Global Health Team in El Salvador: July 2013

Eight students and three faculty members from the College of Osteopathic Medicine are in El Salvador from July 7 to July 22 on a service trip organized by the NYIT Center for Global Health. They are blogging about their hands-on work in clinics and schools, as well as their impressions of the country.

Day 10 - July 17, 2013

The Chagas' disease presentations concluded today with a final performance at a school of our Peace Corps affiliate. It was a bittersweet moment because we have worked together for several months to prepare these presentations. Being that this was our fourth school, we were happy to see that our presentations flowed like a well-oiled machine. We celebrated the completion of the research component of our trip with a delicious culturally rich lunch in the company of many new friendships.

Later in the evening, we continued some of the great conversations which led to the students discussing their experiences and reflections on El Salvador. We continued to learn more about each other and appreciate not only our similarities but our differences as well. We all feel that we have come together extremely cohesively and are building friendships that will last a lifetime.

 

Day 9 - July 16, 2013

soccer game

We started the day with a surprise visit to an El Salvadoran School, Rancho Quemado, high in the mountains. When we arrived, we were surprised to see a retaining wall made of plastic bottles filled with dirt. As we found our way to the main building, we continued to encounter more innovative items created by the school. When we finally arrived, we were told that the majority of the school was in Panama playing in a soccer tournament. We were quick to improvise and ended up having one of the most rewarding teaching sessions of our trip thus far. We set up our Chagas' presentation in a classroom filled with many younger students, ranging in age from five to nine.

Although it was a bit more difficult completing the survey, the response we received was overwhelming. After all of the presentations, we explored the school grounds to find many small gardens with a unique twist. The gardens were actually planted in re-used truck tires and made to look artistic and appealing. We were surprised how this one particular school had so many re-usable ideas implemented.

We wrapped up our time there with a rousing game of soccer with the younger students followed by multiple hugs and expressions of gratitude from each and every child. They were looking forward to having us return next summer.

 

Day 8 - July 15, 2013

Amun Shea

toothbrush demo

Today was so much fun! We went to the Amun Shea School in Perquin. Upon our arrival, the students and teachers immediately began clapping and cheering. It was such a warm welcome! This school was slightly better off than the one we had visited before—there were more buildings as well as speakers, a keyboard and a guitar. The children sang three songs for us, including one about immigration. It really touched my heart.

Many parents move to the United States in order to get better jobs and send money back to their families but without their parents to raise them, especially the fathers, many kids get caught up in gangs and drugs.

The play went really well; the kids loved when Senor Chinche came out and also when Onesis, one of our translators, switched back and forth from a high pitched mom's voiced to a low-pitched boy's voice. We did the hand-washing exercise and we splashed water everywhere! I think I might still have some purple glitter on my face.

The rest of the gang conducted the tooth-brushing exercise and Candice wisely picked individual students instead of calling for volunteers to show how to brush your teeth. Afterwards we led the kids to a side wall where they could all brush their teeth. It was great that we had enough toothbrushes and toothpaste for all of them this time.

The kids were super-excited when they received the footballs (soccer balls) we brought and as soon as they wolfed down lunch, the boys started up a game of football with Onesis. As we were leaving, one of the boys accidentally kicked the football towards the gate so Dr. Laurent and Vijay took turns trying to throw it back to them but it kept falling short. I'm sure they were thinking "Silly Grownups". Eventually one of the smaller boys came and kicked it back in himself.

On the way back home we stopped by Casa Materna to give them origami cranes that we were taught to make.

 

Days 6 & 7 - July 13 and July 14, 2013

El Salvador medical

Saturday and Sunday were full of Salvadorian history for our group. It began with a trip to a civil war museum around the corner from our hotel. It is important to note that the Morazan region we are staying in was home to many of the guerilla combatants during the civil war and was the location of many battles between the army and the guerillas. I think it is also important to note that the term guerilla does not have the same negative connotation here that it often has in other countries. Currently there is a guerilla president in El Salvador. The term guerilla refers more to a political party these days, just like the democratic or republican parties in the United States.

At this museum we were guided through muddy paths with photos, weapons, tools, and electronics used by the guerilla during combat. We climbed through real emergency tunnels and crossed rickety rope and wood bridges once used by the combatants. . Best of all, our guide was an actual guerrilla who shared personal accounts of the war. He had a prosthetic right leg as well as partial paralysis of his left arm and an injury to his head - a clear reminder to me of the authenticity of his stories.

The following day we traveled to a monument in El Mozote. The village suffered a horrific massacre on December 11, 1981, when soldiers brutally killed 1,200 people - including 460 children.

