The Georges in Peru

No one Wants to be an Interesting Patient

02 Apr 2014

Last Thursday I did an ultrasound on a 46 y/o patient who had spent most of the night with fever and chills and was having difficulty urinating.  I saw a 2-cm stone in his bladder and when the patient moved it would sink to the lowest part of his bladder.  "You need to get that taken out!" I said to myself, who happened to be the patient.  

I called an orthopedic surgeon that I know and asked him if he could recommend a urologist.  I called the urologist's office, but no one answered.  Not a good sign.  Amy went with me in a taxi to the lab to give them a urine sample for culture and sensitivities before I started some Cipro and we went to the urologist's office.  We were told he'd show up in about an hour and a half.  He doesn't take appointments.  "Let's go be first in line," I said as we went to wait in his waiting room.  I was pretty miserable, with fever and an irritated bladder.  By 6:45 he saw me, but said that he couldn't take out the stones without cutting my belly open, since he didn't have the sort of equipment he needed, like a Holmium Laser.  I didn't care at that moment how he would operate, just that he'd get that stone out, but after 2 days of antibiotics, I felt a lot better and started searching for better options.  It didn't look like anyone in Lima had equipment either, so I checked with a urologist in Omaha, but I wouldn't be able to get the stones out until April 29th.  With that motivation, I did find a urologist in Lima with the laser, and it appears that I will be able to go to Lima and get the stones removed on Tuesday!  I always think things like this make physicians better doctors.  Pray for an uneventful procedure!

My Feet Hurt!

18 Mar 2014

Yesterday, a woman came from four hours away to see me for foot pain that she's had for 5 months.  As a runner, I always like anything related to sports medicine.  While here, I did a quick exam and looked over the X-Rays I had ordered beforehand.  Then I saw her shoes.  I have never seen harder soles than the shoes she was wearing.  It was as if she had taped a hockey puck to her heel and was walking on it.  I recommended changing her shoes.  I looked at her feet and thought they looked like they were the same size as a pair of shoes that Sarah had outgrown.  I found them in the 'shoe box' and put them on.  The patient took two steps and said, "My feet don't hurt anymore!"

What's wrong with this baby?

27 Feb 2014

Medical quiz...

What's wrong with this baby?  If you took her to a doctor here and asked to just have her 'checked out' chances are she would be diagnosed with 'hip dysplasia' and have X-rays taken of her midsection (irradiating her reproductive organs along the way) on which the doctor would draw lots of lines and measure angles and then tell you that she has malformed hips and needs to be put into an expensive harness for several months.  At the end of this time, the thankful parents would have a happy, healthy, baby.  But they already have a happy healthy baby and the whole thing is unnecessary, costly, and distressing to the parents.  It seems that almost weekly, Amy and I are brought a baby diagnosed with 'hip dysplasia,' yet we've yet to find one case that truly has it.  

La Meta es Llegar

03 Feb 2014

"La meta es llegar."  That is the actual theme for the Arequipa Marathon:  "The goal is to finish."  Isn't that always the goal of a race?  But since the Arequipa Marathon has a finish rate of about 10%, it is especially true.  This is my third time I've run the Arequipa Marathon, but the first time I've finished.  

The first year, I planned on using it as a training run, so didn't plan on running more than half.  Last year, I went in quite undertrained and made it just over 29K of the 42K distance before leg cramps convinced me I had better things to do with my day.  This year I was well-trained.  I had to be.  I was begging donations for SIM's children's camp if I finished and $690.40 had already been sent in!  I'd run all of the course several times (though not all at once!) and knew all the hills and turns and how hard it was.  Amy and the kids were going to 'crew' me during the race, giving me Gatorade or honey packets along the way, a necessity, since the race only provided water at each 5K location.  From a physiology point of view, one needs more than just water after losing so much fluid in sweat and respiration, which I estimated at around 7.0 liters during the race.  Since nary a cloud was in the sky, I knew today was going to be a scorcher.

