Before & after pictures of Dennis, our favorite patient.  He had a very, very sad story and we hope & pray that he will have a much improved life after his surgery.

In surgery with Dean giving anesthesia and surgeons, Dr. Carstens & Dr. Berry.

Tamra polishing nails!

KENYA -Heathrow airport

We're sitting in London Heathrow airport. We have a 5 hr layover here. There's a mall (of sorts) in the airport but it's mostly things like Harrod's and Burberry's of London so a little out of our price range. I saw a little silver python clutch in Harrod's for only £625. That's about $900 I figure, so just admired it! It's so interesting to see people from all over the world wandering around. It turns out there is a shower here that I used for free. It was really nice as it had been a couple days since the last shower and a lot of dusty bumpy roads since then.  Friday was spent traveling to Nairobi. It was all highway and closer to Nairobi it was 4 lane divided highway. It was interesting to see the cows, burrows, sheep etc along the road even as we got into the city. There were vegetable gardens and burrows grazing in the median in places. Then random roadside stands just up next to the highway so you could pull over whenever you saw something you needed. We stopped to buy souvenirs in a couple places. One was a bead making place that hires single mothers and needy women. You could walk into the shop and see them making beeds, painting them, firing them in a kiln then making the necklaces, etc.  Wherever we shopped things were definitely Kenyan. None of this "made in China" stuff here. For supper Patrick made us reservations at Carnivores. When you walked in there was a big BBQ charcoal grill with all kinds of meat cooking. It reminded me a little of Hu Hots. There was a menu board with one price at the top then a long list of meats including crocodile and ostrich. So they brought a little bowl of leak and potato soup then a salad on a lazy Susan that you could take what you want family style with a choice of sauces round the top. Then waiters came one at a time with a long sword with meat on it. One had chicken, then another pork ribs, beef, ostrich, lamb, ox balls, crocodile etc etc etc. you could say 'yes' or 'no' on each one so they would put the point of the sword on your plate and cut off a piece of whatever it was or drop a meatball on your plate. We had a little flag on the table that we left up as long as we still wanted more meat then we laid the flag down when we "surrendered". I've got pictures but am using Kevin's iPad so can't load them right now. We are all willing to visit with any group and give slide shows so don't be afraid to ask. We have sooooo many stories we haven't even begun to tell and more pictures than you can count.

Being in London at least ends the bathroom adventures! The toilets flush with toilet paper right there and no squatting options to even consider. Tony came with us as far as Heathrow. The rest of the team from Omaha and Fremont are traveling through Amsterdam. We'll meet them in Mpls but Tony is going through Atlanta and already took off. He entered the team late when someone else dropped  out at the last. We are looking forward to being in our own beds tonight. 16 days is a long time to be gone and although we've toured around and seen a lot we also worked hard under difficult circumstances and unique challenges. We've come away with yet a new view of the world. The Kenyans were welcoming and the country is beautiful. NN

KENYA

Ready to leave. Minalyn came to see us off. She's the one who hires disabled, HIV etc. I gave her the few sewing kits we had left and done erasers, crayons, etc. she will distribute them to someone in need. She's the one who has helped arrange transport and surgery for Moses, the boy with the broken leg. There is a picture of her and one of Moses with his grandmother. His mother was murdered and never knew his father. He had been in traction for 3 weeks and needed surgery in a different hospital.

Thank you God for today, a blizzard, warmth in my home and time to reflect on the trip I just safely returned from.  As like my previous trip to Nica, I re-live each thing that took place which included laughter and tears of joy and sadness.  I am so humbled and honored to have shared this experience with this unique team comprised of fellow Christians.  Yes, it seems as though we are attempting to empty the ocean one eyedropper at a time but...we did make a difference.  I had such a wonderful time working with "my sister" Carolyn.  Dean is right, we work hard but we play hard too :)  Karl, Sue,  Catherine, Dean and Cole all worked overtime in their respective areas.  At first I had regretted that I hadn't been back to Nica since 2010 but in the end it was okay.  I saw OUR TEAM, members from California and Nebraska be one, work together without any hiccups AND to work with 4 new docs??  Yes, God was the travel agent and did a great job!  Thank you to each person who helped make this trip possible, who supported us with money, prayers and good wishes.  We absolutely couldn't do this without you.  Your friend in Christ, Tamra Boettcher

