Tuesday, October 28, 2014

The Squeaky Cart

In honor of Halloween...here is the story of La Carreta Chillona
This photo was taken in the Cultural House in Dulce de Nombre de Maria, Chalatenango
Throughout El Salvador, the midnight sound of squeaky wheels rolling down pavement or cobbles or pathways of a town brings fear to those who hear it.  The cart passes by at the time when everyone should be asleep, so that none would be exposed to the company of cadavers traveling by cart on their funeral route.  Some believe the cart is filled with the bodies of those who have dared to look upon it as the cart passed by.

Historians believe that versions of this tale were spread throughout the Americas by Spanish rulers, who wanted to discourage the local people from venturing out after dark to conspire against them.  The story was used as a threat to anyone who was caught in the street.

In the hills near San Vicente, the people tell a particularly gruesome version of this tale...

One evening, the haunted cart appeared to a very gossipy woman.  The cart appeared to be moving, but no oxen were pulling it.  Human skulls with grotesque, grimacing faces were stuck onto the tops of sharpened poles on the sides of the cart.  The cargo consisted of a grand pile of naked, decapitated bodies, with arms and legs writhing like the tentacles of a thousand octopi.  In place of their heads, the body-carriers had bunches of grass. They danced around lashing the bodies with a big black whip, making a horrid sound like bullets, and all the while calling out the names of the people of the town who were known liars, cheats and hypocrites. The gossipy woman could not contain her curiosity when she heard the sound of the haunted cart.  She went outside to look at it, and her horror was so great, that she woke up dead*, lying in a pool of her own curious, gossipy, revolting blood.  And the sound of the squeaky wheels of the haunted cart has never been heard crossing the cobblestones of the town since that night.

*"woke up dead" is the way that the people tell the story...an interesting phrase, I think.

Monday, October 27, 2014

Mujeres Emprendadoras: Women Developing Small Businesses

"See you at the fair!"  As we made our way to church early in the morning on Sunday, women from the community made their excuses and made their way to the bus stop.  Church is important, but the opportunity to market themselves and their products took priority.

After worship, we made our way to Tonacatepeque, to the sidewalk in front of the mayor's office.  The fair was small, but the mood was hopeful.  There were not too many people buying things.  We wondered how well the event was promoted to customers.

We wandered from table to table, and we did do a little Christmas shopping - which means our purchases are still top-secret!  I asked if I could take a photo of the woman who sold me a beautifully crocheted item...as a memory for the person who will receive the gift.  This creative business woman also sells natural medicine made from herbs in her garden.

The hand-made items ranged from embroidered cloths and blouses, to knit and crocheted items, to hand-sewn skirts and tops, to beaded jewelry.  Some of the women purchased items such as sandals and hair clips for resale.  Some of the women had brought things from their homes to sell, such as used clothing and toys.  Of course there was food, so we ordered a slice of pizza from the baker.  (Pizza is often sold at bakeries in small towns in El Salvador.)  It was one of the best slices of pizza I have ever eaten!  Since the pizza was so delicious, we decided to buy small loaves of orange bread and banana bread from the same baker.  We were not disappointed!
We were excited to see our friends from the Unidad de Salud (health clinic) participating in the fair.  They were ready to take blood pressures and give vaccines.  It was also a great opportunity to hold up the professions of female healthcare workers in the community.

Each of the entrepreneurs had a turn speaking into a microphone.  Their voices echoed from gigantic speakers across the town square, inviting people to come and see what the women have learned and what they were selling.  We applauded for our friends, and then walked across the street to the town's market.  Men and women entrepreneurs have been selling their wares in this market for years.  About 60% of the booths are dedicated to local fruits and vegetables.  The remaining tables feature everything from underwear to plastic plates.  It's not exactly a tourist stop, but we did find a couple of cute things for grandkids (again, top secret), some undies for a little girl who has none, and some mamones de China (lychee fruit).  The market is damp and dark, under black plastic sheeting or corrugated tin roofing.  It is supposedly going to be relocated and remodeled.  Perhaps the new entrepreneurs are thinking about putting their businesses into the market.

