Our Plans for Cambita Garabito

Cambita Garabito, Dominican Republic

January 25th - February 2nd, 2025

I found out that our plans for the project in Cambita hit a snag with a problem with the hospital's credentials on December 13th. The government said we couldn't go there, so alternate plans were being made to return to Monte Plata. Then, five days later, the problem disappeared, and we were back on track to go to Cambita for the project. However, the camp where we were going to stay couldn't accommodate us until Sunday afternoon.  So, more quick plans by our Dominican hosts and a new camp for Saturday night were found for us. Did I mention that changes make people nervous?  We kept on planning and planning.

Saturday the 25th was our day of transition. Transition from the normal routine to the new normal for the next week. Forty-three of us began early in the morning, but some started earlier than most since they were coming from the airport in Portland, Oregon, on Friday evening. We made our trips from the comfortable, spacious homes we enjoy and the families we love through the airports of the US - Portland, Wichita, Kansas City, St Louis, and Boston to come together in the Dominican Republic. All the participants arrived over a 4-hour period, and we only had one person lost (he actually wasn't lost, but there was a miscommunication of his schedule). Getting us all together, along with almost #1400 of supplies and medications, loaded on three vehicles for the hour-long ride to our temporary camp, was quite a feat.

We stayed at a new camp for those of us regulars due to scheduling problems with our regular camp. After a brief unpacking, we enjoyed our first of many meals of beans and rice. An orientation was then done, and we were able to unpack all the supplies and separate them to medical and surgical in nature for use the following day. The new camp was stuck in the middle of an urban area. The rooms were very small and set up for 4 people but not for suitcases, so we were cramped. The bottom of the bunk bed had only 24" of clearance, so you couldn't sit on the bed, only recline. Sleep was elusive for me because the bar next door played loud music until midnight. When they finally closed, I was able to clearly hear the constant drip of the toilet despite my earplugs. Needless to say, my sleep was not sound, even though we had arisen at 2:30 the previous morning to get to the airport in Kansas to start our day.

We were going to be able to "sleep in" until 7 am, but I gave up and got up at 5:30 to begin my day and have my first cup of Dominican coffee. Breakfast was good, and we were fortunate to have a pastor in our group this year. He presented an encouraging and uplifting message on the five-fold ministries of the church and how everyone's gifts and talents contributed to the team as it does to the church. We reloaded the truck and buses and traveled to Hospital Municipal Cambita Garabito. We arrived and did the necessary reconnaissance in the hospital, determining what rooms we could use and where to put everything. Then, we unloaded the box truck with all our surgical equipment and supplies. The team went to work unpacking and setting up a "new" hospital in a hospital.

As that occurred, the doctors began to see roughly 100 patients and began the screening and scheduling of the patients for surgery for the week. One of our translators was a young man that I have known for almost 20 years as he served as a high school student who spoke 4 languages and served as a translator. He is now a physician, having gone to medical school in the DR while working with us with MMI. Those friendships mean a great deal to me as I return year after year. The Clinic team left in the afternoon for the main camp to unload and prepare for the clinics for the coming week. Each day would be to a new location, so we would set up and tear down every day with our supplies. At the end of the day at the hospital, we were asked to see an emergency room patient with abdominal pain who might have a case of acute appendicitis. The diagnosis was not definitive, and we suggested admission and a repeat exam and lab in the morning. We put the patient on the schedule for the following morning. It was almost 7:30 by the time we got home for our evening meal. After our meal, we were all scurrying to set up our dorm rooms. Lights out couldn't come soon enough for most of us.

Monday morning, we began with a praise song in acapella and prayer as we did before each meal. We then had breakfast together, and one of the first-time participants gave our morning devotion. We were off and running to get to our hospital and the clinic to their site. The hospital was a 45-minute drive in good weather, and the clinic also had to commute to get to their site for setup. By 10, we were able to begin the first case. Our patient with the possibility of appendicitis had been transferred to a larger hospital during the night, so we started with a hole in our schedule. We did 20 surgical procedures on the first day, saw 150 patients, and gave out over 400 prescriptions. By the end of the day, we were all beginning to relax and get into a routine.

