FEBRUARY 10-14, 2014
The WVU Medical Team
February 10 is my first day of mission work in Guatemala. I am working through the San Lucas Mission in San Lucas Toliman' on Lake Atitlan', the most beautiful natural locale in the country.
The on-site volunteer director, Katie Wallyn, asked me if I would like to work for the week with a medical team from West Virginia University Medical School that is staying for a month. Sure, why not? I just left a 17-person med team in Nicaragua.
The team consists of ob-gyn Dr. Maria Merzouk, her 14 year-old son, Ben, Amani, a nurse of 30-plus years' experience, a fourth-year resident, and two third-year interns. This is Ben's second year in Guatemala. Last year he gave up a trip to Hawaii to accompany his mother in her mission work. Good kid. Margaret, another nurse who has a long history of volunteering in Guatemala in the past but is not part of the WVU team, joins us on most days.
The local Maya contact, Jesus Antonio, is a local "promotador," which means that he is trained and responsible for promoting healthcare education, distributing materials, and arranging events like this outreach clinic for a certain number of villages. He has arranged all the locations.
Besides the difference in the sizes of the teams, there are other major differences between the Nicaragua and WVU med teams. In Nicaragua we were in the city of Managua, so the team worked in various public hospitals in the morning, then came to the clinic to tend to the Pathway to Change children, their parents, extended families and neighbor children who all had appointment times. They also had access to public transportation to get to the clinic. The population was mostly mixed-race.
The WVU team are the five professionals, plus Ben, who does the eye chart exams and hands out appropriate eyeglasses donated by the American Lions club. And me. Dr. Maria asked me to assist her in "the farmacia." Oh, wow. Little did I know what that would look like. Take a look at the pictures.
The second difference is that the WVU team goes out every morning to an outlying Maya pueblo rather than the people coming into town. Because the pueblo Maya are overwhelmingly rural, transportation would be a problem. The round-trip might take them all day, which means a lost day's work, many are elderly, and they probably couldn't afford the bus fare for the whole family anyway.
The daily chores of the Maya women would be another obstacle. These women are up at 4 AM to make the daily supply of tortillas, wash clothes by hand in big plastic tubs with cold water, hang them to dry, send the young children to school in the morning until 12PM, serve the main meal at lunchtime, send the older children to school around 2PM, clean the house, which has to be swept and floors mopped daily because they live surrounded by flying dirt and debris, typically will have at least one nursing child that they are toting all day and night so as to feed at any given moment, make the family's clothes, except for the father, and on and on.
The "clinic" is held either in someone's house or in a small two- or three-room concrete community center, if the pueblo has one. Maria thinks that this outreach of taking the clinic to the people likely comes from the fact that West VIrginia is also rural and poor, so the problems of access to medical care are well understood, and the solution is logical, as well as sensitive to the population's circumstances.
Our transport is an open flat-bed truck, so along with the Rubbermaid containers of medicines and supplies that we pick up from the local hospital every morning, and some local people we pick up along the road, it's standing room only for most.
Sometime between 9:30 and 10AM we arrive at our location.
The WVU Medical Team
February 10 is my first day of mission work in Guatemala. I am working through the San Lucas Mission in San Lucas Toliman' on Lake Atitlan', the most beautiful natural locale in the country.
The on-site volunteer director, Katie Wallyn, asked me if I would like to work for the week with a medical team from West Virginia University Medical School that is staying for a month. Sure, why not? I just left a 17-person med team in Nicaragua.
The team consists of ob-gyn Dr. Maria Merzouk, her 14 year-old son, Ben, Amani, a nurse of 30-plus years' experience, a fourth-year resident, and two third-year interns. This is Ben's second year in Guatemala. Last year he gave up a trip to Hawaii to accompany his mother in her mission work. Good kid. Margaret, another nurse who has a long history of volunteering in Guatemala in the past but is not part of the WVU team, joins us on most days.
The local Maya contact, Jesus Antonio, is a local "promotador," which means that he is trained and responsible for promoting healthcare education, distributing materials, and arranging events like this outreach clinic for a certain number of villages. He has arranged all the locations.
Besides the difference in the sizes of the teams, there are other major differences between the Nicaragua and WVU med teams. In Nicaragua we were in the city of Managua, so the team worked in various public hospitals in the morning, then came to the clinic to tend to the Pathway to Change children, their parents, extended families and neighbor children who all had appointment times. They also had access to public transportation to get to the clinic. The population was mostly mixed-race.
The WVU team are the five professionals, plus Ben, who does the eye chart exams and hands out appropriate eyeglasses donated by the American Lions club. And me. Dr. Maria asked me to assist her in "the farmacia." Oh, wow. Little did I know what that would look like. Take a look at the pictures.
The second difference is that the WVU team goes out every morning to an outlying Maya pueblo rather than the people coming into town. Because the pueblo Maya are overwhelmingly rural, transportation would be a problem. The round-trip might take them all day, which means a lost day's work, many are elderly, and they probably couldn't afford the bus fare for the whole family anyway.
The daily chores of the Maya women would be another obstacle. These women are up at 4 AM to make the daily supply of tortillas, wash clothes by hand in big plastic tubs with cold water, hang them to dry, send the young children to school in the morning until 12PM, serve the main meal at lunchtime, send the older children to school around 2PM, clean the house, which has to be swept and floors mopped daily because they live surrounded by flying dirt and debris, typically will have at least one nursing child that they are toting all day and night so as to feed at any given moment, make the family's clothes, except for the father, and on and on.
The "clinic" is held either in someone's house or in a small two- or three-room concrete community center, if the pueblo has one. Maria thinks that this outreach of taking the clinic to the people likely comes from the fact that West VIrginia is also rural and poor, so the problems of access to medical care are well understood, and the solution is logical, as well as sensitive to the population's circumstances.
