Guatemala Day 2: Day of Triage

More than 150 people showed up at the hospital on Sunday to meet with the doctors. I wasn't sure when they arrived, but when we arrived at 7:30 a.m. they had already filled the waiting room and were lined up down the driveway and out onto the grass. But there was no pushing or chaos. Instead they waited patiently and greeted us with happy "Good mornings" in Spanish.

Seeing all these people and their expectant faces got me a little worried.  How in world were the 30 of us going to pull this off in this old hospital?  I didn't even know how helpful I was even going to be.  I didn't speak Spanish and had absolutely no medical skills, but here I was and these people were looking at me with such hope in their eyes.

It was going to be a busy day. The doctors would be scheduling 60 to 65 surgeries to complete over the next four days and our goal was meet all 150 patients who were waiting on Sunday. In addition to the triage, other people on the team were setting up the operating rooms, the pharmacy and the recovery areas.

Before going out, our team leader Dr. Ray Maddox gave some important advice.

“We are all practicing outside our comfort zone… in a third world county and in a different hospital,” said Ray. “We need to be flexible and roll with the punches.”

ONE BY ONE

The advice was well heeded. By 8:30 a.m., the air was already humid and the waiting room was starting to heat up from all the bodies. For those of you who have lived in Texas, imagine that humidity in a room filled with a hundred people. We were hot, hot, hot.

Then the triage began.

“Claudia Lopez!” called out the nurse.

The waiting Guatemalans shouted the name to those in the back of the room who relayed it out to those waiting on the grass, driveway and sidewalk. Before long, Claudia could be seen weaving her way through the crowd, and our work had officially begun.

My role was to help Dr. Gordon Graham in gynecology by escorting in the patients and trying to make the women feel comfortable during their exams. Our first patient of the day was Erika.

Speaking very little Spanish (really, I speak practically none), I couldn’t understand what they were saying, but I could understand the tears and the sadness as her mother explained her symptoms. Erika has been born with a tube around her uterus and had a half developed arm. She now had to go through another surgery and she was afraid.

“I don’t want to do a surgery, but I will do it,” said Erika.

As I led Erika and her mom to the anesthesiology department after the evaluation, I could tell they were a little shell-shocked. Erika would be undergoing her surgery the next day.

Our next patient was a 58-year-old woman with cancer, who greeted me with a kiss on the cheek (so cute that they do this even when meeting you the first time). After her evaluation Dr. Graham told her she would need abdominal hysterectomy.

“Can I take other medication instead?” Francesca asked.

Like Erika, she was scared and was hoping the doctor would recommend something easier. You can’t blame them for being frightened. Unlike in the US, where you may have a few weeks to prepare for surgery, some of them have only 24 hours. Plus, immediately after hearing the diagnosis, they have to decide whether or not they want to go through with it. If they decide no, they may have to wait months before they have the chance to see the doctor again – and by then it could be too late.

But there was another complication to Francesca’s case that the doctor couldn’t fix.



Ezmereld's mom burst into tears when we gave her bus fare to return.

 “We can do what we can for her here, but they may not be able to get her the radiation she needs after the treatment,” said Gordon. “We can only hope there is no microscopic spread.”

Many Guatemalans, like Francesca’s family are poor. While they know they need the medical help, they can’t afford the trip to the national hospital for the follow up.

Similar of heart-breaking stories were happening in general triage area where Dr. Richard Bland and Dr. Surendra Sharma were evaluating their patients. While many of the patients they had seen that day were hernia and gallbladder cases, Richard told me there was one unusual case -- the woman had a large mass that started under her armpit, encompassed her shoulder and was moving into the clavicle area.

“Sometimes there is nothing we can do here,” said Richard. “She had waited too long before seeing a doctor. All we can do is a biopsy to confirm the diagnosis.”

Other cases were less severe and there were times when the patients chose not to have the surgery at all. One 65-year-old man who had a hernia did just that. After speaking with the doctor, he decided his pain was minor compared to having to through a surgery. He opted to wait a few months to see if got worse.

TEARS, FEARS AND OTHER CASES

Over in EMT, Dr. Mark Hoeplinger, medical student Brad Oriel and RN Char Schumann were busy evaluating their cases.

“We had lots of tonsils, a few broken noses and one case where a little boy had a tumor on his cheek,” Char said.

They were also checking ears for possible hearing loss which seemed to be one of the common problems in the country.

“A lot of times, the people in Guatemala have some hearing loss caused by ear infections that weren’t treated. In some cases, the infection grows and the membrane ruptures,” said Char.

Char said another reason for the increased number of cases was that they have been using unpurified water to clean their ears. While they had good intentions and thought the water would get rid of the infection, the bacteria in the water, actually helped it grow.

But bad water was only one issue.

“We have seen a few people with cotton in their ears. Their ears were most likely hurting, so they put it in and left it there,” said Char. “In many cases, they just need to be educated on what they should do.”

There was one little girl that touched us all.

Her name was Ezmeralda and her family had traveled 80 km to see the doctor. Dr. Hoeplinger tried to clean out her ears in order to check her hearing, but she needed to come back a second day to complete the treatment. She was also malnurished as the family couldn't afford food.

“She’s had a lifelong ear problems and she’s currently draining pus so we want her to come back,” said Mark. “We can give her drops today and do the rest on Tuesday.”

Unfortunately, the family didn't have the 56 quetzals to return (roughly $7 USD). They had used all their money just to get there for today's appointment.

Touched by the little girl and the poverty problem of the her family, the doctor gave them the money. The girl’s mother burst into tears, thanking the group over and over. She hugged us all, and yes, I was holding back the tears.



For them, this little gesture of caring was a miracle.

CAN YOU HEAR ME NOW?

More miracles were happening in the audiology area, which was run by Jodi Bova, Susana Wilson and Karen Prevatt, our pastor. One of their patients was a 14-year-old girl. Her mother told us they first noticed she had a hearing problem when she was 6.

“She answered the phone and said no one was there, but her brother was on the line,” said the girl’s mother via Susana who was translating. “We told her brother to shout really loud and she still heard nothing.”

Jodi placed the headphones on the girl. Then we waited in silence for the girl to respond. We watched as she raised her arm to some of the sounds and did nothing through others. It turned out the girl had no usable hearing in her left ear, but the good news was she did have some hearing in her right ear – making her a good candidate for a hearing aid.

“This was good news. It’s very sad if we have to turn them away,” said Susana. “We had two out of the 16 we saw today where we couldn’t help .”

While helping everyone is rewarding, the audiology group did say they had one incredibly happy moment in the morning.

“We had a 2-year-old boy who had hearing loss. Because he couldn't hear the instructions, we came up with a way for him to test his hearing by putting a plastic piece into a container every time he heard the beep,” Jodi said.
They were able to fit him with a hearing aid and for the first time he was able to hear his mother’s voice.

We left the clinic around 6 p.m. feeling exhausted, but satisfied.

We now had our roster of patients. Tomorrow the surgeries will begin.