Reflection of my Experience in Guatemala – Maureen Cho, MD

Written by Maureen Cho, MD PGY4 at the Kaiser Permanente San Francisco OBGYN Residency Program while on global health rotation at the Hospital de la Familia in Nuevo Progreso, Guatemala in March 2015.

I love to travel. I love women’s health. And I love meeting people and exploring new cultures. These are the reasons why I am always itching for my next medical experience abroad. But little did I know that would be embraced with such deep gratitude, lifelong friendships, and true passion for love and life during my one week in Guatemala.

I have had a variety of medical experiences abroad through the years, but this was my first mission trip with one of my attendings from Kaiser San Francisco, Dr. Arlene Cosca. I was extremely excited to be able to perform gynecologic surgeries with her and soak in as much as I could from her superb operating skills, especially in a resource limited setting. Not only did I get to work one on one with my attending, I also had the opportunity to work with Dr. Strohbehn, a Urogynecologist from Dartmouth Medical Center, as well as Dr. Chase, a private practice OB/GYN physician from New Hampshire. That in itself was already an invaluable opportunity that I was so fortunate to have during my last year of residency!

Before leaving for the trip, I knew that there were about 50 of us from various medical disciplines going on the mission together. I also heard how amazing of an experience it had been in the past to work hard together with all these remarkable people who you become good friends with by the end. I had no doubts that would all be true, but I really had no idea how powerful it would feel to have so many people from different walks of life come together for the same cause. How often does one ever have the opportunity to unwind at the end of the day with a plastic surgeon, ophthalmologist, audiology tech, PACU nurse, ENT residents, high school students, nurse anesthetists (…and the list goes on!)? It was so refreshing to hear about other people’s experiences and to share my stories of both work and life with people that were genuinely interested in each other. Since returning from the trip, I still think about these fond memories and what truly felt like “the simple pleasures in life.”

During our week in Guatemala, our GYN team saw a total of 45 clinic patients and performed 12 surgeries for whom we also provided post-operative care to. English-speaking patients were almost never encountered, so becoming best friends with a translator or having conversational Spanish skills was truly a necessity. To set the scene, my Spanish skills consist of speaking in predominantly the present tense in conjunction with lots of charade gestures. I can understand Spanish much better than I can speak, so I volunteered to do the charting for the first clinic patient that I saw with Dr. Chase the day we arrived. My listening skills were good enough to catch the majority of the conversation, so Dr. Chase encouraged me to take a stab at triaging the next patient. I could feel the cold beads of sweat forming as I quickly ran through English-Spanish words in my head while trying to remember the rules of verb conjugations. I don’t think I even finished my first intended question to the patient before Dr. Chase had to step in to save me! That was a total fail. I definitely felt more comfortable with the pen and paper role at that moment, but I was determined to get better at Spanish and not let my lack of confidence impede me. I knew I just needed to warm up and break out of my shell. I had to give up the embarrassment of my inability to speak grammatically well, and focus on my goal of speaking enough Spanish for the patients to understand me. So that was exactly what I did. With each patient that I subsequently triaged, my nerves settled down, my vocabulary expanded, my confidence uplifted, and I was a physician again providing the care and expertise that I came to give to the women in Guatemala (albeit always speaking in the present tense!). I challenged myself and was proud to be able to reassure patients they did not have cancer, explain why vaginal prolapse happens, consent patients for surgery, and prepare them for what to expect after their surgery. At the end of the trip, Dr. Chase commented on how she found it hard to believe that I claimed to only speak “a little bit of Spanish.” Maybe one day my goal to speak Spanish beautifully will manifest, but for now, mission accomplished!

I have participated in abroad medical electives since my second year of residency, and it is absolutely remarkable how different of an experience I have taken away each time based on my level of experience. Having more surgical experience now as a fourth year, I was able to understand the subtleties of different surgical techniques, be mindful of the surgical equipment used, and learn to minimize complications in this setting where access to blood products was slim. It was so rewarding to be able to work with Dr. Cosca and focus on the teaching she was giving me without the stress of all the floor work piling up, concern about the OR turnaround time, the inbox patient messages I have yet to respond to, etc. With the current focus of minimally invasive surgery in my training, I did not feel as confident with my open abdominal and vaginal surgical skills. In Guatemala, without my scope in hand, I had the opportunity to become proficient in vaginal hysterectomies, suspension procedures, colpocleisis, and I even performed my first open abdominal ovarian cystectomy. Being the only GYN resident and having a strong passion for operating, I was able to participate in all of the surgical cases and wished every day that I could’ve done more!

On mission trips like these, there is always something so uniquely special about the bonds that formed with the patients you meet that stay with you forever. It always affects me deeply how far some of these patients travel to come to see us in hopes of getting the care that they need. Every morning starting around 6am, a massive line of patients form along the outside of the building and wait patiently for their names to be announced to get their chart number. We were fortunate to have a team of four gynecologists where two of us could triage patients while the other two were operating. There were some patients that would wait the majority of the day for the surgeons to finish in the OR before they could be seen. The most remarkable thing was that not once did I ever hear a single complaint. They just patiently waited and smiled every time we passed by. It was then that I saw a genuine gratitude. I had post-operative patients that kissed and hugged my hands every time I came to see them, showing more concern for my well-being when it was my duty to care for them. I even bonded with patients and families outside of my specialty. I saw a 2 year old boy and 5 year old girl with their mother and grandmother who had been waiting in the courtyard for at least 6 hrs, so I asked who they were waiting for. The 2 year old boy needed to see the plastic surgeon to see if he would be able to free his webbed fingers. I proceeded to the OR to ask the plastic surgeon if he planned to see clinic patients after his case, relayed the message to this family, and they felt so indebted to us, showering us with kindness and delicious bags of fruit. We played with the kids, took them on walks and had a blast. The best part? I now have a 5 yr old whatsapp buddy that sends me pictures of her and tells me how much she misses me!

The last surgical patient we had in Guatemala is one that I will keep in my heart forever. I started her triage on my own and found out that she lives in Mexico and traveled over 3 hours to see us. She pulled out files filled with ultrasound images, notes from other doctors she has seen, and broke down crying because she was told she had cancer and would need a complete hysterectomy and removal of her ovaries since the cysts did not resolve on hormones. She otherwise was a healthy 37 yr old who has been attempting for a second pregnancy for the last 6 years. After gathering a detailed history, reviewing her workup, and performing an exam, we suspected that she had endometriosis causing cysts on her ovaries and fibroids on her uterus, which was no where near cancer. In my modest Spanish, I reassured the patient and explained to her the impact of endometriosis. I explained the surgery we would do for her, and she broke down in tears of joy when we told her we would not need to remove her uterus or ovaries. We performed her surgery on our last operating day, and she recovered remarkably well. We also met her brother and her mother who were also incredibly grateful for what we had done for her. She was ready for her discharge on the same day we were embarking on our journey back home. We hugged, and as I was giving her my words of encouragement, she held my hands and looked me in the eyes with the most warmth and love, and says, “Thank you so much for saving my life, and giving life again to me and my family.” All those long work hours and sleepless nights I have endured to embrace my career in medicine was totally worth every minute of it.