El Ultimo “Blog” de Los Oregon Siete (7)

Saturday, October 10, 2015

Friday morning we had some tearful goodbyes with the PCI and Casa Materna Staff and of course Arnoldo, Paty and Abesaida lopez. Matt had to stay home and regain form after suffering a "traveler's ailment". Later all 7 gringos made it 3 blocks to the Halcones Bus station with their 12+ pieces of luggage and boarded a somewhat "seasoned" passenger bus direct from Huehuetenago to Guatemala city.

Casa Materna Moms with gifts "Babi Shower"

After a somewhat tortuous and even "aggressive" 6 hour bus ride (especialamente for Chapulin) on Un Autobus de Los Halcones from HueHue to Guatemala City AND a very complicated yet successful business deal involving three taxis, 9 big suitcases and 7 Gringos with 3 chapino choferes, we arrived at the beautiful hotel Ciudad Vieja en Zona 10. After checking in, many of us discovered our ATM and Credit cards had been hacked and our accounts were bled or billed several hundred to thousands of dollars. This was an unsettling event in what was 2 weeks of being treated as friends and family in this wonderful and diverse country. It reminded us that sometimes it is impossible to travel and avoid any theft or mishap. Despite this unfortuitous surprise (which hopefully will be corrected), Los 7 de Oregon gathered themselves, had a wonderful evening at a fantastic restaurant called Kacao (hard to say that without thinking of that Portlandia episode of the same name and not chuckle) and met up with our Chapina medical students Natalia and Grecia whom have started their 6^th year of medical school at Landivar in Guatemala City. It was great to catch up with them, share experiences and later listen to some live music at of all places  - Applebee’s!

Underexposed "Kacao", Mash and Mamut's favorite restaurant

Natalia and Grecia - Landivar Med Students whom spent two months in Oregon and Washington with our Family Medicine Residencies

My own gratefulness for this trip is that we escaped any serious malady, remained safe and were wonderfully cared for by the staff of PCI, the Lopez Guevara family of HueHue and every PCI, taxi, bus and tuk-tuk driver we met.

I was very fortunate to be together with so many remarkable and kind people in our group.

Our residents Matt Sperry (El Chapulin-Grasshopper) and Mali Nakhai (La Paloma Blanca – White Dove) worked hard, never complained, performed dozens of ultrasounds and were both great teachers and partners. Their kindness, grace, openness, humor and flexibility were welcomed gifts to us all and the people they cared for.

No one will ever forget Matt’s performances of “Los Ataques de Matea” and Mali’s well thought out and planned birth kits that were distributed to over 100 midwives.

Our senior faculty clinicians Orlando Acosta (El Chompipe) and Mike Waddick  (El Tejon) were amazing role models of compassion, thoughtfulness, dedication and unselfishness.

Orlando’s obstetrical experience and Cuban-style pragmatism coupled with Mike’s calm gentleness and sardonic humor were needed offsets for my own sometimes complex bossy ivory tower and frequently irreverent personality. Orlando was sometimes the only person that was understood due to his proficiency in Spanish but he still could get better at translating my jokes.
Mike was often the member of our group that the young nursing students swooned about and I think he is leaving behind several broken hearts.

Elena Mejia (La Garceta Afilada – The sharp egret) relieved countless patients’ stress points with her acupuncture and clinical skills.

She was our gift to the PCI staff who work so diligently under very difficult conditions, often with limited resources. And, She was always willing to learn complicated card games as well like Euchre and Scopa, right?







Finally, Suzy Happ (La Ciguena Rosada – The Pink Stork) pulled it off again!
Her knowledge and familiarity of this country and willingness to lead this group of strong minded and opinionated clinicians is an unprecedented feat of great diplomatic skill. It is because she is considered to be a saint in these communities that we were able to be so well trusted and regarded.  Her so obvious love and concern for the people for Guatemala is infectious and beautiful.

