Glimpses of Guatemala and the RVU medical team who ran four clinics treating nearly 600 patients from March 4-13, 2016:
Mi niño no come--le duele el estómago (My son doesn’t eat—his stomach hurts). La cabeza me duele (My head hurts). Los ojos me duelen (My eyes hurt). These are among the complaints treated by the RVU medical team in Guatemala.
Dr. Camille Bentley, DO, director of global outreach, choreographs each clinic from start to finish, pairing students and physicians. She avoids micromanaging, and yet she keeps the pace brisk and operations flowing.
Dr. Lia Fiallos, DO, a board certified family medicine physician, embodies the transformative nature of RVU international trips. Her first medical trip with Dr. Bentley was in 2008 just before the brand-new Rocky Vista University opened its doors. Since her graduation in 2012, she has made at least one trip per year to Guatemala, Peru, or Kenya. This is her ninth medical mission. “As someone who didn’t know how to use my stethoscope the first time I went down there, I also continue to learn on these trips. Different skills are needed when we don’t have the labs and the imaging that we rely on at home.”
At one of the clinics Dr. Fiallos supervises treatment of a patient who is wracked by pain. The team finds an insect in her ear. For nearly an hour, students and doctor work to wash out the ear until it clears.
Margo Tanghetti, a fourth year global track student, leads a case review conference late one afternoon in the palm-tree-shaded courtyard of Hotel Dos Mundos in Panajachel. She discusses a six-year-old patient who has suffered from recurrent urinary reflux since she was a baby. An ultrasound allows examination of the ureter. A referral to a urologist is arranged through SOSEP, the humanitarian outreach group directed by the First Lady of Guatemala.
Next year Margo will be interning in general surgery at the University of California, Davis, before residency in otolaryngology at Oklahoma State University.
Daniel Van Leuven, a fourth-year, treats “a little kid with asthma. In the States, we would give him an inhaler for his wheezing. We don’t have any here. At home we’re constrained by insurance. In Guatemala the constraint is what’s available to use for treatment.” Conditions are similar to what he saw when he was living in Thailand during a church mission. Small, boxy houses may have only three walls, one or two rooms, open-air windows, tin roofs. Nothing is airtight. He recalls being in a Thai home where a skinny cow walked in and out of the house with scant ceremony as if he were a family member.
Dan will be doing his residency at Cleveland Clinic in anesthesiology. He and his wife have a seven-year-old daughter, four-year-old son, and one-year-old son—Dan delivered the last one.
Sara Thomatis, a fourth year, treats a woman who complains of headaches. She instructs the woman to apply hot rags to her head, and she prescribes a course of Ibuprofen for the woman’s back pain. Her patients are also instructed to drink more water, less coffee, less soda.
Sara’s parents have influenced her love of traveling. “I’ve always been proud of how culturally sensitive they are and how lucky they have been to have traveled so many places.” While she hasn’t had the finances or time to travel much internationally, she’s visited all but eleven of the United States. She is headed for a residency in obstetrics/gynecology in Toledo, Ohio.
Daniel Jones, a fourth-year, treats several young patients in the same family for scabies, a contagious skin disorder. Often children may be sleeping in the same bed, and the result is a continuous cycle of skin disorders—scratching, itching, excruciating discomfort. Since the clinic isn’t set up to do a skin scraping to test for mites, he dispenses salves and teaches patients how to keep the skin clean. Daniel thanks a young volunteer from the town for translating Mayan dialects into Spanish. The volunteer asks him about an inter-digital rash on his hands, and he arranges for the young man to be treated at the clinic.
Next year Dan will be at St. Anthony Family Medicine Residency Program in Oklahoma City.
Andrea Dore, a fourth year, says, “The trip to Guatemala was a foreign but welcomed new experience. The diversity of volunteers was astounding. Despite our many different backgrounds and levels of health care experience, everyone came together to provide the very best care we could under sometimes less-than-optimal conditions,” such as a language barrier. “I learned many pearls of wisdom not only about medical and dental care but also communication, teamwork, and camaraderie.”
Next year she will be at San Antonio for Internal Medicine residency at SAUSHEC (San Antonio Uniformed Services Health Education Consortium), the largest residency in the US Department of Defense.
