One forward and two back or two forward and one back?

We were disappointed this morning to hear that Jhonny would undergo another surgery this afternoon. It was especially difficult for Erselia since many of the women talk about him not coming through this. It took some reassuring that this was not as major as the other surgeries and was only to drain some of the fluids. The specialist felt that it was better to put in another couple of tubes so that things would drain better. So it is back to Jhonny being under anesthesia and waiting for him to show response.

While Jhonny was in surgery two young doctors interviewed Erselia about Jhonny's medical history. Every time she tells it I learn more. The same day that she went in for a checkup for the baby, she took Jhonny along since he was getting worse. The doctor in La Pista had given him Milk of Magnesia but that didn't help. I wonder why? Then in Yapacani the doctor told her that they lived in dirty conditions with pigs and chickens and all Jhonny had was an infection. He didn't check him or order any tests. The lack of caring is almost too much to handle. It seems that if you live in the campo you are automatically (1) dumb and illiterate, (2) dirty, (3) have 'bichos', (4) not deserving of proper medical care.

I asked Erselia what was most important in the campo. (1) clean water. That can be solved by a simple filtration system using buckets and sand. (2) a good doctor. I am not sure we can do anything about that but I hope that we can increase awareness of illness - what is serious and what is not. Maybe a yearly medical team? Anyone willing to take that one on?

Improving!

Jhonny is improving. He is coughing and that means his body is working on its own. The fever is still a problem but something with which we will have to endure for now. Today we journeyed back to the 'rich' hospital for another tomography and it certainly looked better. Although there is still some fluid on the brain, the general pictures were very clear in comparison to last week. Things to be thankful for.

Being in the city can be pretty depressing, especially when you sit in the hospital around sick people and their families. Today Erselia and I went for a walk to a local supermarket four blocks from the hospital. I thought it would be a good place for her to know about and it only required one turn. Later she left to purchase diapers for Jhonny and I remained at the hospital reading my book. After an hour and a half I was a bit concerned that she had returned. When she finally came back she said she was lost but did find her way back. She is getting braver.

Small improvements

Jhonny is holding his own. Each day we see small improvements and I am happy to say that is off the respirator and is breathing on his own. His temperature is still a concern since it often is high. The doctor visits him daily and is saying that he is stable. Each day we pray for more improvement.

Finally -- A Better Day

The Condori family was having breakfast when I came to the hospital this morning -- buns and coffee. Erselia was crocheting a mat for a lady who has befriended her and we had a good visit. Jhonny is still not responsive although his body is moving more and the doctor says that he thinks Jhonny will respond in a day or so. The doctors and nurses are saying he is looking better before we ask so that is also a good sign.

This afternoon Erselia and I went to another health clinic to check on the status of her pregnancy. She had gone to the doctor in Yapacani but they were unwilling or unable to go any tests. She presented the documents at this clinic and came out with a big smile on her face and ultrasound pictures of the baby -- not that we could decipher anything. She was told that is was a mujercita -- a girl -- and that it would be born in 9 weeks. I am sure that she is the only women in the community who was a picture of the baby and knows already that it will be a girl.

After tough days it is wonderful to have this ray of sunshine -- a sign of God's love and grace.

A Slow Road

Yesterday was another busy day. The first concern was to get Jhonny a 'catagoria'. This is a type of social assistance and we have been working on this since he arrived at the hospital but every day the lady says "Tomorrow." Finally, after a bit of persistance we finally received the correct papers and Jhonny now receives a lower rate on the lab work, the surgeries and his bed. Erselia was a bit perplexed when the lady told her that all ladies that wore polleras (the native skirt) could not read. The assumption is that if you wear native dress and live in the campo, you are automatically poor.

By the time that was all done and the medications purchased it was too late to bring the tumor to its new home.

At noon we were informed that Jhonny needed another tamography and, thanks to the teachers, we had a 3 p.m. appointment. Of course, that is Bolivian time so it was after 4 before we left since they had problems finding an oxygen bottle for the ambulance. We were thankful that for some reason the ride was free. While we were there the doctors asked if they could get a chest x-ray at the same time. The original price - $42US -- the final price 78 bolivianos or a little over $10.

