Surgery in San Lucas

Every year our friend, Dr. Will Bogel brings down a team of foot, ankle and orthopedic surgeons to work for a week at the missionary hospital in San Lucas Toliman on Lake Atilan.  Last year we took Alma, a young girl who lives near here, for the first of two surgeries on her feet.  This year, we referred six patients, and three of them were candidates for surgery.

Sue, a maternal health nurse from Washington State, was our main contact and became a good friend.  She was just one of 21 remarkable medicos who donated a week to serve our people.

So, the last week in February we spent a lot of time one the road!
First, on the Friday before the surgeries, we went to San Lucas to bring two patients up to the hospital for pre-surgery evaluations the following day. 

Alma went with us again, and was so very excited about being able to walk after this surgery.
 

Dick with Alma after her surgery in February, 2013

We also took Grevis, a little boy with dwarfism, whose legs are at odd angles, making it difficult for him to walk.










We had plans to meet a number of other patients, coming either from the coast or the Lake Atitlan area.  All of them made it except Karen, a darling little girl with spina bifida.  Dick had not been sure she was a good candidate for surgery, and we thought her parents had decided that they did not want to pursue this further.  I wish we had called! (More on this later.)



After the evaluation, Alma was accepted for surgery without reservation.  Grevis, however, was deemed too high a risk after his mother said he had had bleeding problems when he had a tooth pulled.
Joaquin, it was decided, needed to grow a bit more before it would be advisable to operate on him.  Hans would be coming back later in the week for the first of two surgeries.  It was decided, however, that to operate on Nathaniel, who has spina bidifda and no feeling in his legs, would be only cosmetic, and not worth the risk any surgery involves. 

We headed back home Saturday night, and I got to spend a short time with my guys before heading back to the Lake on Sunday.  (I have to share how well my guys manage without me, due in no small part to the competence of Miguel and Tony as companion care givers.  With as much as I was gone this week, even Fidel admitted that he missed me.  Awwww!)

We had to have our patients at the hospital at 7 am Monday, and neither Dick nor I had the desire to leave home at 3:30 am to get there. 

Actually, I had planned on going up only on Saturday, so I could teach this week.  God seemed to have other ideas, though.  For a number of reasons, I strongly felt I should go back.  While my translation skills were needed, I have to be honest.  Alma really wanted me to be there with her, and, since her mom had suddenly died recently, I was happy to take my friend Patricia’s place.  Alma’s brother and sister-in-law were would be with her, but they all said how I made them feel close to their mom again.  So I went.

Looking back, I had written last summer:

I’ve been wondering, lately, with the number of kids Dick is referring to Dr. Will as surgical candidates, if both he and I won’t be spending a week in February playing medical transport home from the hospital.

When we arrived at the hospital Monday morning, we were greeted by Karen, and her mom and dad.  They had not come Saturday because they did not have the money for bus fare, but had called the hospital Monday and were told, since she had already seen Dr. Will, they should bring her in and the staff would work her in if there were any cancellations.

As it turned out, there was an opening on Thursday, and Karen was scheduled.  We decided to put the family up at our hotel, rather than sending them home to have them return only a day later.  Alma’s brother and his sons were already staying with us (his wife would be staying at the hospital with Alma), so we had half the rooms in the small hotel filled.  (Brian, a worker from the Nebaj area, seemed to have taken up the other rooms with patients he had brought to the clinic!)

Though we had a lot of people to juggle, these two families ended up blessing us more than we ever could have blessed them.

As we watched Alma with her brother’s family, we could see that, when her mom died and her dad disappeared, they took her in not out of obligation, but out of a deep love for her.  It was so touching to watch them care for each other.  And they did what they could to care for us—buying us "treats” a number of times during the week.

Karen’s mom and dad are equally amazing.  When we met them, Pastor Miguel, her dad, was leading a church in Cuidad Quetzal, one of the most dangerous areas of Guatemala City.  Now they were in Masagua, near the Pacific Coast.  Pastor had been asked to take over a church that had been through an upheaval and was on the verge of closing.  Watching them with their daughter, and watching both Pastor and his wife minister to any number of people, from the parents of other patients, to the lady who worked at our hotel, was humbling. 

