This journal was written by Lance
Hale, a 1997 high school junior
from Saratoga Springs, New York, during a medical clinic
trip to Nueva Santa Rosa he took with his mother, Pat
Hale who is an Internal Medicine physician.
Tonight I went to Terri Kingmanís house. We displayed
some of our medicine and stuff that we were taking down
to Guatemala while a photographer from the Saratogian
took our pictures for tomorrowís front page. I was
pretty surprised that we are going on the front page;
must not be much happening in the world. We also talked
about some simple translation sheets to be used in
surgery and questioning the patients.
This morning I got up at 5:30 and went to Albany
airport. I forgot my backpack with all of my homework in
it, so Iím in trouble when I get back. I flew from
Albany to New York City, JFK, hung out there for 3 hours
and then flew to Miami. I stopped there for 2 hours and
got my return tickets changed from the 18th to the 17th.
Then we got on the plane for Guatemala. After 2 hrs, I
looked out the window of the plane and saw Guatemala. It
was surprisingly mountainous. There were hardly any flat
areas. The mountains were very steep, too. As we flew
into Guatemala City, I could see the outskirts of the
city built right up to the cliffs. This made the city
have a weird shape, like a giant starfish. We got off
the plane and met the Lions club members from Cuilapa
who were waiting for us. We loaded onto an old school
bus and drove for 2 hrs through the country.
Eventually we arrived at Cuilapa, the city that our
hotel is in. We unpacked, ate, and went to bed, after
looking around the area.
This morning I woke up to the sound of monkeys and
parrots at six oíclock. We had a nice breakfast that
included a poor attempt at pancakes and some bacon from
an unknown animal. An hour later, an escort truckload of
20 Guatemalan army guys showed up to protect us from any
banditos or people that would try to hijack our bus or
mug us. We also had a police car in front of our bus and
there were some unknown guys with machine guns standing
around. I guess that they were from some branch of the
Guatemalan government. The army truck and police car
would stay with us all day. We got on our bus and headed
to downtown Cuilapa which is about 10 minutes away from
our hotel (when you have "Mario", a loco Guatemalan bus
driver that speeds around blind corners).
We went to the Lions club headquarters in Cuilapa
(pictured above) to load all of the supplies for the
clinic onto another military truck.
Our supplies were shipped down about a month ago. About
a week ago, a hurricane (Olaf) passed through and soaked
many of the boxes (Pharmacist "Birg" drains supplies
soaked with water in photo above left). We spent about
an hour filling up the 18-wheel truck with all of our
medicines, equipment, and supplies. Then our caravan
headed out to Nueva Santa Rosa where we set up the
clinic. We arrived and went to a large old church (above
We used 7 rooms to set up general medicine, pharmacy,
dental, womenís, day surgery, ophthalmology, and supply.
I spent most of the day putting together dental chairs,
exam tables, privacy curtains, and other stuff.
I also organized drugs into different types and dosages.
Then I spent about an hour drying off 3000 condoms that
had their wrappers soaked in the hurricane. I met a
dentist named Frankie that lives in Cuilapa and is
helping out with the clinic. He became a dentist because
one day he was on a date with his girlfriend and was
kidnapped by the government to join the army (Guatemala
was in a civil war for the past 30 years or so that just
ended a couple years ago.). The army taught him basic
dentistry and sent him to work pulling gold fillings out
of dead soldiers. (Frankie unloading his office
equipment brought to the clinic by a pickup truck, next
Anyway, I spent about an hour helping him put up a
dental light to look into peopleís mouths with. We
didnít have the post to hold it up so we had to jury-rig
it to the ceiling and window of the dental room. We
finished setting up the clinic at about 5 in the
afternoon and then hopped on the bus back to our hotel.
I am actually glad now that I took Spanish for four
years. I donít remember a lot of it, but what I do
remember has helped me a lot because we only have one
translator with us.
