5 Nov, 10 | by BMJ Group
What with being caught up in the whirlwind of Hurricane Agatha, sinkholes, volcanic eruptions, and the daily grind of life as a doctor, it has been a while since I’ve had the chance to sit down and collect my thoughts, in fact its arguable that I still don’t have the time!
On returning to Guatemala after job interviews (success! Thanks for asking), the drama gathered force as I was promoted to the chief of medical staff at Hospitalito Atitlan. I’ve never previously had much time for those “inefficient” office-bods who always seem to produce the most incomprehensible work schedules and on-call rotas. I’m ashamed to say I have now muttered the words “sort it out amongst yourselves.” I can now definitively say, its not possible to keep us doctors happy, especially when scheduling around fussy volunteers, the inherent time delay of life in Guatemala, and natural disasters!
Just as I had got used to having a pet-dog in the ER, and chickens clucking about the waiting room, I’ve returned to the UK to continue my training. Life is busy in a different kind of way. While I haven’t been rescued from any flooded buses by brave firemen, or clambered my way through mudslides on the precarious road to Guatemala city, I have had to grow up and organise council tax, a television licence, AA road recovery, and how to iron a work shirt.
Oh the home comforts of direct debits, and choice. So much choice. The choice of breakfast cereals, of shampoo, of antibiotics, of investigations, of inotropes. A year is little in terms of mainstream treatments, and I find myself frantically reading to keep up.
I have a weekend free for the first time in many months, and I thought I would take the time to reflect on the most constructive and positive year of my personal and professional life. During the last few months of my time at Hospitalito Atitlan, we were short of medical staff at the hospital due to grounded planes, road closures, and national instability deterring visiting doctors. Because of this, I don’t think there were many nights when my phone didn’t ring with one or other emergency. I never thought I’d be the one capable of responding to such things, but I now find myself wishing my phone would ring and I could do that midnight muddy, slippery run from bed to ER, never certain of what might be waiting. It is amazing what I have learnt, and the things I have discovered can be done.
A good friend told me that when you put people into hot water, they either turn into carrots, eggs, or coffee, or in other words go soggy, get harder, or get stronger. I wouldn’t like to say which foodstuff I became, but I did become resourceful. I remember seeing a patient with a displaced humerus fracture and being advised by the trauma surgeon in Guatemala City to place an abduction cast. Having never seen or done this before, the patient and I sat, together, engrossed in a YouTube demonstration of the casting, and then looked at each other, eyebrows raised in agreement, “sure, we can figure that out.” No abduction pillow? Well it turns out a bleach bottle in a tubi-grip works just as well. I do know that these antics don’t cut it in the UK, but I have no doubt I could finally be the proud owner of a blue peter badge.
I finished work in Guatemala on a Saturday morning after a 24 hour shift. Sadly my last patient was a cyclist who had serious, most likely fatal injuries after a cycling incident. I wearily trudged home, sad that my last patient was unlikely to make it to his 30th birthday.
It was a sad final chapter to many happy months of successes and tragedies. As I slowly packed up a years worth of belongings, I felt the time to leave had arrived. I was exhausted, and I missed training. I missed ringing a registrar, and I needed to not be completely out of my depth again. To celebrate one last day in Atitlan, I had Pepino chicken for lunch with colleagues and friends, with much laughter at my early mistake between the words “pato” (duck) and “parto” (labour). For months apparently I had been saying “is there a duck in the duck-room?” instead of “is there a birth in the labour room?”
Then followed a rather unusual evening in the company of Maximon, the local Mayan deity. After a year in Santiago, I still struggled to understand the religious amalgamation celebrated by the local community. Maximon, a wooden human-formed God clothed, in hundreds, yes really, hundreds of ties and scarves, smoking a pipe and drinking aguadiente liquor has somehow been incorporated into the local Catholic worship. We had an evening of celebration to wish me good luck, to bless me and my health, and to ask Maximon for my swift return to the community. We sat in front of Maximon, with plastic streamers, incense, plenty of beers (an essential part of a Maximon blessing, along with a pipe), and a coffin containing an effigy of Jesus in the corner. It was unusual, but emotional, and definitely a stunning end to a year within the Mayan community.
The 5am phone call took me by surprise. “Twins? Could I come and deliver twins?” One last joyous muddy run to the ER for a semi-elective c-section. The team was great, an obstetrician and myself were operating and there was an exceptional group of nursing staff. Having not had a paediatrician at the hospital for several months, it was perfection indeed when one of the admin staff came to find me to let me know the new doctor had arrived to start today. I had to explain to him that I had no idea who he was, I had already left, but what speciality did he practise? “Paediatrics! Get changed! Get ready for twins! Welcome!”
Needless to say, I said my sad goodbyes with a huge smile on my face and left on a high. The twins, or gemelitos, and mother are fine.
Since my return, I have revelled in the opportunity to train again, and I find myself distinctly less phase-able or intimidated. Without wanting to preach, I am much more appreciative of my job, my opportunities, and resources. I left Guatemala exhausted after a year back to my ‘normality’ and left behind those for whom “normality” is that exhausting and frustrating life. Others continue with the ongoing strive to provide the best care in less than the best circumstances, the battles to get care to those who need it, and the frustration when what we perceive as best medical care is rejected in favour of local practice. On the flip-side, the introduction of e-record prescribing in my absence might be more frustrating than all of the above.
Having said all that, I’m hooked, and my flight back is already booked.
The current Hospitalito building is a relief structure after the devastation of hurricane Stan and mudslides 5 years ago wiped out the permanent hospital. The building is an old backpackers hostel, hence the fireplace in the operating room, and the glorious balcony which makes for a perfect view during meetings. This November, Santiago Atitlan celebrates the opening of a brand spanking new purpose built hospital, and I couldn’t be more excited about arriving in time to help with setting up the new facilities, and hopefully wrapping myself up in the daily events of the ER. Anyone who wants to know more about the new build, the hospital, and its aims can read all about it at www.hospitalitoatitlan.com.
And I will, weather-permitting, keep writing.
Louise Kenny has completed F2 year in the Northern Deanery and is now working in Guatemala.