So about a month ago now (sorry it took so long for me to blog about it), I had the amazing opportunity to volunteer with a medical delegation from the Lutheran church. Bellow is a summary of the "Mission of Healing" by Deb; who was one of the NPs that I had the opportunity to work alongside. I have also provided commentary which is in red and in italics.
Summary Report Mission of Healing (MOH) El Salvador 2012
1 February – 14 February
İNo a al Violencia – Si a la Vida!
(Summary Report completed by Debrah Allison Adams with coments by Erika is red)
The advance team arrived in El Salvador (ES) on Wednesday, 1 Feb. and settled at the Hotel Oasis – a change from the familiar rooms and people at Casa Concordia. We soon learned that the owners and staff at Hotel Oasis were very accommodating, especially since we eventually filled their entire public space with suitcases.
Advance team time was spent in meeting with the Salvadoran planning team on Thursday AM. We heard what was planned for each part of the mission, received a schedule of participating churches, and had a chance to discuss necessary changes to the budget to bring it within the monies available. In the afternoon half the Salvadoran planning team attended Susan’s reflexology class and half Kendra’s crisis management class. The next morning they switched classes. Time at the hotel was spent sorting supplies from the bodega as well as meds and supplies we had brought. Two other members of the advance group arrived Thursday evening. We also met Erika Almquist, a FNP currently living in ES, who worked with us all week.
During these first two days of training, I had the chance to work on my translating skills as I translated for Susan in the reflexology group on Thursday and I translated for Kendra’s crisis management class on Friday. I have to say, I still think my Spanish could use a lot of work, but for the most part I feel as though my translating was successful, which reassures me that although it may be a slow process, my Spanish is starting to improve.
It was also an amazing opportunity to gain some crisis management skills (and Kednra kindly sent me a copy of her power point presentation) that I can pass onto the various communities that I work with here in El Salvador. I also learned a lot of practical skills from the reflexology class. Reflexology is foot massage, in which the massage is focused on specific pressure points within the foot, which are connected to various parts of the body. For instance, if a client were complaining of migraines, there is a specific point on the ball of the foot, that if massaged can provide relief from headache pain.
Susan was very kind and took some extra time to review the usual pattern in which she would give a foot massage so that I could feel confident to incorporate reflexology into my practice as a nurse practitioner. During one of the clinic days in the Clinica Luterana, I was able to take half of the day to accompany Susan in doing reflexology, which was an awesome opportunity for me as I have been able to continue practicing reflexology with the community members in El Pital, which are suffering from various aches and pains. It is really amazing to give a foot massage to a woman suffering from back pain, which is focused on a pressure point connected with the back, and then have her come up to you a little latter in tears because for the first time in three years she can walk around without severe back pain. Since I had the opportunity to learn reflexology, I have been giving a foot massage to a 89 year old woman in El Pital weekly, who suffers from headaches, and it so wonderful when I see her the next day and she tells me how well she was able to sleep the night after the foot massage and how the intensity of her headaches is much reduced. It just goes to show how much simple touch can play in the healing process.
In speaking of healing touch, it is often something we see in scripture; there are many passages but for now I will just remind us of the healing of the leper: A leper came to Jesus begging him, and kneeling
he said to him, "If you choose, you can make me clean." Moved with pity, Jesus stretched out his
hand and touched him, and said to him, "I do choose. Be made clean!"
- Mark 1:40-42.
I hope that in a small way I can also “choose” to work towards healing by incorporating touch and reflexology into my medical practice.
On Friday AM there were classes as mentioned above. In the afternoon Linda, Deb, Pastora Conchi, and Pastors Santiago and Rafael went to the newspaper Diario Co Latino to be interviewed for an article about the mission which was published on 6 Feb. We also visited the Clinica Luterana to see what improvements had been made and how we could best use the space during the clinics. Improvements were considerable. Other members of the group went to the botanical gardens and the Museum of Word and Image. We had purchased bags so were able to sort more medications in the evening (see notes for 2013).
It was such a treat to be able to take a trip to the botanical gardens; a place that I have never visited before. If you check out my pictures, the pics from the botanical garden are the ones that look like they were taken in a garden in Japan or some beautiful tropical place. You would never guess that we were in the middle of the city of San Salvador.
