See Part 1 for the introduction and background information.
Our daily program
Each day, Monday through Friday, we visited a different Mayan village (except for Tuesday when we worked out of the clinic in Quetzaltenango). We’d leave our hotel in the city at 7:00 am, load our already-full van with medications we brought from the U.S., and drive 30-80 minutes into the countryside, admiring the views of perfectly conical volcanoes looming on the horizon. In each village, our patients spoke a different Mayan language: Mam, K’iche, or Kaqchikel. I bet you didn’t know that I’m fluent in all 24 (or so) the Mayan languages spoken in Guatemala! Not. We had local interpreters who translated into Spanish, which I then translated into English for the doctors I worked with. Now you know why everything takes time in Guatemala….
When we arrived in the villages there was always a long line of people waiting for us – mostly mothers and children, though one town had a significant number of men in traditional garb (a rare sight in Guatemala). There was no official starting time. Rather our patients were told to just show up at Ana’s house, the school or the community center on a particular day if they wanted health care. They were incredibly patient (pun intended!) as we set up our stations: the intake desk; triage – where height and weight (for children) and vital signs were taken and health issues recorded; consult rooms for the doctors; and pharmacy. Some folks ended up spending a good five hours or more waiting to see the doctor. While I couldn’t understand what they might be saying in their native tongues, I didn’t get the sense that they minded the wait. They were used to it, and would likely consider our notion that “time is money” unfathomable.
Most days our group of eleven was assisted by Guatemalan doctors and/or American Spanish students (a couple of whom had medical training), helpful when you have 100 or more patients to be seen. Even though our brigade was small, we easily fell into our roles as medical provider, interpreter, or ad hoc pharmacist. By the end of the week, we had become so efficient that we were able to finish by early-mid afternoon, just when the sun would fade behind the clouds and a cold chill would settle in. Speaking of weather, we were lucky. It didn’t rain the entire time we were there – unlike a few days earlier in October when a tropical depression caused major flooding and landslides across the country, killing 39 people, displacing thousands of others, and cutting off major highways.
The patients and their ailments
What kinds of health issues did we see? Since it was the end of the rainy season, many of our patients came in with simple coughs, runny noses and colds. Not wanting to overprescribe medicines (especially antibiotics), we did a quick physical and assured them that their symptoms would go away and that no special medications were necessary. We did, however, give everyone vitamins, which pleased our clients immensely. In spite of how commonplace and inconsequential vitamins may seem to us, the supplements are essential for the health of the majority of these campesinos. Most cannot afford to eat much more than rice, beans, corn tortillas and plantains, and an occasional serving cheese, eggs or meat. So, when we offered vitamin pills to “strengthen their bodies and help fight disease,” they were delighted. They felt that their time at the clinic was well spent and that their health needs were truly being met. (I’m betting that a few of them showed up just to get the vitamins. No matter.)
In one community, in particular, the women all complained of pains in their stomachs. Our Mam interpreter said that she had never seen so many people with the same symptoms at once. You’d think that bellyaches were contagious. (Or that something fishy was going on….) In any case, we gave all our patients (except pregnant or lactating women) anti-parasite medicine because unless they’ve been treated within the past six months, it’s highly likely that have intestinal parasites. Sometimes people described pains emanating from just below their breastbone. With a few questions we determined that they were suffering from heartburn, so we prescribed antacids and suggested foods to avoid (coffee, acidic and fatty foods, etc.).
In other cases, it seemed that the stomach aches were due to anxiety. Speaking of anxiety – or nervios in Spanish – we encountered many women who, in spite of their simple lives in remote villages (without traffic jams, Internet or busy schedules), were feeling quite stressed out. The reasons included not being able to provide sufficient food or health care for their children, husbands who didn’t help around the house, husbands who drank or even beat them, and concerns about the future of their families. Hate to say it, but it sounds a lot like what many women in this country are experiencing….
