A Day in the
Life - The Clinic Diaries - December 15, 2000
December
24, 2000
Merry
Christmas
Everyone!
To our Friends and Family -
Hello from sunny Guatemala!
We are doing fine. The weather is quite cool here, but it
is nice and sunny in this season. It is the dry season so it rains very
little.
We live at 6,600 feet elevation in a little
village called San Lucas, about 35 minutes north of Guatemala City, the
capital.
Our children are going to a Christian missionary school
this year that has a USA curriculum and a USA school schedule. This is
their first year of not home-schooling in four years and they are doing
very well. They enjoy it, but they probably won’t readily admit that!
Daniel is in 10th grade and is excellent in
math and is doing very well in other subjects. He enjoys working out
with weights and exercising.
Alan is in 9th grade and is also doing great
in math and his other subjects. Alan has grown quite a bit since this
summer and is now 1-½ inches taller than Greg! Both the boys are making
many new friends and seem to really like living here.
Rachel
is in 4th grade, and has a wonderful teacher and many friends
in class. She loves school and tries hard to do well and gets top
grades. She has really turned into a little farmer with an assortment of
animals that includes two dogs, two cats, eleven chickens and two
roosters. Oh, and she’s angling - and saving her money - for a horse!
Michael
started a business with a Guatemalan young man with whom he used to
teach with at the school in San Lucas. They are creating Internet web
pages and doing graphic design. They recently took in an
investor-partner, and moved to nice new offices. Michael’s office looks
out over a range of volcanoes. He’s online at
www.atrevido.net What you
won’t find on his web is that he is still going steady – more than a
year now - with a wonderful girl named Gabriella! She lives in
our village and starts university in January.
Anita
continues to work on the medical bus four to five days a week. We have
two employees - a medical doctor and a driver/helper, both Guatemalans
from San Lucas.
Our New Medical Bus
It was such a blessing to receive a donation of two buses (and lots of
donated items) from a group of schoolteachers and students in Ontario.
We are now in the process of converting one of the buses to a medical
clinic to replace the older, ailing bus we now have. The bodywork and
painting have been completed and the carpenter is now building the
interior cabinets and shelves. We hope to be on the road with this newer
bus in January. The older bus needs many repairs but we have a group
that wants to buy it and fix it up.
We love you and miss you and wish you a
Merry Christmas
and a Happy New
Year!
Many
Blessings to all of you,
Gregory, Anita, Michael, Daniel, Alan and Rachel
P.S.
Anita
has written a story that tells about a typical day on the medical bus,
in this case December 15, 2000.
------- The
story follows this introduction and we hope you like it.
---------
A Day in
the Life - The Clinic Diaries : Friday, December 15, 2000
by Anita Giagnocavo
5:00 am
Mornings start early in Guatemala. From our home a few blocks back from
the main highway we can hear buses blowing their horns as early as five
am calling people to ride to the city. Our roosters, numerous
neighborhood street dogs and daily fireworks (to celebrate someone’s
birthday) add to the cacophony.
I rush
to prepare for the clinic for the day by re-stocking the bus with
medicines and supplies. We converted a small school bus into a medical
clinic, like a mini-doctor’s office complete with many cabinets, counter
space and an examination table.
Our current bus – the new one we
are converting is a little bit larger
Greg
leaves at 7:15 to take the children to school, about 20 minutes away.
Our bus driver/assistant, Darvy, arrives around 7:30 and does a quick
mechanical check before he sets off. I take the four-wheel drive Trooper
to pick up the doctor, Dr. Martinez, and Darvy takes the bus on ahead.
On the
road to the village we are going to work at today- San Rafael, Sumpango
- we dodge buses careening down the highway on the first part of our
forty- minute drive. Bus drivers are paid for the number of persons and
are always in a hurry to get to their destination and return for another
trip.
Unfortunately, because the drivers are in a hurry and the buses are
poorly maintained, there are many bus accidents.
This highway has been repaved about eight months
ago but they still have not painted the lines on the road so driving is
always an adventure. People, horses, and dogs walk
alongside, and sometimes
on, the highway.
