Traveling up from Guatemala to San Antonio, TX

Hey crew,

Sorry for the recent lack of updates. Due to my schedule of working full-time in the hospital, and preparing heavily for the upcoming DELE exam (spanish fluency exam), my chances to update recently have been few. However, I plan to retrospectively touch on all my experiences in the coming weeks/months. 

I have finished my volunteering at Hospitalito Atitlan and am currently working on preparing for the DELE (Diplomas de Español como Lengua Extranjera). The level that I am preparing for is C1, which is the 2nd to highest level and would basically qualify me as fluent in conversation, but more on this later. 

At the same time I have been working on paper with colleagues back home on Integrated Medication Management through incorporation of pharmacists into interdisciplinary primary care teams, specifically in low-resource setting (in simpler terms – including pharmacists in medical teams to reduce the number of medication related problems in patients that need it most). Our group applied to run a workshop on this topic at the STFM (Society of Teachers in Family Medicine) 2014 Conference and got accepted! YAY! The conference is in San Antonio, TX and flights were much cheaper out of Mexico City than Guatemala City, and given that the two are fairly close to each other I thought I’d maka a trip out of it and run over to Mexico City to fly out of the country from there instead and save a few hundred bucks. However, nothing is as easy as it seems in Central America! 

I was lucky enough to have a travel buddy, the lovely Amber Coffman to come along for the experience.

Mexico has this funny system where if you spend more than 7 days in country you have to pay a fee to exit, so we wanted to make sure that didnt happen. My flight out to San Antonio, TX was May 3, so we decided to leave Guatemala and head to Mexico City on Aptil 27th. This isn’t my first time heading to the border and each time is a different experience. The first city we decided to visit on the way was San Cristobal de Las Casas. Due to my visa requiring me to leave the country every 3 months, this isn’t my first visit to San Cristobal. My good friend Diego runs a lovely hotel there called Los Altos and everytime I visit he makes me feel right at home. The trip was approximately 9 hours by bus to San Cristobal from Quetzaltenango, Guatemala. We were lucky and only spent around half an hour at the border without any issues. We got settled into the hotel and went off to explore the city. This colonial city is one of the most beautiful that I have visited in Mexico, with its beautiful old churches, cobblestone walkways,  and multiple carless streets filled with restaurants and shops. 

San Cristobal de Las Casas at night

San Cristobal de Las Casas

Me and amber outside one of the famous churches of San Cristobal de Las Casas

Steps to Iglesia de Guadalupe in San Cristobal

View from Iglesia de Guadalupe in San Cristobal

The next day we headed off to see El  canon del Sumidero, which is a spectacular river flowing through extremely steep canyones reaching heights of 1km on either side. The weather was incredible and the sights even more breath-taking. ALong the way we were able to see various formations formed during various seasons by waterfalls and other natural wonders.

Diego, owner of Los Altos hotel

Alligator sighting during the boat ride

Winding through the Canyon

Aligator during the boat ride

This formation is called the Christmas tree and is formed during the rainy season from small waterfalls

Small cathedral formed in one of the caves

Los Canones

Canyon

Beach with vultures

Visiting Tuxtla, MX

City center in Tuxtla, MX

Me and amber on the boat

Pretty views from the boat

That night we decided to take a night bus to Puerto Escondido, MX to spend a couple days on the coast before finally heading off to our final destination of Mexico City. Here is where the fun begins. The bus ride is approximately 13 hours long. Our bust left at 7:15PM with plans to arrive at 8:20AM the following morning. At around 130AM the bus stops, without any news of why we weren’t moving ahead (having traveled through Mexico many times before by bus, I wasn’t too worried as short stops were common). However, at 6AM we were still in the same spot. I wake up Amber and let her know that we haven’t moved in approximately 5 hours. We aren’t too worried yet. At about 7AM the driver makes an announcement that the neighboring town is protesting against the government and has decided to target transportation. They aren’t letting any vehicles through on either side. The worst part is that there is no mention of an end time, they say these protests may last up to 3 days. GREAT.. we might have to spend our entire time on this bus, in the middle of the Mexican dessert, without any food and little water. An hour later the bus driver makes another announcement: If you don’t have much luggage, you can attempt to cross the protest by walking and we will have a bus from our company waiting on the other side to take you to your destination. Awesome! While our luggage was fairly heavy, they were backpacks and walking was definitely feasible. However, after 30 minutes of walking we got to the other side, there was no bus in sight and it was slowly getting much hotter. The line of trucks and cars seemed never-ending on the other side and I was starting to get a serious headache from the heat and lack of water. Finally, after 2 hours of walking, the bus appeared. I have never been so happy to see a bus in my life. We all hopped aboard and we were on our way! The bus dropped us off at the nearest city to transfer to another bus while it went back to collect more passengers. We transferred busses smoothly and headed off on our way (we have currently been traveling for about 16 hours and were well past our scheduled arrival time in Puerto Escondido). It gets better. About an hour into our bus ride, the bus breaks down!! What?! Many people on the bus at this point are fed up, and call taxis, willing to pay $200-$300 for a taxi ride all the way to the coast (which is still 7-8 hours away from where we are). Given my poor financial situation, we decided to wait it out. After about an hour, the bus was repaired, but only enough to take us BACK to the previous bus stop to transfer again. Oh well, we were too tired to really be upset. We went back to the last town and transferred buses again. Finally at around 10pm that evening, approximately 30 hours after we left San Cristobal we arrived in Puerto Escondido, MX got to our hostel and fell right asleep, exhausted. 

Finally getting on a bus after a grueling 30 hours of travel

Road block that we crossed by foot

The beauty and tranquility of Puerto always calm me and brighten my day. If you remember from my earlier posts, this is the site where I spent a month working in rural clinics and setting up a midwife training program with 9 other Northwestern medical students. I have a very strong relationship with the doctor that works with the program, Dra. Sauceda and everytime I come back I love seeing her and being updated on new things happening with the program. It was also nice to see Sol, my previous spanish teacher. Overall, the beach was incredible and a great relief from the bus trip the previous day.

