My final days in Shell

It's hard to believe my time in Shell is basically over. In many ways, it seems like I just got here. In others, though, it seems like I've been here for months. I've seen and experienced so much, it sure seems like I've been here for a much longer time. I've been extremely thankful for everyone here, especially the doctors, residents and interns at the hospital, the friends I've made with other working visitors, and the Hidalgos (my family, seen in the picture above. Their daughter, who is with us, actually lives in Quito, but she was visiting last weekend when we took this picture). I've had such a great time here in Shell, I'm a bit nervous to move on to Quito, where I have to start all over.

These last few days have gone fast. We've been generally fairly busy at the hospital, especially since Tuesday night. After our Bible study I have had each week with the residents and interns, there was a call of a "code" in emergency room 2. We immediately started CPR and I think defibrillation occurred before I got there. We were able to get her stable and on a ventilator, but could get no more. Earlier on Wednesday, the docs decided to transfer her to Quito where she could get a CT scan of her brain, and where there's a neurosurgeon if anything more can be done. I happened to be standing there as they were talking about the flight, and one of the docs asked me if I'd like to go to help if I could. So, I took a plane ride to Quito yesterday! The plane ride went smoothly, and the patient arrived in relatively the same condition as when we left, which was really all we were hoping for. Unfortunately, her outlook didn’t look good, but at least we tried everything we could. My main goals here in Ecuador are to serve, learn, and have an adventure. I was able to do all of them yesterday.

I move to Quito Saturday, after spending Friday night with my family in Ambato. Just the small taste I had of Quito yesterday was, perhaps, a warning of what is to come. I’ve been here in Shell for so long, on the edge of the jungle region, I had forgotten what the city would be like. It’s huge, busy, and crowded. We’ll see what the next stage brings…

Medical Caravan: 150 Kids

On Saturday, I traveled with about 10 others to Salasaca, an indigenous village that just started a program with Compassion International. As part of the Compassion program, the children receive medical care, and we were the ones who were supplying that care.

As you can see by my pictures, these people were beautiful. They were a community of highlanders. Generally, the boys wore ponchos (although the one in the picture has taken his off for his checkup), and the girls wore shawls and dresses. Most of the mothers came in with a spindle and a bunch of cotton or llama hair, each making a spool. It was really cool to see. Such hard work!

I served basically in two ways. First, I was talking with the kids and their parents (actually, mostly with the parents, since the kids basically only spoke Quichua) to get their medical history and to find out how they felt currently. It was very satisfying to realize I could talk with the parents quite well. I praise the Lord and thank you for your prayers. My Spanish has improved incredibly over these past few weeks! After lunch, since we were quite far ahead in taking kids' medical histories, I moved on to do vision tests for the rest of the day.

This is a community that needs quite a bit of help. There are a couple of missionaries up there who are helping out, but some of the biggest battles medically will be fighting some of the cultural difficulties. Apparently, it isn't cultural to tell the children what they may or may not eat. Generally, this wasn't that bad when the only options were rice, potatoes, corn, chicken, and other types of food. But now, with the influx of other possibilities, many kids will end up eating only chocolate or other sweets, and not their healthy food. Hopefully, with added support from this Compassion program, additional education, and help by the missionaries, we'll be able to find out how to, within their culture, help with more of their health needs.

There were about a total of 150 kids who showed up on Saturday. We had 3 doctors, but unfortunately that wasn't quite enough to get through everyone. For everyone, we were able to get their general history, height and weight, and vision tests. For the 40 kids who still need to see a doctor, our pediatrician will be returning to see them soon.

Med school, here I come!

This afternoon, I received an email from Mayo Medical School (Rochester, MN) with an appointment offer for the class of 2006. I'm ecstatic! After interviewing at Mayo, Duke, and Michigan, Mayo was my top choice. I was very impressed with their facilities and resources and I highly desire to be a part of the Mayo community. God gave me the desire of my heart!

