Photos

 View of the hills I run each day from the hospital.

 The hills and sky behind part of the hospital.

A view of Curahuasi from part way up the Miradoras (one of the surround peaks/hills). The heavy cloud cover makes the mountains appear shorter than they really are.

The Value of a Good Education

                Education is valued as much among our youth in the USA compared to many other countries of the world I’ve visited.  In countries like Peru where there is a stark difference between the three classes: the rich, the poor and the very poor, education is a way out.  It’s not uncommon in the government schools for teachers to not show up, not have plans, or to have frequent and lengthy breaks.

                To address this need in the Curahuasi area, Diospi has started a primary school (i.e. elementary school).  The missionary kids will attend, but so will the Peruvians kids.  It’ll be in Spanish.  All the professors are Peruvian, except for the English teacher.  To desire is to raise the standard of education of the Peruvians here.  The school is almost done being built. The Peruvian school year starts in March.  Already 200-300 students are enrolled.

                Several needs remain.  Number one, they’re not found an English teacher yet-----so if you’re interested let me know, otherwise please pray that they find one.

                Number two, it’s a private school.  Those who are able to pay will have to pay monthly school fees.  In order to allow the poor to attend as well Diospi is looking for ~70 people interested in sponsoring a child.  Sponsoring a child would entail donating $55 per month (which would mostly go towards the teachers’ salaries) and in return you would be assigned a picture and information about the child you’ve enabled to attend the private school. 

                Please be praying that God is glorified through this school, they will find teachers to fill the few positions that are still open, and that the construction process will be completed on time.

A desire to gain weight

                It’s super ironic. The common theme both among friends and my patients in the States is a desire to lose weight and stay slim.  Here it’s the opposite. Everyone one wants to gain weight (even those I think look on the heavier size).

                I had a 25yo Quachua lady present 2 days ago with the usual million complaints (stomach pain, acid reflux, bloating, headache).  She also complained of weight loss despite extreme hunger and thirst.  She said she ate so much, but though she’d been 50 kg 2 years ago, now she weighed 39 kg.  I ran couple labs including thyroid tests (her heart rate was 105) and urine (because she complained of a little dysuria). Everything came back normal except for her urine had 2+ glucose.  She had already eaten and we were still awaiting reagents for HA1C test to arrived, so I had her come back the next morning to have her fasting glucose checked….  It was 291.

                I had to talk over the best management approach with Kirsten, one of the other docs here due to the complexity of her social situation. She’d come from far away. She was Quechuan (still wore the traditional dress) and so likely didn’t have a lot of money or easy medical care if she was to have complications of treatment, such as hypoglycemia (low blood glucose)---which is common with insulin therapy.  Based on her young age and thinnest she was likely a Type I Diabetic (i.e. diabetes related to an autoimmune attack against and destruction of the pancreatic cells that produce insulin).  Because it’s a problem with insulin production Type I diabetes need insulin replacement. [Whereas Type II diabetes is an issue of cells requiring high levels of insulin to stimulate them to take glucose from the blood into the cells and use it for energy.  There are various pills that T2 Diabetics can use to help their body require less insulin and utilize more of the insulin already present in the pancreas.  But theoretically these pills, though cheaper and more convenient than insulin shots, will not work for T1 diabetics.  But do to how dangerous and complicated it is to send the Quechua home with insulin and glucometers to check their glucose several times a day due to their limited access to immediate care during and emergency due to money and distance most of the doctors at Diospi try a trial of oral (ie pills) meds [evidently they’ve found that there’s often a mixed picture between T1 and T2 Diabetes and pills, diet, exercise help even the Type I’s for while].

                So I admitted my patient for trial of medications and education and fluids.  I prayed with her that her body would respond to the pills (I gave Metformin 850 three times daily and a sulfonarrhea that we don’t have in the USA 5mg twice daily).  Our prayers were answered.  Her 2AM glucose was 132 and her fasting glucose before breakfast was 171.  Her thirst resolved and her heart rate came down to the 60’s.  I then sat down with her later in the day after the nurses had had a chance to educate her on what she could and couldn’t eat and quizzed her to see how much she had retained of the teaching that she’d be able to take home and apply.  Her mom was present but her Spanish wasn’t very good, so she missed part of the conversation.  A nurse who spoke Quechua walked up, so the mom asked if her daughter could drink “gasseosa” (i.e. Coke /soda/soft drinks—depending on the part of the USA you’re from) J I guess she missed the core of the education

Mountains

I’m in my second week at Diospi!  There are two types of mountains that are common here.

