An Eye Opening Experience

Blue skies, bright sunshine and a balmy breeze accompanied us on an hour and a half drive from Antigua to Hospital Nacional de Escuintla, a public hospital “funded by the government of Guatemala” that has 276 beds. As we approached, there were long lines of Guatemalan natives lining the street, patiently waiting to enter the gates lined with barbed wire and guarded by police with guns. Upon arrival we met with Dr. W. Menendez Nieves (Willie), the head of the hospital that wore multiple hats. From MD to carpenter, nurse to janitor, teacher to director, and most importantly, a visionary; this man was the most passionate man we met today. Amidst sickness and need, he has an abundance of enthusiasm and excitement for what he envisions the hospital could become and relies on the hope that the dreams will be fulfilled one day soon. 

ICU

Upon entering the hospital you are greeted with halls filled with the “lucky” people who were granted access to the compound but now must patiently wait for a spot to open up in the crowded emergency departments. The adult ED (which sees 2,500 patients a month), pediatric ED (which sees 2,400 patients a month) and both ICU’s are located on the first floor of the hospital. They are always filled to capacity, there is no privacy to be found -- only the luckiest/sickest patients get access. There is a stark contrast to the care given to these people when compared to what I’m familiar with as a nurse in the ED. While filled with love and compassion, there is no “spa” feel to the hospital. Patients need to be extremely patient and mainly care for themselves, often needing to do things like holding their own fluid bags, filling empty water jugs with urine if not able to get out of bed, or taking their own toilet paper to the bathroom if need arises.

Pediatric Trauma Room

There is one pediatric ICU, filled with 8 beds with the most critically ill. Among the 8 children there is one oxygen tank that they share, switching off every 2 hours. Monitoring vitals continuously is unheard of and instead there is again one monitor that they must all share. While there is a crash cart, the supplies are low and the defibrillator is non-functioning.

Right next door is the 8’ × 15’ pediatric trauma room, usually filled with two cots. The spotlight does not work, there is mold on the walls and part of the ceiling is missing from damage this past winter. Located here is the one defibrillator that works in the hospital and that carries no promise of working since it only works about 68% of the time.  

Crash Cart - defibrillator does not work

The pediatric ED overflow fills the hallways on the first floor, with beds carrying 2 or 3 babies each.  A simple piece of 8 ½ x 11 sheet of paper taped on the wall shares the essential information needed for a nurse or MD to care for the infant at a glance.

OB is found on the second floor and consists of 3 different parts, each with 10 beds. Women are permitted to stay there for 12 hours after childbirth and then need to leave in order for the next rotation to come through.  This allows the hospital to see approximately 600 OB patients a month, not including the babies. Most of the women do not have any prenatal care, causing many babies to have health issues and longer term malnutrition all due to lack of resources.

NICU

The NICU and PICU also found on the second floor were by far the saddest places as I visited.  It consisted of  tiny babies hooked up to vents with multiple IV’s. Babies in simple beds being kept warm with lamps that we would normally use for desk lamps or those to keep baby chickens warm. The hospital spends 40 dollars a day, per piece of equipment (vent, pump, etc.) to keep these babies alive and is constantly facing the fear that if a payment is missed the company will come in and take it away. Due to this reality, they constantly need to make the choice as to where their money should be spent and which patients get the supplies they can afford. A glaring contrast to the United States is that there are no family members in any of these rooms during most of the time since the staff is busy.  Per Dr. Willie, family is allowed to wait outside the hospital and at noon each day, one-at-a-time might be allowed to see the infant for a short time.  Many babies will not make it out of the NICU/PICU alive and face death due to the spread of germs and inadequate sanitation despite the cleaning staff observed throughout the hospital today.

The women and men are located in rooms on the third and fourth levels.  Typically, 5-10 patients per wide open room with approximately 4 large rooms for each sex.  There is minimal to no complaining from the variety of medical or traumatic patients.

Dr. Willie 

We left the hospital with heavy hearts and many thoughts of how to help the people that have such an immense need. It is frustrating to be so connected to healthcare but still feel hopeless on being able to provide assistance due to strict government control here in Guatemala. However, we also have great hope for this hospital just as Dr. Willie and many of his staff do. At every turn we were greeted with hope and joy both from the patients and caretakers themselves. Dr. Willie has absolute hope that this hospital will continue to grow and provide better care for patients and the community.

 Written By: Tanya Meyer, RN
 River Falls Area Hospital Emergency Department