"Cual es su problema? Es una pastilla para parasito de su estomago. Y despues, dulce. Tiene dolor de cabeza? Cuantos anos tiene? Esta embarazada? Esas son las verrugas. Es necesario tomar la pastilla despues de comer porque sin comida, una ulcera es posible. Jabon para tus pies. No, yo no soy Chino." 

It has been a week since I touched back down in Philadelphia Airport at 1am. In that week, I got some much needed sleep, saw my pain doctor, went back to the University of Delaware, reacquainted myself with my test prep materials, and took a practice MCAT test - those were the “highlights.” One week, and it had been nearly impossible to get those spanish phrases - the ones I had spoken hundreds of times on a daily basis in Guatemala - out of my mind. I had expected this; this occurred last year, and I’ve learned that all I can do is embrace it. The experiences I had are so freshly imprinted on my mind that it still seems like they still belong in what is now my present. This isn’t necessarily a bad thing (I just hope that I’m not thinking about the spanish translations for “soap” and “I am not Chinese” during my real MCAT). 

In fact, it isn’t a bad thing at all - I wouldn’t have it any other way. For one week, my world was Guatemala; the fact that these phrases are still resonating in my mind serve as a small testament to that. I can say, with all confidence, that I found myself much more engulfed in Guatemalan culture this time around. I became much more easily accustomed to their ways and to their lives having some past exposure under my belt. The shock and awe, however, is still fresh - as I believe it will always be no matter how many more additional times I may visit.  

It is this shock and awe - of living conditions, differences between our cultures, abundance of medical ailments, and the lack of care, services, and basic medical knowledge - that continues to drive me to come back to Guatemala. These two past years have sparked a new interest and curiosity in me, one that continuously wonders about the rest of the world and the injustices that occur. 

Last summer, I traveled to Guatemala primarily to “get my fix.” I had felt that I was wasting my summer. My days were long and monotonous; I yearned for something more intensive, a unique break from what had become my daily routine in my parents’ office. After completing this journey, I did not “get my fix.” Rather, I had uncovered a new passion, which at this current time, still has not been satisfactorily quenched by my second trip to Guatemala. 

I want to see more. I want to do more. 

I am not sure if I will visit Santo Maria de Jesus or Santo Domino Xenacoj next year. A few months ago, this same thought went through my mind; my monetary reserves were dry, time to study for the MCAT was valuable, and some physical issues worried my personal physicians. And yet I found myself on the plane headed to Guatemala City, due to the extreme generosity of the University of Delaware Honors Program, and the help of friends and family.  

I hope to do more of this - blogging - in the future. If I am blogging once again, it will mean that I am going on another journey  (I will not be doing it otherwise…). I’m not sure where life will take me. But I cannot wait to discover where I will be off to next.

As you can tell, I am a pretty big fan of serendipity. There is no other adequate way to explain how all this occurred. The word itself, although literally meaning “happy accident,” has been voted one of the hardest English words to translate into other languages (according to a quick Wikipedia search) - it has a meaning that itself is elusive yet all encompassing at the same time. Hence, the perfect way to describe the situation at hand. Many lessons I’ve learned in life come from “happy accidents,” and they have not totally led me wrong thus far. We will see where serendipity takes me next year. 

If you made it this far - to the last post - I appreciate you taking the time to read my blog. I truly hope that it was somewhat enjoyable to read; I assure you at the least that it was much harder for me to write than for you to read. I never promised that the blog would be well written; I understand my shortcomings and accept the lack of competent literary skills as one of them. But I do promise that the content is true, accurate, and a genuine representation of what went through my mind during my trip to Guatemala. 

Attached is a link to the new “photostream” for those who are interested in seeing other other 236 favorited photos (or if you aren’t my facebook friend). Again, many thanks to the University of Delaware Honors Program, and to you readers as well for taking the time to stick around and read my blog. 

As Shawn Smith - the founder of “Now Is The Time” mission trips - (and many locals) would say before a new journey or just as fittingly at the end of one: Dios te bendiga - May God bless you. Vaya con dios - Go with God. Pero no inmediatamente - But not immediately. 

Until next time. 

- Joe 

Photo Set

Day 5 – El Ultimo Dia 

Bittersweet. For days like this, bittersweet is the only word to describe how I feel. It’s the last day of my week-long mission trip to Guatemala. I always feel that I just got used to the job, the people, the language, etc. And, in perfect timing as always, it’s time to travel home. One cannot help but think that there’s still so much to do – there are thousands still in Santa Maria de Jesus alone that need medical attention. The rest of the crews feel the same way with their respective projects, whether it be floors, glasses, donations, or stoves. On the other hand, we’ve accomplished every goal we set out to do. We knew from the beginning that there was a chance that not all jobs could be done – that all statistical goals would likely not be reached. We all agreed on aiming for quality rather than sheer quantity. And still, we did it all - all 70 stoves, all 12 floors, all 500 patients – and more.