A number of people came in with rashes and other skin conditions, which turned out to caused by scabies (a tiny mite that’s transmitted via skin contact), eczema or acne. Or, by an excess of sunlight, especially in the high altitudes. Many of the older women complained of lower back, leg and arm pains. I wanted to respond, “It’s a bitch getting old, isn’t it?” Instead, we asked if they did hard labor, and they’d respond affirmatively. Women in their sixties, and even seventies, are expected to carry large loads of firewood or corn from the fields, wash heavy clothes and blankets by hand and lug them home while wet. At least that’s one thing that most of us here don’t have to contend with.
Finally, we saw patients with chronic diseases such as high blood pressure and high blood sugar – i.e., diabetes. Interestingly, they were the ones that lived in the city, whom we attended at the clinic in Quetzaltenango. Among the more acute ailments we observed were a 10 month old baby with a cleft palate (who we referred to an organization called Partner for Surgery), and a three year old who had been born full term weighing 3.5 lbs and suffered from seizures (she even had one right in front of us – the first time I had witnessed such a thing). There was also a young man with a severe case of athlete’s foot. He worked in a supermarket near the coast and during the huge rains of the previous weeks had spent days at a time in water up to his chest. I doubt that neither he nor his employer were too concerned about his working conditions until his symptoms were so bad that he could hardly stand. Finally, there was a 30-year-old woman with a loud heart murmur. The doctors were surprised that she hadn’t been diagnosed with this condition earlier. Until now, there had been no such thing as preventative medicine in these communities.
The non-medical stuff
By now, you may be wondering if the brigade consisted of anything other than illness and medications. Of course. We did need to sleep and eat, though we did so simply. Our hotel rooms were plain, with hot water and electricity most of the time, but little room for our suitcases or their contents. While in Quetzaltenango, we ate most breakfasts and dinners in the hotel. Nothing fancy (see below). Lunches were the gourmet highlight: Skippy peanut butter on white bread, and barbeque-flavored corn chips. When in Antigua – the former capitol of Guatemala, with beautiful Spanish and Baroque architecture, as well as huge stone ruins, leftovers from numerous earthquakes – the first and last nights, we did a bit better with the cuisine. And, during dinner we were serenaded by a Guatemalan band playing Andean music. I’m not sure what happened to the local rhythms – i.e., marimba…
When not busy with medical work, we walked around Quetzaltenango, and shopped for woven goods and other locally-made handicrafts. A good opportunity to practice our hard bargaining skills. We also visited the produce market and tested our knowledge of strange-looking fruits such as güisquil (also known as chayote, related to cucumbers and squash), pacaya (date palm blossoms), and rambutan (related to lychees). On Wednesday night we braved the cold – or should I say the chilly hard cement stadium benches – to attend a local football (i.e., soccer) game. It was exciting, but not because of the players. The audience was much more entertaining, dancing, singing, passing a huge banner above the tops of spectators heads and, most excitingly, setting off Roman candles inside the bleachers. As for who won the game, I can’t tell you…
One evening we visited Doña Pancha’s Chocolate Shop to learn how Guatemalan chocolate is grown and processed. Our hostess – who arrived at her store after we did, greeted us quickly and insisted on running upstairs to change from her western clothes to her traditional garb before giving us her talk – is a fifth generation chocolatier. Her great grandmother’s photo and that of each of the subsequent daughters cover the walls of the shop, and she proudly showed them off as her son and daughter stood grinning by her side. Of course, we got to taste the chocolate, too. First, we sucked down fresh pineapple, banana, strawberries and papaya – the only fresh fruit we got all week – dipped in luscious, liquidy dark chocolate. Then we slurped up chocolate syrup drizzled into strawberry yogurt.
And, chased it all down with cups of hot, sweet cinnamon chocolate. By the time we were done, we didn’t need dinner. Just as well because the hotel meal consisted of mystery meat (less appetizing than meatloaf), fried güisquil and rice, with Jello for dessert.
Enough, if not too much, said. You get the idea of life as a Timmy medical missionary/brigadier in Guatemala. The only thing missing here is to the answer to one last question, maybe the one you’re itching to ask: Would I do it again? Sure thing.