Random Observations

July 28th, 2009 by INMED
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The indigenous Mayan women who often visit our clinics are very comfortable with breastfeeding and often feed their babies while meeting with us. However, they are very uncomfortable exposing their bellies as these are viewed as a private area! Since our clinics often focus on prenatal care for expectant mothers,  the workers try to be sensitive to the mothers who are receiving ultrasounds but its not always possible in such small spaces. What an odd taboo!


Labor in Guatemala is so cheap that it is more cost effective for large organizations, like the Santa Elena Hospital, to hire men with machetes or small, ineffective weedwackers to mow their grounds rather than buy a lawnmower. When we visited the nearby Utatlan ruins, workmen were trimming the grass in the huge area by machete! Apparently, a common (and possibly cool?) way of greeting someone on the street for children and teenagers to say “Adios!” once the person passes them. This is kind of disorienting because there is never a “Buenos dias/tardes/noches” or “Hola” said first. However, this might just be people making fun of the odd gringo couple that’s always walking around town! :)


Fresh fruit and veggies are cheap and plentiful at the local market, but we have to soak them in water and bleach before eating them. I guess this is supposed to kill the toxins that may make us sick, but even though I can’t taste the bleach it still feels weird to me! Guatemalan food is similar in style, but noticeable less spicy and flavorful than Mexican food. It plays the same 4 cards of rice, beans, corn, and tortillas, but in a less interesting way. Maybe we just haven’t been eating at the right places though…?


Hope you enjoyed those random thoughts that needed to make their way into this blog somehow! Anthony and I are doing well. The Agape in Action house has quieted down now that the 30 person Lancaster, PA mission team left on Saturday. Sadly, Agape’s amazing CEO John V also left the country today after spending about 3 weeks with us. John is an amazing and hilarious person who was always a pleasure to hang out with while he was here.  His stories about being bitten by a Guatemalan dog are stand up comedy worthy!


We spent our “weekend” going to the gringo church, shopping again at Chichicastenango (with better results this time!), watching pirated dvds from the mercado (only 15 quetzals!), and hiking around the rural country side surrounding Quiche. We tried to hike to a supposed Mayan ruin site near Lake Lemoa that was recommended by the Quiche tourism department, but never found it. A later google search of the site found no results so hmmm? :) Today, we had a small clinic at a new location in San Pedro today, then walked around the market afterwards. Flying back to the States on Saturday! Love and miss everyone back home!

Quiché Updates

July 17th, 2009 by INMED
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Earlier this week a 21 person surgical team from Houston joined us and shared our living space here.  They were here to do plastic surgery and ob/gyn cases in the hospital across the street.  They did a bunch of cleft palate and cleft lip surgeries as well as a lot of  ob/gynecology stuff for patients drawn from distant parts Guatemala.  Carrie and I spent one day helping them out which was pretty cool.  I worked with the plastic surgeons in a few cases but mostly helped them communciate with their patients and hospital staff, helped write orders and checked up on patients.   I felt really useful as I had enough medical and language knowledge to really help them out.  I’m not quite fluent in Spanish, but in the field of medicine it’s always been true that ‘when no one else knows how to do it, you’re the expert.’


As far as clinics go, I’m getting slightly more comfortable with my role in seeing patient’s here.  Dr. Pope has been having me see patients relatively independently here which was initially a bit anxiety provoking as I wasn’t confident in my language skills or my medical knowledge.  It’s definitely been a challenge but it hasn’t been impossible as I had feared and I’ve been learning a ton.  Dr. Pope is a very laid back preceptor and readily helps me out whenever I need it, whether for medical knowledge or for Spanish.


We had a really cool clinic in a very small rural village of Tamil this week. We drove a long way down a dirt road and parked at the top of a small valle, after which we climbed out of our truck and grabbed our large pharmacy boxes and carried them for about 15 minutes down the valley, over a small river, and then up the other side to a beautiful white church overlooking the area.  We had a couple of premed students with us (from the aforementioned surgical team) during the day who helped us out which was pretty fun.  We saw a lot of interesting cases and the people were really grateful, it’s been my favorite clinic so far. We just finished up our two-day run at the Aselsi clinic which was a little more difficult but still a good time.


Carrie and I have been spending our late afternoons meandering around Santa Cruz del Quiché and have been finding more and more to like about this small city, from little cafes to interesting graveyards and other sights to see.  It’s growing on us little by little and definitely not as bad as I imagined.

Adventures In ChiChi and Xela

July 14th, 2009 by INMED
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Okay hello everyone! So we had our “weekend” break from clinic on Sunday and Monday, and took a road trip to Chichicastenango and Quetzaltenango (Xela) to celebrate. Chichi is a big tourist destination here in Guatemala because of its huge market days. Needless to say, it was pretty awful! We walked around for about 30 minutes and were harassed by tons of Mayans (men, women, and children) selling over priced touristy crap. I enjoyed exploring the Chichi Catholic church, which is made up of an odd blend of Catholicism and Mayan religons. For example, there were lots of altars down the center aisle of the church where the Mayans burn offerings and scattered rose petals in various rituals. However, mass is celebrated there regularly. We headed out of Chichi pretty early for a 2 1/2 hour chicken bus ride to Xela.


Xela is the second largest city in Guatemala and is unofficially known as the Mayan capital of Guatemala due to high number of indigenous people who live there. After spending a week in Quiche deprived of good restaurants, cafes, and sidewalks, Xela was a welcome relief for us! We managed to find a really good and authentic Indian food restaurant for dinner the first night, and topped it off with some great and cheap mojitos at a local bar/cafe.  On Monday, we woke up early to take a shuttle bus to Fuentes Georginas, local hot springs. What makes these springs so awesome is that they naturally occur from the side of a volcano in the area (Guatemala is full of volcanos, many of which are active!) and have a great waterfall that runs into them. We slathered ourselves with volcano mud and laid around in the hot springs until it was time to catch another chicken bus for the approximately 3 hour ride back to Quiche. Too bad the chicken bus ride undid all the relaxing effects of the springs!


