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Archive for the ‘Remember, No One Cares’ Category

The entire “managed health” component of the privatized healthcare system which we now “enjoy” in the United States descended from the HMO Act of 1973, signed into law by the President whom Hunter S Thompson had famously claimed “could shake your hand and stab you in the back at the same time”. The insurance system we have today, primarily built on the foundation of the profit-inducing-but-patient-screwing HMO system, has built in something called a “moral hazard”, which ostensibly provides the conservatives’ requisite “skin in the game“. For those unfamiliar with this concept, a simplified version of the basic premise is that forcing a patient to cover a certain amount of a medical procedure will decrease the “risk” than an insurance company will have to pay for a procedure.

Let’s stop right here, for a brief moment. The idea that an insurance company, being a for-profit entity with a primary obligation to their shareholders, rather than their clients, has an *incentive* not to pay for a procedure — well, it seems pretty awful. It’s one of the primary deficits in a for-profit health insurance scheme that the three primary parties involved (doctor, patient, insurance company) all have different objectives, which jive with each other (doctor wants to receive pay for care given, patient wants to receive care, and insurance company wants to pay as little as possible, if anything). You can see that the insurance company seems to be the party whose goals seem to disagree with the rest, and it’s the reason why I believe that a private insurer system is doomed to ever-rising costs, risk of medical bankruptcy, loss of accountability, pure graft and corruption, higher mortality rates, loss of quality care, as well as an inevitable collapse. But I digress from my primary point.

We can examine the idea of a moral hazard in health insurance by looking at the general purpose it supposedly serves: reducing the demand for profit-draining healthcare payments. The problem with that argument is that patients do not voluntarily seek unnecessary care in quantities which would cause a system of requiring patient payment to be necessary to reduce risk. Patients seek care when they require it, which means that the only care for which it would decrease the demand would be preventative care. If you follow the aforementioned link, you’ll see that the entire focus of most studies is the efficacy of preventative care in *decreasing costs to insurers* rather than decreasing mortality rates or improving quality of life. That follows a pretty common trend of insurers to perform cost/benefit analyses without the benefit of measuring the *benefits* of treatment options on patients.

So, we have private insurers, attempting to gain a greater profit margin by either denying care to patients for arbitrary reasons, or attempting to bolster profit margins by requiring deductibles and/or co-payments to dissuade patients from seeking care, encourage patients to seek less expensive/less effective methods of treatment, and/or decrease the amount of payout for which they are responsible. It seems as though parties with those motivations would be less-than-ideal candidates for effectively making healthcare and treatment decisions for the public at large, although they do that at the moment, by deciding which treatments to cover, which patients to insure, and how much of a patients’ own money must be spent for healthcare treatment for conditions which may or may not have anything to do with their own action. Not much of a “moral hazard” to avoid there, is there? If a factory worker gets cancer from working in a factory — who pays? Certainly not the factory. Whose fault is the condition? Not the patient. If unsafe drinking water produces parasitic infections or a more hazardous condition — who pays? Not the people responsible. Whose fault is the condition? Not the patient.

I would posit that your opinion of the for-profit healthcare system depends largely on your relationship to it; those who believe that profit is more important than the efficacy of patient care would most likely side with the current system (as well as the unconditional free market leghumpers), whereas those who see healthcare as more of a basic human right or regard the efficacy of care as being the paramount point of importance over the profit of a company would most likely favor a single-payer or socialized healthcare system. (I leave out the uninformed, teabaggers (who also fit in the prior category), and full-on anti-Federalists. There’s no reasoning about human dignity or health with people who believe that some people have the right to do whatever they want to other people due to the size of their wallets — but that’s for another post.)

Finally, there’s some sort of populist anger against the bastards who tanked the economy in 2008 to pad their pockets. It’s just too bad that there isn’t a cohesive set of demands to go along with all of that rage.

