We treat, God heals.

We admitted 2 babies on consecutive days with respiratory distress caused by a lung 
infection. When I saw the first one and the baby was breathing 100 times a minute (normal is less than 60) and had an oxygen saturation of 60 percent (normal above 92 percent), I told the mother that the child was very sick, but that we would try. We started antibiotics and IV fluids. The next day, another infant was admitted in an even worse condition breathing 120 times a minute and with a saturation of 50 percent and again I told the mother that we would try. We transferred the only oxygen we had from the first baby, who was slightly better, but still in need of oxygen, to the second baby. Then, there was no electricity overnight to run the oxygen concentrator, so I was surprised to see that the second infant was still alive the next day. 

Miraculously, both babies survived. “We treat, God heals.”

Come to me all you who labor and I will give you rest.

Minette was a little girl who came in with difficulty breathing and swelling of her legs. She had so much difficulty breathing that she had to sleep sitting almost upright and her breathing was extremely labored for several days. Every time I saw her I thought, “How long will she be able to breathe like this?” I felt that at any moment her breathing could just give out. She had malaria that caused severe anemia which in turn caused heart failure. We treated her with blood transfusions, oxygen, and medicine to help her heart and finally after about 4 days she improved. I knew she was better the day I came in and she was lying down to rest. “Come to me all you who labor and I will give you rest.” Matthew 11:28

Welcome to God’s House

The chapel is at the center of the hospital compound. Every day the staff starts with Morning Prayer and a short reflection before going to work. Surrounding the chapel are garden beds with tiny shrubs formed into words. At first, this might go unnoticed, but the words really struck me and are as follows:

“Welcome to God’s House. Jesus is here, waiting for you.”
“Come to me all you who labor and I will give you rest.”
“We treat, God heals.”

The motto of the hospital is “To see Christ in all by spending time to care.”The core values are Faith, Discipline, and Selflessness.We are blessed to really see these things lived out by the staff each day and it all begins in the chapel.

Thanksgiving

We had a very nice Thanksgiving celebration with an American premed student who has been volunteering at the hospital for the last several months and with 2 Belgian midwifery students who were doing a practical rotation here. We did not have turkey, although we have seen some turkeys around, however chicken was a fine substitute. We had stuffing, mashed potatoes, gravy, green beans, cranberry sauce, Magic Cookie bars and even pumpkin pie. Thank you to Terry and Jim, the volunteers here before us, who had left some things like butterscotch chips, flaked coconut, and canned pumpkin which came in handy. We ate until we were all stuffed!

Special Day

We had a very special day recently.  We celebrated the Baptism of Mokenyu Francis Mundi Akumbom. Jennifer and I are honored to be Francis’s godparents.

We came to know Francis’s parents quickly during our short time here.  His father, Kevin, is a radiology technician at the hospital and Valerine, his mother, is Nicholas’s first grade teacher.  It was a beautiful ceremony and we look forward to getting to know Francis and his wonderful family better in the coming years.

Death

The line between life and death in the developing world is precarious. A patient, whom one thinks will surely die, miraculously survives, while another patient can be talking with you and, a few hours later, that same patient is dead. Many times it is HIV/AIDS that steals people away, maybe from opportunistic infections that we can’t diagnose. Our diagnostics and treatment options for all diseases are more limited here, so we rely on what is most common or probable and treat with what we have. But too often it is not enough or it is too late. Death seems more unexpected and unfair here. It takes babies, children, new mothers, and young people, not just the elderly or chronically ill. As a physician, it makes one question one’s ability to diagnose and treat patients. What is it that lets one survive and the other die? Is it that patient’s will to live? Is it God? Is it destiny? Is it our treatment? Or a combination of these?

Please, pray for those who are sick, suffering, and dying, their families, and those who try to care for them.

God is Great

Precious is a 2 year old patient who came in with vomiting and diarrhea. After a couple days, her abdomen became acute and she was taken to the operating room and found to have intussusception. This is a condition where one part of the intestine slides into another part of the intestine causing a bowel obstruction. After the surgery, she was very ill with a persistently distended belly, total body edema, and electrolyte abnormalities. She had a fast heart rate, fast breathing, fever, and pain.

