Today is my last day with Heidi and Matt in Santa Cruz del Quiche. Duane is flying my to Guatemala City tonight and then I fly out early in the morning. I had a great 4 weeks here, but I’m looking forward to going home and seeing family. I’ll try to post pictures when I get back.
We’re home! It’s nice to be back at the house in Santa Cruz del Quiche after 4 days. Saturday and Sunday we spent at the Ficker’s like usual, with our routine clinics in Canilla on Saturday and San Andres on Sunday. At Saturday’s clinic we saw mostly routine type issues. Sunday’s clinic was also mostly routine, except for a few patients. Our patient from last week that we diagnosed with a fetal demise at about 28 weeks returned this week and unfortunately had not yet delivered the baby. The other unfortunate thing was that in the meantime a local midwife had told the patient that the baby was alive and not dead like we had told her, and she also did some maneuvers on the woman causing the baby to become breech (butt first) versus head down like it was last week. So, now we had to convince this lady that the baby really is dead and now she’ll also have a more difficult delivery since the baby is breech. Another hard OB patient was one that came in for her first visit and we found something concerning. There was what appeared to be a large cyst-like structure near or attached to the baby’s back. As we are not experts in ultrasound, our best guess, and gut feeling, was that it was spina bifida. The baby was about 25 weeks. We encouraged her to come back next week so we can follow her closely. In the meantime will check the internet and other experts to find out what it could be. We also had a lady with awful fungal infections in her toes/feet! It wasn’t very pretty and definitely did not smell so pretty either.
Sunday afternoon Charlie, a 4th year med student from Columbia University, arrived. Then, on Monday morning Duane made several trips to bring us out to a small village called San Pedro Something (we’re not quite sure how it’s pronounced let alone spelled) in the Zona Reyna. The area we went to does not have any roads coming into it. The only way to get in or out is by a small plane or by grueling hikes up and down the mountain. Any supplies they need are bought in other towns and hiked in. I guess their cash crop is the spice Cardamon (spelling?) and they export it.
So, we came by plane. The group included myself, Heidi, Charlie, Leslie, Katie, and Hannah Ficker as the clinicians, Rachel Ficker, Matt, and Bev as the helpers, Duane as the pilot, and Tomas and Armando (locals from Canilla) as helpers and religious guidance/speakers. Please see Matt and Heidi’s blog for more details on the trip and photos of the area as well. There’s a link on the right, or just type in http://agapeenaccion.blogspot.com/
It was very hot there during the day and we were quite sweaty. There are no doctors out there nor are there pharmacies, etc. They do have ‘health promoters’ which have received some health training, but they really don’t have any equipment or medicines. The one promoter does sell Depo Provera, Vitamin B, and some other type of injections, but most of the people there don’t have much money, and a lot of those injections won’t help them with what they have.
The majority of the people we saw were mostly just for overall checkups with complaints of gastritis/reflux, fatigue, body aches and pains, headaches, diarrhea, cough, sore throats, worms, poor appetite. The most common meds I handed out were tylenol, ibuprofen, tums, vitamins, and worm medicine for the kids. Some of the more interesting things I saw were a cutaneous horn (keratoacanthoma) on the head of a 7 y/o boy, a 30 something y/o lady with cerebral palsy that actually seemed to be functioning pretty well. We also saw many people with terrible teeth. I should actually rephrase that and say everyone had bad teeth and gums and some were really bad. There were a few little kids who already had rotten teeth. Unfortunately they eat a lot of candy, and they don’t use toothbrushes or toothpaste. Dentists would have their work cut out for them here. They probably wouldn’t even know where to begin. We were able to hand out some toothbrushes and paste.
Leslie did see a woman that probably has some type of tumor near the roof of her mouth. Basically the woman talked in a very nasally voice, had a hard time breathing in through her nose, a hard time swallowing, and when she opened her mouth her soft palate was pushed down very low nearly blocking off her airway/esophagus. We were able to explain to her that this will likely gradually get worse until it finally cuts off her airway and that we really could not offer her much except prayer. Please keep her and her family in your thoughts and prayers. Apparently her husband also suffers from TB.
