Wednesday, February 27, 2013

February 27, 2013 Mirrors Stolen Off Of The Ministry Truck In Broad Daylight On A Busy Street

I will never understand why people steal!
Today the Ministry Truck was sitting outside of the office on the street in plain daylight and someone stole the mirrors on BOTH the right and left sides of the truck.

I called to see how much they cost and they are 
$125 each used!

When will people ever learn that stealing will not make them rich?

What About Restitution?

The basic penalty principle in the Bible is that when a person who is convicted of a crime they must make restitution to the victim of their crime. For example, the penalty for theft is four, five or seven fold restitution which goes directly to the victim.

Exodus 22:1 If a man steals an ox or a sheep and slaughters it or sells it, he must pay back five head of cattle for the ox and four sheep for the sheep. 

According to this verse the thief must pay his victim four times the value of what he has stolen if it is a sheep. I think that the extra compensation, what is above and beyond the value of whatever was stolen helps to make up for the cost of tracking the thief and bringing him to justice. This multiplied value return, also acts as a deterrent against thievery.  A thief does not get caught every time he steals thus if he only has to pay back what he has stolen, he might decide to steal anyway, knowing that when if he gets caught, he can just give back the stolen goods. But because most men need penalties in order to learn, God's plan is the fourfold repayment.  This places a bite in the punishment.  It also reduces the economic benefits of theft.

It is interesting that stealing an ox, gets additional restitution because an ox is used for work. So if you are stealing the tools that a man does his work with, then you must pay a bigger bite.  Because it is a asset which can be used to produce an income stream into the future the ox is more valuable to its owner than a sheep would be. God is so fair!  Stealing an ox makes the owner less productive not only for today but also for the lifetime of the oxen. 

So if a thief steals your oven or your mixer and you are a baker then the repayment should be more (5x value) than if he steals your lawn furniture (4x value).  As a professional baker your oven and your mixer is what make you money where you can feed your family, therefore the Biblical law requires five fold restitution.   

Yet there are other values placed on other things.

Exodus 22:7 If a man shall deliver unto his neighbor money or goods to keep, and it is stolen out of the man's house; if the thief be found, let him pay double.

If money or goods are stolen from a neighbor who is holding it for you then the penalty is less.

The scripture is clear that stealing to eat is not to be tolerated either. In fact stealing to eat has a larger penalty.

Proverbs 6:30 Men do not despise a thief, if he steal to satisfy his soul when he is hungry; 31 But if he be found, he shall restore sevenfold; he shall give all the substance of his house.

When one steals to eat, it is a 7x penalty.  At first this concept bothered me and then I realized that the Bible has much to say about eating. 

In the Old Testament we see that we must consider God or we will eat and not be full and drink but still be thirsty.  In other words our relationship with God directly effects what we eat or drink.  

Haggai 1:5 Now therefore thus saith the Lord of hosts; Consider your ways. 6 Ye have sown much, and bring in little; ye eat, but ye have not enough; ye drink, but ye are not filled with drink; ye clothe you, but there is none warm; and he that earneth wages earneth wages to put it into a bag with holes. 7 Thus saith the Lord of hosts; Consider your ways.

Psalm 37:25 I have been young, and now am old; yet have I not seen the righteous forsaken, nor his seed begging bread. 

The New Testament says:

Matthew 6:26 Behold the fowls of the air: for they sow not, neither do they reap, nor gather into barns; yet your heavenly Father feedeth them. Are ye not much better than they? 31 Therefore take no thought, saying, What shall we eat? or, What shall we drink? or, Wherewithal shall we be clothed? 32 (For after all these things do the Gentiles seek:) for your heavenly Father knoweth that ye have need of all these things. 33 But seek ye first the kingdom of God, and his righteousness; and all these things shall be added unto you.

I will assume from these verses that the one who steals for food receives a worse punishment to cause him to get close to God, before he starts stealing for other reasons.  God will take care of our food, drink and clothing if we will trust Him.   

These penalties are very different from our modern system of fines and imprisonment. When someone is fined, the money goes to the state.  So unless you have insurance against theft or unless your items are recuperated and returned to you (the thought of that makes me laugh in Honduras) you, the victim get nothing. When the criminal is sent to prison, innocent victims who were stolen from lose and lose and good people's taxes pay for the criminal to stay in jail.  All of this is very unfair.  In God's Biblical system the victim gets compensated for their loss and the thief is very inconvenienced.  He must pay for his crime.

So that brings me back to the mirrors for the 1999 Ford F-350. These mirrors must be replaced where we can drive the truck.  Shame on the guys who stole the mirrors and may God teach them a lesson with His method of justice which is much better than mine.  And may the Lord send me replacement mirrors.

Thursday, February 21, 2013

February 21, 2013 Mercedes Is Buried And I Am Sad

This is my friend Dra. Mercedes Gale Lemor de Argueta.
See that HUGE smile it was always on her face 
except when she was mad at me accusing me of 

Behind you see the Suyapa Church.  She was placed in an above ground tomb in front of the church.

Hundreds of people showed up at her wake and hundreds more at her funeral.
But there were those who could not attend and yet loved her and appreciated her.
Mercedes was not only a dentist but a humanitarian.  
She went into the prison with me to work on the 18th Street gang boys teeth.
Not many would have done that and in true Mercedes style she gave them a hard time for not brushing and flossing.
She literally fussed at them and not many people can fuss at 200 gang members and get away with it.  She was always so full of life in everything she did.  Even with cancer in  her lungs and brain, she worked up until the Wednesday the 13th before she passed away yesterday the 20th and fussed at every patient about "not flossing".

Her husband Rene center grey hair and her handsome son Fernando Rene with the red tie.
Mercedes' funeral was like everything in her life, full of class.
Goodbye my friend. Someday I will see you again and hug your neck!

Wednesday, February 20, 2013

February 20, 2013 My Friend Mercedes Has Passed On To Heaven

Jose came to my room and woke me up this morning, it seemed like I had tossed and turned and prayed off and on all night.  So I was still asleep at 7:30 am which is very unusual for me.  He needed me to correct the name on a Power of Attorney, which he is completely capable of doing, but if you can get help why not... right?  I fixed it in about 2 minutes but while doing it started looking at emails coming in.  23 emails had already arrived early this morning.

