Reflections

For those people unfamiliar with Xavier University's extensive core curriculum, all students are required to take an incomparably large amount of classes that do not have to do with any particular degree program. Among these classes is the infamous Theology 111, an introductory class to scripture including both the Old and New Testaments. While many students simply try to leave the class with a passing grade as they remember what passages represent and the history of Jesus’ ministry, I remember vividly one concept that my professor, Fr. Overberg emphasized over and over throughout the course. The idea of peak experiences, which is also a major idea behind the psychological principles of Abraham Marlow, suggests that certain events have the capability to encapsulate and bring together the mystical and the human aspects of our lives. In other words, because of this experience, everything just makes sense. In Theo 111, the early parts of Judaism and Christianity were presented as their own separate peak experiences, which we encounter today as we read the Bible. So it makes sense that for us to find God, we have to experience something powerful enough for it all to make sense.

As this amazing team of 17 individuals and myself departed from the clinic for the last time yesterday afternoon, the sun was in the process of setting, and cast a red hue on the clouds hanging above one of the volcanoes surrounding Lake Atitlan. Standing on the hill looking at the volcano, I realized that this past week was one of those peak experiences. Looking up at the heavens, it all just made sense. I felt as if I had found purpose to my own life, not just achievement in what I had come here to do.

Over the course of the week, I had done every of the possible stations in clinic, from the hustle and bustle of triage to the relaxed atmosphere of dental. Every day presented it challenges, whether it be from the medications of a diabetic patient, the obvious language barrier, or even trying to pick avocados on a thirty degree uphill slope for our rabbi. Yet each day was also full of innumerable blessings, but being able to follow up with the asthmatic patient from my last blog everyday of this week was something truly remarkable to me. Many thanks go out to Dr. Walters for letting me sit in on all of her visits. Every visit taught me so much about every aspect of medical care; the logical heuristic behind diagnostics, the human aspect of communication, and something I wanted to emphasize, continuity of care. This woman has little to nothing relative to what we have here in America. The least we could do for her as a team would be to make sure she had the same level and quality of care everyday she came in. At our last visit, the patient presented with improvement yet again, and we felt we had succeeded in what we had wanted to do with her during our time in the clinic. Her gratitude was immense, but the gratitude I have for her and her health cannot be quantified.

There were so many of these events in Patanatic this week. Even through all of the bubble soap, stickers, and stains that came from my dental rotation, there wasn't a single thing I would take back from this week. Looking back on the experience now, it is as if I was supposed to be experienced to all of these things. During a dedication ceremony for the clinic, Rabbi Ingber said some words that will stick with me for an eternity. He explained how even though we may heal the people of Patantic medically, these individuals are actually here to heal us. As deep as that may appear superficially, it clicked immediately for me. I experienced all these amazing things, from diabetic and pediatric patients in clinic, to going to experience their home lives, that it couldn't have been by chance. I realized staring at that mountain, and looking back at our mountain village, that I had been sent here on purpose by something greater than Xavier University. It doesn't matter what we call that heavenly force, but I have realized it is quite real, and grown closer to it during this trip. This force showed me what I can do with my gifts that were bestowed upon me, and that I need to continue to use these skills to do what I can to protect patients, each of whom bring their own special gifts to this world.

As we arrived in Antigua today, and entered the city's cathedral, I was overcome by the emotions of the past week and did something I don't do quite enough. I got down and prayed. I prayed for all of our patients this past week, this amazing team, and all my friends and family back at home and XU. Something has overtaken my spirit in Guatemala, and made sense of a cluttered time in my life. I can never be thankful enough for this experience, and to all of the amazing people I have met and had the absolute pleasure to work with. Paraphrasing Dr. Walters during one of our dinner discussions, this team is a group of idealists, and we will not stop until we have made our mark on this world. Now it is on to my next journey; I don't know where that will be, but because of this trip, and it all coming together, you can bet I won't settle until I've left whatever mark I was destined to leave.

Cooper Quartermaine

Giving Thanks

This is our last day in Guatemala and I have to say that it is a little sad.  As we went through Panajachel and listen to music it made me think how blessed I am to go on this trip.  We watched people’s faces as the as the truck passed them.  I see some sad faces, some happy ones even children running happily to their mom.  It reminded me of the people who came to the clinic.  Some were happy and others not so happy.  Some were in very good health with no stress while others’ health was declining because of their stressful situations.

One event that really made me think about this trip was an elderly lady that Dr. Richard saw. She was having issues with her blood pressure and a few nose bleeds.  After Dr. Richard diagnosed her and instructed for her to take her blood pressure medication, I went to pray with her.  As I was praying a Catholic prayer, she was praying with me.  After I was done, she started to cry and told God thank you for her problems and giving her solutions to them.  Thanking God that we were able to come to Guatemala, along with me accompanying her as she prayed.  As she was praying, I was thinking that I hardly did anything and that Dr. Richard was the one working to find a diagnosis.  After she was done praying, I asked her why she prayed at the same time as I did. She said it was a custom to pray and asked God to bless me while I was praying.  At that moment I knew why I was supposed to come to Guatemala.  

That moment with the elderly lady made me think if I pity the people in Guatemala and I don’t.  Every county struggles in different ways.  I admire them and the way the take life, because at one point during the trip I was really sad that we were leaving soon.  I was thinking what they will do for the next year.  How will they take care of themselves and how will they survive.  When that lady was praying, God was showing me that everyone will be fine in Patanatic. That was his job to take of the people in Guatemala because it was his job. With their faith in God they will make it to the next year.  I admire how strong these people are and even though they have a lot of stress, they do what they have to do because it was the life that God gave them.  For that reason they have helped me more than they know.  It was a great privileged to be able to go on this trip and I will take these moments and the memories with me for the rest of my life.

