Babies Galore

Some pictures around Santiago ...

My last call night was a bit stressful. We had two sick babies, one of whom was septic. The septic baby was getting so little oxygen that he looked almost white. It took about 45 minutes of attempting to put in an IV to finally get one. The Hospitalito does not have ICU level care and we wanted to send the baby to Solola (the closest hospital, about 1-2 hours away) but the family didn't want him to go. The dad was not in the picture and the family didn't have the money for the transfer and medical care at the other hospital. Meanwhile, the mom kept asking me if we would 'save the baby'. We had to get social services involved and finally the baby was transferred to Solola. The last I heard, he had arrived at the other hospital. I wonder what the answer to Mom's question turned out to be.

Then, in the middle of the night, came a pregnant woman who was having vaginal bleeding. She was approximately 35 or 36 weeks (almost term) and pretty much in labor when she arrived. There was a question of placental abruption and a question of how far along she really was. Luckily, she did not continue to bleed very much and the baby, although only 2 kg, was just fine.

This weekend we went to Antigua for Dia de los Muertos. The trip did not have an auspicious beginning with 4 people sitting in the back seat of a 4 door pickup truck, one of whom lost her lunch about 2 hours into the journey. Then the hotel we were going to stay at was completely booked. Luckily, the weekend improved considerably from there :) I called other hotels frantically and we finally found a good one. Inexpensive and clean. Plus, hot hot showers. I haven't been so excited to take a shower probably in years. Antigua is a beautiful city, more European than anything else. On Friday night the streets were filled with people (Gringos and Guatemalans) dressed up in goulish or slutty (or both) costumes.

On Saturday we travelled to a nearby town for the kite (barriletas) festival that is held each year. (First we ate breakfast and I got a cinnamon raisin bagel!!!!!) The kites were made out of intricately cut tissue paper and ranged in size from 5 to 30 feet in diameter. There were all sorts of prizes, for aesthetics, time of flight etc. It was a roudy event with lots of Guatemalan fare food and marimba music. That night we went to a delicous restaurant!! We also went to see a convent-turned-hotel where one of the volunteers is going to get married. I must admit that the place was quite magical.

On Sunday morning two of us climbed up a volcano with a guide. We left the hotel at 6AM. The hike up took about 1.5 hours -- it was gorgeous and we could see smoke coming out of other nearby volcanoes. Moreover, there was FLOWING LAVA! The side of the volcanoe was covered with black sand (from igneous rock?) and strange very sharp rock formations. It was quite windy at the top but the lava radiated quite a bit of heat. (My camera ran out of batteries before getting to Antigua or else I would have some pictures.) We took buses back to Santiago which was fine except for the very creepy guy with two gold teeth and one with a diamond on it who was really insistent. I am about to fall alseep so I'd better go. I hope you are all doing well!

Two Surprises!

Today I went with some of the other volunteers back to San Marcos (a small town by the lake). It was a beautiful day, we jumped off cliffs into the lake, and:

1) I found someone to bring back my ballot so that perhaps my vote will get counted.

2) I had a Tofu sandwich.

What a delight!

It seems I may be in Central America from around Christmas to January 12 with no apparent travel or work plans. Does anyone want to come meet me somewhere???

Long Time No Post!

On The Road to Sipacate ...

On The Road to the Ocean ...

Just some Rest and Relaxation

This mural asks: which way do you want: God, Cigarettes, Love, Death, Prostitution or Alcohol? Any preferences?

After the last post I did end up getting out of bed eventually, and it was a good thing too! That weekend we went to Sipacate which is a beach a few hours away from Santiago. To get there we took a van, a few buses and a boat. The buses here are all retired US school buses (>10 years or 100,000 miles) which are repainted a garish red and somehow accommodate about twice as many people as I remember ever fitting in them in elementary school. (Similarly, often times you will see a family of four precariously balancing on one motor bike or bicycle.) The boat (shown above) takes passengers from a dock so small it almost doesn't exist across a mangrove-inhabited brackish canal to the one motel that sits on the beach. The 6 of us who went stayed in one room, but mostly we were either on the beach or on the porch/bar/restaurant area, which was complete with hammocks. We ate and drank well! Sipacate seems to be more a Guatemalan than a gringo destination. The beach was expansive and the ocean a welcome respite from the incredible heat and humidity. We stayed over on Sunday night and on Monday, which was a holiday, all the people at the hotel lined up on the beach and were each given a baby sea turtle to release. The sea turtles raced/wandered to the ocean.

