Romania: Days 9-11

Day 9, Saturday, May 13, 2017

We headed out from Eforie Nord today on a 6-hour trip to the Transylvania – the northwest part of the country. For lunch, we stopped in Constanta at a mall for shawarmas and Starbucks. Our final destination was Peles Castle. Our group made it in time for the last tour at 4 PM. It was a modern castle built in the late 1800s and early 1900s. The fireplaces are all ornamental as there is central heating and air. Our tour group was large and our guide had a heavy accent, so we mostly benefited from viewing the rooms and not hearing the history. The grounds were gorgeous, especially set against the backdrop of the Carpathian Mountains.

How many people does it take to pack a van? Apparently a few plus some onlooking support :)

Road trip from Constanta to Transylvania. Six hour ride.

Yes, they have Ikea in Romania.

Nearing our day's final destination.

Peles Castle in the distance.

Peles Castle

Peles Castle

With a court jester.

Found a knight in shining armor.

Group photo

The castle grounds

I was able to get on wifi at the gift shop while we waited for some in our group to take pictures. My sister was still in labor and the doctor was planning a c-section as she was not progressing further. Our hotel was nearby and we headed through the drizzle to settle down for the night. Dinner was served in a fancy room with a long table. After dinner, we took communion together, sang, and gave thanks as a team before Dr. Jim presented on the Shroud of Turin. The men of our group presented the women with roses for the upcoming Mother’s day. I went to bed after finding out I was an aunt to a niece, born at 2:22 PM Eastern time (9:22 PM Romania time).

Dinner at our long table

Mother's Day rose

Day 10, Sunday, May 14, 2017

Mother’s Day. My sister is a mother for the first time this year. After much difficulty with her labor, the doctor delivered a beautiful baby girl by c-section. I am an aunt to a niece! My mom (and dad) are visiting my sister and bro-in-law currently to help out with the baby, and I am incredibly happy they can be together this mother’s day. It has never seemed strange to me to see other children resemble their parents, but my niece looks so much like my sister, it’s a little shocking.

After coffee and breakfast, our team packed up for our 2^nd day of sightseeing. We headed to Bran Castle, which is fondly known as “Dracula’s castle.” The tour guide was named Mateo and he was a tremendously good guide. His English was great and he was funny. We learned about the history of the castle, how it become associated with Bram Stoker’s Dracula, and toured many of the rooms. It was a rainy day, which made it more memorable.

Bran (Dracula) Castle

Bran (Dracula) castle

Found more knights in shining armor!

Our lunch was Romanian goulash with bread and a Hungarian dessert called Kürtős kalács. Essentially it is dough wrapped around a large rolling pin and spun over the fire, drizzled with butter, sugar, and nuts. So delicious. The smell of the bread cooking as sugary sweet.

Goulash for lunch. So warm and delicious on a rainy day.

We had a few hours to wander the shopping district near the castle and purchase some souvenirs.

Shopping district.

Then we started the 2.5 hour trek back to Bucharest.

Cows grazing along the road without a fence or tether.

Our van was having some issues by the end of the trip and started smoking, but we made it to the airport hotel just fine. Our hotel was swanky with beautiful chandeliers, nice beds, and fancy food.

Our swanky hotel room the last night of the trip.

After dinner, we spent some time taking pictures with team members and giving each other goodbyes.

Loved making and cultivating these friendships this week.

Reunion with my teammates from the Healthcare trip in 2010 to India when I was a student.

Day 11, Monday, May 15, 2017

Our fight left early this morning. We were up at 5 AM for our 6 AM shuttle to the Bucharest international airport. We had a slight scare when one of our team members realized she couldn’t find her passport. After searching, she found it at the hotel restaurant where we ate last night. So glad it was not taken! Once we were at the airport, we had another slight scare because the check-in attendants kept telling us the flight was overbooked. I was prepared to give up my seat if they compensated me ;) Our entire team made it on the flight. The flight from Bucharest to London was about 3 hours – all of which I slept. It’s hard trying to sync your body with jet lag, but I figured if I slept in the morning when it was evening in America and tried to stay awake the rest of the trip, I would be able to adjust more quickly. Again, it reminds me when I watch movies that they never portray how one actually feels when they travel halfway around the world.

The security at Heathrow Airport in London was intense. We were each questioned before we were allowed to leave our arrival terminal and proceed to security at our departure terminal. We also had to clear security at our gate. Dr. Jim, Rob, and Sally split off from our group in London and the remaining 19 of us continued on to Dallas. The international flight was spent eating snacks, meals, and ice cream and watching movies – Dr. Strange, Date Night, and Miss Peregrine’s House for Peculiar Children.

