Nurse Nancy: January 2017

Sunday, January 22, 2017

Saturday Jan. 21, 2017 India Day #10 – And Day #6 of Surgery – 169 Surgeries at the end of tonight!!!

I had a wonderful 8 hours of sleep & woke up feeling nearly 100% & good to go. I was starving & went & had a hard boiled egg & toast for breakfast. I stood for the bus ride & it seemed less bumpy….I know I mentioned the driving here the first few days but truly it feels like you take your life in your hands when you are in a car here. Lane lines are only suggestions, police let people drive however they want even the wrong way on the road & only intervene if there is an accident. The weaving around truck, buses, cars, bikes etc is quite the maneuvering and obstacle course. I am fairly confident that anyone who visits here would have to hire a driver – driving here is like a crash course with nonstop honking. The dirt road to the hotel fits one car max & our bus barely if any other vehicle is on the road it becomes a standoff as to who will go in reverse.

At the morning Team mtg Valentina (who is all of 23 & the PC for this mission) reminded us to think of the determination of all of these families to get here, to get to us for the help they needed, for their trust in us – complete strangers and when we are feeling tired to think of our own passion & motivation to be here – she is wise beyond her years. I was named “Queen of the Day” if that is because I got sick & then still came in the next day I would happily forego the recognition if it meant no being sick!!! We also got the good news that we have done ALL Of THE PALATES…only lips, hemangiomas & other types of surgeries from now thru tomorrow – YAY!!! Also Sharon the PACU nurse from UK finally got her luggage last night – she was so tremendously positive thru all of that – I don’t think I would have been able to manage & it reminded to pack more useful items in my carry on in case that ever happened to me. With her luggage arriving it was like Christmas – she had decorations for the PACU, treats & toys for the kids.

One table today was a local anesthesia table so those patients were coming off fast – we did have 6 that were canceled because the children were sick & clearly they won’t be better by tomorrow so that is always disappointing. They did add on 3 others so I am sure those people are very happy!

Today I gave away my final clothes, dolls, hats, etc. Moni Jana was my 10 year old patient who got the last doll & t-shirt. So places in India there are 30 kids walking around with CHOC T-Shirts and many with new dolls to love or clothes to wear thanks to the generosity of others -I have the best friends ever!!! Pradeep wanted to be sure I was okay & eating (which I was) but from a “doctors canteen” somewhere he brought me toast…who knew they even had that here???

Here they call the nurses “sister” like they do in Africa – it is kind of funny to be walking & hear someone trying to get your attention& say “Sister, Sister” but it is also a tender reminder that we truly are all brothers & sisters & how grateful I am to be here helping my brothers & sisters in India. One of my patients today – the mom was a nurse & I was curious why as a medical person she had not gotten her son surgery before now. She said she is a single mom, her husband left when her son was born, she pays a friend to watch him when she works 5 days a week. While there is a center in Kolkata that would assist in the surgery but by the time she traveled there, missed work & then returned it would be extremely costly – their needs are work, food, shelter even as a trained nurse – again very humbling to get a tiny glimpse of their lives here. I told her I wanted her & her son to do something special together or get something they needed & gave her some rupee – she at first declined & the later accepted the longer we spoke & as I explained that there are good people all over the world & especially where I live who want to help others n matter who they are & they would want to help her. She was also talking to me about the weather & that there is a monsoon season from May-July with lots of mud and rain. I thought of the village near our hotel and what a good rain would do to their lean to houses and dirt road….

There was glimmer of sunlight when we left tonight which was so nice. Before I came here I had put the global clock for Kolkata on my phone & was perplexed at why it always said (usually at night) hazy, smoky, foggy in the description. Now it makes perfect sense because that is exactly what it is – the air is awful here for so many reasons. I can’t imagine how someone with asthma or airway problems would maange here. In the afternoon my roommate Mayra got sick & threw up once – I was hoping it wasn’t because of me!!! Several people have headcolds & many are on antibiotics. They sent Mayra home to rest which I know is exactly what she needed. When I got home she was resting, I made her some tea, got her some sprite & repaid to her the kindness she had shown to me. Fortunately she only got sick the one time. I went to dinner but want up for spicy curry so I opted for crackers & was quite content.

Karen, Sharon & I (the 3 international PACU nurses) visited out on the patio for awhile laughing about all the events that have taken place this week: some of the interesting physician personalities from India, the challenges that are common on missions and some humorous moments we have had – they have been so wonderful and easy to work with – energetic, competent, team players, compassionate and all around great women & nurses. I hope our paths will cross again sometime J

I got an email from Pres. Sujal the branch Pres. For the area that covers Kolkata – I think we are good to meet on Monday – fingers crossed & prayers that will work out! Time for bed – Good night from India.

Saturday Jan. 21, 2017-India Day #10 – And Day #6 of Surgery – 169 Surgeries at the end of tonight!!!

Saturday January 21st 2017 -

I had a wonderful 9 hours of sleep & woke up feeling nearly 100% & good to go. I was starving & went & had a hard boiled egg & toast for breakfast. I stood for the bus ride & it seemed less bumpy….I know I mentioned the driving here the first few days but truly it feels like you take your life in your hands when you are in a car here. Lane lines are only suggestions, police let people drive however they want even the wrong way on the road & only intervene if there is an accident. The weaving around truck, buses, cars, bikes etc is quite the maneuvering and obstacle course. I am fairly confident that anyone who visits here would have to hire a driver – driving here is like a crash course with nonstop honking. The dirt road to the hotel fits one car max & our bus barely if any other vehicle is on the road it becomes a standoff as to who will go in reverse.

Saturday, January 21, 2017

Friday January 20th 2017 - India Day #9 – And Day #5 of Surgery – 142 Surgeries so far!!! And I am on the mend!

I slept okay last night and didn’t vomit after midnight. I tried to sip sprite & herbal tea when I woke during the night. I set my alarm for six but I was in no shape to go in. Pradeep & Karen came to check on me & brought me some electrolyte packs to add to water – it taste nasty but I forced myself to drink it. Valentina also came in & I told her that I thought if I slept a few hours I could go in later & asked if they would get me at 9:30 – so that was the plan…until I slept until 9:30. I tried to reach them to see if they had sent the car & fortunately they hadn’t so I reset the pick up time for 11 am & was confident that after showering I would be okay to go in and do some work. I felt about 75% of “good” but wanted to go in…I didn’t travel 10,000 miles to hang out in a hotel room & I was feeling much better compared to last night. I got down to the outdoor lobby just after 11 & after 3 calls the car finally came at noon – I think time is very relative in India. It did give me a chance to FaceTime Doug which was nice and Imessage a bit with Kelli & Sarah

My ride in to the hospital during the daytime thru the village was a different sight than even the Sunday we walked thru…with no electricity they are up at sunlight working in the fields, the coal pile & the brickyard – we have seen that when we leave at 7 am & it is actually a bit chilly at that time. In the mornings I have seen 5 women breaking up the coal to fuel the brickyard -I am not sure why it is women doing that – it is quite a sight as they sit on a pile of coal breaking it into smailler peces with a chisel. There is always someone at the well getting water and at times just bathing there right next to the well.