For too long, media-created “populists” like the teabaggers have railed against liberal policies, diversity, and government in general to attempt to explain the uncontrolled collapse of the United States’ economy. I’ve heard explainations (discredited, of course), ranging from the Community Reinvestment Act to “too much regulation”, but I find it rather difficult to understand why the Occupy Wall Street protesters seem myopically obsessed with the Bush Tax Cuts and the Citizens United decisions — as if they caused this clusterfuck. Make no mistake, both are odious; one for draining our reserves and forcing us into “emergency” austerity measures for the sake of bolstering the top 1% of Americans (Bush Tax Cuts), and the other for removing the common man’s political power by allowing money, disproportionately held by the top 1% of Americans, to unduly influence the political process (Citizens United).

The root causes of the economic downturn are far, far simpler. We can explain some of it through the greed of multinational corporations, who choose to outsource labor, decrease benefits, and shunt money away from their labor pool to benefit investors and the parasite investor class to an onerous degree. We can explain it through a systematic dismantling of financial system regulations which have been in place since the aftermath of the Great Depression, including, but not limited to: the Depository Institutions Deregulation and Monetary Control Act of 1980 (Carter), the Garn-St. Germain Depository Institutions Act of 1982 (Reagan), the Gramm-Leach-Bliley Financial Services Modernization Act of 1999 (Clinton) and the Commodity Futures Modernization Act of 2000 (Clinton). Let’s not forget our ol’ pal Dubya, with his OCC tricks and gutting the regulatory system. Make no mistake, the primary causes of this clusterfuck are the greed of the banks and the fact that our leadership has been making it much easier for banks to have their way with you, virtually regulation-free. And they’ve been working at it for at least thirty years.

Putting aside greed and deregulation — banks (being considered the hypothetical sociopathic “persons”) — are bastards. Real bastards. Let’s take the example of Bank of America, which is (at the moment) one of the most hated financial institutions in the United States, with the possible exception of Goldman Sachs. I was listening to the radio this morning, and a spokesman for some shill PR group for the consumer banking industry was railing on about “regulations from Washington” and “that Dick Durbin” forcing the poor, helpless banks to institute five dollar a month ATM/debit card usage fees. I think that my rage culminated in his line about how he thought government regulations were hurting banks, evidenced by the mass layoffs at Bank of America. Let’s remember that those layoffs aren’t going to touch the parasite investor class’s ROI, and definitely not the CEO-level compensation or bonus package structure. Nope, not at all. Also, the shills for the banking industry don’t want us to remember that they don’t really make their money off of ATM or usage fees — they’re just a byproduct of suckering you into giving them your money.

Banks make money off of “fractional reserve lending/banking“. They essentially loan money into existence, but it requires a certain fraction of the money they’re loaning out to be “on hand”. This is where *your* money comes into play. You give them your paycheck, and see a nice dollar amount show up on your ATM screen or bank statement — but that money was just fed into the grist mill of short term, long term and mortgage loans. And if you have a home loan through BofA as well, they’re basically charging you to loan your own money back to you. (And they wonder why they’re some of the most hated institutions on the planet.)

That complete disconnection from reality is what, I believe, is fueling public anger — and their insistence in blaming “the gub’mint” for regulating them *too much* (I know, I know, it’s insane to even try to digest that, only a few years after deregulating their derivative trading, commodity trading, and general shaft-up-the-backside to the consumer, that they would consider blaming *too much* government intervention for them sucking, but I digress…) isn’t going to fly.

I hope the protests stay peacefully and spread. The protesters may not be unified (or completely informed), but they have the right idea — and their anger is finally directed at the right group of people.

The Masters of the Universe seem to have a vested interest in the death of 99+ week unemployment benefits, which I’m just starting to realize.

There is a pretty substantial inverse relationship between the DJIA and unemployment rates. By “unemployment rates”, we’re not talking about the Bureau of Labor Statistics U-6 numbers, indicating our entire workforce, but rather the more limited U-3 numbers, which indicate “Total unemployed, as a percent of the civilian labor force”. Let’s face it, it’s in the best interest of the ruling parties to keep the official unemployment rate low, to boost perception.

