The lines were even longer today!

As I write this I am “on break.” It’s Wednesday about 1:15 pm and we are short on translators at the moment. It’s easy to see how important our translators are to our productivity-- the “doc room” is running at 75% right now. I worked with Socrates, the reincarnated Greek philosopher and also our tour guide for the trip to Machu Pichu trip on Friday. We have really great translators. They have been with us so much now and heard us take so many medical histories that if the complaint is say, constipation, we can almost say, “Marco—cue constipation follow-up questions aaand—GO.”



I have officially brought pain medicine to Cusco. I’ve injected trigger points, occipital nerves, tendons and a couple of sacroiliac joints. I even had a perfect opportunity to do an epidural steroid injection today but like a dummy, I didn’t bring any of the needles I needed. I started to try to McGyver a block together but finally decided it wouldn’t work. The patients seem amazed every time. One little man with headaches and upper back pain walked out smiling and saying, according to the translator, “It’s unbelievable—my pain is GONE!” Unfortunately at this point, since the docs have kind of been competing for procedures like joint injections, various yucky aspirations and so on—we are running out of needles, syringes and anesthetics. I resorted to using a 22 gauge which was the smallest needle I could find on a guy today for trigger point injections. But as I said, these folks for the most part are not complainers. He was very happy to be having a doctor do an injection to help his pain regardless the size holes I put in his back.




This was the "It's unbelievable. . ." guy.


The people were lined up down the block today when we arrived today. We triaged 250. Only 220 came through. I must have played my cards right today. I only saw a couple of kids. I also treated among the many a family of Quechua people (hope I spelled that right). They are decedents of the indigenous native people and Inca. They come down from the mountains. They are farmers and have their own very distinct dress. The women customarily wear thick skirts and hats. They are a very simple, docile people. We had two translators going for this family: Quechua to Spanish to English. It was labor intensive.

Overwhelmed...

So, I don't want to disappoint any of you that have become familiar with my husband's awesome use of words and "catch you off guard" humor, but I had to interupt regularly scheduled programming to make an announcement. It's not the announcement you are expecting when you see the title. I know most people are probably jumping to the conclusion that I'm talking about being overwhelmed with three crazy girls and a household that doesn't stop just because one of us (a MAJOR contributor to our day to day operations... more on that later) is away. Far. Away. But I'm actually handling that part really well. I'm overwhelmed at how much this mission trip has blessed me already. I had in my head when Jason first mentioned this trip to me that it would be beneficial to him. That's what I kept telling myself, anyway. I knew he would be blessed and forever changed because of the work he was able to do in Peru, and I knew our family would be forever changed because of that also. However, I didn't realize how directly we would be changed.
First of all, I appreciate so much the things that Jason does... with no expectation of praise or thanks. For example, yesterday I realized that we hadn't gotten mail since Friday... wait... we had gotten mail, I just hadn't gone out to get it. Jason always brings in the mail when he gets home from work. The mailman doesn't drop it off on my counter. Jason does. Duh... how dumb is that!? I just hadn't thought anything about getting the mail, because he does it.
I have had to ask him a couple of times what day the garbage man comes. Thats' just something he takes care of. And I wasn't thankful for that before, but I sure am now!!!
Bedtime at our house has been one of the main times when I miss him. He's usually the one leading our devotional thoughts and now it's up to me. Again, it's not a problem at all to do this, I've just become accustomed to him doing that.
The other half of my team is missing, and I think we make a pretty good team... if I do say so myself.
However, the most important way that I've been overwhelmed this week has been the outpouring of support from my sisters at church! I mean, seriously. I'm blown away at the calls and cards, the texts and emails, the facebook encouragement. You guys are the best!!! You know who you are. There have been so many people to tell me they're willing to come and keep the kiddos so I can get out by myself, or just take a shower alone. There have been so many people that have lifted me up and told me they're proud of me. I didn't expect that. At. All. I don't know, I guess I thought I would be the unsung hero in this whole deal (which I'm very comfortable with... since that's pretty much motherhood in a nutshell), but I can't believe how much people have given such sweet praise to me. Me!!! Thank you, everyone. I can't even start to tell you how much that means to me. Seriously. I think I'm going to make it. I have to make it. Warning: the girls may not have their hair combed for church, and I daresay they'll be dressed alike, but we'll be there, Lord willing, and we'll be really excited on Sunday, because our team will be complete again!!! Thanks again to everyone that has made this week so much easier for us. A special thanks to my mom and dad. You always drop whatever you have going on to come and help me and just knowing that's the case means the world to me. You spoil my kids rotten and I. Love. It. I also wanting to thank Che' and Jonathan for coming to support Adelaide and Lucy at their spring program. They were crushed that Daddy was missing it, but super excited that "their friends" were coming. Thanks to Lauren and Daniel and Suzanna for also meeting us for ice cream after the show. It means so much to know that I have such an enormous support system here. We are so blessed. I love every one of you. Thank you!!