This entire process has been a wonderful lesson in trusting God. Last June, Pastor Louie, my home church pastor, gave a sermon on the end of Matthew 6, the passage addressing worry. He said in his sermon that there are two keys to combating worry. First, you must work really hard and do whatever you can. Then, you must trust really hard and let God do the rest, according to His plan. This was exactly the process I went through. Of course, the hardest part was the second part, where nearly everything was out of my hands. Unlike most applicants, I didn't have much of a "backup" school. If I wasn't accepted to Duke, Mayo, or Michigan, I simply wouldn't be going to medical school this year. But God was faithful and came through. Not only that, but He blessed me with my top choice. Praise the Lord!

(Photo cropped from http://mayoresearch.mayo.edu/mayo/research/departments-mcr.cfm)

The worst side of medicine

Why did I choose to go into medicine? Many reasons, obviously, but the foremost is that I desire to help and to serve people. Today I experienced one of the worst things one can experience, yet one which will probably not be its last. This morning at 10:00 am I saw my first patient die. And what made it even worse was that he was only a child, not even 3 months old (sorry about the email saying 3 years. I goofed. This is the correct age).

When I left the hospital yesterday afternoon I was a bit worried about this patient with respiratory trouble. His oxygen levels had been dipping low, and then his pulse was running high. When I left though, everything seemed to be stable. I wouldn’t have left otherwise. When I returned this morning, I was relieved to see that his room was not cleared out. He was still in the ICU with all his equipment. I was with him from the time I arrived, continually monitoring his O2 saturation to be sure it didn’t dip too low. Eventually, things did start going bad. After a while, his O2 sat began to dip quite low, and then his heartbeat dropped really low. The docs tried CPR-type resuscitation techniques to get the heart beating again and oxygen flowing, but they weren’t working. We tried shocking him twice, but that didn’t work either. After about 30 more minutes of trying, we knew he wasn’t coming back. One doctor stopped chest compressions, and the other stopped the manual breathing assistance.

And I stopped cold. This was the first time I had seen a patient die. I didn’t exactly know how to respond. I couldn’t believe this was happening. After all, aren’t we supposed to be able to fix these kinds of things? What went wrong? Maybe if we had better equipment . . . maybe if we had known about his potassium levels . . . maybe if we’d been able to administer more oxygen sooner . . . who knows? Life is not lived in the “if’s,” life is lived in the present, learning from the past, and anticipating the future.

I realized this morning that I want to serve in medicine more than ever. There are so many out there like this little boy who need help. I want to learn all I can so that I can give every patient the best chance to live. With the experiences and education I have had, am gaining now, and will have in the future, I hope to develop my availability, ability, and affability to be the best possible physician I can be.

Strikes, Bikes, and Flights

The nation of Ecuador has been in a bit of a mess since Tuesday. I don't know too many details about it, but there are currently strikes in my city and much of the surrounding area. People have piled dirt, stones, tires, trees, and other things into the streets and have lit them on fire as road blocks. Currently, getting from here to Quito is basically impossible via car. Our town, Shell, is even separated from Puyo, the city about 5 miles away. I do know, though, that some of the nurses have been able to come here by bike.

The main effects we feel here are basically what you would expect from an isolated town. Although not everyone is participating in the strike, there are several places that are closed because the workers can't get to work. The schools are closed, and even the American school is closed due to safety. Here at the hospital, we're open, but we have very few patients coming in. The last few days have been quite slow. I'm a bit scared to find out how busy we'll be when the strike finally lets up.

From what I can gather, the main point of the strikes is over free trade talks with the United States. Many of the indigenous people (which are most of the people around where I am right now) don't want to see an agreement take place. Part of the problem, though, is that although the free trade talks were the initiation of the problems there have since been added many parts and addendums to their demands. You can find out some more information from http://www.cnn.com (in the World/Americas section) or at http://www.bbc.co.uk (in the Americas section).

For the most part, we're not overly concerned about our safety here. The strikes have generally not been violent, as far as we have heard, and especially not here in Shell. In Puyo, I guess, there was a little scuffle yesterday, but we're generally not that worried.

Please pray for Ecuador. There is a lot of uncertainty and restlessness right now. It is not necessarily likely that anything drastic will happen, but there is always that chance. Pray also for the missionaries down here, especially for the short term missionaries and missions trips. I know several people have trips back to the States or to other parts of the world, and they can't take them unless they can get to Quito. There might be the possibility of flying there but that is unlikely to happen unless a last resort. As far as we can tell, the strikes could be called off tomorrow, or they might go all the way into next week. We just don't have anything certain.