Nicaragua Reflections

Well we made it home. What a trip it was! I apologize for not blogging during the trip but it seemed I was always looking for something like a shower (even a cold shower) and sleep.
This trip was different than any of the previous three but thay have all beeen different. The bonding of the Califonia contingent and the Nebraska contingent is complete. We are one team. Working with the Nicaraguan doc's was amazing. They were so devoted to making a difference in the lives of their people not just medically but also spiritually which is what always calls me back to this place. We did a huge number of what to us might seem like minor procedures but to those patients it was very important. I think they really appreciated the fact that we travelled so far to care for them in ways that they would not get if we were not there. Obviously the need is endless but to those we touched we made a difference. We showed them that a group of people lead by God care enough to come and minister to there needs if only for a short time.
I cannot begin to say enough about my fellow team members but I will give a little insight. It was great to see the Tamra and Carolyn show back together. They get great things done but no one has more fun getting things done than those two. It was great to get to know Dr. Cole. He was always available to help in what ever way he was asked. He is a great example to the Nicaraguans of what a good God fearing young American is like. Karl does not get near enough credit fot the lives he touches with his mechanical and carpentry work. They may seem like small things to us but  again it shows these people that there is a group of American's that care enough to travel year after year to help them in what ever way we can. Catherine was the Pied Piper of Puerto Cabezas. She was always surrounded by what seemed like dozens of children showing them what the love of God looks like. My OR sister Sue was amazing. She probably had the most pressure to perform of any of us. We were without Keveta from CA who has always run the OR and we had Nicaraguan doctors that we knew nothing about (no pressure). Sue handled it like this was nothing new.
My thanks to all of you that supported us though your donations, your prayers, your messages of encouragement or just reading this blog. You have all read about Dennis's story and the work that God went through to get him to us. This is exactly the reason  I go and will keep going as long as I can. It is your support in the ways I have mentioned that make this trip what it is.
Dean

We will try to get more pictures posted.

Nicaragua Team is HOME!!

I am happy to report that the last of the Nebraska contingency of the medical mission trip is home, at last.  Dean & I got back to Columbus just before 1:30 this morning and Sue & Karl would have made their way to Lincoln before that. 

Our day of travel yesterday on Little Corn Island started by arising around 5:00 AM to be ready to walk to the other side of the island.  We followed a teenage boy who carried our bags in a wheelbarrow to the dock where we hopped on a panga (water taxi) to take us back to Big Corn Island where we would catch a plane back to Managua.  We were about 5-10 minutes away from landing when the motor cut out.  We spent a couple minutes bobbing around in the ocean till the driver was able to get it going and we crawled the rest of the way in. 

We flew to Managua, had something to eat and a couple hours later got on our flight to Miami.  Everything is going very smoothly at this point.  We got through customs and immigration & picked up our bags and were very pleased how well the day was going.  We were going to be leaving for Dallas when the pilot mentioned over the loud speaker that there would be a short delay because a light needed to be changed.  We knew we were going to have a tight commection in Dallas so that was a bit worrisome.  A half hour later we leave and we're all hoping that they hold the plane for us especially because, by this time, we had heard Dallas was going to have bad weather move in there and Omaha was expected to get 9-12" of snow during the night & Thurs. morning.  Well, we ran to the gate and were hearing last call for boarding to Omaha for "the party of 4".  We made it on with NO time to spare.  So needless to say, we're happy to be home!!

What an amazing 2 weeks we had.  Our medical mission trip was awesome.  The need in Puerto Cabezas and the surrounding region is so huge and the work seems never-ending.  We can only touch so many people in the short time we're there but we do what we can and the people are so appreciative.  The "Dennis' " are why we keep going back.  I haven't had time to read the other blogs but his story is somewhat different that what I reported earlier.  Apparently, he & his caretaker felt they had to lie (not really sure why because he still has a very sad story) in order for him to get medical care.  But his mother is alive but kicked him out of the home because of his disfigurement from his cleft lip.  His dad is dead but the stepdad beat him.  Thank goodness for the wonderful man who took him in and took the time to seek out care for him.  It was said that he would be going to the orphanage to live but can't because he & his caretaker would get in trouble in the village they live in.  Instead, they will return and discuss it all with the elders of the village and hopefully Dennis will get permission to go and live there. 

