All,

Here is my journal since last blog posting. Sorry...it might be a little confusing. Typical blog entries start with most recent, followed by older entries. This one, long entry begins at the beginning of my trip. I have just discovered that I can put in some photos, so I've included a few to help tell the story. I put a bold heading at the end of each section, to help you skip to parts of more interest to you.

-Chris

The People
I’ve decided to give a quick bio of the people who are joining me on this trip, and the people I meet along the way, so that you can look back and reference this glossary if you see a name you don’t recognize while reading the journal below.

Dr. Paul Froula – The eye surgeon who I’ve known since college. It is difficult to describe such a good friend in just a few words. He is a humble, generous, kind-hearted man who is like a brother to me. He did a medical mission trip to this same location about 5-6 years ago.

Dana Froula – Paul’s wife and former assistant. She knows a lot about what we are doing, but with Tiffany along, she is focusing on other ways to be helpful…and helpful she is. She doesn’t rest. She is doing much of the initial exam and preparation before patients get into the OR. She is also doing all the cooking and cleaning. She loves children and animals….nearly to a fault. Dogs in this country are either mean guard dogs, or unvaccinated village mutts….either way, she loves them.

Seth Miller – Seth is a manufacturer’s rep. for Advanced Medical Optics. He provided the Phaco machine and most of the supplies. He’s been my room mate and side kick for the trip, and he’s really made the trip much more enjoyable for me. Seth, I think could step into any position in the OR, including the surgery itself. He totes heavy stuff. He jumps in to mop the floor. He knows the Phaco machine and monitors it during surgery. He really does understand everything that is going on and can explain it to Dr. Themen or anyone else. He does the measurements during pre-op and advises on lens size. His wife (Tamara) and he have two kids: Eli is 3 and Amelia is 3 months. Seth has done one other medical mission like this to Peru.

Tiffany Glandon – Tiffany is an eye surgeon’s assistant extraordinaire. She does one thing and she does it very, very well. Other than that, it seems to me that she is always in the background. Never needy; never complaining; always fine with just about anything that happens. She has a son, Isaiah who is about 6 years old I think, and between Isaiah and her boyfriend, I think she’s worn out a few international calling cards. She has been on one other medical mission to Romania.

Charles Shirey – Charles is an ordained minister I think. He works for the Southern Baptist Church missions which is called the International Mission Board. His assignment is the Auken people of Suriname. He lives in Paramaribo, but he has a second home in the interior region. His wife, Brittany, is of course also driven to mission work, but balances her time between supporting the mission work and raising their family. She home schools the children: Ethan (about 5 yrs old); Caleb (about 3); and Abagail (about 8 months). Brittany did not go the interior with us on this trip, but she put our menu together and purchased and packed all the food for us to prepare in the interior. She also joined us in Paramaribo after the trip to the interior as we traveled around the city, and helped us with traveling and seeing the city.

Dr. Herman Themen – Dr. Themen is a second generation ophthalmologist in Paramaribo. I get the impression that he is highly respected. He was by chance connected to Paul during Paul’s last mission trip when the missionary at the time contacted Dr. Themen to find out about the availability of a surgical table. Dr. Themen then joined Paul for a portion of the trip, and knowing that he was going again this year, volunteered to join again. He is a very quiet, gentle and patient man.

Mrs. Themen – Dr. Themen’s wife joined us when we came back from the interior and came out to eat with us and gave a couple of us a wonderful tour of the countryside. She is nearly the polar opposite of her husband in personality. She will say what is on her mind, and mixes no words. She knows no strangers, and she made our stay in the city such a great experience, introducing us to so much of the true culture beyond what tourists would typically encounter. I would have enjoyed spending so much more time with Dr. and Mrs. Themen.

Michael Siban– Michael is a physician, but has not selected a specialty and, when he does, will spend a few more years training in Holland. He joined us, with Dr. Themen, in the interior. Super nice guy. When we were back in the city, his fiancé (Aarti) and he came and picked up a few of us and drove us around the city for a couple of hours giving us a tour.

September 23, 2007 8:45am local
Knoxville Airport
After a busy night repacking (numerous times) our luggage, we are finally beyond the packing stage. The luggage is checked and we are through security. We are allowed two checked bags per passenger, each weighing 50 lbs. We have 10 checked bags, each weighing within 5 lbs of 50 lbs, and everyone one of them stuffed completely. It’s quite remarkable really that after all the planning and shuffling, and last minute acquisitions of suitcases, that we ended up so close to our limit. We were very fortunate at the airport. Thinking we would be more overweight than we are, a couple weeks ago I tried to go through Continental and Caribbean Airlines seeking their generosity regarding weight restrictions. Continental never returned my numerous phone calls. Caribbean was considering my request. Then we did some preliminary packing and weighing and figured we would be close enough, so I cancelled my request with Caribbean. As it turns out, the folks who checked our luggage were the most help with weight issues. We are pretty certain that a few of the bags were overweight, but they allowed our luggage to go through….lifting it and saying that it felt okay. We are thinking now, that it will not be weighed again for the duration, so one major issue averted.

What we are carrying
One golf club carrier contains a microscope stand. I’ve not seen it yet…I was supposed to learn how to assemble the thing so I could assemble and disassemble with military precision. I think Paul really just wanted me to feel useful; I suspect we will only set it up once and tear it down once. The microscope head is in another smaller case, that at the last minute we combined in side a larger rolling bag. I ran out last night and got this bag from Ellen (my daughter)…I met her at a restaurant halfway between her apartment and Paul and Dana’s house. So she got a free meal out of the deal, which is pretty much our routine when I come to Knoxville. The Phaco machine is the largest bag (not really fair to call this giant plastic crate a bag. I’ve been told that the Phaco machine is what does the actual catarectomy (I made that word up….Tiffany confirms such). We have an autoclave, and I think that is the extent of the big machinery. We have tons of supplies, most of which I have no clue about. Needles, lenses, plastociser (I made that one up too), drapes, reading glasses. The heaviest is IV fluid bags…..I forget what they call those bags, but I would guess that we are carrying close to 50 lbs just in these fluid bags. Tiffany got to check a bag of her personal stuff, but we crammed more heavy stuff in her bag at the airport. Paul and Dana are sharing a checked personal bag. Seth and I both had to carry all of our personal stuff. Funny that it worked out fine for both of us, but we had to find a checked bag in which to throw our boots. Neither of us wanted to wear our boots and they were too bulky for our carry-on bag….which we discovered independently. He also told me that he brought three boxes of Cliff bars. I brought 2 boxes of Zone bars. I imagine we could exchange our luggage and do just fine for the week.

