Thoughts from Honduras
2001
Contents
How_Much_is_Your_Daughter’s_Life_Worth?
Jan 6, 2001
I am getting older!
At this time of year, many people reflect on the past and look to the future. As the holiday season has ended, the heavy rains, and a round of head colds having put a damper on many of our holiday plans, I can’t help but feel a bit melancholy. The Christmas decorations are back in their boxes, to await another year. The “glow” of the season is past. Things are getting back to normal. And tomorrow is my birthday.
Recently, while trying to determine the dose of cough medicine, I found myself beginning to experience things that I thought were reserved for the “older population”. I found myself trying to read the very fine print on those little sample bottles of medicine; first with my glasses, then without my glasses, the bottle about two inches from my right eye, and finally with a magnifying glass. It is obvious that the inevitable bifocals are just around the corner.
Becky has many times accused me of selective listening. At times, she has been right, but in recent years, I find myself thinking that the device advertised on television, “The Clarifier”, is what I need. Sounds all seem to blend together into background static. When that is added to the echo in our home, the kids playing, and rain hitting the roof, I really can’t hear!
It used to be that I would ask myself, with some concern, “Why does this hurt?” Now I ask myself, “What else will be hurting tomorrow?” It used to be that I only talked to patients based on what I had learned in medical school or from reading books. Now, as the collection of creams and ointments, tablets and capsules in the medicine cabinet grows, I am becoming even more familiar with their uses and side effects. I presently find myself talking to more and more patients from personal experience!
I have also noticed that the majority of my patients are younger than I am. Even those that “look mature” are frequently younger than I. Now, to be fair, the Hondurans do tend to age faster, and have a shorter life expectancy than we do in the US. But I am often referred to as “Don David”, the title reserved for “the elders”.
And when I returned from our summer in The States of eating many wonderful meals at different homes and restaurants, more than one person told me that I was “bien gordo”! The closest equivalent in English is “pleasingly plump”. This is considered a compliment, for to have the appearance of being overweight in Honduras is desirable as a sign of wealth. As I checked the scales, I really had not gained that much, and even as I have lost some of the excess, the new “rolls” here and there seem to persist.
So as the reality of my advancing age sinks in, and I celebrate another birthday, I wonder if I will follow all those recommendations I used to give my “older” patients about some of those not so pleasant medical exams and tests. I do have yet a few years to decide, and hope for more pleasant medical technology to come along before then.
I realize that my childhood dreams of being an astronaut, professional baseball player, or Olympic bicycler are truly dead and gone. But even as my physical prime is past, I still see myself growing spiritually, mentally and emotionally. This is more than fair compensation for the failing of the physical body.
I have no real sense of loss. I am more content than I ever have been. I am with my family, where God has called us, accomplishing His purpose. Here in Honduras, I am not only one doctor among many possible choices. Rather, in many cases, I am the only choice. My life does make a difference. The opportunities to serve are many.
So, as I look forward to yet reaching my “prime”, I truly do experience the Joy of Jesus, and look forward to
immeasurably more than all I could ask or imagine, according to His power that is at work within us
. (see Ephesians 3:20)
Feb 22, 2001
People often ask, “Why isn’t the hospital finished?” or “Why did it take so long to fix your roof?” or “Why does it take all day to get groceries?”
What they don’t understand is that shopping here is not like shopping there! For example, when I go to town to get stuff to fix up the house, there is no Home Depot or Wal-Mart. Usually I need to go to three or four different hardware stores to get everything on the list. Even then I sometimes can’t find what I need. No one store carries everything. When we go for groceries, we usually visit at least three grocery stores; one has the best vegetables, another has the best meat, another has granola; plus visit two street markets, one for oranges and another for bananas, pineapples and melons. No superstores here!
Let me illustrate with my recent quest for black shoelaces. In The States when you need shoelaces, what are your choices? You can get them at a shoe store, at Wal-Mart, and even at the grocery store. Here? No way!