Pastor Miguel talking with one of the parents of another patient, sharing with them the love of Jesus, in word and action.

They don’t serve as pastors, they live as pastors.  They have a remarkable way of meeting people where they are at, and yet always managing to remind them that Jesus is there with them, pursuing them, whether they realize it or not!  I learned so much watching them.

Monday Alma had her surgery, and was released from the hospital on Tuesday morning. 

Before we took her home, we gave her a chance to rest at the hotel, and decided to take the families on a boat ride on the Lake.  We had a great time, even if we were a little soaked by the end of the trip.

We dropped off Karen’s family back to the hotel, picked up Alma and her sister-in-law, and drove them home to Supongo, near Chimal.  We each slept at our respective houses Monday night, and Dick and I turned right around and went back to the Lake in the morning.  We wanted to be there Tuesday afternoon, when Hanz and his dad arrived for his surgery on Wednesday morning.

Of all the kids we encountered at the hospital, Hanz was be far the most timid.  Dick had met him twice before, and still, Hanz refused to talk to him.  Hanz’s dad, too, was pretty reserved.  We were a bit concerned that they were feeling sort of “forced” into the surgery, and I asked Dad if he was sure he wanted to go ahead with the operation.  I got the strongest “yes” I have received from anyone to this question.  (I later discovered that his wife was strongly opposed to the surgery, and that this has been a real struggle for him.)

Hanz’s surgery went well, and though he was in a considerable amount of pain he was discharged Thursday.  We were trying to figure out how to get him home, and still be around for Karen when we found out that she would not be having surgery.  When she arrived at the hospital Thursday morning, it was discovered that she was, for no apparent reason, running a 104 degree temperature.  Of course, this meant no surgery.  Though they were disappointed, her parents easily accepted this as part of God’s plan saying “next year.”  Dick, who had been questioning the wisdom of her being operated on all along, seemed to be relieved.

So, once again, we loaded up the car, heading this time to the coastal area to take both of these families home.  We dropped off Karen and her parents first, and were able to gift them with a water filter and pump for their well before we left. (Click here to read more about this.)

Though they didn’t live far from each other as the crow flies, we had to back track a way to take Hanz home.  (There are so many places here in Guatemala that are the proverbial, “You can’t get there from here,”  or at least not in any way approximating a direct route.) It was well after dark when we left his remote, isolated village and headed back, tired and hot, to Esquintla, where we hoped to spend the night. 

The one decent hotel we knew was full, and, in the dark, it was impossible to locate another hotel.  As we talked, Dick suggested we head down to Puerto San José to spend the night on the ocean.  After such an emotionally intense week, we were both ready for some down time.

Since I had never been to Monterrico, the popular tourist area on the Pacific, Dick offered to take me there.  We found a beautiful hotel which allowed us to eat in the restaurant and spend a number of hours finishing up some computer work, while gazing at the Pacific Ocean.  After a pretty full week, it was exactly what I needed, and I returned home to my guys, refreshed and ready to face another week.

The Menace of Malnutrition, Part 2

In February of 2009, as I was considering my move to Guatemala, I met my first child with malnutrition.  Her name was Lisvi, a six year old who was starving, and she changed my life forever.  Reflecting on our meeting I wrote:

As I prayed on the plane coming home yesterday, God showed me that Lisvi did not need to meet me. I needed to meet Lisvi. I needed to willingly let my heart be touched, and wounded, and trust that He will give me everything I need to heal. I needed to learn again to risk letting my heart be touched, knowing it might be broken, but trusting it will heal. 

Five years later (is it really that long?) I still struggle when faced with malnutrition.  I fall back into feeling,  “Lord, I want to serve you but it hurts too much.”  And I still hear Him saying, “It’s not about you.”

I wish I could tell you that my first encounter with malnutrition, up close and personal, had a wonderful outcome.  But it didn’t.  Lisvi died about six weeks after I met her.  (Click here to read more of her story.)

I’ve spend many hours contemplating the “why?” of our meeting. 

Through Lisvi I began to learn that our ministry cannot be judged based on results.  We must measure our effectiveness by obedience to what God calls us to do; by serving the one He places in front of us at each moment; by faithfulness in the face of what looks like defeat; by our willingness to be broken by a broken world.

