Turtle!

I'll put some back-posts about our time in Monterrico- what was kind of nuts was that we stayed up late to try to see nesting turtles in the middle of the night (and we didn't see any). Then, the next day (our free day), it was sort of overcast, and Tim came back with the news that he saw a turtle come up the beach and lay eggs! So after lunch I went on a major walk (miles), trying to find one; then on my way back I ran into Calvin, Shira, and Derek, and Calvin spotted one behind us! We watched it- it took several attempts to get onto the beach from the waves, and then was very slow walking up the beach- which you might expect, but what we were surprised by was how exhausted it got, and by how far from the waves it went (well into the grass beyond the beach). Then it turned around and dug a hole. But it did not lay eggs; it ended up just digging a whole, turning around, and returning to the ocean.

I was kind of glad it did not lay eggs! While we were the first people to spot this turtle, by the time it made its hole, there was quite a crowd, and I have now heard from several different sources that poaching of eggs is commonplace- Guatemala now simply asks that a few of the eggs are turned into the conservatory- but it sounds like this rarely happens.

Hopefully this turtle came back at another time and lay its eggs while no one was watching! I sure felt fortunate to see it though.

Highlights

Arenales por VIH testing

After seeing a few prenatal patients with Marina, a group of us, including Dr. Gutierrez, headed out to Arenales, a town about 1hr 20min away, via the highway and then a very rough dirt and gravel road.

It was very hot. The surroundings had lots of palm trees, some hills, and outcropping rocks. We set up in a school, and first there was a charla (chat) in Que'chi, then we took people's information and blood and ran rapid HIV tests (results ready in about 20 minutes). I was there to help with running the tests, and to do consults if there were sick folks- we only saw two sick babies, so it was pretty slow.

I think we saw about 35 women and 2 men for testing.

All in all, pretty fun to see another town in this area, and to get out of the clinic for awhile!

Daily life in Buenos Aires

So I usually take a "minibus" ( van) about 15 minutes to Rio Dulce (Q7), then a "tuc-tuc" (Q2-3) from there to the Centro de Salud. Both can be squishy- maybe 20 people or so in the 4 rows in the minibus, and the "tuc-tuc" fit 7 people (several were children). The tuc-tuc is pictured here- no doors, and 3 wheels.

Here is a picture of the house where I am staying- my hosts watch a fair amount of television- and I have to admit, I have gotten hooked on a Telenovela! It is called "Teresa". I like it because they speak very clearly- things are a little overstated/extreme, and the music always cues you to the context- it's pretty fun!

I will take a picture of the water system- there is a hose shower (cold), and a huge cistern for washing in the kitchen. This water comes from a nearby river, and the water is always a lot dirtier after it has rained- if it is really dirty, my hosts use the tank with chlorine in it.

Working in the clinic

I am writing while at clinic, as the afternoons tend to be pretty slow. I spent the morning doing paps with Dolores. Here, we do the pap, then we do VIA as well. Every Wednesday is pap day.

This is a Centro de Salud, a clinic run by the government. The population we see is generally very poor, with a lot of Mayan patients. Yesterday we saw a 71yo woman with crushing chest pain- she also had cachexia, decreased breath sounds in one pulm lobe and crackles in another, and at times an irregular heartbeat, and possibly a productive cough for over 15 days. (Here, if anyone has a productive cough for more than 15 days, they get three sputum samples tested for TB.)

For her, we gave her atenolol (no aspirin or nitro in the pharmacy, only a very small tank of oxygen), and sent her to a nearby town to get an EKG and CXR done and then to come back.

She came back today with her EKG, which just showed bradycardia- the EKG costs about Q50 (about $7), and the CXR (one view because that is cheaper) would have cost Q125 (about $16). She did not get the x-ray done due to cost.

Here, the medicines that we prescribe (that the pharmacy has) are free; if the pharmacy does not have the medication, we write a prescription to be filled (and paid for) at another pharmacy.

After the paps, I worked with another nurse, and we diagnosed clinically hepatitis, Dengue, allergic reaction, and pneumonia. It is kind of nice to rely less on expensive tests, and more on clinical judgement.

There are several labs available here, in fact, but the person who works in the lab is on vacation (I think until November, unless something has been lost in translation!).

