Welcome to Casa Colibrí’s blog!  We are glad you decided to check us out.  There are so many things happening day to day with our activities in Guatemala that we decided to keep our friends and supporters current in this way.  We’d sure like to hear from you, too!

Francisco Fernandez, Jay Eastman, and Linda Eastman traveled to the Casa Colibrí clinic to accomplish several goals:

Train Village Health Promoters (VHPs), as formally requested by them
Follow up on special patients
Administrative visit for the purpose of meeting with:
Women of Nuevo Edén (regarding their petition for a water project)
Barillas Rotary Club
Dr. Carlos Mérida
Dr. Oscar Marroquín
Huehuetenango Rotary Club
Mr. Phillip Wilson of Ecofiltros
Casa de Jade (Antigua) to discuss possible golf tournament fund raiser

The following is a report of that trip.

Village Health Promoter Training

The training took place on July 7 and 8.  Fifteen health promoters participated.  The topics were determined ahead of time by the health promoters themselves.  They had initially submitted an appeal to Linda requesting various pieces of equipment and supplies to help them in their work.  In response, we proposed a training to teach them how to use the equipment, and they accepted with enthusiasm.  Topics covered were Significance and Measuring of Vital Signs, Wound Care and Suturing, Neonatal Resuscitation and Care of the Newborn, and Flu Identification and Treatment.  The latter topic was very relevant due to the recent epidemic of swine flu.

Each participant received a backpack full of equipment which included a thermometer, measuring tape, box of rubber gloves, nasal aspirator, clean string, measuring spoon to make rehydration drink, stethoscope, otoscope with extra batteries, antibacterial soap and nail brush, blood pressure cuff, gauze pads and rolls, adhesive tape, cotton balls, cotton swabs, Bactroban ointment, bandage scissors, flashlight with batteries, sutures, needle holders, thumb forceps, and suture-removal scissors.  In addition, each health promoter received the book, Where There Is No Doctor, in Spanish.

We discussed how to take temperature, pulse, respiratory rate, blood pressure, and signs of abnormalities when checking vital signs.  The participants had a lot of hands-on practice.

There was a demonstration and practicing of suturing using chicken breasts.

We taught resuscitation and care of newborns in the event that the midwife was not available or had to devote her time to working with a mother in distress.  We discussed theoretical aspects, commonly noted signs in newborns, and practical demonstration and practice of CPR in newborns.

The health promoters loved this training!  They said they had never received so much as a pen from any training group in the past.  They also commented that they had never attended a training so useful as this one—so helpful because it was hands on.  They were grateful for the equipment provided and felt that this equipment would help them do their jobs better.  We urged them to network and collaborate with each other and work with their village midwives.  We hoped that they would collect data and give us feedback on how things resulted from their training and equipment.

The VHPs remarked that a machete wound is very common.  People are highly susceptible to being hurt because everyone uses a machete.  Now they can at least do something to help if someone gets cut.

We said that this was only Chapter 1—we’d like to hear topics in which they are interested, and suggestions for possible trainings in the future.  Since our participants were literate this time, we could use books as part of the course.  One of the VHPs commented, “Now it’s as if we have a personal teacher in our backpacks!”

Notes for future training:  It is good to spend breaks and mealtime with the group so you integrate and don’t appear to be “above” the participants.  Bring more suturing thread for practice.  Get topical anesthetic such as Lidocaine.  Bring syringes and a sharps container.  The question was asked, “Is there a simple way to attach tendons?”  Need to find out.

The men submitted a written request for training on how to pull teeth.  We will take it under advisement.

One of the participants really stood out as a leader and a very bright person.  He was obviously educated and caught on immediately to everything that was taught.   We identified him as a possible Village Health Worker to staff the clinic, backed up by Barillas doctors.  We will pursue this further.

Women of Nuevo Edén – Water Problem

We were approached by the village women regarding the water problem.  On our last visit, they asked if we could get them a large number of Rotoplas tanks.  They wanted these tanks to connect to a roof apparatus so that the tanks would fill up during the rainy season and would supply water during the dry season.