It’s been a good trip. When one goes abroad, everyone at home will ask how the trip was when you get back. Sometimes it is hard to put into words a full week-long experience with the roller coaster emotions, new friendships formed, and cultural aspects encountered.

The take away from the trip which I keep returning to is stretching out of one’s comfort zone. As a new “international” provider, it was challenging trying to manage chronic illness in one encounter and most of the time I didn’t. Much of what our patients sought was a listening ear, reassurance that their physicians were guiding them correctly, curiosity of the American doctors, and prayer. I believe our team fulfilled this purpose. It was also incredibly rewarding being able to help guide and educate the students who are interested in medicine. In some ways, it feels like I were just there in their place, but oh how many things have happened to shape my life in the past 7 years since that first trip to India.

Going through the chaos of customs and security again in Dallas/Ft Worth

Romania: Day 8

Day 8, Friday, May 12, 2017

We woke early for the sunrise again. It was beautiful. After we watched the sun rise, a few of us took a walk along the path near the Black Sea and looped back along the road to the hotel. It’s always super interesting hearing another person’s life story! Since I just finished the Perspectives course on the history of the movement of Christian missions, it was interesting to hear my friend’s story about life as an immigrant in the United States and the challenges of navigating the legal system to obtain work visa, a green card, and his driver’s license.

After our walk, we ate breakfast and then headed to the vans to load up to our next site. The drive was only about 10-15 minute and felt super short after the last several days of trips. The church was modern and it was so new the lights were still being installed. We worked out of 4 rooms on the second floor, which all had beds like hotel rooms. Our day was slower than the other days, but it gave us time to talk with our new Romanian friends who served as our interpreters.

The students with me during the day were Kacie and Julianne. During the morning, there was a gal who came in with abdominal pain. By the end of the visit, we realized the reason she was there was actually due to depression. She had struggled for 25 years and did not want to burden anyone in her family. She had receive psychological care and did not want any medical management – it seemed she just wanted to talk and have us pray with her. It was quite a moving situation as I was able to share my own experience with depression and pray with her. It was the first patient who came through this week where I personally felt like I could use my own story to help them.

Our lunch consisted of homemade meat and cheese strudels.

Lunch

The last day of clinic was a great end to the trip as many of us laughed much during our day. During our debrief meeting in the evening, we shared stories of joy from the day – a time when we found ourselves laughing. We also went around the group sharing in one sentence about an encounter with someone we had over the past week, which was memorable. Between clinic and our dinner time, some of the team went down to the Black Sea to do a polar plunge into the cold water. Some of us just watched ;)

At the end of the day, we made a trip to a nearby grocery market where we could purchase some snacks and gifts for family and friends at home.

Definitely more people than seats.

It’s been a good growing experience. Although I’m not a brand new provider, I do not use my skills often in chronic illness management, such as diabetes and hypertension. This trip stretched me to use my physical exams and rely on my medical training. It showed me a world where I was no longer comfortable with the medicine again. The interaction with patients was quite similar to the states and the non-English speaking patients I encounter in my own routine clinic day. But the types of medicine were different and trying to figure out the class of medication based on my limited Spanish/Latin and utilizing the pharmacist was a puzzle daily here.

Romania: Day 7

Day 7, Thursday, May 11, 2017

The church where the clinic was held. Team devotions.

The pastor reading through the New Testament in Romanian with the patients who came to the clinic while they waited to see the doctor. 

The second to last day of our clinics was held at a small church in a village. Many of the neighbors came to be seen by the “American doctors.” A few were super curious and did not have particular medical complaints. Many of the patients with which I interacted made an impression on me. The elderly Romanians lived through communism, hardness, likely starvation and challenges, but they continued to have a sweet spirit and were incredibly grateful we were there to love them. One gal kept stroking my hands as I talked to her – she took a picture with Jasmine, our interpreter, and me before leaving. 

Thee sweet gal who was so grateful we were in her village for a clinic

Half the battle with doing medicine in another country is figuring out what medications they are on. This is challenging enough when one speaks the same language, but even more so when one doesn’t. To add insult to injury, so to speak, many of the drugs go by a different name, so I relied on my pharmacology study of drug class (families) and function to figure out what diseases each patient may have. Although I don’t know the actual statistic, I kept joking with my students that 80% of medical complaints can be linked to medications. Our pharmacist, Josh, was incredibly helpful in solving the drug puzzle over and over during the day.

Josh's medication supply arranged according to color

Medication list in Romanian

Another elderly gentleman came in with vitiligo and wanted to know if we could cure it. He later confessed that he was incredibly curious and just wanted to meet us. Who knows how long he waited to see us, but after a few minutes, he nervously left with smiles and kissing our hands to show his appreciation of us coming to his village.

