Horqueta, Paraguay April 2024

 

If you take nothing else from my stories, please know that if you are reading this you fully embrace the very real truth that we are so incredibly fortunate.

Our team departed DFW on a 10 hour flight to Sao Paolo, Brazil.  Sadly, our flight had mechanical issues prior to take off and we were delayed causing us to be waylaid in Brazil for a day.  This caused our already limited 4-day clinic to be shortened to only 3 days.  

As my mind wanders, my thoughts dwell on the tertiary events of our jobs and interactions.  It astounds and baffles me sometimes.  I have no idea what it is that caused the delay with the aircraft however I can't help but wonder if it was due to someone's laziness or negligence.  I wonder if those involved will ever understand the far reaching consequences of this situation; people who have next to nothing had their nearly non-existent medical care taken from them.  Not everyone travels for holiday or business.  Often those crafts carry precious cargo in the form of resources that we take for granted on a daily basis.  

We landed in Asuncion, Paraguay and saw a brief tour of the city as well as our partner hospital.  We then embarked on a 7 hour bus journey to Horqueta arriving late at night and up early the next morning for our first day of clinic. 

General Treatment Area

Upon our arrival to our clinic site we were met with an open air, covered soccer stadium.  Tables and chairs were set up and we made due with the environment and supplies we had.  

Clinics provided included Family Practice/Internal Medicine, Cariology, Urology, Pediatrics, and Obstetrics/Gynecology.  We had supplies for basic wound care and limited medications provided by our Paraguayan sister facility. 

I had the privilege of being teamed with a gifted OB/GYN and together we saw approximately 100 women.  We saw untreated sexually transmitted diseases, cancer, pregnancy, postpartum, fertility, menopause, polycystic ovaries, genetic disorders, and an array of conditions in between in addition to well woman exams and general wellness checks.  

GYN Exam Room

Pictured above is the side room of the stadium that Dr. April and I made into a make shift exam room.  It was about 95 degrees F everyday with no air conditioning and no fans.  This room was stifling by midday.  We kept it as clean as we could.  We did cervical vinegar washings as a make shift colposcopy and ultrasounds on anyone who could potentially benefit.  Each woman got 100% of our attention and faces of gratitude will never be lost on me.  

After talking to our host, I learned that most of the patients that we saw came from 100-150km (60-90mi) away.  I recall one woman in particular who traveled 10 hours to get an EKG and collapsed in tears when she believe that this wasn't something we could accommodate.  The sheer joy that erupted from her as she was escorted to the EKG room was enough to make this entire trip worth it. 

Dr. April, Tamara (Paraguayan ED Nurse), Me

In 3 days our team saw 792 patients.  We weighed babies, cared for the elderly, educated, and loved on the people of Paraguay.  We gave out toothbrushes, toothpaste, soccer balls, and lots of hugs.

Me & Dr. April - We were a great team!

This sweet one ran up to me and grabbed ahold of my legs in the biggest hug!

This woman insisted on photos and came to the clinic everyday!  When I told her we had come from Texas to care for her, she cried. 

Our International Care Team

Paraguay Bound!

 

Mission Trip #2!

I figured I would just use the same blog, why reinvent the wheel.  I am headed to Paraguay (with a brief stop in Brazil) in May as a member of the medical team traveling from Texas.  I am going with people that I know and care about and am thrilled to be able to care for God's children in this most amazing part of the world.

The trip is not at all free, the hospital is not covering any of our expenses to my knowledge.  If you feel led to contribute, your dollars will be put to good use.

Much love!

Cindy

Tour of the Global Mercy

Here is a very brief tour of the vessel that I have called home for the past 3 weeks and that I will be leaving entirely too soon.  

First things first, where I work.  The primary mission of the GLM is surgical care.  We have 6 operating rooms, full radiology including CT, a 4 bed PACU, 4 bed holding area, 5 nursing wards, and a low care unit for those needing a little more time before they go home.  

OR Hallway

PACU

The cabins on the GLM are significantly larger than the sister ship, Africa Mercy.  I have one cabinmate and we each have our own section of the room and we share a bathroom and small area with a mini fridge.  

My cabin is on Deck 6 which is one of the few places where you can see the entire length of the ship.  The photos doesn't do the size justice.  The ship is enormous

With 12 decks come a LOT of stairs.  

There are a few recreational areas including a the Cafe which is a common area to socialize, play games, and rest.  Outside on the upper deck is a court that can be used for basketball, pickle ball, badminton, or whatever you can think of, a play ground, a pool, and a large open area for children to ride scooters and ride on toys.  There are over 70 children on the ship so having a place for them to be children is such a wonderful inclusion.

There is also a school onboard called "The Academy"with fully qualified teachers and staff to ensure that the children accompanying their parents are being prepared for life off the ship.

