The Team, but without Melissa Dec. 2010

The Spaghetti Feed

Dr. Peter Morin - Family Practice

John Novotny - Ancillary Staff

Dr. Nila Novotny - ENT

Karl Tillinghast - Ancillary Staff

Sue Tillinghast, LPN

Melissa Shemek, BSN

Radio

I heard about our team on the radio this morning on the newscast. They said to send donations via the blog. Our team is #802. They need that number for donors. Our location is Puerta Cabezas, Nicaragua.

Ashley Carstens, BSN

Connie Mohatt, BSN

Dean Athey, CRNA

Carolyn Athey - Ancillary Staff

Planning Meeting

We had our 2nd planning meeting for our next trip to Nicaragua at Sue and Karl Tillinghast's in Lincoln. The team has changed a little because we are joining the California team. Our team now consists of Dr. Nila and John Novotny, Dr. Peter Morin, Dean and Carolyn Athey, Sue and Karl Tillinghast, Connie Mohatt and Melissa Shemek. Dr. Morin is a Family Doctor from Lincoln who works with Sue. He's done other missions, but none like this.

We had a phone conference call with Suzie Smith from Redding, CA and got a lot of questions answered. Since we're combining we may not have to take as much equipment and supplies as we did last year. We learned alot.
We'll be having a spaghetti feed Thursday evening Dec. 9 and I'll be on the radio along with Connie Mohatt at 7 am, KLIR on Dec. 7th. Stay tuned! NN

Presentation

Our presentation will be Sunday, March 28th from 2-4 pm at the Federated Church Social Hall. There will be LOTS of pictures and souveniers and momentos from our trip.

For those of you who are still checking in on this website, please keep checking from time to time as there will be an announcement regarding our presentation which will be open to the public. It is tentatively scheduled for the afternoon of Palm Sunday. Everyone is anxious to share our many stories and pictures. See you there! Carolyn

Home

WE ARE HOME!! We took the plane from PC to Managua, waited for 2 more flights for the rest of our luggage, then made the plane from Managua to Houston. HELLO GOOD BATHROOMS!!! We beat some of our luggage back, but got the rest this morning. Now we have to sort through things to get the hospital equipment back, and everything sorted out. We took down 32 tubs and brought back 4 along with a lifetime of memories. Boris the Blue Bus driven by Denny V. was a great site to our weary eyes after a long day of traveling.
We're planning to have a community presentation. Tentatively set for March 28th, but not decided for sure when and where. Stay tuned for that for anyone interested. We'll show lots of pictures and tell stories. Pete and Tam are slated to talk at a United Way (?) luncheon on March 16th. I'm speaking at Federated Church to the Women's Fellowship this coming Saturday, March 6. Anyone can come. If you want breakfast you need a reservation for 9:30 am. Otherwise you can just come to hear the talk and see more pictures at 10:15.
The crew needed the last day to regroup before coming back. We're really glad we didn't have to do the bus ride 400 miles, 1/4 paved, 3/4 dirt in a hot school bus. Really glad.
I may post some more pictures as we sort through them. There are lots I haven't even seen yet. NN

02/26/10 - Karl

We just got back from a tour of the city and some shopping. We are back in the heat and humidity and a few sun burns. We also stopped for ice cream and got to go and see the ocean and the beach (couldn't get in the water).

This has been an amazing experience and the hand of God touches us every minute of every day. Thanks for all of your comments - it is great to hear from all of you. It looks like we are leaving the compound at around 6 or 6;30 in the a.m. get into Managua around 9 leave at noon to Houston then to Omaha.

We also got to tour the orphanage today - they were not in school today so they were doing their delousing - stripping their beds - washing hair - airing out shoes and beds it was kind of interesting. It is about time for supper and if it is anything like the rest of our meals they have been fantastic. Thanks for all of your support and followers. Love Karl

Market etc.

