Guatemala Medical mission

Ileana sat at her desk at the medical station located deep in the mountains of Guatemala. It was 1982 and she was finishing her last year of medical school. In their last 6 months of medical school in Guatemala, all the medical students were sent into remote areas to practice what they learned. The patients were largely indigenous, and this was their only access to medical care, final year medical students. It was a quiet evening after a busy afternoon treating patients with sore throats, vague abdominal complaints and pregnant women seeking pre-natal care.

She had a few moments to collect her thoughts about the day’s cases. She opened her textbook to catch up on the current management of malaria. She heard a car pull up and park. The clinic was closed for the day, and although she had locked the doors, she felt a surge of fear course though her body. She was a lone woman in a remote location. Guatemala was torn apart by a civil war. The army battled the rebels and the skirmishes were sometimes brutal. She armed herself with a sharp scalpel and quietly sat at the desk waiting to see what would happen next.

Ileana heard a key enter the lock and the door sprung open. She heaved a sigh of relief. It was her supervisor. “What are doing here at this hour?” She asked.

“Come quick!” He spoke. “I need your help.”

Ileana followed him to the car. A man was bleeding on the back seat. They helped him into the medical station. Ileana listened to his lungs. He had a pneumothorax. Without delay, she chose a spot on the chest wall, infiltrated the area with anesthetic. She opened up a minor surgical tray and inserted a urinary foley catheter to release the tension of the pneumothorax. The medical station had limited supplies and a chest tube was a luxury item not included. She connected this to the underwater seal and bandaged the chest wound. The supervisor explained that he had been shot by the army.

The supervisor explained that the army was not far behind. They were in a hurry to leave before getting caught. The supervisor helped the injured man into the car. He said to Ileana, “Get rid of the bloodied sponges. If they think you assisted the rebels, they will kill you.” He hopped into the car and sped away leaving dust from the road in the air.

Ileana had a reason to be frightened. While she collected all the bloodied sponges and equipment, she thought about the drive up to the medical station. There was a tiny village, Dos Erres, that she used to drive past on her way up the mountain. The village no longer was there. Someone had planted trees and bushes to make it seem like part of the jungle. Later she found out that the army had attacked the village one night. They accused the villagers of aiding the rebels. They killed every man, woman and child and threw them down the well. They slaughtered the cows, chickens and goats and threw them down the well. Two young boys who got up in the middle of the night to pee witnessed the attack. They remained hidden in the trees, terrified. The image of the slaughtered village and the genocide filled her mind while she scrubbed the blood from the floor, eliminating all traces of the procedure. The collected sponges and bloody instruments were placed in a plastic bag and brought outside to be hidden in the bush.

Within a few minutes of the clean up, another vehicle pulled up. It was an army vehicle with four armed men. “Where are they? “Shouted one of them. “We know they are here. One was shot.”

Ileana just stared at them while they inspected the small medical station. They went through the garbage and all the drawers. Unable to find anything, they left to search for the supervisor and the injured rebel by jeep. They warned Ileana not to assist the rebels even if they were injured. They told her she would regret it if she did.

Nobody from the army was ever held accountable for the slaughter of this indigenous village and all but 2 of the inhabitants. A 90 year old general was charged with the genocide, but the charges dropped after a “technicality”. Ileana vowed to do whatever she could to help the less fortunate in her country. Her plans to help were delayed. Someone must have said something. A phone call in the middle of the night several months later informed her father that she was on the “list”. Others on the “list” had been shot by a firing squad. Others simply disappeared, over 200,000 including Ileana’s closest friend. He was found shot a few weeks later after suffering terrible torture.

Ileana fled Guatemala. She drove to the airport and escaped with the clothes she was wearing. It would be 20 years later when it was safe for her to return.

43 years later Ileana and I found ourselves in Guatemala on a bus heading up to a remote location in a village called Solola. We were on a medical mission to help those less fortunate who needed medical help. This is our 7^th medical mission over the past 15 years with an organization called HELPS international. All of the medical supplies and surgical equipment had been transported from the warehouse in Guatemala City a week before. Flyers were sent to the local community to let them know we would be performing gallbladder and hernia surgery. The patients lined up for hours to try to get a spot. Access to medical care was marginal before the pandemic. Since then, access to medical care for those less fortunate was nonexistent.

We left the sailboat in the Dominican Republic in the beautiful Puerto Bahia Marina in Somana. Ileana and I had spent a few weeks there before flying back to Toronto. We had committed to help with the medical mission in the last week of April. The HELPS medical missions were cancelled for the past 3 years because of Covid-19, so this is the first time back since 2019. It felt good to be back in Guatemala.

Arriving that first day, there were patients waiting to be seen. We arrived at an Guatemalan abandoned school that was surrounded 10 foot high brick fence and razor wire. The floors had been cleaned and the windows polished. There were 10 troops from the guatemalan army that accompanied us from Guatemala city to ensure our safety. They stayed with us on guard the entire week. The place had been converted to a makeshift hospital but all of the hospital beds, autoclaves, stoves , ovens were transported from the HELPS warehouse in Guatemala city. Non potable water comes from the taps because the water supply is from the town. We were instructed not to drink it. Toxogenic E. Coli waited for us in every faucet. The bacteria has now spread to chicken and eggs, so we are very careful.

The first few hours were chaotic making the operating rooms functional. All the tables, cautery equipment, surgical supplies, laparoscopic monitors had to be set up and equipment connected. Generators were set up to provide enough power for the anesthetic and surgery machines.

The medical team from Bakersfield spent the last 3 years acquiring supplies and medicines to bring on this mission. After 4 hours, the makeshift hospital was ready to see patients. The first 5 patients did not speak English or Spanish. They spoke their own indigenous language. Interpretation went from English, to Spanish and then to the indigenous language. Although it is difficult to know how much was lost in translation, they all agreed to surgery. The plan is to do 10 hernia surgeries and 10 gallbladder surgeries per day between the 2 of us surgeons. Multiple lumps and bumps are removed by the physician assisstant, Steve. We are ready to start.

The process involved Ileana seeing the patients in the clinic first. After making a diagnosis, a referral was made to myself or the other surgeon, Denise Portugal. The patient would proceed to the desk where the surgeries are booked. They would have an intravenous started and would be brought into the operating room. There were two anesthesiologists. One for me and one for Denise. The surgeries were done in the same room with the OR tables separated by 10 feet. We operate from 7:30 AM to 6:30 PM.

The operating room ready to start and our 1 star sleeping arrangements……….

Many of the patients have travelled across the country. Some have walked for hours. Many are impoverished, but they get dressed in their finest clothes when they come to the clinic. Often, they wait all day for their surgery. They never complain about the wait. The only emotion they ever express is gratitude. Every time someone walks by them, the thanks pour out with such genuine, heartfelt gratitude.

When the week is finished, the equipment is loaded into boxes and trucked back to Guatemala City. The supplies are stored for the next mission. We hope to return next year. It is a very fulfilling way to spend a week.

I’ll be flying back to the Dominion Republic at the beginning of May to prepare the boat for the trip north to New York City then Toronto. The plan is to leave May 12th and head north. Chris Parker, our weather router will keep us safe from storms of the North Atlantic. There will be many good stories from that trip!