Thursday, Feb 23, 2012
Last day of “our trip.” My mom used to say, “We looked forward to it for so long and now it’s over!” Well, yes, I looked forward to it but it was really with true trepidation that it would ever even happen! Just a few days before we left, I was in tears whining to my poor husband that it looked liked some of the crucial parts of this trip might not come to fruition despite all of our greatest efforts.
And now, it’s over and unlike many times in life, I can say without the slightest hesitation that this experience went far beyond anything I could have ever dreamed of. The lives that were touched, the people that were given a chance at life, the connections that were made, the friendships that were forged, the hope that was given were more than most could hope for in a lifetime.
Actually, it was almost surreal. Puja and I looked at each other at the end of the day yesterday and said “Did this really happen or are we just in a dream?” While I’m sure that as with everything else in life, we’ll be brought back to reality quickly but for at least this moment, everyone involved in this effort can really smile with real tears of joy and say “Yes, job well done!!”
One of the last patients of the day yesterday broke down in tears after her “LEEP” cone biopsy. For those of you who don’t know what that is, I think Puja explained it best to the patient when she said to her, “Don’t worry…..it’s just a little electricity!!!”
As I watched this patient cry, I wondered if she was in pain so I asked her what we could do to make her feel better. She then threw her arms around me sobbing and said, “ I will never forget all of you for the rest of my life; your group, your team, all of you – I will ask God to bless you every day. Thank you for curing me!” She couldn’t stop sobbing.
It wasn’t her thank you that I needed; none of us needed any thank you. But this wasn’t a “thank you”. It was this mutual exchange of love. While I can’t speak for the others on the team, I would imagine they would know what I’m describing. It was this very deeply emotional sensation, almost as if I was in whatever heaven is. The love this woman was giving me was the same love I was giving her and we were both meeting each other’s greatest needs. Yes, maybe all these efforts from so many people will give this woman many more years of life, but more importantly these acts of selfless love do so much to bring goodness. We can only hope that those many, many acts of kindness will be given forward and the great injustices these women face every day will be made a little better.
So in our 1100 “pap smears”, what did we find and what did we learn? Too many cancers…. lots of “near-cancers”….. but more importantly, at least 24 cases of “just this close to cancer” that we were able to “cure” so easily. At least 24 women will get to live out their lives and raise their children, not being victims of a disease that could have been so easily prevented.
But perhaps even more importantly, we were able to really begin to know what it means to have absolutely no rights as a woman. We heard story after story of women telling us that they were “taught” about sex from their father, their step-father or their grandfather; stories of women murdered because they didn’t do what a man wanted; stories of women who had their “tubes tied” because a doctor thought it was best for them without obtaining their permission. It wasn’t until half-way through our trip that we even realized that women didn’t “count” abuse when it is from their husband. We began to understand that the answer to preventing cervical cancer in Guatemala or anywhere in the world is not about training cytotechnologists, or about having a sophisticated lab or about money (although those are absolutely crucial). It is about accepting the reality that woman and men are born equally in the eyes of God and that we are ALL entitled to the most basic of human rights. In the U.S. we have had a history of very brave people who stepped out against discrimination of ethnic groups, of women, of homosexuals. We may think we have made great strides and yes, we have in comparison to countries like Guatemala. But every time any of us think we are more deserving of anything because we are in the “majority”, we are no better than those who abuse these poor hopeless women.
To say “thank you” to all of you that changed the course of so many lives seems so small. If I even tried to list all of you, I would surely forget someone who might have been the key to it all. So rather than listing people or departments or names, I only want to thank each and every one of you. I have had many great joys in my life – most of those were in relation to my husband, my parents, my sister and my children. I have also had the incredible privilege of working with the poorest people of Guatemala and knowing the joy that they know – which is to live simply and at peace with God. But this month was perhaps one of the most powerful of all the events in my life. It was a time when I truly experienced everything I have ever studied about being “one with God”. And it happened because of the great efforts of so very many people who chose to take a minute, an hour, a day or whatever to stop and just do something because they knew it would be a blessing to someone else. There were so very many people at Promedica that spent so many hours giving of their time and talents; the pathologists, cytopreps, cytotechs, histologists, secretaries, couriers, biomedical engineers, office managers. Thanks to the Cytology and Anatomic Pathology departments and the pathologists for helping us prepare our supplies for the trip, for processing and reporting the biopsy specimens and for answering our many calls from Guatemala. Without your help and speedy responses we wouldn't have been able to correlate some our findings and treat so many patients.The collaboration with so many at the University of Toledo is a testimony to the power that can be had when people work together. There were so many individuals who so generously donated financially to make this work happen. Thank you to Zonta International and to the Rotary Club of Toledo.
