Highlights and Lowlights from Monte Plata 2019


Highlights and Lowlights from Monte Plata 2019

Changes
This was a good year.  It was also a different year.  This year our team went to Monte Plata as we had done before in January of 2019 but this year we planned and did our project as a one week project.  Now on the surface, it would seem as if that is not a really big deal. We still had to recruit, supply and to execute in the same manner.  It seemed that recruiting went easier in asking people to commit for only one week.  In the past the commitment has been one with options.  They could come for two weeks, one week or part of both.  It made it difficult for me because of having to make sure we had the people in the critical positions covered for the whole time.  For example, if all of the anesthesia personnel wanted the first week then the surgeons on the seconds week couldn’t have as many tables to work.  If all surgeons wanted the second week then the anesthesia from the first week had no cases to do.  In most years, I don’t have the team completed until December with sometimes filling in the last slot in early January.  This year with only one week to choose from, we filled the team to capacity in late September.  There is a capacity for the camp where we stay and we filled that number and with the right mix of participants in the critical slots.
For the most part the supply side is a little easier except for the medications.  We collect disposable supplies year round and sterilize them in October prior to the trip.  I estimate how many cases we may do based on prior years experience and on the personnel that we have signed up.  So 1 or 2 weeks just requires different estimations and then collecting the supplies.  God provides all the time, but we sometimes have to work harder.  We must order medications for the clinic and medications for anesthesia in advance, so the estimates differ in amount depending on numbers that we estimate. 
This year we had 42 participants with us and each was able to take a 27 gallon plastic tub with supplies.  Since the airlines limits the weight to 50 pounds for each tub (or suitcase), that gave us a capacity of 2,100 pounds of supplies.  Realistically we probably had around 1600 pounds when we were all packed.
There was a concern with changing to one week we would be sacrificing the reach of the project.  As it turned out we did as many surgeries as last year in two weeks.  This was by having 3 OR tables running for the 5 days of the week instead of 2 tables for 8 days.  The clinic was clearly busier each day of the week with more patients seen daily but only going to 5 locations instead of the 8 last year. 
There was a more concerted effort on the ground in the DR prior to our arrival to advertise and spread the word of our coming this year with radio ads as well as the truck with a loud speaker going thru the towns to announce our arrival. (I’m fairly sure that technique would not go over well here in the States announcing the arrival of a new doctor in town.)  We chose the towns to visit based on last year’s turn out so as to maximize our impact and, it seemed to work.
The Team
We returned to the same “camp” for housing.  We have stayed in a compound that is surrounded by an 8 foot cinder wall.  It contains the Eva Russell School that was built by the local church who sponsors us in the town. 
It was almost new when we first started coming to Monte Plata in 2003.  It has changed over the years with a few new buildings and expansions and growth of the plants and trees.  One of the upgrades this year was converting two of the shower bathrooms downstairs near the classrooms to bathrooms with multiple stools.  That is great for the kids but for our team of 42 it was a little problem especially when one of the remaining 4 showers broke (think gushing water and broken pipes).  That left 2 baths and showers upstairs for the 26 girls and 1 shower and 2 baths downstairs for the 16 guys.  Not quite the standards for a 4 star resort.
We had 13 first timers with us this year and our returning participants had logged 1 -19 previous trips besides myself.  They came from South Dakota, Des Moines Iowa, Chattanooga Tennessee, Kansas City, Jackson and Jefferson City Missouri.  The remainder of the group came from Wichita, Winfield and Arlington Kansas.  It is always interesting to hear the stories of the group when we begin to get to know each other.  Everyone comes for different reason and at different seasons of their life.   We had participants born in the 40’s, 50’s, 60’s 70’s 80’s and 90’s. 
We also had 2 young people born in the 2000’s.  But even with the age range differences, we all enjoyed each other and learned from each other.

Medical and Dental Clinic
We have been blessed with a stable crew of providers to staff our clinic over the years and it paid dividends this year with the shortened schedule.  Our first clinic day was for the people of Monte Plata.  We stayed in the camp since it was a holiday for the school.  It helps to allow the clinic team to do their first day in the camp to develop processes and procedures that allow them to then take the show on the road so to speak.  They then traveled to El Cacique, Don Juan Chirino and Kilometer 12 to provide clinic services to the rural areas surrounding the Monte Plata area.  Our total patients seen between clinic, eye, dental and surgery were actually 10 more that seen in the previous year on a 2 week project.  Our three pharmacists (a rare bonus to have three) were able to dispense 2439 prescriptions to those we saw.
Their cases always seem to have something new and different every year.  This year a man walked into the clinic with a leg wound that had been present for months.  When he pulled his pants leg up we saw a lower leg with no skin left in place and a non healing wound.  It the US the only option for him would be an amputation since the wound could not heal without months of intensive therapy and possibly skin grafting.  We were left but to clean up the wound and dress it properly.  We frequently take for granted the facilities and technology we have in the states.  Most were seen and given prescriptions for their most acute need along with vitamins and parasite treatments.  Some were referred to the hospital clinic for us to see and some had surgery that week others that were referred were then sent to the capital if we were unable to care for them in our surgery clinic.
Our dentist worked under very primitive conditions and was able to provide a full range of dental services to 109 patients.  Everything from cleaning, to filling to sealants and extractions were done in a portable chair in our open are clinic with a gasoline generator to power the dental equipment.  Eye exams were done on 315 patients and 157 of them received glasses.


