Dr. Tom Ball is an internist/pediatrician who practices in Leroy, New York.  He came down to Roca Blanca by himself for 2 weeks during March.  He wrote some reflections on his experience that we present here.

Dr. Tom and Kay with KP duty at El Mosco.

Arrived yesterday at our base in the Sierra Madre Mountains.  We set up our tents and enjoyed a tortilla and a piece of chicken broth with rice.  Afterwards, we shared communion and Troy read a passage from a book which spoke about the exchange that occurs between people when they listen and connect and when there is a healing touch-how one is blessed by being helped and the other is blessed by being able to know the joy of helping someone.  After group devotions, I asked if there was a time that we should be quiet for the night.  This caused some laughter that I would only appreciate after the night in El Mosco.

The air was fresh and cool.  I settled comfortably in to my sleeping bag complete with air mattress.  A Mexican ballad descended from the hills above us.  How quaint, I thought.  Soon I became aware of a cacophony of roosters.  The dogs around our tent joined in the chorus.  Their barking passed along to the neighbour’s dogs and around the valley like a wave in a stadium.  Snorers joined in.  After a while there was a predictability to these sounds that was reassuring.  That was the burro’s cue.  The moment when it all seems like everyone is about to drift off, the burro’s job is to take the party to another level with a painful screeching roar that could raise the dead.  Yet despite this, I somehow managed to fall asleep.  Somewhere, someone in the village must have sensed this because three gunshots rang out jolting me from my slumber.

I must have fallen asleep at some point.  I know this because I woke up to the crow of a rooster.  Maybe it’s just an urban myth, but I always assumed that the first crow of the rooster was the sure sign that morning had arrived.  But as I stumbled out to the tent and looked up at the stars, I realized my error.  Making the most of things, I decided to take a “shower” (splash cold water from a bucket all over me).  At least there would no line.  I then came back and lay down staring up at the tent roof until morning.

After a short while spent in prayer and reading the Bible I joined the others for our group devotions.  Dr. Dave opened in prayer, “Thank you Lord for the night’s rest.”

By Dr. Tom Ball

Dr. Mary Kay and Dr. Tom consulting about a difficult case.

Lauren and team sorting pills for mountain outreach

Tent city in El Mosco. The big one with the red roof housed all six of the Honeoye Falls team.

On a chilly Valentine’s day, the team from Honeoye Falls Presbyterian Church, led by Bertha Guild, left Rochester, traveled all night, and arrived in sunny, warm Huatulco, Mexico the following morning. Because of a travel glitch, Bertha, who was traveling with her niece from Alabama, did not arrive until the following day. This team of young ladies, ages 14-18, along with the mother of one of the girls was eager, energetic, and enthusiastic. After a night’s rest, they began immediately to help prepare for the mountain outreach 2 days later. First, we taught them how to weigh patients, take temperatures, and take blood pressures. Then they helped assemble medications, counting pills and pouring them into bags that would hold a single treatment. They also enjoyed some time on the beach and walked around a nearby town.

On Wednesday, the team of 24 assembled and we packed the trucks and cars with food and water for the 5 days we would be gone, sleeping bags and tents, tables, and boxes of supplies for the mobile clinic, several drawers full of medication, and materials for the children’s ministry, brought by the Honeoye Falls team. We were favored with good weather, no vehicular problems, and no road construction delays as we traveled up to the mountains. We had plans to visit 3 different villages, but as often happens, local political considerations dictated some changes in plans.

Laura, with two of her Mixteco proteges helping in the pharmacy. 

Jumproping was a favorite activity, enjoyed by girls and boys.

Children absorbed in some art activities in El Mosco.

Continued in the “previous” section-click on “previous” to see it.

Visit to Pueblo Viejo

Maricella and Carmella are the Mixteco missionaries in Pueblo Viejo

Prayers written by the children on the wall inside the church at Pueblo Viejo.

The following day we went to Pueblo Viejo, a village about 45 minutes away, and saw about 80 patients with 22 people seeking a personal relationship with Jesus as their Lord.  Not long before this trip, a child had been kidnapped, so the leaders of the village forbade the young women on our team from playing with the children or giving them toys or candy, for fear they would be enticed away and kidnapped. That was definitely disappointing to them, but they understood and helped out in other ways.  We did notice that the younger children in particular seemed to stay closer to their parents  than usual.  Consider how you might feel if a group of Mexicans drove into our village, set up a clinic, and our kids were asked to play with them in spite of the language and cultural barriers.

