"The greater the work the more
important it is to establish it on
a solid foundation. Thus it will
not only be more perfect; it
will also be more lasting.”

St. Louise de Marillac

“Be diligent in serving
the poor. Love the poor,
honor them, my children,
as you would honor
Christ Himself.”

St. Louise de Marillac


A Guatemala Journal – S. Montiel Rosenthal

Saturday, Feb. 24, 2024

It is 6 a.m. when I climb to the patio at the top of our little hotel to greet the morning. From here there is a relatively unobstructed view of the town and surrounding hills and volcanoes. Guatemala has requested international assistance for aerial management of the fires on Agua (volcano) which seem to be spreading even from what we saw yesterday. Further to the west, the volcano “Fuego” belched out a large cloud. It is one of the eight volcanoes in Guatemala that are still “active.”

The rest of the morning passed quickly with packing and then heading by bus to Guatemala City to fly home. I met with each of the medical students and residents and then completed their evaluations.  

They have much to integrate from their experiences. How will they share their experience? What does that learning call them to do as they return to the U.S.? Some of them will return in a year or two – how will they translate medical experience here into service at another level? How will they be as physicians for the future? How will they be advocates for the underserved patients? I look forward to hearing the fine work they will do. They are indeed an altruistic lot and have been a pleasure to work with. We are grateful for a safe journey. Thank you one and all for your prayers along the journey.

Friday, Feb. 23, 2024

We spent our last day of clinic in Chuti Estancia. We had a few pregnant women to see. We encouraged them to initiate their prenatal care through the local health center (Centro de Salud), and have their screening labs completed. While women would do better with a hospital delivery, the distances from home to hospital and limited transportation force many Mayan women to plan on delivering at home. The challenge is to identify those at higher medical risk and encourage them to get more formal medical care and plan for hospital deliveries. </>

Guatemalans are small, not because of genetics, but because of malnutrition as children. Wuqu’ Kawoq has an active program to deal with malnutrition of younger children, to teach parents basic nutrition, provide nutrition, supplements, and arrange for food delivery for the most vulnerable preschool kids.

It is a day of farewell and thank you to our Wuqu’ Kawoq colleagues. A different UC team will return in April. Wuqu’ nurses, physicians and staff will continue their fine work in between. This continuity of care is a hallmark of more responsible care of communities, and helps assure that patients can receive needed care beyond the visits by our five teams a year. We headed to Antigua later in the afternoon, giving folks time to finish medical notes and explore Antigua.

La Merced Church is close by our hotel, and during Lent usually has a temporary sawdust painting on the stone floor. There are usually offerings of local vegetable produce placed around the painting, but I saw only crates of limp greens and ripe tomatoes today. My favorite church is San Francisco. Here lie the remains of Santo Hermano Pedro. He was a 17th century Secular Franciscan, who is beloved for his healthcare, shelter, and education of the poor of Antigua. He would walk through the streets, ringing a bell, begging arms for his ministry. Along the walls of the church are more recent memorials of local Franciscan Friars and laity who have been martyred over the last 40 years or so.

Thursday, Feb. 22, 2024

There has been a forest fire on Vulcan Aqua near Antigua that is only 10 percent contained. You can see that volcano in the picture of the scenic street in Antigua I sent for the first journal entry. Tomorrow we may see the remains when we return. All the volunteer firefighters are engaged in trying to squelch this. The volcano is 32 miles to the east of us, but the haze is getting more dense here. You can smell burnt pine everywhere. Sunrise was just a haze obscuring the view in Lake Atitlan, and tonight, sunset is again a blur.

Today we had been warned the electric company that serves Chuti Estancia would be making repairs, and we would have no electricity. Sure enough, so we used a lot of flashlights. The two faculty who had hotspots we could use on our cell phone plans, shared those with the students and residents so we could still access the electronic medical record, and enter follow-up communication with the Wuqu Kawoq medical staff. I took apart the bottom of the microscope and slipped in a headlamp I brought, and we were in business for the laboratory table.  

Cervantes once said, “The world is full of more sadness than you will ever know.” Children with profound handicaps move our students and doctors with a mixture of compassion and emotional dissonance. They are angered by the disparity between resources their patients can access in the U.S., and what is improbable or currently impossible here. We’ve had chats encouraging them to celebrate small advances, to offer a path for parents to care for their child, to remain advocates for change in a way that will work locally, and to focus on creative responses to what presents itself. We saw a teen today who has epidermolysis bullosa, a hereditary skin disease where pressure o

n skin can cause it to rupture into blisters. He no longer goes to school but stays at home. He insists on wearing a baseball cap to cover bald spots where his hatband has repeatedly rubbed blisters in his scalp. His father is hopeful for a cure, but even with resources in the U.S. this is an awful disfiguring condition. He has a variant which makes the surface of his teeth distorted and prone to fractures. We hope to arrange dental care for him, as well as provide what he needs for skin care.

At the end of the day, we cheered the driver of an overloaded minivan after 10 women finally climbed out so it could make it up the driveway to the clinic. It’s a good thing they will be headed down the mountain. There is no way they would ever be able to pull the hills here.

