Vaginas all week

It was an interesting night of call. Now I probably should start off by saying that I graduated from medical school with a disdain for OB-gyn. I don´t know whether it was the fact that often times I was confused when the ladies would be nice one second and the devil the next, or whether it was the horrible residents I had aka slave drivers who obviously probably could of used some spice in their love life but instead took it out on society, or whether it was just having a bad attitude about the end of 3rd year in general. Whatever the case may be, I didn´t expect to come to guatemala to do tons of OB-Gyn. There are things you read about in text books in medical school like "eclampsia", and pulmonary edema stemming from severe preeclampsia, and the dangers of transvere positon of the baby in mom´s pelvis. You always wonder if these conditions really do exist, because for one, you never see them in real life. Well the truth of the matter is, I don´t even know if i wanted to ever see these things as I really wasn´t fond of OB. In the past week, I´ve seen all of these high risk OB emergencies making me really realize that pathology does indeed exist... esp in communities that have poor access to healthcare and in this situation perinatal healthcare.

2 days ago, we had a lady come in the hospital in acute respiratory distress. She was really tachycardic, blood pressure was through the roof (systolic in the 200´s) and she was 28 weeks pregnant. Obviously the first goal with her was to stabilize her respiratory comprimise and make sure mom was doing ok. After some lasix, 10L of oxygen, hydrocortison, tons of magnesium, albuterol and ipratropium nebulizer treatment we finally got her to calm down a bit. Just in the nick of time, the patient in the room next door, decided it was time for to push and have contractions and poof we were off to deliver mom number 2. Status-post delivery of mom number 2, we checked the fetal strip of mom number 1 thinking that baby was doing fine, only to realize that there was poor variablility no accelerations and in fact some decelerations. I literally sat there for an hour holding the probe on the monitor hoping to find at least 2 accelerations but memories of 3rd year ob gyn came into light when I saw the spikes going down instead of up. Were these decelerations? Oh shit I forgot everything i learned during my ob gyn rotation in med school. Wait the heart rate is going down, i think these are decelerations. In an instant I realized the baby was not doing fine and immediately called the calvary. It was indeed apparent that a C section would be necessary and given the fact we don´t have a obgyn person in our clinic, the closest place where she could get one done was in guatemala city 4 hours away. The bombaros (volunteer firefighters) were called and the plan was to transport her to guatemala city. The mom in her spanish kept inquiring about how the baby was doing... and in my broken spanish the only thing i could say was.. right now the baby is ok, but needs to be taken out now.. and for that she has to go to guatemala city..... she looked in my eyes for reassurance that much i knew and repeatedly thanked me for everything i had done for her that day.

The next morning I woke up to hear the news. The baby had died on the way. The mom was alive however, which was good news... I am convinced that mom´s resp distress was due to pulmonary edema a rare complication of preeclampsia. Later that day and night, I had 2 other mothers who came in with severe preeclampisa but the deliveries went well, and late last night on call.... was another disaster after 2 moms came in having contractions and after ultrasound we realized the babies were in transverse position.

And that is how many week of OB gyn went. I plead to to the ladies of santiago who are about to deliver. Please keep your cervixes closed, keep them high and long. I don´t think I can handle any more vaginal activities this week.

ziplines, kayaks, and a lot of eyes

So it was a weekend full of adventure. Saturday I went to the lake atitlan nature reserve which is located on the other side of the lake. I decided to go with 2 of my co-workers on Saturday as I had the day free since I was post call and had gotten a whopping 3 hours of sleep. We randomly ran into this jewish guy at a cafe here in santiago and took the 12:00 boat out to Panachel. Panachel is one of the more touristy towns and pretty much it is a starting point for ppl who are about to embark on the standard lake atitlan tour of the different towns. Not having much cash on hand we decided to stop at this place called 10quetzals para 3 translating 3 tacos for 10 quetzals (about 1.50 dollars). The tacos were pretty damn good and I went with the recommended option of the hawaiian taco that was in my lonely planet guide book. After lunch we headed out to the nature reserve which was pretty amazing. They had 5 d ziplines at various altitudes where u could speed above with the forest canopy underneath. Pretty kick ass.

Sunday, I decided to go out to the town of San lucas (which was an experience in itself). We took a taxi ride to the town which really wasn't a taxi if u consider hopping on the back of a pick up truck crammed with 10 other ppl and hangin on to dear life. It was pretty fun though.. what can i saw. theres nothing like riding in the back of a pick up truck going at high speeds, wind blowing in your face, light misty rain, and your zipping past the lake and volcanoes among thick foliage of coffee plants and various other lush flora and fauna. At some points, the pick up truck would speed up, as these were points where bandits historically had sabatoged and robbed these pick up truck taxis. In san lucas, we each rented kayaks for the afternoon (about 3 dollars for an hour), and we set off cruising on the lake. Needless to say it was pretty hard as this was my 2nd time kayaking. The waves were pretty choppy and I almost toppled my boat a bunch of times. After 3 hrs of y kayaking, and really really bad sunburn, we headed back which just about killed my arm. I had an awesome time though. def worth checking out again.