Shit, if I were to take a quick look at the DOL page on unemployment, it paints a bleaker picture than the rally in the DJIA which Bloomberg reports is tied to an “increase in job openings”. (Their “live ticker” for official unemployment numbers is here.)

What does this have to do with the “Masters of the Universe”? They’re going to be making a *killing* in the order of billions of dollars as stock prices predictably rise, of course. Doesn’t matter that we are losing manufacturing jobs due to globalization efforts and increased mechanization, or that stagnant wages and rising income disparity means you’ll die poorer and your upward mobility in terms of income is, for all intents and purposes, stalled. Even Ben Bernanke, money printer extraordinaire, says that we’re creating two separate societies this way.

So, why cut off extended unemployment benefits? I mean, unless you’re a brain-dead deficit hawk or a “I’ve got mine so fuck the rest of you” Libertarian, they actually have a pretty positive economic stimulus effect. More so than the pointless tax “cuts” that we’re going to extend until we’re ass-broke, at any rate. The only reason I can think of involves pumping up the stock market, which currently out-earns our manufacturing industry as a percentage of GDP.

It was my last day in Xela, with all of the basic setup, wiring, and other on-site work having been completed on Friday. As I’m lousy at negotiating prices even in English, Jorge was kind enough to go from shop to shop with me looking for some gifts for my wife and keepsakes to take home with me, after I went out with Irv to find a whiteboard for the clinic. The title of this refers to my normal breakfast order in the hotel, which I was finally able to order myself — “scrambled eggs with cheese, no meat”. When it comes to breakfast, I’m a bit more than mildly predictable.

Jonathan had decided to take us to Antigua a day before we had to fly out of Guatemala City because he was concerned about the long ride, potential delays from mudslides on CA-1, and to treat the team with a relaxing day off. I’m still surprised that we made it to Antigua in one piece — the bus driver we had this time treated CA-1 like a racetrack. I lost track of the number of times we passed chicken buses on two lane stretches with visible oncoming traffic, but we still somehow made it to Antigua in one piece.

For those people who want to see Guatemala, avoid Antigua like the plague. Antigua is to Guatemala like naugahyde is to leather. It’s like a really bad European version of the rest of the country, to somewhat haphazardly quote on of the other people on the bus. Everything is overpriced compared to the rest of the country, and the same goods are sold at a huge markup although the same amount probably goes to the poor people who actually manufacture the goods. I bought a few small things, as I had to burn the majority of my remaining quetzals before returning home, but the whole experience of shopping there with the memory of the poverty in Xela and the outlying regions left me a bit sick to the stomach.

Disregarding the income disparity and kitchy nature of some of the shops, along with most of the prices of the European-owned shops and hotels being represented in United States dollars rather than quetzals, Antigua is a beautiful city. People, especially street vendors, are marginally less friendly than they had been in Xela. I think I’d liken their disposition to that of street vendors in New York City, who generally frown upon taking their picture if I haven’t made a purchase from them.

A little later on in the evening, we went out for a trip-closing dinner at a little hole-in-the-wall restaurant hidden off of the central park, to which we had been directed by a somewhat questionable man in a cigar and liquor shop. The food was very good, but the portions were far larger than any of us had expected, and we left there very overstuffed but happy. We headed back to the sketchy cigar and liquor shop, at which point we decided not to frequent his establishment. Jorge suggested we go out to a salsa club, since, as he put it, “when are you going to be in Guatemala at a salsa club again?” We stayed for about a half hour, as it was noisy and overcrowded. Before we left, Jorge pointed out a few obnoxious American tourists as an example of the worst of us. I’d like to think that because Antigua was more of a pit-stop along the way home, we’re not in quite the same bracket as the American tourists who come down here for the sole purpose of partying and making general fools of themselves.

