In December 2021, I traveled to Guatemala during my winter break of medical school. While I was there, I was graciously greeted with the beauty and hospitality of the country and its people. One of the highlights was an overnight excursion to summit Volcan Acatenango. The trek to the peak, which towers more than 13,000 feet above the Pacific coastal plain, physically and mentally drained my body. As we made our final ascent in complete darkness, the wind howled. Subfreezing temperatures turned our bodies numb. Flickering headlamps guided us through steep slopes and slippery rubble. When I reached the top of the stratovolcano, I was met by a mixture of relief and triumph. I stared across at the cloud inversion covering the valley below. The sun had started to rise in the horizon, painting the volcano shades of pink and gold — a testament to our 3:30 a.m. start that morning. I was humbled to learn that what I felt was an arduous experience was commonplace to the guides and porters of Guatemala.
As we set up base camp near the summit of Acatenango, I started talking to a guide named Carlos Garcia over a cup of hot chocolate. One of Guatemala’s three active volcanoes, Fuego, occasionally interrupted our conversation with the sound of eruptions. Carlos grew up in a village near Acatenango, a municipality in the Chimaltenango department of Guatemala. From an early age, Carlos held significant familial responsibilities including financially supporting his relatives. Despite helping his single mother look after his younger siblings, he did not neglect his own education. He worked hard at his studies, but his family continued to struggle financially. Carlos made the difficult decision to leave school when he was 17 and immigrate to the United States to work and send money back to his family.
The first time he entered the United States, Carlos traveled almost 1,300 miles and crossed the Rio Grande River at the Texas-Mexico border. However, after crossing, he was arrested in McAllen, TX and placed in a detention and processing center. The deplorable conditions at the center foreshadowed the 2019 headlines that described McAllen’s Ursula facility (the largest Customs and Border Protection detention center in the United States) as “comparable to ‘torture facilities’” for unaccompanied children.
“It was a good thing I was a minor, though,” Carlos recounted. His mother was fortunate to find a family in the Northeastern United States to be Carlos’ sponsor. Under his unaccompanied minor status, Carlos was moved from the McAllen detention center to Rhode Island. “It was so hard. I did not have support from anybody. My sponsor did a favor to get me out, but I had to do everything else by myself,” Carlos explained. Without money or connections, Carlos found odd jobs to eke out a living and send money back to his family in Guatemala when he could. A year later, when Carlos was summoned to court, he did not attend due to his fear of being deported. He remained illegally in the United States for five years until he was pulled over by the police on his way home from a soccer game. After failing to provide a license, Carlos was arrested and quickly deported back to Guatemala.
Back at home in Guatemala, prospects were grim. Working in the village only provided 50 quetzales (approximately 6.50 USD) per day. This was not enough for Carlos to support his family especially with the added responsibility of caring for his aging mother. Unable to meet his family’s financial needs, Carlos began planning his second attempt to enter the United States. He found a smuggler whose fee was 10,000 USD. Carlos borrowed money and sold everything he owned to make the journey back to the United States. This time, however, Carlos crossed the Arizona-Mexico border. “That was a mistake,” Carlos said. “I walked for eight days in the desert. What we did today — hiking Acatenango — is nothing compared to the desert. We did not have enough water for all of us. Only a few gallons. I walked almost three days without water.”
I was shocked. I had packed one and a half gallons just for myself on our two-day Acatenango trek. In medical school, we learn about homeostasis and memorize the countless feedback loops in the human body that help maintain equilibrium. I wondered if his kidneys suffered any permanent damage because of his time in the desert. For example, severe dehydration can lead to kidney damage by increasing the reabsorption of toxins due to volume depletion. Carlos ultimately did return to the United States, but at what cost?
When Carlos finally made it to Phoenix, Arizona, he decided to cross the country to get to New York, a common destination for unauthorized immigrants. He met up with some friends and left in a large van packed with 18 people headed for Dayton, Ohio. He planned to lay low there for a few months to work and save up money before continuing to New York. But they never made it to Dayton. As they were crossing through Indiana, a sheriff pulled the van over. “This was when I made a big mistake,” Carlos confessed, shaking his head with regret. “I was the only one who spoke English. Just me. I was trying to help my people because most of us in the van were from Guatemala, so I acted as the interpreter.” According to Carlos, when the sheriff made his report, he wrote that he believed Carlos was a smuggler buying food and gas for illegal immigrants. “That landed me in federal jail in Kentucky for a year,” said Carlos. “It’s hard to be in jail in Kentucky, man. Afterwards, I got deported again, and then I got this job.”
While Carlos declined to share how much he made as a guide for the Acatenango hikes, he mentioned that it was not that much more than the daily 6.50 USD pay at his village job. Still, Carlos expressed his gratitude for the chance to be a guide. “I’m so grateful that God gave me this opportunity. When I left my family in Guatemala to go to the United States, I didn’t know if I would see them again. A lot of people died in the desert. Now, I tell people that if they have enough money to stay and live with their family, do it. Do not always try to go to another country. It can be dangerous. I have been in a lot of situations, and even though we are poor, I am so happy to be here.”
Summiting Acatenango with Carlos made me reflect on my clinical experiences back home. At a student-run free clinic in Galveston, Texas, I work with residents and physicians to provide care for uninsured and underinsured low-income patients in our community. Many are predominantly or solely Spanish-speaking. Some are unsheltered. And almost all are dependent on our clinic for primary care. I wonder how much of their stories I am missing because of the language and power barriers between us.
The journey that Carlos shared with me encourages me to consider what brings my patients into the health care system here in the United States. When pressured to deliver care at an ever faster pace, it is easy to skip over patient narratives. I believe it is essential for all health care professionals to take the time to learn patient stories. We must recognize that the people we care for are more than the 15-minute snapshot we see in primary care clinics.
The systems that exist in our country — whether health care, immigration or our economy — often shape human experience. Human stories are the critical context to understanding clinical signs or symptoms and seeing opportunities for patient advocacy on a larger scale.
Author’s note: Carlos gave me permission to share his story. I have changed his name and other identifying information to respect his privacy.
Image credit: Custom artwork by the author for this Mosaic in Medicine piece.