Weekend in Canilla and San Andres

Saturday morning we got up bright and early in order to have the truck loaded and lunches made and packed to be ready to leave at 6am.  We drove about 2 hours to Canilla to the Fickers’ house where we would be spending the day and night.  After having some coffee we got the clinic set up and began seeing people who were already all lined up.  The Fickers essentially have a farm with their house and another house that is set up for guests (like us or other teams that come down to help) and also houses the clinic and storage for all the donated meds and supplies.  It was myself, Annie (4th year med student), Heidi, and Leslie and Katie Ficker (both nurses) running the clinic.  We saw a total of about 50 patients between 9ish and noon.  A lot of the visits were prenatal visits and we did ultrasound after ultrasound.  We also saw several colds, diabetes, hypertension, and UTIs.  After we eventually saw the last patient, we walked over to the main house and began making lunch.  Of course when lunch was nearly ready, someone came to tell us that there was a man at the clinic door that needed help.  By then it was about 2pm and we were getting pretty hungry.  When we saw the man he told us that about an hour before he had dropped an iron bar on his head and it was cut open.  Sure enough he had about a 2 inch or so gash on the left side of his forehead that was deep enough to see his scalp and had a chunk of skin missing at about the middle of the laceration.  Since it had been about an hour, most of the bleeding had stopped, but we decided it was best to suture it still.  Unfortunately we didn’t have the most ideal supplies.  It was a decent laceration and all we had was 6-0 and 7-0 nylon.  So, I thought I’d give it a shot with the 6-0.  We did have some lidocaine, betadine and saline to numb him and irrigate the wound first.  We didn’t have a needle driver or adsons (?spelling), so I just used two straight hemostats.  After a bit of work I was able to close the laceration pretty nicely except at the very middle where there had been the missing chunk of skin so I decided to leave that small area open.  Hopefully it heals up nicely.  Finally we were able to get back to lunch and eat!  Though it was nice to get a procedure in there. Unfortunately we forgot to take a picture to show my handiwork! 

After lunch we went to another house in town.  It was owned by an American man who came down about 20 years ago and had thoughts of building a kid/teen center.  Unfortunately a lot of the projects weren’t followed through on and the man died back in November.  There had also been several teens living there for several years that didn’t have families for whatever reason and so now are left to figure out where to go.  There is a family there now from Michigan that was trying to clean the place up and organize things and such.  The house was situated on a big plot of land that had a beautiful view of the mountains.  Hopefully those kids will find a safe place to live.  They had been offered room and board at any school in Guatemala by the church the man was associated with, but it seems like they are going to choose to stay in town with some friends instead. 

Later we hung out on their porch and played with Abby and Gracie (about 2 1/2 and 3 y/o Guatemalan girls who the Fickers have been trying to adopt essentially since they were born).  After they went to bed Annie, Heidi, Katie and Rachel (Ficker), and I had a good time playing Scattergories. 

Today we got up, had a great breakfast that Leslie made, and then drove about an hour or so to San Andres for another clinic.  There we saw about 80-90 patients between myself, Annie, Heidi, Katie, and Leslie.  Things we saw today included impetigo, pinworms, facial abscess, prenatals, aches and pains, colds, pneumonia, and a molar pregnancy.  The facial abscess was on a cute little 5 y/o boy.  He did such a good job and was so brave as I drained it.  We didn’t have any scalpels so I had to use a large 16gauge needle to puncture it.  It was probably about the size of a ping pong ball in the bottom of his right cheek near the jaw line.  Not too many five year olds in the states that would have laid so still on the exam table like that!  Only a few silent tears were shed.  I was so bummed that I hadn’t remembered to bring any stickers or balloons or anything to give to him.  He well deserved it.  One of the other kids was 9mo old and just looked ill.  His heart rate was about 155-160 and he was working to breathe, though his lungs sounded clear and his nose was not congested.  His sats were about 90-94%.  So we treated him for likely pneumonia.  I really hope that kid turns around.  The hard part is that you try to explain to the parents how to measure out the medicine and how much and how to give it, but it doesn’t always seem like they understand.  Part of the understanding is probably lost in translation (they spoke Quechua and so I was using a translator from Spanish to Quechua), but part of it is that they just don’t have much medicine and don’t have watches or much of an idea of time.  So, we often just tell them to take the meds when they wake up and at bedtime instead of every 12 hours, or with every meal instead of every 6 0r 8 hours.  Also, it took several explanations and demonstrations to be able to teach the dad how to open the child proof ibuprofen bottle.  Heidi later showed me a neat trick to get rid of the child-proof top.  She also told me that often they can’t open the bottles so they use a machete!  So, as I said I pray that baby gets better and the parents remember how to give the meds as instructed.  And that’s the other hard part, most of them can’t read at all, let alone read in Spanish which is not their native language so they rely on their memory for how to take the meds and follow our directions.

