Hey all,

The mission trip to Guatemala was great! Many of you have asked about the trip, so I have tried to describe it below.  I’m sure this is way more than most of you want to hear, so skim quickly.  Otherwise, thanks for asking!

We landed in Guatemala City on Saturday night and spent the first night at a nice hotel there.  There were 80+ of us from the DFW area, Minnesota, Illinois, and even a couple from Alaska!

We boarded 3 buses on Sunday morning accompanied by a truck of about 8 Guatemalan militia to make the 5 hour drive into the mountains.  We had a rest stop at a little place that had great helado (ice cream) and then lunch at a "resort" with a "zoo" and "aviary". (The zoo consisted of a few cages of monkeys, some animals that seemed to be from the raccoon family, along with a field of peacocks & small deer.) Despite the tropical setting in the mountains, we all wondered who would come way out here to a resort.

We arrived at San Cristobal, a small mountain town past the larger town of Coban.  The buses worked their way through the town, laboring to make sharp turns on the narrow and steep streets.  As we drove up to the fenced in hospital, we saw a large line of people who had apparently been lining up since the day before we arrived.  They clapped and waved as the buses arrived.

The hospital was one of several that were apparently built by the US in the 1980's.  Only about 20% of the hospital is used by the locals throughout the year.  The HELPS organization that has been working in Guatemala for over 20 years uses this facility 1 to 2 times a year, I believe.  They have an office in Guatemala City that organizes mission trips throughout the country year round.  The organization of the trip was amazing.  We arrived with red bags full of supplies to set up 2 operating rooms, a recovery room, a pharmacy, a laboratory, a dental clinic, an eye clinic (that also did surgery), and 5 clinic examining rooms.  In addition to medical volunteers to staff all these areas, there were non-medical volunteers (many spouses, kids, and friends of the medical volunteers) to serve on "stove building" teams as well as 6 volunteers who prepared all the meals in the hospital kitchen.

Also with us from Guatemala City, were 10 high school juniors from a private international school who had been studying English for many years.  They were accompanied by their US born English teacher to spend the week with us translating for us.

Apparently a Dr. O’Neal designed the ONIL stove to improved the health of the families in this area.  They traditionally burn wood in open fires in their homes without ventilation, causing many respiratory problems.  This stove provides them with two burners including one that can be "opened" to allow a pot to sink into it and a vent that goes out through the roof.   The teams of about 4 each would build 5 stoves a day for a total of 60 stoves in one week.

When we arrived, we went to our assigned "bedrooms" that had been set up with cots.  We were in all types of rooms throughout the hospital. My friend, Barb Eubank, and I were in a room near the cafeteria with 2 of the "cooks" and a Guatemala born woman now married to an American in the US, who was on the team as a translator. (see attached pic) We had plenty of space, but no windows or venting of any kind.  Luckily, two in the room had brought small fans that did help circulate the air a bit. The five clinic exam rooms were used at night at bedrooms also.  The occupants just flipped their cots up or over and shoved their bags in the corner before clinics opened.  A few rooms were lucky enough to have an attached bathroom, but we had to walk down several large halls to get to the nearest bathroom.  Not bad during the day, but a little unsettling during the night as the bathroom was next to a big door near the back loading dock which was kept open to bring in some breeze.  Even though we were told the militia was out there in the dark guarding the premises throughout the night, we all stopped drinking liquids after dinner in an effort to avoid that trek during the night!  Also, our room was next to the Emergency Room that is in the hospital year round so we could hear much activity throughout the night....luckily I packed my earplugs which came in very handy!

After quickly settling into our rooms, we helped the team unpack all the supplies and began seeing patients about 4:00 pm.  The triage nurses worked with HELPS staff at the gate and began by sending in patients that needed to have surgery.  Some had been referred by local doctors or clinics during the year and some had been evaluated by the HELPS team the year before but had been unable to fit them in last year.  The clinic doctors evaluated the patients to see if they were healthy enough for surgery and sent them to the surgeons for consult and scheduling.  There were 3 general surgeons, 2 plastic surgeons, 1 gynecology surgeon and 2 anesthesiologist and 2 nurse anesthetists.  Monday's surgery schedule was quickly filled, trying to schedule the more complicated cases early in the week, so they could be followed before we departed.  By Tuesday afternoon, the surgery schedule for the week was filled which was sad as we saw many patients that needed surgery.  They were sent to a social worker to help them arrange to go where another HELPS team would be or given the dates to return in a year with advice to be first in line next year.  If they could afford it, they might be able to pay for surgery before then, but most of them will have to wait until they can get it done free by HELPS teams. By the end of the week, the clinics saw 1083 patients, 138 surgeries were performed!

