News from the Edge

Chronic Patient Program: Caring for the Neglected and Forgotten

“The chronic medical program serves this indigenous population that is isolated by distance, poverty and lack of education.  They have virtually no other access to the diagnosis and treatment of common, chronic medical problems and hence are subject to all the mostly preventable complications of them.

However, once identified, a patient is seen monthly and their medicine is adjusted according to written protocols. They are educated about their illness and given the month’s supply of medicine at no cost to them.




We started this program with the goal of treating patients with chronic medical problems, with the same expectations there would be for any person in the developed world.  What we lack in technology, we make up with regular follow-up by bright, dedicated nurses who are part of the local culture.”               Dr. Michael Polifka

As Dr. Michael stated, this program fills a big gap in medical care for the Pokomchi people we serve. Often it is senior patients who are part of the program, as shown in the testimony below by eighty-year-old Carlos about himself and wife (who have High Blood Pressure and Diabetes).

“Before joining the Chronic Patient Program, I was going through a very difficult year. I was very sick. My wife was also very sick. We do not have anyone who takes care of us. We live alone in our house and I need to look after her. I thought I was going to die and leave my wife all alone. I was very afraid that this would happen.  

I am grateful to the nurse who helped us and told us that a doctor was coming who could help us with the diseases that we have. I felt that I couldn’t get out of bed and that I didn’t have the strength left in me to survive. Despite this, I managed to make it to the clinic. Upon arriving at the consultation with Dr. Michael, he evaluated us and gave us the medication that we needed. Little by little we both recovered.

That time before joining the Chronic Patient Program, we suffered from not having good health. I couldn’t plant any crops. We instead struggled to buy corn and beans to survive. Now I have been able to work very hard on my land. I planted and harvested my own corn and beans for own use. I even had enough to sell and obtain a little money. On behalf of my wife and myself, thank you for supporting us and giving us the medication. We know that we wouldn’t have been able to buy the medication.”

Dr. Michael and the team are dedicated in their care of the chronic patients and these patients have a special place in our hearts as Dr. Michael shares in this excerpt from his journal:

“When eighty-nine-year-old Carmen comes in, she reminds me of a hobbit. Walking barefoot with staff, her colorful huipil and skirt seem to accent her prominent ears only slightly less than her long grey hair braided halfway down her back or her big smile missing four front teeth. She entered our chronic medical program six years ago because of a blood pressure of 200/80 and angina. At that time, the bedside ultrasound I did on her showed a significantly dilated heart. I knew that by any stretch of the imagination she wouldn’t survive twelve months if living in the U.S., let alone here. She was started initially on low doses of medicines and every month, according to the written protocol, it was adjusted. Today, pain free, she walked twenty minutes to see us and stepped into the clinic with a smile that lit up the room.”

God has worked miracles in this program.

Patients of all ages are now accepted and the life changes as a result are incredible.

Dr. Michael on our first pediatric chronic patient:

Although our chronic medical program had typically followed adults, Miguel asked me to see Otto Felipe for the first time when he was four.  His mother brought him in every 6 weeks for significantly difficult breathing. Going to the hospital in San Cristobal, one and half hours away, was not an option; they couldn’t afford the dollar and a half bus ride and so Miguel would see Otto Felipe. He’d be given nebulizer breathing treatments, oral steroids and antibiotics, and would get better for a few weeks only to return with similar symptoms.

He was not attending school, nor playing with other kids. In fact, he did not leave his house regularly. His mother was so on edge all the time, waiting for the next exacerbation, that she became clinically depressed. Often, I’d get an email from Conzuelo, asking advice about treating a bad flair up. Typically, when I’d see Otto on my semi-annual visits, he’d be sitting in the exam room, leaning forward in the chair, actively working to quiet his audible wheezing, looking up at me hopefully as his mother recounted the time since my last visit. And so, we expanded the chronic medical program to include not only adults with chronic asthma/bronchitis but also children like Otto.  I re-wrote the protocol and I started him on inhaled medications, standard treatment in the US, but rarely available here. He is seen monthly in our follow-up clinic where our staff makes certain he’s using the meds properly and gives him another month’s supply. Today things are different; both he and his mother have big smiles on their faces as they walk in confidently. He brings in his lesson notebook to show me that he’s in school every day and getting good grades. And he is playing soccer with the other kids. Miguel hasn’t seen him for an exacerbation in the last half-year.”

We are so grateful for Dr. Michael and how he has shared his skills, time, love, and funds for the benefit of the chronic patients and ASOSAP team. However, due to health reasons, he will no longer be able to come to Guatemala and continue in his role as ASOSAP medical director, which he has held for fourteen years. During all this time, Dr. Michael paid for the chronic patient medication out of his own pocket.

We hope and pray that we can continue to change patients’ lives, like fifty-eight-year-old Elva’s life:

“Before, I was looking for help as my health has been very bad. I have ongoing breathing problems and went to various doctors, but nothing helped. I would get so sick that I would need to go the emergency department to be stabilized. I would be okay for about fifteen days only. My symptoms always returned. When I heard that a US doctor was visiting my community, I went to the medical outreach that he was holding. I was seen by Dr. Michael and he told me that I have asthma, a chronic condition which has no cure. He instructed me in the importance of taking my medication and taking care of myself. I was added to the Chronic Patients Program. I have been in the program for seven months now and haven’t had any asthma crises. I haven’t had to go to the emergency department. I have been improving considerably and I’m very grateful for the care and medication. Before, if I had money, I would buy medications that other doctors prescribed. If I didn’t have money I wouldn’t buy it and often I would end up in hospital. I can’t believe that I receive these health checkups and medication every 2 months and I don’t pay a single cent for all of this care.”

We encourage you to watch the video below where Dr. Michael talks about the ASOSAP medical program, especially the chronic patient program. We posted it earlier in the year, but it’s definitely worth watching again!

He will be greatly missed, but we know how important it is to continue the work that he started.

How will this be accomplished?

Pediatrician Dr. Beth who has worked with us for many years will continue to come on medical outreaches. Together with her doctor colleagues, who specialize in adult medical care, she will continue to care for the chronic patients. They will also provide medical consults via email throughout the year.

What about the chronic patient medications?

Dr. Beth will order them and personally transport them here to Guatemala.

What about the funds to pay for the medications?

This is where we ask for your help. The annual cost is $5,000 US. Please prayerfully consider donating to help cover this annual cost.