Caleb's Surgery

Caleb had to go in for a small surgery Friday morning. He was actually looking forward to it since he knew he’d be getting a new toy after the operation. (I know, I know, you’re not supposed to bribe your children…what’s a mom to do?) He did great and was so proud of himself for not crying, even when they put the IV in. He’s a little sore and walking kind of funny, but we praise God that he came through well.

Would You Want to Know?

There are many instances of "The Clash of the Cultures" as we go through our days.  For instance, the main grocery store in town decides not to open on time, people put mayonaise on pizza, etc.  However, at times it becomes more difficult to accept the Ecuadorian way.  According to medical ethics that I have learned and practiced over the past eight years, every person has the right to know everything about their own health.  This is not exactly true in Ecuador.  A few cases in point:

1) A few weeks ago I saw a patient in the hospital who was dying from metastatic stomach cancer.  She presented with some horrific symptoms, including a severe build-up of fluid in her abdomen (ascites).  The patient's family knew of her diagnosis, but nobody had told her that she was dying of cancer.  In this case, I was able to share the news with her.  She was extremely grateful for my honesty with her so that she could face her last days without the fear of the unknown.

2) A study done a few years ago in the major cancer hospital in Ecuador (the word "cancer" is in the hospital name) revealed that 40% of patients in the hospital did not know that they were there being treated for cancer.

3) Today we sent home from the hospital an elderly lady who presented three days ago with severe shortness-of-breath and a large mass in her neck.  We diagnosed her with terminal thyroid cancer.  The family, which consisted of eight children, insisted that we not tell their mother of her diagnosis.  According to them, if we were to tell her, she would die of a heart attack on the spot, leaving their other sibling (who was away in France) without the opportunity to visit her mother one last time.  The family was very heated in their discussion of this matter.  Even though the children admitted that their mother would probably want to know of her own diagnosis, they believed that they could better decide what was in her best interest.  After many prayers were lifted up with the family, with the patient, and with other doctors, we decided to tell the patient, "If you have questions about your diagnosis, please ask your children or return to the hospital.  We would like you to know as much as you want to know."  This decision definitely went against my American ethics.

These differences present some deep challenges, but they offer great opportunities for us to appreciate the diversity of God's people.  The tough cases are also opportunities for us to mentor the Ecuadorian medical residents spiritually.  I was encouraged today by the spiritual maturity that the resident doctor showed in the treatment of this situation.  Be praying for the residents.  Many of them are trying to figure out who God is.  Others are learning how to introduce their patients to Jesus.  One of the main reasons that the Lord led us here is to help them along the right path, no matter where they might be in their spiritual and professional lives.

Thank You, Papa!

We had a wonderful time during our parents' visits.  The kids soaked up grandpa and grandma time and Kristina enjoyed the extra help while she fought with first-trimester sickness. While Papa Roth was here he and Caleb worked on a project for Jael.  We had wanted to buy her a kitchen set for Christmas but when we saw the price tag for the imported ones they had in Quito was over $300 we figured it wasn't quite in our missionary budget :)  Papa worked longs hours to finish a refridgerator, stove/oven set, and cabinet.  The kids have already had hours of fun with it and like to set up "Caleb's Cafe" where Daddy and Mommy can come for a bite to eat.

Centro Yuu

One of our primary goals in coming to Ecuador was to be able to get involved with the ministries of a local church. One often hears stories of missionaries who come into an area and, in trying to serve others, they promote dependence and helplessness. We’ve been really excited about the church that we attend here because the people there were already actively serving others and telling them about Jesus before we arrived. All we had to do was to join in with the fun.

Centro Yuu is a Shuar community here in Ecuador about 2 hours’ drive away from Shell. People there live in little shacks made with wooden planks thrown together and straw for a roof. They don’t have a clean water supply, and their electricity source is practically a little extension cord spliced into about 50 branches. About five years ago, a medical team first set foot in this community for an outreach. Since then, many people in the community have opened up their hearts to Jesus.  They are nearing a number large enough to plant a new church. Our little church in Shell has been working hard to partner with Cento Yuu during this process. Each weekend a couple from our church heads out to the Yuu to help in worship services for young and old.

A couple of weekends ago a group of us got together and brought Samaritan’s Purse Operation Christmas Child gift boxes to the kids in Centro Yuu. It was amazing! During the process, we presented the Gospel to the kids and explained to them that they were being given these gifts to remind them of the gift of Jesus that God has given all of us.  We're also planning a medical brigade to Centro Yuu within the next couple of months.  Join with us in praying that many people in this community will be thirsty to know more about Jesus' love.

 The road to the jungle is only for the strong of heart and for those with a good sense of humor.

