First week of clinic

I’ve had a great experience in clinic this first week.  Normally we work in pairs seeing patients,  with a few students with less advanced Spanish triaging patients and working in the pharmacy.  I am the more advanced Spanish speaker in the pair so occasionally it is a little overwhelming but I’ve found clinic to be really great practice for both speaking and listening,  especially with understanding patients who don’t speak clearly like the teachers at the school or who use vocabulary and idioms that are less familiar.   I has also been a new and interesting challenge presenting and discussing patients in Spanish with the Guatemalan doctors who precept us in clinic.  I have really enjoyed watching them interact with patients- they have great bedside manners and are really great people.

The patient population has been an interesting mix of acute and chronic issues.  We started running both morning and afternoon clinics for the first time this week so we had a lot of new patients which may have made for a lot more acute issues than normal.  As we were advised, lots of patients are suffering from generalized pains, that many describe as bone pain, which we have been taught may be related to dehydration,  fatigue,  malnutrition,  and stress.  I’ve also already learned a lot about the subtleties of parasitic infections from the Guatemalan physicians which has been really helpful and I think the volume of the infections will be really instructive.   But the acute complaints have been really interesting!   I have had a patient I was worried was having a subarachnoid hemorrhage, a patient with really severe symptoms of early onset menopause, patients with multiple acute gynecological conditions,  and a patient we were concerned might be developing multiple sclerosis.  I definitely think there is a lot to be learned here in clinic both from a medical perspective and from a language perspective and I’m excited about the upcoming weeks.

-Jamie

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Overview of the Guatemalan Healthcare System

There is no free chronic healthcare in Guatemala.   There are free public hospitals but these only are available to essentially treat crises or exacerbatations of chronic conditions.  So the system of chronic healthcare is fairly broken, and the clinic where we work plays a small role by providing some free chronic care to residents of Xela and surrounding communities.

There are 4 main levels of care available in Guatemala.  The first most local level of care are the “puestos de salud” or health “posts”.  These provide very basic services and have two nurses available for nutrition and vaccinations.   The second level of care is the “centros de salud”, which provide slightly more comprehensive services including 24 attention for births (I don’t think this is medical attention but care by a midwife or a nurse), as well as vaccinations and a more extensive nutrition program.

The tertiary and quarternary levels of care are the hospitals.   The 3rd level includes regional and national public and private (I think?) hospitals that are more generalized.  The 4th level is specialty hospitals including hospitals that treat patients with only HIV and tuberculosis, for example.

-Jamie

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FOOD

One of my favorite things about being back in latinoamerica is getting to eat all the foods I’ve been missing. Our Xela diet is pretty similar to what I remembered from honduras or ecuador but with some new things thrown in, mostly because our host dad QuiQue (short for enrique) is a really great cook! We are seriously spoiled by our awesome host family.

Breakfasts are always a big bowl of sliced pineapple, bananas and papaya for each of us, with a rotating cast of carbs for us to put the fruit on. Cornflakes with milk, mosh (i.e. oatmeal, but way more liquidy than at home, and pronounced ‘mush.’ Trying to explain in Spanish the concept of ‘mush!’ as a command to dogs in a sled race was pretty interesting), or panqueques (yum!!). Every once in a while we instead have a typical eggs and refried beans breakfast instead- with the incredible black-refried-beans-in-a-bag, which I’m sure are chock full of fat and sodium to make them taste so good. And I always get a cup of black tea with milk and sugar, heaven! Like I said, spoiled.

Lunches and dinners are all over the place but always delicious. I think most of the other students eat a standard eggs/beans/tortillas for many meals, while we are lucky to have tons more fruits and veggies. Some of our favorites-
-essentially a healthier carrot cole slaw, made of shaved carrots, vinegar, salt, and a little mayonnaise
-a spinach cake made of 95% spinach and 5% egg white, plus a little salt
-lentils with rice and indian spices, a recipe quique learned from an Indian family who rented a room for a while
-vegetable soup with huge pieces of lots of unknown veggies, which we eat first for lunch and then again puréed for dinner
-FRIED PLANTAINS my favorite. I like the sweet ones and I think the variety I can find in the states is different because they never turn out quite the same when I make them. Quique’s are sweet and caramelized and just so good. He’s also made them boiled a couple of times which is amazing.
– and at least once or twice a day, the beans in a bag. Yum.

