To the victor go the spoils...(posting from the road)

This seems like a funny way to end my time in Guatemala but it was an enjoyable evening and I wanted to record it for posterity.

After a final team dinner and some tearful goodbyes to new and old friends, a few of us returned to our hotel for a nightcap. The size of our team meant that we needed to split into three different hotels. Only four of us were placed in La Merced – not the fortunate four. It was a small hotel that I imagined had a booming hourly business at one point.

So the four of us (Angela, Traci, Leila and myself) were joined by Lisa for a few bottles of wine in the mini courtyard or our place. I cannot recall how the topic of washrooms came up but as we chatted we discovered that we all had very distinctive and difficult facilities in our room. The conversation deteriorated further to a friendly disagreement over which room had the worst of the bunch.
The only way to solve a problem such as this is to grab the bottle of wine and take a tour of the rooms – a drunken comparison was definitely in order. We traipsed up to the third floor to quickly rule Traci’s palatial bathroom out of the equation. I cannot even believe she thought she was a candidate.

Next stop – mine and Leila’s room, and as I still maintain, the WORST of the bunch. To give some credit to the designer, it is certainly makes use of space, every possible inch of space. First off the door is Guatemalan sized, so the average North American has to adjust their posture just to enter the door. But you also must decide what your intention is before you enter the room as turning around inside is not possible without risking an ankle fracture or soaking your feet.

The toilet is wedged into a small alcove so tightly that pre-lubricating your thighs is not a bad idea. Actually stretches before using the toilet isn’t a bad idea either as reaching the paper requires a sort of yoga move to try and grasp a few precious squares. The floor is on two distinct but very camouflaged levels so even when you know it’s there, every person rolls an ankle on the ½ inch division between bathroom floor and shower floor.

The sink is in the shower. Handy if you want to brush your teeth while showering but difficult of you just want to use the sink after someone has showered. Unless you wash while you are sitting on the toilet...it is possible to reach the sink while utilizing the facilities. After a thorough demonstration of the limitations of our commode, we trekked down to Angela’s room for our only true competition.

Same ridiculous small door to enter, and after you have entered you must immediately sit. Your feet will now protrude into the shower area (as delineated by the hidden ledge) – I guess guys would just stand in the shower and face the toilet. After your have completed your business, you must exit the room and locate the sink down and around a corner. Annoying yes, but I still maintain that this is advantageous since you must put your used toilet paper into a basket next to the toilet and if you can avoid brushing your teeth in this environment – all the better.

The wine was completed before the conclusion of the competition but deep down, I know the true victor. Sad that may be the only thing I ever win.

Tuk Tuk our way to glory...(posting from the road)

I know I have mentioned in previous entries from previous trips that Leila likes to Geo-cache. I don’t fully understand the intricacies of it all but it seems like a treasure hunt for grown ups. On this trip, she has a goal to geo-cache in every country, despite the fact that we had successfully found one in Guatemala city (the second search was abandoned when to police showed up) – Antigua had a few promising treasures to find.

My favourite part of the geo-cache experience is that is generally takes you somewhere new and unique that you may not have found trusting guidebooks alone. This was my fourth trip to the quaint touristy town of Antigua and I am fairly church and marketed out by this point. But Leila’s little GPS pointed the way to a new site...a park overlooking the city. The main problem was that it required a hike straight up a mini-mountain in the sweltering sun. The secondary problem was the time – we had a very short amount of it and we still needed to pick up a few souvenirs.

So in the ‘Amazing Race’ spirit that we tend to attack these things with, we flagged down a tuk tuk and offered him a sizeable amount of money to drive us up the back roads to this park and then wait while we scoured for a plastic treasure box. Of course with my mediocre Spanish I am not sure how much of that clearly came across but the point was made and off we zoomed.

Upon reaching the summit, I snapped a few photos while Leila traipsed off into the woods to start the hunt. I joined her a bit later and we successfully located a small canister. Leila filled out the papers and left a toy pig for some reason before we jettisoned off, back down the mountain in our little tuk tuk.

