A pretty exhausting day! We saw about 80 women. Yes, we did the "paps" and diagnosed more cases of dysplasia and possibly 2 more cancers but more than that, we made wonderful connections and we hope that we have inspired these women to begin to stand up for their rights .  We continue to hear way too many stories of violence and sexual abuse against young girls. It is heartbreaking.  
Chetti and Mani are making wonderful relationships with the only cytotechnologist in this area and the "cytoprep" person.  Chetti was so careful to not be intrusive and now they are well accepted and have been able to work with them to understand their challenges and to find meaningful solutions that we think will have very positive long term consequences. 
Randy is helping with so many things - he's always there to fill in for whatever is needed and he keeps us all light-hearted.  Lauren and Puja continue to function at a level far beyond their training.  They have such passion about this work. Ismael and Orfe continue doing EVERYTHING to make all this possible and productive.
Today, I had a chance to talk with Dr. Guerra who is the medical director for INCAN, the only cancer treatment facility in Guatemala.  He is very interested in working with us and we hope we may be able to connect him with a radiation oncology program at home.  
We are staying at a very beautiful and peaceful place - very basic but very nurturing.  We've never seen so many stars in the sky!  God is everywhere in our midst leading the way.

Here's Mani and Lisa - our lab team! They work tirelessly at the microscope throughout the day giving us results as fast as they can.  Sometimes we walk in with "stat" slides praying that they won't find another cancer. Lisa works so hard to be sure that she is giving us the right diagnosis. Imagine doing this without all your usual resources!
Mani said yesterday that she's never had so much energy in her life - she told me that she couldn't be doing this...it has to be God. 

Each day becomes a little more frightening. We continue to be shocked at the amount of cancer that we are finding - 2 to 3 cases each day and numerous cases of severe dysplasia.  This information is getting around and the lines each morning are growing. This morning we all looked at each other wondering how we'd manage.
I've worked with a lot of people in my day but this team is incredible. Each person seems to realize that what we are doing is the beginning of a very meaningful cancer prevention program here. Our 2 students, Puja and Lauren are functioning at a level far beyond their years. While always treating each patient with the utmost respect, Puja managed to see 67 patients today and Lauren took on a room of 400 women, triaged and kept the day running smoothly. Lisa and Mani work throughout the day non-stop keeping up with getting us results.  They are so passionate about what they are doing.
Orfe has done all of our intake and managed to get complete histories from 90 patients today.
In the midst of it all, we managed to spend all the needed time telling families and patients words they didn't want to hear as well as giving hope to many patients since we have the tools to treat their pre-cancerous lesions.
It was one heart-breaking story after another.   But in the midst of all the chaos are the individual stories. Each story recounts the lives that so many women here face – abuse, neglect, injustice.

Even in the crowded room this morning, my eye went to a tired looking pale woman sitting in a corner.  We have become so accustomed to what we are seeing that I immediately knew she was one of the victims of all of the above.  She came into my little room first and brought a friend.  I glanced at the history that Orfe had so carefully taken – 8 children, husband died last year year….Then,  she recounted the story that I wouldn’t believe if only I had not heard it myself.  Soon after her husband died she began noticing bloody discharge.  She came for help but the nurses told her that you can’t have an exam if you have discharge.  Finally, when the smell became so bad that no one wanted to be near her, she went to the main hospital in the Peten.  There, the doctors examined her just 2 months ago and told her she had a fibroid.  They told her it would be best if she only at tortillas and beans and this might help.  Finally, 2 months later she returned and they told her that her biopsy showed cancer.   At this point, she broke into tears and told me that she had nowhere to turn, no money for travel, no options.  But yesterday, she heard of our group and she gave such thanks to God because she knew that we would be His hands, that we could cure her. She looked me straight in the eyes and held my hands begging me to care for her.  The tears streamed down my face as I heard more about her 40 pound weight loss and lack of appetite.   I looked at her pale hands and knew without examining her that it would be too late.  So how do you tell someone who has complete belief that you are the “hands of God” that the neglect she has received cannot be overcome?
Wiping my eyes, I calmly told her that we now I’d examine her.  In the back of my mind, I frantically prayed that perhaps her weight loss was the result of the “diet instructions” from the doctor.  But as she bravely laid down and I began my exam,  it was all I could do to not weep and run.  In med school, we learned about “fungating” cancers but rarely have I seen one.  This cancer seemed almost to be “evil”.  The stench was so putrid; the foul liquid from it poured from her fragile body.  My mind raced thinking about the virus that some man had infected her with at a young age, about the lack of any prevention program here and about the complete lack of help she received when she sought it.   I doubt that the doctor really thought there was no problem.  Did he just not care or did he know that there would have really been no treatment so why concern her family with this diagnosis until they really had to know?

