By Carol Sullivan
Part I - Clinical Care Before COVID-19
A Wrinkle In Time could well describe our Guatemala 2020 medical trip. In late February our medical team left behind our customary lifestyles in the USA to offer clinics in Guatemala sponsored by Hands for Health Foundation and Rocky Vista University College of Osteopathic Medicine. When we returned three weeks later, accustomed sights had morphed into the surreal. We encountered the CLOSED, CANCELED, and SUSPENDED. In medical offices, which were fast becoming virtual, the dreaded C-word for disease—Cancer-- had ceded first place to Coronavirus.
Threshold—brink, cusp, edge, point, verge. On our trip were 17 medical students, all fourth years on the verge of Match Day when they would learn which if any residency program was to be their first workplace as a physician for the next three or four years. Unknowingly, everyone was poised on the threshold of a global pandemic.
At breakfast on February 25 in Panajachel, trip director Dr. Camille Bentley updated the team about how the coronavirus might upend our medical clinics. Because of the highly infectious nature of this virus, its rapid spread and its incursion into China, Italy, and the United States, our sojourn in Guatemala could end abruptly. If anyone wanted to go home now, ok.
Yet the virus seemed more remote than any lava that could flow from the country’s three active volcanoes. The day before we had boarded a ferry to cross Lake Atitlán to dock at San Antonio Palopó. In a tented area outside the municipal building, we had staged a clinic wrought from chairs, tables, medications, medical supplies, our own labor and that of local volunteers. That night we had walked on cobblestoned streets in Panajachel where vendors and young children sold beautiful textiles and luminous goods.
The morning of Dr. Bentley’s announcement, we had awakened to the sounds of roosters and motorcycles, the sight of palm trees and blue sky. Now a microscopic virus threatened to disrupt our trip, although no COVID-19 cases had been found in Guatemala. We were 17 medical students, 8 doctors, 1 nurse, 1 EMS worker, and 5 other volunteers, and we had planned to offer nine medical clinics.
As it turned out, we did hold those clinics, and we saw 931 patients.
Sam Hart declared unforgettable the group’s experience of dealing with the global anxiety around COVID-19. “This was unprecedented with travel shutdowns and the potential of being quarantined or not being allowed to return to the United States. [We] came together to come up with a rational plan that allowed us to continue to monitor the situation but continue to serve the people of Guatemala. Nobody left early, and people really bonded over the adversity that we faced.”
Patients came—the underserved and the never-served. Lizzie Stoll recalled, “Walking into clinic one day and seeing 100+ patients eagerly waiting for us was an image I will never forget. It was such a privilege to be able to provide care to group of patients who truly appreciated it.” Her cohort Harry Singh was also moved by “the joy on the faces of the patients as we arrived. Someone local made a speech, and they applauded us,” all before a single patient was seen.
Gratitude flowed back and forth as patients and providers greeted each other with smiles, handshakes, hugs. Excerpts from students’ medical notes and interviews offer a kaleidoscope of images and perspectives. Throughout patient care was uppermost. Treatment could bring relief from pain, worry, infection, sickness. Relief also came when student doctors and attendings were able to rule out acute, life-threatening conditions and advise patients on ways to manage chronic problems.
Kiara Blough noted a case that shocked and thrilled her: a 9-year-old boy had started school a year earlier, and his eyes had become itchy, watery, and red from scratching. She recalled, “He was having difficulty in school, constantly getting in trouble for not paying attention. I thought maybe he just had allergies, but on further investigation, I learned that he was almost legally blind. I was devastated for this boy but thrilled to find out the cause in hopes that there was a solution. He put reading glasses on and could actually start to make out words and letters.”
Another transformation came for a 14-year-old who had been “coughing his whole life when exercising.” Krysta Sutyak examined him and heard “coarse rhonchi, wheezing, and little air movement. We were able to give him a nebulizer treatment and some steroids and within 20 minutes his lungs were clear.”
