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.
Finally a break in the action here so I have some time to write. So many of you have made this all possible – I wish I had the writing talent to draw the scene with words – to let you know the impact your prayers and your generosity are making.
My dad was a writer and he used to say just put the pen in your hands and it will lead you – not sure if that applies to a keyboard!
The days here are so packed with emotion, with love, with God’s grace. Sometimes we feel we are making the proverbial difference – sometimes we all look at each other with frustration knowing that only the power of a mighty God can fix the pain and suffering that some have to endure.
This trip is especially wonderful because I have my daughter, Laura with me. Laura is finishing med school in May and will be starting residency in Ob/Gyn in July. Never did I imagine that I’d have an opportunity to share my life’s profession with one of my children. It really is incredibly special. And to add to it, we also have a remarkable medical student, Cydni Siggins with us. Cydni has completed three years at Dartmouth and is taking a year to learn about many things you never get in med school – I hesitate to speak for her but I can see that this year for her is opening her eyes to the great needs of the developing world and she is seeing firsthand what global healthcare is all about. On top of that, she is perfecting her Spanish and learning so much about Complementary and Natural Health Care. So having these two with me brings extra joy to the day and also challenges me in new ways to look at things here afresh.
The week has brought its share of satisfaction, frustration, laughter. Through it all, I always feel God’s grace pulling us along.
First and foremost, the new clinic is unbelievable! May I thank each and every one of you who made it happen. No longer do we have to sweat it out in a hot and dreary building that was rented so we couldn’t improve it. Bright rooms have a cool breeze going through them throughout the day which makes for happier staff AND happier patients. The patients often comment “muy professional” which I think makes them feel that they are receiving the kind of care that the privileged receive.
We see the gamut of mundane to tragic; pregnant girls excitedly seeing their babies for the first time on ultrasound welcoming a new life with anticipation and joy; another sadly experiencing a miscarriage….too many girls with frightening stories of sexual and violent abuse…..
Somehow God seems to always provide what we need. On Friday, we were all feeling a little overwhelmed and helpless in knowing how to deal with so many stories of girls telling frightening stories of sexual abuse and domestic violence. Out of nowhere a psychologist with many years of experience in dealing with these girls came and said she would like to volunteer with us one day each week. She was able to connect us with an organization that provides help for these girls.
But those stories continue to haunt me. How does a girl escape abuse and exploitation if she has nowhere to turn? No money for the basics? Even her family doesn’t want to believe it because if they do, they will have to admit that she would have to leave her only source of support. I cry inside when I picture it. I have to believe that the children in our after-school program will have a different story. Here, they not only receive a real education but they also feel the love from our staff and from each other. They really are like a little family.
The cervical cancer prevention program is continuing to expand. Mayra Martinez completed her education in cytotechnology and now she is working for us full time! She is able to read the paps as we do them so that we can treat people immediately. We will of course be bringing all the paps back for review by our own cytotechs in Ohio but with time, I believe we will have a complete high-quality pap program with a cytology school here.
Laura and Cydney are doing an outstanding job in this challenging environment.
We put in long hours and Laura commented the other day “Hmmm…..this is kind of like a regular OB rotation!” They are amazing me with their Spanish skills and their ability to figure out what is needed from patients who live lives so different to what we are accustomed to hearing about. Sometimes it’s a simple treatment for headaches or gastritis and other times a biopsy for unusual bleeding or a treatment of a precancerous cervical lesion.
We’ve also had some time for laughter. Cydney wants to bring home a machete so she can cut her own coconuts so Ismael gave her a full lesson in the best cutting techniques! Popping open coconuts and drinking fresh coconut water is a pretty special treat. Today we ran a 5 K race with some of the children in our program. Two of our boys took 1st and 2nd place for kids under 13 and Laura and Cydney took 1st and 2nd place for all females! Because we were there, they called it an “International Race”! Randy says we have Gringa power!
Through it all we continue to thank God for our two very special program directors here – Ismael Martinez and Orfelinda Guerra. Day in and day out, they are the ones facing the challenges, working long hours, making it all happen.
Sunday morn at 5AM. The roosters are in full force announcing a new day. What is it about that hour that they like so much! My last day of this trip. I think of all the visits, all the ways this place has changed me - and all the ways Guatemala has changed since than that first time in 1998.
Now there is a palpable wave of hope. The man who was a powerful president here just 2 months ago is in jail along with the former Vice President and a host of federal judges and heads of large government departments. When the Vice President (a female) tried to say she was ill and was hospitalized instead of incarcerated, thousands swarmed the hospital to make sure she did not escape.
