La Escuintla Hospital Visit -- Team 1 by Allison Johnson

Part I

‘Me’ to ‘we’ happens quickly with so many powerful shared experiences – we came here as 24 individuals of a 26,000-employee health care delivery system, and will leave as family. There are incredible bonds being forged on this trip.

Today we visited La Escuintla, a government (public) teaching hospital in the city of Escuintla in south central Guatemala. We heard very moving stories from Team 2 – they visited the hospital earlier in the week – but nothing can really prepare you for what you experience there. Afterward, back in the van, we tried to buffer ourselves from it, offering each other snacks and distracting ourselves with idle conversation, but there was a stillness in the air... we were in shock, processing the unimaginable conditions we’d just observed. The pictures say more (and say it better) than the verbs and adjectives I can string together, but it’s important these photos have context; to that end, I will tell the story. By way of preface, I have to admit that I felt like I was prying into patients’ lives as I covertly snapped photos to document the experience. But, Dr. Willy Menendez (CMO and primary philanthropist) encourages images to be shared for the purpose of awareness – to give these patients a voice in the global community.

The facility itself is over 50 years old and in decrepit condition. It’s primarily a children’s hospital, with pediatric and maternity ECs. Infection rates are high because babies with sepsis might be in a bed next to a preemie weighing four pounds – and if beds aren’t available, multiple babies are placed in the same bed. The mortality rate for children admitted to this hospital in 2015 was about 50%. There are no bathrooms for doctors, no showers or chairs or offices or private space or food. The hospital’s ambulances are just two mostly empty vans. It can be 85 degrees at midday in this tropical climate, and in much of the building there is no air conditioning – in units where air conditioning is most needed it’s a simple ceiling unit, recirculating contaminated room air. Currently, a transitional PICU (pediatric ICU) is in place, with eight beds in a single room.  Construction on a new space was halted after the hospital didn't receive expected funds from the health ministry in December. Dengue fever is commonly contracted because the hospital is entirely open to the elements. There are bats in the stairwell. There is one bathroom for 40+ children in one unit, which is also where medical (including post-surgical) waste and soiled mops are stored. There is just one monitor for three NICU babies, which is rotated on an hourly basis. Twenty percent of moms delivering here are 16 or 17 years old and most receive no prenatal care. There is such a high rate of births (600 per month) that moms are in the hospital for just 12-18 hours before being forced to discharge home so other women, laboring in the EC downstairs, can be admitted.  Afterward, many travel two to three hours home, alone, carrying their baby and anything else they brought to the hospital. Exhausted mothers wait on chairs in the crowded EC with their sick babies. In a darkened room, about 12 feet long and crammed with several basinets of babies in ‘isolation’, a premature newborn – set atop an old office desk beneath a lamp – squealed with all its might as a nurse inserted an IV. A small child in the PICU suffering from seizures stared blankly but knowingly at the ceiling, so still, shallowly breathing, with no one at his bedside.

This is just a sliver of the picture that could be painted about the reality at La Escuintla.  It is haunting, to say the absolute least.

Maternity EC entrance

Orlando, a local Rotarian, introduces us to the campus

A mother in the EC with her child; La Escuintla staff proudly told how this bed was donated by Allina Health

A sink in the PICU

A child in the PICU

...and the view from the landing

Stairwell leading to the second floor…

Nurses' station 

Dr. Willy brings us through the postpartum unit, explaining that the first time 95% of these mothers encounter a doctor during their pregnancies is at the time of delivery

Medications and supplies on a pediatric unit

The single NICU monitor

The future for this NICU and PICU shell space is uncertain

Part II

Dr. Willy Menendez, the CMO and primary fund-raiser for the hospital, has done some impressive work in the last few years to make La Escuintla a place that will attract high quality residents. Veterans of this trip noticed positive changes year over year. But it’s obvious there is no reason you would choose to work in this facility for any other than an intense passion to care for and serve others.

A hand-written sign at the EC entrance, loosely translated by Orlando (one of our guides), reads:

We want to support you in your healing, but we don't have

the resources to provide anything other than emergency care.