Pete found a nice eye clinic. The guy on the motorcycle is the health inspector of the market we think. ........ Well, gotta' go on the city tour. It is swealtering hot. NN

Plan C

OK, the wind is down enough so we can fly out tomorrow morning, unless the wind comes back up. We took a tour of the grounds where we are staying today. There is a school and orphanage. Tam and I did come finish up clinic so we didn't go, but caught up with them at the Clinica, then saw the Oasis, their church's resaurant and their water drilling mission. This is the girls, Melissa, Sue and Katrina relaxing on the steps of our lodge, and a picture of the lodge where we're staying. The kids are'nt in school. It is de-lousing day for them so they are checking hair, and dragging their mattresses out onto the grass to get rid of lice. We toured the Miskito market today. Very 3rd world. I'll include some pictures. Pete found and eye clinic. There was lots of big bags of rice and beans to be bought by the scoop, as well as fresh fish. Caught today we figure. Vegetables clothes, well see the pictures.

We're going to the beach this afternoon. We can't swim there (too dangerous). Then a drive through the city for a tour and by the medical school and swing by the ice cream shop. The ice cream lady likes the missionaries so brought us frozen bubble gum flavored coconut milk slushies in baggies to the hospital the other day. You bite off a corner and suck it out. A bubble gum lovers dream!!! NN

Flexibility is the keyword

Once again, our plans may change. There is very little wind today so we MAY stay today and go back to our previous schedule. The bus ride across country would have been interesting but also I think would have been very difficult. We might get to see more of PC now and also visit the ocean. I personally hope that is the way it works but will just have to wait. Since I don't have a job to return to on Monday, I guess I could wait out the wind situation and stay as long as necessary! But where ever Dean goes, I will follow! What a week. I can't wait to see the hundreds (or maybe thousands) of pictures. Many of us have cameras so we take pictures of whatever we choose. Some of us have been in different areas of the hospital so will have completely different pictures than others. A few of us sat on a porch this morning and talked about the week. Janet told some stories of what she has seen this week that those of us in surgery didn't even know about so I know there will be many many stories for even us to hear. We are about ready to go to town and see the Moskito (sp?) market and other sites. If we stay today we will also get to see the ocean. We will know more by lunch. Our bags are packed and ready, should we be leaving later. I will be happy to unpack a few things if necessary. Hello to everyone following this site. Carolyn

Dean - 02-25-2010

Well I have now spent a week in Nicaragua and have seen two of the most difficult airways I have seen in years. Today it was a beautiful young girl that had a tumor in her throat that after I had her asleep and went to place her breathing tube I found that her vocal cords were nearly covered by the tumor. With the help of the Lord and the team again all turned out for the best. Tomorrow brings a long bus ride to Managua and a plane ride home. I am ready to go but I also could gladly stay and help out longer. There is so much need. It has been a very gratifing week. We have been blessed far in excess in what we have been able to bless. Carolyn says HI. Dean

Mother

This is me with Quillermo's mother. The pictures below are the tracheotomy, us in Recovery Room, and leaving by the Emergency room. Also Carolyn doing what we all have agreed is the worst job, but look at the great smile on that face!!!! NN

Checking out

The word(s) of the day was lo ultimo (the last). It was our last day of surgery. We have follow up clinic in the morning, taking out stitches, packs, drains, checking wounds, etc. The breeze was nice today. It is the first day I didn't sweat all day, but the down side is the wind is too strong for planes to land and it's predicted to last 3 days. Since we're due to leave on Saturday we probably won't make it Managua by plane that day so we made an executive decision to drive. We'll leave after lunch on Friday. It's a 14 hour drive when the conditions are good. And I think they are good??? They left today with of the California team that stayed with us till today. The driver will be extremely tired. The Oregon team will travel with us on the church school bus. They told us to take toilet paper with us and snacks. It looks like there won't be any really good rest stops. They say it is really bumpy. We need to make the plane in Managua before noon on Saturday so we have almost 24 hours to get there. Pray for us.

