12 January 2017
Greetings from Guatemala! I was planning to title our first update something catchy like “Sex in the Aldea” but I decided not to.
“Aldea” is the word they use here to refer to a village or town.
We have been here for over a week now. Shortly after we arrived, I began helping with the clinics—six in a row. Some have been busier than others. The new official schedule is:
Friday: Clinic at Hospital Adonai in Canillá
Saturday: Clinic at Hospital Adonai in Canillá
Sunday: Clinic about 20 minute away in San Andrés
Monday: Clinic at Hospital Adonai in Canillá
Tuesday: Clinic up the mountain in Chiminisijuan [evening English worship and prayer service]
Wednesday: OFF
Thursday: OFF [evening Spanish worship and prayer service]
As you can see, our Sunday is Thursday so my brain is often confused what day it actually is.
To date, there has been no surgery at the hospital. There was one pediatric overnight admission but no official inpatient service.
A huge burden of the care is prenatal which is part of the reason for my title. On Sunday, at San Andrés, there were about 75 pregnant ladies coming for ultrasound, which I think was record. Prenatal care consists of ultrasound for dates and basic anatomy and position when time for delivery is approaching. Many times, the main concern of the mother is the sex of the baby. Each patient then gets vitamins and a return appointment depending on where they are at in their pregnancy.
Hours prior to when we arrived on January 3rd, one of the missionaries gave birth to a healthy baby girl in the hospital. Praise God!!! Word of mouth travels fast here in the aldea and the rumor spread that the hospital was open for deliveries. A lady showed up in labor. In this area, many babies are born in the home with the help of a usually untrained midwife called a “comadrona.” Those who desire to have a “hospital birth” are sent when they are in labor by ambulance to San Andrés where they have a simple birthing center. If anything goes wrong, they are then sent by ambulance again to Hospital Santa Elena in Santa Cruz del Quiché about another hour away. In this case, the ambulance was called. All indications are that if the Hospital Adonai opens the door to full obstetrical care in the future, it will get very busy very quickly.
I was also a little surprised with some of the other reproductive health cases I had on Saturday. It reminded me a little of similar issues I often deal with in Detroit.
One lady had all indications of a genital infection. During the dry season, her husband works on the coast where agriculture continues year round. It is quite common that guys visit the local sex workers on the coast and bring their wives more than a pocket full of money when they come home. There have been some advances in the laboratory services at the hospital which I will talk about later, but there are still no tests for genital infections. I treated various possible infections before she left.
I also had a Quiché-speaking lady who was having some type of abdominal pain. After a five-minute discussion with my interpreter, the only thing I got was “she has abdominal pain.” (Note to self: don’t use the janitor for an interpreter unless you really have no other options.) It was a very busy day and we were short staffed on trained multilingual nurses. It turns out the husband spoke good Spanish and explained to me that a couple of weeks ago, his wife at about 8 months gestation was found to have no detectible heartbeat at a little health center in the mountains where they live. They then went to another government hospital on the other side of the mountain where she delivered the miscarriage. He spoke of stiches inside but clearly said that a c-section was not performed. We came to the conclusion that she probably had an episiotomy to aid in the delivery of the near-term fetus. He came to us for the famous ultrasound to confirm that all was well now since she was still having some pain. Of more value was a negative pregnancy test to confirm that the miscarriage was complete. We did do a “therapeutic” ultrasound to look for anything weird but all looked well.
Finally, I had an approximately 20 year-old (many people here don’t know their actual age) Quiché-speaking lady who had a two year old at home and apparently had been widowed. I never got the details about her husband (again I didn’t have the best interpreter). She was currently living with her parents due to her circumstances. Her chief complaint was that she was about three months late. She denied any sexual activity. In this case the ultrasound was extremely helpful:
Approximately 3-month old fetus with a strong heartbeat. Her first response was “I need to abort the baby.” She talked about a pill that she could get that would end the pregnancy. When we asked her about the father, she said she was raped. The local missionary talked to her about some legal action that could be done to make the father responsible. And we explained to her and showed her in the ultrasound that this baby was alive and that doing anything to stop the pregnancy would be killing the baby. We urged her to talk to her parents about what had happened. We prayed for her about this very difficult situation and that is where we left it. We hope and pray that the picture above will not be the only one that will ever be taken of this baby.
Please pray for these people and many others who are facing similar situations.
Please pray for wisdom, direction, staffing of the Hospital Adonai as they move forward.