La graduación

At school they usually put on a graduation dinner every Friday, as long as there is a student who is graduating.  Instead of having it Friday of this week, however, we had it on Wednesday because 2 girls who are graduating with me had made plans to leave on Thursday to travel before their flights back to States next week.  They didn't end up going until Sat though because of all the rain here, they didn't want to risk traveling with possible mudslides on the highways.  That worries me a little too, since I'll be taking off on Monday.....

Graduation night we prepared the kitchen/dining area by joining a bunch of plastic tables, covering them with fine Guatemalan textiles, and creating the ambience with candles in wine bottles.  Everyone brings a dish to share, and usually the school's student coordinator makes the main dish.  I brought a pineapple pie from the Mennonite-run Bake Shop up in Zona 3.  I've never had a pineapple pie, and I was impressed.  I thought it might turn out too sweet, but it was just right.  One of the students ordered pizza too; it was quite the spectacle to watch her try to order it on the phone with her less-than-great Spanish, but they came to the right place, and we were all very proud of her!

Graduation dinner

Joaquin, Rony, and Miriam - three of the teachers

It was sad to say goodbye to the teachers and administrators.  They have been so nice, accomodating, and informative.  I've only been here for 3 weeks but one of the girls was here for 7 weeks studying Spanish, I can imagine it would be harder for her to leave.  But we left our mark, in a way: the other 2 girls and I made little certificates for all of the teachers and administrators.  I think about 13 in all.  We gave each of them a title like they do in high school yearbooks, "most likely to...."  Just translating this phrase was difficult because apparently they don't have this school tradition here.  So we winged it, and it turned out great.  Edna's (the director) certificate read, "más predispuesta a salir en un anuncio de pasta de dientes (most likely to be in a toothpaste commercial)," due to her beautiful and spotless smile.  She said she was going to frame hers and put it on the wall at school.

The three graduates with our certificates - Me with Liz and Cassandra

El problema de la sangre

Just a little aside here....  Voluntary blood donation is extremely scarce in Guatemala.  There are many myths about what might happen to you if you give blood - you'll get fat, you'll be impotent, you'll just never be the same - that people really believe.  As far as what I've heard from people here, there haven't been any large scale compaigns for blood donation either.  As a result, there is a blood bank, but almost no blood.  For this reason, if someone needs a blood transfusion or is going to have an operation where blood will be needed, before they can receive blood or get the operation, they need to find people to donate blood.  Basically, you need to replace what you will use from the blood bank before you get it.  Usually it's relatives or close friends that will donate for you.  This proved a little difficult for one patient in the hospital, the guy who had the kidney stones.  The doctor said he needed a tranfusion of at least a half liter of blood.  The patient said he asked family members but they either had their own health problems or simply didn't want to.  He also asked a girl that works with him and she said she would donate, but only a quarter of a liter.

Sometimes people chicken out at the screening before the blood draw when they are asked questions about sexuality and infidelity.  Sometimes their blood sample doesn't pass the screen for whatever reason.  And sometimes, after you go through the whole process, the technician looks at your veins and says they won't take your blood because your veins are too thin or too hard to find.  That's what happened to one of my teachers.  She tried to give blood for heart surgery that her mother-in-law needed, but they wouldn't even stick the needle in her arm.  They eventually had to pay someone else to give blood.

A day at the hospital clinic and a bit about Guatemala's public health system

Today I decided to spend the morning at the hospital's public clinic, observing an internist in the women's open clinic.  When I arrive at 7:45 or 8am, there is already a crowd of people lined up outside the receptionist office, and they don't start seeing patients until usually 8:30 or 9am.  I don't know what time they start lining up outside, but it's certainly much earlier.  Most of the patients seen here are indigenous and many don't speak Spanish, so they often come with several family members to help interpret.  After they're signed in, a group of women are given thermometers to put under they're tongues and one by one they're temperatures are noted down before they go in to see the doctor.

Dr. Joanna Rogosh is the internist who sees patients on weekday mornings.  She is from Poland and came to Xela during her travels more than a decade ago to go to Spanish school.  She liked it so much that she decided to stay for a while.  She had always been interested in medicine as a profession, so she decided to go to medical school here.  She was in medical school for the full 6 years and in the meantime met a Guatemalan man and got married.  She now has a 4 year old son, but has divorced her husband since, and has been practicing medicine for 4 years.  Her father now lives in Germany and she has been talking about moving there soon with her son.  From what I've observed of Dr. Rogosh with her patients, I'd say that she's an outstanding doctor by any standard.  She listens intently to the gripes of the patients while also keeping them focused on one thing at a time.  Patients will often just come in and list off all their aches and pains and the doctor has to stop them and ask about the nature and history of each complaint.

It's sometimes a whole other ballgame when seeing patients who only speak their indigenous language and almost no Spanish.  One woman came in complaining that she had not had "orina grande (big urine)" in a few days and she is only able to go every few days.  The doctor asked if she had urinated yet today.  The patient said that she had "orina pequeña (small urine)" this morning, but has not had "orina grande" since a couple days ago.  After many questions and much confusion, the doctor realized that when the patient said orina grande, she was actually referring to poop, and orina pequeña referred to pee.  Whew, ok, so now we know the patient's constipated!  Apparently in a prior lab test they also found that she had tested positive for Helicobacter pylori, which causes gastris and stomach ulcers. 