I would check on her several times a day and see her mother’s usually smiling and confident face. Only once did I see her mother become tearful. Then on Sunday night, the electricity went out and she had no oxygen overnight. I thought for sure she would die that night. I would wake up in the night thinking that she must have slipped away and that the Surgical Ward just hadn’t called me to let me know. I finished my call week and turned the case over to Brent on Monday. I was spent worrying about her and just could not face her mother again to tell her that we were trying, but that her condition was not good.

She lost her IV on Monday and they could not replace it because of her body swelling. Maybe that was a good thing, because when she began to drink, she was able to self-regulate. I could not bring myself to see Precious and her mother again until Thursday, when I heard she had turned the corner.

Today, about 2 weeks later, Precious was sitting outside picking the leaves off of the huckleberry stems to make Njamma-jamma, the local greens eaten everyday with fufu. She won’t let me touch her, but she did let me take her picture. I said to her mother, “God is good” and she said back to me, “God is great.” And isn’t that the truth.

Walking to School

We wanted to share a video of the students singing and praying on their way to school here.  

If you look closely, you can see Elizabeth and Julianne marching along.

Video from Feast of St. Martin De Porres

We wanted to share a video from the Feast of St. Martin De Porres celebration at St. Martin De Porres Hospital in Njinikom, Cameroon.

Ode to Cheese

Oh, how we miss you Cheddar and Pepper Jack, Blue Cheese and Havarti, Mozzarella and Colby.  Laughing Cow, we’ve grown to like you, but, oh, Mr. Laughing Cow, real cheese you are not and will not be. We’ve grown to eat cheesy rice without the cheese and Mac and Cheese just isn’t the same when Mac is all alone. Pizza breads are good with just sauce and French Onion soup is nice with bread, but both would be great with a sprinkle of cheese.

We are hopeful that you are coming with the next visitor passing through customs. Remember you are not a food item when asked by the customs officer. You are medicine desperately wanted by a family in Njinikom.

Conversations

Last Sunday as we were waiting outside the church for the 6:30 am Mass to finish before we went in for the 8:30 Mass. A brother (14 yo) and sister (12 yo) came up to Jennifer to talk. Both are HIV positive, presumably from birth, as their Mom is as well. They were reporting to her that their CD4 levels (the cells in their blood that fight off infections in the body) had increased and that they were taking their medications faithfully.

It was such a profound moment for me. These young children face such a difficult life to begin with and now, with their HIV as a lifelong chronic disease, their day to day routine is so different from the cares I had as a child.

St. Martin De Porres Feast Day

St. Martin de Porres Catholic General Hospital was named after St. Martin de Porres. The Feast Day of St. Martin De Porres was celebrated with a special Mass at the hospital attended by the staff and patients.

Martin de Porres, O.P. (December 9, 1579 – November 3, 1639), was a lay brother of the Dominican Order who was beatified in 1837 by Pope Gregory XVI and canonized in 1962 by Pope John XXIII. He is the patron saint of mixed-race people and all those seeking interracial harmony. Juan Martin de Porres was born in Peru of Spanish and African or possibly part Native American descent. He was noted for work on behalf of the poor, establishing an orphanage and a children's hospital.

This picture is in front of the sign commemorating the 50^th Anniversary of the hospital (1963 – 2013) which was celebrated earlier this year. Often, for special occasions, fabric is created as part of the commemoration. Sr. Xaveria generously had these special outfits made for us out of the 50 ^th Anniversary fabric. Elizabeth even designed her own dress! The words on the fabric are Faith, Discipline, and Selflessness, with the name of the hospital surrounding the picture of St. Martin de Porres.

A Few Luxuries

Mount Boyo

Although our food options are more limited here, we do have a couple luxuries here that we didn’t have in Guatemala. Our water source comes from a spring on Mount Boyo and is clean and drinkable directly from the tap. This means that we don’t have to purify water, we can brush our teeth with the water in the sink, we can just wash fruits and vegetables and do not have to soak then in iodine or bleach water to eat them raw, and dishes, cups, and eating utensils do not have to be completely dry before using them. We also have hot water in every tap, including the kitchen, not just in the shower. We used to boil water to wash dishes, but we don’t need to anymore. There is also satellite TV in the house. Although most of the channels are in French or Arabic, we can get international news at times.

Bell

The children’s day begins, at school, with the ringing of the bell and ends the same.

What happens between these two times changes day to day.

What we learn, who we meet, how we see God working throughout our lives day to day.

We cannot change when the bell rings but we can see how God is calling us to be.... between those two rings.

