Effectively, we just built a hospital. It wasn’t the mortar and brick we carried, but the smaller details that converted a concrete husk to a home for health: pills, stethoscopes, alcohol swabs, bed sheets. As over 100 would-be patients waited outside in the morning sun (many had been there since before sunrise), we scrambled to unload plastic crates from the vans and organize triage, exam and procedure rooms, a laboratory, pharmacy and waiting spaces.
The building itself was a largely empty shell on a still-functioning military base in north central Guatemala, about 20 kilometers from the Mexican border. I suspect it served as army barracks at one time, with five dorm-size rooms off the entry hallway, a large, undivided great room and bathroom stalls and a group shower in the back. It now served as the health center for the town of Playa Grande—about 20 minutes down the dirt road but nowhere near a beach—and its surrounding area. Inside, there were a couple of mismatched gurneys, two sets of rusting tri-fold room dividers and a glass-faced bookcase containing old editions of key medical texts (in duplicate). The walls were covered with public health posters on hand-washing and mosquito-borne illnesses, as well as epidemiologic statistics on various diagnoses and provider schedules. Though it possessed neither the sterile whiteness nor perpetually-busy hum of an American hospital, it still served its duty. With our team members—American and Guatemalan healthcare providers, nurses, interpreters, social workers and outreach coordinators—moving quickly to fill in the functional gaps, it soon became difficult to tell what had been present and what we had imported. Within 15 minutes, the line started moving, and we set to a different kind of work: evaluating unmet surgical needs among the local men, women and children.
Now, “local” is a relative term, and many would-be patients left their homes at 2:00 a.m. to come see us. It had been years since the last “jornada” (medical mission) had visited, and, of course, children were born and new health conditions developed in the interim. Some heard we were coming through newspaper or radio ads, but most learned about us through their local health promoters and word of mouth. They came to us because the effort and expense to travel several hours away to a national hospital was just too great. And though our later efforts would have us working in a school and, separately, a small, unused hospital ward, it struck me that, besides the barriers of cost and distance, these particular patients also had to overcome the fear of entering a military base. Guatemala’s civil war—ignited by the United States and fought between the national military and both rural peasants and intellectuals—ended 17 years ago, but posters of “Los Desaparecidos” (the disappeared, or those kidnapped and murdered by the government) still line certain blocks in the capital.
As an American, I was privileged not to have this fear, and, to be honest, I even took some joy in not knowing what to expect. We had driven from Antigua, a haven for tourists in colonial style, through Guatemala City and then north in a two vehicle caravan. 21 people filled 19 seats, and the remaining space (including the roof) was packed with supplies: portable fans, granola bars, purified water—to provide some comfort as we worked—and even books for the children and breast pumps for the new mothers we were about to meet. The mixed aroma of corn and burning smoke from poorly-ventilated houses along the road punctuated the journey, as did moody swings in the weather: Sun-kissed green mountains were obscured with grey skies and heavy rains. The purported eight hour drive was actually 11, with the last couple of hours on dirt roads void of street lamps. Having never seen our destination before, even in pictures, I felt as if I were slipping into the jungles of Joseph Conrad’s “Heart of Darkness.” I was happy to discover there was a town at the end of our route with a legitimate hotel—a couple, in fact. A late dinner and early wake-up call followed, and, a few hours later, we found ourselves at work.
Somehow I hadn’t expected us to be working indoors. Instead, I had envisioned us erecting tents in the middle of a field somewhere. My quiet naïveté was cute but quickly banished. Slowly at first, and then with increasing confidence and efficiency, our three primary care providers—volunteers from South Carolina—evaluated gynecologic, internal medicine and pediatric concerns in their respective rooms. Referrals for surgery were made and sometimes medications (antibiotics and NSAIDs) were given. Cleft lip and palate in the children was common: a consequence, in theory, of the malnutrition that plagued the country, as were hernias and orthopedic concerns from physically-demanding work. Another team of workers performed IVAA—a procedure to paint the cervix with vinegar, looking for cells suggestive of cancer. At times, it was a bit overwhelming, but we all fulfilled our respective roles. We were neither building walls nor tearing them down. Together, we just lowered them a little, hoping to make a difference. Caked in sweat and grime—exhausted and thinking about a cold shower—at the end of the day, I couldn’t have been happier.
Benjamin Silverberg is a second-year graduate student and practicing physician. His column runs every other Monday. Send Ben a message on Twitter @hobogeneous.
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