Go into all the world

Dr I is only a few years older. She finished medical school here in Honduras and is now practicing as a general doctor while awaiting to get into a US residency. We really like it when she works with us at the clinic. She not only speaks English well, but she is so patient with our many questions, and all the times we ask her to act as a translator between us and our patients. She also goes the next step and uses each opportunity to teach us. She just took Step 2 CE (board written exam #2) in December so she knows what we need to study for our Step 2 in June. 

This particular morning with her first patient she came to us in the other room, and said, "you should come see this." An elderly woman lay on the table in her exam room. "Just feel her abdomen, and tell me what you find" Dr I said. So we took turns gently palpating this lady's abdomen, but lightly because she was in obvious pain. There was a large something just below her ribs on her right side. What we call the right upper quadrant. Maybe an enlarged liver? Maybe she is really really constipated? Or maybe it's a mass? Dr I then began to give us some background on this lady. She came to the clinic 6 months ago because she had pain in her abdomen and was a little constipated. Dr I felt the same 'mass' then and ordered several labs to determine what was going on. She was concerned it could be cancerous, but wasn't quite sure without proper labs. Now 6 months later this woman returns in more pain, with more constipation, and weighing much less than she did prior. (Weight loss is what we call a 'bad symptom' it means something bad is going on, like a cancer, but not always) she brought back none of the tests Dr I had ordered, stating she couldn't afford any of them. So now, all we know is that she has a mass, likely Cancer due to her weight loss. But we don't know what kind, how bad it is, or what treatment will actually help. 

Dr I tried explaining to her that she must go to the hospital. The same hospital I have worked in and written about how overcrowded it is. She tried explaining that we must see what's going on inside her belly, that it is very serious, and she must go. This lady really needed a CT scan, and a lot of labs, but there is no way she would be able to afford it, so we ordered an ultrasound instead. She and Dr I talked back and forth for a while while I just stared on without a clue what was being said. Dr I then explained that this woman told her she would rather die than go to the hospital. She had had too many bad experiences there. After some pleading Dr I made her promise to go, but the lady said if they told her to stay she wouldn't do it. Dr I knew the woman most likely would not go, but she even called the woman's daughter to try and explain the gravity of the situation. Then she called a friend of hers that works at the hospital to have him be on the look out of this woman and know what was going on. 

We were all pretty discouraged after the woman left. We knew that whatever this mass was had already taken a great toll on her body over the last 6 months and it wasn't slowing down. If she doesn't go to the hospital, or if she doesn't stay, we know this mass will take her life. But she doesn't have to die, not from this. Dr I caught it long ago, but because she is poor, nothing as been done. It is so sad to see and realize the gap that exists between the rich and the poor. This would never happen to someone with even just enough money to pay for some tests. This wouldn't even happen to the poorest of persons in the US. If a doctor in the U.S. Finds a large mass in the abdomen of a homeless person off the street, there are ways to get that person the help he/she needs. Say what you want about our health care system or the crazy people that fill our emergency rooms, but at least they are receiving care, and quality care at that. May we not forget how privileged we are. 

This begs the consideration then, what about her Spiritual condition. I didn't have the chance to talk with her directly, but what a difference it makes if she knows Christ as savior or not. God knows exactly what is happening here. He sees her pain, and the hard times she is facing. If she is His then we have full assurance that He will heal her, one way or another. We can rest in the hope that she will suffer pain no more and probably soon she will be worshiping as she was meant to for all eternity! But if she does not know Christ as savior and Lord than this situation is even more heat breaking than before! Instead of soon being relieved of her pain, she will come to know eternal pain and suffering. Oh, may we not forget the importance of the Gospel! Why do we do missions to 3rd world countries even when we can't give much medical care? Because the Gospel of Jesus Christ is the hinge on which eternity swings! It's not about catching and fixing life or death situations, it's more than life or death, it's eternity! 

