Report 1 from Lake Chapala
Dear Family and friends, we have been here in Lake Chapala, Mexico for 4 days now and this is my first opportunity to write you an update.  We are all well and enjoying the perfect weather and the great food, but this trip has certainly been a challenge, and that is an understatement. 
There are 24 of us on this medical team, Dr Doug Thompson, who has been with about 6 other teams and who signed on at the last day, not wanting to leave us without a physician (and cancelling his other commitments), 7 nurses, 1 Pharmacist, David who was on the team last year, a pharmacy assistant, Julie Kropf Charlene’s daughter, a Paediatric Dental surgeon, Dr Ramon Marti from the Rotary Club of London who also signed on at the last minute, Linda and Bob Reid who fit the eye glasses, and a wonderful group of volunteers, each one having a skill needed on this team.
We were able to pack the hockey bags into the bus on Tuesday afternoon, and the Nyenhuis farm family boys came once again to lug those 48 fifty pound hockey bags up the stairs of the depot.  As usual, I did my own personal packing that evening, and picked up David from the train station to stay and nap until it was time to leave.  We did listen to the exciting game 6 of the world series where the Cubs won handily.  
Finally, I napped on the couch but did not sleep, thinking everything out, and remembering I had not packed the insulin in the fridge.  I called Brian and he good naturally came to drive 6 of us the bus in Stratford at 1:45 am.  What a welcome sight to see a Cherrey highway coach bus and our Volunteer driver, Kevin Gibson ready to take us to the airport.  A stop in Shakespeare to pick up 6 more and we were headed to the airport, 23 excited people. (Ramon will come tomorrow)
Everyone got a luggage cart and as the hockey bags came out from the baggage area, they were loaded onto the cart of the designated person, pretty slick.  We had to repack 3 page to add in the personal boxes, and we were ready to check in.  Since we did not “need” the wheelchair and wheeled walkers to get 3 passengers onto the plane, the agent tagged them as luggage.  Great.  The group check in worked well and within about 45 minutes we were headed to the gate.  Some got food, but I just needed a nap as I had already been awake more than 24 hours. 
I had a few poor cat naps on the plane, and then the announcement, that we could not land in Houston due to poor weather, we circled around too long and had to go to Dallas Forth Worth for fuel! Yep!  Back to Houston and the weather cleared to allow us to land.  Our connecting flight was about to leave but we were not allowed on it.  So we spent 5 hours in Houston airport, got an expensive meal and waited, and waited and another poor cat nap.  Finally, we were on our way to Guadalajara.  There was no food on the plane that we could purchase, not even a sandwich. 
 All of our luggage arrived, and not a good sign that there were lots of ‘aduanas’ or customs agents around and they were opening everyone’s bags.  For us it was the start of a 4 hour marathon as they opened every bag, every box, every pail, digging through.  Our letter from Rotary and the lists we had meant nothing.  Dr Manuel, the volunteer from Rotary was a huge help, but he could do nothing either.  They looked at every tube of toothpaste, all 1000 of them, every bottle of pills.  The boxes were ripped open and partially put together again.  And they kept 3/4 of it! ………. Because we did not have the stamped paper from the government BEFORE we got there.  I had asked our Rotary Contacts in Mexico about the rules and regulations, and was sent a paper to say that medications and vitamins were allowed in.  Yes, but nothing that said they had to be pre approved with a stamp.  It is now 1am, 3 am our body time and I have been awake for 48 hours and cannot even think.  I waited 3/4 of an hour while they filled out papers, and the agent asked me to sign, which I did, but because I signed below my name and not above, he ripped it up and started all over again.  I am devastated, of course, because we had prepared with such detail and because I was not given the correct information from our hosts, we may not have any supplies to work with to help our patients.
Everyone is in the bus as I drag my tired body there, and we are off to Lake Chapala, a 40 minute drive, not a lot of traffic at 2 am.  We got our keys to the apartments, but there is no water or toilet paper in them so it is another hour before we are all settled in.  How do you say exhausted?
This is an apartment hotel, but there is not food or drink here.  A caterer has been arranged to bring in breakfast, and they do their best, but making coffee in two 4 cup drip coffee makers for 21 people takes a while.  The breakfast takes awhile but we enjoy the sunshine and check out the pool, which is not clear (OK do we swim in that?) 