Our transport is an open flat-bed truck, so along with the Rubbermaid containers of medicines and supplies that we pick up from the local hospital every morning, and some local people we pick up along the road, it's standing room only for most.
Sometime between 9:30 and 10AM we arrive at our location.
POP-UP CLINICS
Most pueblos sit off-road, up steep inclines, and many are deep into tall vegetation. For one pueblo we leave the truck at the edge of the road and cross on foot a three-plank bridge over a river. The bridge sways right and left and front to back, so "Don't look down" is the advice of the day because otherwise dizziness comes on quickly. We then trek up a long dirt road then down a dirt road to up another dirt road to a home. More than a mile by the time we arrive. At Panimaquip the road is up the side of a mountain with switchback turns that make everyone in the truck screech, especially since there are no guard rails.
Dirt is everywhere - roads, surrounding the houses, and in the communal areas. Some pueblos have some stone roads or walkways, but not many. In Nueva Providencia there are four concrete-commode outhouse toilets and two flush toilets for all 384 residents to walk to and use in a central area of the community. Most pueblo homes have an outhouse in a small wooden shack.
Housing is the typical shed of spare scrap wood and metal. A couple of pueblos have houses made of concrete block, which is a step up. They are not painted, just concrete grey in and out. Rooms have one light bulb up close to the ceiling, which makes for dim, grey light. Some bedrooms have one light between two rooms at the top of a dividing wall that does not go to the ceiling. This lack of lighting makes examining a challenge. At times a flashlight is used.
Most patients are women and children. They wait wherever there is space inside or outside. They are seen in space available - bedrooms, hallways, the outside area in front of the house, a small room or two in a community center. The pharmacy area is usually prominently placed, but also usually cramped. Dr. Maria and I sit all day at small tables with the tubs of meds on the floor. We dole out medicines prescribed by the resident and interns and explain in Spanish how to take them.
Most ailments are chronic and repeat from pueblo to pueblo - lice, scabies, fungal skin infections, colds, coughs, upper respiratory infections, and chronic headaches,all from living in and breathing dirt and wood smoke (cooking is wood-fire) all day every day. Pregnancies, bladder infections, cavity-filled teeth down to the bone, malnutrition of mothers and children, except nursing babies, who are plump because of the high nutrition of breast milk. It is common for these families to eat only once per day, at a midday meal. The usual menu is rice, beans, and tortillas. They either have no meat, or chicken once a week.
Occasionally there is a serious situation, such as the 78 year-old man who complains of sudden onset rectal bleeding, which after questioning, Doc Maria figures is undiagnosed cancer. He is advised to go to the clinic in town for testing, but there's no guarantee that he will because of distance, cost, and inconvenience. Without volunteer foreign medical teams most of the pueblo Maya wouldn't see a doctor or dentist from one year to the next.
Sometime between 4PM and 5PM we pack up our movable clinic and head back up and/or down whatever road, bridge, or hill will take us back to the truck and back to San Lucas.
Most pueblos sit off-road, up steep inclines, and many are deep into tall vegetation. For one pueblo we leave the truck at the edge of the road and cross on foot a three-plank bridge over a river. The bridge sways right and left and front to back, so "Don't look down" is the advice of the day because otherwise dizziness comes on quickly. We then trek up a long dirt road then down a dirt road to up another dirt road to a home. More than a mile by the time we arrive. At Panimaquip the road is up the side of a mountain with switchback turns that make everyone in the truck screech, especially since there are no guard rails.
Dirt is everywhere - roads, surrounding the houses, and in the communal areas. Some pueblos have some stone roads or walkways, but not many. In Nueva Providencia there are four concrete-commode outhouse toilets and two flush toilets for all 384 residents to walk to and use in a central area of the community. Most pueblo homes have an outhouse in a small wooden shack.
Housing is the typical shed of spare scrap wood and metal. A couple of pueblos have houses made of concrete block, which is a step up. They are not painted, just concrete grey in and out. Rooms have one light bulb up close to the ceiling, which makes for dim, grey light. Some bedrooms have one light between two rooms at the top of a dividing wall that does not go to the ceiling. This lack of lighting makes examining a challenge. At times a flashlight is used.
Most patients are women and children. They wait wherever there is space inside or outside. They are seen in space available - bedrooms, hallways, the outside area in front of the house, a small room or two in a community center. The pharmacy area is usually prominently placed, but also usually cramped. Dr. Maria and I sit all day at small tables with the tubs of meds on the floor. We dole out medicines prescribed by the resident and interns and explain in Spanish how to take them.
Most ailments are chronic and repeat from pueblo to pueblo - lice, scabies, fungal skin infections, colds, coughs, upper respiratory infections, and chronic headaches,all from living in and breathing dirt and wood smoke (cooking is wood-fire) all day every day. Pregnancies, bladder infections, cavity-filled teeth down to the bone, malnutrition of mothers and children, except nursing babies, who are plump because of the high nutrition of breast milk. It is common for these families to eat only once per day, at a midday meal. The usual menu is rice, beans, and tortillas. They either have no meat, or chicken once a week.
Occasionally there is a serious situation, such as the 78 year-old man who complains of sudden onset rectal bleeding, which after questioning, Doc Maria figures is undiagnosed cancer. He is advised to go to the clinic in town for testing, but there's no guarantee that he will because of distance, cost, and inconvenience. Without volunteer foreign medical teams most of the pueblo Maya wouldn't see a doctor or dentist from one year to the next.
Sometime between 4PM and 5PM we pack up our movable clinic and head back up and/or down whatever road, bridge, or hill will take us back to the truck and back to San Lucas.