Saturday, July 18, 2015

Off the Beaten Path: Shaw's


One fine afternoon, my friend and I decided to check out a small coffee shop in the neighborhood where we were staying.  It seemed like there were always cars parked out front, and from our investigations walking by a few times, it looked like a nice little coffee shop.  Coffee shop:  for sure!  But beyond coffee, this place has bakery, fantastic desserts, delicious gelato, and chocolate, chocolate, chocolate!!

Folks from San Francisco, California might recognize the Shaw's name, and back in the day the chocolates were imported from San Francisco.  When the government of El Salvador passed a law regulating the importation of chocolate, the owners of the Salvadoran Shaw's had no choice but to learn how to make chocolate for themselves.  The chocolates and desserts might be described as European in style, but they are made locally at the Shaw's production kitchen.  The cacao is purchased from a Central American cooperative.


The menu at Shaw's offers breakfast, sandwiches and a variety of sweet items.  Once we discovered this place, we have especially enjoyed heading over for an afternoon coffee with dessert.  The coffee choices, which personally for me typically include chocolate, are delicious.  The atmosphere (at least at our frequented location) is relaxing and comfortable, with small cafe tables and chairs but also a couple of small sofas and a "reading room."  It is a good spot for meeting up with friends or for holding small meetings during mid-morning or afternoon when it is not crowded.  Shaw's also offers free wifi, and many of the coffee drinks come with a small piece of delicious chocolate.

Salvadorans often say that on a very hot day it is good to drink hot beverages.  I am not going to weigh on on that debate.  If you are not in the mood for an afternoon coffee, there is always gelato...







Monday, July 13, 2015

After the Ceremony

This is a continuation of the story, Beato Romero ...

We walked up the street toward San Jose de La Montaña Church, happy to have been in the throng, and happy to emerge from it.  Our mission:  to find a place to eat lunch, preferably a spot with some seating.  We made up the hill, glad to see a few sidewalk cafés opportunistically set up just beyond the church.  The delicious scent of carne asada and an empty table with a few chairs were all the encouragement we needed to hustle ourselves over to that table.  We peeked over at the grill, and the meat looked as appetizing as it smelled.  We scooted our chairs to the table to the sound of shrieks and laughter.  To our great surprise, friends from Rutilio Grande were eating lunch at the table beside us!  We jumped up and shared hugs and kisses, marveling at the coincidence.  Weeks before the Romero beatification ceremony, we had communicated with these same friends and figured it would be nearly impossible to connect with one another in the midst of the huge crowd.

We chatted with our friends, enjoyed our delicious lunch and watched as the Holy Communion distribution teams walked by.  Each team consisted of a white-robed priest carrying a white gift bag (presumably the sacrament was inside the bag), and a small team of volunteers wearing turquoise t-shirts, one of whom carried a big yellow umbrella.  Each distribution team had been pre-assigned to a designated location, and the process of bringing the sacrament to the people seemed to be taking a while.   We had seen the first teams moving out to their spots as we began our walk away from the crowd.  In fact, we passed by as an old woman held out her hands for communion, but the priest told her he was not in his spot yet so she had to wait.  That seemed a little bit wrong to us.  As we sat eating our lunch, an older priest interrupted his walk a couple of times to hand out communion to old women in aprons and some teen guys.  "He is from the older generation," the pastor who was with us said, "He gets it."   We nodded.

After lunch we decided to walk back to the center of things to see what we could see.  Barricades were still set up, but we could walk easily walk around the Salvador del Mundo monument.  The streets were littered with all kinds of trash, not surprising given the size of the crowd and overflowing garbage barrels.  Entrepreneurs carrying large bags picked water bottles and other recyclables up from the gutters and trash cans.  We ran into Bishop Gomez and his wife, and a few other familiar folks along the way.  Eventually we made our way back up the big hill via the same street we had walked hours earlier.  The vendors for the most part had packed up their Romero posters, candles and other souvenirs.  We stopped to use the portable toilets two-thirds of the way up the hill.  They were clean, which indicated to us that the crowd probably did not make it up to that point.  We stopped for ice cream and then called it a day.



Monday, June 15, 2015

Beato Romero

We woke to the sound of music in the air.  Soon a military helicopter buzzed closely overhead,  drowning out the singing.  The day had arrived:  on this day Archbishop Oscar Romero would be officially beatified by the Roman Catholic Church.  For those who receive inspiration from Romero's walk of faith, this day would serve as a celebration and recognition of the life and sacrifice of the man who is already known as Saint Romero of the Americas.

