La Ciudad

Last night was a blast at the Iguana. We had an incredible dinner as usual and then played that game where you pass the thing around and you try to get your team to say the word but you can't say the word. Tons of fun. There was an Irish couple playing with us and every time our team did something good the guy, Ian, would yell out, "Brilliant!" Typical.

We got up this morning and did our usual exercise. We usually exercise every morning, alternating between lifting weights (really, it's more calisthenics b/c we don't have weights to lift other than Peyton's stretch bands) and running. This morning was a running morning. We run from the house to the docks (~6 min) then run up the hill from the docks to the center of town (~6-7 min). Then back down on a foot path that takes you back to the docks (a gagillion steps down), and then back up the hill a second time and down again and then back to the house. Now, the run up from the docks is INSANE. It's the hardest hill I've ever tried to run up in my life. The grade is probably 25% in some places - just ridiculous - and it never lets up the whole way. It took me several times before I could make it in good form, and even now with "good form" it's like I'm running in place. But still, a few days ago I had my best time. I think adjusting to the altitude here has helped a lot. The lake is somewhere around 6,000 feet I think.

Anyhow, we did our exercise and then packed. I was determined to get all the stuff I brought down in my three bags into two for the return trip, and I succeeded. It made getting around today way easier. After a quick breakfast we cleaned up the house and headed to the docks to catch a lancha to Pana. From there we hopped on a chicken bus to Solola, then changed buses and headed to Los Encuentros. At Los Encuentros we got on a bus to the City.

The ride from Los Encuentros to the City is about 2 hours. During that 2 hours, this charismatic Guatemalan gentleman spent probably an hour or more going on and on about this natural "cure all" herbal supplement he was selling and how if you add it to all these specific juice blend recipes you could cure any ailment - aches, pains, diabetes, heart disease, etc. One thing I learned from him is that if you are going to pick herbs or other plants for the purpose of healing or to extract medicine, you musn't do so unless there is a full moon, otherwise the cure will not work. Similarly, if the plant is wet when you pick it, that won't do. Good to know.

After he was finished a man with a guitar got up and started playing and singing religious songs. He was followed immediately by a pastor-like fellow who gave a brief sermon and then prayed for all of us.

So it was an interesting trip, but it was super cheap and by far the way to go as far as traveling from the lake to the city goes.

Now we're at the hotel dos lunas right by the airport. Super nice place. You gotta be careful in Guatemala City, but this place is in a gated community and is pretty legit. But cheap, too. They have free wi fi and free water, and they feed you a free breakfast in the morning before transporting you for free to the airport. Quite the place!

So this is my last night in Guatemala, at least for this go 'round. I imagine I'll be back. I thought a lot of Craig's program and I'd very much like to stay involved in the years to come. But for now, I'm ready for home. It's been a great month, a great rotation, awesome to spend so much time with Pman, but a long month without Allie. I'm ready for some Allie time.

Última noche

Tonight is our last night in Santa Cruz. This week has been a good one, as usual. Monday Peyton and I did a few presentations for class that took most of the morning. I can't remember what we did Monday afternoon - probably just some studying and such. Tuesday Peyton and I both went to San Pablo for outreach clinic. It was a full day and a good day - a little sad that it was our last outreach clinic of the summer. Today Peyton and I saw patients at the clinic in Santa Cruz until midday, then we sat in on a presentation by one of the other students. We finished up around 2pm, said our goodbyes and headed down to the house to study and relax for the rest of the afternoon.

I have mixed emotions at this point. I am very excited to be going home. I can't wait to see Allie on Friday night, and of course I miss everyone else, too. At the same time, this has been a really fun rotation. I've learned a ton and it's been great living and working with Peyton this month.

Tonight we're eating at the Iguana. They always put out a great dinner. Tonight it's pizza. Craig - the manager here - bought us beers to celebrate, so that's good.

I'll have more to say in summary of the summer, but for now it's almost dinner time.

Recientamente

This past week has been good. After my huge post-fest last Monday, I haven't been back to Pana until today so I haven't been able to update the blog at all this week. And I lost my cord that connects my camera to the computer, so I'm going to have to wait to upload more pictures until I get back to the US and can get a new one.

