CHW Medical Missions Blog

Disculpe, disculpe, we must leave.

I'm so glad that Mary Carol posted before me, to remind the whole team of all the good things that happened and we did.  It has been far to easy to focus on the last day, our flight, the people we left behind wondering, and forget about everything that went right.

There are a few hurdles to leap before going back, but I know once everything is ironed out, the mission will be that much stronger and prepared.

 
No Habla.

That said, here's an introspective look on how some of us feel, my latest attempt at prose poetry:

David Hora, CLS, MFA is thankful to be able to use both sides of his brain on this mission as scientist and asst. blog-meister.  This was his first medical mission and hopefully not his last.

The "I" in TEAM

The quote, "There is no 'I' in Team," has become ubiquitous because of its applicability to almost any group effort focused on a goal. But when the cheers, accolades, or condolences cease, when we turn out the lights to listen to the crickets or ceiling fans, we return, with our fears, regrets, and insecurities, to the lonely 'I'. The Team that has achieved greatness or failed by just-this-much, always breaks into its constituent parts and the 'I' is left to react to the ups and downs of expectation, achievement, and disappointment.

The trip to Timushan was everything I'd expected. A remote location reached by rutted mountains roads, roads we must be off of by dark for fear of Banditos. We dealt with limited resources, language difficulties, improvisation, patients trekking in from long distances, over borders, or simply arriving by horse--the kind of plot anchor to which an industrious writer could add an air drop and murder to fabricate a Best-Seller or Blockbuster. Can I get an "Indiana Jones V?" But seriously, we all felt like we did some good that day, wearing our aches and pains proudly.

From there it was down hill for me. During the slow times I felt all but useless. Limited applicability of my high tech specialty in this low tech environment and I couldn't help translate. All I could do is stand by, watch other people work, and not feel at all part of the team. Three years of this mission had gone fine without a lab tech, and it looked like they would have done fine without me now.

As the week wore on, and business picked up, gradually I saw that, if nothing else, I freed up others to better use their talents. There wasn't a nurse or med student dipping urine or checking blood sugars--they could treat or learn to treat patients as they should. Still, if it wasn't for my additional role as assistant mission chronicler, I don't see much reason for me to return.

I know others felt varying shades of uselessness and worthlessness, and that mutual disappointment solidified the team, brought us to consensus when it was discovered that a robbery had taken place and our security was in question. Unanimously we vowed to keep the clinics open--there were people who needed us--regardless of how we felt about our roles, we knew the Guatemalans appreciated our presence. It is here that I began to see what Keats meant by Negative Capability, "that is when man is capable of being in uncertainties, Mysteries, doubts without any irritable reaching after fact and reason."

That's what made it so hard to close the clinics at 10:30 Thursday morning. Keys at the Basilica had been stolen, locks could not be changed, and collectively we did not feel safe. But what must the people of Esquipulas have thought as we packed up, leaving them waiting with sick children in their arms or grandmothers in tow. How many would go without medical care in the day and a half we wouldn't be there? "Disculpe, disculpe," is all we could say. "I'm sorry, we must leave."

Even now, knowing we had helped a few people live better for a while, as we come back to our lives of comparative splendor, I keep seeing the father holding his son with cerebral palsy pleading, "Ayuda, ayuda, por favor," as we walked, dragging our bags of equipment and medication, away.

This, or something like it, is what each i in our team is seeing right now in the small, sleepless hours of the morning. So if we seem a little preoccupied, a little distant, perhaps reluctant to recount our adventures, please forgive us. The team has gone its disparate ways, each i left to reflect on our accomplishments and disappointments, and ready to do it all again if called upon, no questions asked. We were only gone a week, but the culture shock of clean water, air conditioning, mortgages, and electric bills takes some getting used to, knowing that somewhere near the Guatemalan-Honduras border a child may be sick or dying and I have the cure in my medicine cabinet.

 
 Taking gratitude for food a bit too far.

The View from Your Mission | Mary Carol Todd

Mary Carol Todd is the Vice President for Medical Management and Palliative Care for Catholic Healthcare West. She has been our mission team leader for the last four years. This is the view from her mission:

I have such mixed emotions while on our trip and of course after I return. I was amazed as usual by the team, their commitment, spirit, teamwork and clinical skills. The team was a wonderful blend of experienced CHW clinicians and fresh eyes, from new doctors, nurses, pharmacist, physical therapist and communications and business office personnel. The immediate desire of the team pitch in and help, to see what needs to be done and do it and above all to serve the patients, it is truly amazing to see how quickly everyone found their role and place on the team.

