My trip to Guatemala was my first trip to a developing country and my first global health opportunity. It has been something I have wanted to do for a long time, and I feel that God placed SewHope into my path at just the right time. I have developed such a strong passion for women’s health. When I read about SewHope and their work here in Guatemala, I knew instantly that I wanted to get involved. My time here in this beautiful country has far exceeded my expectations and has left an impression on my heart that I will carry with me always.
I got the privilege to be part of the first group to stay in the beautiful hostel right on the grounds where the SewHope clinic is. I was filled with so much peace on the first morning, waking up and watching the sun rise over the grounds. As time went on, this became routine for me --watching the sun rise in the mornings, and set over the land in the evenings as I reflected on the day. The first few days of clinic we saw follow-up patients whom had an abnormal pathology on their pap smears. Many women returned for further examination, biopsies, or treatment with cryotherapy or LEEP, likely preventing some of them from later developing cervical cancer. Unfortunately, we did have a few women whom were diagnosed with cervical cancer, which served as a reminder of the importance of continuing this work and expanding outreach to more Guatemalan women.
When we went out into the villages, I got an eye opening experience to what life in Guatemala was truly like. I think the most impactful for me was going into the village of Santa Amelia. We traveled along a bumpy dirt road for over 2 ½ hours to reach the village. It was an incredibly beautiful drive. The sun was shining as we took in the scenery of a beautiful green countryside full of rolling hills, flowers, palm trees and ranchers with their cattle. But I couldn’t help but think how hard it was for the people in the village to be so removed from everything. From fresh food, water, healthcare, etc. When we arrived into the village we were greeted by a large group of women. In total we did 99 pap smears that day. While there, we had lunch at a family’s house in the village. A young boy came on his bike and guided our van to their house. We were greeted by a man who was so happy to host us. He told us that they killed their chicken just for us that day! Dinner was served in a one room house, made from blocks and concrete. Inside the home were two cots, two hammocks above holding their small collection of belongings, and a large table to eat around. The home had no electricity, so we enjoyed lunch in the dim light that came through a single window cut out from the stone. For those who clearly had so little, their hospitality and warmth were abundant.
As we went into other villages, I saw the homes they were living in, and learned how so many families are getting by on just a few dollars a day. In one of these villages, we met with a group of women to arrange for them to come to the SewHope clinic for pap smears the next day. They expressed their desire to come later in the morning, as the municipality turns on the water every other day from 7-9am. Access to water every other day for two hours!!! It’s so hard for me to imagine, but this is the reality that they face every day.
Although this trip has been eye opening to me, it has filled me with so much hope that SewHope can continue to not only make strides in preventing cervical cancer, but also continue to impact and empower the surrounding communities. I think one of the biggest hopes lies in the children, to inspire them to work hard and to continue to learn and prosper. I was able to travel to Tikal National Park with a group of the kids from the school here at SewHope. I was really touched by their curiosity and strong desire to learn. We took a tour of the jungle and Mayan Ruins. The kids listened intently as our guide told the history of the Mayans and talked about different plants and animals we encountered. Many of them brought notebooks and took notes along the way, helping each other spell new words or fill in information they weren’t able to hear.
I will forever be thankful for this trip, the experiences I’ve gained, the lessons, and the people I have met along the way. Goodbye Guatemala. Until we meet again!
As our programs and our efforts in Guatemala have grown over the years, we have decided to bring on a full time person to join our U.S. team and help us make an even greater impact there! We have had the very great fortune to find Rachel Easley, a young woman with great vision, significant international experience, solid education but most of all, a heart and mind centered on making this a bit better world every day.
She came with me this past week to Peten and below are some words from her about her first experience there.....
"I could feel it when I first arrived: something special about the SewHope clinic. Ismael had picked us up at the airport and driven Doctor Anne and me here, and as we pulled into the gravel parking lot I tried to find a good word to describe this feeling.
“Is there a word for ‘home’ in Spanish, different from ‘house’?” I asked Ismael. He didn’t know an equivalent.
There’s something in the atmosphere here that feels like walking into your home at Christmastime, where the warm envelopes you as you step in from the cold and a fire is crackling and someone is baking cookies and all of your favorite family members are laughing and talking and playing board games. Except it’s hot and humid here, and maybe drizzling, and there are no cookies, and I’m new here so everyone is a stranger. But the feeling remains.
Then I walked through the clinic and saw what Ismael and Anne and all the others involved in SewHope had built: the multi-colored aisle of exam rooms, the school children engaged in their lessons, the new hostel for hosting groups, the papaya trees and mango trees and rows and rows of peppers and cilantro and heirba mora (a local plant). I feel a new word now: Paradise.
Here the sick are healed, the hungry are fed, the illiterate are educated, and the poor are given opportunity. Like Paradise. Like Heaven, maybe.
Except not always. Not every sick person who comes here can be healed. A good meal at school doesn’t fix a broken family at home. Sometimes the neighbors burn their land, and the smoke kills our crops.
So not Heaven, not yet. If it’s a Paradise, it’s a messy one.
But there is something Special here, some sort of mending of the rift between Heaven and Earth. Here it seems that the Kingdom of God is not so far away. It’s here in our teacher Seiner, as he loves and guides and instructs each of the children who show up in his classroom, regardless of where they come from or what their home life is like. It’s here in the hands of Elder, who works in the gardens, as he tills the earth, and carefully tends the chickens, and teaches the women from the community how to plant and weed and harvest. It’s here in our nurse Mayra, as she greets patients affectionately, and listens to their needs, and offers healing and comfort and medicine. It’s here in our director Ismael, as he coordinates programs, and supervises staff, and drives the “school bus” to pick up kids who live too far away, and takes care of visitors, and watches over the whole operation like a proud father (and does a million other things!).
I do believe that someday Heaven in its entirety will come to Earth: there will be no more sickness or broken families or violence. But for now, this is our imperfect Heaven, where we work hard and pray hard and love hard. A little broken, a lot beautiful: our own messy Paradise."