After 30 hours of traveling this

Sunset in Puerto Escondido

Beach in puerto Escondido, Mexico

Sleeping outside in Puerto Escondido.. it was too hot in our room

Treating ourselves to fresh fish in Puerto Escondido, MX

After two days, relaxing (with a little bit of spanish DELE studying thrown in), we took a 30 minute flight to Mexico City Friday morning. We only had one day in Mexico City so we decided to visit the Zocalo, or city square and Palacio de Bellas Artes, which is the most important cultural center in Mexico, a beauitiful building made completely out of marble, inside and out. In the evening,  I was able to meet up with some friends that I worked with during a 1st year medical rotation back in 2010 which was really nice as well:)

Finally made it to our hotel in Mexico City after 7 days of moving

Metropolitan Cathedral in Mexico City

Inside the Metropolitan Cathedral

Inside the Metropolitan Cathedral

Palacio de Bellas Artes

Metropolitan Tabernacle, attached to the Metropolitan Cathetdral

Standing in the Middle of the central square (Zocalo)

Now, I am writing to you safely from my airbnb stay in San Antonio, TX. Overall, the trip was interesting and exhausting. Thinking back,on it, maybe buying a ticket out from Mexico City wasn’t the greatest idea but it was an adventure that I definitely will never forget and I am so thankful to have had my friend Amber there to experience it with me!

I wanted to share this experience, and in my next posts look for more about my previous experiences in Santiago, Atitlan!! Till next time

Team OB/GYN

Hey everyone! I really wanted to use this post to focus on a time that I spent with two wonderful Ob/Gyns from the US. Hospitalito Atitlan works with many volunteer physicians and residents from the US and other countries and a couple weeks ago, Dr. Michelson from Texas and Dr. Lebo from California dedicated a week of their time to working at the hospital. In general, Hospitalito Atitlan asks for volunteer physicians to devote at least two weeks, but because the need for obstetrical care is so high in the region, they make an exception for gynecologists. During their time here, the gynecologists were on call 24/7 in case of emergency c-sections or other gynecologic emergencies and then also see patients for consults during the day.

With Dr. Lebo and Dr. Michelson

Me with Dr. Lebo and Dr. Michelson

It was very interesting to see them work in a low resource setting. After the first couple days, they quickly adjusted the way they handled visits to accomodate needs. For example, when ordering labs, they tried to order ones that were only absolutely necessary and that would help make a diagnosis and less labs to rule out diagnosis. They tried to clump laboratories together where they could to save costs on patients having to return multiple times for different laboratories. Also, while in the US you would have seperate technicians for ultrasounds, the gynecologists became the ultrasound experts of the hospital and performed many during their week there, and were called on for ultrasound questions by the other physicians as well.

It was also interesting watching them in the operating room. I only observed one procedure, but I learned there are extra challenges that you need to consider when working in a developing country such as working with slightly different instruments, language barriers, trying to make due with limited surgical supplies, and little backup in case of emergencies.

Dr. Lebo and Dr. Michelson working together on a case:

Dr. Lebo and Dr. Michelson performing a tubal ligation

Dr. Lebo and Dr. Michelson

One of the really neat things that the hospital does every month is go out to smaller communities for “club de embarazadas” or pregnancy clubs. They reach two different communities every month, Cerro de Oro and Chacaya, and members of the pregnancy club get free prenatal visits and referrals to the hospital for ultrasounds (which are free if referred from the pregnancy club). In addition to prenatal visits, they receive a lecture in the beginning of the visit on a topic related to pregnancy or womens health. They spoke about pre-eclampsia and pre-natal care during the sessions that I participated in.

I went out with a different gynecologist to the two different sites throughout the week. In a half day we saw approximately 20 patients in each site and I really strengthened my prenatal visit skills. Unfortunately, there is no laboratory at the clinic, which means we weren’t able to do prenatal labs. We referred each patient to get prenatal labs at either Hospitalito or the public hospital (2 hours away). Unfortunately, in this case, much of the responsibilty in this case was put on the patient and those that could afford the trip went, while there were others that were very far along in their pregnancy and still had not gone to get their prenatal labs, mostly for financial reasons. We are very lucky in the US that as physicians, we don’t worry about costs. We do everything we can for the patient and then they either get a bill weeks later or insurance gets the bill and we never even see the costs. Unfortunately, here this is not the case. While most services at the public hospitals are completely free, elective services and those at private hospitals have a cost. The cost seems like pennies compared to the US (for example, its about $150 for a delivery at a private hospital), for a population that makes an average of $3-5 a day, it’s extremely significant. Even for free services, patients at times aren’t able to receive them because of the cost of the bus ride to the closest public hospital. With this in mind, it puts you in a completely different mind frame when treating the patient and doing only what is ABSOLUTELY necessary for their care to not raise their costs.

Below are photos from our visit to rural towns, Cerro de Oro and Chacaya:

Cerro de Oro, one of the smaller villages we visisted

View on the way to Cerro de Oro

At Cerro de Oro, being welcomed by the health post

At cerro de Oro with the daughter of one of the mothers in the pregnancy club

The clinic at Cerro de Oro. Patients waiting to be seen by the gynecologist

The pregnancy club awaiting their presentation

Pregnancy club women participating in the activity

At the health post at Cerro de Oro

With Cirulina, the translator at Cerro de Oro. She helped translate from Tzutujil to Spanish

At the beach at Cerro de Oro with Dr. Michelson

At the beach of Cerro de Oro with Dr. Michelson

The health post at Chacaya

Educating the pregnancy club patients on prenatal care

Me and Dr. Lebo resting in between patients with a snack of tamales

The clinic room that was used in the Chacaya clinic

Finally, Dr. Lebo’s daughter is part of an organization that makes dresses out of pillow cases to donate internationally. She brought down many dresses to donate to the children that came to the pregnancy club and throughout the town. Below are photos of the dresses that we gave out that week to children.

