Friday, March 11, 2016

Be Happy

Prior to coming on this trip, a past participant told me: "There are a lot of bad-ass women in Guatemala", and this quote came to life for me today. My team and I were able to go on home visits with Dr. Richard through the upper sector in the village of Patanatic. Two of the female patients we saw were in their late 80s, and had better than average blood pressures, ideal blood glucose levels, and an activity level that is better than mine! One of them had to hike up and down a very steep, treacherous path with barbed wire on both sides just to leave her home, and she managed to do it EVERY day! On top of all of this, every patient was so gracious and welcoming to let a bunch of American strangers into their home so that we may provide care and also learn in the process. I was so amazed and humbled by the health and strength these women exemplified, despite the difficulties they face in their every day lives. Today allowed me to reflect on what it is that we really need to be happy and healthy in our lives. As another wise Guatemalan has told me--if you want to be happy, choose to be happy.

Molly Kubicek

Jose Daniel: Critical Illness on a Mountainside in Rural Guatemala

When you spend 4 years doing a pediatric residency, you finish your training pretty comfortable with recognizing a sick child.  I think that is probably one of the greatest gift of those 4 years.  Then if you chose to go on and do outpatient primary care pediatrics like I did after training, the first few years you have to learn how to field all of the questions of mostly well children's parents on your own, having had little training in those types of questions. Our training does not prepare us well for intricate questions about potty training, teething, sibling rivalry, sleep issues or other more mundane topics that fill our outpatient office time.  We learn along the way, but we never forget that one patient in training with meningitis, or heart failure, acute leukemia, or life-threatening asthma.  Thankfully even as you fill your knowledge well with all of the outpatient "well child" issues, the critically ill knowledge stays with you, though you do not use it on a daily basis any more.

On Tuesday in clinic on a rural mountainside in Guatemala I was presented with a critically ill 40-day-old infant.  His name was Jose Daniel.  He was the fifth child of the family and was only supposed to come to clinic for a weight check.  But our phenomenal triage nurse, Stephanie, welcomed him to clinic, learned he was premature by 6 weeks and thought maybe he should see the pediatrician while he was there instead of just being weighed and sent home.  As I got his history from his mom I had yet to lay eyes on him.  They bundle their babies here in layer after layer of clothes and perajes (wraps).  What I learned is that he was delivered early because mom had pre-eclampsia.  He was 34 weeks gestational age but did fine in the nursery and was sent home at 3 days of age, having no recognizable problems in the hospital.  He had been seen twice since birth - once at an outside clinic and once by a medical team the week before us in our same clinic.  He was not growing well so in addition to breastfeeding he had been started on some supplemental formula.  He indeed was not growing well as we plotted him out on his growth curve.  I asked mom if he nursed with similar vigor as her other 4 and she said yes - often little 34 week premies have trouble feeding.  So it seemed he was eagerly feeding, but not gaining weight.  He had normal stool patterns and did not spit up, so it seemed he was not loosing calories through stool or vomiting.

So, the next step was to examine the patient.  Mom unwrapped him from his many blankets and I saw his face for the first time.  As you can see in the photo he has some facial characteristics that are worrisome for Trisomy 21 (Down's Syndrome).  He has almond shaped eyes, a small midface and a protruding tongue.  When I put Jose Daniel on the exam table and unwrapped him I knew immediately we were in trouble.  As you can see in the photo and watch in the video Jose Daniel was not breathing well.  He was using every ounce of his energy to keep breathing.  Those little muscles between his ribs and under his ribcage were pulling with all their might to keep moving.  He was clearly in distress.

I asked mom how long he had been breathing like this and she said, "His whole life."  Then I listened to him.  He had clear lungs but had a heart murmur.  I quickly finished the rest of his exam - which was notable for low tone, and no simian creases on his hands (can be common in Trisomy 21).  Then I asked one of the students to get nurse Stephanie in with the pulse oximeter.  As I suspected he had low oxygen saturations at 78% (should be above 90).  Trying to remain as calm as possible we started mobilizing to get him to the hospital.  We briefly told mom her child was ill and needed to go to the hospital now and we were going to take him.  Nurse Stephanie is fluent in Spanish and was incredibly helpful in communicating the urgency gently with his mother.  The mom asked if we could stop at her house in town on the way to the hospital to get some medical records she had on him from his other clinic visit.  I told her that was fine, as I thought it may help solve some of the mysteries of what was wrong with him for the hospital staff.  I decided it would be best if nurse Stephanie went with him in transportation as she is fluent in Spanish and I trust her with my own life!  I figured with mom's history of him having breathed this way his whole life he was compensating well enough that he was not going to crash in the hour it would take to get her to their home and them all to the hospital.  I stayed in clinic to continue seeing all of the other patients who were already backing up in triage.  In the mean time our team of Xavier students all stepped up to the plate to run that triage room like a boss!

You never really know how an emergency room in a foreign country is going to react to a patient sent in from a "foreign" doctor.  Thankfully the emergency room nurse respected Stephanie's statement that she had an ill infant, unwrapped the baby and immediately kicked into gear, getting oxygen on him and a chest xray ordered.  On the film his lungs had bilateral infiltrates (pneumonia, or fluid from heart failure), and an enlarged heart.  She also heard the murmur and little Jose Daniel was admitted for stabilization and the plan was put in place for him to get transferred to Guatemala City for an echocardiogram.

