Final Thoughts

We both had a great time here in Xela!  I definitely recommend the one-on-one Spanish classes in Xela for improving your fluency, and I can speak about studying exclusively Spanish at either Pop Wuj or Proyecto Linguistico Quetzalteco.  For a medical school rotation,  Pop Wuj was a great balance of intensive Spanish with plenty of good clinical exposure.   We were very busy!  February is a beautiful time to come to Xela- the weather is perfect for taking advantage of hiking and the lake.  Overall a highly recommended experience.   Feel free to get our email through the OIA if you have more questions, either of us would be happy to talk about the experience in more detail.


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Causes of morbidity and mortality in Guatemalan Adults

As part of the medical program here we get lectures from the Guatemalan doctors (who by the way are young and hip and really cool) once or twice a week on really interesting topics.  One lecture we had was an overview of morbidity and mortality in the different age groups and genders including pregnant women.   I made note of the major players in adults given my interest in internal medicine.

The top causes of morbidity here are:
1. Respiratory infections
2. Gastritis
3. Intestinal infections
4. Hypertension
5. Diabetes
6. Urinary infections
7. Dermatologic infections
8. Renal insufficiency

The top causes of mortality are:
1. Respiratory infections
2. Peptic ulcers ( or GI bleeds that are presumed to be from peptic ulcers)
3. Renal insufficiency (presumably from hypertension and diabetes)

These causes of morbidity seem very in line with what I’ve seen in the clinic, although we did discuss that there is likely underdiagnosis of hypertension and diabetes and thus these are probably greater contributors to morbidity.  The mortality list, on the other hand, seems pretty strange to me.  I would think that heart disease would still be the number one killer here, and that cancer would still be a major player.  Even with high rates of gastritis I wouldn’t expect GI bleeds to be so high on the list.  I also would think that if hypertension and diabetes were causing high rates of renal insufficiency,  they would certainly also be causing even higher rates of heart disease.  Perhaps the deaths that are recorded only come from hospitals and as such are a skewed sample, and the majority of deaths that occur from heart attacks out in rural communities are not reported or recorded.

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Learning Spanish

I have found the one-on-one Spanish classes here on Xela to be excellent for learning Spanish.   As someone who spoke literally not a word of Spanish before medical school started,  I have been able to make what I feel like is a ton of progress in a short time studying over a few months here in Xela on two different occasions.   My teacher also says I am a “nerdita” so that probably helps.  Right now we’re at the point where we just try to push me to say as many complex things and converse as much as possible in Spanish.   I also carry around a small notebook with me and write down any word I hear that I don’t know throughout the day and later make all the words into tiny flashcards.  I have found it very helpful to force myself to even write down words that sound the same in English and Spanish …words that i understand when i hear them spoken but that I don’t necessarily have readily accessible in my vocabulary and make them into flashcards as well.  My teacher Luis is really awesome- he is a lawyer who is interested in rights of indigenous peoples,  he is currently writing a thesis on domestic and family violence,  and he is really politically interested and active… so we always have lots to talk about.  He has been fascinated by the current political climate in North Carolina.   Never a dull moment with him!


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volver 2

Coming back to the US is like starting to make one of your old standard recipes and having to improvise halfway through because you don’t have all the right ingredients. Or pulling on a pair of favorite pants and realizing your body has changed since you last wore them. Or hearing for the first time a live version of a song you know by heart. No cabe exactamente al inicio, but eventually you settle in and start singing all the words without even thinking about it.

A beautiful and strange thing is how different it feels to think and speak only in english. the sudden jump back has really brought home how much I was living in Spanish for the past month- thinking, speaking, reading, writing, dreaming- and how that shifted my daily experience. A thought born in spanish is very different than a thought translated from english to spanish, and I loved how thinking in that new way somewhat changed who I was and how I interacted with the world, giving me subtly different tools to express my thoughts to myself and to others. me pregunto tambien como hablar/pensar en espanol me cambiaría (o esperamente, come me voy a cambiar) como doctora- voy a ser una doctora diferente con mis pacientes hispanohablantes? As I was weighing different residency programs and their abilities to prepare me to care for Latino patients, I thought a lot about the importance of learning cultural competency, not just language. I still obviously want to learn the culture of my patients- pero que bella que el aprender del idioma pueda ser una manera tan fuerte para convertirme en la cultura tambien!

of course i miss also all the little pieces of a new place- eating mangoes in a bag on the street, dodging camionetas, hubicandome by the volcano, cheerful haggling in the demo- but part of what made those pieces beautiful was how the unfamiliar became so quickly and then fleetingly familiar. the continuous surprise of how easily we can adapt to change.

Sobretodo, me hace triste salir, pero me hace feliz estar en mi hogar. Yo se que no puedo regresar a Guatemala, pero espero que algun día vuelva alla.



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el aprender 2

my spanish teacher Gerson loves the fact that Jamie and I have a blog together, BUT he has given me a lot of flak for writing it in English. he’s right that it would be great practice to write it all in Spanish, especially since our classes are all speaking and very little-to-no writing. most of my homework is writing stories or poems using whatever grammatical structure and vocab we learned that day.

