Wrapping it up

The phrase "wrap it up" brings many images to my mind. There's the wrapping of gifts, the finishing of projects, the coming to an end of a disorienting year, the getting to the point of a lengthy boring narration. 

I'm hoping that December fulfills all of these for us. I'm ready for this year to end with it's infectious disease overload, it's political strife, it's walking on eggshells around people of differing viewpoints than ours. 

God must have said the same thing right before taking on human form and coming to Earth. He had had enough of the effects of sin in our lives and was ready to show us how to live differently. He knew we couldn't fulfill all of the law without his Spirit living in us. His Spirit couldn't dwell in us without him sacrificing himself to the point of death. He knew only he could come back from the dead and give us that ability. 

We Christians want to see this world be different. We want an end to racism, bigotry, mistreatment, corruption, injustice, etc. But non-Christians don't have the power to change their thoughts and behaviors and world views like we do. Government can't make people change their hearts and attitudes. We have to be in the business of sharing the gift of Christ and his regenerating Spirit with this world. We all have the right to participate in politics but we have to remember that only Jesus can get us where we want to end up.  

Let's keep renewing our minds and helping the people we know and love get interested in doing the same. Let's get serious about  praying for our Government, our world, this pandemic. Let's be of the same mind of Christ. 

What's Happening?

On the Covid disease front, our curve is on the downhill side (officially). But our numbers are too high to be able to open up all services. Everything is still pretty much only 50% capacity like restaurants, public transportation, number of people permitted in a building, etc. No public school, no flights, no tourism, no movie theaters, no parks, no pools, no beach access, no permitting people over 60 in restaurants. There won't be any Independence Day celebrations this year. Some hospitals are reporting more available ICU beds which is a good sign, and official Covid deaths seem to be decreasing. Here's hoping...

Bus service from the departments to the Capital is trying to get up and running again. Still not allowed. 

We are enjoying getting back into our regular clinical duties around here. Our patients are starting to get the hang of calling in for an appointment rather than the usual walk-in style we used to have. It has been a little bit of a struggle to get folks onboard, but poco a poco! We are still not able to have mobile clinics in the communities as the churches are not allowed to have more than 20 meet at a time. We look forward to being able to branch out a little in the next month or so.

Love getting to see our prenatal patients and handing out Clean Delivery Kits from our Eastside Church of Christ friends. And yes, there will be a baby boom!

Several of our chronic illness patients (epileptics, diabetics and hypertensives) have commented how grateful they are for our services especially after having to purchase their medications at local pharmacies. Most of them were just unable to buy them and went without or only took half the prescribed dose to make them last. Our staff have been getting lots of  gifts of fresh picked apples, soft drinks and corn on the cob lately in appreciation. We are loved well here.

We've gotten news of more baptisms in the area. One small new congregation will be having 7 baptisms soon. It reminds us that closing the doors of the church building doesn't stop the Spirit of God from working through his people the church. Praise God!

Celebrating with the angels!

One of the biggest news breaks this week was the announcing of the opening of the airport and borders this 18th of September. We will be anxious to see how this pans out as the number of flights per airline/city of origin will be only one per day or 2-3 per week. And they will be requiring a negative Covid PCR test within the last 72 hours to enter the country or a mandatory supervised 14 day quarantine. Everyone is hoping that kind of testing turnaround is even possible. But at least it's a step in the right direction for future medical teams to be able to come in country.

As my dad says, "Won't be long..." We hope! (Photo credit: Bao Menglong)

Out and About

 Well, our days look different, but at least they are busy again. We have settled into a rhythm of office consults by appointment, phone consults, prescription pick up and delivery, ABC well child checkups by telemedicine and by house call. Our area public transportation options have opened up a little (50% capacity) so more patients are looking for face-to-face consults. For others, they still have steep fares to pay to get to town which limits their options. 

Still no local or international tourism allowed so our surgery services are still suspended until we can get teams in.

On the spiritual front, we continue to hear great news about churches keeping watch over their communities and helping provide for the needs of their neighbors. One of our coworkers reports that they have had 14 baptisms since all this madness started--even of people who were steeped in Mayan traditional religion before. He said, "we have to keep talking to people and visiting people in their time of need to share the gospel." 

