Sunday, August 17, 2008

A Day in a Field Hospital

Some candid shots of various departments in our hospital. Here Pastor Scott gets a crash course in being a medic! He was an OR orderly years ago and he pulled on that past life and made a great triage tech! Here Pastor Jude is acting as his interpreter and he fills our our makeshift triage form. By the end of the day he was prescribing basic medications with the rest of us! Nearly everyone who came through got Mabendazole as a worm treatment so that was a very common prescription.
I was doing the initial triage out on the portico. This got to be totally NUTS! As the day progressed the crowds got worse. Here you see the line waiting to talk to me. It was like winning the lottery: You win, you get to see the American Doctor, you lose (runny noses, backache, etc) you have to let the nurse check your vital signs and write you a prescription for vitamens and Paracetamol (Tylenol).
Soon the lines weren't content to sit on the sidelines - the gathered closer and closer in. They were always interested in the diagnosis of the other persons. We were continuously asking them to sit down! I got very claustrophobic at times because there were about 200 people gathered around my little table.
The waiting room is full and all the chairs are taken - here's a rock that looks mighty comfy... These people walked from many miles away.
Chelsea Dolan is crowd control indoors in the line to the pharmacy.
Filling prescriptions. The girl in the middle between Chelsea and Susan is the daughter of one of the local doctors and she was an invaluable help! Only 10 years old, but with great English speaking skills, she interpreted tirelessly for two days and helped our pharmacist people fill medications. We all fell in love with her and want to bring her home with us, but she is much loved by her parents and we have to leave her here! She called us all "auntie" as a sign of respect. (except Chelsea - she was "sister" - I guess she was too young to be "auntie"!)
And the crowd grows!
The OR at the beginning of the day. Note the open doors on the other side of the table and all the supplies that we brought from America are in bins on the floor - all of you who know sterile technique can cringe - we did!

At the end of the week we have seen approx 987 patients in four days - 547 of those on Friday alone! Hard to believe, huh? But with God's help we REALLY did see that many patients. We lost count of the surgeries we performed, but hopefully we are leaving this area with many people some better for our having been here.

A Surgical Commentary

Sri Lanka
WARNING: The graphic nature of some of the photographs may not be comfortable for some viewers - enter at your own risk! (it is interesting though if you can stomach it!)

Another wonderful day at the makeshift hospital. We are absolutely amazed at all the people! This gentleman came in with a mass on his face. He was very uncomfortable and complained of the mass obstructing his vision. He told us he had had it since he was eight years old and had had it drained once but "no answer" - which is Tamil-speak for "the treatment I got didn't work"!

Dr. Harper bravely set out to remove whatever the thing was! Once she got the thing open it quickly became apparent it was a sebaceous syst. The thing drained about 10 ml (2 tsp.) of oil! Once the cyst was collapsed, she set out to remove to cyst wall to prevent it from refilling - don't want him going to someone else and saying "no answer" for OUR treatment! Here you can see how deep this thing goes!
This shows one of the ways we "creatively" used the equipment we had at hand. Dr. Harper got the bright idea to use an angiocath (the thin, flexible tubing that stays in the arm with and IV) on the end of a syringe as a suction device. This worked in many ways over the days. We also used the same set-up for flushing ears and etc.
I love this photo! You can see how challenging our set-up was at times. Yes, that is the yard over our shoulders. The lighting in the room we had as an OR was not always adequate so they just opened up the glass wall and let the breeze blow in! We were blessed with excellent weather and cool breezes so that was nice - the sterility? Not so much! But we prayed hard and covered everybody with antibiotics and will continue praying for no infection to set in. All-in-all I think with God's help we made a big difference in a few lives.A view of the man's face after surgery is complete. This looks a bit worse than it actually was because we smeared antibiotic ointment liberally once the stitches were in! But he can see un-obstructed now, Praise the Lord!
We had no electro-cautery equipment (we didn' always have electricity!) so when bleeding became an issue, we used the old fashioned "let-the-nurse-hold-pressure-for-five-minutes" method! It worked though - the bleeding stopped and he was ready to go! Gotta tell ya', I was praying hard though and even asked Chuck Watson who was our medical photographer to come over and help me pray! I wasn't as confident as Dr. Andrea that this method would work!
Here is a view of our OR from the yard looking in. David George (aka. King David) is our interpreter for the OR and he is standing on Dr. Andrea's left. My hair style for the day? Unavailable to critters - I didn't care what it looked like - just as long as I didn't have any passengers to bring home!Okay, so his vision is still a bit obstructed, but that will come off in a day or so and he will be able to see better than he has since he was eight! How great is our God!

Friday, August 15, 2008

Clinic at the Center

WARNING: There are mildly graphic photos in this post. Read at your own risk...


We are holding clinic at the NCM Center today (the same place we are sleeping and eating). It is a wonderful facility and we are thrilled to be here. We have paused for lunch and I wanted to share a miracle!

This morning has been a zoo! We got our clinic all set up and set up: a triage, a dispensary, and a treatment/surgery room. The people started coming...and coming...and coming! You can't imagine how many people are crowded onto the porch of the Center! We decided we needed to set up a screen to show the Jesus Film on while people were waiting. The screen was too sheer for it to show up in the daytime though. We decided the black blankets on the beds were a perfect fix. I grabbed some of the handy-dandy suture kits from the surgery room and started stitching! The pastors at the center thought this was just great! Here you see Pastor Jude holding the screen up for me to sew - they laughed the whole time! It worked though!
And the people kept coming... Dr. Andrea decided we should send me outside to run a cursory triage and separate the really ill from the curious. You can see ALL the people crowded onto the porch...

