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.