On Tuesday last week I went with the group to Jaibalito, a little town right on the lake. We saw about 25 patients in 3 or 4 hours. There had been some issues with Jaibalito in the recent past. There was a woman there who was neglecting her child and the resulting malnourishment was enough to cause the medical folks to suggest if she didn't shape up her baby might be taken away. Well, she took this as a direct threat and retaliated by spreading rumors that we were all baby stealers. Two weeks ago hardly any patients came. But, thank goodness, the uproar seems to have subsided and we did see a fair number of folks this past week. The thing is, you just have to approach interventions and such in a different way in this culture.

Wednesday is normally a class/lecture day, but this past Wednesday the clinic in Santa Cruz was so busy that Craig had us seeing patients instead. It was good. We each saw several during the morning. I even got to diagnose pregnancy in one nice lady. She was excited I think.

Thursday I went to Tzununa. So it was two new outreach clinics for me in one week - pretty cool. The clinic in Tzununa is held (while the centro de salud is under construction) in a school house up the hill from the lake. We were seeing patients while the kids were reciting Spanish textbooks in unison. It was kindof neat. The kids are adorable.

Friday was a little different this week. Every year a group of dentists from California comes down for 3 days of free dental clinic in Tzununa. Craig organizes the whole thing from the Guatemalan end. A group of the students (myself included) got up early and transported a ton of gear from Santa Cruz over to Tzununa and set up the school house for dentistry work. There were two dental exam chairs, and a bunch of kinks to work out - their "unidades" (the things that hold the handheld water/air guns, etc) were a bit of a challenge to get working, but we managed eventually and all told saw 31 patients on Friday. It was a lot of cavity removal and filling, tooth extractions, and prevention education. By the afternoon, Dr. Ed taught Peyton and I how to do dental cleanings with the little buzzy machine you've all probably experienced at your dentists office. It's really pretty easy once you get the hang of it. We cleaned 4 patients' teeth.

Saturday morning, Pman and I went over to San Marcos to climb. It was an incredibly beautiful morning and we got in a bunch of laps on the two routes they have there. One of them is supposedly 5.9 and the other 5.10. Both are pretty short, but reasonably fun for crumbly limestone climbing. I was able to lead both this go 'round, which I was very pleased with. After climbing we headed home, said goodbye to Riley who had to leave suddenly due to a family issue, and made our way to Santiago.

Santiago is having their Fiesta this week. It's basically like the state fair on a smaller and more rickety scale. But the same idea: people wandering around aimlessley, some drunks, lots of street food, and a few rides, the most prominent of which is the large ferris wheel. We rode it once. It goes pretty fast and the chairs are a little sketch (you can lean forward and almost make them tip over!). Probably the highlight of last night was dinner at the Posada de Santiago. Man, their food is incredible. P and I of course both got the lomito de res (tenderloin) con queso azul (blue cheese), which is amazing. We had dinner with one of Peyton's friends from the Hospitalito, Kent. He is a family doc from U Penn. It was an interesting dinner.

We stayed the night at a cheap hotel in town - most everywhere was price gouging for the fiesta, so it took some looking to find a decently priced place. But it was fine. This morning we went for a run out on the road to the Hospitalito and beyond. Now we're in Panajachel doing some internet work and working on a few presentations we're giving tomorrow morning at clinic. Then it's off to eat some Empanadas - you cannot come to Pana without getting some! - and then grab some vegetables from the market before heading back to Santa Cruz.

I have quite a few decent photos of the dental clinic, climbing in San Marcos, etc that I'll upload when I get back to the US and get a new cord for my camera.

Just three days to go and then we're headed back to the US. We are going to travel Thursday to Guatemala City and then get up Friday morning to catch our respective flights. We had considered leaving Wednesday afternoon for Antigua so we could spend Thursday hanging out there, but that would cost more money and there's not too terribly much to do there other than look at stuff and eat/drink, so I think I'm going to save Antigua for another trip.

Scorpion

Yes, there are scorpions here. And yes, they do come in the house from time to time. You have to check your sheets before bed, and your clothes before you put them on.

Here's the most recent little guy who ventured inside.

Commute

Here are some shots of our commute to the clinic in Santa Cruz. It sure beats the commute I've been doing for the past three years.

This is right close to our house. On the left is the stone wall that Peyton and I traverse when we get a dry afternoon.

There are a lot of stairs on the commute - A LOT.

I don't know whether you can appreciate it from this picture, but the commute is STEEP.