Cody Guggenmos, a third-year, is struck by the fact that patients living in rural areas present fewer cardiac problems, and their blood pressure readings are good—perhaps because the villagers walk up and down steep hills every day, and they farm and eat local nutrient-rich crops. "I really find it amazing that some of the most prevalent conditions that we suffer from in the US are almost nonexistent in this locale. Quite honestly, the discrepancies in wealth don't allow these people to behave in the high fat, sedentary lifestyle in which many Americans engage. It makes sense when you think about it, but it's still very striking to see the difference first-hand."
Anna Austin, a third-year, sees a patient whose bloated belly attests to his complaint of severe pain. She figures out that the way he’s been taking his medications is causing the bloating. He learns what to do differently.
Anna encourages other students and community volunteers to undertake the trip even if they have scant or no medical training. “There’s no way that anybody who wants to help could be in the way.”
Brandon Sonnier, a third-year, treasures the experience of being in another country practicing medicine. “I’m bummed I haven’t done it before.”
Kim Hammernik, a second-year, examines three young schoolchildren who have come with their teacher to a clinic. Kim mimes opening her mouth—at once, the three youngsters open their mouths like baby birds. She notices that children sit for however long the exams take without getting fussy. Likewise, elderly patients including one 90-year-old wait quietly, no cell phones, no flipping through magazines. She’s intrigued by the small stature of Guatemalans, their “tiny kids,” and how they age. “Something happens between the ages of 25 to 40 or so—they start to age really quickly. Older people look really old.”
Jesse Chen, a second year, moves with the ease of a world traveler who has lived and still visits Taiwan in his parents’ native country. While Jesse and Kim are the only second year students on the trip, they are treated as colleagues, and they also find camaraderie in off-hours at night when students enjoy the music, dancing, street markets, and revelry of Panajachel.
Conor Kantrowitz, an EMT finishing his undergraduate education at the University of Alaska, notes that Guatemalans are small persons in contrast to “the big Americans” who staff the clinics. “All this is new to them. They are hesitant to ask questions. I try to help them by showing them where to go. I have learned that I can put a smile on someone’s face, and it puts a smile on my face to do that.” He plans to go to medical school, and this trip affirms his work ethic. “I want to know what’s going on, why, and what I can do to help.”
Michelle Jarrin, RN, runs triage at the clinics. With her are her mother Kathy Jarrin, a community volunteer, and her niece Alyssa Jarrin-Guerette, age eleven. “I like the kids who come to the clinics, and I like helping people. My mother and I want to encourage Alyssa to help less-fortunate people.” She gestures to her niece who is pantomiming tooth brushing and flossing while the man in front of her is copying her motions using his new toothbrush. This is Michelle’s sixth trip. After her first, she encouraged her mother to join her.
Kathy Jarrin had always wanted to do a mission trip. “But I thought since I wasn’t a nurse or doctor, there wouldn’t be much for me to do.” Not so. On this her fifth trip, Kathy seems to materialize wherever she’s needed. “Mostly I help Michelle and Scott (Viñas) in triage, taking height, weight, blood pressures and temperatures, and I also help with registration and patient flow.” She keeps going back because, “I love to help other people, meet new people, and it's a trip my daughter and I enjoy taking together.”
Douglass Crawford, MD, and his wife Barbara, who runs the clinic’s pharmacy, have made four RVU medical trips, including one to Kenya. On this trip, “We gave the best follow-up care [compared to] all the previous trips.” He works for Kaiser in adult primary care in Oakland, California, where patients who have chest pain or other emergent symptoms can be seen immediately in the nearby emergency room. In Guatemala, he refers a diabetic patient who is having new cardiac symptoms to the national hospital in Sololá –his note lists the concerning symptoms in Spanish; SOSEP provides transportation to the hospital.
Dr. Jennifer Goodfred, DO, Memphis, TN, a family medicine doctor, has made three RVU trips. “I like to improvise, using resources in the community and those at hand.” One patient, a young boy, has an ear infection, but the clinic has run out of antibiotic ear drops. She consults Where There Is No Doctor (Werner, Thuman, Maxwell). “It says you use a solution of one-half vinegar, one-half boiled water. We didn’t have either of those. Instead, we used a water bottle, cleaned the rim, used one-half of the purified water from the bottle, and filled the rest of the bottle with peroxide. We taught ‘Mom’ how to apply that with a syringe.”
The wind blows a door closed. A boom reverberates in the large room. “¡La bomba!” cries a patient. Dr. Goodfred lays a comforting hand on the woman’s shoulder. She was probably a child during the Guatemalan civil wars (1960 to 1996).
