Goodbye Huehue

Day 13. Todos Santos.

Fog over Todos Santos

Group discussion with the Comadronas

It doesn’t feel like a trip to Guatemala without going to Todos Santos Cuchumatan, a truly amazing village with an unforgettable visual impression due to the local dress of the people and the landscape of the deep valley cut between towering cloud covered mountains at close to 10,000 feet. No less stunning is the outgoing friendly curiosity exhibited by the overwhelmingly indigenous population, which is not the norm in Guatemala, where indigenous people tend to be quite shy and reserved. Last year, El Loro Verde was so impressed with the warmth, welcome, capacity and indicators of success in reducing maternal mortality of the comadronas in this town that he left one of his teaching models with their organization so they would have an additional tool for their ongoing monthly classes.  Once again, after being welcomed back to their village as if we were all prodigal sons and daughters, we got into groups and reviewed the same themes as we did with the midwives in San Antonio Huista. These sessions were a bit more complicated by the fact that many of the woman did not speak Spanish and we had to have those that did help us translate to the local mayan language to be understood. However, the woman were still very interactive and we learned from them as they learned from us. 

Demonstration with the Pelvis Model

After we led groups with the themes we had prepared, we had requested a presentation from the comadronas on how they are using the model we left with them in their teachings. Once our classes were finished, it was showtime! A woven mat was set up on the stage area and and the pelvis was set in the middle with baby inside. A couple of the midwives got into their roles of scrubbing their hands, drying off, boiling water, cleaning and receiving the newborn in a carefully orchestrated drama with all kinds of props. At the end we were asked to rate their performance, and of course gave them a 10 – it was pretty darn good! They scored some extra points when we asked them to review the steps for what to do with a shoulder dystocia, which they did with some prompting about last year’s talk. At that point Doctora Ana joined in as well as a more dynamic model, pretending to be in labor and delivering her baby with a shoulder dystocia. 

Next came a fairly hilarious portion of our day called “Fun with slap bracelets”. Gallo Blanco had sent us with a honkin stack o slap bracelets to give out to the children and we had a lot left still. Alexis pulled them out, and the midwives went nuts for them. They stuck out their wrists so we could “SLAP” the bracelet on. As the bracelet curled around their wrist they would get startled, then laugh and giggle and sometimes even dance with glee. All in all, it was a fun morning of learning and cultural interchange. 

Mamut buys a purse

In the afternoon we headed out do a little last minute shopping in Todos Santos, known for it's amazing textiles. Unfortunately, Santiaga’s shop of textiles was closed this time, but we found another shop with beautiful (and very affordable) bags and embroidered cloths. We then made our way back down the twisting, winding road to Huehue, stopping briefly at the Mirador which overlooks the city. It was peeking at us throught the cloud cover, welcoming us back for our final night in Huehue.  We had a nice dinner with our host family of Pollo Jocon, a sauce made from tomatillos. YUM!  Then played some fun games with the family before going upstairs to pack it all up for the next mornings journey.

Day 14.  Bye bye Huehue.  

Happy mammas at the baby shower

First stop this morning was Casa Materna, where we had a little baby shower for the patients there. We gave them baby clothes donated by many Portland friends, as well as a Spanish children’s book for each of them. Then we were invited to a lovely goodbye breakfast where everyone said wonderful things about us in typical Guatemalan fashion that we have become accustomed to of giving formal speeches of, in this case, gratitude. Our work for PCI was apparently truly appreciated. Since we have also gotten some experience of the public speech on this trip, we also took the opportunity to share our thanks to the staff for their support of us in our goals of giving our residents some good experiences and the chance to enter in to their lives and the work which they do every day in an area where there is such rampant poverty, malnutrition, and lack of access to services.