In general, Guatemala's public health system is pretty good, considering that you can see a doctor and be admitted to the hospital at no personal cost.  After admission, however, there are many things that the patient will have to pay for out of pocket.  Usually the more routine diagnostic tests, such as routine hematology, xrays, echocardiograms, etc. are done free at the hospital, but if patients needs a CT scan, a MRI, or if the hospital's blood analysis machines happen to not be working that day, they must go to a private clinic where they have those resources.  And at the private clinics you pay out of pocket.  Then you can take the results back to hospital and continue your treatment there.  Most medicines must also be paid for by patients, and when it may be an expensive antibiotic that they need, they often go without.

The last patient Dr. Rogosh saw before I left for the day was an older woman, maybe around 60 years old, that was going through chemotherapy for cervical cancer, which had spread to her bladder.  Poor woman.  Dr. Rogosh had obviously seen her many times before and was closely following her case.  Today she complained of fever, nausea, and vomiting.  She had a catheter coming out of her side, directly from the kidney, because she could no longer urinate normally.  The bag that took the urine had a hole in it and the smell of stale, infected urine filled the exam room in seconds.  They got her a new bag.  Dr. Rogosh informed the woman and her family that she would admit her into the hospital right away to treat the infection, but that they don't have a strong enough antibiotic to treat her with and that she would have to go to the public hospital in Xela instead.  The woman said that she had been there before for her infected catheter, but that she was not attended well.  She said that just a couple of med students looked at it and sent her home, only to then return to this hospital a couple days later.  Dr. Rogosh said that she would send a note with the woman to the hospital in Xela explaining the problem, but then on second thought she decided not to because then they may refuse to treat her because she had already been seen at this one.  It sounds so insensitive, but the doctor said that is the way many public hospitals work.  So Dr. Rogosh told the woman to go to the emergency room and from there the Xela hospital would have to admit and treat her.  We could only hope that after the hour and a half bus ride to Xela the woman would indeed be admitted and not turned away once again for whatever reason.

Mis primos chapines :-)

Today is Saturday, so no hospital or classes.  I was going to go to a water park about an hour and a half or two hours away - in a warmer climate than Xela - but it started raining pretty hard which could cause more landslides, so we decided not to go.  I had made plans to have dinner with Roberto's family.  I think I mentioned them in a previous post; it's a little complicated, but Roberto is the brother of my dad's cousin's husband.  So I just call them my cousins - mis primos chapines (chapin = Gutemalan, primos = cousins) - to simplify it.

At 7pm two of Roberto's kids, Ixquik and Tepeu, came to pick me up in front of the school.  Roberto and Lesbia have 3 kids, all university age.  Ixquik, the oldest daughter, is studying law, Maya is next and she's working but I can't remember in what, and Tepeu, the "baby boy" is in design school.  They live in Zunil, which is not far from Xela, but they also have an apartment in Xela, which is where they took me for dinner.  They welcomed me with open arms, had planned a beautiful dinner for me, and asked me a lot of questions about my trip so far and how my time was in Guatemala City.  I felt guilty for not having contacted them earlier, I guess I didn't realize that they were actually waiting for my arrival. 

The dinner was absolutely delicious.  It was jocóm (sp?), which is a chicken dish with a green sauce made with cilantro, celery, and other good stuff, served with rice.  When Lesbia offered me more I asked for just rice and sauce, but I guess she didn't hear me and gave me a whole serving more of chicken and rice!  We also had this amazing sweet tea - Lesbia said it's Joseph's favorite, I know you're jealous, Joseph! - but I can't remember what the name of it is!  Then after dinner we chatted and ate some of the chocolate I brought from Seattle from Theo Chocolates. 

Ixquik is definitely the most outgoing of the kids.  She asked me question after question, I almost felt like I couldn't finish answering one before she was on to another!  Tepeu was the one I had first talked on the phone to, and he had been very nice and chatty.  In person, though, he was so shy and soft-spoken, I couldn't believe it was the same person I had talked to on the phone.  By the end of the night, it was just me and Ixquik left at the table.  She helped me plan my two week trip around Guatemala after I'm done with classes here.  She even looked up hotels that are near the bus stations I'll be going into in the various towns, and gave me their phone numbers.  We'll be making plans to get together again, and I forgot to take pictures at this outing (oops!) but I will next time, don't worry Mom.

Cirugía

Today Cassandra and I decided to go to observe the cirugías (surgeries) at the hospital.  First we had grand rounds in the auditorium, then they served everyone sweet coffee and tamales for breakfast.  Yum.  We chatted with Dr. Medina, the sub-director of the hospital who is kind of crazy and known for his antics among students and staff at the hospital.  He introduced us to Dr. Aragon (Carlos), who would be doing the pedriatric surgeries for the day.

