Last Sunday

Last Sunday (April 28) was our last Sunday at our church is Santiago.

It was special for a number of reasons.  First of all there was a wedding.  Not just a wedding, but also because the husband to be, was not catholic he received his baptism, first communion, confirmation before the being married.  It was also special as our priest gave a blessing and thanks to us and another volunteer family (The Smiths) for our time in Santiago Atitlan.

Birthdays

We celebrated all of the girls' birthdays in January.

Brent made Jennifer a truly scrumptious chocolate cake.

Elizabeth had a party with some friends. She picked her own menu and every food happened to be vegetable based -- very interesting for a 9 year old. We had corn chowder, zucchini pancakes, broccoli salad, and carrot cake. One of her grandpas noted, when he saw her birthday photos, that she was all smiles in every picture!

We also celebrated Julianne's birthday with some friends. Her menu consisted of burritos with all the fixings and one of our friends brought bruschetta. We made mousse which was a little runny, but still very tasty.

Kids love having a day that is just for them.

Collage

This collage of pictures come from a local preschool class in Santiago Atitilan.   

It is in the pediatric room in our hospital.  

 
 














I especially like the drawing in the upper right, but I may be a little biased!!  :)

 

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.

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.  

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!

School

We came back to Santiago just in time for Christopher, Elizabeth and Julianne to take their final exams for the school year as their school year runs from mid-January to mid-October.  The kids did very well and all will advance to the next grade level in January.
 
The school had a very nice Kindergarten graduation ceremony for Julianne.  Much to their dismay, they are all homeschooling over the break.

We had thought that maybe the transition back to Guatemala might be difficult for the kids after being in the US, but the kids haven't said anything.  Since we've been back, we've heard them ask a couple of relatives on Skype what they had eaten that day.  They certainly enjoyed the wide variety of food while we were on vacation.

Conception and Cecilia

Concepcion came to Hospitalito at 8:30 AM.  She had noticed onset of strong contractions at 4 AM but could not come to the hospital until she was able to get a ride from her village, Cerro de Oro (about 20 minutes from Hospitalito).  When she arrived, at 8:30 AM, she was dilated to 5 cm and the baby was in a breech position. Concepcion also had a history of a previous Cesarean section in 2003.  She was only 29 weeks pregnant and too early to deliver at Hospitalito.  

Preparations were started to transfer to Guatemala City where there is a neonatal intensive care unit.  She was given medicines to protect the babies brain, slow down the labor and help develop the babies lungs.  After one hour she was 7 cm and it was felt it would be too risky to try to transport her for a 3 - 4 hour journey as she might deliver in the ambulance.  

We then had to decide rather to proceed with a repeat cesarian or deliver vaginally. A cesarean would be the least traumatic to the baby but a 29 week newborn would probably not survive while a vaginal delivery would be the safest for mom.  After consulting with a number of volunteer doctors and even a call to a good friend/obstetrician in the USA it was decided to proceed with a repeat Cesarean.

Brent performed the cesarean section with a visiting Obstetrician, Wayne Weber assisting and his son Nathan (an anesthesiologist) providing the spinal anesthesia.  Baby Cecilia was delivered without difficulty with initial apgars of 3 and 6.  Two other visiting doctors from Ventura, California, Drs. Lepore and Noah, helped to resuscitate Cecilia.  Cecilia then began to have problems breathing and Dr. Nathan intubated and preparations were made to transfer to Guatemala City.  Dr. Noah accompanied Cecelia for the 3 hour trip.
 
Cecelia returned to Hospitalito after 6 weeks on a ventilator and 2 months total in the Neonatal Intensive care unit in Guatemala City. She has a long ways to go but she already has come so far. She is gaining weight and developing well.

Rainy Season

The rainy season has begun.  It rains most afternoons and when it rains here it often pours for  hours and sometimes for days.  We went to church the other day in the afternoon, so the rain was in full force.  It was notable at church that most people did not have even a coat on, much less a raincoat, and it was chilly.  Most of the women had on flip flops or other open shoes.  We did not see anyone with boots.  Even though we had on raincoats and boots, after just walking a short distance, we were soaked.  God, help us to be thankful for simple things like boots and raincoats.

On Corpus Christi, there was a procession of the Body of Christ through town after the 8 am Mass.  The rain was unusually early that Sunday and it was raining hard when the procession started.  The procession was due to last 4 or 5 hours.  In the States, I think the procession would have been canceled, but the people here, without raincoats or boots, processed in numbers.  Some had umbrellas or a piece of plastic sheeting that they draped over their shoulders, but many had nothing.  Again, no boots and there was running water in the streets in many areas.  This was an impressive expression of faith.

Quite the Honor

We received quite the honor a few weeks ago when Brent and Jennifer were asked to be the Godparents of Daniel Jonas Pablo Coche. 

Brent had performed the Cesarean section on Daniel's mother, Petronila, in March and Jennifer had taken care of mother and Daniel after wards.  