This morning when I left at noon there were women walking about with water carafes or bags of rice or other items in their hands or on their heads. In the brickyard men have what looks like a balance…a piece of wood across their shoulders and equal piles of 20 or so bricks on each side they are balancing as they move them. Such manual labor. I saw 4 or 5 year old children carrying probably their siblings who were naked 1 year olds as they walk along the street maybe while parents were working. There was a man with a manual sewing machine working on something = perhaps that is his business? I would guess that maybe 90% of Americans have not seen poverty like this – I understand the social disparities in the states but this is a whole separate level of survival. Truly our issues while significant are 1^st world problems and sometimes I think people could benefit from a reality check like this to perhaps stop before they rant & complain about so many “problems” in their lives that really might just be minor inconveniences.

When I got to the hospital walking up the 3 flights of stairs to the recovery room seemed monumental – I just didn’t have any energy. They had only seen 8 patients before I got there but it was crazy busy. I managed patients and just sat down more. It could have been SO MUCH worse….really I was only out of commission 18 hours total & 6 hours of work time so I felt very blessed and knew that I was being carried by the prayers of many at home who I know are praying for me & this entire team. We had another bleeder that needed to go back to surgery so that always makes things interesting and chaotic all at the same time. I did not take many photos today & really “bond” with too many patients I was simply trying to do the work that needed to be done. There were 2 Nursing students here again & they were quite helpful – despite the language barrier I tried to explain what we did in the PACU – how we monitored the patients coming out of anesthesia. SO easy for me to go into teaching mode – which I love! They also helped me give away lots of the fun things I had brought J

The last patient I cared for was another Ganesh (must be a common name here) he was 23 years old & he had waited 3 days for his surgery. He was scheduled on Wed. then things got too late that night so they postponed him to yesterday (Thursday) & he was actually on the table still awake when that other patient started bleeding & had to go back to the OR so they postponed him again. Finally he was the VERY LAST patient today & he was so happy to be having surgery – his before & after photos are remarkable & I will try to post them. Another HUGE difference & when I had him look in the mirror he gave me a HUGE SMILE & thumbs up sign. He told the nurses on Pre-Op where he stayed for 2 days that he wanted to be able to “kiss a girl” which made me laugh!

We left by 9 pm which wasn’t bad – it must be a bit “dangerous” on the roads here as when we leave late at night (or any time at night) they lock the “push in door to the bus” (that really doesn’t have a lock) by outing 2 wooden seats in the door area so that is can’t be opened from the outside. One night whenw e were on the dirt road of the village area one person did jump on & push his fingers thru the door but I think it was more of a “thrill ride” however it did make it all the way to the entrance of the hotel & then the guards shooed him away.

I was spent after just 8 hours or so & ready to go straight to bed – others went to dinner – which they start serving here at 8:30 pm??? Pradeep insisted on bringing me some rice & sweet yogurt her got from the kitchen. He is Indian himself (but from the US) so he has made friends with the hotel staff LOL. It was very sweet of him but I wasn’t really up for eating – I had a piece of bread & some almonds for proton – I really messed up not bringing the protein powder I usually go & buy & bring – oops! At this rate I can get 8 hours of sleep & to me that sounds HEAVENLY!!!

While the USA is preparing for the Inauguration of Donald Trump & people on both sides are complaining & protesting and saying hateful and hurtful things to one another I am pretty happy to be away from all of that. I truly believe that if we could all try to love, accept and be patient with each other even as we disagree the world would probably be less volatile and more positive – we have so much more in common that we have as differences and different isn’t wrong it is just different. If in the world different =wrong than whoever varies even slightly from your perspective will always be viewed as wrong instead of trying to understand and accept their perspective. We don’t have to agree but we can always be kind and respectful and LOVE everyone despite their differences. (end of soapbox)

Friday, January 20, 2017

India Day #8 & Surgery Day #4 HUMP DAY…and then I got sick!

I survived being on call again without the need to go in & slept well. I decided to wear my pink scrubs for Hump Day but I was running late so it was yet again a no makeup day (which is almost always for me on missions) but I did put on lipstick & get several comments – makes me wonder how bad I have looked other days???

I tend to go to breakfast every other day & then eat bars the days I don’t go. Today I got creative with breakfast & made an egg & grilled tomato sandwich on this bread stuff they make.

At the hospital I did my pre-op & post op routine. I was in Awe of Ganesh & how transformed her looked. I posted a before & after photo on social media. He & his mom were so very happy! I also saw my friend Karishmi on post op – 2 days after surgery she was doing much better that yesterday & will go home today J Honestly with 30 or so post op families in the ward area I didn’t even recognize those I gave rupees too & that was fine – it isn’t about making them feel indebted – it is a gift to them. The 2 older women also looked fabulous with one bad twist…one of them had paid a man to drive here here. The Op Smile folks assumed they were family or friends. When she was taken from pre-op to surgery that man stayed at her bedspace in Pre-Op and stole all her $$$ (1000 rupee) and all her belongings including her clothes. That sort of put a damper on her surgery. Bashkar was going to reimburse her the $$$ but I asked him if I could please do that & I gave her 4000 rupee or about $60 US to cover her lost $$$, buy new clothes & pay a new reputable driver to get her back home. She was immensely grateful & I told her there are people all over the world that want to help her including some of my friends & we are honored to give her this.

Pre Op seemed to have patients of all ages & as always some real cuties. We had a pretty quick start to the day with the 1^st 4 patients off & into recovery within 10 min of each other but it didn’t seem too chaotic (at that time anyway) We also had 2 Nursing Students & 2 Translators all from a University 2 ½ hours away so the extra people & hands are always helpful. The translator Akash was so sweet to everyone – once we told him the routine & what to say & ask he would just go around talking to all the parents without us even prompting him. One of my early patients was another young family – the mom was 19 (but she literally looked 15 & the dad was 24 – I was able to discreetly give them 2000 rupee with Akash’s help.