Thank you Rachel for your willingness to help us spread a little more peace, love and understanding in a part of the world that has been so oppressed for so very long....we thank God for bringing you to us!
Subject: The Joy of ReadingToday we had the pleasure of distributing a variety of books donated from a used book program in New York City. They were donated from an old school friend of Anne's who had actually left her engineering job to teach math to an inner city school in the city. It was very rewarding to see my efforts in transporting the books from New York through the airports in Guatemala greatly appreciated. The children treat the books so delicately, more so than I have ever seen in a typical school in the United States. They were very eager to start reading the books and flip through the pages.
Because SewHope's education program is structured primarily through online learning, the students are not often used to flipping the pages or reading aloud. The 400 books previously donated from a school in Toledo were well worn and read numerous times! And of course the children have the bible story books they have are treasured but what a joy for them to just get new books with new stories for them to explore the world with!
Today each child selected a book to read aloud to one of SewHope's volunteers. Not only did the students get to impress us with their reading skills, but listening to the students read is a great way for us to improve our Spanish skills too. After the school day finished, our volunteers took inventory of all the new books. This inventory allows the students to check books out from SewHope's bookshelves to read at home. Since books are extremely costly in Guatemala and the Guatemalan library system differs greatly than in the United States, checking out a book is unique for students who attend the SewHope program. By checking out a book, their eagerness for reading extends beyond the classroom to inside their home with their siblings.
It is my hope that the children will find a book where they can fall in love with the story. Even though it may seem difficult to find books translated in Spanish that are culturally relevant in Guatemala, this suitcase full of books contained serval characters offering Latinx representation. Some of the stories are related to farming, which is a familiar lifestyle to many of our students. (The majority of SewHope students' fathers work on a farm that exports pineapple and papaya). Other stories have relatable characters. One story in particular, called "Esperanza Renace" embodies themes of hope through a strong, optimist female character. I'm hopeful that some of the teenage girls in SewHope's program can find this character empowering. Within the next week, I plan to organize a bookclub to see how the students are enjoying the books. It gives me great joy to know SewHope's bookshelves are growing and so are the students' love for reading.
These past few weeks have been dedicated to teaching the students in SewHope’s Education program the importance of washing their hands, brushing their teeth and making healthy choices. After seeing many cases of diabetes among the women in our clinic, “Doctora Ana” led an engaging discussion in the classroom about the importance of eating healthy and reducing soda intake. Students watched a video from the CDC about the importance of hand washing. They have also listened to their classmate read about the importance of brushing their teeth from a local newspaper article. A descriptive poster now hangs in the classroom for students to read when they wait in line for their toothpaste. Using this poster, I explained how the formation of plaque and cavities are created (which is new information to some of the students).
All 83 children in the SewHope program are provided with a toothbrush. Even though a toothbrush may not seem like much, I think the students like having something they can call their own at school. Before we go outside for snack, the children pick out their labeled toothbrush with their name printed on it. They then line up to excitedly wait and receive toothpaste. Brushing my teeth along side them, I demonstrate how to use toothpaste and water conservatively. It has become part of their routine to wash their hands, eat their snack and brush their teeth.
Despite cases seen at our clinic that may have been prevented in an environment with higher public health standards, SewHope’s classroom, attached to the clinic, offers a receptive learning environment where we can teach the next generation healthy habits. Through washing their hands every day, eating a healthy, nutritious snack, and brushing their teeth, students learn these healthy habits. It is our hope that these habits the children develop in SewHope’s Education program continue into their adulthood.
Here's two little stories of the little miracles that come with prayer.
The other morning our team came out to our waiting area and asked the patients to join us in prayer. Ismael acknowledged the goodness of our God, thanked Him and asked Him to bless our work, to give us guidance, to help us bring healing. He prayed for all the patients that were there. In my church at home, we have a time at every service where our Pastor asks if anyone has any special prayer of thanks or petition that they would like to share. Often, when those prayers are said, there may be someone or many in the congregation who may be able to be an answer to that person’s prayer. So I added at the end “Does anyone have any special prayer they would like to offer or say?”
I don’t think that kind of thing is customary here so Ismael quickly said “Any of you can pray with any of us when you come back.”
So my first patient came in – a 70 year old woman with many of the infirmities that come with the reality of getting older – diabetes, arthritis, lots of aches and pains. I did my exam, gave her a pap smear, offered some medications that might help and then she said “Would you pray for me now?”
Thinking she had some particular problem in her life that needed prayer, I asked “Is there anything special you would like to pray about?” She smiled broadly and said “No, I just think that if you would pray for me, I would feel so much better. I think it would take my pain away and make me feel less worried.”
“Wow”, I thought. “you must think I’m capable of a whole lot more than I do!” I wanted to tell her that I don’t have any closer connection to the Almighty than she does….that I’m just a flawed little person trying to find some purpose in this world. I felt like her request was one of the biggest things I’ve ever been asked to do. You’re saying that just ME praying might make you better!
I’m honestly not AT ALL one of those people who is good at praying out loud. You know how some people can just go from 0 to 90 in one second and invoke all this inspiration and feeling of God’s presence in their prayers. Well I am definitely not one of those. But I just felt so much responsibility….. like she was asking me, an unworthy person, to bring her healing in a way that was so much grander than any medication or surgery.
So I said ok and closed my eyes and held her hands. I paused for a minute (another hard thing for me to do!) and just really asked God to give me the right words (in Spanish, nonetheless!). I don’t even know what I said but whatever it was, she started crying and squeezing my hands so tight. Whoever God is, I could just totally feel Him in our presence – that Spirit that we talk about was just so right there.
The prayer didn’t last very long – maybe a minute or two. At the end, she just hugged me and said she wouldn’t forget this and she was so grateful.