Surgical Services
We continue to work with our colleagues in the Hospital Provincial de Monte Plata.  Some of the staff there has been in Monte Plata since before we came and it is always great to see them and be greeted by the enthusiasm of the patients.  Each morning as we arrived to the large lobby area we were greeted by applause from the patients.  We then would sing “Alabare” and start our day with a corporate prayer.  The hospital works hard to improve the health of the people in Monte Plata and has initiated a campaign to encourage all their staff to reach out to the patients and ask “How may I help you”.  They had buttons made for each of our team and presented them to us with our name on the button to make us feel at home and part of them. 
With our team consolidated to one week, we were able to have three operating tables work at the same time.  It did present some problems from a space standpoint.  Last year with two tables in one OR and one preop room and one post op room we were all close by each other.  This year with more volume we needed two post op and two preop rooms.  That meant that we were spread over a larger area on the second floor of the hospital.  The hospital normally doesn’t use the second floor for patients, just surgery and labor and delivery with the nursery.  We had to use walkie talkies to be able to communicate between rooms and to staff to keep the flow of patients.
Most of our patient has their surgery done as an outpatient going home the same day.   The larger surgeries like gall bladder surgery or hysterectomies stay overnight and go home the next morning. 
That means that we have to transfer the patients to the service of the hospital for overnight care.  The hospital medical director has worked with us at least 3-4 years and she assumes the care during the night.  We return the next morning and see the patients and dismiss them.  The hospital does have an elevator but it broke twice while we were there.  Once while trying to bring the heavy anesthesia machines up to the OR.  The second time was late in the day on Wednesday.  We were all tired and the last patient was ready to go downstairs to her bed.  All of the staff was done except for post op crew.  They were the last finished most days due to the nature of their area.  As they were waiting for the elevator it broke (think trapped between floors).  The prior time with the machines and two of our transport crew a short wait was endured before the hospital opened the door with the key to the elevator.  This time after waiting and trying to figure out what to do with our patient (do we carry her down the winding stairs?) the hospital maintenance staff arrived.  They went on the roof and did something and returned to the second floor and opened the outer door with the key and yelled up the shaft in Spanish “lower, lower, lower” until the elevator was visible and the inner door was opened.  They then motioned for us to push the cart and patient onto the elevator.  After a short delay of people looking at each other, we pushed the cart and patient into the elevator.  (Did I mention that there was not one of those stickers in the elevator telling when it was last certified?)  The maintenance person then closed the outer door and ran down the stairs to the bottom and opened the outer door with the magic key and yelled again in Spanish “lower, lower, lower” until the elevator appeared slowly from above.  Then, he yelled “stop, stop”.  We pictured someone on the room lowering the rope attached to the elevator hand over hand until it was in just the right position with beads of sweat on his forehead.  He then opened the inner door to the huge smiles of the staff that pushed the cart out and down the hall as if nothing happened.
I am occasionally asked what kind of cases you not want do while you are there.  This year I tracked the cases and found them to fall in 5 categories.  The first has to do with coexisting illnesses that make surgery too risky.  While it might not be too risky here in the States, in the DR on project we just don’t have the back up in either technology or personnel.  This would be like patients with uncontrolled high blood pressure or blood sugars.  The second category is for conditions that are too complex.  Cases of obvious cancers that are extensive can’t be adequately staged or treated there in a Provincial Hospital.  I saw a 19 year old with a large mass under his chin that pushed his tongue up.  We don’t have CT scans or many diagnostic studies to define the problem.  The third group involves patients that have conditions that require specialist in areas that are not present on our team.  We had many patients that desired surgery for urologic conditions and we didn’t have a urologist with us, nor the equipment that they use.  One of the broadest groups is for patients that we can’t operate on are those that have pain that is not related to a surgical problem.  When patients know we are coming they show up with symptoms but don’t know if surgery will help their condition but rely on us to tell them if we can help.  Frequently those patients are relieved and reassured that they don’t need surgery.  We had advertised that we would take care of hernias.  One patient came in to have his hernia fixed but it was a herniated disc in his back that he had and it’s not something that we could or should do surgery.
One patient that we saw was an American who was in the DR with another ministry drilling water wells for the villages.  He fell off a ladder and landed on his arm.  It caused quite an abrasion.  After 4 days the pain and swelling had not gone down.  He saw one member of our group at a local ice cream shop one evening and was excited to see American doctors. 
He came to the surgery clinic the next day and we were able to get an x-ray of his arm to find no fracture.  Our clinic provided the antibiotic and wound care he needed to get him thru his project and returned to Michigan for follow up. 
The last category of people who don’t get surgery are those who have conditions where surgery is contraindicated such as for keloid scars.  These can be unsightly but the repair is almost always associated with re-occurrences of the scars that are worse than the first.  We strive to above all do no harm with our surgeries.
An unusual case this year was a young man who was in a motorcycle accident that resulted in him being thrown from the cycle and fracturing his femur and tibia. 
The femur was repaired with a plate place in surgery and a device called an external fixator for the tibia fracture.  That in and of itself was not unusual but it happened 3 years ago and the fixator is usually removed after 6-8 weeks of healing.  For some unknown reason (think financial) he was sent home with the tools to remove the fixator but the patient never followed up with anyone.  He saw one of our translators a month ago and when he heard we were coming he asked if we could help.  Pictures of the leg and device were sent to me over WhatsApp and I showed it to our surgeons who showed it to orthopedics surgeons. 
They said we could and should remove the hardware as the risk of osteomyelitis (bone infection) was very high as long as it stayed in place.  We took some special instruments from the States with us and saw the young man and said we could help.  He was ecstatic having been limited in his activities for over 3 years from the device.  With sedation, a 7 minute procedure was done to remove the device and he went home all smiles, well mostly smiles.