At this time we still don't know all of the answers.  I suspect he may have Trisomy 21 and heart failure from congenital heart disease, which is very common with Trisomy 21.  But he could also have normal chromosomes and just pneumonia or weak lungs from his prematurity.  Either way, he was very ill, we were able to recognize it and get him to a facility that can do the diagnostic work up he needs.  So it all worked - even from a mountainside in rural Guatemala.

Every year I have come on this trip I have mostly seen well children - there has been a child mildly ill with pneumonia, Luisa and her cerebral palsy, the 2-month-old baby 2 years ago we took to the hospital with a fever, but those kids overall did fine and probably would have done fine even if we weren't here.  I don't think Jose Daniel would have done fine if we weren't here.  I think our team was here at the right moment for Jose Daniel.  Since then we have talked about him as a group and individually many times.  Not only did the students learn a whole lot of medicine from him, but he also deepened our relationships with one another.
"Adversity has the effect of eliciting talents, which in prosperous circumstances would have lain dormant."  - Horace
I have so much gratitude from that encounter with Jose Daniel.  I am grateful for my training, and my ability to recognize a critical patient and remain calm enough to make a plan to help that patient, grateful Stephanie Ibemere was there along with Rabbi Abie to transport him, grateful the students got to see all of that, and grateful this beautiful little baby is getting the help he needs.  Gracias a Dios!

Lauri Pramuk, MD

Luisa, Luisa, Luisa

For the past two years Luisa has been our first clinic patient of the week. Both of those times she walked into clinic.   If you don't know Luisa's story the magnitude of that statement will be lost.

Luisa is a now 5-year-old whom I first met just after her first birthday when her mom brought her to clinic with the chief complaint of, "Why is my baby not like my six other children?"  That started our now 4 year relationship of dealing with cerebral palsy in rural Guatemala.   That day, the one-year-old Luisa could not roll, sit, crawl, stand or walk.  She was also microcephalic, had global developmental delays, and was ill with a probable aspiration pneumonia.  We had a long talk about CP, we talked about the importance of physical therapy, we treated her for the pneumonia and parted ways.  I thought I would likely never see her again.

How does one survive with no resources?  I thought she would get recurrent aspiration pneumonia and die.  Her mom, with her incredible, strong Guatemalan determination found a physical therapist about 20 minutes away and has been faithfully taking her there once a week for 4 years.  So the child I never thought would walk, let alone survive, is now walking with assistance and alive and smiling at age 5.  She still needs a person to hold an arm on each side of her, but her core strength was much better this year as she had much more stability in her trunk.  She came to clinic with two of her big sisters and the three beautiful human beings are in the video clip.

She is still not growing and still only says the word "mama."  We brought down a nutritional supplement this year that is used to rehab young children on the verge of severe malnutrition.  It is called "Plumpy Nut" and comes in a foil packet, tastes like the inside of a Reese's peanut butter cup and each packet provides 500 kcal.  We brought it down mostly to try to intervene with kids in the first 2 years of life who are failing to thrive, but we also thought we would give it a try with Luisa.  We sent the family home with a packet and mom came in to clinic to get all of the instructions.

I am in awe of her mother.  She is such a beautiful, strong woman.  It is one of my favorite moments each year getting to see her.   This year I got to introduce her to my own daughter, Grace.  We gave Luisa's mom instructions on how to use the Plumpy Nut.  Unfortunately, as I suspected, it was too sticky for Luisa to eat.  She still has many hurdles in just trying to eat most foods.  At her physical therapy clinic Luisa now gets some sort of feeding therapy, so perhaps over some more time we can try Plumpy Nut again, time will tell.

Every year I learn so much from Luisa and her family.  She is a well loved child who reminds us of the fragility of the human condition, but at the same time shows us our grit and determination to live.
"Be content to progress in slow steps until you have legs to run and wings with which to fly." - Padre Pio

Lauri Pramuk, MD

Small Miracles

Yesterday was absolutely amazing and full of small miracles. I started the day with Dr. Eric in pharmacy (also with Sean) and we killed it! We got the medications packed for the home visits that morning and the school visit we went on today all while filling prescriptions and counseling patients. I'm getting better at counting pills by 5's- my first grade teacher mom would be so proud! I can use that skill this summer when I hopefully work as a pharmacy technician.

One small miracle happened when I was in triage. This moment was just one of pure happiness. I made an adorable friend with strawberry socks on in triage while the pharmacy was slow. I played with her until she went to see Dr. Lauri and then I got to see and play with her again when we were explaining the baby care kit to her mom. She kept dropping the bubbles so that I would pick it up for her. And she wasn't the only one who loved the bubbles-kids came in packs after school just to get burbujas! It was always loud and chaotic after school in the clinic.

In the afternoon, I was with Dr. Richard on home visits. They were amazing and so eye opening. I loved being able to see more of the mountain we have called home this week and to see where the people live. We first saw an older couple with a large family. They were very sweet and insisted that we sit even though the space was fairly small. The man had a diastolic murmur, which Dr. Richard said he only had about 5 of them in his clinic. We were able to try to listen to the murmur. The "woosh" sound was really faint, but I think I was able to hear the "heart sound, woosh, heart sound," that is indicative of a diastolic heart murmur. The next patient we saw had a house with a GORGEOUS view of Panajachel, the riverbed, and the lake. The house had a coffee tree and we were able to see how they harvested the beans before they get toasted. The patient had pneumonia and we were able to hear the crackles in his lungs.