Saturday AM, 4 Feb, the advance group along with many Salvadorans cleaned and set up spaces in the Lutheran Clinic. We anticipated 5 providers – 2 in one exam area and 3 in the other. After lunch we went to the Arbol de Dios gallery and shop; then to the Parque Boquerón at the top of the San Salvador volcano and hiked to see the sites. Most of the rest of the group arrived at the hotel while we were gone, so we now had labels for the medications. The Cross of Life (COL) group arrived just before midnight to complete our team. The names and responsibilities of each US team member are attached.
Unfortunately, I was not able to make it to the Parque Boquerón do to a prior commitment but it is on my list of things to do.
Sunday was a day of worship services with half the group traveling to Jayaque for a morning church service, lunch and tour of the community. The other half attended the AM service at Resurrección Church and traveled about 1 ½ hours to the community Buena Vista for a service in the afternoon. There were confirmations and 1st communions as part of the 1st anniversary celebration of the church building of the congregation Rutilio Grande. Pastor Randy and Vicar Alan had active parts in both of the services. The Jayaque group returned to the hotel before the Buena Vista group and finished sorting and packing the meds.
It’s amazing how similar the Lutheran church service and ideals are to the Episcopal church; I felt right at home.
Monday, Feb 6, was the first day of clinics at the Clinica Luterana. The day started with our group and all our suitcases traveling to the clinic in 2 buses and unloading. There was an opening worship at Resurrección at 8AM, and the clinic started about 9AM. The areas of healing offered were: medical exams, pharmacy, laboratory, reading glasses, dental teaching (and some dental work by Dr. Kenya who has her dental office at the clinic), massage/reflexology, crisis management, HIV testing and counseling, spiritual care and a children’s area (a natural medicine station was also provided). Each person > 2 years old and not pregnant received anti-parasite medication at the end of his/her visit. On Monday we saw about 153 patients, a number arrived at by counting the registration papers received in the pharmacy. This was a surprisingly low number for an entire day, but we made up for it on Tuesday when the clinic started at 8AM. The same services were offered, and the pharmacy had 312 registration papers for the day. Also, an RN and a nurse practitioner (Erin and Deb) saw patients at Casa la Esperanza, the near-by homeless shelter on Tuesday, and Susan gave a massage there. Wednesday was similar to Tuesday, and we saw 209 people. We know some people were seen who did not have registration papers (family members or someone at home with a problem), so the actual numbers are slightly higher than the total of 674 for the 3 days in the city. Dra. Sabrina Santana, a Salvadoran pediatrician, worked with us for 2 of the days in San Salvador. Dr. Solin Urtado worked with us briefly, and Dra. Lídixe Montoya worked with us all 3 days. Dr. Ricardo Funes, the doctor who regularly staffs the Lutheran Clinic, was also there for several hours each day. They were all immensely helpful! There is a new physician, Dra. Belen, who will be working at the Lutheran Clinic when Dr. Funes isn’t there.
Wednesday evening was spent in reorganizing/repacking medications and supplies to take to Usulután. Thursday morning we made the 2 hour trip in 2 buses to the Hotel Campo Real in Usulután and organized the outdoor area for clinic space. Clinic time started after lunch. Two communities were scheduled to come that afternoon and bring a set number of patients each. The same services were offered as in San Salvador minus the dentist and laboratory. In addition, there was a teaching station re how to use the meds in the kit received by each family that participated in the education. Thursday afternoon we saw approximately 136 people. In the evening we had dinner at a pupusaria in El Transito. Friday was scheduled to be ½ day in the morning; however, about 193 people were seen and we finished cleaning up about 3PM. Total number of registration papers received in the pharmacy during the week = 1003. After delivering people from the clinic back to their communities, the bus returned for us about 4 for the return trip to the city. A relaxing dinner and celebration of the end of the week was enjoyed at Las Cebolina’s.
As in the past, the main health problems were respiratory and gastrointestinal due to air pollution from wood and sugar cane fires and poor sanitation practices. There were also a lot of common colds, AKA grippe. Many people had hypertension. Some had been previously treated but had run out of medication. Very few still had medication, and those who did were frequently not taking it as prescribed to make it last longer. In addition, many people are still greatly affected by the violence they experienced during the Civil War as well as by the current violence in the country and the current condition of the economy. In the country (Usulután) the people seemed to have many more problems with their legs and feet with some horrendous varicosities.
