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A Day in the Life - The Clinic Diaries

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  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


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