Orlando is a member of the Escuintla Rotary, which partners with the Buffalo Rotary in Minnesota to coordinate container shipments of donated medical supplies. With a shamefully corrupt government and health ministry, getting supplies to La Escuintla is harder than you’d think. Due to exclusive contracts signed with medical supply companies (some American), containers destined for Guatemalan hospitals are regularly intercepted and if items are found that conflict with these contracts, the entire contents of the container are burned. We’ve heard tell of good Samaritans being murdered attempting to deliver containers to their intended recipients.

Dr. Willy is a man with a vision, and he’s driving change toward it with fierce determination. He’s a dynamo of hope and potential. He is inspirational and observing his interactions with staff was touching – he’s very well loved. He spoke about how we are in his heart and the hearts of his team and they absolutely connect their improvement with us. The mortality rate has dropped almost 20% since Allina Health started supporting La Escuintla two years ago. His team was very encouraged by our presence and many times he told us how much they thank God for us because they know we are thinking about them as they are working hard to improve the care they deliver. They know they are not alone in their endeavor and that gives them the strength to continuously drive forward despite the heartbreaking lack of sanitary conditions, medical equipment and other needed resources. Sofia, a resident, told us through tears that there are mornings she wakes up and can’t bring herself to go back to the hospital.  But if she didn’t, she said, what would happen to the babies?

Afterword

Though there is undignified, unnecessary human suffering at La Escuintla, made worse by the horrific environment, nurses on my team reported that the care they observed being delivered to patients was excellent. Having no background in patient care (although I’ve worked in hospitals for a decade now), I was relieved to hear that. I think patients see it, too. Dr. Willy mentioned how patients come to his hospital from hours away because they’ve heard such good things about the care at La Escuintla.

After reflecting on our visit, I realized I was trying with every ounce of strength to keep my emotions in check. No patient or family member in that hospital deserved to have my tears added to the weight of their burden. Under no circumstances did I want mothers of sick babies to see my reactions to a unit their child was a patient of and wonder what I was upset about. While we know differently, this is their paradigm. They have no way of knowing that health care can look any different than a 50% mortality rate. At the end of the tour, Dr. Willy thanked each of us individually and I thought it was oddly ironic – as restraint left me and I started to cry – that he saw the tears and was comforting me… and how many mothers has he comforted with those same arms for visits with infinitely worse outcomes?

With the former Guatemalan president (and scores of other government and military officials) now ousted and jailed, the country is poised for a cultural and political sea change. Citizens are demanding more transparency and accountability in how their tax dollars are being used. Increasing access to the internet and use of social media is allowing for better social organization and is beginning to shift the culture away from its abundant machismo. In 2015, the many Saturday protests against government corruption were entirely peaceful. With a new president sworn in just last week, there is hope his new cabinet will change the laws and allow foreign aid to be received and delivered safely. To be sure, it appears that within months containers of medical supplies and equipment will be able to be reach those most in need – something that hasn’t happened regularly since the late 1980s.

We're back in the states now and quickly readjusting to the comforts of our comparatively affluent lifestyle. My wish for all 24 of us is that we never forget how we felt that morning in La Escuintla, and to carry that with us. Within that emotional memory is a lesson in compassion, hope and the power of having a vision for a future that’s better than today. Remember the suffering and use that as a driving force to be the change you want to see in the world and to find your passion and pursue it with laser-like focus.

Throughout the trip we saw nothing but the power of connections and dreams, propelled by the knowledge that those who struggle are never alone because someone who is a quarter of the planet away has them in their heart. Don’t let that go. Find something small from our travels – a postcard, a bracelet, a stone, something you found at the market, maybe you kept a napkin or menu from dinner one night, or maybe it’s a favorite photo. Imbue that with the emotional memory you have of our time in Guatemala, and every time you look at it remember what it represents – the hope that remains in Pandora’s box, the unlimited potential of tomorrow.

Good-bye

As we come to the end of our week here in Guatemala, it will be tough to leave this beautiful place. Despite living very difficult lives, the people here are amazing. Their sense of resilience, determination and unfailing optimism is overwhelming. The kids are beautiful and happy, too. I do not doubt that most, if not all of us, will keep Guatemala forever in our hearts.

Mary S. 

Pochuta School Beautification – Team 1 by Allison Johnson

Inocento, an organic farmer, shares his
dream with the group as Maria looks on and translates.

We did amazing things today. AMAZING. 

We drove two hours to a remote rural mountain village and helped entrepreneur, Maria Pacheco of Wakami, make improvements to a pilot school. Maria’s company provides education and training support for rural mothers to become business leaders and change agents – more on that in a bit.

