Sunday, March 25, 2012

Real Life Honduras

The first two weeks of this month I participated in back to back medical brigades. I, along with three other NPH volunteers, was invited to serve as a translator and accompany a group of American doctors and dentists to an area called Montana de la Flor (Flower Mountain). We ventured hours and hours into the mountains along rugged dirt roads and across river beds to arrive at this extremely remote area where the people remain primarily indigenous and stricken with poverty. The brigade was comprised of about 70 people from the US military, Honduran military, a medical mission group of American dentists and doctors, a group of students from the South Dakota State University, a few Honduras doctors, and us translators. It was a very odd ensemble to say the least, and a lot of different people who thought they were in charge. But in the end, we were all there for the same purpose, to help people in need. I have to admit, I stopped and staired as much as the Honduran children did, when the military arrived in their convoy of humvys and began to unload. So we got to work… setting up base camp in the town community center and school, clinic by day and dormitories by night. The US military provided triage and talks on health and wellness education, the American doctors held general consults, the dentists pulled hundreds of teeth a day, and the students from SDSU did nutrition assessments both for the women and children who came to clinic and out in the field.

I worked mostly as a translator for the Nutrition and Food Access study that was being carried out by SDSU in collaboration with the Honduran ‘Ministry of Health.’ Every day teams of two students, a doctor, a US military personnel, a Honduran guard, and a translator would be sent out to find homes in the mountains that contained a randomly selected ‘index child’ to conduct the study on. The first day, our local guide was actually the chief of the village. The group hiked 1 ½ hours into uninhabited mountains, lugging scales, laboratory equipment, and personal gear to find a few clustered homes nestled into the hillside. The goal was to find a mother and child between 6 months and 5 years of age to participate in the study. In the homes we visited we would survey the family on food security and other family history data. Then collect data such as height, weight, arm girth, a physical assessment by the physician, and blood samples from the mother and baby to test for nutrition level and mineral levels such as Zinc, iron, Vit C, and Vit A. Those found to be anemic were then treated with iron and those underweight with a dietary supplement called plumpy-nut.

After a week of house visits and surveys, almost all the situations were the same. Most of the homes were made of mud walls with a dirt floor, no electricity, gathered water from the river, 5-6 children per family, mother nor father had never attended school, nor even knew how to sign their own name. Most families constantly worried about food supply or ran out, children were eating just one type of food every day if available, sometimes going all day without anything to eat, and going to bed hungry. Even after having traveled to many parts of the world and living in Honduras for over a year, this was some of the worst poverty I had ever seen. The first home that we visited that week was the worst, consisting of 4 poles holding up a roof of leaves with three tarps forming the walls. The only furniture in the house was a couple of tiny beds made of sticks stacked together and a few rags thrown on top. The 5 children walked around in tattered clothes, unkempt, caked in dirt head to toe, bellies distended from malnutrition. The mother stood by a pot of corn kernals cooking over a few logs of wood. Since her husband was away she did not consent to all of the study, but we were able to leave them with some soap, toothbrushes, clothing items and iron supplements.

It was an interesting dichotomy to visit this area, where because of their isolation they have managed to maintain their indigenous heritage and continue to pass down their culture and traditions such as their language ‘Tolpan.’ However the lack of influence from the outside world has also hindered their advancement in basic things such as electricity, water access, sanitation and cultivation of a value for education.

The day after I returned to the Ranch began another brigade held at NPH that I and another volunteer, Kate, helped to coordinate. Seven visiting doctors from Spain offered specialties of Gynecology, Pediatrics, and Family medicine. We offered consults for three days in the external clinic on the Ranch and the last day traveled to two very underserved and difficult to access communities. At both areas we held consults in the school house and pieced together a make-shift clinic and pharmacy. We were swamped by women and children seeking out medical services and treatment. But over the week, a lot of good was done seeing 120-150 patients per day. 

Last weekend, the kids put on a talent show. While most talent shows I grew up watching consisted of a majority of singing numbers, here at NPH the kids much prefer to show off their dancing skills. I have always been impressed by how well the kids can dance here, and in a variety of different styles. I could name off any style of dance to a school-age child and they would most likely be able to dance the correct steps (Bachata, Merangue, Salsa, Punta, Ranchero, even Rock&Roll and Disco). A group of the youngest girls showed off their talents with a hula-hoop, some even able to do dance steps while twirling the hoop around their waist. The girls in my hogar self-choreographed a dance to an entire song on their own, with 12 of them actually getting up the courage to perform it.

Today I returned back to the Ranch from a quick weekend trip to visit an area called Santa Barbara. After about 6 months of attempted planning, I and my two favorite caregivers for the girls in Hogar, Carmen and Lizeth, were finally able to make this trip a reality. Lizeth and I traveled about 5 hours north-east to visit the home of Carmen and her family. She lives in a modest house out in the country with her husband, two young children, 15 dairy cows, 4 dogs, 2 pigs, a handful of chickens, and a rabbit. It was a great weekend, both to relax and get away, and also to learn what it is like to be a homemaker in Honduras. There was time for some fun as well as we got to spend the afternoon playing in a river, followed by a hot springs in the evening that curiously spouted out of a pipe on the side of the highway.