"Halfway there"

I can't stress enough how hard everyone is working when by the end of Day 2 I heard several folks saying, "Whew! We're halfway there!" Today was as expected. The patients we saw yesterday went out and told all their friends and by 7:45 am, there was a line of 10 to 20 outside waiting to get through the door. When we hit 200 this afternoon it was still before closing time and there was a crowd pressed up against the door so we let a few more in. By the end of the day we had seen over 220 patients and set up 97 bible studies. The patients are very expressive of their gratitude, something that is unfortunately a rarity in medical practice in the States. Today our process of moving patients through was smoother. There was hardly any downtime. Everyone ate lunch in shifts so we kept all the areas open. Come to think, some people may not have sat down for lunch at all but ate while still working. Barton, Matt and Gary have done a thoroughly outstanding job putting this first medical campaign together and running it.

Well there seems to be a competition going between the optometrists, Jason P. and Rick, and the lone physical therapist, Jason W., to see who can take the severest beating. These guys are WORKING. In my area with Dr. Kerr (my "Attending" as I call him), Jarred and Lori, we had just as steady business but then there are four of us to divide the load. Many patients are signed in at triage to see all of us, MD, OD and PT. Many patient visits involve an adult and a child or children. In my case today, screaming children. You see why it may take a while to get all the patients through? During the wait times they may have a bible study with Gary or Matt and others. Everyone is at least asked if they would like to schedule a bible study. The last stop before the patient leaves is often the pharmacy run by Jeff and Kellyn.

The doctors--me, John Kerr and Jarred Sartain. If we had our own daytime talkshow we would call it "The Doctors." And our show would have real doctors on it.

So I am not a pediatrician. For that I am thankful. Jarred said he would swap me tomorrow two headaches or a constipation for one of my kids. I may take him up on it. He said I sounded like I was remembering a lot of peds from what he could hear during my interviews. I said I was simply trying to remember what Dr. Hamm (our kids' pediatrician) said about such-and-such. For instance after wailing 8 month old with abscessed tooth and 18 months old who was falling down too much and 14 year old who was too short, I finally lost it on "Not eating. Only candy." Rather than write Mom a prescription for "one swift kick in the butt q day" and "get your act together q 4 hours," I proceeded to lecture the boy "you can't eat just candy because your teeth will all fall out, you're gonna get fat and you'll feel terrible all the time. Get up, get some exercise, eat better food and do what your mama tells you." He sucked in his belly to show me he wasn't fat. "Not yet," I said. I promise that's what Dr. Hamm would do. Maybe not. I am not a pediatrician.

What have done about coffee you might say knowing Jason M. to be one of the world's most unrepentant abusers of caffeine. Our hotel serves a very concentrated coffee, about one ounce, in a tiny little pitcher every morning. I saw it the first day and thought, "Ooo good, Espresso" and poured and drank it. Later I noticed everyone else was diluting it with the separately served hot water. Those stains will probably never come off my teeth. Then there's the instant coffee at the church/clinic. Ok, but it's instant which makes it instantly an abomination. Finally, Gary told me of his favorite coffee shop, the French Alliance a half block from the building. The man is a saint in more ways than one because he brought me an 8 ounce cup from there first thing this morning. Soo good. Then of course I owed him a cup so after my lunch while still trying to recover from the morning pediatric onslaught, I walked down to the French Alliance to get two coffees. The funny part was school had let out and the sidewalks were filled with school children. I tend to stick out in most crowds for obvious reasons, but these kids were stopping and staring and I can't imagine they would have been any more shocked if Godzilla himself were walking down the street! Run for your lives!!! A giant gringo in scrubs has come to destroy Cusco!!!

More pictures to come tomorrow. . .

