Sunday-2/12/12- Last Day in El Salvador

The small town of Suchitoto would be our destination for the day. It was a little less than 2 hours drive from San Salvador (depending on how fast Hernal drove). After an hour on the busy freeway we turned off onto a narrow two lane road that weaved up to Suchitoto. We passed these smoking stone huts and found out that they were kilns for brick making.

Suchitoto was a rebel stronghold town during the Civil War. There is the typical white cathedral, cobblestone streets, whitewashed stucco walls in a variety of light colors, and sidewalks that are three feet above the streets. Apparently when the huge tropical storms and monsoon rains hit, since there are no sewer systems, the streets flood. Thus, they build the sidewalks 3 ft above the street. Below is a photo a woman in Suchitoto cooking on the typical smoky wood stove. Above is a photo of Sister Peggy's house.

Sister Peggy O’Niell (a wonderful ex-professor of theology who has lived in El Salvador for almost 2 decades) welcomed us to the Centro para el Arte with a lovely talk about rebirth. There are three of her points I’d like to leave for people to ponder. The first is how the only difference between a grave and a rut is 3 ft. I’ll let y’all think that through on your own.

The second point was a question she asked each one of us to share with the group “You were born once. Each one of us though goes through a rebirth. What’s your most recent rebirth?”

Her third point was that we should all try to be good virgins. This one requires some explaining. Sister Peggy explained that virgins are woman that are strong in character and are not afraid to stand up for their morals.

During our visit to the Centro Arte para la Paz, there was a flute class happening in the old church when we arrived and we left with an impromptu concert from a beginners guitar class.

They also have a small museum, art scattered throughout the centro, a hostel (where a convent used to be before the civil war), and a whole new building with classrooms and a large meeting area opening soon. What exciting plans Sister Peggy has for the Center! They have so many neat programs there including classes for teenage boys to help them deal with being recruited by gangs as that is a fact of life. If a male refuses to join a gang, he risks being killed. On the other hand, we saw stamped letters on houses throughout the town that read Violence against women is not in this house.

Lunch was at Sister Susan’s house in town. Some of us walked the couple blocks to the town’s plaza and cathedral to do some shopping from the local artesenia street fair. Other’s relaxed in the shade of Sister Susan’s house as it was moderately humid and in the high 80s.

Returning from a short walk through town, I sat down to chat with Richard and his mom Maria. Richard had received a heart valve replacement thanks to the mission and was healing well, doubling his weight. Maria told me that she worked as a policewoman. Her husband had been killed by local gangs and she daily fears for her and Richard’s lives. Can you imagine daily facing the threat of gang violence on you and your loved ones? I will not forget her story even though we finished our chat with a discussion on how to get Richard to eat more meat with Dale, the pediatrician who had originally diagnosed him with the heart valve.On our way back to Suchitoto we dropped them off at a make-shift bus station along the side of the freewa. All I can say is “Que Dios les bendiga.”

Our time in El Salvador was coming to an end as we held on to our seats as Hernan raced us towards San Salvador on the bus ride of our lives (He is such a talented bus driver). For many of us, our energy was spent, our hearts heavy, and our perspectives challenged. Returning to Sister Peggy’s question on rebirth, this experience in El Salvador was a rebirth for me in diverse ways, some that will take time to process. May we all never forget this trip: the faces, the names, the love, the pain, the result of violence, and the possibilities of kindness.

Saturday- 2/11/12- Exploring San Salvador

Even though the air was not as fresh when we woke up, it was a gorgeous sunny day. I went on a short, refreshing swim and headed to a delicious breakfast where everyone raved about the nice lady who made the eggs.

We hopped back on the bus with our dear bus driver Hernal to head to various historical sites (if you call the recent civil war places where people were killed historical). Our first stop was the church on the ground of the Hospitalita Divina Providencia where Monseñor Romero was assassinated. As we drove through the gates to the grounds, we left the busy, noisy city and encountered peace. The church was a small, white bleached triangular building. We walked quietly through the pews and looked at the alter where Monseñor Romero had been giving his homily when a car pulled up to the front door, the window rolled down, and a gun fired. Monseñor Romero had made a point for this special mass to do the whole mass by himself as he had received the threats and new the risk he was taking.

