Day 14: DESTINATION-BANGKOK

February 28, 2008

Well today I started out with a bang and a goosh, and whoosh. I wonder who thought of the term “traveler’s diarrhea?” How appro po. I was the 2^nd one that I know of afflicted with this inconvenience on this trip. I won’t mention THAT other person but someone might ask “Ho was that?” Anyway I hope and I think that we should get hazard pay. Now I reported this to our team leader so that he may take epidemiologic statistics for future reference. He sympathetically replied, “Mark, I expected diarrhea of the mouth from you, but I didn’t expect this. I hope that it all comes out well in the end.” Touche! Shut me up! Well, I least my personal physician, Dr. Patton, was caring enough to prescribe me meds to stop up the dam while Pastor Jack hoarded the Depends (he learned from last mission).

ALL ABOARD!

According to our porter, Richard, all 36 bins and luggage are accounted for, and ready to go to the airport packed in a truck. A few from the LEC send us off from the hotel. One small problem. Someone rented the van that we were going to use to transport people to the airport. We scramble and flag down 2 tuk-tuks. How fitting and what a Kodak moment so now everyone has experience a ride in a tuk-tuk. I don’t want to be derogatory so I won’t say what it reminds me of but it’s a plastic surgery term. I can’t wait to go (literally). I’m tired of all this running around. We make it to the Laos airport and Ming does his usual group check-in expeditiously. If anyone wants to go to Thailand, et al, hire Ming, it’ll be worth it. On to Bangkok where we will rest, recover, relax, and regroup for a few days. It will be a stark contrast from the relaxed and quiet atmosphere from Laos. It is a welcomed retreat although some wished they could come home sooner, back to our loved ones. Some aren’t in a hurry because they brought their loved ones with them. We arrive in Bangkok uneventfully and it is one of the busiest cities that I visited. Picture congestion of LA traffic and New York people on the streets and the lights of Las Vegas with street vendors of, well, Bangkok, and you have Bangkok! We say our good byes to Luka our host in Chiang Rai who accompanied us to Laos. (Actually, he missed his flight and came back to see us. I really think he couldn’t bear to see us go.) We’ll see you this summer when FCBC mission trip returns to this same route to bring you Wheels to Heal, Wheels of Fortunate, or Chairs R Us (for wheel). Ming again uses his Thailand connections to arrange transportation to carry all of our luggage and all of us after again smoothly getting us through customs. You have no idea what a saving grace this is.

Bill rewarded us with another stay at the Grand Diamond Suites Hotel. We arrived in late afternoon and enjoy the luxury of spacious rooms and amenities and pampering after two weeks of roughing it. Andy quickly separated the king bed arrangement and put me downwind from the air conditioner to avoid my germs. Little paranoid? No pun intended (this time) but we’re pooped! We’ll plan the next two days according to our energy. Ming volunteered to provide some guided tours to the Grand Palace, Buddhist temples, Bangkok’s version of Epcot Center with architectural miniature versions of the various provinces. Some will catch a Muay Thai boxing match and others will go shopping with the remaining baht. How much difference 24 hours make.

As long as there is a reason to hope to help others we can dream to help. The members brought into fruition this mission to do what Pastor emphasizes: to serve and to sacrifice. You have heard our journey through my eyes and perspective and it is only part of the story. I have enjoyed writing this ejournal and I hope that you could have shared some of the emotions that we, as a team, as well as individually experienced. For those of you who have labored reading these lengthy entries thank you for listening; I hope that it helped some of you go to sleep at night.

I would like to thank a few people. They need no introduction and expect no accolades but when you see them please pat them on the back and say: Job Well Done!

Mr. Luka Chermu: Thank you for the opportunity to serve the Akha. You and your wife Ghan were terrific hosts and I thank you for your hospitality. It’s a pleasure to work with you and appreciate all the connections you had to make this trip a success. By the way, the ice coffee was NOT safe!

Britni Ho: Thank you for setting up the blogspot and taking these ejournals and doing what you need to do to make them available to our family and congregation know what we been up to on this lovely vacation sponsored by FCBC.

Pastor Danny Jack: Thank you for your vision and leadership in the church and the dedication for missions to allow members of the First Chinese Baptist Church Medical Team grow in Christ by this experience.

Mr. Richard Bruce: We appreciate both your brain and brawn giving advice and making decisions to keep the mission flowing smoothly. Your experience on these mission trips and knowledge of the geography was helpful and informative. Thanks for you concern about my health. I’m just getting old.

Mr. Ming Chong: As a member fluent in about seven languages, you are invaluable as a nurse, an interpreter, a resource, a guide, a food critic, organizer, custom agent assistant, and Thailand liaison (need I go on and on). You’re a good sport; we really didn’t leave you behind on purpose. Thanks for always being there when the team needs you.

Mr. Andy Alejo: Thank you for taking me back as a roommate. It’s difficult to be the one opening the floodgates and keeping the patrons behind the line. You were invaluable in directing traffic and assessing the patient’s needs, especially, the children. I’ll room with you anytime. Sorry about my mess and germs.

