Just another Blog.com site
After a frightening bus ride from Morales to Peten, I was thankful to find myself in the comfort of a familiar hotel in Flores and host family I had spent time with three years ago. When I first came to Guatemala with the Healing the Children medical team, we visited this region of the country to perform ear surgeries. This is when I first met Oscar and his wife Rubi, and experienced Guatemala for the first time. Flores is a unique little town densely stacked on a small island that only takes about 20 minutes to walk its circumference. Its narrow streets are lined with colorful cinderblock buildings, with many hotels and restaurants that attract tourists coming to explore the nearby Mayan ruins, Tikal. Coming from Morales, a rural town where I did not see a single white person, it is a much different feeling to now be surrounded by fellow out-of-towners. In Morales, I did not like how they called me a gringo and followed-up their comment with laughter and a spew of Spanish words I didn’t understand. But now that I am one of many gringos, I don’t care for it much either. I suppose the grass is always greener on the other side, right?
Although it has been slightly inconvenient for my hosts to have a visitor during this time, I feel incredibly lucky to be visiting Guatemala during their time of celebration of independence. We celebrate our independence in America with one long day of over consumption, but here in Guatemala, they spread their celebration out over the course of a week. Schools hold sporting events, dancing, singing, and parades for the entire community to enjoy. In Morales, I witnessed the most adorable parade I have ever seen in my life, comprised entirely of children from 4 to 6 years of age. All dressed up in various costumes that represent different aspects of Guatemalan culture, they marched down the street waving flags and dancing to music blasting from car speakers.
There was also a much larger parade in Flores with the whole range of ages. Lead by the military marching in their various uniforms, all the schools in the Peten region showed their pride with marching bands, dancers, and flag wavers. They marched around the island and across the bridge that connects Flores to the town of San Benito. It was so exciting to see this display of national pride and to feel a part of something so far from my own culture.
The night before, when I arrived to Flores from Morales, there was a huge fiesta in the town center. Music, dancing, a food fair, it all reminded me of the scene from Pollyanna when they celebrated the 4th of July. Like in the movie, they also were eating large slices of watermelon, quadruple-layered cake, and buttery corn on the cob. There was even a short firework show when the clock struck midnight to welcome the official Independence Day.
I can feel my patience wearing thin as I approach the end of my stay. It doesn’t help that the clinic I am working in this week is not air-conditioned. Yes, I know how that sounds, but it is extremely difficult to be retubing earmolds, removing impacted earwax from squirmy children’s ears, and educating parents on the importance of hearing aid maintenance when I am constantly dripping sweat in a 90-degree cement room. At the end of the day, I am exhausted, dehydrated, my head is pounding, and all I want to do is take a cold shower and go to bed. I am, however, relieved that this clinic has many more tools than the first two, so I can actually do a decent job at cerumen removal with small and bright enough penlights. Here’s an over share, I removed a glob of wax the size of a peanut from a 7-year-old’s ear today. Gross, but I “cured” his hearing loss in 20 minutes. So I may be miserably grouchy, but alas, I am still improving the hearing of some kids. Bring on tomorrow!
2 years ago, this mother heard there were doctors from the States providing hearing aids to children. She knew that her two twin sons, age 7 at the time, had significant hearing loss, but since they live in a very rural area, and have very little money, she had never brought them in to be tested. For seven years these boys lived in a world with limited sound. They had no speech, and used their own made up signs as a means of communication. They didn’t attend school, but learned how to read at home. When their mother finally made the journey into town to visit these doctors, she found herself there with 800 other children in need. She was told that due to the high demand and lack of supplies, her family would be given one hearing aid, and she had to choose which of her sons would receive it. I cannot imagine telling this to a parent. How do you choose a son to be given a life through amplification when both are equally in need? She made the difficult decision, and left that day with one hearing aid and a broken heart. Rather than this being a joyous day, it was solemn, for she had to make one of the most difficult decisions of her life.
Two years later, I find myself in the small air-conditioned hospital office hearing this story. As I look at these two twin boys, wearing matching outfits, I knew that I could not let them leave without doing something. The boy who had been wearing the hearing aid for the past two years had some speech, although the hearing aid he had been provided had not nearly enough gain for the amount of hearing loss he had, and therefor his speech was very limited. The other boy had no speech at all. At 9 years of age, these boys had never had a true conversation with anyone before.
I did a hearing test on both of them, air and masked bone conduction, and found a moderate sloping to severe sensory-neural hearing loss in each of them. Identical twins with identical audiograms.
I pulled out two brand new Phonak Classica AGC analog hearing aids, recently donated by a previous visiting team, and began making the appropriate adjustments with my little screwdriver based on what I saw on their audiograms. At this point, the mother realized that not only were they getting a new hearing aid, each of her sons was going to walk out the door with a new hearing aid. Her eyes filled with tears of happiness and she began to repeatedly thank me. The boys looked confused, maybe they didn’t understand what was happening. But when I began measuring the length of the tubing for the temporary molds on their ears, they began to perk up and become more excited.
They were also each given a Junior hearing aid care kit packed with all the necessary tools for maintaining their hearing aids. We picked out stickers for them to put on their hearing aids, for fun, but also for the mom to tell the hearing aids apart. I took extra time to walk her through the hearing aid orientation, knowing that it could be several more years before she is able to return to the town for a hearing aid check. Also, since her sons are incredibly far behind in their language development, I gave her tips on how to teach them language. I gave her the Oliver Gets Hearing Aids book and told her to read out loud to them every day. To show her sons how to say words by her mouth movements. When demonstrating to her what to do, the son who didn’t get a hearing the first time aid quickly learned a new word and was even able to say it, “Todos.” This means “everyone” in Spanish. The look of hope that came to her face was amazing, seeing her realize that her sons will be able to talk one day. I made sure she understood that it would be a difficult task, but if they worked really hard, their speech would come.
