Greetings from the USNS Comfort! Since I have the day off today, I thought I'd send out an email to let you know how I'm doing. Unfortunately, our internet connection on the ship is very slow, so I won't be sending any pictures for now.
The ship is currently docked at Puerto San Jose, Guatemala, although we're leaving for El Salvador tomorrow. The largest city nearby is Escuintla. When I was on my mission, I was mostly in Guatemala City and in a town called Jalapa, which is to the east of the capital. This area is within my mission boundaries, but this is the first time I've been to the coast. Guatemalans divide their country into "tierra fria" and "tierra caliente"; the hot areas are the coastal regions, where it’s hot and humid, and the cooler areas are in the mountains, where the weather is much more temperate. As you can guess, we are definitely in "tierra caliente"! There are palm trees everywhere, fields of sugar cane, and huts with thatched roofs made of palm branches. We are docked in an area that is frequented by cruise ships, so there are souvenir stalls and a restaurant on shore that we can visit.
A typical work day begins at 4:30 am; I get up, get ready, eat breakfast, and go to muster for the boats that are going ashore by 5:30 am or so. We are then driven in vans to the clinic sites, which can take up to an hour on bumpy dirt roads. The clinics have been set up in local schools; there will typically be between four to nine pediatric providers at each site. There are pediatricians, pediatric residents and nurse practitioners that are with the navy as well as volunteers like me. The clinic sites also have family medicine, internal medicine, dentistry and opthomalogy, and they often have orthopedics, cardiology, radiology and physical therapy as well. We are seeing lots and lots of kids. On our busiest day so far, we saw 250 children. The patients are coming to line up at 2 or 3 in the morning to make sure they are seen. Patients who need surgery are taken to the ship; usually, it’s things like eye surgery or cleft palate or hernia repairs so the patients can get off the ship before we leave. The work can be draining, with the heat and humidity and the need to see lots of patients quickly. We usually finish about 3 or 4 pm, then head back to the ship. So far I’ve been working two days in a row with a day off after that, so I do get a chance to recover. It will take three days to get to El Salvador, so it will be nice to relax and get some studying done.
It’s a big adjustment to work with limited resources. There are only so many medications in the pharmacy, and getting imaging or consults can be a challenge. This means that I have to rely on my own clinical judgment most of the time, and I have to be ready to think flexibly and creatively to solve clinical problems. I’m seeing lots of malnutrition, anemia, and asthma. Many families can only afford to feed their children beans and tortillas; fruits and vegetables are too expensive to eat regularly. When parents do have money, they often let their children buy sodas, candy and chips at the local stores. So it’s no surprise that the most common complaints I hear from parents are that their children aren’t gaining weight, they have bad appetites and they get stomachaches and headaches. Most parents are very interested in getting vitamins for their kids. I’m happy to give them out, but I’m doing a lot of education about nutrition. Of course, parasitic infections are also rampant.
Treating asthma here is particularly challenging. The air quality in Guatemala is terrible; the houses have wood fires and are full of smoke all day, and garbage is burned in the open air. Many of my patients have asthma symptoms, but so far only one child I’ve seen has had a mask, spacer and albuterol inhaler at home. Usually, the parents have to take their children to the local centro de salud (health center) for albuterol nebulizations. I’m giving out lots of albuterol inhalers and starting kids on controller medications, just as I would in the US. But this is a very problematic approach. You can’t control asthma with just one month worth of medications. And I don’t have masks and spacers to give the kids, so I doubt they will get the medications properly at home. We do instruct the parents that they can make a spacer out of a water bottle, but this won’t work very well for younger children. So I do what I can and hope for the best.
The biggest problems with the local health system are distance and price. You can get excellent care in Guatemala City, but it takes two hours to travel there and it’s expensive. You can get many medications in the local pharmacies, but they can also be expensive. When it comes down to choosing between food and medications, food will win every time. It can be heartbreaking to see children with cerebral palsy or other chronic medical conditions who just won’t get the care they need here, and there’s very little we can do for them. But our patients are very grateful for the care we give them, and it’s wonderful to make a difference, however small, in the lives of these wonderful people. Today, a group of us went ashore to teach a group of local midwives and nurses Helping Babies Breathe, which is a simplified method of newborn resuscitation. It was clear that they were an experienced group that had been trained well in the basics, so it was exciting to teach them more advanced techniques like bag-mask ventilation. They were enthusiastic and grateful, and they will able to take the training materials we gave them to the outlying towns so they can teach others. It’s encouraging to think of the big difference just a couple hours of training can make.
All in all, I’m having a great time. It’s hard work, but it feels great to serve. And of course the kids are incredibly cute. I hope you are all doing well, and I’ll try to keep you up to date with my adventures. Next stop: El Salvador!