There was one little one a 5 mos old age deviation Ghouri & since the anesthesiologists were getting behind on starting IV’s Karen started her IV before surgery – what a great idea!!! She is a Neonatal Nurse Practitioner from Australia & I am loving working with her. I also gave Ghouri one of the blankets & did a good job at giving out some dresses, hats & clothes. The food for the families arrived – Victoria was going to have me go see it so I could take pics of the humanitarian service we provided but that didn’t happen today it was just too busy. It did seem to help though we had less moms come in ready to faint! With a lot of palates on the schedule it was a busy day , plus we had lots of kids screaming as they came out of the black hole of anesthesia & a few we put back to sleep to see if they would wake up happier on round #2, we also seem to have an increasing number of flies joining us in the PACU every day & fanning them off the patients in just the norm.

It was so busy that by 5 pm I had a huge headache because I hadn’t had lunch – I was also feeling nauseous & thought it was because I hadn’t eaten but it all went downhill after that…(no need to read the detail of this paragraph – as always this is mostly for me & I am sure you are wondering why I want the details about getting sick??? It’s a nurse thing) when I went back in PACU I felt worse so I took a Tums, I told Predeep the Intensivist I wasn’t feeling well & he said to take Zofran so I did with no improvement. I was going to go get fresh air (not that there is much of that here) & stopped in the store room with Victoria & told her I thought I might throw up – she said room 122 had a decent bathroom if I needed it & gave me the key. I went straight there but didn’t quite make it & threw up outside the door in the hallway – patients were watching & I am sure they were concerned!!! I went inside & threw up 3 more times. I actually felt better after that & thought I could manage the rest of the night (it was about 7 pm) I retook the Zofran & started Cipro & went back to room 122 & laid down on a stretcher. While I had this issue there was a patient who was bleeding who ended up needing to go back to surgery so that created a lot of chaos for the team. A car was leaving about 8:30 so I went in it & sat next to one of the Jordanian OR male nurses who smoke nonstop & wasn’t sure if I could get thru the 30 min drive with - that smell so I rolled down the window. I felt really nauseous again & prayed I would last the car ride. About halfway to the hotel I also asked to put my head on his shoulder because I literally could not keep it up. I made it back to my room & vomited on arrival 4 more times & was pretty miserable & just laid on my bed. My roommate came in about 10 & was very sweet to me. I got sick again about 11 & vomited 4 more times & by then I had no idea what to do – take more meds etc. So I woke Mayra up & asked her to get Pradeep or Victoria or Valentina. The girls were gone & it sounded like Pradeep was in the shower. She finally got him about 11:30 & he was very kind & said try tea etc. At that point all I wanted to do was sleep. I was achy & miserable & went to bed praying I didn’t vomit again -which I did but just once at midnight. I have only been sick one other day on a mission so I consider myself fortunate & I have no idea wher this came from – food I ate, a virus shared by the little ones I cuddle, who knows but this kind of sick is never fun. I did fall asleep after that & slept fairly well.

Thursday, January 19, 2017

India Day #7 – Surgery Day #3 - 29 cases so 85 Surgeries so Far!!!

I started my day in Post Op & found Karisma – she was definitely less exuberant after her palate repair than before but her mom was so so grateful. I did take a photo of them. In Pre-Op there were some babies, children and young adults…also 2 women one is 45 & the other 47. They were so excited for surgery & wanted to take pics with me & hugged me. I don’t remember them from screening because I was so engrossed in the work & was glad I could see them today. It is interesting – most adults do not smile in photos & are very straight faced – even the school age children. Then when you take a photo of them & show it to them they smile & sometimes I will try to capture a 2^nd picture.

One of my first recovery room patients was Rittika who was 18 mos. Old & weighed 7 kg (about 15 lbs) the kids here are often petite & lean but she was tiny! She also had Dextrocardia & a cleft lip & palate. All we were repairing now was her lip. Her mom put her hands to her chest and bowed as her way of saying thank you or from my heart to your heart– as many have done here. She was very sweet & I spoke to her quite a bit thru Amerita our translator. We talked about the dextrocardia and what type of care she has had – not much. Mom is 20 years old (we have had younger moms) and dad is 24. Neither can read or write and dad is a laborer. The dad wants to learn to be a electrician. After talking to them I felt a strong impression to give them 2000 Rupee = $35 US money. I did it very discreetly thru Amerita & told her to tell the mom that I had children their ages but no grandchildren & friends of mine & I wanted to help them. We folded the Rupee bill very small & put it in her hand. She became tearful and my heart was so full.

On missions I try to feel guided as far as how I can help others & leave a positive impact on the area I go to – I think I have found my direction here & perhaps I will be helping families one at a time just like we change their childrens lives one at a time. 2000 Rupee is about 2 weeks wages and they are likely missing one week by being here. We took a photo together & the she left the PACU.

It was WAY MORE chaotic today than yesterday & I’m not sure why? The Indian people talk very loudly so if their child is crying unlike other places where you might talk softly to comfort them the parents are really loud & almost screaming at them or so it seems. We have been trying to encourage them to soothe them softly – sometimes it works & other times not so much.

We had more moms today who were distraught & nearly passing out despite Child Life showing them photos etc. They simply have no context of surgery or hospitalization. Claire the Child Life & I were talking that maybe when the child goes back the parents have to eat something before they can go into recovery room. I was able to talk to Bhashkar the local PC & offer to get food items for the moms. I then found out is was a bigger issue. Op Smile is feeding the families at the shelter and has a budget to feed the people in post op but there are many more people than expected & the daily food is running out. Earlier in the week I had asked if there were needs I could help with so they came & said it takes about 9000 rupee to feed everyone here in pre/post op for a full day (about 120 adults if 60 patients have 2 people with them. So with the generosity of friends I offered to cover the last 3 days of food that they wouldn’t have had because they have had overage charges from the people who make the food every day. Again I never thought that I would be instrumental in feeding the patients families in the hospital but I am excited to do so! People who are laborers (the ones I saw in the village at the coal mine, brickyard & in the fields earn about $2 US a day. They mostly eat rice & lentils. In fact when the older kids wake up & we offer them juice they often ask for rice – so funny! For fresh fruit 6 mandarins are 50 rupee or 1/3 of a days work so fresh fruit is a luxury.

