Do you have night sweats?

Back in September I wrote about modifying my list of standard medical questions after a patient said "the ants like my urine". Here's the link to the whole story:
http://thegilmers.blogspot.com/2005/09/self-diagnosing-diabetes-mellitus.html

Since adding this question to my standard list which doctors call the "Review of Systems", I have made a few other cultural adaptations to the question list (translating into Tagalog the most obvious adaptation). One of the questions that I have decided to drop from the regular use is: "Do you have night sweats?" The reason I decided to drop it is because most of our patients live in make-shift housing with cinder block walls and sheet metal roofs. Often they lack electrical power and thus no fan to move the air around either. Now even in our house which was designed to be cooler and has electricity for fans, it can still get pretty hot. Lately when we have been going to bed, it has been in the 87 - 90 degree (F) range. I don't know about you but that is enough to make me have night sweats whether I'm sick or not. So I have to question the usefullness of the information gained from this question...
Or maybe I'll just quit using it because I could never quite pronounce the Tagalog word for night sweats anyway.

More unexpected Visitors

The rains have come to the Philippines giving us a break from the extremely hot weather. While it hasn't cooled down completely, the evenings are once again tolerable. Unfortunately we will now have rain until September or October and things will begin to mildew and mold once more. The beginnings of rainy season brought many creatures into our house. We began to see large black centipedes crawling across the floor. WAGs wasn't even interested in messing with them after the first day so we have been constantly picking them up over the last 2 weeks. They are also not very photogenic. This was the best picture I could take.

We have had an invasion of other creatures too. One night upstairs there were small winged bugs flying everywhere. There must have been 50-100 of them. Allan brought up the bug spray and they began "dropping like flys". We were told the rains bring out the bugs and centipedes. While we have never had as many come inside as we did that night, we have had a few visit us every evening. Tonight though was a different story. A big winged bug that resembled the first ones upstairs began flying around the light. Soon it was 2, then 3, then 4, then....well you get the point. I began to kill the ones who flew down near the floor and soon there were none left. Before long, they began coming again. Allan and I discovered they were all over the screens trying to get in. Soon there were many slipping in through the screen, flying and swarming around. Allan thought they were flying termites and after a google search on the internet, I discovered he was right. We seem to have conquered them for the evening. Thanks to our handy bug killer spray. Ah the joys of learning to live in the tropics! I do hope they fly onto somewhere else tomorrow.

What a flying termite looks like

An unexpected visitor

For the last 2 weeks we have had a guest in our home. No it is not some wonderful family member or friend from the US--although we wish(hint hint). It has been a lttle dog named Scruffy. There are many things I thought I would do on the mission field, but babysitting a dog is not one of them. Being so far from home, the mission community becomes like your family away from home. While the transient nature of mission life makes making friends difficult, the friendships that develop tend to be strong. Will's teacher, Ellen, and her husband, Dan hold a very special place in our hearts--not just because they went to Auburn either. We have enjoyed getting to know them this year and do somethings socially especially during football season.

During the last week of school, Dan's father passed away. It is hard to imagine being far from home during the midst of a family tragedy, and Dan and Ellen made the tough choice to return to the States for a few weeks. Therefore, we are watching their little dog Scruffy. He is a tiny little thing, but he and WAGs have gotten along well. The kids were very excited to have Scruff come visit. It has changed the dynamics of our house a little as we have added a 4th dog to the yard. Every few days Scruffy sends an email and a picture about his life and trials in the Gilmer household. The Brooks have posted some pictures and a few of his letters on their blog if you want to check it out at-- http://www.brookslanding.com/

Isn't it about time for a Clinic update?

I want to apologize for the lack of blogs about the clinic recently. Ginger has been very faithful to write updates about our family and adaptation to the Filipino culture. There are a couple of reasons for my lack of blogging. During the last part of April and into this week in May, I have had several bad weeks of feeling miserable, running a high fever, unable to eat, unable to get out of bed. I truly felt like death on a Ritz cracker. The first week in May was probably the sickest I have been in many, many years. Fortunately, the memory of those 2 weeks now just blur together into one big, very long, terrible day. I am still not sure what my diagnosis was – it was a fever of unknown source. All my labs were normal except for a high White blood cell count with a high neutrophil percentage. I had a few ideas about the possible causes but lacked the proper lab tests to distinguish any particular cause.

