Another event was held for people of the Tercera Edad. A lot of people from the community came, and we did a charla on oral hygiene and practiced relaxation exercises!
--Calla
Sunday, December 20, 2009
Sunday, December 13, 2009
9 December 2009
A couple months ago, Dr. Guerrero called me on a Friday afternoon. Dr. Guerrero is a general surgeon that works in the Gotera Hospital, the hospital closest to the clinic where we work. I got to know Dr. Guerrero after he admitted a few of our patients from the clinic. I told him that I wanted to be a general surgeon like him after medical school, and we immediately hit it off.
This Friday, Dr. Guerrero called to tell me that he would be performing an operation tomorrow in the capital, and I was invited to tag along. I was thrilled and told him I would be on the next bus to Gotera. Two hours later, I arrived at the Gotera hospital as he was finishing his shift in the emergency department.
Dr. Guerrero lives in San Miguel, the largest city in the eastern part of the country and an hour drive from Gotera. We drove to his house and arrived by 6. I met his family, had a glorious dinner, and we were asleep by nine. The next morning we left at six for the capital.
Dr. Guerrero has a private surgical practice and also works in the public health system. He was operating on a private patient this morning in a private clinic. We arrived to the capital around nine and pulled up to the clinic shortly thereafter. The private clinic appeared nothing like the public hospital. The most noticeable difference was the utter lack of patients. My experience thus far in the public health system is that wherever you go, there are already 20 patients waiting in front of you. This private clinic was clean and tranquil.
Shortly after arriving, I introduced myself to the patient, and we changed into our scrubs. Dr. Guerrero was going to remove the patient’s gallbladder laparoscopically, which means he was going to make 3 tiny incisions and operate by using cameras. Laparoscopic surgery is ubiquitous in the United States. The surgery was performed without incident. I was thrilled to be in the operating room again and had a great time.
I have probably seen 20 gallbladders removed in the States. It was interesting to see the same operation in a developing country. Because we were in a private clinic the operation was nearly identical to what I had seen before. The operating theatre was smaller and the equipment was older, but it was essentially the same. Like I said, it was awesome to be back in the operating room. It reminded me how much I want to be a surgeon. After the operation we went out to eat with the anesthesiologist at Biggest, the Salvadorian equivalent to McDonald’s. Three hours later we were back in San Miguel.
Once we got back to Dr. Guerrero’s house he told me that he had to work that same evening and was wondering if I wanted to tag along. I said yes, we had a quick bite to eat, and went to the hospital.
Dr. Guerreo was pulling an all night shift in a social security hospital. This is a hospital somewhere between private and public, and as such it had elements of both. While it was very crowded, the hospital, Dr. Guerrero had access to the medicines he needed and could perform the tests he needed to make a diagnosis. Within minutes of arriving, we raced to another operating room where a surgeon had already begun an operation. He was removing the gallbladder of a woman. Although this was the same surgery that he performed in the private hospital, this operation was a bit different.
The operating room was the size of a large closet with concrete walls. The sterilized instruments were wrapped in old newspaper. The gallbladder was removed through an open incision. Unlike the three small incisions required to remove a gallbladder with laparoscopes, this open procedure required a 15 centimeter incision made across this woman’s abdomen. I had never seen a gallbladder removed in this way in the United States. In fact, there is clear evidence that open removal of a gallbladder is a significantly more morbid operation than with laparoscopes. You need a very good reason to perform this procedure openly in the States. But here in San Miguel, there was no other option. As always, I was thrilled to be in the operating room, but it was difficult to think about how much pain this woman will have and how much greater her risk of infection is because she was poorer.
The lack of laparoscopic procedures in this country is a result of a lack of equipment but also a lack of surgical training. Dr. Guerrero had to go to Europe to get his laparoscopic training. One of my career goals is to practice surgery in a developing country like El Salvador. I see a great need for a well-trained surgeon in a place like this. Besides the opportunity to help a lot of patients, I would also have the opportunity to bring the benefits of laparoscopic surgery.
--Bela
A couple months ago, Dr. Guerrero called me on a Friday afternoon. Dr. Guerrero is a general surgeon that works in the Gotera Hospital, the hospital closest to the clinic where we work. I got to know Dr. Guerrero after he admitted a few of our patients from the clinic. I told him that I wanted to be a general surgeon like him after medical school, and we immediately hit it off.