Here is a fun look at some of our visits to area families. They welcome us out and are happy for the socializing even if it's distanced and accompanied by awkward protective gear. One lady laughed and said, "out neighbors are going to think either we're sick or you guys are sick!"

Thank you for your prayers and continued support. We pray that we can soon incorporate medical, dental and surgical teams back into the ministry.

House call version of  well-child checkups for our ABC kids

Over the river and through the woods to the next house.

Learning about the importance of hand hygiene in infectious disease prevention.

Brushing your teeth is still important during a pandemic! 

This guy is letting his creative juices flow.

Triage at Clinica Caris--patients have been very cooperative.

Growing up fast! 

Dentists are up and going again trying to deal with restrictions and tight spaces.

Our dental team getting in gear.

Raining on Our Parade

Enjoying the cool of the rainy season here at Clinica Ezell

We have been living the Pandemic life here in Guatemala like everyone else around the world. The thing that is striking is how everyone around the world regardless of social status is facing the same situation right now: health concerns, financial crises, delays in plans, relationship strain, political unrest, uncertainty about the future, and on and on. It brings to mind how we are all equal in the eyes of God. He is no respecter of persons and gives us all the freedom to choose to obey him or not. But He expects us all to answer to him ultimately.

So aside from the theological lessons we are getting from this year's experiences, we are learning how to function as a Non Profit Organization in a foreign country, while trying to stay abreast of the legal changes, employment regulations, health requirements and decrease in revenue sources and having less access to Government offices due to restricted hours.

Recently we tried to start having appointment-based clinics with triage of patients for better control of Covid risk. Our normal walk-in clinic way of operating isn't going to cut it anymore. We had a pretty decent system going and were ready to try to replicate it in both Clinica Ezell and Clinica Caris.

Triage at the entry to the property. 

The truth comes out...many people don't want to admit to Covid symptoms until they are in the consult room.

Then, one of our staff got sick and tested positive for Covid-19 (from a family contact). Unfortunately, under the regulations at the time the government considered all coworkers as "close contacts," and 11 of us were put in quarantine for two weeks. This included two of us physicians, a dentist and several support staff. Not only that, they didn't count our quarantine start date until the health department representative for our case called to set it up--a week later. Then another coworker got sick (a separate group of workers not exposed to the first one), so 8 more people were put in quarantine including another dentist. So we have pretty much put a break on the clinical duties until we can get everyone back to work.

Quarantine time.

Meanwhile, due to new restrictions our already limited transportation options were reduced again when the government made is so vehicles could only travel on even or odd days depending on license plate numbers. For now we have only a few workers who can still come in to work, so we just shuffle trucks each day.

On a good note, the latest news bulletin from the Health Department has updated their definition of "close contacts" to something more manageable in the workplace, outside of patient care. So we are going back to the drawing board and meanwhile ramping up our telemedicine program with all of our physicians and extending it to include ABC well child checkups. We will also incorporate our dental staff and health promoter staff to do patient education through video chat with families. We were able to visit all of the ABC communities to get out an extra food delivery of corn, beans and other staples.

It's fun to get pictures and videos from our patients in telemedicine. They tell us they miss us and can't wait to come back in person.

Getting out the food packages to our ABC families.

As of yesterday, we've been told that Guatemala has effectively flattened our curve, but that the peak is now projected to occur in late September or October. Then the slow decline to manageable numbers. We keep praying for this to end and to get back to the way things were before. In the meantime we will keep coming up with new ways to work and minister here. We appreciate your prayers.

Getting This Show on the Road

Last Sunday, we were on our way between Chichicastenango and Montellano about a 3-hour trip through three different departments. We are working on preparing the facilities and the staff for working at the clinics and receiving patients. Currently there are travel restrictions between departments except for medical or food transport. So we were armed with our authorization letters and handy work badges that Kemmel made for us. Thankfully we made it through the check stops without even having to show anything--our trucks have our Health Talents logos on them so that probably helped. That and God's provision.

Armed and ready. Masks are mandatory in public as crowding is a way of life here. 