My recent experience with José has led me to spend time recalling the children with malnutrition who have touched me so deeply.  Thinking about how God has let us be part of what He is doing in these families.   Realizing how God has used them to grow me into who I am becoming.

Some of these children have recovered and gone home to not just survive but thrive.

Jessica waiting to see the doctor before she was admitted to the malnutrition project at Hermano Pedro in September, 2012.

Dick met Jessica at a Hope Haven wheelchair distribution.  He called me to tell me he was on his way into Antigua with “Lisvi’s twin,” and could I meet them at Hermano Pedro.  My flesh cried out, “NO, not again.”  But I went in spite of my fear, and have been blessed beyond measure by this little one and her whole family.  She is back home and doing well.  It is a treat when we get to visit her, and she continues to grow, two years after her discharge from the malnutrition project.  Her family has become our family, and I am honored to be called her adopted “abuela” (grandmother).

This is Jessica and her mom when we visited them last January.

Valentina shortly after she was admitted to the malnutrition project.

And little Valentina, who we just “happened” to meet when we were out visiting in Santa Rosa (the same area José comes from).  She came into the malnutrition project at a few weeks old, got “fattened up” and had surgery to correct her cleft lip.  She’s at home and continues to grow until she is old enough to receive her final surgery.  Valentina taught me that we must be willing to respond when the need presents itself. . .even if it’s inconvenient. . .even if we must change “our” plans to follow His plan.

Here she is, ready to go home.
What a little chub!      

These seem like successes. . .at least by my worldly standards.

Others are not so clear.  Little José Antonio (also from Santa Rosa—are you seeing how poor this area is?) was in and out of malnutrition over the years.  A few months ago, after living at home for more than a year, he died suddenly. It sounds like he had some complications from a kidney problem.  He brought much joy to all who knew him---though he was seven, he looked like he was only about a year and a half old. Oh how he knew to use his cuteness to get what he wanted.  José Antonio teaches me how great an impact even a small child can have on so many people. He is greatly missed.

This is Leonel, shortly after I moved to Guatemala in 2010.

Then there is Leonel, who Dick brought into malnutrition before I even moved down here.  He grew stronger and healthier, and was moved down to the children’s unit at Hermano Pedro shortly after I moved here.  His parents just couldn’t care for him at home, though he was doing so well.  And now we watch him withering away once again.  This time not for lack of food, but we believe from loneliness.  Dick, especially, tries to see him whenever possible, but it’s just not the same as being with his family. 

A more recent picture of Dick holding Leonel. 

It is hard to watch him deteriorate.  And we wonder how much longer he will be with us.  And I wonder why, when he is receiving such good care, he’s not doing well.  This ISN’T how it’s SUPPOSED to be.  Leonel continues to teach me about surrender.  But it’s hard and it hurts. . .



Now there is José. . .I don’t know yet all that he will teach me.  He has already taught me, though, that sometimes I must be the voice for one who cannot speak for himself.  That I must, after much prayer, draw a line in the sand when I believe it’s His will.  And it’s scary.  We still don’t know what the outcome will be. 
Will his family blame us if he does not do well?  Will they be willing to take him home again if he does grow strong enough? Did we do the right thing?  Did we wait too long before we did something?

He is teaching me already to trust in doing our best to be obedient as we understand God’s direction—even when the consequences of our obedience are still unclear.  He is teaching me to love someone who doesn’t seem to care if I’m there or not.  To love without expecting anything in return.  To love at the same time I let go.  Hard lessons—all learned from one who cannot speak, but who has purpose. 

Link to Part One

The Menace of Malnutrition

Meet José, a ten year old from Santa Rosa.  He has cerebral palsy, and weighs fourteen pounds. 

While we were in Santa Rosa, I once again held a starving child in my arms. . .and realized once again how helpless I am in the face of human suffering.  José is one of the most unresponsive children I’ve ever held.  Usually, when I look into the eyes of a malnourished child, I feel as if they are pleading for help.  As I look into the vacant eyes of José, I fear I’m looking at a child who has given up. . .who has lost hope of receiving human contact or understanding or love.