Our amazing PCI Guatemala team

Next we found ourselves on a pullman bus to Guatemala City for the 5 hour trip back.  Upon arrival we were miraculously able to fit all 4 of us, the taxi driver, and all the suitcases, many between our legs or on our laps, in the equivalent of a Honda Accord to get to the hotel. We had a final euchre game at the hotel, which Alexis and Suzy won, before Alexis went off to meet with some relatives living in Guatemala city and the rest of us went to dinner.

Day 15.  WHAT NEXT?   

Writing this blog entry on the Houston to Portland leg of the flight home. Reflecting back on a few things learned during this trip:

1. We were not able to do the misoprostol project we had originally been asked to do; the local health ministry changed hands, and the health care system went into chaos, so now was not the time, but we are hopeful that with new connections forged on this trip we may still be able to include that as a future project.

2. With the helpful feedback of our critically thinking team, we were able to come up with a rough proposal for our next trip, a more coordinated approach focusing on one area or village at a time, with preliminary assessments and information gathering, followed by a multi-pronged intervention including coordinating with the health department to do ultrasound training with local staff (they have the ultrasounds in a warehouse with no personnel to teach and have asked for our help on this), as well as ongoing work with comadronas, perhaps including more useful birth kits or advocating for increasing their access to life-saving meds such as misoprostol, and possible trainings of local health promoters as well. 

3. We have done 2 trips so far; each team has a different personality, experience and gifts to offer. It all comes together somehow to create a meaningful experience for all involved. PCI/Casa Materna has given us the open door for our doctors to return at any time; they welcome our expertise and compassionate quality providers of care. This is Suzy writing: I feel proud of the Providence Family Residence Program and the great people I have had the opportunity to work along side of, ride chickenbuses with, play cards with, risk my life along steep mountainous roads with, parasail with, share delicious food and drink with, and take the time to unplug from the usual routine with to reflect on something new together. Something that hopefully benefits not only us and our desire to learn and grow in new ways but also benefits the humble and beautiful people of Guatemala who have welcomed and embraced us over and over. Sorry to go all Guatemala on you and give a little speech; but I have learned from them that sometimes it’s just nice to express your gratitude.

Jacaltenango and around

The Road to Pajal

Day 10. Monday. 

Due to rumors of protests closing the route to Jacaltenango from Huehue, we had to leave at 5am in order to miss the hubbub and get to our destination.  We slept in the PCI vehicles most of the way, only to wake up to some of the most beautiful scenery in the country. Cloud-covered mountains, winding roads, people walking along the roads starting their days by carrying firewood in bundles supported by a forehead strap, herding animals, washing laundry at the outdoor sinks (or pilas as they are known here). 

We arrived in the smaller town of San Antonio Huista first where we had breakfast. There was a locally grown coffee item on the menu, which was delicious, and actually had some strength to it. Guatemalans usually drink their coffee very weak, so it was a nice change.  After breakfast, we took a trip in our PCI pickups to the small village of Pajal, about an hour up a pitted, narrow, sometimes very sharply inclined road to ever increasing rural amazingness. The crops growing on steepest  hills, the houses of the people blending into the landscape, the view of Mexico and the feeling of being on top of the world all added to the experience, along with the adrenaline of the possibility of rolling off the road in our nifty little pickups at any point. 

"Club de Embarazos"

Finalmente encontro los huevos!

Upon arrival, we were greeted by the “club de embarazadas”, or pregnancy group. Though the plan initially was for all of us to meet with the pregnant women, there is such a deficit of medical care in this country that when word gets out that a doctor is in town, one person tells two more, who each tell two more and the result is crowds of people waiting outside the centro de salud. So quick change of plan, Suzy had prepared a talk on prenatal and newborn nutrition which she gave to the women in a nearby structure, Peter started with ultrasounds, and Tom and Alexis were left to deal with the throngs of people waiting for a consult.  Gosh, did we ever miss Brenda, and Doctora Ana! It was an overwhelming number of people just looking to see a doctor. On top of the general lack of medical care, the current political situation is such that many of the “puestos de salud” (small clinic outposts generally staffed by nurses) have recently (and very abruptly) been closed, leaving many villages without an option for medical consult. This village, like many others, is at least half a days journey to the nearest CAP or hospital and the trip is expensive. Knowing the situation it was hard to set limits with the people but it seemed the line never got shorter no matter how many people we saw. After Suzy’s talk, she and Vilma, the other PCI nurse accompanying us, started seeing patients as well to try to increase our volume. With our small team we managed to see close to 70 before having to close the doors so we could make it back down the mountain before dark.  We were all so thankful not to have EPIC charts waiting for us at the end of the day! 