Today is supposed to be another day of paperwork.  I have scheduled appointments, filed several things which needed to be filed, answered all the emails except for one, which I answered and said I would answer later.  It was so long and so complicated it will take an hour or more to answer.

Downloaded more reports off the internet from the government of Honduras, more stuff to fill out and to look up and to turn in.  Probably another day of paperwork just on the one page which I downloaded.  Have I said lately, I hate paperwork.  Lord, please send me a bilingual intern who is very sharp and loves paperwork.  This one wants to know how many people we helped with what over the last years since 2008 and all the numbers on dollars and cents financially.  Who knows if I can pull all that together, but I must try.

Worked on permission for a missionary to take her foster child to visit the USA.

More paperwork... but in order to get it done, I must organize the ministry photos which I have been needing to do for a long time, so I just spent more than 2 hours on that project, now back to the paperwork which they need to be pasted onto... I am making a commitment to organize photos as I download them this year... Maybe that will happen, but maybe it won't.  I am going to try.  I do everything by date and then by subject.  It works for me. That makes it easier for me to BLOG, which I was really bad at doing in 2012 and now I must catch that up also.  But at least now I am organized enough to do it.  Look for a lot of blogs in the coming days, all old, but all important.

Posted the November 3, 2012 Blog... while eating 1/4 cup of raw almonds, a banana, 1/2 cup of blueberries and a cup of cantaloupe... all that for a mere 365 calories, 58 carbs, 15 grams of fat and 8 grams of protein... and while reading about Church Persecution In China... multitasking at it's best...

Fixed a telephone problem with TIGO, the cell company here.  The salesperson "made a mistake" and wanted the missionaries who called me for help, to deposit money into her (the salesperson's) personal account where she could fix it... Like dahhhhh who is going to do something like that.  So when I call the salesperson and tell her to fix it, she says she can't so I sit there for a minute not saying anything on the telephone and I guess she decided I didn't like her answer.  So she starts explaining to me how they (the missionaries) are going to deposit the money into her (the salesperson's) personal account and then she is going to take it out and pay the telephone taxes with it.  Then she is going to send them the new telephones which they bought, which were supposed to go out on Monday and now it is Wednesday... but that since the invoice for the telephones were written up as cash and not as credit it had to be done that way.  So I asked to talk to her boss and then all the sudden she could fix it but it would take several days, but she would do it, blah, blah, blah....  It never ceases to amaze me the corruption in this country.

3:27 pm I was just told that my friend of 8 years, Doctor Mercedes Gale Lemor de Argueta is dead.  I will miss her so much there are no words to explain.

No more paperwork today, going to be with her family.

Tuesday, February 19, 2013

February 19, 2013 A Paperwork Kind of Day

One of the things which I decided this year is that I am going to log more and more of my activities.  I am forgetting some great stories.  Every day is an adventure, so I am writing more and more of it down an blogging it.

This morning I woke up praying for my friend Mercedes and her family.
I remember going to sleep last night praying for her also.

Then I played secretary for my son for a legal document he needed first thing this morning.
Something about having the city go out and remeasure a property.

I sent my 84 year old dad a note a few days ago about a nasty guy that hacked his computer and sent me and several others an email.  It seems he has a computer virus in spite of his virus softwear.  I notified all of his friends where they would NOT open 2 infected emails which were sent out.  He is proactive, mad about it, but kinda clueless where computer stuff is concerned, so I needed to help him.  He seems OK now.

Then I stared working on my paperwork for the Non Government Organization status in Honduras.  What a pain in the posterior annex.  I hate paperwork!
And I think the thing which bothers me the most is that they never even look at it.
In the USA we fill it out on line, pay out $40 and are done with it.
Here it is this paper and that paper and you have to drop it off because there is no functioning 
Post Office and you have to make sure they sign that they receive it OR they say they don't and then you have the privilege of paying a late fee of $650 more or less.

I find myself praying for my friend Mercedes and her family, again.

Checking to see what money has been donated as of today... for the ministry.
I just set up this new donation page on Razoo and it has me so excited. 
I love getting surprise donations.
You can see it at
and we will not be mad at all if you accidentally or purposefully hit the donation button and donate.

I ate a bowl of cantaloupe for breakfast.  Then I logged into my to log in my food for breakfast only to find that cantaloupe my be my new best friend at just 75 calories for 1 1/2 cups and only 5 carbs... This Fitness thing is another New Years resolution and I am doing well.  I am down 11 pounds in 4 weeks.  Can't tell it anywhere but in my face.  I wish I could tell it in a few other places... but I will not quit..

Prayed for my friend Mercedes and her family, again.
Then I called and talked to her mom, Dona Vickie, who instead of thinking of herself and all that she is going through began to thank me profusely for the lasagna, green salad and garlic bread which I fixed for their family yesterday.  I love Dona Vickie and Don Armando, they are like parents to me here in Honduras since mine are so far away.  She assured me that they have more than enough food at the house for tonight, but I began to think after I got off of the telephone that this might not be true.  She rattled off a list of things in the refrigerator but didn't mention any dessert.  So I made a Lemon Bundt cake for them.  It is on the counter waiting to be picked up and  delivered to their home.

Then I began working on my Blog Spot to post Dr. John's "blog" from a recent trip.  It is up and readable if you would like to see it. is the place to log on... but you already know that because you are already here and reading.  I posted it on Facebook for all of my friends to read and see.

Mom called and we talked for a while.  She and dad took the computer to the store to get rid of the virus, which I found yesterday.

Received two messages that people could not read the Dr. John Guest post... What did I do wrong?
Oh I didn't publish it.

Prayed again for my friend Mercedes and her family.