After our short visit to the church, we met one of the Sisters of Charity that work at the hospital and she led us through Romero’s humble house where we saw everything as it had been the day he died: his books, toiletries, and blood-stained clothes. Monseñor Romero is deeply respected both nationally and internationally for living out liberation theology. He stood up for the poor and spoke out against the violence at the beginning of the Civil War, thus, he was killed.

Before we entered his house, the sister asked us to say a word that represents our experience in El Salvador. We listed words such as justice, love, compassion, faith, friendship etc. Then, she asked us to remember that word as we walked through Romero’s house. When we met in his bedroom with his bloodstained clothes, she told us how those words that we said out-loud were now our gift from Monseñor Romero and God, to continue sharing them back home.

Our next stop was the Theological Department at the Jesuit University of Central Ameria where 6 priests and the housekeeper with her young daughter were brutally tortured and killed in the middle of the night in 1977 by the secret police. We walked into the patio area that now has a simple rose garden made by the housekeeper’s husband in the place where the violence took place. Do I need to explain the symbolism of the gorgeous roses that grow in a place that became a place of murder? The art gallery and small exhibits covering the life and deaths of many of the priests, nuns, and people that were killed during the civil war left one numb imagining the pain, sadness, and ripping apart of culture and families. Was one side completely free of guilt? Is there ever any one side free from guilt in war?

Our last three stops of the day were a sharp contrast to the morning’s places of violence. On our way to the first stop we drove threw the richest neighborhood in San Salvador. It felt like we were back in the USA with McDonalds, Pizza Hut, fancy car dealerships, and huge malls. In between the two directions of the highway that ran through San Salvador and near the fancy malls, we could see simple houses of cardboard, scrap wood, and aluminum roofs. Next, as Hernal drove the bus towards the affluent areas of San Salvador, we passed the gigantic US embassy (one of the largest in the world). It looked like a completely enclosed college campus. Apparently, if they catch you taking a picture of it you could get in big trouble..so, no pictures (google it!).

After lunch at a modern restaurant, we headed to the Fernando Llort Art gallery. Fernando Llort is one of the most famous artists from El Salvador and is still living. His work integrates the traditional indigenous art with bold black outlines and bright, cheerful colors. He has taught his designs and style to poorer communities so that they can sell artesenia and remember that part of their culture. He is very beloved by his country. The pictures below are of some of the artwork from his gallery with his most recent being the still-life paintings.

The mural outside his gallery which is his typical style.

Then, after some brief shopping at an open-air market we returned to Hotel Novo to relax before the talk with dinner by Leslie Schuld at Centro de Intercambio y Solidaridad.

Friday-2/10/12-Day 5 of Clinic

It’s the last day of clinic. Has the clinic week truly finished? As I try to look back on the week I find it hard to disseminate day to day. All I see is an endless recollection of faces, mostly women and children with a few older men. Faces as well as their stories blend together to become what I know of as the people of El Salvador. Though the civil war is still ripe with pain in most peoples minds, the natural disasters a stamp on their current livelihood, and the painful gang violence a consistent jagged knife, above ALL this, there is so much hope in their eyes, so much faith in God, and so much solidarity! How can one not burst into a smile with joy in their hearts? Though some stories leave me in frustrated, I remind myself of the older woman who said after hearing of a healthy breast exam, “Oh Thank God!” There is always a reason to celebrate.

And so, Friday AM Heather and I wake up to our last brilliant sunrise at Ayagualo retreat house. Running on our final bit of adrenaline and groggy, we pack up our bags (still watching for stinging stowaways). It seems like it is going to be a warm day already. After a breakfast of pancakes with black bean sauce, honey, and fresh papaya, I throw some gatorade powder into my water and hop on the bus.

Today we are only going to see 200 patients. The plan is to finish by 2 PM so we can cleanup before the despedida (closing ceremony) by the church around 4 with yummy cake (!). Deb and I jumped in with our last day of pap smears, breast exams, and who knows what else. Like every day, we had some interesting cases come up. For example, there were some referrals to the hospital for ovarian cysts, birth control, a couple pregnancy tests, and a few more pregnant women with concerns.

One young woman came in complaining of her stomach feeling hard and very tender. She was due the following week with her first child! When she showed Deb and I her prenatal control packet with monthly visits, we were really impressed with the prenatal care she was receiving. Deb told me it was very similar to the US. It was so fun to take our time talking to and advising this future mom. We listened to the baby’s heart, measured her womb, and explained how it was normal for a woman’s womb to feel hard due to stretched muscles. She was quite relieved and left with such a cute, big smile.

