Hospitalito Atitlán Blog

A doctor, social worker, administrator, two nurses, housekeeping and other mother’s celebrated Mother’s Day upstairs in the Pescador last week. 

108 people lined up on Sunday for eye exams with the ophthalmology team from Idaho. More than 30 received surgery for many problems including cataracts and for the first time in Santiago Atitlán for glaucoma. It has taken years for people here to accept the idea of eye surgery. The team will return in September.

Nursing coordinator Chonita Damian Ixbalan gave an introductory talk to University of Pennsylvania nurse midwifery students who are volunteering in Santiago Atitlán.  The student group is led by Mamie Guidera.

Carolyn Johnson brought her Rotarian friends to visit Hospitalito Atitlán last month. They had a tour, learned about our work and brought beautiful hand made blankets for little ones.  They also donated two portable breast pumps, vitamins and things from our wish list. Thanks so much for your generosity and the visit!

Friday marked the end of the “Brent & Jennifer” era at Hospitalito Atitlán, after three years of service during which time both physicians volunteered. They came with four young children, having chosen Santiago Atitlán as a comfortable place to both volunteer in medical service for the very poor and to raise a family comfortably.

The whole family said goodbye at their going away party with the entire hospital staff. In the photo are their four children, Christopher, Juliana, Elizabeth and Nicolas.

Dr. Brent said that, overall, it has been a good place to volunteer because the hospital has more resources for provision of care than might other Third World healthcare venues.

The couple is associated with Mission Doctors from the United States. This was the first time Mission Doctors has ever sent volunteers to a non-Catholic hospital. After a respite in the United States, the couple will travel to Northwestern Cameroon for another three years of volunteer service.

Hospitalito Atitlán’s solar energy system has been chosen as the Best Project in Guatemala by Energy Globe, an international award, honoring  “brilliant, sustainable…” projects from more than 100 countries around the world.

Our new facility was built to be energy efficient, using solar water heaters and solar panels for electricity generation.  We are very proud and excited about this honor!

On miércoles Santa, there are thousands of people in the park in Santiago Atitlán, waiting for the arrival of the fruit and Maximón. The Managing Diabetes in Santiago Atitlán program coordinator decided to use this opportunity for testing. 21 men were tested, four were detected with diabetes. Not many men attend the clinics.

This is Nathan Broddy with the nice Toyota pick-up truck he and his wife owned until yesterday, when he donated it to Hospitalito Atitlán. He drove to Santiago Atitlán from his home in Hamilton Montana with friend Chad Knaus. They were on the road for ten days.

Nathan’s wife Johanna Drienling is a past medical volunteer as is Dr. Chad Knaus.

The truck will be used to take medical staff and supplied to the community outreach clinics in Cerro de Oro and San Antonio Chacaya, and to pick up staff in the night when they are needed for emergency surgery. Many of Nathan’s friends chipped in on the cost of their trip, for fuel, Hotels, and to pay import taxes.

Nathan feels he has found a good home for an old friend.

Anesthesiologist Russ Lynn organized the jornada with surgeons Alan Schuricht and Carla Fisher, and a number of PAs and nurse anesthestist students. The week included training for staff and for the young set, a climb to the top of San Pedro volcano.

The fourth group of medical personnel (and traditional birth attendants) completed the two day training in Hospitalito Atitlán’s  Manejando la Diabetes en Santiago Atitlán. program which is funded by the World Diabetes Foundation.

Gonzalo Bautista a University of Pennsylvania nurse anesthesist student led a training today for basic life saving techniques for staff. Every morning this week while the surgical team is here, different Hospitalito Atitlán staff members will receive the training. Today Ezequiel and Victor learned CPR on adults and babies, the Heimlich maneuver and how to safely rescue a drowning victim.  Tomorrow Ezequiel will lead the training for Tono, Aklax and Fredy. This is training of trainers, and Victor will take what he learned to Chacaya and Cerro de Oro.

Nathan Boddy and Chad Knauss are leaving this weekend for Santiago Atitlán. Nathan is donating his pick-up to the Hospitalito for use in the night to bring in staff for emergency surgery and for the community outreach clinics. Chad is a physician who volunteered in 2009 and Nathan’s is married to Johanna Dreiling a previous HA medical volunteer. See you on March 21st. Safe Travels!

The past two and a half weeks have been remarkable ones on labor and delivery at the Hospitalito. We’ve delivered about 14 babies, which is about twice as busy as normal. But what’s most impressive is not the volume of the deliveries but the degree of acuity and complexity involved in the care of the mom-baby pairs. In Santiago, 50% of the women plan to deliver at home with comadronas, traditional birth attendants. Of the remaining 50%, the half deliver at the public centro de salud, which has one small delivery room and relatively few resources and half deliver at the Hospitalito.  In the home births, the comadronas do a fine job when low risk moms have straightforward deliveries.And in the centro de salud, the doctors do a great job with the resources available, but they are unable to deal with anything that involves a higher risk situation.  That makes the patient population that shows up at the Hospitalito a high risk subset of the prenatal population in town. It also highlights the importance of having a hospital that can deal with acute complications of childbirth in a town that has over 50,000 people. Some care simply could not be delayed the 2 hours that it would take to get to the nearest hospital outside of Santiago. All of these factors demonstrate the important role the Hospitalito plays in providing essential maternal-child health to the people of Santiago Atitlan.

