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…