of the week in this photo was to bring a shoelace. After the teams were formed the players tied their shoelaces together in pairs of two. If someone hadn't brought a shoelace then they where tied closer to their partner.  In order to free themselves in order to play better, each person in the pair had to recite them memory verse of the week.  This week the verse was: "This is my commandment to you to love your brother.  There is no greater love than to give your life for another."  Then the devotional message (given by Janet the Preschool teacher at Diospi, pictured above) was about friendship and choosing friends who are good influences on us.
   During the message now the youth recite their memory verse to us and through the message they're able to understand it better.  I've noticed the interest and the spiritual maturity of the group has increased alot.

Learning to Know God!

 Left to right: Upper row: Christian, Edy, Maria Pilar, Xiomara, Igor, David
Lower row: Andrea, Angi, Paola, Ingrit

  We're now about 2.5 months into our Discipleship program. Pictured above is our steady group, lacking only Ivette . Please pray for these youth (who range from 10-16 years in age).  This is my greatest joy of each week.  I feel that each one has been called specially by God, and that God has just given us this priveledge of helping them grow closer to Him.  We're on book one of a discipleship series of 4.  This book emphasizes the spiritual disciplines. We've covered: time with God (a daily devotional---which they've all faithfully started), live in the word (which includes reading the bible each day and memorizing scipture), Pray with faith (which includes documenting their prayers and God's responses to their prayers), and currently we're in the section about Fellowship with other Believers (which talks about regular attendence in churches as a way to love and serve our brothers in Christ using our talents and skills that God has uniquely given each of us).
   This week I asked them, how many of their feel that their faith has grown and feel closer to God since starting the study...and all their hands went up.
  Please pray for Igor. David and I were praying and talking about him this morning during our daily run.  I feel like he's our potential "Judas" of the group---someone who's motives aren't completely pure.  I feel the words he says give them impression that he's not here to personally know God (in spanish, "conocer") but thinks being Christian is about knowing about God (in spanish, "saber").  Pray for his heart, that God changes it and that we can begin to see some fruit.
  Please pray for each one by name.  They are each so precious to each, so hungry and thirsty to know God, but I feel like a shepherd sending my sheep out among the wolves.  They live in a tough world.  Christian, is 16-years-old and finishes highschool in December 2016.  His plan is to move to Cusco and study in an University.  Pray for him and the many temptations of women and other things that he will encounter there.  His mother is VERY Catholic.  Pray that God helps him establish a solid foundation of searching for truth and God's will through reading and knowing the Bible.

 I can SEE!

  Ivette is in David's fifth grade class and also in our discipleship group.  Every Saturday David motioned for me to watch Ivette read the scripture that we ask her to read.  I observed as she held the Bible one centimeter from her nose to be able to see the letters.  She had glasses that she never used.
  So we talked to Dr. Ursula the opthalmologist here to give her an appointment. She messured her eyes.  Then Ivette went to find frames that she liked.  I had another commitment, so I left her there with her mom and Amerigo (the Otomotrist).  Afterwards we asked about the frames she'd choosen.  "Box frame and white," she informed us. "And do you like them?" I asked. "No," she replied.
   David and I talked afterwards.  Why had she choosen lense that she didn't like. I figured that we'd just have another pair of glasses that she never used. I talked to Amerigo and he said that he'd only offer for her to choose from lens in the donation section.  Since we had offered to pay for her lens I said to let her pick from the for-sale section too.  So she came back with her mom and  we found a nice thin frame that complemented her face.
   That Friday Ivette's glasses were ready to pick up.  The next day in our Discipleship group, for the first time she was the first everytime to raise her hand to read something!  She was so happy that she could finally see!

