Hospitalito and SHANA TOVA!

While it seems I should have begun some notes last week, now I find the pause.

We have come to Antigua, a colonial capital with cobblestone streets and Spanish architecture complete with fountain filled inner courtyards and an endless list of catholic cathedrals in various states of disrepair.

Its nice to explore a little outside of our small lakeside town of Panajachel, although the 3 hour, curvy, nausea inducing van ride past mudslides and ravines was enough to deter jordana and the boys from being excited about doing too much exploration. No one is rushing to take the trip back.

Monday night we hope to go to synagogue in Guatemala City.

My trips across the lake…..

Volunteering in the Hospitalito is rewarding, frustrating, scary, and humbling.

Going across the lake is beautiful. Every day the clouds take on a new pattern and the volcanoes reveal themselves as if it’s the first time I am seeing them. IN the mornings the water is placid and the lanchas (16-20 person covered boats with outboard motors, and few if any life jackets) proceed easily. Although I have my book to read, my gaze inevitably rises to the shorelines. The plastic bottles, bags and other household trash floating on the surface remind me that I am not that excited about swimming in this natural wonder.

I also read in a newspaper opinion column by a wealthy landowner who has a weekend home around the lake, that the water treament facility around lake atitlan was destroyed in Huricane Stan 2006, and despite government promises, still has not been repaired, thus further impacting the lake’s water quality as well as the overall public health of its surrounding towns.

Adding irony, there is a public relations campaign being waged by the regional tourism board to encourage people to go online and vote for Lake Atitlan as one of the new 7 natural wonders of the world. This could mean more plastic bottles and bags I suppose…

I have now done the trip and told my story enough that I can speak with conviction to the capitans and don’t have to haggle over the price of the trip. I pay the locals 15Quetzales (about $2) rather than the 25-30 Q that tourists might pay. Keeping my stethescope visible doesn’t hurt my authenticity.

Unfortuntaely there is not really any schedule to the lanchas as they leave when full, or when the capitan feels they are full enough to justify a trip across. I have waited up to an hour for a morning departure (making me late of course), but there is really no arguing with them.

So much for the ride…

The hospitalito is a well run clinic, emergency room and 3 bed hospital that Jordana says looks like something out of a M*A*S*H episode. It reminds me more of an old summer camp infirmiry in which someone has then thrown a conglomertion of donated, outdated medical equptment. It is mostly staffed by guatemalan docs and support staff as well as a revolving door of volunteers from around the globe. I have already worked with a Phys. Assistant from Oregon, two pediatricians from Madrid, an anethesiologist from Barcelona, and a medical student from London.

The majority of patients are indigenous folks who speak Tzutuhil, the local mayan dialect, which is actually different from Katchiquel which is spoken across the lake n Panajachel. Thus I am using a translator, either one of the lab folks, receptionist, or recently a guatemalan med student who is originally from this town of Santiago. Funny that the translator and I are communicating in Spanish (not the first language for either of us), and I have had to catch myself trying to speak English to them. My brain really flipped when I took care of an Israeli traveler the other day and attempted to broaden my hebrew to include some medical/anatomical terms. The traveler was clearly surprised and relieved to hear me greet him with Shalom, Mah Shlomcha, v mah ha baayah?

None of these helpful folks are actual interpreters and each of them possess some small bit of medical knowledge and cultural bias. Thus it is not uncommon for the “interpreters” to carry on for a few sentences or a few minutes before offering me only a brief account of their conversation. Much as I have tried to do with the Karen interpreters in Carrboro, although treading more carefully here as I am the new kid on the block, just a pinch hitter, and need all the cultural introductions I can get, I urge the interpreters to fill me in with each sentence.

The problems/concerns for which patients present are not dissimilar to what I see in Carrboro with Latino folks. A lot of prenatal care, diabetes, hypertension, anxiety, depression, and various aches,pains and minor traumas. Also owing to the water situation and a high incidence of helicobacter pylori (a bacteria associated with stomach ulcers) there are more abdominal complaints and diarrhea illnesses. There are many homes which utilize wood burning stoves (planchas) and this results in a lot of pulmonary disease (COPD, bronchitis, asthma etc..).

There is a small pharmacy on site (with lots of donated samples, or expired lots of meds, or cheap generics). I have already found that I neeed to switch patients’ regimens based on what the pharmacy might have in stock on any given day. The cost conscious approach is also not unlike what I am used to.

The guatemalan docs seem to use my presence as a relief for their otherwise over worked schedule. They are a combination of experienced practitioners and those just out of training.