Later in the day there were 3 more families I gave rupees to. I explained to Amerita that it was not based on anything in particular but if I felt prompted to do it I would & they didn’t need to be the patients I recovered they could be any of them but I wasn’t sharing the info with anyone but the interpreters. One of them was the family of Ahmat Raza – it had taken them longet to get here o they just arrived yesterday – the child was screened & fortunately was placed on the schedule today. Mom is 22 & dad is 28, they too are illiterate & the mom was so distraught that the aunt came in recovery to be with the patient & told us of their journey to get here-several days & many challenges. I was hoping the money would help them travel back more easily.

Because of the demonetization there have been issues with the scrub techs & nurses at the hospital not showing up because they haven’t been getting paid. Usually the hospital provides some of these folks to round out the team but that has not been the case here so there have been some challenges but we have not experienced it in Recovery – there are 3 of us international & 1 in country RN Sarita.

By 2 pm we had received 14 patients & were half way there. It seemed we had more flies in the recovery room today – I am sure the open windows, food, blood whatever attracts them? Sharon cleaned our bathroom in the PACU like no other – I am pretty sure it is the best one in the entire hospital.

As I walked patients to post op I noticed the families lining the hallways sitting on our flattened cargo boxes that were outside the storeroom – I asked Victoria if that was the intent & she said no people just started taking them so they weren’t sitting on the floor – necessity is the mother of invention – cardboard mats for all!

We had high hopes that we would get out earlier today but that was not to be – we did some fo the older lip patients so bigger lips & patients=bigger problems. The older women looked totally transformed – I cant wait to see them in post op tomorrow. The highlight of the evening was Ganesh – I posted a pic of him & will do a before & after when I can. He is developmentally delayed & lives far away. They found him as part of the recruitment campaign. He was ALWAYs smiling ear to ear even with his cleft lip. He is very bonded to mom because of the devel delay & the lip. They have been inseperable his entire life. I didn’t find out if there was a dad in the picture. The OR folks had mom go in with him for anesthesia induction & then we had mom in the PACU as he arrived to us. He did wake up a little crazy & mostly wanted his IV out. We showed him in a mirror himself & he just stared – not a dry eye in the PACU

We left the hospital at 9 pm & there was one pt left in the PACU. I was on call again so Sharon said shed stay. Pradeep the Intensivist was on the bus with us – not sure why as typically the PI stays until the last patient is gone & as luck would have it about halfway back to the hotel we got a call that the patient was vomiting & in pain – so we turned the bus abound – not an easy feet on the roads of India & went back. We finally got to the hotel at 10:30. I had a really scratch throat – not sure if its from the chemicals in the hospital, the Sevo gas or the smoke but my throat was reacting & all I did was shower & go to bed

Tuesday, January 17, 2017

INDIA Day #6 - Another 28 Surgeries wow!!!

After going to bed at 11 pm last night there was someone knocking on my door at midnight…it was Mick the PC which is when I realized I was on call!!! And that I had taken a Benadryl to help me sleep – which is not a good idea when you are on call. I sprung out of bed, pulled out my earplugs and answered the door. My roommate was also on call for the OR – Mick just wanted to let us know that we “might” need to go on for a “surgery go back”. I am not sure why she felt the need to wake us up to tell me we “might” need to go on??? Fortunatley she never came back to say “we are going in”. I also had a CRAZY dream about CHOC – I am 10K miles away dreaming about work – it was very detailed too??? And then of course 6 am came quickly.

My routine when we go to the hospital is I go to the pre-op ward to see the patients for today, the post op ward to see yesterdays patients & then the recovery room for set up for the day with our team. . Today when I walked in a little girl Karishma that I had seen & played with at screening day ran up to me & grabbed my legs then when I bent down she threw her arms around my neck & melted my heart!!! We took a photo together that I posted in one of my collages today. She is having a palate repair & I am guessing will not be feeling too well this afternoon. I also saw some other cute babies & there are a few 8-12 year old girls all having surgery today. The 1^st 2 days of the mission they are doing the people who are from farther away 300 KM so that they can get back to their villages & work since they all have “day wage” jobs and a day away is a day without money.

In the post op ward the kids get “Smile Bags” & inside is a toothbrush & toothpaste, a mirror to see their new smiles & some little toys. It is crazy to think that most of them have never seen much less had their own toothbrush no matter what their age – from their excitement you would have thought we gave them new Ipads!

We had a student translator in the recovery room today which was a HUGE help so that we can communicate with the parents and the patients – her name was Amerita – she is 19 & studying communications at a university – such a cute girl & tremendously helpful. AS the day went on she said to me when we were brining moms & das back to comfort the kids – “you know that female family members (mom, aunt or gma) know the baby more” I think that was her reference to “maternal instinct” J

Our first 2 lips back were perfect angels –one little one I gave a pretty pink blanket to – she was cared for by the grandma & dad as the mom left when the baby was born with a cleft becuae she felt guilty & that it was her fault. That is so sad to me for both the mom & baby & now that baby is perfect today!

One of the families I saw this morning the baby came back & was fussy so we brought the mom back & she was good for about 15 min & then looked like she was going to faint – I had Amerita talking to her – I was gently slapping her face, getting a cold cloth, gave her juice & a cookie then got her husband & finally she was okay. She told us she had not eaten for 3 days because of “tension” for the babys surgery. We later found out that was not uncommom & it wasn’t just “tension” but also their way of believing that by sacrificing eating themselves (fasting) their baby would have a better outcome. I am all abut fasting & prayer & know it has a great impact but 3 days was too much for these young moms who were also very stressed.

Karishma my little friend came back about 1:30 pm - & she was not very happy but did well. I am sure some of these kids have no idea what is happening to them – it is scary & painful & unfamiliar. The parents are all so grateful – some are expressive & others are more somber/stoic. But in many instance you would think we handed them 1 million ruppe whenw e show them their baby for the first time – it is so joyful for them & for me.

I made contact with Pres. Sujal from the LDS church & I am going to meet him on Monday before I fly out. We also found an orphanage near here that needed food & medicine for the babies & one of the mission team is helping get that tomorrow, I was also able to get blankets that were needed for some of the children here…all things I can do because of generous friends who send me with their offerings & tell me to “find ways to do humanitarian work that is needed”. I am always amazed when opportunities appear before me that I had no prior plan for….and grateful to help the people her ein India who live in such desperate poverty. What a tremendous honor it is for me to be the conduit for good because of so many others. I am blessed to see it firsthand and be the legs to get the work done but they are the ones who are causing the opportunities to come forth of that I am certain.