Bodies and Spirits

Well Day 1 in our medical mission to Cusco, Peru, the first such mission undertaken by the Iglesia de Christo missionary team, is now in the history books! I blog tonight from the outdoor patio of our hotel where it's probably 50 degrees but where I can wear my Peruvian style 'bogan without anyone seeing me and laughing. It was such an uplifting day. So many smiling appreciative people. So many good folks to work with from the State and Cusco. So many Jason's. Three of us exactly. We have agreed to go by J.W., J.P. and Jason with hair. Haha, ok so maybe I was the only one who agreed to that but it would cut down on confusion. The docs saw over 150 patients today. The MD's saw everything from the ubiquitous "gastritis," to rashes, probable parasitic infections, a massive post-stroke patient, end-stage cirrhosis, menstrual problems, back pain, and the very personal *ahem* male complaint which was from our last patient I saw at around 6pm. In the optometry room the 2 O.D.s were dilating and turning out the glasses as fast as fast as their ophthalmoscopes could go; they were buried in patients! The pharmacists were dealing drugs (the two hottest items were probably Prilosec and "Ibuprofeno") Our physical therapist, "J.W." was twisting and stretching folks and he had a line 2 or 3people deep everytime I looked. Meanwhile, Dennis Williams and others were literally waving people off the sidewalk and signing them up for bible studies. Mike and Nancy were on the frontline at triage when the tsunami hit at about 2 pm. There were so many others having bible studies inside, playing games with kids, fixing coffee and tea for folks waiting to see us, fixing lunch for us. Then there was Jedediah dressed as-- himself ;) Enough cannot be said about our interpreters as well, without whom we could not have done it. Fantastic day! I look forward to tomorrow as we keep working to show the compassion of Christ.

Just Jed being himself.

Pharmacists and the backporch Bible study team.

Jared Sartain, MD in action (or you can call him Zeus).

Yesterday we had worship with the congregation at Cusco and set up the clinic which is at the church building which is a renovated movie house. During the "meet and greet" time during service I shook the hand of a little, old Peruvian lady wearing the typical dress and braided hair. She had a sweet smile and a very pleasant demeanor so when she pulled me down to kiss me as per the usual greeting, I figured I could be doing worse for kissing a complete stranger. The next person I saw was my buddy from Hoover, Rick Williams. I said, "Rick, you really need to meet that little gray-haired lady there. She's really nice." As Rick took the bait I circled round with my camera to try to catch their special moment. I could see it on his face when she reeled him in, he knew he'd been punk'd!! I am so sad the picture didn't come out better.

In the afternoon we paid a visit to the artisan market where gringos go to try to out manuever the vendors on the prices of their wares. I apparently have a thing for these little, round Peruvian ladies (or vice versa) because first-- I am just not a good haggler. Second-- I just feel like I'm trying to cheat these nice, smiling, honest matriarchs whose only apparent happiness in life is to make my wife toasty and warm with a home-made alpaca blanket. Who could haggle on those terms? The last run-in of the night with one of these nice ladies who wouldn't take "no, gracias" for an answer occurred when yet again, I made eye-contact and she followed me a hundred yards across the Plaza trying to sell me one of her painstakingly hand-crafted gourds which was very nice of course and she'd give ME a special price. Luckily, I have been running a lot at home and I finally outpaced her. . . after Rick tripped her. :)

A very nice lady.

Finally, we kind of unfairly gave Mike Clelland a hard-time at dinner for "Miking out" and not eating the cuy, the famous Peruvian delicacy. Which is a guinea pig. Normally, I am all up for eating all things local: steamed mussels in Belgium, boyschl (cow lung) in Vienna. And I mean when will you get another chance to eat somebody's pet rodent?! What an opportunity! Oh, well. I did not indulge either. I settled for the alpaca steak which was good, but I finally felt like I was abusing this poor animal too much in one table sitting because I was also wearing a sweater made from an alpaca. Likewise, I did not indulge in the ceviche-style trout that was being sampled at the table. I'm sure it was fine but I'm really going out of my way this trip to limit my experience with diarrhea to talking about it with my patients.

Buenos noches amigos! It's starting to get cold out here!

Dinner at "Inka Grill." And now your dinner served on a bed of cedar chip and newspaper polenta. . .

View of the Plaza and Christ statue near our restaurant.

What's for lunch

Part of our group sitting down for lunch at the hotel Atlantis (not the one with the dolphins and casino).

Quinua soup which they apparently sell at Whole Foods in the States, and Chicha morada, a purple corn drink.

Aji de gallina, cheesy, peppery sauced chicken and rice with boiled egg and olives. Yes I made the face with it.