I called and am working with a criminal attorney for a kid who is in jail for killing his brother-in-law whom he hardly could have killed since he was recently released from the hospital and had a bag to catch urine hanging from his side and was walking with crutches and had finger implants done because he had severed all four fingers on his right hand in a motorcycle accident.  I am thinking, how can you pull a trigger holding a gun with 2 crutches and a urine bag hanging on your side with 4 severed fingers?  Tell me, does this even remotely make sense?  Oh well, this is Honduras and maybe by some miracle he did it, but why would a miracle happen to do something bad?  
Oh and did I mention he takes care of his old man father and gives money to 
his sister to pay for food for all of her kids?  
He has been in jail for 2 years now with no trial.  
Of course you guessed it they are poor.  
So I found an attorney who will supposedly help him and let him pay later.

I found myself praying for Mercedes and her family again.  

Took a look at my emails and found a note regarding paperwork for non-profits and decided to notify my friends with other Non Government Organizations to get their paperwork done.  More interruptions, but my time is not my own and it felt like the Lord wanted me to do that, so I did.

Also found that some translations were done for some of the people doing adoptions, so I forwarded them to them.  

Wrote a cover letter to the Honduran Consulate about a letter regarding the approval for an adoption for a couple who are adopting from Honduras.

Then I worked on the scheduling with the Hospital in Juticalpa for a OB-GYN surgery team in March.  I had to write letters to the Medical College for the two doctors' reciprocal licenses.  Spoke with the Director of the hospital, etc. Still more to do in this regard but I am one my way to having everything ready for this team.  I still need a couple of nurses to sign on.  Are there any takers?

Received a message from another missionary about registering her gun.  How to do it etc.  Answered that to the best of my knowledge.

Prayed for my friend Mercedes and her family.

Then I go on to work on paperwork for the DEI which is the Honduras version of the IRS.  They want to know where all the wheelchairs went.  Well, I did give them all away, but the paperwork is a real hassle.  4 or 5 pieces of paperwork for each chair.  But I will get it done and since I am looking up the cities where we did the giveaways and on what date for the URSAC year end report it all goes hand in hand.  

By now it was lunch time and Doctor Lizzeth Amaya a dentist friend and a mutual friend of Dr. Mercedes stopped by.  Yum, Fried Breaded Eggplant and Italian Sauce....  She and I are both great friends of Mercedes and we are praying in agreement together for her healing.  
Logged on and made a note of my eating, this news was not so good as this morning's news...
I ate 150 calories and 19 carbs, 7 grams of fat and 3 grams of protein, no wonder I like Italian food.   

Today I ordered paperwork on a child who was adopted and is now in her mid 20s and wants to find her birth mother.   You can find her story on Facebook at

Forwarding translated paperwork for my friends at Aaron's Mission Out Reach, AMOR, which means love, the Dakin family in Talanga.  They are doing the same paperwork which I am doing but theirs is already done and my friend Peggy Perdomo translated it for them.

Called and checked on the ministry's new farm to see if the land had been mowed. It has, at least around the houses and to the front road.  This is the new farm place donated for a children's home.  It has 2 houses, several out houses, 2 garages and 3 tilapia ponds.  Water has been moved from one pond to another, lots of tadpoles, lots of turtles and no fish.  It is looking cleaner!  Praise God, it needed to look cleaner.

I GOT MAIL from a new volunteer for SMART Medical teams. Sent him a quick note and think he will probably join us on some teams in the future.

Now I find myself sending out Thank You notes to donors.  I am doing it on the computer.  I know, I know, how tacky, but I am sending cute little cards.

I am hungry again... that is the problem with staying home and doing paperwork.  
How about some homemade nachos, but just a small plate of them... 
Logged in to make a note and to my chagrin I find that a small plate of nachos has OMG I am going to have to fast tomorrow!!!!!!  A small plate of nachos has 440 calories, 38 carbs, 32 grams of fat and 18 grams of protein.... I am now over my fat grams for the day... Bummer!  No ice cream tonight!  It is all my dad's fault!  He taught me to love sour cream!  I love it with baked potatoes, french fries, nachos, tacos, in fact I put sour cream in my cakes... Opps, my secret is out!   That is my secret ingredient. 
The Lemon Bundt Cake which was made today had sour cream in it...

It is now 6:00, I have been up for 12 hours, I am still in my jammies, I have not taken a bath, in fact I am still in bed and except for eating lunch with my dentist friend I have not seen anyone who is not family.  Yes, we ate lunch here at the house and I was in my jammies and stinky, like I said, "she is a good friend."  

While waiting for things to download and upload today, I have been looking at Pinterest off and on all day between jobs or maybe I should say simultaneously with my work.  I have discovered that I have been away from the USA for too long.   
I found some nifty things and even coveted one or two of them. 

This little darling is called a Ham Dogger, it makes hamburger meat into a hot dog shape...
WOW, I love it! 

And then there is this great piece from a place called Straight Lines!

And then there was the Nice Underwear doormat... it made me smile... on a not so happy day...

But one of the things which I loved the most is a screen for the garden.

To me this is beautiful... I am drooling and then I found some more pretty garden things like this

Like this made from wine bottle bottoms and iron...

and this made from glass and thin steel around it...

And this...

And this one which is a little different but still beautiful...

My day is winding down, I am finally going to get up and do the other million things 
which I need to do around the house.

A lot of paperwork got done, but there is much more to do... I think tomorrow will be another day of paperwork and then perhaps I can get out for a few hours in the afternoon.  
Have I said that I hate paperwork?  I do, it seems it is a necessary evil.  
I wish it wasn't.
Thank you Lord for a productive day!

February 19, 2013 Guest Blogger Dr. John Burgoyne


So, if I were to be a blogger, I guess this is how it would start:

Some of you may wonder what a medical mission trip is like.  Well, first let me say that they are all different, and so I can only tell you what MINE are like.

Before I go, there are some things that have to happen. Lots of them are taken care of for me by Teresa, who runs S.M.A.R.T.  (Surgical Medical Assistance Relief Teams). She is in Honduras, and she organizes the interactions with the local hospitals and government, including the purchase of necessary drugs and oxygen, volunteer local support staff, temporary licenses and hospital privileges, in-country transport, food, lodging and security (we travel with armed guards). She also keeps track of my patients, most of whom require four or more staged procedures, and makes sure they are there for us.