During this time, I was still very much “human” with all my usual personality flaws of which I am so very well aware of. But the difference was that I could forgive even myself for being so short of the greatness of a God who has all the power in His hands. And I could feel that greatness every day. What a joy to work with a very gifted and passionate group of people who wanted nothing more than to rise each morning with the sole intent of making someone else’s life a little better.
We now have great hope that our research and findings will make contributions to eradicate this very curable disease. Last night, Randy and I had the great fortune to meet with Dr. Michael Dean of the NIH as well as a group of very committed and influential Guatemalan people who also want to stop this disease. They were so excited about our findings and they have high hopes that things will change in the near future. I also give great thanks to Nate, Chad and Brian who took a week away from their families to start working on a documentary that will vividly portray what we are up against. Thank you Lisa and Lisa and Mani and Chetti and Lauren and Puja for your tireless efforts and love for these women. Extra special thanks to Orfe and Ismael who have the love of God in their hearts and the know-how to have put this all into place! And most of all, thank you Randy for walking with me in all of this and for having so much kindness in your heart and wisdom in your mind.
And here are the players!!!
Sorry for the lack of updates....we've been so incredibly busy day and night. Nate, Chad and Brian arrived yesterday morning and have already done tons of filming for their documentary about cervical cancer in Guatemala. As with everyone else on the team, they are so compassionate and committed to improving the lives of the women here. We're very excited about the impact their documentary might have for advancing this cause in Guatemala.
Yesterday morning. Lauren and I were able to do some minor surgeries in the hospital in Poptun. I have been trying for years to work within the local health care system so this was a huge step and is a testimony to the great work that Ismael and Orfe have done to gain the trust of the people here.
Everything went so well with the patients and our "film crew" was able to interview the health care director for this region of the Peten as well as the director of the hospital. They are very interested in us bringing surgical teams down here! I know that there are many doctors and of course, our very favorite nurse anesthetist (Melinda) who have wanted to give of their talents for quite some time. The patients were very cute....the first asked if I could just go ahead and take out her uterus! When I told her that wasn't what she needed, she started bargaining with me and wanted to know how much it would cost!! Lauren proved to be a fabulous surgical assistant - she never ceases to amaze me with her talents...
We have continued to find so many problems with this disease. The women cannot believe that they will actually receive the results the same day. Puja and Lauren seem to be able to whiz through paps and yet somehow know when a woman needs to really talk about some tragic event in her life. Mani and Chetti work away at that microscope so they can get results out as soon as possible. Today, it had to be over 90 degrees in that clinic but everyone worked away and the bus load of women were delighted as they left! Randy runs around making sure that everyone has everything they need.
Life here is so different. When we got back to the hotel tonight, I ran out to buy us some popsicles. As I walked down the street, 3 women on the island called out that they were coming to the clinic in the morning for their first pap! They said they'd get there at 6AM so they could get back to the island to work in their stores.
At times we get discouraged and at times, we certainly get tired. But it seems that there is always someone there to pick you up when you need it. We try to remind each other always that this is God's work, not ours. Yesterday, we read 2 Corinthians, Chapter 9 which gave us the inspiration we needed at just the right moment.
"This service that you perform is not only supplying the needs of God's people but is also overflowing in many expressions of thanks to God. Because of service by which you have proved yourselves, men will praise God for the obedience that accompanies your confession of the gospel of Chirst, and for your generosity in sharing with them and with everyone else. And in their prayers for you their hearts will go out to you, beacuse of the surpassing grace God has given you. Thanks be to God for his indescribable gift."
Everyone on this team has revealed God's goodness in so many ways!
To give you a flavor of what it's like doing gynecology here.....look at this woman's thyroid goiter. She came in for a pap and told us this tumor has been growing for many years and no one can tell her what it is. So later in the day, I called Dr. John Brunner in Toledo and he gave me some great advice. We didn't get a hold of her until we were ready to leave our hotel a couple of days later so she came over in a "tuk-tuk"!! We brought her up to our hotel room and after I did a fine needle aspiration, our cytotechs got the slides prepared to make sure we had the cells we needed!!! Not sure that would happen at home! After it was done, I asked her if she had any questions. She just asked if we could give her a dollar for the "tuk-tuk" ride home!
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.