Maybe she thinks some Gringa doctor has some connection with our God that the average person doesn’t have! All I know is that she believed in God and she believed in me. Perhaps God sent her to me to show me the power of prayer – of how when we humble ourselves and ask with a pure heart, anything can happen.
The next day, we had a group of women come for treatments for their precancerous lesions of the cervix. Some of these lesions are pretty significant and they need a procedure done that has some risks. I’ve done it here many, many times. Sometimes it is very easy and other times, there can be some complications that make it a bit more challenging. I had been emailing Randy just 30 minutes before and telling him how the day was going so well and all the procedures were going without a hitch. Don’t I know after all these years that you should never say anything like that!!! God will surely humble you in a second if you start to feel a bit cocky! Inevitably, as soon as you say that, problems start.
So I started this procedure on this woman. There were many reason why it was more complicated but without boring my non-medical audience here, suffice it to say that it was a challenge. The next thing I know, my “loop” (connected to electricity so that it should burn as it goes thus eliminating bleeding) must have hit what Dr. Phibbs used to call the “wandering vein of hemorrhage”!
In one second, it was like I just put a hole in a major pipe and the blood came pouring out. Now at home, this is easy. The patient is asleep so you can manipulate things without them moving. You have great light, lots of assistants, any tool you want at your disposal. But here that is not the case. My heart started pounding thinking about what would happen if I couldn’t get this controlled quickly.
Now the patient had NO idea this was happening. There was a drape so she couldn’t see anything. I didn’t say a word. But a few seconds later she just started praying quietly out loud. And somehow I just knew everything would be OK. Somehow I was able to place sutures quickly in the midst of a stream of blood that blinded my visibility and everything was fine. Again, it was like the Spirit of God just swooped in, brought calm and gave me the ability to do something that was almost beyond my reach.
At home of course, the same thing would have brought a flurry of people and instruments and better light and better attention from everyone. Here, when those things don’t exist, you just invoke the power of God and prayers seem to be constantly answered.
Believe me, I’m not bashing modern technology in medicine – it is incredible. But maybe a little prayer and faith in God’s power would help a bit too! Maybe we should all offer more prayers to each other. Maybe when we say “I will pray for you…we should really do it.” That presence of the Spirit is an awfully nice thing to have around!
From my last visit here in May, I can see how students have progressed in their mathematical knowledge, reading fluency and reading comprehension. Eight months ago I remember working with a boy on basic subtraction and today he consistently answered challenging division facts. There is also a handful of seven and eight year olds who are accurately dividing and simplifying fractions. It is very impressive to watch them complete this mathematical process, sometimes even in their head. Frequently students will raise their hand to ask a teacher a question related to their mathematics on Khan Academy, only for their friend sitting next to them to eagerly explain the answer to them. By listening to how a student explains the answer to his/her classmate, it becomes evident just how well they know the material. This daily occurrence is just one example of how I can easily see the positive impact Sew Hope's education program has for all students.
SewHope certainly provides a nurturing environment for increasing literacy. Last May I remember assisting a five year old sound out words as she was learning to read. After listening to her classmates read the children's bible to close the end of the morning’s class day after day, she now reads aloud to her classmates. Although I am not an expert on grade standards in the United States, the book that this six year old girl fluently reads certainly surpasses the first grade level. Additionally, I asked one of the older students what she likes about the math program here. She explained that she likes how she can answer challenging questions she does not get asked at school. I am very thankful SewHope offers an opportunity for all students to grow academically and spiritually. If it were not for the support and resources SewHope provides to its students, many of these students would not be able to see how they can excel academically. Their evident academic growth and eagerness to continue learning inspires me every day.
Attached is a video of a girl reading her favorite page (upon my request), while another student summarizes the stories the class read. I believe this video is representative of SewHope’s positive impact.
I think this is about my 40th trip to Guatemala – every time my experiences here are so full of everything that God promises us in Galatians 5:22-23
"But the fruit of the Spirit is love, joy, peace, forbearance, kindness, goodness, faithfulness, gentleness and self-control."
On these trips, I’m always surrounded by the most wonderful people – the beautiful Guatemalan people and of course, those who work with us here as well as those who come with us. The people suffer from things we could never imagine in the United States but through it all, they smile and praise God and take care of each other.
Two people came with me on this trip. Tim Kuhn is an engineer in Toledo. This is his fifth trip. Along with a few other great men, he has been responsible for getting all the electric work done in our clinic and now in our hostal. He’s a quiet, highly capable and resourceful person who spends the days working every minute to maximize his effort. In between seeing my patients, I see him zooming around, climbing ladders, digging ditches, laying electric wires, installing electric boxes and while doing it he is endlessly cheerful. He’s always looking for ways to improve our facilities and thus improve the lives of those who visit us.
Meridith Heckler is a third year student at Kenyon College. This is her second trip and she is here for 3 weeks. Her dream is to become a teacher and wow, did she ever find her calling! She spends long days with our children in the after-school program inspiring and loving them. When she was here last May, she only knew French but she was determined to be able to communicate with these children. Spending the last 10 months in an intensive language experience, she now she is actually quite conversant with them!!
I have never seen anyone with the patience and love for children that she has! She just marvels at the success of each child and makes each and every one feel that they are precious. They all flock to her now. And while she is only here for a few weeks, she is integral to our work because she is helping us find gaps in our program that can be made better and she’s surely helping us realize that indeed the students are thriving even more than we had imagined! Meridith honestly delights in the great advances she has seen in the children since her last visit here less than a year ago. Her blogpost is coming!
So I’m attaching a few photos of what's happening here! Thank you all for making this work possible.
Sometimes God happily reveals himself in moments of doubt.
So it’s been a lot of trips, a lot of years coming here. Of course, the longer I come here the more the people of Guatemala become my friends, my family. With each trip, the language gets a bit more comfortable, the culture a little more ingrained in my heart.