Entonces porque estoy tan agradecida a Gerson por todo, debo escribir solo un poquitito en espanol. Tambien estoy leyendo (o tratando de leer) una novella en espanol, para mas practica con el idioma escrito. voy a incluir tambien una de mis tareas, que cae bien con la ultima semana de mi tiempo aqui, porque es un poema un poco nostalgico- mas para mi tiempo in Ecuador, pero con la misma idea de salir de un lugar, posible para la ultima vez. disculpe por favor la falta de accentos y todo mas.

el amazonas

Ojala que fuera otra vez a la selva

viajando por el rio en un barco de madera-

que pudiera oir las llamdas de los pajaros

y sentir el sol en los hombros- oh, ojala que fuera.


ojala que me acostara en una hamaca

escuchando a los buhos hablando afuera

que me despertara con un coro de monos

saludando el amanecer- oh, ojala que fuera


ojala que nadara con un delfin del rio

mirando su sonrisa que cubriera su cara entera.

para descansar me sentaria en la orilla,

en el lodo tan caliente- oh, ojala que fuera.


ojala que mirara la lluvia por el rio

con nada mas que el tiempo para hacer lo que quiera

escuchando a los gemidos de los arboles en el viento,

tan salvaje y en paz- oh, ojala que fuera.



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la salud reproductiva

Last week we had a great lecture on reproductive health in Guatemala given by Sammy, one of the Guatemalan docs who works in the clinic. There were some great differences when compared to the situation in the US but also some striking similarities. Some o the highlights:

– the birth rate (14.7%) is the second highest in latinoamerica

-the maternal mortality ratio is high (different reports about 120 per 100000 births; in the US about 21; Sweden 4; Greece 3) and is mostly caused by uterine hemorrhage and/or endometrial infection

– about 30-33% of births occur in the public hospital, 2% in the super expensive private hospital, and 65% out in the communities with comadronas (midwives).

– lots of factors contribute to the high maternal mortality (and also high rates of birth asphyxia), including several reasons that make it hard for a woman to get a C section when she needs one:  lack of good transport (or lack of any transport at all), midwives not recognizing the danger signs (actually less of a factor but still present), the poor treatment many women receive at the hospitals when they go there (much of this is due to the fact that the hospital staff are typically Spanish speaking mestizos, while the women are more likely Mayan and speak little or no Spanish. Also hospital rules don’t permit family members to stay with the laboring woman, a deal breaker for a lot of families), and lastly, the fact that often the woman doesn’t get to decide for herself but rather has the decision made for her by her husband or his family, especially her mother in law. They may decide its too expensive/difficult to go to the hospital, or just take too long making the decision. Another aspect of the family dynamics is that most families will only allow the comadrona to stay in the house for about 30 minutes after delivery- not enough time to watch for and deal with a uterine hemorrhage or an infection. So even women who are getting good care from a midwife still run a high risk of maternal mortality.

– prenatal care is composed of most of the same things we do in the US, wih the exception of a couple screening labs that they dont do here, and of course a huge lack of access (not that our prenatal access in the US is stellar!). The government will pay for 4 total prenatal visits in the public clinics, with more obviously available in the hospitals and private clinics.

– the family planning situation is really interesting and I’ll try to keep in concise since as Jamie said I could go on about this all day. Essentially (and similarly I the US) there are tons of myths floating around the public consciousness regarding different methods. This one makes you gain weight, this one makes you not get your period so all your blood builds up in your uterus until it explodes, the IUD will end up stuck in the front of your baby’s head, the IUD will fall out if you go over too big a bump on a chicken bus. Machismo also plays a strong role in women’s FP choices- many men refuse to use condoms, an also many men don’t want their spouses to use any birth control. Because of this, women often want a method that doesn’t change their periods so they can hide the fact that they are using birth control from their husbands. So the most common methods are the Depo shot (75%) the pill (20%) and then very low rates of use for the copper T and the guatemalan version of nexplanon which has the pleasing name of Jardelle.


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el aprender

I realize that although we have given y’all an idea of a number of the places, people, an activities that fill our days here, we haven’t talked much about what in reality is the main activity- learning Spanish!

All the students at pop wuj have 4 hours of one-on-one Spanish class, with a teacher who meets you where you are. The teachers are all really interesting/smart and have different styles, so I’ll let Jamie tell about her teacher Luis (briefly, he’s the bomb).

My teacher is named Gerson and he’s also studying for his masters in psychology, so we’ve spent a good deal of time talking about health care stuff, his possible research topics (he’s interested in adolescents, so we had a fascinating conversation about body image concerns and the cultural differences between the US and here!), and other societal problems. The basic structure of the class will be some chit-chatting about my and Jamies adventures about town, then some grammar or vocab review which we’ll practice by having a conversation, which are either more serious (he pretends to be a patient coming into clinic) or more absurd (he asks me to explain what kind of life I would imagine for my future daughter named Fifi). The sheer randomness of our conversations have led to some great vocab words- pasarela (catwalk AND fashion show), alborotarse (to get messed up), chantajear (to blackmail), el peste (the plague), cargarse la culpa (to lay a guilt trip on), en ayunas (on an empty stomach), persignarse (to make the sign of the cross), el Eje (the Axis powers), and many more.

I know that many students have way more structured classes that focus more on grammar, so I think you can kinda ask your teacher for what you want/need. For me just talking rapid fire about all sorts of random things is a great way to stop thinking in English and then translating, and instead just think and speak in Spanish. My favorite class so far was when we went out to a coffee shop w Jamie and her teacher Luis and just talked about the intricate and alborotado US health care system. My ability to lay out complicated and passionate arguments in Spanish is definitely improving!


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