Sunday Funday

(This is a longer post so I put an optional break point if you want to finish later, it's worth getting to the end eventually though!)

What a day Sunday was! I don’t even know where to begin. I guess the beginning is as good a place as any. So I wanted to do a day trip to see some nearby sites before I do more ambitious trips the following 2 weekends (Lake Atitlan and Antigua are on deck). Some of the nurses had been talking about a day trip going to hike Laguna Chikabal which is a crater lake at the top of a volcano on the way to Xela. I was super on board with this plan, none of my US counterparts were down but I planned to go anyway.

Early the next morning as I walked to the bus stop to head to Coatepeque, it really dawned on me how dependent we are on phones for planning. I had sent one last text to both the receptionist I was meeting at the bus stop and the nurse I was meeting at a gas station in Coatepeque and hoped everyone would show up, and ideally around the same time. As the bus pulled up a few minutes late, my receptionist friend was just then walking up and I breathed a sigh of relief. We hopped on the old repurposed school bus (one of the local chicken buses) that looked like our school buses from the ‘80s which had then been mauled by tigers. I began my day early in the morning speaking only Spanish with a thankfully very patient friend as we bumped along for like 1.5 hours.

We got to the gas station eventually, paid to use a toilet paper and soap-less bathroom and saw our nurse friend walking up. His girlfriend soon joined and we waited for a minibus on a non-descript other corner. Many packed mini buses flew by with teenage boys hanging off the side (some didn’t have doors anyway) shouting out the destination of the bus. Thanks to my 3 Guatemalans we got on the right bus and headed to a town called Colomba. On the way, the bus would pick up and drop off people completely randomly, it seemed like if someone was on the side of the road and stuck out their hand it would stop and pick them up, the boy on the side would shout “dale!” to the driver take the money and we’d reer off again.

At Colomba we were heading through a busy street market to get to our next minibus in time and the nurse peeled off in a different direction. Turned out that he had seen his friend driving on the road (many people here do not have cars) and we were able to bum a ride to the town where we could access the trailhead to Chikabal. The views on this road got more and more pretty as we ascended into lush rainforests on mountains with volcanos in the distance. It also started cooling down which was very welcome.

His friend dropped us off and we walked down a steep road to a sign and waited for a white car we could pay for a ride to the trailhead (how would I know this stuff as a random traveler???). After awhile one came and picked us up and bounced up these steep, bumpy roads through a farming town with steep fields and people wearing traditional Mayan clothing made of colorful woven fabrics (this the a first I'd seen of it!). 

We got to a cluster of red buildings to buy a ticket to the trailhead. They charge “internationals” about 4 times more than locals and even with 3 Guatemalans we couldn’t convince them I was local -- especially when they saw my face/I opened my mouth to speak. We also got a guard dog assigned to us to walk with us and protect us from other animals, it was a cute husky with a blue ribbon around its neck.

It was a steep walk up and other than me, everyone else was dressed in nice clothing which doesn’t give you much grip. We got to the top for the view of the crater lake andddd it was all clouds. We couldn’t see anything but white.

-------------------need a break?-------------------

 

Then we walked down 100s of steps into the crater lake. The clouds hung low and moved quickly so you would get brief periods of total clarity and total obscurity.  

There were also tons of flower-filled Mayan shrines around the lake which made it even more mysterious. 

We hiked out and hitched an even weirder mode of transportation out to the road. Then I got to ride my first intercity chicken bus which is basically the same as the local one from the morning except much more crowded and more brightly painted. 

Every row was sitting at least 6 to a row with no break in the aisle, making it very difficult to push through to get towards the back of the bus especially while it was already lurching forward. I squeezed into a seat between a Mayan mother and her cute toddler who was basically on the lap of a random older dude who was asleep wearing a ski jacket. Also I wish I could’ve moved my arms to snag a picture of the row in front of me where 6 large men were crammed in so tight their shoulders were overlapping across the aisle but I couldn't.

