Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, April 24, 2007
    Guatemala - I

    Got back yesterday from a ten-day medical mission to Guatemala. My hospital has joined with an organization called HELPS International to run an annual trip there to provide medical care. This is the first year I've gone, and it was an amazing experience; I'm posting the highlights.

    Saturday April 14

    We arrive early at LAX so that we can coordinate the checking of the supply bags with each passenger (each of us is allowed to check only one piece of luggage; the second is the supply bag). In the departure lounge we sit around and chat. Those who have been on previous trips, especially the O.R. nurses, swap stories. Apparently some patients are kept in the hospital recovery area up to five days postoperatively. Somehow I had assumed all surgeries would be same-day, but this is not the case; the surgeons do hysterectomies, plastic surgeries, gallbladders and hernia repairs. The medical missions originally focused on surgical care, which makes sense as it's a quick way to improve people's lives, but internal medicine is a relatively recent addition. I ask C., one of my partners who's also going on the trip, what people did last year to relax after work. "We went back to the barracks and went to sleep," she replies dryly. Okay.

    One of the dentists, hereafter to be known as Larry the Crazy Dentist, has been on several trips in the past. "You'll see birth defects you've never seen before," he enthuses. "This one guy a few years ago came in. He'd been living as a recluse. So the surgeons all looked at him and they all said, 'We want to take off an ear.' So three surgeons each took off an ear, because the guy had five ears!"

    I stare at him; he does not appear to be pulling my leg. (Ten days later, I'm still not sure.) "What's in the water there that the guy had five ears?" I ask. He shrugs.

    The flight is long but enlivened by a spectacular thunderstorm between Dallas-Fort Worth and Guatemala City. At this point it is nightfall and the plane skirts the storm to the west. This means that on our side of the plane it is pitch dark with nearly continuous flashes of lightning, as if some demented homeowner had let his Christmas light display veer out of control. Looking out the other side of the plane we see the remnants of a sunset, utterly peaceful with no storm activity at all. I like my side of the plane better.

    We arrive in Guatemala City and are bused to the Marriott. We go directly to the lounge for orientation with Megan, who's been working with HELPS for years. Her crowd-control skills are excellent; with this crew they'd have to be. The standout rules of orientation are as follows:

    • "Don't open your mouth in the shower. Don't sing in the shower. Don't use the water from the tap to brush your teeth." Bottled water is made available in the mess hall and the dorms; that's all we drink. My water bottle becomes my best friend.

    • No alcohol allowed while we're in Solola; no public displays of affection; dress modestly; no "fraternization," even with one's spouse. The dorms are male-only and female-only. These rules are set partly because HELPS is a Christian organization but also to be culturally sensitive; rural Guatemala is a very socially conservative place. I see further evidence of this later in the week when the female patients all seem quite relieved to be seeing a female doctor. They hate disrobing in front of male MD's.

    • Don't flush the toilet paper anywhere in Guatemala; throw it in the trash instead. The pipes are small and can't handle it. "The toilets will clog and your MacGyvers will be very cranky." A few times during the trip I do slip up and drop the paper into the toilet; don't ask what we have to do when that happens. You really don't want to know. The "MacGyvers" are our fix-it men, and they deserve the name.

    We are all assigned one roommate for our hotel stays, hereinafter to be known as our "buddy." We are told to make sure that our buddy gets on the bus, doesn't get lost and so forth. My roommate turns out to be a fortuitous choice as this is her twelfth trip to Guatemala with HELPS and she can answer all my questions.

    Sunday April 15

    Today we are up early to get on the bus to Solola (elevation 6000 feet). We encounter one roadblock en route due to road construction, which lasts about 20 minutes. While we wait Larry the Crazy Dentist, natty in maroon scrubs and Guatemalan hat, gets out to take pictures of locals peeing by the roadside. Why, God only knows. We arrive at Solola and settle in for a busy lunchless afternoon (the kitchen team is busy setting up and fixing dinner). We change into scrubs and start seeing patients in clinic as soon as we're done setting up. It is urgent that we do so, since the surgeons want to start operating at 8 am the next day (Monday) and we have to do the preop clearances. Triage has done a good job of selecting patients who are likely to need surgery, and we work for two hours before knocking off for the day. I'm already tired, and tomorrow will be a much longer day.

    It quickly becomes apparent that there are things we need in clinic and don't have. A short list: More K-Y (lubricant for exams). Hemoccult developer (we have cards but no developer). A watch. Urine dipsticks. More gloves. More alcohol wipes. A flashlight, as the lighting in the clinic is really bad. It's a small building with cement walls and floor, one fluorescent strip in the ceiling per room and small windows at the top of the wall of each room. The largest rooms are at each end of the building; these are assigned to S., the OB-GYN nurse who does most of the pelvic exams and some ultrasounds, and to the two pediatricians respectively. The Peds guys split their room by hanging a sheet with duct tape.

    But there is no phone to deal with, no pager going off, no night call. No drug reps. No complaints (either from patients or from me). No TV; fortunately I am TiVoing "24." It turns out that we do have Internet access, as we are quartered on the campus of the University of Guatemala Valley and there is a computer lab. The accommodations are reportedly a big improvement over last year, with nicer dorms and individual rooms (three people to a room) instead of all sleeping on cots in a big cement barracks the way they had to do last year.

    Addendum: a new problem. Giant June bugs have invaded the entry hall of the dorm. The windows are going to stay closed in our room, I can tell you. A can of bug killer applied by one of the nurses seems to help.




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