Oh the Drama in Guatemala....

So we have had quite the week, folks. Since Neil updated you on last weekend, I'll start at this past Monday. First thing's first, we've had a great time in clinic. Neil, Christina, and I have been working with Carmen this week on physical exam terminology and we've gotten to see quite a few patients with her. It's been really encouraging to be able to start taking full histories in Spanish and likewise be able to instruct patients on how to take the medicine we are giving them. We haven't seen anything too crazy, and surprisingly we haven't seen any patients with diarrhea (I'm pretty sure it's because we've taken care of that for everybody, haha). So far we've seen a bunch of URI's, "la gripe" (the flu), otitis externa, heat rashes, gout, and some fungal infections. It's kind of entertaining that we are learning all of the medications in Spanish before we've even learned them in English at school, haha. We also worked with Guadalupe yesterday, the nurse here at the clinic, to learn all about pre- and post-partem examinations with the women of Santa Cruz. The crazy thing is that in this small village of approximately 2000 people, there are more than 60 births each year. Guadalupe is responsible for seeing all of them (at least all that are willing to come in for health care), which is a big job in and of itself. Compound that with women not being willing to go to the hospital when they are in danger, i.e. when the fetus is transverse or feet-first at over 8 mos. gestation, when they are hemorraging, or when they are having fever or abdominal pain. The people here do not think highly of the nearby hospital in Solola and are petrified that if they go there, they will die. So, rather than seek care for their high risk pregnancies, they call a mid-wife to help with a home delivery, which has proven fatal for the mom and/or baby. But women here do not really consider family planning as their husbands won't permit it; to them they are not "man enough" if their wives are not producing many children. I met one 57 year old woman last week who had 13 pregnancies in her lifetime. It is not uncommon for a woman my age to already have 3-5 children here in Santa Cruz (don't worry, I'm not getting any ideas). But it is just extremely unfortunate because, say with a salary of 1000 quetzales per month (for an average construction worker, translates to $130 US per month), they accomodate feeding 7, 8, 9, 10 mouths by purchasing what they can afford, which is usually arroz y papas (rice and potatoes). Approximately 68% of children in Santa Cruz have permanently stunted growth and thus are extremely small in stature due to malnutricion. I don't think it helps the fact that they carry ridiculous loads strapped to their heads/backs walking up the mountain from the boat docks to their homes.

Well, that's pretty much the week in review at the clinic. Except for the other adventures we have survived....

So, on the way home from the market at Chichi last weekend, I started getting pretty bad abdominal cramps or shall we say poopie pains. Oh yes. And come Monday and then Tuesday, they got pretty severe and Tuesday morning I found blood in my stool. Lucky as we are to be working at a clinic, Carmen listened to my symptoms and without a doubt told me I had amoebic dysentery. I must say if you are going to get a GI bug, amoebiasis is the one to get. Other than a few cramps and bloody popo, you don't feel bad at all. So I started on Secnidazole on Tuesday, which is just a day's course, and hoped for the best. Well....Tuesday night before bed I discovered that I had urine the color of coca-cola, and despite the fact that I can't remember what that disease was we learned about (glycogen storage disease..? I dunno), I knew it wasn't good. The next morning it was more of the same, so in a tizzy I called Carmen and ended up having to take the boat over to Panajachel (Pana) to give a blood, urine, and stool sample. Let me tell you how comforting it is to get blood drawn in an open-air facility with a dirt floor and nurse that doesn't even put on gloves before sticking me. Not so much. Do as the Romans do, though, right?

