Wednesday, October 29, 2008

Sparrows and such...

October 29, 2008

Autumn here is not really Autumn with the midwest's cooler days and the changing colors, but after almost 10 years I have begun to understand Fall here as well. The rains have stopped and the pace has slowed after the steady stream of summer visitors. Clinics are slower as many of the men - some with their entire families - have left to work on the "coast'. The "coast" is not really the coast but the lowland where there are huge sugarcane farms. They burn the fields before they harvest the cane so the men work, chopping by hand the burned cane in the heat and humidity. It is exhausting work with little gain. All of the laborers sleep together in one large open polebarn-type building. The spread of disease - particularly sexually transimitted disease - is rampant. Men often come back sick and unfortunately, San Andres now has one of the highest AIDS population in Guatemala.

We have been busy getting 5 babies from our nutrition program ready for their cleft lip and palate surgeries. A group of surgeons from the US will arrive in Antigua next week and we have been working with 2 others missions here to get all the details finalized. Little Fredi out in the Zona Reina is scheduled to go but it has been raining steadily there for almost 2 months. We would like to fly out to get him but probably will not be able to so they will walk three hours over the mountain to the road where they will catch a ride into Uspantan. We will pick them up there either in truck or plane - depending on weather and get them into Antigua. It will probably mean a 3 days trip for them - a mere 100 miles.

We have also had the great pleasure to have 4 month old Enrique Benancio with us for the last week. He is a resident of the orphanage in San Andres but our good friend Oralia (the director of the Home) has not been getting much sleep. She is responsible for 30 other children during the day so we volunteered to help her until he sleeps through the night and gains a little weight. Between the Allison's, Katie and Aaron, and our household, we only miss out on sleep one night out of three - we've all agreed that it is the perfect way to have a new baby in the house.

About 3 months ago little Sebastiana came to clinic in San Andres with the worst malnutrition that I have seen here. She had a huge belly and was edematous and listless with sores all over her little three year old body. This type of malnutrition develops when children have very little protein in their diets. So we began to give her lots of protein along with her milk and vitamins and she began to slowly improve. Her parents thought her progress was too slow so they put her in the nutrition program in the Orphange. I am happy to report she is greatly improved. As I watched her toddle around in the Home the other day, she looked so much like a little bird with her big belly and skinny legs, and I was reminded of Matthew 12:7 when Jesus said, "Are not five sparrows sold for two pennies? Yet not one of them is forgotten by God. Indeed, the very hairs of your head are all numbered. Don't be afraid; you are worth much more than many sparrows."

Thursday, October 23, 2008

What We Do in Medicine

The department of Quiche was the hardest hit during the civil war which ended only a little bit ago in 1999. Because of this, we still see many of the effects of trying to rebuild this area including corruption, poor road and living conditions, lack of medical equipment, buildings, personnel, and medicine, general malnourishment due to ignorance, poor diet, lack of food, money or crops, and death due to ignorance and the inability to or desire to go to the hopsital in times of need. Our regular medical staff is two nurses, and we are set up to run clinics with the nearest hospital being one and half hours away (lacking in most equipment such as intubators) and the governement hospital being two and half hours away (often equipped a little better). In light of the poor hospital conditions and the peoples' unwillingness or inability to travel to them, we stretch ourselves to try to offer as many services as we can within our clinics, although we often feel the gaping hole of the presence of reliable hospital services. And as we confront the many medical and socio-economical conditions of the poeple we treat, we are often humbled by our own limitations, reminding each other and ourselves that Jesus Christ is the foundational and often only hope that these people have.

We currently have three regular weekly clinics in the towns of Canilla (where we live), San Andres (a town about 10 miles or a 30 minute drive from here), and Chiminisijuan (about a 45 minute drive from here. In our Canilla clinic, our patients are about 75% Latin, and we usually treat around 60 patients each week. Most of our patients in this clinic are right from Canilla and the surrounding aldeas (villages), although we have had some coming from as far as a 4-6 hour walk to get a consulta (appointment/consult), traveling from a township located in a department near us. About 90% of our patients in San Andres are indigenous and we usually treat right around 80-100 people each week. Because San Andres is a pretty large township, people will come from aldeas that are a three hour bus ride or longer to get a consulta. Chiminisijuan is located in a small aldea, and our clinic is actually set in a small clearing on the side of the mountain on the border of three different townships - Canilla, San Andres, and Zacualpa. We usually see about 60 patients there as well, all of them indigenous. The majority of the patients we see there dome from aldeas no more than an hour walk away, although we have had a growing number of people come from an aldea that is about a 4-5 hour walk away called Tintauleu.

