We have not blogged for over a year, but since May 11, we have been back here in Sierra Leone in the town of Mattru, and the days have passed rapidly. Our visit here coincided with a visit of a team of about 20 persons, doctors, dentists, nurses and support personnel from Europe and Africa. They were part of the Afro-European Medical Research Network (AEMRN) consisting of primarily Sierra Leonean doctors and dentists that came as a team to give back to their home country by doing dental work and surgical cases. They just left Wednesday evening after another long day, but they were able to do more than 100 surgeries during their 7 days here, primarily hernia repair and simple abdominal surgeries such as fibroid tumor removal. The medical evaluation most days included 50-70 patients. The first day that we were here, it was obvious that the medical screening area would need a significant amount of help, and so I pitched in to assist with that. With so many people coming from the surrounding villages, my Krio expertise was not as helpful, so I pretty much needed full time Mende translation. The situation was made more desperate and chaotic during this time because the government is trying to upgrade the hospital, and is in the middle of a reconstruction project of the medical/surgical ward. This ward normally can hold up to 36 patients and so these patients are scattered between a small triage building and the maternity ward private beds. But there was not nearly enough space for the post-operative patients, and so they had fashioned a makeshift recovery unit with tarps under a roofed space normally reserved as a waiting room for the lab. Many of the surgeries were done as outpatients and they went home after recovery of a few hours. In the middle of construction debris everywhere, even on the sidewalks, a lot of very necessary medical and surgical interventions were carried out for the people of this area. Dr. Charles Senesie is the head and founder of this organization which was providing free surgeries for the people of this area, and we were so thankful to them for the help that they provided. The number of people crowding around for care every day, and there were quite a number who had to be turned away, unfortunately. These cases that were a bit heartbreaking, including a young lady with severe facial deformities due to a growth in the lower jaw, 2 ladies with very large goiters, and those with deformities of limbs that were nonsurgical. There was a pregnant lady who was admitted for a dental abscess who became septic and died, a tragic occurrence because of poor dental care. One elderly man walked for 2 days (fuel and travel were too expensive for him) with a very large hernia, but he got there on the afternoon that the team was leaving. I felt so bad about telling him the free surgery was not available, but told him of the cost of this surgery if he stayed around. He dropped his head, since he could not afford it. But, praise the Lord, our hospital administrator offered him free surgery, courtesy of the benevolence fund which has helped many patients over the years, and that happened without any intervention on my part, which was so gratifying to see. So he will have surgery sometime next week. It has been very hot and humid, much like a south Alabama summer, except that there is no air conditioning. We both do not remember this degree of heat here before, but perhaps our memories are faulty. So we have had some very hot nights, and that is made just bearable with running 2 fans all night. We are so fortunate to have 24-hour electricity in our house. It is a real blessing to be able to sleep under a fan. We will include some photos, and later on, Heleen will update her work with Nyandengoh!

For some reason, I am unable to edit photos with our slow internet, so I will give the explanation here. The first photo is Reverend Joe Abu visiting with Heleen after church Sunday. Reverend Abu is from Mattru, but is now a pastor of a church in Philadelphia, PA. Second Photo: L-R Dr. Senesie and Dr. Mohammed--both members of the team from AEMRN, and Dr. Senesie is the founder of the organization. Third photo: The view out of our current home's back door..nice to sit here in the morning and drink our morning coffee Fourth photo: The wall that is being built surrounding the hospital by the government...work proceeding nicely Fifth Photo: Our house for 3 years when we were here 2017-2020, currently lived in by Dr. Rogers Sixth Photo: Here is the rehabilitation progress on the Medical surgical ward at the hospital.

Musings on the Mountain

Some people who have been following our blog, or have received emails or Whatsapp messages from us, may think that all we do is hike and enjoy the countryside. Today we share some musings from Jon as he reflects on his work at the hospital:

“I sit here under the outdoor canopy at Diospi Suyana on a beautiful, sunny Sunday in Curahuasi, Peru, enjoying a brisk breeze, but needing a coat, as is normal here. The mountains in my view are majestically snow covered, and without the clouds that sometimes hide their beauty. Gorgeous flowers reflect the sun’s brightness, making them even more brilliant. But all is not beauty and light here in the middle of the Peruvian Quechuan highlands. From here, I can hear the huge fan that runs 24 hours a day to pump air constantly out of the isolation COVID unit at the hospital, and the groan of the oxygen generator as it constantly cycles, making life-giving oxygen for the patients at the hospital.  Both noises are constant here, and reflect the growing need for treatment of COVID in this country. Currently, there are 13 patients in the hospital with COVID, and 4 or so that are critically ill and on ventilators around the clock.

