loma de luz staff

Photo of loma de luz staff from '09

Hasta luego Honduras

It’s our last night at loma de luz and we have had an excellent time here. I can’t say enough about the importance of the work that is being performed by the missionaries. The local population would truly be at a loss without the hospital and orphanage. The missionaries display a servant attitude as they go about their daily work. They have welcomed us into their homes and lives, making us feel as though we are part of their family. In essence we are. Each believer is part of the larger family with the goal “to know God and to make him known.” We all have a part in that process, whether it is in our homes, at work, overseas missions or in support of missions.

For me it has been a challenge to maintain this world vision. I get caught in the day to day distractions of life, and to be honest this can occur in the mission field abroad as well. It’s nice to have worked in a location where servitude is the modus operandi. I pray I can carry this attitude back home and to work.

Our last night here we had dinner with the young people that stay at staff housing. Most of these youth are either recently graduated from college or high school or are in the midst of their college studies and have taken six months to a year to serve either at the hospital or nearby at the orphanage.

Anyway, we had a pleasant dinner and were in the midst of playing the salad bowl game when Dr. Daron, a family doc who was on call, was called in by Joele, the nurse working the night shift. Joelle reported that a young lady was experiencing significant vaginal bleeding. While we finished our game Dr. Daron went in to investigate the situation.

Upon further inquiry it was determined that this patient was miscarrying and had a significantly low hematocri at 20. Coupled with her hypotension and tachycardia this patient was teetering on the brink of being critically ill. Dr. Rina (also another family doc, whose house we were at) and myself went into the hospital to assist. One of the significant issues at the hospital is the shortage of nurses. If anyone reading this is a nurse or is considering becoming a nurse, I would strongly encourage you to pray about going to loma de luz to serve for a period of time. Anyway due to this shortage it really requires more physicians to perform the job that it would usually. Which is why Dr Rina and myself went in to help.

I assumed the role of anesthesia provider, Dr Daron assumes the role of scrub tech and circulating nurse and Dr Rina assumes the role of surgeon. Anyway we were able to perform the D&C and stabilize her and I even got to donate a pint of blood for a transfusion for her.
Of note the patient had gone to the clinica de salud (local public health clinic) a few days prior and had been given vitamin K (a vitamin involved in helping blood coagulate). Not to be critical of the outlying clinic but this was not the patient’s problem and had she only done this she would likely have eventually bleed to death.

I would again like to express my gratitude for the hospitality that was provided by all those working at loma de luz Hospital. I will continue to pray for them as they perform the work God has called them to endeavor. These men, women and children went out of their way to make Cody and I feel welcomed. I would also like to say thanks to the patients that I was able to meet, as they were extremely understanding and patient with my Spanish skills. Lastly I would like to express my thanks to my son for his willingness to come on this trip. He sacrificed his spring break to assist with the work here. I hope and pray that the work that God has begun in his heart here will continue to grow. He is quite a young man, and I am proud of him. God Bless to all of you. Thank you for your prayers, until next time…

la voluntad de Dios

So yesterday I was saying how very little had been happening around here. Well yesterday afternoon that changed...

Maria, who looks to be in her late 20's, pregnant with her 7th child (the six other children were home deliveries) arrived after being unable to successfully deliver at home. From what we gather she is at 43 weeks gestation. For reference 40 weeks is full-term and in the states we have started inducing women at 41 weeks to avoid the morbidity associated with post-dates pregnancy.

"How long have you been pushing," I ask.

"Hasta ocho," Maria says.

Since eight this morning and it now being noon seemed reasonable to me. However, to arrive at the hospital Maria was carried in a hammock for four hours until they arrived at a road where they flagged down a truck, and then driven an additional 45 minutes and finally arriving at our doorstep. So we figured she hadn't started pushing this morning.

"Hasta ocho esta manana," queries Carrie, one of the nurses who is learning to do OB.

"No, hasta ocho anoche (since eight last night)."

So Maria had been pushing for 16 hours.

Fearing the worst we search for the fetal heart rate with doptones and are relieved to get a rate in the 140's. I examen her cervix and find that she is not completely dilated. She has what is refered to as a thick anterior lip that is very swollen. Likely, she had started pushing prematurely against a non-complete cervix. To compound the issue she had thick meconium which signifies that this infant had experienced a significant amount of stress as well as presents a challenge in neonatal resucitation.

