Canta como los pájaros (Sing like the birds)

Diana Tzul 

Sing like the birds because you do not know who's day you will make. Everyone has a certain gift that they exercise every day and Mishel and I had the opportunity to meet the doctors thanks to the music we made at that time. Jorge, the person who hired us at that time, proposed to us, to support the doctors in translating. And the truth is that we did not know what we were getting into, but it was the greatest responsibility we have taken on and I can now say that it has been a wonderful decision. I have learned so much during these years with Dr. Lauri that now with my daughter, I see the reflection of that learning. With the many life stories that we have seen in Patanatic, in San Lucas, and now in Coban I feel a great happiness because My family and I come from the same or worse economic circumstances and today have so much at our disposal that words fall short to thank life and all those decisions that my grandmother has been forging. Thank you Xavier and Regis University for choosing us at all times and obviously Dr. Lauri and Dr. Richard who have been our guides all these years. Thank you for being our singing birds each year.

Everyday Moments

Kristen Kellogg

I wasn’t going to write a blog post this year. I love to write; it is my truest and most vulnerable form of self-expression. This was my fourth trip to Guatemala, but this year, words didn’t feel like enough to encapsulate the experiences, the feelings, the moments that happen in just one week spent in the most authentic place on earth. But as I ease back into “normal” life, I find myself struggling more than I ever have. This life in the states no longer feels like what I want my “normal” to be. So it’s time to write. It’s time for you to understand why I don’t want to let go and why I shouldn’t. 

I’ve had several moments in my life that have earned permanent residence in my brain: the look on my husband’s face when I walked down the aisle, the enormous sense of accomplishment upon being handed my college diploma, the glistening of my own tear as it landed on my oldest nephew’s cheek when I held him for the first time. On Wednesday of last week, I had another one of those moments. Ithan was 18 months old and the picture of health. He was calm and cooperative as I measured his vital signs; he wore a small black face mask over his mouth and nose for most of his exam, but his eyes did all of the talking. I had just laid him down on the table to measure his length, and it was then that he showed his first sign of fear. His giant, round eyes welled up with tears and he looked at me in disbelief that I had the audacity to make him go through something so traumatizing. I measured him, then picked him up, fully expecting his tears to turn into sobs. Instead, he rested his chin on my chest and curled his lips around my collarbone. His left hand fell against my back and his right hand latched onto my scrub top. We held each other for five minutes. I can’t remember who else was in the triage area or what the weather was doing or what the sounds were. It was just us. Mary, one of our translators, explained to Ithan’s grandmother that I work in pediatrics, and I needed to get my “baby fill” and snuggles for the week. That is what I told Mary to say, but that wasn’t really it. I needed that moment, that reminder, that oftentimes the deepest form of connection exists in a stranger. And once you feel that, you don’t want to give it up. 

I said to our team this year that it is pretty extraordinary to think that certain events had to occur in each of our lives for us to end up together this past week. But it is no accident. We were all together because we have chosen to live intentionally. There’s something to be said about waking up with gratitude and having the choice to create memories each day — to CHOOSE to fight for justice, to CHOOSE to think deeper, to CHOOSE to love your neighbor. There were so many instances this week where I saw team members and patients fighting to hold on to moments. Some of them were happy encounters, like mine with Ithan, but most patients were fighting to avoid facing reality — the reality that if her daughter tested positive for covid, the mother could not earn the $3 a day to support her family and pay her debt, or the reality of a teenager girl being told for the first time that she could not have children. Those people were fighting to hold on to a life that was no longer going to exist because of the moment that was coming…the moment that was going to change everything. 

The moments I have shared with you from my life are the joyful ones, but I think that we must also deliberately choose to hold on to the hard ones, because it is these moments that propel us to create a better world. It is those challenging times that ultimately brought our team together last week, not by chance, but by an overwhelming drive to be men and women who walk with others. Each of us has refused to be ignorant or blind to the injustices that exist and that is what has encouraged us to keep coming back to this country and to create a new “normal” upon returning to our everyday lives and jobs. I won’t let go of Ithan in my mind. I won’t let go of the picture of the mother refusing covid testing because of what it would mean for her family. These are the things that motivate me and that are shaping the nurse practitioner that I will be. So I choose to hold on. I will use those moments, and the several others from the week, to remind myself and others that “normal” life is what we make it. What we do everyday with what we have is what matters. And I intend for my everyday to look a lot like a hug from a tiny, brown-eyed stranger.

The Same But Different

Kateri Dir-Munoz

I’m back again! A dream come true. With an official nursing license under my belt and about 10 more words of Spanish.  It’s crazy being back in a place you were the year before, but now with a global pandemic. With people in the United States no longer taking precautions and things opening, to being here where only 4% of the population is vaccinated and the virus continues to rage. We are harshly reminded of the injustice of this virus and how the fight is far from over. If you are unable to quarantine because you live in a one room house with 7 people or can’t miss work because you need to feed your family, what are you supposed to do? In the United States we are working on convincing people to get vaccinated while we have more than enough to go around for our population. Whereas people that need it more than all of us combined have no access as countries continue to hold their supplies for themselves. I encourage us all to reflect on what this means. While you are at restaurants, hanging out in big groups and seeing your family. Remember those in other countries who are still afraid for their lives and their family and can’t see the end of this terrifying journey. Again like so many other times, the United States lives in ignorance to what is going on around us.