View from the outdoor terrace behind the hospital, where this blog was written

When one goes around the back of the hospital, as early as 4 o’clock in the morning, people are lining up to be seen at the hospital outpatient center. Since the number of appointments is limited, one realizes that many of them get turned away to come back another day to try again. 

It is not unusual to see patients set up a little tent on the road by the hospital entrance.

Some patients wait more than a week, trying to get the coveted ‘cupo’ that entitles them to an appointment with the doctor. When they finally get in to see us, the pathology that is encountered is staggering.

This past week was an example. I had too many patients that I had to give very bad news to, a task that is even a bit more daunting when you know that our hospital was their one hope.  There was a 40-something-year-old patient that came from Puno, (about 12 hours away from here) with severe weight loss, and abdominal pain. We can obtain CT scans here, and his scan unfortunately showed a large mass in the left abdomen, interpreted as some type of carcinoma. He was going to be the first patient of the day, to give him his results. As I came to the waiting area to call him, they were still finishing up the morning devotions in the adjacent chapel. Two of the missionaries were singing "The Blessing Song" in Spanish, a particularly moving rendition, and as I looked over the crowd of the morning patients, I saw that several were crying. I thought about the news that I had to share and was overcome as well. Another patient that same day had a dangerously low platelet count, with an abnormal CT scan of the brain that suggested cancer. The closest oncology department is 16 hours away by taxi and bus, a daunting ride when you are totally healthy. Thinking of him riding all that way without having any bleeding was a difficult task as well.  One lady of about 60 had been losing weight, having abdominal pain, vomiting, and little appetite for a couple of months. Her ultrasound showed a mass around the liver, and a CT scan showed cancer of the gallbladder with spread to the liver and to the entire abdominal organs. Even in an advanced country, that would not be a treatable condition, and with difficulty I broke the news to her and her son who had brought her.

And then another man with abdominal pain and bone pain came to our facility when a previous workup at another health facility showed nothing out of the ordinary. Our abdominal ultrasound was also negative, but a chest x-ray showed a lot of fluid on the one lung. Once again, the CT scan showed the grim news—a cancer called mesothelioma that had formed in the lung, and also once again, had spread to other organs. There was no good way to break the news to the patient and his son. But this patient’s response surprised me. His first response was that he was a Christian, and that he was in God’s hands. So if he was here on earth, and living, he was in God’s hands, and if he was no longer here living, he was in God’s hands as well. But as he talked, the tears were flowing from his and his son’s eyes, as they realized that life had changed for them forever.

Despite the pressure and sadness of patient interactions like these, I am grateful to have the opportunity to serve at this hospital – a place that clearly expresses hope and trust in a God who is and always will be faithful, whether patients receive healing or face the end of their life’s journey.”

One thing we appreciate about Peruvians is that many of them seem to appreciate the beauty of our country as much as we do....

One recent Saturday we were able to visit some old Inca ruins in Ollantaytambo, an old town in the Sacred Valley

And last Saturday we climbed about 3,000 ft over a distance of 3 miles (yes, that is quite steep!) to see this magnificent mountain lake. 

Here we are resting our legs by the lakeside; with Vera, a German medical student who came along and even swam in the lake, which was extremely cold! The dog adopted us for the time of our visit :)

Our latest Sunday walk..

This week we celebrate six beautiful years together!

Camino Domingo Bello en Mayo

 Our church had very meaningful services on Saturday morning outside, so that we had the first Sunday in May open.    

Open Air church in Curahuasi

We have been bragging how beautiful our walks in Peru have been, including how the beautiful wildflowers are everywhere.  So with your permission, here is our Sunday walk.  We walked up one of the local mountain ‘caminos’ and were attempting to reach a pueblo (village) up in the mountains.  We were stopped by an area that was blocked by a landslide, but there was a narrow path over the landslide.  We made it over the first section, but when the second section of slippery gravel scared me enough, we put a stop to the day’s walk.     “Strait is the path, and narrow the way….but few there be that find it.”  I think there is a sermon there, but please enjoy our walk with us….

