Wrapping Up

Suzy presenting some baby gifts for expectant moms

Suzy here. We are currently riding the bus back from Huehue to the capital. Not a chicken bus this time, it's a nicer Pullman type bus but less than $10 for the 5 hour ride. No borrachos bothering us, we got seats right up front behind the driver. There is time to talk and look back on the last couple of days to create what might be our last blog entry.

Bob and Ana playing tug of war

Yesterday was the second day of the "Feria de salud". It was decidedly much better than the first, since we had learned some important lessons of chaos control, plus it was only a half day. Beto and I ran the ultrasound room again, this time we put a sign of the door "No Entre, Examens Privados", as well as locking it to prevent Cristóbol from barging in. I question the grammar of the ultrasound reports I wrote on the computer, but am not too worried, because Robert Gobbo's name is at the bottom of each of them, not mine. Flaminga the cervix queen did 15 paps in one morning which sent her into throes of ecstasy, and Gallo saw general consultas. 

After finishing up at the Casa Materna, we were treated to a special lunch in the garden with PCI staff and the nursing students who had worked by our side during the Feria de Salud.  There were of course the usual nice speeches--Guatemalans have such a nice way of formally thanking people and have the rare ability to use beautiful flowery language that is imbued with a humble sincerity that is really touching. El loro presented one of the models "Estela" to Doctora Ana, for them to use for educational purposes in their work that will continue on. We are kinda jealous that she gets to stay behind……

Meeting with Dr. Palacios

After lunch we had a nice meeting with the director of the National Hospital next door, Dr. Omar Palacios, where we discovered that there was a degree of openness to do a resident exchange in the future and where we also found out about a group called "Arco Iris" that is coming to Huehue in the spring to do some orthopedic surgeries on children.  This was very exciting news for some of the children of Santa Eulalia we saw earlier in the week.  Little Vicente has some hope to get his foot fixed if we can help facilitate that happening : ).  We then got a brief tour of the hospital, including labor and delivery, the pediatric unit and the mens and women medical and surgery units.

Nursing Students who helped us in clinic

Back at Casa Materna for the final goodbye, we gathered all the patients together in the back room to distribute the gifts our Portland friends had sent. Since there were all those ultrasounds this week, most of them knew the gender of their babies, so we could give them each a package of little baby girl or boy booties, t-shirts, blankets, hats, etc. They were probably a bit surprised to hear that people back in the US cared enough to pick out the clothes for them and send them down with us.  One of the women who was a bit more outgoing than the average shy Casa Materna patient suggested getting up and dancing on the tables much to our delight.  

Dinner at Manuel's house

Since we had already had our formal goodbye at Abesaida's house, we were free to accept an invitation to the "cool urban bachelor pad" of another friend of mine from a decade ago, Manuel Saenz.  Manuel and his former wife Lucky as well as their 3 grown children had the opportunity to study in the US as youngsters so he has a bit more of a worldly perspective and it was nice to be able to lapse into English at times.  He is of a well-known family who operated the town grocery store "Casa Saenz" for 70 plus years until the Walmart affiliated Paiz showed up in Huehue in 2001. They were forced to close the family business, and he has branched out to other business ventures over the years, but has also discovered his artistic side.  It showed through in many different ways: starting with the liquor cabinet which contained everything from fine Guatemalan rum to the more homespun moonshine of the region, Cushe, in different flavors. It was a great tour to take on our last night in Huehue.  Dinner was a tapas-style meal served from the restaurant below on large communal earthenware plates, and was just as beautiful to look at as it was delicious. To top it off, we got a tour of Manuel's artwork which included several local artists and his own creations. Melissa and I were both thrilled with our purchases of his original paintings to bring back with us, yet another recuerdo of our awesome trip to Guatemala. 

We will arrive to Guatemala City in a few hours and are staying at the same nice hotel where we met the other Providence team at the beginning of the trip which seems so long ago now. Melissa found a nice restaurant in her guide book for us to go to, where we will enjoy a last meal together before the flight home the next day. We have realized that the synergy of personalities during our trip has melded together to create a real team spirit (even though Chris Anderson will always be my bike rival) and we will miss being together. We have bonded!  But hey, maybe there will be future trips, with future adventures, learning and bonding in different configurations. Maybe one of you, who speaks Spanish or wants to learn, loves adventure, can be flexible, has an open heart and a desire to serve the most poor and vulnerable (and can handle assuming a bird nickname) might be writing the next blog…. 