A world of help.... Thank You!

September was expected to be a busy month and it was!

Dr. Dabo, the obstetrician, went on a much needed vacation for the month and Brent was in charge of the Obstetrical Service.  This meant Jennifer was in charge of the house, children and working in the Outpatient Department.  Dr. Eugene covered the Medical Wards and Pediatrics. Surgical Services were covered by Drs. Lazare and Foko.

There were 62 deliveries and of these 24 were cesareans and three sets of twins.

The love and support provided by the staff, Sisters and patients was very humbling.
Brent had a world of help and one case exemplifies this.

A young lady who is HIV positive presented with rupture of membranes but without contractions. She was not sure how far along she was with the pregnancy.  The baby was anywhere from 28-32 weeks old (normal 37-42 weeks).  There were many questions on what to do for the baby and the mother. The longer the baby stays in mom, the better for lung maturity so it can breathe on its own when it is born, but the longer the rupture of membranes the greater risk of HIV transmission to the baby and the greater the risk of infection entering mom's uterus.

We contacted US based Obstetricians, a Family Doctor, Perinatologists, a Neonatologist, consulted with Dr. Eugene and even called Dr. Dabo!

In the end we gave medicines to help mature the baby's lungs, antibiotics to prevent/treat infection, and HIV medicines to prevent transmission of the virus to baby.

After about a week we gave mom medicines to induce her labor. Baby delivered without difficulty and weighed 1500 grams (3 lbs 5 oz). The baby spent the next three weeks in the "incubator" and has grown to over 2 kg. It has been receiving expressed breast milk via a tube and nursing some. The baby will stay in the hospital until it can breastfeed and/or feed with a cup and maintain steady weight gain. We hope to be able to discharge the baby within the next month.

Maternal Mortality

Cameroon has a very high maternal mortality. There are approximately 600 maternal deaths per 100,000 live births. Comparing Cameroon maternal mortality to other countries, we have worked in, it is the highest we have seen.

Countries Maternal Mortality comparison:
USA = 24             Ghana = 350        India = 230
Guatemala = 110  Kenya = 530        Malawi = 510
http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf

Here is some additional information from WHO
http://www.who.int/mediacentre/factsheets/fs348/en/index.html

Key Facts

• Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. 
• 99% of all maternal deaths occur in developing countries. 
• Maternal mortality is higher in women living in rural areas and among poorer communities. 
• Young adolescents face a higher risk of complications and death as a result of pregnancy than older women. 
• Skilled care before, during and after childbirth can save the lives of women and newborn babies.
• Between 1990 and 2010, maternal mortality worldwide dropped  by almost 50%

The other night exemplified the challenges facing the developing world regarding education and appropriate available obstetrical services.

Mareline was 9 months pregnant when she presented urgently to St. Martin De Porres Catholic Hospital, from a referring hospital, with bleeding. She had had some bleeding a few days before, at home, but did not think it was of concern.  When she arrived, her clothes were soaked with blood and her Haemoglobin was = 6 (normal = 12-15) . We were able to perform an emergent C-section and found a complete placenta previa.

 A Placenta Previa is when the placenta grows over the cervix and when the mother's cervix begins to dilate, during labor,  the mother can exsanguinate.

 Mareline and baby are doing well!

Orphanage

St. Martin De Porres Hospital has an orphanage that presently has 16 children.

The ages range from 3 weeks to 5 years old. We have visited them a number of times to play with the kids.

The orphanage is different from what we experienced in Guatemala. These children are from families that cannot take care of them at their young age, for various reasons.  After the child reaches 3-5 years old, family members (usually extended family) come and take the children back to their homes/villages.

Sister Nathalia is in charge and notes that she has been there for the last three years.

The orphanage was started in 1953 and is run by the Tertiary Sisters of St. Francis of Assisi

Beautiful

We are fortunate to be in one of the most beautiful spots we have ever been to. The hills are lush in many shades of green. Sometimes the hilltop where the hospital sits actually becomes engulfed in a giant cloud that touches the ground and then quickly disappears. The earth is red clay and slick when wet. The rain is daily now, sometimes all day, and at times torrential. The temperature is mild, good sleeping weather, but usually no need for a sweater. Goats roam freely and the pygmy goat babies are very cute.  Nicholas’ goal is to touch one. There is very little garbage on the ground which may be the work of the many goats.