Our bus flew along the bumpy road having honking standoffs with trucks—I’m happy to have had only a side window view. As we approached Coatepeque, it started to rain, and not lightly but more like end of the world flooding rain. It’s dry season so this was pretty unexpected and was not letting up. The nurse and his girlfriend got off the bus, so me and the receptionist friend were left and the bus passed our stop leaving us at the bus terminal in the downpour.

The bus terminal was a dilapidated building with many leaks in the ceiling, no place to sit, and food vendors around the outside rushing to pack up their goods in the rain that was flooding the area. Importantly, by this point both mine AND my friends’ cell phones were dead (this is why I have no photo evidence after this). We looked all over for an outlet and the few we found were broken and / or smashed in. I asked some random dude to borrow his phone and he sent us to the pay phone which also didn’t work.

My friend asked around and found out that due to the rain, no buses were going to go to Trifinio and since it was now after 4pm on a Sunday, no minibuses or tuk tuks would go either. Getting slightly more desperate, she was asking ME what to do and I had no idea. I looked around outside the bus terminal for an outlet and finally found one in the ceiling that a vendor was using to heat up his chicken. We needed a stool to reach it and had to let the phone hang from the ceiling to charge while the ground below it flooded.

After calling multiple people, we kept getting different information about what we could do and eventually settled on a plan to have her uncle come get us, but in the meantime wait in a mall that had food to eat and a grocery store. However to get to the mall we had to jump out into the ongoing downpour running through flooded streets to hop into 2 consecutive minibuses, where so many people were inside I was literally standing with my head against the ceiling and my butt out the door in the rain on one of them.

We got to the mall and were so happy to be dry and eat and my friend kept telling me only a half hour more till our ride comes (which continued for the next 4 hours) (and yet I could NOT have been more grateful to them!!). By the time we got back home it was 9pm and I was supposed to be back around 230/3, so everyone was super worried and had been just about ready to send the police after me. And after 14 hours of Spanish speaking, particularly in a stressful situation, my head hurt.

Ambulancia

It is not uncommon here to have a patient in clinic who has organophosphate poisoning since it is a main ingredient in most insecticides. This is a rare thing to happen in the US but common in developing countries where its use is very prevalent in farming (we even have cropduster planes on our plantation that fly over every morning for a few hours spraying it around, I stay inside during this if possible!). We also happen to be a catchment area for a lot of people who work on farms. We’ve had many patients come in with neon red hands, which I initially thought was from painting, but found out was from working with insecticide without gloves—apparently they are provided with 1 pair of gloves for protection that they can swap out, but if they lose their first pair, then they can’t get more. I’m pretty sure masks aren’t common either.

Organophosphates can get into your system by ingestion, inhalation, and across your skin (gloves would help) and it makes every part of you leaky and also happens to be a medical emergency. In the US you often go straight to the ICU since there could be a need for intubation, cardiac monitoring, and even pressors to stabilize.

It’s pretty scary to get a patient like that in a rural clinic. In one of these situations, I got to ride in the back of the ambulance with the patient to the nearest hospital in Coatepeque (turns out when you’re pummeling across the road in the ambulance you can get there in closer to 30-45 minutes). I was in the back with the PA student, a nurse, and a nursing student. We only had a back board, oxygen tank, and were carrying atropine with us (we had not given it because if given before the hospital, the patient has to pay but couldn’t afford it (we had already paid for the ambulance ride to help out), but if the same med is given at the hospital , the global insurance should kick in). I was trying to visually monitor the patient to make sure they were breathing and their heart was beating all while trying to finagle a plan for what to do if any of those things changed en route. It was a little nerve wracking.

We dropped the patient off at the hospital and hoped they would treat them appropriately. We then looked around the hospital’s ED just to get a feel, it was pretty small but seemed to have a little bit of everything with different blue painted, open air rooms for maternity, pediatrics, and adults.

