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.

As part of Pop Wuj, they have optional Friday afternoon trips to become better acquainted with Guatemalan culture. This last Friday we went to the open air market at San Francisco del Alto. This is a small town about a 30minute ride on a Camioneta or "chicken bus."

The market was GIGANTIC! Every street was filled with vendors!  We also paid a small fee to climb up to the top of the local Catholic Church. It was pretty cool!

Here are some pics:

Who wouldn't want to buy a basket of chickens?!?!

These piglets were squealing like crazy as they were bought... they were shoved into canvas bags for transport.  

Here is a pic of the church:

GET READY!!! My next post will highlight my hike up Volcán Tajumulco!!!

Since I have been in Xela for a few days now, I have realized a few things:

1) I miss mountains:

2) My Spanish is no where near as good as I thought (making for some very interesting mealtime conversations with my host family)...

3) The people of Guatemala are so NICE!

I can't wait to start working in the clinic. Today we went out to a local village, Llana del Pinal, and we built a "safe stove" in a poor family's home. The extent of the poverty we saw outside of the city was staggering... Pop Wuj has a program that provides safe stoves to families that are currently cooking over open flames.  Not only is this bad for their health, and the health of their children, but it is inefficient and they often us plastic for fuel which is toxic...

Long story short, we learned how to build a stove! The best part? I got to use a machete to cut concrete cinder blocks in half. :-)

Here are some pics:

Hopefully my next post will be pics of a sunrise from the top of a volcano!  Woohoo!

I made it to Xela!!!

The bus ride, however, was not for the faint of heart... or stomach for that matter! I have never been on a bus that took such sharp turns so quickly! #guatemaladriving

Anyways, I met my host family today - well actually just my host mother, Susana. The house I am staying in is gigantic, it has a real hot water heater AND WIFI... Am I in Guatemala or the US?!?!

Here is my room:

Pretty nice if you ask me.

I made my way down to the main square this afternoon and it was beautiful as well.  Can't wait to explore more in the next couple of weeks!

And on my way home I HAD to stop and try the staple Guatemalan beer which is reminiscent of a Budweiser:

Overall, a great first day. Can't wait to meet everyone at Pop Wuj tomorrow!!!

¡Buen noticias! I made it to Guatemala City in one piece!

Today was a long day... I was up at 4:20AM, had a 5 hour layover in Panama City and didn't make it to the hostel I was staying at until 9:30PM central time.

That being said, it wasn't a horrible day. :-)

I enjoyed a few local brews:

I also learned that Panama uses two currencies interchangeably: the USD and the Balboa.  The more you know...

Anyway, I must say that I was thoroughly impressed with COPA airlines... they provided a hot breakfast during the first leg of my flight and a hearty snack with free cocktails on the second and final leg of my flight! 5⭐️!

Well, I'm off to bed... long day tomorrow including a 4.5 hour bus ride to Xela.

I'll post again soon!