Well, Neil, Christina, and I returned from Pana early evening only to find out that while we were out, Jeremy (Laurie's husband for those of you who don't know him) had fallen from a 40-ft watter fall. I'm not sure when Laurie will be able to update this blog, so hopefully she won't mind if I give you the brief overview. He and Fletch, an employee at the Iguana (hostel where we eat and hang out at night) went hiking up a ravine to check out the magnificent waterfalls they have here. They had reached the source, and the most dangerous parts of the climb, and were starting to head back down. What Jeremy thinks happened is that he saw a beautiful sight, took out his camera, and at that point lost his footing. They think that he fell about halfway down, touched down on a rock ledge and then fell the remaining 20 or so feet and hit his head on a rock. Fletch said it took him about 15 minutes to come to, and then somehow, miraculously, Jeremy was able to hike the 1 1/2 hour way down to the Iguana (though he didn't remember the first 30 minutes of the descent). At the Iguana he was complaining of pain in his back, and it was evident that he had a pretty big gash on his head and arm, among other narly abrasions. So, the next hour entailed calling Craig and Carmen, getting the backboard from the clinic, and everyone rallying at the Iguana to get Jeremy secured down and onto the emergency boat over to Pana. There we were met by the volunteer FD, which may I tell you weren't very well trained to get a stretcher into an ambulence. They kept getting the wheel of the stretcher stuck on the rear bumber. Anyhow, Craig and Carmen and Neil rode in the back with Jeremy and Laurie up front up to the nearest hospital in Solala. Thank God as it turned out Jeremy does not have any fractures (talk about divine intervention), probably very much a result of him having a backpack on at the time of his fall. But he did get about 30 stitches in his scalp (a nasty laceration that apparently went down to his skull) and they wanted to keep him overnight. I'm going to allow Neil, Laurie, and Jeremy to fill you in on all the details of the night, since well I wasn't there and also they have some pretty colorful stories, but suffice it to say for now that Laurie wasn't allowed back to see Jeremy all night because he was placed on a "men's ward", the nurses never cleaned him up or stitched a cut on his arm that definitely should have been sutured, his IV stopped in the middle of the night with no one taking notice, and in the morning when he went to use the restroom he encountered a tile floor covered in pools of urine and blood. I think that may have been the straw that broke the camel's back, or otherwise when Jeremy decided to check out regardless of actually being formally "discharged".

So Laurie and Jeremy made it back safely to Santa Cruz yesterday and rested for the day and night, and came in to the clinic this morning to have Jeremy's arm wound irrigated, cleaned, and bandaged and the dressing on his head changed. I haven't talked to them directly since earlier today but Carmen just came into the office where I'm typing a few minutes ago to say that they had decided to head back home to NC. We'll keep y'all posted on that. Please pray for Jeremy's recovery and both of them during this time...and if they are indeed heading home, for a safe journey.

Well, I better be signing off now; if you have made it this far you're probably ready for me to stop typing anyhow! Just to give you a heads up on our weekend plans...the 9 of us are going to head to Casa del Mundo tomorrow, a small hotel where there is supposed to be a great (and clean) place to swim along the lake, followed by lunch in the small nearby village of San Marcos, which is set up as a holistic retreat center (Do you know you can actually pay to come do a program where you meditate in silence for 40 days?!). Then at 3pm we are going to hop on a shuttle to Antigua, where we'll be spending the weekend. So far we've made dinner reservations at Ponce Verde, which is supposed to have the best chocolate mousse in the country (I don't doubt the truth in that; let me just say Guatemala is NOT renowned for its choc), we're (or I am) hoping for some more Salsa adventure tomorrow night. Saturday we are going to hike Pacaya, an active volcano and where you can close enough to the molten lava to roast marshmallows! So excited about that. Sunday we've planned to tour a coffee plantation, then back here to good 'ol Santa Cruz. It's great to be able to have all the other students as travel buddies on the weekend, just to be able to have some down time from the clinic and and get to know everyone. The other students here are so great and really the experience wouldn't be nearly the same without them. I mean really...you know you're with good peeps when you can call on any of them to look at a toilet full of your brown urine ;-)

PS--all my tests came back fine so I think that it was/is either the Secnidazole or the anti-malarial prophylaxis that is somehow causing funny colored pee. But who knows...keep ya posted if I learn anything more, but I am feeling a whole lot better.

Ok, have a great weekend everyone! More adventures to be posted in the coming days!

Much love,
Kristen and the MMA gang