One young woman had been walking to the clinic when she was attacked by a donkey who kicked her in the chest, the abdomen, and then on the side of her head.  Her husband, who was with her, said she was unconscious for about an hour, but was able to walk to the clinic when she came to.  She had a laceration that required stitches, as well as bruises and a lot of abdominal pain.  In the US, she would have had a CT or MRI of the head, and a CT of the abdomen, chest x-ray, blood tests, all within an hour of arrival in the ED.  Here, however, we had to content ourselves with observing her (BP and pulse), giving her some IV fluid, stitching up her cut, and examining her repeatedly over several hours.  She seemed to improve, so we ended up sending her home with instructions about possible complications, and praying that none would happen.

Pictures of children at the orphanage we visited.

Bertha with the newest resident; she was found on the beach.

The day after we returned from the mountains was to have been a free day to go to the beach or to shop, but the team wanted to visit the Orphanage in Puerto Escondido.  We had no formal agenda, but the team members played with, talked with, and cuddled with the children there and were blessed by that contact.

Every night in the mountains, we had meetings in the evenings, and then again Sunday night after we returned.  We were impressed by how tender and touched their hearts were towards the people, especially the children, they met.  They realized the impressive poverty of these children who were often in the same dirty clothes day after day, and who looked on with apparent hunger as we ate our meals.  One of them just wanted to give her plate to them.  They wondered why, by some stroke of luck, they had been born in the USA.  One reported being unable to relate to a friend and classmate who e-mailed, complaining about the color and style of a new car she had been given for her 16^th birthday; this is so totally far from the reality here.  Another noticed that men are served first here and women are very submissive.  It is hearts such as these that God can shape into instruments of life and love.  Guard such a heart for from it flow the wellsprings of life.

Honeoye Falls team with their peers at the orphanage.

When you encounter someone who has been helping the poor and disadvantaged (no matter who or where) he or she will look and speak differently than you remember.  Take several minutes and listen to one or more stories about how God has moved in their lives.

The path from the road to the clinic site. It was steep and slippery!

Dave relaxing a few minutes, with Pastor Lalo sitting in the background.

Our visit to Atoyac this past week prompts a few observations and reflections.  The people’s faces are noble, beautiful, and even regal, despite advanced age or poverty.  They see much, they understand much, they endure much, they accept much.

When a daughter is single, she stays at home in these villages. One woman, 30 years old and with a strong appearing body, presented with symptoms that had no clear explanation.  “How is life at home?”  She responds, “My dad is an alcoholic.  He goes around town and buys beers, and tells the shopkeeper that his daughter will be along to pay for them.  I have to work extra jobs.  He beats me at times.”

A young man, 30 years old, comes in with two small children.  “Why are you bringing them in?”  He responds, “I am helping to raise my sister’s children because she was killed by her husband with a machete.

Meals were served in a nearby home. They were very gracious.

The ubiquitous dust.  When I think my sandals, clothes, nose, eyes or hair have too much, I think of my truck.  After a mountain trip, it takes 5 minutes using compressed air to blow out the air filter.  The dust has been so thick on some of our vehicles that a rancher from Kansas told us that when their truck was spray-painted at a road block, it washed off when the dust was washed off.  It finds its way into the cargo box even when the cap door is tightly closed.

The body lay on the highway on the way home; the motorcycle in pieces on the shoulder.  He was unconscious but with a pulse, and breathing.  He had a huge gash on his scalp that went down across his forehead; the skull looked a bit depressed.  Another large gash went through his mouth, nose, and chin.  His right elbow was open down to the joint; left leg was possibly broken.  He had not been wearing a helmet (we have seen only a handful of helmets during our many road trips).  The white vehicle that had hit him had driven on without stopping.  An ambulance, with a driver,  an armed guard and a gurney arrived; no medical personnel or supplies.  We took a few sheets from our supplies, rolled him onto the sheets, stabilized his head, lifted him onto the gurney and said “GO!”  The hospital was fortunately only 15 minutes away, but to our knowledge it had no one on staff with trauma expertise.  We have no way of knowing what has happened to him.  When do we stop praying for him?