The longer I do this, the more I challenge myself with questions about whether it is right. “Are you sure we’re doing the right thing, the right way? Sure we shouldn’t be just spending our efforts on the poor in our own city? Sure this is really worth the great generosity of all the people who contribute? Sure this is not just a way to justify your existence, to overcome a sense of duty? Sure you’re not imposing yourself on another culture??
The first few days down here on this trip were a bit overwhelming – dozens of ladies lined up desperately looking for answers to their problems. It’s hot. Everyone on our team is working so hard. I hope I’m not asking too much of them.
I said a quiet prayer one morning asking God to give me a little assurance that all of this is the right thing.
I ask God these things a lot at home but the answers rarely come. Here, the little miracles just never stop and as always, I got my answers in a matter of hours.
When we came back to the hotel that night, I saw the woman I had done the "hotel pap" on last year. Six ladies that work in the hotel where we stay had asked if I could possibly do their paps at the hotel. I happily agreed but when that evening came, it was the last thing I felt like doing. I almost secretly wished they had forgotten about it. But no, there they were – all dressed up!
So we went in a room and I did their paps. And incredibly enough, a few weeks later when the results came back, one of the six had an early stage cancer....She of course had not had any symptoms and was as surprised as I was. We had arranged to have her go to the only cancer hospital in Guatemala but that was the last we heard. And now here she was.....
She gave me this enormous hug and we both filled up with tears. She told me she had her full treatment in Guatemala City and now she is hopefully cured.
It gave me more than the assurance I needed that this indeed worth it.
At a time that I am so very disillusioned at what is happening in my own country and so disgusted at what I am hearing, I feel so much happiness and contentment being here. There is just such a sense that we are all God’s people – all created the same in His eyes and all with the call to just take care of each other – doesn’t matter what color, what language, what level of income – just a call to be God’s people in unity.
Sometimes God happily reveals himself in moments of doubt.
“While we try to teach our children all about life, our children teach us what life is all about.” -Angela Schwindt
Here are some thoughts from Sara Aja, a young pharmacist who has joined us here in Guatemala this week.
Today is my third day in the classroom at SewHope.
I have always loved being around children, but there is something so different about this group of kids. I help with Sunday school at my church in the United States and it seems like a constant struggle to keep children engaged and on track. Here children come in and sit right down at their computers. They grab their workbooks and begin their math programs without being prompted, and they continue to work until they are directed to their next task. They all seem so eager to learn, and I wonder what we have done to take away that eagerness from children in the US.
Several older students volunteer their time to help the younger ones, and when a child seems to be struggling with a problem their peers try to assist them. So not only are they staying on task without much direction from their teacher, but they demonstrate teamwork and joy in learning. The best part of all of this is that they are here by choice, it is November and all of these kids are on their version of summer break from school. Children in the program at Sew Hope also go to public school during the year and come here a few times per week to supplement their education. Each day they are here for 4 hours. They CHOOSE to be here and seek to learn.
I think for many of them this environment gives them something productive to do. If the children weren't here they would be at home helping their mothers around the house or not doing much of anything. Each day here they spend time in math and reading, and have time for games together in the front yard.
Most days I've been here they also spend time reading a bible story together. Today we read about the disciple Paul and how he once was a bad man but found the Lord and sought to bring glory to his name.
This time is also used to practice the children's ability to read aloud in a round robin style each taking turns. After we finished reading, everyone helped put the supplies away from the morning and made their way outside for lunch. For lunch one of the mothers cooks here for all of the students. It is amazing to me how quickly they all eat! After lunch each goes to find their toothbrush on the wall of toothbrushes and their teacher Seiner gives them a little toothpaste. When their teeth are cleaned and bellies are full they head home for the day.
Seiner has two groups- one in the morning and one in the afternoon. He is an AMAZING teacher! He provides a lot of one on one time with each student while they are working on their math or reading, and he plans fun games and activities for them each day. Yesterday I was on one of the teams for a relay race, I felt bad for my team because I was the slow one. Beyond his planning abilities, Seiner is also patient, calm, smart, and so creative! I am inspired by his love and attitude for these children!
And truly I am inspired by each of these children through their simple joys found in each day.
I think poverty here is far worse than poverty in the poorest of countries.
Thanks to the great efforts of Ken Leslie and a whole cadre of people who have hearts like I've never seen, I had the privilege today of volunteering at "Tent City" which is described as a "weekend-long event in Toledo that delivers the entire community's compassion to those who often see none."
For those of you who know me, I've spent many years working with the poorest in one of the poorest countries in the world, Guatemala. But today I heard stories that made me cry more than I’ve ever cried in that poorest country. I thought I had heard it all in Guatemala - 14 people living on a dirt floor in one room with almost no food. Children dying prematurely. Mothers dying in childbirth all too often. But somehow the stories today were harder to hear - especially when they were from people living in the richest country in this world. I left today sobbing thinking how it's really just not right. How can a country like ours with so many people living in comfort, in security, in wealth ALLOW this kind of human tragedy to be in their midst. How can I?
I saw hundreds of people today who have had their dignity taken away.
I asked one woman "So where do you live?" And she said "Oh, not too far from here. There's a grassy spot on the corner of such and such where I usually stay. But sometimes I get to sleep inside a room that’s warm but I don't like it too much because they sell me.
And I responded in confusion "They sell you...like for sex?" And she says "Yeah, I hate it because I wake up and there's some guy on top of me"
And then I say "So you get some money?" And she says "No, but I get a warm place to sleep"
And with that...I was without words....really? really? 8 miles from where I live with everything I could ever want, you have to experience that?
So what happened to the whole idea of God-given souls created equally? You know, those souls that we pro-life people fight for with such passion? The souls that we Christians say are so important because our God created them? Do we not all as Americans have a bit of responsibility to fight for those souls?
We're not even talking about food or shelter or water.....we're talking about the most basic of basics....dignity. There are more people here in our country living in LONELINESS than there are in Guatemala.
How on earth does the United States say it's OK for our own citizens to live like this?
