From Santiago, and the Hospital in Panabaj that has been coordinating aid to the mudslide survivors:

Dear Friends of Santiago,

Here are updates on things in Santiago - emails from Dr. Bernie and Dr. Jack.

Ken Wood

Email from Dr. Bernie-

The town at times seems back to normal. There is a tortuous path open from Guatemala City. Jack should arrive tomorrow with Jamie and Avantika. Eggs arrived today! No water or gas yet, though,

From the emails I am getting, it seems that I have written as if you all know the town. Sorry for leaving out some of the explanation. Santiago is a town that probably has 40,000 Tzutujil Maya living in it. Maybe 5000 Ladinos (from Spanish descent) and 100 expatriates, mostly from the US.

The hospitalito is on one edge of town, in the neighborhood called “Panabaj”. Panabaj was partly wiped out by the mudslide. There was some damage from flooding and mudslides in other parts of town, but almost all the dead and missing are from Panabaj. Part of the mudslide ended at the hospital. The hospital was very sturdily made of stone in the 60s (I have seen a picture taken by Father Stanley Rother (later killed by the army) of the stone mason breaking the first rock to build the hospital. It is this stone mason’s son who guided me into the center of town the day of the mudslide). The front of the hospital is buried 8 feet deep in mud. But the mud quit flowing exactly at the hospital. The reception room doors were broken in and mud filled the room 4 feet deep near the door. But by the time the mud reached the hallway, it is only ankle deep, and only filled a small part of the corridor. All the rest of the rooms were just flooded a couple of inches deep with water. It does not look like there is much damage to the interior or to most of our equipment. You can walk out the back door onto green grass and empty clothes lines. I think there should be pictures by now on puebloapueblo.org.

The Centro de Salud, Health Center, or sometimes I call it the Health Department, is right in the middle of town, a 15 minute walk from the hospital. The hospital staff is currently working out of the Centro de Salud.

Today I wasn’t on duty so I mainly caught upon emails. It took me hours and hours and hours. Although I usually love to hear from everyone, I would request that you please not send me emails right now for a couple of weeks. We have met some with the Red Cross. They are really being a wonderful help for Santiago. They have set up chlorinated water stations in all the shelters already and brought in cartons and cartons of medicines. More should be arriving tomorrow (and Jack too!). We have high hopes that they will be able to get us enough to get us through a couple of months.

My current assessment of our needs is:

1) potable water. I think this is covered.

2) A reserve water tank for the Centro de Salud. We were without water today again. That means, unable to flush toilets or wash hands or instruments or wounds etc etc.

3) Food (hopefully covered)

4) Bathrooms With 5000 living in a few churches, the facilities are woefully inadequate. The Red Cross said they would work on it.

5) Showers and facilities to wash and dry clothes.

6) Garbage disposal. Our city dump is beyond the landslide and unreachable. Currently the only garbage pick up is from the shelters. That is being taken a way down the road toward Cerro de Oro and dumped.

7) Mental health Two people have been sent by the government for I am not sure how long.

8) Vaccines Hepatits A is endemic here and most of the adults have had it. But probably the under 5s should all get Hepatitis A vaccines. Did I already write a description of how we treat a case of hepatitis A here? Tell the small child and his Mom that he needs to wash his hands after going to the bathroom and before eating. Smile and send them back to live with the 400 other people in a church building.

9) Gasoline for the cares and boats. The gas company is asking for higher prices than normal to come here.

10) Propane for the stoves

11) Health promoters to talk about washing hands, clean water etc.

12) Houses for 5000 people

13) An answer about the hospitalito. Is it part of the area that is designated a cemetery and unusable? Or can we start to make a plan to reopen it where it is? Or to move to another building?

This morning, I walked down to the lake in front of my house. It has obviously risen amazingly. Usually a tranquil beautiful spot, today there was a black plastic bag filled with ? floating by my feet, and a disposable diaper with a small brown branch floating on top of it. (interesting since almost every baby here is in cloth diapers or rag diapers.

Then I walked out my gate and ran into Ian, who put in the water system at the hospital. He said he took a friend for a sail yesterday, planning to look at Panabaj from the lake but never made it. They found a little boy’s body was floating in the lake. They called and then waited till the bomberos could pick it up. I am told it is normal for bodies to start to float from the gas forming bacteria a few days after they have died. The lake doesn’t seem to lead to tranquility right now.

People keep worrying about how I am doing. Curiously well, I think. In fact, I wonder how I can feel so normal with all the loss. I think it is because we are actually treating few seriously ill or injured people. (This is a people whose women are 90% still wearing the woven embroidered dress they did in the 1500s. They do not go to the doctor, but like home remedies. They accept sickness and death as normal and often do not believe that doctors can change the outcome. So there are undoubtedly lots of people in houses who are ill or injured that we have not seen.) And of the people that I do see, many only speak Tzutujil, so I do not get the full story of what happened to them. And none of the people at the hospitalito, who are the people that I know well, lost family. So I am pretty insulated from all the pain. I did get tears in my eyes tonight when my two year old granddaughter was on the phone and started singing “sing, sing a song……..sing of happy, not sad, sing of good times, not bad…”

7AM tomorrow I will be sitting on a cholera chair and hear the future of the hospitalito.