They clearly do an excellent job without me and while my presence is noted and appreciated, I am not treated as any sort of savior. (of course I still get the occasional wide eyed stares in guatemala, mostly in the pool when my hair is down, because of some possible resemblance to the other savior who is quite popular around here).

Gone on too long….

Heading to guatemala city…

SHANA TOVA TO ALL OUR DEAR FRIENDS AND FAMILY!!!

MAY THE NEW YEAR BRING YOU MUCH PEACE, HEALTH AND INSPIRATION.

yoni

first week photos

Just to throw some more images at you as I have not figured out how to integrate them well in the blog. We took a boat ride to Santiago, across the lake, to a large (40,000) town where I will work in the Hospitalito.(see puebloapueblo.org) My first day was today, but more on that later this week.
We first went to the house of one of Isaiah's classmates, whose mother is on the clinic board and whom I had corresponded with via email prior to coming. One photo is the walk from the dock to their house, through the neighbors bananas and corn.

Aden is seated on in the view from their porch, across a small inlet of the lake.

The indigenous community of Santiago is quite strong with a history of resistance to the armies occupations. It is the largest indigenous community around Atitlan and the people largely speak only tzutuhil. Each town around the lake has its own style of dress largely differing in their color scheme. Then of course there are the backpackers, hippies and such who add a different sort of color.

Monday was Guatemalan independence day which meant a long holiday weekend, lots of guatemalan visitors to the lake and an incessant barrage of firecrackers and fireworks (without color just noise). There were parades of school bands and lots of school groups who make a pilgrimage to Panajachel. Their visit entails receiving a torch from the mayor of Pana, and then symbolically running it back to their own town. In reality they run around Pana screaming, whistleing, carrying guatemalan flags, then hop on their buses, drive back to their towns around the area, and run the last bit into their town. It made for quite the spectacle here, our first weekend.

You can see the suspension bridge in the nature reserve (see jord's blog) and our gear for the zip lines.

Aviv is forever asking to ride in a 'tuk tuk' rather than walk, and these 4 stroke motorized scooter cabs are ubiquitous. I dont actually know what a 4 stroke motor is but it sounds cool and is written on the back of every tuk tuk.

Guatemala #1

Hi friends and family! I am going to attempt to give an overview of whats been happening lately as weve been completely out of contact with too many folks to be able to send emails individually. My hope is that once we settle down a bit more, we will be able to continue with individual correspondence, as I always feel badly sending “group emails” its so impersonal. Please forgive in advance and know that if we had the time, and the internet connection, we would be writing to every one of you!

We finally got to Guatemala last Weds, and immediately put the kids in their new school.

The picture above to the left is the walk to school with Isaiah and Aden in the lower right. On the right is the hotel we stayed in the first week. (havent figured out how to get these pictures in the right place on the blog posts. [yoni]

London was a cold and rainy blur of visiting with friends and family, attending a fantastic Bar Mitzvah, and preparing for Guatemala. The kids’ school is a collection of open air type rooms surrounding a dirt courtyard with a playground and ball field. Its definitely Central America, and none of these spaces would ever pass code anywhere, but luckily Aviv is past the point where I have to worry that she will eat peeling paint, and though very simple and barebones, it is kept clean and has a very campy feel. The boys have integrated well so far, they are in mixed age groups with a combo of Guatemalan kids and gringos, and the kids are meant to speak English in school, except during Spanish. The boys will not be able to get much out of the Spanish in their classes, as everyone is fluent, so we will hire a tutor for them a couple afternoons a week. At $4 per hour for private tutor, we will all do it. At first glance I think its going to be a great experience for the boys, its so different here that being able to speak English all day for them feels necessary, and the gringo kids who go to the school are also so different from them, that even that is a huge change. They have all grown up here, and various mixed nationalities of German/Spanish, Swedish/American, etc, so that English isnt even their first language, though they all speak it. The teachers seem great, and it’s a small enough group that they have already made friends and were even invited to a birthday party this past weekend.

Aviv has had a more difficult time. She was placed in the “kinder” which is 4-6 yr. olds, and she is the only gringo in the group. While this wouldn’t seem like a big issue, since all the kids have just started school, none of them speak English yet! And for many of them, Spanish is their second language since most people here are Mayan and speak an indigenous language. Aviv was miserable and of course I felt terribly as the trip in general has been hard on her, all the moving around and lack of routine, weird food, etc. On the third day of school she moved herself (!) to the younger group, because the teacher in the 3 yr. old group is American and at least feels very familiar to her, plus the class is much smaller and there are some mixed kids in there who actually speak some English. The first group was large and it seemed hard for her to get individualized attention. We were literally bribing her with toys to get her to go to school last week.