Having broken my shoelace for the third time, and not having enough left to re-knot again, I decided to buy some new laces. The first stop was at a shoe store that even sold the shoes I was wearing. Did they have laces? No way! Another shoe store? Same thing. None in the grocery store. They sent me to the fabric store. I was getting closer. They had giant shoelaces that were three times too long and only in red and green. They sent me to another store. They had some in the ballpark for size, but only in white, red and gray. I bought the gray ones (only 6 cents a pair!). They don’t look too bad in my black shoes!
Such was my morning looking for shoelaces, and such is life in Honduras.
April 3, 2001
We performed our first operation at Hospital Loma de Luz yesterday! Actually, it was in our temporary operating room in the housing complex. Dan DeCook, a surgeon from Holland, Michigan, (and missionary kid: he grew up in Bangladesh) was here to assist. We did an inguinal hernia repair with mesh on a 19 year old guy from nearby Rio Esteben. Chrysti Reeck, our nurse, “circulated”, and our Honduran “nurse aids” watched with interest. We gave the patient valium by mouth before the procedure, and used local anesthetic. All went well! We will see him back in a week.
Hopefully this will become a weekly event, since our waiting list is long. We also soon hope to begin doing gastroscopy (looking into the stomach with a scope that the patient swallows). As we continue to expand our services, we soon hope to see other surgeries offered via spinal anesthetic!
May 1, 2001
Our youngest son Jake loves to draw us pictures. His people are beginning to be recognized as people. He still has to give us considerable explanation of what else is in the picture, and the action involved.
Jake thinks his pictures are great! Of course we encourage him and tell him they are good, leaving unsaid the qualifier “for a six-year old”. Jake is adopted. If we were to have chosen a son based on artistic ability defined as being able to produce great masterpieces, Jake would have fallen short. Yet, he would have kept on drawing, and would even have entered the competition with high hopes! He really has a false impression of what is “good art”.
Yet we enjoy and appreciate his drawings, not because of their artistic merit, but because they are given in the spirit of love. Jake is secure in our family, and has no fear of being cast out. His drawings are not to gain our favor or maintain his family status. They are expressions of his appreciation for us.
Many people think they are in a competition to receive sonship from God. They are happily living what they consider a “good” life, unaware that it falls far short of God’s standard for “good”. Even there best efforts appear as distortions before our Holy God. Yet, they feel confident that God will choose them.
The analogy does break down a bit here. God does want to adopt everyone, but He cannot tolerate “bad art” in his presence! So He painted a beautiful picture of redemption and adoption for us via His Son, Jesus Christ. But until we realize that our “art” is faulty, and actually very offensive to God, we won’t understand that we need to substitute the work of Jesus as the only acceptable payment for our sin. So, if we continue happily on our way of doing our best, we will someday be jolted into the reality that it was not good enough. But then it may be too late!
We need to look at our “work of life” through God’s eyes, as described in the Bible. Even our very best actions are as dirty rags, fit only to be burned. Even one lie, one lustful thought, one selfish motive, has disqualified us from the “art show”. We need to realize that we are sinners and offensive to God, to forsake our “good” life as a means of gaining God’s favor, and accept Jesus as the only perfect work that will be acceptable to God.
After that, we can continue on doing our “art work” to the best of our ability, but with different motives. No longer will we work out of fear or in an attempt to gain God’s favor. We will work in an attitude of gratitude for our Savior Jesus Christ, who paid a great price on the cross to save us from the judgment to come.
June 12, 2001
Life in Honduras usually follows the pattern of two steps forward, one step back. But recently, we have been pushed back about three steps!
This year started very slow financially for the Cornerstone. We assume this has something to do with the economic uncertainty in The States. We had hopes of actually moving the clinic into the front half of the hospital this year, but we will have to wait and see.
