Beautiful Chaos

Guatemala here we are!! We have been preparing for this trip for nine months and we are finally here. It feels unreal. The travel was long and exhausting but the second we all got in our bus headed for Coban everyone eagerly looked out the window attempting to take everything in as if it would slip through our finger tips. We settled into Coban and had our first dinner together with the entire team where we were all awaiting the first day clinics with excitement and nerves. 

Our first day of clinic was beautiful chaos. It began with meeting new people, unpacking all the supplies we brought and learning to communicate without a common language. My first clinic day was spent in the pharmacy in the morning then with our adult doctor, Dr. Felipe, in the evening. A highlight from today was occurred after setting up the pharmacy, when we began receiving prescriptions from our doctors. With the amazing help of Dr. Eric (the farmacĂ©utico) MinhThy and I put the medications together and a Guatemalan nursing student, Eduardo, recorded the prescriptions. After completing one prescription, Eduardo asked me the quantity of a particular prescription and recalling the previous prescription I filled I showed “1..2..0” on my hands, with which he wrote “21?” on his hand and I repeated to sign 120 to him. We continued to look at each other confused when he finally picked up the pill bottle and pointed to the pills showing me that there were clearly not 120 pills. I looked back at the original prescription paper and found it was indeed 21 pills. I showed him the paper and we both giggled at my mistake. 

It feels like a silly moment to share but it was one of the best moment I look back at today because one of my biggest fears for this trip was the language barrier and showing that I care despite that. However in this silly moment I realized both Eduardo and I are feeling the same way about the work that is done at Cuidad de la Esperanza. The feeling of belonging that I have felt from my very first meeting with the team has only been amplified upon arriving in this community and it is only the first day!
I am beyond excited for what lies ahead in our time here at Cuidad de la Esperanza.

Mila Trombley

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Longing Anticipation

The view from our bus stop where we took a break to stretch, use the bathrooms, and get ice cream

We made it! It only took 6 years, an expired passport, two flights and a 6 hour bus ride to get here. I was 12 when I went on my first trip to Guatemala and I have been begging my mom, Dr. Lauri Pramuk, to come back ever since. After years and years of my relentless efforts, she finally gave in. The plan was for me to go on the 2021 alumni trip, but unfortunately life held a different path for me. The day before we were supposed to leave we realized my passport was expired. I could not go on the trip. At the time I was heartbroken. I was a senior in high school and I had been eagerly waiting for this trip for 6 years. 

Now, however, I am grateful. My passport being expired was a gift. I had an extra year to prepare with a wonderful team of students and mentors. I enjoyed my freshman year at Regis University while going to meetings every Sunday to learn about a variety of topics relating to Guatemala and health. I got to learn about the different stations we will work in during the week: triage, pediatrics, internal medicine, physical therapy, dentistry, pharmacy, and the glasses room. I do not intend to go into medicine in the future, so all of these stations seem somewhat foreign to me. However, despite my overwhelming anxieties, particularly relating to triage and speaking Spanish, I know that I have all the preparation I need from our weekly educational meetings. 

After a long day of traveling, I am very tired. I am currently laying in my relatively comfy bed, hoping no cockroaches come out to play in the night. I’m anxious for tomorrow as it is our first day of clinic, but I am even more excited to be working with Dr. Deb in physical therapy, and my mom, Dr. Pramuk in pediatrics.

Grace Pramuk

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My roomies and I for the week, left to right: Avery, Mila, Me

A Warm Home

First of all, let me be clear that, at best, my words can only show a shadow on the wall of the real Ciudad de la Esperanza, Cobán, and what this trip truly is. I can describe the actions of this first day, but I know as I am writing this that there are beautiful things here that either I cannot yet understand, or that I would not be able to translate if I could. I will try my best.

Today was the day. After all of the anticipation, all of the preparation, and all of the suspense, we finally got to turn our potential energy into kinetic energy and start our first day of clinic. 

Into the gates, off the bus, and straight into the warm embrace of Esperanza as Nurse Esme greeted the medical team with smiles, hugs, and tears. Esme showed no less warmth to the students, even as unfamiliar as we are. Then straight into good, grounding, physical work, unloading and unpacking all of the supplies that we’d packed and carried less than two days before. It was refreshing, and it felt right, like there was no question that whatever we could do to help get things moving meant something to this community. When I wasn’t smiling it was only because I was focusing hard to understand the Spanish all around me. We set up, we laughed, and we tried to get ready for whatever might happen when the day really began. 