The mother and her two twin sons walked out of the hospital that day with a new life ahead of them. A life of possibilities now that they had good new hearing aids. I feel so fulfilled and overflowing with happiness that I was here, on this day, and able to do what I did. Who knows how long these boys would have gone without hearing aids that provided enough gain. I am so happy to be here, there is nothing else I would have rather done with my summer break.
Sometimes you get cases that haunt your dreams at night. Those kids or families you just can’t help given their dire situation. Although I feel like I am helping many children here in Guatemala, there are some that I cannot do anything for. Issues that kids shouldn’t be dealing with, many face on a daily basis. I’ve contemplated whether or not to share these stories with you, because there is enough sadness in this world, which we don’t need to spread around. But I think it is important for you all to hear that it isn’t just fun and games down here. There are some serious issues that deserve attention.
A 13-year-old girl came with her aunt for her hearing aid check with her hearing aid in its case rather than on her ear. Upon the initial listening check, it seemed to be functioning completely normally. I cleaned it up and put it on her ear and began the orientation I have strategically designed for this demographic. Shortly into the orientation, I reached the point where I tell parents they need to give positive reinforcement by encouraging their child to wear their hearing aid. The aunt solemnly began to explain that their situation makes it difficult to do so. I asked why, and got a response that saddens me to the core. The aunt explained that the girl’s father is abusive and beats her, calling her deaf and dumb when she wears her hearing aid. She has become afraid to wear it because of her father’s uncontrollable fits of rage. My heart is breaking right now. How do I tell someone to wear a hearing aid, something that can provide so much help, when the outcome is abuse? The girl began to sob and all I could think to do was hug her, holding her close to my heart that was shattering into a million pieces. I couldn’t control my tears and they silently began to stream down my face. I didn’t know what to say. What can you say? I don’t know if everything is going to be all right. I rarely wish harm to someone, but I hope with all my heart that her father gets everything that he deserves for causing so much physical and emotional pain to such a beautiful girl. The interpreter I was working with is an English teacher in Morales and has taken the family’s information to follow up. She plans to visit the house, something I do not think I could do for I would not be able to control my outrage if I encountered her father. I asked, “Do we report this?” The interpreter explained that if we did, and even if the police visited the house, it’s unlikely they would make any arrests and the outcome of them even going would likely result in her father becoming even more angry and abusive. “What about child protective services?” She responded with, “It’s different here.” I trust that the interpreter will follow up, for she is just as disturbed as I am, but I was at a loss for what to tell the girl. Her aunt is very loving and knows how important the hearing aid is, so I am at least glad she has one figure to look up to and try to protect her.
A 5-year-old girl in a ragged home-sewn Hello Kitty dress came in, looking up at me with green crossed eyes. Her smile displayed black rotting teeth and her flip-flops were on the wrong feet. Her grandmother, who was accompanying her, said that she does not talk and that she thinks she is deaf. She explained that the girl’s mother died during childbirth, so she was taking care of her now. They came to Morales today from Livingston, the same small Jamaican-like town I visited over the weekend that took an hour bus ride and 30-minute boat ride to get to. They waited all day because unlike the other children who were here for a hearing aid check, they were coming to hopefully have her hearing tested and maybe even get a hearing aid. Even though that wasn’t what I was there to do this day, I knew I had to accommodate them since they came so far. I could tell right away that this girl wasn’t normal. The dazed look on her face was more than just crossed eyes, it was like she just wasn’t understanding what was going on in the world around her. I sat her down and tried to condition her for play audiometry. Here, instead of raising her hand when she hears the beep, she is supposed to place a toy in a bucket to show her behavioral response. With no toys in the hospital, we used paper clips and an empty hearing aid case. We tried for 20 minutes to condition her to the task with no results. I tried turning the chair around and watching for a change in facial expression when I presented the beeps, but even at 110 decibels, she just looked around the room with the same quizzical expression she had when she entered the room. Undoubtedly this girl is deaf. No one could withstand pure tones that loud without cringing at the intensity. Unable to fit a hearing aid that would benefit her, I had to send the grandmother on her way with nothing. I didn’t even have any Beanie Babies that day to give her. The closest school for the deaf is in Zacapa, another 2-hour drive from Morales, so it is unlikely that this girl will ever attend school, or ever learn language. My heart aches for these children because there is so much that can be done for a child who doesn’t wear a hearing aid, but the resources are so limited here in Guatemala. Before she left, the grandmother turned to me and said that the doctors told her that the girl is lucky to be alive after a birth like that, and she thanks God every day for His blessing. I want to be happy, but a part of me hearing that is sadder.