My eyes were opened in a whole new way today. I thank you Steve North for your passion to open the eyes of people like me to see the plight of those who are the most desperate.
I often read about the existence of millions of hungry people in Latin America. When I am there, no one appears starving because of the easy access to corn tortillas which are incredibly cheap. They fill the hunger pains but not only do they not do much for nutrition, they also contribute to the massive level of type 2 diabetes.
So mostly the people don’t complain of hunger.
But I started asking more about it on this trip. What do you eat for breakfast? “Tortillas y sometimes frijoles” For lunch….the same. For dinner….the same
But I was particularly touched by one of the very lovely and exceptional students in our program.
“Did you eat breakfast this morning?”
Her eyes got really big and she said...
“Because we don’t have any food. Ni café, ni azucar, ni nada” (not coffee, sugar or anything).
Thinking she may be exaggerating a bit, I asked “So what do you eat?”
I eat the food that you give us everyday at the school.
I recently read an interpretation of the parable of the multiplication of the loaves (Mark 6:34-44) written by Father Frei Betto, a Brazilian priest, journalist and theologian who was an activist for the cause of the poorest in Central America
In this gospel story, 5000 men had just heard Jesus’ sermon. The disciples suggested that Jesus buy them something to eat. Jesus’ response was that the disciples could “give them” something to eat. (In reality, there was plenty of food to go around). Jesus didn’t ask how much money the disciples had…he asked how many loaves they had. Throughout the gospels, the distribution of bread symbolizes the Father’s kindness and food is associated with life’s abundance. At this event, Jesus realized that of course there were all kinds of vendors at that event selling food. In reality, there were many fishes and many loaves. Does this mean there was not a miracle? Of course there was a miracle. But there was not magic. Magic would be the spectacular action of taking the loaves and fish and saying “abracadabra” and suddenly food appears. The miracle was to alter the natural course of things….changing people’s hearts so that now they were willing to share their goods so that no one would be hungry.
If you are reading this and you would like to help us send more food, please do so. We need your help. It’s not easy to help a whole lot of starving people.
Today a pretty amazing thing happened....one that I've never had happen in my office in at home. A 59 year old woman arrived who I've seen several times before. I've been following her for "carcinoma-in-situ" of the cervix. While this is something that is not quite cancer, it's pretty close. Anyway I did a procedure on her a few months ago and not all the problem cells were removed so I told her I thought she should have a hysterectomy.
So she came in today and said she just really didn't want to have to go through surgery because of all the risks and she really thought I could take care of it. She said "I'd like to pray." So I said "of course" and the next thing she stands up and raises her arms in the air and starts crying and begging God to work through me to take care of the problem.
She continued to pray for about 5 minutes and then she stopped and looked at me with complete peace and said "Go ahead and do whatever you need to do. I'm sure you'll be able to take care of it!"
Anyway, the procedure went well and we'll see. Somehow it felt really wonderful to think that she realized that I can do what I can do but ultimately it's up to our God. It really, really felt comforting to be surrounded and supported by such faith.
A huge "abrazo" when she left. I like being a doctor here!
"Poco a Poco" is what Ismael said today as we marveled at all the things that have happened in the last few years. Every time I return, I continue to be amazed at all that has been done in a short time and with our limited resources.
We now have 2 outstanding Guatemalan nurses who clearly function at the level of a nurse practitioner in the U.S. I find myself asking them for advice as often as they ask me. I might have a bit more training but they have the years of experience of dealing with the illnesses common to tropical places.
I fall in love with the children in our school more and more with each visit. Their eagerness to learn makes me so very happy. This week I met with three of the older students for a couple of hours to talk about ways we can improve the program and find even better means of encouraging the children to achieve.
Our agriculture program continues to grow. Tomatoes, peppers, corn, herbs, watermelons, different fruits...all thriving on our land. The children participate in the projects and benefit from the food provided. Today, we had one of the project coordinators from "Friends of Guatemala" join us to look for ways that we can collaborate in the area of agriculture.
Ismael just finished planting 150 Ramon trees which you can read about here...http://www.rainforest-alliance.org/kids/species-profiles/ramon-tree as well as 75 yucca plants which there are lots of nutritional plans for.
The cervical cancer prevention program is continuing to work so very well. All the women return for treatments and we continue to get more and more referrals from the Ministry of Health. Yesterday, I did a minor surgical procedure on a woman with carcinoma-in-situ of the cervix. Without this treatment, she would have developed a cervical cancer which is almost incurable in this country. When I finished, she was crying uncontrollably. Not knowing if she was in pain, I finally got her to calm down and she said she was crying because she was so very appreciative. She had been worrying about this condition for months and didn't know what she would do. She couldn't believe that we would come here to help and she just kept crying and hugging me. Really, how much more can you ask for in life!!
Construction will be starting in the next few weeks on our new hostal which will give our teams a safe and close place to stay and will enable some to stay for extended periods of time.
Are you content?
With each trip, I gain new little insights into life…..Somehow in a place where I have access to so much less, I learn so much more and I feel like I become so much more.
“El esta muy contenta….gracias a Dios” dice su mama – “He is very content….thanks to God” said his mom.
A tornado of thoughts whirled around my mind. Isn’t it amazing how the brain has the capacity in one second to experience so many more emotions/sensations/words than could ever be spoken in a lifetime? In just a second, your brain can think a “monton de cosas”.
Muy contenta? How could he be content? And what does content mean?
If you think about it, we don’t really use that word very often to describe our state of being. We say we are happy or sad or frustrated or excited or furious or feeling great but we rarely say we are content. But in Guatemala, the word “contenta” is used often. People say it all the time to express that all is good with the world…at that moment they have no worries….nothing hurts….they feel peace…..connected with God…..it’s an all around good feeling. I guess when you suffer often, then being “content” is a marvelous feeling.
Somehow at home I don’t think we value being “content”. Just sitting around feeling “fine” and not suffering is never enough! We have to be doing something, achieving something, experiencing something, debating something, or maybe criticizing someone.