So while hundreds of women sat outside, we stopped to somehow be the “hands of God” that she sought.  I thanked God that Puja and Lauren would somehow be able to manage the throngs of women and keep the program going. How did we get so fortunate to have 2 brilliant, resourceful women such as them on our team?

Orfe and I had her son come in and we did our best. We all talked about life and death and why God ever creates us and why such tragedies could happen.  All I could do was truly thank God again for bringing Orfe into her lives with her quiet understanding and great wisdom.  We talked about how whether we live 20 years or 80 years, it is but a blink in the scheme of the universe.  We talked about how it is really in how we live our lives, how we bring purpose and how care and love each other that matters.  The only hope I could give them was the promise that Orfe would continue to visit with her; bring her pain medicine and help with whatever comes along.  And I asked her to help us get this word out to all the women and the men that this is a completely preventable disease and that it can be stopped.  She happily asked us to record her testimony and put it on the “internet” for all to see.  The fact that she was finally being heard seemed at least to give her a small bit of consolation.  Whether she lives 2 weeks or 2 months is less important than that she dies with dignity and that her family knows that someone cared.

What a day we experienced. It was actually quite shocking. We did about 60 paps and unbelievably found 2 probable cervical cancers (one in a 27 year old beautiful women). We also found 5 more "almost cancers". This data is quite alarming and points to something which must be beyond what we now understand.  I am so grateful that there are scientists  working with us on this who know far more than I do and who might ultimately be able to provide answers. 
Doing this work has also enabled us to come closer to understanding deep levels of injustice against women. One of the women who had a "close to cancer" diagnosis today needed a biopsy. She was reluctant to do it because her husband beats her and she was afraid that he would call her a liar if she told him that she had a problem. My own life is so distant from that. Having a husband who respects and loves you is something that is very far from reality for so many women in this world. 
We feel as though we are in the midst of something which is terribly tragic yet we have hope that with great effort and love, things can change for these women. Thank you all for your encouragement and support.

Sunday Feb 5 2012

Finally a minute to “catch-up”.

After a week in Naranjo, we returned to Flores last night and are now preparing for the next journey.

Sunday morning. It’s only 7AM but already I feel the little familiar simplicities that make me love it here.  I ran down for a cup of coffee and he happily gives me a full “thermo” for only a dollar to bring to my room – oh happy day!  With the roosters calling in the backround, the very same 11 year old girl is riding her bike through the island selling the local newspaper calling with that high pitched call “Nuestra Diario!!!” Today, she has her little sister with her who comes running happily to me when I indicate that I’ll buy one. I give her a little “tip” and she joyously skips back to her sister showing her little fortune!

Perhaps I say that every trip is the “best” one yet and this group is the “best” group yet but I’ll say it again!   At the end of each day, we would look at each other with amazement wondering why our lives are not like this every day at home.  Why are we able to display such constant love for each other and for those we meet in the midst of such great poverty?  We rose every morning around 5:30 and gave every ounce of energy our bodies could muster until our eyes finally admitted defeat each night.  Then refreshed and rejuvenated, we’d do it again the next day. No complaints, no self-seeking; only desperate efforts to make the next day even more meaningful and “productive” then the day before.  The 5 of us came with our unique gifts and Ismael, Orfe and baby “Anita” led the way.  Hard to believe there’s any group that could be led by 2 people with such kindness, wisdom and hearts as big as their’s.  When I consider how we first came to know Ismael, our “bus driver” and his quiet, humble but very powerful wife, Orfelinda,  I’m reminded that indeed the least can do the most.  Sometimes I wonder if they are really people or just angels in disguise!  Baby Anita is only 3 months old and yet, somehow, Orfe is able to keep her smiling and peaceful throughout the day while she interviews our patients,  “sees” everything we need before we can even ask for it and somehow anticipates every need.