I appreciate those of you who prayed for me. I know Ginger sent an email to some about my sickness and in return, we received many words of encouragement through email and phone calls. If I spoke with you or emailed you during that time, please forgive any incoherent statements or mumblings made.

As for the clinic, we have had some very interesting and some very difficult cases recently. It seems the severity of illness that we are treating is increasing. There have been an increasing number of extra-pulmonary (outside the lung) cases of tuberculosis with some showing signs of being resistant to our current supply of medications. I will discuss this more in one of our future newsletters. Some of our sickest heart and lung problems would certainly be hospitalized in the USA but we struggle to manage them through the clinic since hospitalization would certainly deprive them of many of the resources they need for food, shelter and the necessities of life.

One of our biggest blessings this month was the arrival of our ultrasound. This equipment came from the same hospital closure in Illinois that also provided us with an EKG recently. The ultrasound was so large that it had to be crated and shipped separately from the smaller items. In God’s perfect timing and planning, a non-profit group with world-wide logistics connections offered to ship our ultrasound here free of charge. This hospital quality ultrasound will provide a great benefit to our patients. The various imaging transducers will allow us to perform 2-dimensional echocardiograms (heart images), obstetric measurements (for the moms to be), abdominal and soft tissue imagines (such as liver, gallbladder, kidneys, etc).





Our equipment is first off the shipping container.










The packing crate was so big we had to disassemble it just so we could put the Ultrasound on the truck.













Finally on our truck and ready to head back to the clinic!

Isda anyone?

This morning I was awakened at 6:15 by a man walking down the street shouting "Isda.....Isda.....Iiiiiss-daaa". It is not uncommon for us to have salesmen walking down our street announcing their wares, but this was a little earlier than normal. So what type of things are for sale? you ask. Of course we have the Filipino version of the ice cream man, which is either a young boy carrying a Styrofoam cooler slung across his shoulder filled with ice cream, or a bike type push cart that plays a song as it rolls, but we also have other goodies for sale as well. Anything from Ice cream to balut (a Filipino delicacy consisting of a half formed duck egg), to men carrying foam mattresses to plastic ware and of course isda--which is Tagalog for fish. My thought at 6:15 am was-"Who wants fish at 6:15 in the morning?" Quickly followed by the thought--"Of course- fish is a breakfast food here". I am sure someone took the fish vendor up on his offering of fish and right now they have cleaned and cooked that fish and are sitting down to a nice breakfast of fish, eggs, and of course rice. As for me, I will just stick to my toast. After awaking a few minutes early this morning, I woke up the kids for the last day of school. I then decided to lay back down for "just a minute since I don't have to fix lunches." The next thing I knew the kids ride was here and they weren't ready to go. There was no lunch to fix or backpacks to pack. Yet, for the first time this year, they were not ready when their ride showed up. Will didn't even have a shirt on because he could not find his uniform and Emily had not even begun to de-snarl her hair. I quickly helped them finish up and get out the door. What a way to end the school year.

addition to the above blog: It is now 7:20 and it just dawned on me why the kids were late in getting ready for school and the reason I was awakened by the Fishmonger. We normally wake up at 6:00 not 6:30. No wonder the kids couldn't get ready by 6:45. Ooops! Do you ever have those little mental moments?

Fresh Pineapple!

The weather has cooled off a little since last weekend's typhoon. The rains have come and the clouds have kept it from being quite so hot. This afternoon(Sunday), Will, Emily, WAGs, and I enjoyed being out in the back yard. Will was busy doing his "workout" which consists of swinging, running laps around the yard, 50 pushups, chinups, and climbing up a rock wall. He began having a workout routine in Greenwood, where he also used hand weights. He is so funny when he does this. He says he wants to get big and strong. Emily spent her time visiting with the baby bunnies and swinging. WAGs spent his time chasing Will or the Nelsen's dog. Our yard is on a large slope and so the back yard is terraced. As I was sitting at the top of some stairs leading to a lower level I noticed something growing in what I had thought was just a tropical bush or plant. In the center was a cute little pineapple. How do you grow pineapples? Cindy told me that you cut the green part and about an inch off the top of a fresh pineapple and plant it. It takes 9 months to mature. I guess this pineapple was planted shortly after we arrived. One of the things we like about living here is eating fresh pineapple. I usually buy one each week-- my favorite variety is Dole super gold. It is very sweet and smells really good. There are many varieties, but this is one of the more expensive. It costs only a dollar a piece so we bite the bullet and get our favorite. I think over the next few weeks I will plant some more pineapple tops. I will let you know in 9 months how they turn out.

