Friday, August 10, 2018
Today the UW group toured the Hospital Roosevelt in Guatemala City. The group was subdivided into two, and each tour viewed a different area of the hospital. My visit was led by two of the hospital’s nurses, and we observed the emergency room, holding areas, operating rooms and the ICU. Some history facts, the Hospital Roosevelt was built in the 1940’s and is named after President Roosevelt, the healthcare facility serves people from the capital city and the entire country. Patients are referred to the hospital, and the care is free but items such as IV fluids, blood products, and medication are not free, and the patient or their family/friends need to purchase items required for the care which can be difficult for a poor, ill person.
The hospital tour felt like stepping back in time, in the general areas the equipment was very old looking, the holding areas were wards which did not allow privacy for the patients. When touring the ICU, I was pleasantly surprised to see updated equipment, the ICU monitors were modernized, they used the same feeding pumps as my ICU, and the ventilators appeared to be very new. During the hospital tour, there were no overly distressed patients, everyone appeared to be comfortable, the group of patients waiting for orthopedic surgery all seem to be tolerating their injuries well. I thought there would be a lot of moaning and distressed patients due to pain, as it is difficult for a patient to afford pain medications.
Tuesday, August 7, 2018
Today’s clinic was a bit surreal, we arrive at this coastal village via boat and disembark on the beach. The scenery was picturesque, the air was breezy warm, exotic birds fluttered close by skimming the water to retrieve small fish in their beaks, and children in the water, cheerily playing but very focused on the newcomers. The medical team is in high spirits, I cannot tell if this joyful mood is due to the beautiful surroundings or because this will be our last clinic for this trip? I am cheerful for both.
It was my teams turn today to complete a community windshield survey for a village, I am looking forward to this experience for everyone before has enjoyed their village tours. The village health promoter helping us today is Miguel. We started our journey from today’s clinic area and traveled by foot through the village and learning about what the community resources are. We learn of a couple of their income resources, they dry smelt fish caught at the beach and then dry the small fish on large black mats, and package them for sale, a second income comes from selling charcoal, the process for this is burning wood covered by soil which then produces the charcoal for sale.
The village includes two churches, one Catholic and one Evangelist, a large school with three classrooms, a large playfield for soccer, a small tienda (store) which holds food, household products, and some medicine. I am surprised to see antibiotics for sale at the tienda. The homes are all surrounded by fences constructed of barbwire, and the homes vary from traditional materials of wood and palm roofing to concrete structures. One house had a satellite dish which was uncommon. The transportation modes include, boats, walking, bicycle, motorcycle for the villages and the finca (estate) owners have vehicles. For employment many villagers need to leave for two-week periods, to work at finca’s to provide income for their families.
Today’s village tour indeed provided insight into the life of a Guatemala villager and understanding of the struggles they face. The community resources for income are not enough to sustain families, and family members needed to travel for additional income which takes them away from their loved ones for up to two-week periods. We learned that the local school teaches in Spanish and not the traditional language of Quiche, this method could potentially affect the customary native tongue, they could lose this unique language.
Wednesday, August 1, 2018
Starting today is difficult for we stayed in the village overnight due to the length of time required to reach this area, yesterday we had a clinic for the Semanzana village people who travel to Chinachabilchoch to be seen. Today we will be seeing the Chinachabilchoch villagers and then going to our Paraiso Hotel. Staying in the village overnight was challenging due to the lack of comforts after working a long hot day. A makeshift shower system was placed in a building for the teams use, but very few used it due to lighting and privacy issues. The latrine was an outdoor facility used by 20 or more people which did not stay clean. We set-up our sleeping quarters in the same building as our clinic. We prepared for this overnight stay with air mattresses and mosquito nets which were arranged in three different areas of the building. Everyone was tired after our work day but falling to sleep was difficult due to the hot nighttime air and the rustling/noisiness of the other cohorts.
Everyone worked hard today and even though we woke this morning with little sleep and felt at our worst, no one showed any signs of frustration towards the patients or each other during the clinic. I was very proud of our group today and glad to see everyone overcoming the difficult challenge placed upon them with such professionalism. Everyone worked with a focus today as we process 90-100 patients, we were motivated to get back to the hotel for some comfort and relaxation.