Today, we organized a free eye clinic to detect cataracts and pick out patients who needed surgery for cataract removal. Theres a surgeon in town who decided to do these surgeries on Sept 13th. It was a pretty interesting day as I saw a lot of pathology. We had a few patients where u could see corneal pathology with the use of an ophthalmoscope. There were some, were on ophthamological examination you would just see cloudyness with no glimpse into the back of the retina. There was one patient that stuck out in that she was 20 years old with a history of measles that went untreated during her childhood. As part of the sequelae to her infection she developed bilateral corneal abrasions that left her pretty much without vision in both eyes. So pretty much her entire life she has had no vision. Talk about being born at the wrong place at the wrong time. It's pretty sad when u think about how she probably never could go to school, to cook etc, missed out on her childhood secondary to not being able to see. plus u have to add on teh social stigma to ppl with physical disabiliites here as well. The only cure for her is a corneal transplant.. which would allow her to see again. unfortunately the only place where they do corneal transplants thats closest to guatemala is the united states. maybe i'll email some organizations or doctors at musc to see if they would like surgery or maybe assist her in coming to the states so she can get a new corneas. only caveat to docs coming here, is that it would be hard to bring a cornea with them.

priceless

One one-way plane ticket to guatemala: $400
One year of delaying residency: $40,000
The memories of Zip lining at high speeds above a thick forest canopy with jumping spider monkeys and waterfalls: Priceless

the evil eye

It was around 11 o´clock on what i call a slow night of being on call. Just when u hit the stage of "oh well i guess i´ll lay down in bed", someone walks in the emergency room to be evaluated. And poof I had my first encounter with dealing with mal ojo syndrome (aka evil eye syndrome). A set of parents had broughten their 1 week old infant out of fear that he was sick and had diarrha secondary to someone who had an evil eye on them. After talking to one of the doctors and Jacinto the guatemalan nurse, it turns out that mal ojos or evil eye is a common held belief that when one gets jealous about someones fortune they have an evil eye on them that imposes misfortune on them. After a through history and physical, reassurance was the only thing we could offer.

Rain

It was pouring like crazy yet we still ventured out on foot to the center of Santiago to get something to eat. I don´t know why we decided not to take the 3 wheeled taxis or tuk tuks as you call them however, maybe we just wanted an adventure. Dodging huge ass puddles and rivers flowing from the steep slopes down the mountain side, we were soaked as we finally made it to town. And alas we came to know or at least I did that the town shuts down pretty much shuts down when it rains outside. However, despite all the rain, the loud music coming from the makeshift church in the corner hut could be heard from all angles of town. A quick peek in told a lot as it was blatent that it was an evangelical church. Lots of music and preaching however, surprisingly thee was no dancing just clapping of hands. On the other street blowhorns of loud political propoganda could be heard repetively telling us all about why this candidate should be elected as new mayor. it was so loud and so repetitive that evn to this day, the melodies of the voice and music are in constant tune in my head. Amist all this noice, raindrops, insanely wet pants, socks and a sense of a cold chill on our backs, we sat down at El Shadi restaurant for a nice Kosher meal in the heart of what was supposed to be the most traditional of guatemala. I bit into my California sandwich which pretty much was pita bread stuffed with delicious vegetables and sauces, and sipped on my 7-up from a glass bottle of god knows how many times was autoclaved and recycled. A wonderful meal to cap off an interesting day.

a night on call

I´m on call right now. Yes, the inner dork in me has decided to take q4 call. Besides the patient who came in bc of shortness of breath and diffuse body pains, I haven´t seen nor admitted anyone yet. Hopefully this isn´t the calm before the storm!

Horseback riding

Today was a great day. I went horseback riding for the first time in my life. 2 americans who now live in santiago, who by the way are leftist anarchists started this horseback riding tour company in the heart of rural santiago. We started at 7:30 in the morning and after a lovely breakfast of hot strawberry pie and home grown and ground coffee we each got a horse to ride solo on our way up to the el mirador. Along with me were 2 american teachers living in brooklyn, new york, my co-worker who is a physician assistant and 2 other gals one from holland the other studying to be a school counselar in iowa. It turns out that one of the girls who teaches, grew up in Greenville and graduated from USC in 2001. She even knew a few of the ppl I knew back in college. what a small world.