This Friday, Dr. Guerrero called to tell me that he would be performing an operation tomorrow in the capital, and I was invited to tag along. I was thrilled and told him I would be on the next bus to Gotera. Two hours later, I arrived at the Gotera hospital as he was finishing his shift in the emergency department.
Dr. Guerrero lives in San Miguel, the largest city in the eastern part of the country and an hour drive from Gotera. We drove to his house and arrived by 6. I met his family, had a glorious dinner, and we were asleep by nine. The next morning we left at six for the capital.
Dr. Guerrero has a private surgical practice and also works in the public health system. He was operating on a private patient this morning in a private clinic. We arrived to the capital around nine and pulled up to the clinic shortly thereafter. The private clinic appeared nothing like the public hospital. The most noticeable difference was the utter lack of patients. My experience thus far in the public health system is that wherever you go, there are already 20 patients waiting in front of you. This private clinic was clean and tranquil.
Shortly after arriving, I introduced myself to the patient, and we changed into our scrubs. Dr. Guerrero was going to remove the patient’s gallbladder laparoscopically, which means he was going to make 3 tiny incisions and operate by using cameras. Laparoscopic surgery is ubiquitous in the United States. The surgery was performed without incident. I was thrilled to be in the operating room again and had a great time.
I have probably seen 20 gallbladders removed in the States. It was interesting to see the same operation in a developing country. Because we were in a private clinic the operation was nearly identical to what I had seen before. The operating theatre was smaller and the equipment was older, but it was essentially the same. Like I said, it was awesome to be back in the operating room. It reminded me how much I want to be a surgeon. After the operation we went out to eat with the anesthesiologist at Biggest, the Salvadorian equivalent to McDonald’s. Three hours later we were back in San Miguel.
Once we got back to Dr. Guerrero’s house he told me that he had to work that same evening and was wondering if I wanted to tag along. I said yes, we had a quick bite to eat, and went to the hospital.
Dr. Guerreo was pulling an all night shift in a social security hospital. This is a hospital somewhere between private and public, and as such it had elements of both. While it was very crowded, the hospital, Dr. Guerrero had access to the medicines he needed and could perform the tests he needed to make a diagnosis. Within minutes of arriving, we raced to another operating room where a surgeon had already begun an operation. He was removing the gallbladder of a woman. Although this was the same surgery that he performed in the private hospital, this operation was a bit different.
The operating room was the size of a large closet with concrete walls. The sterilized instruments were wrapped in old newspaper. The gallbladder was removed through an open incision. Unlike the three small incisions required to remove a gallbladder with laparoscopes, this open procedure required a 15 centimeter incision made across this woman’s abdomen. I had never seen a gallbladder removed in this way in the United States. In fact, there is clear evidence that open removal of a gallbladder is a significantly more morbid operation than with laparoscopes. You need a very good reason to perform this procedure openly in the States. But here in San Miguel, there was no other option. As always, I was thrilled to be in the operating room, but it was difficult to think about how much pain this woman will have and how much greater her risk of infection is because she was poorer.
The lack of laparoscopic procedures in this country is a result of a lack of equipment but also a lack of surgical training. Dr. Guerrero had to go to Europe to get his laparoscopic training. One of my career goals is to practice surgery in a developing country like El Salvador. I see a great need for a well-trained surgeon in a place like this. Besides the opportunity to help a lot of patients, I would also have the opportunity to bring the benefits of laparoscopic surgery.
--Bela
12 December 2009
On Thursday night, Rebecca, Neal, Bela and I returned to our house after having an early dinner of beans and tortillas up at the clinic. Bela and I quickly readied ourselves for bed, and crawled under the mosquito netting to read a bit before falling asleep. I am slowly working my way through El General en su Laberinto, by Gabriel Garcia Marquez, and Bela is devouring La Teleraña de Carlota, a book he and I both have fond memories of from our childhoods.
Minutes later, the phone rang. It was Joel, the Doctors for Global Health site director for Estancia, calling to check in with us and discuss clinic happenings over the week. We lumbered out of bed, gathered Neal and Rebecca, and put the phone on speaker. After our conversation with Joel, we stayed at the table to chat a bit more.
