Driving up the bumpy mountain road, I stared out the window and a stream of questions ran through my mind: what is that tree that seems cultivated across so much of this part of Guatemala (coffee), what is the name of that volcano (Acatenango), where do people go for healthcare? The poverty was palpable, both in Guatemala City and in the rural countryside.
We arrived at the family compound and site of the clinic in the early afternoon. Family and extended family came to meet us and get us settled into our rooms. We got to work the next morning, following a cup of fresh brewed coffee that was grown, dried and roasted on the compound. The clinic was impressively efficient and had a well stocked pharmacy; we were able to treat most diagnoses that presented during the two weeks I was there. We saw everything from anxiety to severe zoster of the eye and most importantly we did not turn anyone away, regardless of ability to pay. Having a background in women’s health, I took care of a number of pregnant women, for their pregnancies and for pregnancy related complications. It was the heart of medicine, pure and simple, seeing patients and treating them with the resources we had available. Yes, there was electronic medical records, but it did not overwhelm our time. We were practicing medicine, the way we imagined we would in our idealistic medical student dreams.
The vast majority of patients were from the local community, though some travelled from hours away to be seen. Most spoke some Spanish, but a number of patients spoke only their native Qui’iche. Luckily Dr. Self’s brother in law could act as translator for those of us who are only bilingual. It was incredibly rewarding serving this incredibly underserved patient population, and their gratitude was apparent in their faces and kind words. At the end of each day, the work was fulfilling.
When we weren’t in clinic we were on call for the acute care facility, or ER, which is remarkably well stocked with equipment for everything from advanced airway management to automated chest compressor for cardiac arrest. We did a training session on fiberoptic intubation and luckily did not need that skill while we were there. In the ER we took care of very ill patients, sometimes for a few hours for IV antibiotics and fluid resuscitation and sometimes for days managing severe sepsis and dehydration from diarrheal disease.
As residents we had enough autonomy to feel like we were learning how to manage critically ill patients, but had enough support to feel like we always had backup. Dr. Self not only believes in providing high quality, evidence-based medicine to the marginalized and vulnerable indigenous patient population, he also believes in providing high quality education to his staff and community. While we were there we did a review of ACLS and PALS including a simulation lab. We had education session on bedside Echo and point of care ultrasound. This level of education raises the overall level of care of the facility and the quality of care provided to the patients. My days started out sitting on the balcony watching the sun rise over the nearby volcanoes, listening to the sound of clucking chickens and barking dogs and ended with a sense of fulfillment and joy in the work we were doing in beautiful rural Guatemala. This will hopefully be just the beginning of a long term relationship with this clinic and community, providing the best healthcare to the patients who need it most.