From Thighland to Thailand

March 7, 2014-Saturday

Thailand/Myanmar 5.15

We have one more half day to work at the AYDC at Luka’s compound and we’re used to seeing most of the villagers at these clinics and I was hoping to see more familiar faces but the crowd is small.  We enjoyed working in the new building that has ceiling fans and lighting that we are not used to.  In the past we worked in a small building shared by the dental and medical team while the optometry team worked outside in the hot humid air.  Now we had plenty of brand new chairs and tables; we were spoiled.  I mentioned that funds for the new building was donated by the Norwegian group (Thaid.no) run by director Knut Inge Bergem that support financially T-AMF and BCMlives (BaanChivitMai) for disadvantaged children, particularly, at-risk for human trafficking.  Luka happens to sit on the board of that group as the AYDC works with at-risk children as well. That organization started 25 years ago realizing that many children went “missing” and began rescuing at-risk children.  They have a youth hostel and house about 80 children in two homes with their youngest resident being an abandoned 7 years-old child. Knut happened to be at the night market and ran into Blah who knew Bill and when Luka walked up and said “Hi!”  You know that Luka gets around; he knows everyone. Knut found out why we were there and asked Bill if he could bring some of the children from the hostel so 5 youths received dental care today at the clinic whose foundation help build it.  How cool is that!  We also were able to treat many of the ADYC staff that often doesn’t get a chance to take care of themselves.

An American woman, who runs a foundation to help out the Akha youth brought in several patients to our clinic who were recently involved in a car accident near the Thai-Myanmar border near Mae Sai. There were six traveling in a truck sitting in the back and a drunk driver swerved into their vehicle, hitting them, forcing them off the road and wrecking the vehicle.  They went to the local emergency room for treatment and were here for follow up.  One passenger sustained a broken arm while another had a leg laceration that we attended to.  A young girl had a forehead and scalp laceration that required suture removal.  One of the passengers was a young Burmese Pastor, Abraham here to translate the bible into one of the dialects of Myanmar.  He had the more serious lacerations to his face.  Sutures were in the lips, eyelids, scalp, and forehead. His black eyes were slowing resolving.  For a handsome man, the forehead was not a pretty sight.  His forehead was mangled and sewn piece meal back together.  There was an abraded flap of skin tissue that was puffy, discolored, and dusky (poor circulation) and it didn’t look like it was healing properly and the skin edges were uneven.  It’s risky to open up wounds so soon since an infection and occur, but I took it apart anyway to keep the skin from dying, and proceeded to remove hair, glass, and blood clot still into wound which went all the way down to bone.  A nerve appeared so he may have some permanent numbness in his forehead.  I did the best I could to clean it up and getting the skin edges together for improved healing and ultimately a lesser scar, but there will always be an emotional scar.  Other areas of the face seemed to be healing well and the sutures were removed.  Being a Burmese Pastor, I asked him if he knew of Adoniram Judson, one of the first American Baptist missionaries to Burma, and he nodded without hesitation, and was well informed of his history.  It was remarkable what Mr. Judson did for the Burmese people translating a bible into Burmese and writing the first Burmese-English dictionary.  Two hundred years later, a young man is risking his very own life trying to translate the bible into other dialects to spread God’s word in the land that’s mostly Buddhist and continues to perpetuate Judson’s efforts.  That’s remarkable; that’s a miracle.

Except for Jen and Ali who will be staying here for another 2-4 months to continue helping Luka, Ghan, and the T-AMF/AYDC efforts, this is the medical mission’s team’s last day in Thailand for a long time.  Missing our children is a no-brainer for Lena and I as well as the “aunties and uncles” that they are so close to.  Uncle Bill is one of her favorite uncles since he gave her about 3 bins to bring back about 200 fragile Thai lantern party favors for her wedding.  (I guess I have to invite him now.  Okay, let’s see, Gail and a plus one.)  But we will see them face to face in just a few months, and in just a few days on Facetime.  That is so easy, almost too easy in this day and age.  What is not easy is to come to grips that we may not see some of the close friends that we have developed relationships with ever again.  Certainly, the patients of Mywit Wa, our ox cart driver, tour guides, van drivers and even Wendy, our receptionist, cook, janitor, laundry coordinator, at the Golden Triangle Inn that we have known over the past 5 trips here (8 years).  She always greeted us with a warm smile and “Sawadeeka.” 