Cassandra and I with coffee and tamalitos

With Dr. Aragon

First up was a postectomía, which is the medical term for circumcision.  It was on a 2 year old little boy that was getting chronic infections in his penis because the foreskin was very tight.  Compared to what I've seen and described to you in the rest of the hospital, the surgeries are very clean and efficient.  I didn't see any monitoring equipment there either, but there is a respirator and the anesthesiologist is constantly observing the patient and taking blood pressure readings.  I realized that I never really had a clear picture in my head of what a circumcision procedure actually looks like until now, how the foreskin is cut, how much is cut off, and what they suture.  It was a good thing they did it on this kid because when they pulled the foreskin back there was quite a bit of pus in there.

With other med students

Next up was supposed to be a surgery on a boy to drop his retained testicle, but an emergency came in before they got started on it.  The emergency was an older man, he appeared to be about 70 years old, who had gotten into some kind of accident with or in a pick up truck, resulting in his left forearm getting filleted open from pinky to elbow.  Pretty gruesome.  Luckily he had no broken bones, torn tendons, or damaged nerves or vessels in the arm, but the hand was a little more cut up.  That surgery took a while so in the meantime we chatted with Carlos, the surgeon we were following, who was just waiting for the other surgeon to finish with the arm so he could do the testicular retention surgery.  We asked about his life and found out that he plays volleyball and basketball 5 days a week or more, he lives alone, has never married, and has 3 kids with 3 different mothers.  At this last divulgence he turned away in embarrassment, so we quickly changed the subject back to sports.  I was able to take a lot of pictures with the doctors and students and we all exchanged emails to share them.  Cassandra and I had already received an email from Carlos by that same afternoon!

Since the arm surgery was taking a while, Cassandra and I decided to observe a C-section instead before we had to leave.  They have a operating room reserved exclusively for C-sections because they have so many.  The mother was over 9 months along and the baby still hadn't even dropped down closer to the pelvis, so they decided to operate.  The surgeon made a vertical cut in the abdomen and then a horizontal cut in the uterus.  They had pull pretty hard at the opening and pushed on the upper abdomen to get the baby's head out.  Once the baby boy was out we followed him into the next room where they did all the post-birth stuff, cleaned him, weighed him, gave vitamin K injection, etc. while the mother was being sutured up.  It was so beautiful, I'm thinking maybe I'll go into obstetrics!!

La Manifestación

Today was another hospital day and this time more students decided to come.  Cassandra (from near Portland, OR), Liz (from Philly), Josh (Denver) and I met up in front of the school at 6:30am to walk to the bus stop.  As always, we took a microbus to the rotonda to catch the big bus to Totonicapán.  When we got on the bus they only charged us 3.00 quetzales each instead of the usual 5.50Q.  I didn't think too much of it, I thought maybe it was our lucky day.  As it turned out, quite the opposite.

We arrived about 30 mins down the road at Cuatro Caminos (Four Roads) where the bus stopped, turned around, and turned off the engine.  The driver said we had to get out, cross the street, and walk "como cinco cuadras (like five blocks)," to catch another bus, with no further explanation.  So we did that, along with everyone else getting off the buses.  We were confused as to why this stretch of road was closed off, so I asked a man on the side of the road.  At first he just repeated that we had to walk to get to transportation, but this time it was 3 or 4 kilometers.  Finally he told us that it was because there was a manifestación, a protest, that the road was closed off, but that if we walked past Las Cruces, where the protest was being held, we should be able to find transportation to Toto. 

Walking toward the protest at about 7am

It was probably a kilometer before we reached Las Cruces.  There was a stage with large speakers where the protest leaders were giving speeches.  The people there were mostly farmers and indigenous people who were protesting the high cost of electricity.  Apparently, in that area households are paying an outrageous amount for enough electricity to light only a bulb or two, stemming from last year's very low rainfall.  Even after this year's record-breaking rains, they're still paying the higher cost.  There was such an energy there by the stage, with people holding signs and vendors taking advantage of the large gathering to sell food and hot drinks on that foggy morning.  It was encouraging to see that the people here really try to organize and fight for their rights rather than remaining apathetic toward injustice, which would be easy to do when you feel ignored by your government.

The protest at Cuatro Caminos

Cuatro caminos is a very important section of the highway because all transport goes through there to reach different towns and cities in the region - trucks carrying goods to market, buses with travelers, commuters, etc.  Seems like the protesters have a clever strategy, but it's not the government or the electric company that ends up suffering the most, it's the regular people who are just trying to make a living.

We continued walking down the road toward Toto, expecting to be able to catch some kind of bus along the way.  We definitely saw a lot of buses, but they were all stopped and empty along the side of the road.  Occasionally we'd get passed by a pickup full of people.  After maybe an hour and a half of walking we decided this was a fruitless journey, and even if we did make it to the hospital, we'd have to leave almost immediately to make it back to school in time for classes.  So we turned around and walked all the way back to where the bus had dropped us off.......but the buses were gone.  The protesters had extended the road block even further down the road, which added about another 30 mins to our walk.  Finally we got a bus and made it back home at about 11:30am.  Enough time to take a little nap and have lunch before class.

