Once again, I’m in the position of sitting back in the comfort of the US reflecting on the already distant experiences that not long before consumed my existence. It’s been a month since I left Guatemala, flying back to Vermont three days before medical school classes began. The retrospection, thank-you’s and planning I’d planned on have been buried in getting settled in and studying more than I’ve ever done before. Halfway through biochemistry, I’m feeling back in control again. The curriculum is challenging but innovative. Although the material can seem abstract compared to the vivid daily urgencies at the clinic, the hands-on perspective I gained abroad puts the driest facts in a whole new context.
As usual, leaving Santa Cruz was a traumatic experience. I always become so immersed in life it is next to impossible to tear myself away, and the final month was a sprint to accomplish as much as possible. I am particularly proud of the expansion we made in the number of patients we treat, both through doubling our outreach clinics and as our popularity grows through work of mouth.
Growing isn’t easy to do, especially when the resources you work with remain more or less constant. Despite my best intentions, I tangled with bureaucracy and even local corruption. Most disappointingly, many aspects of the truck had to be left in limbo on my departure. I am gradually realizing that successfully implementing it as an ambulance will be a marathon effort and I am hunkering in for the long haul.
Despite these complications, the end of the stay brought many successes. The donated medical supplies I’d solicited from the amazing NGO Heart to Heart finally made it to the clinic. The process was long and complicated. The original intention had been to drive them down in the truck, but we were repeatedly cautioned that was a bad idea. Besides the risk of robbery of breaking down, we were most concerned about making it through customs. The Guatemalan government typically charges about a 30% import tax, regardless of whether the item is meant for charitable purposes. Since these medical supplies were worth at least ten thousand dollars, I could have been put in the position of forfeiting them at the border.
I unsuccessfully explored numerous options, including using contacts in the airline industry to fly the crates in and negotiating with Chiquita bananas to smuggle it in empty shipping containers. At long last an old friend of Dr. Sinkinson’s, Marian Stahl, who has close ties with rotary and a degree of customs immunity. She arranged to have the materials flown down with a Rotary Team, charging us nothing for the shipment or the customs. The supplies are incredibly vital and of top-notch quality. They include blood pressure cuffs, an EKG, a vision-analyzing device, electronic thermometers, specula illumination systems, and top-notch oto/ophthalmoscopes. It is all vital diagnostic equipment that we use on a regular basis.
The last few weeks in Guatemala also packed in some of the most hair-raising and dangerous situations I’ve been in. The road between Pajomel and Chuitzanchaj was completely destroyed in a mudslide in mid-July, completely isolating the village. Although it was clearly impossible to drive, we hoped perhaps we could hike across the exposed mud-field to conduct an outreach clinic in the village. Dr. Sinkinson, Nohemi and myself started to wade in to calf-deep mud, each carrying loaded packs of supplies. It was impossible to proceed much faster than a couple steps a minute. The suction threatened to pull the boots off your feet and the effort or lifting one leg would simply push the other one in deeper.
After ten minutes we were about a third of the way across the slide path when we heard deep rumbling from above us. Three or four Mayan women who had watching us from the far side of the washout started screaming. About ten feet in front of Dr. Sinkinson, a molasses flow seemed to start spontaneously from the ground up. It was the most alarming sensation I've ever felt. Although the earth seemed trapped in slow motion, the inexorable amplification mass and momentum was unbelievable. Tree trunks and underbrush groaned and snapped as suddenly the vegetated hillside was rolling past in front of our eyes. As it crested over the edge of the roadway, it erupted in hair-raising clattering as it swept boulders down thousands of feet into the Jaibalito canyon.
We turned to flee in absurd slow motion. I left my mud boots entombed behind me. All told it was a small landslide--we had been very close to the point of release, about ten feet wide and forty feet above. But I'm sure death would have been certain if we'd just been a dozen steps further along.
By the time the three of us made it to solid ground, we looked like we'd crawled out of a concrete mixer. As the adrenaline subsided, we tried to scrape mud from our clothes, treated a sizeable gash on Dr. Sinkinson's hand, and discussed the pros and cons of continuing with outreach clinic that day or turning back. We ended up taking a 45-minute detour hike up and over the source of the mudslide. At times we were grabbing handfuls of jungle vegetation to pulling ourselves up the steep and muddy path.
At the top we were meet by the very same local women who had first yelled to alert us. They had climbed up from the other side to help guide us down the other side. They even took Dr. Sinkinson and Nohemi’s packs. When we arrived for outreach clinic at Pajomel, two hours late, the word of our journey had clearly spread to every corner of the town. I've never felt so welcomed.
A few days later our clinic staff was alerted about a middle aged woman with multiple chronic diseases in dire shape in San Pablo. On arrival, we found an 80lbs 45 year-old, diabetic and with multiple system failure, who hadn’t left her bed in months. Her glucose was well over 500 despite only eating a cup of corn porridge a day and she had a mass the size of a bowling ball in her stomach. Examination of the pelvic area revealed decubitus abscesses combined with some sort of massive fistula/abscess/PID, involving at least a liter of maggots and pus. It turns out she has AIDS as well, which explained why her family had not cared for her in any way at all. The stigma is so strong that they preferred to let her rot in bed rather than transport, wash, or care for her. We took her by ambulance overland to the hospital in Sololá, where she died not long afterwards. The clinic covered all the costs of the ambulance and hospitalization, but the family then angrily demanded we cover the cost of the funeral and burial as well, since it was our “fault” she had died away from home. Yikes.
Meanwhile, the official side of bureaucracy was no easier to deal with. I had already sold the truck to our clinic and paid my import taxes on the truck at the Mexican border—a process that took 11 hours and cost $800. I believed at this point I’d made the last payoff to the Guatemalan revenue service. Unfortunately this wasn’t the case. As the importer, I still had plenty of tramites (red tape) to get through to get Guatemalan plates and transfer ownership to the cocodes. When I went in to inquire about the next steps, I learned that I would need to pay another $300 and leave my passport at a government office anywhere from two weeks to a month. That wasn’t a chance I was willing to take with my flight home in three weeks. Furthermore, our plan to give the cocodes the legal right to own a communal vehicle turned out to leave them liable to a huge range of tax code.
I was faced with the choice to do something hasty and ill-advised or exercise restraint. In a few-day blitz of activity, I signed over a power of attorney to allow the truck to be used by our clinic to continue conducting outreach clinics in the three communities and to transport ill patients to the hospital. It has made my return to Guatemala next summer imperitive. When I return, I will undertake the remaining tramites, including forfeiting my passport for three weeks, to complete the process of transferring ownership. If I come up with the funding, I may choose to refurbish the truck’s exterior. This winter, I need to raise the money to send Malaquias, our 19 year-old driver, to driver’s education school in Sololá. When I return he will have an official driver’s license, and I’ll be legally able to help teach him the ins and outs of the truck.