Mary Carol working the lab station at one of our clincis.

Our planned schedule was changed daily, yet the team never let that slow them down, just stepped in and up to the adjustments necessary, when we started with a clinic the day after arriving, after spending over 18 hours just getting to our destination. Several team members had the opportunity to educate local nurses, which was a real breakthrough, I think we found one key to improving the health of the patients we serve, through the local nurses and nursing students.

We were also excited to have medical students working with us every day in our clinics, the ability to provide hands on education as well as information on how the US health care system worked was gratifying for our team and the students as well. In addition to the Health Promoters we have worked with in years past, we had an exciting new corps of volunteers. Led by Selvin, a young local man who has worked with us for the past three years with an amazing smile and desire to help, there was a group of teenagers, known as the Collaborators, who volunteered daily in our clinics.

Our friend Selvin, who has become an indispensible member of our team.

The teenage collaborators helped identify reading glass magnification needed for older patients, provided sunglasses to people with eye irritation due to long hours working in the fields, weighed and measured the children for nutritional screening and varnished the children’s teeth with fluoride. Without their assistance we would not have been able to provide the varnishes nor assess for malnutrition, they were an amazing addition to our team and example of young people with a desire to volunteer, WOW!

The daily referral sessions with Dr. Castellano, were new this year and very reassuring as well as informative, we learned that there are more follow-up resources available than we knew, and had a greater sense that severe cardiac or nutritional problems would be addressed. We also learned more about the significant differences between US and Guatemalan healthcare. In order to have a relatively simple surgery there, it is required that you provide two units of blood, because there is no blood banking system, no volunteer donor process. Also the compatibility testing is only performed in Guatemala City, 4 hours away and the specimens are taken twice a week there for testing. They will not perform surgery if blood has not been donated and tested, so it sometimes makes it very difficult to have hernia surgery, if you do not have two people who can travel to the hospital, an hour away by bus, donate the blood, then the patient must return on the specified day of the week for a possible time slot. Very complicated and time consuming for someone who must work the coffee harvest or in the fields. Also fro Dr. Castellano I learned that there are not enough physician resources to see and diagnose patients who need follow-up, our team provides those resources which allows the patients with needs to access services that are available to them, once an accurate diagnosis is made.

Dr. Frank Baudino and Nancy Link spent the months before our trip working out a nutritional assessment process to identify malnourished children at our clinics. Thanks to the librarians (Candace Walker from Dominican Hospital and Eva Perkins from Northridge Hosptial Medical Center) who conducted the literature review that led us to our methodology. Using children’s height and weights, and a reference chart we were able to identify when a child was acutely malnourished and also identified some children with stunted growth from long standing chronic malnutrition. In the daily referral process we learned that the children would be provided with “Plumpy Nut” an amazing notional supplement, combining peanut butter, sugar and dried milk, tasty enough for a child to want to eat it and not requiring refrigeration. It is provided in Guatemala by UNICEF and we found hundreds of empty packages on our clinic.

Mary Carol, trying on the baby sling

We had several patients that were sent to the hospital, for acute illnesses, several that we will be following for surgical services, such as the cleft palate child and the boy with the club foot, described earlier, who would be eligible to have the surgery in Guatemala, but we discovered he lives just on the other side of the Honduras border, so a new plan is needed for his follow-up care.

When we are in Guatemala we always take precautions for the safety of our team. This year we experienced several situations that questioned our safety and sadly resulted in our decision to leave Guatemala early. Our team discussed the situations and identified the priorities, serving patients and our safety being the two most important and in that order. I had such mixed emotions about leaving early and the feeling of sadness about leaving before we had completed our clinics. I have learned that leadership often requires us to make decisions when there are competing priorities and strong emotions. With the assistance of our team and reaching out to our leaders at home, we saw that the safety of our team required us to leave early. While we are all saddened by the early departure, there are so many things that were accomplished and patients served, I feel very proud of the team’s accomplishments, support for one another and for the unwavering desire to provide services to the people of Guatemala. I anticipate we will have further discussions with our partners in Guatemala as we sort out the circumstances of our situation, supplies, follow-up, needs and future plans.

I have only positive memories of my time in Esquipulas and the expressions of gratitude we received from the patients as well as our clinical partners and volunteers there. A part of my heart remains in Esquipulas and my fervent hope is to return and continue our work.

Home Again

It has been several days since our mission trip came to an end. There have not been any posts to this blog since Wednesday night as we have all been traveling and reconnecting with our loved ones back in the States. Our total number of patients served remains to be counted but we estimate about 125 people per clinic per day (including children) for the four days we were able to run clinics.