Looking back downhill at the lake.

On the right is the local school in Santa Cruz.

The building with the green bottom and yellow top is the clinic building. Our clinic is the second floor. The area just outside in front of the clinic is the soccer field for the school kids.

Casa del Mundo

On Friday afternoon, Peyton and I met a bunch of the students at Casa del Mundo. It's a beautiful 25 minute hike from Santa Cruz, and a wonderful place to eat lunch and swim. It was a bit cloudy and rainy last Friday, but we still had a great time. We hiked back in the pouring rain.

This is a view of Casa del Mundo from the trail.

Hammocks at Casa del Mundo with our fellow students asleep.

Casa del Mundo has a ton of terraces right down on the water. You can swim off of any of them, which we of course did, despite the cloudy and rainy weather.

Pahomel

This past Tuesday and Thursday we went to San Pablo and Pahomel for outreach clinic. San Pablo is right on the lake and Pahomel is a village way up the mountainside from Tzununa, about an hour's hike straight up. It's a great workout. This time, because the road was complete washed out from a mudslide, we had to hike up with all the medicine loaded into our packs. Normally someone drives the truck up with the meds.

Here's some of us on the lancha on our way to the docks at San Pablo.

This is the view of the docks in Santa Cruz. The Iguana (where we hang out from time to time and sometimes eat incredible dinners) is just to the right of the picture, out of view.

This is the spot where you can wait for lanchas in Santa Cruz. We're all dressed for hiking with our packs loaded down with medicines and equipment for the clinic in Pahomel.

This is the group waiting on a van to take us from the docks to San Pablo. We had to wait a while that day. We pack all our supplies in roller suitcases, duffel bags, and tool boxes.

This is the dock we use to access San Pablo. We're loading up to head home after a full clinic day.

This is the building we use for clinic in Pahomel. It's basically a general purpose municipal building with a few rooms that serve as exam rooms.

Once we get there we have to construct a pharmacy from the piles of meds we brought in our packs - completely unorganized. Lauren and Amanda led the organization project last Thursday and did a magnificent job. One of the makeshift exam rooms is behind the pharmacy table.

The hike up is gorgeous. This is looking down from the edge of Pahomel before beginning the descent. You can see way down by the lake in the notch the village of Tzununa where we catch the lancha back to Santa Cruz.

This is the spot to wait for the lanchas in Tzununa.

Fotos de Xela

I've already written a bit about our climbing trip to Xela a few weekends ago, but at that time I didn't have any pictures to share. Here they are.

This is a picture of one of the 20 or 30 prayer circles up in the boulder field below the cliff line. I was a little unsure whether to take pictures of them, but they were all so friendly and open that it seemed all right. I only took a couple. They would chant all day long - I mean ALL DAY LONG.

Some of their sites had tin roofed structures for when it rains. You can see a few in the picture; there were many many more, and the tin roofed spots were by far the minority. So that gives you an idea just how many groups were up in this boulder field.

This is me leading a really nice arete that we graded 5.8.

And here's Peyton climbing a hand crack on the same wall. We figured it was also about 5.8.

On Saturday Pete joined us and we climbed the same few great lines we did the day before. He's starting up the hand crack in this photo.

Yours truly, with the prayer boulder field and farmland in the background.

Ambulancia

So here is the story. I have to omit some details because my conscience just won't let me put everything on the internet. I've got to be honest, I feel somewhat conflicted about telling this story. I think it's because it was such a horrible situation for the patient and I'm not sure proper respect will be paid if I tell all on the internet. That said, I think what happened illustrates a few important points about the culture here and how it relates to medical care, which makes it worth telling. So here goes.

This past Tuesday (6 days ago) we went to a local town on the lake for outreach clinic. Towards the end of the clinic Craig asked if I’d go see a few home bound patients that people were saying needed attention. So I went with Amanda, a first year medical student, and Odelia, a Guatemalan who works with us as an interpreter (Spanish to the local Mayan dialects). We go to this ladies’ house, which is about 10 feet by 8 feet and contains three things: a “patate” (basically a wood cot with a blanket on top), a tiny fire pit in the corner (no chimney or other ventilation), and the patient lying on the patate. This is how many people in this region live. She is a single parent of three children, none of whom work. They have no source of income.

