Bats and Hitchhiking

I'm beginning to love the rain here. It's rainy season until November or so and the pattern seems to be a little rain after lunch, a lot of rain around 4, and often rain at night. The rain isn't annoying and violent like it sometimes is back home; it's just background noise here.
(photo: view from balcony upstairs during an afternoon rain)
The weekend has been very relaxing. Slept in Saturday...recovering from the birthday celebrations. Yuan taught Maria how to cook fried rice- and I attempted to help, but mostly got in the way...shocker. The weekend of cooking continued- lasagna made by Alex last night and Janelle made a chicken dish tonight. The day ended with Friday Night Lights, of course. There's talk of a movie marathon sometime this week...it's an exciting life we live down here at night.
Saturday night was hysterical thanks to Ashley. Bats fly around at night, so we keep doors closed to prevent them from coming into our rooms. Ashley and I were on our way upstairs when she commented to me that we need to be sure to close our door- and right as she said that a bat flew out of our room and she let out an ear piercing scream. I shrieked and then burst into laughter. It was the funniest thing I think I've ever witnessed. Ben, Dr. Ruben, and Alex all came down to see if we were ok but I was laughing too hard to respond. The bat is now a running joke around here- good times.

Sunday is the day we all make our own meals- so breakfast is kind of whenever and we all lounge around. This place is definitely feeling like home now. Conversations over breakfast are less formal and more playful. I worked on secondaries after breakfast, but then decided it was time to visit Magdalena, the next town over. So Yuan and I set off walking to take in the sights that we can't see when we run because running requires looking down to avoid twisting an ankle or tripping over the rocks and holes. If I haven't said it enough already, the sights here are so beautiful. The walk probably took about 40 minutes and it brought us right into the center of town. Magdalena is definitely more developed than Santa Lucia- better roads and tiled floors in several of the houses. On Sunday there is a big market in Magdalena, and we arrived as it was ending. We went into the farmacia/tienda to get me a phone and after a nice conversation with the store owner, we found out his sister is the doctor at the health center there, Cesamo Magdalena. After exploring some more we came across a legit soccer game going on in the campo. There were jerseys, food vendors (delicious looking pupusas), and a vuvuzela! It was such a cool thing to witness- and they are really common around here so I'm excited to go to more. We finally decided to head back, took a different way and felt that we were slightly being followed, but ended up being fine. Right as we were discussing how we think we'd be fine to hitchhike, a truck pulls up and we hear "vamos?!" After making sure it was ok- checking for women in the back- we asked where they were going (Santa Lucia! was the response) and hopped in the back. It's funny, before I left charlie was telling me the best way to sit in the back of a truck- advice at which I laughed and said I doubted I would ever use. Chuck- you were right. Hitchhiking is super common around here. We hopped out in front of the health clinic and joined everyone for Sunday leftover lunch inside. I spent the rest of the day working on secondaries on the upstairs porch. The view from there is so incredible and the hammock that is up there completely swallows you. I could sit there for hours just looking at the mountains.

I finally decided to enter my data into the Shoulder to Shoulder database- Alan came down to help me and we found out that those doing the project before me did not enter the data correctly into the system, so now I have to go back and fix them-- difficult, no, but time consuming. No worries though- as I keep saying over every meal "Life is good".
Miss everyone a ton and would love to hear from you all :)

