"What are you doing for others?"

Today's experience was hopefully the first of many. 

As a nurse, my primary section here at the hospital is working MedSurg. For those who don't speak "Nurse" this means that I work with sick patients and those who are going to go into or have just come out of surgery. In a sense, they are "easy" because they have something wrong with them that I have to help fix (disease or operated wound). The hospital where I work at (here) is a hospital that specializes in working with people affected by Leprosy - a disease considered in many parts of the world to be eradicated. It has two wards: MedSurg and long-term Hansen (aka. Leprosy). 

This morning I headed over to our long-term Hansen ward to learn how to do wound care. In our MedSurg ward I have seen my fair share of wounds, but because of the specific nature of my job, I don't do a lot of the deep wound care. The wounds that people affected by Leprosy have are special wounds. Most of the time they are so deep and extensive that they require grafting and occasional debridement (basically, stripping of the bad parts of the wound). They can smell bad and look mangled and gruesome. 

First off, at 9:30 every day, the patients are wheeled into the Foot Wash room and they set their wounded feet into warm salted water for 20 minutes. They take off their own bandages (or sometimes with the help of their family assistant) and gently clean their wounds. After the soaking they cover their feet with vaseline (Petroleum Jelly) and head over to the Wound Care room. 

I have had a quick peek of the patients in the Foot Wash room and I am already surprised by their wounds. It's my first day and I want to make the patients feel a welcoming spirit and not one of disgust. I have already been praying through the night for this moment. 

I gown myself and head over to meet those who have finished their foot wash in the Wound Care room. 

The first man has an enormous smile on his face and directly tells me that he wants ME to do his wound care because his wounds will certainly heal faster with my lovely touch (Gah!). I banter with him and take my place at his feet and to the side of the male nurse who is teaching me. The man has half a toe... That's it... 9 1/2 of his toes are gone. I watch the male nurse as he uses a new gillette to shave off the calluses around his open wounds. The wounds will heal better if there is tender skin around it to help it close. I flinch every once in a while, as I am unaccustomed to the patient's insensitivity to pain. It should hurt. But it doesn't. That's what Leprosy is like.  

Next up, and my first, is a 70 year old lady who doesn't have nor has had Leprosy. She has an enormous (diabetic) ulcer that won't close on her leg. I can plainly see a necrotic tendon and perhaps also a bit of bone peeking out. I'm not sure. But because she doesn't have Leprosy, every time I touch her… It hurts. She flinches and pulls back and I'm only wiping her gently with Simple Saline and a small gauze. I encourage her, chit-chatting - trying my best to distract her from my work. I can see tears in her eyes and am amazed that she hasn't cried out already. I realize that she is most likely accustomed to this and her tolerance is already heightened. Just, wow. 

Call it gross. Call it nasty. Call it whatever you want to call it. 

Everyone has a heart for something. Your heart (or your stomach) might not lead you towards the kind of work that I do. But, with an honest self-examination you'll find yourself inclined in some direction. I feel blessed when I can help my special patients. 

Interestingly, there's quite a bit of irony in all this bit of doing things for others. You give and give… But it doesn't matter how much you give, you always get something back. You will never be able to empty yourself. 

In the words of MLK: What are you doing for others? 

Need an idea of something small you can do to start? Create awareness! Check out The Leprosy Mission UK's Feet First initiative. No money donation needed (if you don't want). Just a cool 24hr challenge. 

Waiting…

It's 5:00pm on a Sunday afternoon and I am on the floor. I have at my charge 2 clinical patients and 1 post-surgical. One of the three is giving me a run for my money. His O2Sat keeps dipping and I am forced to check on him every 15 minutes to make sure nothing worse happens. I have tried taking him off of oxygen two times, but apparently he literally can't live without it. By 5pm he has started to stabilize and I finally have a moment to breathe.

