Editor's note: Will Lowrance, M.D., a third year urology resident, traveled with the group to Guatemala for his first international medical trip, and kepts a journal of his experiences.

Will Lowrance, M.D., and a patient

Feb. 4 - We arrived at the hotel in Guatemala City today - it couldn't be nicer. Travel was a breeze. The group is getting to know each other and the Shalom Foundation staff has been outstanding, making everything very easy. I can't wait to see what the clinic has in store for us tomorrow.

Feb. 5 - Today was a clinic day. We saw between 50 and 60 kids today, some from more than 300 miles away. The clinic was about 20 minutes from our hotel. It is owned and run by the Guatemalan Pediatric Foundation. There were at least 20-30 families there waiting patiently - kids were running around everywhere. We met the staff and then were shown to an exam room. We began seeing the children while one of the staff translated for us. The patients had a large variety of urologic conditions.

A very nice family came into the exam room with their child, Wanda, wrapped in blankets - I couldn't see any part of her. I pulled back the blanket and was shocked, to say the least. She had severe hydrocephalus (increased fluid within the brain), was blind (you could only see the whites of her eyes) and could hardly move. She was there to see us because of repeated urinary tract infections. She had a neurogenic bladder with severe urinary reflux. Her parents spend much of their life caring for their 12-year-old daughter. They live 30 miles outside Guatemala City and have little money and minimal heath care access. Obviously, we wanted to help as much as possible.

The second patient was a 5-year-old girl named Mia who was with her mother. She was unbelievably cute and immediately gave me a big hug and a kiss and said, "Thank you for coming to Guatemala to see me." She had a left sided kidney stone but otherwise was just fine. She and her mother were so appreciative and we all got our pictures taken together. All in all, it was a spectacular day with wonderful kids. Tomorrow should be a real adventure.

Feb. 6 - Today was a big day - eight cases. One of the procedures was on Wanda. Her parents were very worried about her.

Will during games at the Shalom school.

They paced up and down the hallway outside of the OR waiting for her surgery to finish. The case went well. We then went out to talk to the family. They were quite emotional, extremely thankful, and kept repeating, "God bless you." The day ended late, and we didn't leave the OR until about 8:30 p.m. It was well worth it, and everyone on the team would have stayed even later if need be.

Feb. 7 - We did team rounds at the hospital when we arrived today. All of the children were doing well. It is amazing how stoic the kids are, and again the parents were all so thankful! The entire hospital and OR's look like something from the 1960s or early 1970s. Clean but very dated. Everything is designed for short people - I have probably already hit my head about 10 times.

Today we did seven cases total. Wanda's parents returned today with gifts for the team who operated on their daughter - they were handmade leather key chains with Wanda's name and "thank you" written on them. It was quite touching. They have very little money, but were so thankful and wanted to give us these gifts.

.

Feb. 8 - Today was a great day. We performed seven cases. One of the many highlights was our dinner in the zone 18 area of Guatemala City, one of the poorest zones in the city and where The Shalom Foundation built a school. We went there for dinner and were greeted by at least 200 people, half of them kids. I think I might have been the tallest person some of them had ever seen. We sat down as honored guests, played with the kids, and ate a home-cooked meal. It was a very special night.

One of the kids we operated on today had an incredible story. Elio is a 16-year-old boy from eight hours away. He had polio as

Elio and his mother

a young child and was partially paralyzed and could barely swallow for almost a year. He recovered but had a significant deformity of his lowered extremity. In addition, he was born with one undescended testicle and never had the opportunity to get it repaired. He had worked in the fields since age 11 - cutting coffee and corn with a machete. For the past 8 months, he had been working and saving his money so that he could pay for the trip to Guatemala City for his surgery. His family was so poor that such travel expenses were a major burden on them. Unfortunately his father had died a year earlier to kidney disease, so Elio was now the "man of the house." He and his mother were so appreciative of us being there to help them. Certainly, a few tears were shed over his story.

Feb. 9 - Today was an eventful day. Once we arrived at the hospital, we rounded on the patients who were admitted the day before. Then we headed off to the ORs. We performed eight cases and all went well. It is hard to believe how fast the week is going.

Feb. 10 - This was our last day, and we completed four cases and packed up everything we brought with us on the
trip, including all of the medical equipment and any supplies we had left —which was nothing compared to
what we came with. Several of us traveled to Antigua for some R&R for a day before returning to Nashville.

Feb. 13 -We are back at home in the states and I now realize how valuable my experience in Guatemala was and how much the people of that country touched me, especially the children. I have a new respect of our medical system and the health care luxuries most of us enjoy. Many of the Guatemalan children are without any health care at all and are desperate for any and all help. I was struck by how appreciative the children and their parents were toward our group. It was hard work but unbelievably rewarding. The trip was a nice reminder of what is really important in medicine, and it was the highlight of my residency thus far. I sincerely hope I'll be able to continue taking similar medical mission trips in the future.