It is a joy to be back in Guatemala amongst staff and friends at the hospital and in the town of Santiago. I have fallen straight back into old habits of greeting strangers in the street without receiving the strange looks you get on the streets of Newcastle.  I find that in the UK, we rarely even greet those we work with everyday or pass in the corridors, and here the world and his wife wish you a good day as you walk by. Buenas Dias!

The hospitalito is in a critical, stressful, and exciting time of transition. The new build has reached a point where the big move is possible, and planned. I decided that on this occasion I was going to step back from practising medicine and I am here this time to set up the ER. Walking into the new build, I was amazed at how far it has come along, it is simply beautiful.  Crisp and clean, and painted! When I left 4 months ago it was lacking walls, and direction, and now it feels like a hospital, I can almost feel the bustle, the noise, the sound of the bomberos pulling up onto the purpose built emergency ramp, and swing doors flying open into the spacious functional ER.  The old ER functioned so very well but being built as a backpacker hostel led to every imaginable logistical problem for the treatment of patients.

I had spent a lot of time thinking about how to set up an ER and I believe hospital planning is an actual career, but as I stood in the new room with the architects and resident doctors and nurses things began to fall into place.  Imaginary beds dropping down into the scene with a matrix style schwoom noise.  Bishbashbosh and the resuscitation area slots together with wall mounted monitors and everything right there at hand.  No rummaging for an extension tube to supply oxygen, no acres of wires to trip you up as you step around the fireplace to reach the defibrillator.  The thing of dreams.

The hospitalito has been built on the generous donations of many different foundations and individuals, most of whom were heading to town in 3 days for the inauguration. We had 3 days to make an empty building look like a hospital, but importantly without dismantling the old ER and OR in order to be able to continue providing care. 

It quickly became clear that there was simply too much to do and too little in resources to be able to set up one ER without taking from the other. We settled on the idea of a movie set in the hope that visitors would be fooled, or contented by the presence of trolleys and empty resuscitation carts. Roles shifted from organising medical care to scrubbing floors and glamourising the building!

This meant we would then have unpressured time after the inauguration to set up properly, and this mammoth task started the day after. I had visualised this as an opportunity to get rid of all of the expired and useless equipment and supplies, but the team packing up the ER reminded me of the early morning television programme “supermarket sweep!”  A binbag held at one end of the shelf and one big sweep!  So much junk!  It has always been frustrating to me how nothing gets thrown away here, and I do understand this is for good reason. It is a concept deeply ingrained, and everything, however useless or out of date, does get kept.  The last time I was here I became so frustrated with not being able to find a saturation probe that functioned in the box of hundreds of used ones, that I threw them all away, only to discover them all back in the box after my lunch.  It has taken a while, but I realise that understanding and careful communication is the remedy to this problem, and never saying we’ll throw it out, just that we’ll put it somewhere else.

As we unpacked boxes after boxes of equipment, more than half was put into the pile of “I don’t care where this goes, but its not coming in here” As I unpacked one box, I found a number of other empty boxes inside which made me chuckle and then the magic moment of opening a binbag to find a box inside with a mouse nest, complete with mouse!  “Right, who packed the mouse?!”

The following day began with a sinking feeling as I opened the doors to be greeted by boxes and bags and complete chaos, but slowly it began to take shape.  It felt good and a little emotional while standing back with one of the nurses, with the newly prepared suture trolley, and saying, well where do you think it would be best kept?  Or asking what was the most difficult aspect of the old ER, and how can we change it so you can all work better, and happier.

I, and all others who worked at the old hospitalito will miss the charm of the place, but the feeling of development and opportunity within the new building is overwhelming.  Of course there are ongoing teething problems, for example we can’t mount the oxygen tanks because the walls are plaster and we still have no sink, but the initiative and creativity of attitudes here never ceases to amaze me, and it won’t be long before the doors are open.

Almost exactly a year ago I wrote about a young woman who attended the ER requiring an emergency cesarean section.  It was thanksgiving, my first thanksgiving in fact, and she arrested on the table.  You may remember the tales of extubation in the back of a truck and helicopter transfers. Although both mother and child survived, the events of that day still haunt me. I want to include this photo, for myself and for all the other medics who fought to save lives here. This is Febe at almost 1 year old with her mother, who died, lived, and flew in a helicopter for thanksgiving, with her older sister and myself at the inauguration of the new Hospitalito.  A day of thanksgiving if ever there was one.