We walked back to the mayor's office.  Soon the music started.  Street music in El Salvador is never quiet and this did not disappoint:  super loud karaoke, sung by the local school's music teacher.  He was pretty talented, and a couple of the grandmas started dancing in front of the sales tables.  They were both much less than 5 feet tall, had great smiles and demonstrated some pretty sweet moves!

We enjoyed the music and dancing for a while, and then headed back to our sister church community.  We felt really proud of our sisters' business efforts.  Hopefully the movement to help women create sustainable small businesses will not end with the fair.

Friday, October 24, 2014

Just Click: San Salvador 2014

Every now and then, I take a ride through San Salvador with my camera at the ready.  I stick it out the window and click...never knowing what images I might capture.  Despite the rainy weather, I managed to collect a few images from October 2014:
Arbol del Fuego - Tree of Fire -- blooming in full force all
across the city and countryside

It's hard to appreciate just how closely we drive next to the buses
when in the center of the city

This photo is not auto-corrected - this is the real color of the sky
on this day...the blue and white of the sky reminded me of
the Salvadoran flag...which, appropriately, is flying next to the
monument to the constitution

The mayor's office in this municipality adjacent to San Salvador
has a huge problem organizing trash pick-up

Along the round-abouts on the north side of the city, people
sell a variety of things, from coconuts to furniture.  During October,
kites are for sale because the winds usually come and it is the
month of the child

Mural along Constitution Blvd

A new twist on an old favorite - green mango with chili!
The mango is put onto a spindle and rotated and cut to create
long spirals of mango (in the bags) - add the magic powders
and sauces and you have one of my favorite treats.  (You
can recreate this in the US with green apples, cumin, lime juice
and chili sauce.)

When the October winds come, so does cold and flu season.
Salvadorans really love their cough medicines...and many people
know how to make them from the plants in their gardens!

On the northern outskirts of the city, Nejapa Power has expanded
its diesel power plant.  This formerly wooded valley was cleared for
sugar cane, and now the cane competes for land space with factories
and housing developments.

Thursday, October 23, 2014

Fighting Chik

Chikungunya.  Most Salvadorans just call it "Chik."

Chik scares people.  "Our bodies have no memory of this disease, so we cannot fight it."  It runs through family members in rapid succession.  Data indicates that the majority of victims are teens and young adults.  Parents are frightened to see their energetic youth suddenly stricken by fever, severe headache, joint pain and a red, itchy rash.  For some, the joint pain is so severe that victims cannot walk or stand, and pain seems to linger in the wrists after the other symptoms have passed.  For some, rehydration with IV fluids is needed.

Clinics are inundated with cases of Chik.  Doctors are seeing four times the number of patients usually seen in a day.  Pregnant women, people with chronic illnesses and high-risk patients are hospitalized.  Treatment consists of taking acetaminophen for the pain and drinking lots and lots of fluids, especially Suero.  For some, complications occur when patients take ibuprofen or other pain reliever and damage is done to the patents' kidneys.  For some, joint pain can be permanent.  For most, the disease lasts a miserable seven days, and then the patient is fully recovered.

Chik is spread by the same type of mosquito (called zancudo) which spreads Dengue.  Zancudos are day-biters.  An infected person receives a bite; the zancudo bites another person and shares the virus with that person.   While Chik is scary, Dengue can be deadly.  The ramped-up efforts by health departments, clinics and mayors' offices to fight Chik are efforts which should be (and often are) used to fight Dengue.

The best defense is to eliminate the habitat for zancudo larvae or to eliminate the larvae once they hatch.  Larvae develop in clean water, like the water kept in pilas (the big cement sinks used to store wash water) and barrels for drinking.  Barrels must be kept covered.  Pilas must be scrubbed periodically and outfitted with a little bag of premethrin or be a home for a couple of tilapia which eat the larvae.  Zancudos also like to lay eggs in places where rain water collects, which means every bottle, cup, plastic bag, plant container, or depression in a rock, must be searched for larvae.  In neighborhoods where there is no trash collection, this is an overwhelming task.