It's interesting to see how the different areas of the country are doing life. We saw the majority of people wearing masks in public, including kids. A lot of small towns have their own market areas too which helps keep central markets less congested. However, the small towns don't have big spaces, so things get pretty heavily trafficked there too. Restaurants are still closed for the most part, but people still like to sit and have a Coke or coffee together in front of little stores. Visits to family and friends are discouraged so people stand outside their houses to chat.

One of our neighbors stopped by to say hi and ask about a friend in common. 

No public transportation in the buses or minivans or boats so the street corners and crossroads and lakes are completely transformed with the lack of vehicle congestion. But you do have to watch for motorcycles and bikes everywhere riding on both sides of you on the highways.

We've never seen the Lake Atitlan at midday without boat traffic.

One of the things that has surprised us most and given us the most joy to see is how people are reaching out to each others to provide for their needs. Several of our coworkers and church members have told us of how the churches are reaching out to help their neighbors, how family members who are still in the States are wiring money back to help their family and vulnerable neighbors, and how local organizations are reaching out as well to help provide emergency food relief. Our patients that call for a medical consult are kind enough to share our medical "hotline" number with family and neighbors and even translate for them over the phone or send pictures/videos on their smartphones to facilitate a telemedicine call.

Telemedicine via Whatsapp photo and video calls. Moms are getting better at showing me sore throats and mouth sores!

This pandemic is hitting us hard in Latin America and is not going away soon. Our national hospitals  are getting overwhelmed by respiratory cases which limits attention and resources available for other illnesses. In countries where heath care is socialized it is easy to overrun the system in an epidemic situation. Government places drastic restrictions in an effort to minimize the damage. But the tight regulation means people are out of work.  And many informal jobs (day labor and self-employed workers) in the rural areas are linked to service industry, agriculture, market sales, tourism and mass transit. "Nonessential" workers still need to eat.

We drove behind this group and realized they were delivering food packages to people. 

We don't know how long we will be under these tight restrictions, but many project out til late in the year before public transportation begins to open under very tight regulation of limited passengers and until 2021 before international tourism begins to function. These two things have a big impact on our ministry and other ministries in this country. At first glance it should be easy to just open clinics and see sick people and do surgery like we always have. But, we can't get our staff together easily, or get our patients to our clinics easily, or if we could go to a large enough town and do a mobile clinic, we can't allow for large groups of waiting patients. We have staff who are in the high risk health category (age, chronic disease or pregnant) which means they can't legally be at work with the rest of us. Our volunteer surgery teams come from the United States which means no surgery groups until next year most likely.

Please pray for us to be wise stewards of our resources and staffing. To look for ways to minister to those in need. Pray for this country to learn to overcome these hardships, and pray for the churches to keep being resourceful and creative in their outreach to neighbors and nonbelievers so that Jesus would be known by even more people. And pray that this Virus passes.

I just like this Snoopy rock that's out on the side of the highway. In the 15 years we've been here it's always been painted and kept up by someone, not sure who. God bless that person!

"Exactly The Same"

Just an update from our last post. We continue to have very strict restrictions here in Guatemala in an attempt to limit social interaction and decrease spread of CoVid-19. Since late March the Government has put in place stay-at-home orders and limited what types of businesses can be open. Basically any food service or grocery or pharmacy can work freely. And any business that can do telecommuting. Other businesses can get permission if they comply with sanitation and infection control practices for all of their staff and clients. We are all required to wear a mask outside of the home now.  Our biggest hurdle continues to be prohibition of public transportation and the shortened work day--businesses have to close by 2:00 to allow people to get home before curfew. Only private vehicles are allowed to circulate and with limited passenger numbers. In our areas of ministry, the majority of people use public transportation including our patients and staff.

Each Sunday, the whole country waits anxiously for the president to announce what restrictions will be lifted or changed or added. For the last 2 weeks the answer has been, "everything stays exactly the same." Yesterday the answer was basically the same but we are entering into a new phase of cautious re-opening. We get to go to shops that are in plaza setup but still no public transportation and no travel between the Capital and other departments. So far the State of Emergency has been extended through May and most authorities predict the highest numbers of cases somewhere near mid to late May.

The President, Dr. Alejandro Giammattei is a physician as well. This is a snap of one of his daily epidemiology reports.