Krysta also saw a woman who had delivered every baby born in her hometown for the last 20 years. The midwife said she had to stay healthy so she could continue helping women give birth. Krysta addressed her diabetes management and chronic ear infection, and she gave the woman osteopathic manipulation and showed her exercises for back pain. “It was rewarding to be a part of her story.”
Meng Smith examined an 80-year-old whose gnarled hands looked like roots of an ancient tree. She noted, “This patient [has] had rheumatoid arthritis for 58 years. He had been using crutches for the last 8 years, but he could no longer walk, and he could not afford a wheelchair. “On physical exam the patient had grossly swollen and deformed joints on both hands and knees. We prescribed prednisone to help decrease the inflammation and acetaminophen for pain relief and signed him up to receive a wheelchair.”
Osteopathic manipulation helped melt jaw pain that a 13-year-old had for 6 months. Kayla Vanderkooi diagnosed him with TMJ syndrome and performed trigger-point OMT. Immediately he felt better. She advised him to be careful when eating hard foods. She placed him on a prednisone course, which was an aggressive attempt to halt the inflammatory process in his jaw, end his chronic pain, and allow him to eat normally again.
Another patient, 17-years-old, told Kayla he felt well except for a chronic cough and itchy throat. Her physical exam revealed “a large hair in his right ear canal that appeared to pierce his tympanic membrane.” She used tweezers to extract the hair, which may have caused his cough, and she also gave him antihistamines in case the cough was unrelated to “the foreign invader.”
Many patients had chronic diseases, scant access to medical care, and new medical conditions piled on top of old ones.
An 82-year-old waiting in a long line told a volunteer that he still was able to farm his land though he had diabetes and had suddenly lost vision in his left eye. Gracias a Dios, his sight was returning. When Harry Singh treated him, his blood pressure was in the 170s and his glucose was 220+. Harry told the man that high blood pressure probably caused his sudden vision loss. Harry vividly recalled, “He was perhaps the most grateful patient I had this whole trip. He shook the hands of myself, my attending, and all those working pharmacy because he was just so genuinely happy that we offered him some care, help, and answers. For me, this was another reminder of how helpful we can be to patients with limited supplies/medications. Sometimes just listening and providing a patient with information/education is enough.”
Tara Bjorklund encountered a 67-year-old woman who complained of recurrent headaches, facial and jaw pain that felt like surges of electricity across the left side of her face. Tara diagnosed the patient with Trigeminal Neuralgia, a chronic pain disorder which she had not encountered in the USA, and she prescribed cyclobenzaprine, because specific neuro -medications were not available.
An 86-year-old man had severe joint pain. Tara successfully performed her first joint injections to alleviate his knee pain, and gave him acetaminophen. The man also complained about itchiness throughout his body, which had begun two years ago when he was placed on medication for high blood pressure. He asked if he could stop taking this drug, whose name and dosage he couldn’t recall. Tara explained the nature of chronic conditions that require continuing medication and counseled him about a range of medications to treat hypertension. She noted that “Several patients would ask if their diabetes or hypertension was cured now that they had taken medication for it.”
One family remains imprinted in Tara’s memory. A mother bought her three children ages 8, 6, and 2. “She was dressed in traditional Guatemalan garb with old stains evident on the bright-colored fabric and each child was dressed in stained clothes, covered in a layer of dirt, and riddled with tears/holes.” Tara recalled, “When evaluating these patients, it was clear that on top of their issues with otitis media, gastroenteritis, scabies and headaches, the main thing impacting their health was their poverty level.” The single mom tearfully described breastfeeding her two-year-old so that he would be nourished, not having money for diapers, and allowing him to soil himself. Tara realized, “Without our presence here there would be no way for this mother to afford to give her children antibiotics, pain medication, fever relievers and information on how to handle some management of infectious disease [that her children had].” Meng Smith helped gather basic living resources such as toothpaste, soap, shampoo, conditioner, and lotions, and Meng felt that even in this way, “It was a privilege to provide care to this family in need.”