Because of this slow down, the construction work force has been diverted somewhat to missionary homes, which may be a good thing! We have two mission families here in Balfate needing homes, and two others hoping to move here before the end of the year. The O’Neils have been told that the house they were renting is now for sale, but the asking price is unreasonable. So they have started work on their new home near the hospital. The Schofields, our newest mission family, also need a home. More on that in a minute.
A couple weeks ago, two of our workers were injured, one seriously, when our military truck rolled down a hill. The seriously injured worker suffered severely broken bones, and several internal injuries. He required emergency surgery at a private hospital in La Ceiba, and probably will be there another 3-4 weeks. Cornerstone is responsible for all the medical bills, as well as continuing his salary for life, whether he can work again or not. Our truck was also totaled.
About that time, we received word that Karen Schoffield’s father had died unexpectedly. She, her husband, Will, and their youngest child went to The States for the funeral. Less than a week after they returned, their home at the McKenney’s ranch was burned to the ground. They lost everything.
God is not unaware of these events. He was not caught off guard. We have the confidence that even these discouraging times are for our good, and that nothing can separate us from the love of God! Already we have seen the love of Christ demonstrated, as many people, here and abroad, have responded to these needs. We look forward to the days ahead, not with fear or anxiety, but with confidence that God will accomplish His purposes, and we will all be better for having been a part of it.
June 26, 2001
I knew as soon as I saw her sitting weakly on the bench, awaiting her appointment, that she was going to be a complex patient.
As she was carried into the exam room by her mother, grandmother and friend, it was evident that she couldn’t sit any longer, and that she needed an IV. She was pale (hematocrit of 16), with yellow sunken eyes, breathing rapidly. Her mother told me that her daughter, only 28 years old, had been sick for 4 months, and had been in private hospitals twice, but no one could help her get better. They thought she had hepatitis, and showed me her lab results. They only showed that she had hepatitis A in the past, but did not have an active infection currently.
She looked like an end stage cancer patient, dehydrated, not long for this world. I could not see an obvious cause for the problem on physical exam. I looked for a vein to start an IV, but had doubts. I prayed for God’s help, found a small vein, and was able to cannulate it and begin the rehydration fluid.
As I looked over our list of lab tests, checking almost everything. I hoped this might only be an advanced untreated case of malaria, but I also checked the “HIV” line, the test for the AIDS virus. I called the visiting medical technologist, who drew blood with skill, and hurried off to the lab to begin work. I called two of our nurse aids in training, and instructed them on how to obtain a urine specimen, advising them to wear gloves, since the patient might have a contagious disease.
Many other patients were waiting, so I continued on with clinic while awaiting the results. A while later, the lab tech knocked on the door. His face showed some urgency. Almost every test ordered was markedly abnormal. The HIV line was marked “Positive”. My heart sank. I would have rather seen her with an incurable cancer than this. The ramifications were so far more reaching.
I sat down, collected my thoughts, and prayed for wisdom.
As I entered the room, the mother and grandmother stood up to hear what I had to say. The patient looked up weakly, hoping for an answer. As I spoke the word “SIDA”, the Spanish acronym for “AIDS”, her eyes turned away and filled with tears. Her mother was emotionless, as if she already suspected so. Her grandmother quickly sat down in shock.
I placed my hand on her emaciated shoulder and waited. Finally her eyes turned back to mine, to see what else I had to say, asking the question silently “What next?” I asked about her husband. “Gone!” Nothing more to say about him! She had a daughter, one year old. I inwardly feared for her health. I asked if she was well. “Yes,” she responded. I encouraged the family to bring her to be tested. More tears!
I left her alone with her family with the promise to return in a few minutes, when I had the rest of the lab results. I gathered our clinic staff for a quick, unscheduled meeting. I told them about the patient and the diagnosis. I reminded them of the need for confidentiality, and of the need for infection precautions, not just with this patient, but also with every patient, since we never know who may have the disease. We prayed together for her and her family, and for wisdom for our staff pastor who would give her spiritual counseling.