How Dennis got treatment is a miracle in itself.  He & Enus (sp?), the caretaker, traveled to Puerto Cabezas but didn't know how to find the hospital.  They were wandering the streets when one of the nurses from the hospital (Alice, who was a huge help to us during the week) took a different way to work that morning to the hospital and saw them.  She saw his cleft lip & immediately took them under her wing and got them to the hospital and then he was brought to the compound to see the doctors for evaluation.  From there everything moved very quickly and Dennis had surgery that day.  Can you imagine how scared this poor boy was having a bunch of strangers flashing lights in his face, to see his mouth and palate,  taking pictures, sticking him with needles and hauling him to surgery only to wake up from the surgery in pain with his face so swollen?  But he was the best patient and we can only hope he can have a somewhat "normal" life, whatever that could be for him. 

I could go on and on with stories of our time in Nicaragua but there's too many to tell.  We were very busy so didn't have the time to blog a lot but hopefully we were able to give you a peek into what we did and why we do what we do.  We have many pictures and will post some.  Stay tuned for more.  Thanks for following our story and keeping us in your prayers.  We hope to return to Nicaragua next year!   Carolyn

KENYA

We had no Internet at al last night so no communication back home. Someone got a secret password this morning so now we're all posting before we head to work for the day.

Kenya - MacGyver John's report

I thought it was time to make a post about my experience here thus far. Like most 3rd world mission trips I have been on, the usual challenges have presented themselves. In a nutshell I suppose a few themes sum it up. 1) Lack of money for needed items, services etc. 2) Lack of organization on many levels 3) Lack of desire for change by the locals and 4) Poor condition of most local equipment and available resources to fix them. This is not surprising as we are serving in a high need area, so it all goes with the territory. Normally you don' t do mission trips in low need areas, so we knew what we signed up for.

Most of my days are filled with trying to fix or patch equipment, processes or logistics to support what needs to be done. I've worked on electrical problems (which are abundant), ran errands (equally as abundant), organized supplies and materials, assisted in the operating room, etc. here, I can freely walk in and out of an operating room, and that be considered "routine". I'd never do that back home.

Yet, there is a feeling of accomplishment at the end of the day. You hope that there is a sense of teaching/learning by example more than forcing "our way" on others.

Our combined Columbus/Omaha teams have been great to work with. We all have high points and frustrations we share at some evening meetings. The food is definitely Kenyan (lots of stew, potatoes, room temperature milk, mangos, etc. Sometimes I think they are trying too hard to give us their gourmet food, and sometimes we long for just ice cold drinks (no ice routinely here), a greasy burger and fries, or something besides Coke. But the food is safe and nutritious for the most part. Only drinking bottled water though.

Other highlights of the trip have been the safari, which we got some bonus sightings you usually don't see (like the circle of life with a lion kill aftermath being cleaned up by the hyenas and vultures, monkeys, leopard, and Masai village tour (local indigenous people).

Each mission trip is unique, even if repeated. We are thankful for all the folks back home that helped in some way to get us here. As with most mission trips, we probably get more back than we give. Signing off for now.

John

KENYA - Back to Naivasha

We did a morning bush drive today near our lodge and saw a herd of about 8 giraffe, one with the umbilical cord still attached, but up and running.  We then had breakfast and were on the road by 11:30 for the 4 hour drive back to Naivasha.  Part of our safari included a trip to a Maasai village where the warriors did their jumping dance and then the women sing.  The village is inside a stick fence which keeps out predators (like lions) at night.  They are herders and legend says all cattle in the world belong to them.  Inside the circle fence are about 10 huts made of sticks and dried cow dung which stands up even in the rainy season.  The village has about 60 or 70 people and the houses make a circle inside the fence.  The houses have a walled off area where the young calves and milk cows stay so they can have fresh milk every day.  They have large horns that they collect the milk in, mix it with blood, etc and drink it.  They also let it ferment to yogurt.  After the dance and singing they took us in groups of 4-6 into the huts for a tour.  The chairs were about 8" off the ground and you could only stand up straight in the middle of the room.  They sleep 8-10 per hut.  There are 2 bedrooms.  The total house including the cow room is quite small.  I'll put in a picture since I'm not good at estimating the size.  I know it's not as big as the smallest house in Columbus.

Maasai guides with our driver, Patrick

Maasai warrior jumping dance

The guides all said they were in their thirties thereabout when asked how old they were, but said they don't really count their age in years.  They count by seasons, so really if you ask when their birthday is they can only tell you it was in the rainy season when they were born and they don't know the date or year.