An 8-year-old boy came into the clinic with his aunt who wore a housemaid’s uniform. Looking into his ear canals, I could see that there were no eardrums, no ossicles, just red empty space. I asked her about ear infections, and she said that he has had infections his whole life, and he is HIV positive. His parents are both dead, died from AIDS. He was supposed to have tympanoplasty surgeries a year ago, but there was a mix-up at the office and he was sent to the wrong city where surgeries were not taking place. He missed his chance. Now, a year later, I am not here to do surgeries, and there won’t be another surgical team here until November 2014, and even that will be in a city on the other side of the country. I had to make a decision. Do I fit a hearing aid on a medically impacted ear? All of my pediatric studies would say no, but his other option is to go without intervention for another year, falling even more behind in school. A child with severe health issues is now isolated because of his hearing loss and has barely any language to communicate as it is. I did a hearing test using the portable audiometer, wildly out of calibration. I showed my supervisor how to do masking for bone conduction testing. Presenting tones the normal way through headphones, he showed thresholds up to 60 decibels, a moderately-severe hearing loss. When presenting the tones through bone conduction, bypassing the outer and middle ear, his thresholds were all at zero, perfectly normal inner ear function. Basically if he had eardrums and middle ear bones, he would not have any hearing loss at all. Ideally, I would fit a bone conduction hearing aid on him, so his pathologic outer and middle ear could be avoided, but none of those are available. Instead, I made the decision to fit a normal analog hearing aid on him, and carefully instructed the aunt on how to care for the ear. I gave her several pairs of foam earplugs for him to wear in the shower or when swimming. The look on his face when I turned that hearing aid on made my heart smile and weep at the same time. He picked out soccer ball stickers to put on his hearing aid, and immediately began flipping through his Oliver Gets Hearing Aids book. I want to be happy, but I can’t help but think about the life he’s had and his future. His aunt is already working two jobs, trying to care for him in addition to her other children.
Really, the parents and caregivers of these children are the inspiration to me. They love unconditionally, and will sacrifice their wellbeing if it betters the life of these kids. There’s so much wrong in this world, and we will drive ourselves crazy trying to figure out why. I am sorry if I have made you sad, but I have been carrying this burden and it helps to get my thoughts on paper. My plan is to continue doing all I can, and hopefully my efforts will provide some help to someone out there.
After a morning of hearing aid checks in El Estor, we had the afternoon free to explore the area. El Estor rests on the edge of Lake Izabal, home to the manatees. Unfortunately, they weren’t out to play today, however this small town has much more to offer. Myself and the Realizando Suenos crew, consisting of three other women and our male driver, had a peaceful lunch at a restaurant by the lake. To get to the restaurant, we drove through large fields of grazing Jersey cattle that ranged in size from the newborn calfs to enormous bulls. At the restaurant, swans drifted past the deck, their honks filling the empty space between laughing at the table. The water was calm and glassy except for the ripples made by the swans.
After lunch we drove a short distance to a popular local swimming hole. We parked the van and walked along a creek where mothers washed laundry while their young children bathed. As we progressed up the creek, I could hear the increasing sound of water crashing. Around a corner appeared a majestic waterfall about 25 feet in height. There were a few other people already climbing the gnarled roots of a tree that draped its vine-covered branches over the side of the waterfall. Once to the top, they threw themselves over the ledge, plummeting into the water below. I was reminded of Whatcom Falls Park, a popular spot for summer fun where I grew up. These falls, however, are unique in that water rushes from a hot spring above, meeting the cool water that rises from the caves below. I wasted no time in stripping down to my bathing suit and joining my fellow adventurers on the climb to the top. Grabbing hold of the roots, I could smell the sulfur of the water. Dark burrows from behind the roots called out squeaks of possibly hundreds of bats. I climbed quickly to avoid the chance encounter of them deciding to flee their nest while I was blocking their exit. I know from my experience and fear of heights, that the longer I wait before jumping, the harder and scarier it is. That feeling of immense fear that overcomes the body before taking a jump that cannot be retreated from once it is made. I have felt this a few times during my trip, but not in the literal way. Now I found myself on the edge of a cliff, peering down at the water below. Before I could think of any possible outcome, I leapt off of the ledge, aiming for the center of the pool. I love that moment. After leaving the safety of the ledge, but before impact. It is a perfect metaphor for my life right now.
Treading water below the falls, the hot water hit my head and shoulders, immediately cooling off from the water at my feet. “You want to see the cave?” Asked a local guy from El Estor? This entailed holding my breath and swimming under the crashing water and rock to an opening behind the falls. Hesitantly, I said yes, but made him promise not to leave me behind. He went first, and after a long moment, I took a deep breath and followed behind, kicking hard and trusting there would be air to breath on the other side. I broke the surface with a gasp, wiped the water from my eyes, and opened them to find an aquamarine cave filled with light from the sun reflecting from the water. It was about 15 feet long, and only 3 feet high at its highest point. There was a ledge of rock under the water that I could stand on, removing the need to tread water. The ceiling was littered with small stalactites, dripping with condensation. All I could do was laugh, and smile, and say, “Oh, my god.” Just as I was getting use to this new environment, my tour guide said, “Are you ready for the next cave?” With an even more hesitant reply, I nodded my head as I looked towards the dark water he pointed at in the far end of the cave. Again, he went first, but this time he extended his hand back to me from under the rock after reaching the other side. This made me feel a little more at ease, knowing it was a short swim to the other side. I took a breath and ducked under the rock, quickly reemerging in a much smaller, darker, and cooler space. This cave was not blue like the last; it was dark and only showed black water beneath me. It was about half the size in width and height and the unknown below haunted my imagination. He said the caves continue deeper, but to my relief he recommended not pursuing them since the water level was unusually high. I had no problem with this, and opted to duck back under the rock to the first cave. Finally emerging back into the daylight, it was surprising to find that the sun had so quickly vanished and it was now pouring rain from the sky above. Rain in Guatemala isn’t like the Seattle drizzle, it drops rain like water from a bucket. They call it, raining frogs. Sensing that it was our cue to go, we packed up our soaking clothes that we had discharged on the rocks and headed back down the muddy trail that had since turned into a river of flowing red water mixed with clay. This time, I couldn’t sleep on the drive home, for I was too filled with excitement from the novelty of the afternoon.
