Leaving Lake Atitlan

I had booked to travel back to Antigua – leaving at 2:30pm from San Pedro to head back to Antigua.

I woke up at about 9am and packed my things. The view from the door of my room was beautiful and I felt very glad that I had stayed the extra night:

I made my way down to the deck and sat on the edge – looking over the lake and the mountains ahead.

I met up with someone who had been on the same bus as me on the way from Antigua and spent the morning walking from San Pedro to San Juan and then on to San Pablo. The views whilst walking along the only road connecting the towns was very picturesque.

  

I think it’s the combination of the mountains and the water which gives each picture a postcard-type look. The towns were very similar to each other – none of them were as touristy as San Pedro – they had local houses and shops with lots of bibilical pictures on the walls.

It was soon time to catch the shuttle back to Antigua. The journey was generally without problem – although there was a large amount of traffic getting in to Chima which delayed the journey significantly.

I also spoke to a couple on the bus who had been in San Pedro for the same time as me. The previous day they had also been walking along the road from San Pedro to San Juan and all of a sudden were confronted by two people in masks with machetes. They, of course, gave up their bags and were spared injury – but they lost their camera with all the pictures on it.

I arrived in Antigua soon after 7pm and made my way back to the house where I had dinner and relaxed before heading off to sleep.

Indian Nose and Lake Atitlan

I woke up at 3:30am and quickly got ready to meet the group going to Indian Nose at 3:45am. There were 16 of us altogether. The bus journey took about 45 minutes and climbed most of the height for us.

It was still very dark as we hiked the remainder of the way up. It took about 30-45 minutes and there were regular screams as a dog would walk past us.

We arrived at the top to see a magnificent view. The lake was glimmering in the light as the sun began to rise. The lights from the local towns could be seen and the silhouettes of the mountains gave a beautiful background for the rising sun. 

    

 

Even the animals seemed to want to watch the sunrise!

As the sun rose, the colours of the sky changed and we stayed watching the astonishing scenery for about an hour before heading back to San Pedro.

  

Having had very little sleep, I slept for a few more hours before spending some time exploring the town again. I also took the boat across the lake to San Marcos and looked around that town. It was very different to San Pedro – San Pedro is very touristy – full of people from abroad staying in hostels. San Marco on the other hand is a retreat for those who wish to explore their spiritual side – with most places offering Yoga, spiritual enlightenment and a spiritual focus. It was a very pretty town with lots of greenery and the housing / hostels often blended in with the natural surroundings.

That evening I broke my fast in a restaurant called Shanti Shanti – where I could eat and admire the view of the lake. Although the landscape prevented me from seeing the sun setting specifically, the change in light was clearly reflected in the lake as it became darker.

I spent the evening walking around town again and soon headed off to sleep.

San Pedro and Lake Atitlan

 I woke up nice and early to make sure that I had packed everything for my trip to Lake Atitlan. The shuttle was meant to collect me at about 8:30am. The shuttle then went around Antigua for a bit longer collecting others on the way. By the time we left it was about 9:30am.

The journey to Lake Atitlan took about 3 hours – we were taken straight to San Pedro which is where I had booked a hostel for the night. When I arrived, I saw how the hostel literally was on the lake – and the hang out area had a place from which you could jump into the lake!

   

The view from the hostel was beautiful – looking across Lake Atitlan to the smaller towns and mountains on the other side.

I spent a few hours walking around San Pedro and decided that as Monday was a day off anyway, I would spend one more night in San Pedro before heading back to Antigua on Monday evening. The town itself was not very big – the main street was full of market stalls – often selling the same thing! There was also a strong sense of religiosity with many walls having large signs with quotes from the bible.

Having walked around town, I decided that I would take a Kayak and explore the lake. Amazingly, the cost for hiring a kayak for one hour was only 10Q (less than £1!) and so I hired one for 3 hours – planning to kayak around the Lake as far as San Marcos and then come back to San Pedro.

  

Taking a kayak out onto the lake was very peaceful. I enjoyed just sitting in the open water in the peace and quiet and slowly making my way around the towns – San Juan and then San Pablo and eventually San Marcos. At San Juan there was a house which was half in the water which seemed a bit strange to me! But no one was living in it!