We took several buses back to Santiago and got a chance to see the transition from the coast to the mountains. We also saw quite a few housing projects (perhaps government-sponsored?) which were not inhabited. It seems that abandoned or not-yet completed buildings are the rule rather than the exception here! I have heard various reasons for the unfinished houses including that until you finish your house (cutting the rebar etc.) you don’t have to pay taxes. I wonder how many people pay taxes anyway … This week back at the hospital was very busy, partly because Monday was a holiday and partly because 2 medical students and 1 resident left. Also, we didn’t have clinic on Friday morning due to a meeting for all the people working at the hospital. I’m not sure if it was because I wasn’t feeling well or because I didn’t understand most of it, but the meeting was interminable. It was half rally cry for the staff to work together and half presentation of statistics about the hospital. I have never seen so many numbers on one slide with such intricate PowerPoint transitions and graphics communicating so little information.

Friday was a sad day as there was a delivery of a fetus that died in utero at 8 months to a 20 year old woman who had already lost one three-month old baby. This couple had to be right across the hall from a huge rejoicing family who just had their third or fourth baby on Thursday. Although we got a few new patients during the day and the evening on Friday, everyone was set to go home today! It was a very quiet night and I spent a few hours talking to the nurse who was on call. I think my Spanish may be improving a bit. Last week I had 3 classes with my Spanish teacher which, while exhausting after work, was quite helpful. Also, a pharmacy technician who is volunteering at the Hospitalito just moved into the Sojuel’s house with me. I’m not sure how long she will end up staying here, but it is wonderful to have her here! When I was sick this week she tended to me and I think that just listening to her talk is soothing, which may be partially due to her being from Ireland.

One other thing before I go: I got my ballot today!!! So, I can get mail here. It takes about 3 weeks. My address is:

Francisco Sojuel (Rebecca Stein)

Canton Xechivoy

Santiago Atitlan 07019

Solola, Guatemala C.A.

Reasons Not to Get Out of Bed

1) Yesterday I was on call. In fact I did sleep quite a bit, but this is a good excuse.
2) It is still raining.
3) Thursday there was an earthquake.
4) Thursday night while cooking the stove exploded. It moved about a foot, the racks were thrown off of it and the fruit salad capsized. We were very lucky because it seems that if the gas line had been broken it would have been a lot worse. No one was hurt.
5) Friday night someone robbed the house of a volunteer while she was home. She is okay, but he did hit her resulting in an impressive black eye and the need for some stitches.

Are you convinced?

24 hours of rain?

The hospital and clinic were quite busy this week. I was thinking about going to study Spanish somewhere for 1-2 weeks, but it seems that I, and the 3 other med students and 4 residents, are gainfully employed/volunteered. One day I stitched up a gash on a 2 year old's forehead. This made me reconsider my plan to get some thread from the market here and try to embroider. That same day on my way home I was looking for a dog to give my leftover meat from lunch to. I found a very appreciative dog and all was well. But then I continued on my way home and happened upon the Saddest Dog in Santiago Atitlan. I'd seen it before: all skin and bones and mange. But I had already given away my meat, so I went to get some bread from a tienda. Much to my embarrassment I couldn't hold it together long enough to complete the purchase and pretty much fell apart in front of the shopkeeper. I think she was baffled by my explanation which was along the lines of "sad, sick, hungry dog". Anyway, the dog seemed to enjoy the bread and I may have prolonged its miserable life a little bit. (Until it eats the poisoned meat that the city puts out periodically to control the dog population.)

I was shaken out of my despair when I got home by a very large spider on the wall next to my bed. I tried to collect it with a coffee cup, but it was TOO BIG! A cereal bowl, however, did the trick. I know that spiders are supposed to be good, and Charlotte was wonderful and all, but I think this spider could have bitten off one of my digits. I didn't take it too far away from the house and we may meet again ... I hope I don't shriek this time. Where did this visceral fear come from, anyway.

Instead of going elsewhere to a Spanish school, I decided to just hire a tutor here in Santiago. Today was my first lesson, which lasted 2 hours. It is about $5 per hour, which is more than other places, but I am really hoping it will help. We just talked and read stories, which I summarized. I even have an assignment which reminds me of second grade: use all the words that I didn't know from the stories in sentences. I think I used to try to use all the spelling words in one sentence. I'm afraid that my grammatical skills (or lack thereof) will not allow me to do this in Spanish, but maybe the next set of words :)

Tonight I'm going to eat dinner with some of the other volunteers and tomorrow is call in the emergency room of the hospital again. I hope that it stops raining so I can go to San Pedro over the weekend!

