Saying Goodbyes

It´s coming down to it here. Today I am taking off from Cobán for good and heading out for a couple weeks before I come home. I´ll work on two more surgical missions and that´ll be it for Guatemala.

I´ve been running around visiting all the sites where I´ve worked. In June, we had our annual meeting where I got to see off all the health promoters that I´ve worked with this last year. This past week, I came back up to Cobán and went out to see all the families at the coop. I´m having one last throw down with my Peace Corps friends tonight. Guatemalans always get torn up with goodbyes and I am terrible at them, so it´s pretty exhausting, but it´s got to happen. I am really going to miss this place.

Team Pic with everyone from Partner for Surgery

Mayra and Carmelina

Walking out to visit Federico in his village in La Tinta

One last Marimba dance in Tactic

Last mission and travels with Mom

It is coming down to it. Just bought my ticket home and I will be headed stateside for good come July 22nd. Since getting back into the action post-appendectomy, I have had another mission and a trip to Colombia to fill these remaining months. Also, I now have my replacement down here, so we'll be spending some solid time doing site visits this months as I get ready to pass over the reigns of Partner for Surgery. I can't even begin to wonder what the adjustment will be like going home much less the process of leaving behind the country I've poured my life into for the last three years. For one thing, I know I will miss it dearly, so I will be soaking up what I have left.

Earlier this month, I finished my last medical mission. This time around, instead of having a triage mission for surgical patients, we focused on training local doctors on how to do cervical cancer screenings. We had an American OBGYN and my mom come down to train three local doctors. We spent a week doing the screenings and saw roughly 500 patients in 4 different sites. As rural Guatemala has next to no access to labs and pap smears, cervical cancer goes unnoticed and untreated until it is too late. We are teaching a technique to local docs where during a pelvic exam, they visually inspect the patient to see if there are any precancerous lesions on the cervix that could develop into cancer. Using a tank of nitrous oxide, the lesions are frozen off preventing them from developing into cancer. It is a much cruder method than anything you'd see in the States, but it gets the job done. We got a grant approved to fund the project, so the idea is to pass this training onto the local health system in Alta Verapaz. It is such a simple technique and if applied well, it could really make an impact on Alta Verapaz. It's easy to harp on the inefficiency and poor training of local docs, but after a week watching them work with Dr. Rick, I have a lot of respect for them. They learn by doing and are incredibly adept at the technique. Given the resources, they are as good as anyone else.





It was a different type of mission to run, so I did not really know what to expect. We ended up having huge turnouts and a crazy busy week. To combine it all, it was hotter than hell with it being 103 in the shade. Mom handled the pharmacy and took blood tests on anyone who got referred for surgery. She also got in on the lovely action of cleaning the speculums (anyone else feeling inspired to volunteer?). We had so many people coming through that Dr. Rick had me come in a start the pelvic exams so he could do the tests on two patients at a time. Never imagined I'd find myself that situation, but whatever, it was interesting. Overall, it was an amazing week. It was especially great to have Mom down here on a mission and to have someone from home see what it's all about.


Right after the medical mission, I took a week off and went to Colombia with Mom and Aunt Anita. We visited Dorothy and Elberto, Mom's aunt and uncle who live in Barranquilla. Short story, Colombia was great. We spend most of the time with the relatives in Barranquilla and it was relaxed. We took one trip up to Cartagena and and out to the Carribean Islands north of there. Cartagena is an amazing city and it colonial structures make Antigua look like a shanty town. Later in the week, I took a couple days and went scuba diving in a national park in Santa Marta north of Barranquilla.

The Colombia Connection

Post-dive in Tayrona National Park

Swimming in Islas de Rosario off of Cartagena

Qana' Dominga

Just to update anyone curious, I went by and checked on Dominga, the patient I wrote about in my last post. The surgeons said it was a miracle she survived as they had to remove over 40 lbs of ovarian tumor and fluids from her abdomen. She is doing much better and should be out of the hospital in a week (although she will have to learn to walk again without those 40 lbs).

When I told her about my own surgical tribulations last week, she asked to see the scar. She laughed and then I got ripped on hard in Q'eqchi' for having such a wussy scar compared to the train tracks she now has on her stomach. I'm glad to see she's got a good sense of humor about it all. Here's a couple pics of her with her Dad.

More Missions and my busted appendix

I took a little break from blogging as the last few months had been pretty uneventful up until recently. Really, it’s been nose to the grindstone with work. I led a solid mission in February with a group of docs from Minnesota and spent most of March preparing last week’s triage mission. Somewhere in there, I got a few days off for Holy Week, but a terrible stomach bug forced me to hang close to a bathroom at all times.