We began walking down Paseo General Escalon toward the El Salvador del Mundo plaza a few hours before the beatification mass would begin, allowing plenty of time to navigate the 3 km journey and predicated large crowds.  The road was closed to traffic.  Up ahead we could see teams assembling a big screen in the middle of the road.  It seemed a bit last-minute to be doing that work so close to start time, but given the deluge of rain that fell the night before, maybe it was wise to procrastinate.  As we descended the hill, we noticed a few hopeful, opportunistic entrepreneurs set up along the sidewalk.  Posters, t-shirts, candles...Romero would be astounded at the grand multitude of his image portrayed on everything from baseball caps to balloons.  On the light poles and street signs along the way, the city had posted welcome signs in Spanish, Italian, English a fourth language we didn't recognize.


As we got a little closer, lines of orange-shirted volunteers greeted us...every one of them greeted us!  Many had shirts that said "bilingual volunteer."  As we approached the next big screen, a little line of watchers sat on the pavement watching a documentary about Romero.  The spaces were ready for big crowds and we wondered where the big crowds were!

Nearer to the Salvador del Mundo plaza, we found crowds.  Our initial idea had been to hang out near the periphery, but once we got to the crowd, we wanted to dive into the experience.  Actually, a better description would be "sucked in."  The crowds were tight!  There is this great dynamic in a crowd of such size and density:  whenever a little hole opens up and one person starts moving, it creates a stream for others to follow.  We perfected our technique of streaming and ended up near the line of clergy who would soon process to their places near the stage.  We made a game of "can you get a shot of a cardinal?" as we caught an occasional scarlet-capped head approaching.  We were near to the water tent, the staging area for huge piles of bag water.  Upon closer inspection, we noticed each bag featured the face of Oscar Romero.



We decided to move when another stream opened up, and we wedged ourselves between a cement wall and metal gate to escape the crowd.  We headed uphill, plotting out a route to get around the crowd and maybe get to a spot facing the stage.  We had no delusions that we would get close.  We were a little group of three, so fairly mobile, and one of us (that would be the Salvadoran Lutheran pastor), sweet-talked a guy with a gun into letting us go down a closed street back into the crowd.  The determined pastor elbowed his way in, creating his own stream and pretty soon we were stuck.  Solid people.  No more moving.  We could see the stage in the distance and make out images on a couple of big screens.  We had arrived:  the complete Beatification of Archbishop Romero experience, and it was beautiful.



As mass began people sang -- really sang -- songs from the Salvadoran folk mass.  The crowd was faithful and enthusiastic.  Every now and then a stream would open up as vendors passed through calling, "Aguaaaa, Gaaay-tor."  At first thought, it might seem disrespectful to be pushing through a worshiping crowd selling water, Gatorade, fried chips and ice cream, but it was really hot out there, and there was no way to move out to get food or drink.  My husband commented that he thought Romero was probably more present right here with us, in the crowd, with the people who had to sell bottles of water for $1 so that they could feed their families for the next week.  Less so perhaps on the stage with the fancy ones.  That thought was reconfirmed when, just as the beatification pronouncement was being read in Latin from the stage, a halo formed around the sun.  "Romero esta aquí," the crowd gasped, "Romero is here."  Everyone had goosebumps.

The mass continued, and we stayed for most of it.  As Holy Communion was being organized for distribution, a small stream of people made its way to the side of the road, and eventually we made it out of the crowd.  We headed up the same street that had led us to the crowd, deciding that lunch would be our next destination...

to be continued...







Thursday, May 21, 2015

Look, Listen and Learn: Learning Lessons from Dad

The team carrying record bags and the vaccine cooler
We walked to a ridge on the side of the
volcano, where there was a welcome breeze
"It's not about the numbers, but the person."

The list of visits for the day included the names of 74 children.  Of the 891 persons living in the neighborhood, 74 were under 5 years of age, and their vaccination records needed to be checked.  In communities with health promoters, the vaccination rate is 100%.  Each family receives 8 visits per year, for vaccinations, holistic education, and water monitoring. Keeping track of water storage and disposal is critical in the fight against dengue and chikungunya.

Vaccination records are kept by the promoters in plastic-covered notebooks.  These log books are meticulously scrutinized by the clinic directors, and by the bosses of the clinic directors.  Each child or adult keeps his or her personal book of vaccination and medical records at home.  Children have green books.  Pregnant women have their own special books.  The information in the patient books is cross-checked to be sure that it matches the information in the clinic notebooks.

