Kwong, Helaine

School of Medicine

Guatemala

During my trip to Guatemala, I will be a member of an interdisciplinary medical team comprised of physicians, nurses, pharmacists, and health care students. I will help provide direct patient care for almost 1,000 patients over the course of a few days. As a group, we will transport all necessary supplies and medications to our base in San Lucas Tolimán, a small village on the shores of Guatemala’s Lake Atitlán. We will serve 5 rural villages around Lake Atitlán. Each day we will transform a local community gathering space into a functioning clinic and pharmacy, complete with private examination and counseling areas.

A high percentage of patients will be of Mayan descent. Most patients will speak Spanish and some will speak the local Mayan dialect of Kaqchikel, affording me ample opportunity to improve my language skills. We will provide basic primary care with some specialty care including women’s health, STI prevention, and simple bedside procedures.

This elective will include the opportunity to teach and work with medical students. I will develop my patient education skills by training local villagers to become “Health Promoters”—lay people who will be trained in basic first aid, blood pressure, and blood sugar measurement who will work with local physicians to help bring health care to their communities. Through this experience I will build on my fund of medical knowledge, polish my teaching skills, and gain an appreciation of what it takes to provide medical care in resource-poor areas and developing countries.

The University of Toledo College of Medicine | Maumee, OH

It was a crisp and cool morning at San Lucas Tolimán when we all piled into the back of a pickup truck and drove toward our first clinic destination. The road was dusty and the scarce roadside vegetation did little to protect us from the glaring tropical sun that had just begun to peak over the crests of the three majestic volcanos surrounding Lake Atitlán, Guatemala. The truck bed was crowded with second-hand army duffels packed full of medical supplies and medications. There was scarcely room for passengers, but somehow, we wedged into every imaginable free space in between our medical supplies. Mercifully, our driver only modestly exceeded the posted speed limits and we barreled down the mountainous two-lane country road toward the first village at a leisurely 60mph.

Every day was the same routine—wake up at 7am, breakfast at the local parish at 8am, and hit the road with all our gear by 9am. The only variable was which village we were going to serve that day. In the more affluent communities we were allowed use of a community center with amenities like electricity and indoor plumbing. Other days we utilized whatever free space we could find amid local homes and worked under the light of portable lanterns and headlamps.  Sometimes women from the local community cooked us a simple meal for lunch, but often our mid-day meal consisted of peanut butter and jelly atop a white flour dinner roll.

    

Left: Going to clinic. Right: Clinic

Patients would filter through our clinic until sunset, stopping first at our triage table before being funneled into various queues to see the doctors or dentist. We saw a breadth of patients ranging from young adults to the very elderly. Some patients had urgent complaints, such as wounds and abscesses or parasitic infections. Other patients had chronic issues such as diabetes, hypertension, or arthritis and could not afford medications. We always attempted to arrange follow up care with the local physician, but there were fewer than a handful of local physicians in the area so oftentimes only patients with the most complicated issues could obtain expeditious follow-up. We were able to do simple procedures in the clinic such as EKGs, knee injections, wound debridement, and even lipoma and ganglion cyst removal. The dentist on our team worked diligently extracting teeth, and our two pharmacists filled hundreds of scripts from our limited supplies of medications. Permethrin cream for scabies was a hot commodity and when we ran out mid-way through the trip we were forced to purchase more from the local pharmacies. Patients requiring more complicated procedures or specialty care were referred to Guatemala City, more than 3 hours away.

We met with all the local health promoters from the neighboring villages and worked together assembling water filtration devices for them to distribute. One simple filter provides clean water to a single family for years, stemming the prevalence of illness and parasitic diseases. On our departing night, women in the community prepared an authentic Guatemalan cookout for us in our hotel courtyard, complete with traditional grilled meats, squashes, corn, salsa, and plenty of guacamole. As the sun sank behind the volcán, we reflected on the trials and triumphs that we encountered during our trip. Most of us were already planning what we would do on our next visit.

Health promoters with water filters

People

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases
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July 2018

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