Thursday, February 28, 2013

Mi ultimo and primero día en uno.

28 febrero

Hi everyone,

Today is the day that Tyler gets here!  It is also my last day of classes, last day of working in the clinic, and my last day with my host family.  As you can imagine, I'm having a lot of conflicting emotions...I want to stay and study more, I'm finally hitting my stride in the clinic, I am going to miss my host family, but of course I'm so excited to see Tyler and have a few days of a more independent and unscheduled lifestyle.

Yesterday was a very routine and busy day in clinic - 25 patients, mostly from a single bar, came.  I actually had to leave before the last ones to get back for lunch.  Today I'm going in a little later and will stay later to help Javier with his February report, which we can't complete until all the patient's for today have been seen. The reports track a few outcomes for the populations of interest: all females, all men, all trans, and the HIV-positive populations in each group.  We are calculating the monthly prevalence of HIV, chlamydia, gonorrhea, trichomonas, condom use with partners, condom use with clients, and a couple other things I can't remember.

The rest of the day will be busy too.  I have class from 2-6, then am going to meet Tyler at the bus station, come back to town to hopefully introduce him to my host family and then go out to dinner!  Tomorrow we are planning to have a Xela day, full of avocados, the cemetary, and introducing him to all my favorite things and people here.

Will try to write more later but in the meantime, be well!


Tuesday, February 26, 2013

Momentito Guatemalteco 5


5:54 am

I must be on another planet.  It is pitch black except for the ring of illuminated ground in front of me, courtesy of my headlamp, which is all moon-dust colored.  I change the ground with each step, gray dust and gray pebbles and gray rocks tumbling lightly down in the wake of my shoes, occasionally meeting another persons' and continuing on down the slope.

I look up and see two figures in red hoods, self-illuminated in a column of light like mine.  They are 20 feet above me on the trail, so their heads appear disproportionately small as I crane my neck.  Farther up, a group of white lights and one red one bob upwards, detached from any visible bodies.  Farther up still, I can make out the border of the slope, defined by the start of stars.  The lowest star of Orion's belt is nearly tucked behind it.

I look left and see another border, this one intersecting bands of clouds and constellations of lights.  The bands continue on and on until I am looking behind me and see the edge of the planet, silhouetted by a linear beam of orange light.  The line is punctuated by 4 or 5 peaks that get taller from left to right, and one smaller one all the way right that is fuming, a vertical puff of smoke expanding upward

I am wearing a space suit of layers - a sports bra, tank top, wicking t-shirt, under armor long sleeve, cotton long sleeve, cotton zip jacket, my Patagonia trench coat, and a windbreaker.  I have a striped beanie, black ear warmer, and the hood to the windbreaker on my head. Every stimulus is completely unearthly except for my struggle.  My feet are leaden and my toes are numb as they move one in front of the other.  I am inordinantly proud of myself each time the left lands some distance, no matter how small, further up than the right.  A wave of heat starts in my core and moves up my neck over the front of my face and teeters on nausea.  Thanks, gravity.

Some pictures from Tajamulco

26 febrero

As promised, here are some pictures from our hike to Tajamulco

Claiming and organizing our gear in the am. (Michelle and Molly)

Packing up

Our private, chicken-less chicken bus

Michelle, me, my headlamp, Molly photo bomb

11:45, we arrived!


De-layering once before we started hiking

Tajamulco is tajall. (Get it? Like "tall")

The caballo and his caballero who carried all of our tents up.  Oof.

Pat, with a triple decker sandwich of beans, tuna, tomatoes, cucumber and onion.  At one point, I ate a hand-held salad.

Loading up with firewood before the summit.

Michelle, Gari

The view from our campsite

Talia with Sharky's long underwear, complete with butt snaps.  I think her exact question to him was, "Are those normal or are you quirky?"

The largest tent ever, in which about 14 college kids slept.

Michelle, Sharky, Me.  Sharky is really warm because of his long john onesie.

6:00 am or so, sunrise over Central America.  

It was good we brought our sleeping bags to the summit.

Almenacer.  We could see Santiaguito errupting!

El crater.