The horseback riding was amazing . The horse I was on was about 2-3 years old and was quite a naughty fellow. All he wanted to do was graze on grass and take paths that was different from our possee of horses. We rode through coffee trees, corn fields, guava trees and various other flora and fauna until 1.5 hours of uphill climbing we reached the el mirador which overlooked lake atitlan on one side and the pacific ocean on the other. What a beautiful site. The trek down was even more fun, and at the bottom we were treated to a wonderful lunch of rum, cinnamon marinated pineapple with waffles, eggs and fresh strawberry jam. It just made my day.

Yesterday, I took the 45 min boat ride to panachel to branch out from rural santiago for a bit, and wow it definately felt like I was back into civilization. I even had pizza for lunch which was nice for my stomach and I could tell my stomach was pretty happy to have some familiarity basting around in it´s hydrocholoric acid.

The spider in my room

The spider is an expected aquaintence as I enter my cabin each night. We share our room and in to a certain extent we have an understanding. I am wary of his size and his appearance, he his cautious about my intrudance in his former habitat. I guess we both are slightly scared of one another, however every night we have an unspoken understanding that for now we will be sharing the same habitat and will not intrude in one another´s space. This is not bad by all means. It´s nice to see some sort of familarity after all the randomness I experience every day. And yet, at 630 in the evening against the dark right corner of my front wall I expect to see him resting every single day.

On another note, I´ve had a pretty darn interesting week so far. I have now started to administer direct patient care to my patients without guidance (despite my beginner-intermediate spanish). Yesterday, we were interrupted during morning report by a lady who had all the signs of preeclampsia blood pressure in the 180´s who ultimately seized during labor making this the first eclampsia patient I have ever seen. Needless to say the delivery was a success and the baby that I delivered was a health baby boy.

I also, diagnosed my first patient with a new diagnosis of diabetes in clinic today. the patient had come in with a chief complaint of ¨being really thirsty¨ and after a random finger stick blood sugar level I was able to give him the diagnosis and start him on metformin therapy. There is a lot to been seen and learned at the clinic in that we see a full spectrum of patients as this is the only hospital in santiago. I´m definately excited about the upcoming weeks.

Theres not much to do in santiago, so today I decided to take the 40 minute boat ride across the lake to panachel to do some site seeing and maybe even some grocery shopping. Tommm the plans are to go horseback riding with a coworker who just finished PA school. Anyways, back to exploring this town.

adios

Trauma in guatemala?

We were interrupted during our guatemalan equivalent of ¨morning report¨ after a nurse informed us that there was a patient who suffered a severe burn walked in the door. Apparantely he had been working on some electrical wiring and had gotten shocked, entrance wound in the hands, exit wound on the soles of the feet. His scars looked like a nightmare however his demeanor was modest. At once we rushed down and memories of 3rd year surgery core small group passed my mind as in an instant i realized I would need to use the parkland formula to figure out how many liters of fluid he would need. We cleaned him up pretty darn good and after some silvadene and wet to dry dressing, we did all we possibly could as he definately would need some sort of burn speciality center. His muscles were tightening up and although I could not understand his language I knew from his gestures and his eyes that he was in pain and this his muscles were all cramping up. Burn patients esp electrical burn patients are at high risk for developing compartment syndrome. While fluids were up and about flowing in his veins, I tried as hard as i could to move his lower limbs from flexion into extension. Alas, we were able to get a makeshift ambulance over for the 3 hour transport to guatemala city. Alert and oriented, oxygen saturation in the 90´s and adequate urine output with no evidence of rhabomyolysis well at least not yet, we shipped him out. Hopefully he´ll survive it´s not a good prognosis.

sick

I think i´m sick. Hope i don´t have dengue fever or maybe it´s the weather. Severe, severe headache. back to bed

Santiago Atitlan

Well, I finally made it to Santiago Atitlan. Wow what an amazing town. The town is set on the majestic Lake Atitlan which is the most amazing lake i have ever seen. Surrounded by volacanoes in each direction, there are 5 to 6 towns that encircle the lake. I started my journey from Antigua and took a 2.5 hour bus ride to panachel which is the only drop off point for commuters coming to atitlan. From panachel, I hopped on a ferry which was a 30 minute ride to santiago. I lucked out as on my ferry ride I happened to be sitting right next to a girl who is a 3rd year family practice resident in ventura california who is also working in the same hospital as me. I finally made it to Hospital Santiago around 1 yesterday. This hospital has an interesting story as it is totally run by volunteer docs from all over the world. They basically do everything and tons of residents and faculty members mostly from family medicine in the US come and help staff the hospital at various points in the year. And wow, the place where I am living is even more interesting itself. I am living literally in the middle of a jungle surrounded by corn fields, bamboo trees and various other flora and fauna. Needless to say I was kinda worried when I heard from the staff that don´t be surprised if I see scorpions crawling around my room. My first night was interesting, as there was a a small earthquake that rattled my cabin. I had never experienced an earthquake before. I also got awoken early this morning around 4 am to the sounds of god knows how many roosters crowing out in the distance. I swear i´m surrounded by lots of wildlife. In addition, I totally didn´t bring any blankets so I was freezing my butt off all night. The jacket i had on and the mound of clothes I had piled on top of me didn´t do justice. I bought a bunch of stuff blankets etc (hand weaved by mayans) today so hopefully things will be just fine. I awoke in the morning to realize that my shower is located outdoors and the stall is surrounded by bamboo leaves for privacy. It´s an intersting experience to shower outside with the sun shining on you.

