Hasta Luego Guatemala

Dear Guatemala,

Thanks for a great 4 weeks! As I reflect back on our time together, I can't help but think about the next time we meet and I. CAN'T. WAIT.

Why you might ask? It's obvious::

1) Guatamalans are some of the most sincerely friendly people I have met.
2) Your country is beautiful.
3) I have grown to love "chicken buses."
4) Hiking volcanos is a BLAST!

That being said I am glad to be making my way back to the states.  I can't wait to sleep in my bed. To take a shower with perfectly hot water. To be able to throw my toilet paper down the toilet. And salad - JESUS, how I've missed salad.

As I reflect on my time away, as always I am so very greatful to have the opportunity to travel abroad to experience another culture and to meet new people and practice medicine on a new health system.  I know I'm a privileged white male that grew up with a loving family, in a safe neighborhood, with clean drinking water, never worrying whether or not I had access to healthcare and never going to bed hungry.  This is definitely not the case for most Guatemalans and often times not the case for many of my patients in the USA.

I hope that everyone reading this realizes how lucky we are to live in the US. To have clean drinking water, minimal to no corruption in our government or out law enforcement officers, great roads, access to healthcare, access to public school past 6th grade, I could go on and on.

I urge you all to consider traveling to a less developed country to experience this first hand. If you can't that's cool, but next time you are getting upset about how the Barista at Starbucks screwed up your order, or your primary care doctor is running 30 minutes late or your internet is slow, it could be worse. Much worse.

Please consider supporting Pop Wuj and all of the amazing work that they do!

Here's the link again:  http://www.pop-wuj.org/volunteer/partners.html

Thanks for following me on my trip! Can't wait until my next adventure!

Take care,

Bradley

Antigua

Last weekend (my last full weekend in Guatemala) we decided to travel to Antigua. So Matt, Alex and I hopped in a checked bus early Saturday morning and made our way west to Antigua.

So first off - our chicken bus driver was a LUNATIC. At this point we have been on quite a few chicken buses, and they always take corners a little fast and speed through residential areas like a bat out of hell, but this guys was just "loco."  It was reminiscent of the double decker bus from Harry Potter driven by a shrunken head - luggage was flying off the overhead area and smashing innocent grandmas and you had to have two hands white knuckling the handle bars and two feet firmly planted on the floor to avoid being dislodged from your seat. I would say that maybe it was just that we were gringos and didn't know this is how things were done, but on this bus, native Guatemalan and gringo alike was white knuckled wondering if each turn may be our last.

Anyways, we survived and made it to Antigua (not mentioning our connecting chicken bus which was so full that each seat had three adults and then people in the aisle) in one piece!

WHAT A BEAUTIFUL CITY!  Apparently Antigua used to be the capital of Guatemala so there were a large number of Catholic Churches built that now lie abandoned and in ruin due to a decrease in population when the capital was moved to Guatemala City.

So we took a walking tour and ate and drank our way through the city.

Here is a selection of pics:

All in all it was a great day! So we made our way back to our luxury hostel and hung out on the roof deck partaking in a few beers!

Here are some pictures from our hostel:

We headed back on a Sunday! All in all a great weekend - other than my bout with traveler's diarrhea. But we'll leave that for another story!

Champerico

Last Friday we took a day trip to the pacific coast of Guatemala! Champerico is a coastal town that is NOT touristy at all - that is unless you are a Guatemalan tourist.

We woke up early to take a chicken bus to the coast... it was about a 2.5 hour endeavor to get from Xela to Champerico and we needed to switch buses once in Retalhuleu.

When we arrived on the coast the temperature was easily 20-30 degrees warmer than in Xela. It was warm, it was sunny and it was humid.  Perfect beach day!

So we found a restaurant that we used as our home base and then grabbed a few liters of beer and walked down to the beach. It. Was. Epic.

Black sand beaches with warm water... it was heaven!

Here  are some pics:

And to make the weather and seafood and beer even better? On our way home in the chicken bus we heard "Total Eclipse of the Heart" in Spanish.