It is again late & I have another early morning – not a lot of deviation from my “mission routine”. This is work I feel so grateful to be able to participate in – I can’t imagine a time I would welcome this intensity or be able to manage it but I know I am being blessed as I serve. I am grateful for the internet to get this posted tonight & get caught up. I was also able to facetime Doug tonight. So all in all it was a wonderful day!

India Day #5 - First Day of Surgery - 28 new SMILES!!!

I have been sleeping well just not getting enough sleep I think so 5:30 seemed quite early as far as a wake up time!!! Breakfast was at 6 & since I was a bit tired of curry potatoes, tomatoes & boiled eggs I decided to try an “omelet” which I found out was really just eggs with a lot of spicy green peppers in them-in my mind a 10/10 on the spicy scale!!! A protein bar was great & I won’t try that option again!

There was no internet at the hotel this morning so I couldn’t connect with home or upload my blog – but I know lots of family & friends are praying for me so I let that carry me as I started my day J I truly am “off the grid”. I purchased Verizon coverage for India & had it in Delhi & Kolkata but not here!!! My phone just says No Service…

When we got to the hospital I went in to the pre-op area to see the children who would be having surgery today & coming to us in the PACU. What I saw as the empty pre-op area wasn’t a lot different than this morning except for thin mattresses on the cement floors & a blanket for each parent & child. Because of the culture here only moms could all stay together in the pre-op area with the children. I know some patients had dads with them as the primary parent so I am not sure where they stayed??? It was a busy place there this morning but I did get a chance to snap a few photos.

Right after that we went to finish setting up the PACU – seriously this might be the nicest PACU we have created yet!!! Just because since Op Smile has been out of India for years (ling story) and couldn’t ship in regular cargo like usual we had all new monitors – 5 of them that were beautiful, new resuscitation bags, and the new crash boxes we had put together. We also fit 5 beds in there which was good because several times today all 5 beds were full!!! We have a great team – Karen from Australia, Sharon from the UK & Sarita who is a local nurse (there is a bit of a language barrier there but she is sweet). I told Karen she is the PACU Charge Nurse. I am in charge of all sorts of things at work every day so here I just want to be a “Real Nurse”. I was however given the responsibility of the PACU walkie talkie.

We did the mock code per protocol & Karen made hand off report sheets for us to use when patients leave the recovery room to post op – we are all about quality here & inside the PACU you would never know that outside the PACU we were in a 3^rd world country.

We got our first patient at 11 & then 4 more within the next 5 minutes – so goes the feast or famine chaos of the recovery room. And it was complete chaos because despite all of our new great equipment we are lacking in our normal pain meds & the hospital didn’t want to allow us to bring parents back to comfort their children….we dealt with that for the 1^st 6 patients then deemed it unacceptable as patient #7 had bad emergence delirum from the anesthesia so we brought that mom back & started bringing parents back as needed for the rest of the day/night – it ALWAYS makes all the difference in the world. Moms & Dads can calm their children in ways even wonderful caring medical staff team members can’t…

One mom I brought back was overwhelmed when she saw her baby with a repaired bilateral cleft lip & looked like she might faint so with a translator I asked if she was ok & she told me she “was weak with relief and had praises to her Lord Jesus Christ and appreciated us” that gets me every time. I am not sure how many Christians are in India but clearly she was one J

By 1 pm we had seen 9 patients and found out 3 cases were canceled because the kids had colds or fevers. We are hoping they will get better before the end of the week & can be rescheduled. Throughout the day we had many more hours of chaos. I was able to start giving away some of the clothes & dolls & blankets, hats etc I brought. I am kind of rationing it a little for each day. People are so grateful even when you just give them a pair of socks….such tremendous needs for so many things exist here.

In the afternoon when I was walking patient to post op one of the surgeons had just called for a baby & was taking him into the surgery door & the mom of the baby fell to the floor wailing…the dad & grandparents tried to comfort her to no avail & it made the entire area very intense. I worked my way thru the crowd to get to post op. Later in the day I heard that the moms reaction was because she thought she would never see her baby again – this whole process is so foreign to these people. It was towards the end of the day so I don’t remember if we brought the mom back with us or who she was but I am certain she was glad when all turned out well at the end of the procedure.

We did 28 surgeries today – not bad for a first day and we finished & were back at the hotel at 9 pm so that was nice. They had dinner available but I had a tuna pack about 7 so I was fine to come to my room for a little down time. We had 4 palates today & 21 lips so since lips are a lot easier it made our pace nice. Tomorrow we have 14 palates – so we know ahead of time there will be LOTS of screaming & chaos…but that’s what we signed up for & it’s a small price for a great outcome. I realized I went all day yesterday without going to the bathroom…usually I base my fluid intake on the status of the bathrooms – there are “squatty pottys” here but they aren’t that bad – I think I just didn’t hydrate so I need to be better about that to stay healthy. I am taking my “On Guard” essential oils pills a friend at the hospital gave me so that’s good!!!

I am headed to bed it is 11 pm & 5:30 will come quick again. Hoping I can post this in the morning or if not then tomorrow night. Love & Miss my family & friends but feel their love from afar. Goodnight from India!!!

Monday, January 16, 2017

India Day 4 – Hospital Set Up & a walk thru the Village of Uluberiya

Namaste from Uluberiya India

It was very nice to get to sleep in until 7 am!!! We had breakfast which here is potatoes in curry sauce, toast, broiled tomatoes, boiled eggs, lentils, a creamed pasta & some variety of meat that never looks very appetizing. Another ting I forgot was the “interesting meals”. At breakfast we found out we weren’t leaving to go to the hospital for set up until 9 which is what gave me time to get my blog post from yesterday. We headed to the hospital for set up & we have a great space for the recovery room. We had to move out alot of stuff – an old Xray machine, some old gurneys, and boxes of supplies. We will have 4 beds & a bassinette for the little ones. Since most of these areas of the hospital haven’t ever been used because of the patient funds Op Smile pays the hospital I think they bought all new beds for the post op area, mattresses for the pre-op area & we got some bedside tables. I have never had “new stuff” on missions. The ORs were a little different though...the one that is being converted from a storeroom is still “under construction” with holes in the wall & ceiling!