I was assigned to work in the clinic with Dr. Doug Byers, a family practice doctor from Illinois. We were assigned Pablo, a 15 year old student, to be our translator. (see pic)  Pablo was great and eventually caught on to Dr. Byers joking which sometimes didn't translate exactly.  We had many instances of the patient talking for several minutes but Pablo translating that the patient said "the pain is in her stomach" leaving us to wonder or ask what the rest of the story was.  Actually, my limited Spanish did help some in that often I could sort of follow that the patient's dialogue but Pablo was much quicker and more accurate in getting the information that we needed.  With the line of patients outside waiting to be seen not getting any shorter all week long as more people came each day, Dr. Byers did a great job of getting a good history, doing a thorough enough exam and explaining what the treatment would be.  The 3 of us developed a good system of Pablo staying in the exam room with the doctor and patient as Dr. Byers spoke no Spanish.  As needed, which was for the majority of the patients we saw, I would escort the patient to the lab for bloodwork or urinalysis and use my basic (and rather broken) Spanish to explain what was being done and where to wait for the results, and/or show them where to wait while I ran (or walked quickly) to the pharmacy to get them some medicine.  I would use my basic Spanish to explain to them how to take the medicine.  If they were able to read which was not always the case, the pharmacists had written the instructions in Spanish on the little bag of meds.  This all worked fine except for the people who didn't speak Spanish, rather one of the 3 indigenous languages of the area.  The one we heard the most was Pokomchί.  In these cases, a local friend or just another patient from the waiting area, would translate from the patient's Pokomchί, to Pablo's Spanish, then back to Dr. Byers or me.  It worked but did take a little longer to converse in 3 languages back and forth!

We saw many patients that needed hernia repairs, possibly a consequence of the hard lives they live of hauling wood, crops, and everything else they need to carry up and down the mountains from the village to their homes.  We all saw a lot of gallbladder disease, possibly because of the high fat diets they eat.  One of the first patients we saw on Sunday was a 13 year old girl with cleft lip and palate that had never been repaired.  I think she had surgery on Monday, but we were so busy in clinic I never had time to actually see her after the surgery.   Barb did run into a one year old boy she saw on Sunday as he was leaving the hospital several days later after getting his cleft lip repaired.  His sister had had her cleft lip/palate repaired by the same Dr. Heath several years prior!  Apparently, some inbreeding in these remote areas increases the chances for these birth defects.  Other patients had various infections and others had aches and pains from their hard lives.  We handed out many bags of ibuprophen for the aches and vitamins to try to keep them healthy….things so basic for us, but was like gold to them! 

Each day a clinic team would do "outreach" which meant we took our clinic out to the community.  On Tuesday, Dr. Byers, Pablo, Karen (one of the two pharmacists) and I rode on a small bus with the stove teams and were dropped off (with a militia) at an elementary school.  We used a classroom as our clinic and a dental team set up next door in another classroom. People lined up outside all day as we saw them one by one.  We had a exam table (not sure how/when that arrived!) and some plastic chairs and a table in the room, with student desks pushed off to the side.  We saw a variety of issues, and I helped by checking blood sugars when needed and even did two pregnancy tests!  (Unfortunately, the one hoping to be pregnant was not, but the one with the 5 month old baby who thought breastfeeding was good birth control found out she has another one on the way!) The most unusual incident of the day though was when a family rushed their 14 year old son into the room and onto the just vacated exam table. They said he fainted outside while hearing his cousin screaming during dental work next door.  (The fainter was apparently in line to be next and hadn't eaten much that day.)  When he didn't regain consciousness quickly, we asked more questions through the translator and realized he had hit his head when he fell so had a pretty bad concussion!  He stayed in the room quite awhile as we continued to see patients and slowly came to with the help of some juice leftover from my sack lunch and a little time.  When we instructed them on watching him over the next 24 hours to make sure he stayed alert and to apply ice to where a hematoma was forming, we learned they don't have ice.  (In fact, most did not have refrigerators we found out when we recommended they keep the liquid antibiotics refrigerated.)  So, we eventually sent them on their way and hoped for the best.  And, no, he didn't make it to the dentist that day after all!  In all, the outreach clinics served another 300 patients in one week.