Emily checking out the pineapple

Will and our pineapple

This young coconut tree was planted when our house was built about 5 years ago.

One day it will provide some shade for Will's swingset

Our boy!

I just thought I would post this picture of Will. A friend took this picture of him at school and sent it to me today. I thought it was really good. He has changed so much since we moved here. The kids are growing up so quickly!

Our first Typhoon!

Well we have survived it--our first typhoon. Early Saturday morning a catagory 1 typhoon passed through. We knew it was coming from the news, but I am not sure I really believed it. We had done a little prep work of filling buckets with water and bringing some chairs in off the balcony. About 3:30 in the morning the winds began to really blow outside so Allan and I got up and shut all the windows in the house. Shortly after, the power went off.

The Philippines averages about 19 typhoons (a pacific hurricane) a year. I guess it is like snowfall in the US. When it snows a little down south, everything shuts down, but in the colder regions, it takes a blizzard. That is how it is here--like the northern US in winter. Emily's class was having a sleepover at school Friday night. No need to cancel that for some rain and wind. 8 am Saturday morning when she returned home, Jeepneys, trikes, and people were out in the rain going about their business. People went on with lives and work like it was just a long summer shower. Power outages are not rare here so even that didn't seem to slow anyone down. The grocery store just fired up their generator and continued business as usual.

As for the Gilmer clan, we stayed home and enjoyed the cool breezes that blew. It was a great day for me to curl up on the screen porch with WAGs and a book. Allan did do a little work on our generator and finally got it going in the afternoon. It ran for about 4 hours so we could didn't lose the food in the fridge. We also had one light for a couple hours in the evening. It turned out to be a nice relaxing day. By Sunday morning power was restored and it was off to church for Mother's Day! We went out to eat with another family afterwards and it was like nothing had happened. We are still having really cool weather. I hope it last, but know it won't so I will enjoy it now!

More Slumber Party Pictures

Here are a few more pictures from Friday night's big event!

Eating Pizza!

Hanging out on our roof!

We have a flat roof with a metal spiral staircase leading up to it. The kids love to play up there. Emily and Will often ride scooters there. I avoid it usually because I hate climbing down the spiral staircase.

The girls brought baby powder to make their faces white and "scare" the boys

Will's class

Last night our house was full. Will's class of 13 came to our house for a sleepover. He has an exceptionally sweet group of kids in his class and so his teacher wanted to do something really special as they wind down the school year. It began as soon as school was out with a couple hours of swimming at Faith. After that, everyone piled into our van and Mrs Brooks car and headed over to our house. The kids organized themselves into a game of capture the flag while we waited for pizza to be delivered. After dinner, we watched the original Little House on the Prairie movie from the tv series. The class has just finished reading "Little House in the Big Woods" and studying the American pioneer era. They were sufficiently worn out by this time to fall asleep just after 10. Boys stayed down stairs and the girls stayed in Emily's room.

It was great fun and the kids were all so well behaved. One of the nicest moments of the day came just before bed. He Min (aka Joy), a little girl from Korea, closed our day in prayer. This year, Mrs. Brooks has really encouraged the kids to pray in the language they feel most comfortable using when talking to God. It is good for those who do not speak English as a first language to feel free to pray in class in their "heart language". So Joy ended our day by praying first in Korean and then in English. It was very sweet. I wouldn't normally have 13 kids over to spend the night, but we have loved this class this year. It has been such a good class for Will to be in. He has made some great friends.

more WAGs Tails

A funny thing happened tonight. WAGs went into the closet in the office. There is an old mirror in there and it really freaked him out. His hair stood up on his back and he began barking at himself. Allan and I had a little fun with him. Al pulled the mirror out and WAGs kept circling it looking for the other dog behind the mirror. It was really cute. I am not sure he ever got it. Al and I are such exciting people that we can be so easily entertained by a dog. It reminds me of the days when Emily was a baby and we spent all our time watching her do exciting things like bat a toy hanging above her head- not that she in anyway reminds me of a dog.