adiosss

Una entrada breve

First week down- several more to go. I'm really starting to get comfortable here and loving it more and more. Today was a fun day- only one patient for my study in the morning, and none in the afternoon. Fridays are generally slow. Mondays are the busiest for sure.
This afternoon was great- mostly Doris and I talking a ton about English and Spanish. We've moved past just working on my Spanish, to now working on her English as well- it's a blast.
I'm pumped for tonight because we are celebrating all of the birthdays that were in August.
I want to tell you guys about Thursday. Well, first, it's interesting to note that Wednesday's here are "pregnant lady day". It's the only day a week we perform ultrasounds, so the pregnant women and girls all come in to have that done. It's amazing that our clinic does so much for pregnant women in the area.
So Thursday a woman was in labor for most of the day. I wanted to observe the birth, but there were already a ton of people in the room and I didn't want to crowd everyone. Ashley and I were hanging outside of the room waiting to see what was going on for most of the time. When Deysi and the other nurses walked out I was able to peek in. I will never forget this image- I saw Rosbinda stitching the mother. It was only for a moment, but kind of surreal. She looked so calm yet so incredibly badass.
Afterwards I wanted to help somehow. I asked Deysi if she needed help and she told me I could help clean the instruments- I was really excited to do that, as odd as that seems. But that was all the direction I got... So I went into a room with a sink and sat there for about 5 minutes trying to figure out what to do. Eventually, I got Ashley to help, but then there were two confused people. Long story short, I ended up almost using gasoline to clean them...yea, don't ask.
Think I'll end the post here- nothing really exciting going on currently, hopefully I'll have stories after the weekend.
I'm posting a picture of where we wash dishes below...

Oh, and I've been dreaming in spanish...good sign, right?

Settling in.

So my first real week begins.. So far, so good. There are definitely some downs though. Times when I kind of sit there and ask myself, “what are you doing? Can you even communicate to anyone?”. It’ll get to you for sure if you think about it too much.
Monday in the clinic was great. Liz was with me in the morning, and we got two patients. Alan and Yuan observed me during one of the encounters, so I was nervous, but it went well. The kids I’m working with are absolutely adorable. I’m posting some pictures below.




