“Always check the pockets before washing”

 Today, following Jennifer’s instructions to check pockets before washing, I found numerous Jocotes in Nicholas’s pockets.

The jocote is a small fruit that grows on a tree that can be up to 25 feet tall.  Now is the time of year the fruit are coming in.

We have a Jocote tree next to our house that the kids love to climb and snack on the fruit too!

The weight of the world ....

I was walking to town the other day with Nicholas.  We have a marble game. When one of our children does a good deed they get a marble when they perform the opposite then a marble is taken away.  When one of our children gets 10 marbles they get to have a "special day"  On a special day the child gets to go for ice cream alone with mom or dad, all alone, no other siblings !  

While walking we came around the corner to see this man lifting up a load of recyclable cans and plastics.  You can't see it in the picture but there is a man behind trying to help him lift it. I thought it was a powerful image of how those with less carry so much of the burden in the world.

Nice Surprise

Had a nice surprise the other day as a medical student was presenting a patient to me,  in the outpatient clinic.  While reviewing the chart, I noted it was a patient we had seen in the emergency room over a year ago after an accident.

Diego Sosof, was riding on the back of a motorcycle and, as is the custom here, without a helmet.   He was going to get medicine for his wife when they were hit by a truck. He arrived at the hospital unresponsive, pupils fixed and dilated and with difficulty breathing.  It did not look good as head trauma in our setting has a very poor prognosis.  We intubated him and transferred him to the capital where patients can be treated for head trauma and where ventilators are available.  After the incident I had heard he had survived but had not seen him and never knew for sure his outcome or functional status.

He informed us that he had spent almost two weeks in the referral hospital with many days on the ventilator.  After he returned home, he had little use of his right arm but after 4 months of physical therapy he now has full use of his arm.  He still feels weak and tires easily but is able to help out around the house and attends church.  His wife works odd jobs to provide for the family. 

Traditional Birth Attendants

In Santiago about 70 percent of all births occur in the house.  Many of these are attended by Traditional Birth Attendants (TBAs).  

Our interaction is mostly when one of their patients is having a difficult labor and come to Hospitalito for help.  We have learned a lot during these interactions and really appreciate all the good work that they do.  

Each month the TBAs participate in monthly trainings where they ask questions and report births. The Centro de Salud, Prodesca and Hospitalito Atitlán take turns hosting the event and a training is provided. The topics range from antepartum care, acute care to   post partum care.  

The last meeting's topic was breast feeding.  These meetings are a lot of fun where there is a role playing and lots of laughter!

Pedro and Susana

Pedro, Susana, and their daughter Debra have become good friends during our time here in Santiago.

Susana is the Chief of staff at Hospitalito.  She does an incredible job organizing all of the medical volunteers and their schedules. She also helps review all the patients that are admitted and helps to trouble shoot when problems arise.  

Pedro is one of Hospitalito's finest nurses and is always ready for the challenging patients that present to the hospital.  

Debra is now two and we have really enjoyed watching her grow over the past two plus years.  

Ana

Ana arrived to Hospitalito at about 9 months pregnant.  she had been leaking fluid without contractions and was diagnosed with Premature rupture of membranes.  She was started on medicine to start contractions.

After about 8 hours it was noted that the baby was having slowing of the heart and an exam revealed that the cord had prolapsed (fallen) down in front of the child's head.

This can be a devastating complication of labor with many children not surviving. 

The Doctor on call quickly called the team together and Ana was delivered by an emergency c-section.  All went well and Ana was very happy to see her new child.

Examination of the placenta, after delivery, showed a "Velamentous cord insertion".
This is where the cord inserts abnormally into the placenta and can be very dangerous.  

The first picture is of Ana with her baby, Lydia, her mother and her grandmother.  4 generations !  The second is a picture from their postpartum checkup.

Birthday

Guatemala has one of the highest infant mortality rates in Central and South America.   It is no wonder then, when a child turns one, that it is a time to celebrate.

Recently we had the honor to attend the birthday of our godchild Daniel Jonas (see previous blog). It was a fun afternoon filled with laughter, music, cake, party hats and a piñata.

Manos de Compasion

We have been so blessed to come to know Dave and Deborah Reichard.

The Reichard's are a young couple who oversee the local orphanage here in Santiago Atitlan. The orphanage called "Manos de Compasion" was started in 1999 in Guatemala City and moved to Santiago Atitlan in 2006.  In 2009 Dave and Deborah took over.  

We came to learn about Manos de Compasion as Dave and Deborah would bring the children to Hospitalito for their initial physical exams and acute illnesses.

 

They have 20 children in their house with 9 of these in diapers!  And we thought it was a challenge to have three in diapers. 

We have been able to share a number of Holidays and birthdays with all of them at the orphanage and at our house. Jennifer has also been able to fill in, at times, taking care of the kids when Dave and Deborah need to go to the City for the day. Jennifer is truly amazing!
 

Each child that comes into their care brings with them such tragic stories but each day they are at Manos de Compasion is an opportunity to witness Christ among us through the love and care that Deborah and Dave give. 

To learn more about Manos de Compasion visit these web sites:
http://guatemalaministry.com/about.htm
http://guatemalaministry.com/
http://www.gua-ministry.blogspot.com/

Edgar

Edgar arrived to the Emergency room after a truck backed up and pinned him between the truck and a wall. He had severe chest pain, a thready pulse and oxygen saturation that was dropping rapidly.  On exam he was noted to have no breath sounds on the right side of his chest and you could feel the air bubbling under his skin. He was diagnosed with a pneumothorax and feared to be developing a tension pneumothorax.  

 

This is occurs when the lung is punctured (in Edgar's case by one of his many broken ribs.) Air, from the lung, enters the thoracic cavity and compresses the lung.  The increasing pressure causes the lung to collapse and if the pressure is not relieved can cause collapse of the venous return to the heart and death.  

The ER crew acted rapidly and placed IVs, started oxygen and prepared for a tube thoracostomy. This tube, placed into the chest wall, helps to relieve the pressure that is increasing in the patients chest.  

The tube was placed without difficulty and immediately Edgar was breathing easier and his oxygen saturations increased.  Edgar then was transported to Guatemala City where he spent 8 days in the hospital and ended up having part of his damaged lung removed.

On follow up he was all smiles and very thankful for the care he received. 

New Year

The new year has arrived and so an opportunity for reflection.

We have been here for nearly two years and will begin the third year of our three year commitment to Hospitalito and the diocese of Sololá-Chimaltenango.

We have been blessed in so many ways.  

At the Hospital we've been part of a remarkable trans location from the old "interim" hospital -- which was a backpackers hostel -- to the "new" Hospitalito, which should be called "Hospitalote" or grande, allowing plenty of room to grow in the future.  We've seen the Guatemalan doctor staff grow to 4 full time generalists, an obstetrician and now a pediatrician.  Hospitalito has become part of the country's education of pediatricians which places a final year pediatric resident at Hospitalito full time.

We have also seen our role change from primary caregivers to more educational and administrative roles.  In this regard, Brent was recently elected to the board of Hospitalito.

Our children have made friends, attend school locally, and continue to amaze us at how little it takes to make a child happy!

We are so grateful for the many ways our family and friends back home continue to support us -- thank you!