Guatemala, Part 2

 
If you missed Part 1, you can find it here.

Sam’s goal for this trip was harder than mine: he was to explore possibilities for collaborative research and to work on his Spanish.  That required him to make connections with doctors in Guatemala, for which he was dependent on our contacts here.  But the timing of our trip was determined by my work and placed us in Guatemala during the holidays, so the person he was supposed to meet in the teaching hospital in Guatemala City was out of town. Strike one.

He rallied well, though, and was game to do some home visits with us, so on Wednesday, we went down the mountain to Chiquirines and began visiting Hilda’s list of kids with hard cases.  First up: a child with an infection on his face.  (This should have been right up Sam’s alley, right?)  One of the pediatricians who had visited a month prior had given the child an antibiotic which had improved the infection, so when we saw him, he was a three year-old with fistulas on his cheeks, just under his eyes, which were draining pus.  I have never seen this before. 

Turns out Sam had never seen it before either, which always makes me feel better (though it didn’t help his confidence any).  We took a history: at birth he had had blocked tear ducts [my diagnosis, not the mother’s], and at 18 months old, he had developed an infection in one eye, which lad led to the development of the fistula.  Six months later, the same had happened to the other eye.  We don’t see this in the states, because babies here with congenitally blocked tear ducts (a relatively common condition) are referred to ophthalmology and undergo stent placement, which prevents fistula formation.   So we explained that he needed to go to ophthalmology (which the mother had never heard of) and Hilda said she would come back with the referral information.

It was like this all day.  Case after case, often found in a house full of barefoot children and poultry, of children with bad complications of relatively simple conditions.  Congenital herpes infection.  Ocular herpes.  Blindness from a congenital cataract.  So many things I had only read about– or, in the case of the fistulas, that I had to reason out based on my knowledge of anatomy, since I had neither encountered it before nor read it.

We also visited the pediatrics ward at the regional hospital.  There was a child with a neck mass Hilda wanted us to see; he had been waiting at the hospital for 3 days to have a biopsy.  In the states, it would have been scheduled as an outpatient surgery, but that doesn’t happen there.  So he was walking around the pediatrics ward in his pants and robe, waiting.  We saw a child with a huge abdominal mass, and another with EBV.  Sam met the residents and the head of pediatrics and arranged to come back the next day to do some teaching.

On our way back to the coffee farm after our day of home visits, we had to stop at the mall for Marco (the doctor who will run the pediatric clinic when it opens) to get his wifi connection working.  While we were there, the other doctor “just happened” to run into a childhood friend (whom he hadn’t seen for thirty years) who is a local ophthalmologist.  Marco told his friend about the child with the fistula and the child with the ocular herpes.  His friend said he would be happy to see both children without charge if Marco sent them over.  It was this moment of pure grace that gave me hope for this project, and that reminded me that relationship are really what make everything work.

Sam spent the following morning rounding with the peds residents and teaching them.  This was medical relationship-building.  The more we can contribute to the quality of care and teaching at the hospital, the better care our patients will get when they are referred there, and the more likely they are to take our cases. (I do the same dance here, with how I build goodwill at the hospital so that they will take my uninsured patients.)  Sam did this all in Spanish, which was so good for him–he knows so much Spanish but really doesn’t get a chance to practice it.  That day was Spanish boot camp.  He and Marco brainstormed about the laboratory needs and capacity available locally.

When I look back at the trip, I feel frustrated with how much time we spent trying to get “so little” done.  The efficient part of me strains against the pace of international work.  I find myself apologizing to those who sent us to Guatemala with their prayers and financial support, because it was so much money to accomplish “so little” medically.  But this is how it is.  And the relationships we built with the Guatemalans doing this work every day– Marco and Hilda and Ada and Millie– are what will endure, and encourage them to keep going despite the weight of hopelessness that pervades in a setting of poverty.