El Laboratorio

The school kids are now out for the year on their summer break...which means, we have very few patients. That in combination with a surplus of volunteers and medical students has left me plenty of time for branching out from the Nurse Practitioner role in the clinic. Jen and I have now taken over what we so lovingly refer to as "the poop lab." We anlayze urine for infection and pregnancy, vaginal dc wetpreps for yeast/BV/trich, feces for parasites, and blood for RBC and hemoglobin level. We are working on figuring out how to do a CBC, but we're still coming out a bit inaccurate...everytime one of us bravely donates a blood sample, we either end up having leukemia (way too many WBCs) or typhoid (way too few)! The lab is also loaded with awesome books on parasite identification and descriptions. I have learned to love the lab and am now hoping to apply to an infectious disease course in Lima, Puru. Not for a while though. The program doesn't have any openings for another year and a half. If you are curious about what the parasites look like under the microscope or if you want the scoop on the scary things they do inside of us, check out my earlier now-updated entry entitled "A Whole New World."

The 17 hour hike...yeah there aren't 17 hours of daylight in Xela

Early Sunday morning, my friends and I got together to a hike to the Santa Agito crater. However, as the thick clouds rolled in, we decided on a different hike. This other hike usually involves about two hours of walking through the city and climbing a smaller mountain until you get to a spill of old volcanic rock and boulders. Once you get to the rocks, you scramble over them for about 2 or 3 hours until you get to a cave at the top of the mountain, Candelabra. You climb up through the cave and come out to see one of the most amazing views of Xela and the surrounding towns that Guate has to offer. Round-trip, the hike usually takes about 7-8 hours.

This time, the trip took 17 hours! Why, you might ask? Never ever take a person on a high hike who has not adjusted to the altitude and who you have never been on a hike with before. My poor friend had just arrived from the states about 6 days before the hike and consequently hadn't gotten the necessary 2-4wks to make enough RBCs to compensate for low oxygen level in the air here. We got to the top caves all right, granted very slowly, but on the way back down, my friend started shaking and saying she had no energy left in her body. Eventually my other friend, Zack, had to half-carry, half-drag her over the boulders, which this time took about 6 hours. We stopped midway to wait for the moonlight to come out (gracias a Dios we had a full moon that night!) and then fought our way through the sharp, jagged dried lava by the light of the moon. The highlight of the hike occured around 11pm, when we finally made it up one of the highest points of rock, which we thought was our destination point from which we could start heading back down again. Unfortunately all we saw at the top of the peak was a gaping 100ft void surrounding us on 3 sides. We had to turn around and start backtracking and then reclimb another intensely high ridge. In the words of one of my Georgian friends here, "Geez, oh man!" I was pooped, but felt even worse for my friend who at this point wasn't making any sense and was shaking all over. Throughout it all, I do have to say that the view of the city lights and the still mountains as clouds silently swept through and around the peaks was breathtakeningly stunning. Because I never thought I'd be doing a moonlight hike over shards of volcanic rock, the experience was especially awing. Now that we are all safe and sound, I am thankful for the experience...all 17 hours of it! When we finally made it back to the road in the wee morning hours, we walked the rest of the hour into town and finished off a few plates of delicious street food before collapsing in our beds and hitting a coma-like sleep in minutes.

The next day, today, I met my friend in the clinic and I am happy to report that the same girl who seemed on her deathbed just a few hours ago in the night had perked up completely and was able to examine several new Womens Health patients all morning. I'm so proud of her! Lesson of the day...or night as it happened to become: when making hiking-buddies, start off with small hikes until you know peoples' abilities. I will never make that mistake again! Thank goodness we all made it back in one piece apart from a few bumps, scrapes and bruises :)

Mobile Clinic #2 : Bella Vista

Me with a patient


Zack with a captive audience


Part of the travel team en front of the school


The school

Rambuncious smiles of boys who begged me to take their foto on the walk home from clinic


Two of the Guatemalteca med students I work with: Eva and Dulce



The school's patio


Me with a patient


One of the cutest little ones had a big crush on this collegio estudiante


One of the sweetest families yet...the boy ran around the room the whole time, stopping only long enough to chat with each person, and the little girl spent the entire time in my lap :) FYI: the little boy is still running around the room and so did not make the pic!