Ashley Carter

An Amazing Journey

As our journey in Guatemala comes to a close tomorrow, it is very appropriate to spend some time reflecting on the experiences we have had throughout the week. Spending each day in the clinic working with the people of the community was an experience that is not easily explainable to those who have not had the same experience. Not only was working in the clinic a wonderful opportunity to learn from our amazing physicians and healthcare professionals, it was also a great learning experience about the culture and lifestyle of the people in Patanatic and the surrounding areas. The extreme gratitude expressed by the people in the community was a very nice reminder there are many things in our lives that we take for granted, like access to quality healthcare. When looking at the problems the people in the Pantanatic community face each day makes many of the problems in our life seem much smaller and less important which provides us the opportunity to reflect on our lives and see how much we have been blessed with.

One of the most influential experiences during the time at the clinic was traveling to the homes in the community to make sure their water filtration system was working properly. In order to get to the homes, we had to travel up the mountain which was not a small task. Traveling the hills in Patanatic makes all of the hills in Cincinnati look very small. It is amazing how the people travel up and down the mountain every day in nothing more than sandals. Once we reached the top of the mountain, we began entering homes to check their filtration system. Having clean water is something we take for granted in the United States but to hear that they did not have any water to put in their filters since it has not rained for a while hit hard. Not only do they have to filter their water which makes it fairly clean, they do not have access to water when it has not rained in a while since there is not enough pressure in the pipes to provide access to the water. Seeing the condition of the houses and the lack of access to water allowed me to see a little into the lives of the people in Patanatic.

As our time in the clinic ended yesterday, we were given the opportunity today to experience other parts of Guatemala. This morning we traveled to Lake Atitlan where we took the opportunity to take a nice group photo with the three volcanoes in the background. Our view has been incredible throughout the entire trip, but being able to see all three volcanoes at one time was just breathtaking. As if that view was not incredible enough, we traveled to Iximche which is one the sites of Mayan ruins in the highlands of Guatemala. Our tour through this historical site was extremely helpful to understand the history of the site including the explanation of the five plazas and the structures we were seeing. Following our time at Iximche, we traveled to Antigua where we took a self guided walking tour. It was fascinating to learn the city was once the capital of Guatemala until the city was continually destroyed by earthquakes when the capital was then moved to Guatemala City which remains the capital today. Tonight we will share in a Shabbat dinner to help close out our time in Guatemala and remind us of the different cultures and beliefs of those around us and continue to encourage us to be open and supportive of those traditions and beliefs other than ours.

Cathy Wirrig

God With Us

After the last day in the clinic, so many emotions are running through me.  A journey that started only four days ago, will challenge my life from here on out.  On the very first day, during one of our times of group reflection, Dr. Lauri mentioned something that stuck with me for this whole trip.  She said that an experience like this will ruin your life forever but in the best way possible.  Now at first my group was kind of confused and for good reason but after a great explanation it all clicked.  After seeing all the people in the clinic and in Patanatic in general, it is impossible to go back home the same person with the same state of mind especially when it comes to material objects.  Coming to Guatemala isn't only to learn how to spell pharmacy drugs or to hear wheezing during breath sounds, though so much wisdom was learned, it is about so much more. It is about making the effort to get to know the people being treated.

This concept became very concrete yesterday during our home filtration group tour.  This was where a group of us and a translator went out into the village to inspect that condition of the water filters in each house.  This gave all of us a great opportunity to understand exactly how the people we saw every day  in the clinic were living.  There was a wide range of wealth based on their houses.  Some houses were very nice with brand new appliances and  new tile floors on the other hand in the same region of the village there were houses that had an incredible about of flies with open entries without doors.  On our way up to one of the patches of houses there was this older man sitting on one of the stairs leading up to the houses.  We tried to quickly walk past him to get to the houses.  What I noticed while we walked past him was that he didn't move in the slightest to allow us to get around him; he also had a few flies that had landed on his arm.  He wore an old flannel and a pair of old jeans.  It looked like he had been sitting in the sun that whole day.

On our way back down from the houses, we noticed that he was in the same position as before.  I grabbed my water from my backpack and gave it to him.  He quickly looked up and said thank you.  I thought that would be the last time that we would see him.  For the rest of the day, the image of him sitting on the stairs was ingrained in my head.  Today in the clinic started like all the other days with patients eagerly waiting for triage and their appointment.  Then Caroline came in from Dr. Richard's office and told me that the same man that we had seen the day before was in the prayer room.  She said that she could hardly recognize him and that I had to see it for myself.  I was working in the pharmacy this morning; so we quickly filled his prescriptions and waited for him.  He looked like a completely different person.  He had a nice clothes on, a straw hat, and a wonderful smile.  His name was Manuel and his story will always give me chills.

As the week comes to a close I have gained a different perspective on my life and how I want to live it in the future.  I am so grateful for this experience and for the incredible people rather friends that I have made on this trip.  I have learned so much insight not only from the staff on our team but also from my peers; however, most importantly the people of Patanatic.  I am so appreciative for this experience and no amount of thank you's will be able to suffice for this trip.  Though,  we fundraised and brought medical supplies nothing that we gave the people of Patanatic will never repay what they gave to each of us.

Shannon Carney

House calls, influenza and pneumonia...

Tuesday the community in Patanatic had a ceremony at the end of clinic to unveil the XU Interfaith Community Engagement logo that is now mounted on the entrance to the clinic. Literally every patient that walks in the door goes directly under the logo. The community elders were there with Jorge and they said blessings and words of thanksgiving. Rabbi Abie did as well with many tears of joy and gratitude. Jorge asked one of the students to speak on behalf of XU and it was Caroline. She was very poised and eloquent.


Right after that we were packing up in clinic and ready to get on the vans to travel back to the hotel when Jorge asked me if I could see a child who was ill in his home. So I took 3 of the students with me and followed the community health worker down the hill from the clinic into the village. It wasn't too far away from clinic though the terrain is so steep it was a hard walk. En route I was asking Ade, the community health worker, what she knew about the sick child. She said he was 4 and had been in the hospital for pneumonia for 4 days a month ago.