I will have one scoop of Neopolitian please....(posting from the road)

My final clinic days were the best and the worst of our clinic days. The third was back in the town of Jocotan that we visited last year. Here the people have access to the vices that the mountain folk do not have. As one of the clinicians this presents a problem...no longer are we treating the aches and pains of hard work – rather the traditional North American ailments of high blood pressure, depression and type II diabetes. The people are more impatient, demanding and far less thankful. And if that wasn’t enough...the set up is in a church that does not promote airflow. It is a cement building with a tin roof (the same design as the average Guatemalan oven), with pharmacy being banished to the choir loft...absorbing all the extra heat. (I actually did extra clinician time here because they got to sit in front of fans).

The last day was in a teeny village of Poshaba just over the summit of one of the towering mountains in the area. The drive was one of the most stunning I have ever taken in this area. We set up in a school again and able to bring the school a giant bag of supplies – one of the teachers actually shed a tear. (The kids in this school were in the process of making globes out of paper)

All day long, our entire team (split day so there were only about 16 of us here) was treated to handshakes and hugs from all our visitors. We still suffered some disappointing moments – diagnosing permanent blindness in a 9 y.o. boy and telling another lady that she will be blind soon – but even they thanked us for helping. Leila and the children’s team worked frantically to make hundreds of balloon creations for the young and old – balloon hats being the most popular by far. The best balloon of the day however was a gift for me! Leila made me a Poncha balloon!! (Poncha is the spider monkey that lives at the Ministry center – yes, the one that bit me). Utilizing only four balloons, Leila made a monkey on a palm tree. It is absolutely the best balloon animal ever.

The bizarre highlight of this day came while I was talking to someone about her GERD and I stopped listening because I started to hear the ‘ice cream truck’ song. I just assumed that I was finally going crazy when I definitely noted the sound getting louder. I popped outside to see a beat up old jeep pull up, the load speaker blaring ‘ ice cream truck’ song while someone sat in the back of the jeep, scooping out homemade ice cream. When the few customers that stepped up had been satisfied, the truck bumped away up the rocky mountain road. I know this doesn’t sound that unusual...but we were ABSOLUTELY IN THE MIDDLE OF THE NOWHERE in a poor mountain village, in the Guatemalan heat and someone was selling ice cream from a jeep – and more then that – he was playing the ‘ice cream truck’ song. It was so amazingly unusual that I had to state it twice.

It was with a heavy heart that, after listening to a little speech thanking us for coming to their village, I climbed into the back of the pick-up truck and bounced down the mountain. It was nice to be thanked and appreciated, but these people will never truly know how much my time there has meant. It has been a humbling experience that has left me thankful for everything I have, proud to be part of an amazing team and once again, in absolute awe of the Guatemalan people. Their ability to flourish under harsh circumstances, and to do it with a smile and a wave – there is a lesson in there for all of us.

Embrace the day...(posting from the road)

Today was Embrace day again (for an accurate description, read the post entitled “the greatest gift I ever refused” – Guatemala 2011) and a chance for me to 1) meet my sponsor child, Octavila and 2) see Heydi.

My eyes lit up as Heydi entered the grounds and teared up when she gave me a little wave. Her independent spirit and intelligence has not been damped in the year I was away from her. She was playing right away and showed Octavila how to do the kid things that we take for granted like swings, monkey bars and slide. The day progressed similar to last year; playing, crafts, shopping (yes, I gladly overspent), lunch and a trip to the hot springs for a swim.

I had intended to go and visit Heydi’s home again but a shortage of trucks meant this would not be possible as Heydi lives on a different mountain than the rest. I explained this to her mother at the end of the day and gave them some money to take a truck taxi home instead of walking the 3 hours, but the hard part came when I had to tell Heydi. She looked up at me and asked if I could come to her house again and I had to tell her ‘no’. It was one of the most heartbreaking moments I can recall.

The plan was to visit Octavila’s home in La Mina instead, as there was a truck heading that way. Leila and I, and 25 other people climbed into the back of the pick-up truck and started the longest, most painful ride up a mountain. No picture will ever do justice the absolute awkwardness of that ride. The gringos inability to balance with minimal support lead to a tremendous amount of inappropriate touching/grabbing to avoid falling on the Guatemalan children who had somehow managed to fall asleep on the bed of the truck. At one point poor Leila had a Guatemalan woman sitting on her feet, holding a sleeping baby, nestling her head into Leila’s pubic area while Leila inadvertently smothered another woman behind her who had become lodged between her and Steve. No one died on that ride; in fact I think someone may have actually been born in the back of that truck.