The first school we visited was in Las Mojadas, where we completed heights, weights, physical exams, muestra sampling, and an educational preventative program with just over 400 niños! We also saw several walk-in patients on our last day. This next school, Bella Vista, has fewer students, about 160, and so we were able to zip right on through, finishing in just 2 days! Here are some pics:

View from my second story room in hostel Pasado Adreas

Yes, I have to get up at 5am most of the time...but this view and a cup of coffee in my hands certainly make the wee morning hours more bearable!

More Pics of Santa Maria

My friends and I, slowly making our way up



My good friend Zack, AKA el buenisimo poop specialist en todo de Xela



Religious ceremonies at the top of the volcano inside of a cloud



A view from a lookout



Another pretty site

The Guatemala Outside my Clinic

Obviously, the clinic is my primera passion aqui en Xela...however, I get home from the clinic around 2 everyday and always manage to pack a lot more into the day.

In the afternoons, I have a wonderful job in at Miguel Angel Austurias Spanish School, the same school where I learned Spanish in January. I am the student coordinator at MAA, which involves the grueling work of socializing with students from all over the world, taking students out salsa dancing, hiking up mountains and volcanoes with them, helping out with potlucks, answering phonecalls and emails, and much more...all things I can't believe I actually get paid for! Though the job does take quite a bit of my free time, I really enjoy meeting all the interesting students, making friends with all the Guatemalteca maestras, and helping out with the activities. It doesn't hurt that I make a whopping $1 per hour, which is actually just fine for me to live on!! I'd recommend this school to anyone.

Also, here's a little publicity for one of my good friends here. Karla is an intelligent, patient, university-certified teacher who would like to teach people Spanish over skype at the almost miniscuel rate of $10/hour. Karla is trying to put her daughter through collegia right now, which is fairly expensive, and so could use some extra financial support. Please email me (cstumpemory@yahoo.com) if you are interested or if you know anyone else who'se interested.

Apart from my school job and the clinic, I love to go hiking up the volcanoes that surround Xela. Each weekend a group of my friends and I set out for new and old climbs. No matter how many times I do the same mountain or volcano, I never get bored. Below are some pictures of my last climb up Santa Maria, from the top of which it is possible to see another volcano, Santa Agito, erupt. Que bueno ondo!




Other things I do include:
1.) cooking with the incredibly cheap fresh fruit and vegetables (I can buy a pound of blackberries or strawberries or a head of broccoli for 20 cents, and I can buy 4 red peppers for 50 cents...seriously, I'm in heaven!),
2.)salsa dancing,
3.)attending the various festivals, which are plentiful (it seems like there's something new to celebrate at least every week),
4.)watching pirated DVDs in español that haven't even come to theatre yet in the states,
5.)steam bathing,
6.)studying,
7.)playing soccer,
8.)taking crazy aerobics classes choreographed to loud Spanish hip-hop and pop music, that I can't get enough of, and
8.)participating in possibly the greatest game of all time, fuzball!

Everyday I can't help but be overwhelmed by how blessed I am to have this opportunity. Thanks to all my friends and family who've helped make this possible!

Semuc Champey

A few months ago, some friends of mine and I took a 13 hour bus ride to Semuc Champey from Xela. If you know me well, you know I can't sit still for longer than a few minutes, but I'm pleased to say that the incredibly long bus ride was completely worth it. Semuc Champey is one of the most beautiful places I've ever seen! Granted I was in great company :)

Here's a view from the lookout, just a short 30 minute hike


Waterfalls and rivers in between pools


One of the many crystal green pools we swam in




Our sweet hostel, complete with rope swing (see pic above), mariachi bands, treehouses, and delicious food (the cook caught the fish we had for dinner 2 hours before we ate it!

More Mobile Clinic

The hike to our first school/clinic...I know, rough life, huh?





Two cuties waiting to be seen

The Mobile Clinic Begins

Paper airplanes anyone?

