Saturday, March 19, 2011

Guatemala Medical Mission

Let me start with a common interview scenario. 

Interviewer: "Joe why did you decide to go into the medical field?"
Me: "Well let me tell you, about 8 years ago I had the opportunity to live in Uruguay in South America on a religious mission for 2 years.  While I was there I developed a horrendous sinus infection and was constantly filling my handkerchiefs with a bright glowing green Nickelodeon gak type material that would harden like concrete when it dried up." 
Interviewer: "Wow that is disturbing, and borderline too much information.  How did you get the appropriate medical help for such an infection in an underdeveloped country?"
Me: "I wouldn't call it appropriate, but let me tell you.  Like any naive gringo would do, I asked the natives.  Here are a few of the remedies in which they prescribed:  Make a very potent tea with straight lemons and breathe in the vapors every morning and night.  This was very soothing and calming but did nothing for the infection.  Rub lemon juice over the nose and under the eyes every night before you go to bed.  I will be honest I did not do this because once I rubbed onion juice under my eye and cried for a week.  The last remedy that I tried was obviously not a good idea but I was getting desperate.  Cut a lemon in quarters and squeeze the lemon under the nose while inhaling sharply through your nose."
Interviewer: "He wanted to you 'snort' lemon?"
Me: "Looking back, I probably would have rubbed onion juice directly into my eyes.  It hurt so bad, and it bled just a little bit."

I have to apologize for the eccentric opening to my Guatemalan trip.  The interview actually never took place, but the events discussed within the interview did take place.  Since that event I vowed to someday return to underdeveloped countries to bring Augmentin Extended Release 1000mg tablets, 2 tablets every 12 hours for 10 days for acute bacterial sinusitis.

I have to also give a special thanks to Sarah's parents Eric and Jeanne for staying with Sarah, Rosy, and Rock.  Without them I could have never left my 3 month old Baby Rosy and 2 year old Rock. 
My travel companion. 
This is my good friend Kade Esplin.  We flew out on the same day, slept in the same room the entire 17 days, and flew back on the same day.  But like on a religious mission we still had some boundaries.  "You can sleep in the same room but not in the same bed."  We did follow this little White Bible passage to a capital T.  We started our trip in a extremely nice hotel in Guatemala City, this is where we were lulled in a sense of false security.  Because after that night, say goodbye to your beds that are over 6 feet long, and say hello to Mayan 'Toy Story' beds.  As a side note, I actually slept great without Rockwell waking up at 1 AM asking me to put Dumbo the flying elephant on TV, and me being so tired and confused that I actually did it.  Sleeping without kids is nice, but honestly a little boring.  I think I had tried to yell out Kade's name in Spanish a few times just to make the nights a bit more interesting.  Our next day we went to Antigua and rented a car.  This sounds boring right, well if you gain anything out of this long, frightful, and fun blog, it should be DO NOT RENT A CAR IN GUATEMALA.  It is just a bad idea all round.  But we did.  Twice.  Fool me once, shame on you.  Fool me twice, shame on me.  We then traveled to a small town Quiche and stayed with some of Kade's friends.  Then we drove to the beach and stayed in a nice romantic overpriced beach side inn.  The beaches in Guatemala have black sand, which sounds awesome, but it turns out is extremely hot and a little uncomfortable.  I do love the beach though.  The water temperature was perfect, not too hot, not too cold.  The waves were amazing, and huge, and the undertow was very strong as well.  We later found out the hard way why none of the locals would go out past their knees deep.
Antigua is where the mission was based out of.  I was also pleasantly surprised to see such amazing architecture.  When they asked me what I wanted to be when I grew up in elementary school it was either a cartoonist or an architect, and in high school it was an architectural engineer.  I only sometimes regret the decision to not become an architect.  But I still love to look and see new and old architecture, and Antigua was full of old beautiful buildings. These next pictures are devoted to my love for architecture.

Let me end the architectural pictures with a well liked statue at the park in central Antigua.  This statue illustrates the abundance of breast milk found in Guatemala.  "How old is your kid?"  Talk about a good halftime snack for a pee week soccer game.