Here is a summary of some of the cases from the past couple of weeks

· A 30 year old woman came in with vaginal bleeding at 30 weeks of pregnancy. She had not received any prenatal care. At the Hospitalito we quickly diagnosed placenta previa by ultrasound, administered steroids to help the baby’s lungs develop and transfered the patient to an outside hospital more equipped to manage her care.

· A 27 year old woman at 35 weeks was transferred from the centro de salud for an abruption. On arrival the baby was in acute distress. Despite arriving in the evening when only 1 doctor was working, 3 volunteer doctors answered the call to come in and do anesthesia, baby resuscitation and help out with the surgery. They baby was born within an hour of arrival.

· A 31 year old woman was induced for being passed her due date. She was given medicine to start her labor and monitored closely. 15 hours later a perfectly healthy boy was born.

· A 21 year old woman was transferred from the centro de salud for high blood pressures. On arrival to the Hospitalito, she was diagnosed with preeclampsia and started on magnesium to decrease her risk of seizures. She did not progress past 5cm and ended up needing a c-section. Despite the fact that it was 5am when the decision was made to do a c-section, 2 volunteers doctors came in from home to do anesthesia and surgical assist. The baby was 9 pounds which was very big for a 4 foot 11 inch, 160 pound woman. During her post-operative time in the hospital her blood pressures were monitored closely and she and her baby did great.

· A 19 year old woman was transferred to the Hospitalito after she had 3 eclamptic seizures at home. On arrival she quickly got magnesium, an ultrasound, and was put on the fetal monitor. After a couple of minutes of seeing the baby on the monitor, it was decided that she needed a c-section. She got pre-operative antibiotics and anti-nausea medicine within minutes. Despite the fact that it was a Sunday afternoon, again 3 volunteers were present to do the c-section, anesthesia and baby care. The c-section was uneventful. Post-operatively she developed a very rare and extremely dangerous condition called HELLP syndrome. The team was prepared for the worst but ecstatic to see her make a complete recovery.

· A 24 year old first time pregnant woman at 38 weeks was transferred from the centro de salud, contracting with preeclampsia. She had not received any prenatal care and was brought in by her comadrona. On arrival we confirmed what the centro de salud had diagnosed: twins! The second twin was breech. Given that this was her first pregnancy and that we didn’t feel safe attempting a vaginal delivery, the patient elected to have a c-section. We suggested that she deliver at the government hospital because the babies looked little; about 5 pounds each.  The family refused the transfer and were talking about going home.In the end we convinced them to stay. We did a c-section and she had two very vigorous and healthy, although small babies: 4 pounds 6 ounces and 4 pounds 2 ounces. The babies ended up getting transferred in the morning and have done great at the government hospital.

· A 22 year old 40 wk G2P1 was transferred from centro de salud at 10cm. She had been pushing for “hours” without progress. After an hour of no change here, she was taken back for a c-section. The baby came out great. Mom (who had a history of post-partum hemorrhage that required an operation after the delivery of her first kid) however had a massive postpartum hemorrhage.In total, she lost about two and a half liters of blood. Thankfully we were able to stop the bleeding with medicine and fill her up with many liters of intravenous fluids and transfer her to the government hospital where she could get a blood transfusion. After several days and a couple of return trips to the operating room, she is finally improving.

· A 34 year old woman could not get past 6cm and had a c-section for failing to progress.  At the c-section the baby was found to be “sunny-side up”.  Mom and baby did great.

· A 28 year old woman who had a history of 2 prior c-sections came in and was found to be 10 cm. As we prepared the operating room for an emergency c-section (no one in the US would ever plan to do a VBAC on a woman with a history of 2 prior c-sections), she had an uneventful “VBAC” (vaginal birth after c-section)

· Two separate cases of women who were unsuccessfully pushing at home for several hours with comadronas came in and needed vacuums to pull the babies out due to maternal exhaustion.

 In each case, the health and welfare of the mom and baby was dependent upon having a safe place to deliver, a well staffed labor and delivery ward and hospital, a clean operating room, the resources needed to provide care (suture,surgical tools, medicine,ultrasound machine, vacuums, etc), and a robust group of physicians who were available on call whenever help was needed. I don’t know what would have happened to all the moms and babies over the last few weeks if the Hospitalito wasn’t here. But I think the care they received is a very real demonstration of what Hospitalito Atitlan has to offer to this relatively poor, indigenous Guatemalan town.

submitted by Dr. Andrew Smith

Every year, Jenny Audette brings a group of physical therapy students from the University of Rhode Island to visit the Hospitalito. Today Jenny Stone, Catherine Stone, Brenna Rock, Emily St. Pierre, and Ryan Diloreti toured HA and learned about ADISA and other programs in the Lake Atitlán area.