All crews had a short day; we would all end around noon to start packing unused materials, donations, medications, etc. In those 3 hours, Emily and I felt a little overwhelmed. There were a number of interesting cases as always; we actually met a girl who presented with pain on her left side after having heart surgery to close her ductus arteriosis – a blood vessel in the fetal heart that reroutes the blood from the pulmonary artery to the aorta, bypassing the lungs which obviously have no oxygen at that time.

However, it wasn’t the physically sick people who truly stood out in our minds today. Our second patient of the morning seemed to be fine for a middle-aged woman – she had no unstable gait, no cough, no major respiratory problems, etc. Her chief complaint was that she had pain – pain in her head, stomach, and heart. As I learned last year, many Guatemalans say that they have “dolor en mi corazon,” pain in my heart, when they are feeling intense sadness and anxiety – depression, as we Americans know it. We continued to talk and her story slowly unfolded as she began to cry. Over the years, she had lost all of her family; they had either passed away or moved from Santa Maria de Jesus. In a culture where family is everything, she felt stranded, simply going through the motions in life without purpose or meaning - as she put it. She stated that she didn’t care anymore – she didn’t care if she lived or died. I was dumbfounded, speechless.

A second woman who also complained of anxiety and depression like symptoms came soon after the first. She was much younger than the first at 20 years old – my age. She seemed detached from the world; as we talked, she expressed no emotion or body language. There was no happiness, no sadness – a simple blank stare on her face. We continued to talk, trying to find the root of her depression. She still had a family and there was no traumatizing event in her life from what we gathered. Emily asked if she had talked to her friends about how she felt. She replied that she had no friends, nor did she want them. This 20-year-old woman had grown so used to being alone that she no longer desired friends. 

After these two cases, Emily and I felt somewhat drained. We had nothing to give these women, but advice – to talk to others; to share their stories.

At the end of the last night, we meditated around a question; “What will you be bringing home from Guatemala?” The obvious answers came – many new friends, relationships, and experiences. But as I thought about it, what appeared in my mind first were these depressed women and all the others who had come to the medical clinic feeling similarly. Because I had met them, because I had heard their story, I was sharing their pain. Pain was one thing I was bringing home. I continue to think about these women - the thought of their depression and hardships that they face everyday genuinely saddens me. But by sharing their pain with me, some of that burden was lifted off their shoulders. It’s a pain I don’t mind bearing. They took the initial step to overcoming depression by voicing what had been troubling them.

One of our last patients provided a much-needed boost in spirit, which thankfully set the tone for the rest of the day. The man in the third picture for today was easily one of the most enthusiastic patients I had ever met - he was missing half his teeth yet ate the parasite pill without hesitation, aged over 70 years old but had the energy of a teenager. We asked if he would like to pray, as we do with all our patients in this very religious culture. He responded by taking 30 minutes to tell us his life story and his spiritual journey.

There was so much fervor in his speech, so much passion – we couldn’t stop him. I was lost within a minute, but I sat there, listening to the raw emotion, if not the meaning of the words. I tried participating every so often when I heard a familiar word, a plan that mostly worked – until I responded “muy bien” (very good) when he was speaking about witchcraft and death (Emily appropriately scolded me). After the patient left, Emily gave me a short synopsis of his story, in which he described how he almost died in an accident with a train and how God saved him. He spoke of dreams where God spoke to him, where his mercy spewed from the volcanoes as white ash. He even described God as having a goatee, if anyone was wondering what he looked like. This vigor is what astounds me about these people.

The other pictures are from the Vacation Bible School, where all groups meet on the last day to have a few final hours with the children of Santa Maria de Jesus – all 400 that we saw over the week. 

- Joe  

  • Question: How do you feel after seeing two years in a row of those people in third world countries; where they do not have medicine, nor real doctors that could help them? - Anonymous
  • Answer:

    Interesting question. Last year, I think I had the same feelings that most people would have in response to seeing a 3rd world country. After a second year, in which I visited a more impoverished village, I can only say that my feelings have been further solidified.

    First and foremost, I have the utmost respect for inhabitants here. They are easily some of the most hardworking, loyal, and resilient people I have ever met. They work lengthy days – hard manual labor for both men and women – and yet still make a daily wage that is well below the world standard for poverty line. Most live in terrible conditions; small shacks supported by unstable wood beams, covered by thin rusted metal sheets are the usual makings for a house here. Mangy animals and dangerous parasites wander into homes freely, while smoke from open fire stoves pollute their small living spaces. And yet despite the situation here – which seems like a competition for survival – you get a sense of camaraderie in small villages like this; people seem to look after one another. What small things they do have, they share. Children walk the streets freely, yet it never seems to be unsafe – even on the busiest streets. Toys – costly, sacred possessions here – are shared among children of different families, while it seems that many more of their American counterparts are being more and more possessive.

