Busy, busy, busy

Teaching the patients waiting in line

We finished up last week with only a couple days between teams.

I continued to clean the rock walls...and finished Anna's room yesterday afternoon following clinic.

On Saturday, late afternoon the big medical team arrived.

The last three days we've seen over 800 people.

I start the day talking to those waiting in line about the various health topics that I always focus on with a waiting crowd.

Things like: cataract prevention, not putting small objects in ears, how to prevent and treat colds, vagainal dischage, high blood pressure, heart burn, breastfeeding, knowing your medication, skin care, massage, aloe plants....and a new one is anti-tabacco due to many smoking and sniffing tabacoo up here on this cold mountain (lows in the low 50's this week).

After I answer any questions folks may have I've been helping with pharmacy.

There are 3 practitioners seeing children, one seeing aduts and one seeing women.

Today we saw the woman who I delivered her second twin while my folks were here. Following the deaths of her children at day 5 and 10 after delivery, she became very sick.

She continues to do poorly and appears to have suffered from a mental issue. She received prayer and some IV fluids before being sent down the mountain for additional medical care.

Please continue to pray.

We will continue to have full clinics for the next two days and a 1/2 day on Friday before the team heads down the mountain.

On the house...they started putting the foam on the interior walls today.

Interesting Delivery [Long post due to 4 of us sharing]

At the end of a long day working on the house I drove the quad back and waited for the truck with the others so that I could help unload. I looked forward to some hot onion soup I knew that Anna was making and just relaxing with the family. But seeing a man on a motorcycle coming in directly behind the truck made me suspicious as he didn't have any cargo that Cory would have bought. After Cory talked to him a bit and they both looked at me I knew that it was a medical consultation. His wife delivered a healthy baby earlier in the day but the placenta did come come. So a rapid change of clothes, loading of the medical bags, and off Cory, Mom, Anna, and I went following the man. 

Anna and I repacked the biggest backpack with items I guessed I may need. At the fork in the road where we normally turn right we continued down a new road for me. The man we were going to help stopped to pick up a lady and her stuff who had been standing along the road. I told him we were in a hurry and he needed to continue-for an emergency. He was very calm and nonchalant. Soon we arrived to a path and grabbing my backpack I headed up the small path, telling Anna to make sure Grandma made it o.k. 

A few women supported the young lady in a squatting position. One held a small new born. While the cord dangled by a thin thread, a quick exam confirmed that there was more going on than a placenta that didn't come out...while she and other's knew she was to have twins, apparently the dad did not. Kris

It almost seemed like something from a novel...an unknown mountain top, a road without name, talk of hoping to avoid the local witchdoctor's place where vehicles tend to stop working, the darkness of the night, the sense of urgency for the new mother reportedly with a retained placenta, a narrow path through a garden....and then seeing the new mother outside a Haitian house...on a small mat on the ground, perhaps 18 or more people milling around her and Dr. Kris, who had arrived just a few moments before we did, bending down to do a first visual exam.  With a small flashlight to aid in the exam..it became readily apparent that there was no retained placenta..but another small baby...hours after her sibling was born..in great peril. Carol / Mom

I remember seeing a group of people in front of a hut. One lady was kneeling on the ground with other women supporting her, Mom already crouched in front of her. I thought her stomach looked awfully big to just have a placenta, but was quickly distracted from that fact. I saw about 12 deliveries at the field hospital after the earthquake, back in 2010 (I was 9), and two more several years later at our own clinic, but I had never seen twins, so I didn't really think about that, till Mom made the announcement. Anna

Not only did we have a twin who apparently had not delivered in hours [different people reported very different times when I asked when the boy was born]. But the presenting parts were a hand and a foot.  Attempts to feel the second foot had me even wondering if this could be a case of triplets. Then I had two hands and a foot as the young mother [her first delivery] cried out she couldn't do this anymore and resisted my exam. Praying the whole while for wisdom and help-I did notice when the small limbs under my hand moved-indicating  that the baby still lived.

