Burket Thoene Family Mission

Edgar

2012-02-13T09:06:00.000-08:00

Edgar arrived to the Emergency room after a truck backed up and pinned him between the truck and a wall. He had severe chest pain, a thready pulse and oxygen saturation that was dropping rapidly. On exam he was noted to have no breath sounds on the right side of his chest and you could feel the air bubbling under his skin. He was diagnosed with a pneumothorax and feared to be developing a tension pneumothorax.

This is occurs when the lung is punctured (in Edgar's case by one of his many broken ribs.) Air, from the lung, enters the thoracic cavity and compresses the lung. The increasing pressure causes the lung to collapse and if the pressure is not relieved can cause collapse of the venous return to the heart and death.

The ER crew acted rapidly and placed IVs, started oxygen and prepared for a tube thoracostomy. This tube, placed into the chest wall, helps to relieve the pressure that is increasing in the patients chest.

The tube was placed without difficulty and immediately Edgar was breathing easier and his oxygen saturations increased. Edgar then was transported to Guatemala City where he spent 8 days in the hospital and ended up having part of his damaged lung removed.

On follow up he was all smiles and very thankful for the care he received.

New Year

2012-01-24T11:10:00.000-08:00

The new year has arrived and so an opportunity for reflection.

We have been here for nearly two years and will begin the third year of our three year commitment to Hospitalito and the diocese of Sololá-Chimaltenango.

We have been blessed in so many ways.

At the Hospital we've been part of a remarkable trans location from the old "interim" hospital -- which was a backpackers hostel -- to the "new" Hospitalito, which should be called "Hospitalote" or grande, allowing plenty of room to grow in the future. We've seen the Guatemalan doctor staff grow to 4 full time generalists, an obstetrician and now a pediatrician. Hospitalito has become part of the country's education of pediatricians which places a final year pediatric resident at Hospitalito full time.

We have also seen our role change from primary caregivers to more educational and administrative roles. In this regard, Brent was recently elected to the board of Hospitalito.

Our children have made friends, attend school locally, and continue to amaze us at how little it takes to make a child happy!

We are so grateful for the many ways our family and friends back home continue to support us -- thank you!

Step Along the Way

2011-12-20T10:43:00.000-08:00

Jennifer and I first read this poem on Dr. Stoughton's blog during his time in Zimbabwe. It was initially attributed to Archbishop Oscar Romero and more recently to Bishop Ken Untener of Saginaw.

Not only does it seem appropriate for us during our time here in Guatemala but I think it speaks volumes to all of us where ever we may be on our journey with God.

During this Christmas season, when new beginnings are celebrated in the birth of Jesus, may we all find our "step along the way"

Peace and Love
Brent, Jennifer, Christopher, Elizabeth, Julianne and Nicholas

A FUTURE NOT OUR OWN

It helps, now and then, to step back and take a long view.
The kingdom is not only beyond our efforts,
it is even beyond our vision.
We accomplish in our lifetime only a tiny fraction
of the magnificent enterprise that is God's work.
Nothing we do is complete, which is a way of saying
that the kingdom always lies beyond us.
No statement says all that could be said.
No prayer fully expresses our faith.
No confession brings perfection.
No pastoral visit brings wholeness.
No program accomplishes the church's mission.
No set of goals and objectives includes everything.
It may be incomplete,
but it is a beginning, a step along the way,
an opportunity for the Lord's grace to enter and do the rest.
We may never see the end results, but that is the difference
between the master builder and the worker.
We are workers, not master builders; ministers, not messiahs.
We are prophets of a future not our own.
This is what we are about.
We plant the seeds that one day will grow.
We water seeds already planted,
knowing that they hold future promise.
We lay foundations that will need further development.
We provide yeast that produces far beyond our capabilities.
We cannot do everything, and there is a sense of liberation
in realizing that. This enables us to do something,
and to do it very well.

Amen.

Mission Together

2011-11-26T04:00:00.000-08:00

This is the half way mark of our three year commitment and the time has really gone fast. Like so many times in life, some days seem to last forever but when looking back the weeks seem to pass by without realizing where they have gone. We are excited for the coming year to continue our work at Hopsitalito, school for the children and strengthening our relationships with the people we've come to know and call friends here in Santiago.
We also want to take this opportunity to thank our family and friends who support our mission here in so many ways. Through your prayers, kind words, emails, letters, and financial support, we are able to continue to answer this call to serve. We realize that this is not the Burket-Thoene Family Mission, but really our mission together.

Thank you.

School

2011-11-11T10:56:00.000-08:00

We came back to Santiago just in time for Christopher, Elizabeth and Julianne to take their final exams for the school year as their school year runs from mid-January to mid-October. The kids did very well and all will advance to the next grade level in January.

The school had a very nice Kindergarten graduation ceremony for Julianne. Much to their dismay, they are all homeschooling over the break.

We had thought that maybe the transition back to Guatemala might be difficult for the kids after being in the US, but the kids haven't said anything. Since we've been back, we've heard them ask a couple of relatives on Skype what they had eaten that day. They certainly enjoyed the wide variety of food while we were on vacation.

Home

2011-11-02T18:54:00.000-07:00

We recently got back from a visit back home. It was really nice to see family and friends and to catch up on everyone's lives. Though Skype has been great, being home in the presence of loved ones is truly something special. It was one of the best vacations we've had because we had more time to just be with people.