But at the same time while I am facing all these differences in states of the pandemic, I am reminded of similarities between our two communities and this disease. There are physical parts that come with the pandemic, but just as much there are emotional. Mental illness and trauma does not go away when physical illness emerges, but instead they become more evident. Leaving your routine, losing your family members, isolation, how can you cope with this on top of your physical health? And to put it in perspective how can you deal with these emotions when there aren’t antidepressants you can afford, or psychologists that you can talk to? The anxiety builds and the depression keeps you up at night. I will continue to advocate and remind others that mental health is just as important as physical and should be treated as such. It takes as many lives as any other illness. Please continue to check on your friends and family in this difficult time, because as I struggle for the words to comfort and communicate with these patients in Spanish, I know this knowledge is something that I can be aware of and take back to my own community and job as an adolescent psychiatric nurse. 

Above all on this trip, I have been able to see the capacity building. With a local pediatrician, nurse and dentist, you could feel more than ever that we were a branch off the tree and not the trunk. Leaving the clinic on that last day felt sad for the reason that I wouldn’t be able to see these amazing people that I’m just completely in awe of for their talent passion and dedication to their community, but not sad that I don’t think they’re going to be able to get care that they need. What it means to do holistic care is at work in Ciudad de la Esperanza. Where social workers fighting sexual abuse, have offices next to teachers working with students to achieve their goals, while students from rural areas can live at the school to have education access all with a clinic to assess their basic needs. Truly a community clinic, where they know your family, your struggles and dreams. That’s how healthcare needs to be. All aspects of our life influence our health states, and should be treated as such. Communities need to take care of communities, because that’s how they truly understand each other and what they’re going through. I can’t wait to continue to see this role model of an environment grow, because every moment on the frontlines and from the sidelines has been an invaluable gift. 

Starting Small

Debbie Bauer

I have known Dr. Lauri Pramuk for over 25 years. I met her when our husbands worked together at Regis Jesuit High School. She was in her residency, I was applying to graduate school. They, along with the group of educators that my then-boyfriend was close with, introduced me to Jesuit thinking. The Jesuit ideal of “service with and for others” closely aligns with my belief in the Jewish commandant of doing mitzvot - good deeds. 

Years went by and I learned that Lauri had joined together with a Rabbi to create an interfaith program with Xavier University taking medical students to Guatemala. Combining the teachings of Judaism and Jesuit education was something I felt strongly pulled towards. I messaged her that I had always been interested in doing some sort of outreach program, this seemed to be an awesome collaboration, so if they ever had need of a pediatric physical therapist to please let me know. 

More years went by. Lauri and Chris moved their family back to Denver. I learned that Lauri was continuing her work in Guatemala with Regis University. I read about some of the amazing work they had been doing. I again let her know I was interested. 

With Covid, a small bit of silver lining occurred. Lauri messaged that this was the year I could join! They couldn’t take their usual student group, but still wanted to provide support to their community in Guatemala. I joined an amazing group of alumni heading to Coban, Guatemala to serve the community in ways I never would have dreamed of. Who would have thought a PT would ever collaborate with a dentist and use dental molding equipment to create a replica of a patients feet to make orthotics! We supported individuals and their families that presented with movement disorders, chronic pain, rare diagnoses. The people of this community are so incredible. There is no limit to their love and resilience. As a team, we came together to provide many Covid tests, dental care, medical care, even surgical care! I had the privilege of treating children, educating parents, and even was challenged by treating some adults. There were some patients we were not able to provide a medicine or a cure or a piece of equipment, but we were a supportive ear and a strong hug letting them know they are not alone in their drive for understanding whatever they are facing. 

One day, during a lull in patients, I was able to work with Diana, one of our talented interpreters. She has congenital hip dysplasia. Over the last year, after having her baby, she has suffered from increased pain and weakness and asked for some exercises she could do. I educated her, provided an exercise program and she thanked me so much, stating she would take this knowledge back to her own community and share it. That by helping her I had helped others too. 

That evening, at dinner, one of our amazing nurses, Therese, expressed her struggle with feeling ineffectual. She worries that our work here is a “drop in the ocean” of what is needed. We are able to help but a few, when there are so many that need it. She is not wrong. The team acknowledged her feelings and supported her, as we all held each other up at some point during the week. I thought back to my conversation with Diana earlier, and reflected that our small drops in the ocean create ripples. Ripples join together to make waves. Small waves become larger. 

Be the drop in the ocean, and, one day, together, we will create a tsunami. 

A drop in the ocean still starts a ripple

Therese Murphy

Last night at dinner, I shared my rapidly growing and deeply aching worry that the work we are doing feels like a drop in the ocean compared to the expansive need that we see in front of us. It doesn’t feel like enough. Enfermera Thy then said something that I held with me throughout my day. She said to look for the little things, the small bursts of life you might just miss if you aren’t looking. Ever the insomniac, I was predictably awake early this morning thinking about this conversation. I made it my goal to soak up each moment for all that it was worth. 