Our project?? Pretty phenomenal….somehow God sent ALL the right people as always.  Yes, …..yes, we do have the 2 BEST medical students in the U.S with us….but how does a 72 year old woman with fairly serious health problems but with the knowledge to make all of this work have the faith to come on a project such as this? With 50 years of medical experience but more importantly HUMAN experience, Mani has been our lab director and “mom” all week!! In the midst of starting a fairly sophisticated lab, she installed a gourmet “kitchen”. The love that she puts into preparing the food (mind you she brought spices!) makes me feel that I am nourishing my soul and body with every bite.  Without a doubt, she is an Indian version of my own mom and now I feel as though I have two!  During the 25 years that I’ve been “doing” paps, never did I realize the painstaking effort, concentration and skill that goes into insuring that they are interpreted correctly.  They never have the personal joy of hearing a patient thank them that their cancer was prevented but they take such pride in their work. We doctors can be so critical if results are not back immediately, if there’s any glitch in the system. How arrogant!  After so many years, how wonderful to work side by side with the people who work behind the scenes with me every day.  Our other lab technician, Lisa, gave up her vacation time and even a week of her masters degree classes to join us.  Watching her and Mani furiously work to devise new techniques to overcome the environmental lab challenges of heat and humidity has been once again amazing (Ok….I know it’s the most overused word of the year!!).  One of the highlights of the week was when Lisa ran over to my room with tears in her eyes saying “we have a high grade dysplasia”! She knew that that meant we could treat this 38 year old woman who would otherwise die of cancer in a few short years.  She knew that our whole trip would have been worth it if only for this.

So far we’ve “seen” about 250 patients.  Any of you who work with us know that we make a very special effort to never focus on numbers.  “How many patients did you see?” is the common question when we get back….as though saying 1000 in a week would be anything better than a “human safari”!  Can you imagine if you heard that your own doctor spent that little time with patients! Facing great cultural and language barriers, we struggle to make each “encounter” one that blesses each person in a meaningful way. 

On Tuesday morning, we all lamented that this trip unfortunately had to be one where we need “numbers” since we are trying to get data in order to push a meaningful cervical cancer prevention project in Guatemala.  But within an hour, as Lauren came to me with tears in her eyes to “present” a patient, we all realized that God puts those that he wants you to help directly in your path. And it is in those moments, we can choose to press on with our earthly goals or we can stop and realize that it is in those moments of sharing love that we can restore the brokenness of hearts and lives.

Lauren’s Spanish is pretty exceptional and so is her heart so in the midst of filling out our form and gathering our “data”, she was able to find out why this woman of age 40 looks like she is 80.  She and her 10 children have been physically abused by her husband for many years.  Her children have known such violence so it is no surprise that her teenage son had such anger within him that he raped a girl in his community.  When the girl’s father discovered what happened, he went to their home and murdered the boy’s 2 year old sister in front of them all.  Since then, the husband left this woman with all her children……no money…..only tortillas and beans. Did I hear that? Is that what she is really saying? We had Orfe come in so that we could be sure what we heard. Yes, it is true. That is why the life is gone from this woman and she is slowly dying of a “broken heart”.  There are no police to call, no lawyers to engage.  All we can do is our little bit. We cried and prayed together. We promised her that we will do what we can.  What gives me a least a little comfort is knowing that indeed, Orfe will continue to see this woman. We can do a little bit…give their family the KAH food each day, perhaps sponsor one of her children for school.  Who knows…..maybe she’ll have a garden next year or at least a little hope that someone cares and she is not alone. 