Generally, I'm still doing very well down here. Since we haven't had many patients, I haven't been able to help out or learn a ton this week, but I still have been able to do some. Thank you for your prayers!

Kevin

Hospital Vozandes del Oriente

Many of you are probably wondering, “What kinds of things do you do there?” Well, yesterday, I learned a bit more about the hospital itself. Hospital Vozandes del Oriente (HVO) is a 40-bed primary care hospital. It’s one of two hospitals run by HCJB World Radio Inc. As a primary care hospital, we have inpatient services, emergency services, and general consult. I’m helping out in all of those areas, but primarily in the ER. We see different people from all over.

As a hospital, we’re probably the best in the area. There aren’t many places you can go and receive this kind of treatment. We’re also closely tied to the Quito hospital (HVQ), which can accept all kinds of patients. Although we’re good comparatively, we still don’t have lots of the new modern equipment for the more serious cases. If we need to, we can fly patients to Quito for better, more advanced treatment.

Almost all the doctors here are missionary doctors who have come to serve this people. We’re able to offer care for very reasonable prices. To see the doctor here, it’s about $3-$4. An X-Ray is about $8. A day in inpatient starts at around $20, with additional costs for things like IV’s making a general day about $40. Compared to the U.S., that’s very reasonable. However, if patients can’t pay in dollars, we still try to get them to pay something, somehow, so they feel that kind of responsibility. I just learned that we have a gift shop where people can exchange goods for care. There are several handmade items. I think they can also bring other things like produce to pay for their care. It’s really great to be able to bless these people in this way.

A Mountain Adventure: Reader’s Digest version

This is the version for those of you with a bit less time, and it has also been censored for my mom so she knows how much fun we had this past weekend and how safe we were the entire time. See the post below for details.

I spent Friday night and Saturday with 7 other volunteers on a trip up to one of the nearby mountains (what is supposed to be about 2.5-3 hours away). Unfortunately, we got a bit lost on the way out there, and had car trouble, so we ended up knocking on someone’s door and paying him to take us to the Hostel. Our 2.5-3 hour trip had turned into more than 6.

We took off in the morning on muleback and rode for 3 hours to a “refuge” where we got off and completed the rest of the journey on foot. The hike was about 2-3 miles, and about 1000 feet up. It was rather difficult, as we were at 13,000 feet, where the air is very thin. In the end, only 5 of us actually made the complete hike to the lagoon.

Al Altar was at one time a volcano, but it has now turned into a lake, and a beautiful mountain. Where we were hiking was to the lower edge of that lake, the lagoon. The last picture in the post below is of me across from the snowcapped peaks. It was incredible.

It rained pretty hard on our mule ride back. Cold, wet, and tired, we arrived back at the Hostel just before the sun went down completely. We warmed up a bit by the fire and then headed back home. It was definitely an adventure.

Mom, you might not want to read this

Apparently I arrived in Shell just at the right time. I guess several of the other college-age volunteers here hadn't been on a getaway in a couple months, so they planned to take a trip up to see Al Altar (one of the snowcapped mountains around here) this past weekend. We took off Friday at 6 pm with 7 volunteers and 3 Ecuadorians in Rodrigo's (one of the Ecuadorians) family truck. We strapped a tarp over the bed of the truck so we could ride in the back without freezing or getting rained on. The first picture I have is of us when we arrived in the nearby town, Baños. (I left the shutter open a long time and took this without a flash, so that's why anything that wasn't stationary looks blurry). At this point in our trip, everything seemed to going generally pretty well.

In Baños, we diverted from the main road to Quito and began heading toward Al Altar. Now, apparently Rodrigo didn't quite have complete directions, as we must have made about 3 or 4 wrong turns, and we backtracked quite often. Eventually one of our girls remembered she had a tourist guide which had some vague directions on how to get to Al Altar. However, we still only had a general sense of direction. After going a little while longer, our guys stopped and asked a lady which way to go, but again they only got a general sense, not the clear-cut directions we would have liked.