The first are the physical mountains that surround the hospital.  The Mirador is one that we climbed this last weekend.  It’s about a 3 mile hike to the top and the great hope of all who climb it is that you can see the taller snow-capped mountains on the other side—which is dependent on whether or not its cloudy.  Unfortunately, during the rainy season here (i.e. now) its not just a matter of looking out your window and realizing its going to be a cloudy day.  Today is a classic example.  This morning when I awoke it was thundering and pouring.  Midday the sun was shining, blue skies, about 70-80 degrees F.  Now at 5p its overcast, thundering , pouring again, and about 50-60 degrees.  So it was rainy and overcast when I awoke Saturday morning. We postponed the hike for an hour hoping the clouds would burn off.  It was overcast (but less so) and not raining when we left.  It was chilly, rainy and overcast when we reached the top, and it stayed that way.  Until way later in the day—long after we’d returned from the hike-- about 5 or 6pm when it was bright blue skies and you could see the snow capped mountains.  Though ironically, despite being overcast, rainy and 50 degrees-ish, nearly everyone who went and wasn’t wearing a hat had red painful necks and faces that night at game night J (supposedly the atmosphere is the thinnest in the whole world in Cusco—thinner than even Australia. Plus the elevation is so great---so you sun burn much more easily). 

The other mountain here is distance and resource barriers.  I started seeing patients Monday.  One of my first patients I had, after talking to her a bit my initial instinct was to do just a couple simple things and have her follow up (i.e. like I would in the US).  But I learned quickly that I had neglected a couple factors/barriers that now significantly influence how I treat my patients here.  Number one, distance.  Many of them come from 4-6 hours away.  Not 15 minutes, like in the states.  Number two, to have the appointment if it’s not an emergency, they often times start lining up the night before to get an appointment coupon.  And many of them will wait in town for 3-5 days trying to get an appointment.  Number three, to be seen is a whole day affair.  Usually we see patients in the morning, order tests, and then discuss the results and treatment regimen in the afternoon.  So it’s better to do a lot of exams/labs/imaging and treatments all at once, then for them to come and only address one problem at a time.  Also, though many of them only have simple, non life threatening chronic diseases/illnesses/issues due to the lack of medications/resources in the government hospitals and the limited number of appointments at Diospi, they’ve never ever really had an evaluation or treatment of their chronic issues.

Please pray for Diospi.  That the resources and staff are able to meet the spiritual, physical and emotional needs of the people of Peru efficiently, effectively and in a sustainable way.

Also, I’m still looking for a place in town to live.  There are a couple other women I may be able to live with.  Please pray that God provides the best place: location (some are 4 minutes walk from the hospital, others are a 30-45 minute walk—which is less favorable when its pouring or in the middle of the night), view, cost (the Peruvians unfairly increase rent because they know that Germans and westerners are moving in and the Peruvians think all Germans are “rich”.  One Peruvian doctor, Luz, who may share a place with me, said that the price given for one place I looked at was comparable to the price one would pay in Lima, which is very westernized, unlike Curahuasi), and quality (the typical Peruvian housing is very basic. Their idea of a kitchen is an open fire outside and a sink/basin outside with one faucet.  Since the number of missionaries in town has been increasing every year, though missionaries come and go, the amount of “acceptable” housing options in town are very limited.  Oftentimes missionaries will have to pay rent in advance to the owner of the house/apartment so that they can afford to make it livable.)

Is it possible to See God?

I’ve arrived in Curahuasi at Hospital Diospi Suyana!  I flew to Cusco Saturday and then took a minivan (about a 2-3 hour ride) to Curahuasi.  Currently I’m staying in one of the apartments located on the hospital grounds while I adjust to the hospital system and culture, until I can find an apartment to move into in town.  So far I’ve been getting to know the hospital, missionaries, staff, and town during the day.  I started shadowing the other doctors a little today.  I’ll starting seeing a couple patients a day starting next Monday and increase the numbers I see as I get accustom to the language, culture, and system.

                The way the hospital system works is people line up to be seen early (some even the night before).  In the morning coupons are given depending on how many patients the doctors can see per day.  At 8:30 am the hospital starts with a 30 minute worship service/devotional in the chapel.  Labs and xrays/ultrasounds/cat scans are done as needed and patients are treated and sent home if possible. They’re admitted into the hospital if needed as well.  The doctors are on call 5-6 times per month over night, and see all emergencies that come in.