Today I did an otoplasty to fix a deformed ear and some smaller cases. I took more packing out of Quillermo's nose so he can breath out of one side now. He seemed really happy about it. His mother looks a little like the lady in the video photo. She was wandering around saying goodbye to us all and wondering if he needed more medicine, etc. We gave her a package with rice beans and powdered milk. He has to hang around next week to get the rest of his packing out. I'm afraid to remove it so Dr. Taylor will start advancing the pack next week slowly. I gave him a bottle of the illegal vitamins with iron the government didn't allow us to bring, but slipped through customs anyway. He seemed glad and so did his mom. We'll let him out of the hospital until Tuesday but he can't go home. Home is a 2 hour drive (bus), then 2 hour horseback ride so it might be hard to get right back if he started to bleed again.

We are spending this evening sorting all our packed stuff. We're finding things we didn't know we had and couldn't find all week. We found lots of nasal packing in a leftover California tote. Hmmm that could've come in handy the other day.............

We may not blog much tomorrow unless we get to Managua in really good time and will go to the hotel and shower before we get on the plane. We should be home Saterday evening to Omaha about 8 pm.

We all enjoy your comments. It's fun to see who is following us so please leave a comment.

FE field reps

We don't want to forget the support we have received by the folks that met us down here once we arrived. Those connections are critical and appriciated.

Jeff and Kris Thompson are the field reps for Forward Edge in Puerto Cabezas that have been like "our parents" or "house parents" to us, taking care of all the non-medical logistics details once here.

Keveta Andersen is the resident nurse who also lives in Puerto Cabazes who has many of the contacts with the local hospital and other medical professionals here.

Suzie Smith is a flight nurse with the California team that stay behind to be with us this week, her team left last Saturday.

Pastor Earl and his wife Damaris have been kind hosts and provide the facilities where we are staying. There are many other support people as well.

The conditions these support people have chosen to live in, and still serve, are nothing short of amazing. The extreme limited resources the local medical's have to work with are horrific. It's hard to explain (even with photos) the degree of poverty, but we will try as the days go on.

One thing that is excellent here, is the food. Not a place to lose weight. Some of the best food we've ever had, prepared by some of the most loving and caring people you could ever meet.

John

ps: In the photos, vultures in the hospital courtyard, a horse in the hospital courtyard, off to work each day in the back of a pickup, and Tamra with a patient.

More Hospital

This is the hospital lab, the coal storage outside the kitchen door and the best bathroom in the hospital. I know it's pretty gross, but it's reality. This is the one right by the OR. You don't want to see the bad public restrooms.

The rat ran too fast for Tam to get a good picture. NN

Post op

Pictured is the finished cleft. There are two of PED in surgery.

There are guards at the hospital with real guns!!! Makes me feel really safe. PED is w/ a child with an eyelid tumor he removed. Dean's mother made some pediatric hospital gowns that are a big hit. PED is closing a thyroid with Jody, Lionel and Dean. He's stepped out of his usual zone here. He might just give up that eye thing he does.

We had tour of the hospital kitchen. Mrs. Rigsby led us around. She is on the video we showed everybody, a nurse at the hospital and can speak English, Spanish and Miskito, the native language. She's a lifesaver!!! She's showing us the bags of coal for the kitchen which is the next door on the right of the picture. NN

Update

This is the hospital kitchen. They use coal in a fire to cook with.

This is Melissa with Dr. Taylor at the hyperbaric oxygen chamber. He has quite a story to tell about his life. Too long to go into here, but a wonderful man. There are lots of divers here parilyzed from the waist down from the benz. The chamber helps.

I'm including some random pictures. Janet L. and Katrina S. have been working nonstop in recovery and doing a splendid job. They are pictured with Peggy, a pharmacy tech from the California team who stayed and did pharmacy for us. No problems..... awesome. We gave some Spanish medical books to a couple of Drs. Dr. Taylor is doing the preop assessments and looking after our hospitalized patients for us. He got 2 and seemed thrilled to get them.