Elida Marisela is a resident Chemical Biologist from the University of San Carlos who is working at Hospitalito Atitlán for six months in the lab. She is making recommendations for quality control of test results. Yesterday she gave a training for nursing staff on procedures for taking blood samples.

Christin Jones and friends at Zane State College have been fundraising for the Hospitalito to help us to improve our laboratory. She hopes come to Santiago Atitlán to volunteer in the lab someday soon (and visit her parents, Rob & Linda). In this photo are Jessica, Chris, Jerica, Sierra and Laura (MLT teacher).

There is an orphanage in the back of the bay in Santiago Atitlán. Today the children are receiving dental care with a jornada from Dr. Glen Dean. The children learn English and brought their homework while they wait in the makeshift X-ray room.

Dra. Jennifer Thoene prepares the sweet part of the Hospitalito’s Día de Cariño celebration with the help of Elida and Chenta. There were doblados de papas, games, a gift exchange and a lot of giggles.

Tono and Gaspar helped to unload a part of a donation from a container received by Juan Forester (Guatemala’s most famous Rotarian). Michael Bostelmann of Club Rotario Guatemala del Este delivered the donation, accompanied by his wife Guni. Michael says there will be more to pick up in the capital. Thank you!

Luis Armony and Juan Francisco Pira, our coffee producing friends visited today to see how their construction donation was used (they were impressed).  They also brought a check to pay off the ambulance.

Our good friend Phil Sperl returned to the Hospitalito this week to work. He first volunteered in Panabaj in 2005 to renovate the inpatient building. He has returned every year or two bringing Rotary friends. Mike Bredimus, Tom Schussman and Phil are standing in front of the baseboard tiles they installed today. Ana Paola Leiva (daughter of our beloved surgeon Dr. Fernando Leiva) came along to help and to see the operating room named in memory of her father. They are staying at the home of Linda and Mario Rosito of Club Rotario Guatemala Oeste. Their clubs worked together on a Rotary International grant for Hospitalito Atitlán to get the diesel generator, a photocopier, commercial washer and dryer and more. Great friends and supporters of the Santiago Atitlán community.

Dr. Juan Manuel Chuc met this week with Diputado Antonio Ralda Sarg and Taiwanese Embassador Adolfo Ta-Chen Sun to receive a $15,000 donation towards Hospitaito Atitlán’s ambulance. The funds will also cover training and an emergency fund.

The second group of physicians just completed Hospitalito Atitlán’s Continuing Medical Education course in medical Spanish and culture of Santiago Atitlán this week. Three physicians (and one’s child) studied Spanish.  Family members also joined the cultural tours and talks after lessons. Next course is February 17th to 24th. http://www.hospitalitoatitlan.org/CME/index.php

Wednesday Hospitalito Atitlán welcomed officers from the British Embassy of Guatemala. The Embassy provides funding for community outreach for the Pregnant Women’s Clubs in the aldeas de Cerro de Oro and Chacaya.  In the photo are Program coordinator Victor Ramirez, British Embassy Officers Farah Morán, Patricia Lemus, Steven Wignall, Lyn Dickey and HA social worker VIcenta Chavay. The visit was short but very productive.

Ambulance driver Josué Lacán has a smile on his face because he got what he wished for… a regulator for small oxygen cylinders.

Our friends from the Wisconsin based Farmer to Farmer organization visited Hospitalito Atitlán today with Jody Slocum (right), the group Director. The organization sells coffee and tipica products to raise money for organizations and women in Guatemala. They brought children’s clothing and items from our wish list for the Hospitalito. It is always a pleasure to see them.

When GSF came to Santiago Atitlán for the week of cleft lip surgery, they were so loaded down with medical equipment that one piece had to remain behind at the airport. This week it arrived. Dr. Usama Hamden, president of Global Smile Foundation generously donated an Electro Surgical Unit that is better than what we have been using. ¡Gracias amigos!

This week another clinic for diabetes testing opened in Santiago Atitlán thanks to a grant from the World Diabetes Foundation.

On December 7th at Hancock Church in Lexington MA, many talented young people sang and played classical music to raise money for Hospitalito Atitlán. Joe Blumberg the moderator for the Pura Vida project organized the Lexington High School students and the event. The evening raised $3,800 for the medical care of women and children in Santiago Atitlán. 

During the week of cleft lip surgery with the Global Smile Foundation team, pediatrician Julia Koehler took a photo of the nursing staff, who worked tirelessly during a jam packed week of surgeries. Left to right are two nursing students who are doing their practica, Jacinto, Brenda, Diego, Maria and Walter.