This morning we finally were able to talk to the surgeon who informed us that the tumor was half the size of Jhonny's brain and that was the reason that recovery was taking so long. He says that Jhonny will be in 'a delicate state' for two or three more days and we won't know much until then.

I was very happy that the doctor talked to us since we were all feeling low. Since Sunday four children have died -- one ten year old and three babies. Erselia expressed this morning that it seems that only dead children came out of that ward. This morning was especially hard since the mother is single and was alone when she was told her baby died. It was a very hard couple of hours until her friends came. There is no type of grief counselling and the staff just walk passed looking straight ahead. It is the other people with children in intensive care that end up helping and supporting.

Every day I am thankful for the health care system we have. You have no idea what it is like to have to pay for every little thing before something can be done. But on the other hand, the public system is not always the cheapest. I brought the tumor to its new home today -- a private lab that will have the results quicker than the public system. The price was 100 bolivianos cheaper at the private lab -- you just never know!

A better day

Jhonny appears better today. Erselia said that he had a tough night, running a high fever. She bathed him with cool cloths until 1 or 2 in the morning. His breathing seemed a bit labored earlier today but now it was more normal. His blood pressure is also normal.

But a day could not go by without some excitement. This morning I had to bring the tumor sample to the cancer hospital. The tumor was in a plastic container and I didn't look at it that well. A block from the hospital we hit a bump -- and the bottom part of the container slid from the top part, which was in my hand. The tumor and all the liquid fell to the floor of the taxi. What to do but scoop the tumor up, jump out of the taxi , run back into the hospital and request that they please replace the liquid. Thankfully they could do that and I proceeded to the cancer hospital -- only to find that it is a holiday (Medical Day? Day for Doctors and Nurses?) and many of the personal at the hospitals were off. So, again, I returned back to the Children's Hospital with the tumor and will bring it back again tomorrow.

We still haven't been able to get Jhonny on Social Assistance so we will try that again tomorrow. I might have to get my girlfriend to help since she speaks Spanish much better than I do.

More Surgeries

I came to the hospital this morning to find that Jhonny was scheduled for surgery again this morning. Because there was fluid and swelling on the brain. It was another six hours in surgery and we really have no idea what is going on. All we know is that they used one more unit of blood and three of plasma. It has been a very hard day on both myself and Erselia.
Today I brought the sample of the tumor to the other hospital and tomorrow I need to do the same with the samples from today's operation. It will be ten days before we get the results.

One Tough Day

I expected that today would be an easy one with Jhonny resting comfortably. Another dream in Technicolor. Jake arrived this morning and we went to church and then to the hospital. We planned to stop to say hello and then go out for lunch and have some time together. Another dream in Technicolor! We arrived to find that new tomographies were needed and Jhonny would be taken to another hospital for these -- but they needed our approval since we would pay the bill. So instead of going out for lunch I viewed the procedure in a very upscale private hospital. The technician said that he could not see much since there was too much swelling and blood. This, however, means that Jhonny will undergo surgery again tomorrow to relieve the swelling and remove some of the liquids. We also noticed that his breathing is very labored and that causes some concern.

We probably would take this more in stride except that another 10 year old boy died today in ICU. He had had a tumor removed two weeks ago. The whole concept of death here is much more 'matter of fact'. The boy died and within a short time all the tubes were removed from the body and they put underpants on him rather than a diaper. Then he was wheeled into the hallway. Within less than ten minutes male members of the family arrived with a coffin and the body was placed in it. The men then carried out the coffin through the front exit of ICU and placed it in a station wagon. Along with the coffin went the candles, lamps, etc. that they use for Catholic funerals. We are not sure if they went directly to the cemetery or to a church. Everything was over at the hospital within half and hour and other baby was in the space.

This whole incident affected both Erselia and me and it does make me more apprehensive about tomorrow's surgery. We ask for all you prayers tonight and tomorrow.

A Day in Surgery

The alarm went off early and off I went back to the hospital. Filipe was trying the bathe Jhonny and shave his head for surgery. His hair off in bits and pieces and Jhonny was crying so I took over that part of the job. It is hard when there is no assistance. Soon Jhonny was tucked back into a warm blanket and off to surgery.

