Reflections on Hospitalito Atitlan

It has already been useful for me to take a step back and reflect upon my week in Santiago, Guatemala working at the Hospitalito Atitlan. My overwhelming impression is positive, for many reasons. Perhaps I was lucky, but without exception, the people I encountered were upbeat and made every effort to be productive. It is a challenging situation, but that does not deter the healthcare professionals and staff at the Hospitalito from seeking constant improvement, and working to better the situations of their patients. I did not encounter the negative attitudes and burnout that are generously sprinkled thoughout the U.S. healthcare system.

Before I arrived at the Hospitalito, I was nervous about the degree to which I might need to improvise, and how I would respond to practicing medicine without my customary supplies and support systems. No doubt, there were tests and specialists that would have been very nice to have, but on the other hand, I quickly discovered that I needed to become a better diagnostician, to think more, and to become less reliant upon the “shotgun approach” to testing to which we are so accustomed. There is indeed a certain lack of precision that leads to heightening of the senses in order to regain that diagnostic acumen, and even in a short week, I found myself looking and listening to my patients with a less hurried and more critical approach.

The faith and trust of the patients were remarkable. I did not encounter a single complaining patient. Was this because they had lower expectations or less medical knowledge? I don’t think so. I think it is because they are a people of “please” and “thank you,” who are grateful when they are assisted. When I walked home after work wearing hospital scrubs, everyone smiled and many greeted me. No one begged or tried to sell me anything. I was instantly accepted as part of the community, as a helper. In America, there are many people who appreciate their doctors, but these days, there seem to be just as many who have complaints.

I was disappointed, but not surprised, by the lack of environmental and public health awareness. Large portions of the over-fished lake are polluted, there is a constant haze of smoke from wood-burning fires, garbage is strewn in the community gardens, children are malnourished, prenatal care is inadequate, and there is little attention to many of the basic measures of hygiene, nutrition, and natural resource consumption that we all know to be the cornerstones of a healthy life for people and our planet. But I understand full well how food, clothing, and shelter take priority over conservation, and how education can only be effective if governments can put people into a situation where they are motivated to learn, and protected from harm while they learn. So, on the flip side, there are libraries, and community outreach efforts, and local citizens trying to better their communities.

I did not sense the tension between young and old people that exists in our country. Elders are respected, and are not uncomfortable wearing their traditional garments when surrounded by westernized youths sporting jeans and modern haircuts. I did not witness taunting, and saw very few law enforcement officers. While crime no doubt occurs, if there had been a significant number of assaults, we would have known about it. If there was an illicit drug culture, I did not encounter it. While there were many opportunities for the locals to have their way with me economically, largely because I do not speak Spanish, no one tried to take advantage.

Rebuilding the Hospitalito Atitlan is a worthy cause. With far fewer resources than would be implemented in an equivalent operation in the U.S., the new hospital will contribute to the health and welfare of a relatively larger population to an extraordinary degree. The people of this lake region deserve it, and it is my great hope that the Guatemalan government will support it, as hopefully will many good people of philanthropic intent.

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

Tags: Hospitalito Atitlan, Guatemala , wilderness medicine, outdoor medicine, healthline

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