So what did we learn this trip besides "what happens in Guatemala stays in Guatemala"? Some simple things like:
* Always bring earplugs so barking dogs, roommate snoring and roosters crowing at 2 am prevent any disturbance from blissful slumber.
* Label your toothbrush so your roommate does not “accidently” brush his teeth with it on average 3-4 times.
* Bring a towel.
* Always choose "Comida Tipica" on the menu.
* Never pay the first price for any item.
* Never exchange your shoes and belt for a handcrafted item that might be made in China.
* Be prepared for the schedule to change, for the need to be great, for the resources to be little and for one’s heart to be open and experience some suffering.  
* Stay and learn from the poor as much as you can, be humble and be forgiving.  
* If you eat street food, make sure to watch it being prepared/grilled before eating it.
* Never use your ATM card that allows for access to your bank account.
* Make sure to take a Tuk-Tuk at least 2 times every trip.

"Don't forget me"

* Clean up after your workshop or clinic.

Senor Toad's Wild Tuk Tuk Ride?

Abesida y Arnoldo Lopez

*Always offer your hand and be prepared for many hugs and kisses.



* Don’t eat lettuce.
* Drink lots of water.
* Next time, try to come back with a smaller butt so you can fit better in the caravans and not feel like sardines in a can
* Always use TWO condoms when creating a makeshift Bakri balloon. 

Chapulin y Chompepe's Comida Tipica

* You can never be too grateful, speak perfect Spanish or eat enough at Abesaida’s house.  
* It takes about 2 weeks before you consistently remember to put the toilet paper in the little garbage can instead of the bowl.
* You only get away with bad Spanish for so long and be careful about inventing new verbs (choosear).
* Even though the rum is cheap, try to not drink too much of it.
* Pray for each other and the people of Guatemala who are going through their own transformation.
* Encourage our government to protect their right to a fair and peaceful transition of power and an end to massive corruption whether its former comedian Jimmy Morales or former first lady Sandra Torres as the next Presidente..

"How many more patients must die because of lack of resources (supplies)"

I am grateful to all our family members and companions here and at home who made this trip possible. Thanks to our partners back home who are covering our work, desktops and duties. Thank you to all who have donated. Casa Materna needs a new roof that would cost about $5000 US so maybe we can raise enough for them over the next few months before the rainy season. (See donation link to the right on this page if interested--help prevent future exam room floods like the one that almost drowned Mali).  Hopefully, some of you can have your own Guate experience in a time in the not too distance future.

Viva Los 7 de Oregon!

Viva La Gente y Tierra De Guatemala.

Amor and Brazos<

Bob “El Loro” Gobbo EE.UU.

La ciguena rosada says:  Thank you Loro for your thoughtful, funny and truthful summary of an amazing trip!!!

CAIMI, Mosh y Altiplano de Guate con El Tejon

The entry del dia is from the very nice badger man from the departmento del Wisconsin, Mike Waddick! Vaya los Tejønes!

Banner at the Infant and Maternal Hospital en Solama - La Verdad!

Parade of Tuk Tuk's

The group had a busy day Thursday.  We all woke up feeling fortunate to have survived last evening's Tuk Tuk rides from the restaurant.  After sampling more tipical comida for breakfast (mosh) (see below) ....

Bowl o' Mosh con Cafe

we went to the local health post and saw about 60 patients and ultrasounds prior to embarking on the winding mountain road back to Huehuetenango.

We saw a variety of patients and offered the best we could, certainly making a real difference in a small way for patients who have very little access to care and medicines.  The most difficult case for me was a roughly 9 year old boy who was essentially living on the streets who may have had spinal osteomyelitis.  His only real option for adequate care is at least 3 hours away, and has no money or ability to get care.

Before seeing patients, we got a tour of the health post which includes one room for deliveries, one sparse room with a blood stained sheet for c-sections.  They have one OB/Gyn doctor who was very overstretched.  Many sections are actually sent to Huehuetango 3 hours away.