The surgery lasted seven hours. There is not a lot said but they used three more units of blood than they had planned. The good thing is that they just used them and didn't get us to pay for them first. I would have had to change some money and that could have been a crucial delay. The majority of the tumor was removed but they were unable to get it all. After surgery I was presented with two vials with parts of the tumor which I brought to the cancer hospital across town. They were not receiving items until Monday morning --what do I do with tumor parts? Thankfully the hospital took them back and is storing them until Monday morning.

Jhonny was resting quietly when I left. Not that that says much. He was very drugged and these Bolivians don't show it when they are pale.

In the Bolivian hospitals there are many ladies from different churches talking to the patients and their families. One befriended Filipe and Ersilia and they stayed at her place last night. It is great that they have a place to go instead of a hotel room.

Thank you for all the prayers. I will post pictures when I get them off my camera

Adventures of the Medical System

Today was a calm day -- waiting for the operation tomorrow morning. Filipe, Ersilia and Daimer slept at the hospital last night. They joined all the other families sleeping on the floor in the hallway.

Bolivia does have a type of social assistance for the poor. DAVASON provides medicine in exchange for a donation. That was the way we purchased the medications today. It turns out that we paid more for them through the donation that had I purchased them at the pharmacy. Because you do not know the value of the product the donation may be too much or too little. However, this program subsidizes the beds so we will be paying 25 bolivianos per night instead of 50.

Today I calculated all the expenses I have incurred so far. It comes to 4251 bolivianos or just under $600. Imagine that the average wage in the campo is 35 bolivianos a day. Already we have spent 121.5 days of wages! Compare that to earnings of $100 a day and we have spent the equivilant of $12,150 dollars.

Another Day in the Hospital

Filipe and Samuel left this morning for Yapacani. Erselia took the micro from Patujusal to Yapacani. From there Samuel would return home while Filipe and Erselia returned to Santa Cruz. Although I arrived at the hospital at 9, I was informed that I could not sit with Jhonny since I was not his family. Instead I purchased the items for the anesthesiologist. That took until 12:30! Of course, another list was added. I fed Jhonny his lunch and had to leave until 3.

It was good to see the change in Jhonny. He was able to sit up for about 30 seconds before he would loose his balance. That doesn’t seem like much but yesterday he did not have the energy to lift his body off the bed. His appetite returned and he ate all his lunch – after I went across the street to get a spoon so that he didn’t have to eat with his fingers. His speech has returned and the constant questions were "What time is it?" and "When is Daddy coming back?" However, his depth perception has been affected so he has trouble getting the food to his mouth and when he pointed at something, he could not do it.

Another medical system quirk. One has to pay to use blood and it is not cheap by Bolivian standards -- 250 bolivianos or a little over $60 a unit. But before the surgery can be done, one of the parents much donate the units back into the bank. So we purchased 3 units of blood and Filipe must donate 3 units back. He did not do that before he left so surgery is delayed one day.

The items I purchased today were much more expensive than those purchased yesterday. One realizes how the poor simply cannot afford to have these type of operations performed. I changed $500 this morning and the majority of it was used to purchase medication and supplies.

And we complain about our medical system?

Medical System

Last April one of the ladies from the community asked me if I would take her son to the doctor in Santa Cruz. He had been suffering from headaches for the past two years and he had a soft spot on his head. The first doctor wrote a note explaining that she felt the situation was urgent and that she thought Jhonny had a tumor in his head. After looking at the X-rays the doctor at the Children’s Hospital said that yes, there might be a tumor but the biggest problem was ‘bichos’ – the catch all phrase for all worms and insects. Erselia and Jhonny returned home and life went on as normal – or so I thought.

On Saturday the teachers asked what had we had found out about Jhonny – he hadn’t been back to school and his brother said that he was not walking or talking. I talked to an aunt but she knew nothing. However, early the next morning her husband biked over the Erselia’s and found Jhonny in bed. He could no longer walk without assistance and was barely talking. Erselia came to church to ask for prayers for Jhonny so after the church service all the members went to the house since Jhonny could not be moved easily. Jhonny was responsive but very tired. On his head there was a soft spot that felt mushy and his face appeared slightly larger than usual. He was running a low grade fever, had problems with vomiting and incontinence.