One of the local children in the homemade drenes brought by Dr. Lebo

Dr. Lebo dressing one of the children in dresses she brought from home made from pillow cases

Working with these women was truly a phenomenal experience. They made me feel so comfortable and really let me participate to learn different things. Thanks for the opportunity and hopefully I see you guys soon!

Till Next time 🙂

Surgery Jornada in Hospitalito Atitlan

Things are going well here in Santiago, Atitlan and I am getting used to living here and working at the hospital. I wanted to focus this blog on one of the best experiences that I have had at Santiago so far. During my 2nd week here I had the incredible opportunity to work with a surgical team from various hospitals around Minnesota. Each year, a team led by Dr. Kevin Bjork come to Hospitalito Atitlan to offer up their volunteer services for the week. The team included approximately 40 people including 2 general surgeons, an ob/gyn, a urologist, anesthesiologists, nurses, physicians assistant, translators, technicians, EMTs, undergraduate students, and more. While I spent most of the week with the surgical teams, the rest of the team performed a number of other services ranging from installing solar panels (which will save the hospital approximately $20,000 a year), to sewing curtains and planting a medicinal plant garden.

New solar panels installed

The medicinal garden built that week

The week started out on a Sunday. The community had advertised about the coming Jornada (in english this translates roughly to event) and patients came from Santiago and villages all over the lake. The lines were out the door. The team saw and evaluated approximately 120 patients on Sunday and scheduled approximately 60 surgeries for the next 5 days. These numbers are incredible given the circumstances. There are 4 surgeons that were evaluating the patients, making it an average of 30 patients per surgeon to do a history, physical examination, and evaluation for surgery. Many of these patients had little to no previously health information available. Making things even more difficult, many patients did not even speak spanish but the local Mayan dialect, Tzutzujil. While some members of the team had spanish knowledge, a lot of translating was needed and with only one translator that was able to translate from tzutzujil to english, in many cases double translating was needed from tzutzujil to spanish to English. My main role this day was helping with the translations The day was exciting, and the surgical team was ready for their full roster of surgeries.

Waiting room on day 1

What I witnessed the following week was nothing short of amazing. When working in a developing country, you are definitely expected to run into some snags and unexpected events, but the way the team dealt with these issues made me proud to be helping them. Below are some of the highlights of this week.

1. The first night there was a question by overnight guatemalan team about one of the patients, and while they were able to get someone in from the surgical team, there were issues with translating. After that night, they made sure that there was someone that would stay all night at the hospital form the surgical team, along with a translator. Physicians Assistant, Chris Kane, stayed overnight almost nightly without hesitation, with translator and nursing student, Katie.

2. I had never witnessed a team that had such a high level of care for their patients. Taking time away from their careers, away from their families, working for free this week, they put the needs of the patients before theirs. Members of the team were getting dehydrated from staying in the operating rooms for hours, surgery after surgery, giving up valuable sleep, sleeping in the hospital, and taking the time to explain all the details to every patient.

Chris, Physician Assistant, rehydrating after many consecutive long shifts

In the locker room, resting in between patients

3. This is was the first time the Jornada had brought a Urologist, Dr. Brad Qualey, making his patient load extremely large. Dr. Brad is one of a kind, with the kind of personality that melts your heart. He did an incredible job but as to be expected ran into some issues. Many of the procedures performed were TURPS (trans-urethral resection of the prostate) for which he used a newer technology called a green light laser, which is ideal for this setting because it decreases recovery time and post-op bleeding. However, on more than one occasion, the machine over-heating. The technician worked overtime to keep it running and working throughout the week. In order to have good visualization during the procedure, there needs to be a pressurized flow of saline solution through the equipment. While in the US, it would be pressurized automatically here there was no such equipment, which meant that someone needed to use all their strength to hand squeeze saline through the equipment (this involved rotating people every 10 minutes or so during the procedure). Pictures below of the Urologist, Dr. Brad Qualey and working with him.

Me and Jenna with Dr. Qualey

Dr. Brad Qualey

Getting ready for a TURP procedure with fancy protective eyewear

Dr. Qualey, performing a TURP

Green light laser machine used for TURPS, that was generously donated to Hospitality

Me and Jenna,

4. The hospital is not equipped with a blood bank. This did not pose a huge problem as many of the procederes performed had minimal blood lose, but there were a couple open procedures that necessitated that they work quick with no mistakes.

5.For the first time ever, I saw a surgeon cry, faced with the difficult decision to remove a large thigh mass and worried that the procedure might not be safe given there was no imaging to show whether the mass had invaded into any important vasculature (they ultimately decided to remove the mass completely and safely :))

6. While many of the patients had happy endings, as we all know it medicine, bad news is inevitable as well. I remember having to translate to a patient that their bladder mass looked unmistakeably like an advancing cancer that had little chance of cure, or translating to another patient that had waited 2 and half years to get a procedure done that the proper equipment was not available to safely perform the procedure and he would have to wait till next year. The surgeons did all they could with what they had, but as situations go, even in the US, not everything turns out the way you want it to.

7. It was exciting to scrub into surgeries again since my 3rd year surgery rotation. I saw and participated in a range of different procederes including hernia repairs with Dr. Kevin Bjork and Dr. Dawn Stapleton, prostatectomies with Dr. Brad Qualey, and tubal ligations with Dr. John McGuiness.

Me, helping suture

Me, helping suture

Overall, it was an exhausting, but thrilling experience. I saw a side of surgeons that I rarely saw during my surgery rotation. Even to this day, even though the team is back home to their regular careers and families, they call into the hospital for updates on patients that they treated.

