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.”

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.

Manos de Compasion

We have been so blessed to come to know Dave and Deborah Reichard.

The Reichard's are a young couple who oversee the local orphanage here in Santiago Atitlan. The orphanage called "Manos de Compasion" was started in 1999 in Guatemala City and moved to Santiago Atitlan in 2006.  In 2009 Dave and Deborah took over.  

We came to learn about Manos de Compasion as Dave and Deborah would bring the children to Hospitalito for their initial physical exams and acute illnesses.

 

They have 20 children in their house with 9 of these in diapers!  And we thought it was a challenge to have three in diapers. 

We have been able to share a number of Holidays and birthdays with all of them at the orphanage and at our house. Jennifer has also been able to fill in, at times, taking care of the kids when Dave and Deborah need to go to the City for the day. Jennifer is truly amazing!
 

Each child that comes into their care brings with them such tragic stories but each day they are at Manos de Compasion is an opportunity to witness Christ among us through the love and care that Deborah and Dave give. 

To learn more about Manos de Compasion visit these web sites:
http://guatemalaministry.com/about.htm
http://guatemalaministry.com/
http://www.gua-ministry.blogspot.com/

Step Along the Way

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

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.

Home

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

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

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.

Maria

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.

 

Holy Family

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!

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

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

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

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

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

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

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

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.

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

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. 

Happy Mother's Day

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?