Right before we gave up and started walking back

I talked to my host mother, Marta, about the manifestación and she said that Guatemala is a country of many protests, but with little results.  There were two other protests around Xela just this week, one for children's education, and one for access to healthcare and medicine.

El Volcán Santa María

Today is the day I reached the top of the world.  Or at least as close as I'm going to get to it.

We met at the school at 4:30am and our guide, Martín, drove us in a van to the base of the Santa María volcano.  A few of us from Miguel Angel Asturias went, as well as about 10 other people from other English schools in Xela.  Last weekend I went for a bike ride to a neighboring pueblo with a guide and two of the other students I went with also came on the volcano hike.  We started hiking just after 5am.  About 20 mins into the hike one of my classmates started getting so dizzy that she couldn't walk straight.  This was before we had climbed any significant vertical amount, so Martín was going to take her back to Xela. 

In the meantime, we continued with the other guide.  The first part was relatively tame, we basically walked in a little creek bed - that is only a real creek when there are heavy rains, like there were 2 weeks before - until we made it to la meseta, a flatter, grassy area before we start climbing the actual cone of the volcano.

View of cone of volcano from la meseta

Xela is at about 7,700 ft and the top of Santa María is at 12,375 ft.  If I do my math right, that's more than 4,600 vertical feet of climb.  And it sure felt like it!  From the meseta the cone didn't look all that imposing, as another student pointed out, but of course, that was enough to jinx it.  It was a steep climb from there with lots of switch backs.  Every time I though we were getting close, the guide would say, "Oh, not much more, maybe another 2 hours or so."  As we got closer to the top we started spreading out more because some people, like myself, were more affected by the elevation and had to stop more often to recover.  At one point I was going at about the same speed as a group of 4 indigenous women, representing 3 generations.  They said the they hadn't had anything to eat or drink since the night before because it's better to make the climb on an empty stomach.  I had already had a cinnamon roll for breakfast, which in hindsight was probably not the best choice.  I didn't feel quite as out of shape seeing that the women had to stop almost as often as I did to catch their breath.  However, they were climbing in foam flip flops with their lunch wrapped in cloth on their backs.  And they do this climb very often.

As I neared the top of the volcano I started getting nauseous.  I would catch my breath just fine when I stopped to rest but then once I started moving again I felt like I had to rest every 10 steps.  I finally got there at 9:40am.  I sat with a group of students who had already arrived and tried to eat some of the bread and peanut butter I have brought.  I didn't get far into the food before I had to stick my head behind a rock and vomit up everything I had eaten that day.  I felt a little better after that, but still like I couldn't fully enjoy the view and the experience of being there, which was truly amazing.  I laid down on one of the many huge boulders and took a 40 min nap in the sun.  It was cold enough to need a fleece and jacket over it, but in the sun it was perfect.  After I woke up I was finally able to look around and appreciate where I was.  We could see every little town and the clouds were racing by just below us.  Groups of people in their indigenous dress were doing their prayer rituals mixing Spanish, Quiché, Christianity, and indigenous rituals.  Some people climb the volcano to pray every weekend.

View from the top

At 11am we started the descent, which was much more pleasant.  Usually my knees and hips start bothering me when I go down, but this time I felt fine the whole time.  We reached the vans around 2pm.  I thought I was going to be so sore after such a hike, also because I haven't been doing any significant amount of exercise recently, but I actually felt great the next day.

The girl that had gotten dizzy at the very beginning of the hike had actually continued after sitting for about 30 mins.  I couldn't believe she still wanted to keep going after getting so dizzy fromt he very beginning!  She was pretty hardcore.  We ran into her on the way down the volcano, she made to within about 20 mins of the top, but never actually made it there.  Later that day she said she had really wanted to get to the top and asked if anyone would do it with her the next day.  Seriously?  The next day?!  Maybe in a couple weeks.

Disturbing incident in cuidado intensivo

Every Friday at the hospital, all the med students doing their rotation there gather in the auditorium for announcements and a guest speaker.  Today it was actually a very inspirational speaker.  I don't remember his name, but he was a very experienced M.D. who also did some family counseling.  It was more of a motivational speech about how our (the med students') attitude toward work and their personal life will dictate how well we do and how much we can achieve in both those realms.  These were all ideas I've heard before, but for some reason it touched me differently, perhaps because it was in Spanish, with different metaphors and different ways of explaining things.  One line that I particularly liked was, "No es responsable por la cara que tiene, pero sí es responsable por la cara que me pone."  Translation: "You're not responsible for the face that you have, but you are responsible for the face that you give me." 

