The end of my stay in Guatemala was emotional and difficult but full of future promise. The scope of our clinic’s operations has progressed remarkably since I last wrote. Much of my work went into streamlining and expanding our outreach clinic logistics, and then transitioning my responsibilities to the local staff. This has allowing us to see much greater numbers of patients at our existing outreach sites, and I hope maintain these improvements well into the future. I was able to inaugurate my long-time goal of a “médicos con mochilas” program (doctors with backpacks)—a series of hiking outreach clinics to the village of Pajomel, Laguna Seca and Chuitzanchaj. These trips involved each trekking fifty pounds of medications and equipment nearly straight-up the mountainside to communities entirely bereft of medical care. I’ll never forget some of the cases we saw there—a two-week old infant who contracted Gonorrhea during birth (his teenage mother received it from an unfaithful husband) and hadn’t opened his eyes since birth, a boy who started seizing in the middle of my consultation with him, and nearly universal skin and intestinal parasites. In so many cases, it is amazing to see the difference a dollar’s worth of antibiotics and the attention of a someone with rudimentary medical training can make.
My time abroad was interspersed by a brief trip back to Vermont in September. The purpose of my return was twofold: to bring back donated and purchased medical and dental gear and to interview at UVM’s medical school. All told the trip couldn’t have gone any better. I returned to Guatemala with three massive suitcases of donations and discounted emergency equipment. Best of all, the physician I interviewed with was one of the kindest and coolest I’ve ever met. She has gotten me involved in a UVM program called Imaging the World that is developing state-of-the-art portable and cheap ultrasound machines for developing countries. Laypersons can easily operate them in remote locations and the compressed images are sent by satellite for reading by physicians anywhere in the world! If I am lucky our clinic may get to pilot test of the devices. We’d not only get to contribute to a groundbreaking project but also provide prenatal screening to women in the most remote villages, preventing many of the obstetric complications our ambulance chiefly responds to.
One of the most gratifying experiences over the past two months involved a specific patient, Doña Paulina (Doña is a respectful title in Spanish, like Señora). Doña Paulina is around 85 years old can’t be much more than four feet tall—she reminded me a little of Yoda from Star Wars. She has outlived all her family and lives alone in a mud-and-stick hut. We heard from her neighbors she wasn’t feeling well and when the clinic staff arrived she was nearly comatose with fever with an ulcer the likes of which I hope never to see again. It is fortunate that I spent much of the past summer as a “wound care technician” for smaller ulcers or I would have had a difficult time coping. We are not sure how she got it, but what is clear is it had been bed-ridden for many months and was on the verge of lethal, system-wide sepsis. It fell on me to be her caretaker and for the remainder of my stay I hiked every-other day to her village to dress her wound and administer antibiotics and nutritional support. Our initial prognosis was fairly grim and I believed my role would be mostly palliative. To our amazement, she has been healing at an astronomical rate! She is up out of bed, chatting away (in Kaqchikel of course, seemingly oblivious to the fact I barely understand a word), and cooking her own food. It is clearly not an accident she has survived to 85 (decades longer than the average), and I hope she has many years to go.
The sorrow of leaving Guatemala has been ameliorated by the fact that I didn’t truly have to stay goodbye. I’ve been working hard on shaping my return plans for the months of April. I will spend the winter converting my pickup truck (a ’94 4WD Toyota) into a basic ambulance. Barring grave misfortune, the end of the ski season I will load it with gear and drive it down through the US and Mexico to Guatemala. I’ll spend the summer living in the community of Chuitzanchaj, one of the villages we visited on “hiking outreach clinics”. I have high hopes for my accomplishments there, including training emergency committees similar to those on the lake shore and operating the ambulance until I can transfer its ownership and responsibility to the community. I’ll convert the small casita where I’ll be staying (a two-roomed concrete building without running water or a fridge) into a supply depot for medications and medical equipment. This will allow our physicians much greater ease in making the hike up to provide outreach clinics, and hopefully I will be able to provide simple medical services the days I am alone there. I will hire a full-time translator to help (almost no Spanish is spoken in these villages) and do my best to learn as much Kaqchikel as I can over the winter.