This mission started at 3 am, with my eyes closed in a place far from home. I listened as a single bird song grew with the morning into a larger chorus of many birds. When my alarm finally went off, I would have believed someone who told me there were 100 birds singing outside my window just for me. A single voice had grown into many. 

At La Ciudad de la Esperanza, one of my first patients was isolated under the COVID tent. Although she was only there to accompany her son to his appointment, it soon became clear that she suffered from chronic pain, most often presenting itself as a never-ending headache. Much of her day-to-day life is spent doing manual labor, making sure her community has filtered water that is safe to drink. Deb, our magical Physical Therapist, promptly put on her gown, gloves, and face shield. Within 10 minutes, her hands had provided my patient with relief from a pain she thought was there to stay. Deb then taught my patient’s son how to do the same thing, passing along the gift of comfort. This moment, although smaller and less dramatic than most, radiated in all directions. A small thing making a big difference.

Similarly, joy blew through the triage tent in the form of a young boy with a bright blue lollipop in his mouth, hugging Kristen’s leg and refusing to let go. Happiness was found in a vision screening when a woman got a pair of glasses that would make her detailed work much easier on her eyes. Love was glowing in the eyes of a grandmother there with her whole family, her face full of pride. Gratitude ran out of the clinic with a tiny boy and a new toothbrush, flashing his freshly cleaned smile. Peace settled with the haze over the clinic as our last patient of the day slowly walked through the front gates with her new medication clutched in her hand. This is what today gave to me. 

It is my hope that we are able to give even an ounce of what we receive.  I know we are all striving to use our skills, knowledge, and love for this beautiful community to help provide good healthcare. But, I also hope that we can be just as successful in reflecting back to them the same joy, gratitude, and peace that they give to us.

All of these moments are small, yes. But just like a single bird turning into a complete chorus, I do believe that these little drops of life, health, and community start ripples that can make changes to even the largest ocean. 

My mission today ended with my eyes closed in a place that now felt like home. Thank you, Guatemala.

Zebras where taking care of horses is hard enough

 Zebras where just taking care of horses is hard enough

By Dr. Lauri Pramuk

There are around 400 board certified pediatric rheumatologists in the United States.  It is a critical shortage that makes children who live in rural areas often have to travel long distances to see these doctors, who tend to cluster around large metropolitan areas.  Pediatric rheumatologists take care of lots of zebras.  In medical school you are taught about the horses, common diseases you will see day in and day out that have well defined diagnostic criteria and treatment options. And you are taught about the zebras, diagnoses that have odds like 9 in a million, things that are so rare you probably will never see over the course of a career.  The tend to have ill-defined diagnostic criteria and treatment options because there just has not been a large enough cohort of patients to establish those parameters.  

I have had several zebra diagnoses over the course of ten years of coming to Guatemala, but none quite so rare as a young woman named Etty, who joined us in clinic on Monday.  She is a 16 year old young woman who was perfectly healthy until February of 2020 when she had flu like symptoms that were followed by a reddish, purplish rash on her arms and face that was painful. The rash resolved to be replaced by severe muscle pain and weakness.  Her mom, who is a psychologist, took her to many doctors around Guatemala and she had lots of blood work, head imaging and an EMG that all pointed to a zebra - dermatomyositis, incidence 9 in a million.  Dermatomyositis is an autoimmune disease that is often tripped off by a virus - many viruses have been known to start the cascade that ends in dermatomyositis.  We all know what virus was showing up for the first time around February of 2020.  We don’t know what virus set Etty’s off, but it is clear she is very ill now.  She is no longer able to walk.  Her mom used the wheelchair at clinic to get her around for the visit on Monday.  She doesn’t have a wheelchair at home, so we are working on solving that problem.  Her mom brought her to the clinic to get a third (or maybe even 4th or 5th opinion) on the diagnosis.  Her mom had a stack of papers of her results - all in Spanish.  As I was wading through them trying to put two and two together I asked Dr. Ricardo to join us.  Dr. Ricardo Valdez is a wonderful, young Guatemalan pediatrician who is doing a year of service with our community in Coban.  As I was tracking the rollercoaster numbers of her elevated CPK and reading her EMG results there it was, dermatomyositis.  He summarized his assessment of her and it was clear, right in front of us, a zebra.  I have never seen a patient with dermatomyositis and I can safely say I will likely never have another one.  The multitude of Guatemalan doctors who she had seen over the last 16 months had put her on a cocktail of immunosuppressive medications to try to keep the disease from ravaging her body even more than it already had.  I then learned that Guatemala has one pediatric rheumatologist.  One.  And adult rheumatologists won’t see patients until they are 18. Rare disease, and scarcity of people trained who can treat it, a bad combination.  

