by Cody Bowers
Vanderbilt University School of Nursing
It has been two weeks since I touched down in Guatemala City and I haven't had a dull moment since my arrival. From the bus rides through the mountains to the hikes up mountains, Lauren and I have found profound experiences and learning wherever we go. The cultural lessons have been exceptionally enlightening as well as the medical paradigm shift. I have been treated in a Western model of medicine and become comfortable with treating the chronic diseases that ravage so many of the patients I've treated in the States. Now I find very little continuity of care, nor complete trust in Western medicine because many of the locals prefer the treatments of traditional healers first. I can look for hypertension and diabetes here, but will the patient be able to pay for the monthly prescription of hydrochlorothiazide or metformin? Would they trust me in my diagnostic abilities? How can someone trust their health in the hands of someone who struggles to speak their language? Would the diagnosis be relevant to their personal happiness? I find myself engaging in these circuitous internal debates, but I am optimistic that the rapport, communication and treatments will be culturally appropriate.
The patients here, especially the children are fairly fascinated with Lauren and me as we appear so much different than everyone else. I am over six feet tall and I oftentimes find myself more than a foot taller than grown adults. The differences can be glaring, but the patients and I share an intimate connection and similarity and that is the goal of health. Despite the language difficulties, it is easy to seek treatment with a 23 year old woman who fell walking down a hill a month ago and continues to have back pain. Verbal communication hurdles can be overcome with help from peers, careful physical exam and repetitious questions. Lauren and I have been able to help some patients significantly and routinely examine and reassure many others as we navigate our first few weeks in the clinic.
In her first week at the clinic Lauren noticed a physical sign during her exam that suggested the Guatemalan patient might have a rare, serious, but treatable form of brain/eye cancer. She noticed a ‘white reflex’ while shining the ophthalmoscope light into the child’s eyes, which looks exactly like the ‘red-eye’ effect found in a camera photo, but the circles in a child’s eyes are white rather than red. This ‘white reflex’ is often indicative of retinoblastoma, a form of cancer, and no other volunteer in the clinic had any idea what the ‘white reflex’ meant, except Lauren, who noticed it, and the medical doctor who ordered further testing. This child was referred for a CT scan of the brain for a more accurate image of what could be cancer or a benign response to an useful exam technique. If Lauren noticed cancer on small child, she may have saved a life, which is an inspiring and worthwhile lesson for any potential or current global health volunteer.
I've been in Guatemala for a week less than Lauren and she helped me adjust quickly. Together we have been going to mobile clinics which involves loading a backpack with medicines and going to a local school and seeing roughly 80-100 children. With 7 providers, we usually see 10-12 patients per provider and most of the exams are well child checks. For the most recent mobile clinic we all boarded the city bus and commuted 10 minutes down the road toward the Santa Maria volcano and unloaded at a desolate and dusty roadside stop. From here we hiked 20 minutes to the school which is up a long hill.
I usually keep myself in good physical shape, but with the medications backpack on my shoulders and only a week spent in the thin air of 7,600 feet elevation, it was an arduous hike with many breaks. We reached the school and set up the clinic in a classroom with tiny desks and chairs as our exam room and table. Out of the 10 children I assessed and treated this day, only 3 had complaints of illness. Two were abdominal which is common here because many children, especially the younger ones with poor hygiene have intestinal parasitic infections, but the third child had a serious skin infection causing exceptional discomfort. She was rather healthy and well nourished, but very uncomfortable. Her unease was clearly visible on her face. She smiled slowly, half-heartedly and only because she was being courtesy in response to my smile. This girl, for 7 days now, had a skin infection behind her ear that was becoming worse daily and it was by the far the most advanced case of impetigo I've ever seen. Impetigo can be described as a superficial shiny, pus-oozing, red and excoriated epidermal infection. I’m guessing she hadn’t slept well in over a week because when I touched her ear cartilage - not the site of infection - she cringed severely and any movement of the head on a pillow would definitely cause pain and awakening. I prescribed her systemic anti-biotics for the next week and told she’d be sleeping better shortly. More worrisome is whether or not she would have actually received treatment if the Primeros Pasos group hadn't gone to her school that day because she was coming from a very impoverished community.
Lauren has been awesome with the children and we all rely upon her pediatric knowledge. I am continuing to get acclimated and fit into the flow of the clinic and language requirements. I treat the easy and obvious and ask for support in navigating any vague chief complaint. Both Lauren and I have been effective and useful to the people we are treating as we are able to provide comfort, health and healing, which are essential to the happiness of any patient. We have stopped a few serious infections, offered advice to other volunteers in need of collaboration and most importantly we are engaged in a vibrant atmosphere of medicine, culture and language where we are both learning daily.