BC Business
On the front lines with the B.C. doctors, nurses and other volunteers of Medicos En Accion as they ply their trade during two weeks in poverty-stricken Guatemala.
The room is a prison-like cubicle with a door and a single window grated with black iron bars, a couple of plastic-backed metal chairs and a small mattress lying at an angle on the floor. An old bed-sheet divides the space into two spare examination rooms. Dr. Brian Poelzer, stethoscope slung around his neck and an ever-present smile on his face, seems right at home in this concrete shell that today serves as a health clinic. The 46-year-old Kamloops-born and -raised physician has just sent home a middle-aged man who was complaining of chronic headaches but had no other discernible symptoms. One thing was certain from the brief consultation: the man’s diet is desperately poor in nutrition. Poelzer gives him a bottle of vitamin supplements – a bit of a crapshoot he admits, but worth a shot. Voices in at least three different languages reverberate off the bare walls and floors of the building. Down below on the streets of San Pablo La Laguna, there’s a clamor of excitement as a mob of children, some barefoot with dirt-smudged faces and others in sandals, chases balloons floating down from the balcony and landing in the open sewer gutters among empty pop bottles and chips bags. The balloons are a distraction for the kids as their mothers, elderly folks of indeterminate age and anyone else who happens to pass by jostle to get through the doors to see los Canadienses. Suddenly the crowd parts as a battered pickup drives by with a loudspeaker on its roof blaring out some crass exhortation to buy pop – the cola wars are raging here – adding another voice to the din. Curiously the atmosphere seems festive, as though a chain of circus wagons has just arrived in town and people have dropped everything to see what the fuss is about. In this case the circus includes a bunch of volunteer medical workers from Canada: B.C. nurses Fearon Blair, Myrna Quinn, Pam Rorie and Robyn Stetsko, massage therapist Barb Bishop, and GPs Poelzer, Jill Peacock from Rossland, B.C., and Kyle Waldman from Montreal. Not to forget the non-medical but essential volunteers Meaghan Rorie, Stephanie Peacock and Steve Flynn, who chip in to help entertain restless children, dispense pharmaceuticals and schlep supplies from the boat dock to the clinic. They’re all here in San Pablo La Laguna, Guatemala, 6,000 kilometres away from a cold Canadian winter, volunteering for a small, B.C.-based non-profit group called Medicos en Accion. Last February BCBusiness decided to tag along for an up-close look at Canadian professionals doing front-line humanitarian work in four Guatemalan towns where medical care is a luxury. Poelzer steps out of the examination room onto the balcony for a quick breath of fresh air. A block away from the clinic you can see the street is more or less deserted, winding through town and descending to the shores of Lago de Atitlan, sparkling like an emerald in the afternoon sun. Despite the town’s dishevelled appearance, you couldn’t find a more idyllic spot, perched on a hillside and surrounded by verdant coffee plantations. Such scenic beauty is the reason, a few kilometres down the lakeshore in San Marcos, wealthy Ladinos from the capital have built mansions and crystal-gazing Euro-travelers and gringos have opened massage centres and yoga retreats. All of this highlights one of Guatemala’s most striking features: staggering wealth rubbing shoulders with grinding poverty. “Are you ready for another one?” Pam Rorie calls out from downstairs. “Yup, send ’em up,” Poelzer replies. Before long he is placing a welcoming hand on the arm of his next patient, Rosa, extending a greeting in halting Spanish, which, by his own admission, is laughable. “Buenas dia. My name is . . . uh. Mi llamo es Dr. Poelzer.” She smiles modestly, but says nothing. What the 46-year-old physician lacks in linguistic virtuosity he makes up for with a compassionate, disarmingly avuncular manner. Rosa, a strikingly beautiful woman, thinks she was born around 1976, but doesn’t know for sure. At four feet, 10 inches tops, she is petite even by the standards of the slightly built indigenous Tzutuhil Mayans who form the majority in San Pablo. Like most women in her village, she wears traditional clothes or traje: a navy blue wraparound dress, or enredo, and a brilliant red-and-blue sleeveless tunic, or huipil, the colors of which distinguish her distinct ethnic roots. Poelzer turns to his interpreter, or rather one of his interpreters. A number of linguistic hurdles stand between the doctor and a reliable diagnosis. First a bilingual San Pablo