Earlier that morning I had seen a 4 year old who had been in the hospital a month ago for pneumonia for 4 days, so I suspected it was the same child. In morning clinic he was one of my regularly scheduled patients coming for a check up with one of his siblings. Mom had told me about the admission and how he had seemed to get all better for a while. But two days ago he started coughing again, though not as bad as he had previously. Then he had a low grade fever yesterday. In clinic he was coughing but playful and active. He had been playing soccer in the clinic entrance with some of the XU students just before he came in to see me. He had clear lungs so I thought he was probably getting a new respiratory virus and gave her some acetaminophen for his fevers.

She said he did fine throughout the day until about 3 pm when he felt very warm and said he hurt all over. That is when she contacted the clinic to see if I could come to the house. All of this was happening while we were at the dedication ceremony so it was probably about 4:30 by the time we got down to the house. He was clearly ill. He was also pretty frightened by 4 gringas and Stephanie Ibemere (to interpret and help) walking into his house. He cried a bit as his mom pulled him to the end of the bed. He was super hot, he had fast heart rate, ad was breathing a bit fast. When I asked him how he felt he said his whole body hurt. He probably had influenza. He wasn't struggling to breath but the fever was making him breathe fast, shallow breaths. I listened to him and found crackles, typical of pneumonia in his left upper lobe of his lungs. So I sent two of the students back up to the pharmacy with what medications I wanted.

In the mean time the remainder of the team had split - some had gone back to the hotel and some had gone with Richard to do a home visit on his sweet Valentina who we always visit and a few of the team had stayed behind awaiting us at the clinic. Thankfully Eric, our pharmacist was one of those that was still at clinic. Dakota and Shannon came running (up the steep mountain) with my pharmacy orders for Eric.

The three of them gathered supplies and came down to the little boy's house. While we were waiting for them I was giving the mom instructions on how to alternate ibuprofen and acetaminophen every 3 hours to control his fever and how to recognize if he is getting worse in case he needed to go to the hospital in Solola in the night. The little boy had just been sitting quietly on the bed and I was watching him to see if he was worsening or not. When Eric arrived with his bag of medications and graduated cylinders and colorful medication dispensing spoons the little boy perked right up and crawled over on the bed to get a closer look. It was reassuring to see the little boy still had his curiosity. He is probably the sickest acute illness patient I have seen here all 5 years. I gave Eric instructions on what antibiotic we were going to use so he started mixing it up standing at the bed side. I gave the boy, who was very attentive to Eric's workings, a dose of ibuprofen and then a dose of the augmentin as soon as Eric had it mixed. We asked mom to bring him to clinic first thing the next morning (Wednesday) at 8:30 so we could check his oxygen levels and re-assess. Again we made sure she knew what to go to the hospital for if he was worsening.

Wednesday morning mom brought him back up to clinic and he was doing great. He had not had fever overnight and by 8 pm (a couple of hours after we were in his home) he had asked for dinner. It is always a good sign to see a hint of appetite come back. He was his active self again and his vitals were all normal including his oxygen level. Each year here comes with unpredictable graces. I am glad we were here this week to see him.

It is a privilege to step into someone's home as a physician. I have been fortunate these past five years to be in many of their homes, but this is the first time I was called in to see a really sick child. In this community that lives with such economic hardship, it is a wonder how any of these children make it to their fifth birthday. They are undernourished, their living conditions make good hygiene very difficult, and their health care literacy is low. These mothers do everything they can for their children. Almost all of these kids are breast fed for the first 2-3 years of life which helps with nutrition and immunity. Every one of them are current on their vaccines, though Guatemala is not able to vaccinate against many diseases because the system cannot afford it. Influenza is one of those diseases it does not vaccinate against, so is Hepatitis A (I saw 5 kids this week that had all been diagnosed a month ago with hepatitis A). Unfortunately when you get these diseases in early childhood in an undernourished state and you live in abject poverty in a dark cinder-block house with no insulation or glass for windows to keep warm your chances of survival diminish.

This little guy will do fine with this illness. We checked in with him again on Thursday, our last day of clinic. He still had not had a return of his fever. He was still coughing, which I told mom is normal and will likely continue for a couple of weeks, slowly resolving. Now we just have to hope he doesn't get sick again or he times it to do so when another medical team is here.

Mom taught me a great tip - she tied the gray shirt around his neck and taught him to cough into it instead of his hands - that should reduce the risk of him passing his illness onto others. Simple and ingenious.

Lauri Pramuk, MD

What We Bring Back

Where do I begin?  I have had so many different experiences while down in Guatemala and they have all created fantastic memories already.  I have learned so much from both the people of Patanatic as well as my team members.  It is so hard to believe that we are approaching the last day of our trip.  It seems like yesterday that we started packing our bags full of medicine back at Xavier yet somehow this is our last day in the clinic.  Both of our physicians have been incredible to watch work and have taught all of us so much.  Over the past two days, I have been a part of two separate events that completely changed my experience while here.  The first experience took place after clinic on Tuesday when I went with Dr. Richard, Rabbi Abie, and Ashley to visit a woman that has been seen since the start of the clinic.  She is an older woman but was described as having a young spirit and being full of energy.  Unfortunately, we arrived at her house and were taken aback by her living conditions and her deteriorating health.  When we walked in the front door, we entered a pitch black hallway and almost had to feel our way down to the front of her room that served as her house.  She was huddled in her bedroom that had no windows, no carpet, and one single light in the corner.  I tried to recall the mental picture that Dr. Richards had created in my mind and compare it to this frail looking woman sitting under several shawls and could not see how this was the same woman.  It was shocking to see the how dark and cold it was in her room and how small it really was.  I left her house and almost felt depressed for the rest of the day thinking about how this poor woman should never be subjected to this type of living.  However, there was a moment of inspiration when Ashley served as our translator even though she kept trying to tell us that she was not good at Spanish.  She did a fantastic job and asked the exact questions that Dr. Richard wanted the answers to even before he asked.  Ashley was easily the hero of that visit and has remained humble enough to say that she doesn't know Spanish even when everyone else agrees that she is the most fluent student.

