Feb 24: Sibinal
I have a little catching up to do about our very long day in San Antonio (the village in Tacaná. After leaving the school at 7:30, all of us except Luis thought we were headed for a restaurant and then our hotel. What we didn’t know is that there are no restaurants in the wilds of rural Guatemala. People don’t go out to eat as a social event, generally because no one has money to throw away on frivolities. But another reason is that when you are living so close to the edge, food is seen as fuel, not as something to fulfill various sensory and emotional needs. Where we might be looking forward to perusing a menu and choosing something that appeals to each of us, the local people would be thinking only of assuaging their hunger. Of course they want their food to taste good and there is conversation at meals about the spiciness of the sauces and the great tortillas, but the extraneous things such as setting, choice and variety, that we count on to enhance our dining adventures, are not part of their experience.
All of this leads to where we actually ended up after our first clinic day, and particularly, after Mary’s first day. I’m sure she was feeling some sense of relief, and certainly exhaustion, and was looking forward to relaxing over dinner. The mood in the care was jocular and everyone was a discussion about large alcoholic beverages, and the values of gin versus tequila when Luis announced that we would be stopping to see a “sick man whose family was trying to decide whether to take him to the hospital,” i.e. we were going to do a house call. As there was only one internist in the group, this meant that Mary was going to be doing a house call. To her amazing credit, Mary did not reach over and bop Luis on the head, nor did she let loose with a string of Italian curses. Instead, she said, “You’ve got to be kidding!” Of course, Luis was not kidding, and after another winding drive up and down dirt roads we arrived at the man’s house. Mary, true old- fashioned full service physician who does house calls on her patients in Albany, put on her kindly, no non-sense doctor face and did a thorough history and physical on a middle aged man who turned out to have a viral infection. When she was finished and we thought we would be on our way to the restaurant, Marcos, a young man who is the local director of the garden project, appeared from the back of the house and invited us to dinner. It turns out the “restaurant” was right there and the patient was Marcos’ father, hence the house call.
Marcos’ wife and mother have been paid to provide our meals while we are in Sibinal. In lieu of restaurants, families often run these “restaurants” in their kitchens and feed visitors. They also provide meals for single young men who live in the village, usually in a single room without cooking facilities. We all trailed after Marcos into the kitchen, Mary muttering about the wisdom of eating in the house where a sick person was lying on a mattress in the next room, germs swirling through the air, contagious family members making and serving the food. We asked to wash our hands and were directed outside where we waited while Marcos’ wife hunted down a bowl filled with cool water. Bette asked for soap, and after a longer wait, a bottle of liquid soap was produced. Bette acted as “faucet,” pouring water over our hands as we took turns washing and shaking our hands “dry.” Towels are not generally part of the hand washing experience here. We then trouped back in, Mary having resigned herself to mouthfuls of virus along with her meal. We sat at a long table where four mugs of hot water and a box of tea bags were waiting. Bette’s mug had some extra protein, a floating fly, which she offered up for exchange, but none of us felt the need for insect sustenance so she got a new mug. The dinner was delicious – huge plates of scrambled eggs, beans, Guatemalan tamales (no filling) and hot sauce.
After dinner we drove just two blocks to the hotel. By Guatemalan standards it was quite comfortable and clean with plenty of hot water. The main drawback besides the noise in the morning and the lack of WIFI is the lack of central heating – normal for Central America. We were all very cold. I slept in my clothes and added a few layers from my suitcase. Mary woke periodically to add layers. For tomorrow night, the manager promises more blankets.
So on to Tuesday, the first of two days in Sibinal. The clinic was held in a large house and Mary and I each had a large upstairs room. The local officials had everything organized so the patients moved in and out smoothly. Savannah worked with me today, bagging medications and writing out directions in the basic Spanish she learned yesterday working with Mary and Bette. She also gave out stickers and school supplies to the kids, both of which I was doing yesterday, making my work more efficient. The patients in Sibinal were not as desperately poor as in Tacaná, though they are still classified as extremely poor. There is only one health center for the whole municipality, a huge area with dozens of villages spread over many miles. Families have no money for doctor visits or medications, and no transportation other than a few very old communal pick up trucks, so most have not had medical care for years if at all. Mary took the brunt of this, seeing adults with untreated hypertension, diabetes, arthritis, heart disease and various other chronic diseases. Layered on top of these were the basic deteriorations of hard fought aging. All appointments were long and complex.
I saw many children with complaints of headache and stomach ache “for years.” They all had normal exams and seemed to be thriving, but the mothers seemed truly concerned. I also saw a four year old for “red face and runny nose when he’s angry,” and an eight year old boy for rapid heart beat only when he listens to the radio. In the midst of these rather mundane patients, a thirteen year old girl was carried in by four men. She was “unconscious” in their arms, carefully maneuvering her head and arms as they came through the narrow doorway to avoid a collision with the wall and then going limp again when the way was clear. Following the men and their burden was a gaggle of her classmates, all in their white gym clothes. Apparently the girl had been running in gym class and had collapsed on the turf. She had been scooped up by the bystanders and carried to he exam room. After a reassuring exam, I let her friends gather around and “observe her while she gradually “woke up,” and gave them the job of offering her small sips of Pepsi and wiping her face with a cool cloth until I rechecked her and let her go. It was a high drama they all enjoyed and will remember. Only the parents will suffer ill effects.