As is my custom, I move over to the side window of the Nurse's station from which I can see out into the main courtyard of the hospital. I see people arriving. I keenly observe them, trying to figure out what their emergency could be - because I am also in charge of the ER during my shift. They are carrying brimming feed sacks, like those 25kg ones filled with chicken feed, and travel bags. At this point it's only two of them and they don't seem to be in a hurry to get medical attention. In fact, they head over the the waiting area, put down their bags, and proceed to prepare tereré (a national communal tea prepared with loose-leaf herbs and drunk through a metal, filtered straw). I am about to go out to them to see if there is anything I can help them with, when the hospital guard walks into my Station. I simply ask him about the new arrivals.

"They are here for tomorrow. They've taken a number and are going to wait their turn for the morning consultation hours. Some of them have been traveling all day to get here."

I had heard about patients such as these, but hadn't had the opportunity to see them for myself.  For some reason, I had stored these stories in a mental box of ancient history. It's one of those stories that is told in churches about how things were in the "old days" when people would walk for kilometers and travel cross-country to make it to the mission hospital; arriving bedraggled and exhausted. But this was just yesterday evening, May 25, 2015. The "old days" were staring me in the eye.

Lost in thought, I don't immediately notice the on-call Doctor walk in. He walks up behind me next to the window to see what I am looking at and looks at me quizzically.

"Why do they come so early?" I ask him. The question is basic, but my interest drives deeper. He doesn't disappoint me with his straightforward answer. I insist.

"It costs 60.000 ($12US) for an ER consult at the hospital and 40.000 ($8US) for normal hours. Why would they go through all this inconvenience and discomfort just for 20.000 ($4US)? Why not just pay the extra and go home?"

I can see the doctor's gaze glaze over and can sense a long answer is being processed. Thus, I take a seat.

"This hospital is well-known to a lot of people. The efforts of those who came before us, going out deep into the interior of the country, seeking out patients and offering them hope and healing has poured over into today. These simple people have heard the success stories from their neighbors, uncles, aunts, friends, friends of friends of how they came to km81 and were healed. Many of them have been screwed over so many times by their local health services and are tired of it all. They are willing to travel for days just to get treated fairly and by good doctors who will fix them up. I have heard it said by humble people (el campesino) that the eucalyptus trees that line the entrance of this hospital filter the evil and sickness. Just by entering this place, your healing begins. Then they get here to us and are received with such enthusiasm and love and care, and another part of them feels healed. All this happens even before they speak a single word to a doctor! Sometimes we are able to fix their problems, sometimes we aren't. But, nonetheless, we take the time to listen to them and to appreciate them as a whole. Sometimes the patient just wants someone to listen to them. And thus the legacy continues… Getting back to your question: They come because they know that there is hope, blessing and healing at this hospital. And they want that."

I was speechless and so moved by his words. I could literally feel God's invisible presence stroking my arm encouragingly as if saying, "I am here. These are my people. This is MY work."

I didn't want to forget this moment and so I stood up, left the Station and inconspicuously put my cell phone on camera mode.

There they are. 

Some of them are sleeping already, while others sit around chatting. All of them waiting... to receive hope, blessing and healing. 

I just gotta say that I love being a part of it all  <3 p="">

Workshop: Leprosy and Kids

The month of May is our Fundraising Month at Km81. As a part of this effort we go out to some of the 32 churches that commitedly support us on a regular basis and give them an overview of the work that is being done. As Pastor and a member of the administration, my husband is often asked to give an update on the hospital. This year was no exception. Although, in addition, one church asked me to talk to the 1st-6th graders in Children's Church about Leprosy and our work here. I jumped at the opportunity! I love our work here and it gives me great joy to share the amazingness of it all.

About 30 kids were present as I shared of the fun activities a kid could enjoy living here at the hospital (as we do): Pony rides, zip lines, fishing, feeding baby calves, etc. But not only are there fun activities, but there is a large building where sick people can go to see a doctor who can fix them up. Our doctors see all kinds of people and all kinds of diseases -- especially Leprosy. I taught them what Leprosy looks like and how it is and is not spread and cured.  We did volunteer  activities where the kids were placed in a situation where they were "crippled" by the consequences of this disease. One child, with socks on his hands had to imitate the loss of fine motor skills and perhaps also digits, needed to close buttons on a shirt. Another needed to serve herself a cup of water and drink it. Yet another needed to write her name on a chalkboard. All these exercises proved difficult and frustrating to all participants. The point was driven home… Many of those who go undiagnosed with Leprosy face the consequences of not having the medication that cures them and therefore are prone to accidents, due to loss of sensitivity. These consequences make life more difficult to some because they are no longer able to do menial activities as efficiently as before. With socks on their hands, the kids got a taste of what "different" feels like.