So our suspension of medical and dental services continues at least until public transportation opens. Our physicians and dentists are fielding phone and text consults from patients and calling in prescriptions to local pharmacies. But face-to-face attention has been put on hold. Other staff are helping call patients who had appointments in dental and pre-op to reschedule. 
Our ABC sponsored families are getting their regularly programmed food deliveries and our scholarship kids are getting the support they need to keep up online studies.
Administrative staff are working to make sure we are in line with government regulations and updating our data digitally for easier communication with banks and government entities we report to. Purchasing and ordering processes with new online options are getting added so that will help streamline our supply chain here in country.  

We are communicating with staff and local partner churches to plan our reopening and trying to figure out how to work around short work days, spacing of our waiting areas and triage of our mostly walk-in patient population and will probably have to continue to put a hold on dental patients as the requirements for maintaining a safe environment for both patients and staff are more stringent and will require more supplies and time per patient. We still don't have a good feel for when international travel and free circulation of tourists will be allowed. Some are predicting into Fall before that happens. So we wait until then to welcome our visiting surgical teams.

One of our sweet patients sent us a greeting with her new fashion statement.

On a very bright note, Health Talents International has just successfully completed a fundraising effort called One Hour at a Time that brought in over and above what we asked for. A good measure, pressed down, shaken together and running over was poured into our lap to help cover salaries of staff and operational costs until we can get back to offering our full spectrum of elective surgical and dental services (a large piece of our funding for payroll). We are so grateful to God and to all of our faithful supporters who have stepped up and contributed to this work. We are mindful of the economic straits that many people are experiencing in the States and see your generous spirit at work. We are also thankful to God for the health we have all enjoyed to date and pray that the toll from this virus would be limited both health wise and economically. Please join us in prayer for our governments and authorities around the world that they would make wise decisions and for the church as a whole to take advantage of every opportunity to be a witness to the powerful love God.

New Normal

Hello from Guatemala. I'm sure we are not the only ones trying to figure out how to live life in these weird times. We've been watching the news and social media constantly trying to keep up with the latest recommendations and restrictions here and in the States and wondering how this will translate into day-to-day life.  Guatemala is only starting to have cases of corona virus show up--as of yesterday we had 61 cases and none registered as community-acquired yet. I'm sure that will change soon. 

Part of the new normal is wearing masks while in public. I made us some so we wouldn't waste the medical ones. I think this is a wise thing as many people with the virus are asymptomatic or mildly ill only. Love your neighbor and protect each other!

Thankfully we are healthy, apart from the seasonal allergies that plague many of us. We've had a lot of people asking how things are here in our neck of the woods. Well, we have a lot of the same restrictions everyone else does, like no public events or gatherings. Churches no longer gather and schools are dismissed. Thankfully, we are pretty well connected by internet and phone to be able to worship or praise or communicate in groups relatively easily. Weekly markets are closed and daily food vendors only sell til noon. Supermarkets are allowed open but have long lines. No dine-in restaurants allowed, but most are delivering food which is fun.  Borders are closed and no commercial international flights are allowed. We also have restrictions on the work sites that can continue open.

Streets are pretty empty around here. But a church with a sign painted on their roof, "Jesus Loves You." What a great reminder.

One of the means of public transport here.

But the thing that has pretty much shut down the country is prohibition of public transportation (buses, minivans, shuttles, pickup-taxis). In this country the majority of people travel via public transportation. And we have a strictly enforced curfew--everyone except for cargo and fuel transporters must be off the streets by 4:00 in the afternoon until 4:00 a.m. This makes for a very short work day as your last 1-2 hours are spent trying to avoid traffic issues and accidents. Anyone who is still working takes off at 2:00 so they can try to walk or find a ride home before curfew. Those who can't go to work or work from home--and most are informal laborers without contracted salaries--are justifiably worried about where they will find the money to buy food for their families.