Megan joining the jump

Maasai home

The women all lined up and sang about mama and rain.

Maasai women singing

Inside entrance/seating area

Left side is father's bedroom.

Cooking, to Rt is women's bedroom

 The guy in red is the chief's son.  His father has several wives and they each have their own hut.  You really had to duck and squeeze to get inside.

Inside cooking, eating area

KENYA

Serious conversation between Dr. Stice and John leaving the lodge for Naivasha. About lives impacted. Many times unknown to us.

KENYA Olarro Lodge safari

We went on a bush drive near the lodge this morning and will be headed back to Naivasha at 11. We need to get back before dark. I've heard stories of bandits on the road but haven't seen anyone suspicious anywhere. We saw a herd of 8 giraffe this morning. It was really awesome to drive around near here and see that and a herd of wildebeest, zebras an all kinds of gazelle and impala which are a dime a dozen. Then add in the Maasai herders with cattle, sheep and goats, there is a lot to see. The land is kind of like western NE or Eastern CO. Dry season now so dusty grassland with bushes scattered about. Savannah. The big difference is there might be a lion or leopard under the bush! We had a leopard walk right in front of our cruiser yesterday.
I'll see if I can put on a couple pictures. Again the good pictures are on my camera so these are from my phone.
One picture is hyenas and vultures at a Cape buffalo kill.

KENYA

The safari was more than I could have expected. We had 4 Maasai warriors each driving Toyota Land Cruisers with knife, traditional costumes that they really wear from their villages along w cell phones. They go to guide school to do this and are quite good at finding big cats hiding out in the bushes. We saw about 5 lions and one leopard (hard to find) along with the usual giraffes lots of elephants. Hyenas chewing on a Cape buffalo carcass with vultures standing by just like you see in TV.
Then we went to a Maasai village. We were pounced on by the ladies selling bracelets, carvings etc. thrusting their arms into our vehicle. Putting stuff in our hands. "Only $5" "only $10" etc. turns out John and both bought about the same thing. We got to see their jumping dance and sing with the women. Then toured their stick and cow dung homes. You can stand up straight only in the center if the house. Then we went to their market where we each got a personal shopper who would hold on to anything they thought you'd like then bargain got it in the end. The price came down 90% in the end so we got some things.
We have to head back tomorrow. I'm already worried about what trouble we'll have in surgery next week but have thoughts on it all. This has been quite an experience.

KENYA - safari

In case anyone was wondering about this man cave. John and I have our own room. Mosquito nets and all. Nila

Nicaragua

Our mission is complete...Karl, Sue, Carolyn and Dean are on their way to Little Corn for some much needed and deserving R&R.  Cole, Catherine and I will take the second flight to Managua, spend the night and head to NE tomorrow.  This has been another mountain top experience.  We truly are ONE team here even though we come from different areas.  Dennis is doing extremely well and is staying with the Orphange nurse for a few weeks to monitor his recovery process.  God has blessed us beyond belief and it has been an honor serving HIM.  Until next year...Tamra

KENYA Friday 2/15/13

I finally have reliable Internet and a little uninterrupted time to write. We've had quite the trip and quite the day. There are so many new things every time I turn around. This is not for the faint of heart. 

The week of surgery was full of ups and downs. It was a little frustrating because most of what I found to do was tonsils which is a slick and easy thing to do for the most part.......  Unless the electricity and equipment doesn't work and then it's a nightmare!  Dr. Stice had it right when she brought what she calls her entire OR with her including her scrub nurse and a supersonic electrical transformer. I think I wore out Kristy, Wendy, Megan and Kevin, who took turns scrubbing for me. They were all enthusiastic and quick learners (thank goodness) and helped each other out as they switched back and forth but I'm sure they all have a new respect for an experienced scrub nurse just as we've all come to respect the areas we've gotten to participate in that are outside our usual comfort zone!

The weird ear tumor I found the first day in clinic popped out like a marble. He's got terrible ear disease deep inside his head still though he said the pain was much better and now he can sleep. Patients like this tend to bury their heads in the sand about the ear as long as it doesn't bother them but it will come back to haunt him some day so I told him he will need to go into Nairobi to see someone who has the ear equipment that Naivasha doesn't have. I got a lead on an ear microscope from an ear group in Michigan that they might donate. We (mainly Dr. Stice) are sending a large container of medical equipment when we get the $10,000 cost to ship it so we might get the microscope to send along. A new microscope will cost $20,000 so it's a bargain if it gets donated. The new hospital isn't open yet for lack of the proper electricity. Surprised?  We saw a huge electric station on our drive today. They get electricity from thermal power from nearby volcanoes. 