Now, like I said, we had 10 people in this tiny truck, and we were driving up mountains. Eventually, the truck began stalling as we were trying to head up the mountains. And to make matters worse, the battery was dead (alternator problem/wire loose?), so we had to push the truck and pop the clutch to get it going again, which of course couldn't happen while we were going uphill. Eventually, the truck was stalling so much that we were holding on to the back of the truck and then jumping out and pushing whenever the truck began to have problems. Now, at 9,000 feet, this was no easy task. We were all getting quite tired. And we still had little clue where we were.

Eventually, we had had enough pushing and aimless wandering. We stopped by a house on the side of the road and asked for directions. At this point, it was about midnight. There ended being to men in the house who offered to take us to Al Altar for $40. We were pretty sure we would never make it ourselves, so we accepted the offer. We then jumped into the back of his big truck while Rodrigo drove his truck without the extra weight. It turned out that we were actually quite close. We were on the next mountain over. Please sense my sarcasm. We finally arrived at the Hostel at 1:30 in the morning, where we met up with one of the other volunteers who had been on a medical caravan all last week.

The Hostel itself was beautiful inside. We generally tried to sleep, but many couldn't because it was so cold. It was about 50 degrees inside, and the blankets weren't very warm. Being the fresh meat from Michigan, I didn't have too much trouble sleeping for a few hours. In the morning we had breakfast and then got ready to go. Unfortunately, there was a little miscommunication about the price, and also we had more people than they were expecting, so they didn't have enough mules ready. Unfortunately, our Ecuadorian friends didn't feel they could afford the trip, so they decided to head back to Shell, leaving 8 of us to head to Al Altar on our pack mules.

These mules were amazing. They put up with us on their backs for 3 hours, climbing up steep hills and through extremely deep mud, trekking on in low O2. The ride was a little scary because often we were right on the edge of the mountainside. The especially scary part was when the mules would randomly try to fight for position. I have no clue why. During the trip, we were continually moving in and out of clouds. It was getting colder as we went, but it didn't start raining until we were fairly close to the refuge where we would leave our mules behind and head for Al Altar on foot. At that time, it was so cold that we could actually see our breath inside the refuge.

The hike to Al Altar was about 2 to 3 miles and about 1000 feet up. As we took off, we were worried that the clouds would obstruct any view we might have. Al Altar was at one time a volcano, and we were climbing up to the edge of it, what is now a water-filled lagoon. The hike up was rather difficult, at around 13,000 feet with several steep elevations. Only 5 of us actually made it to the lagoon. It rained a little on our way up, but as we neared the lagoon the sun actually came out a bit. In fact, the sun was so intense that I ended up taking off my jacket and fleece.

Up until now, we had continually been marveling at the beauty around us. However, at one point, we turned a corner and I was speechless. It was one of the most beautiful sites I had ever seen. And as the clouds rolled in or cleared up, it only got better. Al Altar was gorgeous. The last picture is of me on the other side from the lagoon, with Al Altar in the background. (I promise it’s not just a backdrop! I was there!) The elevation where we were was about 13,400 feet, with barometric pressure of only 18 in mg (456 mmHg, 0.6 Atm).

We were only at the lagoon for about 30 minutes, but in that short time the clouds began to roll in again. As we took off, we realized that it would be easy to come all the way there and stay several hours without seeing the snowcapped peaks. We felt very blessed.

We got back to the refuge around 4pm and still had a 3 hour ride ahead of us. On the way back, I don’t know what got into the mules, but they began to vie for position even more, and they were even kicking quite a bit. Several of us got kicked to some extent or another. It was also a bit scary when they would try to run ahead and pass another mule when were on the edge of a cliff. For some reason, I don’t think a trip like this would be allowed in the States, especially without signing our lives away. Shortly into our ride home, it began raining. Furthermore, since we left around 4, we were fighting daylight. (Remember that Ecuador is on the equator, so the sun consistently rises and sets at 6am and 6pm.) I was mostly worried about the end of the trip back since that was when we knew we’d have the worst downhills. I was very impressed with our mules, as they generally managed to stay on all fours, sticking out their front legs as they’d slide down the muddy hills.