Mama Chapina con su hija

Mali and our K'anjobal translator Reina

After seeing patients we had to race to beat the fog and clouds that descend on the altiplano like clockwork every afternoon.  With mountain passes and 500-1000 ft drop-offs, visibility is a sought-after commodity.  Fortunately, our drivers William and Henry from PCI were excellent and delivered us safely though the mist and clouds back to Huehuetenango.  We were greeted with an amazing meal of chile rellenos from Abesaida and her family.

Incredible Dinner with the beautiful familia Lopez Guevara de Arnoldo y Abesaida.

Tomorrow we leave Huehue after a good bye breakfast at Casa Materna we take the 5 hour bus ride of Los Halcones and hopefully see the chapina students from Landivar! Hasta pronto!

More Fun and Games in Soloma

Though it's Bob's login as usual, this is really Suzy now, updating the blog for a change. I've been a blog slacker I admit. But I promise I haven't been too idle; some nights I have been coordinating the packing up of animal shaped children's vitamins into little containers, or organizing supplies shlepped from the back of pickups to hotel rooms, or yelling my head off cheering Mali and Matt at the soccer game--(followed by a helmetless ride home on the back of a PCI motorcycle holding onto the star soccer player Otilio I might add, in the dark and drizzle, up and down steep roads in Santa Eulalia). All the adrenaline really wore me out that night.....

Santa Eulalia this morning!

Our PCI Team - Left to right: William, Bob, Elena,
Suzy, Matt, Mali, Orlando, Mike, Jeny and Edward

This morning, we packed it all up and moved the show down the road a few more miles to the larger town of Soloma. Despite the fact that it's a fairly big and bustling town in the altiplano, like Santa Eulalia there is not another gringo in sight. Walking around the streets we are like a parade of freaks for the gente, with children pointing and shrieking, middle schoolers daring each other to come up and say a few words in English to us, you get the picture.

Today was a repeat of Monday's activities, but in a different place. We are getting really good at this song and dance; we all have our stations down pat, just in time to leave. We started with the comadronas again in the morning, doing small groups, and handing out the Providence backpacks with flashlights and birth kits at the end. Next we presented to the personnel of the CAIMI (which is a center for maternal and child health in Soloma), and all the health posts in the area, with a few social workers and anthropologists thrown in for good measure in the afternoon.

Mali with Comadromas reviewing the birth kits.

One of the Solama Comadronas with
her Providence Backpacks with Birth Kits.

We enjoy the hands-on classes, the cultural interchange, learning how people practice their professions here. Without material resources, they often compensate with their own ingenuity and are motivated by their commitment to the people of their towns and villages. Everyone from the K'anjobal speaking midwives to the nurses aides to the doctors assure us they loved our presentations and learned a lot. They showered us with one armed side hugs, flowery words, blessings, huge smiles and often a lot of laughter.

Gringo Parade in downtown Soloma

Matea, the cross dressing seizure victim made her reappearance again today at the end of the day, which is always a hit. I wish I could recreate her voice for you all on the blog. It is sort of mix of Mr. Bill and a screeching cat. You will just have to ask her to do a personal show for you when we return. One takeaway of all of this is that I feel like we have a ton to learn from the Guatemalan penchant for warmth, welcome and making us feel very special. If only we could learn to treat visitors, travellers, and foreigners that way in the U.S.! Out of all my travels to this place which are many, I ONCE got ripped off in 1995 on a chicken bus ride to Huehue; the amount of people who have welcomed me with open arms outnumbers that one incident a thousandfold.

 Suzy addressing the midwives

Mike Waddick demonstrating breech delivery technique.

