Sunday, June 29, 2014

CHECK IT OUT! The Hospitals Website

Please check out the hospitals website.  You can read it in English. They have frequent updates on needs, the work of the hospital and their other projects.  Also they have many great pictures and testimonies of those working here.

http://www.diospi-suyana.de/?lang=en

Finding a Church Home



Finding a church to call home has been difficult.  It’s hard for me to visit all the churches and then “settle” because I feel like I’m letting people down in all the other churches I visited.  

  Friday evenings all the Americans and other English speakers meet together in the Caire’s home (one of the other American doctors).  To me that’s where I feel encouraged by the body the most,  because it’s in English, they understand my culture, they’re at least a little older than me and can challenge me in my faith.  So that leaves me free to find a church in town to worship with where I feel I can encourage the church even if they have nothing to give back (or don’t realize that that’s their responsibility as well There’s a church in town where the other missionaries mostly attend that we call the “Missionary church”, for that very reason.  I’d stayed away from it because I really wanted to attend a church of Peruvians). 

   I’d been going to one church called the Puente (“the Bridge”), because it’s located next to the bridge into town.  It’s a reasonably large church of 60-100 attendees Sunday morning, and predominately Quechua speaking, though services tend to be in Spanish.  I liked it because of the Quechua presence.  I’m take turns teaching kids classes in Puka Puka (a village a 1 hour walk up the mountain from Curahuasi) and teaching kids’ classes for the church.  But recently the church has been having problems.  Both pastors (the Quechua pastor and the Spanish speaking pastor) resigned because it’s a large church not interested in changing, knowing God, or doing anything more than sit on a pew.  I’d been praying about what to do.  I have a couple friends at the church, but they’re all people I know from the hospital.  Because of the language and cultural barrier (the Quechan barrier is thicker and harder to penetrate than the Spanish barrier).

   There’s another church I’d been attending Saturday evenings (“youth/young adult night”) call IEP (international evangelical church of Peru)  [The two main divisions of Christian religion in Peru are Catholic (the majority) and Evangelical (the minority; the equivalent of non-denominational or protestant in the USA I guess).  It’s almost entirely Peruvian, but it’s a younger generation (my age-ish) that’s in love with God and on fire for his mission.  Many of my Peruvian friends go there.  It’s a young church (less than a year old—it’s a church plant of that denomination, IEP, from Abancay and Cusco) so it’s still pretty small.  This weekend there was a group in town from the IEP churches in Abancay, Cusco and Kiabamba doing outreach in town.  It was a fun weekend. The church was full.  There were new believers meeting with the church.  I went to church there Sunday morning and afterwards we all went out to eat.  I felt like I was back in Tulsa again with my friends.  At Park Plaza we’d always eat out and talk for 2-3 hours after every church service.

Thanks for all your prayers for me to find fellow Christians to worship with, serve with, grow with, and encourage.

Sunday, June 22, 2014

Peace and Joy



The greatest spiritual battle I face here is complacency.  At first I thought the spiritual complacency was similar to Tulsa, but now I think it’s worse here because what I see here is Catholic complacency.  A complacent Evangelic Christian in Tulsa will go to church once or twice a week, be a “good person”, and live their life with their own plan and purpose.  A complacent Catholic in Peru claims to believe in God, has no clue what He commands and desires, never goes to church, does whatever they  want with their life, and live lives full of fear and anxiety because they realize they’re not in control.  My greatest struggle is knowing how to awaken their thirst and hunger to know God, walk with Him and seek out his purpose.
   But this last week I met a child who has more faith, peace, and joy than all the other patients I’d cared for that week put together.  Yet he has the least reason to.
   I’ll call him Eric.  Eric is a 10 year old boy who came to the hospital with his grandmother. His grandmother informs me that a year ago he was running and jumping and playing.  But for the last year he’s been unable to walk.  He complained of a little vague hip pain, but nothing more.  Range of motion was normal without pain on physical exam. Neuro exam was normal except I couldn’t elicit patellar nor babinsky reflexives (neither positive nor negative).  I didn’t think much about those findings because it’s really hard to check reflexives here.  You tell the patients to relax their muscles like they’re dead and so they either start moving the limb back and forth or completely tense up all the muscles of the joint.  It doesn’t matter was language you tell them in, they don’t know how to control their muscles. Nolan, the physical therapist, is always saying how hard this cultural aspect makes his job.  He was a little chubby, so I was thinking Slipped Capital femoral epiphysis.  When he walked, he walked swinging his legs out wide, keeping his knees pretty straight, and sometimes with his toes pointed outwards, sometimes with his toes pointing inward. 
   I got reviewed the hip and knee x-rays later that day.  Normal.  It was 5 pm by them, so I asked him to come back the next day after I had time to figure out what else I wanted to order.  I read that night.  I consulted the other doctors at our morning meeting on the case the next morning.  I ordered physical therapy eval, CRP (a marker of acute inflammation), ESR (a marker of chronic inflammation), CK (a marker of muscle inflammation), CBC (to check white blood cell count), and a lumbar spine x-ray (so that I could rule out above and below the “problem joint”).
    Nolan sees me before lunch and tells me he saw Eric.  Nolan found Eric to have profound proximal lower extremity muscle weakness, trunkal weakness, and positive Gower’s sign (where to stand up they inch their hands up their legs because of lack of proximal muscle strength).  Nolan’s guess was Muscular dystrophy. The x-ray came back normal. The ESR, CRP, and CBC came back normal.  The CK came back 15,000 (normal less than 200 or so).
   Duchenne muscular dystrophy is the most common and the most rapidly progressive muscular dystrophy, with most patients losing the ability to walk by 12 years of age and requiring ventilatory support by 25 years of age (which is probably not a possibility in Peru).  It’s rare for them to live beyond 30, even in the USA.
   I wanted Eric and his grandmother to understand well what he had, prognosis, and treatment options so I asked Martina to talk to the family with me.  I wasn’t sure if I knew all the right words in Spanish and I wasn’t sure of treatment options available in Peru for him.


