Sunday, March 15, 2015

Supporting Community Health Promoters in San Lucas Tolimán, Guatemala

Week 1

San Lucas Tolimán is a town on the side of Lake Atitlán with a population approximating 30,000-35,000 people. Over the past 15 years (after the signing of the Guatemalan peace accords of 1996), there has been decreasing violence and a slow increase in trust of government systems, which have helped to create paved roads, more reliable electricity, and internet in many towns. Children are vaccinated through government programs, with requirement of vaccination before official birth registration can be completed. Nevertheless, children suffer from severe malnutrition and are too frequently born with neural tube defects and cleft palate from folic acid deficiency in pregnancy. Domestic violence is common and few resources are available to women other than bringing a denunciation to the legal system. Obesity and diabetes are increasingly becoming a problem as the Tuk Tuks (local taxi system) have decreased individual physical activity, while a little extra disposable income has increased the consumption of sugary beverages like Coca Cola.

Upon my arrival to San Lucas, I found my way to the Hospital Parrochia, founded and run by the Catholic parish of Father Greg, who passed away several years ago, leaving the leadership and finances of the hospital in a bit of disarray. Nevertheless, Dr. Rafael Tun continues as the primary doctor for the hospital, on call 24 hours a day, 7 days a week, offering medical consults for children and adults, performing ultrasounds, delivering babies, and maintaining a small inpatient ward for simple emergency cases. As I learned on my arrival, he also welcomes four or five surgical missions each year, offering local patients operations in ophthalmology, podiatry, orthopedics, and gynecology.

The week that I arrived, a group of podiatrists and orthopedic surgeons had arrived, organized by Dr. Steve Miller, a podiatrist who has led many surgical missions around the world. To their credit, he investigates new partnerships carefully to ensure that follow up services will be available. At the Hospital Parrochia, a podiatrist from Seattle (Dr. Will) now lives full-time in San Lucas providing orthopedic and podiatry services, offering follow up care for post-op patients as well as assisting in case finding for upcoming missions.

I have never before learned so much about clubfoot, a relatively rare condition but neglected globally, with severe functional limitation of teens (pain, inability to walk) until corrected surgically (with a fairly substantial surgery often requiring multiple stages). But, if brought to care early (ie: first 6 months of life), clubfoot can be corrected without surgery, with simply a series of hard casts (the Ponseti method). However, getting infants to care is not easy, as there is significant stigma against any child born with birth defects, with claims of being possessed by evil spirits.

This week we will begin our work with the network of community health promoters in San Lucas. There are approximately 24 community health promoters, working in 16 rural communities surrounding San Lucas. The program has been set back by some corruption over the years (a few promoters were recently released from the program after having skimmed funds and donated goods for their personal benefit). Nevertheless, the majority of promoters, nominated for their leadership and integrity, are doing important work in communities with little access to basic medical resources and knowledge. The promoters were organized through Father Greg’s parish, with a head promoter named Vicente who works hard to keep the group going, despite lack of funds. Only promoters working with the vitamin project of Paul Wise of Stanford are currently compensated. More to come on our work in future posts.

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