Tomorrow we fly home, and I’ll be spending another day of being on planes, trains and automobiles (all apologies to Del Griffith). I’m going to be relieved to be home, but I’d like to believe that I’m better off after coming down here. If I ever forget how lucky and privileged I am, I just have to think back to some of the places here.

(To anyone following this, sorry for the delay in posting.)

More than half our our crew parted ways to do a mobile clinic today, whereas Irv, Shelley and I stayed behind with Dr Christian and a few med students to attempt to get the EMR functional in a way which would jive with the clinic’s workflow. I hit quite a few snags in some of the UI implementation, since I have been pretty hands-off in the development of the UI over the last few months. Even with that, we managed to get the registration and triage components up and operational, while at the same time stringing category 5 cable around the clinic.

(Again, my job called me for another favor — this time a load balancer reconfiguration. I wonder if I get comp’d vacation time for this?)

So, after a day of implementation and clinic beautification, the POP-WUJ Clinic looks much better than it did before we arrived. The staff doctors thanked us all profusely for our help in making the clinic a nicer place — however, there was one moment which Jonathan referred to as the “pay it forward” moment. A local carpenter’s wife had been seen in the clinic, and he noticed that one of the doors seemed ill-fitted in regards to the frame in which it sat. He came back down later that day and refitted the door by shaving it down properly as a sort of thanks for the clinic having attended to his wife.

As an end of week “send off”, Dr Sullivan and her husband invited us over to their house for some wine and cheese. The whole thing would probably have been a little bit better if the sky hadn’t opened up with a monsoon on our way over, but thankfully most of us were wearing suitable rain gear. On the way back, we got lost trying to drop Shelley off at her host family’s house, so Irv and I ended up taking a cab back to Casa Mañen, more or less completely drenched.

It has been a fantastic week, and we have accomplished a great deal — but I’m getting to the point where I really miss being home. One more day of picking up stuff for the wife at the local market, driving to Antigua for Saturday evening, and I’m on a series of planes back to New England. Maybe we didn’t save the world this week, but at least we did our best to make some improvement, somewhere.

It’s day five of our trip to Xela, and we’ve come to the realization that the damn server isn’t going to clear Customs before I leave the country. That being understood, I got FreeMED up and running on the machine which was originally designated to be the secondary / failover server. The guy who set up the router which is being used by POP-WUJ is unfortunately in Spain, and has left no information on access, so I’m unable to appropriately set up port forwards for the server. In lieu of that, autossh tunnels are now running back to Connecticut, so I can still access the server. It’s just not very conducive to anyone *else* trying to access the server from beyond the walls of the POP-WUJ building.

All of this was done despite efforts from my day job to occupy as much of my vacation as possible with fixing firewalls and failing over between colocation centers. That ate up the middle of my day, for the most part. While I was busy doing this, Jonathan and the part of the crew that hadn’t gone out hiking at 4am started work on beautifying and improving the clinic. By 5 or 6pm (as everyone else got back around 2pm), the pediatric exam room had been repainted and decorated, the main room had been decorated, and much had been improved in the pharmacy and in the electrical system areas. Thanks to my sister Shelley, there are nice printed signs which are to hang on the exam room and pharmacy doors, and a large tapestry hangs where a few photos had been haphazardly taped to the walls. Jorge painted the walls in the pediatric exam room with a roller, adorned with a plastic ziplock bag over his head and a surgical mask, and some of the nurses attached a semi-permanent measuring tape to the wall for height measurements, decorated with cutouts of popular childrens’ characters. With any luck, the kids who are seen in the clinic will feel much more at ease when they visit the doctor.