    Obviously, after seeing these conditions for the first time, I felt sorry for these people – who wouldn’t? For what and how much they do, they deserve more. I started comparing their life to mine and I often felt guilty. They don’t have the money, the possessions, the sheer amount of opportunities that I have had – it’s unfair. And yet, the more and more I spent time with them, especially after two years, I realized this; they don’t care. What I mean is that our lives simply are not comparable. They are a different people, with different priorities. The Guatemalan people – the pure, unadulterated culture that can be best seen in these villages – are proud. They are proud of their past and how they do things. You can see it in the eyes of their children; they enjoy life, no matter how poor I may think the conditions are. It’s hard to explain without experiencing it yourself by interacting with them. Their priorities are simply different. Sometimes I think “feeling bad for them” is one of the worst things I can do – it undermines their lives and accomplishments. Rather, I respect what they do and how they do it.

    This is not to say that there are not problems. There are countless – and even more medically. It’s sad when in this day and age, something that is mass produced in the billions in the US – simple ibuprofen and acetaminophen – is almost unattainable in a country less than 3 hours away from our boarders. Ibuprofen for example is not only rare, but also can be 4 times the cost than what it is in the United States. The lack of access to the majority of Guatemalans is unacceptable – their life expectancy as a country is indicative of that. Preventative care is almost nonexistent unless you are wealthy and live in a decently populated city. I do not have an answer to the health care situation of Guatemala. But I have seen them firsthand. This was a rather roundabout way to answer your question - I wasn’t totally sure as to what you were looking for. After taking everything into account – and as I look back on the two years/the two weeks of Guatemala – I feel honored more than anything to help these deserving people, if only for a little time in the grand scheme of things. 

    Thanks for asking! 

    - Joe 

Photo Set

Day 4 – More of the Same

Another beautiful day in Guatemala. This amazing weather – mid 80s, breezy, clear and sunny – is unheard of during the rainy season. And yet it’s been like that all week. Too bad the weather didn’t exactly translate into ideal conditions for our medical clinic, located in a concrete walled, single window room with a lone florescent bulb lighting (and heating) the area. We found ourselves outside more than usual, enjoying the climate with the local children and town members – as you can see in the pictures. Of course, this is not to say we did not see our fair share of patients – on the contrary.

The first patient Emily and I saw caught us… off guard. A woman brought her two sons to the medical clinic and handed us one blue slip while pointing to her 5 year old son, indicating that he was the sole patient (people are supposed to pay around $1.50 American dollars for each blue slip per patient – we usually treat them all anyway). He presented the usual symptoms such as headaches, malnutrition, etc. However, after we gave the appropriate medications and vitamins, and as we were about to accept another patient, the mother stated that there was one more problem – one of his testicles had not descended yet. 

Emily and I were obviously unqualified to continue the case. We again requested the help of Dr. Ray Keller (conveniently seated next to me). He performed a visual examination of the boy, and confirmed that, indeed, his left testicle has not yet descended. Given his age, surgery might be necessary soon – the older the boy gets, the higher the chance that long term consequences (such as infertility) can occur. We instructed her to start seeking professional surgical consultation if the condition does not change in the near future. We are again possibly looking into using some of the mission surplus to help fund this surgery.

The cases that followed paled in comparison, at least in seriousness. Warts were high in number again - we distributed a large amount of duct tape before the day was over. A number of women had chief complaints relating to their menstrual cycle. Many asked for pills to cure their cramps and headaches while others thought hot flashes were extremely hazardous to their health. Mothers came in worried about their teen daughters, for they had not had menarche at age 14 and 15, something than can very  normal. It was interesting to see what the Guatemalan people knew or believed regarding the female cycle - we found that the majority was ill informed.

Perhaps the best reaction was from a 49 year old woman who was concerned that she had not her period in over a year. A 49 year old – IE most likely she’s menopausal. We informed her that she probably wouldn’t have any more periods in her lifetime – news that elicited a huge smile from her. She prayed and thanked God for us, as if we… did something miraculous for her. We tried to tell her otherwise, but she was so elated, so ecstatic about the news – we just left it at that. 

- Joe 

Photo Set

Day 3 – Anything and Everything

Perhaps it was somewhat premature to be proud about seeing 110 patients in one day; 130 Guatemalans were seen this day and given medical aid with time to spare.

Today’s patients were not only memorable in number, but also in variety. I can confidently say that I have not experienced such a diverse group of patients in age, condition, or… attitude. Both infants and the elderly (one claimed to be 91) visited the medical clinic. Some came presenting problems such as hernias and meningitis, while at the other end of the spectrum was a complaint of smelly feet. The majority of patients were notably pleasant and grateful, while a particular baby kept… crying and pulling her mother toward the door as she saw me. Again - diverse to say the least.