This morning I woke up at 6 am again. Today we went
straight to Nueva Santa Rosa without stopping at Cuilapa
on the way. When we got there, several hundred people
were waiting for us in the church.
We went in and there was a big ceremony to commemorate
the beginning of the clinic or something like that.
8:00am. After this, I went straight to the "Farmacia"
(pharmacy) and started helping there. When the gate
opened, we were bombarded with people waiting for their
medicine. We had enough doctors to diagnose the patients
quickly but, after seeing the doctors, they would all
come to the pharmacy. We only had one pharmacist to help
us out, so we were swamped.
I spent almost the entire day in the pharmacy. I was
measuring out medicine, counting out pills, and giving
medicine to people, using some of our new translators to
help me tell them when and how much medicine to take.
Tons of people seemed to have parasites today; we also
gave out a lot of simple stuff like Tylenol, benadryl,
antiacids, and Advil. At 5:30 pm, we closed the gate to
any new people coming in and at eight o'clock we were
finally done with all of the patients in the building.
In all, we went through a little over four hundred
patients in 10 hrs.
It was a lot of work, especially when you consider that
it was like 90% humidity and 90 degrees F. I took two
breaks from the pharmacy. I spent about an hour, total,
giving out 25 gallons of Gatorade in 300 cups to all of
the patients who were dehydrated waiting for their turn.
My other break, besides a quick lunch, was to attempt to
flirt with "una senorita bonita" (a pretty girl). It
wasnít too easy because my Spanish wasnít very good and
her English was non-existent. She was pretty though, and
I got her picture. We finally got on the bus and went
back to the hotel where I ran to the shower.
This morning I woke up around 6:30 and my roommate told
me that my mom had been up sick all night. We got on the
bus and went to Nueva Santa Rosa at 7:30. Today we went
straight to work instead of having a big ceremony before
hand. I spent at least 4 hours today sorting out pills
and medicines into smaller packages (ex: 30 Zantac). I
also am learning to read prescriptions. I probably got
medicine for about 30 or 40 prescriptions on my own. I
learned the proper amounts and dosages for each
After I got all of the medicines on one prescription, I
would put Spanish labels on each medicine that told the
patients how many and when to take their medicine.
After I got everything set up the way I thought it
should be I would run the prescription and the medicines
past "Birg", the pharmacist. He is about 6í6", 240 lbs,
Norwegian, and wears purple every day. (We call him
Then I would go to the front of the room and try to find
the person who the medication is for, out of the 50
impatient Spanish-speaking people waiting for their
medications. Once I found them, I would have to
communicate to them how to use the drugs. There were
usually translators there to help me though.
Also, 3 times during the day, I had to help Ryan, the
water boy, get some more water for us to turn into
Gatorade and give to the people waiting for service. We
gave out 40 gallons of Gatorade today. We had to get all
of our water from a store ľ of a mile away. We would
have to walk across town to this store, out of the
protection of the army guards. We then had to carry 5
gallon barrels of water back on our shoulders. That
wasnít fun. We estimate that we took care of at least
500 people today. For most of the day, my mom was sick,
receiving IV fluids, and sleeping in a bed up in the
church. We were worried that she may have caught some
weird tropical disease that she wasnít immune to.
However, now she is doing much better. Also, some
ophthalmologists from Guatemala City came today and had
a couple of girls with them who helped us translate. The
surgeons should be getting here in a couple days and we
will have small operations going on.
Today I woke up to the sound of a parrot that speaks
Spanish. I just found out today that the parrot actually
talks, before I thought it was just making random noises
because I didnít think that it would be speaking
Spanish. I tried the usual "Hola" and "Como estas" on it
and got some pretty funny answers. It likes to say "Guapo"
and I think what is Spanish for "poop". I was late
waking up so I had to scarf down breakfast real fast.
Then I ran to the bus, past the guards that were
carrying guns. I slept on the bus ride to the clinic.
