The purpose...(posting from the road)

The annoying trill of multiple cell phone alarms is how my day typically starts - at 0445. That leaves an hour and half for breakfast, dishes and to pack the 3 pick-up trucks with all of our equipment and team of 27 people. An on-time departure means that we should arrive at the mountain top in about an hours time. When I say mountain top, I really mean the literal top of mountian. This guarentees that our morning drive is straight up and our afternoon drive is straight down a rocky, partially washed out "road", many times with a cliff on one side, while bouncing around in the bed of a pick up truck - through pelting rain or searing sun.

This gives us 15 min to descend en mass upon either a church or school and transform it into a clinic that will see 400 patients in 7 hours. Improvisation and brute strength are needed to rapidly form areas for triage, massage, assessment, pharmacy and children's play area (includes balloons, nail painting, puppet shows, gift bags etc) by moving furnitute and stringing ropes all while Guatemalan children play underfoot.

By 0730 "doors" open and the line-up forms of patients ranging in age from 13 days to 90 years. Unlike traige in North America these people are patient - no one complains, yells or pushes. They wait an average of 90 min throught out the day, never uttering a word of discord. The community is screened a few days before our arrival and the 400 chosen to visit us recieve a "ticket". Although only 400 people are technically assessed by the clinic, another 200+ will show up - just to see what's going on. It makes for a VERY crowded workspace (in contrast...Thunder Bay Regional (at least when I was there) would see about 325ish and Harborview Medical Center will see about 150ish in a 24-hour period...granted the acuity is certainly different, but still...we are crazy busy here).

The acutiy for the most part is low...many dermatological conditions (lice, contact dermatitis, scabies,fungal infections), GI upset (the diet here is mainly tortillas and coffee - everyone drinks coffee including the babies) and coughs and colds. We screen for malnutiriton and the really bad children we try and get enrolled in the "Embrace" program (more about that in a different post). The cases that are really sad are the ones that we cannot help, these are generally people that have been waiting for a clinic to come to their mountain for days, months, and in some cases years - all We can do is try and get them transferred to a higher level of care. Some of you may wish to stop reading now...I don't think this will be too graphic but I am going to write some of the more intersting cases that I can remember...

1) 10 month old with severe dehydration - poor thing had a sunken fontanelle, and would not respond to even a light shone in her eyes. The mom stated that she was "sleepy" for a few days now...this story has a happy ending, after a bottle of rehydration salts the baby perked up and was laughing and giggling. The biggest problem that we had with this case was logistical - the suitcase with the rehydration salts fell out during the drive . This means that while this sick baby sat in the church, I had a driver take me 1 hour down the mountain, borrowed some rehydration salts from another clinic and then drove an hour back up the mountian.

2) 19 y.o. man with an "ear infection" - this man had "ear pain" for 7 years! Our clinic was the first chance he had to have access to medical assistance. At this point he has no ear drum on the right and most likely none on the left (too much pus to fully assess). Dr. Tom was worried that he had developed mastoiditis as well. It is difficult to tell without equipment, but he was most likely 'legally deaf' and was mainly hearing from vibrations in the bones. We didn't have the correct antibiotics at our mountain clinc so we gave the poor guy some ibuprofen and some local currency to take a truck taxi (pick up trucks that travel up and down the mountian to shuttle people) to our clinic the next day for a shot of Ceftriaxone. A simple ear infection that resulted in a complete loss of hearing.

3) 22 y.o. female with an undiagnosed seizure disorder - most likely epilepsy based on the information from the family but she now has burns as well after her last seizure caused her to fall into the fire. She will need to travel to Guatemala city for diffinitive help (that is paid for through donations) but was apprehensvie to make the trip to a big city alone. Nancy, one of our organizers, was able to find a local that will volunteer to make this 16 hour day trip so the girl can get her diagnosis and medication.

4) 45 y.o. male with blindness in one eye - what started as most likely a corneal abrasion in one eye was untreated and developed a massive infection. There was nothing we could do at this point for this man...just a sad case.

5) 5 month old with severe spinal bifida - was not a "ticketed" patient but one of our providers who was assessing the sister and noted a lack of movement with this guys right leg. A very happy baby but without intervention will have a very hard time surviving in his location - this is not a handicap friendly zone. It will take some time, but plans are underway to arrange for him to be transferred to Guatemala City for extensive spine surgery.

There really was so much more...it's actually a little depressing to write about so I have to stop. On a positive note, we were able to see close to 1600 patients and in a few instances made real interventions. Our patients were all treated for paracites and given some medications that will make their existance a bit better, at least for a few months.