Mrs. Arlean Jack: Thank you for keeping Pastor in line. Your experience as a clinical nurse was helpful and you worked well in whatever clinic you were assigned too. I am sad we didn’t get to hear a duet with Rachel at the Akha church, maybe next time. Can I at least lip synch with you guys?

Mrs. Cindy Wu: It was great catching up during our 18 hours together. I’m sorry if you caught something from me, but I think I caught it back. Thank you for your laughter as it was always a joy and distinct. Your smile truly brighten up our days. As the better looking half (sorry Andy, I like hair) of the triage team your assessments help narrow down the problem and helped the docs get through the patients at a faster pace allowing us to see more patients. I look forward to working with you again.

Mrs Geraldine Jue: You are so pleasant all the time. I enjoyed working with you on these two missions because you start the day off with so much energy. You’re so nice and so kind; Ben you’re so lucky! You guys make a cute couple. (When can I get my “KEEP OUT” sign back? Thanks for keeping Ben company while David was away.

Mrs. Gail Ho: I’m so glad that you came along. I am sure Bill enjoyed you more than me as a roommate. When Bill’s happy, we are all happy. Your sincere affection for people and your empathy for the patients will have an enduring impact on the lives that you touched. You’re a really nice person and I know where Britni gets her sweetness from. Thank you for starting my day off with a smile.

Dr. David Chow: I didn’t know how funny you were. You kind of have my dry sense of humor. You’re my kind of guy, if I liked guys, but I don’t, but I do like you, but not in that way. You are a good natured guy willing to step up and pinch hit in the optical department without qualms or hesitation. Thanks for being flexible; the team and patients really needed you. Your desire to help patients was made perfectly clear.

Dr. Ben Jue: Thank you for your knowledge and advice of the different drugs and the patience to read all of our handwritings. Nothing seems to faze you. You are a great team player and I enjoy your laugh. You are a generous guy, hardworking, and dedicated.

Dr. Dennis Chinn: You have a no-nonsense approach to visual correction. Your experience over the years helped a tremendous number of patients. You gave them an immediate impact on the quality of their lives and literally allowed them to appreciate the world differently. Thanks for helping the blind so that they can see.

Dr. Akiri Tajiri: You are the epitome of stamina. You have a lust for perfection as a craftsman and optometrist. Thank you for challenging us to keep up with your pace and for the lifelong change to the people who can now see clearly.

Dr. Obregon: Thank you for your experience and the privilege of the FCBC members of working with you again. We gelled as a team even better this time around and we appreciate your leadership and coordination to allow this mission to be as successful as it was. I look forward to our next mission trip together. You are an inspiration for the dedication you have to help throughout the world.

Dr. Jack Patton: Thank you for being my personal physician and treating my ailments during this trip. I really didn’t mean to be a burden. Your soft spoken, Marcus Welby, approach to evaluating and treating the patient was exemplary. If only I could be so kind. Thanks for watching my back.

Dr. Doug Owyang: I would also like to thank you for keeping me out of trouble. Thanks for letting me toss ideas back and forth with you. It’s comforting to know that the patient can get a few opinions all under the same roof. Thank you for letting me know that you like to spend a lot of time on the computer yourself writing your own personal journal so that next mission YOU can be the designated ejournalist

Dr. Rachel Jack: It’s nice to see someone without gray hair on this trip. You remind me what I used to be at your age: energetic, eager to learn, and eager to perform new tricks. While only a rookie, you kept pace with the veterans. Thank you for reminding me what youth is and that I don’t want to act my age.

Dr. Larry Lowe: Thank you for always being helpful and able to troubleshoot any problem. You are a dedicated worker and seem to have that laughter and optimism no matter what happens. You never seem to complain (you leave that up to me) and just go with the flow. You’re just an all around nice guy and pleasant to work with.

Dr. Lester Lowe: You have a great sense of humor and are very resourceful and knowledgeable in just about everything. Thank you all the camaraderie that you’ve given me during these trips. I thank you for all the background time and effort in making those videos and I anticipate another one this year. It takes a lot of time to sift through thousands of photos and hours of video to make a succinct video and it will provide us with a nice representation and memories. Most importantly, it will be a lot easier watching your video than reading all these ejournals again!

Dr. William Ho: aka fearless leader. You really have to be fearless and confident to do the job that you do. You started with a desire and vision of not only seeing this mission trip to Chiang Rai but also to Laos. Not only did you have a vision for the medical and dental and optometric team, you foresaw the need for wheel chairs throughout this part of the world and have that in the works. For the past year you have been campaigning for the mission trips and part 1 has been successfully completely far exceeding our expectations. Although, “retired”, you are still working and you are a dedicated member of FCBC and God’s soldier. Being a team leader is an enormous responsibility requiring patience, flexibility, commitment, coordination, planning, politicking, and fundraising. You do this with economic considerations and practicality. You have been a great team leader and I am proud of you and proud to be on the team. Thank you for allowing me to be part of this team. Nice job, Bill.

Congregation: Thank you for letting me vent and letting me be silly. It help me document some things that I will forget later. Thanks for putting up with my typographical errors and misspellings and tangents and runs ons and so ons and come ons and going on and on and on. I know that I am usually a man of few words but what else did I have to do in my spare time? This ejournal allowed you to experience what we did almost in real time. I hope that you can appreciate the preparation and the sacrifices emotionally and physically and financially that the members of the team incur. The missions can always use your help because the budget dictates how far we can reach. The volunteer workers also have to be safe and comfortable so please support the missions by giving. The church accepts cash check, and credit cards with a photo id. Your hard earned dollars certainly got their money’s worth this time.