She was in a horrible state; the worst I’ve seen in medical school (or any other time). The complaint that filtered through the grape vine to us at the clinic was “diabetes” and she certainly had that. We checked her blood glucose on Tuesday and it was 537. But there was a lot more going on. Apparently she had not gotten out of bed for the last 3 months and during that time had been eating just one cup of atol each day. Atol is a corn mush drink that many people drink here. She had been having chills, night sweats, and had lost a huge amount of weight over the preceding months. I’ve never seen anyone so emaciated; she was literally just skin and bone. On exam she had a 10x10 inch abdominal mass – not good. She was essentially immobile. We discussed the situation with Craig back at the clinic and decided to return the next day with IV fluid, palliation meds, and some other meds and equipment. She was insistent that she did not want to go to the hospital even though in our estimation she desperately needed it.

The next day we returned. This time Peyton and Craig came as well. What we found was appalling. Not in a derogatory sense, but in a “how could things have gotten to this point” sense. There were a few things I had neglected to investigate on exam the first day due to her extreme pain with any kind of manipulation. But when we returned we wanted to check for a few other things. In the process of doing so we discovered some shocking things, which prompted us to urge her and her family to allow us to transport her to the hospital.

After 10 minutes of discussion they agreed to go to the hospital. So Peyton and I got on each end of her, carefully lifted her on her blanket and were half way out the door when a lady runs in off the street yelling that we can’t take her and to put her down immediately. (This is all in Qachiquel, the local mayan language). So we of course put her down. Nohemi and Leti (our two interpreters) have a 10-15 minute discussion with this lady, who I think was a relative of the patient’s, and finally convince her that she needs hospital care. So Peyton and I again pick her up and start moving toward the waiting stretcher, when in runs a man off the street saying the same thing! “Put her down, she’s my sister and you can’t take her anywhere!” What the hell, people? We’ve got to go. The ambulance isn’t going to wait all day! So another 10-15 minute Qachiquel discussion ensues and Nohemi and Leti convince him that his sister does really need to go. So finally we get her out to the stretcher and into the ambulance.

It was Peyton’s and my job to ride with her in the back of the ambulance to the hospital. Sounds fun for two medical students. Turns out this was probably the most miserable hour and half of medical school so far. Even though I’m not going to go into the details of this patient’s condition, I will say that the resulting smell permeating the ambulance was unbelievable. Luckily the ambulance had two small windows which we could open to get some fresh air, but this just barely tempered the odor. Then, about half way through the trip the patient stirs a bit and motions to one of the two open windows. We don’t speak the same language obviously, but I got the idea that she wanted it closed. Crap. Well, we closed it for her and there went our ventilation. The horrible smell was making us incredibly nauseous, but what made things even worse was the driving. Now, not all of it was the fault of the driver. The road up from the lake to the Pan-American highway is very windy and hilly, with a million switchbacks. And the road back down to the hospital from the Pan-American highway is the same way. So there was reason to get motion-sick. But what our driver failed to realize (and this was our fault; we should have explained things) was that this was a completely non-urgent transport. There was no emergency here. The patient had been in this state for months. What we needed was a nice casual transport to the hospital. Instead we got a sirens blazing, weaving in and out of traffic, peeling out around the switchbacks experience that nearly put Peyton and me over the top. By about the half way point we were as green as could be and concentrating all our energy on keeping our GI contents within the GI tract. I have a new respect for EMTs and paramedics. They have a tough job. At one point the patient was being very still with her eyes closed and we decided it was reasonable to check and see if she were still alive. So we searched for a pulse. We couldn’t find anything, not even a carotid! Luckily, we stopped shortly after this and with the ambulance still we could easily tell that she had great peripheral pulses. I can’t imagine how hard it must be to take a full set of vitals, start IVs and all the rest in a speeding ambulance. Way to go paramedics.

Anyhow, we eventually made it to the hospital and delivered the patient to the ER. We explained things to the nurses and waited about an hour until we could talk with the doctor on staff. After explaining the situation to him, we left. It was dark and we had to find our way back to Santa Cruz. Thankfully, we didn’t have to wait long for a bus down to Panajachel, and we made it to the docks in time to catch the last lancha back to Santa Cruz. It was a long day, but overall I suppose a good experience. I really hope this lady does all right, but my suspicion is that she is not going to do well at all.

What happened here brings a few important points.