We make the decision to transfer her the hour to la Ceiba to the public hospital. A few calls are made on the radio to rouse the troops. Dave, as he frequently does, volunteers to drive. He is a former volunteer firefighter and EMT so this work is right up his alley. Amy, an RN volunteers to ride along in case of an emergency, i.e. delivery.

Prior to transfer we pray...

"El nino esta llegando," Maria says upon termination of the prayer.

I lift the sheet to verify what she is saying and sure enough there is the head on the perineum. We quickly switch to delivery mode.

Maria delivers easily at this point with only a couple pushes...a girl...a lifeless girl...

We quickly bulb suction the infant (we didn't have time to get the equipment to perform endotracheal suction). No response...no respiratory effort...no heart beat...

We start the code...providing ventilations via the bag-valve-mask...start chest compressions...we call for more help... shortly thereafter Shaw and Sharon arrive....we place an umbilical line and start to administer IV fluids as well as epinepherine..atropine...sodium bicarb...we get her intubated...tube placement is confirmed...check the monitor and see a rhythm...check the pulse...present but slow...we continue respirations...heart rate slows...we restart chest compressions...more epi...more atropine...more fluid..more bicarb...

Reflecting over medical school and residency training you realize there is no way to prepare a physician for events like this. Laying before you is an apparently healthy looking full-term infant that just needs to breath and move...but now matter what you do you cannot will it to happen...

After an hour of resucitative efforts we declare the obvious, that the infant is dead and further efforts are futile.

Carrie, with excellent spanish explains the outcome to the mother...while tearful Maria is at peace..."es la voluntad de Dios (it is God's will)," she says.

A few hours later Maria leaves, to be driven, then carried the 4-5 hour trip to her village...along with her newborn baby who is to be buried...

Eye Dilema

Not much has been happening here over the past couple of days. I have been working in the clinic, seeing the usual; back pain, abdominal pain, headache, eye glued shut with super glue, parasites etc.

A boy arrives from far from here (hours). Locals don't measure time here in distance as much as they measure it in how long it takes to arrive at a certain location and that is dependent upon the weather. While we are currently here in the dry season, when it rains it can often be impossibe to travel. To get to the hospital you have to cross through one river when coming from the west and two rivers when arriving from the east. If there is rain up in the mountains the rivers can become dangerous if not impossible to cross.

Anyway this gentleman of 16 years was applying super glue above his head and it dripped into his right eye subsequently gluing his eyelid shut...three days ago. So he arrives with an eyelid that is swollen as if he'd been punched or stung by an insect.

Fortunately I have some experience in this sort of thing...eyelids being glued shut that is. Back when I was a resident Dermabond had just come into use. Dermabond is medical grade skin adhesive with the same properties as super glue. Anyway, I was repairing a laceration on the eyebrow of a toddler when some of the glue dripped into his eye subsequently gluing his eyelid shut. I quickly looked at the parents to see if they had yet noticed...they had...they were watching me like a mother bear watches her cub. I would like to say my knowledge and experience from medical training kicked in and I calmly resolved the situation. That however would be far from the truth. I did what any person whose accidently glued his/her fingers together with this adhesive would do, used brute strength to physical seperate the eyelids. It worked amazingly well, the lac was repaired, the eye was open and I told the parents this was a "common occurence when we repaired these sorts of things"...that quote was the result of my extensive medical training...

Alright, back to our adolescent with the same problem. I remember back to the toddler and quickly and forcefully seperate his eyelids. Amazingly it works just as it did 10 years ago, the only problem is that all his eyelashes are now located on his upper eyelid...hopefully they'll grow back...

Playing Soccer

Whitewater Rafting

Shaw, his daughter Jenna, Cody and myself went whitewater rafting today. On the Congrejal river outside of la Ceiba class II-IV. Short trip, approx 2 hours, but lots of fun.

Photos

Cody at beach

Yours truely on top of the water tower.

Cody at Front Gate of Hospital

Cody thinking about getting on that horse...

Dr. Shaw Yount (left), Dr. Joel Tumlinson (right)

performing hospital rounds

Guardian Angel

Liz McKenzie, who I've mentioned previously, manages the orphange with her husband Iain. She is keeping watch over young Olvin here, who going on nine months.