Centro de Salud: Rio Dulce

Today was my first day at the Centro de Salud (public health clinic); I worked with a nurse there, who was great.

Here is some handy vocabulary for the day:

Acuosa (diarrea acuosa) = watery

Cefalea = dolor de la cabeza

Comadronas = midwives

ITS= infecciones de transmision sexual

Moco = mucus

Sospechoso caso = suspected case

I ran into an Epidemiology article that lists what was seen Jan-July 2001 in Guatemala (I'm not sure where the data are from exactly):

Resp infections 498,746

Intestinal parasites 367,112

Enfermedades diarreica agudes 221,181

Anemia 190,628

Skin infections 127,621

SOMA 31,793

Peptic ulcer 30,583

Malaria 29,107

PNA y bronchopneumonia 19,589

UTI 13,549

Malnutrition 12,307

Conjunctivitis 5511

Hepatitis 2234

Varicela 1580

Leishmaniasis 317

Cardiopatia isquemica 240

Parotiditis 236

TB 73

Colera 3

Here is what I saw today and how it was treated (by me and the nurse):

1. 11mo F with cough: tylenol, ibuprofen
2. 5mo F with PNA: amoxicillin x7days, tylenol

and diarrhea: zinc

and amoebas: metronidazole

3. 2mo M with stomach pain; amoebas: metronidazole
4. 24yo F with moderate inflammation and infection with Candida on Pap: doxy x5 days, ibuprofen (already got antifungal at last visit)
5. 60yo M with HTN: atenolol

and back pain (scoliosis): ibuprofen

6. (Que’chi) 10mo F with vomiting and diarrhea: zinc, metronidazole, SRO (oral rehydration)

and PNA: trimethoprim

7. (Que’chi) 14mo F with diarrhea, amoebas: metronidazole, tylenol

and parasites: mebendazole

8. (Que’chi) 34yo F with reflux: antacid Rugel q8 hours
9. 7yo F with vomiting, dolor de estomago, and nurse had concern for jaundice/hepatitis: we checked her urine
10. emergencia- 73yo F from Las Flores with chest pressure/pain: we gave her Atenolol and sent her to Morales for an EKG
11. 79yo M with HTN: atenolol
12. Prenatal check at 33 5/7 weeks: listened to FHTs with stethoscope: PNV
13. Dolores translated in Que’chi for a death certificate of a 1 year old, who had had cough and fever before death
14. removal of remaining stitches in the skin post-C-section
15. 15. (Que’chi) mastitis: Amoxicillin, ibuprofen

Day 16: Transit back to Rio Dulce

Re-reading my last entry, I can see that I was pretty traumatized by the tour of the dump. It still does horrify me, and I'm not sure of a good solution.

I also definitely had a bout of homesickness this morning (especially after chatting with my parents!). Also, everyone else in the group went home to the States either yesterday or today, we had closure from the trip, and I would have happily gone home as well!

Instead, I mustered up my will-power, got a cab to the bus station, and hopped on the 6 hour bus ride to Rio Dulce, feeling a bit apprehensive. As luck would have it, though, I sat next to a very nice Guatemalan pediatrician, Eleana, who looked after me at the bus stops, and was interesting to talk with- she has been to the States many times, including to New Orleans post-Katrina.

We passed a lot of previous mudslides near our highway- this has been one of the rainiest seasons for Guatemala on record- and Eleana thinks this is pretty good evidence of global warming and extreme weather. I thought I had a heightened sense of my own mortality due to the recent dump tour as I was thinking about dangerous roads, situations, and mudslides, but even Eleana pointed out the emergency exit and said that she likes to sit on the right side of the bus, because it is further from the oncoming traffic. She would like the government to use dynamite on some of the cliffs overhanging the highway, and it does seem like these roads could be made a bit safer.

All this being said, it has not rained at all today, and our driver was great. I have safely arrived in Rio Dulce; I am staying with Edgar and Auri from the church, and am geared up for a good week. The surroundings are beautiful, and it is going to be interesting to see how they treat a lot of the same conditions that we have been seeing the last two weeks. Plus, I can tell that my Spanish has gotten a lot better since I arrived, and it will be good to see patients here for another week.

