A local operating room nurse travels to Central America to work for two weeks in a historic hospital, helping many who have waited decades receive a life-altering surgery. She encounters language-barriers, erupting volcanoes and the culture shock of an underdeveloped healthcare system.
In early February, Tashina Morgenstern traveled to Antigua, Guatemala, a city built around preserved ruins and named one of UNESCO’s World Heritage Sites, to provide medical care to the less fortunate. “It was such a humbling experience,” she said.
Morgenstern and a team of surgical staff under the nonprofit organization Medicos en Accion (“doctors in action”) performed 132 surgeries over the course of two weeks at Obras Sociales del Hermano Pedro, also known as St. Peter Hospital. “That’s more than we would ever do here,” she said.
In Fort Frances, Morgenstern works full time at La Verendrye Hospital, caring for patients before, during, and after their surgery.
She said she already plans to return to Guatemala next year.
Founded in 1981, the hospital is easily recognizable by its 15-foot, mustard-colored walls and intricate colonial architecture. It serves as a medical facility, safe haven for the homeless, church, and tourist attraction.
On her morning walk to the hospital, Morgenstern recalled being greeted with friendly faces and the words buenos días by almost every passing local. Patients were already be lined up down the street by the time she arrived, each of them holding a brown envelope that contained all their health records.
“So all of their bloodwork, any X-rays that they had, any doctor’s letters,” Morgenstern said. “These people have the sole responsibility of making sure that they had all their documents and their envelope and didn’t misplace anything so that they could be seen.”
Patients were charged for the surgery based on factors such as the state of their living conditions, she said, adding that those living in a home with dirt floors would pay less for a surgery.
Expenses remain one of the biggest challenges impacting whether someone can receive medical care, Morgenstern said. When some patients didn’t know they required a COVID test before the surgery and didn’t have the extra money to afford one, the Medicos team looked for creative solutions, in many cases offering to pay for the test themselves.
Amongst the many eye opening experiences, Morgenstern said restocking medical supply shelves was one of them. “Here, you have people that do that, and like the shelves are pretty much always full. So you don’t realize how much you actually use.”
Medicos had shipped about three containers filled with medical supplies to the country before the team’s arrival. Once supplies were deleted, which happened quickly, the team shopped for more at the bodega, wracking up a bill for $10,000 by the end of two weeks.
“That’s a lot of money, right? So we’re trying to use what we had. It was really interesting just to see the difference,” Morgenstern said.
She said that hernia repairs, laparoscopic cholecystectomy surgeries for the gallbladder, and hysterectomy surgeries that remove the uterus were the most common surgeries they performed.
“These surgeries were so life changing for people,” Morgenstern said. “Some of these people had traveled six hours down from the mountain.”
Many patients told stories circumstances that were unheard of in Canada, she said.
One woman in her mid-20s, experiencing uncontrollable bleeding, had been housebound for the past two years until she could finally receive a hysterectomy. In another instance, a man had waited 32 years to have his hernia repaired because he couldn’t afford to take time off from work.
“He hadn’t had it repaired because he had to pay to put his kids through school so he couldn’t afford his surgery or to be off for recovery,” Morgenstern said.
“And so he talked about how he would go to work every day, and quite often his hernia would pop out, and he would just pop it back into place and keep working. But now that his kids have finished school, he could afford his surgery and afford to take the time off to recover from it.”
“It was hard to come back. You know, I know what I do is valued here, too, but it was just such a different feeling doing it there where you see these people who just have so little coming for their surgeries.”
“For me, [walking in the operating room with one of my patients] was a really emotional moment because it was an older lady. And you know, we don’t speak the same language, but she knows that I’m there to help her. And she just so trustingly took my arm and held onto my arm and allowed me to walk her, knowing that I was there to care for her,” she said.
Morgenstern recalled a funny moment when one of the volunteer nurses from Winnipeg, who is originally from the Philippines, discovered a hidden superpower on the second day of the trip: she could speak near-fluent Spanish. “She’s like, ‘yeah, our dialect in the Philippines is very similar and a lot of words are the same. And I didn’t know I could speak Spanish until I got here.’”