The group from our church, including some visitors, was excited to serve.  Faces you may recognize include Steve, Lori, and Caleb Patee, Tim Roth, and Matt and Amy Kappen.  Pastor Angel is the gentleman in front.

Serving the Lord is a job for young or old, thin or with a bit of baby fat.

These kids aren't going to wait until next Christmas to open their gifts.

Never Seen It Before

Come to think of it, most of my blogs could have the above title--anyway, we admitted a patient from the jungle to the hospital the other day with a strange story.  Her name was Mrs. L.  She had developed shingles around her eye, and around the same time had developed increased confusion and difficulty walking.  Upon presentation, she knew her own name but didn't know where she was.  When asked if she knew the name of the lady with her (her sister), she named a fish.  Just having shingles around the eye can be an important problem for sure, and it can be vision-threatening.  Fortunately the eye situation seemed to be under control, but we couldn't figure out what was going on with her other symptoms.  Mrs. L had some resources and was able to get a CAT scan of her head, which revealed that her brain was small in size.  This finding is definitely not normal for a lady in her early 40's.  On further questioning, we learned that Mrs. L had actually been pretty confused for several months now, often losing her way in the jungle or forgetting what she set out to do--for example, going to get a machete and bringing back a banana.  We decided to withdraw a significant amount of spinal fluid from Mrs. L, and we found that she probably didn't have an infection around her brain (therefore there was probably no link between the shingles and the confusion).  However, just pulling out the spinal fluid seemed to make many things better for her within a few hours.  Now Mrs. L recognizes her sister, walks almost normally, and knows that she is in the hospital.  She appears to be suffering from a condition known as normal pressure hydrocephalus (NPH).  I've never seen a patient with this problem before.  In NPH, the increased fluid makes it difficult for the brain to function normally.  This is normally treated by surgically placing a tube that leads from the brain into the abdominal cavity (a ventriculoperitoneal shunt), and many times the symptoms are greatly improved with treatment.  Mrs. L has been sent to Quito for consideration for placement of the shunt.  Please be praying that it will go well for this young lady.

A Big Surprise

Because Kristina was so sick during her pregnancy with Jael, we thought it was unlikely that we'd try to have more children.  However, God has different plans in store for us...we are expecting our third child in December!  We are excited about the news and are praying for an easier pregnancy this time around.  Kristina has been feeling quite sick some days, but thankfully her parents are here right now and have been helping tons with Caleb and Jael.  We had plans to come home for Christmas this year, but these plans with have to be changed as our little one is due December 24.  We will have to obtain a visa and documents (the baby will have dual citizenship) before we can make our trip to the states.  Our news made the decision about Kristina teaching a lot easier; this work will have to wait another year or two.  Please pray for the baby, Kristina's health, and how God will use our family here in Ecuador as it grows.

A Priceless Smile

Yesterday was a really busy day.  Since Matt Kappen (my buddy from med school) and I are the only family docs here right now, there's a lot for us to do each day.  There was a lady in labor, two admissions to the hospital in the first couple hours of the day, hospitalized patients to see, stuff going on in the ER, I had a full outpatient clinic scheduled, and Matt and I were hanging out in the endoscopy suite for much of the morning as Matt works on honing his endoscopy skills. 

Amidst all the craziness, I saw a lady in my clinic who was 75 years old and about 4 foot 3.  The nurses got a kick out of seeing us walk side by side because of our height difference.  Many of the indigenous folks are pretty short, yet they still like to call me "Doctorcito", which means little doctor.  She came into my office and her granddaughter translated for her.  The elderly woman did speak a little bit of Spanish, but she was much more comfortable with her native indigenous language.

The ladies were very stoic during the interview, as is the custom of many of the folks from deep in the jungle.  They told me about how she was suffering from worsening pain in both knees, her right hip, and her right shoulder.  Her knees bothered her more than anything.  You could tell by looking that those little joints had done more than their share of manual labor during 75 years of hard life in the rain forest.  An exam confirmed that she had horrific osteoarthritis, with not much more than bone-on-bone in her knees.  Those little knees sounded like a bowl of Rice Krispies when she bent them.

We talked about treatment options, and she decided to have her knees injected yesterday, and to bring home some Ibuprofen to be used as needed.  I got everything ready and she bought the injectable steroids ($2.00).  After the injections, the stoic lady from deep in the jungle came down off the exam table.  Since an immediate effect is provided by the Lidocaine in the injection, you could tell that she already felt a huge relief.  I explained to her that it would take a couple of days for the steroids to kick in, but you could see a huge smile creep across her weathered face.  It's not a perfect treatment, but it will give her many days, and hopefully months, of relief from her pain.  As they left, I told them, "God bless you".  The ladies were so happy at this point that they were practically laughing.  "Yes," they answered, "we do trust in the goodness of God!"