Arrival in Cusco

My fellow travellers to South America are people I have known at church but not really. You know there are lots of those you just pass, "Hi" "Doin' fine", maybe shake and head for the nearest person you really KNOW. Well, I don't think I have known Dennis or Nancy Williams or Mike Clelland and spending 8 hours waiting for a connecting flight like we did in Miami yesterday pretty well facilitates getting to know someone. This mission is blessed with these workers who bring a wealth of prior mission experience with them. They are undaunted by the long flights, ridiculous lay-overs and delays or chatty strangers in airports who make me want to get up and move to the next terminal. Neither are the 3 concerned that this mission is altogether different from their previous experiences this being a medical outreach mission. But they are here, eager to work, and ready to tell people about Jesus.

Dennis and Nancy are longtime Hoover church folk. They can tell you who worshiped there and when and probably what pew that person sat on. Dennis is the indefatigable Sunday a.m. auditorium teacher. Nancy is "just a housewife"-- her introduction of herself tonight to the rest of the mission team. I smiled and shook my head at that because anybody that's been married to "just a housewife" knows what a grueling job it is. The woman that can say that expresses it out of her typical selflessness and dedication to her family which always comes first. I admire Dennis and Nancy's tenacity and passion for foreign mission work. The Williams's also enjoy Starbucks which I found cool for a couple their age!

Mike is a veteran of Tanzania and Guyana. He is coming to Peru to do one thing: work. He is ready to be put to use wherever, however the team needs him. He is roadtested and has offered me a lot of pointers on travel in less-developed countries since this is my first time out in a city that lacks an espresso cafe, a pastry shop, and an art museum on every corner. Mike also reminds me of my dad in that he can pick up a conversation with any number of random folks in an airport and talk to them like he's known them all his life.

Tomorrow I'll talk about what we've eaten so far!

Oxygen hemoglobin dissociation

I used to love the adventure of international travel. If you were to ask my wife, she'd tell you I have done some pretty impulsive things while traveling. I used to buy a cheap plane ticket to some place I'd heard about, throw together a bag, buy a travel guide book and go. No reservations, no foreign language experience, no idea where I was going, not even a cell phone. I just went. Now is different. Today, when I left on my first medical mission trip to Cusco, Peru, I left behind a lot of responsibility and four sad girls and it just about made me turn the car around at the airport and go home. And if I didn't believe what I am doing is exactly what God put in front of me and intended for me to do-- I would have gone home and enjoyed a week of vacation with my family instead. The thought seriously crossed my mind today. Three out of four girls cried when I left today (you may find it hard to believe, but I haven't always had that effect on women :) Tiff stated it best and it was then that I realized the Lord's purpose in this trip. She said "what blesses you, blesses this family." That's when I decided I should go even if it pulled at my heartstrings; even if I thought I wasn't ready. But was Moses ready? Was Jonah ready? Of course not. Did God expect them to go regardless? Yes He did.

I will be doing primary care with about three other MDs and two optometrists at 11,800 feet. I only know one of the other docs. We will open clinic Monday and see as many people as show up for four days. When I say I don't feel ready, I mean I have not done any variety of general medicine since my internship *gulp* TEN years ago. Time flies, you know. I think it will come back to me. I am certainly taking enough equipment with me to make a good showing: a stethoscope, an otoscope, a pulse oximeter, some bandages, tongue depressors and sutures and a handy medical Spanish phrase book. Most of the stuff was borrowed from Dr. Marsha Wakefield, a colleague and foreign mission veteran at UAB, who, besides my wife, family and church has been very encouraging.

I have been taking Diamox, a mild diuretic medicine which I hope will blunt the effects of high altitude (this blog's title refers to the physiology involved). "Acute Mountain Sickness" is something I do not wish to experience. But the effects of the medicine the last few days has been strange to say the least. Besides pee-ing all night like a 70 year-old man, it has some unusual effect on the taste buds. We ate at Moe's on Wed night and the Diet Coke from the drink fountain was absolutely terrible. I complained to the counter that their Coke:carbonation mix must be off. He "fixed" it. I got a refill. It was STILL disgusting, so I got lemonade instead. The next day at lunch I met Tiff and the girls at Firehouse subs. We sat down and I took a sip of my Diet Coke and. . . *gag* "Their drink machine is goofed up TOO!" It was then it dawned on me, hmmmm, what are the odds of that? A friend had posted on my Facebook the same day her experience with acetazolamide also involved some minor taste alterations.

Please pray for our group's saftey. Pray for my Tiffany's strength, stamina and sanity :) She's the toughest woman I know, but even she has limits and Adelaide, Lucy and Juli push her to it sometimes. Pray for the success of our mission to attend to people's bodies and spirits. Like Jesus asked which is greater, to say rise up and walk or your sins are forgiven? The answer is implied since only He is the "Great Physician."