On September 4, we began the mobile clinics. There are 3 teams. Each team includes doctors, nurse practitioners, health educators, Guatemalan med students, and perspective Guatemalan med students. Our dentist unfortunately does not come out on these trips. For the mobile clinics, we set up the clinics in a local school of a village muy lejos. These villages often can't be reached by bus or car. Our first mobile clinic is the furthest. I get to sleep in until the late hour of 5 am so that I can make it to Minerva terminal to meet up with the rest of the clinic volunteers. Then we take a bus as far as it'll go, hop off with mochilas full of medical supplies and then hike the rest of the way to the school where we set up clinic. The hiking is by far my favorite part of the travel because I get to see some of the most beautiful parts of Guate this way and because I need something to keep me going in those wee am horas. All in all, it take about 2 hours to get to the schools. We take all needed medicine and supplies in our backpacks. For the first few days, we examine and provide health education for all the school children. On the last two days, we open up the clinic for walk-ins.

...by the way, I absolutely LOVE this!!!

Medicamentos a La Clinica

Medicamentos y Abreviaciones

Acetaminofen – ACET
Aciclovir – ACL
Acido Folico – AF
Albendazol – ALB
Ambroxol – AMB
Amoxicilina – AMOX
+ Clavulanato – AMOC
Antiacido – ANC
ASA
Benzoato de Bencilo – BB
Betametasona + Gentamicina + Clotrimazol – BGC
Bromexina – BROM
Cefadroxilo – CEF
Ceftriaxona – CFT
Ciprofloxacina – CIP
Clonixinato de Lisina + Propinox – CLO – antiinflamatorios, analgesicos, migraine
Propinox-anti-spasmodic drug
Cloranfenicol – CLOR – abx (mas fuerte)
Clorfeniramina – CLF - antihistamine
Chloroquina – CRQ -
Clotrimazol @ 1 % - CLOT
Clotrimazol @ 2% - CLOT2
Complejo B – CB
Diclofenaco – DF
Dipirona (metamizol sodio) – DP - NSAID
Enalapril – EN
Eritromicina – ERI
Fluconazol – FLUC
Glibemclamida – GLI
Guayacolato de Glicerilo – GUAY
Hierro + Complejo B – HB
Ibuprofeno – IBU
Kalamina – KAL
Metformina – MFM
Metoclopramida – MTC -reglan
Metronidazol – MET
Nistatina – NIS
Pasta Lassar – PL
Penicilina Benzatinica – PB
Vitaminas Prenatales – VITP
Ranitidina – RAN
Salbutamol – SAL
Suero de Rehidratacion – SRO
Trimetropin Sulfametoxazol – TMP
Loperamida
Paracetamol – pain, loopy
Paradex – paracetamol 325mg, dextropropoxyphene napsylate 50mg, (opioid)

Information on Primeros Pasos

Location and Services

Primeros Pasos is a small clinic located in the Palajunoj Valley of Quetzaltenango, Guatemala. The mission of the clinic involves providing primary healthcare to children through adults, health education programs, outreach mobile clinics, dental services, a woman{s health educator program, and a soon-to-come woman's health clinical program. All services are very low cost and medicine is free.

Our Patients

The clinic serves children and adults from from the 14 districts that make up the Palajunoj Valley. Patient's can be seen as walk-in patients most of the day except, when we are doing the physical exams for the school groups that come through the clinic. When the students come, each receives a complete check-up, a stool sample analaysis, a health education class, and a dentist visit. The school children come into the clinic by grade. We see one grade (or about 30-40 students) every day, except for Friday because Fridays are vaccine and wort removal days. Each grade in every school of the 14 districts comes through the clinic.

Laboratory

The lab is very basic. The clinic provides pregnancy tests, urine dipstick tests, glucose monitors, and microscopes for stool evalution via wet-preps with normal saline. If you want to learn more about what we find in the stools samples, check out the post entitled "A Whole New World"...there are some fun pictures there!

