OK, I am going to be all over the place with this, I’m like Jo-Jo the circus boy with my pretty new pet, so buckle down…

Sorry for a bit of delay since my last post.  For one, I just really wanted it to sink in, that we are going to be here in Honduras for awhile.  And two, we had to split the country for a week.  The government wanted us out, so we had to sneak out.  Ok, so it wasn’t quite as exciting as that sounds, it was a scheduled ‘Visa’ trip.  We are here in Honduras on a ‘vacation visa,’ which means that we have to leave the country every 4 months.  And they make it a little tricky, you can’t just hop over the border into Guatemala and back.  You cannot go to a neighboring country, and you have to be gone at least 3 days.  So the two closest countries that fit this criteria are Belize and Costa Rica.

And so we returned recently from a fantastic week in Costa Rica, visiting with my Dad, Pam, and brother Wes.  We stayed in a place on the west coast of CR, near the surfing town of Jaco.  We had a really relaxing week of beach time, enjoying each others company, fishing, and playing many games of cribbage.  We were really grateful for time connecting with family, in a really beautiful place.  Thanks again for the trip, Dad and Pam!  ‘Pure Vida!’

Owen claims he was bitten by a bullet ant.   He says it hurt really bad.   So I did a little research on bullet ants, and yes, they are in this area.  Then the other night I caught a rather nasty looking ant on the porch, with huge mandibles.  I consulted Google (which is the source of all accurate information, especially very useful information about your health–NOT…  please, for the Love of Jesus, do not get me started on how bad the internet is for health information.  It’s really good for finding a natural vitamin for just $19.95 that will cure, well let me see… EVERYTHING!   oops, that felt suspiciously like a rant…)  so anyway, the picture on Google (again, source of all truth in the world) looked just like this ant.  So, yeah, bullet ant…

 

A very cool situation is that we had 4 Honduran medical students come down this past week to do some shadowing with us.  This could be the beginning of a great relationship, because we may have the opportunity to help these students at the very start of their careers, building a foundation of sound medical practice.  And also, sharing the integration of our faith as the impetus for why we are here trying to heal people.

Interestingly, they all tell me they plan to try to apply to residencies in the United States.  There are very few residencies here in Honduras, for the amount of students they graduate.  So apparently, you can just kind of say ‘I’m a cardiologist,’ or neurologist, or whatever, and that’s good enough.  Again, I think I’ve said this before, but if you need brain surgery I’m going to have to recommend that you just stay in the states and try to find a good neurosurgeon up there.   Cause if you come here, YOU GONNA DIE…  That being said, Jeff and Dave, our do-it-all surgeons, could probably look the surgery up in a book (or on Google, I’m sure) and do a pretty serviceable job on your brain, because they are both amazingly good at their craft.  But still, go with the board certified Brain Surgeon in the US, if possible.  Just sayin.’

 

 

The other morning I had to take Will down to the main road to catch the school bus (which takes him into Rio Esteban for school).  He has to catch the bus at about 6:30 AM, but sometimes they are early (and sometimes late) and so we try to be there a bit early.  On my way down to the road, as I was passing the guest housing complex, I saw a snake in the road.  It wasn’t very big, maybe 2 1/2 feet long, but it had the characteristic markings of a Barba Amarilla (yellow beard) which is a very poisonous and aggressive snake.  Since it was moving toward the guest housing lawn, I felt obligated to intervene.

We were in a bit of a precarious spot, with the steep bank of the Cubrada to my right, and the red bank of the hillside to my left.  I pulled Freddy (the name of the little suzuki masada that we are renting) over to the left and just planted its nose against the bank, since the parking break doesn’t work.  The snake had now slithered it’s way up the embankment onto the grass in front of Staff Housing, where several visitors were staying currently.  I looked for something to use as a weapon.  All good vehicles in Honduras have a machete stashed somewhere in them.  In truth, any real man here should be carrying a machete on his person at all times.  Alas, I fall short as a Honduran man, because I not only did not have a machete, but I didn’t even have a good stick or other long, hitty-sort of implement.  What I did have in the back of our vehicle was a boogie board.  So, it was to be death by boogie-board-beating.

