A Tale of Two Cities
Every day in Guatemala City, food and goods vendors flock to the square in front of the Presidential Palace to set up their goods.
When the sun rises on Guatemala City, the true nature of the city comes with it. In between the staples of North American life, the Taco Bells and the Sherman Williams, is a city of painted cinderblocks, street vendors and beggars. Crowds flock to the square in front of the Presidential Palace where these groups congregate.
The scents of roasted corn and fresh cut fruit permeate the air in the market as vendors shout their inventories to anyone who will listen, and even those who won’t. One man carries a large bag of boiled peanuts while another totes bags of cotton candy. Old women sell baskets while children sell baskets of various fruit. Near the road a man slices the skin off pineapples and sells the cut fruit for about 60 cents. It’s sweet and wet and sticky and a little sticky. A few streets of way under a sign that says Tipicos is the underground market, where hand woven goods meet with various tact types of mass-produced t-shirts. The vendors there act the same, calling out their goods as we walk by. Several say proudly that their goods were made in Atitlan, where we’ll be going on Saturday.
Street vendors litter the streets of Guatemala. Under the sign named Tipicos, vendors peddle their goods in an underground Market about a block from the Presidential Palace.
Beggars sat on cardboard outside the large Cathedral de Santiago de Guatemala on another end of the square. Inside, there was a christening and confirmation going on. Outside, in the square, a large stage was being set up for a visit from the most recent Latin America Idol winner. Those stereos duel with a marching band that’s leading a processional for the celebration of a saint.
When we left Guatemala City, it didn’t take long for high rises to give way to the cinderblock slums and automobile salvage yards. Small homes were stacked on each other closer to the city, but as winding mountain roads snaked and hair-pinned northwest to Chichicastenango, homes of brick and scrap wood and sheet metal began to take the place of the cinderblocks.
Driving in Guatemala is like skateboarding down a roller coaster with no harness and no helmet. Buses loaded with people, some hanging on top of the bus, barrel around jackknife turns while swerving around traffic. The road was out in some place where mudslides, the consequence of carving the roads out of the mountains, had washed it away. In some places, the road narrowed to two lanes. Pedestrians, whether children on foot or men on bicycles, traveled the same roads in a way you don’t see too often in the United States. At the end of this treacherous stretch was the city Chichicastenango, a town full of gray one-lane wide cobblestone streets and devoid of the chains that dot Guatemala City.
But the people are the same, which has made Chichicastenengo perhaps even busier of a city than Guatemala. The market may only be open two days a week, but people still line the streets in an attempt to sell whatever they can. The streets are still packed with buses, cars, and any other mode of transportation that can possibly take a person from one place to another.
Most of the streets of Chichicastenango are one lane wide but the natives still drive like an open field. Only now pedestrians are more prone to walk directly in the street. The buildings are concrete or cinderblock and the city can seem quite chaotic at times.
A street on the Guatemalan city of Chichicastenango, or Land of the Poison Ivy. Thin streets will feature repainted American school buses squeezing next to taxis, large trucks, pedestrians any everything else that uses the street that day.
However, the people of Chichi have been like everyone else in Guatemala. They are helpful, understanding and cordial. They run on their own time, a trait that makes it difficult for a person whose life is normally centered on deadlines.
From my limited experience with the two cities, it’s amazing how two cities so different in size and scope can come with the same feeling. The people have, thus far, been friendly and hard-working.
Our next stop is in the mountains. The first village the missionaries will visit is so remote that they haven’t had any medical care in years.
The Arrival
Lightning was still arcing in the sky when our plane traveled through the heavy turbulence into a landing so hard that my father, who was sleeping in the seat next to me, let out a yelp and clenched the seat in front of him.
In Oklahoma, it was just after midnight on Sunday when we landed after long delays in Houston. I stepped off the plane, taking my first steps into Guatemala City.
My first sight was a Playstation 3 set up in the terminal a few steps away from a Pizza Hut.
In many ways, Guatemala City is a lot like any other major city. In the rainy Guatemalan night, or rather really early morning, familiarity was not hard to find. Whether it was the logo of the Volkswagen dealership or the Sherman Williams paint store near the airport or the Burger King that are identical to the stores at home, one could be forgiven for believing they were in the United States. Despite the suitcases of pills and syringes and various other medical implements, the customs agency didn’t examine the suitcases. That was a far cry from what Bill Brewer remembered about the first time he came to Guatemala in 1991. Then, customs wouldn’t let one suitcase of medicine through without searching it, much less 20. Now our customs forms were given a quick glance and we didn’t lose a step as we wheeled them out onto a waiting bus where we met one of our interpreter’s for the trip, Raul.
