The revered wooden gentleman above is none other than the deity Maximón. It took two boats, a steep climb and an 80 cent payment to an enterprising six-year-old guide to have the privilege of paying my respects; or at least gawking like the shameless tourist that I am. It was a fascinating ritual during which one man was praying while Maximón was given rum and cigarettes. The man to Maximón’s left did nothing but collect the now-holy cigarette ashes. I spent some time taking it all in before paying my dues and leaving. By the way, it costs surprisingly little to have Maximón place a curse on someone, but I won’t go into that now.
This week was my second visit to the clinic at Tzununá. We basically just hauled all our equipment into the municipal building and set up shop in whichever rooms were available. Very simple, very effective and definitely not JCAHO accredited. It’s kinda nice to provide healthcare without all the bureaucracy we’re used to in the US. And whatever bureaucracy there is here, I’m pretty sheltered from it as a student. I’m definitely going to miss that aspect of this rotation. But, the truth is, I’m ready to be back in cold, dreary Washington. Just a couple weeks to go.

Halfway

All the interesting events here seem to involve the animal kingdom. The dead bug count is now at four scorpions, two wasps, one centipede, two spiders that exceeded their size limit and two bugs that I couldn’t identify but looked scary enough to deserve a pre-emptive strike. Shock-and-awe was used effectively against a pack of dogs that decided to form a fight-club outside my window at two o’clock in the morning. And one unfortunate armadillo was turned into a tasty meal by the local tuk-tuk driver. No, I didn’t eat any.
Yesterday, in our new clinic at Tzununa, I saw a nine year-old boy with a case of the scabies that makes the Harborview ER look sanitary. He was nearly covered with itchy sores. We gave his whole family Ivermectin but it’ll be nearly impossible for them to clean all of their clothes and linens. We saw the normal amount of patients with parasitic infections and a handful of gut problems that were probably due to rotavirus. And, locally, a boy was bitten by a dog without vaccinations. For me this place sheds a whole new light on our relationship with the natural world.
I’ve been given an interesting case to follow, a woman in her 40s who had the misfortune of developing viral pericarditis several months ago. Since then she’s lost about 40 pounds and is quite malnourished. We’re trying to get her nutrition back on track but her weakness, cardiovascular state and a recent bout of diarrhea have complicated things. Part of the reason she’s in such bad shape is because a local curandero convinced her family to pay him a significant amount of cash to take care of her. For the most part I have no problem with traditional healers but he really took them for a ride, leaving her health in a pretty precarious state. But, with daily visits and encouragement, she’s been showing some improvement. We also have a bit of a mystery case on our hands, a young boy with bleeding gums/lips and petechiae. Likely von Wildebrand’s but we’ll know for sure when he visits a hematologist in Guatemala City next week.
Well, that’s enough med-speak to make everyone think I’ve been working hard. Yesterday I took a hike up to El Mirador, one of the little peaks overlooking Santa Cruz. It took about 2 ½ hours to get to the top but the view was worth every bit of the soreness I’m feeling this morning. I’ve also been meeting some interesting people here. There’s an odd mix of locals, ex-pats and travelers, all drawn here by the beauty of the lake and a different pace of life. Some come from strange, far-away lands like Italy, Australia and Alabama. One of the ex-pats rents out kayaks and has a 9’ Sunfish he said he’d let me take out when the wind is right, maybe today.

Just pics

Some more images from Lake Atitlan.

