Monday 2/6 - Day 1 of Clinic

Another brilliant sunset rousted us out of bed at 6 AM. As we loaded up into the bus, everyone admired the scorpion Andrea (interpreter in Ojos 1 y 2) had found hanging out in her suitcase. She had touched it twice on accident but luckily was not stung. He was a big guy so not as poisonous.

We pulled up to the church compound at the back entrance at 7:45 AM. People were just being let into to the large waiting area. We could see many more faces peeking through the fence as they stood waiting in line. After some brief set up of tubs with bleach solution to clean each used speculum and another tub of clean water for dipping the clean ones in, Deb and I began seeing patients (Deb is in the photo to the right). Ana, our Salvadorian nurse would tell me either “prueba de mamas” (breast exam) or “citologia” (pap smear) and any other details she thought we would need to know.

The morning flew by as we got into a somewhat bumpy rhythm with a lot of pap smears, breast exams, and a couple pregnancy tests - one of which was positive. It was interesting to see the almost stoic reaction of the young woman’s face. Had she guessed already based on the morning sickness? She took the news as if it was just a fact of life. She was still nursing her first child**. The local Salvadorian doctor arranged a referral for her to start prenatal care and Deb counseled her briefly. We were able to listen to the baby’s heart beat and give her the due date. (Photo to the Left shows Deb at her usual station at the GYN table)

Note about nursing: In El Salvador, it seemed like almost all women breastfeed their babies for 2 years. The only women we saw who said they didn’t breast feed were the young moms under 20 years old who were unable to.

We found out at 2 PM that the box of pap smear slides had to be turned in at 3:15PM every day so that Ana could take it to the local government health clinic (who would send it to the lab). So, at 2 PM, we had to do 8 pelvic exams in a little over an hour. We made it, barely, with Ana running out the door with the slide box. I found out that Deb likes AND is very good at working under pressure. Our last couple of hours were much more relaxing with breast exams and consults on a variety of women health issues. (Photo to the Left is of Ana helping watch a little one while we see the mom) The whole clinic saw about 310 patients with most patients going to at least 2 different areas. Pediatrics was swamped and did not finish until around 6:15PM. Mujeres finished seeing patients about 5:30PM. Thus, we finished our first day of clinic, and we climbed back on the bus to head back to the peaceful Ayagualo retreat house to carefully check our suitcases for scorpions. Silent, dry lightning flashed across the sky.

Sunday 2/5-Setting up Clinic

The bus parks outside the entrance to the parish compound. There is a large covered area with classrooms down one side, a stage directly in front and the church on the other side. We meander into the church for mass with the locals. The priest is a vivacious, charismatic man with a good sense of humor. After mass as we receive hugs and kisses from the locals, I meet a young teenage girl named Rocio. We small-chat with her for a bit with me interpreting. This was my first introduction to the rural Salvadorian accent, and it was challenging. She told me of her family, how she lived up in the hills, and where she was in school. Though we did not talk more than twenty minutes, it was a special chat. I only wish I had had time to help her with her math homework. She left a handmade card for me at the pharmacy later in the week that I will always treasure. One never knows how a short conversation can make a lasting impression between two people. She will always be in my prayers.

After mass, the classrooms are transformed into rooms for each clinic and the large covered area is filled with chairs and desks for a makeshift waiting area. Below is a list of the clinics in each classroom:

Ojos 1 y 2: Eye exam room

Optometrists Ken, Walt, and Bob with Andrea and several high school students from elite school in San Salvador interpreting. (Photo below of Bob and Andrea taken by Mary)

Ojos 3: Glasses distribution

Heather, the optician, with Sister Marilee, Leanne (LN), Mary (LN), Carlos (local volunteer), Rosa (local volunteer), and several San Salvador high school students. (The awesome Ojos 3 team below with students taken by Mary)

Mujeres: Women’s Health

Debra (CNM) and I interpreting with Anna, a Salvadorian nurse in training

Pediatria: Kids!