Curahuasi is a Small Town

Curahuasi is a small town and that means everything is conneted. One Saturaday morning we awoke to the doorbell ringing at 6 AM. We answered the door phone and it was the mom of Maria Pilar (in David's fifth grade class) and Andrea (in Davids 7th grade math class), two of the girls in our Sunday school class and in the discipleship class.  I went down to the door to see what was wrong.
  In tears their mom, Soledaridad, and her sister-in-law explained that they had finally brought Saldaridad's brother-in-law (the wife of the other lady) to be evaluated.  He already had a pathology report diagnosising him with cancer of the bladder.  He was bleeding and his Hemaglobin was 5.  He had just recieved 5 units of blood in Cusco the other week.
  The Peruvian Urology resident from Lima was on call and had honestly told them that treatment for cancer was in Lima.  The family didn't have money or family in Lima and didn't want to go.  Unfortunately the people don't trust their own countrymen, and so they traveled across town by foot to beg me to let him stay.  I talked with them about the reality of our resources and said that they should talk honestly with the resident.  So they convinced the resident to admit the patient and trasfuse 3 units of blood.
   Monday morning we talked about the case all together. That week Dr. David, the German Urologist, did a cystoscopy and found a huge bleeding cancer. He cauterized it the best he could.  He atleast was able to cut back the bleeding significantly.  David said the patient needed a bladder resection, which would have to be done in Lima.
  Over a week later Maria Pilar and Andrea's uncle is still admitted and they're trying to convince the family to go to Lima.  Their uncle is not a believer, so this has given us several opportunities encouraging the girls to share their faith with their uncle.  Please pray for this situation.

Summer 2016

Dear Friends and Family!

    I was blessed with the chance to share with many of you during my visit to the states.  But David and I were wanting to send you a collection of photos from various events and groups ranging in time from January 2016 until present (July 2016).  ENJOY!!!

Following the Cloud--- Ari's Spiritual Growth

              Numbers 9:17-18, “Whenever the cloud lifted from over the sacred tent, the people of Israel would break camp and follow it.  And wherever the cloud settled, the people of Israel would set up camp.  In this way, they traveled and camped at the LORD’s command wherever he told them to go.  Then they remained in their camp as long as the cloud stayed over the Tabernacle.”

              This is the lesson that God is teaching me these days. I’ve been practicing medicine in Peru the last 2.5 years with an American medical license and a temporary Peruvian license.  But now in order to comply more with Peruvian laws, the Diospi Suyana Hospital board of directives has decided to make it mandatory that all doctors practicing in the hospital more than 6 months either have a Peruvian medical license or at least have their application “in process.”  The requirements are a headache and subjective.  What they required of me they didn’t require of Will the other American doctor.  Will turned in the same things as one of the German doctors, but they rejected his application and gave him a list of additional documents they wanted (all original documents with lots of stamps and signatures).  The first deadline was June 30^th. 

              Because of God obviously working and a lot of help from friends and family in the States I turned in all my documents July 1^st, and am officially “in process.”  But when I turned in my documents I realized the “Doctor of Osteopathic Medicine” is unknown in Peru.  The secretary at the Peruvian medical school informed me that the school had rejected the application of another American D.O. previously.  I knew there’s countless countries around the world, rich and poor, that accept the D.O. title as equivalent as the M.D. title, but I had forgotten to check if Peru was one of them when I accepted the position in Peru.  So now I checked.  Columbia, Chile, Brazil, etc all of these countries around Peru accept it, but Peru…no.  I said to David, “I don’t know why it didn’t occur to me to check the list before I came to Peru”.  David responded, “I’m glad you didn’t.”

              That week before we went to Lima, and even now I feel like I don’t even know what tomorrow will bring.  I told David, that my entire life I had my life planned out at least 1 year if not more.  But now I don’t even know if I’ll be here for another day.  As soon as my application is rejected I can no longer work at Diospi.  But God is faithful.  One of the sermons I was listening to as I ran in the morning mentioned this picture in Numbers of Gods desire to guide us step by step, day by day.  And so in child-like trust I and We keep pouring ourselves into the work God gives us each day.  We’re really putting all of our hearts into our new discipleship group, even though the trajectory is that it will last a year and a half.  I feel like Satan wants us to hold back because of the uncertainty of how long we will be here, but I hear God whispering, THIS is how my kingdom will grow here in Curahuasi.

My life mission - - David’s Spiritual Growth
Romans 10: 14-15 " But how can they call on him to save them unless they believe in him? And how can they believe in him if they have never heard about him? And how can they hear about him unless someone tells them?  And how will anyone go and tell them without being sent? That is why the Scriptures say, “How beautiful are the feet of messengers who bring good news!”