Who's that in the mirror?

"Where did he go?"

Happy Birthday to me!

Today was my first birthday spent in a foreign country and it was declared a national holiday. The kids were off from school and we went for a swim in the afternoon. Later we had a cookout with the Nelsen's and another family. It was a lot of fun and good fellowship! It was nice that a holiday was declared in my honor. They called it Labor day, but I really know the truth! (Funny how in the US people have a hard time remembering if Labor day is in May or Sept)

For my birthday, Emily baked her first cake. She got the recipe out of an old American Girl magazine that belonged to Anna, who lived here before us and is now around 20. It was really easy and the taste wasn't too bad, but it wouldn't win any contests. I think Em was proud of herself, but a little disappointed in the taste. I explained to her that the recipe has a lot to do with how good something is and a cake recipe that lacks eggs, lacks a lot. I was so proud of how good she did with no help. We had a great laugh when I told her about the first time I made a macaroni cassarole for Allan's dinner as a young newlywed. I didn't know you were supposed to cook the macaroni first. Oops! It was a little crunchy. I think she was glad my cooking skills have come a long way. Anyway I am now....well I am not going to announce my age on the internet. Those of you who love me know how young I am.

Emily's cake with a beautiful flower candle!

Another Way to Beat the Heat!

Have I told you we are in love? Will's new dog has stolen our hearts. He is so fun and cute! He is a little obsessive compulsive though. He really loves his ball. He has 2 of them-one inside and one outside. He almost constantly has one of them in his mouth. He really loves for you to throw it so he can retrieve it for you. Will loves this since the Nelsen's dog, Bonnie and his Nana's dog never really seemed to get the concept of fetch. Will would throw the ball and they would run away with it. WAGs on the other hand brings it back and places the slobbery thing in your hand to throw again. He can play this game for hours and after 2 months has yet to lose one of his balls. If only the kids were so careful with their toys!

Chasing a ball all day tends to make WAGs a little hot, so what does he do to cool off? Well...We have a fountain in our front yard--or what used to be a fountain, but until recently has just used by the dogs as a large water bowl. Last week, WAGs started sticking his head under the water. He has always loved a bath and the cool feeling he gets afterwards so I guess he decided to get that feeling more than once a week at bathtime. Soon this wasn't good enough though. If sticking your head under water makes you feel cool, surely getting your whole body wet would be better. So WAGs now takes time each day to sit in his "little pool". He loves it. The kids like throwing rocks the size of their fists in the water and watching him search and rescue the rock. He is so cute blowing bubbles. WAGs has certainly taken to water and probably wished we had a lake he could take a dip in each day. There are days I would gladly join him in his "little pool" if only it were bigger!

Go fetch WAGs!

Hot season #2

April and May are not only the hottest months here in the Philippines, but also the driest. The lack of rain causes things to be even dustier and dirtier than usual. Things begin to turn brown and leaves fall off the trees. A common practice here is to burn debris that falls onto yards and streets or even whole sections of grasses, not just in hot season, but all year long. Often the smell of something burning hangs in the air. All of this burning combined with the high levels of pollution causes a high percentage of people to suffer from asthma and breathing related illnesses.This is a common problem among many of our patients. One of the things I have had to learn to use at the clinic is the nebulyser. Inhalers are also a common treatment. I always love hearing Allan and Scott explain in Tagalog how to use the inhaler. The word for puff in Tagalog is boomba. I wonder if people find English words funny sounding when they are learning our language?

In another couple of months, the rains will come, and for a brief moment the air will feel cleaner. Unfortunately, it will rain and rain and rain then everything will begin to grow mold. We've lived through that season though so maybe we will begin to get used to the seasons of the Philippines.

"How's the weather?"

