Monthly Archives: May 2011

Susan Dean Returns from Guatemala, Reflects on a Job Well Done

So now the team is back home and what have we learned?  A few facts about Guatemala:

  • The average Guatemalan gets 4.1 years of schooling.
  •  Only 30  percent of the population pays taxes.
  • Public school is free, but students pay for their own books.
  • In Antigua, Guatemala, the average family has two or three children; in the villages, however, the average number is eight per family.
  • This is chronic malnutrition in Guatemala; in fact, worldwide the three most malnourished countries (in order) are Afghanistan, Yemen, and then Guatemala.

…and what have we learned about the Obras Sociales del Santo Hermano Pedro, the hospital where we worked?

  • It is the home of over 250 people.
  • More than 250,000 people are served here annually. They are the sick and the poor.
  • The hospital was destroyed in 1976 and rebuilt with a greater vision. Programs now include education, recreation, and social programs for students.
  • The hospital now has a nutrition recuperation center.  Patients stay for 1-3 years, or for as long as they need to stay. Parents come into the hospital to take care of their children.
  • The hospital has a daycare program, allowing parents to work outside of the home.
  • Outpatient services are provided. They include colonoscopies and substance abuse programs.  Special cervical cancer screening tests are also done.  Sadly, cervical cancer is the leading cause of cancer-related deaths for women in Guatemala.
  • An audiology department is being built!

So the way I see it,  we are part of a growing, and incredible hospital and outpatient clinic….and this hospital is a part of me.

So, I invite you to join us some time on a “health care trip” and see how it changes your world!

Susan Dean, MD
Kaiser Permanente San Francisco Medical Center

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Susan Dean Writes From Guatemala: Renewal for Patients, and for Caregivers

 May 2

We started surgery today.  There were two gorgeous babies (girls) today who had their cleft lips repaired. The parents were super happy with the results. These will be perfectly normal babies…with beautiful brown eyes!

They get to all of us.  On a sad note, a 35-year-old woman came in hoping we would help her have babies, but the laparoscopic surgery found so much scar tissue and we could not help her.  Children are really valued down here.

I am pooped.  We started really early!!

More updates to come. Need a Guatemalan latte.


 *   *   *

May 3

We have been starting our mornings with inspiring devotionals surrounded by beautiful blue sky and active volcanoes.  Today we heard the story of the wealthy father who took his son to see how a poor family lives.  On the way home the father asked his son what he had learned about the poor family.  The son responded: instead of having one dog they have four; instead of walls around the house to protect them, they are surrounded by the horizon; we have a pool that goes to the middle of our yard and they have a creek that runs forever; we buy our food and they grow what they eat; instead of having walls, they are surrounded by friends.  Then the son adds ¨Thanks Dad for showing me how poor we are.¨

This mission gives me many moments to realize what life is really about. The Guatemalan patients trust us and give us a reason to be grateful to be here.  The Guatemalans, who don’t have much, are a happy people showing us how we have forgotten the most important things in life. Rich or poor is not dependent on money. Personal wealth is not measured in money.

Today, while doing cases, we were told we needed to finish and stop operating because we were losing power.  Power at the Obras went out at 4 a.m. so the generator switched on. Then the generator overheated. The OR was using up too much power and the generator could not keep up with the demand.  Our hopes were dashed.  We want to do as many cases as possible.  Now the plan is to work late the rest of the week so that all of the scheduled cases will get done.

This is what happens when you are in a third-world country.

By the way, the seven Kaiser Permanente team members are:

  • Rachael Schering, MD anesthesiologist, Kaiser Permanente Santa Clara Medical Center;
  • Gordon Haddow, MD, anesthesiologist, Kaiser Permanente Santa Clara;
  • Robert Karoukian, MD, anesthesiologist, Kaiser Permanente San Francisco Medical Center;
  • Paul Preston, MD, anesthesiologist, Kaiser Permanente San Francisco
  • Tracy Liu, RN, Kaiser Permanente San Francisco
  • Margaret Petrie, RN, Kaiser Permanente San Rafael Medical Center.
  • And me!

I will try to send more pictures soon!

Take care,


May 4

We all wondered what we would find in the OR today.  Would we have power?  Would we be able to operate?  We all just knew we were here to do whatever was possible. We don’t know if we will be able to regulate the temperature in the OR tomorrow, but we know we have a full day.  We will do our best to help as many people as possible.

I will write more tomorrow; today, the computer connection is bad.


May 5

We started our morning with a special,  non-denominational chant/song. Looking around this outdoor room one could tell what the group was thinking, meditating and contemplating. All of the words and the Kleenex and sniffling gave it away.  The song reminded us how we had connected and “heard” the Guatemalan people we had met. We were there for a reason. We could empathize with these people.  They weren’t strangers anymore. We are here to offer them the best of us. We realize that these people are poor and have no understanding of the medical system. They don’t understand what their procedure entails or the healing process, and yet they give us their complete trust in allowing us to treat them.

The group is smiling yet tired.  What is making us get up at 5 a.m. to get to the operating room?  (Could it be the great Guatemalan coffee that is waiting for us?)

We are all inspired. We are not just here alone; we are surrounded by each other.  The people that we care for are so different from us yet we are the same in so many ways. We are all inter-connected.  Our patients come in scared and nervous, realizing that something bad could happened to them and nothing is in their control. We can hold their hand and use what we have learned to help them.