After walking all over El Salvador with health promoters on larvae-patrol, my friend and I became obsessed with looking for larvae.  When we visited homes we found ourselves gazing into the pilas, and meandering about the yard flipping cups and containers upside down.  Sometimes we would find a duck on the premises which made our search easier:  ducks eat zancudo larvae.  With this rainy October being especially wet, the task was never-ending.  Old tires are especially popular locations for larvae.  "Bury them and fill them with dirt," is the standard instruction.  At a little celebration which was held for us at an elementary school, we decided to give have a charla (educational talk) about larvae, and we took the kids out on patrol through the school yard.  Sure enough, we found some swimming around in a pool of water in a plant container which had no holes in the bottom.  The teacher was horrified!  The next day she planned to fill all the holes in the big pile of volcanic boulders with dirt so larvae would not hatch in the holes.  Every now and then we would find a yard with a duck.  Since ducks eat zancudo larvae, we did not have to check the cups, bowls or containers on the ground.

When larvae patrol is not successful, and pupa develop into zancudos, officials bring out La Bomba.  Fumigation is a last resort in the minds of health officials.  The chemicals are expensive, cause allergic reactions in many people and are dangerous for people with asthma.  Bomba sprayers usually wear gas masks.  Big cans of gasoline are stored at the health clinics for running the bombas.  The general public asks for fumigation - they like it because it is easier than hunting for larvae and it does kill the zancudos.  To us, the bombas seemed much more scary than Chik.

As news travels around the world about one frightening disease or another, Salvadorans are mindful that the challenges of poor infrastructure and many people living in small spaces make the population susceptible to infections which run wild.  This is the root reason behind the fear and furor surrounding Chik.

My friend and I want to hold up the amazing efforts of the ECOs and Health Promoters (government and church promoters) throughout El Salvador who are working every day to educate families and mitigate the risks to the health of the Salvadoran people.  We also think every family should have a duck and a couple of tilapia.

Friday, October 10, 2014

How can this be?

The town is small.  The municipality is large.  The small government clinic attends to the needs of people who do not have healthcare.  These are people who work in the informal economy and much of the care is centered around pregnancy, birth, the care of young children and of old women.  A few men come in for check-ups and vaccines.  This community north of San Salvador includes a broad range of living conditions, and the care area is huge.

Today we accompanied the chief doctor, the head nurse and a health promoter as they did a home visit to investigate the death of a 2 year old boy who reportedly died of malnutrition.  We were told to prepare to walk a long distance.  We were told to carry water.  We were told that the child died because the family did not care for him properly.  There were many things which were not told.  The reality of this dead child's short life and the lives of others in the home leaked out secret by secret, breaking our hearts bit by bit.

A little boy was the first to greet us.  He is six years old, very small with stick thin legs and arms.  He wore a "necklace" which was an old waistband from a pair of men's underwear.  The health promoter pointed out his little stool where he could sit with us on the veranda in front of the adobe house.  The grandma moved the stool to the other side of the veranda, away from us.

The doctor took a stapled pack of papers out of her metal clipboard case - the baby's medical chart.   On the back of the last page, she began to take notes:  the exact age of the deceased (2 years, 2 months and some days), the circumstances of his birth, the history of illness, the comings and goings of the family members.  The baby's mom is 19 years old.  The grandma cares for the six year old.  His mom and dad were both murdered.  The grandfather works.  There is no food.  The goats gave milk, but now they don't.  There are plants all around, but there is no food.  We saw a sack of grain in the house, but there is no food.

The health promoter and nurse had been to the home many times in an effort to educate the family and care for the boys.   As the doctor asked questions of the grandmother, the nurse opened her big red bag and pulled out an apple.  She gave it the little guy; then out came some packages of vanilla cookies and some grapes.  He held it all in a little bag, and would not eat anything despite much urging.