Dr. Frank Baudino at one of the clinics.

These few days were as meaningful an experience as any service we have done in Guatemala. We remember so fondly the faces of the people we served and their genuine gratitude for the time we spent with them. Some were very ill and others just wanted the peace of mind that comes with a wellness check. As seems to always be the case, we all feel that they gave us so much more than we gave them.


A young patient with type-1 diabetes gets treated with an IV saline drip while Pamela Hearn runs labs on another patient. Privacy is a luxury in Guatemala.

Though our goal is to serve as many patients as possible on these missions, the safety of our team members is the foundation upon which all our work is built. As our mission progressed we encountered a few disheartening thefts from our rooms at the basilica. The monks graciously refunded us what we lost. We were of one mind about continuing the mission and set about setting up our clinics the next day.

But when it was discovered that the spare keys to our rooms had gone missing, and that re-keying all the locks was impossible on such short notice, we felt we had to make the difficult decision to bring everyone home early in order to ensure their safety.

We are heartbroken that we could not finish our last two clinic days, but are confident that the basilica will take steps to ensure that future guests are well cared for. This is a set-back, but we are resolute in our mission of caring for those in need and we do believe we'll be back in Esquipulas next year.

At the end of every mission year we ask each of the particpants to write a reflection about their mission experience. We post these reflections to this blog so please do keep checking in. Since the mission ended early we weren't able to publish posts from all the team members so we will start with those reflections first.

Thank you all for your kind support of our work and please continue to send us your prayers and thoughts.

From Zarephath to Esquipulas

Nancy Link, RD has been a Registered Dietitian for 48 years. She is technically retired, but continues to work all over the world. She volunteered in a home for women with high risk pregnancies in Nicaragua, worked for Catholic Relief Services in Nicaragua and El Salvador, continues as a volunteer at two stateside CHW clinics, and the list goes on. This is her 2nd year in Esquipulas and says she just really like to help people feed themselves.

During Sunday's education session with the local nurses, Nancy asked about their hopes or dreams for health care in Guatemala. They listed: help for young people with drug and alcohol problems, family planning availibility, breast feeding for all mothers, better clinic conditions for safe care, and more nutrition education.

Nancy made one of their wishes come true. Before she left for Guatemala, Nancy did some research on local Guatemalan food sources. Not the kinds of things grown on farms or available in markets in town, but nutritious herbs and vegetables that grow wild in the forests and fields around Esquipulas. Because names for these edibles do not always translate well and because many of the people we are serving are illiterate, she printed photo flash cards to show the patients referred to her for nutritional education.

"There are gifts out there in the forest," Nancy told me, "hierbas y verdures, nutritious food that will more than supplement their tortilla diet." She went on to describe a woman, originally seen for a swelling in her neck, referred to her for prenatal nutrition counseling. She was pregnant with her sixth child, her other five ranging in ages from 10-16 years old, and her husband was dead. Nancy began show the photo flashcards and the widow nodded along with each one, "Yes, we eat that. Yes, we eat that. Yes, we ate that one yesterday."

 

Nancy then told me about the prophet Elijah and the Widow of Zarephath (I Kings 17: 8-24). During a famine, God told Elijah to travel to Zarephath where a widow would provide for him. Elijah found the widow and asked for water then a morsel of bread. The widow told Elijah that she had no bread, only a little flour and oil. She was headed home to make a meal for herself and her son--so they may eat in and die. Elijah told her to do as she planned but make some for him as well. Do this for me, he said and "the jar of flour will be used up and the jug of oil will not run dry until the day the LORD gives rain on the land."

There was another question that Nancy asked the nurses she was educating: "What would you like the rest of the world to know about Guatemalan nurses?" They listed, hard workers, brave, intelligent, responsible, strong, strivers. I think between Nancy's tutelage and the nurses' resilience, Guatemala's flour jar and oil jug may never be empty.

The Public Hospital in Chiquimula

Today a group of us went on a tour of the public hospital in Chiquimula.  Conditions were very poor.  I was surprised that we were allowed to walk into the surgery room without putting on disposable sterile gowns.  Then again, none of the equipment looked very clean.  The supply room is a dingy closet and feral cats are allowed to roam around freely.  We learned that the nurses are responsible for cleaning and sterilizing their own equipment.  As I walked around, I began to understand why every morning when we arrive at the Clinica de Salud in Esquipulas there is a line of people waiting.  As rudimentary as our clinic is, we do our best to make it a clean environment for healing. 