Let’s start with the unusual. There must be many common misconceptions about how exactly the body works in Guatemala – the side effects that numerous patients reported simply do not make sense or are completely normal. Many pregnant women came today as usual, again requesting for prenatal vitamins. However, one complained of excessive saliva production, hoping that we would be able to cure it. Increased saliva production is a well known normal occurrence during pregnancy - there is no “fix” for it. The same reaction was elicited from us when a man said his chief complaint was that he had bad smelling feet. As one would expect, our clinic was ill prepared to treat this life-threatening problem – hopefully the organic soap and cucumber pomegranate lotion will suffice.

Emily and I were also perplexed with a few patients who seemed to be able to pinpoint their stomach pain to a certain organ. The kidney seemed to be a popular choice; it can actually be a warranted complaint signifying nephirits, kidney stones, etc. But given their medical accessibility, we highly doubted that many of these people could truly distinguish back pain from kidney pain – a common problem that many people in the United States have. It was especially uncanny that those who did complain of “kidney pain” all came to us in immediate succession. Somewhat suspicious.

Three more serious cases stood out in my mind amidst all the coughing, runny noses, and headache diagnoses that we made. Two of them both had girls suffering from inguinal hernias verified by our doctors. At this point, they may not be of utmost concern, but further complications can possibly be fatal if out pouching reaches the point of intestinal strangulation. Our mission is looking into possibly funding the operations necessary to correct the herniations if funds are available.

To me, the most memorable patient today was not actually one of my own. Dr. Sherry Keller and her daughter, Erin, had a patient who had brought in her 4-year-old daughter. Her daughter was born healthy, but soon caught meningitis at 3 months old. The infection spread quickly, ultimately causing severe neurological damage. In her current condition, she could not walk, talk, eat solid food, or see – with this, she may not even make it more than a few more years. We tried to give her the best chance possible, with much needed liquid vitamin supplements. Apart from that, not much can be done at this point, even if she were in the United States. Despite the situation, her young mother was understanding and hopeful, knowing that if anything, her baby was given the unconditional love and care that she deserved.  

- Joe 

Photo Set

Day 2 – Back To Basics 

6 hours, 3 medical stations, 110 patients (at the least) seen. For those who enjoy pure numerical figures, a little math shows some rather revealing statistics – 18.3 people seen per hour is simplified to 6.1 an hour per group, or 9.8 minutes spent with each patient on average.

9.8 minutes.

9.8 minutes to connect to a patient, to understand a patient’s suffering, to comprehend their past medical history, and to make a working diagnosis on which a plan of treatment is devised from - all while adjusting to both the language and cultural barriers that separate our different societies. And this is just the first real day of our mission.

Our vans arrived at the community center shortly after 9am. We unloaded and proceeded to our makeshift clinic, where we first recapped what medicinal inventory we had obtained and how we had organized it to ensure all knew how the “pharmacy” was organized. The line outside started to grow quickly however - we decided to start accepting patients, hoping that our system would be as efficient as we intended it to be.  

The elusive basic Spanish medical vocabulary taught to me during sophomore year in high school (and reinforced in Guatemala last year) started to resurface, with words like,  “tos, dolor, fiebre, and mancha” being used with almost every patient interaction. However, I quickly found that the rest of my Spanish skills… had vastly deteriorated. I could barely muster a sentence, let alone one with correct grammar and verb agreement. Having my translator, Emily, beside me helped immensely especially in the morning when my Spanish was the worst, allowing our group to make the progress needed to see all 110 patients who had signed up for the day.

The majority of the patients that Emily and I saw had similar symptoms – headaches, gastritis, heartburn, and joint pain. We administered vitamins and anti-hookworm medicine to everyone in addition to their appropriate medications for their specific ailments, whether it be Ibuprofen, Dexilant, etc. There were a few more serious cases that required stronger medication, such as antibiotics; Urinary Tract Infections (UTIs) were rampant, with many women (and teens) claiming that they have had them for many years without relief.

Three women complained of “ovarian infections,” two bringing radiology reports from a local hospital dated only a few days back. After confirming with the hospital’s findings, these “ovarian infections” actually turned out to be ovarian cysts, something that can be totally harmless, or can cause internal bleeding, intense pain, and ultimately need surgery to correct. Despite their pleading, there is no “pastilla” (pill) that cures ovarian cysts, nor were we equipped (or trained) to perform such surgery. We gave as much pain medication as we could and advised that future consultation with a surgeon may be necessary if pain persists.

Speaking for Emily and I (I am sure the rest of the medical crew will agree), the children are often what… affect us the most. We see a small infant and our language instantly changes to “Spanglish” baby talk. The adolescents are so innocent and willing – willing to trust us despite sporting foreign faces, clothing, equipment, and pills. There was an 8 year old girl who complained mainly of intense migraines, stemming from her poor vision, which has never been checked by a professional. We did have an eyeglasses clinic, but given her condition and age, dilation was necessary for the exam. Without hesitation, she took the numbing eye drops (which sting) and the subsequent dilating drops. Tears instantly rolled down her cheeks, but she wasn’t “crying” per se – she smiled and thanked us, and proceeded to the other room to get fitted for glasses. By far, the best patient, young or old, I have seen to this date.   