We're not sure what this flower is, but it attracts hummingbirds like a magnet.  You always find them fighting over these.

We call these wild zinnias..reminds us of home.

These flowers are beautiful, but do not go close to the dead seed heads--you will be covered with hundreds of seeds on your clothes.

Here is a field of anise.  Curahuasi is the anise capital of the world, and we believe it.  The fields are so beautiful when they are blooming.

More roadside flowers

A corn field that ends abruptly at cliff's edge...

Lunch in the shade of eucalyptus trees, and a little rest...

These are the flowers of agave.  They put up impressive stalks 30-40 feet high when they flower and they attract hordes of hummingbirds as well. In the US, we call these types of plants 'Century Plants'

This is Mt. Padreyoc, 18,904 feet high, and impressively visible from our apartment.

   

Here on our way down the mountain, are the anise fields scattered out in the valley below....

Work and a visit to Cusco.

Happy Easter! Our daily devotional tells us that we are now living in what traditionally was called “The Eight Day”, or the “Bright Week”, the week after Easter in which we continue to remember the joy of the Resurrection of our Lord and Savior!

Here is an update on what keeps us busy here:

Jon is working daily (Mon-Fri) from 8 am – 5 pm. He divides his time between the Outpatient clinic and the Emergency Room. Every morning around 6 am patients begin to line up at the entrance of the hospital. The doctors try to see as many of them as possible, but there are limits, so every patient has to get a coupon to be seen and when the coupons are finished, they will have to come back a different day. The hospital mainly serves the Quechua, the indigenous people of Peru. To increase access, the prices are kept low enough for people to pay – and if they really can’t afford it, an exception is made. After an initial screening, all patients are brought into the large entrance hall that borders the Chapel, so everyone can participate in the short morning service led by hospital staff. Many of the patients travel for hours (sometimes up to 16 or 17 hours!) to be seen, so the doctors here generally spend a good amount of time with them, listening to their stories (often of multiple failed treatments) and carefully examining them. The hospital is blessed with multiple diagnostic options, including a CAT scan! The founding physicians of the hospital want nothing but the best for the poorest! The patients usually have all their tests done the same day, and most consultations after lunch are spent explaining and discussing the results, and prescribing treatments. Jon is grateful that his Spanish has improved enough to understand most of what is said, and his vocabulary is daily increasing, which improves communication with his patients and colleagues. Compared to our time in Sierra Leone, he really enjoys having colleagues and being able to knock on their doors to discuss some of the more complicated cases.

Outpatient Clinic (after work hours - that's why it is so quiet!)

On March 31, Heleen was able to send her completed dissertation to her professors. Although there probably will be some minor revisions to be done, the major job is completed! It has been very hard to find a date on which all eight professors who will be involved in her PhD defense are available, so the date has been set for October 25 – quite a long way off! But in the meantime Heleen is glad to have more time available for her work with Nyandengoh! Thankfully internet has been good enough so far to provide online training for the team and to continue to work on plans for the Nyandengoh! school. She is also going to start working on a Sunday school curriculum that addresses stigma, and will help churches understand the needs of children with disabilities and their families.

We are happy with our living conditions. We have a nice, light room, our own bathroom, and share our kitchen with a varying number of Peruvian staff, mostly doctors/residents who work here for several weeks or months. Almost every day after work and in the weekends, we put on our walking shoes and explore the mountains around us. 

Our room is where the towels are hanging!

On a Saturday when Heleen was still busy with her dissertation, Jon climbed up the mountain to see the Apurimac Canyon (you can see the Apurimac river at the bottom)

Over Easter the hospital was closed for 4 days so we arranged a ride to Cusco – a beautiful town about two to three hours away. Despite strict Covid regulations (which closed all tourist attractions) we were able to explore the town by foot and public transport. We even were able to meet with pastors David and Roberto of the Cusco Mennonite church. The Covid pandemic has caused many challenges to both the church and the school (Promesa), especially being located in an area that survives on tourism, which has been non-existent for the past year. Pastor Roberto invited us over to his house where we had a lovely time with his wife, daughter and some friends, and were served delicious coffee and traditional “tres leches” cake! We so enjoyed connecting with these brothers and sisters!

Beautiful, old Inca walls everywhere in Cusco.