All of us went out for Tex-Mex food at a local eatery with Meg and her husband. I broke from my tradition of only eating local food to help myself to a grilled burrito “de res con queso” with beans and flavored rice, with a helping of the local beer. It was offered in light, dark, and “medium”, which we surmised was made by mixing equal parts of the light and dark brews. Regardless, it was a good tasting meal. I grabbed a chocolate flavored coffee, and Irv grabbed a regular, to help keep me up for a stint of finishing up the triage UI logic. I ended up going with a system event bus approach, in that new registrations are pushed out via “systemnotifications”, forcing the UI to update itself whenever new patients are registered at the registration stage. This should allow the triage person to see all registrations as they come in from a single screen which does not require any sort of manual refreshing to function properly.

The crew is splitting in half tomorrow. One half is visiting a daycare in the pueblos outside of town, and the remainder, including Irv and myself, are staying behind with Dr Christian to man the clinic in Xela. I’m staying behind so that I can help push adoption of the EMR for demographics and vitals collection, and Irv will be assisting Dr Christian in seeing as many patients as they can. The hope is that we can break for a while to visit the marketplace, as I promised my wife I’d buy her some local fiber, yarn and other knitting supplies. If I’m lucky, I can find a local artisan who makes instruments — but I’m not holding my breath.

Today we left early in the morning, around 7am, to head out to the village of “Aldea Pujujil” in Solola, Guatemala to do a travelling clinic. We took two “micro buses” with ten to thirteen people in each with equipment tied down to the top, and left Xela heading back towards Guatemala City on the Pan American Highway.

The local town had set up their central meeting building, which was a stone edifice with a grooved tin roof, as a sort of makeshift clinic. There were individual treatment “rooms” created by hanging wire with plastic garbage bags and painter’s tarps, and a large tarp separating the main registration and triage area from the rest of the “rooms”. Five separate treatment areas were available, in addition to an area for the dentist who came with us. More than half of the prospective patients spoke qui’che instead of spanish, so there were a few local translators to help the doctors, registration and triage crew.

The children there seemed very shy at first, but were enamored by the doctors, having their pictures taken, and having balloons made for them by the nurses and me out of spare latex gloves. In the afternoon, the local school emptied out at the same time as the daily rain, so the “clinic” area was flooded with refugees from the water. They quickly joined in playing with the inflated gloves and posing for pictures with the clinic crew. It was interesting to see that two of the boys were using old Corn Flakes boxes as protection from the rain.

Even though I had the job of documenting the clinic visit with photos for POP-WUJ fundraising to get more supplies to do this sort of thing in the future, I couldn’t help but feel a little helpless. The people who came needed medical help, some more than others, and the most I could do was try to make the children laugh a little and stand out of the way as a silent observer of the doctors trying to help this village, which, if lucky, would see these doctors a few times a year. Unfortunately, as the paper process used to see patients is pretty inefficient at best, we probably could have helped more people if we had a way to organize this better. The “distance workstation” project I’m looking at starting should help out with that, if I can clear some minor technical hurdles in the implementation department.

After a few hours in the bus, we came back to the clinic. Irv, Shelley and I stayed at the clinic and kept the door open so I could work a bit more there, and we headed back to the hotel around 7 or 8pm local time. Irv, Jorge and I went to a little restaurant called “Cafe Shalom” (alternately spelled “Cafe Shalon” on half of the posters) near Parque Central, and had a brief dinner, then walked back.

Back to the medical record… The server is stuck in customs in Guatemala City somewhere, so I had to get the secondary server up and running. It had been slightly damaged in transit, which jostled the RAID card loose and knocked a few connectors off of the backplane. Regardless, after my father made a quick trip to the local bookstore to pick up a blank CDR (as the BIOS in that model didn’t properly boot off of my Debian USB install key due to its particular vintage), I got Debian running on that machine with little trouble. The uplink here isn’t fantastic, so it’s a matter of starting the upgrades and downloads then walking away for a while. There are also some electrical system issues. The single outlet available to us is ungrounded, which may cause some issues, so we’re arranging a UPS to be purchased locally to act as a bit of a safeguard between the fairly unstable electrical grid in Xela and the servers and switching hub. We may have to drill a post to ground the system to the earth properly in addition to all of that.