As we were not as busy, just steady, we were able to serve some of the women volunteers who had been helping us all week including the cooks (such fun ladies). On a more serious note, one patient seemed a very guarded, married woman. When we asked her if she was sterilized, she said she used the 3 month injection. The way she said it made us probe a little more. Her husband is a hospital security guard and wants more children but she doesn’t. Thus, she gets the injections secretly because she can’t get sterilized without her husband’s consent. Deb and I looked at each other with Deb being so much better at hiding her dislike of a woman not able to choose what to do with her own body. We were relieved that she said she felt safe at home. Still, I wonder if this was just situational or if there is a law that women must get a husband’s consent to get sterilized?

One last patient I’d like to leave you with exemplifies the happiness one finds within the trials of the Salvadorian people. She was a seamstress with a round, cherry face. As we went thru her medical history, she told us she had 3 pregnancies with the last being a miscarriage very late in the term. The doctors had found the baby had Down’s Syndrome (and maybe there were other compications?) so they aborted the pregnancy. We talked about this as Deb did the exam and though she was sad about the miscarriage, it seemed like she had overcome the loss. When we asked her about her other 2 childrem, we found out the 11 yr old boy had a severe cleft palate and clubbed feet. He had not wanted to come to clinic today so he was visiting grandma. It was so special to see her face light up talking about this little boy who was such a happy, considerate kid. Doctors had told her the palate was too extensive to fix so he stays home and loves visiting grandma in the country. I only wish we had gotten to meet him! We parted with big hugs and kisses. It was such a nice note to end our week.

Around 3 PM we finished seeing our last patient and rearranged Mujeres into a classroom with the help of our local volunteers. I cannot say enough of our local volunteers! They were always good for a hug or a willing hand.

The Despedida, ending ceremony, began after we finished cleaning up (except pharmacy where Melissa, Moises, Sylvia, and Kathy rushed to organize the leftover meds they’d save or donate to local clinics and the church). The Father, after a short greeting invited a Mexicano Salvadorian folk dance troupe to the stage (Mexicano is a suburb of San Salvador). The bright shirts of the men and silky dresses of the women gave me an extra boost of energy. What a celebration each dance was! I had never experienced a more touching despedida. The first dance the men care-freely carried sacks on their back. With their skirts flying, the women joined them for a machete dance and a “paper flowers on a tall stick dance” (as seen in photo). Before the giving of gifts, they did a thrilling bull dance where a man carrying a wooden papermache bull over his head chased the other dancers.

Then, the priest handed each of us a lovely hand drawn pendant of Monsenor Romero and a hand painted picture with a feather. Kathy and Sister Susan handed out gifts to our local volunteers saying that we saw 1600 patients in those 5 days in San Jose Villanueva. We also sent 5 people to the hospital. To finish, the troupe danced around a maypole held up by a teenager from the audience. He almost lost his grip several times and everyone had a good chuckle over his nervous face,

especially his mom. We ate a deliciously moist cake with custard filling and fresh fruit on top! How hard it was to say goodbye to our new found friends from El Salvador! I will dearly miss Anna, Dona Carmen, and her aunt Claudia who helped us so much in Mujeres!

We left San Jose Villanueva for the final time and headed to San Salvador, the capital. I have never had a greater respect for a bus driver. There were several seat-gripping moments where it seemed like there was no space between our bus and a nearby truck or car. The horn-honking traffic was a sharp wake-up call from the quite, slow-moving life in San Jose and Ayagualo. Before we crashed at Hotel Novo in the capital, we stopped at a Pupusa restaurant where each pupusa was less than a dollar. Pupusas are the thick Salvadorian corn tortillas filled inside with either beans, cheese, and/or meat. Man, do they stick to your stomach! Fidel, the music aficionado, called over a mustached guitar singer hovering nearby to play a variety of Latino favorites. So, we sipped our beers, listened to the music, and savored the tasty pupusas. The clinic week was over.

Thursday- 2/9/12 -Day 4 of Clinic

We had been warned that today and Wednesday we would see patients from some of the poorer communities. Each day of our clinic a different community came. They were “pre-screened” by the local health promotors and told to come on a certain day. So, we prepared ourselves for our last full day of clinic (Friday we were only planning on seeing 200 patients).