My second experience occurred on Wednesday during clinic hours when we traveled through Patanatic to check on the water filters that have been given to the people of the village.  We walked from house to house for several hours and, yet again, it was amazing to see the different living situations throughout the area.  We were able to see the two extremes of the socioeconomic classes when we entered houses that had new appliances, microwaves, and full electricity and then there were houses that did not have actual walls or floors and little to no electricity.  Later, during the group discussion, Dr. Richard mentioned a point that stuck with me and I know made many other people stop and think.  He said that we need to think about what we are bringing back with us from Guatemala, the lessons that we have learned and the memories that we made.  I know that there are memories, new ideas, and new friendships that are never going to fade.

Adam Spegele
Xavier University Class of 2016
Biology Major, Chemistry Minor
College of Arts and Sciences

A Beautiful Privilege

It's hard to believe that it's already the second to last day at the clinic! As the end of our trip slowly comes into view, each minute here becomes more and more precious. I find myself looking around at my amazing team, these beautiful people, the breathtaking view of the lake, and trying to tattoo it onto my memory so I can pull it out and remember when I'm back at home.

Lake Atitlán

For me, one of the most amazing aspects of the trip is the way that we get to be in multiple medical roles throughout the course of the week. All 12 of us get a chance to be nurses, medical assistants, optometrists, teachers, pharmacists, and a few things in between. Practicing the different aspects of these roles is so critical, not only for guiding us in our future careers, but also giving us a fuller picture of what medical care really is. As a nursing student, I may never again be in a pharmacist role, truly being the last voice a patient hears before they're off on their own. I may never again be in an optometrist role, doing whatever possible to make sure that my patients can see the world around them. It's absolutely amazing to be able to learn so much about so many different aspects of healthcare, I feel like my knowledge about my profession has grown as much in this week than it ever has.

Looking at my team, I can tell this learning is happening with them as well, whether it's Ralph speaking his first words of Spanish, or Caroline taking blood pressures like she's done it her whole life. Each person has grown exponentially and it's overwhelming to look around and seeing the learning that flows between us, so immense that it's almost tangible.

Before I came on this trip I thought it would be us helping the people in Guatemala and it's become so clear to me that really it's them helping us. In nursing, we've spoken a lot about how privileged we are as health care providers, our patients let us witness some of the most private moments of their lives. That concept comes alive here. The people in Patanatic have been so gracious in allowing these American strangers to come and speak a foreign language over their heads, look at them in the exam room, play with their children, enter their homes, and let us learn from them. I don't think I'll ever be able to thank Rabbi Abbi, Nurse Stephanie, Stephanie Renny, and Lauri Pramuk enough for choosing me to participate in everything that this small village has to offer. Allah has blessed me in so many ways, and this experience is without a doubt one of the best of them.​

Farwa Fatima A. Sheriff
Xavier University 2017
Bachelors of Science in Nursing

Dream Big

Martin Luther King Jr. once had a dream that all people would be recognized as equal, not because of their skin color but by the beautiful colors that radiate inside every person. A little over 5 years ago, Xavier alum Josh Bidel had a dream to bring medical care and education to Guatemala so that others could have the opportunity to live a healthier life. He shared his dream and with the courage and dedication he and the previous medical service teams have instilled to the people of the Lake Atitlan region, anything is possible. Just yesterday, there was an unveiling ceremony of the Xavier University Center for Interfaith logo on the front of the clinic and the emotion was surreal. While I did not experience what it was like serving this community 5 years ago, I know that there have been tremendous improvements in the clinic and also in people's health, all because of the hard work that has been put in over the years. Just to be a small part of that work brings pride and happiness to me that I have not ever experienced and I hope to remember this uplifting feeling for as long as possible.

Sometimes a dream may feel like a fairytale, something that cannot be obtainable in our lifetime, but if we speak out about that dream and have confidence in ourselves then a lot can be changed for the better. I've always been told to dream big which is sometimes hard for me because of my realistic nature but over the past week living with the best medical service team I could have asked to be with and sharing the compassion we have to help those in need, I definitely am more optimisitc in dreaming big. I have learned a lot over the week from Dr. Lauri, Dr. Richard, Nurse Stephanie, Rabi Abbie, and the fabulous Stephanie Renny, from the families and children who live a simple and content life yet are some the happiest people I have come in contact with, and from experiencing Guatemalan culture that I will bring back to the United States which will allow me to be even more open and understanding through out my medical career and wherever life takes me. I want to thank Josh for beginning the Guatemala medical service trip at Xavier which has allowed 12 students each year to come together and grow as a family and have the opportunity to learn but also to see that dreaming big can be a reality. The future belongs to those who believe in the beauty of their dreams.

Greg Reyes

A New Perspective

Throughout the course of the week I've had three chances to work with either Dr. Lauri or Dr. Richard. This has been my first experience working with doctors closely and it's such an excellent base to what I'll be eventually be doing every day. I had two takeaways from my experiences this week. The first is how connected nursing and medicine are. When I tell people that I want to be a nurse, every once in a while I get a person who asks "Why don't you just become a doctor?" and for me this kind of question always stems from a misunderstanding of the profession. People either don't know or forget that the basics of nursing and medicine are the same, we are all building off of the same foundation. The importance of a health history, the necessity of knowing how drugs act in the body, being able to ask questions to elicit a complete response, all the beautiful detective work, it's all the same. What we do with the information is different, but we're all working off the same base.

My second takeaway is something that I've only felt on service trips in the past. There's always this sense of renewal, of coming to know what actually matters. When you work with people who don't have access to things we take for granted, it puts things in perspective. At home it's so easy to get caught up in all the problems we seem to have, failing tests, losing things, issues with friends and family, and day to day it seems like these things are important and large. But when you're away from it all and learning from people who's problems are how they're going to feed their children or how they're going to get their life-saving medication, it makes what's going on at home fit on the head of a pin. I love that part about service trips, day by day it feels like shedding old skin and stepping into a new one, with more knowledge and a better understanding of the world than before.​

Farwa Fatima A. Sheriff

Xavier University 2017

Bachelors of Science in Nursing

Smile

We always hear in the United States about how far a smile will go. It can say a thousand words, but what words are these smiles trying to convey? Back home, and even at Xavier, smiles can come off as forced, fake, or even devious at times. Smiles are something taken for granted, and the emotional significance behind them has been in decline as I have aged in the USA.

