Antigua

Ah, another night on call = another night of solitude and sleeplessness due to the sounds of nature in Guatemala (cows, chickens, people, dogs). Que bueno.

So, I will follow up Jing´s post with a post about our FAVORITE city in Guatemala thus far...ANTIGUA!!!!

People who do not know much about Central America other than the fact that some Spaniards came over on big horses, spread some disease, and killed some folks and now everyone here speaks Spanish probably won´t know what Antigua is. I certainly had no idea what Antigua was before I came to to Guatemala. In fact, I didn´t even really know where Guatemala was. Oh what a new cultural experience!

Being the travel fiends that Jing and I are, we braved the high prohibitory cost of traveling in Guatemala (private shuttle for less than $30 together) and packed our bags for Antigua. We arrive Friday night and met up with our long lost friends from Xela: Brunce, Linda, Julie, Jacob, and a new friend Letiza. We had a beautiful dinner at Las Palmas filled with stories, filet mignon, cliantro fish, and free copas de vino courtesy of the down-trotten turist industry.

We decided to stay in a mid-range hotel called Casa Rustica in the heart of the city less than 1 block away from Central Park (every city seems to have one of these here) for a little over $50 a night. The first night we were given a triple because they had run out of doubles and the following night, they decided to switch us to the matrimonial suite. Ironically, the latter habitacion was not nearly as nice as that from the first night. However, overall the hotel was very nice with private showers and a clean environment. Because it was so close to the city center, the music from the many venues of live music permeated our walls until almost 1am.

After dinner, the lot of us decided to go out and explore the town. We were SHOCKED to find that the town had sidewalks suitable for walking, only a small handful of stray dogs, and most surprising of all, NO TRASH on the ground. This place was spotless. Ruins lit up in the night and tourists and well to do Guatemalans alike roamed the streets; some barachos, others just out to have a good time. Plenty of police on every corner and open cafes, bars, and restaurants gave Antigua a very safe and fun atmosphere. Look, we even found Wifi in the park. How many US parks can boast this??

Beautiful Cathedral sitting right by Central Park lit up in the night

We soon found ourselves wandering into a bar called Fridas, for a tribute bar to Frida Kahlo. Everything in the bar resembled Frida or Mexico in one way or another. We got some delicious drinks and listened to a very talented singer perform live on stage. Jing was especially impressed by his ability to play the kazoo and make other unusual sounds with his mouth while playing the guitar and singing.

The next day, Jing and I fulfilled our craving for bagels. OH FINALLY some decently made bagel-wiches with cream cheese that tasted like cream cheese. It was at a beautiful little shop called the Bagel Barn. We weren´t surprised to find that 100% of all customers are American. After all, what other country boasts as large a bagel industry as ours. Maybe Israel?

Following a delicious and much anticipated breakfast, we embarked on our touristy journey to discover what this city is all about. Most tourists we hear come to Guatemala solely to visit Antigua. However, if one were to visit Antigua only, he or she would have a very skewed and distorded perception of what Guatemala is like. This clean, well paved, wealthy, and very international side of Guatemala is in fact not Guatemala at all. Antigua is as Guatemala as Cancun is Mexico. That being said, it is by far the most beautiful and liveable city in Guatemala, in my opinion. Instead of doing a guided tour which would have set us back $25 a person, we decided to use Letiza´s Lonely Planet book and follow their ¨suggested walking tour¨. We visited beautiful 17th century churches destroyed by the awful terramoto as well as artisenal shops, photography studios, and more churches. I think we can safely say we managed one or two sites then took a nice long break and then one or two more sites. We perhaps saw 25% of what was in the book before we decided to call it a day, play some cards, and go to dinner!

The famous arch that was used as a passageway for nuns, whom did not wish to be seen by the public, to cross the street

Merced Cathedral with a lily pad fountain in the middle of the courtyard.

Ruins from the earthquake almost 250 years ago left as was.

Desecrating the famous site (not really).

We really liked the ruins and all for Q3!

For dinner, we all went to a delicious Thai restaurant called Cafe Flor in the heart of Antigua. While it was much more expensive than we were used to paying, the food, at least for me, was phenomenal. I got the traditional quote unquote pad thai and it was slightly soupy but delicious sabor nonetheless. There was also a piano bar where a couple sang Don´t Cry for me Argentina. Despite the request, Jing was about to cry anyway because of how depressing the singing and playing were. We scadaddled and found a much more livelier spot...MONO LOCO (funky monkey).