When we got there, there were about 300 sick people
waiting for us at the gate. Most of the day I spent in
the "Farmacia", filling out prescriptions. I now know
what to prescribe for parasites: Vermox (one a day, 3
tablets for under 16 and 6 tablets for older than 16). I
am learning how to diagnose parasites as well. Over 40
percent of the patients that come to the "Farmacia" are
diagnosed with parasites.
I also had to help the water boy make a couple more runs
to get water and buy cups. We went through 70 gallons of
water today. The worst part of getting cups is going out
the front gate of the clinic and wading through the mob
of sick people. It is packed tighter than a mosh-pit and
they are all sick and coughing on me. Iím not feeling
too good tonight. I think I caught something from them,
because my throat hurts and my sinuses are messed up.
Itís nothing as bad as what my mom had though.
The good thing about working in a pharmacy is that
whenever I feel bad there is some Advil for my back or
Levaqin for the strep throat that I picked up the night
before we left America. All of us are going to have to
take some Vermox and Lindane shampoo before we go back
to the US for our parasites and lice that we probably
picked up from the water, food, and people. The stores
close to the clinic must love our business. Each
morning, we spend 30 Dollars (180 Quetzales) on cups and
we spend about 200 Quetzales on water for the patients
and us each day. (1$ = 6Quet.). It may not sound like a
lot, but here that is more than a lot of people make in
One of my friends, a girl that is almost done with
college to become a nurse had to teach people how to use
the condoms that we are giving out. She used one of
those lights that doctors use to look into peopleís eyes
and ears. It was quite humorous.
So I just worked in the pharmacy until 7:30 at night
when we had our last patient, then we loaded up the bus
back to the hotel. Our pharmacy on the first day had
about 3 times in value what a normal Rite Aid or Fays
has on hand.
This morning I woke up and ran down to the cafeteria to
have 6 pancakes before we left for the clinic. Today
there were no Mormon missionaries to help us translate.
Yesterday there were four of them. They were pretty
cool. I talked to them a lot. One of them plays football
at UCLA, and his grandparents own the Dole Pineapple
Company in Hawaii. I spent the day doing the usual in
the pharmacy. Around 2 o'clock I went with some of the
local boys that I met and we played basketball in the
town park that is just across the street from the
clinic. In the middle of the game a couple little kids,
probably 7 and 5 years old started fighting. They were
on the the ground punching each other in the head and
all the older Guatemalan people were just standing
around watching the 5 year old get beaten bloody. I had
to run over from the other end of the court to pull them
apart. No one else would do anything. After I pulled
them apart, I took the little kid (who was crying) over
to a street vender and bought him a drink to help calm
him down. Then I went back to the clinic to help in the
pharmacy until the end of the day. I have taken a few
prescriptions all the way through the process on my own.
From taking the paper from the patient to getting the
right drugs, putting the right dosage labels on them
(sometimes I have to write this myself in Spanish (ex:
Una Pastilla tres veces al dia cada dos dias), calling
out the patients name from the crowd of people waiting,
and describing to them how to use the medication. It is
gratifying to hear the thanks that they give when it is
done. Later, we went back to the hotel where we met up
with the two surgeons that just flew in today. Dr. Mac
DePan and Dr. John Bulova. Mac has been described as a
living legend. I was told that he is just about the best
surgeon there has been in the US for a long time and
probably will be the best for a while after he is gone.
He can perform operations twice as fast as most surgeons
and that would allow him to do very difficult operations
that usually would be deadly because he could have the
patient open and closed in one hour instead of 2 Ĺ hours
like many other surgeons. This causes the body much less
trauma or shock and allows the body systems to recover
sooner. He is getting older and is retired but still
helps out sometimes. Tomorrow he is going to Cuilapa to
do some surgery in the hospital there. Thursday I get to
assist him and John in some day surgeries at the clinic.