  
We sometimes examine patients and end up referring the patient to specialists in the Capital city.  Some follow up and go; others don’t for a number of reasons.






Progress

Sometimes it seems as if nothing changes.  It almost was like stepping into a time chamber for us and we return and seem to pick up where we were last year.  This year a couple of things changed.  The ministry works largely because of the permanent staff in the Dominican Republic.  They do all the leg work to make sure we can do what we do with the government blessings.  They also maintain all the hard assets necessary for doing the short term projects.  That includes trucks, buses, cars as well as all the OR tables, lights anesthesia machines and supplies that we bring in excess of need.  Several projects are unable to bring anything with them and the extras are what they run their project with.  This year I was pleased to be able to tour the newly constructed warehouse.  It was made of 3 shipping containers in a “U” shape with a metal 2 story building over the top. 
It is in a secure area with some land around it.  It is quite an improvement for the ministry and the staff to have.
The second area was in personal growth and development of the staff.  One of the interpreters that I have worked with for 10 years will begin the final year of medical school in the DR in March along with a second person a year later.  Another supply manager last year has left the ministry to start his own foundation in Sabana Grande de Boya to help the youth of his home town.  It is so easy to get excited and want to come back to a place where there is such a giving and caring environment.


Conclusion
I think that the point is that there is not a conclusion to helping others.  The need continues and by addressing that need we all can find meaning in our lives.  So while we may know we are home by being reminded with the blistering cold winds and snow, we know we will step back in time to the DR in a few months to the warmth of not only the weather but the friendships we have made and cherish.

Monte Plata Journal 2018


What follows are the contents of my journal for our most recent mission project to the Dominican Republic to the city of Monte Plata.  For the most part it is the summary of my thoughts.  My habit is to write early in the morning when my mind is clearest, although that is not always the case.  Sometimes nothing profound happens but I try to look for the events that happen during the mist of my day and hopefully learn from them.

January 21, 2018 Sunday morning
This morning we delayed breakfast till 8 am!!  That is a rare luxury here.  I still woke around 5:15 and stayed in bed just listening to the gentle roar of a hundred roosters.  I got up a 6 and took my shower and the electricity went out at 6:15.  That makes it very dark and very still.  That was a quick reminder that we are not in Kansas anymore and to carry a flashlight wherever we go.  The lights were back on within 30 minutes, which is longer than it usually takes for the generator to kick on. 

The 30 of us arrived without too much problem.  We had 25 from Wichita to Atlanta and 2 joined us from Des Moines.  Three hours later the last 3 from Grand Rapids came.  One more tonight will complete our Monday crew.  I say it that way because 2 more join us Wed. afternoon then 3 more next Sunday.  We will have 7 leave on next Saturday and 3 on Sunday.  Then the following Saturday the remaining 24 of us will leave. (Yes, I know, we will have two leave next Thursday).  That is a lot of trips to the airport for our crew.  It is fortunate that the project site is so close to the airport (90 minutes).  When we arrive the first order of business is to claim our sleeping accommodations for the project.

Logistics are a huge part of this project.  The behind the scene activity is large.  All those coming and goings affect the cooking crew as well.  They must plan and feed that constantly varying number.  They will arise every morning at 4:30 to begin to prepare for our meals.
Today is all about preparation.  We will spend the day in orientation and team building.  All our supplies must be sorted and the staging will begin for the clinic.  The surgery team will go to the hospital and do the massive job of set up.  Once we arrive we will be told what rooms we can “have”.  We will have one OR, one room for pre op, one for post op, one for central supply and one or 2 storage rooms all on the second floor.  Downstairs we will get one or two consultation rooms although they usually change daily as others sometimes need to use the rooms.  We will remove most of all of their equipment and supplies from the rooms and then replace it with all of our equipment and supplies.  Some is brought from the MMI warehouse in Santo Domingo (the OR tables, anesthesia machines, Cautery machines, lights and sterilizers) but also the disposable supplies we packed and brought from Wichita (27 tubs and boxes of supplies, medication and equipment).  We should be able to set up so that tomorrow morning, we will be ready to start by 10-11 am.  The clinic will go to Otaña tomorrow to do their primary care clinic along with the dental and vision clinic.




January 22, 2018, Monday morning
So much for my infallible internal alarm clock.  I slept longer that I had intended and didn’t get up in time to shower before breakfast.  I just need some quite time each day to organize my thoughts and without that I seem to scramble more.  Yesterday was quite a challenge for both teams.  Sometimes it seems as if a not so gentle reminder must be given to us from America on these trips.  The reminder is as if God says “you are not in control, I am”.   It is amazing how God can be gentle and stern at the same time. 


After we had finished preparing the hospital Sunday afternoon, we met our new Dominican anesthesiologist.  I thought that she would be there earlier to set her stuff up, but she didn’t so we realized that we would still have a lot to do Monday am.  We saw 27 surgery consults which is ok, but not too many in the afternoon. We scheduled 9 cases for the 2 OR tables total for the day.  It should be a reasonable number for the first day.  We were told to expect low numbers for the first day because of the National Holiday, Dia de Altagracia, the Day of Altagracia, the patron saint for the DR. When we arrived to the hospital, there was a crowd of people that knew we were coming.  The hospital waiting room on weekends is usually quiet.  We all filed in with our backpacks and supplies and we were announced to the people by one of our Dominican health educators.  To our surprise they all stood and started applauding us.  That was quite humbling and not something we are used to seeing in the United States.  And this was prior to doing anything for them other that coming to help if we could.  Several of our participants had more than one tear in their eyes.
We were able to begin to establish a routine today.  Out breakfast is served at 6:30 each morning and the menu varied daily.  At 7 am we have a short devotional presented by one of the participants and then we try to leave by 7:30 to 8 for the hospital and the medical clinic.  Most of the participants on the surgery team will walk the one mile thru town to the hospital each morning and back in the evening if we finish early enough.  In the evening, we try to serve dinner at 6:30 and that is followed by a report from the hospital and medical clinic and a brief wrap up of our days to keep both teams together in spirit.  Later in the evening there will usually be some kind of group activity. 
In the late afternoon in town there were parades and fireworks to celebrate that continued late into the night.  That added fireworks to the music, roosters and barking dogs to the things that keep us up the first night.