These last three days have filled every waking hour with new sites and adventures. There is something exhilarating about never spending more than 24 hours in one place, however this continuous movement has left me exhausted in my hotel room ready for sleep at 5pm.
Zacapa presented the hottest and most humid weather yet, with temperatures rising to 95 degrees with 90 percent humidity. This town also brought forth the most hearing aid patients with 56 children! Up until now, the most children I have seen in one day has been ten, which I am still trying to do the math to figure out how it was all possible. Well, I suppose waking up at 4am, not taking a lunch break, and working into the evening would explain it. When we first arrived to the cement building that doubled as a church, there was no sign of my interpreter and a long line of families already gathering outside. Two children were also waiting to have hearing aids fit. Looking through the box of hearing aids I could see that the only options were these large beige Phonak analog hearing aids with trimpots. The main difference between these hearing aids and the ones we now use in the clinic at school, is that rather than using computer software to digitally program the hearing aids to fit a person’s hearing loss, we use small screwdrivers to adjust the settings for sound pressure level and automatic gain compression. I am thankful that I took a couple hours to review trimpots before coming to Guatemala, but I still felt highly uncomfortable programming a child’s hearing aid with the amount of expertise I had. For the first child, I was handed a BAER (brainstem auditory evoked response) print out which showed a single threshold of 70 decibels for each ear using a click stimulus. For the sake of sparing a long and confusing explanation, I’ll just say that this is about as vague as it can get for programming a hearing aid. There was a moment of despair where I thought, there’s no way I can do this, especially since my interpreter was still nowhere in sight. But the thing is, if I don’t do it, no one else will. Seeing what the maximum gain output was for this device, I put it to one level below full on gain with linear compression, attached a temporary earmold and put it on the boy’s ear with the volume control set to one. Anticlimactically, when I turned on the hearing aid, there was no change in the boy’s facial expression, however the look of horror on his mother’s face was more than enough to make up for it. Unable to reassure her that I had purposely underamplified him in order to avoid blasting his ears, I just continued to my next step of turning the volume control up to three. A raised eyebrow, and then a smile appeared on his face and I could feel my eyes get blurry with wetness and a lump form in my throat. Here I had a 7-year-old boy who has had a severe hearing loss since birth and no exposure to amplification, hearing conversational speech for the first time. My heart swelled with pride that I was able to overcome a barrier of working with unfamiliar technology, and provide a new hope for this family. My job, however, was not done yet. I still needed to verify that the settings on the hearing aid were strong enough to make speech sounds audible without making them too loud to cause further damage. Since we did not have a test box to measure gain in response to an averaged speech stimulus, I used the next best thing, the Ling 6-Sound test. This includes these 6 sounds: /a/, /i/, /e/, /m/, /s/, /sh/, presented at normal conversational level, and without visual cues. If he can correctly repeat back these sounds, we can assume that the hearing aid is providing adequate amplification. On our first attempt, he only repeated back half of the sounds. I got my screwdriver and increased the trimpot to full on gain with the volume control set at 2. Magically, he repeated back each of the sounds and I was able to get a confirmation from him that it wasn’t uncomfortably loud. I can’t say that it was a perfect fitting, but I am certain that he is far better off than he was before he came in today. Just as I was finishing the adjustments to the hearing aid, my interpreter appeared in the form of a missionary and his teenage son with thick North Carolinian accents. Hallejuha! Mildly amused by their pronunciation of Spanish words, although far better than my own, we continued into the hearing aid orientation. Even though they wouldn’t be included in my study since they are a new hearing aid user, I still gave the mother the whole orientation and supplies that she would need for care. I also gave her the questionnaire just to test my counseling skills on a first time hearing aid user. The boy was excited to put flame stickers on his hearing aid, and I gave a snail Beanie Babie to his little sister so she didn’t feel left out.
The rest of the day is a blur to me, perhaps due to the heat, humidity, or lack of food. I have no other pictures to show for this day, it was that crazy! I didn’t even have to break to use the restroom since my pores took care of that (gross, I know). At the end of the day, our crew went to a restaurant nearby and had a big steak dinner with cervezas and futbol. I slept the entire 2 hours back to Morales and barely made it to bed after a cold shower.
After the day I had on Friday, I was incredibly relieved and excited to have the weekend off. Paty, one of the girls I met down here, offered to take me to a couple nearby towns to do some touristy things. We departed Saturday morning on a bus to Puerto Barrios. By “bus” I mean an old Toyota 16-seater van. We climbed in the front, Paty sitting shotgun, and myself sitting in between her and the hairy, tick-fingered middle-aged Guatemalan driver. The thing I love about humans is that just when you think you have nothing in common with someone, something comical happens that makes you realize we’re all just the same. Silently we were making our way down the road bordered with fields of grazing cattle, passing trucks carrying loads of pineapples and watermelons, when driving towards us in the other lane was a, at minimum, 300 pound man on a tiny red scooter. He looked more like a bear riding a bicycle in a circus act. The driver and I both let out a simultaneous identical chuckle, followed by immediately turning to look at each other to find the same whimsical grin on one another’s face. Yes, this was going to be a fun ride. A little further down the road we came to a horrible car crash. I couldn’t see the wreckage, but I knew it was bad from the long line of cars backed up. The experienced driver knew that these accidents can take hours to clear and quickly pulled a U-turn and proceeded to turn down a rocky road. I knew I was in good hands, but the flashing gas gage still made me nervous as we rocked and thumped down this road taking us deeper into the jungle. We passed old houses made of sticks with dirty children playing outside. One yard had a play-pen made of 2x4s and held a baby and a puppy sitting at opposite ends with frightened expressions. I’m not sure who was avoiding who in this situation. 15 minutes into this Indian Jones jungle ride, we can to another “bus” that was stuck in the mud. Everyone was standing alongside the vehicle trying to push it forward. After a couple minutes, they were moving along and everyone got back in the van. My bus driver was obviously skilled and made it through this troubled area without difficulty. We passed more shacks scattered along the road as molting chickens dashed across the path. After about a half hour of bush whacking through the jungle, we made it to the other side where we met back up with the paved road. The driver charismatically said, “free tour,” and we were back on our way to Puerto Barrios.