On the final day that the team was in Santiago, they invited me and Jenna to take a boat ride across the lake and out to lunch. It was a perfect way to end the long week.

the view of the lake from the boat

The whole team, celebrating a long week

On the boat during the last day

Me with Barbara, nurse

This week was definitely one of the most memorable weeks that I’ve had here. One of the most wonderful feelings was watching patients, that had waiting so long to get procedures that were once out of reach, treated. A big THANK YOU to Dr. Kevin Bjork’s team for all that you do for the people of Santiago every year. Hopefully next year I can be available to come and see the work you do once again

More pictures of my experience below!!:

one patient that is looking at a mass the surgical team removed from his chest – so precious!!
Photocredit: Jenna berger

Me and Jenna with student, Reed

Me and Jenna with Dr. McGuiness

Operating room

me and Jenna in the operating room

Chris and student, Aaron

Jenna became one of the patients as she got a small cyst removed

me and Jenna, with members of the team

Me and jenna with fellow students

Me and one of the students, Tim

Operating room, ready for a patient

Chris, Physician Assitant with his daughter

Dr. Stapleton and Dr. Bjork discussing cases

Post-operative recovery room

Jacinto, local scrub tech, hand washing laproscopic equipment

thigh mass removed

Specimen of large gallstones removed after removing the gallbladder

finger amputation

Mass removed from a breast

Gallbladder after being removed

Till next time!

Week 1 in Santiago Atitlan, Guatemala and working in Hospitalito Atitlan

Hey everyone,

While this marks the third week since I have moved to Santiago, this post will focus on my first week here. Santiago is a very small town situated on Lake Atitlan opposite of the largest lake city, Panajachel. It is incredibly beautiful and has, in my opinion some of the best views of the lake. Below you can see a map of the lake and its surrounding towns and photos of gorgeous Santiago.

Map of the towns around the lake

Beautiful Santiago Atitlan

Sunrise over Santiago

Beautiful Santiago Atitlan

Beautiful Santiago Atitlan

I moved into a 2nd floor apartment owned by a family that lives on the lower floor. The father of the family works as an electrician and does a lot of work at the hospital as well. He lives with his wife and daughter. I am mostly independent but see the family from time to time. You can see my apartment below.

My bedroom!!

Living space in my apt

Kitchen in my apartment

I am starting a 4-month period of working at the nearby Hospitalito Atitlan. Hospitalito Atitlan serves the Santiago population of 50,000 people and nearby towns as well. It is a private non-profit hospital and provides preventative, clinical, and obstetric services. It is also the only 24/7 Emergency Room in a two hour radius. The hospital was re-built in 2007 after it was originally destroyed by the mudslides following tropical storm Stan in 2003. The hospital is funded through donations through donors, volunteers, medical missions, etc. Below are some photos of the hospital today

Hospitalito Atitlan

Entrance to the hospital

Mission Statement

Sign for outpatient consulte

During my first week at the hospital, the first day I started with an Orientation given by Jenna Berger. She is working as a Princeton in Latin America fellow in the Development Office of the hospital. The hospital has approximately 6 general practicioners, 1 gynecologist, and 1 pediatrician. There are 4 clinic rooms (2 for general medicine consults, 1 for gynecology and 1 for pediatrics). The hospital is equiped with 30 inpatient beds as well as 2 operating rooms. During my first week I was mostly on outpatient consults. I spent one days doing general consults, one day doing pediatric consults and one day on call (24 hour shift).

Dr. Toc and Dr. Pedro (Pediatrician) discussing a patient

Examination room

Where the patient charts are picked up

What I found very interesting was the diversity of patients we saw. We saw patients from wealthy families, and patients from the poorest of Santiago, and all were given treatment. However, since the hospital is private, there is a charge for the services, which poses a problem for the poorer population. There is an amazing social worker that works at the hospital and is able to sort out who is able to pay and who isn’t so the hospital provides a lot of free care. We also saw a large variaty of ailments, from prenatal care visits, to diarrhea, pneumonia, croup, skin infections, molar pregnancies, respiratory infections, and even bladder cancer. This week I was really trying to get my bearings at the hospital, figure out their paper system, how to fill out all the different forms, learn where everything is located and proper use of all the resources. It was overwhelming at first but by this point I am starting to feel more comfortable. Below are more photos of the hospital

Me with Jenna, Princeton in Latin America Fellow

Hospital Library

Hospital library

Cookind dinner with nurse Herson while on call – beans!

Empty Emergency room at night

X-ray of patient in ED – can you spot the pneumonia?

Hospitalito Atitlan, main hallway

Waiting room at the end of a clinic day

Scrub sets

on-call room

Ultrasound room

And more photos of the beautiful lake:

Volcano San Pedro!

View of one of the restaurants across the lake

Amazing view of Lake Atitlan from Panajachel

Until next time!

My time in Celas Maya Spanish School

Hey All!

Sorry I haven’t written in a while. Things have been pretty hectic. I have recently moved to Santiago, Atitlan. My blog over the next couple months will be talking about my experiences in Santiago, with a mix of my previous experiences in Xela since due to my hectic schedule in Xela I wasn’t able to touch on all my experiences. I hope to be blogging much more during the coming months. This blog will focus on my spanish school and classes that I took over the last four months.

I took classes at Celas Maya, which is one of the many spanish schools in the city of Xela. The reason I chose Celas Maya specifically is because it has teachers that are specifically trained to teach towards the DELE exam, which stands for Diploma de Expanol como Lengua Extranjera (Diploma of Spanish as a Foreign Language), and is equivalent to a spanish fluency exam. There are various levels at which one can take the exam and at the end of May I will be taking the C1 or 2nd to highest level which would put me at fluent in the Spanish language. I started taking classes at Celas Maya 4 months ago, and depending on my schedule I took between 15-20 hours a week of classes in the afternoon after finishing morning clinic.