I encouraged and challenged them to be accept and help those who are different than they are -- even those without Leprosy. Their eagerness to learn was humbling. I can only hope that a tiny seed was planted within each one their lives that will bloom into a gorgeous blessing.


In preparation for my presentation, I used the very helpful guides specifically made for children that a German organization that works with Leprosy designed (click here -- in German).

Person of Interest #2: Ken Gibson

The Leprosy Mission Ireland is a worthy cause to support. They work with educating, curing and facilitating reintegration of those affected by Leprosy.

Leprosy is a disease close to my heart, not just because I live and work at a Leprosy Hospital, but because my husband had his own personal experience with this disease 5 years ago (If you are interested in reading of his experience click here). His approach to processing his diagnosis was to write about it in his blog. The post in his blog made its rounds among others who work with similar ministries as our own and eventually resulted in an invitation for him to attend a workshop in Ireland among peers & partners. To say the least, we were honored by the invitation.

In my first entry of this series on people of interest, I briefly touched on my naïve close-mindedness. In the first entry I unintentionally defined a person´s personality based on a preconceived cultural idea I had concerning this person´s Indian heritage. I was about to make a similar mistake with Ken Gibson.

My husband and I are so relieved to finally make it to the hotel where the workshops will be held. These meetings are the main purpose for our transcontinental trip. Since before even purchasing our tickets we have been wowed by TLMs organizational skills and attention to minute details. I (with my preconceived notions) am imagining this efficiency is due to super serious, industrious, incredibly focused office mice who rarely breathe anything that doesn't have to do with the world of Leprosy. I am imagining that the leader of TLM Ireland must be some intimidating, big headed, dictatorial type who directs everything with just a glance.

We are immediately received in the lobby by a friendly looking man with glasses, disheveled hair and a huge grin on his face. He looks like your favorite uncle. He welcomes us, directs us to the check-in counter, and asks for us to meet up later at the bar to chat. We go up to our room, thoroughly impressed by the organization, the hotel and the friendly people. After leaving our luggage, we move back down to the lobby to meet up with Ken. He and two other men are already there. I don't know that Ken is one of these 3 men. From the mood of it all, I assume that these 3 are friendly participants having a good time before sessions open. We talk about the long trip and about how amazed we are by all we have seen. The 3 guys chat about the weather, give us tips on things to check out in town and comment on the upcoming meetings. I feel completely at ease with the bi-specled man and lucky to be a part of the group.

And then the mood takes a serious turn and formal introductions are made. Guy 1: Emcee and facilitator of the sessions. Guy 2: Administrative Assistant. Guy 3: Friendly Glasses Guy: Ken Gibson, CEO of The Leprosy Mission Ireland. Unintelligible words stumble out of my mouth as I am overwhelmed and slightly embarrassed by the fact that I have been "improperly informal" with the man in charge of the entire workshop and his administrative team. I feel like a shoe. ("What does he think of me? He can't think that I am a serious adult after all this joking around!")

I am once again shot down by my squareness. Ken Gibson is a lovely person, filled with energy and passion for his work. He transmits joy and a desire to put one's best foot forward to further the Cause. I feel humbled by the fact that the leaders in the world of Leprosy are as human as I am. They are actually fun to be around :)

Thank you, Ken, for the wonderful impression.

Follow Ken on twitter and check out his Blog to get to know him and TLM Ireland better.

Huge Bills

A man was checked in at our hospital with gastrointestinal problems and stayed for 5 days. I come in on the fifth and final day and am given the task of checking him out. He is finally going home. There is much joy and expectation from his wife and himself.

