A Guatemalan mother listens as doctors explain there is little
that can be done for her daughter, who is unable to walk

Volunteer medical mission helps with work of Hermano Pedro in Antigua

By Buzz Trexler
for The (Maryville, TN) Daily Times, November 2000

ANTIGUA, Guatemala — Nearly anywhere you stand in Antigua, you can look south and see Agua Volcano. A seemingly gentle giant, the 10,000-year-old volcano, which looms 12,333 feet above sea level, has not erupted in modern history.

In contrast, you have to sometimes work your way around, peering through branches or between buildings, to catch a glimpse of the slightly higher, 12,342-foot Fuego Volcano.

Fuego has erupted more than 60 times since 1524, making it Central America’s most active volcano in modern history. In 1974, Fuego grumbled for 10 days and shot a cloud of ash more than 4 miles above its summit. Just a little more than two months ago, on Sept. 5, the volcano erupted and sent a 2,600-foot column of ash and smoke into the air; on Sept. 21, Fuego spewed a large cloud of ash, causing officials to issue an "orange alert" and consider evacuating nearby residents.

Agua is the gentle giant whose eruption sent water flooding the countryside, thus its name which translates into "water."

Fuego is the testy titan whose ash and smoke reminds you why he’s called "fire."

Both are omnipresent in Antigua, just as are the servants and patients at Obras Sociales del Hermano Pedro, or "The Social Work of Brother Peter."

Antigua was founded in 1543 and was originally called Santiago de los Caballeros ("St. James of the Knights"). Located at the foot of Agua Volcano, King Phillip II of Spain gave the city special recognition and it became an art and cultural center.

It was against this backdrop in the early 1600s that a Franciscan priest named Hermano Pedro ("Brother Peter") Betancourt founded the first hospital in a small thatched hut near what is now Belen Convent. The priest would walk the cobblestone streets looking for the sick and abandoned, carrying them in his arms or on his back to the hospital. Dressed in rags and tattered clothes, Brother Peter was a common sight on the streets. He would often walk about, ringing a bell asking for donations to feed and clothe his patients.

But the source of its natural beauty has long been a problem for Antigua, as well as Brother Peter’s legacy: In the 300 years since its founding, the hospital has been destroyed several times by earthquakes — one of which devastated the city in 1773, the height of Antigua’s golden age.

But Brother Peter’s work went on, and over the centuries others would follow in his footsteps to care for the sick, poor and abandoned. One such man was another Franciscan priest, Guillermo Bonnilla, who resurrected Brother Peter’s ministry.

In 1974, almost exactly 200 years after the great quake in 1773, the hospital was again shaken to the ground. By that time, the facility encompassed an entire city block and was being operated as part of Guatemala’s National Hospital network of acute-care facilities.

Ten years after nature left the government hospital in ruins, Brother Guillermo could be seen picking up the work of his Franciscan brother: gathering abandoned elderly and orphans, housing them in rented homes, and appealing to the people for help. At some point, the ruined hospital began to undergo reconstruction.

Today, the facility is operated by the Franciscan order of the Catholic Church under the direction of Father José Contran. Funding comes solely through donations. The hospital itself is under the direction of Dr. José Humberto González Arenas.

As Father José Contran walks a visitor down the corridor, he says simply, "This is our service; this is our life." As he speaks, the silver-haired priest spreads his arms out as if to encompass all who are within the city-block facility. Approaching the foyer, he says, "This is our symbol," and points upward. The visitor half expects to see something similar to an official sign or crest, but finds instead a crucifix with the maimed body of Jesus Christ; blood-painted stumps replace his left arm and right leg.

"This is our patients," he says.

"You see the broken Christ in your patients?"

The priest nods, then walks away in silence.

When 30 medical missionaries from the Knoxville area awoke in Antigua the morning of Oct. 29, Agua was still silent, and Fuego was fuming a little. In short, it appeared to be a normal day for the Central American city.

And "normal" meant crowds of people would be waiting to see foreign doctors at Obras Sociales del Hermano Pedro. Some of the prospective patients had been living with medical conditions for decades; many of them had walked for hours from their villages.

The four surgical teams arrived at the hospital around 7:30 a.m., and several would later say they were somewhat unprepared for what they found.