After the speaker, I went on rounds in the men's ward, then up to cuidado intensivo de recién nacidos, where I had been the whole week.  They had already started rounds with the doctora, and were huddled around a baby in the corner, discussing that case.  I joined them for a minute, then went around to look at the patients, seeing who was still there and who had gone home.  I stopped at a little baby boy, one who I had seen on my first day, the preemie that was born at 34 weeks gestation.  He was under a phototherapy light for his jaundice and had his eyes covered with a little blindfold.  As I looked closer, I thought I was hallucinating that his chest wasn't moving.  Sometimes premature babies will "forget" to breath for a few seconds, then usually start up again.  I waited, still no movement.  I couldn't tell what color the baby was because of the bright blue light he was under, but as I looked closer, it didn't look normal.  As I took all this in, it didn't register right away and it was hard for me to believe that no one else had looked at this baby earlier (they are supposed to do their physical exam right before rounds) or noticed that anything was out of the ordinary.  My heart was pounding.  Was this really happening?  Am I overlooking some obvious sign that he's really OK?  I had to tell someone, so I called a student over, he opened the incubator, listened to the baby and called the doctor over immediately.  She felt and listened to the baby, and almost right away said he was dead.  At this point it was a little hard for me to understand what she was saying because she was both talking to herself and yelling at the students, but I assumed that he had been dead a while because there were no attempts made to resuscitate him.  The doctor proceeded to lecture the students that it appeared that the baby hadn't even been looked at before rounds, when the physical exam was supposed to be done.  Afterward, we went on to the next patient and nothing further was said about it.  At that point I decided that I'm never going to have a baby or have any kind of health problems near this hospital, nor will any of my loved ones.

It occurred to me how easily something like this could happen in the cuidado intensivo here.  There are no monitors on the babies to read their heart rate or oxygen levels, so if a premature baby stops breathing, which can happen very often, there is nothing to alarm the staff about it.  The doctor and students are usually busy with rounds and paperwork, and there are only 2 nurses staffed for up to 17 babies.  Obviously the treatment the babies are getting is better than nothing at all, but it just scares me how easily a baby in trouble can be overlooked until it's too late.

Mole de plátano

Today I went to Daniela's host family's house and her mother, Sylvia, taught us how to make mole de plátano.  It's somewhat similar to the Mexican chocolate, spicy mole that they put on enchiladas and chicken, but this one is a little sweeter and goes on fried plantains....mmmm..... 

If you're really nice to me I'll make some for you. :-)

Cuidado Intensivo de RN vs. UW NICU

The hospital is very flexible and accomodating to volunteers, lucky for me.  I mentioned that I like working with babies and they sent me to the department of RN (recién nacidos or newborns), which includes the postpartum and intensive care (cuidado intensivo) units.  I was so excited, first of all because I just love babies and second because in the States I've been volunteering in the NICU (neonatal intensive care unit) at the University of Washington.  I thought it would be so interesting to compare the same units in such different settings. 

The UW specializes in micro-preemies, the smallest and most premature babies, but they also care for bigger babies with health problems.  Every baby, no matter what their problem, is hooked up to a monitor that measures heart rate, respiratory rate, and blood oxygen levels.  The monitors have alarms that alert the nurses, for example, to a baby whose heart rate or oxygen levels have dropped suddenly.  There are usually six babies per large room, each with their own crib or incubator, and 2 or 3 nurses to a room, each assigned to specific patients.  There always has to be at least one nurse in the room if one leaves to go on break or has to retrieve something from another room.  The nurses are constantly charting, doing feedings and treatments, or simply checking in on their patients.

The UW NICU's counterpart in the public hospital here is.......different.  It is only one room, including a little connected "isolation" room, in total probably the size of one room at the UW.  I always put "isolation" in quotations because they don't seem to take many of the isolation precautions that I'm accustomed to when treating those patients, as I described in the previous post.  The big room has 3 incubators, 2 beds with lamps for light therapy, and 7 cribs made of metal tubes and plexiglass, all side by side.  The isolation room has 2 incubators and 3 cribs.  I love going on rounds with the very friendly doctora and 4 med students.  I listen to them discuss the baby's background, health issues, and treatment plan.  They have one pulse/ox monitor that they take around to each baby, clip onto the foot or hand, and record the heart rate and oxygen levels.  One baby's story was so sad: she was 3 months old but was very small because she was malnourished, and her skin was peeling and raw around her neck and chest.  Both of her parents are alcoholics.  The neighbor heard the baby crying for a while and so went to check on her, and basically found the baby abandoned in her home, which is when she brought her to the hospital.  In the week that I saw her, her skin improved immensely and she appeared to gain energy and strength.  Who knows what will happen to the baby when she's discharged.

¡Día de la Independencia!

This whole week there are independence celebrations going on, but tonight (Sept. 14th) is the official start of the independence which also goes through tomorrow.  There is so much energy around town with kids dressed up in their marching band attire going to and from their parade, the discotecas fill up with the young crowd for dancing, and at midnight there is a big fireworks show in Parque Central.  The feria is also going on through this coming weekend where people can go on rides, play fair games and eat lots of street food.  It's a ways away from my school and homestay, and I decided to stay away from that huge crowd of people, though I heard it was enjoyable.