It took 1.5 hours by truck to reach the drop off point (we did have to stop for about 10 min when the truck over-heated) for Octavila and her family. Leila and I were going to run over for a visit and then have the truck pick us up on the way back down the mountain. This plan was abandoned when we discovered that their home was still another 60 min by foot.

We were able to see the home of another Embrace child, Deyri, who lives in La Puenta – VERY far up the mountain. She had the photo frame we made at last year’s Embrace day hanging in a plastic bag, tacked to the exterior wall of their mud shack. The nice thing about La Puenta is that people are genuinely happy to see you, they don’t ask for candy or money, just a wave.

Embrace day makes me truly happy and sad – I laughed and cried a lot I played in a giant game of catch with 12 other people and everyone was all smiles and laughing – no need for translation. Getting to spoil the kids and giving them a day off from being a Guatemalan mountain child is truly an amazing experience - I just wish it could be more.

This time the kidnapping charges would have been justified...(posting from the road)

I won’t bore you with the mundane details that comprise our clinic days. It was similar to any previous clinic day, a mixture of humour and horror. Here is a bit about a couple of my most memorable patients.

Case 1
A 24 year old female sat down in front of me holding a baby wrapped in a towel – not unusual. She complained of the usual symptoms of GERD and bone pain. She had also had registration write and additional problem on the form – “convulsions”. With the assistance of the interpreter we were able to decipher that she has full body convulsions when the moon is full. They generally last two days in duration. As we don’t stock anti-psychotics in the make shift pharmacy, I suggested that she attempt to visit one of the free clinics in town. We asked if the baby needed to be seen and were told “no, she is fine”. Both David and I became concerned at this point that we hadn’t seen the baby move too much and just wanted to have a look. So under the guise of admiring the cute baby we peeled back the towel and found a horrifically emaciated baby.

This was the most malnutrioned baby I have ever seen. She was two months old and every single one of her ribs was visible. There was absolutely no muscle tone anywhere on her body. I, who have never gravitated towards babies, have never wanted to snatch a baby and run so much in my life. I held that baby for a bit while we attempted to make arrangements to get mom and baby to a clinic down the mountain later that week where she would qualify to receive some formula milk to help supplement breast milk in order to gain weight. But this plan would require follow up...I have no doubt she will be there on Thursday, as we have arranged for a driver and I have spoken to the clinic, but I worry about the future. In order to bring a baby back from the brink like this, extensive commitment would be needed from the mother – the mother that thinks the full moons give her convulsions. So while I sat there that, this teeny little baby gazing up at me, I knew in my heart of hearts that she would die soon. Maybe not this week, but given her lot in life (6th most malnourished country in the world, mountain home, crazy mom)...she would not be long for this world.

Case #2
The tragic smell of Harborview (or B hallway for any TBRHSC folks reading this) wafted across my nose just after I finished devouring my peanut butter sandwich. I slowly turned, wondering if this was all just a dream and I was going to need to call for 4-point restraints in a minute, when in stumbled an inebriated man in a cowboy hat asking for suture removal.

Normally a rather simple procedure requiring no medication...in this case however...it was a good thing he “self medicated” prior to arrival. I asked how long the sutures had been in – “15 days”. “15 days” is the standard answer, kind of like the “I just had two beers”. My guess, those would have been at least a month.

So in lieu of any sort of additional sedation, we gave this inebriated man a lollipop to suck on while Lisa and I started to dig the sutures out of his clearly infected skin. He moaned once about dolor (pain), so we gave him a fresh lollipop and all was well. It took some time but after the sutures were finally removed, and a lesson on how drunk machete use was never a good idea, our patient stumbled out the door and on his way. (Tragically the smell made me miss a lot of you...)
The rest of the day was filled with parasite ridden children and aches and pains associated with carrying water and wood. It was a super busy morning thus allowing our afternoon to pass fast and us time to get back to our home base in time to assemble water filtration systems that had recently been purchased out of donations. These relatively simple containers will be given to families who do not have access to fresh water, a method to be able to remove parasites, bacteria, dirt etc – and fresh water has the ability to fix more health problems than anything our clinic will be able to do.