Father José Contran met with the group as they finished a breakfast of pancakes, black beans and sliced mango. The priest, who speaks very little English and relied heavily on translation by Olga Aragon, tells them the hospital’s story and then explains that the facility was still undergoing reconstruction and remodeling.

"This is the first year that this part has been done," he said. "Some places are not touched yet."

Father José tells the group of the many facilities within the compound, noting the hospital maintains a Nutritional Recovery Center for malnourished children. The center is currently serving about 20 underweight mothers who also bring their children to receive free milk.

The priest notes the police brought another child to the center the night before.

There is also a school that trains adolescents to become self-sufficient; other children go to school outside of the compound, some in their wheelchairs.

The priest proudly notes that five students graduated last year with proficiency in accounting, while two others were trained as bilingual secretaries.

The facility also includes a home for children and youths with cerebral palsy, as well as separate residential facilities for adults with heavy handicaps, disabled elderly people, and those who are blind.

As for the hospital, Father José estimates 46,000 people come for treatment each year. Medical teams from around the globe come to assist in treatment; in fact, the previous week a team of surgeons from France served the hospital. The teams bring their own medicine, arrange for lodging, and coordinate with the hospital what type of surgery can be done. Medical personnel must provide the Medical Board of Guatemala with documents showing certification.

Medical aid is given to low-income patients who are suffering from chronic conditions and would likely be unable to receive treatment. Guatemala’s National Hospital only provides treatment for acute conditions, and the only other alternative is private care, which is too expensive for most in Guatemala.

Priority is given to very poor people, who give a donation for services.

Today, the priest says, there are about 250 people waiting to be evaluated by the four surgical teams from Tennessee.

"You are the hands of the people who are going to help them get better," he says. "You are the hands of the Lord."

The priest then gave the group a tour of the facility, which many of them would later say had the greatest impact.

"That was a real sobering experience," said Dr. Chad Montgomery, an anesthesiologist with DOR PC Anesthesiologists in Knoxville. "That was really difficult. I think that was difficult on most everybody. It’s just not something that you see every day in the states. I think it left most people speechless."

One such person was Pam Sparks, a registered nurse who works at Fort Sanders Parkwest Medical Center. Sparks said that touring the infant and adolescent wards probably had the greatest impact on her at the hospital. "The little children in the ward … they just need love, attention, and just the ... touch of somebody," she said.

Jennifer Simcox, a scrub nurse who also works at Parkwest, echoed Sparks’ words: "I expected it to be bad, because I had seen some pictures ..., but it’s just different when you’re there."

Retired Registered Nurse Barbara Walker said seeing the abandoned children kept in wards brought a former time to her mind.

"It sort of reminds me of what we had back in the states years ago at Eastern State," she said, referring to the mental hospital that once operated in West Knoxville.

"The children just seem to cry out for being touched and loved," she said, "but the nurses here do an excellent job of keeping them clean and nourished."

The team saw scores of physically and mentally handicapped children being cared for by staff as well as volunteers. Rows of cribs filled one room, housing children whose ages ranged from toddlers to teen-agers. Instructions in Spanish and English were spelled out on a sign attached to the ward door.

Joseph Petrites Jr. of Golden, Colo., was volunteering in the "nursery" the day the team arrived. "This my kind of vacation," he said. "I don’t go to resorts or anything." Throughout the team’s visit, Petrites made himself available as a translator for the team.

Another volunteer, Esther Menting of Doentinchem, Holland, was later seen assisting in the same room, feeding 17-year-old Gloria Patzay from a bottle. The 36-year-old tax clerk was giving two weeks of her time as part of a yearlong sabbatical.

"Life is short," Menting said. "A good salary isn’t the only thing that’s important. It took me a lot of years to learn that."

After the tour, the team went to work interviewing the hundreds of people who came for treatment. The task ahead of them: Each of the four surgeons had 27 hours of available operating room time over four days and would have to "triage" the patients during the interviews. The surgeons included:

ä Dr. Lytle Brown of Knoxville, a general surgeon at Parkwest who organized the trip;

ä Dr. Randy Hartline, an obstetric and gynecological surgeon at St. Mary’s Hospital;

ä Dr. Paul T. Naylor of Knoxville, an orthopedic surgeon with Tennessee Orthopedic Clinic (TOC);

ä and Dr. Rick Parsons, an orthopedic surgeon with TOC.

