Hope---Esperanza!

This week a family came to Diospi with their 4 year old son who was swollen, breathing fast, and appeared to be at the point of death. Dr. Martina was in charge of his care, as the pediatrician. They reported that they’d just come from another hospital, but it always takes a while to sort out the truth.  It was a poor uneducated family who lived in the country.  They had noticed that their 4-year-old son was gaining weight so had actually put him on a diet for a couple of weeks, but he them became very week so they went to a hospital in Cusco.  There he was admitted for 2 weeks and found to be in renal failure (they threw around the diagnosis of “Membranous glomerulonephrosis  disease” but never did a biopsy to confirm the diagnosis).  Usually they put most patients on hemodialysis (which is through the veins and is every 2-3 days in a facility) but since he was so young they’d put him on Peritoneal Dialysis (which is through the liquid in your abdomen, and can be done at home each night if you have the equipment and fluids).  They stabilized him and sent him with to Lima with a transfer order (but these transfers are always by private vehicle and so you have little control as to whether they actually go.  Many of the people are afraid to go to Lima if they don’t have any family members there). 

                But his parents didn’t take him to Lima.  They went home to their village.  They decided that he’d heal with Herbs and prayer.  They didn’t understand what complete renal failure meant, nor that we cannot live without kidneys.  Two weeks later they presented to us, with him at the point of death.  He was still making a little urine.  But he needed super high doses of Lasix to do so.  His pH was 6.93, his potassium was 8.6 and his hemoglobin was 6 when he arrived.

                Martina was also trying to unite all the evangelical churches in Curahuasi for a Easter Service.  Most of they time they don’t get alone and bicker about minute details.  But there are missionaries that attend each of the 2 Baptist churches, the Peruvian evangelical church and the nondenominational church.  She had a meeting with a representative from each of the churches with the hope that they could unite together at least to celebrate the Resurrection.  But she walked away from the meeting downcast in heart.  They refused to work together.  They said that if Diospi planned everything and invited them, only then would they come. 

                Then the 4-year-boy died.  The plan had been to stabilize him and send him to Lima (an 18 hour bus ride from Diospi).  His second day he seemed to be doing a little better, but then he worsened and died.  The sadness of the unnecessary loss of life convinced Martina that the only hope we have in this life full of pain and suffering is the resurrection.

                She again became determined that this Easter service with all of our Christian brothers united together happened.  She decided to ask an American, Brandon Conley (who attended university at ACU) to preach.  He’s a bible translator in Abancay working with another Christian organization.  He’s fluent in Spanish and Quechua.   His wife, Erin is a dentist and works at Diospi once a week.  Martina decided that if he agreed to preach, then she’d go forward with the Easter service plan.  Not only did he agree to talk, but he agreed and was greatly honored and exited about the opportunity.  This greatly encouraged her, and so she sent out invitations to all the churches.

                Please pray for this service and for unity in Christ’s body despite the differences that will always exist.  Please pray that God is glorified in this moment and that we draw near to him.

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Another moment of hope happened today.  Since I’ve been studying with Dennis and Rosemery I’ve realized how valuable it is to them to read the Bible with someone who has known it for years.  I learned the Bible reading it on my own with commentaries so I didn’t realize how valuable it was to them to read with others.  One time Dennis and Rosemerry made the comment that went they read on their own it doesn’t make a lot of sense, but that when we read together it because clear.  Like the Ethiopian Eunoc in Acts, “How can I understand what I’m reading if someone doesn’t explain it to me.”

                So I’ve had it on my heart for a while to ask the owners of my house (Mario and Domingo Asurin, who live on the 2^nd floor, we live on the 3^rd floor) if they wanted to study the bible.  The other day I arrived at the front door the same moment that they did.  Domingo had just returned from 3 weeks in Lima.  Normally she’s real serious and a little cynical at times (she reminds me of my dad’s mom).  But consecuently I’m used to ignoring that.  So with a loud happy voice I welcomed her home.  Instantly her continence melted and a smile shown through.  She was so moved she invited Inessa and I for lunch.  I always try to make her smile.  Usually its pretty easy.  It’s the end of rainy season now and has been raining in the mornings when I go out to run, so I’m quite a sight completely  covered in mud returning from my run.  It’s impossible not to smile.  The other day I was calling my patients and there was her name.  They all have to stand out in the rain at 6:00am hoping that they’ll get an appointment for the day.  It had been busy because it was the last week of school vacation.  They distribute the appointments by chance.  They draw a number, for example 5.  And so every 5^th person in the line gets an appointment.  Half joking I said to her, you could have just come upstairs and knock on my door.