Food and the Market

We have been very fortunate in Cameroon so far as there is a cook assigned to us who has been cooking most of our meals. I found that one of the most unexpected gifts for me during our months home in the States this past summer was that I wasn’t obsessed with thinking about food. Even though the food was plentiful in Guatemala and there was a lot of variety, there were no grocery stores in Santiago, some items were only available on certain days of the week or only if one got to the market early, and some items were scarce and/or expensive, for example, cheese and peanut butter. I did careful meal planning and a little rationing (my family would call it hoarding) of special foods. It ended up that I spent a good part of my days thinking about, buying, and preparing food in Guatemala.

So, here in Cameroon, even though I will be able to ease into 

the meal preparation, I did want to see what the market had to offer. There are tomatoes, onions, carrots, okra, garden eggs (a small form of eggplant), and bananas available daily. At times, I have seen green peppers, celery, green beans, potatoes, yams, avocados, and pineapple. There is bread, rice, pasta, black beans, pinto beans, soy beans, and dried fish, plus eggs, flour, oil, vinegar, and salt. Dried corn which is ground into corn flour and made into corn fufu is plentiful as corn fufu is the food that everyone eats daily. The market day is every 8th day and on those days the market also sells fabric and new and used clothing and shoes. I saw tomato paste in sachets and canned sardines. There is groundnut paste (passable for peanut butter), Ovaltine, milk powder, and something similar to Nutella, which has been a sweet treat. Only live chickens are available. We’ve received homemade cheese as a gift from one of the sisters at the convent and that has been a treat.

First Few Weeks

We have been spending the first few weeks shadowing the doctors at St. Martin De Porres.

Dr. Tim and wife Sheila have been helping us to settle in and we have really enjoyed their camaraderie and wisdom from their years of mission work. 

We are seeing many of the common illnesses we saw in Ghana.
AIDS, Malaria, Typhoid, Meningitis and the various obstetrical complications.

One of the big differences is that the people with HIV are now being treated with medications.  This was not the case in 1990s. Now there is hope and acceptance (or at least more so than we experienced before)

Dr Tim and Sheila leave this week and the Obstetrician leaves for vacation (gone for a month)  in September.  The kids will begin school September 2nd so we are gearing up for a busy September!

You Are Welcome, You Are Very Welcome!

This is the greeting we have heard again and again since our arrival in Cameroon on August 12th.

We arrived without missing a connection or loosing any luggage. Sister Xaveria and Sister Gratzia met us at the airport along with one of the drivers, Emmanual. Our children did great with the air travel, but after about 24 hours of traveling they were asleep in the car before we even left the parking lot at the airport. We were taken to the Tertiary Sisters of Assisi hospital and residence in Douala for the night before driving on to Njinikom the following day.

Our reception in Njinikom was amazing as dancers, drummers and staff greeted us at the hospital entrance with hugs and many, “You are welcomes” and lead us to our new home. By the time we arrived it was dark and there was fog adding to the ambiance, but fortunately, no rain. We had a wonderful dinner with Dr. Tim Cavanagh and his wife, Sheila, who are seasoned missionaries with Mission Doctors and have been filling in until our arrival.

We’ve spent the last week adjusting to the 8 hour time difference, unpacking and organizing, and shadowing the other doctors at the hospital.

We, indeed, feel very welcome.

The Journey to Mission

When I reflect on my journey to mission work, it started when I was very young although I did not know it. It began with my parents as examples of love and service. As a youth and young adult, I was blessed with a very alive, interactive experience of the Catholic Church, a church that moved and inspired me to follow Christ‘s example. I was fortunate to attend schools that taught me my faith and again a spirit of service. After graduating from college, I joined a volunteer program and had the opportunity to do a year of service and to live in community. Finally, I went to medical school where Brent and I met and we found that we shared the same call. In my journey to mission work, I had many opportunities growing up, many chances to hear Christ’s call in my life.

However, there is also a part of this journey that I cannot explain, that is beyond the concrete

experiences that have influenced me. I do not like the unknown. I would not describe myself as adventurous. I am easily ruffled by little things. I would like to live closer to my family. I like things to be clean. I have many faults. I am not holy. My faith is not strong. Yet, for me, there is some undeniable, indescribable pull to be a missionary. Life would be easier in many ways if this was not the call I heard. However, with a measure of God‘s grace and the power of the Holy Spirit, I can journey through the unknown and into the mission field and answer my call.

