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Brigade Report Public Trip - Guatemala July 2010 Timmy Foundation Building Healthy Futures Brigade Report – Public Trip Guatemala, July 17-24, 2010 The following report summarizes the Timmy Foundation’s July 2010 brigade to Quetzaltenango, Guatemala with general volunteers and medical professionals. A special thanks to all of the volunteers—both students and medical professionals—that made the brigade possible. Volunteer Specifics 10 general volunteers travelled on the brigade—six men, and four women. Five total medical professionals were recruited by Timmy staff, including one physician assistant, two RNs, and one pharmacists. The former Timmy Foundation’s International Programs Coordinator, the current Programs Coordinator, the Timmy LAMP intern and medicine coordinator were also present on the trip. The Medical Programs Director in Guatemala also participated in the trip. The total number of trip participants totaled 19. For a complete brigade roster, please refer to Appendix I. Though facets of the trip are summarized below, please refer to Appendix II for a complete hourly schedule, revised according to the group’s actual movement. Travel Flights All participants arrived according to schedule and met Timmy’s Medical Programs Director and driver at the airport. The first groups to arrive were transported to Antigua where they got lunch and waited for the remaining flights to arrive. Everyone but the two on flights arriving after 8:00 PM had dinner together at Las Palmas in Antigua. Ground Transportation Transportation was organized throughout the week by Juan Antonio Loarca, a private transportation contractor that works principally with non-profit organizations in Quetzaltenango, Guatemala. He, along with partner driver Francisco, ensured that all luggage/baggage was secured on the roofs of the “microbuses”—15 passenger, diesel powered vans—and that there was ample space for all 19 trip participants. Though space was tight in the vans throughout the week, drivers were very safe and competent. Clinic Clinic was scheduled for all work days this week. Full days of clinic were scheduled for Monday-Thursday; half day on Friday. In total, the Timmy team attended to over 400 patients during the clinic week. Pop-Wuj sent around 12 medical students to assist with clinics in the morning each day. These students travelled with the Timmy team to clinics each morning and left around lunch time each day. The students were extremely helpful, particularly in triage where they took patient histories and assisted general volunteers with Spanish translation. Monday – Buena Vista The Timmy team visited Buena Vista twice on this brigade, on Monday and again Thursday. In total, the team saw 178 patients there including: 37 males, 141 females; 20 young children (ages 0-5); 31 children/adolescents (ages 617); and 125 adults (ages 18 and older). The group easily adjusted to the three-way translating necessary in Buena Vista, a Maya-Ma’m village 30 minutes northwest of Quetzaltenango. Many patients spoke Spanish in addition to Ma’m, making communication fairly easy and requiring only a few Ma’m translators. The brigade clinic was hosted at the home of a local midwife, Doña Ana, where a child was birthed during the day. Tuesday – CEIPA in Salcajá On Tuesday, the Timmy team attended to 100 patients: 36 males, 64 females; 19 young children (ages 0-5); 30 children/adolescents (ages 6-17); and 51 adults (ages 18 and older). The clinic was hosted at one of CEIPA’s schools in Salcajá. CEIPA—Centro de Educación Integral Pastoral (Pastoral Center for Comprehensive Education)—is a program for children and adolescents largely affected by social issues such as abuse, domestic violence, rape, single parents, etc. The school requested the help of Pop Wuj, Timmy’s partner in Guatemala, to see the students during one of its school days. While previous Timmy clinics at CEIPA schools have resulted in a high percentage of well-checks, this particular clinic seemed to consist mostly of sick patients with several instances of pediatric malnutrition and/or stunting identified. The patients seen during the day have very limited access to healthcare and few resources to seek medical care if it is needed. For this reason, periodic visits to CEIPA are recommended. Because