A PiLA Fellow's Journey at Hospitalito Atitlán

Delaine Winn
February 9, 2017
          Maria, age 4, one of our youngest hernia patients for the week, snapped this gem of me and Dr. Juan Manuel Chuc, director of the Hospitalito, when I let her play with my phone before her surgery. She took 376 more pictures, but sadly I only have space for one here.    

 

              One of the coolest things about Hospitalito Atitlán (HA) is that it’s run almost entirely by Guatemalan staff. In fact, my boss, my co-fellow Haley, and I are the only gringos (in other words, people originating from the US) on staff. The majority of my coworkers are also indigenous Maya from the Lake Atitlán area. This means that local folks can get come in and get care in their native tongue of Tzútujil. (Many atitecos speak little or no Spanish, so going to a “Western” medical practitioner—already an unnerving prospect for a lot of people— would be out of the question if our doctors and nurses weren’t local). I think that this firm integration with the local community and culture is what has allowed HA to grow into the trusted institution that it is today. It also makes it a really special and totally unique place to work, even if I can’t understand any of the lunch table banter most of the time.

                As a hospital, however, we do still count on the support of the many foreign volunteers who come here to donate their time. We get all types of medical volunteers, from OBGYNs to nurses to acupuncturists, who come to contribute their skills and share their knowledge with the medical staff here. This constant flow of medical experts sort of ends up being like a never-ending source of continuing medical education for the staff here, which is fantastic for the quality of care we’re able to offer patients.

                A lot of volunteers come down on their own— docs or nurses who take a month or two off from practice, or residents who can take a “global health rotation,” for example. But six or seven times a year, the Hospitalito receives big surgical teams for what we call jornadas. Jornada literally translates to a “work day” or even a “day’s journey,” which doesn’t quite capture what the rotations are like (although it’s kinda fun to tell my friends here I’m too busy going on a surgical journey to hang out when these jornadas are in session). During these weeklong events, the Hospitalito offers surgical services to as many patients as possible. Mostly, it’s for stuff like hernias, gallbladder removals, sebaceous cysts— non-emergency issues that the patients have nonetheless been ailing from for months or even years.

 The visiting teams come from all over the States (and occasionally Europe), and usually include a full staff of nurses, techs, anesthesiologists and surgeons. While HA has two beautiful operating rooms, we can’t afford to keep a surgeon and anesthesiologist on staff, hence the periodic buildup of patients who really need these routine procedures in the area. Typically, the visiting surgeons subsidize the whole thing, either with personal funds or grants from their home institutions. This is awesome, because no matter what we do to keep costs down (and even given the fact that we’re somewhat outside the orbit of the exorbitant U.S. healthcare system), these surgeries cost a lot—especially for folks here. Because the surgical teams are so generous in funding their own work, we can offer much-needed treatment to a lot of people who could never afford it otherwise.


The entire visiting surgical team, along with some Hospitalito staff, outside HA at the end of the week. 

 

A couple of weeks ago, we hosted the first jornada that I’ve been here for. We were supposed to have one back in September, but the team had to cancel, and the rest of our general surgery jornadas are scheduled for January-May (really can’t blame all the docs for wanting to come down to sunny Atitlán while it’s winter in the States).

Though we’d had a couple dental and ophthalmological teams come down since I started last summer, I wasn’t really prepared for what the week would be like. We keep a running log of potential surgical patients at the Hospitalito, and in the weeks leading up to a jornada we get in touch with all of them to remind them to show up that first Sunday of the jornada, which is when the surgeons do all of their pre-op evals and schedule all of their surgeries for the week. I showed up with Haley and Jane, another volunteer in our office, at 7:30 am for a long day of translating for the surgeons, who didn’t speak much Spanish. A lot of patients don’t speak much Spanish either, so for a lot of patients we had to use two interpreters. As you can probably imagine, this can be difficult and frustrating for everyone involved, but sometimes there’s just no way around it. Somewhat unavoidably, a certain degree of chaos reigned in the Hospitalito that first day—there were so many people, all hoping to be seen and told that the surgeons could fix their ailment. It was, without a doubt, a taxing day. I was beat when I got to my house around 5:30 in the evening, and I thought, nervously, “How am I possibly going to make it through the rest of this week?” As I soon found out, the long hours of that sluggish first day were totally worth it.

                The next day, I got to the Hospitalito at a crisp 7 am and changed into full OR attire (if only I could just wear scrubs all the time…). Though I already felt exhausted when I walked in, this ended up being one of the most meaningful and exciting days of work I’ve had since starting at HA. My job was, essentially, to translate wherever and whenever anyone needed, which was all over the place and all the time. Because almost everyone on the team spoke little to no Spanish, I was running around—from the pre-op room to the OR and out to the waiting room—all day long to help wherever I could.

 Like any OR, this one undoubtedly seemed like a madhouse to the uninitiated. I was on my feet and scrambling around all day. It was challenging day, but I felt stimulated the whole time. The surgical team was wonderful, and everyone, from the nurses to the surgeons, was willing to take time to answer all of my questions about what we were doing. All of the patients were extremely grateful, and in most cases their relief was relatively immediate (not always the case with surgery, of course). We were at the Hospitalito from 7 am until 7:30 pm that first day, and the rest of the days were pretty similar. By the end of the week I was utterly beat (truly no idea how residents physically survive years of that). But despite the exhausting intensity and duration of the work, I was engaged and excited the whole time. It was, to put it simply, a great week.


Jacinto, chief OR nurse at the Hospitalito, myself, and Juan, Hospitalito maintenance staff in the post-op room.

 

 

In general, one of the best parts of my work here is when I really get to connect with the people the Hospitalito serves, whether it’s a kid in the Maternal Infant program I help to manage, or an elderly person at one of our field clinics. At the risk of sounding cliché, it’s what makes the job worth it, especially some of the less write-home-to-mom-worthy parts—the grant-writing, the donor emails, all of the office grind.

 It feels great to actually connect, face-to-face, with the people who are at the heart of this work, and serving as a translator during the jornada put me in a really unique position in that respect. During that week, starting with that first day patient evals, I was able to make a direct, tangible impact in people’s lives. The responsibility of translating patients’ medical instructions, of being charged with essentially all of the communication between the staff and the patients, gave me the opportunity to do much more than just that. Having been here for eight months, I came into the week knowing that many of our patients have scarcely, if ever, seen a western doctor even for a checkup— much less for surgery.

Mustering up the little Tz’utujil I’ve learned, and doing my best to make myself attentive and available to everyone who came in, I tried to provide even just a modicum of extra comfort to the jornada patients; I particularly love working with kids, so it was especially rewarding to help make their experience a little less terrifying (and from personal experience, I can confirm that kids here are just as scared of grown-ups in medical masks as they are anywhere else). At the end of the day, the most important thing is that they’re getting free, often life-changing surgery. But their feelings about their experience—whether the Hospitalito was chilling and uncomfortable and filled with strangers, or warm and welcoming and aware of their needs—are really important too. Being not just present for but actively involved in the intimate moments of people’s healthcare—especially during the often-scary experience of surgery or a loved one’s surgery—was a privilege. 
 


Dr. Zaida Alejandra, Hospitalito physician, and Dr. Dawn Stapleton, one of the visiting surgeons. The jornada was an awesome opportunity for collaboration between the Guatemalan medical staff here and visiting medical staff from the States.