2006 Bolivian Mission Journal

Friday, February 17, 2006

This year we planned to be different than the past years. In the past we hit the ground running as we had so little time to accomplish the tasks we had planned. Yesterday we arrived and spent most of the day unpacking and setting up the equipment we leave here every year so we don’t have to bring things like computer printers, transformers, hair dryers, and the like. We like to come on a Thursday so we can attend the Rotary Club meeting as they are our most faithful partner here. They run the foster home, the carpentry shop, and coordinate out medical projects like the surgery, and this year, the AIDS testing project. Other friends help with the building of houses in the campo, the country, and with other projects.

We will have a feeding project this year, similar to those that we had in the past, but coordinated with a course of “The Purpose Driven Life,” Una Vida con Proposito” en Espanol, in Spanish. We will have to work out the details, but my thought is to have a dinner on Sundays when we will discuss the week’s study. I have purchased 24 copies of the book, and I will soon try to see if it is available here in Santa Cruz. That would make our classes easier with more books to go around. Our other project concerning the church Dios Es Amor is building a house for the pastor of that church. He has always been very helpful with our evangelical projects, and, at the present time, he and his family live in the basement of the church.

Continuing our project in the community of the Guarani, a displaced group of Indians, we will try to build a community building for medical clinics, meetings and school. This will obviously be a multifunctional building and very useful to their group of about 200 persons. The group seems to stay the same size as the young adults are leaving the community to go to other place in the country and in the world, to seek a better life for them and their families.

The medical projects include the distribution of the ten fetal monitors that were donated to us by the Baptist medical system in Tennessee and Mississippi. Each year they send me a list of equipment that they have available, and some of it would be useful to our mission. Last year we had many defibrillators, and this year the monitors. Three of these are fairly new, and have automatic blood pressure monitors as well as a probe to check oxygen content in the blood. These have been common in the US for 15 years, but not available here due to the cost. While the monitors were free, the patient cables cost about $1000 per machine to make them useful. All these will come in luggage and in a crate I sent two days before I left. I hope we have a better experience with their shipment than the equipment I sent last year. It arrived several months after we left and I shipped it two months before we left. This I shipped by air freight. That cost another $1000 but it needs to arrive while we are here. Earlier, we transported a portable X-ray machine to a near-by town, Portachuelo, which has already arrived. That was transported to Bolivia with a car that the daughter of the mayor of that town was shipping at the same time. We will visit that machine/ town soon, and Jennifer Forrester, an X-ray tech at the Highlands Cashiers Hospital will help to teach them how to care for the machine and use it properly. This machine was donated to the mission by the Highlands-Cashiers Hospital, as it was no longer needed. It had been sitting in the hall of the X-ray department for years. Jennifer will also give a refresher course to the people she taught the use of the ultrasound machine last year. Her husband, Robbie, will do the same with the defibrillators.

Martha will do here evangelical work with Mary Yoder, while Fred Rodenbeck will do his dental clinics. Dr. San Ho Choi will continue his teaching of the laparoscopic surgery technique, and do some small surgeries in the clinics as well. I will be working with a medical student who was our translator our first year, and I will also help some premed students find work in the hospital, clinics and house calls. The group from the University of Mississippi is returning with 12 honor students, who will be joined by two freshmen from Liberty University. Our youth component has shrunk to only three high school students who will accompanied by three chaperones. That ratio should keep them in line.

My cell phone had corrosion on the battery and didn’t work. We changed the battery three times and it wouldn’t charge, so I think there is something wrong with the phone itself. They gave me a charged battery today, but I think the phone will quit working when the charge is gone. We will see. The other problem I have is the printer I have had here for four years or possible five. It has a parallel port and the new computer I bought this last year uses a USB port. I don’t think there is any way this can be fixed by a cable connection. The good news is the printers now cost much less than they did when I bought the old one, and they have a whole stack of them at a local shop, and I had to go to Santa Cruz to buy the one I have now. I am sure I will have no trouble finding a new home for the old one.
Joanna and I went to the foster home this morning. As I feared when we first set this home up, they had sent all the older boys to an orphanage in Santa Cruz. I have always tried to tell them that this is not an orphanage, but a home. I still have some work to do to convince the Rotarians that this is a different concept. In fact I have a project that only the older boys can do. Perhaps we can find another family to house the older boys in a separate facility on the property, or next to it. The older boys were to begin work in the carpentry shop later this year, and my pen making project was a way to slowly and safely bring them into the shop with meaningful and possibly profitable work. They have plenty of small pieces of wood that have no value to building furniture, but can be used to make pens. I have brought all the equipment needed to make several hundred pens that can be sold back in Highlands. This could be a way to help fund the foster home in addition to teaching the boys a useful skill.