On the clinical side this all has severe ramifications for us of Health Talents International. Almost all of our staff and patients use public transportation so they are unable to mobilize. Several of the smaller communities are blocking entry to their towns if you are not a resident there. We have no surgical or medical/dental teams coming until July due to border closings and obviously a  reluctance to travel by most people now.  And yesterday, the President announced that starting today and during Holy Week, there would be no travel permitted between departments (states). This has caused us to temporarily suspend our clinical services and puts us in a difficult financial situation as well. Our payroll comes from funds raised from visiting teams, elective surgery and dental fees we charge and the income from our mobile clinics. We are heavy-hearted at the thought of not being able to attend to our regular patients. But at the same time many of those same patients are in the high risk category with chronic illnesses and we would be unable to adequately separate them from our sick visit patients as we operate on a walk-in basis. So maybe it is for the best.

Walk-in clinic--triage would be difficult when there's nowhere to separate people and many are not forthcoming with symptoms, to avoid public backlash.

So for now we wait and pray for our world, our family, our staff, our patients and those who are struggling with corona virus illness. We ask for your prayers as we look at ways to restructure this ministry and live the "new normal," and for you to consider financially supporting our virtual fundraiser One Hour at a Time--trying to cover part of the payroll expense of our staff once we are able to mobilize again.

Planted my mustard greens just in case things get difficult in market!

February Fotos

We have been traveling around a little more for work--between Clinica Caris in Quiche, Clinica Ezell in Suchitepequez and the Health Talents office in Guatemala City. While it is a little tiring, we try to make it to our destination by the end of a clinic day and give ourselves a little rest time the next day. This gives us the opportunity to worship with different congregations, see a little different countryside and spend some time with coworkers at each site.
Kemmel has been meeting with staff and I take advantage of the time to develop educational material when I'm not in clinic. On the road we get to enjoy the beautiful landscapes changing so quickly as we descend or climb the mountains. And we managed to get in a trip to Lake Atitlan to celebrate Kemmel's Valentine birthday.
Here are a few pictures from our month so far.

Walking through market to go buy groceries on a Sunday in Chichicastenango

Cousins--Josue Alvarez and Marta Alvarez--finishing up their government service and getting ready to graduate this year from Medical School. We had them see some patients at Clinica Caris and they did a great job!

Chilly morning in the Capital--it was 62 degrees...

February Cumpleañeros--Cesar, Martina, Cesi and Kemmel

Tomas and Juana invited us over for lunch--always a treat. Juana makes the best fried chicken and chile that is out of this world good!

Julie Plunkett, RN visiting her host family from last year's MET internship days.

Good times around the table.

A little road weary but well cared for by good friends and coworkers.

Driving by Volcan Fuego--kind of intimidating!

Beautiful sunset greeted us after a long day at clinic.

One of our patients from the Mactzul area came to Clinica Caris in this tuc-tuc. The driver is a member of the church out there and said it took them about 1 hour and 15 minutes driving "tranquilo". 

Tomas' bee hive that they moved over to the kitchen sink area. They are stingless bees by the way.

Trays of empanadas at Pizzeria Florencia in Panajachel waiting for their dip in the grease.

Jumping into January

It's been a good first few weeks of the year, getting our clinics off to a good start, new coworkers settled in, and new routines figured out. Clinic has been busy as always and we enjoy seeing our patients after the long holiday. They are extra sweet to tell us how much they missed us and are thankful to have the clinic. Our chronic patients especially(with epilepsy, diabetes, hypertension, etc.), voice their appreciation for the quality care, Godly counsel and economically priced medicines.

This week a 6 yo patient came in with new onset of seizures for the last 6 months. We evaluated him and found no other neurological findings, so we treated him for presumed neurocysticercosis and gave him anti-seizure medicine.

Example of tapeworm cysts in brain.

Neurocysticercosis is a disorder caused by pork tape worm that has migrated to the brain and formed cysts and calcification in the brain that lead to seizures. In developing countries it is a common cause of seizure disorder. In addition to medication, it is important to talk about how this disease is transmitted, and easily avoided.

Life cycle of pork tapeworm

We see several patients a month with epilepsy and hear about their past episodes of injuries during seizures--falls, burns, etc. To be able to control their disease and help people live a more normal life is a great blessing. They are so appreciative to be able to get these medicines at an affordable price. Thank you to all of you who contribute funding toward our operational expenses like these medicines which change peoples' lives dramatically.
Happy New Year everyone and thank you for your prayers and financial support!