Xela, Guatemala

pesticides in guatemala

      There will always be patients that leave an indelible mark upon your career, future treatments and personal emotional strength. Yet medical providers do their best to find coping mechanisms to prevent the emotional burnout of seeing tragedy after tragedy, but these barriers can be overcome. I've had a few very influential patients in my short time working with medicine, but there is one at the Primeros Pasos clinic who continues to interrupt my thoughts because of his illnesses and how he his plight affects my deepest personal values. I've seen this patient three times now and he has become a frequent forethought during my time here in Guatemala. He came in once for a follow up clinic visit after going to the hospital a week before and then he came in a second time to introduce himself and discuss his future treatment options with Lauren and me. This patient, named YE for the sake of identification, went to the emergency room two weeks prior to visiting the clinic with vomiting, diarrhea, diaphoresis (sweating), abdominal tenderness, anxiety and all the other side effects of the body's attempt to ride itself of a poison. He was diagnosed with "intoxication" given fluids and some medicines to control the symptoms and sent home. In my realm of possible medical diagnoses, 'intoxication' only triggers thoughts of alcohol poisoning and a mistake perpetrated by alcohol. In Guatemala however, the diagnosis of 'intoxication' is entirely different and it was an enlightening, but very depressing learning experience for me. Intoxication is very common among men, especially farm workers and is at the top of emergency room differential diagnoses. These patients come to the hospital because they are poisoned from significant pesticide exposure in the farm fields and their bodies cannot cope with the poison properly. The field workers are absorbing the chemicals through their skin and then their bodies go into a form of shock in an attempt to filter the foreign matter as fast as possible. There is a form of chelation therapy treatment in the local hospitals that can help bind the chemicals and flush them from the body and assist the liver in the purification process, but rarely is it used due to cost and the less than impressive results. 

      One of the studies I found during my research on pesticides cited that the immediate consequences of exposure to small amounts of pesticide include a rash, nausea, vomiting, and blurry vision. Immediate effects of a larger and more prolonged exposure include disorientation, loss of continence, coma, and even death. Delayed consequences of pesticide exposure may include sterility, birth defects, neuro-degenerative disease, and cancer. It sounds as if YE was fortunate enough to fit into the first category where he only had the nausea, vomiting and blurry vision, but with waves of the more significant symptoms like abdominal tenderness (liver damage) and disorientation. The first time I encountered YE he was with his 5 year old child in the clinic and complaining of persistent paresthesias (symptoms of tingling and burning) up and down his legs and significant fatigue. The medical director recognized that with YE's recent intoxication diagnosis and that the legs being the frequent site of absorption for pesticides, YE's ailment was a result of the chemicals. These toxic pesticides were hypothesized to have been absorbed through the skin of YE's legs when he was spraying the crops and the subsequent exposure caused nerve damage throughout his legs and lasting discomfort.

      Children of migrant workers are also at a high risk for pesticide intoxication because they come in contact with the agricultural chemicals as their family members, who work in the fields, bring the chemicals into the house via their boots, clothing, or work equipment. There have been multiple research projects in the United States studying the levels of pesticide metabolites in children's urine and the neurologic complications of organophosphate toxicity from pesticide exposure. One study, with a sample of 60 children and performed in North Carolina by Acury et al., found that one of the children studied had no evidence of pesticide metabolites in his/her urine, ?ve children had one pesticide, another had two different chemicals, 16 children had three pesticides, 17 children had four pesticides, eight children had five, nine children had six pesticide detects, and three children had seven different harmful chemicals in their urine. A combination of several toxins in a single child may have a synergistic effect and among the 60 children in the study by Arcury et al., 54 had at least two or more pesticide metabolites. Another study by Eskenazi et al., discovered that children whose mothers were exposed to pesticides during pregnancy scored lower on IQ tests and about 50% of the exposed kids at age 2 had some neurological/developmental deficit. These statistics are not merely meant to draw shock and drive fear by depicting the trauma the farmers and children of farmers suffer, it is only meant to illuminate the fragile connection between food production and health.