And this, this is why God sends us each into the world. Teachers, business men, accountants, whatever, we have the key to eternity. And the woman who lives next door to you who is dying of cancer and doesn't know Jesus is in the same grave situation as the woman here if she doesn't know Jesus. What does it matter if she receives top notch health care if she dies only to face eternal death? The Gospel of Jesus Christ, this is our hope, this is our mission, this should be our aim each and every day! As this rotation comes to a close and I head back to the US, I am heading back into my mission field. No the people I will see won't be in as much need of medical care as those I have seen here. And I surely won't be able to offer Americans as much as I can offer Hondurans, but my people are in just as much need of Christ. The Gospel, this is what my people need more than anything, the pure unadulterated Gospel of Jesus Christ! 

Do this in remembrance of me

Reading through the Old Testament, it is clear that God wanted His people to be set apart. I mean He did call them a royal priesthood, a holy nation. I've been reading the laws Hod put in place regarding sacrifices, food, cleansing from illness etc, and I have been overwhelmed with the amount of rules given. But it is very clear that God wants His people to be clean when they come to Him. He is holy and cannot tolerate sin. So before Christ came all these commands had to be followed in order for sin to be covered temporarily, but the people could only offer those sacrificed if they were ceremonially clean. Not only did God require the sacrifice, He required cleanness while offering them. 

This morning I had the privilege of taking the Lord's Supper with my brothers and sisters in Honduras. Most of the service I struggled to understand, but that is one thing we can all do together. Even though language has put a barrier between many of the people and myself, and even though culturally we are different, we can worship together in the Remembrance of what Christ did for us all. He was perfectly clean. A lamb without blemish or spot, slain from the foundation of the world. His body was broken for us, for me. And His blood was not only sprinkled over me, but it has washed me so clean that I cannot become unclean again. There is no way I could clean myself to come before Almighty God and offer any kind of sacrifice for my sin. But now just as I am, I am clean, perfect, spotless. And my sin has not been only covered, but paid for! I can't even understand that! And here in Honduras, with sisters and brothers I have barely known on this Earth, we together celebrated the Ultimate sacrifice that liberated us all! 

And we worshiped! I love singing with people from other countries in other languages because it so demonstrates the transcendence of God's grace and love and power. And what a small picture of what heaven will be like. People from all over the world, celebrating and worshiping our common savior, our common Lord! Even if we are different on every Earthly level, we have ONE God, and ONE King, and ONE Lord, and that's all that matters! Our sin offering has been paid!

House call

Yesterday we didn't go back to hospital Escuales. Doctora said she had two house calls to make and she wanted us to go with her nurse so she could stay and work at the clinic. We grabbed our backpacks with a few medical supplies in them and hopped in the car with Jedida, a rather feisty, yet caring nurse, who puts up with our limited Spanish. We drove about 20 mins into one of the mountains and pulled over in front of a metal gate. Jedida knocked on the door and we were let in by a small boy who beamed when he saw us. We said hello to an elderly woman and walked back into the furthest room in the house. There lay a teenage boy in his bed with his younger brother sitting at his side. The brother quickly left when he saw us. The room had one window facing the street, a TV and an old play station. The boy's hands and feet were wrapped, and a catheter hung by his bed. He was a paraplegic and we were there to clean a large pressure ulcer. Apparently Jedida had been taking care of him for 8 years now. We rolled him over and I noticed that his back and legs were totally flat, something I had only seen in hospice patients who didn't get turned in the bed regularly. Not only did he have a large ulcer in his lower back but also ulcers where calf muscle used to be. 

This is what happens when constant pressure is applied to one area of the skin. Our bodies were not made to stay in one place all the time, but to move. Our skin is an amazing barrier when it can transfer pressure and stresses along different points, but when it can't move and the pressure stays there, eventually our skin will breakdown. Then our body is open to infection. In diabetics this happens when nerve endings in their feet stop working because their body has been over saturated with glucose. When they can't feel their feet they don't notice when a rock is in their shoe or they step on a nail. Their feet don't shift with constant pressure against them, and all too often the skin breaks down leaving a path for infection. This is the leading cause of leg amputations in the US. Because once infection gets to the bone it is very hard to stop, and drastic measures must be taken to save the body. 

Thankfully for this boy, his ulcers didn't look infected yet. But if his body is constantly lying in that same bed that same way, his ulcers will never been relieved of the pressure that caused the problem in the first place. How is their hope of healing? All we can do is apply antibiotics so that hopefully he doesn't get a horrible infection. 