The drive to the Maasai region today was littered with goat and cattle herds grazing along the roadside. You couldn't drive a half mile without seeing them. There are scattered donkeys in the mix. In Naivasha there are donkeys pulling cards with water barrels. They buy water at the Catholic Church, which has a well. Then they drive along the road selling it to households and businesses. 

John has been befriended by everyone around the hospital with something to fix and that's about everybody. The maintenance guy is eyeing his tools so John will give an in service on how everything works next week and leave the tools with them. 

I wish I could post some more pictures but I'm using Johns iPad and most of the pictures are on my good camera so I can't easily transfer them. Please read The links to Kevin, Wendy and Megan's blogs. I think you have to join to read Megan's but the others you can just click on. Also Molly and Erin are posting lots on their FB pages and I'm putting others on FB Columbus Medical Mission Team - Africa. You can look at it even if you are not on FB since its a public page I think. 

Well, I'd better head to bed. We have a wake up call at 5:30 am. We leave for the safari into the Maasai Mara game preserve at 6 which they say is prime rhino time. We get tea and coffee before leaving and eat breakfast and lunch in the "bush". NN

KENYA Safari

Somehow Cindy managed to get us Kenyan rates on both he hotel in Naivasha and the safari. I've had the most fun I've had for a long time! Laughed so hard I thought I'd die! We traveled 4 hrs. 3 on good highway and 1 on a very bumpy dusty road to get to the Olerro hotel in the Maasai region. They had us walk through the bush for a bush supper. We saw zebras etc along the way. Then a 5 course meal and topped off with Maasai worrier tour guides for tomorrow's safari! They drove us back to the hotel in the land rovers we'll use tomorrow. John and I are in a suite "the man cave" with Ray, Kevin and Tony. It's awesome. Look it up in the Internet if you're interested. Molly knew what to expect. I'll post a picture of the room. Gotta go to bed. We're getting a wake up call at 5:30 for the Maasai Mara.

Nicaragua 2013

Nicaragua 2013

Nicaragua 2013

KENYA - GOING ON SAFARI

We didn't have internet last night so didn't get a chance to blog.  I had a record day.........  When I took my gown and gloves off after my last case my entire scrub suit was drenched in sweat from my neck to my knees.  I have to admit sweat dripped into the edge of the field a couple times, but not in the wound.    A lady walked in during the morning with a large neck mass.  I thought Dr. Wachira and I were doing it together, but in the end he went to eat a bite, then when he came back he thought it was going so well I didn't need any more help so left without me knowing.  He lives in a different city.  At any rate, in spite of no AC and John spending about an hour on the floor trying to connect and reconnect the suction and cautery along with the fan we did well and she looked like a million bucks today.  She was in her 20's and had the mass growing for a couple years.  I'll try to post a couple pictures. The drain situation is interesting.  The little tube I thought would be a suction drain, but then realized we can't do suction drains so I put in a penrose drain (the larger one).  I rebandaged it and she'll stay in the hospital over the weekend while we're on safari.  

Gotta go.  Safari leaving.


 Then I helped Dr. Stice with a huge ulcerated scalp.  You can't imagine it.  We removed about 2/3 of his scalp.  Thing of the worst cystic acne x 10 and add large open ulcers grapefruit and pineapple size with skin 3" thick in places.  He lost a lot of blood like you could imagine if you've ever had a cut on your scalp.  I won't post pictures of that.

Nicaragua

Sorry but I forgot to mention how busy Karl has been.  He has been working on the house for a nurse who takes care of kids at the orphanage.  He house has been broken in several times and is quite delipidated.  Karl, along with RJ, have been working on fixing up her house and making it safer for her.  He is the all around fix it guy and is surely the most popular person here.  EVERYONE wants Karl!  We could not get along without him. 

Now, off to supper.    Carolyn

Nicaragua

Can't believe we've been gone a week!  We have been VERY busy so unfortunately, we didn't have time to blog on Wed.