A field of low growth and a family of goats stood between us and a less-sturdy home made from corrugated tin.  As we talked, a young woman quietly emerged from the tin house and walked toward us.  She wore a faded yellow Sponge Bob shirt, and a tattered maroon skirt which was decorated with a few dirty stickers.  She sat on a concrete block behind my friend.  We rearranged the plastic chairs a little so that she was in the circle.  In a few moments, she was standing behind my friend, hiding.

"How old are you?" the doctor asked the grandma.  She did not know.  "What year were you born?"  The grandma paused and said, "I cannot say.  My man has the papers and it is for him to say."

"What happened on the day the baby died?"

"He was tired from breathing.  He was making a noise.  I put him on the bed.  I left to do something.  When I came back, he was dead," the grandma recalled.

"So, you left him to do something and then he was dead?"

"He died in his mother's arms."

It wasn't clear who was caring for him when he died.  It was clear that the mom, hiding behind my friend, was choking down her emotions.  The doctor asked questions about the nurse's visits and the promoter's visits.  The investigation concluded, and the team focused on talking to the two women about nutrition for the 6-year old.  I walked over and crouched near the little boy.  He was enjoying the company of the dogs and ducks who wandered about the patio.  "He can eat duck soup, or fruit from the garden or a little bit of flour"  I walked over and crouched down next to his seat.

"Are the ducks your friends? Like the dogs?  What do the ducks say?  Quack, quack..." I made funny duck sounds.  The little guy smiled.  I quacked and woofed and he giggled a little.  I pulled a grape from his bag and encouraged him to try it.  The doctor had finished her questions and she came over, pulled a cookie from its wrapper.  He took a tiny bite.  The 19-year old never said a word.  She smiled a little, all of her front teeth were gone and her back teeth were rotted black.  I slipped over to her corner and whispered in her ear,  "Do you have someone to talk to?  A pastor or priest?"  She nodded.  "You can talk to the health promoter or the nurse, whomever you trust.  You have the right to live your life."

We walked a distance away from the house, and I turned and motioned to the sad mother whose baby had died from malnutrition.  She paused and waved a little bit, posed with a slight smile, and I took a photo of her standing half-hidden behind the pila (concrete sink).  I turned and walked down the mud path past the latrine with no walls, to the barbed wire gate, and down the muddy rock trail to the road.
The health promoter needed to visit additional homes.  She headed up the hill, carrying the vaccine box and waving good-bye.

The rest of our team turned and headed back to a main road.  We walked quietly for a bit.  "I was there for the vigil," the nurse shared.  "There was no light, no candle and not one flower on the caja (coffin or box).  The family did not even have one cup of coffee for the guests.  I went and bought some things for a proper vigil."

"The father is a big man, very dark  Sometimes I would come and there would be a huge quantity of dogs viciously barking.  They were there when the man was there.  He controls everything.  No one can talk except him.  The boy would not eat anything unless the grandma said it was OK.

The grandmother had told us that she and her husband slept apart.  "He's too hot," she complained.  We laughed awkwardly at the time.  We walked back toward the main road.  The nurse spoke quietly:  "The husband is in a sexual relationship with his own daughter.  We think he is with the three daughters, the one out with him now is beautiful so he takes her.  This one is not so beautiful, but he is with her when he is at home.  The baby was his child.  There was another baby that died when it was six months old.  Neither that one nor this one had a proper funeral.  I was there.  No flowers, no candles, no coffin.  The body was put in a cardboard box, like an animal.  He buried the box in the yard.  No cemetery. Like an animal."

We were all worried about the little boy who would not eat even a grape without permission.  The nurse said the grandma would eat that food.  The boy has no one to care for him because his parents were murdered.  His mother was pregnant and very large when she was killed.  We asked if it the deaths were related to gang violence.  The nurse said it may have been that, or some kind of internal justice.  The baby she was carrying was probably the grandfather's.