Monday, February 25, 2013

Un buen día

25 febrero

Today was a great day.  This morning in clinic, I worked with Javier on some reporting tasks that he was given on Friday.  Some gentlemen from Guatemala City who work for the country's equivalent of the CDC visited and told him that he needs to be doing monthly reporting of the prevalence of various STIs and preventive behaviors.  (Coincidently, they knew of UNC-Chapel Hill because they had worked with the School of Public Health.)  This morning, I told Javier that it was interesting and he confessed that he didn't really understand what they wanted him to do.  We spent the next hour or so running reports from his electronic medical record, which is specially designed to track STIs internationally, and talking about the differences in calculating and interpreting incidence and prevalence.

Back at school, I skyped with Tyler, Owen, and Roy (Owen's duncle).  I donated 5Q to help pay for the school's ex-homeless cat's food.  My maestra and I talked about our weekends and, despite having spoken almost only English all weekend during the hike, my sentences were more coherent, the conversation easier.  It's been happening gradually but today I noticed it more, that my words are more liquid than individual solid states, like I'm starting to approximate the fluid in "fluency."

I walked back here, to school, from yoga feeling happy.  Despite my best efforts, I like the poneytailed teacher.  His classes are varied and I feel stronger but safer, with fewer twinges and asymmetrical aching than I've had in awhile and in spite of hiking to almost 14,000 feet yesterday.  I met a new friend from yoga, another medical student who is from San Francisco and is going into family medicine.  We are going to get dinner tomorrow.  I felt taller when I walked and realized that I actually kind of love the narrow, slippery cobblestoned sidewalks because they force a lot of "buenos días"es and other greetings as people squeeze past telephone poles and nearly run into each other.

Overall, I could appreciate a certain crescendo to my trip today.  I hope it continues!

3 days until Tyler gets here!

Sunday, February 24, 2013

Friday night

24 febrero

Just got back from an awesome hike to the summit of Tajulmulco.  Will write more about that in a subsequent post but also wanted to share a couple of pictures of our awesome dinner at school on Friday night.  Last week was the last of the busiest weeks of the year for Celas Maya because a large group of anthropology undergrads from Holland left.  The maestras worked tirelessly to put together a typical sit-down dinner for the whole school in the courtyard, which was both lovely and delicious.  At the end of class on Friday afternoon, I was so distracted by all the lights, flowers, and food being prepared:


Nice speeches.

Some of the UVA crew:

Jen, my new housemate, me, and Leon

Our delicious dinner: corn, grilled onion and eggplant, beans, and tortillas.


Thursday, February 21, 2013

Mid-week Update

21 febrero

Hi everyone!

Things have been going great here this week.  My last amiga de Carolina del Norte, Kim, left this morning but I already have a new housemate who is from California.  Kim and I had a great time yesterday wandering around the mercado and a really neat textile cooperative called TRAMA.

The last couple mornings in clinic have been really slow actually so Javier and I have occupied our time with other things.  Specifically:
- I attempted to translate English idioms (e.g. "My eyes were bigger than my stomach") into Spanish
- I showed him the online OB wheel for caculating due dates, etc
- He read out patient ID numbers to enter into an STD registry - flashback to MPH year!
- We ate tacos and pan con pollo
- I read the newspaper
- We stood in the sun and chatted up some of the other health center workers and my face got burned despite putting sunscreen on twice beforehand.

My lessons this week have been going well with my new maestra, Claudia.  The 3 hours actually flies by compared to 5.  This weekend, I have made the questionable decision to hike Tajumulco, which is the tallest mountain in Central America.  I've heard it's very cold but worth it.  We are going to hike up most of the way Saturday morning, camp overnight, and hike to the summit on Sunday to watch the sunrise.

In GREAT news, Tyler surprised me by buying a ticket to Guatemala and will arrive next week!  My last day of classes and of work will be Thursday and we will spend the last week-ish traveling together.

Here are a couple new pictures of my walk back to school from the clinic:

A line of people outside El Centro de Salud:

Goats tied up for unclear purpose in the market:

A view of Xela's streets and mountains:


Wednesday, February 20, 2013

Momentito Guatemalteco 4: La Perrita Perdita


10:24 am

We are walking down the street in Panajachel, checking out all the woven goods for sale in long rows of vendor tents.  Our bellies are full of our breakfast of beans and eggs and plantains and a pre-breakfast of Mennonite-baked carrot bread.  We had descended on the bread like vultures after putting off eating it until we could sanitize our hands post-chicken bus.

From between two stalls emerges a dog, which appears well-fed, is wearing a tattered light blue collar with paw prints, and is mostly black with a white stripe between its eyes, white lower legs and paws, and some white around its neck.  In short, it looks a lot like Owen.  I say "awwww herro perrito" in my well-practiced dog voice and make a "ts ts ts" noise, at which point the dog's brown eyes meet mine.

