Small victories.

Byline: Tim Christie The Register-Guard

EDITOR'S NOTE: The Eugene-based Cascade Medical Team spent six days in Barillas and the surrounding countryside helping indigenous Guatemalans. Today's story picks up action on the fourth day of the team's mission in the country's western highlands.

BARILLAS, Guatemala - Even for the most skilled, caring doctors, practicing medicine in rural Guatemala has its limitations.

Surgeons repair hernias, do hysterectomies, fix cleft lips and palates. Ophthalmologists remove cataracts. The operations can bring about profound changes in a patient's life.

But family doctors, pediatricians, nurse-practitioners and physician assistants face a different challenge. They see people complaining of aches and pains and rashes. They examine, listen, ask questions. And often, all they have to offer is Tylenol, multivitamins and an encouraging word.

The limitations are even more pronounced on the daily "out trips" to aldeas, or villages, in the mountains surrounding Barillas. Each morning, 10 or 12 members of the Eugene-based Cascade Medical Team, accompanied by Guatemalan soldiers and staff members from the group's parent organization, pile into the back of a pickup and an SUV and drive to one of the rough villages.

On this first Thursday in April, the day's team of doctors, nurses, interpreters and helpers leave Barillas around 8:15 a.m. After a 45-minute drive, the last half on a one-lane jeep track, the away team arrives in a dirt clearing marked by two soccer goals and a cluster of shacks: Aldea San Felipe Sakchen.

Verdant hillsides, covered with coffee and banana plants, surround the village. The only sounds are birds chirping, roosters crowing and the faint strains of marimba music from somewhere on a hillside.

The village is home to about 30 families. Another 300 people live in surrounding villages. A man in a blue ball cap blows a whistle and soon people begin congregating in small groups under a cloudless sky as the day heats up into the 90s.

Even in this remote outpost, American culture has crept in. Men and boys pledge allegiance to the Yankees and 49ers, Reebok and Calvin Klein, Stallone and Van Damme on their ball caps and T-shirts.

Three doctors - Doug Bailey, Peter Howison and Larry Dunlap - set up their clinic in a one-room schoolhouse that has a corrugated iron roof, rough-hewn wood siding and dirt floor.

Howison spies a big chalkboard on the back wall and writes, "Bien Venidos de Oregon, USA": Welcome from Oregon. Then he and Dunlap collaborate on a crude drawing of a bird, which sort of resembles a duck. To make sure there's no confusion, Howison writes, "Los Patos."

Outside, people wait in line to see Sgt. 2nd Class Lilian Antonia Rivas Lopez, one of three Guatemalan soldiers providing security on the out trip. Rivas Lopez writes down each patient's name, age and complaint on a white slip of paper. She hands them a dose of worm medicine to combat the parasites endemic to rural Guatemalans.

Inside the schoolhouse, each doctor sits with an interpreter and a table supplied with medicine, sanitary wipes and tongue depressors.

Bailey, a family doctor from Junction City, checks out 42-year-old Andres Pelo, who lost two fingers on his right hand long ago in a sugar cane machine accident. He's now complaining of total body ache from heavy, hard work, he says.

Bailey examines him, touching different parts of his body, asking, "Le duele?" Does it hurt? "Si, aqui," Pelo says.

Bailey gives him Advil for the pain and vitamins.

"We're seeing mainly hard-working people with headaches and stomachaches and back pain," Bailey says.

At the next table, Howison is checking over 16-year-old Juana Maria and her 11-month-old boy, carried in a sling on her back. The boy has a fever and cough.

Howison, a family doctor from Dunes City, feels the boy's back, and he starts crying. The doctor puts a tongue depressor in his mouth; the boy howls. His mother complains of body aches and stomach pain. Howison feels her lymph nodes. He gives her antibiotics for the baby, and antacid and vitamins for herself.

At the next table, Dunlap, a semi-retired emergency doctor from Eugene, cuts a wart off a woman's foot and uses gauze and duct tape to bandage the wound.

Dunlap says the doctors' visit provides the people with at least "a temporary boost."

"The other thing we do is we put them in contact with the rest of the world," he says.

"Hope it's not the last team"

Guatemalan doctors don't come to this village, and it's been two or three years since an American doctor visited. When people get sick, they go to Barillas.

The people "are happy and thankful because these guys come to help the people," says Gaspar Baltazar Francisco, a village leader. "They hope it's not the last team to come see them."

The town was established only about five years ago. Its main industry is cutting firewood.

The school is shut down because the teacher left when teachers across Guatemala went on strike last winter. Though the strike is over, the village committee hasn't hired a new teacher "because everyone is working," Francisco says through an interpreter.

After lunch, the team presents the village leaders with a bright red soccer ball donated by Nike. In short order, a pickup soccer game is under way on a bare dirt pitch between two netless goals fashioned from timbers.

Dunlap and Howison, joined by kitchen helper Nancy Hughes, Helps International staffer Marco Antonio and two of the soldiers, face off against the villagers. It's a spirited game: Howison tumbles to the ground after colliding with another player.

The game ends when Antonio unleashes a powerful shot that soars over the top of the goal and into a stand of trees. Final score: Villagers 2, Cascade Medical Team 1. The doctors go back to work and the men and boys of the village keep playing.

At 2:45 p.m., the team climbs back into the pickup truck and heads for Barillas.

"Highly subjective" medicine

Back in Barillas, people wait in long lines to come into the team's general medical clinic to get help with various ailments. Inside, 50 or 60 people sit and stand in the waiting room, watching a Spanish-language video about the life of Jesus, provided by Helps International, the nondenominational Christian organization in Dallas that sponsors the trips.

