A Little Something Came Home With Me.....

Lots of great things happened during my last few days in Brazil. And generally I felt well during those days, although I may have had a low-grade fever often, and even more often I had a mild headache.

On 5 Sept I felt well enough to go to Novo Airao with a group of about 15 others from the church for an outreach program called "Louvorzao".  This was coordinated by the Presbyterian church there, and we Methodists were invited to participate.  The theme, as you can see in the photo, was "We must be one..."  A large stage with a beautiful painted backdrop was set up in front of the Presbyterian church. 

On Friday and Saturday nights there were a variety of singing presentations, drama acts, sermons, and testimonials.  It was very powerful.  In the afternoon of Fri and Saturday we went door-to-door inviting people to come to the evening presentation. This was a beautiful experience, and it was fun to wander the streets of Novo Airao, a small town that I first explored in 1998. 
In fact, this is where I met Gleicyanne, on 18 August 1998.  Now 16 years later, I'm living with her and her family in Manaus for these three months.

Going door-to-door, street-by-street in Novo Airao.

On Saturday morning we took a series of small boat rides to a beach on an island in the Rio Negro.  It was splendid toplay in the warm water for a few hours.

While returning to Manaus on Sunday morning, we stopped at a popular beach along the highway, called Praia Acutuba.  Here the water was still so high that many trees were present where we were swimming.  Lots of people climbed the trees and jumped from them into the water.

Gleicy at my farewell party.

On Sunday night at church, I received a very rich and warm blessing as this was my last Sunday in Brazil.  Incredibly, I was able to give my farewell speech without crying.  This was followed by a spectacular party/feast upstairs that Gleicyanne coordinated.  There was a huge cake, musse de maracuja (mousse of passion fruit), lasagna, soft drinks, and hundreds of people.  I received many gifts from individuals and many photos were taken.  Gleicy told me later that while setting it all up during church service, she had to go into the bathroom and cry for a long time.  She has really enjoyed having me around for longer than a week or ten days.

Monday, Sept 8 was spent in packing up for my return, and on Tuesday Gleicyanne took me to the airport at noon.  Thyago and Mirtene met me there, with more gifts and tearful hugs.  My persistent headache and some nausea were present during the flight to Miami, and the next day, too.   I arrived in Montana at 16:45 on 10 September 2014.

But my mission experience isn't quite over yet.  On 11 Sept I had to go to our Emergency Room here for 2.5 liters of IV fluid.  I was anemic before all that fluid, and my liver enzymes are substantially elevated.  Blood cultures haven't yet grown anything.  My leading diagnosis is typhoid fever, and Dr. Lacerda in Manaus is quite sure of it.  Today (16 September) represents 5 days since I started taking ciprofloxacin regularly.  The fevers and headache are gone, but now I'm turning yellow with jaundice and my liver enzymes are even higher.  It will be interesting to see how this plays out.

4 September – Winding Down and Throwing Up

Yesterday was truly awful.  I was hanging out in the cafeteria at Gleicy’s college, waiting for her to finish with morning classes when I began to get sick.  It started with a fever and sweating, followed by tremendous shaking chills and terrible nausea.  I thought I wouldn’t see her till 11:30, but she happened to pass by at 10:20 and saw that I was ill.  I asked her to quickly get a trash can, which she did.  Then I puked numerous times into said trash can, while simultaneously shaking and sweating.  I must have been quite a spectacle for the hundreds of students nearby. 

I was very weak, but slowly walked to her car after she brought it up to the door of the building.  Gleicy took me to a public hospital, where I was quickly evaluated.  My axillary temperature was 38 C and my blood pressure was 110/50.  Blood tests showed elevated white blood cells and low platelets.   A very gentle and pleasant nurse gave me some intravenous dipirona, and I soon felt better.  Dipirona is banned in the USA because it can cause bone marrow failure, but I’ve yet to meet a Brazilian doc who has seen that happen.

Gleicy had to go to her afternoon clinic assignment (she’s in her last year of studies for Clinical Psychology), so Pastor Augusto came to get me to get me from the hospital.  We learned that my lab tests would come back for at least 2 hours, so he took me to his house and went back later to get the results.  I was actually hungry by the time he got me to his home, and still desperately thirsty.  So I had three small glasses of Coca-Cola and ate two breakfast bars.  Then, I slept for five hours while evidently sweating profusely.  My clothes and the bed sheets were soaked with sweat.

Today I feel better.  My abdominal region is sore from all the violent puking, but I don’t feel nauseas. 

Tomorrow I will go to Novo Airao with a group from the church.  But if I feel sick at any time today I will just stay in Manaus.   

