Howler Monkeys

We congregate to have breakfast at 7:15am. Everyone is eager to get going. The short walk to the clinic along the short stretch of 50 yards of so on busy main road. Turning left we head up a concreted roadway. Early-stage grey concrete construction of what seems to be storage lockups or else small market kiosks to our left. A three-story guesthouse hotel to our right, next to a bank kiosk then a small cafe and a local supermarket/haberdashery that seems to sell absolutely everything.

At Maximillo’s wooden kiosk we turn right and head along between small bungalows. The bad ass hill awaits. Off the concrete pathway and back on uneven, rocky road, the hill crests and eases giving us time to cool down and catch our breath. A short stretch of downhill along by the fence, the tall trees to the gate of the clinic. A few people are already waiting even though we are there before 8am. Time enough for the doctors to walk through the setup one more time.

Fernando helps out with registration outside the double doors under the overhang in the cool air. Ailish starts the acuity testing in the first room. It is a picture version and soon the air is peppered with the soft Spanish voices casa (house); buta (boot); pato (duck); tasa (cup) and then as the images get smaller casita (little house); patito (little duck); tasito (little cup). Some patients are a little bemused at the simplicity and not sure of the answer. Ailish has to pick up some Spanish to manage, seguinto por favor (next please) and Londi, now on registration is helping out.

One by one the patients move on to Dr Cheryl for assessment and glass fitting. More conversation starts to fill the air. Patients are consulted for reading glasses, sunglasses and for many, prescription glasses. Occasionally there’s an outburst of joy as the lens testing restores their ability to read or see. And a whole lot of gratitude as patients pick out frames for the glasses they will receive fully fitted with prescription lens this coming March or April. Sony with an eye for detail is quick to find a suitable pair for each person. Tania is helping with translation in between checking the logistics for the lunch; organizing the cataract patients and addressing any questions from the Guatemalan team.

Next in the queue is a visit to Eric (Doctor Knight) and a health check, eliminating for glaucoma; confirming if cataract surgery is a suitable option or in some cases confirming a diagnosis that cannot be resolved. Many patients leave this room with a clean bill of health but it is hard at times to deliver less positive news. Dominic has the joy and sometimes the harder job of translation. As qualified medical personnel Cheryl and Eric sometimes discuss diagnosis in specific medical terms. They are in full work mode as if in their clinics at home, tuning out the heat and humidity with a focus that puts the patient at the centre of care.

Meanwhile over in surgery the early morning is a slow start as the bus bringing patients from a neighbouring region has taken a wrong turn. When they do arrive it is half the number expected for the day. Three patients with three deciding not to go through with surgery. There can be so many reasons not least anxiety; a lack of access in the remote areas or no-one to care for them in the week after surgery. Fernando has joined the surgical team. He greets the patients as they arrive; the students start examinations and preparations. The closed doors and the quietness around the building reflects the calmness inside as surgery commences. Dr Jair and surgical nurse Deanna create a space where patients can feel safe and confident that this team is going to do the best that they can for them. It is a grounding and focusing process that sets the tone for best outcomes.

Back in optometry we see 30 patients before breaking for lunch. Anne has organized the women’s cooperative to prepare food each day just after noon. Fresh, local and delicious Guatemalan food served with a refreshing natural juice drink served by three local women. We get to sit together and discuss the mornings work; checking in that everything is okay with all of the team. The hot pepper salad is hot. It is a time to remind ourselves of our surroundings and context. By 1pm we are heading back to our stations and push on with the work.

Surgery finishes by 3pm and that team hold a review with the students, taking opportunity of learnings from each case. Finished first they head down the hill towards home. Optometry are pushing on to see all patients in the queue, another 36 in the afternoon with a total 66 for the day. Then it is sweep, clean, tidy up; leaving everything ready for tomorrow. It is time to head back and find the rest of the group for a well-earned cold beer. We meet for dinner and then back to our rooms. Eat, sleep, repeat. The last word on a good first day is left to Eric as if we needed any more of reminder that we were in rural Guatemala.. Never in my life did I think I would be doing an eye exam with howler monkeys screaming in the background!