Just after my young fainter, a 14 year old boy was brought in by his concerned father. The story was confusing, typical here as the history is never given chronologically. A parent will begin by saying their six year old child had pneumonia but the treatment didn’t work as the child is coughing and has fever and also diarrhea. After much questioning, coming at the problem from various angles, it will turn out that the child had pneumonia in infancy and recovered but still gets colds and coughs (the treatment didn’t work.) Starting yesterday, the child developed a cough and fever but has had diarrhea for a week. Anyway, the father stated that he had four sons and this one had never had the same energy as the others and lately, whenever he exerted himself, his chest would hurt, his heart would race and he would feel faint. The boy looked a little off color, and tired and was thin.
When I examined the boy, his heart rate was 42 and his oxygen saturation was 80%, both abnormally low. Further questioning revealed that he had actually fainted several times with mild exertion. The family is from a small village and didn’t have money to see a doctor nor a means of transportation. When they heard we were coming, they made the trek to Sibinal. Mary and I saw the boy together and Luis will make arrangements for him to see a cardiologist.
We stopped for lunch and returned to Marcos’ house. Lunch was veggies and chicken, tortillas and cheese and tea. There is a very nice custom in Guatemala; the youngest son of the house greets each guest when they arrive. Marcos’ son is eight and he performs this ritual without fail, an embarrassed little smile adorning his face. After lunch we drove around Sibinal to see the gardens and greenhouses. Though created only three months ago and not yet producing vegetables, they are thriving. In one area, they have been able to bring water from the Nacimiento to the garden, and the growth is amazing. Next to this garden is one that receives only rainfall, and the contrast is amazing. We also saw a greenhouse with organic tomatoes. Sheep are penned nearby and provide manure for a giant compost pile.
Because of our lunch excursion, we got back to the clinic late and ended up seeing only 64 children and 53 adults. Wednesday will be a full day to try to see as many of the remaining patients as possible. Dinner was at the house again, and I did the house calls, this time on the two children in the house. Both had mild colds, adding their germs to the general atmosphere. We returned to the hotel after dinner, and true to his word, the owner had provided large thick blankets for Mary and me. Now if he could just put up a roadblock to keep the trucks away in the morning…..
I have a little catching up to do about our very long day in San Antonio (the village in Tacaná. After leaving the school at 7:30, all of us except Luis thought we were headed for a restaurant and then our hotel. What we didn’t know is that there are no restaurants in the wilds of rural Guatemala. People don’t go out to eat as a social event, generally because no one has money to throw away on frivolities. But another reason is that when you are living so close to the edge, food is seen as fuel, not as something to fulfill various sensory and emotional needs. Where we might be looking forward to perusing a menu and choosing something that appeals to each of us, the local people would be thinking only of assuaging their hunger. Of course they want their food to taste good and there is conversation at meals about the spiciness of the sauces and the great tortillas, but the extraneous things such as setting, choice and variety, that we count on to enhance our dining adventures, are not part of their experience.
All of this leads to where we actually ended up after our first clinic day, and particularly, after Mary’s first day. I’m sure she was feeling some sense of relief, and certainly exhaustion, and was looking forward to relaxing over dinner. The mood in the care was jocular and everyone was a discussion about large alcoholic beverages, and the values of gin versus tequila when Luis announced that we would be stopping to see a “sick man whose family was trying to decide whether to take him to the hospital,” i.e. we were going to do a house call. As there was only one internist in the group, this meant that Mary was going to be doing a house call. To her amazing credit, Mary did not reach over and bop Luis on the head, nor did she let loose with a string of Italian curses. Instead, she said, “You’ve got to be kidding!” Of course, Luis was not kidding, and after another winding drive up and down dirt roads we arrived at the man’s house. Mary, true old- fashioned full service physician who does house calls on her patients in Albany, put on her kindly, no non-sense doctor face and did a thorough history and physical on a middle aged man who turned out to have a viral infection. When she was finished and we thought we would be on our way to the restaurant, Marcos, a young man who is the local director of the garden project, appeared from the back of the house and invited us to dinner. It turns out the “restaurant” was right there and the patient was Marcos’ father, hence the house call.