  

 As I had taken so long to get around the first couple of towns, I rushed a bit to go to San Marcos. As I went around the lake, I saw people bathing on the edges and some were even fishing. I asked them if there were many fish and they said that there weren’t many – and the ones that were there were only small. The edges of the Lake were a lot dirtier than the centre – I guess it’s because people were bathing and washing things on the edges.

  

I returned by about 6p.m. and had a shower – by which time it was time to break my fast. I met someone who was also from England who had been on the same bus as me from Antigua and we walked around town at night. I ate at a Mexican place – the quesadillas were very tasty. Later on that night I met a couple who were also on the same bus as me from Antigua and we spent a few hours in the hang out area of the hostel.

As I had planned to go to a place called the Indian Nose the following morning for sunrise, I made my way to bed soon after midnight.

Successes at Casa Maria

In the morning I made my way to Casa Maria. The number of patients we saw this time was significantly less than previously. The patient with the suspected dermatobia seemed to have a healing wound with no signs of the protruding dermatobia. Other patients seemed to be recovering well with some continuing to have similar symptoms. The patients with arthritis often continued to have some pain and it was difficult for me to tell them anything else as I tried to explain that it was a long term condition with little more that could be done apart from analgesia.

Interestingly there were some patients who were brought who hadn’t yet been seen by me but had been unwell for over 2 weeks…nonetheless we seemed to be making good progress and with only two sessions left, I hope that we had actually made a significant difference.

One patient in particular had made a dramatic improvement – it was the patient who I first saw in the isolation room. His skin was no longer peeling, his hair felt less dry and he was moving about and even smiling. It was amazing how quick his recovery had been – and it was good to see that they no longer were isolating him.

The afternoon and evening were much the same as normal – a bit of a rest, some time with my tandem and then dinner. As one of our housemates was leaving this weekend we went out to have dinner and there was some salsa dancing too which was great to watch. Those who were dancing were spinning each other and moving so well – one of my housemates decided there and then that he would learn how to salsa! 

Volcano Pacaya

The morning was very similar to many others – I went to the clinic and spent some time triaging patients. I also spent some time dispensing the appropriate medication and injecting the medication required.

By about 12:15pm we were ready to leave and made our way back to Antigua. I rushed home and ate lunch quickly before making my way to Maximo Nivel where I waited to be collected by the shuttle bus that was to take us to Volcano Pacaya. The volcano is an active volcano which most recently erupted in March 2014 – that’s right – just 3 months earlier!

There were about 12 people in our group altogether – mainly people of a similar age to me, but there were a couple who were quite elderly too. We had been told that the trip was a reasonable hike, but only about 2 hours up and 1 hour back down. Those who were unable to make it were able to hire a horse which would carry them up.

The journey from Antigua to Pacaya was about 1.5 hours. When we arrived we were greeted by children trying to sell sticks to use on the hike up as well as some people offering a horse.

The climb was quite steep but very manageable – with a few people asking for a horse including the elderly couple. We stopped for breaks many times along the way and that helped us stay together as a group. It was a great chance to get to know each other.

There were some beautiful views as we were climbing and we were fortunate enough not to have any rain during the trip.

After about 1.5 hours, we were at the highest point we could go. We could see Volcano Pacaya beside us with smoke billowing out of the top and the old lava all around the side.

We looked in awe at the volcano and the area on which the lava had flown. Yellow Sulphur could be seen near the top of the volcano itself.

  

From this vantage point, we were also able to see Agua – the volcano that is often seen in the background of pictures of Antigua. 

We spent some time admiring the scenery before making our way down to where the molten lava had spread. The heat from the lava was still present and, after visiting the Lava Store, we spent time on the lava heating marshmallows!

We then made our way back to our previous vantage point where we were able to see the sun starting to set. The clouds which were present were seen just below us and the top of Agua was clearly visible. It was clear: with such beautiful views, it’s not possible to have a bad picture!!

   

By the time we were down it was getting dark and we were soon back in Antigua where I had dinner and relaxed with some of my housemates. 