To my wife, Lena, Allison, Steven, Jennifer (who I may be able to go with next time): I thank you for all of your thoughts and prayers and emails and whose voices kept me going and lifted me up in times that I was down. I know that you worry when I am gone and I appreciate your concern. Thank you for letting me go on this trip especially during your birthday, Allison. I love you all so much and I can’t wait to come home.

As I gaze through my hotel window, I see a lit cross atop a church sitting in the middle of Bangkok. It is just a solitary light tonight, but with time, as we spread the Good News, we can hope that there will be more to light up the sky. As a congregation we all went to Thailand and Laos in mind and spirit and body. What a trip.

P.S. Good news. This is my last and final entry. Because for the rest of the time…What Happens In Thailand, Stays In Thailand!!!!!!!!!!

Day 13: DESTINATION: HATXAYFONG DISTRICT HOSPITAL

February 27, 2008

WALK IN THE PARK

This time we strategize our walk. Andy and I get a second opinion on directions and Dr. Owyang goes with us. We’re like the Three Amigos. I feel safe flanked by a kung fu master on one side and a black belt karateka on the others. Master, what is the best technique when confronted by a group of thugs?” I ask. “Grasshopper, your body is your temple and it is sacred. You do not want to blemish the outside fearing that you will have internal disharmony.” “In other words run your butt off and you make sure you are not the slowest one, Grasshopper.” We had a brisk walk to the Arche de Triomphe in Vientiane. The French influence is still apparent in names of buildings and businesses, like “La Petit Sushi.” There are a number of temples and the monks are seen leaving the temple grounds to go through their daily routine of walking and begging. Many people have already been to the market already and surprisingly, there are joggers. One in particular is running around the Arche and punching in the air a la Rocky Balboa. An elderly man is practicing his tai chi. We past the Presidential Palace, Laos’ version of the “White House”, and, curiously do not see guards or military presence. This is Laos PDR (People’s Democratic Republic) not referred to as the “C” word. I guess it is considered an alternative democracy. Lester and Larry have already had a head start and travel past the Arche and we can’t catch them. They get up most mornings and are even seen hitting the streets at night. Dave also likes to go out nights as well to hit the internet café. He had an encounter with a very friendly Laotian “lady of the night” the other night who grabbed his hand and greeted him with “$10.” “For what?!” he said as he grabbed his hand back.

BOMBS AWAY

We head out on the outskirts of the city near the Thailand border. We cross a bridge that connects the countries and is called the Friendship Bridge. Apparently where we are going they still have live ordinances from the Vietnam War in the ground and sometimes an unsuspecting individual will be killed or maimed when one of them explode. According to Richard and Pastor, Laos was the most bombed country in the world. What country in their right mind would have done that to this little country? US as in U.S. Who won the war anyway? Pastor, who is a lot older than me, gave me a history lesson. We travel down the road paralleling the Laos border. You can swim across the Mekong River about 2 miles wideif you wanted to escape Laos. There is not much separating the countries. It’s almost as easy to cross into Thailand as it is to cross the US/Mexican border. You can leave but you can’t come back. That’s the choice you make to escape the country. May you’ll never see your family and friends again. That’s the price of freedom here.

LAST STOP: HATXAYFONG DISTRICT HOSPITAL

Our last stop in Laos and our last day of mission work is at the Hatxayfong District Hospital. It’s somewhat comforting that there is a new addition being built. It is still a small building maybe 1500 sq. ft. The patients are already lining up outside jockeying for position. This is our last day in Laos so we are trying to see as many patients as we can. At first the workers did not seem to be happy that we were there. They weren’t smiling. I think we were more of an inconvenience since we had to move things around. In one “wing” there was a large bee hive with bees flying around INSIDE the building, so we had to BEE careful. I wanted to work over there in case there was a sting operation. The dentists are crammed into a room with a single dental chair which isn’t much use. Larry works in the aisle next to a door leading outside so there is good lighting with a slight breeze at least part of the day until the sun shifts. Rachel, Lester, and Bill are quite intimate by now and make do and it is getting hot inside their room. It’s a pretty routine day for the medical and optometrists. Clinic from my perspective is actually quite fun. I get to play doctor. It’s still a little our of my comfort zone because the perfect specialty for this job is family practice. But my surgical background also is invaluable if I had to do procedures and take it one step further. I have to dig way back into my medical school training to diagnose many ailments. Paroxysmal Nocturnal Hemoglobinuria. What is that patient doing in our clinic when it needs the hospital? Whether or not we can treat a patient is another thing and how long we can treat it is even only a short time. Several patients wanted second opinions for upcoming procedures, like a back operation. Many patients have gone to other doctors and are asking us about their treatment plan wanting assurance from the docs. Even a government official opted to see one of the American docs at one of our clinics rather than see one of their own. The patients are fairly appreciative even when we can’t help. Some have strokes, yellow hand syndrome, or burn contractures. I saw a 3 year old with contracted fingers from burns and I saw a 50+ year old with a similar injury. He was afflicted with this contracture where he couldn’t extend the 4^th and 5^th digit since he was a child. “See, it works fine for me” he said as he demonstrated his limited hand movements that he has been living with for 50 years.