Andrew Wojtanowski alongside his professor Dr. Jing Gao oversaw 131 ultrasounds ordered by his peers who in turn were overseen by attending physicians. Andrew described a patient whose life may have been profoundly improved by the treatment she received at the clinic. A 39-year-old woman had a worrisome mass on her neck, and also wanted to hide it for cosmetic reasons. Counseled on the risks of draining the cyst and the likelihood of recurrence, the patient chose to have it drained. The evaluation, imaging, and procedure showed “just how easily we can impact lives in simple ways.” Similarly, Andrew’s own life has been impacted by clinical experiences and his close work with Dr. Gao. He said, “I look forward to paying this education forward.”
Ria Joseph treated a one-year-old who had a hernia since birth, according to his older sister who had brought him to the clinic. The child had “a marked enlargement of the right scrotum. On ultrasound, this was revealed to be a hydrocele [a swelling around the testicle] rather than a hernia with bowel.” Although he was referred to a local doctor, it was uncertain whether the child would actually get that care. Ria emphasized to the patient’s sister “the importance of his being seen and the increased risk of malignancy of undescended testicles at over one-year-old.”
Ria also saw a 22-year-old woman who had missed her period and was experiencing unusual cramping. The patient said she did not need a pregnancy test because, “I am single, of course there is no chance that I am pregnant!” Ria recalled, “I told her we did not need to do [a pregnancy test] if she had truly not had sex, but that I needed her to be completely honest with me. She looked down at the floor and quietly admitted that we should in fact do the test. The test and ultrasound were both negative, and she was extremely relieved.”
Lizzie Stoll treated a 28-year-old who had slid off his motorcycle going around a corner, landing on his left knee and left hand, the day before. He had been wearing a helmet. She ordered an ultrasound that showed he had fractured his first metacarpal. The thumb was splinted, and pain medications were also given. RICE—rest, ice, compression, and elevation—were advised. The man left the clinic whistling and said adios to a volunteer who had joked with him that his skinned knee was “handsome.”
Sam Hart saw a 24-year-old who had been unable to conceive for six years. Her husband’s edict was that infertility was a woman’s issue. An ultrasound revealed “a moderate sized uterine fibroid and normal appearing ovaries. I explained to her that this could be a factor in her inability to conceive, but also educated her that her husband should also be worked up. She found comfort in this because she felt guilty for not being able to conceive and had been shamed by her husband.”
Sam also treated infants and children whose moms worried because they wouldn’t eat. One two-year-old looked well-nourished even as his mother complained that he wanted nothing but her milk. Another five-year-old sat wide-eyed and healthy-looking on her mother’s lap. Sam told these moms that children will eat when they are hungry, and they will adjust to alternate foods. “No one wants a kid to be hungry,” Sam acknowledged. Encouraging good nutrition in a culture where diabetes is rampant and meals are pro-carb—rice, beans, corn, tortillas—is challenging.
A vexing ethical concern that becomes even more complex in global medicine is informed consent. When Kiara Blough underwent hip replacement surgery six weeks before the trip, temporary loss of feeling in her leg made her see why a doctor should never offer a quick, dismissive explanation of side-effects and complications. “The onus is on us” as physicians to be more careful in communicating risks. Even a simple procedure like a joint injection carries risks such as a septic joint which can be a surgical emergency. Kiara plans to become an OB/GYN and she acknowledges that while she “loves to cut and to excise,” every physician must carefully weigh any barriers to communication such as language, health literacy, and cultural differences.
Matty Zemel saw a 78-year-old man who became short-of-breath when he walked; the man also had knee pain and lower leg swelling and knee pain. He took no prescription medications. After an exam and ultrasound, the patient was told he had heart failure and osteoarthritis in both knees. He was referred to a local doctor and given acetaminophen for knee pain. He was also given Lisinopril for heart and blood pressure control.