Yesterday Liz left after lunch and I was on my own. While waiting for patients who met criteria, I talked with Doris. She is seriously awesome. She wants to work on her English more, and I want to work on my Spanish, so we converse back and forth. She is great to practice my Spanish with a) because she is so nice and personable and b) because she speaks clearly and not too quickly. I love that I work down there with her and I’m excited to see where it leads. She is also great about helping me make sure I get the patients I need. I’ll come down in the morning or after lunch and she will have put some charts on my little table/desk area. I also use the charts to complete the chart review and get the other details I need. It’s fun to try and find the docs or nurses to fill in their review. It’s amazing, after just a day of speaking mostly Spanish I already feel so much better about my abilities. Though listening is still incredibly difficult for me. Some of the people in the clinic speak soo quickly, and the more rural they are, the more difficult- often due to lack of teeth.
The clinic “closes” at 4:30 pm. Closes is in quotes because the clinic is open twenty four hours, but after 4:30 only the nurses on call see patients, and they are supposed to be emergencies only.
So in the afternoon the new volunteers had another orientation with the gringos that have been here longer. It was so great to hear about the various projects that Shoulder to Shoulder has done as well as those in which it’s currently involved. For example, often the health promoters go out and perform “paquetes basicos”. With these the promoters provide food and other services to people in the communities. The census is another big project they do. I’m hopefully going to Conce next week with them to see how they interview people in their own homes. I’m going in hopes of improving my own interview style in the study. It really is more than just asking a few questions. You want them to be comfortable and you want to make sure they understand you and what you’re asking. It’ll be incredible to go into the homes and see how people interact with health promoters-- the reception, the dialogue, as well as the scenery. To use an anthropological term, it’ll be real fieldwork. I can’t wait. I also am excited to check out areas outside of Santa Lucia. I still haven’t seen a ton of the area mostly because this first week has been about getting to know the people here and understanding how it all works. If and when I go to Conce I’ll probably stay for a day or so, then there is talk of the Santa Lucia volunteers all going there for the weekend to hit up a waterfall there.
Back to S2S.
I am seeing a lot more behind the scenes type things, more on the administrative side I would say. So what I didn’t realize is that while yes, Shoulder to Shoulder is a health clinic, it is intended to be for emergencies and births. People are supposed to come here after being referred from another clinic in a nearby municipality or aldea, or if they cannot afford care elsewhere. A visit here is 5 lempiras (lemps) if you’ve been referred and 100 lemps if you have not. The exception being if you’re from the aldea of Santa Lucia (and maybe Magdalena as well), then it’s 5 lemps either way. Shoulder to Shoulder is a non profit NGO—which contributes to some difficulties it faces as it continues to grow. People find it hard to believe that S2S can’t provide endless services and treatments, especially when gringos are working in the clinics and have laptops upstairs. But it’s not that simple- money is needed, and getting that money can prove to be difficult at times. It’s also interesting to learn about the difficulties S2S faced when establishing itself. Prior to S2S (and still goes on to a certain degree), most of the Honduran health care providers didn’t really go to work each day- and to their defense, when supplies aren’t there, treatment can’t be provided so it isn’t exactly worth it if you can’t help the patients. Another big issue is that they do not like someone coming in and telling them what to do or how to do their job. Which makes sense…which is again why “helping” involves working with them and ensuring that they are on board and that what’s going on is what they want. Definitely makes decision making more complicated and requires meetings every month. In fact, about 20-30 health care promoters, physicians, nurses, and other people came to the clinic today and are in a big meeting now. If the clinic isn’t busy this afternoon I’ll hopefully go in and observe the meeting.
Another key issue at play is the idea of visions vs. actions. Vision is wonderful and necessary, but vision doesn’t exactly get things done. So many details and issues have to be acknowledged, and as soon as one issue is addressed and dealt with, about 6 more pop up. That definitely explains a lot of the frustrations I’ve heard about and witnessed. One last thing to consider is that S2S is doing what it can with what it has. Someone noted at our orientation yesterday that “sterile” is “clean” and clean is “pretty clean”. Which is not to say that things are dirty by any means, just that it isn’t as easy to keep a sterile field when you’re not in a state of the art hospital with tons of supplies at your disposal. I would say that the clinic runs very well and I love working in it.
After our little orientation we had dinner—pupusas that were so delicious. I still can’t get over how good the food is here. Again, I “helped” the two Marias (the two cooks) by attempting to stuff a ball of dough with cheese and then flatten it out and throw it on the grill. Again, they just laughed at me—but they know I’m trying and we joke back and forth about it. After dinner we all decided to begin Friday Night Lights—there’s not much else to do at night. So we watched two episodes- after that some people went to bed and a few of us stayed up to celebrate Alan’s birthday which is today. To keep it going, we watched Dave Chappelle before calling it a night. I could definitely get used to this.
Today so far has been incredibly busy! I’ve already had four patients, and I think I missed one or two who left before I could get to them. I know I keep saying this, and in these same words, but it is so amazing to interact with the children and (usually) their mothers. The mothers are so kind and nice, which is incredible because my Spanish isn’t the best and I often pause trying to figure out how to rephrase what I need to ask them. While I began just reading the survey verbatim, I’ve gotten more comfortable, and it’s turning into more of a conversation and actual interaction. When I ask them if they want to participate, I feel like they think they have to comply- I need to figure out how to tell them it’s ok if they don’t want to participate. But at the same time, they are just waiting in the clinic, so I guess it gives them something to do until the doctor sees them. Oh, Janelle, the head nurse here gave me the best complement at lunch today- she said she heard me talking in the clinic and she was impressed by my Spanish. For real? I wonder if it was me she heard...She’s from Roatan originally and has been working here for about a year and a half. I told her I would love to visit there, so hopefully that happens before I leave. I should probably stop writing and head back down to the clinic- hopefully there will be patients to see! Though if not, I’ll try and engage Doris in conversation.
More stories to come…

I will definitely post tomorrow about the week so far, but I wanted to at least write something. Had a great night-- celebrated some birthdays, watched friday night lights and laughed at some dave chappelle. Too tired to write about today, but definitely stories for tomorrow.

buenas noches

xx

Arrival and the end of day 1

So I had no internet last night, and I wanted to write what went on during my arrival- so I did it in word and I'm pasting it below. Then I'll get into my first day here! I don't think I'll write every day, but so far, that's what I'm doing...enjoy :)

