Before I get to today’s activities, there were a couple of things I forgot to mention in yesterday’s posting, I was able to put a few photos in Picasa, one of Luis telling Jaime and Kali his background, one of the volcano at Antigua and one or two of an amazing sunset we saw as we entered San Marcos, with mist rising up out of the valley. Tonight I’m in a hotel near Sibinal and there is no WIFI so I’m writing this entry in Word and hope to transfer it in the next day or two. I think there may be WIFI at the house where we are holding the clinic, and if so I’ll post it tomorrow.
The two things I forgot are both related to the government of Guatemala. The first is that Guatemala is divided into 22 districts, each with a Governor, and all of the Governors are appointed by the President, rather than elected by the people they govern. This, of course, gives the President enormous power and control of the country and feeds the culture of kickbacks and corruption. Luis had been the personal lawyer for the Governor of San Marcos for the past two years but resigned a few months ago. I thought it was because of all the allegations of corruption that took the President down, but it actually was because all the Governors had to leave office when the President “stepped down” (and went to jail.) I asked Luis about his opinion of the newly elected President and his take was, “As for political experience, he ran for an obscure office once and lost, and as for his professional life (a stand up comic,) he tells very bad jokes.”
The second thing I learned, this from Kali, is that there are two government programs in Guatemala designed to fight malnutrition in pregnant women, nursing mothers and young children. The first is that all women who are pregnant or nursing infants up to six months of age and all children age 6-36 months are supposed to get Encaparina, a very nutritious grain based supplement that can be mixed as a drink or porridge. In addition, children aged 6 to 23 months are supposed to get a micronutrient powder 180 days each year. This program was voted in and funded a few years ago. However, in 2015, a typical year, only 15% of the Encaparina and powder were distributed, for a variety of reasons. In some cases, there was no funding for transporting it, in others, no infrastructure for figuring out who would load it up and distribute it, etc. Most is sitting in warehouses about to expire before the 2016 load gets delivered. Luis will check with officials he knows in San Marcos to see if there is any available for his district, but it’s one of those things that drives one crazy when dealing with hungry kids.
So, on to today. We left San Marcos at 6:00am after picking up Maria, the general practitioner. She recently moved to Guatemala from Cuba along with another woman who is also a GP. Half way through the morning, this second woman arrived, and the two of them were kept busy seeing adults most of the day. They were very funny but nearly impossible to understand between their Cuban swallowed consonants and their tendency to interrupt each other mid-sentence to clarify or correct. It made me dizzy trying to follow a conversation with both of them. Tomorrow I’ll try them one on one.
You have to really want to go to Sibinal to put up with driving there. The road goes up and over the volcanic mountain with not enough switchbacks so it feels like being on a badly designed roller coaster. There are signs every 100 yards or so saying, “Curva Peligrosa,” (dangerous curve,” as if one wouldn’t notice. Despite these blind “curves” and the nearly vertical pitch, drivers are constantly trying to pass each other where there is clearly no room to pass and certainly no view of the upcoming traffic. In the towns along the way there are enormous speed bumps every 50 yards or so that require one to stop before driving over. Going over them without stopping risks whatever might be on the undercarriage of your car. Most drivers navigate the towns by driving as fast as they can from one speed bump to the next, stopping, going over, dashing on, etc. It’s crazy. Luckily Luis is a prudent driver, but you still arrive in Sibinal feeling a bit beat up.
We saw patients in a large house shared by three generations of one family. Our meals were prepared by the current grandmother, mother and 15 year old daughter and were delicious. My patient load was light today as the kids had been given the day off to help with the corn harvest. Once the corn has completely dried, the ears are remove from the stalks by hand, then the kernels are stripped and toasted over open fires in huge pots before being ground for tortillas. The entire village turns out on the day designated as perfect for the harvest. I have some wonderful photos that will eventually be on Picasa when I have access to WIFI.
Though I only saw about 40 kids, less than half the usual number, the first two had problems that reminded me how lucky we are to have access to advanced medical care. The first was a 12 year old boy who was the size of an eight year old. He walked in assisted by his grandmother and aunt. He had a very abnormal gait, wide-based and had an obvious tremor. Between the grandmother and aunt, the story gradually emerged. They had travelled for eight days, first walking for two days out of their very remote village, then riding a burro and horse for two days and then coming by bus the rest of the way in order to have this child seen today. They had very little knowledge of his history as he doesn’t liv with either of them nor with his mother. He lives with neighbors, they thought. There were some documents from an evaluation done by “a general doctor somewhere,” but in the rush to leave home, they had left them on the table. They knew he had been born at home but didn’t know if he had been early or small. He had always needed help to walk, had never spoken except to say, “Ma,” but could hear and understand. They came because they wanted him to have an evaluation and to get services for him.
It was heartbreaking for me to sit and listen to them tell their story. The boy, who was very engaging and seemed on what examination I could do in my limited circumstances to be of at least average intelligence, likely had a brain injury around the time of his birth. Diagnostically, he would likely fall into that broad category of “cerebral palsy.” If he lived in a city, he could get physical therapy, educational services, speech therapy, and on and on. Here, living as he does in a remote village reached on foot horseback, nothing is available. Luis will arrange an evaluation by a neurologist that may at least give his grandmother and aunt some information, but it won’t really make a difference for the boy.
My second patient was a seven year old boy with a mass in the lower jaw. His mother said that he lost a lower incisor in July and then the gum started to swell. She saw a doctor who gave her an “antibiotic” called ibuprofen for the infection. He finished that yesterday but the swelling was worse and painful. The swelling came from the gingiva, was firm and distorted the lower alveolar ridge – pushing the lower lip out so the boy couldn’t close his mouth. I’ll be seeing patients in the Policlínica in San Marcos on Friday, and Luis arranged for the boy to come then so the dentist in the clinic can see him and we’ll go from there.
After a few more patients there was a lull so Luis took Bette and me to see a “surprise.” This turned out to be a stunning turn around that’s happened in Sibinal since our February visit. A group of 100 women got together to form a collective, and using some of the money for the garden projects, they have been growing vegetables in large plots all over the village. They built fences, first harvesting cane, hauling gravel from the streambed and then wiring the cane together, (photos to come.) They bought goats, sheep and a cow and are using the dung to fertilize the crops so everything is organic. They’re growing broccoli, cauliflower, beans, cilantro, potatoes, corn and some other local vegetables. The greenhouse that was full of tomatoes last year has been reconstructed and is now huge with a high ceiling and is full of roses. There is a second greenhouse, also with roses, a hutch with rabbits and a beehive. Chickens are running around everywhere and their eggs are part of the diet. The vegetables are so big and healthy with no insect damage and hardly a weed to be seen. The beans grow up the corn stalks, so no beanpoles are needed. The pride of the women as they showed us around was obvious. They explained about how the food was divided among the families, how much went to market for money to buy seeds to sustain the crops, how they planned which crops to plant to maximize their goals of nutrition and sustainability. I asked if there were any plans to use the wool from the sheep to weave or knit articles to sell at the market and one of the women said that the abuelas (grandmothers) in the group were discussing it but that they were all still recovering from building the gardens. The knowledge and sophistication of these women, and their poise in explaining their project was humbling. So often, I think we fall into the trap of perceiving rural people as less intelligent and less able than ourselves. Clearly that would be a huge mistake here. I’m still trying to put what I saw yesterday together with the Sibinal I saw just eight months ago. Luis will see if Rachael from USAID can come a little early on Thursday and bring her over here to see the Sibinal project before coming back to Tacaná to see the irrigation project there.
Today we’re expecting a large crowd of kids as the harvest of the corn is done. More tomorrow.
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