I never noticed a smile during our journey throughout the Cincinnati or Atlanta airports. I'm positive that people were smiling genuinely there, I just never noticed that happening during my time there. Every person was just another face, and they faded out of my memory as quickly as they entered. This all changed during the flight down to Guatemala City, when a young boy of no more than three, most likely a privileged Guatemalan, started to make faces at me, the tall American boy seated across the aisle. For the duration of our descent into Guatemala City, we had the most intense staring contest I have ever competed in, but finally he cracked. I had won, but more than the trivial contest on an airplane. When that boy blinked and lost focus on me, he giggled and his mouth beamed into the purest smile I had ever seen. Just the genuine joy and excitement behind that smile motivated me for the rest of this journey.

My arrival into our remote mountain clinic came with much suspense and nervousness. I was signed up to do triage the first day, with our amazing nurse Stephanie Ibemere. Spanish is not my greatest intellectual gift, and I was terrified to be the person to greet patients and take their vital signs prior to seeing either Dr. Walter or Dr. Pramuk. The first patients were terrifying to be honest, and the uncomfortableness of the situation would have been quite evident if observed. Yet, once there was a break in the tidal wave of initial patients, there were no patients to be seen in triage. Patients were in the waiting room, and a majority of them were children. To pass the time, we went over and began to play with them; blowing bubbles, playing soccer, or just coloring. And the smiles lit up our little dark corridor that welcomed the patients to their visits. That first day was filled with smiles I will never forget, as people were so grateful and appreciative of even the vital signs that were being taken by the triage team. It was so moving for me to experience those smiles first hand, and I'm positive that other people experienced the same feelings that I did as well during that first day.

The main reason that I decided to write a blog about smiles was because of an experience I had while shadowing Dr. Walter both yesterday and today. To abbreviate the story, an older asthmatic patient required a new medicine to control her breathing. I had taken that medicine before, and was able to show her how to use it herself. It was extremely gratifying, but pales in comparison to when I walked into the exam room for the patient's return visit today. When I walked in, I received such a beautiful smile from the woman, as if all of her symptoms she presented with yesterday were alleviated. Exams would show that her lung functioning had improved, and the woman was so thrilled that she was breathing and could sleep consistently throughout the night. That smile will be ingrained in my memory forever, as it was one of thankfulness, blissful joy, and love that I rarely noticed back home. Our patient's smile reminded me why I want to pursue a career in medicine. The power behind that smile was surrounded with humility and gratitude. It showed how impactful the relationship is between practitioner and patient, and it just reiterated the human aspect behind medicine. Our little mountain clinic hopefully made that woman's life just a little better. Little does she understand the impact that her smile made on me.

Cooper Quartermaine

¡Gracias a Dios!

Wow. Just wow. We have had a long day today (Tuesday) and had a nice, deep group meeting after dinner, and all I can say is we have an amazing team. Whoever's reading this has probably heard this before that we've got a good team, but I want to emphasize how awesome everyone I'm surrounded by is. Tears were shed, we shared some laughs, and threw some shoutouts to each other. Our day today just shows that even more.

Dr. Lauri and Richard were each asked to come to do a house visit. Dr. Lauri, our "Nigerian Thunder" Stephanie I., Farwa, Dakota, and Shannon stormed to the house to see a young patient who had come in earlier and that I saw while shadowing Lauri in the morning. He had really gotten a lot worse from when we saw him earlier with the possibility of influenza which may have brought out the pneumonia that he had already had a month ago. Without a word or thought, they headed down there to help him which was fantastic. Also, Dakota and Shannon had to run up the steep hills to get Dr. Eric before he left to get the prescriptions they needed and to actually make them. Without question, Eric and those two hurried up the rest of the hill to the pharmacy in the clinic and back down with the medicine he needed. It was awesome to see them go down even after such a long day to give back to the community and show just how much they genuinely cared.

Richard, Adam S, Ashley, and Rabbi Abie left to go see Richard's "girlfriend", Valentina, an women in her 80's that they just love to see and check on. I've got to mention that I kind of "volunteered" Ashley to be the translator for this visit because Stephanie I. was gone with Lauri. She did spectacular and is great at Spanish (even if she says she's not). I would have felt bad if it hadn't gone so well (check out her blog!) since she had to translate in Spanish about someone's health which is so important. Richard has seen this patient since their first trip to Patanatic and has been making home visits once she couldn't make the trip to the clinic anymore. The way Richard and Abie describe and discuss her is one of true caring. It's incredible. We've got so many people running up and down hills to make trips and interpreting in another language to ensure that someone is taken care of even though you were volunteered by someone else. It's amazing!

Everyone is so willing to go the extra mile. This has been happening the whole time we've been here. In glasses, some of us have gone through 30 pairs to see if we can help get that vision corrected to 20/20 or as close as we can with the stock of donated glasses we have on hand. Everyone's gone around and blown bubbles or played soccer with the kids at least for a tiny bit to make it less of the general doctor's visit. Some of us even just waited to let the others go on the bus first to check on Valentina while hanging back at the clinic to wait for Lauri and her team to return so we could head to the hotel.

It's been a true blessing to experience this united front to not only just get people through our clinic but to go even further to truly help change and affect their lives as much as we possibly can during our limited time in this beautiful country. I hope this attitude can serve me further along in my days whether that is in medicine or whatever I choose to do in my future. Gracias a Dios!

Adam Purvis

Words of Wisdom

Upon coming to Guatemala, I was excited to experience a new culture.  I felt like a sponge and took everything that Guatemala had to offer.  We hit the gown running when we arrived to Pahachile.  I literally felt like a chicken with my head cut off.  Every day I leaned something new.  Whether it was trying to understand the different Spanish dialect, the importance of listening to a patient, and even the importance of filling a prescription.