At 19-years-of-age, after visiting some Christian camps and to continue growing in my spiritual life, I felt called to serve God in missions.  So decided to leave my university studies, but my mother said no.  Nine years later, God has sent me into missions using my career.

 

The Civil Wedding….The Religious Wedding…And Cancun!

The civil wedding in Lima.  Upper: judge, Yolanda (David’s mom), me, David, Rebecca (David’s cousin).  Lower: Me, Yolanda, David.

Upper two: Religious wedding.  Lowest: We went to Cancun, Mexico and I was in heaven because all of their hot sauces where actually spicy (unlike Peru).

Searching for Danny….FOUND!

Danny, David’s 11-year-old student, ran away from an abusive family.  Uppermost: Andrea, one of David’s students helping on one of the search parties through the villages surrounding Curahuasi looking for Danny.  Lower: Danny, a hyperactive, fun-loving kid playing on the swings at the Diospi Hospital.

Left: Christian (the German school director), Danny, and Caroline (the social worker who was a friend to Danny and came back from Germany to find him---and found him).  Right: David’s class, the classmates of Danny after he was found a month later in an orphanage one hour away from Curahuasi.

              After Danny was found, him and his sister were both placed in a Christian orphanage an hour from Curahuasi where his friends and classmates can visit him.  Danny was thriving in the orphanage away from an abusive home situation. When they found him he was actually doing his homework and had gained some weight.

Mother’s Day

David strongly believes in Sunday school, because the kids eventually bring their parents.  For Mothers Day many of the children who come to Sunday school alone brought their mothers to a special Mother’s Day service and breakfast at the church.

It Didn’t Rain this Year

The heaviest rains are usually in December through March.  This year it hardly rained.  Though it means I’m less muddy after running, for the people it means that they might not eat this year.  Above is a picture of the cornstalks we run by each day.  They never even grew enough to produce corn.  Please pray for the people who mainly rely on agriculture for a living.  They are crying out to their government for help when they should be crying out to God.

Two Worlds Apart, But Closer than it Seems in Age --- American High-schoolers

              A group of American High-schoolers came for a week to serve the community here.  They held a day long event one Saturday.  They invited several youth groups in town as well as our Ultimate Frisbee group.  Even though to our group the Americans looked a lot older than them, they were about the same age.  The American group ranged from 15-17 years old.  Through out the day the Americans presented various activities and messages to the teens about Jesus.  They all had a great time!

The American teens also taught in Sunday school the next day.

And then they shared again during Ultimate Frisbee Wednesday.

Women: Living, Loving, and Playing!

              Monday nights the women keep coming J It’s a time to connect, knit, crochet, cook, do other crafts and study the Bible together.  This year the break down has been one hour of crafts/activites and 30 minutes studying the Bible.  We’ve been slowing reading through Mark this year, story by story, responding to the questions: 1) What happened? 2) Why? 3) How does this apply to me? (with some variation).  My desire and hope is that they learn to actively read the bible and listen for what God is telling each of us.  Because we open with crafts, there’s been more time to talk and get to know the women and relax.  We now have a faithful group that continues growing each week because the enjoy the environment and learning new crafts.

Above: Karla (a doctor from Bolivia), Damaris (the psychologist), Ruth (custodial worker in the hospital, and her son, Igor, is in David’s class and in our discipleship group), Yulisa (works in the Diospi lab, her daughter Paola is the little girl in the picture), Pricilla (a 2^nd year internal medicine resident from Switzerland), me, Maria (the mom of Katerina, a girl who started coming to the women’s group over a year ago and then started bringing her mother), Sarah (below me, the sister-in-law of Maria).

Above: Mary Cruz (the wife of the Peruvian co-director of the Diospi School), Karla, me, Elizabeth (the 2^nd grade teacher at the Diospi school), Hipolita (a nurse in the Diospi school), Yulisa (face hidden), Katerina, Paola.

Cleaning Up Curahausi---!Lister, you just collected the garbage from your house!

The Diospi Suyana school had a “Clean up the Community” day. Each student was given a large garbage bag to fill up.  Lister (a energetic student known by many in town), showed up with trash from his own house! :)

Camping…is Marriage counseling?!!