- Joe 

Photo Set

Day 1 – Reacquainted

Travel Day: Flights on time, quick though security, and no questioning through customs – fluid and facile.  Apart from meeting thirty new people and loading up over 3,000 pounds of donations, the rest of the day was spent aquatinting (or reacquainting for those returning) ourselves with our duties, our jobs, and the culture we were now immersed into. 

After a year hiatus, riding the traditional Guatemalan “Chicken Bus” to Antigua and stepping foot back into Hotel Candelaria immediately brought back memories and feelings that have been absent for quite some time. As cliché as it may sound, it truly felt as if I had never left. The bus, the hotel, and the people – everything felt so familiar. And here I am on the roof of the beautiful Hotel Candelaria, contemplating the events of the day carefully, just as I often did a year ago.

Our first full day here was spent learning.

We learned about the people of Santa Maria de Jesus. The community center of the town – our “command center”– was painstakingly cleaned before our arrival, and we were given a presentation by the children of Santa Maria de Jesus that gave insight to the history of the culture of the town. Afterwards, we toured around the town, visiting old friends of the mission who offered an even more in depth look into their lives. The setting was akin to Santo Domingo Xenacoj, but was visually much poorer in comparison. Many here still relied on weaving quilts, hats, etc. Others were relying on tortillas for their main income, their lungs fighting the thick fire smoke for over seven hours a day to hopefully earn the $1.50 daily wage needed to provide the bare necessities for her family.

We learned about our job for the week. After a delicious lunch prepared by the women of Santa Maria de Jesus, we split up into our respective crews. While the stove and concrete floor team walked off to their first project sites, the medical, eyeglasses, and donations crews remained in the community center, spending the afternoon unloading suitcase upon suitcase of supplies, donations, and medications. The rooms for these three groups are modest and small – yet over 500 people are expected to come through the doors of the medical clinic in a time span of 4 days. To maximize efficiency, three medical stations are setup to simultaneously see three groups at a time. Dr. Ray Keller will be seated in the middle, both seeing patients himself and also acting as an advisor for the other two groups. His wife, Dr. Sherry Keller, and his eldest daughter, Erin, will be seated to his right; his youngest, Emily, and I will be on the left. This system proved to be very successful last year, maximizing not only the sheer amount of people seen, but also the efficiency of the group as a whole. The doctors can easily be consulted if a difficult case arises, and when counsel is unnecessary, patients can be seen quickly by anyone, effectively triaging them based on their condition at the same time.

And finally, we learned what we are here for: our purpose. Our “job” is to build stoves, to cement floors, to distribute donated goods. We may fail at our “job” – we realistically may not finish all 70 stoves or 12 floors, due to traffic, weather, etc. We may not see all 500+ patients waiting for their first doctor’s visit in years, or have enough time for all 3,000 pounds of clothing and shoes to be given to needy families and children living in extreme poverty. To accomplish every statistical goal is not the purpose of this mission. We are here to give these people hope. Hope that they are not forgotten, that fellow man still cares for those living in extreme conditions. All intended projects will be completed one way or another, as reserve funds are allotted to finish whatever we started. But our sheer presence has a much greater effect that any statistical value could represent. Relationships will blossom, friendships will be made, children will be taught, and all will be cared for. 

Photo Set

Picture 12 - Anything and Everything 

1 Hour: Leaving for the airport. 4 Hours: Leaving the country. 10 Hours: Touching down in Guatemala City. And it starts. 

Please disregard my enthusiasm, I know this is going to sound melodramatic. But I’m…  rather excited. I’ve been waiting to continue what was started last year ever since I stepped on that fight back to the US. A deep sense of achievement was quickly overshadowed by a realization that so much more needs to be done. And after a year of eagerly waiting, I can finally do just that - I can finally do more. A little bit more. 

I didn’t quite make the 20 or so picture count that I had planned - my apologies. So for the sake of my own closure of knowing that I posted the most important ones, here are the others that unfortunately didn’t get the lengthy caption, but are still worth mentioning in my book. Err… Blog. 

1. Picture of me with some of the children in Santo Domingo. The boy next to me was like every other boy there, except for the fact that he has metal caps/crowns on every single one of his teeth. Dentistry here is almost non-existent; the cheapest and quickest way to deal with poor teeth is to simply cover them with metal.

2. This girl quickly stole of the hearts of all who worked in the medical clinic. There had been complications during her birth (which I believe were also exacerbated by an accident drop by a doctor or nurse in her infancy). She was hard of hearing, had atrophied muscles all over her body, especially in her neck, and seemed to suffer from a learning disability. Yet she still mustered a smile and a laugh during her visit. Her mother refers to her daughter a continued blessing from God. 

