This year's Street Medicine Symposium will be held in San Juan Puerto Rico. Taking this opportunity, I would like to introduce the Puerto Rican hosts of the symposium which I had the great honor to meet and work with during their yearly missions to Guatemala. When I met Dr. Chaco at the Houston’s Street Medicine Symposium I expressed my great desire to work abroad in third world countries. Without any hesitation, he invited me to join his crew "Iniciativas de Paz" on their annual mission to Guatemala to provide medical services to the indigenous community of Caribe Tzul in the highlands of the Petén region in Guatemala. How could I have refused? To do field medicine in the third world was what ignited and has sustained my desire to become a physician. It didn’t matter if the trip was in ten days and I was in the middle of my school exams and economically incapable to travel, I went. Ten days later I was in Guatemala City awaiting the arrival of the crew. I had no idea that these would be some of the most incredible people I was yet to meet in my life and that they would take me to such a tremendously remarkable place.

It was evening when I first met them in the capital. They had brought their own medicine and supplies from Puerto Rico. We spent the first night in a hotel in Guatemala city packing and preparing the equipment, supplies and the food for the 13 hour journey. The next day we woke up early and we packed whatever else needed to be included and departed on the long journey. We left the city and started up through the mountainous jungle, the entire trip the extraordinary scenery was out shined by the laughter and song of the Puerto Ricans. They were joking and singing along the whole time, although everything was overwhelmingly new, they welcomed me right into the group. The last few hours of the journey we were driving through dense jungle into a place far more remote than I had expected. When we arrived in the small village at night the crew had no concern for hiding their emotions. The clinic that they had been trying to build for five years was finally complete and they where seeing it for the first time. There were tears and celebration as they toured the brand new 5 room clinic and unloaded the supplies. There was no room for us all to stay in the village so we had arranged to stay in the church of a town two hours drive away. We could have stayed in a hotel but instead we slept on the floor of the church in sleeping bags. The group leader Dr. Chaco had arranged it this way because it was his philosophy that when working with the poor we must feel and understand how they live to do the best work. It would not be the same if we stayed in a comfortable hotel with hot showers every night. Plus, we could buy medicine with that money, it would be hypocrisy to stay in a hotel, Chaco said. So we slept on the cold church floor and the next morning we drove to the village and I got to see in the day light exactly what the village looked like and the challenge that lay ahead. The clinic was most formidable structure in a village of mostly hut like homes, and around was wrapped an astonishing line of hundreds of brightly dressed villagers. It was extremely hot and humid with dark green jungle all around.

             I knew that the work would be demanding but I had no idea. We set up five stations the first being the triage, next the dental care, then the general practitioners, the pharmacist, and finally the pediatricians. Each member of the group had their stations, there were 14 of us in all, 7 being physicians. In the triage sat me, Dr. Chaco, and Hector, doing vital signs and rapid assessment for each of the people that made up the long line of hundreds, we would send each person to the appropriate station. The dental station was the dentist Liliam Ortiz and her husband Ariel Rodriguez. The next station was manned by the general practitioners; Dr. Joe, Dr. Hector Velez and his wife Dr. Ivonne, and Dr. Felix Matos, the pharmacy was run by pharmacist Mariela Guzmán Vales and Tomas Ortiz who works for Base-X and on previous missions had provided the working shelter and the portable clinic. In Pediatrics where the pediatricians; Dr. Omar Ortiz and the resident Dr. Michelle Gomez. The heart of the whole operation however was Yoly Cabassa who coordinated the whole operation, managing finances, arranged to buy the medical supplies, food, and transportation, she was the foundation of the operation. She was indeed the person  that gave me beside the information of the organization, arrangements and the history of their work, also a great and warm friendship which I do cherish as one of the greatest experiences of my life.

Each day the sun beat down hard on the humid village. The line of people coming from far and near was already an endless snake by the time we would arrive in the early morning. It was indeed a daunting prospect to behold. Handling all those people, many of whom were afflicted by serious conditions was overwhelming to think about but as soon as we started into the middle of it there was never time to reflect. We were only going to be there for a few days and there were hundreds to see and treat each day. Most of the patients were women and children with parasites, skin infections and mild flu. It is a nonstop and truly exhausting feat that the Puerto Rican crew handles ever year in Guatemala. The conditions were unbearably hot and humid. On a particularly hot day three of the crew lost consciousness from the exhaustion and heat. All of a sudden we were six crew members short, the three sick ones and three physicians taking care of them. Working with these people I was allowed access into a world of celebrated devotion. The effect the doctors had on me was the stoking of a fire that I have had inside me since I was a child. The joy and dedication that these people bring to medicine is something that, if one has the chance, is a marvel to see. During the trip I got to know all these amazing people, here I will tell some more about a few of them. 