San Marcos and Call Night 2

The Market in Santiago Atitlan

Typical Dress in Santiago Atitlan

Over the weekend I had one very lazy day (think cat stretched out in sun with most activity being a yawn every once in a while) and one adventurous day. Saturday was a very restful day except for when somehow I lost all my music (almost 2000 songs) off my computer and iPod. As you can well imagine, much consternation followed, but to no avail. They still show up as mp3 files, but they won't play :( I recovered from that over dinner, which I had with the other volunteers. Dinner included salad, baked ziti, watermelon, and carrot/banana bread with cream cheese icing. This was quite a change of pace and I was thrilled :)

Sunday, I went with two other volunteers to a town on the lake called San Marcos. It was incredibly beautiful and a haven for yoga-vegetarian-tree-hugging gringos.Needless to say, I am attracted to this :) We watched some kids jumping off a cliff into the Lago Atitlan and hiked around along the shore of the lake. I also made a friend: a dog named Scott who led/followed us on our 1-2 hour walk. I didn't even feed him!

Call yesterday/today at the hospital featured several babies with 'la falta de respiracion' (difficulty breathing) and a 70 year old man who fell 15 feet from the tree he was climbing. I don't think I have ever been around such profuse bleeding. Besides deep and extensive wounds on his head, multiple ribs were broken and he had bled into his thorax. So, after sewing him up and putting in a chest tube (I was retracting/blotting/cutting sutures/holding the oxygen mask on), he went by ambulance to Guatemala City (3 hours). I know he made it that far, but I don't know what happened from there. He was completely with it and even was asking what time it was. Besides learning some about trauma patients (what we would do in the US vs. what we did) and pneumonia/fever in kids, I have established (>99%) that emergency medicine is not the place for me.

So, who is watching the debate tonight (or is it tomorrow)? Is there anyone who hasn't already decided who they are going to vote for? I have to admit that I still have not figured out how to get mail (which is why I haven't emailed out a street address). So, does anyone want to come down and bring my ballot? Oh, one thing that I am kind of excited about is that my task at the Hospitalito is to organize their books. This is difficult due to the Spanish/English Doctor/Nurse divides and the large collection of Ancient Texts. But, don't worry, I will figure out some arrangement that will promptly revert to chaos :) I think that the force of entropy is stronger here in Guatemala than I have ever before witnessed. That must be why this blog post has gone stream-of-consciousness. Well, let me reiterate that I miss you all and I love to read your comments!!

Call Night 1 and a trip

Let me first tell you about the ER yesterday/today and then about the trip. My call ('turno') was 7 on Thursday morning to 9AM today. In addition to having an outpatient clinic, Hospitalito Atitlan has 3 inpatient rooms (2 beds each) and 2 beds in the ER itself. Overall, it was one of the least painful call nights ever as I slept for 5 hours (on and off) and worked with a very nice resident. Two incidents of note, and I'll save the nicer one for second. (I've changed patient names just in case any of you knows anyone in Santiago Atitlan.)

1) Elisa, a 38 year old woman, presents with acute mental status changes. Her relevant past medical history is that she had some sort of 'stroke' at age 23 and has since then been both physically (left side) and mentally impaired. Elisa has not urinated in 24 hours and has not defecated in 2 weeks (per family). She sits quietly sobbing, hunched over, with what can only be described as deer in the headlight eyes. Her family's understanding of her illness includes spirits inhabiting her body and somehow causing delerium. Anyway, she doesn't say much but her family reports that she stopped peeing because it hurt. I desparately want the cause of her delerium to be an easily treatable urinary tract infection (which I know, I know, shouldn't cause delerium in an otherwise healthy person). But she won't/can't pee. So the nurses try an in and out catheter which you can only imagine how hard she fights. Then I go to check on her and she is quite literally out of the hospital, still luckily within sight. I still really do think that a urine test might provide the key to her treatment and I practically beg her to return. She returns, but tells me that she keeps seeing 'phantasmas' and deamons which is why she is running away. In order to encourage her to give a urine sample, I say I will give one at the same time to decrease her shame. (Or just increase mine?) So everyone leaves the room and they bring a bucket and a jar. Luckily, Elisa agrees to try first. But, she can't support herself due to hemi-paralysis (from her first stroke). I will not go into further details, but suffice it to say that it is surprisingly hard to hold up a small-sized hundred pound person and that a few drops at least went into the bucket and the sample jar. Oh happy day! But no, not a happy day. She came back only positive for a primarily sexually transmitted disease. And no bacteria. By this time we were feeling increasingly like she might have had a second stroke. We asked to transfer her to a hospital about 2 hours away for imaging and further workup (and also treated her Trich). Well, one after one the family told me that they did not want to do that. They wanted to take her home. They had been in Solola (the other hospital) about 15 years ago and didn't think it would be helpful. Plus, they are extremely poor. Then there was an agrument between these two doctors about whether the family needed to sign (or rather finger print as they didn't read/write) a form releasing the hospital from blame (saying that they left Against Medical Advise). Anyway, they signed the form and were going to leave and then Elisa started crying again and saying she wanted me to go with them. So the family lied to her and said I would visit. And then they dissapeared. I'm glad I'm good at holding someone's hand, but I wish we could have done something more.