The last patient I saw today was about 76 y/o and was brought in by several men (?husband or son). She was from an outside village and I guess the men had tied her to a small wooden chair and then strapped her onto one of their backs and carried her for probably about 1 1/2 hours up and down the mountains. They were soaked to the bone with sweat and dripping like crazy. It’s amazing what these people can do and the strength that they have.
Yesterday we saw patients up until just before dark. We then walked down to a little creek that was only a few inches deep and bathed there. When it was dark, Duane set up a movie for them. It was a movie on the story of Jesus and it was translated into their local language, Ke’kchi! Pretty amazing. I think the whole village had come out to watch it. The vast majority of them have never seen a movie before, let alone one in their native language. Despite there probably being 200 or so people there, it was silent as everyone watched. The local people had carried up a generator they had nearby in order for us to be able to hook up the DVD since there is no electricity there. It was set up outside with a sheet used as the screen, hanging on the side of a building.
We all slept in the same building that we had clinic in. We had brought in some air matresses which helped since the building was just a wood structure with a tin roof and dirt floor. Needless to say with the sleeping quarters, the dampness, the gobbling turkeys and roosters, we did not get much sleep.
We finished up with clinic by noon today so that Duane would be able to get us all out before dark. He had to make 4 trips to bring us all back to Canilla and each roundtrip took about 1 hour. Due to weight restrictions, we ended up having to leave some of the equipment and medicines behind in the the village to pick up at a later date. Luckily we were all able to arrive safely back to Canilla. We pray that the trip was worthwhile for the village and that we were able to help them, if even a little bit, physically, spiritually, emotionally.
The diet of the people there consists mostly of rice, beans, eggs, tortillas, and coffee. They did have several chickens, roosters, ducks, pigs, and turkeys walking around so I assume they also probably eat these. Everyone there drinks coffee including the little kids and they even give it to the babies sometimes. This happens in most of the poorer areas of the country.
After returning to Canilla we had a nice big lunch and then Heidi, Matt, Isaac, Charlie, and myself jumped in the car and made the 2-2 1/2 hour drive back home. It’s nice to be back here and have a nice hot shower and sit on a comfy couch. And now I’m looking forward to sleeping in a real bed.
The sad part is that today was my last day of seeing patients here in Guatemala as we have no clinic tomorrow or Thursday and I leave early Friday morning to head back home to South Bend, Indiana. It was also my last day with the Fickers who are an amazing family. They have devoted their lives to helping the people down here with both medicine and ministry. They have been down here now for almost 10 years!
Annie, the 4th year med student here, left to go back to the states today. We will miss having her around. This morning Heidi and I went to Hospital Buen Samaritano for her gyn clinic. We saw about 7 patients, 3 of which were post-op patients from hysterectomies that Heidi had done. The others were all pretty routine.
The rest of the day was spent reading, relaxing, and packing for the weekend and upcoming trip to the jungle.
Tomorrow we will head to the Fickers for our regular Saturday and Sunday clinics in Canilla and San Andres. Then early Monday morning we will fly into Zona Reyna (the jungle) for clinic there. Duane will have to make several trips with his Cessna to transport all of us and our supplies. There are no roads that go to this area of the jungle. We will do clinic all day Monday and spend the night and may or may not do clinic again on Tuesday. I will not have any phone or e-mail access during that time, so there won’t be another post until Wednesday or Thursday. On Thursday, Duane will fly me to Guatemala City where I will spend my last night before flying back to the States. I will try to post pictures when I get back to the States.
Today was clinic again at ASELSI. It was a pretty straight forward day with mostly routine type complaints. I did see one 16 y/o girl that reported ‘fainting’ about every 2 weeks. The description of these passing out episodes was difficult to interpret and didn’t really fit any particular cause. I wasn’t for sure if she was orthostatic, having panic attacks, conversion disorder, seizures, etc. We asked her to keep a diary and write down her symptoms and the events that occurred just before and just after each episode. The hard part is that her parents cannot read or write, only she can. So we’ll be relying on her to keep an accurate history. I’ll be interested to see what comes of that.
