Friday, December 26, 2014

Look, Listen and Learn: Back to Where it All Began

There are many times when we look back at moments shared or things accomplished with our sister church in El Salvador that we just shake our heads and marvel.  The connections made and friendships built during our very first little Mission of Healing in our sister church community is one of those moments.  We had never been to our sister church community before, we knew nothing about the neighboring community, Distrito, nor the little clinic there, but the wisdom of the locals to cultivate relationships between their neighbor nurses and their new US friends has born a lot of fruit over the past 15 years.

On Friday, after a couple of days out in the countryside dodging cows and learning about rural, door-to-door medicine, we traveled back to where it all began:  the little clinic in Distrito Italia.  We were pretty excited to go there - to see if maybe some of the original staff was still there, to see how the clinic has changed since our last visit there several years ago, and to connect with the medical staff who regularly interact with folks from our sister church community.

The director of the Unidad de Salud (health clinic) was eager to meet with us, but was busy conducting an autopsy when we arrived, so we waited for a bit.  Curiously, a motorcycle was parked next to a set of stairs-to-nowhere in the middle of this strange little waiting area.  Modern art?  Physical therapy zone?  We couldn't decide.  Pretty soon the autopsy was complete and the director led us into a very nice, large, air-conditioned conference room.  We talked about the retirements of some of our friends, and others who were working in different clinics.  We were super happy to see the head nurse, an old friend.  We made good plans for working together.

Despite the fancy meeting room, it was pretty clear that this Unidad has some pretty big challenges.  They have no phone lines (apparently local thieves made off with the cable - more than once) so the doctor and head nurse give out their own cell numbers to manage emergencies.  Most communication, setting up appointments, etc. must be done in person.  As local gang boundaries shift from one community to another, the staff is flexible with accepting patients who technically should be visiting another nearby clinic for their care.  Because this area has been designated as "urban" there is no ECO or team of health promoters to travel to the homes to provide care.  This is a very big challenge, because although the communities surrounding Distrito are only a bus ride away from the city of Apopa, the families live on tiny plots and survive by living in large family groups and pooling together resources from farming rented land, working as day laborers, raising a few chickens and selling items in the market.  Poor sanitary conditions, low water quality and insufficient control of mosquito habitat greatly impact the quality of health in these poor communities.

We toured the facility.  The pharmacy was small, but seemed to have the basics.  The exam rooms were clean and most had been remodeled.  We were surprised to find a large physical therapy room with a few pieces of old yet functional equipment.  We were very surprised to meet the psychologist and two members of the art therapy team.  In a region where poverty and violence touch every family, this art therapy team is a true blessing!  We were absolutely impressed with the enthusiasm and creativity of this team, and with their availability to go out and do workshops in different communities.  We know from our years of work with the Mission of Healing that this type of healing resource in a community can do much more to heal the spirits of the people than a little zipper bag of ibuprofen.

We spent quite a long time talking with the director and all of the staff members and imagining ways in which we could work together in the future.  As the church works to develop its team of health promoters, there will surely be opportunities for the church and the Unidad to complement one another.
Physical therapy room
Gasoline for the mosquito fumigation machines

Fumigating for mosquitoes

Exam room
Art Therapy

Clinic director in the dental treatment area

Sunday, December 14, 2014

Look, Listen and Learn: Super Doctora

A calm bit of road which allowed for a photo
Another early morning and another long ride out to San Pedro Puxtla.  Upon our arrival we were excited to learn that this day was a truck day!  On truck day, the team has access to the government pick-up truck in order to deliver heavy boxes of medications and supplies to remote sites where once per month the team runs a medical clinic.  The ride to this month's remote site was "in the opposite direction of the ECO base, in an area that scares us because the gangs have come there and sometimes threaten the health workers."  It was sad for us to hear that gang activity had come to this remote location and hard to understand what possible economic value gang members could find in terrorizing these incredibly poor farmers.  We bumped along the road without incident, bracing ourselves so that our heads would not hit the ceiling of the cab.  We could not stop laughing because the bumps were incredible!  We asked if the truck had a name, and since it did not, we all agreed to name it Caballo (horse).

Delivery accomplished, we traveled down the same dirt and rock road we had walked the preceding day and arrived at the ECO clinic.  We spent the morning observing all of the operations of the clinic, noting that most of the patients where women who were expecting babies, had recently delivered babies or are raising babies.  Nutrition is a huge issue among these rural families who survive on what they can grow and store.  Many mothers receive powdered milk from a government program.

Dog vaccines are free - provided
by nurses.  The sign below says
"Don't threaten your kids with
Family Planning Information
The clinic itself does not have electricity, so the refrigerator which the government sent for vaccine storage is still in its box.  The team (doctor, 2 nurses, 3 health promoters and a utility guy who cleans and runs the pharmacy) has to run some fund-raising activities in the town in order to pay for an electrical hook-up.  La Doctora has a great educational style, and the makeshift walls between treatment areas are covered in educational posters.  The government actually requires information to be posted about nutrition, dengue/chik, HIV/STD's, and a variety of vaccines.  There was a very helpful bulletin board about family planning, however, at this clinic like so many others, the medications or devices are not available.  It seemed to us that the government simply cannot keep up with the demand nor the expense, and it reinforced our efforts to at least bring a suitcase full of condoms for the Mission of Healing.

The team treated us to a delicious lunch which was made in the community and brought to the clinic:  carne asada (stewed beef), chirmol (fresh tomato, onion & cilantro), rice and avacado.  We shared a lot of laughter around that table.  Re-energized for the afternoon, we loaded up on water and hopped into the truck for a ride out to a patient who lives quite a distance from the ECO clinic.  The story of our Super Health Promoters on that afternoon is recorded in another Blog Post.

At the end of our day, we made the long drive back to San Salvador, stopping for about an hour at La Doctora's house, where we were served delicious homemade pie and hot chocolate.  It was a huge honor for us to share in our friend's work, her friendships, her family, and her struggles.  We have often marveled at the stories she told about her work and the sacrifices she makes in order to have a job.  Now, having walked alongside her for a few days in her own work setting, we are even more convinced that she, like so many healthcare providers in El Salvador, is a Super Doctora!