3. This boy ran out of the donation clinic with a jacket from my childhood. That is all. 

4. A mother brought her son and daughter to us, with them reporting continuous tooth aches, starting over 2 years ago. The boy and girl were both under 10 years old, and did not complain once of pain. The examination revealed cavities that rooted all the way to the gum. 

5. Little man came in with a nosebleed and completely ruined his new shirt from the donation clinic. Cleaned him up and fitted him with a new donated Ralph Polo shirt. Looking sharp. 

6. The view from the volcano we climbed on the last day in Guatemala. 

7. Abendazol is an antiparasitic medicine that each patient received. It’s terribly chalky in taste and consistency - not exactly the favorite among patients. Every child still took it without question. Lindsey and I wanted to try it to know exactly what we were dishing out. We hid our true expressions pretty well. 

8. The aforementioned line on the first day. 

9. Picture overlooking village in Guatemala. Representative of living conditions in most towns. 


Picture 11 - Back To Back 

When this young man walked into the clinic, I couldn’t help but think to myself, “this looks bad.” 

Diego (I really think that was his name…) was the typical 16 year old Guatemalan. He farmed with his family during the day, and played many sports in his free time, including soccer and basketball. I questioned him about his arm, expecting a response relating to a work injury, etc. It looked pretty serious, with a makeshift cast and enough gauze wrap to measure 3 inches thick. His explanation for the cast was this: “Mi amigo me golpeo con un palo.” - My friend hit me with a stick. 

Given my comprehension of Spanish at the time (and at present time…), I didn’t know what else to say in reply, apart from “lo siento” - I’m sorry. But he quickly informed me that the injury was not the reason he came to the clinic. He complained of chronic headaches and pain, all stemming from his neck and shoulder area. He allowed us to carefully take off his shirt to exam his back visually, as light touches triggered facial expressions of intense pain. 

With his shirt off, the problem was obvious. For reason, his right scapula (shoulderblade) was lower on his back in comparison to left. Much lower. We were perplexed - this type of condition does not just occur overnight. Nor should it have been taken lightly in the past; the pain that potentially comes from this… we could not have imagined. The scapula is a vital part of the back, being the origin and insertion point for over a dozen muscles, including the biceps and triceps. 

Our best hypothesis? The excruciating pain due to its position (whether due to improper development, a severe injury, etc) day in and day out continue to aggravate Diego to the point of developing migraines and headaches. Again, his current state must have taken years to get to this point, provided that he truly didn’t sustain any major trauma to his back. 

The lack of medical care in his village means that Diego is on his own. Pain medication like Tylenol, Advil, etc are rare, and surgery is almost out of the question. He stated this was the first time that he had seen a real doctor, as is the case with most of these people. He barely makes enough money to feed himself and help with his family; we know that our advice to seek further medical attention will most likely be ignored. And so the vicious cycle starts where he will be unable to work, unable to relieve his pain, unable to provide. 

We gave him what we could - extra gauze for the arm and ointment (in case there was a wound), and extra ziplock bags of ibuprofen and acetaminophen in hopes of relieving even a fraction of his pain. Even knowing that the medication was by no means a panacea for everything, he was extremely appreciative, clinging on to the hope that one day he’ll be able to work again and ultimately recover. 

- Joe 

Photo Set

Picture 10 - Toms 

This picture has very little to do with our medical mission, but It’s still one of my favorites. 

Blake Mycoskie was a competitor on The Amazing Race in 2002. He traveled all around the world for the show, battling other duos in many events that required stamina, endurance, intelligence, direction, and intuition. After Blake and his sister Paige finished third in the show, he traveled to Argentina for a short time, discovering that thousands of children here (and around the world) walked with no shoes. Feet were susceptible to cuts, infections, parasitic invaders, etc, and many die due to complications each year. In countless cases, education is also limited by the lack of shoes, with them being a requirement to attend school even in third world countries. 

While in Argentina, he grew fond of the local “alpargata style” footwear that many farmers wore there, and was inspired to create a company that vowed to help those without shoes around the world. He sold his current business and started TOMS Shoes in 2006. Adopting the alpargata style to his line of original products, sales in the United States took off not only due to their fresh take on footwear, but also because of the company’s promise and mission - for every pair sold, another would be put on the feet of a child who previously did not have shoes. 

Sure I had heard of the company… the girls on my freshman floor at the University of Delaware all had 20 pairs of them. And their collection keeps growing. But in this day and age, seeing is believing. Scams and scandals are everywhere, and skepticism is… somewhat needed to ensure that you’re not on the receiving end of a bad deal. To see TOMS Shoes being worn by children over 2,500 miles away from my home… well, it was unreal. 

It was reassuring to see an honest company - a company actually doing exactly what they said they would be doing. My medical clinic was in Santo Domino Xenacoj - a small mountain town that doesn’t even have its own Wikipedia page! And yet a substantial amount of children were running around and playing in TOMS. 

Of the 11 in the picture, 6 had TOMS on their feet, a percentage that seemed accurate throughout the whole village. Again, not totally related to my mission, but noteworthy, at least to me. 

