Waste Not

Hi all, I'm home, the trip is over, but inside of me, its still very much alive.
our last day in Guatemala, a few of us had the opportunity to visit another project of the Guatemalan Pediatric Foundation: a clinic and meal center in Asentamiento La Paz, one of 16 neighborhoods built on the City landfill, where many residents eke out a living by sifting through the garbage and selling anything possibly recyclable.

at this clinic I met an amazing woman, Who met us at the door introducing herself only as Martha.  She is Dra. Martha Julia Velasquez Herrarte, a family physician with specialty in adolescent medicine who has been the main physician at this clinic for 9 years.  she sees 40 patients per day, and the meal center serves 250 children two meals and a snack per day, with the only requirement that they stay in school, and bring their homework to the snack time in the afternoon.

 The clinic with the Guatemalan Pediatric Foundation Logo painted on the outside

 Dra. Martha and I

 Mural in the center which feeds 250 children from the neighborhood per day

 to the right of superman is a thank you letter made for Dr. Martha from patients. it is homemade paper that was made from paper found in the dump and adorned in plastic flowers, also from the dump

 A child with Asthma receiving a breathing treatment.

A family awaiting their visit with the doctor



When I spoke with Dr. Velasquez about the needs for the clinic she mentioned the following:

Tubing for the nebulizer machine (being used by the child in the picture above). For perspective, our clinic alone throws out about 10 of these masks and tube sets a week. at this clinic, they resterilize them until they fall apart.
an instrument used to examine ears, nose and throat (you will recognize this hanging on the wall in most doctor's offices) her's was ancient and held together with tape.
Stethoscopes
Surgical instruments for basic in office procedures. (they have re-sterilized theirs so much that they have lost their sharp edge).

I'd like to form a sister clinic relationship with this clinic and my own, as we do similar works in many ways. our resources here are so vast. in the operating room after the first day of surgery, the Guatemalan OR nurses approached me and asked if we could save for them all the unused clean material from the surgeries (gauze, plastic containers, etc). We routinely throw such things away, but they are used to re-sterilizing them for future use.

Stay tuned for ways you can help with this sister-clinic idea.

Thanks for reading!

inequalities

Guatemala is full of wonderful people and horrible injustice and inequality. a place of true contradictions.  Here are some pictures of some of the wonderful people from today:

                                             Yanira the wonderful taking out an IV

                                             Maria at spa room 5A with attendant N.

                                                    three of the fantastic floor nurses

also it is a day of real sadness for me. on top of yesterday's sadness came a call from a mom of another patient from 6 years ago. she has only one kidney, and had another urine infection this september that due to lack of family funds, was not treated until 9 days later and by then she had lost the function of this remaining kidney. remember my second post and the statistics there? well, KR is one of those. her family cannot afford dialysis (the closest machine being 5 hours away) or a transplant and so have made the agonizing decision to "leave her in god's hands".  No 13 year old should have to die due to lack of personal funds. I cannot imagine the heart of her parents tonight.  Please lend your prayers to her family in Mazatenango, Guatemala.

uncertainty

A part of  poem by Pablo Neruda, "Ode to Life" goes like this:

The entire night
pain has hit me with an axe,
but the dream
passed washing like a dark water
blood soaked stones.
Today again I am alive.
Again 
i lift you,
life,
onto my shoulders.

Oh life, clear glass,
suddenly
you fill
with dirty water, 
dead wine,
agony, losses,
overwhelming cobwebs,
and many believe
that you will always maintain
this color of hell.

It's not true.

these two days have been sad ones for me, so I want to believe that last line.

M loved life. At 14, she had survived cancer of her kidney at a young age, radiation treatment which left her paralyzed from the waist down, and a neurogenic bladder (a bladder that doesn't coordinate itself well and doesn't empty well).  This causes high pressures in the bladder and the urine backs up into the kidneys.  6 years ago we met her and she had a large operation with us, where her appendix was used to make a small channel from her bladder to her skin, and a channel was made from her belly button to her colon.

In these ten years, the team of surgeons has performed these two surgeries for about a dozen children. It allows children with spina bifida, or other causes of neurogenic bladder (like M) to self catheterize their bladders and flush out their intestines, eliminating both types of incontinence that makes them dependent on diapers and on the constant care of others.  Yesterday you learned about a young woman for whom these surgeries allowed independence to study. For M, it simply made her life better. she could go to school more easily, and just feel better about herself.

Two days ago, Martin and I learned that M  died unexpectedly in July.  Last night we sat down with her parents and celebrated her and mourned her. she was a shining star of humor and kindness in the face of really great odds and suffering.  Her remaining kidney gave out on her after an illness, and she did not survive.
The surgeries performed in this week can change people's lives, but they don't change the unknown's of life and the health disparities with which people live here that often shortens their lives.  here is her sweet picture:

We loved her and she loved us.

A is a young man born with spina bifida (Guatemala has the highest incidence of this birth defect in the western hemisphere). He had the same two surgeries as M did.  He's a serious arm wrestler as you can see (here beating Martin handily), likes to lift weights and is crazy about just about everything.  He doesn't need to wear diapers anymore and he can go to school.  We don't take him or any other child here for granted. May his life be sweet.