The classes are 1 on 1 and you have the option to change teachers as often as you like. I had the amazing privledge of having a local teacher by the name of Gladys Perez. We quickly became good friends and she continued to be my teacher for the entire 16 weeks that I was in Xela. During my time with her, in addition to learning grammer and vocabulary, we took many trips around the city. Each week we substituted part of one class with a cooking class in which she taught me to cook various Guatemalan meals. We quickly became good friends and even hung out outside of class. She invited to come with her to church, to events such as her sons birthday, and to the Independence day fair. Below are photos from our times together

Me with my spanish teacher, Gladys

Me with Gladys

Me with Gladys

Me with Gladys in the school garden

Two of my favorite people, Gladys and another staff member, Juventino

Me and Gladys studying

Gladys and her son

With Gladys and her family celebrating her sons birthday

At Gladys’s son’s birthday

Gladys’s son blowing out his birthday candles

Gladys showing me how to keep the flames going on the barbeque

At Gladys’s home getting ready for a barbeque

Cooking plantains during our first cooking class 🙂

Another cooking class, we baked cake and im trying the batter!

This may look gross, but its actually DELICIOUS, liver.

One of my favorite meals Gladys taught me, El salvadorean pupusas

Another one of the meals we cooked up. Fried bass with salad and tortillas

After a day trip to the market, Gladys gave me tips on bargaining.. All this was bought for approximately $5

Apart from spanish classes the school offers many afternoon activities. Activities include cooking classes, movies, hiking trips, visits to local villages, visits to hot springs, etc. Unfortunately due my schedule I was rarely able to participate in activities with the school, as I worked in the clinic in the mornings and took spanish classes in the afternoon during the activity times (most students at the school actually take classes in the morning). 

During the first day of the week, the school goes through their calendar of events for the week

Apart from my spanish teacher, the rest of the staff at Celas Maya is just as charming. I loved walking into the school everyday and laughing and joking with the workers in the cafe and the office. Many of the workers/teachers at the school became like a second family away from home. I also had the opportunity to meet my roomate that I had in Xela through my spanish school. He is a spanish teacher and became one of my closest friends in Xela.

Me and my roomate during my Graduation

Me and my roomate, who also teaches at Celas Maya

Last week was my last week taking one on one classes with Celas Maya until May, when I come back for 3 weeks of classes before taking the DELE exam. The school has a graduation for students after they finish their classes. I am proud to say that over 16 weeks I completed 252 hours of Spanish class. Over the next four months during my time at Santiago Atitlan, Guatemala I will continue with spanish classes, but only 5 hours a week online as my hospital schedule is 50-60 hours a week and doesn’t allow for much more. I miss all my friends at Celas Maya Spanish school and in Xela, but I am excited to start my new adventure in Santiago! More pictures below from my time at Celas Maya. If interested in more information about the spanish school their web address is: http://www.celasmaya.edu.gt

 

My graduation certificate from Celas Maya! – 252 hours!

Thanksgiving dinner at the Spanish school

With Kevin, one of the tour guides and spanish teachers at the school

With some of my favorites, Gladys, Arturo, and Juventino

Fixing a Broken System

Hey there followers!

My deepest apologies for not writing for the past couple months. I have been completely immersed in my work at Primeros Pasos Clinic. Now would be a great time to let you in on the work I have been doing. When first arriving at the clinic 3 and a half months ago, I was eager to find some way to give back in a productive way. When speaking with the volunteer coordinator, she mentioned that the clinic could benefit from a implementing an electronic medical record system and that the clinic was wired to add a system, but they were lacking the actual computers. Simple solution right? Just get computer donations and BAM! new system in place. Working with another medical student, Sarah Harmon, we began analyzing the paper system that they had in place and discovered that there were some major holes. In order to properly implement an electronic system, you need a paper system that works. It looks like we had a lot more work than we initially suspected This is how the system they had in place worked:

There is a large excel spreadsheet that they use to record each patient visit. Each time a new patient comes in they get a new line in the spread sheet that includes name, age, phone number, community, type of visit, charges, diagnosis, treatment. They make a new folder for new patients with the last name, first name and the folder goes into the filing cabinets at the end of the day. The files are seperated by children and adults. The age line between child and adult is not very clear (somewhere between 12-14). You can start to see where there are problems:

1. Since the clinic is mostly run by Guatemalan medical students doing rotations ever 2 months, every week there is a new person working in registration. Each person may have their own idea on inputing spellings of names, etc. So files inevitably get lost. For example, I have seen the last name Estacuy spelled Yztacuy, Ixtacuy, Extazuy, etc which means that it could either be filed under the letter Y, I, or E

2. Age is a changing variable so organizing files by age inevitably doesnt work. If someone comes in and they are classified as an adult, but their last visit was as a child, you will never find their file in the adults, and make a duplicated file.

3. Organizing files alphabetically is not as easy as it sounds. The first step of reorganizing the system was re-alphabetizing it and we found it to actually be extremely difficult. Also as soon as you put one folder back in the wrong place, it turns into a spiral of placing things around that folder incorrectly and the whole alphabetization gets ruines (which is exactly what we found).

As you may expect, in a system with around 4,500 patients we found about 1,000 duplicated files. Incredibly, as soon as they were removed there was much more room in the file cabinets for inclusion of new patients, etc.

Here are the changes to the medical record system we made in the past 3 months:

1. Something that didnt exist before, we made an electronic register of all the patients in the clinic using excel. Each patient was given a unique patient number, so now they were organized in the file cabinets by number instead of name. The register includes only identifying information: Last name, first name, phone number, birth date, community. This way when a patient that already had a patient file came to the clinic, they could be found in the register using multiple identifying points and then found in the file cabinets quickly by their number

2. Relabeling all the files with their new unique identifying number, and organizing them in the file cabinets by number.

3. We cleaned up the file cabinets: removed approximately 1,000 duplicated files, put in new file folders for the ones falling apart, put in new labels, etc.

4. We also designed a new excel sheet for recording each visit that includes drop down menús for communities, diagnosis, etc so that they can be easily sorted for potentially analyzing data in the future.

We began using the new system this previous week and after fixing a few glitches it seems to be running smoothly. We were able to find the files of all pre-existing patients using their identifying information.