All I have to do is scrounge up donated medical and other supplies (including cosmetics for gifts for the nurses- VERY important), pack and go. Oh, and pay for your ticket and $1,000.

Teresa really feels a strong calling to be here and help the people, and is organized, forthright, outspoken, and willing to do whatever it takes. She is also a gun aficionado, owns about fifty guns, and usually carries a Glock on our trips.

Teresa is originally from Arkansas, more recently from Kansas City, and has been living full-time in Honduras for several years. She is about five years older than me, and about a foot shorter, with long hair that is up in a bun for our trips. She is a minister, and when not organizing medical missions, she works with orphanages, adoptions, and trying to save the gang members of Honduras. At times she teaches Bible classes in the gang prison (you can get a seven year sentence just for having a tattoo- but most of them are real criminals).

A couple of years ago she took me into the prison, where I removed a few bullets and drained a few abscesses from the ignored prison population.  As an aside, the prison itself was fascinating.  The government had found it expedient to simply put all the 18th Street Gang prisoners in one warehouse - like building. Inside, the Gang was in charge. They built partitions, ran a commissary, sat around watching TV or talking on their cell phones, or being entertained by the women who were allowed in for a small bribe. The guards stay out of it. The leader when I was there was Spider, a friendly and charismatic fellow, who had a bullet fragment in his forearm that I removed first, so that I could then work on lesser Gang members with more threatening problems. The power went out while I was working there, so we went out into the prison yard and worked in the dwindling sunlight. I finished under flashlight conditions. Spider later got out of prison.               

As is usual, this trip I left with my two daughters, Genevieve and Gabby, on the red-eye from Seattle to Houston on Wednesday night.  My goal is always to be asleep before we are off the ground- a very important skill I strongly endorse. After a three hour layover in Houston, we did the three hour jump to the Capitol, Tegucigalpa.  This time, we spent much of the layover looking for pants- Genevieve was wearing shorts, having spaced out the fact that in Honduras only prostitutes and confused American newbies wear shorts. This being her twelfth trip, she really knew better.  I wasn't all that worried, but she was.

The first thing you notice in Tegucigalpa is that the runway is a little short. They REALLY stomp on the brakes. Every time. Comforting. Passport control is also a pleasure, with more forms and stamping than you would need to get into Cuba. Oddly, the thing that irritates me is that they are sloppy with the visa they staple into the passport, and so it makes it messy in my pouch.  I hate that.

I should mention that I always wear a fanny pack when I travel. Partly because of my obsessive need to always have my passport attached to me. Well, let's be honest, my obsessive need to have ALL my stuff attached to me.  My kids have told me for years it is not acceptable.  I ignore them, but if someone with more clout objects, I will need to get a new system.

While waiting for my bags, I always run to the restroom, just because that is my last chance in Honduras to actually flush toilet paper. It is forbidden in our hotel. Turns out that having to throw toilet paper in the waste basket really annoys me. Sorry, TMI. (To much information)

We then exit into the sweltering heat and indescribable odor that is Tegucigalpa.  Teresa is there, and everyone is looking out for the tall gringo doctor in the orange shirt, which I always wear just for that reason. We hop into the truck, armed and dangerous, and head over to Popeye's Chicken for lunch. There, of course, they have an old man with a shot gun to make us feel safe.

At this point the girls and I met our companions for this trip- Alan, a Florida appellate judge, and his daughter Leah, who just finished college and is headed to Nashville to pursue a career in music. They have both been heavily involved in various missionary service projects, and are currently in the middle of a 7-week stint in Honduras doing a number of different things.  Alan was an EMT in a former life, and has been in the ORs with Teresa's groups quite a few times over the past 15 years. Even here, he runs several miles every morning (I am way too cowardly to venture out in the streets myself), and is lean and tan. Leah has long dark hair and big eyes, and the three girls look enough alike to be sisters.  Certainly the Hondurans can't tell them apart.

The ride to Choluteca is about 2-3 hours, depending on traffic. The road is a main north-south thoroughfare, meaning a two-lane highway with multiple washouts and tank-trap sized potholes, with slow moving semis and crazed Honduran drivers more than willing to try to squeeze down the middle, forcing everyone onto the shoulder, where present. Shiver.

Our driver is José.  José requires some explanation. Teresa met José in 1998, when she was down here after hurricane Mitch, which really devastated Honduras. At the time, José was a member of the elite national police (the Cobras), and was assigned to Teresa's protection detail. He caught her attention by finding and returning a LOT of money that fell out of her stuff in the truck.  Actually RETURNED it. Unheard-of.  Over the years he became her personal security guard, then essentially adopted son.  He is now an attorney, who works with the adoptions, among other things. A couple of years ago, he ran for Congress here.  Despite his legal work, he still comes on our missions (or "brigades" as the locals call them), drives, provides security, but most important, entertainment. He is rotund, happy, and hilarious. My girls think he is almost like a cartoon character. We love José Benavides.

On my last trip, José was driving the other car, and since Teresa's shoulder had been broken in a freak slip-and-fall at the grocery store, I was pressed into driving. I really prefer not to.  REALLY.  I am way too gringo to be comfortable on the Honduran roads.

We then arrive in Choluteca, a town of about 100,000, with the infrastructure for about 20,000. Of the three intersections with traffic lights, one is broken. We make a pit stop at our hotel, the Hotel Flamingo, run by some of my favorite people in the world. Sonya, although undergoing chemo for cancer, makes wonderful food, the rooms are clean, the compound is safe.  Their daughter, also Sonya, is in medical school in Tegucigalpa, having been inspired by the hundreds of mission team members who have stayed in her hotel over the years.

I should add here that I have three rules while in Honduras: Only drink what Teresa gives you, only eat what Teresa gives you, and only go where Teresa tells you.  I have never been sick, and never felt in any danger with those rules. Teresa knows everyone, from cabinet level ministers to gang leaders, and is well positioned to escape from most situations that could come up.

