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

Monday 22

Well, I'm both tired and wound up. Everyone else is asleep or at least in bed, but I'm up like I was last night thinking about things tomorrow. Carolyn and Tam (I think) had my camera today. I put in a couple pictures from the OR. You can see Pete, Eye Dr. turned dermatologist operating with Lionel. Then there is Keveta, Sue and Jody. They are exhaused tonight. And, last but not least proof positive that they have a fly swatter in the OR. Notice the shoe holder behind Jody. It's the perfect way to organize suture, gloves, blades, etc. The California team dreamed it up and kept it for us.

It panned out that my worry about today was correctly placed about how to deal with a man with a large nasal tumor. He came advertised as a polyp (no big deal). Let's see, didn't I think that before??? Well I scoped him last Friday and knew it wasn't just any old polyp. He had a biopsy done in Managua months ago that said inflammation, but it wasn't just that. There is no CT scan to be had here so I pondered what it was, etc, etc, etc. He was 2nd to last of 12 cases today. The day was going incredibly smoothly up until the tumor was found to be attached quite tightly in more places than I expected, but I was at a point of no return. 3 units of bleeding later I got the tumor out. It was about the size of a golf ball, way, way, way in the back. Then it started REALLY BLEEDING. Finally 3 more units of bleeding later, I had in the most heavy duty pack I could make and we had it well controlled. Sue scrubbed, but pretty soon Jody and Tam were retracting on posterior pack sutures. Never mind that I accidently hit Sue pretty hard when one broke. I'm hoping she will forgive me. I still don't know exactly what the tumor is. I've cut a deal with our pathologist to look at any unusual specimens I bring back so there is a little piece of it that will find it's way into my suitcase so the patient won't have to wait the usual month for a report........

By the way, the emergency tracheotomy patient was up and talking to me today. I should be able to take it out tomorrow. Tonight I'm going to worry about the 11 month old cleft I'm doing tomorrow..............

The team is working together so well it's unbelievable. They are making it look easy inspite of the conditions. The best bathroom in the hospital is right by the OR. There is no toilet seat or paper or flushing handle. You have to pour water in to kinda' flush it. There is a big tub of water beside it with a big scoop floating in it to get the water to pour from. The floor is wet, it's just gross, then there is no sink to wash your hands.
Around the corner is the scrub sink with city water (undrinkable) till noon and a PVC pipe with a wrench type handle with other water that was collected from somewhere else??? I don't really know. I have TP in my backpach at all times and use lots of hand sanitizer. Later.... NN

1st day is over!

We're finally done with our first day of surgery! Some of us went to work at 6:30 am and we got back after 8:00 tonight. Long day but pretty amazing. I worked in surgery and cleaned and sterilized surgery instruments. The conditions are NOTHING like any of us are used to. Pretty unbelieveable, to say the least.

We Americans are spoiled. Yesterday we spent some time with children from the orphanage. It's amazing to see how little it takes to make them happy. Giving them one little "smartie" will make them smile from ear to ear. They are very loving children and so well behaved. It can make you sad to think that their future will more than likely be very bleak.

Others are in line to blog. Time to shower and go to bed with no blankets necessary!
Carolyn Athey

Monday 2-22-2010

I visited with Scott Boettcher tonight by skpe, I am still amazed that the technology exists to do audo/visual over the internet from such a remote place like we are in.

Today was our first official day of scheduled surgery, about 11 cases in the OR, and Dr. Diedrichsen had many skin lesions in a minor procedure room.

We are having fading memories of snow and cold, with each day being upper 80's with about that much humidity.

Other team members will be blogging later, limited time right now as we are all just getting back from the hospital (8:00pm or so).

