Thursday, May 10, 2012

Guatemala Travelogue: Working in a Rural Clinic, Student Discovers How Much He's Learned

Freedom. Responsibility. Excitement. Naturopathic medicine student Mark Shortt writes about putting his education to the test in Guatemala.

Portrait of Mark Shortt in Guatemala
Mark Shortt
Courtesy Mark Shortt & Carly Erickson

To test what you're learning in the classroom, try using it in the real world. That's what 20 Bastyr naturopathic medicine students did this spring in the Guatemala mountain town of Panajachel. They traveled for a week as Bastyr representatives of Naturopaths Without Borders, treating patients in a clinic and on house calls to outlying indigenous communities.

Second-year student Mark Shortt offered to share some of his emails to a friend. Here's his account of working with limitations in the developing world, discovering how much he's already learned, and using a diaper as a diagnostic tool.

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The first morning our group made house calls on the outskirts of town, the poorest part. Our translator, Sergio, was in his mid-twenties and spoke English well. He said he played national basketball for Guatemala. Now he works as a sports coach and also as a big brother for kids who are abandoned, addicted to drugs and in gangs. He was constantly telling stories about Guatemala and Panajachel, and he was super passionate about helping people. I liked him.

We saw four people that day. The first was a 3-year-old with diarrhea. I went into the room with my classmate Blake. We asked about the symptoms. Blake asked about the quality of the stool, but it was difficult to translate so at one point the mother went into the next room and brought out a diaper. I was standing to the side watching and she unwrapped it and held it up to Blake's face so he could really see the stool. He was taken by surprise and gagged a little bit. It was a funny story to tell afterward.

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The woman we visited after lunch was welcoming and super energetic even though she was in her 60s or 70s and had diabetes and hypertension. We worked together to give her a physical exam. I took her pulse and blood pressure. She was compliant but also very tense. She had heart pain and a dry cough for the past two weeks, and it was hard because we didn't have much to offer her as treatment. In the end Blake performed a physical therapy on her called cranio-sacral therapy. Afterwards she was very relaxed and said she liked it, and we left so she could keep resting.

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The next day my group went to the clinic and saw a lot of patients. I saw a girl with throat pain, a small boy with a fever who was very weak, a young boy who had a fever and cough ever since he hit his knee really hard in soccer practice, and a 66-year-old man with a blood glucose level of 500 (normal is 100!).

It’s kind of complicated because there are very few medicines at the clinic so we have to make do with a few things that have all been donated. For this trip, someone donated a hundred bottles of this stuff called Nordic Berries, which are these candy multivitamins for kids. But they are also the only thing we can give out to most patients.

The man with high blood glucose (which essentially means he is diabetic) would probably go to the hospital in North America. Our options were basically to tell him he had to change his diet and walk more. We also showed him how to make cinnamon powder into capsules to help him regulate his blood sugar. Then we gave him some herbs that are used to treat hypertension, which was another problem he had. In the U.S., he would ordinarily be prescribed a drug called metformin for blood sugar that high, so we told him to ask about that at the hospital. He told us you could get it in the drugstore without a prescription. I think that's true for a lot of pharmaceuticals in Guatemala, but they are also very expensive. He wrote everything down and seemed happy with the treatment plan. Most everyone was very grateful, even if we couldn't give them much more than a physical exam, some advice and some candy multivitamins.

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Today we visited a Mayan town. We set up a clinic in a brick building and saw elderly Kaqchikel women all morning. They were so gentle and nice. It was incredible to be with these 70- and 80-year-old women with such vitality. They were so grateful at the end of the visits, and each one came to give us a kiss on the neck as they left.

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I feel like we had a lot of freedom there but also a lot of responsibility. It really makes me want to know more so I can offer more. But I was also impressed at what I did know. It made me more excited to come back to school. I definitely want to do more of this, travelling and volunteering in clinics in different countries. Not so much because I thought I was really saving people, but because I learned so much from actually practicing medicine. This also helped me see the importance of making medicine accessible. I could tell that it was powerful for people who weren't paying anything — who couldn't pay anything — to sit with three people entirely focused on their health for an hour. They told us it was powerful.

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