Saturday, March 25, 2017

A Week's Difference

One week ago, I wrote about arriving in Guatemala and beginning our journey. Today we are heading home, with healed hearts, after being broken numerous times, and renewed hope. As I reflect on what this week has meant to me, I am in awe and I am still not quite sure how to put it in words. Before this trip, my hope for a better world was incredibly dim. I did not see much of love, or of God. Now I see God everywhere and I hear God in every waking moment.

The difference this week has made in my life is unforgettable. I see love everywhere now. I see God everywhere. I see God in my peers, who wore their hearts on their sleeves and fully threw themselves into this experience. I see God in the medical team, who are fully committed to their patients and taught us what it means to heal and be healed through serving others. I see love and God in the Guatemalan people, who do not let the inequality they witness everyday harden their hearts. These are God's people, who always end their conversations with "Vaya con Dios" (Go forth with God). They are rooted in their faith and have taught me what it means to be completely reliant on God and trust him. They have taught me to love abundantly, without hesitation or resentment. They have taught me to readily forgive. They give without expecting anything in return, and in that way, they have taught me to be more generous.

I am grateful that I was given the opportunity to be a part of this trip, of this journey. We have all said that our hearts broke a thousand times throughout the week, but it was put back together much stronger and much more capable of genuine love. I am grateful because I met some incredible people who are now like family to me and I could not have asked for a better team to with whom to have this experience. I know this week touched my soul because when I woke this morning, my first thought was, "I want to stay home". I've found a new home in the Guatemalan people.

Aichetou Waiga 

Tears and Joy

Our final day at Choacorral yesterday was met with both tears and joy. It was sad to say goodbye to all the patients, children, and community members, but we were all excited to reach out and help the community of Chapernas the following day.

After an hour long ride to Chapernas, I step off the bus and experienced a huge amount of culture shock. There were no paved roads, very few buildings, and a thin layer of dust covered everything. The school building that we were calling the clinic had no air conditioning, few lights, and a barely functioning bathroom. When I first walked into the clinic I could not belief the number of people that had showed up. The entire room was lined with men women and children, all trying to see a doctor.

I spent the morning with Dr. Lauri in pediatrics. It is so inspiring to watch how Dr. Lauri works. She always has a tremendous amount patience with the kids and easily diagnose patient after patient with confidence. Near the middle of the day I was running a script to the pharmacy when Brad pulled me into his room. Brad was a trained nurse who volunteer at this school made clinic twice every weeks, and he just happened to be from Ohio. The reason he pulled me into his room was to show me a very interesting case. When I walked into the room I saw a frail old woman sitting in a chair. As I moved further into the room I immediately realized why she came to the clinic. The woman, who was an astounding eighty-nine years old, was completely missing half of her nose. The skin and cartilage that should have been covering her nasal cavity was gone. Brad explained to me that the woman had small spec of skin cancer on the tip of her nose that went untreated and eventually resulted in her losing half of her nose. Now she comes in twice a week to get the area cleaned and bandaged.

What was heart breaking to me was the fact that had this woman lived in a more developed country that cancer spot could have easily been removed. While this woman may have lost part of her nose, she never lost her pride and determination. She held her head up high and managed to live ten years with the open sore. This woman showed me that when life deals you bad cards you can either complain and give up, or you can accept it and face it with a smiling positive attitude which she did.

Joseph Kavanagh

Where I Feel Called

Friday was undoubtably the most tiring and mentally and physically challenging day of clinic for me. Chapernas is a small village about 30 minutes from the coast in western Guatemala. As we drove into Chapernas we knew it would be different from Choacorral. The dirt roads, open air houses, and the type of illnesses varied vastly from Choacorral. Walking off the bus into 90 degree weather was not only a physical shock but when looking around i was shaken to the core. The two large buildings were basically just huge rooms that we took over and set up our stations at. We walked in the main building and it was packed with people waiting to be seen by our medical staff. However, when we turned the corner God blessed us with another pair of intelligent hands and a caring heart. Nurse Brad came into our lives as a surprise. He is an American nurse that does mission medical work in Guatemala and visits this site twice a week. He was just as surprised to see us as we were to see him. We worked seamlessly together to serve this huge population of people who needed medical care. I worked in triage all day. Hearing people's stories, investigating their health issues, and using nursing skills is my favorite part of triage. The fast paced atmosphere was especially difficult in this clinic. The heat paired with the amount of people and the acuity of the patients made the day especially hard. Working with Maddie and Xye was incredible. Our Spanish skills and nursing backgrounds prevailed and we were essentially done triaging by lunch time. However the most difficult things to witness was nurse Stephanie having to turn away patients. There were just so many people and not enough time or resources to see all of them. This was devastating but it shows how much continued efforts are needed.

My time in Guatemala has taught me more than I could have hoped. On Friday I learned, or perhaps rencountered, the fact that I, as one person, have the ability to change the world. If I changed or positively effected one persons life in the little town of Chapernus I did good. My last patient of the day was a old woman who had diabetes and was leaking, for lack of a better term, from her legs because of all of the edema and fluid retention. She had extremely low blood pressure but her blood sugar was only 175 without taking her medicine for her sugar for a number of days. This was not a problem of diabetes this was congestive heart failure. However, what I learned from this woman was not about her diagnoses, it was about the smile she had on her face when strangers were talking a foreign language surrounding her. It was about how her family advocated for her needs and care. It was about how her daughter was doing the best she could with what she had and was full of gratitude for our being there. My time in Guatemala was not about saving the people. These people do not need to be saved. They are strong, compassionate, loving , hospitable, grateful, and rich in life and love. They are different from the people I am normally familiar with, but that doesn't make them any less worthy of love and care. They need to be walked with not changed. Guatemala has officially broken and ruined me in the best way possible. This beautiful country and its people have changed the way I view health care and have possibly changed where I feel called in this world. They have taught me to love and wear my heart on my sleeve, that it is okay to ask for help, that vulnerability is not a weakness, and that it is more important to be rich in faith, hope, love, and community than in anything else. I am so grateful.

