Today was our last clinic day and was held at the site of the first Community Garden. A big group of villagers was gathered at the “casita” close to the garden that Luis had renovated to be used for clinics or gatherings of the community. As a “next to last” surprise, he showed me the sign he had erected in front of the clinic, RANCHO BARTLETT, in appreciation for my recognition of the need for gardens and initiation of the project. So now if I feel like being snooty, I can tell people I have a ranch in the jungle in Guatemala.
We left Por Venir around 7:30 this morning after a quick breakfast of eggs, beans, tortillas and wonderful strong coffee, a rarity here. We arrived in Malacatán an hour later and unloaded our medications and equipment in two rooms at the casita. Mary started seeing adults while Luis and I took a short hike to see the last surprise. Of course the hike was straight down a steep hill with shallow steps hacked into the turf and spindly trees to grab for balance. I made it down without breaking a leg and arrived at a farm where corn, beans and peanuts were growing. There was a small house there, about 12x15 feet where a family of 10 were living. There was a stone cook stove outside, a big tub for washing, and a latrine down a path out back. Luis explained that this whole area used to be a large private farm that grew corn, but as part of a project to relieve poverty, the government had bought the land several years ago and broken it up into 1-2 acre parcels that to rent to the poor. The only problem is lack of water. Most of the land lies unused for lack of irrigation. The surprise that Luis had brought me down the hill to see was a small tributary from a large river. The lucky family that rented this parcel of land is able to irrigate their field and grow not only corn but beans and peanuts as well and therefore are well nourished. With the seeds provided by the garden project, they will be able to harvest excess produce to sell, and eventually will rise from their current level of poverty. The plan for Malacatán, like that for Tacaná and Sibinal, is to fund the placement of pipes and pumps to bring irrigation to the fields. All the unused fields will then be rented, seeds provided and families and the towns will be on the way to better lives.
As an aside, in Por Venir, we saw an organic garden and greenhouse that a family has used project money to build. They have two goats and they add the droppings to a huge compost pile. The greenhouse is full of lush tomato plants and the garden, watered from a well, is thriving. (see photos.)
When we arrived back at the clinic, there was a long line of mothers and children waiting for me. Luis stood in the middle of the group and made a speech that made a huge difference for the day. I should preface this by saying that because most people here have little or no access to health providers, their history always includes every present or past illness or injury in their lives. A common history goes something like this: “ My son has a terrible cough and is so hot and has no interest in food, he’s so skinny and the doctor gave him some medicine when he was in the hospital and it helped him a little but I couldn’t fill the prescription as I had no money and then the infection came back and his rash is worse and it itches him so much and in school he has a terrible headache at school and is so dizzy and has failed two grades and the worms are making him throw up. I think he needs some vitamins and his legs hurt at night and he’s really coughing so much phlegm. I’m so worried because he was born too early.” After many questions and side tracks, it might turn out that the boy was a month premature, setting up the mother’s worries, he perhaps had pneumonia two years ago, hence the history of medicine at the hospital and the discharge prescription she couldn’t fill. He likely has worms, chronically, but that’s not really today’s complaint; mom just wants to be sure to get the antiparasitics she hopes I have. Many of the kids here and at home have leg pains consistent with “growing pains;” pain only at rest and full out activity all day. Finally, further questioning about the school issues revealed that the parents had taken him out of school for a couple of years to help at home and now he’s behind and embarrassed to be in a lower grade. The point is that it takes a tremendous amount of time to sort through all of the history, reducing the number of patients that can be seen that day. So Luis’ speech was about trying to be concise. He began by saying that we would be working straight through without a lunch break until 4:00 but would then have to leave for San Marcos. In order to see all of the patients, he asked that everyone please decide on just one or two problems and not ask about everything they could think of. He did a wonderful job making his point without causing offense. He was hopping around pointing to his toe and heel, his elbow, the back of his neck, pulling up his shirt to show his belly button, all to demonstrate a person finding 15 things to have the doctor check. He then shook his finger in the classic Latin American gesture for “No,” and indicated a person giving a small cough and then touching his forehead to indicate a headache. There were smiles and laughs from the crowd, and they got it. In general, the parents I saw today focused much more on the current illness and on one or two complaints.
Most of the kids today were relatively healthy compared to those in Tacaná and Sibinal. The jungle climate makes for an easier life and a bit more food. I saw a one year old girl who may have an immune deficiency or perhaps just bad luck. She was hospitalized shortly after birth with pneumonia and has had two more three week hospital admissions since then for respiratory illnesses requiring IV antibiotics. She’s thin and pale and behind in her development. I don’t think she has any real developmental issues in that her neurological exam is normal and she seems bright and appropriately interactive, rather I think she’s delayed due to illness and time spent tied down to IVs. The current problem is that the mother can’t afford milk or formula for the child. She’s feeding her watered down juice from oranges stolen from a nearby plantation, and tortilla water, but the child isn’t gaining weight. ( Hmmmm… guess not.) I Spoke to Luis and Políclinica, through Shuarhands will cover the cost of Encaparina,, a milk and grain based formula used here for the next three months and then reassess.
Unlike the clinics in Tacaná, Sibinal and even Por Venir where we were dressed in layers and I was shivering, here in Malacatán we are all hot and sweating. Since there is a very nice bathroom here we are trying to stay hydrated as we race through the patients. At around two, Luis brought us each a bag of snacks based on what he thought we would like. I got yogurt, and Savannah’s bag had Pepsi, two kinds of potato chips and some cookies. I didn’t see what he brought Mary an Bette, but Savannah and I thought he got it just right for us. We packed up around 4:30 and drove back to San Marcos where it was quite a bit chillier. We had dinner at our usual restaurant and Mary had a glass of the local beer, Gallo, Spanish for Rooster. We all thought it was fitting since the roosters have been her alarm clock every morning this week. While we were eating a man came to the table and Luis introduced him. He owns the company where Luis purchased seeds for the garden project. He is involved with the project I mentioned in an earlier blog where there are large plots of various vegetables planted along the highway and tended by master gardeners. Once they are at their peak, representatives from all over Guatemala will be invited to come and learn from these masters about the vegetables and about cultivating them, and will take this knowledge back to their villages. This man is the person who obtained the 10 slots for the villages of San Marcos, and Luis wills] choose who will come. It’s amazing how everything has fallen into place. I’m reminded one again of how important it is to have someone local, like Luis, withal of his connections and his commitment, for a project to succeed. It may have been my idea to initiate the project and the fundraising, but without Luis, it would never have turned into what will become a life-changing agricultural project for multiple communities. The credit for that goes to Luis and the teams of men and women who have grabbed this opportunity. It’s hard for me to describe the mood of the people involved with the gardens. When we visited the Nacimiento, grown men were leaning down to splash water into the air for the photographs. They knew I would be sending the photos to possible donor and they wanted to be sure to show how “fresh and pure” the water was. A week ago I was fretting about how to convince Luis to stop building new gardens and focus on sustainability while all this time he and his village teams have had a long term plan for the future all along. A he explained it, the villagers have always been “campesinos,” they just haven’t had the means to buy seeds or the water to grow the crops for a long time. Now that funds are available through the project, they know what needs to be done.
After unloading the few leftover medications at the clinic and our luggage at the hotel, we took a quick tour through the town so Mary and Savannah could see the market and the ancient cathedral that sustained severe damage in the last earthquake. It will have to be demolished. We stopped at the supermarket to get a price on the Encaparina; $100 will buy enough for three months, and then returned to the hotel to shower and head to bed. Tomorrow we’ll leave for Guatemala City at about 8:30 with stops in Xela and Antigua, and then home on Sunday.
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