The dining room serves all of the crew, families, and day crew aboard full meals several times a day.  It is also a place to gather, chat, rest, and enjoy the company of your crewmates.

The ship is a fully functioning operation with a Crew Bank, Ship Shop for incidentals and items made by local artisans to purchase, meeting rooms, chaplaincy, and even a coffee shop.  This is a photo of Deck 8 where most of those area located (many to the back of this photo)

With the constant turnover of staff, good signage is very helpful to find your way.  It is very easy to get turned around or end up somewhere you didn't intend.

The crew on board are an amazing, selfless, and devoted group of people from all over the world.  I am honored to serve beside them. (OR crew below)

Week 3

We are continuing this week with more maxillofacial and general surgeries.  Watching life trajectories change is humbling.  I got to see babies who are able to nurse for the first time as their cleft lips are repaired, huge lipomas (fatty tumor) on every surface of the body removed allowing normal clothing, sleeping, and way of life, amongst others.  Snuggling sweet little ones who are waking up frightened in a strange place with strange looking people is the best part of my day.  

Sunday night we had a Team USA get together!  Just a fun opportunity to have some snacks and connect with those who come from your same homeland. It's amazing how many Americans are on board! 

The riots in Senegal were intense with many fatalities.  The chaos started to subside and on Tuesday we were let off of the ship.  I nearly ran for the door. (I have learned I would do terribly in prison.)  After 10 days on the ship, I was ready to get off! A group headed out to Goree Island.  Senegal is in the western most portion of Africa and Dakar was one of the primary locations for the shipment of indigenous African people during the slave trade.  

We visited the House of Slaves museum where thousands of humans were trafficked to the Americas and Europe.  It is a hugely emotional experience knowing that my nation was a part of this atrocity. Below is one of the whipping posts where "troublemakers" were beaten into submission.

The door of no return.  Those who walked through this door never saw their homeland, their families, friends, or anything they had known again.

The island of Goree is a stunning place.  It is a small town with no motorized vehicles.  There is a ferry that runs multiple times daily that allows for visitors and transport of locals on and off the island.  The architecture is stunning and the flowers that seem to come from not where are covering the island.

Week 2

 My second week on board the Global Mercy has been just as rewarding as the first.  We said goodbye to 3 amazing PACU nurses and said hello to 3 new faces.  I now work in a department with 3 Americans, 2 Aussies, 1Dutchie, and 1Swisse.  Our entire surgical team spans the far reaches of the globe.  Being a part of the experience where all of these nations come together for the good of God's people is the opportunity of a lifetime.  The magnitude is not at all lost on me.

This week we did about 65 surgeries including general surgery and maxillofacial reconstruction.  Multiple cleft lip and palate, tumor removals, hernia repairs, skin grafts, wound revisions, lipoma removals, and many more.  The public ostracization of many will be at an end.  I am forever grateful to be a part of this team.

Senegal is unsettled.  A political opposition leader was sentenced on Thursday to two years in jail causing civil unrest in the country.  We have all been confined to the ship for the weekend in order to ensure our safety.  Some of our Day Crew workers have been unable to get home as a result of the riots and are being safely housed on board.  Please pray for peace in Senegal.

In the meantime, I have been enjoying some quiet time on the upper deck getting to chat with crew mates and enjoy the sunshine. 

Koulouk Mbada Immersion Trip

Travel is fatal to prejudice, bigotry, and narrow-mindedness, and many of our people need it sorely on these accounts. Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one’s lifetime.

—Mark Twain, The Innocents Abroad, or The New Pilgrims’ Progress (1869)

This needed a post of it's own.  

Steve is one of the onboard chaplains and has formed a friendship with a tribe chief named Songo.  Together, they arranged for us to visit his village for a cultural immersion trip.  I'm still processing it all.  

34 of us were on the dock at 4:45am to begin the journey to the village.  Songo met us on the dock.  I'm not sure what I expected when I met him for the first time but Songo is a delightful gentleman who wears polos and trousers just like anyone else.  I was expecting something more tribal and elaborate and was stunned to see him.  After the 3.5 hour bus ride, we arrived to the village of Koulouk Mbada.  We met the village elders, mayor, and Prefect.  The mayor is a woman who wore the most beautiful purple dress (I'm not sure what the local name for it is).  All of the men stood when she arrived which is a cultural norm that I did not expect.  Her position is highly respected.

We were divided into groups and sent off with our hosts to meet our families.  I'm quite certain this was the first time that most of the children had ever seen a light skinned person.  They were so inquisitive and just stared at us incessantly.  Bambi, Ayson, and I shared a room in the home were we were provided with all of our meals and a safe place to sleep.

It was hot.  Incredibly hot.  According to some weather sites, it was about 106 F, but it felt much hotter than that.  The sun is relentless.  Mornings are an industrious time while it is still cool and most everything stops about 11:30-12 until later in the evening/afternoon.  