AMAZING GRACE: THAILAND 1194 LAOS 891

As far as we know we have just established a position in the Guiness Book of World Records. We have treated an incredible and unfathomable 2085 patients in a week and a half in Thailand and Laos. During the last mission trip we treated about 1000 patients. We’re cooking. While we pat ourselves on our backs for far exceeding our expectations and well surpassing last years numbers we still are saddened by the numbers that were either not seen or we couldn’t offer them assistance with what we had. However, we did offer them a level of sophistication unequalled by their own current health care system. Some countries are sophisticated and still can’t get adequate health care to everyone, although it is available. A small country west of here, USA, comes to mind. The country is impoverished and the health care is a reflection of this state. Some live on $100 US per month. Many have their own businesses or “shops” as part of their home to supplement their usual day job. It was disheartening to see a frail looking mother with her 3 very young children begging at the entrance of the hotel. She apparently was going door to door looking for handouts. If was difficult to see and you struggle with giving them money or food if anything. As I do at home, I like to buy food rather than give them money, lest they use the money for drugs or alcohol or cigarettes. My prejudice extends abroad and I choose to give her food. There is a lady in front of the adjacent building cooking corn and something like a hot dog on a stick. I quickly deal with the lady to give me 4 corn husks and 3 food sticks as I loose sight of the family making way down the street. I catch up with them a few doors down and proudly give her the two bags. I don’t see a smile, nor expect one, or acknowledgement. My act of giving was my satisfaction. Money is the only common language and I didn’t understand what she was saying but what followed was unexpected. I turned back to the hotel as she continued her journey. I glanced back at her and she threw the bag of food sticks to the ground as if in disgust rejecting my hand out. Now, I don’t get it. There are 3 hungry looking children that could have eaten the food. Were they vegetarian? Did she rather have money than food? Isn’t that the essence of survival-food? I wonder if strategically, if she didn’t look impoverished walking around with bags of food in her hand, others would not give her money. I try not to second guess her anymore since it’s not my position to judge but I see this at home where people use different techniques to beg at the mercy of our sympathy. I have seen more beggars in San Francisco than I have seen here, clutching their small baby or reading the newspaper next to the collection cup as they sip their coffee from McDonalds. I think is a difference in work ethic.

EXTRA! EXTRA! READ ALL ABOUT IT!

For you enquiring minds who want to know the FCBC Medical Mission Team made the Lao newspaper, “People”, I guess their version of People Magazine. There was a nice photo of the dentists working under the tent from the previous day. It shows Lester working away, and Bill posing for the camera with Pastor Saykham. He was still wearing his mask because he didn’t want to show off his perfect set of teeth. Now, my Lao isn’t very good but loosely translated the article seems to talk about a medical team from America, starring William Ho, DDS, who have come to help people of Laos. Over a three day period the team composed of medical, dental, and eye doctors went to three places: Nashay Church, Xaysettha Hospital, and the Hatxayfong Hospital. The team spent 3 days with people and helped 1700 kids (political propaganda) with a budget of 70,000,000 kip (about $9000 US). People tried to come up to Dr. Ho for autographs and pictures but you know Bill, he’s paparazzi shy.

POLITICS

We had a very nice dinner at one of the local restaurants, Salongxay Restaurant, located in the Lane Xong Hotel. (Bill, remember this one for the summer trip, only $33 US per night.) There was about a 7 course meal for $5. We had a joint dinner with several governmental dignitaries including Minister of Health, pastors from the LEC, and VP of LEC. They exchanged pleasantries and Bill presented the Laotians with tokens of appreciation. Pastor Jack presented them with a framed letter from the American Baptist Church with regard to having the privilege to work here in Laos. They had expressed something to the effect of “looking forward to working with you soon, or else.” We had a enjoyable dinner with about 35 attending. There was a nice show of Laotian dancing and international singing and a contortionist that was a little twisted. As we left I couldn’t help but notice a elderly Caucasian sitting with a young pretty Asian girl at dinner time. They made an odd couple, I thought. Then after dinner she “escorted” him upstairs, I presume for a night cap. Dave, you can ask that fella what $10 got HIM.

It’s time for my night cap…Geritol.

Day 12: DESTINATION-XAYSETTHA DISTRICT HOSPITAL

February 26, 2008


HAPPY 17th BIRTHDAY LINDSEY LOWE! Your daddy loves you very much and will surprise you with a brand new car of your choice when he gets back home.