      YE has been victimized by the chemicals used to farm here, but his medical history began 8 years before I met him and in a much more serious manner. I had heard the story of a special patient at the clinic and due to his medical history and the story I was told, I envisioned an old man, but upon seeing a strong 29 year old man with a 5 year old wrapped around his leg, I was surprised to find the contrast between my imagination and reality. I saw YE the first time when he was seeking follow-up care after the intoxication diagnosis, but it was not until hours later that I was relieved of my ignorance that the 'special patient' was the 29 nine year old man I'd treated moments before. YE moved to the United States when he was a teenager and the time when he returned to Guatemala is still unclear. He was living well for himself and was pressing for the American dream 8-10 years ago when devastating headaches started afflicting him daily with sequelae of serious visual disturbances. He had been in the United States for roughly 4-5 years and working in northern California when the headaches began. The profound headaches and visual changes were devastating and he dragged himself to the one of the best emergency rooms in the country. At the hospital he was able to use health insurance to receive the rapid and necessary testing for optimal medical care. The doctors ordered a CT scan of his brain and noticed a tumor residing near the optic chasm and sella turcica (where the pituitary gland sits) and this tumor was pushing on his optic nerves. He was referred to a neurosurgeon who followed up with more blood tests, which showed that this was likely a prolactin (hormone released from the pituitary) secreting tumor that is oftentimes controlled with medication. It appears from the paper work YE brought with him that the surgeons performed the surgery to remove the tumor in hopes of restoring his vision because he was nearly blind in his left eye, alleviating the headaches and then after the surgery they would proceed with the medication to control the prolactin levels. The surgery went well enough and he was able to go home the next day, but in the report the surgeons mention that they were unable to completely remove the tumor.     

     This all happened 7 years ago in the United States where Y.E. received the best care at one of the best hospitals in the country. Now he is having an exacerbation with his vision diminishing further and he is running out of the medicine, which maintains the prolactin levels and prevents the tumor from growing back. Y.E. is going in for an MRI in January to get another visual of the area, but there is only one neurosurgeon in Xela, Guatemala to serve roughly 800.000 to a million people. He is 7 years post-operation and his sight out of his left eye is less than 10%, but thankfully his right eye is above 95%. The headaches and visual changes continue to ebb and flow as he struggles to pay for the medication that prevents the tumor from growing. Lauren and I are currently exploring treatment options and fundraising potential in order to get YE to his next MRI in January with his remaining vision intact. The challenges of medical treatments continue to persist in a resource limited setting. From the children with dangerous heart murmurs to pesticide intoxications and prolactin tumors, we are pursuing medical treatments amongst the perceived resource restrictions in order to restore health in Guatemala all while managing the indelible effects of memorable patients.

The Unknown Killer

Nov 09 2010

by Bill Frist, M.D.

Huffington Post

Even some physicians I know are amazed when they hear that the leading killer of children under age 5 in the developing world is pneumonia. Not malaria. Not AIDS. A highly preventable and treatable illness is claiming 1.5 million young lives every year.

Vaccines exist which can prevent the leading causes of pneumonia and cost-effective antibiotics can treat most cases. If developing countries had these vaccines and medicines, more than a million children could be saved each year.

That's why Save the Children and more than 100 health and humanitarian organizations have joined forces to promote World Pneumonia Day this November 12th. We know if Americans understand that children are dying needlessly, they will take action to help.

This is a problem with a proven solution. And few causes can offer a better return on investment. A course of antibiotics can treat most cases for less than $1. Other low-cost prevention measures include exclusive breastfeeding for six months, ensuring good nutrition, reducing air pollution, washing hands and preventing mother-to-child transmission of HIV. No other interventions currently available have the potential to save children's lives at this scale.

So why are we still losing this battle? Many children who contract pneumonia simply do not get the care they need. Though it is common, it is rarely diagnosed, as few caregivers can recognize the symptoms and begin treatment in time.

The current critical shortage of 4.3 million health care workers is another reason more children do not receive prompt diagnosis and care. Community health care workers can fill this gap, learning in just a few months of training how to use a simple timer to measure breaths and providing lifesaving care to children in the hardest-to-reach places, where most deaths occur.