I have to say, although I enjoy every member of Team Guat and I am lucky to have so many talented, caring, and dedicated people around me, I got especially lucky today to have Diego with me for our first rotation in Dr. Felipe’s office. See, Diego has a great sense of humor, he is an excellent friend and teacher, and Diego. Speaks. Spanish. I don’t even want to think about how difficult it would have been to stay afloat at the very beginning of the day through Dr. Felipe’s long medical interviews with patients had Diego not been there too, cracking jokes, encouraging me, teaching me, and helping me connect with Mateokggh, Felipe, and Esme. Muchas gracias mi amigo, si lees esto.

Clinic began, and we got to shadow the wonderful Dr. Felipe as he showed us what a great doctor does: Listens to and speaks to his patients. I couldn’t understand half of the language and I could tell the care that Dr. Felipe put into finding out what his patients needed. In-between, he would teach us in Spanish and English about the interviews, and I swear between Diego, Mateo, Dr. Felipe, and the patients, I learned how to use more Spanish in two hours than I ever learned in my three years of classes. My brain was smoking out of my ears.

Mateo of course also deserves his own mention. Our photographer from Ciudad, he has been nothing but kind, patient, and funny since I’ve had the courage to try to talk with him in Spanish. His humor is sharp, which is great both because you need to be able to laugh at yourself when you’re practicing a new language, and because it is motivation to learn enough Spanish so that I can finally crack a little back. I asked why he’s studying philosophy instead of photography in school, and I learned that he is trying to open up his mind’s eye more to enhance his photography even further (or however else you can say that without being so flowery, that is definitely not verbatim). Anyway, I think his approach to education is ingeniously creative, and I hope that I can learn to think about my goals the way that he plans out his.

Finally there was triage and the rain, the former overseen by Dr. Steph and Nurse K.K. (the latter obviously overseen by something else entirely). Triage was my first real opportunity to practice my Spanish and medicine with patients independently, and boy was it fun. I felt like a mess, don’t get me wrong, and the most common Spanish I used was “lo siento”, but I also felt like I was really doing something helpful, that I was challenged (mostly) without help, and that I was learning. Every single patient that I encountered today was kind, overwhelmingly patient, and with good humor in a way that I have never seen in any of my healthcare experience in the U.S. And watching a little girl’s and boy’s eyes and smiles light up when you all start blowing bubbles: priceless. My number one lesson today is that nothing transcends the language barrier quite like bubbles. For my number two lesson, I found an even deeper admiration for Dr. Steph and Nurse K.K. today; I have never seen two people who are so tired, stressed, and busy, show so much compassion, understanding, and kindness to a bunch of kids that only have a vague understanding of what they’re doing. Thank you both. Without your patience we may not have the courage to be here. 

If you haven’t noticed, kindness has actually been the theme of this ramble. In fact, I believe it is a large part of what may be one of those beautiful things that I said I could not understand at the beginning of this post: Ciudad de la Esperanza feels like a warm home. Seriously, I know that’s corny, but hear me out okay. Imagine your best friend’s home, or maybe your favorite cousin’s: you walk in, and people are happy to see you, and you are excited to be there; people are joking and laughing and smiling; people are listening and trying to help each other; we’re sharing our meals together; you know that people have your back. They care. I’m not exaggerating, that is what Ciudad feels like. You can relax, even when you’re working. It feels safe.

The rain rolled in, and I stepped outside to decompress and get some space at the end of the day. And I thought to myself, this is the most beautiful countryside I have ever seen. I will do everything that I can to earn getting to experience this view, getting to meet these people, and getting to learn this work. I felt more energy running through my bones today than I have felt in a long time, and that’s even after the 15 hour travel day.

Anyways, it is way too late, and I will regret not turning this in sooner in the morning, but I felt that there was a lot more that I needed to say than I originally thought. No one really gave me any guidelines for these blog posts, so to whoever this may concern, I hope you find some value here. I did at least. Goodnight.

