A (grand) reopening

Today the clinic reopened. Having spent the last few days enjoying luxurious lie-ins (if you can call waking in a $2 a night hard, lumpy bed with slightly stale smelling sheets luxury!) I thought I may have trouble getting up, but the weak sunlight filtering through the translucent curtains woke me early and I had a spring in my step as I skipped to the luke-warm shower.

I have enjoyed having time to explore Xela a little more, yesterday climbing to its highest point, allowing me to get my bearings a little better as the calles and avenues all seem to lead to nowhere or the same place at ground level. From up there, I got more of an impression of the way people live, with washing lines strung between breezeblock or tin walls belonging to neighbours. It is incredible where people have managed to create a home for themselves, many of them in the remnants of once-grand buildings: neoclassical doorways are often all that remains with a semi-permanent construction teetering on the rest of the rubble.

But these are not semi-permanent homes, they hold the stories and futures of Xela´s families. Up in the mountains where the clinic is, homes are similarly built but with a little more land around them, and poorer access to essential facilities. Yesterday I read in a local paper that an estimated 70% Guatemalan homes do not have access to potable, running water in their homes - even in the capital, 1/5 people have to find water from whatever source they can (http://www.aaas.org/international/ehn/waterpop/guata.htm). And I complain when my shower isn´t hot in the morning.

We weren´t sure how busy to expect to be today. Whilst patients were not queueing down the rutted entranceway, there was a steady stream of mothers and children on whom I could try out my newly-learned Spanish medical phrases. Of course, I soon realised that the clear, precise and slow conversations I have with my teacher are not quite up to the fast-paced mumbled descriptions of the patients - any person visiting the doctor around the world is a little nervous and worried, flying through their complaint and frowning at you expectantly. Also I am beginning to see some of the cultural differences in peoples´expectations; here the last thing they expect you to ask them is how they are feeling in themselves, they just want you to give them the right pills and make the problem go away. So many of the mothers with young children I saw today needed reassuring that their child was ok, not a magic potion, but it was too difficult to explain this through the cross-cultural barriers and inadequacy of my language.

The most shocking and frankly, frightening, thing that happens in the clinic is the way medicines are handed out. Patients are essentially given an unlabelled doggy-bag containing a mixture of all sorts of goodies - antibiotics floating freely with multivitamins, with the briefest of explanations of how to take the medicines. It really does work by the blue pill in the morning, red one in the evening´rule here. I have no idea if the patients take their tablets properly, or store them safely - whilst I am firmly against all the ridiculous and binding health and safety regulations imposed on us in the UK, this is one of those matters where actually they do make sense. If I achieve anything in my time here, I hope it is to convince them of developing a clearer and safer way of labelling the drugs. Of course the flip side of this is that I much prefer we gave medicines to people seriously in need of them than not at all.

Working at the clinic is so rewarding yet deflating at the same time. For every achievement there appears to be a minor drawback: all the children are given toothbrushes, but when you ask them if they have toothpaste or even bicarbonate of soda at home they stare at you bemusedly; ´No´, they say, ´We clean our teeth with (probably dirty) water´. The mother of the 2-year old we saw today who was over 2kg underweight said she had been to the classes run by Primeros Pasos and knew he needed to eat vegetables but when she tried to feed him them he didn´t like them (not really all that disimilar to children at home then...).

This is not a simple problem. Simple preventative measures are helping greatly, but this is fundamentally a problem with the system - the people here need better education, better water and sanitation, and less corruption within the people in power.

At least I have found one use for myself - babies that usually scream their heads off and wriggle and squirm when any person towers over them brandishing a stethoscope seem to become tranquil and placid when my strange white face and blonde hair pull´s funny faces at them. I wish I could say it is all down to my skill with handling children, but in reality I´m sure they just think I´m ´poco loco´...