Bal Maria offers her thanks and best wishes to us the the moms at Casa Materna

Parting Shot

We hope you have enjoyed reading about our adventures and seeing the photos that convey the amazing spirit of life in Guatemala. thanks for tuning in. it has been nice to have your company on the journey. Paz to all on behalf of the team, Suzy, Melissa, Bob and Chris.

P.S. We will post some of our best "dichos" (sayings)...words and pics later this week. Stay tuned.

Feria de Salud

Would you come to see this doctor?

Our days are rapidly winding down in Guatemala. Wednesday and Thursday were prescheduled at Casa Materna as a "Feria de Salud" (Health Fair). For the last several weeks, Casa Materna had a billboard with a seductive female doctor announcing the feria. We really weren't sure what to expect when we arrived but we quickly found out.

one more ultrasound?

There were about forty! women who wanted ultrasounds, both nonpregnant women with pelvic discomfort, and pregnant women wanting to have an ultrasound. Bob and Suzy managed to do 28 ultrasounds at a patient cost of $6 each (that's a net $170 for the day). Melissa was once again the queen of pap smears, and did about 20 paps. Chris did "consultas generales" and worked with a couple of nursing students from the University Rafael Landivar, which has a nursing school here in HueHue and a med school in Guatemala City. We are going to meet with the director of the school tomorrow. 

Rosio and Suzy

Back to the "Feria" which did not include any corn dogs, coin tosses or thrill rides, In fact we are not sure why it was called a "Feria", it was more of a "Clinic Cluster" and an opportunity for the poorest of HueHue to get some care they otherwise could not afford. We did get pretty tired and even a wee bit grumpy, as the lights dimmed in our exam rooms, the air became heavy and more patients kept showing up. The "Fair" was broadcast all day on the radio and tales of the Dra. Caliente (we know as La Flaminga Negra) spread. Still, we did not have to deal with EPIC, so we realized it could have been much worse!  It was worthwhile to be of service and we were again touched by so many!

our mark at the shop

We met with Bal Maria, the director of PCI in Huehuetenango, her husband Ariel, and daughter Elisa after "office hours" in an amazing coffee bar in HueHue that had the most amazing cup of the bean we had ever savored. After leaving our mark at this fine place, we did manage to aquire some of this gold as well as some Sal Negra (black salt) that will be coming back with us if La Aduana (customs) allows. Finally we dined with la familia Lopez (Abesida's family) and were treated with the most delicious Chile Relleno Guatemateca ever: Abecida's son Manuel confided to us that she had labored all day to prepare this delicacy by hand for us as a special gift. It does not get any better!

La Familia Lopez
Edward, Evelyn, Abesaida, Pati, Noeli
Arnoldo, David, Samuel, Manuel

Tomorrow will be a bittersweet day as it is our last full one in Huehuetenango. We will start with "La Feria day 2" and then after some meetings with the directors of the national hospital, will be celebrating with the staff and patients at Casa Materna.

Hasta Pronto: El Loro y El Gallo

Todos Santos, Todos Fuertes, Todos Amables October 22, 2013

After a stormy and cool night with no heat in the Hotel Fran Pab in Santa Eulalia high in the Guatemalan mountains, our team packed up the PCI pickup trucks and headed to Todos Santos about 3 hours away to meet with 60 midwives who serve that community. Our trip there was made memorable by clear skies, incredible scenery through mountains and the Altiplano, a breakfast of eggs, corazon de trigo (cream of wheat) and coffee in a small restaurant in Soloma and our first live broadcast in Guatemala.

We were interviewed by La DJ “Dominga” on Radio 88.5 FM by cell phone, which was translated into Q’anjob’al. Dominga helped us the day previous with translations during the evaluations of the children with disabilities, yet also is a disc jockey and radio personality in Santa Eulalia. She had actually invited us to her radio station, but because of our long journey and desire to not be late for the midwives or “co-madrones” waiting for us, the cell phone interview was the next best option. Although we could not of course hear the interview, since we were speaking to her on the cellular.

Chris is looking for a YouTube version to post on the web. I wonder if she including our “Motes” or nicknames in the broadcast. For your information, El Gall Blanco (Chris – the white rooster) translates as “Saj Mam Kaxlan” in Q’anjob’al, but he prefers the Mam translation of “Sec Se”, for obvious phonetic reasons. There is no equivalent my nickname “El Loro” in Q’anjobal since there are no parrots that high up in Guatemala! Que Lastima!