Again, how much is this like the Body of Christ? We are meant to move, to be active and vibrant working for the Lord. Yes pressure comes, but as a church body we can bear one another's burdens so they are not too heavy on one person. Or individually we are to laid our burdens at the feet of Christ and not try to carry them alone. When we do carry our burdens alone we stop moving towards God through the trail. In doing so the pressure gets to us and starts breakdown our defenses. Satan attacks our minds and makes us question Truth at the core of our faith. What an infection of lies he can bring about! And how destructive it can be! Oh that we would lean on God, and allow others in our church bodies to bear our burdens with us, so we may stand firm in the midst of trial. Then instead of an ulcer forming, allowing a rout for infection, we develop tougher skin, calluses that are able to withstand more and more pressure. 

After we left this house, we drove further away from the city. We turned onto a road that reminded me more of the roads in Malawi or Mozambique than Honduras. We bumped along then suddenly we turned into the tall grasses. Here the only marker of a road were two beaten tire tracks between grass taller than myself. We mowed the grass down with our vehicle as we drove down a steep hill and stopped by a creek. Jedida got out so we followed wondering what was going on. Down the stream some kids were swimming and a truck slowly tried crossing to the other side. In a few minuets our patient came walking through the water to us. She was a quiet gentle elderly woman with a simple smile. She had fallen on some rocks and bruised her ribs. We were there to give her some pain medicine and make sure we didn't feel any broken ribs (Granted you can't feel hairline fractures, but practically we wouldn't change her management unless they were grossly broken). She thanked us and crossed back over the creek. Then we started our climb back up and out. There's just something about those bumpy roads that makes me smile like crazy! I absolutely love them!

As we drove back and I notice the time that had passed, I realized what a sacrifice it was for Doctora to spare her staff and so much of their time, and to give the medicine and treatments. But then again we are told in Luke, 

"What man among you, who has 100 sheep and loses one of them, does not leave the 99 in the open field and go after the lost one until he finds it?

When he has found it, he joyfully puts it on his shoulders,

and coming home, he calls his friends and neighbors together, saying to them, ‘Rejoice with me, because I have found my lost sheep! ’

I tell you, in the same way, there will be more joy in heaven over one sinner who repents than over 99 righteous people who don’t need repentance."

I was thinking how much it is like God to call us to sacrifice after one lost sheep. After all His sacrifice was an amount we cannot even imagine and it's worth is far beyond our understanding. So great is His love, and mercy and compassion that He will go after the one. But He also knows who needs repentance and is ready to repent out of the 100. Wouldn't it be like Him to set the one aside as a way of showing that they are ready for repentance? We need not ignore the opportunities to sacrifice even for one person. Only God knows the eternal value of what we may give. When eternity enters the equation things of this Earth grow strangely dim. 

Waiting room

All along the walls were metal stretchers separated by curtains that were pulled back. The nurses station situated in the middle was full of medical students and residents either sitting and talking or doing paperwork. On the other side of the room there are a few beds with a small mattress atop a board frame. Each bed is full and each each stretcher housed one and sometimes two patents. It is so crowded, people are waiting in line for a bed or stretcher in this emergency room. As I walk in I pass patients holding X-rays waiting to be read, a row of patients sitting in chairs waiting for a bed, some with hands or feet wrapped in bandages soaked in blood. Several look like they had been beat up with swollen faces, some are lying in pools of blood waiting for stitches. I couldn't help but wonder why in the world all the students and residents were standing around with so much that needed to be done! One resident pulls me over to a bed and pulls out the patients CT scan and shows me a large subdural hematoma. This poor kid was just lying there with an NG tube. The resident explained he was waiting on the neurosurgery attending to get here so they could evacuate the bleed. Then he shows me a lady in the line for a bed who's CT shows a ruptured aneurysm. How she was still sitting there I have no idea! We found out that all these patients were waiting for surgery. I was in the surgical ER and the place was so overwhelmed by patients that emergencies were waiting in line for a bed to wait in line for an OR to operate.