The boys sang songs in Spanish and in English that they have been taught. The English teacher was present while we were there, and she was disappointed that her best pupils, the older boys were no longer in the home. The shop had furniture in all stages of completion, and we hope to export some of there items to the US for sale at a good price. The wood here is of a much higher quality than is available in the US. Eventually, the shop will earn enough money to support the foster home, and they announced at Rotary last night that they had made their first profit last month. There were seven rather young men working in the shop. They still need some additional equipment and I need to buy a drill press for the pen project.

There is a lot of work to do, but plenty of time to do it before the first group comes. Monday I will begin screening the patients for surgery on early March. This afternoon, I will visit the church and the clinic where Dr. Rodenbeck will work, and I hope to get a printer, and a new call phone. We need two anyway, and if the other can be fixed, we still need another. The new phone price is 1/3 of what it used to be. Some things actually do get better with time.

Sunday, February 19, 2006

Yesterday I went to the jail, el carcel. As I walked in the early morning, I noticed very little change in the buildings. Every year we have noticed changes in Montero, but this year, no. I suppose the people with enough money to build are waiting to see what the changes in the government will bring. So far, I have not talked to anyone who thinks things will get worse, but there is a concern. There is a movement for each region to have more autonomy, which is another way to say that “we want our taxes to stay in our area.” We in Highlands and Cashiers surely can understand that feeling. I got to the jail before Dr. Plata, but I went in and sat in the exam room. I noticed all the things that we have supplied to this place. The medicine cabinet, still full of medicines left last year, the stethoscope, and the blood pressure machine, both the envy of any doctor in Montero, and quite frankly, better than what I have in Highlands. I got all this equipment free for doing pharmaceutical company’s programs. The blood sugar machine still works, as they remove the battery after each use. The first machine had corrosion from the battery and could not be repaired. The same thing happened to my cell phone. I will need to purchase a new one tomorrow as the battery will not charge.

I looked out the window, and thought there were more prisoners in the jail this year, and they looked tougher. Many had the scars and bruises of recent altercations. Dr. Plata finally arrived as he was waiting for me outside the jail. The patients immediately lined up outside the door, and were allowed to come in one at a time by the trustees. These were sicker than before with many having serious conditions. I think these men and women would be excellent choices for our AIDS tests. One man had an explained anemia. He was treated with iron, as that is a treatment available, and is cheap. Unless he has a blood loss that he and we don’t know, this will not work. He needs a full anemia workup. Another man had lymph nodes of various sizes on the right side of his neck. He was treated with antibiotics and didn’t respond. I suggested another week of a different type of antibiotic, and if this doesn’t help, and I don’t think it will, I will suggest a biopsy to see what he really has. Most likely he has TB, lymphoma or AIDS. Several men presented with severe beatings, which apparently they inflicted on each other. Now they are friendly. I am sure alcohol had a lot to do with their conditions. One also had a gun shot wound and an abdominal stab wound. I wouldn’t wonder if he was drunk each time he was injured. This would be a good place to begin an AA chapter. There would be, at least, a captive audience.
Later we went with Dr. Patzi who always has a new place to discover. This one was right across from his farm, but it was closed for lack of business. We ended up going to another place which we had visited before. This hotel had a small pool and looks out over a valley with mountains in the background. The place is aptly named, Buena Vista, the good view. It was a beautiful afternoon, and we returned in the evening as the sun was setting with a colorful sunset at our backs. The sunsets are spectacular here as there is always dust and smoke in the air. This is good for a sunset, but I have developed a slight cough, as always when I first arrive, due to these same elements.

We walked to a restaurant we found last year only three blocks from the hotel. So many things change from year to year, but this one was still there and just as good. We supped on grilled chicken and lots of vegetables, all thankfully cooked.