Minus the half day in which I was doing reflexology, I spent all the other clinic days seeing patients in “consulta” or in other words doing medical exams, making assessments, and then providing education and treatment, prescribing medications from the pharmacy of meds that the medical delegation brought from the US. It was a great opportunity to practice my clinical skills as a nurse practitioner and increase my confidence in those skills (thanks to some encouraging comments from the pediatrician that was working with us) but I have to say it kind of felt like I was part of an assembly line just pumping out medical diagnoses (which I suppose would be my criticism of the American health care system in general). Overall though, I feel as though all of the medical providers provided amazing care to all of the patients they saw, I just wish we had more time to focus on health care education.
Outside of the medical consults the patients did get a chance to receive health education in the form of educational “charlas” or health talks, which I think was a major plus to the Mission of Healing. There was a dental “charla” and an educational talk with every first aid kit that was given out in Usulután. It was amazing how little the patients new about the meds that come in a basic first aid kit; for instance many people thought tums were for headaches.
In brainstorming what parts of the Mission of Healing I would incorporate into future medical delegations, I think providing first aid kits with education regarding what is in them and how to use the supplies is a very useful and sustainable practice. I also felt as though the complimentary areas of healing: massage/reflexology, crisis management, HIV testing and counseling, spiritual care, educational “charlas”, and education on effective and safe natural medicine are areas that would be good to incorporate into future medical delegations. The HIV testing and counseling was actually completed through the ministry of health of El Salvador and I think that in general it is more beneficial and sustainable for medical delegations to provide medical services in combination with the ministry of health.
All but the 5 post-mission team members departed on Saturday morning, 11 Feb. The 5 of us visited the Parque Cuscatlán – the wall of memory and the art gallery there; then shopped a little at the artisans’ market. We tried to visit the UCA and the museum at the Technology University but both were closed for the week-end. In the afternoon we started the sorting, inventorying, and repacking of the meds and supplies to be distributed or stored before Tuesday.
On Sunday the post team visited the community Los Héroes where the Missions of Healing started 12 years ago. A celebration of the missions was held during and after the service at Los Héroes de la Fe. It was a wonderful witness of what the missions have meant to the people of that community who had their “own” clinics for the first several years of the MOH but made the sacrifice of having them moved to a more central location for the greater good. After lunch and a stroll around the square in Tonaca, we returned to the hotel and finished organizing the supplies. Each participating church/community received a kit of basic medical supplies and a kit of school/craft supplies after the service and evaluation meeting Monday morning at Resurrección. There were 32 kits of each type.
Due to what we thought was a miscommunication, the community Rutilio Grande did not attend the MOH; so the post team drove to Rutilio Grande with their kits. We had a brief tour of the community, visited the school, and had refreshments. A very exciting development for the health of the community is the new ECOS (Equipos Comunitarios de Salud) operating a clinic there daily. It seemed to be well-staffed and well-stocked with medications and supplies and may be one reason people from the community did not attend the MOH.
The post team departed for home Tuesday, 14 February.
| St. John’s Family | Cross of Life Family | Western Family |
| Barbara Joan Barthel Spiritual |
| Debrah Allison Adams Nurse Practitioner Trip Mama |
| Vicar Alan Dreyer Spiritual Healing Youth Area | Michael Gutzeit Doctor Trip Papa | Robert Glenn Adams Pharmacy asst. |
| Rhonda Hill Empowerment Classes | Lura Jennings Nurse (former ICU) | Erin Marie Chairez Nurse |
| Susan Holty Massage Center |
| Helen Harris Nurse |
| Abigail Johnson Pharmacist Resident | Sally Thomas Nursing student | Andrew Sheppard Nurse Practitioner |
| Frederick William McManus Translation | Corrine Boyce Nurse |
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| Linda Marie Muth Coordinator/Translation Trip Mama | Jan Constable (male) Glasses | Randy Olson Pastor Spiritual Center |
| Tim Muth Translation | Diane Dressler Nurse | Sara Wilkinson Translator |
| Mitzie Evelyn Schlueter Translation |
| Camilla Madson Children’s Area |
| Kendra Stea Empowerment Classes |
| Anne Dixon Children’s Area/Translation |
| Dean Arneson Pharmacist |
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| Amy Nelson Translation/Nursing | Erika Almquist Nurse Practitioner |
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