Not 10 minutes after we arrived back at the barn, the sun had completely set and it was dark again. We were all soaked through, and hardly any of us had much more to wear. Thankfully, we were able to start a fire in the Hostel’s chimney to warm up a little bit before taking off again. Since Rodrigo and his friends had already left, we took a camioneta (a truck with the back open for chickens, hay, or passengers) to the bus stop, where we were told the bus would be arriving 30 minutes later, at 9:30. There was a nearby restaurant, so we went over there to have some hot drinks since we were still a bit cold. While sipping our tea, we began talking to the waiter who told us the bus would not be coming until 12:30. We could try to get another camioneta, but it would cost another $15, and it would only bring us to Baños, where we would have to catch a bus to Shell anyway. We decided to wait. The bus did eventually come at 12:50, and we took it to Shell. I arrived back at my house at 3am, tired and ready for bed.

It had been an incredible adventure. It seemed that anything that could go wrong did go wrong (even worse than any youth trip I’ve been on, including Dawntreader 2000). However, I also saw God working out everything in the end. It seemed to be a lesson in trust, something I’m learning a lot these days.

Rainy day endoscopys

Before I left, my grandpa told me that Shell gets somewhere around 25 feet of rain a year. I'm kinda wondering if he's underestimating. Thus far it's rained every day. The weather is generally wonderful (between 65 and 85), but it also changes on a dime. I took this picture from the back of the hospital today (looking at the resident's house). It was beautiful and sunny when I came in this morning.

My job here has become much more defined the past few days. I generally have been helping out on the floor (working with inpatients) in the morning when I first arrive, and then I move to the ER where I help out wherever is needed. I've seen a lot of things already, including snake bites, general illness, and others. Today I helped out with 4 endoscopys (specifically gastrointestinalendoscopys, upper GI endoscopys). An endoscopy is basically when a camera is attached to the end of a long tube that can be placed into the body to see things. We were looking mostly at the esophogous and stomach. It was quite interesting. When the docs found something cool, they let me take a look in the scope.

Tomorrow evening we're planning on going hiking on one of the nearby mountains. Although, it might fall through because the intern who was organizing it might have to go Quito tomorrow. We'll see. If it happens, I should have some great pics this weekend!

A safe arrival, and the beginning of the adventures

Buenos tardes, todos!

I just got done with my second day at work here in Ecuador. Things are going very well thus far. I arrived Friday night with all my luggage, and then I took a bus down to Shell (about 5 hours). The drive through the mountains was beautiful. Shell is still in the mountains (3000 ft), but it is not nearly as high as Quito (9000 ft). We’re more surrounded by mountains instead of being way up in them. The picture of the sunset is from right outside my house.

I’m living with an Ecuadorian family, the Hidalgos, who have a thirteen-year-old son. Thus far they’ve been quite forgiving with my Spanish. Generally, as long as they speak slowly enough I get what they’re saying. I’m still having trouble conjugating my verbs correctly, but they don’t seem to mind too much. At least, they haven’t laughed at me yet. I’m certainly having many opportunities to practice my Spanish and also listen to it.

Today I finished my second day at the hospital. I’m not completely settled in to a job yet, but it looks like I’ll be helping out with general nursing responsibilities when I arrive, and then I’ll be helping out the residents and interns in the E.R. I’ll also be shadowing some of the docs on rounds and possibly with other things when interesting cases arrive.

Hope everything is going well with everyone. I’ll be back later with more stories and pictures!

Kevin

Updated support information

This morning, my dad discovered that HCJB has the option to donate online or via phone. If you'd like to donate and this would be easier, you can use the following instructions:

Go to http://www.hcjb.org/
Click on "Donate Now" (it's one of the main links at the top)
Click on "To Missionaries"

Fill in the information:
Missionary's Name: Kevin Dufendach
Account #: 128104

Continue with the site's instructions. You will be directed to a secure website to complete your tax deductible donation.

Prayer and Update letter

The following is a general update letter I sent out to many of you. I'm posting it here for those of you who didn't receive a copy (at least, not yet) and would like to know a little bit about what I've been doing these past 4 years.

February 2006
Dear Friends,

Much has happened since I started college three and a half years ago. It seems that I’ve been in and out of town so much that I’ve hardly been able to catch up with everyone. I figured a general update would be helpful to let you know where I’ve been and what I’ve been doing, as well as what my upcoming plans are.