Our last stop was one of the small miracles of the day, if I can even call it small because it was really amazing! It was crazy, insane, and miraculous all wrapped up into one! First of all, we had to descend down a hill with a path of dirt, wood, and rock that was lined on either side with barbed wire. We weren't nearly as stable on our feet walking down the mountain as we probably assumed we were because there was a lot of slipping, sliding, and grabbing onto each other. It was a struggle, but another great instance of our teamwork. The miraculous part happened once we made it to our destination. We met another elderly couple, around 90 years old. Neither of them took any kind of medication and had perfect blood pressure and blood glucose levels. It was amazing to see, but the most amazing part was to learn that they walk up and down the barb wire-lined path each and every day. It made me step back and realize what I take for granted and look at how you can really do anything if you set your mind to it even if people doubt you could. We worked extra hard on the way back up the mountain to attempt to feel as capable as the couple.

Our cultural event at Mishel and Diana's father's restaurant was enlightening and delicious. The food was great and we learned how to make our own tortillas.

Today, we visited a school in San Andreas. I was able to play with the kids, learn how to take history from Dr. Richard, and watch Dr. Lauri do amazing things with her patients. The small miracle of the day was when I saw all the kids running around and happy. It just made me so happy and their demeanors and attitudes summed up how I feel about this medical mission trip- ecstatic, grateful, and moved beyond compare.

All of the many small miracles over the course of the week will always be with me and I will love them forever.

Brooke Chastain

Thursday, March 10, 2016

Sadness Surrouds

*A Note From the Editor: Grace Pramuk is helping document the trip of this year's Medical Mission Team, using her unique gift of photography, videography, and storytelling. Leave a comment at let her know what you think of her fantastic work!

Grace Pramuk

Among the Mayans

*A Note From the Editor: Grace Pramuk is helping document the trip of this year's Medical Mission Team, using her unique gift of photography, videography, and storytelling. Leave a comment at let her know what you think of her fantastic work!

Grace Pramuk

Wednesday, March 9, 2016

Completing the Little Things

I am feeling so refreshed by the beautiful scenery, people, smiles, laughter, and joy that I have encountered everyday. Watching women climb the mountain balancing a huge basket on their head while carrying a child on their back is just a small example that shows the true dedication, hard work, and strength the people of Guatemala possess.

Today, in clinic the patient who really spoke to me was a beautiful 80 year old woman. Through her beautiful appearance and big smile on her face I could only wonder the amount miles her feet have traveled, the hard work her hands completed, the sights her eyes have witnessed, and the amount of love she has outpoured to others. I completed the visit with her in the prayer room where she hugged, kissed my cheeks, and thanked me so many times. 

My favorite quote by Mother Teresa is, “Do small things with great love.” As I continue throughout my nursing career, I need to always remember that sometimes it is the smallest encounters that you can have with your patient that can show the greatest love. My time spent within the clinic has most importantly taught me to be fully present with each patient, to take my time, and to always focus on completing the little things. For as Nurse Stephanie told us, “It is the little things that we can find unimportant that will bring about the biggest difference.”

Lauren Francis

“If the longing you see is not before you it’s ahead of you.”

Day Three of being in Guatemala and already I have learned so much about myself.  I always ask myself “what is my purpose in life?” I have been struggling with this question since my junior year of high school. During my high school years I fell in love with being of service to others. It felt good going to the soup kitchens, shelters, and volunteering in any way possible that I could. I fell in love with the people that I met, and the stories that were shared, and what they taught me about life. I enjoy being of service to others because it makes me happy.

What makes me uncomfortable is the amount of privilege that I have and sometimes hold over them. How can I do justice when I am not on the same level of the people in which I want to help better their lives?  I don’t want to be a savior; I don’t see myself fit to save anyone from their problems. In order for me to fully understand the people I must first understand them as humans. Humans that hurt, cry, love, live and breathe the same way I do. What am I, a black American, doing on an interfaith trip in Guatemala……going back to that question of discernment “what is my purpose in life?" I know that I am in love with serving others and volunteering but am I truly impacting anyone’s life?

Nurse Stephanie answered my question today, she said “don’t down play the little things you do in life because you don’t know how much they impact someone's life.” I guess for me it’s hard because I don’t see that impact, and if I didn’t see the impact did I really helps better their lives? I struggle with these questions daily and as I grow spiritually and mentally I realize that everything I do regarding serving others is coming from a place of love, and that place of love allows me to do the best I can, and be the best I can. I want to be the change that I want to see in the world; this requires me taking baby steps and being patient. This change wouldn’t happen overnight but it will happen as long as my motives are driven by love.

So far I have had an amazing experience with the healthcare professionals on my team.  I have quotes to describe each one.
Dr. Eric: “Be like a duck: be calm on the top, but paddle like hell on the bottom!”
This quote exemplifies Dr. Eric very well. In his pharmacy in Guatemala he is very calm and has a great system that the pharmacy runs on. But at the same time he is “paddling hard as hell”; he is making sure each patient is receiving the appropriate medication, and takes his time to double check with the doctors. The pharmacy is never out of order and he makes sure that each student learns accordingly.   -   Gracias!
Dr. Lauri:  “Feminism isn’t about making women stronger, women are already strong.  It’s about changing the way the world perceives that strength.”
This quote describes Dr. Lauri so well; she exemplifies strength as a woman, a doctor, and as a mom. She has inspired me so much on this trip and I am so blessed to be in the presence of such powerful women. She says that the women in Pantanic are “kick ass females”; she in turn is a kick-ass female. She is an amazing doctor who shows others what it truly means to be women and men for others, and to cura personalis (to care for the whole person).   -   Gracias!
Nurse Stephanie: “Butterflies can’t see their wings, they can’t see how truly beautiful they are.”
Nurse Stephanie: I don’t think she realizes how truly beautiful she is. Her soul is beautiful, her characteristics are beautiful; her passion for caring for others is beautiful.  That is what makes her an incredible nurse. People like Stephanie are willing to beat someone up, in order to make sure patients like Jose Daniel receive proper healthcare.    -   Gracias!
Dr. Richard: “Do small things with great love.”
Dr. Richard exams and teaches us students with great love. Everything he does while in the clinic comes from a place of love. He makes sure he has the time to educate us and allow us to gain hands-on experience. I now know why the past participants on this trip were very fond of Dr. Richard. He is an amazing doctor who is passionate about caring for patients.    -   Gracias!

