As I write this article for the Herald's "summer edition", I'm listening to cold rain falling on the tin roof. I've been living in Guatemala for the past two months, or precisely since the rainy season began. I hope to stay through November, which of course is about when the rain stops. At a mile above sea level, the weather here can be downright chilly. Yet it's hard to complain. I live next to Lago Atitlán, the deepest lake in Central America and one of the most beautiful places I’ve ever visited. When the clouds lift, it makes a seven-mile wide reflecting pool for the three surrounding volcanoes.
I’m working for a small non-profit called Mayan Medical Aid. In cooperation with the Ministry of Public Health, they operate a clinic in Santa Cruz la Laguna, one of a half-dozen towns along the northern shore. Hemmed in between the mountains that drop straight to the water and the lake itself, most are only accessible by boat or foot. Women wear traditional embroidered skirts and blouses and many people only speak the Maya dialect Kaq’chikel. Yet isolation also means most families do not have access to potable water, sanitary plumbing or gas cooking. The verdant hillsides are being cleared for firewood and cornfields, while erosion and sewage cloud the lake.
My journey started with an impromptu decision last fall. As my summer job raft guiding wrapped up, I faced three months of unemployment. On a whim, I bought a plane ticket to the cheapest place I could find in Central America. I flew in to Guatemala City the night of my twenty-third birthday.
I was lucky enough to find work as one of two guides for a Dutch-owned rafting outfit. My predecessor had broken his leg and herniated a disk in a bad flip at high water. No one seemed to mind I'd only be a guide for one season. Coming from one of the most popular sections of river in the world, the Río Cahabón was amazingly and unnervingly remote. The water was placid and turquoise, until the unmistakable horizon line and watery rumble signaled an upcoming rapid like Entonces (“and then…”), Chulac Falls or Skull Canyon. An occasional rope bridge, curl of smoke, or children’s shrieks of “Gringo!” provided the only clues the river valley was inhabited. We never saw another boat.
We'd often hire Don Napoleon, one of the few men in town that owned a truck, to drive us back from our longer trips. I owe him much of my awareness of the injustices in Guatemala’s past and present. Don Napoleon had worked as an interpreter between the government and rebels negotiations in the nineties. His accounts of wartime atrocities consumed hours of harrowing back-roads travel.
Returning from our first overnight expedition, we drove through a shantytown erected outside an imposing concertina-wired wall in the middle of nowhere. Our truck was encircled by a dozen machete-wielding campesinos. Along with hundreds of other families, they’d been evicted from their lands by a strip mining operation called Maya Nickel. The only gringos most of these men had ever seen were from the mine.
After a seemingly endless exchange, Don Napo managed to defuse the situation. We were soon having sugary coffee-water with Lú (Pedro in Keq’chi, so my name as well), the spokesman for the displaced families. Our friendship with Lú grew every time that we passed through. Despite intimidations and death threats, Don Napo spoke at a protest of twenty thousands farmers a few weeks later.
As the date of my departure approached, I resolved to return to Guatemala for a more involved stay. I spent my last two weeks in Guatemala traveling across the country, visiting half-a-dozen different clinics I’d found online or by word of mouth. My search led me to my current work.
I returned to Guatemala two months ago. Although it's seemed a tumultuous time to travel, headlines by-and-large have passed Santa Cruz by. Despite our proximity to Mexico and some truly remarkable human/porcine cohabitation, swine flu has yet to catch on. The first military coup in Central America since the Cold War, across an equally porous border to the south, has equally failed to provide any local intrigue.
I'm currently residing in a hut in a grove of avocado trees. I'm renting from a French ex-pat who's fled back to Europe for the rainy season. Her collectible tins, wind chimes, and cat figurines provide shelter for a scorpion population fit for an Indiana Jones' movie. Getting stung hurts like the devil and makes your mouth and fingertips go numb. Like a video game, my arachnid adversaries have progressed from cowering in the corner to dropping from the ceiling and crawling in my clothes.
I've had it easier than some. The clinic's last dentist tried to kill a scorpion by throwing her shoe at it. The misplaced shot only scattered the brood clinging to their mother's back. A pincered plague literally came out of the woodwork over the next few weeks and drove her from the house.
My arrival coincided with the departure of a married couple who spent the previous ten months volunteering at the clinic. Replacing a fourth-year medical student, and a third-year law student has been a daunting task.