Now to the good stuff.  The first week of the Medical Mission we took a bus to a small town an hour or so outside of Antigua.  Half of the group stayed at a convent with the most amazing people ever, and the other half stayed in Antigua.  I stayed in the convent and had the time of my life.  The Sisters and Mother where so loving, caring, patient, good natured, fun, and a little quirky, and I loved it.  They would cook for us, clean after us, and joke around with us.  I was lucky enough to spend my time at the convent in a room full of 7 guys and 1 bathroom.  I'm sure you can do the math and come to the correct assumption... it was a bit malodorous.

Please notice my 'Toy Story' bed at the end, and my feet hanging joyfully off the edge.

Here is where we would try to help the hermanas do all of the many, many, many dishes.  Also, please note that Kade is not standing on a chair.
I love to cook, so naturally when I saw the Sister's cooking I asked if I could help.  Later I think they wished that I didn't, because I am horrible at making tortillas.  My new friend JJ next to me is actually amazing at making tortillas.
This is the Guatemalan version of Dance Dance Revolution, and this little girl was so cute I couldn't help but challenge her to a dance-off. 
This last picture is of the Madre.  She was so nice, she gave me a Rosary and called me Josesito.  I'm not sure why she decided to call one of the biggest guys on the mission 'lil'Joey' but it was endearing.

While we stayed at the convent we set up a clinic in San Andres for days 1-2 and San Martin for days 3-4.  The following week, we stayed at Antigua and on days 1-2 we set up a clinic in San Lorenzo, and we finished up the medical mission near Antigua on days 3-4.  In the following pictures I'll try to explain what we did and some of the impacts that it has had on me.
This is the pharmacy crew, or what others (when I say others I mean we) like to call us "The Dream Team".  Me and Kade are in the back and Jake, Sally, JoAnne, Emilyn, and Stephanie are in the front.  We all had a great time working with each other, and aside from me trying to sneak kids vitamins every chance I got, we got along fine.  We always spent the first part of the morning setting up our make-shift pharmacy.  This was our first day in San Andres and our best set up.  After the first two days at San Andres, our pharmacy moved from the shelves to bags and suitcases and were separated by the class of the medications.
Our pharmacy table with the 'fast movers', pain medications, antibiotics, and GI meds.
Here you can see a common set-up with the med bags.  And yes, that is me rolling up my scrubs in an attempt to start a new mens Capri fashion in San Lorenzo, Guatemala.
Here I am preparing for a beautiful day of triage and counseling... in the smallest chair they could find.
Some of the more fluent Spanish speakers spent time in triage, sorting out the patients and their reasons for being seen.  I say 'fluent' lightly, because although at one time I would have boasted a semi-fluentness in Spanish, it turns out if you do not use it in 8 years, you can actually forget a lot of Spanish.  I was able to pick it up with some time, but that doesn't mean that I didn't make up a few words here and there.  "That lady knew exactly what I was talking about when I said 'constipacion' with a nice Spanish accent." ... It was either how I said it... or how I acted it out. 