House-call in Pajal

In addition to the consults that we saw at the “puesto de salud”, one woman had come asking for a doctor to see her daughter. The daughter had recently had a home delivery and was not well.  Tom and Suzy set out on a house call to see her, particularly concerned (and curious) when someone said that they had ‘felt an animal running around her insides. The woman was laying in her bed in her small one room house. A quick exam showed she was had abdominal tenderness and a fever and most likely had endometritis. She had apparently been given antibiotic when she first became febrile but had taken one dose and then was advised by her midwife not to continue the medicine. Postpartum infection along with postpartum hemorrhage is one of the main causes of maternal mortality in this area and without her antibiotics this woman was in danger. We recommended resuming her antibiotics or starting another one if someone could obtain it for her, and going to the hospital as soon as possible if no rapid improvement. Unfortunately, as it has been with most of our consults this trip, there is no easy follow-up and we are let wondering what her outcome was after our departure. 

After a full day’s work, we were shepherded into a local woman’s house where we were served a late lunch at 4:30pm of beans, rice, eggs and veggies on Styrofoam plates. We tried to pay the woman for her services but were told that the community had come together to pay for our lunch. It is so humbling knowing that many in this community often did not have enough for their own families had thought to provide a lunch for us. After lunch we we got to drive back DOWN that amazing road, past San Antonio Huista to the town of Jacaltenango to Hotel Florida for sleep. The hotel was nothing like Florida, but the owner was friendly and welcoming and we were very thankful for showers with hot water!

Day 11. Tuesday. 

Small Group Teaching

 After another breakfast and good coffee in San Antonio we drove across town to the “salon” where we were to meet a group of 40 local midwives. We were scheduled to start at 8am but upon our arrival at 8:30 there were two women waiting for us; we are all on Guatemala time now. At close to 10am we had 28 women and a group big enough to start with. It was impressive to hear the experience that was in the room! Some of the younger comadronas had been practicing for only 4 years, but ages and experience ranged up to a few in their 70s with 50 years of experience! We split into 4 groups and had small group discussions on the topics of Prenatal nutrition, “sinales de pelegro” (danger signs), Postpartum hemorrhage and neonatal resuscitation. Most of the woman were very engaged and also shared their own experiences with us. One  woman told the story of the birth of her own twins which she delivered at home; the first normally and the second breech delivered by “covering my hand in oil, then reaching up inside, finding the mouth with my finger and pulling to deliver the head”.  It sounds unbelievable but these woman have seen and done unbelievable things!


 

The comadronas practice breech deliveries

After the small groups we gathered back together, all the women sitting in children’s school desks, most with their feet swinging inches above the floor. For our final activity we had also brought pelvic models along with us to teach some maneuvers for difficult births. Although the midwives are taught that if the baby is breech she must deliver at the hospital, it seemed that the majority of the midwives had attended at least one breech birth so we decided that it would be useful to teach breech delivery. One woman started to tell the group about a breech delivery she had had, and proceeded to describe, step by step, everything we were about to teach. With such a clear description of a successful breech delivery we only had to demonstrate with the models before giving the women some hands on practice. 

Day 12. Wednesday.  