                The name of this blog comes from the presentation Dr. Klaus John (a general surgeon and also the founder of the hospital, along with his wife) gave me about the start of Hospital Diospi Suyana.  He’s a surgeon and his wife, Martina, is a pediatrician from Germany. Some of Dr. Klaus’ training was in Germany, but some was at Yale as well.  The Lord gave them both a vision when they were teenagers for practicing medicine in developing countries, and caring for the poor (they’re now in their 50’s).   They toured South America together during a gap in their training.  They fell in love with the beauty of the land, yet were disturbed by the lack of basic medical care the indigenous people had.  They spent multiple years working at Shell Hospital in Ecuador, and then the Lord called them to Peru. 

                The story about how the hospital has come to be is one reflecting baby steps of faith the entire way.  For as frustrated as a felt coming into the country trying to obtain a missionary residents visa while I’m here, the John’s story is filled with so many more obstacles, red tape, and the rich trying to charge them a million fees.  One of the classic missionary culture shocks is that you’ve given up well paying jobs, friends/family, comfort and you come to a country to help the poor and the government/system/rich all get in the way and no one appreciates what you’ve given up.  The beauty of these obstacles is that that’s how all can most clearly see God.  If it was easy then the missionaries could take credit for the good that was accomplished.  But God has been glorified countless times in Peru, through all their news papers, magazines, and news stations as bureaucratic barriers collapse, supplies are donated and the hospital continues to grow.  Dr. Klaus has an hour or more long presentation of every single miracle that God worked to allow for Diospi to be what it has become. 

                One example would be that he had a projector that he used as he traveled throughout Germany and the USA giving presentations in order to raise money and equipment and workers for the hospital.  On one trip back into Peru his $1000 projector was confiscated in customs (they claimed that he’d never declared it and let them tax him for it) and they refused to give it back despite multiple letters from powerful friends within Peru.  But while shopping around looking for a new projector a man happened to overhear his presentation in one of the stores who was related to the owner of the shop who was moved by the presentation and wanted to help.  This man was high up in a satellite company.  They ended up giving a satellite for phone and internet use free of charge.  This included the $50,000 annual cost of the service, which was also donated for free for an unlimited number of years.  This happened 8 years ago, so God’s already made $400,000 out of the lost $1000.

                Another example would be that the John’s medical degree/license was not recognized in Peru even though their training is far superior to the training offered in Peru at the time.  They went through more than a year process of trying to get their license approved, and yet still were rejected.  But then they knew someone who knew someone who knew the president of the country.  They were able to talk to him and he granted their certification of their Peruvian license.

                Another example is that you’re taxed 30% of the value of everything that comes into the country other than a number amount of personal items.  Much of the equipment for the hospital had been donated from Germany new so was worth a lot.  They talked to many people but no one could figure out how to get all the equipment into the country.  Finally, again it was through meeting and talking with the new president of the country that they were able to get all of the equipment easily and quickly through customs.

                The answer to the question of can we see God is an easy “yes.”  We see God when God uses 12 uneducated men to build his kingdom.  We see God when he feeds 5000 with a few loaves of bread and a few fish.  The nation of Israel saw God when a million miles from a destroyed Jerusalem, 3 men were NOT burned in a fiery furnace and Daniel was not harmed in the lion’s den.  And in the same way, even though no one wants taking care of the poor to be hard, that’s the moment that no one can deny that God is here and mightily at work!

