It’s 5:00 am on Tuesday and I’m in a funky little hotel near Sibinal, a municipality in the mountain region. I’m writing in Word for now and will transfer my notes to the blog when we return to San Marcos and the world of WIFI on Wednesday night.
Yesterday was extremely long and exhausting for all of us, but particularly for Mary who was seeing adults with their myriad of medical issues. When I see children, even in the most remote villages where there has been no previous access to medical care, I am usually dealing with acute illness on a background of chronic malnutrition. Mary, on the other hand, was seeing adults who had multiple acute and chronic concerns layered upon years of untreated hypertension, arthritis, old untreated injuries, and problems related to a lifetime of deprivation and poverty. Luis, not being medically savvy to the differences between pediatrics and adults, had told the village team to plan on 80 patients for each of us.
Mary was amazing. With Bette interpreting and Savannah acting as Medical Assistant, packaging medications and writing out directions, Mary quickly moved into a rhythm and saw 77 patients to my 75. They ranged from young mothers with toddlers on their backs complaining of shoulder pain and tingling in their hands to men in their late 80’s with untreated diabetes, Parkinson’s, hypertension, vision and hearing problems. In the end, we had to set a time to leave, and at 7:30, 20 adults had to be turned away. Tomorrow, Luis will book a more realistic number of patients. Still, though I feel Mary made a huge difference for the people she saw, I know it was incredibly frustrating for her. For a physician who is used to giving her patients comprehensive care and managing their medical problems with full knowledge of their history, and then giving them the proper medications and follow up, today felt to Mary like, “less than a Band-Aid,” in most cases.
Since Bette was with Mary today, I was on my own for most of the day. We had breakfast at the home of a young man, Noe, who is from an extended well-to-do family in the village. He spent two years in South Carolina working as a sous chef and made us a gourmet Guatemalan meal of eggs, beans, tortillas and a salad from one of the project gardens. Noe has good conversational English, so Bette recruited him as a second interpreter to work with me as needed.
Although it’s too early for the gardens to have made any difference, the children I saw were generally in better health than last year. I had a great run of chubby breast-feeding babies, and when classes were over at the end of the day, a stream of middle-school age boys and girls arrived, all with vague complaints of “headache and dizziness for a month.” It was obviously a planned after school activity, and they each got a sticker and a bag of school supplies as a reward for their “deception.” I enjoyed them thoroughly.
Although the best part of my day was not related to patient care today (more later,) I did have one other great encounter. At one point in the afternoon, two young mothers came in together with their 15 month olds. I’m not sure if they were sisters or friends or just needed each other’s support. Both babies had colds and as soon as I approached the first one, both began to shriek. The exams were full of kicking and twisting and neither mother was able to secure the little fists and feet. Both babies were wrapped in multiple layers of damp cloth, and one managed to twist himself halfway to the floor, trying to avoid my ministrations. As soon as I completed the second exam and stepped back, the crying stopped immediately. It was exactly as though a switch had been flipped. There was no sniffling or catching of breaths; both babies were suddenly sitting calmly on their mother’s laps, staring at me. Then, the little girl started waving “bye bye,” and the boy followed, adding a big grin. I cracked up, and luckily the mothers also saw the humor.
The entry is obviously very long, but it was an amazing day, and soon I’ll have to stop to get ready for the first of our two days in Sibinal. I awoke early on purpose to write this entry, but as I’ve been typing there has been an amazing cacophony going on outside. NO ONE could be sleeping! Yesterday we were awakened at 4:00 by an errant rooster and a pack of responding dogs. Mary forgot her alarm clock, and when I went to knock on her door, she greeted me with, “the rooster beat you to it.” Today, there has been a parade of huge trucks going by on the highway right outside our windows. Each one revs its motor and blasts its air horn as the hotel is on a hill and a curve. In addition, services began at 5:30 at the Evangelical church, adjacent to the hotel. They have been singing, sermonizing and having lots of repetitions of praises to Dios over a loud speaker – still going now at 6:37.
So now to the garden/hunger project. I have been in a state of moderate to high anxiety about the project for the past few weeks. Even though the project has already exceeded my initial expectations with six large community gardens and multiple small family gardens completed, my fear has always been that we would fail at sustainability and in two years all would have reverted to weeds. A major goal of this trip is to have serious discussions with Bette and Luis about the plan for wrapping up the garden creation phase and setting the sustainability plan in place. There are some donors who may be interested in funding sustainability projects, but I need to have data to show them. It turns out that all kinds of amazing things have been going on in Tacaná that Bette has been unable to tell me about. Luis swore her to secrecy because he wanted to surprise me when I returned to Guatemala. As Bette put it, “Luis wanted to see your face when you saw the results of your dream.” Well, it was certainly worth all the secrecy because I was stunned when Luis showed me what he and the people of the Tacaná region have done and what the next step will bring. I’m sure my mouth was hanging open, and I know there were tears – lots of tears. I’m going to close now as it’s time to leave for Sibinal. I’ll do a second entry about the surprises Luis presented.
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