Tuesday 5:15 am
Yesterday on Monday, the clinic went to Otaña which is a very small village about 15-30 minutes from camp.  Their numbers were down as last year they saw over a hundred.  This year 60 patients were seen.  It gave them a chance to build their team and develop their processes.  Quite a few patients received dental care and vision screening.
Our American anesthesiologist was to arrive at midnight to the airport and then get in to the camp around 2 am.  He texted me around 9:30 pm that he had just missed his connection in NYC so he would get the next flight in the morning.  So we decided to finish getting ready which occurred quickly in the morning and allowed us to start around 10:30.  The team worked well with a mix of new and experienced participants.  I received another text around 9:30 am saying that our anesthesiologist was on the plane in Atlanta and would be here by 1:30 pm.  So the team began our surgery day with a child with a hernia.  We worked out the logistical bugs as we went along.  I went to the clinic downstairs and began seeing patients.  The numbers were down, with only seeing 27 patients but that was probably due to the holidays.  The Dominicans don’t do too much on their national holidays except celebrate.
We slowly continued thru the surgery schedule which was set up for 2 tables but with just one anesthesia provider we had to have her switch between the tables.  My next text from him was to let me know he was in Customs and that they had confiscated his medication and bags.  Since he didn’t speak Spanish, he was delayed over an hour.  He was able to finally get all his stuff back.  There are certainly benefits to all arriving at once with papers from Customs and the Health Ministry to explain all our supplies.  He finally got outside and was picked up by the MMI van.  I thought we were over the hump and he would be there soon to help us finish the day.  That was until he texted to tell me the van had a blow out in the parking lot of the airport and they couldn’t get the lug nuts off to change the tire.  By the time he got to the hospital we were doing the last general case and after recovering the last patient and transferring them to the floor for overnight care, it was 7:15 pm.  Pretty long day for us but it was productive.  It will help to keep us flexible for the coming two weeks so that we can remember who is in charge and who gets the glory for our work. 

Wednesday morning
I enjoy the quiet of the morning with fresh Dominican coffee and a time to write and reflect.  It was another restful night for me.  Some of the others are not as accustomed to the DR yet and will take a few days to get used to the environment.  You have to find places for your stuff so you can find it again.  It also takes time to get accustomed to the different climate and time zone.
Surgery went better with 2 anesthesia providers.  We had a couple of patients not show up so by the end of the day we we’re home around 5 which was about the same time as the clinic team.  I saw consults in the morning to see if they needed surgery and scheduled their dates for surgery.  Between the gynecologists cases he would see his gynecologic patients.  Taking a history thru an interpreter is difficult to make sure that you are getting the whole picture.  We had scheduled a patient for a hysterectomy for tomorrow when we found out the she was on a blood thinner that takes 7 days of being off the medicine to be able to safely operate.  So we cancelled her surgery and then found out she had been placed on the medicine for a stroke 6 months ago.  That made the surgery too much of a risk for the project by itself even without the blood thinner.  We almost missed this because we ask are you taking any medicine thru the interpreter and she responded no because she thought we meant “today”. She didn’t take any medicine today, just yesterday. 
Even though the hospital is only 4 years old, the air conditioning doesn’t work consistently.  That is an issue in the OR in gowns and under the intense lights.  The ceiling tiles were stained from water leaks and there were some big cracks in the walls.  Unfortunately, their abilities and finances up keep up the building are limited.
The clinic went to Don Juan yesterday and just like last year, when they arrived no one seemed to know that they were coming.  The church where they were supposed to set up was closed.  The medical clinic where they went last year when the church was closed couldn’t or wouldn’t let them us their facility.  The only place in the town available was an open air bar next to the cock fighting arena.  So they set up there and the people came to them.  It actually was a good location being open air was cooler that being cooped up in a building.
In the evening after dinner the group enjoyed a rousing game of “Heads UP” which is a modern version of charades.  The laughter and fun was infectious.  Our free time is mixed between just visiting, going into town for ice cream, cards and dominoes.  The team is bonding well and great friendships are being formed.  It is good for everyone to interject new participants with our veterans. We have 19 veterans with 1-26 prior projects and 12 first time participants this week.  Everyone is adjusting to the routine and the cultural changes well.  The food is always good and plentiful.

