Friday, December 24, 2010
Thursday, December 23, 2010
Wednesday, December 22, 2010
Friday, November 12, 2010
Although Santiago Atitlan does not really celebrate Halloween, it is one of our kids favorite holidays. So, we thought that maybe we would make it our annual tradition to have a Halloween party. We hosted about a hundred people (hospital employees and their families, neighbors, friends, and hospital volunteers) for lunch and a piñata. Jennifer began cooking the week before and made the biggest pot of chili she’s ever made and thankfully had enough food to feed everyone. The kids enjoyed a lot of hot dogs.
Christopher was a Power Ranger in a costume we found for about a dollar on the street near the market in Santiago where they sell used clothing from the US. Elizabeth was Mulan and Julianne was a cat. Both girls were able to wear both costumes, so they each got to be both Mulan and a cat. Nicholas was a superhero (yet to be named) and also a princess (also yet to be named). We all had a great time!
November 1st is All Saints Day and the 2nd is All Souls Day or the Day of the Dead (Dia de los Muertos). In Santiago, as in the rest of Latin America, it is a time to remember family members and friends who have passed away. Many thousands fill the cemetery to pay respect to their loved ones. The day before is spent decorating the local cemetery with pine needles and cut grass to cover the graves, flowers, candles, and incense. It is supposed to be especially beautiful at night with the lit candles as people hold a vigil in the cemetery overnight from the 1st to the 2nd.
Monday, November 1, 2010
Tuesday, September 14, 2010
After about 15 minutes, Miguel’s father is dropped off in Cerro de Oro, the village where they live, to tell relatives what is happening and to get money to help pay for their expenses in Solola. The hospital in Solola is a public hospital so the care is free, but there are costs for the parents to eat, etc.
Every jolt and bump seems to tug on the endotracheal tube and Brent and Diego look at one another hoping not to have to re-intubate on the way, but each tug confirms the nurse’s taping job was excellent. Brent is providing Miguel’s respirations methodically reciting “squeeze, rest, rest, squeeze, rest, rest...” trying to maintain 20 - 30 breaths a minute and watching Miguel and the pulse oximeter. The pulse oximeter has been going down 99, 95, 90, 88. Brent notices the bagging becoming more difficult and gives a dose of albuterol (a medicine that helps to open up the lungs) via the endotracheal tube. This appears to help as the oxygen monitor increases to 97 again. The bomberos note another one to one and a half hours to go.
Diego observes Brent looking queazy and offers to take over the ventilations. There are so many 180 degree turns on the road that you begin to wonder if you are really going forward and not just going in circles. Brent is reminded of a similar curvy road growing up, the Green Springs, and the many times his father pulled over for him!
Diego sees the oxygen saturations dropping again and a quick look at Miguel shows him moving his mouth, a sign the paralytic agent is wearing off. Another dose of that, his saturations increase, and he is resting again. They finally arrived to the Pan American Highway and a direct shot to Solola.
Arriving at the National Hospital in Solola, a team of Guatemalan physicians greet and attend to Miguel and his mother. The Hospitalito team stays with Miguel and his mother until they feel comfortable with the change over and begin their journey back home.
Miguel did well during his hospital stay there, was extubated (endotracheal tube removed) after three days, and after 8 more days in the hospital he returned home.
Thinking now of our time with Miguel and the people he brought together from different parts of the world, working together for a common good, his name seems fitting -- one who resembles God.
Tuesday, September 7, 2010
Morning report is a time to review, with the other doctors working in the hospital, the patients admitted and seen in the ER during the day and night before. Jennifer quickly reviews the patients and then focuses on Miguel. Brent arrives at 7:40, a bit late, but in time to hear Miguel's story. The doctors then go down to see Miguel and the other patients.
Miguel is now breathing 50 times per minute, but his oxygen saturation has again dropped into the 80s. His pulse is 180 and his lungs are tightening up again. He is shows signs of tiring and is not able to maintain his oxygen at appropriate levels as his respiratory rate slows.
The team this morning includes doctors from Guatemala as well as from Spain and the United States. Many specialties are represented including obstetrics, family medicine, and gastroenterology. They realize Miguel will not be able to keep this up much longer. They begin working in unison: continuous nebs, a phone consult to a pediatric intensivist in the US, comforting the parents, and preparation for intubation.
Rapid sequence intubation is a process of giving sequential medications that paralyze the patient and allow for placing a tube into the trachea. This then allows the physician to take over the work of breathing for the patient.
Assignments are given, drugs prepared, high flow oxygen started. All drug dosages checked and double-checked.
The ER this morning is a cacophony of sounds -- the bubbling of oxygen, the drone of the suction machine, voices of physicians and nurses and the labored breathing of Miquel.
The medicines are given and Miguel stops breathing on his own......
Seconds seem like hours during this moment as all attention is focused on placing the tube into the trachea.
