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.