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/