As we departed the Golden Triangle Inn, perhaps for the last time, gathering our belongings, we reminisced about the good times here and how is played out as a headquarters for our mission trip.  As Gail looked around her room for possibly the last time, (since the GTI might be sold and torn down) the ceiling light bulb in the middle of the room went “poof” and the light went out and the room darkened.  Our spirits in our hearts go “poof” when we leave and the spirits in the eyes of the patients go “poof” when we leave.  Our highs become lows, our bubbles burst, the candle grows shorter and the flame slowly dims until there is darkness.  We can keep that flame of hope flickering in their eyes with continued support in further mission trips and funding of their projects.  We hope that other organizations and churches can continue their support or start getting involved; the more the better.  It was great to have a joint effort with the Sanger and Fresno churches working as a team.  We don’t have to do it alone.  It’s all about teamwork.  We had two very different religious groups, Christians and Buddhists, with different beliefs work together and many different cultures and ethnic groups working together.  Our mission team went, and you went with us.  The home churches, friends, and families prayed for us, and felt our pain and joy, and I hope through this journal it brought you into the action even though you can try but can’t imagine the needs or pain of those we served.  Thank you for supporting YOUR mission team and for allowing this opportunity for the churches to do what is commanded of us; that is, to serve.   

Where we go from here is up to God.  How much we support Southeast Asia as a medical team or more financially for projects will be decided after we determine the needs of the people we want to serve.  I hope that others get involved because the more, the merrier. 

Before I sign off on my final entry (I will try to post photos afterward when I’m home from the 70 GB of photo/video) I would like to tell you about my last patient that I treated today.  I have known her for 8 years; her name in Lin.  I first met her when she was about 10 years old.  It is one of the daughters of Luka and Ghan.  I saw this life-threatening lesion on her shoulder that’s a large congenital nevus about the size of a quarter.  It had multiple dark black and brown spots over this bed of tan pigment.  It looked nasty since some of these individual lesions can develop into a malignant melanoma over the years.  I was concerned for her then, and I am concerned for her now.  Left alone, in time, there’s a good chance that it would turn into cancer.  This is not your typical  “Excuse me, can you take off this mole?” moment.  Now it is larger almost 2 inches in diameter and has some areas darker, speckled, and irregular, which lesions are more prone for malignant change.  Due to its location around a joint and because of its size, it is difficult to excise without resulting in a very long scar and in a patient that tends to keloid.  She received some laser treatments done in Chiang Rai to no avail.  So after evaluating the lesion I decided that the best of both worlds (smaller scar and eventually resect the entire lesion) was to stage the resection.  First remove the areas that have the most potential to become cancerous and leave a scar, that might keloid or not, within the lesion which will come out anyway in a later surgery. This would give her a fresher scar that won’t widen as much (less tension on closure) or be as long as much compared to trying to remove it at one fell swoop.  Decision made.  Hmmm, this is a classroom.  There is no operating room.  There is no bed, just a laminated hard table, but it will do.  There is no pathology.  We wrap a piece of plastic around a sleeping bag for a pillow.  There is no gown so she sheepishly pulls down her right sleeve of her T-shirt to exposes her shoulder and chest.  She is scared and she calls out for her mother.  Lin is crying.  A crowd of about a dozen surrounds her on one side of the table to help hold her down and not move.  Her mother holds her hand. Lin is very popular amongst her friends and this tight knit community, after all, she is their leaders daughter and has seen her grown up.  There is no anesthesia equipment or sedation.  I only have local anesthesia and she gets stuck several times to that I can numb the area, jerking her body writhing in pain at each needle stick.  My daughter Allison, with no medical training, helps me in the meantime, until help arrives. Fortunately, Ali is not afraid of blood, and helps me get Lin ready in the meantime.  (“Dexter” is one of her favorite shows and she enjoys the “Twighlight” saga with Bella, Edward, and Jacob so she is use to blood and guts so this is nothing to her.)  Where was I?  Linh, a nurse at Childrens’ Hospital, is used to working with pediatrics, and has been a great help to me on most of the surgeries on this trip and learned to “assist” with surgery.  She brings comfort to Lin. I put on my 2.5 power surgical loupes that begin flashing as the battery runs out and use my Surefire camo pattern headlamp for lighting. I don’t have all of my plastic surgery specialty instruments but disposable grade instruments.   This is as good as it’s going to get.  It’s backwoods medicine with our very own MASH unit: hill tribe edition.  As we work with this life and death surgery, the rest of the team has lunch.  How can they eat at a time like this?  After I place the drapes to partially cover her face, her friends distract her.  A short stroke of the #10 scalpel blade nicks her skin without a response. I am good to go.  I excise around the premarked pattern that will encompass the central half of the lesion all the way to the fat and resect the football shaped specimen.  It’s bleeding so I hold pressure to avoid a hematoma.  I reach the OMG stage when the wound opens to 3 times its size due to the elasticity of the skin as someone wipes my forehead sweat away so it won’t drip into the field.  They don’t know that my hands are dripping under the latex gloves, as I often need to shake hands.  My suture is limited and the needle holder barely adequate but I refuse to use a stapler or super glue.  The wound slowly comes together as a layer the sutures in and I am relieved, though I hope that it won’t break open under tension, develop a blood clot, or get infected when I leave.  The sutures will dissolve and hopefully leave a thin scar to resect later with the rest of the lesion.  The round lesion is now oblong. I cover it with tape butterfly stiches as well to give it extra strength.  Lin attempts to peek at it and then is relieved that it is over.  By now she is brave and smiling and wants to see the specimen and takes a picture with her phone crying out “Eweeeww in Akha.”  (I think it was Akha.)  We make do with what we have and the surgery was a success.  The patient made it.  It was touch and go for a few moments.  There is no follow-up so I leave her with antibiotics and pray that it heals satisfactorily and doesn’t break open.  We treat, God heals.  All of us have something in common. We do with what we have.  God knows what we need.