People here in Guatemala, especially the folks in the small villages who still speak the local Mayan dialect, have a very different view of hospitals than we in North America do. Our back and forth with everyone about whether this patient was going to the hospital or not seemed a little ridiculous at the time, given the gravity of her condition, but it represents a very common attitude. That is, many people here do not want to go to the hospital under any circumstances, no matter the seriousness of the situation. And they have good reasons. Often the hospitals provide sub-par care and the patients are looked down upon as second class citizens. Most of the time, no one at the hospital speaks their language (and they don't speak Spanish). And to top it off, most of the hospitals won't allow families to visit at all. So the experience is awful. It's lonely. They are frightened in part because they don't understand what's going on - indeed, it would be hard to understand even if everyone involved spoke the same language, but you can imagine how hard it must be when you don't speak the language of the people taking care of you! Because people resist hospitals so much, and the care at the hospitals isn't so great, people end up holding out as long as they can - until their conditions are very severe, before going to the hospital. Thus, people have the attitude that hospitals are places where people go to die - and that's it. So I can understand why this patient and her family put up such resistance to the idea of going to the hospital. It's a tough problem.

Nuestro casa en Santa Cruz

Here are a few shots of our house in Santa Cruz. It´s super nice, with a view straight out to the lake. From our house you can look directly across the lake at Santiago and San Pedro Volcano.

As Peyton likes to say, ¨we take our breakfast on the porch.¨ It´s pretty nice, I must say. I think this morning the menu was scrambled eggs, pancakes, and toast.

Most nights the students try to eat as a group. Often the result is that Peyton and I cook for everyone. Everybody usually contributes to the overall food supply and then we come up with some meal or other. This was my second night I think.

As a result of the recent super heavy rains, the bridge on the path from the docks and town to our house got washed out. It´s just a huge ravine now with a sizeable creek/river running down it.

So every morning we have to hop the river rocks across to get to town and to the clinic.

Santiago

Here are a few pictures I took on a walk through Santiago, which is where Allie and I spent our time down here.

These few are of us walking around Santiago. Most of the towns around the lake are very similar, so this represents pretty much what they all look like from street level.

The little red thing next to Allie is a ¨tuk-tuk,¨ a very cheap form of transportation - like a little covered scooter.

One night Peyton stayed over in Santiago to hang out with us, and this is the hotel where he stayed.

I took this shot on the road from the Posada to the center of Santiago. Note the little blue sign. It contains a reasonably clear depiction of a lifeguard on duty. I surmise this means there is (or would be sometimes) a lifegueard on duty. But the sign is on the side of a big road above a huge drop off (veritable cliff) that goes down 300 feet to the water where no one would ever swim. And no one has ever seen a lifeguard there, ever! What´s the deal?

Here´s a look down on the women washing clothes in the lake. This is practically a full time job, and they´re at it all day long. The boats on the shore there are the typical guatemalan boats that the men use to fish and to get around.

Empanadas

Ok. The most important thing to discuss today is empanadas. There is this little tienda in Panajachel where all they sell are these uber deep fried hunks of deliciousness. I´ve had 7 since last Thursday - 2 last Thursday, 2 last Sunday on the way back from Xela, and 3 today. That´s right, my tolerance is increasing rapidly. Pretty soon it´s going to be a full blow addiction.

There have been some changes at the clinic. Three students left over the weekend and we´ve gotten three new folks, all from UVA. So it´s a new vibe, but a good vibe. The UVA students typically come down and do Spanish school in Xela for a few weeks then migrate over to Santa Cruz. They often have their own projects to work on, as is the case with two of the new students.

Today, Peyton and I gave our little presentation on el reposicion de hormonas (hormone replacement therapy). It went just fine, and now we have the rest of the afternoon to study, take care of business, etc. Tomorrow we do outreach clinics as usual. I think I´m going to try to get in the group going to Jaibalito, somewhere I have yet to go. It should be fun!

Peyton and I actually saw a few patients in clinic today. Craig was teaching a beginner Spanish class to some of the newer folks so they had us see a few patients. One had some back pain that we think was MSK pain and the other was a little girl who came for a check up on her finger; Craig removed her nail a week ago after it got slammed in something. She was fine today - healing well.

Overall I´d say I´m adjusting to life here pretty well. It´s not much of an adjustment, though. Life is pretty simple. Eat, sleep, exercise, study, go to class, go to outreach clinic, and occasionally make the lancha voyage to Pana to get empanadas. Oh, and of course take time to update my emo blog (as Peyton calls it).

