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.