Our day started off yesterday with a young boy (Dennis) being brought to the compound from a village in the jungle a day away north of here.  He was accompanied by a man who was his present caretaker.  He had a very nasty looking cleft lip.  He was evaluated by the doctors here and was immediately sent to the hospital to prepare for surgery later in the day.  As his story unfolded, we learned that he was 16 yrs. old and looked no more than 12 due to years of malnutrition.  His mother had died and his stepfather had beaten him.  Dennis had been wandering through the jungle.  It was very emotional for all of us to see such a sweet boy and know that he has a miserable life.  He got to ride in a pickup to the hospital and didn't even know how to open the door.  He hid his face as he was ashamed of the way he looked.  Many a tear were shed over him yesterday and last evening.  He is doing well post-op and was expected to leave the hospital this afternoon.  We hope his life will be improved with his "new lip".

Tamra and I have been working almost non-stop helping the Dr.'s with minor procedures such as scar revisions, mole removals, biopies to evaluate for skin cancers, keloid removals, etc. We have worked with all 4 of the doctors but primarily Dr. Gomez who was one of the co-founders of Nicaplast and who runs a medical school in Leon. Today we did 22 procedures by 1:00.  Would have done more but we had to give up the operating room that we were working in to a Nicaragua dr. 

Dean & Sue have kept very busy in the OR's, Catherine with the children's ministry & Cole has been everywhere helping wherever he has been needed.  He has done a great job and we're all hoping he chooses medicine for his career.  He would be a great assest to any medical community he would choose.  He has the loving and caring spirit that would make him a wonderful dr.  Catherine's experience as a teacher has served her well.  The children have enjoyed their time with her and have been blessed by her talents. 

We have been so blessed to be working with 4 wonderful doctors.  They LOVE their patients and it shows.  They are very caring and take special care with each and every one of them.  Dr. Kurt shared with us last evening some of his story and said that his faith in God has become much stronger because of his experience with us this week.  He was very touched by Dennis' story as well, and felt very honored to have been involved with his care and treatment.  Dr. Taez (not sure if spelling is correct), ENT, is a pastor in Bluefields and has been a joy to work with too.  Dr. Gomez has shared many of his experiences with us and is a very interesting gentleman.

A special treat for me last evening was being able to attend Mass and Ash Wednesday services at 1 of 3 Catholic churches here in Puerto Cabezas.  It was a big church and was completely full.  That was a pleasant surprise to see so many people there in spite of the heat.  I found out during a procedure with Dr. Gomez during the day that he was Catholic and was hoping to go to Ash Wed. services.  He invited me to go along if time allowed and it all worked out.  I was a bit nervous on the cab ride back to the compound though.  It's pretty scary being out at night here in PC and we've heard stories!  Services started at 6:00 and we didn't get back to the compound till almost 8:00.  Dean & others were worried when I was gone so long and I promised that I wouldn't go out again when I would be after dark getting back.  I surely didn't realize services would be so long.  But it was a good experience. 

The surgery crew is still at the hospital but those of us that are at the compound will be eating pretty soon.  Hope all is well back home.  The time is flying by quickly for us here. We're all well here!
Carolyn

KENYA UPDATE

I'm up sitting on the balcony with Tony and Kevin. We decided to post an update on the various jobs here.  I'll start with Tony Waweru.  He's been giving anesthesia in the OR.  He's working Dr. Betty O. and Wycliff O, CRNA.  We have 2 ORs with 2 tables in one room and one in the other.  Only 2 anesthesia machines are currently working so the 3rd table has locals and sedation.  We have an anesthesiologist also, Jeff Hawthorn who is working mostly with Wycliff.  Tony (originally from Kijabe, Kenya) says his biggest challenge is finding where stuff is.  A scrub tech, Micheal, seems to be in charge and is THE GUY who knows where things are.  Tony says he's using it for job security. The picture is Mary, who does instruments, Wycliff and Micheal.  He is the best interpreter around.

Kevin worked in clinic today.  He helped Laura do wound care on the wards also.  There are some horrendous wounds.  I will not post those pictures.  His biggest challenge the language.  He's used to speaking Spanish so this is hard.  Some patients seem to know some English, but not much.  The illnesses he's seeing, especially the burns on children are heartbreaking.  Laura scrubs and debrides them while they are screaming.