Melinda Birky

Wednesday, March 15, 2017

There Are No Secondary Causes

We all have special people who come into our lives and leave lasting impressions.  Father Vince O'Flaherty was one of those people for me.  I lived with Father Vince, a Jesuit priest, in my senior year of college at Regis University in an intentional faith community in a low-income Latino barrio in Northwest Denver called Romero House.  At age 70, Father Vince was our leader, living amongst 20-something year old college students, learning to cook for the very first time in his life, leading us by his example of selflessness.  One of the things he would always say was, "There are no secondary causes."  The gentle hand of God was present in all things for Fr. Vince.  This is a very Jesuit concept and I am grateful I learned this from him.

This week in Guatemala I have been reminded of that sentiment over and over again.  This is our seventh year on this trip.  The community we first encountered 6 years ago went from having never had a physician in their village to having a fully functional, independent clinic in that time span.  This year that community has 17 groups coming to volunteer this year.  And in a little over a year one of their young men, whom we met as a community health worker 6 years ago, will graduate from medical school in Guatemala and come back home to serve that clinic year-round.  So we made the difficult decision last summer that when we were planning for this year's trip we would probably be of better service to move on from our old village and start anew with a community who did not have so much help.  It was difficult to think of not seeing our wonderful families of Patanatic again, but they had many helpers at this point.

In a random act of God's gentle hand last summer Rabbi Abie met a phenomenal couple named Jose Roland and Lisa Monterroso.  Lisa is a Xavier graduate of the OT program and had met Jose Roland when she traveled with a Xavier OT trip to Guatemala several years ago.  The two fell in love and are now living and raising their two young boys in Jose Roland's native Guatemala.  When Lisa and Jose Roland were visiting Lisa's alma matter of Xavier last summer they met Rabbi Abie and the conversations about the medical service trip to Guatemala began.  Jose Roland - also known as Roland, then became our Guatemalan contact.  He started the work of identifying two new communities in Guatemala who needed services.  We could not have met a more generous and loving human being.  He identified two communities for us to start a relationship with, in hopes of giving them a gentle lift up in the next few years so that they can in the mean time identify people in their communities who can train as health workers to sustain their own communities.  Our hope is that over the next 10 years or so these two new communities can, with some help from our trip, become self-sufficient in their own health promotion.

In January, Rabbi Abie, Eric Bertelsen (our pharmacist) and I traveled to Guatemala for 3 days to meet with Roland and community leaders in these two new villages to see how we may best serve them.  Our first community is in San Lucas and has a government medical clinic but there is little to no staff for it.  When we toured the clinic I became aware that this community has no access to economical, clean, filtered water.  Without clean water it doesn't really matter what we could do down here - it would be like putting our fingers in the holes of a dike.  Water filtration has to become universal.  I told Roland that we needed to see how to bring clean water to these people.  The next thing I knew, a few hours later we were touring the factory of a globally known and respected manufacturer of home water filters called Ecofiltro.  Roland knew the factory owner, had called him up and asked him if we could come meet him.  We learned all about Ecofiltro and he learned all about our trip ideals of building capacity in communities so that they may become self sufficient in taking care of themselves.  The next thing we knew, Ecofiltro was donating water filters to our two new clinic sites and their schools.  And Ecofiltro agreed to come into the new villages and sell water filters to all the families for a very affordable, subsidized price.  So, probably over the course of 2-3 years those homes will all have free filtered water in their homes.  Even if we do nothing else in those two villages that will dramatically change the trajectory of their health.

Each time we have presented Roland with a new problem, he works at it and solves it.  He knows pretty much everyone in Guatemala and has a heart for helping - especially for helping people feel empowered to help themselves.  We were waiting in the bus at a bank one afternoon after clinic so the Xavier students could exchange some of their money.  I saw Roland warmly greeting two beautiful adolescent Guatemalan girls in their pristine school uniforms, who were clearly delighted to see him.  When he joined us on the bus I asked him who they were and he told me he had known them since they were toddlers.  They were HIV orphans and he knew them from the group home in which they live.  So, literally we go from him knowing the CEO of a major international water filtration company to these two HIV orphans.

Roland and Lisa walking into Rabbi Abie's office that day this summer was definitely the work of the gentle hand of God.  There are no secondary causes.

Lauri Pramuk, MD

A Kite Rises Highest Against the Wind, Not With It

Winston Churchill said, "A kite rises highest against the wind, not with it." That saying has often come to the fore in my life as adversity has entered. The great statesman was referring not only to a country, but to a community and to the individual person.

Nowhere is that more evident than in our Guatemalan community - with the beautiful Mayan people who line up outside the entrances to their clinic and to our Xavier medical family in each and every exhausting hour.

In the fall of 2016, a friend and colleague, Dr. Carol Scheerer, head of the Occupational Therapy Department, came to my office at Xavier. She wanted to introduce me to Jose Rolando Monterroso and his wife. Lisa Monterroso was an OT graduate of Xavier, who had met her now- husband on an OT trip to Guatemala. Jose Roland and Lisa were visiting Cincinnati with their two young sons, Lucas and Jacob.

Carol thought it would be nice for real Guatemalans to meet me, an honorary Guatemalan. Little did Carol know we were ready to move on from having accomplished our long term medical mission in Patanatik. In that Western highlands community we had totally transformed the community's capacity to take care of its own health care. It took six years, incredible Xavier students, medical colleagues and an inspired and dedicated community to achieve that goal. It was time for a new community and a new local inspired soul to handle our logistics and create a lasting bond with the local population.