Jill Nanadiego treated an 18-year-old with painful urination, pain during sex with her husband, and malodorous vaginal discharge. But the clinic had no tests for gonorrhea and chlamydia. Jill noted that the young woman’s symptoms appeared to be sexually transmitted in nature. “She was very mature for her age and forthcoming about her symptoms and sexual activity. She was eager to understand her infection. When I explained how her infection was transmitted sexually and that she could get re-infected if her partner went untreated, she asked if we could also treat her husband. She immediately called him.” Jill treated them both.
A 23-year-old woman had constant nausea and had missed her period. Jill noted, “Most of the patients that I had seen with nausea/vomiting as a complaint were either infectious in nature, food poisoning, or had other symptoms describing gastritis. In the USA, we get a pregnancy test on almost every female of fertile age. However, because I was in a country where infections and food poisoning are common, pregnancy was not high on my differential. But her history and exam did not seem infectious at all, so I decided to get a urinalysis and a pregnancy test anyway. Turned out that the pregnancy test was positive. This pregnancy was a total surprise to the patient. However, when she saw the little heart beating on ultrasound, she cried and told me she was so grateful.”
Compassionate, skilled care can yield immeasurable benefits. Erika Anderson said clinical care was “simultaneously challenging, humbling, frustrating, and inspiring. For me, it was an opportunity to step out of my comfort zone and really remember why I’ve had my head in the books for all these years—to help people.” Small moments can matter— “ten pills of Tylenol, reassurance, education, letting someone know that what they are going through is normal.” As to A Wrinkle in Time, that was the title of Madeleine L’Engle’s acclaimed 1963 fantasy of another sojourn where the unimaginable changed everything.
Part II - Linguistic Labyrinths
Medical students, doctors, and volunteers working in clinics March 2-12 threaded the way through a linguistic maze— Mayan, Spanish, and English. Eight local interpreters, led by Roberto Pérez and assisted by José Días, both of San Antonio Palopó, helped, as did Spanish immersion.
All medical students were required to take one-on-one instruction in a Spanish school in Antigua the week before the clinics. Students stayed with host families. Ria Joseph found, “My host mom would speak slowly, using her hands, and correct our grammatical errors. One night at dinner she shared with us her experience (in Spanish) of being diagnosed with stomach cancer 16 years prior. She told us about her surgery, her daily struggles and pain, and most importantly her attitude and strength. It deeply moved me, and I was so thankful to be able to relate to her in such an emotional way, despite the fact that we live completely different lives and speak different languages.”
Another serendipitous relationship during Spanish immersion brought together Kiara Blough and her assigned teacher-maestra. A bond quickly formed between Kiara, who is studying to be an obstetrician-gynecologist, and her teacher, a nurse. Kiara mentioned that The Vagina Monologues were being staged in Antigua, and she said that she had recently helped produce and act in that very play in Denver. The play’s campaign against violence toward women and children “totally piqued my teacher’s interest.” Kiara, age 30, still feels awe at the bond she developed with her teacher, age 72, as they started talking about barriers to women’s health.
A strong, unexpected, linguistic-medical connection happened when Shay Pradhan, senior pre-doctoral anatomy fellow, worked with Diego, a Guatemalan medical student studying in his native country. “It was a unique opportunity to interact and work alongside a colleague trained in a different health system than my own,” Shay said. “We fell right into step when working with our patients. Diego spoke some English and I spoke some Spanish; we were able to communicate bilingually and feed off of each other. When I had difficulty explaining in Spanish certain symptoms or methods of taking medication, he would understand what I was trying to say medically and ‘translate’ to the patient. Although we learned in such different systems, we both were able to easily converse in the same medical language working together.”
Translators acted like lifelines between student doctors and patients. Annelisa Pessetto admitted, “I was not able to speak Spanish well enough to provide good patient care, and this was overcome with help from my fantastic translator.” Annelisa treated a patient who had a 30-year-history of rapid heart rate, and she effectively used both physical exam and ultrasound. “Her PMI [Point of Maximum Impulse] was displaced laterally and inferiorly. She was diagnosed with valvular heart disease on ultrasound examination. She was treated with 50 mg of atenolol at bedtime and referred to the local physician.”