Children in the parade

Talking to my host family about all the festivities going on this week, they seem pretty burnt out about it.  There are desfiles or parades almost every day, for the pre-primary kids, the primary kids, the secondary schools, the high schools, and the high school bands.  Each parade lasts 4 or 5 hours.  They never start on time and there always seem to be more kids than anticipated.  I can only imagine what it's like for families with 3, 4, or 5 kids of all different ages in all the different desfiles.  There is some pretty tough rivalry between the two largest high school bands.  They both come out and parade through the Parque Central just after the fireworks show at midnight and they were talking about not even having them do the parade because of physical fights that happened between them last year.

Fireworks at midnight

Bandas on parade

Selling sweets in Parque Central

A group of students and I all went dancing at a club before the fireworks, mostly merengue music, which I love.  It's amazing how many different and interesting people you meet on a night out in a foreign country, people that normally probably wouldn't hang out together if it weren't for our connection as travelers.  Our group just kept growing, and by the end of the night we were all exchanging emails and names to find each other on facebook so we could share photos.



Because of the late night, the next day I decided not to plan anything and studied and read a little at a café with another student.  I felt like it was one of the few days where I could sit back, be on my own schedule, and just take a deep breath.....aaaaaahhhh.

El Hospital Público de Totonicapán

I already described the ride to Toto in the previous post, which is always an adventure.  Actually, not a bad way to start the day.  The hospital lies at the end of a long driveway flanked by grassy area and a kiosk close to the hospital where you can eat lunch or get a snack.  One time I saw a little boy urinating into the grass on the side of the driveway, which is not at all unusual, but then I saw a woman about 10 feet away on the grass popping a squat under her skirt, right in front of everyone.  It's normal to see men urinate on the side of the rode or onto the side of a building - even in the middle of the city - but that's the only time I've seen a woman do it in public.

Funny sign on the way to Totonicapan - "Prohibited to urinate in this place."  There is a Q50 fine if you are caught.

Driveway up to hospital

Hospital in Totonicapan

The hospital is 2 floors and also has a public clinic where doctors see non-emergent cases.  One of the other American students I volunteered with was always amazed at the lack of sanitary practices.  It's true, the doctors would use the same stethoscope on all the patients they see, including those in "isolation" rooms without cleaning with alcohol afterward, and without washing their hands.  The bathrooms have toilets with no seats, no toilet paper, no soap for washing hands, and no towels to dry hands.  All toilet paper goes into a trash bucket next to the toilet, nothing gets flushed down the toilet, but this is true of every bathroom in Guatemala.  I kind of think of all this in the context of where we are and the resources, or lack thereof, available to the hospital; I recognize that it's not going to be as clean and efficient as the hospitals that I'm used to in the U.S.  I do wish that they there was more soap and more handwashing though!  And another interesting note: there are big analog clocks in every single hallway, sometimes you can see 3 at once depending on where you're standing, and none of them actually work.  Not one.  The hands don't even move.  Nobody seems to know why, either.

At 8am sharp I usually go on rounds in the men's ward with a doctor and a group of 4 or 5 med students who present their cases to the doctor.  They discuss diagnosis, lab tests, treatment, and what they need to study up on for the next day.  During the first week I went to the hospital, there was a poorly controlled diabetic, a man with a urinary catheter and a kidney stone 1cm in diameter (ouch!), and a man who'd been drinking for days and now had a tube up his nose with dark green bile-looking fluid in a bag at the other end.  Unfortunately, alcoholism is a huge problem here, and very openly practiced.  It is not at all unusual to see several men, rarely women, passed out drunk on the sidewalk during a leisurely stroll through the city.  There was also a man in "isolation" that had been in a motorcycle accident a few days before, suffered sever brain injury and was essentially a vegetable.  He had no ID on him and no family came to claim him, so he ended up dying alone.  I thought it was interesting that he was not connected to any medical equipment like a respirator or monitor of any kind, just an IV drip.  Though none of the other patients were either.

I could understand a lot of what was being said about the patient, what they were asking him directly, but not as much about diagnosis and treatment.  Obviously much of it was over my head because I haven't studied it yet, but the basic problems and reasons for them I was able to grasp fairly well.

La Escuela de Español Miguel Angel Asturias

Miguel Angel Asturias Spanish School

Miguel Angel Asturias Spanish School is located about a 5 minute walk from the Parque Central, the center of downtown Xela.  It's named after a Guatemalan poet, novelist, playwright, journalist, diplomat, and winner of the Nobel Prize for Literature.  He was on ly the second Latin American to receive this honor.  He is a source of national pride for helping establish Latin American literature's contribution to Western mainstream culture and at the same time drawing attention to the indigenous population of his native country (thank you, Edna and Wikipedia).