Jose Roland was that man - thoughtful, capable, inspired and with a heart that could span from Guatemala to Ohio.

We entered into our relationship slowly, letting the gentle hand of God sew the disparate fabrics together. A mid-January preliminary visit only served to confirm that all of Guatemala was in his pocket. We had entered into his heart, as he had into ours.

The interfaith medical service week has now come and gone. All the planning, all the fundraising, all the medical education came together in a way that can only be described as magical. The 19 member team, supported by the  prayers and donations of hundreds, brilliantly executed our service trip. Hundreds of patients were seen and cared for, hundreds of pairs of glasses changed lives, but over and above it all, the twelve Xavier students were forever changed. They saw hundreds of community members, in native dress and Western attire, young and old, desperately sick or just needing an affirmation of relative good health, pass in front of them and enter into their hearts. These special descendants of a great, inspired Mayan tradition, taught them resolve and faith. It is a hard life in our two impoverished communities. It is a difficult daily grind to navigate the hillsides and the heat, the poverty and the bureaucracy. But every person they met flew their kite so high against the adversities they encountered. Not one patient noticed the slight hesitation in their blood glucose finger prick. Not one patient complained about the wait to see doctors or our pharmacist. Not one patient expressed concern as they tried on tens of used eye glasses to find their own 20/20 on our eye chart. Not one patient was frustrated with some of our team members' broken Spanish. Not one. Despite the daily adversities, caring for children and family took priority and found quiet resolution. Despite the adversity not one patient was bowed. Their faith, their love of family, their pride in their Guatemalan heritage lifted our spirits and brought joy to each team member. At the end of each and every day our exhausted team members found the strength for medical debrief and reflections. Tears of joy, compassion and growth lifted our spirits.

We will be back. The beautiful people of San Lucas and Chapernas have partnered resolutely with us. They want to help themselves. They want to sail their kites high. Our beautiful young people will hold the kite strings with them. God will provide the wind.

Rabbi Abie Ingber

Sunday, March 12, 2017

A Sunrise in Every Soul

For as long as I can remember, I think that I have known a few truths about the world, and the only people I can thank for this knowledge is my parents. When my sisters and I were little, we were fortunate enough that our Amma and Baba took us on adventures around the world, and these experiences in countries other than my own taught me more than I realized at the time. I had seen the reality of most of the world on trips to Pakistan ever since I was a few months old, and I had also seen the beauty of the world.

During the months leading up to our trip and our meetings, we learned about the realities we would see: the people we were preparing to serve lived lives much different than our own. As the type of human whose heart bent when she saw even a too skinny dog walking around outside the clinic in San Lucas, I knew this would be immensely difficult for me to see and experience in a more direct way than ever before. For this reason, I knew that I would have to seek the beauty of the world during my time in Guatemala.

Every morning since we landed in Guatemala City, I would wake up earlier than I should have. Partly because of the roosters that would would signal a too-early start to the day at 3 am but mostly to see the sunrise. The first day in San Lucas, I realized only after the world was suddenly full of light that I was facing the wrong direction and missed it. The next morning, I tried again but the mountains were blocking my view. On Wednesday, I woke up my lovely roommate Xye so we could find the sunrise together but our view was less than ideal. The same dilemma was the case on Thursday and Friday, but I did not want to give up.

This morning in Antigua, I woke up early again with Xye determined to finally accomplish my goal with my last chance. As we climbed onto the roof of the hotel to find the best view possible, we realized that the only thing we would see would be the light appearing behind a fluffy and almost impenetrable layer of clouds. As I began to feel a little disappointed that I still had not seen a Guatemalan sunrise in its beautiful entirety, I understood that this realization was completely wrong.

I saw the sunrise every day in our clinic in San Lucas playing futbol with the kids who  filled my heart with hope: they smiled no matter what words I strung together to say a sentence in Spanish and covered me with stickers of princess from head to toe. Though they did not have much, they were joyful and hopeful.

I saw the sunrise working in the glasses room in Chapernas: the light that illuminated each face after someone put on glasses and could finally see the world.

I saw the sunrise in every single soul I encountered that belongs to Guatemala.

I saw the sunrise through the amazing Dr. Lauri and amazing Dr. Richard, who showed me what selflessness looks like and taught me the most important thing about medicine: the people. And through Dr. Eric and his never-waning excitement and happiness. I saw the sunrise through Nurse Stephanie, who amazed me in more ways than I can could ever count and stopped to teach me the importance of believing in myself and who I am in the middle of a chaotic triage. Through Stephanie Renny, who handled every obstacle with grace and always made sure that we were all getting enough water. Through Roland, who instilled a desire to stay hopeful and to aim to make a difference with what I do. Through Diana and Mishell who never stopped smiling and talked to me about the importance of hope. And through Rabbi Abie, who allowed us to experience a Shabbat dinner together. My fellow students gave me the sunrise every day as we worked together and every evening during our group reflections, teaching me through their eyes.

If one of my goals of this trip was to see the sunrise, I think I saw it more times than I could have hoped. Because I learned that no matter how much darkness the world may see, the sun will always rise and fill it with light and hope.

Zenab Saeed

God's Good Works

Today was our last day in our clinic in Choacorral, and it didn't hit me how fast this trip has gone until I started saying goodbye to all of my patients. The experiences I have had these past few days will forever be ingrained into my heart. I have grown more as a person and learned so much more in this week in Guatemala than I have in the two years I've lived here. That's how impactful this trip has been for me.