Then it is off to the Hospital Del Sur. When I first started coming to Honduras, they basically gave us a large room with an OR table. We had to supply all the other equipment and personnel, including anesthesia and nursing, sterilizing equipment, and, of course surgical instruments and supplies. Now, all we really need is me and my three suitcases of disposables and instruments. They supply me with nurses, anesthetists, recovery staff, gowns and drapes. It is really nice, and all these are unpaid  volunteers from the local hospital.

The nurses are great. They giggle incessantly, amused by the giant gringo who seems incapable of remembering the names of any instruments despite having done hundreds of cases here.  They are mostly very short and very round, and my daughters observed that I am like Willy Wonka surrounded by oompa loompas. They donate their time, all for love of the children- and a few make-up kits.

The anesthesia in Honduras is mostly provided not by MDs or nurses, but by anesthesia techs. They really work hard for us as well.

Despite the upgrade, it is still primitive. We have frequent power outages, water only about half the time, terrible lighting, no patient gowns (we wrap them in thread bare sheets). One memorable trip, the power went out during an emergency C-section in the adjoining room, and by far the best flashlight available was my Blackberry.  Literally. Shiver, shiver.

Triage is the first step. This trip, we did that in a truly sweltering hot-box of a room designed as a barracks-like dormitory. I am sure it was 110 degrees, and clearly 100% humidity. At this point it became
clear that I was to be overwhelmed. There were 26 patients who needed advanced-stage procedures- in other words patients I could simply NOT turn away, and three first stage patients who had each been turned away twice before, and two thyroid patients who really could not wait.  That made 31.  Translation: not much down time.

My ear patients and their families are like a fan club.  They all know each other, support each other, and make sure everyone knows when I will be back. I love them. They love me. 

Due to a combination of genetics and nutritional issues, the incidence of microtia is much higher in Latin America than in the US.   Microtia is a birth defect where the outer ear is missing or misshapen. Often the inner ear works, but since there is no good ear canal, they really can't hear from that ear. If they have one good ear, however, it is the missing ear that is the problem much more than the hearing  They have a special highly perjurative insult here for kids with the condition, and they really can't go to school. The reconstructive surgery takes multiple procedures, and they often look worse before they look better. The interesting thing is, once they have had their first procedure they generally WILL go to school.

The kids are SO sweet and SO cute and SO grateful.  As far as we can tell, I am currently the only MD who does the surgery in Honduras. Since to go to the US for the several procedures would be around $40,000 just for the medical bills, plus getting there, it is truly out-of-reach for Hondurans, whose average per capita income is $1600. Sometimes I have wondered if my time would be better spent on something more life-threatening, but this surgery is so life-CHANGING for these children that I have decided I should stick with it.

We started surgery about 6:30 Thursday night, and six cases later we were back to the hotel before 1:00 am, which was a major victory. Sonja sent over dinner, which was delicious.  Leah had the opportunity to scrub in on a thyroidectomy. That also included the opportunity to turn green and have to sit on the floor to recuperate. 

We then took quick showers and went to bed. The challenge for me at the hotel is that the bathroom is truly smaller than those in some campers I have visited, and the toilet area is certainly smaller than a port-a-potty.  And I am large.  Between the elbows and knees banging on the walls and doors, and the whole toilet-paper-in-the-waste-paper-basket issue, I am, to say the least, a little challenged.  The unheated water was refreshing, and I slept like the dead until about 7:00, when the dulcet tones of José yelling awakened me.

After a Sonja breakfast (hot cakes, ham, fruit, eggs, OJ, rice and beans), it was back to the hospital. First we had to see all the post ops from the night before, all of whom were doing great. There was also the obligatory photo op.  Katarine, who is now 12, is still trying to figure out how to smuggle herself to America in our suitcases.  She thinks the girls would be amazing big sisters. I can’t say that I disagree.

When we met Katarine, she was eight, VERY personable, and full of life and love. She was apparently unrestrainable, and tore open her chest incision dancing so it healed poorly and had to be re-done. Twice.  She has given me numerous gifts, mostly food and little painted wooden touristy things. Her mother is one of the chieftains of the Dr. John fan club, and organizes everything with the others. Often, if Katerine is discharged but we are still there the next day, she will show up in her finest confirmation-style dress for more photos. We love her.

Friday we did fourteen cases, including three first stage procedures. These procedures start with an incision in the chest, going down through the muscles and exposing the ribs. The place where the ribs attach to the sternum (breastbone) has some excellent cartilage, just there for the harvest. You have to be careful to separate the under surface of the ribs from the underlying tissue in order to avoid tearing the sac around the lungs (the pleura), or puncturing a lung.  Both of those things are considered "poor form". No one wants to lose style points. No problems encountered.

Anyway, once you have the cartilage, you need to whittle it into the correct three-dimensional shape for a frame, and then bury the frame up in the place where you are building the ear. People are always fascinated by the whole idea of making an ear out of a rib.  I explain that an ear is one thing, but if you are good, you can make a whole WOMAN out of a rib.

The cartilage heals to the skin, and on subsequent procedures I have to fold skin under to bring the ear out from the head, make an earlobe, and thin out the flap. In the USA, I would operate about every six weeks or so.  In Honduras, they have to wait for my next trip, so usually about six months. They are surprisingly patient with the long waits. I am used to Americans, for whom this kind of long-term process would be maddening.

Anyhow, we moved right along. All the rest were old friends of mine, some of whom needed major work, some minor.

The local medical director assigns a public service MD to help us, and she did ALL the paperwork for me.  All I did was operate, eat, and rest.  If only my practice at home were like that!  It is really a way to experience the pure joy of surgery, as long as you don't get upset by the little things, like the poor equipment and lighting.

Friday night's bathroom adventure was enhanced by towel forgetfulness (I had to be rescued), and then a small mishap. While doing my ballet act to simultaneously dry myself and avoid touching any surfaces (germ phobia), I slipped and caught my ankle on the lip of the shower. As it turns out, that edge was quite sharp, slashing my ankle in three places. Bloody mess.  Not being interested in infection, I broke out the first aid kit, cleansed and dressed the wounds. Doctor-speak for putting on a bandaid.  Actually three, in this case. Near death experience.  I'm really much better with other people's blood. Mine should stay INSIDE its vessels.