We thought that maybe the kids would be struck by things they saw in the US that were different from Guatemala, but we were surprised that they really didn't notice a lot. Christopher commented about a toy that we saw in a store, "Who would pay $300.00 for a toy?" Julianne wondered why there were so many cars. Jennifer was struck by how good the infrastructure is in the US -- good roads, drains, sidewalks, fire hydrants.... things we take for granted in the US that just aren't present in other places.

It was interesting that when we were in the US and we would talk about Guatemala, we would say, "At home....," meaning "in Santiago" which means that we must now consider Santiago Atitlan home.

While we are very grateful for running water, an indoor toilet, and pretty reliable electricity in Santiago, upon our return we were reminded how much we miss hot running water, water pressure, and just how light everything is in the US. However, after being back, we realize how good it feels to have the chance to use less resources just by the very fact that we are here.

Conception and Cecilia

2011-08-01T07:49:00.000-07:00

Concepcion came to Hospitalito at 8:30 AM. She had noticed onset of strong contractions at 4 AM but could not come to the hospital until she was able to get a ride from her village, Cerro de Oro (about 20 minutes from Hospitalito). When she arrived, at 8:30 AM, she was dilated to 5 cm and the baby was in a breech position. Concepcion also had a history of a previous Cesarean section in 2003. She was only 29 weeks pregnant and too early to deliver at Hospitalito.

Preparations were started to transfer to Guatemala City where there is a neonatal intensive care unit. She was given medicines to protect the babies brain, slow down the labor and help develop the babies lungs. After one hour she was 7 cm and it was felt it would be too risky to try to transport her for a 3 - 4 hour journey as she might deliver in the ambulance.

We then had to decide rather to proceed with a repeat cesarian or deliver vaginally. A cesarean would be the least traumatic to the baby but a 29 week newborn would probably not survive while a vaginal delivery would be the safest for mom. After consulting with a number of volunteer doctors and even a call to a good friend/obstetrician in the USA it was decided to proceed with a repeat Cesarean.

Brent performed the cesarean section with a visiting Obstetrician, Wayne Weber assisting and his son Nathan (an anesthesiologist) providing the spinal anesthesia. Baby Cecilia was delivered without difficulty with initial apgars of 3 and 6. Two other visiting doctors from Ventura, California, Drs. Lepore and Noah, helped to resuscitate Cecilia. Cecilia then began to have problems breathing and Dr. Nathan intubated and preparations were made to transfer to Guatemala City. Dr. Noah accompanied Cecelia for the 3 hour trip.

Cecelia returned to Hospitalito after 6 weeks on a ventilator and 2 months total in the Neonatal Intensive care unit in Guatemala City. She has a long ways to go but she already has come so far. She is gaining weight and developing well.

Rainy Season

2011-07-25T06:08:00.000-07:00

The rainy season has begun. It rains most afternoons and when it rains here it often pours for hours and sometimes for days. We went to church the other day in the afternoon, so the rain was in full force. It was notable at church that most people did not have even a coat on, much less a raincoat, and it was chilly. Most of the women had on flip flops or other open shoes. We did not see anyone with boots. Even though we had on raincoats and boots, after just walking a short distance, we were soaked. God, help us to be thankful for simple things like boots and raincoats.

On Corpus Christi, there was a procession of the Body of Christ through town after the 8 am Mass. The rain was unusually early that Sunday and it was raining hard when the procession started. The procession was due to last 4 or 5 hours. In the States, I think the procession would have been canceled, but the people here, without raincoats or boots, processed in numbers. Some had umbrellas or a piece of plastic sheeting that they draped over their shoulders, but many had nothing. Again, no boots and there was running water in the streets in many areas. This was an impressive expression of faith.

Quite the Honor

2011-06-13T11:06:00.000-07:00

We received quite the honor a few weeks ago when Brent and Jennifer were asked to be the Godparents of Daniel Jonas Pablo Coche.

Brent had performed the Cesarean section on Daniel's mother, Petronila, in March and Jennifer had taken care of mother and Daniel after wards.

It was a really nice ceremony held after Mass. There were about 15 babies baptized during the same ceremony. Daniel received a beautiful white garment to celebrate the occasion.

Celebration of Family Day

2011-06-03T04:00:00.000-07:00

Instead of celebrating Mother’s Day at the children’s school this year, they decided to celebrate Family Day since some of the children don’t have mothers. Each class did a song or skit and there were some raffle prizes, although some of these came at the expense of really embarrassing the parents. Then the teachers served a lunch of chicken, rice, vegetables, and sauce which they cooked themselves for over 300 people! Jennifer wore the traditional women’s attire for the first time and managed to keep her skirt on without it falling off.

Christopher's Birthday

2011-05-31T11:55:00.000-07:00

We celebrated Christopher's birthday recently with a party. He invited the children from the local orphanage, neighborhood kids, and a few friends from school, in all about 30 children. We had a great time with lunch, a treasure hunt, piñata, and cake. Elmo (the piñata) was the only one who had a rough day!

At the end of the day when asked what the best part of the day was for each one, Christopher said, “Playing with all my friends,” Elizabeth and Julianne both said, “The food,” and Nicholas said, “The piñata.”

Clean Cook Stoves for Better Health

2011-05-11T09:17:00.000-07:00

At Hospitalito we see many patients who, at a relatively young age (40 years old), have Chronic Obstructive Pulmonary Disease (COPD).

In the US it is mostly due to smoking, but here in Santiago Atitlán it is caused by years of cooking over an open fire in an enclosed space.

