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.