the patient profile at other locations was generally healthy, it might be useful for Timmy to send clinics to different CEIPA locations throughout the year in order to provide care to different communities while Pop-Wuj provides treatment and medications (particularly for any chronic patients) in between brigades. Unfortunately, the leaders at CEIPA told most of the patients to come to the clinic at noon, so the morning went very slowly. Only having to translate from Spanish to English did make the day go faster, though, and the team was still able to finish with the clinic in plenty of time to return to Los Olivos for dinner. In the future, Pop-Wuj and Timmy should emphasize the need to have patients arrive on time in order for Timmy to be able to provide the best quality of care for each patient. Wednesday – Xeabaj On Wednesday, volunteers, medical professionals and Pop-Wuj medical students attended to 73 patients in Xeabaj, a community displaced and rebuilt following Hurricane Stan in 2005. Of the 73 patients, 17 were males, 56 females; 13 were young children (ages 0-5); 17 were children/adolescents (ages 6-17); and 43 were adults (ages 18 and older). For more specific information regarding the morbidity statistics in Xeabaj (and all other communities and age-groups), please refer to the brigade data in subsequent pages. Translation in Xeabaj, a Maya-Quiché village, can be quite difficult. The majority of doctors and patients required translation support from Spanish to Quiché to properly understand the patients’ histories and treatment options. Because of the three-way translation (English>Spanish>Quiché and vice versa) and because of the shortage of designated Quiché translators, communication throughout the day was delayed and frustrating for many participants. Nonetheless, all patients were seen during the day and community leaders were very grateful for the team’s presence. Thursday – Buena Vista Doña Ana distributed tickets for the day in advance and advised patients to be lined up for the clinic to begin at 8:00 AM. By 9:00 AM, very few patients with tickets had arrived and several community members without tickets were patiently waiting. Timmy and Pop-Wuj staff consulted with Doña Ana and determined it was best to distribute tickets to those who had been waiting in line all morning without tickets in order to provide care to as many patients as possible, particularly given the absence of many ticket holders. By 2:30, Timmy and Pop-Wuj staff agreed to close intake as no more patients were in line. By 3:00, a few additional patients arrived with tickets. Since intake and triage had already completed for the day, these patients were provided with directions to the Pop-Wuj clinic as well as hours of operation. One woman was given medication per the direction of Doña Ana despite not being seen by the doctor since she was illiterate and could not understand the directions to Pop-Wuj. She only needed medication for gastritis, and the pharmacists were comfortable dispensing vitamins and ranitidine to her per Doña Ana’s request. Friday – Pop Wuj On Friday, the Timmy team attended to 43 patients in the half-day clinic that began at 9:30am and commenced at 12:00pm. Of the 43 patients, 16 were males, 23 females; 6 were young children (ages 0-5); 3 were children/adolescents (ages 6-17); and 34 were adults (ages 18 and older). Following clinic, all medicines were categorized and set out to be inventoried into the Pop Wuj pharmacy. Because very few team participants travelled from Indianapolis, meaning we transported fewer medical supply bags to Guatemala, the Timmy clinics had to tap into Pop-Wuj’s supply of certain medications. This should be taken into consideration in planning the medications for the October brigade to ensure that Pop-Wuj has adequate supply for the coming months. Activities There were several planned cultural activities throughout the week beginning on the IU participants’ first full day in Guatemala. Chocolate Tasting at Doña Pancha’s On Monday evening, the Timmy team walked to Doña Pancha’s in Xela to sample locally produced chocolate and hear the history of chocolate in Mayan culture. The team sampled chocolate covered fruits, strawberry yogurt with a chocolate sauce on top and hot chocolate. Afterwards the team was welcome to purchase