I sit myself down, grab a pencil and a calculator and begin the tedious and meticulous task of figuring out the bill. 5 days is a lot of days to be attended to in the ward. This means 3 meals each day for husband and wife, adding up the liters of IV fluids, ampules of medication, the syringes that correspond to each application, the number of doctor visits, blood glucose tests, other external lab tests, etc. For a regular one-night stay the numbers are already daunting. Imagine 5! I dutifully punch in the numbers, erasing sometimes and starting again when needed. After what seems like hours I finally have a final sum of Gs. 1.450.000 to be billed to the patient. My hands feel sweaty because I now need to give this bill to the patient - and the number makes me nervous. In Paraguay, minimum wage is Gs. 1.890.000. (approximately $400 US dollars). This man is going to receive a bill for almost his entire monthly paycheck.

What I didn´t mention before is that this man was once diagnosed with Leprosy. At our hospital anyone who has been diagnosed with Leprosy receives free care for any conditions related to the disease. Many people affected by Leprosy take strong medications similar to a chemotherapy combo. These meds irritate the gastrointestinal system and this is how our patient came to be check-in at the hospital. As an institution we are grateful to many NGOs that make it possible for us to be able to offer free care to our special patients. Because without this free care they surely would not seek out the treatments they need.

The man´s wife takes the bill to the Administration and returns to me with the receipt. She has tears in her eyes. This is not the first time she has had to go to the Administration to settle a bill. She knows that once she gets to the cashier´s window the accountant will quote the figure to her and remind her that she owes nothing. Others have paid for her husband. It is all free. She puts her hand on my arm and whispers her thanks.

        "Thank you for taking care of my husband. There is no other place like this hospital. You truly 
          care for us. Thank you! God bless you!"

There are no words to describe the feeling you get when you realize you are a part of something that´s huge. You are a tangible part of change in this world. It´s been 5 years and 4 months at this hospital and my everyday encounters with these Special People still give me goosebumps.

It´s just that great.

Someone´s already paid for you...

Today I went to the pharmacy at our hospital because I needed to purchase a necessary item. As I was in there waiting for my turn a young man walks in.

There are so many different ways I could attempt to describe this man, but the words fail me because it was all so intense. His eyes were downcast, his face pale, his hair disheveled. His posture, although standing, was fetal - as if he was sheltering what little was left of his shredded spirit. He looked like a man who was having the worst day of his life. I was puzzled by his demeanor, but at the same time figured it wasn´t so out of place. I was at a hospital, after all. All sorts of bad things happen here. I try to dissimulate my curiosity and hope desperately that I am succeeding. I surreptitiously take one more look at him and I see he is holding something in his hand. Suddenly, I know. 

Compassion envelops me as I figure out that this 30-something year old man has just been diagnosed with Leprosy. What he holds in his hand is the first of his 12-month supply of Multi-Drug Therapy (MDT). He walks uncertainly to the lady at the counter and hands her a slip of paper. She takes it, turns around and goes to the back of the store to collect the necessary medications; 4 boxes of Complex B, 3 small bottles of Prednisone pills and one injectable med I don´t recognize. I discreetly observe the man as she brings the items to the counter, one after another. She grabs for a bag and it can barely hold it all. I can see his fingers twitching close to his back pocket. It is obvious he is doing some quick mental math, trying to figure out how much all this will cost him. I can't help but feel even more empathy for him as I see the combination of his grief and shock over his new diagnosis merging with the desperateness of how much the overflowing bag of medications are going to cost him.  

"Cuánto me alcanza?" (How much is it?) He asks the Pharmacy Lady. His voice is barely louder than a whisper. 

I know the answer (even though he doesnt yet) and I eagerly keep my eyes and ears on the drama playing itself out before me. I want to hear her say it and I want to see his reaction to it. 

"Nada. Alguien ya pagó por ti." (Nothing. Someone else already paid for you) 

He looks up at the lady, clearly shocked. Both are silent for what seems like a long time, his gaze never leaving hers. He takes his little bag and leaves the store in the same manner in which he entered. 

End of story. 

Oh, but it isn´t. 

