A Surgical Team Success

At 7am on January 15th, Dawn Stapleton’s Minnesota-based surgical team gathered in the education room at the Hospitalito to go over the plan for the week’s surgeries. Some group members had been coming to Guatemala since the early 2000s, and for others it was their first exposure to the beauty of Lake Atitlán.

After the short meeting, the group came downstairs to see almost 50 patients and their families crowding the waiting room, awaiting their evaluation for surgery. Each patient spoke with the surgeons and anesthesiologists with the help of translation between Tz’utujil, Spanish, and English to determine their eligibility for surgery. After seeing the doctors, patients spoke with Dr. Chuc, the hospital director, and Vicenta, the social worker, to schedule their surgery and discuss pre-surgery directions such as not eating or drinking anything after midnight the night before. By 4pm, all patients had been seen, and most had been scheduled for surgery. The team went home tired but happy after a successful first day. 

For the rest of the week, the team arrived early to begin the day’s procedures. They repaired hernias, removed gallbladders, and took out cysts and other masses. For many patients, this surgery represented the end of a long period of waiting for treatment- one woman had had a hernia for over 14 years.

The week was truly a team effort between local Hospitalito staff and the visiting team members. Despite language barriers, the team’s nurses worked together with nurses from the Hospitalito to prep patients for surgery, and the surgical staff collaborated with HA doctors for post-op care. 

Pre-op nurse Stacy with Dolores, HA nurse

This general surgery team is one of about five groups that come every year to provide specialty care at the Hospitalito. The services they provide include gynecological surgeries, ophthalmological surgeries, cleft lift treatment, and dental services. However brief, this access to specialized, high-quality care is invaluable to the communities around Atitlan. We are incredibly grateful for the work of these groups, and are always looking for opportunities to host additional surgical teams at Hospitalito. 

(from left to right) Steven, medical student, Greg, nurse anesthetist, Jim, anesthesiologist, and Lisa, nurse, in the OR about to begin a surgery

By the end of the week, the team had performed over 40 surgeries, and they were awed by the gratitude expressed for their work. “I had a patient who only spoke Tz’utujil, and the translator kept going on and on with continuous thanks and gratitude. Another patient gave me her rosary,” noted Dr. Stapleton, coordinator of the surgical team. Dr. Jim Turner, the team’s anesthesiologist, explained why he returns every year: “I keep coming back because who wouldn’t. It’s a beautiful country with beautiful people… Once we’re here it’s such a great time. Everything flows.”

The whole team at the end of the week

Welcome Back!

As we wrap up another year filled with patient care, community outreach projects, and generous volunteer work, we are excited to re-launch the Hospitalito Atitlán Blog.

dr-ken-1Earlier this fall we were grateful to have Dr. Ken Dolkart, an Internal Medicine specialist from New Hampshire, as a volunteer. Here he shares his experience spending an afternoon at a Día de Salud, or Health Day, a program funded by the Strachan Foundation that provides provisional clinics and health education in three rural communities of Santiago Atitlán.


* * *

We pile equipment and ourselves into a pickup truck that soon climbs the roads south of Santiago Atitlán. Javier, a volunteer gynecologist-obstetrician from Spain, Chelsea, our Global Health Fellow and Family Practitioner, Bianca, program coordinator, a cadre of support staff, and myself are piled in amongst the medications and other supplies. Curving mountain roads are obscured by a rising mist, but the driver, Lino, knows the route to El Carmen Metzabal well. This is a finca, or plantation, whose impoverished workers grow coffee beans for export.


Patients wait for treatment outside the clinic at Carmen Metzabal

The clinic is a two room shelter from which a bare electric bulb hangs by a single wire from the ceiling. Wooden benches and tables serve as intake, and a makeshift pharmacy accommodates the needs of waiting mothers and children.  A generator across the street starts, lightbulbs come on, and as chickens scratch next door, a portable ultrasound machine comes to life. In the adjacent room, numerous expectant women receive expert evaluation with, paradoxically, state of the art technology for maternal-fetal health.


A family being seen at the Día de Salud

This afternoon, we treat at least 30 women and children contending with infectious diseases such as diarrhea, parasites, impetigo, and dengue fever as well as diabetes, hypertension, anemia, respiratory ailments and nutritional issues. Although the larger unsolved issues related to poverty clearly lie before us, here there is regular care that would otherwise go unprovided for this vulnerable population.

Dr. Andy wright and family

Dr. Andrew Wright & familyDr. Andrew Wright, his wife Blossom and four children from Wisconsin are finishing up a month in Santiago Atitlán. Dr. Andy is a family practice physician who has completed a surgical obstetric fellowship. He is filling a great need at HA this month by covering for emergency C-sections. Here they are enjoying lunch at David’s little comidor next to Hospitalito Atitlán. Beautiful family… we wish they would stay.

Morning report

We are sometimes asked if morning report continues in the absence of medical volunteers. Yes it does, every day at 7:30 AM.  There is less training when there are not volunteers, so we hope that some apply soon! Dr. Andy Wright from Wisconsin is here to volunteer for one month with his wife and four children.morning report

Managing Diabetes in Santiago Atitlán

Hospitalito Atitlán’s dentist, Dr. José Alejandro de Leon Villatoro leads a training on how diabetes affects dental caries. Many speakers are involved in the two day course funded by the World Diabetes Association in Denmark. The participants will be educating and working in community health clinics in Santiago Atitlán and using equipment supplied by WDF.WDF cap. dentista

8th Graders raise money for HA

Maureen “Molly” Wolfe is a midwife in San Jose California. She is visiting Santiago Atitlán with her son Joseph Ammirato and his friend Travis Burnell, and they volunteered at Hospitalito Atitlán over the weekend, packaging vitamins and cleaning the shelves in the pharmacy. Josue came in on a Sunday to lend a hand. Discovery Charter SchoolJoseph and Travis have also been busy fund raising by making jewelry with classmates at the Discovery Charter School. They donated $1000! Beautiful jewelry and great work. Thanks!

Justin Freeman’s senior project

Justin Freeman donation

The John Caroll Catholic High school in Meridian Maryland requires that seniors take on a community project before they graduate. Justin’s sister Candace had returned from Guatemala with the University of Pennsylvania nursing school as he began his senior year so he became inspired by here work at Hospitalito Atitlán. Justin began sharing the Hospitalito wish list with classmates, church members and family and succeeded in filling six suitcases with a little bit of everything from our list. Today the family delivered the donation and toured the hospital. Candace came too with her friend who had also volunteered. Amazing work Justin, thank you and everyone who made his senior project a success!

Dr. Justin StormoGipson

Eye surgery jornada

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.

Goodbye Brent, Jennifer, Cristobal, Elizabeth, Juliana and Nicolas

Brent & Jennifer

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 receives environmental prize!

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!


Diabetes testing in the Park


victor & carmen in the park

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.

Thank you Johanna and Nathan!

15 degrees north latitude

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.

Nathan Boddy giving the keys to Dr

Primeros Auxilios


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.

Toyota pick-up coming our way


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!

Sofia with the twins


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

University of Rhode Island


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.

resident chemical biologist


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.

Fundraising for the LAB!


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).



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!

East Salem Rotary

east-salem-rotary.jpgOur 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.