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Clinica Medica

Two thousand miles. Four days. One mission.


Just before 8, they begin their six-minute trek surrounded by sunshine, diesel-smelling air, and mountains rising 9,000 feet. The streets are quiet except for the crows of unseen roosters and the occasional whistling jalopy truck or taxi. They walk by several tiny stores called tiendas, a Mormon church and school, blocks of tightly spaced concrete houses and men in uniforms with guns. The soldiers stand guard outside a military compound surrounded by high rock walls topped with shards of glued-down glass.

Around the corner from the compound is the Lutheran parsonage, a gated, salmon-colored, two-story building with a neatly kept, half-acre yard. This is where the team will plant itself for the next four days, half of them operating the clinica medica inside the parsonage, the other half constructing a much-needed storage building outside.

The team assembled in San Marcos comprises 10 Rich-monders on a mission trip with Trinity Lutheran Church in the West End, a Lutheran pastor from Indiana and his family who live in Guatemala City, a Lutheran liaison who coordinates missions and a youth representative of the evangelistic arm of the Lutheran Church in Guatemala. This is the ninth year Trinity Lutheran has sponsored a trip to Guatemala — each year to a different town or village. For some volunteers, it’s their fifth trip or more; for others, it’s their first. They have come to help the poor and the sick in a place that seems forgotten. They won’t break records. They may not save lives. They won’t complete the building project. Still, something about their presence here will linger. And the reality of this is what makes the mission matter most.

In addition to being the first day of the clinic, it happens to be Army Day in Guatemala, a national holiday that commemorates the revolution of 1871 and honors its military. Festivals will carry on throughout San Marcos, which is a small concrete city like other small concrete cities that jut ubiquitously across the Sierra Madre highlands. Most of the people who live here and in neighboring villages are poor, even by Guatemalan standards, surviving on $2 a day. The national government is not especially popular among the poor. Many say it hasn’t done what it promised to address their needs. And the presidential election in November doesn’t foretell a turnaround. Consequently, it’s hard to guess how the holiday will impact the clinic’s traffic, whether people will be more or less inclined to come.

The mayor of San Marcos, Carlos Sachajer Barrios, is the first to arrive at the clinic, while the group works quickly to set up the two examining rooms and pharmacy. He is close with the local Lutheran pastor who oversees the parsonage. Everyone stops to gather for his welcoming. “It’s nice to greet you,” translates Aaron Putnam, the liaison for the national church. “Your medical clinic contributes to the well-being of the lives of the people of San Marcos. This is your house, your home, your country. May God bless you while you’re here,” he continues.

“He’s already pitching for you to come back,” Putnam tells the group.

By 8:30 the clinic is ready for action.

A jovial gray-haired man in a blue vest ambles into the clinica medica, removes his wide-brimmed hat, sits down, hikes up his left pant leg and presents evidence of contact dermatitis, an itchy, mangy skin condition he’s suffered for years. In minutes, he’s handed steroid samples to clear it up. “Gracias,” the man says, gathering his hat to return outside.

Next, a family of four is ushered into the same makeshift exam room. A woman with an infant and two young children takes a seat in a wooden chair. She undoes the tzut — an all-purpose cloth used to carry infants on women’s backs — and lifts the baby around to place him in her lap. Her school-age son and daughter flank her, staring quizzically at the doctor, then at the table. Necessities top the table — a clipboard with pen and paper, a bottle of water, hand sanitizer and medical instruments.

The woman utters her worry in Spanish. “He never gets rid of his cough and often is out of breath,” explains Dr. Antonio Mu¤iz, translating. Mu¤iz is a pediatrics and ER doctor in Richmond. This is his fifth trip to Guatemala with Trinity Lutheran, his wife’s church. The boy’s name is Jorge Ramirez. He wears a blue T-shirt and blue Addidas knit cap, and though he looks 5 or 6, he is 8.

George Mueller, Mu¤iz’ assistant, checks the boy’s ears. “Buenas dias,” he says cheerily, lifting the cap from Jorge’s head and shining a small light in his ears. The boy winces. Mu¤iz places a stethoscope on the boy’s chest then his back to hear his heart and lungs. He pinpoints the problem: “He has asthma nobody knows about.”

He calls for a medical student in the next room. A young woman with close-cropped blonde hair wearing hospital scrubs appears. “Listen to the blue kid, listen to his chest,” Mu¤iz instructs. Katie Noller Hrynciw unwinds her stethoscope and repeats Mu¤iz’ routine. Jorge breathes in and out until Hrynciw seems satisfied. “I hear wheezing,” she says.

Mu¤iz, who is fluent in Spanish, explains Jorge’s condition to his mother then directs the family to the next room for medicine — a three- to six-month’s supply of Albuterol for Jorge and a month’s vitamins for the entire family.