Sunday morning I went to the church Dios Es Amor where the feeding project and the Purpose Driven Life project will take place. I walked to get some exercise, but the morning was already hot. Approaching the market I experienced the usual cacophony of noise from the cars, busses and people, plus the smells of food, some fresh, and some not. A man came out of his butcher shop with a bucket of water, looked in both directions and threw the water into the street, where the remains of the flesh and blood will soon join the other odors of the market. Aside from the lack of “Gardez vous” this could have been a scene for Dickens. This is, unfortunately, the busiest day of the week for the market, as this is the only day the poor folks from the country can travel to buy supplies to carry them to the next week. There is no time to go to church.

The aroma of urine increased as I crossed the wide street to the other side of the market, but when the church came into view, it was like an oasis in the middle of the dessert. There were young people sitting on the steps with smiles on their faces, and happy children running around. It didn’t take long to find familiar faces, and soon I was talking to Pastor Roberto. He took me around to the back of the church where we had paid to have the yard paved with bricks for our feeding project. There was now the skeleton of a two story building present. The supports were in place to pour the cement for the second floor, but the sun shone through the hole to the people cooking below. They are selling meals to help pay for the construction costs. These are excellent meals as compared to the thin soup that is the general fare in the market. We talked a while about the project and planned to meet later to discuss our thoughts with the group of elders. This will be Tuesday night. My agenda is quickly filling up as it usually does. All this free time is disappearing. I went to the service which was in Spanish. Last year the morning service was in Queshua, a native language. Pastor Lucio is fluent in both Spanish and Queshua, and was teaching Spanish to a few of his parishioners when I first met him earlier. We will build Lucio a house later when the other groups come. I was asked to speak again, but I know enough Spanish to not get nervous when I speak. I mentioned having a life with purpose, as Lucio had mentioned this in his sermon, but I was careful not to mention the course, as I don’t know exactly how this will finally be presented, and I didn’t want to set something in stone which could only be changed later with difficulty.

I walked back, stopping by the supermarket to purchase some food for lunch, as the hotel will not begin to prepare meals at lunch and dinner until more people come. I really don’t eat much normally for lunch, but here lunch is a big deal. There are always many courses and desert also, which I never eat, but if it is there, I will eat it, and eat we do very well here.

In the evening Dr. Patzi, Joanna and I all went to a concert of a group of musicians who have become quite famous for Bolivia, traveling around the world with their music. The group is called Savia Andina and they play guitars, flutes, pan flutes drums, and sing. The first part was mostly classical music played with these instruments like I had never heard before. The second act was traditional music from South America and Bolivia in particular, and the crowd loved it. This is something one had to experience for oneself, as it is impossible to explain. I was thinking of the Rolling Stones who are about as old as this group, and now doing a final (I hope) tour. These tickets cost 30 Bolivianos each, about $3.50. I don’t know how much the Stones charge, but I know I enjoyed this more than I ever could like them. Their artistry had improved to near perfection. The few moments I watched the Rolling Stones during the half time of the Super Bowl showed me that their group had not similarly improved.

We arrived back at the Pinocho at midnight, and hospital rounds begin in the morning at 7:30. No dinner. I am not really hungry.

Monday, February 20, 2006

We discussed the patients that came in over the weekend. As in past years, the doctors that cover the ER are not good. The interns don’t yet have the confidence to over rule them with their orders, and the group of teaching doctors raked the interns and the ER doctors over the coals. We made rounds and saw very ill patients. Two terminal patients with cirrhosis were there. One that were going to drain the fluid from his belly for comfort, but this practice is not done much in the US as it really shortens the patient’s life, as it removes a lot of protein and the fluid returns quickly. The other had ulcers on one of his legs from the swelling and the lack of protein to heal the wound. This, too, is a hopeless case as he can’t muster the defenses to heal himself. Another man had his nasal septum eaten away from a parasite that is mosquito born that enters the body and resides in the nose where it does its damage. I have never heard about this disease and I suggested another possibility called mucormucosis, a fungal disease that affects diabetics. Since this man does not have diabetes, this is a long shot, but the interns will learn another disease as they research the topic.

We examined the patients for surgery after we talked to the surgeon and selected the cases. We will do three a day, and we scheduled 21 people for surgery leaving several days more for emergencies. Unfortunately, only three patients showed up to find when they should come for the operation. Tomorrow is the last day to be certified for out surgeon. This is Bolivia, so I
shouldn’t be surprised. The show last night started more than a half hour late and even then only about half of the patron’s were in their seats.