                I’m friends with the step-son of Mario’s cousin (Glicerio) and their granddaughter, Maryori.  They both go to the church and are believers.  Mario and Domingo aren’t believers but have gone to the Catholic church in the past.  Glicerio came out running with me the last two Mondays.  He always manages to come on the days its raining.  I usually have my prayer time in the middle of my run before I head back (rain or shine) because I can concentrate better out in the country.  It was Glicerio’s idea to run with me.  I told him that’s fine but that he can’t interrupt God while I’m praying.  So he came along and had his own prayer time with God.  This last Monday when we came back Mario was at the door.  I said good by and left Glicerio at the door talking with Mario (I don’t think they know each other real well).

                Then today we went out to lunch after church at the home of a couple of the foreigners who attend the church.  Maryori came to and sat near me at the table.  A couple weeks ago she had a couple bibles that she said she was talking to her grandparents (Mario and Domingo).  I asked her about this today.  Maryori said that Mario had asked her for them so that they could read the Bible. Walking home, I decided that I would ask if they wanted to read together the next time I ran into them.  As I walked up to the door Mario greets me from their balcony on the second floor: “Where are you coming from? Work?”  “No from church, “ I reply.  At this point I’d already decided yelling up to the second floor balcony wasn’t the best time to see if they wanted to read the bible together.  Mario replied, “When are you going to take me to your temple (church)?”  “Whenever you want,” I replied. “Do you want to read together sometime?”  He replies, “so that you can explain what I’m reading to me?”…And so the plan is to read together tomorrow when I get home from work. 

                So here are two more people that you can be praying for: Mario and Domingo (which means Sunday in Spanish) Asurin.

Extending a Hand (Alcanzando la Mano: ALMA)

                *Knock, knock, knock*  “Would you like another kid?  Here take this one.  I would have kept him if he’d been a girl.” ---Child number 5.  Sounds unrealistic.  But it happens here to Lyndal frequently.

                There’s another mission organization here in Curahuasi run by Lyndal, one of the ladies who also working in the radiology department of Diospi.  She’s taken in several kids that either don’t have parents, or more commonly, the parents can’t care for.  Child protective services don’t exist here in Peru.  If they did, I imagine they’d of taken the majority of the kids into government custody already.  Little kids (only 3 years old) are wandering the streets at night, only sometimes with “older siblings” (up to 8 or 9 years of age).  I think the majority of the people are not married.  The use the word “conviviente”, which means like “live in (boy or girl friend). That’s the marital status of the majority, and consequently there are a lot of single moms taking care of a lot of kids, often times from various dads, and with little help.  And so a number of kids have ended up under the custody of Lyndal.

                One of the young guys, Elvis, now works as a security guard at Diospi.  He had a Steven-Johnson reaction (a severe, life-threatening reaction) to a medicine and all his skin peeled off.  His dad had two families.  When Elvis’ mom died his dad left him and his brother (he was 16 or 17 at the time) and went to live with his other “wife.”  Lyndal found Elvis very sick at home with hardly any food or resources.  She offered to continue to come by for dressing changes in his house or he could stay in her house with the other kids she cared for.  He came and stayed with her for a while.

                This is only a couple of countless stories.  Lyndal’s dream and the dream of Alcanzando la Mano is an orphanage where they can better care for and address the needs of the kids here that have been born into very unhealthy and dangerous social situations.  [There’s a family who lives down the street from me that my previous roommate, Lisa, worked with a lot.  It’s a woman with 4 kids.  Lisa says from different men.  And probably all from rape situations.  They were previously staying in an abandoned house that was open, without protection.  Men easily came and went at night.  The family tried to earn money working their field, but it was never enough.]

                The pictures above are from the ground breaking ceremony of the land where the orphanage will be build. All the churches in town were invited to take part in the ceremony and pray of the land and the children’s home.   Yesterday was the first day of work.  There’s not a lot of money, but they’re moving forward in faith.  All year they are open for teams interested in helping with the construction.  If you’re interested in forming a group to come down and work or would like to support them financially just shoot me an email (ari.cale@gmail.com).

Pregnant, Anaphylaxis and a Human Knot

Friday night through Saturday night was nice and eventful.  I was on call Friday night.  The missionary, Will Caire who hosts English bible study Friday nights was out of town on vacation, and so there was no group that night.  I was hanging out at the hospital when I received a call that a couple of the young adults from the church where going to eat out at almost 8pm and I was invited.  So I went.  Claudia had invited everyone.  I didn’t realize it was a special occasion.  But when everyone had arrived she said, “I have a announcement to make…”  We all went to Claudia’s wedding in December (her wedding photos are on the blog).  Knowing it wasn’t her birthday, and she already was married, jokingly I said, “You’re pregnant!”  I was right J  After a fun night joking around with my friends I returned to the hospital to sleep.