Things got interesting last week with a triage mission in northern Alta Verapaz. This time around, we had three docs instead of the normal two, so I spent a lot of extra time and money on promotion. A good week of triage usually results in about 100 patients scheduled for surgery. We ended up at 250 by last Friday. I’d describe the week as loosely controlled mayhem.

Besides the shear number of patients, the types of pathologies coming into the mission were amazing and sometimes heartbreaking. The latter would be the at least 10 patients with various types of terminal cancer. Translating that diagnosis is always depressing, but the families usually know something bad is awry and are thankful that we tell them straight. The flipside is that for the first time we have a team committed to doing pediatric neurosurgery, so kids with spina bifida and hydrocephalus (aka gigantic heads) that we used to have to turn away will now get surgery. We should be able to operate about 30 in May. One patient that I will never forget is a woman who came in on Friday that looked to be pregnant with triplets. Turns out she’s had this growing mass inside of her for 17 years. The OB said it looked like a gigantic ovarian cyst. After an 8 hour operation yesterday, a team of 4 surgeons removed 40 pounds out of her abdomen. Here’s the before pic (my apologies to the squeamish).

In a previous post, I mentioned my axiom that after living in Guatemala for awhile, crazy shit is bound to happen to you. I’m now convinced it’s natural law. After we finished the mission on Friday, I woke up early Saturday morning with some stomach “issues” that I assumed was some undercooked meat from the night before. I had to drive the docs 5 hours back to Antigua, so I took some pepto, sucked it up and started the drive. I eventually had to stop the caravan to yak and wretch behind the van with everyone watching, but I wasn’t ready to concede the keys. Further down the road, it hit me that I was not a safe driver. We stopped for a break and sitting in my chair, I had such a fever that I felt like a broken dryer shivering myself across the floor. One of the docs volunteered to drive and I laid down in the car as I started getting the worst stomach cramps I’ve ever felt. I was a little embarrassed at how bad I was handling it all as I’ve had plenty of stomach issues before. I was convinced it was just a particularly nasty bout of food poisoning.

By the time we got to Antigua, we just went right to the hospital to get an IV as I had tossed all my fluids out the window on the last leg of the drive. In my whole life, I don’t think I’d ever felt so weak and just all around sick and miserable. Thankfully, I was in good hands with the three American doctors. They took one quick look and suspected it was my appendix causing all this fuss. The Guatemalan doctors did some tests and confirmed it. As such, I ended up in the OR about an hour after that with a ruptured appendix. I guess somewhere along that agonizing drive that disgruntled little appendix of mine decided it was time take down the house.

I remember having one lucid moment before the surgery thinking that most foreigners would freak out going under in a Guatemalan OR outside of the capital. Really though, I couldn’t have cared less at that point nor could I have raised much of a fuss. The gynecologist on our trip said he could take it out if need be and that was good enough for me. However, we ended up making some calls and found a recommended doctor who worked with the hospital. Dr. Humberto it was. All in all, it worked out best this way. It wasn’t until during the surgery that they realized the appendix had actually burst. Had we waited much longer, it would have been far more complicated. And if anyone was particularly worried, just have a look at the painting next to my bed; it was actually Dr. Jesus removing my appendix.

Thankfully, this is mostly behind me and another story from Guatemala to remember. I am out of the hospital and walking around pretty well. Besides the occasional laugh or sneeze that makes me think I’m gonna blow the stitches out of my side, the pain is managable. Lastly, here’s a couple pics of the hospital. It was actually a great place to recover.

New Year's Rush

Since returning from my holiday travels, I have not left Coban for anything more than a day trip. I think that's the longest stint I had here in about a year. Less driving certainly makes my life seem much calmer--no more flattened animals, wrecks, etc. However, my workload has been huge. I'm getting myself ready for three triage missions over the next four months while trying to manage a host of other projects. Furthermore, starting in February, we will have a surgical team down every week for about 3 months. These are definitely the busiest months down here, so I feel like my life is all work. But that's cool. It's what I signed up for and why I'm spending a third year down here.

Here are some of our patients from a big plastic surgery medical mission we had this month. Before every mission, we gather all the patients in Coban from rural areas and then send them down in a group to Antigua. This last mission, we sent in about 20 clefts. These are a handful of patients in Coban right before the mission.

Roadkill and the holidays

I apologize for the infrequency of these posts. I swear I have plenty of material; it’s just the down time to write up a post that I’m missing. Anyways, since the last update, I’ve gone home for Thanksgiving, completed my 3^rd medical mission and spent another Christmas far from home in Guatemala.

