The Gem of GuatemalaPrint This Post
Fear, nervousness, solitude and excitement…this is what I felt as I flew through the thousands of miles on my way to a small country in Central America. The unknown can be scary especially a few months after the wake of 9/11. Even though I was to be alone on my flight I did not yet know if I was destined to be alone on my upcoming journey. Prior to this excursion, Guatemala was just” some country in Central America”, but after seven enduring days it would become much more.
An earthly, well–traveled gentleman was seated next to me on my long flight from Miami to Guatemala City. We exchanged pleasantries as I fumbled through my backpack to retrieve my important tool, the Lonely Planet’s Guatemala. Realizing I was a medical resident the man’s face brightened and he began to share stories of past journeys through this strange land. The one comment that stuck in my mind was the increasing need for good medical care. That’s right, good medical care! He explained the lack of doctors receiving good medical training coupled with an abundance of poverty equaled a poor health care system. Many native Guatemalans either were unable to access health care providers or obtain comprehensive health insurance. Just at that moment I glanced out the window and noticed the green flowing hills and small villages encircled by three large mountains or should I say volcanoes. My anticipation grew as my journey would begin soon.
I knew arriving at the airport would be a minor yet necessary challenge. Knowing travelling alone, not being a native speaker, and meeting the DOCare team for the first time would not make for a smooth navigation through the airport, I suddenly became focused. Luckily I noticed two team members in front of me in line at customs thus ending my journey of solitude. With their direction I intermingled among the team and headed outside to board the bus to Antigua. This “typical” bus ride took us through the poverty-ridden streets of Guatemala City. Next came a vivid image with a touch of stark irony. Travelling up a hill heading out of the city I saw a small, bewildered shack where a family was living. This impoverished family was more of the norm rather than the exception. However, hovering above their shack, on two gargantuan metal posts was a pharmaceutical billboard advertising a new medication. A medication that this family and most of Guatemala would never see.
The roads leading to Antigua took us through many villages and small towns where Guatemalan faces along the road glanced at us with apprehension touched with a sparkle of excitement. My comfort level seemed to increase after spending some time traveling with the friendly DOCare team. This 42-year old volunteer medical missionary group composed primarily of DOs and osteopathic medical students delivers healthcare and education annually to the Guatemalan people for a four-week period. Volunteers span from all over the U.S. as well as a handful from other countries including volunteer translators from Canada, Europe, and South America. After realizing I was the first New Jerseyan to participate in this annual endeavor, I was overcome with gratitude and felt a sense of honor to be in such great company. Just prior to arriving in Antigua the bus passed a large coffee plantation, spanning the side of one of Antigua’s three volcanoes, where many older women were picking coffee beans. Yet another irony or shall we say “social injustice” came over me…Guatemala is one of the largest producers of the world’s richest coffee, yet most natives rarely indulge in a high quality cup of “joe”. This is because only the tourist towns brew the good coffee for the tourists while the natives’ drink the weak instant variety. Where do the majority of the highest quality beans go? They are cultivated strictly for export.
Upon checking into our hotel in Antigua I was not sure what to expect. I was pleasantly surprised to enter a clean, well-furbished room with warm towels. Every member of the hotel staff treated us with respect and gratitude. All of our meals, hand-picked to give us a flavor of native cuisine, were prepared daily in the main dining room. To give an idea of the Guatemalan diet…Breakfast (or chapin) consisted of eggs, beans, fried plantains, tortillas, and coffee. Lunch (or almuerzo) was the main meal of the day and included soup/pasta, meats, starch, coffee, and dessert. Finally dinner (or lacena) was a light meal resembling similar foods prepared for breakfast. After taking in “lacena” I headed upstairs to retire for the night and prepare for the day of patient care fast approaching.
