Trip to Tikal

The third-year health promoters will graduate from their training program on December 15th. To celebrate, we all took a trip to Tikal. A nurse practitioner, visiting phyisican, and the Parrochia all pitched in to fund the 12-hour road trip and all the meals. This was the first time many of the health promoters had traveled past Guatemala City. In all, there were 9 health promoters, 6 of their children, 3 gringos, and the driver…19 in a minivan made for 15 (only two of whom got seatbelts), so that meant kids on laps, on the floor, and balancing on half butt-cheeks. But we made it in one piece and without much drama.

We did get stopped by the police for what remains an unclear and undeclared reason. The driver had to tuck a good sum of money in his registration papers so that we could continue on (this is “just the way it works” here).

We stayed at a Parish in the town of San Benito in the region of Peten. There is a thriving health-promoter program there and we briefly met their promoters but, through a little miscommunication in planning, didn’t spend an evening sharing traditions and performances with them as had been done during the trip two years ago when the current graduated class celebrated their graduation.

The first night we met with Sue Hammerton who started the health promoter program in San Lucas and is ADORED by them all. She was delightful though I only got to speak with her for a few minutes. That night the health promoters treated us all (in honor of Sue) to a great ceremony of traditional dancing, songs about illness and health, mock patient visits, games, and jokes. We fought off heat and mosquitos to get a little sleep that night.

The next day we visited the small, peaceful island town of Flores where we met, Janette, the expatriate nurse who orders medications for health promoters across Guatemala via Concern America. Then we took a boat to a tropical island animal reserve called Petencito.

On Sunday we visited Tikal, which the “Rough Guide to Guatemala” says is “possibly the most magnificent of all Maya sites”. Tikal was a Maya metropolis first constructed around 900 BC and inhabited until about 900 AD. It was “discovered” in 1695 and excavated beginning in 1956, though only 15% has been fully uncovered. The temples are enormous and the stairs up them are remarkably steep and of questionable stability. In fact, the stairs up one of the temples were closed in January due to two serious falls, one of which was fatal. The views from their tops over the jungle are incredible. When we started out in the morning we saw a couple of different monkey troups and later in the day saw a red fox, a pisote (something that looks like an anteater), and several toucans.

We returned home and slept for 4 hours before embarking on the long return drive marked by a brief stop at Rio Dulce, a large river and lake in Southern Peten.

Petrona and Rosa getting ready to danceShom and Socorro hugging to pop a balloonRosa and her daughter waiting for boat to PetencitoGroup on boat to Petencito from FloresSocorro and little Helen on boat to Petencito

Outside of Petencito

Petrona and Rosa in Petencito

Vicente and Abelino with a wild pig in PetencitoLeopard in PetencitoToucanKate and Abelino hiking the trails of PetencitoDominga and Rosa hiking in Petencito

Petrona Castro trying out gringo shades

Kate and Vicente on dock to return from Petencito to FloresHealth promoter group entering TikalJungle canopy in Tikal

Shom and Rosa on top of pyramidHelping Vicente capture our feet AND the top of the pyramidResting at the top of the pyramid

Un-excavated pyramid

Rio Dulce

Baptism of Estefany Merleny

I had the great pleasure of being asked to be the godmother (madrina) of a baby I have taken care of a few times over the last 3 months at the hospital. I was really flattered to be asked by her parents, Ana and Byron, but wasn't sure I should accept since I'm not Catholic and I will only be here for a year. But they were sure they wanted to go ahead with it and I got the blessing of Father Greg, so I accepted.

They had explained to Father Rich, whom they had asked to be the godfather, that they felt the baby had been so sick so much of her life that they should bring health and God together with a doctor as the madrina and a priest as the padrino. Estefany is now healthy and so hopefully their worries are behind them.

Today was the ceremony and it was a nice experience. It will take some creativity for me to figure out how to support and impact Estefany over the years from a distance but I'm determined to do as good a job as I can. Ana is only 21-years-old and Byron is 24. They have three children, 3 years, 1.5 years, and 4 months (Estefany). They all share one room with two beds in a home of 18 people. Ana's mom (Estefany's grandmother) has 11 children, the youngest being just 1-year-old. Ana and Byron are hoping to not have any more kids for the time being but they aren't comfortable with birth control, for religious and social reasons. I can see a struggle ahead of them.