For a great video on how “Water changes everything”, please visit this website...
http://www.charitywater.org/whywater/

Prada Prada...(posting from the road)

It wasn’t until the second day that we realized a box of medications was missing...this box contained the majority of the ibuprofen and antacid medication – two of our ‘best sellers’. Having clinic without these two medications would be akin to a Pollo Campero running out of chicken.
Luckily as this is Central America, they tend to be a little loose with the regulations surrounding any sort of medications, Gary, the world’s best pharmacist and I decided to split from the group while on an excursion to the outskirts of Chiquimoula and rectify this situation. (This was a huge step for me as I swore after my brush with the law in this town that I would never set foot there again...)

So the plan was, we would hop into a taxi and dart over the La Pharacia, pick up the meds and then meet the rest of the group at a local shopping mall. As with the best laid plans, it fell apart early...first off there are now actual taxis in this town. This town has adapted a strict decrepit old minivan with no door transportation system, one that until this point in time I had developed the ability to avoid. But with time a wasting we quickly opted for adventure and tried to ascertain which truck was headed our way – turns out they all were and thus the first fight broke out.

Gary and I seemed to be some sort of prized fare and a fist fight broke out between two drivers while someone else rapidly escorted us to the front of a van and sped off, bumping the van parked ahead of us in a frantic effort to get out. The van operated much like taxis in Montana – everyone states their destination and the van simply drives there – taking everyone else along for the ride.

As we were speeding through the streets of Chiquimoula, randomly dropping off passengers, we saw the most entertaining store ejection. First a giant stream of water got our eye as it shot out of a doorway, dousing an elderly gentleman on the sidewalk causing him to slip in the now newly formed puddle of water. As the old man tried to get up, his cowboy boots kept slipping causing him to slide around as if he was dancing really badly. It took about a minute for him to get fully erect before another dousing of water shot out of the storefront. And the dancing process was repeated.

All traffic in all directions had now stopped to watch this spectacle. The dancing man had now decided to try and enter the shop again while performing a series of high kicks in an attempt to assault the shopowner (it was here that a clearly recognized the signs of the belligerent drunk). The whole scene was briefly out of sight before the man and the shopowner tumbled out into the street, fists flying!

The showowner had at least 100 lbs and 30 years on the drunk ‘dancer’ – it was hardly a fair fight. So, without thinking I started yelling at whole mess to stop while chivalrous Texan Gary was about to hop out of the car and intervene. Our driver could this was on his mind as well, and before the great gringo intervention, he sped away clearly upset that he had ‘won’ the prized fair.

After no less than 5 more stops, we arrived at the pharmacy. Our poor Spanish was apparently inadequate – as was charades (seriously – how to you act out gastric reflux?) as our pharmacy tech handed us a telephone with a semi-English speaker at the other end. This was an improvement but soon the conversation proved frustrating to all and the man on the other end of the phone decided to just join us on site.
This was a fantastic improvement to our communication and in short time we were dashing out of there, with all the PPI’s and nausea meds they stocked. We headed back to the center square – taxi central – and figured that we could secure a ride in seconds.

What greeted our eyes were 50+ minivan taxis, none signed and in no apparent order. Walking around to random vans and showing them a photo of the mall we were supposed to meet at was unsuccessful so , as time ticked away, we decided to just walk the streets and yell the name of our destination. We remembered it started with a P-R-A. So I yelled “Prada” up and down the street and Gary yelled “Pradaxil” – eventually somebody figured it out , picked us up and took us to ‘Pradara’. I am still not sure if it was a taxi or just a guy with a van who was tired of hearing us yell, either way the ride was still a quarter.

Gracious for reading!

‘Stop being poor’...(posting from the road)

Today was a very frustrating day. It was day one of our clinics. For those unfamiliar with the clinics I speak of...a team of about 35 people ascend up a mountain to a remote mountain village, take-over a school or church and in 30 short minutes set up a full clinic that will see 400 patients a day. Traditionally I am part of the pharmacy team...and I still am a little on this trip. My preplanning and clinic day step up is pharmacy but during the day, due to an unexpected shortage of physicians, I am serving in the role of a clinician.

Pharmacy is a role that is more hands off I now realize, we see patients and talk to patients and hear their stories but in a different way than the clinicians do. Now I have to see patients -

listen to their problems and then order them something from our limited pharmacy. They sit across from me and look for an answer to their ailments and sadly the only thing I can think of is to say “stop being poor”.