Becoming the clinic's pharmacist was the first big surprise. We stock hundreds of regular medications and thousands more donations, spanning every imaginable language and expiration date. During the first few weeks I felt an uncanny resemblance to an archivist presiding over vaults of arcane texts. Although I was the only person who knew how to find something, I had no clue what anything actually was. Through frequent consultations with my iPod Epocrites database and an attending physician, my knowledge of elementary pharmacology has come a long way.
Most of the work Mayan Medical Aid does goes into outreach clinics. We try to visit each of the towns in Santa Cruz’s district regularly, meaning we’re out of the clinic at least every other day. Common afflictions include respiratory infections, scabies, impetigo, osteoarthritis and every sort of gastric parasite imaginable. Although we can treat most patients with just a few dollars worth of medicine, other cases are more involved. It took weeks of paralyzing agents, tubes and saline irrigation to dislodge a shoelace-sized worm that had migrated into a woman's bile duct. For the past month, I've seen a gentleman for daily treatment for an ulcer that covers most of his calf.
Every consultation is rife with fascinating complications. Between foreigners and local Kaq'chikel Mayas, almost no one speaks Spanish as a first language. Throw in a couple interpreters and visits often seem like a game of telephone. Cursing and witchcraft are popular local diagnoses. A patient came last week complaining of pain shooting from the fingertip where her husband's lover had bit her six months before. Mother's swaddle their babies head to toe to protect them from evil eye, an affliction passed by sight from menstruating women, lecherous men and dogs in heat. Of course, evil eye's symptoms—fever, irritability, and loss of appetite—are present in almost every infant we see. Even our nurse practitioner, an exceptionally competent clinician, loves to recount the time a talking cat warned her of a ghost in her home.
As I get a handle on my daily task at the clinic, I'm shifting my focus toward an independent project. In theory, Santa Cruz is served by the hospital in the department capital of Sololá, just across the mountains that encircle the lake. Yet getting to the hospital, especially in an urgent situation, can be prohibitively difficult for most Mayas. Public motorboat shuttles are unreliable, packed to the brim and don't operate after dark. Acquiring a private boat or truck can cost a week's wages.
I'm working on establishing a volunteer ambulance service to access to villages around the lake. The ministry of public health has donated a small motorboat for the ambulancha (a amalgamation of the Spanish words ambulancia and lancha, or boat). In the nearby village of Tzuzuná, ten villagers have already assembled into a volunteer committee.
To carry out the project, I'm drawing on past experiences as well as new preparations. I became certified as an EMT in college and have been working the past two winters as a ski patroller. I’ve begun by teaching first responder classes in Tzununá every Sunday afternoon based off curriculum I've developed. As our classes attract attention, we're recruiting similar committees in each of the villages in the district. I hope to raise funds to purchase a shortwave radio setup and equipment like backboards and oxygen tanks for the ambulancha.
The service has the potential to make greatest difference in responding to obstetric emergencies. Almost all births in Santa Cruz take place at home under the care of a traditional midwife. Yet around fifteen percent of pregnant women will develop a potentially life-threatening complication. Although unpredictable, most obstetric emergencies are easily treatable with prompt hospitalization. Getting women to the hospital is the problem. Santa Cruz's department has one of the highest maternal mortality rates in the Americas—around 270 deaths per 100,000 live births. By contrast, most developed nations have rates in the single digits.
Prophetically, our first class in Tzununá was interrupted by a messenger from the midwife. A woman who’d given birth that morning was presenting with fever and edema. It had begun to pour, and the town's terraced streets had transformed into muddy cascades. In bulky woven skirts and cheap plastic slippers, the committee's female members took off at a sprint through the deluge. Despite my trail runners and best efforts, I arrived minutes later, both humbled and inspired.
The call took place during daylight, close to the shore, and required no hospitalization. But it was an encouraging start. A doctor from the clinic arrived in the ambulancha within forty-five minutes of our call.
Unfortunately, not every scenario ends as well. Just two weeks later in the next village over, a 19-year-old developed headaches and dizziness going into labor. She wasn’t sent to a physician until she’d lost consciousness and started to seize from high blood pressure. The baby died, and the mother is now in uncertain condition with liver and renal damage.
I look forward to reporting further progress and misadventures from the rest of my stay. I would grateful accept any donations to help purchase medical equipment and radio communications for the ambulancha. Tax deductible gifts can be made out to Mayan Medical Aid and addressed to Sandy Vondrasek at the Herald. Thank you!