More lab results indicated an infection that we could treat. Maybe we could help her improve a bit, for a while. We started the antibiotics, and continued the rehydration fluid as the pastor talked with her. She claimed to be a Christian, and claimed to be ready to die. The pastor encouraged her as best he could, and prayed with her and the family.
After three liters of fluid, her veins were fuller, she seemed to be breathing easier, but was feverish. We don’t have in-patient facilities yet, so we gave her some medications to take home, and helped her to the waiting pick up truck.
I don’t know If I will see her alive again. If the statistics and predictions for Latin America are correct, we will see many more like her. We will certainly need to be involved in end of life “hospice” care. Sick people will come to us “North Americans”, with some hope that we may be able to help them. We can’t begin to afford the medications available easily in The States to treat AIDS. But we can offer comfort care, possibly making the exit from this world a bit easier, and the love of Christ, hopefully pointing the way to a better eternity!
August 9, 2001
When a stone is thrown into a pond, it generates a series of ripples that spread out, causing everything in the pond to undulate. A big stone causes a large change. A pebble only alters its environment a little. But everything in the pond is changed to some degree.
Recently we hosted a team from our hometown in Ohio. The ripple effect was obvious. As my family had been caught up into the ripples of Honduras in 1996, so have many of my friends, and many folks I had never met before. Each of us has magnified the effect of the original ripples, influencing others with our enthusiasm for God’s work in Honduras. The effect continues on. None of us will ever be the same again. Those within our sphere of influence will likewise be affected as we share our experiences with them. Possibly they will be caught up in the ripples, to make their own ripples, and to change others in the process. Only eternity will reveal the full impact each of us had on others, and the future.
There are certainly enough bad things that set off ripples in our society. Thank God for the good things! May we continue to be caught up in the affairs of God, propagating His Truth and Love to those we influence.
August 20, 2001
Life will never be the same!
Last night we went to church in Lis Lis without driving THROUGH the rivers! We drove OVER them on our two new bridges!
The bridges are not quite completed, but finished enough to be used. Another contractor needs to fortify the approaches so they don’t wash away during the rainy season.
For the people in Balfate and Lucinda, this means they won’t be stranded this year by the rains. They will be able to send the milk from their cows to the dairy year round. They will be able to ride the bus rather than slop through the mud and wade through the rivers. They will be able to keep their general stores stocked. Of course the people further down the road will still need to deal with the Lucinda and Esteben Rivers. But once they get to Lucinda, they will be able to catch a bus.
It also means that property value in our area will likely probably soar as people from La Ceiba will be more attracted to the beach and country. This will have mixed blessings, as we probably will see the area become more developed around the hospital.
For the hospital, the bridges mean that more people will be able to reach us during the rainy season. Teams and visitors can come all year with less fear of being stranded.
For us, it means that we will not need to pack over night bags every time we go to town. The afternoon rains will no longer be a problem for travel. It also means that we will not need to stock up on food for the rainy season, nor will we have the sometimes welcome benefit of being stranded without visitors. And our car should have less wear and tear without the constant travel through the rivers.
Life indeed will never be the same. We are thankful for the bridges, and are interested to see what this rainy season will be like.
10/27/2001
I have a new perspective on patients. This week I have spent hours at the bedside of my mother in Emory Hospital in Atlanta. She just had surgery for pancreatic cancer.
I know too much! For a general surgeon, there are few diagnosis that are so difficult to treat and have such a dismal prognosis. When I first received the news of her diagnosis, found during what was supposed to be an operation for a benign process, my heart sank. My earliest childhood memory, burned forever into my mind at age three, was the image of red and blue tubes protruding from the abdomen of my mom’s father after his operation for pancreatic cancer. He died shortly thereafter.