But I guess when you are in a place where everything is scarce and nothing can be taken for granted then being “content” is a luxury. But to say that this young man was “muy contenta” really startled me.
So Daniel is a 20 year young man who is a paraplegic. We came to know him 5 years ago when he was involved in an accident involving a drunk driver that left him paralyzed from the waist down. He has suffered numerous other complications including the need for a permanent colostomy. AND….he lives in a place where there is such limited health care resources, no health insurance and no real help. There are no physical therapists, occupational therapists. No medicines. No nada. The one little thing that we do for him is to bring him colostomy supplies. I have gotten them from Toledo Hospital and from a great organization that supplies these. You would think I was bringing gold to them. When they run out of the supplies we bring, they have to buy things which means they then have less to eat. Or they have to use makeshift supplies that cause even more problems. I brought a “monton” of supplies this time. For Daniel’s mom, it looked like Christmas. She eagerly went through the bags with a huge smile every time she saw something that was EXACTLY what she had been praying for. And there were even more goodies! Special ointments and powders that she didn’t even know existed. Oh….the hug she gave me when we left!
The last time I visited them was about six months ago. Daniel was laying in exactly the same lounge chair that he was in now. When I say lounge chair I mean one of those plastic kinds that we used to use at the beach years ago – the ones with the plastic strips that go across and break easily. He had a towel under him. I mentioned that perhaps a lambs wool pillow might be better to prevent skin breakdown. They laughed at the idea of it! I thought maybe I could find one – seemed like a simple thing. And then I thought how many simple things I have that are treasures here; things I don’t even think about it; things I think I can’t live without.
So whenever I come to bring Daniel his supplies, I always know that he will be there….sitting in the lounge chair by the small old style TV. On my last visit, he showed me some drawings he had done and was excited about learning to draw….drawings of birds. I asked him if he was still doing it but he said he has been too busy. Too busy! Again, the whirlwind of thoughts…..busy going what? How could he be busy? “I’ve been studying a lot now and finishing my education.” And then I thought about how much time it must take just for him to get dressed, to eat, to get in a chair. But who am I to know is future? Perhaps his future holds far greater things than I could ever imagine.
We chatted a bit. I wanted to cry inside thinking about the young teen who could have had a different life. A life taken away. But then I realized the remorse was mine, not his. His mom has stood by his side in all the ways that a mom does. She has had to become a nurse, a doctor, a healer. She has stayed up long nights seeing him through moments when he came close to leaving this world. And maybe it’s because of her that he smiles so easily.
So as we left, I imagine I had a look of pity on my face and I asked if we could do anything. They both smiled happily and his mom said “El es muy contenta….gracias a Dios!” and he nodded in agreement. It was not said in a way to make me feel comforted nor as a way to minimize the reality. It was just said as a truth. At that very moment, they were there as a family….her other children running in and out….he had no pain, no fever today…..the gringos had just brought the gold….all was well with the world.
So that was my lesson….a lesson I often read about….the very lesson that Paul said in Phillipians “I have learned to be content in all things”.
As I wrote this, I had just found out that our plane was delayed….we might not make the connecting flight…hmmmm…..I have a lot of “important” things scheduled tomorrow. Perhaps I won’t get frustrated but just be content that really all is good.
Yes, there are things in my life that I wish were different. We all do – but how much better if let go of even thinking about them. Instead, it is people like Daniel who have taught me to be content and joyful about the things of beauty in my life. But there are so many things that are beautiful, that draw me close to God, so many joys that of course are mostly connected with my greatest treasures – the people I love and that love me.
This post comes from Meridith Heckler. Meridith is a sophomore at Kenyon College. I had the great privilege to travel with her to Guatemala where she spent the week working with the children in our after-school program. Here is what she writes and she has attached a wonderful video of the children which you will love!
"The students diligently worked to complete their lessons on Khan Academy (an online program with differing levels of mathematics) and Raz Kids (an online program with differing Spanish leveled reading) as they usually do. Some of the students have read all the Spanish electronic books on Raz Kids leveled A-Z. So, they have listened, read aloud, and happily took reading comprehension quizzes for over 250 different books. Their eagerness for learning can also be seen in mathematics: an eight year old girl just delightedly learned to multiply decimals accurately and an eleven year old now understands how to divide fractions.
After spending most of the week assisting students with Math and Reading, it was a treat to hear them sing "Orgulloso de ser Chapin" (translates to "Proud to be a Guatemalan"). The song's lyrics explain how it is an honor to be Guatemalan (or "Eres un Guatemalteco con honor"). I feel that these immensely respectful students' gratification can expand beyond the pride of their country as they can hold pride in their progress in literacy and math as well! With absolute sincerity I tell the students, "Usted debe estar orgulloso de todo el trabajo duro," or "You should be proud of all your hard work!" By attending the SewHope program, the children have made tremendous strides they can certainly be proud of. It makes me smile knowing that these students have the opportunity to sing this heartfelt song together about their Guatemalan pride. I feel humbled and honored to have the privilege to teach them and for them to teach me!"
My mom used to say "Where does the day go?" No truer words were ever spoken! I always have the greatest of intentions in letting you all know how things are going when I'm here but the days surely "get away from me..."
Really there are no words to describe how things are flourishing here. Since we finished the new building, ALL of our projects are doing so well. So many patients here.... all really happy to be treated in a beautiful setting with a good system. Thanks to our friends, Dr. Jim Skon and Doug Karl, we have a fantastic wifi system and so we are able to have an excellent electronic medical record. So now it's really easy to track our patients and follow up when they need treatment. As always, Orfe has done an incredible job connecting us with other organizations and arranging everything for a really successful "jornada" this week.
The municipality paid for a bus today to bring 40 patients from one of the remote villages. It is because of Orfe that these connections are being made. Of course, there were already 50 patients here before the bus arrived so I was a bit nervous! But somehow it all worked.