And we all began to pray for our heavenly Father's divine intervention.  I remember Kris saying.."God please help us" over and over..it mixed with mine own prayers as we could see a tiny hand and foot presentation.  I knew also that Anna and Cory were praying as they searched for the medical supplies that were needed..and heard that back home the guys also were praying. 

Mom had recently rearranged the bags, and despite having glanced through them in the truck on the way, I had no clue where anything was, or what all she was asking for. Dad was similarly disabled.  We usually managed to find everything... eventually. Mom soon found a foot. It looked quite chalky, deathly so to my inexperienced eyes. Next a hand appeared, and the prayers became desperate. 

I asked that the women's head and shoulders be put back on the reed mat below her and for Cory to help lift her hips up to help the baby's body slide up into the mom so that it would hopefully shift positions making delivery possible. Thankfully the Lord allowed it to happen. 

 We so desperately need God's help. Then by changing the mom's position, the baby's position was changed also and two little feet and legs were rapidly delivered, followed just as rapidly by the perfect little body of a small baby girl. 

The woman was not appreciating Mom's trying to shift the baby. Mom had them put her head down, and suddenly we were supporting her in a sorta upside-down position, trying to get the baby to shift back enough to change its position. Mom was suddenly holding two tiny legs, we put her back down, and the baby slipped out. We kept on asking for something to tie the cord with, but it took a bit. Meanwhile we tried clamping it with a hemostat, but it only tore a small corner, so Mom crouched pinching it. Eventually they handed us two strings, and Mom directed me to tie it. 

While waiting for something to tie the cord I stimulated her small body and she responded with a weak cry. The mountain nights start cooling down as we near sunset and by now it was dark. A few pieces of thin cloth served to wipe her down and stimulate her. As soon as we got the thread, tied off the cord, and cut it I handed her off to my Mom. 

 The baby moved, cried weakly..had a strong heart beat and quickly was in my arms to hold and stimulate. 

Kris asked for something to sit on right about then. We later realized she spent about 20 minutes crouching.

Suddenly I became aware of my aching feet/legs and that I had people literally bumping both elbows. I asked for a low chair to sit on while waiting for the placenta to deliver as well as asking for a bit more space. One man had put on gloves and was telling folks that the cord had blocked the delivery. I assume that he was a local midwife and asked him later after the placenta was delivered to massages the uterus but I had to correct the statement that the delay was the cord's fault.  He ended up agreeing with me. 

 The rest of the delivery was over quickly...and both babies were examined by Dr. Kris...they were small, but strong and viable.  Praise Be To God.

Then Kris prayed for the babies, the mother, the family, giving thanks to God..and I remember wondering if a prayer to the true God had ever been spoken in that place before.  

Most of the time we were there I could hear the women mumbling along the lines of "Give her the strength Lord", or "Thank God," when the baby was finally born. Whether they were just expressions or heart felt...

Now for the enjoyable part of deliveries. Holding the babies and checking them out. Both checked out OK although small in size. The mom apparently did go for pre-natal care and didn't have any problems.  I talked about the importance of breastfeeding, keeping them warm, skin-to-skin contact and massage. Someone produced some warm water to bath the girl but I knew we should pack up and head back home. 

I prayed over both babies and for the mom and family. I talked to a couple of the women providing care to make sure they knew not to pull the umbilical cords off on day three of life, as I've seen in other locations. We also discussed the need for mom to eat well and breastfeed the twins often in the first few days to help milk production. Other locations women may wait 2-3 days before starting to breastfeed. 

The walk back to the truck felt much longer than walking up. The dad escorted us as they said there were dogs in the area and then lead us part of the way back following on his motorcycle. Anna and Mom decided that they will be organizing my medical bags so that it is easier for those assisting to find requested items. And we need to locate my head lamp that I used during this summer's dental teams as every time I asked for something the person holding the flashlight would tend to turn around to look.

What a powerful witness to the people of a God Who loves them..perhaps many seeds of the gospel's truth were planted in a place where so many do not know Him.

