Dia de los muertos: market and fair

Today is a holiday in Guatemala--Dia de los muertos, or day of the dead. The day is a celebration remembering the dead, and interestingly, is a lively celebration rather than a mourning day. The streets fill with people heading off the cemetery, families get together, kids fly kites, and music is heard in the streets. I asked 3 armed men (one military guy and two local police toting giant rifles and lots of ammunition) why they were standing in a particular place, if they were guarding a particular grave or something. But they said, no, everyone deserves protection, dead or alive. As crazy as it was for me to approach three heavily armed men (can you picture this, because it still makes me feel a little queasy), his response was pretty telling to the way things seem to go here.
Right outside the cemetery is a carnival and street fair, with food vendors, music, shopping, and all sorts of floral arrangements to bring to the cemetery.

New Apartment

About a week ago I felt like I had hit an emotional wall with my host family, and decided it was time to move out. As kind as they were, I wanted to be able to have my own space, cook for myself, and be closer to the center of town. I moved on Friday. That's where my blogging energy went--I have been setting up my new apartment. Aside from one small repair that had to be done (thanks Cody!), and massive kitchen-cleaning, the place has been nice. I've been able to cook every day, and have plenty of space to do my work, and relax. The building is a sort of strange old colonial building, with a courtyard in the middle, and lots of patio space. My computer and camera had a disagreement, so all I have is a photo of the corridor leading to my place. The entrance to my apartment is on the left.

Mobile Clinics: Daycare #8

We seemed to get a little lost walking to daycare #8.

But when we finally got there, we found a bunch of smiling kids.

We saw a few more babies here than in other places. Both of these were kids I saw (above and below).

As you can imagine, with so many kids in one place, it's not all work. We play some games and hang out with them while we're setting up.

We got a warm goodbye from these kids. The whole group trotted out to the front to see us off!

As we were trekking out, we got a good look at some of the houses in this area. When you see these it's easy to see how so many of their illnesses are related to the environments, because of lack of clean air, clean water, and good sanitation systems.

Mobile Clinics: Daycare #7

After just a few days away from mobile clinics, we quickly got back into the swing of things. Yesterday we were at the clinic in Tierra Colorada, as usual. We waited for the girl from Monday who had the heart problems, but she never showed. I heard that she went to the clinic today, so tomorrow I will have to get the update.

The walk wasn't far, and we saw some familiar faces. This is the place where the teacher has brought the students to the clinic.

The kids were lined up waiting, and playing when we got there.

We found some interesting stuff, though hopefully nothing was too severe. Cody found a boy with an unusual murmur, who had to be sent for some tests. I saw a girl with a chronic ear infection that was draining smelly green-ish goo.

Some of the kids we see in these clinics are actually babies whose moms work in the clinics, or extra people who get invited in. The mom didn't want to be in this photo, but she stuck her son on my lap to pose for the picture.

Daycare #6

Daycare #6 was pretty much in the center of town for this area. It was brand new, and just opened a few weeks ago. Even the walls still smelled like paint! Many of the kids were healthier, but the teachers didn't know them as well so the histories were even shorter. We unpacked our giant bags of medicine, and set out to weight and examine all the kids.

I saw two pretty healthy, though underweight, kids. The first child I sent away with her bar of soap, toothbrush, health form, and albendazole, because all I could see was a little runny nose. Half-way through my visit with the second child, the teacher came up to me and told me I forgot to give her her cough syrup. Well, her lungs were clear, and she had a dry cough. What was I gonna do? There seems to be a strong belief here that symptoms can be treated, and people are willing to try anything. I told the teacher that I didn't have any medicine that would work, because she didn't have pneumonia, and the cough medicine was only for productive coughs. She looked at me like I was crazy, but accepted my answer. I really wonder what she was thinking, though. Maybe it's easier to give cough medicine for kids who don't need it, just to make the parents and teachers happier. Because what happens when we really need them to come in (like for heart problems!) and they don't...
Each kid at the schools get these little bags of medicine and goodies. And at the daycares, this is invariably where the plastic bag goes. I've almost stopped trying to take it out of their mouths!

Daycare #5

I've come up with a theory (okay, okay, hundreds of other people have had this theory before, but I'm jumping on the bandwagon...). The more rural the place, the more health problems we are seeing. I'm sure when you get into the extremes of urban areas you see these things, too, but in general from the daycares and schools we have been to this seems to be pretty true.

The water supply is different in the rural areas. People get their water from big basins in common areas, and carry it back to the house in jugs and big containers in wheelbarrows, hands, or on top of their heads.

Today we went to two new daycares, and I got to see this theory in action. As we got off the bus, we saw a water area like the one above. Once we got closer to daycare #5, the water area looked like this. Daycare #6 was located pretty close to the first water area.

Once again, we were walking along a beautiful country road. The volcanoes and mountains loomed above the valley. Dust was going crazy every time someone drove by. And cows stared at us as we walked.

We even caught sight of a man spraying his fields with pesticides. No boots, no protective gear. Just the spray.

When we got to the daycare, we were greeted by a few overly-excited kids, who shouted friendly "buenos dias" good morning greetings to us. The rest of the kids were lined up waiting for us.

As for the theory, we saw some pneumonia, impetigo, malnutrition, coughs, and what was probably a heart defect. My first patient was a 5 year old girl who was a little small for her age (just on the border of what we'd diagnose as Grade 1 malnutrition). She didn't want to talk to me, so I just went on with my exam, and figured I'd have to find out for myself if there was anything going on. First thing I did was I had her stand in front of me (as I sat in my little toddler-sized chair) and I put my stethoscope to her chest. WOW! It was a grade V/VI murmur. It made all the other murmurs I've ever heard seem like a joke! It was so loud I couldn't hear her lungs well. It radiated to her back and both axillae. There was a strong thrill, strongest on the right side. The murmur was audible everywhere, but strongest at the aortic and pulmonic points. It didn't take me long to go get some help. I went and talked to the clinic's doctor who by chance was with us, and we noticed that she had strong peripheral pulses but had some clubbing and peripheral cyanosis. Her liver edge was palpable about 4 cm from her ribs. We got a little bit of history from the teacher, and it seems that she had fainted once. I'm not sure what else was in her medical history because her parents weren't around to answer.

We tried to refer the girl to the hospital, but the teacher told us that her parents wouldn't take her, even though we explained that it was important. The teacher, sadly, said something like "her mother wouldn't care if she died." So we wrote her a note to go to the clinic tomorrow, and we'll do more tests and try to get them into the hospital from there if need be. I'm working at the clinic tomorrow, and I really hope they make it in to see us!

As we said goodbye, not only did we get heartfelt thanks from the teacher, but we had a little follower who ran out after us. :)

Thermal Steam Baths - Los Vahos

Los Vahos is a place about 3 km outside of Xela, where people can go into private steam bath rooms. The nearby volcano produces the steam, and they have it coming out of vents in tiny little rooms, with a ton of eucalyptus branches. Each steam room also has a larger dressing room area with some wooden benches/beds. The cost for us 5 adults to enter was about $12. But we did have to hike up 45 minutes of steep mountain-hill.

As much as I struggled for breath on the steep parts, I will say that the view was gorgeous. We could see the city of Xela, and the farmland and houses nearby. Some of the farms were actually growing flowers, which made the view even more picturesque.

By the time we left, we hitched a ride (for a small fee) with another family traveling down. The car was an old SUV, whose lights kept turning on and off, which was terrifying on the neglected dirt road at night time. I closed my eyes more than once!