Manuel Baldizon, one of the most corrupt politicians on the globe was sure to win the election just 3 weeks ago and then, with all of the sudden hope that things could change, the people voted instead for the only "honest" person on the ballot - someone with no experience who is a television comedian!
I have wondered what has spurred such sudden change? Why did tens of thousands of people march in Guatemala City for months without anyone even leading them? What gave them the courage to take on a government run by "narco-politicians"?? The political pundits will debate this for years, but from what I hear it is that the masses have now had their eyes opened with a new world of technology. They all talk about the Arab Spring and they suddenly believe that to be the "poorest of the poor" is not inevitable. Extreme poverty and the treatment of human beings as "disposable" is really not OK - and although it is a relatively small number who realize this, it is a start. They are hearing the message that indeed all people are created equally . Pope Francis is now reminding us of what the Gospel has always told us - that all people are not only created equally but that God may be even more present in those who suffer.
Yes, the pope is finally speaking the words upon which our faith is supposed to have been based. It's amazing to me that people seem so moved by words that in reality should have been in all of our hearts all along. You don't need to be a bible scholar to know that the central message of Jesus teaching was to "restore the Kingdom" - reach out to those most in need - the widows, the orphans, the imprisoned, the forgotten. Isn't this Bible School 101? Yes, thank God that the Pope is finally saying the very words that Jesus preached but perhaps it wasn't until the poor had the tools to speak up that anyone cared to hear the message.
So here in Guatemala, there is now a hint of hope - a small hint - the suffering and poverty and oppression continue for the majority. People cling to the concept that the days of extreme excess for the wealthy that have come by exploiting and oppressing the poor are starting to unravel. Or maybe they are not. "Only time will tell."
In the meantime, our little organization along with all of you who support us continue to fight for the very people whom Pope Francis and indeed our Gospel talks about - the lonely, the suffering, the oppressed - those on the lowest rung of the inequality ladder. This week, just like all of my weeks here, I surely see the presence of God.
Sometimes there are so many things that I wish I could do but I can't. I wish I could speak Spanish fluently; I wish that I never upset anyone. I wish I had the insight and brain capacity to fix the things I care about. But right now, I wish I was a great writer so I could bring all of you who are reading this, right here, right here in this moment. I wish you could see what I see. Maybe a few pictures of a few people and a few little stories will help.
Here's Jose. He started in our after-school program a few weeks ago. Already his ability to read and reason and do math is progressing at an impressive speed. He's one of those kids who always had it "in him" but never had a chance to shine. Orfe decided to start a running group. He's the captain! The other day, fifteen children told me they wanted to run with me in the morning. He was the only one who showed up at 5AM and ran 6 miles - this from some who has only ran twice before! He has no running shoes so lots of blisters. When I told him that we would buy them for him, I wish you could have seen his face! In the picture below he is volunteering to paint our new clinic! He's the kind of kid who could be a great gang leader or a great leader of a new generation. With help and love from all who work in our program, I think he will be the latter!
And here is one of our patients with Orfe. We diagnosed her with a very early stage of cervical cancer and were actually able to treat and cure her. None of this would have happened if our Social Worker, Orfe had not joined forces with other Social Workers in the local municipalities and brought these women for testing. When this woman was diagnosed, she refused to come for treatment because of unfounded fears. But Orfe RELENTLESSLY sought her down and thank God, she is now healed. How very blessed are we to have Orfe leading many of our projects.
Last night, a baby was born in our Casa Materna! Here is Catalina, our midwife. She takes such pride in this work.
And here are the children whom God has entrusted to our care. So many thanks to all of you who have sponsored them. You cannot imagine how their lives are changing......
And last and surely not least, here are photos of our clinic. The work that Ismael and Camillo, the construction team leader have done is beyond words. This has been a work of love and they have given up most of 2015 for this effort. A million thanks to them!!
It is so hard for me to ask you to consider contributing to this effort. It is something I struggle to do but all of this work takes resources. Every contribution you give makes a world of difference to so many. Thank you!
Dr. Coral Matus and her husband, Ed are in Guatemala this week with a team of physicians, engineers, construction workers and of course, their 3 children! In addition to seeing patients, they are working on installing electricity and other projects for the clinic. Coral will be sending an update later today but for now, enjoy these wonderful pictures of their work and of the new clinic!