3:30 am on Monday Jhonny, his brother Samuel, his father Filipe and I headed to Santa Cruz with all the documentation of the previous visit. We arrived at Mision de Esperanza, a hospital operated by a group from USA. They were unable to help but contacted a neurologist who would meet us, even though it was not his clinic day. He, in turn, sent us off to another clinic where a tomography was taken. By this time, little Jhonny was tired and the only way he could move was if someone carried him. I never thought I would be able to carry a 10 year old boy. Since we would not see the neurologist until 6:30 p.m., the family rested in a little hotel for a few hours. The neurologist informed us that there was a large tumor in Jhonny’s head but we needed to come to the Children’s Hospital the next morning to determine a course of action.

Tuesday morning Jhonny was admitted to the hospital for an assessment. This was 8:30. Finally at 3:30 he had a bed. We had an interesting day in the emergency part of the hospital and I learned a lot. If you need a splint, make one from cardboard. The lack of efficiency is directly related to the amount of paperwork. Nothing can be done until payment is made. The patient buys everything for the treatment – except the cardboard!

First you get a number, go to the cashier, and pay the amount needed for the initial consultation. Then you go back to see the doctor. If there is lab work needed, you go back to the cashier and pay another amount. This lab work is done. Then some more lab work needs to be done. Back to the cashier so that it can be done.

A list two pages long contains all the items needed for the surgery. Off to the pharmacies along the street to buy everything from the saline solutions to the thread for the stitches. Back to the hospital to find another list of items that need to be purchased – and then another list. Finally, we are done and Jhonny is given a room in the ward. Imagine the hospitals 40 or more years ago – an open room with 10 beds. The parent stays to help and only one visitor is allowed. No children are allowed to visit and the visiting hours are strictly enforced. Before we left for the night, I received another two pages list of items needed for the anesthesiologist.

Are we still at the end of the World?

There are times when we become frustrated with the lack of ability to get things done. And then everything happens at once. We purchased a tower for the cell phone but were unable to raise it since we did not have the manpower. It is difficult to do such a project when you are unable to give the proper instructions in Spanish. Thanks to all the muscles of the group from Texas – and their understanding of what needed to be done – the tower is now standing and we have reception on the cell phone. However, we are so used to living without a phone that we don’t remember to turn it on! With the purchase of an additional cell phone Jake will have the advantage of being able the call me and give me his shopping list when I am in the city.

Our new friend Lucy

Is it a swimming pool? And who is Lucy? Everything needs a name so our new venture was named Lucy by Candice, a friend from Canada.

Back in January we started another project – water storage. However, after a few days our helpers found other things to do and the work halted. (Did I ever say that patience is something you learn when you live here?) For months we had a large structure about 5.5 meters in diameter and about a meter high sitting in the yard. When neighbours came they questioned us about our swimming pool. That we were building a large water storage tank was a bit more than they understood.

In May, with the help of Dana and Candice, a couple of Canada and a few Bolivian friends we were able to complete the construction. Although the Bolivians were not comfortable constructing something round and large, they managed.

Using the advice of our cousin who built similar structures in Australia, we tackled the project. Bricks were first laid on a cement foundation. When the brick tank was completed it was reinforced with wire wound closer at the bottom and farther apart at the top. Then a layer of cement was applied to the outside.

At this point all the workers left. Dana and Candice returned to Canada and the rest of the helpers went back to their own work. Jake spent the next week applying the cement to the inside of the tank. Not being as skilled at applying the ‘reboque’ as the Bolivians with a trowel, he used his hands. No one will see the inside anyway, he says.

Jake needs to complete the spouts to the tank and the cover. Then we wait for the rain. When the tank is filled we should enough water with pressure for the house and even be able to water the plants – with a hose rather than a bucket! All we need is a bit more patience for the rains to come – but we are more than willing to wait for that.

And then there is even more water.

A fellow missionary, Daniel Beams, works with well drilling projects. One of his groups, a team from Texas, wanted a jungle experience. Danny knew that this area had trouble with iron in the water and was curious at what level one would reach iron-free, sweet water. Although we didn’t feel we really needed another well, it was more appropriate to dig at our place in case good water was not available.

The first well, 12 meters deep, produced lots of iron laden water. A second well, 50 meters deep, gives iron free water. We are sending some to be tested to ensure that it is drinkable without further filtering.