Return to Casa Maria

Today I returned to Casa Maria. It was interesting to see how things were going as the medication had been packaged last week and I wanted to know if the patients had received their medication. I was also interested in seeing the gentleman with what I had thought was dermatobia.

When I arrived, we set up the make-shift clinic and started seeing the patients that we had already seen as well as those who the nurses felt were unwell.

The first encouraging thing to see was that the medication that we had put into packets had been used! All patients had been given (assumedly the correct) medication and from the reports they had been given them at the right time.

The first patient we saw was the patient who I thought had dermatobia – unfortunately they had taken off the dressing and so we were unable to find out if the dermatobia was really present. For those who are interested to know what dermatobia is....

Many of the patients seemed to have recovered quite well – much to the pleasure of Jorge (field manager) but I’m not entirely sure if the medication was responsible or if they were going to get better themselves anyway.

At about 11am, a small group of people had come to bring muffins for the residents of the elderly care home. They graciously offered us some as well. As they left, one of the residents (unaware that we had already been given one) came up to us and offered us their muffin – as a thank you for the work we were doing. Such kind gestures really touch you when you consider their situation.

By 12:00 it was time to go and I made my way back home for lunch before meeting my tandem for Spanish. She was having English exams and so we focussed on that for the day – interestingly she was halfway through one paper and so she asked me about some of the things she had read through from the rest of the paper.

Corpus Christi Celebrations

I woke up at about 9:30am as I had been told that there was a procession which was going to be going by our house at about 10:00am celebrating Corpus Christi. I had breakfast and waited around to see when the procession was going to go past. By about 10:30am people were starting to get ready for the procession and soon enough the people started walking past. The road had been decorated and the people passing were often singing and some were playing instruments.

It was lovely to see the community get together for the event.

After watching the procession, I returned to the market place where I spent the rest of the morning. By early afternoon, it was raining heavily and I stopped at a Mexican place for lunch – and ate some vegetarian quesadillas which were really nice and cost less than £2 altogether.

When I returned home, I found a new girl had joined the house. She was from USA and as the world cup game with USA was about to start, we went to watch the football between USA and Portugal. It was a bit of a roller coaster game with Portugal scoring in the last 20 seconds to equalise…

It was early evening by now and we decided we’d go for dinner. We walked towards 5^th Avenue (where the yellow arch was) and we had dinner before heading back home.

Thelma’s son and his family were at home when we arrived and we spent some time talking to them as I had not met them before. It was nice to see their family getting together and it was a good time to practice more Spanish!

Exploring Antigua

Today was a day spent exploring Antigua. I had read about Antigua and its history in the Lonely Planet guide and had noted a short walk exploring the town detailed in the guidebook. Of course, a lot of the buildings are ones which I pass by everyday – but instead of just passing by them, the plan was to spend time actually admiring the architecture and the history behind the buildings themselves.

I woke up at about 9am and spent some time making sure I had what I needed and having breakfast and set off towards Cerra de la Cruz. It was early in the day and the sun was shining so it was nice to walk through the city and admire the buildings as I walked towards Cerra de la Cruz. It was a pretty straight path up but when I got to a point where I would have thought to go one way, there was an arrow pointing in the opposite direction. I followed it and ended up in a very typical Guatemalan area – with small shacks for houses and a clear sign of poverty. I backtracked and followed the road round until I saw some more clear signs for the Cerra de la Cruz.

The site was beautiful – the cross stood tall in front of Antigua with the backdrop of Agua volcano. Unfortunately some clouds covered the top of the volcano, but the view itself was picturesque and I spent some time just sitting on the edge of the wall looking over the town.

I then made my way back down to Antigua itself. Following the guidebook, I passed various church ruins including Iglesia de la Canelraia, Templo de Santa Rosa de Lima and many more. When I arrived at Iglesia el Carmen, I was feeling a bit hungry and I saw that there were some ladies offering food from the back of a truck. They had various containers of food and would take bits from each container. I asked for the vegetarian parts only and they offered me some rice with an onion based salad and some spinach. It was very tasty and only cost 10Q (less than £1!).

 I then walked towards the famous yellow arch and on my way there the rain began to fall.  I decided to take a few pictures and then went to watch the football for part of the afternoon.

