Experiences
One important rationale for the partnership is to understand the realities of life in Maya Quiche Presbytery and how our lives may be impacted by this understanding. Past mission trips made great strides in the improvement of health care for the Mayan people. To date, two water purification systems have been installed and are operational, providing potable water for many people. In recent years eyeglasses were donated and have been distributed to those who had impaired vision. In 2005, for the first time a medical team was organized and sent to Guatemala to provide direct medical care. Medical supplies were gathered and sent with the team into Guatemala.
The medical team was inspired by Hebrews 13:2 Do not forget to entertain strangers, for by doing so some people have entertained angels without knowing it.
Day 1, 10 February. The team flew from Houston, Texas to Guatemala City then bused to Hotel Alba in the city of Mazatenango.
Day 2, 11 February. The team went by mini bus to the village of Pala where we were guests of the Presbyterian Church La Paz de Dios. Two Toyota pick-up trucks were utilized to transport the team and medical supplies up a steep, winding, dirty road surrounded by high mountain peaks and steep ravines. The mountainsides were adorned with coffee and banana plants. Our clinic was set up in the local church with stations for triage, medical treatment, and the dispensing of medications. In a period of about 5 hours, 94 patients were seen. By and large the children appeared to be well nourished, happy and well cared-for by their mothers. The great majority of patients were women and children as most of the men were busy working in the fields.
Prior to the start of medical operations the local pastor held a special service for the team. Several Mayan songs were sung to the accompaniment of three men on the marimba and a small child whose feet could not touch the floor beating on the drums. The music was enthusiastic, loud, and spirited. For lunch, the locals prepared a delicious meal of fresh chicken with noodle soup and corn tortillas. Some local volunteers were utilized to translate from Quiche to Spanish. Our staff continued the translation from Spanish to English for the doctors. The Mayan patients seemed quite appreciative of the medical care given them. Because of time and logistical constraints, only acute, minor illnesses were treated.
Day 3, 12 February. After breakfast we traveled to Guineales where the team was hosted by two of the Presbyterian churches in the area, Rey de Reyes in Guineales and Rayo de Luz of Pasenyaba. Before seeing patients, the team was part of a worship service in appreciation for the “Kids in Crisis” program that had been supported by John Calvin Presbyterian Church. Local church leaders became aware that children were left unattended and unsupervised while one or both of their parents were working away from the home. A day church school was started in late 2004 that included Bible stories and lunch. During the service 83 young boys and girls participated in song and recitations. The local pastor thanked Mission Presbytery and CESSMAQ for making the program possible. [Trip leader’s note: This program at Guineales is prospering and shows what “Kids in Crisis” money can do. Noe had enough money to start 5 of these programs. He would like to start 7 more.]
The medical team saw 106 patients in the improvised clinic. Medical conditions treated included asthma, respiratory infections, a variety of intestinal problems, muscle and joint pains, skin conditions including impetigo, cellulites and rashes. Many young women who had borne multiple pregnancies complained of fatigue, weakness, light-headedness, and palpitations. Medications were not available to treat suspected anemias and chronic fatigue. Because of limited resources and time, little was done to diagnose and treat chronic illnesses such as diabetes, hypertension, and heart disease. The most serious medical problems involved very young children with fever, cough, and shortness of breath. Fortunately, Omnicef, a third generation cephala sporin was available to treat suspected pneumonias. All medications in powder form were pre-mixed, and dosing was carefully explained to the mothers prior to dispensing.
Medical records were kept on 3x5 cards and numbered sequentially for later analysis and collation of data. Local Mayan volunteers were valuable assets as translators from Quiche to Spanish. Patients were seen on a first come, first served basis, but care was taken to triage for acutely ill patients. It has taken several days to maximize efficiency and improve patient flow during clinic operations. Because medical care was free, many patients showed up with minor or no medical problems. Because of the remoteness of the villages, referrals for more serious medical and surgical problems could not be made. Patients were given medications to relieve pain and discomfort. A daily inventory of medical supplies was made. Re-supply was difficult because of the limited supply at local pharmacies. The most urgently needed items included asthma medications (Albuterol), cough syrup, antacids, vitamins with iron, and antihistamines. Fortunately the team was amply stocked with ampicillin and Omnicef, Tylenol and Tylenol arthritis tablets. There was frequent use of electrolyte solutions for children with diarrhea.