We were dropped off near the marina to take a boat the Livingston, the only way to get to this small Jamaican-like town. Sitting in the front row, my spine soon ached from the pitching of the bow along the small choppy waves. After a 30-minute boat ride, we arrived to this quaint town nestled on a point protruding from the jungle right below the Belize border. We were immediately greeted by a dark man in dreadlocks and a Rastafarian hat with a Bob Marley screen-printed tank top. He said, “If there’s anything you need at all, man, you let me know,” with a slight smirk and twinkle in his eye. I think I know what he meant, but I just smiled and said muchas gracias! We walked up the paved path past booths selling conch shells beaded bracelets, fresh fruit. A woman with cornrows called to me saying she could braid my hair for 100 Quetzals, but I made a promise long ago to never be that white girl with cornrowed hair on vacation. We asked an older gentleman if he knew of a clean hotel with air conditioning and for a small tip, he walked us up the hill to a nice house set on the edge of a cliff overlooking the ocean. We checked in, but noticed there was no electricity. The hotelkeeper said that the whole town doesn’t have electricity until it gets dark, but that it would come on in time to get the air conditioner going for a cool night. I’ll tell you right now, the electricity in the town never came on, and no, it was not a cool night.
We walked around the town, observing groups of children trying tricks on their bicycles, men playing cards on overturned crates, and women braiding young girls’ hair on their front stoop. Older teenage boys competed in barefooted sprinting races up one of the paved hills. We listened in on conversations spoken in their native Garifuna language, which sounded much differently than the Spanish I have become use to hearing. After a lunch of torando, a specialty of the town consisting of a cocoanut milk soup with an assortment of seafood, we took a taxi to the far side of the town to a nice beach. Here, we swam in the warm Caribbean water, drank cervezas, and let our neglected skin soak in vitamin D. The sun soon set, and it became apparent that the electricity would not be turning on. The town fell dark, and the lack of music that normally comes on when the sun sets, made the area seem solemn. The hotel turned on a generator long enough for us to shower, but they regretted to tell us it would not remain on for long. I shrugged, not really comprehending what that meant, and we left towards the town to have dinner. I was thankful I brought my headlamp with me because it proved very useful on this walk. Footsteps clicked on the cobblestone behind me and I swung my light around to find two black dogs with pink tongues hanging from their mouths following closely behind. Houses illuminated by candlelight guided us to the main stretch where several restaurants had powerful enough generators to be open for business. The dogs snuck in behind us and found a nice spot under a table nearby. I had a tasty dinner of locally caught fried fish and french fries with a margarita, or two. Not finishing all of my food, I saved the leftovers for my furry friends. Returning to our hotel room, the sweltering heat declared its gravity and the impact it would have on my sleep. Coupled with the intense lightning, very little sleep was acquired this night. The window would flash bright followed by a roaring thunder only a couple seconds afterward, affirming the impact’s close proximity. The next morning, the generater was back on and I had to take a second shower to cleanse myself of the tequila I seated out during the night.
After breakfast, we took another boat up the Dulce River, past the lilly-padded waters of El Golfete, to the town of Rio Dulce, which marks the entrance to Lake Izabal. Small huts scattered the shore along the way, home to local fishermen and their families. I observed as a man and assumingly his son pulled a net out of the water and onto their hand-carved wooden canoe. Rio Dulce was bordered with docked sailboats of all different sizes, which we continued past towards the Castle of San Felipe, a 400-year-old site built by the Spaniards and now left in ruins for tourists to admire. We exited the boat and walked around the park, doing what tourists do best, taking lots of pictures. Finally I didn’t feel like I was the only out-of-towner so I felt much more comfortable being negligent with my picture taking. The afternoon brought scorching sun and drained for a long couple of days and limited sleep, we decided to take a bus back to Morales for a relaxed evening in my air conditioned hotel room. Tomorrow brings more hearing aid checks in El Estor and if we finish early, a meet and greet with the manatees!
Wrapping up my time in Xela is bitter sweet. The hospitality that I have been provided here has been above and beyond that I could have even wished for. On the final day at the clinic, I worked with Fabiola to teach her new techniques for hearing aid orientation, and trained her on how to do tympanometry. She recently received a donated GSI Tympstar machine, the same one we have in the school clinic, but she has not yet received any training on how or why to use it and how to interpret the results. Her frustrations on getting a seal with the probe tip reminded me of when I first started using the equipment, and I utilized techniques my supervisors did when teaching me. I’ve never regarded myself as a very good teacher, but after this experience, maybe I’m not so terrible after all. Before I left, I made sure that she could get a proper seal and interpret results for each Jerger type. I decided to forgo training on acoustic reflexes since this requires a much more complicated interpretation of results and will be less useful in her clinic than tympanometry (I can feel Huckabay cringing). I explained when reflexes could provide useful knowledge and assured her that next time I am in Xela I will teach her if Mike or someone else doesn’t get to it first.