Guatemalan Public Health: CAP on strike

The next day we got to go to the local health center or CAP, Centro de Atencion Permanente. The CAP in Jacaltenango is run by a young doctor named Dorian Rojas who had met last year’s team at the handling obstetric emergencies talk given by Drs. Gobbo, Anderson and Paulissen.  He was kind enough to invite us to visit the CAP, a great opportunity to see how the public health system works in Guatemala. What we ended up seeing was not a typical day at the CAP, but probably was a good view of the reality of public health here. When we arrived at the CAP there was again a huge line of people waiting to be seen. Typically there are several doctors and nurses at the CAP who see consults all day, along with emergency medicine and deliveries. However, the day of our visit the people were told thy would not be seen other than emergencies and pregnant women in labor. Most of the staff had gone on strike and traveled to Huehueenango to protest recent cuts in government support. For this CAP recent cuts meant that none of the staff had been paid in 3 months. Despite not getting paid most of them, including Dr Dorian, continue to work every day, doing what they can with very limited medicines and equipment for the overwhelming number of poor people who need health care. I have to give a shout out here to Tisha at SE clinic and the Providence Warehouse for sending us down with extra medical supplies. Many of the items that wouldn’t be utilized at Casa Materna were brought here to the CAP. Dr. Dorian and the others who were here working today were so grateful for the gauze, the needles and syringes, the wound cleaner, gloves, the instruments for minor surgeries, etc.  They kept thanking us over and over. 

Dr Dorian on the ultrasound

Though we were not able to see general consults, we did have a morning full of ultrasound to do. They do not have an ultrasound at the CAP and patients have to pay out of pocket to a private doctor to get scans for prenatal care. Since we had brought the portable we were able to do 15 ultrasounds on women from 4weeks to 39 weeks pregnant. Alexis and Peter got more practice and Dr Dorian got to do some scans as well. Our hope in the future is to be able to continue to train local doctors to do prenatal ultrasounds at the CAPs in more remote communities. Overall it was a good day and it was fun to show the women their babies on the ultrasound and for some tell them the gender. We also had some more sobering cases; a 24 year old woman pregnant with her 6^th baby and two cases in a row of fetal demise. 

CAP Jacaltenango

After a long morning of ultrasound we left Dorian and headed back to Huehuetenango. This time we (mostly) stayed awake for the drive and got more impressive views of Gorge like passages, rivers, and of course beautiful local people an adorable children along the way. We arrived in Huehue exhausted, but invigorated from our journey.

NICKNAME QUIZ: the contest remains open.
Team: Susie, Tom, Brenda, Peter, Alexis
Nicknames: Mamut, Spuds, Tibarone, Mash, Santa ____

Halfway Through

Ultrasounds with Peter and Brenda

Day 6: Thursday

Another day at the Casa Materna.  Tom was able to spend a bit more time teaching ultrasound to Doctora Ana and a couple of the nurses, everyone worked hard to get through the line of patients, since there was an important lunch at Casa Materna in the afternoon. The leadership from PCI, San Diego was there, along with some important local health professionals. We were treated to marimba music and pollo pepian.  

Tom and Doctora Anna

Mamut bones

After lunch we got to go see a fascinating piece of local archeology, El mamut; a big pit in this old man’s back yard, where when he was going to dig a well many years ago happened upon some old bones, that turned out to be those of a wooly mammoth. So we got to hear his story and see the pit, and the little museum that accompanied it. All the more fascinating after hearing Peter’s story about people in japan trying to clone a mammoth and have it birthed out of an elephant.  Really cool! Then that evening, we got to go visit Suzy’s friend Manuel Saenz in his awesome penthouse apartment full of beautiful paintings, many of which he created  himself, and a nice liquor cabinet just full of surprises and history.  He served us tapas and we had a lovely evening of great conversation, laughter, and cultural education.

With Dr Jaime outside Hospital Nacional

Day 7: Friday

NICU at Hospital Nacional

The morning at Casa Materna, helping Doctora Ana with her Friday business as usual.  we were then able to take a break from work to go on a tour of the National Hospital next door.  It is one of only 3 public hospitals in the entire department of Huehuetenango, and the throngs or people in certain areas waiting for medical attention made an impression.  We visited the pediatric ICU, which was in the process of moving to another space, the delivery suite, the emergency room, the surgery wing, etc. Dr. Jaime, the new hospital director, was very hospitable and took an hour of his time to show us around and answer our questions.