What a fun albeit slightly inappropriate shirt! Love the mono.

I can´t go anywhere without coffee and luckily we found one of THE BEST coffee shops I´ve ever been to, the US included. It is called Tretto Cafe. It is owned by a guy who calls himself Frosty (because he was a fat kid and reminded his parents of the snowman) and started up a boutique coffee joint. Not only does it serve excellent coffee that is prepared professionally, it also provides a great environment to meet new people and chat in both English and Spanish. Guatemala doesn´t have good coffee for sale in the country as previously mentioned but there is a coffee culture starting up. For a very reasonable (but expensive for locals) Q15 per cup, you have a selection of some of the best local coffees. The same coffee which sells for Q75 a pound (<$10) at Tretto sells for $23 in the states from Intelligentsia Coffee. I should´ve bought a pound there...DARN. Please check them out at Tretto Cafe.

Enjoying a great cup of coffee and conversation

Central Park Fountain in Antigua. It works! Unlike the one in Xela and in fact everywhere else in Guatemala we´ve visited thus far.

La Familia

While in Santiago Atítlan, Jeff and I are staying with a lovely family of sisters Lolita and Chonita y sus padres. The family has lived in Santiago for many generations and is quite well known in town. In addition to running the homestay for UVA students and volunteers of other international NGOs, the sisters also manage small convenient shop and embroid beautiful clothing for weddings. The father is in his sixties, but you'd never be able to tell just by looking at him. For someone who has worked his life away on a farm, he looks pretty darn wrinkle free. He leaves the house around 4 in the morning, rows a cayouko to his farm, and tends to his coffee and avacado plants. He comes home right before lunch with fruits or fire wood from his farm.

La Madre embroidering a new pair of pants for her husband.

Their home sits on top of a hill and has a perfect view of Volcán San Pedro. Our second-floor suite has a bedroom, adjacent kitchen/dinning area, and a small bathroom next door that is under our private staircase to the rooftop. While simple, there is plenty of space, privacy, light, and comfort. The bathroom is seriously compact, Jeff feels a littlle claustrophobic using it. However, it is beautifully tiled and has all the hot water we want in the shower (after Xela, we definitely appreciate both qualities). The big bedroom window overlooks the prolific lime tree in the courtyard and of course, San Pedro. The courtyard wraps around one side of the house and has more fruit trees, a big washing basin, and a fowl coup. Yep, rooster, hens, and geese all right behind the house.

Jeff in action

I can wash my feet in the shower while seating on the toilet if I ever feel inclined to do so.

Every morning, Jeff and I wake up to the sound of one of the sisters clapping her hands together, making the family's daily supply of tortillas. She is still at it when we come downstairs to sit in the itty-bitty kitchen for our breakfast. Our Guatemama in Xela never made her own tortillas, so this is a treat for us. Their hands work so fast, completely second nature. Each tortilla looks exactly the same as another, perfectly round and thin. After a few minutes on the wood stove, the black tortillas (made with black corn) come to the table and disappear into our eager tummies.

I love eating by the stove fire, chatting with the family, watching as they cook delicious foods, and listening to Chonita sing. The kitchen fills with family warmth. Sometimes though, they are busy with other thing and leave after setting our food on the table. Strangely, this is when Jeff and I start to feel the lack of space in the kitchen, notice the fully - occupied strip of sticky fly-trapper hanging in the middle of room, and other oddities in the kitchen.

The women of the family are all wonderful cooks! For breakfast, we always have a big portion of fresh fruit cocktail consisting some combination of banana, watermelon, pineapple, or papaya. Along with fruit, we also get pancakes, french toast, or mosh. I LOVE mosh! It is a big bowl of hot oatmeal that the sisters serve with lots of bananas and vanilla cookies. We always feel so full after breakfast.

Chonita working at the table where we also eat our meals.

After a long morning in clinic or the ED, Jeff and I race home to lunch. Today, We had an awesome roast of beef with squash, carrots, corn on the cobs, and potatos as well as a vegetable soup. In the past, we've had delicious chow mein, tacos, hearty soups, and some of THE BEST fried chicken I've ever had. It's so hard to come back to work after such meals.