Since coming here in '99, we have a felt a burden for an area in northern Quiche called the Zona Reina, near the Ixil Triangle. This area is one of the neediest medically in all of Guatemala, having the highest infant mortality rate in this country and being seemingly cut-off from the rest of the country due to poor road conditions which allow it to be accessible only by air for up to 10 months of the year. We made our first jornada (medical-evangelistic weekend trip) into this area in April of 2006 to a village called San Marcos. That weekend began the opening of other doors into that area as God started to lead and provide means to work in that area. Over the past two years, our ministry has been provided with two different aircrafts (more info can be found under the aviation section) that have allowed us to fly into villages 3-5 hour walks from the nearest roads. We have also been able to do emergency flights into this area, flying people to a hospital that would otherwise be a 9-11 hour drive after the 3-5 hour walk to the nearest road. We have also been able to make monthly trips into a town called San Pedro since January, although we continue to pray for God's direction as to whether and where we should set up a regular presence.

Although all of our current work is set up in the department of Quiche, we have found the two areas that we work in (our three surrounding villages versus the Zona Reina) to be quite different in what we encounter in all areas, including medically. In our three regular clinics, we have three areas that we primarily focus on: our nutrition program, prenatal care, and continuous management of chronic conditions. These three areas are further described below.

We have anywhere from 70-100 children that we treat in our nutrition program. The majority of children that we treat are children that were still primarily dependent on breast milk when the mom became pregnant with another child, leaving the first child with a short supply on food and nutrients. Also in our area, people are almost always only able to plant once a year during the rainy season since water is so precious and scarce during the dry season. Because of this, our numbers will gerenally increase at the tail end of the dry season as well. A few of our children are also in our program due to medical conditions such as a different types of heart defects, and then of course some are just malnourished due to general lack of food and poverty. All children in our program receive either formula or NIDO (powdered whole milk), incaparina (a protein-enriched formula that can be made into a drink), and vitamins. They are seen every two weeks to be weighed and re-assessed, and most of them will be on the program until they are about 1 1/2 - 2 years old. Although this is not a set nutrition program, we also frequently give out beans, rice, oatmeal, and other foods to widows and families that are in need of it.

Our prenatal program has taken off in even greater numbers over the past two years in large part due to the presence of the OB/GYN (Dr. Heidi Bell) who worked with us for the past two years. (More about her, her husband and their son can be found on their blog Agape In Action by clicking on their link on the left side of our home page.) In Canilla, about 60% of our patients are prenatal patients, in San Andres about 30-40% are there for prenatal care, and in Chiminisijuan we continue to add patients almost weekly and are up to about 10-15%. We give out prenatal vitamins and check blood pressures at each visit, although one of the greatest pieces of equipment and attractions that we have is our ultrasound. One of the largest reasons for the high infant mortailty rate in this area is due to fetal (and maternal) deaths during a breech delivery. Because almost every birth here is performed in the home with a lay midwife, there is no option for an emergency c-section in the case of a breech delivery discovered during the bithing process. However, we have been able to help the moms and midwives know the fetal presentation before delivery with the use of the ultrasound, and can make referrals to the hospital ahead of time if the baby has a breech presentation close to the due date. We have also found the ultrasound exams to be something the mothers enjoy coming back for monthly which has increased compliance, allowed us to check for other prenatal conditions such as pre-ecclampsia, and most importantly allows us to build relationships and trust with these women in the hopes of leading them to or dsicipling them in the freedom a relationship with Jesus offers.

We also have about 50 people which we see regularly for chronic conditions including diabetes, hypertension, asthama, and seizures. The majority of patients we see with chronic conditions have either diabetes or hypertension and we are able to supply them with the needed meds while also helping them control their sugars or blood pressure with diet and activity. Obviously, as with anywhere in the world, we often fight the non-compliance, apathy, and ignorance that can accompany patients with these diseases, although we have found again that the monthly contact have been a bridge to building trust and relationships.

Other than these three focuses, we treat acute cases with about 90% of our patients being women and children. The number one killer of kids here is diarrhea, which we treat frequently with anti-amoebic and worm medicine or oral/IV fluids or referrals to the hospital in the cases of a viral infection. The second cause of death is pneumonia which we can treat with oral antibiotics and oxygen if needed, although we are unable to provide IV antibiotics or intubation. After the common refusals to go to the hospital to receive these services, we often send them away with an oral Zithromax and prayers. Other acute cases we see range from ENT infections, hepatitis, and scabies to machete cuts, dog bites and burns. We also have performed deliveries, although we refer all deliveries to the hospital or home and usually only deliver in emergent situations. We do not see many cases of malaria or jungle fever type conditions in our area.