I am a Xavier University student on an interfaith trip to Guatemala.
I wonder if I will ever find my purpose in life.
I hear babies crying, Spanish being spoken, and students yelling “Uno, Duo, Tres,  ESCUPE!!
I worry if the people in Guatemala will ever be free of their struggles
I dream of a world that everyone has the equal opportunity to thrive
I hope that our 2016 medical mission trip has served a great purpose
I want the world to see the beauty of this world, which God has created for us.
I wish for peace and love toward those who are marginalized

Enlara E. Ndum 

Jose Daniel

Once again my time in Guatemala has proven to be both an excellent academic experience as well as an important spiritual education. My day, the 8th of March 2016, started off with a filling breakfast and a humorous discussion about the “Donald Trump” phenomena which was occurring back in our home country. It says a lot about the people you are with when you are able to talk about politics when your conversation doesn’t turn into a yelling match. From there we traveled to the clinic and began performing our duties. My job was to work in the triage section of the clinic during the morning and to then alternate during the afternoon to lea patients in prayer before they received their medication.

My duties in triage proved to be, at first, difficult and draining as we received a slow but demanding group of patients. Mistakes were many and efficiency was lacking but I persevered and found that triage proved to be the most bountiful academic experience so far. The interactions with the patients and the medical knowledge complimented each other both in their outcome as I was able to learn Spanish as well as learn what the proper way to obtain proper medical data is. Triage became hectic as time progressed but thanks to the help of Nurse Stephanie as well as my partner we were able to deal with all our patients efficiently. My only regret during this experience was that I wasn’t able to perform at the same level during the morning as I did during the afternoon.  This self-assessment would carry itself over to my next duty.

Being a part of a patient’s spirituality is a unique and surreal moment. Prayer takes place after patients are diagnosed and educated on what lifestyle choices they will have to make or stop after we leave. The prayer room is a small and quiet room which promotes the patients and me to converse (poorly on my part) and to pray together. It was during my time working with patients I met Jose Daniel, a unfortunate infant who suffered from complications from birth which resulted in a wide range of negative symptoms which had taken a toll on his growth. The whole clinic had to halt all operations to properly asses Jose’s situation and what steps we could take with consideration of our limited resources. That being said my limited involvement with this child was when I accompanied Jose and his mother to the prayer room. It was here I was forced to look at the grave reality of the situation. In that moment I felt useless. Jose was truly suffering and all I could do in that moment was pray and hope that things would get better, while the experienced members of the clinic went to work trying to actually fix the problem.  Jose and his mother were taken to a hospital which had more resources at their disposal and from there he will hopefully be transferred to a larger hospital where he can receive even better care for his symptoms. The feeling of utter uselessness lingered within me for the whole day until I had the chance to reveal these thought to the rest of my team. They were quick to show me that what I was feeling was normal but that at that moment it is easy to view what little help you did was significant but everything that was done that day led to Jose getting the proper care he needed. The most important lesson that I learned today was that if you truly wish to help people then you must never compartmentalize others actions based on what you assess to be impactful. You must understand the importance of all actions, both big and small, to truly appreciate the connection you foster during your time with you patients.

Shrinath Suresh

Genuine Enlightenment

Communication, medical education, and learning about the human person on a physical and metaphysical level are common themes I have noticed since arriving in Guatemala on Saturday morning. These themes have enlightened my mind and have changed my way of thinking and my view of the world. What I am experiencing in Guatemala is surreal. The interactions between the medical team, the locals of Patanatic, and nature, have truly created a unique experience that is extremely genuine.

Communication is a vital part of truly engaging myself in the culture of Guatemala. It is the best way to immerse myself in the culture and understand the lives of the patients we are serving. While sometimes a language barrier does exist, there seems to be unique sense of understanding between the team and the people of this beautiful country. A smile and bout of laughter go long way in forming an emotional bond with an individual. One experience that stands out to me in particular was a short conversation I had with a young boy while his mother was waiting for medication at the pharmacy. I approached and asked him who is favorite soccer player was, and he quickly responded Lionel Messi. The next couple minutes consisted of us talking about why we preferred Lionel Messi to Cristiano Ronaldo and discussing how Messi was truly a magician with a soccer ball at his feet. While the conversation was short and was about two soccer players, it serves as an example that two people from different parts of the world share a unique bond with each other.

The medical aspect of this trip has been nothing short of amazing. I have learned more knowledge about medicine in the past few days than sitting in a science lecture. Through shadowing Dr. Richard my fist day in clinic, I learned the application of medicine and science is much different than learning the science. When speaking with his patients, Dr. Richard chose the medication he thought was best for each patient while considering other medications the patient was taking, possible side effects of the medication, and the overall mental well-being of the patient before filling the prescription. Dr. Richard also stressed the importance of taking your time with the patient so accurate data can be recorded, allowing for proper treatment. One quote that Dr. Richard mentioned, while talking to us about blood pressure, resonated a lot with me, “If you are not going to take blood pressure correctly, you are better off not taking it at all.” This quote is very important to me, and it gives me an idea of the type of doctor I want to become.