Sadly Olvin was harshly abused as an infant. He has multiple subdural hematomas (blood clots around the brain) and now suffers from development delay, seizure disorder and disorganized swallowing. He has a feeding tube but as is quite common suffers from significant reflux causing recurrent aspiration pneumonias. Olvin, absent a miracle will never be normal.

The cynics among you may say why waste the time, resources and money on someone like Olvin, there are times when I would feel that way. But the guiding principal in service here on earth must be Matthew 25:40, "When you have done it for the least of these, you have done it unto me."

Holy Week Tragedy

"HR3 RWT -Doctor Rick", came the voice with urgency on the other line. They primarily use HAM radio here to communicate.
"Quinientos", I say in return, indicating that the triage nurse on the other line switch to channel 500 so we can talk.
"Tenemos un nino que se ha agohado," she states with panic in her voice (we have a child who has drown).
"Yo vengo," I say in return (I am coming).
I put down the radio and sprint to the hospital from the dorms (no more than a quarter of a mile).
Upon arrival Dr Shaw Yount, who had been doing administrative work in the hospital, was performing chest compression and Norma King, RN was providing mask ventilation. I start into assist the team with warming and resucitation...

This week is "Semana Santa" (Holy Week) in this largely nominal Catholic country. This is their big holiday week. If Hondurans have the finances or if they are lucky enough to live nearby they travel to the coast to enjoy the holiday...

Isaac (4 years of age) had been enjoying the day playing and swimming along one of the local rivers. Like most other children his age, he was likely hopping from rock to rock, searching for bugs and reptiles to play with or torture. Enjoying a week with cousins. Somehow like evry curious child he had seemed to wander off by himself...

Isaacs mom was nearby catching up with her family, cleaning up after lunch. Surely Isaac was being watched by one of the older children. Suddenly her sister-in-law screams that something is wrong, in her heart she knows it's Isaac, that boy is always getting into mischief. As she crests the riverbank she sees the lifeless body of Isaac being pulled from the water. Quickly they carry him to the road and flag down a vehicle to transport them to loma de luz hospital...

We work on Isaac for over an hour, multiple rounds of epinepherine, atropine, defibrillation... We attempt to rewarm his body... He is intubated and a central line is placed... We pray... We think we see some cardiac activity on the monitor... We try some more... We all know that the chance of Isaac surviving would require a miracle... there are no miracles to be had today...Isaacs mother is informed of the news...she is griefstricken...no one should have to bury their child...especially not during Semana Santa...

There are few patients that I remember from my short medical career. Physicians remember interesting cases, and the saying is that you don't want to be an interesting case. We also retain very few memories of success...we seem to preferentially remember our failures...this probably goes for most people in most areas of life. Hug your children, if they'll let you... extra hard tonight...

Cody's Work

Cody has been working construction with Mike Yost (originally from Ohio) and Josh (from California by way of Montana). They have been working on expanding the temporary housing at the orphanage. Iain and Liz McKenzie (from Scotland) run the orphanage and have children there from 7 months to 17 years of age. The expanded homes will allow people to stay who are either here to work/volunteer on a long-term basis or families of patients who need a place to stay while their family receives care.

A few facts about Honduras (take from WHO)

We are along the northern coast east of la Ceiba in Balfate

(click on map to expand)

Total population: 6,969,000
Gross national income per capita (PPP international $): 3,420
Life expectancy at birth m/f (years): 67/73
Healthy life expectancy at birth m/f (years, 2003): 56/61
Probability of dying under five (per 1 000 live births): 27
Probability of dying between 15 and 60 years m/f (per 1 000 population): 229/133
Total expenditure on health per capita (Intl $, 2006): 241
Total expenditure on health as % of GDP (2006): 7.4

Happy Customer

Little guy with an asthma exacerbation

Temporary Home

Dorm where we are staying.