Today was special because patients I had met earlier on in the week returned again and again and I began to see familiar faces. Specifically with one family, in which I developed a relationship with. I sat down with this family and learned who they were and what their story was. It was two sisters, their mother, and all of their children. In the thirty minutes I talked with them I found out that they walked over an hour and a half to get to the clinic, both sisters married young, at 15 years, and both sisters had kids at a very young age. I was astonished at the stark differences we had in that sense, I mean I'm 21 and barely am able to take care of myself, how could I ever take care of children, especially when I'm still a child myself?

It definitely left me pondering the whole day, but it also showed me how wonderful these women are and how strong they are to take care of not only themselves, but their families as well. The fact that they walked over an hour and a half just so their kids could be vaccinated is just astonishing, and by luck they were able to come on a day when we were here. However, I wouldn't call it luck, things happen for a reason in life. There was a purpose and reason for why I met that family and developed a relationship with them. In a way, it was God's way of showing himself to me, of demonstrating his good works. It was his way of showing that even in the toughest times and I don't think He's there, He really is, in moments like these.

So where do we go from here? That's the question we're always left pondering because we're only here for a limited amount of time. How will we know if the patients we attended to will be able to continue on without us? How will we know if they're able to buy their medication again after they've run out of what we've given them? Will it be too expensive? These questions have been circling in my head this week, and now that our journey is soon coming to an end, they've become more pertinent. Even though we offer care and medical attention to these people, I wish we could give more. I wish I could give more of myself to them, but in reality I can't, as much as I would like to.

Moreover, it breaks my heart that I won't be able to come back next year to see these wonderful people. It truly saddens me because it's through these people that I was able to see what I have to offer and what my calling is in life. As much as I've done for them, they have done way more for me, more than I could have ever imagined. I hope to see this relationship of our medical team with this town develop more profoundly, in a way in which the livelihood of the people are changed for the better; in a way that builds up the community to the extent that in future they will be sustainable and be able to thrive on their own, much like at our old clinic in Patanatic. I can only imagine the wondrous strides this town and this clinic will do for the people of the community, I can't wait to see what's to come in the near future for them.

Angela Ellis

Thursday, March 9, 2017

Privilege and Perspective

It has been a privilege to spend the past few days in Guatemala. I have already learned so much from the staff members accompanying us on the trip.  For example, Dr. Lauri demonstrated how to properly examine an eye and view the capillaries then allowed for me to practice the technique.  Nurse Stephanie reminded me that the clients are always the priority, no matter what is going on around you.  Stephanie’s actions reminded me of this when triage was a madhouse, but she managed to still provide a young boy, Wilmar, with attention and education while accomplishing other tasks.  Dr. Eric taught me the importance of a smile by always having a smile on his face and announcing how many hugs and kisses he receives in a day.  Rabbi Abie taught me about the brain’s great ability to compensate in incredible ways when sight is involved.  Stephanie Renny emphasized the importance of organization to maintain order, a necessity when several doctors and many many clients are involved.  Finally, Dr. Richard demonstrated caring for the whole person, not solely the physical aspect of a person.  It has been remarkable thus far to see how dedicated and engaged the staff members are, but also my fellow Xavier students.

Each day has been incredible, but today was by far the best.  I had the privilege of spending the morning with Dr. Eric in the pharmacy which allowed for me to further learn about medications, especially the different forms of insulin replacement therapies.  In addition to pharmacy, I was able to play with all the kids, help educate them about proper dental hygiene, and simply hold babies.  Something about holding a child puts all of life’s problems into perspective, especially in Guatemala; the mothers are so trusting and willing here.  Then, in the afternoon, I was afforded the opportunity to shadow Dr. Richard.  Shadowing Dr. Richard was certainly a treat due to his love for education and wealth of knowledge.  He is able to spout of information about cholesterol, thyroids, vascularization, etc. without even having to stop and think.  While I did greatly enjoy learning about Statin medications, the best and worst part of my day occurred during an interaction with a client.  On Monday, I had met a girl only a few months younger than me who loved Twenty-One Pilots, Fergie, and Coldplay, so naturally we rocked out to Fergie.  However, on Wednesday I learned that the same girl was faced with many life difficulties and was having physical symptoms because of it.  It was a hard pill to swallow that I hadn’t seen it on Monday, but it was a reminder that so many people have things going on that others know nothing about.

Madeline McGraw

Sweet Little Abraham

Wow. What an incredible three days. Between traveling to a brand new part of the world, with some amazing friends, to finding my sea legs in a small clinic in a new language, I’m exhausted. But a good, tired to my bones after three long hard days of work, tired.  I wouldn’t change this feeling for the world. In fact, I’d give anything to always feel this way.

Today went so smoothly for me in my little pharmacy corner and triage spot. Want to know why it went so smoothly for me? Because I have the best team in the world. I did not have to worry about trying to communicate medication instructions, because I have friends who actually studied Spanish (minorly regretting my choice to study French) and a pharmacist who might not know a lot of Spanish, but he knows the Spanish he needs. And yesterday, one of the best people on this planet stopped me and told me to essentially buck up, because I am a FREAKING NURSE. And you know what? I am. I’m this close “ “ to being a nurse. THIS CLOSE. I am a freaking nurse. And I might not know how to speak Spanish, but I know how to point, and they know what to do. And I have scripts, (which today I realized, I do not even need anymore.) I adapted. And I learned what I needed to learn to do what I needed to do. That moment yesterday of I have no idea how to say what I want to say and I want so badly to communicate with you almost paralyzed me. I could not have done it without the most blessed Stephanie Ibemere. What a super woman. Words cannot describe how much I appreciate the confidence boost that was. I will always remember that moment and that little baby who I was then able to triage. Sweet little Abraham. He might have spat up on me, but he never once stopped smiling at me, never knowing that he almost paralyzed me.

