“Be diligent in serving the poor. Love the poor, honor them, my children, as you would honor Christ Himself.”
St. Louise de Marillac
A Guatemala Journal – S. Montiel Rosenthal
Part Four
Wednesday, February 11, 2026
Looking west from the shore of Lake Atitlán, ancient volcanoes rise from the far side of the water, their peaks often half-hidden in the clouds. From right to left stand San Pedro and Tolimán, both inactive and safely hiked. Behind Tolimán looms Volcán Atitlán, considered active, though its last eruption was in 1853. The lake itself was formed some 84,000 years ago after a massive volcanic eruption created a caldera more than 1,100 feet deep, which eventually filled with water.
We are still operating as a smaller team, having at least one young doctor sidelined with gastrointestinal distress each of the last three days. We leave them back at the hotel in Panajachel with oral rehydration packets and adjust our workload at the clinic site.
For the next three days, we are holding clinic in Chutiestancia in the modern home of a family currently in the United States. It is noisy but well organized. Patients wait outside in the sun near a cornfield, our “waiting room” under the open sky. A hanging scale attached to the garage door weighs babies and small children. Children color and draw pictures while their parents and grandparents have their blood pressure and other vital signs taken. We are still refining logistics, especially how to use the space effectively while protecting patient confidentiality. Dr. Strawhun and I are stationed inside the garage, working with a view of the surrounding landscape.
We had another child in distress today, having panic attacks after the death of her grandmother and thoughts of suicide. Her mother also has anxiety and depression. We set up a safety plan, including a phone number the family can call if her distress worsens. We will see her again tomorrow, and set her up for a telehealth visit later this month. Again there are no counseling services up here in the highlands, and transportation is a barrier for many, including this family.
lake
Morning comes to Lake Atitlán.
Dr
Dr. Strawhun prepares for the day with his thermoses of coffee – his fuel for the day’s work.
Children
The entrance to our clinic space for the next three days.
Tuesday, February 10, 2026
My resident and medical student were visibly shaken yesterday after seeing a young boy. He came for constipation, but his mother shared that he is sad all the time. Several years ago, his father attacked his mother in front of him. The father had been physically and verbally abusive toward both of them and now claims that his 9-year-old son is the reason he no longer lives in the home. The cycle of violence continues, with an older sister who is also physically and verbally abusive toward him.
I asked him to draw pictures of things that made him happy and things that made him sad. From a box filled with many colors, he chose only black to draw himself, his house, the cloud around him and the fence surrounding the home. A yellow sun rose above his favorite animals, colored brown, with pink inside the ears of his rabbits. As he drew, he brightened a bit and made eye contact. He asked if we had paper he could take home, as he had none. We gathered a small stack of paper and a bag of crayons for him.
I emailed S. Jackie Kowalski (a former child psychologist) for an urgent child psychology consult. She kindly responded right away with practical suggestions for helping in this remote area where there are no counseling resources available. In the Pulitzer Prize winning book “Guns, Germs and Steel”, the author Jared Diamond notes that although we often assume domestic violence is more prevalent in large cities, it is frequently in rural and remote areas where people suffer most. There are fewer formal social services, fewer counseling options and less opportunity to distance oneself from danger.
We affirmed his mother’s loving concern for him, and our team will see him from time to time. His mother has already noticed he seems happier since being able to talk with us. This was a reminder that even in the midst of helplessness and vulnerability, there is resilience. He has his mother’s love, the ability to “speak” beyond words through art and, we pray, the protection of God. As physicians, we are reminded of our own powerlessness to directly effect change — and of the profound healing that can come simply from being deeply listened to.
We also spent time listening to a woman whose husband died a month ago. She sees him in dreams – an angel bringing him home to her one more time after being gone for days on a drunken spree. She knows he is dead, but longs to have him to return. She did not need medicine for her grief and depression, but to be reminded of the blessing of her attentive grown daughters, and again to be deeply listened to.
Today, I mentored a Guatemalan physician and one of my medical students in performing knee joint injections.
We’ll pack up all our medicines, supplies, and donations and have those trucked to our next clinic tomorrow in Chutiestancia.
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S. Montiel Rosenthal teaching a medical student and Guatemalan physician how to prepare medicine for a joint injection.
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One of the medical students on the team performing a knee joint injection in their alternate office, the bus.
Monday, February 9, 2026
On this sunny but chilly day, we are up at 8,100 feet in elevation in the village of Chichimuch. One of our challenges here is space: we only have three exams rooms in which to see patients. To keep care moving, we use our bus as a place for medical students and residents to complete patient counseling, which frees exam rooms for those still waiting. This village has a few patients who primarily speak K’iche’, yet another idiom (or language) spoken here. To serve them well, we have a Spanish-K’iche’ interpreter. One elderly K’iche’ woman brightened up when we explained in English, then Spanish, then K’iche’ how she could better manage her diabetes. We made up medicine sets for her with brightly colored symbols for sunrise, midday, and nighttime.
The medical students have voiced greater confidence in using their Spanish without needing the assistance of an interpreter. All of them have slipped into a stance of flexibility with needing to make multiple changes in plan through the day, and communicating with all members of the team. They are becoming more comfortable with treatment protocols we use here for conditions such as childhood malnutrition and Helicobacter pylori diseases like stomach ulcers, which are more common here.
We had a 54-year-old woman complain of neck and shoulder pain. She plucks chickens all day for a living, and understandably experiences myofascial pain from muscle overuse. After demonstrating an exam to my medical student, I performed a scalene muscle release, modeling the technique for both my medical student and for the patient. I explained how she could teach family members to help her continue this treatment at home. I find it gratifying when patients are empowered to understand what is happening with their bodies and are able to take greater ownership of their healing.
