CHW Medical Missions Blog

On Holy Ground

As a writer, it surprises me every year that I have such a difficult time putting my thoughts about these missions to words. For the last three years I have been honored to join this team of caregivers and to write to all of you about their time here. With each year we do learn more, the teams get stronger, and the people we treat are just as grateful. I was the lone blogger for our first mission trip and am very happy to have had Andy North along these last two years to make sure that each of our fabulous team members are able to tell their story.

My first mission trip here was a difficult one. I had never seen poverty like what I saw here. I'd seen photographs, driven through poor neighborhoods, heard politicians speak about the plight of the poor. But I'd never walked into a home with a dirt floor, holes in the ceilings, and pigs walking through the living space. When I returned home from that first mission it had become very clear to me why dignity was a core value - and often the very first one on the list - at CHW. I was brought face-to-face with the reality that extreme poverty robs people of their dignity. And I cannot abide that.

The second mission trip was no less difficult even though I was more prepared for what I saw. The poverty was no less acute, but the people living here were resolute and charming as ever. Pope John Paul II said that the sins of the world can be read in the faces of the poor. He was right. The terror of everyday life that Peggy Styer spoke about in an earlier post is very real here.

The Cristo Negro, or Black Christ, is arguable the only real source of hope here. The sculpture was carved out of a tropical hardwood in the 1700s and over the centuries has turned completely black. Many, many miracles are associated with this sculpture. The shrine has become the spiritual center for Central America and a pilgrimage location for thousands. 

Cristo Negro

The hope for change and peace for millions of people is bound to this image. I don't often find myself identifying with symbols, but on this trip I was aware of the cross almost everywhere I went. It was a constant, but gentle reminder that when you are a witness to suffering you are on holy ground.

This posture towards suffering helped me when I was called upon to help on the mission in new ways. When the clinics were at their busiest I was trained by our nurses (thank you Jennifer Perez and Tiffany Edmiston) to take vitals and run lab work. It is a completely different experience and one for which I am incredibly grateful.

Tricia Griffin, taking vitals

Yet, I am a photographer for these mission trips, so I am seeing things first hand as well as recording what I see. Sometimes I wish the photos could do more. They aren't able to communicate the acrid smell and haze of burning garbage, the gentle touch of a patient's hand on your arm as they pass by, the excited tension in the air when the crowds line up outside the Basilica to receive a blessing from one of the monks.

What we do here is sacred work, just as it is in our hospitals and clinics. I am so grateful to have had this opportunity for three years and to get to know some of our caregivers in such a deep way.

And on behalf of all of the 2009 mission team I want to thank all of you back home for checking in on us regularly. We were getting about 1,000 hits to this blog a day. Knowing that you are following our journey is such a valuable part of our experience. Please do keep checking back. Each member of our team will be writing reflections upon returning to the States and I'll post them here.

Until then, via con dios.

Clean Water

Two members of our team - Ron McDowell and Michelle Telford-Vegas - have been steadily gathering water samples from around Esquipulas and the outlying villages we've visited. They are looking for areas where we might be able to set up a clean water project (perhaps a rain water collection system). Their samples have returned a number of interesting results.

Michelle and Ron review their water samples

In many cases, water that we assumed was clean (for example, the faucet on the side of the Basilica where all the visitors re-fill their water bottles) was very much not. And in other cases - water from a shady looking cafe - was very clean.

They are currently talking with the director of the orphanage we visited to determine whether a rain water collection system there would be feasible.

It's all part of our ongoing work here.

Water samples. Anywhere you see purple is E-coli.

The View from my Laptop

So, we have come to the end of yet another mission and it has been an incredible experience once again. This specific blog entry is a bit of a collection of my own thoughts from the week. I know, since I am one of the bloggers you have already heard my voice through the stories quite a bit but I wanted to capture a few things that didn’t really fit anywhere else.

First, let me introduce myself. I am Andy North and I work at St. Rose Dominican Hospitals in southern Nevada and Saint Mary’s Regional Medical Center in Reno doing a variety of things ranging from advocacy to marketing. Just like my job at home, in Guatemala I have had the opportunity to do many different jobs. During the day I have worked on patient flow through the clinic, taken vital signs, run hemoglobin (and other) lab tests, and of course, taken photos. This week alone I have taken over 1,000 photos because there have been so many wonderful experiences.

At night I interview my fellow workers and then try to write out their experiences in a meaningful way for you. Most nights it’s just me and my laptop until late but I love the work as it gives me a chance to reflect on what happened during the day.