Later

John

Good evening all...we have had a relaxing day which is good. We need to be well rested as tomorrow is the start of a crazy week. We went to church as a group and it was extremely hot and humid. We were served lobster tail for lunch...for those of us hoping to lose weight this trip, not a chance! We then got into our swimsuits and loaded up the kids from the orphanage and headed to the river to swim. That was a blast! We are now just hoping that those of us who swam won't be getting sick from the water. Pete, John and I jumped from a 20 foot cliff into the water because we could and as Dean says...he can say he didn't because he didn't want to! The kids are warming our hearts and are so happy, respectful and kind. They fell asleep in our laps on the ride home, wanted us to play with their hair and of course loved the candy we shared with them today. When we got "home" we packed some things and took them to the hospital in preparation for tomorrow. Pete and I are going to do some lesion removals while Nila does her surgeries. Carl and John were trying to fix a fan in the room that we are going to be using and spotted...a bone on the floor. The bone is a human bone, probably from a previous orthopedic surgery? It looks like part of a leg bone. We haven't seen the rats yet, but have been told they will be running through the rooms that we will be working in. I am NOT excited about that, especially if the lights go out, come back on and some beady eyes are staring at me-you will hear me scream in Nebraska.

For those of you who have read about our excitement last night. The man that had the emergency surgery is doing bueno!!!! He is stable and comfortable. He has no family, it is very sad.

Well, it is going to be a short night - thanks for the thoughts, prayers and blog responses. We love hearing from you all. In His service, Tamra

Uh,.....what they all said. There is a class clown in every group, and they are paying me big bucks to perform that role. Now where is that scalpal? John

Other thoughts

You know that God is with you when the the worst airway you have seen in years is 'after hours' in a third world country and everything turns out for the best. The challenges are great but so are the rewards. Great to have a full change of clothes. Dean Athey

Despite the obvious poverty you don't hear any complaints. The mornings are beautiful. Pete

The roosters start crowing around 4:00 to 5:00 but are still able to sleep our room is one of the lucky ones that has air conditioning when the electricity is on. I know the experience is just beginning but is and will be one that will last a lifetime.
The list of lives that we have touched is growing and growing. Today breakfast is @ 8:00 - church at 9:00 - river in the P.M. with the children from the orphanage.- two school bus loads. Karl Tillinghast-

So far this trip has been amazing. I could not have asked for a better team to travel with.....at the last minute. The people that we saw at the clinic yesterday were awesome! It's neat to know that by taking off a mole, here they call it "ditzels" can really change their lives. It could be cancer. It could be cosmetic, but whatever the reason, they came to us with so much hope. The hardest thing yesterday was knowing that we had to turn people away. There are so many wonderful things that we are about to experience and do this week. We are all so enthusiastic that we are here to help them. These people are strong and they are tough and it's going to be good! Thank you for all of your prayers and thoughts! We NEED THEM and so do all the people of Nicaragua...... Melissa

Emergency

We we were all settling in for our evening team meeting around 7:30 pm when a General Surgeon from the Hospital, Dr. Cespedes showed up looking for the "Otorino" (that's me). He had a patient about 40 years old who thought he got a fish bone stuck in his throat about 8 hours ago. He wanted me to come and help get it out. "Fish bone", I thought, "no big deal. " I've seen lots of foreign bodies including many fish bones. I'd get to show them how easy foreign bodies are. They are one of my favorite things. Quick, easy cure. So we gathered up a few instruments and my headlight, a fiberoptic scope and scrubs. It turns out Dr. Cespedes came in the Ambulance to get me and was a little anxious. I went along with Dr. Diedrichsen (next to me) as assistant, Tam Boettcher to photograph our first emergency and Dean Athey (at the head) in case we needed to put him to sleep to get it out. Suzie and Keveta (green print hat), the nurses here who know the system well, came along to keep track of us. When we got to the ER there was a man with a neck as swollen as any I've ever seen. A little guy with a NFL linebacker thick neck, in obvious distress. I won't give all the details, but the option was to 1) put him to sleep, do a tracheotomy to secure an airway and then see what was in his throat, or 2) let him die. We decided we would go with #1. Dean gets the big award for putting him to sleep with much finesse and securing the airway with me standing by with a knife in hand and neck scrubbed. Once we had an airway Dr. Cespedes (across with no headlight) and Dr. Diedrichsen (next to me) assisted me (black headlight) in the tracheotomy which went without a hitch. We then had time to look at the massively swollen throat. There was no foreign body, no abcess, no obvious infection and no real explanation for the problem. There is no CT scanner here so we couldn't get one of those. I kept asking if we could get a white blood cell count to check for infection. They didn't seem to know at first, but finally decided they could. I have to confess they never did draw any blood, but they said they would. We couldn't just leave a breathing tube in through his mouth because there is no ventilator and he would have to be kept asleep if he had one, or he would thrash around so much it would come out and lose his airway. We left him in the ICU on antibiotics and steroids with a tracheotomy tube stitched in and no family anywhere. The ICU nurse had to hunt awhile to find some suction and oxygen, but we left him there stable for the night with oxygen and suction. We got home about 11 pm. NN