After taking a group photo at the retreat house in the gorgeous sun (which I will insert in this blog once we get the pics but for now you are stuck with a picture of me taken by Mary), we loaded up into the bus. This morning I especially noticed all the political candidate billboards and signs with paint bomb splotches or gun shot marks on their faces. We would often hear and see these trucks full of youth wearing certain political parties colors and waving the party’s flag. It was such a volatile political atmosphere. Elections are in March.

Clinic started off smoothly with Deb and I jumping into pap smears, breast exams, and consults on women health issues. I’m afraid I can’t tell you too much about the areas of the whole clinic but I do know everyone stayed busy. General medicine tried a new technique called group visits where one doctor and the med student met with a group of 10 or so patients at once. After getting each patient’s vitals and chief complaint, they would talk to those patients who had similar complaints and do group discussions with education. Thus, the patient received more information and time with the doctor. It worked well.

Deb and I were on a roll Thursday. We took a brief mid-morning break and kept seeing patients. There were several referrals from General Medicine and one from Peds. We were able to counsel a mom with a young teenage girl about her health concerns (women and those not queasy about women's health can read about this in a little more detail in the future women's only blog post).

During lunch, we watched the parish’s chickens walk around in the fenced yard behind us. (To the Left are several of the wonderful ladies who cooked lunch every day) The priest happened to be sitting next to me while we ate and said, pointing to the chicken I was eating, “He used to live there.” I thought he was joking but ...well, I wasn’t sure. Everybody got a kick out of my reaction once I translated what he had said. He was a very lively priest with a great sense of humor. I still wonder if he was joking. Those chickens didn’t look fat enough to be the one I was eating but..oh dear.

Later in the afternoon, one particular patient stood out for us among all the routine women´s exams. She was dressed traditionally with a head scarf and a long skirt with blouse. She was in her mid-40s and almost full term with her tenth child with some concern over pain. Most importantly, she wanted to have us deliver her baby in the clinic right there and now. (Word had gotten out the first day that there were WOMEN doctors covering the women's health consults) Ana informed us that the patient had no prenatal care, lived in the hills, and was supposed to have her baby in the hospital. Deb, following a brief exam, figured that she still had a couple weeks to go. We explained to the patient that she was not in labor yet but we should check her womb with an ultrasound. Salvador found an aging placenta which is not uncommon for a woman at her age. Still, that with the fact that she had had no prenatal care made them send her to the hospital immediately. The local Salvadorian doc said that at the hospital they would probably induce labor and get her some birth control/sterilized.

Note about Sterilization: It seemed fairly common for middle-aged women to be sterilized after their last birth by tubule litigation in El Salvador. Some did not even know how they were sterilized but they just knew it (!). Deb and I only had one patient who told us that her husband had been sterilized. We both could not help looking at each other surprised. When I asked her why she said that the hospital told him he had had too many kids so that was that!

Note about Birth Control: It seemed like less than 10 women were on a birth control pill and for all of them, it was for regulating heavy periods. Most pre-menopausal women that were not sterilized used the 3 or 1 month injection. About 20 women we saw had IUDs. And, only about 10 women admitted to just using family planning (calender).

The rest of Thursday went by fairly quick. We finished a little early with enough time to sit in the open area of the compound and compare stories with other volunteers who had also finished early. See the photo below taken by Mary of Leah, our awesome ear-wax removal queen and do-all-nurse in General Medicine, having a fun photo break with some new friends.

Deb decided to take some pictures of two local sisters, ages 7 and 9 who were hovering near by. They loved posing with big shy grins on their faces while Deb asked them basic questions through me like: “How old are you? What is your favorite color?” They eventually came to sit next to us and we slowly got them to chat a bit more about their life in El Salvador. They have nine brothers and sisters with only three of the youngest left at home. Their dad died suddenly a couple years ago after falling off scaffolding at work. (At this point we heard their younger brother burst out crying in Pediatrics so the oldest one went to check on her mom and scared little brother). The youngest sister continued telling me how they live in a tiny house with no running water or electricity and an outhouse up in the hills. When I asked her if they had a garden, she gave me a long list of fruit trees and some veggies like corn and beans that they take care of around their house. She also mentioned that she did NOT like music when Fidel inquired (Fidel is a volunteer interpreter from Springfield who is an avid music aficionado). Fidel could not believe it!