My local friends tell me that I’ve now passed the final test of becoming a true citizen of Manaus  - I spent half a day in a public hospital.  But it really was not a terrible experience.  There was no delay in taking vital signs and I waited only 10 minutes or less to see a doctor.  She sat primly behind a very neat desk in her perfect white doctor’s coat and grinned as I relayed my symptoms and recent travel history.  She wrote the request for a malaria smear and CBC on a piece of paper, and instructions to give me the dipirona after the blood was obtained.  I waited about 10 minutes for my turn in the phlebotomy chair, and about 20 minutes for my injection.  And all of this was free.

 

Just 5 more days before I leave Brazil.

31 August 2014 – Five Medical Boat Missions Later…..

The "Georgia Team" - led by Tommy Halliburton

Yesterday I left the medical boat for the last time this year.  And just like a scene from a hundred movies, I watched it until the very last visible second as we drove away.  It’s been so hard to hold back the sadness as so many things were done “for the last time” this week.  Cleaning up Friday afternoon after seeing 80 patients was quite difficult because I knew it was the last time we’d do it.  My last chilly shower in brown Amazon water, the last devotional after supper on the boat, the ebullient joy of the team after completing an extremely successful week, the last dessert of passion fruit mousse layered over rich chocolate, the last glimpse of the southern cross on the dark horizon with a dazzling galactic swarm across the sky – all of this  and more – for the last time. 

We crossed over to the Rio Negro at about 11 PM and cruised upstream towards the boat’s docking point.  I sat on the roof with six people from Georgia as we slipped under the spectacular bridge over the river, for the last time.  It’s evident that my connection to the people of Amazonas is extraordinarily powerful.  There was very little angst leaving my patients in Montana to come here for three months, probably because I knew my town is full of other good doctors.  But here, I was usually the only doctor that anyone had seen for 2 or 3 years.  In the region where we traveled this last week, there is one dentist for 27,000 people.  He sees 5 – 8 people on weekdays only.  The nurse in one town this week told me that if somebody had a terribly painful tooth problem today, he would not likely get to see a dentist until sometime in March next year.

The Bible calls us to “care for the least of those” among us.  In some respects that includes the river people (ribeirinhos) and indigenous peoples of the Amazon.  Yet when I’m with them, they don’t seem like any less than anybody else (does that make sense?).  They are as full of laughter, hope, worry, love, pride, confidence, and uncertainty as people anywhere else.  Hard physical work is an absolute reality for practically everybody.  I have endless admiration for the man who fishes for most of the night and works his fields for most of the day.  His wife is out there in the muddy fields with him, yet somehow caring for her several children.  At 6 AM the children are in their school uniforms, waiting on a tiny wooden dock or along a rutted road for the yellow boat or battered van to take them to school.  It seems that here, like almost everywhere, a focus of all the labor is to create a better life for their children.  Yes, they lack an astonishing number of things that you’d feel are necessary in a decent home.  But love and pride and a determination to create a better life are present in abundance.   So, it’s with tremendous humility and admiration that I have the privilege of serving a few of their medical needs.  They always thank me over and over with such gracious sincerity.  But I feel so richly blessed and I’m so thankful for the opportunity to be here and share a moment of their lives.

This last team was from Macon, Georgia.  Meeting them in the Manaus airport, my first impression was that I may not be able to understand their syrupy southern drawls!  Nearly everyone on the team was older than me, too!  They worked like a herd of teenagers every day, and we accomplished a tremendous amount of work.  Our totals for the week were:  296 pairs of glasses fitted, 142 dental patients treated, and 651 medical patients served.  There was one awesome dentist and one very talented surgeon on the team.  The surgeon (Roy Smoot) was enthusiastic, very intelligent, funny, and quite capable of providing excellent basic medical care.  He worked with a good translator, and one of his last patients had full-blown thyrotoxicosis.  Like 50 other people that day, he came in with “a cough”, but Roy figured out the real problem and got him an accelerated referral (we hope) to an endocrinologist.

396 children came to us during the week.  Most got a fluoride dental treatment, and all of them participated in a dozen splendid activities.  The ladies on the team received gifts from many of them, Facebook friend requests, and struggled to not sneak several cute little kids into their bags to take home.

I can’t say enough good things about the team dentist, Richard Lipfert.  Back in Georgia, he coordinates a small group of dentists who provide care in nursing homes.  He therefore is very adept at pulling teeth while his patients are lying in their beds.  This enabled him to set up dental work off the boat this week, in a school room, or corner of a church, or on somebody’s back porch like the rest of us.  He usually set up two tables and was able to double the number of dental patients we usually see.  While the anesthesia was kicking in on one patient, he could be pulling out the teeth of the person on the next table.  And pull teeth he did!  One (poor) guy required the removal of 16 (sixteen!) teeth.  These were not teeth with modest cavities, these were teeth rotted to the gum line.  Many had abscessed roots.  Most of them broke into pieces as he worked them out.  Richard was an absolute dynamo of good humor, compassion, and superb dentistry.  Nearly every patient had two or more rotted teeth.  He often worked well after dark.  Four or five people usually helped him stay maximally efficient.