For us, the answer to that question is almost always "hot", just the degree of hotness varies. For the Filipino, it actually feels cold at times. Back in January, Filipinos and kids at Faith who have grown up here, were wearing sweat shirts while the Gilmers still wore sleevless shirts and shorts. It is now officially hot season though! April and May are the hottest months of the year here in the Philippines. This afternoon about 4, I checked the weather channel online, it said the temp in Manila was 95, but it "feels like 102". I will agree with that. While the temps rarely get above 96, the humidity, the proximity to the equator, and lack of central air make it feel just plain hot. So, how do people here deal with the heat? Well, as we drive through the squatter areas near our home, we see naked little kids running around and bathing in plastic tubs to cool off. Any sourse of water becomes a pool or sprinkler. Around the house, men and boys are without shirts, women wear loose house dresses or shorts and sleeveless shirts. (Although, when out in public, a Filipina always wants to look her best--this means pants or jeans for women regardless of temps.) Even though there is not a rain cloud in sight people carry umbrellas to provide relief from the sun.

For us, we tend to have our fans running all day. We also tend to take 2 showers, one in the morning and another just before bed. These days we rarely even try to get hot water to come out of the tap. The cold has a nice warm feel, especially in the evening. The other afternoon when Allan washed his hands at clinic the water was actually hot! The water at the clinic comes from a storage tank. Most Filipinos (including some missionaries and weathier Filipinos) get their water from a water truck that pumps it into storage tanks usually placed on the roof. We are fortunate to have a a deep well pump here in the neighborhood that usually brings water into our house. The clinic is too high in the neighborhood to get much water from the pump, which is why we rely on the tanks there. Since we have moved here, we have often had sporatic periods of low or no water. There seems to be little rhyme or reason to this, nor any warning. Sometimes the lower we go in our house (it's 3 stories) the more water we can get, so we can take our shower on the first floor. We also have water storage tanks on the roof in case we get desperate and choose not to wait for the water to come back on or don't want a bucket bath. We can flip a lever and the water from the tanks will flow out of the water taps in the house. We haven't used it yet, but I am sure sometime after a typhoon we will have to.

So, we are now at about the halfway point of "summer" or hot season and so far it hasn't been too bad. Those years in middle Georgia and Augusta have prepared us well! The good news is while you are sweating this summer we will actually be a little cooler than most places in the South. Of course winter never comes so I'm not sure it is an actual win.

3...2...1... BLAST OFF!

Emily's teacher enjoys building rockets each year with his class. Even though he is the Social Studies teacher and not the Science teacher for the 5th grade, his class gets extra science and math as they learn about rockets. Last Saturday we got up bright and early to drive to a big field in Makati and shoot off some great rockets the kids had built. One rocket had a camera in the nose. We haven't seen that picture yet, but the kids can hardly wait for it to be developed. We drew a crowd of Filipino workers at the nearby construction site and the street cleaning crew. It was a BLAST!

We have lift off!
Emily is in the hot pink shorts

Mr. Kuiken and some of the class rockets

Field Day

This week was a short week for the kids due to Easter, so Wednesday, the last day of school for the week, was Field Day. The kids enjoyed the track and field events. Will continues to pick up some speed as he gets taller. He did well in the running events. Emily surprised me by being really good at the hurdles. She first ran individually over a set of lower hurdles. The next race was against 4 girls and they used higher hurdles (you can see them at the edge of the picture of Will running). Em's form was great and she took the hurdles with ease not knocking over one. At the last hurdle, she was in first place. Unfortunately that is where trouble arose and she caught a foot in the hurdle and took a tumble. The kids had fun, but it was HOT! I understand why they have field day in April and May in the US. It is a little hard to run bundled up in a winter coat, but here it is the hottest time of the year. We could have had this in January and still worn shorts. We did go to the Faith pool after school and enjoyed cooling off with the other kids and moms. It was a popular place.


Emily and Will take off on the long jump

Preparing for the shot put

50 years of Faith!

Faith Academy

located just outside Metro Manila

This year Faith Academy celebrates 50 years of educating the children of missionaries. This boarding school has played an important part in the spread of the gospel not just in the Philippines, but Southeast Asia as parents are able to provide a quality education for their kids. Today marked a special day in the life of the school that has become an important place in the life of our kids (who are day students). After many years of prayer, the school broke ground today on a new Auditorium/classroom complex. Until recently this event loomed far on the horizon, but thanks to a donation from a Korean Church in California, it is now becoming a reality. It will hopefully be completed in time for the 2007 graduation. Those of you who have ever sat crammed in a hot unairconditioned gym in July will be able to aprreciate that the school will finally have airconditioning not only for graduation, but school plays, band concerts, etc. Emily was thrilled that one of her classmates was chosen to represent the elementary school by swinging a sledge hammer in the demolition of a small maintenance building. The picture below shows her class on a back hoe at the ground breaking.

