Day 19 - Home!

My day started with a 3 1/2 hour drive to Guatemala City and ended at home.  Filipe, he man who drove me to Guatemala City is the H.I.M. in-country coordinator's cousin and does not speak English.  I no longer remember enough Spanish to carry on a 3 1/2 hour conversation so there was time to reflect on my trip.  However, we did our best and it was really good practice.  What is the universal language?  Soccer?  No, baseball!  I asked him if he had ever visited the U.S. and he said no, but he wanted to because he loves baseball and wants to watch a major league game.  We talked baseball for the rest of the trip.  Filipe knows the sport inside and out.  He plays for a team and coaches a group of high school-aged boys.  He showed me pictures, videos, and even took me to their fields in Guatemala City.  When I told him my husband is a Red Sox fan, we discussed Big Papi's year and speculated on whether he will actually retire after a year like this.  It was a lot of fun.  I invited him to go to a Mariners game if he ever visits Washington. 

What an amazing experience - one that I hope I repeat multiple times in the coming years and for much longer periods of time in my retirement, but this is where I belong.

Day 18 - Guatemala

Another good day.  We started our morning at Maria's daycare.  Maria is a woman who was taken to the United States for a necessary surgery when she was a child and lived with the founder of H.I.M. for a year while she underwent rehab.  She returned to Guatemala, grew up, and began working for H.I.M.  She saw a need in her village.  Young children under the age of 4 were staying at home without any adult supervision all day while their parents worked.  Many older children were not attending school because they were caring for their younger siblings.  They also were not getting enough to eat.  Maria started a daycare for these children so they would have proper supervision and their siblings could attend school.  They start off each day with a bath and fresh clothes and a meal.  The kids put on a little program for us and showed off the English words Maria has taught them (a lot!).  The 13 children seemed very happy and were obviously well-cared for.  It was 45 minutes well-spent seeing the difference that one act can make.  Without the surgery, one act, Maria would have had a severe disability and would not have been able to work.  In fact, she may have starved.  Instead, that act allowed her to grow into a woman who saw a need, and in one act - founding the daycare - has changed countless children's lives.

I spent the day at the H.I.M. House physical therapy clinic supervising PT and OT students and assisting with care for over 20 patients.  The other 2/3 of our group set up a mobile clinic in another village. 

Before dinner, a group of us went up to a waterfall that is about 3 miles from where we are staying and went for a swim.

Tomorrow I travel home.  It is time to hug my boys tight.  And shower.  And burn my shoes and a few of my clothes. :)

From the roof of the H.I.M. House

Day 17 - Guatemala

Lovely day in Guatemala.  A small group of us traveled through a mountainous and lush region to Mulan, where H.I.M. has a complex consisting of a nutrition center, which currently feeds and houses 13 children, an orphanage, which currently houses 9 children, a senior center, which hosts seniors one day a week and the intent is to soon make it an adult day care center, and a physical therapy clinic.  We evaluated and treated about 20 patients and saw a wide range of diagnoses: recent stroke, chronic stroke, Friedrich's ataxia, s/p ankle dislocation, tunneling pressure ulcer (in a little boy with an AFO that didn't fit well), venous ulcer, neck and shoulder tightness from a huge benign tumor in the neck, acute MCL tear, and many others, including a few children with cerebral palsy and one with severe bilateral club foot.  The larger group traveled to a village to set up a mobile clinic.  They saw a wide range of patients, too, including a man with a bilateral above-knee amputation with a scorpion bite on his elbow.  He was very worried that he would lose his arm, which is essential for his mobility.  They also saw a family with three non-ambulatory boys ages 14, 12, and 9.  The parents carried them to the clinic.  The boys had undiagnosed Duchenne Muscular Dystrophy.  Remember the life expectancy I mentioned yesterday?  About 14.  The two PTs at the clinic had to tell the parents their children's diagnosis and arranged for them to be evaluated at the nearest city hospital.  What a tragic day for this family.

The clinic was busy, and was short translators for the first hour until a woman walked in and asked if she could help translate.  She is a professor of Kinesiology in San Diego and was visiting her family in the village and heard that there were Americans providing a free clinic.  She helped translate all morning.  God knows all of our needs! 

The orphanage



 

 

My view for lunch

 

Members of 'Music in Motion' practicing.  Local children only attend school in the morning, and are often lightly (or not) supervised in the afternoons while their parents work.  This ministry of H.I.M. invites them to learn to play an instrument in the afternoons.  They have a building and practice right next to the PT clinic.  Unfortunately, I will miss the concert they are giving on Thursday.

