Letter from Dr. Bernie
November 25, 2006 from Santiago Atitlán
The makeup of the hospitalito staff has changed significantly and probably will change more. We now have 3 new young doctors: 2 Guatemalans trained in Cuba and a young Spanish doctor. The Guatemalans hope to work here for at least a year. Sara Cruz, the Spaniard, for 4-5 months. We expect to have a new director the beginning of the year, although there has been no official announcement.
On the up side, the young doctors are all very bright, motivated, hard working. Jack is starting to teach Eliseo how to do spinal anesthesia so that Cesareans can continue after we leave. Sara is very interested in learning ultrasound. Juan Gabriel is interested in everything, but lives in San Lucas, so would not work as the primary anesthesia person. Leah and I are trying hard to cut back our overnight shifts. Eliseo however was away for a while, due to the death of his grandmother, so we are still looking forward to when we will cut back. We hope to structure working so that the 3 young doctors would get teaching much like residents in the US. So Leah or I stay with the doctor in the ER all day, available also for backup for the clinic doctor. Needless to say, there are often many simultaneous questions. At night, when a young doc is on, we take call from home. This makes me suddenly aware of what Leah has been doing the entire 2 years, taking backup OB call 24/7/365. Well, of course that is an exaggeration. We do get some volunteers here who help that call. John Nelson, a retired OB-Gyn form Utah has been here for several months several times and given wonderful support. But as those of you who take call know, being on call is a pain even if there are no calls. There is always the expectation of calls.
The last shift I had, I had a woman pregnant with her first baby in labor. She, like most first time mothers, was having a long, slow labor. We started her on pitocin, a medicine to increase the contractions a little. It needs close attention and the nurse that night was totally inexperienced. So after multiple visits to the labor room, I decided that I would move my laptop into the room. I figured as soon as I was set up with the computer and all my stuff, she would really start moving the baby down and I would have to pack up and move out. Wrong and right. I had only turned my computer on when another lady in labor arrived. The first lady kept chugging slowly along, but the second woman’s baby’s heart would drop from the normal of 140 to about 60 with every contraction and stay down long after the contraction was over. A signal the baby is in danger. And when I checked her, she was still in early labor. Away went my computer, out came the oxygen, IV hydration, positioning, Leah, Jack and on she went for a C-section. The first lady of course also started having slight signs of distress of her baby. She had been at home pushing for over 12 hours when she had arrived at the hospital, way to early in her labor for pushing to have any effect other than to exhaust the Mom. Which it had done.
So now, when she needed to push, she could only manage about 15 secs. I called John Nelson in and he helped deliver that baby with forceps almost at the same moment as the second. Both babies and moms doing great. But I didn’t get my computer work done that night.
As everywhere, the politics of working in a specific location often weigh increasingly more heavily as time goes by. I think that we three long term American volunteers are somewhat exhausting our patience and energy. A couple of examples. Leah’s Dad’s rotary donated a fabulous portable x-ray machine. We have it in the room that serves us as a laboratory. Needless to say there are a lot of patients passing through and waiting in that room. The x-ray machine has frequently been noted not to have the brake on. Without the brake on, a two year old leaning on it could push the fragile head of the machine into the wall. I put up signs to always put on the brakes. No effect. We talked about it for several weeks at our meetings.
Finally the administrator said he would have a corral built around it. Sounded like a great idea. This week, the corral was in place. It is not attached to anything and is easily moved by any pressure AND it protects the brake, not the head. Then there is the x-ray developer. At night from about 6-9, for unknown reasons, our electricity at the hospitalito flickers repeatedly. It was noted that the developer made strange noises after the flickers. It finally quit altogether last week. The tech came and said the answer is simple: don’t use it from 6-9. No solution in sight yet about the flickering. Machinery here is a huge problem. Those two machines are new, so break downs are suspicious of problems with the electricity. We also have a fetal monitor, old, that is starting to have electrical seizures. Losing it would be a catastrophe for us. Also one of the three IV pumps, old, that John and Rita Nelson generously brought down, needed to be reset every minute when we used if for the first woman in labor mentioned earlier. IV pumps are essential when giving medicines like pitocin to prevent dangerous fluctuations in the levels of the potent medicines. Overall, it seems like the staff at the hospital is not used to using delicate expensive machines and does not understand preventive maintenance. We have already lost use of multiple oxygen concentrators. Not sure exactly why, though the fact that no one knew to clean the air filters may have contributed. A year and a half after opening, the hospitalito still does not have whatever official papers it needs for us to be able to obtain morphine, a drug important for heart patients, occasionally post-op patients, and dying patients. All the morphine we have has been given us by American doctors, and we hoard it.
On the other hand, the hospital census is up. Another American doctor, David Collins, is returning in December to help and will be here at least till March. So Jack and I, as we start our preparations to leave, do not feel totally guilty for deserting Leah. The new young doctors are eager to learn, and we also have 2 Atiteco (from Santiago Atitlán) nursing students here who are bright and eager to learn also. One, though still a student (still in the equivalent of a 6 week course) was Leah’s scrub nurse for the last Cesarean because he was the only one available. The land for the new hospitalito is in the process of being cleared. The rains are decreasing markedly.
We worked all day Thanksgiving, of course. Can’t tell the people here that it is an American holiday and so clinics are closed. Then we had a great dinner. Jack made turkey and chicken. Students from Colorado brought sweet and regular potatoes, the Spanish doctor and her husband brought Sangria, the Guatemalan and his Honduran wife brought grapes, Leah brought pineapple, a nurse from Ireland and Kathy Roach, from Virginia, brought vegetables, a Canadian pre-med brought carrots, and a Pennsylvanian pre-med brought beer. I melted some chocolate that Kathy Roach had given me and we dipped the fruits and had them with some shortbread with pumpkin-pie-spices. It was a great evening. We ran out of water. Bad side: we ended up asking people to go outside to pee. Good side: couldn’t do the dishes that night!
On the road to San Lucas one beautiful location has numerous small houses going up for victims of Stan. I am told that these houses are for people from the area of Santiago above the soccer field. I would guess that about 20 families from that area lost their houses. I am also told that there is no money to build new houses for the hundreds of people from Panabaj, where the hospital was. They are still living in the plastic sheeting houses that were put up immediately after the hurricane. In an area since condemned by the government as an area of high risk for another mud slide (as anyone who drives or walks through it would guess).
Jack is going this week to a hospital in the Petén to see if he would want to work there after January. I plan to go back to Durham to work ½ time. That would be work ¾ time for 3 months and then take a month off, hopefully to return to Central America to volunteer. We are looking forward to January, home with the family. Our time here in Santiago has been a very important event in our lives but it has not been without cost. Being back with family is very important to me while Jack still feels a need to give more time to some of the billions in need. What’s that story about a starfish again?