It’d be easy to look at the flashing fast food signs and find such familiarity, but even in one night the differences started to creep through. I could smell the water even through the persistent rain. I couldn’t tell whether it was sulphur or something else, but it reminded me immediately of the first thing I was told about my trip to Central America. Never drink the water. Even after midnight we could hear the blaring horns of a taco truck as it drove past, its driver unhappy with the speed of the buses’ progress on the street. Dance clubs darted the street view and we had to take a detour to the hotel when we ran into a police blockade. Shortly before we got to the hotel, a man was walking through the street in plain view, his eyes darting around as he held a loaded shotgun in his hands.
Raul told us that such a sight was common, not only in the relative metropolis of Guatemala City, but throughout the country.
“It’s everywhere,” Raul said.
A Guatemalan flag waves slightly in a light breeze early Sunday morning in Guatemala City.
It was well after 1 a.m. when a doorman at the hotel locked the door behind us when a drunk man knocked on the glass and tried to get in. We’re exhausted, but in a few hours we’ll leave, traveling to southwest Guatemala to the city of Chichicastenango where we’ll set up our base for the bulk of the trip.
Going to Guatemala
On Saturday, a group of volunteers will leave Oklahoma City and fly into the Central American country of Guatemala. Their suitcases will be loaded with bottles of medicine, latex gloves, bandages and anything else they can pack along with them. They’re medical missionaries and from through Monday through Friday, they’re going to provide basic health care to natives in rural areas.
Guatemala is located south of Mexico and west of Belize and Honduras in Central America. According to the CIA World Factbook, there are more than 13 million people living in Guatemala, according to the most recent estimates. The average life expectancy is roughly 70 years and the risk of infectious diseases is high. More than half the population is below the poverty line.
That’s part of the population the medical missionaries will be targeting. The group will base out of the city of Chichicastenango in southwestern Guatemala and travel to rural villages to set up clinics. Many of the people they’ll treat have no other access to medical care.
I’ll be with the group, helping out where I can. I’ll be blogging throughout the trip, assuming there’s internet access throughout.
The group consists primarily of medical professionals, a doctor, a dentist, and three nurses. Including me, there are five others making the trek as well.
What’s it going to be like for doctors to provide health care to places without running water or electricity to people who may have no other access to a health care?
Come Monday, I’ll find out.
Know It: Cancer – an in-depth cancer resource
As part of The Oklahoman and NewsOK.com’s new monthly special project, ‘Know It…’, we are proud to present our first topic this month.
Search ‘cancer’ on NewsOK.com to explore Know It: Cancer.
The special Web site is an online resource on everything you’d need to know about cancer – living with it, getting treatment, supporting someone with it, choosing a physician, finding cancer-related events and so much more.
One of the key parts of the site is the hundreds of links that our researchers put together to give you a starting point for any cancer-related topic you are looking for. The Web site also offers interactive forums to discuss various aspects of cancer with other people.
The video player offers vignettes of people who have cancer stories to tell to compliment our comprehensive range of cancer stories told on a very personal level.
Related articles from The Oklahoman and from all over the Web are automatically fed to the page, so whether you look at the stories today or in six months from now, the content will be up-to-date and give you the most current information you need.
Everyone is touched by cancer in some form or another. Know It: Cancer is the place where you can gather all the information you need to help your situation when cancer gets close to you.
- Lindsay Hodges, Web editor
Did you miss Doctor’s Day?
You can be forgiven for thinking yesterday was anything more than a nice day to watch college hoops.
It was, but it also was National Doctor’s Day.
The American Medical Association uses the day to honor the more than 900,000 physicians in the United States.
“On this day of tribute, Americans can express appreciation for physicians’ continued commitment to providing exceptional medical care,” according to an AMA release.
The nation’s doctors, throughout almost 1 billion patient visits annually, are called to be healers, confidants and advocates, the AMA says.
The organization also says two-thirds of U.S. doctors provide some form of charity care and in 2006 were ranked the nation’s most trusted occupation.
Furthermore, the AMA says:
- Ninety percent of patients say they are very satisfied with their doctor.
- Americans’ life expectancy has increased by seven years since 1960.
- There has been a 77 percent decrease in the infant mortality rate since 1950.
- There has been a 63 percent decrease in the overall death rate for heart disease since 1950.
- There has been a 72 percent decrease in the overall death rate for stroke since 1950.
- There has been a 14 percent decrease in the overall death rates for cancer since 1990.
Do you consider the medical profession admirable and respectable? Do you respect your physician? Are you satisfied with him/her? Drop me a line at The Medicine Bag blog at http://blog.newsok.com/health.
Now back to basketball!