The team also drilled one well in Tarumá, the neighbouring community. Carlos, the well driller that work with the teams, will continue to drill well with the men of the community over the next month.

A Cell Phone -- Sometimes

Oh if I could count the times when I wish that I could just call someone to reschedule a meeting due to bad roads! Two things prevent this – not everyone has a phone, and even with a phone there may not be reception.

Many of the men in the community own phones so that they can keep in contact with their families in Yapacani. Some have small antennas but others are more creative. They found that if they stand underneath a certain tree located near they can get reception. If the reception is poor, it can be improved by climbing the tree!

At our place we are surrounded by trees and do not have a clear line of sight for reception. We do, however, have a tall metal shed. If Jake climbs up the ladder on to the roof, and then climbs another strategically placed ladder to the peak, he can phone to Yapacani. We still cannot receive phone calls unless he just happens to be up on the roof when a call comes in.

We still hope to get the antenna put up and when that is done we should have reception for the cell phone. If we liked the connectivity to the outside world again we are not sure. But we can always turn the phone off!

A View From Above

Our blogs and newsletters have frequently mentioned the flooding problems and road conditions. Everyone looks for a solution but sometimes we are not sure what the problem is. A remedy for our lack of knowledge was a flight over the Yapacani River to view the present flooding problems and the meanderings of the river.

Since the river broke a new channel last November the communities in our area have not suffered from river flooding. That does not say it is not flooding. Ten inches (25 cm.) of rain a night can cause its own flooding problems! However, across the river, in the county of San Juan, serious flooding has occurred. That county would like to close the new channel and redirect the water back through the old channel which would cause flooding in our area once again. Since that is not a viable option, a new solution needs to be found. We have to admit that we are not convinced there is a ‘solution’ since the river moves where it moves.

Two representatives from Yapacani county and one from the San Juan county joined us. Two had never flown before and we made sure everyone had eaten and had taken Gravol before the flight. The day was very breezy, making the flight in a 6-seater plane more than interesting!

We flew to Yapacani and then up the river. When we arrived at our group of communities we saw that the river became a real ‘snake’ with lots of curves. It would be interesting to know how many miles of river there are in that small piece of land. The picture we saw was much different from the Google map.

All the pictures we took will be put together to provide a profile for the communities, illustrating where the river broke through and the flooding in the communities on the other side. We could determine where and how the river had moved by surveying the growth of trees.

Now the community representatives are left with the challenge of determining what action should be taken, drawing up a proposal, and finding funding for the project.

A Road in Danger

The highway from Cochabamba to Santa Cruz is the main thoroughfare through Bolivia, and without it; Santa Cruz would be cut off from all materials – diesel, gas, food. This past week the waters in Rio Pirai, close to Montero, caused problems. Although the water is not high, its force is wearing away the soft banks. Last year and enormous amount of time and money was spent building ‘defensibles’ that were meant to prevent this erosion but already these have broken and the river has changed its course.

Last week the water was about 50 to 75m. from the road and now it is starting to undercut the bank. The pavement is cracking. The military and road crews are building cages for rocks and sand and literally throwing them over, along with logs, to give the bank some protection.

While work is done on the road, all traffic is stopped. Long line ups occur. Traffic can proceed through the work zone for an hour while the men have lunch or when the work day is finished. Trucks and cars line the road while vendors sell food and drinks to those waiting to cross. Truckers take a snooze under their vehicles, lying either on the asphalt or in a hammock. Trufi taxis and moto taxis ferry people to the front of the line where they walk through the construction zone, then hire another taxi on the other side and proceed to their destination

Christmas Fruit

Coming from Canada, I am missing my usual Jap oranges at Christmas. That always was my favorite Christmas food. So here I am living in a region where I can enjoy mandarins for at least 6 months a year and I am missing them now!

So what do I have instead? How about mangos? In Canada, mangos were the treat in the summer and I was thrilled to buy a case of 10 for $7.00. Although we have mango trees planted they are not producing so I still buy my mangos at a much cheaper price.

There are two types of mangos – those with fibre and those without. The native mango is a smaller fruit with a green skin. It contains a lot of fibre and people suck out the juice more than ‘eat’ the mango. Otherwise you need lots of dental floss. The most common hybrid mango is the Manzana or Apple Mango. It is larger, has a reddish skin, and much less fibre. Delicious! We buy them for 1 boliviano, about 25 cents, each.