Things we will miss about Guatemala

As we prepare to leave for Cameroon and are looking forward to our new home, there are many things we miss about Guatemala.
Here are a few of them:

Friends.

The beautiful, elaborate embroidery the Mayan people have on their traditional dress.

Traditional thick corn tortillas hot off the fire.

Avocados, which we ate almost everyday, for 12 to 25 cents a piece.

Beans and rice, which we eat here, as well, but not with the frequency as in Guatemala.

Mangoes -- large and luscious.

Paca -- the enjoyable pastime where you can look through piles of used clothing form the States and buy almost anything for 40 to 60 cents.

Lake Atitlan -- volcanic in origin, filling an enormous caldera.

The beautiful temperate weather, but also the rainy season with cool, refreshing rain.

Majestic San Pedro volcano, which we could see from our window.

Journey Together

We want to take this opportunity to thank you for your support during our past 3 years in Guatemala and to give you an update on our future plans. Mission work is the way we both personally feel called to follow Christ's example and with the help of Mission Doctors Association (MDA) and you, our family and friends, we are able to fulfill this vision for our lives.   

During our time in Guatemala, we were part of an incredible transition as Hospitalito moved from its temporary location to its new building. We saw Hospitalito grow in its medical staff from two Guatemalan physicians to six and  to begin to address sustainability for the future. We were blessed to have been a part of this history at Hospitalito.  We worked hard, were inspired by many people, tried to live simply, learned more Spanish, and were challenged in ways we did not expect (as life seems to do wherever one is). Our children went to school, made friends, grew, played, laughed, cried and adjusted amazingly well.

After prayer, reflection, and discussion with Mission Doctors, we have decided to continue with MDA for another three year commitment, this time in Cameroon, West Africa. We will be working at St. Martin De Porres Hospital located in Njinikom in the Northwest Province about an hour outside of Bamenda. The hospital celebrated 50 years of service earlier this year. We are looking forward to working along side the staff, especially the Tertiary Sisters of St. Francis of Assisi, who have been running the hospital since it opened. You can find out more about the hospital at http://stmartindeporreshospital.com/index.htm.

We ask you once again to join us on our mission as we try to bridge two cultures and serve those in need. We appreciate any support you are able to give: your prayers, your time, your talents. If you are able to support us financially as well, MDA will designate your tax deductible gift of any size to help cover our direct expenses. You can make your donation online right here (on the right with the big blue button under "Donate to our Mission") or by mail.
Mission Doctors Association
3435 Wilshire Blvd., Suite 1940
Los Angeles, CA 90010

Please indicate that your donation is in support of the Burket Thoene Family Mission.

We are hoping you will continue to follow us on our blog at http://burketthoenefamilymission.blogspot.com/ or you can reach us by email at burketthoene@yahoo.com.

Looking forward to our continued journey together!

Last Sunday

Last Sunday (April 28) was our last Sunday at our church is Santiago.

It was special for a number of reasons.  First of all there was a wedding.  Not just a wedding, but also because the husband to be, was not catholic he received his baptism, first communion, confirmation before the being married.  It was also special as our priest gave a blessing and thanks to us and another volunteer family (The Smiths) for our time in Santiago Atitlan.

Recycling

All of our recyclable paper and cardboard goes to Adisa, the school and workshop for developmentally challenged individuals. They make many products from recycled paper and cardboard that are sold on Novica.com.

There is a truck that comes around and buys all things metal. We give our food cans and aluminum cans to one of the older women who has a store on the main road and she receives the proceeds from that.

For the first 2 years we were here there was no recycling locally for glass or plastic. We would save it up and take it to Antigua (2 ½ hours from here) once or twice a year. We don’t have that much plastic and glass recycling as we make most things from scratch and can’t buy a lot of things in bottles. However, now there is a local place that accepts recycling called Punto Verde (Green Point). This has made recycling much more convenient.

Corn is the staple food in Guatemala and can grow anywhere….. Even in the drainage ditch on the side of the road.

Eco Bricks

Trash is a problem all over the world, but when we first moved to Guatemala we were really struck by the amount of trash everywhere. That is when we learned about Eco bricks. Eco bricks are made from plastic drink bottles stuffed with trash. Since we rarely buy a drink in a plastic bottle, we started looking for bottles on the ground while we were walking back and forth to town. Then we started stuffing bottles.