And the agriculture programs are spectacular! The children have been involved in growing tomatoes, cilantro, peppers, watermelons. They even have their own eggs with chickens ready to hatch.
We now have a psychologist here once a week to help the children and moms deal with the incredible stress in their lives.
We also now have a music teacher!
We've been truly blessed to have Meridith Heckler join us this week. She is a 3rd year student at Kenyon College. She is working with the children with more enthusiasm than I have ever witnessed! Every time I go in the room, she is kneeling by another student helping them with their math and reading. I LOVE hearing her stories when we return to the hotel each night. I'm considering dropping out of medicine and becoming a teacher.....
As always, every day there are heartbreaking stories but for today, I chose to look at the happiness in the faces of the children and the hope we are giving them for a better future! A huge thank you to all our supporters and especially to our workers here who make these things happen every day - THANK YOU ISMAEL (OUR FEARLESS LEADER! , ORFE, MAYRA, SEINER, and ALFREDO!!
Today I had a 15 year old patient that was madly in love with her secret 21 year old boyfriend.
Here’s a little background about this patient...She finished school last year because her parents could not afford further education. Unlike most girls her age that we see in clinic, her family made it clear that they did not want her to date, or marry-off like many other girls her age do after leaving school - they wanted a better future for her. Her family was struggling financially and therefore up-rooted to another village where jobs were more promising. So, she now was working 1 day a week at the only available job she could find. She spent the rest of her free time at home, pining over her secret love-interest she was unable to see.
In the clinic, she initially was textbook depressed. That being said, after 15-20 minutes of chatting, she began to open up about her secret love and it was clear that her current emotional status was one of helplessness, anger and resentment toward her family for not letting them be together. Recognizing a chance for impact, I presented to Dr. Ruch who pulled in Myra so the 4 of us could all talk. After another 15-20 minutes, it unfolded that the patient really valued pursuing her education but felt powerless without the funds to make it happen. The 3 of us decided to use this moment to discuss the possible trajectories of her current dilemma: she could run off with this man without an education, little opportunity, and likely be pregnant very soon, or find a way to pursue her education and maybe get the man as well. With our help, she slowly began to realize that if he truly felt for her what he claimed, he would likely wait for her to finish her education, and maybe even help her pursue it. This is what those who respect you, those who love you, will sacrifice for you. --She nodded.
As we tied up the conversation, we felt a little lighter knowing we had seized the chance to impact the life of a young impressionable woman… until we were about to leave the room.
Myra quickly asked the patient in a secretive manner if she understood all of our previous conversation. The patient nodded shyly. Myra then asked her if she understood what the word “respeto,” or respect, meant. The patient looked down and embarrassingly said no.
Witnessing that some of these young girls and women that we treat do not have a conception of the word “respect” is absolutely jarring. Life as a female is a different beast for many of the patients we see at Sew Hope. When reflecting on the immense injustices women face here, it cuts deep to realize that many of these women will never realize that they deserve better – unless the idea somehow enters their world from an outside source. One visit with a patient like this can make a huge difference if the effort is made.
By the look on her face at the end of her clinic visit, I’m confident this patient left with her mind reeling with possibilities, questions, hope, and a budding sense of self-respect.
Hotel Paps – a story of comedy, tragedy and a really good outcome
I’ve been back from Guate now for 6 weeks but I was telling my friend a story of something incredible that happened while I was there and she said “you HAVE to tell everyone that story”. So here we are
“It was a typical day at” ……the clinic. Bumbling around in a sweat, I was trying to be a teacher to my 2 trusty med students while still keeping the patient flow moving. As I moved between rooms, our social worker, Orfe, came to tell me that the reporters from the television station were here to interview me. Seriously?? You’re kidding. She laughed and said I’d have no problem. In my Spanish?? You really think I’m even going to understand the questions?? And I have no make-up on. Bad enough to have a 58 year old face but one unmasked is even worse. And my hair! Really…my hair. Bangs were too long to wear as bangs but too short to pull back – a natural hair disaster which any women who has been there knows is a reason to hide much less appear on television.
So I said no. Then Orfe just laughed and said “Of course you’re going to do it. You have to. The people have to hear about what we are doing. Don’t you CARE about this??? OK….guilt always works with me.
So the TV crew set up their stuff and they put the camera seriously RIGHT IN my face!! Somehow I just pretended I was in the twilight zone and went on autopilot. They started asking about cervical cancer and I just went with it. I started thinking about all the tragedies I had seen..all the injustices…all the girls who had been raped at a young age or women who had been abused and as if that wasn’t enough now they were paying the price of having a disease inflicted upon them.
The TV guy seemed incredulous that I was pulling together the Spanish words and that I was getting a bit passionate about the whole thing. He asked “What can we do to prevent this?” So I thought quickly and said “Men need to stop cheating on their wives. Men need to stop having sex with very young girls. Women need to stand up for their rights. They need to demand access to basic health care.”
Anyway, they showed it on TV and they put it on facebook and I got more “likes” and ‘”shares” than I ever thought was possible for me –
So….next segment of the story.
The next morning Laura and I went for our 5 am run and when we came back, the hotel guy actually started talking to me. Before this, he was pretty much ignoring us. He smiled a lot and starting asking me about my run and how it went …I couldn’t understand why he was suddenly engaged. Then he says “I saw you on TV…it’s great what you all are doing” Wow! This was the closest I will ever come to celebrity status!!
So off we go to the clinic and then when we come back in the evening, this little young woman who works in the hotel comes up to me and says
Es possible que nosostros podemos hacer un pap? (Would it be possible for us to get a pap?”
So I think “of course” BUT how are we going to do it?? The clinic is about 20 minutes away by car and these poor little ladies have to work ALL day long.
So I say “do you want me to do the paps here?”
“Oh, that would outstanding”!!
Ok….so the next evening I will do the paps at the hotel.