When I first heard about Mom’s symptoms in April, my surgeon’s training said, “rule out pancreatic cancer!” As her workup continued, the tests were negative for pancreatic cancer, but my suspicion was still there, as it was for the doctors involved in her care. I anticipated each new test, and was relieved with the continued “good news,” but yet I had my doubts. Pancreatic cancer is like that: sometimes difficult at times to diagnose, at times even until the end.
Becky and I had discussed the possibilities and plans for the worst case scenario. When I did not receive the expected voice mail on my cell phone the day of surgery telling me that all went well, I went to bed for a troubled sleep. At first light, I checked my phone. There it was, my sister’s voice, giving me the news I somehow expected but hoped wouldn’t be.
Quickly we made arrangements for a trip to the States to be with my mom. Becky and the kids stayed in Honduras for now. During the preparation to leave, I discovered that my emails of the past month, which I had thought were making there way to the intended recipients, were lost in cyberspace. Ignorance was bliss! It was too late to investigate or correct the problem. I had hoped to share news of my mother’s illness with our friends and supporters via email to encourage prayer.
At Emory, I was quickly confident that Mom was in the best hands possible: one of the best of the best medical facilities in the world. The care provided was excellent.
It was hard being a patient family member. I spent two overnights with Mom, and several days, feeding her ice chips, rubbing her back, emptying her potty chair, and waiting for the doctors to make rounds. From the doctor side, what seemed to be a passing discussion of possibilities or promise of a medication change was totally different from the patient viewpoint. Mom was hurting! Why did it take so long to bring the medicine? Why did the resident have to mention an NG tube? The fear of another insult, another discomfort amidst the misery of being poked and prodded and tethered to bed by countless tubes and drains sent Mom into quiet anxiety. “How much more? Was it worth it?” she questioned.
And then, the wait for the pathology report. For me, the future hung on that one written document. It would tell me if this would be Mom’s last Christmas with us, or if she had a chance. The doctor said it would be out today! We waited, all day! I struggled with my emotions, trying not to discourage my parents by showing my fears. I left the room for just a few minutes, and returned to find out that I had missed the doctor and his entourage of residents! He made no mention of the path report! We would need to wait another day! I had never experienced this part of being a patient before. The expectations, the fears, the questions, the waiting!
Then, the unexpected: the junior resident showed up with a copy of the path report for me to read, “Hot off the press!” This would have deserved a significant reprimand in my residency days. It was the attending surgeon’s job to “break the news.” I have broken the bad news many times, never enjoying it, but always attempting to minister in the midst of turmoil. This perceptive resident saw my struggle and ministered to me, at his own risk. My family determined to appear “uninformed” when the attending surgeon finally showed up the next day to give us the news.
As I read the report, my mind was in a whirl. The margins were clear. The tumor was small. Only one lymph node was involved, and that by direct extension, not by lymphatic metastasis. I had to read it again, and once again as I tried to understand the meaning. Mom and Dad looked on, waiting for me to tell them what it meant. In short, it was good news in a bad situation. Mom was fortunate to have her cancer caught early. It gave her a fighting chance of 20% to live another five years! Not good odds, but too me, it was welcome news! The usual odds for pancreatic cancer are 50% chance of living 18 months, 5% at 5 years.
Then, what about chemotherapy and radiation? In the usual advanced case, they would offer little to survival. But for Mom’s select subset, Emory was participating in a study that used both, which, in the Emory experience, was offering a possible 40% chance of 5 year survival. That’s approaching 50-50! Those are odds that are more acceptable and less discouraging!
So, as we wait for Mom to recover, and contemplate the future, I begin to formulate plans, options, “what ifs.” I return to Honduras tomorrow morning and share the news with Becky. Then we wait: wait for mom to feel well enough for a visit from the whole family, wait to see how she responds to chemotherapy and radiation, wait to see if the tumor recurs.