The clinic team returned to camp on time (around 5:30), but surgery was late getting home to camp. Our 50-minute drive to and from the hospital seemed to get longer as the week continued. We finished our meal by about 8 pm and then gathered under one of the cabanas for a little more time to become more acquainted with each other. It was good to hear each of our stories about how we came to join this team. We finished by 9:30, and then I completed the schedule for surgery for the next day and was in our bunk room to bed by 10:45pm.

My alarm went off at 5:30, and I had a much better night's sleep. After a cold plunge (that is what I called my morning shower without hot or even warm water) and a cup of coffee, we gathered for breakfast at 6:30: pancakes, sausage, and fresh fruit. Our morning devotion centered on the book of James and its relevance today to our tongues. We were all on our buses and off to a new clinic site and the hospital by 7:45.

Our hospital day was very full, with 25 cases being done and 4 procedures being performed at the clinic site. This was the first year we sent a surgeon and nurse to the clinic site for minor, local anesthetic procedures. It was quite successful; 46 procedures were done in total, and another 19 consultations were done in the clinic, which spared the patient from going to another site to have procedures done. Each morning, we start with a praise song called Alabara, which means I will praise my savior. It is well known to the citizens of the towns we serve. We then pray and enter the hospital to begin our day. The OR crew readies the rooms, the preop team checks in the patients for the day, and the surgeons make rounds to check on the patients who stayed overnight to discharge them home. Today, during our scheduled cases, an emergency case came in with a patient who had a miscarriage. Since we had taken over the ORs with our equipment and procedures, we made room to add this case to the GYN room. This did push our schedule back somewhat, and then the last case in that room ended up taking almost 3 and a half hours, finishing at 6:30. She had low blood pressure. We stayed at the hospital until 7:30 before driving the hour back to camp. We ate our dinner after 8:30 and were in contact with the nurse at the hospital until 10:30. During the night, the hospital director came back in and decided to transfer the patient to the capital of the province to a larger hospital.

The following morning, we were told about the transfer and that she had to have blood transfused and reoperated. This dampened the mood of the OR team, which was concerned for the patient and her family. Our morning devotional compared situational awareness at our workplace to the situational awareness we need to have concerning the things of God. Wednesday was the heaviest surgical volume scheduled so far. While the OR crew was preparing for the day and beginning the first cases, the hospital director had me in his office to explain the protocols we were to follow going forward after the difficult case from the night prior. This municipal hospital did not have a blood bank, but all major cases - by their definition - had to have 2 pints of blood on site prior to surgery. This protocol is not currently in place in the United States. He also stressed that all patients had to have preop lab work. Once again, this is not something we have encountered in the DR before. The director then canceled 3 of our cases for the day. The patients left, went to the capital to purchase blood, and returned the following day. We also contacted the patient for Thursday and instructed them to do the same. With our schedule being shortened, we were able to leave in time to return to camp even before the clinic returned. Today, they had a long day in the clinic, serving in a small village in the main square under a large tent. A hot, long day for them. One patient was a 54-year-old man who was very thin and came with family, as most patients do. He told our doctors that he had recently been diagnosed with lung cancer but had not seen a doctor to find out any details or options. Our doctors were able to determine that he had a very advanced disease by their exam. They were able to explain to him through our translators the nature of his diagnosis and the gravity of his condition. We were able to pray for him, and he responded by saying that he didn't know how long he had left, but he would be praising Jesus all the same.

The following day, we returned to begin our scheduled cases. Sure enough, the three major cases we had scheduled showed up with a unit of blood as well as the two from the day before. We were in communication with the patient who was sent to the capitol. Her husband said she was doing better and appreciated all we had done for them. That was welcome news to everyone. One of the scheduled cases had high blood pressure that had not improved since seeing her in the clinic, and she was canceled and sent to see a cardiologist to obtain clearance before surgery could be done. That allowed us to add one of the cases from Wednesday. Then another patient revealed that she was on a blood thinner, something that had not been revealed before to us. She likewise was canceled until she could be taken off the blood thinners for 3 weeks prior to surgery. And the second patient in waiting was added to the schedule. God knows these things. Further discussion with the hospital director yielded a plan for next year where he, as a physician, will screen all candidates for surgery two weeks prior to our arrival to check them for surgery and obtain any lab or clearance we need. We were encouraged that they still wanted us to come back next year. A full day of surgery was completed just late enough for us to have to drive home in heavy rains on winding narrow roads but safely.

