Miriam Katarina Dolores was born August 18 to Hospitalito Atitlán’s social worker Chonita Mendoza. Lucky for Miriam and her family Guatemalan law gives her mother 3 months paid maternity leave. HA’s pharmacist Rosalia has experience working alongside Chonita, and is filing her shoes and very soon a second social worker will join the staff, giving Chonita the opportunity to work full time with the growing Maternal Infant Sponsorship program and other community outreach projects.
A typical day at the hospitalito turned more than strange when elevenyear-old Jose David Ajcot Botan arrived at Hospitalito Atitlán lastFriday afternoon. He was pointing at his throat and gagging. “UnQuetzal,” (the Guatemalan coin) he was trying to say.
Dr. Rudy Salvador, a recent graduate of medical school fromGuatemala, was the physician on-call that day. He ordered an X-rayimmediately, and then called on the other physicians in theHospitalito, including the Medical Director, Dr. Juan Manuel Chuc, aswell as the Chief of Staff, Dr. Mark Lepore, to help remove the coinfrom what was presumed to be the child’s esophagus. Rob Jones,paramedic from Seattle, was also on-call that day in the EmergencyDepartment.
What to do with Jose David?Much discussion about what to do ensued. Should we send Jose Davidelsewhere by ambulance where a surgeon could operate to get it out?Our experienced paramedic, Rob, felt that the coin could getdislodged in bumpy transport and might put the child at greater riskof having it completely obstruct his airway.
Looking at the childgagging, unable to swallow, and drooling, with occasional retractionsand apparent increasing difficulty breathing, Rob was indeedcorrect. That left us with 2 options: push the Quetzal down or tryto grab it back up.Suggestions about pushing the coin down were also voted down for theconcern of either rupturing his esophagus or having the coin getstuck in his intestines even if it were able to pass.
It was Dr.Rudy who saved the day by suggesting the use of a Foley catheter topull the coin back up. The catheter usually meant for urinarybladder drainage has an inflatable balloon on the end that could beblown up after passage down the child’s esophagus and used to pullthe Quetzal back up.In a truly collaborative effort, Dr. Lepore administered Ketamineanesthesia with the child sitting up at the side of the bed.
He wasquickly placed supine, then administered 100% oxygen via bag valvemask and paralyzed. Rob intubated the child with a small tube (anormal size for that child was unable to pass either secondary toairway swelling or because of the coin itself). Julie Burdakin, aphysician’s assistant from Idaho, bagged Jose David while Rob heldthe tube. Dr. Chuc placed the foley, inflated it, pulled back … andno luck. He tried again … and this time, felt something give,reached into Jose David’s mouth, grabbed the Quetzal, and flipped itup into the air onto the floor with a big “Hooray!”
Jose David had a very sore throat, but a very uneventful recoveryovernight in the hospitalito. This picture was taken on his day ofdischarge the next day.