Before finishing this post, I want to recognize the other people that worked on this Project. Sarah Harman, a 4th year medical student from Virginia and Kate Eccles, an economics student from Australia helped with designing the new system, doing research on implementing systems in underserved countries, buying supplies, etc. Elaine Lydick, from Washington DC, Tanja, from the Netherlands, And Markéta Gregorovičová, from the Czech Republic, Sandra and Cynthia (two of the Guatemalan medical students) helped with relabeling all the old patient files. This was really a team project and would not be able to be accomplished without the mentioned individuals.

Given all this, there is still a lot of work to do. With a working paper system, we can start to think about implementing an electronic system. The first steps have already been taken. Working with Sara and Kate, we applied for the Clinton Initiave Grant in hopes of using funds to get computers and a sustainable electronic system that would benefit the clinic. Below are pictures of the project during its different processes.

So many diles

Kate and Sara, starting to look through the files initialy

Files as they are gettng reorganized

Sandra, Guatemalan medical student reorganizing patient diles

Me working with Sandra, guatemalan Medical students re-organizing diles

Re-labeling the file cabinets

Final file cabinets, relabeled

Instruction sheets for the new system

The file folders, re-organized by numbers and re-labeled

 

 

Till next time!!

Living in Quetzaltenango, Guatemala

This marks the beginning of my seventh week in Quetzaltenango, Guatemala. I’ve really started to love it here and feel very connected with the local community. I wanted to focus this post on living here and new things that I have noticed.

First, a little bit about the Quetzaltenango. It is called Xela for short by the majority of the population. The name Xela comes from the Kiche name for the city which is “Xe laju’ noj” which translates into “under ten mountains”. Xela is surrounded by mountains which is where the name comes from. The city is quite large with a population of 224,703. I currently live in the heart of the city near central park (shown below).

The city is composed of 13 zones. I currently live in Zone 1. For my first 5 weeks here in Xela, I stayed with a host family, The Ixcot’s. Below is a picture of me with my host family. Living with a host familiy is an incredible experience that I think most people should experience. It’s truly the best way to get to know the local culture, food, and practices. In addition, it’s a great way to improve your Spanish. I had my own room in my host families house and was provided 3 delicious meals a day (maybe too delicious, as I definitely put on a few pounds). My family was mormon and were strong members of the local morman church. They spent many nights telling me of their beliefs and I am thankful for the opportunity to learn about a new religion. IN addition, two times a week they hosted missionaries for lunch so I was able to meet missionaries form all over the world and hear of their stories. After a while I felt like a member of the family. In the mornings I would go jogging with my host father. I went with them to birthday parties, baptisms, etc. The only issue I had with my family is that I lived fairly far from the school and I missed cooking my own meals.

After 5 weeks, I decided to move out. Currently I am renting an apartment with one of the Spanish teachers at my school. He continues to challenge me at improving my Spanish and correcting me. This is my second week living in my new apartment and I absolutely love it. It’s a block from my Spanish school and a block from the central park. I go to the market and buy fresh fruits and vegetables and am able to cook for myself. I plan on staying here till the end of December, when I will be changing the hospital at which I am volunteering at.

Something else that is extremely, EXTREMELY common in Xela, are fleas. There are fleas everywhere, including households. After my 3^rd week I noticed bites on my ankles, across my entire stomach, arms, etc.  I would wake up in the middle of the night itching from fleas. This is most likely my own fault as  at times I like to play with the stray dogs in the streets. Below are some pictures form my experience. The clinic that I work at was able to give me some calamine lotion to clear the bites and I proceeded to spray everything I owned with anti-flea spray. Currently I think I have been successful at getting rid of fleas as I have had no bites in the past 2 weeks. YES!

Another lifestyle difference that I have noticed, is parasites. The majority of children that come into our clinic will test positive for parasites. This is mostly due to poor hygiene and improper disinfection of food. If you eat food from the streets, there is a good chance you may end up with the nasty bugs in your belly. Sure enough, after my 3^rd week here I began having stomach pains and diarrhea. After a quick exam in the clinic, sure enough, I was diagnosed with intestinal parasites (entamoeba Hystolytica).  Luckily, after a week of anti-parasitics I was back to normal. From now on, I try to be careful when eating at the market and disinfecting all my fruits and vegetables. Since moving into my new apartment, I have been cooking for myself more and more. I love the markets here, where you can find fresh fruits and vegetables and am careful to disinfect everything.

cooking chicken in my apartment

All these fruits for $5 at the market

Another thing I have noticied is that this city loves to have fairs! Maybe it’s because I am here during holiday time, but it seems like every weekend they are celebrating a holiday, or religions figure, etc. This is just a small look into my life here. Below are pictures of the the beauty of Guatemala! I Love it here!

Lake Atitlan, Guatemala

Lake Atitlan, Guatemala

Hiking

View from hike

Slides at baúl

view from baúl

Theater

Bus I take to work everyday

View from Baul

Month 1 in Primeros Pasos Clinic!

Current clinic team!

So I have officially completed my first month in the clinic!! Its been a pretty steep learning curve but I am finally getting the hang of how things work in the clinic and am able to be an effective member of the team. Before I go into my experience more,a little bit about the health care system here in Guatemala:

In comparison to what I have seen in Mexico, the healthcare system in Guatemala is much less developed. While they have a universal system, up to 40% of the population has no access to care. The system is divided into 3 sectors: Public, private non-profit and private for-profit. The public sector is run by Minesterio de Salud Publica y Asistencia Social (MSPAS) which provides health care services through facilities ranging from primary care service to tertiary hospitals. Services are free of charge at these facilities.

The Private non-profit sector is monitored but not under direct control of MSPAS. The Integrated Health Care System (SIAS) contracts with private providers to provide healthcare in remote rural areas that have no access to health facilities. Each private provider is services approximately 10,000 residents. Next there is IGSS (Guatemalan Social Security Institute) which covers government employees that pay into the system. Finally, the private for-profit sector, which is largely unavailable to the general population because of its high costs.