So, what to do next.  Gratefully, my friend of more than 25 years, Deb Bauer joined us on this trip.  Deb is a pediatric physical therapist that has been a friend since her husband, Tim, taught high school with Chris when I was in medical school.  Deb was able to work with Etty and her mom on some exercises and is even working on making her some ankle foot orthotics using paper mache molds while we are here.  Motion is lotion - even though the body doesn’t want to move, in order to not lose more function, in diseases like this, you have to keep the body moving.  We are also working on securing her a wheelchair so she can get around. We didn’t learn until after she left clinic on Monday that the chair she was in was the one that belongs to the clinic.

 I told Dr. Ricardo that when I get back to the states I can email a friend who is a pediatric rheumatologist and come up with a game plan to try to get her through until adult rheum will see her.  We just need a road map of  lab frequency, medication parameters, etc.  Mom has been educated on what signs and symptoms are emergencies and when to seek immediate care.  In the mean time we hope and pray the disease doesn’t worsen.  

It is hard enough to see the horses when you don’t have typical resources to help them.  Seeing the zebras is remarkably humbling.  

Dr Ricardo, Dr Lauri, Diana and Etty

What was once a dream

Thy Nguyen

Picture this:

Physical therapist utilizing dental molds to create orthotic casts for debilitated children.

Nurses, medical students, and people alike teaming up for a child’s dental extraction in heat of the sun, draped in the sweat of their blue PPE. 

Strong nurses escalating care for a preeclampic pregnant woman and urgently transporting her to the nearest hospital.

Doctors refusing to back down from caring for positive COVID family members 

Children and adults alike overfilled with joy when they put on a used pair of glasses

Families who have travelled as far as 6 hrs to see a doctor, or dentist, or PT, for the very first time in their life 

A coalition founded by Padre Sergio to build capacity and solidarity to serve the community members in a city called “esperanza”

Multiple strangers, medical providers, and students from all different parts of the US, joining forces to serve the underserved. 

Imagine a community that is able to access healthcare… a few years ago, it seemed like only a dream. 

Imagine that.

I really can’t sum up all the events that have happened in the past four days of clinic. I can spend this whole blog post listing everything that happened, but it all brings us back to ..why? 

I ask myself, Why do you keep going when you feel like triaging a patient is not going to fix their permanent disabilities or chronic diseases?  Why do you keep going when you can’t provide all the money in the world to help a family during quarantine? Why do you keep going when your actions seem small and don’t seem significant in this moment in time? 

When you are caring for a community, you don’t think of these things in the moment, you don’t think of how disadvantaged these people are when they approach you with so much joy and kindness. Nonetheless, the incentive of our actions are fueled by love.

Purely, love.

What seems minuscule to us as providers, may seem like the world to the Guatemalans. I bet the community members don’t think about how impactful they are to us either. I can confidently say that our healthcare practice is exponentially improved because of them. 

And because of that, this medical team has broken the boundaries of what it means to be a healthcare provider. Each day, I am in awe of the commitment that each member of the team has to provide holistic, culturally considerate, and compassionate care. They really are the prime examples of what healthcare should be: resilient, unconditional, and loving. These once strangers are only able to entrust each other and to collaborate with one another because of each members’ determination to serve this community.

The beauty of building capacity is that we have developed the infrastructure for healthcare that is accessible. The compassionate and holistic care can continue. 

What was once a dream, can now be a reality, not because of these strangers from the US, but the community of Coban, that fuels it forward. These patients seek the medical attention and education so that they can fulfill their own dreams, they can aspire to fulfill their full potential to whatever means that may be. We are merely a stepping stone. At the clinic we provide those second hand glasses, primary and secondary health screening, dental exams, physical exams, physical therapy consult, and a toothbrush and toothpaste. We merely provide the tools. Guatemalans don’t just believe in their dreams, (as the beautiful mural would suggest), they put it into action so it can be only once a dream and now into hope. The resiliency, the kindness, and the joy, that we, as a medical team have, is actually the reflection of the Guatemalans we meet. 

I am beyond grateful that I get to share a part in building capacity in the city of hope. 

As one of my patients would say, “gracias a dios!”

Nos vemos, Cobán. 

Renew

Melinda Birky

Being back in Guatemala is like a breath of fresh air, even with a mask on. Since the second I left Guatemala in 2017 I have wanted to return. This past year has been one of the hardest I’ve had in my life but quite possibly the best thing to come of it is getting to return to this place where my love for community and public health was born. In a way, Guatemala is a part of my personal and professional origin story. Getting to return feels a lot like coming home. 