In many cases, they simply want the comfort of having an American doctor hear their complaints and examine them. And they expect to receive free medicine when they leave: ibuprofen, antibiotics, vitamins, worm medicine, cortisone cream, something.

Earlier in the week, Dr. Jerry Dayton, a 71-year-old retired pediatrician from Eugene, sat in an exam room and listened to a 12-year-old boy describe his problems.

About two years ago, the boy says through an interpreter, he was running down the street, looking backward, when he ran into a wall. Ever since, he feels pinching pain in the back of his head, running down his arms, and he has headaches. He never saw a doctor.

Dayton asks questions and learns: no seizures, no dizzy spells, no vision problems. Dayton listens to the boy's chest with his stethoscope and looks in his ears, eyes and throat.

Finally he asks the boy, "Are you smart?"

"Just a little bit," the boy says.

"You look pretty good," the doctor says.

Dayton gives him some adult vitamins and tells him to cut them in half.

"He doesn't seem to have any bad things going on," he says after the boy leaves. "There was no substance to his complaint."

Dayton says practicing medicine here is "highly subjective."

"People want to be seen so they come up with symptoms," he says. Sometimes they list 10 different symptoms.

"With clinical care, we see people but we don't have any long-term contact. We see a number of things that have been let go a long time," he says. "We do as much as we can within the circumstances."

The setting is better suited to surgery, Dayton says.

Up the hill at the hospital, Dr. Bill Day's most common surgery is hernia repairs. The people lead hard lives, and the strain of carrying heavy loads of wood and coffee beans takes a toll on their bodies. Dr. Tom Dreyer, a plastic surgeon from Eugene, repairs numerous cleft palates and cleft lips, as well as burn scars. Dr. Debra Dotters, a gynecologist from Eugene, does mostly hysterectomies, as well as tubal ligations and cyst and tumor removals.

Many Guatemalan women need hysterectomies at a relatively young age because they have prolapsed uteruses - their uteruses have fallen and are hanging out of their bodies. Dotters says that's caused by having numerous children and carrying heavy loads.

Uterine prolapse is rarely seen in the United States, and when it is, it's usually in elderly women, she says. The surgeries Dotters is doing in Barillas involve not just removing the uterus but putting other parts of the women's pelvic structures back in place.

By late Thursday afternoon, team leaders are trying to wind things down, but not before encountering a few more bumps in the road.

The condition of Marta Esteban has worsened. Two men carried the 17-year-old woman on a chair for three days to get to Barillas earlier in the week. Her appendix burst and she had surgery Tuesday, but the massive infection in her abdomen requires continuing care.

Doctors and Helps officials decide to fly her to a Guatemala City hospital that afternoon. Her temperature, her respirations and her pulse had all increased, indicating the infection in her abdomen was still bad, says Valorie Schuelke of Eugene, one of the nurses supervising the recovery room.

"She needed care beyond the time we'll be here," she says. "Things can go either way with her."

Focus on what's possible

That night back at the hotel, some team members start to show frustration. Bill Knight, a Eugene facial and jaw surgeon, questions what real good he's doing after spending the day in the dental clinic.

"I'm not solving anything. It's just a temporary reduction in their discomfort," he says. "We're treating symptoms rather than treating causes. The people waiting in line for dental care are eating candy and soda and they never brush their teeth.

"We're shoveling sand against the tide."

That's a common challenge for first-timers, says Steve Miller, Helps president.

The group's philosophical bent is to focus on surgeries, but primary care physicians fill a vital role by referring surgical candidates to the surgeons.

The work they do in examining patients, dispensing medications and providing reassurance is critical as well, he says.

"Their other role is to be the only kind hand these people have ever seen, and to make them have an appreciation for medicine they haven't had before," he says.

Bailey, the Junction City family doctor, says physicians are able to help most of the people they see.

"It's not frustrating, but we have limitations," he says. "There's definitely a lot of good we're doing. But the ones that stick out in your mind are the ones you can't help."

Dr. Charlie Radebaugh, a retired optometrist who practiced in Cottage Grove and now lives on the Olympic Peninsula in Washington, says it's important for doctors to focus on what's possible.

"You see so much that is devastating," he says. "The best you can do is provide the things you're able to and let the other things go by the wayside, even though it doesn't make you feel very good.

"The things you can give them is a heck of a lot more than they have now. You can't be hung up on the things you can't give them."

Next: A 3-year-old blind and deaf boy arrives in Barillas, and a doctor overcomes his doubts to perform cataract surgery in the hope of giving him limited vision.

CAPTION(S):

Dr. Peter Howison checks over 16-year-old Juana Maria and her 11-month-old boy as the message `Bien Venidos de Oregon, USA' lets patients know where the doctors are from. He and other physicians visited rural areas to try to expand the medical team's perimeter of treatment. Many residents of the small village of Aldea San Felipe Sakchen came for help when the Cascade Medical Team set up a one-day clinic. Thomas Boyd / The Register-Guard Austrian dentist Peter Schopf pulls teeth outdoors in a remote village an hour's drive from Barillas as boys watch from a distance. Rural residents in Guatemala get little dental treatment. A Guatemalan man holds a sleeping child as he waits to see a doctor at the clinic in Aldea San Felipe Sakchen, a small cluster of shacks housing about 30 families. A mother gives anti-worm medicine to her child at the one-day clinic that the Cascade Medical Team set up in the village of Aldea San Felipe Sakchen. Thomas Boyd / The Register-Guard Dr. Larry Dunlap (front) and Dr. Peter Howison play villagers in a quick game of soccer after a new Nike soccer ball was presented to the village leader. Please turn to VICTORIES, A7 Victories: `Shoveling sand against the tide' Continued from Page A6