local named Josefina translates from Tzutuhil into Spanish. Then Patricia, a Canadian citizen born in El Salvador, interprets the Spanish into English. One can only wonder how the message evolves after these language gymnastics are performed. Rosa, her two children sitting patiently on the floor next to her, presents with some ambiguous but common symptoms: chronic headaches and abdominal pains. She smiles and looks anxiously at Poelzer, then at the two intermediaries and finally at me, the guy with the pen and the notepad. Not exactly the most private circumstance in which to discuss one’s health problems, but around here privacy sometimes takes a backseat to expediency. “Ask her if the pain increases after she eats or drinks,” Poelzer says, waiting for his question to be relayed into Tzutuhil. The interpreter Josefina appears easily distracted by the commotion outside and by her own rambunctious toddler who darts repeatedly in and out of the room. A brief dialogue ensues between Rosa and Josefina, after which the conversation is distilled into a simple “Si,” or “Yes.” Poelzer waits for more information, but none is forthcoming. “How about when she goes to the bathroom?” “Yes.” Rosa looks downward shyly, shuffling the floor with her plastic sandals. “How long has she had this pain?” “Two months, mas ou menos, more or less,” Patricia translates. This back and forth carries on as Poelzer struggles to decipher the odd morsel of Spanish. Finally he asks her to lie down on the mattress for an examination. Rosa rolls up her huipil to expose a brown, muscular belly. She tenses and her mouth twitches when Poelzer presses her abdomen on the right side. Poelzer nods to himself, thinking aloud, “Could be gastrointestinal, but it’s probably a urinary infection.” [pagebreak] When Poelzer inquires about her diet he learns that Rosa’s daily liquid intake consists of two weak cups of coffee filtered from beans her husband purloins from the plantation every day, a meagre perk for this backbreaking work. “If you don’t drink water, you don’t urinate and if you don’t urinate you don’t flush out the toxins,” Poelzer tells his patient, mocking the stern demeanor of an overbearing father. They both laugh. This is medicine at its most basic. Stripped of the high-tech diagnostic tools and laboratory support we take for granted back home, the doctor’s most valuable asset is an ability to see and hear, to gather information with the senses. Using a stethoscope and a blood pressure cuff is as advanced as it gets here. And when all else fails, a healthy sense of humor and unflappable optimism come in handy. Rosa gathers her brood and waits while Poelzer heads to the outdoor patio where a mobile pharmacy has been established. Meaghan Rorie sits cross-legged on the floor sorting pills, ointments and supplements. Nearby, patients stare wide-eyed at the overflowing duffel bags of pharmaceuticals like kids cruising a candy store. Poelzer glances at his watch – it’s lunchtime – then looks out the door where an ancient-looking man with a wrinkled, dried-apple face and a placid expression has been waiting patiently all morning for a simple procedure, but one with quite profound results: he needs the wax flushed from his ears so he can hear again. ‘Must eat something,’ Poelzer seems to be thinking, torn between seeing one more patient and escaping for a quick bite with the rest of the crew. Poelzer shakes hands with Rosa while giving her instructions and a vial of antibiotics to treat the infection. Meanwhile, Fearon Blair, a 56-year-old retired public health nurse also from Kamloops, is downstairs attempting to fend off a desperate crowd. She looks over her shoulder into the room where Pam Rorie and Myrna Quinn have set up a triage with translators and a line of patients. Then she turns back to the throng and raises her hands in a half-hearted calming gesture, but it seems as futile as trying to plug a hole in a dam with a single finger. There are at least another 50 patients to go, and the boat back to their hotel base in Panajachel leaves 45 minutes before nightfall, 6 p.m. at the latest. In other words, they’re booked. “No es possible! No es possible!” Blair tells the crowd in broken Spanish. The message seems lost on the crowd; nobody makes a move for the exit and Blair retreats to the lunchroom looking exasperated. As the group discusses what to do with the horde outside, Poelzer seems excited, as though he has just struck a vein of gold. And in some ways it was a lucky strike – they only landed here after the village mayor heard they were seeing patients at nearby San Juan and dropped by to urge them to visit San Pablo. If they could show up on Wednesday, he promised space for a temporary