We arrived at the race (8170 feet above sea level) at around 7:30, 30 minutes before the start.  I had petitioned that the race start at 6 or 7 am, and rumors started circulating that my plea had been accepted, but later I found out that they were just rumors.  "We've always started at 8 am, they told me."  Paul was running the 4.5 K race for kids and lined up in his corral behind the marathoners, while Morgan (an Aussie missionary who just planned on running 10-20K as a training run) and I lined up for the marathon (below with neighbor/ friend Manuel).  There were rumors that a Kenyan had signed up to try to win the $3600 first prize, but again just rumors.  A friend carrying a clipboard with all of the registered runners confirmed there were no Kenyans on the list of 240 entrants.

I started my GPS watch around 7:50, early enough to be sure to find the satellites, but late enough so that it wouldn't automatically shut off to save battery power before the race began.  I looked around.  Morgan and I were the only white guys.  There was one woman.  Most looked 20-35 years old.  I didn't see anyone else with a fuel belt (I loaded mine with a bottle of water, a bottle of Gatorade and honey packets)  I ripped out the holes that I had previously cut into my required race shirt to improve ventilation.  Good thing I started my GPS with plenty of time, as the race started 3 minutes early!  We were off.  Finally, what I'd been training for for the last two months was playing out.

During my training runs I calculated that a heart rate between 120 and 127 would be a good work level to maintain.  I found that on the initial downhill portion during training it was hard to keep my HR above 120, but within a km my HR jumped up to the 135-range and I felt comfortable, so I decided it was best to not let gadgets trump how I felt. Glad I did.  My first km went by in about 4:30, which was on pace what I ran during training runs.  Lots of people passed me early on, but surprisingly, many were already walking after 2 to 3 km.  What are they doing?  Why are they here?  The free shirt?  At the 4K point, Gonzalo, a friend from the swimming pool passed me.  I wanted to keep up with him, but I told myself, "Run your own race.  You'll catch him later."  Lots of people passed me in the first 11.6K, the point where my first crew team was waiting for me.  I arrived about 5 minutes earlier than predicted. Ben and Sarah were there and switched out my empty Gatorade bottle and gave me a couple of packets of honey.  I would see them again in 10 more km at our next refueling point.  I decided to see if I could pass 10 people before I saw them again.  Initially, things went the opposite direction, 3 people passed me!  But they all were looking a bit spent for this early in the race and soon I had passed 2 of them back.  Oswaldo, the third, disappeared ahead of me.  By 17K there were people walking. They hadn't gotten past the downhill yet!  At about 18K, we reached the bottom of the course, at 6983 feet above sea level.  As soon as we turned and started heading uphill I was continually passing people.  I felt like I was persistence hunting the other runners, slowly but surely overcoming them as they gave in to dehydration and exhaustion.  At 21K, when I saw Sarah and Ben again, I had passed 24 people, and none but Oswaldo had passed me and stayed ahead.  Ben and Sarah slathered another layer of sunscreen on me and refueled me as I continued forward.  I was about 8 minutes ahead of schedule.  3K later I passed Oswaldo, who gave me a bit of a 'how is this possible?' look.  Sorry youngster!  At 25K I caught up with Gonzalo who was walking.  I offered him some water, but he said he had some "up ahead".  It turned out his wife and kids were waiting with Amy, Paul and Mia with drinks.  (Paul had finished his race, which turned out to be only 2 or so Km.  He had paced himself for 4.5,  so was very disappointed to see the finish line appearing when he still had so much energy.)

But Gonzalo had had enough and I never saw him again after we refueled.  I had now passed 51 people.  Almost no one remained on the course, victims of dehydration.  By 30K I was basically alone. I walked the steep hills. I think I was faster walking than running.  There was one more runner near me who would leapfrog past me and then I would slowly catch up and pass him. After 31K he gave up.  At 32K Ben and Sarah got me a popsicle, which never tasted better, but I had 10K to go and felt like I couldn't run any more.  During km 33, I started getting some cramps in my quads and ran a 10-minute km.  If I can't get running again I'll not finish in under 5 hours!  I walked a bit more and then made a deal with myself to run until I got to Amy, Paul and Mia at 35K.  I couldn't see any other runners on the course.  The cramps went away (it got slightly less steep) and when I turned the corner I could see a pair of runners ahead.  I found I was able to run without stopping and caught up with them, but they took off and moved ahead.  I walked a bit more, but my legs weren't cramping, so I asked myself, possibly audibly, "Why are you walking?  You don't have cramps.  Of course, you're tired, but get to work!"  By 39K I reached the highest point of the race, 8538 feet.  

