From Santiago Atitlán
This week will be the one year anniversary of the mudslide that buried our hospitalito. Yesterday we had the groundbreaking for the new hospital. The new location is in a zone deemed safe from mudslides, very near our house. It is on the road toward San Lucas, on the opposite side of town from the original hospital. The majority of the land was donated by two Americans, Ray and Ron, friends of Ken Wood. An additional parcel was purchased with additional donations. An architect from the US is donating his services, working with the Comité to build in a modular from which can be expanded later. The Comité is selling “bloques”; cement blocks for 5Q, about 80c a block. One donor has said he will pay for a totally equipped delivery room. Fundraising is underway.
Meanwhile work continues at the temporary hospital. Our in-patient census is up a little. My last call there were 6 patients: 2 women with vaginal deliveries and their babies, a diabetic man with uncontrolled high sugars, a 13 year old with appendicitis. Doesn’t sound like much work, but in addition there are the ER patients. We are currently doing daily dressing changes on a little girl with 2nd degree burns covering the entire front of her R leg, and half the front of her L leg, as well as a number of other time consuming patients. We have recently had a huge turnover of nursing and other staff for a fascinating variety of reasons. The result, however, is that we frequently have very inexperienced nurses working. Why is that a problem? An example: Jack wanted to give 2mg of Decadron to a patient. It came in a vial “8mg/2cc”. Jack thought that he would give a dedicated young nursing student a chance to shine. “How many cc do you need to give to give 2mg?” he asked. The student was totally stumped. Jack, the diplomat, said that is after all why he is a student, to learn stuff like that, and that he should ask the nurse. So they did. She couldn’t figure it out either. So Jack explained that it would be 4mg/1cc and therefore 2mg in 0.5cc. OK, lots of smiles. Jack has been here long enough to ask them to show him the dose before giving it. The nurse happily showed him a syringe with 0.05 cc of Decadron. So after a brief discussion, the patient was given the correct 0.5 cc and all were happy. Time consuming. We are trying to do some math lessons. Basic math lessons.
The good news with the staff changes is that our new director of nurses, Felipa, is very conscientious and pleasant to work with. The new nurses are very motivated, and the student nurses are incredibly motivated and eager. Since many of you know the staff, here are the people who have gone: Luisa, for more money and no night shifts, to PRODESCA (a public health position in Santiago), and for “other reasons” Concepcion the nurse, Diego, the head nurse, Pedro the lab tech, Maria the laundress. Also an update: Selman, Aclax’s son, (thanks to Peyton’s tutoring, Hurrah!), passed his chemistry test. He and Rebecca now only need to pass their reading comprehension tests (which seems to be the hardest to pass) to be accepted to medical school. Rebecca goes down to Guatemala City tomorrow to take it again. Jacinto is taking classes to get an official certificate as a scrub nurse. Felipa is continuing her classes to be a “graduate” (RN level) nurse.
A note of why we don’t like to refer our patients. Our administrator, a man of about 30, has had intermittent knee problems. With his last flare, he said he couldn’t stand to put weight on it, that it was locking up in certain positions. Exam by us non-orthopedists was negative other than joint line tenderness. We put him in a splint and said that maybe he would want to have an orthopedist check the knee, since it seems to flare up often. He came back with x-rays, a diagnosis of a “bone fissure” and a regimen of daily injections at home and pills and a follow up appointment in 3 weeks. To us, his x-rays look fine. Any orthopedist want to weigh in on that? (for the non-medical people, in my 36 years of medicine, I have never heard of a bone fissure, nor of daily injections to help heal an injury (other than an infection). But the orthopedist is richer! And that is the private system.
Right now we have 2 emergency doctors here from Philadelphia for a week, AJ Dean and Kathy Beaver. In addition to doing shifts, AJ is doing and teaching ultrasounds and Kathy is doing extra dermatology. Just arrived are 2 residents from University of North Carolina, Chapel Hill: one pediatrics (Lisa DeCamp) and one medicine-pediatrics (Carrie Cox). They are here for a month, and promise to give us tons of teaching, also in addition to doing shifts. They said that they have a black cloud. Everyone laughed. Then, 30+ patients arrived from a pick-up truck accident. Luckily AJ and Kathy were at the hospital and did the triage, sending the vast majority home so, freeing Carrie and Lisa for the more seriously injured. Carrie and Lisa are settling right in. They decided to move from their first room here when the roof leaked on the bed. They actually read the orientation info I sent and brought a flea collar and plastic sheets so now they have sprayed their new rooms and are covering the beds to hopefully avoid the bedbug, or is it fleas, problem at the Milpas. And the beloved dog will get the flea collar. So far Carrie and Lisa are in good spirits, unperturbed by leaks, a deluge of patients, the threat of fleas or bedbugs. I love young doctors!
Last summer the U Penn medical students made a video for us in Tzutuhil on how an asthmatic patient should use an inhaler. I forgot to tell Lisa and Carrie about it. Their cultural encounters the first day included trying to tell the brand new mom why she should not give her newborn a baby bottle filled with tea, as well as how incredibly difficult it is to get a Tzutuhil to use an inhaler correctly. They know where the video is now.
The hospitalito has hired a wonderful young Mayan doctor, Eliseo Cojon, to work full time. In November we plan to hire a second. Both went to medical school in Cuba under Cuba’s program to train third world doctors for free. Both just finished their schooling and so are more or less interns. Although I have only worked with them a tiny bit, I think they are close to the level of US interns. What a great program Cuba has! Great for PR for Cuba, great for health of the third world countries. Very comparable to the US program of…… well, I guess we don’t have one.
I just returned from an entire month of vacationing. First I went to the states and saw my family, then went to Korea with Jack and joined our two youngest kids, toured Korea a couple of days, then India for 2 weeks, then London for 2 days, then returned. It was a great visit with our 2 kids, and a great break.
Showing my ignorance, when I first heard that tortillas were made of corn with lime added, I thought it was lime as in lemon. It is lime as in calcium oxide. Here it is called cal. Yesterday at the groundbreaking, the footprint of the new hospitalito was outlined in cal. The day was beautiful, warm, sunny, a nice breeze, blue sky, bright multicolored streamers hung from the trees, kids playing. The president of our Comité, started the program with a moment of silence for the loss and suffering of October 5, 2005. As usual, my mind wandered. I looked around at the bright day, then the footprint made of cal caught my attention. After the mudslide cal was sprinkled on all the paths leading to and through the area. The lime was described as being there for various reasons. To keep down the smell from the buried bodies, to protect the people walking through. We think it was maybe a symbolic protection from the spirits of the dead more than anything else. Anyway, yesterday the cal was a poignant reminder of the disaster that caused the need for the new building.
Dr. Bernie Page
