We went to the Hospitalito Christmas celebration the other day. It was at a nearby chalet with a pool and big grassy area. We played games and groups did skits. The group that was in charge of the cooking made an incredible meal on an open pit BBQ. They made grilled chicken, carne asada, chorizo (pork sausage), grilled vegetables, potatoes, salsa made from grilled tomatoes, and guacamole. It was delicious.
We don't eat a lot of meat here, so Julianne kept asking for clarification on each meat she was eating..."So this is the chicken's leg and this is cow and this is pig. I like pig!"
We, and especially the kids, are looking forward to Christmas. The holiday is creeping up on us here without TV and the Christmas sales that start in October (or before).
The priest emphasized at Mass one day that Christmas does not begin until the 25th. Now it is Advent, the time of spiritual preparation. It seems that for many in the US, when Christmas finally comes, the Christmas season ends the same day. It has been refreshing here. Of course, the hardest part is that we will spend it without our extended families.
We did buy a small artificial tree which is decorated with a few ornaments, ribbons, and things the kids made. It is just right! We are planning a Christmas Day dinner here with the volunteers that will be here over the holidays.
P.S. The picture of the tree is not our "small tree" but the tree in the center of town!
Yesterday we woke up and it was 57 degrees inside the house. (We do not have an outside thermometer, but it was clearly colder outside.) We never thought we would be cold in the mission field especially after being in Ghana where we were always hot.
It warms up beautifully during the day, but nights and mornings are cold. We are at 5,105 feet so I guess the cold should be expected, but sure makes it hard to get out of bed in the morning especially with no heat to turn on!
It's been a busy time at Hospitalito. The first floor of the new hospital has opened after years of work in planning and building. As much of a challenge as it was to build the new hospital it will be as big of a challenge to run it. As Hospitalito enters a new era, we are honored to be part of this and hope we are able to help in the challenges that lie ahead. There are still many sections of the hospital that are yet to be completed and we are awaiting these areas with great anticipation over the next year or years especially the blood bank.
We have had a number of visitors who helped with the opening and moving everything from the old hospital to the new hospital. Lynn Powe, a nurse, came for the month of November, taking Spanish classes in the mornings and working in the hospital in the afternoons. She provided much appreciated support to the nursing staff. We were also able to use Lynn's baby sitting services and enjoyed a dinner out.
Linda Harris, an obstetrician, and Betty Kaye Taylor, a nurse midwife and ultrasonographer, both from Medford, OR and people who worked with us at La Clinica, came to help set up the obstetrical department. They did a great job and helped with a number of deliveries and ultrasounds as well. They brought us many goodies which we are savoring and took us out to a wonderful Thanksgiving dinner at a local restaurant that caters to gringos. We had everything good and wonderful for dinner. Julianne kept asking for more of the "chicken with salsa," translation turkey with gravy.
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.
We have found a number of organizations working here in Santiago that are helping the people of Santiago. One of these we have recently been introduced to is The Cojolya Association of Mayan Women Weavers.
This organization employs local weavers which provides work for up to 80 weavers and runs a social program aimed at improving the lives of its workers, their families, and the local community. They also have a small museum about weaving that goes through the process from making the thread to the finished product.
They have a great web site which gives more history and some options for Christmas gifts that will make both the recipient happy and help the people of Santiago. www.cojolya.org
The trip from Santiago to Solola at any time of the year can be difficult, but especially this time of the year with mudslides and road closures. Brent is elected to go with Miguel. Diego, a new nurse to Hospitalito, is assigned to go, as well, and along with Miguel, his parents, the bomberos and Brent, they begin their journey.
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.
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.
At 6:00 a.m. Brent awakens to the proclamation of “Daaaad, I have to pee”. Julianne feels the need to announce this and serves as the morning alarm for the household. Four kids to get up, dressed, fed and teeth brushed. Somehow Jennifer is able to do this without a hitch, but for Brent it is always a challenge. Jennifer won’t be home from the hospital until about 9 a.m. The kids know the routine, but still feel the need to deviate at times, depending on who needs a little more Daddy attention on a given day.
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.
Tuk Tuk
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.
It’s the rainy season, but more so this year than in the past few years. The rain seems relentless at times. Downpours last for days at a time, a constant drone on the metal roof. Roads resemble rivers more so than streets. Mudslides have replaced villages with mud and boulders and there is a general sense from the populace of a heavy coat blanketing all the senses. But even with all of the rain a "Buenos Dias" is never far from the lips of all we pass by. 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.
"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.
We started working in the hospital in mid May. We are excited and happy to be seeing patients again and working with the very dedicated staff at Hospitalito. As always with new work, there are unforeseen challenges. We studied Spanish for our first three months here so that we could communicate with the staff and patients, but are finding that a vast number of patients speak no or only a little Spanish. It is hard not being able to communicate with patients directly in their native language. There is something lost in the history taking, in the patient education given, in the encouragement we want to impart. Unfortunately, our Spanish is still not proficient, so learning Tz'utujil will have to wait a little longer.
There are also many things about the culture, the cultural practices and beliefs, and the people’s day to day living that we need to learn. This is a slow process, because you really don’t know what you want to know until a situation comes up that provokes questions. Someone can’t sit down and tell you that these are the differences between our culture and their culture. Some things may seem so natural for one culture that it is hard to even explain what provokes a particular belief or practice. For example, several patients have asked if bathing in cold or hot water will affect their medical condition, but we have not yet been able to figure out what concern perpetuates this belief.
