Twice the Amount of Fun

Today was the first day that we traveled to two towns to provide medical care. 

We loaded up on a boat at 7:30 AM and made our way across Lake Atitlan to a popular town visited by many tourists, San Pedro. As we loaded off the boat and began walking into town to meet the van, we saw lots of locals selling fruits, juices, and hand made goods on the street. Everyone watched and turned their heads as they witnessed 25 people all dressed in green scrubs and sweatshirts carrying duffle bags up a hill. You could tell they looked at us with equal amounts of admiration and confusion; they were aware we were medical persons coming to provide care, but it must have been comical to see everyone looking exactly the same. Regardless, everyone greeted us with a warm “buenos dias” and children waved and followed us up to our van.

Heading to the boat 

Loading on

Pulling up to the town

Heading to the vans
Check out the guys on the left staring at us and wondering what we are doing

Beautiful quits for sale 

Look at all the fresh fruits on the right for sale 

The first town we drove to, Santa Clara, was approximately 10 minutes outside of the main city center of San Pedro. This was the first village where we had translators, which I was extremely thankful for because I was placed on registration! Myself and two other students, along with a translator, helped to register 100 patients for the morning session. We were responsible for getting the basics: name, age, address, social history, surgical history, family history, and the reason that brought them to the clinic. While this sounds simple, I found the process to be very difficult. I stumbled on words necessary to take a history leaving a lot of silence and me floundering for the right Spanish word. When I finally asked the right question, the patient would often go into a lengthy description of their concerns and I had no idea what was being said. I could pick out key words, such as “cough,” “headache,” or “pain” but anything beyond that was lost in translation. I was very dependent on the translator during the first couple of registrations, but eventually I developed a better script that allowed me to get through the process in about 4 minutes rather than 10 (especially since if the interview were in English the process would take about two minutes).

We were in a school building in the center of town. All day we heard children go out for gym class

When I first started to take the histories, I was surprised how embarrassed all the patients were when I asked if they smoked cigarettes or drank alcohol. While in Belize, whenever we asked this to patients the majority of them were very honest and would openly admit to drinking a lot of beer or smoking marijuana for pleasure. Each patient in Guatemala, regardless of their age, giggled a little, hid their head, and shook it very quickly to say “no.” Eventually, I found out from the translator that the community we were in was very religious and drinking/smoking cigarettes is frowned upon. These people were raised to never even imagine partaking in those activities, so they found it very humorous when the Americans decided to ask them about their social habits.  

A beautiful church right next to the building we were in

Compared to other villages we visited during the week, I was surprised by the vast differences in the patients we saw that day. Since this village is more centrally located and not in the mountains, there were more patients, especially female patients, who had jobs. I had quite a few female traffic officers and other women in professional dress come in with a cold or to get a wellness check and acquire vitamins. In no other village did the women seem to have job other than maintaining the children and taking care of the home (and “taking care of the home” means something completely different than what you’re thinking & I'll explain later). Even the way that the women dressed, shirts with glitter and sparkles on them and skirts in bright fresh colors, contrasted from the villages in the mountains where women wore duller colors with no extra frills. I did not notice it in the moment, but upon reflection after visiting all of the villages I realized this was the most affluent village we had the opportunity to volunteer at.

It was also rare to see men at any of the clinics, especially those who wore a uniform

The second village we went to was approximately 20 minutes up the mountain from the city center of San Pedro. As we drove up the mountain into the more remote villages you could see the difference in how people lived. Houses were in poorer conditions with more cracks and less privacy, the children were running around in the middle of the day instead of being in school, and more people were walking on foot than taking tuk tuks (the local taxis) or cars. Regardless, we arrived at a gym and immediately upon entering the building we saw at least 30 people sitting in chairs lining up to be seen. I knew we were going to have a busy afternoon at this village.

Looking down on San Pedro as we head up the mountain

You start to notice more people on the street  

Living conditions start to become more basic the higher you get in the mountains

I was placed on physical exam with five other students. Thankfully after having registration in the morning I was more in tune with my inner Spanish phrases and it was a little bit easier to understand and communicate with the patient to discuss their problem.

One of the first patients I had was an older lady who came in for a headache. She said she has had this headache for many years now and some days it causes her a lot of pain and discomfort. I did the physical exam and everything was normal, which is to be expected. I told her that I would be giving her some ibuprofen to take when the pain is very bad, as well as some vitamins. As soon as I mentioned we would be able to give her medications she looked down, began praying, and continued to tell me “gracias, gracias, gracias” over and over. We I went to walk her over to the pharmacy, she grabbed my arm and we walked hand in hand all the way through receiving her medication until she left, which is when she gave me a big hug and a final thank you. I was so touched by this moment. All I did for this lady was give her a few doses of Ibuprofen and a month’s worth of vitamins, but she made me feel like I cured her cancer. We take things like NSAIDs, which we pop like candy here in America, for granted and forget that they are too much money for the average Guatemalan to afford. I was incredibly rewarding to know that this lady was so thankful for our visit and would be feeling some relief for her headache soon.

So happy someone took this photo of this moment. 

Another patient that I had the opportunity to help was a 7 month pregnant female who came in complaining of blurry vision. I did a physical exam, checked her vision, and concluded that the patient probably needed glasses to solve her problem. Out of habit from pervious patients I saw who were pregnant, I asked her how the baby was doing and if he was moving. She suddenly had a look of worry wash over her face and started to describe to me and the translator that three days ago she felt a sharp pain in her side and she has not felt the baby move since then. A look of worry probably fell across my face as well and I started to think the worse. I excused myself for a moment and went to ask if we had a fetal Doppler so that I could try to find the fetal heart rate. Unfortunately, we did not have one so instead I tried to find the heart beat with my stethoscope but I could not hear anything. I educated the patient that if anything were to change or she still didn’t feel the baby move, she needs to seek help at the hospital.

