Gratitude in Guatemala

I recently returned from a two-week trip to Guatemala where I, along with several UVM attendings and residents in pediatrics, anesthesia, ENT, and plastic surgery participated in a medical-surgical mission experience.  In Nuevo Progreso, a small town approximately five hours from Guatemala City, our team of 50+ physicians, nurses, and trainees assisted in performing general, ophthalmologic, gynecologic, and plastic surgeries for one week.

Although we all left the country with an overwhelming sense of pride for having accomplished our goal, it was clear that we gained just as much, if not more, than the patients we saw.  Reflecting back on my experience now, I can think of three important lessons that I will hold close as I continue my journey in medicine.

1. A little bit of gratitude goes a long way.

A common thread throughout our trip was the gratitude shown by each patient and family member we encountered.  Within a few hours of our arrival, we quickly learned that our patients had traveled hours, sometimes days, to arrive at the hospital’s doorstep, hoping for a chance to be seen by a surgeon (there was no guarantee!).  Patients who had surgery as an option happily agreed to be operated on, without much of a consent process or

overview of risks involved.  Mothers willingly handed over their children to undergo cleft lip and palate procedures, silently brushing away tears and smiling to hide their anxiety.  Those coming out of surgery thanked their medical teams profusely, and their families also expressed immense gratitude.  Most heartbreaking for me, however, was delivering bad news and telling an elderly gentleman, with a disfiguring, invasive skin cancer, that there was nothing our team, with our limited equipment and time, could do for him.  Still, he thanked us for seeing him, shook each of our hands, and held his head high as he graciously walked out of the exam room.  I have observed that healthcare professionals in the United States have an often thankless job. Because highest-quality and compassionate service is the expectation (as it should be), when provided, it can sometimes go unnoticed and unappreciated. The sense of gratitude that we felt from our patients in Nuevo Progreso was therefore invigorating, moving, and contagious.

2. The practice of safe and effective medicine can be simple.    

I had heard and read about physicians lamenting the evolution of their practice to what they’ve coined CYA or “cover your ass” medicine.  We live in a nation where patient safety and quality improvement research has created detailed checklists, protocols, consent forms, note templates, and the like, which dominate our time, taking away that spent with actual patients.  In Nuevo Progreso, administrative work was limited to standard paper charts for documentation, allowing us to spend more time with our patients and see a higher volume.  The turnover rate was unbelievable; our medical-surgical team was able to perform over 300 surgeries in just seven days.  Furthermore, the complication rate was extremely low; whatever issues there were, were minor.  It was refreshing to witness the fluidity of transitions and the exceptional patient care, and it made me think twice about the way we practice medicine in the United States.

3. Do not underestimate the power of a small gesture of connection.

Having taken some Spanish in college, I felt fortunate to be able to speak with our Guatemalan patients in their native language.  I was able to learn, for example, that one non-verbal patient was, in fact, catatonic due to severe depression, while one mother carried enormous guilt and self-blame for her child’s cleft palate.  Many of my colleagues at the hospital, without the assistance of translation services, resorted to gestures and charades to communicate with their patients.  Still, I noticed that verbal communication was at times unnecessary, that sometimes all that was needed was an empathetic smile, shared tears, or a strong hug.  I vividly remember a scene where a Vermont nurse and a Guatemalan nurse embraced amidst children they had both cared for. The feeling of human connection remained palpable in a room where no words were spoken.

My time in Nuevo Progreso, Guatemala, and each patient I met there, offered a unique, eye-opening experience.  They helped me to remember one of life’s simpler lessons – that healing is a gift, meant to be exchanged.