During this remarkable event..we had three generations represented..Anna, Kris and myself...what a special memory to share for all of us..like I said, it was almost a thing of stories...but it did emphasize just a bit of the need here in this isolated place for Kris and Cory.  A life, perhaps two, were saved..we now pray that many lives also will be saved for eternity.

The dad is a motorcycle taxi driver. I have been to his grandparents house, to pick up rebar he had neglected to bring the rest of the way to us. Not good when our house construction crew is waiting on the supplies to be able to continue working.  Others here have also had trouble with his delivery delays but I am glad we could show forgiveness and help his family in their time of need.

Cory

We plan to return for a quick visit at some point or expect that the women will come to see us as they told us to expect them. Will ask about baby pictures at that time. Sorry about no pictures but I kept my three helpers hoping as they helped and located needed supplies and our camera doesn't do well with low light. 

I'm so thankful that the Lord allowed my first home delivery and first house call in the Délice area to end up so positively. Thank you for those of you who partner in prayer with us. When ever you think of us, day or night, please send up a prayer. Thanks. 

Medical teaching..

The medical chats with patients waiting to be seen at clinic continue to go well.

I started this back in April. Mondays continue to be the bigger days but for a while this summer, with the government medical residents being on strike, and a special deal here of some type, many days all three benches overflowed with patients.

[Pictures from back in June on a busy day]


I introduce myself and explain that while they wait we can discuss medical or health issues. Some days I talk and answer questions for two hours, while other days no one wants to talk [or only a few return patients are waiting who've heard the normal chats already] Then I just walk back home.

The talks not only help people learn more about medical conditions and ways to prevent health issues but allows me to learn more about what they believe about the human body or medical topics.

Occasionally the nurses or other clinic staff ask me questions as well.

Three weeks ago I restarted teaching in the adult literacy classes on Monday afternoons, now getting a full hour a week. Today I was asked to pick up an extra hour of class tomorrow as the normal teachers are ill. OK-so I can add substitute teaching to my resume.

still giving out chaya to those who want it

I started the first couple classes asking for topics. While some of the questions remain simple like those I hear on the medical chats, they also want to tackle big topics like heart disease and infections.

Being in a classroom setting it is easier for me to prepare a topic to share. Easier does not equal easy.

Remember these adults may have just started school again or for the first time. They focus on basic reading, writing, and math skills. Even those who have been in the program for 5 years do not have all the education of a fourth or fifth grader, and don't study all subjects like science.

One of the first topics the mostly female class wished to discuss was menopause... I learned rapidly that I need to define all the terms when no one had a clue what a hormone was...

So I work to keep the words, examples and topics as simple as I can. This can get tricky as well due to Creole not having many of the words we generally use to describe medical topics. While most of the students have attended church for years-the French vocabulary heard in reading the Bible and hymns does NOT include all words needed for scientific topics.

The language limitation, levels of education, and complicated subjects make class interesting. This week we talked about skin-so I reviewed the definitions of bacteria, virus, parasite, and fungus.

Couldn't really find the word for fungus but the normal teacher provided me with it. Great! Used it during the hour only at the end to have the teacher confess that it was the word for fern. Oops. OK class forget that word and we'll use the word for mushroom instead!

Also interesting to hear what 'they say /I've heard'...some truth, some urban legend and some just wild ideas.

Trying to sort it all out can be tricky..especially when 'the doctor said'. Much wisdom needed trying to balance what I know to be true, keeping things simple enough to be understood, and trying to think/understand what the doctor meant/or what the patient may have misunderstood.

Having prepared for a full class on a topic helps me with some of the questions for the clinic chats as well...uterine fibroids for example.

Education still needed

A talk with one of the nurses who helps to run the pharmacy on the Fauche campus stressed the need for good health education.

Her health issues include: high blood pressure, diabetes, arthritic pain, and itchy skin. She shared with us the burden of buying her own blood sugar monitor, the test strips, insulin, and broccoli.

She tried to follow her Haitian doctor's instructions-checking her blood sugars every day, wearing shoes, eating broccoli...but soon ran out of strips, and unable to refrigerate the expensive broccoli, it spoiled.