Day 14: Packing and Tour of Guatemala City Dump

Slept luxuriously here at the Barcelo (such a comfortable bed! Dry! No bugs!), woke up, had breakfast, and was ready by 8 to head to the church and unpack/organize stuff. We created boxes and first aid kits to go to the villages that we visited, and tried to put things away in a way that would make sense for the next group (in February).

For the afternoon, we had an appointment at Camino Seguro, which we got to (after a few miscommunications and stresses in getting there, and a fast stop at McDonald’s). I was not quite ready for the emotional rollercoaster that is inherent in visiting Camino Seguro and the Guatemala City dump.

We viewed the dump from above- even from a distance it smelled horrible. There were packs of vultures hanging out and circling in the sky over the dump. Our tour guide, Freddy, was formerly a professional soccer player in Guate, and has been involved in non-profit work here for many years. He was telling us awful stories about the war here, being poor in Guatemala, and life in the dump. Meanwhile, we are walking through above ground graves, listening to funeral music (there was a well-to-do funeral going on not that far away), smelling the horrible stench of the dump, and watching as mobs of people fight over the trash that is being dumped out of garbage trucks down below.

The dump is located in a sort of ravine, and there are several rivers under the dump. This creates a very unsafe environment- there have been several sinkholes where people have died; there have also been explosions from the methane gas. In recent years, children have been banned from collecting in the dump- some children are lucky, and get to go to Camino Seguro- but it sounds like there is a long waiting list. Camino Seguro serves 600 kids; I think the whole dump community is about 50,000 people.

We drove through some streets where the collectors live- large piles of plastic bottles, or broken plastic stools, or piles of cardboard, were all bundled up inside and just outside of people’s homes. The collectors work 12-15 hours in a day, and sell the plastic/glass/whatever for maybe $1 per day. Shockingly, they have to pay the city I think Q45 a year for the privilege of collecting in the dump.

We then visited Camino Seguro and watched film footage of people living in the dump- without electricity, water, or real toilets; eating food found in the dump, including meat that was a week old- it was horrifying. We also watched interviews with Hanley Denning- a young teacher from Maine, who saw the need to help kids in the dump- went back and sold all her possessions and moved to Guate, and started Camino Seguro, I think around 1997. Tragically, she was killed in a car accident about 3 years ago.

The whole day was so sad- I think all of us were on the verge of crying throughout the whole tour.

What Camino Seguro is doing, though, was uplifting- they provide meals and school for kids age 1-about 20. They provide a lot of free playtime as well. They have programs for the parents, and we were able to buy jewelry made by many of the mothers participating in the program- the beads for the jewelry were made from things collected in the dump. This part of the program has been so successful that the women make enough money from the jewelry that they don’t have to collect in the dump anymore.

The actual buildings for Camino Seguro were lovely- a place to take pride in- landscaping was actually done by grad students in landscaping from the UW!

Anyway, it was depressing, eye-opening, and hopeful to see. Here is the website for more information:
http://www.safepassage.org/

Day 10 Guate and then to Monterrico

Today Mike left really early to catch his flight with the dentistas. We had a fun night the night before, having some drinks and dinner at the hotel and swimming.

Today at the church, Zora, Anne and I did see and treat for four women. They were all sophisticated- they all had had paps before, and knew a lot about planificacion and cervical cancer- one of them had actually taken a class on see and treat!

See and treat is where you look at the cervix with acetic acid, and if you see a lesion, you can freeze it (cryotherapy).

After lunch we headed to Monterrico in two large vans. It rained the whole way there, including on our ferry ride (when the whole van is put on a floating raft thing with a motor). Our van was in pretty good spirits- listening to Shakira and the rain.

Day 9 Drive back to Guate

So yesterday there were tropical storm warnings- tropical storm Matthew was pretty much headed right to our area in Guatemala- and everyone was worried about mudslides, road conditions, and if we went to Nacimiento, that we might get stuck there. Instead, we ended up booking it back to the capital after breakfast. I was a little nervous, but the weather and roads ended up being okay.