loma de luz

loma de luz Hospital

following taking from Cornerstone Website

www.crstone.org/

A Brief History
The Cornerstone Foundation was founded in 1992 by Jefferson C. McKenney, MD, with Rosanne Lillard McKenney as co-founder. Since that time the Lord has brought together a Board of Directors (both in the US and in Honduras), committed career missionaries, part-time volunteers, and supporting churches and individuals. God has also granted cooperation from the Honduran authorities for the perfect location and full title to the property. Extensive electrical and water supply project have been accomplished as well as that of roads and bridges. The hospital itself and accompanying support structures--such as Dormitory / Staff Housing, Kitchen and Laundry Facility, Warehouse, Equipment Repair Building, and the Power Plant Building--have been constructed. Continuing construction goals include Sanctuary Housing, additional missionary housing & warehouse space, an airstrip, and on-going outfitting, equipping & maintenance of the various buildings in the hospital complex.
In January 2003 the hospital, Hospital Loma de Luz, saw its Grand Inauguration. Loma de Luz is a 30,000 square foot, 50 bed, modern, full-service medical care facility. Working through its Honduran board of directors ( APAH), Hospital Loma de Luz is a rarity in the small world of Christian mission hospitals. It was built and is administered without the backing of a denominational system. An average of 900 patients are seen through clinic and outpatient surgery monthly, and many more with minor problems are seen and treated in triage. Hundreds of these patients are ministered to through the on-going Chaplaincy program at the hospital, with new believers and recommitments being made almost daily.

The Vision

The vision of Cornerstone is one of a diverse community of Christian believers cooperating to provide medical care and a constant, present, on-going hearing of the gospel of Jesus Christ to the people of the north coast of Honduras. In order to accomplish this, a tertiary care referral hospital is the structural hub of various services and outreaches including public health & community development, chaplaincy, pastoral/Christian leadership & discipleship training, home health care outreach, and ministry through local schools. We pray that the hospital and community surrounding it would be a "city set on a hill that cannot be hidden" and that we would not only meet physical needs, but that the meeting of those needs would serve as an in-roads into peoples' lives. It is our goal that the people who would come to the hospital for medical care, the people who would find employment related to the hospital, and the people who would benefit from other connected services would not only hear the gospel preached, but also see it lived-out in the lives of the Christian workers.

Honduran Material and Physical Needs

The need in this part of Latin America is concrete, ubiquitous, and “with you always.” Honduras is considered “the poorest nation on the mainland of the Americas” with over half the people living below the poverty line and an unemployment rate above 28%. About the size of Tennessee, Honduras has a population of 6,560,600. The average per capita income is $660 per year, but the lives of the people in the remote countryside, where we are ministering, fall far below the statistical averages for the country as a whole. Malnutrition, intestinal parasites, impure water & improper sewage disposal, along with inadequate housing, are major causes of health problems. Diseases such as malaria, dengue fever, and TB are not uncommon, and HIV disease in Honduras is “the elephant in the room,” a present and quietly growing crisis.
Reaching the nearest public hospital often requires nearly a day of travel for many of the people in our region even with the best of weather conditions and is often simply inaccessible during the rainy season. Even if one reaches that hospital, chronic shortages of personnel and supplies make the effort a gamble, and “extra” expenses such as food, lodging, medicines, and materials make this care prohibitive for most of our people. From a physical perspective it boils down to this: with the simple “wear and tear” diseases of life, Hondurans in the countryside are likely to suffer without relief. From an injury, such as a broken arm or burn, they are likely to be crippled. From a simple emergency, such as appendicitis, an obstetric complication, or a serious trauma, they are likely to die.

The Spiritual Needs

Although 93% of the population is statistically considered Roman Catholic, the majority of Hondurans living in the countryside have often never understood basic precepts of faith or of the Christian life--due to widespread functional illiteracy, nominalism, and the intermingling of superstition & occult practices. Those who are believing Catholics also suffer from an acute shortage of clergy (the ratio of priests to parishioners is about 1 to 22,000). Among the growing minority Protestant population, there is often great need for balanced Biblical discipleship and freedom from legalism. In short, Hondurans in the countryside are likely to live their entire lives without understanding that Jesus Christ is the Way, the Truth, and the Life—without understanding that He is a real person rather than a mythological character or a religious system or manmade legal code. Our hope is that through this work, He will become known as the Savior who walks with them, shares their burdens, never leaves nor forsakes them, and offers them a life of grace and hope.

Day #2

A little more productive today. I saw 11 patients. Most interesting one is photographed here with before and after photos. I tried to get him to smile for me after the procedure however he was not too impressed with the western physician inflicting pain on him. I never did find out how he injured his head. But as energetic as he was I doubt this will be his last visit to the doctor.