Our OB/GYN team is really busy.  Dr. Norton and Dr. Schulte brought in an emergency C section with the Medical Resident from Washington holding his hand inside with the mother on her elbows and knees, pushing the baby off the prolapsed cord, counting the heart rate.  They got everything ready, rolled her over onto her back, put to sleep, C section as fast as you could blink.  Turns out she had TWINS!!!  Mom knew because she had 2 blankets and 2 hats.  Everyone else was surprised.  She was prolapsed when she walked in.  Molly, Erin and Wendy are in their element in L&D, but we stole Wendy and Megan today to scrub for me (Dr. N).  Kristy scrubbed for me yesterday, but when we realized there was no one in Recovery and that's what she does back home, we rearranged.

Wendy and Megan traded off scrubbing for me today.  Wendy just walked up here.  She says the hardest part is paying for Kevin's pop and water (LOL).  The hard part is knowing what she needs before you need it.  The suture makes her crazy.  We've got tons of spread all over in cupboards and totes in the new and old hospital.  I think she's locked in for tomorrow at least.  We wore out Megan in the morning.  It was pretty hot and the cautery smoke did her in.  She ended up going shopping later with some of our other women to the place that hires HIV, disabled, orphaned and criminal folks to give them work.  They make beautiful stuff and the rest of us will get there sometime.  Wendy finished up my last case and then helped out Dr. Stice, Diana and Joan doing some major burn scars on a 16 year old who was playing with gasoline near a fire months ago.  Bad idea.

Wendy, Dr. N, Med Student in OR.

Kristy with my first tonsil in PACU

John baled us out on the cautery and sharpened the adenoid currette at the blacksmith and got the tool to sharpen the other ones. HERO
Dr. Dumitru lectured on CHF and Caitlin worked on the stove project.  She's extremely enthusiastic so it will be interesting to see how it goes.  Good day today.  NN

KENYA 2-13-13

Dr. Schulte doing an ectopic pregnancy that came in through the ER right as we were preparing to start surgery. Then there's a picture of one of the many signs posted in the hospital with the costs on them. These signs are also in Swahili. This is quite different from other missions I've been on. Working side by side with the local ENT doctor and having lots of students along slows things down immensely. Then add in equipment failures, using Kenyan equipment and electrical problems it can be quite frustrating. My ENT colleague had never seen the tonsil mouth gag I use or how to do a tonsil with cautery. She said they only pack the adenoid and if its still bleeding some surgeons hold the babies upside down so they don't choke on blood. A novel approach. She also
Was very curious about the nasal septum I did as she apparently doesn't do them at all or does them very differently. The L&D nurses are trying to convince the nurses that fetal monitoring, fundal checks and Oxygen on newborns who don't move much are useful things to do. Today they are going to work on post parting things I won't go into here. They are extremely enthusiastic. We're going early today to make rounds. Two of the horrible tumors are going to Nairobi. It looks like both are lymphoma and need chemotherapy rather than surgery. The parotid mass almost fits under my hand if its fully stretched out. She can't hardly move her head and also is HIV positive. She can't go start chemo till she has $200 to be seen in Nairobi and so will probably die soon.
It turns out there is stew at every meal so guess. What we're eating?! NN

Nicaragua

Hello, my turn today.  It was another busy day at the hospital today.  From what I could see,things moved more smoothly today, but a lot of that is being in the rhythm on that second day and knowing what you are facing.  However, by way of a disclaimer, I am in the childrens ministry end of things, so have a very different perspective from the docs and nurses.  I have the wonderful job of coloring with and meeting the children who throng the hospital, children who are patients, children who are with patients, or children who just wander in from the neighborhood because the hospital is a safe place to hang out.  They are precious.  My Spanish may be useful, but today I found that it would have been a lot more useful to know Moskito.  Most of the children that came today spoke Moskito as their primary language.  Luckily there were bilingual children, too.  Yesterday I was very distressed that there were any kids there because here it was the first day of the new school  year and they should all have been in school.  According to many of the children they do not go to school because they cannot afford the uniforms and supplies.  Others say that education is not a priority for many of the people.  Either way, by today I had had an epiphany.  I was there to do school for them.  We covered a wall with beautiful art throughout the day and I think we succeeded in raising the morale for some of the patients and families that passed by also.  The place is so bleak, peeling walls, trash everywhere, dogs eating the trash in the middle of the courtyard in the middle of the hospital, an old army barracks, open plan with outside corridors.  Our team is a model of efficiency passing by the chaos with patients on gurneys, doing incredible things.  We have a new nickname for Cole, which is Dr. Cole.  He has been observing in the OR and has been witnessing some amazing things.  Today he spoke of the removal of a cancerous tumour on a ninety year old, which involved some plastic surgery for reconstruction.  He said it was incredible to watch.  Something quite interesting today.  There was a team from Lincoln, Nebraska, Union College, in fact.  They had run into some trouble and had had a large amount of money stolen, which was holding up their trip, but they were learning about things at the hospital, and then two of the California team members took them on a tour of the orphanage here at the compound.  Speaking of the California team, they are so much fun to work with.  I for one am learning a lot from them.  Karl and RJ continued their work on Maria Elenas house after getting everyone shuttled to and from the hospital, and shuttling drinks and lunches and fixing things as needed.  Ask Karl to tell you about the six head cattle drive along the main street followed by a vaquero cowboy on a bicycle. Sue said to say that surgery is going remarkably well and we are blessed with some amazing surgeons and she is blown away by their expertise.  We have also commented that the doctors are some wonderful human beings that are great fun to get to know, who are not at all standoffish, and happy to share their knowledge.  It is a blessing to be here to be a blessing.  Thanks to everyone for their support and prayers.  Catherine