The job of scheduling operating room time fell to Scarlet Perdarvis, a registered nurse at Parkwest.

Many of the people had traveled six to eight hours by bus to be interviewed by the American doctors; many of them had been suffering from their condition for years.

Brown said, "For example, the first lady (scheduled for surgery on Monday) had the problem for 15 years." The Knoxville surgeon was speaking of Victoria Saquic Can, a 65-year-old woman from Solola who suffered from a huge thyroid cyst about her neck.

"The majority of people ... have come from surrounding villages and its amazing how far they come from," said Montgomery.

Later in the week, Montgomery recalled one woman who brought her child 200 miles to reach the hospital. After undergoing surgery, they took the bus back 175 miles and had to walk the last 25 miles on footpath back to the village.

"We’ve seen a lot of people like that, and those people are extremely appreciative," said Montgomery.

On Sunday, the team only interviewed and considered the "very chronic" conditions — cases that would not be taken by the national hospital. Still, it is a difficult thing for the patients to travel to Antigua. Sometimes they can afford neither the transportation, nor the time off from work.

"There is no way for the people to get the help they need, unless a group like ours comes down," Brown said.

During the interview sessions, the teams pared down the masses to the few who could be helped during the four days of surgery. Some fell into the category of simply inoperable; others had merely waited too long for care; while others would have to wait for another team better equipped for their cases.

ä Daniello, a 12-year-old boy who fell out of a tree six months prior. The growth pate slipped in his left leg and has healed in that position. When he quits growing, Naylor said, surgeons can lengthen his leg.

ä Wilson, a 15-year-old boy who has a dysplastic hip, where the bone did not form correctly, and is now in need of a total hip replacement. (Parsons and Naylor said there may be enough replacement cases to warrant returning with the tools to do so next year.)

ä A 4-month-old baby born with club feet — a corrective operation that the surgeons said was normally done at 8 to 9 months.

ä A 15-month-old who was born hydrocephalic. The child has a shunt in the brain, but is now suffering some sort of paralysis. "She’ll never be able to walk," Naylor told the mother.

ä Samuel, 3, whose arm was caught in a grain belt when he was 1½ years old. The arm is now useless below the elbow and the doctors recommended amputations. The parents left to discuss the recommendation, but never returned.

ä A teen-age girl who suffered a gunshot wound to the spinal cord five years ago, leaving her paraplegic. The doctors determined the bullet could not be removed.

By the end of the day, hundreds of patients had been interviewed; 44 were scheduled for surgery.

"Probably the biggest surprise was people who had spinal cord injuries ... come in with expectations there was something we could do," said Naylor. "There’s no way in the world you can cure a spinal cord defect." He noted there is a lot of research going on in that area, but that "there’s no cure, to date."

"It’s kind of sad to have people come a long distance with some hope that some American doctor’s gonna help them, and you have to sit there and tell them, ‘Gosh, we have nothing at all,’" he said.

Naylor recalled the "very disappointed" 17-year-old mother who brought in a child with a defect in the lower spinal cord.

"This poor child has flaccid paralytic legs, and there’s just nothing we can do. She was hoping that if we somehow corrected the feet and made them look a little better, the child might walk," Naylor said. "It’s tough to explain to a 17-year-old child that their child is not gonna, in fact, walk ever, there’s no treatment at all. You could see the devastation in her face.

"I wish I understood the language better to see how they felt after that, when they hear we can’t help," he said sadly.

The hospital has three operating rooms, the smallest of which is a little larger than a walk-in pantry. "It’s so small there’s no room for any germs in there," said Barbara Walker, a 65-year-old nurse who has "retired twice," but calls Parkwest home.

Brown’s general surgery team worked in the smallest, while the orthopedic surgeons Naylor and Parson worked in the largest of the three rooms. Hartline’s ob-gyn surgical team took the remaining room.

The surgeries included 20 orthopedic cases, 15 general surgeries and nine ob-gyn cases.

One of the more memorable cases included Aylin Guzman, a 2-year-old girl from Chimaltenango who had two extra toes.

