La Cesarea y Corupción

August 2, 2010
OH MY GOSH GUYS, I GOT TO SEE A C-SECTION TODAY!!!!!!!!! It was crazy. We had already had a HUGE day at the clinic. Alisha and I switched doctors this week, so I was with Mercedes Vico, the family practice doctor, and she was with Luis, the gynecologist. In my office, we had 29 patients, and worked until nearly 1:30, which is about 2 hours later than usual. A lady had come in earlier that day, and her water must’ve broken, because we knew all day that we would be doing a C-section when everything else cleared out. When the last patients finally left, things started moving pretty quickly. Everyone changed scrubs, donned masks, booties, and hairnets, the doctors scrubbed in, and Alisha and I squeezed into the operating room. The operating room at the hospital is probably the most beautiful place ever – a great juxtaposition of medicine and landscape. It has banks of windows on two sides, with the most gorgeous view of Lake Atitlán and the surrounding mountains and volcanoes. It was also incredibly hot in there.
Dr. Velilla started cutting and everything was going great. Then the anesthesiologist repositioned the overhead lights (the really important ones), and they went out. And refused to turn back on. The doctor had already cut down to the uterus, so there was really no turning back at that point. The closest the doctor has ever come to saying anything remotely resembling irritation occurred then. “Oh. My. God. No puedo ver NADA!!” was all he said, but he barely speaks English, so I feel like it carried a little bit more weight than normal. The backup flashlight (a giant Black-and-Decker job) also didn’t work. He kept cutting, mostly because there was nothing else to do, but he couldn’t see as well as he needed to. The nurse handed the flashlight over to me and told me to see if I could turn it on, which of course I couldn’t do any more than she could. While I was fiddling with it, Alisha hit my arm and told me to pay attention. I looked up and there was the baby’s head! Less than 15 minutes after we first opened the lady up, they had already popped the baby out like a slice of toast and handed her off to a waiting nurse.
At this point, another nurse showed up with a portable surgery light and got it positioned so that the doctors could see to suction and suture. But she is really short, shorter than me (up to this point, I had believed that impossible), so she had a tough time keeping the light steady. So they told me to go hold it, which meant that I had prime real estate on the suturing process. It also granted me the nickname “Statue of Liberty” for the next few days. The doctors were really great about pointing stuff out to us, like the Fallopian tubes and the different landmarks on the uterus and the ovaries and such, except that I had to hold the light (positioned at the patient’s feet) and try to see into the gaping hole in her midsection, all without violating the sterile field, which didn’t actually work out that great. And the whole time, my pants, which were about 3x too big for me, with sprung elastic in the waistband, threatened to succumb to gravity’s insistent pull, despite my best attempts at tucking them into my underwear. Also by the way, the O.R. scrub pants are white and thin. My underwear was brightly figured paisley. Classy, to be sure.
By the time the doctors finished stitching the patient up, they were completely covered in sweat. We wheeled her to her room (where she would stay for maybe 6 hours before going home) and got her positioned on the bed. We helped clean up a bit, and then left at nearly 3:15. We were both super pumped, and so decided to splurge a bit and visit “Tourist Town” for some food. The restaurant had great guacamole and free tortillas and AWFUL American music (Ice, Ice, Baby was just one of the many terrible songs that we heard).
Oooh, what a great day.



August 4, 2010
Every so often, Dr. Velilla goes on a tear about the state of things in Guatemala, which is very informative. Evidently the Guatemalan government does absolutely nothing to facilitate the entry of necessary medication and other supplies into the country. Guatemala doesn’t have any way to manufacture the drugs or what-have-you, and the only facilities are laboratories and such for processing tests. As such, everything must be shipped in from Europe and the U.S., which is obviously a BIG problem if the government decides that holding everything up at the border is the flavor-of-the-week. And that particular flavor-of-the-week isn’t just of the week, it seems to be more or less the status quo. The Guatemalan incumbents seem to be intent upon keeping their population sick and poor, refusing to do anything to improve the lifestyle or quality of life for anyone except the richest citizens (incidentally, their supporters). Corruption is a BIG problem here – if a politician isn’t bribed to do his or her job, you can bet your boots he or she won’t do it, or at won’t do it to a satisfactory level. Consequently, those who live in the poorer barrios (and much less, the slums and squatters) are pre-prepped for disaster, such as when Agatha roared through. However, in the richest zones of the City, the lights never go out, the water never runs out, and the streets are paved 2 or 3 times per year. By keeping their citizens poor, sick, illiterate, and ignorant, the Guatemalan government can essentially do whatever the hell they please, without incurring the wrath of the majority of the population, all the while keeping that majority in a state of constant fear and under constant repression.
One of the biggest problems in the less-developed countryside, at least medically speaking, is the abundance of medical quacks. Several times per week, if not every day, a woman will come into Dr. Vellilas and say “So-and-so up on the mountain told me that I have a tumor on my ovary that needs to be removed, but it costs Q12,000 ($1500) so I just wanted to be sure” or “So-and-so on the volcano said that I was pregnant but then the baby died.” Both of those cases have happened, along with an abundance of others, equally sad. The woman didn’t have a tumor, and the other’s baby was still alive and hopping around in the womb like a Mexican jumping bean, by the way. But sad as it may seem, the vast majority of Guatemalan health-care providers are in it for the money and the prestige, and may or may not legitimately know anything about medicine, and may or may not extort their patients and play off of their trust in the medical profession as a whole.
Machismo is also an extremely big issue, both at the clinic and in Guatemala as a whole. Machismo is defined simply as “male-dominated society,” and is incredibly prevalent in Latin America, if not the majority of the world. At the clinic, one of the most oft-seen cases of machismo involves the treatment of STDs. Women come into the clinic with an some or other STD, Dr. Vellila prescribes a treatment, and also gives them additional doses for their husband. After the woman leaves the office, however, he looks at us, shakes his head, and says that the husband will never take the pills, that it’s always the woman who bears the brunt of his visits to prostitutes, and that “it’s always the woman’s fault.” We’ve also both seen cases where a couple will visit Dr. Vellila for a gynecological issue (OBVIOUSLY a problem with a WOMAN’S body) and the husband does all the talking. The doctor may even directly address the woman by name, and she still sits silent and unresponsive, while her husband prattles away about the level of pain she is experiencing and the nature and duration of the problem. Because obviously, he knows.