Body Language
A patient complained of chest pain and el dolor de todas partes del cuerpo—pain everywhere in her body, and she also said she was having problems at home. Torri Igou was impressed that the woman seemed aware of possible connections between the physical and the emotional. A physical exam helped to yield a diagnosis of GERD. Aiming to practice family medicine in underserved populations, Torri appreciates the physical exam as a way to glean more information that the patient cannot verbalize. Torri also encountered misinformation about women’s reproductive capabilities. Several women claimed that cysts interfered with fertility. Torri noted that she never saw a single pathologic cyst on ultrasound, and she counseled patients that cysts are a normal part of a women's cycle which is necessary for pregnancy.
Linguistic finesse
Delivering bad news to a patient requires nuanced yet clear language. Erika Anderson, a senior pre-doctoral anatomy fellow, saw a 36-year-old mom with seven children at her side. She had masses on her arm and chest. Ultrasounds were concerning, indicating the need for additional imaging and biopsy. Readying herself to convey a treatment plan to the Spanish-speaking mom, Erika kept a laser-like focus on the patient, heeding the example of a renowned surgeon she had witnessed many times as he gave bad news in a patient-empowering way. She also consulted Dr. Emily Bender who is fluent in Spanish. Together they told the woman, “There’s a possibility it could be cancer” as they described the next steps she could take. Understanding why a patient wants medical attention requires a similar linguistic and emotional intelligence. Erika saw a 40-year-old man who had uncontrolled diabetes II that had resulted in end-stage organ damage. He had poor vision, difficulty walking, whole-body fatigue, and a high blood glucose reading. “On exam, he had bilateral cataracts, severe bilateral diabetic neuropathy and ultrasound showed kidney damage. Because we had no insulin available, we didn't feel it was pertinent to interfere with his DM [diabetes] management, particularly because he has a primary physician who manages it in the local town. For pain, we encouraged hydration and Tylenol use.” Erika had never encountered a patient with end-stage organ damage from diabetes, nor “a fully functional, mentally competent patient with a blood glucose in the 400's.” As she listened to the patient, she realized that “he was mainly seeking reassurance, and help with his bone pain and headaches, and fortunately there were options available for this.”
Every student endorsed this trip as a positive learning experience and recommended it to others. Ria Joseph advised: “1. Brush up on your Spanish ahead of time and be willing to learn! 2. Study parasites and fungi that are endemic to the region, and how to treat them. 3. Keep a positive attitude and know that it's ok to not know everything as long as you are willing to work hard and learn-on-the-fly.”
The Other C-Word in Spanish & English
While COVID-19 was never named in the clinics as a concern, a 16-year-old did say she had the flu. Swathed in a black scarf covering her mouth, she sat in triage with downcast eyes. Her vitals were taken, she did have a fever, and she was fast-tracked to sit in a single chair removed from some 20 other waiting patients. Michael Neinast saw her immediately. He noted, “Her temp was 38.3 so before I did anything else, I got a surgical mask, removed the eye shield, and gave it to my patient to wear. We talked about her symptoms, which included subjective fever, chills, mild dry cough, and malaise.” Michael verified that the young woman had actually used the word ‘flu’ rather than the Spanish word, “gripe,” a more general term for illness. He said, “I felt it important to differentiate the two upfront. More importantly, though, was the fact that this young girl was so tearful during our interview. I was never able to find out why she was so tearful, but I tried a few times to console her and reassure her that she's young and healthy and that this isn't a fatal illness. She seemed to understand but there was something lost in translation about her emotional response.”
Michael later said, “I never really considered COVID-19 for this patient. We were in a remote enough town, the patient was young enough, and Guatemala had no reported cases. This was enough for me to feel very comfortable ruling it out early.” The first case of COVID-19 was announced in Guatemala the next day and was identified as a man who had flown from Italy to Mexico to his home country.