In our experience with the people of the Zona Reina, we have found some interesting contrasts. Because it rains almost year round, they are often able to get in two growing seasons, and will tell you that they are not poor or malnourished people but are really just lacking in good medical care. Because of this, we have not found our nutrition program to be of great need out there, but our ability to provide prenatal care and care of chronic conditions has been the most beneficial in addition to the acute cases we see.

In addition to regular clinics, we do weekend medical-evangelistic "jornadas" (like what we started with in the Zona Reina area) which are a way for us to not only be exposed to the needs of other areas and help medically, but also try to partner with other churches or Christians in the area to present the gospel with films, preaching or various Bible-school type activities.

What We Do in Agriculture

As it is our desire for the people to be prosperous in this land, we have found agricultural work to be one way that we can help them provide for their families, and we continue to experiment with various types of crops to produce income and to provide a more balanced and nutritious diet. Almost every family has a small piece of ground that is their main source of supply for the corn that they will use to make their tortillas (the staple food in their diet); while everyone in this area use oxen and hoes to cultivate and plant, our equipment is able to till deeper into the soil, bringing up fresh nutrients each year, in half the time and cost to them.

We have also started raising Talapia as they are a good source of protein and multiply quickly. We unexpectedly found that the Guatemalans (especially the indigenous people) love fish, and we have been able to encourage them to use the fish as another source of variety and nutrients in their diet. We currently have a couple ponds and are still learning how to best manage them with the hopes of being able to encourage and help others in beginning their own ponds.

In the past couple years, we have also partnered with a few families beginning chicken projects. The families either raise them for meat or eggs, in the hopes of using this as a way to not only feed their families, but also to make some money.

The Beginnings and Why We Still Do It

We are a typical Christian family who lived in a small Illinios town about 30 miles from St. Louis. We were serving God in our local church when we felt called to the mission field. We, as a family, went on 2 short term trips to Guatemala in the late 90's. When we felt the call to move to Guatemala in 1999, it was a decision that wemade as an entire family, and we all packed up the bus and truck that brought us down through Mexico and into Guatemala. A "road trip" that tested our faith and obedience to God's leading from the beginning, it was the start of a journey that has proven over and over the faithfulness of God as we have surrendered to His will in serving the people of Guatemala through various outlets of ministry. We intially started with a one year commitment which we served working in an orphanage in San Andres. While there we learned the culture and the language. We felt a strong calling to expand the ministry to include more medical outreach, we moved to Canilla and our ministry continues to grow. We live in the department of Quiche it was one of the department hardest hit during a 30 year civil war that ended in the past 10 years. The area still feels the effect of war today: poverty, corruption, lack of education and resources, lack of basic health care, and often a struggle to simply find food for families.

As AIM was birthed, so did the foundational verse Matthew 25:40 "The King will reply, 'I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.'" We also committed to serve the Guatemalan people by meeting not only their physical needs, but more importantly their spiritual needs by seeking to lead them to a relationship with Jesus Christ through intentionally building relationships with those that they come in daily contact with.

When asked why we do what we do, we point back to our Statement of Beliefs:

We believe both the Old and New Testament are verbally inspired by God: the revelation of God to man: the infallible, authoritative rule of faith and conduct. II Timothy 3:5-17

We believe in one God existing in three persons, the Father, the Son, and the Holy Spirit. Matthew 28:18

We believe in the creation and the fall of mankind. We believe in man's spiritual depravity and inability to attain righteousness. Romans 5:12

We believe that Jesus Christ was conceived of the Holy Spirit, born of the Virgin Mary, fully God and fully man. We believe that He died on the cross, was buried and on the third day was resurrected. We believe that He personally appeared to the disciples and ascended into heaven to the right hand of the Father. John 1:18, Isaiah 7:14, I Corinthians 15:1-4, Romans 4:25

We believe in salvation by grace through repentance and faith in the perfect and sufficient work of the cross. Eph. 2:8-9, Heb. 9:12,22

We believe in the present supernatural ministry of the Holy Spirit, including the indwelling, inner workings and baptism of His person in the believer. We believe in the multiplicity of spiritual gifts and supernatural signs that follow those who believe. II Cor. 7:1, Acts 4:30, Rom. 12:1, Heb. 2:3-4, Acts 2:1-41

We believe in the resurrection of believers into everlasting life and blessing in Heaven, and the resurrection of unbelievers into everlasting punishment in Hell. John 3:16, John 5:24, Mark 9:43-48, II Thess. 1:9, Revelations 20:10-15