At the site of the massacre, a woman we met told us the story of what happened that day. She told us that the government army had come to the town and told a man that belonged to Mozote to gather everyone in town. The people were tricked into gathering in a central area and once they were together the men, women and children were separated and then killed. The story really shocked us and I was surprised at how shocked I was considering I had been to Mozote before and heard the story two years back. I don't think any of us could fathom how such an atrocity could have happened and how the people have moved on from the event. Only one adult woman managed to escape the massacre, so her first-hand account has been passed down to others in the village allowing the story to continue to be told to visitors.

A new monument to the massacre was also constructed over the past year. The structure has several statues including Mahatma Gandhi, Mother Theresa, Martin Luther King, Pope John Paul II and Jesus; all symbols of peace and equality. The site was a beautiful tribute to the people lost that day.

One of the most surprising aspects of our weekend was that our college-aged translators were not aware of their country's history before this weekend. They told us they did not know the story of El Mozote or many details about the guerrillas' fight. Apparently this information is not outwardly shared in schools. Since the guerrilla party is currently in power, we speculated that they may change this in coming years.

While somber, much of the information we gathered this weekend helps me better understand the people we are meeting in schools and at clinics in this region. I look forward to learning more about the people and this country in the coming weeks now that I have a better understanding of events they have endured.

 

Day 5 - July 11, 2013

El Salvador

chagas

Today was a wonderful experience. Some of our group joined up with a Chagas research team to trek to very remote areas of San Fernando in order to collect blood samples. Our drive began winding up the mountainside out of our local town until we met up with the local health promoter who would be our guide. We caravanned behind our health promoter's motorcycle past check points with armed guards until we pulled over to the side of a dirt road. He then led us on a wildly mountainous 4-hour hike to some of the most remote homes in the community.

During parts of our hike we were separated from the Honduran border by only a river. We trekked down steep, muddy slopes, across rocky streams and through thick vegetation until a mud house with a tin roof seemed to appear out of nowhere. At house after house, we were met by chickens, pigs, cows, and overprotective dogs, yet the homeowners were always welcoming and offered us a chair to rest in.

It was really amazing to see how people lived and how ready and willing they were to receive spontaneous medical attention. Even young mothers would allow our team to draw blood from their babies. There was a clear sense of trust between the health promoter and the community. It was a great feeling to see how quickly our presence was welcomed. We all shared an epiphany by the end of the day that helping 'one' IS truly helping 'everyone' and not only in a metaphorical way, but for real!!

The project of the health group and blood draws to screen for Chagas' Disease will absolutely help to improve the health status of the local community, and as well carry on further to help the world. Chagas' Disease isn't isolated to one tiny microcosm of a community in northeastern El Salvador. It exists in South America and North America as well, very similar to other diseases that, because of globalization and international travel, are not isolated to their country of origin.

Our eyes are being opened to the fact that the world is very small, and although there are certainly cultural differences that exist between us, we are all joined by a common link - that of being human. And helping our sisters and brothers who live in a tiny shack built on dirt floors with chinches in the cracks of their walls IS helping humanity overall, and doing our part to make the world a better place. Even if we did have to trek a mile and a half through barbed wire fences and thick vegetation, it was well worth it!

Day 4 - July 10, 2013

washing hands

skit presentation

Hola from El Salvador! Today, we visited a primary school where a Peace Corp volunteer named Mike arranged for us to present our Chagas disease skit. Our group wrote a story centered on an El Salvadorian boy named Jose who is bitten by a reduvid bug, a.k.a. Senor Chinche in the skit. The boy encounters the bug at night in his room and is bitten because he does not use a bed net. The next day, the boy tells his mother and they travel to the doctor to get treatment for Chagas disease.

We conveyed the importance of using a bed net as well as the signs and symptoms of the disease so the kids will know what to expect if they are infected. The children LOVED the skit and thought Senor Chinche was hilarious.

teeth

Next, Melissa and Dr. Blazey did a hand washing presentation. They used glitter to show how germs are spread from person to person if their hands are not washed. Vijay and Alex also did a presentation on proper tooth brushing technique and they were practically mobbed by kids enthusiastic to get closeup view of the large teeth models. The children were even more excited about the toothbrushes and toothpaste we handed out. We had them brush their teeth until they were foaming like rabid dogs so the idea of toothbrushing was cemented in their brains.

After taking a quick lunch break, we went to Mike's bottle school where we got the chance to help them build it. What is a bottle school? It's a structure made using old plastic bottles that are stuffed with at least 300 plastic bags. The bottles are then adhered together to make the walls of the school and more plastic bags are added to fill the gaps in between. This made the school a very eco-friendly structure and reduced school building costs from $12,000 to $5,000.

child with toothbrush

It was invigorating to see the impact we were making for this town and it was also empowering to see how we were changing the lives of the children in the community. As we were working at the school, baking in the sun, we thought back to what Dr. Gotfried said: that if you can help change the life of one person, you are still helping humanity at large. At the end of the day, even though we were drenched with sweat, it reaffirmed our decision to become doctors and motivated us to do even more trips like these in the future. Hasta manana!

