August 9, 2005

Hi gang-

Last email from Guatemala as I head out later this week. For the past 12 days I have been in San Lucas Toliman, a community of about 15,000 located on the beautiful Lake Atitlan. We joined one of our professors, Dr. Paul Wise, who has been visiting and working here for the better part of the last 30 years, as well as a team of other med students, residents, and docs--about 12 in all. While I cringe at the concept of "medical mission", this has truly been an amazing experience and I honestly think and hope is helping in some way.

The majority of the days we do mobile "consultas"--basically we all pile into the back of a pickup truck (sorry mom...it´s the only way to get around) with several large chests of drugs and travel to nearby communities that have been alerted of the clinic day. We station in whatever building is available, often just one large room, and set up mini stations of a few chairs around the room where patients line up and come to discuss their concerns. Often, there is a line out the door and around the building, yet people are more than willing to wait. Often one mother will come in with her 3-6 children who will all have some medical issues, and thus we end up treating several in one visit. The majority of complaints are diarrhea (amoebas, giardia, worms), skin stuff such as scabies, other infections, and just general colds, aches and pains--often times untreated for several months or even years. Discussing poop with Mayan women has certainly become a lot easier now--although it is not a skill I will necessarily need in Palo Alto. While it isn’t a perfect system and these people should be getting more regular care, it certainly does seem to be a valuable service, and we ourselves are certainly learning a lot. Today we hiked out about a mile from the road to a remote village and held clinic outside amongst some trees with dogs, chickens, and children running around our little stations. I doubt it was up to sanitation standards but it was all that was available. And all in all we saw 65 patients in about 4 hours. Even Kaiser would be proud.

Bryan and I spent a night at the "ER" last week in the clinic in town, which is run completely by the two night nurses. The one doctor in town will come in only for severe cases. About 20 minutes after we arrived a man walked in with an exaggerated limp and a huge bandage over his groin. He stated that he had fallen at his work site and cut his "parte". The nurses took one look and immediately sent him to a hospital on the other side of the lake, as the 5cm laceration in his scrotum could not be treated at the clinic.

After he left, they told us his story was a bunch of bull, and said he probably got in a bar fight or his mujer attacked him. No sooner had he gotten out than a very pregnant young woman (perhaps 19) came in with what she thought were the beginnings of labor. Bryan and I were very excited about potentially watching a birth and helped the women into her room and took her vitals (the nurses were amused to let us do the menial tasks). No sooner had the nurse begun the pelvic exam when zap, the electricity went out--as it does at least 4 times a day (in fact as I sit here at the computer I am praying it doesn’t die before I finish typing). No one seemed to flinch. We fumbled around in the dark and Bryan triumphantly produced his hiking headlamp from his bag. The nurse was so amused by the tool, and when we offered it to him, he was able to complete the exam quite effectively with the hands-free luz. While alas the women was not in fact in labor, Bryan’s headlamp did get to participate in its first ever pelvic exam.

However, we were able to participate in a birth this past weekend. The whole experience was surreal, mainly due to the lack of any type of machine. There was no fetal monitor, no IV pump...just pure silence with occasional groans of pain by the stoic young woman delivering her first child (without an epidural). The nurse was the only one working, and he recruited us to support her legs, check the progress, etc. After 3 hours of labor, the woman delivered a healthy girl. What bothered me most was the look of disgust and disappointment on the mother-in-law’s face at the announcement that it was a girl and not a boy. Asi es.

I leave Guatemala on Thursday after a month of many adventures.

Besos a todos,

Tress