Friday was met with mixed emotions. I was sad that the project was coming to an end but was pleased with all we had accomplished. The plan for the day was to finish the schedule at surgery with a short day since we could not do major overnight cases due to our leaving and not being able to discharge our patients the day after surgery. One of our highlights today was seeing and doing surgery on a precious 3-year-old named Sonja. When I evaluated her on Sunday for surgery, she was found to have a mass on the inside of her mouth on the lower lip. She was happy, and at the end of the examination, she told me in Spanish that she could speak English. I said great, talk to me. She responded by saying in perfect English, "One, two, three, four!" with great satisfaction. When she came with her mother on Friday, her personality was still as effervescent as before. She was carried by the anesthesiologist to the OR without hesitation. When the surgeon prayed over her before surgery, as we always do, she joined in with the Amen. She then joined in singing "Alabara," even providing verses we didn't know. All went well with her surgery, leaving smiles on the faces of the team.

Stats for Cambita Garabito, 2025

Patients Seen in Clinic:   553

Health Education:   887

Prescriptions Filled:   1,967

Eye Exams:   185

Dental Patients:   120

Major Surgeries:   56

Minor Surgeries:   83

Consults:   169

Commitments to Christ:   28

When we finished the last case at 3 pm (a couple of hours later than we had planned), we still had to take down the entire OR and pack it into the white box truck for transportation to the next project. The clinic team also had to see all their patient and then pack for transporting all the supplies back to the warehouse in Santo Domingo. So, by the time we all returned to camp, we were tired but satisfied. After our evening meal, we gathered under the cabana and had time to share and debrief to be able to look back over the week. I enjoy hearing the comments of the participants during this time. Seeing the life-changing insights that come from these experiences is so encouraging. We shared the preliminary statistics that we keep to track our progress. All were pleased. Some of the impressions of the team centered around the gratitude they saw from the patients, not only for what we could do for them but also just the fact that we came. The participants were also excited to be part of a cohesive team and the camaraderie that developed so quickly among all team members, from repeaters to new timers, doctors to general helpers. They also became more aware of how fortunate we are to live in the US today, and for all we have.

Saturday, we got to "sleep in" again since we set breakfast time at 7:30 instead of 6:30 am. We enjoyed our last meal at the camp and packed all our belongings to put into the buses and trailer. The remaining part of the camp equipment was loaded on the truck, and we were off to the capital, Santo Domingo. It took over an hour since we traveled through the middle of town, and it is always "rush hour" like traffic. We parked just on the outskirts of the colonial zone, left our buses with the drivers, and walked into the square. We could all visit some of the sites and have lunch before those leaving Saturday for home, returned to the large bus and headed to the airport. Sixteen of the team stayed over until Sunday to return home so that we could enjoy the city before the long trek home.

We stayed at a new hotel near the location where the buses waited to take the rest of the team home. At 3 pm, we were able to check into our hotel (along with 30 other folks, and yes, they only had one person to do the checking, but fortunately, he spoke English). The last husband and wife of our group checked in, and to our dismay, the last one could not find his passport to check-in. He looked through all his bags and his backpack, where he had seen the passport earlier. He did have a picture of his passport, which the front desk person said was okay for him to use. We all knew that was the least of his problems since he couldn't fly without a passport. He was getting ready to drop his bags in his room and run back to where the bus was parked to see if he could find it along the way. (Yes, I know what you are thinking, and that is what I was thinking, too.) Just then, the couple that checked in last came through the elevator doors excitedly, remarking, "I found it!" When they got to their room, she prayed out loud, "Lord, let it be in the backpack." When she looked in her backpack, his passport was on the top. We later pieced together that their backpacks were beside each other on the bus, and his passport had fallen out of his backpack. Someone noticed it on the floor of the bus and just put it in the nearest backpack, which was hers. What an answer to prayers, certainly not in the way we expected.

The remainder of our day was restful and uneventful.  We were able to do some sightseeing and enjoy a couple of meals together. On Sunday at lunchtime, we went to the airport and began our travels home to the cold weather and the hot showers. The flights back home were not nearly as rushed, and customs were not nearly as tense because we were home. But the new people we had met and befriended and the lives we had touched were still freshly imprinted on our minds. And the plans for next year have already begun. I think that I am starting to better understand the process of planning.