Pediatricians Norm and Dale with Lysette and Pat interpreting

Farmacia: Pharmacy

Melissa (MD) in charge with Moises (LN), Sylvia (Salvadorian doctor), and several more San Salvador high school students (photos below of all the the pharmacy before and after all the tubs were unpacked)

Medicina General: General Medicine

Doctors Charlotte, Lorne, Jon, and OHSU medical student Brit with Fidel, Elba, and Blanca interpreting. Leah (LN) covered all urine, blood sugar tests, and lots of ear wax removal. Jaime (Salvadorian with MD from Cuba) and Dr. Angela (local) arranged all of our referrals to the local hospitals for patients needing more specialized treatment. Salvador, a radiologist from El Salvador, performed ultrasounds.

Each clinic spent a couple hours before and after lunch organizing their rooms. Pharmacy took all day to organize the medicine. In Mujeres, we had some local volunteers with Fidel set up a tarp to divide the room in half, thus providing some privacy for the GYN exams. You can see our GYN table in the Mujeres classroom below.

It was a pleasure to work with these amazing local volunteers from the church for the whole week. Doña Carmen stood all day for the whole week at the door to the Women’s classroom and did a superb job of handling patient flow. Also, she would go find Kathy or Sister Susan for us if we had a question or take patients down to Salvador for an ultrasound. She was a dear friend by the end of the week.

Another important volunteer for the Mujeres room was our local nurse in training, Ana. Ana is 23 yrs old, speaks only spanish, and has a young one of her own at home in the capital of San Salvador. We would have been lost without her help, especially due to one key word: Pap smear. The very first appointment on the first day I used “pappinicolao” for pap smear (what I use when interpreting in the US) and the poor woman gave me a blank stare. Afterwards, Ana informed me that they use “citologia” in El Salvador. That is one of many examples that I could give you of Ana coming to the rescue for Deb and I. Ana became our go-to person for any cultural or Salvadorian language questions.

Following a tasty lunch of lightly seasoned grilled chicken, beet-potato salad (it was pink!), and rice made for us by local women certified to cook for gringos, we finished up our rooms before a presentation by the Salvadorian Department of Health. Then, those of us who were done unpacking joined the people putting 30-day supplies of vitamins into plastic bags for each patient.** It was monotonous work to bag vitamins for three hours, but it was exciting to see the huge tub-fulls of multivitamins, flintstones, gummy bears, etc.

**Note about vitamins: Each patient was given a month supply of vitamins based on their age and needs (women above the age of 50 were also given calcium). We placed 30 in a plastic bag so that the patients would not be tempted to sell them for food and so that more patients would get vitamins.

We climbed into the bus around 6:30 PM for the short drive to Ayagualo. Dinner, a short orientation and early to bed for me.

Sunday 2/5 Part 1

Heather and I grumbled out of our beds around 7 to the sunrise seen in the photo to the right. All of a sudden, I heard Heather cry out and say, “There’s a lizard in the closet!” Sure enough, there was a little green gecko glued to the wall inside the metal closet. " Welcome to El Salvador," he probably wasn’t saying but that was what we thought!

Breakfast was salami and pancakes with what I would call a black bean sauce and honey. There was fresh papaya and several mystery fruits whose names I still don't know. The number of fruits down there seems to be more than double the fruits we know in the states. As we decided whether we liked pancakes with bean sauce and honey, the table and ground started gently shaking beneath our feet. Now we were really awake. Luckily, it was only a tremor, though it reminded me of the painful history of natural disasters that have occurred in El Salvador and that have caused so much poverty - volcanic eruptions, tsunamis, and earthquakes.

A little note about the Ayagualo retreat house (in photo below): It is a clean, luxurious (especially for El Salvador), peach and white colored stucco-several-story-house with a cafeteria and several large courtyards. There is a large church near the house and the nuns who run the retreat house live near the church. The Ayagualo compound is on top of a hill with views almost to the sea. We never saw a dull sunrise. It was the site of the Peace Corps' first attempt to meet with the locals towards the end of the war, in an effort to start sending volunteers to help with the post-war needs. The base of a local gang is right across the highway and a body was found in the woods recently. Thus, the morning runners always ran together.

We piled into the bus for mass at 10:30AM in San Jose Villanueva, the town where we would spend the next 6 days. It was already getting warm from the sun beating down on the tropical mango, papaya, and coconut trees. Later in the week, from below the steep and partly washed out driveway of the retreat house (yikes!), we would see men working on a small field of coffee plants.