We finished clinic around 2pm and then walked down the street to see one of the local women’s loom which she uses to make their traditional clothing.  It’s amazing how they ever finish any outfit!  It looks like a lot of work.  They say it takes about 1 week to finish one skirt!  On on skirt without much design costs about $52.  Remember that they only make about an average of $3-4 per day!  We then drove back home to Santa Cruz del Quiche which was about 2 hours, but it was such a beautiful ride. 

I’m now pooped and ready for a shower!

spoiled

Today I feel very spoiled and lazy.  Today was supposed to be gyn clinic in ChiChi at the hospital where Heidi does surgery.  When we got there at about 8:30, there were no patients waiting.  So, we walked around the streets for a little while going in to various shops and buying a few needed veggies.  When we returned to the hospital there were still no patients waiting.  The ladies at the front desk then informed us that today was a religious holiday and many people were involved in various activities at the churches and so would be unlikely to come.  So, we decided to drive back home and were back by about 10:45.  We didn’t drive out there for nothing though since Heidi still had to round on her post-op abdominal hysterectomy patient.  The patient was doing so well and we sent her home on post-op day 2.  The patients here could definitely teach us and our patients a lesson in pain tolerance.  Narcotics are essentially not used here.  Since the surgery, the patient has only taken the ibuprofen 600mg q 6hrs as scheduled per Heidi.  She never requested or took any prn meds. 

Since we returned so early and there wasn’t any thing else scheduled for the day, I grabbed my book (”P.S. I love you”) and laid on the hammock until lunch.  It was great.  Then, after lunch I took a nap.  I feel so lazy and spoiled today.  The weather is also very nice, right now it’s 73 degrees.  Though last night it got pretty cool, down to about 40 degrees and we have no heat. 

Tomorrow we will head to Quiche to stay with the Fickers.  The Fickers are a family from the states that have been living here for about 9 years.  The father Duane is the man who flew me from Guatemala City to Santa Cruz del Quiche, and the mother is Leslie, a NICU nurse, that runs clinics in Quiche.  So, we will help her out on Saturday and Sunday and spend the night at their place.  I will not have my computer there so probably won’t post anything until Sunday night.

Heidi and Matt’s Blog

Not sure if I mentioned it yet or not, but please also visit Heidi and Matt’s Blog.  Heidi is the doc that I’m working and living with.  They have pictures on their blog that gives you an idea of what things look like and some examples of patients we see. 

www.agapeenaccion.blogspot.com

Clinic in Chi Chi

Today we had morning clinic at ASELSI (don’t ask me what it stands for) which is in Chichicastenango.  This clinic is much more Americanized/modern in the sense that the patients have charts, there are nurses, a lab tech, a pharmacy and pharmacist.  There is also a Milk program that is run there for malnourished kids/babies.  It was built and is run by an American couple.  They really built a beautiful clinic and it is very nicely run.  Patients come from the surrounding villages and some have appointments, but many show up as early as 4am to get in line to get a number or appointment.  Unfortuneately many of the women that work in the clinic are only allowed to work there until 2pm at the latest (apparently their husbands expect them to be home in time to make lunch).  So, Heidi generally sees about 30-35 patients, and unfortunately those that didn’t get a number have to make the trek back home. 

It was very nice to have the lab there as we were able to have UAs done and even a fecal test done for giardia before we even saw the patient.  Things we saw today included routine pre-natal visits (and yes, even the Mayan women want to know the sex of their babies), rheumatoid arthritis, giardia, UTI, gastritis, diabetes, high blood pressure, H. Pylori positive patient, Bell’s palsy, and possibly Rett’s syndrome in a 3 y/o little girl.  The little girl was a doll but per her mother does not walk or talk, just babbles.  But, apparently she did talk for about a year before not being able to talk again.  Her hand movements and her loss of vocab really made me suspicious, but unfortunately there’s not much to do here.  Luckily though, they do have therapists at ASELSI clinic and she is in speech and physical therapy which may help some.  The poor mother just looked so exhausted. 

After clinic finished at about noon, we went into the market in Chichi and did some shopping.  There were plenty of vendors selling beautiful tapestries, blankets, dresses, skirts, purses, jewelry, and limestone.  Yes, there were actually people selling limestone.  Apparently they grind it up and add it to their mixture of corn when making tortillas!!!  I had no idea.  The nice part is that it provides them with some extra calcium in their diets!!!  We also encountered many other Americans and Europeans throughout the market as many of the tour buses stop there. 