The forty-five minute drive up the side of the volcano brought us to a small town called Santa Maria de Jesus. Upon disembarking from the bus we were greeted by a swarming group of young children. “Pluma, pluma, pluma” is what they shouted. These children loved plumas (or pens) and thought of them as we would toys. Just giving them one pen put a smile on each of their tiny faces. Just ahead was something unfathomable…a line of over 250 people waiting to see a doctor. Patients came from as near as down the street to as far as four hours away to seek care. Some only see a physician once a year while others have never seen one. Walking past the many gracious faces and their echoes of “gracias” put a smile on my face, along with a good feeling inside. Why? Simply that we were needed. Dr. Pax, the local well-respected doctor, greeted us at the door and helped direct us to the facility. The first order of business was the creation of the pharmacy. This task involved unloading all the suitcases filled with medication samples and stocking and categorizing them based upon the disease. It was quite burdensome at first, but would prove to be a savior later in the day. Upon completing the pharmacy one of the team members directed me toward the converted store which served as a patient room where I would be spending the rest of the week. I was given a small room with an old dental chair and a wooden table. My volunteer translator for the day walked in and said, “Let’s begin”.
My first patient was a young boy suffering from diarrhea and abdominal cramping for nearly one and a half weeks. Viral gastroenteritis came to mind initially, but I need to stop and think for a moment. Children in an underdeveloped country drinking contaminated water and playing in dirt for most of the day…endemic fecal-oral infectious disease. Gastroenteritis resulting from E. coli, typhoid, salmonella, and cholera are all extremely common in this population, however parasitic roundworms needed to be on top of my list, namely Ascaris lumbridoides. These children play in the egg-infested dirt and transfer eggs from their hands to their mouths. Abdominal cramping is often the presenting complaint, but may lead to more severe gastrointestinal problems. For instance, small bowel obstruction from sheer numbers of worms as well as malnutrition secondary to strong competition from the worms for nutrients can occur if left untreated. It was imperative to treat this young boy so I gave him samples of the least expensive anti-parasitic drug available, albendazole. Albendazole paralyzes the worms and prevents them from migrating out of the gut into peripheral organs eventually leading to their death.
Even though DOCare only makes one trip per year their presence makes a deep impact. Not only are we able to treat infections such as Ascaris, but also lay the foundation for health prevention and awareness. We educated the parents, informing them of the danger of allowing their children to play in the dirt around the outhouse and instructed them to boil all water and wash their hands with soap and water. It was nice to realize we were making a difference and possibly helping to prevent malnutrition in these children.
Next walked in an elderly woman with a slight grimace on her face wearing a multicolored shawl accompanied by a younger woman. My translator informed me the patient only spoke a Mayan dialect and would need the help of her daughter who spoke both Mayan and Spanish…so my questions were translated via two translators and three languages. She was experiencing both neck and low back pain on a daily basis. Thinking about what the Guatemalan women do for a living things started to make sense. For example the transportation of clean water from outside to inside the village is accomplished by the women balancing large water pots on their heads. This in turn, exerts direct force on the cervical spine causing recurrent strain/sprain. Also throughout most of the day these women are working in the coffee plantations bending over picking coffee beans, thus leading to constant low back pain. This seemed like a perfect opportunity to incorporate osteopathic manipulative therapy (OMT) into my treatment plan. My choice of where to perform OMT on this patient came down to a rigid dental chair and an old beaten up couch. I choose the latter. With the help of the translators, I performed both myofascial and muscle energy techniques directed at the cervical/lumbar spine. Upon completion I instructed the patient to teach a family member to assist her in some of these techniques at home. She obliged with a smile and heart-felt “gracias”. I learned something valuable in treating this patient… OMT is very practical and useful even halfway across the world in an underdeveloped country. These two patients helped me come to some interesting conclusions about the typical Guatemalan and their medical problems.
Nearly half of the patients either suffered from some form of peptic ulcer disease/GERD (24%) or a combination of osteoarthritis/musculoskeletal disorders (24%). In terms of numbers the diagnosis of headache, most often tension-type, followed a distant third at 11%. To my surprise, I only encountered 8% diabetic patients and no cases of hypertension. Their medical problems demonstrate how diet and lifestyle play a large role in dictating their health. Compared to the US, the Guatemalan diet contains very little sodium and carbohydrate, helping to explain the scarcity of diabetes and high blood pressure. Fresh foods consisting mostly of protein, fruits and vegetables are the norm. On the other hand the same diet and lifestyle contribute to the medical problems that are more prevalent. For instance coffee is a staple beverage in this society leading to problems with peptic ulcer and reflux disease. Also, the amount of manual labor performed results in many cases of arthritis and musculoskeletal strains/sprains. It seems we might be able to learn a few health tips from the Guatemalan people. I believe anyone would agree the combination of gastritis and arthritis is a lesser evil when compared to diabetes and hypertension.