"Sterile" implements in the supply room.

There is a part of the hospital that is impressive.  The Labor and Delivery area is a newly built wing and looked clean and modern.  It even had air conditioning.  The contrast between the old part of the hospital and the new is drastic.  Though this area is still not up to US standards, it felt as if we were stepping into a different world.  The hospital administrator explained that they would like the entire hospital to be modernized in the same fashion.  Hopefully we can find a way to build a bridge and make this a reality.   

A Field Trip to the Orphanage

Today our team of 24 caregivers spent some time at other health sites around the area to see first hand what kinds of resources are available to the people who live here. One group traveled about 45 minutes away to the public hospital in Chiquimula. Another group drove about 15 minutes through town to a local orphanage.

The land for the orphanage was donated by the Basilica and the orphanage is operated by the Sisters of Mary and Martha. Those of us who went to the orphanage fell in love with all the kids there and came back later in the afternoon to provide toothbrushes and flouride treatments.

The kids at the orphanage with their toothbrushes and new sunglasses

There are about 25 or so children at the orphanage ranging in ages from about 2-17 years old. They are very well cared for and the grounds are beautiful. The sisters are expanding the living quarters so that hopefully they can house as many as 100 children.

We are working with the Sisters of Mary and Martha to determine how we can best continue to support them. They are doing very well and the children are happy. This, in an environment with so much lacking, is no small feat.

Tiffany Edmiston takes one of the children off to nap time.

Doing What Others Claim Can't Be Done

Virginia Okabayashi, R.Ph. is a pharmacy clinical manager at Sequoia Hospital in Redwood City. This is her first medical mission experience.

Upon arriving at the Basilica we were each provided with a reflection journal that has readings for each day. Two of them are standing out for me. The first is one that we read before our day of educating the local nursing students and health promoters: "Ideal teachers are those who use themselves as bridges over which they invite their students to cross, then having facilitated their crossing, joyfully collapse, encouraging them to create bridges of their own." - Nikos Kazantzakis

I'm drawn to this saying because I think a lot of what we're trying to do here is building bridges for sustainability. We're working to give people the tools they need to improve their quality of life. And it's not all that different from what we're trying to do back home. It is fascinating to me how similar this process is in the U.S. as it is here. Educational deficits with regard to healthcare are not a regional problem. Just because we are from and economically affluent culture doesn't mean that people understand how to be healthy and how to care for their chronic illnesses. This is a world wide issue. Both here and in the U.S. we have non-compliant patients or patients who simply require re-education multiple times. Likewise, both here and in the U.S. we meet people that are pretty knowledgeable. The main difference is the fact that we have so many choices and here there are so many limitations.


Ginny Okabayashi prepares a dose of antibiotics for a patient at Clinica San Luis

We took a tour of the Chiquimula hospital today and it just made me sade. Walking through their pharmacy -- which really isn't that much different from the pharmacy I'm setting up every day at our clinic sites -- all I could think about was how much waste we have in our hospitals. For every drug that we have available there are 5 or 10 of the exact same medication made by different companies. Here they only have one drug. I am able to see so clearly now the disparity between my life (a week ago I was trying to decide which of 30 antibiotics a patient could be given) -- and what happens here. The excessiveness in our health care system is so much more clear to me now than it was. Today is a holiday in Guatemala and there was no pharmacist on duty at the hospital at all. I can't imagine that. All of the caregivers are working so hard to meet all the needs of their patients. They don't have much in the way of antibiotics or blood. If you are really, really sick it would be difficult to make it through in these conditions. And yet people do.

The pharmacy at Clinica San Luis

The other reflection that is sticking with me is the end of a Franciscan Benediction that reads: "And may God bless you with enough foolishness to believe that you can make a difference in the world, so that you can do what others claim cannot be done." I know that we're not going to conquer world hunger, but if we are aware of the small changes we can make then we can really make a difference. We can't just look at a problem and decide that it's overwhelming. If you're brave enough to take the one step in that direction, it may be difficult and you may not succeed in the way you envisioned, but it's better than doing nothing.

I was prompted to do this mission because it's something I always wanted to do and I felt that this was the right time. I decided to take action to become part of a larger group that shared my desire to improve the lives of others. I want to use the skills I've developed over the years to try to affect people's health. This is a perfect venue for that. And this team is fabulous. Given how little we knew of each other when we started this trip, we really work like a well oiled machine. This speaks volumes about our people and our organization. CHW is doing something right to develop team players like this. I can't tell you how magical it is.