A handwritten sign reads “Farmacia de Sancho,” but the pharmacy is unmistakable. Drugs are everywhere. Hundreds of plastic Ziplock baggies full of pre-sorted pills and countless boxes of sample antibiotics, antacids, antihistamines, pain relievers and unused or expired prescriptions cover two tables, a sink countertop and brim over an auxiliary of open suitcases. It took a year to collect the drugs. They come from hospitals, doctor’s offices, pharmaceutical companies and individuals, from anyone or anyplace that will donate them. In the United States the drugs are worth $35,000 to $40,000. In the Guatemalan highlands they’re priceless.

San Marcos is a place where mothers bundle babies in blankets upon blankets until, unknowingly, their sweat glands won’t work. Where neck and back problems are signs more of youthful productivity than old age. To see a doctor at a private clinic costs 30 quetzales, more than a day’s wages, in a village where many don’t have jobs. So when word spreads that a mission team will see patients and dispense drugs for little or nothing at all, families hike the steep miles it takes to get here.

In the waiting area people sit or stand along the walls and watch Spanish videos on a television. Some of the women are braiding their hair; others embroider what will become cortes, the rainbow-colored wraparound skirts traditionally worn by Mayan women. Once patients are seen by Dr. Mu¤iz or the medical students and receive their medication, they return to the waiting area where they sit and talk to Betty DeVallejos, the youth representative for the Guatemalan evangelistic organization. With her prop, the Gospel Cube, she explains to them the meaning of salvation. The Cube is a block of pictures that tells the story of Christ’s dying on the cross for them. Stacks of brochures and booklets in Spanish about everything from AIDS to birth control to the Bible line a table at the entrance to the clinic.

By lunchtime nearly 80 patients have passed through the clinic, seeing either the doctor on one side or the two medical students on the other. There have been infants with worm-causing diarrhea, children with ear infections, skin rashes like scabies and lingering infections from pneumonia. Mothers with low blood pressure who need vitamins, and grandmothers with headaches and body aches. There have been pregnant young mothers sick with nausea, who believe they can’t take anything to treat it. Dr. Mu¤iz gives them Maalox. There also have been sexually transmitted diseases and teenagers suffering from anxiety and depression.

Records aren’t broken this year as they have been every year since the trips began. Last year, the group saw 751 people on its mission to a coastal Guatemalan city to the east. But it’s not about setting records, Mu¤iz insists.

Still, the numbers are staggering — 670 people will be treated in four days at the clinica medica. When word spreads that a free clinic is coming to town, people show up. Muniz calls it clinic-hopping. There are numerous clinics like this one that crop up throughout Guatemala and are organized by different groups from the United States and elsewhere. It’s the only access the poor have to health care.

Most, like the Ramirez family, need a quick remedy. Inevitably, it’s a remedy as temporary as the clinic. In time, medical samples will run out. Unavoidable plagues will return. According to the United Nations Development Program and the Inter-American Development Bank, more than half Guatemala’s population — nearly 13 million — doesn’t have access to safe drinking water. Forty-six percent of its children are malnourished.

Four decades of civil war in Guatemala ended with the Peace Accords in 1996. People had hoped it would be a fixture for change. The doctrine pledged to improve civil rights, especially for women and indigenous populations, and to enhance social services like healthcare and education. (Ninety-eight percent of Mayan women are illiterate and most children don’t receive more than five or six years of schooling.) But by all accounts, little progress has come in seven years. And apart from the rich milpas (cornfields) and rainbow-colored huipiles (dresses) intricately woven and worn by Mayan women, the daily fixtures of local life remain the shantytowns and careening, overflowing chicken buses — defunct school buses used commercially to shuttle people.

In Guatemala, a few cities have sewage systems, but wastewater treatment is nonexistent, meaning rivers and streams become aqueducts for raw sewage. But with no alternative, people bathe and swim and depend on them. Consequently, persistent infirmities abound like internal parasites, diarrhea and amoebic dysentery. Then there are the seemingly anachronistic risks that — in the highlands — accompany acute altitudes: respiratory problems from cooking over open flames, neck and back pain from carrying wares mile after mile, and injury and frequent death from falling off a mountain while farming precipitous land. Such facts and factors have an impact on the degree to which a four-day medical clinic in Guatemala is successful.

“Basically it’s a Band-Aid for a chronic problem,” confesses Scott Flint, a pharmacist in Richmond who is spending his summer vacation dispensing medication at the clinica medica.

Still, something keeps Flint coming back to Guatemala, replenishing Band-Aids. This is his sixth mission trip with Trinity, where he is a member. Flint’s own family has been altered infinitely by the experience. It led him and his wife to adopt a son from Guatemala, then a daughter.

Despite poverty, everyone who comes to the clinic appears happy. Smiles are a given about the place. And the familial love is abundant and profound.

“We always come back feeling we received more than we gave,” says Trinity pastor Phil Bruening. This year’s trip is his 10th. He knows the words he hears most often from Guatemalans when they leave the clinic. ­Dios le bendiga! God Bless you. And as Bruening points out, in a country where the average income amounts to less than $3,000 a year, the value of a three-month’s supply of vitamins or free medication becomes immeasurable.

A little after 5 the waiting area outside has been emptied. The clinic closes for the day. The group returns to the Hotel Perez to wash up before dinner.