Suddenly, something flew by right over our heads. I startled and jumped out of my chair.
“It’s a bat!” Rebecca yelled.
“Oh cool!” Neal responded quickly, as both Rebecca and I scrunched up our faces.
Bela jumped out of his chair, and moved behind me. “You had a rabies shot, so it’d be better if it got you!”
The bat continued to fly in circles around the room, probably becoming more agitated as our voices got louder. Bela explained that in Kenya people shoed bats out of their houses with brooms, and ducked outside to grab one. Neal enthusiastically took the broom from him and ordered us, “Stand back!”
Bela hid in our bedroom, and Rebecca and I cowered in hers, as Neal went to work. He swung at the bat every time it swooshed by. It appeared that we would spend the night watching Neal swing, and the bat fly circles around his head.
Abruptly, I heard a splat, and a dark object whizzed past my head. “Run Rebecca, run!” I yelped as I darted back into the common room and into our bedroom.
“Neal, get it out!” Rebecca exclaimed as she dashed out.
Neal ran in, opened the bedroom window and tried to shove the bat out. He was unsuccessful, however, and the bat flew back into our shared space. Out he charged, more determined than ever to rid the house of the bat. He stood in the center of the room, knees slightly bent, and choked up on the broom. Again, the bat swooped by, and he wound up and swung. I heard a crash, and saw, briefly, as our one and only light bulb exploded and rained down upon Neal, the bat swoop towards the wall.
The sound of glass tinkling on the ceramic floor continued for a few seconds.
“S%$#!” Neal exclaimed, as he tiptoed to his bedroom to grab his headlamp.
“That was amazing!” Bela responded, in awe.
“The bat’s still in here!” Rebecca reminded us.
Neal diligently swept up the glass, remarked that we would all have to be careful about being sure to wear sandals in the house for a few days, and steadied himself to continue the battle against the bat.
A few more swings, and Neal batted the bat out the front door. It landed, stunned, on the front porch. “Come take a look,” Neal said, “I’m going to throw it into the corn field.”
“You didn’t have to kill it,” Rebecca responded, despondently.
“It looks like a rat, or a tipisquintle*!” I remarked upon having a closer look.
“Neal, dude, you should not touch the bat with your bare hands. Get a bag,” suggested Bela.
Neal ran back inside, and covered his hand with a plastic bag. Outside again, he approached the bat, and grabbed for its wing. The bat, obviously recovered, rolled over and flew off. Neal walked back towards us, a smile on his face, clearly the victor.
--Calla
*A tipisquintle is a rat-like mammal that lives near the bank of the river, likes to eat guayabas and the bark of sweet trees, and has sharp enough teeth to kill a dog if it feels threatened.
5 December 2009
A few weeks ago, we went for a hike up a mountain that overlooks Estancia, called El Cerro Pelon. We started early in the morning, with a large group that included Rebecca and Neal, the other volunteer couple, Miguel, in charge of all of the maintenance of the clinic, Juan Carlos, the recent graduate of medical school, and Cesar and Javier, two early adolescent boys who live in Estancia. After a breakfast of plantains, tortillas, and cuajada, a soft cheese, we headed to the bottom of the mountain. After a forty-five minute walk, we began the ascent.
* * *
The mountains around Estancia are of particular historic importance. Many people say that the civil war, which lasted from the late 1970´s until 1992, was fought mostly here. Every family was affected. Some families left under the cover of night to cross the border into Honduras, where they stayed in refugee camps until the end of the 1980´s. Others stayed, but were forced to flee into the hills almost nightly, as bombs dropped from airplanes onto houses and schools. These families took cover in the numerous caves that cut into the mountains. Still others joined the resistance army, and fought against the United States’ trained and funded Salvadorian army.
* * *
The top of the mountain is flat like a table, and, once there, we sat and enjoyed oranges, chocolate, and sweet breads with pink frosting on top called novias. We watched the birds fly below us, and chatted about how small the River Torola looked from so far away.
We descended the mountain around noon, and shortly thereafter the sky broke open and rain poured down. The road back to our house turned to slushy mud, and in parts was covered by water that rose up over our ankles. However, we made it home and dried off. The difficulty of the climb in daylight left me both in awe of and horrified by what the people of Estancia have suffered. They have lived through things that I cannot imagine in nightmares.
--Calla
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