At present, the women have to get water from far away and tote it back to their homes.  There are two problems, one short term and one long term.  The lack of rain means that they have to take water from the lake or river.  This water is not clean.  We are considering filters for people who want them, one filter for each household.  We will try to provide them with 24 filters.

There is also a possible solution which will require some engineering of the existing system.  We will try to address this problem before the next dry season.

There were several requests from small groups of villagers.  Because of this, we clarified our position that we will discuss issues with the mayor and village council.

Patients We Are  Following

Isabela – 2-lb. preemie with cleft palate is now 21 months old.  She weighs 13.2 lbs. and is looking good for surgery, possibly in February if we can convince the Iowa MOST team to operate on her a little earlier than normal.  They usually want to wait until the children weigh 20 lbs.  Gave her infant vitamin drops with iron.  The girl’s developmental milestones are a little worrisome.  Will watch closely.

Nicolás – Double cleft lip and palate, was turned away for surgery last February because he was wheezing.  We brought Alupent syrup and infant vitamin drops with iron.  He was well and looked great.  Gave instructions about the medicine.  Parents seemed to comply with the advice we gave them last time about taking the baby out of the house when the cooking fire is burning.

Little No Name – baby from San Angel was born with cleft lip and palate.  Now weighs 6.6 lbs.  The village schoolteacher weighed him and reported to us.  Baby was named Mateo.

Diabetic lady – Blood sugar was 126 (random/not fasting).  Last time was < 100.  She had done well on dosage, but she decided she didn’t need the medicine anymore.  She had tingling and numbness.  We went over the instructions again.  Explained that she could lose a toe or finger.  Her eye grounds had no diabetic changes.  We will consult the eye team on this patient.

Man with peeling hands – Rx hand cream.

Teenaged girl came with abdominal pain, upper abdomen.  Claimed she was not pregnant.  She had had her period 20 days before, and it was normal.  No physical finding of pregnancy.  Rx antacid.  (Girl was with her mother at this visit.  There was a question of whether she was being completely forthcoming with information.)

María Ingrid – Nearly 3 years old, Ingrid is doing well.  She did not have any apparent fluid on her forehead, and she doesn’t seem to be having any problems with the shunt.  She was still uncertain about us, however!  It looks like she sees out of her left eye, and the right eye does not focus straight ahead.  Recommend eye consult when the eye team comes to the area.

Barillas Rotary Club

We attended the Barillas Rotary Club’s weekly meeting on Wednesday night.  They have a lively, energetic group, young by most Rotary Clubs’ standards.  Each member introduced him/herself to us personally.  Their president, Wagner López Cardona, was extremely welcoming and willing to collaborate with Casa Colibrí on any project.  We mentioned that we wanted to submit a Matching Grant application to Rotary International, and he was prepared to sign on the spot.  Wagner is in charge of a scholarship program with the health organization ADIVAS, and his wife, Arlen (whom we met) is a teacher.  She also works for ADIVAS, and her area of expertise is nutritional education.

Wagner’s dream is garbage.  No joke!  He has a vision for Barillas, and he is passionate about it.  He wants to clean up the city and teach people about ecology and preserving the environment.  We told him about Owen Carney, a successful professional waste manager in Squamish, BC.  Wagner’s eyeballs popped of his head!  He could not wait to contact Owen to get some advice on how to go about starting a massive cleanup campaign in Barillas, complete with recycling and education.

Barillas Rotary Club has some very viable projects.  The club is working on a project to provide water filters and tanks in a nearby village.  They also want to replace a hammock bridge on one of the main trade routes in the municipio.  Of course, Wagner’s #1 goal is city beautification.  He is considering expanding the plan to educate children in schools about how to make their community “green.”

The Barillas Rotary Club was eager to collaborate with us.  They talked about equipping the clinic as a first trial of a Matching Grant and getting started with it immediately.  We offered to do hands-on projects, collaborating with Rochester Rotary and other clubs.

Upon our request, Wagner and Arlen are going to get statistical data for child, maternal, and infant deaths in the area.  The data we have now is very inconclusive and sketchy at best.