Then we got an interesting case. A gentleman walked up to me and complained of localized chest pain. He said he had received an injury a year ago from a "soccer boot" that he got kicked with while playing soccer. He was very uncomfortable and there was a slight swollen place on his chest. I called Dr. Andrea and the three of us headed into the surgery.

Dr. Andrea deadened the area with Lidocaine and then opened the skin over the mass. She dug around a bit and was a bit perplexed - there was inflammatory tissue, but she couldn't seem to see anything else. Then she found it - she thought she had a bone spur that had developed on his bone as a result of the trauma. She was doing one last bit of poking around explaining to the man through Sugun (our interpreter) that he would need to go to a hospital to have his injury repaired. She pushed on the mass and he winced - in terrible pain. Then she moved just a bit and we saw something interesting start to peek out of the wound - it was a hard mass! It just came popping out - apparently on it's own, but we all know God touched the thing! She laid it on the gauze I was holding and then pressed on the spot where all the pain had been... his pain was TOTALLY gone! We all got tears and goosebumps! Here you can see the tumor that was removed.

And here is a photo of the patient with his surgical team...

Well, our lunch break is over and the droves are outside waiting on medical care so I must go and help. Our patient count is now at 208 for the morning and we are still going...

Wednesday, August 13, 2008

The Vomit Comet

Bright and early this morning we stumbled from our warm beds and headed down to a hearty bowl of oatmeal. I don't typically like oatmeal, but I gagged it down because I knew we might not get lunch for a long time. I was right. Don't we look nice and chipper?

We headed out the front door of the Center and got in a mini van. This thing was normally a 7 passenger van - we stuffed 12 people in that thing! We were told we would be going approximately 30 miles to a Dispensary to hold clinic. The roads were so twisty we were breathin our own exhaust - and I am NOT kidding!! Amy nicknamed the van "The Vomit Comet" - and she was right. Two of the local pastors came along to the clinic to act as interpreters. The driver was a local fellow - not from the church - and he was a great driver, but it was still a very harrowing road. Yesterday on the road from Colombo, there were two drivers along - one to actually drive and a second riding shotgun to get out and negotiate with other drivers when we met one on the road. There are many times the road is a very narrow one land and they think nothing of two or even three cars squeezing through! We have learned to NOT look out the front window - it is just better for our nerves and coronary system.
We arrived at our destination and were ushered into a very aged building. The floors were cracked concrete with dirt showing through in many places. There appears to be electricity in one room but not in the others. No running water is available. We went into one room and met the physician who typically runs the office. He watched Andrea Harper triage one patient and she was doing surgery on an abcessed leg within about 5 minutes - at that point he decided we could handle things and he left!
This is what the waiting room looks like within half an hour. People came from everywhere! Maladies real and imagined were presented. We did one other surgery and saw around 75 people total.
This is a crude triage area we set up in the outer room. I found one very suspicious-looking ear using my handy-dandy otoscope. Sure enough, there was a critter in there that Dr. Andrea had to extract!

We are tired and headed home but feel very good that we have helped a few people. Thanks so much for all your prayers!

More of Sri Lanka

The medical team in the Houston airport before departure. Amy Thomas (in the middle), Andrea Harper (on the right) and me!

On the way across the country to get to the Nazarene Compassionate Ministries Center, we stopped at an eating establishment which was on the site where the movie "The Bridge on the River Kwai" was filmed. I have never seen the movie, but it was certainly a beautiful corner of the world.
The road leading from the airport was very rough, twisty and windey! We drove approx 75 miles and it took us four and a half hours! I had always thought the roads in Arkansas where my parents lived were bad, however they aren't even close! When we arrived at the Center, the bus that had been hired to transport us and all our luggage and equipment could not make it up the hill to the Center so we were forced to walk up! This is the bus stalled out at the bottom of the hill.
Pastor Scott, Ted Diehr and John Rezac enjoy a pizza at the Dubai Airport. For some strange reason they served ketchup with it!

The man with the cast-iron stomach! Pastor Scott chose to eat curry for lunch and it was incredibly HOT!! I thought I could eat spicy (after all the Cajun food I grew up on) but this stuff was just unbelievable!

Tuesday, August 12, 2008

Sri Lanka

We are finally here in Sri Lanka. We started on Sunday afternoon for the airport (around 3 PM). There were some hairy moments upon loading the aircraft and they delayed us for nearly two hours as they informed some people that they were not going to be allowed to fly on that flight. I have no idea what the situation was, but the men they pulled off looked like they could have been potential terrorists - I am just glad they weren't allowed on. Take as long as you need to screen every passenger, just don't let us get hijacked!!

Fifteen hours later our plane landed in Dubai. We had an 8 hour lay-over so decided to go shopping in a nearby mall. It was around 9 PM there and we were just sure we could find somebody willing to help american tourists part with some dollars. We stepped outside the airport and folks, the weater was hotter than an August day in Houston! At least in Houston it cools down below 90 at night - this did not! The heat was unbearable and SO humid, it was actually difficult to suck it into your lungs. We pretty much turned around and walked back in the airport to read, play games and watch TV for the next 8 hours.

We landed in Colombo with no problems. There was a bit of a hiccup when they wanted to search Ted Diehr's case that held the generator for the projector of the Jesus Film equipment. It took about 45 minutes, but they finally did let him through - with ALL our equipment! Thank you for all your prayers about this - it really did go smoothly and quickly.

I am fading fast tonight so I will start telling you about the bus as soon as I have a minute and a phone connection. Love to all for now.