Second Week in Guatemala

Clinic
     Administered medications and took histories this week.  The med students left and now we may actually be short staffed, as opposed to the last couple weeks when there were so many students we were fighting for patient interaction.
     On Wednesday, I visited a midwife's clinic where I mostly observed.  The midwife Dona Ana acts as a general practitioner as well.  A 9 year old boy came in with his grandfather for diarrea for the last two days.  Palpating his stomach, you can feel something like a long tendon running up and down the midline.  According to Dona Ana, it was a worm (I should probably research this).  Meg the pediatrician is doubtful that the worm is palpable (even if it did cause an intestinal obstruction, it would not feel like a 5 inch long straight tendon); however, she would like to witness for herself what Dona Ana is observing.  Que interesante.
     One of the directors just asked me if I could help another midwife for two days this week.  It feels good to actually be useful, rather than be treated as a burden for being a student.  Unfortunately, because the Pop-Wuj clinic is short staffed, I have to stay with the clinic.  On Wednesday, the clinic is going to a school for kids with special needs (really cool and really sad at the same time).
     Also this morning, Meg gave a short lecture in parasitic infections.  The prevalence is 67% and 49% in rural and in urban areas, respectively.  The top causes are 1) ringworm, 2) whip worm, and 3) hook worm.  She also talked about giardia, a protozoal infection.  She said that 80% of raw water and 15% of filtered water in the U.S. is affected (surprise!!).  The World Health Organization (WHO) position for treating parasitic infections is empirical treatment:  in areas where prevalence is 0-50%, treat adults and children every 1 year; in areas where prevalence is >50%, treat every 6 months. Guatemala falls in the latter group.  BUT, like all anti-pathogenic drugs, people do build resistance with more medication, so Meg's message is to make darn sure the patient hasn't taken the antipathogenic drug in the last 6 months before prescribing more.  She sometimes asks the patient 3 times.  By the way, antibiotics do not need a prescription here and the general trend is that people will take it like its candy and pharmacists don't mind selling it. 
So, what's my take home?  Education is muy importante:  washing your hands is the best preventative medicine and boiling and filtering water is the best way to purify it.

Excursions

On Thursday morning, went with a couple students to a glass factory.  Here are the pictures. 

On Saturday and Sunday, went to Lago Atitlan with seven other students.  Here are the pictures.  
Lago Atitlan is the biggest tourist attraction in Guatemala, and it is obviously so - the hippy gringos, the pesty vendors, the exagerrated gringo prices, the warnings about robberies if you hike out on your own.  The lake and its surroundings are beautiful, but the views were hampered by the rain and clouds.  In the future, I will give Lago Atitlan another try, but only during the dry season.