Wednesday, Feb. 21, 2024

Morning light came early today, as the sky was clearer. I enjoy praying down by the lake when our schedule permits. The clouds are different here as some are created from the smoke plumes of volcanoes nearby. The volcanoes send out little puffs or belch out cartoon-like puffy clouds that spread out low over the horizon when the wind blows. The clouds made by volcanoes tend to be colored a tan-pink-gray and are different from the higher white to pale gray cumulus or cirrus clouds you normally see. In the town many of the motorcyclists are wearing surgical masks, not because of concern about COVID, but because of the smog from vehicles and open fires. We had a shorter ride to Chuti Estancia today, but had to wait for staff to open the building we will use these next three days. In order to be able to see more patients, we needed to tie up another tarp to the rafters to create a “room” with a modicum of privacy. We are down one faculty member as they are indisposed today. We have a larger percentage of Kaqchikel and K’iche’ speaking patients today. Dual translation is important even though it takes longer, and is a key service to provide for patients here. Imagine yourself ill as a tourist in a country where no one speaks anything close to English, and needing medical care. We saw a fair number of new patients today, diagnosing two new cases of diabetes. We also saw a very irritable 10-month-old with stunted growth who has some sort of neurological syndrome, possibly cerebral palsy. He will need integrated care that is possible here but will need coordination and prayers.

Tuesday, Feb. 20 2024

Today we were back in Chichimuch seeing more patients, including some folks I recognize from prior years. I was paired with one of our fourth-year medical students for the entire day. She plans on going into pediatrics and internal medicine, and is working on her master’s degree in public health while in medical school. She is inquisitive, precise in her assessment and recommendations for patients, empathetic, and will be a fine young physician.

One farmer came for trigger point injections. He prefers to use his machete in his right hand and overuses the muscles in his right upper back as he slashes down through scrub vegetation. He has returned in successive years for treatment after schrapnel injuries. Violence reached into the mountains over tumultuous times in Guatemala, and scars are physical as well as psychological for many folks here.

We finish our time in Chichimuch today. The next team will return in April, making sure an 8-year-old gets a formal eye exam. She has a partial developmental syndrome with hypothyroidism. For this small of a community, we have seen an unusual amount of thyroid-related diseases in children, not related to iodine deficiency.

Monday, Feb. 19, 2024

This morning, we wound our way up the mountain on roads that make Mt Hope or Incline Street in Cincinnati look tame. We traveled in a bus big enough for 16 people, not as large as the “chicken buses”, the decorated school buses most folks use in many places south of the U.s. Our bus is barely small enough to travel around tight corners or to pass another car in villages along the way. A chicken bus would never make it to where we need to travel.

The medicines and lab equipment we use were brought in by pickup truck today, and our Spanish to Kaqchikel or K’iche’ translator arrived by car from his home village. Anacleto is a joy to work with, over the eight years I have been coming to the highlands. His passion and gentle caring for Mayan elderly and children from the rural areas are endearing.  He hopes to retire soon from his regular job as a teacher.

Technology here has improved over the years. Electricity and Internet access which we need for record keeping are still spotty, and the software to make communication easier is still a work in progress. I still rely on paper and a pencil as my primary way of recording data, to refer to once the tech is “behaving.”  

Residents and medical students are slowly working through their patients. They are largely on target with their assessment and plan, and as faculty, we offer tips in making plans practical for the local situation. The residents and students are an altruistic lot, and most plan on working with Spanish-speaking patients later in their training and medical practice. It is a mind-bending exercise to identify what the diagnosis and plan are, and then to invite folks to think outside the box in responsible ways. It is the living art of creatively making the improbable possible, something the poor in our world live out every day.

We see from time to time sad cases which become object lessons on the importance of screening medical tests we take for granted in the U.S. We saw an 8-year old boy with significant developmental delay due to undiagnosed hypothyroidism, from birth. He was only diagnosed at age 5, putting him years behind kids his age. He needs daily medicine and medical follow-up, which starts today. This was not his parents fault, but is preventable when people can get the care they need. Our residents and students understand at a deeper level that health care is a basic human right, or at least should be.  

Sunday, Feb. 18, 2024

I was grateful that Sister Pat scraped the ice off her car and got me to the airport before 4 a.m. on Saturday. I was heading down to Guatemala to work with our medical mission in the highlands of Guatemala. I arrived in Antigua to meet the rest of the team for dinner, and get ready to head further west on Sunday. We would need to leave early Sunday morning, as Antigua was closing off all the streets for a Lenten Procession and Stations of the Cross. We loaded our bus and headed west to Panajachel, on the edge of Lake Atitlan. It is only 90 miles from Guatemala City, but it takes five hours on the best of roads. We will use Panajachel as our base for the rest of the week.

As faculty my role is to serve as a supervising physician for our three younger Family Medicine residents, along with four medical students from the University of Cincinnati College of Medicine. We have a driver, one person for logistics, three translators, one family physician from Arkansas, a Global Health Fellow, and a recent graduat from our residency program who is volunteering in Guatemala this year. That seems like a lot of folks, but supports our two-fold medical mission to serve Mayans in the highlands who have limited access to health care; and to model that for younger physicians in a way respectful of culture. Many folks in the highlands do not speak Spanish, and so we work in dual translation into Kaqchikel or K’iche’. There are 32 official languages in Guatemala, making communication a rich challenge.

We have partnered these past nine years with Wuqu Kawoq (Mayan Health Alliance), a NGO founded by former Cincinnatian Anne Kraemer Diaz. They serve at the invitation of local villages and communities in providing health care, nutrition programs for children, empowering women in artisanal work with fabrics, and preserving the local idioms (languages).

Today, while the rest of the team traveled across beautiful Lake Atitlan for some sight-seeing, I had the opportunity to connect with some of the New York Sisters of Charity, who live two hours north (20 miles away) in Santa Cruz del Quiche. I knew S. Nora Cunningham from the SC Federation Novitiate when she was a novice director, and I was a novice.  She loves being in Guatemala and seems ageless.  She is the current Novice Director for S. Mayda Fernandez, who aspires to ministry with young children and women. S. Rosenda Castañeda ministers as a nurse and vocation director.  She also has an interest in local herbal medicine, homeopathy and physiotherapy. Our time together was limited but I hope to meet up with them again.

Tomorrow we head to Chichimuch, one of my favorite villages to visit. More later.

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