The afternoon was occupied with trying to find out how to pay for the crate of monitors I sent just eight days ago from Atlanta. I paid for these with a credit card, but they showed that it was a collect transaction. I called the credit card company, and they had no such transaction on the books, so I will pay for this collect as indicated. I hope the documents I have actually signed by Condoleezza Rice will allow the goods to pass through customs without charge. Another adventure tomorrow. The next day we travel to Cochabamba to begin the trip to the carnival in Oruro. Every day is another adventure.

Tuesday, February 21, 2006

The morning begins as they all do with a full breakfast in the dining room of the Pinocho. There are several kinds of bread, the varieties change daily, coffee or tea, regular or coca (not cocoa), eggs, bacon, and fruit of the season. Papaya is always in season, and always present. Pina, pineapple, is seasonal, but now in season. Today there is a very small one all pealed as are all the fruits, and cored. This was the best tasting pineapple I have tasted this year. We are at the end o the season for mangos, and the one today is the larger variety which ripens later. Soon these, too, will be gone. There are the more exotic fruits like cherimoya and ichacharou, with huge seeds and little edible portions. These taste good, but they will never be popular due to the difficulty in eating, much like a pomegranate. These fruits are fun to eat every once in a while, but not as common fare.

I go to the hospital to make rounds and the method of teaching has not changed. The attending doctors belittle the interns at every opportunity, and discuss the cases in the presence of the patients, often talking about the bad outcomes and all the possibilities of ill effects of medicines, and how lucky the patient is to have survived the night with such inferior care. Not many malpractice lawyers here yet. Things will change when they arrive. As we left the interns to do their work, the doctors were talking about where they would go when they got sick. All the more reason for them to transfer their knowledge in a supportive way that rewards rather than condescends.

I left to meet the president of the Rotary to take our document to the customs to pick up our shipment of monitors. This was my first experience with the bureaucracy in this country. Joanna had to endure some of this when I had my heart attack two years when we shipped some items home. We got a badge to enter one area. There we paid the freight charges that were supposed to be charged to my credit card, but at this time, the charge has not appeared on my account, so we paid the cost. Then we took the papers to another building where we had three layers of offices, each approving the papers after some discussion, but in the final office, they noted that I sent the case to the Rotary Club, and while they has a certificate to accept donations, the final recipients would be the hospitals, so we needed a letter from the Rotary Club stating that they would donate these to the hospital. These letters and forms would then be faxed to La Paz and finally approved, maybe by Thursday. Since Joanna and I will leave Thursday morning for Cochabamba, Pancho, the President, will have to do this on his own, which he is more than willing to do. It seems that the president every year is charged with these duties. I am sure he will be glad to see me leave in April. I am sure I could not afford all this time if I were to have to do this type of duty at home. This is one of the reasons that this club is so valuable to our mission here. We talked about all the problems with the foster home and the possible solutions. We decided to have a meeting tomorrow with the people interested in the mission and the foster home in particular.

Tonight I have a meeting with the church to discuss our project.

Wednesday, February 22, 2006

The meeting at the church went very well. It is good to be in a group of like minded Christians. You can feel the warmth, and the power. I presented the project as well as I could, and both the pastors filled in the places that I had left out. I can only imagine how my Spanish sounds to these people. I think it must sound to them, exactly like our Mexicans who can’t speak English well sound to us, but with the help of God, the message is passed on. We will begin the Purpose Driven Life course after the Carnival, but due to the construction, the meals will begin on both Saturdays, and Sundays on March 11 and 12th. The foreman for the project said he would increase the work and be able to finish the floor/roof by that date. The power is really here. I have no doubt that he will finish on time. The women who will do all the work cooking were ecstatic to accept all this work for no pay in hot conditions in which none of us would ever work because they were filled with the spirit. What an amazing meeting of an hour long duration. Following the meeting, Dardo and his family picked me up at the church to go to dinner. Dardo speaks English very well, but as the years progressed, and my Spanish got better, he speaks very little English, I am sure by design. I like that. It shows that he has confidence in me and my language ability. New restaurants are popping up all over Montero. This new one was as good as all the others we have visited this year. In the past this would have been impossible.