It begins trotting alongside us down the main road in Panajachel.

10:26 am
The dog is still walking with us as we turn left back toward Kim and Nichelle's hotel to get our bags.  I wonder if the dog lives near the hotel, if it's a boy or a girl, where it's owners are, and if I could fit it in my suitcase.  I make a joke that it can smell its cousin on my clothes.

10:28 am
The dog is scampering delicately over a concrete slab that covers a man hole in order to continue walking with us down a side street.

10:33 am
We are back at Kim and Nichelle's hotel and the dog is still hanging with us.  I feel guilty about attracting its attention in the first place and wonder if it's hungry or thirsty.  I think of Owen and immediately forget all knowledge of Pavlovian conditioning and for that matter, simple logic.  I reach into my purse and pull out a small piece of leftover Mennonite-baked carrot bread and put it on the ground for the dog to eat.  It gobbles it up.

I turn around to follow my friends up the stairs and immediately hear the clicking of claws accompanying us.  Kim makes the sound of a broom to shoo the dog away and it hesitates, clearly considering the risks and benefits of any further pursuit of friends with carrot bread.  After a moment, the dog follows us up both flights to the door to Kim and Nichelle's room. We all groan and quickly walk in, shutting the door and the dog outside it.

We hear a rhythmic whine outside the door which, loosely translated from Spanishdog, means "please let me in, friends with delicious carrot bread."  My friends laugh that I thought the dog would go away and I laugh too, embarrassed but sure that the dog will give up once it realizes it can't get into the room.

The whining outside the door has stopped and I'm relieved.  Surely the dog has gone home.

We open the door to leave with our backpacks and the black and white dog is sitting patiently outside.  "Maybe it's thirsty?" I say, looking for an excuse that alleviates me of some responsibility here.
"I'm pretty sure it lives at a lake," Jenna says.
We walk down the stairs and, now predictably, the dog follows us down.
"At least it can't get on the boat," Jenna says.

We arrive at the boat dock and are told it will cost 15Q to go to Santa Cruz.  Our canine companion nervously walks down to the edge of the water and drinks from the lake.  I am relieved, since clearly it just wanted some water the whole time.  We board the boat with our things and I take a seat on the left side, closest to the dock.  Our black and white companion, however, is finished drinking, cautiously walks across the wooden planks, and sniffs at the air between it and the boat, whining once again.  Guilt spreads in me like it can only in a total dog fanatic - I know I should not have solicited its attention and simultaneously want desperately to make it my pet.  The dog's whining continues as it paces laterally along the side of the dock and periodically inches forward and backward to the edge as if to assess the distance to the boat and the material makeup of the air and water between it and us.

The dog sits, and I can see for the first time that it's female.  She stops whining and lays down on the wooden planks outside my window.  The boat Boss tells us that, actually, it will be 25Q to go to Santa Cruz because, apparently it's out of their way to stop there.  My angst about the dog makes me irrationally angry about having to pay more than I was told but I fork over the money anyway, á la chicken bus.  I avoid all eye contact with the dog, my conscience aching with remorse.  The longer we sit and wait for more sucker tourists to get on the boat, the harder it is for me to not cry and to ignore the dog's soul-piercing gaze.

The boat is nearly full and The Boss unwinds the rope from its attachment to the pier.  The dog immediately stands and resumes her pacing and edging and whining, only louder, faster, more high-pitched and frantic.  The boat drifts inches away from the dock and the dog's cries only get louder and faster and exponentially more pathetic as the distance between her and us - and by us, I mean me - widens. I glance back at the dock and see her looking around in confusion and desperation at the end of the dock.  I feel a mix of relief and intense sadness as I imagine her going back to her home.

I hear someone say, "she's not going to jump off the dock, right?"

The dog on the dock, before things got really bad:

The dog has jumped off the dock.  A wave of gasps moves from the back of the boat to the font as the splash sends a stab into my stomach.  I remember how nervous the dog was just to get a drink of water from the lake.

Another American girl yells, "don't turn on the boat!" and we all realize in horror that the dog is swimming perilously close to the boat's rear propeller.  I think back to middle school lessons about why manatees are endangered and feel a surge of nausea and duck my head in fear of witnessing the dog's gruesome and untimely end.

