February 23rd: Three Surprises

Tacaná 2/23 - Three surprises

On the drive to Tacaná, we passed by some fields laid out in a perfect grid, each planted with a different grain or vegetable.  All appeared to be thriving, and though it was Sunday, there were people tending the plants, adjusting irrigation sprinklers and hoeing weeds.  Luis explained that this is a USAID project where they are growing a wide variety of plants to see what grows well in various soil conditions.  In March, ten representatives from ten poor municipalities, including Tacaná will be coming to learn about the plants and will take back information to their communities.  Although this was not one of the official three surprises Luis had promised for the day, it was immensely exciting for me.  I had been talking to Bette about the possibility of building one garden in San Marcos as a demonstration garden where Luis’s crew would plant potatoes, larger beans and other vegetables that might provide more protein.  Produce from this garden could then be transported to the villages for the people to try.  This USAID project is much more far-reaching and will educate many more people.
At the lunch break in San Antonio, the village in Tacaná where we were holding the clinic, Luis drove us to a large greenhouse that is being watered by hoses coming from a new well dug by the community.  The plants are huge.  Next to the greenhouse is a garden that relies on the rain, and the plants are much smaller and less developed. It pointed out vividly one of the big obstacles for the indigenous poor in the mountainous regions.  Even where land is available, it is nearly impossible to grow anything other than corn because of the lack of water.  Although this well is providing water for the greenhouse and a few family gardens, most of the available land is at too high an elevation for wells to be practical.  The cost of digging to the depth required to find water is prohibitive.
Next we drove to the second surprise, a large greenhouse that contained at least 50 pine tree seedlings and 50 fruit tree seedlings.  There were apple, pear, peach and avocado trees.  This tree project belongs to a collective of 80 women directed by a woman named Mary whom I met.  The women have been interested in the environment for a few years but until now have not had the resources to act.  Money from the Hunger project allowed them to buy the seedlings and build the greenhouse.  Some of the evergreen trees will be planted at the “Nacimiento.” (see below,) and some will be planted in areas that need environmental stabilization.  The fruit trees will feed the village and in the future provide fruit for sale, generating income.
The final surprise was the “Nacimiento Project.”  I began the Greenhouse Hunger Project after my last visit to Tacaná where I saw so many malnourished and stunted children and realized that they needed food much more than they needed me.  My plan was to raise money for community gardens and greenhouses so that the people could grow vegetables to supplement their meager diets.  My dream was that eventually they would add potatoes and quinoa, and perhaps grow enough that they could sell some of their produce for some income to buy seeds to replenish the gardens.  I also dreamed of later additions of chickens and goats and other protein-source animals.  What has actually occurred under the guidance of Luis and Marcos, a village leader in Tacaná is way beyond my dreams.
It turns out that there are a couple of families in Tacaná who own fairly large plots of land that have lain fallow for years except for occasional corn crops.  Nothing else will grow due to the dry conditions.  There is a large spring two miles away called “The Nacimiento” – the birthplace or source.  There are several large holding tanks, built many years ago for a failed irrigation project after which the site was abandoned.  For a cost of around $5000-$7000, mainly for pipes, water can be brought to the fields in Tacaná.  With irrigation, all manner of crops can be planted in huge abundance. Not only will the people be fed, they will be able to sell the excess and raise their standard of living.  When Luis showed me the spring and told me his vision of Tacaná as a center of fruit and vegetable farming with the people becoming educated, thinking about their future and that of their children, I was overwhelmed.  The people here had big ideas of their own all along.  They just didn’t have any resources and just needed a little bit to get started.  Everywhere we went there were groups of young and old men and women waiting for us, proudly showing the results of their labor and ready to discuss the next phase once the irrigation project is complete.
I can’t wait to go back and talk to the people from foundations that expressed some interest if there was a good sustainability plan in place.  I’ve been thinking it would be my job to come up with one, and all the while the people of Guatemala had it all worked out.  Tomorrow we’re in Sibinal, another high village where we’ll be fore two days.  There are more gardens there – the most recent. Luis promises more surprises.

February 23rd: Mary's initiation an Hunger project surprises

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.