Another patient is “a little girl, age eleven, not eating, tummy ache, headache, upset at school.” She reassures the mom that her daughter is healthy, has no parasite, no brain tumor, simply needs love, and can be encouraged to play sports.
Dr. Goodfred’s passion for international medicine started with a medical trip to Honduras when she was age fourteen; she went with with her dad, a nurse anesthetist. “My heart hurt when I saw the poverty and filth. Since 1990 I've done something in medicine in Guatemala or Honduras nearly every year. Now I have a family. My husband is also a physician, and he sometimes accompanies me on trips. Since medical missions are more my passion, he encourages me to go,” and he stays in the US with their three-year-old son.
Phil Sullivan, MD, has made four trips with RVU. “I’m very impressed with the overall maturity level and dedication to their profession of RVU students as compared to other students with whom I’ve travelled from other medical schools.” For nearly thirty years Dr. Sullivan practiced in the emergency department in a level one trauma center at Swedish Medical Center in Englewood. He now works at Doctors Care in Littleton in a clinic for the underserved.
Dr. Synneve Skeie, DDS, has brought toothbrushes galore and gives away 600 of them, along with tubes of toothpaste and dental floss. Dental care includes tooth extractions, medicated fillings, cleanings, and fluoride treatments for 100 or so persons.
Under her supervision, post-operative instructions are given in Spanish by medical students Margo Tanghetti, Andrea Dore, Sara Thomatis, and nurse Diane Posada. The youngest members of the medical team, preteens Alyssa Jarrin-Guerette and Tenley Viñas, teach patients how to brush and floss their teeth.
She herself had “quite an adventure.” Boarding the bus to a clinic, she dislocated her shoulder. “Everybody came through to help. I would also say that the quick response of the medical personnel on site made all the difference in the rapid recuperation of my injury.”
Dr. Skeie is assisted by her son Tarek Alameddine. A personal trainer and competitive soccer coach, he says, “Being here fires up my passion, groups helping each other. You step into a space where you have to adapt, where anything is possible. It’s an opportunity for new experience in a place of unknowns.”
Scott Viñas, a Fire Lieutenant who lives in Summit County, Colorado, offers tests for diabetes and pregnancy. He confesses a love for “blood and guts.” He does finger stick tests for diabetes and simple dip-stick urine tests. Once he reported a positive on a pregnancy test—only to learn that the patient was 76 years old. He confesses, “I mixed up two tests.”
He advises the medical students, “Come to serve, work hard, and make sure your heart stays open. You will leave being served. ”His characteristic dedication to his profession and playful spirit are expressed in his motto: "Kids tell me they want to be firefighters when they grow up—I tell them they can’t do both!"
Scott and his wife Carmen Viñas have an intimate tie to Guatemala: their daughter Tenley, an eight-year-old Kaqchikel Mayan whom they adopted when she was an infant. He says, “We want Tenley to appreciate hard work and have respect for her elders, two traits of Guatemalans. We want her to know that life is not all about one person’s benefit. How can we help each other?” Tenley connected last year with her biological family, and now regularly sends money she’s earned in the States to her brothers and sisters.
Carmen Viñas has a background in finance. At the clinics she marshals her organizational savvy to set up and process intake papers, and she functions as “whatever to anybody.”
Diane Posada, RN, Ft. Lauderdale, FL, uses her fluency in Spanish to interview patients. She learns that one woman in her thirties started sewing at age nine to help support her family, and now has numbness in her fingers, swelling hands, and pain radiating up and down her arms and into her shoulders. Another woman who washes clothes for a living says her hands ache. She is given a seven-day supply of Ibuprofen and told to apply ice. But ice is hard to get in this village. Long-term relief for both women is more likely to come from exercises that Dr. Goodfred teaches them to encourage functional movement.
At home in Ft. Lauderdale, Diane works in urgent care and teaches weekly clinicals. She’s also designing a photo journal of the trip and her reflections.
Keven Meyer gives eye exams and dispenses 76 pairs of reading glasses as well as sunglasses. Those who make their living sewing or crafting jewelry or pottery often need spectacles for their close work. Laborers in the fields need sunglasses. One girl is referred to local professionals for cataracts.
On a lighter note, Keven describes going to sleep the first night at Hotel Dos Mundos. As he and his spouse Camille Bentley were drifting off to sleep, Keven heard then saw a figure climbing in through the window by the door. In the half-haze of sleep, Keven squinted at the man and thought he recognized an RVU student. He did—it was Brad Cross. Having no room key, Brad was trying to re-enter his room without awakening his roommates. Keven lifted his head off the pillow and called out with characteristic sangfroid, “Hey, dude, you got the wrong room.”