How old?

I always love the little ones who come to the clinic. The preschoolers are my favorite. They usually speak no English and therefore I am forced to speak Tagalog to them. Unfortunately sometimes my attempts at language with kids are met with a blank stare. In case your worried that my Tagalog is that bad, well it probably is, but Scott who is darn near fluent often gets the same blank stares. The babies on the other hand do not care what language you speak to them. They smile and coo at me in the way only babies can (except for the ones who scream as I try to take their temp). Last Friday, Allan had a sweet little baby boy come in for a re-check. He was one who really didn't want me messing with him. After all, I did rudely awaken him from a nap to weigh him and then pinned his arm to his side to take his temp. I tried hard to get his pulse-ox (oxygen level), but Allan said the measurement wasn't correct because the value would have meant he was close to death.
By the time the baby was seen by Allan he was awake and alert and gave me such sweet smiles and giggles. After his initial exam, I went with Allan to the "pharmacy" to help him fill meds. Most of the time Allan and Scott know exactly what medicine(s) they need and the filling of the prescription is easy, but sometimes they stand looking at the meds trying to decide what should be the course of action. This was such a case. Questioning Al about what was wrong with the baby, he replied "he probably has congestive heart failure." What I thought was a 5-6 month old baby turns out to be an 18 month old toddler. His condition, most likely combined with poor nutrition, has delayed his growth and development. It also explained the blue-grey color of his skin especially his hands and feet. It is a condition that probably could have been corrected through surgery in the US, but lack of health insurance and cash make even diagnosing his condition tough.

Go Dawgs!

I bet you are wondering why the title of the post seems to be a cheer for our college rival. This actually started out to be an email to 2 of our dear friends and ardent University of Georgia fans, but I thought others might also like to see a picture I took at clinic last Friday.

Do you ever wonder what happens to all those clothes donated to Goodwill and the Salvation Army? Wonder no more- some of them obviously make it to foreign shores. Often, we see our patients and others out in the community wearing clothes that seem out of place. Friday one of our patients had on a Myrtle Beach t-shirt. I am not sure he even knows where Myrtle Beach is; let alone has been there. We have a picture that Larry Holmes took out in the tribe of a man wearing an Atlanta Braves t-shirt. I can honestly say this guy was probably not pulling for the Braves to win the World Series. I actually enjoy seeing little bits of home here and there on Filipinos and it usually makes me smile. Such was the case on Friday. After seeing the Myrtle Beach shirt, I took the vital signs and did a urinalysis for Casimira. It was a few minutes before I realized there was a UGA Bulldog on his faded red baseball cap. It immediately made me think about our friends Steven and Kathryn--well really Steven who loves UGA so much that his whole wardrobe is black and red. I was wishing he could see it. I was so thankful the Nelsen's camera was at the clinic and I could snap a couple of pictures to send him.

As is often the case, what began as a fun or happy moment at the clinic, did not end that way. You see Casimira is sick and can't afford the treatment he needs at a local hospital. Being the sole supporter for a wife and 7 kids, he doesn't feel he can even afford the blood tests that would enable us to treat him for a related health problem- tests that run about $5. Can you imagine not being able to afford a $5 blood test? People respond to the bad news we sometimes have to share in different ways. Some act like what they have been told was nothing more than having a cold, while others break down. It always breaks my heart when they cry. This was the case for Casimira. Caught in a situation that looks like a dead end, he sobbed. It is at times like this that I understand why Allan and Scott don't try to see 45 patients each during clinic. The clinic is about more than passing out medicine and bandaging wounds, it is about ministering to the emotional and spiritual needs of the soul. Casimira puts a face on our ministry here. Please pray for him as he struggles with tough decisions in the coming weeks. Also pray for us that we would remember that our clinic is about more than medicine.