Guatemala 9/14: the fun

When we planned our trip six months ago, I chose the dates based on Sam’s schedule, my work schedule.  I didn’t actually look at a Guatemalan calendar, which I should have done, because September 15th was Guatemalan Independence Day, and we weren’t able to do any work that day.  While it was too late to change our flights, we did have time to change our in-country itinerary to include a day in Antigua.

Sunday morning, as we left our hotel in Guatemala City, I saw several groups of high schoolers in uniforms running along the main road.  I asked the bus driver why they were running.  “Because of the holiday,” he told me.  It sounded unfair to me, to make them do PE on Sunday just because Monday was a holiday.  These schools were hard core!

Over the day, as we rode the bus to Antigua, we saw group after group of young people, running with torches (the torch of liberty) and whistles.

 

All day, as we wandered the streets of Antigua, we heard whistles and cleared the road as group after group of running students passed us with their torches.

 

Last November, Antigua had been a somewhat sleepy touristy town with almost more tourists than locals.  This time it was densely packed with patriotic Guatemalans.

As the day wore on, marching bands and drum corps joined the informal groups of runners.

All day, despite rain, and into the night, despite darkness, bands and whistles and torch-running continued. We did a little shopping, but mostly we just watched. We had stumbled on a national party, and it was great fun.

We had to leave Antigua at five next morning to make it out of town before the streets were blocked off for the parade, and we took the early bus out of Guatemala City for the same reason.  When we finally arrived in the towns where we’d be working, more parades stopped our progress, and we sat in the car, watching the parade through the rain.

During the week, there was little for entertainment. After teaching each day, we walked half a mile to the corner store and had an icy soda as we watched people heading home for work.

I think they liked watching us as much as we liked watching them. A few folks were curious enough to come and talk to us, and we had some great conversations about life in the village, and what we were doing there. Pam introduced Maria, who worked in the little store, to her first taste of diet coke. “Is it sweet?” Maria asked. One tiny eighty-two year old grandma watched us every day from next door, peering over the low concrete wall like Kilroy, but we weren’t able to convince her to come sit with us.

Those moments of conversation were one of the best parts of the trip, when the wall of us-them broke down, and we were just neighbors having a conversation after work.

If you missed my other posts about my trip to Guatemala, you can find them here: Guatemala: the work, and Grateful: home safe.

Guatemala 9/2014: the work

Apparently my pre-trip communication was a major fail, and many of you didn’t know I was leaving until I was packing.  This trip was six months in the making and was a follow-up to the trip we made last fall as a family.

The University of Colorado and Children’s Hospital Colorado have partnered with the Banasa banana plantation to improve the health of twelve small communities (a few would be big enough to call towns) in the south-west corner of Guatemala, near the border with Mexico. Banasa’s interest is mainly in the health of their workers, but the clinic is open to everyone in the community.  There are other national “health posts” in the area, but the nearest hospital is an hour or more away by car, depending on the rain, and most folks’ main mode of transportation is their feet.  Motorcycles are also popular, but it’s hard to ride on a motorcycle when you’re in labor…

So anyway, they built a clinic (staffed by a family physician and residents from Colorado; open since April) and a two-bed birth center (not yet open). They also have a community maternal-child health program that focuses on nutrition, child development, and prevention of maternal complications.  Currently, the community health workers drive out into the communities to find pregnant women by word of mouth. Then they provide free (individual) prenatal care, education, post-partum and newborn visits, and then group visits for moms and babies until age three.  Pam and I went to teach group care.

are we there yet?

A team of midwives and physicians has been working on the content for four visits, and then we worked with the community health workers to show how those visits could be interactive, instead of lecture-based.  The health workers jumped right in, quickly appreciating how group visits could streamline the huge amount of time they spend traveling back and forth between their communities.  Likewise, group care can ameliorate some of the isolation experienced by the women. But it will be a huge shift for this community, where women mostly stay at home– like really at home–  and few of them have phones to ease communication.

getting to know one another

The second day of our teaching,  Pam and I got to go out into some of the communities to make home visits.  We saw first-hand how much time the community health workers spend driving.  We had to make several stops to locate one woman who had moved.

We also made an unscheduled bathroom stop at the home of our colleague’s sister, where Pam got a tamale-making lesson.

