A Jornada with it's Own Pace

Today’s activities were and were not what I was expecting. Christine and I were sent to do eye screenings with two trained health promoters in a rural area about 45 minutes outside of San Benito. I really didn’t know what to expect, but imagined a large gathering of people in some of kind school gym or open space forming lines for us to quickly check their vision (near and far), aid with glasses, and maybe hand out some minor medications or make a referral. The latter part of this idea was correct as far as the medical service, but the pace of the day was almost the opposite.

After taking public transport to the area with both tuk-tuks and a van-bus, we reached the building used for health prevention. It was locked upon arrival so a lady helped us to open it and set up our things outside of the building. I didn’t ask why we weren’t setting up inside of the facilities. Maybe it was for publicity? Anyway, there was absolutely nothing to the healthcare room; in fact, it may have scored negative points on the healthcare scale considering it was dirty. The location and set-up didn’t seem too unusual, but I was caught by surprise that after we set up, we sat down and waited. There was continually one or two people at our station at a time, but never a noteworthy line or rush. We moved very slowly too. The eye exam was a well-working assembly line with Michel and myself screening and filling out the patients' eye cards and Christine and Luis helping with the correction lenses, fundoscopic exams, and referrals. As functional as our assembly line was, we took things so slowly. I wondered if we went faster, maybe the continual stream would continue, but stream faster; I don’t actually think that this would have been case. At the end of the morning and afternoon, we had seen around a total of 35 patients. All in all, I was happy to have screened the persons that presented, worked with the health promoters and learn more about their jobs, see a new area, and experience my first jornada with Christine.

More on the pace: The slow paced nature of the event was interesting. I suppose I was expecting something busier because I was considering what it would be like if an area in the U.S. didn’t have health care available. If we only had eye screenings on-hand two or three times a year in a U.S. city, wouldn’t there be a mass number of people going to the event? I feel like it would even be a bit competitive if they recognized that there were only a certain number of glasses and some were more expensive or more trendy than others. But in this little area in Guatemala, there was no rush for such care… even though it was free! I don’t truly know why this was. I am sure it was for many reasons. For instance, the weather was mild so most of the men were out practicing agricultural since it is the main profession of the community, the kids were in school at another nearby community (perhaps?), and maybe the women were disinterested or there was medical gender inequality preventing sought care (even more of an uneducated guess). It may also be that most of the people in the village had excellent eye sight, but I hesitate with this since the women cook over open fires and there was a large proportion of elderly people in the area. Maybe the screening did not reach the public well? Maybe eye care isn’t a priority of the people in that particular area of the Peten? Perhaps the pace was culturally consistent with what I had seen in the other areas and city? People didn’t seem to rush anywhere in particular while in these areas. Sure, residents had tasks to do and people to see, but their approach to time was distinctly different than the stereotypical American approach. For example, an American family would go to the grocery store on a weekend day to purchase food for the week. They would preconceive what events were taking place later in the week for scheduling purposes, if they would be having guests, if they had a lot of time to cook or a full week with other events. Of course, money allows one to purchase the food, cook the food efficiently, keep the food as leftovers, and so on, but I don’t think that a tradational Guatemalan family would do this. From what I had experienced, when it is lunch time, the woman of the house would walk to the store when people were getting hungry. She would then purchase lunch and bring it back. Perhaps she would pay heed to collecting things for dinner as well, but maybe not. It seems like the Guatemalan culture is more oriented toward the present and what is going on at this time with less regard for future plans and commitments. When you think about the American family planning for a week’s worth of food and compare it to a culture that is set in the present, the American clan seems almost neurotic.

At the end of this stream-of-conscious and inconclusive reflection, I don’t know why there weren’t more people present to be seen at the jornada. Besides confounding factors, I suspect it has something to do with the fact that my expectations were grounded in American culture and I think that Guatemalan culture is distinctly different. All the same, I consider my experience to be great and I am happy to have helped.

Meeting with Susana

Right away I knew I would like Susana because we shared the same name…just kidding. But actually, I was very much looking forward to not just working with Susana, but hearing everything that she had to offer. I knew it would be an emotional and educational landmark in my life. I felt it in my gut. I may be being a bit dramatic right now, but she honestly shared so much with us. Just thinking back on our morning and afternoon with her in Las Cruces, I get excited to continue to set forth about things in antipciation of living and working in Latin America.