Wagner promised to get us an official map of the area.

• We would like to discuss ADIVAS further, and possibly make a visit to ADIVAS.
• We invited them to come to the Casa Colibrí clinic.  They are eager to do so.
• Gave the Rochester Rotary flag, took lots of photos.
• Our Casa Colibrí road sign is missing, and we wondered if they might help us track it down.
• I ordered one of their club’s t-shirts and talked about our clubs becoming sister clubs.
• Juan Mérida, a Rotarian who works at the Centro de Salud, requested a health promoter training for his group.  I told him that we would be happy to do it.  He needs to submit it in writing, and I gave him my card.

Dr. Carlos Mérida

Dr. Mérida gave a PowerPoint presentation and sent us home with a copy of it.  He has a very ambitious vision for the Municipio of Barillas.  His proposal for the Casa Colibrí clinic is to make it an outpost within the overall health system in Barillas.  In his vision, there will be 26 health posts in the rural areas.  (There are 4 at present.)  There will be 4 central facilities which will have a professional medical staffer and will be open 24 hours, 7 days a week.  The rest of the facilities will be outposts which will be staffed by a nurse’s aid and will be open Monday through Friday, 8 hours a day.  He offered to provide a nurse and/or assistant if we decided to become an outpost.

Under his plan, the villages will donate the land and an existing building to the municipio in exchange health services within their communities.  The government will then fix up these buildings and make them into health outposts.  (Dr. Mérida showed us a photo of one such building, and it could not be described as anything but a shack.)

Right now, we want to stay independent and see how the plan develops.  We will see how our clinic fits into the plan.  We definitely have no desire to hand over the land and the building at present.  We very gingerly asked him, “What if we politely declined this opportunity and wanted to remain independent?  Would you have a problem with that?”  He said no, we were providing a service to the people of those communities, and if we are there giving care, it is taking some of the weight off his shoulders.  He assured us that he would not be an obstacle.  He is willing, upon receipt of CVs and licenses, to give his blessing to our medical activities.  We promised to supply him with CVs, resumes, and licenses of all the medical professionals who work at the clinic.

We don’t want to step on anyone’s toes and will do everything possible to cooperate.

Other items discussed:

• Dr. Mérida and his staff will select the midwife group for the large midwife training (75) in February 2009.
• He wondered if it would be possible to train all the midwives in the municipio.
• We asked if he would help us with getting medical supplies and equipment past Guatemalan Customs.  He said he would do whatever he could to help us.
• The new governmental hospital is supposed to be operational in January 2010.  Equipment is purchased, and theoretically they will be ready to open by then.  We are highly skeptical.
• The Centro de Salud is open to referrals from the entire municipio.
• His assistant gave Linda three books which dealt with promoting health and hygiene in primary schools.
• Dr. Mérida did not make an offer to provide a doctor or nurse practitioner at our clinic.  (We ran into an acquaintance of Francisco’s in Barillas.  She is a doctor with an office in the downtown area.  She may be interested in our program.  Francisco will look into this further.)
• Dr. Mérida said that his vaccination teams have the best cold chain in Latin America.
• In terms of follow-up care at the Centro de Salud, we cannot promise our Casa Colibrí patients anything for follow up in Barillas, other than first aid, suturing of cuts, delivery babies, and referral for TB.  They can do chest x-rays and TB tests.  They will refer on anything more specialized to the government hospital in Huehuetenango.
• Dr. Mérida was gracious in offering his sources for purchasing medications in country at low prices.
• We need to ask about the status of midwives or village health promoters using Misoprostol as an emergency measure to stop post-partum hemorrhaging.
• ADIVAS is a non-governmental organization subcontracted by the Ministry of Health.  They have a direct budget.  They do outreach, training, vaccinations, and weigh babies with oversight by the Ministry of Health.
• We told Dr. Mérida that we are not interested in segregation, we are interested in cooperation with all the groups with whom we have a common goal—the health and well being of the needy people of the municipio.  We do not want to become involved with local politics.