Saturday morning started with Sonja's famous French toast. Really more like a pastry, it is so sweet. Once again, all of the post-ops were doing well, even the three who had rib harvesting were only using Tylenol for pain. Everyone went home.

During rounds, Gabby started to feel woozy, and spent the morning sleeping in the anesthesia lounge. She woke up when the OB/Gyn guy asked the girls if they wanted to watch a procedure.  Turns out it was a D&C, and they were totally grossed out.

For me, the day consisted of nine procedures, all upper stages, and all of which went well. I had a little anxiety as the day wore on and supplies dwindled, but we made it to the end.  In fact, we finished by 6:00, earlier than on most trips. The grand total of cases for the trip was twenty-nine, the most ever.

We then went back to the hotel, and after dinner I unloaded and re-organized all of my stuff for about an hour while the girls watched TV, showered, and was in bed by 9:30, and in a coma by 9:32.

Sunday morning was the reverse trip, starting with a quick trip to see my patients from Saturday, more French toast along with eggs and tamales, then on the road for the trip back to Tegucigalpa.  The traffic was not as bad, but the potholes were even more annoying, since we had to slow down so often and so suddenly.

Leaving Honduras is typically inefficient.  There are three long lines to check in. The first is for anyone traveling with a minor, where they make sure that you have the notarized authorization to travel from the other parent. It is interesting to me that THIS is the point that they check for that. Why here?  It seems that checking before I left the USA, or perhaps on ENTERING Honduras would make more sense. In any case, that is the system.

Next is the standard airline check-in, same as at home. The third (and longest) line is to pay the airport tax, which also seems unnecessary - why not just add it to the ticket price and get it from the airlines, like everyplace else in the world?  It DOES give them the chance to staple a couple of other receipts to our boarding passes. They love that.

We always eat lunch at the airport McDonalds. Why McDonalds? Why not? One trip a less-compulsive/paranoid team member left her passport and ticket in her backpack slung on the back of her chair at this point, and someone managed to make off with it while she was sitting there. No problem, with Teresa there to pull strings, and with the US Embassy's assistance, she was able to get new documents and leave on a later flight- five DAYS later. Passports, wallet, tickets are all high on my list of things that do not leave my body.

This is not the end of the red tape. After lunch, it is back in line to have passport and papers checked by two separate people, three feet apart, then the usual security screen.

Finally, we get through to the boarding area. Of course, to actually board they have one person to take the ticket, a government agent to check the passport, an airport official to collect the tax receipt, and another place to hand check the bags of anyone who meets profiling criteria.

I always try to stay awake on the flight to Houston so that I will be tired enough to sleep to Seattle.  This trip I was lucky enough to have secured seats in the very last row, so reclining was not an option in any case. I perhaps didn't mention that one of the reasons I try to get to sleep so quickly on planes is that I am so cramped at 6'4" that I am just too uncomfortable if awake.

In Houston we traditionally enjoy the authentic cuisine of Panda Express. As usual, I had the choice between the one hour layover or the three and a half hour one. Having had some rather unpleasant near-misses (you have to clear customs in Houston), I have opted for the latter.

One more flight and we're back to Seattle at 11:45 pm, ninety-six hours after leaving, where we are met by my gorgeous girlfriend and delivered home. Good thing I don't have to be at work until 8:30 Monday morning!

Friday, February 15, 2013

February 15, 2013 Another Typical Day In My Life

Today is day three of trying to get some foster children assigned to my missionary friends.  IHNFA called me four days ago and asked for some help finding a good foster home for an 11 month old. 

I could hardly drag myself out of bed this morning, I was up until after 1:30 am working on book work last night, after a long day at IHNFA and I was so tired, but I finally did dragggggggg myself out of bed albeit, 10 minutes before I knew I MUST leave the house in order to get be on time for my scheduled appointment at Denny’s with my gringo friends.

I found 500 lempira ($25) and added it to my purse; I just set it inside my purse, not in my billfold.  After all I was in a hurry, I sent Jose to add gas to my car with a different 500 lempira bill, and while he was gone, I took a shower, brushed my teeth, brushed my hair, threw on some clothes all in 10 minutes and walked out the door as he was arriving back at the house. I arrived at Denny’s before everyone else, but still later than agreed upon.  Whew, they started off with a typical late Honduran day.

We (Melissa the missionary and I) had a scheduled appointment at IHNFA (Honduran children’s services) at 9:00 am but when I asked if it was “Honduran time” or “gringo time” I was told “Honduran time”, so we ate at Denny's talked with old friends, met new friends, called and were told they were ready to see us and then headed out to IHNFA at 10:30ish, Honduran speak for 9:00 am.  It was no surprise to me that when we arrived they were not in the office, even though they told us they were waiting for us on the telephone.

The missionary’s husband has spent the last 3 days “buying a car”. So we left him with the man selling the car, an attorney and the attorney’s brother and the Denny’s bill.  I gave him 100 lempira for my part of the breakfast and 20 lempira I laid on the table for a tip.  Melissa and I left and headed out for our day of adventure.

First we met with two of the mothers of two of the children who are “at risk” and need the “temporary shelter” of a foster home.  Mother #1 was raised for 17 years in the IHNFA home and at 18 years old was sent out to live on the streets, with no family and no home and the only place she had ever known as a home was IHNFA Los Casitas. One month later she was pregnant.  Mother #2 also had lived in Los Casitas, but I am not sure for how long. She is still 18 and has her baby also.

Both of the mothers are 18 years young, there are no fathers in the picture.  Mother #2 had a relationship with a common street thief and he was unceremoniously killed not long after the mother found out that she was pregnant.  Both mothers were very loving towards their babies and both wanted what they think is best for their babies, however the best thing is NOT for the children to be living on the streets of the most dangerous country in the world.  We introduced them both to the missionary nurse who is willing to raise the children, on a farm in the country.  At first both were adamant that they wanted their children NOT to go with anyone else to live.  Mother #1 walked out of the room and left. Mother #2 stayed and talked and asked for money. 