Luckily while my head was ducked, The Boss shooed the dog away from the back of the boat and was able to put a safe enough distance between us and the dog to start the boat and pull far enough away for at least the olfactory connection between the dog and I to be severed, if not the emotional one.  She is paddling right, arcing back towards the shore.  We exhale and and remarks fly about the close call, and my friends jokingly remind me of the perils of dog-whispering.  I, of course, am wrecked from fear and guilt and cowardice, and my laughter teeters on a precipice between heaves of humor and tears.

Kim yells, "oh my God!,"  pointing behind us.  I lift my head and follow her fingerpoint.  "She's stuck!"  Now, all heads in the boat turn back and to the right of the boat to see that the dog is stuck in the rope mooring another motor boat in the lake.  She is paddling, going nowhere.  Any relics of humor or not caring are lost, I burst into tears, burying my face in my hands and my whole face-hand complex into my lap.  It's possible I am actually on the floor of the boat, as there is nowhere farther away to go.  I killed the dog I killed the dog I killed the dog.

Ever the quick thinker, Mariah yells, "We have to jump in and save her!"  As I cry helplessly into my lap, Mariah and a French stranger/friend start removing layers of clothing, starting with their shirts.  They are clearly willing to strip off any and every piece of clothing necessary as Mariah moves toward the window to dive into the lake.  Just as she unbuttons her pants, the dog seems to move in a direction that isn't toward the lake floor and we can see that she has managed to free herself, swimming in the opposite direction.

I am still a hot, sobbing, mess.

The boat stalls in confusion, The Boss and The Captain clearly confused by all the crying and near-stripping. I am now laughing and shrieking and still crying as my friends recount the poor dog's second near-death, even as she paddles the last few meters to dry land.

A middle-aged man, who is tan and has longish gray hair parted in the middle and who is probably from California walks toward the back of the boat.  We assume that he has had enough of our antics and emotion and has decided to bail.  He reaches the back of the boat and says something to The Boss that prompts him to command The Captain to turn the boat around.  We immediately protest, extremely concerned that we may yet pitch this dog a third strike if we get anywhere close to her again.

A game of telephone happens in which one of the girls overhears the Californian man say something about 25 quetzales for the dog, which gets passed to the one-shirt-less French girl who tells Jenna, who tells Kim, who tells Mariah, who is still putting her top back on, who says to me, "oh my God, he thinks that's our dog."  We realize in disbelief that this man thinks the dog is our pet and we immediately infer that he thinks we are the worst human beings on the planet.  Specifically, that we would rather let our very cute, very loyal dog be chopped by a propeller, get stuck in a slow drown, and go hungry rather than pay the equivalent of $3 to bring it with us on our lakeside vacay.

Much yelling and arm waving in Spanish and English commences, one of which eventually gets through to the Man with Good Intentions and without Faith in Humanity.  It may have been my crazed voice rising above the din of protests saying, "DON'T YOU THINK WE WOULD HAVE TRIED A LITTLE HARDER IF THAT WAS OUR DOG?!!?"
He replies, "Oh, sorry," and goes back to his seat at the front of the boat.

The boat starts up again and we see with relief that the dog has not been tempted by our near-return to risk her life again.  In fact, she is trotting back toward the dock, her back to us. I am feeling so terrible on so many levels, taking full responsibility for all of the dog's brushes with death, for yelling at the man, and for giving him any reason to believe that we were actually the kind of people he thought we were.  I quickly realize there were many reasons: the dog's steadfast loyalty to me and my carrot bread, our almost heroic measures, and my copious tears being only some of them.

Our boat is moving away from the dock yet again.  I can see the black and white dog on the dock, approaching a group of gringos we know from Celas Maya.  In my last glimpse, I see her shake off just like Owen, white-striped face to white-tipped tail, spraying Lake Atitlan water all over a girl who we all know to be kind of a negative Nancy. Against my best attempt at logic, all I can think is, "I love that dog."

Tuesday, February 19, 2013

El Centro de Salud

19 febrero, parte 2

It just didn't feel right to write about the lake and my clinic work on the same page because no segue came to mind.

I started volunteering yesterday morning at El Centro de Salud, which is essentially Xela's health department.   I am working in what I understand is the city's only STD clinic with Dr. Gonzales, who I call Javier.