The lady who makes tortillas for our neighborhood is about 45 years old. Brent delivered one of her grandchildren recently. We buy tortillas from her several times a week. We have also seen her in the hospital at times for her COPD. After visiting her one day and noticing her coughing with her child and grandchild in the same enclosed smoke-filled space, we wondered if there was something we could do.

We spoke with our social worker at the hospital and found that there is a program to get clean cook stoves into the houses of the local population. In Santiago Atitlán it is estimated that half of the households cook over an open fire, while 47% use an inefficient masonry stove with varying degrees of ventilation. It is also estimated that cooking over an open fire accounts for up to 30% of the families' expenses. Clean cook stoves are up to 60 -70 percent more efficient.

We were able to purchase and install a stove for about $50. The stove actually costs more, but is subsidized by a doctor who worked here in the past. The smoke is ventilated through the metal pipe so it is much less smokey. Since the stove is much more efficient, it uses less wood which means less expenditure for the family on wood and better for the environment.

You never know how anyone will react to changing the way they have done something for their whole life. In this case, the transition seems to be fine. The tortillas look and taste the same (Brent thinks better) and it is much better for their health and the environment.

Maria

2011-04-15T11:38:00.000-07:00

Maria presented to Hospitalito Atitlan with a history of a previous cesarean section about 2 years ago. She had received some prenatal care at the Central Salud (a government run clinic in town), but she knew that when she went into labor she should come to the hospital.

When she presented to Hospitalito she was in early labor. The fetal monitor showed that the baby's heart pattern was "not reassuring" and by Ultrasound the amniotic fluid was too low. We did not have good dates regarding how many weeks pregnant she was but by a late US and unsure last menstrual period we felt she was somewhere between 36 - 38 weeks. It was elected to proceed with a cesarean section. The cesarean section was performed by 2 visiting Obstetricians from Hungary and anesthesia was provided by Brent. We also had a pediatric resident from the states, Kati, who was present to help with resuscitation of Mary's baby if needed.

Mary's baby was born with an initial low apgar of 4 but the second apgar of 7 was more reassuring but over the next few hours the baby began to have more respiratory difficulty and the oxygen saturation was decreasing and the baby was becoming cyanotic (blue). The team at Hospitalito worked together to place an endotracheal tube ( a tube in the child's lungs) so that we could breath for the child. The baby was then transferred to Guatemala City, to the government hospital Roosevelt.

Mary's baby spent the next 8 days on a respirator and 15 days total in the hospital, and returned to Santiago with mom.


Mary, baby and Kati, the pediatrician	who helped with the resuscitation.

ADISA

2011-02-17T08:49:00.000-08:00

As we have mentioned, in an earlier blog, we have found a number of organizations in Santiago Atitlan doing good things.

ADISA is doing GREAT things. Asociacion de Padres y Amigos de Personas con Discapacidad de Santiago Atitlan (Association of Parents and Friends of People with Disabilities in Santiago Atitlan) was started in 1997 by parents of a child with hydrocephalus who subsequently died at the age of 9. They saw first hand the lack of resources available to children with disablities.

ADISA has a number of programs to help this population including education, health care, early stimulation, education of the community, physical therapy, vocational training and job placement.

Our family has been blessed to know this exceptional organization, the staff and the people they serve. We have also been able to help ADISA as Hospitalito has partnered with ADISA to help with some of their health care issues.

Their web site is excellent and gives more history as well as opportunities to support their work. www.adisagt.com
from there you can click on Conozca nuestros productos and then click on www.novica.com

Holy Family

2011-01-04T05:12:00.000-08:00

The 26th of December was the Feast of the Holy Family. It is always interesting to hear what the priest is going to say about the readings on this day.

However, we were really surprised when the priest announced that there were going to be 23 marriages during Mass. This was not a Las Vegas style group wedding. Each couple took their vows individually, exchanged rings, and had their blessing and applause. Needless to say, Mass was a little long that day (more than 3 hours!), but the kids did very well, despite not being able to see much. The brides all wear their traditional dress and then a white veil.

Many couples here are together, but not officially married, so the priest was very happy that so many couples were getting married. His homily was excellent and he remarked that we should look to the Holy Family as our model for marriage. The Holy Family did have to endure many trials in their life together from doubt over an immaculate conception to living in a foreign land to having a child that they had to let go of.

Loving God, help us to look to the Holy Family as a source of inspiration for our own marriages.

Christmas and New Years greetings to everyone!

2011-01-03T08:52:00.000-08:00

Christmas crept up on our kids too. We had been lighting a Christmas candle each day at mealtime that was counting down the days to Christmas and reading a little book every night that was also an ornament for our little tree. Yet, when we were putting out cookies and milk for Santa, Elizabeth (who is almost 7) said, “You mean Santa is coming tonight!” Then our kids who are 7 and younger slept until 6:45 on Christmas morning. Quite amazing!

We had a Christmas Day dinner with some of the other volunteers who are here over the holidays. We did not make tamales which is the traditional food in Guatemala for this time of year. We are going to learn how to make tamales this weekend, so maybe next year...

Christmas at Hospitalito

2010-12-24T07:00:00.000-08:00

We went to the Hospitalito Christmas celebration the other day. It was at a nearby chalet with a pool and big grassy area. We played games and groups did skits. The group that was in charge of the cooking made an incredible meal on an open pit BBQ. They made grilled chicken, carne asada, chorizo (pork sausage), grilled vegetables, potatoes, salsa made from grilled tomatoes, and guacamole. It was delicious.