Upon leaving the clinic I walked across the street and bought a small stalk of sugar cane. This is what the children buy instead of candy. There are no chocolate bars or hard candies, sugar cane is it. You peel off the outer shell and suck on the inner fibers to enjoy the grainy, sweet cane gel. Realizing I had some time before the bus was set to depart I ventured into the streets of Santa Maria and I noticed young girls carrying their infant siblings on their backs while their mothers worked in the coffee fields. I also noticed many stray impregnated dogs scampering around searching for scraps of food. The dirty streets were lined with one or two bedroom cinderblock houses with tin roofs without indoor plumbing. Providing mothers, carrying ceramic pots filled with clean water on their heads, congregated around the community well on a daily basis. Lacking electricity and gas, all of their meals are prepared over wood burning stoves. As we arrived back at the hotel, I realized how fortunate we were to have modern conveniences and the importance of never taking things for granted, someone always is less fortunate.
The rest of the week consisted of long, busy days treating patients similar to the ones mentioned above. However, the upcoming weekend offered a bit of fun. I chose to spend my time on the black, sandy beaches of Montericco. A small group of us jumped into a van and headed down to the coast for what would eventually turn into a spectacular weekend. Prior to reaching the beach, we unloaded our gear and headed for a covered boat that had been waiting for us at the edge of the water. Our captain, a weathered soft-spoken Guatemalan gentlemen, steered us through the luscious mangrove swamps while pointing out waist-deep fishermen patrolling for dinner alongside wading water cows. Upon arriving at the beach a few of us headed to the black sand and stumbled into a small seafood restaurant. “Some of the best seafood” around said the locals, I would have to agree. The afternoon consisted of spending time in the warm pacific waters and touring a sea turtle hatchery. Interesting, but watch out for mosquitoes! Our trip back to Antigua included an unexpected, but pleasant surprise. Off in the distance in the night sky volcano Fuego was beginning to erupt. We stopped our van and admired the sight knowing full well there might not be another opportunity such as this. That sleeping giant with its red-orange glow capped off a nice leisurely day as well as my rewarding mission in Guatemala.
IN THE 11 YEARS SINCE DR. MAZURE VOLUNTEERED IN SANTA MARIA DE JESUS, THE NEARBY VOLCANO DEL FUEGO HAS ERUPTED REGULARLY. IN SEPTEMBER 2012 A POWERFUL ERUPTION HURLED THICK CLOUDS OF ASH NEARLY TWO MILES HIGH AND SPEWED RIVERS OF LAVA DOWN THE SIDES OF THE VOLCANO PROMPTING THE EVACUATION OF 17 NEARBY VILLAGES AND ALMOST 33,000 PEOPLE FROM AREA COMMUNITIES. THE CITY OF ANTIGUA SITS ABOUT 6 MILES NORTHEAST FROM THE ACTIVE VOLCANO AND WAS NOT IN THE PATH OF THE ERUPTION. AS RECENTLY AS FEBRUARY 16, 2014, THE VOLCANO PRODUCED MILD TO MODERATE EXPLOSIVE ACTIVITY AT THE SUMMIT VENT. OCCASIONAL STROMBOLIAN EXPLOSIONS EJECTED INCANDESCENT MATERIAL UP TO APPROX. 200 METERS ABOVE THE SUMMIT WITH ASH PLUMES RISING 500-800 METERS.
Jeffrey M. Mazure, DO
Board Certified Family Physician
Temple Physicians Incorporated
Jenkintown Medical Group
Published March 4, 2014
Jeffrey Mazure, DO, is a board-certified family physician, Dr. Mazure has a special interest in diabetes mellitus, sports medicine and pediatrics. He earned his medical degree from the University of Medicine and Dentistry of New Jersey – School of Osteopathic Medicine and completed a residency in family medicine at Our Lady of Lourdes Medical Center in Camden. He has also volunteered with the Special Olympics and AIDS Coalition and has served in the past as the team physician for the Camden Riversharks baseball team and the Camden High School football team.