The love and the grace that I’ve experienced in the community astounds me. From my team, to my patients, I couldn’t do it without you. I am incredibly grateful to those patients who patiently waited for me point and scrape together words. To those patients who have given me hugs throughout the days, know that I will never forget those hugs. I love you Guatemala. God Bless you.

Michelle Indelicato

Pulled in a New Direction

Yesterday morning, I got to nervously eat my breakfast in anticipation for the dreaded shift in Triage. I kept running all the necessary tests, exams, and measurements I would need to take for every patient that made it through the clinic that day while trying to picture how if I would even be able to take a head circumference on a crying baby. My partner for Triage Katie held some similar pre-shift jitters and wanted to practice taking blood glucose and pressure to ease us into it. My blood pressure was on the high side, and all the healthcare professionals and my partner immediately started making me drink tons of water. The nerves continued to build up until our first patient.  We ran through all the steps, took all the measurements and asked any questions when we were uncertain. We successfully completed our first patient’s triage and then her family’s.  Triage had finally found some rhythm, no administration and paperwork problems were occurring, and we simply had less patients to see that morning. The pace was calm and organized and besides a few little mistakes, Triage was a great success for me. One baby even put my owl pen into her mouth so I would even go as far to say that I enjoyed Triage. The ambush I was expecting never happened, and my blood pressure stabilized. I was almost disappointed that I did not get to experience the crazy mess that Triage had been… almost…

I got to spend another afternoon with Dr. Richard Walter examining the adult patients to unravel any secret symptoms or events the patient to us that day. Working alongside Madeline, Dr. Richard Walter allowed us a more hands on approach with the patients. He let us look into ears and mouths while asking us to identify the tympanic membrane or the ear wax in the canal or comparing the sizes of tonsils in our patients. I even got to use the tongue depressor. After hearing a few of the interesting cases Dr. Richard had seen in relation to our patients’ symptoms, an eighteen year old came in with her sister.  Her sister explained many of the symptoms and a concern for her sister being depressed while showing an inspiring and heartbreaking concern for her sister.

The girl had complained of stomach pain, swelling, and a numbness of the face. Dr. Richard identified the likely cause of an infection, but he slowly took the time he needed to determine any possible explanation for face numbness.  He began asking her about any upsetting events that have occurred recently. After a little bit of time, she responded. Her life was hard. She had been suffering in many ways recently and more than a lot of people do. Dr. Richard described how these events in conjunction with the infection could further her symptoms and bring her to a worse state. Dr. Richard expertly advised the woman about counseling and seeking more resources and support for herself while she had the most gratitude for being a physician that actually delved deeper and explored her life to come to a wholistic, appropriate, and individual examination of this woman. This had not been the case for the previous doctors she had seen.

I couldn’t help but to keep thinking back to the fourteen year old girl that Dr. Lauri had seen the previous day with me shadowing. Caty had cerebral palsy and was completely blind. Her mother carried her all the way the massive hill that leads to the clinic. Caty’s hair, teeth, fingernails, and her clothing were all perfect which none of these especially the toothbrushing are easy tasks for a mother to perform on a child who has cerebral palsy. All I could see in this incredible mother was unconditional love for her daughter.  This superhero of a woman did everything she could for Caty alone. She was astounding. This profound love displayed by Caty’s mother and the love of our patient’s sister who picked up on a sudden change of emotion has been rolling in my head for the past few hours.

There are no coincidences is what the Mayan priestess kept saying. Our team and all of its members came here for a reason and that cannot be attributed to luck. I do not believe that I was in both of these patients’ rooms by chance. I feel like I’m being pulled in a new direction and am excited to explore it more fully whatever that may mean.

Evan Purvis

Gratitude and Joy

Two days in and I’m already overwhelmed with all that I’ve seen, heard, and done. After we arrived on Sunday, the nerves and anxiety associated with this trip began to sink in. I didn’t know how much help I would be, how well I would be able to communicate with patients, or if I would be able to make a difference at all. After yesterday and today I can confidently say that those worries have vanished. I can physically see the difference we are making in these people’s lives.

This difference comes in many shapes and sizes. Yesterday I saw it while working alongside Rabi Abie in glasses. Many of the elderly patients coming in had lived their whole lives without even knowing what good vision is. It was so rewarding to have a patient walk in nearly blind and leave with almost perfect eye sight. Even if we couldn’t improve their sight significantly, every single patient showed a tremendous amount of gratitude and joy. It really made me question how much we take for granted in the United States.

Another place I saw this difference was when I was shadowing Dr. Richard. While he taught me a lot about internal medicine, he taught me even more about doctor-patient relationships. The amount of time and energy he puts into each patient is truly amazing. Each patient was given so much attention and care. He never made a diagnosis or wrote a prescription without fully examining every aspect of the patient.   I would be lucky to be a physician as thorough and caring as him.

Joe Kavanagh

Wednesday, March 8, 2017

An Open Heart and Mind

"Enter this journey with an open heart and open mind," Megan wrote me in the journal she gave me before leaving. I didn't realize how meaningful this would be until I finally had the opportunity to work in the clinic these last two days. I started my morning working with Dr. Richard examining patients. Right from the start I knew it would be a busy day because although he had only scheduled 10 patients for today, he was told he would also be seeing some of the 21 diabetic patients who come to the clinic every month for a checkup. It wasn't long before we realized we would not get through half of these patients before lunch time. The four patients we saw that morning had complex situations that needed more than a simple examination, whether it was for extreme anemia, high blood pressure or from simply being completely confused about which medication should be taken and at what times.

