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…