I'm spending most of my energy on the patients. Today was the first day I became a complainer and made them get me a drink of water while I was doing surgery and asked if they could aim the a/c toward me. Keveta gave me grief for whining so I bucked it up and quit whining. I must admit it's nice to go to work every day in flip flops and shorts. We change into scrubs at the hospital and are so hot and sweaty and dirty we wear them home to shower before changing back. I've used my scrub pants as a towel after washing my hands in the undrinkable water at the scrub sink. The wrench handle so far has always had water. There is no soap there, but we have Avegard. I did a couple of big thyroids today. I was frustrated because there is no pathology readily available. Where is Dr. Lacey when you need him? I took out a small portion of the gigantic pack in the guy that bled from his nasal tumor.

Our cleft baby went home, eating and smiling. She's already learned to look at the pictures after you take one.

The rat in the recovery room, heading for Carolyn's sterilizing area and the flock of vultures out back are the talk of the team today.
Dr. Cespedes (of the fish bone) helped in surgery today. He's full of jokes and stories in Spanglish. Then we have Lionel who is a scrub tech and has a very interesting fold job he does on the drapes. He gives you exactly the corners he wants you to have and makes you open it in a way I'd never have dreamed of. He's also taken the liberty of telling Sue & Jody how to arrange their trays (which hasn't gone over the best).

Pete, Tam and Melissa gave talks tonight to some of the local medical folks, Drs, Nurses, etc.

at the Oasis restaurant across the street. We gave out our stethescopes and various medical gifts.

Tamra was the lucky one to be the first to see one of the hospital's resident rats today. Glad it was her and not me! The thing that is the hardest for me to get used to is the unsanitary conditions. Maybe that's because I'm cleaning most of the surgical instruments and the area is in a dark little corner with a sink where the water comes from a big barrel that sits next to the sink. I never feel like I'm getting things clean but at least they have a sterilizer that works well. There isn't any area in surgery where you can wash well and dry your hands. Nothing like any of us are used to! Thank goodness for hand sanitizer and wet wipes. Our meals have been very good here at the compound and we've tasted some excellent Nicaraguan dishes. The Nicaraguan people are very appreciative of our help and continually offer us their blessings for what we are doing here. Time is going fast and tomorrow might be our last day in surgery. We all have accomplished a lot and have worked well together as a team. We have also met a lot of neat people from the other teams who were helpful to us in the beginning to get us rolling. We are thankful to them for all their help. The last of the California team is leaving tomorrow and we wish them well. It was a pleasure meeting them and working along side them. Thank you to everyone who has shown an interest in our mission. Carolyn & Dean

Think of the very hottest most humid day in Nebraska x 24 hours!!! But, it is hard to complain too much while you realize people live in this all the time. I switch from my heart breaking at witnessing the suffering here to being filled with joy at being part of this wonderful experience. Today we finally hit our groove with surgery--things went really well. Looking forward to tomorrow. God bless you all at home, thanks for all the prayers and good thoughts we feel them lift us up. SUE

Cleft

Well, the cleft went very well. PED was an awesome first asst who helped me map out all the little flaps, measure, etc. In the end I thought it wasn't symmetrical enough, etc. but looking at my references afterword to see what I should have done different I saw that all their post op results had the same asymmetry as mine did so I was reassured. The mom looked really happy and Channa was eating an up right away. Melissa was in her glory with that baby, helping with the IV. We put in an IO (like a bone IV in the leg). Sorry about the picture. I have plans to get a good one. Please tell Deb Curry. She was interested in the cleft, but I don't think she does much internet.

I put in a picture of John and Karl with their OR table adventure.