And during all this, what of God? What of our faith? God is all knowing and all wise. And He is all powerful. He is also present with us through all circumstances. And He exercises all these qualities in love. We have the confidence that no matter what happens, even though it is difficult to understand from our finite point of view, that this will turn out for the good of Mom, and Dad, and my sister, and all our families, for we do love God! And even death, which appears to be our enemy, will be swallowed up in victory. For whenever it happens, for Mom, or for any of us who know Christ, we will be in the presence of our Lord and Saviour, Jesus Christ, where there will be no more suffering, no more tears, no more death, only life forever, as life was initially intended to be, in perfect fellowship with our Creator and God.
(A poem by Abbie Drozek, age 11)
There is a great big problem in our home.
There are creatures popping up from places unknown.
Lots of different kinds of critters scurrying around,
On the ceilings, and the counters, on the walls, and on the ground.
There are cockroaches, centipedes, even a snake!
Ants in the sink, for goodness sake!
Yes ,There is a great big problem in our home,
For there are creatures popping up from places unknown.
A few weeks ago there was a larger problem.
There was an anteater in our tree; all black and golden.
It's tail was like a monkey's and it smelled like a skunk.
But when we had come back from swimming, away it had slunk.
There are also lots of little crabs that scurry here and there.
They are light brown and tan, and haven't any hair.
Yes, there's a great big problem in our home,
There are creatures popping up from places unknown.
Last week the exterminator came and sprayed around;
In the yard, in the house, and in the septic tank on the ground.
The exterminators went all over with gas guns buzzin'
And out of the septic tank came cockroaches by the dozen.
Yes, there's a great big problem in our home,
There are creatures popping up from places unknown.
An iguana fell through our ceiling on April Fools' Day.
When we told our mother she thought it was a joke and said, "No Way!"
But when she came with us to see, she saw it was no joke.
The iguana was right there, just as we had spoke.
One day we were swimming by the waterfall.
There was a large tarantula in the way on the wall.
Adam saw only one. I saw another, and Daddy saw him too.
Adam, staying away from number one, got very close to number two.
Yes, there's a great big problem in our home and all around,
There are creatures popping up from the walls and from the ground.
One day as we were sitting at the table,
I cried, "There's a snake!" and it was no fable!
Mommy tried to sweep it out the house,
But in to a hole it shot, like a mouse.
We feared it would come back out all day and through the night.
When Daddy got back home he caulked the hole up tight.
Yes, there's a great big problem in our home,
There are creatures popping up from places unknown.
One day when we were riding home on the coast.
We were talking about what things we feared the most.
Mommy said a tarantula was what she most feared,
And when we got home, right there one appeared!
Tarantulas, cockroaches, centipedes, a snake,
Lizards and ants; For goodness sake!
Yes, there's a great big problem in our home,
There are creatures popping up from places unknown.
November 28, 2001
What does God think about a human clone? How does He see him? Is the clone a being that bears the image of God? Does it have a sin nature and a spirit that requires salvation? On the answers to these question hinges our response.
What is the purpose of human cloning? It appears to me that there are no good reasons to do so. It circumvents the usual means of producing a human being that God has established. It fulfills the selfish desires of individuals to have “organ banks” of compatible tissue for future use. It lets scientists feel like they are gods.
Let’s for a moment assume that cloned human beings are not human; they merely represent an off growth of the donor, a cell that has been induced to reproduce into an identical image, an identical twin, removed in time. How shall we treat this being? If it is to be saved for organ donation, we certainly don’t want to become attached to it! But someone needs to care for this future donor. Do we need to raise it somewhere away from us, maybe on a farm, where it can be fed and kept healthy until the day it is needed? Do we educate it? Do we keep it as a pet? Does it have rights? Does it receive a birth certificate and citizenship? Can it vote? Can you insure it? Will it be covered by your health plan?
Maybe someone will vainly want an image of himself to raise as a child; to grant it a better life than they had and to somehow attain a sense of immortality in so doing; to see their own image in a better light. Certainly in this case it would be desirable to grant the clone full human rights and protection! If it were killed, it would be murder.
Can we have it both ways?
