Last week was our full week of clinic to provide pap smears and women´s health services to all those women we had signed up in the community. Each day of the week, we hosted a different community in Madrigales, a central small town among all the villages, where women would arrive for clinic, some having walked up to four hours to get in line starting at 7-8am.
Madrigales is up a winding steep dirt road leaving from El Corpus. There is a simple conference and education center there where we set up "exam tables" and homemade stirrups for the exams. On Monday morning, and every morning that week, we´d pile into the back of a truck owned by Pedro the husband of Juana, the community liason for our homestays and project coordination in El Corpus. Pedro would wind his wayup the dirt road, passing banana trees and plots of corn and beans nestled on hillsides so steep they towered over the road. The road was bumpy and uneven, and those riding in the front were charged with the duty to yell "branch" when it was necessary for everyone to duck.
For clinic we worked in med teams comprised of a second and fourth year. Together we would do the interview and medical history, and the we would take turns doing (or toward the end of the week, the second year would do most) breast and pelvic exams. Then we would present to one of our two attendings, and develop a treatment plan, if necessary. Among the normal complaints that correspond with urinary tract infections and STIs, nearly everyone had a headache or some sort of tummy pain. After seeing what life is like in those communities, and all the incredibly heavy work they do, I was not surprised. Things like ibuprofin and antacids are cost prohibitive to most campesino families, so the little aches and pains of life tend to add up after awhile.
Clinic was amazing in so many ways. I had so many "breakthroughs." Like hearing a heart sound that I knew was not normal, and starting to really understand S3 and S4. Or getting really good at visualizing a cervix and taking a pap smear without breaking a sweat. Or even the young woman who told me she had never had a sucessful exam- she always bled and had incredible pain. So we talked about it beforehand, I went really slow, and stopped whenever she needed a break, and eventually the exam was a complete success. She was thrilled.
Tuesday, July 15, 2008
Monday, July 14, 2008
Into Espaveles...
Well, after a few days of R and R, I am going to try and explain the last two weeks. I can´t believe it´s only been two week since I was lounging in luxury at the hotel Maya in Tegucigalpa, wondering why I had worried about being in Honduras. That same Monday that I posted my blog, we left the city for El Valle, a training and conference center about an hour outside of Tegus (the capital´s nickname).
In El Valle, we reviewed all of our health education presentation, or charla, materials. The charlas this year cover everything from family planning and STD prevention to nutrition and hypertension, with a new focus on introducing the idea of problem solving and identifying root causes of community health problems. El Valle had lovely cabins with cold water showers and a comon dining area. The food was muy tipico- beans, rice, cheese, tortillas, and some veggies and juice.
After two days in El Valle, we got on our own private "chicken bus" (one of those old American school buses that have been converted into the public transportation machines all over Central America) to head to El Corpus, in the southern state of Choluteca. This would be our home base for the next week of activities, including clinic and travel into the communities to give the charlas. El corpus is a little mountain town with steep cobbled streets, a large white church, and a medum-sized population of mainly middle-class Honduran families. On the outskirts, farther up in the mountains (sometimes as far as a few hours in truck), live some of the country´s poorest susbsistance farmers, who work day after day to clear rocky mountinsides to cultivate beans and corn to feed their families. These were the families we were hoping to reach with our charlas and gynocological exams for the women.
In El Corpus I shared a homestay with Rene, a rising fourth year medical student who just finished her MPH this past year. We had the luck of the draw in our homestay- dona Tula is a sweet grandmotherly woman who is determined about two things: to keep bats from flying into our room and to send us home fatter than before we came. Excellent. Her children all work as professionals and live in the larger cities of Choluteca and Tegus, and she manages the house by herself, so she likes the company of her "gringuitas."
After a day or so to get settled in El Corpus, we paked our charla supplies, toilet paper, hand sanitizer, and granola bars, and took buses to our respective communities in pairs. For the communty postion of the trip, I was paired with Kim, another rising 4th year who just finished her MPH, in the community of Espaveles, a sweet sleepy village of approximately 37 households nestled at about a 15-minute walk from the dirt road that winds up into the mountains. We took a bus with some of our classmates who weren´t so lucky, as they had a long hike or burro ride ahead of them- somtimes as long as 6 km, just to get to the community where they would stay.