Thanksgiving was wonderful. Going home had never felt like such a vacation. I loved seeing everyone and it was totally relaxing. Coming back from KC to Guatemala, it usually takes me awhile to get back into things; however I had a medical mission the following week, so I was busy as hell and didn’t have time to dwell on it all.

We had the 3^rd mission in the Nebaj area of El Quiche about 5 hours due west of Coban in the highlands. I drove out there prior to the mission to set up promotions and then headed down to Antigua to pick up the doctors to bring back to the site. Between all this promotion and traveling is a whole of driving. During Peace Corps, public transportation was my public enemy #1. With that in mind, driving is a real privilege, yet it has some serious drawbacks. Actually, for me it’s been okay. Those who have really suffered at my driving are Guatemala’s street animals. To this day, my death toll is 2 dogs, 2 cats and 1 badly wounded chicken (my buddy Dave etched the tally into my kitchen table to remind me of the slaughter). Anyways, the real story was the last dog.

Driving to Antigua to pick up the docs, I had a long, frustrating day on the road that included multiple construction sites, blocked roads and a minor wreck. Driving the Quiche to Antigua route is really beautiful minus the last half hour driving through Chimaltenango—AKA Guatemala’s armpit. The town is a sordid strip of whorehouses and used car lots stretched alongside the InterAmerican highway that is always congested with traffic thus granting ample time to ogle the woe that is Chimaltenango. As I drove through town already irked by the delays, a little puppy decided to wander in front of the van. I skidded to a halt a narrowly missed flattening the little guy. However, the no-good tailgaters behind me did not fare so well and the two vans behind me ended up slamming into each other causing considerable damage (I barely got bumped, no damage).

In Guatemala, no one has car insurance, so you have to argue it out at the site and come to an agreement. At first, both drivers tried to blame me for starting the whole mess. In situations like this, the card I play is the “Irate Gringo.” Flexing my filthiest Spanish, I told them off and acted outraged that they didn’t understand the traffic laws (well they were tailgaiting). This worked for awhile, but then the cops showed up. With all the cars still in the middle of the highway and everyone telling us to get off the road, the cops explained that if we didn’t come to an agreement, it’d have to go to court and I would have to make a special trip back to lovely Chimaltenango. With that in mind, I swallowed my indignation at having to pay anything and coughed up 200Q under the condition that I never have to make a trip back to Chimal. So, 200Q less, I was able to drive on.

And what of the mischievous puppy that caused this whole mess? Well, after I skidded to a halt, he jumped back and then trotted into the other lane where he was pancaked by a dump-truck. All things considered, he probably got what he deserved.

With all that rancor behind me, I continued on to Antigua to start December’s medical mission. To be brief, it was a great mission. We found a ton of patients and the doctors that participated were great to work with. They were the kind of people that make me want to go home and study medicine. Also, we spent the whole mission in the Ixil area far from Coban. As such, it was rewarding to get to know anther part of Guatemala in such detail.

After the mission, I spent some time working in Coban before slowing things down for Christmas. My old roommate Dave and his sister Justine came back down to Coban and we rented out a cabin outside Coban for Christmas. It was relaxing and we stuffed ourselves silly. From there, we started a grand tour of Gautemala.

First, we hauled over to Nebaj to start a 3 day hike across the Cuchumatan Mountains into Huehuetenango. My new sitemate Mike also joined us with a couple other Peace Corps friends. The hike was awesome. We hiked out of Nebaj up onto the high plains through meadows and mountains. It was cold, but the scenery was stunning and it was great to stretch the legs after all our Christmas gluttony.

From Huehue, we made our way down to Lake Atitlan for New Years. Last weekend, I said goodbye to Dave and Justine and am now back in Coban to start preparing the 2008 medical missions.

Oh, I almost forgot. I finally spotted the quetzal up close driving back to Coban. Here he is.

Extreme Guatemala

More so than most weeks, this last one was rather insane with its high and low points. Really, that’s been Guatemala for me over the last two years—extreme highs and lows. It’s a maxim that after living in Guatemala for awhile, crazy shit will happen to you, and it has certainly held true for this past week.

I’ll delve into last week later here, but I’ll start with an update of the last month. Most importantly, I finished my second medical mission. We were in the Polochic Valley which is an incredibly poor area. There is one terrible road going out through the valley known for its poor condition and abundance of highway robbers. Throughout the valley there are a handful of towns and villages that have very little access to basic health care and much less, surgery. As such, we had a very good turnout and set another record for number of patients found. The temperature was upwards of 100 degrees during the day and it was a pretty stressful experience, however at the end of the day, we found a ton of patients who will be coming in for surgery. The valley itself is incredibly beautiful. Here's a pic.