We don't eat a lot of meat here, so Julianne kept asking for clarification on each meat she was eating..."So this is the chicken's leg and this is cow and this is pig. I like pig!"

Preparing for Christmas

2010-12-23T08:54:00.000-08:00

We, and especially the kids, are looking forward to Christmas. The holiday is creeping up on us here without TV and the Christmas sales that start in October (or before).

The priest emphasized at Mass one day that Christmas does not begin until the 25th. Now it is Advent, the time of spiritual preparation. It seems that for many in the US, when Christmas finally comes, the Christmas season ends the same day. It has been refreshing here. Of course, the hardest part is that we will spend it without our extended families.

We did buy a small artificial tree which is decorated with a few ornaments, ribbons, and things the kids made. It is just right! We are planning a Christmas Day dinner here with the volunteers that will be here over the holidays.

P.S. The picture of the tree is not our "small tree" but the tree in the center of town!

Cold

2010-12-22T19:00:00.000-08:00

Yesterday we woke up and it was 57 degrees inside the house. (We do not have an outside thermometer, but it was clearly colder outside.) We never thought we would be cold in the mission field especially after being in Ghana where we were always hot.

It warms up beautifully during the day, but nights and mornings are cold. We are at 5,105 feet so I guess the cold should be expected, but sure makes it hard to get out of bed in the morning especially with no heat to turn on!

Busy Time

2010-12-22T08:46:00.000-08:00

It's been a busy time at Hospitalito. The first floor of the new hospital has opened after years of work in planning and building. As much of a challenge as it was to build the new hospital it will be as big of a challenge to run it. As Hospitalito enters a new era, we are honored to be part of this and hope we are able to help in the challenges that lie ahead. There are still many sections of the hospital that are yet to be completed and we are awaiting these areas with great anticipation over the next year or years especially the blood bank.

We have had a number of visitors who helped with the opening and moving everything from the old hospital to the new hospital. Lynn Powe, a nurse, came for the month of November, taking Spanish classes in the mornings and working in the hospital in the afternoons. She provided much appreciated support to the nursing staff. We were also able to use Lynn's baby sitting services and enjoyed a dinner out.

Linda Harris, an obstetrician, and Betty Kaye Taylor, a nurse midwife and ultrasonographer, both from Medford, OR and people who worked with us at La Clinica, came to help set up the obstetrical department. They did a great job and helped with a number of deliveries and ultrasounds as well. They brought us many goodies which we are savoring and took us out to a wonderful Thanksgiving dinner at a local restaurant that caters to gringos. We had everything good and wonderful for dinner. Julianne kept asking for more of the "chicken with salsa," translation turkey with gravy.

Halloween in Santiago Atitlan

2010-11-12T13:45:00.000-08:00

Although Santiago Atitlan does not really celebrate Halloween, it is one of our kids favorite holidays. So, we thought that maybe we would make it our annual tradition to have a Halloween party. We hosted about a hundred people (hospital employees and their families, neighbors, friends, and hospital volunteers) for lunch and a piñata. Jennifer began cooking the week before and made the biggest pot of chili she’s ever made and thankfully had enough food to feed everyone. The kids enjoyed a lot of hot dogs.

Christopher was a Power Ranger in a costume we found for about a dollar on the street near the market in Santiago where they sell used clothing from the US. Elizabeth was Mulan and Julianne was a cat. Both girls were able to wear both costumes, so they each got to be both Mulan and a cat. Nicholas was a superhero (yet to be named) and also a princess (also yet to be named). We all had a great time!

November 1st is All Saints Day and the 2nd is All Souls Day or the Day of the Dead (Dia de los Muertos). In Santiago, as in the rest of Latin America, it is a time to remember family members and friends who have passed away. Many thousands fill the cemetery to pay respect to their loved ones. The day before is spent decorating the local cemetery with pine needles and cut grass to cover the graves, flowers, candles, and incense. It is supposed to be especially beautiful at night with the lit candles as people hold a vigil in the cemetery overnight from the 1st to the 2nd.

Cojolya

2010-11-01T14:52:00.000-07:00

We have found a number of organizations working here in Santiago that are helping the people of Santiago. One of these we have recently been introduced to is The Cojolya Association of Mayan Women Weavers.

This organization employs local weavers which provides work for up to 80 weavers and runs a social program aimed at improving the lives of its workers, their families, and the local community. They also have a small museum about weaving that goes through the process from making the thread to the finished product.

They have a great web site which gives more history and some options for Christmas gifts that will make both the recipient happy and help the people of Santiago. www.cojolya.org

Part 4

2010-09-14T14:57:00.000-07:00

The trip from Santiago to Solola at any time of the year can be difficult, but especially this time of the year with mudslides and road closures. Brent is elected to go with Miguel. Diego, a new nurse to Hospitalito, is assigned to go, as well, and along with Miguel, his parents, the bomberos and Brent, they begin their journey.

After about 15 minutes, Miguel’s father is dropped off in Cerro de Oro, the village where they live, to tell relatives what is happening and to get money to help pay for their expenses in Solola. The hospital in Solola is a public hospital so the care is free, but there are costs for the parents to eat, etc.