When we arrived in Pochuta all the school kids, teachers and other workers gathered in a room of the school where we introduced ourselves and there were many warm words of welcome and gratitude. Then Maria gave a short presentation about Wakami's mission, vision, and business model, and we did an activity where we each drew our dream and shared it with the group. Many were similar, hoping for homes and food and education, but one was particularly stunning – the PTA president explained that her dream was for sex education to be available. She explained that Guatemalans know they will have more resources for food and education if they had fewer children, but health clinics have no education resources for teaching family planning. Another barrier is that in the highly conservative Guatemalan culture, speaking about this is taboo.

Maria with the PTA president, speaking about Wakami’s partnership with the school.

Maria’s organization focuses on building prosperity in rural Guatemalan communities, and has a strong focus on nutrition and education as the keys to ending the cycle of poverty. Many mothers here think coffee and tortillas are ok to feed babies – with coffee often being the first liquid given to infants after breastmilk, starting at around 8 months of age. Some mothers have so little resources for food they feed their babies sugar water. As a result, babies are small and as their bodies don’t grow, their brains aren’t reaching their full potential either. By the age of 2, that gap can’t be made up for even with good nutrition later in life. Many of us were shocked when the school kids told us their ages, 12 and 13 year-olds looked to us like 8 or 9 year-olds. The malnutrition rate in Guatemala is about 50%, and it’s increasingly common to see children who are undernourished but overweight, because pop and chips are cheap and readily available. In fact, Maria explained that when the government wants to run a vaccination initiative they use Pepsi and Frito Lays’ logistics because these trucks go everywhere in Guatemala. 

Women here are commonly taken out of school by fifth grade (or earlier) in order to work to support their families and become mothers by 15 or 16. The cycle continues – the culture of machismo firmly underpins all of this. However, if women have income (through learning a skill or service – which is how Wakami first becomes involved in a community) they can send their daughters to school and it breaks the cycle of poverty.

The next step is for Wakami to partner with schools. If women have money to send children to school, but the education is poor, the improvement cycle fails. So we’re here in Pochuta today to complete several improvement projects that Team 2 started earlier in the week.

The 12 of us broke into smaller teams and worked on various projects around the school and its grounds. We finished the painting that the team from earlier in the week started, built a stove and assembled water filters for the kitchen, painted a mural, planted an organic garden and beautified the yard with other small decorative gardens and painted rocks. This was absolutely the most fun I had, and judging by the smiles and energy, I think others on my team did too.

Michelle, Chris, and Brett painting the school.

Cesar and Jose painting the school.

 The kids and I worked on the mural.

The cook begins serving lunch in the classroom.

Around midday we took a break for lunch, which was cooked on the new stove. We were served generous portions of rice, potatoes, carrots, guisquil (a squash-like vegetable), green beans, braised chicken and tortillas. It was an incredible meal, shared with everyone who was there – the Allina Health team, Maria and her local business leaders, our bus driver, our police escort, and of course all the kids. Our new little friends eagerly cleared any remaining food from our plates, the most advantageous ones wrapping leftover chicken in paper napkins to save for later.  They were so excited to have plastic knives and immediately started practicing using them to cut – afterward they wiped them off with their fingers and placed them in their pockets for whatever industrious future uses they could devise.

The school leaders present Maria with an honorary diploma.

The kids pose in front of the completed mural.

After lunch we finished working on our projects, had a short closing ceremony and took a lot of pictures!  Maria was presented with a symbolic diploma from the teachers of the school.  What an amazing day, working side by side with this incredible community and meeting Maria. She is an inspiration and is doing so much good in this part of the world.

This says it all – friendship and generosity.

De La Gente

On Wednesday, we spent the day at De La Gente which means “From the People”. There are 30 members of the San Miguel Cooperative. The farmers are small-land owners with approximately three acres of land. Many of these farmers inherited their plots from their parents and grandparents. The farmers and their families cultivate, harvest and process their own coffee.

We walked to the farmer’s coffee plot where we learned the process of planting, cultivating and maintaining the coffee plants. We then had the opportunity to pick the coffee “frutas”.  In total we picked 20 lbs. of caturra and bourbon coffee beans. After completing the harvesting of the beans we went to the farmer’s home where we participated in the processing of our coffee beans. The shelling process is done using a bicycle hooked to a de-pulper. The beans were then roasted over an open fire by the farmer’s family member.  We all had the opportunity to grind the roasted coffee beans using a lava stone base and stone rolling pin.  These grounds were then used to make our coffee for lunch, which we all agreed was the best coffee that we had ever had. 