 

Day 16 - Guatemala

There are not words to describe my morning.  We made bean tortas and rice milk and visited a village that is located in a garbage dump.  A dump.  I've read about people who live and scavenge in dumps, but never thought I'd see it.  It is beyond heartbreaking and was extremely difficult to see. 

It is a very organized system.  We could see people's work areas where they sorted their garbage, and we were told that there is a strong honor system and people do not take one another's findings.

We worked with a high school youth group who had collected clothing and shoes to distribute.  We served over 100 people. 

While a piece of clothing will not change someone's life and a sandwich will not sustain a child for a week, it is a way for H.I.M. to build relationships with the people in the village so that they can then bring mobile medical clinics to them.  In fact, while we were there, a woman brought her son to us to ask for advice as he had sustained a femur fracture and was still having pain.

The PT group opened a mobile physical therapy clinic in Pueblo Modelo from 11:00 - 3:00.  The people there are actually as impoverished as the people who live at the dump.  They just got running water this year.  Houses are constructed of a combination of clay bricks, corrugated metal, boxes, and blankets or sheets.  There were no floors.  I was able to enter a home to borrow a bench.  The woman there was cooking over a clay oven with an open fire.  We treated about 30 patients and saw everything from kids with mild to severe cerebral palsy to ankle sprains to a woman with an upper extremity prosthesis to a man with knee pain from muscle weakness following a femur fracture to a man with rib pain following a fall from a roof to a woman with nerve damage from a machete wound.  Quite a range!  The OT group gave a half-day course on working with autistic children to parents and educators in another town.
 

Making sandwiches

 

Serving sandwiches

 

Some of the PT students playing soccer with kids.  Note the girl with bare feet.  Imagine what she could step on in the trash.

This is Eduardo.  He is 8 years old.  Evan's age.  He is smaller than Nathan.  I cannot write more about him without tears.  It is not fair.

This picture is courtesy one of the students.

Most of the houses were at the edge of the dump.  If you look closely on the right of this picture, you will see two houses that were actually right in the middle of the dump.  There were others, too.

 

Women scavenging for anything that they can sell (metal, glass, etc.)

 

 This is someone's work space.

A home in Pueblo Modelo.  Note how one wall is made from hanging material.

Betio is an 8 year old boy with Duchenne Muscular Dystrophy, a neurological disorder characterized by progressive muscular degeneration and weakness.  He was able to walk until he fell from a roof into a fire.  He has massive scars from the burns and subsequent skin grafts.  His wheelchair does not have a cushion and is too big for him and has no foot rests so he couldn't put his feet over the edge.  He has severe hip and knee flexion contractures from sitting in the wheelchair like he is in this picture.

My students worked on decreasing some of the contractures.

Then they rigged his wheelchair so that he could get his legs over the side and have a foot rest.  It's not perfect, but will hopefully prevent further contractions, which would make it very difficult for his family to care for him.  Betio has an older brother with Duchenne Muscular Dystrophy.  Life expectancy for a boy in a developing country (without cardiac and respiratory care) is around 14.  So much pain for one family.  The high school youth group that is down here is working on a house that H.I.M. is building for the family.  Betio came to the clinic with his friends because his parents were helping build the house.

Leah, an occupational therapist, and I talking to a little girl at the autism course.

Day 15 - Guatemala

Great day!  I am working with Hearts In Motion (H.I.M), an organization that serves the district of Zacapa, Guatemala.  I am spending my time with a group of 24 physical therapy and occupational therapy students from Grand Valley State University in Michigan.  I am serving as a clinical instructor for them while I am here.  This morning, we split our group.  Most of the group ran an outpatient clinic in a very primitive (picture below) clinica in the village of San Agustin.  I went further up the mountain (for Leavenworth folks, think the forest service road up to 8-mile or Colchuck) with a smaller group to a nutrition center for malnourished babies.  The center is run by Sister Edna and one other woman.  Two other women help with the cleaning and building upkeep.  They have 13 babies and one 8 year old child with severe cerebral palsy who Sister Edna has been raising since she found her as a baby.  At times, they have had up to 18 babies living there.  The babies are identified in the mountain villages and are taken to the hospital for nourishment and then live at the center until they are well enough to return to their families.  This is quite an undertaking since they are often the youngest of 9 or 10 children and the mother must go with them to the hospital.  Other villagers must take care of the other children or sometimes H.I.M. will pay the father to stay home from the fields so the mom can travel.  The moms don't stay with them at the center and are not able to visit due to having so many responsibilities at home and a lack of transportation.  We performed developmental screenings on the babies and one group worked with the older girl.  We spent the rest of the afternoon at the outpatient clinic in San Agustin.  I was the translator for my group.  Boy, am I rusty!  We saw everything from a boy with a spinal cord injury to a woman with a very recent stroke to low back pain to machete wounds to old gun shot wounds to knee arthritis.  Overall, we saw 40 patients at the outpatient clinic. 

