Next: Guatemala

After Mexico I didn't think that going to another country in Central America would be that different, shoot, Mexico and Guatemala even share a border! But I was wrong. Words, food, buildings, countryside, customs, weather, and more were all quite different and it gave me a bit of a culture shock to be honest!

What were we doing? First off, "we" was a group of first year medical students and a number of physicians. We were on the shores of Lake Atitlán in the town of San Lucas Toliman to partner with the local mission in delivering medical care to a number of the 17 small towns located in the mountains surrounding the lake. The mission employs two health promoters who work closely with the foreign medical teams to facilitate as much follow up for patients as possible. I quickly came to see the success of the program we were assisting with rested on the shoulders of these two men, Vicente and Jesus Antonio. We would have been toast without them! For one, many of our patients spoke Katchikel (one of Guatemala's 23 indigenous languages) and thus they would have to translate from Katchikel to Spanish which we then had to translate into English as our attendings did not speak Spanish. They also knew most of the patients, could recognize many of the disease presentations, and new what resources we could recruit for patients.

But, before clinic specifics a few pics to give you a sense of where this all took place. I found the area we where in breathtakingly beautiful and the following pictures only do partial justice.

One common site that I do not have a picture of (because I would have felt weird taking one) is men walking on the side of the road bent over with a huge load of branches that have just cut up on the mountain and now have wrapped in ropes that come to a point around their forehead and are bringing into town to sell.

(Our team.)

(A view from the hotel we stayed at out over lago Atitlan.)

(A morning view of the lake.)

(The lake with one of the several volcanos that ring it in view)

(An erupting volcano I saw from a morning run!)

(Morning run view of devastation from Hurricane rain damage months earlier. I usually think of water as something I enjoy drinking but this morning was all about the aftermath of its power.)

(What used to be a tranquil/small stream bed...)

(A typical street. dogs were everywhere! In fact, they were so common and considered pests that twice a year poisoned meat is put out to try and reduce their number. From my observations this had been of limited success.)

(The two main forms of transportation. Ever wonder what happens to school buses after they are retired in the US? Why, they go to Guatemala! Where they get painted fancy colors, accessorized, outfitted with sound systems and bright lights and used as general buses. For some reason the bigger a vehicle is the faster it is driven - aka the buses race around tight twisty pot-holed roads at speeds that have you predicting an accident every other moment! The man who collects the bus fare will climb out the back emergency exit while the bus is moving, traverse the roof while outside, and then pop in through the front main door! I was told many of them die or get injured doing this.

The other transportation method common is the little 3-wheeled vehicle you see above called a tuk-tuk. They are everywhere and race around honking their little horns. They function as in-town taxis and you have to continuously be on the watch to not get run over!)

(Two brothers with their wares. They tried to sell me things but soon realized i wasnt going to buy and then talked with me. I ended up seeing the man on the right all over town. his name escapes me now. each time he saw me he would excitedly shout my name and we would chat for awhile. One memorable meeting happened when I was heading back from clinic and he was going out to buy bread. I accompanied him and we talked, bought bread, and then ate it together. Nice!)

Clinic

(This pic is our team crossing a spot in the river where the hurricane floods had destroyed the former bridge. We hauled all our supplies over the two little wooden bridges you see and up another 200m to have clinic. A normal trip to clinic involved a sketchy ride in the back of a truck up steep mountain roads but our river crossing adventure topped even that!)

(Riding in one of said pick ups!)

(About to set up clinic. Kami, Gus (from the mission), and Jasen L-R).

(Inside a clinic. Patient privacy you say, what is that? We did the best we could with what we had. Needless to say no pelvic exams were performed.)

As you can see space was an issue but even though there were no walls between exam rooms and we often didn't speak their language the patients we saw did not complain. As medical teams rotate through the 17 communities there are sometimes month long stretches in which no medical personnel will come to a particular community. It made for rewarding and humbling work.

One situation that was hard for me was a Saturday we held clinic and our pediatrician diagnosed a newborn as having down syndrome. She also heard abnormal heart sounds on exam and was worried the infant's heart was not correctly formed (this is common in down syndrome babies). It fell to me to translate to the mother during our entire encounter that her child was not like most babies and that he needed to see a special doctor to check his heart. The language and cultural challenges of this case left me feeling overwhelmed. I do not know if the mother can afford to see a pediatric cardiothoracic surgeon. The Guatemalan nurses present did not seem too fazed. Many babies do not make it there. if this one was not healthy enough to survive it simply would perish.

Hike

(This is a pic from a morning hike I led some students on. We had been told that hiking into the hills/forest would get us robbed but after 10 days of only looking at the beautiful highlands I had to check them out. I took a solo hike with no valuables (in case I was accosted) and encountered no problems. So, the next morning I led a group up the same way at 6am. Looking down at the waking town as the mist lifted was awesome.)

(San Lucas Toliman, morning)

Carlos:

A fun evening activity that our group participated in was an evening soccer game in a small turf field fenced in on all sides with 4-6 players per side. Ball handling was the name of the game and I lacked in this area to say the least. The turf provided tremendous traction, so much so that one evening I rolled my ankle fairly badly. I decided to return to our hotel and see if I could find some ice.

Upon entering the front gate I saw Carlos, the man who came in the evenings to work as a guard. I asked him if he knew where I could get some ice and he said no, but that his day-job was a "curandero" or healer and that he could help me. What the heck, I decided to give it a try. He busted out a small jar of green paste and started to massage it into my ankle. We began to chat and after 15 minutes or so I got up and walked a bit and you know what, it did feel better than before! From that point on I would stop by and talk with Carlos each evening. Even though he did not have many material goods he said he was a happy man because he had enough of the basics and he had his family. I learned that he had not spent a single night at home in his own bed with his wife in several years as he does not have any days off from his guard job.

Two days before I was to leave he invited me to visit him at his home. I took him up on it and ran over the next day in the late afternoon. He was working when I arrived and there were several patients lined up to see him. He took a break to introduce me to his son and a gaggle of grandkids. Then he took me into a side shed were he showed me his art. This consisted of wood that looked like a blossoming flower. How had he shaped it I asked? Nature did, he just revealed it was his reply. And he wasn't kidding! What I was looking at was a branch of an avocado tree that had been infected with a parasitic vine that burrowed into the avocado tree to extract nutrients! Where it attached to the host tree there would grow out a nodule that was half avocado tree and half parasite vine. Carlos laborously extracted the parasite portion and was left with the most amazing looking wood shapes that he would then combine into new forms for his art. He gifted me a small one and you can see it below.