Our host family in Espaveles were Julio and Nery, a sweet middle-aged couple with seven children, only the youngest of which, Nacho, 13, and delenia, 20, lived at home with them. But two of the older sons lived on either side of the house with there wives, and their grandchildren streamed in and out of the house, giggling and tubmbling around like puppies. The house has no electricity or running water, although there is a "pila" or cement water container that gets filled every morning with the water that the family will use for the day. The house is of adobe with stucco covereing, cement floor in the main room, and an earth fireplace where the food is cooked and prepared. The abthroom facilite are a little walk behind the hosue, in an unfinished adobe latrine. It took me two days and a serious pep talk from Kim before I could do all my business on that thing.
We spent three days in the community, giving charlas down the hill at the "centro de oracion" (prayer center) and registering women for clinic. We also played with the village children- a group of about 50 5-to-13-year-olds with enough energy to tire out an entire football team. Kim and I would take turns with Mother May I and Simon dice (simon says) until we would look at each other each afternoon, both of us swaying with exhaustion, and say "do you want to lead one, or should I?" The kids were enthusiastic and so sweet,never crying or pouting, and always smiling and giggling, even when you were just sitting there wiping the sweat off your face. We would climb back up the steep hill for home each afternoon at about 5, where we would eat dinner by candlelight (it gets dark at 6pm or so here) and climb into our hammocks for the night. Sometimes after dinner we would sit and share stories, or sing songs. Delenia had a beautiful voice, and Julio and Nery were quite curious about the USA- they knew many young people who had tried to give it a go as immigrants, and the were eager for the first-hand report on how life was abroad.
Some of the stories they would tell me were heartbreaking. Three years ago, Nery lost a son to muscular dystrophy. He was 15, and Nery spoke glowingly about a group of school-aged children from the US who had sent her son a wheelchair so he could get around. I contemplated navigating Espaveles in a wheelchair, with its dirt paths, cobblestones, and steep hills. Julio spoke about his worries about his ability to keep his family fed, with prices the way they are. Nacho, who is 13, is starting to go to the fields with him, and he is a big help, but still, it´s hard to grow crops with the soil as bad as it is- nearly imposible without fertilizer, which is really expensive. Julio sometimes supplements his income with contracted work on Sundays. He says that during mango season he gets paid to climb trees and pick mangos- it´s good money. When I asked him how good, he told me that for picking 1,000 mangos, he gets about 30 Lempiras, or about $1.50. That takes him about 2 hours or so. I nearly cried when I heard that. While in community, I thought about these children, who live with no television or books, of girls who stop school to have children, and of boys who leave school to work in the fields. It´s overwhelming sometimes to think about what it will take to change the cycle of poverty. It´s also so inspiring that it takes my breath away, the way these families work, and the love that they share wih each other. Nery and Julio have one of the most beautiful families I have ever seen.
By the end of our time in the community, I had conquered my latrine fears like a pro, we had an entire entourage of children wherever we went (starting just after daybreak) and we had 58 women registered for clinic. Quite a success. We returned to El Corpus on a Sunday, where we met our attendings and prepared for clinic, which I will describe in another update. Hope all is well!
In El Valle, we reviewed all of our health education presentation, or charla, materials. The charlas this year cover everything from family planning and STD prevention to nutrition and hypertension, with a new focus on introducing the idea of problem solving and identifying root causes of community health problems. El Valle had lovely cabins with cold water showers and a comon dining area. The food was muy tipico- beans, rice, cheese, tortillas, and some veggies and juice.
After two days in El Valle, we got on our own private "chicken bus" (one of those old American school buses that have been converted into the public transportation machines all over Central America) to head to El Corpus, in the southern state of Choluteca. This would be our home base for the next week of activities, including clinic and travel into the communities to give the charlas. El corpus is a little mountain town with steep cobbled streets, a large white church, and a medum-sized population of mainly middle-class Honduran families. On the outskirts, farther up in the mountains (sometimes as far as a few hours in truck), live some of the country´s poorest susbsistance farmers, who work day after day to clear rocky mountinsides to cultivate beans and corn to feed their families. These were the families we were hoping to reach with our charlas and gynocological exams for the women.