I then walk back to the orthopedic section where I met the orthopedist who eagerly shows us how to apply casts. He then turned over the casting to us and only showed us who needed which cast and then left. One lady had almost chopped her thumb off and was there to get it cleaned and hopefully sown back together. As the student cleaned her wound I could tell that part of her thumb had already begun to die and there's no way we could save it. We didn't get to her fast enough and now she would have to have part of her thumb removed. Then these parents bring their son to us on a metal stretcher. He had been in a motorcycle accident and his arm looked like it had 2 wrists. It was an open fracture so we had to clean the area very well and then we casted it so he could be admitted to the hospital for antibiotics for a few days before doing the surgery to fix it. He laid in the hallway after we finished for several hours with his family standing there, until they were told where they could take him next. No nurse or hospital staff is wasted moving patients. The families or friends must move them from line to line or room to room. I often saw people alone on stretchers in the hall waiting for someone to move them. 

We casted just about everything. Apparently the only resource here is plaster. Very few ace wraps, and no knee sleeves or ankle braces. We casted ankle sprains, knee sprains, and then of course the broken ones too. I watched the ortho resident pop a displaced tibial fracture back into place, and then another resident try and fail to re-approximate a displaced distal radial and humerus fracture. It's just a different world here. Use what you have to help people as fast as you can and get them out so we can keep the line moving. One guy couldn't afford the material to fix his leg (patients must go buy part of the materials because the hospital runs out quickly) so we just sent him home so we could reuse that bed. And if a patient needed stitches, it was done as fast as possible with as few stitches as possible. Forget all the techniques to minimize scarring. That is a luxury. 

If you walk out of the ER you will find a long hallway outside of X-ray which has been overflowing with people each time I have walked it. Everyone is waiting for an X-ray to go wait to have it read . . . It seems so wrong. And yet has I have sat and considered these things each day I've noticed they really are doing the best they can. There's just too many people for so few resources. And it works, it's not the best but it gets the job done and helps the most people possible given the conditions. 

But I can't help but be so thankful for the way God made our bodies! He made us perfect and then sin wrecked havoc and now bones get broken and motorcycles wreck. But His grace is so great that He still gives us a way to heal. I mean all we have to do is line up the broken bone together and it repairs itself! We just have to hold the skin closed long enough for it to replace the hole with new skin! Grace is in the details we often look over. How much harder it would be if our bones didn't heal or our skin was left with a hole! 

You know it even reminds me of us as the body of Christ. We have been healed but the world around us is so broken and is bleeding and waiting to find the right 'cure' for their ailments. We have the Way to bring healing! The Only Way! And it doesn't have to be perfect on our part! We don't have to have the perfect words or illustration. Yes God asks us to be faithful and be there to apply a 'cast' or a 'stitch' but those things don't heal, God does! And yes, the harvest is plentiful but the workers are so few!    Who is it that God has placed around you or me that is waiting to be healed? 

Hope in the midst of pain

January 21

I sat across the room from her talking in broken Spanglish with other medical students and the doctors. She was another young mother here to deliver and like most of the women in this room she wailed in pain with each contraction and even cried out 'doctor, doctor!' As our conversation eased, I again heard her cry and felt the urge to go sit beside her and try any seemingly small measure to bring comfort, but I hesitated because I knew it would be difficult to converse with my very limited Spanish. There was just enough room for me to sit between her and the next laboring mother. I tried to ask in Spanish her baby's name which she told me, then she said in perfect English, "it hurts really bad". Woah, she's speaks English! This began a long discourse where I do believe we became friends. 

