NEPAL

It looks like things are lining up to go to Nepal on our next mission.  Our national academy sent out a request for ENT surgeons and other medical personel who were interested in setting up a new mission site in Nepal.  We will be doing reconnaisance and not the usual surgery dawn to dusk.   We will be able to hike to the base camp of Mt. Everest while we are there.  This is totally different from our other trips.  It's what keeps things interesting.  Every mission is unique and we've been studying up on Nepal already and getting in shape for the trek.

GUEST BLOGGER - LINDA CARLSON

Today's guest blogger is Linda Carlson.  She's a retired nurse from David City and the wife of Dr. Mark Carlson.

Haiti 2014  -  Abundant Blessings

Mark and I had talked for several years about going on a medical mission trip.  It was kind of a bucket list item for me.  Last year we found out that several people we knew were going.  We were encouraged to come by Nila & John Novotny and Joe Miller.  We decided that the time was right and felt good we were going with people who had been on a medical mission trip before and had the experience, after all we were rookies!

Mark and Linda Carlson beside the guest house. 

I had done some research and knew it would be a whole new world in Haiti, different than anything I may have seen before.  Although reading, watching videos, trying to learn some Creole helped a great deal, nothing prepared me for what we experienced and witnessed.  I certainly was stretching myself and stepping out of my comfort zone, big time!  Those that know me now know that I’m not a fan of flying but I made it.  The two hour ride from the airport in Port Au Prince to Pierre Payen gave us a view of great beauty and also heartache.  To see clusters of tent cities still to this day in place after the 2010 earthquake was so saddening.  I saw first hand and understand why they say Haiti is the poorest country.  Our team was large which was encouraging to me because I hoped it meant that we could help many people in our short week there.

Tent city along the drive from Port au Prince to Pierre Payen.

Once we arrived at Pierre Payen and got settled into our living quarters, we ate supper and had an organizational meeting in the guest house.  I had hoped that Saturday would have been a day or unpacking supplies and orienting to the clinic and hospital.  That soon turned into a very busy chaotic day with seeing patients and jumping right in.  I felt so inadequate that day.  I just prayed that I could be of help and service and not be a hindrance to our cause.  It was really hot but didn’t seem to matter after awhile when I looked into the many faces of the Haitian people waiting in long lines to see the doctors.    I was concerned that I would not be very helpful for the fact that I had been away from my nursing career for a long time.  Everyone kept assuring me I would be fine.  I spent my time divided between helping Nila with ENT clinic patients and my husband, Mark in the Family Practice clinic.  Nila was so great to work with and very patient with me learning the ropes.  Thank you John Novotny for the crash course of ENT instruments she would need for exams and proper techniques.  I easily could have been fired on day one but not in Haiti.

Mark and Linda in the clinic.  ........ Not sure what he's working on!

I had the joy of working mostly with Shirley, Kevin, Kim, Kristie, Kate and Molly in our wing of the hospital.  They are the most caring, compassionate and talented group of people I have ever had the privilege of working with.  I knew God had brought us together as an entire team for this purpose.  I was the one feeling blessed again for so many new friends and the bond we will forever share.  The number of patients we saw seemed to get lost because it was one after another, after another.  It was the faces of the people I couldn’t get out of my mind.  I didn’t take time or maybe it was that I wouldn’t allow myself to let things actually sink in until I got home.  I got home and the first few days were very hard and emotional.  I felt almost paralyzed when I tried to go back to my normal day to day routine.  Nothing seemed normal or the same and I kept thinking of everyone we had tried to help. The heartbreak was those that we just couldn’t do much for.  I cried for the woman who was 6 months pregnant and saw no heartbeat on the ultrasound and how we told her that her baby had died.  You never get used to that even in the years of labor and delivery nursing that I did.  I kept telling myself, God’s plan is greater than I know and understand right now.

The orphanage.

I was encouraged to do things that I wouldn’t normally do on my own.  Thanks to my roomies, Kate, Mary, Molly, Vanessa, Laci and Kelsey for helping me become a little more adventurous and see as much of Haiti as was possible in our short week.  I am forever grateful!

Morning team meeting in the guest house.

You frequently hear about how a mission trip is a life changing event.  As true as it is it also seems like such a cliché.  For me there were conditions and challenges beyond my imagination.  The barefoot children walking on the rocks and rough terrain up the hills, laundry and bathing being done in the river, people coming to the clinic hours away and patiently waiting hours to be seen.  The Haitian people are good people and deserve more.  They were thankful for our presences and happy for the most part.  I’ll never take for granted what we have in the U.S.

Hike up the hill behind the hospital.