Our lunch was a delicious, yet incredibly messy, lunch of shawarmas. The village where we were working is near Bulgaria. Much of the cuisine in the region is of Turkish origin as we found out throughout the week of lunches.

Eating shawarmas for lunch

The last patient of the day was a gentleman there for leg pain. After a series of questions, I was much more suspicious for heart failure than any other source of leg pain. On exam, he had a noticeable heart murmur and bilateral lower lobe crackles, which were also consistent with this diagnosis. If he had been a few minutes later checking in to see us, we would not have had him as a patient that day and he might have missed an important diagnosis. We had him come back the next day with his medications to see if we could add anything else in to help with symptoms and educated him on when to seek hospital care. He will also follow up with his main doctor to discuss these symptoms.

This particular clinic emphasized creativity with clinic structure, spacing, and interaction among the team members. At one point, Rob was pulling teeth in the passageway between the main sanctuary, bathroom, and dental area due to space constraints. I love how the situation does not have to be perfect to be used by God to make a difference in a person’s life. Just as Jesus made do with a small lunch of fish and bread, we work with what is available and God uses it for his glory. Not only is this true of physical spaces, but it is also true of giving our lives to his work. We may not think we have much talent, skill, or knowledge to offer, but God uses our willingness to make a difference.

Dentist Rob pulling a tooth in the hallway.

When we returned from clinic, I crashed for a 20-30 minute power nap before dinner. We had debrief time after dinner and finished early in order to enjoy pool time. Nearly our entire team headed down to the salty pool and then hit up the wet and dry saunas before it closed at 10 PM. Fun team bonding!

The hotel pool

More than Halfway

More than Halfway - Days 5 & 6

May 9, 2017

Tuesday we were back at the same church in Constanta where we worshiped on Sunday night and had clinic on Monday. I was able to work with the same interpreter, which was helpful as we had a good connection and she was excellent at translating to English. Maddie was with me in the morning and Ed was with me in the afternoon. Our day was busier than Monday.

One of the harder cases was a sweet elderly man who just wanted a “checkup.” He was smiling and not complaining of any pain or other symptoms. It appeared he just wanted to meet with the “American doctors.” However, on closer questioning, we discovered he had a diabetes and did not take his medicines like he should as he would forget them. We checked his blood glucose – and it was 595. We re-checked it – it was out of range (600+). Clearly this man had uncontrolled diabetes. We were able to educate him on why we care that his blood sugar is high, the complications of high blood sugar such as ultimately blindness, nerve pain/numbness/lack of sensation of the feet, kidney problems, and heart failure. We also educated why the pills help. He loved Jesus and told us the Lord has work planned for him still and that is why he is still living and has something worth living for.

The large medical room where Drs. Honderick, Lynn, Marcia, and myself worked. My portion was the past corner on the right. 

Another challenging case was a pre-teen girl with chronic headaches. She was diagnosed with hyperthyroidism 4 months earlier and started on thyroid lowering medications with labs trending back toward normal range of hormone levels. Her headaches were a mystery however. When I discussed the case with one of the other providers, she mentioned it is common to get headaches as the TSH levels are stabilizing. I love being able to learn something new every day!

These Romanian men were in line for optical. The second guy asked for me to take a picture of them. 

Our lunch was Romanian pizza. They must have thought we would be hungry because they ordered enough for nearly 1 pizza per person. The pizzas contained 6 slices, did not have pizza sauce on them, were served with ketchup, and come with a variety of toppings such as meat (pepperoni, sausage, Canadian bacon, chicken), corn, and tuna.

Lunch in the kitchen. We were each allotted a personal pizza each. 

After clinic, we had time to spare before dinner, so Jill, Josh, Ed, Dr. Jim, and I went for a walk along the beach, down to a marina. We met a ship captain there who spent several minutes chatting with us. Come to find out, he sailed for a cruise ship at one point and now was the captain for a search and rescue boat. His English was broken, but the British accent and formal use of “sir” made him seem even more the captain of a sea-faring vessel.

We had dinner in the hotel per usual, and then met for debriefing and teaching. Dr. Honderick asked me to teach the abdominal exam on the fly, which I did. My student volunteer was ticklish, which made for a fun abdominal exam demonstration. We ended the day mulling over minimal details of a case presentation we were going to tackle the next day during debriefing and training time.

May 10, 2017

One of the guys on the team talked us into getting up early “rain or shine” for the sunrise this morning. Both Jill and I were up before 5 AM and made our way to the shore with Josh. Ed joined us later. Alas, the sky was too cloudy to experience the sunrise in all its glory, but we did have a fun time freezing in the salt sea breeze and listening to the waves crash on the shore.