Week in Lima

I arrived late Monday night to Lima.  I fly to cusco tomorrow (Saturday) and then catch a minivan to Curahuasi (pronounced "curawasi"; a 2-3 hour drive).  I'll be staying in the apartments on the hospital campus initially for a week or two. And possibly then moving into an apartment in town (a 15-30 minute walk from the hospital). I'll get some orientation on saturday and on monday.  My first day of work is Jan 20. So a get a little over a week to ease into the system/culture.
              My first day in Lima was the hardest because I didn't completely understand what I was suppose to be doing.  The Lord provided and the rest of the days have been refreshing.  Its kinda funny that God has to force a vacation upon me to make me slow down.  I've kinda been longing for the opportunity to sit down and read a book for a couple months now.  But when ever I finally got a day off from work it ended up getting filled up with errands and hanging out with friends and family (which i enjoy too--don't get me wrong).  I think I've read more the last couple of days (between hanging out and getting to know 5 other workers from the hospital who are at same hostel as I in Lima) than I have in the last 6 months.
              Below is my journal entry at the end of Tuesday (my first and hardest day). I share it because of a lie I've heard in Christian circles: that it’s easy for some people to leave their country, friends, and family and go to a new country where a different language is spoken, different foods are eaten, different cultural rules and habits exist.  Hearing and believing this lie, some Christians convince themselves that since none of those things would be easy or sounds fun to them that God's not calling them to serve in other cultures and countries.  I share the following so that you can know the truth.  It is never easy to leave everything and serve in a different location or culture. But God calls some (not all) to do so, and just because it seems hard, doesn’t me that he’s not called you.  Besides, as the Lord promised Joshua so the Lord promises use that He’ll be with us:

First Day in Peru.
            I’ve never been in another country as long as I’m anticipating being here.
            My heart kept dropping several times today
                        -Realizing I didn’t get a long enough visa time frame
                        -Realizing I was missing a document I needed from the States for my visa
                        -Realizing there are scope of practice issues even at Hospital Diospi
                        -Realizing internet reception is bad at the hospital
                        -Realizing that there are 2 other family practitioners who just arrived as well at
                                    Diospi
                        -Realizing that a majority of my patients are likely going to speak Quechau

            All of these things can be summarized into a couple different fears:

-          Fear of wasted time

-          Fear of wasted/spent money

-          Fear of not being needed

-          Fear of not reaching my full potential

            Truths that negate each fear:
                        -God brought/called me here
                        - If I’m focusing on being His light, loving/knowing people, and maturing
                                    relationships, no time/opportunity/or moment is wasted.
                        - Every taxi ride all over tarnations lends itself as an opportunity to share the truth
                                    and love of God with all those I’m “forced” to meet.  Plus they can teach
                                    me a lot about the culture and serve as language lessons as a talk with
                                    them during the ride.
                        -America is a culture of “hurry up and wait”à why not just trust God with timing
                                    and focus on the role/responsibility he has given meà get to know people,
                                    love people, speak the truth of Christ into their lives.
                        - Up until this point God has always known better than I on how to best prepare
                                    me for what he has prepared for me to do in the future (going to In His
                                    Image for residency is a great example. I didn’t want to go to this
                                    residency program but I trusted God, and I ended up not only loving it  
                                    and the people there, but also realizing that everything I thought was
                                    important in my preparation wasn’t, and the things that ended up being
                                    most important I wasn’t even aware of). à why should that change now?
                        -God owns all the money in the whole world.  And the value to God of even one
                                    lost child turning back to Him is priceless.
                        -The more money I’m forced to spend on red tape/and every imaginable fee
                                    known to man, the more my brothers and sisters in Christ are going to
                                    grow in their intimacy and dependence on Him as they give more and
                                    more of what He’s given them first (whether little or much).
                        -I’m NOT needed.  But I’m precious and loved by God, and it gives Him great joy
                                    to use me to build His kingdom.

Unexpected blessings:

-          My taxi driver spoke at length with me as we drove all over town.  We talked about everything, even religion/faith, and he said my Spanish was “good” [meaning “understandable”---though he did proceed to correct me from time to time and help me with words when I got stuck.  I felt like I was playing Taboo all day trying to get him to say words I was looking for and had either forgotten or hadn’t ever known.]

-          4 other Americans [Stephen (a dentist) and his wife Finley (a social worker) and their son Matteo (10 months and a walking ball of energy), and Nolan (Stephen’s brother and a physical therapist) and his wife Conica) arrived at the guest house who are going through the same visa process I’m going through, and are actually exactly one step ahead of me and 2 of them had already made every single mistake you could have possibly made.  So they were able to tell me what to do next and what not to do.  They all arrived at the guest house and were introduced to me at exactly my lowest point when I didn’t know what to do next, I couldn’t call anyone and felt hopelessly lost.  Basically they told me there was nothing more that I could do at this point, so I just relaxed and enjoyed the rest of my time in Lima.

-          After talking with the Americans I realized that they all have strengths (ie are actively involved in discipleship work already in Curahuasi) that are my weaknesses and I’m excited to learn from their examples---which is they way I learn best.