I had a chance to use nursing skills that I had not experienced since working in the NICU, or Children's outpatient clinic, or since nursing school.  (My years of cardiology research definitely did not apply here!)  I administered insulin to a patient who needed to get his blood glucose lowered so he could proceed with his eye surgery.  I did intramuscular antibiotic injections to several women and one man who had STD's....one of the women even gave me a beautiful handcrafted purse before I stuck her!  (hoping, I would use a sharp needle?)  The Spanish I had used at Children's to instruct Spanish speaking patients on taking their medicine did come back along with being refreshed by listening to the translator a time or two.  Barb and I could say that a least some of the conjugations and vocabulary we had reviewed in our Spanish class at SMU did pop into our minds occasionally!  (Our teacher would be so glad!)  I only checked blood pressures on patients that knew they had hypertension or the doctor suspected they did, so at first I was thinking perhaps I was really rusty in that as the readings I got were so off the charts.  (We aren't talking automatic BP machines here but the original cuff and my old, retired stethoscope!)

After a few days, Dr. Byers caught on that I welcomed any opportunity to hold a baby, so would make sure to suggest the mom needed my help in that way, even if she really didn't.  Our cute young translator got that job when I was out of the room with another patient, and complained that his arm was falling asleep after just a few minutes of holding the baby.  The baby's mom and I got a good laugh at that!

Barb and I had talked before the trip about packing our workout clothes to use at the fitness room at the Guatemala City hotel when we got back there on Sunday.  By mid-week, we were laughing at ourselves thinking we would need the exercise.  As I said, we were on the run each day, trying to maneuver patients through the system as quickly as possible so that as many as possible could be seen.  Clinic days were typically from 8:00 to around 5:00 with a lunch break, otherwise working non-stop.  The cooking team kept us well fed with hot oatmeal, fresh watermelon and boiled eggs in the morning, soup & sandwiches for lunch, and hearty comfort food at night. While it was definitely not light (or gourmet) by any means, I think we managed to burn it off each day!

On Friday night, the community prepared a native fiesta dinner for all of us.  We saw them grilling some kind of beef strips (didn't ask what kind....didn't want to know) on the porch.  They had delicious small (compared to ours) thick corn tortillas, great homemade salsa and re-fried black beans.  (so good they had to be full of lard!)  During dinner, we were entertained by some musicians playing a huge instrument with a blind man playing the mariachis (?) in front.  (See attached pic.) After dinner, though, was the most unusual fireworks show I've seen.  A man "wearing" a rectangular box contraption fitted with various fireworks, danced around the courtyard to music, while the fireworks shot off of him!  Muy LOCO, but I was glad at least to be surrounded by skilled medical help if things went wrong! (picture NOT attached as it was too dark for a good pic, plus I don’t want anyone getting any ideas! J) The music continued for several hours with people dancing from what I hear, but Barb & I retreated to our room so she could study for an upcoming test for the nurse practitioner program she is in, while I kept her company with some pleasure reading.

On Saturday, we had clinics in the morning from 8 to 11, surgeons did some last minute minor surgeries requiring no recovery room time, then everyone proceeded to start packing up all the supplies.  Amazingly, everything was packed, inventoried, and loaded onto trucks by 3:00 pm!  We then took a hike up the mountain to get a view of the beautiful mountains and village below us. Attached are photos of people we met with their coffee crop, a young girls carrying corn on her head, a view of San Cristobal, and me with Barb and Steve Harris, our OB-GYN friend from Dallas). That evening, after a dinner of hot dogs and leftovers, we had skit night.  Some team members who had done the trip before (many being annual members for many years) had apparently worked all year on their entries.  It was quite entertaining.  One of the best parts was, however, when the 10 Guatemalan high school students got up and spoke about being from the "bubble" of their privileged, sheltered lives and how they had seen and learned so much during the week.  They said they really had no idea that people lived in such hard, poor conditions in their own country and were amazed that Americans used their vacation time to come give their time to help people in their country.  Like the American youth who came with their parents to volunteer, their eyes were opened to the needs of others and they were able to experience the joy of giving of themselves.  It was great to see their lives affected so much while they were such a huge help to the team.

We left San Cristobal on Sunday morning, Barb & I returning to Guatemala City with the young translators, where we spent one last night at the nice hotel enjoying wonderful, hot showers and a nice dinner out before catching our early Monday morning flight back to DFW.  Most of the team went on to the quaint town of Antigua for a few more days of R & R before returning to their busy lives.  The team members were all amazing, giving people who worked so well together.  We loved getting to know them and have such respect for all of them who take a 10 days off of work each year to use their talents and hearts to help these very appreciate people.  It was a great week and an honor to work with them all!    

Kay Fulton

214.692.5306 Home

214.538.9974 Mobile