Tonight we went into town from the hotel on a Tuk Tuk named Emely, driven by about 20 year old Enrique, 6 total fit into the thing--seriously! Another thrill ride! On the way back the driver was no more than 13. Tomorrow we are going to do more consults at the health center right next to CAIMI; we are trying to get out of here to make the trip back to Huehue before the fog sets in. It sounds like a dangerous endeavor to attempt to get out of there by 3 at the latest....especially because today Elena heard a truck with a bullhorn announcing our consults tomorrow. Yikes. But we are motivated by the desire to arrive in Huehue in one piece. I predict chaos. We will see what tomorrow brings.

Not Mr. Toad's Wild Tuk-Tuk ride

Hasta Pronto and Dios Bendiga
Susan Happ

Dia de "CAP" Santa Eulalia

Waiting Room at the CAP at 8 am, line goes out the door quite a ways

A simply amazing and remarkable day. We were scheduled to provide consults and perform prenatal ultrasounds today for the people of Santa Eulalia along with many of the nurses and staff who participated in our training yesterday. It was a truly lovely morning at 9000 feet, blue skies, the sun shining, a great breakfast of Panquakes and we were off to the CAP. Now I am not really sure what that acronym stands for, but what we witnessed was a bare bones, clinic and emergency care single level stucco building staffed by dedicated, mostly young and bilingual professionals (that's Spanish and the Mayan language K'anjobal), crowded by the poorest yet gentlest people in Guatemala.

Happiness is doing lots of ultrasonidos

By the end of the day we provided care to nearly 200 people including 39 ultrasound exams. We saw babies, infants with febrile seizures and failure to thrive, many mom's in varying gestations of their pregnancies, domestic violence, scarlet fever x 3, and a few older people who were dying as their families asked for guidance as to what to do next for their beloved and honored father or mother. Sure, there were logistical and cultural barriers, but all in all, despite the dis or organized chaos, it went great! Suzy was our generous pharmacist, while Mike, Orlando, Matt, Elena, Mali and I saw patients. There was no EPIC charting, denials of meds (although we had a limited formulary (see above), PAR's, insurance forms, billing hassles, or meetings! Orlando and I were in heaven!

Mali'e Med List

Me and the ladies who were translators, "I needed a lot of them"!

Yet, the day fished with a few very humbling and kindhearted words form the head nurse. She earnestly shared that we were so very much appreciated and apologized that we had to practice in a place with so little resources. Little did she probably understand how grateful we were to be allowed to touch so many today and provide some kindness, help and our expertise. Many tears came to our eyes, the patients were so greatful, hugged us at every chance and asked us to come back.

Check out the brim!

We all know that the problems of Guatemala with its poverty, environmental poisoning, malnutrition, violence, corruption and just the peoples' very difficult and arduous physical existence can seem overwhelming. But we from North America have our own difficulties too, sometime because so much has been given to us, sometimes because we can suffer too, sometimes because we are ignorant to what is really happening.  It just seemed that our two worlds came together today, and it brought me a sense that there is hope for a better world, small step by small step with dignity in one hand and love and compassion in the other.

Maybe this is why the murdered American priest Father Stanley Rother who felt willing to fight for their peace and justice. Fr. Rother was a missionary priest from Oklahoma, serving in the Oklahoma Catholic Mission in Santiago Atitlan Guatemala when he was martyred in the rectory of the parish church on July 28, 1981. He was killed by right-wing paramilitary forces opposed to the work he was doing to improve the lives of his poorest parishioners. We visited his parish this past weekend in Santiago de Atilan. It is often said that one can only meet the Divine by living with and serving the poor.

Tomorrow we travel to Soloma which is about 35 miles south of our current perch for another series of workshops with the midwives and staff of the children's and maternity health post. This evening was topped off, by the way, with an exciting match of futbal in a covered small field (cancha) complete with artificial turf, drunken fans and our own Mali, Mike and Matt who played with local chapinos. Pretty much a blast with many "Golazos" and cheers from the Los Guerroros Verdes de Portlandia, Oregon (Suzy, Elena and Loro) while Orlando got some well deserved rest).

