Just call me Dr. House...

I haven't exactly been able to post my thoughts as I write them. This is from yesterday.

Jueves 2 Julio 2009

It’s 7:30 at night now. Because I’m not too tired I think I will try and give a brief description of the Mission House, my experience the last few days in the clinic, and the other things I’ve been doing. I feel like every day thus far, I have woken up with the sun and have been busy until I am serenaded to sleep by the music pouring from the Taberna across the street. What great neighbors! Good thing I have earplugs…

First, I’ll go over Barillas. It’s a town of about 6-8 thousand people apparently, though it doesn’t seem like it at all. There is a elementary school, high school, a few clinics and doctors, and a public health office (also functions as a clinic). There is the main road into Barillas which is lined with both houses and businesses. Often, one building serves both purposes. I bet somewhere along this avenida one could serve whatever interest they had: food, auto repair, supermarket, ice cream, clinic, police station, army outpost and ferreria (bus stop, really more of a bus hub; the sidewalks are usually lined with people waiting for a bus, van, or pick-up truck to somewhere. Many of these people are indigenous Indians that have come into Barillas to pick up something, see the doctor, etc. There are over 250 aldeas (small towns or villages) that surround the vicinity of Barillas. And many still wear the “traje tradicional,” the traditional dress complete with hair wrap, long skirt, belt and shirt. It is not uncommon to see someone carrying a baby wrapped in a large piece of fabric and slung around their back, balancing water or food on their head, or hauling a bag of good on their back or strapped to their forehead. The fabric of the traje tradicional is brightly colored with beautiful patters.). There are also a few busy streets that branch off from the main street that are filled with restaurants and stores. I don’t think any of the streets have names and if they do I haven’t seen any street signs to identify them. There is an open air market about 5 blocks off the main drag which is surrounded by many stands selling clothing, toys, food, etc. And business is certainly not constrained to any official store building. Many houses blocks from other business centers sell firewood, homemade ice cream, and more.

The Mission House, where I am staying, is just 4 blocks from the main square-park, Centro Municipal (town center, I don’t know exactly what goes on there, probably tax and business information, but this morning there was a long line to get in) and ferreria. And like I said, there is a tavern kitty corner to the house. Today I explored the furthest into Barillas that I have been to find a restaurant that brought food to a Rotary meeting I was at last night. I only knew its location because when a family drove me home in the pitch black night during a HEAVY rain storm and we stopped on the way to pay. I was lucky though because I walked past the President of the Rotary club and his wife, who let me know I was a block off and a few blocks past the restaurant. The food hasn’t been that great at the restaurant I am at, my waitresses cold has been a little unsettling and I just couldn’t finish the breakfast yesterday morning so I needed a change of scenery. I had ordered fried and breaded chicken breast, what I think was a lunch dish, and it came with cold beans and rice. Furthermore, the hot milk in my cereal (similar to the sweet milk in the mush) seemed overcooked and the coffee tasted a little off. Usually I am fine with meals in foreign countries, but this meal was just a little too foreign. But, enough about food…

For the past three days I have been working with Dr. Guillermo Gonzalez. Gonzalez lived in El Salvador but was born in Guatemala. He is now married to a woman of indigenous blood. Today we went to his clinic in San Mateo, a neighboring town about an hour drive on the dirt road out of Barillas, and stopped at her family’s house on the way back. While his wife wears no indigenous dress and speaks both Spanish and Q’anjob’al , the local indigenous language, everyone in her family over the age of 12 wears the colorful indigenous dress and speaks mostly Q’anjob’al. This also happened to be all women, the men and older boys were out working. I have noticed at least in Barillas that the indigenous dress is mostly conserved by the women. The characteristic indigenous, Guatemalan outfit for a man consists of a cowboy hat, and colorful (though less so than for women) cowboy outfit. I have seen the hats on many men, but not so much the rest of the traje. I began in the clinic on Tuesday (we spent all Monday traveling) at 8 am and worked until noonish. It was a ferriadia (sp?), a holiday for banks and schools and the clinic was only open half the day. Dr. Gonzalez works in two clinics in Barillas and we even drove between the two to see different patients. The clinic founded by Dr. Aller and HFPF is called Clinica Medica Bethesda. It’s a pretty large operation for such a small town. Gonzalez has two nurses, one indigenous woman who has translated for one patient who knew absolutely no Spanish. This was a surprise for Dr. Gonzalez, but there was more translation needed in San Mateo today; the people there speak Chuj. Gonzalez has hired a woman of indigenous decent in San Mateo to help, but his wife can also translate ads Chuj and Q’anjob’al are somewhat similar. There is also a young lab technician who runs all the tests in a room down the hall. He is equipped with pretty basic equipment, a microscope, centrifuge, microcentrifuge, test tubes and pipets, and a handful of commercial tests, dies, and chemicals.