Marcos’ wife and mother have been paid to provide our meals while we are in Sibinal. In lieu of restaurants, families often run these “restaurants” in their kitchens and feed visitors. They also provide meals for single young men who live in the village, usually in a single room without cooking facilities. We all trailed after Marcos into the kitchen, Mary muttering about the wisdom of eating in the house where a sick person was lying on a mattress in the next room, germs swirling through the air, contagious family members making and serving the food. We asked to wash our hands and were directed outside where we waited while Marcos’ wife hunted down a bowl filled with cool water. Bette asked for soap, and after a longer wait, a bottle of liquid soap was produced. Bette acted as “faucet,” pouring water over our hands as we took turns washing and shaking our hands “dry.” Towels are not generally part of the hand washing experience here. We then trouped back in, Mary having resigned herself to mouthfuls of virus along with her meal. We sat at a long table where four mugs of hot water and a box of tea bags were waiting. Bette’s mug had some extra protein, a floating fly, which she offered up for exchange, but none of us felt the need for insect sustenance so she got a new mug. The dinner was delicious – huge plates of scrambled eggs, beans, Guatemalan tamales (no filling) and hot sauce.
After dinner we drove just two blocks to the hotel. By Guatemalan standards it was quite comfortable and clean with plenty of hot water. The main drawback besides the noise in the morning and the lack of WIFI is the lack of central heating – normal for Central America. We were all very cold. I slept in my clothes and added a few layers from my suitcase. Mary woke periodically to add layers. For tomorrow night, the manager promises more blankets.
So on to Tuesday, the first of two days in Sibinal. The clinic was held in a large house and Mary and I each had a large upstairs room. The local officials had everything organized so the patients moved in and out smoothly. Savannah worked with me today, bagging medications and writing out directions in the basic Spanish she learned yesterday working with Mary and Bette. She also gave out stickers and school supplies to the kids, both of which I was doing yesterday, making my work more efficient. The patients in Sibinal were not as desperately poor as in Tacaná, though they are still classified as extremely poor. There is only one health center for the whole municipality, a huge area with dozens of villages spread over many miles. Families have no money for doctor visits or medications, and no transportation other than a few very old communal pick up trucks, so most have not had medical care for years if at all. Mary took the brunt of this, seeing adults with untreated hypertension, diabetes, arthritis, heart disease and various other chronic diseases. Layered on top of these were the basic deteriorations of hard fought aging. All appointments were long and complex.
I saw many children with complaints of headache and stomach ache “for years.” They all had normal exams and seemed to be thriving, but the mothers seemed truly concerned. I also saw a four year old for “red face and runny nose when he’s angry,” and an eight year old boy for rapid heart beat only when he listens to the radio. In the midst of these rather mundane patients, a thirteen year old girl was carried in by four men. She was “unconscious” in their arms, carefully maneuvering her head and arms as they came through the narrow doorway to avoid a collision with the wall and then going limp again when the way was clear. Following the men and their burden was a gaggle of her classmates, all in their white gym clothes. Apparently the girl had been running in gym class and had collapsed on the turf. She had been scooped up by the bystanders and carried to he exam room. After a reassuring exam, I let her friends gather around and “observe her while she gradually “woke up,” and gave them the job of offering her small sips of Pepsi and wiping her face with a cool cloth until I rechecked her and let her go. It was a high drama they all enjoyed and will remember. Only the parents will suffer ill effects.
Just after my young fainter, a 14 year old boy was brought in by his concerned father. The story was confusing, typical here as the history is never given chronologically. A parent will begin by saying their six year old child had pneumonia but the treatment didn’t work as the child is coughing and has fever and also diarrhea. After much questioning, coming at the problem from various angles, it will turn out that the child had pneumonia in infancy and recovered but still gets colds and coughs (the treatment didn’t work.) Starting yesterday, the child developed a cough and fever but has had diarrhea for a week. Anyway, the father stated that he had four sons and this one had never had the same energy as the others and lately, whenever he exerted himself, his chest would hurt, his heart would race and he would feel faint. The boy looked a little off color, and tired and was thin.
When I examined the boy, his heart rate was 42 and his oxygen saturation was 80%, both abnormally low. Further questioning revealed that he had actually fainted several times with mild exertion. The family is from a small village and didn’t have money to see a doctor nor a means of transportation. When they heard we were coming, they made the trek to Sibinal. Mary and I saw the boy together and Luis will make arrangements for him to see a cardiologist.
We stopped for lunch and returned to Marcos’ house. Lunch was veggies and chicken, tortillas and cheese and tea. There is a very nice custom in Guatemala; the youngest son of the house greets each guest when they arrive. Marcos’ son is eight and he performs this ritual without fail, an embarrassed little smile adorning his face. After lunch we drove around Sibinal to see the gardens and greenhouses. Though created only three months ago and not yet producing vegetables, they are thriving. In one area, they have been able to bring water from the Nacimiento to the garden, and the growth is amazing. Next to this garden is one that receives only rainfall, and the contrast is amazing. We also saw a greenhouse with organic tomatoes. Sheep are penned nearby and provide manure for a giant compost pile.
Because of our lunch excursion, we got back to the clinic late and ended up seeing only 64 children and 53 adults. Wednesday will be a full day to try to see as many of the remaining patients as possible. Dinner was at the house again, and I did the house calls, this time on the two children in the house. Both had mild colds, adding their germs to the general atmosphere. We returned to the hotel after dinner, and true to his word, the owner had provided large thick blankets for Mary and me. Now if he could just put up a roadblock to keep the trucks away in the morning…..
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