Ultrasound Study

We have been involved in a ultrasound study for the past two years in Santiago Atitlan.

We are doing the study to develop intrauterine growth curves for the local Mayan population.

The hope is that by using ultrasound we can identify pregnancies at risk for intrauterine growth restriction (when baby in mom is not growing well) and then intervene in the pregnancy so that the baby has a better chance of surviving.

While the study continues there have been many benefits from the study already.  Our relationship with the local clinics, National Hospital and comadrones (traditional birth attendants) has improved and this has helped to provide better care for the population in Santiago Atitlan and San Lucas Tolimon ( a nearby village).

This picture is of one of our favorite comadrones Juana (on the right) who is with one of her patients at a recent Ultrasound clinic. 

Day 10

There are people from all over the world doing amazing, selfless work with vision, initiative, and very few resources.

Gratitude for little things is very important.

A positive attitude can go a long way in making a tough situation better.

Challenges in the Mission field are never what you expect. There are always surprises, good and difficult.

Day 9

"Baaing" goats sound like crying babies outside your window.

People can carry anything on their head/back. We've seen mattresses, backpacks, desks for school, huge basket of live chickens (seems dangerous), side of beef... you name it!

People eat all the parts of the animal. They sell the cow leg from the knee down with hoof and all, eyeballs, skull, chicken head and feet, as well as many organs which we cannot identify. In Ghana they even ate the chicken bones - probably a good source of calcium!

Day 8

Roosters do not only crow at dawn. We actually don't think they can tell time at all as they seem to crow at any hour and many days begin at 4 am. After you've lived in a place for a while, you stop hearing them so that is a good thing.

Bimbo is an unusual name for a bread company in Guatemala.

Day 7

The water filter can amazingly make black water, clear.

Many days, plunging the toilet is a more than a once a day event.

Day 6

Rain in the tropics is impressive, as is the thunder and lightening.

One can get a flea infested house without having a pet. The fleas come from the squirrels and rats that live between the ceiling and our roof.

We've also seen beautiful red tomatoes growing with plastic pesticide containers strewn around the base of the plants. So that's how they become so red and delicious...!?

Day 5

Dogs and squirrels eat avocados, a delicacy that we bet most dogs and squirrels never get to sample in the US.

You know that your children's Spanish is better than yours when your kids tell you not to speak to them in Spanish in public or when you look to your children to tell you a word or how to say something.

If soap sits around long enough, it turns black and becomes almost unrecognizable as soap. We found this in the first house we lived in in Guatemala.

Day 4 and 2 more...

Moths can be the size of small birds. You find this out when you have the brilliant idea of putting a new light socket over your kitchen sink so that you can see better at night and the bird-sized moth scares the begeezers out of you.

It is not a good day when you wake up with what you think is rain coming from the ceiling onto your head and pillow only to realize that it is not raining. When you consider what could be happening, you realize that it is actually urine coming through the ceiling boards from either a squirrel or a rat that live between the ceiling and your roof.

Day 3

Head lice can be incredibly easy to get and very difficult to get rid of.

When you accompany your kids on their first school field trip to the "beach," you encounter this as the dock.

Day 2

When there is a lot of bat guano in your ceiling and it rains really hard, it comes down in big black streaks on your walls all the way down to the floor.

Shade grown coffee does grow in the shade, but this shaded field is also often littered with garbage.

When you get a double yolk in one egg, it is cool. When you get it in a second, it is really interesting. When you get it in a dozen, it is unnerving. What has that chicken been eating?

10 days and 26 ways

Over the next 10 days, we will be sharing 26 things we've learned or only experienced in the missions. 

1. You know you've lived in the Missions for a while when you tell a story and your kids ask you, "What's a comforter?" or "What's a driveway?"

2. Cars and trucks that look like they could never be functional, somehow function with nearly flat tires, so many people in the bed of the pickup that the back bumper is just a couple inches off the ground, missing fenders, broken windshields, lurching movements, and unsettling sounds.

“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.

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!