We need more pneumonia fighters on the front lines. Join the World Pneumonia Day movement and see how breathtakingly easy it can be to save a child's life.

Former Republican Senate majority leader Bill Frist, a physician, is chairman of Save the Children's Newborn and Child Survival campaign.


schnepper kijabe 1

If first impressions mean anything, then this trip to Kenya will be one I will always remember. Not that I expected anything less. We arrived at Kijabe about one week ago, and there already are a number of things that have awe-struck me. But perhaps what has stood out more than anything to me is the people here. While many of them have little in the way of possessions, you couldn't find a more happy, gracious, or appreciative people, making this journey all the more special.

After quickly getting oriented to the operating room here, our activities thus far have consisted of providing anesthesia for a large variety of patients: including parturients, elderly, and children. We have witnessed pathology here that you would rarely see in the States: large bilateral cleft palettes, two myelomeningocele defects in one patient, etc. There is also a large amount of trauma here, and a high volume of orthopedic surgery. We have been teaching and refining some of the nurse anesthetist's skills at regional anesthesia, providing an option for patients to avoid general anesthesia and developing another means for postoperative pain control. We have also spent a lot of time teaching the student anesthetists, including conducting oral and practical exams for them.

Lastly, I have attached a picture of the ICU nurses after Humphrey Lam (the other resident that is here with me) and I delivered some medical supplies. The big balls of white are all pulse oximeters—giving the ability to monitor patient's oxygenation—something that is not always easy to come by here. One of the nurses was so excited when we dropped off the supplies, she couldn't stop jumping up and down. It's moments like these that make you realize how rewarding this opportunity is to be here.

by Jenny Eaton Dyer, Ph.D.

Senator Frist talks about the history of Hope Through Healing Hands in the video below. He recounts its origins, its emergency relief efforts through the years -- with the tsunami, Katrina, and Haiti, and he describes our Frist Global Health Leaders program showcasing our student health professionals who have served in clinics and hospitals around the world.

We invite you to watch this short video to get a glimpse of the work we do at Hope Through Healing Hands. We hope it is a helpful tool to highlight the health care done for the world's poorest.


Xela, Guatemala

lauren eppinger

(Water Source for Primeros Pasos)

According to the World Food Program (WFP), over 70% of people in Guatemala live in poverty. The country has the 4th highest rate of malnutrition in the world, and the highest rate of malnutrition in Latin America. The WFP says that 49.3% of children in Guatemala are undernourished. Most of these children live in the rural areas, and most are of indigenous descent. I can definitely vouch for having seen something of a geographically-based health disparity here. From what I have seen personally, and heard casually, there is little malnutrition in the city of Quetzaltenango (Xela) because of several outreach programs, and relatively clean and accessible water and sewage.

The United States once went through a period of time having malnourished children and adults as well. In 1946 the school lunch program was started to prevent and treat childhood malnutrition, after it was discovered that many young men were ineligible for combat when drafted in World War II. As a result, several measures have been put into place, and have virtually eliminated the issues of under-nutrition in the US. These days, aside from a few rare cases, most of the malnutrition we see in the US is actually obesity, and that’s a story for another day.

The area where Cody and I are working is only a few miles outside of the city, but those few miles make a huge difference. Those few miles mean that not all people have water in their homes; they have to collect it from a communal water supply. Some of our patients use latrines as bathrooms, since they have no indoor plumbing. The lack of clean water and adequate sewage systems is correlated with the presence of gastrointestinal infections, which can be not only uncomfortable, but even lethal. All of these factors contribute to the high levels of malnutrition, as well as sheer lack of food and nutrients, and the lack of consistent quality medical care.

One of the things I am working on at the clinic is the development of protocol for treating and screening for malnutrition. In a place where primary care falls by the wayside, because of lack of awareness and lack of financial resources, children do not get check-ups, and they often only go to the doctor when severely ill. That is not to say that we don’t deal with our fair share of coughs and colds, but people are definitely not seeking care often.