It wasn't downhill yet, but at least it wasn't uphill any more.  I approached an intersection and I looked around.  I thought I was supposed to turn here, but there was no one with an arrow sign.  A woman on the corner said, "That way!"  I knew that if she was wrong I could still find my way back to the course, so I turned and saw another runner a couple of blocks ahead.  After a few more blocks I started the downhill.  At the 40K point I hoped to get some water, but there wasn't anyone manning the water station any more!  Just plastic bags littered everywhere!  I still had some Gatorade in one of my bottles, but the thought of drinking it made me nauseous.  I started to flow down the hill and soon caught the runner in front of me (the 58th one I caught), but the two I nearly caught 30 minutes before stayed out of reach.  I finally reached the stadium and I finished in front of the bleachers during the awards ceremony.  They had taken down the inflatable finish line, so I didn't know where to stop.  When I finally stopped, my watch said 4 hours, 47 minutes 7 seconds.  (The winner incredibly finished in 2 hours 30 minutes!) I found some water and got a post-race massage, which I didn't enjoy at all. It wasn't really a massage, but rather more of a stretching session by some masochist named Hugo.   I asked someone in the tent, "Where can I find out what place I finished?"  "I think you were about 23rd."  I have a tough time believing him (I'd guess around 40-50th), but if only 10% finish, I guess that's about right.  Shortly after I arrived, they finished the awards ceremony and starting tearing down all the equipment.  I guess that those that finished in 5 hours were out of luck?

I asked one more question:  "Where do I get my finisher's medal?"  "We don't have medals this year."  Usually, I don't care if I get a medal, but since fewer people have finished this race than have finished the Western States 100-mile endurance run, I kind of wanted some proof besides my Garmin maps.  

Afterwards, I was so dehydrated I felt nauseated and couldn't drive home.  Amy forced a Gatorade in my hand and made me drink it.  After an hour or two I started feeling okay, but I still couldn't eat anything until about 4 pm.  

Thanks to my crew.   They were flawless in their execution.  I truly couldn't have done it without them.  I know that by looking at the 58 other runners I passed, most of whom didn't make it.  I love you all very much.

Seven-hour Appointment

20 Jan 2014

Many of you have been praying for Manuel, a friend I met running who lives in our neighborhood.  He is deaf but is the most enthusiastic Bible student I've ever had.  We worked through all of Genesis, Exodus, Matthew and Romans in about 2 weeks!  

Today, I accompanied him to see a medical specialist.  Since he is deaf he needs someone to go with him to write down what the doctor told him.  We left our house a bit before 6:30 am to go get in line at the hospital.  We waited in the first line 45 minutes to be told when we reached the counter to sit down and wait to be called.  This happened about 6 times before we got his medicines and went home.  It was like waiting in serial lines at Disney World without having nearly as much fun at the end of the wait.

At the end, we waited in line an hour to make his March appointment, only to be told that the system doesn't book that far in advance.  Manuel has to go back February 4th, just so he can wait in line again to get an appointment for March!

Fine for cat abandonment: $1286

11 Jan 2014

This week, all of the Peru SIM missionaries were in Lima to attend our Spiritual Life Conference.  Before the conference, we stayed near Parque Kennedy, which is known for its numerous stray cats.  Since our kids love cats so much, the park was a big hit.  We don't know who let the first cats free here, but we do know how they survive:  several neighboring restaurants donate their left overs to the cats.  They cover the sidewalks and don't even wake as people pet them.  Others are draped from branches in the trees like pumas resting after a kill.  But don't even think of dropping off your unwanted cat here, or you'll face a $1286 fine according to this sign.  There is also a campaign to get the cats all adopted, but then why would anyone go to the park?