For snacks there are always plantains or tiny crazysweet madarinas laying around, or we sometimes buy a little taco or empanada or deep fried chile relleno from the woman who comes to the school during our morning class break. You can get lots of great stuff on the street too, at the risk of mild or not-so-mild GI upset: frozen chocolate covered bananas, tons of little frozen granitas (essentially snow cones with condensed milk and other stuff), bags of cut up fruit covered in salt and ground up squash seeds, and ceviche in a cup (i kid you not- street ceviche in a cup.) And then Tuesday an Friday are bakeshop days (the Mennonite bakery) so we can grab a doughnut or something else delicious. Last Friday was valentines day, so we got our host fam a loaf of bakeshop carrot/ginger/honey bread which they scarfed down pretty quickly- quique admits that he also has a sweet tooth, one of the many reasons we get along so well 🙂

There have been some odder things too- at Dona Ana’s house I’m pretty sure I ate a corn-based tripe soup, and drank some sort of hot corn tea. And then this past weekend in momostenango we had a hot broccoli/orange/lettuce salad, which was really good. And a breakfast of cut up fruit covered with honey and peanuts(?). Also one of our host brothers, Daniel, has his own ajo aioli sauce business, so we often eat that with veggies. It’s kinda like a super duper garlicky tartar sauce.

All in all the eating is good here in Guatemala. And the number of crazy fruits you can buy for a song on the street (either still in peel or get some fruit wash) is incredible!

-Claire

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Getting to know our host brothers

This weekend we were invited to a cabin in the woods in Momostenango, a smaller mountain town about 45 minutes outside of Xela by our host brothers.  One of their old friends owns a cabin, where the older of the family’s sons has been staying for the past few weeks for work.  So Claire,  Katie the British girl who also lives with us, our brother Daniel,  our brother Pablo, the cabin owner Angel and a random Italian guy Manuel all had a nice relaxing Valentine’s day weekend in the mountains.  On Friday night there was a band playing at the cabin’s bar, so we hung out there and talked and had some beers.  It was nice to have some conversation with the hermanos away from the family… to learn a bit more their perspective on life in Guatemala and things more relevant to people of our generation.  Por ejemplo, the song “blurred lines” by Robin Thicke (which I hate) came on, and we were explaining how it is a bit ( or more than a bit) anti-feminista, and they seemed really surprised to hear that we all identified with “feminisita” ideas as if that were something they perceived fairly negatively.  That launched us into an interesting and somewhat intense discussion where I ended up clarifying with one of the brothers that for us feminism is more about women having equal opportunities in society,  in the workplace, in relationships,  as well as having protections in place to be free from violence.  For them, they perceived feminism to be a direct reaction to “machismo” where women tend be very proper and closed off from men and keep to themselves.  It was interesting to hear how different our concepts of feminism are.  Some other things struck me as interesting too- for instance that neither of the brothers wants to live in Guatemala.   They are interested in moving abroad, perhaps to Europe or China or India.  They seem very jaded by life in Guatemala,  the chaos of it all, which I certainly can understand.   They also describe a frustration with the way of thinking of the people here, which I’m not sure I understand and would like to explore further.  At any rate, a very interesting weekend of getting to know our generation in Guatemala, something we have been lucky to have the chance to do.

-Jamie

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Hiking Volcan Santa Maria!

So this was awesome.  We did this last Saturday morning with Adrenalina tours (Quetzaltrekkers,  the more popular group didn’t have a trip).  We got picked up at our house at about 5am and started hiking by 5:45.  We went with another friend from our school and two Canadian tourists, a Guatemalan guide and two armed police men which is now the norm as there have apparently been increasing numbers of robberies on foreign hikers.  So we felt very safe!

The hike was tough! It was definitely very steep but I think the altitude really affected me the most.  I was feeling a little nauseous and breathing extremely hard by the end.  But the view from the top was incredible- a 360 degree view including Xela, the highest volcano in Central America Volcan Tajumulco,  and Santiaguito, an active volcano at the base of Santa Maria.

We also found it pretty hilarious that the fruit juice (or probably more appropriately referred to as “nectar”) that they gave us for the hike has as its slogan ” the difference between drinking something and eating it”, presumably because of its sugar content? See the pictures.  Regardless, it was delicious while watching Santiaguito erupt, admiring the vista, and recovering from the effects of the falta de aire.  Overall highly recommended.20140208_083012 20140208_065029 20140208_085146 20140208_093004 20140208_093026 20140208_094938 20140208_10130620140208_064206

-Jamie

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Dona Ana, part 2

i want to follow up on the last post about Dona Ana to tell a little more about her patients and to convey a sense of how incredible this woman’s life has been. we returned to her house the next afternoon with plans to spend the night there. when we got there she showed us an upstairs room in the sprawling open-air house that we could sleep in. there were two beds, one of which had 3 tiny, 1-week old kittens in a little pile in the middle. ‘you girls can share this bed,’ she said, pointing to the one unoccpied by adorable animals, ‘because that other one is for the kittens’. this was not a joke. (we actually apprecaited sharing a bed later when it got super cold!)

