CHW Medical Missions Blog

Nursing From the Heart

Carmen Montano-Coronado, RN is an Ambulatory Care Nurse at Woodland Healthcare in Calif.  She is a veteran nurse with 21 years experience in labor & delivery, emergency care, and ambulatory care.  She shows genuine concern for every patient she sees.  

I love my job as a nurse but I have to say that I have never done it in a more rewarding area.  Patients in the US have high expectations.  The people of Guatemala have been wonderful and very appreciative of even the most basic care. 

On my third day here I met a 13-year-old teenager.  He was very sick with a respiratory illness.  He was also homeless, unkept, and hungry.  He told me that he was from a far away village and had been living in Esquipulas for almost a year.  I thought he was a runaway. Instinctively I tried to find a way to get him to go back home.  When I asked about his family, he told me that his mom had a new husband and he was no longer welcomed in the house.  I felt very sad for him and lost control of my emotions.  I could not hold back my tears.  I thought about my three sons back home and could not imagine ever turning my back on any of them for any reason.  We provided him with medication, took up a collection of 200 quetzales (about $30), and made sure he had a decent lunch.  I hope that somehow we made a difference in his life.

I am very grateful to have the opportunity to participate in this mission.  Working with new people has been very good.  We all share a common goal and jump in to help each other.  We became a team very quickly and go above and beyond to get the job done.

Caring for others brings joy

Trish Warren RN, is a Pediatric nurse at St Mary's Medical Center in Long Beach Calif. She has always wanted to use her medical skills to be able to help in an underserved area. She is excited to be in Guatemala on her first medical mission.

I was very excited when I was chosen to go on this mission. It has been a blessing to be part of this team of extrordinary people all working together. Being a newcomer I was unsure what to expect. Bumping along on the very rough dirt road to Horcones I was a bit nervous. The peds clinic that day was set-up across the street from the main clinic in a one room school house. My nursing skills kicked in and the nervousness left.

We saw many of the local children that day and I was reminded that children are so resilent. Although they live in poverty and lack many things we in the US take for granted, they were still playful and quick with beautful shy smiles for us caregivers. It is difficult to see the struggle life must be for some of these families.

There is a medication, Albendizole, that's given for treatment of intestinal parasites. In 25 years of pediatric nursing, I have never before administered it. Today in Central de Salud, we gave it to almost every child we saw.

Hopefully our being here, giving them a little access to medical care, can help improve their lives in some small way.

We Make Our Destiny Through Our Choices

Herbert Villafuerte, RN, BS, CEN, is the director for emergency services and critical care at Glendale Memorial Hospital and Medical Center. He grew up in Guatemala not far from where we are serving.

It is difficult sometimes to realize how fortunate we are in life. It is through genuine effort and an act of kindness that we find our true selves. I joined this mission with the expectation to make a difference for the people of Guatemala.  Last year, it was difficult to see our efforts make a significant difference because we could not follow through with the patients appropriately. We were here for a week and although we evaluated well over a thousand patients, we were unsure they would be appropriately followed up by our contacts.

Herbert Villafuerte (left) works with Jennifer Perez to conduct an intake assessment

I was very fortunate to be chosen this year again to come on this mission. Through great efforts and a stronger partnership with local healthcare professionals we are able to get referrals and send patients to the right specialty required to provide definitive care.  For example, we had a young man come to our clinic that had been suffering from fever, headache, a peticheal rash, and abdominal pain. In previous years, we  would treat the infection and send him home. This year, we were able to contact the a physician on staff at the local hospital and get him direct access to appropriate medical care.

I believe people make their destinies through the choices they make in their lives. In my life, my choice has been that of service. My destiny has brought me to this great opportunity to serve the community in which I grew up. Not knowingly, I joined an organization committed to serving the people of Guatemala. It is not every day that we find an organization that is willing to send some of its workers to serve following in the steps of our Lord.
 
The biggest proof of this commitment comes from the commitment all of us have shown. The commitment that has led us to leave our family and friends for ten days. I am a single father and it kills me to be away from my son. Although he knows what this mission is all about; I think it is difficult for him to understand why I have chosen to join. I hope that through the efforts of people like the excellent professionals joining me in this mission he is able to grow spirituality to see outside the box and realize how fortunate we are. I hope he can see that the meaning of life is not about how much material things we are able to amount but rather  that the meaning of life is that of service. Service to the needy; service to the orphans and widows and to those that are not fortunate enough to have not even running water.

We live in a world where impressions count; I hope this blog can impress you enough to see outside the box and reach out to someone in need.