Today was our second day in clinic. Day two feels good. We’ve got our groove down and it’s refreshing to be back in a holistic healthcare space. This year, in addition to our MD’s, Pharmacist, and Nursing team, we have a Physical Therapist and Dentist. It’s incredible the difference the both of them have made in just a few short days. It’s a reminder that healthcare can and should be integrated, not siloed by specialty. This was most evident with a patient that I triaged and saw both Dr. Lauri and Deb, our PT. She and her mom came to clinic wanting a third opinion on a very rare, strange, string of symptoms that occurred after she had flu like symptoms in the spring of 2020. This patient is 16 years old and in the span of less than a year she went from running and dancing to not being able to stand on her own. She was quiet during her triage, letting her mom do most of the talking, she looked tired. A similar tired that I see in the face of many patients whom are facing the exhaustion of living with a chronic illness. Due to lack of testing and lack of treatment this patient struggled to obtain answers to why this happened, but she did get a diagnosis that Dr. Lauri confirmed. Dermatomyositis. This is a rare life long autoimmune disease that one is born with that is revealed after fighting a viral illness. In this scenario it could have well been COVID, but do to lack of access to comprehensive care we do not have the privilege of knowing the virus that uncovered this immune response. It can be treated by continual use of steroids but largely the symptoms do not cease to exist. This disease has robbed this patient of independence. She can no longer walk, run, or stand on her own. This family, against all odds has taken fantastic care of this young woman. Unfortunately, we couldn’t tell her anything they didn’t already know and that the prognosis is poor: her condition will likely not get better.

 This is the reality of so many dealing with chronic disease in Guatemala. Inadequate and unavailable testing/ treatment leads to late diagnosis and poor health outcomes. Truthfully, we did not do anything extravagant for this patient today. We listened, we cared, we collaborated, and we shared knowledge, and yet it still feels like we barely made a difference for this patient. However, I’m hopeful that the way in which we cared for her and her mom that we were able to bear witness to the struggle they face. When in Guatemala I’m often left with feelings of frustration and righteous anger toward the systems that exist to perpetuate lack of access to healthcare. It always feels like we can never do enough to make a dent in the problem, but the fight is worth it nonetheless. Guatemalans continue to do what needs to be done for their community as a whole, even when resources are scarce. Their strength and resiliency is almost as incredible unbelievable as their hospitality and kindness. It’s an honor to be a small part of it all.

As an emergency department nurse, I often find myself frustrated with the lack of holistic care I participate in. Of course, during an emergency it is more important to address the imminent threat than fine tuning medications. But it is so clear to me here in Guatemala the impact that consistent holistic assessment has on an individual’s quality of life, health, and longevity. Fighting for access to this type of healthcare is some of the most important work I’ll ever do. When I care for folks, I’m invited to evaluate the ways that I am privileged and the ways I contribute to the oppression of others. I suppose it is true that it’s all about what we do with the cards we’re dealt. With my hand I want to create a better healthcare system for all people. I am grateful for the renewed sense of purpose and responsibility. I want to continue to fight for health equity and justice. Perhaps this means returning to school to become an NP.... we will see. What I do know is that Guatemala and the community here has softened my heart in a time that has made me numb and angry. For this, I am grateful and as the Jesuits say, I am ruined for life (again).  

A Vaccine or a Clean Glass of Water

Lorenzo Patti 

Returning to Cobán a year and a pandemic later I never thought I would be here. Driving into La Ciudad de Esperanza this year was definitely not the same as last year. While the bus was surrounded by a thousand smiles last year, it seemed barren this year. Covid has been a hard time for everyone this year but the struggles at home seem minuscule by comparison. At home, vaccines  are widely available and in some place things feel as though they are returning to normal, what ever that is. But here, it is nothing like that. Covid rates are higher here than they have been for the entire pandemic and only because we were privileged enough to receive the vaccine we’re we able to travel here for a week and partner with this community. 

Yet when arriving here Covid is not the same as it is in the US. People aren’t arguing about wearing a mask or whether or not to get the vaccine. Instead it’s a fight every day for them to be able to make just enough money to help care for their family. I met a woman today who had to be convinced for twenty minutes to get her daughter tested for Covid. The woman feared that if her daughter had Covid she would not be able to go to work. She worked every day of the week and needed to so that she could provide the ten dollars it makes for her family. People here are living in fear because if they get Covid it could mean their livelihood. Whereas people in the US are upset because they might have to return to work in person. Here these people don’t have the medical infrastructure or a government who will allow them to access or distribute a vaccine that could help millions. 

Yet despite this struggle walking into La Ciudad you can still find people here fighting for their communities. You can find people fighting for the the fact that everyone has a right to good, sustainable healthcare. Yet when sitting here and watching the few patients we are able to help, it’s hard to believe we are making a difference and yet the people make us believe that we are. When a woman hugs everyone in the room after getting a bottle of Tylenol and she thanks you for everything that you are here to do, she gives you hope that you are helping to make a change. When a man is excited that a pair of old used scratched glasses can help him to see one line further on the eye chart it makes you believe that the few things you can actually make a difference.

Even in despite of these moments it can be difficult to believe that you can help to create healthcare infrastructure in a place that feels like you are swamped by potential downfalls. Despite this you keep putting one foot forward in a hope that each step is closer toward others making the same climb as you. Steps that hope to carve a path to global change in healthcare that allows everyone the privilege of a vaccine for pandemics or even just a clean glass of water. 

Nuestra Esperanza

Natalie Castillo

I never thought I’d be back in Guatemala with the same medical team I came with 4 years ago. Though in a different town, I still feel that same sense of humility I felt the first time. 