  This picture is taken 10-20 minutes after Eric and his grandmother had been told everything. Including the fact that he would never walk again and wouldn’t live much past 25.  I commented out loud on how joyful he appeared.  His grandmother responded, “He loves the Lord.  He asked to buy a Bible while he was waiting these two days.”  The peace I saw in him---the peace that passes all understanding—only comes from the Lord and the Spirit living within you, and is very rare here.  The culture here is one of a life of anxiety and worry.
   I commented on this to Juvenal, one of the nurses that was helping me that day.  He responded by saying that he used to worry a lot too.  But since coming to know the Lord, he has that same peace and tranquility of spirit too.
Please pray for Eric and his testimony---that through his hardship many will come to trust the Lord with all of their life.

Sunday, June 1, 2014

Potter's Syndrome



We aren’t a very high Obstetric volume hospital because it’s free for the patients to deliver in their local health posts.  So it’s surprising that a rare anomaly like Potter’s Syndrome would deliver at our hospital.  Potter’s Syndrome has a 1 in 4,000-5,0000 incidence in the general population.  The babies don’t develop kidneys in utero, so consequently their lungs don’t form, neither does their urinary track.
     A pregnant lady traveled to Diospi from across the country with her family at nearly 35 weeks gestation to deliver at Diospi.  All of her prenatal care had been performed at the local health post.  When she arrived she was in labor with strong contractions.  On ultrasound there wasn’t any amniotic fluid.  No right kidney could be visualized. Something could be visualized where the left kidney should be but it didn’t look right.  The baby was breech, so the OB/Gyn (Jens) made the decision to take her to C-section.  It was only after delivery that Martina (an experience pediatrician) recognized it was Potters.  She says, it’s nearly impossible to make the diagnosis before the child is delivered.  The baby had respiratory distress despite intubation and adequate ventilation.  On xray the lungs were “white” despite ventilation.  Not because of ARDS (neonatal acute respiratory distress syndrome) but because the lungs had never formed correctly without kidneys.  The child also had an imperforate anus, ambiguous genatalia, and no urethra.  Most Potters don’t live more than a couple hours.  When it was realized that it was a Potters, after a long discussion with the family, life support was withdrawn and the baby died shortly after that.

On a happy note.  Here are a couple pictures I took along my ride to work (I got a bike probably about a month ago, because I felt like I was wasting the whole day walking everywhere).  Right now I'm living in a little village called Lukmos, which is just below the hospital in the other direction than Curahuasi.  I'll move in with another gal into her apartment located on the other side of Curahuasi in August:



The President's Sprint





Imagine Obama sprinting through your work place “taking a tour”.  That’s literally what happened Friday.  The president of Peru had a meeting in Curahuasi with the regional directors or something.  They’d asked to land his helicopter on Diospi’s helicopter landing pad.  I guess the local government health post here doesn’t have one.  Klaus said fine but was insistent that the president took a tour of the hospital.  I guess because of political reasons he’d tried not to associate himself with the mission hospital up until this point.  But it’s helpful to have the president’s blessing in able to get things through customs more easily and faster.  Right now we have a CT scanner which has been sitting in customs for a month in Lima.  For these reasons Klaus was super insistent that the president toured the hospital.  After his meetings, right before he got back on his helicopter, the president said he had 5 minutes to tour the hospital…and so they literally sprinted through the hospital on a tour.  He stopped long enough to talk to one of the dentists who’s from Switzerland and to take pictures with the kids of the hospital staff/volunteers.
    When he first arrived, he arrive in a bright orange poncho.  I guess his PR people wanted him to appeal to the Quechua here.  Ironically, none of the patients were wearing a poncho.  I think it's regional.  The hospital staff said that his poncho was more typical of Andallais which is probably 6 hours away driving, on the other side of Cuzco. And instead of coming up the side walk from the helicopter pad, he walked the hillside, through the grass and plants to get to the hospital ground where everyone was.
    Klaus and Jens had the staff line up to greet him and show respect.  My favorite moment was at the end of the day.  The president was just sprinting past where I was standing.  Next to me was one of my patients from the day who was probably in her early 30’s.  She was very “Quechua”:  She had the typical Quechua outfit on.  She had the remains of a bruise likely from her abusive, alcoholic husband (which is very common).  One of the things I was treating her for was carpel tunnel syndrome (which is very common because they hand wash all the clothing for the family every day).  I looked down at her and said, “There goes your president.”  Her response was unexpected: “Really?”  So interesting that the Quechan poor are so removed from the media of Lima that they don’t recognize their own president.
    The other interesting thing is that their president had promised to help the poor, so all the poor rural folks voted for him and the rich upper class of Lima where afraid of him.  But his term is almost over and he hasn’t lived up to any of his promises.  Yet the rich of Lima (including Luz, hate him) and the poor people where we live love him.
   The president later sent an email back to the mayor of Curahuasi saying that Diospi is the nicest hospital in the south (since Lima is in the north).