After 20
minutes, we pull off the main highway on to a dirt road in bad
condition; we drive very slowly for another 18 minutes as the road winds
up and down the mountain. We see rolling fields where workers - men,
women and children - with long hoes and machetes cultivate and harvest
the crops of vegetables and melons. I again dodge hores and people
loaded down with heavy loads of firewood -used for cooking-, harvested
crops, etc.
It
still amazes and saddens me to see very young children (as young as
five) and old people walking barefoot with heavy loads. I feel guilty
for riding in my old beat up Trooper as they struggle up the hills on
foot. In the rainy season they sometimes use plastic sheets as rain
protection, but often not. The people seem friendly and smile quickly as
I wave hello. When we have room, we give rides to the people, hopefully
lessening their load for one moment.
The
road is bumpy and I drive carefully where there have been rockslides or
mudslides that have been cleared by hand. Driving off this road would
mean a drop of perhaps 1,000 feet or more.
As I
enter the village where the majority of people work as field laborers,
shy children in native colorful clothes - called typical clothes - peer
at me and giggle.
The
native language in and around the village of San Raphael is Catchiquel
but the younger children are learning Spanish in school. The language is
difficult with sounds like clicks and “sh” sounds. We work with a man in
the village who speaks Spanish, Catchiquel and, a few words of English
which he proudly uses whenever he can..
He
reminds people when we are coming - we come here each Friday - and
passes the message on to the people. Unfortunately, even though he has
had no training, he likes to think he is a doctor and sometimes
dispenses medicine that was donated to him by some Americans.
8:45 am
It takes me ten
minutes to set up the bus inside and get ready to see patients. Darvy
passes out numbered tickets to the people waiting. It has been a year
and a half since we first started coming to this village once a week.
There is no other doctor or medical clinic in this town, and the bus
service is not frequent.
Adults
earn about US $3 a day working in the fields all day and younger
children working along side them earn about $1.50. Because a gallon of
liquid milk costs $3 and bread about a $1 a loaf, these types of food
items are not even brought into this village to sell. Besides, hardly
anyone has a refrigerator except one tienda (little corner store)
that proudly displays a hand-painted sign that announces they have cold
sodas.
The
diet here is mainly tortillas made from field corn, black beans, rice
and an occasional vegetable cooked in with the rice. Drinks include a
sort of “coffee” that they make by pouring boiling water over blackened
tortillas in which they mix sugar – it tastes like sweetened water with
a hint of coffee flavor. They might sometimes have the cheaper, inferior
coffees that have grain mixed in with low-grade coffee beans.
They
also make a thick drink, called atole, from finely ground
field-corn that is mixed with sugar and water. It tastes like sweet corn
made into a drink. They also drink sodas when they can afford it,
because much of the drinking water is unsafe to drink unless it is
boiled. Babies, children and adults drink coffee, but I am trying to
teach moms not to give coffee or soda to babies, which unfortunately is
a common custom.
Many
women are gathered around the pilas, which are public cement
sinks with running water where they get their water, do their clothes
washing, and even bathe their children. Few people have running water in
their homes, so young girls carry plastic jars of water on their heads
to take home to use for cooking.
Many young children have to
look after the babies in the family while the parents work.
I see
a five year-old walking along with a baby of about one year tied to her
back. She walks with difficulty but tells me her mother is working in
the campos (fields) all day and it is her job to watch the baby.
She is feeding the baby a bag of “Tortrix” a cheap kind of salty corn
chip that, to me, tastes like salty sawdust.
This
type of junk food is so common, because it is cheap and they like the
taste; but it’s not good for the children. I always try to encourage the
moms to give their children vegetables and meat, but they don’t always
have much more on hand than tortillas and beans.
Three
kids show up – some of our ‘regulars’. They like attention, any stickers
or treats we give. The one boy, Fernando, we nicknamed “Senor Zapato”,
because he keeps begging us for shoes. (zapato means ‘shoe’ in
Spanish.)
They
tell me their father works in “Guate” (the city) and their mom often
works in the fields. They are 6, 8, and 10 years old.