Just like many others on this trip, I too was once an undergraduate student with a dream of becoming a medical professional and coming back to the county that strengthened my resolve to follow this path. It’s been amazing to see the same individuals come back as trained healthcare providers, now with a more skilled perspective. 

I spent most of our days in clinic working with Dr. Richard. My first year in medical school gave me some insight into patient interviewing and physical exam skills, so I had the opportunity to do just that with Richard’s guidance. To no one’s surprise, the very first patient I saw was not an easy one. Not so much because of his complaint, but because of his lack of findings which prevented us from giving him an answer. With no ability to do chest x-rays, ECGs, echocardiograms, or exercise stress tests, we are limited in our ability to diagnose a chest complaint. But I soon realized that this would be a trend throughout our trip. For many of our patients we had to improvise and work with what we had or do our best to get them an appointment with a specialist around the area. The lack of resources is evident, but even more so the resilience in the medical team we work with in La Ciudad and the patients who live here.

Dr Richard and I found ourselves running into patients he had seen the year prior. Last year’s medical team was the first to come to La Ciudad de Esperanza, and yet so many individuals remembered their visits with him. It was moving to see the connection and the trust they had formed. This reinforced the value in creating a sustained partnership with communities like these. The continuation of healthcare and capacity building was why I became so interested in the work this team did. Many of the students who came last year told me that the size of the clinic had doubled since then; the clinic had only one floor with two rooms then, and now it had a second floor with a pharmacy, dental room, and two other rooms for administration. We saw first hand what it means to build capacity. 

It truly is a blessing to be able to be a part of something so empowering like this and to experience teamwork and community like we do here. One moment I’m interviewing a patient with Dr. Richard, the next I’m watching a tooth extraction with Dr. Christian, then helping with patients in glasses, and even learning about physical therapy with our PT Deb. And throughout these moments I understood the integral part each person plays in providing holistic healthcare. Most importantly, I realized the most valuable player here is always the patient. After all, we would not be here without them. 

 

Back with open arms and an open heart

Angela Ellis

 Yesterday was first day of clinic and without missing a beat it was like I was transported back four years ago when I came to Guatemala with Xavier to help build capacity in a community that needed help in providing comprehensive primary care to their residents. I first came to Guatemala in 2011, where I moved here as part of a US diplomatic mission. For two years I was immersed in this beautiful country’s culture, and I fell in love with it and its people. It was here where I decided that I wanted to pursue a career in medicine, and so when the opportunity presented itself that an alumni trip was in the works for this year’s trip, without hesitation I asked Dr. Lauri to count me in. 

The Covid-19 pandemic has hit everyone hard, but especially hard on developing countries like Guatemala. They simply do not have the same access to resources as the US, which makes this year’s trip that more critical. In addition to the hundreds of medications and medical supplies this trip brings every year, we were also able to bring important PPE and Covid-19 kits. Resources that are scarce in the country, and nearly nonexistent in the rural highlands where we are. This important partnership that we have with La Ciudad de Esperanza is one step closer to providing everyone the equitable healthcare they deserve, because healthcare should be a right. 

What also makes this trip special is for the first time we have a dentist with us, Dr. Christian Alegrías, who came on this trip when he was an undergrad at Xavier. Dental healthcare is so important because it can drastically affect your health. If you don’t have good dental hygiene it can cause other systemic and chronic problems in the body. And from the first patient that we saw, which required two extractions and four fillings, I saw how much this community lacked not only in the access of proper dental care but also education in maintaining good dental hygiene. Dr. Christian explained how the certain types of inflammation and periodontal disease that we were seeing in these patients reflected problems and chronic illnesses in their overall health, such as diabetes. I was amazed that even though Dr. Christian and I became efficient at seeing patients, providing the fillings, cleanings and/or extractions they needed, many still have to come back to get more work done because of the poor oral health many had. That’s why our community partnership is so critical to this program, because we want to make sure that after we leave we have providers to check on our patients and to eventually become so self-sustainable that we are no longer needed.

As I am about to embark on a new journey this fall as a first year medical student, this trip has reminded me of why I want to be a doctor: to not only improve the health of others, but to also be a token of change, to set the world on fire and work towards creating a more equitable and sustainable future. This trip is just one example of this and I can’t wait to see what the rest of the week has in store for us. 

Back Again

Christian Alegria

 For the first time since our arrival in Cobán, I am able to reflect just exactly how I have arrived at this moment. It has been almost 10 years since the first time I came to Guatemala with Dr. Lauri and Dr. Richard. 

When the opportunity to return first presented itself, something deep within me immediately said, “you must go.” Over the past year, there was a lot of uncertainty with the pandemic whether this trip would be possible at all, but in the blink of and eye, here we are in Cobán after our first day in clinic. 

It is amazing to be here with such a special team. To work alongside others with the same intention. A similar desire to go, to do; whatever that may be.  When two or more individuals are gathered with a common purpose, that is when the magic happens. The first day of clinic presented many challenges trying to organize supplies, establish patient flow, all while doing so in the midst of a pandemic that is still at it’s peak here in Guatemala. It was remarkable to witness every team member proceed without hesitation to face those challenges and provide great care while also keeping volunteers and community members safe. 