With my bus ticket already purchased, my translator, Susy, drove me to the bus station with 15 minutes to spare. Upon my arrival, I noticed there was no bus in the lot. I shrugged and thought, it must not be here yet, but it will be. Unloading my 3 suitcases, the man who sold me my ticket the day before approached us rattling something off in Spanish. The concerned look on Susy’s face said it all; I didn’t even need her to repeat it in English. Obviously, there was no bus coming and apparently it was because the driver just didn’t show up to work that day. I felt anxiety rising as a lump in my throat and had to talk myself down by reminding myself that I had two days to make it across the country to Morales. I was refunded my 60 Quetzals and advised to try this other bus station nearby. We drove to the new location, and no bus. Finally there was one last company we would try, and luck would have it that one more bus was leaving for Guatemala City in a half hour. I have been blessed to encounter motherly figures throughout my trip that would do anything to help me, and Susy is no exception. In the middle of the bus terminal, she got down on her knees and said a prayer as she laid her hands on me and each of my suitcases. To be honest, I have strayed some in my faith in recent years, but knowing that prayers were being sent on my behalf made me feel more at ease. It was in God’s hands now. I watched as my luggage was searched through and I was patted down with a metal detector, then I made my way to my window seat towards the back of the bus. A guy about my age who spoke both Spanish and English sat behind me and annoyed me with excessive questions about why I had so many pieces of luggage. “You’re here alone?” He exclaimed. I replied with a simple, “Yes” and shrugged my shoulders. “Wow, you’re brave.” Was his response, typical from what I’ve received from other travelers when they discover my independence. Before we left, the driver came around and took our picture, “just in case something happens.” I hesitated before asking the guy behind me what he meant, but then thought my imagination would probably be far worse than what the precautions were actually for. He explained that with the rainy season upon us, it isn’t uncommon for roads to be washed out, taking any vehicles with it. The pictures could be used for identification purposes. I was wrong, for once my imagination was just as bad as reality. I was familiar with what he was describing because three years ago I recall driving a detour route to Antigua around a road that had been washed out. I don’t mean that some mud covered the road. The entire highway was swept away like the glacier that carved out Puget Sound, displacing all material down a long corridor of fallen trees in a deep ravine. Regretting that I asked, I turned around in my seat, put on Magna Carta Holy Grail on my headphones, and ignored the obnoxious comments coming from the seat behind me. The bus rattled and shook between intermittent engine failures as we slowly made out way up the winding narrow road, up and over the geographically hostile landscape. Sleep was not a realistic option, so instead I focused on Jay-Z’s voice as I unsuccessfully tried to relate to his lyrics. 4 hours later, we arrived in Guatemala City. Nauseous from the smell of the porter potty that took me there, and exhausted from the anxiety, I waited until the last of the passengers departed with their luggage before approaching my three regretfully large suitcases. As I struggled to wheel them off with no help offered from the workers, I saw something I don’t think I was suppose to see. Coming back for my third bag, I saw as they opened another luggage compartment door to let out 2 dirty stow-away men from the darkness underneath. Like a kid caught reaching into the cookie jar, the expression on the bus attendant’s face when our eyes met told me that he was doing something he should not have been doing. Quickly, I adverted my eyes, grabbed my bag, and walked away, hoping I would not hear voices calling after me. I was relieved to find my friend David waiting eagerly for me in the terminal and he immediately grabbed two of my bags, offering the help I could have used moments earlier.
Now it is the next day and I sit scribbling this blog on a piece of scrap paper on a bus headed to Morales. In 5 hours, I will be on the Caribbean side of the country in the heat, humidity, and dengue zone. Already preparing for the mass amount of mosquitos, I have OFF wipes ready to wipe down my body when I exit the bus. Tomorrow we travel to Zacapa, home of the famous Zacapa Rum, to do hearing screenings. All of this traveling from town to town relates heavily to the current book I am reading, John Steinbeck’s Travels with Charlie. At the age of 58, Steinbeck sets out for a 3-month cross-country road trip with his bleu poodle Charlie as his only companion. I wish I had a companion like Charlie for this trip. Steinbeck’s desire for adventure and descriptions of traveling alone remind me very much of my experience of past and current travels. I’ll leave you with this quote from the novel, and may my journey continue perhaps with difficulty, but without consequence.
“Once a journey is designed, equipped, and put in process, a new factor enters and takes over. A trip, a safari, an exploration, is an entity, different from all other journeys. It has personality, temperament, individuality, uniqueness. A journey is a person in itself; no two are alike. And all plans, safeguards, policing, and coercion are fruitless. We find after years of struggle that we do not take a trip; a trip takes us. Tour masters, schedules, reservations, brass-bound and inevitable, dash themselves to wreckage on the personality of the trip. Only when this is recognized can the blown-in-the-glass bum relax and go along with it. Only then do the frustrations fall away. In this a journey is like marriage. The certain way to be wrong is to think you control it.”