5 Days Left! 



Picture 9 - Tengo Tos  

In less than a week, I will be once again in the country of Guatemala! All forms filled, all dues paid, and… my sister is in the process of getting my 100 pound quota of donations ready. Just gotta finish another week of MCAT studying first… 

On to the clinic itself. As mentioned before, when we arrived on the first day, a long line of school children greeted us, all eager to be seen by the “Americans” (the more plausible reason is because they were missing school). Students ranged in age anywhere between 6 and 12 years old, with the younger given priority. Most were pretty timid, understandable when considering that this may have been the first interaction with Americans in quite some time (or ever). We found that there was this discernible quality in all of them, a quality of innocence that just seemed… different. 

This innocence was soon put to the test. As we talked to more and more students, the crew all started to notice something. Apart from a few who actually had a noteworthy diagnosis like asthma or a real runny nose, all had the exact same complaint - “tengo tos.” Simply translated as, “I have cough,” these seemed to be the key words. The key words that they were instructed to tell us by their teachers and or parents. Some felt uneasy uttering this downright lie, feelings made evident to us by their tapping feet, changing stories, and their continuous hesitant glances to the back of the room where their proud teachers stood. 

Some could barely muster the courage to say the phrase - and when they finally did spit it out, they had nothing else to say. Others went along with the lie and embraced, adding a host of other problems to the list such as headaches, runny noses, itchiness (with their duration of their ailments, no less!) when there was no physical signs of any such problems. Either way, we knew to expect it - in a town with little to no medical medicine, students were told to tell the little while lie to try to get as many medical supplies as we would give them. And we couldn’t just let them leave empty handed. 

Each student that walked in left armed with some children’s vitamins (of the Flintstones variety if they were lucky), a lollipop in hand, possibly a box of Batman band-aids, and a tablet of Abendazole (an antiparasitic medication) digesting in their stomach - after praying with them for continued watch, as we did with every patient. More [interesting] patient stories to come. 

- Joe 


Picture 8 - Christine 

On the morning of our first day at the clinic, 100 teachers and students from the local school were lined up in front of the Church’s stone gates, patiently waiting for our arrival. The local women who helped Shawn organize the clinics for Santo Domino Xenacoj greeted us at the door with wide smiles, excited to finally open the doors to the church courtyard that housed the Vacation Bible School and our medical clinic/eye glasses clinic. 

As we headed towards the door, one of the female elders was holding onto a baby stroller - the one you see in the picture. The team members who were in front of me all peaked in to make the obligatory guttural baby noise (in broken Spanglish, no less) at the infant, trying to evoke a simple smile or laugh. When I looked in, I quickly realized that the baby looked familiar. She was the spitting image of my cousin, Christine.

When Christine was born, the life of my Aunt (and her family) changed forever. On the day of her birth, she was diagnosed with Down Syndrome. Also called Trisomy 21, it is caused by complications in Meiosis (cell division), specifically during nondisjunction of Chromosome 21. This extra chromosome not only affects the physical growth and development of a child, but also tends to limit academic performance and cognitive abilities. My Aunt and Uncle knew what such a condition entailed - extra care, attention, schooling, supervision, health care, etc. Despite this news, they quickly vowed to give all the time and love they could provide to Christine, just as they did to her sister, Grace. 

And somehow my Aunt and Uncle foolishly choose me to be her Godfather. ME. I was chosen to help lead Christine through life, assisting her in discovering and defining her faith - when I am far from accomplishing the same with my own ideologies. We’re talking about the guy who finds himself sleeping more than listening in church. The one who never gets it right the first time. The one who tucked his tie in his pants for the family portrait 10 years ago. And I was supposed to be qualified to impart wisdom to Christine? 

The baptism still happened nevertheless, which turned out to be a milestone not only for her, but for me as well. As unsuited as I may have been for the job, I promised that day to take an active and permanent role in Christine’s upbringing. Two and a half years of being a godfather have instilled in me a sense of great pride of Christine, a feeling that I could not help but be reminded of when I saw that baby in the stroller. 

When I discovered that my cousin had Down Syndrome, I did some research and parents everywhere all shared similar stories. They said that their child became a role model for others on how to love - these people exude it in such an unconditional and perfect way.

The baby I had seen in Santo Domino resembled Christine almost perfectly. Seeing “Guatemalan Christine,” as I remember her, gave me fitting inspiration for the first day of the medical clinic, reminding me of that impartial and unconditional care that I hope to strive for when I become a physician and a father.

- Joe  


Picture 7 - The Pharmacy 

Our medical clinic was run out of an “outdoor” classroom. As a whole, we saw and administered medicine to over 300 people in a week. This small corner of the room was converted into our pharmacy. 

