El POMAL, Guatemala – The heat was stifling, lying like a wet blanket over the tiny village of El Pomal in southwest Guatemala. A CU School of Medicine team sweated through their pale blue scrubs as a line of children snaked around the concrete school house.
“We have seen 12 children so far and nine had diarrhea for more than two weeks and about two-thirds have parasites,” said Edwin Asturias, MD, director for Latin America at the Center for Global Health, part of the Colorado School of Public Health. “What we are seeing is a chronic cycle of poverty.”
There were children with kidney disease, infections, anemia and malnutrition. Ten-year-olds looked like 6-year-olds, tiny with match stick arms and legs. A scrawny dog poked around looking for scraps before drifting off.
“When you see a dog malnourished, you know there isn’t a lot of food around,” Asturias said.
But he and his team weren’t here just to examine children, they came to assess the wider needs of the population and lay the groundwork for a revolutionary public-private partnership that will usher in the university’s first permanent medical presence in a developing country. If successful, it could lead to similar outposts around the world.
The Trifinio region of Guatemala, not far from the Pacific Ocean, is among the poorest parts of this densely populated nation. On the surface it seems a tropical paradise, verdant, lush and studded with papaya and coconut trees. Vibrant red and yellow orchids wrap around palm trunks and iguanas peep from pastel roof tops.
But basic hygiene is lacking. Residents often live in homes with dirt floors shared with livestock. The rainy season brings floods causing toilets to overflow and contaminate drinking water.
Doctors are few, hospitals fewer and most demand payment before performing services. People go into debt trying to pay medical bills or they seek help from village curanderos – traditional healers – or priests or pastors. Sometimes they pay bills rather than eat.
In El Pomal, Asturias talked to a woman who took her son to a curandero who claimed he suffered from `pilitis,’ a phony disease that she charges to `heal’ with an injection of some unknown substance.
Asturias shakes his head.
“This is what happens when there is no medical oversight,” he said. “When you have no health system available, you ask for help wherever you can get it.”
Mehner, who studied Spanish in Mexico, was working with local parents on a child development and reading project called Bright Beginnings while Eblovi was jabbing little fingers to test for anemia. The sobbing of children, more scared than hurt, echoed throughout the village.
Gaensbauer did medical exams with Asturias in a cement block room as children and mothers peered through the door and window. Smoke from fires beneath boiling vats of tamales wafted in.
Perhaps the most important part of the visit was the collecting of blood and stool samples to determine the extent of the anemia and parasite problem in the region.
Every night the specimens were taken back to Asturias’s family home for testing. The house sits on a sprawling coffee plantation in the cool, misty highlands about an hour from the steamy villages below. This is where the students lived during their time in Guatemala.
Asturias spent his childhood here, learning to wield a machete long before his hands ever held a scalpel. He set up a microscope in his library where Mehner, Eblovi and Gaensbauer scoured slides for malevolent microbes.
The first sample revealed four kinds of worms and parasites.
“Parasites are something we don’t see a lot of in the U.S. They are a manifestation of poverty. And that’s why I’m here, to do a reconnaissance mission so to speak, to get the lay of the land and level of need in Guatemala,” said Gaensbauer, a Denver native who previously worked in Nepal and American Samoa. “Having a permanent base will be great for the community and for us. A lot of people come and go but that is just a band aid.”
About two-thirds of all children tested had parasites, the result of poor hygiene, inadequate sanitation and contaminated water.
Jose Cordoba Lopez, a banana plantation worker, said his kids regularly experience bouts of diarrhea.
“When they get sick I take them to a clinic but they don’t have the medicine we need,” he explained.
The problem of hygiene was illustrated the next day when a family was found washing dishes in a muddy river.
The work was exhausting, occasionally frustrating, but intensely rewarding.
Mehner, from Cape Girardeau, MO, said the experience had inspired her. She had earlier worked for Stephen Berman, MD, the renowned director of the Center for Global Health, on the Bright Beginnings program in Colorado. She wants to eventually design aid programs around the world.
“I’d love to cure cancer but I’d also like to eradicate the things we can cure now like diarrhea,” she said. “This has made my passion stronger. Being out there every day in the heat and meeting these families helps you connect with them on a deeper level. You feel like you are part of something big, important and permanent.”
“Most people go to medical school because they want to help people but that can get lost along the way,” he said. “This kind of experience can reinvigorate you as doctor.”
The next morning in the hamlet of El Troje, Asturias and Mehner were doing routine physicals at a school when a crying child was hustled toward them with a deep gash on his head.
Asturias quickly laid him on a table. Children gathered to watch as he injected anesthesia into the wound and began sewing it up. The unflappable Mehner nimbly assisted, cleaning the cut while soothing the bloody, sobbing 8-year-old.
Twelve stitches later and it was over.
The boy’s mother, a weary looking woman with deep lines on her face, cautiously approached.
“How much do I owe you?” she asked quietly.
Asturias wiped the sweat from his face and smiled.