On a typical school day, I volunteer at the public hospital in the morning and have Spanish class in the afternoon.  I wake up around 6am, get ready, eat a quick breakfast (I tell my host mother to leave it out the night before so she doesn't have to get up so early to cook), and walk the 5 minutes to school to meet up with other students at 6:30am to take the buses to the hospital to arrive there by 8am.  The hospital we go to is not in Xela, but in a town called Totonicapán.  We walk to catch a microbus, which is really just a large minivan that serves the urban area.  The driver has a helper that hangs out the sliding door -which remains open the whole ride unless there is a policía nearby because it is actually ilegal - and calls out their destination.  Sometimes it gets so full that people are sitting on each other's laps, and it always seems to be the ones in the very back corner that need to get out first.  In the microbus we ride to la Rotonda, which is basically the entrance to the city.  From there we take a "chicken bus" - very colorful old school buses - for almost an hour to Totonicapán (or just Toto) and get dropped off right in front of the hospital.  The buses never refuse a ride to anyone because it's too crowded.  People will sit on top of each other, stand in the isles and hang out the open door before they wait for the next bus! 

I get back for lunch with my host family around 1 or 1:30pm.  Then class starts at 2pm and goes until 7pm, with a 30 min break in there.  Each student has one teacher with one-on-one tutoring for those 5 hours.  The teacher changes every week unless we put in a request to have the same one.  Right now there are only 7 students including myself; in the summer months it gets up to 35-40 students!  Most of them hardly know any Spanish at all, but you can hear their improvement over the few weeks that they are here.  Since I already know a lot of Spanish, my classes are mostly conversation and learning medical vocabulary.  The school also hosts various different activities such as watching movies in Spanish, visiting indigenous weaving cooperatives, or tours to old churches in the area.  There's always something to do here!

Woman weaving at Trama, a local women's weaving cooperative

Iglesia de la Hermita in Solola, the oldest church in all of Central America

¡Por fin llego a Xela!

After speaking with one of the marvelous directors of Miguel Angel Asturias, Juan, I decided to spend however many more nights I would have to spend in Guatemala City with Raquel, a woman who works with the school.  She takes students into her home when they are on their way to or from Xela and going through the City.  She was wonderful to me, offering me lots of good - and safe - food, and drew me a map so I could go and walk through Central Park and not get lost.  She called the bus station for me every day and finally made a reservation for Thursday morning, Sept. 9th.

Normally the ride up to Xela is about 4 hours long on a bus.  This trip, however, took about 7 hours.  We left the City at 7am and arrived in Xela at 2pm.  Not only did we pass the big landslide that had covered a bus and killed so many people - only one lane of traffic at a time could get through there - but there were landslides all along the highway route.  In several areas there were long lines of traffic waiting to get through bottlenecks.  It looked absolutely devastating.  It was devastating.

A landslide blocking half of the highway.  This was a small one.

Xela, a.k.a. Quetzaltenango, is the second largest city in Guatemala, next to Guatemala City.  It is, however, much more charming with its cobblestone streets and colorful buildings and homes, and safer.  I met 2 girls on the bus who are from the States and shared a cab with them from the bus station to Parque Central, where they got off and I continued to my school, not far away.  Then I was taken to my host family's house, just a few blocks away from school.  My mother is Marta, my father Julio.  They have 3 older kids, Robyn, Ingrid, and Julio, who are studying at the university or working, but they all still live at home.  It's normal for children to live at home until they get married, sometimes into their 30s.

Municipal building in Parque Central

Tree in Parque Central

View of the Cathedral

Houses in the cities in Guatemala, as in Mexico and most of Central America are, from the street, a cement wall with a door and a garage door, often with barbed wire or broken shards of glass fixed to the top of the wall.  But inside there's usually a little courtyard and overall charming living areas.  My room is separate from the rest of the family, above the garage where they have several rooms and bathroom ready for students to come stay.  Marta prepares 3 meals a day for me and she or her daughter, Ingrid, always sit and chat with me while we eat.  It's actually great accomodations for me because I almost always have someone to talk to, but I still have the privacy of my own little living quarters.

My room

View from the roof terrace of my house

Esmeralda

I ended up getting a hold of the school in Xela later that first morning at the new hotel, after having to call the office in the States and figuring out that they ahd published the wrong number on their website.  Later that night, on Sunday, I was using the internet at the hotel, reading news about the landslides that prevented me from getting to Xela, when I struck up conversation with the woman sitting next to me.  She told me she was going to Cuba soon to get married and she showed me pictures online of her future husband.  She was so nice at the first meeting and we seemed to click, so we made plans to meet the next morning at 9am to go out together because she was also nervous to go out by herself in the city.  I figured the buses probably wouldn't be running by then anyway.  Her name was Esmeralda, and as I found out the next day, she has an amazing story.

Esmeralda was 2 hours late for our date, and I couldn't wait to eat.  I had already gotten up at 6am to see if there were any buses to Xela, but no dice. The receptionist at the hotel, Pedro, who was very nice and accomodating, recommended that I get take out for breakfast so that I wouldn't have to go out searching for food by myself.  So I did it....I can't believe I did it.....I had McDonald's take out in Guatemala City!  I never even eat McDonald's at home!  But I have to say, it was better than having to go to the bathroom every few minutes.  Finally Esmeralda arrived and we went walking together to a mall, where we would meet up with a friend of hers for lunch.