Thursday:
I arrived in Santa Lucia tonight around 7:30 (9:30 back in NC). I don’t even know where to begin talking about today. I met Liz- my boss who’s the principal investigator on the study, Ben- a guy who has been working with S2S for about a year, did the peace corps in Bolivia and now takes care of a lot of things here, and Kerri- a graduate of UNC undergrad and UNC SPH. They all are so great already and it’s going to be a blast getting to know them. It’s slightly intimidating because they’ve been here for a while, and they mentioned that no one really told them volunteers were coming until recently. Though that wasn’t the case for me, because they’ve all known for a while that I was taking over the study, which is good. Not too sure what the other new people will be doing… They missed their connecting flight today, so they’re getting picked up by someone else tomorrow. As soon as I found the crew of three waiting for me, they ask me how I feel about fish, because we are going to stop at a place on the lake where we can get great fresh fish-naturally, I got extremely excited. So we pack all of our stuff into the back of the truck, and set off. I don’t want to narrate the entire car ride, but I have to talk about the sights. Unreal. I really don’t even know how to describe everything and the pictures I took are almost insulting to what I was trying to capture. The roads were pretty rough and the ride was bumpy a lot of the time, but I loved it all. I was amazed as Ben maneuvered the car over, around, and through mud, water, rocks, and mountains. Extreme four-wheeling for sure.

Back to the sights.
Some of the areas are so incredibly run down; garbage all over the streets, broken windows, missing doors, and sinking roofs. At the same time, though, there’s almost a beauty in the mess. When you look at it, it all seems so calm, so in place. There is no background noise of streets or cars, just a picturesque quiet. But the second I think or say this I quickly question what exactly I’m thinking. By just saying that the scene is beautiful and calm I’m highlighting the fact that I am so unfamiliar with the place, that I have no idea what life here is like. It seems like such a cliché- a Westerner going into the third world wide eyed and excited. Can I really say that things are run down, undeveloped, or lacking? Do I have any idea how Hondurans feel about their daily lives? No. Things seem legit fine. Now where that plays into "helping" another country is another issue. Kind of goes back to the whole philosophy behind working in another country; you can’t do anything without them, they have to be the ones doing it, and they have to be the ones to decide what is best and how to do it. That's what I really like about Shoulder to Shoulder-- it's been here for 20 years- it's the city's clinic, and they are the ones that decide what's best for it. Those of us that come to work here are just that, workers. It's amazing. I love that I have an actual project to work on; a sort of purpose here.
I could go on about the rest of the drive (all 7 hours of it), and how everything, and by everything I mean the handful of sights I took in today, is so untouched, but I want to quickly describe the clinic before I end the post. Granted I only saw it in the dark and pouring rain, but I an at least describe the inside. Walking in the main entrance you enter into the common area, there is a couch, an old tv, and the table where everyone eats. There is a fridge and some other stuff around as well. Off of that room is the kitchen, and further into that is the dishes room. There is an interesting system to washing the dishes- you have to scrub them, then rinse them with water from this huge tub, then put the dishes in bleach water to be later rinsed and used. This room also connects to outside…I can probably give a better description when I see the place in the day time. If you go through the main eating room area, you are faced with a few stairs that lead up to the “apartments”. That place is awesome- there is a common area, kitchen, and office right when you walk in. Beyond that there are about four or five bedrooms- most of them doubles. Come October, one of the rooms will be mine and I cannot wait. Currently, I’m living downstairs in the “dorms”. The room is legit like summer camp. There are five bunkbeds in the two rooms- I am on the bottom bunk in one of the rooms with another girl working here for a year- Ashley. When the other new people come tomorrow I’m sure it’ll be just like summer camp.

Tomorrow Liz is going to show me around the clinic and hopefully we’ll have some patients to recruit together. Saturday everyone is planning on doing some Skyline Chili cook off thing….whatever that is, and they know it’s my birthday then so they have deemed it my birthday celebration as well. We are also talking about going to see the sunrise somewhere on Sunday to continue the celebration.
Ah there is so much I want to do and see here. We drove through Concepcion and Magdelena- both of which have clinics of S2S’s, so hopefully I’ll be able to visit and work there! Apparently the buses are the way to go, so I’m sure I’ll be riding those in no time. I’ll end the post here and will wait to post until the end of the weekend or early next week. Below is a pic of the front of the clinic.