After meeting them, we all had a meeting in the lobby of
the hotel to talk about procedures that we want to
change at the clinic so we can run smoother. Each day,
we take patients from a different village so that we
will not be overcrowded. The local Lions club went to
the villages before our trip to set up which one would
come each day. On Thursday, we are going to do the
people of Nueva Santa Rosa (where the clinic is set up)
and all of the people that we gave return forms to. (We
gave return forms to people who need to come back for
day surgery, for removing goiters, tumors, etc, and eye
problems because the doctor for the eye clinic is only
coming back again on Thursday). Today Frankie pulled 105
This morning we got up early and went to the clinic as
normal. The surgeons and their nurses went to Cuilapa to
talk with the hospital staff. I spent the morning
working in the pharmacy and helping set up some day
surgery areas. Around noon, the two surgeons got back
from the city and went to work. They spent a lot of
their time examining patients just like the other
doctors. Shortly after that, Dr. DePan did the first
surgery of the clinic. I stood by and watched as he cut
a benign tumor out of a 40 year-old manís eyebrow.
On the next surgery, I assisted Dr. Bulova in the
removal of a benign hemangioma from a 30 yr old male
leg, about 5 inches above the knee slightly to the
inside of the thigh. I did the job that a nurse or
second surgeon would normally do, because John and I
were the only two people working on the operation.
First, I made sure that we were all sterile. I put on
sterile gloves, then got out sterile sponge pads,
instruments, and gauze. There was a special procedure
for doing each of these tasks because we could not
contaminate our gloves or utensils. Even by slightly
touching anything, there would be a chance of infection
or the entrance of parasites such as maggots off of
flies. Once we were all ready, John made the initial
incision. When the skin was cut open, he showed me what
a few of the structures near the hemangioma were. While
he cut and pulled at the hemangioma, I blotted out any
blood that was coming to the surface of the incision so
he could tell what he was doing and so that the patient
would not get dirty.
Once he pulled out the benign hemangioma, we had to sew
up the cut. I helped him cut each stitch. Because of the
nature of the cut, we used 7 individual stitches.
Another option that we used on the next operation was to
"run a stitch". This means that we use one continuous
suture string run all the way across the cut. We "run
stitches" when there are lots of capillaries and
complicated flesh or when we have a very large cut. I
think that running the stitch causes less trauma to
these types of cuts, but Iím not positive. So, as he did
the sewing, I would help in applying tension on the
string or cutting off stitches. After we finished
stitching up the man, we cleaned the area with some
gauze and bandaged him up.
The next surgery that I assisted in was the removal of a
benign lipoma from a manís mid-forehead. (See above) I
went through all the same things as the last surgery.
Unfortunately, this was a lipoma, not a hemangioma.
Lipomas are harder to remove because they could be
considered a sort of web or string of balls, whereas
hemangiomas are like one large ball. Because of this,
lipomas are more intertwined in the flesh. This makes it
so that you have to carefully pick out each section
without missing any. If we miss some, it is possible
that the tumor could come back. Because it was a bigger
cut, and it was on the forehead, we had to "run the
stitch" this time. I helped keep tension on the suture
string and cut the ends while John tied the knots.
When we were done, we wrapped his wound and he was on
his way. I was so proud, and the man looked at me with
so much envy and respect as he thanked me several times.
It was funny because the rest of the day, as he was
waiting for his medicine at the pharmacy, he was walking
around wearing his cowboy hat on top of the large
bandage that we put on him to apply pressure, this made
his head look like it was 1.5 feet tall.
About 4 hours later, he came back to us over at the
surgery room and said that he had a headache. We asked
him if he had taken his pain killing medication He told
us that he wasnít supposed to take it until morning! I
would be hurting too if I had a big cut in my head
without any Tylenol. After this, I just helped doing odd
jobs like translating for my Mom while she examined
patients. She doesnít know an ounce of Spanish.
