April-May 2005

SOLOLÁ. GUATEMALA - Crammed on a "chicken bus" with my triage partner, Margie, and more Guatemalans than that bus was ever designed to hold, I experienced one of those unforgettable flashes of comprehension that come unbidden and refuse to leave.

We had just finished a 16-day jornada (medical clinic) for the indigenous hill people of Guatemala in the area of Sololá, an experience so rich and intense I will replay it for months. Our patients stood in line, some days more quietly than others, to receive free medical services from our team of 75 doctors and nurses. We offered consultations, surgeries and miracles during days and nights of grueling work under less than ideal conditions. During our 16 days, we saw 3,330 patients in clinics and surgery!

In triage, Margie and I sorted hundreds of people into manageable groups every day, and I thought I had a good sense of our patients' lives. But as I sat squeezed on a seat in that overloaded bus, I truly realized how hard it is for those hundreds to get to our clinic. Some families traveled only a few hours, others literally for days. And after their time at the clinic, they got back on those buses to return to their villages, even those who were just barely out of our surgery post-op ward. The full impact of their journeys hit me hard: to sit on a crowded bus for hours, only 48 hours after a hernia surgery, is beyond my imagining. And yet they did it. My exhaustion and aches seemed petty and insignificant in comparison.

Our patients queued up for an opportunity to be seen by a doctor for ailments from headaches, gastritis, cancer, skin rashes, cavities, bullet wounds, colds and cataracts to swollen feet, or to be referred to one of our surgeons for everything from hernias, cyst removal, tooth extraction and hysterectomies to burn scar repair. Every day was exciting and challenging; if we hadn't brought the supplies with us, we had to do without them. So out of the mountains of baggage we produced materials for an efficient mobile hospital, as if we were magicians pulling trick after trick out of a seemingly bottomless hat. All the tedious planning, itemizing and packing of medical supplies we did during the long cold winter paid off.

One of the most popular aspects of our clinic was the miraculous suitcase-sized ultrasound computer. Once any patient came back to the clinic area from the little ultrasound cubicle brandishing the images of gallstones or tumors, everyone else wanted an ultrasound too. Such an anomaly: here is a villager in his traditional outfit, someone for whom Spanish is his second language, asking for an ultrasound picture of his gall bladder!

Our in-country parent organization, Helps International, provides us with cookstoves, refrigerators, cots, a huge generator and crates of medical equipment which are used by the several teams which come to different parts of Guatemala to work. And the wonderful young Guatemalan interpreters recruited by Helps become so much a part of our team we hate to say goodbye.

In our "other" lives, we team members may not even have met each other, but within a few hours working together in Sololá we become a close-knit family, knowing we can depend on each other no matter what role we fill with the team. This year our jornada was 16 days instead of the usual 8, with some intrepid souls staying for the entire time, a first for our group. Others came for either the first week or the second. Sleeping accommodations are in what I would term a "Peace Corps class" hotel, rather than a two- or three-star property. Some rooms, such as the one dubbed The Nunnery (where 20 women slept) had no water or bathroom, so those of us with en-suite facilities often woke up to find someone in our shower. We had hoped to use a large tent in the garden of a nearby seminary as a dorm for 22 men, but the tent blew down the first night requiring some scrambling for sleeping spaces. People slept in the kitchen, in the pharmacy, in a relatively quiet corner of the ward or the OR, or even standing up at the end of a tough shift. One night, after working the triage line for 10 hours and the ward for another 6, I fell asleep on a pile of sheets. Luckily they were the clean ones.

I love working the triage line: every patient is different, and the stories are by turns sad, funny, horrific and delightful. Sometimes I make a connection, while brief, that is so real and deep it takes my breath away. The faces, voices, gentle shy smiles and quick touches stay with me all year, back here in my other life. Patients and families are always wanting to give us something besides their smiles; handworked bracelets, crocheted hats, or other craft items are proferred when really, the thank you is more than enough. This year, one teen girl from San Antonio who had brought her mom to the clinic gave me a huipil, the handwoven embroidered blouse the women wear. Each one is distinctive to the village of the wearer, and by my reckoning, a work of art. This one had been her grandmother' s, a little frayed at the edges and still subtly scented from her abuelita's last wearing. I cried. Actually, we all cried.

Triumphs large and small occurred every day:

Josefina, whose brush with death was closer than she knew. Her courage and spunk pulled her through, and her family and friends were there with her 24 hours a day. Her three beautiful young daughters, resplendent in their trajes, or traditional dress, contributed hugely to her recovery.

Fernando, who came hours on the bus from the coast with a tumor on his lip, and waited so patiently for his turn in surgery. Our miracle worker of a plastic surgeon couldn't completely repair the damaged lip, and Fernando had some difficult hours in post-op, but we are in awe of his positive and gentle spirit.

The 90-year-old woman from a remote village we saw at the end of a long day in clinic. I just couldn't send her back on the bus after she had waited all day in the heat and the dust, and Dr Chuck Pyfer graciously made time for her. She was accompanied by a young man, not even a relative, who could speak her rare dialect as well as Spanish. He turned his back to give us privacy during the exam, which revealed nothing more serious than the results of a life of exceedingly hard work. Although I understood not a word of her language, the sentiment was perfectly clear and her relief palpable. Her companion told us that the language is dying out with the elders of the village.