Making A Difference Means The World To Me

Tiffany Edmiston, RN is a critical care nurse at St. Mary's Hospital in Long Beach, Calif.  This is her second year serving on the mission.  Her experience with the community last year fueled her passion for nursing.

Coming back to Guatemala for me is a continuation of helping those who don't have the resources that I am accustomed to.  I see how the people here receive healthcare and how we give healthcare back in the states and I think:  This is so difficult for them.  They wait for us to come, and hope for our help.  We in turn listen to their concerns, give them appropriate medicine and a therapeutic touch they have never felt.  When I get to do that, it makes leaving the comforts of home worthwhile.

Tiffany takes vitals for a patient in Timushan.

The few days we have been here so far have been challenging, which I anticipated and expected.  I see the challenge and want to be of service.  The question I have everyday that I am here is:  How can we best serve this community with the scare resources available?  We try our best and I am glad I can be a part of a team that contributes their skills and creativity with the limited amount of time we have with each patient.  Guatemala is a beautiful place with beautiful people and I hope we can make a sustainable difference by being here.

The work I do here is so different from what I do on a daily basis.  It is frustrating at times and difficult for me to get through the language and cultural differences.  Yet I find that my teammates help me through it and everyday I learn more.  Giving my services to this special community is very rewarding.  I feel that every smile and hug I get from a grateful patient is a payment that can never be measured.

 

It Starts With Us

Jennifer Perez, RN, is an emergency room nurse at St. Mary Medical Center in Long Beach. This is her third mission trip with the CHW Foundation for International Health. She also has completed medical missions with the Flying Samaritans and with the U.S. military.

I have been lucky enough to have had the opportunity to come on this mission trip for the last two years. I was actually packing for a medical mission with Continuing Promise when I got word that I would be coming back to Guatemala with CHW. There is a lot going on in my life and I wasn't sure if I could take the time to do this trip too, but I know wholeheartedly that everything happens for a reason, and although timing seemed less then optimal, there was a plan. I know this medical mission well enough -- I know what is expected of me, what we as a group are capable of giving and I felt fortunate for the fact that I was able to make myself available.


Jennifer Perez triages patients before they go to see one of the doctors.

The first day we worked in Horcones and the one thing that kept coming back to me was how lucky i am to be part of such a cohesive and passionate group of people. We had many new members, many returning and so many times during the day it hit me how honored I am to be in these team members' presence. All my fellow team members are obviously great at what they do. They're all leaders and you'd expect there to be some friction with people who are accustomed to being in charge having to suddenly follow. But how quickly and effortlessly we all got together and worked out how to run a functional clinic. And then there are the patients. It's so refreshing to see the looks on the patients' faces just to be heard.  Some walked for four hours to see us and they are all dressed in their Sunday best. Nothing quite compares to looking into their eyes. It's such an honor to be given the chance to sit back and look at someone, to see their human-ness. To see the couple who look upwards of 80 years old each -- they hold hands and he carries her bag -- the simple life that they live makes me so appreciative and envious.

Many of the patients I've seen are affecting me in different ways. The 85 year old beautiful grandma who just wants to get her blood pressure checked. I was revisited by a young girl named Wendy who wanted to come home with me last year; she remembered me and had to come say hello. The 14 year old boy with the cable-knit sweater and the hat he wore sideways, who broke my heart to pieces, complaining of flu-like symptoms and a sore tooth. He was alone, waited for hours to see a doctor and spoke of living on the streets because his mom got a new boyfriend and didn't want him. I could not stop crying. We wanted to get him set up with some permanent help, but he didn't come back for his follow-up appointment.

All in all, we were chosen for this sort of experience for a reason. We just have to be open to the opportunity. I have been so blessed in my life to be able to be useful in a critical situation, but I do believe that being open allows us to be in the present and appreciate the smile in an old woman's eyes, a handshake or a smile, a pregnant girl putting my hand on her belly and showing me pictures of her baby. If we only took a few moments of our day to appreciate the beauty all around us we would all be much better off. It starts with us, each of us, every day, and I'm going to continue to strive for that clarity. It makes us better. I want everyone to have the chance at an experience like this -- one that will stay with them forever and change them inherently.

Improvisation and teamwork cures all ills

Seneca Carrillo, MD is an ER physician at Chandler Regional Medical Center.  Although she is a world traveler, this is her first medical mission.  She was kind enough to share some of her frustrations:

Futile. The word kept jumping into my head today as I saw patient after patient. I couldn't help but think it, even though I know its not true. I treat the patient for worms, something nearly ubiquitous in the water supply here, and realize as they take away their one dose of Albendazole, what did I really do? When this patient has no source of clean water, their worms will likely be back the next gulp of river water they take. I hand the next patient her papers for treatment of an STD. I include a dose of antibiotics for her husband. But without educating them both on how to prevent this, will she get it back in a matter of weeks? The woman with an infected foot ulcer who needs dressing changes daily, using a wet and then a dry one to pull off the dead tissue...but has no clean water to use to wet the bandage, no money to buy dressing changes, and has been wearing the same stained and tattered gauze for what looks like weeks. How does she heal without resources as simple as clean water?