We’re now in the air, headed from Knoxville to Houston. Flight departed on time. It is sunny and beautiful outside. There are a couple of empty seats in this plane that looks to carry about 50 passengers. I would estimate that we are 10% of the passengers and 40% of the total weight.

Monday night (10:10pm) September 24, 2007
Dritabiki Suriname
Happy 17th birthday Francis. I’m pretty deep in the interior of Suriname, but surprisingly this is not nearly as primitive as expected. I don’t know where to start really with this journal. This is the first chance I’ve had to write…..partly because my computer batteries went dead and I couldn’t find a power source in any of the airports or my hotel last night. The power in the hotel was 120V, but it required an adapter that I did not have.

Paul and Seth in front of our hotel in Paramaribo.

The flight into the interior (Dritabiki)
Amazing. Highlight of the trip, so far. Charles and his whole family are sick with Giardia (they think). I’ll have to look up the spelling of that later, because my spell check doesn’t even recognize how I butchered that one. Backpackers are well aware of these bacteria. It is one of the primary reasons we filter water. It delivers bad intestine problems including vomiting and diarrhea. His family had planned to come with us today, but because of the illness, and because we really needed Charles in order to figure things out around here, he came without the family. His wife and kids had planned to come with us today, but because of the illness, and because we really needed Charles in order to figure things out around here, he came without the family. The rest of them plan to come on Wednesday with the Ophthalmologists from Paramaribo. So Charles changed our flight plan today. There is one airline that serves the area and they operate from a small airfield near the city. Instead of flying in a little larger plane that would carry all our supplies and his family, we flew in on two Cessna single engine, 4-seater planes. We unloaded our vehicles and stood on a scale with all of our equipment, and so began again the art of loading, reloading and going through our equipment, food and supplies trying to figure out what can wait until the Wednesday flight. We were about 150 lbs overweight. Paul, Charles and Seth took off in the first plane, while the girls and I waited about 30 minutes for them to get the next plane ready. We waited with another group of 35ish year old men from Holland. They were in university together, and every 5 years they take a trip. A couple guys plan the trip and don’t tell anyone where they are going. You have to decide if you are going, and put your money in before they will tell you the itinerary…except the date and cost. Then, a couple weeks before departure, they have a dinner together and announce the destination. This year, they were going into the interior region of Suriname on a sort of eco-tourism trip. Suriname used to be a Dutch colony, so the language here is Dutch and there are still many Dutch roots. I think I will try to get some of my friends to consider a similar excursion plan. I love it.

So we went out to the airstrip and they asked us who wanted to ride up front. I was not bashful. It was surprisingly difficult to get into this old plane…..that’s how tight it was. I was in the copilot seat and had my own set of controls. We took off with very little introduction to our pilot, except that he said he had read all the books, so he felt very comfortable flying us today. Once we started our take off, it was clear that there would be no more conversation. The noise from the engine was deafening. I was right there at the instrument panels, flying out over the interior region, gradually ascending to about 7500’, and I was taking pictures and excited the entire time.

Looking down on Paramaribo soon after the flight began.

At one point, the pilot pointed out in front of us, and I could see the plane that had dropped the guys off, headed in our direction. By the time I could turn the camera back on, he had zipped past. We reached our grass airstrip and came down to a smooth landing. It was spectacular.

Approach to the landing strip.

We unloaded on the grass airstrip, moved our stuff to the shade of a large tree next to the airstrip and watched him take off. Nobody from our group was around, in fact there was one man in a small wood building who helped us unload, and there were some men working on a nearby building, but we were quite alone. Maybe it was the dramatic shift from overpowering noise to jungle sounds in the matter of a few minutes, but it was amazingly peaceful for that 5 minutes or so that we stood in the airfield without much conversation and took it all in. I could hear unrecognizable birds in the bush, but not much else. It was cool enough out….maybe 80 degrees in the shade. I would have enjoyed another hour or so of just waiting, but there was work to be done.

Passenger waiting area, Terminal A

Clinic set up this afternoon
Seth, Tiffany, Paul and I set up the clinic. We set up in a nice size room with an attached bathroom, though it was not very clean and there were no cleaning supplies or much water. Also, the power was not on, though we will have power tomorrow. Seth and I got the table from the top floor of the radio tower. It is the same table that was constructed for Paul last time, but they’ve been using it as a desk. It is pretty much a simple table large enough for a person to lie on, but one end has a section missing….so the patient can lay with their head supported, but the doctor can access around the head. Sort of picture a table in the shape of one of those chalk body images you see in a movie murder-crime scene, except that the only silhouette is head shape….the body is a big rectangle. We also set up the microscope, which is a large frame apparatus that is self supporting and Paul uses to look at the patient’s eyes while he does the surgery….this machine took up two of our luggage pieces. I didn’t even see the phaco machine yet, but I’m sure it was unpacked….it, I understand, is the most complex and expensive of the equipment we carried in…..though we are likely out of business if any one piece isn’t working. We assembled all the supplies and cleaned the room, but there is still work to do in the morning, despite the fact that we expect patients to be here bright and early.

The building in the background is the clinic, in the foreground is housing for clinic staff. You might be able to see on the right a black tank for collecting water from the roof's gutter system.

Dinner
Charles’ wife, Brittany (I just met her briefly today) put together a menu and purchased all of our food. We are doing the cooking though, and Dana has sort of taken on the domestic role for the group, and does not want much help. We had spaghetti tonight. Dana is being very thoughtful in leaving some sauce without meat. (note added after return: Everyone has asked me about eating worms and beatles. I didn't get to experience such. Our food was very typical to what I would have been eating at home. Sorry.)