LOST AND FOUND


Okay, need to do some aerobic exercise. I tell my patients that the trick of weight management is calories in and calories out. Simple. The more you take in above what you put out the more weight gain. The more calories you expend, the more that you loose. We definitely be puttin on them calories. In defense, we never know when the next meal will be or if it would be “good quality.” So me and Andy decide to get some calories out. We take our morning stroll. People are already walking early in the am, going to work, or preparing to work in front of their homes setting up shop. Others are sleeping in their shops. Last time we went right, then right, then right, then right and it worked. Andy’s technique worked. Okay let’s try left toward the Mekong River. This is great. My Z coils are becoming part of me. I have to slow down for Andy since I spring forward with each stride. We wave to our monk friends who are walking as well. I should have brought my camera but I feel it might be a rude awakening to have this flash go off in the dark (it could remind them of bombings) or I don’t know if they would be offended and mug us. But then I wouldn’t have missed the Kodak moment with the monkey sitting on the scooter seat and holding on to the driver from behind. So cute! The street cleaners are up using there wisk broom into the bamboo containers. Some are bringing bags of fruits held between two people and a lady is pushing this 10 foot cart balanced by one set of wheels stacked with goods. They are taking it to their kiosks to sell.


We notice a congregation of motor cycles, tuk-tuks look alikes, bicycles, and people carting away food in long wooden carts (also saw a high tech one made of metal). There was a lot of foot traffic, bumping, and shoving. Then it opened up. We found the Lao Farmer’s Market. It was still dawn and there were about a thousand people in the open market. Food vendors with fruit, vegetables, live catfish gasping for air, etc. in there own tiny space that they are squatting sell there goods. A lady is gutting chicken with her bare hands. A shopper is grabbing live frog with her bare hands putting them in her shopping bag destined for a meal. A wooden cart with the remains of a slaughtered cow go to the meat market pass us by uncovered and unprotected. It probably isn’t grade A choice meat. Sanitation is not a priority. Curiously, there are apples covered with the protected netting to pad them. Imported? Hmmm… I am upset I didn’t bring my camera. On the other hand this mob might rip it from me for taking their pictures. There are no formal stores. The vendors bring their goods and ware and sell them. I am told that some vendors get here at 3 am to set up. Early risers and hard workers are competing for your business. They want your kip (8000 kip=$1 US). Where do all the farmers come from? They must have to bring them in from outside the city hauling them day by day. Their trek must take all day by foot. Later I am told that many people have this small business and IMPORT! As it turns out they’re not farmers, they’re business men and women. Many of these foods are imported from China and Thailand and then sold here. Some grow their frogs in there homes for extra money. It’s similar to San Francisco Chinatown but flat. I haven’t seen any rat-on-a-stick here like they have in China. Good for you, you entrepreneurs! We see a man pushing one of the long carts with a lady sitting in it. He must be the chauffeur, or the husband.


AIMLESS AND ANDY


Andy and I find our way out of the market through a side street onto a long street. We past two drunks and its only 6:30 am. There are already about 8 empty bottles next to them. One shouts at us and the slurred words confirm his intoxication. No thanks, we don’t want to party with you. We check our bearings. Andy’s sense of direction is un-uncanny. “I think the Mekong River is that direction” he says with authority. Neither of us, I think, is an eagle scout and the stars are fading away. Some family is outside so we go over to them to ask directions. They don’t understand our Lao. A light bulb pops over my head. A hah! I reach into my wallet and pull out the hotel business card-DON’T LEAVE HOME WITHOUT IT! It has the address on it in in Lao and English. Finally we will find our way home. “You a Speaka Engrish?” I ask. They don’t know. Hmmm, aren’t we just around the corner? It’s getting late because we have to meet for breakfast.


Taxi?!? Tuk-tuk? We see this pair of drivers and their vehicles just waiting for customers. Are they in cahoots or are they going to fight over us. I strategically hand them the hotel business card. Clever, aren’t I. They say 150 baht ($5). That seems a lot. “50 baht I argue.” They volley back with “50 each.” I thought these guys are hard up for money. We are hard up for a ride back. I hesitate and move away like “Hey Andy, we can walk.” Then they didn’t come after us so we reluctantly said “Okay.” As it turns out we were about 2-3 miles away and headed in the wrong direction. And would have continued in that direction. So we headed back for a long ride back with our tails between our legs. At least we got to see a monkey on the back of the seat holding on to the driver of a scooter. What a site. They were just monkeying around. Then we see the team headed for breakfast since we are kinda late. mmmmm errrr errrr … the tuk-tuk gives us away. We at first try to hide our faces but explain to them that we were on a guided tour from this tuk-tuk we chartered. Our feelings were hurt because no one was looking for us. Well, we’re on our own.


DAY AT THE OFFICE


We set up house at the district hospital. There are 4 major hospitals and 8 district hospitals. These “hospitals” would only be classified as a rural clinic by US standards and it would be substandard and shut down by OSHA . Even my own office/OR is more well equipped that this and more sophisticated and sterile. We set up outside on a platform. The dentists are on a field and they move a tent to shade them. It is fairly hot and humid today. It’s always crowded but we have to work with each clinic side by side and bump elbows. We see a lot of gastrointestinal pain, heart “jumping”, back pain, and tendonitis.


One of the interpreters was telling Andy she became a Christian 4 years ago. She was Buddhist. She lost a 24 year-old daughter who had advanced nasal cancer which had metastasized. Apparently she was being treated in Oakland and still she died. She was invited to church so that she might be consoled her since she couldn’t sleep and eat for three days. She started crying as she explained this to Andy. She said she was comforted by the church and was invited to accept Christ. It gave her a sense of peace and hope. Another lady shared with Andy that she was sick with a neck mass. She went to the Buddhist monks “charged her” for them to pray for her and it didn’t work. She got fed up and she was invited to a Christian church and they prayed for her and the mass went away. She in turn accepted Christ. She shared this experience with others in her village and eventually 35 accepted the Lord because of her experience.