 

This was hard for me today, to reconcile how to help these people with what we have at our disposal and what they have at theirs...which isn't much. But I came to realize, if we can target what we do know to the simple things, we can make a huge difference. 75% of the patients I saw today had dentures and they were in their twenties. If we can give the children toothbrushes and show them how to varnish and care for their teeth, this could be averted. Teaching our patients how to prepare clean water, avoiding contaminated water and doing the simple things to avoid the parasites and bacteria that are infesting their running water, we can aid in treating a multitude of illnesses. And lastly, utilizing the local doctor here to help refer the sickest of the sick to the specialists they need, like the 60 year old farmer who had a heart rate of 32 and kept passing out while working in the field. The pacemaker he probably needs could actually be a reality if someone knows about it locally and can get him to the central hospital run by the government to be seen by the cardiologist.

So futility led to a sense that we just have to target our resources and we can actually make a big difference. I just have to realize that lab tests, CT scans, and lots of referrals to dermatology and ENT, all the things I would usually do as an ER doctor back in the US, have no use here...its all about the simple things giving the most bang for the buck. There is a common saying with this Guatemala mission brigade crew, when you just have to work with what you got and make it functional, you do it the "MacGyver way".

Multi-Cultural Education

Pam Davis, MD is a Family Medicine physician and educator at Northridge Hospital and Medical Center.  She is new to the Guatemala Mission, but has served Southern California's Latino community for years. 

While seeing patients is what brought us all here, I was intrigued by the promise of contributing to the education of the health care nurses and students affiliated with the Basilica. As the Residency Director for the Family Medicine Residency at Northridge, I love the idea of teaching the next generation of physicians and nurses.

Today I had the opportunity to provide a presentation on OB emergencies to a class of Guatemalan nurses and nursing students. My seventeen year old mentoring student worked with me to prepare a power point presentation full of facts, pictures and points for discussion in English and Spanish. Thank you Ruby Talavera. Great job!

 

One of the mission team's nurses, Candy, helped me translate, and though she is young, her experience in labor and delivery was invaluable. Fortunately, I was old enough to know of the days when nurses used fetoscopes and listened through contractions for decelerations. Candy was surprised to learn that these nurses practice all types of medicine with little technology.

The presentation was well received but the questions were the most memorable. Many of the nurses wanted to tell their own stories of patients with involuted uteri, postpartum hemorrhage, and postpartum fever--too afraid to go to the hospital. We were struck by their knowledge, experience and bravery. It was an honor speaking to this group and one of many moving experiences here in Esquipulas.

Power of the Human Spirit

Mia Paredez, OTR/L is from Northridge Hospital in Southern California. This is her second mission and she has become an indispensable team member, loved by children, parents, and all who encounter her.  Her energy is infectious and she can make anyone smile.

Mia holds a baby, while mom sees the doctor.

Here she shares her experience:  

I am not sure I can ever truly put into words what goes on here, with this unique group of people; we come together and venture into unknown places, trying our best to change lives for the better.

This is my second year here.  I thought I knew what to expect, but as life has it things did not start out according to plan.  After our four hour plane ride, followed by a five hour bus ride we were told that we needed to prepare for clinic the next day.  The clinic site was to be a two hour drive, yet there was not one complaint in the group.  I knew then that everyone was ready to serve and that we shared a common purpose.

I had forgotten how much I did not miss the cold showers, flooded bathrooms, and total blackouts in the city (while having dinner in town).  I had forgotten the challenge of knowing that you just have one shot with each patient who comes to you.  In this brief time you must evaluate, treat, and then discharge this person.  One can only hope that somehow, someway in that ten minutes, you have made a positive impact in their life.  But maybe what I had most forgotten was the gratitude on people's faces, the smiles in their eyes, and the overwhelming feeling that just maybe we are doing something right.

Mia is elated to see her patient make progress.