When intubating a patient you are always told to have a backup plan. What will you do if you are unable to intubate the patient? The last patient, Brent had intubated, was 6 years ago while working in an ER in Northern California. Brent ran through the different options in his mind -- bag, bougie, laryngeal mask, needle cricothyroidotomy.
The first attempt is met with coughing, signifying Miguel is not completely paralyzed. Another dose of the paralyzing agent is given and this time the endotracheal tube is passed without difficulty and taped into placed. Oxygen is hooked up to the bag and one of the doctors rhythmically compresses the bag which now does all the work of breathing for Miguel.
Miguel’s oxygen saturation increases rapidly to 99%. He appears at rest now after working so hard for so long.
The local volunteer bomberos (firefighters/paramedics) are called and Miguel is prepared for the 2-3 hour trip around the lake to Solola, the national hospital where specialists and ventilators are available.
Monday, August 30, 2010
|Julianne and Elizabeth|
At 7 a.m. Ingrid arrives, our house helper, who makes this chaos a little less chaotic. With Greetings of “Buenos dias,” a few instructions and an update on the activities of the day, Brent heads up the small hill, leading from the house, with Christopher and Elizabeth in tow, backpacks on, and their “chicken mask” school projects in hand.
Christopher and Elizabeth wave to Hospitalito, knowing that Mommy is somewhere inside and will be at school to pick them up at the end of the day. No time to walk today, as Brent is on OB call and needs to be at the hospital at 7:30 a.m. for morning report. They catch a tuc tuc.
The tuc tuc ride is like some racing car video game as the driver swerves around pot holes, dogs, and puddles that resemble mini lakes this time of year. Christopher and Elizabeth squeal with joy as the tuc tuc is forced into one of these “mini lakes” by an oncoming "chicken bus" headed for the capital. After climbing the hill to the parochial school, Colegio Catolica Padre Apla’s, the kids and Brent have arrived, a little wet and all sleepiness cleared from their heads.
The kids enter their class room with a “Buenos dias, Maestra” and a “Buenos dias, Compañeros” and with a “Buenos dias, Cristobal” and “Buenos dias, Elizabeth” from their teacher and classmates, the children proceed to sit down at their desks. The walls are lined with the alphabet, numbers, and words written in a mix of Spanish, Tz'utujil and English. Brent is reminded of Christopher’s protest during study time at home for their last exams, “It’s not fair we have to study three languages!” Brent leaves the kids with a kiss on their heads and a quick checkout with their teacher, Juanita.
Monday, August 23, 2010
Miguel’s parents were up with their child late into the night reflecting on the past few days. It started as a runny nose, followed by a dry hacking cough and then the rapid breathing, each breath an effort to get more air. They went to the local health center and received various remedies that seemed to help initially, but now, as their child looked up at them with a plea for help and fear of the unknown, they knew he was getting worse.
They say an asthma exacerbation is like trying to breath through a straw, as it worsens the diameter of the straw grows smaller and smaller........
Jennifer had just laid down in bed during a 24 hour in-hospital call. She’d seen and treated numerous patients that day. Routine stuff mostly, but now as she laid down at 4 AM she heard the unforgettable "clack, clack, clack" of the tuc-tuc coming down the dirt road to Hospitalito. At this hour of the day it could mean only one thing -- a patient in need of acute care.
She gets up before the guardian can knock on her door, fumbling around in the dark in a place that is becoming less foreign each day. She hears a rooster crow, a dog barking at some unknown nemesis as she puts on her doctor’s coat --loaded with all the “essential” paraphernalia from 15 years of practice. She grabs her stethoscope, a close friend since her days in medical school, and heads down the stairs to the ER.
Andrea, the nurse, had already placed oxygen and gotten vitals when Jennifer entered the room. Miguel’s eyes were bulging and wide with panic as his chest wall heaved with every breath. Sensing the acuity of the situation, Jennifer questioned, examined, and gave orders almost simultaneously -- pulse oximetry, intravenous access, nebulizer treatments, I.V. steroids. With treatment, Miguel’s pulse oximetry began to rise from the low 80’s to low 90’s. His respiratory rate began to drop from the 80’s to 50’s and his lungs began to open up. He looked a bit better now.
It was almost 7:30AM and time for morning report.
Tuesday, August 3, 2010
"We don't need Sherlock Holmes to figure out that Brent Burket and Jennifer Thoene don't event fit the description of your usual medical volunteer. The evidence is everywhere upon entering their home: two pairs of kids-sized rain boots, swirly blue and pink, a bookshelf of children's literature, tables loaded with crayons and coloring books, the movie choice of the day is Toy Story 2, and the final clue, a small voice saying, "mama, it's not fair".
So, why do two US physicians with four children under the age of eight, choose to move to highland Guatemala..." read the rest of this article interviewing Brent and Jennifer on the Hospitalito July Newsletter.