clinic and as many patients as they could handle. “This is the kind of place we’ve been looking for. There’s a lot of need here and you can tell there’s not a lot of access to health care or education,” Poelzer says. What he really means is that it’s the kind of place where water-borne parasites flow from the taps, where sewage treatment is an unfamiliar concept, where – thanks to the mysteries of the global economy – bottled water is more expensive than pop, and where campaneros working in the plantations subsist on a nutritionally bankrupt diet of coffee and tortillas. Nevertheless, he sounds decidedly upbeat about their morning’s work, trying to bolster the team for the afternoon onslaught. Three days ago the Medicos en Accion team arrived in Solola, the bustling town situated on the rim of Lake Atitlan’s ancient caldera. The driver pulled the van over to the side of the road and the Canadians all bailed out to behold one of the most beautiful sites in Guatemala. From here Vulcan San Pedro and Vulcan de Santiago, both of them lush and almost perfectly conical, tower forebodingly above the lake. To the west a hazy skyline turns crimson in the afternoon by smoke from the burning cane fields on the Pacific Coast piedmont. In the highlands around Solola, fields of onions and carrots cultivated for North American supermarkets give way to coffee plantations that thrive on the moist hillsides and rich volcanic soil around the lake. “We have big hopes for the new president, but he’s made a lot of promises and you never know. This is Guatemala after all,” the driver Perfecto Lopez says, laughing with typical Latin American fatalism as he drove past a giant billboard adorned with the smiling visage of the new president Oscar Berger (see Guatemala’s Troubles, page 177). Indeed, when issues such as access to clean drinking water and public health tend to be treated by government as an inconvenience, and a tally of 45 people dead in last year’s election-related violence is considered a success, Guatemalans have much to be cynical about. Of the country’s nearly 13 million citizens, an estimated 60 per cent are indigenous Mayan and the rest are Ladino, a mix of Mayan and Spanish blood. Among the poor, malnutrition is rampant. Though plantations producing crops as varied as pineapples and peas are everywhere, little of this produce ends up in their kitchens. Lack of potable water leads to the double whammy of dehydration and gastrointestinal disease. According to the World Health Organization, five to six out of every 100 Guatemalan children die before the age of five. In Canada the rate of infant mortality is less than one per cent. The Guatemalan government spends 4.8 per cent of its gross domestic product on health care, or roughly US$86 per year per capita. Our government spends 9.5 per cent of its GDP on health, or US$2,163. But health statistics are cold and don’t say much about the day-to-day struggles and triumphs of people’s lives. Back in San Pablo, I set off in search of the recently elected town mayor hoping to learn more about the town and find him upstairs from the clinic in a plain office with a door marked simply Alcalde, or mayor. Several hombres in cowboy hats loiter outside, nod at me politely and mumble, “Buenas tardes.” I introduce myself to the mayor, an intense-looking middle-aged man. He asks me to wait in a chair against the back wall while he speaks in hushed tones to a woman with a child. At first the mayor, Jose Ixcaya Ixcaya, is justifiably reticent and suspicious. A Canadian claiming to be a journalist shows up unannounced and without credentials and starts inquiring about the state of his village. When he realizes I’m traveling with “los doctores,” he warms to a public relations opportunity. I ask him what the people of his town need the most and he unleashes a laundry list of things most Canadians can take for granted. “We need clean drinking water. The main problem is sanitation. We need public bathrooms. I need to buy land for a garbage dump and we need a dump truck,” he says, with the energy and ambition of a politician who has held office for just 20 days. He calls government support inadequate and earnestly wants the Canadians to come back to San Pablo every month. In the haunting 2002 book about civil war in Guatemala, Silence On The Mountain, American human rights activist and author Daniel Wilkinson says the key to finding out things in a country ruled for so long by fear and recrimination is to listen not necessarily to what people tell you but to what they don’t. Just as Wilkinson struggled to uncover stories about the war while researching his book, I sense that I’m receiving a filtered version of reality from the mayor.
