Mobilized medicine: A local team spends a week providing health care in Guatemala
Posted to Web: Saturday, Mar 21, 2009 11:46PM
Appeared in print: Sunday, Mar 22, 2009, page A10
News: Last Seven Days: Photo
Karen McCowan/The Register-Guard
Fidelito Augusto Garcia Hernandez, 12, reacts to news that Cascade Medical Team surgeons will repair a hernia that has caused him pain for years. He sits between his mother, Maria Hernandez Tepaz (left), and Guadelupe Aguilar Tale (right), a nurse practitioner from his village who came along to translate for Tepaz, who speaks Kaqchikel.
Dr. Gary Halvorson of Eugene asks Catarina Chavez de Perez to describe the location of her kidney stone pain while her husband, Julian Mendoza Perez, listens to the conversation.
Karen McCowan/The Register-Guard
The morning sun casts long shadows as Guatemalans seeking medical care arrived outside the gates of the college campus where the Cascade Medical Team operates its hospital and clinics.
Karen McCowan/The Register-Guard
News: Last Seven Days: Story
Editor’s note: Earlier this month, Register-Guard reporter Karen McCowan visited the Guatemala projects of two Eugene-based nonprofits: NextStep Recycling and Cascade Medical Team. Today’s articles look at the work of Cascade Medical Team. Saturday’s articles looked at NextStep’s use of refurbished computers in rural Guatemala.
SOLOLA, Guatemala — Looking at the excited face of Fidel “Fidelito” Augusto Garcia Hernandez earlier this month, you might think the boy had just won a front-row seat to his national team’s next soccer match.
But that’s not what prompted the 12-year-old’s big smile. Fidelito was thrilled because the Eugene-based Cascade Medical Team had just agreed to repair the hernia in his groin the following day.
“I’m the person that feels the pain, and I’m very happy that the pain will go away,” Fidelito said in Spanish at the bustling medical center that materializes here once a year.
In a transformation reminiscent of the mythical village of Brigadoon, more than 100 Cascade volunteers descend each March on a quiet college campus in this highlands city overlooking volcano-ringed Lake Atitlan. And, for a week, so do poor Guatemalans. Hundreds throng each day outside the gates of the college, a former military hospital built during the country’s 36-year civil war.
This year’s Cascade team handled 1,647 patients at Solola March 1-7. They did 73 surgeries — repairing hernias, cleft palates and horrific burns, performing hysterectomies and removing cataracts. They provided 299 dental exams and pulled more than 500 teeth. They conducted 201 eye exams. And they did so despite losing all running water on day five of their weeklong stay. (That crisis eased when Solola “bomberos” — firefighters — showed up with tanker trucks.)
The 103 volunteers were the seventh annual team to pay $1,900 per person in travel and lodging expenses to come care for some of the Western Hemisphere’s poorest people, mostly indigenous Mayan Guatemalans. The Cascade group also worked with Texas-based HELPS International to renovate portions of the old hospital into contemporary surgery and recovery areas.
Solola is the capitol of a 659-square-mile Guatemalan province of the same name. The Cascade team comes to Solola because most of the province’s 310,000 people are poor Mayans living in remote villages with few medical facilities.
Fidelito, for instance, traveled by boat and then in the back of a pick-up truck from his Lake Atitlan village of Santa Cruz La Laguna. His mother, Maria Hernandez Tepaz, said Fidelito has suffered pain and swelling in his groin for at least six years. Like most rural Guatemalan children, Fidelito must do heavy lifting that can lead to hernias. In addition to the typical child’s chore of gathering firewood and carrying it on his back, Fidelito helps his father, a “lancha” water taxi operator, load heavy cargo such as 5-gallon water bottles, propane tanks and construction materials.
“We do not have money to pay for this surgery,” Hernandez Tepaz said. “We are a family with a lot of members and very little resources.”
Return trip for many
Many Cascade volunteers return year after year. Among them: PeaceHealth RiverBend neonatal intensive care unit nurse Ann Krenek. On this, her sixth trip, she worked outdoors in the chaotic triage area, asking each patient, “Where do you hurt?” to determine which team member they should see. Though Krenek speaks Spanish, many of her Solola patients speak only their traditional Mayan tongues. In a typical exchange, however, Krenek managed to convey to a Mayan mother that she needs to know the medical problem of the woman’s child. The mother answers by yanking down her daughter’s lower jaw to show Krenek the girl’s aching teeth.