Pharmacy

Most of our pharmaceuticals are donated, but we also make weekly trips to a pharmacy to buy the basics, like acetaminophen. If you want to learn more about the specific medicines we use, look for a future post entitled "Pharmacia"

Common Diseases Here

1.) Skin (usually related to parasites)
-piojos (lice)
-sarcoptiosis (scabies and/or bedbugs...no distinction is made here)
-ongos (fungal infections, especially tinea corporis,tinea capitis, and tinea versicolor)
-candidiasis
-vericella
-herpes simplex
-warts
-impetigo
-acne
-Kawasaki Virus
2.) Gut Parasites (see "A Whole New World")
3.) Chronic Illnesses
-diabetes mellitus, type II
-conestive heart disease
-obesity
4.) HEENT
-foreign body (especially garapatas, a type of tick)
-acute otitis media and otitis externa
-upper and lower respiratory track infections (many people cook inside using open fire, and they so are constantly they are constantly exposed to the smoke. Pneumonia is very common)
-tuberculosis
-pharyngitis
5.) Other
-burns
-malnutrition (both kwashiorkor and marasmus)
-biliary stones
-UTIs
-STIs (syphilis is quite common)

Website for Primeros Pasos

http://www.primerospasos.org/

A Whole New World!

H. nano -

H. nano is a very common parasite here. It eventually becomes a tape worm, so we prefer to find it quick and give it a good old dose of Metronidazole. Still works like a charm here.



Whipworm -

Whipworm is usually not found in Xela, but closer to the coast. One particular school had many students infected by this parasite. Most had taken a beach trip about a week or two before we collected their stool samples.



Mystery Parasite -

Zach found this parasite a while ago and had no idea what it was. He even described it in detail to our sister labratory, but they had no idea either. If any of you who are reading this know, please comment!!



Blastocyst hominis - the only pathological amoeba



Cryptosporidium

Some sources say crypto is pathologic and needs treatment whereas others say no. The sources that sat to treat describe a bad, giardia-like diarrhea that crypto can cause. We usually treat if there are a lot of them. Crypto is smaller than the other parasites (only 5um). It's the tiny ball of balls in the center of the slide.


Ascaris

This is one of the parasites we can see with a microsope. The ovum of ascaris is swallowed by someone and then develops into larva in the gut. The larva gets coughed up and then swallowed again. Once back in the guy, the larva turns into the lovely worm blow he microscopic ascaris ovum pic. The worms can perforate the intestines, causing peritonitis, or travel up into the lungs or stomachat which point the patient coughs them out. Aspiration is a major concern...but if we see them in time, the little guys are super easy to treat! Just a round of metronidazole does the trick just fine.

Pasillo de la Clinica

La Biblioteca de la Clinica

El Laboratorio

La Sale de Clase

La Area para Esperar

A Tour of Primeros Pasos

Primeros Pasos

La Farmacia

El Cuarto para Pacientes

La Oficina para Entrar

Oakhurst Wrap-Up III

Ruins

Oakhurst Wrap-Up II

Quick Reflection Moment

Last night during reflection, Emerson, our guide for the week from Cedepco, shared something I would like to always remember. One of the Oakhurst youths was crying in memory of her grandmother who recently passed. I don't often know what to do when people cry. Sometimes I want to hug them, sometimes I want to talk to them or pray with them, sometimes I think it's best to just sit with them and be present. Regardless, I've never felt comfortable around someone crying. Emerson, who seems completely at ease with any emotion, began to tell a story. He said that his friend's uncle one day received a phone call and found out that he was a new grandfather. And so he was overjoyed and crying with happiness. Then, another phone call interrupted his celebration, and he found that his father had just died. He was crushed. His tears were now tears of pain and grief. Emerson concluded the story saying that we must always remember that we all have two hands: one is for receiving and taking, while the other is for giving and letting go. I am very thankful to have received this story.

A Week with Oakhurst's Youth, Wrap-Up

The day after visiting the dump in Guatemala City, we woke up bright and early in order to help serve breakfast to the students at Mi Refugio. In 1987, a woman named Karen Engen opened Mi Refugio, a school for children who work in the dump or whose families work in the dump. Out of all the schools I've seen in Guatemala, this school is the most beautiful. Set against beautiful rolling hills with rich foilage, animals, gardens, and wooden buildings, the school provides the children an opportunity to study outside of the city, away from the dump. When I asked Karen how the school stayed afloat financially, she replied simply, "faith." For its complete 20 years of operation, Mi Refugio has been entirely funded by volunteers.

Catching up on Guatemalan history and art, we were amazed by the many different showings at the Museo Popol Vuh.