22 year old Hope was in college as a marketing major when she became pregnant. Apparently this caused many problems in her family and even caused her to stop going to church because as she said, "I am so much a disappointment". Her contractions became greater, longer, and more frequent, and each time she would hold her breath and squeeze my hand. Then apologize for squeezing so hard. She kept saying I am never having children again, I just want a c-section! I tried explaining that really wasn't best for her body and it would be good if we didn't have to. But the pain she felt at the moment was all she could see, along with the disappointment she was to her family. I asked to pray with her and we bowed our heads. I didn't ask God to take the pain away, but that He would help her through it, and that He would bless her and her son. That's when she asked if I was a Christian. And from there she told me her story, and the weight she bares. A smile crept across my face as I explained to her why Jesus is so good. He knows we mess up and He knows we aren't perfect, but He still offers forgiveness if we ask. He offers healing, wholeness. And even when we mess up, He can make it into something beautiful like a precious baby boy. Who knows what God has in store for him! God didn't make a mistake creating him or choosing her as his mother or even choosing the timing of his birth! Jesus came for people like us, people who mess up and need to be forgiven. The weight she bares can only be lifted by the God who who already bore it. Her sin engulfed her with physical and emotional pain as literally the consequence of her specific sin, and yet also literally as the consequence of her sin nature. But thanks be to God who has defeated sin, and made a way to be forgiven! 

Just as we finished this conversation, the Doctora whisked me away because a baby was crowning and I was next in line to deliver. As I stood up, Hope made me promise to come back to her bedside. The Doctora was so helpful to urgently yet gently show me the way through my first live delivery. The poor mother had a rough time. I don't think I'll ever forget the Spanish words for Come on, push! "Siga, Siga, Siga, Puje!" The actually delivery was easier than I expected, at least my part that is. It is an absolutely amazing thing that takes place with that first breath of air for a baby. As I held her tightly in my palm and cleaned her off I couldn't help but take a moment to marvel in the miracle taking place! In that moment her circulatory process was almost completely reversing. For the first time her lungs were full of air and blood coursed through through them to fuel up. I watched her fists clinch and then open almost as if she welcomed the space to move more freely. I must have taken too long, because Doctora had the cord clamped and ready to cut before I realized it. I cut the cord and laid the baby down. It was this moment that helped solidify my desire to go into pediatrics. I didn't want to leave the baby! 

But I finished helping the mother and back we went to the labor room where still more mothers waited. Soon after I sat back down beside Hope, the OB came in to round on the women. He noticed Hope had stopped progressing in labor but still was not far enough along to deliver. So he decided she needed a c-section. She was relieved, but quietly asked me to please make the cut and repair carefully so the scar wouldn't be too big. She had a rather large abdominal scar already 5 inches in length and almost 1 inch in width from an appendectomy a few years prior. She was very embarrassed about it and didn't even really want us looking at it. She then grasped my arm and said, "you're so white"! "Haha, yes I am," I chuckled. "And you don't mind that my skin is dark?" I was taken aback by her question. Really, could she be serious? My heart broke that the question even came to her mind. 

I went with her to the operating room and talked with her as I held her hand still. I watched as her baby boy was born and she was able to see him for the first time. Finally a smile appeared on her face! The OB must have noticed the embarrassment she had of her scare because instead of the typical incision, he chose to use the previous incision made and in so doing he will have given her a much nicer looking scar. So now that place will no longer be a shame to her but rather a reminder of the day her son was born! I didn't get to see her after the surgery, and I know she is still trying to bare the weight of her sin alone. All I can do now is ask God to continue to show Himself to her. To open her eyes to who He is that she would repent and find forgiveness in Him. I pray that her son would not be a reminder of her sin, but rather of God's Redeeming grace! God sent us to meet each other last night, and I pray it has an impact on eternity!

"You shall bear children in aguish" Gen 3:16

First night in labor and delivery

Well I had my first over night 12 hour shift last Wednesday night. I was nervous mostly because I didn't know how my body would hold up. We arrived at the hospital a little after 7, and were taken to a room with 8 beds against 2 walls. Several beds were already occupied by mothers in labor. Their were also several Honduran medical students who really acted like residents. The physician came in and we rounded on those who were there. Trying to determine who was ready to deliver and who, if any, needed surgery. It didn't take long before the first was whisked to the delivery room. One student was gowned up and ready to go. Now, as I have never delivered or even actually seen a live birth, This was quite fascinating! I am still in awe of how God created the womb, but more in awe of all the changes that take place with that first breath! Buts that's for another time. My extremely limited Spanish did hinder some of what I could do, and really hindered what I could learn as the doctor taught the students. However, a few students knew English and were so helpful to relay the important information to me. One student in particular took the time to talk me through a delivery and also teach me many techniques to measure important information without the high tech machines we use in the States. He made sure we knew what was going on and got in on the c sections etc. 