Cambita Garabito; It's All About The Plans

Jeremiah 29:11 begins with, "I know the plans I have for you, declares the Lord." The unfortunate thing is that I am pretty sure I don't know what His plans are when it comes to the mission trips we make.  You would think that I know that by now after 34 trips, but I just keep learning. For instance, our recent MMI trip to the Dominican Republic on January 29, 2024.

MY PLANS

It takes quite a while to "plan" a trip like this.  But this is not just me; it involves coordination with a large number of people over a long time.  Sheri and I, and Bill and Pat Waswick are involved throughout the year before the trip.  The challenge is that we don't know how many people will go with us, how many people we will take care of, nor what those conditions will be.  So, making plans in and of itself is complicated by any number of erroneous assumptions.  But we have the benefit of experience and a history of doing this kind of thing.  One of the difficulties is in remembering that this is God's plan and not our own.  We make a prediction of how many we will have and what we will do, then go about trying to achieve that goal.

Peoples

It begins with the people who join us.  We know that to set up and run a clinic, we need at least 5-10 participants, and in surgery, we need 15 to 20 to run two to three surgical tables.  The size of the places we go can limit us also.  So, when we had 33 sign-ups to go, we thought we might have a few too many.  Most people who go want to be busy.

Jim Collins, the author, says it's not enough to have the right number of people on the bus; they have to sit in the right seats to make an organization productive.  However, when one of our participants had to return home for a family emergency, and two more came down with COVID, we ended up with the right number of people, and they were sitting in the right places.

Places

This year, we were returning to Yaguate, where we went last year.  At least, we thought we were until we were told around 2 weeks prior to leaving that the hospital in Yaguate was being remodeled, and we couldn't go there after all.  A new hospital had been recently opened in Cambita Garabito.  As we found out, it was so new that the surgery area had not been used at all.  We were scheduled to go to 5 different villages and set up our medical, dental, and vision clinic, but not until we arrived did we find out that 3 of the villages could not host us.  Fortunately, the MMI staff in the DR was at work behind the scenes, and replacement sites were found.

Products

What we can do is certainly controlled by who and how many we bring, but what we bring also impacts what we do - namely, the supplies, equipment, and medications.  In the DR, MMI has a warehouse that can hold the big equipment and supplies such as tables, lights, anesthesia machines, and sterilizers that we need for a project since we can't count on all the hospitals to have what we need.  We can set up a "MASH"-like hospital in almost any facility.  However, disposable supplies are more of a problem. 

We generally bring 1,000 to 1,500 pounds worth of supplies as our checked luggage (27-gallon Rubbermaid-like tubs).  We collect those supplies year-round, process them here, and then take them with us.  Medications are purchased from a not-for-profit wholesaler.  We know that we usually see around 500 patients in the clinic, so we try to bring enough medications to provide for that number.

Vitamins are commonly given to each patient as they represent a luxury for the people there.  So, I ordered 18 bottles of 1000 each to take only to find out in November that they couldn't supply the order since there had been so many worldwide needs (Ukraine, Tsunamis, Earthquakes).  So, I approached our church, and a "Vitamin Sunday" was set up for people to bring vitamins to church on December 3.  Together with what was collected and donations made, we were able to take almost 13,000 doses of vitamins.  I had to send a list of each bottle and amount to Customs in the DR 6 weeks in advance, so I sent my list only to find on my front porch three days before Christmas a box that had the full 18,000 vitamins that had been back-ordered.  God provided abundantly and more than we planned.  The abundance will provide for future projects in which we cannot collect the vitamins to provide for those who need them.

HIS PLANS

I have learned that the best way for me to follow His plans is to not get too far ahead and be willing to be flexible if I find that I was wrong about what I thought I heard Him say.  These projects certainly prove that.  Being flexible seems to be one of the most valuable skills that one needs to participate in a mission project.  So, with that view through the rear-view mirror, I can better see how His Plans have unfolded.

Unity

1 Corinthians 12:25-26 So that there will be no division in the body, but that its parts should have equal concern for each other.  If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.  We brought 33 people from the US and worked with 11 from the Dominican Republic with such diverse backgrounds, including 2 countries, 10 cities, 5 states, multiple jobs at home, and most of whom didn't know each other before landing in a foreign country.  It was that common purpose that united us all into a cohesive and productive "body" that we equally suffered and equally rejoiced during the project.

Service

John 13:15 : "I have set you an example that you should do as I have done for you." The wonderful part of going on a mission trip is that everyone who comes does so voluntarily and of their own free will expecting to serve. 