Early in the morning, myself and one of our interpreters, Mishel, were filling bags with toothbrushes, toothpaste, and floss to give to our patients. As we were chatting to pass the time, she said to me how happy she was that we were here because it was rare for many people to have the opportunity to see a dentist  for fillings, or a cleaning, or extractions. She explained that many do not take care of their teeth, not because they don’t want to, but because they may have never been shown how. It broke me to hear this, but selfishly, made me feel like I had a purpose. And so I moved forward through the day with a mission objective. We were able to complete many fillings, cleanings, and extractions today and hopefully provide some needed relief. 

As we close day one, I can’t help but feel this overwhelming sense of gratitude to be able to return to a place that gave so much to me ten years ago. To thank whatever circumstances brought me here again. And in the spirit of serving together with all of the wonderful people here, 

Seguimos adelante

 Empty classrooms, dimmed eyes

It is so good to be back at Ciudad de la Esperanza. This is my third time here.  I first visited this community in March of 2019 to see if it would be a good fit for a partnership with Regis.  After a few minutes of being on the campus, meeting the core staff and talking to Padre Sergio about the work being done here, it was clear this was the perfect fit.  And thus the agreement to bring teams of Regis students down to help further their healthcare efforts began.  The second time was March of 2020 with our first Regis student team.  Both of those trips the campus was teaming with life - hundreds of school children giggling at the gringos and running around during breaks from class filled the air with joy.  But coronavirus closed the school just days after our last trip, and it is still closed.  The staff has done an excellent job keeping the children learning, and Padre and his core staff have continued to carry out the mission of the project, helping to continue their work in human rights, and advocating for victims of abuse.  They have done a remarkable job in just helping the community not starve by providing food assistance.  They have even managed in the past year to add a second floor to the clinic and install a dental chair and equipment.  So there is a now a trickle of people coming to the center throughout the day for health care and social services.  But boy do I miss the school kids being here.

The sense of doom about the pandemic is written on people’s faces.  The government here is not even close to providing an adequate response for testing, contact tracing and vaccinations.  They seem instead to be blaming the people for spreading the virus.  So far, I have not seen the blatant disregard for masking that we have in the United States.  People everywhere are wearing them.  I even saw a guy on a motorcycle last night with one on under his helmet - that sure isn’t happening in Los Estados.  We have a full team here who could have easily vaccinated a mass of people this week, and we gave plenty of notice to the ministry of health we were coming and able.  But there simply are no vaccines to administer.  The wealthy nations all need to step up and donate more vaccines, but right now the Guatemalan government needs to step up and get what vaccine they have to the people.  Supply chains and distribution protocols have to become priority number one.  

Amidst the melancholy we are never far from glimpses of hope. The first day of clinic I saw a little toddler who had a cleft lip that had been recently repaired.  He came in with lots of viral symptoms, so we tested him - even just being able to test him is a huge step forward.  The rapid test was negative, so with about a 20% false negative rate I told the mom to presume he had it, we reported the negative to the health department - from there they will either confirm with a PCR, repeat a rapid in a couple of days or do nothing.  Today she came back to clinic with her older 4 kids.  Technically they should all be quarantining, but she said the other 4 had never seen a doctor in their lives and she wanted them to be checked out.  The oldest, a beautiful 13 year old named Ilsa, came right up to me in the parking lot and said, “Hello” in perfect English.  So I asked her a bit later what other English words she knew and she started spouting out the months.  This family’s native language is Q’eqchi.  We did the visit all in Spanish, and this little girl is also learning English.  Three languages, but she has never seen a doctor in her whole life and has never even once taken a pain medicine like ibuprofen or acetaminophen.  The mom left clinic yesterday telling one of the nurses she is sending her sister and her family tomorrow to see us.  So, we gain a little trust and move the needle a little bit each time.  

Padre Sergio, the visionary Guatemalan priest who started this school for the cast away people living off the landfill 17 years ago, is one of those people who seems to always have a twinkle in his eye.  He sees the kingdom of God and tries to embody it here in these beautiful people around him.  I cannot wait for the school to be brimming with the chaos of the children again.  You can see the devastation in Padre Sergio’s eyes as they are just a bit dimmed.  Like all good leaders, Padre stands up where he sees injustice.  He is leading the fight here in Coban to try to get the government to vaccinate the people.  There is a long history in Central America of activist priests being silenced when the government feels they have pushed the boundaries too far.  I hope my saintly priest friend is careful, but I do not blame him for raising his voice against the injustice.  I cannot wait for the school to be brimming with the chaos of the children again.  That will help Padre find the twinkle again. He has such a love for this community.  The virus sucks, but the human response of those in charge is criminal.  