Every jolt and bump seems to tug on the endotracheal tube and Brent and Diego look at one another hoping not to have to re-intubate on the way, but each tug confirms the nurse’s taping job was excellent.   Brent is providing Miguel’s respirations methodically reciting “squeeze, rest, rest, squeeze, rest, rest...” trying to maintain 20 - 30 breaths a minute and watching Miguel and the pulse oximeter. The pulse oximeter has been going down 99, 95, 90, 88. Brent notices the bagging becoming more difficult and gives a dose of albuterol (a medicine that helps to open up the lungs) via the endotracheal tube. This appears to help as the oxygen monitor increases to 97 again. The bomberos note another one to one and a half hours to go.

Diego observes Brent looking queazy and offers to take over the ventilations. There are so many 180 degree turns on the road that you begin to wonder if you are really going forward and not just going in circles. Brent is reminded of a similar curvy road growing up, the Green Springs, and the many times his father pulled over for him!

Diego sees the oxygen saturations dropping again and a quick look at Miguel shows him moving his mouth, a sign the paralytic agent is wearing off. Another dose of that, his saturations increase, and he is resting again. They finally arrived to the Pan American Highway and a direct shot to Solola.

Arriving at the National Hospital in Solola, a team of Guatemalan physicians greet and attend to Miguel and his mother. The Hospitalito team stays with Miguel and his mother until they feel comfortable with the change over and begin their journey back home.

Miguel did well during his hospital stay there, was extubated (endotracheal tube removed) after three days, and after 8 more days in the hospital he returned home.

Thinking now of our time with Miguel and the people he brought together from different parts of the world, working together for a common good, his name seems fitting -- one who resembles God.

Part 3

2010-09-07T08:35:00.000-07:00

Morning report is a time to review, with the other doctors working in the hospital, the patients admitted and seen in the ER during the day and night before. Jennifer quickly reviews the patients and then focuses on Miguel. Brent arrives at 7:40, a bit late, but in time to hear Miguel's story. The doctors then go down to see Miguel and the other patients.

Miguel is now breathing 50 times per minute, but his oxygen saturation has again dropped into the 80s. His pulse is 180 and his lungs are tightening up again. He is shows signs of tiring and is not able to maintain his oxygen at appropriate levels as his respiratory rate slows.

The team this morning includes doctors from Guatemala as well as from Spain and the United States. Many specialties are represented including obstetrics, family medicine, and gastroenterology. They realize Miguel will not be able to keep this up much longer. They begin working in unison: continuous nebs, a phone consult to a pediatric intensivist in the US, comforting the parents, and preparation for intubation.

Rapid sequence intubation is a process of giving sequential medications that paralyze the patient and allow for placing a tube into the trachea. This then allows the physician to take over the work of breathing for the patient.

Assignments are given, drugs prepared, high flow oxygen started. All drug dosages checked and double-checked.

The ER this morning is a cacophony of sounds -- the bubbling of oxygen, the drone of the suction machine, voices of physicians and nurses and the labored breathing of Miquel.

The medicines are given and Miguel stops breathing on his own......

Seconds seem like hours during this moment as all attention is focused on placing the tube into the trachea.

When intubating a patient you are always told to have a backup plan. What will you do if you are unable to intubate the patient? The last patient, Brent had intubated, was 6 years ago while working in an ER in Northern California. Brent ran through the different options in his mind -- bag, bougie, laryngeal mask, needle cricothyroidotomy.

The first attempt is met with coughing, signifying Miguel is not completely paralyzed. Another dose of the paralyzing agent is given and this time the endotracheal tube is passed without difficulty and taped into placed. Oxygen is hooked up to the bag and one of the doctors rhythmically compresses the bag which now does all the work of breathing for Miguel.

Miguel’s oxygen saturation increases rapidly to 99%. He appears at rest now after working so hard for so long.

The local volunteer bomberos (firefighters/paramedics) are called and Miguel is prepared for the 2-3 hour trip around the lake to Solola, the national hospital where specialists and ventilators are available.

Part 2

2010-08-30T09:46:00.000-07:00

Julianne and Elizabeth

At 6:00 a.m. Brent awakens to the proclamation of “Daaaad, I have to pee”. Julianne feels the need to announce this and serves as the morning alarm for the household. Four kids to get up, dressed, fed and teeth brushed. Somehow Jennifer is able to do this without a hitch, but for Brent it is always a challenge. Jennifer won’t be home from the hospital until about 9 a.m. The kids know the routine, but still feel the need to deviate at times, depending on who needs a little more Daddy attention on a given day.

At 7 a.m. Ingrid arrives, our house helper, who makes this chaos a little less chaotic. With Greetings of “Buenos dias,” a few instructions and an update on the activities of the day, Brent heads up the small hill, leading from the house, with Christopher and Elizabeth in tow, backpacks on, and their “chicken mask” school projects in hand.

Christopher and Elizabeth wave to Hospitalito, knowing that Mommy is somewhere inside and will be at school to pick them up at the end of the day. No time to walk today, as Brent is on OB call and needs to be at the hospital at 7:30 a.m. for morning report. They catch a tuc tuc.

Tuk Tuk

The tuc tuc ride is like some racing car video game as the driver swerves around pot holes, dogs, and puddles that resemble mini lakes this time of year. Christopher and Elizabeth squeal with joy as the tuc tuc is forced into one of these “mini lakes” by an oncoming "chicken bus" headed for the capital. After climbing the hill to the parochial school, Colegio Catolica Padre Apla’s, the kids and Brent have arrived, a little wet and all sleepiness cleared from their heads.

