Stories from the Field: Clínica Tzanabaj (San Pablo, Guatemala)

by Deborah Flores, RN, Ed.D, MBA E-mail

Lake Atitlan is a large lake approximately 340 meters deep, situated in the Guatemalan highlands. It is flanked by several volcanoes and surrounded by towns and villages inhabited by descendents of Mayan people. They are proud and strong people. The lake itself is one of the most beautiful in the world.

This lake supports coffee and farm crops. Most of the indigenous population survives on very little money as they make a living from the land. The lake is a major life force in their lives. There is cyclical contamination from fertilizer run off, etc. which leads to bouts of cyanobacteria in the lake.

Although the weather is temperate, the rainy season brings mudslides and flooding, which has been known to destroy homes, commercial property and lives.

There are several small hospitals around the lake; one is public, and the others are private. There are also many clinics which provide basic medical and dental care. These are supported by churches and/or by locals, and some of these are private as well. Providers are predominately volunteers who either come in to the area from Guatemala City or are on short assignments from US, Europe or other parts of Central or South America. Much of the equipment is donated either through medical companies or churches. This in itself can be a challenge.

In December 2010, my husband, a general surgeon practicing in the US, decided to retire from medicine. He is from Guatemala, and for many years has desired to return there. He has always been drawn to the lake area, as so many people are. He decided we could contribute if we opened a health center to care for the people, because basic healthcare needs are difficult to meet. For example, basic dental care is in great need, infants suffer from dehydration and the women suffer from early respiratory disease due to cooking over an open fire that often is not vented properly.

After much deliberation and planning, the clinic is now being built in San Pablo, a town with inadequate water and sewage systems.

Most children get a basic education but seldom leave the lake area. It is a closed community and very difficult to earn people’s trust.

We hired approximately 50 local workers and, with the help of a family member who is an engineer and architect, the workers were taught how to create and build using the earth underneath them. All of the materials are made on site, and rock is hauled from the riverbed to use for the rest of the structures. These men have acquired skills that they will now be able to use for the rest of their lives, hopefully to gain future employment after the project is complete. At this writing, this site has been under construction for over two years. The project itself has had an economic impact on the community, as it is the largest construction project that has ever been implemented in San Pablo.

Before breaking ground, a shaman blessed the land, as this was very important to the local workers. We then joined a local parade to advertise the coming clinic. Our workers started a soccer team for “Clínica Tzanabaj” and wear special shirts to denote who they are. We will continue to find ways to advertise the facility, but in reality, you cannot miss it driving through the area between San Pablo and San Marcos.

Until the clinic is finished, my husband travels from town to town to assist with surgeries as needed. When the clinic is complete, I will join him there to provide primary care. We hope in this way we have been able to impact our world far more than if we had stayed in the US and continued to provide care.

Deborah Flores will be joining the faculty of Research School of Nursing, which is affiliated with Rockhurst Univerisity.  Her husband is a general surgeon who retired early and is providing free care in Central America, and she joins him every few months to assist.

Global Health News Last Week


Human Rights Watch has urged the Bahraini authorities to halt what it said was a “systematic campaign” to intimidate doctors and other medical staff suspected of sympathising with recent anti-government protests.


  • The GlobalPost has been doing an excellent series of stories examining President Barack Obama’s Global Health Initiative (GHI) is focusing on in Guatemala. Slow in its implementation and hampered by little new money, GHI was supposed to be an example of Obama’s new, innovative commitment to global health.
  • The King of Swaziland has called for all of the men in the South African nation to get circumcised in order to prevent the spread of HIV/AIDS.
  • Results from a pilot program in Philippines have shown that deaths from rabies can be dramatically reduced when taking a community driven bottom up approach.
  • A child in Khartoum, Sudan is the first to receive a rotavirus vaccine, kicking off a campaign to vaccinate children in 40 low and middle-income countries.


  • A recent report from UNAIDS cites data from a recently released South African study that shows the effectiveness of male circumcision reducing HIV prevalence in men.
  • A campaign to encourage African men to get circumcised to prevent infection by HIV gained a powerful boost on Wednesday by three new studies unveiled at an international AIDS forum in Rome.
  • A new study has found that women in conflict areas want to utilize
    contraceptives, but only 4 to 16 percent are able to gain access.
  • At the International AIDS Society, one of the big stories is a CDC study showing the drug Truvada prevented HIV transmissions in more than 60 percent of heterosexuals. The study’s author Dr. Michael Thigpen discusses how much Truvada costs, why HIV is so pervasive among women in Botswana, and how much people must take the drug for it to be effective.
  • Researchers have discovered that chloroquine, often used to treat malaria, may be effective in treating other autoimmune diseases.
  • An antiviral drug to combat HIV/AIDS synthesised by genetically modified plants is being tested on a small number of women in the UK to establish its safety, reports the Guardian.
  • A recent study has shown that stress experienced by a pregnant mother can have a negative impact on the development of the child in the womb.
  • Researchers presenting at the 6th International AIDS Society Conference on HIV Pathogens, Treatment, and Prevention in Rome, say that they have inched closer to a vaccine by leveraging a genetically altered version of SIV.


  • The World Health Organization is sounding the alarm on hospital safety and infections acquired while patients are in a health care facility, saying that a hospital  stay is riskier than air travel.
  • Researchers have determined that Hepatitis C can be transmitted sexually, after performing a 5 year study on HIV positive MSM.
  • Famine in parts of southern Somalia has killed tens of thousands of people, mostly children, the UN said Wednesday in an official declaration of what aid officials describe as the worst humanitarian crisis in the troubled country in two decades.
  • A new study warns that Pakistan “risks becoming the last global outpost of [polio], this vicious disease.” The disease has also resurfaced in four other countries.
  • Even in developing countries where child mortality is falling, the poorest under-fives are at high risk of dying from entirely preventable diseases because they do not receive basic immunization and have no treatment for diarrhea.
  • Peter Hotez, president of the Sabin Vaccine Institute, says new studies indicate a parasitic infection, schistosomiasis, may be one of the most important — and least recognized — co-infections increasing the risk of HIV transmission.
  • An All Africa editorial examines how the price of drugs leads to deaths that could be otherwise averted.