Even though I have been learning so much since I have been here, noting compares to what I have experienced today.  My Spanish is not bad but it is not the best to say the least.  I can understand and read in Spanish better than I can speak.  However, when Dr. Richard rushed to me and asked if I could translate for him, I was in shock.  I was thinking in my head, where in the world is Stephanie I. but she was with Dr. Laurie.  I stuttered yes, as Dr. Richard was looking at me for a quick response. The women who needed Dr. Richard was Valentina and she could not go to the clinic.

I was nervous the whole trip to Valentina’s house.  I was thinking of words to say in Spanish because I knew she spoke a different dialect.  My nerves really began when the taxi stopped at Valentina’s house.  As we got closer into her apartment, I said a little payer and then I was in her in her home.  It was a huge eye opener of how blessed I am.  I realized I take many things for granted in my life.  Her house was not small but I never saw that type of house before in my life.  I felt like I was in a movie because her house reminded me of a dungeon and it was pitch black when we were entering her house. Her floor was concrete with a very little kitchen with four other rooms.  

When I started to translate for Dr. Richard, everything started to flow.  I was able to translate for Valentina and her son-in-law.  I also had privileged to see the importance of at home health care. Dr. Richard was so kind and so gentle with Valentina it made my heat melt.   He treated her with the upmost respect.  I also really appreciated that her son-in-law understood English but he still spoke in Spanish.  Being in Valentina’s home was a great honor, especially, when Valentina and had words of wisdom.  After having personally conversation with her, I felt like I could do anything.  She only knew me for a short period of time and I left her house like I knew her my whole life. I am really grateful for Dr. Richard for believing in my, especially since he has never head me speak Spanish and Adam P. for having faith in me by mentioning my name.

Ashley Carter

One Human Race

It's been almost 36 hours of being in this unbelievably uplifting community that is Patanatic. Driving through the villages yesterday and looking out the van window seeing a mother carry gallons of water on her head as her two sons and daughter followed behind each carrying sacs of corn the size of each of them, I immediately could sense the compassion the Guatemalan people have for one another. Yesterday, we arrived at the clinic in the afternoon and I got to work in pharmacy. At first I was overwhelmed being in a new environment and having to find and give out medications that I could not pronounce nor write, but with pharmacist Eric and Dakota's teamwork we all worked together and delivered medication to patients who were extremely grateful for us helping them with their health care. This morning, I helped children and their mothers learn how to properly brush their teeth. Sadly, many of the children do not brush their teeth regularly and it was surprising to see so many young children with rotted teeth and cavities just because they were never educated that oral health is so important especially in childhood development. However, after we brushed our teeth together many of the children and mothers were smiling and I knew that with time these patients will not have to worry about having many of the oral issues that they do now, and that was extremely gratifying for me.

This afternoon I had an encounter with a 12 year old boy and his 9 year old brother that I will never forget. They were both sitting in the waiting room and I could tell that they were really close buddies. I had a little bit of a break and I wanted to get to know some of the kids outside of all the busy work that was going on inside the clinic. I asked them both if they wanted to play soccer and immediately their faces lit up with truly the best smiles I have ever seen. We played soccer for a while and if anything I learned from the talent and athleticism both of them had. It was great to see that regardless of our native countries and the languages we know best, none of it mattered because we were happy, simply playing a sport we all enjoyed to play. About two hours later I was fortunate enough to be in the pediatrics ward with Dr. Lauri and the two brothers visited us for their checkup. I didn't expect much to be wrong with their physical health because I had seen their athletic ability earlier. Little did I know the older brother had spina bifida when he was younger and without his surgery, I may have never had the opportunity to play soccer with him. In hindsight, it is unbelievable to know that his physical health is just like most 12 year-olds and that because of the medical care he got he is now able to live the life every child deserves. Soon after we went to the prayer room and read two prayers in Spanish. It was very renewing for the family because religion is part of everyday life, but I also was able to be present in a very special place for this family which was an unbelievable experience for me on my first full day in Guatemala. The interactions I had today I will remember for many years to come. I am extremely blessed to be part of a terrific team of medical caregivers and I cannot wait to see what the rest of the week has in store. I would like to end with a quote that Kofi Annan once said which is very special and meaningful to why it is so important to treat everyone, regardless of where we come from and the beliefs we hold dear to our hearts, with the upmost respect becuase in the end, we are all humans who simply want to live a life of happiness. "We may have different religions, different languages, different colored skin, but we all belong to one human race.

Greg Reyes

Ruined for Life

Today, my life was ruined. Ruined in a way that my life will never be the same. Ruined to the point where I will never be able to ignore the silent cries of the people around me in the village of Patanatic and throughout the world. That seems like an obvious comment, to never be able to ignore the underserved. That's what we all say that we strive for whenever we do any form of service. But to be completely honest, you don't really know what it feels like. You don't know what it feels like to see a community of people starving for food, education, healthcare, money and well, survival. It changes you. It makes you feel guilty. It ruins you. But frankly, I needed to be ruined.

Today, we began our two hour journey to the clinic in Patanatic, where we will be providing healthcare for the rest of the week. We were fortunate enough to be able to take a back road route to the clinic where we saw the transition from Guatemala City to a series of villages leading up to Patanatic. With each mile I felt more and more of myself ruin as we saw houses, markets, businesses and the faces of the Guatemalan community. I wish I could do these images justice, but no words would truly suffice.

Upon our arrival to the clinic, we all quickly carried our luggage inside and began to set up triage, dental, glasses, the pharmacy and the two patient rooms. I was placed in the pharmacy today with Greg and our pharmacist Eric, allowing me the privilege to unpack suitcase after suitcase in order to replenish the clinic with a full supply of medication. It was an awe-shock type of feeling to see bare shelves reaching full capacity. Furthermore, Greg found medication that was soon to expire in February. We realized how blessed we were having to move our trip up to Christmas break, as we would have had to waste a lot of medication if we were to arrive in early March as originally planned.