Reminds me of professors talking in medical school about asking patients about barriers to care..in this case..money.  Being able to afford to see the doctor and buy some of the items I think made her forget to check the Konsey books for advice.

Better to spread the test strips out to once every 2-3 days to avoid running out, or at least have a few left to check one's blood sugar when not feeling well than follow a well-meaning doctor's advice to check daily.

Better to use one's money to raise or purchase locally grown vegetables, fruits or tree leaves than to pay expensive prices for an imported vegetable you don't know how to use.

Even better-plant the chaya bush starts from Cory and grow your own green veggies.

Better to try some home remedies for itchy skin that persists despite medical treatment than suffer doing nothing.

Better to learn to use aloe gel and massage to ease the pain than to suffer with only occasional relief when pain medications can be purchased.

Better to learn how to reduce stress, make better nutritional choices, improve resistance to illnesses, and prevent sores/illness than to have to go for expensive tests and treatments.

So we chatted a while about practical ways she can help to manage her problems and she received chaya starts that same day.

A few days later I headed down and talked to the doctor who was very understanding. But I felt I needed to do more and so this week I've started walking down to clinic and chatting with the patients waiting to be seen.

Both days so far I've enjoyed connecting with people and talking about ways to improve and protect their health. The first day a few people arrived after I'd discussed helpful information for acid reflux, so I asked a young teen who already heard my talk to give some advice.

His detailed answer showed how well he listened.  The young doctor walked by yesterday on his way to see patients and enthusiastically noted how helpful my talking to patients could be for their health.

I'd gotten discouraged in the last few years trying to connect with a couple different groups of people but I think this could really work!

Health issues already motivated these people to spend money on health care and they really don't have anything better to do while waiting... a motivated, captive audience! They return home with new, practical information that can treat their problems and help them avoid other problems. Win, win.

Last Clinic a Grande Rivere

Today no clinics and no bumpy ride to another town as we will all stay in Cap Haitian this morning to attend church.

We will be splitting from the team to visit Cite Chauvel Wesleyan. We will return to the hotel for lunch with the team and then head home.

Tomorrow the team will hold clinic at Madeline before returning to the USA on Tuesday's MFI plane.

Yesterday felt longer and communications and thinking felt harder for me and some of the team.

Don't know if the forth day of travel wore us down or what but I stuggled with  frustration  with several patients.

I know they were also frustrated with me as my diagnosis did not match what they throught they had therefore they did not receive the medications that they wanted.

With mobile clinics one needs to focus on education. Giving advice that can improve lives otherwise the few days of medications will hardly make a different before they return to the same suffering as before.

A few cases were simple enough to treat and they will heal but most cases need some lifestyle modification to make a difference.

Thankfully the Lord gave us several dear older people who were very appreciative of the care and very cute children to smile and brighten our day.

Konsey books sold well. Many people need to see the dentist and reduce the sugar, pop and candy in their diets.

Thanks for the prayers.

Grande Rivere

Good day yesterday. I think that each day most of us look less forward to the bumpy trip but continue to enjoy the beauty of Haiti and the people.

Saw over 50 yesterday. General items like sore/itchy eyes, muscle and joint pain, no appetite, a few infections, lots of cateracts, stomache pain....

A few uniquie ones like: 'I feel empty when I walk'. A young girl with very limited eye movement. A gentalman with a leg wound, 5 months following a motor cycle burn.

I spoke to the group at the beginning and then Cory followed. By the end of the day I started to see patients who bought one or both of the Konsey books. Very encouraging.

Cory actually sold out of the Konesy II books [had brought fewer with us] so he and Anna went to the warehouse in Cap Haitian where some are stored and picked up a new box.

Same location today. Church visit and plan to head home tomorrow.

Dondon clinic.

Tuesday afternoon we packed up the truck and headed to Cap Haitian to meet up with the Holy Cross Lutheran team.

This will be the third time we join the team from Ohio since we returned to Haiti in September 2013, but this time we will be focused on a couple of towns to the South.