The kids enter their class room with a “Buenos dias, Maestra” and a “Buenos dias, Compañeros” and with a “Buenos dias, Cristobal” and “Buenos dias, Elizabeth” from their teacher and classmates, the children proceed to sit down at their desks. The walls are lined with the alphabet, numbers, and words written in a mix of Spanish, Tz'utujil and English. Brent is reminded of Christopher’s protest during study time at home for their last exams, “It’s not fair we have to study three languages!” Brent leaves the kids with a kiss on their heads and a quick checkout with their teacher, Juanita.

Miguel: Hebrew origin: one who resembles God, Part 1

2010-08-23T10:36:00.000-07:00

It’s the rainy season, but more so this year than in the past few years. The rain seems relentless at times. Downpours last for days at a time, a constant drone on the metal roof. Roads resemble rivers more so than streets. Mudslides have replaced villages with mud and boulders and there is a general sense from the populace of a heavy coat blanketing all the senses. But even with all of the rain a "Buenos Dias" is never far from the lips of all we pass by.

Miguel’s parents were up with their child late into the night reflecting on the past few days. It started as a runny nose, followed by a dry hacking cough and then the rapid breathing, each breath an effort to get more air. They went to the local health center and received various remedies that seemed to help initially, but now, as their child looked up at them with a plea for help and fear of the unknown, they knew he was getting worse.

They say an asthma exacerbation is like trying to breath through a straw, as it worsens the diameter of the straw grows smaller and smaller........

Jennifer had just laid down in bed during a 24 hour in-hospital call. She’d seen and treated numerous patients that day. Routine stuff mostly, but now as she laid down at 4 AM she heard the unforgettable "clack, clack, clack" of the tuc-tuc coming down the dirt road to Hospitalito. At this hour of the day it could mean only one thing -- a patient in need of acute care.

She gets up before the guardian can knock on her door, fumbling around in the dark in a place that is becoming less foreign each day. She hears a rooster crow, a dog barking at some unknown nemesis as she puts on her doctor’s coat --loaded with all the “essential” paraphernalia from 15 years of practice. She grabs her stethoscope, a close friend since her days in medical school, and heads down the stairs to the ER.

Andrea, the nurse, had already placed oxygen and gotten vitals when Jennifer entered the room. Miguel’s eyes were bulging and wide with panic as his chest wall heaved with every breath. Sensing the acuity of the situation, Jennifer questioned, examined, and gave orders almost simultaneously -- pulse oximetry, intravenous access, nebulizer treatments, I.V. steroids. With treatment, Miguel’s pulse oximetry began to rise from the low 80’s to low 90’s. His respiratory rate began to drop from the 80’s to 50’s and his lungs began to open up. He looked a bit better now.

It was almost 7:30AM and time for morning report.

A Family Affair

2010-08-03T08:50:00.000-07:00

We wanted to share with you an article from the Hospitalito, July Newsletter.

"We don't need Sherlock Holmes to figure out that Brent Burket and Jennifer Thoene don't event fit the description of your usual medical volunteer. The evidence is everywhere upon entering their home: two pairs of kids-sized rain boots, swirly blue and pink, a bookshelf of children's literature, tables loaded with crayons and coloring books, the movie choice of the day is Toy Story 2, and the final clue, a small voice saying, "mama, it's not fair".

So, why do two US physicians with four children under the age of eight, choose to move to highland Guatemala..." read the rest of this article interviewing Brent and Jennifer on the Hospitalito July Newsletter.

Our Days are Full

2010-06-21T14:33:00.000-07:00

We started working in the hospital in mid May. We are excited and happy to be seeing patients again and working with the very dedicated staff at Hospitalito. As always with new work, there are unforeseen challenges. We studied Spanish for our first three months here so that we could communicate with the staff and patients, but are finding that a vast number of patients speak no or only a little Spanish. It is hard not being able to communicate with patients directly in their native language. There is something lost in the history taking, in the patient education given, in the encouragement we want to impart. Unfortunately, our Spanish is still not proficient, so learning Tz'utujil will have to wait a little longer.

There are also many things about the culture, the cultural practices and beliefs, and the people’s day to day living that we need to learn. This is a slow process, because you really don’t know what you want to know until a situation comes up that provokes questions. Someone can’t sit down and tell you that these are the differences between our culture and their culture. Some things may seem so natural for one culture that it is hard to even explain what provokes a particular belief or practice. For example, several patients have asked if bathing in cold or hot water will affect their medical condition, but we have not yet been able to figure out what concern perpetuates this belief.

Our days are full. We’ve been busy balancing the new work schedule, family, and involvement with the church. The kids seem unfazed by it all and wake up each day with smiles on their faces and ready for a new day (unfortunately usually before 6AM). We have no after school activities, no TV, etc., yet we are busy. Our two first graders go to school from 7:30 until 12:30. By the time they get home and we eat our main meal about 1 or 1:30PM and they have a little time outside to play, it is 2:30. Just enough time for a couple of hours of homeschooling, then it is dinner, a shower, reading and bedtime.

All the activities of daily living are very time-consuming and less so for us than for most of the local people because we are very fortunate to have a washer, refrigerator, and gas stove (so we don’t have to have gather, cut, and burn wood for cooking). Shopping is an almost daily necessity as we can only carry so much home at a time. Meal preparation is very labor-intensive as almost everything needs to be made from scratch and raw fruits and vegetables need to be prepared specially.