Dinners are simple and small, nothing too memorable. Jeff and I always end up snacking or going out for more food later in the night. All in all, we appreciate that there is a lot of vegetables and fruit in our diet, and that the food is amost always delicious. We also love that meals are ready when we come home or wake up. Oh my goodness, almost forgot to mention that the sisters wash our laundry and bedding weekly for no additional charge. How spoiled we've become. :)

Crazy amount of rain almost everyday here. This specific storm closed the roads to Gautemala city yesterday. We hope the roads will be open for us to travel and fly back to the US tomorrow!

Quila´s!

Oh Santiago Atítlan, you are so lovely without tourists. But at night, you are . . . too quiet. For the first few nights here, Jeff and I were so studious and productive because we had zero distractions. No internet, no TV, and having already beat all levels of Angry Birds, we buckled down to study medical Spanish and read Spanish literature for "study breaks". If you know Jeff, you then know he was dying for coffee shops or any establishment with people around. So you can imagine our joy at hearing about Quila's.

Quila's is a restaurant/bar/lounge in Santiago owned by a Belgium man named Martin. He has lived in Santiago Atítlan for over a dozen years. He finally got tired of asking other people to open a bar here and decided to go for it himself last year. The place is fantastically welcoming and the food is delicious. Jeff loves the nachos and spicy peanuts here. My favorite is the delicious bacon burger with some magical sauce. The prices are super reasonable so we don't feel guilty about having second dinners here almost every night. We always show up towards the end of happy hour and get two beers for $3, dinner for another $3. Sometimes, I splurge and get dessert. Martin's wife Amanda is from LA and bakes for the restaurant. I am obsessed with her chocolate chip banana bread.

Finally, drinking that double Gallo for your birthday, David!!

Martin and Amanda really created a fun place to hang out. Quila's has a dozen board games, free wifi, and very comfy couches. Every night, we see fellow Hospitalito volunteers and meet other foreign NGO workers here. On thursday night, Martin hosts a poker tournament. The buy-in is Q200 or $25. Our first night here, Jeff was slightly tipsy when he excitedly agreed to join the next tournament. He spent the next few days regretting his decision as if he already lost $25. The night of the tournament, he totally rose to the challenge and came in second place, winning Q160 in addition to his buy-in.

On Sunday nights, Martin rearranges the lounge and hosts movie nights. These movie nights make ending weekend travels slightly less painful. Martin has quite a selection of movies; agreeing on a movie is sometimes a problem amongst guests. Comedy seems to always win.

movie night set up

Because Quila's and Hospitalito volunteers are tight, they happily deliver to those who are on 24-hour call. In Santiago, this delivery service is unique and so appreciated. I know I have gone on and on about how wonderful this place is, I promise they didn't pay for this blog post. But honestly, if not for the fact that they close on Monday and Tuesday nights and that we travel on weekends, we´d be there embarrassingly much.

cards just the two of us

vocabulary cards on the table to help us learn espanol

EcoSpanish School

Because we are hardco´ about this learning Spanish business, Jeff and I manage to fit lessons into our work schedule. The only weekday we have off is the day after each of our 24-hour call duty. So we rest in the morning then attend a 3-hour one-on-one session in the afternoon at EcoSpanish School.

The incredible setting of our Spanish classes. Hard to always focus on learning Spanish when the day is beautiful like this.

Throughout class yesterday, several hummingbirds hung out with us. It was totally magical.

EcoSpanish School takes place in the yard of a beautiful home own by an American from Washington. He is responsible for starting and maintaining the rescue squad in the neighbring pueblo San Juan. We haven´t met him because he returns to the U.S. during rainy season. In exchange for using his property for EcoSpanish School, the program maintains his garden. Also, part of our tuition funds 50 scholarships for the local children. Pretty impressive way to have a sustained and meaningful relationship with the community!

close up

My Spanish teacher here is Gaspar de San Juan. He is very young but very well spoken and passionate about sharing his language and culture. Gaspar is interesting to listen to because not only is he well educated and acutely aware of world affairs, he is also a firm believer of Mayan traditions. He told me today about the professions that Mayans believe one has to born into. For example, he was determined at birth to be a consejero, or an advisor, which is the most highly regarded. His 18 year-old new wife is a sobador de hueso, a bone healer.

