Jo’s Nurses in Chocola by Alicia Frederick

Day one, all the nurses posing for a photo.

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Jo’s nurses: Lily, Brenda, Alicia, Emily.

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One of two surgical suites. Our team performed 34 surgeries in 5 days ranging from gallbladder removals, to adult circumcisions, to hysterectomies.

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One of our peds surgical patients. This guy was full of smiles even after waiting for hours.

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She was so scared of me and would cry everytime I came near her bed to check vital signs. I finally won her over with food and stickers!

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Mercedes and Lisa the local nurses that we worked with in the hospital. These two worked rotating 32 hour shifts, 24 hours in the hospital and then 8 hours in the clinic. They both worked tirelessly caring for patients and always with a smile on their faces and kind words. Many of the patients we saw did not speak Spanish, they only spoke Quiche one of the local Maya dialects. Mercedes and Lisa were the only medical staff that could speak Quiche and communicate with these patients. I was struck by the power of communication as I spoke English to our interpretor, who spoke Spanish to Merecedes or Lisa, who spoke Quiche to the patient.

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The women in the middle was in her late 60’s and only weighed around 83 pounds. She traveled alone from a distant village one and half hours by foot to have surgery.

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This is Jamie, one of our fantastic translators. Jamie’s father is an OBGYN in Guatemala and Jamie spent a lot of time helping his father as a kid which proved to be invaluable to me on one of our very busy days. Jamie was translating for me as I bounced back and forth between pre-op and the post-op hospital ward. We had a patient in post-op that was very sick and required much of my time. After about an hour of working with our sick post-op patient I headed back over to pre-op to find a line of 8 patients waiting for surgery. I asked Jamie to bring the next patient in to pre-op so that I could get vital signs and start their IV. When he brought them in the room he said he had already taken their vital signs, it turned out he had taken vital signs on all the patients waiting for pre-op. I was blown away by his thoughtfulness. When I told him thank you he said “you are helping a very sick patient, and that is very important. It is easy for me to take vital signs so that you can do what is important.” Jamie repeatedly impressed me with his willingness to go above and beyond his duties as a translator and with the compassion and love that he showed to each of the patients that we cared for.

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There were two patient interactions that stood out for me and that I will always remember: Alba a post-op patient that had multiple complications and Sabrina a single of mother of three with a breast lesion.

Alba had a hysterectomy on day one, on the morning of day two she was tachycardic and febrile. The surgeon took her back to surgery to stop internal bleeding, and later that afternoon she looked to be improving. Overnight she was febrile and complained of being cold, the local nurses put heat lamps on her to keep her warm. That morning we explained to the local nurses that Alba had a fever and she should not have heat lamps and extra blankets as they would cause her temperature to rise more. We were able to get Alba up out of bed and ambulating in the a.m. and she seemed to be improving. Later in the day when I checked on Alba she was short of breath and febrile again. This continued all day and into the next day. On day four Alba continued to have a fever and spiked at 104 in afternoon. We continued to try to explain the local nurses how to bring the fever down. We would uncover Alba and put a fan and cool compresses on her and then 10 minutes later we would come back and the fan and compresses had been removed and Alba was covered with blankets again. It was interesting to see the cultural difference in how to treat a fever, the local nurses kept telling us that Alba said she was cold so they were covering her up. It took many conversations to reach an understanding about how to treat Alba’s fever. Alba continued to deteriorate that afternoon, she had multiple rounds of diarrhea, was short of breath, and became hypotensive and appeared to be septic. After a few hours of attempting to correct Alba’s hypotension the decision was made to transfer Alba to a hospital ICU. Alba was scared and begged us not to send her to the national hospital. In Guatemala the national hospital has a reputation of being a place that people go to for help and end up dying. Many people in Guatemala would rather suffer from illness than go to the national hospital. Refuge was able to arrange for Alba to go to a private hospital paid for by Refuge. The hospital was an hour and half away from Chocola on poor roads that were complicated by darkness. Alba was transferred to the hospital in the back of an SUV driven by a Chocola local that volunteered, two of our nurses accompanied her in case of further complications. Alba spent two days in the ICU but was recovering well by the time we left Chocola.

 

Sabrina a single mother of three came to clinic with complaints of a very painful breast lesion. It was determined that a biopsy needed to be done. The cost of the biopsy and pathology was about three months’ wages and Sabrina had no way to pay for it. The breast lesion was so painful that repeated injections of lidocaine was not controlling the pain of the biopsy. After the biopsy, Sabrina became very emotional and was crying and crying, Chusi (one our interpreters) and I stayed with Sabrina hugging her and giving her words of encouragement. Sabrina had a long bus ride home and asked if she could rest for a while before getting the bus, while she was resting our team lead was able to arrange for Refuge to cover the cost of Sabrina’s biopsy and pathology. Sabrina was so relieved and thankful, she asked to see our team lead to say thank you in person. I was grateful that we were able to help Sabrina in that moment but I couldn’t help but wonder what the future will hold for her and her children.