At 7 they gather again in the dining room. The conversation ranges from the day’s work, to the unexpected mayor’s visit, to “Austin Powers.” The total count of patients seen today is 130, someone points out — not as many as they’d hoped for, not as many as this time last year, but still more than any doctor’s office or hospital emergency room can handle in one day.

The second day at the clinica medica is slower than the first. In one exam room, Katie Hrynciw and Pam Mickell treat a woman named Dominga who is 77. She complains of pain in her muscles. After taking her blood pressure and determining she has no other troubling ailments, they send her to the pharmacy where she receives some ibuprofen. Next, they see a woman whose eyes and ears are causing her pain. She, too, appears very old, with deep-set wrinkles that crease her face and press upon her eyelids, giving them the appearance of being closed. Her eyes itch and burn, and her ears ring, she explains in Spanish to Mickell, a second-year medical student who also speaks the language fluently. She calls Mu¤iz into the room to consult. After inspecting the woman’s eyes and ears Mu¤iz tells them the woman suffers from ptyrigium, a condition caused by overexposure to the sun that causes the eyelids to grow over the eyes. “If it doesn’t hurt their vision, there’s nothing we can do,” Mu¤iz says. Likewise, the ringing in her ears is tinnitus, he determines, for which there’s no remedy either.

In the pharmacy Amy Mu¤iz, Dr. Mu¤iz’ wife, greets a little girl named Da¤ela. “Buenos dias, chica,” she says. “¨Quantos a¤os?” The girl smiles and holds up four fingers then giggles. Though she doesn’t appear to be sick, she has parasites and worms. Amy Mu¤iz gives her some liquid Albendazole from a vial dispenser to treat it.

A blast of loud shots pops suddenly from the street as a group of boys set off firecrackers. It’s a pastime in Guatemala. By late morning there are no people at the clinic, no line, no wait. The four who have been manning the clinic gather in the first examining room to devise a plan to bring people in. They suggest putting posters at the town square. But there is no paper. The daughter of one of the pastors has crayons and markers, and pledges to find something to make the signs. The downtime gives Mu¤iz, Mickell, Hrynciw and Meuller a chance to talk, to share their personal reasons for coming to Guatemala.

“The main impetus is to see people much poorer than we are,” says Mu¤iz, 39, who is an associate professor of pediatrics and emergency medicine at Virginia Commonwealth University Health System. “Sometimes we can’t treat or diagnose them,” he confesses, but the hands-on experience is invaluable. “We learn about conditions we don’t see in the United States because of better medicine.” He recalls a 7-year-old he saw on last year’s trip who suffered from systemic poliomyelitis and could barely walk. For the persistent problems, the clinic can ease the symptoms — at least for a while, perhaps three to six months, until the next medical clinic pops up somewhere. “A temporary fix is better than nothing,” he says. “My purpose for coming is to see how world medicine works — to broaden my scope and see how a community lives without medical care,” says George Meuller, 25. Mueller is an emergency medical technician in Richmond who hopes to go to medical school. Though he’s been to Asia and Europe, this is his first time in a Third World country. His Spanish is just two days old, he points out.

That’s where Mickell and Mu¤iz come in. Both speak the language and Mickell has studied abroad in Guatemala. Mickell, 27, also is trained as an EMT and has just been “promoted” to her second year of medical school at MCV. She’s not a member of Trinity, but this is her second trip with the group. She hopes to graduate and find a job with Doctors Without Borders. “I’ve come to see what it’s like, to see if it’s what I want to do,” she says of treating the sick in foreign poverty-stricken countries. “And it is,” she says.

“Here you see clinics everywhere but the people can’t afford them,” says Hrynciw, a medical student at MCV, who helps collect the pharmaceutical donations. “It’s a matter of money. … We have people who will walk from 10 miles away and wait all day. You’ll never have them say ‘What took you so long?’ or ‘Why couldn’t you see us sooner?’” she says, adding: “These people who come, we are their medical care.”

“It doesn’t hit you at first,” Mickell says, “but it’s coming at you 10 hours a day — the language, people, culture, your limitations. Then you look down and see this line stretching down a block and that stays with you for years to come.”

It’s 11:45 and the clinic still is empty. But the volunteers tell themselves it will pick up. It does. After lunch, slowly a crowd will grow, though there won’t be a line that stretches blocks. Tomorrow and the next day will be busier and bring more of the same kinds of cases: people, families and pains.

And when the wick of this mission expires, there could be an afterglow, a kind of rationing of faith, that what’s given and received here will last until next time. The Mu¤izes seem to think so. Already they’re planning for next year’s trip. And there’s a possibility the group will go to Panama. For now, Dr. Mu¤iz is content to reflect on what makes Guatemala distinct. “Sometimes you’ll awaken in the night and remember what people withstand over here,” he says, “and it keeps you motivated.” S

Mary Fisk-Taylor, a professional photographer who lives in Richmond, is co-owner of Hayes Photography.

Brandon Walters traveled with the mission at her own expense.

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