The very next “patient” was 51 years old.  All I had to do was say “How are you?” and she burst into tears.  Nine children at home and her husband died of a brain tumor a few months ago.  When I asked if he received any treatment, she laughed and said “Somos pobre” (We are poor).  Without any further explanation I know that this means they had nowhere to turn.  Perhaps there is a hospital in Guatemala City but how do you even get there without any money to get on a bus? Where would you stay? Who would care for your small children?  So she watched her husband die in agony and now her young children have to scrounge to find little jobs that will bring in enough money to feed them.  Go to school? Really? How would they do that? There is no “welfare” system, no health insurance, no one to turn to….only God.  At our planning meetings, we always try to find ways to introduce good nutrition, clean water, education…..all the things that should be basic to human existence. But how do you do any of that in the midst of such stories?

So, as always we press on.  Before every trip, I’m always overwhelmed and exhausted with all the preparation. But once I’m here, I somehow have so much peace within as I realize that it is really only with God that anything is possible. I often think of Paul’s words in Philipians “I have learned to be content whatever the circumstances. I know what it is to be in need, and I know what it is to have plenty. I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want. I can do everything through Him who gives me strength”.  As we left Naranjo yesterday, Puja and I walked along the road. She and Lauren have been part of this effort since the first day Flori arrived in our clinic less than 2 years ago. We thought about how this story evolved.  We thought back to the day that Flori came to our clinic, desperate and in agony. We thought about all the lives she touched both here and at home and that even though she in now gone, her soul lives on in this work and in this place.  Our lab was actually set up in Flori’s sister’s house and many of the women we saw were only there because of her story.  How many women will live to raise their children because of the courage of Flori? I will never, ever believe that God decided that she would die so tragically but I will believe that God gives us the grace to bring goodness from great sadness.

6Pm night before our trip. Just waiting for Randy to come home from running so we can go out to dinner. In the midst of my chaos, he is always the one who stays calm and shows reason!
The preparation for this "trip" has been one of the more exhausting....mostly because of it's significance. God puts people in your life and He takes them away. For me, one of those was my dad. My dad grew up in a place not much different than the poorest villages of Guatemala. They had no running water; they mostly ate potatoes and they had a one room school house that they had to walk a long way to get to.  The older I get and the more I see around me, the more amazed I am that he was able to navigate the "system" and get to this country. The opportunities here enabled him to marry my mom (the most loving, giving person I have ever met) and to educate me and my sister so that we could make better lives for our children.  To him and my mom, I am ever-indebted for giving me a chance to go on a trip like the one we start tomorrow.
The other person that God put in my life and He quickly took away was Flori.  It's inexplicable how another human being who has absolutely nothing in common with you can become like family in a matter of minutes. Perhaps we were more similar than we were different.  I would never, ever believe that God ordained her cancer and her death so that others might be saved. But I do believe that God put those of us involved in this effort in her path so that others might be saved. 
So after many, many months of tireless preparation from so many people , we are off.  We'll see where it will all lead. This "blog" thing is an opportunity to engage so many of you who have made this happen into a reality. Please write back and share your thoughts.
I know that you've all heard this bible verse so many times but it is one that I think of all the time.
John 15:5-17
I am the vine; you are the branches. If a man remains in me and I in him, he will bear much fruit; apart from me you can do nothing. If anyone does not remain in me, he is like a branch that is thrown away and withers; such branches are picked up, thrown into the fire and burned. If you remain in me and my words remain in you, ask whatever you wish, and it will be given you. This is to my Father's glory, that you bear much fruit, showing yourselves to be my disciples. As the Father loved me, so have I loved you. Now remain in my love. If you obey my commands, you will remain in my love, just as I have obeyed my Father's commands and remain in his love. I have told you this so that my joy may be in you and that your joy may be complete. My command is this: Love each other as I have loved you. Greater love has no one than this, that he lay down his life for his friends. You are my friends if you do what I command. I no longer call you servants, because a servant does not know his master's business. Instead, I have called you friends, for everything that I learned from my Father I have made known to you. You did not choose me, but I chose you and appointed you to go and bear fruit - fruit that will last. Then the Father will give you whatever you ask in my name. This is my command Love each other. 
As I think about these words, I think of so many "branches". I think about Melinda and Chris who were so crucial to all of this effortI think about Janet who will get up at 3AM tomorrow morning to bring us to the airport. I think about Anne and Kandi at my job who will keep things going while I'm gone and my partners who were willing to take call for me and to care for my patients. I think about Gloria and Dave and Coral and Gary and Kathie and Bob and Julian and Christine and Robert and Deena and Rick and LeighAnn and Pam who have been at this day in and out throughout the year. Or Sara and Peter who have given so many hours without anything in return. There are so many people who will never get to experience the "hugs" but without them, none of this would happen. Thank you Tim and Ben and Dawn who worked to get us all the equipment that we need functioning! Thank you to Dr. Conway for enabling so much of this to happen. Thank you to Kevin Webb for allowing Flori to come here and a very, very special thank you to all the doctors and nurses who took care of her. Thank you to my children for always challenging me in this effort and always inspiring me.!
I think about all our supporters, all the people who are willing to give an encouraging word or who so willingly do whatever is needed or so generously give of their own resources. And thank you to those coming on this trip - Chetti and Lisa and Lisa and Mani and Randy and Lauren and Puja and Nate and Chad. And thank you to those "on the ground" in Guatemala - to Doctora Luckey and to Marta and Isabel. Thank you Isabel - you are theThank you for taking a step in faith to work toward healing a broken world. 
There are too many details in this trip; too many opportunites for failure and perhaps, too many opportuntiies for love! We can only pray that in following the words of our Lord we will spend this time looking for ways to give God all the glory!
I am deep in prayer that good will come of this endeavor.  Please share your thoughts and insights!