Our Lodging
We are in a fairly large building reminiscent of just about any Camp Marymount building. Concrete floor, exposed rough-sawn framing, tin roof, screens on the top half of the building. This is pretty typical to all the buildings around. The water is collected from the roofs into plastic barrels (look to be about 400 gallons) . The wiring is just like at home, but the power source is a generator running in the nearby shed. I have to shut if off in a few minutes…then all goes dark. Right now, there are about a dozen, 2’ long fluorescent strip lamps on and another 7 or 8 ceiling fans running. The building is about 25’wide x 50’ long with a tin roof. It is one open room with a kitchen on one end with propane range and fridge. Next to the kitchen are two small bathrooms, each with sink and toilet. The large room has sort of a hall running down the middle, but there are no walls….just posts and horizontal wood at about 5’ high. We tie hammocks between these horizontal boards and some matching boards on the exterior walls. There’s probably enough room that you could sleep 30 or more in here if you had to. This building was set up for this purpose: to house mission groups that come into the area. Some groups come for medical missions, some to do other physical work I suppose, and some for evangelization. There is a shower room out back. Right now, we are all (5 of us) getting showers and settling in. Not much privacy, but not a huge deal for me, and I’ve not heard anyone complain. One of the next door buildings is the (second) home of the missionary family, the Shireys. Charles is from St. Charles, Louisiana and their main home is in Paramaribo (about an hour flight away, the nations capital). Charles flew in with us today and is over there sleeping right now.

This is a view of the lodge from the kitchen. Yes, those are pringles on the kitchen counter, and the table is our dining room. That is Dana making her bed.

The Shireys have a really nice house, albeit rustic. Somewhat like you might run into for a second vacation home in the woods. I’ve not seen a lot of the village yet, but I was very surprised by the condition of things, as were the Froulas who were here 5 years ago. Last time Paul and Dana came, they did eye surgery under the stairs of the Shirey’s home, and everyone in the group stayed in their home. Now there is a new clinic, that is not quite finished in construction. There are jalousie windows with no screens, but very modern. Running water and power are problems, but you just sort of get used to it I think and get things done. The landing strip is a grass field. There is a satellite phone system, and the Shireys have their own phone…I hope to call home tomorrow with a phone card I purchased in the city. Many of the buildings are connected by concrete sidewalks.

I just shut down the generator, so things are darker and quieter. There is another generator running nearby for a radio building where they broadcast throughout the area. I imagine they will be shutting down soon. It’s about 10:00pm here. Charles said that the broadcast today included messages about the eye surgery tomorrow. He included the important message that we would not be doing glasses…only cataract surgery. We don’t know how many people will show up, and we still don’t know how we are going to organize the work.

Tuesday, September 25, 2007
10:10 pm (local time, which is two hours later than Nashville)
Our lodge in Dritabiki

What a day….first chance to journal. I’m going to go back and tell the story of our travels before I tell of today’s events because the memory is fading fast. We flew from Knoxville to Houston on a full plane and without incident, ate a nice meal in Houston and then went to Port of Spain, Trinidad. That was a pain. Maybe it was because we are inexperienced world travelers, maybe it was because we didn’t book through a wise travel agency, maybe its because Trinidad-Tobago is a pain in the year country in which to connect, maybe its just part of traveling that is typical. In Port of Spain, we had to make a connection and change airlines to Caribbean Air. Though I had contacted both airlines via email and phone, I received conflicting reports as to how this process would work. Caribbean Airlines gave me the answer I did not want to hear, but it turned out to be the honest answer. In order to connect through Port of Spain, we had to go through immigration, collect all of our luggage, go through customs, then carry our luggage to the front ticket counter and go back through security. We waited for nearly an hour just to go through immigration. We made our flight with no problem, but it was just a little frustrating.

We arrived in Suriname (the capital city of Paramaribo), went through immigration, collected our luggage (which took a very long time), and met our cab, which had been arranged ahead of time by Charles. It was after 1:00am before we were in the cab and driving at somewhat frightening speed down a fairly nice two-lane highway for nearly an hour. This was not expected….though none of us really knew what to expect. Our driver spoke very little English. We finally pulled into a decent hotel, and were in bed and asleep by 2:00am. I’ve discovered a new travel companion from my medical professional friends. It’s called Ambein (i.e., little white pill that makes you sleep sound and wake refreshed.

Next morning, Paul got up and went for a short run. Seth and I went for a short walk. We found a nice little grocery store with all sorts of stuff we did not recognize. We had breakfast at the hotel and met Charles for first time. He lived a block from the hotel, which certainly had something to do with the selection of this hotel. We also met Dr. Themen, the ophthalmologist who is coming tomorrow to work with us. Breakfast was scrambled eggs, juice, a slice of cheese and toast.

Now to the good stuff: eye surgery
Today was amazing. Hard to believe it would have topped yesterday’s flight in, but today was every moment full of awe. It’s 11:15pm, and I hope I can get a few things written before I run out of steam. I’m supposed to turn off the generator in a few minutes, but I can go on computer battery power.

Eye surgery in progress. Left to right, Seth is adjusting the Phaco machine, Paul operating, Michel taking a snap shot, Tiffinay assisting, Dr. Themen archiving with video camera, lying is a patient.

We operated on 8 patients today. One of them had work on two eyes. He was our last patient, effectively blind, and probably the most remarkable; though I was not really aware of it at the time. I happened to be in the room when Paul first examined him. Paul had done cataract surgery on him during his first visit in 2001. I don’t know the technical side of what has happened since then, but he has cataracts in his other eye and has gone blind in the other (from something like cataract….or maybe it was cataract). The team talks about what they are doing, and Paul does a great job of explaining things to me and even allowing me to look into the microscope to let me see the close up, but really, I don’t much get it. All I really know is that this is an amazing procedure and I am one lucky guy to be witness to what is happening here. At one moment today, and I forget exactly when it was, I was walking from our lodge, back over to the clinic….maybe I was on a delivery run, and I was shocked that I was nearly overwhelmed and tears filling my eyes. It was just a small moment of alone time….much too rare these past few days….and I was able to reflect just a little on the happenings of the day. Even now, tears are in my eyes as I pause to reflect. This man’s son, who looks to be about 10 years old, had to accompany him wherever he goes, because he cannot see to get around. Within a few moments of meeting the man, Paul recognized him and explained (through Charles, who acts as interpreter) that he had given Paul a gift back in 2001, a hand held fan that Paul has hanging on his wall at home. The man did not recognize Paul at first, but Paul recognized him, and in recounting the tale of the fan, the man remembered with genuine fondness. It struck me deeply, and I have not even yet had time to figure out why or how it did so. That Paul would remember the man, who was one of a couple dozen patients from so many years ago, is a testament to the capacity of his brain. I have seen this in only a few people (my brother-in-law, Sean….also a physician is one of them). This capacity for recall, along with the powerful processing capability of his brain is so impressive. Paul’s humility also is profound, and somehow this experience exemplified it once again for me. That he remembered this man, even more than the man remembered Paul, was somehow astounding. And yet, only now as I am writing this do I recognize that it is my own lack of humility that would bring me to such a conclusion.