Jeff Raymond, Medical Writer
A new way of looking at diabetes
Researchers have seen that weight-loss surgery appears to cure type 2 diabetes, which they have attributed to the huge drop in pounds. After all, being overweight is a risk factor for diabetes, and losing weight can effectively take care of the problem.
An article that appeared in a supplement to last month’s issue of Diabetes Care argues that the bowel is the site of mechanisms that lead to diabetes.
The study’s author, Dr. Francesco Rubino of New York-Presbyterian Hospital/Weill Cornell Medical Center, presents evidence on the mechanisms of diabetes control after surgery.
“Clinical studies have shown that procedures that simply restrict the stomach’s size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. By studying diabetes in animals, Dr. Rubino was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese,” according to a press release.
Rubino’s previously has shown that the main way gastrointestinal bypass controls diabetes is by skirting the upper small intestine — the duodenum and jejunum.
“It has become increasingly evident that the gastrointestinal tract plays an important role in energy regulation, and that many gut hormones are involved in the regulation of sugar metabolism,” according to the release.
Rubino’s findings suggest bypassing the upper intestine may work by reversing abnormalities of blood glucose regulation.
He guesses the upper intestine of diabetic patients may be the site where an “abnormal signal” is produced that causes or predisposes one to diabetes.
Gastrointestinal surgery offers the possibility of complete disease remission. This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease,” he said.
What do you think of using surgery to treat diabetes? Have you had an experience with it? Leave me a comment at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Fear of retiring
Is retirement going to be a luxury for thirty- and forty- something workers? I increasingly think it will be, and a new estimate from investment giant Fidelity does nothing to dispel that.
A 65-year-old-couple retiring this year will need approximately $225K to cover medical costs in retirement, Fidelity estimates. Let’s not lose sight of the fact that this is in addition to the coverage available under Medicare, which may itself not be available when I and others retire.
The hypothetical retirees will still have to have enough money to live, either independently or in long-term care.
Perhaps what’s even more sobering than the estimate is its growth since 2002 — 41 percent.
The roughly 6 percent annual growth in the Fidelity projection about matches the growth of my 401K fund during a slow year. I know that doesn’t take into account contribution matching and interest compounding, but I think it raises a worthwhile point nonetheless.
And health care costs show no signs of flattening or decreasing.
Does paying for retirement terrify you as much as it terrifies me? Leave me a comment at http://blog.newsok.com/health.
Fidelity recommends:
- Creating an individual retirement plan
- Starting early and maximizing opportunities to save
- Assessing health status and becoming a smarter consumer of health care
- Determining details of any employer-sponsored coverage
- Understanding the financial impact of health care costs on Social Security income
Jeff Raymond, Medical Writer
Going to dust
We Oklahomans know dust — perhaps better than anyone. Like it or not, the hardscrabble Joad family is as much a part of our cultural heritage as Curly, Laurey and Jud.
The Dust Bowl completely destroyed the state, and some would argue it took us a half-century to recover.
I mention this because University of Colorado researchers have found the West has become 500 percent dustier in the past 200 years because of human activity.
My first thought was how they measured such a thing. Turns out the researchers used sediment records from dust blown into lakes in Colorado’s San Juan Mountains. Co-author Jason Neff, an assistant professor of geological sciences at CU-Boulder, attributed the “sharp rise” in dust deposits to the railroad, ranching and livestock of western expansion.
“From about 1860 to 1900, the dust deposition rates shot up so high that we initially thought there was a mistake in our data,” Neff said in a press release. “But the evidence clearly shows the western U.S. had it’s own Dust Bowl beginning in the 1800s when the railroads went in and cattle and sheep were introduced into the rangelands.”
A paper on the research was published in the Feb. 24 issue of Nature Geoscience. In it, the scientists described a “dust fall” that exceeded that of the previous 5,000 years. Because of the size of the dust particles, the authors concluded the dust particles came from the Southwest.
Neff said the West’s increasing dustiness isn’t drought-related. Instead, he said, it is because of “intensive land use, primarily grazing.” Researchers used radiocarbon dating and lead isotope analysis of soil cores to determine this.
“There were an estimated 40 million head of livestock on the western rangeland during the turn of the century, causing a massive and systematic degradation of the ecosystems,” he said in the release.
The five-fold increase in nitrogen, phosphorus, potassium, calcium, magnesium and other byproducts of ranching, mining and agriculture can affect ecosystems.
Then, of course, there’s dust’s effect on allergies.
“There seems to be a perception that dusty conditions in the West are just the nature of the region,” Neff said. “We have shown here that the increase in dust since the 1800s is a direct result of human activity and not part of the natural system.”