Cambita Garabito, 2024

Patients Seen in Clinic:   442

Health Education:   837

Prescriptions Filled:   1,634

Eye Exams:   192

Dental Patients:   101

Major Surgeries:   48

Minor Surgeries:   33

Consults:   107

Commitments to Christ:   10

Almost every year, I have people share that this type of comradery and environment is why they went into health care in the first place.  Likewise, the responses to us by the patients and families we see are heartwarming. 

Statistics are a poor way of quantifying our impact, but they still help underscore the services that we were able to provide to "the least of these" that Jesus talked about.

I received a beautiful hand-written note in lovely cursive English from one of our patients that I would love to show you sometime. It is soon to hang on my wall.  It was interesting that she thanked us not for our medications, our dental work, or even our skilled surgical procedures but for our presence.  We just showed up and followed God's plan.  If I stopped my post here, it would be considered nice, heartwarming entertainment.  But there is more.

YOUR PLANS

So now the hard part.  What does this mean for you?  There are many opportunities to serve on mission trips with MMI in over 23 countries annually.  For some, that is not a good option.  For some, going with us to the DR next year around the last week of January may be an option.  Or maybe it's helping with the purchase or packing of the medications and supplies.  And hopefully, it includes praying now for next year.  But as I read it, the Great Commission doesn't seem to have a "none of the above" option.  So, consider going, giving, praying, or maybe all of the above for the least and the lost as we begin to try to figure out the plans He has for us all.

September Dominican Republic Project

The COVID-19 pandemic has prevented short-term medical mission projects since our January 2020 project to Monte Plata. So, we were pleased and excited to return to the Dominican Republic in September to a hospital in the village of Palenque. One of the primary functions of our project, in addition to helping the underserved with surgical care, was to make sure that we could safely provide care. Our project was a pilot project to begin to reenter the short-term mission field armed with new COVID protocols. There had been a small medical-only project 3 weeks before our arrival, but we were the first to do surgical procedures.

The primary precautions we took focused on three areas.  One was personal protection. We took and used PPE for all our staff.  All of our participants were fully vaccinated and tested negative prior to returning to the country. The second area concerned social distancing. We limited our group to 17 participants to allow more space in our transportation (the yellow school bus), our sleeping accommodations, and our meals. The last precaution had to do with our patients. All patients were tested with a rapid antigen test on the day of surgery. Only one patient of 60 tests done were positive.  So that surgery was cancelled.  All of the patients seen were fully vaccinated.

The good news is that we were able to safely see and provide surgical procedures to 57 patients. The local hospital averages 1 surgery per week normally. We are now focusing our attention on slowly ramping up the projects to the DR and around the world.

Let's Commit to Monte Plata During COVID-19

A pharmacy station at a recent medical missions trip to Monte Plata.

Some of you have probably been wondering about the project and the people of Monte Plata, Dominican Republic. Here is the latest on the project status. Before COVID-19, we had planned to return to Monte Plata in late January for what would have been our 20th annual project to that city. From a planning perspective, all projects since March last year have been canceled. MMI has been canceling projects about 60 to 90 days before the anticipated day of departure. The planning for a project begins shortly after one project ends, but these are different times. So, we pushed the date for our project back to mid-March in hopes of a turnaround with the pandemic.

We plan to do a smaller project (15-16 participants rather than the usual 35-40) to maintain some social distancing. We have also developed new protocols for surgery practice in the post-COVID world and plan to do a surgery-only project. The CDC then placed restrictions on international travel, making it almost impossible to get a team there. The case level in the DR spiked in the locality where we were to go, requiring them to need the beds they had allocated to us. So, this year's project was canceled and rescheduled for January 2022.

We were sad, but it is more tragic for the local Dominican staff. On a large project, they would occasionally employ up to 20 support staff for us. Those folks have gone without support from the projects for a full year now but are still passionate about the mission to their people. The country has had a curfew that restricts travel after 6 pm until 7 am. So, the staff has been giving out the PPE and medications in their warehouse to the hospitals and patients we serve. They are now sending small local teams back to the villages we used to serve to provide physical, mental, and spiritual health care to stand in the gap until the larger projects can resume. We hope to be able to begin to resume projects in late summer or fall of this year to the DR.