Get this. I think Bill tried to console me by giving me an interpreter named, you guessed it Jen. Ohhhh! (sigh) It’s not the same. I saw a 14 year old who looked odd always smiling and not making eye contact. He felt anxious. No suicidal or homicidal thoughts but he felt like hurting someone. Unfortunately, the shootings at the colleges and schools in States come to mind. Further questioning revealed some mental illness. I think he is schizophrenic and had delusions and hallucinations. He needed a lot of help but we only had a few drugs to palliate his abnormal thoughts. He seemed to understand he had a problem and wanted to do something about it but we can only give him limited treatment until his “system” can help him. I got to see some blood and removed a cystic mass behind a reluctant lady’s ear. Her last doctor said that if it was operated on it could spread to the rest of her body. I don’t know if that was poor judgment and he thought it was cancer or he just didn’t want to or couldn’t do it. I thought it was a sebaceous cyst and was able to remove it in a small room under semi-sterile conditions with an assistant holding a small flashlight. She lived.


The dentists are literally out standing in their field (I know, old joke). I guess you can consider them migrant field workers (better?). Anyway, as you gaze over there with three or four patients with their mouth wide open, like an angelic sounding choir, you not only get a sense of the impact that they are making on all of these patients who would have otherwise have rotten teeth, you appreciate the time and expense and the sacrifice of working in suboptimal conditions that they make in a tremendous effort to work with what they have here and bring with them. As the sun moves throughout the day, so does the large tent to alter the shadow to cover the dentists. Ming makes his rounds assisting the dentists in big top. Indeed, it often looks and feels like a circus but all are serious in what they do, except for one guy who clowns around a bit. The docs are getting squeezed tighter on the platform since the sun’s rays are beating on our backs and we head toward the shade for cover. All in all we saw hundreds of patients and we are on a roll. More of the same and in larger numbers. Today went smoother so it was less hectic and more controlled without the strays making their way into the clinic. Some of the strays were Hmongs traveling from the hills that tend to get pushed aside by the natives. Tomorrow will be another district hospital. Since there was some patients that could be seen by Cindy who is a nurse practitioner, she was able to take care of some patients herself and advising appropriate drugs so that they didn’t have to go to the docs. This will help us tremendously and get patients in and out faster. Way to go Cindy; you go girl! The local news media (newspaper and t.v. wear here covering the story. “Makeup!” They mingled and had photo ops. Maybe we will be on t.v. With a lot of us wearing masks it looks like a bird flu quarantine.


CHOW TIME (NOT DAVID)


Our fearless leader decides to take the team and helpers out to a nice buffet. We seem to be going in the direction of the airport. Pastor yells out to Bill, “We’re picking up Jennifer!” Now I didn’t set you up Bill. It must have been wishful thinking. We attend this wonderful buffet at the airport. We like buffets. All you can eat, the American way. What a spread of Laotian food, desserts, sushi, smoothies, soup, steak, and all the alcohol you can drink (no we didn’t). Okay, stop feeling sorry for ourselves. The members of the church team said they never experienced this type or as much food at one time before. A lady said, “Thank you, this is a big treat. We don’t get to eat like this.” It would be just too expensive. Our US cost was $6.00. We are trying to stay under budget. We mixed up the tables to break up some of the cliques and to be more sociable and learn about them. The Americans, as usual, make ourselves at home and pig out. Forget about the calories in/calories out thing. I sat with the daughter of the Pastor or chief of the Lao Evangelical Church. Her English is pretty good and she said she learned it in adult school in 4 months when she and her dad visited Fresno a few years back. I thought that was pretty cool. We get transported in this big fancy bus reminiscent of the Partridge Family. There are about 45 of us and sometimes the headcount is off. Oh well, at least they can call for a tuk-tuk.


Lena told me she doesn’t know when these ejournals end because they seem abrupt with no good-bye. Okay, for me good night and for you, good morning.


I love you Lena and Allison…I miss you…Now I’m going nigh nigh.

Day 11: DESTINATION-EGLISE EVANGELIQUE (EVANGELICAL CHURCH BRANCH OF LEC)

February 25, 2008

HAPPY BIRTHDAY ALLISON (I’m such a terrible father)

Sweet Sixteen-WOW! (Everyone please call her and wish her a happy birthday!)

Rise and shine

I was getting a good night’s sleep, one that I hadn’t gotten in a long time. Beep! Beep! Beep! Andy turn’s over to shut the alarm off. “Time to get up already? What time is it?” “5:30” Andy yawns. “Wanna go walking?” “Well, I’m not doing anything, let’s hit the road.” The manager of the hotel sleeps on the ground or couch at night and wakes up to let us out the front.

I didn’t mind walking in pitch black. A lot of the members of the team have had this routine. Bill would jog, the Lowe’s walk, Andy and Dr. Obregon walked etc. Since Andy has his black-belt it was like taking my own body guard with me.