I am blessed and I am thankful.  So even though this is one more event crossed off my bucket list, I can not turn away from the work God calls us to do.  I’ll continue to help in as many ways that I can.  Do I see another mission trip in the future, yes for sure!  Not a day goes by that I don’t think about the Haitian people we have been blessed to help and serve and also the entire mission team.  Our mission work is not done and I am the one who has been changed and blessed!

Blessings,

Linda Carlson

PATHOLOGY FROM HAITI

I just now finished going through all the pathology reports from the specimens we brought back.  There were 11 specimens from ENT.  I don't know about Urology or OB/GYN.

I've made an individual page for each patient to return to Dr. Gardy, the Haitian doctor who administers the hospital in Pierre Payen.  Each page has the name, location of the biopsy and diagnosis along with a photo of the patient or tumor.  It was hard to keep them all straight.  The handwritten names were hard to read and I had some spelled differently than the lab, so it took very careful comparisons.  Fortunately I kept a written list on my phone of all my operative patients and their diagnosis.  I'm very glad I took as many photos as I did.  Many photos included the specimen bottle right over the registration paper with the patient's name on it.  I'll e-mail them to Haiti, but also hand deliver them when I see Dr. Gardy in May when he travels to Nebraska.  We are hoping to have him speak at Federated Church either May 18 or 25th.

Of the 3 massive thyroids, 2 were multinodular goiters and one was a Hurthle cell adenoma.  Not cancer.

Multinodulaar goiter, 32 years old. She did great!

We had one Hodgkins lymphoma and one squamous cell carcinoma in the ear.

Hodgkin's Lymphoma.  This is a very treatable and potentially curable type of cancer.  I have been in communicaiton with him via the internet and he may be coming to the US for treatment.  Pray for him.

The cheek lesion in the 12 year old boy, even with a generous biopsy is inconclusive.  I put my money on a parasitic infection, but they didn't see any parasites.  Very weird.

Cheek mass.  Parasite? 

There was the worse fungal sinusitis I've ever seen without being a 'face-eating fungus'. It was eroded into the eyes.

Fungal sinusitis.  If you look closely you can see polyps in her nose and the left eye deviates outward. 

The massive facial tumor looks like a salivary gland malignancy.  This was posted a few posts back and is worth looking at if you haven't seen it yet.

The massive jaw tumors included ameloblastoma.  There is another picture posted earlier.

Ameloblastoma.  A low grade, slow growing malignancy which could be cured by removing his jaw.

Squamous cell carcinoma of the jaw.

Squamous cell carcinoma of the jaw. 

 An odontogenic cyst.

Odontogenic Cyst.  The oral pathologist from UNMC is still looking at this.

There was nothing straightforward in Pierre Payen.

We have so many "worried well" here (yes, there is even a diagnosis code for "worried well"), that it just messes with my mind to see so much really dramatic and terrible pathology so concentrated and so advanced.
Please pray for all these folks who did not ask to be born in a country without the capability to treat these early.

Ciao. NN

GUEST BLOGGER - KIM HARM

Today's guest blogger is Kim Harm, BSN, APRN, PhD.  Kim has worked in primary care and is opening her new business, Harmony Health and Wellness.

The trip to Haiti was life-changing. I was able to go on the trip with wonderful people including my husband and my best friend. I feel so blessed to have met others on the team who have such high character and devotion to serving God and their fellow humans. It was an honor to work along-side these wonderful people. I felt part of a great team in our clinic setting. I was so glad to get to work with my husband but it was great to meet and work with Dr. Mark, Linda, Dr. Shirley, Kristie, Kate and Molly.

I was initially struck by the poverty. I felt it hard to choke back tears on the ride from the airport. I prayed God would not give me more than I could handle here. I have seen poverty on TV and in pictures but seeing in person impressed me beyond my ability to express.

Laundry day at the stream.

I had the opportunity to work at the poorest part of the hospital, where those who cannot pay are placed. The conditions were deplorable. I was sickened. There was no privacy offered to a woman with intractable diarrhea and vomiting at the bedside, in the middle of a room, with a bucket. The beds were lined up in the room and privacy must be for those with money. I was able to see Dr. Joe evaluate a woman who had been suffering with abdominal pain for 2 months at home and then suffered for 9 more days in the “hospital” before she was seen by a physician.  She had not had a BM in 10 days.  Finally on this 9^th day of moaning in pain in the hospital with no diagnosis she was seen by Dr. Joe. 

The community hospital across the street.  We filled in for nurses while they went to the seminars.

Community hospital.