The other amazing side of this story is that we worked on him until we were holding flashlights in order to see our work. The clinic does not have electricity, and our equipment was being served by the generator that we brought from Charles’ home. The microscope has light, so Paul can see what he is doing as he operates, but for the rest of us, it was getting tricky. Paul decided to work on both eyes. Charles and I walked the man down to the river and helped him get into a canoe that would carry him across the river. He was totally blind of course, one eye completely bandaged, the other having just had surgery but not as invasive as the first, so he had a simple clear shield over this eye. In the morning, we expect him to have fairly good vision in both eyes.

Another frustrating example of Paul’s humility involved the shower door. When Seth and Paul first went to see the shower room yesterday, the door fell off its hinges into their hands. A couple of times during the day, Paul remarked that we needed to fix it. As we got up from lunch, he wanted to fix it, and I suggested that we get over to those waiting for eye care at the clinic, and that I would take care of it later. Later in the day, during one of the errands over to the lodge, Paul and Seth repaired the door. Here was something routine and mundane, but weighing on Paul’s mind for reasons unknown to me. Did he feel bad that it had come off in his hands? Did he feel bad for the women because now they had to shower behind a temporary shower curtain instead of a door? Did he just want a more mundane distraction? Or did he simply see that as one more thing on his list to get done today…..eat breakfast, perform eye surgery, fix bathroom door. As I get to know Paul more and more, I think this latter is more his motivation. Tiffany says that he is the only surgeon in his group who will help clean the operating room. This mentality doesn’t fit so well into my “efficient and effective” scheming. Maybe there is a lesson for me to ponder.

Meeting with patients, post-op, just outside the operating room. Paul is on the left, then Seth, then a patient, then Charles then another patient. The big black think is a water collection tank.

Critical Components
We absolutely must have Paul, though we can get some of the process done without him. We absolutely must have Charles, though we can work a little without him, and translators are a little easier to come by in the bush than are eye surgeons. Tiffany and Seth, in my estimation so far, are equally necessary to the process. However, I think Seth could step in and replace Paul if he had to. He really understands everything about the process. Tiffany and Paul work in the sterile zones, which are confined to the area around the eye, and the tray that holds the instruments. I suppose I could be taught to assist, if Stephanie took ill and Dana were otherwise busy, but it would be sort of like teaching a twelve year old how to drive a car to the hospital while you are performing CPR on someone in the back seat.

The Procedure
Without complication, cataract surgery can take as few as ten minutes from the time the patient is draped to the time that the drape is removed. Equipment that requires electricity is the autoclave (used between surgeries), the microscope, which really only needs power to supply light onto the eye, and the Phaco machine. The Phaco machine is a very specialized piece of equipment that belongs to the company for whom Seth works. I think Seth said its value is $45,000. There is also an “A” scanner that is used just before surgery to measure some part of the eye. This measurement is used to determine which lens size will be implanted.
The surgeon administers medication, sometimes an anesthetizing “block” to the optic nerve, but the patient is awake for the entire procedure and sometimes under intense pain. He makes a small incision sort of sideways so that he can work on the front of the eyeball…working in from the side and looking straight down into the eye. All of the work is done on what the layman might call the front of the eye. That is, the part of the eye closest to where you would touch if you stuck your finger in your eye. After making the incision, the surgeon uses the Phaco machine, which works like and ultra sonic probe and vacuum to chop up the cataract while putting fluid into the eye and simultaneously removing the fluid and the chopped up cataract. Once the cataract is removed, a new artificial lens must be implanted. The Doppler size of this lens, just like glasses, must be sized individually. We brought many different sizes of lenses with us and never ran out of any size…though we came close. After the lens is implanted, ther is a series of injections and drops, but the surgery is over. This, of course, is a gross simplification of the procedure, and there are many other steps where I don’t know what is happening.

Trust
There is so much to learn about trust on this trip. The arrangements, the traveling, the other people, the equipment, the supplies: all must be in place. Yes, we adapt when things don’t go as planned, or when things were not planned well, but even with adaptation, there are certain components of this trip that are indispensable to successful eye surgery. If we loose a generator (as happened today) we can find a back-up plan. But if we loose the Phaco machine or the autoclave or the microscope or the doctor or the translator; these are the indispensables, and there are likely others of which I am not aware.
The trust we must have that these things will work out though pales in comparison to what it must be like to lie down in a room full of strangers with whom you cannot communicate while they clamp your eye open and start cutting. I’m sure the valium helps, and for most of the cases, I am working in the operating room and unaware of all that happens prior to their arrival in the OR. But when they do arrive in the OR, it is usually without a translator and we simply start probing and jabbing and cutting. Some simply lie there and make some sort of grunt or indicate with body language if they are having a problem. More often than not, this might result in us making an adjustment or two and hoping we addressed whatever they were trying to communicate, but rarely do we seek Charles and ask him to help us to allay fears.

The sterile zone
I am surprised by the intimacy of the procedure. The exam, with an ophthalmoscope (this is a flashlight sized, hand held instrument used for initial exams) requires that the doctor nearly touch eyes with the patient, and the exam might take several minutes. I suppose we are used to such trust and intimacy in all health care, but in this case, I think the language barrier, and the cultural barrier is so great that the trust and intimacy degrees are heightened.

For surgery, the patient must lie on their back with the head on a small pillow. This is typically the most difficult part of the entire procedure to communicate, I suppose because it requires active participation from the patient. Once in place though, the patient’s head is taped to the table and the upper half of their body is completely draped except for their eyeball. It is a very strange thing to see a large blue sheet with a human eye ball exposed in the middle of it. With the patient lying down in place, the surgical team takes over and I’ve noticed that the only thing that causes any sort of nervous reaction from the surgical team is when the patient tries to move their body or tries to move their hands toward their eye. Sterility is critical, and I’ve learned that there are certain zones of sterility. The eyeball, the instruments, the surgeon’s hands and the assistant’s hands are sterile. These cannot come in contact with anything that is not sterile, and the interaction between the sterile zone and the non-sterile zone is more than fascinating, it is sacred.