Louis Gonzaleshttps://drive.google.com/uc?export=view&id=1PKkZr5QTw4bbvvUQKSgKdInPFJg2t4Cqhttps://drive.google.com/uc?export=view&id=1rOXN4bTd7qF5otuSqG5pOb9wm1r-eXCd

Lifelong Friends

Some of the medical team







Some of the medical team (left to right)

Dr Deb Bauer, pediatric PT, Ricky Perez, trip coordinator, Kristen Kellogg, RN, Lauri Pramuk, MD - pediatrician, Fr Kevin Burke, Jesuit, Dr. Stephanie Ibemere, PhD RN, Dr. Eric Bertelsen, pharmacist 


Tonight a group of 27 of us will depart from Denver, North Carolina and Ohio with a singular purpose - to meet in Guatemala and continue a partnership that began between Regis University and Ciudad de la Esperanza in 2019.  It always seems like just before we depart from Guatemala something big is happening.  In March of 2020, it was the opening act of the pandemic.  That was the last time we were able to take a student group down.  We left just a day before the lockdown.  We didn’t know how close we were cutting it.  And this year, it is coming on the heels of a mass murder of grade school children.  It is hard to muster the strength to even talk about the latest school shooting.  As a pediatrician it is more than evident to me just where our priorities lie in this country.  It isn’t with children.


As we do our best to repair our broken world, on the eve of this new trip, I mostly am grateful for friends.  I have traveled to Guatemala annually now for 11 years.  This is the first of those years I will not be meeting my dear friend, Richard, in Guatemala.  Richard is the “grown up” doctor who usually goes on the trip with us.  I see the kids, he sees the grown ups, but in reality he is the biggest kid of all of us!  Richard has had some medical complications from a surgery on his spine last fall and isn’t physically able to travel this year.  He will go again, both he and I are sure of it.  So, I will be making a new friend with our internist, Felipe Amador.  I am overjoyed his wife Tristen and daughter, Elena are also coming this year.  Richard and I will text and talk about everything still.  He will be with me in spirit. I know how hard it will be for him not to be there.  


Our core medical team of Dr Stephanie Ibemere, nurse Kristen Kellogg, and pharmacist Eric Bertelsen will of course be on the trip.  We are joined by two new medical team members who went on the alumni trip last summer - Dr. Christian Alegria - a dentist who went as an undergraduate with Xavier in 2012, and Dr. Deb Bauer, pediatric PT, whom I have known for almost 30 years.  Ricky Perez, who is a Regis team alumni is back as our trip coordinator and his mom Mary is coming again as an interpreter.  In the fall of 1989 as a freshman at Regis, I took my first ever class in theology from a young Jesuit named Kevin Burke.  Father Kevin and I became good friends.  I was babysitting his nephews for him on campus one day a year later when he introduced me to Chris…a few years later he presided at our wedding.  He went on to baptize two of our kids.  He now works closely with Chris as VP of Mission at Regis.  He is coming to Guatemala this year too!  We have lots of great work ahead of us and will be starting some new partnerships in an effort to build on ways we can make our relationship with the people at Ciudad de la Esperanza more sustainable.  


Our 14 Regis students on this trip are a mix of nursing, pre-med, pre-dental and psychology students.  We have met with them weekly throughout the academic year to help them prepare for this experience.  And they may not really know it yet, but they are all ready.  I cannot begin to guess what experiences we will have in clinic, but I know they will all come to deeply love Guatemala just like the rest of us have.  There is no way to adequately prepare them to have their hearts broken and put back together or how to predict how that may happen.  I am also deeply grateful my daughter, Grace will be among one of those 14 students.  Grace first went to Guatemala with me at age 12 and to say it impacted her is a gross understatement.  She was unable to go last summer on the alumni trip due to an expired passport (top mom fail moment).  So she fundraised and attended all the prep classes with the rest of the students this year so she could make her way back.


In an extra special turn of events, Chris will actually be able to join us for the last two days.  He will meet us in Guatemala City for a meeting we are having the administration of the Jesuit university in Guatemala (Universidad Rafael Landivar) to start an international partnership of Jesuit schools to help build sustainability for the clinic at Cuidad de la Esperanza.  He arrives in Guatemala with another close friend, the best man from our wedding, Stephen Belt, who will be doing some traveling in Central America this summer.  And our two days in Angitua we will be joined by my friend Emily Zielinski Gutierrez, who is a PhD in public health, lives in Guatemala City with her family and is the director of the CDC for Central America.


For me this is like the all star line up of so many wonderful parts of my life.  To be able to spend some time in one of my favorite places in the world with some lifelong friends, and to be able to make new friendships, I am just thankful.  The students and medical team will be blogging during our trip, so you can follow along.  It takes us a day or two to get the blog rolling down there, but I encourage you to follow along.  


Dr. Lauri