After the football had finished, I went to explore el mercardor (the market). It was very similar to how many markets in East Africa are organised – there is the outside part which most people visit and then there are parts which are further inside – where they sell all sorts of foods: herbs, meat, fruits and vegetables.

I made my way home and rested a little before having dinner and then going to a place called Café No Sé for the evening. 

Progress begins at Casa Maria

I met Jorge at 7:45am to go to Casa Maria. Having made sure that we collected the bag of medication, we set off for Casa Maria.

When we arrived the residents were still eating and so we set up our mini clinic and started making small packages for each of the residents who required medication. In each pack, we put in the appropriate amount of medication and wrote on the front what was inside and how much of each medication they should take and when.

The idea would be that we not only would have given them the correct medication each, but we would also be able to check to see if they had been given the medication as we could count the medication that was left – I guess on Wednesday next week I’ll find out if they actually were given the medication they were meant to have.

We then started to see some new patients and review some of the patients we had previously seen.

The patients who we had already seen had sometimes been given their medication, and other times not. This was the main reason for creating the packs and hopefully there will be some improvement by Wednesday next week.

One patient we saw who I initially thought may have a skin abscess had symptoms in keeping with Dermatobia (human bot fly). The premise is that the fly makes a small puncture into the skin and lays eggs nearby which go into the puncture and form a larva inside the skin. The hole that is made oozes fluid (which is excrement from the larva). This was, therefore, the first actually tropical disease I felt I had diagnosed. To confirm the diagnosis – and to treat the patient – the idea is to block the hole so that the larva feels it needs to come out for air. Then remove the larva as it comes out for the air. I therefore covered the wound with a dressing and will assess it when I return on Wednesday.

We left the clinic and I returned home where I ate lunch and went to meet my tandem. We spoke for just over an hour and I then made my way back home. I talked with my housemates and had dinner before going for a walk into town.

Returning to Casa Maria

Today I returned to Casa Maria to see more patients in the Elderly Care home. We started very much in the same way that we begun the previous week – meeting the team and setting up a clinic area with one of the nursing staff. It turns out that the nursing staff are not trained nurses but carry out work that nurses would normally be expected to carry out.

The patients who I had seen the previous Friday had mostly not received the treatment that I had prescribed – the reason given being that they did not have much of the medication left and so they didn’t give any.

This was confusing and disheartening as the risk of complications greatly increases with delay in treatment. One patient, for example, had a skin abscess which had been draining pus. As incision and drainage seemed like an unsuitable option (due to likelihood of poor aftercare and so repeated superimposed infection) I prescribed some antibiotics to hopefully reduce the infection and aid healing. The patient had not been given any antibiotics and the abscess remained with a small blind ending tract.

Numerous other patients required a treatment of antibiotics but these were not readily available. Fortunately, my field manager suggested that we may be able to retrieve some of these from Maximo Nivel as they receive medicines as donations from doctors which can be used. 

One patient had been admitted a few weeks earlier with peeling of his skin. They had placed him in an isolation room – although it was unclear why. I assume it was because they thought he may have leprosy? I could not think of any other reason. He was very skinny and his bones were clearly visible. He had associated dry hair and the skin that was peeling was over many parts of his body. He didn’t have any signs of anaesthesia and the lesions were not hypopigmented. There were also no discernible thickened nerves. To me it seemed most likely that he was very malnourished which was leading to these  signs and his isolation did not seem necessary.

Having seen many patients, we gave instructions to the staff regarding the treatment plans for the patients and returned back to Antigua.

I went home for lunch and then went to the school where I spent an hour and a half talking to Helga. After this, I met my field manager again and we sorted through the bags of medication that they had received. It was a complete mixture of lots of medication and we put some aside that we thought would be useful for Casa Maria.

I spent the evening talking to the volunteers at the house and went for a walk into town. 

New volunteers at the clinic

The morning started off like many others – I woke up early, ate breakfast (pancakes with maple syrup, papaya and bananas…yum yum!) and walked to the bus stop. I arrived at the clinic at about 8am and we started to triage the patients.

At about 8:30am two medical students from America arrived and started to help – they loved the babies and always wanted to play with them instead of actually triaging the patients!! But it was fine as there weren’t that many patients and by 9:30am the triaging was mainly complete.