As I was sitting in the labor room, listening to the shouts of women in labor pains, I could not help but be reminded of the curse of sin. There it was as loudly as I had ever heard. And yet even so it was not nearly the worst consequence of sin! Not only do we labor in pain, but we are separated from the God who made us. All I could provide in that moment was love, a hand to squeeze or a pat or rub on the shoulder. She had to bare this pain herself, but oh praise be to God that we do not have to bare the weight of sin ourselves! That is the good that comes from the suffering of labor. It is an amazing reminder of the curse of sin and our need of a Savior! Please pray with me that though there is a language barrier and though these women are in much pain and don't necessarily want to chat, pray that that the Holy Spirit would show me how I can shine. Even if it is a hand to hold or my presence at a bed side so she knows she is not alone. Tonight I head back for my second shift in Labor and delivery. Although I am praying hard that my feet don't wear out and I can stay alert all night I am also praying for the women and students there. That even though I will be tired, and there will be a language barrier, that God would shine!

Whispers of Wisdom

Well I made it to Honduras. One day late, but I didn't miss much. We bought some groceries and then settled into our apartment for the month. My last visit here I was surprised to find that Baxter provided internet services for those staying here, as well as the clinic I was working in. So this was my fist international trip where I expected to have some form of communication with those back home. Well when I arrived I found out neither of those internet services were working, and even now as I type (1-15-15) it is in hopes that eventually I will be able to post this online sometime later. Communication has always been the hardest part for me on these trips. I want to know that I can reach people if I need to, and honestly I just like to keep in touch with people back home if possible. Maybe this is a product of my generation? Or maybe it's sin . . . Trying to have and maintain some form of control?

Before I left the states, my pastor preached a sermon on James 1. "Consider it all joy my brethren when you fall into various trials" "now if any of you lacks wisdom, he should ask God who gives to all generously and without criticizing, and it will be given to him. But let him ask in faith without doubting. For the doubter is like the surging sea, driven and tossed by the wind." As my pastor says, everyone is in 1 of 3 groups. You are either in a trail right now, you just came out of a trial or you are headed for a trial. Well I figured I was probably headed for one, and though the internet being out is not really a great trial, I am trying to apply the same principles to even the small stuff.

You see, God has promised us that all things work together for our good. He refines and purifies us as a silversmith refines silver. And He uses trials to do just that. Unfortunately, there is no better medium than fire to cleanse impurities, and that applies to our hearts too! So what James is reminding us here in chapter 1 is that there is wisdom to be gained when going through trials, and it is a joy to gain it. Of course we lack the wisdom in the first place, that is why God allows trials. So when we lack wisdom and God is allowing a trial, we should focus on looking to God for that wisdom, or the purification He wants to bring from it. But we must ask Him believing that He will grant it, and that there is a purpose for the hard time we are enduring. It's not about getting through the rough times as fast as possible, its about growing through it. God will end our suffering when and if He chooses. Our concern should be what is God trying to show me or trying to perfect in me. We should focus on not missing the blessing in the midst of the storm.

So why, you may ask, is having no internet a trial for me? This is my 8th international trip. With each trip I was prepared to have zero or limited communication with people in the States. For this trip however, I was not prepared. All I could think when I arrived was how mom was worrying because I couldn't let her know I had made it safely. It goes back to one of my biggest fears. I never want to cause anyone else pain or in this case worry (I do realize that with the career path God has chosen for me I will have to cause some pain, but it is for the greater good. . .kind of like how God deals with us . . .). So yes, the thought of mom anxiously waiting to hear from me for 2 days got to me. As I prayed about it that Still Small Voice whispered "Am I not more reliable than the internet"? Ouch! yes, Lord! What I really want for my family is peace, and who am I to think that I can bring it by using the internet more so than God can bring them peace without it! My God is a God of peace, and He brings comfort, better than anything else!

So, as we see, God always speaks in the storm, no matter how big or small it may seem. The key is to listen, expecting Him in the Still Small Voice.