The scientific and physical aspect of medicine is very important; however, so is the metaphysical and spiritual aspect of medicine. Both Dr. Lauri and Dr. Richard both exemplify this type of health care. They always make sure that the patient is content with the medication they are on and are willing to be flexible with the patient. These types of actions say a lot about their character. I have been seen by a few doctors who do not have this same mindset, and it is not an enjoyable experience as a patient. The human person is composed of the body and the mind, and should be treated together as a single entity. As a young scientist, this is a way of discourse I hope to acquire when I am a physician.

Jacob Noll
Xavier University 2017
Biology Major
Chemistry and Economics Minor

Life and Death

What if there is a mystical quota for each and every day of how many people should die and how many should live? With life and death on the same continuum, our day in the Patanatic clinic makes a little more sense.

For two and a half days we have cared for the 283 families in this small Mayan community. One of the infants who came to see us was the grandson of a member of the community. Jose Daniel was born just 40 days ago and was one month premature . I will let the other medical professionals describe the nature of his illness but I was privileged to accompany this young infant in his journey to the hospital  of Solola, 40 minutes away.  The last time I made such a trip was three years ago. Thank God that little boy received quality care and his life has continued.

It was an eerie feeling to drive through the same gates and to enter the hospital knowing the doorways that would lead us right into the Emergency Room sans paperwork. Nurse Ibemere debriefed instantly on the severity of Jose Daniel's state and the hospital immediately began oxygen treatment and made plans for his admission and care. We left the baby with its mother and grandmother by his side. It was not an easy parting but we had done everything we could to save this baby's life.

As our van began the descent back to Lake Atitlan and the clinic's locale we were suddenly stopped along the winding two lane road. The road hangs perilously along a mountain cliff and there are often accidents, tragic ones. Were we again to witness the thin line between life and death? As we inched forward a police officer came up to our driver to explain the cause of the massive traffic jam - it was a funeral. In Guatemalan custom the coffin was being carried by hand up the mountain road. Trucks full of villagers, children, loudspeakers and flowers led the path for eight men carrying the adult coffin on their shoulders. "Dear God," I prayed, "let this be the older person one who in their passing has allowed our young Jose Daniel to have a chance at life."

As Ecclesiastes so elegantly wrote:
There is a time for everything,
   and a season for every activity under the heavens:
     a time to be born and a time to die,
   a time to tear down and a time to build,
     a time to weep and a time to laugh,
   a time to mourn and a time to rejoice.

Rabbi Abie Ingber

Tuesday, March 8, 2016

Nuestro Superhéroe (Our superhero)

Today started off like days passed in the clinic. Triage is always the part of the clinic that takes a long time for a patient to get through because there's a lot of steps. For the babies and kids we have to get their weight, height, head circumference if they are under two years old, heart rate, temperature (trust tiny humans do not care of getting their temps taken or us listening to their heart!) and then ask their parents a number of questions about their medical history. This is all occurring in Spanish for my beloved students that are learning how to do their jobs in triage and learning basic phrases to help the patient thought triage.

Today, a tiny human went through triage today that truly had superhuman strength. His name is Jose Daniel. I remember him coming into the clinic all wrapped up in 3 blankets and a number of baby clothes. When I held him initially I knew he was tiny but you could barely see him. His mother told me he was premature and they had to deliver him early because she had preeclampsia. At that moment I knew this baby had already been through quite a bit. She informed me that he was about a month early and she had been to the clinic last week, with a different medical team, they just asked that they measure this tiny human's weight and length every week to monitor his growth. So, that was that. Yes he was quite small on the growth curve. Very small indeed. I remember asking his mother if she had any other concerns and she said no.

So, we passed him and his mother along to Dr. Lauri for further assessment. Well I'm not sure how much time elapsed but a student came out of the Dr. Lauri's clinic room and said Dr. Lauri needs you and the pulse oximeter. At this point, as a critical care nurse, I began to run all types of scenarios in my head as I informed my students in triage that I was needed in an exam room. It is very seldom that I am needed in such a manner as we generally see well patients. I prayed that whomever this patient was I was being called for, would be alright. So I headed to the interior of the clinic with the pulse oximeter we had. When I walked in the room I realized it was Jose Daniel. Dr. Lauri uncovered him from his cocoon. At that moment I understood. Our tiny human was breathing with all his might. The muscles in between his ribs were pulling with all their tiny might just so he could get some air. This tiny human was in distress. At this point, Dr. Lauri in all her poise, wisdom and calm had come up with a plan. She asked me to accompany this superhero and his mom to the hospital along with Rabbi. So we began the process of getting our selves together for the trip. I spoke with Sonia, one of the community health workers, and informed her of the situation. I asked for a bus that could take us to the hospital because waiting for an ambulance could have taken quite some time. While we were waiting, I went back to the pharmacy area to inform Jose Daniel's mom about how much time we would be waiting before going to the hospital. When I saw her in the hallway, I noticed that she seemed perhaps overwhelmed but still confused.