January 25, 2018 Thursday morning
Yesterday was very busy.  We haven’t had much rain but humidity remains high most of the time.  Flies have been bad but not much a problem with the mosquitoes.  The open air buildings make it easy for the flies to bother you all the time even in the OR.
We had 2 more participants join the team yesterday and our Dominican anesthesiologist left at the end of the day.  She was very nice and did a great job.  I was anxious about her but no problems were encountered and she fit in well with the team.  The clinic in the hospital was either crazy or slow.  There never seems to be a level pace.  We still have patients that we can’t care for or don’t actually need surgery, like the man who responded when we said we took care of patients with hernias.  On history and exam his hernia was actually a herniated disc in his back.  Still, he was not angry or upset.  He just said thanks and moved on with his CT scan. 
I got to help and do 3 or 4 surgeries today and get out of the clinic.  It was like I had never left the OR, except the air conditioner doesn’t work very well and the temp was around 80ish in the OR.  Most of the patients surgeries are uneventful but there are always things unknown or not translated.  One of our patients had some respiratory issues that we were able to treat successfully but still is a cause for pause and prayers.  The patients and their families are all so appreciative of what we have come to do.  The kids are especially cute when they are trying to be brave and the staff loves the interaction even the one who woke up from his circumcision operation and stated loudly “No me gusto los americanos”  which roughly translated means “I don’t like those Americans”.  We all had to snicker in understanding how he felt at that point in time. 
The medical clinic had an elderly lady who had an amputation and had to be carried in a plastic chair around the clinic.  The group began to collect funds for buying a wheelchair.  They were able to collect more than enough money within a day.  I can imagine how surprised she will be when the Dominican staff shows up next week with a wheelchair for her. 

The needs here are sometimes overwhelming.  The team went to an orphanage last night after supper.  They were impressed with the set up but were shocked by the youngest orphan who was only 8 days old.  The house was hot without fan or air conditioner.  The orphanage is sponsored by the same church and school that sponsors us here in Monte Plata. 
The children at our home church in Wichita participate in a program called Awana and they collected money as a mission gift to the Oansa program here at the school which is part of the same international group.  The director was very grateful and pleased as his organization has recently had some financial cuts and the donation will help to offset the shortfall.  It was obviously not expected or anticipated by them but was planned by our church without knowing there would be a need across the world.  Even with being presented with money, he wanted us to give it to the school director so that everything would be above board.  Even though we never considered that he wanted all to be above question. 
We got home from the hospital last night in time for dinner a little early that allowed us to go the orphanage and still have time for a quick trip into town to have ice cream.  It was a good day all in all.

Early Friday morning 26 January 2018
Another day in the DR.  It has not been hot but in the 80’s the whole time during the day.  Early in the morning, it drops in the low 70’s so a sheet and sometimes a fleece feels good in bed.  This is opposed to August and September when it never cools down and I sweat all night long.  We have had the usual midday and sometimes night time rain to replenish the humidity.  Yesterday our medical clinic had its busiest day as of yet.  Crowds were lined up in Chrino before they arrived and with the new APRN that came yesterday we were able to have 5 providers seeing patients.  They finished seeing 133 patients and filling 439 prescriptions by 4 o’clock. 

I was so pleased that the team was able to raise the funds to buy the elderly lady a wheelchair with funds and had more that they needed.  The excess will be shared with the Dominican staff at the end of the project along with gifts that we have brought from home.  It is amazing to see how quickly God can bring about answers to the needs of his children but at the same time how long had the lady been in need?  We never know how long God’s plans take to bring about His glory.
The surgery team was very busy yesterday.  Wednesday and Thursday is usually when we reach our stride as a team.  We had a few patients cancelled for hypertension but others that were added on to fill out our day with 15 surgeries today.  One of our nurses was walking by the labor room and ran into the room just in time to deliver a baby.  The staffing at the hospital is not the same as at US hospitals.  Another OB nurse with us got to watch a C Section.  She did note several significant differences from our procedures in the states.  Enough said.  All turned out well in both cases. 
New consults are slowing down as we get closer to filling the schedule.  There seems to be a lot of stopping and starting.  That allowed me to do some surgery and that was enjoyable.  It looks like we will be done on time for dinner tonight, but all can change quickly.  The medical students are enjoying themselves and gaining great experiences with front line medicine.  This is a great experience since most hospital and clinic rotations occur with groups of students and residents so the one on one interaction with experienced doctors is great for them.  As I mentioned yesterday, we also had a new CRNA join us and the Dominican anesthesiologist returned to her home in San Christobal.  That is one of the challenges of a project when there is turn over in staff.  We have to make sure that all are integrated and oriented as well as included.  The large number of experienced staff helps with the transition that occurs.  We have to be vigilant to make sure new participants are comfortable with our environment and not just assume that fact.  Friday night we will have 2 participants leave for the city and Saturday 4 more leave for the US.  Sunday 5 more leave and 3 participants arrive for the second week to help fill in for the leaving participants. That will give us 25 participants for the second week of the project.  That does make for some difficult staffing issues for the project.

Saturday afternoon
The medical clinic was very busy yesterday as was the surgery team.  Everyone was ready for some decompression time today.  Today was my day of rest.  We woke for breakfast at the usual time of 6:30.  Twenty two of our group boarded the big yellow school bus to head for the north coast and a day at the beach.  It is a 2-3 hour drive each way thru the rain forest, the mountains and the rice fields of the DR.  Six of our group will board the plane to head home today.  It was a sad time as the team began to change.  I say change because 5 more leave tomorrow and 3 arrive to begin the next week.  We have to be intentional to meld everyone into a new team and prevent cliques or others from feeling like outsiders. 
A mission project is very unique in team building because everyone is here voluntarily and all are truly anxious to help and serve.  Not everyone is of the same faith or even professes faith but everyone is united in the desire to help and in the spirit of cooperation.  We do several team building exercises prior to coming down with informational meetings, packing events and supply preparation.  That helps but it is not till everyone arrives that the bonding of all participants occurs.  Even though it has been a year and sometimes more since the participants were last here, the returning participants pick up with friends like it was only yesterday.  There is very little distinction between doctor, nurse, pharmacist and general helper.  Back in the states those barriers sometimes inhibit teamwork.  It is truly a unique environment down here.  Last evening we had a time of sharing so everyone could share thoughts and thanks with others prior to their leaving.  Those times also help with the team building process.