Among all of these interesting things, I was also chased by a german shepard on my way to the cabin last night. What a scary experience. I also randomly ran into one of my housemates that I had been living with in Antigua as he was out touring Lake Atitlan today. What else can I say. Everything seems like it will be one hell of an experience and I´m having the time of my life. And oh, I have no idea what´s going on in the world. It´s great. I think I just realized how much television is meant to brainwash our minds. The news, the stories on our telvision sets in the US does not do justice to what´s really going on out in the world. It´s liberating in a way to be away from all of that.

Anyways, my next adventure will be tonight, where I will staff the hospital during the graveyard shift. Wish me luck!! bye!

A little love, some coffee and a very small world

Today I visited a Coffee farm here in Antigua. It was pretty interesting as I drink a lot of Antigua brewed Starbucks coffee in the US. I got a chance to see the stages of coffee bean cultivation from seedling all the way to the nice cup of coffee. I really like antigua a lot, but i'm definately ready to move on to hospitalito santiago. This week, I ended up doing lots of reading to brush up on my clinical diagnosis skills in between seeing some of the ruins here in antigua. Needless to say, I end up doing lots of walking throughout the day. I really haven't spent much time back in the house (which has been totally awesome as I have met tons of ppl from diff culturs) as the last thing i want to do is go back home and speak MORE spanish. All of my roomates except one are pretty much fluent in spanish leaving me to be all clowny during meals. That being said, I just love going out and meeting people and I hate to be indoors.

I found out few days back that a few of the teachers at my school have a crush on me. In fact my teacher had told me this. In all honesty, I feel like the class clown of the school however it's relieving in a way to know that they're not all laughing at me, but are rather being flirty. I was getting a bit annoyed at all the gigling. I also had a guy approach me while i was reading in the park yesterday only to realize 5 minutes into the conversation when he invited me to his home and asked if i was single(he said, mi casa es su casa) that he probably was gay. Other than that there isn't much drama and I'm having a blast. It's amazing how two ppl can live in different parts of the world with diffrent lives and at some random point, paths converge and you are face to face conversingat a bar or at a restaurant and then u go your separate ways. It's just awesome and destiny definately has something to do with it. In a span of 2 weeks I have met ppl from all over the world, Israel, australlia, the netherlands, iceland, sweden, switzerland, and many more giving me a diff perspective on way I see things.

Volcano Pacaya

If I had to rank the 10 most memorable experiences in my life, I would definately include my trek to the summit of Volcano Pacaya. What can I say, this was such an amazing hike and words cannot describe the view. I went with a group of tourists this past Wednesday leaving at 3:00 pm. The journey to volcano pacaya is about 1.5 hours driving distance from the city of Antigua and we ended up starting our ascent around 4:30ish. Volcano pacaya is an active volcanoe at times spewing volcanic ash, molten rock and lava streams. The most recent eruption was estimated to be about a few years back but the volcano has active spurts almost on a daily basis. The trek up the mountain turned out to be about 5 hours most of it was mid-hard level in difficulty. We reached the summit around 8 o'clock at night and were rewarded with a fantastic view of lava streams mixed with fantastic views of surrounding mountains and the city below. In fact, we were higher up than the clouds and it felt almost like I was on the set of the Lord of the Rings. The last 1 km I would say was the hardest as we had to hike through mounds of igneous rock and debris.

A trip to the Rural side and working with Children

I took the chicken bus to a rural village yesterday. Chicken buses are basically old school buses that were used in the United States but are now retired. They were sold off to Guatemala very cheap and are now used as a mode of public transportation. It was pretty interesting being crammed in a bus with at least 100 people. Needless to say, I had a pretty interesting time trying to figure out how to get off once my stop had arrived. I visited an organization yesterday, that works with children in a small rural community who have been physically, emotionally and sexually abused. These children range from 6-12 years of age and do not go to school. Instead they are out busy working helping to gain a source of income for their respective families. It was great to see volunteers teaching children how to read and write, and we even got the opportunity to play games with them.

As for my espanol is concerned, things are steadily making progress and my skills have increased at least 10 fold. I have met tons of people just like me who are either traveling are engaging themself in worthy volunteer projects throughout the country. Besides learning spanish and working, living in Antigua has given me the chance to do some really cool site-seeing things. For example, today I am off to the Volcanoe Pacaya with a group to climb to it's summit. Should be very interesting considering it is an active volcanoe.