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.