28 Feb 2013
High in the mountains, where the air is brisk and cold, lie the two most faraway communities that we visit. The Pop Wuj mobile clinic comes to Xeabaj and Pujujil once every two months. Always one right after the other such that you can’t avoid comparing the two.
Usually mobile clinic days are hustle bustle. Community volunteers dash to and fro, organizing the line of waiting patients and setting up our clinic space and supplies. The first time I went to Xeabaj I was met with eerie quiet. For unknown reasons the mood spilled over with sombre. The few people at the site walked slowly as if carrying something heavy on their backs, eyes cast towards the ground.
In Xeabaj we needed interpreters to translate the native K’iche’ into Spanish, which most of us mentally convert into English. Three languages at work at once makes for an interesting patient visit. Besides this, each time I started with a new patient I had to hunt another interpreter to translate for me. They kept disappearing, leaving the grounds to go to the tienda, go home for a snack, congregate elsewhere and gossip. By the end of the day there were still patients waiting but few interpreters left standing.
Later I learned that Xeabaj is a community displaced. In 2005 the threat of Hurricane Stan was imminent and the town had to evacuate for fear of being covered by landslides. Leaving with their children wrapped up to protect them from the storm and the few belongings they could carry, they were crowded together in a shelter. Later they were relocated. The location of Xeabaj II is further up the mountain, where the land is more rock than earth, dry and barely fertile.
The adjustment has been difficult for everyone. The formerly agricultural town has had to look to other forms of industry – the women make candles and textiles while the men work as day labourers elsewhere – as their crops barely sustain them. There are no extra to sell. The hardship has taken its toll, bringing out disputes and grievances. Dividing the community.
In my first visit to Pujujil I saw a sea of waiting people as the mobile van pulled up to the school auditorium. Several young men dressed in black immediately began unloading our supplies. I followed them into the auditorium. Tables and chairs were already set-up. More young men dressed in black were hanging curtains, creating private consult rooms in which we could see patients.
The native language of Pujujil is Kaqchikel. Getting a translation was never a problem. All those young men had come to volunteer as interpreters as well, wearing black so we could easily identify them. They stayed close when they were between patients, gathering outside the curtained consult rooms, so we could easily find them.
Why were all the interpreters young, you may wonder. Because the youth have learned more Spanish than their elderly grandparents, conceivably because of slowly improving access to education. Why were all the interpreters male. Because Spanish is learned in school, and boys are still kept in school longer than girls.
I was very grateful for those young men, eager and happy to help their fellow townspeople and us. But this language situation can have complicated effects. In the middle of the day I saw a young female patient. I thought her clinic visit was almost over. Then my interpreter had to step out for a second. Immediately the patient began to tell me about vaginal discharge, of which she had been too shy to mention in front of the male interpreter. I had to scramble to find a woman in the village who could translate for me.
The town of Pujujil seemed very much a community. They came together to help us bring health services to one another. At the end of the day the volunteers and the patients were still on the grounds, gaily chattering away and helping us pack our supplies. But so much togetherness can also be a bad thing.
Every few months Pop Wuj hosts a medical brigade from Timmy Global Health. For brigade day we had given Pujujil community workers 100 tickets to distribute to patients. The extranjero medical volunteers would see at least those 100, more if they had extra time.
They did. Neighbouring communities caught wind; some came and tried to line up for healthcare. But the people of Pujujil physically blocked them from passing through the centre of town.
“No. This is just for us.”
For the last few hours of the day, volunteers ended up just sitting around.
Yet Xeabaj and Pujujil can be very similar. Especially when it comes to the illnesses that one sees. The disease profiles are very different from those of more urban populations. The city has seen an increase in rates of hypertension and diabetes, with a more sedentary lifestyle and the rising popularity of unhealthy food. Whereas, in an entire morning of clinic at Xeabaj or Pujujil, I can go without seeing a single case of diabetes or high blood pressure. Instead I see more infections like conjunctivitis or pneumonia. More diseases that relate to hygiene like parasites and scabies*.
What scares me the most is the frequency of medically advanced diseases in rural areas: infections like tuberculosis that has been ignored for a year, chronic conditions like hypertension where the patient’s blood pressure is dangerously high, even massive growths.
At the start of one mobile clinic I spotted Doña Noemi from across the auditorium. She was sitting in the waiting area, several meters away, huddled in her seat beneath her layers. My mother taught me not to stare but it was hard to stop gazing at the enormous growth on her right eye.
She didn’t end up being my patient. But she did allow all of us to examine her mass. It originated from below the upper eyelid, vascularized and tender. When Noemi looked from side to side the mass would move with her glances. We learned that it had been growing for two years, bleeds, and is painful. Another sad thing is she went to a permanent clinic a few months beforehand. However she was so turned off by the way she was treated – which could have been either a linguistic misunderstanding or physician rudeness – that she left. We referred her to an ophthalmologist in the capital.
The communities are distant, so removed in multiple ways – isolated locations, language barriers, economic constraints – that patients do not seek care and instead wait for it to come to them.
*The scabies mite can infect anyone, regardless of personal hygiene. However it is more often seen in crowded living conditions with poor sanitation. Hygiene also plays an important role in prevention and control.