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Medical students prepare medications and provide instructions for use for a patient in Chichimuch.
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Sister of Charity Montiel Rosenthal demonstrates a muscle-release technique.
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3: Following S. Montiel’s demonstration, a medical student performs the technique with the patient.
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A member of the medical team reviews a patient’s record in preparation for ordering medications.
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Guatemala is often called “the land of eternal spring.” Here peach trees are already blooming.
Sunday, February 8, 2026
I started the day early with Mass at La Merced Church, and prayed for the safety and health for our team members, and for peace in our world. The sky was clear but the temperature was brisk at 50 degrees when I went for breakfast. I welcomed the coffee as a hand warmer.
Before setting out, I went up on the roof of the small hotel where we stayed. In the distance, the Volcano Fuego was puffing away, creating its own gray clouds. The volcano reminds me of an old man who contentedly puffs away on his tobacco pipe, blowing little clouds of smoke. As long as he does this, clouds of gray smoke make their own weather, and there is no problem. Dust wafts down, forming mountains and mineral-rich soil over time – soil that has sustained people here for thousands of years. Or moisture in the atmosphere collects on the smoke particles and becomes rain, watering the earth. But when the old man stops smoking his pipe, an active volcano builds up pressure near the surface and becomes quite dangerous. Almost eight years ago, Fuego erupted, sending a smoke cloud nine miles high into the sky. Pyroclastic flows and lahar (hot mud) destroyed two towns. More than 3,000 people evacuated the area. Estimates suggest that as many as 2,900 people died or disappeared. The official tally of recovered bodies was only 190 people. The rest were vaporized, burned or buried and never to be recovered.
Then suddenly my reflection was interrupted by a loud “rat-a-tat-a-tat-a-tat-a-tat.” One block away a puff of smoke emerged from a house. It’s customary here to celebrate your friend’s birthday by setting off firecrackers outside their house. Happy Birthday, whoever you are! And now it’s time to pack up and move out.
Gastrointestinal upset from contaminated food or water is the bane of teams who come here. Fresh fruit – artfully cut by street vendors and ready to slake one’s thirst – is especially tempting. I remind our team that it is, quite literally, diarrhea on a stick, and that their enjoyment of fresh fruits and vegetables is best saved for when they return home.
Three of our young team members came down with vomiting and diarrhea and were miserable throughout the night. Keeping them hydrated will be a challenge as we travel west by bus to Panajachel today. We’ll stay in this small city on the edge of Lake Atitlán as our base, making day trips into the highlands to visit two villages later this week.
Church
The Convent and Church of the Society of Jesus in Antigua, where the Jesuits served for almost 200 years until their expulsion from all Spanish colonies in 1767. To the left, the Volcano Fuego has smoke pouring from its peak.
Produce
One of the many fresh fruit vendors lining the streets of Antigua.
Cappucino
S. Montiel Rosenthal warms her hands on an artfully presented cup of cappuccino.
Packing
The bus bound for the highlands is packed with the team’s medical supplies for the week ahead.
Saturday, February 7, 2026
Although I left for Guatemala today to serve as faculty for a team of medical students and Family Medicine residents, the planning and anticipation began earlier. In late January, members of the team gathered to pack medicines, medical supplies and donated items, each of us allotting space in our checked luggage to carry them south. Any personal items, we would have to carry onboard with us in the flight cabin. Fortunately, this time my flight connections, and making it through Customs, were quite easy.
We are a team from the University of Cincinnati College of Medicine. Dr. David Strawhun, one of my former residents, is volunteering this year as a physician in Guatemala. He is working with Wuqu’ Kawoq, the Mayan Health Alliance, a nongovernmental organization founded by a Cincinnati native, Anne Kramer Diaz. This is the organization I have partnered with for the last 14 years or so.
Our group includes three young physicians from the West Chester Family Medicine Residency Program, along with six fourth-year medical students from UC. The students have all taken the Medical Spanish Elective at UC, and bring varying degrees of fluency. Part of their elective is a service requirement, assisting with Spanish-English medical translation. As good as they are, all of us will be challenged with working in dual translation (English-Spanish-Kaqchikel) up in the highlands where many of the patients we will see are Mayan. Guatemala has 32 official languages, most of which are not linguistically similar. Wuqu’ Kawoq is committed to working with folks in their own language.
The traffic from Guatemala City to Antigua was crazy when it moved at all – motorcyclists whizzed between lanes of cars, chicken buses overflowed with people and street sellers’ wares, trucks rumbled past packed with onions and live cattle, and roadside vendors hawked snacks, bottles of water and souvenirs.
I will spend the night in Antigua before we head west tomorrow. Antigua means “ancient or old” in Spanish. Founded three times in the 16th century, it was originally called the City of Saint James of the Knights of Guatemala, in the Kingdom of Guatemala. Cobblestone streets and irregular slabs of stone for sidewalks mark the paths through the old city. Ruins of churches, convents, casas, and governmental buildings give Antigua its unique architectural flair.
The rest of the team, who came to Guatemala a week earlier, hiked up the volcano, Pacaya, today. We had dinner together as a team, and all of us will sleep well after a strenuous day.
Supplies
In January, the team gathered to pack medical supplies for the trip to Guatemala.
Mixco
Motorcycles and riders weave at high speed between lanes of traffic in Mixco, where S. Sarah Mulligan ministered for more than 20 years.
Church
San Jose Cathedral in Antigua, illuminated at night.
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Our team at dinner before heading west to Panajachel.
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