Crazy how life can seem so surreal at times. Today, when I visited the clinic construction, I thought about all the meetings, debates and great planning that went into it. I remembered the young architect, Jonathan Zee who so generously came with us to Guatemala and designed this wonderful place.
Five “trabajadores” were busily working away – installing the steel beams in preparation for the roof. The heat surely wasn’t slowing them down at all (nor the minimal tools they had to use. Every space, every window, every column was laid out exactly as planned – and the best part is that all the thought that went into it seems to have been so worth it! A lovely breeze and lots of natural sunlight is present in EVERY room! The building is laid out so beautifully on the 2 acres – It seems to welcome you and says “hi” as you approach in your car! There is plenty of space for the patients to wait and the design is really perfect for great patient flow. I think of all the years that we thought about it and here it is!
So we brought the children from our after-school program over there so they could see their new classrooms (on the other side of the clinic). They were so delighted! Then, Camillo, the owner of the Construction Company came and spoke with the children. He talked to them about the importance of knowing math when you are doing construction. He told them a bit about his life (he didn’t even learn to read until he was 18!)and all he had to overcome to get to a point where he could direct a job like this. He even talked to them about being an architect or an engineer – what inspiration for them considering that they never heard of such jobs in the past!
Then we returned to the clinic and I gave the children some books that were sent from the Ottawa Hills school system. They were so overjoyed at the thought of a new book to bring home tonight! I also gave them each a bracelet made by the family of one of my friends. You would have thought I was giving them gold and diamonds! Once again, I am reminded of how lives can be so changed when we all share our gifts! I can’t thank all of you enough – today was just an example of all that can be done when we work together to make it a bit better world for those that God puts in our path.
Things that are better about being in a “poor” country such as Guatemala (enjoy the pictures below that show some of them!)
1. You get to see your patients riding ahead of you on the way to the clinic in the back of a pick-up truck as you yourself are on the way to “work”!
2. It is so wonderful taking care of patients who are so very, very grateful for all you do! Today and yesterday were awfully busy - and sometimes when we are so busy, I worry that I have enough time to make the patients feel valued. In the middle of my very busy day today, one of the patients actually started crying as she hugged me and told me that everyone was so grateful that we were there. She said they are so desperate for medical care and they can’t believe that we are taking the time to care for them. How often do you get that in the U.S.??
3. There is such little waste. People here find ways to use all the things that you and I would normally throw out. Hanssel, (our agriculture project director) cuts large plastic pop bottles in half and hangs them on strings so that they can be hung up one on top of the other. He fills them with dirt and plants seeds in them. Pretty soon there are plant seedlings that can be transplanted into the ground. He even uses the trays that my pap containers come in to do the same thing!
4. Families and neighbors TRULY care for each other.
Yesterday, we were asked to go to the home of a woman who was very sick. Turned out that she had uncontrolled diabetes as well as uterine fibroids that were causing her to massively hemorrhage. When we arrived, there were at least 40 people standing outside her house praying for her! We gave her some medications and IV fluids and then got an ambulance to bring her to the hospital. Everyone was so grateful and I was just happy that she had something we could treat – and not another terrible diagnosis of cervical cancer.
5. The dogs here are so much better controlled! This may seem silly but actually, it is so cool to be able to run here and not have dogs threatening you! Mostly, they just ignore me as I run past them! And if a dog is walking with it’s “master”, there is no need for a leash – they just follow along. I love watching the “Dog Whisperer” at home. But here, I think there are lots of Dog Whisperers. The difference is that they know how to treat dogs like dogs....
6. People here have FAR BETTER immune systems! Honestly, it is incredible. Yesterday, I ate lunch in the home of a very poor person who so graciously shared all that she had with us. While all the Guatemalans had no problem, I spent the night with diarrhea and vomiting. What has happened to us in the U.S. that our systems are so very fragile???
7. There is not the constant barrage of consumerism. This morning, I saw a great sign that someone wrote on a wall outside a relatively big store here (of course, nothing like our big stores!). It read “If you don’t buy it, we won’t desire it….” I’m going to remember that one!
Dra. Kim and I spent the first three days of Pediatric clinic at Casa Matena in El Chal and the final two at our clinic in Santa Ana. The number of patients seen was lower which allowed us more time to talk (and listen). This helped us better understand the community needs and how we can better serve them. Between patients we had time to discuss various ways in which we could better communicate with our patients. We are in the process of developing handouts for the most common complaints and later we plan to make audiovisual materials for use at the clinic. We will probably use both material already available on the web as well as making some of our own.