Monday, June 21, 2010
Wednesday, June 16, 2010
Wednesday, May 5, 2010
The life of a mother in the developing world is very different, in many ways, from what I have seen back home. The daily routines of cooking, washing and caring for the children is an all consuming endeavor. The gathering of wood to cook, the fetching of water to drink and wash, the carrying of laundry to the lake, the making of clothing for the family, the trip to the clinic with a sick child.... the day is endless and the next day the same.
At times it is hard to find many similarities between the world I came from and the world I am living in now, but in a “mother” I can see a commonality with the mothers I’ve known best: my mother, my children’s mother, my sisters and my mother-in-law. Their primary desire being the wellness of the family, is a commonality of mothers I see here and the mother’s most dear to my heart.
This commonality is shown in their unique ability to focus on the day to day needs of the family and exemplified by the gifts of calmness and directness at achieving those needs, often times in the face of great adversity. What underlies these gifts is an undying compassion and love for their children and families.
So today I wish to say “thank you” to my mother, the mother of my children, my mother-in-law and to all the mothers of the world for their love, support, compassion and care that they gave yesterday, give today and will give tomorrow.
peace and love,
P.S. I wonder how much better the world would be if a few more mothers of the world were leaders of the world?
Thursday, April 15, 2010
Christopher and Elizabeth enjoyed their week off from school and couldn’t figure out why we wanted to continue home schooling. They received their first report card and did very well with their lowest scores in English (we still can’t quite figure that one out) and Physical Education. Julianne also had a week off from preschool but kept asking when she could go again. Nicholas celebrated his 3rd birthday April 5 (our first family birthday in Guatemala). We enjoyed hot dogs, a cake, and playing with friends.
Friday, February 26, 2010
The children are doing great, exploring their new surroundings and making new friends. Christopher and Elizabeth have started 1st grade at the local Catholic school. It’s amazing to see them go to school everyday without a complaint nor a worry that they don’t speak Spanish and that the teacher doesn’t speak any English. Kids are so adaptable! Julianne is attending preschool two days a week and is enjoying that. To our surprise, she asked the other day when we were going to get to Guatemala. When we told her that this is Guatemala, she just said “Oh.” Nicholas says “Hola” to everybody with such a big infectious smile that all seem to walk away with a bigger smile. Jennifer and Brent have started language school and are finding out how much they need to learn in the next few months.
We will continue in language school until mid May and then we will start working at Hospitalito. The hospital is in the process of being rebuilt (see previous blog). It appears that the hospital is functioning well at the interim location, but you can sense the excitement surrounding the building of the new hospital with a projected opening date in late summer or early fall.
The people have been very friendly and helpful. They really love children and are curious about our diverse family.
The area is beautiful and the climate temperate. The yard in the house we are staying at has evergreens and many exotic, tropical flowers, as well as birds. The kids love running up and down the long grassy area in front of the house playing make-believe games of kings and queens and rescue. No toys necessary, just one big stick that we try not to let Nicholas get a hold of. There is also a great tree for climbing.
We go to the local market several times a week. There is a good variety of fruits and vegetables, beans, rice, and, of course, tortillas. The tortillas are made by hand out of masa right while one watches and then cooked on a stone griddle. They are best eaten hot, right on the street! The bananas, pineapple, cantaloupe, mangos, and papaya are all as sweet as can be and the avocados are the best and biggest we’ve ever seen. We have splurged on peanut butter and cheese which are not at all a local staple, but can be found in town.
Walking or riding a tuc-tuc is the most common mode to get somewhere. The kids love riding in tuc-tucs: no seatbelts, open air, holding on to the edge of your seat as you wiz dangerously close to other vehicles. Click here for a video of a tuc-tuc ride in Santiago.
The church is very alive here. There are three masses on Sunday. Two in the local language,Tz'utujil, and one in Spanish. The Spanish Mass had over 800 people and was standing room only, the overflow extending out the back of the Church.
The Tz'utujil dress is very colorful with intricate patterns of birds and flowers in purples, reds, greens, and yellows. This along with the music and singing made for a very exciting mass that even Nicholas enjoyed until halfway throught the homily when he was tempted (as Christ was tempted in the Gospel this week) to get off Daddy’s lap and make a break for the back of the church. The other children did surprisingly well at Mass eventhough it was a bit longer than at home.
We want to thank our families and friends for all their support, especially over the last few months, to help make this transition go as well as it has.
We hope all is well with you and your loved ones.
Peace and Love,
Brent, Jennifer, Christopher, Elizabeth, Julianne, and Nicholas :)
Wednesday, February 10, 2010
On the left in the group foto are Christopher, Brent, Jennifer and Julianna Burket. Aklax is holding Elizabeth and Juan Manuel has little Nicholas. (yes, four small children!) The staff was so eager to meet the new family that they arrived to welcome them, and to help carry luggage.
We are very happy that they have arrived!
Mission Doctors is the organization that facilitated their volunteer time with HA. It was September 2007 when Dr. Brent arrived with Mission Doctor’s director Elise Frederick. We have been patiently awaiting his return.