And just like last year, we were introduced to and able to hold several sweet little babies who had been abandoned at birth or were in states custody and waiting for the legal processes to allow them to fiind a potential home.  The degree of suffering that one can witness and experience in the national hospital of a third world country such as Guatemala can be very sobering. 

Baby Holding

After a busy week, we decided we wanted a nice break, and the Lago Atitlan area was the consensus for us. Our faithful driver Josue insisted on giving us a lift, so we got to go in comfort and ease, through the mist and winding roads, knowing we were safe in his hands on the road.  We arrived in Panajachel on the late side and talked Josue into staying at our hotel for the night before driving back, and treated him to a nice dinner with us. 

WEEKEND: LAGO ATITLAN

Parasailing Lago Atitlan

Day 8: Saturday  

Panajachel.  Peter had floated out the idea a few days earlier that it would be a good idea to go parasailing over Lake Atitlan.  All three of us instantly responded, yes!  One of us was on the fence until the last minute when either he or she was running down the launch pad on the side of the mountain with the guide, waiting to see if the parachute would actually pick him/her up into the sky, or fail to open, causing said person to just roll pathetically off the cliff.  But at the last instant it worked!  It went up!  It was truly amazing to glide back and forth over the lake, taking in the villages and the three volcanoes surrounding it.  

Another game of Up and Down the River

The rest of the day was just relaxing after coming down from our adrenaline highs, and ended in a familiar fashion, with good food and a great game of cards while enjoying a genuine rainstorm in an open air restaurant as a handsome Argentinian guy sang in the background.  P.S  Alexis won again.  No one can beat her yet in up and down the river. Maybe we need to switch to a different game, one that Brenda doesn’t need to know how to pronounce the different suits correctly…..

Day 9:  Sunday

We wended our way to Quetzaltenango, or Xela as it is known in the native Mayan tongue, where we got to meet the family Alexis had lived with for 5 months in 2006. It was clear she had become a part of the family, as we watched everyone greet her with love and hugs.  While Alexis stayed to hang out with her people, the rest of us got a ride up the Fuentes Georginas, a gorgeous hot spring up in the mountains around Xela. It is a holiday weekend here, so many of the pools were packed, but not the really hot one that we tried out or the one you had to walk way way down to get to by the side of a rushing river.  Ah, lovely! Then came a sad moment when we had to say goodbye to Brenda, as she had to return to Portland after only one week. Now our team feels incomplete.....it will never be the same! 

Goodbye Brenda!

 NICKNAME QUIZ:  Last year Rachel Linder guessed everyone’s nickname correctly. However this year, they might be a little more obscure, and they aren’t birds. They have just arisen on their own through the course of the past week.  See if anyone can guess who is who:  La Tiburon, Mash (hint: it’s someone’s name in Aguateca, a local dialect), El Mamut, Spuds, and Santa______.  Whoever guesses correctly first gets a prize!

Arrived!

Well, after several days of internet connectivity issues and multiple messages to international tech support Chris Anderson, who some of you may recall as Gallo Blanco from last time, we finally have our blog up and running. We can’t guarantee the frequency of being able to post as it seems the internet is less reliable than it has been in the past, but we will do our best!

Arrived in Antigua!

Day 1:  Saturday. We arrived in Guate Saturday night and Suzy’s friend Estela met us at the airport. It is wonderful to have Suzy’s connections here to welcome us and help us navigate around. We were whisked off to Antigua, and after a little moonlight stroll around the city, we were ready for bed.