Hollywood Bill (thatís not his real name but for some
reason we call him that anyway: a couple years ago he
was on the national basketball team for Guatemala) and
I make a fairly good translating team because he speaks
a little English and I speak a little Spanish. Tonight
we went back to the hotel and after dinner a bunch of us
went to a room and had a little party. Dr. Bulova and I
make quite the prank team.
I woke up and we all loaded on the bus for the clinic.
When I got there, I hung out with the surgeons right
away. The first few cases were simple cases that they
decided werenít appropriate to work on. About 2 hours
into the day, a man came in with a strangulating
inguinal hernia. It was incredible; the right side of
his scrotum was about the size of a softball, no
exaggeration. Dr. Depan was able to put the needle into
a certain vein or something so that he could drain some
of the fluid to reduce the size. We couldnít perform the
whole operation of removing the hernia because it would
have taken too long and we didnít have the necessary
equipment. We put the man onto a sort of stretcher and
carried him to a truck outside.
Later, I found out that on the way to the hospital the
truck broke down so they had to throw him onto another
truck to get to Cuilapa; they ended up taking three
different trucks to get to the hospital.
The next patient was a man with a huge, baseball-size
lipoma on his back. Dr. Bulova, Dr. Depan, Midge, and I
preformed the surgery. We had him open for about half an
hour, which was much longer than any operation we had
done before. Again, I did the job of the nurse with
Midge. I helped sew up and keep the cut dry and clean.
We had to make an incision about 3Ĺ inches long. The
surgeons slowly cut and tugged out the tumor. It was
incredible when it came out. At first, I thought that we
were pulling an organ out of him, it was so big. There
was an incredible difference visually when the operation
was done compared to before when he looked like a camel.
(See photos next page)
My next patient was a 3-year-old boy. He was
uncircumcised and his overlapping skin was so long that
it would eventually cause him to be unable to urinate
and he would probably die. I had to assist in a
circumcision. What fun! There was a lot of prying and
pulling and shoving of big metal objects like clamps,
that I donít even want to talk about. All I can say
about the operation is that there was a lot of squirting
blood that I got on my surgery clothes and the whole
time I had to hold the kids legs down while he was
yelling "my big d---" in Spanish. It was kind of funny,
because, he was 3 years old. After they finished
cutting, all of the doctors and nurses left me alone
with him and his "madre". I had to take care of cleaning
all of the blood and other stuff off of him. That took
me about ten minutes. Then I had to bandage him up and
get his pants on.
After this, I hung out in the pharmacy for a while
helping out there.
About 2 hours later, my mom was examining the same kid
that we circumcised to make sure that there was no
bleeding and that the cut was good and clean. While she
was examining him and preparing to give him an
injection, a 7-inch worm crawled out of his buttocks.
This is the kind of thing that we give out Vermox for.
Lots of people here have parasites, probably 50%, and
almost everyone in the country has had them at one time.
They are easily cured with medicine, but if they arenít
taken care of, they can be fatal. The reason that the
worm decided to leave then was because when we
circumcised the little boy we gave him antibiotics and
anesthesia that the worm couldnít stand, so it left. We
gave the boy some Vermox and sent them on their way.
They would return the following day for a recheck. The
mother was so grateful, because, if we hadnít taken care
of him today, and he hadnít been treated, he almost
certainly would have died. It was a really cute kid too.
After that, I hung out in the pharmacy some more,
filling prescriptions. Dr Bulova said that I have "great
poise and steadiness" during surgery. One patient that I
didnít work on, but was very interesting, was a little
girl that had 6 toes, it was quite remarkable and looked
fairly normal except for when I counted them, there were
6, not 5. During one of the minor surgeries Dr.Depan
commented on how each surgery that we did would have
cost a patient a minimum of one thousand dollars, and
some would be much more. This was our last day, so we
had everyone that was involved with the mission go over
to the hotel and we threw a big party.