The
two boys are dressed in regular clothes- old patched jeans, various old
sweatshirts or T-shirts. The girl dresses in what are called ‘typical’
clothes, a woven one-piece wrap-around skirt held on by a woven belt and
a short sleeve slip-on blouse embroidered with colorful flowers. It has
been too small for her for some time, so to make-do, her mother has made
cuts into the neckline so it won't be so tight.
None
of the children have shoes but someone had donated boots to the youngest
boy some time ago. When he outgrew them, he cut out the toes to get
several more months wear out of them.
I shoo
them off the bus as our first patient, a man named Domingo, practically
crawls onto the bus. He is 45 years old and recently hurt his back
carrying a very heavy load of firewood.
It
happened four days ago and in desperation he caught a bus (there are
only three buses a day that come and go to this village) to travel about
a half hour to the nearest town that had a public health office. Many
times only have poorly trained nurses, so the patients don’t always get
the best care and the indigenous people are discriminated against.
The
nurse at the clinic gave him four tablets of a muscle relaxant but he is
still in agony. He has no money to buy pain medicine and our Guatemalan
doctor who works with us, decides to inject him with a painkiller and
anti-flammatory drug.
We
give him medical advice on how to treat his injury and instructions on
taking additional medicine. He is very grateful and surprised that we do
not charge him; later his young son returns with five eggs as a thank
you gift.
We
then see a one-and-a-half year-old baby girl who weighs only 14 pounds.
She has had severe diarrhea for several days. We give the mom advice and
medicine for the baby.
The
mom has also brought her daughter Sarah who is three and her son, Byron,
who is 6 years old. Both have open sores on their arms, legs and faces
that are infected. It's a bad case of
impetigo.
Along
with medicine, I give her several bars of soap and explain to the mom to
bathe the children twice a day. They don’t not have running water, and
no hot water, of course, and so the mom must bring water from the public
pila to her home.
Many
parents believe that if their children have a cold or cough you cannot
bathe them. This lack of bathing sometimes causes children to end up
with impetigo more so, because many families keep their chickens or pig
in the house at night.
These
animals are an important source of protein and food; families might only
eat meat every two to three weeks. The animals are not kept in pens, so
they roam freely all day foraging for food around the house or nearby. I
often hear squeals under our bus as pigs, chickens and street dogs
wander around.
We
then see five more patients that have anything from colds to bronchitis
and we give out more medicine and advice. We see a little boy who is
complaining of general pain and dizziness and we discover he has a bad
ear infection.
One
father comes with an offering of five small baskets of blackberries as
an offering. He says his 7-year-old daughter, Vilma, has been
frightened, won’t eat much and won’t answer him when he talks to her. We
doubt her condition has anything to do with being frightened.
Dr.
Martinez immediately checks her throat and ears and we find out why she
doesn’t answer her father when he speaks to her. It turns out that she
has a very bad ear infection, and she really can’t hear. We give her
antibiotics, Tylenol and vitamins and hope that there is not permanent
damage to her hearing.
She
smiles sweetly at me as I put a shiny heart sticker on her hand; she
quickly shows her daddy her sticker. Her father probably would not go
all the way into town to take her to a doctor because he would miss time
in the fields. And if he did get a prescription for an antibiotic, he
would not have the money to buy it.
Another woman, Genevieve enters the bus. She cannot read or write and
the previous two visits she said her age was 38 and 44 years old. Today
she says she is 27 years old. Age doesn’t mean a lot here and few people
celebrate birthdays except with occasional fireworks if someone has a
bit of extra money. She has an infection in her foot and it is red and
swollen. She is very thin and malnourished.
Although her first language is Catchiquel, she speaks passable Spanish.
Her plastic sandals are covered in mud and she says she lives “up the
mountain”. The infection started in her toe from a cut. She only owns
one pair of sandals but most of the time she goes barefoot.
We
give her medicine, cream and of course, antibacterial soap. I explain
how to care for her foot and hope she understands me. I explain that if
it is not better in eight days (a week is counted as 8 days) to come
back to our clinic. She repeats over and over “Gracias, Dios le paga”
(Thank you, may God repay you.) *** see the end of this story to
learn what happened later
Older woman sells bananas to
earn some money. She is wearing Indian-style, or “typical” native
clothing.