Once we arrived at Todos Santos through most incredible mountain passes, our truck and “piloto” Josue negotiated the mud roads as we sang Beatles songs and entered the village.

Todos Santos has a remarkable association of midwives, who meet monthly, train their apprentices and even do case reviews of poorer outcomes.

Their community has had no maternal deaths for the past two years and much of this is directly linked to Casa Materna’s support of the midwives for the past 10 years in helping them deliver infants safely in their villages and identify higher risk pregnancies for delivery in the National Maternity Hospital in Huehue 2-3 hours a away.

Lider of the Midwife Association Francisca and Susan

Once we arrived at the education center in Todos Santos, the 60 colorful Co-madrones welcomed us with a communal prayer, chants and singing that was mesmerizing and incredible, we even started quietly chanting along with them. It was truly beautiful that reflected the spiritual devotion of these amazing women.

Bob with midwives in the Postpartum Hemorrhage Workshop

Suzy facilitating the discussion on Eclampsia in pregnancy

We presented the same program as the day previous and the women were organized by the PCI staff into 4 small groups of about 15-20.  Chris, Melissa, Bob and Susan used the Mannequins (named Simone, Estela and Pascal) for workshops in post-partum hemorrhage, medical conditions such as pre-eclampsia/eclampsia, bleeding in pregnancy and birth dystocia. Each group participated actively and the experiences and knowledge of these women were quite exceptional. Many had attended several hundreds to thousands of births. Melissa learned that many “co-madronas” have large families themselves, but when they receive the call (usually on a cell phone!) in the middle of the night to attend a birth, despite rain, cold and wind they walk up mud paths and narrow streets in the pitch dark to assist a woman in labor. We were struck by their skills, their wisdom of thousands of years their traditions and yet still they maintain a desire to learn and improve their abilities.   

Chris foolishing acting out the "Tonto"manuever, to be schooled by "Comadrona Suzy" on the correct way to safely care for a woman with a shoulder dystocia in labor.

McRoberts and a Comadrona to the rescue. Now that is better!

We finished with a medical drama of shoulder dystocia with the “Not Ready for Acting in Mam or Spanish” players and received several cheers and laughs. The session ended after 2 hours with salutations and gifts. We presented the community with one of the Mannequins (we think it was Pascal) so they could use this teaching tool to help train each other and future midwives. We shared lunch with this community of strong and committed women, who clearly demonstrated a passion and professionalism for their chosen vocation.

Presentation of beautiful woven sacthels and our mannequin

We did get a little shopping done in Todos Santos, and then were safely “piloted” back to Huehuetenango by Josue. Bal Maria, the director of Casa Materna invited us to dine with her family and we learned much of the troubles and hardships of Guatemala, and recanted our experiences of the past day. We shared our vision for the future hopes of the friendship between ourselves, Casa Materna and the people of Guatemala…..but more to come on that as it is getting late and the steady rain is lulling us to sleep. Peace.

Shepherding in the Altiplano of Guatemala

Comadronas and Discapacitados (Midwives and Disabled Kids)

El Mirador with clouds and volcano

Monday began with another trip up north over El Mirador and onto the altiplano. This time we headed through San Juan Ixcoy and Soloma to the community of Santa Eulalia (ay-oo-la-lee-ah). The drive took 3 hours over a very windy road over the Cachumatanes mountain range. Santa Eulalia is a community of 50,000 people in the western region of Guatemala in the departament of Huehuetenango named after Saint Eulalia a 13 year girl from Barcelona who was killed by the Romans for refusing to recant her faith. The predominant language in the area is Q'anjob'al (kahn-ho-bal), then Castellano (Spanish).

Santa Eulalia from a distance

Due to various delays, we arrived for our meeting with the comadronas (midwives) about an hour late. As  we awkwardly entered a small room, we received a round of applause from a group of about 60 comadronas quietly waiting for us. After a speech by a leader of the comadronas in Spanish, Suzy and Doctora Ana made gracious comments from us in Spanish which were interpreted to the comadronas in Q'anjob'al. 

Comadrona leader interpreting in Q'anjob'al

We broke into four groups to have small group workshops on specific topics: bleeding in pregnancy, preeclampsia, postpartum hemorrhage, and prolonged labor, with about 15 women in each group. Each group had its own Q'anjob'al interpreter. They told us they were doing a lot of deliveries, with some women delivering 2-12 women per month and one older woman having done 2,000 deliveries. Many followed their mother or aunt into the role of comadrona. After the small group workshops, we did a small drama about shoulder dystocia, demonstrating the McRoberts and Gaskin maneuvers, the latter maneuver having originated with comadronas in Guatemala. The comadronas expressed their thanks profusely, saying "Yuj wal dios" (thank you in Q'anjob'al) many times. They also asked about getting some resources such as backpack kits to include scissors (to cut the cord), thread (to tie it off), suction bulb, clamps, and gloves.