Day 8: Clinic at Las Flores

Las Flores (former plan was to go to Las Brisas)- got there by vehicle- we all packed into a truck- I think we fit 14 people in the flat bed of the truck (with bunches), and 7 people in the front cab part, with a pretty rough road, and a minor water crossing.

Emily’s day in the pharmacy! Had a lot of fun working with the girls in the pharmacy- I think we ran a pretty tidy ship. There were a few pretty sick kids seen today- two needed albuterol nebs, another we felt should go on to the nearest actual clinic and maybe hospital. There was a woman who did know she was pregnant until our test, and she had 7 children already.

We had a nice set-up in a part of the school; we also had very good crowd control. It was kind of nice to take it easy in the pharmacy today.

On the way back, Jennifer, Carol, Miriam, and I went to a meeting with Dr. Marta to discuss me working at the clinic week after next, and to discuss our clinics so far, and VIA. Should be interesting! My Spanish is coming back/improving daily- hopefully I will understand what is going on when I get there a week from Monday (8am sharp!).

This evening was eventful- lovely swim. Turns out that Mike had a frustrating day where he and Tim were waiting on Edgar to go get materials and get to work, but E was with us in the town all day (this actually really sucked). The evening proceeded with one of our party cutting her finger with a scalpel, and another breaking her tooth at dinner, oh and there was a needle-stick earlier in the day.

Needless to say, we were sort of a sorry bunch!

Day 7: Nuevo Nacimiento de Calles

Nuevo Nacimiento de Calles- got there by a boat- first the lake, then a tributary/ narrow passageway, then 2 people took horses, and the rest went by foot on this very open, very hot trail (supposed to be about a 30-45minute walk). The tractor truck was going to meet us, but was still on its way back to the river from the town when we arrived. The going was hard- a lot of mud and water on the trail, and the sun beating down on us (prob about 830am or so). Thankfully, the tractor did end up picking us up for the last 1/3 or so of the way- we actually had to tend to our own for a while before setting up clinic- she almost had heat stroke, requiring needing to lie down, drink fluids, we put cold water and ice on her, and tried to fan her.

I think all of us dumped cold water on our heads.

Once we had recovered, clinic was open for business. We some interesting things, including two abscesses on kids. Carol and I removed a piece of wood from a girl’s foot!

I stepped out of clinic for a minute to attend the community meeting (all men)- they were very excited about smokeless stove ideas.

Day 6: Snorkeling in Belize

Free day! In the past, the group has gone to Tikal or taken a trip on a river. Shira read in her book about an excursion to snorkel in Belize, and made it happen. We got up at 5am, took the bus for 45 minutes to Rio Dulce, then hopped on a boat that took us to Livingston- this boat ride was beautiful- after the lake, the waterway narrowed, and there was lush jungle sloping in, and overhanging the river, with lots of birds flying from shore to shore. During the bus and the boat ride there was a spectacular sunrise. At Livingston, we found our tour group/restaurant, got sized for snorkel fins, and had breakfast. After having out passports stamped at the immigration office in Livingston (and paying $10 dollars), we headed to our boat! Not much different than your standard lancha, I was simply glad it was covered. We headed straight out into the Caribbean Sea.

It was a gorgeous day- clear blue sky, sunshine, and shimmery blue water. The boatride out was maybe 1.5 hours? Straight out into open water. Seemingly in the middle of nowhere, we started to see shallow water and reefs below us, and a few tiny tropical islands, each with 1-2 palm trees. We got out on two of the larger islands- that had primitive bathrooms and bunkhouses. There were some really cool iguanas- up to maybe 4 feet long, and orange!

The snorkeling was really fun- the boat stopped at two different places- the 2^nd place had more varieties of fish- fun to get so close to them. Others in the group saw barracuda and a sting ray!

Day 5: Clinic at Agua Caliente

The morning went more smoothly today- the clinic was already set up, and I felt more used to the temperature. We took more frequent short breaks with snacks, and much more easily worked through the day, with lunch again around 3pm.

We were torn- we needed to go to a community meeting, but we also wanted to swim in the famous hot water springs waterfall (which we meant to do yesterday, but it was dark by the time the meeting ended). We decided to swim first while it was light, and then head to the community meeting. This worked out great!