Alongside the busy, mostly one lane main highway, people were walking to and from church. The women and girls carried baskets of food or belongings on their heads. Several miles down the highway we passed a gated community with large houses peaking through the trees. Another securely gated community that looked like an American subdivision was just off the narrow, bumpy road to San Jose. Between these two, rich communities were some of the smallest brick houses with animals hanging around out front. This was the route we would take every day between San Jose to Ayagualo.

San Jose Villanueva seemed like a modest little town. We were not allowed to leave the church compound where we set up clinic so I honestly only saw about two streets of the town. I did not see a single house with glass windows. All the windows have a wire fence on the outside and are shuttered shut on the inside. Sick mutts roam the town that I can’t look at.

Saturday 2/4/12 - Traveling South

How interesting it is to look back at the first impressions I had of the group of volunteers I was to spend the next ten days with in an intense medical mission in El Salvador! Mary, a nurse in the ICU, drove up with me on Friday afternoon. Debra Goldstein C.N.M., was my roommate in the SEATAC hotel. She had a “Practical GYN” book on her bed when I came in before leaving to see my brother, John, at Seattle U. I had no idea that we would spend 8 hours a day together for the duration of the clinic with me serving as her interpreter.

While I was having a tasty dinner with John at the Honey Hole, the other volunteers packed up the 35 tubs of vitamins, meds and supplies. All of us could only bring a carry on with us so I packed very light.

We left SEATAC at 8:30AM without any problems for the 4 hour flight to Houston. As we waited for the plane, I started meeting the other members of the team like Dale, the pediatrician from Orcas Island; Bob, the optometrist from Ellensburg; Heather, the optician from Seattle who would be my roommate at Ayagualo; Brit, the OHSU med student from Eugene; Leanne, the nurse from Bellingham; and the list could go on and on. We came from all over the Pacific Northwest and came from different faiths, with the majority being Catholic. Some had gone on previous missions.

During the layover in Houston, we ate at a fish restaurant where Dale introduced me to New Orleans cuisine with a shrimp Gumbo. It hit the spot. Then, we separated to make final calls to family before a brief orientation led by the mission director, Kathy Garcia. Adios a los Estados Unidos!

We arrived in El Salvador around 9:30PM, tired from a long day of traveling. The airport looked like any other airport, though obviously it was a lot warmer. I happen to be the first to go through customs with Norm, a tall, lanky pediatrician from Alaska, so I served as his interpreter. The customs officer asked me to stay at his side to interpret for the rest of the group. Poor Deb and Charlotte (ER doc) were one of the unlucky ones who had to get their luggage x-rayed (You are chosen at random). After waiting an hour for the tubs to go through (only one was lost and was sent to us the next day), we loaded up the truck and climbed in the bus that was to be our transportation for the duration of the trip. Hernal was our dear, talented, and ever-considerate-about-our-water-supply bus driver.

The drive to the Ayagualo Retreat house that was about an hour away passed quickly and we were asleep by 1 AM.

Introduction

Hello to family, coworkers and friends here in the States and abroad! Thank you so much for taking the time to read this blog on my brief but poignant experience as an interpreter with the El Salvador Health Mission in February of 2012.

As I feel a bit of a loss on how to answer the quick questions you ask me (How was it? Did you have fun?), I have attempted to put down those ten days in words. All of these entries were written after returning, due to how busy we were (I also forgot paper to journal but you don’t need to know that). Maybe after reading this blog you will understand why I struggle with answering those “quick” questions. More importantly, I hope you can take something away from reading this, whether it be a more informed mind on women’s health, Salvadorian Spanish, or just a greater respect for those who live in El Salvador.

This medical mission is run by Kathy Garcia of Peacehealth and Sister Susan of the Sisters of St. Joseph of Peace. Please see the mission’s website for more general information:

http://www.pazsalud.org/

They are in their eleventh year of leading trips down to El Salvador. This particular trip was a general medicine clinic with eye care for the town of San Jose de Villanueva. The volunteers from this trip are from all over the Pacific Northwest and most are Peacehealth employees.

To finish this introductory post, I want to give a shout out to my family, coworkers, and the lovely ladies with PEO who donated vitamins! You have no idea how excited EACH patient was to get their vitamins. Their faces would light up when the docs said “And we are going to give you some vitamins....” (more stories to come about patients getting their vitamins)

Que Dios les bendiga y nos vemos pronto!