We stuff all trash that is not compostable or recyclable. If you use a stick to push the trash down in the bottle, we found that we could fit a whole cereal bag full of trash in one bottle. We’ve found that wide mouth bottles are easier to stuff and pick up those up preferentially. Since we compost even our toilet paper, recycle everything recyclable, and stuff bottles, we only have a small cereal bag size of trash every 2-3 months!

The Eco bricks are then used in place of cement blocks or other building materials to build things. A

frame of wood is made and chicken wire attached to both sides. The stuffed bottles are then slipped between the chicken wire. They can be used with the bottles showing to make things like garbage cans that don’t need to be sealed or they can be covered by cement for a home. Recently a school in a town nearby was collecting them to make a playground and a local school garden project took some to make some benches in the garden.

Holy Thursday

Although Easter has passed, I wanted to write about my favorite Mass of the year in Guatemala. It is the Holy Thursday Mass. It is outdoors at 5pm in the square of the Church with at least a thousand people present. During the Mass, one can see majestic Volcan San Pedro and the sky changing colors as the sun sets.
 

Each year the priest has had the same message. Holy Thursday is the commemoration of Christ giving us three gifts… his love for us, the Eucharist, and the priesthood. Each year I’ve thought that was a simple, true summary of what we celebrate on Holy Thursday.

 

 

Ending time

We are finishing our time here in Guatemala and will return to the USA for a few months before continuing with MDA in Cameroon at St. Martin de Porres in Njinikom.

It is a busy time, as we prepare to leave, say our good-byes and finish up various projects that we hope others will continue....

We've had little time to reflect on the past 3 years.
    So many special people have entered our lives and touched us profoundly.
    So many late nights/early mornings spent caring for patients.
    We have seen our children grow, afternoons helping with various school projects, making new friends, celebrating birthdays and holidays.

As we finish our time here we will reflect on some our experiences in Guatemala that we haven't written about.

We also want to take this opportunity to say THANK YOU for all of your love, support and prayers.

Courage

We counseled the mom that her son needed a splint and then, in a couple of days when the swelling went down, he would need a cast on the fractured arm. She wasn't sure about this course of treatment because hueseros (traditional bone "doctors" in Guatemala) often treat fractures and sprains with manual manipulation, distraction, and massage without a cast. It took some convincing, but she allowed us to put on a temporary splint.

We thought that the patient might not come back for the cast, as often patients don't, but the mother did bring her son back 2 days later. The mother told us that many people told her that she should just take him to a huesero, yet against that advice, she brought him back to the hospital and he received his cast.  I was really struck by her courage to make her own decision for her own son, as this is not the norm for people in Guatemala. Family opinion has tremendous influence. We praised the mother for doing what we thought was the right thing for her child.

I saw Christ today.

We had two boys fall out of trees today, both from a height of about 4-5 meters. One had a huge amount of facial swelling, but thankfully no broken bones and the other one had a forearm fracture.

While doing a thorough exam on the second boy, we removed his socks and shoes to make sure we didn't miss any other injuries. He was dirty, his shoes were worn, and his socks were stiff and caked with mud. His family was poor and although he was school age, he was not in school. Public school is free in Guatemala, but the family still needs to provide school supplies, a PE uniform, etc... which is often too much for the family to afford.

A little while later, I saw the nurse with a basin of water washing the boy's feet. He was doing it with such gentleness, compassion, and love. It was Christ washing the feet of one of his followers. It gave me chills and brought tears to my eyes. I hadn't asked the nurse to do this and he had other pressing duties, but he took the time out of his business to touch this boy. He wasn't being judgmental or counseling the boy that he should be cleaner. It was just an act of pure love.

Birthdays

We celebrated all of the girls' birthdays in January.

Brent made Jennifer a truly scrumptious chocolate cake.

Elizabeth had a party with some friends. She picked her own menu and every food happened to be vegetable based -- very interesting for a 9 year old. We had corn chowder, zucchini pancakes, broccoli salad, and carrot cake. One of her grandpas noted, when he saw her birthday photos, that she was all smiles in every picture!

We also celebrated Julianne's birthday with some friends. Her menu consisted of burritos with all the fixings and one of our friends brought bruschetta. We made mousse which was a little runny, but still very tasty.

Kids love having a day that is just for them.

Collage

This collage of pictures come from a local preschool class in Santiago Atitilan.   