Señora Clara Luz, a woman in her late 70s, was waiting outside of the glasses station when I called for her to see Dr. Richard. "Como se siente oí?" I asked her. "Muy feliz." She told me she was happy because we were here to help her with her vision and pain she had been having for a while now. We began by observing and asking questions about her medical history and her current health problems. It was inspiring to see how Dr. Richard was so patient and empathetic with his patients, even though he did not speak the language. After his evaluation, he decided to prescribe a medication she would be taking every day along with the one she already had. She explained that she would not be able to afford taking this medication every day and that she was just getting by with the one she was already taking. Often times we forget about the obstacles these individuals face every day. We forget that they may not have transportation to the city in case they are in need of more specialized attention or how difficult it is to arrange a trip there. We forget that they may work every day and can't afford to take a day off to see a doctor, and we forget how emotional this can be not only for us, but for the patients themselves.

Señora Clara luz was only one out of the many cases with challenges that we encountered these last days. Challenges that go beyond the science. We come as advocates for these people, as Dr. Richard said, giving them tools for better health. However, the people we have seen have also helped us. They have helped us see through a different lens and appreciate things we often take for granted. They truly have helped me open my heart and mind and I can only hope that we can continue to grow as we all embark this journey together.

Natalie Castillo

Tuesday, March 7, 2017

Why We Do What We Do

Today was our first day in the clinic and I'm at a lost or words. I was so excited that I was back in a country that I'm glad to call my second home. I spent two years of my life here and it's this country that has inspired me and pushed me to pursue a career in medicine, specifically global health.

Today allowed me to see a piece of what I could be doing in the future, and I couldn't have asked for anything better. I started off my day working in Spanish pediatrics with Doctora Patricia, who's experience and knowledge definitely transcended in the doctor's room. She was kind, loving and was extremely good with kids. She highly emphasized the importance of the growth curve and how mothers should always ask for them and know what they mean. While there was some difficulty in understanding her methods and trying to figure out how to incorporate our methods with hers when it came to the clinic, everything in the end turned out great.

The second part of my day included working with Dr. Lauri, another pediatrician. She was very informative and allowed us to be hands on, more than you could ever get in a shadow visit. She challenged us and got us thinking on important pediatric issues such as failure to thrive and what the child should be doing a specific age, such as being able to sit up by 6 months with support or babbling words near 7-8 months. As well, it was amazing to be able to spend time with the little babies who were absolutely adorable. However, among the many children we saw today, many were falling behind on their growth curves, either barely making on it or not even making it. It really brought to light the lack of nutritional foods that the kids have access to as well as fresh water.

Fresh water was something that Dr. Lauri highly emphasized and asked questions about for each family, because many of the root causes of the sicknesses and illnesses in children are caused due to drinking non purified water. She constantly brought up the clay water filters we have that were donated and that members of the community could buy for Q300 (~$43) which would guarantee them fresh water for several years.

Finally, my day ended working in glasses with Rabbi Abie. In particular, we had a specific patient who was 77 years old who was blind in one eye and could barely see in the other eye. She told us she has been considered blind since she was a child. After many trial and error runs, we were able to get to read 20/20 with the glasses and the expression on her face was priceless. She was amazed at the fact that she was finally able to see and it was so heartfelt that we all started to tear up and we shared a sweet moment with her.

This is why we do what we do. These people who come and sit for hours on end without complaining just to get basic healthcare offered to them are just incredible. That have offered more to me than I think I could ever offer to them. We are one with these people, no matter where we come from, no matter what religion or cultures we have, in the very core we are all human who deserve love and care.

Angela Ellis

Make it Work

Today was the first day in clinic and boy did it feel like a first day. There was so much to do and a lot of kinks to be worked out, but I am pleased to say that we did it. I believe that a big part of taking part in trips like this one is being adaptable, and with that, having the Tim Gunn “make it work” attitude. No matter the situation, first days always bring the unknown. No amount of planning and preparing can truly prepare you for a new experience. However, I am of the opinion that the right attitude can. Today was chaotic, but it was not pure chaos as it could have been, and I’m going to credit a decent portion of our success to the incredible attitudes that everyone in triage came to clinic with.

Please forgive my seemingly triage-centric blog entry, but since I spent both my morning and my afternoon in triage, I did not get to explore much of everything else that was going on and have to base my account of the day on what I saw and experienced. I’m confident that the passionate and persevering attitudes that I am describing were not specific to triage, but I can definitely say that they were crucial for our success. Deciding to make it work, whether “it” being blood glucose tests without lancet devices, or overcoming a language barrier, was something that we did. It was a Tim Gunn day and I can only see the week getting better and better from here.

Xye Inzauro

Language Isn't the Only Form of Communication

My day started waking up to a rooster at 5:59. An actual rooster call, like one you would see in a cartoon. As if that wasn't unreal enough already, I emerged from my room surrounded by beautiful volcanos. However, I'm not sure that the amazing landscape can compare to the amazing people I had the privilege of working with today.

At the clinic first day nerves set in right away. When we got there patients were already lined up waiting outside. I started my day setting up our pharmacy, but once we were waiting for the prescriptions to start rolling in Katie, another student on the trip, encouraged me to come with her to blow bubbles with some of the children waiting in line. They looked at us like we were a little crazy at first, but eventually they couldn't help but smile. Les burbujas were definitely a hit. I was nervous to interact with the kids (or anyone for that matter) because I don't speak Spanish, but this experience showed me that language isn't the only form of communication, smiles and laughter count just as much.

