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.