Saturday, January 31, 2015

Look, Listen and Learn: Outside and Inside the City Limits

There had been a death of a child.  An investigation needed to be made.  We took a bus.  We walked.  I wrote about this at the time it happened, and in reading what I wrote on that day, it breaks my heart.  In retrospect, I remember how serious the team was as we hopped on a city bus and rode into the countryside.  As we descended from the main road into the woods, I remember thinking that we were entering another world.  Just outside the city limits, but like being in the middle of the wilderness.


We passed by a couple of landmarks where the dirt road opened up a bit.  "This is for a statue of a saint," said one of the nurses, as she played the part, scrunching herself into a little roadside altar.  When we looked at the picture, we laughed like crazy when the promoter said, "Looks like Santa Azul is going to the bathroom."  The nurses with a full university degree wear blue uniforms and are affectionately called azules or "blue ones." We walked ahead,
passing a munching cow.  A butterfly landed on the road, a bright spot on the dusty road.  "Love Life!" I thought.

The investigation was made.  It was discussed later that day in a meeting.  Now, some months later, we wonder how the family is doing.  Was anyone able to intervene?

We decided to take the long walk back to town.  We needed the fresh air.  Along the way we noticed gang signs painted on the underpass.  The road we followed was hidden, narrow and wooded.  We asked if it is safe.  "Yes, said the blue nurse, "I have walked alone this way for years and years."  She remembered walking this way during the war.  We trusted her.  We have worked with her on and off for fifteen years because she used to work in the clinic nearest to our sister church.  The shade was calming.

We took a turn at the river and walked along its banks.  During the height of the rainy season, our pathway would be well under water.  We walked past a former "spa-like" place and chatted with neighbors.  We could hear laughing and singing ahead of us, turned a corner and found a group of women washing clothes in stone pilas which had been created in the rocks along the riverbank.  We asked if we could take a photo and they happily said, "Sure!"  It seemed like a cheerful place to do laundry in the company of friends.  Further along we found an abandoned swimming pool.  "Someday," the doctor pondered, "the municipality will find the funds to restore these places."  An older man emerged from the pool, combing his hair, apparently the little bit of water flowing into the pool still serves as a pretty good bathtub.

We returned to the clinic around lunchtime.  We sat at the table with the doctors and nurses, some with lunch boxes like us, and some with food made by a neighbor with a small catering business.  We ordered some great coffee and it was delivered right to us in the lunch room.  The TV in the corner broadcast the latest news - clearly a regular routine providing a little chance for the busy team to catch up on what is going on in the world.

After lunch we headed over to the local radio station for a quick tour.  The community radio is located in an old colonial building, with a courtyard garden, a lot of charm, and more than a few needed repairs.  The doctor does a half-hour educational program each week.  Then it was on to a strategy meeting, which was held in the community youth building.  Chikungunya was the topic of the day, with a review of community clean-up efforts, mosquito larvae abatement and fumigation routes.  The police, youth leaders, local government officials, health department coordinators and several non-profit organizations were represented.  This municipality seems to have its act together, within the city itself and well beyond into the little colonias and countryside surrounding it.  Near the end of our meeting, the doctor brought up the subject of our morning investigation.  Everyone felt the frustration of the situation.  Maybe the police have investigated further.  Hopefully a solution has been found to overcome the limits placed upon authorities by threats of revenge or retribution and protect the victims in the family without endangering the lives of those who are trying to help them.

Sunday, January 25, 2015

Look, Listen and Learn: The Clinic in Nejapa

We are in the last moments of preparing for the Mission of Healing 2015, and this year’s experience will be fine-tuned according to the learning and planning which took place during the visits Deb and I made to the Unidades de Salud of the northern micro-region.  The visits of October were made possible in large part through the efforts of Doctora Chiquillo, who works at the Unidad in Nejapa.  We spent one full week observing all aspects of work in the Nejapa clinic, learning from the staff, brainstorming ideas with Dra. Chiquillo, and walking through a wide range of climates and environments with the health promotors.  Dra. Chiquillo paved the way for us to meet with the coordinator of SIBASI Norte -- the governmental agency which oversees all of the Unidades and ECOS Familiares in the northern region.  We are extremely grateful for Dra. Chiquillo’s coordination and collaboration as we seek to support through the Mission of Healing the everyday work of healers who have dedicated their lives to caring for those most in need...


After a quick meet and greet in Nejapa, and a fruitful meeting at the SIBASI offices, what would two grandmas most love to do?  Hold babies, of course!  We finished off our first morning in Nejapa by hanging out with the maternal health nurses.  As we had observed elsewhere, the teaching and care offered to mothers was of excellent quality.  One of the primary focal points for the Unidad de Salud in Nejapa is the milk bank.  It is the first (and we believe only) collection site for breast milk.  Mothers change into gowns and carefully clean their breasts before donating their milk.  A mom can feed her baby from one breast while a technical nurse helps to collect milk from the other.  A mom can also manually express milk while a nurse or volunteer holds her baby nearby.  All of this is done in a clean room, designated exclusively for this purpose.  The milk is immediately stored and then taken to Benjamin Bloom children’s hospital where it is used to feed premature babies.  (Upon our return, we were able to gather more than 45 electric breast pumps, which are making their way to El Salvador a few at a time with delegations.  Short gowns (such as mammography capes) would make it a lot easier for the moms and the staff who wash the gowns.  Campaigns are held periodically to sign women up to be donors.  The clinic has also hosted two large collection days in the town.  We will be promoting participant registration in this program during this year's and future Missions of Healing.

Care for babies was followed by listening to a charla (educational talk) about how to prevent pregnancy and transmission  of Sexually Transmitted Illnesses. (Yes, somewhat ironic.) A health promoter from one of the local Lutheran congregations accompanied us to the clinic in order to provide the charla.  She teamed up with a technical nurse from the staff, who hauled out her prop:  a ginormous, carved, wooden penis.  This thought ran through our minds:  Wow, someone had to carve that thing.  Deb said, “Great contraception – any woman who sees that thing will run the other way!”  The audience was captive (waiting for their appointments) and interested.  They asked a good number of questions.

Once the giant penis was put away, our crew (Deb, me, the promoter and a pastor who was volunteering to organize files in the Archivos) walked across town for a late lunch.  It was delicious and gave us energy to walk partway back before the Salvadoran team members hailed a moto-taxi.  During the afternoon we took a complete tour of the clinic, including learning about some of the forms which Salvadoran medical providers use for various referrals and lab results.  The information we gained on the way that clinic personnel organize patients and conduct triage will definitely serve us well as we continue to fine-tune our own triage process.

Day #1 complete.  A night of rest and on to the next day's adventure...


Tuesday, January 6, 2015

Just Click: On the Road 2014

Taking a little break from the health clinic stories...as we traveled the highways one community to another, I kept my camera at the ready.  You never know what you might see out the car window...