2) Juana, a 27 year old mother full term with her 3rd child, came in at 7 PM having contractions every 1-2 minutes and fully dilated (well, 8 cm). She had a beautiful baby boy by 8:25 PM (post meconium clean-up) with no anaesthesia and no yelling or crying at all. There is something infitely hopeful about being present and even helping with the first breaths of air that a baby takes. Also something very comforting seeing a proud, albeit exhausted, family together for the first time.

Anyway, those were the two major things on Call #1. I will be on call again Monday (approximately every 4 days). However, Call also means the next day off! So today after I left the hospital at 9, Guatemala was mine to attack! I went with Jay, the resident I worked with on call, to another city across Lake Atitlan, called Panajachel (or Pana for short). We had a delicious lunch (after I made my shrimp look more like pop-corn shrimp at a greasy spoon fish place and less like the animals you find in aquariums with eyes, legs and tenticles). We also went to a huge market -- Pana is similar in some ways to Santiago (where I live), but about 5 times more touristy. It was kind of nice to be somewhere for a little while that was a little bit brighter and cleaner. We even went to an art gallery. My most exciting purhcase was lettuce. I almost want to go downstairs right now and just nosh on it! But, it is for making a salad to take to Las Milpas, which is the place that the majority of the volunteers working at the clinic live. Anyway, I'm looking forward to it :)

The sun hath set and so must I,
So please write a comment, or at least try :)

A better day

Why was today better you might ask ... well, for some reason I felt more useful and capable. To some of you this may seem ridiculous, but I made major progress on the artificial intelligence (not real intelligence mind you) front; I have now secured the most recent version of epocrates (computer program full of drugs, doses, symptoms etc) on my palm pilot. Also, I fed a stray dog today leftovers from lunch. Yesterday was the day of multiple patients with ulcers, and today a day of infectious disease: worms, lice etc. One more thing: this being the 9 days between Rosh Hashanah and Yom Kippur, I want to blog out my aplogies (a method I'm sure was never intended) to anyone who I hurt over the past year. Also, to anyone who may have hurt my admitidly sensitive feelings, you are forgiven! Water under the bridge, and may we all be inscribed in the book of life. (This is all Jewish reference stuff.) I have included a picture of Lago Atitlan (above) and the town (below) ...

Hospital Day 2

This post will be short. Today wasn't so great. Well, lunch at a small taco place was delicious and that does count for something :) But, the obstetrician I worked with in clinic was less than thrilled about any possible teaching or having me involved. So I left early and biked around the town. Also I went to a gym with Andrea, the 20-something daughter of Fransisco and Argentina where I live. It was, I think, the place that old, broken American gym equitment goes to die. You can join for a week for US $3. My visit today was less than $1. But I think this may be proportionately similar to the US considering the wages here. Regardless, the low price will probably not entice me to return. I think I am a US gym brat (for the moment anyway). I am going to study some and hopefully tomorrow will be a better day! I will comment on my own blog and say "Patience, Rebecca, Patience"!

First day at Hospitalito Atitlan

First of all, thank you all for reading, commenting and emailing :) Sitting about a million miles away I still feel loved (or at least liked)! I would like to report that my first day at the hospital was good. Anyway, there were no disasters and I count this as a win. This morning I couldn't sleep past 5:30 when the roosters seem to start their day, but this may be secondary to going to sleep around 9 last night.