Every 2 minutes a person is diagnosed with Leprosy in the entire world. That means that on any given day there are approximately 720 new cases of Leprosy. 720 people´s lives are forever changed: poor people, rich people, important people, humble people, ordinary-everyday people, etc. I would dare to guess that most of these people´s experiences aren't too different from this young man´s: shock, confusion, loneliness, fear… 

If you´ve clicked on the link at the beginning of this entry, or if you know me personally, you know that I/my husband work at a hospital which specializes in helping people diagnosed with Leprosy. It´s a mission hospital which aims to minister physically, spiritually and emotionally to this special group of people. It gives me no pleasure at all to see the inner (and outer) turmoil these people go through. But it fills my heart with pride and a sense of belonging that I am a part of the answer the Pharmacy Lady gave to the young man. "Someone already paid for you…" 

"Paying" is not only done monetarily in the form of bills, coins and bank transfers. It is also accomplished when your heart reaches out to those in need. When you see the fear, desolateness and need of another human and you want to help. How? You can help by praying. You can open the doors of your house to those who feel as though they have no where else to go. You can invite them to participate in community programs. You can visit them. You can touch them… because sometimes no one else dares to go near them. 

And on a personal note… And closer to home… 

Remember.

Never forget.

Someone´s already paid for YOU!

World Leprosy Sunday - Don Herculano

We went to visit this guy on Sunday. 

Sunday was World Leprosy Day. It´s a day that we remember world-wide, those who have suffered or have been affected by Hansen´s Disease (aka. Leprosy). 

My husband is an ex-hansen patient. To read his experience with it, you can visit his blog here. We wanted to show our support of another ex-patient and headed out 100kms from our home to visit the elderly Don Herculano. I am not very familiar with this man´s story. But what I do know is that he has an extremely large heart and leads services in a makeshift church that the community has put up. 

Don Herculano is always smiling. He gets around on his crutches. Orthopedic shoes made at our Leprosy Hospital adorn his feet. The man lives in a one-room structure. One bed for his mentally challenged nephew who cares for him and one for himself. The floor to his house is new cement. A volunteer youth group went to his place last year and fixed up his home, replacing the dirt floor for the cement one. There are food staples lined up on a shelf on one side of the room - noodles, tomato paste, canned peas, oil, flour, etc. A quick glance of the room is all it takes to surmise the man´s condition. A second (and more trained) glance gives you a look at the care and pride the man has in what little he has. Everything has its place and there is nothing on the floor. His smile welcomes one and all. 

Many of our patients struggle fitting into their communities once they have been diagnosed. There is a lot of stigma associated with Leprosy. Its not uncommon for a patient to be literally shunned or cordoned off from the community. This is not the case with Don Herculano. He is obviously dearly beloved in his community. At his late age, he is still committed to serving his neighbors. A chair is always ready for a guest, a warm handshake from his mutilated hand, fruit from his neatly tended groves, even a self-penned song on his guitar are offered to the delight of anyone willing to listen. 

Funny how a man who is technically lacking physically from the unfortunate consequences of the disease can apparently be so much more complete than most of us who have all our body parts intact.  

Just some food for thought… 

We are the hand and feet of Christ… Go ye therefore! 

Leprosario Sta. Isabel - Sapucai

It was such a great day today! I can't decide whether to write in English or Spanish to tell it all! I'll stick to English, since most of you who speak English are overseas & perhaps would benefit most from this amazing cultural experience.

Today we had the wonderful opportunity to visit the Leprosario Santa Isabel in the outskirts of Sapucai. This means nothing to you guys who don't live in Paraguay (and perhaps also nothing to those who live here too ;). Enough said that it's about 80kms from Asuncion, the capitol of Paraguay.

ARRIVING
The journey to Sta. Isabel was not a long one. A Family Day was made of the experience, so the kids came along. With us were the other families of the Administrative Team here at Km81. With our friends the Schmidts, we shared a Combi - 7 kids, 4 adults. The little town of Sapucai is found on the side of the interstate. As we entered the town, I began to pay more attention to signs and buildings hoping to catch a first glimpse of the Leprosario. The town was quaint. Sunny and friendly. People were sitting outside in front of their houses drinking terere or working about the house. There wasn't much traffic since it was a Saturday morning. The kids distract me with requests for a snack. I drag my eyes away from the passing scenery to tend to them. As soon as they are appeased, I return to my sightseeing. We are no longer in town. There is now a dirt road and what the Germans here call "Busch". It's scraggly, forresty land - albeit "civilized." We continue down dirt roads that get narrower, the Busch alternating with grazing and farmland. Eventually we arrive to the embossed gates of Santa Isabel.