After clinic Annie, Heidi and I went into the market at Chichi for some last minute shopping. After returning home Matt and Isaac joined us and we drove out to some nearby Mayan ruins. It was pretty interesting to see. There was a nice little museum with pictures of how they thought the ruins looked and the timeline of the Mayans in the area. The ruins themselves are not very well preserved and people are able to walk all around them. They have also not been fully excavated. Most of them are still covered in grass. In some areas you can’t actually see the ruins, but by the shape of the grass/ground you can tell there are ruins under them. Many local Mayans still come to the ruins and perform various rituals/sacrifices. You can see areas where they have burned candles and there are many ruins that are black in areas where this was done. There is also a cave there that supposedly goes under most of the ruins, but we were not able to walk much into the cave as there were three Mayan men at the mouth of the cave doing some type of ritual with candles and salt and such and we did not want to disturb them. I would have loved to take a picture of that, but it didn’t seem right to do.
For the last few days Matt, Annie and I were able to drop the missionary work and be tourists while Heidi and Isaac traveled to North Carolina for a job interview. It was a nice break. Monday morning we got up and drove about 2 hours to Panajachel where Lake Atitlan is. It’s a huge lake at the base of 3 volcanoes that I think is about 10 miles across and 1000 feet deep! It was a gorgeous day and the sky was clear in the morning so that we were able to see the tops of the volcanoes and take some great pictures! We took a boat ride from one side of the lake to the other, which was much longer than it appeared to be. But it was a nice boat ride with some beautiful views. The color of the water was beautiful. The town on the other side was a perfect set up for tourists with plenty of vendors selling any souvenir you’d like. Of course I had to partake. We then got back on the boat and stopped at another little lakeside town where we ate at a local restaurant. I had some delicious fish and a papaya drink. Yum. Finally we got back to Panajachel around 2pm, got in the truck and drove about 2 1/2 hours to Antigua. Once settled into our hotel we walked to a neat artesan store that had various souvenirs/crafts that were specific to each region of Guatemala. We then ate dinner at a restaurant that apparently many famous Americans eat at when they come to Antigua (including Bill Clinton and Charlie Sheen). It was delicious. By then we were tired and headed back to our hotel. The hotel only had I think 8 rooms but it was really cute. It had a nice center garden courtyard and the rooms still had a lot of old wood as part of the structure. For those that don’t know, Antigua was the original capital of Guatemala and has tons of old buildings that were built back in the 1500s that are still standing. It’s a very colonial town and very beautiful, still with cobblestone streets.
The next day Annie and I spent the morning shopping in the market and then met up with Matt for lunch at a nice garden cafe. Annie went back for more shopping, while Matt and I stopped at a cool cafe with seats made out of coffee sacks for an afternoon coffee and then back to the hotel to rest for a bit. We then ate dinner at a cuban restaurant. We were the only customers there at 6pm since that is too early for dinner here, but it was nice because there was a band there practicing which we were able to listen to. We then met up with the brother of some friends of Heidi and Matt that happened to be in the same town and went to some bars. Lots of gringos! Mostly because there are many Americans and Europeans that come to Antigua one for vacation but also to attend the various language schools located there. Apparently it is also a place where many couples come to adopt Guatemalan babies.
Wednesday we drove into Guatemala City where we did some grocery shopping for items not found in Santa Cruz del Quiche at Hiper Paiz and Pricesmart (Walmart and Sam’s Club, respectively). We then went to a huge, very nice mall and ate lunch at Chili’s! of all places. After that we picked Heidi and Isaac up from the airport and then drove 4 hours back home. That’s a lot of driving in one day!
Tomorrow it’s back to work. We’ll be going to ASELSI again in Chichicastenango and then probably to the market afterwards since Thursday is market day in ChiChi.
Friday we went to Hospital Buen Samaritano and saw only about 6 patients. That is supposed to be an ob/gyn clinic. The first patient we saw was a 13 y/o girl who had about 28 days of vaginal bleeding. She had been seen by a private physician earlier in the week and had a workup done including an ultrasound. They diagnosed her with PCOS (polycystic ovarian syndrome) and gave her a ton of medications. A nun who helps take care of her brought her to see Heidi because she felt the girl was given too many meds and was throwing up. She brought along the ultrasound pictures which were really nice, but did not show PCOS and the girl herself did not have any PCOS characteristics. Our best hunch was actually that she had had a miscarriage, but was probably too afraid to say anything with the nun there. We saw several other prenatals and someone with a urethral cyst and another with the start of menopause. The rest of the afternoon we had off. Annie and I went for a 3 mile run on the outside of town. It was great except for when the big trucks or buses went by and blew all the exhaust in our face! It was nice to see the countryside though and get some air.