The clinic that I am working at in completely funded by donations, but does receive informational pamphlets and contraceptives from the Ministry of Health. We have one physician and 6 local medical students. I am currently one of two foreign medical student working at the clinic. The medical students here have much more responsibility that those in the US. They run clinic rooms on their own, prescribe medications, and deliver educational plans. I have heard from other students that have visited the public run institutions and many of them have only one medical student as the “doctor”. It’s phenomenal the amount of responsibility placed on students. During my first week I was completely overwhelmed. In the US, I had never written a prescription or seen patients without the oversight of a physician. By the 4th week I was starting to feel more confident in my abilities to see patients on my own with a fellow Guatemalan medical student, but also felt secure that there was a doctor in the room next door in case I had any questions.

The 5th week of my time here was probably the steepest learning curve for me. The clinic got a whole new group of Guatemalan medical students and the doctor wanted me to help train them in how the clinic worked. Even though I had spent the last four months at the clinic, I was still struggling in writing proper notes in spanish and other basic things. However, I was surprised at how much I had learned that month and was able to teach other other medical students. I am excited to keep learning!!

One of the major things that I have noticed in the clinic is the lack of a really strong method of data collection. Each patient that is seen has a folder, and the folders are kept in large file cabinets. The sheets that the histories are written on are very simple and include history, physical, diagnosis, and treatment. If files are misplaced, a new folder is made without any reference to previous notes. I have had a significant amount of patients that I thought were “new patients” but that just had their folder misplaced which makes it harder for quality longitudinal care. In addition, lake of a sufficient system of data collection makes doing any sort of research almost impossible. A few years back the clinic had a volunteer that had set up a network so that the clinic was wired for an electronic system, but there was one problem: They were not able to afford computers! I have made it one of my goals during my time here, along with another foreign medical student from UVA to try to get refurbished computers from the US to this health clinic. That is definitely the first step to improving data collection, and a result being able to get sufficient data for research projects that can improve patient outcomes in the clinic.

Finally, during my time at the clinic I was able to spend one day with the education program, but more on that in another entry. Also, super interesting, one week we had a group form the US from Engineers Without Borders come visit the clinic in hopes of one day setting up a water sanitation system! Hope this was interesting! Pictures below of more of my time in the clinic! Till next time!!

Local volunteer painting a new sign outside the clinic

Celebrating birthdays for the month of September

Engineers without borders

Engineers without borders

Every Friday, a local medical student brings liquid nitrogen to freeze warts. Shown here is Guatemalan Medical Student Ceci freezing warts

patient with warts

patient with warts

patient with warts

Primeros Pasos Clinic

 

San Andres, Xecul

While a lot of the focus of my blog is on my medically related experiences, I thought I would make this blog entry more of a cultural read and talk about a visit to a nearby pueblo called San Andres Xecul. In addition to clinical duties in the morning I spend the afternoons in Spanish classes increasing my level of Spanish. During my class this Monday, we decided to visit San Andres Xecul. It is a sweet little town approximately 20 minutes outside of Xela, where I live. It was originally named just Xecul, which in the local Kiche language means “below hills”. Xe means “debajo de or below” and Cul means “cerros or hills”. It was later also given the name San Andres in order to honor the apostle Andres. The town is best known for its Church, seen below.

It is considered one of the most beautiful and extraordinary churches in Guatemala because of its brightly colored exterior. The date the church was constructed is unknown but thought to be around 1900. It was reconstructed in 1999. Each color and pictures seen above has a specific meaning. The different colors specify different crops, such as corn and other fruits and vegetables, the red specifying blood of workers in the fields. Each side also has a judge, signifying that only God can judge you. In the bottom left is San Andres and the bottom right is the Virgen Guadalupe.

There are a number of traditions in the community as well. Every November there is a large ceremony to celebrate the harvest. 13 men are specially chosen, with each man representing one month of the Mayan calendar. One month before the celebration, all the men move into a house together. They spend the month praying and preparing for the celebration. During this time they are not allowed to bathe or see their wives or girlfriends. It is said that if they see their wives or girlfriends, it will bring bad luck to the harvest. On Nov 22, begins the celebration. The 13 men come to the city center and perform a traditional dance. Two men climb up the 100 ft pole shown below, tie themselves to a rope and then jump off spinning to the ground.

Details on the church represent this ceremony. For example, these two jaguars are holding the bottom of the pole for the dancing ceremony to better protect the dancers. Also the figures along the top of the frame of the church represent spectators watching over the dancers. They are at the same level of the pole as where the dancers jump off. Below are more pictures of the church from the outside

We were able to enter the church, but no photography was allowed inside. The inside is just as beautiful as the outside, filled with images of Jesus during various periods of his life and afterlife.

Our trip continued with a stop at the cemetery shown below. Like most cemeteries in Guatemala, the graves are above ground and filled with colors, flowers, and decorations to honor those inside.

The final stop on our trip was to visit the sanctuary of San Simon. Simon is a saint celebrated by the Maya people in some areas of Guatemala. There is a shrine located in San Andres Xecul and another in Zunil, Guatemala. He is moved to a different house each year and visitors can come by and offer money, cigars, liquor, chocolates, etc in exchange for good health, good crops, and other favors that they wish for. He is not what one would consider a traditional saint in Christianity, but a sinful one. He is offered these gifts in an attempt to not anger him and in hope that he will grant their wishes. His shrine is shown below.

As you can see he is completely dressed with a cigar in his mouth and sunglasses, surrounded by a liquor bottle. Sometimes there is a hole where his mouth is so that he can be given liquor by worshipers. The caretakers of the shrine dress him every morning and place him at the shrine. Every evening he is undressed and placed in his bed shown below. Many times the bed and room of San simon is nicer and in better condition than the beds of the caretakers.

