The Boeing 747 pulled away from the gate after only a two hour delay and I shifted apprehensively in my seat. I am departing on a humanitarian medical mission to Guatemala. I had retired two years ago from a successful private medical practice which I started in 1984 and built into one of the busiest in the state. Since retirement, I had been asked to work part-time running the Gastroenterology Department at Jersey Shore University Medical Center and teaching medical students at Robert Wood Johnson Medical School. While this work was fulfilling, I had been searching for something more. I had traveled to Europe, Alaska, and Asia. I had skied the chutes at Jackson Hole, scuba dived caves in the Yucatan, and kayaked through the Grand Canyon. I had come to realize that taking all that life has to offer leaves one empty and unsatisfied, always hungry for greater and bigger challenges. As we take the soil gets depleted and the plants wither. Giving back, helping others, nourishing and providing, creates a verdant and bountiful life. I had just finished reading Mountains Beyond Mountains, a deeply moving and inspiring book about Dr. Paul Farmer, who went to Haiti and South America to dedicate his life to helping the poor sick people there.
“Put up your tray tables and return your seatbacks to their full upright position.” The plane was landing. I met up with the group at Miami airport. People were flying in from all parts of the country, but the largest contingent was from the Miami area. It was organized chaos to get 85 people and 110 bags on the plane, and everything went like clockwork. The people were very friendly and many had been on multiple missions. Alfredo, a gastroenterologist from Miami, filled me in on what to expect.
On landing in Guatemala City airport we loaded the bags onto a truck and half the group went to the clinic to set up. I was with the other half sent to the supermarket for supplies. The buses were colorfully decorated with outlines of nude women on the outside and pictures of Jesus within. Perhaps this is a metaphor for the male psyche. An armed guard “rode shotgun,” sitting next to the driver with a loaded shotgun to discourage banditos from robbing or kidnapping wealthy Americans.
We shopped in pairs for safety. I escorted Maria, an attractive Cuban-American girl, who had a large shopping list including soft toilet paper, a comfortable pillow, and a liter of Grey Goose Vodka. We turned into the liquor aisle and the entire busload was there shopping. I stupidly had thought we were on a sacred spiritual mission with a Christian group. I obviously had never hung out with young Latinos before. This was going to be interesting.
The bus snaked through the crowded polluted city streets. I glimpsed the poverty of a third world country as we sped past. We climbed up into the mountains to 7,000 feet, through gorgeous countryside and small pueblos and finally over unpaved roads arrived at the orphanage, Misioneros del Camino. It was a large compound of perhaps a dozen buildings surrounded by a razor wire fence. Beyond the fence were fields of maize and vegetables with farmers swinging machetes and hoes, living a seemingly idyllic pastoral existence.
Leonor, the head of the orphanage, affectionately known as Mami Leo, greeted us as the bus pulled into the compound. We carried our bags to the closest building- a single story whitewashed adobe built around a center atrium. The women were assigned two rooms on the right and the men to the left. My room was a little larger than my bedroom at home and was crammed with eleven bunk beds to be shared by twenty-two people. The tiny bathroom had two toilets, two sinks, and three showers. I guess the Marriot was full. But I didn’t come here to sleep or soak in a Jacuzzi. The toilets did not have American plumbing so we could not throw used toilet paper in them, instead there was a garbage can in each stall, and one learned not to breathe deeply while in the commode. The water trickled from the showerheads, but at least it was hot. I was certain that the women could never survive this, but the Latina women would emerge at 6:00 am each morning dressed, made up, and foxy despite having a broken toilet for one day.
I found that dinners were late; usually starting around 10 pm. since we often saw patients until 9 pm. How could we not see the patients waiting in long lines all day long? They had traveled sometimes for days and walked miles to wait in lines forming at 3 am. I always found vegetarian options- tortillas, rice, beans, and local vegetables. I drank only bottled water. We even avoided rinsing our toothbrushes in the tap water. We used tap water only to wash our hands and to shower, avoiding getting any into our mouths. Some of the group were so mysophobic that they ate only peanut butter and jelly sandwiches and never touched the local food. I convinced myself that I could treat anything I picked up. I just hoped I was not being too arrogant.
I slept on the bottom bunk which was about as comfortable as a cot at a Motel 6. But considering how exhausted I was, I slept well. I used earplugs to muffle the snoring. Twenty-two guys in tight quarters produce quite a symphony. Alfredo, who’s a light sleeper, got up several nights to shut up a particularly loud snorer. He crept around between the bunks but was unable to locate the source since it came from all sides like surround-sound. Moreover, the young Latinos would be drinking and carousing outside our room sometimes until 4: am. I have no idea how they woke at 5:30 am each morning. I guess that’s why they invented Cuban coffee.