I ran up the bank, cautiously, as this snake is known to aggressively chase and strike people.  Once I found it, the attempted bludgeoning began.  It turns out that a boogie board is not a great striking weapon, which is probably why Mall Security guards use the long, black metal flashlights to subdue shoplifters, rather than foam boogie boards.  Alas, the snake eluded me and my trusty boogie board.  I hope that he slithered back in to the Cubrada pit viper ravine of death, never to emerge again, but I cannot be sure.

To make matters worse, but much to Will’s delight, we missed the bus…  Which meant that he couldn’t go to school because we have to cross 2 rivers, and ‘Freddy’ doesn’t have the fortitude to cross them.  Home-school day.

So, needless to say, we appreciate ongoing prayers that none of our children are bit by venomous snakes here…

New patients this past week, Jose and his Dad Juan:  I grabbed my first chart off the door and started reading the brief chief complaint that was scribbled.  I have come to take these with a grain of salt, these short descriptions of the patient’s reason for coming to the hospital.  No offense to the lovely women who check-in our patients, but they are sometimes way off the mark.  A child with a cough is often represented as ‘baby in respiratory failure,’ and likewise an old man with chest pain and signs of heart disease may sit out in the waiting room all day with ‘a muscle spasm.’

Jose’s chart said that he was 18 yrs old, and had ‘a pain in his spine.’  I walked out to the packed waiting room and called Jose’s name.  His dad responded, they got up, and within 3 seconds I had the diagnosis that seemed to allude Jose and his father for the last 18 yrs.  As he struggled to walk down the hall to my exam room, I noted that he looked like he was closer to 13 or 14 yrs old.  They sat down in my room and I asked his Dad, Juan, for how long had he suffered this condition, knowing the answer would be since birth.  I asked about his birth history, which dad said was ‘normal’ as far as he knew, but that he struggled with some problems breathing for about an hour after he was born.  His development was substantially delayed but his father said that his condition didn’t seem to affect his mental development or capacity to learn.  “Can you read,” I inquired.  Sadly, no, because he couldn’t get to school due to his ambulation challenges.  His speech was garbled, and not just because my Spanish is terrible. They had seen doctors before in the past, mostly when he was younger, but they were never given a definitive diagnosis.  They certainly didn’t seem to offer any recognition to the term “Paralysis Cerebral” when I offered it to them.

So as you can see, this young man has Cerebral Palsy, which is an acquired syndrome usually caused by a birth complication.  It is not curable, and offers many lifelong challenges, especially for someone living in a country with few resources.  But these challenges are certainly not insurmountable, and so I hoped to empower him.

To continue, I explained the diagnosis to them.  I also tried to show them that it is actually a common and well known syndrome with many different variations.   And, although it is not curable, the silver lining here is that Jose has a ‘mild’ case of it, relatively speaking.  Oddly, they were not familiar with the lovable character of Walter “Flynn” White Jr., from the enjoyable family program known as ‘Breaking Bad.’  Of course now that I am a missionary, and hence perfect, I don’t watch such scandalous shows such as this, but prefer more edifying entertainment such as ‘The walking dead,’ and ‘Game of Thrones.’  A side note here on Game of Thrones:  1)  I only watch it in the presence of my wife, who also enjoys it (although she is currently protesting violently about ‘dragging her down’ in this blog revelation of our depravity.  Hey, if our pastor and his wife can admit on Facebook that they have watched GOT, then I have the green light to confess our shame)  However, Heidi is quick to throw up her sweaty palms in front of the computer screen when some villainous queen or scheming harlot plops out her boobies.  2)  I just want you to know that I read these books way before anyone had ever heard of GOT (although, Al, I guess I have you to thank for directing me to this masterpiece) and it’s not fair that you can just waltz right in and watch it on TV without trudging through the YEARS of waiting for each new book to come out.   You didn’t earn it!  And for crying out loud George, get to work on your writing!!