Sterile items either come wrapped in sterile packages, or they have been run through the autoclave. I’ve seen one exception to this. Near the end of the surgical procedure, an injection is given. The needle is sterile, but the bottle containing whatever is being injected is in the non-sterile zone. Of course the contents of the bottle are sterile, but the outside of the bottle is not. In a somewhat graceful procedure, the technician (non-sterile zone), after wiping the rubber cap on the bottle with alcohol, holds the bottle upside down, while the assistant inserts the needle into the rubber stopper and fills her syringe. This extremely small contact area of syringe needle to rubber stopper is the only exception to the sterility barrier that I have noticed, and it is alleviated with an alcohol wipe.

Is the sterile zone analogous to the grace of God? Above, in the sterile zone, God is in control and all knowing, acting in ways that we cannot understand, yet always working to our benefit. All this, while we lie below with our limited perception, ignorance, and varying levels of fear, trust and faith; occasionally, and sometimes in desparation, making contact with the sterile zone. The patients have varying ability to see. Sometime their vision is blocked by their own cataracts; sometimes by drugs administered by the surgeon; usually by the bright light which is shining in their eye for the procedure. The only connection between the patient and the sterile zone is through this single, very limited perspective: their eye. Completely vulnerable, yet intact and whole, the patient lies on the other side of the sterility zone aware that their eye is exposed to the sterility zone, yet unaware of what is happening up in the sterility zone.

It is fascinating to be watching from the sterile side and think that on the other side of that eyeball lying beneath the blue drape is a human being.

Thursday, September 27, 2007
10:30pm
Our lodge in Dritabiki
We saw post-ops this morning and did 6 surgeries. We decided to do the last two surgeries before breaking for lunch because things were moving along so smoothly, we were going to make an early day of it anyway, and taking a break seems to take quite a bit more time than the actual break time. But the last surgery lasted much longer than usual, and we didn’t break for lunch until about 3:30. We ate a nice lunch and then went for a boat ride up river.

Visiting a village

Once again, I don’t know what my expectations were, but what we experienced left me in a state of awe. It’s sounds cliché to say that I felt like I stepped back in time, but as I am trying now to process the striking impressions, I am sort of reminded of living museums such as a pioneer village or an American Indian tribe reenacting the living conditions of the people they are emulating…..except that this was no act.

Travel between villages is by dug-out canoe, many with modern outboard motors attached, and this is how we traveled. The river was breath taking with brownish water, tropical trees, and blue skies with tufts of white clouds. Frequently there would be signs of civilization like a boat or two tied to the bank, or a clearing with a few buildings.

Here is the river with a typical canoe on the bank.

Charles maneuvered the boat through unseen channels and pulled up to the bank of a little village. He said that he wanted us to see where one of the patients lived. The bank was fairly steep and slippery clay for several steps, then it was mostly sandy paths with all sorts of tropical trees. We saw banana trees, ate fruit from a cashew tree, coconut trees, and many others ranging from the very small to the enormous. We came very soon upon a middle aged woman working beneath a small pavilion like hut (posts holding up a palm frond roof). Inside was a very larger (5’ in diameter) metal pan that was about 12” deep. There was a wood fire next to and beneath the metal pan, and there were some large metal bowls, one with a meal looking substance. It was pretty obvious that this hut served the single purpose of processing this yellow meal. Charles spoke with the woman at length and we eventually asked if we could try the meal, also to take a picture. She was generous with both requests. The meal was made from casaba root, and I guess they sort of toast it in this large pan. What I ate was still very warm from the cooking, it was about the consistency of grape nuts (the cereal), it was yellow, it smelled warm and hearty, it tasted at first like corn flakes, but it left a sort of bitter flavor, which I liked.

The casaba "pavilion"

While this was happening, I cold see a young mother a few huts away who was sort of tending to kids and tending to her yard. She was sweeping the sand in her front yard with a palm frond, much the same as we mike rake leaves out of the grass of our yards, but on a smaller scale. There does not appear to be much order to “street” layout (which is all pedestrian traffic). Many of the kids wore nothing at all. Some wore pants of some sort. The mothers wore a bra or the top of a two piece bathing suit, and a wrapping cloth around their waste, and sometimes around their shoulders. I saw few men, but when I did, they looked as if they wearing a wrap around their waste, much in the same way you might see a man in our culture wearing a towel around his waste.

Fairly typical home.

Trouble with the autoclave
The autoclave sterilizes the instruments between surgeries. I guess there are different kinds of autoclaves, but the one we brought fits the instruments into a cassette about the size of a box of chocolate….then into the machine it goes to run through a cycle that takes about 5-10 minutes, but it must maintain a certain range of high pressure and high temperature for 3.5 minutes. This is done through very sensitive and complex components. On a previous mission, another physician was out of distilled water, so he used D5W, which is sugar water. Not a good idea. On our first day, the autoclave worked once or twice, then would not complete a cycle. We removed the cover and discovered brown and white droplets on many of the parts. Apparently, the sugar made a solenoid valve stick….this is what releases pressure, and as a result the unit must have sprung a small leak, spraying sugar water around on the internal parts. The white dots were crystallized sugar; the brown were crystallized sugar that had landed on hot parts and caramelized. This, in and of itself was not a bad thing, but we discovered that the solenoid valve was sticking and causing the cycle to go into fault. It became my job for the rest of the mission to monitor the autoclave. We left the cover off, with all the parts exposed, and I would watch the unit while it was operating. If the solenoid valve stuck open, I would smack it with the handle end of a screwdriver. It wasn’t eye surgery, but it was a nice break from mopping the floors.

Friday, September 28, 2007
10:30pm
Our lodge in Dritabiki

Why I came to Suriname (Revised).
We went to a nearby village again tonight. This time only with Charles, Paul, Seth and I, and this time it was sort of on an evangelical mission. This is, after all, Charles’ purpose in being here. We met with one of the patients in front of his home, and a couple other men from the village joined us with about half a dozen children. It was deeply gratifying to see this man, Umlana, welcoming us to his home and so appreciative of his ability to see again. While at the clinic, the patients are not “at home” and their recovery is not apparent, so their joy is often very reserved. I am glad that I could witness his joy at his home and hear him describe in his broken English how he could see again.

Mostly, the conversation this evening was in Auken, and Charles played some jungle gospel music on a portable CD player and a dramatic gospel reading. The men were “believers” and we sat around in a circle until well after dark. It was a nervous but beautiful ride home on the river, and I saw the night sky like I have never seen it before in my life. The band of the Milky Way was visible.