This was a wonderful start to my day because it gave me a small amount of confidence, and opened my eyes to a new perspective when working with patients as well. I spent the afternoon shadowing Dr. Richard, and I'm not sure that a pre-med student could even hope for a better shadowing experience. He exemplified what a doctor should be. He spent as much time on a patient as needed without worrying about time. This means he never let anything a patient said to him slip through the cracks. He listened to everything the patient was experiencing and was able to make the connections necessary to treat them. He did all of this while taking teachings moments for me, in order to make sure I understood why he was doing what he was doing. It was also inspiring to see him do this because he, like myself, does not speak Spanish. He had an amazing interpreter with him Mishell, but was still able to connect with his patients and give them the highest quality of care on a personal level. This was incredibly important for me because it reinforced the idea that I can still make an impact on someone's life, despite the barriers we may face. Clinic day one may have come to a close, but I can't wait to see what other surprises the week will bring.

Anna Klunk

Monday, March 6, 2017

Early bird gets the worm...

¡Hola amigos! Today began our journey to Guatemala. After packing our suitcases yesterday, we woke up at 3 am today, driven by caffeine and our desire to be for others, ready to head to the airport. We have spent countless hours planning and carrying out fundraisers, we've learned medical terms and techniques and we've worked on our Spanish skills and it's all lead to this moment. As I'm writing this, our plane just started moving and we are headed to Atlanta. Our excitement is obvious because we are the only section that can be heard at 5 am, probably annoying everyone else on the plane but our intentions are pure. We are sleep-deprived but extremely pumped to start our work in Choacorral!

We were welcomed by the community with open arms and wide smiles. After lugging dozens of suitcases full of medicine and equipment, we spent some time unpacking and arranging the clinic! It's exciting to see how much we've already made in just one day!

What stands out the most to me is how Guatemalans carry their hearts on their sleeves. I have already met a few people and we speak as if we have known each other for years. This kind of genuine sense of community gives me the permission to be freely vulnerable with those around me. It's only day one and I can already feel that I am growing into my better self.

Aichetou Waiga

A Poignant Perspective

Whenever people asked me how I felt for the months leading up to our trip, I could not really put it in words. Before we began our journey to Guatemala (that started with meeting promptly at 3:45 am on Sunday morning with our caravan drive with all of our luggage to the airport), I think my primary emotions were nervousness and excitement. But still, it never really felt real until we were actually in Guatemala. As soon as we landed in Guatemala City, however, it finally kicked in that this was real and going to be our reality for the next week. In that moment, the excitement took over the nervousness (mixed with a bit of tiredness and sore musclesness from the lack of sleep and the heavy lifting of pounds upon pounds of medical supplies from the packing party the day before).

After we loaded all of our bags onto the bus, the first thing we did was head to a cemetery tour in the city. Before I describe what I learned in this cemetery, however, I feel like I need to provide a disclaimer that I have a weird thing for cemeteries. Whenever I go on family vacations with my family and we happen to be in a city with a famous cemetery, like Père Lachaise in Paris, I make them all visit it with me. I think there is something so uniquely beautiful about all the brilliantly intricate marble tombstones and looking to see which grave sites still have fresh flowers. Though I certainly saw some fancy marble handiwork at this cemetery too, I leaned that they only stood to mark the deaths of the wealthy. As we stood before an overwhelming Egyptian-styled grave complete with a massive pharaoh head, Jose Rolando, an amazing and hilarious human being who has been organizing our trip for us in Guatemala, described how this cemetery stands as a direct depiction of the difference between the rich and the poor. Just a couple of meters (practicing using the measurement base unit that I will soon be using with Dr. Lauri to complete growth curves in the clinic :)) beside this elaborate grave were the graves of the people who were not as wealthy, buried with just enough room to fit their coffins and their graves decorated with fresh flowers. As Jose Rolando said, even in death, the difference between the rich and the poor can be seen. Seeing the cemetery from this point of view made me see this inequality from a new and very poignant perspective, and it all happened within hours of landing in Guatemala.

Now, I think that the excitement has most definitely overtaken he nervousness and I am looking forward to seeing what else I will learn in the coming week.

Zenab Saeed

A Kind of Calm

The first ever Guatemala Medical Mission Trip to San Lucas began like the previous medical trips with this massive caravan of undergrad students with too little sleep and the entire team dragging a ton’s worth of medical supplies. I’ll admit I was not the happiest person in the world at 3:45am, but by the time we got lined up at the airport, all the excited and nervous energy for the trip started to slowly build up and once we got through security we were all busy chatting away. We all thankfully made the first flight to Atlanta, and a bunch of us just passed out for the hour long flight.

Getting to Atlanta and meeting Dr. Richard Walter was when it all just sort of hit me. I am going to Guatemala. This trip that I have been working towards with the rest of the team for these past months is finally happening! Eric began interviewing us asking how we were fee1ing. I wanted to say nervous, but I couldn’t. I was just so content and excited for this trip. I hone1stly have a small idea of what to expect for the trip. I don’t know what actually running the clinic will be like besides busy and sometimes stressful or how long or exhausting these days are going to be… But I just felt assured. Confident. The long hours of meetings, fundraising, and preparation has just left me with feeling that being in this clinic at this time and date is exactly where I am supposed to be. A kind of calm.

Now, I know this is probably just the calm before the storm. Our team though gives me this confidence in the face of that storm anyway. Seeing everyone’s pure joy and even nervousness when reaching Guatemala, the moment for reflection, solidarity, and mindfulness at the cemetery, the conversations we had eating Pollo Campesino, dragging all the medical supplies up that absurd hill in Choacorral and seeing each other laughing and smiling the whole way up between some pretty big breathes, us taking charge to set up the clinic with the other community members of Choacorral expecting to improvise our first day of clinic too, and screaming Adele's "Hello" on the bus ride back to the hotel. Our translators, Roland Jose, and a pretty fantastic dinner with strawberry flavored marshmallows. All these moments, people, and working with our team... They have been fueling my experience this first day. I am ready to go through the rest of the trip with these people and see exactly what my twin brother Adam described as "the single best experience I had with Xavier" because this first day was exhausting but great.

