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).  


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