 Loading up supplies before heading to the clinics

 

The clinic in San Agustin

The clinic in action

 

My students evaluating Jaime at the nutrition center.  She is two years old.  She can crawl, but does not pull up to standing or walk.

 

Julio, who is 10 months old and meeting most of his developmental mile markers

 

One of the PT students taking a break.  The girl in the pink shirt is a college student with us this week.  She supervised and played with all of the other babies while we performed our evaluations.

 

I don't even know this little sweetheart's name.  He attached himself to me after I was finished with my evaluations and decided he liked me.  He clung to me and struggled when I tried to put him down when it was time to leave.  I could still hear him crying as I walked out the front door to our van.  Heartbreaking.

 

We walked up to the church in San Agustin when we finished clinic.

Day 14 - Belize to Guatemala via El Salvador

I only have one picture today because it was purely a travel day.  I took the first flight out of Punta Gorda, stopped briefly in Placencia and Dangriga before deplaning in Belize City.  I waited four hours at the airport for my next flight, which was to Guatemala City with a layover in San Salvador.  Then I rode in a car for five hours from Guatemala City to Zacapa.  It is usually a three hour drive, but it took five hours due to an entire mountain pass of construction. 

 

What I learned: 

1) Guatemala City is a very modern city.  Adam and I were shocked at the state of the Belizean ‘cities’.  Ask us about Belmopan, the capital city.  It is almost beyond description.  Guatemala City, on the other hand, felt like coming home.  Not Northwest home, but like I belonged there.  It had a flavor that reminded me of a cross between Guadalajara and Seoul. 

 

2) Driving in Guatemala City is not for the faint of heart.

 

3) I probably decreased my lifespan by several months by breathing in the fumes from all that traffic.  It took 1 ½ hours to get out of the city.  The boys will tell you I'm a stickler for keeping the windows rolled up on the freeway and in heavy traffic.  But it's a whole other story in Central America with no air conditioning.

 

3) There may not be any straight roads in this region of Guatemala. This is a very mountainous region.  It was beautiful, but felt like driving in West Virginia except with bigger mountains.

 

4) The truckers do go through Guatemala.  This is something that Adam and I were speculating about.  We can count on one hand (Adam did) the number of semi-trucks we saw in Belize.  There just isn’t the infrastructure (or industry) for them.  The main highways are two-lane (one in each direction) roads that are not always paved.  It is very, very rare for a side street to be paved, and when they are, they are ridden with huge potholes.  The roads are much better in Guatemala.  We noticed that right away when we crossed the border.  There are LOTS and LOTS of trucks on the roads in Guatemala.

 

This is a picture of me with Sarah, a psychologist and the director of the orphanage here, Luis, a 14 year old who lives at the orphanage, and Carlos, our excellent chauffer.  The three of them picked me up from the airport and I felt like we were friends after spending 5 hours in the car with them.  Carlos and Luis don't speak English, so I was able to dust off my Spanish.  I need a lot more practice!

Belize - Day 13

I performed a site-visit today at the Hillside International Clinic in Elridgeville, Toledo District, Belize.  I rode a packed old school bus to get to the spur road that it's on and walked the rest of the way.  The clinic is doing important work here.  They provide healthcare and healthcare education to the villages in the Toledo district, including taking mobile clinics to 16 remote villages each month.  I met with the Director of Rehab, a PT from Sweden, and spent the morning providing outpatient evaluations with him.  We spent the afternoon doing home health visits.  Unfortunately, there were too many barriers (mostly space issues) for it to be a good option for me to bring students here, but it was a great experience none-the-less. 

Tomorrow: Guatemala!

I have a broken screen viewer on my camera and no photo editing on this computer, so my pictures might be rough.

Patient waiting area outside the clinic.  Adam will tell you that this is actually nicer than the waiting area in my first clinic in Germany.

The PT clinic

 

Patient handout on machete use

 I opened the supply cabinet and look what I found!  The book on the left was written by my friend and mentor, Rich Baxter, and the second edition was published while we were in Korea.  I sent him a message to let him know that he is reaching all corners of the world.

  

The director of nursing discussing a case with two British medical students.

 

PT student, Samantha, putting wheelchairs into a landrover for home health visits.

 

There is only one ambulance in the whole district and I spotted it in town this morning.  Adam will not be surprised to hear that I learned that motor vehicle accidents are the leading cause of death in Belize.