In El Corpus I shared a homestay with Rene, a rising fourth year medical student who just finished her MPH this past year. We had the luck of the draw in our homestay- dona Tula is a sweet grandmotherly woman who is determined about two things: to keep bats from flying into our room and to send us home fatter than before we came. Excellent. Her children all work as professionals and live in the larger cities of Choluteca and Tegus, and she manages the house by herself, so she likes the company of her "gringuitas."
After a day or so to get settled in El Corpus, we paked our charla supplies, toilet paper, hand sanitizer, and granola bars, and took buses to our respective communities in pairs. For the communty postion of the trip, I was paired with Kim, another rising 4th year who just finished her MPH, in the community of Espaveles, a sweet sleepy village of approximately 37 households nestled at about a 15-minute walk from the dirt road that winds up into the mountains. We took a bus with some of our classmates who weren´t so lucky, as they had a long hike or burro ride ahead of them- somtimes as long as 6 km, just to get to the community where they would stay.
Our host family in Espaveles were Julio and Nery, a sweet middle-aged couple with seven children, only the youngest of which, Nacho, 13, and delenia, 20, lived at home with them. But two of the older sons lived on either side of the house with there wives, and their grandchildren streamed in and out of the house, giggling and tubmbling around like puppies. The house has no electricity or running water, although there is a "pila" or cement water container that gets filled every morning with the water that the family will use for the day. The house is of adobe with stucco covereing, cement floor in the main room, and an earth fireplace where the food is cooked and prepared. The abthroom facilite are a little walk behind the hosue, in an unfinished adobe latrine. It took me two days and a serious pep talk from Kim before I could do all my business on that thing.
We spent three days in the community, giving charlas down the hill at the "centro de oracion" (prayer center) and registering women for clinic. We also played with the village children- a group of about 50 5-to-13-year-olds with enough energy to tire out an entire football team. Kim and I would take turns with Mother May I and Simon dice (simon says) until we would look at each other each afternoon, both of us swaying with exhaustion, and say "do you want to lead one, or should I?" The kids were enthusiastic and so sweet,never crying or pouting, and always smiling and giggling, even when you were just sitting there wiping the sweat off your face. We would climb back up the steep hill for home each afternoon at about 5, where we would eat dinner by candlelight (it gets dark at 6pm or so here) and climb into our hammocks for the night. Sometimes after dinner we would sit and share stories, or sing songs. Delenia had a beautiful voice, and Julio and Nery were quite curious about the USA- they knew many young people who had tried to give it a go as immigrants, and the were eager for the first-hand report on how life was abroad.
Some of the stories they would tell me were heartbreaking. Three years ago, Nery lost a son to muscular dystrophy. He was 15, and Nery spoke glowingly about a group of school-aged children from the US who had sent her son a wheelchair so he could get around. I contemplated navigating Espaveles in a wheelchair, with its dirt paths, cobblestones, and steep hills. Julio spoke about his worries about his ability to keep his family fed, with prices the way they are. Nacho, who is 13, is starting to go to the fields with him, and he is a big help, but still, it´s hard to grow crops with the soil as bad as it is- nearly imposible without fertilizer, which is really expensive. Julio sometimes supplements his income with contracted work on Sundays. He says that during mango season he gets paid to climb trees and pick mangos- it´s good money. When I asked him how good, he told me that for picking 1,000 mangos, he gets about 30 Lempiras, or about $1.50. That takes him about 2 hours or so. I nearly cried when I heard that. While in community, I thought about these children, who live with no television or books, of girls who stop school to have children, and of boys who leave school to work in the fields. It´s overwhelming sometimes to think about what it will take to change the cycle of poverty. It´s also so inspiring that it takes my breath away, the way these families work, and the love that they share wih each other. Nery and Julio have one of the most beautiful families I have ever seen.
By the end of our time in the community, I had conquered my latrine fears like a pro, we had an entire entourage of children wherever we went (starting just after daybreak) and we had 58 women registered for clinic. Quite a success. We returned to El Corpus on a Sunday, where we met our attendings and prepared for clinic, which I will describe in another update. Hope all is well!
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