LEPROSARIO: Definition
A Leprosario is an antiquated Spanish term for 'Leper Colony' (-also an antiquated concept). Paraguayan history reveals a tremendous movement of social discrimination towards this particular group of affected people. Leprosy is now considered a curable disease, thanks to Multi-Drug Therapy which erradicates it from any infected body. This cure, however, was not created until 1988! That's not even 25 years ago! And the provision of FREE medication to all endemic countries wasn't implemented until 1995. This means that until not even 20 years ago, no one here in PY received a definitive CURE to Leprosy. Other medications were being used, but were not successful/efficient long-term. A person who is affected by untreated Leprosy runs the risk of mutilation & infiltration. What Leprosy does to the body is it kills nerves. Therefore, if you don't have nerves (feeling) in a certain part of your body, you can step on a nail & not even feel it. This creates a wound, which gets infected, which could lead to amputation. All because you lost the feeling on the bottom of your foot! That's why you see pictures of people with leprosy without fingers and other deformities. Infiltration means that the bacillus that causes Leprosy congregates all in the cartilage of your face and lives there. So it looks like you have lumpy skin where there are little groups of them. These physical affectations, PLUS the Biblical stigma, unjustly creates a discriminated and set-apart group of people throughout time. It is in this moment and mindset where "Leprosarios"/Leper Colonies are created. Not to cure them... but to separate them from the healthy population. Conditions were hideous (not like the modern-day pics i show here).

First sign we see

 "Leprosario Santa Isabel"

Another Welcome Sign

THE VISIT
The kids fell all over each other to get out of the Combi. It was a sunny day with a cool breeze. Absolutely PERFECT for a field trip. The grounds were impeccably neat. The "colony" is funded publicly and privately, allowing nuns to care for the sick and also benefiting from state money. In the past years, there has been an influx of mentally ill patients sent from the government. The colony is residential. There are dorms where the sick live, each having his own bed and tiny corner of space. Some even have rooms - mostly the women, who are fewer.

Dorms

Community Garden

Perhaps what impressed me most of this visit was the seemingly orderly and proper functioning of the colony. It's definitely unusual to see any program here in Paraguay to be shadily run. I was expecting molding walls, smelly rooms, mangy dogs, crumbling buildings, etc. None of those proved true (well, except for the pet dog ;). As you can see from the pictures, all is nice and neat.

Patients' House

THE CEMETERY

As is the reality with most institutions like this one, there is a cemetery. Some of these bodies "had no place to go" and were buried here. It had a melancholical beauty to it. Perhaps in the light of such a beautiful day, the eye fools the reality of it all.

RETURN HOME

On the way back home we passed the same fields and the same Busch, but this time I wasn't so distracted by the kids. It's a long, difficult journey for anyone who wants to come in or go out. No bus lines, no paved roads, no neighbors... nothing. This is/was intentional. Eventually we reach the edge of town & the normal Andy Griffith, small town life beauty returns. First to catch my eye is a small group of people in front of a "despensa" drinking terere around a man playing a harp. yep... a harp. Quaint, right? But the thought troubled me... Now-a-day the people of Sta Isabel apparently live a decent life. But imagine 60 years ago... Lepers were outcasts. And the quaint townsfolk from the beautiful town playing the harp and drinking terere? they were those who'd sent them away. Times have changed. The colony looks great... but they ARE still set apart, while others continue to live their Leper-free lives. Just some food for thought...

If you are interested, here are 3 Interesting sites. The first one is the website of the hospital where we live & work - also serving those with Hansen's Disease (aka. Leprosy).



Hospital Mennonita Km81
Paraguayan Efforts for the Control of Leprosy (Spanish - Gov't Page)
Elimination of Leprosy in the Americas (English - World Health Organization Page)