In my letter to my friends and family asking for their support of this trip, I wrote that I was going to Suriname to help bring sight to blind people. Now, as our mission nears its end, I have had time to reflect more deeply on what we have done, and why I would consider coming again. The Aukeners are living a life more primitive than anything I’ve ever witnessed, and at every turn I am looking for ways that I can help them. I want to raise money to purchase an autoclave for Dr. Themen. I want to give the children a coke. I want to figure out a way to improve their transportation or their electricity or their sanitation. I want to give them cash. I want to adopt a child and promise an education in the United States. I have had to resist the urge to do the simple gestures as well as to begin scheming for the more complex. I have thought about what I can and should do to help these people, and I’ve come to this conclusion. I would come back and do this same mission again, but my purpose would be only somewhat revised: not only would I again want to help the Aukeners overcome the devastating effects of cataracts, but I would be more open to them helping me with my own blindness. It really is a pretty simple mission, and I have to resist the temptations of the complicated world in which I live.

Paul and patient, during visit to her village two days after surgery. Generally, it is rude to take pictures of older women. She was all smiles....still reluctant for the photo, but willing.

Numbers
Tuesday: 6 cataract surgeries; 1 terigeum (remove excess tissue from the eye); one membrane removal (I don’t what that is, and likely one of the pros wouldn’t be able to figure it out either….I just sort of took a few notes and this is what I heard). So, total surgeries for the day on Tuesday is 8.

Wednesday: 1 attempted repair from a fish hook injury (on a patient who had cataract surgery the day before); 8 cataracts; one terigeum. Today the blindness was more severe than yesterday.

Thursday: 6 cataract surgeries, including one 88 year old man who developed complications. The lense implant would not stay in place…..I think the white stuff of the eyeball had been compromised, leaving nothing substantial beneath the lense. Surgery lasted 45 minutes, and finally he was sutured without a lense. Dr. Tamen and Michael made several phone calls and arranged for a special kind of lense to be flown in tomorrow.

Friday: 2 cataract surgeries, 1 pterigeum; and the lense for the 88 year old man finally arrived at about 3:30 pm. His was the last surgery of the week and it ended at about 4:30m.

Total: 22 cataracts; 3 pterigiums; 3 other; for a grand total 28 surgeries. We came prepared for and had a target of 30.

Saturday, September 29, 2007
10:00am
Airfield in Dritabiki

Have seen all post-ops, packed everything and are in the air field waiting with about 15-20 other people.

12:30pm
Still waiting at the airfield. Quite awhile ago they closed the gate (fence gate like you might see in your back yard) to control people from coming and going into the airfield area. There are about 60 people inside the airfield area and about 50 on the other side of the fence. I can hear the plane. I cannot figure out what all these people are doing, and how they decide who gets to get on this plane, and with what luggage. Though our luggage is considerably less heavy, we are still traveling with a lot of weight and a lot of pieces.

Sunday, September 30, 2007
8:30am
Hotel in Paramaribo
The flight out was not nearly as enjoyable as the flight in. Twin prop plane, with seating for 19 packed in like sardines (including three people around me who had little children on their laps (so total passengers was at least 22 people and one bird).

After some logistics of moving people and luggage around, we immediately went to lunch at Roopram. It’s sort of a fast-food Hindustani cuisine. Very good, and some great options for non-meat eaters. We also got to spend some time finally with Charles’ family (the Shireys), and they were thrilled to have Dad back. Then back to the hotel and a walk to the neighborhood market to get some water and phone cards. There was a bit of a mess-up with the phone cards, so I walked with Seth to Charles’ house to get some help. Then back for a quick shower before meeting for dinner at an excellent Javanese (Indonesia) restaurant. Dr. Themen and his wife joined us. Then back to the hotel. At this point, I was pretty exhausted. Seth and I were staying in the same room and sort of made a pact that we wouldn’t sit around in a hotel room if there were things to see and do. So we went across the street to a little bar that was completely empty and had our first Parbo Bier (Suriname’s own brew). It was pretty good. After a few minutes, Paul joined us and shortly after, Michael and his fiancé, Aarti, drove up. They asked if we wanted to go see the city, and without hesitation the three of us jumped into the back of their Toyota Corolla sized car (sans shock absorbers) for a three hour tour.

They took us everywhere and showed us everything. We were all three begging to go back to the hotel by the end of the tour, which came about 12:30am. We were exhausted and suffering from cramps and pains. But what a great tour…for which we remain so grateful. Michael is of Javanese descent and Aarti is of Indian descent….there is a very large Hindustani presence in Surinam. I think the word Hindustani is used interchangeably for people from India. Suriname, particularly Paramaribo, has an enormously diverse population. There is a strong presence of Dutch (Suriname was a Dutch colony until 1975), Chinese, Javanese, Hindustani, African, indigenous people and man others. There is a rich history with Holland and some painful growth during the transition to independence. The chief export of the country is Bauxite, a mineral used to make aluminum, and many from Tennessee would recognize the name of Alcoa, which has a long history of mining not far from Paramaribo.

During our tour with Michael and Aarti, we came across three different party scenes. That is, heavy traffic and people walking around centers of activity. One was looked to be a reggae band giving an outdoor concert and attracting mostly people of African descent. The Caribbean dreadlock look is alive and well in Suriname. We drove past a nightclub attracting a large Hindustani crowd to another concert. There was also a large group of people in a downtown district that apparently attracts crowds every Saturday night.
Somewhat typical street view in Paramaribo
I could not get used to driving on the left side of the road, nor the steering wheel on the right side of the car. The roads are in fair condition, almost all are narrow, two-lane roads. There are no overpasses, and the only large bridge is over the Suriname river, and it is something of pride to the residents. The city seems quite big, with most development going horizontal rather than vertical. I think the tallest buildings I saw were a bank and the American Embassy (which is not particularly big, but it is about 5 stories tall). There are some taller church steeples, but even the larger buildings are typically top out at three or four stories. Most of the buildings are wood construction, and there is a strong Dutch influence. Much of the architecture reminds me of New Orleans, with second story porches and columns on the front of the wood buildings. We went into some very nice areas of modern homes that were lavish by Suriname standards, and definitely upscale by U.S. standards. There is a lot of crime, so we had to be somewhat guarded in the areas we would visit. Nearly all the homes have iron bars on the windows and doors, are surrounded by walls or iron fences, and have guard dogs inside the fence. There are, I think 4 hospitals in the city, though only one emergency room in the entire country. Education is similar to the U.S., but the schools all look alike and are very simple architecture. A school building will have maybe five classrooms all lined up end to end, with a concrete wall separating each, and the side walls go halfway up with concrete, and the rest of the way up with chain link fence. It sounds worse than it looks, and actually seems like a very simple, effective design. I did see several police stations, but otherwise rarely saw a police presence.