 This weekend I will get on an airplane for the first time in 15 months and fly south to one of my favorite places in the world, Guatemala.  I will be joined by 15 other medical professionals and people who similarly adore the people of Guatemala.  This will be the tenth team I have had the honor of working with over as many years in the amazing Central American country.  In 2010 I was asked by Rabbi Abie Ingber, the director of Xavier University’s Center for Interfaith Community Engagement, to be the medical director for a medical service trip.  That following spring we took 12 pre-med and nursing students down to a village in the Western Highlands and helped set up a primary care clinic.  After being the first physicians to ever work in that community, six years later we moved on to another village.  A young man we had met from the village had returned to be their physician and in the course of the six years the community had built a clinic and trained community health workers to serve the village.  The idea is to put ourselves out of business - to build healthcare capacity where before there was very little.  Those first years I lived in Cincinnati where my husband taught theology at Xavier while I practiced pediatrics.  We had the opportunity to move back to my home state of Colorado in 2017 around the same time Rabbi Abie retired.  The Guatemala medical program wasn’t continued at Xavier with our departures, so in 2020 I took my first team of similar future health care professionals from Regis University (my alma mater) to Guatemala.  We literally left Guatemala with that first group of Regis students the day before Guatemala shut down due to the pandemic in March of 2020.  

The last 15 months I have slogged through navigating working as a frontline healthcare worker and worried more than just a little about our community down in Guatemala.  Our new village is a special place.  It is a center that was founded 17 years ago by a Guatemalan priest to serve a community of indigenous Mayans who were living off the local landfill.  This is the extreme poor of Guatemala.  The community, thanks to Padre Sergio’s vision, now has a school that serves more than 450 pre-k through high school students, a center to train people in job skills, a psychologist and social worker to help the community with mental health and human rights issues, and a newly formed primary health clinic with a phenomenal community health worker.  This center is run by people who are committed to the heart of Catholic social teaching.  We hope to accompany them over the next few years to establish their own capacity to care for the healthcare needs of this community.

Because of the pandemic, I could not take another team of Regis students this year.  Every year as soon as we come back to the USA, the students universally express their desire to return to Guatemala.  So last fall I thought, this would be the perfect year to have an alumni trip.  So, I put the word out to the more than 100 students who have traveled to Guatemala with me over the last 10 years, and quickly formed a team of 16!  We all work in healthcare, so we are all vaccinated.  I am fairly certain this is the first ever joint venture of Jesuit universities of its kind.  Some of them went to Guatemala on the Xavier teams and some from Regis.  We have 5 RNs, 2 MDs, 1 medical student, a dentist, a pediatric PT and a 3 pre-med students.   And I am thrilled that my daughter, Grace, is also coming.  Grace went on one of the Xavier teams when she was 12 and for the last 5 years there is hardly a day goes by that she doesn’t ask when she can go back to Guatemala. 

We are traveling at a critical time in Guatemala.  To many people in the USA the pandemic seems to be over (it isn’t), but to many parts of the world it is really just beginning.  Pandemics hit impoverished areas first in their belly.  In places where simply feeding your family every day is hard, when the country shuts down starvation is a very real concern.  Then, last fall our community was hit back to back by two very late season, severe hurricanes - both of which were attributed to climate change.  These families live in tin roof, dirt floor huts, so imagine hurricane force winds and rain in such a structure.  It is literally like having a river running through your home.  

Viruses follow the rules of Darwin just like the rest of us - survival of the fittest.  We have now had a year and a half of this coronavirus and it is a much different beast than when we started.  It knows we are trying to outsmart it, so it is doing what viruses do - it is mutating to try to infect more people.  The variants spread easier and are proving to be more deadly.  So, right now COVID is surging in Guatemala.  The current percent positivity is 26%!  The vaccine efforts have been slow, with only about 4% of the population having received a first dose.  

There are times in our lives where we can mark a significant event and in looking back you know that “the gentle hand of god” was involved.  About two years ago in the fall when I was selling Guatemala textiles for a fundraiser after mass at Regis a woman introduced herself and told me her daughter lived in Guatemala.  We got to talking and this woman, who lives just a few miles from me, is the mother of the regional director for Central America of the CDC!  So, that is how I met Dr. Emily Zielinski Gutierrez.  Emily lives in Guatemala City with her husband and 2 kids.  We started emailing and were able to meet in person our last night in Guatemala that fateful March of 2020.  We have kept in contact throughout the last year and Emily has been an invaluable resource for me and our team, keeping us informed of where things stand in Guatemala in regards to the pandemic.  She was able to meet with our team via zoom this last week to give us up to date numbers - that is how I know the current percent positivity is at 26%.  These kinds of meetings simply don’t happen for a reason.  Emily is on leave right now, visiting her family in Colorado, so we met at mass at Regis last weekend and she gave me this little Guatemalan mother and child ornament.  The little masked mother will be my talisman for this trip.  I usually take a small token on each trip to stuff away in my pocket to help guard against whatever catastrophe may occur.  So, Dr. Emily’s masked mama will be our guard.  

We hope to do lots of things this week in Guatemala.  Aside from the hundreds of pounds of medications and supplies we are bringing, we hope to be able to see peds patients, adult patients, patients needing dental care and physical therapy.  There is even a chance we may be able to administer COVID vaccines, which, really would be the most critical work we could ever do in Guatemala.  We will blog as we are able, please follow along to see what adventure awaits us.  Lauri, Pramuk, MD