Monday, July 30, 2018
Today our village clinic was in Esperanza Tunico, people were already waiting for as we arrived to get set up for the workday. In total for the day, we saw about sixty patients comprising mostly women and children, for the men are at work during our clinics which run from 9 a.m. to about 2 p.m. For this clinic I worked in the vital sign station, the station rapidly became chaotic as patients did not understand the flow process and the language barrier provided additional challenges. It did not take long to come up with an organized process which improved the patient flow, this is where I noticed my passed charge nursing experience came into action. Mostly the patient’s vital signs were stable, as this group of people are seen every six months by the GVH team and regularly by the local health promoter. The GVH records the data for each patient seen, and we noticed very few new clients at this clinic.
Today I was able to work on my Spanish skills to communicate greetings, my title and what my station was providing. It was easy to feel motivated to help this population for the patients were very pleasant, cooperative and eager to seek help. I noticed the patients were well dressed, I felt the people were in their best clothing to come to the clinic, they show pride in the cultural attire. During the chaotic day, I never once viewed a client who was angry, upset, or pushy, everyone displayed a pleasant disposition. I wondered if this clinic was really helping the people of Esperanza Tunico as it felt like we were band-aid healing. I learned that the local health promoters follow-up with patients care, which helped me think that we were making a difference.
The most difficult challenge for this clinic was dealing with the hot, humid weather and remembering to drink plenty of fluids. Drinking warm water was not refreshing but adding flavoring to the water, like a GU electrolyte helped me to take in needed fluids.
Saturday, July 28, 2018 Blog by Ronald Carrick, Guatemala
Today we traveled by bus from Guatemala City to the Santiago training center (2hrs) which is owned by Jennifer Hoock, our trip manager from the Guatemala Village Health (GVH) group. Jennifer does not live at the center, she has a local family living at the center which manages it. The center has a main house, which is in continuous improvements, we learned there were new kitchen cupboards placed and a new tile flooring in the last year. A new range stove and refrigerator arrived today at the center during our visit. The center had an example of a functional out-house toilet which is built in the rural villages. There were water purification systems (ECO system), which consists of a ceramic clay pot (clay is mixed with wood shavings and baked, this curing process turns the wood shavings into carbon, then the clay pot is painted with silver) housed by a plastic pale. Water is poured into the clay pot, and purified water is removed from the bottom via a spigot. There is also a carpenter training area too.
At the training center the UW group, the GVH group, and the Guatemalans unpacked the supplies that were transferred from Seattle, WA to Guatemala. The center houses medical supplies which are used during the clinic visits in the rural villages. The travel clinic supplies were stocked and sorted by systems, i.e., GI, Pulmonary, Cardiac by the three groups. This process allowed the groups to become acquainted with one another.
We then set up for a mock clinic which turned into a regular clinic, as locals turned up for medical treatments. The clinic visit started with registration, then vital signs, triage, group charlas, finally to see the doctor and/or pharmacy. It was great to treat the locals, about 43 patients were examined, this allowed a good practice for the planned village clinics. During this training session, I was a triage nurse, a Spanish interpreter was needed to complete the patient assessment, and data was entered into the Electronic Medical Record (EMR) and on a papelitos (little papers). The patient moved through the clinic with the help of a runner. During the day’s activities, I learned how important it is to have a system in place to run a clinic efficiently. It takes many hands to prepare for a mobile medical clinic.
Today we took a long boat ride past Livingston to get to the Baltimore Village. We were not sure that we were going to be able to make it to this village today because there was a huge storm the night before that was possibly going to prevent us from boating. I worked in triage translating this day. This village had many Spanish speakers with little need for translators. I noted that this people in this village were much more over weight and even the children had cookie wrappers and such they were clinging onto. The adults complained about pain in their hearts which I was not sure the cause of. I thought maybe it was heart burn from so much junk food. They also had rather poorly controlled diabetes. As we were leaving the clinic, we walked past rows of drying fish. We learned that the town sold these salted dried fish at the markets nearby for a profit. As we were leaving we watched little children in the water playing with a small boat. It was truly humbling and beautiful to watch these people who had so little be so happy and content with their lives. On a side note, the hotel “finka tatine” is AMAZING. Wonderful owners, food, animals, and it right off the river essentially in the tropical swamp grounds.