After breakfast of rice in milk with cinnamon (there must be some name for this) and coffee I rode my bike to the hospital. This was a bit of an adventure as the streets are mostly cobblestone and extremely riddled with pot holes. Also I go down a relatively steep hill to get to the hospital. (Riding home was even more of an adventure as Tuk-Tuks whiz by, think speeding bullet on wheels driven by a 12 year old, and the street was wet from the huge rain storm that hit us this afternoon.) Anyway, I got to the hospital early and no one else had yet arrived (the dr. on call from the night before was there). Hospital volunteers trickled in between 7:30 and 8AM and clinic started around 8:30. There are only 3 rooms for clinic patients and I saw patients mostly in a group with another student or resident. I also spent some time with Dr. Chuc who is the main doctor at the clinic. I certainly did less during my time with Dr. Chuc, but it was quite interesting to see how he interacted with patients. I would say that over half of the patients only speek the native dialect (Tzutujil) and except for Dr. Chuc all of us needed to have an interpreter.

The hospital formulary is quite a bit more comprehensive than I had expected. However, we requested remarkably little blood work. In the hospital there is a technician who can do a basic CBC (no platelets), but almost everything else has to be sent to a larger town. Also, the patients don't seem to like to have the relatively painful and expensive experience of the blood draw. The clinic has a sliding scale, based on things like what kind of floor and roof the patients have at home. We saw several patients with high blood pressure, and some pre and post-partum visits. The clinic has a two hour break for lunch! Horray -- siesta time :) I don't quite have time to come home for lunch and I think I will go get something from a stand in the future. Today I lunched on luna bars, a green orange and several small bananas. I'm going to go downstairs for dinner in a few minutes and am crossing my fingers that there is no meat. For the record, yesterday I did eat chicken (I have been vegetarian for about a year) and beans (I am a bean-o-phobe). Who knows what I will eat tonight!

Arrived!

Yesterday was a day of travel and today a day of exploration! The trip was relatively uneventful but I did have a scary experience where I tried to help an Salvadorean woman with her luggage and to find our flight but couldn't understand what she was saying. I will just say that my confidence was not enhanced by this experience. I flew through DC and then San Salvador (which was only about 120 miles from Guatemala City). In the airport I changed money and met Jose, the driver Francisco (who I am staying with) arranged to pick me up.

On our way to Santiago Atitlan, which is about 3 hours, we stopped to get a cell phone. $25 got me a basic phone and 40 minutes time. I saw some of Guatemala City, but it soon got dark. For some reason I could understand Jose relatively well; it may be because his first language is Tzutujil, the dialect of people of Mayan descent indigenous to Santiago Atitlan.

On arrival to the house of the Sojouels where I am staying, I met Argentina and her husband Francisco. They are quite gracious, and patient with my Spanish. The first floor of their house has a living room, dining room, kitchen and two bedrooms. Through a courtyard is an outdoor staircase to the second floor where my bedroom is along with three other bedrooms, a sitting room and the bathroom. It sounds like a huge house, but really most of the rooms are small. The walls are brightly colored stucco and there are pictures covering the walls. My bedroom is cozy and yellow and connected to a sitting room (see pictures). I also met Francisco and Argentina's kids -- 20 something Andrea and 16 or so year old Ricardo. I talked to them a bit, Ricardo showed me how to use the wireless and Andrea encouraged me to venture forth to visit the lake.

This brings me to the exploration part. I had walked around a bit with Argentina to take two bikes to get them fixed and see the market, so I had some idea of the town. Later in the afternoon I went to the lake, and walked around the market for a while (and bought a few things). Also Argentina took me to the organization that she and her husband run to help kids with disabilities (http://www.mayacom.org/organizations/santiago.htm). There were only a few people there as it is Sunday, but I met someone making crafts which the organization sells to raise money. This afternoon I napped and read a bit which was lovely. I wonder what tomorrow, my first day at Hospitalito Atitlan (http://www.puebloapueblo.org/ha_history.html)!

Packing

Hi Everyone :)
I should be packing but at the moment we are suspending my cell phone service and I'm feeling quite anxious about not being able to communicate with anyone. (I am planning to get a phone down there, but for these several days what will I do??) I hope to post here occasionally from Santiago Atitlan. Anyway, I think it is time to put my entire life into several suit cases :) You can reach me on Skype where my username is rebecca.stein or by email: rebecca.stein@duke.edu.

PS Here you can see that I planned to pack Mojo ...