The more that was revealed about this family's horrific existence, the more we struggled to figure out how this could be.  Where were the police?  Where is the protection for the daughters, and the little boy?  "We could make a denunciation," said the doctor, "but we have no evidence, only suspicions.  The threats will then come to us and we will lose our lives."

Later in the day we sat in on a big group meeting at the civil defense/youth center.  The doctor spoke about the morning's investigation.  The police will probably try to investigate, but they will have to be careful not to cause trouble for the medical team.

In the meantime, a little boy and a family of women live under the oppression of the grandfather,  We carry with us the tragedy of this family and ask,  how can this be?

Monday, October 6, 2014

Super Health Promoter!

We drove down the second most bumpy road of the day.  It was a long distance from the clinic, too far to walk for a child or for a mom who is weak from illness.  It's no wonder the mom missed her appointment.  The doctor or the health promoters sometimes walk to visit the patient, but with today's access to the health ministry's pickup truck, the team was able to drive.  As we bumped along, my friend and I almost wondered if it would be easier on our bodies to walk than to be jolted side to side, despite the hot sun.

The two of us are shadowing a community-based family health team (called an "ECO").  Healthcare reform was implemented during the Funes administration, and the Salvadoran government continues to work to increase the number of ECO's in rural communities.  This ECO is based in a converted community center and depends on the cooperation and fund-raising capacity of the local mayor's office, community leaders and the medical team in order to be sustainable.  The team is made up of a doctor, a nurse, three health promoters and a utility guy who runs the appointment desk, does the cleaning, dispenses medications from the pharmacy and drives the pick-up.

We arrived at the patient's home in the mid-afternoon.  We hopped out of the truck and were greeted by cows.  Big cows.  "Two months ago, a guy got killed by this bull," the doctor told us.  "Really?" we asked.  She was dramatic.  She did not want to through the cow pen to get to the house.  Suddenly one of the health promoters, a small man with bright blue eyes and a lively spirit, leaped over the barbed wire and ran through the cow yard waving his arms and shouting "yee-ha" like a cowboy.  He ran to the house to see if the cows could be relocated.  The nickname we gave him earlier that day, "Super-Promotor de Salud," was sure to stick after this crazy stunt.

A few minutes later, Super Heath Promoter returned with bad news, the cows could not be moved.  He told us the cows would not do anything to us, so, one by one we ducked through a space in the barbed wire and walked by the cows.  The yard was soft with black dirt and a little bit steamy with fresh manure.  The doctor, my friend and I were welcomed by the patient into her home.  "Come in, sit down," she insisted.  We sat on plastic chairs.  The only light coming into the adobe house was through the open door.  A small table in the corner was covered with a torn red lace cloth and piled high with the family's belongings.  a few things hung from the ceiling.  The doctor and the patient spoke quietly.  Diabetes, hypertension, HIV, dental problems.  The dentist comes once per month.  She would see the dentist on Monday, but did not want to stay for an appointment with the doctor because she wanted to go to her daughter's school for the Day of the Child festivities.  The next clinic day would be Thursday.  "Will I live until Thursday?" asked the woman.  She was serious.  "Come on Wednesday.  I will make a special time for you," said the doctor.

A young face had been peering around the curtain to the back room of the house.  As the doctor and her patient finished talking, the little girl came to sit by her mom.  "Good afternoon," we smiled, "nice to meet you."  We asked if she would like to have her picture taken.  Her mom sent her back to get her shoes.  She stood in the doorway and she smiled for her photo.  No one from far away had ever visited before.  No one had ever taken the little girl's photo.  Maybe the doctor can take a printed copy to the little girl.

We were thanked for our visit.  What a surprise to have guests from so far away.  We picked our way back through the cows and the poop.  We ducked through the barbed wire.  We got back into the truck.  "Will she come for her appointment?"

It's a long way to walk.