As to Coronavirus, Jill assessed its impact on the trip: “We were the class that dealt with the fears of COVID-19 while abroad. Would our trip get cut short? Would we be able to get home? Would we get stuck in quarantine? Despite all of these fears and uncertainties, one thing that I love about my class and our group is that all of us, without hesitation, agreed to stay the whole time and continue to see patients. That unquestionable dedication will definitely stay with me and affect my attitude in the future when I go out in the next coming months as a newly-minted doctor in the face of COVID-19.”
Unquestionable dedication in Guatemala on the threshold of a pandemic that would soon require them to work as resident physicians in its throes.
Part 3 - Attendings & ‘Ayudantes’ On & Off Chicken Buses
“Her name was María José,” Annelisa Pessetto said of the retrofitted bus that carried us to clinical sites. “She was beautiful, and our driver was a magician, able to get us through small streets and up and down impossibly steep cliffs.” Colloquially known as a “chicken bus” (spelled “chiken” in Spanish), the vehicle clambered up steep winding roads, squeezed through narrow streets, and bounded along dirt paths that would challenge a military jeep. Our driver Gabriel remained tranquil as he steered around hairpin curves and showed his dimples every time we spontaneously applauded him. Dr. Phil Sullivan called him “Angel Gabriel,” and the angel dubbed the doctor “San Felipe.”
Chicken buses carry workers, school children, and tourists throughout Guatemala. On board each bus next to the driver stands an ayudante, an assistant who functions like a co-pilot, periodically jumping out of the bus to guide the driver. Each command shouted by the ayudante coaxes another: “Dele, Dele , Dele” means to back up; “Dale, Dale, Dale” directs the driver to go forward; “Paré!” means STOP. The skills and judgment of the ayudante are as essential as those of the driver.
Similarly, many persons on our global medical trip might be deemed ayudantes, all essential. As the primary providers who treated each patient, fourth-year medical students acted in the role of drivers. They discussed each case with attending doctors. Other crucial roles were performed by a triage nurse, an EMS, spouses, and other volunteers. Keven Meyer, spouse of clinical director Dr. Camille Bentley, was everywhere yet nowhere, never in the way, directing traffic and serving as community liaison through smiles, gestures, and keen awareness.
Acts of kindness also brought significant medical care. One day Dr. Lia Fiallos, an RVU graduate, heard that local registrars were pleading for a doctor to see two patients, even though the clinic had just closed. Dr. Lia grabbed her stethoscope and located the patients seated on a bench in a small entryway. Buenas tardes. Qué pasa? A mother cradled a baby wrapped in folds of a thickly woven blanket. The infant’s tear ducts had clogged; Dr. Lia reassured the mother, telling her that a warm cloth on his eyelids would clear the infant’s vision. Next she turned to a hunched, white-haired woman. The elderly patient had calloused heels; medical students scrambled through packed bags to find a salve. Examining a wart on the woman’s hand, Dr. Lia reassured her that she could wait to see a physician on the next visiting medical team.
Dr. Jennifer Goodfred carried a worn, beloved copy of Where There Are No Doctors. Undaunted whether facing cultural or medical gaps, she never seemed short of ingenuity. If medical supplies were insufficient, Dr. Jenn would improvise. Her credo is simple— “Everyone has a story, and it helps to be aware that it’s different from yours.” Dr. Jenn’s story is layered with understanding of what it means to be poor, since she experienced such a life in her youth. Her optimism rarely flags. “What motivates me is to think what I can do and to get others on board. I am not easily discouraged.”
Two of the attendings were in the same residency program in Fort Collins. Dr. Emily Bender, a second-year resident, and Dr. Brianna Anthony, a third-year resident. These international clinics treat common health problems that might otherwise go untreated, both physicians noted. Dr. Emily said that patients with chronic conditions such as diabetes and hypertension rely on sporadic clinics. An MD, she lauds osteopathic doctors’ skill in Osteopathic Manipulation Treatments, which can be “really helpful” for chronic conditions such as back pain.