In addition to the coffee plants, they also grow corn, tomatoes, orange trees, avocado trees and other trees that they can harvest and sell. A technique that was learned in the United States was to grow other crops among the coffee plants to utilize the land, produce food that can be sold and ultimately protect the coffee plants from the wind and heavy rains.

We had the opportunity to have pepian con pollo, a traditional Guatemalan dish for lunch, prepared by the farmer’s family member. The food was good, but the hospitality shown to all of us by these farmers was unrivaled. 

After lunch, we chose artisan projects that we could participate in. Some did textiles and made bags, others did ironworking, some made lotions and others did woodworking.

During the woodworking project we meet Ruberto, the carpenter, and he gave us a ride in the back of his pickup truck along cobblestone roads – that at times were very steep – to get to his shop. Once we arrived at his shop, he showed us around and we began the process to make our wooden serving tray. The process to shape the wood using hand-held planes was very labor intensive and required great attention to detail. The end project was a wooden serving tray with glass base covering – a traditional Mayan fabric that they cut from a traditional shirt. While we were working on our projects, we told Ruberto that we were staying at Common Hope. He left us for a minute and returned with a newspaper from Monticello from October 2004, that had a picture of him and members of a construction company from Monticello that were on a mission trip at Common Hope. He told us that he and the others were constructing the buildings here. It was a proud moment for Ruberto. 

School Supply Distribution in San Rafael

In Guate (as the locals say), the school year begins in January and runs through September. Today, team two traveled to the rural town of San Rafael to distribute school supplies. As we arrived, a long line of mothers and children had formed in anticipation of kicking off the school year.  (Think Cities Sampler Guate style.)  We handed out over 500 bags of supplies to preschool through junior high students.  One girl, perhaps 10 years old, came alone to collect the supplies for all of her siblings – six in total.  Each bag was quite heavy, let’s say heavier than a milk jug.  It took only a bit of help, but she wrapped all six bags in a blanket and successfully walked out of the school year carrying them on top of her head!  Time and time again this week, we have been reminded that if you empower the mothers and educate the children, life here changes for the better. 

Recess was so much fun!  I played tickle tag with the girls and did cartwheels with the boys.  And the kids would walk by and just brush their fingertips across our low backs – as if to see if we were real.  Then my roommate, Julie, and I got to meet Glenda. She is a six year old girl that Julie and I have decided to sponsor through Common Hope.  Glenda is a sweet and soft spoken girl with the eyes of an ancient soul. She told us about her siblings (two older and two younger), her pets (lots of chickens), and that she likes school. She is just starting her preschool year.  She gave me a high five and we took photos that we promise to send to her!  I hope that, by sponsoring her education, Julie and I can have a positive influence on this girl’s life.  In particular, I hope that we can watch her grow into a confident, educated woman who can do what her heart desires. 

Finally, we took a tour of San Rafael outside the school yard. We walked around the back of the school along a ‘road’ that was deeply rutted and speckled in animal feces. We walked alongside houses with walls of corn stalk.  We passed a woman aged by the sun and grit, walking barefoot and carrying a bundle of firewood on top of her head.  I cried again. Sacred tears, as we have started calling them. The ones that I can’t explain in words, but that I feel deep in my heart. The ones that make me reach out to hold the hand of whoever is closest.  This week in Guatemala has changed me.  For the better.  And I am thankful. 

With Hope,

Linsey

San Miguel Milpas Alpas by Allison Johnson

Today we distributed 542 bags of school supplies and uniforms for children in San Miguel.  Most of the children were in school during the morning hours of the festival-like event, so their moms or other family members came to the pickup location. It was so rewarding to interact with these families and see the gratitude in their faces.

Entrance to the gymnasium 

The distribution took place in a large gymnasium and we formed a bucket brigade to unload several pallets of supplies that were sent down on a container ship after a school supply drive in Minnesota last October. There were balloons and decorations, a PA system for announcements and prayers before the distribution started, and also a lot of really wonderful things being said about us. No one was translating for us, but we could all see how reverent and thankful the families were.