Gary, Ginny and I make quite a team!! We laughed so hard over dinner last night that my ribs hurt today!! Gladys will be happy to know that we revisited her 'ribs' place, and had an equally interesting dining experience!!  Gary, the techno geek keeps us all on our toes with his wise words and sense of humor, and Ginny with her servant's  heart, is willing to do ANYTHING needed at any moment!! She even listened to me babble until midnight last not after a really long day...  What a friend!! 

Nearly every visit contains a story of grief or despair if enough time is spent digging deep. A 21 year old teacher with chest pain when she lies down at night. She can run and play with the children without symptoms. She is otherwise thin and healthy. Her exam completely normal. I reassure her and go on to the next patient who happens to be her mother. She reports headaches for 2 years...'what happened 2 year ago', I ask?  (I had also asked the daughter with no significant response). Her son, who was also a teacher, was murdered while walking to school one day. They don't  know why...but 'the susta' (extreme worry and despair) has overtaken them. 

A woman who hasn't slept for 8 days... 'What happened 8 days ago?'  It  was the 1 year anniversary of the death of her husband in a moto accident.  She and her 4 children barely survive on the money she makes doing odd jobs. 

My goal was to tell every person I saw that God loves them and cares about them. I was overwhelmed by some of the responses. Many told me that they would pray for me. One woman told me that she always prays for all of the people in the United States because she knows we can help her people. A few looked away, not wanting to meet my eyes, but hopefully the words will ring again in their heads as they close their eyes tonight. 

Nearly every visit can contain a moment of hope if enough time is spent... There is always something for which to be thankful, and tonight I am thankful for the opportunity to serve Christ, for friends who are willing to serve beside me, and my family who is understanding and  willing to let me be away at this time I the year!!

Can't believe tomorrow is Friday!