I couldn’t have asked for a more interesting week. I arrived in Panajachel on Saturday and in Santa Cruz on Sunday. The beauty of this place is awe-inspiring. Santa Cruz is a town of about 2000 that sits on a hill on the north side of the lake. The touristy businesses are located on Lake Atitlan but the center of town is about a twenty minute walk up the steepest set of stairs I’ve ever seen. The 5100 foot altitude makes the walk even tougher. I usually walk up the considerably less steep street that winds its way up to the village but still get passsed by 70 year old women carrying bundles of wood. But the tough climb is more than made up for by the incredible views of the lake and the two volcanoes on the other side.
I’m paying a bit more than I wanted for lodging at Casa Rosa but have a nice little apartment complete with furniture, hot water, a kitchen and scorpions. I’ve been told that there also black widow and brown recluse spiders to keep me company but none of them have introduced themselves as of yet. I don’t blame them after what happened to the scorpion. The hotel is surrounded by a small jungle and has some impressive views of the lake.
On Tuesday I went on my first boat trip to a local village named San Pablo to set up clinic for a day. Lots of kids, lots of parasites and even orbital cellulitis. I gave out more albendazole in one day than I saw in a year and a half in Seattle. Wednesday was supposed to be a lecture day but we were asked to help a man in the mountains who had fallen. After a 45 minute climb in the mid-day sun we found the guy and helped him back down to the clinic. Fortunately, he appeared to just have heat stress and recovered well. Totonicapan was our destination on Thursday. The clinic is a 2 hour boat/van ride from Santa Cruz and serves primarily adults. The most interesting patient was an elderly woman with congestive heart failure and diabetes. Not too different from what I saw daily at the VA but both diseases are pretty rare in this region. Both diabetes and cardiovascular disease are extremely uncommon in Santa Cruz due to the shorter life-spans and the amount of exercise the locals get walking up and down the hill. Interestingly, at least three of my patients yesterday attributed their problems to "sustos", or frights, that they had received years earlier. Just one of the cultural differences that makes working here so unique. On the way back we met an ex-pat that lives in Santa Cruz and was doing some shopping. He offered us a ride back across the lake so we loaded our stuff onto his party boat and headed out. About ten minutes into the ride his boat broke down and we were left stranded with a strong wind pushing us farther out onto the lake well after sunset. One of our assistants was able to call a friend to come rescue us but it took about an hour longer than we had planned. The good part was the chance to enjoy the lake after dark. After 3 ½ years in Seattle I had almost forgotten what stars looked like.
My plan for the weekend is to stock up on some necessities in Pana and then hit the market in Chichicastenango. I’ll definitely do some hiking if there’s time. There’s also diving and hang-gliding here so I’ll be running out of money before I run out of things to do.

First few days in Guatemala

What a wonderful world we live in. A person can be in a totally different world in just a few hours.
My first couple of days here weren´t too exciting. I didn´t head out to the beach like I had originally planned but stayed in Guatemala City instead. On my first day here I participated in my favorite recreational pastime, sitting on my ass doing nothing. It was while I in the Central Plaza, engaged in this strenuous activity, that I met a gentleman named Hector. He´s a rural schoolteacher who was in the city to get some dental work done and file a dispute over his pay. Neither of us had much to do during the morning so he offered me a walking tour of the city. We ended up wandering around for hours practicing Spanish/English and admiring rows upon rows of dead animals in the market that tourists are warned not to go into. After a great lunch we parted ways and I ended up spending some time at the typical tourist sites. My second day was spent doing much of the same, with the added excitement of having my pocket picked on the city bus. They didn´t get much money but stole a sizeable chunk of my pride. In 20 years of traveling to somewhat sketchy places I´d never been robbed. Cest la vie. By the third morning my lungs were starting to feel like they´d been put through a meat grinder due to the pollution so I hopped the bus to Antigua.
I had forgotten just how beautiful this town was. There are a lot more tourists than I remember seeing 13 years ago but it´s still an incredible place to visit. Much of the city was destroyed by a large earthquake 200 years ago and several since, leaving some great ruins to visit. A luxury resort was built on one of those sites so people can enjoy crumbling walls for only $140 per night. Unfortunately my stomach started feeling a bit bad last night so I downed Immodium and Cipro and headed to the farmacia to stock up on gut goodies. An American woman stopped me at the counter and insisted that I try Xanax for my ills. She said she was a paramedic and gave it to her patients. Then she pulled out a blister pack of Xanax and offered it to me. She added that she also had a supply of morphine if I so desired and that it was all okay since she was a paramedic. Rule number 17 of international travel, the tourists are often far more interesting than the locals.
Well, it´s about time to head to the market, this time with my money in a safer pocket.