The author with some of the bags. 

We checked in about 200 families using a barcode system -- we scanned the Common Hope ID card, validated the ID number, then matched the number with a voucher for whatever grade school supplies were being picked up for all the kids in that family. The person picking up the supplies signed the voucher and then went to the various stations around the gym where they would trade the voucher for school supplies or uniforms. I connected with over 89 sets of eyes, greeting every one with, “Hola, buenos dias!” and then, "Firma aqui, por favor". I also noticed how important the id cards were to the Guatemalan people.  I saw brand new cards and some worn out since the bearer had been a Common Hope affiliate for years. Throughout the day we saw the intense need for resources, but also saw how thankful everyone was. There is deep gratitude from Guatemalans for everything they have.

Following the school supply distribution, we walked across the street to the San Miguel health center, where the local Common Hope volunteers made very moving statements of thanks for what we did that morning. They also talked about how through our supporting of Common Hope, some other important dreams are being realized. Aurora, a health promoter in San Miguel, told us how she is graduating from high school this year, 29 years after she dropped out of school because he parents couldn't afford it.  She wanted to become a nurse, but due to her age she can't follow this path. Instead, she’s decided to become a psychologist because there is such a need for this service in her community.  She told us we would be in her prayers until God comes for her. A truly moving moment… the words of these women from such a humble place with so few resources and their recognition that their only gift to us could be their prayers and good graces. Really touching.

There is intense poverty in San Miguel, with running water only being available for two hours every six or seven days (the water is shared with other mountain villages, so the access is rotated). Residents have to collect all the water they will use for the next week during those hours in large basins.  Whatever they will need for drinking, bathing and other needs must be met with this supply. For this reason, it's very difficult to bathe because there just isn't enough water. They also have very little access to the internet – there were two internet cafes, but one has since closed. So, while many residents have cell phones, there is only one place in town to get online. Most of the town works in carpentry or agriculture, and we got to see two local businesses up close. The first was a small carpentry shop, run by a self-taught man with eight children who were excited to help out in the shop after their homework was finished. The other was a green bean sorting facility, with maybe twenty workers sorting beans and snapping the ends off of them. Their small children ran around while the women worked. They earn 30 quetzals (about $4.30) for each hundred pounds of beans they sort. The facility supervisor chided Alma (the local Common Hope volunteer who helped organize the school supply distribution) that no one was working today – they’d all gone down to the gym to pick up school supplies.

Alma, our guide, at the facility used for 1st-3rd grades and junior high.

Finally we walked through various schools in the area and got to see the facility used for pre-k/k, and then another building that is 1st -3rd grades in the morning and junior high in the afternoon. In Guatemala the school day is just five hours long and includes breaks for meals and snacks, so the time spent learning is very short.  Students wear uniforms of long pants and shirts with sweater vests as uniforms all school year (January to October).  We're in jeans and t-shirts and it’s warm, so I can't imagine wearing such a uniform while trying to pay attention and learn in school. 

Mucho felicidad y tristeza

It’s the end of day three, and it’s been a roller coaster of emotions for many of us.

Yesterday, we visited the public hospital in La Esquintia. I'm really at a loss for words to describe what we saw. The condition of the hospital was unlike anything in the USA. So many emotions on our tour. Heartbreak as we walked past the parents forced to wait outside the NICU knowing that two of the five babies in there would most likely not survive. Helplessness to see the lack of resources as beds, equipment and medications were shared between patients. Awe at the resilience of the people as greeted us warmly despite their conditions. Joy to see the pride of those who worked in the laboratory and shared their 'newer' instruments. Shameful of what we take for granted. Determination to emulate those who share the vision to create something better, no matter how small it may feel.

Today we visited the Wakami village. This group has focused on empowering women by incubating businesses to support them economically. Maria is AMAZING! This woman is driving the vehicle of change in Guatemala and is a true inspiration. Our group learned about the history of the Wakami group and was then asked to draw a picture of our dreams. As we shared our dreams it struck me how we are so much more like these women than different.  

Sharing our dreams.

My afternoon helpers and Spanish instructors.

We also had the opportunity to partner with local children to help paint their community school. My face hurts from smiling and laughing with them as we spent the afternoon with them trying to teach me Español and them English.

The love and community is infectious.

Julie

Coming together to improve the school.