Dr. Brianna, a DO, cited a maternal concern that might otherwise go untreated is one that may be associated with shame. In Guatemala miscarriages are often unattended at home, and many women feel they accidentally caused it. It is important that doctors educate patients that the vast majority of miscarriages are attributable to genetics.
Dr. Bri’s husband David Cummings dispensed reading glasses. During a break one day, he said in an interview that as a civil engineer, his eyes were drawn to the makeshift structure of buildings in each pueblo. He noticed protruding rebars on most buildings, unplanned and half-finished, and roofs made of steel sheeting. Men hand-mix water and lime to make cement for masonry. Most everything is built by hand. No accommodations are typically made for accessibility for those who use crutches or wheelchairs.
Kathy Jarrin and her daughter Michelle Jarrin, an RN who has worked triage on these and other RVU trips, have been coming to RVU global clinics for eight years. Kathy finds she is “still excited each time by the simplicity and beauty of Guatemala.”
Twelve-year-old Tenley Viñas, adopted in Guatemala by Scott and Carmen Viñas when she was ten days old, helped weigh and measure patients. In one clinic she was surprised that a pair of twin girls, 30 months old, were the same height, the identical weight. Tenley’s dad Scott, a lieutenant in Summit County, Colorado EMS, was known as the fireman-bombero who used knee pads to be eye-level with patients as he gave them finger sticks. Patients would find themselves smiling as he caught their eye and winked or spoke in ways he deemed “the universal language of friendship.” Tenley’s mom Carmen worked at the registrar’s table and befriended staff from an office affiliated with Guatemala’s presidency.
Dr. David Gray, an attending physician, spouse Denise, their daughter Kayla who is a medical student, and Kayla’s mother-in-law Karen Vanderkooi brought their prodigious work ethic to the clinics as well as their inimitable stories. As a family, they sought out a young man whom Kayla and her dad had met on previous medical missions. Adonias had severe scoliosis that caused his spine to twist and inhibit the growth of his thoracic and abdominal organs. Kayla remembered that “his trunk resembled the shape of a rectangular box.” The group leader of those medical missions was able to marshal financial, medical, and diplomatic resources, and Adonias underwent surgery and physical rehabilitation in Spain. The Grays hadn’t seen him since his successful surgery 12 years earlier. While working in a clinic in Adonias’ hometown, Kayla and her dad were able to see the young man, now age 19, spine erect, in a happy, tearful reunion. They learned he was in medical school. The next morning, the last day of clinics, the Grays were aglow with the story of their poignant reunion.
On a Sunday afternoon several medical students including Kayla connected with a broad swath of the country outside of clinics. Matty Zemel said they rented motorcycles and saw a country shimmering with flowers, crops, and tiered farms. Along the way they experienced local food, spontaneous conversations with townspeople at various stops, and unexpected sights like “a wheelbarrow full of eggs on the way to market, and farmers toting bags of produce on horizontal sticks lashed together to create a stiff backpack.”
Nearing 5 pm after our last clinic, our bus backed into the drive of our Panajachel lodging—Dos Mundos. An aide to driver Gabriel jumped off and jogged to the rear of the bus where he called out Paré! The bus was parked, the engine shut down, and the medical team dragged medical supply bags off the bus and headed to their rooms to get ready for a special dinner that night.
A final indelible experience was a celebratory dinner. Kiara Blough offered a toast to Dr. Bentley on behalf of all global track students. She reflected, “I truly believe that we do not share often enough the impact people have on us and how much we respect them. I was thrilled to honor her and share how significantly and positively she [shaped] our experience in the global medicine track.” On that last night in Panajachel the sun set behind the mountains encircling Lake Atitlán as the landscape bid us Hasta luego.