chocolates from the shop. The team really enjoyed the talk and the samples, but would have preferred to not watch the video that followed. In the future, Timmy should continue to go to Doña Pancha’s but request the explanation without the video. Cultural Competency Lecture – Roney Alvarado As is custom on each Timmy Foundation medical brigade, Roney Alvarado, Pop Wuj’s director of health programs and the foundation’s main contact at Pop Wuj, gave the group a brief yet important overview of Guatemalan culture. Roney, an anthropologist by training, framed our clinic week with a bit of a rhetorical question—“why are you here?” Among the topics covered in the cultural competency lesson were: the differences among cultural perceptions and reality; the difference between western and traditional medicine; the necessity to learn throughout the week; the importance of self-evaluation and reflection throughout the week, specifically in regard to individual’s motivation for attending the medical brigade; and the responsibility one has for the work during the week and follow-up thereafter. Fair Trade Shops On Wednesday afternoon, the group visited TRAMA, a fair trade textile cooperative in Quetzaltenango. The store offers high-quality, hand-made goods at very reasonable prices, while also offering patrons additional information relative to where products were made, who makes them, how they are reimbursed for their work, etc. Antigua To make transportation to the airport quick and efficient on Saturday morning, the group departed from Quetzaltenango shortly after finishing clinic on Friday afternoon to stay the night in Antigua, Guatemala, a colonial town 45 minutes outside of Guatemala City. Known for its beautiful colonial architecture, old churches and cathedrals, gardens, and cobblestone streets, Antigua is always a favorite of Timmy medical teams. After checking in at Hotel Santa Lucia IV, the group spent a brief amount of time shopping near the hotel before gathering to walk to dinner at La Peña del Sol Latino where participants were treated to great food and live music. A short reflection session followed dinner at the hotel where trip participants were invited to share their thoughts with the group. Wellness About half of the group reported feeling ill during the brigade. Most team members suffered only mild symptoms such as very mild headaches and sore throats. Only two trip participants became more significantly ill with more severe nausea, vomiting, and diarrhea. The majority of those feeling ill affirmed that symptoms disappeared in 2448 hours. The cause of these health issues has not been pinpointed, but there are a number of factors that may contribute, including: the altitude in Quetzaltenango (roughly 7,500 ft.), patient contact, lack of proper hand washing throughout the week, consumption of raw vegetables, and travelers’ GI tracts adjusting to different food. Feedback Debrief with team members each night Would like to have team member profiles and bios prior to trip Update the trip booklet with greater emphasis on bringing warm clothes Forewarn participants that there is little time to spend at internet cafés (may want to get international cell phone coverage) Delete the recommendation that participants not bring iPods or laptops for public trips Desire for more traditional Guatemalan cuisine—accommodations otherwise found to be very pleasant Would like to have an evening free to eat in downtown Xela Interest in mid-week free day like the Quito trip Would like to stop along the road to take photos of some of the scenery Don’t schedule first day at Buena Vista because it can be overwhelming Take time Sunday night to examine our equipment such as BP cuffs, thermometers and make sure they are all working after the trip (could also use this time to train people who don’t know how to use them) Be more realistic about the time schedule for the itinerary – make sure people realize the limited number of opportunities they will have to shop Basic Spanish introduction More interpreters be made available More advanced communication from Timmy needed Would like email confirmation when trip documents are received Be sure to translate when community leaders (such as Doña Ana) give talks If possible, have community leaders give an introduction to their community before the clinic