But in the meantime, there is something we can do to help. The DR needs funds to help buy medications and supplies and support their staff. Transporting or shipping supplies is very difficult with their new government, but they do have places where they can purchase those things. Would you consider donating to Live Greater Medical so that we can forward it to support the efforts in the Dominican Republic?

Highlights and Lowlights from Monte Plata 2019

Highlights and Lowlights from Monte Plata 2019

Changes

This was a good year.  It was also a different year.  This year our team went to Monte Plata as we had done before in January of 2019 but this year we planned and did our project as a one week project.  Now on the surface, it would seem as if that is not a really big deal. We still had to recruit, supply and to execute in the same manner.  It seemed that recruiting went easier in asking people to commit for only one week.  In the past the commitment has been one with options.  They could come for two weeks, one week or part of both.  It made it difficult for me because of having to make sure we had the people in the critical positions covered for the whole time.  For example, if all of the anesthesia personnel wanted the first week then the surgeons on the seconds week couldn’t have as many tables to work.  If all surgeons wanted the second week then the anesthesia from the first week had no cases to do.  In most years, I don’t have the team completed until December with sometimes filling in the last slot in early January.  This year with only one week to choose from, we filled the team to capacity in late September.  There is a capacity for the camp where we stay and we filled that number and with the right mix of participants in the critical slots.

For the most part the supply side is a little easier except for the medications.  We collect disposable supplies year round and sterilize them in October prior to the trip.  I estimate how many cases we may do based on prior years experience and on the personnel that we have signed up.  So 1 or 2 weeks just requires different estimations and then collecting the supplies.  God provides all the time, but we sometimes have to work harder.  We must order medications for the clinic and medications for anesthesia in advance, so the estimates differ in amount depending on numbers that we estimate. 

This year we had 42 participants with us and each was able to take a 27 gallon plastic tub with supplies.  Since the airlines limits the weight to 50 pounds for each tub (or suitcase), that gave us a capacity of 2,100 pounds of supplies.  Realistically we probably had around 1600 pounds when we were all packed.

There was a concern with changing to one week we would be sacrificing the reach of the project.  As it turned out we did as many surgeries as last year in two weeks.  This was by having 3 OR tables running for the 5 days of the week instead of 2 tables for 8 days.  The clinic was clearly busier each day of the week with more patients seen daily but only going to 5 locations instead of the 8 last year. 

There was a more concerted effort on the ground in the DR prior to our arrival to advertise and spread the word of our coming this year with radio ads as well as the truck with a loud speaker going thru the towns to announce our arrival. (I’m fairly sure that technique would not go over well here in the States announcing the arrival of a new doctor in town.)  We chose the towns to visit based on last year’s turn out so as to maximize our impact and, it seemed to work.

The Team

We returned to the same “camp” for housing.  We have stayed in a compound that is surrounded by an 8 foot cinder wall.  It contains the Eva Russell School that was built by the local church who sponsors us in the town. 

It was almost new when we first started coming to Monte Plata in 2003.  It has changed over the years with a few new buildings and expansions and growth of the plants and trees.  One of the upgrades this year was converting two of the shower bathrooms downstairs near the classrooms to bathrooms with multiple stools.  That is great for the kids but for our team of 42 it was a little problem especially when one of the remaining 4 showers broke (think gushing water and broken pipes).  That left 2 baths and showers upstairs for the 26 girls and 1 shower and 2 baths downstairs for the 16 guys.  Not quite the standards for a 4 star resort.

We had 13 first timers with us this year and our returning participants had logged 1 -19 previous trips besides myself.  They came from South Dakota, Des Moines Iowa, Chattanooga Tennessee, Kansas City, Jackson and Jefferson City Missouri.  The remainder of the group came from Wichita, Winfield and Arlington Kansas.  It is always interesting to hear the stories of the group when we begin to get to know each other.  Everyone comes for different reason and at different seasons of their life.   We had participants born in the 40’s, 50’s, 60’s 70’s 80’s and 90’s. 

We also had 2 young people born in the 2000’s.  But even with the age range differences, we all enjoyed each other and learned from each other.

