For the denizens of rural Guatemala, access to medicine is sparse, and more advanced medicine like surgeries are out of reach. The resources that are available, such as the state-of-the-art facilities in Guatemala City, are not accessed by enough people due to the lack of traveling means. Many aren’t even even aware the facilities exist. Including the usual sicknesses that people contract, the people of Guatemala face the highest rate of chronic child malnutrition in the Western hemisphere, with rates often higher than 80% in rural areas.
Since 2007, Dr. Shom Dasgupta has been going to Guatemala as a fieldworker and staff physician for the non-profit organization Wuqu’ Kawoq. We profiled his work here in a Resident Spotlight in 2011.
Since then, Dr. Dasgupta has continued his work with Wuqu’ Kawoq and has ferried residents to go with him on what always amounts to an eye-opening journey of the practice of medicine.
Drs. Moran Gotesman, Muneesh Mehra, and Manjiree Karandikar recently went with Dr. Dasgupta to Guatemala.
Second year resident Dr. Mehara, who received his MD degree from University of Medicine & Dentistry of New Jersey, has been to Guatemala four times and plans to return in May. It was the first trip to Guatemala for Drs. Manjiree Karandikar (Wayne State University) and Moran Gotesman (Sackler).
So what’s it like practicing in Guatemala? Did you work out of a hospital or make house calls?
Karandikar: For the majority of the trip, we went from village to village making house calls for each of the patients so the only supplies we had were the ones we carried with us in our backpacks. It was difficult because we were never quite sure how ill the kids might be.
Gotesman: There were a few patients that we followed consistently. There were more chronic patients that we’d check in on, and even some patients that just had surgery. A lot of times, though, we would just go to different villages and people would come to us with acute problems and we’d treat them.
Did you have any experience working abroad before this trip?
Mehra: I went on a mission to Northern India during medical school.
Gotesman: I went to medical school abroad so my whole medical schooling was abroad. When I was in medical school I had experienced practicing medicine in areas of extreme poverty. So that component of it wasn’t too much of a culture shock.
What is the difference between working in a usual hospital setting and being abroad in Guatemala?
Gotesman: It was very interesting to practice medicine in a place that didn’t have the means that we have here. You really have to think in a different way. 
Here, we’re so used to having fluids, antibiotics, and imaging modalities that are easily accessible, but over there you really have to think about the tests that you’re going to do. Here at Harbor, we can send off a bloodwork and see what happens. There, you have to think about what are you going to do for this kid: ‘Is this really going to change his management?’. We were very limited on the medications we had over there as well. So you really have to think ‘How can I use what I have for this kid?’ and ‘Do they even really need it?’
Karandikar: You really have to think about what type of treatments or procedures they might require. It’s a very resource limited setting, and we really had to think twice before ordering tests or imaging, or prescribing medications.
Did you feel like the stakes were higher when you were treating patients in Guatemala, compared to at Harbor?
Mehra: The stakes are the same, but we don’t have the ability to admit a kid to the hospital for a night and watch him. We have to do a little bit more outpatient counseling, really cover our bases because we might not see the kid again.
What sorts of illnesses did you see and treat?
Gotesman: Same things kids get sick with here, they have over there. But the reasons why they get the sickness may be different.
Gotesman: Guatemala also has a big problem with malnutrition, so a big malnutrition program was started to follow-up with baby weights and to make sure they gain weight. But we see that here as well.
Do you think your experience at Harbor helped prepare you for what you faced in Guatemala?
Karandikar: The benefit of training at Harbor with the hands-on approach and the independent learning that the residency program fosters was very useful.
How did you guys manage navigating and translations?
Gotesman: We traveled with health promoters that would help us with translation and navigating. They’d also follow up with the patients and communicate with main health promoter to make sure the patients got the follow up they needed.
What were the people like? Happy to see you?
Gotesman: The people were amazing and so welcoming and thankful for our services. We stayed in the home of one of the health promoters and they cooked all of our meals and provided everything we needed. There were many kids in the villages — some we took care of, some we just hung out and played with.
What is your biggest takeaway from your experience in Guatemala?
Gotesman: I think just the way to think about medicine because I think we lose a lot of the way we practice medicine because we’re so dependent on our imaging and tests, and there you really have to use your brain and the limited resources. It definitely makes you think more.
Karandikar: I’ve definitely developed an appreciation for practicing more cost-effective medicine. Also, it made me realize the importance of developing a cultural awareness for some of our patients that might help us better communicate with them.
You are not the first Harbor Resident to go to Guatemala, and probably won’t be the last. What do you think is drawing residents?
Karandikar: I think many of the residents are drawn to the chance of working in rural villages in Guatemala because serving an underserved population is a big part of the Harbor Pediatrics tradition.
Why do you think it was so beneficial to go to Guatemala?
Gotesman: I feel like it was a good experience because it made me a stronger doctor. It was my first time going and I plan to go back, if I’m able to. It was an amazing experience.