Bob and Dominga, who had a missing arm from birth

After our session with the comadronas, we met with an organization called "Pixan Konob" (Heart of the People). Pixan Konob (see link) was founded one year ago by community leaders to advocate for disabled children and adults. What we found is that although all Guatemalans have access to free emergent care in the municipal health center or the departmental hospital (in Huehue), children with special needs often receive no special care or therapy and instead are mostly kept out of sight. As a result, their development is often stunted. During the afternoon, we saw thirty children and created a database with their diagnoses and recommended treatment. Their were several children with limb deformities (club foot, missing legs/arms) as well as many children with severe developmental delay and cerebral palsy. There was one 15 yo girl with obvious features of Down Syndrome that the mother had never sought or received any medical care and was unaware of her diagnosis. This was by far the most emotionally challenging times during our trip, seeing the disabilities and lack of access to appropriate care. We are hoping to do some resource connecting for some of the patients as well.

Pixan Konob leaders with our team

We ended the day sharing dinner with the directors of Pixan Konob, one of which who won the national "Mayan Princess" award for 2011. This was a recognition of her outfit, native language speech, and comportment. We spent the night at Fran Pab, a small but comfortable hotel in Santa Eulalia which ran a whopping $10 (80 Quetzales) per person for a shared room.

Vicente, who had a foot deformity and a penchant for charming Suzy

Down Time

Main street in Todo Santos

SATURDAY

In the days leading up to Saturday, we made plans to go on a five hour walk from the town of Todos Santos Cachumatán to a town called San Juan Atitán. As the best made plans go, so did this one. All of us were feeling fairly run down, both Bob and Melissa were feeling ill as well. So while Bob caught up on rest and was pampered by Abesaida, the rest of us set out around 7am to the bus terminal near downtown Huehuetenango. We shortly found out that a bus to Todos Santos wouldn't be leaving for about 3 hours, but we found a microbus that would take us 2/3 of the way and hoped to catch another bus from there.

Crossroads on the altiplano

The bus from Huehue, which sits at an elevation of 6,200 feet, climbs a 3,000 foot switchback road to a lookout called "el mirador" (the viewpoint), then upward through a region called the "altiplano" (high plain)  which sits at about 10K feet). We got off the bus at the crossroads which leads to Todos Santos and had an hour or so to appreciate the effects of high altitude.

Men in Todos Santos

We caught the bus and descended into Todos Santos which sits in a valley at 8,200 feet. Todos Santos is an amazing small town that celebrates its annual feast day on November first which is All Saints Day (Todos Santos). The local language is Mam, as in the village of Polajá. In most Mayan towns, the women's clothes stand out due to the brilliant colors of the hand woven fabric. In Todo Santos, it is the traje (uniform) of the men that stands out, with striped shirts that have hand woven collars, red pant, a panama style hat, and often black chaps.

Suzy and Santiago

After having a late lunch, we walked through the market into a cooperative textile shop where (surprise) Suzy knew the proprietor Santiaga from 20 years ago. She showed us around her shop while catching up with Suzy over kids and grandkids. Fortunately we were still inside the shop when a big thunderstorm struck and buckets of rain started coming down. We realized that we weren't going on a 5 hour hike and decided to sit down and have some coffee and made the best of it by meeting a new friend, Katia (in the picture) who was 8 years old and baby sitting the 1 year old grandchild of Santiaga. She taught us Mam words, like "Chonte" for thank you.

Suzy, Katia, and Melissa

We headed home on a 3 hour bus ride that was a true chicken bus experience, a true Blue Bird bus with boxes of baby chickens in the luggage rack. The three of us barely squeezed into the back door with the central aisle crammed with bodies. Most of the ride went smoothly until we were approached by a borracho (drunk) who had lost his manners.

SUNDAY

Mercado in Huehuetenango

Sunday we slept in until 9am! Our intent was to stick around town and take it easy. We took a 15 minute walk from Abesaida's house to the downtown market to explore. As with many marketplaces in developing countries, Huehue bustled with noise, cars, motorcycles, and lots of people. What stood out was that despite being in mid day it did not get too hot, and that we saw perhaps 2 or 3 other foreigners.