Medical and Dental Clinic

We have been blessed with a stable crew of providers to staff our clinic over the years and it paid dividends this year with the shortened schedule.  Our first clinic day was for the people of Monte Plata.  We stayed in the camp since it was a holiday for the school.  It helps to allow the clinic team to do their first day in the camp to develop processes and procedures that allow them to then take the show on the road so to speak.  They then traveled to El Cacique, Don Juan Chirino and Kilometer 12 to provide clinic services to the rural areas surrounding the Monte Plata area.  Our total patients seen between clinic, eye, dental and surgery were actually 10 more that seen in the previous year on a 2 week project.  Our three pharmacists (a rare bonus to have three) were able to dispense 2439 prescriptions to those we saw.

Their cases always seem to have something new and different every year.  This year a man walked into the clinic with a leg wound that had been present for months.  When he pulled his pants leg up we saw a lower leg with no skin left in place and a non healing wound.  It the US the only option for him would be an amputation since the wound could not heal without months of intensive therapy and possibly skin grafting.  We were left but to clean up the wound and dress it properly.  We frequently take for granted the facilities and technology we have in the states.  Most were seen and given prescriptions for their most acute need along with vitamins and parasite treatments.  Some were referred to the hospital clinic for us to see and some had surgery that week others that were referred were then sent to the capital if we were unable to care for them in our surgery clinic.

Our dentist worked under very primitive conditions and was able to provide a full range of dental services to 109 patients.  Everything from cleaning, to filling to sealants and extractions were done in a portable chair in our open are clinic with a gasoline generator to power the dental equipment.  Eye exams were done on 315 patients and 157 of them received glasses.

Surgical Services

We continue to work with our colleagues in the Hospital Provincial de Monte Plata.  Some of the staff there has been in Monte Plata since before we came and it is always great to see them and be greeted by the enthusiasm of the patients.  Each morning as we arrived to the large lobby area we were greeted by applause from the patients.  We then would sing “Alabare” and start our day with a corporate prayer.  The hospital works hard to improve the health of the people in Monte Plata and has initiated a campaign to encourage all their staff to reach out to the patients and ask “How may I help you”.  They had buttons made for each of our team and presented them to us with our name on the button to make us feel at home and part of them. 

With our team consolidated to one week, we were able to have three operating tables work at the same time.  It did present some problems from a space standpoint.  Last year with two tables in one OR and one preop room and one post op room we were all close by each other.  This year with more volume we needed two post op and two preop rooms.  That meant that we were spread over a larger area on the second floor of the hospital.  The hospital normally doesn’t use the second floor for patients, just surgery and labor and delivery with the nursery.  We had to use walkie talkies to be able to communicate between rooms and to staff to keep the flow of patients.

Most of our patient has their surgery done as an outpatient going home the same day.   The larger surgeries like gall bladder surgery or hysterectomies stay overnight and go home the next morning. 

That means that we have to transfer the patients to the service of the hospital for overnight care.  The hospital medical director has worked with us at least 3-4 years and she assumes the care during the night.  We return the next morning and see the patients and dismiss them.  The hospital does have an elevator but it broke twice while we were there.  Once while trying to bring the heavy anesthesia machines up to the OR.  The second time was late in the day on Wednesday.  We were all tired and the last patient was ready to go downstairs to her bed.  All of the staff was done except for post op crew.  They were the last finished most days due to the nature of their area.  As they were waiting for the elevator it broke (think trapped between floors).  The prior time with the machines and two of our transport crew a short wait was endured before the hospital opened the door with the key to the elevator.  This time after waiting and trying to figure out what to do with our patient (do we carry her down the winding stairs?) the hospital maintenance staff arrived.  They went on the roof and did something and returned to the second floor and opened the outer door with the key and yelled up the shaft in Spanish “lower, lower, lower” until the elevator was visible and the inner door was opened.  They then motioned for us to push the cart and patient onto the elevator.  After a short delay of people looking at each other, we pushed the cart and patient into the elevator.  (Did I mention that there was not one of those stickers in the elevator telling when it was last certified?)  The maintenance person then closed the outer door and ran down the stairs to the bottom and opened the outer door with the magic key and yelled again in Spanish “lower, lower, lower” until the elevator appeared slowly from above.  Then, he yelled “stop, stop”.  We pictured someone on the room lowering the rope attached to the elevator hand over hand until it was in just the right position with beads of sweat on his forehead.  He then opened the inner door to the huge smiles of the staff that pushed the cart out and down the hall as if nothing happened.

