A Day In the Life…

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…of Two Medical Students with Wuqu’ Kawoq – Maya Health Alliance

David (4th year Harvard Medical student) and Nora (4th year Mayo Clinic Medical student) are spending a year in Guatemala work with us. Here is a day in their life…

cornOn Monday morning, Nora and I set off for what would – a bit unexpectedly, I must say – turn into two full days of adventure and misadventure. I present to you a timeline of events of the first day:

Monday 6:45 a.m.: Nora and I head out with our colleague Sandy in the green Ford Focus. We already feel that we’re late. I gingerly roll over each of Comalapa’s famous, huge speed bumps.

Monday 7:45 a.m.: We arrive in Tecpán to our offices. Our team of five crowd into our Suzuki SUV to head to a town 45 minutes away. Nora and her partner Sandy plan on carrying out a women’s health clinic. My two partners, Yoli and German, and I will be making visits to homes of malnourished kids.

 

Monday 8:15 a.m.: I am already carsick on the winding road to the town. Ah!

Monday 8:45 a.m.: We arrive at the town’s health center. German asks the doctor to sign a letter for one of our patients to get an MRI in the public hospital. The doctor then says she needs to take the rest of the day for meetings….but we are only just starting.

Monday 9:30 a.m.: We begin making visits to the homes of the kiddos. My colleagues show me the ways in which this community is different from others in which we work. In short, there is more poverty and less community cohesiveness here.

Monday 11:00 a.m.: We successfully visit two homes. The kids are chronically malnourished, which means they are short but appear plump. Basically, they have been receiving a deficit of calories and protein each day of their lives, but not enough of a deficit to make them starve. Two other visits are less successful; in one home, both parents, sadly are drunk and are unable to talk to us about their child who is malnourished. This does not happen often, but it is disheartening when we encounter it.

Monday 12:00 p.m.: We return to the health center and learn Nora has been inundated with patients referred from the health center itself. (Remember, the doctor  has had to attend meetings for the rest of the day!) One patient has an amputated tip of the finger. Nora is a bit stressed and I don’t blame her.

Monday 12:15 p.m.: I get a call from our case manager that one of our most well-known patients, a 21-year-old girl with a rare disorder called Takayasu’s arteritis, might be seriously sick. She is taking blood thinners, and she may be bleeding into her stomach. Unfortunately, she lives in a remote area where there are no medical centers capable of caring for her. It would be a three hour drive to visit her.

Monday 12:16 p.m: I take a deep breath and think for a hot second.

Monday 12:18 p.m.: I call our medical director and we review the case together. “Well, that doesn’t sound very good,” he says after I present her case. We decide to get her some lab testing and a CT scan. Our case manager, Jose, somehow arranges all of this within about two minutes. He is a miracle worker.

Monday 12:40 p.m.: I inflict my fears on German. “This could be life threatening,” I tell him. We both hope for the best.

Monday 1:00 p.m.: Nora finally is freed from more patient referrals and we head out back to Tecpán. I am angry at the health center for putting her in an impossible situation, but, I also remember: What do patients do when their normal doctor isn’t there? This is an example of what happens in a place where the health system is not adequate.

Monday 1:12: p.m.: I’m carsick again.

Monday 2:00 p.m.: Back in Tecpán, German and I see another baby boy who’s been referred to us for malnutrition and an inguinal hernia. When we chart the infant’s height and weight, we see that the baby is so incredibly short and below weight that we wonder if we’d made a mistake with our measurements. We check again and see that it wasn’t a mistake. His length-for-age Z-score is -6.8 and weight-for-age Z-score is -5.0. Basically, at 15 months of age, this little guy is half the weight and a foot shorter than he should be.

Monday 3:15 p.m.: We are done seeing the kiddo. Along with our boss, German and I make a plan to intervene along multiple modalities: a laboratory evaluation, education for the parents, and food supplementation. When the baby gets fattened up, we’ll also make sure to get him the surgery he needs for his inguinal hernia. I think how it’s fun to work for an organization that will provide kids with the holistic services they need to get healthy. In my experience in Latin America, it’s very common to have programs that weigh and measure kids. But the question is, what do you do when a kid isn’t growing, or “failing to thrive” in medical jargon? Most programs don’t do anything; they scold the mom and just keep measuring and weighing every month. At Wuqu’ Kawoq, we try to provide the same level of care to these kiddos that they’d receive in Cambridge, Massachusetts.

Monday 4:40 p.m.: We get word that the patient with a potential hemorrhage is stable and her results came back mostly normal. I silently thank the Mayan god(s).

Monday 5:30 p.m.: The patient with Takayasu’s arrives in our office directly from the laboratory. I examine her, and she looks surprisingly good. I have a long talk on the phone with the medical director about the next step. We finally decide to have her stay overnight in Tecpán and check her again in the morning. The patient is a polite, shy girl. Her artificial aortic valve makes a “ding-ding” sound when we are all quiet. She tells me with a smile that it’s her “alarm clock” each morning. Her mom thanks me in Kaqchikel and I wish to myself that I could be a fluent speaker, that I will be. The whole family seems really wonderful.

Monday 7:30 p.m.: Nora and I decide to stay in Tecpán overnight. German applauds the decision. (We have an on-going debate about which town, Comalapa or Tecpán, is better) Nora and I go on a walk to the town supermarket where we each make stereotypical purchases (me: noodles, cheese, Skittles; Nora: apples, an avocado, and granola bars).

Monday 9:30 p.m.: We pile on the blankets – it’s really cold in Tecpán – and doze off for more adventures tomorrow.