                                        (Claudia laughing as Miqui and I thumb wrestle :P ).

           I was awaken at 5:30am by the nurses, “There’s a foreigner here with a sore throat and she’s pregnant.”  Half awake I got dressed a walked out to the nurse’s station wondering since when a sore throat was an emergency and also if they were tourists since the nurses hadn’t referred to the patient as a missionary.  I walked into the ER to find my friends, Crissy and Shaun, who are Americans serving as missionaries working with a mission separate from the hospital but run by one of the Australian missionaries who works as an ultrasound technician at the hospital.  Crissy is 27 weeks (about 7 months) pregnant.  I asked what was going on. 

                Crissy working hard to take in air (almost with the sound of stridor), trying to explain the situation with a hoarse voice, completely panicing.  Inside I began to panic.  My least favorite type of patients are friends who are pregnant and I think could die if I don’t treat them and I think I can hurt the baby if I do treat them.  She  explained that she felt a tickle in her throat the night before and thought she was about to develop a viral infection.  But she woke up in the middle of the night, feeling like her throat was swollen shut or something was stuck there and she couldn’t breathe. 

                Her lungs where clear, her tonsils normal sized, oxygen saturation 100%.  My brain said anaphylaxis, but she had not other signs: no nausea, vomiting, wheezing, rash, etc.  And of course she’d didn’t want me to give her any medicine that could potentially hurt the baby.  So I started with the class B medicines (in Pregnancy there are various classes of medicines: class B= safe, class C= we don’t really know, class D= harmful to the baby): Albuterol nebulization (she said her chest felt tight), Benadryl, Ranitadine, and Tylenol.  I asked Shaun if she’d had panic attacks before, he said “no, but she’s prone to panic.”  Me too if I can’t breath.

                We usually also give a steroid (like Prednisone) in anaphylaxis (class D), and the only medicine that matters in whether or not the patient lives: Epinephrine (class C), and for the best prognosis you have to give it within the first 30 minutes of the patient presenting in the ER.  I called the OB-GYN to see if EPI was safe to give because some class C medicines we give all the time without problems.  Jens responded I could given any medicine I needed to give.  Great help, that meant what I lecture I listen to always says: the worse birth defect is if the mother dies, because the baby dies too.  I mentioned to Crissy what I was thinking and that I wasn’t to give EPI.  She was still receiving the breathing treatment at that point at that time and feeling a little better, so she refused it and said she wanted to wait and see if the other meds helped.  In the USA as a physician I can only suggest treatments.  If a patient is in their right mind, I can’t force any treatment on them even if it will save their life.  Usually when I’m convinced that a patient needs a certain treatment I can convince them to agree…but at this point I still wasn’t convinced 100% it was anaphylaxis.  There was no trigger.  Only one system (upper respiratory) was involved, not two…which was part of the diagnosis.  But when nothing else really helped and Crissy continued to work hard to suck in air, almost with a stridorous sound and we were nearing the 30 minute mark I walked in and told her I wanted to give the EPI (inside I was completely worried).  Afterwards she told me that before I had walked in that last time she’d told Shaun she wasn’t going to accept the EPI, but I told her with such determination that it was what she needed and I told her she had to receive it within 30 minutes to have the best prognosis that she relented.  Five to ten minutes after she received the EPI I walked back into the ER and she was completely different.  Still with a hoarse voice, but breathing easily….it was anaphylaxis.

                I called back later in the day to see how she was…fine.  That’s when she told me the other parts of the story and I told her that she’s my least favorite type of patient.

                A couple hours later I left the hospital to join the jovens of the church who were playing volleyball.  I left after an hour or so because I was feeling pretty bad from the adrenaline after having Crissy as a patient, and not eating yet.  That night we had Night of Jovens (adolescents and young adults) at church.  Miqui (who works in IT  at the hospital) was recently put in charge of the Jovens this year.  They started a more structured evening including a study on the life of Jesus and ending with interactive games/ice breakers.  I was in charge of the games this night, so I taught them the Human knot.  Here’s some pictures. :)

Please pray for the jovenes of the church and the Night of Jovenes.  There are a lot of ministries for kids in Curahuasi, but less for the young adults, who get pulled away from God by the very strong influence of culture.  Also pray for Monday nights.  We finally finished Beth Moore's Believing God series last week.  Monday we will start a book called: How to be a Woman of Excellence.  Please be praying for this study and that God brings the women.  There's a lot of negative influence and pressures place on the women in this culture.  Pray that God uses this opportunity to help them learn to please Him and not man.