Evan Purvis

Saturday, March 4, 2017

Packing Party

Each year, the Xavier University Interfaith Guatemala Medical Service Trip brings hundreds of pounds of supplies to stock the clinic. This year, the team packed 37 50-pound bags (that's 1,850 lbs, nearly 1 ton of supplies!). That doesn't include all of the additional supplies that were sent via mail ahead to time, and coming from LA with Dr. Richard.

Check out this time-lapse video and watch 2 hours of hard work flash before your eyes:

Friday, March 3, 2017

Shaking the Tree Women in Guatemala

A tribute to two beautiful young women for International Women’s Day, March 2017

Seven years ago in a dusty grade school gymnasium on the side of a mountain in the western highlands of Guatemala I met two young sisters, Diana and Mishel.  At the time they were bridging the gap between adolescence and adulthood.  One was 20, the other 19 years of age.  They were hired as medical interpreters for Dr. Richard Walter, an internist from LA, and myself, a pediatrician from Cincinnati.  Richard and I were embarking on our first trip to help improve the healthcare and lives of the people in this small village in Guatemala.  This was Richard’s first time practicing medicine outside of his office and practice in LA.  I had a bit more experience, having studied pediatric malnutrition for a month in medical school in rural Honduras.

The little community we were matched with had never had a physician in their village before that day.  We were there with Xavier University’s Center for Interfaith Community Engagement’s Guatemala Medical Service trip.  The trip was organized by the center’s director, Rabbi Abie Ingber.  We brought with us two triage nurses – also both from LA, and 12 Xavier University pre-med and nursing students, along with Rabbi Abie’s assistant.  Somehow we had to transform this dusty gymnasium into a clinic for a week.  With the help of some sheets and tarps we strung up with ropes, we made two exam rooms and started seeing patient after patient.  I knew some medical Spanish, but Richard, really knew none.  Randomly Diana was assigned to me in the peds room, and Mishel to Richard for the adult patients.  We dove in, not really knowing what we were doing.

After a long, hot and exhausting day of seeing patients and teaching students we all piled into the vans to go back to our hotel.  I ended up sitting next to Richard in the van.  We had only met each other the day before, but now seven years later I count him as one of my closest friends.  Richard looked at me on that van drive home, overwhelmed by all of what we had seen that day, but the first thing he asked me was, “Your sister, your interpreter, Diana, is she really smart?  Because the one I have, Mishel, is amazing.”  This launched a conversation that is still ongoing between Richard and me about the myriad gifts these two girls possess.  Within a half of a day of working with us, Mishel and Diana knew how to take a full medical history.  Each new chief complaint was memorized and categorized into some intricate filing system into their brains.  If Richard was seeing a patient with headaches, Mishel knew the next ten questions he was going to ask about headaches. They intently listen to everything we say, translate it into Spanish or Kachiquel and communicate it all so seamlessly.  They are fluent in several languages.  Having worked with students in training our whole careers Richard and I can honestly say we have never worked with more accomplished students.  They are quicker learners than any medical student I have encountered in my career.

They also understand that doing medicine well takes time.  Sometimes you have to ask that next question.  They have been in rooms with us as patients have revealed very private and personal information.  They have helped us learn about rapes, immigration horror stories, domestic abuse issues and many more.  And they do all of this with compassion and grace.

Several days into our first week, we were out in the evening looking for a good place to get some guacamole and Gallo beer to unwind and decompress after our long day.  We walked by a colorful restaurant on the main strip of Panajachel playing the most wonderful marimba music.  To our surprise the musicians were none other than our Diana and Mishel.  Their father, Miguel, who I could write chapters more about, owns the restaurant and his daughters play the music along with a cousin.  Their lovely mother is the cook!  We have since enjoyed hours of entertainment listening to them play the marimba.  They are now famous around Guatemala for their marimba skills.  If you are ever in Panajachel stop at El Pinguinos to say hello to them – it will be well worth it!

A few years ago we added a pharmacist to our annual trip.  His name is Eric Bertelsen and he travels with us from Cincinnati.  When he first met Diana in the van that year he asked her what she was studying in college.  She replied, “Psychology, so I can help my people be happy.”  Eric can’t recall this memory without tearing up.  She was so genuine, so honest and so committed to changing the world around her.

One of the days toward the end of our trip each year we try to do home visits for patients who are too ill to come to clinic.  Because I am the younger of our two physicians, I go up the mountain to see home bound patients (both adult and children), while Richard goes down the mountain.  It is a nerve-wracking day for us, since we both feel like fish out of water taking care of patients not in our typical age group.  As an infant, Diana had hip dysplasia that was not diagnosed in time, so she lives with chronic hip pain.  Because of this we decided it was best for Diana to go with Richard on the less-steep terrain.  So we switched interpreters.  Little did we know how brilliant this switch was until Richard found himself taking care of a child with respiratory issues and I had an elderly woman with diabetes.  We both were in unchartered water.  But the girls had been with us so much they knew what we would do and what questions we would ask.  Mishel knew the adult medicine from working with Richard and Diana knew the pediatric from working with me.

Even more impressive than their sponge-like brains, is their zest for life.  They are ALWAYS smiling.  They are joyful to be around and always lift us up.  Needless to say, our trip to Guatemala each year would not be the same without them.  They have been with us now each week for six years straight.  This year we are starting a new clinic in a different community and Mishel and Diana have agreed to travel with us for the week, giving up the other responsibilities of their lives to come and help us.   When I think about women who should be known to the whole world on a day like International Women’s Day, I think about Diana and Mishel!

Lauri Pramuk, MD