Again I lift you life onto my shoulders.

resilience and pepian

Hello ardent blog followers. well, here we are on day 3. What a day. I am going to keep it short today and just say that the sweet patient below actually cried when she had to leave today to go home. yes, we make it that fun for them (not everyone feels this way, but I do think they leave feeling very very special and sometimes no one outside of their family has ever seen them as "whole" children before.
this sweet girl was run over by a car 4 years ago, her pelvis crushed, and has had a lot of urologic complications since.  she got my heart day one.  she is from San Marcos, the department of Guatemala most affected by the earthquake last week. Her family found out about the Urology clinic from an ad in the newspaper.

This is from the first day of clinic, when she had known us for all of 1/2 hour. lets just say that it was easy to love her and become endeared to her.

and then this is martin enthusiastically perched over a great crock of "pepian" a traditional stew made for us by the mother of one of our patients from last year. amazing is all I can say.

amazing the love here, the faith, the energy and great generosity of all the staff here for the children and us.

good note on which to lay my head down.
love to all
maria

1st day of surgeries

The first day of surgeries is always exciting and a little crazy! today the surgeons performed 9 surgeries.
there is a really special young man whom we have known for 6 years since he had his first surgery. at age 16 he was paralyzed from the waist down in an accident at his car mechanic job. we met him when he was 22, by which time he had lost most of his back side due to pressure ulcers.  the surgeons did a surgery where they divert the ureters to a part of the intestine, and bring it all to a hole in the skin called a colostomy. having this allowed this young man to heal his sores and be healthy again.  one of the treats each year is to see him again. here he is:

here is a shot of the surgeons at work:

more tomorrow! i'm beat. thanks for checking in.

Consult day

Hello friends,
just a brief note tonight as I"m crawling into bed...it was a sweet long day today, we saw 87 or so patients and will do about 36 surgeries this week. A few beautiful young women gave me permission to tell you a bit about them and show you their beautiful selves. I've decided not to use their names for privacy sake.

 This stellar young woman, born with spina bifida and paralyzed from the waist down, until last year (age 19) needed her mom to give her enemas and catheterize her or she needed to use diapers. she really wanted to go to college, but until she was independent with these things, she couldn't go. Last year she had a surgery which created a channel between her bladder and her skin (using her appendix) and so can catheterize herself, and had another surgery connecting her bowel to her belly button, so she can flush out her bowels once/day and have no more accidents.  she just finished her first year of college!!

 The sign greeting patients to the outpatient pediatrics clinic.  "by and for the children of Guatemala"

 the waiting room, filled with folks waiting to bring their case to the pediatric urologists

This beautiful young woman is Quiche and from a very rural area outside of Chichicastenango.  She would like to become a doctor. she was born with her bladder open to the outside of her body.  5 years ago she had a procedure which created a pouch from her intestine, and her ureters were brought into this pouch, so that now she can wear a bag and be completely continent. until that time she couldn't go to school because her family couldn't afford diapers all of the time and she would smell like urine.  she just finished primary school and is hoping to start middle school next year.

lots more stories, but the most moving one today was two parents from a very rural area, the father spoke Spanish and Quiche, the mother only Quiche, who brought in their child who was born with ambiguous genitalia. we had an hour discussion about how gender identification is best decided when it is not clear (basically the major tenet is to wait until the child can tell you how they identify and what gender they feel they are). they didn't know anything was wrong with their child until a neighbor told them that all little girls do not look like their 3 1/2 year old. their little girl in fact has a condition where the body does not fully have receptors to testosterone, and is thought to have testicles (in her abdomen) and a small penis,  but has been raised as a girl thus far. it was an amazing conversation to have, and my brother Martin did a fabulous job of explaining what was happening. The parents asked awesome questions and now have more understanding of what is going on and how to proceed.  What an honor to be there!

Sleep well my peeps. see you tomorrow!
Maria

Relaxing, and Setting up

Today we had some free time in Antigua, Guatemala, and then returned to Guatemala City to the Hospitalito to get the operating rooms ready. Tomorrow is a long day of consults (we see about 80-90 children), seeing who needs surgery and what can be done this week. It is a long wonderful day where we get to see a lot of kids who come back for follow up. some we have known for as long as 10 years.

I haven't yet mentioned the earthquake that rocked this country less than one week ago. there are thousands of homes destroyed and many people died.  I'm including a link from the NYT here:

http://www.nytimes.com/2012/11/08/world/americas/guatemala-earthquake-leaves-dozens-dead.html?_r=0

and from Guatemala's Prensa libre from today:

http://www.prensalibre.com/

If you would like to donate funds for the victims, one of the Guatemalan nurses we work with here, recommended Caritas. I'm including their information here:

http://www.caritas.org/newsroom/press_releases/PressRelease9_11_12.html

 Nurses Patty and MariaElena, who will be working with us in the OR all week, help set up.

 The wonderful nursing team from Indianapolis setting up donated supplies that they have collected all year.

Tracy and Debbie awesome OR nurses setting up one of the Operating Rooms


That's all for now! thanks for reading and will check in tomorrow.
Maria