There were well over a hundred people there including
the Colonel from the army, our bus drivers, an
incredible marimba band, my Mormon translating
missionary amigos, and all sorts of other people. We
gave out awards that we made to all of the Guatemalan
people. We danced and swam. It was actually a pretty
cool party. Later, I went up and hung out with the
Mormons, watching Latin soap operas and infomercials
until about 2 oíclock when we finally went to sleep.
This morning I woke up in the wake of a party. Our room
was a mess and there were people sleeping all over the
place. We spent about an extra hour getting all of our
stuff at the hotel ready because it was the last time we
would be there. I talked to Elder Greathouse on the bus
on our way to Barbarena. There we said our "goodbyes"
and they left to continue their diverse missions in the
middle of Central America. It was pretty sad when they
left. I had become a fairly good friend with them in
just a few days and I knew that I wouldnít see some of
them again. I think that Greathouse is going to come out
to New York with his dad and visit us in December. So
from there we drove to Nueva Santa Rosa. We arrived at
the clinic and started packaging all of the clinic
supplies and equipment to be sent to a hospital or
stored with Pepe until we return in April. We spent
about 3 hours packing all of our stuff up and cleaning
the renovated church rooms. I played a little
basketball, we gave away some of our clothes, hats, and
miscellaneous things to the local kids, and we took
pictures with a bunch of the Guatemalan people that had
helped us. As I got on the bus, I had to say farewell to
the kids of Nueva Santa Rosa that had helped us. From
here we had about a 3-hour bus ride to the capital city
where we stayed at a nice hotel the last night.
On the bus, I sat quietly in the back thinking about a
million things. Thinking about my new- found friends
that would wake up in a week still in their poor town.
My friends that would leave their homes at the crack of
dawn, work hours that would leave most Americans crying
and threatening to sue, earn about as much as I spend on
a soda for lunch each day, and for all this work, what
do they get? They get enough food to survive on; they
earn just enough to get by. Sick days and vacations are
a joke. This was real life, everything that I did here
seems so massively more important than my life in
America. The past few days, I have not thought for a
moment about my normal, lucky life. I havenít thought of
my friends, our parties, our games, and our countless
ways of wasting time. The world here is so involved and
the experiences pull me in so deep, this is life and I
will never forget it. Never. I donít even want to go
back home, Iím not looking forward to leaving a world
where I can make a difference, a place where I could
help change peoples lives. I wish that I had the writing
skills to express how raw, real, and unrestricted life
is here where a woman would get up at 4:30 in the
morning, walk for 4 hours on bare feet to carry her sick
child to our clinic. Needless to say, I was a bit
glossy-eyed on this bus ride. When we got to Guatemala
City, we checked in at our hotel and headed to our
rooms. I ate all of the food out of the refrigerator and
watched Seinfeld. I took my medication for parasites and
washed myself for head and body lice. Around 11 pm, I
went out for a walk. I left the hotel and wandered
around some quiet streets thinking about the kind of
stuff that makes me want to cry. I was walking down one
alley and heard a band playing some great music. So I
sat on a stairway listening to "Inda-godda-davida" and
looking around. After sitting there for a good
half-hour, I walked back to the hotel and started to
cheer up. I thought about how even though the people
have it tough here, there is still happiness. They still
have love, marriage, and friends. A bit of irony is that
their poverty doesnít bother them close to as much as it
bothers me. They are used to it, and it is simply their
way of life. Many of them donít know what they are
missing, so the things that strike me about their lives
do not phase them because of their different
perspective. So what have I learned? While people may
look different, have completely different surroundings
and environments, we all share the same emotions and
personalities and this is what I think can draw people
together. To a blind person, there should be no such
thing as prejudice because in general our looks are the
first and only difference between our people. I have
learned that no matter how bad I think I have things,
there are countless people with it ten thousand times
worse than me. I have learned the pride that someone can
get from helping a stranger, trying to make a
difference. I can only hope that I will not lose sight
of the things I have learned here and that these lessons
will make me a better person.
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