We rode the bus about half an hour to Sumpango, the largest pueblo in the province, where we set up our clinic. The streets were narrow cobble stone or unpaved. Women were walking carrying large bundles of wood on their heads for their cooking fires. Garbage is burned in the streets and the air was smoky both from the fires and from the volcanoes nearby. Men were leading donkeys. There was a large dirty fountain in the center of town where women were doing laundry. They’d wash the clothes in the water, scrub them on the rocks, then hang them to dry. I thought I had stepped into a time warp and emerged a hundred years ago. Many lived without electricity or running water. The fire wood also provided heat since the mountain nights could be chilly. As we pulled up to the church, hundreds were waiting in long snake lines that extended up the block and out of sight. The church was massive and beautiful and was situated on the highest point of the town which spread out below us. It says something about the priorities of a people who live in squalor but build such a magnificent structure.
The clinic was set up with separate curtained cubicles for each of the thirty doctors. Mine was between another gastroenterologist and a neurologist. Consultations were simply a matter of walking the patient to the appropriate cubicle- dermatology, gynecology, internal medicine, pulmonary, etc. Inside my exam room was an examination table and step stool hand made for us by the locals and illumined by two bare bulbs. There were shelves with bottles of various GI medications and antibiotics. Most of the people we would be seeing couldn’t read so we came up with simple graphical instructions. I put pills into individual zip lock bags sorted by disease and labeled with icons consisting of a sun and a moon with, for example, the number 2. This told the patient to take 2 pills in the morning and 2 at night. Any instructions more complicated would not be taken properly. I looked around the room and noticed several birds flying overhead. They had made nests in the ceiling. I was glad I wasn’t doing any sterile surgical procedures here.
I proceeded to triage to help get some of the children waiting in line seen promptly by the pediatricians. The women looked older than their age due to a lifetime of hard manual work and poverty. Some of the mothers were teenage girls. They marry at an early age, have many children, live in a shack with a corrugated roof, prepare food from scratch, cook it over a fire, wash laundry by hand, clean the house, and care for the children. The husbands would work in the fields all day and come home hungry and horny. The wives were often abused and were treated as little more than servants. They wore beautiful native dresses hand embroidered in many colors.
The mothers would be surrounded by several young children clinging to them and within a blanket tied across their back were several more infants. The mom would pull the hidden bundle to the front and out would pop several tiny heads. One would invariably start crying and she would start nursing as she was standing in line, answering my questions, and watching over the toddlers. I briefly looked over the children to make sure none were acutely ill and took axillary temperatures, which often required negotiations with the child. Sometimes offering my stethoscope as a toy would work. These people were native Indians of Mayan descent and the children had beautiful Asian faces and eyes.
After triaging about fifty children, I started seeing families- both the adults and children together. I took from each a history, vital signs and a finger stick blood glucose. Most had never had a blood pressure taken before. It amazed me how many were diabetic or hypertensive and never knew. When we look at World Health Organization statistics, we find a very low prevalence of these diseases here because no one has bothered to check.
The line never seemed to diminish and the flow of human bodies continued unabated. I was surprised when someone mentioned lunch was being served since I had lost track of time. Before lunch we made hundreds of peanut butter and jelly sandwiches and handed them out to those tirelessly waiting on line. They had traveled so far and hadn’t eaten, so we ourselves couldn’t eat while they waited hungry. Lunch was large and delicious. We had chili rellenos, tortillas, beans, rice, native vegetables, and mangoes. Afterwards, I felt bloated and sluggish and needed a nap. I now understood the importance of a siesta. I used to think it was a sign of laziness. There was a group heading to the kitchen so I followed. They were taking shots from plastic medicine cups of a dark black liquid. “Cuban coffee”, I was told, “It’s liquid speed.” I took a shot and my fatigue evaporated. I felt invigorated and refreshed; ready for anything.
After lunch, I worked in my exam room seeing people with various ailments. Common were intestinal infections, bronchitis, and various skin rashes. With practice my Spanish was improving. The people were both humble and polite. Afterwards they would often embrace and hug me, thanking me repeatedly, “Muchas gracias, vaya con Dios.” Go with God. God was so important to them. He seemed to be always with them. Was He with me? He seemed to be doing His work through me. I didn’t feel worthy of this honor. Perhaps we first become worthy when we do His work. The good deeds are what are important.
A continuous stream of patients flowed through. After a while I noticed a patient entered and said, “Buenos noches.” I was startled and ran outside. The sky was black and a full moon hung overhead. I drank in the cool evening air and felt the soft moonlight wash over me and the adobe buildings in the town below the plaza. I felt rapturous and exhilarated. God was close.