Most indigenous patients have come in with some sort of gastrointestinal infection accompanies other pain that is the real cause of their visit. For example, one woman today had pain in her forehead, especially when she looked at the light, felt a little dizzy at times, and a cough with phlegm. But, upon palpation she also had pain in her stomach and a positive urine sample confirmed a stomach bacteria. There have been a few pregnant women who have had ultrasounds which I have watched. It is so neat, wonderful, and amazing to see another human being living inside of a woman and see its heart beat; and then to measure their head and femur to figure out how old the baby is and when the projected date of birth will be is astounding! After performing the ultrasound on one patient Dr. Gonzalez used a tool (I forget what it is called-it uses radio waves) to project the heart beat, which I then counted as a check of normal heart size and growth development. 137 beats/minute, wow! It sounds really high, but don’t worry, babies have higher heart rates. (There was an interesting case yesterday- a women 29 weeks pregnant, who was bleeding and have slight contractions. Gonzalez prescribed medication to slow both in hopes that the baby would have more time to develop. Babies born before the 36-37 week normally don't live and before the 40th week are considered premie. All of their organs are underdeveloped and they haven't had the proper time to grow and strengthen. The woman will return in a few days. I hope the drugs work...)I was able to watch an electrocardiogram of an overweight man, not common in Barillas at all, which measured the electric activity of his heart. For this procedure, the nurse attached cuffs to his wrists and ankles and then 6 metal electrodes around his heart. Then, Gonzalez analyzed the results and showed me where the indicated block occurred in the heart beat image. I have been able to watch a lot; consultations by Dr. Gonzalez, lab procedures, other examinations and even been able to check some blood pressures and pulses and listen to a few irregular breathing sounds in patients’ lungs and see a few ear infections. It's very interesting to see the entire medcal procedure all happen in one place, from consultation to medical administration and prescription "pick-ups." I can actually see the tests occur that confirm whatever diagnosis Gonzalez determines from his examines. (The eliminated wait time is very helpful for this. He can order a urine test for H. pylori, a common intestinal bacteria and have the results in 15 minutes. It is also very interesting to see globalization at work. The clinic does not have sufficient supplies or the latest models of equipment because it is things can be so expensize. The lab techinician may wear the same set of thin, latex gloves all day, and today (Friday) the nurses inserted an IV and none of them wore gloves to do it. However, drug companies have been able to make simple and expedient, one-time use tests for things like H. pylori, E. Coli and AIDS that they use here in the clinic. Today, Friday, there was a SIDA test. Thankfully it was negative!) Dr. Gonzalez also takes care to explain everything he’s doing, why he’s doing it (what symptoms he’s checking for and how he does this, why it might lead to a certain diagnosis), what drugs he’s prescribing, why and what they do. He’s even had me read through a large dictionary of pharmaceuticals that contains the indications for why one might prescribe a certain medicine, what drugs it contains (if multiple), what it does and side-effects. It has been a very FULL experience. The one challenge has been that it has all been in Spanish and much of it that I don’t understand, because of lack of Spanish medical terminology, a limited Spanish vocabulary, of just handling a conversation. The hardest part is that many Spanish medically related words don’t translate to similar sounding English words, and I don’t have an in-depth Spanish-English medical dictionary. Still, because of my past exposure to medicine, medical and scientific procedure, and limited medical and scientific education I understand for the most part what is going on.

Today was an especially interesting day. Usually the clinic in Barillas opens at 8am, but today we left at 7am for San Mateo. We drove into town and parked at the edge of a stretch of market, right next to a crowd of people. It wasn’t until we got up to the clinic and looked down from the porch that Dr. Gonzalez explained that the well dressed man in the center of the circle was selling some yellow solution (probably a mixture of water and oil) as a cure-all medicine for ailments commonly endured by the indigenous people, skin irritations and other infections. A complete scam. As it was early and no patients had arrived yet, we walked down between a few buildings and through the rest of the market where you could find fruit, vegetables, spices, clothes, baskets, toys and more, to an old, old Catholic church. The architecture was not spectacular, but I wish I had gone inside to see what the church held as it was so old. Outside there was a metal cross mounted upon a large (about 10 feet tall) metal stove with open sections about stomach height. A older couple was adding some sort of oil or grass to the fire as a form of prayer. I don’t think it was exactly Mayan, but there are still some people who practice Mayan rituals in and just outside Catholic churches. As Gonzalez said, the conquistadors came with the metal armor and swords and if you didn’t convert you were killed, but the result was a somewhat intertwined faith at times. Now, there is an evangelical Christian movement sweeping the country. Gonzalez also pointed out a overgrown area of grassy mounds a few blocks away that he said were Mayan ruins that the people have not protected from all foreign exposure and exploration, archaeologists and anthropologists. It would have been cool to see up close… Still, Gonzalez also told me the hills in the area have gold and showed me proof at his house which I could swear is fool’s gold (though I didn’t question it openly). Still, he may be right. Above all, I wish I had brought my camera as the scenes were beautiful and would have made captivating photos. Maybe another time…

That’s all for now.

Spanish word of the day: ear of corn=elote
Q’anjob’al word of the day: Ish-sman=man Ish-sall=woman