Dr. Oscar Marroquín

We met with Dr. Marroquín on Thursday evening.  We wanted to ask him if he would be interested in helping Casa Colibrí achieve some of its goals.  He responded very favorably—so much so that he accepted our invitation to serve on the board of Casa Colibrí Guatemala. (!)  He is a member of the Huehuetenango Rotary Club and welcomed us as Rotarians, inviting us to visit his private hospital the next morning and also to take advantage of the opportunity to meet the District Governor of his district who happened to be visiting the Huehue Club that day.

He agreed to be a channel for buying meds and equipment.  He offered his warehouse and transportation connections.

He offered his lawyer to file the paperwork for legalizing Casa Colibrí in Guatemala.

He offered his hospital to be the referral center for cases we identify at the clinic—thus bypassing the labyrinth and long delays for patients who are referred to the government hospital.  The doctors’ fees and hospital stay will be gratis.  We have to pay for medicines and anesthesia.  This is a godsend.

Dr. Marroquín listened carefully to María Ingrid’s story and agreed to be the follow-up doctor for her if she has any trouble with her shunt.  He is more than qualified to do so.

He suggested that his hospital would have “hernia fairs,” at which time we could bring 10 or 20 patients with hernias there at one time, making it much more efficient and less time-consuming than we have had to do it in the past.

He offered to train personnel who would be working at the clinic to operate medical equipment.

Dr. Marroquín felt that we should bypass Barillas altogether when dispatching medical equipment from the United States because it doesn’t always end up where it was intended to go.  He also felt that it is best to buy equipment in country because of warranty and availability of service.

The Marroquín family plans to visit the Casa Colibrí clinic in August.

He suggested that the eye team that comes to Huehue check out the Casa Colibrí clinic to see about feasibility to use for case finding and possible surgery.

We are welcome to have equipment that Gary Pacha left behind for the orthopedic team (slings, arm splints, toes, wrists, figure 8 bandages, etc.).

We toured the hospital and were extremely impressed.  It is very modern with state-of-the-art diagnostic imaging equipment.  We met his radiologist, Melanie, who said that she would train our personnel on any equipment.

Huehuetenango Rotary Club

We met members of the Huehue Rotary Club briefly, as they were having a big working meeting with the visiting District Governor, Dr. Marcelo Coyi.  We met the DG and his family, who spoke English.  Gave them a Casa Colibrí brochure and told him about meeting the Barillas Rotary Club.  We informed him about our Matching Grant.  He said it was surely possible to get the grant.

We met club president Amílcar Velázquez and his wife, along with several other Rotarians.  (There are 20 members, all men.  Women are not allowed into the club as yet.)  They gave us a pound of coffee from Huehuetenango, saying it was the best coffee in the world.

Venicio López

Past president from the Huehue Rotary Club, Venicio is a firefighter who traveled to the Quad Cities in Iowa to see about obtaining some firefighting equipment from FAMSCO.  He looked at some dental chairs in the FAMSCO warehouse to see if they would be usable for us.  The report is that they are definitely used, but they would be okay for our clinic.  The problem is getting them down to Guatemala right now, as it is so hard to get anything through Customs.

Ecofiltro

We visited the Ecofiltro factory and were extremely impressed with the filters.  They are well made, reasonably priced, and the water is delicious.  Their standards are very high, and they check the purity of the water on an ongoing basis.  They gave us two filters to take up to the village to demonstrate how they work, and if the villagers are in favor, we will initiate a project through Rotary to purchase one for every family in Nuevo Edén.  We got this contact through the Gerard Foundation, the people who approved a grant proposal to do the big midwife training in Barillas.

Casa de Jade

Our last meeting was with the owner of Casa de Jade, a Rotarian who lives in Antigua but is a member of a Guatemala City club.  He helped us brainstorm about the possibility of a fund-raiser golf outing in Antigua.  This event would be held at a Pete Dye-designed course nestled among the volcanoes near Antigua.  Golfers would stay at a 5-star hotel that is part of the complex.  This is a very exciting idea, details to follow.  This was Francisco’s brainchild; we just wanted to explore some possibilities.  It was a very interesting meeting and gave us food for thought.