 

My final sunset on the Rio Solimoes, last day of the last mission trip.

The biggest jacare' that we caught all summer.

Aunt and niece (in the blue shirt).

Reflections, always reflections.

The John Wesley Medical Boat

Our last stop, you can see that the water is
finally going down significantly.



"How beautiful are the feet of those who bring the good news". Romans 10:15

The boat actually made it way down this tiny waterway, to Novo-Canaa'.

 

 

Yesterday I learned that I'm to become a grandfather!  In January, my son (Brad) and his wife (Laura) are expecting the arrival of a baby girl.
This incredible news came to me via a text message as our medical boat passed a small town with a cell tower on the Rio Solimoes.  It was followed by a tremendous celebration involving our entire team of 18 crazy and wonderful Brazilians.  Of course, I led the celebration with very tearful joy.

 

An ordinary afternoon vista in the Amazon.  This photo followed a day of good, hard work.



Dr. Regina, talking to patients at the end of the day.



The "alpha girls": Dani, Priscyla, Paula, Regina.



Team Ferocious, but nobody fears them.  In Ouro Verde, where
I hope to help build a church in Feb 2015.

Amazon sunrise.

Amazon sunset

The very best part of Brazil, the people.

Friday, 8 August

 The last couple of days have been somewhat chaotic.  I was prepared to go to a church clinic on Monday, but my ride (Pastor Augusto) couldn’t come get me because he was occupied with an ill son.  When I finally met him at about 11 AM, he told me that the pastor of the church where I was headed had forgotten to inform the congregation anyway, so nobody would have been there for me to see. 

On Tuesday, I did attend patients at the Methodist Church in Mutirao (this is Augusto’s church).  It was busy, to say the least.  I saw 107 people between 08:30 and 15:30.  And I even had a 1 hour lunch break!

 Wednesday I helped a guy move all the furniture out of Gleicy’s house (where I live) so that tile can be installed on the floor.  Just to add to the inconvenience, the entire neighborhood lost its water supply, and about an hour later the electricity disappeared, too.  The heat is unbearable with no ability to even cool down one room of the house.  They tell me it typically gets hotter every day until October, when the rains start. This combination of events convinced me that continued living in this house was not possible.  Not possible for me and not possible for my Brazilian family.  I called around, and the only hotel with rooms big enough for all of us was the Go Inn, in downtown Manaus.  So here we are, spending three nights in a hotel while final construction takes place on the house.

 I went back to the house yesterday, to help the guy doing the work.  Our car broke down and the engine started to smoke.  A mechanic replaced the thermostat and says we need to change the oil filter.  Because the car was in the shop, I had to take a motorcycle taxi to and from a house call for an elderly woman with severe rheumatoid arthritis and two destroyed knees.  She was a real sweetheart, telling me all about her well-controlled diabetes and hypertension.  We spoke at length about her daughter who died just a couple of weeks ago from renal failure caused by lupus, at age 40.  Her son appears to have Sjogren’s syndrome.

 On Sunday, a team from the state of Sao Paulo will arrive at mid-day.  At 5 PM on the same day I will depart with them for a week on the boat.  We’re going back to Ouro Verde because there’s a lot more dental work needed there.  Pastor Augusto wants to also fortify his presence in the community since a new church will be built there as soon as possible.  We will return to Manaus on the following Saturday.  That day, I will hook up with a team from Georgia and will leave on the boat with them on Sunday.  I hope I am not afflicted with illness or too many bug bites as there will be no opportunity for recuperation between these two trips.  I’ll barely have time to visit the house and pick up a change of clothes for the second trip.

River Trip #2, More Adventures with Wonderful New Friends

Mariana, Ludmila, LiVia, Me, Amanda, Jose, and Zaac

 On Friday night, 25 July, I joined a group of missionaries from the State of Rio de Janeiro (as opposed to the city of the same name).  They were from the Igreja Metodista Pendotiba, in the city of Niteroi. It was a huge team, 23 people!  [We had felt somewhat crowded with our team of 15 from Montana/Colorado.]  When Augusto and I joined them, there were 25 of us, plus 2 cooks, and 4 crew members.  It was amazing how readily adaptable everybody was.  I heard no complaints till the end of the trip when several people had trouble with frequent diarrhea and the three bathrooms were often occupied.