Let’s for a moment again think about what God may think. To be safe, to avoid the problems of the past that we had thinking that Jews and blacks were not human, or that unborn babies were not human, let’s assume that indeed this cloned human is fully human in God’s eyes, just like two identical twins are both human with a unique soul and spirit; a unique personality and ability to learn; a unique future in which they deserve the right to seek life, liberty and happiness. We must assume that this cloned being, since in reality it is created from and resembles a being that God created in His Image, has a sin nature and a spirit in need of redemption. This cloned being then needs a family; needs to be loved and educated; needs to be granted full protection as a human being, and can not be treated simply as an animal waiting to be slaughtered for consumption by its owner.
Therefore, why bother?
It appears that human cloning is our modern Tower of Babel, in which man seeks to exert his will over the Will of God. Man is exalting himself into the heavens in an attempt to make and sustain a name for himself. Nothing about man has changed, only the time and place.
How Much is Your Daughter’s Life Worth?
December 10, 2001
How much would you spend to find out if your daughter’s injury was fatal or could be corrected? $200? How much would you spend for surgery to correct a life-threatening problem? $2000? How about if you could possibly afford $200, but not $2000? To spend $200 to find out that your daughter needed surgery that you couldn’t afford, or that she had a fatal injury anyway would just frustrate you and put you in debt. To put it into perspective for a North American, maybe the figures of a $100,000 and $1,000,000 would be more comparable.
Two Saturdays ago, we had big plans to work around the house. It was a sunny day, in the 70’s, clear blue sky. Becky was making bagels to give out as Christmas gifts. I was emptying the bodega (storage shed) for a much needed cleaning and sorting. Then our plans changed drastically. The doorbell rang.
It was a messenger looking for our empleada (housekeeper). Luisa works in the mornings doing routine household chores, freeing Becky’s time for home schooling and other activities. Luisa’s husband, Tino, one of our hospital workers, had gone to La Ceiba to cash his paycheck. He had taken their 7-year-old daughter, Sylvia, with him to spend the day with her grandmother. No one is quite sure what happened, but as they exited the bus, Sylvia was caught in the head with the back bumper of a passing garbage truck. She had a huge gash in her head, bleeding everywhere, and was immediately unconscious. Tino thought she was dead. A helpful person on the bus arranged for a cab and had them transported to the government hospital.
The same helpful person arranged for a phone message to be sent via the local Hondutel radiophone in Balfate. The messenger rang our doorbell. I was in the back yard and thought it was probably some of the neighborhood kids coming to play. A few minutes later Adam urgently announced “Mom needs you right away in the front”. As I started toward the gate, I expected to see another machete wound or sick baby, but instead saw, and heard Luisa overcome with emotion. As we pieced together what information was available, we decided to take Luisa to town to look for Sylvia in the hospital.
When we arrived in the government ER, only Luisa was initially allowed in. I “pulled rank” announcing that I was a doctor from Balfate that needed to see a patient in the ER. They allowed me to enter.
The ER was full of people bleeding and moaning. There were some familiar faces from the Balfate area. They had brought in someone who had part of his face sliced off in a machete fight. I was glad they didn’t go to my house first! There were many others, most on the floor since there were not enough beds to go around. Then I spotted Tino and Sylvia. Tino was covered in blood, but oblivious to it. He was relieved to see Luisa but also overcome with grief over Sylvia. She was unconscious, covered in blood, with a bandage soaked in fresh blood covering her head. I peaked under the dressing enough to see an ugly wound. Her pupils reacted and were equal; a good sign.
At this point a tired, overwhelmed appearing young lady walked up a looked at me, awaiting an explanation for my presence and actions. I introduced myself, and found out that she was the government “intern” assigned to do her social service, her first year after medical school, in the ER. She filled me in on the initial care given, and appeared happy to have another doctor offer some help. We reviewed the X-rays, which were of very poor quality, but hinted at a fracture in the skull. We both agreed that Sylvia needed a CAT scan to determine the seriousness of the problem. The young doctor told me that there was a neurosurgeon in town, if we needed him, but he only worked at one of the private hospitals. The CAT scan unit was also affiliated with the private hospital, and would not set up an appointment over the phone. So off I went to see about the scan.