In addition, to the shrine there is a wall of pictures of people that asked for various things, one of which was being able to move to the United States and their wishes were granted. The pictures are here to remind worshipers that San Simon is true to his word and grants many wishes.

This concluded our trip to San Andres Xecul. While this post is different than my medically directed ones, I definitely wanted to include it because of how interesting the visit was. My blog in general will be a nice mix of medical and cultural posts. Till next time!

Primeros Pasos Clinic!!

Hey Everyone!

Today marks two weeks in Guatemala! I’m starting to get into the swing of things and how things work here so I thought this would be a great time to make a post introducing the clinic that I am working at. But first, a breakdown of my daily schedule. Until mid December I will be in Quetzaltenango, Guatemala. Quetzaltenango is called Xela by the majority of the country. It is the 2nd largest city in Guatemala and filled with a rich histoty and culture, but more on that later as I want to focus this blog on the clinic. Primeros pasos is a small clinic located about 15 minutes outside of downtown Xela in the valley of Palajunoj.  While there are other small clinics in the region, it is the only source of comprehensive and affordable local health care in the area. I spend 5 days a week working in the clinic from 8am-1pm. Here is a pictures of the clinic below:

Primeros Pasos Clinic

Re-painting the sign outside the clinic.

Outside the clinic

The clinic was started in 2002 by a group of Guatemalan and foreign doctors and medical students. It had previously been an abandoned mission clinic and was then revitalized into the clinic it is today. While the clinic was originally started as a children’s clinic it now also serves women and men as well. The patient population continues to be approximately 80% children, with the rest of the 20% mostly women and some men. In addition to clinic rooms, the clinic is equipped with a pharmacy and laboratory. While the clinic does receive some basic medications and educational material from the government, the clinic is almost completely run and funded by grass roots fundraising efforts by the volunteers through the efforts of the Developmental Coordinator. For example, last week the clinic put on a fundraising event at a local restaurant and part of the proceeds went to the clinic from the purchase of food and beverages. Below are some more pictures from inside the clinic including the lab and pharmacy

Reception desk

Pharmacy

Clinic room

 

Lab Technician, Irma Mazariesgos and foreign student, Alex working in the lab

Laboratory

Hallway of the clinic

The clinic is overseen by a clinical director, Maria Elena Xuruc. There is a one main doctor at the clinic, Dra Gabriela Alonza, an amazing women that makes the majority of the clinical decisions. There are 4 clinic rooms in total. One clinic room is run by the doctor working alone, and the other 3 rooms are run by a pair of medical students, usually one from the local Guatemalan medical school, San Carlos and a foreign medical student. Apart from me there are two other foreign medical students, one from Switzerland, Sarah and another from England, David. David’s last day was last Thursday so now me and Sarah are the only foreign students in the clinic. The teams in each room are responsible for seeing each patients, performing a physical exam, making a diagnosis, and writing the correct prescription. Patient cases and plans are confirmed with the doctor for correctness.

Guatemalan medical students Ale and Cecilia

Guatemalan medical students Dine, Cecilia, and Ale

Me with David

Foreign medical students David and Sarah with Guatemalan medical student, Beghli

Hallway of the clinic

In addition to general consults, pharmaceutical and lab services, the clinic participates in a number of projects in the community. For one, they are the only dental provider in the region, with a dentist that volunteers his time and services twice a week.

Also, there is a Children’s health education program, Run by directors Lucia Alvarado and Margarita Perez, which has two programs to service the local 10 primary schools and nearly 3,000 children.  The first is health field trips where small classes from the local schools come to the clinic and get medical and dental check-ups, and participate in local education activities on basic hygiene and nutrition. One of the biggest health issues in the region is malnutrition in children and parasites so these educational programs aim to improve both children’s nutrition and hygiene. In addition, this program also travels to the schools and gives workshops and lectures on age-appropriate themes. Fellow NU undergraduate student Elizabeth Larsen (seen below) has spent the last 6 weeks working  and collecting data on the nutrition program to measure its effectiveness. Unfortunately, the educational program that brings students to the clinic has finished for the year and will begin again in January of next year, so I will not be able to participate but the outreach programs will continue throughout the year.

Fellow NU student Elizabeth Larson with Guatemalan med-student Cecilia

 

Next, there is a Women’s health education program, run by Miriam Lopez , where women from the valley are able to come to the clinic and participate in a year long curriculum working to educate women on topics such as hygiene, nutrition, first aid, family planning, menopause, contraceptives, and breast cancer. So far I have not been able to participate in this program but I hope to during my time here.

Next, there are mobile clinics that reach out to distant clinics in the Valley that are unable to reach the clinic. Primeros pasos uses the main clinic as a base and each year go out to the distant communities with a team of medical professionals and health educators to provide care, vaccines, and health education. The clinic also has a scholarship program for bright students with financial needs in the Valley. The above is just an overview of the programs the clinic has available. As I delve more into working at the clinic, I will continue to talk about the programs.

During my first week at the clinic, I worked with the main doctor in a clinic room to get an idea of how things were run. The second week I was paired with a Guatemalan med student, Roberto. The amount of responsibility the med students are given is impressive. They are pretty much able to consult, examine, write notes, prescribe as needed with very little confirmation from the main doctor. I am still in the phase of gathering my bearings and figuring out how notes and prescriptions, etc work here. Next week I will be working with another Guatemalan medical student, Beghli. That should be enough for now, but I hope in my upcoming posts to update you on how things work in the clinic compared to the US and more on the Guatemalan health system. Stay tuned!

Below are some more pictures from the clinic:

Playing with kids as they wait for their mother to finish her dental visit

Found baby chicks outside the clinic!

David playing with baby chicks outside the clinic

More views outside the clinic

Cow outside the clinic

Laboratory

Lab Technician, Irma Mazariesgos and foreign student, Alex working in the lab

Me with Guatemalan medical student, Dina

Celebrating Dra’s birthday at the clinic

 

 

 

 

Related articles

• Guatemalan Children: Problems with Parasites (outrageandinspire.org)