We talked with Katalina about needs for the Casa Materna. She does not have antibiotic ophthalmic ointment for eye prophylaxis, she she may need that. Her newborns also do not receive Vitamin K injection. Oral Vitamin K is available, but is less effective and requires three doses, and I don't know the cost. We may need to do more research to see if we should provide this. She delivered the third baby in Casa Materna this week - a boy. Katalina may also be interested in checking blood pressure or glucose to see if the should deliver in a hospital. I don't know if this is appropriate, but it is something to consider. The clinic is beautiful and the patients really enjoyed it, so hopefully our clinic helped get the word out and her business will increase.
We stopped by the construction site for the new clinic. I was struck by how much larger it looks vs on paper. The men were hard at work under the hot sun and are making rapid progress. I think that it will be a beautiful site when completed. Hansel is doing a great job with planting trees and vegetables. I can't wait to see the finished product.
The "old " clinic still functions well. Kim successfully fitted the shoes that Dr John Lane had made for the two diabetic women. We also were able to do some staff education. Kim demonstrated measuring blood pressures, nebulizer use (for emergencies), and use of bag valve mask for newborns (in El Chal). We discussed some common problems, but have much more staff education to do in the future. Kim also gave a career talk to the students in the clinic. All of the girls want to be pediatricians, but none of the boys do.
We had a pleasant dinner withe Martinez family at La Luna. We discussed potential use of the therapeutic food described in the Herperian book for malnourished children. I also asked Ismael about the current direction of Sewhope - if there are things we are not doing that we should start or things we should stop doing. He feels that we have made good decisions and are moving in the right direction.
At the end of the day Friday, we stopped to visit the Santos family. The boys look good and the new house is wonderful. They are growing tomatoes and raising chicken and have a little pig. They were very happy to see us.
Having Kim on this trip has been a special blessing to me. I am truly amazed at how she has grown since her trips as a med student then resident and now an attending physician. Her expertise in evidence based medicine, patient safety and a patient centered focus have helped shape a vision of how we can better serve the children of the Peten.
The precious puppy died. Maybe his little life had a purpose.
On my arrival here in Guatemala two weeks ago, four busy little joyful puppies greeted me vying for my attention. They would lick the salt off my legs after I had been running; they would push to get into the house when I opened the door. Mostly they did what puppies usually do - they made me happy!
Another week went by and one started looking a little smaller than the others; his little tail didn't wag quite as vehemently; he was always the one pulling up the rear. Then Tuesday, it was me who seemed to lag behind. I got the infamous stomach bug here and I had a night of "vomitando". But I took my cipro and slept a good bit and by the morning, I felt much better. But that morning, I looked at the little puppy I had grown to love and he looked like I felt the night before. He just laid there. Couldn't bring himself to give a tail wag. He didn't have the words to complain; didn't have the assurance that of course, he would be OK. His little siblings pretty much ignored him. Maybe it was because I had been sick that I felt so especially sad for him. I wondered if he "knew" that his little life wasn't here for long. I wondered if he "felt" sad or miserable or if there was just no feeling left at all.
One of his brothers has turned out to be particularly aggressive which is good if you've been created for the purpose of being used as a guard dog. He struts around already at six weeks clearly the leader of the pack.
So the whole scene was kind of a mirror of humanity.
Yesterday, we left in the morning to work in a distant place called Sayaxche. We spent the night and came back this evening. The car door opened and sure enough there were now only three puppies. He put up a great fight but finally, he couldn't do it. Hanssel had buried him already in the backyard.
Of course, we see it all the time. We are all created so differently - some strong, some so very weak. Some live a long life and do lots of great things; others are gone before they get a chance to even make a choice about anything. But weak or strong, I guess our lives can still make great impacts - even if we're just a 6 week old puppy.
That little pup's life made a difference at least in my life. He made me smile; he made me laugh; he made me cry and he made me angry at the injustice of suffering and death before it's intended time. He reminded me of all the pain and injustice that I sometimes see here. He also reminded me how sometimes the most vulnerable can bring others the most happiness.
And then tonight I read this poem and it seemed to pull all my thoughts together. It's written by Pulitzer Prize poet, Mary Oliver
The Summer Day
Who made the world?
Who made the swan, and the black bear?
Who made the grasshopper?
This grasshopper, I mean-- the one who has flung herself out of the grass,
the one who is eating sugar out of my hand,
who is moving her jaws back and forth instead of up and down--
who is gazing around with her enormous and complicated eyes.