José’s mother and grandmother are estranged, and he has been living with his grandmother.  For years she has refuse to admit him into any malnutrition program.  She would say that it was because she would miss him too much, but as I watched her with him, in the two plus hours it took Dick and John to fit his chair, I never once saw her talk to him or caress him.  He lay in her lap staring off in one direction as she stared off in another.  While I don’t pretend to understand her life, the mother in me believes José needs more than Grandma is able or perhaps willing go give.

A year ago, a family from Omaha agreed to sponsor this little one and we have been providing food assistance to the family on a monthly basis.  Flori, the social worker from this area who has been taking the food to them, had concerns that José might not be receiving the food, since he was still not gaining weight. We began sending only formula.  Still he was not improving.  Yet grandma refused to bring him into Hermano Pedro for an exam, saying at for years missionaries have told her he would die, and here he is, still alive.

When I faced José at the distribution, I did something I have never done before. . .I told grandma that if she would not allow José to be examined at Hermano Pedro we would stop sending help.  I detest when North Americans think they know better than families how to care for their children, but, after talking extensively with Dick and Flori, I couldn’t help but feel that we were contributing to the neglect of this young boy if we did not set some limits.  I explained to Grandma that I was not saying that José needed to stay at Hermano Pedro, but that I needed to make sure there was not a medical reason (other than his severe Cerebral Palsy) why he was not gaining weight. 

Grandma reluctantly agreed, but Flori told us that she had talked with Hermano Pedro about José and they had said that in this instance his mother would have to be the one to admit him.  It was hard not to feel like we were fighting a losing battle here.  Grandma said she did not know how to reach her daughter.

Enter Vitalina, the amazing office manager for the mayor’s office.  She knew the mother.  She told us Mom lived on the same piece of land on which Grandma lived.  She told us she would handle this.  And she did.  She talked to mom, and explained that Dick and I would drive her to Antigua with José if she could come the next day.  She could not, since she needed someone to care for her younger child. . .and evidently Grandma would not do so. 
She did agree to come in the following day with a group that Flori was bringing to Hermano Pedro from their area. Vitalina found space for her in the van, and they did come in.  Without hesitation, Mom agreed to admit him to Hermano Pedro when we agreed to assume the financial responsibility for any lab tests he might need.



So, our little José is in the malnutrition ward.  I wish I could say that he is thriving, but that is far from the truth.  Dick has been told that it is almost impossible to get him to eat, but they are trying before they use a feeding tube.  I can’t help but feel that he’s just given up.  Still, when he’s held, he does not make eye contact.  He does not cuddle in the way many children, even those with CP, do when they are held.  And my heart breaks anew. . .

Did we do the right thing?  

Was it too little too late?  

Did we just make a bad situation worse?

Those are hard questions to contemplate, and they are impossible to answer. 

I trust, though, that Vitalina and Flori knew the situation better than we do, and used us as the “clout” to get the family to do what was needed for this child. 

I trust, too, the expertise of the staff at Hermano Pedro to provide the best possible care for this child.  Their track record speaks for itself.  (Click here to read about other children they’ve cared for.) 

Most of all,  I trust that God will honor what we did our best to discern what he wanted us to do for José. 
Please pray for this little one, and the dozens of other like him around this country.  I often want to ask God how he can allow these children to suffer and often die from lack of proper nutrition.  But I don’t dare, because I know the answer.  He has provided enough for all his children.  It is we who need to see that they receive what they need.  I can’t end the menace of malnutrition, but, I can respond to each child God puts in my path.  I pray I will be faithful.

Link to Part Two

Time with a team

In early February I was able to break away from school for a few days and accompany a Bethel Ministries International team on a wheelchair distribution to the department of Santa Rosa, near the El Salvador border.

This group was from Dick’s home town area, and I have met a number of them in the past.  And, as God would have it, I needed to go to this area to check on a child we are sponsoring, and wanted to visit some old friends.  I was able to accomplish all of these things in one trip.

This is one of my favorite areas to visit.  The mayor of Oratorio has a great commitment to helping children with special needs, and it is always encouraging to visit here.  (For the folks that were on George Powers Guatemala team in 2009, this is where you all went!)  My good friend, Flori, who is a social worker who frequently comes to Hermano Pedro, is also from this area.