Mixteco translators; theirs is a difficult job!

Bertha and Mary Kay leading the children in "God is so Good" in Spanish and Mixteco.

House calls are always interesting and it is a privilege to visit people in their home.  Here it almost always means someone is terribly ill, possibly in the very terminal phase of an illness.  In Atoyac, the pastor came to us the second day and said there was an elderly man in the village who had been sick for a week with high fever, abdominal pain, and diarrhea.  We gathered up the “black bag”, IV bags, equipment for starting IVs, IV antibiotics, pain medication and trekked over to the house with the pastor and some team members.  It was a tiny, windowless adobe hut.  At the doorway sat an older woman, dressed in traditional Mixteco ie a long, heavy striped skirt and a necklace-she was scowling and would not permit us to enter, saying “He does not want to see you”.  As we milled about, a younger man (his son) appeared, brushed his mother aside, and went in and spoke loudly to his father.  Eventually we were allowed in (only the translator and I)-he was huddled in a corner on a blanket on the dirt floor.  We could hardly see, and it was extremely hot.  He was emaciated and his skin was very warm, and he could barely speak.  We eventually learned that he had gone to the local health center when the illness began, and then went to the local witch doctor, but was getting worse by the hour.  He had quite a lot of abdominal pain and tenderness.  We suspected he was probably septic (ie infected in the blood) , probably from a urinary tract infection, or possibly an intestinal infection.  He was very dehydrated as well.  Though we could barely see what we were doing, we were eventually able to start an IV and gave him two different antibiotics, and also gave him a shot of pain medicine.  We were able to leave IV fluid for a day or so and additional IV meds and oral meds as well.  They asked the pastor with us to pray for him, though clearly the woman did not approve.  She apparently was openly and vocally hostile to the pastor and his church.

As is so often the case, we do not know how he fared.  Hopefully the fluids and the IV antibiotics were sufficient to treat his infection.  Perhaps when we visit the village next year, the pastor will be able to tell us what happened.

Right after the house call, Mary Kay was stricken with abdominal pain and was unable to work.  But she was wonderfully ministered to by the team; they set up a comfortable place to lie down, gave her medicine, prayed over her, and one young woman fanned her for over 2 hours (it was beastly hot in there).  By the time the afternoon was over, she had improved significantly, and by the time we encountered the motorcyclist in the roadway, she was able to jump out and assist the others in assessing him and getting him into the ambulance.   The concept of teamwork had special meaning that day.

We were not allowed to take pictures in this town, so we do not have a picture of his arm to show you.

He showed up before 7AM at the clinic.  He was taken to the morning worship program at 7AM and they prayed over him.  With a large, dark growth on the right side of his nose, he was very noticeable on the bench of waiting patients as we entered the clinic.  In terms of cosmetic deformities that cry out to us for help, his was impressive, no question.  What was it?  Dave was asked by the Mexican doctor, Eder, to give an opinion.  Once past the surprise and shock of its appearance, they began to reason.  Although it had been there for 3 years, and had started very small, it had not made him sick or feverish, although there was foul-looking drainage coming from the hole in the right side of his nose.  Upon a closer look under better light, it was not uniformly black or smooth, as you can see in the photos.  Fungal infection, even Leishmaniasis crossed our minds.  But ultimately, we felt this had to be a slowly growing locally invasive skin cancer.  Dave thought it was a basal cell cancer of the skin that was outgrowing its own blood supply so that skin and other tissue had died off, leaving a hole in the nose.

This presentation is almost unimaginable in the United States.  What happens now?  We don’t know.  Maybe our favorite volunteer plastic surgeon is coming sooner than we know. Meanwhile, the patient has been referred by the local hospital to go to Mexico City (a teeming mass of humanity >12 hours away by bus).  Has he ever been there before?  Is there anyone to take him?  Does he have any money to live on in Mexico City?  I don’t think so. 

Too frequently we see conditions here that could either be prevented altogether, or treated easily at an early stage.  But presentation to us can and does occur in stages in which function is lost irretrievably (even vision), or treatment (reconstructive facial surgery) is not available (distance, time, money, lack of services).

We have e-mailed our plastic surgeon consultant.  Hopefully we can give you an update in a month.  We pray we can help him more.

This lesion was tiny when it began 3 years ago.