Monday, October 1, 2007
8:30am (Suriname time)
Port of Spain, Trinidad Airport
This is the first few minutes of down time I’ve had since last journal entry. We have about an hour here, then a 4.5 hour flight, then a long layover in Houston, so I hope to get this journal caught up and ready to upload as soon as I get home. I’m pretty sure the Reggae band that played on Saturday night was on our flight this morning. I’m working on very little sleep….never caught up from the trip, and went to sleep about midnight with a wake-up call at 2:20am.

Monday, October 1, 2007
11:15am (Suriname time)
Somewhere over the Caribbean
We got up around 8:00 Sunday morning to go to church with Charles and family. They are Southern Baptist, and the church where they worship is about a 30-40 minute drive. We arrived to find out that the church was closed. It is a small church….looks like a converted house, and we found out that they decided to do an evening service because it was the 5th Sunday of the month. So we headed back to the Shirey’s home and had a little devotional time followed by trip debriefing, then to lunch with Dr. and Mrs. Themen at their favorite Javanese restaurant. I’m sure I would never go hungry in this city: I like these ethnic foods. Near the end of the meal, Dr. Themen said he would like to sing for us. I had heard that he had a beautiful voice and that he loved to sing, but I had not heard him yet. Mrs. Themen told us that he wrote this song for us. Then, in the middle of the afternoon, in this outside patio restaurant, he began singing for us. He was standing beside me, and I nearly came out of my seat as he began to sing. He is a very quiet man, and I usually have difficulty understanding him because I cannot hear him speak. But when he sang, he sang with such power and beauty. I had to turn around and watch because what I was hearing did not at all match my imagination of what he would sound like. He had written a beautiful song about how we had lifted the spirits of the people. I am going to write and ask him to send the lyrics to me. It was very moving.

After eating, the Themen’s offered to give us a tour, and Seth and I took them up on it. Paul was taking sick with a headache, so he opted to go back to the hotel with the girls. Later, talking to Charles about our tour, he said he was sorry he hadn’t come with us, as we saw so much that he has never seen. Since we had seen much of the city the night before, most of our tour was of their personal home and the surrounding country side. The Themens are true Surinamers, well established in the city. Dr. Themen’s father was an ophthalmologist in Paramaribo. He died just this past year at age 100. They live now in Dr. Themen’s childhood home that has a ground level clinic where he sees patients three nights a week. Otherwise he is working at the hospital. In his clinic, he still uses some of the equipment that his father purchased fifty years ago. Their home is very old, several stories tall, all painted wood inside and out, with natural air flow through shuttered windows and a beautiful main level porch full of plants and overlooking the street below. I told them that if my wife ever came into this house she would not want to leave. We left the house and some more of the city, but headed towards their “land house” which is about a 30 minute drive into the country. This is sort of a pleasure farm, family retreat house with several acres and has been in Dr. Themen’s family for many years. There is a pool with cabana and a house that is now used by their son to run his trucking business. We drove around in the country, stopped at a large bakery in an outlying town and picked up some fresh baked cinnamon bread. Mrs. Themen knows no strangers, so if she wants information, she tells Dr. Themen to stop along the country road, where you are likely to see people walking between houses. The area we were in is mainly inhabited by bush Negroes, as Mrs. Themen calls them. She is of African descent, so I took this to be politically correct. We stopped at a medicine man’s house and met a reggae looking fellow who sold us two watermelons in exchange for enough money to buy a beer. We stopped at some houses along the road that had a sign out front advertising wood carvings. We ended up buying several items, but Mrs. Themen did all the bartering and she ordered Seth and I to stay in the car and don’t show are white faces, and definitely to not talk, which would reveal our American accent. We then went out to see the Alcoa mining factory…..huge. I call it Alcoa, but it is the Suriname division, which is called Surialcoa (or something like that). We stopped in at a friend’s vacation home on the river. I was surprised to see any pleasure craft, but there were some folks out on jet skis. This house was pretty amazing. The owners obviously were wealthy, and they were very gracious to us and welcomed us warmly, insisting that we stay and have a drink. I think they had high regard for Dr. Themen, and who wouldn’t? The vacation home was actually partially under construction, but there was an existing sort of cabana, or covered porch area for outside entertainment. The place was not ostentatious like I might expect to see of a similar situation in the states, but it was very nice. The most beautiful and amazing aspect of the home was that the wife was a gardener by hobby and her plants were everywhere. It was very much like visiting a botanical garden with scores of different species, all perfectly manicured and displayed individually, often with statues or other hard-scape. She also had a few bonsai trees and she told me that she taught bonsai classes sometimes. When I first got out of the car and met them, I was almost rude in ignoring our hosts so as to admire the gardens and take photos. I think this pleased her and she was so gracious in giving me a tour.

I could not do justice to her gardens with my little camera.

It was getting late, and we had plans to meet back with the rest of the group by 7:00pm for dinner. Seth and I had not expectation that we would be gone so long. We didn’t get back into town until about 7:45 but it turned out fine for all. We then went to dinner, but on the way, Charles had asked Paul to take a look at the eye of a friend of his who had severely injured his eye and face in a welding accident. Paul needed a special scope to view it, so they went to Dr. Themen’s home and examined the fellow, which was a great segue into inviting the Themens out to dinner with us. This time, we ate a Dutch pancake restaurant…..anything you can imagine just about, cooked into a giant sort of pancake or crepe. I chose tomato, mushroom, cheese and egg. Sounds gross, but it was very yummy. Others had things like coconut milk with almonds, or Canadian bacon with pineapple, or ice cream with chocolate chips. We ended the spectacular day by packing our things together so we could wake up and meet our 2:30am cab to the airport.

Monday, October 1, 2007
8:13pm (Suriname time)
In the air between Houston and Knoxville
I’m not feeling the exhaustion so much, but once we land, I still have to drive back to Nashville tonight. I’ll have to get all jacked up on Espresso and sleep it off tomorrow….but I already know I’ve got a meeting or two in Nashville tomorrow. Right now, I’m having a little trouble getting back into the right frame of mind.