Anyway, I tried to explain to them that Jose is actually quite fortunate that he can even walk, as many with CP cannot even feed themselves, let alone ambulate.  Also, he was blessed to have his brain apparently fully functional.  And I emphasized that the key for his future is education.  His dad wondered if he would ever be able to work, which I assured him absolutely ‘yes’, but not a job that would require physical skills.  Herein may lie the problem, as I don’t know if they have the resources to make this happen.  They don’t own a computer.  And they live on the sleepy island of Utila off the north coast of Honduras.  This kid may be the next Albert Einstein for all I know, but because of where he was born, and the socioeconomic situation he is in, we may never see the fruit born of his mind.  So please pray for this sweet young man, who gave me a big hug at the end of our visit.

We were able to fit him with a walker to help his ambulation so I am hopeful that increased mobility, along with our pep-talk, may open some doors to liberation of his mind, and new freedoms.

 

A young man came in at 2 in the AM after a Moto (motorcycle) accident, with wrist pain, both sides.  He told me the accident occurred at 5 pm, so i’m not sure why he waited so long to come in (probably because he knew I would be peacefully sound asleep, and he just wanted to wake me up in the middle of the night and ruin a perfectly good slumber.)  His wrists were hurting, but not too bad, and he said he didn’t really need anything for the pain at the moment (which would later go to show that this dude was pretty tough).  I put his wrists in temporary splints and had him return in the AM for formal X-rays.

The X-rays the next morning showed bilateral (that means both sides) distal radius fractures (the big bone closest to your wrist).  His left side was broken clean off and dislocated, right side not as bad.  I consulted with Dr. Jeff, and we proceeded to sedate him (with midazolam and Ketamine.  Ketamine is a really useful drug down here, we sedate kids and adults with this, and it makes it really easy to do extremely painful things to them without much fuss.  See this, for a little idea of how it impairs ones awareness. Watch for about 1:10 minutes if you want a good laugh).  After he was comfortably in La-La land, Dr. Jeff forcibly reduced his bones back into place and we casted them.  His left arm was casted in 90 degree fashion above the elbow.  His right we casted below the elbow, so as to give him a little more mobility.  Needless to say, this fellow was going to have some major challenges over the next 6-8 weeks, since both his wrists were immobilized.  I just want you to imagine wiping your bottom with two big ol’ bulky casts on both your arms.  Awkward…

The situation reminded me of a poor fellow that I took care of when I was a working as a nurse’s aid on the Orthopedic Trauma Ward of Harborview Medical Center, in Seattle. As a side note, it’s a good thing for a doctor to break his teeth as a nurses aid, it teaches some perspective on the things you are asking a nurse to do for you.  For instance, it’s really easy to write:  Fleet’s enema q 1 hour until BM.  However, what that literally means is: Torture this person by shoving a slimy liquid up his butt every hour until he craps profuse diarrhea all over his bed, and probably all over the room as well.  And when he’s done doing that, you need to wipe his bottom and clean the room, change his sheets, and spray some lovely perfume throughout the hall so that it smells like roses and poop.  Only when you have been on the receiving end of that instruction, and have implemented those orders, can you feel justified in asking someone else to do that too.   Check.  Been there and done that.

Back to this certain fellow, years ago;  he was a kind, developmentally delayed gentleman who had fallen forward and broken both his elbows.  The Orthopedists did surgery to repair them and he was put in casts that went from shoulders to hands, 90 degrees.  He literally couldn’t use his arms or hands for anything.  Imagine all the things he couldn’t do, such as shave, eat, comb his hair.  Further, you can imagine that he probably couldn’t wash his private parts, urinate, or wipe his own rear.  That’s where good ol’ Ryan, the male Nurse’s aid came in.  Man, I was good at my craft…

 

Things to pray for:  

• Heidi is substitute teaching this week for the 3rd grade class, which she has been very excited about.
• Deneli, the little girl with Xeroderma pigmentosa.  Her continuing care.
• The many needy patients that we see each day, who are so gracious and patient.  For their health, and for their faith.
• The Honduran government.  That they would work with us and acquiesce to some of our needs, and that they would care for their indigent population.
• Fundraising for our next year of service.

 

 

 

A few pics of us ‘suffering’ in Costa Rica, on our Visa Trip.