A moment of reflection in Santa Cruz

Written by Jodi Grahl

The Oncological Surgery Team is on day four of its eight-day Mission Trip at the Cancer Institute of Eastern Bolivia in the city of Santa Cruz. On Sunday, we met with our partner physicians to finalize the five-day surgical schedule. On Monday, we completed the first three surgeries, including two laparoscopic hysterectomies for women with cervical cancer and an excision of multiple neurofibromas in a patient with Von Recklinghausen disease.

Before heading to the hospital this morning, Lindsay, our team chaplain, gathered us for a moment of reflection. She invited us to recall a moment that had a particular impact on us over the past few days. Part of me resisted. As trip leader, I generally prefer to just keep moving forward -- answer the next question, track down the next medical supply, arrange the next meal, make the next pot of coffee. Stopping makes it too easy to think about what I am not getting done, and what I can’t do. The questions I can’t answer. The needs we can’t fill.

We are achieving many amazing things. On Saturday, our Puente de Solidaridad (PdS) colleagues took us to visit two of our 2018 patients, including 27-year-old Victor who was diagnosed with colon cancer at age 19. Surgeons removed 30 cm of his large intestine, and he was left with a temporary colostomy bag which could be removed once his colon had healed. But Victor could not afford the surgery to restore his intestinal function and for the next seven years, he felt like his life was on hold. He could no longer comfortably participate in sports, losing a big part of his identity. He struggled to find steady work - when bosses found out about his colostomy pouch, they were reluctant to give him a job. He had a steady girlfriend, but he did not want to propose until he had rid himself of the burdensome colostomy bags. As the years passed, he suffered bouts of deep depression as he couldn’t see a solution.

After Victor’s successful colostomy reversal in March 2018, he started to get his life back. Within less than a year, he married and had a beautiful baby girl. Visiting them in their home on the outskirts of the city was one of the most gratifying moments I remember on any of my 20+ trips. It is a rare treat to reconnect with a patient a year later. We were overjoyed to find him so happy and full of plans for the future.

Our PdS social worker invited Victor to come in to the hospital for a follow-up visit with our missioner, Dr. John Gregory, who had participated in his 2018 surgery. During that visit, Victor described a few worrisome pains he had begun to suffer. John was concerned that Victor had not undergone a follow-up colonoscopy to catch any cancer recurrence. It is a perennial concern -- systemic poverty and the limitations of healthcare in under-resourced communities often make it difficult for patients to maintain critical follow-up care. Victor also revealed that his mother was told she might have colon cancer as well, but she does not have the money for further testing.

There are highs and lows in mission work. Together with our partner surgeons, we were able to do something wonderful for Victor, helping him return to an active life and even start a family. But the breadth of what we can offer is often sorely limited. We hope our partners will be able to take Victor’s mother’s case, but they are also challenged when patients cannot access the costly diagnostic tests and treatments they need.

Now we are in the operating room, completing day two of surgeries. The U.S. and Bolivian doctors did rounds together on yesterday’s three patients, two of whom are well enough to go home already. I am back into my preferred rhythm -- tracking down a suture, welcoming a pair of Bolivian medical students observing surgeries for the day, ordering salteñas for dinner, and putting on a fresh pot of coffee. I also stepped in to translate the final discussion of the surgical plan for a young woman with early-stage cervical pre-cancer. The surgeons will attempt a radical trachelectomy procedure, which aims to remove the cancer while preserving her ability to have children.

This is Mission. Moving forward step by step, patient by patient. Celebrating lives restored, and doing what we can to maintain hope for a future for our patients and their families. It is joyful and devastating and inspiring and frustrating all at once. That makes it all the more important that we occasionally pause to reflect, even when we resist, even if for just a moment.