This trip to San Marcos was one of the most difficult in that there was very little down time. On previous missions, we have returned each night to our "home base," a hotel in the city of San Pedro/San Marcos were Luis has the clinic, and arisen early each morning to drive to the next village. Coming back to the hotel provided a place to relax, shower - sometimes hot, sometimes not - prepare medications for the next day, and have dinner either in a restaurant or from things bought in the local market. It separated the days and kept an order to the week. This time, our destinations were a little more remote, and since this would be the first visits by medical providers, we stayed longer each day and spent two days in Sibinal. Rather than driving two hours each way, Luis arranged rooms in a hotel in one municipality and in a "bed and breakfast" at the mayor's home in another. Still, we traveled a little over 1300 miles during the week over winding, bumpy roads, some paved, many just narrow dirt tracks. As we drove around each left-turning curve in the road, there was a loud grinding noise from the right back wheel that Luis explained away as something about a new tire. A smell of burning rubber accompanied the noise, but the smell gradually diminished, and so did the noise. Though it never disappeared, it either got softer or we got used to it. Mary, whose car sickness can ground her even on the NY Thruway, managed to ride in the backseat without a hitch. My theory is that terror over-rules nausea every time.
The medical care we provided was similar to my previous trips and in general can be categorized as "less than a Band-Aid," as Mary neatly put it. Although it's very frustrating to realize that, I'm at peace with what I do here. I feel there is value just in coming, seeing the children, examining them, listening to the mother's concerns, and in reassuring them that their children are basically healthy. Each time I come, there are a few children for whom I can make a life-changing difference, and that alone makes the trip worth it. On the first trip it was two little boys who needed cornea transplants, and they are now, three years later healthy with normal vision in both eyes. This time, I was able to connect with an organization out of Stanford University that comes to Guatemala to do volunteer orthopedic surgery, and they will take care of the three year old with bilateral congenital hip dislocation. The same doctor in Xela who did the corneal transplants will see a young boy with an injury related cataract, and finally, for $100, we were able to provide formula for a frail one year old who has been hospitalized three times since birth with respiratory infections. She may have an immune deficiency or her problems may just be due to her mild prematurity, but either way, she needs nutrition, and her mother has been giving her tortilla water and coffee.
Having Mary along on this trip really opened my eyes to the complexities of caring for adults. Each patient she saw brought a lifetime of chronic illnesses layered upon the wear and tear of a hard life living in extreme poverty. She saw hypertension, diabetes, arthritis, chronic lung disease, kidney and liver disease - all untreated for many years. Some people knew they had these conditions, having seen a doctor at the government hospital in the past, but Mary made many first time diagnoses as well. Though we brought 56 pounds of medications, she could generally give each patient only a month's supply of pills, and hope that they would be able to obtain a similar cheap alternative. Luis explained that most people with chronic illness understand that they need lifelong medications, but just cannot afford the expense over time. Mary found the week frustrating and heartbreaking, and on the way home we talked about what she felt was really needed, a project for adults. It was similar to my reaction last year when I realized that the medical care I provided was very much secondary to what the children and their families really needed - food - and started the garden project. Mary realized at once what the adults need. Though I have no plans to take on another project at this point in my life, here it is:
Get a grant to pay for a supply of generic medications for six to eight of the most common conditions, hypertension, diabetes, irritable bowel, arthritis, gastritis...Find a source for the drugs at some discount and make sure the grant is renewable so the drugs don't dry up.
Recruit women from each village and bring them to San Marcos for a few days for training in taking blood pressure, reading urine glucose strips, giving and teaching insulin administration, discussing diet for diabetes and hypertension, etc and make them the keepers of the drugs. They then become the providers for each village and see the patients gratis (perhaps with a small stipend from the grant,) every month or three months?, check pressures, urine glucose, and dispense medications.
That's it. Not very complicated and it would make a huge difference for many. Having the chance to share this experience with Mary was fantastic. She is one of those doctors that everyone wishes they could find for themselves, kind and caring, knowledgeable and thorough. She's also very straightforward and not a bit shy about saying exactly what she thinks. When there was a discussion about whether we might see more patients on Saturday morning before heading to Guatemala City, it was Mary who, while not saying she wouldn't do it, tactfully made it clear that a half day meant noon, not 3:00 pm and that it seemed unlikely we would be able to close the door on a crowd of needy people to make an escape. Bette and I who are always trying to accommodate Luis, might have done it, but hearing Mary lay it out made it clear how ridiculous it would have been, especially since the drive from the jungle to Guatemala City would have taken six hours.