We have a bathroom in the recovery room & we opened the door to it & immediately the smell bothered our eyes & throats. We found out that they were storing the fumigation machine in there??? I have no idea why but we immediately closed it & let the hospital people know. They removed the fumigation machine and we are hoping that they will open the door & let it air out overnight. We finished by 2 or so & came back to the hotel. We were supposed to have “Team Day Activity” at the hotel but there were still quite a few people at the hospital finishing up charts etc so it never happened which was fine. Karen & I wanted to walk the little village here on the dirt road – Uluberiya. A few of the younger girls on the team asked the front desk people about going & they said it was dangerous & you weren’t allowed to go & needed to take a man etc but earlier the anesthesiologists had gone & said it was fine. Karen & I decided to go on our own very discreetly, we felt safe, it was the middle of the afternoon & I have been in far more dangerous countries. Andrea saw us leaving in stealth mode & came with us too.

What an utterly amazing experience to really see how our patients live…it was “good weather today” so many had come down to the river for bathing. There is no running water in the village – there are 2 wells. Seeing 20+ people all bathe in the river was reminiscent of Ethiopia. As we walked we felt very safe – there are always a few sketchy people but it was mid day & fine. Seeing their “homes” up close was much more heart wrenching than driving by on the bus. They had cemest bages being used as “curtains” over windows, corrugated metal as a roof & a makeshift door of any sort made a home more luxurious. Most had openings (doors/windows) you could see right into their space. They gather & chop wood that they then place on top of their homes to dry out & use for fires. There are cowpies they hae made everywhere drying in the sun that are used for fuel & some on houses used for insulation. In this town there is a brickyard where some people work & fields where others work. The saddest sight was a coal pile where a woman was breaking up coal that is used for heat in the brickyard. There were 2 girls at the well getting water for their family & another place where tiny children (maybe 2-6) were playing right by the fire, by the road by a pond of water…at home we would never let our kids play alone near one of those (open fire, body of water & the street) let alone all 3 at once. We saw some people with goats near their homes & an older woman moving her 3 cows thru the road. We said hello & some of the kids in the village followed us as we walked around – we tried to talk to them but they were very shy. Other women & children came out of their huts I am sure to see the “white people” we would wave, smile & greet them. Most here speak Bengali (which none of us speak) and the national language is Indie. We met one father with 4 children & engaged with them in sign language for the most part & took their picture. Bikes seem to be a common mode of travel after walking, then motorcycles. The only cars are taxi types that aren’t in the village. There seemed to be general poverty but also a few levels within that – huts with dirt floors & some with brick floors we saw women sweeping. Different types of roofs & walls. Despite what we all would consider “terrible conditions” they looked happy and seemed content with their lives in this little village despite all the hardships we could identify –perhaps because this is simply the life they know. It does make me wonder what they think when they come to the hospital? And some things are the same – closer to the hotel by the river where people came to be for the day there was a man on a bike with a cooler selling ice cream for 5 Rupees (about 8 cents) & a mom buying 4 children ice cream. Like our trips to the beach they had carried with them chairs and blankets and food and sat by the river. There were men out fishing on the river. In time it became less and less shocking as we looked past their circumstances and just saw them saw them living their lives as families & as a village. I think of talks I have heard about being ‘grateful or cheerful in any circumstance” and this was a very visual lesson for me today. I truly have absolutely nothing to complain about and so much of what people in the states are concerned with are all 1^st world trivial problems when you take a global perspective. How blessed are we in the United States and how much we have to give of our bounty.

We came back & had some time before a 7:30 dinner & mtg so I started to get things packed & ready for the first day of surgery tomorrow. It is looking like we will do between 180-190 surgeries in our 7 days – it seems unbelievable that this team will change so many lives in one week! Tomorrow will be another long day. Wake up call at 5:30, breakfast at 6 leave at 6:30 to be at the hospital by 7. The days will be long & the work challenging but I am so grateful to be here & use the talents I have developed and been blessed with for good. Our Recovery room group seems wonderful -we all set up today & Karen is ultra-organized so I love that – we are set for a great week! I miss my family but was able to skype voice call Doug tonight which was nice – even at the hotel there is no cell service just intermittent wifi. It’s now 11 pm & I need to get to bed – hopefully I can post this to my blog in the morning.

***Alas there was no internet this morning so I am posting this Monday night my time & hoping to write & post todays blog as well :)

Saturday, January 14, 2017

India Day #3 Screening Day 293 Patients seen & an 18 hour day!

I am writing this blog post the next morning because by the time we got back to the hotel it was 11:30 & all I wanted to do was sleep!!! The day started at 5:30 am to get up get my backpack packed for the day and be at breakfast for the Team mtg at 6:30. Our hotel is on a river (not sure which one???) but there was actually a beautiful sunrise over the river. We are thinking this is a place that folks in West Bengal India might come to have a “staycation” there is a pool, playground & it is basically tucked away far from anything except for the little village that is on the road to the hotel & a brickyard that I assume most of those people work at??? It is not bad at all and pretty typical for mission standards. The things that make you realize you are in a 3^rd world country are all the same – hot water that is in a small maybe 5 gallon “water heater” in your room that you turn on, after about 20 min you hope it has eated up & then quickly shower before you use the hot water. The towels are pretty gray and very thin and small so one little miracle is that I packed a towel on this trip – I have NEVER before brought a towel on a mission and boy and I glad I did here, so that was a bit of a divine inspiration!!!

We left for the hospital at 7ish (time is relatively fluid when moving with a large group although they do like to keep a tight plan). When we got to the hospital there were about the same # of people waiting, we went inside for our team meeting & then started getting set up for screening. Valentina the Program Coordinator asked me to be the “Gatekeeper” which I have done on several missions – it’s a lot of work & organization but I am fine to do it. Our Clinical coordinator is even more organized than me so she had a very structured system I just needed to learn – color coded just like my 5 color highlighter – it was a match made in heaven!

It takes awhile to get all the stations set up – intake where their chart is started, PIT where pre surgery photos are taken, Nursing where a medical history is done & vital signs, the they see the pediatrician, surgeon, anesthesiologist, speech therapist, dentist then Gatekeeper & we send them for labs if they will likely have surgery. Since the gatekeeper is the last station & it is typically a slow start I don’t see my first patient until 1-2 hours after screening starts which gives me a chance to go out & be with the patients & that is what I LOVE the most. SO SO many beautiful children with moms & dads & grandmas, very humble people. We are at a decent private hospital but one that isn’t completely finished so wires coming out of walls & ceilings, light fixtures are minimal and on our tour there are no beds in any of the rooms we will use so clearly we will somehow do a transformation, I was told that typically in ths are only 1 in 10 people have ever seen a doctor in their lives – 10% so if only 10% have seen a doctor clearly even less have been in a hospital – probably why this hospital has not been used much in the 10 years it has been here. Also for most of these kids this will be their first “medical experience” with a lot of strangers who don’t look like them! But outside in the waiting area they were fun to see & hold & as always bubbles & stickers are the great equalizers – they follow you around like the pied piper when you have those. SO SO many little cuties & LOTS of cleft lips in little ones, school ages, teens (who mostly wear a scarf over their face to hide it) & adults. This will be an AMAZING 10 days changing so many lives so simply. I took a lot of photos while I was outside & posted them on Facebook & Instagram – I really need to increase my technology skills & figure out how to put them on my blog in real time – maybe next mission??? Also while I was outside 3 vans/buses showed up with patients – it was like the clown buses as I watched I could not believe how many people came out of each bus – that definitely increased the patient # & chaos.