I’m making pretty good headway with FreeMED modifications for the clinic, and have started on the triage screen, with some input from Jorge. I’m hoping that it can act as a “junction” in the flow of data around the clinic, but that remains to be seen. After I finish up the screen tomorrow, I’ll do some limited implementation testing to see how well it works or doesn’t work.

The clinic was open for the first of the two days it will be open during my stay in Xela. It was a pretty crazy scene — a line going to the end, if not around the end, of the block.

We had Isabel, the local intake/registration person, working with my sister Shelley to do registrations, after which the patients were sent to Jorge, who war running triage. Dr Meg Sullivan treated the pediatric patients, while Irv and one of the local doctors handled the adult patients. Within a half hour or so, the makeshift waiting rooms upstairs and downstairs in the clinic were packed with waiting patients. One thing I did notice was that the children were remarkably well behaved — much more so than children their ages in the United States.

American Airlines, never striving to be the speediest in baggage recovery, still hasn’t delivered the bag containing the primary server. As I haven’t had any actually setup or installation work to do, I spent my time alternately documenting methods, coding some pieces for FreeMED which would handle some of clinic’s various registration and triage functions, taking pictures for fundraising use, and doing basic gopher tasks for the doctors and nurses. It’s a little disconcerting that we aren’t able to get people trained up on the system yet, but it’s just going to have to wait until their server comes in.

Another hurdle is the wiring. There isn’t really any “modern” electrical wiring, in that most of the circuits aren’t grounded at all. Most look like they barely have any sort of insulation over their conductors. The clinic has a little bit of money for supplies and such things, so we may end up having a UPS purchased to attempt to shield the servers from the somewhat inconsistent wiring and power grid there. The laptops can probably function with simple surge protectors, since they have their own sort of “UPS” through the use of their batteries.

Well, apart from an emergency colo flip for work (which I’ve been up until a little after midnight local time performing), I’m looking to get some shut-eye, as we’re heading out to the pueblos early tomorrow morning. I think that I’m going to be a little less useful than I have been in the clinic, but hopefully I can glean some further “best practices” and workflow in such a way that I can make it easier for the docs to do their jobs.

Update for those who were waiting for pictures: I’m in the process of uploading some pictures from the POP-WUJ clinic to a Flickr set, so check my Flickr account early Wednesday morning or so to see the first batch.

I ended up passing out on top of the sheets in the hotel due to the tired state in which I arrived, but today was full of plenty of excitement and activity.

We walked down to the clinic after breakfast from the nice people at Casa Mañen. The clinic is, to my knowledge, the only permanent free clinic in Xela, and has a few permanent staff members in addition to the volunteers who come down with the “medical brigades” (as Jonathan calls them). I spent the majority of the morning organizing components and parts for the systems after American Airlines confirmed that they found our primary server and that it would be here Tuesday morning (tomorrow). My sister Shelley went with me, as my Spanish is just about as good as my Greek (which is to say, non-existent). We were able to ride the “micro buses” to take us out to purchase a SIM card for the T-mobile Android phone which my sister-in-law loaned me for the trip, as well as scoring some replacement parts and some webcams.

As a quick aside, if you’re looking for Ubuntu support for the “Manhattan USB Webcam”, don’t. It uses the gspca driver’s pixart_pac7311 driver, from what I can divine, but the USB ids aren’t present in the stock driver, so it’s going to be a fairly painful process to get support worked in, especially since the gspca is in the mainline kernel now …

Getting back to the day’s events — We were lucky to have taken the microbuses, at a bargain rate of 1.25 quetzals a person, since it started raining again. I, of course, had no rain gear, but my backpack is/was waterproof, so the laptop and camera remained safe. Everyone was amazingly friendly, even to the point of walking us to a store when we didn’t understand their directions. I also tried to be friendly with a few of the feral dogs, but they mostly kept their distance, probably because I didn’t give them any food. Better that way, Natasha wouldn’t be very happy with me bringing home another dog.