It was a really nice ceremony held after Mass.  There were about 15 babies baptized during the same ceremony.  Daniel received a beautiful white garment to celebrate the occasion.

Celebration of Family Day

Instead of celebrating Mother’s Day at the children’s school this year, they decided to celebrate Family Day since some of the children don’t have mothers.  Each class did a song or skit and there were some raffle prizes, although some of these came at the expense of really embarrassing the parents.  Then the teachers served a lunch of chicken, rice, vegetables, and sauce which they cooked themselves for over 300 people!  Jennifer wore the traditional women’s attire for the first time and managed to keep her skirt on without it falling off.

Christopher's Birthday

We celebrated Christopher's birthday recently with a party.  He invited the children from the local orphanage, neighborhood kids, and a few friends from school, in all about 30 children.  We had a great time with lunch, a treasure hunt, piñata, and cake.   Elmo (the piñata) was the only one who had a rough day!

At the end of the day when asked what the best part of the day was for each one, Christopher said, “Playing with all my friends,” Elizabeth and Julianne both said, “The food,” and Nicholas said, “The piñata.”

Clean Cook Stoves for Better Health

At Hospitalito we see many patients who, at a relatively young age (40 years old), have Chronic Obstructive Pulmonary Disease (COPD).

In the US it is mostly due to smoking, but here in Santiago Atitlán it is caused by years of cooking over an open fire in an enclosed space.

The lady who makes tortillas for our neighborhood is about 45 years old. Brent delivered one of her grandchildren recently. We buy tortillas from her several times a week. We have also seen her in the hospital at times for her COPD. After visiting her one day and noticing her coughing with her child and grandchild in the same enclosed smoke-filled space, we wondered if there was something we could do.

We spoke with our social worker at the hospital and found that there is a program to get clean cook stoves into the houses of the local population. In Santiago Atitlán it is estimated that half of the households cook over an open fire, while 47% use an inefficient masonry stove with varying degrees of ventilation. It is also estimated that cooking over an open fire accounts for up to 30% of the families' expenses. Clean cook stoves are up to 60 -70 percent more efficient.

We were able to purchase and install a stove for about $50. The stove actually costs more, but is subsidized by a doctor who worked here in the past. The smoke is ventilated through the metal pipe so it is much less smokey. Since the stove is much more efficient, it uses less wood which means less expenditure for the family on wood and better for the environment.

You never know how anyone will react to changing the way they have done something for their whole life. In this case, the transition seems to be fine. The tortillas look and taste the same (Brent thinks better) and it is much better for their health and the environment.

Maria

Maria presented to Hospitalito Atitlan with a history of a previous cesarean section about 2 years ago.  She had received some prenatal care at the Central Salud (a government run clinic in town), but she knew that when she went into labor she should come to the hospital. 

When she presented to Hospitalito she was in early labor.  The fetal monitor showed that the baby's heart pattern was "not reassuring" and by Ultrasound the amniotic fluid was too low.  We did not have good dates regarding how many weeks pregnant she was but by a late US and unsure last menstrual period we felt she was somewhere between 36 - 38 weeks.  It was elected to proceed with a cesarean section.  The cesarean section was performed by 2 visiting Obstetricians from Hungary and anesthesia was provided by Brent. We also had a pediatric resident from the states, Kati, who was present to help with resuscitation of Mary's baby if needed.   

Mary's baby was born with an initial low apgar of 4 but the second apgar of 7 was more reassuring but over the next few hours the baby began to have more respiratory difficulty and the oxygen saturation was decreasing and the baby was becoming cyanotic (blue).  The team at Hospitalito worked together to place an endotracheal tube ( a tube in the child's lungs) so that we could breath for the child. The baby was then transferred to Guatemala City, to the government hospital Roosevelt.
 
Mary's baby spent the next 8 days on a respirator and 15 days total in the hospital, and returned to Santiago with mom.

Mary, baby and Kati, the pediatrician 

who helped with the resuscitation.

 

ADISA

As we have mentioned, in an earlier blog, we have found a number of organizations in Santiago Atitlan doing good things.

ADISA is doing GREAT things.   Asociacion de Padres y Amigos de Personas con Discapacidad de Santiago Atitlan (Association of Parents and Friends of People with Disabilities in Santiago Atitlan) was started in 1997 by parents of a child with hydrocephalus who subsequently died at the age of 9.  They saw first hand the lack of resources available to children with disablities. 

ADISA has a number of programs to help this population including education, health care, early stimulation, education of the community, physical therapy, vocational training and job placement. 

Our family has been blessed to know this exceptional organization, the staff and the people they serve.  We have also been able to help ADISA as Hospitalito has partnered with ADISA to help with some of their health care issues.

Their web site is excellent and gives more history as well as opportunities to support their work. www.adisagt.com
from there you can click on Conozca nuestros productos  and then click on  www.novica.com

Preparing for Christmas

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!

 

 

Cold

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!

Busy Time

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.