Day 2:  Sunday.  Upon waking, we had various logistical and leftover work responsibilities to attend to, so finding Wifi to complete chart notes, finding chips and minutes so our phones could function locally, and figuring out the day’s plans were at the top of the list. We enjoyed a nice lunch with Abesaida and Arnoldo, our Huehue host family who were in Antigua for the day, and then our natural born tour guide, Peter, spirited us away on a tour he had arranged for us to climb Volcan Pacaya.  Upon arriving, We were all excited to get some good exercise, but the local boys on horseback who were following us a few paces behind had different plans for us. “Hey, Senora, it gets pretty steep up there” they would say when they saw one of us breaking a sweat. Like hovering over a laboring woman with the promise of an epidural to take away her pain, they were waiting for any sign of weakness. They probably saw many, however either due to being too fit, stubborn, cheap or afraid of horses, depending on which of us you talked to, we persevered and they eventually gave up.

Roasting Bonbones over hot lava rocks

   



We were rewarded for our efforts of the climb by the chance to roast marshmallows over hot lava rocks, and also to ski down the scree on the way down!  

Rewarded with a spectacular view!

Buscando huevos con ultrasonido

Upon return to Antigua, we were able to practice using the portable ultrasound we have on loan from the company our PMG group works with, by scanning one of Estela’s pregnant family members. We then went out for a nice dinner, and off to bed in preparation for the next day’s travels.





Day 3:  .  Monday.   Rony and Josue, two of our favorite drivers from last time, arrived in their Project Concern International (PCI) vehicles to take us up to Huehue. Such nice guys! Always courteous, often funny, super helpful, we spent most of the day with them getting up to our destination of Casa Materna. Starting with these guys, we started to get used to the questions…..where is Loro Verde?  Y el Gallo Blanco? La flaminga negra?  Our team last year apparently made a big impression and are missed by the people here. I expect no less from this year’s team. Upon arrival to Casa Materna, we were greeted warmly if shyly from the women who are currently admitted here awaiting their babies to be born, and some of the staff as well. Bal Maria gave us an orientation to the Casa and to the programs PCI is involved with. We returned to our house to enjoy a lovely meal of delicious Guatemalan tamales (the best!) and enjoyed the company of Abesaida’s daughter Evelin and her family.
Day 4: Tuesday.  Hijo de la gran puchica! What a busy day. Adjusting to the med list, the flow of consults, the equipment, and a long line of people with only Ana and one nurse helping our docs made for a taxing day, but with some interesting learning for the residents.  No one really had a spare minute to even take photos, so you will just have to trust by the words on the page that we were just doing our best to help out how we could at the Casa and learn or teach a little along the way.  That evening we discovered that all of our team likes to play cards.  The first of several evenings of” up and down the river” was born, and a few nicknames surfaced, but they aren’t birds. Not sure if allowed to share publicly yet.  Stay tuned.

Jornada Medica en Chocal

Day 5:  Wednesday.  Our team with Doctora Ana Miranda, the young, thoughtful, compassionate competent Casa Materna doctor, went to the small pueblito of Chocal in the Malacatancito area near Huehue to give health consults and help promote Casa Materna to the area. On the way, there was a road blocked by construction, and a failed attempt at a detour which was resolved when our driver asked a guy working in his garden how to get to the village we were looking for. It was simple: just go back down the big hill to the entrance to the stadium, and turn left at the Casa of Don Oscar.  Aha! We had missed a vital piece of information. It proved very useful in locating the CORRECT detour.  Way way up in some very beautiful mountains we went to the local health center which is unfortunately closing soon due to the current collapse in the local health system. The government recently decided to cut  ties with many NGOs they had formerly worked with, so with already huge gaps in services for poor people in Guatemala, sadly, that gap will be growing. 

We spent the day doing ultrasounds and seeing kids, women’s health, prenatal and general consults.  Can we just mention something here? The kids are adorable. The photos speak for themselves. 

*This post thanks to the persistant dedication of Suzy (who wrote this 3 times before we succseffully posted), the technical support of El Gallo Blanco, and photo insertion and arrangement by Alexis.