"It's not about the numbers, but the person."

Elias said that.  He has been a health promoter since 1982.  We walked under umbrellas to fend off the sting of the hot sun.  "Rattle, rattle, rattle," we shook the gate or "knock, knock, knock" we rapped against the metal door.  "Hi, we're here from the Unidad de Salud!  Bring your tarjeta (vaccination record," the nurse sang out.  Sometimes we were invited inside.  Sometimes, vaccination books were poked at us through holes in barbed wire fences.  "There was trash and smelly water EVERYWHERE," I recorded in my journal.

Elias talking with a young mom about hygiene
As we went from home to home, Elias poked his nose into the pilas (water storage basins) and containers, looking for mosquito larvae.  "A few little tilapia will eat those larvae right up."  Tilapia seemed to be the preferred method of pest control here, as opposed to the permethrin sachets which are also commonly used.  Every now and then, Elias would sidle up behind the nurse and female promoter to listen more closely.  "Have you had your annual pap smear?" he would occasionally interject, following up with a little speech about how important it is for women to have annual gynecological exams.  He was very comfortable in his role:  The Team Dad.

Literally, Elias is the Team Dad.  His daughter became a health promoter in 2008, and works right along side her father.  Watching the two of them working together was quite a treat.  He watched his daughter with pride sparkling in his eyes.  She nurtured the relationships which he had grown over the years.    We met families who lived in a wide set of circumstances.  Our route came to its end in a neighborhood which had a wide street and homes made of concrete block.  The morning shift of school let out, and a big group of kids ran down the road to greet us.  "Hello!"  "Good afternoon, how are you?"  Children are always eager to try out their English on a couple of native speakers.  We walked up to the school to visit an adult technical training program for aspiring beauticians.  If we return, they will want to cut and dye our hair!

Beauty School Class
Practically melting from the long walk in the sun, we decided to wait inside a little cafe for the pick-up to come and get us.  The cafe consisted of a few picnic tables under an awning outside of someone's home.  Pupusas were frying on the griddle, but it was too hot to think about eating.  We talked about the morning's visits, marveling that out of all 74 children, only one needed a vaccination in order to be up-to-date.  The conversation became a little more serious as we spoke about struggles with violence in the neighborhood.  Elias was the dad, the protector:  of course it was best to sit inside while waiting for the pick-up. Sometimes we are oblivious to the care which is being given us. The hostess brought out ice cold orange soda for our little group.  She refused payment, just delighted to give us this small gift in gratitude for our visit and for the work of the health team.

Vaccination delivered.
We returned to the clinic, and said our good-byes, and we were all just a little bit sad.  Our week working with the Unidad de Salud in Nejapa was amazing.  We learned so much in just one short week and gained incredible respect for the community-based work of healthcare professionals who bring basic care and education to the people who are most in need.  The openness of the Unidad de Salud to team up with the Salvadoran Lutheran church is a huge blessing and an opportunity to bring improved access to quality healthcare to people who live in poverty.








Monday, May 11, 2015

Look, Listen and Learn: A Little Farther Up the Volcano Road

 We hiked back up the rocky trail to the highway, back to our vehicle.  We drove a bit further up the road to our next location.  Not too far off of the highway, we found the 3-year-old girl who was the next one to be weighed and measured by the health promoter.  Before we could attend to the little one, the child’s mother and her sister began to tell us of their own health issues.  One of the young women complained of extreme stomach pain and had a leg injury.  We could tell that she was very swollen around the middle, and the dressing on the leg looked pretty scary.  Promoter Yani was very patient, listened, gave the sisters the speech about HIV and the need for yearly pelvic exams, and helped the sister with the injury to make an appointment at the hospital for the next day.  Yani looked around the large yard and identified a few plants which the family could harvest to improve their nutrition.  Overall though, there were not many fruits or vegetables in sight, though there were various herbs and greens.  The small corn field seemed to belong to someone else and maybe as the caretakers, they were allowed to keep some of the corn.

It was time to examine the little one.  The first order of business was to dump the urine out of the girl’s plastic sandals and to take off her wet panties.  Yani hung her spring scale in a tree, lifted the little girl and placed her into the sling.  She read the weight, scooped her out, gave her a hug, and set her back down to play before recording information in her medical log.  All the while, Yani spoke to the sisters, “It’s important that your daughter learn to use the latrine.  When she has an accident, you need to bathe her.  Wash her bloomers and when you hang them up to dry, be sure to hang them right-side-out so flies do not land on the inside and leave germs which can contaminate her vagina.”  Yani spoke kindly, but in a way that let the sisters know she was serious.

