by Dr. Ellie Wallace, EM PGY2
I traveled to Guatemala through a program run by a charity called Pop Wuj. This program uses the teachings of the Mayan culture to teach Spanish language through immersion and community service projects. Through this intensive language instruction and community development, participants are able to gain a better understanding of the social, political and cultural differences of Guatemala and provide better care for the patients in the clinic. These community projects include a Family Support Center, which provides support for single working mothers who have been affected by violence, substance abuse and family disintegration, as well as their children in a small rural community. They also run a Safe Stove Project, which helps local communities build stoves in safe locations with proper venting so the people of the village are not exposed to smoke while cooking. Finally, the program runs a primary care clinic during the week, as well as multiple mobile clinics and malnutrition clinics in the surrounding rural communities.
It was through this clinic that I spent most of my time working in Guatemala. I was able to speak with patients in Spanish, through the assistance of translators, and work with local Guatemalan doctors to provide care. Most of the conditions that we saw in the clinic were very similar to those seen in the United States, and included diabetes, hypertension, gastritis and arthritis. They were profoundly different, however, because of the social, cultural and geographic differences in Guatemala. Patients in these communities had virtually no other access to health care other than this clinic, and often traveled 5-10 hours to make it to their appointments every few months. It changed our treatment plans because we were not able to give return precautions, or make arrangements to follow up with a patient in a few days to reassess the success or failure of the treatment. We relied on patient education and local support networks from their families, and had to be very conservative in our management with the assumption that the patient would not be able to return to clinic or visit a hospital easily.
What I gained from this experience was a stronger ability to diagnose conditions without extensive diagnostic testing, and learned to rely more on the history and physical exam. I also learned to practice more independently without significant ancillary support. Moreover, the greatest lesson that I gained from my time in Guatemala was an appreciation for human resiliency and a great admiration for my patients. For my patients, every day was a struggle to find adequate food and shelter. I was impressed and humbled that they were willing to travel great lengths for their medical care, in a community in which their greatest challenge was survival. I hope to be able to return one day with my much-improved Spanish skills and contribute more to this population that has so much need, but also so much resiliency.