It’s awful, listening to their issues and realizing that so many of them would never exist if they were simply born somewhere else. There was a family that all had colds because they don’t have blankets for night. One man had been experiencing urinary retention and hydronephrosis for 8 years after an accident – it was too expensive for the surgery but he is saving up...1,000 Quetzales or $125 USD. (Imagine having a painfully full bladder for 8 years) I had the chance to diagnosis congestive heart failure on my own using entirely archaic measures (fingers crossed that I am correct). Many people had GERD/heartburn after a diet exclusively of tortillas and coffee but some people’s abdominal pain actually resolved with food – it wasn’t a stomach-ache they had – it was hunger.

There were the usual aches and pains from carrying firewood and water hundreds of miles a month – what do you tell them? Or the family who must be living in some horrible conditions as several of the children had infected insect bites where some type of fly laid eggs. Then there is the telltale ‘pregnant’ bellies of the children that are full or parasites who are in so much pain the simply don’t eat. People come with such hope – it is hard to crush that...I had to tell a man that there was nothing we could do to fix his failing hearing or vision, he was simply getting old. This was especially frustrating for him as he was responsible for carrying all the wood for his family – he’s 80.

I don’t ever tend to get emotional about patients at home...in fact is has been a point of criticism from previous coworkers in the past. I rarely remember a patients name after I step away from their bed and rarely ever recall the reason that brought them to the hospital in the first place.

Well today I didn’t make it through the first patient before tearing up. Jessica is 3 yrs old

– she ranks in the severely malnourished category for 2 reasons. First her little body is parasite ridden and thus not interested in eating. And secondly, the family simple cannot afford food. On average Jessica will eat a tortilla a day and drink a little coffee. Mom said, occasionally they find eggs from some of the wild chickens so she gets a bit of protein a month. We are attempting to get Jessica enrolled in a special program (Embrace – more on that later) that allows people to sponsor Jessica to get her out of the severely malnourished category. At first her mother declines the offer but when we press for a reason and she self consciously replies that it is simply because they cannot get to the enrolment meeting in Camotan (where we are staying). It is at least an hour drive by truck and there is simply no way Jessica can walk that far. Realizing that this is the only hurdle we simply give them the fare to and from their village ($3.20 USD). That’s right – 1 latte was the only difference between this girl getting food and potentially dying. See why I started to tear up? If she shows is anyone’s guess.

On my 60 min bone crushing, organ squishing drive straight down the mountain from Hierba Buena, I reflected back upon my day, frustrated that I really seemed to do little to help but more thankful than ever to be Canadian.

Good to be 'home'...posting from the road

I am Canadian, a fact I share on almost an hourly basis with just about anyone who will listen. But I have called the United States of America home for the past few years, and despite their unhealthy love of deadly weapons and the Kardashians, it hasn't been a bad ride. The country that I have visited the most, outside of Canada and the US is now officially Guatemala.

Stepping off the plane today into the humid chaos felt oddly satisfying. As our driver barrelled through the streets, death seemingly chasing us down - it seemed right. I am here this time with my friend Leila (from the Africa trip) and as it was her first trip to my third homeland, I felt a sense of duty when it came to showing some true Guatemala. So we went to Pollo Campero.

Those unfamiliar with the place maybe the lucky ones. This is latin America KFC except with butter customer service. The chicken is piping hot and oozing artery clogging grease. As Leila is a fellow zoo-fanatic, we enjoyed our delicious specialty at the Guatemala city zoo. (Getting the zoo is not easy...zoo apparently is a different word in Spanish - I had to resort to drawing a picture of a giraffe and elephant on a piece of paper. I am just glad the driver figured out what I meant by that, I would hate to have had to charade it out!)

I, being a self professed zoo snob was pleasantly surpirsed at this place. Granted there was a definate lack of "you are here" maps and an almost schizoprenic organization to the place but the animals all appeared healthy and had roomy enclosures. Ironically the best show of the day was two large Canadian grizzly bears who got into an all out brawl.


There is also a large collection of house-sized wild cats and birds (house seperately of course) at this zoo. All and all a fairly uneventful day...apologies for the general boring nature of this post - quite fatigued and tomorrow promises to be a busy day. Just writing a bit as we will be away from internet for about a week or so - but made it safe and sound, crawling into bed now!

Buenos noches!
(p.s. top photo is the view from our hotel room)