Christopher and Elizabeth continue at the local Catholic School. They are learning Spanish, the local Mayan language, Tz'utujil, and a little English as part of their school curriculum. They had exams recently and while we were studying, they had some practice tests at home. In one day, they took tests in all 3 languages. Christopher thought that this was very unfair :). We’ve participated in a number of school events including a field trip to the beach on another part of the lake (we paid for this thinking it was going to be at a local beach and then the day before found out it was a boat trip away, after which the teacher allowed Brent to tag along as a chaperone), Mother’s day celebration which was a huge, wonderful celebration complete with tamales as a treat for all the mothers, and a school birthday celebration. Christopher’s birthday was at the end of May and so we brought a little snack for the class. We were completely surprised when Christopher was inundated with gifts and hugs from his classmates. He received a couple of toys, but most of the gifts were completely practical: socks, towels, cups, bowls. This was so generous and thoughtful as we are sure these students’ families do not have money to spare.

Julianne and Nicholas are both in a local preschool two days a week and really enjoy their time with the other kids in the community. Many little art projects are covering the walls in our house and are providing creative decorations.

Peace

Brent, Jennifer, Christopher, Elizabeth, Julianne and Nicholas

Gratitude

2010-06-16T08:54:00.001-07:00

We are writing to thank you for your support of MDA that, in turn, gives us the opportunity to be messengers of your love for many of the forgotten ones in Guatemala.

We realize more and more each day that our time here is a reflection of the love and support you give and have given.

Your prayers are heard as Jennifer manages a 15 year old, scared pregnant girl in labor, providing a safe and caring place for both mom and babe.

Your love is seen as our child asks why the elderly women is picking up the pieces of corn off the ground and with our answer of “because she is hungry” our child gives the 2 Q she had for ice-cream to the woman.

Your teachings of love, knowledge, patience and hope are felt each day as the challenges in front of us dissipate with a hug and thank you from a patient.

Your kind words are heard in the early morning as the birds, singing outside our window, tell us a new day has come with new hope of a better day for the forgotten ones who will not be forgotten today.

Peace

Brent, Jennifer, Christopher, Elizabeth, Julianne and Nicholas

Happy Mother's Day

2010-05-05T14:22:00.001-07:00

Mother’s day in Guatemala is celebrated on May 10th every year. It is a time to reflect on and give thanks to our mothers (and all mothers of the world) for their love and devotion to our children and to our families.

The life of a mother in the developing world is very different, in many ways, from what I have seen back home. The daily routines of cooking, washing and caring for the children is an all consuming endeavor. The gathering of wood to cook, the fetching of water to drink and wash, the carrying of laundry to the lake, the making of clothing for the family, the trip to the clinic with a sick child.... the day is endless and the next day the same.

At times it is hard to find many similarities between the world I came from and the world I am living in now, but in a “mother” I can see a commonality with the mothers I’ve known best: my mother, my children’s mother, my sisters and my mother-in-law. Their primary desire being the wellness of the family, is a commonality of mothers I see here and the mother’s most dear to my heart.

This commonality is shown in their unique ability to focus on the day to day needs of the family and exemplified by the gifts of calmness and directness at achieving those needs, often times in the face of great adversity. What underlies these gifts is an undying compassion and love for their children and families.

So today I wish to say “thank you” to my mother, the mother of my children, my mother-in-law and to all the mothers of the world for their love, support, compassion and care that they gave yesterday, give today and will give tomorrow.

peace and love,

Brent

P.S. I wonder how much better the world would be if a few more mothers of the world were leaders of the world?

Semana Santa

2010-04-15T08:59:00.000-07:00

We hope you and your loved ones are doing well.

There has been a lot of activity in Santiago. The Easter week or “Semana Santa” is the largest celebration of the year here. It was a special time seeing the community come together in preparation for this holiest of celebrations.

The schools all let out the week before Easter and businesses worked half a week to begin preparing. There were many preparations going on, but the most beautiful was the making of “alfombras” or carpets. These are various religious images or images of flowers painstakingly made entirely out of brilliantly colored saw dust, colored gravel, flowers, and/or plant parts that almost fill the width of the streets. The alfombras cover about 10 blocks surrounding the church. On Good Friday, at least 60 men carrying a large platform with a figure of Christ on it, process through the streets over these alfombras. The procession is very slow. It starts around 3 pm on Good Friday and we heard continues throughout the night until it arrives back at the church at dawn. Our children lasted about 1 1/2 hours, not all night!

Christopher and Elizabeth enjoyed their week off from school and couldn’t figure out why we wanted to continue home schooling. They received their first report card and did very well with their lowest scores in English (we still can’t quite figure that one out) and Physical Education. Julianne also had a week off from preschool but kept asking when she could go again. Nicholas celebrated his 3rd birthday April 5 (our first family birthday in Guatemala). We enjoyed hot dogs, a cake, and playing with friends.

We moved into our permanent residence last week and we are excited to be settling down and not living out of suitcases. Brent and Jennifer continue in language school and we are finding language acquisition much more challenging than for our children. We will begin working at Hospitalito in mid May and are looking forward to working with and for the people of Santiago.

Peace and Love,

Brent, Jennifer, Christopher, Elizabeth, Julianne and Nicholas

Our Life in Santiago Atitlan Begins...

2010-02-26T11:17:00.000-08:00

We arrived in Santiago Atitlan on February 9, 2010. After a night flight and then a 3 hour drive to Santiago, we were warmly greeted by many of the staff at Hospitalito. They graciously helped unload our many heavy bags and carried them down the path to the house where we will be living for the next 2 months. The staff had a welcome lunch for us the next day where we had a delicious local dish called caldo de pollo (chicken soup) and tamalitos, which are little tamales without the filling.