But while this all this was going on, Mother #3 came in with a 3 month old beautiful little boy.  Mom #3 is a “crack cocaine” mom who was nursing her baby and “taking good care of him”.  He surely is beautiful, looks healthy and fat, but a crack mom?  If she really is a crack mom, how is he so healthy looking?  She cried because they were going to take the baby away.  It was pitiful.  They ask mom #3 for the baby’s birth certificate but she has never registered him.  So he exists but doesn’t exist on paper.  I have no idea how the social worker and the attorney make these kinds of decisions all day every day.  It is discovered from reports that mom #3 and her husband leave the baby where ever and wander the streets at night drunk and high.  Many neighbors have reported them and thus she was picked up. 

Mother #3 was barely out the door when through the window we hear howling (the kid) and screaming (the mom). The social worker stands up and looks out the window just in time to see Mom #4 with kid #4a and kid #4b.

While the screaming and howling is going on outside the building, we find out that Mom #2 had already given her baby to another woman.  That woman went to the Registry of Persons and that woman lied saying the child was hers and got a birth certificate on the child.  That happens a lot here, more than I care to think about.  Meanwhile that other woman, who is there fighting for the baby and saying how she can take good care of her, the woman whom the Mom #2 had given her baby to, who had illegally gone in and applied for the birth certificate for the little girl, saying she was her mom, walks back into the attorney’s office and asks me for money.  “Please, I do not have money for a bus!”  So she is here fighting for the baby because she can give her a “good home” and take “god care of her” but she doesn’t have $1 for a bus ride across town.  While she is still standing there “convincing” me that I need to give her money, Mom #4 is coming in the door, her son is the screaming kid which we have been hearing outside the window. Mom #4 has in tow, kid #4a her son and kid #4b is a beautiful little girl with wide eyes who never made a sound the whole time she was there. 

Mom #4 was turning her son over to IHNFA because he didn’t want to go to school, wanted to be with his dad who is a “drunk” and was running around with “gang members”.   The attorney by this time has gone outside and physically picked up child #4a in his arms and carried him in like a 2 year old with him screaming and kicking all the way.  Tears flowing, the attorney sat the 9 year old down in a chair and he continued kicking at the desk and wailing.  So now we have hard shoes kicking against metal, mom #4 screaming, kid #4a howling, kid #4b wide eyed and beautiful and the missionary and I, the social worker, the attorney, a male helper and the fake birth certificate, not real mom all in a room the size of a very small postage stamp.  Melissa the missionary and I sat there watching the show.  I looked over at her and she had tears welling up in her eyes.  I am watching the show, thinking, “This kid needs some good discipline and a lot of the Word of God.” 

The social worker looks at me and asks what I think; I respond this is a spiritual thing and a discipline thing.  She nods her head in agreement.  She tells me she is a Christian.  I am thankful. 

The attorney stops mid-stream and asks if I have found a home for a 9 year old boy who does NOT have AIDS.  But his mom and dad are dying of AIDS and his little brother and sister 2 and 3 years old are in an AIDS clinic/home already, they too are dying.  He is hoping to get the boy placed where his mom and dad will know that he is safe and sound with a home to grow up in, before they die.  According to medical people mom’s death is imminent, so there is a huge hurry and of course they want someone who is willing to allow him to visit mom and dad until they die.  And what is left unsaid is that after they die, all the family members who currently do not exist because there is medicine to buy and caskets to buy, will show up to claim the child as soon as mom and dad are in the ground, because he is old enough to work and he is a boy and he can contribute his money to their family.  Does anyone want a 9 year old little boy?

Without any regard for the conversation taking place, the “fake mom” for child #2 is still asking for money but she has been shoved out the door by now yet she continues to pop her head in and out of the door.  The attorney shoos her head and shoulders out of the room, her feet and legs were already outside.  By now there are about 7 other people gathered in the hallway to watch as the show unfolds.  The attorney slams his hand down on the desk; the kid quits crying for a second and then starts it up again. I look at the missionary, she looks at me.  The attorney sends all the others down the hall, but they only partially comply, moving a few feet down the hall and edging their way back towards us to see what is going to happen.  The attorney gets up, crawls over the screaming kid’s legs, who is still kicking the desk, crawls past the other man who is helping to control the kid (lol) and then crawls over my legs and the missionaries legs, passes by mom #4 who is still mad as a wet hen, past beautiful little girl #4b and disappears down the hall, herding all the people standing in the hallway as he goes. 

You might be thinking, “Why doesn’t he just shut the door?”  The reason is that it is 83 degrees, noon and high sun, roof with no insulation under it, one window, a room the size of a postage stamp about 8 feet by 7 feet, replete with 2 desks, 5 chairs, 6 adults and 2 children and head and shoulders of yet another adult popping in and out.  Oh, and I almost forgot body odor and stinky diapers. 

The street mom, mom #2 takes advantage of the attorney being busy, remember she is the one who has the 11 month old, whose father was a street thief who was killed, walks back in and asks me for money, which I declined to give to her.  She walks out again. 

The attorney still is not back.  So we chat with the social worker who says her dad wanted her to be a nurse but she wanted to be a social worker. 

Another lady who came with mom #1 walks in and asks me for money.  She explains that she is a street missionary and lives on donations.  I explain to her that I have not cashed a check today.  This is my normal way out for the 20 times a day which people ask for money, except for the days which I do cash a check and then I just stay home.  She explains that she will have to walk to downtown if I don’t give her money; I explain AGAIN that I have not cashed a check today.  She kisses me goodbye, holds my face in both of her hands, and smiles with every other tooth missing, her which probably have been touching dirty diapers are now holding my face, she kisses me again on the cheek and heads off out the door to catch a private cab which is 3 times as expensive as a bus.  Go figure!  Of course one of the others was excited to tell me about the private taxi; just where I would know that she really didn’t need the money, but I am sure they expected a reward for the information.  Meanwhile several people ask Melissa the missionary for money. 