The families were warm and welcoming.  We had a translator with us who helped as much as he could with the language barrier.  They speak a language called Serer which is a very new language to me as it did not seem similar to any of the other languages I have been introduced to.  It was very difficult to learn and pronounce.  We did our best and there was a LOT of charades.  LOL

We were taken to the local mosque.  We were not allowed to enter as we, aside from not being Muslim, had not done our absolution to become clean.  Women are allowed in the back rows if there is room, otherwise they remain outside.  Men wear simple patterns and there are no objects, paintings, or other distractions in the room.  The object is to remain in constant prayer and meditation with only God on your mind.  Any item or design that could distract you is removed. 

The clinic is about 2km away and consists of 3 rooms. The one pictured is the room where women give birth.  It is nothing more than a simple palate bed with a mosquito net over it.  There are no medications, resuscitation equipment, and only very limited supplies (her box consisted of a scalpel, umbilical cord clamps, and a surgical mask).  The midwife of 30 years was there.  She delivers between 25-30 babies here every month and our fast math added up to 9000 deliveries.  She told us that 2-3 per month experience complications that require going to another hospital but she did not elaborate. 

There is an elementary school nearby but all of the high school children walk 7km each way to school daily.  There is currently fundraising opportunities to help with the school.  The perimeter wall alone is a cost of over $50,000.  There is an agreement with the government that if the villagers provide 2 of the 12 proposed rooms and the bathroom, that the Senegalese government will step in to provide the remainder of the school.  If you are interested in donating to this cause, I will gladly put you in touch with Chaplain Steve.

My life is forever changed.

 

Days 4-7

I got a bit caught up in the business of the ship and didn't get an opportunity to update until now.  There is a lot to include here... :)

Day 4 was a pretty regular day.  I was a first case arrival at about 10am.  We have mealtimes on the ship and lunch is from 1130-1300 only.  It doesn't matter if you are the first one in or the last one, this is when you are able to get your lunch.  I'm learning about our Day Crew workers and how to interact with them.  They are such a joy to be around!  

Day Crew are Senegalese nationals who come on board for the day, they do not reside on the ship.  They help with multiple areas of the ship, the one that I interact with most are our translators.  Every patient going to surgery has a 1:1 translator at all times while awake and when waking.  Our Day Crew are kind, intelligent, and resourceful people. I am loving getting to know them.

I got to leave this ship and go out with some crewmates for ice cream.  This is my first real experience in Dakar.  It is an intense, loud, and crowded place.  People are constantly yelling at one another although rarely does it seem to be in any sort of animosity.  It just seems to be the way they communicate.  The gelato was divine and we headed back to the ship where I sat down for a cup of evening tea with some new friends for conversation.  I'm learning all about healthcare in the countries represented by my crewmates.  New drugs, new processes, it's all so impressive!  

Day 5 - I was a late start today which means I get to finish up the day.  I arrive to work at 1200.  My cabin is an inside cabin so I don't have a window.  This is glorious for a mid-day nap, but horrible for waking up on time.  I have learned that I must set an alarm if I want to get up or not otherwise I will sleep the day away.  With only one roommate, no light, no dogs, and no noises, my body will apparently sleep for quite a long time.  LOL

We ended up staying until past 8pm as the patient in our last case needed a little extra time and attention.  Anesthesia can  be a funny and tricky thing.  Our patients here have generally never taken medication before.  It's an odd concept as western cultures have utilized medications from birth onward where most here have never taken a tylenol.  We have to be very cautious in the doses that we give as they are very sensitive.

After work and a quick shower, my colleague and I walked to a nearby restaurant to meet the rest of the OR crew for dinner.  A glass of red wine and a gigantic plate of hummus were just what the week needed!  We had covered outdoor seating where we could see the lights of the ship. It was wonderful!  We were saying farewell to three of our PACU team.  It was starting to me just how quickly those bonds formed.  

Alice, Leslie, Emily, me

Day 6 - Dr. Peter is one of our anesthesiologists (or "aneethetist" as they say it in Australia) who helped organize a day trip to the Bandia Nature Preserve.  

13 of us (including my fellow PACU nurses pictured) climbed in a  van and drove about an our out of town where we were greeted with causually wandering monkeys and monitor lizards.  The monkeys are hysterical to watch and very opportunistic.  The preserve is large and we were taken on a 2 hour tour and then had lunch in their lovely restaurant. Giraffe, white rhino, multiple species of gazelle-type animals (I don't remember their names), buffalo, warthogs, hornbill birds, zebra, and many others were on full display for us to marvel at.  Our guide was fabulous and told us all about them and how they live naturally.  

Lunch was delicious!  The herd of wart hogs that trampled through the center of it was quite and experience and the sleepy warthog who was waiting just under the table (much like our doggos do a home) for a possible snack was hysterical! 

What an amazing week!