I found it difficult to be in a situation that I had absolutely no control over. There was nothing I wanted more than to reassure the patient that the baby was okay and the pain was probably a result of the weight from her belly pulling on her back; I couldn’t let those words out of my mouth because I honestly did not know. We can come prepared with as many medications and equipment as possible, but there will always be something we don’t have. I still think about that patient and I hope that as soon as she left the clinic she felt the baby’s foot sweep across her belly and she is doing fine.

It was very busy day filled with over 200 patients across 2 villages. I am so proud of myself and my classmates for being able to keep up the energy and positivity all day long. Everyday has made me more and more excited for the villages to come.

Leaving San Pedro after an incredible day 

Santa Catarina Palopo

Clinic Day 1

Best part of the day was giving children their goody bags

While in Belize we cared for people that had the bare minimum for healthcare insurance; regardless, they still had the privilege to see the doctor when they needed to if they did not feel well. In these small villages of Guatemala, these people have nothing. After my first day in the clinic, I discovered that the people in Guatemala rarely go to the doctor and they often have no insight into their own medical problems. Even pregnant mothers rarely go to the hospital to have their babies, instead they have “comodromas,” a Midwife, who delivers the children. Medications such as Tylenol or Ibuprofen are too expensive to buy and the patient has to suffer in pain for many days. It is not that the people do not care about their health, it’s that they don’t have access or the funds necessary to maintain all areas of health.

Walking towards the first clinic

The clinic we set up was up the stairs on the right
The building is a medical office for the locals to go to if they have a problem; however when we arrived it seemed like no one had used it in a very long time

The town we visited today was a first-time clinic for the program; never before had we been in this town to provide medical care. Not only did we not have a previous relationships built with this town, but also the locals had no idea who we were and there was no established foundation of trust. The best we could do for that day was advertise that we were there and hope people showed up.

The town of Santa Catarina

This is a "taxi" where people climb into the back of the truck, hold onto the rails, and stand until they reach their destination 

Another obstacle for being a first time town was that we did not know common specific problems in that area, so we only brought a few supplies and medications to hand out. We were supplied with Ibuprofen, Tylenol, acid reflux medication, Benadryl, hydrocortisone cream, anti-dandruff shampoo, cough drops, and a goodie bag for everyone that included a month supply of vitamins, soap, toothpaste, and a toothbrush. Unfortunately, we had no antibiotics, blood pressure medication, or diabetic medications. 

I was assigned the role of pharmacy, where I had to hand out medications based on the physical exam findings. I found myself saying “sorry” too many times because we did not have antibiotics for a baby's respiratory infection or Metformin for a patient’s high blood sugar. It was devastating seeing a patient's face drop after you explain that we don't have what they need. Eventually a few people ran to a local pharmacy to buy some antibiotics, blood pressure medications, and metformin pills but we had to hand them out sparingly because our stock was limited. I was happy that 95% of the patients only needed some Tylenol and hydrocortisone cream, supplies we had an abundance of, but I wish I never had to deny a patient medication for a problem they had. 

Pharmacist for the day! 

Sometimes patients had a new problem right before they were about to leave.
No problem, we got it covered! 

We also faced one more challenge for the day… no translators and only 2 people knowing enough Spanish to speak a full sentence. I know very little Spanish, and the phrases I do know have nothing to do with medicine. And while I know very little Spanish, the citizens of Guatemala know very little English. I was forced to jump right in, make a lot of mistakes, but eventually figure out enough to say  to describe how much and how often they should be taking medications. I spent the majority of the day describing how to take medications in details; however, it made realize that too often as clinicians we assume that all patients know exactly how many and how often they should be taking their medications. No matter who the patient is, one you see every month or someone who speaks a different language than you, time needs to be taken to explain exactly what to do. I like that different experiences in Belize and Guatemala have reinforced statements I had heard during the didactic year of PA school to make them more realistic and reinforce their importance.

Explaining how to dose the medication 

Writing down instructions for this mom so she knows how many vitamins to give her children

Overall, the first day at the clinics was incredibly humbling. I saw so many people, over 60, and situations that I will never forget. One patient came in who was 15 years old and she had a son who was 6 months old. She was accompanied by her 17-year-old sister, who also had a baby of 9 months old. The 6-month old baby had a bad infection and while a person was out at the pharmacy grabbing some antibiotics, the baby would not stop crying and screaming, no matter what the mother seemed to do. Eventually, I watched the sisters switch babies and the older sister began breast feeding her nephew. I do not know all the specifics of the situation because the language barrier prevented me from asking, but I found the situation sad, yet moving at the same time. It saddened me that a 15-year-old child has a kid of her own and she is struggling to keep her son in good health. Regardless, the sister stepped in without a second thought to feed her nephew. It shows that family bonds and blood are the way that people live in this country. Family will do anything for each other and friends will always keep an eye out and lend a hand. I was really moved by this experience and the significance of always being there for family.

We ended our time in the Santa Catarina village by visiting local women who make woven bags, tapestries, and other hand made items. They demonstrated the amount of precision and work that goes into creating intricate designs on shirts and quilts. Just a small table runner takes up to 6 months to complete; that is so much time for such a small item! Every woman was so proud of the work that she had done and when you bought something you knew it was more than something from a factory, it was a piece of art made with love and passion. It was a great stop to end our first day in the villages of Guatemala; we got to experience local culture as well as serve a community in need.

The women will sit on the floor to make their art 

Look at all of the tiny detail

Everyone picking out their favorite item to buy!