Yesterday morning after a beautiful sunrise over the sea and a tasty breakfast of omletes we waited a bit for Pastor who unfortanaly experienced car trouble.

After a late start we headed out with our truck and his to Dondon, about 1.5 hours away.

Once we arrived I spoke to the waiting people while the rest of the team set up stations in the small church.

We ended up with one location for check-in and vital signs [Eli]. Three locations for seeing patients, (one for me) and Cory translated for one of the nurses. The last location consisted of the pharmacy area where Anna helped out.

Cory also spoke about nutrition to the waiting folks and a few impressed folks bought a total of 6 of the Konsey books.

Did not hear a final count but think it was close to 60 patients seen.

Today we return to the same location.

Team Day One

A very nice day with a slight wind, big fluffy white clouds and lots of sunshine.

The team enjoyed breakfast and I think everyone slept well.

Helps after traveling a couple of days that makes one very tired.

Cory showed the the school and then called me when they headed over to clinic.

On the way we stopped in the big depo [storage barn] and looked at the stuff in it.


At least one of the new nurses reported she did not realize any medical supplies had been stored there.










Goals:

• Sort through the boxes.
• Identify the supplies that could be used
• Sort
• Clean
• Rebox
•  and move over to clinic where the nurse can sort, organize and store
• Dump the bad stuff
• Clean the depo in preparation for storing the Konsey II books

The morning's project occupied most of us.

We did not complete the job but sent a pick-up truck's worth of supplies down to clinic and at least a second truck's worth to the dump.

Office work, school and some Bible school preparations also occurred before lunch.

This afternoon the team met with the Fauche children on campus.

Per normal there were about 20 kids on time at 3 p.m. but an hour later a few were still arriving and the numbers were close to 100.

The story for the day with puppets covered David and Goliath.

The normal Haitian leaders review the story after the team to make sure everyone understood.

They learned Hebrews 13:6. So we say with confidence, "The Lord is my helper; I will not be afraid. What can mere mortals do to me?"

Action songs like Father Abraham and head,shoulders, knees & toes....always a big hit.

Everyone left with a sticker and a paper with the verse in Creole.


Tonight supper will be traditional Haitian pumpkin soup and some rice & beans left from yesterday.

The coconut candy topped off our lunch of spaghetti and coleslaw.

Good first day. Thanks for the prayers.

A week in review.

100 pounds of cooking bananas-before Cory's joints hurt.

Sorry about not updating for a week, time got away from me.

Tuesday through Thursday we worked on team laundry and school.

We decided that a long Family Fun weekend would be great as many weekends and days recently we traveled, hosted visitors or remained busy.

Started out OK with some computer games, video, special food but by Friday night Cory became sick with Chikungunya. Saturday he slept more than 90% of the day- which he said helped avoid the pain. He slept most of the time of fever.

Early Sunday the fever broke and he felt much better but still 'terrible'.

Yesterday we started our school week and Cory was able to be up and lead nursery work, although remains weak. We're working on a newsletter.

Vanilla vine and pods.

This morning Pastor Rigo asked me to cover clinic as they had no one else.

I've had joint aching on and off the last couple of weeks but a nurse could write charts for me. So I headed down the hill, slowly. I think the rocks grew in number and sharpness recently.

Thankful the Lord protected me as there were only 3 patients and by the time I saw the third one the one needing a lab returned with the results.

I did mess up. When I arrived I hobbled into the clinic area forgetting to greet the patients waiting on the bench. When I walked past them a second time I heard one of them comment and realized my mistake.

I apologized and sat down on the bench with them explaining that my head was a bit mixed up with the change from school to clinic and my joints hurt. They smiled and forgave me.

The lady who'd made the remark happened to be the first patient and wouldn't you know it-a weird symptom likely related to stress. Many patients here as in the USA want to leave with medications to treat their problems but I didn't want to sell her vitamins that she didn't need.

So I prayed with her. As she stood up to go she asked me if she could hug me. Wow. Not only was she not upset she wanted a hug. Don't remember any adult clinic patients every asking for a hug. Some OB mom's I delivered or children yes but not like this patient.