Dr. George and team calming child before tooth extraction.

Tuesday, we traveled to Llana Verde where over 85 medical patients and 30 dental patients were seen and 37 accepted Jesus, including the President and Vice President of the village.  And this is following a simple inquiry as to whether they have a spiritual life, believe in God, and want to hear about Jesus.  The people of the town asked for a pastor to come and minister there.  Between Pastor Miguel and Carmella that will be arranged.  Toothbrushes and toothpaste were distributed and some education attempted (though it was a chaotic scene).  Sofia, a Mexican woman with the James River team, was a tremendous asset as she organized some games for the children (mostly boys-girls tended to sit out the games), and tried to keep them in line (ie taking turns, no hitting). 

Team members teaching kids to jump rope

We repeatedly wonder at how God takes a diverse group of 40+ people who love Him, and fashions them into a dynamic body that works harmoniously through hardships, across cultures and languages, and accomplishes good things, leaving its members often in tears as we debrief later.  He is indeed an awesome God.

Dave and Mary Kay with El Mosco children.

Team members on departure day; note workers on roof.

Her name was Maria, and she was 64 years old, though she looked much older.  She was stiff as a board.  At first we thought she was simply awkwardly seated in the sling chair they had given her.  But when her son and son-in-law helped her get out of the chair, they braced her feet on the ground and pulled her up as if she were a board.  They “walked” her by kicking her feet straight ahead (like pegs), one at a time, as they supported her weight.  She lay very stiffly on the bed, and we could see that her teeth were clenched tightly shut, and her neck muscles pulled as taut as steel wires.  She was unable to speak, but could make some noises that her son was able to interpret.  She was Chatino, so they had to interpret for her in any event.

Prior to 3 weeks ago, Maria was very active, did all her own household chores, carried wood and water, and was the Senora of her family.  Suddenly, one evening during the meal, she clutched at her throat, and said she was unable to swallow anything-even water came back out.  Furthermore, she was in a great deal of pain.  Over the next few hours to days, her jaws became clenched, and the rest of her became stiffer and stiffer and she suffered severe, painful spasms spontaneously, and whenever she was moved.  They were able to dribble small amounts of water into her with cotton balls soaked in water.  She saw a couple of doctors who did blood tests and x-rays and were told they could not find anything wrong.

Her sons were very attentive and worried.  She was clearly mentally alert, but unable to communicate very well except by moving her lips a bit.  When we tried to slip a tongue blade through a 1-2 mm space between her teeth, she bit down on it even harder.  Periodically, she would stiffen out her whole body and cry out in pain.

We were looking at “Lockjaw”, or tetanus.  We had never seen it before, but knew it could not be anything else.  Lockjaw is almost unheard of in the US.  However, in 3^rd world areas where immunizations, especially of older people, are often lacking, and hygiene is poor, and shoes are not always worn, tetanus is more common.  It is treatable, but requires special medication, and often ICU care, including intubation and artificial ventilation. The person has to be paralyzed because the spasms can become so intense and severe that the chest wall becomes rigid and will not expand and contract to let air in and out.  Artificial nutrition is also necessary.  That sort of care is available in only a few large cities in Mexico, and needs to be arranged.  We spent a long time with the family, and asked them to bring their other records in the following day while we explored what arrangements could be made with a hospital (closest one being 8 hours away), and how to get her there.  They seemed completely committed to that plan.

We were devastated when they did not show up the next morning.  We had no way of knowing what had happened.  Had she died overnight?  Did her family (with or without her consent) decide that they could not afford the time or money to transport her and have someone stay with her?  Had they not understood how serious her condition was because of our communication shortcomings?  Had they decided to see if she would get better on her own?  Did they seek yet another medical opinion, or perhaps the counsel of a witch doctor?

Are you up to date on your tetanus and other immunizations? Don’t take protection for granted.

We were not allowed to take pictures of this woman.