On day three, the community health workers hosted a sample group for nine traditional birth attendants (TBAs). The health workers did an amazing job of making the group model their own. I was so impressed by their confidence, their professionalism, and their enthusiasm. That group had several goals: transparency (the patients for whom we care are attended during labor by these TBAs, and we want them to know we are not trying to supplant them); education (the only formal training the TBAs receive are periodic lectures from the Ministry of Health) and community building (the goal is for the birthing center to be an alternative and safer location for the TBAs to attend their patients).  While the group went really well, we discovered that every time our center has hosted them in the past, the TBAs have received gifts, which was their expectation and something for which we were not prepared. Despite that I think it went well, but we’ll see how many show up to the next teaching.

after our pilot group

driving the TBAs back to their communities

We spent time on day four discussing the cases we had visited on Wednesday.
a Pictionary-esque review of what we’ve learned together

Each of the women we visited were at major risk for some obstetrical complication, and our unpacking of that gave us hours of fruitful teaching.  In a tiny country where two women die every day from obstetrical complications, preventing maternal hemorrhage becomes invaluable.

simulating Leopold’s maneuvers on my make-shift pregnant abdomen

So, to sum up, I learned so much this trip. I have deep admiration for those who are there day-in and day-out, making this program work. It was a privilege to teach and learn and get to know these women.

Grateful: Home Safe

Hello, friends.  I’m home today and grateful for a really good trip.  I’ve so much to be grateful for:

:: for the five community health workers we had an opportunity to get to know

:: for their commitment to education and the health of their community

:: for laughter

:: for the gift of Spanish, which was indispensable this trip

:: for the tour bus of Salvadoran physicians who spontaneously gave us a ride to Antigua

:: for the kind couple who drove us from the bus station to our hotel

:: for Pam, whose company and partnership were such blessings

:: for Kim and Kelly, our house-mates, who are working there another week (and who humored my desire for game nights)

:: for the refrigerator that held the milk that Kelly made that made my morning tea work

:: for all the prayers that traveled with us (including those of a lovely prayer warrior sitting next to us on our plane down to Houston who had a pre-existing love for the people of Guatemala)

:: for all the love lavished on my family while I was away
More details to come, I promise!

7 Quick Takes as I pack for Guatemala

1. So I’m leaving tomorrow and still haven’t packed anything.  I am a packing procrastinator, and this time I’m glad I waited because LAST NIGHT I found out that we will be staying at the banana plantation where the clinic is (think 90 degrees F and 95% humidity with no breeze) instead of at the coffee farm (50 degrees with misty rain at night).  I need a totally different set of accoutrements.

Where I thought we’d be staying:

2. Like a mosquito net soaked in DEET.  I don’t want malaria. Or dengue.

3. When we lived in Cairo, the mosquitoes loved me.  Once I slept outside my net and half my face was so covered in mosquito bites that I looked like I’d had an accident.  I hate mosquitoes.

4. It’s 32 degrees and threatening snow in Denver right now.  It’s a good thing I believe that germs are what make us sick and not going through a shocking temperature change or going out with my hair wet.  (And my hair will be dripping wet with sweat in Guatemala.)

5. Normally when I’m leaving imminently, I spend the day sewing a piece of clothing I don’t really need.  Or something for our house.  When I was going to Haiti with no idea what treating cholera was going to look like, I made a skirt.  When I was heading to Thailand, I made this cute quilt.  (The quilt was a winner, if I say so myself.)  But my sewing machine is totally, completely dead.  I thought it was just mostly dead and took it to the shop, but the repairman called me to say that I’d have to replace the foot pedal and plug ($60) first so that he could replace the motherboard ($130 without labor).  I’m pretty sure I can get a new sewing machine for that.  But anyway, no new skirt.

6.  I am completely addicted to black tea.  With sugar and milk (or preferably, half and half).  Now I’m not even sure I’ll have access to a refrigerator.  How am I going to keep my milk cold?  And really, if this is my biggest problem, it’s going to be a good trip.

7. I am traveling with my friend Pam who worked with me in Chicago for five years, was with us as a doula during my labor with Owen, and traveled to Haiti with me the first time.  Let’s just say she’s seen me at my worst.  Last night she reminded me of the our first night in Haiti.  We had taken the red-eye from Denver and got to the compound around noon, where they greeted us and told us to take a nap because we’d be working the night shift that night.  I got up at five and found there was no milk, no way to heat the water for my tea, and no Pepsi as the truck couldn’t get through because of the riots.  Night shift minus caffeine equals no good.