We were walking in dark alleys and streets. All of a sudden a group of monks start crossing the street like ducks in a row. The monks are bald, wear orange gowns, and are barefoot. The carry collection bags to receive money from merchants in the street after they say a prayer or blessing. They walk by quietly and then start chanting at the person’s house and the kneeling occupants and they give them money. I was trying to remember how to say, “I gave at the office” in Lao. The monks quietly walk in a straight line with bare feet arranged either from oldest to youngest or could be tallest to shortest. I look at Andy he could pass as a monk if he had a orange robe. Maybe he’s too tall. I want to pause and tell them about Commandment 1 (Do not worship any other gods) but I think it might be futile. My high tech $$$Z- coil shoes stand out next to their bare feet. I am getting used the bounce and recoil of the shoes and my back feels wonderful but feel like I’m bouncing like a kangaroo. Maybe I need Stride-Rite shoes. Many of the merchants are already getting set up shop. They sleep in their kiosk overnight and there is a man asleep in a chair guarding the bikes or scooters that he will rent the next day. People are walking on the streets already going to work. Weight challenged individuals are rare due to the exercise inherent in walking great distances. We see another set of monks lined up walking coming from a nearby temple.

Andy has a strategy to find our way back to the hotel. He says as we walk, just turn one way and you’ll always turn toward your start point. I said “Sounds great.” (He didn’t know that I took a business card from the hotel just in case we had to ask for directions.) So we head out. It’s great walking. I forgot how to walk. So Lena, we are going to walk more when I get back. Hold me to it, okay because I am one of those weight challenged individuals. He has an uncanny sense of directions. I wasn’t worried but I did eye those taxis or tuk-tuks. We saw a lot of French influence still in the names of buildings and architecture. There is even an Arche de Triomphe in the city. Andy has an uncanny sense of direction and brought us back home as promised. How silly I was to have doubted Andy.

I SEE THE LIGHT

After a meal with the members of the Blue team we headed to a church. Bill had to do political shuffling with the members of the Lao Evangelical Church regarding, well, support for the interpreters. It was an unexpected expense that he had to deal with but he handled it well. We have about a dozen or so helpers including several pastors from the LEC that will accompany us to the various locations to help with translation. Some of us met Pastor Saykham from one of the churches here. They are all under the umbrella organization LEC. We went to the Nashay Evangelical Church.

The dentists were working the in the dark literally. They looked like miners in a coal mine with their headlights shining for illumination. The room was hot and humid. The optometrists worked in there as well. We do well do adapt to the circumstances and facilities that are available to us. We have make shift exam rooms for privacy. For the most part, patients accept not being private. Dr. Tajiri recruited Dave for helping work on the lenses. It is a two man minimum requirement. Gi helped when we were in Thailand and was great at it. Dave helped fill in the gap and is a fast learner. I think he was being groomed in Thailand for this position. That leaves Ben to work the pharmacy but has Gerry to help with pill counting sorting and writing the labels. There seems to be some jobs that are monotonous. I am grateful for the variety of patients that I see and the dentists have their fill with garden variety and complex cases.

NEXT!…

Those nurses triage (direct patients) for 6-7 working hours in the hot sun with crowds vying for position in line. “I was here first.” “How much longer to see the doctor?” “Is the doctor on time?” The apparent disorganization is really organized. The patients have to be themselves (patient). They are the gatekeepers. Now, Andy has been working for Children’s hospital for 22 years (mainly ER) and Cindy has 25 years as a clinical nurse, teacher, and FNP (Family Nurse Practioner). By the time we docs get the patient there is a lot of screening done and history taken and sometimes we just need to sign a prescription. So they are excellent in what they do and they make a great team. We see a lot of children so it’s nice to have Andy’s experience in acute care and Cindy who can be thorough as a nurse practioner. They fill out a form and assign them a number and the patients wait to be called and escorted. It can be monotonous.

The pharmacists have tens of thousands of pills to first find and then sort, count, package, and label for all of the dental and medical patients. I think they end up cross-eyed and will have to see the optometrists. The worse of it is trying to read the doctors’ handwriting! They must really like what they do-pushing drugs-by sorting by hand. But it can be monotonous.

The optometrists and Dave along with Arlene and Gail are a sight for sore eyes. They planned their department with foresight and you can see clearly why they can process so many patients through the production line. Every day, all day long. How many eyes can you examine? Don’t they all look alike? How many visual chart exams can you do before the chart looks like a Rorschach pattern? Does Dr. Tajiri ever break? How many lenses can he whittle away to fit the lenses? Is he enjoying himself? I hope that he doesn’t have an axe to grind. Dr. Chinn must be a sharp shooter by now with his PAR gun. Now that seems monotonous.

GO WITH THE FLOW

Variety is the spice of life, right? Not! I first get hit with this lady with a mass the size of a softball on the side of her cheek. How long has it been there, you may ask. 19 years. It feels like a fatty tumor or it could be a salivary gland tumor. I think this disfiguring mass should be taken out. So where can we do it. It is hard to get cooperation from local hospitals. Sometimes it is difficult for us to express our thoughts and desires through interpreters. The hospital would need to charge $300-500 US to “support” this patient so they ask who would “support” this patient. Certainly not the hospital or government. We brought most surgical supplies anyway and we just needed a place to do it. The logistics to set it up, get a preop workup, and no follow-up was weighed and we decided not to pursue it. It may have taken 2 docs away from clinic and put the added burden from our absence on the remaining docs in clinic so no go. “Hey, since I am here can I get this tooth extracted and get some glasses?” she asks. Why not!? That has been the burden because some patients want multiple clinic evaluations and at first we went with the flow.