January 23, 2018 Sunday morning
We were able to sleep in a little today but have plans to go to a Dominican church at 9:30.  The events of the prior day were certainly noteworthy for some of us.  I stayed back in camp and didn’t go to the coast.  That enabled me to walk to the hospital and discharge the patients that stayed overnight with some of the participants who were leaving in the afternoon.  We had quite a bit of rain which made for nice sleeping weather in the afternoon.
There was an accident of sorts.  Fortunately, it turned out okay but one of our participants fell out of the boat while trying to walk the plank to the dock after they returned from the island.  They had spent the afternoon on the beach and the water was very rough both coming and going.  As the boat pitched, out participant was pitched into the water.  The only injury was to his pride (and his I Pad).  But it did make for a great story and subsequently he wrote a poem to commemorate the occasion. 

January 29, 2018 early Monday morning
The weekend was very good.  Everyone got to relax somewhat.  It rained intermittently but that really doesn’t slow things down for very long.  Even though heavy at times the ground soaks it up and doesn’t get muddy and mushy like at home when it rains (or when it used to rain).  People were sad to see their new friends’ leave that had bonded quickly in this environment but the new ones fit in well.  We were able to worship in a Dominican church yesterday.  We all walked to the church (about 10 blocks).  The service lasted an hour and a half and we didn’t have a translator but with 10-12 songs (some of which were recognizable) and prayers, offering and communion mixed in, it went by quickly. 
I announced today that a change in plans for the clinic had occurred and they would be able to visit the prison to bring health care services to the prisoners on Wednesday of this week.  I had some reservations, but the team didn’t.  In the past when we went to the prison, the experience was rewarding for the entire team.  As a leader your first concern is always for your participants.  It is of course scriptural (widows, orphans and prisoners are all lumped together frequently as those in need.)  We will have 2 full days and a half in the OR before packing up to leave.  Once we got started the time flies by us. 
Unfortunately, 2 of our group going home missed the connection in Atlanta and had to stay overnight there.  They will catch a flight into Wichita this morning at 9.  Such are the risks of international air travel these days.

Tuesday morning 30 January 2018
There is always some concern with new participants at the start of week two.  We have always had fewer participants for the second week and the patients seem to increase the longer we are here.  This year was no exception.  The medical clinic stayed in camp today because school was out for Dia de Duarte.  Juan Pablo Duarte was the patriarch of the DR in the mid 1800’s and his birthday is celebrated today and is similar to our Presidents’ Day.  This gives the team a chance to serve the local people of Monte Plata since the school was cancelled and we can use the camp for our clinic.  Not to disappoint, today was the largest volume of patients with the smallest number of participants.
In surgery we also had our biggest day in number of patients and surgeries.  Even though we were fewer we have become more efficient but God gets the credit.  I only saw a few patients in the clinic downstairs for Preop consultation since the schedule is largely full.  That was a good thing since we are down to just 2 surgeons including myself.  I was able to do an umbilical hernia, a bilateral inguinal hernia, 2 tubal ligations, and a hydrocele surgery and remove 2 lipomas.  The other doc was likewise very busy but we were able to finish the surgery and be back at camp by 5 pm. 
We have a great multi-generational mix in our team and all have interacted and worked and played well.  Our ages ranged from 77 to 13 in our 36 member team with a good mix of 20 year old and as well as 30 year old participants.  It is great to see young people catching the vision for world missions.  We’ve played charades, UNO, dominoes, and cards as well as walking into town together to get ice cream.  It appears that everyone has been able to work hard and yet relax and enjoy sharing the experiences with others.  I think that the multi generational mix as well as the mix of faiths is an integral part of the success of the project.  That success is not only in relation to the patients we serve but also in personal growth and development no matter where we stand or started from spiritually.  Having our pastor from home on the trip has been great.  He has worked as hard as anyone helping in Central Supply but also has had a good listening ear and heart for the team.  Life is complicated and complex and is it good to have someone skilled at listening even for the team.  A new day will start soon and it should be another busy one.  I am sure our team will be up for it.

Wednesday 31 January 2018 morning
Well, we weren’t disappointed by the day on Tuesday.  It was the busiest day yet in surgery and the medical clinic had one of its busiest days.  In surgery we only had one patient not show up for surgery.  It was a 14 year old boy who had a small hernia that was not causing him any pain.  My guess is that 14 year old boys are not any different in the DR that in the US.  He probably refused.  We had several patients return for us to check their incisions or for more ibuprofen for discomfort.  That is generally all we give other than maybe 3 or 4 doses of a narcotic even for gall bladder and hysterectomy surgery patients.  Their pain management is easier that in the states since most of the patients have never taken any narcotic medicines and rarely take anything, even Tylenol.  One patient brought gifts for her doctor including a coffee mug and bracelet to say thanks for the surgery.  One of the patients that had open gall bladder surgery was discharged to home from the recovery room when in the states would have been in the hospital 2 or 3 days at the least.  He went home with those same ibuprofen tablets. 
The medical clinic is scheduled to go to the prison today here in town to provide care to the prisoners.  There isn’t a prison health or dental service so many will want to be seen.  When we went there last time the prisoners were told that they would have to give up one of their monthly family visits for the privilege of seeing the provider.  It was very rewarding for the team in the past and I’m praying for a similar experience.
There wasn’t much activity in the camp last night.  The dining hall is where we eat and meet and visit and play games.  It is a large open room with tile and louvered windows next to the kitchen.  It can get very noisy especially with the laughter and loud dominoes that the Dominicans play.  It is refreshing to see the interactions of the participants and Dominicans in the evening.  Even though it was quiet there were people all around comparing pictures and air dropping them to each other even without Wi-Fi access in the camp.
Today will be a slower day as far as volume is concerned since we have to break down and pack up all the stuff in surgery to load it on the truck at the end of our day.  We have scheduled light to be able to do that.  It shouldn’t take as much time to load as it did to set up.  There are always a few patients that show up on the last day wanting surgery but didn’t get around to coming by till the last day.  It is sad to turn them away but we can never see everyone and do all that could be done, but there is next year.