The next morning, after a harrowing night of trying to keep children from dying of cholera, the chaplains asked us what we wanted to pray for.  I said I needed a NICU nurse who could put an IV in a rock, and I needed the Pepsi truck to come.  The chaplain blinked at me for a minute and then prayed that God would hear our requests, no matter how frivolous they seemed.  I went to bed.  When I got up at six, they introduced me to Theresa, the NICU nurse who had just landed and would be working the night shift with us, and Pam told me that the Pepsi truck had gotten through.

So anyway, if you need me today, I’ll be busy praying for a refrigerator.

7 Quick Takes is Jen’s idea and her blog is so fun– go check her out!

Daybook: Sept 8

Out my window: it smells like fall.  I LOVE that.

In the garden: last week Sam and I bought some new plants for our garden as an anniversary gift. (How lucky am I that my husband wants to GARDEN for our anniversary!)  We also put in two trellises so that the clematis and sweet peas that have been languishing in the mulch all summer can stand up.  It made a huge difference.

That’s the front garden.  The back has been decimated by the chickens.  Actually, my unpruned tomatoes are so dense that the chickens can’t really get in to destroy them, but the cucumbers and chives are completely gone.

In the kitchen: I need to do a little planning ahead so that while I’m gone next week, my parents aren’t scrambling for meals.  I think I’ll marinate some beef and chicken to grill (or throw in the crockpot) that they can serve with the vegetables from the farm.  But tonight, a friend is cooking for us.  Grateful!

In the schoolroom: I don’t have anything extraordinary planned this week.  We did read a lovely book on women’s suffrage in Wyoming for history: I Could Do That! by Linda Arms White. Like all the best history books, it managed to display the history in the greater context and in the microcosm of one individual’s life.  Loved it.

And as a part of our college prep curriculum, we are trying to have Frisbee class at least twice a week, because we all know that playing Frisbee is a very important part of college.

On the Needles: no photos since it’s a gift, but I managed to finish knitting the dreadful second sleeve on a baby sweater gift that’s a year late.  Now I can work on the dreadful second sleeve of my own sweater that’s been on the needles for a year and a half. Maybe longer.  If I didn’t love the yarn so much I’d just chuck it.  I’ve got my fingers crossed it will be worth it in the end (which of course may be part of why it’s been so hard to knit…)

On my mind: I leave Saturday (yeah,5 days from now) for another trip to Guatemala.  This time I’m traveling with friends and colleagues while Sam holds down the fort.  Continuing with the project I worked on last fall, I’ll be teaching group prenatal care, and I’m really excited about it. But there are a bunch of gaps in my planning (like what to pack and school planning for while I’m gone) that have to happen this week.  Really important stuff, like what I’m going to read on the plane.  (Two planes! A layover!  Imagine how much I could read.)  God worked out the harder part of this project when that looked impossible, so I’m trusting he’ll handle the rest of it, too.

Grateful: for the opportunity to travel with friends.  For the privilege of teaching my children at home. For Sam’s brother & family’s visit last week and brunch Saturday with friends (our kids all played, and we actually got to have a conversation! Imagine!!)  For my friend Mary’s success.  For God’s ability to make all things new.

Praying: for the Neals and Simons as they minister across cultures (and that I will be able to do the same next week). Mandy. Judy. Kathie. Clare. For all those risking their lives to treat ebola victims, and to minister to those who can’t be saved.

In case you wanted to catch my other posts about last fall’s trip to Guatemala with the kids, you can find them here: Sam’s work in Guatemala, the children’s perspective, my thoughts on traveling internationally with kids.

Guatemala Part 4, or Traveling with Kids

You can catch up with Part 1 or Part 2 or Part 3 if you missed them.

Lucy the kitten

Sam and I headed into this trip with a great sense of its being an answer to prayer for us.  But my children’s response to the proposal was very different.  “Why would we want to go there?”  “Do they have wi-fi?” were two of the first questions (from the boys.)  The girls were more concerned about the food and if there would be wind there.  I reassured them all, “We don’t need wi-fi,” and “Yes, there will be lots of fruit,” and packed our bags.

We brought a babysitter with us, since I wasn’t sure what Sam’s “schedule” would look like.  I asked her to plan some nature study assignments and gave her a packing list.  We arranged for a Spanish school to send a teacher to the finca to teach the children Spanish while we were working. I bought a bunch of snacks, a Frisbee, and some small games and packed them in our bags.  We had medicine to prevent carsickness.  I thought we were ready to show the children another part of the world.