Graduating fourth-year Sam Plesner continues to expand his medical repertoire while he tutors fellow students on this, his fifth trip. Sam has brought a portable ultrasound machine that he uses for 68 exams during the clinics. One thirty-seven-year-old woman has a history of surgery to remove breast cysts. In the clinic she is distressed because she feels lumps in her breasts and fears that she has more cysts. Ultrasound examination finds simple expected scar and normal breast tissue. She is reassured that no biopsy or surgery is indicated.
A five-month-old boy has a cone-shaped cyst on his anterior fontanel. The ultrasound shows a cyst without signs of complications. The mother is advised to protect the area from infection or cuts, and to seek further medical assistance when the entire fontanel closed. Five pregnant women also get to see images of the new life in their bulging bellies.
Sam voices a conviction that seems to be shared by his fellow medical students at the end of their Guatemalan trip. The trip nourishes the personal call to become a Doctor of Osteopathy. “We treat persons who are extraordinarily in need and appreciative of the services we provide. We get to do procedures and work with patients hands-on at least as much and sometimes more than in typical rotations. This completely unique opportunity reaffirms my drive to go into medicine and encourages me that I’m doing exactly the right things for my life.”
Sam is headed to Spokane, Washington, to the Providence Sacred Heart Medical Center for the Transitional Year program followed by Radiology Residency at the same location.
Margo Tanghetti affirms the bonds and insights she and her fellow medical students have experienced. “I truly loved having such an eclectic group, both medical and non-medical professions.” She calls it “a simulacrum of a bustling medical community in the United States administering productive and thoughtful care. We had so many amazing people working together,” including nurses, doctors, a dentist, dental assistant, EMT, premedical student, and “our own trip historian.”
After the long clinical days, she enjoyed sharing meals and stories outside the grind of medical school. “One of my fondest memories from the trip was playing a guessing game with the two young girls on the trip in the bus after the clinics.” The front of the bus was awash in laughter and fun.
Dr. Fiallos recalls, “I love witnessing the students hone their clinical and interpersonal skills--you see them improve daily while we are down there—picking up pearls from providers, translators, social workers, and one another. My hope is that many of the students will remember these trips fondly and continue to help the underserved both in the US and abroad.”
Dr. Fiallos adds, “My father is from Honduras and has Mayan ancestry. Honduras has unfortunately lost a lot of the Mayan culture that we see in Guatemala. The corruption and level of danger there makes it very difficult for foreigners. So, in an alternative, safer way, I feel that I get to give a little back to my Mayan background through work in Guatemala.” She adds, “I’ve made lifelong friends in Guatemala. It’s also where I met my fiancé.”
Currently studying integrative medicine as a fellow through the University of Arizona (Arizona Center for Integrative Medicine), Dr. Fiallos lives in Denver and works as a family physician in Westminster- at St Anthony North.
She is fond of asking participants on the trip, “See you next year?”
At a celebratory dinner the night of the last clinic, Dr. Bentley no longer needs to be alert to teachable moments nor insist on best practices. Now she offers unstinting praise: “The learning and the medical care that went on was tremendous. I didn't hear a peep about someone else or something not being done, nothing negative, everything seemed positive, everyone going along with the flow, working to pitch in. I'm blessed to have been on fifty international medical trips with students and doctors. This one was a very positive experience for me in terms of support from doctors, health care providers, community volunteers, and local support here from SOSEP. Real synergy. You opened your hearts.” --Carol Sullivan
Note: Carol Sullivan chronicled the trip and also participated in triage at the clinics. She delighted in being a part of the medical team, savoring “the skills, energy, kindness, and compassion of each person.”
She also got to see her husband in his role as an emergency physician. “When Synneve dislocated her shoulder one morning as she was boarding our bus, Phil examined and diagnosed the injury. He asked her if she wanted him to try to reset it. She did. He instructed her son Tarek to pull one way, he pulled the other, and presto, the bone slid back into the joint. Synneve said the pain stopped instantly.”
The villages and peoples surrounding Lake Atitlán have stirred Carol, as they have other writers. “After all,” she says, “here is where Antoine de Saint-Exupéry wrote some of Le Petit Prince. A little prince falls to earth. He encounters loneliness, loss, friendship, and love. And now? Here we are telling our own versions of that same tale.”