Today I brought pictures on my usb drive, but I forgot the climbing pictures so I´ll have to upload them later. So I´m going to add pictures to previous posts, or maybe make a few new posts with pictures, we´ll see.

That about does it. It´s 3pm and it hasn´t rained yet, which is nice. Usually it rains by now and doesn´t stop until late at night or early morning. But it is hot today, so some rain might actually be nice.

Hasta la proxima vez!
SH

Xela

This past Thursday we did an outreach clinic to Pajomel, a small pueblo high up above the lake. It´s a rough drive up, so Peyton, Karen, and I decided to hike. We took a lancha to Tzununil and then it was about 1:15 from the docks up to Pajomel. I was drenched when we got there - exactly as if I had just jumped in the lake. The clinic was great. I worked with Kelsey, a rising 2nd year who is great. Things weren´t super busy on Thursday - we saw just three patients. One elderly woman with chronic sinusitis, a little 3 year old with acute sinusitis, and a 20 year old with sun dermatitis, which is something a lot of folks get down here, and which we just treat with antihistamine, steroid cream, and sunscreen for prevention. One of the great things about this program is that pretty often the 4th years are basically practicing independently. At Pajomel we had Guadalupe, a Guatemalan nurse practitioner who is great. But otherwise, it was just Peyton and me, the 4th years, plus a few rising 2nd years. It´s incredible practice and a ton of fun.

After clinic on Thursday, Peyton and I rode with Pete from the lake up to Xela. Pete had business at the Mexican border and Peyton and I planned to climb Friday and Saturday. The hostel we got is awesome - complete with kitchen (with frig) and hot showers! On Friday Peyton and I found our way via bus and van up to a little farming pueblo called Chicua, which sits at the base of the cliff line reported to be the best climbing in Guatemala. From Chicua it´s a 20 minute hike up through a substantial scree/boulder field to the base.

This scree field is like no other I´ve ever experienced in my life. Scattered throughout the scree on almost every flat area you can find, there are religious groups that gather to chant prayers ALL DAY LONG! They sing songs, chant prayers, give sermons, perform interventions, etc, etc, the entire day without much of a break. The groups range in size from 2 or 3 up to 25 or more. A common chant we heard was ¨Poder de Dios, Poder de Dios, Poder de Dios...¨ It´s stuck in my head now. I guess I got used to it pretty quickly, but it was one of the oddest climbing experiences I´ve ever had for sure.

We climbed Friday and Saturday. Pete joined us on Saturday. The afternoon rains limited our time both days, but even so we were able to get in a bunch of quality climbing. This one spot we stumbled upon turned out to be the best in the whole area. There was a sweete arete (5.8), two bolted face climbs (10a/b and 11b/c), and a nice hand crack (5.8). None had grades and we had no guidebook, but those were the grades we settled on after climbing them a few times.

We´ll stay here in Xela tonight and then head back to the lake with Pete in the morning. Next week holds more Spanish/clinical class and some more outreach clinics.

I´m hoping that tomorrow while in Panajachel I´ll be able to find an internet cafe where I can upload some photos to my previous blog posts. It might be next week before I can get them all up, but I think I´ve figured out a way to do it - it just requires a somewhat lengthy trip into Panajachel to get access to some faster internet.
 

La Clinica

A brief update because I don't have much time today:

Work started on Monday. We meet about three mornings a week at the clinic here in Santa Cruz and have Spanish/Clinical lectures, which are great. There's about 11 students right now, but three are leaving this weekend. Tuesday I did my first outreach clinic in San Pablo, which went well. Lauren, a student from Montreal, and I worked together and saw a bunch of patients. It was fun. Today was another class day here in Santa Cruz, and tomorrow I go to Pahamel for another outreach clinic.

This weekend, Peyton and I are traveling with Pete to Xela, which is the closest town to "the best climbing place in Guatemala." Pete has some business to take care of at the Mexican border, then he's meeting us for some climbing on Saturday. Should be fun.

That's all for now. Life is good here. Missing home and Allie and the dogs and cat.