To keep costs low, many medical missions buy their medicine from international foundations who sell in bulk. These companies sell random allotments of medication for a low price - the medicine is donated by pharmacies and organizations because they were not needed or because they are near of slightly past their expiration date (almost all drugs are actually conservatively dated to ensure effectiveness, while they tend to last much longer after their “sell by date”). This system is cost efficient and effective for situations like this. A huge amount of medication can be purchased cheaply (and can get through customs that much easier) and for a small village that has no pharmacy, any medication is helpful. 

It was actually exciting for us to open the boxes to see what we were given in this… “pharmaceutical lottery.” The first box was… somewhat demoralizing however - half of the prescription bottles were in German. Or Italian. Or Latin. Or something. Luckily, after opening the rest of the packages, a list was found documenting all the medication, their quantity, and their generic American name. 

Surprisingly, a good amount of the medications seemed promising, given the people we were helping. Cough and Flu syrups were abundant in number along with a good supply of prenatal vitamins and antibiotics, which ultimately proved to be very useful. However, common over the counter items such as tylenol and advil were completely missing from the boxes. Hydrocortisone and other fungal and bacterial creams were donated, but in very limited quantities. Hypertension and diabetes often plague those of hispanic descent, and yet we had nothing to administer for those conditions. Perhaps the most aggravating aspect of our allotment was the absurd amount of Diflucan given to us. Diflucan is an oral antifungal medication that is usually taken to combat yeast infections - only 3 people had such symptoms out of the 300 patients. 

Despite our somewhat random supply of medication, the pharmacy kept busy and we seldom came across a patient that we were ill equipped to assist in some way. 

- Joe 


Picture 6 - Celebrity For A Day 

This picture was taken moments after my last picture, when we were taken into another room for a special lunch they had prepared for us.

Meet TJ, a 10 (I think) year old boy from Florida that I met along with his mother on my trip to Guatemala. His mother Carrie thought that the trip would be a great experience for young TJ to experience the world - in an effort for him to see the harsh realities that many still call life in this day and age. For this moment however, instead of feeling grateful and appreciate for what luxuries he has at home… he perhaps got the wrong message.

Being a white youthful boy in Guatemala made him a somebody, a celebrity, a superstar. While many mission trip groups do choose Guatemala as their target country, seldom are adolescents (let alone a 10 year old) brought for safety reasons. TJ’s presence made it easier to approach these young boys and girls - he somewhat… bridged that gap so to speak. This White American boy was like them, a notion that made all students flock to him. TJ was never without a Guatemala companion tagging along next to him. And yes, all Guatemalan children are that cute - the one sporting the KIM POSSIBLE T shirt was a crowd favorite. 

Being 10, TJ was probably in the fourth grade or so. It was his first time out of the country. He stuck out like a sore thumb across a sea of dark Guatemalan students with his pale freckled skin and freshly buzzed mow-hawk. And he knew not a word in Spanish. Yet the children immediately took him as one of their own. While all this attention may have given TJ a short ego boast, he ultimately had a great mission trip, experiencing events that hopefully will pave the way for a life of continued altruism. 



Picture 5 - A Quality Education 

Remember my first post of the photostream? The mother who came back 3 times throughout the day to ensure all of her children were seen by us? And how she brought her eldest son to the clinic right before it closed - the blind one? This is a photo from his school. 

Santo Domingo may be bigger in population and size when compared to majority of other mountain towns in Guatemala, but it is still far too small for the Government to even contemplate building a school in the area. Unfortunately, the same goes for all but a select few towns - public education simply isn’t a big enough priority to try to expand its reach past urban city districts. Due to this, Guatemala is known to very limited options when it comes to education, with very few public schools and secondary schools  supported by the Government. Even is there is an institution present (offering free education) in the area, the cost of books, uniforms, and supplies not supplemented by the state often deter families from placing their child in such programs.

The school uniforms that many of the students wore reminded me of my Catholic Middle School days. The presence of the all too familiar embroidered male sweater vests, the collared shirts, and the plaid skirts completely surprised me given the financial state of most of the families here. I know all the students and parents at my school complained incessantly about the inflated prices of our uniforms - I can only imagine what percentage of these Guatemalans’ savings went to sending their children to this school clothed in the correct dress code. 

This alone is a testament towards how much of a priority an education is now. Guatemala, as you know by now, is an almost completely rural country, with small mountain villages and valley towns making up most of the population. Of this population, almost 30% cannot read - a statistic not beaten by any other South American country. The fact that over 50% of all families live below the poverty line also does not make for an environment conducive for learning and educational prowess.

However, schools like this one in Santo Domingo shows promise - attendance is now at an all time high. It’s not a “state of the art” facility by any means; as you can see, the building seems like it was converted from a barn - probably because it was. But these children want to learn, and now that the majority of books, uniforms, and supplies are donated, there is little in the way of stopping them. The students genuinely seemed happy to be there when we visited - possibly because they rarely see Americans… But regardless, when asked if they like school, they all replied that they love it. Try to get that same response and fervor from many of their American counterparts… it’s likely much tougher. 

- Joe