Chapulin y La Paloma in action

Hasta Manana,
El Loro -

Doble K'aj y Doble Talleres

We arrived early this morning at Santa Eulalia after climbing past 10,000 feet in the altiplano in the 4 hour journey from Huehuetenango. Orlando is our featured bloggist today and will describe the joys of a corn and wheat based gruel that we are been fortunate to be treated to today. Here goes:

Orlando, the most interesting man in the world:
"I don't always take public transportation, but when I do, I usually take a Tuk Tuk"

An impossible hotel, gaudy, yet dilapidated hotel, with views over the hills and fog,  whose vintage appears to be the 1940s, but the locals swear that this hotel has only been here 5, maybe 10 years at most.   How can this be? Santa Eulalia was a saint from Barcelona.  The Romans placed her in a barrel and rolled her down the street.  If this had occurred in Guatemala, she would have rolled 700 miles to the ocean, picking up some plastic bags and tortillas on the way.   Even the elevation of Santa Eulalia is in question.  Our headaches and giddiness imply at least 10k feet, though wikipedia experts say it is less. People here share a positive attitude, friendly even in the face of a difficult political and economic reality.   A few days ago I had to explain, once again what the hell a family physician is, much less one that might be interested in providing care to pregnant people.

Elena teaching about breastfeeding

Honorary Comadronas Bob, Orlando and Suzy with our new tribe. Note the Providence Bags with the Midwife kits.

Mali and PCI Member Rudy passing out the midwife kits

We spent a wonderful morning working with comadronas (midwives), via an interpreter translating from our lousy Spanish to K'anjoBal. Beautiful women in their outfits and ideas completely at odds to our own scientific biases.  An afternoon with nurses and nurses aids who work in outposts was easier and both were really fun.  These people take care of major emergencies, births, revolutions with zero governmental support, no gauze, no stitches, NO SHIT, I am not kidding.  Really inspiring.  

Anyways, mis companeros have come to not only tolerate but appreciate my unique personality, which I can say most do not.  On to another day tomorrow.  This is really fun.

The K'aj del dia

Orlando, El Chompipe.

Quincenera de Casa Materna y Lago Atitlan

Susy and the CMO and CNO in Huehuetenango
accepting the Misoprostil donated by our Providence Pharmacy.

Attentive Nursing Students listening to Elena's
Presentation on the breast pump.

Quinceañera De Casa Materna and visit to Lake Atitlan - Sorry that we have not written much in the past few days. We have finally been joined by our 7th member, El Tejon (the Badger) from Wisconsin, Mike Waddick who arrived safely even though one of his bags with some important supplies somehow bypassed Guatemala. Rumors are that penguins in Antartica have been selling the metronidazole on the "white" market. We spent most of Thursday seeing patients and doing ultrasounds at Casa Materna. Friday, however was a very special and beautiful day for Casa Materna, as we celebrated its 15th birthday, complete with speeches from dignitaries (like our own cigueña Suzy), music, singing, pastel and of course - a Piñata.

Santa Susana speaking at the "birthday party"

The Hood River Contingent outside the PCI office.

We spent the weekend bonding and relaxing at Lake Atilan, were we took in the amazing sites, failed miserably at haggling for the better prices and ate mountains of churrasco and great comida tipica. The nature conservatory was a highlight, with live coati's, spider monkeys, waterfalls and frightening suspension bridges. But the best thrill rides were the Tuk-Tuk that whizzed us in the narrow and bumpy streets of Panajachel.

Desayuno Tipico

Our "Guide" Pedro and the first poor bargaining
"deal" of the day

Tomorrow we will be in the mountains and the altiplano's at 7000- 10000 feet and will be working with midwives, physicians and nurses in the two smaller communities of Santa Eulalia and Soloma. Both still have a high maternal mortality rate and we will hope to learn from the midwives and health care workers what barriers they encounter and see if we can help them in their very difficult work.

Lago Atitlan at Sunset with the volcanos in the distance.