Monday, September 29, 2014

Reflections on Healthcare, Guatemala, and Pop Wuj

By John Hann, MD

John was a Pop Wuj Medical Spanish student in May, 2014.  At the time he was finishing his Family Medicine Residency at Ventura County Medical Center in Ventura, CA. Thanks for being a fantastic Pop Wuj student and volunteer -- and for sharing your story and pictures! 

Women walk on the streets while carefully placing their feet in the areas not yet soiled by the stray dogs who rummage through plastic garbage bags that line the streets. Unable to afford niceties of street sweepers, clean engines, or even trash cans, the city instead relies on bright colors, flowers, bustling markets, and the inevitable afternoon downpour to shine through. Even through the thick soup of exhaust belching out from passing buses, the flowing colors of women's clothing can be seen. 

Like many others, Guatemala is a land of contrasts: beauty enveloped by pollution, tranquil people inhabiting cities filled with chaos, and a culture of stamina that belies the chronic disease and pain suffered by many.

Forty-two hospitals cover the 18 million people that live in Guatemala, a country whose economic sector is said to be dominated by money sent by family members living in the U.S. Twenty-two official native languages are recognized that have all descended from the Mayan empire.  Family members are accustomed to systems that are slow, inefficient, and racist. 

The clinic created at Pop Wuj by Guatemalans with the support from the U.S. is, for some, the only healthcare they receive. The projects started with scholarships and building safe stoves before expanding to provide child care for women living in the impoverished countryside and later healthcare.
Stove building material delivery day

Delivering bricks and other materials for the stove construction
Though established by Guatemalans, the organization (like much of the country) relies on foreign donations and volunteers. In the last decades, U.S./European volunteers’ interest in international development waned as interest in medical volunteering rose. Reading the writing on the walls, Pop Wuj teamed with local doctors and organized a volunteer clinic that eventually grew to what it is today.

Pop Wuj's clinic is not entirely dissimilar to clinics in the States. Spanish-speaking patients, diabetes, hypertension, poverty and, of course, "one last question" as you are leaving the room. As is the trend in the states, medical records are stored electronically on old Linux machines.  Teams of volunteers with varying Spanish skills work with local doctors, one of whom is even the daughter of the founders of the school. 

Lining up for clinic

Getting things done, in some ways, is even easier than in the states: very little regulation exists for medications and labs can be ordered just by paying for them (no doctor's Rx is needed). Not having to worry about insurance companies or copay, billing is non-existent, and deciding which medication to give is as simple as determining which medication is in the stockpile that month. 

Parasites and worn out joints dominate chief complaints, but with joint replacements being the equivalent of 15 years wage, most walk away with Tylenol.  Low administrative overhead from all donations keeps things slim on the organization front, but, as it does in every country in the world, perseverance and flexibility are the "recipe for success."
My experience was not limited to the clinic. Building stoves with chimneys for women living in one room, one bed, tin-metal walled, multi-children, smoke-filled homes was especially rewarding. As was being a first responder to the inevitable motorcycle accidents that happen in the anarchic streets...twice. Even my teachers sought assistance with us for their skin infections and wives with hypertension.

Building a safe stove
On the eve of graduation from residency, it is nice to reflect on my training and the blood, sweat and tears I have put into the last three years. Being able to slip from a busy, Spanish-speaking clinic and ER in the states into a busy Spanish-speaking clinic in Guatemala makes me appreciate what the long nights and countless charts have yielded. I look forward to the next adventure and am grateful to those organizations, Family Medicine Education Fund and Pop Wuj, who helped make it happen.

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