TODAY-- Friday

First real day of "work". Legit amazing. I am so glad to be here. Although, once Liz (my boss) is gone...I may be struggling. I'll be on my own, and while others can help me- it'll be my project. Exciting! This morning I went over all of the forms with Liz and organized my little "station" in the pharmacy. Doris is the pharmacist and she is so great. She only speaks Spanish, so our communication is limited, but that will (hopefully) change soon. After lunch--which, for the record, was chesseburgers--was when I got to work with patients for the study. To briefly sum it up- the clinic opens around 8 or 8:30, and at that time most of the people who will be seen during the day arrive. I go look at the charts and see what triage has seen. If there is someone that meets criteria- a fever with any other respiratory symptom (cough, sore throat, difficulty breathing, etc)- then I go find them to work with while they wait to see the physicians. It's incredible, I have to speak entirely in Spanish. I ask the child's guardian if they would like to participate in the study, they agree, and then I proceed to read them the consent form...which is complicated enough in English, let alone in Spanish. So once that's done, I ask them the questions from the questionnaire, which, again, is easier said than done- though I have to say, I'm making due with the Spanish I know, and I really want to work to improve. So then after that's done, I take the little swabs from the baggies and swab the kid's nose twice, three times if the doc thinks they have the flu--and that swab is used in a rapid influenza test that is kind of an addendum to the study.So I had my first patient! She cried a bit for the swabs, and I was so nervous trying to communicate, but it went well!. After the patient visit, I go to the lab and aliquot the samples into vials-- some are frozen, and some are going to be stored in this new type of buffer system that doesn't need to be frozen for shipment back to the U.S. As soon as I finished working in the lab, another kid qualified, so I went through the whole process again, feeling much more comfortable. I'm sure I'm repeating myself but it's so great that this place is so established. The area is not touristy at all. It's legit another world here, it's unreal..
In the afternoon some of us went on a walk around our town. I tried to take pictures but they don't come close to what I'm seeing. It is so different...every door is open- or maybe they don't even have doors. Some places just seem so dirty and falling apart, but that doesn't seem to phase anyone. Kids are playing in the streets and jump roping just beaming with joy- it's incredible. I want to just sit there and observe for hours. I want to know what is in the houses, what they talk about, what they do throughout the dayand night. There are shops scattered around too, though you would never know they were shops unless you peaked your head in. I don't like to read what I'm writing because I wish I was more eloquent or able to capture the feeling I get when I look around, but I can't.
The new volunteers arrived tonight, so we are all sitting upstairs right now in the more permanent living quarters hanging out. Enough writing for now- I will try and post pictures either tonight in bed or later this weekend at some point.

peacee

Departing in the morning

I'm getting up in roughly four hours but am nowhere near tired. Been saying goodbyes for the past week which of course makes me sad because I just may be the biggest sap, a fact to which I'm sure you all can attest. I don't think I'm going straight to Santa Lucia tomorrow, most likely staying in a nearby town, but then off to my new home on Friday! If anyone wants to see where I'll be living, check out the Shoulder to Shoulder website online. I'll be living there, but not working for them exactly. The research I'm doing is run by the Cincinnati Children's Hospital Medical Center and funded by the NIH. I somehow got lucky enough to find a project that would let me work with them and set me up in Latin America, and the woman I'll be working for is amazing. To give a brief description of the project, we're trying to determine the viral etiologies of acute respiratory infections in rural Honduran population of children less than five years of age who present to local clinics with fever and respiratory symptoms. I'll recruit patients throughout the day, obtain consent, help them fill out questionnaires, and take naso-pharyngeal swabs to be frozen in a lab and later shipped to the US for analysis. I'm incredibly excited, but extremely nervous.

So I'll try and keep this blog neat and concise, but I'm sure it will run how I talk and think...all over the place and without much sense. However, I hope you all can enjoy the stories and pictures I share!

muchos besos