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.