Every trade or profession has certain tools that are needed to complete the job. For audiology, there is the testing equipment like audiometers and headphones for simple pure tone diagnostics, as well as the many other testing tools for immittance tests, BAER, OAE, vestibular… the list goes on and on. The clinic here in Xela has a makeshift booth and GSI 16 audiometer that is over 20 years old. Testing a little girl with profound sensory-neural hearing loss was accomplished, but the reliability of my results is unknown since the calibration is long past due. When I asked about calibration, I received a simple reply of, “We don’t do that.” This is unsettling to me since we have our equipment at school calibrated every year, and even with that frequent of calibration, correction factors usually need to be placed before the end of the year. I am coming to terms with the fact that audiology is just different in Guatemala, but we make the best of what we have.
When working with hearing aids, there is a long list of tools for simple repairs, evaluations, and maintenance. We need earmold impression material to create a custom mold, but parents can’t usually afford this expense. The cost of one earmold in Guatemala is 150 Quetzals, less than $20, but even this can be several days’ work worth of wages for some families. Instead, many children are fit with rubber molds, which there are three sizes to choose from. These work, but the fit is less comfortable and can cause red marks of irritation in the ear canal. It’s never good to give a kid a reason not to wear their hearing aid, so pain should be avoided at all cost.
Yesterday, a parent brought in a custom acrylic earmold that was made for her daughter, but said she couldn’t hear out of it. After a quick inspection, it was evident that someone had glued the tubing to the mold with superglue, but while doing so, completely filled the sound bore with glue. Using one small twist drill, I spent 45 minutes drilling out hardened superglue, essentially creating a whole new sound bore. I was so afraid of breaking the mold, for I could not think of something worse than ruining something this family had saved up to purchase. Luckily my earmold modification skills (thank you Martha!) paid off and I was able to successfully make a hole big enough to fit new tubing through. Unfortunately, the only option I had for securing the tubing was to use superglue again since the clinic has no thin cement and TRS tubing isn’t effective in acrylic molds. Being extremely cautious and using a small amount of glue, I was able to bond the tubing in place, but advised the family to be cautious when taking the hearing aid off the ear.
One huge frustration I have been repeatedly facing is the lack of tools for cerumen management and the enormous need for the service. I feel (somewhat) comfortable with my skills for removing earwax, but there isn’t much I can do with one penlight and one large scooped tip. Many of these children have ear canals far too small to use this tool, so I end up having to tell the parents that there is nothing I can do and they will have to spend money at a doctor’s office to have the impacted plug of wax removed. When we were at the school for the deaf in San Marcos several days ago, I attempted cerumen removal on a handful of children with Trisomy 21. A common characteristic of this syndrome is microtia, which can take several forms but is usually a very small ear canal with these patients. I didn’t even have pediatric otoscopy tips to look in their ears, and the penlight tip I had didn’t even fit in their canals. That was probably the worst I have felt so far this trip having to tell parent after parent that there isn’t anything I could do because I didn’t have the appropriate tools.
These drawbacks are frustrating to me, but I continue to do my best to make it work. I keep reminding myself that I am doing the absolute best that I can, but I am often too hard on myself and become discouraged when I cannot help families. Next time I come to Guatemala, I hope to bring my own tools and supplies with me because I cannot rely on these clinics to have them. I don’t want to be limited to the help I can provide based on the tools I have at hand. Oaktree and Westone, two large audiology equipment companies, can expect to receive letters in the near future from me asking for donated supplies.
I leave Xela this afternoon, but here are a few photos of this fantastic city. I look forward to returning here in the future and exploring more of this wonderful place ☺
I awoke this morning moments before my alarm to the sound of a distant marching band. Worried that I slept through my alarm, I startled awake to check the time. 4:57. Confused, I got out of bed and stood in my hotel room with a dazed look on my face. I was sure I must have been experiencing an auditory hallucination since I couldn’t localize the sound, and it was distinctly a marching band, not the radio. Furthermore, I could not conceive a logical reason for why a marching band would be practicing that early in the morning. Still groggy from the Benadryl I had taken the previous night, I undressed and got into the shower. When I stepped out from behind the steam filled curtain, the cold air prompted goose pimples all over my body. The music was gone. Confirming my hypothesis of an auditory hallucination, I continued getting ready for the day. I sat down at the breakfast table and again, the marching band was back, sounding just as obscure as it did in my room. I was alone, so had no one to ask if they could hear it too. Shortly after finishing three cups of coffee and an assortment of fresh fruit, I was picked up by my translator. We drove through Central Park, and to my delight, observed an assembly of school aged children in kilts with large brass instruments waiting for their cue from the drum major dressed in all white. Laughing at my discovery, I had to ask, why in the world are they practicing this early? My translator couldn’t really answer that question other than reminding me that September is a celebration month of independence for Guatemala. I trust this is only the first of many unique celebration rituals I will witness in the coming weeks. If there is one thing for sure, Guatemalans sure know how to party!
I just have to devote one blog to my experience with the language barrier. Already I have expressed my frustrations with not knowing the language and how it has forced me to be dependent on others when I am a naturally independent person. However, I have still been able to find humor in the miscommunications that occur on a regular basis. For any of you who have seen Lost in Translation with Bill Murray, one of my favs by the way, you probably can recall the scene where he is shooting the commercial for a Japanese whiskey company. The director would spout out several minutes of instruction in a very fierce tone, and then the interpreter would say to Bill Murray, “He want to you turn and look at camera, okay?” This went on for a while in the movie and I couldn’t help but laugh to myself when the same thing happened to me. Typically when using an interpreter in a clinical setting, it is best practice to use shorter and simpler phrases for more accurate translation. Well I was practicing this technique, however I noticed that the translation would be at least four times as long as what I said. I realize that languages have different words to describe the same thing, but it was obvious that the translation was not exact. I don’t doubt the interpreter’s skill because I had lengthy conversations with her in English, but I was mildly entertained by the discrepancy.
