We stepped off the plane into darkness. Disoriented after the bright city lights visible on our decent, we wondered the dark corridors until emerging into an equally dark baggage claim. Airports of previous adventures would rarely get this dim, even in an early morning hours. I wanted desperately to cross-reference the time showing on my watch but my phone would not be turned back on for weeks. This dim room would have been spooky, but for the throngs of passengers speaking hurried Spanish.

Our first adventure began when we realizing that, due to the flight delays in the States, our translator would be arriving the next day. She happened to be the only one who knew arranged driver. I yearned for my phone, or at least, more reliable method of finding our ride besides being an obvious group of confused foreigners. Our driver found us; we piled in the van, and headed to Jalpatagua.

The drive was another disorienting adventure. Our driver careened around corners, unfazed by the rain or our scramble for hand holds. He seemed giddy to the extra weight holding the van to the road and the new English speakers for practice. We arrived, groped through the dark, and fell exhausted, onto our beds.

The first morning was an amazing assault on our senses. Bright sun, heavy humid air, and vibrant blue sky. The trip continue as a blur of new experiences. The only known routines were the surgeries. Medical students are accustomed to feeling disoriented. Our Guatemalan clinic was no exception. Gone were the shortcuts of American hospitals, I only had a note pad, pen, and stethoscope. Without auxiliary diagnostic tools, we relied on medical fundamentals. With proper questioning and examinations, the patients told and showed us his/her diseases.

In the experience, I finally grasped that humanitarian medicine was all about efficiency. Anything that could be reused was sterilized and returned. Disposable items were precious. Such items were too precious for a lowly medical student to handle. Efficiency was apparent in the use of medications and operating room procedures.

One particular vivid memory was entering the OR after an open hernia repair began. I was positioned at the head of the table, and during the case, fell into the old habit of looking over the drape towards the anesthesia monitor. I was shocked to see the patient's eyes flit from the ceiling to meet my gaze. The patient was awake! A spinal was used for his surgery. In those passive, patient's eyes I was allowed a glimpse of Guatemalan spirit. He was austere, patient, and as I was soon to find out during my post - op checks, resilient and tough. I thought back to his screening visit. He had supported his family, performing manual labor while his hernia grew over the years. He has been dismissive of his pain and seemed surprised to be asked how the hernia was affecting his life. Life to him seemed no more disturbed by his hernia than by inclement weather; annoying at times, but part of life. He was unfazed by his open surgery. He denied pain worthy of taking the oral NSAIDs we offered. Without subjective pain, he paced the small ward with an occasional hitch of an antalgic gait. Eating, drinking and with pain well-controlled, he wanted to leave the hospital and return home. He was a dream patient.

With the last incision sutured close, I noted how interesting it was that we had embarked on this trip to practice humanitarian medicine. Our goal was to provide medical aid via surgery. How was it that we felt we had been given a gift instead? These gifts were multiple. We were give a glimpse into Guatemalan life, even welcomed into personal lives and homes of some. We were given a glimpse of how the practice of medicine was formerly performed. Healthy patients had fixable problems. Hospital stays were brief. Minimal pain management was required and NSAIDs were refused because pain was not severe. Open surgeries were done without post-op anti-emetics. Patients recovered with home-cooked food brought by family.

On the last night in the village, we walked now the familiar streets. Accustomed to this simply flow of Guatemalan life, our nerves calmed, and our spirits were at peace. Guatemala was an epic adventure. Startling with the bustle of Guatemala City vied from the small van window. Dim city streets were lined by flashes of neon store fronts and traveled by lumbering vans and zipping mopeds. It was a shocking contrast to Jalpatagua's serene streets. A lone store's warm glow peeked through the figures lounging in the doorway. Even in the , the buzz of life was palpable. The village remained austere and efficient. one store remained open, necessities could be acquired but not with the convenience of which I was accustomed. A small group of men chatted in the park. They were quiet and friendly, enjoying the simple pleasures of friendship and a cigarette in the cool, humid night.


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