Finca del Paraiso waterfall is gorgeous- it is a large waterfall of warm water, falling into a cool stream, and perfect for swimming. The rocks that come down to the river also had hallowed out areas, with caves you could get to by bobbing your head under water and under the rock (I put my hand into the cave- and it was super-hot, like a sauna.

Matt and Mike jumped off the top of the waterfall- I just hiked up to the top and then walked back down- there were cool caves off the trail- full of bats and toads! Mike got some great pictures. The swimming was definitely a highlight, and the waterfall was a MUCH warmer shower than those at the hotel! (which were just cold water). The cool river made it all refreshing.

Some of us then headed to a community meeting at Boquaron- the women had a great meeting about cervical cancer and things. Usually we like to think that it is best if folks from the community learn to do health checks and procedures, but at this meeting a few women said they strongly preferred to have strangers do these exams- the community is so small, and they find it embarrassing.

I was at the other meeting- a mix of men and women- and I talked about stoves. They were concerned with respiratory problems, and the fact that black ashes from their ceiling would fall on their food. I passed around my camera with pictures of the stove from Common Hope, and people were very positive about it. It got dark partway through the meeting, and we could see a lot of lightening in the distance. Our meeting ended abruptly when the storm picked up and there was pouring rain and wind (it was good timing actually, the meeting felt complete)- I got to briefly see a stove, and then we headed on our way, back to the hotel.

Crazy storm at dinner- so things were pretty stormy as dinner got started, and we were all enjoying watching the lightening over the lake- but then it got much stronger, with rain coming in at a slant and soaking the dinner table, and a lot of wind; and the power went out. It was a rather cozy, shared experience, and the storm continued with force through the night.

A note on cozy group dinners: one of my favorite meals was when we were at small tables, and Mike and I got to know Luis Alberto and Luis Cristobal, Xijira, and Ingrid a bit better with the help of Samuel (who has a great sense of humor). Both of the Luises seem interested in engineering, and loved chatting with Mike about building racecars.

Day 4: Clinic in Agua Caliente and meeting in Tablitas

There were a lot of folks waiting at the church when we pulled up in the bus, and it was super-hot right from the get-go. We had one building- with triage and lab in the front; then a sheet wall, and then two exam room areas. There were also two rooms (with doors) in the back- one for the dentists, and one for the OB/Gyn exams. The pharmacy and check-in were in two tents in the yard. My exam area was in the back right, and the sun really beat in through the window.

It was a little rough getting organized and starting, but we did eventually get in a groove, seeing patients from around 830am and working right through lunch- I remember taking a break around 2pm, and then feeling so tired, it was all I could do to help out in the pharmacy for awhile. We ended up having lunch at a restaurant nearby around 3pm- everyone seemed so exhausted/tired/hot/hungry, there was barely any conversation at all. We definitely needed some recovery time.

Some notes about the patients: a lot of them spoke Q'eqchi' (sometimes spelled Kekchi), so we would pull an interpreter to help from Spanish- mainly the local pastor. There were a lot of skin infections (scabies, fungal infections), lots of abdominal pain (gastritis, reflux), colds and coughs, and one really red eye x4months where the woman had lost vision in the eye (we provided referral for that one). A few people with new diagnosis of HTN, and we put them on a list to have their BP rechecked in 2 weeks after initiating captopril.

Per the dental team- almost all of the dental patients would bleed a lot- as if they were on coumadin (due to malnutrition? Weird supplements? Genetic issues?).

Right from our quick lunch, we headed to Tablitas for a community meeting. This was a really neat town on a hillside. The meeting was well-attended by about 5 men and 2 women; one of the men was a young pastor. Many other women chose to go to the meeting discussing cervical cancer- led by Carol and Anne.

Issues brought up in the community meeting that I attended included nutrient-poor soil, and having their corn fields flooded this year, so there is a real concern about having enough food; they also wanted to have more classrooms in the school. Mike and I talked about a possible stove project in the future, and the villagers were positive about it, but wanted to ensure that each home would have the opportunity to get one. At the meeting 6 months ago, they had set a goal to work on gardening. After the meeting, we looked at the school, the community garden they set up (growing a lot of different vegetables), and I got to see a stove (open fire over rocks; blackened walls and ceiling from smoke).