Our days are full. We’ve been busy balancing the new work schedule, family, and involvement with the church. The kids seem unfazed by it all and wake up each day with smiles on their faces and ready for a new day (unfortunately usually before 6AM). We have no after school activities, no TV, etc., yet we are busy. Our two first graders go to school from 7:30 until 12:30. By the time they get home and we eat our main meal about 1 or 1:30PM and they have a little time outside to play, it is 2:30. Just enough time for a couple of hours of homeschooling, then it is dinner, a shower, reading and bedtime.
All the activities of daily living are very time-consuming and less so for us than for most of the local people because we are very fortunate to have a washer, refrigerator, and gas stove (so we don’t have to have gather, cut, and burn wood for cooking). Shopping is an almost daily necessity as we can only carry so much home at a time. Meal preparation is very labor-intensive as almost everything needs to be made from scratch and raw fruits and vegetables need to be prepared specially.
Christopher and Elizabeth continue at the local Catholic School. They are learning Spanish, the local Mayan language, Tz'utujil, and a little English as part of their school curriculum. They had exams recently and while we were studying, they had some practice tests at home. In one day, they took tests in all 3 languages. Christopher thought that this was very unfair :). We’ve participated in a number of school events including a field trip to the beach on another part of the lake (we paid for this thinking it was going to be at a local beach and then the day before found out it was a boat trip away, after which the teacher allowed Brent to tag along as a chaperone), Mother’s day celebration which was a huge, wonderful celebration complete with tamales as a treat for all the mothers, and a school birthday celebration. Christopher’s birthday was at the end of May and so we brought a little snack for the class. We were completely surprised when Christopher was inundated with gifts and hugs from his classmates. He received a couple of toys, but most of the gifts were completely practical: socks, towels, cups, bowls. This was so generous and thoughtful as we are sure these students’ families do not have money to spare.
Julianne and Nicholas are both in a local preschool two days a week and really enjoy their time with the other kids in the community. Many little art projects are covering the walls in our house and are providing creative decorations.
Peace
Brent, Jennifer, Christopher, Elizabeth, Julianne and Nicholas
We are writing to thank you for your support of MDA that, in turn, gives us the opportunity to be messengers of your love for many of the forgotten ones in Guatemala.
We realize more and more each day that our time here is a reflection of the love and support you give and have given.
Your prayers are heard as Jennifer manages a 15 year old, scared pregnant girl in labor, providing a safe and caring place for both mom and babe.
Your love is seen as our child asks why the elderly women is picking up the pieces of corn off the ground and with our answer of “because she is hungry” our child gives the 2 Q she had for ice-cream to the woman.
Your teachings of love, knowledge, patience and hope are felt each day as the challenges in front of us dissipate with a hug and thank you from a patient.
Your kind words are heard in the early morning as the birds, singing outside our window, tell us a new day has come with new hope of a better day for the forgotten ones who will not be forgotten today.
Peace
Brent, Jennifer, Christopher, Elizabeth, Julianne and Nicholas
Mother’s day in Guatemala is celebrated on May 10th every year. It is a time to reflect on and give thanks to our mothers (and all mothers of the world) for their love and devotion to our children and to our families.
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,
Brent
P.S. I wonder how much better the world would be if a few more mothers of the world were leaders of the world?
There has been a lot of activity in Santiago. The Easter week or “Semana Santa” is the largest celebration of the year here. It was a special time seeing the community come together in preparation for this holiest of celebrations.
The schools all let out the week before Easter and businesses worked half a week to begin preparing. There were many preparations going on, but the most beautiful was the making of “alfombras” or carpets. These are various religious images or images of flowers painstakingly made entirely out of brilliantly colored saw dust, colored gravel, flowers, and/or plant parts that almost fill the width of the streets. The alfombras cover about 10 blocks surrounding the church. On Good Friday, at least 60 men carrying a large platform with a figure of Christ on it, process through the streets over these alfombras. The procession is very slow. It starts around 3 pm on Good Friday and we heard continues throughout the night until it arrives back at the church at dawn. Our children lasted about 1 1/2 hours, not all night!
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.
We moved into our permanent residence last week and we are excited to be settling down and not living out of suitcases. Brent and Jennifer continue in language school and we are finding language acquisition much more challenging than for our children. We will begin working at Hospitalito in mid May and are looking forward to working with and for the people of Santiago.
Peace and Love,
Brent, Jennifer, Christopher, Elizabeth, Julianne and Nicholas
We arrived in Santiago Atitlan on February 9, 2010. After a night flight and then a 3 hour drive to Santiago, we were warmly greeted by many of the staff at Hospitalito. They graciously helped unload our many heavy bags and carried them down the path to the house where we will be living for the next 2 months. The staff had a welcome lunch for us the next day where we had a delicious local dish called caldo de pollo (chicken soup) and tamalitos, which are little tamales without the filling.
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 :)
We were so excited about the arrival of the Burket Family, that we sent Aklax to the airport ONE DAY EARLY! Brent and Jennifer have arrived to volunteer at the Hospitalito for THREE YEARS. They are both family practice physicians with the ability to perform cesareans.
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.
