As an unexpected treat, I will be flying home a couple of days earlier than planned. This has been a fantastic trip, and I am so glad I had the opportunity to come! However, I have been gone for almost a month now, and these last couple of days I will only be kicking around in Guatemala City with nothing much to do. So it’s nice to be able to have the couple of extra days at home to see my two favorite people in the world (my husband and the cat).
I am developing a crush on Guatemala. It is a such a beautiful country, and the people are so admirable in many ways. Hard workers, happy, flexible, welcoming. They are all gorgeous too — must be in the Mayan genes.
In my own personal education and growth department, I’m really happy with how my Spanish has come back around. Definitely not fluent, but more functional than I was before, particularly when asking about specific “dolors” and such. And it is great to practice medicine in a very limited-resource setting. It is a reminder about how to get back to basics (history and physical is 90% of your work!), and also a reminder about when a diagnostic test or a specialist consultation is really going to make a major difference in your medical advice. When things are readily available, the over-arching mentality is that you may as well do everything if there is even a remote possibility that it might be useful. This is not even mentioning the pressure from the toxic medical-legal environment that exists in Western medical practice. That attitude is a lot of what has caused the medical economics crisis in U.S. healthcare, and we would do well to remind ourselves every once in a while whether a CBC and a metabolic panel every morning is REALLY going to change what we’re doing for the patient. We could definitely stop getting chest x-rays for every patient at the door of the ER. There is the flip side of the coin as well, which I also ran into quite a bit –situations where a diagnostic test actually WOULD be useful, but since they are not available or patients cannot afford them, we end up airing on the side of overtreatment rather than undertreatment. Things I would have been comfortable watching for a few days in the U.S. I ended up treating here, simply because follow-up is so difficult if things end up getting worse. More than a few times I had no idea what I was treating, but the patient certainly seemed to have something legitimate needing some attention, and so a lot of educated guesswork came into play regarding which antibiotic, how much, and how long a course would be needed to treat that “something”.
Today we had a half-day of clinic, where the complaint of the day was pelvic pain. I don’t know whether people share symptoms while their waiting in line or what, but everyone seemed to have the same story. Bilateral ovarian pain, followed by epigastric pain, and then (if I let them keep going), headache. It’s interesting to see how complaints cluster in different populations – I hardly had any pelvic pain in Rio Dulce.
Yesterday was a bit of a “rest day”, for some more than others. In the morning we had teaching for the prometoras (lay health workers) and comedronas (lay midwives) in the four villages surrounding Monterico. I gave my little speech about diabetes and metformin again, which is becoming pretty slick now! It was nice to see all the interest from the women – and a few men – who came to the training.
In the evening, we cooked dinner for our Guatemalan hosts, which is a tradition passed on from other trips. We made a “fish stew” with tilapia, potatos, carrots, and a few other interesting things, including (not intentionally) a generous helping of MSG. Apparently someone thought it was salt. Oops!
Since I am leaving earlier than planned (and rather at the last minute — this only came together tonight), I did not get to do all of my official goodbyes or take last photographs or anything like that. So I suppose I’ll just have to come back. So there =).