When a patient became unresponsive post-surgery, the Medicos team “ran a code,” a process involving CPR to try and bring the patient out of cardiac arrest. At that moment, the language barrier added another level of stress to the situation, Morgenstern said. “We’re trying to speak to the Guatemalan staff whose English isn’t the best and figure things out.”
Before leaving Canada, Morgenstern had a friend in Fort Frances, a Guatemala-native, help translate common phrases that she often used in the operating room. Phrases such as te veo cuando despiertes (“see you when you wake up”) and te vamos a cuidar (“we’ll take good care of you”) were scribbled on a small paper, tucked safely in her back pocket.
“When I would forget, I would just be able to pull it out of my pocket quickly and look at it and say my little phrase to the patients. And I don’t know if I was saying things 100 per cent correctly. But it always seemed like it was appreciated, you know, they’re smiling when I would say these things.”
Every second was a learning opportunity, Morgenstern said. She picked up tips and tricks from the volunteer nurses who each had a different way of doing things from their respective hospitals.
During one of their last nights in Antigua, Morgenstern coincidentally reconnected two former colleagues at the team’s going-away dinner.
While chatting about laparoscopic instruments to Dr. Hardy, one of the volunteer surgeons, Morgenstern mentioned a former colleague and retired surgeon named Dr. Spencer who had first introduced laparoscopic surgery to the Fort Frances area.
“He practiced over 125 times before he did it on a real person,” she said. “And then … [Dr. Hardy] piped up and said, ‘Do you mean Jas Spencer? I did a two week residency with him back in I think it was 1985.’”
“It was like, ‘oh my goodness, small world! So he ended up writing a letter for me to bring to Dr. Spencer. So I was able to reconnect the two of them. That was really neat. And Dr. Spencer was quite pleased to get that and then emailed Dr. Hardy right away.”
At the end of each work day, Morgenstern said she enjoyed sitting by the hotel pool watching through a pair of binoculars the Fuego volcano erupt from not too far away. “Sometimes you could hear them and like a couple of times they rattled the windows at the hotel while we were there. And you could see them putting off little poufs throughout the day. That was pretty neat,” she said.
Lately, towns across northwestern Ontario have faced difficulties in retaining healthcare staff. Morgenstern said that the only general surgeon in Fort Frances has been gone since mid-February, around the time when she returned from her trip.
“All last week, we didn’t have a surgeon so if there were any emergencies, they would have had to be flown to Thunder Bay,” she said, adding that she was currently working on-call at the time of the interview and that if her support was needed for an emergency surgery, the hospital would notify her through her big pager “like in the 90s.”
As a temporary solution, locum surgeons stood in for the role one week at a time.
“I think a lot of times we take for granted what we do have for healthcare. I know at times it is frustrating. We have to wait for different tests and procedures and wait times are extra, extra high these days. But you know, more or less when we need something, we’re able to get it. We’re not waiting 32 years, or, you know, young women are housebound, because they’re having such issues with their reproductive systems, things like that,” she said. “That would never happen here.”
Upon hearing that the current locum surgeon was from Whitehorse, Yukon, Morgenstern asked her if the locum knew about the Guatemala trip, mentioning that several volunteer nurses on the trip were also from Whitehorse. “And [the surgeon was] like, ‘oh yeah, I told them about Guatemala. I was there in 2018.”
Morgenstern said she was surprised once again at how small the world seemed at that moment.
“[I give] a big, heartfelt thank you to all who donated towards my mission,” Morgenstern said.
She added that she is grateful for sponsorship from the Ontario Nurse Association.
Obras Sociales del Santo Hermano Pedro, while founded in 1981, was originally established in the 1600s by Dominican friars. Over the centuries the hospital was destroyed by earthquakes and rebuilt many times.
Morgenstern said she plans to brainstorm more fundraising ideas for the Medicos en Accion mission trips and for newer equipment at Obras Sociales hospital, which from the looks of it, will continue to serve the most underprivileged for centuries to come.