Independencia

Independence day - for more than one reason. Of course it's the 4th of July. We didn't do much to celebrate today, it's not a big deal for Guatemalans as you can imagine. But today Allie left for the US, leaving me down here for the next month - a much more somber kind of independence, for sure. It was tough to say goodbye at the airport this morning, but we managed.

Overall, our vacation was a success. We saw some incredible places, did some fun things, and ate some amazing food. What more could you ask for?

Tomorrow I start at Mayan Medical Aid. I moved my stuff from Santiago to Santa Cruz today,  which was a scosh laborious. Thankfully I had already taken my climbing pack with the rope and gear to the house on Saturday. But my one huge duffel is rather heavy, and there was copious walking involved. After a brief time when I thought I had no access to money, and with none on me at the time, thought I was going to have to beg for handouts to get to Santa Cruz, I did make it just fine. There was actually an ATM open on Sunday. Why do the ATM's close? Isn't that point of ATM's, to be open when the bank is not? That's a rhetorical question - of course that's the point of ATM's. But not these, save that one I came across. Then the lancha ride from Pana to Santa Cruz - oh boy. We were loaded down, slam full of people plus a bunch of other random stuff. And my duffel ended up at the very tip of the bow. A loaded lancha is not a dry ride, and the tarp they use to cover the stuff and people would have helped for sure had it been covering my bag! But no, my duffel was the one object on the entire boat not covered by the tarp - perfect. It got drenched. I was fuming. But, thank the good lord, when I got to the house in Santa Cruz, only a couple things were wet, and even those weren't that wet. Lucky.

So tomorrow I should have some kind of orientation to the clinic, the town, etc. Pete, the guy who organizes things for the students will orientate me. After that I don't know what the day holds. Usually Monday's are days we stay in Santa Cruz at the clinic and have Spanish class. Two or three days a week we go out to communities around the area to do outreach clinics. My guess is Tuesday this week will be my first one of those. Can't wait!

The house is great. It's got three rooms - one for Peyton, me, and one other student. It's a good group. The house has a big porch with a view of the lake. I finished my book (Into Thin Air by Krakauer) on the porch this afternoon while the rain drizzled in the surrounding garden. Pretty peaceful.

There's no internet at the house, so I have to come to the local hangout at the docks, La Iguana Perdida, to use the internet. That's fine, it's a 5-10 minute walk from the house. But uploading pictures may be an issue. I'll keep posting text for sure, but I may have to go back and add pictures when I can during this month, and perhaps even after. We'll see.

Hasta pronto!

Santiago

It's our final full day in Santiago. We're sitting at the Posada waiting on breakfast, looking out across the lake at the San Pedro volcano and watching the men walk down hill toward the fields to work. It's going to be a beautiful day.

Yesterday morning Allie and I went horseback riding. Nancy and Jim, a couple in their 60's from the US who have lived here for 21 years, have a "finca" at the far inland end of the bay. On their unbelievably beautiful property they have a bunch of horses along with 17 dogs! Our guide Chico took us up 1500 feet to a "mirador" that as best I can tell sits in a saddle between two peaks. From that vantage point you can see lake Atitlan of course, but in the other direction on a clear day you can see all the way to the Pacific. It was a neat spot.

During the afternoon we met up with Peyton and one of his best Guatemalan friends, Rebecca. She is in medical school and a really cool person. On Friday's the center of town is jammed full with the weekly market. We strolled through, but with no camera. Allie and I found a great "cubre cama" and I bargained for a good while and got a fair price I think. After meandering around town some more we came back to Posada. Allie read her book at the pool while Peyton and I baked in the sauna then sprinted to lake. We swam in the pool and jacuzzi for a while. Last night, the Posada hosted a local band that played classic rock! We ate with some girls we met here at the Posada from NC, and enjoyed the live music. After lighting a fire and reading for a while, we were zonked. It was a great day.

Today we're venturing across the lake to Santa Cruz by way of Panajachel. Should be exciting. It'll be good to see where I'll be for the next month, and we've heard there's a volunteer veterinary service in Panajachel, so we're going to investigate that.

A few more pictures:

Oh, and did I mention that yesterday I got crazy sunburned after sitting outside reading for just 30 minutes! I guess that's what you get when your sun exposure approximates that of Dracula. Stupid med school. 

Peyton makes fun of my emo blog all the time, and one of the most emo things you can do I suppose is take pictures of yourself in the act of blogging. So here you go, Peyton.

And this is the front of the Posada.