 

Day 3 - July 9, 2013

group picture

Greetings to everyone back home from Perquin, El Salvador! We spent our second full day here at a level one clinic in the lovely little town of Mozote, where the people are friendly and the dogs and chickens run free.

The physical clinic was not an impressive structure, but what happened inside was quite impressive. There were makeshift exam rooms of wooden tables hidden behind green and white sheets - no fancy equipment, no clean linens to change between patients and not even a working bathroom for patients.

Clinica El Mozote has only been open for one and a half years since El Salvador's major healthcare reform. While it is certainly not perfect, the reform seems to be improving the care of many of the poorest in the country. Before the reform, specialists were only available at the major hospital in the country—a nearly impossible trip to fund for the vast majority of the El Mozote community.

Now, specialists travel to a different location each day to bring care to these poor communities once every month. The clinic has a dentist, ob/gyn, pediatrician, nutritionist and a wonderful family practitioner who coordinates the entire operation. Mental health issues are taboo in Latin America so it was surprising to learn that the clinic always has a psychologist in house and that people are willing to even ask about speaking with the psychologist. It turns out that with the reform, communities had a say in what resources they needed most. The massacre in the village during the 1980s continues to haunt this community. For this reason, a psychologist is always present and runs group therapy sessions for different age groups. Quite progressive.

Specialists also make home visits. For example, if a woman is pregnant, health promoters go other and advise she visit the clinic once a month. If she is unable to get to the clinic, the OB/GYN will visit her at home. This results in a low maternal mortality rate (only one case of pre-eclampsia over the past year).

The specialists' service are free. It sounds amazing, and the number of people who now have access to health care is incredibly impressive but there are drawbacks as well: sanitation, waiting time, resources, etc.

One member of our group believes they are worlds ahead of the United States health care system, ethically speaking, although many obstacles to healthcare remain.

medical patient

We were struck that so much gets done at the clinic with so few resources. The level of efficiency at which these practitioners run the clinic is remarkable. Included on the premises was a pharmacy so that patients could receive their medications instantly and without cost. One particular case that struck many of us was a two-year-old boy who had undergone corrective surgery at birth for a congenital heart defect called tetraology of fallot. Doctors saw him at the clinic because he had an upper respiratory infection. His treatment would be routine. However, we were amazed that he had undergone surgical treatment shortly after birth without complications in the first place. Given the existing lack of resources it was clear that something in the El Salvadorian healthcare system allowed this little boy to thrive.

Another interesting case we saw involved a 21-year-old woman with cerebral palsy who came to the clinic to see the rotating physical therapist. This woman was able to survive with minimal resources; she was confined to a wheelchair that had broken handles that scratched her arm and a wheel held on by a rope. She needed someone to do everything for her in a country where every member of the family must contribute to the house to survive. The physical therapist commended the mother for helping her daughter and made arrangements to get the woman a new wheelchair. We were struck by how we take something as simple as a wheelchair for granted in the United States while in El Salvador this woman suffered for months in a broken wheelchair.

After seeing these cases and hearing stories from local doctors, we were able to witness the new health care system in El Salvador first hand. We concluded that this system is an improvement from the old one and is definitely changing the country for the better.

group picture

Pictured are NYIT medical faculty and students with doctors from Perquin, Peace Corp volunteers, and translators.

Day 2 - July 8, 2013

Today we were introduced to Dr. Fuertan, the director of the Morazan clinic. He told us about the history of medicine in El Salvador as well as the major recent health care reforms of the new government. I was surprised to learn that many guerilla members of the infamous Civil War were actually a mix of university students and farmers.

The health care in El Salvador is free. This is not the case in neighboring Honduras, so many Hondurans cross the border to access the El Salvadorian system. We met a Honduran patient with an 8-day-old boy. In El Salvador, the government pays doctors directly and the free health care is partially sustained by high taxes on cigarettes, alcohol and gas. Medical students are required to work in the community health clinics from their very first year and if they fail that portion, they must repeat their entire year. It may seem like a difficult system but it produces doctors that are close to the community.

We had some down time in the afternoon so we stretched out in the hammocks, rocked by the cool mountain breeze. We closed out the night by practicing the Chagas play we intend to perform for school children.

Day 1 - July 7, 2013

scenic view

Our first impressions of El Salvador were wonderful. The country has a tropical climate with many banana trees, coconut trees, and sugar cane fields. We were surprised by the presence of large acres of cornfields that provide food for the cows and maize for the people.

The Perquin Lenca Hotel in Marazon is absolutely beautiful. The dining room and meeting rooms are set at a lower elevation while the villas are on a rise behind them. We saw a giant grasshopper the length of a cell phone that kindly obliged us as we took photos. And in answer to the ever popular question: Sunscreen or DEET first? The majority of our group answered sunscreen.