For more health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Waiting for a liver
The need for donor livers outstrips their supply. Each year, about one-third of those with end-stage liver disease who need an organ will receive one. Some die while on the waiting list.
The February issue of Mayo Clinic Proceedings examines how the current system for allocating organs in the United States affects recipients’ outcomes.
The United Network for Organ Sharing (UNOS) oversees organ allocation. With the goal of giving organs to the most critically ill transplant candidates, UNOS adopted the MELD — Model for End-Stage Liver Disease — scoring system in 2002. The score is calculated from the results of three lab tests.
“Unlike past evaluation systems, the MELD score de-emphasizes the length of time a patient has been waiting for a donor organ. … Research has shown that although the donor liver shortage persists, implementing this allocation system has decreased the number of patients who die while waiting for donor organs,” according to a Mayo Clinic press release.
The study looked at the evaluation practices and acceptance criteria for liver transplant used by the Mayo Clinic Jacksonville Transplant Center after implementation of MELD scoring. Researchers examined medical records from 555 patients referred for liver transplants at the Jacksonville center from Jan. 1 through Dec. 31, 2005. Of these patients, 53 percent were denied for a transplant. Half of those denied were considered too early to have the procedure, while the rest were excluded because of medical conditions and psychosocial issues — poor support systems or continuing substance abuse problems, for example.
Many were subsequently accepted.
“Patients seeking referral often undergo repeated assessments by selection committees, as their eligibility can change over time or following treatment and/or changes in conditions that led to their initial exclusion,” according to the release.
Data suggest a “broad range” of patients could benefit from early referral to a transplant center, according to the release.
Basically, management of their disease and other medical and psychosocial conditions could make them transplant candidates sooner.
To read the report, click here.
People seldom realize transplant waiting lists are anything but static: They constantly change, depending on organ availability and patients’ medical states. They’re definitely moving targets. People move up, they move down; they drop off, they’re added back.
“Our study suggests that early referral for LT (liver transplant) evaluation is beneficial for reasons unrelated to the time patients spend on the LT waiting list. If patients too early for LT were evaluated but not listed, LT centers could initiate management of ESLD (end-stage liver disease) and address psychosocial issues in a sub-group of patients who could also ultimately benefit from LT,” the authors wrote.
Although not exactly the same thing, last month I wrote about this man, Dr. Ludvik Artinyan, left, who registered on organ waiting lists in California and Oklahoma. He was able to receive a liver transplant quicker by traveling to Integris Baptist Medical Center to have the procedure performed rather than having it done in Los Angeles. Because patients’ MELD scores typically are higher in California for various reasons, double-listing likely allowed the Armenia-born physician to shave months off his wait time and perhaps saved his life.
UNOS allows potential transplant recipients to be listed in multiple regions — they must meet each site’s criteria and be ready to respond to the phone call or page when an organ becomes available.
Is the current organ allocation system fair? E-mail me at jraymond@oklahoman.com or post your thoughts at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Keeping men healthy
Statistically speaking, men will die six years sooner than women. We have higher death rates for the 15 leading causes of death.
Here are some stats from the National Center for Health Statistics:
- In 1950 the age-adjusted death rate per 100,000 men was 1,647.2.
- For women it was 1,236.
- In 2000 the rate for men was 1,053.8.
- For women it was 731.4.
- In 2004 the rate for men was 955.7.
- For women it was 679.2.
- In 1950 the death rate among men from heart disease was 697.
- For women it was 484.7.
- In 2000 the rate for men was 320.
- For women it was 210.9.
- In 2004 the rate for men was 267.9.
- For women it was 177.3.
The numbers, whether taken together or broken down by cause of death, show that while age-adjusted death rates of men and women have made huge strides, men still trail.
Check out the rest of the document here.
I bring this up to spotlight Integris Health’s annual Men’s Health University Men’s Fit Club. The program appropriately began the day after the Super Bowl. It is a weight-loss class offered just for men, of all ages. It focuses on eating habits and increasing fitness.
Men-U is a series of events throughout the year to educate men and their loved ones on how to take care of their health. Health checks such as prostate cancer screenings are featured, and then there’s the Man Card, from Integris and WWLS The Sports Animal. Cardholders earn points that can be redeemed for prizes.
The class runs through April 17 and will be every Monday from 5:30 to 7:30 p.m. at Integris Pacer Fitness Center. The cost is $240 — less for those with a Man Card. Call (405) 951-2277 or (888) 951-2277 for more information.
One reason men die earlier may be because they avoid going to the doctor. A 2007 survey of more than 1,000 men for the American Academy of Family Physicians showed almost one-third wait as long as possible before seeking medical attention.
For health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