The biggest impact of this trip was the huge turn of events in the garden project. My fears about sustainability and the ultimate impact the project would make are completely gone. The three irrigation projects, two from natural springs and one from a river, will make large tracts of farm land arable for Tacaná, Sibinal and Malacatán. Each of these municipalities has 100-150 villages and they are grouped closely enough to benefit from communal farmlands. The land, some privately owned and some available for rent from the government is being made available to the villagers because without irrigation, it is useless. Since the villagers will own the irrigation pipes, pumps, etc, and be in charge of running it, the land owners have given them use of the land. It helps that the owners have family connections within the municipality. Luis estimates that each of the three irrigation projects will cost around $5000.00 dollars, but even if it is twice that amount, I feel confident that I can obtain grants. Luis has hired a consultant to create a report with exact numbers on acreage, pipes, pumps, people, etc.
So that's it. I'll post a few final photos. I'm unable to captions them all - something about Picasa. Thank you again for your interest.
The medical care we provided was similar to my previous trips and in general can be categorized as "less than a Band-Aid," as Mary neatly put it. Although it's very frustrating to realize that, I'm at peace with what I do here. I feel there is value just in coming, seeing the children, examining them, listening to the mother's concerns, and in reassuring them that their children are basically healthy. Each time I come, there are a few children for whom I can make a life-changing difference, and that alone makes the trip worth it. On the first trip it was two little boys who needed cornea transplants, and they are now, three years later healthy with normal vision in both eyes. This time, I was able to connect with an organization out of Stanford University that comes to Guatemala to do volunteer orthopedic surgery, and they will take care of the three year old with bilateral congenital hip dislocation. The same doctor in Xela who did the corneal transplants will see a young boy with an injury related cataract, and finally, for $100, we were able to provide formula for a frail one year old who has been hospitalized three times since birth with respiratory infections. She may have an immune deficiency or her problems may just be due to her mild prematurity, but either way, she needs nutrition, and her mother has been giving her tortilla water and coffee.
Having Mary along on this trip really opened my eyes to the complexities of caring for adults. Each patient she saw brought a lifetime of chronic illnesses layered upon the wear and tear of a hard life living in extreme poverty. She saw hypertension, diabetes, arthritis, chronic lung disease, kidney and liver disease - all untreated for many years. Some people knew they had these conditions, having seen a doctor at the government hospital in the past, but Mary made many first time diagnoses as well. Though we brought 56 pounds of medications, she could generally give each patient only a month's supply of pills, and hope that they would be able to obtain a similar cheap alternative. Luis explained that most people with chronic illness understand that they need lifelong medications, but just cannot afford the expense over time. Mary found the week frustrating and heartbreaking, and on the way home we talked about what she felt was really needed, a project for adults. It was similar to my reaction last year when I realized that the medical care I provided was very much secondary to what the children and their families really needed - food - and started the garden project. Mary realized at once what the adults need. Though I have no plans to take on another project at this point in my life, here it is:
Get a grant to pay for a supply of generic medications for six to eight of the most common conditions, hypertension, diabetes, irritable bowel, arthritis, gastritis...Find a source for the drugs at some discount and make sure the grant is renewable so the drugs don't dry up.
Recruit women from each village and bring them to San Marcos for a few days for training in taking blood pressure, reading urine glucose strips, giving and teaching insulin administration, discussing diet for diabetes and hypertension, etc and make them the keepers of the drugs. They then become the providers for each village and see the patients gratis (perhaps with a small stipend from the grant,) every month or three months?, check pressures, urine glucose, and dispense medications.
That's it. Not very complicated and it would make a huge difference for many. Having the chance to share this experience with Mary was fantastic. She is one of those doctors that everyone wishes they could find for themselves, kind and caring, knowledgeable and thorough. She's also very straightforward and not a bit shy about saying exactly what she thinks. When there was a discussion about whether we might see more patients on Saturday morning before heading to Guatemala City, it was Mary who, while not saying she wouldn't do it, tactfully made it clear that a half day meant noon, not 3:00 pm and that it seemed unlikely we would be able to close the door on a crowd of needy people to make an escape. Bette and I who are always trying to accommodate Luis, might have done it, but hearing Mary lay it out made it clear how ridiculous it would have been, especially since the drive from the jungle to Guatemala City would have taken six hours.
The biggest impact of this trip was the huge turn of events in the garden project. My fears about sustainability and the ultimate impact the project would make are completely gone. The three irrigation projects, two from natural springs and one from a river, will make large tracts of farm land arable for Tacaná, Sibinal and Malacatán. Each of these municipalities has 100-150 villages and they are grouped closely enough to benefit from communal farmlands. The land, some privately owned and some available for rent from the government is being made available to the villagers because without irrigation, it is useless. Since the villagers will own the irrigation pipes, pumps, etc, and be in charge of running it, the land owners have given them use of the land. It helps that the owners have family connections within the municipality. Luis estimates that each of the three irrigation projects will cost around $5000.00 dollars, but even if it is twice that amount, I feel confident that I can obtain grants. Luis has hired a consultant to create a report with exact numbers on acreage, pipes, pumps, people, etc.
So that's it. I'll post a few final photos. I'm unable to captions them all - something about Picasa. Thank you again for your interest.
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