For some reason one of the doctors wasn’t in (again) and so the one doctor had to see all of the patients.

As the medical students wanted to sit in with the doctor, I let them and I sat outside to triage any new patients that arrived.

At 12pm we made our way back to Antigua – and I rushed home for lunch before heading to the school to meet my tandem. Her name was Helga and she was learning basic English – pretty much at the same level as my Spanish. It was nice to spend time just talking in Spanish and I think that it’s one of the best ways to improve fluency as you have to think very quickly about what to say and that allows for quicker vocabulary recall compared to written exercises. You also try to construct sentences that you are not sure about and the person speaking to you corrects you which helps you improve your language.

I spent the rest of the day at home resting.

Just another Monday

This was a pretty normal day – I woke up at 6:15am so that I was ready to head off to the bus station by 7am.

The bus journey and walk to the clinic took about an hour and I arrived just after 8am. On the way, I get a beautiful view of Sumpango town from a bridge – with a volcano silhouette behind.

The two students from the previous week had already left and so it was just me at the clinic. I helped triaging the patients until about 9:30am – by which time we had finished triaging all the patients. I went to ask the doctor if I could sit in with her and spent the rest of the morning with her seeing patients. It was interesting to see how she dealt with the patients – and it was actually quite pleasing to see her being particularly stern with some of the patients who were not following their treatment regimes and the doctor’s advice. The problem of limited medication remained – with some patients having to return from the pharmacy saying that the medication they had been prescribed was not available.

I returned home – and on the way went to check if I was going to have a “tandem” (someone who speaks Spanish to sit and talk to – not formal lessons) today. Unfortunately I wasn’t going to but I would start from tomorrow.

I rested for the remainder of the afternoon and spent some time talking to the new volunteers in the house. In the evening, I went out to meet some friends and ended up spending some time with a few people who had moved to Guatemala from Scotland, America and England over the past years. It was very interesting to meet them and find out a bit about why they had moved and how they had found their new life here.

Acatenango Part 2 - The final ascent

Having had a generally sleepless night, I awoke to the sound of my alarm at 4am. The wind was howling outside our tent but I gathered my things together and got ready to go to the top of Acatenango.

As I stepped out of my tent and called out to our guide, I heard a reply of “Not possible! Too many clouds and wind!” After a bit of persuasion we decided that we would leave at 5am and still try to get to the top for sunrise – which seemed reasonable.

It was very cold – the wind was not helping matters as the temperature dropped to the extent that a woolly hat and gloves would have been ideal – unfortunately neither of which I possessed. We clambered to the top – as the clouds continued to roll past and were rewarded by very brief moments of clear views. Most of the time, the clouds filled the area and the howling wind made it very difficult to wholly appreciate where we were.

But when the clouds cleared, we were able to see the nearby volcanoes Agua and Fuego. Unfortunately for us, we were unable to see the lava spewing from Fuego but the views of the Pacific and Lake Atitlan allowed us to appreciate where we were.

      

Two weeks earlier, there had been a couple of people who were climbing Acatenango and due to the clouds and the cold weather, they got lost. One person had passed away. To mark this event, a cross had been erected at the top of the mountain in memory of the man.

 

Climbing down the mountain was actually a lot easier that I thought it would be. With the ash-like nature of the soil which would haul you back a step every time you climbed up a step, you were able to slip down one step further every time you climbed down! Someone joked that they wish they had brought a snowboard with them…it does seem like that would be the ideal way to descend.

When we returned to our tents, we rested for a short while before continuing our descent. The way down was much quicker and continued to reward us with beautiful views. The ash like consistency continued but sometimes the harder ground was slippery and the treacherous nature meant lots of people were stumbling and slipping.

As we got further down, we returned to the jungle-like atmosphere and it wasn’t long before we were back to where we started. By now it was only 11am and the drive home took about 1.5 hours.

  

I ate lunch and rested for a while before going to meet Grant (and Anna) before they set off on the rest of their travels the next day. It had been a long day and after I returned for dinner, I noticed that there were four more volunteers who had joined the house. They were from all over the world! Brazil to Germany, Australia to America!