Graciela - outside the Clinic the day of her three week post-op visit

 Graciela is a 76 year old woman who came to see us at the Clinic in October.  She has high blood pressure, heart failure and persistent swelling in her lower legs.  She walks with a walker and had a difficult time climbing the stairs to get to the second floor for her appointment.  Graciela had uterine prolapse, which means that whenever she was on her feet, her uterus would “fall out” and be in a dependent position between her legs.  She had been to see other doctors over the past four years, all of whom told her that they would not operate on her.  They told her that because of her other medical problems, the risk of surgery was too high.

We had two visitors with us in November.  Dr. Suk Chang, an anesthesiologist from Michigan, and Dr. Marv Eastlund, a gynecologist from Fort Wayne.  We talked to Graciela about the potential risks of her surgery, and she wanted to proceed.  On November 8 we performed a vaginal hysterectomy with some other surgery to support her bladder and rectum.  She was up out of bed the day after surgery and never had any problems; she went home on November 11.  She came back for a post-op visit this week and looks wonderful.  She told me as she was leaving that she wishes she had come to us four years ago.

We have had continuous blessings from the Lord in our operating room here.  We have been able to do complicated procedures without the support of ancillary services.  We thank the Lord for sending us talented professionals to help in the Clinic from both here in Ecuador and from other countries.  And we recognize where all the credit goes.  God’s mighty hand has done marvelous things here – all the praise and glory to our almighty King!

I want to share with you a story about a woman whose circumstances are somewhat different than what most of us are used to.  About a month ago we saw her for the first time in the Clinic at San Lorenzo.  She came to see us because she had been bleeding heavily from her uterus.  Her hemoglobin was 6.4 (normal for a woman is 12 – 14).  We gave her some medication to try to stop the bleeding and some iron to help treat her anemia.  We talked with her about surgery to remove her uterus – but obviously that would not be possible until her anemia improved.

As most of you know, the Clinic is located near the Colombian border.  We have many Colombian patients, some who now live in San Lorenzo, and others who make the trip to the Clinic from their homes in Colombia.  Lorena lives along a river in Colombia. 

The Mira River in Colombia

She travels about two hours to get to the Clinic.  She came in for a follow-up visit today.  Her hemoglobin is improving (now at 10.8) and although she is still bleeding, it is better controlled.  She is eager to schedule her surgery, so we made plans for early December and talked with her about the cost of her surgery.

She and her husband have forested land in Colombia, and they could easily sell some of the timber to pay for her surgery.  They have a problem however.  The guerrillas have planted mines all over their land to prevent them from felling their trees.  They are unable to even enter this part of their property for fear of setting off the explosives. 

Today she only had money to pay for her trip back home and a single blood test that we need for her surgery.  We helped her with the two medicines that she needs to continue to take until her surgery.  She and her husband have resources, but they are unable to convert those resources into the money they need for her surgery. 

We will still plan for her surgery in December.  She will come back at the end of November and let us know what arrangements she has been able to make.  If needed we will provide economic assistance so that she will be able to undergo her surgery.

Many of you are familiar with our involvement in the effort to eliminate river blindness in Ecuador. We have played a fairly insignificant role when you consider the scope of the project, but are pleased that we have been able to help in some small way with the eradication of this disease.

River blindness is caused by a parasite which is carried and transmitted by small black flies. Once the parasitic larvae is transmitted to a human host, they form subcutaneous nodules in affected individuals. The larvae mature, and adult worms remain in the nodules just below the skin. Innumerable microfilariae (tiny worms) are produced and released into the circulation, from where they gain access to the eye. If not treated early, an intense inflammatory reaction can cause irreversible blindness. For more than 20 years the river blindness team has been working to eradicate the disease from Ecuador. We have helped by traveling to communities along the river systems where the disease is endemic and removing these nodules for study and guidance as to how the treatment plan was progressing. As the years have progressed, there have been fewer nodules to remove, and many of the “nodules” that we did remove were actually lymph nodes, lipomas or other small masses.

In October Dámarys and I participated in the last planned trip to the river communities to remove these nodules. We traveled with Raquel Lovato down the Cayapas River to Santa María.  

Santa María - looking down toward the Cayapas River

 We saw patients for two days and removed over 20 “lumps and bumps.”

Removal of a lipoma in Santa María

 Once again, we found no evidence of active disease in any of the patients. One older woman did have an old, calcified nodule – one of the last remnants of the disease from which she had been cured.

A calcified nodule with no viable microfilariae or adult worms

We congratulate all those who have been involved in the river blindness project. The disease has effectively been eradicated from Ecuador, and the formal recognition of this accomplishment is forthcoming. We are thrilled to have had the privilege of being part of the team!