I feel I would be very inadequate if I ever wanted to marry and run a household in Honduras. I learned many new tasks this weekend such as cow milking (very tiring by the way if you haven’t developed the right muscles in your hand and forearm), corn tortilla making, how and what to feed pigs, and how keep children and a husband happy. Carmen is able to maintain the household in a very sustainable way, in that the majority of the staple foods her family eats come from their property. The milk, cream, and cheese comes from the cows, eggs and meat from the chickens, beans are grown in the garden, not to mention the huge variety of fruit trees on their property. When it was blazing hot in the mid-day sun, Carmen said “I think some lemonade would be good right about now” and she went out into the back yard and plucked the limes off the tree. One of the things Carmen told me this weekend that had a lot of meaning was “It is possible, with some hard work, to live a comfortable and happy life on very little.”
 All packed and ready to go on the Montana de la Flor brigade, where we volunteered as medical translators.
 Hiking up the mountain to selected home sites with all of the survey gear, military personelle and students.
 Typical 1 room mud and stick home in the village of Rincon.
 The first home we visited, Maria Luisa with her five children. The boy in the middle demonstrating the typical fashion for carrying babies and toddlers in a cloth sling.
 Typical handicrafts made by the Montana de la Flor women.
 One of the little girls we surveyed, showing off her bandaided fingers after we took a blood sample to measure her nutrition status.
 One of the National Guard members teaching the local children handwashing technique in the river.
 Daytrip away from NPH, we converted a one-room school house into a make shift clinic for the brigade of Doctors from Spain.
 Deedee and I ran the admission, vital signs, and pharmacy at a few tables out front of the school.
 Jen, my fellow volunteer nurse, and I in the back of a pick-up truck on our way to the remote village of Las Pilas to attend to the medical needs of the community.
 One of our youngest (and cutest) patients.
 The little girls (ages 4-6) putting on a hula-hoop performance for the talent show.
 A day hanging out with the girls... Cathi and Carmen.
 A typical way of cooking in most Honduran households with a wood-fueled fire below a large metal plate, where pots, pans, and tortillas can be heated.
 The view of the property at Carmen's home.
 The "Pila." A normal fixture in most honduran households that serves as a water container for the daily water use of the household. The scrubing board attached serves a variety of functions such as clothes washing, dish cleaning, handwashing, and teethbrushing.
 Playing in the field with Carmen's daughter Valeria (5 years).
 Learning how to make corn-flour tortillas. First you have to make a ball and get it as even and flat as possible.
 Then you place it gently on the comal (stove surface) being careful not to let it burn.
 Learning to milk a cow, not as tedious as I thought, but definately tiring.
Enjoying the hot springs.

Sunday, March 4, 2012

For the love of Bees

Well, another busy 5½ weeks have gone by since my last blog entry, and I am trying to recall the most important highlights to share with you. As January came to a close, I tried to get the clinic in order and in tip-top shape to turn it over mid-February to Jen, our new volunteer RN. For months, I had been trying to get someone to come and remove a large bee hive that had been growing in-between the wall and the roof of the clinic, and also get someone to fix the front metal door that would jam and I had to kick open every morning. Each day when the sun came out and heated up the wall, the bees would swarm and I was always worried a patient would be stung. Well, coincidentally on the same morning that that the metal workshop teacher came to fix my door, the farm manager came to remove the beehive. While trying to scoot around the sparks flying around the clinic from the metal door being sawed off, the bees started going crazy as their hive was disturbed when the roof above the admission room and pharmacy was removed. This situation would have been okay except that I still had about 15 patients in the other building of the clinic waiting to see the doctor. By the time I came out of the pharmacy, my staff had all disappeared into the laboratory, and the patients were nowhere to be found. I went outside and realized that the metal door to the building where my patients probably were was still stuck open. I ran up to the patient building and quickly untied the door and pulled it closed. I found all the patients inside, huddled at the end of the hallway, trying to swat down the angry bees that had entered.

I spent the next 1 ½ hours holding the front door closed and watching the swarming, kamikaze bees dive-bomb the screen windows, trying to sting the patients inside. Luckily they seldom were able to find an opening to enter, but when they did, they went straight for the first thing they saw moving. Luckily only a few patients were stung, and no one was allergic. As I sat there, trapped with my 15 patients, listening to the buzzing grow louder and louder, and a little girl who had to go to the bathroom “really, really bad” for the last hour, I felt like I was reliving the movie killer bees, and couldn’t help but think “only in Honduras!” Finally the ‘bee venom’ arrived and the majority of the bees were killed, leaving a thick layer of dead bees, sawdust, and honeycomb on the floor and walls inside and out of my clinic. When the doctor finished all his consults and declared it ‘probably safe’ to finally let the patients out of captivity, I opened the door and we all ran across the clearing a safe distance from the hive, just as the doctor himself got stung.