Nursing From the Heart

Carmen Montano-Coronado, RN is an Ambulatory Care Nurse at Woodland Healthcare in Calif.  She is a veteran nurse with 21 years experience in labor & delivery, emergency care, and ambulatory care.  She shows genuine concern for every patient she sees.  

I love my job as a nurse but I have to say that I have never done it in a more rewarding area.  Patients in the US have high expectations.  The people of Guatemala have been wonderful and very appreciative of even the most basic care. 

On my third day here I met a 13-year-old teenager.  He was very sick with a respiratory illness.  He was also homeless, unkept, and hungry.  He told me that he was from a far away village and had been living in Esquipulas for almost a year.  I thought he was a runaway. Instinctively I tried to find a way to get him to go back home.  When I asked about his family, he told me that his mom had a new husband and he was no longer welcomed in the house.  I felt very sad for him and lost control of my emotions.  I could not hold back my tears.  I thought about my three sons back home and could not imagine ever turning my back on any of them for any reason.  We provided him with medication, took up a collection of 200 quetzales (about $30), and made sure he had a decent lunch.  I hope that somehow we made a difference in his life.

I am very grateful to have the opportunity to participate in this mission.  Working with new people has been very good.  We all share a common goal and jump in to help each other.  We became a team very quickly and go above and beyond to get the job done.

Caring for others brings joy

Trish Warren RN, is a Pediatric nurse at St Mary's Medical Center in Long Beach Calif. She has always wanted to use her medical skills to be able to help in an underserved area. She is excited to be in Guatemala on her first medical mission.

I was very excited when I was chosen to go on this mission. It has been a blessing to be part of this team of extrordinary people all working together. Being a newcomer I was unsure what to expect. Bumping along on the very rough dirt road to Horcones I was a bit nervous. The peds clinic that day was set-up across the street from the main clinic in a one room school house. My nursing skills kicked in and the nervousness left.

We saw many of the local children that day and I was reminded that children are so resilent. Although they live in poverty and lack many things we in the US take for granted, they were still playful and quick with beautful shy smiles for us caregivers. It is difficult to see the struggle life must be for some of these families.

There is a medication, Albendizole, that's given for treatment of intestinal parasites. In 25 years of pediatric nursing, I have never before administered it. Today in Central de Salud, we gave it to almost every child we saw.

Hopefully our being here, giving them a little access to medical care, can help improve their lives in some small way.

We Make Our Destiny Through Our Choices

Herbert Villafuerte, RN, BS, CEN, is the director for emergency services and critical care at Glendale Memorial Hospital and Medical Center. He grew up in Guatemala not far from where we are serving.

It is difficult sometimes to realize how fortunate we are in life. It is through genuine effort and an act of kindness that we find our true selves. I joined this mission with the expectation to make a difference for the people of Guatemala.  Last year, it was difficult to see our efforts make a significant difference because we could not follow through with the patients appropriately. We were here for a week and although we evaluated well over a thousand patients, we were unsure they would be appropriately followed up by our contacts.

Herbert Villafuerte (left) works with Jennifer Perez to conduct an intake assessment

I was very fortunate to be chosen this year again to come on this mission. Through great efforts and a stronger partnership with local healthcare professionals we are able to get referrals and send patients to the right specialty required to provide definitive care.  For example, we had a young man come to our clinic that had been suffering from fever, headache, a peticheal rash, and abdominal pain. In previous years, we  would treat the infection and send him home. This year, we were able to contact the a physician on staff at the local hospital and get him direct access to appropriate medical care.

I believe people make their destinies through the choices they make in their lives. In my life, my choice has been that of service. My destiny has brought me to this great opportunity to serve the community in which I grew up. Not knowingly, I joined an organization committed to serving the people of Guatemala. It is not every day that we find an organization that is willing to send some of its workers to serve following in the steps of our Lord.
 
The biggest proof of this commitment comes from the commitment all of us have shown. The commitment that has led us to leave our family and friends for ten days. I am a single father and it kills me to be away from my son. Although he knows what this mission is all about; I think it is difficult for him to understand why I have chosen to join. I hope that through the efforts of people like the excellent professionals joining me in this mission he is able to grow spirituality to see outside the box and realize how fortunate we are. I hope he can see that the meaning of life is not about how much material things we are able to amount but rather  that the meaning of life is that of service. Service to the needy; service to the orphans and widows and to those that are not fortunate enough to have not even running water.

We live in a world where impressions count; I hope this blog can impress you enough to see outside the box and reach out to someone in need.