Next
we see two women, 60 and 70 years old woman. They are old for
Guatemala, where statistics say the median age is only 54. Both women
complain of sore bones, fatigue, and low energy yet they both still work
in the fields and one lady hunts daily for firewood, because she is a
widow living alone. We give each of them aspirin for their arthritis,
and vitamins. They both happy for the kind help and attention and leave
saying “Gracias”, “Dios le bendiga” (God bless you) several times.
10:30 am
Our next two patients are pregnant women. One is almost nine months
pregnant and has not yet been to a doctor during this pregnancy. She
will have the baby in her dirt floor home where she has had her other
three children. She is only 19 years old. She complains of having more
pain in her legs and stomach then the previous pregnancies.
Even
at this late stage of pregnancy, she is still doing all the laundry by
hand, preparing the field corn to be made into tortillas, gathering
firewood along with her three children, plus she carries her 1
1/2
year-old on her back everywhere she walks.
We
tell her she needs rest, and she nods her head in agreement. But she and
I know there won’t be time for resting. We give her vitamins to help
build up her resistance and Tylenol to use when she has severe leg
pains.
Her
blood pressure is ok, but she looks very pale. If she is lucky maybe her
husband has steady work so she can at least have a fairly healthy diet.
However, some of the fieldwork is seasonal and manymen will be out of
work soon for a month or so.
They
are hard workers and very enterprising. They weave clothes, sell
prepared foods or do whatever they can to earn a few quetzals here and
there. (A quetzal equals US$0.13) I am always amazed at how hard the
people work. We make her promise to come back to see us often.
The
next pregnant woman is also having her fourth child; but she is older,
at 23 years old. One of her children died when he was a baby. She did
not know why. Sadly, many children die without the mothers knowing why.
In many cases, the real reason is something “simple”, such as diarrhea,
or a treatable infection.
Poor
health and weak defenses are sometimes to blame -- a result of a bad or
poor diet, lack of food to eat, infections, malnutrition and sometimes
worms or parasites. This mother is very thin and looks worn out. Again
we give her prenatal vitamins and encourage her to eat a good diet and
rest as much as possible.
Our
next patients are brothers: a three year-old boy named Bernardo, and his
ten year-old brother Abram, who are both small for their age. They shyly
hand us their tickets that Darvy had given them earlier in line. Their
mother says that they have no appetite and have stomach pains. We
suspect parasites and give them medicine to kill the parasites.
We
also give them chewable children’s vitamins that we had especially made
at a laboratory here to include iron, as so many children are anemic.
Greg ordered these vitamins specially formulated with extra iron and
with an orange flavor. But the drug company colored them purple??
We
later discovered that for many rural people there is not a clear
connection between color and taste – even the drug company didn’t think
there was anything unusual about purple-colored pills with orange
flavor!
A family from another
village – despite their terrible circumstances, they always have a smile
for us!
Our
next patients have skin rashes. One man was working in the fields
spraying chemicals to kill crop bugs and the chemicals have left red,
scaly patches on his arms and hands.
These
field workers are not taught how to handle the chemicals, and they can’t
read the warnings on the packages. I worry about the longer term effects
of these chemicals and the effect of inhaling them, especially on windy
days. Especially because many young boys and girls use these sprayers to
earn money for their families.
We see
several more cases of “gastritis” which is their general word for
stomach problems. Some of it is bacterial infection, other times it is
pain from a poor diet, or worms and parasites.
Our
next patient is Maria, another pregnant mother, who is having her sixth
child at 24 years old. Two previous children died in infancy. Today she
has an abscessed tooth.
We
give carefully give her an antibiotic and Tylenol even though she is
pregnant and should avoid taking drugs if at all possible. But in this
case there was nothing else to do. Dentists won’t work on patients if
they are pregnant, because of the risk of infection.
Another mother, Juana, enters the bus with a gift for us, a bag of
homegrown tomatoes. She is grateful that we give her daughter
19-year-old Bernadina an anticonvulsant drug called Epamin.
Before
she came to our bus her daughter was having four or five seizures a day.
The reason was that the family could not afford the ten quetzals ($1.30)
daily that was needed to buy her this medicine.