Back at the hotel, dinner was fun, with the sisters teaching me and Mike and a whole group of the dice game called Frunkle (?).

Day 3 Drive to Rio Dulce

Saw a few patients and families with Zora at the church Sunday morning during church services. It was fun- a lot of the patients gave us hugs at the end!

Then as a group, we were introduced on stage to the whole congregation- Mike was introduced as mi “esposa”, which made me turn red (goodness).

After lunch we headed out in a school bus. The drive to Rio Dulce is supposed to take 6-8 hours- we left around 2pm.

The drive actually wasn’t that bad- pretty scenery, roads were okay, though there was some rain. We were all in a school bus, so it was easy to socialize. Dinner at hotel- the hotel is a series of cabanas; the restaurant is a great rotunda-like shape without real walls, looking at the lake. This is in Finca de Paraiso, on the edge of Lago Izbal.

There was a really friendly (tail-wagging) cute dog on the beach by the lake that I pet (it rolled on its back to have its tummy rubbed)- I KNOW you are not supposed to pet dogs in foreign countries, but it was so cute, and looked fairly well cared for. I was feeling fine about it, until I turned back to go to dinner, and the dog grabbed my leg with its front paws, and then sort of jumped up and down with excitement, nipping. Yeah. Well, I promise I won’t pet any more dogs here!

Arrival in Guate and the first few days

I meant to have a picture of me and Mike with the 4 enormous blue duffel bags (provided by CCCG) that we brought with us, but it was a bit hectic getting packed and making it on to the airplane.

Day 1:

After a quick flight to L.A., and then a red-eye, we arrived in Guatemala City around 530am. We were met by Samuel, and brought to the church, where we had breakfast with the school children, and then took naps upstairs (much needed naps!).

The church is in a dramatic and beautiful location, on the edge of a steep ravine (see photo); certainly a nice place to spend time.

Half- asleep still, it was then time to head to Antigua for our two meetings; we were joined by two others in our group, Shira and Tim.

The first meeting was in Antigua, with the group A.L.A.S., where we learned a lot about their family planning services and cervical cancer screening and treatment. This is a very impressive organization- very well thought-out, and makes efforts to be culturally appropriate. I learned a lot from this meeting. I'm happy to share any notes or contacts; what seemed helpful to me is that ALAS would be willing to train community promotores in the communities we are going to- it seems like a great connection to make.

The second meeting was with Mario at Familias de Esperanza, just outside of Antigua. This was a meeting to learn more about their stove-building projects, and see in-person how they are put together. Mario was very helpful and kind- there are several good stove designs out there; one of my goals for this trip is to get a sense of whether this type of project would be helpful and well-received in the aldeas we are visiting. It seems like we could have a simple stove design that the youths at the church could make in their metal-working shop.

It seemed like a productive day! I wished that some folks from the church could have come to the meetings (especially the stove-building one), but there will be more meetings and opportunities to further establish the connection.

Mike and I settled in at Hotel Barcelo- it has a great outside pool (heated) and hot tub- which felt great at the end of a long day.

Day 2

Many more people from the group arrived overnight or in the morning. We headed to the church after breakfast and spent the day meeting in groups, preparing for seeing patients, and sorting through all the stuff people brought. In Mike's case, he fixed a lot of things. I worked on organizing the pharmacy. We worked pretty hard all day, wrapping up with a late dinner as a group.

Oh dear, I almost forgot the most exciting part of the day when I burned my eyeball! I have this contact solution called Clear Care, and its main ingredient is hydrogen peroxide. It comes with a special case, and has a process where the solution neutralizes over the course of 6 hours (so, while you sleep), and it works really well in cleaning off the debris on the contact. Unfortunately, I forgot one of my bags at the church that had the case in it, so I put the contacts in regular cups- low and behold, overnight the liquid did not neutralize, and when I put in my right contact, I basically put hydrogen peroxide in my eye, and it burned and stung immediately, with my contact stuck to my eye! it was awful. FYI for you readers out there, hydrogen peroxide can cause an abrasion on the cornea; redness, irritaiton, and pain, but usually no lasting damage. You are supposed to just flush the eye with a lot of water. Needless to say, I will be wearing my glasses for much of this trip.