Bernie Page, M.D.

Email from Dr. Jack, Bernie’s husband

It is Wednesday morning, one week after the mudslide that caused so much death and sadness. It is 11 AM and the sun is burning through the absent protection of hair on the top of my bald head. After being stranded in Guatemala City for 6 days, I finally made it back to Santiago yesterday.

We left the capital at 6 AM in a rented four wheel drive pick up truck. Like every other day, we collected information from the police, the army, our friends in Santiago and professional drivers on which roads where open. As always, we got lots of conflicting information. But we took a shot at an all road route to Santiago avoiding a difficult transfer of our bags and medical supplies from the pick up, to boat, to pick-up. It was not to be. First one road, then another, was blocked by new slides. The ground is so wet, and at least every afternoon, it continues to rain and new slides occurs. Since the people are aware of the problems, few lives are lost or injuries occur, but it further impedes the recovery process. So we were directed to Solola, on to San Gorge and then to the shores of the lake via a one way, total mud ¨road¨ where small boats were grounding themselves onto the shore and when filled taking off for all points on the Lake. My group consisted of a fourth year medical student from the University of Pennsylvania, a new one year volunteer nurse from the US and myself. We shared the boat with a Spanish pastor and his wife working to provide food and medical supplies around the lake and a US psychologist who had been volunteering elsewhere in Guate when the disaster hit. Emotional support and a safe water supply are probably more important than one more US trained medical doctor.

When we got to Santiago we were met by my smiling and very tired wife, Bernadette, Kathy Roach, our volunteer director on nurses and other US volunteers looking to help out any way possible. After dropping off our supplies at our house, the new nurse and I needed to go to the hospital to see first hand what had happened.

The mudslide came out of the night, sounding like a large truck driving by, with feeling the sound more than hearing it. It was 4 AM, still dark outside. People had been arriving for hours at the hospital looking for safety from the pouring rains and rising water levels so the waiting room was full. Suddenly the noise, the vibration and the front doors where smashed open and mud began to pour into the waiting room. Into the corridor, some screaming, some onto their knees praying in Spanish, Tzu´juhil. Almost as fast as the terror spread, the noise stopped. Cautious looks outside the other windows, then doors, revealed mud six feet deep on one corner, no mud on another. The slide had stopped for us at the hospital. Not so for our neighbors in there mud floor, cornstalk walled homes. They were swept away. In fact, the old doctor´s house, built with the initial hospital in the 60´s, was also swept away. Now only a sea of slowly drying mud, tree limbs and garbage. No houses, no dogs, no children; quiet, an occasional bird, but far too quiet. The nurse and I both had tears in our eyes and a sudden inability to talk.

We heard last night that the government is deciding whether to let people reoccupy those buildings left standing and our hospital. Probably we will not be so allowed. There is a strong desire to not search further for the 100´s missing for fear of exposing more of the living to infectious diseases. Totally unthought of by me, there is not guarantee that another slide might not occur now or in the near future. It will continue to rain but hopefully not anywhere near the force of Stan. So tonight I will work my first shift in the Centro de Salud. A good and very simple facility that is usually only open Monday through Fridays, day time only. One of the signs of progress in this town of 45,000 is that there was no thought of not continuing with the access to emergency care for this town that had been without for the last 15 years.

Yesterday the Centro de Salud ran out of tetanus immunizations for the people. Today, in a joint operation by Dr. Gil Mobley from Missouri, American Airlines, the US Army, the US ·Embassy in Guatemala City and Guatemalan authorities we now have tetanus vaccine and hundreds are standing in the hot noon-time sun, patiently waiting their turn. We will also be administering hepatitis A to children under five as soon as we can get back in out mudded hospital and get some needles and syringes! This also brought tears to my eyes to see so many people, working together across international boundaries and languages to bring something so basic but so needed to prevent further damage from the one same disaster.

Part of the reason the top of my head is so sore is the walking around town I did with our Board today seeking other temporary locations for our hospital. We found at least two possible sites. Each is too small, too limited, but better than our shared space at the Centro de Salud and far better than going without. Whether we are allowed to rebuild or not, it will be at least months before we are back in a real hospital.

Time for a nap before I report to work tonight. Love and thanks to all who have provided us so much support. You are the light in the night!

Jack

Bernadette Page

Kenneth Wood

President

Pueblo a Pueblo Inc.

P.O. Box 11486

Washington, DC 20008