Quetzaltenango, Guatemala

lauren eppinger 1

I arrived in Guatemala almost two weeks ago. The experience of walking out of the airport into Guatemala City is a five-sense sensation—the colors, the voices, the rain, and the pollution that you can smell and taste. The intensity hasn't lessened at all since getting here.

I spend half of each day volunteering at a clinic called Primeros Pasos. The clinic is located in a rural area, where most of the patients are Quiche Maya. The clinic sees mostly children, but has been expanding to treat more women and men as well. The cost of care is relatively low (about 60 cents for a child's visit and medicine, or a tenth of a day's wage), but people still receive care inconsistently. Preventative visits are particularly rare, as most people only visit the clinic when they are sick, often after a problem has persisted for a while. The clinic has a unique model, where patients are seen by local and foreign medical students, which shows the strong value that the clinic places on education. Nurse practitioners (like Cody Bowers and me) are also part of the clinical staff, headed by a Guatemalan doctor. The clinic also works with schools, offering preventative care and education for children. Recent outreach efforts have brought a significant number of women into an educational program as well, covering nutrition, hygiene, health, medical care, and natural medicine.

The diseases seen at the clinic are extremely different from what is seen at home. It is surprising how much an environment can affect the body. Many factors come into play, such as hygiene, clean water, indoor cooking fires, physical labor, exposures, immunizations, and the high cost of care at most places. Immunizations here are inconsistent, and almost none of the children receive all of the recommended immunizations. In my first two weeks I have seen both varicella and hepatitis A, which are both almost entirely absent in the pediatric population at home. I have also treated several children for various GI infections from bacteria, parasites, and worms.

Interestingly, many of the children in the community are born with midwives at home, and are not examined by doctors until they are a few months old. Therefore, careful examination of infants at sick visits is extremely important, because it may be their first medical examination! Most babies have no records of their birth weights so it is impossible to monitor their growth rates. If the children were brought in regularly for well baby visits, we could monitor their growth, and provide immunizations, etc. but that is not the custom here.

Another prevalent issue is malnutrition. Fortunately, the clinic has made significant improvements in the nutritional status of the local children through several outreach programs. These days most children are only mildly or moderately malnourished, while in the past many were severely malnourished. However, despite this improvement, every day I have seen at least one child, and sometimes several with some degree of malnutrition. Over the next couple of months I would like to work on developing an effective way to treat these children, who so easily fall through the cracks because they are not seen to be "severely" ill.

The experience overall has been incredible. Each day I learn something new, see something new, and live with an intensity that feels unique to Guatemala.