One thing I forgot to mention about clinic on Thursday, was that one patient said that we are white because we drink a lot of milk and they are brown because they drink a lot of coffee! That cracked us up.
Saturday we drove again to Canilla to the Ficker’s house. About 1 hour (13.5 miles) into the drive we had to turn around and go all the way back to town to take another road because a big gas truck had turned over on the road and it may be hours until someone could come and pull him out. So it turned about a 2 hour drive into a 3 1/2 hour drive. And no, they aren’t paved roads.
Clinic in Canilla at the Ficker’s was mostly uneventful. We saw 70-80 patients. The majority were just routine prenatals, coughs and colds, aches and pains, a few pneumonia, chicken pox. We did have one 14 y/o girl who had had a cyst removed from under her tongue in August by an American surgical team. A few weeks after the surgery, the area began to swell again. It looks like maybe her veins had been affected by the surgery and now she essentially has a big venous pool under her tongue. Unfortunately we couldn’t offer her anything then and we’re not sure what we can offer her still, but we took her info and will talk to a few more people for suggestions. The other unfortunate thing was that I forgot to take a picture of her tongue to be able to show others and maybe get suggestions for what to do.
Saturday afternoon Leslie and Katie and Rachel Ficker took Annie and I to some local Mayan ruins. It was small but very neat to see. There was a temple and a soccer field. Then Rachel, Katie, Annie and I played Apples to Apples.
Sunday we had another delicious breakfast made by Leslie and then Leslie, Katie, Annie and I headed to San Andres for clinic. It was a long day. Between the 4 of us we saw over 100 people. We saw prenatals, coughs, colds, pneumonia, diarrhea, amoebas, impetigo, warts, headaches, diabetes, etc. One woman came in at about 24 weeks and hadn’t felt her baby for 2 weeks. She had a fetal demise. Another girl was 20 y/o and brought in by her parents. She probably has schizophrenia. It was very sad because we don’t have any anti-psychotic meds and there aren’t really good places to refer her to. And if we did have meds, the girl may not take them or be able to come to clinic regularly to get the meds on schedule. We felt bad not having much to offer. At the very end of clinic, a father who didn’t have a number (appointment) asked if we would see his son. This boy was about 14 y/o and just looked malnourished and dehydrated and ill. He had been sick for 2 weeks with body aches, stomach pains, diarrhea, fever, sore throat and no appetite. His heart rate was 120-140 and his respiratory rate was 40. Both too high for him. His lungs were clear, his abdomen was diffusely tender but not rigid or like an acute abdomen, his neck was not stiff, his joints/bones/muscles all seemed tender, his throat was clear, and he had a slight heart murmur, no rashes. We weren’t quite sure what he had, but felt he needed more than what we could offer. So, we gave him some rehydration solution, and convinced his father to let us drive them back to our house and bring him to the hospital across the street from us. The boy slept most of the 2 hour drive back to the house. We talked to the ER doctor and gave her the story and she took over. Hopefully he was given IV fluids and was admitted, but apparently they don’t often admit people. And may not have even done any labs on him. We may try to go over to the hospital tomorrow to see if he was admitted, but we never got his name so that may make it difficult. He may have endocarditis, rheumatic fever, JRA, lyme disease, etc… Or he may have just had a bad viral illness and wasn’t able to hydrate himself enough. The number one cause of death here is respiratory illnes, and the number two is diarrhea.
Tomorrow Matt, Annie, and I will drive to Panajachel to see Lake Atitlan and spend two nights in Antigua and then on Wednesday we will drive to Guatemala City to pick Heidi and Isaac up from the airport. It will be a nice break from clinic to do the touristy thing. So, my next blog probably won’t be until Wednesday night.