We didn’t get our first patient at Gatekeeper until 10:30 or so 0 3 of us were there at that station – Mick the CC, Karen another recovery room nurse I will be with all week who is from Australia & me. They would look at the charts for completion, one of us would write out a card to be used for the schedule and I wrote every patients info into a master log.

It was after 11 pm when we got back after having gotten up at 5:30 it made for a long day – I posted a few photos to social media then went to bed. I didn’t fall asleep right away even thought I was exhausted – just too many things to think about, faces to recall & mostly an overwhelming sense of gratitude for the opportunity to be here with this team and make a difference in peoples lives.

Today we will go back & create the Operating rooms & recovery room. The hospital has 2 OR rooms & we will put 2 tables in each room & we are also turning a closet into an operating room & a Drs lounge into an operating room – that should all be interesting. I haven’t heard anything about the recovery room – more to come after we see it! After set up is done we will have a “team day” which should be interesting as there is absolutely nothing in this area – someone said we may play some games. It is really just about bonding together before we start working together in an intense environment. More to come.

Friday, January 13, 2017

India Day #2 Delhi-Kolkata-Panskura - What a Day!!!

So after all the delays in Newark my flight to Delhi wasn’t too bad – it was however completely full!!! And one of those passengers was George an Anesthesiologist from OSI I have worked with before. It was great to see a familiar face & have someone to travel with thru the foreign airports. I was trying to figure out when to sleep on the 15 hour flight. They served a meal right after we took off so I ate that, watched one more movie and then took a sleep aid to help me sleep & it worked!!! I slept about 6 hours I think then rested off with music on & on as best I could in an airplane seat. After all the delays in Newark we only had about 2 ½ hours in Delhi & we needed all that time to get our Visa’s, get our luggage & unfortunately the handle on the bag I was planning on coming back with was ripped off – the other bag I brought to leave was missing a wheel that I was bit bag handicapped! We also had to change money, recheck our luggage and get the domestic boarding pass then go to a new terminal that was really far away & by then it was 20 min til boarding. And all of this was between midnight & 2 am India time – but my body had no concept of time. The 2:30 am flight from Delhi to Kolkata was also completely full??? And resting on that flight was less successful. They also served a snack & proceeded to wake up every person who was sleeping ask if they wanted food. I have no idea why?

When we landed in Kolkata we got our luggage & went out the door & were meet by Valentina the PC for this mission who is delightful!!! She had been at the airport pretty much 24 hours straight getting all the team members arriving & still had 2 more after us. Also about 4 people had not gotten their luggage – that hadn’t even entered my mind so all of a sudden I was grateful for my luggage arriving albeit a bit broken. It was 5:30 am when we got to the hotel. I tried to enter my room quietly to not wake my roommate & even thought I was so tired the honking & beeping of cars on the road outside was nonstop. I did fall asleep thought & slept til 9 am. I showered & got ready for the day & actually felt pretty good, had an interesting breakfast…curry was on the menu but I ate a boiled egg & some vegetables. Vivian my roommate & I decided to go exploring in the few blocks by the hotel – I wish I could capture all the crazy sights & sounds-it is very over stimulating! There was a block where people go their “meat” fish, chicken or lamb (beef & pork is outlawed which makes me glad I got thru customs with beef jerky in my bag!). It was pretty gruesome – the poor chickens in the cages had no idea they were going to be killed as soon as someone bought them! The next little alleyway had all vegetable sellers – that was more my style & always is so pretty. We also saw a place where about 10 kids were lined up in uniforms & then a few minutes later they walked in – it was their school for this neighborhood. We asked if we could go in & the teacher said yes – she was so sweet & explained what they did it was grade K-4 with about 100 students and 2 teachers. School didn’t start for an hour but the kids who were there always came early from where they lived because the brick building is “better” that the lean tos they live in – but they all had uniforms? I asked her about supplies & she said they were meager they could use paper, pencils etc so I asked if I could give her some $$$ for these children – she said yes but I needed to talk to the head teacher – she was the assistant & so I did & It all worked out. I was so happy that because of others generosity I can be led to help those who I don’t even know. We were supposed to start our drive to Panskura at noon but things were delayed and we left at 1:30. We went in cars in groups of 6 & I ended up with the guests/volunteers from Stryker (a medical company) They were super nice & are only here for the first few days. It was about a 2 hour ride…the road to Panskura with lots to see along the way. It reminded me quite a bit of Ethiopia – donkeys pulling carts or bicycle carts, lots or small cars and even buses overflowing with people. Small roadside stands selling fruit, snacks, corn. Women and men carrying baskets on their heads & bushels of thatching, lots of dogs in the streets and an occasional cow (which is sacred here) or goats. The biggest difference was the absolutely CRAZY DRIVING that includes non stop honking. I am not sure if people get any drivers ed here but if they do I am pretty sure honking all the time is said to be ok and almost hitting other cars or people walking or on bikes is pretty normal.

We got to the hotel at 3:30 & were greeted with a magnolia lei – it was so nice! We had to be ready to go to the hospital at 4 so not much time to unpack. The hotel is off a dirt road & is right by a river. We are guessing this is a place that people from India come for a “getaway”? The rooms aren’t bad – aside from the lizard in our bathroom & the toilet area & shower are one in the same (think RV). The drive to the hospital was about 30 min. MY roomate is Marja – a surgical nurse from Sweden –she is really nice! It is a newer private hospital that was built about 10 years ago & never fully finished & not used much - possibly because only 1 in10 people here has ever been to a doctor in their life so with only 10% seeing a Dr less are ever hospitalized.

As we drove thru the gates I was overwhelmed to see hundreds of people already waiting there – which is not an unusual sight on screening day but this was a day before – we were only there to tour & for logistics & all these people dressed in beautiful colors with smiling faces and children who need surgery. They had already traveled from afar & were there hoping for help…that sight will never stop taking my breath away. Before we left we were able to visit with a few of them…there is a language barrier but the eyes tell a story of love & the people of India are beautiful people!

