Where´s the shade??

Hello, hello…

I hope this finds you all well…I am happy, healthy and content here in Las Cruces, Guatemala. Although…I am hot. Super hot…

I’ve been wondering how to continue this letter to you guys. I was really tempted just to jump right in, but my sister reminded me that I haven’t ended the Colombia part yet. Good point.

As a reminder, you can read the previous entries at briangood.blogspot.com or on my facebook page at the bottom left. I haven’t reread them so I am not exactly sure where I left off. I hope I didn’t leave a big cliff-hanger that I am neglecting.

My last month in Colombia was incredible. It seemed nearly like a final exam, with the stressful preparation, the execution and the quiet feeling of achievement. I was nervous leading up to it, as I was to be the primary medical care-giver for the project. Alan, Julie and their son Gregory had left the country as had been planned. Melanie and I kept the program going. I designed and taught a course in childhood illnesses and then Melanie, Ismael and I traveled up a river basin and visited 5 communities. This photo was taken by Melanie as Ismael, a promoter and I spent an hour clearing debris to get our boat upriver.
The people we met and treated were fantastic, and the scenery unique, but we got back to Riosucio completely worn out. For me this developed into a pretty lousy illness that made my last few days in Riosucio full of napping and hazy memories. By the time I flew back home, I was starting to feel better.

(side note…Everyone has been asking about Ismael and my feet…Ismael is doing well and is happy as ever and my feet healed well…eventually. There was a small bump in the road with one of my feet. I developed a pretty unique (to me) ulcer. I had a doctor colleague look at it and take some samples. She wasn’t as impressed as I was, and the microscopic testing was negative for anything noteworthy…and it has since completely resolved…I didn’t take a photo.)

Though I hadn’t been away for very long, the return home felt surreal. I was happy with what I had accomplished, excited to see family and friends, but scared to death about working and teaching in the children’s hospital. I wasn’t sure how interested the residents were going to be about my improving knowledge of health promoter training and low-resource medicine. I knew that was not going to be the priority for patients’ families. After a few days in Boston with family and attending my high school reunion, I arrived in Utah late Sunday night. My truck registration was WAY expired. Despite valiant efforts from a close friend, the Utah heat had done a number on some plants. Besides that, I was sort of late for work. I went into the office on Tuesday and started taking care of kids again on Wednesday. Wow. A huge leap.

The easiest part of the winter turned out to be the work at the hospital. I loved it. The kids were pretty sick, but teaching and learning along-side the residents and med students really made me happy. I had difficulty juggling my new job, trying to re-connect with friends, and continue to do the activities I enjoy. Looking back, I had an amazing winter. I met some great new people, made some incredible new memories with old friends…egad…bordering on cheesy, huh?? Moving on…

I arrived in Guatemala over a week ago. Due to my new-found contentment with hospital work and Salt Lake City, I was reticent to leave. My last few weeks at home were fun, but had a definite somber overtone. As did my arrival here, despite the wonderful welcome.

I am currently in Las Cruces, Peten, Guatemala. It is in the Northeast portion of the country, not too far from the Mayan ruins of Tikal and the neat little town of Flores. Looking back, when I first took the bus to Las Cruces in 2002 at the recommendation of a friend of a friend, I had no idea I was meeting people that would eventually become such close friends and teach me work that would form such a large part of my career.
We had planned that I would return here this year to help with the large number of health promoters that are being trained in this region. I will be working with Susan, who visited Colombia last year and about whom I wrote. She is a wealth of tropical health knowledge and enthusiastic about clinical medicine. Her life and approach to clinical care are inspiring. I am fortunate to be here working alongside her.


Our home here serves as a clinic, pharmacy, teaching center, as well as a spot for sleeping, cooking and cleaning. Here is the view as you walk up our driveway. The teaching area is on the left; Susan’s room is on the right, kitchen straight ahead. I have my own room in a building in the back. Mira is currently living in a room behind the kitchen.

Mira was 7 when we first met; she had just moved from the US to the clinic with her mom. She loved to dance and sing and was well on her way to being bi-lingual. She has grown into an energetic, grounded woman, who is actually an accomplished health promoter as well. On our way home from dinner last night she identified a child who needed sutures, injected local anesthetic and stitched his chin. Pretty impressive. She also has been very helpful in advancing my Spanish. “Mira…why did the instructor just say the man gave HIV to a half an orange??” When she stopped giggling she clarified that the saying meant “his better half…” Thank you Mira. She is leaving here next week to live with her mom in the US and finish high school there. We will miss her energy and attitude. (here she is picking lemons for lemonade, you can just see her white pants.)

We have clinic at our home four days a week. (ok…this might be funny to those who knew that my paid full-time job required less clinic days than that…)…On a recent “off- day”, Mira and I volunteered…umm…were volunteered…to clean the water tank. There weren’t many people vying for the opportunity. We drink rain water that collects from our gutters and gets stored in a massive tank.
As the current hot, dry season is wearing on, the water level was slowly decreasing, and the water itself was getting fairly funky. It was kind of brown and didn’t smell all that good. A huge flood this winter had deposited an abnormal amount of mud in the tank (the last time I checked, there were some impressive flood photos on our website, concernamerica.org). Mira and I got some ladders, buckets, brushes and bleach, went over the top and into the muck. It wasn’t the most romantic view of international medicine, but we felt productive. After clearing out 5 large frogs, Mira shrieked…”something just sucked onto my foot!”…the small windowless cement tank didn’t allow her voluminous proclamation much escape. As our hearing recovered, we emptied the rest of the water out, muddy bucket-full at a time…and found nothing…the exact form of the ankle-kissing beastie is still unknown…

Each clinic day, we have patients lining up in the early morning to be seen.
Running a clinic here allows the continual opportunity to train the promoters clinically, as an adjunct to their lectures. Yawning, stretching, shuffling outside in pj’s, toothbrush in mouth…I bet we look pretty good, and certainly professional and completely reputable. When we don’t have active clinic we are trying to prepare courses or medicine (or clean water tanks, do laundry…fun stuff). We are always available for emergent cases. People come to our kitchen door from miles around with most problems, urgent or otherwise. I can’t believe the amount and severity of trauma I have seen, just in the past week. My suturing and microscope skills are improving. Yesterday in the midst of a busy clinic, I realized that I was completely happy. I am being challenged. The ability to practice medicine here with limited resources is effective. Working this way and passing whatever knowledge I have on to others are both rewards in and of themselves. Somewhere in the past week my reticence about leaving has faded and I am looking ahead to 6 amazing months…stay tuned…