I am making a valiant effort to learn Spanish and I can tell that my vocabulary has already increased quite a bit. The problem I am realizing though, is that I have no idea how to piece these words together in a sentence. I probably sound like a 3-year-old when I talk, using just verbs and nouns with no definite articles to connect them. This isn’t much of a surprise I suppose, since syntax was one of my least favorite subjects in undergrad (sorry to all you school teachers out there!)
The best strategy I have mastered is the use of context. When discussing pure tone audiometry, there are only so many possible phrases that can be said. I listen for the intonation, if the person is saying a statement or question, then reply accordingly. I give a chuckle if it’s a statement and a “si, por favor,” or “no gracias” if it’s a question. I realize that I am bluffing to the extreme, but it’s been working so far, I think. When I go out to eat, I know the first thing the waiter is going to ask will be regarding what I would like to drink. If it’s breakfast or lunch, I say, “café con leche por favor,” and if it’s dinner I say, “Moza cerveza por favor.” I always say please and thank you because manners should not be sacrificed even if there is a language barrier. I have all of the simple greeting phrases down and can actually understand them when the other person is talking fast. Embarrassingly, I am starting to talk with a Spanish accent when I speak in English. I guess I was always vulnerable to that (insert Canadian joke), haha.
Another language barrier I experienced today was at the total communication school for the deaf in St. Marcos. I continued with hearing aid orientations with parents for the children who had assistive devices, and attempted to communicate with the other children who used sign language only. There is no universal sign language unfortunately, so Guatemala has it’s own sign repertoire different from ASL. When I was introduced, the students, about 15 of them, made up a sign for my name. It made me feel rather special to have my own sign. To sign “Karen,” make a “D” in ASL with your right hand (pinky, ring, and middle finger up with the pointer finger and thumb touched together in a circle), then separate the pointer and thumb. While making this pose with your fingers, swipe your hand laterally across your forehead from center to the right temple. There you have it, Karen! They signed a song for me, while the teachers sang, and it nearly brought tears to my eyes to see these children communicating when all odds were against them. If you are profoundly deaf in a country like Guatemala, cochlear implants are not a realistic option, so your only choice for communication is through sign language. The kids at this school ranged from 5 to 15 years old and all of them performed wonderfully.
Here is my clinic coordinator for my time in Xela, Fabiola. Also, my new skirt!
Returning to my hotel room, I say goodnight to my bird friends that perch on the vines outside my window. Puffed up feathers to keep warm during the cool night, I say, “chirp chirp,” and I think they understand me better than the hotel staff I said “Buenas noches” to on my way in.
On the first Sunday of every month in Xela, Central Park becomes consumed with farmers, craftsmen, artists, and food vendors in one giant market. Strolling through the narrow walkways, booths of colorful woven blankets, clothing, souvenirs, pottery, and paintings beg to be bought. Feeling slightly claustrophobic from the dense crowd, the only thing keeping me lucid was the fact that I am about a head taller than most of the crowd. Usually I’m use to being tormented about my height from my 3 inches taller and 5 years younger sister, but now I am seen as a giant. Rather than being called “shorty,” I am being teased with the name “Barbie,” which isn’t the worse thing I could be called, but I still feel like I am being made fun of. No exaggeration, I am probably taller than half the men here and 99% of the women by about a full head.
I have seen many beautifully woven skirts on the women here and have wanted to purchase one for myself. A navy blue wrap skirt stripped with colorful Guatemalan textures caught my eye. I purchased it for 80 quetzals, the equivalent of about 10 dollars! Continuing down the walkway, my nostrils began to become intoxicated with the fragrance of fried food. Colorful tents covered a maze of food vendors selling familiar items like pastor tacos and grilled ears of corn in addition to foods I have never seen before. We sat down on some plastic chairs and shared cups of atol de elote, a hot creamy beverage made of corn and topped with cinnamon. I wasn’t sure if I would care of it, but it was absolutely delicious and soothed my throat as I gulped it down. We sat there for a while talking and observing locals coming and going with plates of food with their small children in tow. A young girl no older than 4 years of age peeked from behind her mother’s leg and gave a little wave towards me. I smiled, and I received a toothless grin in return. I watched a woman about my age for a while as she prepared garnacha, another Guatemalan street food delicacy. These were small tortillas pan-fried, topped with meat, pickled cabbage, and salsa. She was selling about 3 plates every 5 minutes, which kept her busy systematically removing and replacing the empty spaces on the pan. After observing her for about 20 minutes, and teasing my senses with the smell of her product, I had to try it. I ordered 3 garnachas and returned to my plastic chair to indulge myself. It was hot and crunchy and reminded me of the tostadas I so dearly loved in Todos Santos. I could have gone back for another helping, however I wanted to test how well my stomach handled it first. Now that it is a day later and no negative side effects have occurred, I think I will go back for that second serving.
Heading back towards my hotel, we passed more vendors who had set up since we arrived. Barrels of roasted peanuts, pretzels, and cocoa beans tempted me, but my group seemed in a hurry. Elderly women in colorful woven dresses and aprons sat on the ground with small deep fryers in front of them preparing doughnuts. They would look up at me with a big grin of empty spaces where teeth should have been, and named out prices of their product. Other women passed by balancing large baskets of fruit on their heads. If you like farmer’s markets in the northwest, you would fall in love with the Sunday market in Xela. Last night has been one of my favorite cultural experiences here in Guatemala so far and I hope to see more of these markets in the next towns I visit.