Sometimes the government drug agency from which we buy our medicines
does not have Epamin, so then I have to run around to several
pharmacies to find it and pay the retail price. However, I know that if
we don’t have it available for her daughter, she will not get any.
The
young boys in the village tease her and people generally shun Bernadina
because they think her epileptic fits are caused by evil spirits.
Thankfully, the Epamin keeps her seizures under control. ***
for more on Bernadina, see “A Wristwatch for Bernadina” in
newsletter #2, or in the Stories section of this web site.
Next,
the man who translates the native language for us takes us to visit a
lady in her home, about a ten-minute walk from where we park our bus.
She
speaks very little Spanish but told us she is 44 years old, although she
looks at least 55. Two weeks ago she was bedridden with fever, bad
cough, fatigue and our doctor diagnosed her with pneumonia, and possible
tuberculosis.
When
we arrived on the last visit, she was lying on a bed of woven bamboo on
a wooden bed frame. There is a packed dirt floor. The walls for the
first four feet are made of mud, then dried corn stalks with a tin roof.
There are many cracks in the corn stalk walls and it is chilly here at
night. She has only two very thin blankets on her. There is no other
furniture.
The
dirt floor room was small but very cleanly swept. She had not eaten very
much for several weeks and lives alone except for an occasional visit
from her youngest, a 16 year-old son. She will not go to the public
hospital partly because of her lack of education and, fear - she
believes you go to a hospital only to die.
She
had earlier told our translator that she has seven children, who live
far away, except for her one son. Her husband was killed 14 years ago
and she has never really recovered from that.
Today,
we knock on her tin door several times, but get no answer. Maybe she
went to stay with someone. Nobody seems to know where she is today. The
last time we saw her we gave her a can of Ensure powder to
increase her defenses. I hope she is all right, and I say a silent
prayer that she is doing better.
12:00 Noon
We have already seen 30 patients and it is now12:00 noon, time to go to
our next small village of Santa Marta. As we are leaving this village, a
mother comes running up to us, so we stop to talk with her. She happily
shows us her five month-old baby. The baby looks healthy and smiles back
at me.
However, two weeks earlier this baby was seriously sick with a bronchial
infection, and severely congested. We told the mother that if the baby
became sicker, to go to the hospital. However we knew it would be
unlikely that the mother would go to the hospital. We gave her
antibiotics, expectorants and Tylenol for the baby. Today, the mother is
happy that her baby is doing so well and so are we.
Santa Marta -click
for info on Santa Marta
As we pull into Santa
Marta we park in our usual place, in front of a school. They are finally
cementing part of the schoolyard. In the rainy season, the schoolyard is
usually a mess of mud mixed with whatever the free-roaming pigs and dogs
leave behind.
The
government rule is that children must wear shoes in order to be allowed
to attend school. But in this poor village, so few children have shoes
that the school director ignores that rule.
Five
or six children are happily playing in the hill of sand to be used for
cementing. One boy about four wears a ‘typical’ girl’s skirt because his
poor mom only has one pair of pants for him.
The
children crowd around the bus to say hello. I urge them to run and tell
their parents that we are here. They scatter and in about ten minutes
people start lining up outside the bus.
One of
our first patients is a man of about 70 years who has fallen and his leg
is badly bruised and sore, but not broken. I wrap it with a tensor
bandage and give him medicine for pain and inflammation. He thanks us
profusely and leaves.
About
eight minutes later I see him returning and I ask him what’s wrong. He
states that the medicine doesn’t work because he still has pain! I
explain that when you take medicine orally it takes about twenty minutes
to feel the effect. “Oh, ok” he says and thanks us all again as he
hobbles away.
Next,
we see a young girl of eight years old who has just returned from the
hospital a week ago. She had surgery for an intestinal blockage, caused
by worms. She had been to another doctor earlier that month and received
medicine for worms.
The
other doctor had carelessly given her a big dose of strong medicine that
killed all the worms at once. But because she had so many worms, the
mass of dead worms caused a blockage in her intestines.