Now she lifts her pale forearms and thoroughly washes her face.
Now she snaps her wings open, and floats away.
I don't know exactly what a prayer is.
I do know how to pay attention, how to fall down
into the grass, how to kneel down in the grass,
how to be idle and blessed, how to stroll through the fields,
which is what I have been doing all day.
Tell me, what else should I have done?
Doesn't everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?
“Don’t ask whether you can do something!”
Today I heard an intriguing comment. We should never ask whether we can do something difficult or perhaps perceived as impossible. We should ask “HOW can we do it? It really changes the scenario, doesn’t it?
I’m sitting here this Sunday evening in Ismael’s house in Guatemala watching the “Transformer” movie with the Santos family (the family you all built the house for this year)! Their 10 year old daughter Roxanne is sitting by my side holding on to me. Oh if we could all love each other like this! Why do we have to grow up?? She follows me around, giving me kisses and hugs. She tells me her little dreams for her life– to have a puppy, to work with us when she grows up – maybe both will come true....
I think of the day we first met their family. Everything seemed so desperate….so hopeless. Instead of asking how could I do something, I asked myself if anything could be done. Fortunately, Ismael thought differently. He approached me and asked if we could raise funds for this family and he would get a house built for them. And in 2 days, you all responded!
Here we are are a few months later. They have a beautiful little “casasita”. The mom grows vegetables and fruit in her back yard. Her laundry business is growing. They now come to “church”. Church is a large group of people who come to Ismael’s backyard on Sundays to sing, praise God and study the word of God for our lives. Afterward, Orfe prepares little refreshments and everyone gets to be together. Hanssel, Ismael’s son has such a big heart. He thought it would be nice to have a “movie night” for the Santos family so here we sit with popcorn and ice cream. Life doesn’t get much better than this!
Running in Guatemala
I used to think I couldn’t spend extended time in Guate because I’d miss running too much. I used to think it would be too dangerous and there were too many cars and it was surely too hot!
You may recall that we had our “Carrera” (race for cervical cancer prevention) here in the Peten a few months ago. It was the first race I ever heard of here in the Peten. Since then, there is now a Carrera here every couple of weeks! The “first” Carrera for this and the “first” for that. It’s unbelievable! There have been so many unforeseen blessings from the work we do here – that is just one of them. Now there are lots of runners out in the mornings. The weather is a little cooler and there is plenty of room by the side of the road. I’m not usually a morning runner but running along here with the wide open space and seeing the sun rise is one of the most beautiful, peaceful ways to feel the presence of God. It is a blessing I never expected here.
This morning was my weekly “long run” – an unfortunate and painful part of preparing for a marathon! It’s one of those things that makes you wonder why you’re doing this! But this morning as I ran along, MUCHOS personas recognized me and honked and waved from their car. One little girl leaned out the window waving frantically!!! It surely made the run a whole lot less painful!
Yes, we work hard all week but today was an especially restful and peaceful Sunday. I often wonder why people ask me why I do this work. It’s not work…. It’s an outpouring of love all around that surely makes this world feel like heaven here on earth.
What an amazing day we had!! God's timing really is so perfect!
After 3 years of dreaming, planning, working, praying... the Casa Materna (birthing center) saw its first birth today!
We went to the birthing center this morning to have a meeting with ALAVI (the group who will be in charge of running the center). Catalina pulled me aside to say that she had a patient who had been contracting all night and could she bring her to the birthing center...
I tried to hide my excitement when I answered, 'Claro!'
Aura is a 20 year old primigravid (1st baby) who labored throughout the day under the loving care of Catalina, Ginny, and me. After a long, 'first baby' labor, at 1203 am she became the first woman to 'dar luz' at the Casa Materna in El Chal.
God is good!!
We'd like to introduce you all to Hanssel Martinez, one of the newest SewHope employees in Guatemala. Hanssel is currently studying agriculture at the University in San Benito. He has a great passion for looking for ways to provide healthy food to the poorest people in his country.
In addition to working with the families and communities in starting vegetable and fruit gardens, he is also involved with the construction of our new clinic and Community Center. His talents never seem to end.....he also has a keen eye for photography and sends us monthly reports of his work complete with awesome pictures. Click on the link below to see all that he has accomplished in just this last month. The pictures are inspiring and so encouraging!
We continue to give great thanks to all of you for your support in making this work possible!