We shared hugs and playful moments with the little girl.  We left worrying that the sister with the swollen belly and leg injury would not keep her appointment at the hospital.

We walked to the highway and went a little further down the road to visit a family with a preschool girl and a 5-year old boy.  The boy was a little gentleman, chasing the two diligent guard dogs to a safe distance and then sitting calmly on the porch in his 5-year-old-sized chair.  His sister was afraid that she would get a shot.  This is one of Yani’s challenges – convincing children that she is more than just the “vaccination lady.”  After the children were weighed and determined to be healthy, we learned about the family kitchen.  The mom and her sister talked about the great amount of time the generations of women in the household spend cooking and telling stories in the kitchen.  Deb and I could feel the love centered within the family kitchen, and thought about how in our own homes, generations of women gather together to cook, share recipes and wash the dishes. 



 

 We visited a family compound which housed more than 25 people, sons and daughters, grandsons and granddaughters with the Grandma and Grandpa heading up the household.  Little ones were weighed and measured while older children got ready for school or watched us with shy smiles.  Moms did laundry – there was laundry hanging everywhere – all washed with collected water.  Water totes, cisterns and barrels were tucked into every corner amidst squash plants and herbs.  The system was designed to catch every bit of rainwater via a system of roofs, troughs and gutters.  The only source of water for this family, as for most of the families who live on the side of the volcano, is the rain.

We walked below a large and low trellis, home to cucumbers and lorroco, and ducked our way into a little patch of sun and into the next home.  A pink bike was parked in the sun, next to a crouched old man.  “Is he OK?” we gently asked Yani.  “He’s just cold,” she replied.  As in every home, we were treated like dignitaries.  Benches were cleared so we could sit.  The grandmother and two young mothers sat and chatted with us.  The grandfather crouched, his feet flat on the ground, his arms clasped around his knees, his head down – he did not move.  The six-year old boy turned the bicycle upside down in the yard.  He turned the pedals and checked the chain.  The babies were weighed, the mothers were counselled, the grandmother chopped onions, and I was mesmerized by the boy with the bicycle.  He went over to a white tool bucket and took out a small tool or two.  Pretty soon he had the bicycle chain off and then on again, had tightened a couple of screws and was riding in tiny circles next to the grandpa.  When it was time to leave, the grandmother presented Deb and I with two big bags full of bananas which they had grown themselves.  We graciously accepted the gift, hugged the adults, kissed the babies, congratulated the bicycle repairman on his excellent work, and bid farewell to the grandfather. 

We made one final stop in a home with another new mom and an adorable baby girl.  The home was located in a small family compound and the family had sufficient resources to purchase a few more fancy items for the baby.  A male relative who had been drinking stood outside and Yani closed the door.  Yani gets her amazing energy by being with her children.  She hugged and cuddled the last little baby girl for a good long time, resting up before heading over to Yani’s satellite office. 

Most afternoons Yani returns to her home community and has office hours in the small clinic there.  The community is just a tiny hamlet with one rocky dirt path, just barely navigable by vehicle.  The community school is just up the hill from the clinic, so as Deb and I sat on the porch, we were able to greet the school kids as the shifts change at midday (little kids go in the morning and big kids in the afternoon).  Yani snuck off behind the clinic to her house to cook us some lunch, so Deb and I poked around the clinic a bit.  We were pretty impressed with the amount of educational material she had, as well as basic medications, an exam table, scale, wall posters and the mandatory wall map of her promoter-zone.  Pretty soon Yani appeared with two plates full of fresh, scrambled eggs, beans, tortillas and crema.   We could not contain our admiration for Yani’s work nor our humble gratitude for her generosity.  She showed us her log books and the way in which she records each patient’s information.  She updates her records every afternoon and is often interrupted by people coming by for advice on a health issue, a check-up or to pick up some condoms.  Yani runs educational workshops for the community, and treats emergency cases until an ambulance arrives.  She is trusted by everyone in her care-zone and beloved in her community.  After lunch, she walked us to her own home, and gave us a tour of her garden.  Cutting bananas from her own tree, she presented us with a gift of fruit.  This is how we said good-bye.

Yani and her patients taught us about life on the side of the volcano.  They taught us about survival in remote places, dependence on family and community, and the vital place health promoters have in in the lives of families which have extremely limited access to healthcare facilities. 