The mother and daughter are among indigenous patients who form a colorful waiting line. The women and children still wear the traditional trajé (traw-HEY) — colorful skirts, tops and belts woven and embroidered in hues and patterns as distinctive to each village as a Scottish tartan.
Many patients also still have traditional medical beliefs, said University of Oregon dentist Jan Halvorson, who extracted rotting teeth with her daughter, Sonja, a South Eugene High School senior, acting as makeshift dental assistant.
“Some think they have bad spirits in their teeth,” she said. “After we pull one, they hold a kerchief over their mouth to keep the spirit from returning.”
This year’s Cascade trip was a family affair for the Halvorsons: Eugene family physician Gary Halvorson joined his wife and daughter in Guatemala. Sonja, a graduate of Eugene’s Buena Vista Spanish Immersion School, recruited her parents after serving as a translator on a previous team. She cited the opportunity to “actually see another culture — to really get to talk to people, instead of just seeing landmarks.”
Jan Halvorson was the hardest parent to win over.
“I’m pretty obsessive-compulsive about a really sterile environment,” the dentist explained. But Halvorson quickly saw how much good she could do in less than ideal conditions.
“We saw people whose mouths are so swollen and full of pus that they are in a huge amount of pain and at risk of brain infection,” she said. “I took three teeth out of a 7-year-old boy, and he asked me if I would take another.”
Gary Halvorson, however, was sometimes frustrated at his inability to help patients, such as a woman in her 40s with a “huge, hard tumor” on her leg. The woman had previously traveled to Mexico where a doctor warned it might be cancer, he said. But she had no money for surgery. Now, years later, the tumor has grown so large she can no longer walk. She’d come hoping the Cascade team could do the surgery. But she’d become dangerously anemic from the fibrous growth’s internal bleeding. Halvorson had to turn down her request.
“In the U.S., if you’re anemic, they just give you a blood transfusion and do surgery,” he said at dinner one night in the team’s Solola “mess hall,” the college gymnasium. “But we don’t have that option here.”
Moments difficult and rewarding
For Sue Trezona, a nurse midwife at Women’s Care in Springfield, this repeat trip to Guatemala included the difficult task of telling several women they had terminal cancer. But there were rewarding moments as well, she said. She was among many Cascade volunteers happy that this year’s team included a medical lab technician.
“We can check for diabetes and rule out a lot of things,” she said. “We can also do sperm counts.”
That proved a boon in treating infertile couples, who can be ostracized in a culture that celebrates large families. Women bear the brunt of the criticism and abuse, Trezona said.
“In the past, I’ve had women tell me, ‘Every month when I get my period, my husband beats me up,’ ” she said. “Now we can let them know that it’s also the man who is responsible.”
The team also brings an ultrasound machine for pregnancy assessment and spotting tumors or other problems. This year’s ultrasound diagnostician, Susan Bodtker of Junction City, found her first year as a team member “really rewarding.”
“These people are just grateful that you are here for them. They hug you and thank you. Sometimes patients will even bless you.”
Among Bodtker’s highlights was relieving the fears of Elia Buch Ramos, who thought her fetus had died in utero.
“We have a heartbeat!” Bodtker told the anxious woman. Buch Ramos broke into a smile when Bodtker told her that the baby appeared to be a girl — welcome news for the mother of five sons.
Dr. Andy McIvor of Portland was part of a surgical team that spent most of one morning removing a huge “multi nodular goiter” from the throat of a Guatemalan patient.
“In the U.S., as soon as someone feels a little bulge, they go right to the doctor, but things are a little more neglected here,” McIvor said.
Wes Wever, a Guatemalan HELPS worker, said the Cascade team has rapidly become the largest of the dozen U.S. volunteer groups it works with. “This is an incredible team,” he said. “They’re very flexible and caring — it’s incredible the heart they put into what they do.”
Jan Halvorson credited the leadership of Cascade team leaders Robert and Tamra Orlando of Springfield. Tamra, a McKenzie-Willamette Hospital recovery room nurse, “smoothly runs what essentially becomes a hospital,” she said. And Robert, a logger with little formal education, calmly manages the personalities and behind-the-scenes logistics.
“Both Robert and Tamra put themselves out there raising funds, ‘herding cats,’ solving problems and calming the strains that, of course, arise,” she said. “They are remarkable people.”
Want to volunteer with the 2010 Cascade Medical Team? Write to P.O. Box 528, Eugene, 97440 or visit www.cmt-oregon.org. Tax-deductible donations may be sent to Cascade Medical Team Foundation, P.O. Box 1545, Eugene, 97440.