We
look at her scar – unfortunately the surgical doctor made a very long
scar, about eight inches long. The scar is red and puffy. We explain to
the mother how to keep it clean and dry and we give her antibiotic
cream, antibiotics and soap.
Upon
questioning, the mother admits that after her daughter’s surgery she had
been given a prescription for antibiotics but did not have the money to
buy it. So we give her some antibiotics.
Next
up is a plump little baby named Daniel, eight months old. The mother is
so proud of him, especially since he is so chunky which she feels is a
sign of being healthy.
I think back to a
little baby girl we saw in the mountain village of El Hato a few
months ago. She was about five months old and so malnourished that
her face seemed shrunk into her skull. Her mother, who was
breastfeeding, said she had very little milk and five younger
children. She had no money for formula.
Thank God someone had
donated some powdered infant formula to us, so we had given her all
we had. The road up to El Hato was very bad, and in the rainy season
almost impassable.
With our bus giving us so many mechanical problems, we could no
longer go to that village. However, the people there are so needy, I
hope that with our new bus, we can try to go back there again.
El Hato has no public
bus service and no running water. The well in that village dried up
several years ago, and the people are still waiting for the
government to dig another well. Meanwhile, they have to fetch water
from a mile away and carry it back home through the mountain paths.
Sadly, today the plump baby boy Daniel isn’t very happy. He has had
diarrhea for quite a few days and seems very irritable. After
questioning the mother and examining the baby, the doctor writes a
prescription.
I
gather the prescribed medicine while the doctor explains to the mom how
to make rehydration fluid. The mother’s thank you is a bag of guicoy,
small round squashes that are common and tasty.
We see
several more children with respiratory infections and parasites. They
always get so excited when I give them a sticker. I use these stickers
to reward the children for being brave, to encourage parents and
children to see us and, to lessen their fear of “gringos” (white
people).
Anita,
Amparo and woman with sick baby from a very poor settlement called
Balcones de Palin
1:00 pm
One mother brings in a little girl who has had a fever for several days
and has a bad ear infection and, a throat infection.
She
admits that she should have gone to a doctor earlier but her husband has
not received a paycheck for two months from his employers. She has no
money, not even for a bus trip to the city to a public health center.
Poor
people seem to have so few rights and I often feel angry towards those
who take advantage of them. But I know that God sees all.
The
mother explains that two days ago a six-inch long worm came out of the
girl’s mouth. When a person has a fever, the worms do not like it when
it gets hot, so they will leave the body through the mouth or rectum. We
decide to treat the infection first to bring down her fever and treat
her next week for worms.
Next,
we see two pregnant ladies and give them prenatal vitamins. One has a
bad cold so we give her Vitamin C and Tylenol and encourage her to drink
plenty of fluids. I can say, “get plenty of rest” but seeing the four
small children with her, I realize she won’t have that luxury.
Today
I must leave a little earlier than normal to attend a Christmas party in
the city that I had promised to go to. I feel guilty leaving early and
not waiting to see if some mother is still making her way down the
mountain. I remind everyone to tell their neighbors that we will be back
the following Friday.
3:00 pm – The Contrast
As I am sitting at a good meal in the nice restaurant in the city I am
thinking about where I was less than an two hours ago.
The
irony strikes me that probably none of our patients could ever afford to
eat even at this modest restaurant.
Their
dirt floor homes are a contrast to the carpet under my feet. The shiny
silverware, nice dishes and clean water a strong contrast to their
little shacks where they don’t even have running water in their homes
and only have a few chipped plates and tin cups to use.
My
daily admonishment to the mothers to boil their water that they give to
their children is tough for them to follow when they hardly have enough
firewood to cook their meals.
The
sound of Christmas music in the restaurant contrasts sharply to the
sound of crying babies, pigs squealing and people talking to each other
in a native dialect I don’t understand.
Yet
these people in the mountains are as precious to God as the people that
have nice clothes, modern homes and cars.
The Blessing
Even though my life is so very different than it was in the USA three
years ago, I enjoy every day here. I feel privileged to be able to do
what little we can.
These
people have taught and blessed me with their unselfish gifts, quick
smiles and heartfelt gratitude. I am so often humbled by them.
Anita Giagnocavo, RN
December 15, 2000