Olga, in for hernia repair. Her mother wanted to see "the part the doctor took out", reasoning that if the lump was there, then gone, there must be something the surgeon removed for her to see. A demonstration of poking a knuckle through a hole in a napkin, then retracting it, was the best we could do for a visual effect.

The brujo, or village shaman, who came in for surgery. His retinue of supporters was at his bedside faithfully till he left. His presence was far wider than his slight physical self.

The ladies and their cell phones. Midwife Sue Trezona reported that not just once, but three times, ladies in the midst of pelvic exams answered calls on their cell phones! The ladies carry a square of handwoven fabric, whose design is unique to their villages. Into this bundle all manner of things are crammed. They also tuck things into their huiples just above the belt holding up their skirt. It's pretty alarming when the phone in either location goes off.

The little abuelita, grandmother, who stayed a little longer in post-op than was strictly necessary while our medical social worker found her a ride back to her remote village. The longer she and her daughter-in-law were there, the more other maladies they remembered they had, and we discussed them all at great length.

The woman being discharged after hernia surgery, with instructions to avoid heavy labor. Charge Nurse Valorie Schuelke, with a twinkle in her eye, had me translate to her husband that he would need to do the cooking, cleaning, childcare and heavy lifting for some days after they returned home. The look on his face was priceless!

The nine-year-old boy who had never been able to walk. His mother and father, not much more than five feet tall each, had carried him everywhere. We were not able to help him medically, but our medical social worker, Olga, was able to refer the family to specialists for free physical therapy and a wheel chair, since they lived in a village where the chair could be used.

And the end to a story begun three years ago: three-year-old Marvin, blind since birth, came to our jornada in Barrillas. Dr Cox performed surgery on one eye with huge success, giving Marvin and his family the precious gift of sight. Everyone was most taken with this special little boy, but our jornada did not return the following year to the same area so Dr Cox could not follow up with an operation on the other eye. Our in-country team searched for Marvin's village and early this spring finally located his family. They were invited to come to our clinic in Sololá, miles away. No one knew if they could manage the trip or not. Then, in the triage line on Sunday, I looked down in the crowd and recognized the little imp, Marvin. He and his family had walked (I heard two days, but I'm not sure about that) and ridden on a bus for 15 hours to come to us! Dr Cox performed a successful surgery on Marvin's other eye, much to the jubilation of doctors, nurses and family. In addition, our plastic surgeon repaired Marvin's aunt's severe cleft palate, and Dr Cox operated on the eye of another villager, again a child blind since birth. To be witness to so many miracles in so short a time is almost more than any of us can take in!

Families stayed with the patient in the post-op ward day and night, so for every bed occupied by a patient there were at least three family members helping, supporting, feeding, walking, commenting, The children colored pages from a coloring book, carefully staying in the lines more than my grandchildren ever did. The lively young interpreters entertained the little ones by blowing soapy bubbles and singing endless songs, which seemed to revolve mostly around crocodiles and orangutans.

However, much of the work that we do during our jornada involves taking care of preventable health problems: dental caries and the aftermath of gum disease, lost teeth and pain; chronic bronchial conditions; and crippling burn scars resulting from falls into open fires. We know we have made a difference in many lives with our clinic and surgery, but if we could prevent some of the recurring problems, we would happily put ourselves out of work!

So it was that last year Dr George McCulley and his dental team decided to begin a pilot project in dental health. The team chose a village near Sololá, and with the assistance of the teachers in the local school and well-known local health advocate Irene Grinnell, launched a modest dental health education initiative. Children's mouths were checked for number of cavities (average eight per mouth in the village), and Irene and the teachers distributed toothbrushes and demonstrated their use. Teachers agreed to follow through for a year to encourage the oral hygiene techniques. The team expected that it would take three to five years for the impact of the initiative to be noticeable. They were more than surprised to discover that in the year since our first visit, the average number of cavities per child had dropped from eight to two! Now we need to expand the project to more villages: this initiative offers real-time improvement in the lives of the children.

Our second legacy involves reducing chronic bronchial problems and the debilitating burn scars suffered by children who have fallen into the open three-rock fires used in the indigenous homes. The ceilings of the rooms used as cooking areas in the traditional home are festooned with hanging stalactites of creosote from the years of open fires. The women spend hours every week hauling firewood, often up to 100 pounds a day, carried on their heads. Women and children, most likely family members to be inside around the fire all day, suffer constant bronchial distress. The open fires present a danger to children who often tumble into the flames with resulting burn scars on hands and arms.

An engineer with our parent organization, Helps International, designed a simple stove, easily built with a type of cement block and installed quickly onsite; it burns efficiently yet is cool to the touch on the sides, and is vented to the outdoors. Called an ONIL stove, it is produced in Guatemala. A team of volunteers can install stoves in 10-15 homes per day. This year, our jornada included four "stover" teams who installed 150 stoves! During one of our installation days, a representative from the Environmental Protection Agency was on hand to observe a stover team in action. Area women are so taken with the stoves that teams report they are waiting with wood & food at hand, so that the minute the stove is declared ready for use, they put it to the test.

These two simple projects will make a far bigger difference in the lives of the Maya of the Lake Atitlan area than all the medicine and surgeries that we can offer in our clinics. Our fondest hope is that soon, with better health education and safer cooking areas combined with the government's commitment to improved health care for all Guatemalans, we will be out of a job.

In the meantime, however, patients are waiting for us. I can't wait to go back.

Gail In Eugene