As the clinic opened and we began to fill prescriptions, I quickly learned a lot. On the surface I learned what medicines could treat which conditions and what shorthand notation meant for the prescription of each mediation. But past this fully enriching medical education, I had the opportunity to deliver the medication to each individual patient. Although I found the language barrier to be challenging, I was able to see a flash of relief in the eyes of each patient as they received medication that they otherwise would not have been able to afford. Obtaining medicine is something that is so easy for us to do in the United States. Therefore, having this reality of inaccessibility to something as simple as medication brought to life is truly eye opening.

As I sit down to write this blog, I'm sitting out on a balcony overlooking the city of Panajechal enjoying the cool breeze, well knowing that this is something I could never experience back home I'm Cincinnati. I find myself doing this a lot; comparing everything I've experienced in the last 48 hours to home. I hate that I'm thinking this way; always thinking about what I have compared to the people around me. But at the same time, I'm truly starting to understand how surreal our time here is. We are all here working in the clinic for a measly four and a half days. That's incredible. Four and a half days to provide healthcare to people who may only have this one time to see a doctor, knowing full well that if I get sick while I'm down here I have unlimited access to two doctors, one nurse and one pharmacist. Four and a half days to give members of this community an ounce of comfort knowing that they are going to be able to have medicine to hold them over for the weeks to come, knowing full well that at home I could easily just drive up to my local pharmacy. These thoughts are what ruin you. But they are also what drive you to give every ounce of yourself during your time down here. They are what force you to reexamine your life here and now in order to make a positive impact on the lives around you in the future. They are what define you as a person; not letting them freeze you, but drive you to make purposeful actions toward a better tomorrow each and every day. Now that I have been ruined, I see that not many people are. So frankly, through each of these blogs my goal is to ruin you too.

Dakota Kulis

A Holy Image

The day started with my 6:45 alarm clock ringing, I woke up totally unaware of what the next 12 hours would present.  Each day the expectations are high, but blurry meaning I know where I am going to be in the clinic and who I will be working with; however, the experiences that each patient brings is totally and completely unexpected.  My first full day in the clinic started in the glasses room.  The morning was packed with half a dozen patients strolling through the room each with different levels of strength and clarity for their eyes.  After a quick lunch break, the afternoon rolled through where I was placed with Dr. Richard, the internist, here I observed the doctor patient interaction as well as had the opportunity to ask questions during free moments.  After the patients received their check-ups, their prescription was then sent to the pharmacy.  After this, I took them into the prayer room where I offered to pray with the patient and their family.

This is just an overview of my day; however, if we only ever looked at the cold facts from day to day we wouldn't be able to pick out particular moments that inspired us or that will stay with us forever.  I had one moment in particular that will last, not only through my college career, but my life in general.  Just as I was really starting to feel comfortable in the glasses room, an older lady came in with a smile on her face and greetings for all.  We opened her folder to find that her vision was very impaired.  Cathy came in with her after taking her vision test in triage, to report that she could barely read the first two lines of images on the poster hanging from ten feet away.  So Rabbi Abie suggested that she step her half way to see what her vision would be, and as expected it was twice as could she could see to the four line with some hesitation.  With a quick word in English, Rabbi Abie asked what the goal would be for this patient, I replied with 20/50 which was the fifth line from the top.  He looked at me like I was crazy; I simply replied I'm hoping for a miracle.

After trying on only five pairs of glasses, her face immediately lite up while saying "claro" meaning clear and with confidence, still standing from five feet away, was able to read the pictures to the eighth line.  As she was reading the pictures without any hesitation, my eyes started to water, in that moment I was experiencing that holy image that I will treasure forever.  She then backed up to about seven feet away, still with a smile on her face was able to read the pictures to 20/40 which was the the sixth line from the top.  After a few more steps back, she was ten feet away from the poster and was able to read to the fifth line.  I can honestly say that I witnessed a miracle today.  Later that day, I saw the same woman with her grandchild and her brand new pair of glasses patiently waiting for Dr. Lauri.  From across the room, still smiling of course, she noticed that we made eye contact and so had I; I simply waved and she waved back.

It is amazing to think that one pair of glasses can change someone's quality of life.  Just like one personal interaction can change your perspective on life.  In the same way, one prescription can improve a patient's life.  It is incredible to imagine that even though there are twelve students, a triage nurse, two doctors, a pharmacist, and a rabbi; we all come together to form one team that has come to Guatemala in search of one goal, to help the people of Patanatic.

Shannon Carney 
Xavier University
Class of 2017
Biology Major

A New Feeling

This is familiar, this feels the same, this is what I'm used to in a way and these are things I felt before today. This time last year I had recently returned home from Afghanistan completeing my second deployment in less than two years. I was used to the idea of being away, I was used to the foreign countries, and I was used to providing medical treatment to people I could barely communicate with. Applying for this service trip was in part a way for me to keep deploying even though I was no long apart of the military. The other part of me just wanted to keep helping people using the only skillset that truly enabled me to do so.

The first night in Guatemala felt all to familiar as most deployments follow the same routine. Landing in a new country, getting situated and finally getting to the mission at hand as smoothly as possible. Unfortunately I have to admit that the beginning had yet to phase me aside form being in Guatemala for the first time, the trip had yet to provide me any surprises. More than anyting I was just eager to get to work and hope that the awe of being in a new place would intensify as I finally got to interact with a new culture of people. I had expected everything to be within my element and whatever was new to me I would pick up quickly as I had previously done in such a situation. However, when we finally arrived at the clinic my expectations were very quickly tossed aside and then there was nothing but an open mind.