I am occasionally asked what kind of cases you not want do while you are there.  This year I tracked the cases and found them to fall in 5 categories.  The first has to do with coexisting illnesses that make surgery too risky.  While it might not be too risky here in the States, in the DR on project we just don’t have the back up in either technology or personnel.  This would be like patients with uncontrolled high blood pressure or blood sugars.  The second category is for conditions that are too complex.  Cases of obvious cancers that are extensive can’t be adequately staged or treated there in a Provincial Hospital.  I saw a 19 year old with a large mass under his chin that pushed his tongue up.  We don’t have CT scans or many diagnostic studies to define the problem.  The third group involves patients that have conditions that require specialist in areas that are not present on our team.  We had many patients that desired surgery for urologic conditions and we didn’t have a urologist with us, nor the equipment that they use.  One of the broadest groups is for patients that we can’t operate on are those that have pain that is not related to a surgical problem.  When patients know we are coming they show up with symptoms but don’t know if surgery will help their condition but rely on us to tell them if we can help.  Frequently those patients are relieved and reassured that they don’t need surgery.  We had advertised that we would take care of hernias.  One patient came in to have his hernia fixed but it was a herniated disc in his back that he had and it’s not something that we could or should do surgery.

One patient that we saw was an American who was in the DR with another ministry drilling water wells for the villages.  He fell off a ladder and landed on his arm.  It caused quite an abrasion.  After 4 days the pain and swelling had not gone down.  He saw one member of our group at a local ice cream shop one evening and was excited to see American doctors. 

He came to the surgery clinic the next day and we were able to get an x-ray of his arm to find no fracture.  Our clinic provided the antibiotic and wound care he needed to get him thru his project and returned to Michigan for follow up. 

The last category of people who don’t get surgery are those who have conditions where surgery is contraindicated such as for keloid scars.  These can be unsightly but the repair is almost always associated with re-occurrences of the scars that are worse than the first.  We strive to above all do no harm with our surgeries.

An unusual case this year was a young man who was in a motorcycle accident that resulted in him being thrown from the cycle and fracturing his femur and tibia. 

The femur was repaired with a plate place in surgery and a device called an external fixator for the tibia fracture.  That in and of itself was not unusual but it happened 3 years ago and the fixator is usually removed after 6-8 weeks of healing.  For some unknown reason (think financial) he was sent home with the tools to remove the fixator but the patient never followed up with anyone.  He saw one of our translators a month ago and when he heard we were coming he asked if we could help.  Pictures of the leg and device were sent to me over WhatsApp and I showed it to our surgeons who showed it to orthopedics surgeons. 

They said we could and should remove the hardware as the risk of osteomyelitis (bone infection) was very high as long as it stayed in place.  We took some special instruments from the States with us and saw the young man and said we could help.  He was ecstatic having been limited in his activities for over 3 years from the device.  With sedation, a 7 minute procedure was done to remove the device and he went home all smiles, well mostly smiles.

  We sometimes examine patients and end up referring the patient to specialists in the Capital city.  Some follow up and go; others don’t for a number of reasons.

Progress

Sometimes it seems as if nothing changes.  It almost was like stepping into a time chamber for us and we return and seem to pick up where we were last year.  This year a couple of things changed.  The ministry works largely because of the permanent staff in the Dominican Republic.  They do all the leg work to make sure we can do what we do with the government blessings.  They also maintain all the hard assets necessary for doing the short term projects.  That includes trucks, buses, cars as well as all the OR tables, lights anesthesia machines and supplies that we bring in excess of need.  Several projects are unable to bring anything with them and the extras are what they run their project with.  This year I was pleased to be able to tour the newly constructed warehouse.  It was made of 3 shipping containers in a “U” shape with a metal 2 story building over the top. 

It is in a secure area with some land around it.  It is quite an improvement for the ministry and the staff to have.

The second area was in personal growth and development of the staff.  One of the interpreters that I have worked with for 10 years will begin the final year of medical school in the DR in March along with a second person a year later.  Another supply manager last year has left the ministry to start his own foundation in Sabana Grande de Boya to help the youth of his home town.  It is so easy to get excited and want to come back to a place where there is such a giving and caring environment.

Conclusion

I think that the point is that there is not a conclusion to helping others.  The need continues and by addressing that need we all can find meaning in our lives.  So while we may know we are home by being reminded with the blistering cold winds and snow, we know we will step back in time to the DR in a few months to the warmth of not only the weather but the friendships we have made and cherish.