February 22: Mayan Ruins and a Long Drive

Mary and I both slept well despite a lively party in the street outside her window and conversation from a late family dinner wafting p the stairwell.  I discovered a delightfully noisy air conditioner in the corner of my room and turned it on full blast, allowing it to lull me to sleep.  Of course I woke up freezing about 2:00 am and had to turn it off, but by then all was quiet.
Luis picked up Bette and Savannah, the 17 year old niece of a friend at 6:30 and then returned to the hotel where Mary and I were packed and waiting.  Bette and Savannah had their own harrowing travel story to tell.  They arrived three hours early for their shuttle from San Diego to Los Angeles, only to find that there was NO PILOT there to fly the plane. “No Problem,” said the cheery gate agent, there are still two seats available on the van!”  Delta’s solution for the absent pilot crisis was to pile the passengers onto a van and speed them down the freeway to Los Angeles where they had a mad dash and scramble to make their Guatemala flight.  They were both too hassled to sleep on the plane but managed to pull themselves together nicely for the long day ahead.
We drove south on the main highway for 1½ hours before stopping at an authentic/tourist restaurant that I’ve eaten at a few times before.  The food is great - especially the tortillas, made all day by two women in traditional dress at the front of the restaurant (the tourist part.)  There were several venders’ booths there, and Bette bought a few things from a woman with whom she has traded for several years.  We then continued driving for another hour until we reached the site of the Mayan ruins.  There are partially excavated plazas, temples and buildings and an area where local Mayans conduct ceremonies.  Last time I was there, a traditional Mayan wedding was going on, and this time, there was a purification ceremony.  We were standing back, trying to be respectful and unobtrusive when a young Mayan woman greeted us and said we were welcome to take pictures and to ask questions of the priest/healer who was conducting the ceremony.  He was her father, and she explained that he had been born with the ability to see into people’s souls and to know if they were in need of spiritual cleansing. She also had this gift.  She had her two year old daughter with her, dressed in beautiful traditional clothing that the mother had made.  We went down and spoke to the priest who explained that the Mayans were holding this ceremony to try to bring harmony to the earth and it’s four elements, air, fire, water and earth, and to end the current battle between Catholics and Evangelicals.  He said that Mayans believe in Mother Earth and feel that both Catholics and Evangelicals sometimes forget the importance of Mother Earth and mothers in general in bringing life, and concentrate too much on Dios.  Concentrating on Mother will lead to peace, the Mayans believe.  Anyway, that was what I took away from his discourse.  I’ll post some photos of the ceremony.
We then continued our drive to San Marcos.  The road climbs and descends, winding around rock faces, rarely maintaining a level cant.  It always reminds me of a racetrack, especially when the packs of motorcyclists zoom by, weaving in and out between the cars and trucks and giant busses.  Mary, who says she can get carsick on a straight, flat road, took her Bonine and was fine.  Perhaps she was in shock, too aghast at what she had gotten herself into to succumb to motion sickness.
We finally arrived in San Marcos, dropped our gear at the hotel and went to Luis’ favorite restaurant for a late lunch/early supper.  By four, we both had appointments to see patients. Mary saw Luis’s wife’s 22 year old daughter from a previous marriage for a breast lump and I saw an 8 year old girl with poorly managed asthma.  From there it was back to the hotel to organize medications.
So here’s the plan:  Tomorrow, we leave at 6:00am and drive two hours to Tacaná, the municipality where the extreme poverty and malnutrition drove me to start the garden project last year.  Mary and I will see patients and we’ll get to see the gardens and greenhouses as well.  We’ll stay the night in a hotel in the mountain region and on Tuesday we’ll go to Sibinal, another mountain municipality with a similar level of poverty.  Ours will be the first ever visit to this area by medical providers.  Luis has just completed their garden, so we will view that as well.  Wednesday will also be devoted to Sibinal because of the large number of people who are expected to show up.  We’ll return to San Marcos Wednesday night and then spend Thursday, Friday and Saturday morning in villages in the jungle region.
Because we are spending 3 days away, we had to split up the medications, leaving about a third of them here for the villages in the jungle region.  It took Mary and me about two hours to wade through the piles of bottles and make our choices.  Now we’ll get to see whether our combined 60+ years of experience served us well.
I’m not sure what the WIFI availability will be for the next 3 days, but will post when I can.  I’ll try to put up some photos if the WIFI holds.