Severely malnourished children are given aggressive treatment in the hospital, or through some outpatient support programs. However, most of the children we see at the clinic are mildly or moderately malnourished. Despite the less severe name, these conditions are still quite problematic. They may not receive much attention here, but even a mild level of malnutrition would warrant a comprehensive medical work-up in the United States. These children easily fall through the cracks here because of the attitude of treating serious but not mild illnesses. The local doctors agree that it is sad, but their attention is often more desperately needed elsewhere, so these children are not treated aggressively. As a result, we see kids with growth stunting every day, and numerous other effects of malnutrition.

I have been working with the clinic on enhancing the screening process, and using every patient encounter as an opportunity for diagnosing and treating malnutrition. The hope is, that with this protocol, there will be a straightforward and regulated way to address these problems in each visit. This way, primary care can be given to a child, even though she is only coming in for an acute sick visit.

I am currently in the process of working with the clinic and the board to figure out exactly how to implement and fund the protocol. Hopefully this will help us see the levels of mild and moderate malnutrition decline in the near future for this community. It is my hope that with the implementation of such programs, we will be able to eliminate malnutrition in Guatemala, and in other parts of the world, just as we have done in the United States.

Xela, Guatemala

cody bowers 3

After a month of time establishing ourselves in Xela, Guatemala, Lauren and I have found a much happier balance with the culture, communication and medical treatments of the area. I've learned to identify the signs and symptoms of an abdominal infection requiring anti-parasitic medications, or the difference between a patient needing trimethoprim-sulfamethzole or metronidazole. Intestinal infections, lack of appetite and respiratory infections have become the typical chief complaints requiring treatment in the past two weeks. The prevalence of flu-like symptoms have been extremely high recently, which has been locally blamed on the heavy fluctuations in weather patterns and the body's ability to cope with the cold and rain. Patients seen in the mobile clinics and day care centers over the past 5 days have shattered our status quo of illnesses and treatments, bringing new challenges and learning experiences with each visit.
     The end of last week and the first day of this week have been spent on the road moving from guardería to guardería (daycare centers). A camping backpack was been loaded with medications and we covered 6 different guarderías in 3 days and treated roughly 150 patients and I myself examined and treated 25 children from the ages of 2-8 years old. The first patient I saw on Thursday walked up, sat down in the seat in front of me and proceeded to remain completely mute for the first 2 minutes of our visit. I couldn't even get her to nod yes or no to my questions, she was just utterly terrified. Another volunteer stepped in and was able to discover that the child had a stomach ache, but that still wasn't exactly useful and we were left with more questions regarding the girl's health. Finally one of the teachers showed up and informed me that this girl had been having trouble moving her right arm for the past week. After an examination and discussion among the medical providers, it was decided that this girl needed to be sent to the hospital for x-rays and a possible casting. We quickly discovered shortly thereafter that this child had a cast on her arm just last week, but for some reason, someone unbeknownst to us, had removed the cast and let the girl run freely without proper traction. If we had not visited the daycare center that day, nor cared for this child, she may have continued to live day to day with a broken arm and very restricted mobility. Still, we have yet to determine if our continuity of our care will be sufficient for this girl and her arm.
    Friday presented further challenges and patient encounters requiring collaboration and collegiality which resulted in our collective best treatment within the limitations of restricted resources. Upon entering the second guardería on Friday, we found a boy lying on a mat in the middle of the play area being soothed by one of the teachers. He had been thrown out of his chair not 5 minutes earlier by a tonic-clonic seizure and at the moment we entered, he was suffering the confusion and exhaustion of any post-ictal phase. We were told it was his second seizure documented and he was only 5 years old. He received the full attention of all three Guatemalan medical students while Lauren and I tended to other children and consulted on the examination and discussed possible differentials for the child victimized by a traumatic seizure. Lauren noted this boy had erythemic tympanic membranes of his ears and a fever. From these noteworthy clinical observations, the group decided on a treatment plan of Tylenol to reduce the fever, Bactrim for the ear infection and a follow up appointment on Monday were the best options we had for this child. From our education at Vanderbilt, Lauren and I knew that febrile seizures occur in about 5% of children and that they often suffer more than one seizure before growing out of this very disconcerting habit. But the limitations of my education for treating Guatemalan patients became apparent the following day after another Guatemalan practitioner discussed treating seizures here.