While I did triage I came to appreciate my life and truly respect those humble Guatemalans which I talked to.  There was one girl in particular who was eleven, she had slight asthma and some serious dental problems.  I have never had much luck with my teeth and have had my share of root canals, fillings, and tooth extractions.  When I saw the inside of her mouth I almost cried like a baby.  Right before I left for Guatemala I had a tooth that broke, and although it didn't hurt at the time, it was a ticking time-bomb.  I couldn't imagine going on the mission without it fixed, and luckily my sisters, husbands, brothers, friend is an awesome dentist here in Glendale and fixed my tooth before I left.  As I sat there and looked at her teeth, knowing full well the pain and agony that she must be feeling, I felt so helpless.  We did not have dental for the first week, and there was nothing that I could say or do to help her poor teeth.  Some mild to moderate pain medication and dental hygiene tips were the best we could offer.  It's funny that I could not think about going a few weeks with a cracked tooth that didn't even hurt, and this little girl has to live every day in pain with little hope of relief from her cracked and rotted teeth.  It makes it easy to appreciate the ease at which we can get health care, when you see the suffering which others go through because they cannot.  It makes bickering over health care reform plans seem pretty trivial.  Also, although these people make only $100 a month to support their families and have absolutely no access to health care, they are also the happiest people I have ever met.  They are so appreciative of us and even pretend to understand us when we start making up words.   
The Physician's would give us quite a bit of freedom to choose appropriate therapy for patients based on what was available at our make-shift pharmacy.  Many times we would have to consult each other, our PDA's, or the pharmacists working with us.  We were lucky to have Brian, Sally, and Megan as not only great resources but also great seat warmers.  I love how this picture is almost a perfectly candid shot...
An important role of pharmacy students at the clinics was counseling.  We where always the last people the patients saw and interacted with and many times it was important for them to not only be counseled on the medication they are being dispensed but also important lifestyle changes.  Just a quick statistic, we saw between 2500 and 2700 patients in the 8 days which we held clinics.  That is about 325 patients a day and a lot of vitamins, tylenol, and antibiotics...
All they want is a few gummy vitamins then I swear they won't come back... Until tomorrow.  I had a hard time turning the kids down, when I could understand the need.  When I was in elementary school I would sneak 10-20 of those large Vit. C tablets that tasted like Orange candy and looked like Necco's in my pockets to devour at recess.
If only you could see the look on the mothers face as Kade throws her baby up in the air.  Sheer terror. 
Here we are just about to experience some Guatemalan Chinese food.  I have to note, that no one else was brave enough to venture into this wonderful place.  If it weren't for the scraps which they used for chicken, it would have been amazing.  Oh the food.... I haven't talked much about the food yet, but I feel I should mention it now.  I loved the food, it was so good.  Especially when we were at the convent and the Sisters were cooking for us every day.  Here are a few of my favorite things...chocolate pancakes, beans, tortillas, warm oatmeal drink, Atol, fresh squeezed OJ, beans, tortillas, fresh fruit, beer chicken, cooked mustard veggies, noodles, bean loafs, tortillas, homemade tortilla chips, chicken fried squash, carrot soup, spicy squash soup, and chicken soup.  Did I mention tortillas and black beans, because they ate them for every meal and they were delicious. 

Now get ready for some randomness.

By the end of the first week, me and Kade had begun to finish each others thoughts.  One of our joint thoughts were to leave Antigua and catch a chicken bus to Lake Atitlan for the weekend.  Half of the group had left the day before to spend the three day weekend at the Lake.  This turned out to be a great decision... Other than the chicken bus ride to the Lake.  Just imagine the ride Viper at Magic Mountain Six Flags but in a crowded, stinky, and polluted old school bus that was painted fun colors to hide the rust.  Now imagine being on that ride with someone who gets carsick very easily and is sitting right in front of you.  These pictures are when Kade almost made it to the window in time.  He did get the window down which created a pretty strong air current into the bus.  So when Kade puke out of the bus, it just came right back in again all over the last 5 rows of seats, including me and a handful of angry locals.  It took me a while to get all the chunks cleaned out of my hair and sweatshirt.
Rosa and Marta, or our Aunts from the mission.  These beautiful ladies where kind enough to allow us to stay in their extra bedroom in the nice Lakeside Cottage that they rented out for the weekend.  These ladies were volunteers and loved the work, and we loved them.

Sometimes you just never know what's coming.
We went on a nice nature hike at the lake with some good friends from the mission to a waterfall and we also saw some monkeys, and got to go over a bunch of these sweet bridges. 

Dancing in the streets, or just jumping. 

Volcano erupting.   This was neat, but one night we did a Trivia game on top of the roof of a building and we saw the volcano erupt several times, the bright red lava coming out of the top was amazing.  Also, it is a good thing that I decided not to hike to the top of the volcano to camp for a night (which along with zip-lining was the only other thing I really wanted to do), I'm pretty sure that duck-and-cover does not work with real lava.

Teeter totter with JoAnna, just a slight weight advantage.

The Lake

The garden and path along the lake. 

Zip-lining!! So fun and a little scary for someone who is not a huge fan of heights.  It was 1700 ft across and 450 ft tall.

The paradise down by the Lake.
Our new DO friends, Will, Jason, Alex, Brian, and Amy, Jackie, and Sarah thanks for making the trip so fun with plenty of would you rather, scum, tootsie roll, Egyptian Rat Screw, near death experiences, trivia, and a broken down car.  Which brings me to the point of the blog... 
Go on a Guatemalan Medical Mission because it will change your life, but DO NOT rent a car.  They will give you an older one that breaks down and leave you stranded roadside for 4 hours while they decide how they are going to place the blame on you, so you pay for the repairs...But I'm not mad or hurt.  I am so happy I was able to go and have this amazing experience.  We want to go next year, but with Sarah and in a few years with Rocky and Rose as well.