Lin still has premalignant lesion, albeit, half the size still present.  Time is ticking.  Now, we have to go back to Thailand, to resect the remaining premalignant lesion.  Everyone reading this, we need your support.  Our work is not done.

For you number crushers the final rough estimate for the number of patients treated by the FCBC medical mission team and by the wonderful Myanmar physicians, who worked by our side with unequaled stamina and dedication, are:

Myit Wa, Myanmar:           3411 patients (26 hours in 2 ½ days)

Yangon, Myanmar               202 patients (6 hours in 1 day)

Chang Rai, Thailand           272 patients  (9 hours in 1 ½ days)

Chang Khong, Thailand:     557 patients  (11 hours in 1 ½ days)

Grand Total:                      4170 patients seen (give or take a few)

We say farewell, but not good-bye to our colleagues and friends in Myanmar and Thailand who has made this mission effort a success and precedence for future mission trips.  We have established relationships that we hope to be long lasting.  I am proud of the mission team and I thank you for the privilege to work along side of you.  Thank you to the congregation of the First Chinese Baptist Church and Sierra View Community Church for your financial support of this mission.  Thank you Pastor Jack for being our spiritual leader and keeping us mindful of why we are serving and how we can bring others closer to God, while becoming closer to God ourselves.  Thank you Dr. Bill Ho for coordinating the mission trip and for your patience.  You are a good man.  My wife, Lena, and I leave Thailand leaving behind our beloved daughters Jennifer and Allison, whose charitable hearts and unselfish desire to help others by sacrificing their time, money, and efforts, and by enduring discomforts and inconveniences working out of their comfort zone, and by leaving their loved ones behind so that they may serve God and humanity.  We are soooo proud of you and love you so whoa whoa whoa muuuucccchhhhhh!!!!!!!  You are an inspiration to us all.  I hope that God will bless you deeply as He has for your mother and I.  We miss you but will see you soon.  Bye-Bye sweethearts-daddy’s little girls.

Mark