Esmeralda looked to be about my age, late 20s, maybe early 30s.  She wore tasteful, modest clothing and had a charming laugh, which she used often.  Throughout the course of our conversations I found out that she is from el Petén, the department of Guatemala where the Tikal ruins are located, and is staying with a "poor, Christian family" just across the street from my hotel in the City, while she waits for her and her fiancé's papers to come through so she can go to Cuba for the wedding.  After they marry there they want to come back to Guatemala to live.  He is a Cuban doctor who had done a 2 year mission in Esmeralda's town, which is where they met.  He had left 3 months before, which is how long she's been waiting for these documents to come through.  She was hoping they would be ready by the 9th, just a few days away.  I also found out that she has 4 children, the first one she had at 15 years old, with her first husband, who died.  I didn't want to ask how.  She also said her parents have already died, in an accident.  And now she's a grandmother!  With a 1 month old granddaughter named Ghiseline.  Did I mention that Esmeralda is only 31 years old?  I was glad that she wasn't offended by incredulity, she could hardly believe that she was a grandmother either.  I couldn't get over that she's only 31 and she's already had more than a lifetime of experiences!  I asked if it was normal in Guatemala to have families so young and she said it is in the rural areas but not in the cities.

We talked as we waited for her friend to get off work for lunch.  She told me all about the experiences she has had with her fiancé in Petén, where she assisted him at the hospital.  One story involved a 19 year old boy from the States who went skinny dipping in the river and literally swam into the mouth of a crocodile.  He succeeded in escaping by sticking his fingers in the croc's eyes, but not without severe bite wounds around the face and neck.  He crawled naked up to the road where he got a ride to the hospital.  He didn't know much Spanish and all that he said while Esmeralda's fiancé was stitching him up was, "estética, estética!"  Apparently he was more concerned about scarring than about the fact that he was almost eaten alive by a crocodile!

Later we had lunch with her friend Jaime, who was very nice but liked to make little jokes that were hard for me to understand, being a non-native Spanish speaker.  We all got along really well and later Jaime took us to see a movie in the big mall, Miraflores.  A little taste of great American entertainment in Guatemala City.

Stranded in Guatemala City!!!

I'm doing a little backtracking, so this might be a long one.....

I left on a 6am flight on Sept. 4th from Seattle, through LAX and Dallas, and finally on to Guatemala City.  I was a little nervous about arriving in the city because of the warnings I'd received from various people who've traveled there about walking alone in the streets, gettind duped by taxi drivers, etc.  I have traveled through various countries in Central America, and have even lived in Mexico City!  So I've had my share of nervewracking travel experiences and situations.  But I think one can never let her guard down while traveling, especially such an obvious gringa such as myself.  I got some great tips from my dad's cousin, Jean, and her husband, Martín, who is from a town near Xela, which is where I will be spending about a month.  They've been traveling back and forth between the States and Guatemala for about 25 years.  They have also been very generous to give me the names and numbers of Martín's family there and have let them know I'm coming so I can meet them!

I arrived in the city at about 7pm on Saturday the 4th.  I spent the first night at a very nice hotel that Jean had recommended for me.  It was a bit expensive for my budget, but worth it for a clean room, cable TV, and a hot shower after a long flight.  It's also run by a couple and their two daughters, I felt very welcomed.  The next day I took a taxi to the Linea Dorada bus station, which is supposed to be the nicest one of several bus lines, with air conditioning and a bathroom, which is nice for the 4 hour bus ride to Xela.  When I got there at 6am I went to the counter to buy a ticket, but the woman told me there was no bus to Xela that day.  She told me there had been landslides that blocked the highway and said I'd have to get a taxi back to my hotel.  I had not heard anything about the landslides, so I thought maybe another bus line would be sending buses up there.  I took a taxi with a very outgoing taxi driver that told me all about the landslides that had happened just the morning before, when I was on the plane and oblivious.  There had been an extreme amount of rain that had fallen the week before I arrived and into the weekend.  A bus carrying about 30 or 40 people had been hit by a landslide and then when people gathered to rescue them from the mud and rain, another slide fell on them and covered everything.  By the next morning more than 42 had died in that one landslide.  Apparently there were other slides all along that stretch of highway that killed more people.  Needless to say, the other busline wasn't running buses either.  The taxista took me to a hotel - Ejecutiva Reforma - that was 2 blocks from the Linea Dorada station so that I'd be close in case they started running buses again. 

It was a nice enough hotel, the rooms were clean and there was hot water, though the sheets were so threadbare I might as well have sleeping directly on the mattress.  But there was cable TV! Yes!  At least I'd have some distraction if I ended up having to stay here a few days.  I slept a little, then went to explore the few blocks just around the hotel, I didn't want to venture too far yet.  The only food available around there were either in fondas, little dining areas which are basically the main floor of people's houses where you can get some eggs and beans and tortillas, or chain places like Dominos.  That day I went for Dominos.  I know, I know, why Dominos, of all places, when I could savor typical Guatemalan cuisine?  I did it for my stomach.  I really didn't want to get traveler's diarrhea first thing, when I was already a little frustrated and disappointed about not being able to get to Xela that day.  So I enjoyed some hot pepperoni pizza while sitting on the steps of a monument nearby.