"That actually went pretty well," said Naylor, who performed the surgery with Parsons. "The family’s very appreciative. Nobody likes a congenital defect where you have extra toes; it’s difficult for shoe wearing. The baby probably won’t realize what happened, she’s too young; the parents most certainly did and very appreciative."

Toni Morello, a nurse anesthetist from Rockford; Mary Margaret Carter, a surgical registered nurse from Knoxville; and Kristy Reed also assisted in the case.

But it was Montgomery who may have been the proudest: "I got a kiss from her going out the door when she was headed home. To me, that’s the magical moment I won’t forget for my trip."

Still, the most tense moment during the trip may have come during surgery on Lucila Rodriquez, a 45-year-old woman from Guatemala City. Hartline said pre-operation examination showed an ovarian tumor that was not believed to be cancerous, but was getting pretty large and needed to be removed.

"The ultrasound had already been done months before I saw her, so the thing’s getting bigger and bigger and my concern was how much longer was it gonna be before she gets to some hospital that would be willing to do it," Hartline recalled. "Plus, my gut feeling was it was gonna be benign. And that wouldn’t be a hard case."

Hartline said he discovered that she had already been to one of the national hospitals and for some reason she left without the surgery being done.

"She said it was hurting so bad she couldn’t walk, and it had already been going on for a year," he said.

However, once surgery began, it was discovered not to be an ovarian tumor but a fibroid tumor — benign, but a more difficult situation.

Brown was called in to assist.

"It really wasn’t too bad as we started, but it started getting bloody at a point where we couldn’t stop and close," Hartline explains. "We were at a point now where you’ve got to finish; you’re committed. You’re in it, you’re committed, you’ve got to go.

"So, we’re getting blood loss in a case you can’t go fast on."

Hartline explained the surgery progresses something like this: The surgeon makes surgical cuts, then stops; he stops the bleeding, then makes more surgical cuts before stopping again to halt the bleeding. The effort is repeated as he moves along.

"So, the surgery’s dragging on and you’re losing blood," Hartline said.

Brown , who was assisting Hartline, was suffering from a local intestinal problem and had to leave the operating room twice. Hartline asked if a gynecologist was available in Antigua, and was told about one who occasionally came in to volunteer. The local doctor was summoned for assistance.

Prior to arriving in Guatemala, the team had been told not to count on obtaining blood locally. However, during the six-hour surgery, "We actually got four units of blood in about 30 minutes," Hartline said. "In my opinion, we got it as quick as we could get it at home."

After six hours, the surgery came to a close.

"She did very well," Hartline said. "Of course, we had good anesthesia help, I can’t say enough about that. Lois (Spahrs) and others were keeping her with fluids, got the blood, and kept the patient alive while we were working on her."

"The next day, she’s ready to go home," the doctor said in amazement. "She’s out on the street, sitting by her car."

Simcox was the surgical technician during the operation and said she spent the entire six hours in the operating room, "except for a 30-minute lunch break."

"Debi Garner (a surgical technician from Loudon) came in and relieved me," Simcox recalls. "That was a tense situation. I would have really wanted to leave if it hadn’t turned out the way it did."

Hartline said the case will definitely impact future decisions about what surgery he will do in Guatemala.

"I’ll choose my cases a little differently," he explains. "If it’s anything of any size tumor probably at all in a setting like this, I’ll probably just walk away from it. You just have to weigh the pros and cons of what you do."

After talking about the Rodriguez case, Hartline reflects on the reasons he came, and what he has received.

"I came because I had a curiosity about it, but also I felt like I needed to serve the Lord," he says. While not diminishing his medical service "at home," Hartline said that as with all occupations, it sometimes feel it’s just another job.

"You start to feel like ‘If I’m going to truly give, I need to be giving service to people who can’t get it and who can’t pay for it,’" he explains.

He recalls feeling "an urgency" to do so when contemplating coming to Antigua.

As the trip came to a close, Hartline said a strange thing happened.

" It struck me that I came to give out of a calling to God, but these people have done the same thing. Christ called them, too, and they’ve given me, I’m sure, more than I’ve given them."

The Rev. Frank "Buzz" Trexler is managing editor at The Daily Times and pastor of Green Meadow United Methodist Church, wwwthemeadow.org. You can e-mail him at PastorBuzz@nxs.net.