 

Sarah's Graduation and Prom

23 Dec 2013

Friday, Sarah graduated from Peruvian high school and had prom that same night.  Graduation is not like in the US.  They do have several speeches, but there is no cap and gown and the graduates don't walk across the stage.  We were proud of Sarah for getting the highest score in German class (since it is a German-Peruvian school, that gets special notice) and she also got the highest scores for her class overall for the year.  That night we all went to prom.  "You can't overdo it."  We were told by another missionary when we asked what to wear.  Most of the graduates were dressing trying to look 5 years older and most of the parents were dressing trying to look 20 years younger.  This was the chance for the graduates to walk across the stage and be acknowledged one at a time. The parents were served a fancy dinner while the graduates had a dance and cute little snacks.  It was a bit stressful, since we didn't know what to expect, but it turned out to be a pleasant event.

Corriendo para Campamentos

08 Dec 2013

In 2013, 401 children attended summer camp at Camp La Joya, SIM Peru's camp located about one hour from Arequipa.  Kids from 8-18 years old spend a week enjoying the pool, horseback riding, archery and Bible lessons taught in a fun way.  Many make life-changing decisions to follow Christ.    Last year it cost about $59 to send a kid to camp for the week.  We only charge them about $33, so we spend about $26 for each child that attends.

February 2nd is the Arequipa Marathon. These seemingly unrelated events have a connection this year! I will be running the marathon which is just over 26 miles. Would you pledge to give $1 per mile to the camp (donate online at http://www.sim.org/index.php/project/89270)  to cover the expenses beyond what we charge for one child to attend summer camp?  Your donation helps make each year's camp better!

Common questions:

Will a cute Peruvian kid send me a thank you note for my part in changing his life by sending him to camp and invite me to his wedding some day?  Sorry, I think that's another mission you're thinking of.

Wait!  Then will my donation actually allow one more kid to attend camp?  Not directly.  Camps will already be underway when I run the marathon.  Your donation will help guarantee that we cover expenses this year and enable us to put on camps again in 2015.  

I hear the Arequipa Marathon is so hard, that less than half of the starters finish.  What if you don't finish?  Do I still have to pay?  I'll finish.  But just in case I go lame at the 18-mile mark, you can donate $18 instead.  If you want to make me run harder you can pledge to give $2 per mile if I finish in under 4 hours and 30 minutes.

Check our blog at http://www.missionshub.org/georges-peru for updates on our ministry and marathon results.

If you are free on February 2nd, why don't you join us? If you don't want to run,  you can still be a volunteer at the Gatorade/water station that our church will man!

Here's something you can't see in Nebraska.

08 Nov 2013

 

Why can't you ever see this in Nebraska?  Because there is no shadow!  At 11:29 am yesterday, the sun was directly overhead.  Since Peru lies between the tropics on the globe, twice a year the sun goes directly overhead.

Yesterday I visited Alejandro, the crippled, 83-year-old that we help.  He had gotten hit by a car (luckily, just his crutch that was poking into the street got hit, knocking him down, and the driver sped off) and his crutch was broken and he was sore from head to toe.  I got him some Tramadol 300 mg extended-release tablets, which I nervously gave him (it's a high dose), but he is in so much pain the benefits outweighed the risks.  Today he was smiling from head to toe and when I gave him his crutch that I fixed he smiled even more.  He said his pains were all gone!  Of course, when the constipation sets in he might not be so smiley.

Paracas

11 Oct 2013

This is Spring Break.  Yes, I know, but we are in the Southern Hemisphere!  Sarah's graduating class decided for their Senior Trip to go to Salinas, Ecuador. Sarah decided that she'd rather go on a family vacation somewhere in Peru, so she chose Paracas, an 11-hour drive up the coast from Arequipa where there is a nature reserve that one can visit on boats and see the birds and sea lions.  Lots of birds.  They look like they are computer generated on the hillside darkened by several thousands of cormorants and boobies.  In the 1840s, Peru's economy thrived by exporting guano mined from these islands where it accumulated meters deep due to the lack of rainfall.  There used to be 10 times as many birds, but they say the fish populations have decreased and the bird populations and guano production have gone with it.  The islands have old rusting infrastructure from the glory days of guano that look like the inspiration for the video game Myst.

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