    Neurocysticericosis is not an infection I ever encountered or read about during my 6 semesters of education in medicine, but here in Guatemala I was informed that it is a leading differential whenever there is a new onset of seizures. Spread through fecal-oral transmission and poor hygiene, neurocysticericosis is a parasitic infection that has become the leading cause of acquired seizures in the world (DeGiorgio, et al., 2004). Once merely a worry in developing countries, but now neurocysticericosis is a growing problem in the United States and it should be a recognizable risk especially among immigrant populations (DiGiorgio, et al., 2004). The larvae of the parasitic migrate to the brain, cause an immune response that leads to viable cyst formation within the cranium which can last for years. Neurocysticercosis is quoted as being responsible for 10% of emergency room visits for seizures in the southwestern region of the United States (DiGiorgio, et al.). A CT scan is the recommended diagnostic tool and albendazole is the preferred treatment over praziquantel because it is more affordable the causes less drug-to-drug interactions (Davis, L.E., 2005). I spoke with the medical director at Primeros Pasos briefly about the prevalence and presentation of neurocysticericosis in the hospitals he has worked. He has seen the infection many times and ordered multiple CT scans to rule out neurocysticericosis whenever a patient presented to the hospital with new onset of seizures. The anti-parasitic and anti-inflammatory medications help the treatment along, but neurosurgery is required to remove the cysts as well. We are all hoping here at the clinic that the child we saw was experiencing febrile seizures, but neurocysticercosis must also be ruled out.
    The last patient I saw, on Friday of last week was an 8 year old boy who presented as a completely healthy, vibrant and playful child. I was about to send him back out the front door of the guarderia with the typical fun bag of an anti-parasitic medication, a toothbrush and bar of soap until his teacher informed me that this child was having chest pain multiple times a week, especially during exercise. He had not told me anything about this ailment through 3-4 minutes of my persistent questioning regarding his body, health, illnesses or current medical needs. After thorough questioning, his history dictated that he may in fact have a cardiac abnormality and further testing was certainly warranted. We gave him a prescription to report to the clinic in three days for an EKG and hopefully an appointment to receive a Holter monitor and eventually an echocardiogram. Despite these measures, we have very little idea whether the continuity of care will be established or even if this child and his family will pursue medical care. We are often confronted with resistance to Western medicine, but hopefully we made enough of an impact with this child convince him and his family to seek the appropriate follow-up care under the discretion of a specialist.
    After pondering the possibility of a parasitic infection causing seizures, the orthopedic ramifications of a young bone healing without a cast and an atypical presentation of chest pain and tachycardia, our medical team had one more serious diagnosis the following Monday afternoon in the 6th guarderia on our 3rd day on the road. The child walked into the poorly lit room and was going to be in the diligent and exacting care of Lauren, but as soon as Lauren touched her stethoscope to this child's chest, she realized this was going to be a patient cared for by the entire medical team. The 5 year old girl had a grade 5 heart murmur audible in all areas of her precardium with a palpable thrill radiating across her chest. Her feet were cold from poor circulation and she had fainted on multiple occasions due to her weakened heart. An immediate EKG, echocardiogram shortly thereafter and a pediatric cardiology consult were needed as soon as possible. Since this encounter, Lauren and I have been exploring the possibilities of Rheumatic heart disease in hopes that it will be an infectious process that can be controlled with medications, but from the sound this child's heart is emitting, the history and examination, it certainly appears that she has a structural defect of her heart requiring expertise far beyond our scope of practice.
    The constant ebb and flow of patients usually seen and easily managed on a daily basis is occasionally disrupted with scenarios such as the four patients just mentioned who presented with conditions well beyond our scope of practice and available resources. Another obstacle for reliable care is our inability to ensure continuity of care and follow-up appointments. There is resistance to western medicine in many of the areas we provide treatments. We cannot ensure that the broken arm will be mended because it is likely that a family member removed the cast initially and would thus be resistant to returning to the hospital to have another one fitted and placed. The boy with tachycardia and chest pain was resistant to even confessing his illness to me because their exists a stoic nature in the culture of many patients' approach to health and illness. The child with seizures needs thorough follow-up testing and care to rule out neurocysticercosis, but the imaging is expensive and the child has had a seizure before and we aren't sure care will be pursued this time around. Lastly, it was rumored that the girl with a grade 5 murmur had been diagnosed with the issue months previously, and apparently her mother refused to take her to the doctor for treatment. We do not understand the level of neglect some children experience or whether it is voluntary, cultural or circumstantial, but the ability to encourage follow-up, continuity and complete care is a daily challenge we attempt to overcome with education, compassion and strong encouragement.