Tonight a small group of us had the opportunity to visit a young man in his home.  All we knew was that the patient had been in a motorcycle accident earlier this year and had broken his back and legs.  Immediately upon our arrival, it was evident that we were dealing with someone with a cervical spinal cord injury.  He has very limited mobility in his arms and is paralyzed from the chest down.  Yet this young man was full of hope and ready to do any exercise presented to him.  What he had not done since his accident, ten months ago, was learn to perform the most basic life skills.  The team was able to teach him to weave a fork between his fingers so that he could feed himself.  He also learned to use both hands to lift a glass and give himself a drink of water.  Seeing the look on his face, after he took a drink of water independently for the first time after his accident is what this mission is all about.  I am so thankful that we were able to have a positive impact on his recovery.    It is people like him, who in the wake of a life changing injury, can genuinely smile and be so full of hope, that make me love my job both at home and on the international front.  The power of the human spirit really is boundless.  

 

 

Focused on the big picture

Brian Fong, MD, is an emergency room physician at St. Mary Medical Center, Long Beach. This is his third trip to Guatemala with the CHW Foundation for International Health. He also serves on missions to Mexico with the Flying Samaritans.

After working in the dark the first year, I'm pretty much prepared for anything. My first year I was concerned mainly with keeping up with the pace of the clinics. Now I find the rhythm fairly quickly and don't worry so much about what's happening outside my clinic room. I take one patient at a time and do the best I can for each person. There are times when it's clear the person who has come to see us isn't very sick. Sometimes they're just looking for someone to listen to them. They just want the reassurance that someone is there and cares. I'm very cognizant this year that I'm not going to rush through the patients, because sometimes listening is therapeutic too. We've been talking in groups about this process and we're all pretty much in agreement that if you help just one person then you've made a difference.


I really like traveling out to the villages and seeing people there. We get to see some of our previous patients and follow-up on their care and their living situations. It's not always happy news, though. I was sad, though not surprised, to learn that the girl who's MRI we saw two years ago had died. She was suffering from a brain tumor that was putting pressure on her optic nerve so she'd gone blind. Somehow, she was able to get the diagnostic test she needed to determine what was wrong, but didn't have the resources to get treatment. In the U.S., this would have been diagnosed quickly and treated. Here, there was nothing we could do for her and she died.

This is part of what we learn when we come into another culture to deliver care -- that we have to think about things in their terms. Some things would just be unacceptable in the U.S., but here they are accepted without much thought, especially when it comes to medical futility. In the U.S., we only talk about the futility of a situation behind closed doors. Here, it's fairly out in the open. There are a number of patients we've seen on this trip who needed to be referred to a hospital for additional tests or treatment, but they all stated that they couldn't afford to get these services. They feel pretty hopeless. In the U.S. we have this certainty that help is out there and we'll be able to get it; that we deserve to get it. Here, they've come to terms with the fact that the help may not come. It's a balance to figure out how to work with the values they have and the values we have.

A big part of figuring out how to help them improve their infrastructure is to understand what is already available. This is where the education we do is so important. We're trying to help the local nurses and health promoters learn a little more about what to look for and empower them to improve things. The desire to learn is there, but the structure for teaching isn't formalized. I'm looking forward to working with the medical students over the rest of the week, but would also like to bring in the nursing students. We need to reinforce what they're learning in the class room it by bringing them into the clinics and giving them hands-on experience. They can't call 911 and have someone there in a few minutes - they may be called upon to deliver first aid and medical care for hours.


Not every patient we see at the clinic is going to need immediate care or referral, so if we can integrate the nurses into what is a typical interaction. We need to make them do this work so that they have the confidence to do it when we leave. The only way they're going to learn is to engage and do it.

One good thing about CHW is that we've committed to coming out here for five years to see what we can get done. Can we help bring some self-sufficiency to people? No one really knows the correct way to do this, but we're getting better everytime we come.

I Was Meant To Be Here

David Ferneau is a Physical Therapist at Mercy General Hospital in Sacramento, Calif.  He is the first person from Mercy General to serve on the mission.

The day started off a little slow for David. That is until he saw a 6-month-old patient with a club foot.  David knew this child needed a custom foot brace or possibly corrective surgery as soon as possible.  Unable to provide either, he grabbed a knee brace and had to use some creativity.  He was able to use the stove at a nearby house and warmed up the knee brace just enough to make it pliable.  David was able to fashion a foot brace for the baby.  After fitting the baby with the brace David commented, "This patient just made the entire trip worthwhile."

David fits his young patient with a "custom" foot brace.

We later learned from the local health promoter that a club foot specialist is scheduled to arrive in Esquipulas this November.  David's patient received a referral to be evaluated for corrective surgery.

"This was an amazing opportunity, that presented itself at just the right time.  I felt that I was meant to be here, just to take care of this baby.  In the US this type of condition is unheard of.  If this is condition is not repaired, the baby will not be able to walk on his own."