Before their brother was done in Peds, Deb showed the youngest girl how to take a picture with her camera. The girls had never taken a photo before. Getting to take pictures for the first time probably made their week! It was hilarious watching the youngest take her first picture of us and see the image on the small screen. I think Deb had at least 15 pictures of just Fidel, Deb, and I in various grins and faces. Eventually, Deb got her to take pictures of other people but she couldn't quite figure out how close or far to stand to take a picture. Next lesson will have to include: how to zoom. Oh, it was such a light hearted way to end the day!

After seeing those two sisters with their mom and younger brother walk out into the dark street, we loaded up on the bus and passed them walking slowly down the road on their long walk up into the hills on dirt tracks to their house with fruit trees.

Wednesday 2/8- Day 3 of Clinic with lots of gusty wind

How refreshing it was to wake up every morning to a light cool breeze and the birds singing like the recordings one hears while in the tropical area of a zoo! In the evenings it would cool down gently and it was never very cold at night. During the days it was usually a humid 80 degrees. Wednesday it might have been around 70 with gusty wind.

After starting the day with 5 or so Paps with breast exam (I could never keep track), Kathy told us the 16 year old girl was back and said she had had a fever that night. At first, Deb was concerned but when we talked to her the girl seemed much better with no temperature. We explained to her how the medicine should get rid of the infection within a week and to go to the local clinic if she wasn’t better within 2 weeks. However, it was obvious that she was doing better already after 12 hours on antibiotic. Also, the Peds doc had been able to examine her baby that morning and found him to be a healthy baby. So, we loaded her up with formula and, after seeing her grandma, said goodbye.

As Deb and I saw more patients, the wind got stronger and almost pulled the tarp that divided the classroom in half out from under the desks holding it down. The ladies were getting nervous so once we reached our 3 PM deadline, I recruited several of the amazing local volunteers to help. Somewhere they found some heavy rocks and two guys retied the tarp to the roof where it had been torn by the wind.

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.

Now back to Wednesday: Ana was able to find us a bigger slide box so we could do more than 30 pap smears since there were only 30 slots in the original box. Thus, Deb and I tried to be more efficient at seeing patients. It was quite a challenge to do 30+ paps before 3 PM. We both disliked how we could not spend more time with the women. We also knew by now that the women really appreciated getting their pap smears done by a female doctor (especially Deb since she was so quick and gentle). Many would tell us of painful pap smears by male doctors in the past.

It is important to note here that Deb was impressed by the country’s women’s care. Most women were getting a pap every couple years and a variety of birth control options are available for free. Also, for the women we saw who had a serious women’s health issue, the treatment they received or were receiving was usually what Deb would have suggested. The only area we were surprised with was the fact that only a few women had had a breast exam. Pat, a NP who has worked in El Salvador for many years, told me how the health department places more money in prevention care for uterine health since there is a higher occurrence of ovarian and uterine cancer for women in El Salvador than breast cancer. Hopefully, the local clinic is not overwhelmed after I told every single patient to perform self-breast exams and to go there if they find anything suspicious.

After 3 PM, we had several women bring in their 80+ years old mothers for breast exams. The older women were dressed in simple calico or gingham dresses with traditional aprons. Though they were hard to understand, they were so sweet and grateful for the simple breast exam. One woman who was lifted onto the exam table by her youngest daughter (out of 11 kids) was just skin and bones with barely any breast tissue. Deb, without blinking an eye, gently did a breast exam. When I interpreted Deb’s words that the breasts were fine, the woman lifted up her long, worn hands as if in prayer and said “Thank God! Thank God!” (Another tears in the eyes moment) Then, there were hugs and kisses all around and several “God Bless you.” May God bless her!

After cleaning up, we had a few minutes (for once) when it was still light out to watch the kids playing in the compound. The children loved to pose for anybody with a camera as you can see in the pictures below. Then, I headed over to the eye glasses distribution room to interpret as they were completely overwhelmed. It was terribly comical to see the men walk out with sunglasses that were ones we would call “granny glasses.” They thought the big sunglasses with the side shields were the coolest thing!