Davis, LE. “Neurocysticercosis” Emerging Neurological Infections edited by Power, C and Johnson RT. Taylor & Francis Group, 2005. 261-287.
DeGiorgio, C. M., Medina, M. T., Durón, R., Zee, C., Escueta, S. P., (2004). Neurocysticercosis. American Epilepsy Society: Epilepsy Currently, 4 (3): 107-111. 

October 22, 2010

by Brande Jackson 

The H2O tour has wrapped up its summer run, and the Water = Hope campaign is proud to have built so much for clean water issues amongst country fans! Our final two weeks on the tour were a bit of a whirlwind, with stops in San Francisco, San Diego, Phoenix, Albuquerque, Boise, Salt Lake City and Denver. Along the way, as always, we were joined by some amazing volunteers! Excited Water = Hope volunteers!

San Francisco and San Diego brought out lots of veteran volunteers, many of whom worked with us on tours with the ONE Campaign in years past – it was great to see familiar faces like Rochelle, Mary and Christine – all of whom were among the first ONE volunteers we ever worked with! It was a lot of fun to get to talk to so many fans while in California.

From there, we moved on to Phoenix, where we were amaed to learn it can be over 100 degrees in September, go figure! We were joined by a massive crew of volunteers, including some veterans from our work on the Warped Tour and with Dave Matthews, and lots of new volunteers from local high schools and colleges as well.

Albuquerque proved to be one of the best nights on the entire tour; we were joined by an AWESOME team of volunteers: college students and high school students and community members who all are passionate about clean water issues. We had one of our best nights of the entire tour in Albuquerque, a direct result of our awesome volunteer team! We also met author Sandra Postel who has written extensively about clean water issues; she was in the crowd and saw our PSA show on stage before the show, and came out to find us! You can learn more about her here. As we headed out for out the very final weekend of the tour, we made our first stop in Boise, Idaho. After an eventful first couple of hours (including trying to track down our missing tour bus!!), we met our awesome volunteer crew for the night. The venue that we were at was on the Boise State campus, so we weren’t surprised that we had many dedicated BSU do-gooders! We had Katelyn and Daniel, freshman year roommates who actually went to their dorm and signed-up their whole floor, as Tara with her friend, as well as a couple other students.

Water = Hope support

We also had a mother with her three daughters who were huge Brad Paisley fans and did awesome throughout the night!! All in all it was a great first night back, thanks to all the cool people and Water = Hope supporters that Boise had to offer. After a three AM bus visit from Easton Corbin and his crew due to their bus breaking down, we landed in Salt Lake City and met our one man volunteer crew for the night. Josh, who had just moved to SLC recently to pursue his love of skiing, worked by himself and helped get the majority of our sign-ups for the night. He is really dedicated to volunteer work, and expressed over and over how much he really liked Water = Hope’s vision and goals. It was great working with him and we are so thankful to him for helping us out in Utah!

Next we were off to Denver, Colorado, a bit unhappily because it would be Water = Hope’s last night working with the tour. We weren’t ready for it to end! However we couldn’t have ended the whole journey with a better crew, twelve dedicated and hardworking individuals who agreed that we should end it all with a bang! We had a group of four people that came individually and throughout the night bonded over the Water = Hope work, and they ended up leaving as friends after watching the show together.