In August of 2002, I began my education at Taylor University. I finished in January with majors in chemistry and mathematics. While at Taylor, I was involved in several ministries both on and off campus, including worship and children's ministries at my church, and for two years I was a personnel assistant (Taylor’s version for a residential assistant) in Wengatz Hall. I also had the opportunity to serve on several missions trips, and I thank the many of you who provided support for those trips with both prayer and finances. In spring of 2004, I went with a group from Taylor to Mexico where we worked in several orphanages, doing construction/maintenance work and showering the kids with love. Last summer I went with a team to Sri Lanka where we spent two weeks building homes for those whose own homes had been destroyed by the tsunami. I also had the opportunity to work for a few days doing cleanup for victims of hurricane Katrina. Each of these experiences has helped me develop my passion for service and helped me realize that God can and wants to use me now.

Since I finished at Taylor a semester early, I have decided to use my time to volunteer with HCJB (www.hcjb.org), a mission organization specializing in radio broadcast, medical care, and training of nationals. I will be working a total of 2½ months in Ecuador in two different hospitals. For the month of March, I’ll be in Shell (the airbase of the movie End of the Spear) at Hospital Vozandes del Oriente, and then I'll spend the rest of my time in the capital city at Hos-pital Vozandes Quito. I'm not yet sure of all the opportunities God will send my way, but pray that at the very least I will be an encouragement to the people down there and a light to those around me. I've included a prayer card so you can be reminded to pray for me while I'm away. The idea is that I'll use this trip to experience life as a medical missionary, serving the people of Ecuador while gaining even more hospital experience before, Lord willing, beginning medical school in August.

Speaking of medical school, I recently finished my med school interviews and will find out in March if/where I have been accepted. I interviewed at the University of Michigan Medi-cal School, Mayo Clinic College of Medicine, and Duke University School of Medicine. A lot of people ask me where I would go if I had my top choice, and to be honest, I'm not quite sure. It would be wonderful to receive my medical training at any of these schools. My specific inter-est at this time is in pediatric neurosurgery, although I could certainly change my mind once I begin my clinical rotations.

Before I close, I wanted to mention a few ways you can be involved with my time in Ecuador.
• I already mentioned the prayer card. Please put this card somewhere so you'll remember to pray for me while I'm in Ecuador.
• The second way is by signing up for email updates through my mailing list. If you go to http://groups.google.com/group/Kevin-Dufendach-updates, you can sign up to receive short updates of what's going on in Ecuador. All you need is an email address. My goal is to keep these emails brief, only mentioning highlights or prayer requests so you can read them in about a minute.
• If you'd like to read some stories and see some pictures of my time in Ecuador, then you can visit my updates blog at http://kevinduf.blogspot.com. The blog also allows you to make comments or set it up as an RSS news feed so you notice when I've posted some-thing new.
• I am hesitant to mention this because I know that most of you already have several minis-tries you support, and I don't want you to feel pressured into helping me out as well. The purpose of this letter is to provide you with a general update and to thank you for your involvement in my life, and I don’t want to distort that purpose in any way. This letter is a thank you, and not a request for money. That being said, I also realize that there are those of you who would like to help out financially as well, so that information is avail-able below. The total for the trip will be approximately $2500 ($1125 for airfare, $16 per day for room and board, plus other miscellaneous expenses). If you would like to help out, you can send money to my account through HCJB. See below for instructions. Per-haps you could sponsor a day or two, put it on your calendar, and remember me specifi-cally that day. Anyway, for those of you who are interested, the opportunity is there, and I thank you.

Thank you again for your involvement in my life. I hope this letter finds you well. I’ll see you soon on my emailing list! If you have any questions, don't hesitate to ask!

Blessings,
Kevin Dufendach



Support information:

Designated to: Kevin Dufendach, working visitor with HCJB World Radio, Inc.
Account number: 128104

From (fill in address below, please):




Mail to:
HCJB World Radio, Inc.
P.O. Box 39800
Colorado Springs, CO 80949-980

• Checks or money orders should be made payable to HCJB World Radio. My name should not be written on the “pay to the order of” line.
• All funds sent to HCJB are considered donations to the ministry of HCJB World Radio, Inc.
• Donors will be issued tax-deductible receipts.