This was my first sobbing episode among all the tears shed. I cried for her suffering, I cried for the lack of care available, I cried for poverty. At home if she were this poor she would have Medicaid and could go to the ER after one hour of pain and demand sophisticated tests to rule out every possible life threatening issue. She had been not suffering for an hour but for weeks and weeks. I shed tears from some shame of the abundance and waste of my own culture. I shed tears feeling there was nothing I could do. So I prayed. Fritzi caught me sobbing and I rambled about all these feelings and she talked me down. She said not to feel any shame but instead be empowered and offer what I could do. Shame only promotes negative feelings and we as Americans have a lot to make up for when it comes to Haiti. We have insight in how to elevate their status by education so I worked to educate on self-care as best I could. This is what I love to do at home and I found many opportunities to educate in the clinic.

Molly, Fritzi (from NYC) and Kim at the front entrance. 

My second opportunity at the poor part of the hospital was a quiet afternoon. All the staff were in the educational sessions offered by the team and I and an interpreter were “in charge” in case anyone needed anything. So I prayed again so that they would need only what I could handle. Then I got to visit with my interpreter who only came back to Haiti 3 months ago. He had been living in the US since he was 11. We compared and contrasted the cultures. He reviewed the history of dictatorship in the country and what he thinks would improve the status of Haiti. It was easy to see how superstitions develop with those who are poorly educated trying to make sense of the suffering and illness. We talked a bit about voodoo and how this developed to help explain and treat suffering and illness. It makes sense when witnessing poverty how one might feel cursed when they get a large tumor on their neck. I visited a woman whom Dr. Novotny removed a huge thyroid. She was lying quietly in bed that afternoon. She grew a huge smile on her face when I checked her incision and talked with her about how much better she must feel without that football at the base of her neck. Her whole face lit up, her eyes were bright. I did nothing heroic in Haiti but I was proud that my friend with her surgical skills did. She helped this very poor woman who likely had little hope of being cured of her curse. More tears, more prayers of thanksgiving. Then among the poor conditions of the hospital with the heat and sweat a wonderful cool breeze came through and lovely blossoms from a tree I had not noticed were falling like the snow I left back home. It was beautiful. I felt I was where God intended me to be at that moment. So many friends at home were praying for our trip and I felt it. I felt prayed for.

Dr. Novotny with thyroidectomy patient. The mass was as big as a large eggplant. 

I was also touched that despite the widespread hunger and daily stress of trying to exist in poverty, everyone wore their very best to the clinic. Haitians are very proud people it seems. One elderly gentleman was in a threadbare button down shirt but it was neat and tucked and he wore a belt. His hem was tattered but trimmed neatly, his worn out shoes were laced, and an old hat he removed when entering the room. One woman was very sick with metastatic cancer and could barely walk with leg pain using a stick as a cane and she was coughing up blood. Even she was dressed up in what seemed like her finest dress and hat. She was found to be dying of metastatic lung cancer spread to her neck and her femur. Ethically she was difficult for me because her family refused to allow us to give her the diagnosis of terminal cancer. The son was upset that nothing could be done and asked what we would do in the US.  Even at home this advanced of disease could not receive curative treatment. They could not afford pain medication and there is no system in place for refills of pain medications I ordered. I talked to our pharmacy team and Sandy graciously said she would give them everything she had to allow this woman to go home and die without the terrible pain she was in. As a former hospice nurse I have seen how painful metastatic cancer seems and it was humbling to think that despite all the poverty, hunger and daily suffering of these individuals, they still must suffer even more. More tears. More prayers.

A treadmill in the carport. 

After I was done with clinic one day I snooped at the hospital side looking for my friend Wendie. The asthmatic young woman many have written about was in the hospital. Everything is open there and a group was gathered at her door. (So open in fact that I saw chickens walking through the hospital). I joined in even though I knew I had nothing to offer. I was impressed by the breathing pattern I saw, she was gravely ill. I was touched by Kelsey’s description of the efforts to save her with limited resources. Her deep caring and effort to work so hard on her tells us all what a wonderful physician she has become. I prayed. I prayed harder for her than I think I have prayed for anyone except for the children with cancer in my community. She is so young and otherwise so very healthy. She was still with us the next morning and maybe it helped, maybe it helped Kelsey get the strength to stay up with her all night. Whatever, I hope it helped.

Chicken in the hospital.

In my practice at home I try hard to live my faith. I look for Jesus in my patients, even the drug seekers who resort to all sorts of storytelling and manipulation.  But in Haiti, there is no need to look. Jesus looks at you with big brown eyes in every room, in every encounter. Jesus is everywhere. God is great. Those who have done anything like this know what I mean. I returned from the trip and was amazed at how I felt. I felt good that I did something good for our global community but was it enough and what can I do to serve more? More tears. More prayers.   

Kim