Knowing that my patients had been delayed many hours by this ordeal, I knew I had to try to fill their prescriptions and get them on their way as soon as possible. I collected all the patient’s prescriptions and called the nurses hiding in the laboratory to tell them to be prepared to open the door, and I made a run for it. Once in the laboratory, we had to make runs down the hallway to the pharmacy which was directly under the open roof and deteriorating bee hive. After several trips back and forth with dead bees falling from above, and drugged bees buzzing around in circles, we were able to collect enough medications and materials to set up a make-shift pharmacy in the laboratory, and quickly distribute the medications. Once the bee situation was under control, we began cleaning up what looked like a war-zone in the clinic, and the metal shop professor was able to return safely and continue shaving off the door again. Needless to say, I was left with a hole in the roof of the clinic for 5 days, through rain and shine, until someone was able to come and repair it. A few minor maintenance repairs turned into quite a big event.

A few weeks ago, I had the lucky excuse of two more Graduate school interviews to make a week long trip home to the states; first spending the weekend in Minneapolis for an interview at St. Catherine’s University and simultaneously getting to see many good friends in the area, followed by 5 days in Park City with my family and an interview at the University of Utah. Highlights included a Camp reunion-potluck, being at home with my entire family, and attending a Univ. of Utah vs. Stanford gymnastics meet. I am not officially committed to any one school yet, but chances are very high I will be moving to Minnesota in September.

When I arrived back to the Ranch last week, I had 107 pairs of glasses waiting for me from our previous Ophthalmology brigade, to be fitted and distributed. Over this week, 30 NPH children received glasses, mostly for distance vision which will greatly help them improve their school work. The remaining glasses went to employees, family members, and other patients from the community. Some of the kids are so excited about their glasses, and others (mostly the girls who are more worried about fashion over functionality) are not so thrilled. My favorite patient, one of the special needs boys named Carlos, has been asking me about his glasses for the past month. Since the minute he received them, I haven’t seen him take them off once. I am hoping that the kids who are a little more apprehensive about their glasses, either for appearance or adjusting to the strong prescription will eventually come around and see the benefit of having better eyesight.

The same week our 5 volunteers left, the children’s housing sections changed as the older kids in each hogar group moved up and new younger kids moved in, a process that happens each February before the school year starts. 11 of my 19 girls moved next door to an older age-group section, and 12 adorable younger girls moved up into our hogar. Moving day was a big ordeal. When I arrived to my hogar in the evening, there was a line of  girls outside the door, each with their personal belongings wrapped up in their bed blanket. As they entered the hogar, they had to sit down on the floor with a Tia and inventory all their belongings, so that those missing important clothing items could get more from the storehouse. The evening was a chaos of cluttered floors, girls meticulously folding their clothes, and organizing their prized possessions into their locker. The new group of girls as a whole is very well behaved, a little less loud and dramatic than the older ones who moved up, and they have already started bonding well.

The hardest part of this last month was saying goodbye to my closest friend and roommate, Caro, from Austria, as she and the majority of my entering cohort finished their 13 months of service and headed back to their respective homes. Of the three volunteer cohorts I’ve watched leave, this one was by far the hardest, possibly because of the realization that I will have to go through the same process of separation and goodbyes in two months. I am realizing how much I have truly come to love the kids here, especially my hogar girls over the year. It is a love that is new to me, and that I didn’t even realize was growing inside until one day, it was just so blatantly obvious it was there. It is different than romantic love, or the love one feels for their parents and siblings, but the type of love that I can only imagine would be most closely compared to the love that a parent feels for a child, ‘unconditional love.’ It is a love that wants the absolute best in the world for the child, that loves them no matter if they do good or bad, and wants them to stay safe and protected always.
 A night in the city with Nancy, Irene, and Kristina.

 21 volunteers squeezed into a van for a day trip to the Honduras version of Child Protective Services.

 Visiting the Basilica Suyapa in honor of the patron saint of Honduras.


 Enjoying some campfire time with three sisters, Elsy, Digna, and Carmelina.

 Digna roasting marshmallows in a bamboo shoot.

 Adorable Evelin.

 The cake I made for the goodbye party of the 11 girls who moved to another hogar.

 Moving day... all the younger girls lined up outside awaiting their turn to move their things into the hogar.

 Carmen, with all of her personal belongings wrapped up in her one blanket.

 Tia Dania doing inventory of Carmelina's belongings.

 Daniela helping Carmelina organize her clothes to put in her locker.

 Josselin showing off her new locker.

 The explosion of 'things' that ensued as the girls found their place in the hogar.

 Patients waiting for a consult outside of the clinic where I formerly worked.

 Patients waiting for their consult in the hallway on diabetes club day. The same hallway I was trapped in for 1 1/2 hours during the bee episode.

Moises and Juan Carlos showing off their new glasses.