Of note, we had been bumping around and accelerating/decelerating suddenly while we were in the back of the ambulance on the way there and then we had to turn right around and head back, mostly with my head between my knees or poking out the little window.

Some random clinic musings:

--Everyone, including you and your patients kiss on the cheek to say hello. I’m not sure if handshakes or this style of greeting is worse for transmitting infections in the medical setting..

--“Fiebre adentro” (fever inside) is a very common complaint describing feeling generally unwell and trying to describe an infection or similar process moving into the body. I can’t totally wrap my mind around what it really means though.

--We take our porcelain toilets for granted when asking questions about stool changes, it’s a lot harder to determine if anything is different when your toilet is a dark hole in the ground.

Also, THIS is a cashew fruit:

And it's disgusting except for the little nut inside that top green shell part.

Feria

The first weekend was a mix of many cool experiences. First, on Saturday, I got myself invited to our cooking/cleaning lady’s mother’s birthday party. As I left the plantation with some Zika researcher friends (they have been here for quite some time so have made strong connections with people in the community) I realized I had not left it all week! It’s pretty self contained. We didn’t go far but we got to their beautiful home that is larger than most and has a super spacious back yard filled with mango and coconut trees, chickens, and with it’s own water system. 

They are relatively well off compared to many in this rural community. Turns out that all the husbands in the family are working as undocumented immigrants in America to send back money to support their family and it clearly shows. The heartbreaking part of it is that the kids have never and may never meet their fathers since they can’t risk leaving the US, especially now.

Well anyway, it was very gracious of them to let a complete stranger in on their intimate celebration, and I felt fortunate to be a part of it. The birthday lady is a grandmother at 45 which kind of blows my mind. The whole family, which includes many generations and small children, were all there (minus the men as above).

They cooked a delicious spread including pico de gallo, chirmol, escaveche, chicharrone (fried pig skin), and pig ribs. One of the guests had used one of the many pigs roaming around the banana trees for the feast. It was all very tasty. They even had a cake after and sang a happy birthday song.

There was a little baby and they genious-ly hung her in a soccer net like hammock structure to keep her rocking when no one was holding her. She didn’t cry at all except when someone set off firecrackers in the back yard for the celebration which scared us too.

That night we headed into Coatepeque for the Feria de Verano. We got there at like 4pm because the nurses told us a concert started then. I have no idea when or if a concert ever started, but there were tons of people, carnival rides (looking pretty rickety, so rickety they were even fixing a ride while we waited in line to board it), churros, beer, and latina music. The tough part about the music was that there were a lot of dancing venues which were all open air, all next to each other, and all competing to be the loudest. I definitely left the place with a headache but had a good time hanging out and dancing there with the Guatemalan nurses.

The following day we crammed all our beach stuff, a cooler, and 5 people into a small tuk tuk 45 minutes to the town of Tilapa on the Pacific Ocean. When you arrived you could smell the scent of fish and salt, the banks were covered in trash butttt we paid someone with a boat to take us along this beautiful inlet surrounded by lush forests and mangroves. 

We hopped out in a mangrove and walked out to Tilapita which is a small beach town with lots of nice houses but maybe 1 restaurant and hotel. Since there are no restaurants along the beach, it is an option to knock on peoples’ doors and ask/pay them to cook a meal for you. (Can you imagine knocking on beachfront property in Malibu and asking for food? And those people HAVE the resources.)

We walked across town to the beach which is a mostly black-sand beach—let’s just say this makes it feel even hotter—and found an unclaimed techo made of palm leaves and set up some hammocks. 

The beach was huge and mostly abandoned, there were white capped waves and heat radiating off the black sand, but it was quite lovely under the techo. I asked my research friend if I should run north or south along the beach, and he asked me if I had my passport with me (this beach is less than 2 miles from the SW Mexican border.) Apparently both Guatemalans and Mexicans think that the other country and its people are much more dangerous than their own. I ran south to be safe. Also, I somehow got burned all over my body despite spending most of the day in the shade, go figure. Must be that gringa skin.