Cleft

This is the cleft on the schedule for Tuesday. Pete will help with it. NN

Saturday

To say this is an adventure to this point is an understatement. Nothing bad has really happened thus far but our initial vow to remain flexible sure has come in handy. The flight finally out of Managua was calm and beautiful. The plane held exactly all 12 of us and the flight was a little over an hour and a half. We were then brought to the airport terminal where we waited for our carry-on luggage, most of us had 2 pieces of luggage which "houses" the necessities, underwear, scrubs, toiletries, etc. Well, it is Saturday and most of us STILL haven't seen our luggage. They say it is still coming, we remain hopeful and flexible :). The food is fabulous and the compound where we are staying is better than expected. Yes, the showers are cold, but it doesn't matter much. It is hot and we are working hard and sweating a lot! Yesterday we toured the hospital which is not far from the compound where we are staying. It is in much worse condition than what any of us expected or saw in the video. I think I can safely speak for the group, that we were and are very humbled and that a lot of us walked around with tears in our eyes when we saw the poverty of the people here. The pictures of the hospital are heart-wrenching. These people are kind and appreciative. Some of the team even got to see a baby be born on the initial tour. The team from California left today so the "ball is in our court". We held a clinic today at the church. We saw approximately 140 people from 8am-1pm. We have established the surgery schedule for the week and will be doing miscellaneous things that come to the hospital during the week as well. We will try to blog when we have electricity and time, not much spare time and the electricity is sporadic. We are safe, feel safe and are enjoying the challenges before us...Tamra

Managua

The hotel, Las Mercedes is a Best Western with a good menu and a couple of swimming pools as well as free internet. We ate supper which was delicious and sat poolside to visit and looked around a little. We're headed off to bed now since we are all VERY tired. I'll put in some pictures of the trip. The surrounding area is quite poor. This is like a little oasis. This is a picture of the appetizer, fried plantains and fried cheese (goat, I think)with refried beans in the middle. There were some pickled chopped onions on the side too. The food was good. NN

Trip

We left Columbus on the blue bus Boris at 1:30 like planned, flew Omaha to Houston, changed planes and on to Managua without a hitch. We met Susie Miller from the Villa who took our tub for the orphanage and the Villa just as planned and loaded the other 31 tubs onto a Toyota pickup which took off on the 14 hr drive (if the weather is good) to Puerto Cabezas. The one snag in the plan was the wind near PC was blowing so hard our flight was cancelled so we called Susie, then our contact in PC and are now ensconced in Las Mercedes Hotel across the street from the airport. We'll get up at 4 and be at the door of the airport before 5 when they open the door. If you get bumped you get first chance at the next flight, but only if you are THERE. Then we'll take off at 6:30 and get to PC at 8. We still may beat our tubs. The hotel is as nice as it gets here. NN

Loading

We loaded the bus at 5 pm tonight. The only glitch was the autoclave weighed too much so at the last minute we had to abandon the plywood box Tom Shemek worked so hard to build. We took it down to UPS who are masters at packing so now it's bubble wrapped in exactly the right size box. We'll meet at Federated Church at 1:30 am, drive to Omaha with breakfast from Kathy Shemek, meet the Continental 'group representative' and get our tubs boarded. We leave at 5:45, change planes in Houston and land in Managua a 12:30. Then we go to La Costena (the local airport) and get on the 2:30 flight to Puerto Cabezas. The plans have changed a couple times, but it looks like this is how it lines up. We'll spend all day Friday working with the Redding, California surgical team and learn everything we can about the OR and hospital there. Saturday will be clinic, Sunday church, Monday-Friday work. Home on Saturday. Pray for us. NN