I decided at that point my needs were going to sit in the back seat for a minute. I sat with her for the 15-20 minutes it took for the bus to get to the clinic. I asked her, "¿Entiende lo que está pasando?" In English, do you understand what is happening? She was able to tell me that she knew the baby was having difficulty breathing and we needed to go to the hospital. It was at that moment that she asked me if we couldn't just wait a month for when he would be going to get further lab tests. As you can imagine, I was frightened. I was frightened because she didn't understand that how much he had been struggling to breath. She hadn't quite yet put it together that his work of breathing was related to him by growing. So, I had a heart to heart with her. I explained that he was "luchando por aire" or fighting for air and everything he eats has been going to is work of breathing. I explained that is why he wasn't growing. She asked me if that is why he needed to go to the hospital now. I had to tell her yes. I had to tell her that we needed to figure out what was causing him to struggle so much.  So we took him. We made a stop at his home and I spoke to his father. His concern was that they had just seen a doctor last week and they told them he was ok. Disappointing is all I could think. How disappointed Jose Daniel's father looked when he told me that information.

As we drove through the beautiful hillside to Sololá, I started thinking about how I was going to get the point across in Spanish to the doctors or nurses or both that we would meet at the emergency room. All I kept thinking is, I'm willing to fight someone to make sure this child is admitted. And as God would have it, the nurse I met that day looked at me and said, "¡Gracias a Dios que traen este bebe al hospital!" Thank God you all brought this baby to the hospital. Immediately, I knew our journey was into compassionate and knowledgeable hands. He had a nasal cannula in his tiny nostrils within 5 minutes after she tried and tried to get a pulse oximetry reading on him and could not. He was back to X-ray within 10 minutes. It was a much smoother process than I had concocted in my mind. So we left this family there, in capable hands.

I have had a few difficult patient/family conversations before and they can be difficult. I just hope I was gentle enough with this mom.

That day I think about often now. The importance of taking your time and making sure all involved know what is going on. The importance of having a medical team that can maintain calm when things become critical within seconds. To be a part of a group that has doctors that are thorough in their assessment of their patients. I am blessed beyond measure to have encountered Jose Daniel. I am lucky to say that I got to be the one to have a heart to heart with his mother. I am lucky to have been the last one to leave the emergency room when his mother had her breakdown. And Jose Daniel is lucky to have the mom he has. That she followed the prescription of the physician. I'm glad we didn't let her just do the weight and length as she had wanted. I'm proud of the students as they were flexible and able to move into positions to cover the spots myself and Rabbi left open. I'm just grateful. I am praying for you every day Jose Daniel. I'm praying for you always.

Stephanie Ibemere

First Eight Hour Shift Grind and Loved Every Moment of It

When was the last time you didn’t dread working an eight hour shift and actually enjoyed it or even loved it?  Today we had our first full day clinic visits from 9:00 am- 5:00 pm and I couldn’t get enough of it.  Specifically what stuck out to me the most was my rotation in triage.

Starting off in the morning, I worked alongside the fantastic nurse Stephanie in triage, performing tasks such as taking vital signs, measuring height and weight, plotting growth charts, taking blood sugars, and performing eye examines.  Working alongside Stephanie in triage gave a sense of excitement and satisfaction that reiterated my belief in my future career as a nurse.  Serving as the first line of care, I really enjoyed organizing and gathering patient information while being surrounded by such humble, loving patients and staff.  I cannot emphasize enough how beautiful and kind-hearted the patients are, with so much patience and appreciation for the healthcare that many Americans take for granted.  Not to mention how incredible our staff has been working together and forming strong bonds beyond our passion for healthcare.  The community at the clinic has established my love for every second of work during the course of the eight hour shift.   The combination of productivity, patient interaction, and warm environment gave me a sense of awe in my practice as a nurse and realization that my care for patients is worthwhile.

Maddy Mayer

Pride and Prejudice

This is my sixth year as medical director on this trip.  Each year has brought me new surprises.  My 12-year-old daughter, Grace has watched me prepare for this trip, helping to fundraise, organize pharmaceuticals, and has genuinely wanted to come for several years.  This year we were able to make that happen and she has been such a gift to us all here.

Today Grace was able to spend the day in the eyeglass room with Rabbi Abie, Maria and Jake.  This is the room where every year miracles happen, and today was no exception.  Every year we bring down a suitcase full of donated eyeglasses and when a patient in triage fails the eye chart, they are taken to the glasses room and the team will try to find the right pair for them.  This is a tedious and trial and error endeavor.  But amazingly each year we have miraculous stories of being able to find a pair that drastically improves the patient's vision.  Grace got to take part in that today and witnessed what a life altering event that is for a person.  Tears were shed, hugs were given and Grace will remember it forever.

As amazing as that moment was, it was made more phenomenal tonight when we were doing our medical debrief at dinner.  We eat dinner each night in a private conference room in the hotel and while we eat we go around the table taking turns telling the whole group the highlights of the day, so everyone can get a sense of what kind of patient diagnoses they saw and what experiences they had.  Well when it came to Grace's turn she opened up her journal and read what she had written about helping a person see today.  She is such a poised and articulate person and her writing is beyond her years in age just like the rest of her.  Well, she caused more than a few in the room to tear up and all of us were stunned by her telling of the story.