It is in the pediatric room in our hospital.  

 
 














I especially like the drawing in the upper right, but I may be a little biased!!  :)

 

Community Outreach

We have started community outreach to two villages near Santiago.   The day starts with a educational talk and then either general medical clinic and/or ultrasound clinic. 

Hospitalito has recently received a portable ultrasound and we have been using this for these outreach clinics. 

Ultrasound Study

We have been involved in a ultrasound study for the past two years in Santiago Atitlan.

We are doing the study to develop intrauterine growth curves for the local Mayan population.

The hope is that by using ultrasound we can identify pregnancies at risk for intrauterine growth restriction (when baby in mom is not growing well) and then intervene in the pregnancy so that the baby has a better chance of surviving.

While the study continues there have been many benefits from the study already.  Our relationship with the local clinics, National Hospital and comadrones (traditional birth attendants) has improved and this has helped to provide better care for the population in Santiago Atitlan and San Lucas Tolimon ( a nearby village).

This picture is of one of our favorite comadrones Juana (on the right) who is with one of her patients at a recent Ultrasound clinic. 

Day 10

There are people from all over the world doing amazing, selfless work with vision, initiative, and very few resources.

Gratitude for little things is very important.

A positive attitude can go a long way in making a tough situation better.

Challenges in the Mission field are never what you expect. There are always surprises, good and difficult.

Day 9

"Baaing" goats sound like crying babies outside your window.

People can carry anything on their head/back. We've seen mattresses, backpacks, desks for school, huge basket of live chickens (seems dangerous), side of beef... you name it!

People eat all the parts of the animal. They sell the cow leg from the knee down with hoof and all, eyeballs, skull, chicken head and feet, as well as many organs which we cannot identify. In Ghana they even ate the chicken bones - probably a good source of calcium!

Day 8

Roosters do not only crow at dawn. We actually don't think they can tell time at all as they seem to crow at any hour and many days begin at 4 am. After you've lived in a place for a while, you stop hearing them so that is a good thing.

Bimbo is an unusual name for a bread company in Guatemala.

Day 7

The water filter can amazingly make black water, clear.

Many days, plunging the toilet is a more than a once a day event.

Day 6

Rain in the tropics is impressive, as is the thunder and lightening.

One can get a flea infested house without having a pet. The fleas come from the squirrels and rats that live between the ceiling and our roof.

We've also seen beautiful red tomatoes growing with plastic pesticide containers strewn around the base of the plants. So that's how they become so red and delicious...!?

Day 5

Dogs and squirrels eat avocados, a delicacy that we bet most dogs and squirrels never get to sample in the US.

You know that your children's Spanish is better than yours when your kids tell you not to speak to them in Spanish in public or when you look to your children to tell you a word or how to say something.

If soap sits around long enough, it turns black and becomes almost unrecognizable as soap. We found this in the first house we lived in in Guatemala.

Day 4 and 2 more...

Moths can be the size of small birds. You find this out when you have the brilliant idea of putting a new light socket over your kitchen sink so that you can see better at night and the bird-sized moth scares the begeezers out of you.

It is not a good day when you wake up with what you think is rain coming from the ceiling onto your head and pillow only to realize that it is not raining. When you consider what could be happening, you realize that it is actually urine coming through the ceiling boards from either a squirrel or a rat that live between the ceiling and your roof.

Day 3

Head lice can be incredibly easy to get and very difficult to get rid of.

When you accompany your kids on their first school field trip to the "beach," you encounter this as the dock.

Day 2

When there is a lot of bat guano in your ceiling and it rains really hard, it comes down in big black streaks on your walls all the way down to the floor.

Shade grown coffee does grow in the shade, but this shaded field is also often littered with garbage.

When you get a double yolk in one egg, it is cool. When you get it in a second, it is really interesting. When you get it in a dozen, it is unnerving. What has that chicken been eating?

10 days and 26 ways

Over the next 10 days, we will be sharing 26 things we've learned or only experienced in the missions. 

1. You know you've lived in the Missions for a while when you tell a story and your kids ask you, "What's a comforter?" or "What's a driveway?"

2. Cars and trucks that look like they could never be functional, somehow function with nearly flat tires, so many people in the bed of the pickup that the back bumper is just a couple inches off the ground, missing fenders, broken windshields, lurching movements, and unsettling sounds.