Saturday, February 21st: A Harrowing Day of Travel

Just so no one has to suffer through a suspenseful, anxiety-provoking chronicle of the day, be reassured that Mary and I are safely ensconced in a family-run hotel surrounded by a high steel fence with spiky posts spaced every three feet and a well-manned gate at the entrance, in Guatemala City. We each have a private room with bath, complete with toilet paper and a bottle of water. We each have a well-stocked fridge, with juice, soda and beer that we likely will leave for the next guests.
That said, the day did not go as planned.  To explain some of the anxiety, I must describe some of the packing activities on Friday afternoon.  Although I had done most of my packing ahead, I had left the medications till the end, mainly because I wasn't sure how to manage them.  Taking medications into Guatemala is legal as long as they are not expired, but I suspect there is a preferred method involving customs and fees and long delays.  My goal was to bring in the 56 pounds of antibiotics, antihypertensives, antiparasitics, vitamins, creams, drops, ointments, pain, cold and cough medicines and a few more random remedies without having to explain their presence. I do have a letter from Luis inviting me to come to do volunteer medicine and a letter from MAP International listing the medications and stating they are a gift and not for resale, but in the end, if I were asked to open my suitcases, someone might question the number of bottles or feel a need to levy a tax.
In the spirit of bringing in the medications without a lot of fuss, Randy (my husband) and I spent a lot of time wrapping them up in shrink wrap bags in an effort to reduce the noise made by the rattling of dozens of bottles of pills.  When they were all packed and I lifted up the suitcase to weigh it, (which is how I know there are 56 pounds of medications,) the bag sounded like it contained an entire mariachi band.  We ended up splitting the medications into two bags and wrapping everything in towels and my clothes.  In the end, to jump to the conclusion of this part of the story, the customs agents waved us through without a glance - I could have just thrown the bottles in one by one.
Mary and I went to fairly great lengths to mesh our flight schedules so we could meet up in Charlotte and fly to Miami and then on to Guatemala City together.  Luckily, Mary's flights came off without a hitch and she ended up, as planned, in Miami at around 1:30 pm, with a long layover until our 6:50 flight to Guatemala. My flight to Charlotte was an hour late due to "crew fatigue" and I was therefore booked on a later flight out of Charlotte.  It turns out I could have made the original flight; I arrived in time to see the last few stragglers board, but my bags were on the later one so my fate was sealed.  The later flight began to board around 1:00 pm, and suddenly, groups 1 and 2 began filing off the plane.  The pilot's seat belt was broken, AND there was no replacement seat belt in the whole airport.  We waited until 3:30 for another plane to arrive with a new seatbelt and took off around 4:30.  The pilot made good time and we were about to land in Miami with 20 minutes to spare when, at 500 feet from the runway, the plane suddenly swooped back up into the air and made a big turn before leveling off.  Turns out there was another plane on the runway and the control tower gave a last minute shout to pull up.  When we finally landed, I made a mad dash to the gate where Mary was waiting.  She had asked the gate agent to pull her bags off the plane in case I didn't make it, but, in the end, we both got on WITH our bags.
That's all for today.  I'm off to bed.  I'll try to post a couple of photos  before I sleep. One is of the mountain of reading glasses people donated.  Mary will have the pleasure of giving these out to adults who need them. No one has glasses in the villages and they will make such an amazing difference for those who can no longer see to do fine work.  The other is of a second mountain - medications.

Returning to San Marcos, Guatemala

On February 21st I'll be returning to the district of San Marcos, Guatemala, a district where the majority of the population is designated as living in "extreme poverty." UNICEF and the World Health Organization define extreme poverty as "not having sufficient funds to buy a basic basket of food." What that means is that the people can't get enough food to fulfill their basic caloric needs, and for the children, it means they are malnourished, stunted and always hungry. Teenagers look like 10 year olds, eight year olds are the size of toddlers, and one year olds are barely above birth weight. Last year at this time, during a clinic in the rural municipality of Tacaná, I saw children who subsisted on coffee, sugar, a few tortillas and "vegetables."  The vegetables are actually weeds, grass and leaves that their mothers boil in sugar water and feed to them so they have something to fill their bellies.  When I returned home, I began a fund drive to help the villagers build community gardens.  The project has been very successful with multiple large and small gardens and some greenhouses in villages at high elevations. The project pays for leasing land, soil testing and enrichment, tools, gravel, drainage, fencing, and the services of a local agriculturalist  who advises the village elders on plants hardiness, fertilizers and gardening techniques.  Fundraising has been through donations at www.crowdrise.com/greenhousehungerproject,  and through some small grants.  We are now looking toward financing the sustainability part of the project.
A good friend from medical school, Mary Rappazzo-Hall  an internist in Albany, New York, will be accompanying me on this trip.  It will be wonderful to be traveling with a friend, and the fact that she will see the adults is a real bonus.  I always feel terrible turning them away.