Gin, from the Rotary Club comes to meet us at breakfast and we make some plans.  It was nice to meet someone I had been E-mailing with for the past 9 months.  She states everything is ready for the clinic tomorrow and I ask about the 10 requested translators, but she is not sure about that.  By e-mail, Gin had offered a 35 cup coffee maker which we were happy to accept as there is no coffee until the caterer gets set up with the four cuppers.  This morning she said yes, again.   Dr Manuel takes 2 of us back to the airport and try to find customs offices to find out the procedure to get our medications.  We realize we may never get them in time to use for this clinic.  They may be released months away as everywhere we go, offices are only open 9 till 2!  In the mean time, the team gets another apartment for the supplies and get them out of the laundry/storage room of the hotel and take everything apart to sort and plan repacking.  As we had not been back from the airport, the group explored the town and the area restaurants as we have to find a place for dinners.  Dr Doug found Roberto’s and for $10.00 Canadian including taxes and tips we have a 3 course Mexican meal with food beautifully presented and tasting even better.  Dr Ramon arrives today and he even finds us at the restaurant.  With a refreshing drink, and stuffed to the gills, 3 hours later we walk home.  You have to be careful walking on cobblestones in the dark.
Our accommodations are basic, one and two bedroom apartments, with very old furniture and dishes, but we have no time or ingredients to cook.  There is a fridge to keep a beer or some wine chilled, a welcome refreshment at the end of the day, and that is a plus.
Breakfast is a hot tortilla stacked with ham, beans, cheese, cream and a green tomato (tomatatillo) sauce.  But no knives to help cut it to eat, so a bit of a challenge to eat with a fork and a teaspoon.  But very tasty.  The two small buses arrive and we pack our few hockey bags of supplies into the back and us in the seats we are off to our first clinic, excited to do what we have planned for 9 months and came for.
The clinic at Tepehua is attached to a kind of community centre provided for the poor indigenous peoples in this hill community.  The clinic is brand new, and furnished by donations and grants from about a dozen Rotary Clubs in Canada and USA, probably many of them having members who winter here in Ajijic    (Ah-HEE-heek) and Chapala. Some of the boxes with filing cabinets have not been opened.  There is a beautiful pharmacy with work table and shelves that we are given to put our meagre supplies on.  Moonie, the President of the board at this clinic has the only key to some of the rooms and she does not arrive until 40 minutes after us, so difficult for us to set up, not knowing what spaces we are allowed to have.  But we scout out tables and chairs and basically plan where we all might work  
Linda and Bob Reid have a nice well lit room with a curtain for privacy for their eye clinic and Marilyn Holmes and Stuart Arkett find another room and also locate a treatment table for their physio clinic.  Nursing a medical and lab are in another area where this clinic is so new, the plastic is still on the assessment treatment beds.  Registration team of Brian Hall and Josy Britton and her sister who lives here, set up Registration, we have patients with charts and no translators.  Moonie arrives and tells us we will have 2 Doctors (one never does show up) who are bilingual and a clinic worker who also speaks some English.  No, Moonie and Gin will not be translators.  I impress upon them that we cannot work without translators and we need 10, 7 a minimum.  They start to make some phone calls.  I hear a patient speaking English, a beautiful woman who is pregnant and brought her niece to the dentist.  She agrees to work with us all day, and she is invaluable as she works with Dr Doug and Joyce Gerber and Jaimie Weber.  There are lots of women coming for PAP smears and the local Dr does not come, so Doug works with Joyce to teach her how to do it.  New skill for Joyce.  Two men from the addiction clinic where we will go on Monday show up.  They are a bit rough around the edges but they are attentive translators.  Victor, a Rotarian and a Chiropractor who has an office here, arrives and Marilyn would function better with a translator in getting her patient’s story, so Victor goes to translate, but ends up taking over her patients treatments!  Thankfully, it is close to lunchtime and I tell Victor we need his excellent English with the nurses, and I give Marilyn Simon, one of the men from the rehab place.  Victor is an excellent translator with the nurses, but again, he takes over with the diagnosis and the treatment.  A diabetic who was on Metformin and Insulin, had a blood sugar of 18, 3 times the normal.  She did not take her insulin because she had to purchase the syringes.  We had them, but Marian wanted to explore her life style to be able to find other options to control her blood sugars, but Victor would only focus on the syringes.  So, we give her syringes today but what does she do when they are used up?   
