We were a generation of students and residents of special pediatrics; marked by the Guatemalan civil war that had its strong endogenous reasons and its relative geopolitical, and exogenous economic causes.
By: Dr. Jesús Arnulfo Oliva
At the University of San Carlos of that time he insisted on the theory that the only way to end the inequality and social injustice, was an abrupt change in the structure of the state, a “revolution”. Against this, there were the dreams of our fathers and also intimately our purposes to be doctors … by the virtue to save lives regardless of who they were. Pledges to abandon our career were at the order of the day, they wanted us to join guerrilla cells, they said that the only way to end child malnutrition and prevalent illnesses was a change in the system; that the only way was armed confrontation under an ideological slogan … and we had to make a decision: to be with them or against them.
I knew about the death or disappearance of many bright fellow doctors, we found that some of them had joined the guerrillas and others had gone into exile. Many of us opted to stay in hospitals, because we knew that children needed attention because they needed us and we loved medicine.
Although the vast majority sympathized with endogenous reasons for the conflict, medical vocation of service overwhelmed us, that flooded us.
The General Hospital San Juan de Dios was, as it is today a center of desperate war against death; fraught with technical and infrastructure deficiencies, where medical heroism was an everyday occurrence. We live our own war against misfortune, illnesses and death; against the consequences of social injustice, armed only with our intellect, our ongoing effort to learn more, ready to offer the best we could to our young patients. We tolerated almost anything, but never, never, never the negligence, indolence, or the irresponsibility in the treatment of those who trusted their life to us. That was our ideology, social sensitivity, responsibility and our job.
We worked and studied 365 days a year and took turns every four days for 36 hours straight, yet time ” was not enough” to cover the vastness
We saved many lives and many others passed out before our eyes and hands, we were powerless before the adversity of the lack of resources; but it was nevera n excuse for us… we were tremendously demanding on ourselves and we questioned our actions carefully to the point of concluding “that we always could have done something else.”
I remember eating or sleeping were not factors we took into account (we were losing between one and two pounds in one turn). Electronic monitors that time were our eyes and our hands. Modern appliances mechanical ventilation were both connected to oxygen cylinders which we actioned rhythmically with our hands, with the demand to make it despite the fatigue, not even flinching was allowed to. Our catheters to measure central venous pressure were nasogastric feeding probes that we adapted to insert into the veins of our patients.
We dreamed? Yes, we dreamed. We always dreamed of the moment when we had climbed positions in the pyramid of decision making, we could equip our hospital with the best technology and inputs so that children would have more chance of survival.
Our generation grew up and we graduated almost undercover, as pediatricians. When we went out, we were unemployed, we should find somewhere to insert ourselves, we wanted to be productive and contribute to the support of our families, most of them middle-class and low.
Gradually we were finding the provided way for our struggle that the divine providence gave us. Some left into the republic where they were most needed, others managed ourselves to get a a scholarship to continue our studies outside the country, some stayed to work ad-honorem in the hospital awaiting a position by opposition, others were hired by NGOs and international agencies and a few continued teaching our career in the faculty of medical sciences. Several began to “break stones” in their private clinics.
I got hired by an NGO, I set my private clinic in Zone 1 (where I entertained myself with reading and swatting flies), while also wandered from embassy to embassy looking for an opportunity to continue studies out of the country, in which I finally succeeded, a miraculous way to Spain University. For when I came back and was unemployed I got some consulting calls in international agencies. After working ad honorem for a few months in the general hospital, I finally got a position as department head at a 4 hours shift and a year later, another 4 hours shift in a position by opposition as graduate school professor of pediatrics at the USAC and at the same hospital.
Others, and as a God’s blessing on their efforts, achieved a deserved success in the different paths they had chosen.
There is a person belonging to that generation whom particularly I want to pay tribute on this occasion, Dr. Erwin Raul Castañeda whom I met while being undergraduate student when he was already studying pediatrics residency in this specialty. From a humble beginning, he always felt proud of three things: being born in Zacapa, studying secondary in the Central National Institute for Boys and graduated as a physician and surgeon in the glorious Universidad de San Carlos de Guatemala.
Of course we had a number of virtues, it would be a very long list I shall confine myself to three of them:
- He was profoundly human.
- He was jealously responsible with his patients.
- He was very capable and prepared.
Raul or “Casta” as his friends called him, also reaped success according to his expectations, which were not material wealth, it came to the merit that he became the Head of the Department of Pediatrics at the hospital so loved by him. This position was occupied by him for about 25 years. During his tenure and against all odds and indolence of the state, he built next to his collaborators Critical Care Unit, the service for burned patients, bifurcated spine unit, strengthened the unity of Hematology-Oncology, the service for patients was improved.
With a chronic disease, he endowed with minimal technological resources specialists and put most department services on his charge. He was concerned because he wanted students and residents to have a decent rest period after each shift; he managed, to summarize, in the company of his hospital team a significant decrease in infant mortality in pediatrics. Alongside he was a university professor in their field and selflessly of any youth shared his vast knowledge, experience and human character.
His brilliant career led him to be elected by voting, president of the board of IGSS. First as a substitute for the University Board of Governors of the USAC and then as a main member by the College of Physicians and Surgeons of Guatemala.
This great human being was far far away from being able to imagine that a position he held with the idea to continue building a decent health system for the country, would eventually lead to his death.
Raul died on September the 7th. after nearly 16 months of “preventive” imprisonment along with other members of the board an administrative decisión commitee, regarding a decision which he never could have guessed it would have the consequences that his accusers imputed to him and they have not been yet confirmed.
I witnessed the depression caused to him due to seeing truncated sudden and brutal way his career by not receiving an alternative measure which could allow him to continue working for social and economic moral maintenance of his family while the day came closer, when the oral proceedings or trial will happen.
I witnessed his constant fear of the malignant melanoma which he had suffered a couple of years ago (and which he was a survivor of) but as a product from captivity was reactivated.
I witnessed that despite everything, he still had dreams to fulfill.
I witnessed his earthly death under circumstances that he did not deserve.
My faith in God tells me that now “caste” is with him, next to his mother, also deceased in late December last year and caused a devastating sadness being depressed.
God does will be right with him so during his life gave to others.
Hopefully his departure will serve as a reflection for many of those who accused him and condemned him without giving him the opportunity to prove his innocence.
He is physically no longer with us, but his footprints will remain imperishable in the smiles of many children whom he saved and in the memory and hearts of those him cherish and appreciate the positive impact that he caused on us.
May God fill you with eternal peace and celestial happines, Dr. Erwin Raul Castañeda Pineda and I express my wish of strength to your wife, children and other family.
Your former student, colleague and friend.
Dr. Jesus Oliva Leal
Former dean of the Faculty of Medical Sciences
University of San Carlos of Guatemala