Last year we went out to each of the villages to provide care, and I feel we did great work but I left with the feeling that we really needed to spend more time educating the people on how to care for themselves. I think everyone else had the same thought as this mission seems to have an education theme. The people came to us every day instead of us going to them and that gave the health providers the opportunity to keep the clinics open longer and spend more time with each patient. We brought along someone that could teach the people to fix their worst health problem, poor nutrition. And, probably best of all, we invited the local volunteers and health professionals to an entire day of education.

The education day was today and our doctors and nurses provided lessons to the volunteers on proper posture and lifting techniques, basic first aid, basic emergency care and how to both take and understand vital signs. They received backpacks with thermometers, blood pressure cuffs and other basic tools for care as well as the training on how to use them. The local doctors and nurses received advanced training on some of these same subjects.

In addition, they all received training concerning proper nutrition and how it can be one of the best tools against some of the more common ailments faced by the people of Esquipulas. The training included pictures of local fruits and explanations of their nutritional content and how they can help.

By the end of the day those that participated were all smiles. They were excited to go out and use what they had learned in the communities where they live. From my perspective, this particular day is probably one of the most important I have been a part of here in Guatemala. The local volunteers and medical professionals had an opportunity to learn new skills that they can use to help their friends and neighbors during the weeks and months when we are not here. Education, along with some of the other projects we are implementing such as a clean rain water capture system are all core to the real mission of making a sustainable impact.

Finally, I want to shift gears for just a second and thank the young men that are volunteering here from St. John’s University in Minnesota. Last year we had Phil and Theo (hopefully you guys see this, the playground you built is amazing) and they helped us out every day. This year we had Adam Sheldon and Luke Ekelund for the entire week and Patrick Deering and Matt Ott for part of the week. They did anemia checks, dental varnishes, blood pressure, pulse checks, worked as assistants to the pharmacists and continually ran back and forth between the clinics.

Adam Sheldon doing anemia checks.

Luke Ekelund giving a tour of the basilica bell tower.

Yesterday was our last clinic day and at the larger clinic we arrived to see hundreds of people waiting. In all we saw more than 200 women and children at that one site and the smaller clinic was also extremely busy. Like every other day this week, Adam and Luke dug right in and worked until they looked like they were about to pass out. As a matter of fact, near the end of the day Adam finally admitted he was not feeling well and when his temperature was taken it was 103 degrees! Luckily we had medicine to give him and sent him back to the Basilica to sleep (he is feeling much better today). While we don’t condone working in such a condition, it is just one example of many of just how extraordinary these young men really are. Here is a great big thank you to all of you from all of us.

So, I end where I started, in front of my laptop. It has been a wonderful journey and I am grateful that I had the opportunity to come back again this year.

Having Faith in the Possibilities within People

Dr. Frank Baudino is a family practice physician in Merced, CA. About seven years ago he sold his private practice and for a few years after that he was only working a few hours a week. “I felt kind of lost,” said Dr. Frank (as he has been referred to down her). “I needed to find something new and rewarding.”

At about that point in his life Dr. Frank made two changes. He began teaching residents  and he decided to try and combine his love for travel with his desire to serve more people.

“In 2005 I connected doctors without borders and ended up spending six months in Sudan. That was probably the hardest thing I have ever done, other than raising my kids. There was really no place to send sick patients. With rare exception you could send a patient that needed surgery to Kenya but it was a two hour flight. Mothers that had obstructed labor sometimes had to wait quite a while to be transported and I know of at least two cases where the mothers died.

“My main job on that mission was to treat malnourished children. That was a very gratifying component of the experience as mothers would come with their children and stay from four to eight weeks. I would get to know them and I would see them almost every day. If everything went well the children would go home in a much better condition.”

While Dr. Frank has done a variety of other service type journeys, this is the first medical mission he has gone on since his experience in Sudan. “The people on this mission are terrific,” said Dr. Frank. “There is not a single person here that I have not loved working with. They are all donating their time and we are all largely on the same page with regards to healthcare and reform and taking care of vulnerable populations.”

During this past week Dr. Frank worked in pediatrics and he was impressed with how cohesive the little team was right off the bat. “There were no problems with people working outside of their normal job descriptions,” said Dr. Frank. “Everyone did whatever it took to get the job done and we really bonded as a team.”