We had a long day that day. We got back to the hotel and 8:30 PM and I was kind of pooped. I was hoping they forgot about it. We walked into the hotel and out of the corner of my eye I could see a tiny group of women way in the back almost hiding but clearly looking at me. But I was pooped and also kind of grimy. But I no sooner went up to my room than there was a knock at the door saying that the women were ready for their paps!
OK. Great. So me and my speculums, slides, spatulas, cytobrushes, and gloves went down to the lobby. And there were 8 women all really dressed up for the paps! You would have thought they were going to a prom. Many had 3 inch heals. All had really nice dresses and all looked beautiful.
I don’t know why but I was in a complete sweat. I really don’t know why. I do paps all the time. I guess it was just being in a hotel room and all of them treating me so nicely and all of them feeling that they had to dress up for this “special occasion”. It made me feel so small for some crazy reason.
So each one came in…they were so incredibly grateful and kind to me.
And I did each one but there was one that seemed like something was wrong. As I took the sample, the tissue on her cervix sloughed off. I have never seen that before in my 25 years of doing paps here. Hmmmmm. ……kind of weird.
So I told her to come to our clinic the next day which she did. And yes, I did a biopsy. And YES, the biopsy showed an early stage cancer.
Wow! Really! All because Orfe arranged to have a camera crew come to our clinic to interview a doctor who didn’t want to be interviewed and some woman had the courage to ask if she could invite her friends for paps and I said yes and on and on. Because of all those things, here was a 47 year old woman with absolutely no symptoms who just happened to have cancer. Wow! Do you call that coincidence? Do you call that a miracle? Do you call it God’s hand working through the love of others?
Well the story does not end here. When Orfe told her the diagnosis and that we could set her up for a curative hysterectomy, she went to her church and the pastor told her that only God could cure her. So she spent 40 days fasting and praying and staying within their church!! All during the time that I was working so hard to set her up for surgery.
But at the end of the 40 days, she did consent for treatment and ultimately yes, she had a hysterectomy. I think she is cured although only God knows for sure.
She is only person, only one life.
But how do you explain it?
If she gets to live another 10, 20, 30, 40 more years, the world will be changed in ways big and small. To her family, it will be enormous. Maybe in the world it will be enormous. Who knows?
I just know that it took a LOT of good people just doing the right things to make this story.
I’ve always believed the foundation of the patient-doctor relationship is grounded in trust. Here in the Petén region of Guatemala, while poverty and a culture of violence, mistrust, and corruption dominate, somehow the roots of the trusted patient-doctor relationship remain – for better or for worse.
Guatemaltecas have a unique devotion to health promotion despite limited access to resources and minimal education. On the whole, without their health they cannot work, and without work, life falls apart – so they do their best to take care of themselves in any way they know how. So, for many patients with limited resources and education, their only option in health promotion is to trust their doctors. We’ve seen patients paying exorbitant amounts of money for unneeded tests, treatments, and preventative vitamin injections, simply because "the doctor said so," even when putting food on the table is a constant struggle - and we're talking 1000’s of quetzales for treatment when a meal for a family may only cost 15-30 quetzales. Some of these patients live in homes with dirt-floors, however if the doctor says their health is compromised and can be fixed with X, Y, and Z, patients will somehow get the money, and make it happen. Many patients see no other options because without their health, they have nothing.
For some reason, local physicians are suggesting these exorbitant tests and treatments. I can’t count how many women I met in clinic who had their uterus removed for asymptomatic fibroids after unnecessary ultrasounds from outside hospitals. These women are being proactive personal health promoters, however they continuously fall victim to a system that shows no shame in taking their money and “matriz,” or womb, for no reason.
As a student witnessing this, it has created an overwhelming sense of responsibility as I proceed through my career as a hopeful future ob/gyn. These patients have given me clear, obvious examples of the repercussions of non-evidence based medicine directly impacting a patient and their family’s well-being. This experience has also allowed me to engage in valuable patient education on topics I never thought I would need to discuss. It’s humbling, and has ignited a fire to do absolutely right by these women.
(written my Cydney Siggins, 4th year medical student)
Imagine the best way to give a flavor of life here is to share a few patient experiences with you. Yesterday, I went into our "intake" room and noticed a woman talking to our nurse and Orfe in hushed tones. With tear-filled eyes, they completed getting her BP and blood sugar and weight. And then they did a pregnancy test which was positive. She broke down crying and then "passed" into my exam room.
She recounted the story. The day before was the one month anniversary of her 14month old baby s death. She described in great detail what happened - a day just like any other - she was caring for her 5 children as well as her 2 nieces. Her sister had "fled" to Guatemala City years ago and so the 2 nieces were left to her care. She was selling her tortillas and the 14 month old was running around feeding chickens. Suddenly the baby couldn t breathe and they frantically went to the hospital - a 30 minute drive. Sobbing, she described what happened then. Panic, doctors and nurses racing around, tubes being put in arteries and blood spewing in the air, tubes being put down the babys throat. And then the news that the baby was dead.
And now she is pregnant again. You might think she would look at it as a gift in this situation. But consider...she is caring for 6 children every day, little money, constant stress, never being given even a moment to grieve. Instead of everyone gathering around her to love and care for HER in this terrible time, now she faces one more trial - another pregnancy, another "mouth to feed". So all we could offer was love. Cydney treated her as if she was her sister - listened without judging - encouraged her to just talk about it all....talk about everything that happened....talk about her fears for the future. Orfe came and cried with her and prayed with her. We all acknowledged that in these times of great pain, it is only a loving God who can give us the strength that is sometimes hard to find. And that God acts through us. I felt so happy to have such a team of people here who genuinely care...who are willing to give their time and their hearts to right the wrongs, to be there for others in times of greatest need. I was glad we were there. At least we could give her an ultrasound so she could see the new baby and at least know when it would be born. We could give her some vitamins, some advice. The new psychologist will be starting with us next Monday and she eagerly made an appointment with her. In as society where women are looked up as expendible, I am so happy that we can be part of a change.