Nicholas Preston, a Canadian resource management consultant, has been living in Guatemala for two years working on development projects in the Lake Atitlan region and confirms some of my suspicions about San Pablo. In a nutshell he calls the town a case study in dysfunction. [pagebreak] “In San Pablo sanitation is nearly non-existent. Human feces are a walking hazard. Most people defecate in the coffee plantations above town or in the streets at night. Most of the garbage also makes its way to the coffee plantations,” Preston says. To make matters worse, literacy rates are low and political corruption, intimidation and bribery create a quagmire that can easily bog down the best intentions of even the most dedicated development worker. Those not benefiting from projects have tended to cook up tales to incite others to drive the benefactors out of town. Past mayors have opted to green-light expensive mega-projects which generate a bigger cut – what Guatemalans refer to as ‘mordida’– for the mayor and his relatives. Into this public health basket case, Medicos en Accion willingly wades. Over a quick lunch, the banter flows easily between team members, so much so that you’d think they had been doing this for years, although most of them met for the first time less than a week ago at the YVR airport lounge. Working in adverse conditions has a way of dissolving barriers and building camaraderie. And the work can be very intense – day-long struggles with an unfamiliar language and culture as they try to decipher symptoms and sort out the one or two people looking for free drugs from those with legitimate complaints. Medicos en Accion got its start in 2001 after a bunch of Kamloops medical workers, who had previously worked with another non-profit called Poco a Poco, decided to go it alone and create an autonomous organization. (Poco a Poco was formed in the early 1990s by Qualicum Beach veterinarian Jill Sampson, who earned a 2003 Governor General’s Award in recognition of her humanitarian work.) Medicos en Accion continued the work they had been doing with Poco a Poco, mainly two-week stints of surgery at the charitable Hermano Pedro Hospital in Antigua, fairly routine, assembly-line stuff like hysterectomies, hernia repairs, gall bladder surgeries and the like for people who couldn’t afford a visit to one of Guatemala’s private hospitals. Two years ago Medicos endeavored to expand its operations. And that’s when Poelzer came in. He was contacted by a colleague in Kamloops and asked to lead a second team out of Antigua and into the field – a sort of mobile outreach clinic. At first he was reluctant to take it on, nervous about building a medical relief project from scratch. Now he laughs when he looks back on that first trip to Panajachel in the spring of 2003 when he arrived with a greenhorn volunteer medical team and a vague, idealistic notion of dispensing health care and medicine to the needy in poorer villages around Lake Atitlan. “We basically just showed up with a van full of supplies and no contacts at all,” Poelzer says. “It was real nerve-wracking at first, but when we pulled it off there was a great sense of satisfaction.” Poelzer did what any newcomer should when trying to get a foot in the door of a strange community; he asked for a meeting with the mayor. That meeting led fortuitously to a network of ex-pat Canadians and Americans living in Panajachel who were already involved in volunteer work. People like the Scatchards, who ranched for 20 years on the benchlands above the Fraser River halfway between Lillooet and Lytton before retiring to the warm and benign climate of Guatemala. The Scatchards had a couple of things Poelzer needed badly: fluency in Spanish and contacts with local health officials and community leaders. The inaugural mission didn’t exactly run like a well-oiled machine. Sometimes the team felt its efforts were misallocated; for example, in some towns relatively affluent locals with cellphones and shiny Nikes showed up for free medical advice and drugs. However, lessons were learned and it was an important first step towards getting established in the Lake Atitlan region. Back at the clinic I join Poelzer and a translator on a house call to the home of Señora Concepcion Yojcom Pop. The squat and smiling 36-year-old matriarch had visited the clinic the previous day with her feverish 20-month-old son. The toddler had the telltale hollow, raspy cough of bronchitis. Poelzer examined the sickly child and gave him an expectorant to loosen up mucous plus a cycle of antibiotics to keep the possibility of a serious infection at bay. Moments ago she returned panic-stricken to the clinic, looking for Poelzer and describing the child as being in a much more dire state than yesterday. Poelzer manages to sneak off between patients, and Señora Concepcion quickly leads us a few dusty blocks away to her family’s home, a plain one-room box with three beds. The walls are bare save for a garish painting of Jesus Christ next to a stark wooden crucifix and, on the opposite wall, a stiff portrait of a man in military uniform. The air in the house is stuffy and hot, and the tiny child lies on a bed, face peering out from a thick swaddle of blankets. Señora Concepcion looks imploringly at Poelzer with the frantic expression of a mother whose child is sick and whose only ability to communicate is a constant, pitiful wail. Poelzer places the stethoscope on the baby’s tiny brown chest and then a hand on his forehead. “Actually, I think he’s doing fine, looks good,” he says, explaining through the interpreter that the child had been experiencing febrile convulsions – alarming for a mother, but a normal physiological reaction to high fevers and a sign that the body is healing. A broad smile of relief sweeps across Señora Concepcion’s face and she makes what looks like a motion of genuflection towards Poelzer, who seems almost embarrassed by the gesture. The yard outside the home is large by village standards and the family cooks on an electric hotplate, not an open fire as many rural Indians do. We learn that her husband toils hard for these small amenities, picking coffee beans in the plantation that blankets the hillside above San Pablo, 50 kilograms of beans per day in the unrelenting heat to earn 20 quetzales, about $3.50. On this salary he supports a family of four. Once, when he fell ill, a local doctor gave him a prescription for pills to treat diarrhea. They cost the equivalent of $4 each. “The guys work hard, they don’t eat well and their water is contaminated,” Poelzer says, summing up the plight.