Wednesday, May 6, 2015

Look, Listen and Learn: Up Volcano Road

We drove up the volcano road, past the familiar turn-off to Parque el Boqueron, to the neighborhoods on the side of the volcano.  To get to these small communities, we parked on the highway and trekked our way in.  Promotora Yani was our guide, we walked from one home to the next, following barely visible paths of mud and rock.  Yani's goal for the day was to weigh and measure all of the children ages 5 and younger.  

Baby being weighed using a spring scale
Our first stop for the day was at the home of a 12-year old boy with a shoulder injury.  He had a sling and had been to the clinic for care.  The injury was the result of an accident.  The father had  been riding his bike, either picking up or taking the kids to school, and the bike crashed into the boy.  It seemed a pick-up truck was somehow involved.  Dad had a fractured finger, which he had "fixed" himself.  Yani checked each of the children over, weighing the little ones, and prescribing acetaminophen and anti-parasite medication for the boy with the hurt shoulder.  As Yani worked, we observed family members emerging from hidden spaces and soon realized that as in many homes, this was a family of several generations working and living tightly together.  The family was very friendly and happy for our visit.


The size of this hill was really much larger in person...
check out the ladder used to climb to the top of it
Our second hike of the day took us deep into the woods, where we had to climb our way to a little community of a few homes perched precariously on the rocky mountainside.  We smelled smoke, and crept down a steep rocky "staircase" which led us to an enormous mound of smoldering wood.  The fire at the center of the hill has probably been burning for years.  The man and the woman both looked older than their ages, and I imagine that they tend the fire day in and day out.  A couple of children climbed onto the pile, picking out the precious charcoal, which is sold to sustain the family.  Los carboneros (charcoal makers) survive by carrying on this ancient profession for those who live on the side of the volcano.  

We greeted the fire-tenders, and continued our walk along a muddy ridge above another house.  A quiet woman stood next to the wood pile - wood to be burned to make more charcoal.  We noticed a fantastic collection of plants growing along the side of her house.  Perhaps these are plants the family has gathered from the forest to sell at the market.  Yani thought maybe the woman gathered them so she could have a beautiful garden.

We arrived at our destination a little further down the path - a tiny home made of mud, sticks and tin.  Mom and Dad were tending a baby who looked to be about 6 months old, the patient on Yani's list for this household.  The family consists of 2 parents and 9 children who share the 1-room home.  We stood outside, and a few of the children tentatively peeked out from the open doorway to see who had arrived on their front porch.  A make-shift table held a large, fire-blackened aluminum bowl full of weak coffee.  We had arrived at breakfast-time.  Some of the children emerged to claim their small cups of coffee and little breads.  We enjoyed talking with the family, especially the dad, who marveled as we did at the great menagerie of exotic birds singing and fluttering in the tree-tops on the hillside below the house.  

I asked the children if it was OK to take their picture, and they agreed.  Some of them ducked behind the beds.  It was the first time foreigners had come to their home.  It was the first time for them to have a picture taken.  One of the girls who was about 13 had already left school to go to work to help support the family.  She and her dad both work in agriculture, spraying insecticide on farm fields.


Part of the rocky path to the Carbonero's home
A small stool on the front porch of the home
with 9 children
Dad and the happy baby
Children having their first picture taken

Thursday, April 23, 2015

Look, Listen and Learn: Mental Health Day!

This is a continuation of the series of stories from the month-long experience my friend and I had shadowing physicians, nurses and health promoters in the Unidad de Salud (public healthcare system) in El Salvador.  

One of the great things about spending a week working out of the same clinic was the opportunity to get a feel for the daily rhythms, to catch a glimpse into the relationships between patients and caregivers, to share in the friendships among the staff, and to experience a bit of the physical and emotional toll which working in public health takes on the workers.

We started our day by walking to the other end of town and wandering through a parking lot with some semi-trucks where we luckily found the community education center.  This is where Pastor Gloria, Deb and I would join half of the local clinic staff for "mental health day."  We sat around with the nurses, doctors, health promoters and other professionals, waiting for the psych team to arrive.  We chatted with a few of the people we knew, and introduced ourselves to others.  Apparently the air-conditioning has only two settings:  OFF or "FROZEN MEAT," so we all ended up sitting along the wall, shoulder to shoulder, shivering.

When the facilitators arrived we realized that the psychologist was someone we had met at a different community clinic during the previous week!  The mental health and art therapy team from that clinic is available to run events for clinic staff throughout the whole region, just as they are available for patients who need them.  For our event, the facilitating mental health team consisted of the highly animated and energetic psychologist we recognized and her quiet psychiatrist sidekick.

