The fiesta for Sansón was quite a success - with cascarones, a piñata, and a delicious cake made by a cousin especially for the occasion. Our house was filled with family - sisters, mothers, grandmothers, cousins, nieces and nephews - there was not a single adult male in the house. It seems the poodle´s birthday was just another occasion to bring all of the young children in the family together and to enjoy each other´s company. It seems that enjoying one another´s company is something quite integral to the Guatemalan life. We spend at least 2 hours eating lunch and dinner, and not because of the quantity of food present!
The hospital is lacking in many of the diagnostic tests that we have at our fingertips every day at University Hospital - particularly laboratory tests for histoplasmosis. So almost every patient with HIV that has lost weight, had fever, developed a pneumonia, or presents with a complaint that is not explained by sputum gram stain and culture, receives a bone marrow biopsy. I watched two biopies yesterday, and I´m told that I will get the chance to do one at some point this month. Blood products are scarce as well - there are several patients on the floor with Hemoglobin as low as 3 and Hematocrits of 11 that are not being urgently transfused. If the patient is clinically stable, they have to ask their friends and family to go the hospital and donate blood so that they can receive a transfusion. Vital signs are taken once daily. Laboratory tests that we consider "daily labs" in the US occur once every 5 or so days here. And the labs that monitor one´s HIV course such as the viral load can take up to 4 months to return, because the lab will not process the request until the government pays for it, and it seems the government doesn´t always pay on time.
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