Today there’s no doubt Poelzer and the other doctors and nurses have been well received, in fact enthusiastically embraced by the locals. But as soon as you begin to unravel the multi-layered problems of a town like San Pablo, you can’t help but question the efficacy, and even the naïvete, of parachuting into a village for a few days of medical philanthropy when the social, economic and political problems run deep and dirty. What happens after foreign doctors board the plane for the comforts of home and the free antibiotics have run dry? The drinking water will still be contaminated, the diet poor and the town’s poor residents still crowded on the lowest rung of Guatemala’s socio-economic ladder. Guatemala has always been an attractive getaway for Canadian volunteers. Every year hundreds of them, under the auspices of dozens of different organizations, come to work here. There are evangelical school-building brigades hoping to win converts for the Catholic faith and crack teams of plastic surgeons helping kids with facial deformities. The country’s appeal is complex; it has a certain ‘third world’ exoticism while not totally lacking North American amenities and comforts. If you choose, you can stay in a hotel that would rival a five-star property in Canada while doing your altruistic duty, a way to insulate yourself from the far less comfortable and more basic conditions that prevail in the countryside. It’s also stunningly beautiful and the benign winter climate is dry, but not too hot. And for the anthropologically curious there’s a vibrant and easily accessible indigenous Mayan culture to learn about. For all these reasons it seems at times as though international volunteers are tripping over each other in Guatemala [pagebreak] Dr. Andy Hira, a political scientist from SFU who specializes in Latin American development, has recently published a book titled Development Projects For The New Millennium. He is less than charitable in his assessment of most short-term aid and relief projects, and for that matter, the entire ‘development industry’. He believes humanitarian aid is best applied in disaster relief situations, be it for war or a devastating hurricane. Adversely, he likens a two-week medical blitz to sunny Guatemala as a form of volunteer tourism that does more to assuage North American middle-class guilt than it does to effect meaningful change in developing countries. “You’re not going to gain the trust of locals in two weeks let alone five years. In my opinion the best thing you can do is help local people organize so that they can make demands on their own government,” Hira says. Call it the give-a-man-a-fish-and-you-feed-him-for-a-day, teach-a-man-to-fish-and-you-feed-him-for-life school of development thought. What’s worse, humanitarian groups often show up with unaffordable, unsustainable, distinctly first-world solutions that simply fizzle out after the funding dries up and the expertise goes home. Such was the case in San Pablo a few years back when a high-tech water treatment plant was constructed courtesy of foreign aid dollars but the village couldn’t afford the expensive maintenance bills. The project was mothballed. Compared with behemoth humanitarian groups such as Doctors Without Borders or CARE, Medicos en Accion clearly falls on the grassroots end of the scale. All participating doctors and nurses travel to Guatemala on their own nickel, covering the costs of airfare, accommodations and food that can easily add up to more than $2,000 for two weeks. It’s run entirely by volunteers and almost all the money and donated medical supplies gathered in Canada will hit the ground in Guatemala to directly fund the day-to-day operation of clinics and equip the surgeries. Most important, Poelzer adds, Medicos en Accion is non-denominational and doesn’t have an evangelical mandate that says, ‘Sure, we’ll help you, but first you have to watch this Jesus video.’ One evening, after a hectic day at the clinic, I meet Poelzer in an outdoor bar in touristy Panajachel. Across the street a marimba band is playing in a restaurant to a disinterested audience. The air is wonderfully warm and we watch the activity on the town’s bustling main street that leads from the bus stop to the lakeshore, lined all the way with vendor stalls and restaurants. Beguiling muchachos peddle scarves, oven mitts, hats, hash pipes and handbags to the tourists who pass by with video cameras slung around their necks. Over bottles of Gallo, Guatemala’s de facto national beer, we talk about altruism and the unique draw to Guatemala that courses through the Poelzer clan. His aunt, an eccentric academic from California, spent time in the country during the height of the civil war and was involved in clandestine organizational work with the guerilla movement. An uncle also worked in Guatemala on aid projects. Poelzer has inherited this sense of duty, the desire to give something back to a world that has been generous to him. “I really enjoy the human contact and interaction. That’s what really does it for me,” he says. He also acknowledged a more selfish reason for