San Cristobal, Alta Verapaz, Guatemala
15 January 2015
In addition to the chipi-chipi, the nearly constant mist here in the Alta Verpaz, it had rained through the night and so even though the backpacks were already full of medicine and minor surgical supplies for the day’s clinic in Pambon Grande, I made sure that I had extra doses of scabies medicine. The skin parasite flourishes when multiple, typically 5 or more, share then same bed and blanket in the constant moisture that embeds the simple wood homes. The ninety minute hike down the narrow trail starts in the tropical forest. The large leaves, dark green, glisten with water drops. The fresh mist which rises from the forest floor fills my lungs and clears my head. After 45 minutes, the trail leaves the forest and begins to cross the steep field of corn and the footing quickly becomes thick, light brown mud. Every step is unsure, more of an attempt to control sliding (prevent a mud bath); concentration is step by step. So the view across the narrow river below is pointless, there isn’t any.. So much for ‘ethereal’.
We arrive at the small church where we will hold today’s clinic and make a minimal attempt to kick off some of the 1″ thick mud that has collected on my boots before entering the dirt floored church. We move most of the plain bench pews where patients will wait to the front of the church and set up the few chairs that are available near the door and single window, as this will be our only light. The pews quickly fill with mostly women of various ages, all wearing bright multicolored handwoven full skirts, often with young children at their side. We organize into two workstations. I’m fascinated by the side and back lighting of the faces of the women being interviewed and examined by our nurse providers and await one of them to come to me with a clinical question, my opportunity for a “teachable moment”.
After interviewing his third patient, Emilio presents to me a 62 year-old woman with a six-month history of cough. My eyebrows raise, he has my complete attention. “Yes, often with blood in her sputum”; “Yes, she has fever at night”; and “Yes, she has weight loss”. I slide my stethoscope down the back of her white huipil with embroidered flowers and listen to her lungs; sounds of pneumonia in the upper portion of her right chest further add to the suspicion that she has tuberculosis. I call over the two other junior nurses and had just begun a discussion of the very serious implications of this probable diagnosis to the patient, her family, and all of this small isolated community of 250. It will be our responsibility to make sure that we get her to the regional hospital in Coban to get tested because, for the patient, this might as well be a journey to the other side of the world. And for us, this is just the first step; we are virtually the only health advocate she has.
Conzuelo, the senior nurse, comes over and interrupts to say that there is an emergency. In five years working with her, she has never said this. “Now?” “Ahorita” (right now), she answers.
(To be continued in a future post)