Thanks Lord. Pastors meeting on campus today as they prepare for the summer conferences.

A visit from folks from an agricultural conference. A good day. Edited.

Today's visit from some folks attending an agricultural conference based at a near by university in Limbée went very well.

Cory went and picked up one of the two truck loads this morning and returned. First - introductions all around.


Some came from other parts of Haiti and about 1/3 were students in the agricultural program at the university.

A tour of the yard and gardens started off the visit. I tagged along at first until we came to the star fruit tree.

People were interested in both trying the fruit and getting seeds.


I did tell the one gentle man who exclaimed after trying one that the sweetness could be because he had just tried a miracle fruit but his enthusiasm encouraged the other's to try some.

So Evon and Cory picked some and the kid's and I prepared the fruit for lunch and cleaned the seeds, while the other's continued the tour.

Around 1 p.m. Cory called to let us know that lunch was being served at the school cafeteria.

We had not planned on joining the group but the lunch had been ordered for 30 and being about 10 short [some due to Chikungunya fever] our family and Cory's men joined the meal.

We added the star fruit and chaya to rice and beans served with a cashew sauce, beef so tender I thought it was goat meat, fried cooking bananas, beet salad and spicy Haitian coleslaw.

Fresh natural fruit juice hydrated everyone.

In the afternoon I shared some basic first aid information: splinting, transport, wound and hemorrhage care.
After the talk for pictures to report to the other groups back at the conference they reviewed some of the points using my props.

No one was hurt during this lecture!

No don't pull out that impaled stick!

 Then answered some questions and gave every one a health book telling them they were now obligated to share the information with their family and neighbors.

Cory shared a bit more information about plants as well as cuttings and seeds before driving the folks back to the university.

Now the kids and I need to go and prepare beds for the 14 guests arriving tomorrow.

Yes, stabilize and transport. 

My visual aid: impaled piece of metal, and stuff not to push back in and the back side showed an open fracture [cow's bone] and an a avulsion injury of skin and muscle.

A good day.

Testing…..testing

This morning after checking for our test results and not finding them again I put on my 'board's song'. ["Our" means: myself, the Lord and my prayer team.]

Back in 2004 Mom told me to listen to this song and that she thought of it as my board song and that is what it became… here's the chorus

You raise me up so I can stand on mountains
You raise me up to walk on stormy seas
I am strong when I am on Your shoulders
You raise me up to more than I can be

Read more: Selah - You Raise Me Up

The peace that I enjoyed during the testing remained, but with each passing day the pressure to think about 'what if' the Lord did NOT provide a miracle increased.

I went so far as to ask a good friend and fellow physician what she would do in my case if I didn't pass.

I started this week to word the E-mail in my head to the Academy to find out how I would be able to regain my Family Practice Diplomat status if I let it lapse a few years.

The last few days I started checking the web site only to see the same status….no update.

I started to review my comfort verses, listen to my faith building songs and pray again for His will [reminding Him of my preference--like He may have forgotten!]

I really didn't even think about the test even when I opened the E-mail around noon titled 'Notice of Becoming a Diplomat"   but that rapidly changed as I went in search of Cory to confirm what I thought I read.

YES, we did it!!

Dear Doctor Ter Avest-Thede: Congratulations! We are pleased to inform you that you have successfully completed the necessary requirements for recognition as a Diplomate of the American Board of Family Medicine. As a result of your successful performance on the examination, you have exhibited a level of mastery of medical knowledge worthy of recognition as a specialist in Family Medicine, and in keeping with the Board's mission, you have demonstrated a commitment to excellence in our specialty. 

Thanks Lord for taking care of the questions that I didn't have a clue how to answer.

He carried me through this and gets all the glory and honor!!!  [Like I blogged before it is very comforting to go into a major test with the Lord who knows all the answers!!]

Thank you to those who prayed. Thank you to those who helped me study especially Cory, Eli, Anna and my folks.

