Primeros Pasos

Before arriving at Primeros Pasos for the first time, I am not embarrassed to admit I was petrified. Of simple questions such as how I was going to find the place, of worries that my (very) basic Spanish would prevent me from being remotely useful, and that pit-of-the stomach nervousnes we all fel when we are about to embark on the unknown.

My fears were quelled instanteneously, were made a mockery of, as soon as I leapt off the cog-grinding old yellow schoolbus that had bumped its way through ruts and potholes in the road up to the clinic in the foothills of the Paljunoj valley. I was greeted by open grins from children chasing about in the waiting area, and warmly greeted by the other volunters. A ´guided tour´of the clinic made me realise how much can be achieved in such a small space with very litle equipment or technology. There is a reception area (a desk and rusting filing cupboard in the entranceway, with an old computer that switches off smugly with the frequent power cuts), three consulting rooms consisting of a concrete floor, black plastic couch from the 1970s and scatttered instruments, a lab which is a bench with a lone microscope and much-used slides (mostly for watching giardia and various ova and cysts stare back at you with glee from faecal samples), a pharmacy with donated boxes of brightly coloured pills lining the shelves and a classroom with homemade posters and stories for teaching the schoolchildren about health and hygiene.

I was amazed at the trust proferred to me simply for having the title ´medical student´. Along with Guatemalan medical students, we take histories and examine the children and walk-in patients that walk to the clinic from their villages in the hillside, before testing samples, making a diagnosis and dishing out medication. Whilst most of the problems are simple, a respiratory infection from cooking over open fires in the home, gastroenteritis from various tropical (and not-so-tropical) bacteria and protozoa, and aches and pains from hard toil on the fertile land, the ignorant trust these people place in my diagnoses and treatments frightens me. I know if some foreign student turned up in my town and told me I was suffering from X and should take this medicine (probably only just in date), I would point-blank refuse until all reasoning had been fully explained to me. Thus is the benefit of an education, of the freedom (or trappings?) to be able to choose.

This region of Guatemala is predominantly of indigenous populations, a people discriminated against and particularly affected by the ramifications of a recent civil war. Lack of education and basic commodities and little help from government - in fact often the exploitation by politicians - has led to an infant mortality rate in excess of 25%. Much of this can be accounted for mainly by problems of poor nutrition and preventable infectious disease, and lack of access to healthcare - in this region there is one doctor and one nurse for a population of 15000 people.

Hence the work at Primeros Pasos is invaluable to the children in this area. All schools in the 10 communities served by the clinic participate in a health edcucation programme (hygiene and sanitation, nutrition, infectious disease prevention and so on) and receive a yearly check-up. Women in the area are also targeted, by programmes in their own villages that teach them about basic health and hygiene, and empowerment through encouraging the women to become involved and teach others what they have learned themselves. Many studies have shown that improving the education and health of women in rural communities is key to improving the health of the population, and is one of the UN´s Millennium Goals http://www.who.int/mip/2003/other_documents/en/MDG3.pdf And here the key really is primary, preventative healthcare.

However great their plight, all the people I have seen at the clinic are happy and smiling. Whether this is because they do not know the scale of the healthcare problem here, or whether it is because they have learned the hard way to smile in the face of adversity, it is a refreshing change to patients in England who grumble that they had to wait an extra ten minutes to be seen, or that the newest and most expensive treatment they have seen advertised on the internet is not available to them right now.

We can only want what we know about: I am beginning to believe that knowing too much can be a dangerous game, and serves to make us unnecesarily greedy when not tempered by a little realism.

After all this seriousness, I will end by exclaiming as to how joy-filled my days are, roaring through the placid villages in the gas-guzzling schoolbus to be greeted by the friendly faces of the other volunteers (Emily, Katie, Fergus, Chris and Elizabeth to name a few) and the ear-to-ear grins of the children we are seeing - at least until we advance towards them with a threatening stethoscope, or worse, oroscope. I wasnt even deterred on my second day when I stepped off the bus into a knee-deep muddy people, to the glee of the schoolchildren watching´...