Suzy and don Samuel, Abesaida's dad

Later in the day, we had a grand lunch with all of Abesaida's children, Manuel, Evelyn, and Pati. As we have mentioned before, Abesaida is an incredible cook, and she outdid herself with todays lunch. The main dish was rice and chicken with a delicious sauce made from too many spices to name. Of course every meal is served with small thick corn tortillas. Along with lunch, there were several jokes told, including Bob's rendition of the priest, minister, and rabbi trying to convert the bear.

Ruins of Zaculeu

After lunch we visited Zaculeu (see link), a few kilometers outside of Huehue. Zaculeu was the capital of the Mam kingdom for several hundred years until it was taken over by the Ki'che' and ultimately fell to the Spanish in 1525 who besieged the city for months until the residents gave up instead of starving. United Fruit Company (now Chiquita) restored Zaculeu to its present condition in the 1940's before collaborating with the CiA in overthrowing Jacobo Árbenz in 1954.

Chillin in Chiantla with Pati

To wind up the day, we visited Nuestra Señora de Chiantla (our lady of Chiantla), a silver statue of Mary in the church of the nearby town of Chiantla. The visit included a trip to a store where they made "chocobananas" by dipping frozen bananas in chocolate. We came back to Huehue to plan for our two day trip to work with comadronas (midwives) in the surrounding towns of Santa Eulalia and Todos Santos.

Ultrasounds and La Comunidad de Polajá - Ixtahuacán

Thursday

Bob giving the "charla" (presentation) on ultrasound basics

Thursday and Friday were both intense and memorable days for our team Providence Oregon Family Medicine in Guatemala. After Wednesday’s successful conference on Obstetrical Emergencies, we were asked to put on an ultrasound course for the staff of Casa Materna and our friend and “el adorable” Dorian (a rural physician who came for our conference the day previous). Chris and Bob were busy Wednesday night translating the PowerPoints and material into Spanish with the wonderful assistance of our host Abesaida.

Patients awaiting ultrasound at Casa Materna

Starting on Thursday morning at 8 am we instructed 7 staff members on use of their new machine that had been donated by a non-profit from Japan. The day went a little slower than expected, primarily due to having only one machine, several learners, and many patients. There were both women from the community of Huehue, as well as women residing at Casa Materna in their final days of pregnancy whose homes are hours away. Also there were several women there for a pelvic ultrasound who weren't pregnant, and Bob did these. We scanned over 40 patients from the community and Casa Materna and were invigorated although exhausted after our last session at 6 pm.

Doctora Ana improving ultrasound skills

One of the patients from Casa Materna was found to have oligohydramnios, hyperreflexia, a history of eclampsia (seizures in previous pregnancy), and was immediately referred to the national hospital which is adjacent to Casa Materna. A few other non-pregnant patients were found to have abdominal masses and were referred as well. Yet, most of the scans were on pregnant women of all gestations. It was such a joy to watch the patient’s faces light up when they saw the images of their infants on the screen, and even more wonderful was seeing how quickly the staff became comfortable with operating the ultrasound and getting great images.

Friday

El Gallo y El Loro lugging an exam table for the Feria

Does she know what she is carrying?

On Friday we traveled to the indigenous village of Polajá near Ixtahuacan to participate in a “Feria de la Salud” (health fair) in a village about 90 minutes away in the mountains west of HueHue. At the end of the road, our team, including Doctora Ana and the nurses from PCI Casa Materna, transported all the equipment, exam tables and medicines over a very long and wobbly suspension bridge and then up a trail another mile to the village by foot. We were accompanied by mostly women villagers, all about 4 and a half feet tall who insisted on carrying most of the materials for us.

Doctora Ana (and Giovani) demonstrate the Papanicolau

After arriving in the center of this small and beautiful village that was ringed with tall mountains,  we set up in a big “salon” while the townspeople met and their leaders explained the purpose of our visit in their native tongue, Mam. The community of Polajá is one that has had the most success with the EMPODERAMIENTO (empowerment) program PCI helps organize and empower the women of 30 different villages. The empoderamiento program focuses on cooperation, including micro-financing for loans and economic support for small business, medicines and other needs from all the members of this cooperative.

The pediatric exam station

One of the more comical moments of the day was when our friend and PCI Physician Ana, explained how a Pap smear was performed, demonstrating on a female mannequin with speculum and spatula all in full view of about 180 women and children. Giggles resonated with facial expressions that revealed surprise, hilarity and modesty in harmony. Giovani, a young male nurse, fluent in Mam and Spanish, was cool as a cucumber while he translated Ana’s words. We then were each presented with a diploma individually by the “lideres” of the town.