Honestly, I hardly have words to explain the ridiculousness that is riding a chicken bus for transportation here. Now that I have about 7 rides under my belt, I’m starting to feel like an expert on the topic. So these things are manned by a team of two people- the driver and a “helper”who basically screams the destination of the bus whenever its stopped and collects money. The helper typically runs around manically in order to drum up business and climbs on top of the bus (sometimes while its moving!) to position and throw down passengers’ baggage. This person performs an amazing array of acrobatic tasks such as running behind the bus, grabbing onto the back ladder, and swinging himself through the back exit door at 30 mph while going around steep mountain curves. Keep in mind that these curves are usually very tight and not quite built for a huge American school bus to go around at breakneck speeds! The driver, who typically has the highest standards for the safety of the passengers, fixes this problem by simply blaring on his horn while blindly taking up both lanes to round these blind corners. This is all set to an soundtrack of ear splitting Mariachi music. The whole thing reminds me of Grand Theft Auto!


We have a rural clinic tomorrow at a place we have to hike our supplies up to. Anthony taught me how to take blood pressure readings, and hopefully tomorrow I’ll learn how to check blood sugar as well. I’m so thankful to be able to help these people who are so in need of attention and care (not entirely medically!) Okay, bedtime! Hasta luego!

Second Clinic Day

July 9th, 2009 by INMED
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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.

Our First Clinic Day

July 8th, 2009 by INMED
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First, the briefest of introductions.  We are volunteering through a program called Agape in Action which focuses on health care needs of Central Guatemala.  We are staying a heavily indigenous city of ~100,000 people called Santa Cruz del Quiché in the Quiché provence.  The city is poorly developed, lacking the “basics” like laundrymats, supermarkets and movie theatres.  The city is not much to look at and has a congested, run down feel but the natural surroundings are actually quite beautiful once outside the city center. We are living across the street from a tiny Hospital in a secure and comfortable compound which is in marked contrast to our surroundings.


The Agape in Action medical team is headed by Dr. Sherwood Pope, a young American family practice doctor and assisted by his wife Areli, who is from Mexico City and studied international affairs.   They run4-6 clinics per week throughout central Guatemala and usually only have one clinic per village once per month.


So, this morning, after we loaded 4 large crates of medicine onto their pick up truck, Dr. Pope and Areli drove Carrie and I for about 30 minutes down a very bumpy dirt road to a very tiny school in which we based our clinic. We were warmly greeted by about 30 people who had been waiting for our arrival.  The people were indigenous Mayans who have extremely limited health care access and subsist predominately by substitence farming.  They were colorfully dressed in traditional garb and of all ages, from 3 weeks to 80 years.  Spanish was not generally their first language, and several spoke little of it at all, instead relying on neighbors as interpreters for their local dialects. We set up shop and passed out numbers to the clinic for two quetzales, a very nominal fee of about 25 cents.
Carrie and I worked with Dr. Pope for the morning, as he helped me become oriented to his system and Carrie worked at inputting patient information into his database.   Later in the afternoon we split up and I was seeing patients independently.  We saw typical things that you would see in any US based practice — eldery men with diabetes, blood pressure, babies with skin rashes, children with coughs, teens with sore throats.  We saw people with all manner of aches and pains.  There were several prenatal visits.  A husband and wife were surprised and a little dismayed when they found out that the reason his wife had nausea was that she was pregnant, with twins, which will bring their children to a total of 8. By far our most difficult case of the day involved a 5 year old girl who had lost the ability to walk three months ago and had been having persistent vomiting and diarrhea since that time.  We totally lacked any way to reasonable to “work up” this problem without any diagnostic imaging available to us, so we recommended that she try to go to the hospital where at least they can do some head imaging.  I hope she will be alright.  All in all it was a successful day, however, and I felt we genuinely helped out the majority of people we saw.  We’ll see what tomorrow brings!

Hello from Santa Cruz del Quiche!

July 7th, 2009 by INMED
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Hi everyone! We made it safely to Santa Cruz del Quiche on Monday after spending the last week backpacking around Guatemala. We had a great time exploring Guatemala City, Antigua, and Lake Atitlan but are now ready to get to work in the medical clinics in the region.


We arrived in town via “chicken bus”, which is the main form of cheap transportation in Guatemala. Basically, these are old U.S. school buses which have been transported to Guatemala, outfitted with more seats and sound systems,  painted bright garish colors, and often dubbed names such as “Esmerelda”which have been airbrushed on the windshield. It was a bumpy and cheap ride which reminded us both of being in middle school!


We’re staying in a housing complex dubbed the “casa de Americanos” in the compound of Hospital Nacional Santa Elena, one the largest hospitals in the region. Right now, there are only 3 other people staying here (Dr. Pope, his wife Areli, and Ron from Texas) although various medical and religious teams from across the States will be staying here for various lengths of time in the next month. We will spend most of our time here helping with the rural medical clinics in the region.Tomorrow we will go to our first clinic at a school approximately 30 minutes outside of the city. Anthony is currently reading up on his medical spanish in preparation. I really have no idea what to expect tomorrow, but am very excited and hopeful that we will be able to help the amazing people of this war torn country.

Introducing Myself

July 2nd, 2009 by INMED
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petruso-anthonyHello! My name is Anthony Petruso. I am a medical student at Ohio State University College of Medicine, and I’m starting my INMED service-learning experience at Agape in Action in Guatemala beginning in July 2009.