Rabbi had told us about the recognition Xavier University had recieved for all its hard work, he mentioned the imprint of the Interfaith symbol on the outisde of the clinic. When everyone was marveling at the symbol I found myself looking elsewhere. I was instead taking in the reaction that Rabbi was experiencing and found it hard to remember the last time someone was so passionate over something positive. This event was something that I kept in mind throughout the day reminding me of a common military phrase "honor those who have gone before you." Working in the clinic has taken me out of my element and allowed me to experience something I've never felt before. This feeling of ambition was something I believed only the military could bring me but now there is a new found pride in what I'm doing and who I'm working with. There are only a select amount of times I have ever felt in my life when I knew I was doing an absolute good, and I am confident to say this is one of them. This was not familiar, this did not feel the same, I was not used to this, and this is how I feel now.

Ralph Banchstubbs

If You Don't Believe in Miracles...

Expect failure, be surprised by success...

Five and a half years ago when my husband, Chris, and I were in Haiti meeting for the first time the two children we were adopting, Sophia and Henry, I remember going to the US embassy in Haiti to file some of the mountains of paperwork involved in such endeavors.  We had an American woman who was directing our trip and had been in Haiti on several occasions helping us navigate the embassy visit.  I guess at some point she must have been trying to address some of our fears about the actual chance that the right paperwork would reach the right person's desk necessary to make the long adoption process slog along.  She told us, "In Haiti you'll have a lot less frustration if you go into everything expecting failure, because then you are surprised by success."  Well due to an earthquake that killed 250,000 people a mere 6 months after that but managed to spare our kids, we were able to get Sophia and Henry out of Haiti and home to Cincinnati just two weeks later.  I remember during those dark and scary two weeks coming back to that saying again and again.  Would we be able to get them home?  Everyday there was some element of expecting failure, but thankfully plenty of surprise at the successes.

Luisa

Well, every now and then in the practice of medicine we expect failure and are surprised by success.  For those of you who are familiar with the Guatemala trip you already know a very special little girl named Luisa.  I first met Luisa 3 years ago this week, just days after her first birthday.  Luisa is the youngest of 7 children and her mother came to clinic that day with a sad heart.  Having already raised children she knew there was something fundamentally different about Luisa.  She wanted to know why Luisa could not roll, sit, crawl, stand, walk, babble or talk like her other children did at age one.  During the conversation I was having with Luisa's mother Luisa herself was hidden from me, wrapped in her hand-woven peraje and tied like a sling to her mother.  Without even laying eyes on her I knew Luisa had a major diagnosis.  As we pulled the baby out of the sling and put her on the exam table in front of me I saw a baby with profound quadriplegic, hypertonic cerebral palsy.  She already had joint contractures, frozen up wrists stuck in constant flexion, scissored legs.  I finished my exam and sat down to have a hard conversation with Luisa's mom.  Doctors never want to give bad news.  I told her I didn't think that Luisa would ever walk or talk.  The way most cerebral palsy patients die is from aspiration events that lead to pneumonia.  Luisa had no gag reflex and that day she had pneumonia.  I gave her mom instructions of how to keep moving her joints and told her to try to find physical therapy and occupational therapy to help her.

I honestly thought that would probably be the last time I would see her.  Without proper nutritional support, treatment of future pneumonias, PT, OT, how could she survive in this little impoverished mountainside?

A year later Luisa's mom proudly carried Luisa into clinic beaming with joy that her little treasure was still alive.  She had found a pediatric therapist to do PT and OT with her once a week in a town about a 20 minute car ride away.  Luisa's joints were no longer stuck, but now she was very hypotonic.  She still at age two would only nurse for nutrition, blocking any type of solid food, but she had not had any aspiration events.  Then last March I saw her for the third time when she was just over 3.  Her family was very faithful to her therapy regimen, taking her to town every week.  She had started to scoot around the house in a baby walker.  At age 3 then she had only one word in her vocabulary, "mama."

She has become the star pediatric patient on each trip.  She has so much to teach these future doctors, nurses, occupational therapists, and every year she teaches me.  This year is no different.  We arrived to clinic this afternoon and were still getting all of the supplies that we brought down set up - a thousand pairs of glasses, suitcases full of medications, toothbrushes, hygiene supplies, etc when I looked to the entrance of the clinic to find three people WALKING into clinic holding hands.

Luisa was being flanked on each side by her oldest sister and her mother, but she was lifting each leg and putting it one in front of the other.  She was walking into clinic.  It took me several seconds to register what I was actually seeing.  Luisa was walking.   Her mother was gleeful to see my surprise and delight.  Luisa turned 4 last week, last month she started walking with both hands held.  For the last 3 years I had been expecting failure, today I was surprised by success.

If you don't believe in miracles, you need to meet Luisa.

Lauri Pramuk, MD

Up Close and Personal

Today has been filled with nervous energy and exciting awareness of the reality that today is the day we finally set foot in Guatemala. It seems as if we have been awaiting this day for the longest. Lots of hard work and planning has allowed this day to happen. Before I reflect on today, I believe it is important to mention the team activity that we all gathered around to participate in yesterday night.. Eric, Stephanie Renny's husband, asked for us to find a partner, form two lines, and stand directly across from our partner while facing them. The first phase of the activity had us walk closer and closer to our partner until we were less than several inches away from them. The second phase had us do the exact same thing but without breaking eye contact. Nervous laughter filled the room, but as we got closer to our partner, the more we talked to our partner. This activity reflected the intimate situations that we will be thrown into at times this week. It also mimicked the special moments that include putting yourself out there, feeling slightly uncomfortable, yet in the end, gaining an experience that allows us to grow closer to another person.

After lots of stalling in airports and attempting to sleep during the plane ride, we finally landed in Guatemala City. As we crammed in a bus to head to our hotel, practically sitting on top of one another, we joked that this was just like the activity the other night- up close and personal. We agreed that after that activity, nothing could be awkward between all of us. The vibe has definitely shifted amongst our team. It's as if as soon as we landed and were accompanied by Dr. Richard, a determined spirit of our mission is now with us. Dinner at a beautiful restaurant only decorated this new spirit as we cheered for our mission, for our clinic, and for our friends -those we have yet to meet and those who have stood by us and supported us along the way.

Caroline Wehby