When mango season just starts the best ones are purchased from the Japanese farmers at Santa Fe, just a little ways down the road. I bought my Manzanas and then the lady encouraged me to try the new varieties – Mango Platano (banana) and Mango Papaya. I thought the Manazanas were good but these were even better – and completely without fibre. And the price – same as the Manzana.

Each time we come into town we buzz down to Santa Fe for our mangos because they do not sell the newer varieties anywhere else. Jake purchased seven Mango Platano trees and the Mango Papaya and another new variety will be ready in three months. The young man says they should start producing next year. So I will have lots of mangos for Christmas but I still will miss my good old Jap oranges.

.... and Higher Prices

The diesel problems and other problems in the country have also led to higher prices of all commodities. We, and most other missionaries and foreigners, have sufficient money that these increases do not prevent us from doing our normal activities. This is not true for the lower middle and lower income people here. I do not buy a lot of groceries since we grow most of our veggies and we have been given meat to last us a couple of months – lots of fish and a couple of chickens.

Just a few examples that I have noticed.
A 1 kilo bag of flour cost 3.5 bs. now is 5 bs.
Sugar was 12 bs a bag, now is 20 bs.
Peanuts have risen from 5 bs to 15 bs a kilo
Rice has risen from 3-4 bs a kilo to 6-8 bs.
And these are the basic things that everyone would buy.

For the things the locals would not buy:
Cement up from 45 bs to 60 bs a bag
Bricks up from 600 bs./1000 to 1200 bs/1000
computer paper up from 25 bs to 33 bs
cappuccino frio, up to 12 bs from 8 bs;
chicken dinner, 12 bs from 9 bs.
The cost themselves are not that great but the percentage increase is great. They say that at one ‘gringo’ restaurant in Santa Cruz, the prices have doubled.

In addition to that, the people are not getting the same value for their American dollars. They are paid for their soy and rice in dollars and feel that they are getting less when they change it to Bolivianos. They used to get 8 bs per dollar but are now getting somewhere between 7.5 and 7.6 per dollar. We had a shelf built for the bathroom and the carpenter, for the first time, wanted bolivianos rather than dollars. We think that the inflation rate is about 25-30% but there are no firm statistics.

Shortages

Things are changing in Bolivia but because I do not understand what is happening, I do not feel that I can comment on what is going on behind the scenes but I can tell you how it impacts the community.

The major problem we have faced for the past two months is a severe diesel shortage. There has always been a sensitive diesel situation and we always made sure that we filled up whenever we were in town, just to be safe. However, since October the situation has escalated. This is the time for soy harvest and rice planting all at the same time so the amount of diesel needed in agriculture alone from September through January is substantial. Then add to that all the truck transport that carried all the goods through the country. There is no other means of transportation for the animals, vegetables, fruit, sugar cane, cotton and all the other products that are either used within the country or exported to neighbouring countries.

Because the price is controlled by the government there has been no increase in cost, just in supply. News reports say that the imports of diesel are down by between 60 and 70%, thus the shortage. When the shortage first became evident we noticed often two of the three stations in town would be out of diesel and there would be a line up of 4 or 5 vehicles at the other station. Then the line ups started to get longer and longer. It became very frustrating when trucks with a couple of tanks and 4 or 5 barrels would need to be filled. We calculated the average fill would take about half and hour. But in Yapacani you could take your jerry cans and get them filled while they waited between trucks.

To be honest, we never had to wait a really long time in Yapacani but the situation in Santa Cruz was much more serious. We have one friend who waited from 10 in the evening until 3 in the morning to get his truck filled. Another waited for three hours and when he got to the pump they were only giving 6 liters per vehicle.

A couple of days ago we purchased some extra gas and diesel and now we have enough to carry us through a minor shortage. Often when we come to town there is no gasoline and we use that for the quad and the generator. Technically, the stations are not allowed to sell gasoline in jerry cans but we found a place that will sell it if we don’t want a receipt. Another one of these wonderful laws that are set to control the gasoline being purchased for drug production!

Yes, I know that you pay way more for gas and diesel that we do but you know when you go to the station that you will be able to get the vehicle filled.