Activity #1:  Each of us had to announce what country we would travel to on what kind of animal - and I think they both had to begin with the letters of  our names.  We also had to act out the movement and behavior of the animal, and no repeats were allowed.  I rode a lion.  The Salvadorans laughed and laughed, enjoying each other's antics (and ours too).

Activity #2:  Dynamic psychologist chanted a little rhyme and each person took his turn as a coqueto or her turn as a coqueta wiggling head, shoulders, then hips while walking to the center of the circle (picture doing your best sexy runway walk).  Even a couple of the Salvadorans were shy about this one.  Deb and I wondered if our mental health was improving, and we also agreed what happens in mental health class stays in mental health class.

The psychiatrist led a discussion about the stresses of work.  Each person wrote a short list of things he or she could do to be healthier on a brightly colored piece of paper.  The papers were put up on a board, and all of the ideas were shared.

Then it was on to Activity #3:  Meditation.  "Picture a tree from your childhood, a tree that has special meaning for you..."  There was classical music playing in the background.  I meditated about laying on the green grass in my backyard, looking up at the branches of my favorite elm tree.  I used to construct blanket tents over the clothesline that my dad had attached to a hook in that elm tree.  I thought about Pastor Gloria and her family.  She grew up in Apopa.  There is a gas station there which is THE meeting spot whenever folks need to connect for rides or find one another in the crazy chaos that fills the streets of Apopa.  In fact, we had picked Gloria up at the gasolinera that morning.  When Gloria was young, there was no gas station but instead there stood a giant tree, surrounded by a park and a woods which led down to the river.  Generations of children met up at that tree to organize pick-up games of soccer; families met to coordinate picnics and walks into the woods.  "Let's meet up at the tree!" everyone would say.  I wondered if Gloria would choose that tree.

Activity #4:  Make your tree.  We received piles of scrap paper and some glue.  "Rip the paper into shapes and make your tree," the psychologist instructed.  Well, for me, this activity was just fine.  For Deb, who absolutely hates doing little craft projects, this activity caused more stress than it relieved.  She created a quick tree and was done with it.  To me it was interesting that both Deb's tree and my tree had colorful leaves:  red for the maple, and yellow for the elm.  By the time our month in El Salvador would end, the leaves on the trees at home would be gone and we would have missed the fall colors altogether.  The gallery of trees decorated the wall. We shared and listened as each person described his or her tree.  The Salvadorans marveled at the thought of leaves turning bright yellow. orange and red.

Activity #5:  Balloon Volleyball with needles!  The goal was to pop more balloons that the other team.  The goalies had the needles, everyone else tried to get the balloon to your own needle.  If this sounds a little dangerous, it was!  The Salvadorans were brutal.  Who knew that volley-balloon-needle-ball was a tackle sport?

At the end of the morning we made our way back to the clinic and shared a late lunch in the break room.  Deb and I could see that this morning of diversion really was helpful for the Salvadoran healthcare workers.  Tales from the morning activities filled the lunch conversation.  The experiences from the previous day were still heavy on our hearts.  The TV news (always a fixture during lunch) showed a lengthy serpentine line of people outside of the Rosales (public) Hospital pharmacy -- the reporter feeding the perpetual worry that medication supplies for this or that will run short.  After lunch, we rejoined the routine of the clinic, observing patient care and logistical processes that would help us to coordinate our work with the Lutheran Church healing ministries in a more effective and efficient way with the work of the local clinics.

During our observation time, I took notes.  Patient #2:  older woman; pain in right arm; makes tortillas and washes clothes; 10 children; 2 miscarriages; 3-month-old died; 5-year old child lost during the war but was found through a DNA test - has photos of her but no contact.  Doctor asks lots of questions and repeats them to get to the truth of why woman is here:  Do you live alone?  Is there someone who can give you injections?  Do you have food that you can take with your medicine?

A young couple came in with a baby born 5 weeks early.  The dad was so cute, proudly wearing a pink diaper bag across his shoulder.  The doctor was very patient watching mom and dad carefully undress then diaper and dress the baby.  Doctor says the parents should put baby in the sun for 10 minutes in the morning and in the afternoon, covering her eyes and her genitals.  Dad got a little lecture about watching for signs of depression in the mom.

The last entry in my journal for this day:  "Walked to Mexican restaurant for bread pudding and te de jamaica (hibiscus tea).  Free wifi, and peace and quiet."  We are very privileged to have such mental health moments at the end of our day.