These two photos are from Bambu, a restaurant&hotel next door. It's a beautiful, removed world unlike anything else in Santiago Atitlan.

Casa Del Mundo

Most.Beautiful.Place.Ever. That´s really all I have to say. Rest will be told in pictures. We live the hard-knock life here.

View of Casa Del Mundo from the lake. It´s built on the cliffs overlooking the lake. Started by an Alaska-Guatemalan couple 20 years ago and they´ve been building it ever since. Absolutely gorgeous.

Up close view of a patio that is underwater. Every year during the rainy season, the water rises dozens of feet submerging portions of property. This is completely expected. We actually initially thought this was a lake side bar and so did other tourists not aware of the drastically changing water levels.

Beautiful, intricate, and sometimes steep stone stairwells permeate the property leading lodgers from one portion of the hotel to the next.

The speed boat dock where JIng and I wait for the next lancha or speed boat to take us to other towns on the lake. It also offers a breaktaking view of the lake. Note the birdhouse on the right. Jing really wanted it in the photo.

Very European and magestic feel. Fountains, flowers, pottery are scattered throughout the property. You fell like you´re walking in a small European city or botanical garden.

Am I still in Guatemala??

I bet the owners had so much fun collecting these items and dotting the property with them.

Beautiful patio where Jing spent much of her Sunday listening to the ripples on the lake crash into the cliffs.

Our private balcony.

Early morning sunrise over Lake Atitlan

Our view right above our private balcony over Lake Atitlan in the wee hours of the morning.

Kayak rentals!

First time sea kayaking in a double...needless to say, the things prevening water from entering the boat, didn´t do such a good job keeping my pants dry.

Jing and I realy strive for the authentic Guatemalan experience by laying in the hammock. Here, I spent most of my Sunday morning moaning and groaning from over application of my 40% DEET lotion. I learned first hand what DEET tastes like, and what happened when you get too much systemic absorption/swallow DEET.

Hospitalito- Week 1

This week, Jing and I began the 2nd half of our mission in Guatemala, to work in a healthcare facility. Here, we treat patients and learn medical spanish unde the not so watchful eye of other physicians. Unlike the US, few physicians here will want to see the patient after the students see them. More ofthen than not, they just sign off on the chart, your prescriptions, and a return visit date. The 1st day of work was, how do you say.....useless. Initially, Jing and I were wrongly sentenced to work in the farmacia and bodega under false assumptions that we spoke little to no spanish. While I am by no means suggesting I am the next Cervantes, I believe Jing and I have more than enough spanish to listen to a patient´s story, ask pertinent things, and perform a complete physical exam by using the word ¨asi¨or like this, in spanish. I therefore spent the morning bitter and packing gloves and alcohol swabs into bolsas for easier storage. While the original idea of our sentencing was so we can talk to the people there to learn conversational spanish better, I spent the morning talking to no one but grumbling to myself. Everyone worked there is from the region and spoke Tz´utujil, the regional Mayan dialect. Jing did not fare much better. While we initially thought the farmacia would be a better learning experience only taught us that Jing has an allergy to dust. She sneezed the morning away as she wiped shelves in the farmacia and putting packs of medicamentos on the shelves after they were spotless. Did she talk to anyone? No. After an unproductive morning doing tasks unsuitable even for the lowliest premed looking to gain something that resembled medical experience, our volunteer coordinator, Rebecca, at Hospitalito recognized our unsatisfaction with our tasks. She approved of our Spanish after a short conversation and wondered why we were subject to the aforementioned labor in the first place. We were placated by our fastidious placement into the clinic and we began seeing patients. With the supervising physician at first, then alone.

Front view of the hospital

Not all hospitals in Guatemala look like this. In fact, people have said it´s VERY westernized compared to other hospitals in the country.

