So we are in our fourth week here in Santiago, Atitlan.
The hospitalito (“little hospital”) was built with much fanfare in April 2005. A mere 5 months later, Hurricane Stan came and brought deluvian rains on this area. The side of a nearby mountain crumbled away and caused a massive mudslide, killing approximately 2,500 people, and destroying the new hospital. In retrospect, the people here realized that this was a known mudslide area that had been destroyed many times over throughout time.
People rallied together, and within 15 days, a new hospital was opened at the site of an old backpacker hostel. This two story building was quickly converted, and has been slowly augmented to its current state. Construction is now underway on a new hospital, which promises to be a much larger facility. THIS time, they have decided to build it in a mudslide free zone. The current hospitalito has 3 clinic exam rooms, and outside conference area, a small pharmacy, a social work office, an ER with 2 beds, 4 inpatient beds, 2 delivery beds, a small lab/xray area, and a small operating room. There are 3 full time local docs here who take turns running the place, and the hospital staff is made up of local indigenous people. They depend heavily on medical volunteers, financial donations, and medication/equipment donations. They are doing their best to slowly win over the trust of the local Tzu’tuhil mayans who live here. It is not customary here to visit a doctor. Most go to the local curarero (“curer”), “huesero” (bone setter), or rely on native plants as herbal medicines. The men carry generators, firewood, and 125lb bags of coffee beans using only a strap going over the top of their heads. The women carry immense loads as well on baskets on their heads. They sleep on the ground on woven reed pads. To say they must have chronic pains would be an understatement. They are tough, and regard life as being the same. They wield sharp machetes all day long in the fields and in construction sites (there are very few machines- almost the whole hospital is being built by hand- boulders chipped to size with machetes. MACHETES!). These people don’t show up in the ER with a paper cut asking for a note for work. Many see the hospital as a place you go to die. Unfortunately, this seems to be a self fulfilling prophecy, as they finally decide to come when all else has failed, and they are quite sick.
Diabetes is rampant (more from genetics than diet), and high cholesterol and hypertension is frequent as well. Many (especially women) have advanced COPD (emphysema) from cooking over smoking fire inside their houses, sucking in fumes all day long. Few get prenatal care, and alcoholism has a firm grip on many of the young men.
But they do come every once in a while to the clinic or the ER. And they don’t come alone. Every patient comes with his/her own troupe of family members/friends/neighbors. Patients that are admitted to the hospital never have to stay alone. In the room, outside the room, and outside the hospital, their family waits throughout the night. They don’t talk much, and they all share their meals (brought in from the outside by the family). The women never make the choice, but instead defer to the husband and the rest of the family. And money plays a big part. We don’t have a thrombolytics, CT scans, echocardiography, specialists, etc, so often we have to refer patients to Guatemala City (3 hours by ambulance through treacherous mountain terrain). Last week we had a woman with an acute MI. She, and the family, were adamant that they did not want to send her to the city. So we had to do the best we could here (we had one tablet of Plavix!). Today a man presented with an acute stroke involving the whole left side of his body. No CT. There isn’t much to do in the states, despite all the NIHSS scales and expensive meds, but here, man, we can’t do nothin’!
The defibrillator here is old, and does not have pacing function. But I just heard yesterday from a local paramedic (from Washington) that he gave the hospital a relatively new one 1 month ago. Seems no one really has a great grip on what we do and do not have, so their trying to dig that one out from the closet.
The volunteer coordination is not great either, apparently. We were told to expect to work 5-7 days a week from 730-5, and be on our own. But there are plenty of docs here. And this week another 5 showed up. So most of the time, we have more docs than patients. But as my dad always says “if life throws you a lemon, make lemonade”, so we’re letting the new docs work for a bit and taking a 2 week vacation. We’d love to go to Cuba, but since that’s not legal we CERTAINLY won’t that :-)
Quite the adventure here.
Peter, Gillian, Alexander and Annika