In the afternoon, we set up the four donated workstations in the clinic, but rearranged them to function as inventory collection workstations for the pharmacy for some short term data collection, mostly due to the clinic being open and overbooked on Tuesday. We used Google Docs to create a quick and dirty web form with some simple constraints as a frontend to a shared spreadsheet for drug collection. This was done since we still don’t have the primary server, and I decided on “bulk loading” the drug data into the system later on, to save entry time.

I have learned a great deal from the clinic staff and volunteers about not only clinic and pharmacy work, but also about some of the problems with operating in conditions which are less than optimal, including so-called “distance medicine” work in extremely rural areas. Tuesday, I’m planning on observing the clinic operation to see if I can streamline any parts of the interface to help facilitate ease of workflow and smooth adoption a little. Wednesday, we’re headed to the pueblos outside Xela so that I can watch the distance medicine teams, and attempt to figure out the best way to bring in data (as well as provide access to data) in extremely remote and poorly connected areas.

I’m struck with just how much I have in common with the doctors, nurses and other volunteers here in Xela; they all seem to have a pervading sense of need for social justice and feel that a little effort can make a difference. I wish there were more people willing to staff places like this.

In comparison, there are shops here selling American goods and foods at prices that are on parity, considering the exchange rate to dollars, with what they would cost in America. Then I realize that the average pay here in Xela is something like 35 to 40 quetzals … a week. (That’s something like five American dollars.) Once you start to think about that, the social support systems in America don’t really seem that bad. We spend a lot of our time taking for granted things like even and well maintained sidewalks, relatively clean air through use of emission controls, and even basic animal control… Guess you don’t miss them until you visit a place that doesn’t have them.

As part of setting up the POP-WUJ Clinic in Xela, Guatemala with an electronic medical record, I have headed down with a team of ten other volunteers to the city of Xela in western Guatemala. I’m going to document the trip and the work we’re doing down here by a series of daily blog entries chronicling our trials and tribulations setting up and installing FreeMED there. I’ll post pictures as soon as I get the chance to upload them to Flickr.

Day One: Planes, Trains, and Automobiles

We left Connecticut last night around 11:00-11:30pm, and picked my sister up in upper Manhattan a few hours later. Along with us were a few Rackable Systems servers, kindly donated by SGI and some laptops donated by my employer, as well as an assortment of donated medications and medical supplies. Shelley flew out on a separate airline from us, but we all ended up arriving in Guatemala City around 12:15 pm local time.

From there on in, we took a chartered bus/van the 170+ km from Guatemala City to Xela, through the mountains. It’s pretty poor in a lot of these areas, but what struck me as odd were the armed guards at convenience stores and banks, as well as the razor wire surrounding those same banks. There were also a lot of stray dogs, some in packs, some idly following people around looking for scraps. The “chicken buses” were old US school buses which had received chrome and paint jobs, usually packed with riders, even to the point of having the overflow spilling out the doors. Our driver Pedro was very nice, and took us to a restaurant on the “Intra American Highway”, which served delicious food.

American Airlines lost one of the bags, unfortunately containing the primary server. I’m planning on deploying the workstations we brought with us and doing any additional wiring which may be required. After that, if the bag hasn’t surfaced, I’ll promote what was supposed to be the redundant backup server to the role of being the primary EMR server and will proceed with the remaining steps of our installation. The POP-WUJ crew is able to give me help doing translation work for the EMR, as well as fleshing out the necessary functions of their day-to-day workflow. Hopefully, we can fine-tune the system to work like a well-oiled machine.

It looks as though choosing Rackable Systems is going to pay off, as I’m most likely going to finish up configuring the backup server using the serial console “roamer” port with my handy USB to serial adapter and null modem cable.

Thanks to Google Voice and Google Talk, I’m able to communicate with friends and family back in the states without breaking the bank, and they can contact me. On the downside, I miss my wife, and I’m sure she, along with the dogs and cat, misses me too.