Side view of the hospital

The hospital is a newly built hospital for the local population. It´s not big by any standards hence giving it the name hopsitaLITO. There are roughly 6 rooms for patients. 2 ¨sala de parto¨or birthing rooms with 2 beds each, 1 inpatient male room with 3 beds, 1 inpatient female room with 3 beds, 1 inpatient pediatrics with 3 beds, and 1 septic room with 3 beds. The emergency room has 4 beds total. This gives a grand total of 18 beds. Right now, as I sit in the hospital typing at 10pm on a Monday night (because I´m on call....lame) there are 2 inpatients and no patients in the emergency room. Busy eh? On a normal day, consulta external (walk in clinic) begins at 8am and ends at 12pm, resumes after a siesta at 2pm and ends at 5pm. I would guess the clinic average 40-50 patients in the morning with 3 or 4 providers each morning. Afternoon, one would generally see 10 patients total between 2 providers. This is because right now it´s Guatemala´s rainy season and the rain is a large deterrant for patients. The waiting room is jam packed in the mornings and eerily silent in the afternoons. The walk in clinic sees the majority of the subacute/chronic patients. Patients with wheezing, high fevers, and other problems that one would generally in the ED in the US goes to the clinic where they are taken care of and sent home. The ED tends to see the very acute patients, or patients needing procedural treatments such as minor surgical procedures, suturing, nebulizor, etc. Pregnant women with abdominal pain are a huge fan of the ED. On average the ED will see 6-10 patients in a 24 hour period.

One of the 5 clinic rooms. Here the sheets are not changed after each patient and the doctor washes his hands maybe two to three times a day.

However, the Hospitalito gets a small piece of the excitement pie. Last week, Jing single-handedly (no doctor was watching or present) drained a large abscess from a 15yo´s inner thigh. This thing was at least 5cmx5cm and BIG. That same day, Jing and I did 90% of chest compression on a poor guy that decided to kick the bucket. Our resuscitative efforts proved useful initialy as the man regained a cardiac rhthym but decompensated a few hours later and died. Just tonight, a 27wk premature neonate was rushed into the ED after being born at home by a Guatemalan midwife (comadrone). Unlike midwives in the US, the comadrones here do not need and most have no formal medical training. It left the hospital breathing in a rudimentary incubator and no formal breathing assistance. It´s a sobering fact to what outstanding medical capabilities we have to utilize in the US.

Sala de Emergencia

The most shocking disparity is the lack of tools of the trade and how much guess work comes into medicine in a 3rd world hospital. Practicing medicine in an environment such as this relly allows you to take a step back and ask how medically relevant a lab test is to the patient´s care. In the US, we follow guidelines and standards of care that we all hope works out best for the patient. Tests are also sometimes ordered out of intellectual curiosity and not medical necessity. After a slew of hopefully medically relevant tests, images, and consultations, we end up with thoughtful diagnosis like FUO or Fever of Unknown Origin. (I firmly believe that one of the reason why so many extra tests are ordered in the US is not due to medical incompetence or the doctor has fun wasting patient money, it´s because of the darned lawyers and disgruntled patients that decide to sue for everything. While many medical errors are preventable but hindsigh is always 20/20. A patient has the right to shop for doctors as much as I have the right to shop for a computer. When my Dell craps out in 3 years, I don´t turn around and sue Dell; I go and buy a Lenovo. If you child get Autism, it´s not because I gave him a LIFE-SAVING vaccine, it´s due to a myriad of other causes.) But I digress.....

Cultural practices are also interesting. While many people in the surrounding communities have adapted to be more accepting of western medicine, many still prefer to be treated at home by a community and spiritual healer. This wariness changes the way we practice in the hospital. One example is that no matter how subacute someone´s breathing difficulty, very low grade fever, and dry cough has been, he or she will always leave the hospital with a form of antibiotics. While part of this is due to the culture of medicine here (unlike the abx-phobia we have in the US), part of it is that all patients EXPECT to walk out with a cure in hand. No one will accept the wait and it´ll pass method. If it gets better on abx, great, western medicine ROCKS. If it doesn´t get better and the pt wasn´t given medicine, then they will ask themselves why did they pay to go to the doctors? Another example is nervios, a specific psychiatric illness found ONLY in latinos. Accorind to the DSM:

In Latin America, some people suffer from something called nervios (nerves). They feel a great deal of anxiety, insomnia, headaches, dizziness, even palpitations. It usually begins with a loss of someone close, or with family conflicts. Since family is everything in many cultures, family problems are often at the root of psychological problems.

The treatment? A nice healthy dose of Acetaminophen every 8 hours. Tylonel carries MUCH more weight here than in the US. When they come back in a week, they´re magically cured! Placebo was it´s best.

Beautiful mural that adorn the waiting room