One of the community leaders thanking Melissa

The makeshift clinic was then was the site for “Consultas” which continued throughout the day with providers speaking Spanish with interpreters who spoke Spanish and Mam. We saw over 160 women and children. Most the children were seen by Chris “El Gallo Blanco” and he only scared of few of them. He also supplied amusement to the crowd by falling off his chair to screams of laughter.  Ana and Melissa did Paps and medical consults and Bob “El Loro Verde” opened his consultorio with the help of Yolinda, his Mam interpreter while her infant slept in a sling on her back. Most of the women suffered from what would expect from people who endure a difficult life: Headaches, knee and back pain, fatigue and abdominal pain. Their spirit and smiles were so beautiful. We saw about 6 pregnant women as well whom will all deliver in their community and met their impressive and wise “co-madrona” (midwife).

Bob's Mam interpreter Yolinda (left) with mom & child

We finished about 5 pm and were lucky enough to have a truck transport the equipment back to the suspension bridge as both the community and us wished each other well. After carrying the equipment back over the suspension bridge, our two trucks were loaded up and we had enough time to take some photos of our team and wish each other well.

Relaxing at the end of the day at Tienda Dolores

Unfortunately one of the trucks broke down on the steep and treacherous dirt road, so we spent about the next 3 hours on the steps of a little convenience store somewhere high above Pulajá as the woman proprietor, Dolores and her 5 children, sold us sodas, chips and candies and we spent the time telling stories and feeling the warm rain fall. Finally a mechanic that was summoned fixed whatever was wrong with the other truck with a flashlight and a few tools and we made it back to HueHue late in the evening. We were treated with a wonderful meal from Abesaida of chorizo, pepinos, zanahorios, papas y a delicious warm chocolate beverage.  Violation of work hour restrictions aside, we have had an amazing experience so far that few Americans are privileged to participate in. We feel very humbled by the strength and the spirit of these people despite the poverty, hardship and oppression they experience in their daily life.

Melissa's Turn

Bob's charla (presentation)

Yesterday we gave presentations (en Español) and taught small group workshops about obstetrical emergencies for about 15 nurses, 30 interns from the local hospital and 5 experienced physicians working in isolated, rural clinics. Beto and Cristóbal (el loro y el gallo) were their usual dynamic selves. Our scheduled interpreter had to cancel for a family emergency but we all survived thanks to the patience and assistance of our audience.

One of our graduates

We were inspired by the providers we worked with yesterday and learned as much from them as they did from us. One doctor, Dorian, grew up in a mountain village in Guatemala and wanted to provide medical care for his community. He comes from a poor family and couldn't afford medical school in Guatemala, so he went to Cuba to study and train. He then returned to his village to work in a "mini-hospital" as a general practitioner (including OB care) for about $10,000 a year. They work a 28 hour shift every four days, as the center is open 24 hours a day, seven days a week. He could make more money as a specialist in Guatemala City,  but chose to work in his community instead. Dorian requested to be able to participate in the ultrasound workshop that is happening today, always focusing on bettering his skills to further assist his community.

Photo with PCI staff

We were also impressed by the adaptability and ingenuity of the providers, some of whom work with very limited resources 7-9 hours from the nearest hospital. For example, some doctors will use an inflated condom (like a Bakri balloon) for persistent postpartum hemorrhage.

The whole group, interns in blue

We also talked with Julio, a pediatrician from the national hospital who is one of the residency faculty. the hospital has 4 residencies: internal medicine, pediatrics, general surgery and OB/GYN.  He invited us to give our presentation in the hospital so more of the doctors there could benefit, but unfortunately Suzy la ciguena slavedriver has overbooked us with too many other work opportunities on this trip. I guess we will have to come back some day. It felt like a coup actually to be invited so quickly into the hospital, as in the past, there has been resistance to foreigners coming in and teaching.  Perhaps our emphasis on informational exchange during the workshop helped with any concerns of bossy gringos coming in to dominate the scene.  

"Oh, that your smile isn't bitter and your hope does not die"

Today, Beto y Cristóbal will teach an ultrasound course at Casa Materna for the doctors and nurses who work there. There are a line of patients in front of the clinic waiting for ultrasounds already and it is only 8:30. Suzy and I will plan the workshops for the midwives in Todos Santos and Santa Eulalia.