Thursday, October 23, 2008

What We Do in Medicine

The department of Quiche was the hardest hit during the civil war which ended only a little bit ago in 1999. Because of this, we still see many of the effects of trying to rebuild this area including corruption, poor road and living conditions, lack of medical equipment, buildings, personnel, and medicine, general malnourishment due to ignorance, poor diet, lack of food, money or crops, and death due to ignorance and the inability to or desire to go to the hopsital in times of need. Our regular medical staff is two nurses, and we are set up to run clinics with the nearest hospital being one and half hours away (lacking in most equipment such as intubators) and the governement hospital being two and half hours away (often equipped a little better). In light of the poor hospital conditions and the peoples' unwillingness or inability to travel to them, we stretch ourselves to try to offer as many services as we can within our clinics, although we often feel the gaping hole of the presence of reliable hospital services. And as we confront the many medical and socio-economical conditions of the poeple we treat, we are often humbled by our own limitations, reminding each other and ourselves that Jesus Christ is the foundational and often only hope that these people have.

We currently have three regular weekly clinics in the towns of Canilla (where we live), San Andres (a town about 10 miles or a 30 minute drive from here), and Chiminisijuan (about a 45 minute drive from here. In our Canilla clinic, our patients are about 75% Latin, and we usually treat around 60 patients each week. Most of our patients in this clinic are right from Canilla and the surrounding aldeas (villages), although we have had some coming from as far as a 4-6 hour walk to get a consulta (appointment/consult), traveling from a township located in a department near us. About 90% of our patients in San Andres are indigenous and we usually treat right around 80-100 people each week. Because San Andres is a pretty large township, people will come from aldeas that are a three hour bus ride or longer to get a consulta. Chiminisijuan is located in a small aldea, and our clinic is actually set in a small clearing on the side of the mountain on the border of three different townships - Canilla, San Andres, and Zacualpa. We usually see about 60 patients there as well, all of them indigenous. The majority of the patients we see there dome from aldeas no more than an hour walk away, although we have had a growing number of people come from an aldea that is about a 4-5 hour walk away called Tintauleu.

Since coming here in '99, we have a felt a burden for an area in northern Quiche called the Zona Reina, near the Ixil Triangle. This area is one of the neediest medically in all of Guatemala, having the highest infant mortality rate in this country and being seemingly cut-off from the rest of the country due to poor road conditions which allow it to be accessible only by air for up to 10 months of the year. We made our first jornada (medical-evangelistic weekend trip) into this area in April of 2006 to a village called San Marcos. That weekend began the opening of other doors into that area as God started to lead and provide means to work in that area. Over the past two years, our ministry has been provided with two different aircrafts (more info can be found under the aviation section) that have allowed us to fly into villages 3-5 hour walks from the nearest roads. We have also been able to do emergency flights into this area, flying people to a hospital that would otherwise be a 9-11 hour drive after the 3-5 hour walk to the nearest road. We have also been able to make monthly trips into a town called San Pedro since January, although we continue to pray for God's direction as to whether and where we should set up a regular presence.

Although all of our current work is set up in the department of Quiche, we have found the two areas that we work in (our three surrounding villages versus the Zona Reina) to be quite different in what we encounter in all areas, including medically. In our three regular clinics, we have three areas that we primarily focus on: our nutrition program, prenatal care, and continuous management of chronic conditions. These three areas are further described below.

We have anywhere from 70-100 children that we treat in our nutrition program. The majority of children that we treat are children that were still primarily dependent on breast milk when the mom became pregnant with another child, leaving the first child with a short supply on food and nutrients. Also in our area, people are almost always only able to plant once a year during the rainy season since water is so precious and scarce during the dry season. Because of this, our numbers will gerenally increase at the tail end of the dry season as well. A few of our children are also in our program due to medical conditions such as a different types of heart defects, and then of course some are just malnourished due to general lack of food and poverty. All children in our program receive either formula or NIDO (powdered whole milk), incaparina (a protein-enriched formula that can be made into a drink), and vitamins. They are seen every two weeks to be weighed and re-assessed, and most of them will be on the program until they are about 1 1/2 - 2 years old. Although this is not a set nutrition program, we also frequently give out beans, rice, oatmeal, and other foods to widows and families that are in need of it.

Our prenatal program has taken off in even greater numbers over the past two years in large part due to the presence of the OB/GYN (Dr. Heidi Bell) who worked with us for the past two years. (More about her, her husband and their son can be found on their blog Agape In Action by clicking on their link on the left side of our home page.) In Canilla, about 60% of our patients are prenatal patients, in San Andres about 30-40% are there for prenatal care, and in Chiminisijuan we continue to add patients almost weekly and are up to about 10-15%. We give out prenatal vitamins and check blood pressures at each visit, although one of the greatest pieces of equipment and attractions that we have is our ultrasound. One of the largest reasons for the high infant mortailty rate in this area is due to fetal (and maternal) deaths during a breech delivery. Because almost every birth here is performed in the home with a lay midwife, there is no option for an emergency c-section in the case of a breech delivery discovered during the bithing process. However, we have been able to help the moms and midwives know the fetal presentation before delivery with the use of the ultrasound, and can make referrals to the hospital ahead of time if the baby has a breech presentation close to the due date. We have also found the ultrasound exams to be something the mothers enjoy coming back for monthly which has increased compliance, allowed us to check for other prenatal conditions such as pre-ecclampsia, and most importantly allows us to build relationships and trust with these women in the hopes of leading them to or dsicipling them in the freedom a relationship with Jesus offers.

We also have about 50 people which we see regularly for chronic conditions including diabetes, hypertension, asthama, and seizures. The majority of patients we see with chronic conditions have either diabetes or hypertension and we are able to supply them with the needed meds while also helping them control their sugars or blood pressure with diet and activity. Obviously, as with anywhere in the world, we often fight the non-compliance, apathy, and ignorance that can accompany patients with these diseases, although we have found again that the monthly contact have been a bridge to building trust and relationships.

Other than these three focuses, we treat acute cases with about 90% of our patients being women and children. The number one killer of kids here is diarrhea, which we treat frequently with anti-amoebic and worm medicine or oral/IV fluids or referrals to the hospital in the cases of a viral infection. The second cause of death is pneumonia which we can treat with oral antibiotics and oxygen if needed, although we are unable to provide IV antibiotics or intubation. After the common refusals to go to the hospital to receive these services, we often send them away with an oral Zithromax and prayers. Other acute cases we see range from ENT infections, hepatitis, and scabies to machete cuts, dog bites and burns. We also have performed deliveries, although we refer all deliveries to the hospital or home and usually only deliver in emergent situations. We do not see many cases of malaria or jungle fever type conditions in our area.

In our experience with the people of the Zona Reina, we have found some interesting contrasts. Because it rains almost year round, they are often able to get in two growing seasons, and will tell you that they are not poor or malnourished people but are really just lacking in good medical care. Because of this, we have not found our nutrition program to be of great need out there, but our ability to provide prenatal care and care of chronic conditions has been the most beneficial in addition to the acute cases we see.

In addition to regular clinics, we do weekend medical-evangelistic "jornadas" (like what we started with in the Zona Reina area) which are a way for us to not only be exposed to the needs of other areas and help medically, but also try to partner with other churches or Christians in the area to present the gospel with films, preaching or various Bible-school type activities.

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