Day 4, 13 February. We traveled on relatively level terrain an hour’s drive from the Hotel Albl to the Presbyterian Church Elim in Monte Carmelo. The population was unique. The people were obviously of Mayan ancestry, but they spoke only Spanish. It was not clear how this group of Mayans spoke Spanish and not Quiche. Of course, translation was simplified. Clinic hours were long and extraordinarily busy. The medical team saw and treated 184 patients. It became increasingly apparent that controlling the number of patients in a day was a difficult problem to solve. How could patients be turned away after they had waited so long in the hot sun? It was a particularly hot day, and open windows and doors provided little relief. The church sanctuary, which had a dirt floor served as the clinic. Partitions had been pre-positioned by the church members. The most serious medical conditions that we saw were asthma, pneumonia, and diarrhea with dehydration. The oldest patient was 95 years old. A bright 16-year-old girl, Maria Gonzales, volunteered as assistant to the nurse, Grace Cox. The locals prepared delicious chicken, rice and fresh vegetables for lunch. Our biggest challenge was the depletion of basic medical supplies. Local pharmacies were unable to fully support our medical requirements. Besides, the cost of drugs locally was expensive and limited in quantity. In the future, medical teams will need to better forecast the medical supply requirements and begin getting donations from USA pharmaceutical companies long in advance.
Day 5, 14 February. Departing from our home base at La Alba Hotel we were bussed to Chuisajcava where the clinic was set up in Manuel’s home. Patients came from 3 villages from the surrounding area, Tzampoj, Chirijirondini, and Chuisajcava. The oldest patient was an alert, spry 100 year old Mayan. The sickest patient was a 10-month-old infant who was seriously ill with diarrhea, severe respiratory distress, and dehydration. Dr Larry Park, our pediatrician, prescribed electrolyte solution and Omnicef antibiotics. It was questionable whether the infant could survive without hospitalization. The team saw a total of 125 patients. After seeing a total of about 400 patients over the past three days the team was short of antibiotics. Cough syrup was difficult to purchase locally. The schedule called for two full days of clinic (about 250 more patients) prior to heading home.
As an aside, it is not uncommon for Mayan women to bear many children. One 26- year-old woman who complained of fatigue, headache and dizziness, had borne 10 children. She was given ferrous sulfate with folic acid. Anemia, but not malnutrition, was a common occurrence among the Mayans. Impetigo was also commonly noted, as well as scabies. Treatment for scabies was not available.
Day 6, 15 February. A temporary crisis developed that could have aborted the entire mission. Word got around that a strike was going to be initiated at 4:00AM by a Mayan group that had fought the Army years before. All major roads were essentially going to be shut down, perhaps for days. However, the blockades never materialized and we were able to leave Matzatenango by van for a 2-hour ride to Quetzaltenango and a stay at the hotel Modelo. The ride was highlighted when we saw an erupting volcano with billows of volcanic ash blowing towards a higher mountain peak. As we ascended to an altitude of over 5,000 ft, the flora quickly changed. Coffee, banana and sugar cane fields were replaced by neatly cultivated fields of vegetables and gardens that extended halfway up a mountainside.
Quetzaltenango or Xela is the second largest city in Guatemala, and was by far one of the cleanest, least polluted, well maintained cities we had visited. We stopped at CESSMAQ headquarters where Noe Sam and the CESSMAQ executive committee prepared a beautiful lunch and held a brief meeting to express their deep appreciation for the work of the medical team. To date the team had treated 527 patients over the past 4 days. Each member of the medical team was presented a certificate of appreciation. We all fully realized how much was accomplished in the name of Christ for the Maya Quiche Presbytery. It should be noted that medical care was not restricted to church members.
Medical supplies were replenished to support what we projected to be 300 patients over the next few days prior to our departure from Guatemala.