 We went to Alto Manaquiri, an initial journey of about 30 hours.  The farthest little “town” was called Ouro Verde (“Green Gold”).  It was a beautiful place, with a large pasture /futeball field where many cattle grazed and pooped everywhere.  This did not impede vigorous soccer games, with most people playing in bare feet.  Our boat crew eagerly played a match here and in all the places we stopped.  They even have the same uniform to wear.  This “town” also was actually just a collection of families from a large section of the river.  There was no mercado, no street, no electricity, no government.  There was however a nice school, and that’s where we attended our patients and did all of our work.  The community leader has donated a very pretty piece of land upon which a Methodist Church will be built.  I got to hold up one end of the banner proclaiming this while it was nailed into place. 

This is where a new church will be built in Ouro Verde.

We were very far off the grid here, surrounded by dense rain forest.  Most of the population consists of indigenous people.  I asked an old tribal woman if there were big spiders around, big enough to eat birds.  She sort of snorted and replied, “big enough to eat people!”  Then she laughed and laughed.

 The team was magnificent!  Two people gave haircuts all day long.  Great activities were coordinated with the children.  And there were four pediatricians, a cardiologist, an allergist, and a dentist with the team.  The church’s Pastor also was with them, and she was a great asset. 



Cutting hair, in Ouro Verde

Riverside home, Ouro Verde

 "The Clown Show" - a splendid mechanism to convey the grace of God and the love of Christ.

Captain Paulo and Gerson, off to play a futeball match in Ouro Verde.

 

 At 6 AM each day a group met on the boat’s roof for an hour of singing and prayer.  Each breakfast and supper was preceded by singing (guitar accompaniment), prayer, Bible reading, a devotional study, and another devoted prayer.  This typically led to a substantial delay in eating, so our food was usually cold by the time we got to it 30-70 minutes after it was on the table.  That may have contributed to the many people who developed significant problems with diarrhea and nausea.  Only 2 or 3 actually vomited. 

 Each afternoon, a clown show took place.  Three people in very complete clown costumes put on a performance regarding having a happy and clean heart after accepting Christ as one’s savior.  All the kids and even all the adults who watched were genuinely impressed and entertained. Then children were invited to come forth and become Christians.  Quite a few usually did.  Then their parents were invited to join them, followed by anyone in attendance.  The Pastor then gave a sometimes rather fiery sermon.  At each little town, a fair number of people joined the family of Christ via this “clown show”. 

Mirian

Because there were so many other doctors, I actually got to do other things this week!  I was able to use up every one of the 150-180 reading glasses that were left over at the end of the Montana trip.   This was a very rewarding experience.  People were so very happy to be able to see things up close again!  Fishermen were elated that they could tie knots and use their fingers so much better.  One older woman absolutely cheered when she saw that she would be able to start sewing again.  She was just bouncing up and down with joy in the chair.  I also attended “a boatload” of patients.  One or more of the other docs was usually out for the day with diarrhea, so there was plenty of work for all of us.

Curiously, even with all these doctors, the team had no capacity to treat themselves when and if problems developed.  I “saved” a couple on the first day or two with a dose of my ciprofloxacin and zofran, earning eternal gratitude.  I “saved” several others as the week went on, including the team leader who was puking over the side of the upper deck on the boat as we were unloading on the day of our return.

 This team was naturally somewhat cool towards me when I joined them.  But on the third night of the trip, five young people came to me on the roof with an “homagem” – a ceremony to honor me.  They had each selected a song with my name in it, and they took turns singing a few words. Because all Brazilians have trouble pronouncing my name, it was simply hilarious.  The songs were (possibly!) “Don’t Leave Me Now…”,  “Don’t Go Away Baby…”, “Don’t Stop Loving Me….”, “Don’t (something else)……”.  And the grand finale which they all sang together was “Dom, dom, dom, dom!”  After this, I knew that I was totally accepted. 

Truly, every member of this big team became a gracious friend and I am so pleased to have met them all. People I hope to remember always, who were especially kind and friendly towards me:  Amanda, Rogerio, Sias, Jose Cunha, Ludmila, Mariana, Zaac, LiVia, Dra. Selma, Rosana, and Mirian.  I will remember that it was Amanda who first came to talk to me at length.  And Mirian, I will never forget the sincere and loving hug that you gave me on top of the boat after the morning devotion.  I was expecting just a quick, friendly, somewhat superficial embrace.  But instead, you gave me a genuine abraco, full of Christian love, support, and fellowship.  I sought her out when we got back to Manaus to tell her how much I appreciated it.  She tipped her head to the side, grinned, and hugged me again in the very same way.

 Joel at sunset on the boat.  He is "muito gato"!

Fishermen resting in the shade after being out fishing all night.