Mary Kay with Yarita, reading Children’s Bible Stories

When we arrived in Roca Blanca, there was a team from a church in Tulsa, OK that had been doing some medical outreaches prior to our arrival. Their last visit was to an orphanage in Puerto Escondido that we have visited at least once every year for 6 years. They had brought with them Bibles, one for each child with his or her name engraved on it-a gift that took some forethought and planning. The orphanage has had 17 children for several years, though recently added 2 sisters, 2 and 3 years old, as well as a 4 month old infant. The “parents”, Vicki and Octavio, are incredibly loving and caring parents who have instilled the love of God as well as respect and caring for one another. We have seen most of these children grow up from being youngsters 5-10 years of age, to 10-16 years old. One girl will be going off to college next year and is learning English as well. Can you just imagine having 17 adolescent or preadolescent children living under your roof, and keeping your sanity? They are blessed with the equanimity to do so. And now, they are taking on an infant and 2 toddlers as well. They confess they need prayer for stamina and good health to continue their ministry.

We have also seen the facility expand from one story 6 years ago to 3 stories now to accommodate better quarters for the parents, and a class room with computers (some donated by the Tulsa team) for the children to use when doing their homework. They have been very good stewards as well as excellent parents.

After we shared pizza and soda with the kids, the Tulsa team handed out the Bibles to the children, one at a time. They were very handsome Bibles, not all identical, but all engraved with the child’s name. It was very touching to see how pleased, thankful, and yes, reverent, each child was. They also provided 3 children’s Bibles for the little ones.

Children with their Bibles

The trip down – 2009

Greetings to all from warm and sunny Mexico where we have arrived safely, although faster and perhaps more tired because of driving through the night for 34 hours.  The details: We reached Louisville Sunday night and Waco, Texas Monday night.  Freezing rain between Memphis and Little Rock was a threat.  It coated the mirrors, wipers, antenna, road signs, trees – but thankfully the roads did not freeze, even on the bridges.  While driving, we were always anticipating a slide or a spin-out.  We saw ice on bridge railings even south of Dallas.

On Tuesday morning, we left at 7 am to meet 3 other people also bound for Roca Blanca.  They had come from Tulsa, OK and had tried to nationalize a truck (unsuccessfully), and agreed to wait half a day for us so we could convoy to Roca Blanca.  About 3 pm, after getting visas and registering the truck, we set off for Roca Blanca.  They were bent on getting to the base ASAP – including driving through the night in order to hit Mexico City (the world’s largest) in the early morning hours.  We agreed, praying for the stamina to keep up with the younger folks.

Our first worry was soon behind us as both vehicles were granted green lights as we went through customs.  Therefore, there was no scrutiny of our cargo, or even our papers.  Our next challenge  occurred right after a toll booth, when a (friendly) federal police officer pulled us over.  He only wanted to check that we had the proper sticker on our truck windshield and then sent us on our way.  The next challenge occurred in Mexico City about 2 am when we were pulled over again, this time by less friendly city police.  They wanted to see Dave’s license and the truck papers, and then informed us that we had been driving illegally on the inner ring around the city with a truck with cargo.  Between our limited Spanish and their meager English, it became clear we were destined for the police station where our vehicle would be impounded for some indefinite period of time.  We had lost touch with our friends (a blessing in disguise) as the walkie talkie batteries were dead and the other person’s phone had been turned off.  The police had seen them and inquired about the Mexican who was driving an American-owned car (illegal in Mexico).  We told the police he had dual citizenship, and they lost interest in them but seemed determined to take us in.  Finally, we said, “Can’t we just give you some money?”  They quickly responded “yes”.  Since we had just enough pesos to get to the Base, we offered American dollars.  They accepted all our American dollars ($80.00), considerably less than the $300.00 they originally wanted.  Later, at the Base, folks said we had gotten off very well indeed, as Mexico City has the most expensive bribes.

Thankfully, our friends in front of us had kept on driving, but apparently turned off on a side street so were able to see us drive by when we finally were released.   We were blessed with light traffic, and we also had with us the Microsoft “Streets and Trips” program with a built in GPS and we were able to get back on track fairly quickly when we got lost twice, and also to find the poorly marked turnoff to Acapulco.  We soon climbed to our highest altitude, almost 10,000 feet, and the temperature was 33 degrees.  Our gas tank was nearly empty when we finally rolled into the Pemex station.  We wound our way across the mountains with vistas, twisting roads, and beautiful bridges down to the coastal road, and eventually arrived at the base about 5:30 pm.  We had been alternating drivers and becoming increasingly tired, so it was wonderful to arrive and discover that our room was ready even though we were two days early.  We were asleep within a very few minutes of our heads hitting the pillows.

CPR class