Flori had told me that José, a ten year old with malnutrition who we have been sponsoring for a little over a year now, was coming with his grandmother to this distribution.  I especially wanted to see him, since she had said he was still not gaining weight.  We were able to meet with his grandmother, and ultimately facilitated his admission to the malnutrition project at Hermano Pedro.  (Click here to read more about this.)



Dick and his good friend John Bosman worked almost the whole day constructing a very special chair for José. and during this time I was able to get to know him and his grandma a bit better.  While many chairs were given out this day, it was one of those times when focusing on “the one” became more important than meeting the needs of  “the many.”  Thankfully, this team had some very experienced members, who were able to do a great job seating the others who had come. 



As often happens when I am at a distribution, I spend more time talking with the families who have come in than I do working on chairs.  (I do know which end of the wrench to us, but this is not my strong suit.)  As a result of these conversations, I often find many unmet needs—especially in the area of education.

Maybeline really wanted to take a “selfie” with me

Today was no different.  I met Maybeline, a fourteen year old young lady with a cognitive disability who wanted more than anything to be able to go to school.  As I visited with her mother, I discovered that they were there to get a wheelchair for her grandfather, who her mother was also caring for. 



Mom explained, much to my surprise, that there was a  private school in the area which would accept special needs students, but that they had no money to send her there.  As we talked, I could see how much this young lady wanted to go to school, and also realized what a help this would be in providing a small break for her mom while she was in school. 

Upon further investigation, I discovered that the cost of this would be about $25 a month, and that this was the last week they would be accepting new students for this 2014 school year which began in January.  Usually we look for a sponsor before we agree to put a child in school, but this time I felt a strong prompting to step out in faith and enroll her.  (If you would like to sponsor Maybeline, or other special students like her, please email me for more information.)

I was still a bit skeptical about whether or not this school was really teaching children with special needs, and wanted to see it myself.  Vitalina, the manager of the mayor’s office in Oratorio, agreed to go with us to visit the school the next day. 



I was so pleasantly surprised to be welcomed with open arms by the Director.  She explained their approach, which is pretty much the regular curriculum adjusted to the special student, and took me to meet the two special needs boys who were currently enrolled.  Both of them were very excited to tell me about their studies, and it was obvious how well they were accepted by their teachers and peers.  It was a real treat for me to see “inclusion” at its best in this small Guatemalan town.




Tania would also like to attend school.  Would you consider sponsoring her for a year at $25 a month, so this little girl can reach her goal of learning to read?

News from New Life

A new school year began for us in Santa Maria in mid-January.  We have received a number of new students, some with rather severe learning and physical disabilities.  My student load this year has increased to about 30 students, all of whom need special attention and customized instruction to be able to learn to read, write and do basic math.





Cesar (left) and Dulce (below) teaching me how to use their “name sign.”





I continue to work with our deaf students two days a week, but we are ecstatic to have the help of Latin Deaf Services two days a week.  Three of their staff members come and work with our deaf children, teaching them Guatemalan sign language, and working on academic skills as well.  I so enjoy when these kids come up to "talk" to me. . .I only wish I were better at understanding their signing.





One of the most exciting things I am doing this year is working with Yamelin, our blind student.  Last June a good friend, Donna Hultmann, a teacher of the visually handicapped. came and spent two weeks working with us and helping us plan for our blind and low vision students.  This was a huge blessing, since we really had very little idea how to approach teaching students who could not see.




We had thought that Yamelin was autistic as well as blind, but Donna told us that what we were seeing was pretty typical of a blind child who has not been worked with.  After talking with Yamelin’s mother, she agreed to begin sending Yamelin to school when classes began in January.

Using the techniques suggested by Donna, along with a high amount of predictability and structure, we are seeing great progress.  Yamelin is walking to our classroom with minimal help, and loves to ride the elevator.  She is using more and more spontaneous language, and is beginning to learn general concepts as well as identifying specific objects.  She is using her hands meaningfully to complete simple tasks independently. More and more she is listening to what is going on in group activities, both in my room and in her regular classroom.

I never expected to be honing new teaching skills at this point in my career, but I have to admit I’m enjoying the challenge.  I love how the kids teach me something new everyday.