Awake

I've been laying awake at night thinking about all this. Last night I was going through the logistics of 300 patients in one day of clinic. Some get turned away because they have something we can't treat, but even half is a lot more than the 20 I usually see in one day. PED and Tam B. will see them with me, but that is still a lot. I better bring a few extra tongue depressors! NN

Change

The plans have changed again. We got an e-mail from Jeff Thompson in PC last night saying we will be going straight to PC from the Managua airport instead of the night in Managua. This has changed back and forth a couple of times so far. Part of the problem is the planes to PC can't leave too late because they don't have radar so 2:30 is the latest one and we don't know if we'll get throught customs fast enough. We have 32 tubs of supplies. We won't get to tour La Chureka (the dump) or the Villa and drop off our supplies for them. One of our goals is to be 'flexible' so this will work out just fine no matter how or when we get there. Our Harmonic Scalpel and the suture hasn't arrived yet....... NN

Planning

The plan now is to get the last few things packed. We are still waiting on the Harmonic Scalpel (which cuts about 1/2 hour off a thyroidectomy), and our suture. It was supposed to be shipped Feb. 8, but we still haven't got it. We have some backup suture that will get us by if it doesn't show up. Both of these are from Ethicon, so I'm not too impressed with their helpfulness in this, but I can't change it. The big blue bus, Boris will pick up our tubs and carry on luggage at 5 pm Wed. Feb. 17. We will all meet at Federated Church parking lot at 1:30 am to board the bus and travel to Omaha. Continental is opening early just for us and all our "stuff". We have 32 Rubbermaid tubs, 18 gal each filled with equipment, medicine, gifts (sewing kits, medical books, stethascopes, toys, books, jewelry, lab coats, jump ropes, toothbrushes and toothpaste). We have a few snacks too, for ourselves. We have 2 tubs of tools for John and Karl to fix things with. Most of the clothes I'm going to wear, but leave there so we'll be traveling light on the way back. This is a picture of Boris. The Missions committee at Federated is having a prayer vigil while we're gone, so if you want to sign up to pray, call the office 402) 564-2812,and let them know, E-mail would get you on the list too. jrains@federatedcolumbus.org NN

Commissioning

We headed off to Lincoln to be commissioned at 1st Presbyterian Church where Sue and Karl go, but had to turn back when we hit a white out blizzard a few miles out of Columbus. Pete was with us and Tam and Scott B. were going, but didn't because of the weather also. I hope all went well for Sue and Karl, but the roads were just too bad. Nicaragua is looking better by the minute. The last thing we heard was it was hot and dusty, the bugs are out in full force. This is the best season, between the hurricane season which just ended and the rainy season which starts in June. I included a nice picture of the snow. Note the flags flying straight in the wind!! This was taken out my front door when we got back home. NN

A week from now, Feb. 18th, we will be in Managua, Nicaragua! And on Friday the
19th, we will go on to Puerto Cabazas where our work will begin.
Time has flown by so fast and our adventure is soon upon us. Please keep us in your thoughts and prayers. CKA

We were commissioned yesterday at the Federated Church, praying for a safe and fruitful journey. It was a very nice service. We had our final group meeting. Things are becoming more "real". It is 10 days from now that we will be in Nicaragua. The planning, fundraising and hardwork had really paid-off and brought everything together, quite amazingly I may add. I personally am really looking forward to getting to know each of the teammates better, in a whole new light and hope to have a meaningful and productive trip. Keep coming back to the blog...it will be our intent to update daily! Tamra

More packing

I spent all last evening packing more stuff. I had another informative visit w/ Suzie Smith on the phone mostly about travel arrangements and customs. Once we get through customs the adventure can start. We're adding on more supplies all the time and have more to take than we really should, so we may have to pair down a bit. NN