After several welcome hours off in the afternoon for shopping and sightseeing, we met at Noe’s home church at Cantel, located on the outskirts of the city. We set up the clinic in the church. We saw 57 patients over 3 hours. One case involved a 9-year-old girl who had congenital heart disease. Her heart rate was 150, she had an obviously enlarged heart on examination. Since heart surgery is not available, her prognosis is very poor. [Trip leader’s note: We are pursuing a possible solution to this problem with surgeons in Houston. More as time passes.] Another case involved a cute 14- year-old girl with a huge ganglian cyst on her wrist. Again we did not have the equipment to properly remove the cyst. Noe got an estimate from a surgeon in Quetzaltenango to properly remove the cyst. [Trip leader’s note: As I was relating this story to the staff at Mission Presbytery we received a check that will cover the surgery!!]
Since we were at an altitude of over 6,000 feet the temperature at night often drops to 40 degrees. There are no heaters.
Day seven. 16 February Today we traveled up steep mountain roads for an hour to the village of La Cumbre that is at an altitude of 6,000 feet. The local church is called Iglesia Evangelica Presbyteriana, El Espirito Santo. The church hosted the clinic and fed us lunch The principle language here was Spanish. We saw 57 patients.
A note on public health and sanitation: CESSMAQ installed 120 latrines in the area 12 years ago. Additionally 3 concrete clothes washing facilities were built in the area complete with running water and concrete basins for 14 women to wash clothes. The one pure water system that was installed by Mission Presbytery was looked at. The station, a concrete building with a pump and water storage tanks on the roof was installed in September 2004. The station has never been operational because of difficulties with the pump. At a cost of $5,500 for the building and pump, one questions the cost effectiveness of such a project where maintenance is a problem. It would appear that funds would be more wisely spent on long- term goals such as health education, birth control, alternate ways to augment income, and the support and protection of women and children. The health status of the Mayans will improve only when the overall standard of living improves.
A word on how patients were notified when the medical team was coming to their area. The women’s committees of each community were responsible for contacting persons who needed to be treated. Priorities and criteria for patient selection were set by each women’s group. The negative aspect of this procedure is that there may have been a number of acutely ill patients who were not seen. [Trip leader’s note: This was confirmed by Noe when he said there were cases of TB and other serious diseases that did not get to us.] Few adult males were seen for obvious reasons. There is a need to establish evening clinic hours to accommodate men who work.
Day 8, 17 February. This was the final day of clinic activities before a travel day and day of relaxation prior to flying home. We drove up to an altitude of 9,000 feet to the village of Chajabal where the clinic was set up in a private home. The Presbyterian Church, Principe de Paz, is still under construction. We visited the water purification unit that was constructed in March 2004. Currently the plant is operational and generates about 25 gallons per week. There may be a conflict between what the villagers pay for their water and what local water companies charge for bottled water that is delivered directly to the home. Cost-benefit studies will have to be done to decide whether further treatment plants need to be built. The team treated 83 patients. A total of 725 patients were treated over 7 clinic days. Dr. Larry Park, our pediatrician, demonstrated to mothers how to percuss their child’s chest to prevent pneumonia. Noe Sam plans to pass this type of preventive care to all the 22 villages.
Conclusion and Summary
A medical team that included 4 physicians, 1 RN, 2 translators and 3 administrative staff treated 725 Mayan patients over 7 clinic days. This was the first medical mission trip sponsored by Mission Presbytery and the first ever to visit Maya Quiche Presbytery. Much was learned that will help those who plan future medical missions.
- After this initial experience it is felt that future teams could include a mix of LVN’s, medical assistants, and physician assistants.
- Because of the absence of laboratory and x-ray support, only basic medical treatment plans could be followed. Acute illnesses were managed with a short list of commonly used medications that had minimal side effects. Prior coordination and planning with Noe Sam, the Director of CESSMAQ is essential.
- Water purification plants may have become obsolete because of the competition with local bottled water companies that can make home deliveries.
- Cost of medical supplies can be significantly reduced if interested physicians can request donations of medications months in advance. A list of needed medical supplies should be developed based on this year’s experience.
The Medical Team
Bill Harrison - Team leader
LeAnn Crim - Admin. Asst.
Bryan Anderson - Logistics
Edward & Silbia Esparza - Translators
Grace Cox, RN, MSN - Nurse
Larry Park, MD - Pediatrics
Arthur Allison, MD - Emergency Medicine
Ted Boyce, MD - Family Practice
Richard Park, MD - Epidemiology & Public Health
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