Here is a photo of surgery in progress. Seth has his back to us. Paul is operating. Tiffany is in the red shirt handing him instruments. Dr. Themen is on the right with the video camera, he was documenting the entire procedure for reference. Michael is in the background taking a picture. I'm the guy snapping this photo.

Saturday, Sept 22, 2007 9:30am
My office


I've had a few questions of late regarding the trip, so I'll try to give a few answers here:

Who is Going?
Me and four people in the medical profession (specifically in eye care).
Dr. Paul Froula is the ophthalmologist. He and I have been good friends since college. He has done this trip one time before.
Dana Froula is his wife and former assistant.
Tiffany Glandon is Paul’s current assistant. By the way, I’m sure there is more professional title than “his assistant” but I don’t know what it is.
Seth Miller is a manufacturer’s rep for medical supply company. He provides equipment and supplies to Paul’s clinics.

What organization is in charge?
Actually, I was surprised to find out that I don’t think it is fair to say that any particular organization is in charge. Paul decided he wanted to do this trip. He knows others who do similar trips, and there is some good trading of information and medical equipment for such trips. But, this is pretty much a Paul Froula endeavor. This is not to say that others are not helping. A ministry that Paul supports in Knoxville, Hands and Feet Ministry, is, I think, the social outreach component of a church where Paul sometimes worships. I’m not sure really that Hands and Feet is tied to this one church though. Paul has told me of many of the efforts of this ministry, including things like car clinics for single mothers. Hands and Feet is supporting this trip, but I suspect Paul is a significant benefactor of Hands and Feet, and likely he expects to make sure that Hands and Feet does not loose money on this particular endeavor.

The organization in Suriname that is helping significantly with logistics is a missionary component of the southern Baptist church http://www.n2allnations.org/. This website tells a lot more about their mission and the region than I will be able to tell. If any organization could be said to be sponsoring this trip, it would be this one. Charles Shirey (the lead missionary) is helping significantly with logistics and arrangements, and has put together a schedule of events. I expect he is also doing all the communication to people who will be receiving medical treatment.

How is the trip funded?
I don’t know about the others, but I agreed to pay for my own trip (travel, food and lodging). I don’t yet know the amount of this commitment….maybe about $2,000. But this will be somewhat offset by contributions that I have raised (to date, about $2,000). So, I get a free trip, right? Not exactly. There are many costs for which I will not be reimbursed. I hope to raise more money than what I have already raised. I am not sure if the others are similarly trying to find individual “sponsors” or if Paul recruited them with the understanding that he would pay for their expenses, or if they are paying their own expenses. I suspect a combination of all the above. Of course there are significant costs that are not attributed to any individual….the medical supplies for example. Some is donated by Seth’s company, some by Paul’s practice, some is purchased. I hope that my fund raising efforts will go towards offsetting the total cost of the trip.

Today’s Info
Getting ready to depart for Knoxville.....sometime today, sort of depends on how quickly I can get things together. We depart in the morning from Knoxville. I don't know if and when I will be able to connect and update this blog. My brother is letting me use a handy little tablet computer, and I will use it to keep my journal and collect photos. I’m sure I will have time to write while in flight tomorrow, but I don’t know if I will have access to internet in order to post. On Continental, we go from Knoxville to Houston to Port of Spain, Trinidad. Then we switch to Caribbean Airlines and fly to Paramaribo, Suriname. I think we spend the night there (what’s left of it) and then catch a local aircraft to the interior. If I can connect to the internet, I will download more.

Monday, 9/19/07, 8:35am

Knox County Health Department
One week from now, if all goes as planned, we will be in Paramaribo, the Capital city of Suriname, having arrived at 1:00am on Monday. I don’t recall where we are staying that first early morning of arrival…..I need to check on that in the next couple of days. I’ve just received the second series of vaccination shots for the trip, and I have to wait in the clinic waiting room for 15 minutes before they will release me. Good opportunity to start this journal.

A tip to international travelers: Davidson Count Health Department does not do travel vaccinations. I will be spending about $300 by the time I’m done with all the vaccines (not including anti-malarial prescription) at Knox County. The only options in Nashville are private clinics or Vanderbilt, and total cost would be more than $600. Most of the shots are in one visit, but Hepatitis A&B are a series of three shots: $50 in Knoxville, $125 in Nashville. So with a daughter at UT, and my good friend and travel companion, Paul Froula in Knoxville, it is pretty convenient to make a trip to Knoxville, take Ellen out for dinner, meet with Paul and do some more trip planning, and sneak into the clinic for my AB fix, then I’m in Nashville and back at work before lunch time.

Wednesday, September 19, 2007 8:15pm

Water Purification
While backpacking in the Sierra Nevada’s this summer, we came upon a couple at lunch time sitting near a mountain lake where we all were stopping to pump water. Pumping water is just one of those chores that comes with backpacking, and I can’t remember ever pumping water while not being simultaneously attacked by mosquitoes. While a few in my group were at water edge pumping water through the filter system as quickly as possible so they could get away from the bugs, I stopped to take a look at the lake. The guy sitting with his wife asked if I wanted water…..sort of an odd question that left me with my mouth open and clearly confused. He told me that there was water in the bag hanging on the bridge handrail next to where I had just set my pack, and I could have all I wanted; he was just going to dump it out in a few minutes. Turns out, he had a fairly innovative purification system made by the same company and utilizing the same filter as my pump system. It is a bag that holds 2 ½ gallons of water, you hang the bag, and at the bottom of the bag is a filter. Water gravity feeds through the filter into a tube. Just open the valve at the bottom of the tube and put it in your water bottle and watch the purified water gradually fill your bottle. It didn’t take me long to realize that I needed such a filter, so it didn’t completely disappoint me when my pump system broke at the end of that trip. An excuse to upgrade!

That was a long story…..which is my nature. I spent an hour or two calling around and surfing for the bag filter system. I found only one in town, so I asked the guy at Bass Pro Shop to put it on hold for me, and last night I ran out to Shopryland and bought the Katadyn Base Camp water filter system along with a couple of collapsible water jugs. I cleaned and tested the filter system last night and now it is drying and waiting to be packed. I think this system is going to be perfect. Obviously, water filtration is a major concern. Though we have been assured that the water quality is good, I prefer a little less risk. I plan to find a spot to simply set up the water bag and keep a pretty constant supply of filtered water available. Of course, this is not fail safe. This filter does not remove viruses that might be in the water, and there are plenty of other ways than from drinking water to get nasty bacteria and parasites. Careful and hopeful is the best I can do.