Once we dropped off the kids, we commenced in earnest to find a place to live. This seems to be a primarily word of mouth endeavor here, asking everyone and literally anyone if they know of anything. Any of you who know Yoni well know that he loves this type of wild goose chase, chatting up the man on the street type activity, so we ran around with Sebastian, a tuk-tuk driver and our new BFF, looking at all kinds of dwellings. I am not exaggerating when I say we were shown literal shacks without running water in the kitchen and outhouses for bathrooms. True they were very cheap, but we werent going to live in them, I mean, we are way past that! We were also shown large homes behind huge rock walls with an abandoned feel but could certainly be fixed up. One such place we looked at was like a fortress, with a pool in the courtyard and the feeling of past splendor, with a “guardian family” living on the grounds. The place had a weird vibe, and when we looked at it a second time with one of the moms at the school, she told us the previous owner was involved with one of the drug cartels and died when a substance he was smuggling exploded in his body. The police were there for months, they cleared everything out, the wife now lives in Brazil and the lawyer will rent it to us for a very good price. Fantastic, that sounds like just the place for us. Additionally we were shown a gorgeous property, owned by gringos who are away for a few months, simple yet beautiful small houses set perfectly amidst the jungle grounds, with a waterfall out the window and serene gardens. These types of properties are a bit isolated from the town and although foreigners live in them, they just didn’t feel safe to me. After all, there must be a reason why all those homes are behind immense stone walls and locked with big dogs just beyond the gate. And it’s a long winding walk back from the school, one that I wouldn’t feel comfortable letting the boys do alone. We finally took a house owned by one of the hotels and in the back of the hotel property. Spending a few days walking the area by day and by night, I decided that security really is the most important thing, particularly as there will be several nights when Yoni will stay at his clinic, and I need to feel comfortable alone with the kids. At least the hotel security are around here 24 hours. And there is running water in the kitchen! Now we just have to get used to washing all our fruits/veggies in a bleach solution, and reminding the kids to only brush teeth with bottled water.

Today is our first day of real life, having dropped the kids at school, then Yoni off to the dock to negotiate a price across the lake to his clinic, and me left to go to market and figure out how our home life is going to work. Aviv is only in school until noon, so I will have about 3 hours to myself in the mornings. Luckily I can send the laundry out, or that would have been a big time sink. Driving up the winding switchback road from Guatemala City to Panajachel, we passed many small villages and our driver pointed out cisterns in the middle of the towns where all the women were washing clothes(in the pouring rain, I might add). He told us the women work in the fields in the morning and then come to do wash in the afternoons since there is no running water in the homes. Aden piped up, “Mom, that means you can go in the morning to wash, as they’ll all be in the fields and it wont be crowded.” Thanks, Aden, for that fantastic idea. Needless to say, I found a place to send out our wash immediately. At 5 quetzales or <$1 per pound for wash, dry, and fold, its worth it.

The town is a mile high up, surrounded by large volcanic mountains, on the edge of the lake, and the views are truly breathtaking. Yesterday, with the task of home hunting finally behind us, we went out of town a bit to a nature reserve, wonderful hikes across long swinging bridges that crossed waterfalls and jungle with great opportunities to observe groups of spider monkeys swinging from tree to tree. It reminded us of all the walks we took in Costa Rica, very similar terrain. Yoni and the boys did a zip line tour that looked terrifying, luckily for me Aviv was too young so I was able to stay with her.

We also took a boat ride to Santiago Atitlan on the other side of the lake where Yoni’s Clinic is. The lake is huge and the fast boat takes 30 minutes to cross. Some boats have life vests, some don’t, and I was very happy we decided to schlep one of our own for Aviv. Because it’s the rainy season, the weather turns quickly in the afternoon and the ride back was very choppy. Poor Yoni, that’s when he will be returning from work. The Hospitalito is a two story open air type building much like the main gathering structure at a camp, very rustic and basic. They actually do surgeries there, though I cant imagine. As we were shown around I made a mental note not to get sick for the duration of the trip. Yoni is at his first day of work now, so I’ll be interested to hear how it is there, and hopefully he will report.

Weekends we plan to do small trips around the area, though the drive up here was so windy that I am reluctant to do it again. We have some Jewish contacts in Guatemala City where we hope to go for Rosh Hashanah, and depending on how its all going, we may leave this area a week early and travel around the country a bit. That is totally dependant on how the kids are doing with school and their life. The boys were anxious to feel settled after so much travel.

That’s all for now and I will attempt to post this and have Yoni weigh in some other time.

Jordana