Our last week in Santiago Atitlan

As Leah and I prepare to leave Santiago tomorrow to work in villages south of Antigua, I’d like to share some of my favorite pics (next post) and some of the more touching moments.

The poverty and needs continue to be overwhelming and sobering.   What does one do with the sense that a step forward is a wonderful thing, but a “drop in the bucket” ?   There have been times when I have felt the most honest response would be to burst into tears, maybe even sob in response to the sadness of the lack of education, nourishment, basic resources, or access to the most basic healthcare. Right in front of us.  Everywhere.  Given this is not an appropriate response (especially not a culturally appropriate one!), I remind myself we are making a difference here, no matter the size.  There was the morning with the community health nurses where Leah and I helped the women understand the few but available contraceptive options in their community.  Visiting in the narrow, dusty alley that was the meeting place of two women’s homes, tattered clothes drying on the lines above our heads,  I watched one of their young boys, hair thin, head too large for his body with large tired eyes, and knew there were so many others like him. In truth, I have never seen a malnourished child. This mother was interested in contraception. Maybe our time with her that day will help her obtain it, use it successfully, and be able to best care for her family.

There was the 39 year old woman with her 8th pregnancy at the hospital at 38 weeks by a 24 week ultrasound with definitive signs and symptoms of intrahepatic cholestasis (ICP).  For us as providers, what a difficult situation — was she term? preterm?  Was she 35 weeks and an induction of labor would put her baby in jeapordy due to lack of resources here to support the needs of a baby if premature?  Or, if she did have ICP would continuing her pregnancy be potentially fatal to her baby, especially if she was 38+ wks?  As I spoke spanish to the translator, who relayed the inforamtion to her in her indigenous language, it was clear that with her level of education and the literally foreign concept of what I was offering, there was no way I could successfully transfer this information about abstract medical options, risks, benefits, and treatment.  She wanted nothing to do with interventions, so that provided our “answer”, but I was left with a sense of, “how do we do this”? and hoping and praying that her baby would be safe and born healthy.

There have been several opportunities to pass on education, information and demonstration on intermittent monitoring in labor (as opposed to continuous or not enough), the benefits of maternal position changes, and skin to skin after the baby is born.  There is a long way to go, but I am hopeful.  My greatest lesson in this area carries a familiar ring, that we must all work together — the midwives, docs, nurses, and staff — to make it work for the mothers and babies. I believe we can do this, and do this together.

There are many more stories, including the worst from today’s report from the night call MD — the one year old who died from acute diarrhea. Yet, I am once again inspired by the efforts made here by many both locally and from all over the world. Hospitalito is able to provide services from birth to emergency and surgery to this community – a rare and unique service in these more remote areas. Not to mention provide a site for medical missions such as Smile Network. Que Milagros! Then there are the Community Health nurses from El Centro de salud get right into the homes to help those that may not be able to make it to the health center for food, antidiarrheals for their children, or vaccines, or who might not be aware that contraception is available. And there are peace corps volunteers, Europeans, Americans and Canadians starting libraries and cooperatives, and many medical missions that local people have built and rebuilt after devastating mudslides.  Especially inspiring is the relationship between the local midwives (comadronas) and the medical community who seem to understand the need for collaboration.  Leah and I attended the monthly meeting this week where a local doctor from the community health center taught the midwives to recognize danger signs and when to transfer. The comadronas were interested, responsive and engaged and the doctor supportive, committed, and respectful. We were asked to give a presentation at the next meeting. Que suerte! While we will not be here, I hope to do so with the students during our November trip.

Needless to say, these are people who know how to move forward. So, what does one do with the sense that a step forward is a “drop in the bucket”  but to keep moving forward? I am reminded of our Dean’s famous sayings, “onward”.  And so here we go, onward, into this wide neighborhood full of beauty, need, sadness, miracles, desperation, and always, birth.