Now my praying friends….with the success of one of our families two MAJOR events for 2014 behind us let us turn our prayerful attention to the referral of our sibling set by Haiti's social services. I'm ready to know our kids!!!! [Twenty weeks and counting….]

P.S. Eli also did very well on his SAT's.

Post team Monday.

Enjoyed a nice 3.5 inches of on/off rain from Saturday afternoon through Sunday morning and a half inch last night.

Since the rain softened the ground, after finishing up his office work today, Cory worked on smoothing out a new location for his rooting house as the old one is under a tall 'Fransis' mango tree whose crop now threatens the cuttings. The tree hasn't had more than a few fruits per year until now. The drought did help the mangos set a heavy crop.

Thank you notes printed and ready to be put in the mail on Wednesday as the plane comes in a day late this week so folks can avoid carnival activities by staying at home.

Learned today that the new Creole health books should be ready to pick up in Cap Haitian later in the week.

Then Cory will need to try to get some of the 7,500 books to the National Conference later this month.

Eli, Anna and I continue to spend hours in our studies. I will need to grade a report on how a diamond anvil cell works and a compare/contrast paper horses vs. oxen.

Cory helped today and tomorrow make sure that the Compassion children's activities on campus had water, electric and video equipment.

Team clothing donations boxed up and ready to pass along to the pastors. These are clothes that they wore, not ones brought down to Haiti to give away.

As one can buy clothes here we try to encourage local businesses as much as we can.  However even painting clothes and old clothes can be used as rags.

The picture is the view from my study spot in the plant nursery. Countdown to recertification exam stands at 1 month, 2 weeks and 5 days.

Hard to know what to study with any age patient, any organ area, and any disease being possible on the test.  Not to mention all the medications and testing that I've never used or seen for over 15 years or never!

Most of my medical 'practice' at this point is e-mail or phone consults and I think that is ONE area that will not be on the test-at least not tropical/developing world international consults.

My 'wrong' answers often reflect how my technique has modified after 15 years of very limited resources and testing.

Know it will be the Lord who will allow me to pass this test and my great prayer team. Some days I feel like I'm making progress with my review but then I hit a bunch of new information and feel that it would take another residency to prepare me.

Either way I will praise Him. He's in control.

Goal Reflections

This time of year many people set personal goals. This week Cory signed both Eli and I up for spring tests.

I know that good goals should be measurable, should be in small obtainable steps, should be items that you can do.

First on our list would be to match with our new kids and move huge leaps toward getting our little ones home with us but…I really can't do anything more than pray for that one.

My biggest personal goal for 2014 consists of passing my Family Practice Boards re-certification exam.

Cory signed me up this week to take this exam on April 23rd, in the Dominican Republic. I now can start the countdown.

I've started to study as the notebooks filling with facts and FP journals scattered throughout the house can stand witness to.

I'd not forgotten the frustrations of spending hours on a task and the only physical evidence of that hard work would be that the pages turned or contain more highlighted words.

Discovering new and interesting facts I still enjoy.
Dusting off facts not to bad…oh yes I remember this!

But a new frustration now adds weight to my studies...learning that some of the facts that I worked so hard years ago to learn and put into long term memories have fallen out of favor and now sit in a pile labeled 'harm outweighs benefits' or 'not enough evidence to recommend'.

I do NOT remember my professors or textbooks noting that this treatment or test that they recommended was not backed by strong science.

A question now frequently whispers in the back of my head "I Wonder what you're learning now that isn't really true? What 'fact' will fall out of favor this year or next?'

Makes me very thankful that my God and His Word do NOT change.

So if the time between blogs stretch out longer than normal please forgive me as I prepare for this test. Send up a prayer. I'd much rather finish this goal on the first try than to have to spend more months of study, more money for travel and to retest in November.

Thank you to Cory and Anna for the fun pictures. Yes, I've started to teach Anna how to cut hair. Yes, it was a bit scary and a whole lot of fun. Yes, Cory looks fine.

Anna's Nan Mango pictures and one from surgery.

Only Anna is standing on the step.