San Juan La Laguna, Guatemala 2/3/22

Picture it, San Juan. On a cool spring morning. The team are rested and ready to go. Kitted out in our blue or pink International Vision Inc scrub tops. The pockets of these are the handiest thing during a long clinic day. Breakfast is a take out from our favourite San Juan restaurant and we share it on the terrace at the hotel. Dogs are barking here and there throughout the town. In the distance boats criss cross the lake although the steady hum of motors are just beyond our hearing, carried in every now and again by the breeze. All in good time we head up the hill to ODIM, saluting the friendly tourist police and vendors on the way. The clinic staff are already on site and open the clinic rooms so we can get ready for our day.

Lets jump straight in to mid morning clinic. The patients are coming from San Pablo and the surrounding area. Everyone is diabetic so the doctors agree that eyes will be dilated for full examination. Janyfer and Rebecca are helping Ailish in the short hallway outside the pharmacy with Herman on hand for additional translation. The patients do not speak English or Spanish but Kaqchikel or Tzʼutujil, two of the 34 or so enduring and active Mayan languages. So here is the additional challenge for today's clinic.

Ana speaks only Tz'utujil. Concepción speaks Tz'utujil and Spanish. Tania speaks Spanish and English. Cheryl speaks English (and Haitian Creole which is of no use in this instance) and is picking up Spanish over the course of the week. Cheryl asks Ana a question, Tania translates it to Spanish for Concepión who then translates it the Tz'utujil for Ana. Ana responds in Tz'utujil to Concepión who then translates the response into Spanish for Tania. Tania translates the response to English and back around the room to Cheryl who can then ask the follow up question. As almost every patient needs prescription glasses the process moves steadily but slowly. Ana's eyes are then dilated and she now moves to Jair's examination room. Here Jair speaks Spanish and so only needs one translator to work with him. It is not a noisy clinic in spite of all the extra translation needed but it is an extended translation chain for everyone. We learn 'uut' which means 'good' or that the patient is happy.

One woman presents in distress, her eyes are stinging and tears run down her face. Cheryl administers drops to temporarily alleviate the discomfort. It works but this patient needs a follow up prescription for her condition which the clinic will help her source. This woman is there with her mother and her daughter, all three generations receive eye screening. Although the Mayan patients we see today are all the same calm and quiet demeanour there is a strength about them all from the confident replies of the granddaughter to the soft spoken but definite answers of the grandmother. Steady, determined, admirable, vibrant with life force; it is hard to find the appropriate way to relate back to you the experience of meeting the Mayan community.

Lunchtime allows for some tortilla making with our local vendor. Glee and laughter at our misshapen tortillas. The vendors work all day long making food and we cannot hope to learn the hand to hand patting technique in such a short lesson.

Clinic again finishes at 5pm and we pack up and load us along with the equipment to bring back to the hotel by tuk-tuk. Time for group photographs and many goodbyes to the staff at ODIM who repeat the invitation to return to work with them in the future. The tuk-tuk takes the corner onto the main street and narrowly avoids an impromptu roadside meeting. Eight men in local guatemalan garb and stetson like hats worn easily on their heads standing together. Against the backdrop of the cobblestone street; the tiled roof of the white one story house; a collective; a snapshot in time, framed against the blue Guatemalan evening sky.

Back at the hotel it is a quick turn around as Tania wants to bring us to see women's cooperative KEMI. We are taken through a demonstration of the most natural and chemical free process you could devise to make an array of fabrics, clothing and accessories. The spinning and weaving process is intricate, using handmade tools. The weaving process for a bolt of cloth can be one week or a month depending on the size of the piece. Physically the repetition takes its own toll on hands; backs and legs. As we learn more about the production process it is clear that there is an appreciation of the resources in nature. It is reflected in KEMI's sustainable approach to protecting their raw materials and the environment around them. It is the same approach in a local chocolate factory, natural products, sustainably sourced and handmade.

Dinner in a restaurant near to ODIM and the conversation returns to today's clinic. Jair was in particular checking for diabetic retinopathy, a complication of diabetes that can affect the vessels in the back of the eye. All day long he saw patients,no damage. Refraction is still the major diagnosis of the day. Incredible because in the US, Denmark or Ireland we would see high incidence of diabetic retinopathy in patients. The clinical discussion from this weeks clinic takes up the evening. Tomorrow there is no clinic, we are visiting a hospital across the lake so it is back to the hotel and repacking bags for the next leg of the trip. We will miss San Juan La Laguna, it has been good to us but we are also excited to explore further and meet the staff at a nearby hospital. Buenas noches Guatemala, you are definitely weaving your magic on our little group.