The Plaza de Armas, normally bustling with people, almost empty now....

This little water fall surprised us in the middle of town.

Plants and flowers everywhere!

We were able to see a small part of Sacsayhuaman.
The llamas were surprised to see some tourists! :)

At pastor Roberto's house. Pastor David on the left, pastor Roberto on the right.

We miss you all but are glad to serve here!

 

Estamos en Peru!

On Monday March 1, we were taken to the airport by our great friend Deborah Martin, and less than 24 hours later, we were at our destination of Curahuasi, Peru.  The wonders of modern travel never cease to amaze me.  Our flights were very smooth and (almost) trouble free, even though we had to reschedule our flight to Cusco when we reached Lima, for some unknown reason.  But by catching the next flight we arrived only 2 hours later than scheduled. 

At the airport in Atlanta we were given plastic face shields which we had to wear in addition to our facemasks upon arrival in Lima and on our flight to Cusco. 

We were met at the airport by Ricardo, a capable driver who negotiated the curvy, mountainous, Pan-American Highway to get to Curahuasi.  March is the towards the end of the rainy season in Peru, so wildflowers and cultivated fields were simply gorgeous.  If you couple that beauty with driving through one of the deepest gorges in the world (up to 9800 feet deep, twice as deep as the Grand Canyon), it was almost enough to keep us awake.  But fatigue and altitude of up to 12,000 feet unfortunately conspired against us, and Heleen slept through one beautiful stretch, and Jon almost dozed off as well.

Arriving in Curahuasi, we were given a room in the Residencia, which has 10 one room units.  They seem luxurious with hot showers, constant electricity, and internet.   Because of Covid, we were placed in quarantine for the first 5 days.  The hospital served our food in disposable containers, and we rested for the first day or so.  Heleen then began working once again on her studies and Nyandengoh! activities, while Jon was immersed in learning as much Spanish as possible.  The days seemed a bit similar from day to day, and although we met some of our neighbors (mostly Peruvian doctors), we had minimal contact with most people in the hospital. 

We soon learned that we would not be able to eat all the food they would bring us.  We found that the Sopa y Segundo served every day (the lunch meal of soup and a second plate) was enough for 2 meals for us.  So most days we would eat some of the main course (Segundo) at lunch, and eat leftovers and the soup for supper.  

The scenery around the hospital is breathtaking, and pictures do not really do it justice.  There are tantalizing glimpses, and then more often longer glimpses of the snow-capped Andes mountains in the background, with their huge snow pack glistening brightly in the sun, and mountain range upon mountain range piled up on one another.  We probably had our mouths wide open for the first few times we walked, so it is good they were covered up by our masks.   Two reasons for that—we were puffing so hard to breathe because of the thin air, and our mouths were open in awe.  Mask-wearing is not optional here, and people are very compliant with the government rules.  

We love going on early morning walks, when the sky is often clear and the sun shines on the snow-capped mountains. The building with the orange roof below is the hospital.

View from our room. 

Difficult things of the transition and altitude adjustment were overshadowed by the death of Ethan Good, Jon’s father-in-law, on March 3, 1 day after we arrived.  Thankfully, we were able to be in contact with the family the whole time, and also able to view the very meaningful memorial ceremony online as we grieved together with family at home. 

The license for Jon came through on Friday, just in time to begin work on Monday.  The hospital is truly amazing with all modern equipment that is well-maintained.  Sinks work, toilets flush, electric is no problem, oxygen is made onsite, and everything is very clean.  The grounds are immaculately landscaped with all kinds of plots of garden plants, fruit trees, and decorative flowers. We just wander around and wonder at what can be done.  So far, Jon’s first week has been one of learning his way around the hospital, the computer system, and being totally immersed in Spanish.  The first two days, he worked in the ER, Wednesday with general/family physicians in the outpatient clinic, and Thursday with the pediatrician. He is supposed to start working on his own next Monday.

Ready to work!

We are so grateful for a good and safe transition and continue to covet your prayers for a fruitful time here.

A beautiful flower garden with in the background the hospital chapel.

This adorable baby alpaca lives on the hospital grounds.

We like to go exploring, and found this wonderful field of wildflowers which is full of all kinds of hummingbirds, jostling and fighting with each other. However, the field is so full of flowers that trying to keep others out is impossible for the feisty birds.