begins Appendix I Trip Participant Roster Public Trip – Guatemala – July 17-24, 2010 Last Name First Name Specialty/ Occupation Kulon Amy PA Shepherd Susan General Volunteer Tischbein Sara General Volunteer Tischbein Phillip General Volunteer Lomax Becky Medicine Woman Carmichael Tanya RN Cairns Catherine Public Health Howes Laura Accountant Morrow Andrew LAMP Intern Belden Zachary Undergrad Schneider Bego John High School Zanko Michael High School Portman Thomas General Volunteer Portman Mark Pantalone Janine Lienert Josephine Pharmacist Morris Kathleen TF Staff Shultz Paul TF Staff Sullivan Meg TF Staff Undergrad RN Appendix II Revised Hourly Itinerary th Saturday, 17 of July 8:00 AM-9:00 GROUP Arrivals PM Last Name 12:00-3:00 7:00 PM Sunday, 18 July 8:30 AM First Name Flight No. From/To Arrival Time Cairns Catherine TA 7979 FLORES 9:10am Howes Laura TA 7979 FLORES 9:10am Carmichael Tanya AA 981 MIA 10:30am Pantalone Janine AA 981 MIA 10:30am Morrow Andrew Delta 461 ATLANTA 11:25am Shepherd Sue AA 983 MIA 1:10pm Kulon Amy AA 983 MIA 1:10pm Zanko Michael AA 983 MIA 1:10pm Schneider Bego Henry AA 983 MIA 1:10pm Tischbein Sara CO443 IAH 1:13pm Tischbein Phillip CO443 IAH 1:13pm Morris Kathy CO443 IAH 1:13pm Lienert Joey CO 443 IAH 1:13pm Lomax Becky CO 443 IAH 1:13pm Portman Thomas CO 443 IAH 1:13pm Portman Mark CO 443 IAH 1:13pm Belden Zachary COPA 390 PANAMA 8:12pm Shultz Paul AA2195 DALLAS 8:40pm Lunch/shopping/touring Antigua (while waiting for others to arrive) Dinner in Antigua –Las Palmas & Welcome by Kathy 6a Ave. Norte # 14, between 4a & 5a Calles Tel.: (502) 7832-9734 Breakfast – Kaffee Fernando 9:30 AM 9:30 AM Check out of Hotel Santa Lucia Exchanged money, hiked to Cross in the Hill, shopping 1:00 PM 2:00 PM 6:00 PM 6:30 PM Lunch in Antigua – Doña Luisa’s Leave for Quetzaltenango Arrive in Quetzaltenango, check in at Hotel Los Olivos Dinner at Los Olivos 7:30 PM Monday, 19 July 7:30 AM 8:00 AM 12:30 PM 6:00 PM 7:00 PM Tuesday, 16 Mar 7:30 AM 8:00 AM 12:30 PM 4:30 PM 6:00 PM 7:00 PM 7:30 PM Orientation, Overview of Medical Clinics (Paul, Kathy, Dr. Sullivan) Organize Medicines (Med Professionals, Volunteers) Breakfast at Los Olivos CLINIC: Buena Vista Lunch Dinner at Los Olivos Chocolate Tasting – Doña Pancha Breakfast at Los Olivos CLINIC: Salcajá (CEIPA) Lunch Free time to explore downtown Quetzaltenango Dinner at Los Olivos Organize medicines Cultural Competency with Roney Wednesday, 17 Mar 7:00 AM Breakfast at Los Olivos 7:30 AM 12:30 PM 6:00 PM CLINIC: Xeabaj Lunch Dinner at LO 7:00 PM Organize medicines 8:30 PM Drinks at local bar Thursday, 18 Mar 7:30 AM 8:00 AM 12:30 PM Breakfast at LO CLINIC: Buena Vista Lunch 5:00 PM Free time to explore downtown Quetzaltenango 6:00 PM Organize medicines 6:50 PM 7:00 PM Leave for Pop Wuj Goodbye dinner at Pop Wuj – Mingle with Medical Students, etc. Friday, 19 Mar 7:30 AM Breakfast at LO 8:00 AM 8:15 AM Check out of Hotel LO Leave for Pop Wuj 8:30 AM CLINIC: Pop Wuj 1:30 PM Lunch: Pollo Campero 2:00 PM Leave for Antigua, Guatemala 5:30 PM Check in at Hotel Santa Lucia #3 6:00 PM 7:00 PM Free time to shop/explore Antigua Dinner at La Peña del Sol Latino Saturday, 20 Mar 7:15 AM – 3:10 PM DEPARTING FLIGHTS Shultz Paul 7/23/2010 AA 2196 DALLAS 8:40am Lomax Becky 7/24/2010 CO 457 IAH 7:15am Kulon Amy 7/24/2010 AA 2196 MIA 8:40am Shepherd Schneider Bego Sue 7/24/2010 AA 2196 MIA 8:40am Henry 7/24/2010 AA 2196 MIA 8:40am Zanko Michael 7/24/2010 AA 2196 MIA 8:40am Belden Zachary 7/24/2010 AA982 MIA 11:40am Cairns Catherine 7/24/2010 CO 867 IAH 11:45am Howes Laura 7/24/2010 CO 867 IAH 11:45am Tischbein Sara 7/24/2010 CO500 IAH 11:50am Tischbein Phillip 7/24/2010 CO500 IAH 11:50am Morris Kathy 7/24/2010 CO500 IAH 11:50am Morrow Andrew 7/24/2010 Delta 596 ATLANTA 12:35pm Carmichael Tanya 7/24/2010 AA 2132 MIA 2:25pm Pantalone Janine 7/24/2010 AA 2132 MIA 2:25pm Lienert Joey 7/24/2010 CO 436 IAH 3:10pm Portman Thomas 7/24/2010 CO 436 IAH 3:10pm Portman Mark 7/24/2010 CO 436 IAH 3:10pm Brigade Report – Public Trip Guatemala, July 17-24, 2010 The following report summarizes the Timmy Foundation’s July 2010 brigade to Quetzaltenango, Guatemala with general volunteers and medical professionals. Patient and referral data was collected during the brigade and clinics and is summarized below. PATIENT PROFILE TOTAL Patients 394 Under 5 (age 0-5) School-aged Children (age 6-11) Adolescents (age 12-17) Adults (age 18 and older) 58 43 38 253 Males Females 106 284 Schoolaged Children (age 6-11) 11% Under 5 (age 0-5) 15% Adults (age 18 and older) 64% Adolescents (age 12-17) 10% Males 27% Females 73% OVERALL MORBIDITY Stunting Gastritis/GERD Other musculoskeletal General Pain Malnutrition Headache (non-… Urinary Tract… Abdominal Pain Cold/Cough Allergy Other Well Check Anxiety/Depression Parasites Diarrhea URI Non-specific Other derm. Diabetes Mellitus Anemia Prenatal visit/pregnant Vaginitis Menstrual/Menopause Dermatitis Scabies Hypertension Osteoarthritis Other neuro. Other laryngo/pulm. Ear Infection Other ophth. Conjunctivitis Bronchitis Other gyn. Yeast Infection Fungus Strep Throat Tonsilitis Impetigo Exema Other Cardiac Injury/Lesion Dry Eyes Caries Pneumonia Lice Abscess Osteoporosis Other gastro. Murmur Other psych. Cataracts Migraine Asthma 74 73 56 47 38 32 28 26 25 24 22 21 21 17 15 14 14 13 13 13 12 12 12 11 11 10 9 9 8 7 7 7 7 7 7 6 5 4 4 4 3 3 3 3 3 2 2 2 2 1 1 1 1 0 10 20 30 40 50 60 70 80 INFANT MORBIDITY (age 0-5) Stunting Malnutrition Well Check URI Non-specific Cold/Cough Diarrhea Scabies Vaginitis Parasites Other musculoskeletal Other derm. Fungus Allergy Other neuro. General Pain Tonsilitis Abdominal Pain Dermatitis Murmur Other Anemia Other psych. Caries Other laryngo/pulm. Bronchitis Asthma Impetigo 29 12 9 9 5 5 5 4 4 3 3 3 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 0 5 10 15 20 25 30 35 CHILD MORBIDITY (age 6-17) Stunting 45 Malnutrition 26 Well Check 11 Gastritis/GERD 10 Other 6 Allergy 6 Other musculoskeletal 6 General Pain 6 Dermatitis 6 Headache (non-specific) 5 Menstrual/Menopause 5 Abdominal Pain 5 Other derm. 5 Ear Infection 4 Cold/Cough 4 URI Non-specific 3 Strep Throat 3 Diarrhea 3 Scabies 3 Exema 3 Abscess 2 Caries 2 Pneumonia 2 Prenatal visit/pregnant 2 Fungus 2 Impetigo 2 Other Cardiac 2 Anemia 1 Dry Eyes 1 Conjunctivitis 1 Other laryngo/pulm. 1 Tonsilitis 1 Other gyn. 1 Yeast Infection 1 Other gastro. 1 Lice 1 0 10 20 30 40 50 ADULT MORBIDITY (age 18 and older) 63 Gastritis/GERD 47 Other musculoskeletal 39 General Pain 28 27 Urinary Tract Infection (UTI) Headache (non-specific) 21 19 Anxiety/Depression Abdominal Pain 16 16 15 13 13 11 11 11 10 Allergy Cold/Cough Other Diabetes Mellitus Parasites Anemia Prenatal visit/pregnant Hypertension Osteoarthritis 8 7 7 7 7 7 6 6 6 6 6 Vaginitis Other ophth. Other neuro. Other laryngo/pulm. Menstrual/Menopause Diarrhea Conjunctivitis Bronchitis Other gyn. Yeast Infection Other derm. 4 4 3 3 3 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 Ear Infection Dermatitis Injury/Lesion Strep Throat Scabies Dry Eyes Osteoporosis URI Non-specific Tonsilitis Lice Fungus Other Cardiac Well Check Cataracts Migraine Pneumonia Other gastro. Malnutrition Impetigo Exema 0 10 20 30 40 50 60 70 MORBIDITY TOP TEN Infants (age 0-5) Other musculoskeletal Other derm. 3% 3% Stunting 33% Parasites 4% Vaginitis 5% Scabies 6% Diarrhea 6% Cold/Cough 6% Malnutrition 14% Well Check 10% URI Non-specific 10% Children (age 6-17) Menstrual 7% Stunting 34% Headache Dermatitis General Pain 4% 4% 4% Other musculoskeletal 4% Allergy 5% Other 5% Well Check 8% Malnutrition 20% Gastritis/GERD 8% Adults (age 18 and older) Other 5% Gastritis/GERD 22% Other musculoskeletal 16% General Pain 13% Cold/Cough Allergy 6% 5% Abdominal Pain 7% Anxiety/ Depression 7% Headache (nonspecific) 9% Urinary Tract Infection (UTI) 10% TOP TEN MORBIDITY PER COMMUNITY Buena Vista 39 Stunting Gastritis/GERD General Pain Other musculoskeletal Urinary Tract Infection (UTI) Headache (non-specific) Anxiety/Depression Abdominal Pain Malnutrition Allergy 34 32 22 19 17 14 14 11 10 0 10 20 30 40 50 Xeabaj 22 Other musculoskeletal Gastritis/GERD Stunting Cold/Cough Malnutrition Headache (non-specific) URI Non-specific General Pain Dermatitis Ear Infection 14 14 12 12 8 7 6 5 4 0 5 10 15 20 25 Ceipa – Salcajá 15 Stunting Well Check Other musculoskeletal Gastritis/GERD Malnutrition Allergy Cold/Cough Hypertension Anxiety/Depression Other laryngo/pulm. 14 13 11 11 10 7 6 5 5 0 5 10 15 Xela 14 Stunting Other Gastritis/GERD Other musculoskeletal Diabetes Mellitus Urinary Tract Infection (UTI) Abdominal Pain Hypertension Malnutrition Other neuro. 9 7 5 5 4 4 4 4 3 0 2 4 6 8 10 12 14 16 20