Just before we came on the trip Grace chose a book to read for her next English assignment at school.  She chose to read Pride and Prejudice, by Jane Austen.  Now   keep in mind, she is 12.  When I saw that she had chosen that book I was delighted but anxious  at the same time.   I was so indecisive in college I ended up getting a BA in English and a BS in biology because I could not decide which of my two interests I wanted to pursue, and Jane Austen was my favorite author.  But she is a complicated writer and I was worried the book would be too complex for Grace.  Boy was I wrong.  Grace dove right into it that week.  She asked lots of questions along the way, needing definitions of words and even reading some sentences out loud to me that she needed help deciphering.  She loves the book and brought it on the trip to continue reading it.  I know the word pride has different connotations, but watching Grace these past few days in Guatemala I am exceedingly proud of her.  And as her mother, I know  I am a bit prejudiced in my view of her, but I think she is one of the most remarkable 12-year-old girls on the planet.    This week I am witnessing my own version of  "Pride and Prejudice."

Lauri Pramuk, MD

Exceeding Expectations

Where do I begin? Honestly I have no idea.

So far, this trip has been overwhelmingly amazing.

This whole year, up until now, we have been working tirelessly to make this a reality. At that time the thought of being here was so surreal, but now that we are here, I personally feel as though I’m on cloud nine.

I had high expectations from everything that I have heard, but so far, the experiences have far exceeded the expectations.

The land around us is so refreshing. Everything around us is so colorful. The people are so kind. I just cannot put it into words.

One thing that I truly appreciate and am thankful for is our team. We have established a bond where we are all just so comfortable with one another. A group that can function together is important for a trip like this. It gives us room to really focus on what we are here for.

The clinic experience has been absolutely amazing. Working with the patients and the children that stop by are wonderful. They approach us with smiles on their face, ready to run through the course of treatment.

The interfaith aspect of this trip has not been overlooked. We visited the ancient Mayan ruins of Iximche (ish-im-chee). WOW! Was this an experience. The land of Iximche is so rich with history. After touring this land, it made me realize how superficial our modern day society is. We learned about the faith and traditions of the people of this ancient time and it was a truly awesome experience.

It has only been two days and my expectations have been exceeded. I can’t even imagine what’s coming up next.

Tamara Mahmoud

Humbling Gratitude

My experience in Guatemala has been so refreshing. While riding through the foggy, winding roads in the mountains, I was at peace. Breathing in the fresh air and taking in the fresh imagery of the flowing landscape was awesome in the true sense of the word. No place in America has such a unique atmosphere.

What amazes me every single time I meet a new patient in our clinic is the fact that the people of Guatemala are so incredibly grateful for the service we provide for them. Even when I am limited by my limited clinical knowledge and a language barrier, the people appreciate what I can do. I remember one elderly lady in particular whose eyes lit up with appreciation when I brought her something so little—just a toothbrush and toothpaste. She took me by the arm, smiled, and genuinely thanked me. This level of appreciation was truly humbling.

This is such a stark contrast to what I see in America. For example, I’ve heard too many horror stories of individuals self-diagnosing on the internet and demanding their physicians to prescribe the drugs they think are appropriate or expecting that their healthcare to be as McDonaldized as a trip to the drive-thru. There simply is a difference between our American value system and that which I see in the culture of Guatemala.

I experienced one of the most telling examples of this today; and that was the children. The children we saw in clinic today were so eager to learn about maintaining their health. And time and time again, I met children who were one step ahead of me in the dental education room. It is so fulfilling to see such amazing children, and this shows that the educational mission of the clinic is working very well.

Amid all of this richness in the environment, the culture, and the environment, one cannot help not to notice the economic poverty that exists. As we went up the mountain, it was difficult to see so many houses that were just corrugated metal walls and a roof. However, what really broke my heart was the sight of so many young girls who have to sell trinkets and textiles for a living. They deserve to be in school instead of attending to tourists’ materialistic wants. This is a socioeconomic problem that only revolutionary change in infrastructure and government will bring, and I pray that someday these girls will have an equal chance at the solid education they deserve.

Sean Lewis

Monday, March 7, 2016

Becoming a Sponge

It has only been the first day at the clinic and I have already feel like I have gain so much! Each person that I meet, the education that is shared, and the smiles that are on everyone’s faces is bringing me pure bliss! We left all of our textbooks and technology behind and applied what we have learned through written material into practice today. It was not easy to organize 35 baggage of luggage and communicate with the patients, but through teamwork we accomplished a successful day! The medical staff that we have the opportunity to work alongside are absolutely amazing. By observing Dr. Lauri, all the pediatric complications that I have been tested on came to life. She explained each scenario in depth and I will forever hold onto the valuable assessment skills she has taught me today. It is not just looking at the patient’s chart; it is taking your assessment and critically thinking about how to connect all the dots. Many smiles and thankfulness were exchanged with the villagers today. We thank them for the lessons they are able to teach us, and they thank us for the care we provide to them. Dr. Lauri stated it best to one of our patients, “This is how the world should be, and we should all share all knowledge with one another.” That is exactly what we did and what we will continue to do!

P.S. I also shattered my iPhone today. In the U.S. I would have freaked out and immediately gone to Apple but here it is not a worry. My goal is to become a sponge this week, trying to soak up every moment that I can. No need for an iPhone to accomplish that!

Lauren Francis

Un Pequeña Amiga | A Little Friend

FINALLY IN GUATEMALA! It is my very first time being out of the country, and I am loving every second of it. Today was the first day of clinic! We woke up at 6 am sharp to eat breakfast at 6:30 am. This breakfast was amazing! I had handmade tortillas, refried black beans, eggs, fresh cantaloupe, fresh watermelon, and papaya juice. The fruit here is so delicious and juicy!