The experience brought back memories of Dr. Frank’s medical training. As a resident he was put with a team that included nurse practitioners and physician’s assistants. This created a great deal of comradely and each person supported the other through the process. He is now teaching part time for that same residency program but they no longer use the team approach. After his experience here he said he has decided to go home and recommend that they bring the team teaching approach back as it is much more like a real world situation.

Of all the children that Dr. Frank saw this week there is one that really sticks out to him. A mother brought in a 21 year-old boy with severe cerebral palsy. The mother wanted him to be treated for bronchitis and Dr. Frank did that but he also sent him over to Mia Paredez for some physical therapy.

“The next thing I know I was being called to see that Mia already had him walking,” said Dr. Frank. “I did not think he was even physically developed enough to walk but apparently he was. That experience really drove home that I should not jump to conclusions; I should have faith in the possibilities within the people I am treating. They can astonish us sometimes.”

“On a mission like this I think the medicine that we practice is real,” said Dr. Frank. “That is to say that everything we do is needed. In the US we tend to over medicate and over treat and so much of what we do does not really seem to benefit the patients. The need is so great in Guatemala that everything we do is needed.”

Following are pictures of some of the patients Dr. Frank and the pediatrics team treated this week.

Improving the Journey

This has been Mary Carol Todd’s third CHW medical mission but the fourth time she has stayed here at the basilica. The other time was when she came down with another group on a medical mission to see how they were doing things and what she might be able to learn. Those that know her know would not be surprised by that fourth trip, as she is always looking for ways to improve things.

She has been the co-leader with Susan Whitten and clinical lead for each of the three missions. In each she has continually sought feedback and tried to change processes so that things would run better and better. Following are some of our thoughts regarding that journey:

“We were very much novices the first year and many things we did wrong were due to a lack of experience. I had personally had never done anything like this in another country. Each year we have come to understand more things about the health system and the people we are serving down here and each year we have been able to improve our service to them. Because of these improvements each year has been a better clinical experience for those who come to serve as well as for those who receive our service.

“Some examples of our improvements include the year to year refining of the list of medications we bring down and making them more consistent. The quantity of drugs we bring has also been better. The education has improved because we have gained a better understanding of the culture and needs of the people. And, the process for the clinics has improved with regular small tweaks as well as the larger change of brining the clinics to us.

“Specifically concerning our decision to move the clinics closer to us, it has been so much less tiring this year. When the clinicians are less tired they can better serve the people. The other good thing was having a day of preparation right after we arrived. That decision turned out to be extremely important this year, especially with the customs situation. If we had not had the extra time we would have had to cancel the first clinic day. Also, it really helped our people to get here and get centered for the task ahead.

“The final thing I was really happy about was the education of health promoters. They started out a little hesitant but as the day wore one they became fully engaged. While they did not become fully proficient they got the basics down. And it will be interesting to come back and see how they have progressed.”

In years past Mary Carol has regularly been seen holding and caring for little babies. This year was no different; she held the little ones at every possible opportunity. The really neat thing about watching her hold a child is to see the change that comes over her. When she is in the clinical setting she has a laser focus and determination to make everything come together. However, when she holds a child in her arms you can really see her compassionate spirit and it is as if that child momentarily becomes her whole world. 

“I know others have discussed the septic baby,” said Mary Carol. “For me, the reason that situation really stood out is that our actions came as a direct result of knowledge that was acquired in the CHW clinical innovations sepsis mission possible program. Once we identified that the child may have been septic we implemented the sepsis protocols and I think it may have saved his life. Later it was a really neat experience to see him doing better in the hospital and then yesterday he was discharged and the mother brought him by the centro de salud, it really came full circle.”

“One other experience that really stands out is the boy who came in with club feet yesterday. Last year we were able to connect a little girl named Juana with another group that was doing surgeries and get her feet fixed. Her mother became angry with us because we took away her livelihood (her mother used Juana to beg for donations). When the boy came in we asked if the mother was sure she wanted to proceed with helping him get his other foot fixed and I was worried about what the answer might be. The mother looked up and said, “of course I want to have it done, I want to help my child.” At that moment I was so overjoyed because I know we can help him get the care he needs.

“Finally, I would like to say that the team was absolutely amazing. An experience like this really brings out the best of CHW people who feel a sense of connection to the mission. And I think once they are here it deepens their own connection to CHW and its mission. It is wonderful to be part of something like that.”