After the medical mission, I spent some time in Antigua with a surgical team that was down to operate some of our patients from the rural mission. I then traveled up to Nebaj to work on the December medical mission before coming back to Coban for the beginning of my insane week.

Last Wednesday I was planning to head down to Antigua but got a call that one of our patients from the Polochic had died. It was a total shock, so I decided to drive out into the valley to see what had happened. Her name was Dominga Cuc Botzoc and she had been operated for both a prolapsed uterus and a hernia. What was so crazy was that although she had two major operations, she was one of the fastest patients to recover. She was 77, had 8 children and lived by herself selling tortillas to get by. Coming back from Antigua, she had gone with one of our managers and then got let off to travel the last leg of her trip home. She was apparently fine the first couple days at home, but got an infection that turned for the worse. 8 days after the operation, she passed away.

When I drove out into the Polochic, I kept thinking worst case scenario of how the family was going to be upset and I would end up getting chased out of town by an angry mob. When I came into town, there was a huge group of people around her house and she was laid out on an altar. I went to the wake and spent the day talking with the family about what had happened. Her children did not get along and no one had been able to really take care of her. When her health went bad, she had called our area manager who had tried to get her to the local hospital. However she decided she’d had enough and didn’t go. She said her goodbyes to her children and passed away shortly thereafter.

It was a difficult experience to digest. We helped with the funeral and the family was very supportive of us. However, mostly it was just a very sad situation. The family was upset they hadn’t been around to help out and did not place any blame. For us, it was incredibly frustrating that we couldn’t convince her to get to the hospital. She was a very strong woman and in the end was not interested in letting anyone else control her future. She decided her time had come that the she would decide the hour of her passing.

So, after going through all of that, I decided to take a day off and go hike a volcano. I went down to Antigua and met up with two good friends of mine from Peace Corps. We took off Friday morning and set to climb the Acatenango volcano outside of Antigua. This turned into another extreme Guatemalan experience that held true to the maxim I mentioned before.

For starters, I got food poisoning on Thursday night and by Friday morning I was still throwing up everything I tried to get down. After my terrible week, I was in no mood to sit around in Antigua being sick, so I went anyways. Despite a few yacks in the first leg of the trip, my body started collaborating and realized there were bigger fish to fry—namely my racing heart and need to ingest water as we hauled up the volcano.

Acatenango is a 13,000 foot volcano just outside Antigua right next to the active Fuego Volcano. The hike was brutal. It was straight up for 8 hours and we made it to the crater just as the sun went down. We were the only ones up there and we set up our tent right in the middle of the crater. It was eerily quiet and extremely cold. The only sounds were the occasional gusts of wind and the explosions of the Fuego Volcano. The air was thin and we barely slept.

At dawn, we got up to see the sunrise over Guatemala. Seriously, this was of the most incredible experiences of my life. We could see from Mexico to El Salvador and looked right down onto Fuego Volcano as it smoked. We could see all the other volcanoes of Guatemala and it made the country look tiny. The sun crested right over the crater of the adjacent Agua Volcano—it was euphoric and made the experience completely worth it given what followed on the way down.

After sunrise, we packed up and started down the mountain. We passed some other tourists coming up and kept heading down from the crater. My buddy Bryan was in front of me by about 20 yards and I saw him stopped and talking with some scruffy looking Guatemalans. It didn’t look like a cordial conversation, and when I caught up one of the guys pulled a zip gun out of pocket and told us to have a seat. They went through all our bags and got our phones, camera and money. Thankfully, we convinced them to leave us the memory chip out of Bryan’s camera. They wanted to continue up the mountain to rob the tourists up top and told us we had to come with them so we wouldn’t run down and get the police. We refused and said we’d keep our lips sealed and they let us go. As we hiked down, the robbers came by us again and continued down the mountain. They then robbed some kids from a youth group coming up the mountain and kept going down.

When we caught up with the other group, they told us there were some cops coming up the mountain with a group of Salvadoran tourists. Just as they mentioned that, we started hearing the gunshots. We knew the thieves only had one shot, so we assumed the police did most of the shooting. When it ended we followed down the mountain and met up with the cops. They said they recognized the robbers and just decided to open fire. That’s how it works in Guatemala. The justice system is so ineffectual that the cops prefer to just kill the robbers. However, these cops didn’t shoot so well and just scared the robbers off into the woods. I asked one if he hit anyone and laughing he said, “Oh maybe I hit one, I shot a clip at him so maybe you’ll find some bodies down there.” We thanked them for their efforts and ran down the mountain.

With all that behind me, I’m still glad I went up Acatenango. Living in Guatemala, I can never complain that I get bored.

I’ll be home for Thanksgiving.