Women walk on the streets while carefully placing their feet in the areas not yet soiled by the stray dogs who rummage through plastic garbage bags that line the streets. Unable to afford niceties of street sweepers, clean engines, or even trash cans, the city instead relies on bright colors, flowers, bustling markets, and the inevitable afternoon downpour to shine through. Even through the thick soup of exhaust belching out from passing buses, the flowing colors of women's clothing can be seen. Like many others, Guatemala is a land of contrasts: beauty enveloped by pollution, tranquil people inhabiting cities filled with chaos, and a culture of stamina that belies the chronic disease and pain suffered by many.
42 hospitals cover the 18,000,000 people that live in Guatemala, a country, it is said, whose economic sector is dominated by money sent by US family members back home. 22 official native languages are recognized that have all descended from the Mayan empire. Family members are accustomed to systems that are slow, inefficient, and racist. The free clinic created at Pop-wuj by Guatemalans with the support from the US is, for some, the only healthcare they receive. Following a circuitous route, the clinic first started as an outreach center that focused on building clean stoves and providing day care for women living in the impoverished countryside. Though established by Guatemalans, the organization (like much of the country) is dependent on US donations and volunteers. In the last decades, US/European volunteers interest in international development waned as interest in medical volunteering rose. Reading the writing on the walls, the organization teamed with local doctors and organized a volunteer clinic that eventually grew to what it is today.
Pop-wuj' clinic is not entirely dissimilar to clinics in the States. Spanish-speaking patients, diabetes, hypertension, poverty and, of course, "one last question" as you are leaving the room. As is the trend in the states, medical records are stored electronically on old Linux machines. Teams of volunteers with varying Spanish skills work with local doctors, one of whom is even the daughter of the founders of the school. Getting things done, in some ways, is even easier than in the states: very little regulation exists for medications and labs can be ordered just by paying for them (no doctors Rx is needed). Not having to worry about insurance companies or copay, billing is non- existent, and deciding which medication to give is as simple as determining which medication is in the stockpile that month. Parasites and worn out joints dominate chief complaints, but with joint replacements being the equivalent of 15 years wage, most walk away with Tylenol. A 3% administrative overhead from all donations keeps things slim on the organization front, but, as it does in every country in the world, perseverance and flexibility are the "recipe for success."
My experience was not limited to clinic. Building stoves with chimneys for women living in one room, one bed, tin-metal walled, multi-children, smoke-filled homes was especially rewarding. As was being a first responder to the inevitable motorcycle accidents that happen in the anarchic streets... twice. Even my teachers sought assistance with us for their skin infections and wives with hypertension.
On the eve of graduation from residency, it is nice to reflect on my training and the blood, sweat and tears I have put into the last three years. Being able to slip from a busy, Spanish-speaking clinic and ER in the states into a busy Spanish- speaking clinic in Guatemala makes me appreciate what the long nights and countless charts have yielded. I look forward to the next adventure and am grateful to those organizations, Family Medicine Education Fund and Pop-wuj, who helped make it happen.