When I arrived, the building was closed but the guard said he could call the radiologist and technician. He quoted me the price, about $150. I told him I would be right back with the patient!
Back at the ER, as I picked Sylvia up to put her into my car, she woke up! She began talking rationally, and said she was hungry! Her mother was much relieved, but concerned that Sylvia couldn’t remember anything about the accident.
When we arrived at the CAT scan facility, the guard called the tech to come in. She quoted a different price, $200, since it was a Saturday, after hours. She also wanted the guard to verify that I had the money before she would come in. I confirmed that I had the cash.
As we waited, I thought about the medical system in Honduras, and the frustration the poor must feel. In The States, we are accustomed to receive whatever is needed, when it is needed. Discuss the cost later! If you can’t pay, don’t worry! If I had been a poor man with my daughter in this situation, in my frustration, I would have been ready to sign up for the communist army, or anyone’s army, who would promise me the opportunity to receive equal care for my daughter! Yet, I also could see the point of view of the private medical facility. Their fees were a bargain! I wondered how they could ever pay off a million-dollar machine, let alone maintain it and pay the staff with their low fees! They couldn’t afford to do charity work. Certainly in the States, we are blessed!
After the scan, the radiologist was not available to be reached! The tech called the neurosurgeon to come review the scan with me. He was a very congenial guy, who had been interrupted from sleeping in front of a football game (soccer) on his television. We together looked at the films which demonstrated a depressed skull fracture (the bone had been broken and pushed in to the brain) and a subdural hematoma (a collection of blood underneath one of the linings of the brain). Both were borderline in size concerning the need for surgery, and since Sylvia showed no obvious neurological problems, other than the earlier loss of consciousness, he felt she would do fine with close observation. I offered to keep her at my home (totally loath of the thought of her returning to the government hospital). The neurosurgeon gave me his card, and told me to call if there was any change for the worse. He wouldn’t accept any payment.
Sylvia still needed to have her head sutured. I decided to do that on my own turf in the OR at our hospital. After leaving my family at our house, and Tino near his, Sylvia, Luisa and I went to the hospital. As I removed the dressing, I could not believe that there was not more neurologic injury! The scalp had a gouge in it, with loss of tissue, making closing the wound very difficult. Right under the wound was a 50 cent sized piece of bone depressed about an eighth of an inch. No X-ray was necessary to see that! Sylvia certainly had no loss of strength, as my suture repair turned in to a wrestling match. Was I ever glad to put in the last stitch!
That night, Sylvia and her mom slept in our spare room. I checked on them frequently during the night, doing “neuro checks”. Luisa insisted on keeping the bright bedroom light on all night. A luxury for them, since they don’t have electricity.
Sylvia did wonderful over the next few days. It was difficult to keep her from being too active (she is a lot like our Jake!). She was overjoyed when her brother and sisters visited, but pouted when she couldn’t go home with them. Her family lives in a mud hut with a thatch roof and dirt floor. To get there requires a surefooted walk up a steep hill, which in rainy season is especially slick. I wanted to be absolutely sure the wound was healing well, and she was well overall before I let her return home.
When she finally did go home, her mother brought her to work with her the first couple of days, since she could not trust her to limit her activity at home. I daily checked her swollen face and scalp, and other bruises. All continues to go well. Thursday we plan to remove the stitches.
We are so thankful for the opportunity to minister to this family in need. I think having children of my own, I could better put myself in their place to a degree, and sense the anguish that many other families must feel when health problems arise that are beyond their financial means to address. It is for people like this that we are here. We can be Jesus to them, hopefully demonstrating his love through our actions, and building relationships that will have eternal consequences.
