So here I go, I’m going to try and reflect on the exciting things that have happened over the last three weeks. After writing a 5 page reflection, in Spanish, about my last 3months of orientation with the Ministry of Health I have to say I’m a little tired of writing but that was more of a formal reflection so I’m going to focus more on personal things. For those of you who know Spanish, please keep your eyes peeled as I will be posting my Ministry of Health orientation reflection in the near future and I really think it gives a good picture of what my clinical experience has been like here in El Salvador over the last 3 months.
Ok, now back to my blog; can you tell I’m a little distracted. At least I have some goodies that my family and Rich (family friend) recently sent, so I have “puppy chow” and maple candy to keep my energy up. Although, I have to say I can’t stop eating the “puppy chow”, I picked up the package on Monday and I think I’m going to finish it by Friday (feel free to send more). And just so you all know, packages and mail have been getting to me, so don’t be afraid to send things; as a reminder my address is: Colonia San Luis, Pasaje 2, Bloque 11, Casa 26, San Salvador, El Salvador. Oh, also if any one wants to talk to me face to face, I do have Skype (my name is Erika. Almquist).
Right, so over the last three weeks, I have been out of the city (just got distracted again; the lock to our front door isn’t really working- it will take me 10minutes just to get into the house because the lock won’t turn- and the workman just got here so I had to give him the break down of the various door problems; he says we need to replace the lock). So back to my reflection; the first week, I was in El Paisnal, which is in the northern part of the country (about one hour north of San Salvador).
El Paisnal has a small community health center that is on the edge of many rural communities and there are several small clinics that have been set up within these rural communities where two different ECOS-F teams provide services (look back at previous posts to learn more about the ECOS teams but it stands for “los Equipos Comunitarios de Salud”= community health teams; F stands for Familiar=Family and E stands for Especializador= Specialized). I specifically worked with one ECOS team called ECOS-F San Francisco Dos Cerros; they had one main clinic (which had a small pharmacy and other clinical equipment), which was about a 30minute ride over rocky roads from the main community health center in El Paisnal. My daily routine, consisted of being picked up from the house where I was staying in Augilares at 7:00AM (although the driver would usually get there 20min early) and then we would go to the community health center in El Paisnal to pick up the rest of the team and usually some supplies and then we would go to the clinic ECOS-F San Francisco Dos Cerros. As the team held clinic in a different community everyday, we only actually had clinic in San Francisco Dos Cerros one day, all of the other days we would just pick up supplies and then go another 30minutes deeper into the campo (rural area). Sometimes we would set up the clinics in a school or community house but in one community we just set up outside under a tarp. In this community, we actually did pap smears inside individual women’s houses because there were no exam tables or closed off rooms to allow for privacy. This was quite an experience for me, kneeling down on a dirt floor with my patient positioned in the lithotomy position on the bed before me, with a flashlight in one hand and a speculum in the other. In one case, after I was finished with the Pap smear the women jumped up and headed to her freezer where she offered me a chocolate banana to go (what a treat for completing a pap smear). In general we were fed everywhere we went. Since there was nowhere to buy lunch, in each community that we went to, one of the patients would always bring us a simple but delicious meal for lunch (usually beans, cheese, and tortillas). In one case we were actually invited to eat at a patient’s house. I was definitely overwhelmed by witnessing a group of people who were willing to share food so freely while they barely had enough food to feed there family.
The hospitality that I experienced in El Paisnal did not stop with the patients we served in the clinics; I was also filled with thankfulness by the nurse, Irma Florentina Brizuela de León, who opened her house to me. When we walked into her house, she told me you are now part of the Brizuela Familia and she sure treated me like part of the family. I ended up sleeping in her granddaughter’s bed, while her granddaughter slept in with grandma and granddad (despite my objections). She made sure to cook all the typical Salvadoran meals and of course always made sure I had plenty of food to eat. One night, Mimi, Irma’s daughter, invited me to accompany her to an aerobics class around the corner (it was crazy hard), and another night I accompanied the whole family to the park where they were having a small carnival to celebrate the town festival. At the carnival, I had my first experience on a Ferris wheel in El Salvador; it seemed pretty safe but I have to say I got a bit motion sick.
Another first experience that I had, was transportation in el campo on a motorcycle. One evening after clinic, the truck was running late to pick us up, so the driver offered me a ride home on the motorcycle, up and down hills and over crazy rocky roads. It was quite an experience and I have to say it is one of the most beautiful rides I have ever had (unfortunately I couldn’t take picks because I probably would have fallen off if I tried; it was quite a leg and core body work out). You should still check out my picks though, because I took a ton of picks from the truck window when we were driving in and out of the campo (there is the YASC album 2).
Ok, now onto week number two, which was in San Martin, which is about 45minutes east of the city.