Making Great Strides

Ron McDowell has been a physical therapist with our missions for the last three years. He is a gregarious and kind man who lives deep within his heart. He has this to say about his third mission with CHW:

I really fee like there is a great progression of the work we're doing. I'm happy that some of the dreams we had last year are starting to happen this year. As an example, last year we started to dream about tangible clean water projects. On this trip we've been testing the water from various sources to see where the water is good and where it isn't to determine where we're most likely to make inroads. And the little orphanage outside of town is interested in rain water collection.

We're also learning more about some of the natural remedies that are available here. There's a plant source here that works great for anxiety. I've been recommending it to patients who seem to be having a hard time coping with some of the difficult things that have happened to them.

For myself, I feel like I am finally really teaching my patients. I have the space, the time, and the communications skills now to educate them. Now I'm learning how to respond to them in a more nuanced way by watching their body language. That in itself is a huge evolutionary process for me.

I'm also really impressed with how our team has evolved over the years. Each year we have our own team culture, and this year the thing that I've noticed is how each individual has felt free to be more creative in their response to the needs before them. I'm delighted to get to know my colleagues here. Though we all work for the same organization, I would never have been able to meet any of the team members, and even if I did it would not be the same. This shared experience over a longer period of time allows us to open to each other in a really positive and meaningful way.

Coming Home

Olga Alvarez now lives in Northridge, CA and works for Northridge Hospital Medical Center but she is originally from Guatemala City. One day at work she was checking e-mails and saw a message about a medical mission to Esquipulas, Guatemala. “I immediately knew I wanted to apply for the mission,” said Olga. “Next thing I know I had turned in an application and was on a phone interview as part of the final selection process. At the end of the interview they told me I was selected and after I hung up the phone I did a little jump because I was so happy.”

During her time in Esquipulas Olga has been surprised by the various local terms used here that are not used in Guatemala City. She has also noted many differences in culture, foods and living conditions. “It is so sad to see how little food they have,” said Olga. “I wish I could do more for them.”

Olga has been serving as an interpreter but has some prior clinical experience and has also been helping with taking vital signs in the triage process so she has been involved in many of the cases. Yesterday one particular infant came in and was having seizures. Dr. Frank asked the mother to come back today for a follow up visit. The mother said she did not have enough money to pay for the trip.

“The other people did not have any money either but Mary Carol has such a kind heart and she figured out a way to get a ride for the mother,” said Olga. Today the mother did in fact come back and her child looked worse so Dr. Frank decided to have the baby transported to the hospital in Chiquimula. As the ambulance pulled away Mary Carol and Olga realized that the other woman’s son was crying near them. They were overcome with emotion at the moment and began to weep themselves.

“That little boy was worried about his brother and his mother,” said Olga. “I was worried about them as well, you just get so involved and connected with these people and you want all of them to be healthy and safe.”

Freedom and Beauty

For Janet Hoffmeister, her second mission trip with the CHW team was a great deal more work, but also very rewarding. Janet is a pharmacist at French Hospital Medical Center in San Luis Obispo, CA, and serves as our lead pharmacist at the San Luis Clinic. Being in the pharmacy doesn't afford her a great deal of contact with our patients, so what she gets to see are the caregivers who serve this mission with her. "The team is just fantastic," she said. "I love all the clinicians - these guys are so adaptable and flexible."

Janet and Peggy Styer in the pharmacy

Still, there are times when she can step out to say hello to some of the patients. "I get a lot of hugs and kisses from them, which is just about my favorite part."

Her experience on previous medical missions to Guatemala gives her a unique perspective on the progress we're making here and on the work yet to be done. "Our volume is higher than before and there are a lot more prescriptions for blood pressure medications, more undiagnosed diabetes, and hypertension," Janet notes.

As she considers the lives of the people we're here to serve, one of her deepest hopes is to see the women feel safe and empowered to act on their own behalf. "In the States, when we choose to do something we are empowered to do it," she says. "Here, it takes three to four generations if you're lucky. I'd like to see some relief from the oppression."

Janet derived a great deal of hope from the site visit to the local orphanage just outside of Esquipulas. "I was so afraid of what I was going to find there, and was so pleasantly surprised by what was there," she said. "These children are happy and loving and very well cared for."

Even though their stories are sad - most lost both parents to violence or disease - and there were several sets of siblings there, all were playing well together and weren't really lacking for a family.

"It was breathtakingly beautiful in many, many ways," she says.