Our thyroid was totally routine, but for lack of most of the key instruments I'm used to. The ear drum perforation made history as the first ear surgery ever done here. The local nurses were all taking pictures.

I took out the trach. The guy was happy.

Our nasal tumor 'Quillermo" is in ICU still with all the packing. OK, I didn't do my math right and he really only lost 1 1/2 liters of blood instead of 6 units. I'm going to start unpacking it today.

I befriended a new med student, Jassinia, pictured above. She's been in med school 3 weeks and just finished high school. They go 5 years combining college and med school compared to our 8 so she's just now taking triginometry and has zero experience. I gave her a scrub suit from my office. She's living in the orphanage with her brother. Her mom was shot by her stepfather and is paralysed from the waist down so can't take care of her or her siblings.

We're learning a Spanish word of the day (my idea). I think tengo (I have) will be for today. Yesterday was entiendo (I understand).

John and Karl regaled us with a story about the dog with the bloody guaze in it's mouth in the hospital compound being followed by a vulture. There are dogs everywhere sitting outside patient rooms and the nursing stations. There was a horse there the other day. I think Carolyn wanted to ride it. The fish the used guaze out of the trash and wash it and refold and use it. It turns out beautiful and give jobs to people.

Janet and Katrina have totally hit their stride in the Recovery Room. The TV station came with video cameras and interviewed Janet. I guess we made the local news, but we don't have a TV to watch it. They say she looked lovely on camera, swetting and all.

I have so many stories I could write all day. I can't imagine anything more exciting can happen than the emergency trach, bleeding and cleft so the rest of the week will be a piece of cake. NN

Melissa February 23, 2010

Today was another great day.....still long and hot, but great. These people appreciate every little thing that we can do for them. The pictures that I am including are those of me and "Doctor Pete" doing a procedure from yesterday. Also, a photo of me and some kids on the streets in front of the hospital. The most exciting part of my day was that we couldn't get an IV started on a dehydrated baby that was sweating buckets pre op! We did an Intra-osseous needle on the surgery table on the cleft lip baby......cool stuff here. Melissa :)
Tell Deb Curry that NN did a cleft!

2-23-2010 John

Well, our day is nearly over for Karl Tillinghast and me. We fixed an OR table, converting it from electric to manual. Many items just get so rusted from humidity, and they don't get maintenance routinely. We turned the OR table on it side to work on it, and mouse dropping, left over used medical supplies, oil, broken glass and dead bugs fell off onto the floor. Amainingly, the OR table would work electrically when the table was on its side, but not in the upright position. So Karl and I greased and worked to get the table to work manually. Nila was having a big day with the cleft palate surgery, tympanoplasty, thyroid, etc. It is about 5:30 pm and the rest of the team is not home yet. Don't expect them for a while.

Karl and I also worked on many air conditioner units, some lab equipment and tried to get an old x-ray machine to work that had been donated about 6 months ago. Kinda the attitude down here is that if it does not work for a few months, they give up. Partly due to no money, and partly due to lack of technical ability. Some of the items donated are high tech, and after a mission group leaves, the locals just don't know how to run the item. For instance, the lab machine was in Spanish for the software, but the working manual was in German. You get real good at sign language.

This was an especially hot day here, and we just have to make some re-arranging of our sleeping situations. Some of our accomodations have A/C and some don't. The one's that don't are just brutal. So, we are probably going to go Camp, or Boy Scout/Girl Scout with separating the couples so everyone gets A/C, but we will have 4 to a small bedroom, which is a very tolerable tradeoff from the heat.

Did someone say below zero up in NE? Send some down.

The trip is amazing, the support from all the folks that helped to send us here is so appreciated by the team.

There will be more blogging as the team gets back in shifts.

In the photos are hospital ladies folding gauze that was rewashed from yesterday's patients. Yes, they recycle gauze here. Also, our laundry service is done by hand, and by some of the most carring people you would ever meet. The last photo is a child who lives in the area.

John