taking on such assignments. “I love adventure and I get to see areas that I normally wouldn’t get to,” Poelzer says unapologetically. Simply put, volunteering can take you to places the guidebooks don’t write about. Between pulling shifts at the obstetrics clinic back in Kamloops, Poelzer’s busy 2004 volunteer calendar includes, in addition to Guatemala, a trip to Malawi in March with Canadian Physicians for Aid and Relief, as well as one in the fall to Nepal with yet another volunteer group. It’s easy to understand how you can get your travel jollies through volunteer work, immersing yourself in a strange culture, learning a language and challenging your North American notions of comfort. Measuring the effectiveness of your efforts, however, is a more ambiguous business. The controversy surrounding development work and how best, or even why, to bother, is not lost on Poelzer. “I’ve thought about this a lot. Is it worthwhile what we’re doing, parachuting in with drugs and North American solutions?” he says. “But if you have someone who’s been suffering from a bladder infection for six months, yes, you can make a difference in their lives.” Later that evening Nurse Fearon Blair joins us for a beer. Blair seems well suited to work in developing countries and displays the easy adaptability of a seasoned world traveler who has taken cycling trips in places as diverse as Vietnam and Italy, but this is her first overseas volunteer mission. She shares Poelzer’s dual motives for taking part – a love of travel and a desire to parlay her medical experience into some sort of philanthropic enterprise. Yet the thrill of working in a foreign country is tempered with nagging doubts. “I was frustrated by the fact that there are so many large problems like sewage and drinking water that require long-term solutions and that’s hard to do in two weeks,” Blair says. Despite her reservations, she already feels a certain affinity with the folks of San Pablo and hopes to return with the group next spring. Jon Just, the Kamloops surgeon who oversees the Medicos en Accion volunteers at Hermano Pedro hospital in Antigua, raises another interesting dilemma. What if all this well-intentioned development and medical aid in the end only helps to perpetuate the systemic problems that plague countries like Guatemala? “The negative side is that it allows the [Guatemalan] government to abdicate its social responsibility because groups like ours are here to fill the gap,” Just points out.
Clearly Medicos en Accion would be amiss not to take an unflinching and critical look at its role in Guatemala. Next year the group plans to focus its two-week mission more tightly. The surgeons will continue their work at Hermano Pedro hospital in Antigua. The Lake Atitlan team, instead of trying to hit as many villages as possible, hopes to concentrate its efforts in San Pablo and perhaps one other village. The group will maintain the daily clinics, treating the usual suspects (diarrhea and a potpourri of other infections), but volunteers will also offer more public health education with an eye on long-term change. They will teach children the importance of personal hygiene, how drinking pop and eating candy rots the teeth and how a simple rinse of the mouth with water, even if you don’t have a toothbrush, will improve dental hygiene. Medicos en Accion also plans to set up a skills workshop for local paramedics in Panajachel (in a classic example of misguided philanthropy, a foreign group had donated a defibulator to the ambulance attendants, but failed to show them how to operate it). Medicos en Accion – its mission and mandate – is a work in progress and probably always will be. That’s the nature of the game. But let’s face it, none of these Canadians would be here if they thought it was hopeless. For people like Poelzer, Blair and Just, it boils down to a simple choice. You can choose to shrug your shoulders, succumb to apathy, do nothing and retreat into a cynical shell. Or you can try to give something back, however little that something may be. The sun sinks low on the horizon and a saffron haze blurs the summit of Vulcan San Pedro across the water from San Pablo. A slight breeze ripples the surface of Lake Atitlan and the soft evening light glows on the white Stetson of a Tzutuhil man jigging for fish from a wooden dugout canoe. Poelzer bounds along the wharf with three bags full of drugs and supplies slung over his shoulder, looking as cheerful as ever, followed by Blair and the rest of the crew. Once all the gear has been loaded the boat lurches away from the rickety dock; the circus is leaving town. As night approaches, a few amber lights twinkle in San Pablo on the hillside. Blair and Poelzer settle into chairs on the deck of the boat and savor the beauty of the tortured, volcanic landscape surrounding Lake Atitlan. There’s no doubt humanitarian work is an imperfect and complex endeavor, often raising as many questions as it answers. But as far as this group of adventurous Canadians is concerned, if it brings light to one or two more lives then you can chalk it up as one small succe