There are so many children around, that it is very difficult for the oral hygieneteam to get set up or function.  This is the first time in about 25 medical trips that we do not have fluoride for the children’s teeth.  In groups of 6 to 8 children, thorough tooth brushing is done with a prophy paste to irritate the enamel, rinsed well and the fluoride trays inserted over the teeth for 90 seconds, spit out and no food or drink into the mouth for 30 minutes.  In this time frame, the children who are quiet and a captive audience are taught a lot of information about oral health.  By E-mail, I explained how we proceeded and asked for input from their dental team.  The answer from 84 yr old Dr Geo, the dental consultant was that doing fluoride was “sloppy dentistry, I don’t do sloppy!”  He wanted the children to come to the clinic for proper assessment and cleaning (which of course, most of them cannot do).  So, we did not bring fluoride.  The team tried their best to teach proper brushing and hand washing but were almost mobbed trying to give out the brushes and toothpaste.  We could not actually have them do the brushing because we had no space without creating a mess with the children spitting.  And we could not get them organized into small groups to be able to have them spit into our pails.  Gord and Josy had brought colouring books and crafts and the smaller children were engaged in that.
We had a big lull around 11 when we had seen all of our patients in the first hour!  Everyone is looking at me, “Where are the patients?”  we are assured that more will come.  Sure enough, about 2 we get a big surge.  The older children are home from school and the families have finished their big meal of the day.  
In the end we had 129 patients, some had returned in the afternoon for a different service, but a good number had all services. 
Jaimie identified a man who brought his wife for treatment, but he was not a patient but seemed in pain.  She looked at him briefly and got him registered and assessed.  He was a fruit picker and whether he fell out of the tree or tried to catch a basket of fruit from the pickers in the tree, on October 16th he broke some ribs and completely dislocated his collar bone at the sternum.  His clavicle was protruding 1 and a half inches on his mid upper chest!!  He had had an Xray, but was told they could do nothing for him.  He was not able to work because of the pain and because he was not working he could not afford the Tylenol.  He did not sleep because of the pain.  He looked worn out, and maybe that is what caught Jaimie’s eye.  Doug and Jaimie assessed him and took him to Marilyn, our physiotherapist.  She too, was taken aback at his condition, assessed him and taped his proximal collar bone into a more normal position to relieve the spasms of his neck and chest muscles.  People who saw him, report a huge smile when he came out from Marilyn’s treatment.  We got him Tylenol and Ibuprofen to control the pain and inflammation so he can sleep and be comfortable.  Marilyn will see him again at our hotel after our clinic on Monday, and Linda will assess him for glasses, sunglasses, hat and we’ll find him some crocs to replace his shoes, probably the worst we saw all day.  He left the clinic a much happier man, and I guess if just being here to help him today, it is enough.
I triaged a woman with a huge right thyroid gland.  She stated she has had 3 biopsies of both her right and left thyroid and there is no cancer.  (There is no guarantee of that until further investigation including surgical removal.)  She knew she needed surgery, but it cost 35,000 pesos (C$2500.00) and she could not afford that.  My heart just broke for her as my 13 year old grandniece just had a thyroidectomy for cancer.  The surgery would be done in a private hospital.  HOWEVER, if she was registered in the public care system, she could have the surgery for free, s o m e t I m e…..  So we urged her to at least get registered and get into the system.  People need to be urged to do that for whatever reason.  
At the end of the first clinic day, always organized chaos, but this one even more frustrating because of a lack of translators, we felt good about our efforts and the effectiveness of our care.  
It was Friday night, and on the way home from the clinic, we stopped to pick up a beer and celebrate Day 1.  We went off to Roberto’s again for a 2 for 1 dinner, another 3 hour session, BUT lots of social interaction with the other volunteers, so important to building a cohesive team.  So much for my ‘set dinner menu, set time, set price.’  We are all OK.
Feel free to forward this information to anyone you think might enjoy reading it.