The attorney walks back into the room and starts caressing kid #4’s head and talking to him and he calms down.  He has been screaming most of this time. The social worker asks him a question and he says that mom is abusive to him.  She (the mom) starts screaming at him and he starts making “go to hell” eyes at her.  When he furrows his eyebrows, I finally get a good look at him to see that his forehead looks like he has been dragged across asphalt or rocks.  Mom #4 continues telling how he refuses to be obedient and he is always in the streets and won’t go to school and he calls her a liar.  They give him a pencil and paper and he starts writing like a 2nd grader even though he has said he is a 4th grader.  They asked him his name and he tells them one thing, then mom says he is lying and his name is something else. Who should we believe?  She is asked if she has a birth certificate for him to prove his name, but she has none. 

I look at the missionary and she no longer has tears in her eyes.  Thank God, I was thinking that this whole thing might be too hard on her, but we still had not finished our business.  How could we with all of these interruptions. 

The street mom, Mom #2, who has the 11 month old, whose father was a street thief who was killed, walks back in and asks for money, which I declined to give to her for the 3rd time. 

It is decided that we need to go talk to the judge at the children’s court to see if we can have a little boy who is 2 years old given over into the foster care of the missionary.  We get up to go.  The hall is once again filled with people, each of which looks us over as we walk out the door.

We go out to the car, but of course someone has parked behind us and we cannot move until they come out of whatever office they are in to move their car. We finally get free to leave and Melissa the missionary looks at me and says, “I don’t pray for you enough.  I need to pray harder for you.”  I laugh.  It is now 1:15 and we head to the courthouse.  On the way, I decide to stop and use a clean bathroom for a minute and then decide to leave my car and take a cab because the Kid’s Court is in a bad neighborhood and you have to park several blocks away. 

I call about seven taxis and all are busy.  Finally I call a friend of one of the taxi drivers whom I know and used to trust, until this afternoon I trusted him anyway.  The guy shows up in a 1918 model taxi with no shocks, no air conditioning and the windows rolled down.  Melissa the missionary and I get in, my butt hits seat springs and they are not comfortable.   I pull my gun out of my purse and place it between my legs for easy access in case I need it.  The taxi driver visibly gulps.  I call the friend who referred him to me and tell him that it really is not correct that he referred me to a taxi with no windows and no air conditioning, it is not safe in Tegucigalpa and he knows that.  He says he knows, but he is his friend and it will never happen again.  I am sure it won’t happen again at least until the next time he can’t do a run and refers him again, two taxi telephone numbers off my list.  The taxi driver drops us off, I give him the 85 lempira plus a 15 lempira tip and he speeds off. 

We go into the courthouse, wait for the papers on the case.  Chat to pass the time and then go up stairs to the waiting room to see the judges.  My phone rings with a problem about two children siblings who were “rescued” by IHNFA and escaped and now have to be re-rescued.  I am told that they want to go to a children’s home where the other two siblings are living.  Since the missionary who the children escaped and ran back to wants them in a safe place, she called me to help with the details.  The waiting room is about 100 degrees, several moms and dads waiting to see the judges.  A case worker from another ministry was with a little girl and her mom with AIDS, and there were many other cases of moms and kids.  Two teens walk in escorted by armed police guards, two different teens walk out escorted by armed police guards.  Melissa the missionary and I sit and sweat.  The place stinks.  I call IHNFA and arrange for the children to be turned over to the children’s home on Thursday.  By now I am bored and hungry, I pull out a piece of candy for myself.  I give some kids in the waiting room some candy.  About an hour later we go in to see the judge.  He agrees to what we need.  We are told to bring in paperwork next week.  He also agrees to the rescue of another kid who really needs rescuing.  We leave, go downstairs and wait for Jose to pick us up in his car with windows and air-conditioning.  I didn’t want to give another unknown taxi driver a heart attack by pulling out my gun and placing it between my legs. 

We then went to the Attorney General’s office where we give them the paper with the order to “rescue” the boy at risk.  It is basically a capture order but since it is for a child it is called a “rescue order”.  They agree that they will rescue him when they can. 

Completely worn out we went to TIGO to pick up Melissa the missionary’s two new telephones.  On Wednesday we spent more than two hours filling out the paperwork and were supposed to go in and just pick them up.  That was a joke!  We spent another two hours redoing the paperwork and getting everything tweaked and then off to eat Chinese.  We still did not get the telephones which were promised for Thursday afternoon.  Now they will be sent by courier sometime next week.  I have 100 lempira which says that it won’t happen… but that is the plan. 

Chinese food was good and since we had not eaten lunch we were starved.  Jose dropped me off at my front door and Melissa the missionary and her husband took off in their newly purchased car.  Before Jose could get the car parked, I was asleep, so I am writing this early morning Saturday but posting it late night Friday… The wonders of blogging! 

1.   The rescue order written and delivered for a teenage boy who will be picked up by the police.
2.   An agreement for the placement for a 2 year old boy with Melissa the missionary.
3.   The verbal agreement for placement of two children 11 and 13 years old in a private Christian children’s home.
4.   An appointment scheduled for the rescue of two little girls ages 2 and 3, sisters to nine others who have all been placed in foster care and mom is pregnant with number twelve and not one of the children have the same father.
5.   An appointment scheduled for paperwork for another 9 year old sister of theirs to be signed over for abandonment.

1.   The placement of a 9 year old boy whose parents and siblings have AIDS.
2.   The placement of a 9 month old girl.
3.   The placement of a 3 month old girl.
4.   The placement of 3 orphaned little sisters whose parents were killed in a car accident.
5.   The receipt of 2 telephones.
6.   Delivery and placement of the teenage boy after he is arrested.
7.   Follow-up and delivery to the children’s home/orphanage of the 11 and 13 year old siblings.
1.   Find the 500 lempira which is missing from my purse.

I need to do a million things tomorrow, but tomorrow is tomorrow.