Just a few months after completing her residency at Ventura County Medical Center, Dr. Connie Friedman joined the medical team at Ajkun Pa Le Qatinimit, or APQ, for door-to-door patient visits in rural Guatemala. House calls aren’t the norm for most doctors, but Dr. Friedman and her team were checking to see how some new water filtration systems were working to improve drinking water.

During their outreach, physicians checked for common symptoms of stomach pains, as well as taught patients how to use and clean the water filters. It’s the kind of whole-person care that Friedman said she wishes she could bring back to the United States.

Friedman is the newest global health fellow through the Global Health Fellowship program with Ventura County Medical Center in Ventura, California. For two and a half months, she’ll work at APQ before traveling to other sites for a total of six months abroad, then back to Ventura. She’s following in the footsteps of Dr. Zack Self, also a former VCMC resident, who co-founded APQ with his wife in 2015.

Self is originally from Tennessee, but visited Guatemala over 20 years ago while completing his residency at VCMC. Self said that at the time he witnessed local injustices and the effects on people’s health. The physician and his wife, a nurse who is now the clinic’s executive director, agreed to return to her hometown of Santo Tomas La Union to start a medical clinic.

Nearly two decades later, the staff at APQ offer vital services and whole-person medical care to rural and indigenous residents in Guatemala.

Outpatient services are most common at APQ, but the clinic offers a myriad of services, including a pharmacy, ultrasound, inpatient, and critical care. Patients come from across the region, some traveling hours for health services. Dr. Self said that patients who are part of indigenous communities are often unable to access healthcare services in their own language, making it difficult to find quality, compassionate, and culturally appropriate care.

To address that need, he’s hired bilingual and trilingual staff who can speak with and think about patient needs and expectations throughout the healthcare process. Most patients arriving at the clinic speak K’iche’, the Mayan indigenous language spoken in the western part of Guatemala. With the help of family, friends, doctors from the Ventura residency program, and a nonprofit in Alabama, Self and his team have created a two-story clinic that meets the health needs of Guatemala’s indigenous communities.

“We (want) excellent healthcare to extend and improve their quality of life,” Self said. “We hope to be the example of what’s possible.”

Friedman visited Guatemala twice before applying for the fellowship program. She said it was “eye-opening” to see how the indigenous people lived and the basic water services that they were seeking. The family medicine physician said that she met Dr. Self the year prior in Ventura and became interested in the program to help her better serve patients in the predominantly Spanish-speaking population of Ventura and Oxnard, California.

“So it feels in some ways, full-circle for me to come back now as a doctor, to be able to give back to the community and feel like I’m continuing to learn and grow,” she said.

While Guatemala has expansive freshwater streams and rivers, many rural residents lack access to clean, potable water. The result can be consistent abdominal pain, diarrhea, malnutrition, and acute waterborne illnesses. APQ staff have distributed over 2,000 water filters to make drinking water available and improve health conditions.

Drs. Self and Friedman said that because not all residents have access to potable water, waterborne illnesses are somewhat commonplace. Residents are regularly prescribed antibiotics and anti-parasitic medications to overcome illness. However, the water filter is a preventative measure to improve patients’ overall quality of life and reduce trips to the clinic for care.

“Obviously, boiling is not enough to get all the parasites and bacteria out of the water,” said Dr. Friedman. “Patients will come in with these symptoms very regularly, and I think for a lot of them it’s almost normal.”

Without potable water, residents have turned to alternative beverages, like sugary drinks and bubbly beverages, that predispose residents to chronic conditions.  

Most patients are experiencing uncontrolled diabetes, hypertension, and chronic obstructive pulmonary disease, or COPD. Dr. Self said that traditionally, women cook meals over a fire, which has contributed to COPD.

The clinic’s unique ability to provide extensive services is valued, but the doctors said that having staff who understand the daily needs of their patients is critical, too.

“They’re taking a lot of time to get to us, and we don’t (always) have all the resources at our clinic. If they need surgery, we refer them into the city, but there’s this understanding that they have already traveled hours to get to us,” said Friedman. “Do they have the time and money to even get to another city and back?”

Friedman said that the ability to consider a patient’s needs and fit their care with their quality of life is the “perfect world of medicine.”

“It’s just very humbling to be able to work here,” she said. “It’s such a privilege to be able to come here and be a part of their community.”

Direct Relief has provided Ajkun Pa Le Qatinimit with more than $10.8 million in medical aid since 2013. The organization has also received a pharmaceutical-grade refrigerator to store temperature-sensitive medications, as well as financial support to expand medical oxygen for patients.