Today was a busy day, especially the morning. Right when we got to the clinic we had to unload all 36 suitcases. My role was setting up the prayer room. The prayer room was originally a midwife room with a treadmill and two assessment tables, so I was concerned about how I could make the room comfortable and sacred for prayer. I started with putting all the care packages filled with shampoo, toothpaste, soap, toothbrush, and a comb on one of the assessment tables. Unfortunately, a couple shampoo bottles decided to explode on the plane, so there was a bit of a mess, but it all worked out. I was assigned to shadow Dr. Lauri and take her patients to the prayer room after the appointment. It was amazing learning from someone as smart as Dr. Lauri. With each patient, she explained every little detail where it all made sense. I am so privileged to shadow her.

I made una amiga with a little girl. Her name was Hensis. This little girl has the most beautiful smile I have ever seen. We blew bubbles together, colored, practiced brushing teeth, and ended the day with a big hug. The people here are so breath taking with their smiles and warm welcoming.
I am looking forward to the rest of this week and taking this all in for it has already been life changing.

Maria Hill
Xavier University 2018
Bachelors of Science in Nursing

New Connections

Today was our very first half-day in the clinic! I was in the pharmacy with the lovely Dr. Eric, who is not only hilarious but also a fantastic teacher! There is a huge emphasis on pharmacology in my curriculum right now as a senior nursing major, so it was very beneficial to review medications in clinic. I also had my first experience with some tiny Guatemalan humans today! We played futbol, blew some burbujas, and made homemade paper jumping frogs.. and I quickly learned that frogs do not say "ribbit" in Spanish. Clearly I still need to work on my Spanish, but luckily we have Ade and Sonia to help us communicate with the patients. Both of these ladies and the translators do an amazing job of running the clinic and I was immediately very impressed.

After the clinic, we went to visit ancient Mayan ruins called La Ciudad De Iximche. I loved being able to learn about history and rich culture of the Mayans. For me personally, I find much of my spirituality through nature. When I go on a hike or swim in the ocean, I feel so connected with the world and my Higher Power that I believe created it. I had an immense appreciation for the Mayans’ respect and reverence for nature and the world around them. Even though the people we were learning about were alive centuries ago, I felt a connectedness to them through this reverence for nature that they expressed in their culture so richly.

Molly Kubicek

Above the Clouds

Grace Pramuk

Sunday, March 6, 2016

Clinic Videos

This whole process of formation that is involved in making these 12 outstanding Xavier students ready to travel down to Guatemala each year on their school vacation begins early in the fall semester. In addition to all of the fundraising and weekly preparation meetings late into the night where they learn about Guatemalan culture and history as well as how to take vital signs and plot kids on growth curves, these busy pre-med and nursing students also become healthcare educators. The students are broken into 3 teams and given a health care topic to research. Then they are given the assignment of making a short video about their Spanish. These videos play in the waiting room and are used by the clinic to educate patients and community healthcare workers about basic topics like dental care, diabetes, etc. This year our three education videos for Guatemala came out amazing. Our three topics were, how to prepare for a visit to the doctor, heart health, and basic newborn care. I am so proud of how much amazing work went into these this year. This is a lasting legacy of these students' time at Xavier, probably having more impact on people around Lake Atitlan, Guatemala than our short week in clinic does. Please take a moment and take a look at their excellent work.

Lauri Pramuk, MD

A Little Family

The picture was taken as we were descending into Guatemala City this afternoon. That's when it hit. We finally arrived sleepy, but most importantly safely! The first to greet us outside the airport was Jorge, who is going to be our guide, travel organizer, and overall lifeline throughout the week. He bought us lunch as soon as we arrived, then safely got us through the rocky roads, and mountainous terrain to our home for the next week. This part of the travel took the longest, but I loved the way the team has become a little family. We sang songs, played games, laughed out loud, and even slept on each other's shoulders. When we finally arrived at our clinic I couldn't get over how perfect it was- up on hill, just the right size, white walls, beautiful windows, and built by the hard-working people around it. When things couldn't get any better, we past blocks and blocks of paintings, clothes, tapestries, sculptures, FOOD, music, and more people! Once we settled in to our rooms and had a delicious dinner, we couldn't wait to get out and explore the streets. So we did, =) but not for long! We start our first day at the clinic tomorrow bright and early tomorrow! I CAN'T WAIT.

Ana Calvopina

A Long Awaited Harvest

It is hard to explain the feeling of finally actually being here in Guatemala. Because of an unnecessary mishap involving my other commitments on campus, I was unable to participate in the medical service trip last year, as I was originally supposed to, after having contributed to a lot of the fundraising for the trip. Needless to say, I am finally getting a taste of what my team members and I have been working so hard for.

Our travels were exhausting today. From having to be up and ready to go by 4:15 this morning to lugging up to three 50 pound suitcases around the Guatemala City airport, it’s safe to say we were all both physically and mentally checked out by the time we got on the bus on our way to the clinic – a solid three hour endeavor after taking into consideration the chaotic, bustling city streets.

I did, however, find myself engulfed in the nature around us while curving around the mountain side on our way to Panajachel. The bus driver (who, by the way, had to deal with a bunch of sleep deprived students who still managed to sing to any song that popped into their heads) turned on some easy-listening, Latin guitar music as we watched the sun go down over the foggy mountain roads. I couldn’t help but stay smiling throughout the majority of the trip. I was entranced.

And to think this was not even a complete day’s worth of events. I am eager to start being able to help in healthcare provision of the residents of such a fruitful environment.


Ali Ahmed
Xavier University 2016
Life Science | Business