I’ve been studying with Rossmery for years now, though not always every week like before.  But now we’re studying with both her and her “husband,” Rafael.  Sometimes at our house sometimes at their house.  Through this study God has given me Rossmery as a good friend.  Of all of the nurses (she works mainly in physical therapy in the Diospi hospital), I feel like she’s one of the few who feel at least as much compassion as I in the hospital. You don’t have to be a Christian to work in the hospital, and for that reason work-ethic varies from worker to worker.  I can’t do everything as a doctor, and especially with my Quechua speaking patients, but I can always depend on Rossmery to do the very best for the patient with lots of patience and love.  David has gotten to know Rafael, and they play soccer together Friday nights.  The picture above is of Jose (their 6-year-old son) and Rafael in the background.  Us five went camping together to a nearby hot spring during Easter weekend. David and Rafael went midnight fishing while the rest of us slept a little.

During Ari’s trip to the USA….David adopted a son!

Me, Elysia (my youngest sister), a friend and Shalina (the oldest of my younger sisters) at a Mariners game!

              In Abril and May I was in the USA for 2 short weeks.  Visiting and trying to “get stuff done.”  Thanks to every single person who opened their home, and shared a meal or a moment with me.  I was very blessed.  There’s nothing like a 1.5 years outside of your country to make you really miss the American people and culture.  Thanks all for being crazy Americans like me.  There’s no other culture like us J!

              While I was in the states, David invited Frank Yohan to stay with him for a week.  Frank Yohan was held back last year and now is in 5^th grade again, but this time with David.  Frank Yohan is one of those kids that lacks motivation or desire to succeed.  He’s the youngest of 5 siblings---all the others are out of the house and one in jail.  His father is in Argentina. His mom makes her living selling Chicha (a homemade alcoholic drink).  Frank Yohan’s skills include: climbing trees to pick off fruit, playing marbles, Ultimate Frisbee and forward flips.  His weaknesses include: thinking before acting, empathy, doing his homework, concentration, attention, critical thinking, and comprehension.  He’s at the point of failing again and getting kicked out of Diospi.  So David thought a little more attention and accountability would help him.  But sometimes we don’t see how God works or if God works.  Frank Yohan is struggling and the only thing that can help him is a new heart.  Please pray for Frank Yohan.

One of Frank Yohan’s homework assignments while with David was to make a homemade guitar.

The FIRST Ultimate Frisbee Tournament in Curahuasi! (told by David)

"Ultimate Frisbee" What is that? This sport was first played in mid-2014 here in Curahuasi among a group of friends and missionaries.  Gradually it gained popularity.  This last year we’ve had approximately 50 people---including children, adolescents, and adults---every Wednesday coming out. So we said let's organize a championship.

We chose captains and formed seven teams of seven players.  We had the shirts designed and made in Lima.  We made reservations for the municipal stadium, etc...
And start playing (18 June 2016).

It's amazing how God is using this sport to create communion between children and adults, Peruvians and foreigners, Christians and non-Christians--- all coming together to be part of this event.

After a day of frisbee (each team played each other team once, six games in all) and a time of meditation on the Word of God, the results of the championship were given:
-- In 2nd place, team green holding the silver trophy.
-- In 1st place, team black holding the gold trophy. It is worth noting that it was a team of six players and one of the six was the littlest player (Gorki, 8 years).

The Lucmos Kid’s Club---The Life of Jesus

Thursday afternoons we continue to teach the children of Lucmos (a village nearby).  We just finished teaching the life of Jesus. Our time with the children includes games (upper left), songs (upper right), and a story (lower left), which the kids often times help us act out (here the story of the four friends who lowered their paralytic friend through the roof to Jesus to be healed.

Project’s Week: Sources of Energy (told by David)

Project’s week is a week in which the students of Diospi leave their regular classes and explore the world in a practical way. My theme was "Sources of Energy."  No person can create energy; but with God all things are possible. THEREFORE: God created the energy---this is the conclusion at which my students arrived.

Several of the missionaries helped out with my project: Physics Prof. Helmut (Germany) and engineer Marcus (Germany).

We visited Hospital Diospi Suyana’s solar panels, where students observed how solar energy can be transformed into electrical and thermal energy.