we headed back downstairs to shadow her with more of her afternoon patients- a guy with stomach pain and a BP of 160/80, to whom she gave essentially DASH diet recs, a course of flagyl and albendazole, and an appt for a blood glucose check the next morning; a couple of ladies there for their routine prenatal care, including BP checks, and lastly, a young woman who spoke almost exclusively Mam and came in already seeming pretty upset. she spoke almost without breathing for a few minutes and stared tearing up when Dona Ana told her to lay down. As soon as Dona Ana felt her stomach, she looked at us and said simply ‘un aborto,’ i.e. a miscarriage. The woman sat back up and pulled out of the pocket of her large, traditional dress a plastic baggie with a folded up piece of notebook paper inside. she handed it to dona ana, who put on a glove and unfolded it, then showed us the contents- el feto. Dona Ana then left for a few minutes to get the antibiotics the woman needed for her UTI, and the woman looked at us and said the only words she spoke in Spanish the whole visit- Perdi mi bebe. i lost my baby.

later over dinner we asked dona ana how she came to be a midwife.

‘My mother was a midwife, and so my first experiences were very young. she had a book that described a lot of medical procedures including labor and delivery, giving injections, and all of that. so i read the book and liked it, but never went with my mother to any of the deliveries. then one day when i was 11 years old, my mother was sick, and a woman came to us and said that her friend was in labor in a pine forest near there, under the trees. my moher said that she couldnt go, but that she would send me. I said I couldn’t, I didn’t know how, but she just explained to me what the steps were, how i should massage the uterus after the placenta came out, and all of that. so i went, and did as she said. and that was my first birth.’

Dona Ana is about 33 years old and has delivered 12,000 babies- as she says, ‘un pueblo.’ she ended up going to nursing school when she was 18, but it was mostly to reinforce what she already knew from years of experience. now she is already delivering the babies of women that she delivered when she was a teenager.

there weren’t any births the night we stayed over, unfortunately, but she said she would call us the next week to let us know when to come. we spent the night listening to the kittens crying, the neighborhood dogs barking, and finally the silence of the country asleep.

 

-Claire

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Dona Ana, part 1

ok, so now some good stuff- like what we’re actually doing here!I know jamie already wrote a bit about our awesome host fam, the school, etc., and she’s doing clinic this week so i’ll let her talk about that too. instead of doing clinic, i spent this week going to a village a few miles from Xela to work with Dona Ana, a local midwife/nurse/baller. this lady is honestly incredible.

another student (serena) and I first headed out to Dona Ana’s house on wednesday. the journey to and from is a big part of the adventure. here were our written directions:

1. walk down to the corner of 19th avenue and 7th street, zona 1 (side note 1: xela has three zones with all the same streets, just to make things confusing), and wait under the san sebastian bread shop on the corner.

2. flag down a camioneta thats headed for san juan ostuncalco (side note 2: ‘camionetas’ are old american school buses that have been painted in crazy colors and racing stripes, christened with names like ‘maria jesus’ o ‘la gloriana’, and then packed full of people clown-car style. they are awesome and will happily run you over if you dont get out of the way)

3. ride through a couple of other towns, then get off in the central park of san juan

4. ask someone where the texaco is, then walk there

5. past the texaco is a microbus station. (side note 3: microbuses, the even sketchier mode of transport available in guatemala, are super junky 12-passenger vans filled with 25+ people. favorite activities: prolonged honking, careening around corners with all the doors open and people hanging out the sides, bottoming out on speedbumps). catch a microbus towards aldea buena vista, but jump out just past km marker 217. just tell the driver you’re going to dona ana’s house, he’ll know where to stop.

6. walk down the dirt road for a bit until you see the big blue and yellow house, then you’re there!

once we made it to dona ana’s, we hung out for awhile and waited for patients to show up. we needed to leave by dark, so we were worried we wouldnt have time to see much, but all the sudden lots of ladies rolled up to dona ana’s house/clinic. most of the patients were pregnant women with a few other medical issues mixed in, and most spoke a mix of about 20% super-fast spanish and 80% Mam, a mayan language. dona ana would translate intermittently.

our very first patient was a young woman who was pregnant- she looked to me like only beginning of her third trimester, but dona ana said she was 34 weeks- more evidence of the poor nutritional situation for women around here. after feeling her uterus, dona ana called me over, guided my hands to where hers had just been, and said a word in Mam that i couldnt pronounce or remember but that clearly meant ‘breech.’

seconds later, dona ana moved me out of the way and began pushing on the young woman’s uterus much harder than before, moving the fetus’ head down and to the left, smoothly but firmly. the patient sucked air through her teeth but didnt scream, and then- it was done, el bebe volteado. something i’d never seen before- she made it look so easy!

we had to skedaddle before it got dark but made plans to return the next day and stay overnight in hopes of catching a birth. then we had the surreal experience of riding back to Xela on a camioneta, looking out at the beautiful sunset over the mountains while a dubbed version of Thor: the Dark World played on a jerry-rigged tv. a great day!

 

-Claire

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