Share this:

Today was our clinic in the village of Nuevo Nacimiento, and it was definitely the longest day so far, and the hardest village to get to. And it was the first day we brought someone out from the village and back with us. Interesting story. I will explain.
Nuevo Nacimiento is a lovely village, likely because no one is able to get in or out of it very easily! We began the day on a speedboat out in the Rio Dulce, which is quite beautiful! It is a very large river, with various islands that seem to be inhabited completely by birds. After about 30 minutes on the river, we turned into a small tributary that was, literally, like a Jungle ride at Disneyland. I was watching for the large mechanical hippo to emerge from the river and threaten the boat in a sufficiently frightening but benign manner.
After 15 minutes or so in the tributary, we docked and disembarked. Then began the long, muddy (MUDDY) trek through corn fields and cow pastures to the village. It was at least 40 minutes worth of walking, and every step of it was muddy, sometimes ankle deep. There was also a small stream to be forded.
I should digress here to say that it was not just ourselves that had to get to this village. All of our gear – and there is a LOT of it – had to get there as well. This consists of about nine 50-lb bags, and a few extra accoutrements. In years past, there has been a tractor and/or a couple of horses available for this purpose, on loan from the owner of the Finca (farm) on whose land the village is built. However, the village and said owner are apparently fighting, and so no tractor and no horses were to be had this time. So our Guatemalan pals, who I have never heard complain about anything on this entire voyage, got up an hour earlier than the rest of us and hand-hauled these 50-lb bags in to the village. By hand. Through the mud. Good Lord.
So we did eventually make it through the muck — did I tell you that it started pouring on our way in? — and emerged into a very beautiful little village pasture. We set up shop in the school and got down to business.
Each clinic seems to have its own population with a characteristic complaint or two. In this village it was dizziness and fainting. I had no fewer than three patients with this same complaint. Interestingly enough, it was all men. Men here are the same as men in the States – they do not like to come in to the doctor. So the fact that I saw three men during the course of the day with this very wierd complaint of dizziness and fainting caught my attention.
Being a U.S. trained doctor, my major focus was on ruling out heart disesase or a cardiac arrhythmia. But that didn ‘t seem to quite fit the bill. For one thing, these guys were all in their forties, and had pulses in the 60s and blood pressures around 100/60. I did of course ask about chest pain and difficulty breathing, but these guys – like everyone I saw – tended to answer yes to everything. I wonder if patients feel like I won’t take them seriously or give them treatment if they deny a single symptom I ask them about? Language barrier is still also an issue, even though my Spanish is getting better. For example, while probing one gentleman about his chest pain that he claimed to have, I enquired about heart problems in his family. He said yes…and then launched into a story about his brothers in Guate city, and that it “hurt his heart” (me duele el corazon) because his brothers drank a lot of alcohol. I began to realize that maybe his chest wasn’t hurting exactly the way I was worried about.
Basically, I was not sufficiently familiar with my population. I finally pulled one of the other doctors aside and complained about this odd consellation of symptoms, which included headache, eye pain, dizziness, and fainting several times a day. The other doctor helpfully explained to me that these particular men work out in the sun about twelve hours a day, with sometimes not so much water. Aha — now I recognized this population. They are like marathon runners! Now the diagnosis was clearer — heat exhaustion, heat stroke — and the treatment is drinking a ton of water with salt in it (so as to avoid dehydration and hyponatremia).
The last patient of the day was the sickest – why does it always happen like that? It was about 4:30pm, and everyone was making urgent noises about needing to start trekking back so that we were not driving the boats in the dark. So I started to hustle with my last patients, which was a young girl with a rash on her neck – not a problem – and her little brother with asthma, who was breathing at a rate of 60 breaths per minute and wheezing all over. This was a problem.
I ran out to stop the rest of the team from packing the nebulizer machine away – which they were in the process of doing right at that very moment – and hooked up my little friend. Unfortunately, like I suspected, one treatment did not do the trick. He was still breathing fast and using his abdomen, all not good. Now the question was, what to do with him? In the states, this is the kind of kid that you would keep in the ER for about 6 hours, giving treatments and keeping an eye on him. He wasn’t definitely sick enough to need the hospital right away, but was not looking right enough to be okay by himself. If things went south (for example, he started getting tired of breathing so hard), they would go south fast. Kids are tricky like that.
Well, we patched together a solution. Essentially, we decided to pack up the kid, his mom, and his older sister and take all of them back to the hotel with us. That way we could keep an eye on our small patient, and give him breathing treatments through the night if needed. It seemed like a logical solution, since any hospital was far away, and getting the patients both there and back again would be a major issue. Fortunately, there is another team going back to Nuevo Nacimiento tomorrow, so if he improves our little friend can go back with his family tomorrow morning. If not, I suppose we’ll figure out a way to get him to a hospital and back again. But for now, he is tucked into one of our hotel rooms, with his mom and sister. It will probably be one of the nicer nights they have had in their lives thus far. His older sister may in fact be counting her lucky stars that her little brother came down with an asthma attack, since she earned herself a boat ride, a hotel room, a chicken dinner with ice cream, and the attention of about 25 doting women in the process. That is interesting – and humbling – to think about.
At this point, I can at least report that after a dose of prednisone and two nebulizer treatments, things are looking better. He is now actively screeching and crawling away from the nebulizer machine, which is quite a good sign. I may not even have to get up in the middle of the night to check on him. We’ll see!
I’m afraid I don’t have many pictures from today — too busy and too tired. (Did I mention I slipped and dunked myself halfway into the lake at the very end of the day? It was definitely the last straw). I do have a picture of my shoes covered with mud, which I will post later. They may never be the same again. However, by about 8:30 pm I was able to acheive a shower, some dinner, and a large-ish glass of (mediocre) wine, which greatly improved my outlook on life.

Advertisement