Learning and Growing

Michelle Telford-Vegas, a family nurse practitioner at the Folsom Family Clinic in Folsom CA, has been on all three of the CHW medical missions and has been the core of the women’s services we have been able to provide in the country. Because of this she has been able to watch the evolution and give a valuable perspective to help gauge how well we are progressing.

“The first year was a totally new experience and none of us really knew what to expect,” said Michelle. “Every little obstacle seemed like a big obstacle and I really felt like I needed to answer every question and resolve every problem.”

Now she says she has come to a better definition of what her role really is. “I know now that often times I cannot solve all of their problems but what I can offer is a compassionate ear. I can listen to them and do my best to educate and help them feel better.”

In addition, Michelle has noticed a positive evolution of the team’s approach. “We came down for the first mission and had a solid plan on how the clinics would work according to the framework of how things work in the U.S.,” said Michelle. “When things went wrong it really impacted our team and processes. I think we have learned from that and become much more flexible and better able to handle changes as they come in.”

One such innovation and adaptation occurred last year. A young girl with cerebral palsy was brought in and was extremely malnourished, anemic and apparently near death. The mother explained that it was extremely hard for the girl to swallow more solid foods. When Michelle saw the child she thought of Nancy Link, her dietitian friend from Folsom. She called Nancy, explained the situation and received several suggestions on how to proceed.

The team used Nancy’s suggestions to help the girl and also secured for her a referral to a nutrition program in Guatemala. Today the mother showed up at the centro de salud clinic with her daughter and was all smiles. Her daughter had gained some weight, looked much better and was now drinking from a cup. In addition, Nancy Link is with the team this year and had the opportunity to see the results of her consult and provide additional information to the mother.

Both Nancy and Michelle were very excited to see such positive progress and for Michelle it really drove home the point that this effort is making a difference in the lives of the people. “I am so grateful to have been able to participate in this process three different times and I am looking forward to helping with future missions.”

Making a Difference without Imposing Our Values

Peggy Styer has been an integral part of the Guatemala missions from their beginnings three years ago. As the director of supply chain management based out of Phoenix, Ariz., she has the formidable task of pulling together all of the medicine and supplies we use on our missions. While in country, she assists in the pharmacies, is up late every night helping the caregivers re-pack their bags for the next day, and keeps tabs on the status of all our supplies.

"It gets easier every trip to get into the rhythm of supporting the caregivers," Peggy says. "The greatest people in the world are the ones I get to work with here, as well as in Phoenix -- the members of my team who did so much to help me prepare for this. I'm just reminded every day of how special CHW is."

Peggy Styer (left) with pharmacist Janet Hoffmeister

What doesn't get easier is the ever increasing perspective that comes with each trip. "With every trip I've come to a much deeper realization of the complexity of providing care in underdeveloped countries," she says. "The complexity of the politics and the culture is a big barrier. You'd like to think you can make a difference but when you're not familiar with the culture it can seem insurmountable."

She is also very aware of the fact that Guatemala's economy hasn't fully recovered since their civil war, and the nation is experiencing a significant drought. "The patients are coming to us skinnier, sicker, and having gone without health care for longer," she notes. "And the terror of violence in this country is having a serious impact on the health of the community...really just the terror of every day life."

The real question, in Peggy's mind, is how do you facilitate change without forcing our values and lifestyle on someone else? "I don't think they need to be like us, but I'd like to see the needless suffering relieved in some way," she says.

Some of the answers are hard in coming, but the site visit to the hospital in Chiquimula provided at least a pathway for how to help. The hospital itself was "about what I expected having traveled in underdeveloped countries previously," she said. But this hospital was probably the most in need and furthest from our standard of care she'd seen in a long time. There was almost a complete lack of infection control -- there was blood on the floor and mold on the walls.

Yet she wasn't disheartened. "The trip to the hospital was a very valuable one for me because I know CHW is committed to doing what we can to help our sponsoring congregations ensure the poor can get care in Guatemala," she says. "I was able to identify what kinds of equipment can be supported here. There is just an extreme lack of supplies." As an example, she said that a typical U.S. ICU unit will have 500 different medicines on hand. Here, there were 20. And there's only one ventilator for the entire hospital.

"They need everything," she says. Just a few items on her very long list included dry X-ray equipment, IV pumps (most were hung without a pump or controller), new anesthesia machines, suction machines for the OR, surgical lights, incubators...the list goes on.

In the end she realized that there are certainly plenty of ways to make an impact, and that the time and dedication given to a long-term commitment is the only way to effect real change.