I helped interpret for Sister Marilee who was finding glasses for an older women. When I asked if a certain pair of glasses fit well, she said, “Yes, now I can read the Bible again!”

Next, I helped Sister Marilee find glasses for one of the local volunteers who I had met before. We were joking around with her and Sister Marilee showed her these really flashy glasses thinking the volunteer, who has a vibrant personality, would like them. However, the woman looked at me with a “what the heck” look on her face and said, “I need glasses that will get me a boyfriend!” Her comment was so out of the blue that the three of us laughed quite a bit. Sister Marilee then found some more conventional glasses. One of my favorite things about speaking another language is that one can relate to someone else from a different culture! That sounds so cliche but my most special memories from this trip are from when a patient and I could empathize with each other, even if it was laughing over a pair of glasses with too much bling that it would scare the boys away.

It was such a pleasure to be in Ojos 3 for an hour or so and see the delight on so many patients’ faces when they found a pair of glasses that made reading possible again (near and far away). It was such a joyful room!

And so the day came to an end around 6:30 PM with everyone seeming a bit more refreshed after a cooler, smoother going day. The wind had died down to a light breeze and the sun set as we loaded up onto the bus

Tuesday 2/7 - Day 2 of Clinic

Each morning we woke up at 6 AM to the sound of birds chirping and wind in the trees. This time for breakfast there was beans with rice mixed in, thick corn tortillas, and hotdogs. The days started to blend together at this point with Deb and I getting into a smoother rhythm. The photo above is of Me, Ana, and Deb. As an interpreter, one is only supposed to interpret exactly what the doctor says to the patient and what the patient says to the doctor. Typically, no small chat is allowed or paraphrasing. However, as Deb and I did breast and pelvic exam for each patient, I began jumping the gun with the same questions we would ask each patient:

How old are you?

How many kids do you have? **

When was your last period and how long did it last?

Are you sterilized? If yes, how?

Are you using some type of birth control and if so, what kind?

When was your last pap smear?

Have you had a breast exam before?

Are you married?

Are you having sexual relations with only one partner?

Also, Deb let me go ahead and educate the patient about doing self-breast exams while Deb did the breast exam. We ran into less than ten women who had had a breast exam before and even fewer who had had a mammogram. Any women that had a mammogram also had a history of suspicious cysts or lumps.

Any questionable lumps or pain were checked by Salvador, a radiologist from El Salvador who volunteered his time to help us at the clinic. It was such a blessing to have him there, especially since the women would have to wait anxiously for an appointment to get an ultrasound.

**Note based on our observations of the women we saw: We never asked women over 20 yrs old if they had kids. The question was always how many. Probably no more than 10 women that we saw had only one kid. There might have been 3 that were under 30 with no kids. Most had 3 or more kids with the max being 15.

Cultural note about being acompañada: Getting married is beyond many couples price range. They have to get married first by the law with a license, and then by the church. Thus, most couples make a verbal and permanent commitment to each other that is well-respected as a marriage though they will say they are “acompañada” or accompanied instead of married.

Just to make those who are reading hungry, lunch was a delicious bean and beef (we think the meat was beef?) soup with a soft, spongy white cheese( queso de mantequilla, dice la cocinera), thick corn tortillas, and avocado, of course.

During a brief break after our 3 PM PAP smear deadline, Deb and I noticed a policeman walking around the compound with a loaded gun. Apparently, there has been a need for more security for the local Health Promoters and for Sister Susan.

Later in the day, Kathy came in while we were doing a breast exam and said they were sending over a 16 year old new mother from peds with her 1 month old newborn. She had some concerns about intense lower abdomen pain, discharge, and whether her stitches from the birth were infected. It brought tears to my eyes to interpret for her while I held her baby because she was in so much pain during the exam. Luckily, he stayed asleep for the most part while the warmth of the baby left my scrub top damp with sweat. Deb diagnosed her with an infection in the uterus and prescribed some antibiotic from our pharmacy. As I handed the baby back to the girl, it seemed like she didn’t know what to do with it.

That shy 16 year old girl would leave a lasting impression in my mind. She seemed such a young 16 years. I felt numbed out as we did a few more breast exams and then cleaned up for the day. The clinic as a whole saw over 350 patients on this day.

I finished the day with finally getting a quick email out to the family and helping one of the nuns who runs the retreat house send an email with an attachment. I never thought I would do that.

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.