As the doctors make morning rounds, we find our prayers have been answered; our patients are doing really well.

May 6

Good morning,

All of our surgeries have been completed. Seventy six patients have been treated.  More than 80 procedures have been done. Our team has learned a lot: We each carry part of the world within us.  When we change the world, we change ourselves.

Getting outside of our routine, day-to-day experiences and having the opportunity to do this work is a renewal of the spirit. Some people concentrate on their bodies with classes and retreats. We, on this team of 40, have found this same type of renewal through caring for patients. We give to the Guatemalans medical treatment and hope, and receive back renewal hope and love. We are lucky this team needs people that translate, people that enjoy cooking, recovery room nurses, operating room nurses, anesthesiologists, and surgeons. This allowed us all the opportunity to have this experience….and what a life-changing experience it was!

Susan Dean, RN
Kaiser Permanente San Francisco Medical Center

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Susan Dean Shares Impressions From Guatemala

Susan Dean is a nurse manager at Kaiser Permanente San Francisco Medical Center.  She’s currently in Antigua, Guatemala, as part of a medical team with Faith In Practice, a nonprofit organization that provides continuity of medical care to the poorest of Guatemala. This is Susan’s fifth consecutive year serving on a Faith In Practice surgical mission.  She sent along this dispatch. We’ll publish subsequent dispatches as she has time to send them.

May 1, 2011
The team arrived safely in Antigua, Guatemala … some from the Bay Area, others from Chicago, Oregon, and Ohio.  Seven are from Kaiser Permanente! All of us are looking forward to doing a lot of cases.  The expectation is to do 80 cases this week…plastic, gynecology, and general.

Lots of children were in the triage area, some for hernias and others for clefts.  We heard a very interesting presentation by a man named Jose from Faith In Practice. Jose was a patient found by a village team and brought in for surgery.  He’s so grateful for the care he received that he spoke with some of the FIP team and ended up working for FIP as an assistant to the Obras director.

We spoke about why some of us are here.  We are grateful how the patients trust us; we feel privileged to be able to come and care for them. We are all traveling out of our comfort zone and feel an obligation.  It is a privilege to come to Guatemala and participate in this mission.

Our intent is to bring the same high quality of care that we give at home, here — just in a different setting. We will be doing time outs and debriefing just like we do at home. Patients are checked and double checked.  Lab work is checked.

But it’s definitely different than home. More than 75 percent lives in poverty here, making $2 a day.  The infant mortality rate is 25 per 1,000 in Guatemala; in the United States it is 6 per 1,000.

Faith In Practice expects to serve 25,000 patients in 2011. That care will be delivered for 16 weeks by FIP personnel; for the rest of the year, it’ll be delivered by volunteers like us from around the world.

Here’s a photo gallery for our team.

Take care,

Susan Dean
Nurse Manager,  APC1, APC3 and HIV/AIDS Module
Kaiser Permanente San Francisco Medical Center

Dr. Sarah Beekley’s Work in Kenya – With Her Three Daughters

Note: Sarah Beekley, MD, a pediatrician at Kaiser Permanente Redwood City (Calif.) Medical Center, volunteered late in 2010 at a clinic in Matibabu,  Kenya. The clinic is endorsed by The Permanente Medical Group. While many TPMG physicians have volunteered at the clinic, Dr. Beekley brought along her three adult daughters — Anjali Joseph,  Jenna Hahn,  and Lauren Joseph — who volunteered in the village while Dr. Beekley worked at the clinic.

The Matibabu clinic provides medical and community health services to rural families in one of Kenya’s poorest regions.  Though a tight-knit and resourceful community, the children suffer from the lack of clean water, poor nutrition, and a high rate of communicable diseases.  A large number have been orphaned by HIV. Most have to leave school before their teens. Nearly every child brought to the clinic with fever had malaria and many had secondary infections or profound anemia.

Each of the three Matibabu doctors sees 50-plus patients a day, and I had to work hard to keep up.  I quickly learned the basics of tropical medicine and the limits of working without sophisticated equipment. The clinic is fortunate to have some basic diagnostic equipment, health educators, and a small pharmacy on site.  Despite this, there were the daily frustrations of working without the equipment that I routinely took for granted at home, such as a head CT for the young boy with a probable brain tumor, or a cardiac echo for the young girl in congestive heart failure.   Tests are not cures,  however, and regardless, these families had no resources for treatment.

My greatest, and unexpected, reward was watching how enthusiastically my daughters adapted to the new culture, and how creative and resourceful they were in contributing to Matibabu’s work. Jenna and Lauren put together a plan for a children’s center designed to attract young families and designed the content for a year of educational events. One of these events was modeled after Kaiser Permanente’s own educational Teddy Bear Clinics. They also translated information on sanitation and hygiene from English into the local language of Luo. They then distributed soap and educational material and performed demonstrations to both small and large gatherings in the community. Anjali worked at the Youth Center, continuing the work of a previous volunteer who had inspired a group of teens to write and perform a peer-to-peer play dealing with alcohol and substance abuse. She also took the initiative to design a handbag using the beautiful batik fabrics of East Africa. The three girls then kept the majority of seamstresses in Ukwala and at Matibabu’s vocational training program “Stitches for Change” busy sewing these bags.

My daughters, and the Kenyan youth they worked with, reminded me not to underestimate the ability of young people. Rather, my task now is to help find new challenges for them!

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