February 1, 2018 Thursday morning
We all are sitting here drinking our coffee waiting for breakfast this morning.  Breakfast was set for 8 this morning instead of the usual 6:30 but my internal clock woke me at the usual 5 am.  Today is the day we break camp and drive to the old Colonial Zone for the beginning of 2 days of sightseeing and relaxation before return home.
Yesterday the medical clinic at the prison saw 101 patients. It was a rewarding experience as we had hoped.  Almost 40% of the patients seen were guards rather that prisoners underscoring the need for primary care services in the community.  Dental and eye care services were much appreciated as well.  We had scheduled light in surgery since we were leaving today and didn’t want patients to have to stay overnight after we had gone.  We also had to break down and pack and load all our OR supplies (I am using the “we” very liberally).  We finished all the surgeries by noon and stopped to eat lunch (our usual peanut butter and jelly or ham and cheese on a hot dog bun) and then went as a team downstairs so that the hospital administration staff could present us a plaque and we could present them with one also.  They were appreciative of all that we do for Monte Plata and we were humbled by their praise.  All the left over supplies from our project and the stock from MMI will be taken back to Santo Domingo to be organized and readied for the next project in the north of the island in one week. 
Last evening, we had a kind of debrief or after action report like the military does.  It gives the people a chance to articulate and begin to process their thoughts and feeling after being surrounded by such poverty but at the same time such joy and love.  We had a chance to give gifts as a team to our Dominican host and staff.  Most just work by the day for MMI so our gifts and monies we collect to give them are very much appreciated.  It is interesting to see the point of realization that the participant understands that while they came to help others, frequently they are the ones touched and helped.  The participants leave being impacted and their hearts touched by a simple fact that touching others sometimes touches us.

Saturday afternoon, mid-flight to Atlanta from Santo Domingo
I came down with a cold (not the flu) during the day on Thursday so I took Dayquil and Nyquil continuously for 48 hours and slept at every occasion.  The days of vacation in the Colonial Zone and in the resort in Juan Dolio were largely missed by me but by this morning I was back to baseline for our travels home.  This marked the first year in the last 7 or 8 years that I have not been taken out of line at the airport while waiting to board the plane to identify my bags.  Each year I generally bring back 40 pounds of Dominican coffee.  It always looks suspicious on X-Ray so I have to open my tub and show it to them.  I only brought back 20 pounds this year so maybe that is the secret to not getting stopped and questioned.  We were down to 23 at the airport today with 22 of us going to Atlanta.  Two will then leave for Des Moines and we will proceed with 20 back to Wichita.
A great project by all accounts.  The team meshed together well and had no drama or problems.  The mood was joyful and there was not illness other than a few colds.  All were already talking about next year.  Yesterday, I found out that the cash gift that we gave to our Dominican host was not equally divided among them as we had expected.  While at the prison on Wednesday they saw a friend of mine and theirs.  Dr Julio Gomez is a Dominican Ob/Gyn and a pastor in his local church.  I have known him for almost 18 years and he has helped in surgery in many of our previous projects.  He was at his home in the capital one evening and a man broke into his home and shot his nephew and threatened his daughter.  Julio defended himself and as the man ran away Julio’s house, the neighbors caught him and beat him up.  He was taken to the hospital and later died.  Julio was then placed in jail, since the man died.  He has been there over 8 months still awaiting trial as is his nephew.  The Dominican staff instead of taking the money themselves choose to give it to Julio to help pay for an attorney.  American justice system may have some problems, but not in comparison to the rest of the world.
 
You can see why we have such a high rate of return participants.  When they get to know the Dominican people, it is hard to forget them.  They are such a loving and grateful people in such a beautiful country.  We all like to get back home to our families and friends, but each time a part of our heart stays there, till next year. The plans will start soon for the next trip…

Worst Beach Day by Steve Trembley



Everything started out pretty well. We had some time to spare.
I sat next to Selena. We always share a chair.
The wind came through the bus windows, along with morning smells,
Of diesel fumes, and sewer gas, and burning trash as well.

It is a bumpy 2 hour ride, the Road to Samana,
But it would be well worth it. The beach inspires awe.
There was a urinary emergency, a pit stop overdue.
This should have been a warning, but hilarity ensued.

We boarded a boat to the island, that didn’t look too safe.
The water was quite choppy, and rain fell on my face.
The beach was almost deserted, but later people came.
The sun appeared from time to time, but then down came the rain.

We huddled neath the shelters, while sand and breezes blew.
Very few went swimming. There wasn’t much to do.
The food itself was tolerable, if you like beans and rice,
And chicken and mystery seafood. I think I went back twice.

We left the island hurriedly, the waves weren’t quite as rough.
But no one wanted to stay there. Somehow we’d had enough.
When we docked to leave the boat, I sensed impending disaster.
The boat was rocking to and fro, and up and down much faster.

I climbed down from the upper deck. The boat began to pitch.
I grabbed at nothing in the air and fell just like a brick.
My backpack hit the water first. I followed close behind
And sank beneath the surface. Some thoughts raced through my mind.

What new dumb thing had I done? Would this be how I’d go?
How could I be so stupid? Have I hit a new low?