Dawn, before the "supposed"-sunrise.

Beautiful shell beach.

Because why not?

After a quick breakfast, our team headed out to a local village called Chimogeni, which was about 50 kilometers southwest of Eforie Nord where we are staying. The clinic was held at a governmental facility, which was quite nice. We divided the rooms into our areas of ministry – triage in the foyer, pharmacy and optical in the library, vitals and labs in the room leading to the back, and medical and physical therapy in one room divided into 4 partitions with curtains. As we were cautioned, the people in this village were much sicker than most of the patients we saw in the city the previous two days.

On the road just outside our clinic for the day. Oh, the irony.

Our clinic building for the day.

The pavement. Super artsy.

Romanian medical card with prescriptions listed and when and how much to take.

Chronic venous insufficiency with ulceration.

Dressing the man's ulcers.

Some of our team with interpreters and the mayor of the village.

The students crashed in the back on the way home after a busy day in clinic.

During our debrief time tonight and earlier in the day in a private conversation I had, we discussed how many people in lesser developed countries do not have access to care, do not understand preventative care, and/or only present to the doctor when there is pain – sometimes when the disease or illness has progressed to becoming “incurable.” Examples of these types of situations from today include broken, rotted teeth with no hope of saving; a man who was dying from pancreatic/liver cancer, whose wife had passed away, and who had a 16-year-old disabled son at home; a gypsy women who suffered from intense panic attacks and stress due to her family situation– her husband was abusive, cheated on her with prostitutes, and raped their daughter.  

This part of the trip is always when it gets hard as everyone is tired from jet lag, several days of clinics, and the emotional fatigue of investing in so many hurting people day after day. Please continue to be in prayer for God’s power to sustain our team, his love to become apparent to those we encounter these remaining days, and for seeds to be planted spiritually. Pray the Romani people come to understand and embrace the only hope which can sustain life and overcome evil for eternity. And pray the hearts of our team members be filled with courage and boldness to love extravagantly through the power of the Holy Spirit.

A few cultural norms were made known to me today. First, the Romani (especially elderly) are superstitious of the “wind,” which would be equivalent to a draft or a breeze. Some will not use a fan or the air conditioner. They do not open two windows, or a window and a door, at the same time in the home as the breeze can “cause” all sorts of illness. I encountered a man today who attributed his right-sided anterior neck pain to the “wind”; he was only one of many who attributed their illness to that same source. Second, the Romani are a proud people, as mentioned to me by one of our native interpreters. Third, they do not believe in stretching their muscles. Culturally this is viewed as writing them off by not giving them a medicine – it suggests to them it is only in their mind and we are trying to treat mental problems, which have an incredibly negative stereotype in this country. No one will see a psychologist or psychiatrist in Romania due to the stigma associated with these types of patients. This third enlightenment of the day made me realize how hard our physical therapist’s job must have been this week in this country.

I love trying the cultural foods in new places. This trip has been filled with delicious food, which was no different today. For lunch we had home-made strudels with cheese filling as well as pears and apples. It was fun trying a new, ethnic food. Turkish meatballs with eggplant and a cabbage salad with dill were new foods consumed tonight.

After dinner, we met for debriefing of the day, which was incredibly tearful on the part of several of the students. As we heard story after story of heartbreaking situations, it reminded me of the need and hurt people experience in a fallen world, and how only Jesus can truly remedy evil. However, it is encouraging to know that, although our work is but a drop in the ocean, when we do it in Jesus’ name, he can multiply our efforts to have lasting influence. Rationally, it doesn’t always make sense; but kingdom math always means multiplication, not solely addition.

Another good conversation we had with some of the students this morning on our drive to the clinic was the idea of being a Christian in one’s vocation. In medicine, just as in other service fields such as teaching, law enforcement, firefighting, and social work, it can be easy to become jaded. It is a battle to fight to keeps one’s heart soft and compassionate and not hardened to cope with the difficulties of other peoples’ lives. I clearly remember being told by the staff when I first joined the emergency room as a technician that I would lose my faith in humanity and become cynical and distrustful of people. At least one person told me I would lose my caring spirit. I made an effort to prove that person wrong and it is a battle I still fight periodically as a physician assistant. It is especially challenging when one is surrounded by negative, critical attitudes of those he or she works with, making it twice as hard to continue to stay empathetic. This trip is teaching the students these same life lessons. Compassion is draining, but worthwhile to maintain in one’s service. We must never forgot why we do what we do – and that is for Jesus’ glory and fame.