I love this country.  Can't wait to retire here!

Until next time,
- B

Last week was great!  We had an awesome time providing medical care in a small village outside of Xela.

Here was my work station last week:

We had a few mobile clinics which was awesome. Again, the malnutrition rate in the kids here is horrific. Something I never see at my clinic in Boston.

Good news: Pop Wuj is doing amazing work in the Xela area! If you want to donate please use the link below. There is so much to be done and every donation counts!

http://www.pop-wuj.org/volunteer/partners.html

Anyways, we have clinic the rest of this week and then I'm going to the coast on Friday and to Antigua on Saturday/Sunday.

Stay tuned.

-Braulio

Lake Atitlan and San Pedro de la Lago

This weekend we decided to visit Lago Atítlan and it was GORGEOUS!!!  Matt and Alex and I braved the 3 hour "chicken bus" ride on Friday afternoon.

Let's digress a bit and discuss the "chicken bus:"
The cheapest and easier form of transportation around Guatemala is that of the chicken bus.  This fleet of retired school buses have been souped up, painted and renamed.  When and where do they travel, might you ask? Great question.  Here is what I know:
1) there is a panel at the front of the bus above the windshield that states where the bus is headed
2) there is no published schedule you just ask the locals - or who seems to be the guy standing at the chicken bus stop in the town you are in who apparently is a specialist on the schedules and destinations (all very unclear)
3) these buses don't stop. They don't stop for bathroom breaks. They don't stop to let people on (just slow down to a creep). They don't stop to pick people up (unless it is on the interstate).
4) the man who collects money, also is in charge of tying freight on top when people have large items.
5) each seat "fits" 3 adults
6) they are all standard transmission
7) the emergency exit door at the back of the bus is also an entrance and can be opened at any speed...

Anyhow, we survived the chicken bus to Panajachel. Total cost 30 quetzales (a little more than $4). From Pana we needed to take a ferry across the lake to San Pedro where we had reserved a hotel for 230Q a night (about $30). After going to the wrong dock initially, we eventually found the public ferries and hopped in. It. Was. Choppy.  But 35min later we arrived in San Pedro.

We were starving so hit up a restaurant. After that we decided to grab a few beers and head up to the rooftop area at our hotel and plan what we were going to do on Saturday.  It was pretty low key.

Saturday we woke up and decided to climb Volcan San Pedro. So we got up early, ate a large breakfast and headed to the trailhead in a "tuk-tuk."  Our guide Pedro was a hoot.

The trailhead

Coffee plants EVERYWHERE

View point

Weird flower

Is at the top. DAMN CLOUDS!

I was filthy after the hike!

After finishing the 5 mile, 4000ft elevation gain hike, we were tired, hungry, dirty and needed a beer. So we showered ip and went out for food and cocktails! The night life in San Pedro was AMAZING and the people watching was even better.  We ended up rocking out at Sublime (local bar) to a live band and dancing like fools.  We ended up by a fire pit at the lake edge by the end of the night which was awesome!

All in all a great weekend.  Can't wait for Antigua next weekend!

Hasta luego!

Pop Wuj Clinic and Nutrition Program

Hey guys! 

Haven't posted in a while and it's because I've been busy!  I started working in the Pop Wuj clinic last week. It is nice to get back into practicing medicine, however, everything here is so different...

The clinic itself is located below the Spanish school.  It has 3 exam rooms and a pharmacy and a triage area.  The floors are concrete, the exam tables are ancient and we use plastic chairs for the waiting area.

Patients are scheduled - about 25 per half day session - and they start by getting checked in. Once checked in, vitals are taken and a chief complaint is elicited. They then return to the waiting area and the physician/student/resident calls them into the room for a more in depth history and physical exam.  The only 2 test that are available is a point of care serum glucose level and hemoglobin level. No other labs are available in the clinic.

The reason for the visits range from follow up to seizure disorders to brain tumors. The patients are so impoverished and have little to no healthcare literacy...