Wednesday
The pictures above say it all!! I know that for you in the United States who are so used to "conferences", this is status quo. But in Guatemala this is huge!!! The fact that there are a whole room full of health promoters and midwives listening to Dr. Coral Matus and Dr. Gary Collins is huge! These are people who live in the poorest of villages in the world. These are people who have absolutely no resources and have so much suspicion of the outside world. The fact that so many of these people are there gives so much testimony to the work of these doctors. 
Dr. Matus wrote.....
Three gringos educating 80 guatemalan health promoters and comedronas (nurse midwives)...now that was quite a sight!  The women (and men) were delightful and very interactive. After everyone arrived (around 8:50) for the 8:00 training session, and the leaders of the training session (from the local health center) spoke for about 20 minutes. Gary, Ginny and I spent about 30 minutes talking about safe delivery, pre-eclampsia, postpartum hemorrhage, shoulder dystocia, and helping  babies breathe in the first minutes of life. They seemed to enjoy the talks, but became quite animated when we broke into 'small groups' of 25 and did some 'hands on'' stations to practice what we had learned.  The stories that some of the comedrona shared were amazing. There were women with 36 years experience delivering babies in their own homes (on their own beds), and young ladies who were just starting training. One more experienced comedrona demonstrated a flawless breech delivery! Most had stories of delivering footling breeches or other malpresentations successfully. They also shared many sad stories of unavoidable deaths- fetal and maternal- due to difficult circumstances with lack of emergency care.  They asked some insightful questions and appreciated the 'goodie bags'.
As if Orfe doesn't have enough to do, she and her sister made sandwiches with a mixture like chicken salad for all of the people who came (120 sandwiches!).  We spent some time with several of the comedronas listening to their stories and offering them support. They are very interested in learning and really truly want to help their people!!
Can you believe that several of the providers had travelled over 2 hours to come to the session!! Of course,  we so happily agreed to see  them in the clinic.  
I have never seen so much activity on the island of Flores as there was tonight. Ismael was explaining to us yesterday that today is a special holiday in Guatemala: quema del diablo. ("burning of the devil"). The tradition is to get a piñata that is shaped like the devil (or some other doll) and burn it to get rid of all the bad/ sin in your life. 6 pm is the official time that the burning commences, and there are lots of fireworks. When we went  back to the island around 7 PM, all the roads were blocked off and we had to walk to our hotel. In the streets there were dozens of tables set up with traditional Guatemalan food (they call is 'mesita', or 'small table'). We weren't brave enough to try any of the street food, but have enjoyed watching the people having a great time, enjoying the evening. The kids had sparklers and light-up toys and balloons...I'm just hoping that the fireworks settle down soon so we can get some sleep!!
Thanks for all your prayers today. Between my modest Spanish and Ismael's adequate English we seemed to connect with the group today... The courage and hope that we see in these people is amazing despite so many challenges! Thanks to all who have had a hand in this ministry!! Giving them hope and telling them that there is a God who loves them and that they are worthy of being loved is sometimes the only and best gift we can give them
Coral Matus

Another steady day of patients. Some patients are familiar faces who used to come to pueblo Nuevo but found us in our new location. Many new faces who seem grateful to be seen by an American Doctor. Even though he 'Centro de Salud' is close by in this community, there is not a Doctor available there, and the limited training and limited resources of the nurses and health  promoters makes it difficult for them to treat  even simple things at times. 

Many times the women especially seem so thankful to just be able to talk ad express the many discomforts they feel. They often have no other outlet for expressing their concerns, so a therapeutic listening ear and some encouragement goes a long way. We are really not so different...

A 60 year old with an obvious breast cancer had been seen at a couple of different clinics and given antibiotics. She was so skeptical when we recommended that she go to the government hospital to be evaluated so Ginny and I finally attempted a core biopsy...hopefully the sample we for will give some answers, but then what?

We have been spending so much time talking about the big picture of our mission here, but I never want to lose sight of the many little pictures we see each day...  There are still children without enough food and families without a father and mothers who have lost babies and children and sadness and fear and hopelessness. The only hope we can bring comes through Christ, and that is what I hope is apparent in every interaction this week. 

Tomorrow, we will be meeting with 60-80 comedronas and health promoters to talk about basic life support in obstetrics and neonatal resuscitation. We made some goody bags tonight (80 of them!) with 2 pair of gloves, 2 band aids and a cord clamp (umbilical!) for each one. Although basic, these are luxuries they often don't have. 

Please pray that our language skills will be adequate to convey our message!