We had time to get settled into our room before our team mtg & dinner & about that time my jet lag was in full force. I am making myself write this so I don’t forget – but I am sure I did miss a few things. I will post it to my blog in the morning because the only place for wifi is in the outdoor reception area of the hotel so I am not going down 3 set of stairs & out there tonight. There is a party going on at the hotel with music ouside you can hear clearly in our room but I am so tired I think I will be fine. Hoping for a good nights sleep – they say we will likely screen 350 children tomorrow & with parents or siblings that’s about 1000 people moving thru the process. Gearing up for a

Wednesday, January 11, 2017

En Route to Panskura INDIA - Op Smile Mission #12

So I am sitting in the Newark airport and about 1/5 of my way to Panskura India. Just so I have this record for myself here is how I got to today. My last mission was in March & then I was busy with a family vacation, Sarahs wedding and life in general. I was hoping for a mission in the fall - it is actually HARD as a Recovery Room Nurse to get on missions they have way more volunteers than needs on missions so it is a bit of good luck when you are able to secure one. I contacted everyone I knew at Op Smile & was SO EXCITED to be asked to go on a mission in November in China. I started making contacts with a friend there & got my visa etc & then about a month before the mission it was canceled. I was super disappointed knowing I couldn’t fit a mission in during December & wondering when I might be able to go. Fortunately the coordinator for the China mission said she would try to find me something and a few weeks later she called & asked me to go to India. The dates worked so I said yes without hesitation and in hindsight I was at home & where I needed to be in Nov. for some important events & family needs. I LOVE how things often work out as they should. So now it’s January & here I am on my way to India.

The last 2 nights were late ones, 2:30 am Monday & midnight last night packing & getting ready – as a result of the generosity of friends my largest 50 lb suitcase is filled with stuff for the children in India – about 20 dollies donated by Dollies for Daughters, 14 dresses made by a friend of mine, 30 CHOC t-Shirts, 10 blankets, 10 knitted caps, some books I bought,10 little boys outfits, lots of socks, dollies donated, and in full disclosure some for for me. I am not a curry or mutton fan & I have heard that is a staple there – so it’s tuna, peanut butter, protein bars, beef jerky and snacks for me for the next 2 weeks – I may try things but I need to stay healthy to do my job.

Doug took me to LAX this morning and 2 movies later the first 5 ½ hours of flying are over & I am in Newark. I got a pass for the United Club so I enjoyed a few hours there then headed to the gate. My flight was delayed an hour but I knew that this morning & all it did was decrease my 5 hour layover to 4 hours in Delhi. I went to my gate at boarding time & had a mini heart attack – you had to have your Indian visa to board the plane – I had my visa application complete with barcode & photo but they wanted the email saying it was approved. Fortunately I have a great assistant at work who helped me sort thru the 15 emails & attachments I had & she did print the “VISA APPROVED” email for me & they signed off my boarding pass but I was panicked for a few minutes and could not imagine what I might do if I was stuck in Newark & missed my flight & all the rest of the transportation BUT crisis averted!!! Then at the gate they told us that the pilots had “timed out” of their flying time so we are now another hour delayed while they get us a new crew. Again I am fine – and pretty certain that waiting in the Newark airport is a better option that waiting in the Delhi airport.

This mission travel I think is the longest ever for me…25 hours of flights 8 hours of layovers and a 13 ½ hour time difference (I have no idea about the extra ½ hour time zone but that is what I am told!) I was fortunate to get economy Plus & those extra 6 inches do make a difference although I dream of the day I can be in a full bed recliner in Business Class!!! So the next flight is 14 hours to Delhi – I am trying to figure out which of those 14 hours I should sleep to try to get on the Indian time zone – I will let you know how that goes…..now I think I will only have a 2-3 hour layover in Delhi then a flight from Delhi to Calcutta (or Kolkata) where I arrive at 4:30 in the morning on the 12^th & the team leaves that day at noon for a 3 hour ride to the rural area of Panskura we will be. I have tried not to think too much about the travel or it is overwhelming!!!

This mission is longer than the usual and it is being done in partnership with Inga Health in Mumbai India & is called the “Future of Smiles” mission. – Op Smile has been out of India for awhile so they anticipate a “backlog” of needs and we will do 8 days of surgery (typically it is 5) I am good with 5 & just a wee bit worried about 8 as the days are long like 5 am -10 pm then try to be in bed by 11 or midnight & do it all over again but I always manage 5 days & will just take the extra days one day at a time & KNOW that I will be lifted & carried by the love of the work, the lives being changed & the prayers of many friends & family at home. I believe the goal is 175-200 surgeries??? That’s is A LOT of lives changed & my heart just swells thinking about it!

Of course I have had Zero time to even figure out what I need to know about India – it is a very impoverished country, and last November the Prime Minister there demonetized the 500 & 1000 Rupee bills which I was told accounted for about 75% of the bills in circulation so there has been a huge financial impact on the people there who already struggle – it is so sad. I cannot imagine the government saying that US $50 & $100 bills now have no value??? We really are blessed to live in the USA. Panskura is a rural agricultural area & the primary income is from farming. I have contacted some folks from my church there and in Calcutta there is a small congregation of 20 people. I don’t think I will see them on my way into the country based on my travel but I am hoping to connect as I depart. I have also reached out to a CHOC nurse who has a non-profit there that feeds & bathes the railroad children (orphans) and am trying to figure out when we can connect.

I am posting this intro to my mission now because I am unsure of my wifi resources in Panskura. We are told there is wifi in the lobby of the hotel but not the rooms & it is spotty – so I am hoping to be able to email & blog. It sounds a lot like Kenya where the lobby had wifi but it went in & out & I spent late nights in the lobby doing my blog/journal

Despite the travel, the uncertainty of where I am going & what it will be like I am so so HAPPY to be able to go & serve these people who I have yet to meet & who I know I will fall in love with. I am so blessed to be supported and encouraged by Doug, my family & so many on these missions – I so appreciate all the love & support I get & feel like I take a little part of my family, friends & CHOC with me when I go….I know there are many who will be praying specifically for me & for the team & patients & families & when times get tough I will draw on that for strength. On the plane I saw a young girl with a journal & on the front of it was the scripture Phil 4:13 I can do all things through Christ who give me strength. That will be one of my mantras this mission. Time to get back to the gate for the flight to Delhi I am off again to “Change Lives One Smile at a Time”

Nurse Nancy