Meet Dr. José A, Vargas Vidot

Everyone knows Dr. José A, Vargas Vidot as Chaco. As a matter of fact, he does not like to be called a doctor but just simply Chaco.  Chaco told me, that it was at a very young age which he recognized he wanted to pour his heart and soul into the impoverished, underserved and unprivileged communities. Having struggled through his childhood, living in the streets and in poverty, Chaco understood suffering first hand. It was the neighborhood doctor who sparked the humanitarian desire in Chaco’s heart by caring for him, offering  a kindness and love that none else had done before.   That was the first time he was introduced to great human generosity, altruism, kindness and compassion which would inspire him. Chaco, made a promise to himself; that he was going to give back to the world the care and love he had received. In the nights when he slept out on the pavements and beaches, it was the voice from within that gave him hope, company, strength, comfort and endless imagination. Chaco followed it and found himself fighting for the voiceless people. The ones that no one wanted to care for and the world did neither tolerate nor noticed. After finishing medical school in the Dominican Republic, Chaco returned to Puerto Rico in 1987 to keep the promise of taking care of the ones that no one else would. Upon his return, he started an “underground clinic” which did outreach work and was in violation with the Puerto Rican laws at the time for needle exchange. The clinic, called “Iniciativa Comunitaria” helps injecting drug users (IDUs) who are often discriminated against at clinics and hospitals.  This outreach team was one of the first medical team to provide medical support, methadone treatment and needle exchange programs, which have proven key to lowering transmission rates of the AIDS epidemic. As time progressed, he continued tirelessly and consistently helping the IDU community of La Perla, one of the island’s most dangerous slums. The needle exchange program is the islands only needle exchange group which continues to save lives by setting out buckets for ID users to drop their used needles and in exchange get clean ones. This program however, was not an easy idea to put in practice. The needle exchange program is one of the most controversial tactics for curbing the spread of the AIDS epidemic. Dr. Chaco still struggles with accusations of fostering drug abuse and sanctioning criminal behavior. But Chaco by using his power of faith has been capable of overcoming these barriers. He insists that through needle exchange program, efforts are made to prevent the spread of a fatal disease before it engulfs addicts’ sexual partners and children. In Puerto Rico, in contrast to the United States where the primary means of transmission of AIDS is sexual contact, more than half of the HIV cases are infected through drug abuse with needles. Another large percentage of new cases are among those who have had sexual relations with infected injecting drug users.  He was faced with staggering obstacles and no support for his dream, however he never stopped caring for the IDU community of La Perla. He couldn’t save their lives, but he could improve them. He proceeded to build a system of services that would include treatment facilities, a pharmacy and later a group of residential homes for recovering addicts. The Community Initiative was officially created in 1992.  Besides being the Executive Director of “Iniciativa Comunitaria” and teaching in the University of San Juan he also finds time to work in third world countries. About 6 years ago he formed “Iniciativas de Paz” and with only a few colleagues from Puerto Rico, went to provide medical treatment where there was none, in one of the poorest communities of Petén Guatemala. Chaco, who feels most at home in the world when he is among the poor, immediately fell in love with the community and promised them a medical clinic they could not even dream to have. Five years later after long economical, mental and emotional struggles Chaco and his “Iniciativas de Paz” brought to life “Bantioch” clinic. The name comes from the Quiche’ language and means “thank you”.  Chaco chose this name to express his gratitude to all the people that trust their lives in the hands of the doctors. I was there when the crew arrived and saw the clinic for the first time, it was a time of tears and embraces.  The inauguration of their dream come true.  To Chaco this was not simply a clinic but far more than that, he called it “ Un revolucion de amor, una clinica de fe y un puente de esperanza” (a love revolution, a clinic of faith and a bridge of hope) . Chaco’s quest may be difficult for those around him to understand. However, Chaco still strives pouring his energy and joy to spread love and by doing so, to prove something that not many are prepared to believe. The world might not be ready for the type of transformation and love he strives and the actions he provokes but I guess this is both his gift and his curse. The gift to connect with the universe and the world through a compassion that is beyond normal human understanding, but at the same time the curse to be so utterly alone and disconnected from mankind because our world does not understand love the way he does, for him as he said it, it is something that exists in the universe, free, unconditional, effortless, perpetual, constant, consistent, and permanent.

 Meet Doctor Lili

This is not her first mission with “Iniciativas de Paz” in Guatemala, the young and extraordinarily hard working Dr. Lili has participated before and still eager and determined to serve this community. The first thing one notices when meeting Lili, is her remarkable beauty. Not only she is striking and full of sensuality but also energetic, intelligent, bright, fun to be around and full of love. She is the only dentist at the clinic. The first room in the clinic goes to her. As Ariel, her husband, helps her to arrange the supplies and  equipment, she gets ready to assist as many as 100-150 patients each day. Chaco says that when Lili does outreach in Puerto Rico with  “Iniciativa Comunitaria”, she places a chair anywhere in the streets wherever they might be, pulls out her tools and start pulling teeth, filling teeth, and other dental work to the injecting drug users. To see her work is astounding. She has strength and dedication that is unimaginable. But beyond the hardworking confident, strong, sophisticated and intimidating doctor, resides a nurturing and soft woman that has much love, compassion, and kindness to give. She is a healer,  Wherever she walks and whoever she heals, she gives out a light, as a green torch of fire, lightening the lives and worlds of whoever she touches even if it is for a very short period of time.     

Meet Dr. Felix Matos