Supper

Well, Jen will be amazed but I cooked dinner today. One word of wisdom for future travelers to the developing world (that is the politically correct way to say Third World), don't try to save money on meat.

I was doing some education on comparison shopping with Cody, showing him how much we can save with just comparing costs. So we pretty much bought all generic items. You see in our family if spending money was the fire, I am the water and all other members of our family are gasoline. Anyway I talked Cody into buying the cheaper meat "Estofada". I didn't know what that meant but have found out it means stewed meat.

It tasted strangely similar to the horse meat that they served at the medievil festival in Motta where we lived in Italy. Anyway by the end of the meal Cody wasn't feeling to good. It could have been my cooking...but I'm going to blame the meat.

The photo is of a Toucan outside our room.

Cody on the Ferry

First Day

So again, I am sure that if I wasn't volunteering I would be fired... I see about eight patients this morning in the outpatient clinic. A myriad of problems from asthma, hernias, back pain, knee pain, muscle pain and diarrhea. My Spanish is pretty rough and as my pride dictates I decline a translator (I figure it forces me to remember quicker). When I ask "me entiende", or "do you understand", the patients smile and say "si", but their body language leads me to believe they are just being kind.

This is a picture of the hospital loma de luz.

Arrival

Yesterday started with a dive followed by a ferry ride to the tierra firma (mainland) followed by one hour trip by Landrover to loma de Luz. We went through the flurry of introductions at the temporary lodging and unpacked. We were able to have dinner (French Toast) at Drs. Shaw and Sharon Yount (Family Doc and Pediatrician) and their two children Jenna (14) Mykaela (12) who have been career missionary physicians for the past couple of decades, first in Kenya and Zimbabwe, then subsequently here. Shaw did his Family Medicine residency at ECU, about 60 mile from where we currently live.

This is a view from the road leading up to the hospital.

Sea Horse

Arrived at the hospital yesterday. Our day started in Roatan where we went diving again. Saw a large free swimming Moray eel and a Sea Horse. Amazing how camouflaged those animals are, blend right into their surroundings so that they go unnoticed. Interesting when you think about it how we can camouflage ourselves into our surroundings to avoid being noticed or avoid conflict. While we all despise those who seek gratuitous attention we have to be wary of going through life attempting to secluded ourselves from the surrounding world. While interaction with events/people outside our comfort zone may cause pain and even harm to our egos and physical being it is wise to remember that only those who experience pain can experience growth.

Denegado

"Denegado" is a word that I have been hearing much too often recently. It means denied and as you can imagine refers to our credit card. It's wise to ensure your credit card company knows in advance that you are leaving the country. So Cody and I have pretty much all our cash burnt through prior to completing our first weekend in Honduras. Did I mention how much fun we are having and how beautiful it is here. By the way we've had some fresh fruit today and I hope "augua purificada" means it's good to drink for a gringo. I'm sure I'll have more on that in a future post.

Diving

After arrival in Roatan, Cody and I quickly went to the Dive Shop and went on a refresher dive. Absolutely beautiful with excellent visibility. Roatan is on the second largest barrier reef in the world behind Australia's. Saw all sorts of tropical fish and really enjoyed ourselves. Plan to go again tomorrow before we head back to the mainland and to the hospital.

Today we took the ferry to Roatan , which is an island off the coast of Honduras. About 90 minutes of agony for me. I stood out on the deck with all the others who are prone to motion sickness, just hoping no one would break loose and fortunately arrived without incident. Upon arrival we were met by the onslaught of taxis and requested one to take us to an inexpensive hotel. I think my Spanish must be a little off because he took us to one of the more expensive locations. However this is a big vacation week for locals (Holy Week) and we should be happy we have a roof over our heads.

Atlanta Airport

Flew out of New Bern this morning 0600. Cody is hungry and tired already. Eating a healthy breakfast at McDonalds in the Atlanta Airport. You can see how excited he is ;)

Another Trip

Well I'm off again. Tomorrow, Cody and I leave for a two week trip to Honduras. We will be working/staying at loma de luz Hospital which is situated near Balfate, Colon. Hopefully I will have internet access that allows me to keep this updated. More to come...