The children are doing great, exploring their new surroundings and making new friends. Christopher and Elizabeth have started 1st grade at the local Catholic school. It’s amazing to see them go to school everyday without a complaint nor a worry that they don’t speak Spanish and that the teacher doesn’t speak any English. Kids are so adaptable! Julianne is attending preschool two days a week and is enjoying that. To our surprise, she asked the other day when we were going to get to Guatemala. When we told her that this is Guatemala, she just said “Oh.” Nicholas says “Hola” to everybody with such a big infectious smile that all seem to walk away with a bigger smile. Jennifer and Brent have started language school and are finding out how much they need to learn in the next few months.

We will continue in language school until mid May and then we will start working at Hospitalito. The hospital is in the process of being rebuilt (see previous blog). It appears that the hospital is functioning well at the interim location, but you can sense the excitement surrounding the building of the new hospital with a projected opening date in late summer or early fall.

The people have been very friendly and helpful. They really love children and are curious about our diverse family.

The area is beautiful and the climate temperate. The yard in the house we are staying at has evergreens and many exotic, tropical flowers, as well as birds. The kids love running up and down the long grassy area in front of the house playing make-believe games of kings and queens and rescue. No toys necessary, just one big stick that we try not to let Nicholas get a hold of. There is also a great tree for climbing.

We go to the local market several times a week. There is a good variety of fruits and vegetables, beans, rice, and, of course, tortillas. The tortillas are made by hand out of masa right while one watches and then cooked on a stone griddle. They are best eaten hot, right on the street! The bananas, pineapple, cantaloupe, mangos, and papaya are all as sweet as can be and the avocados are the best and biggest we’ve ever seen. We have splurged on peanut butter and cheese which are not at all a local staple, but can be found in town.

Walking or riding a tuc-tuc is the most common mode to get somewhere. The kids love riding in tuc-tucs: no seatbelts, open air, holding on to the edge of your seat as you wiz dangerously close to other vehicles. Click here for a video of a tuc-tuc ride in Santiago.

The church is very alive here. There are three masses on Sunday. Two in the local language,Tz'utujil, and one in Spanish. The Spanish Mass had over 800 people and was standing room only, the overflow extending out the back of the Church.

The Tz'utujil dress is very colorful with intricate patterns of birds and flowers in purples, reds, greens, and yellows. This along with the music and singing made for a very exciting mass that even Nicholas enjoyed until halfway throught the homily when he was tempted (as Christ was tempted in the Gospel this week) to get off Daddy’s lap and make a break for the back of the church. The other children did surprisingly well at Mass eventhough it was a bit longer than at home.

We want to thank our families and friends for all their support, especially over the last few months, to help make this transition go as well as it has.

We hope all is well with you and your loved ones.

Peace and Love,

Brent, Jennifer, Christopher, Elizabeth, Julianne, and Nicholas :)

Arrival

2010-02-10T09:58:00.000-08:00

From the Hospitalito Atitlan Blog

EXCITING NEWS!

We were so excited about the arrival of the Burket Family, that we sent Aklax to the airport ONE DAY EARLY! Brent and Jennifer have arrived to volunteer at the Hospitalito for THREE YEARS. They are both family practice physicians with the ability to perform cesareans.

On the left in the group foto are Christopher, Brent, Jennifer and Julianna Burket. Aklax is holding Elizabeth and Juan Manuel has little Nicholas. (yes, four small children!) The staff was so eager to meet the new family that they arrived to welcome them, and to help carry luggage.

We are very happy that they have arrived!

Mission Doctors is the organization that facilitated their volunteer time with HA. It was September 2007 when Dr. Brent arrived with Mission Doctor’s director Elise Frederick. We have been patiently awaiting his return.

Our Journey Together

2009-11-24T06:48:00.000-08:00

Dear Family and Friends,

In January 2010 we will join Mission Doctors Association (MDA) and start a three year commitment to work in Guatemala. We will be working along side the people at a hospital called Hospitalito in Santiago Atitlan in the diocese of Sololá-Chimaltenango.

This hospital, founded by Fr. Stanley Rother in the 1960s, cares for a large indigenous Mayan population the Tz'utujil. The Tz'utujil are impacted by both disease and poverty. The hospital is in the process of being re-built by the local and international community following a devastating mud slide in 2005 that closed the doors and required that a new location be found and developed.

As many of you know, before coming to Southern Oregon, we were in Ghana with MDA for over two years as medical missionaries. We learned a lot from that experience and would like to share with you our hopes for this mission in Guatemala.

Our hope is not only to share the gifts we’ve been given with another culture, but to learn from those whose lives are so profoundly affected by the struggles of day to day living. We hope to see and try to emulate Christ in our daily lives, to live more simply, to grow spiritually and to help connect two cultures.

Each of us have been given gifts/skills that are so urgently needed by so many. We learned in Ghana that a great deal we take for granted is so acutely needed - not only food, water, clothing and health care but also organizational, financial, and educational skills.

We are asking you to join us on this mission by creating a network of support to link you to the people of Santiago. We would appreciate any support you are able to give: your prayers, your time, your talents.

We look forward to our journey together!

Peace,

Brent, Jennifer, Christopher, Elizabeth, Julianne and Nicholas
burketthoene@yahooo.com