We believe in the personal, literal, and bodily return of Jesus Christ in power and glory as the King of Kings and Lord of Lords. I Thess. 4:13-18, Zech. 14:5, Matt. 24:27, Rev. 1:7, Rev. 19:11-14

We are honored to have been called to serve the people of Guatemala and continue our efforts to build His kingdom. The people in this area are hungry for anything that brings hope to their lives, and we are confident that the gospel is the most precious gift we can give to them.
In the years that we have lived in Guatemala, God has given us numerous opportunities to minister to the people who live here. He has opened many doors allowing us to use our abilities and experiences to spread the gospel. We see our ministry growing in ways that we could never have imagined. We have come to love these people and our lives have become intertwined with theirs. We have been with them through births and deaths, hurricanes and droughts and through it all we have seen the love of God. We may not always understand what is going on but we know that we serve a God who is faithful and will never leave us. The verse that comes to mind is James 2:23-24 which says “And so the scripture was fulfilled that says, Abraham believed in God and this was accounted to him as righteousness, and he was called God’s friend. You see that a man is justified through what he does and not alone through faith (through works of obedience as well as by what he believes)”

Please stand in prayer with us.
In His love and service,
Duane, Leslie, and family

Grace and Abi

Grace, born in February of 2005, and Abi, born in November of 2005, are our adopted children. Although from different families, they quickly and easily became a part of our family and we cannot imagine life without them!

Grace’s mother was extremely sick when we met the family in a village near us. They came because Grace’s 7 year old sister was caring for her and Grace had been dropped several times. Grace was very malnourished and had really bad pneumonia. We took her in to make her well, and it was only by God’s grace that she lived (hence her name). Although her mother got better, her family felt they could not take care of her any longer and she has been with us ever since, officially becoming a Ficker in 2008. She is shy, although quite talkative, always watching out for everyone, and always ready to snuggle up with you and a good book.

Abi came to us only 3 hours after she was born. Her mother died during childbirth and no one knew who her father was, so her grandfather brought her here. After much prayer, we knew very strongly that we were to adopt her, a legal process that we are still working on. Abi is completely full of life, joy and energy and enjoys keeping us on our toes! However, she is also quick to laugh and, if you can get her to sit still for more than 5 seconds, also enjoys sitting down to read a good book.


Rachel is 13. She is thinking about being a elementary teacher possibly down here. She loves Guatemala and her family.


Joseph is 18 years old, and he is planning on being a pilot. He helps out with keeping the planes maintained and anywhere else help is needed. He loves Louis L’amour books and riding his horse.


David is 20 years old and he is the fix-it-man. He oversees the agricultural work and maintenance of all the vehicles - of which there is much down here! He loves living in Guatemala.


Hannah is the oldest daughter and now in school at Baylor University studying to be a Physician's Assistant. She likes to be here in Guatemala whenever she gets a chance and helps out in the clinics whenever she is down here. She also helps keep the ministry going Stateside.

Ryan, Katie and Jacob

Ryan and Katie got married September 2006 and they just had a baby! Ryan and Katie help the ministry from the US. Ryan is a manager at a local business in Marine, IL. Katie now stays home with little Jacob and takes care of him. Jacob was born on the 21st of December 2007 and he weighed 6 lbs and 3 ounces. He is so cute!

Aaron and Katie

Aaron and Katie were recently married on October 3 2007! They moved into a little house by our hanger at the runway here - only a mile away. Aaron is the oldest of the Ficker family children, and he is a licensed airplane mechanic and oversees all the maintenance on the aircrafts. He is also working towards his pilot’s license. Katie is a nurse who came down and stayed for one year before they got married in October. She works in the clinics and helps out with anything else that is needed. They both love working with this ministry and helping out their family.

Duane and Leslie

Duane was raised in rural Illinois, and throughout his life he has worked as a carpenter, corporate pilot, and flight instuctor - all three of which were valuable training for his work down here in Guatemala. He is currently the head of the aviation department, the chief pilot, and is using his instructor's license and experience to train Aaron and Joseph. He is also the head of the construction department, both overseeing and personally involving himself in the maintenance and repairs needed. His farming background also allows him to reach out to the farmers in the area through various agricultural projects. Leslie has had experience in a variety of settings within the nursing profession, although the majority of her experience was in the NICU. She is the head of the medical department out of which we currently run three established weekly clinics and monthly weekend medical-evangelistic outreaches to remote areas in Quiche. She also keeps the house running, including heading up the home-schooling of her children.


We will now be updating on our new blog! Please feel free to continue to float between here and our website (link can be found at the left).