Today was our morning clinic at ASELSI, the clinic set up by another American couple that has been here for about 20 years. Heidi does clinic here every Thursday morning. Today was not a very eventful day in clinic, with most patients having fairly normal and benign complaints. We did have a man with fairly bad psoriasis. His sons wanted to know if it was caused from him abstaining from alcohol. I guess he was an alcoholic but quit 20 years ago and that was about the time the psoriasis started. I told them no and that he definitely should not try taking on alcohol again to get rid of the psoriasis. They then also asked if it could have come from the blood transfusion he had about 20 years ago. Apparently during the war that was here about 15-20 years ago he got shot several times and was in the hospital and received several blood transfusions.
We also saw a 22 y/o girl who was worried she had high blood pressure and diabetes. She was not married and had no kids. Apparently here that kind of labels you as an ‘old maid’. And Heidi and Matt say that many women in their 20s that aren’t married have many somatic type/vague complaints. She also talked a mile a minute and was very fidgety. When asked why she thought she had diabetes she told me because when she eats sweet or salty foods, her mouth gets dry.
At the end of the day we say a baby boy about 10-15mo old that had a rash over most of his body but worse on his hands, legs and around his neck and lower part of his face. He’s had it for about 2 months. I guess originally it was thought to be scabies and he was treated for that, but it didn’t go away. It didn’t get worse though either. He scratches at it, but it is not red. None of us could really figure out what it was. Heidi and Matt posted a picture of his arm on their blog. I looked through a skin disorder textbook and really couldn’t find anything that matched it. Any ideas?
Later this afternoon I enjoyed a short nap on the hammock! I love those things.
This morning Regina, a Mayan women who is friends with Heidi and Matt as they have helped several of her children with cleft lip/palate, brought another family with a baby with cleft palate along with the 3mo old we saw last week. If you remember, Tomas, the 3 y/o we saw last week only weighed about 6#. Heidi taught them how to feed the baby with a syringe and gave them some formula and encouraged them to feed the baby more frequently. Well, after only a week the baby has gained 1#, which is pretty good considering he was only 6# to begin with. The other baby that was brought today did not appear to be malnourished. Since last week Heidi was able to get a hold of bottles with nipples specific for cleft palate and gave those to the families. Regina also brought us a little boy about 5-6y/o with mircrotia. After seeing these kids, we jumped into the pickup truck and the families all jumped into the bed of the truck and we drove them back to their village (about 1-1 1/2 hr drive). Heidi and Matt had wanted to meet with the community leaders there to try to set up a regular clinic if possible since there seems to be a pretty good need.
When we got to the town we stopped in front of a school where all the kids were outside playing. When they saw us they yelled “Gringos!” and then they all stood at the fence and stared at Isaac, Heidi and Matt’s baby. Heidi and Matt were then able to talk to two of the community leaders who seemed really interested in getting a clinic set up. Things went a lot smoother than most of us thought they would. We think probably the biggest help for them being welcoming to the fact of gringos coming to set up a clinic was that Regina knows Matt and Heidi and must talk highly of them. Otherwise, the Mayans tend to be a little skeptical and not always trusting of Americans coming into their village, especially if it’s unannounced. But, at the end, Heidi and Matt were able to schedule the first clinic to be held there on March 24th! Although I won’t be here to see that happen, I really hope it goes well.
On our way back, we got stuck in construction a few times and finally I couldn’t hold my bladder anymore! So, I did as the Mayans do and peed on the side of the road! Luckily no one caught a picture. At least not that I know of!
Tonight, Toby and Brittany and her brother Zach, will be coming over. Toby and Brittany are from the States and have been living here for awhile and work at one of the local schools. Toby also works with the volunteer fire department here as well and has been able to bring down a lot of donated equipment for them. Previously they just fought fires in their jeans! Now the have some coats and helmets and such.