Javier is a middle aged guy with 3 kids who used to be the only doctor in a hospital in which he treated all the patients medically and performed appendectomies, hysterectomies, and hernia repairs.  He lived and worked as a physical therapist in California for 7 years so he likes to practice his English with me and with a top 40 Chicago radio station that he listens to online.  Generally, I speak to him in Spanish and he responds in English.  I really appreciate that he likes to eat as much as I do.  Each morning, we take a break and get a snack of tacos or a mini sandwich or chile relleno that a lady sells outside the building or that a couple sells out of the back of their station wagon.

Javier began working at El Centro de Salud relatively recently.  He sees all-comers with concerns of STDs and having very frequent check-in appointments with the city's sex workers.  The female patients work in "bars" and each day in the clinic is assigned a particular bar's workers.  The women come every 15 days for a brief check, every 3 months for a more detailed interview, every 6 months for an HIV test, and every 12 months for a pap smear.  In general.  There is a lot of variation depending on her complaints/symptoms, if any, and the availability of pap smear supplies and personnel in the lab.   In general, we see 12-20 patients in a morning, which for me is 8-12.  This morning was interesting because we also had 2 male patients, who were more of diagnostic challenges than the women are.  We also had one pregnant patient.  If women have symptoms, Javier prescribes syndromic treatment, which essentially means covering for the major STDs with a combination of 3 or 4 antibiotics.

I'm definitely getting more comfortable doing the patients' exams and speaking in Spanish about their symptoms or lack thereof.  Yesterday was a bit awkward as I got used to the phrases and the invasive exams but the women are really friendly and made it less so.  At one point, I found myself being asked to be in a picture with three women from the same bar and at once felt touched and also very tall.  It's a strange feeling to be memorable here, after spending the last several years mostly in clinical situations where I am one of so many trainees.

Anyways, my days are a bit busier now, with clinic all morning, lunch afterwards, classes from 2-5, and often yoga until dinnertime.  I did, however, find time to go by the Mennonite bakery again today immediately after about a strange transition.

Thanks, as always for all the e-love.


Lago Atitlan

19 febrero parte 1

Hi everyone!

I have a bit of catch-up blogging to do today...

Over the weekend, Jenna, Mariah, and I went to Lago de Atitlán, a large lake about 2 hours southeast of Xela that is known for its beauty and the individual characters of the towns on its shores.  We met up with another friend from UNC, Kim, and a student from ECU, Nichelle, who she had been working with the prior week in another city.  We had breakfast in Panajachel, which is the largest town on the lake and from there (after significant drama involving a dog...more on that later) took a boat to Santa Cruz.

Our hotel was in Santa Cruz, which is a very small village of essentially two hotels, a boat dock, and a small village higher up on the hill.  It's less touristy than Panajachel or San Pedro but the other hotel, La Iguana Perdida (The Lost Iguana) is quite well known for its weekly Saturday night party and its avocado and pineapple licuados.  We had heard about both from our UVA housemate and immediately decided to go.  Each weekend, they have a huge communal BBQ for about 80 people and the party is "fancy dress," which is British code for cross-dressing.  They have a costume closet and between that and my "makeup forever" eyeliner, we had quite the field day.  We befriended some "ladies" from Michigan, Sweden, and London, played cards, ate a delicious (and veg-friendly dinner), and danced the night away in our manly attire.  I, of course, also suggested and then promptly won a limbo contest.  It was a close win against the hotel owner who, of course, happened to have some sort of connective tissue disorder that made him freakishly flexible.

After a leisurely breakfast and second round of avocado and pineapple licuados, we went on a hike from Santa Cruz to San Marcos, the next town over on the lake.  We took a boat back to Santa Cruz afterwards to gather our things and return to Panajachel, where we caught a decidedly un-chicken shuttle back to Xela with, of course, several other 4th year medical students (one from UCSF and one from U of Illinois).

Here are some pictures from the weekend!  Read on to my next entry for a stark change of subject...

Breakfast in Panajachel.  Mucho café was needed.

Mariah and Jenna

 Kim and Nichelle:


Boat ride to Santa Cruz

el lago

We have arrived!

We were glad the hotel included peace.

plantain chips and beans in a bag is a winning combination.

but not as good as avocado and pineapple.

 Looking at Santa Cruz from above

"Sharky," "Ron," and "Herb"

The jocks.

The ladies and us.

The ladies loved to can-can

The vistas from our bungalow:

Hiking to San Marco with our new friend Eric

The actual ladies