Say what you will about the healthcare system in America, but at least we HAVE a healthcare system...  in Guatemala there is no national health insurance (no Medicare, no Medicaid) and the expectation is that patients will travel to public hospitals for healthcare. Which could work, assuming each town or city has a hospital and people had great access to said hospitals.  That, however, is not the case. Xela - a town of about 60,000 people - has only 1 public hospital...  which means that even if the patients can get to the hospital from their small pueblos, they may be looking at waits, shotty resources, etc.

So... back to the patients: 

1) diabetes - it is really common here. Insulin is out of the question given its cost so there are only oral agents to manage the disease... Our pharmacy is stocked with meds that have been donated so the supply is often less than ideal and changes week to week. This makes management of diabetes difficult because one month we may have metformin 850mg tabs then 1000mg tabs or no tabs. Which means there is a fair amount of switching meds based on available resources from month to month.

2) I also had a really sad case come in last week: the patient was at work and the mother was there requesting a refill on her anti-epileptic medications.  The patient was in her 20s and had been having seizures for the past 3-4 years. However, recently they had been happening more frequently so she was referred to a neurologist. Long story short - she has a 4 cm brain tumor that requires gamma knife to remove. It will need to be done at a private hospital which will cost 30,000 quetzales... this is more than a full years salary for the average Guatemalan who makes $1.58 an hour.  So the patient was at work and not able to make the appointment because she is trying to save up money for her procedure.  Judging by the increased frequency of her seizures the tumor is growing. My guess is that she will likely perish before she saves up enough money for the procedure... not a happy case. :-(

So if you ever want to complain about the ACA, or how long you have to wait for your doctor to see you or why your insurance won't cover Botox injections remember: at least you aren't going to die from a brain tumor because you are poor.

Sorry for the Debbie downer story... hopefully my next post will be a bit happier.

Volcan Tajumulco

While in Guatemala I had a few thinks on my list of MUST DOs, one of which was to climb a volcano.

So, obviously, I decided to climb the tallest volcano in Guatemala.  In fact, it is actually the tallest peak in all of Central America!

The trick to climbing this volcano, however, was to be at the peak for sunrise as to get breathtaking views from the top.  This meant a few things:

1) we leave Xela at 10PM

2) we get to the trailhead around 1:30AM

3) we start hiking at 2AM as to be at the peak around 5:30AM so we wouldn't miss the sunrise

So, I talked with a local tour group and we scheduled said trip.  I bought a headlamp, I bought some "lycras" which are the closest things to long johns (and of course they were way too short) and we were all set!

Or so I thought... after Spanish class on Friday afternoon, I started feeling really crummy with fevers and chills and headache... I thought I was going to have to cancel, but with 800mg of ibuprofen, a 2 hour power nap, and a stubbornness that only a Buchheit could relate to I got on the bus to go to the trailhead.

Come to find out, my sudden fever would be the least of my worries...

Upon arriving to the trailhead, I immediately realized that I may had not brought enough warm clothes: it was gusting wind to ~25mph, it was "misting" and the baseline temperature at the bottom of the mountain was probably 40 without wind chill.

So we clicked on our headlamps and hoped for the best.  I'm not one to complain about outdoor activities or being uncomfortable, but this hike could have been best described as one of Dante's levels of hell yet to be discovered:

I was slightly febrile. It turned from mist to intermittent rain showers. As our oxygen supply decreases with elevation gain, the wind gust only increased in intensity. My glasses were practically worthless given the weather, and - to top it all off - I was short of breath, had a headache and was nauseous in the setting of being at 13,845 feet above sea level.

Then to place a metaphorical maraschino cherry on this "shit sundae" of an experience, we got up to the summit at 4:30AM and had to wait around for 2 hours before sunrise... you might be thinking to yourself: at least they had some time to rest at the top. In actuality- we were cold, we were wet, we were tired.

I found myself  huddled together with 2 4th year med students who I had known for 5 days and a firefighter from Idaho that I had known for 4 hours to prevent freezing to death for what seemed like an eternity...

Was it worth it?

Hell yea.

Let's just say that I won't be hiking anymore volcanos in the next 3 weeks.