Today’s clinic was up in the mountains in a village/town called Chiminisijuan (not sure of the spelling?). It’s a clinic that Leslie and Katie Ficker usually do every Tuesday and today we decided to go and help out. Most days I’ve been wearing pants and closed toed shoes with a t-shirt and cardigan or long sleeve shirt and often bring along my fleece jacket as well. But, today I wore capri pants with sandals, a tank top and cardigan, and of course it was pretty cold today with some rain/misting! I was chilly. Luckily Leslie and Katie are very sweet and caring and helped me to get warm by lending me a wool sweater and allowing me to warm up my hands at the little fire they had going and Leslie made me some chai tea with a mix she had. Yum! Though it was hard to feel to cold when I was dry and inside the clinic while most of the patients were waiting outside to be seen and became pretty wet. Some of the poor little kids didn’t have much on and just looked so cold. We only saw about 45 patients today. Prenatal visits, colds, fungal skin infections, gastritis/GERD, body aches and pains, etc. There were two little kids that Duane tried to fit for glasses. Their vision was pretty bad as both of them squint really bad. And actually with the little girl we aren’t really all that sure that she can see much of anything, especially out of her left eye. The Fickers gave them each a pair of donated glasses that will hopefully help, and will work on trying to get them hooked up with an ophtholmologist.
Tomorrow morning we know that Regina (a woman who’s had 4 of her own kids with cleft lip/palate, and who brought us a little 3mo old last week with cleft lip) is bringing us another baby with cleft lip/palate to be evaluated and put on the list for surgery. She is also bringing another child with microtia (small, malformed ear).
Today we had clinic in Chicabracan which is only about 20 minutes away. The clinic is held in a very small room that is part of a school. The school lets Heidi use the space every other monday. For this clinic we have to bring all of our supplies and medications with us, as well as the ultrasound machine. We saw about 40 people today. A lot of them had very vague and nonspecific complaints about different aches and pains and abdominal complaints. We did have a few interesting things though. One guy came in complaining of pain and burning in his feet and when we checked his sugar, sure enough it was quite high and so we had a newly diagnosed diabetic. It’s very hard for people here to change their diets, especially when it consists mostly of tortillas, potatoes, rice and other starches. And they eat a lot of sugar too through pop, candy, fruits, etc.
We also saw a little 1 1/2 mo old boy with a decently bad club foot. We gave them the name and info for ASELSI which is the clinic we go to on Thursdays that has physical therapy and also an orthopedist that comes every so often.
Probably the most frustrating thing we saw was with the last patient of the day. Just a quick reminder that the patients show up early and buy an appointment number and we go from #1 until the last number sold in order. Well, the last patient to come in was a woman with a little girl on her back. We asked who the number/appointment was for and the mother told us it was for herself. Then she nonchalantly mentioned that her daughter (almost 3 y/o) probably has a broken arm. We asked again if she was sure the appointment was for her and not her daughter, and if so did she want to make an appointment for her daughter as well but she said no; that some woman or healer had looked at the girl and done something to make it better and that the girl would get better on her own. The little girl had apparently hurt her arm last Wednesday. To be sure nothing was seriously wrong and that her arm wasn’t broken, I wanted to take a look. As soon as I got close to the girl she began screaming hysterically. It got even worse when we tried to take off her sweater to get a good look. It was obvious the girl was in a lot of pain. And even before getting the sweater off you could see how the arm just kind of hung down and the girl was really guarding it and not moving it really at all. Once the sweater was off I could tell her elbow was swollen and likely broken. We were pretty upset with the mother for not taking the child to the hospital after it happened. We offered to drive her to the hospital after clinic to get x-rays to see if it was broken and if so exactly where and what we could do about it, but the mother declined. She apparently had several kids all under the age of 6 that would be left at home. She wanted to wait to see if her husband who works in the capital could come back home and take them. We really tried to express the importance of getting the x-rays and getting treatment to the mother and that it was her responsibility, and that her daughter could have a malformed arm or lose the use of her arm if it wasn’t taken care of properly. The only thing we could do was give her some children’s motrin that would hopefully relieve some of the girl’s pain. It was amazing to us that the mom didn’t bring the girl in to be seen and that she had made the appointment for herself and not her daughter. And would you like to know what the mother’s complaint was that she wanted to be seen for? A headache! Very frustrating. I pray and hope she takes that little girl in to be seen/evaluated.
Later in the afternoon after returning home, I enjoyed another great nap on the hammock. I love hammocks!