Then we had our basketball girls, who all played together on the local high school team. Michaela, Lindsay, Bree and a few friends worked the entire night to get those donations and raised almost two hundred dollars between them, as well as getting a ton of signatures. All you Colorado-ians were so supportive of Water = Hope and we had such a huge amount of people walking up to the table that we could barely talk to all of you! In between watching the crew play pranks on the artists as they performed and watching the donations pile up, I think everyone agreed that we had a great last night in Denver! Signing up After four months of weekends full of talking to fans about clean water in 33 different cities, we are proud to announce that Water = Hope hit our goal of raising $20,000 to build wells, and signed up nearly 14,000 people in support of the Water for the World Act.

Perhaps more importantly, this means that some 14,000 conversations about clean water happened over this summer between our volunteers & campaign team and the fans in each city, and we can only hope that some of those 14,000 people are going to share that message, get inspired to volunteer themselves or even lead clean water initiatives in their own communities.

None of this would be possible without the hard work and help of the 239 volunteers that joined us this summer; they inspired us night after night with their dedication – again, a HUGE thank you to all of you that joined us! We are proud to know that they’ll take what they learned and work to inspire thousands more this fall and spring on their campuses and their communities so that we can bring clean water to even more people.

Water = Hope truly believes in this idea of ‘a small drop making a big ripple’; the work of our volunteers and the fans that supported the campaign this summer is all the evidence that we need. Keep checking in for more campaign updates and ways you can get involved, and visit our Facebook photo albums to check out all of our pictures from the summer!

eppinger schools

The Guatemalan school year has ended, and mobile clinics and educational programs for school children from Primeros Pasos have also ended. All of these initiatives are a part of the healthy school program that Primeros Pasos runs, but only take place during the school year. Now these children are on their own for care and education until the beginning of next year, although the clinic will be open through mid December.

The mobile clinics are extremely useful, because they serve as screening programs for malnutrition, infection, and serious illnesses, and also offer a great educational opportunity for the children. We were able to identify several acute infections, as well as some chronic diseases. Several children with wheezing—and likely asthma—were sent to the clinic for asthma medications. Asthma can be very dangerous if not treated, and referral for proper treatment can save a child's life. Last week I referred a child back to the clinic because of a heart murmur, to run some tests and assess further to ensure that he was not anemic and malnourished. Although I am not sure what the outcome of his situation was, it was important to be able to identify children like this who are at risk of more serious problems, who can be treated.

All of the children are supposed to give stool samples at the schools. This leaves a huge amount of work for the lab to do, checking to see if there are any parasites or signs of bacterial infection, but it is worth it. A couple of days after the initial visit to the school, another group goes back to the school to distribute medicines to all children who were not already treated based on their symptoms. The children are given a bag with their medication (free of charge) and dosing information is written and illustrated for the parents to read. Although many children are treated for intestinal infections based on their symptoms, a significant amount of infections still go untreated until the stool samples are analyzed. Intestinal infections can cause discomfort, malnutrition, dehydration, and impaired growth. Therefore, identifying and treating these infections, even when relatively asymptomatic, is extremely important for a child's health.

Now that school is on break, the clinic will start bringing mobile clinics to the daycares, where pre-school aged children are cared for. Many of these children, like in the elementary schools, have few resources at home. Similar screening and treatment programs are done with these young children. I am excited for the opportunity to continue to work in the community, and identify children in need of treatment. As sad as it is to find a sick child who nobody managed to bring to the clinic, it is rewarding to know that we are able to help.

Quetzaltenango, Guatemala

cody bowers pp1

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.



by Jenny Dyer

We want to give a special thanks to HTHH supporter, Rachel Flynn, who lives in Crossville, TN for hearing about our opportunity with Lamar Advertising and then offering us space on Flynn Signs Co., Inc. in Crossville, TN!

She and her husband Tom within hours were able to post our Water=Hope message up on 2 billboards in Crossville on their Flynn Signs.

water hope flynn

We're excited to partner with Flynn Signs!


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