Five days in Guatemala By Tina Grear and Louise Hart Day one We’ve been working with the US-based NGO Food For The Poor for several years, in multiple countries. On our way to Guatemala, we take advantage of a stop in Miami to meet FFTP’s senior management team, tour its headquarters, learn about FFTP history, and view its warehouse of non-pharma items, pre-positioned to respond to the 2019 hurricane season. Day two Arriving safely in Guatemala City, we meet with around 20 staff from The Order of Malta: a key partner for Food For The Poor, which sends the order about 25 containers each month, including donated medicines from IHP. Our activities while visiting there include a GDP (good distribution practice) audit of their main warehouse. The Order of Malta is working across all 22 departmentos (states) of Guatemala, supporting over 400 health facilities. They took us to visit one of them, in the municipality of Mixco. This clinic provides services including dental care, ophthalmology, maternal care, general practice and psychological support. When we see it, the pharmacy was well stocked, with some IHP products; but shortages are common. Day three A full and productive day, visiting two more clinics and the homes of individual patients. The first clinic is in Palin, southwest of the capital, at the foot of a volcano that dominates the landscape. This clinic specialises in maternal and paediatric healthcare and provides vital care in early diagnosis of complications in pregnancy. The second clinic is in Villa Canales, an area that faces multiple challenges including gang violence and drug trafficking. This clinic was established by a survivor of breast cancer and has improved access to healthcare in an underserved area, including villages as far as 35km away. Many people do hard physical work, so the clinic sees many cases of injury and joint pain. Malnutrition is another major issue, and the clinic often treats children who have scurvy. Day four We’re in the stunningly beautiful city of Antigua, in the shadow of a ring of volcanoes, one of which erupted in 2018, killing at least 190 people. We begin the day at Hospital Pedro de Bethancourt, serving up to 1.5 million people, and seeing 500 outpatients a month, as well as 1,000+ cases of emergency and trauma. We’re given a guided tour, and see the difference our medical supplies make: “We use them quickly – it’s like they evaporate,” explains the director showing us around. Shortages of supplies mean single-use equipment is sometimes sterilised and reused, or used in the wrong size; resourcefulness and improvisation can save lives. Later we meet paramedics working in a voluntary team, who show us their first aid kits and medical equipment, including a broken defibrillator. In the absence of an emergency ambulance service, they respond to around 12 emergency call outs each day. Day five On our last day in Guatemala, we meet with members of Integral Alliance, a network with whom we work closely. One member is Food For The Hungry, which began working in Guatemala in response to the major earthquake of 1976. FFTH’s staff are working to meet social and spiritual needs alongside physical needs; they explain to us the need for building understanding about nutrition, hygiene and health, and why tackling child malnutrition is a major focus for them. Our other meeting is with Medical Teams International, whose team members had an eight-hour round trip to meet us. They’re building health capacity at a community level, and strengthening health systems by offering training, improving infrastructure, and equipping facilities. It’s been a fascinating trip – we’ve learned so much!