Susana was so impressive. She graduated from USC in California with a major in biology and moved to Guatemala with her husband thirty years ago. Her spouse is actually in Chi Chi Castenango doing medical volunteer work as well. After moving about for a few years, even jumping from community to community in the forests during the Guatemalan war, she eventually established a clinic in a rural area called Las Cruces. The clinic was open several days a week in the morning to early afternoon to serve patients from near and far as they presented. It was not unusual to see trauma, deliveries, dramatic parasitic infections, and so on. While Christine, Dr. Novak, and I were in clinic that morning, one patient in particular stood out to me. A mother brought in her 2-year-old child who had Erb’s Palsey, some kind of hypersensitivity to bug bites, malaria, and was malnourished. This was the first patient that I saw while in the clinic, and I honestly didn’t feel like I needed to see anyone else to understand the degree to which Susana was helping the indiviauls in the area. Clearly, there was need and clearly, Susana was doing what she could do (and had been doing for the last thirty years) to aid the sick and suffering.

So, perhaps it is interesting to consider that I was struck by Susana’s character, strength, and temperament more than the by the medicine being provided. Sure, I may have been more moved by the patients if we had been in the clinic longer or I had the language ability to grasp personal expression rather than the simple medical interview, but wow, Susana’s presence was unusual. What was it about her that I have such a reaction to? I think she embodies and is the person whom I have read about. She is the Paul Farmer who opened a clinic in the middle of Haiti to provide whatever health care she could. She is the Amartya Sen who encourages and actually trains health promoters to exponentially increase medical care availability and sustainability. She is the Rigoberta Menchu would jumped from indiginious community to community during the Guatemalan war to offer her medical skills in the midst of an incredibly dangerous and physically and emotionally trying state. She is the Archbishop Romero who speaks on behalf of the Catholic Church to those who ask about the state of the impoverished and what the government is doing (or not doing) to help ease the suffering. What more, she is American! Needless to say, it was an incredible experience to meet such a mild-paced and strong individual.

Rotavirus and Bazar

After working for several mornings in the Clínico Médico Pedriátrica with Dr. Flavia Rojas, I feel as if my clinical skills in regards to working with children have greatly approved. I have learned so much watching him interview and exam, and then doing it myself. It is neat to use the newly learned viruses and parasites and their appropriate meds during clinic hours. I am beginning to understand that what we memorize on paper (i.e. the high prevalence of RSV in children) actually plays out with patients! Nice to know we are learning for future practice. Not only do I feel like I am using Stritch material taught in class, but I definitely am taking in a lot of new information too. I think the biggest thing that I am gaining is opportunity to do the physical exam on children that Dr. Flavia teaches. I am impressed that it can reveal so much about the child’s health. I consider this a great benefit to treating the little ones since there is no conversation that can take place to describe the pain characteristics, the scale, onset, duration, and so on. Although I have had limited to no experience working with kids in the U.S., I believe it is rare to see the signs of dehydration and malnutrition in so many of our little patients back in Chicago and so I want to use this time to really pick up on clinical exam skills.

Yesterday, a woman brought in a 2 year old to be examined by Dr. Flavia. We did a physical exam, sent for a serum test, and found the baby positive for rotavirus. We treated the baby accordingly, but I was unaware of the implications of this diagnosis.

After the two left, Dr. Flavia expressed his concerns that extended beyond the visit from the woman and the baby. He explained that the woman worked at a non-profit facility called Bazar, sponsored by Christian and Spanish rotaries. Bazar houses children and adolescents for a variety of reasons. For example, many of the children are orphans; while some of the kids are there because their parents are drug addicts and some because their parents couldn’t financially afford to care for them (which is a relative concept). Many of the children at Bazar are in poor health or are at high risk for poor health. Although the facilities provided for the children to the best of their abilities (really to their financial ability), most of the house was seriously malnourished, which leads to weak immunity against infections and sickness and growth retardation. Additionally, many of the kids have psychological disorders because of in-utero drug abuse, previously being in violent households, receiving little emotional and physical attention, and so on. Because of these factors, and the fact that 20-some children and young adults lived together, the community was at very high risk for serious infection if rotavirus was present in even one child.

I was struck by the implications of one case of rotavirus in a little one and the dangers that it carried for the rest of the house. Dr. Flavia ended up cancelling clinic for the next day. We went to Bazar and did well-child checkups on twenty-sum children. It was a remarkable experience to have patient after patient in this manner.

A quick note on two of the patients there: I met a 14-year-old girl who had lived in the house since she was two years old. The girl was pregnant. It was emotionally difficult to imagine the baby and young mom living in such an unstable environment with little options for their situation to improve. Another young girl around the age of 13 presented Dr. Flavia and I with a baby less than a year old (8 months?). The baby had a severe Tinea infection with some open sores all over his body. The mom reported the baby have diarrhea very frequently. The young mother didn’t know her HIV status. We made a referral to the capital for the baby to get HIV testing done as soon as the fourteen year old could take her baby to an appointment. Who knows how long it will take…