Photos: Patients

6-year-old girl in Nueva Providencia with severe malnutrition and FTT

2.5-year-old boy in Nueva Providencia with macrocephaly

"Save me brother!" 6-year-old boy with growth failure with his mom and sister
Rodman

Impetiginized tinea corporis

24-year-old with snake bite on his little finger. He sliced the bite with his machete and placed a tourniquet

Another snake bite...8-year-old boy
Pityriasis alba
Scabies

Morquio?
Still undiagnosed. His older brother looked similar and died suddenly at 12-years-of-age. His mom wants to know what the future holds for her son.
Madelung deformity?

Going Upstream

There is a parable that is often told in public health circles to illustrate why it is so important when trying to remedy a problem to look for the root of the problem and fix it rather than focusing all effort on the numerous results of the problem. The parable goes like this:

You come upon a fast-flowing stream and you see a toddler struggling to stay afloat. You jump in and save the toddler. But no sooner do you get ashore than another baby comes floating down the stream on the verge of drowning. Each time you get to shore the same thing happens and you aren’t able to save some of the babies because it’s just you. So you start calling for help and townspeople come and start helping as well. Some have good ideas about how to save more of the babies, like placing a net across the river or making a chain of people to pass the babies back to shore. Meanwhile, one person thinks to walk upstream to find out why so many babies are coming down the river. It turns out that 50 yards upstream, the fence guarding the shores has fallen and the toddlers are wandering into the stream unknowingly. The townsperson fixes the fence and you all get together to celebrate over a Gallo (the local beer).

I’ve been thinking a lot about where I am in this stream lately. I’m treating a lot of scabies, URIs, LRIs, fungal skin infections, GI parasites, and malnutrition. On any given day, I meet at least one person whose story really compels me and I think “I’m going to sponsor this person. I have the money and they really need _____.” In the blank might be school fees (one mom told me in confidence that she’s been crying a lot lately because her husband says the four girls they have, oldest being 12 years, can’t go to school anymore because there’s no sense in wasting money educating girls), money for a continuing education class (the head health promoter wants to take a social work class for $150/mo to improve his ability as a lead health promoter; another health promoter was orphaned at 4 years of age to his 80-year-old grandfather when his mom, dad, and two other siblings were killed by the army but has since showed himself to be a very bright and dedicated health promoter with a great deal of understanding about natural remedies and a desire to take some classes on the subject), money for asthma medicine (a 2-year-old girl with bad asthma has been being treated with very frequent two or three day courses of IM gent and ampicillin by local pharmacists for her resp exacerbations because her family doesn’t have the money to bring her to clinic when she gets sick or buy her inhalers). Anyway, literally every time that I have my mind set on where I’m going to put my money, I find myself stopped in my tracks by the reminder that the money I have could make a much bigger difference if I could get further upstream.

The Parrochia makes is 100% clear that their belief is that as upstream as you can get is buying people land. People will never escape the problems associated with poverty if they don’t own land. In addition, by giving them something they can use for a variety of things: build a house, cultivate coffee, open a corner store, you have given them dignity and self-determination. I buy into this notion and found myself more recently thinking that when I leave here in June, I will donate towards purchasing more plantation land to be allotted to those still living under a system of indentured servitude. The idea of land purchase is really appealing when you see the beautiful new communities of Totolya, Tierra Santa, Por Venir, and Nuevo San Andres. All are peaceful communities supplied with electricity and water in with each family has its own home as well as a front and back yard.

But this week, when we visited Vicente in Quixaya, I started to doubt that this was the ultimate solution either. Vicente’s own father had been given land by the Parrochia many years back as part of a similar resettlement. Now that parcel of land is split between Vicente and his 4 or 5 siblings and their spouses and children. Each lives in a tiny house, kids and parents sharing beds, no free land for growing fruit or vegetables (they have a couple of potted vegetables). As the numerous grandchildren grow and get married, the property will be even smaller and I have to wonder if some will return to living on a plantation, renting land they can’t afford and ultimately return to the same destitute state they came from generations before. Of course, the land grant was important and valuable and makes them so much better off than they were before but now I’m thinking that further upstream is the issue of family planning.

If people continue to have 10-12 kids, despite wanting only 2 or 3, poverty, overcrowding, and disease will continue. I’m sure, I will come to think even further upstream than this over time but right now I’m feeling like funding a program that disseminates information on family planning and makes the methods accessible is the most valuable thing I could do with my money.

Photos: Rural Communities and People

Current school in Pampojila
New school in construction in Pampojila
6th grade classroom in Nueva San Andres
Young boy in traditional San Lucas dress
New houses being built in Nueva San Andres, where mudslide victims have been relocated