 One interesting occurrence that may help you appreciate our tow trucks, police, etc was that yesterday on our way to ChiChi we passed an unfortunate dump truck that broke down right on the curve of a very curvy and steep road.  We saw him stuck there on our way to the hospital in ChiChi around 1:30 and the truck was still there on our way home at about 5:30pm with its owner still sitting in the same spot on the side of the road.  And believe it or not, on our way to ChiChi this morning at about 7:40am the truck was still there and the guy was also still sitting on the side of the road in the exact same spot!!  Thankfully, on our way home form clinic today the man and truck were finally gone.  Can you imagine being stuck in the road for nearly 24 hrs! 

Tonight Matt made a delicious dinner of baked fish covered in a crabmeat and shrimp seafood sauce with rice.  We then topped it off with brownies covered with fresh strawberries (we bought in the market today) and whip cream!!  Yum!  What a Valentine’s day treat!

Happy Valentine’s Day!

House Calls

Generally when you think of house calls it means the doctor comes to the patient’s home; however today house calls meant that the patients came to us.  Many people know where Doctor Heidi lives and so often just come to the house and knock on the door.  This morning we had a family bring a 2 1/2 mo old little boy with fairly significant cleft lip and palate.  The sad part was that he only weighed 6#!  It seemed like his eyes took up the majority of his face.  So Dr. Heidi took down their info for when the surgical teams come down so the baby could have surgery.  We also gave the mom some formula and a syringe and taught her how to feed the baby with that.  That poor little guy just sucked that formula down so fast. 

Their was a little girl along with them who was about 4 y/o.  I gave her some stickers to entertain her while waiting.  She opened the package and kept smiling and looking at them, but after awhile when she didn’t stick them to her hand or clothes it occurred to me that maybe she didn’t know what a sticker was or what to do with it.  So, I took one off for her and put it on her hand and she was amazed!  Her dad at first seemed very concerned and worried that it was permanent and tried to take it off, but then realized it was okay so put it back on.  Next thing we knew that little girl had taken nearly all the stickers and had them up and down her arms! 

One interesting thing that I didn’t mention the other day was that many of the Mayan people do not know their birthday or exactly how old they are.  Age doesn’t seem to matter to them.  But it’s a little frustrating not to know exactly how many months a baby is, especially when trying to figure out how much they should way or eat and such. 

This afternoon was Heidi’s surgery day and so Annie (the med student from Houston) and I joined her on an abdominal hysterectomy that went very smoothly.  The lady had had bleeding/spotting nearly everyday for awhile and was becoming more and more anemic.  Her uterus ended up having 1 large and 2 smaller fibroids vs endometrial polyps that took up the majority of her uterine cavity.  Heidi did a great job of teaching us both and guiding Annie through the surgery. 

Yesterday was our day off.  We worked out for a bit in the local gym and then after showering a spent a good part of the day laying in the hammock or sitting in the sun reading my book.  It was perfect.  In the afternoon Heidi, Annie, and I went to the market to buy some fresh papaya, pineapple, tomatoes, cilantro, etc. 

Tomorrow we will go to a clinic in Chichicastenango in the morning, and then go to the market there.  Chichi has the largest open air market in Central America.  We’ll mostly be going there for food that we need, but may have time for purchasing some artesan type things.

first day

Yesterday after four flights, I arrived safely to my new home for 4 weeks in Santa Cruz, Guatemala.  Heidi and Matt’s friend Duane flew me from Guatemala City to Santa Cruz in his Cessna which saved me at least a 4 hour bumpy drive and was much appreciated.  While in the air we saw two beautiful rainbows.  Today we drove about 2 hours to a nearby town for a clinic.  Matilde is the local pastor that lets us use his church for the clinic once a month, and he is also the one that translates from the native Mayan language Quiche to Spanish.  The clinic is a small one room wood/sheet metal shack with dirt floors, but does have electricity.  Today was a fairly busy day and we saw patients straight from about 9am to 2:30pm.  Things we saw included diabetes, eczema, regular prenatal visits, pre-eclampsia, gastritis, and skin cancer.  It was hard to tell the pregnant woman of 29weeks with pre-eclampsia that if the hospital would not admit her, that she would need bedrest.  After wrapping things up at the end of the day, we ate lunch in the car while we drove about 2 1/2 hr back to the house.  A very nice first day.  But of course very difficult to try to treat patients when we don’t have everything we’d like to have and to give them medicines with instructions when many of them can’t read and don’t speak Spanish. 

Hello world!

Welcome to Inmedblogs.us. This is your first post. Edit or delete it, then start blogging!