Someone cried “Man overboard!”, or something in Dominican.
There were not any ladders, or place to put my hands in.
Between the dock and rocking boat, I treaded frantically,
But nothing seemed to be working. I prayed “Please rescue me!”

So Garrett came to my rescue, and possibly saved my rear.
At least he saved my billfold, and more it would appear.
Someone threw a life rope, and dragged me up the side.
I almost lost my swimsuit, and therefore all my pride.

I sat there momentarily, unsure of what transpired.
I didn’t know that backpacks float, but hearing aids expire.
It wasn’t very pretty, I’m sure if you had seen it.
But it was pretty exciting, and I really, really mean it.

In the bigger picture, this wasn’t a big deal.
But at the time I wondered, if I’d had my last meal.
Melissa gave me comfort, on the way back home.
And I began to realize, that this could be a poem.

So if you think you don’t have friends, and you are sure you float,
Just throw your hands into the air, and fall off of a boat.
If someone comes to help you, grab hold his open hand.
You need to accept help at times, and God loves every man.

Everything’s dried out now, and I’m no worse for wear.
There is no lasting damage, but memories are there.
And bad days at the beach are rare, so here’s some food for thought:
No matter how bad the beach is; going to work it’s not.

And also remember these valuable tips:
As there’s many a slip twixt the cup and the lips,
There’s many a slip twixt the dock and the ship.

MMI Packing Event 2017

December 3, 2017

We had a great event yesterday here in Wichita putting together supplies to take to the Dominican Republic in less than 2 months.  We had 29 of our participants in attendance and another 9 came to help us assemble the tubs of supplies.  When all was said and done we had packed 38 tubs of supplies and had another 5 or 6 tubs of materials ready for next year.  We were able to finish in a little under 3 hours and everyone had a good time and got to know some of the people we will be traveling to the DR with us.
Keep us in your prayers for logistics, travel, safety, health and for the hearts and minds of the Dominicans we come to help.

Thanks














































Success in the DR

This year In the Dominican Republic I decided not to do a daily journal. Actually, I didn’t decide to not do a daily journal entry, I just didn’t do it. So it was not a conscious decision but by default. I was ask to do a devotion toward the end of the second week and I shared on a topic that comes up frequently for all of us as we return home from a mission trip.


Inevitably, as we return people will ask, “How was the trip, was it successful?” So in anticipation of that question, I began to think and ponder the trip and our time in the DR. I first sought the Webster’s definition of success because I knew that success had to be more than a money or business term. I found that success can be defined many ways but the first definition was: the favorable termination of endeavors or the accomplishment of one’s goals. I also look to the antonym or the opposite and found failure. Then I went to my Bible software favorite, You Version and searched for success. I found more references than I could ever look up and read that success is something separate from financial prosperity. 1 Samuel 16:14 says “In everything he did he had great success, because the Lord was with him” speaking of David. In Proverbs i8:18 it says “with me are riches and honor, prosperity and success.” So, success appears to be much more the monetary gains. So, I chose to look upon the success of the trip in light of the attainment of our goals.

If you are like me, you probably don’t spend a lot of you day setting daily, weekly or even monthly goals. But in regards to the mission trip each year, I do spend some time setting goal and planning for our trip. So I thought I’d share with you some of them and the results of our Monte Plata 2014 trip.

Goal One: Glorify God

This one is pretty basic in the life of a Christian. Everywhere we read in the Old and New Testament we are told over and over that our only job is to glorify God in all that we say and do. Everything is secondary. So, I can say that what we did in the DR was for the glory of God and we tried to be his witnesses and ambassadors to the people of the DR. Goal One – Success

Goal Two: Be Faithful to our Call

Well we did pretty well on this one too. God had selected just the right group of people to be here this year. Each of us felt a call, a tug on our heart or something that stimulated us to come on this particular trip. All of us showed up, paid our fees and worked hard the whole trip, knowing that we were appreciated by a people that would not have had the access to the type of health care we provide. Goal Two – Success

Goal Three: Travel Safety

Our travel down, while there and back, while not exactly as we planned in all cases (in case some of you forgot the harrowing bus trip thru the palms) was free of accidents and injuries. Goal Three - Success

Goal Four: Maintain Health of Participants

This year we all stayed relatively healthy, except for some minor ailments associated with cramming 40 close friends into a smaller space that we are used to be. But, by and large there were no big problems for all who came. Goal Four – Success

Goal Five: Metrics

Metrics are the score cards that are used not only to record what we did but also to communicate to the Dominican Government and MMI office what we were doing while there. I do a budgeting process early in the year before a project, to try to anticipate how many patients we will see and treat. The supplies and medications that we take are somewhat determined by what is donated, but also what we think we will need. We didn’t run out of anything this year either in medications or supplies. There are many of MMI’s projects that don’t have enough to do what they want to do. Success

In the medical clinic, we saw and cared for 445 Adults and 381 children. Also we treated 757 patients for parasites. Over 1400 patients received health education by a trained Health Educator in their own language. Almost, 2700 prescriptions were given to those in need. Success

We were honored to help inaugurate a new Provincial Hospital in Monte Plata that had been under construction for at least the last 3 or 4 years that we knew of. We saw 181 patients in consultation and did 87 major surgeries and 47 minor cases in our two weeks. We had much closer interaction with the local health care providers than in any year in the past. Success

The seed of the Gospel message was planted in the lives of over 1000 people during their stay with us. No one was required to respond but 30 people answered a call from God on their lives to follow Jesus. Success



So, I guess you can see that by all measures, we had a successful project to Monte Plata, Dominican Republic in 2014.