Glens Falls Medical Mission Foundation.

A Journal Ė Medical Clinic Trip to Nueva Santa Rosa, Guatemala
By Lance Hale

Medical Mission performs surgery.

Small boy and mother. Small boy was circumcised and given Vermox, which caused a parastitic worm to crawl out of his body.

Parasite from inside small boy

Guatemalan children

 

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.

7/10/97
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.

8/10/97
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.

9/10/97
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 right).

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 page).

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.

10-10-97
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.

11-10-97
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 medicine.

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 Barney sometimes.)

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.

12-10-97
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 a week.

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.

13-10-97
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 teeth.

14-10-97
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.

15-10-97
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.

16-10-97
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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