The winding road to the clinic and Dr. Self’s home was long and bumpy, three hours from the airport, with over an hour on a winding, stone-laid roads. Many stones had fallen loose, forming potholes and crevices throughout the passage to Santo Tomas la Union, Guatemala, home to Akjun Pa le Qatinimit, or Clinica Medica Cristiana. The clinic serves the local community and surrounding villages; patients often walk, mototaxi, or hop in a friend’s truck to reach the clinic. The clinic is run by Dr. Self, a VCMC graduate, married into the community, who lives just across from the clinic with his wife and three daughters. He has built his clinic into the community, and patients come from the surrounding communities for the high-quality, low-cost services of the clinic.
Dr. Joanne Kim, Dr. Anna Rogers, and myself shared call with Dr. Self, caring for patients during regular clinic hours, but also in the middle of the night, when patients came in for everything from hypotension and severe dehydration, to viral exanthems, medication reactions, and pregnancy. The clinic is both high and low technology, working with limited resources and diagnostic capabilities, but with several high-tech but simple to use interventions. Labs are limited to point of care hemoglobin, electrolyte or blood gas panels (which are limited in number as they are shipped from the United States), and multiple ultrasound machines for imaging, including a small portable ultrasound that served as a constant companion at clinic visits, something I don’t have easy of access to at my own clinic. Despite limitations, Dr. Self and his staff are committed to high quality care in this low-resource setting, and have chosen the highest impact resources to provide this care.
Although I speak Spanish comfortably, I was challenged in my communication skills during my stay. Although many locals speak Spanish, many are most comfortable or primarily speak K’iche, a Mayan language that varies in dialect based on region. I started many of my clinic visits in Spanish only to quickly realize that an interpreter for K’iche would be needed. The clinic staff were indispensable in providing language assistance, and in many cases, cultural context, to many of my clinic visits.
Teaching and emergency preparedness were vital parts of clinic education. Dr. Self holds education and administrative time for the clinic staff on Wednesday afternoons, allowing for much needed training and enrichment, as although instances of such emergencies are not common, Dr. Self’s clinic takes all comers and emergencies do present themselves. We had the opportunity to participate in and assist with modified NRP and ACLS training sessions, learning how to use the LUCAS chest compression system, and a dirty epinephrine drip. At VCMC, our many healthcare providers are eager to jump in and provide chest compressions, but at Akjun Pa le Qatinimit, where often there is one provider and one nurse, the more free hands the better. I greatly enjoyed applying emergency interventions, usually smoothly running and plethoric with staff in our level 2 trauma center, to a low resource clinic focused on the most life-saving interventions. We also practiced our difficult airway skills.
Overall, Akjun Pa le Qatinimit is a low-resource, but high impact, clinic tucked in the coffee plantations and hills of western Guatemala. Dr. Self has dedicated himself to building a clinic/hospital with the capabilities to providing the highest quality care possible despite low resources, so that quality of care is not predicated by geography.