Today we headed to the outskirts of Chichicastenango, about a 45 minute drive from our place. Chichicastenango is a Mayan dominated small village which proudly proclaims itself as the “mecca of tourism”. This is somewhat of an overstatement, however they do receive a large number of tourists on Thursdays and Sundays for some of the most famous and colorful street markets in Guatemala. There are a lot of traditional Mayan items and a lot of random tourist kitsch that you people back home can expect as gifts.
The clinic itself was very nice, with a working pharmacy, examination rooms, decent documentation and excellent Mayan to Spanish translators. Carrie took off and was doing some work with some other aspects of the group while Dr. Pope, myself and a nurse saw patients. The way this clinic works is that the first 50 or so people in line get a number, and apparently in order to guarantee yourself a number you may have to arrive by 3 or 4 AM. The large majority of the patients we saw today were sick kids under the age of 4. The most striking feature was how tiny these kids were — the larger ones were in the bottom 20th percentile for height/weight, and many were at or below the 5th percentile. This is in part genetic and in part nutritional and definitely exacerbated by the large burden of parasitic and bacterial diarrheal disease around. The clinic offers a Leche (milk) program which gives nutritional support for some of these kids but only the worst of the worst.
Anyways, we saw a parade of cute kids with fevers, stuffy noses, cough, diarrhea, stomach pain. If I don’t get sick I’ll be lucky. The big dilemma with a lot of them is knowing that they won’t have adequate “follow up”. What I mean by that is that in the US, if a physician decides to be a little conservative in his or her treatment approach, the parent can readily bring their sick kid back the next day or the day after if things get a little worse. We aren’t afforded that luxury obviously so it becomes necessary to treat things a little less than ideally. None of the kids were terribly ill, but a couple got us worried. These were a 15 day old and a 17 day old with fevers of around 102 degrees and no really obvious source of their fever. Newborns can get pretty sick quickly (’decompensate’) in situations like this sometimes, so in the US these kids are generally admitted the hospital for full infectious work ups and monitoring. No such luck here, but thankfully these two kids actually appeared generally alert and playful. We struggled with the idea of giving them antibiotics (Are we treating anything?) but erred on the side of caution and informed their moms that at the first sign of anything worsening they’ll have to find a way to the nearest hospital, 45 minutes away if they can get a ride easily. Let’s hope they will be alright.