Things started out well in San Martin, when I got to the community health center, the nurse director showed me around the community health center and then we jumped into a truck to take a look at a few different ECOS-F clinics. San Martin has four different ECOS-F teams and one ECOS-E (specialist) team. The nurse director also hooked me up with a nurse (Diana), with whom I was going to stay. That night, I joined Diana, her son, sister, and mother for a dinner out, where we had the best pupusas I’ve ever had. It’s funny because Diana’s mother warned me against eating the cortido (which is pickled cabbage) because when her husband was visiting from the states he ended up with diarrhea after eating cortido, but I reassured her that it would be ok because I’d been eating cortido since I arrived in El Salvador 4 months ago and never had a problem. Well, that night was the worst night I have had yet in El Salvador; who knows if it was the cortido or the food I ate in the campo of El Paisnal the week before but I was up all night with stomach pain, reflux, body pain, body sweats, chills and come day break, diarrhea. The next day, I still got up and made my way to the clinic with Diana as the plan was to perform 20 pap smears that day (they were having a pap smear campaign, which I have to say was very successful). Luckily I was able to do a quick stool test first, where I found out that I had a bacterial infection of E.Coli in my intestines and was able to start on antibiotics and re-hydration solution before we headed out to the ECOS-F clinic to begin our day of pap smears. I was in and out of the bathroom all-day and retired to the exam table as soon as we were done with patients but I was still able to perform a handful of pap smears before I crashed. Diana’s family was extremely kind and looked after me all week, making sure that I was drinking enough liquids and finding food that I could eat.
Although I felt pretty under the weather most of the week, I was still able to participate in the pap smear campaign and on my last day, I went out with the specialist team (ECOS-E), where I got to see how the specialist are incorporated into the primary care model of the ECOS-F teams. Basically the general doctor or licensed nurse from the ECOS-F teams will make referrals throughout the month to specific specialist (the pediatrician, the psychologist, the nutritionist, the physical therapist, the internist, the gynecologist, or the dentist) and the specialist team has a specific day through out the month where they visit each ECOS-F clinic to see the patients that have been referred. With this system in place, patients don’t need to take the long trip into the city, where they usually have to wait up to days to see a specialist and instead can see a specialist in their community ECOS-F clinic, which is at most a 10minute walk from there house.
All right, now onto week 3, where I stayed with Ani’s family in Guarjila. Ani is one of my housemates in San Salvador but she grew up in Guarjila, where her mom and sister (10 years old) still live. Guarjila is near Chalatenango and about 3 hours north of San Salvador.
It was very cool getting the chance to stay with Ani’s mom who was a member of the guerrilla forces during the civil war in El Salvador, as she continues to be very passionate about social justice in El Salvador and is very involved in community development and political activities. In fact one evening after clinic, I accompanied her to a FMLN meeting in Chalatenango.
Here is a small Wikipedia snip on the civil war in El Salvador to give some background: The Salvadoran Civil War (1980–1992) was a conflict in El Salvador between the military-led government of El Salvador and the Farabundo Martí National Liberation Front (FMLN), a coalition or umbrella organization of five left-wing guerrilla groups. Significant tensions and violence had already existed, before the civil war's full outbreak, over the course of the 1970s. El Salvador's Civil War was the third longest civil war in Latin America after the Guatemalan Civil War and the armed conflict in Peru. The United States supported the Salvadoran military dictatorship. The conflict ended in the early 1990s. Some 75,000 people were killed.
My clinical experiences based out of the Guarjila community health center were also very interesting. I spent most of my days with the specialist team (ECOS-E), which consisted of a gynecologist, internist, nutritionist, and a health educator. It was nice because I got to join the nutritionist and the health educator for two prenatal educational group activities. I also spent a lot of time with the gynecologist, which gave me the opportunity to learn more about how women’s health issues are managed here in El Salvador. But my favorite day was actually the day I got to spend with one of the health promoters because I had the opportunity to join him on a vaccine campaign in a community that you couldn’t access by car. We had to hike 30minutes into a community consisting of 10 families where we went door-to-door vaccinating adults with the tetanus vaccine. It was an absolutely beautiful hike and we were right on the boarder to Honduras, so we could actually see a small Honduran town just down in the valley past the community we went to (check out my picks). It was also very cool to see how far El Salvadoran preventative health services are reaching.
One negative aspect to my trip to Guarjila was that I got sick again; this time apparently from amoebas, which kept me home sick in bed all day Monday and running in and out of the latrine all day and night.
So that is what’s been going on in my life these last three weeks. Now, I have the very cool opportunity to accompany a Lutheran medical delegation on their “Mission of Healing & Wellness” so keep your eyes open for a blog yet to come in a few weeks on what the “Mission of Health & Wellness” is all about.
Also, an interesting fact is that I am in the process of training for a 1/2marathon, which will be occurring in two weeks right in the city of San Salvador. Wish me luck!
P.S. I finished the "puppy chow"; feel free to send more.
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