KENYA

The hotel rooms.

KENYA

This is our hotel. You can see 4 rooms. Kevin, Ray and Tony are upper left. John and I at right below them with the open door. The other two rooms have some of the women.

KENYA - Tuesday 2-12-13

Just before we left for the hospital yesterday Nila with Megan, Erin, Molly and Caitlin in the restaurant at our hotel.  You can see what the view is like.

These are some pictures of the hospital.  It's surprisingly clean all in all.  I haven't seen a dog, horse or vulture yet.  Rumor has it that dogs make it in there.  Megan took particular interest in the ambulance.

Below are birds nesting on Lake Naivasha on our hippo tour, then is our boat driver, Paul and the long awaited hippo.  We saw maybe 15-20 total, but this was the only one who would fully get out of the water to accommodate my camera.

Nicaragua Monday evening

Monday February 11

We are finished with Monday - At the hospital it went good the docs did amazing work and it got off to a great start for the week.  There were tons of kids at the hospital and about wore the childrens ministry out.  This is the day to do our shopping trip around town and get a few things that we were not  able to get in the totes.  Right now we are done with supper and we are getting showers and doing our skyping and our magic jack phone calls.  So far it has kept up the tradition of raining - much but enough to raise the humidity that is already at about 90+ .  Tomorrow RJ - Oscar and I are working on a house that belongs to the nurse at the orphanage.  It has been broken into several times and has had their pots and pans stolen and etc. Steve from the church put in a new door on the front today and new knobs and locks that RJ brought from Cal.  Tomorrow we will put in the back door and put some new siding on and do some work on the windows - shutters - windows - bars-  Thank you all for all of your support -  we could not be here without your support.   God Bless You. 

Love Karl

KENYA - Day 1 at the hospital

I will keep it short as there isn't good internet tonight for some reason.  There's lots to tell.
It looks like it won't let me load any pictures.

Today was the first day working in the hospital.  We had 3 clinics; Plastics, GYN and ENT.  We sent 'troops' all over the hospital, but mostly to OB and Pediatrics to see what they want us to do.  The nurses were frustrated by their lack of resuscitation of newborns and the new hospital isn't up and running yet, so we'll work out of the old one.  We had a warm welcome from the CEO at the hospital and were surprised to find an physician from Washington University in Seattle who is living here for a year.  The have a program to help improve medical education here and she's involved.  I won't go into the details, but it's a very ambitious program which includes students and residents from the US and Nairobi who do rotations here so we'll be working with all of them.  As far as my clinic, the patients were preselected by the ENT who comes here from Nairobi 2 days a week.  It was tonsil, tonsil, tonsil, tonsil, horrible tumor, then tonsil, tonsil, tonsil, horrible tumor, tonsil, tonsil, tonsil, inoperable horrible tumor that looked like a large melanoma in the roof of the mouth.  Only one nasal septum, but almost every patient needed surgery.  Very interesting clinic.

There is a lady in the women's ward with a huge parotid tumor covered with a bandage who just came in today.  Maybe big as a grapefruit if you partially flattened it on the side of the head.  We'll do a bandage change tomorrow and get a better look at it.  The pediatric ward is 4 rooms side by side with large glass windows for walls with 8 metal, white paint peeling beds in each room.  Most of the kids have what appears to be a mother with them, but some are orphans.