I feel that I gained a mountain of perspective from this study abroad trip. I was able to see how people in another country of a different economical background survive. The political climate and the overall culture of Guatemala were hard for me to digest. I think that on our day with the promoters, I had true sadness brought to my attention. I was talking with one of the promoters who said he did his best to teach about safe partnerships, the importance of family planning, the need for contraception, and healthy relationships. This man recognized all of those problems and was doing his best to educate the youth. I asked him what he thought was going to actually change the way things were, he said he didn’t know if it could change because of the machismo culture. It made me so sad to hear this man who was pouring his heart and soul into educating the youth say he didn’t know anything would make a difference. These problems are on a country level and are not going to be able to change unless huge endeavors are made. I do not know how you can change a deep-rooted culture or a country that is strong on its religions beliefs even if it seems it is pressing the people deeper and deeper into poverty.
Our travel to the Baltimore clinic was by boat from the Finca Tatin hotel. At first, we weren’t sure we were going to be able to make the clinic day as it had rained so hard the night before. However, word was that the ocean had calmed down and there were no safety concerns about travel to the village after all. This village was off the Caribbean coast, and one of the more resource wealthy villages that we visited. I was surprised that this remote feeling village still existed as it does being so much closer to “city”life in Livingston and Barrio in comparison the more rural villages we had already visited in the mountains. There was a group of men and children waiting for us on the shore. Kids were laughing, playing in the water. We walked past a tarp covered in sardines as we trudged through the sand and grass to arrive at the clinic. This clinic was also larger and more spread out, which made patient flow a little easier. I was excited that this day was our windshield survey as I wanted to get a better view of the village and how its people lived. I was surprised to learn that school had been cancelled today because the teacher decided not to show up from Livingston. What a bummer for those kids, having a teacher that didn’t seem invested in her job. I wondered what kind of motivator might work to keep teachers coming back? I also was pleasantly surprised at the village tienda, which sold snacks as well as many common personal products. There was even a refrigerator/freezer in the tienda! (although it was not plugged in). The homes even had fences, some had gardens, a water source, and the animals that co-habitated (dogs, chickens, pigs, turkeys) all seemed a little more plump compared to the mountain villages. Our leader that took us on the tour, Manuel, was obviously a known community leader as several groups of kids came over throughout our walk into town to give Manuel a hug. Overall, the patients we saw on this day were more overwheigt and seemed to have more problems with diabetes and hypertension compared to our other clinics. I am certain that being less than a 20 minute boat ride to a larger city with resources (Livingston) made a difference in both patient activity level and proximity to processed food and other non-healthy resources. I was sad when we drove away in our boat, as we watched the children giggling and waving at us in their canoes close to the shore. This was our last clinic day for the trip. What a beautiful spot to call it a wrap.
We only stayed in Guatemala city for a day before we left to head East in our giant old school bus to reach villages in the jungles of Izabal. The 8 hour ride was intense. It was hot, sweaty, and literally kept me on the edge of my seat. The gravel roads and steep cliffs mixed with sporadic drivers had me clenching the seat in front of me. As we traveled deeper into the country, the attire of people began to change. Instead of generic t-shirts and pants, I noticed the women dressed in colorful skirts and lacey tops layered over satin tank tops. We stopped at a diner and I got a hamburger. As I took my first bite, I thought about seeing the ribs on the cows as we passed them on the side of the road.
When the animals are not being fed enough, it is clear the people are also struggling to get enough food. The burger tasted dry and gamey. I could only tolerate one bite before I passed it on to the others at my table. I felt guilty not finishing my food. Moving forward, I decided to eliminate beef from my diet for the trip.
Then we went to a special place full of Mayan ruins, where we were in awe of the beautiful stelea –the natural rocks that were upgraded to carve the inscription of hieroglyphic texts and images of rulers. These were dated as far back as the 200 A.D. years. While we were taking pictures of the plaza juego de pelota, we saw clouds congregating above us and a roar of thunder in the distance. Before we knew it, we were welcoming the giant, warm drops of rain as we ran squealing with excitement and delight under the large palm leaves above us. The moisture from the sky was so refreshing after sitting on the sticky and hot bus all day. By the time we arrived to our final destination –Palaiso –we all happily went to our cabins with fans and cool a/c for our first sleep in the rainforest of Guatemala. Our adventure to the other side of the country had been a success.