CLUELESS

The next patient I see breaks my heart. She’s skinny, weighs about 65 lb. Her neck looks like a tree trunk with two large firm masses along side her face and neck. What the neck! It has been getting bigger over the past two years. It is starting to affect her swallowing and certainly her speech. She saw a doctor who said go to Thailand. Apparently Thailand has more sophisticated technology, doctors, and treatment. There is only one CT scan for four “major” hospitals in the capital city, Vientiane. In Fresno there is one on every major block. She cannot afford to go to Thailand, much less afford the treatment. I look at her and think she is going to die. This must be cancer. Some lymphoma. I reach way back into my medical school training. Hodgkin’s lymphoma. Burkitt’s lymphoma. Non-Hodgkins lymphoma. Don’t-matter-what-kinda-lymphoma. Infectious lymphadenopathy. The mass is stiff and hard about 5 inches by 3 inches on ONE side and 4 inches by 2 inches on the other. It is hard for her to speak. How am I suppose to tell this patient with her angel eyes, who is only 20 years old, that she is going to die? She traveled from afar to meet the sophisticated doctors from America and what are we going to offer her, vitamins?” This case belongs on “House.” This is a ROYAL pain in the neck! I’m frustrated. We have grand rounds with the other docs. She at least needs a biopsy of the tissue. No clue. No help. Is this some exotic cancer indigenous to the region from a source or influence that we know nothing about? Maybe I can make her comfortable. I learned this hospice thinking when Lenas’ mother was dying from lung cancer and was medicated for several months just to ease the pain especially when her mom developed shingles on top of the cancer.

I send her to the pharmacy to give her pain medication to make her comfortable and advise her to go to Thailand. I imagine she is thinking, “Great advice, doc. Go to Thailand to be buried? I can do that here. Thanks but no thanks.” Even if she were to go and get a biopsy and the diagnosis could be made, the tumor could be so advanced that she may die anyway. She walks away no better than she came. I feel useless. “You’re too empathetic”, I tell myself. “Be detached, I’ll live longer.” She’s about my daughter’s age. Parents aren’t supposed to outlive their children. I have to clear my mind to address others that I MIGHT be able to help. What great medical advice can I tell the next patient? I am feeling useless. I need to cut something out to cure the patient. I’m a surgeon, not a medicine doctor. Perhaps a witch doctor could help. A few patients go by and I am feeling my confidence back. I see a familiar outline of a person’s face, which I cannot see, with the bright background. Another “Tree trunk Syndrome”? WHAAAT!

A young boy in his twenties at this same clinic who lives far away from the other girl has a similar condition, except the masses are smaller. I can make out several large lymph nodes the size of marbles adjacent to the solid firm masses above. They parallel his neck line and obliterate the jaw line. He only had these masses for two months. Why so fast growing? Cancers are fast growing. Some infectious process may be as well. The docs discuss this and we don’t know what it is. If someone reading this has a clue, LET ME KNOW! Please! I go to my iphone and search the internet. I can’t find anything useful. Even if I knew what it might be how could they can afford treatment. I get the girl back and talk to them together to see if their was some epidemiologic connection. I find none. If by chance this was a benign process or an infectious one by some odd ball organism, it might respond to antibiotics. So I prescribed some antibiotics with pain relief which hopes hat something might help. The consolation is she accepted the Lord earlier in the day. I pray for her comfort and healing. She may be terminal but she is saved.

As the day grew longer, we got more exhausted mentally and physically. We had a lot of patients and could not see everyone. Some patients sneaked through and said I lost my paper. Naively I would get them another one so they ended up cutting to the front of the line. Some would go to one clinic and then complain about a dental or visual problem and then they would go to the front of the line at that clinic. One Hmong family apparently travelled far. She said they had a number. I said, “What number.” She pulled out a 2” by 2” piece of paper with the number “117” written in neat red magic marker. Her friends pull our “183” and “185” This paper looked unfamiliar to me or anyone else. I want to be fair so I go to registration and triage. We were not using numbers so they were fake papers. Were those patients duped by someone else or were they trying to dupe use. What nerve! They go to the end of the line. She was pregnant with two kids and she may have traveled a great distance, but we had to turn her away.

We are ready to go back to the hotel. We pack up and I don’t have a total for today but we helped a lot. Others, weren’t helped at all. I am ready to go back and rest. I decide not to join the group for dinner with the LEC helpers. I need to chill, and jounal (that’s why you got two yesterday). The team went to a restaurant and we took the helpers. They are trying to budget (especially with this new expense) and ate for about $6.00. Good thing it was a 13 course meal. The team was gracious enough to bring me dessert and left-overs. I did eat the food which was fairly good. Well I’m beat and need to go to internet café then I’ll catch some zzzz’s.