But then reality set in.  The flights were great; we arrived at the airport hotel for the first night, and they were already hungry.  A third of my snacks disappeared before dinner.  All the transportation was more expensive than we had been quoted.  The guidebook said to haggle, but it’s hard not to look desperate when you’re at a seedy bus station with five wide-eyed children.  And really, what they were asking was still peanuts compared to US prices.  So we just paid it and got off the street corner and into the cab.

We stayed at a beautiful coffee farm (“finca”) with a housekeeper/cook who did all our meals and laundry.  Good, yes.  But frankly, having five children with you and no kitchen access was a challenge.   My kids are used to being able to eat fruit or carrots whenever they are hungry.  Normally we eat at 7:30ish, 11:30ish, and 5:30ish.  Meals at the finca were at 6:30 am, 1:30 pm, and 7 pm to accommodate those going down to do medical work (which is an hour away).  There was no option to wander into the kitchen for an apple.

All our snacks (the ones they liked, at least) were gone by day 3.  I didn’t have a way to get to the supermarket.  So honestly, my kids were hungry most of the week.  The food we ate was delicious and plentiful, but not geared toward a kid’s metabolism.  And having been able to adjust our home schedule to their needs, I had forgotten how important regular calories are for kids.  We’re not yet at the point of being able to say to them, “Remember how hungry you felt?  Some kids feel like that all the time.”  Right not I’m still in the stage of saying, “I’m so sorry you were hungry all the time.”

Spanish class was fantastic.  The school sent two teachers (we had engaged for one, so the price different was almost double) for 5 hours/day Monday-Thursday.  The teachers were creative and patient and positive and excellent.  None of the five children were accustomed to sitting at a desk putting 5 hours of sustained attention toward anything (especially 3 hours past when they were hungry), but they learned a ton of Spanish.  All four of mine are practicing, throwing Spanish into every day speech whenever they can, and enthusiastically showing off to their grandparents.  Score there.  We hope to continue with the tutors via Skype in the spring.

But all my plans for nature study in the afternoon?  Well, the rain started at noon. Every day.  So by the time Spanish was over and the children had eaten, the deluge had already been going on for two hours, so even if they had wanted to go play in the rain [the girls did], it was so slippery and muddy that the housekeepers wouldn’t let them.  [I probably would have felt the same if I were the one hand washing all their muddy clothes.]  If I get a do-over, I will plan nature study in the morning and Spanish school in the afternoon.  But it meant I had tired, cranky children who didn’t get any exercise hanging out in the house every rainy afternoon with not a single magic wardrobe in sight.

Our weekends were wonderful.  The first weekend we went to a water park and then saw a national heritage sight with standing stones and an amazing Mayan observatory (Takalik Abaj).  Our guide here was so good.  We spent the second weekend in Antigua, where the children practiced their Spanish bargaining for things in the markets.  Moriah was especially adept at this– next time I will put her in charge of finding us a taxi.  Everyone walked around and ate whenever they wanted

We took a tour of the Catedral de Santiago, which collapsed in the earthquake of 1773.  Part of it has been rebuilt, and we saw two weddings there over the course of the weekend.  Our tour guide was animated and funny and full of great history, and the children liked the tour almost as much as the cheesecake.  The weekends gave us an opportunity to process together much of what we had seen and experienced during the week but couldn’t talk about as frankly as we would have liked.  I loved sharing this history and experience with my kids.

So what do I take away from this?  The trip pointed out to me how much control I have over my children’s day-to-day experience.  I have worked hard to have the flexibility to be with them and I cherish the opportunities to do so, but in Guatemala I didn’t really have any ability to micromanage their experience.  The children’s week was dominated by their minute, every day experiences: hunger, sticky bug spray, rain, throwing the toilet paper in the trash instead of the toilet.  I hope as time goes on, they will be able to see the forest instead of the these inconvenient trees.  If I had it to do over (and I hope I will in a year or two) I would bring a lot more snacks and schedule nature study in the morning and Spanish class in the afternoon.  And while our babysitter did what I asked, she was a little young for what I was asking her to do.  I don’t think we will need one on our next trip, but I would choose someone older if I could, and someone who already spoke Spanish.  I don’t know that anyone would have been up to the task, actually.  Even when I spoke with the house staff in the morning about an issue, once I left at 7 am, it was out of my hands.  When I came back twelve hours later, nothing I asked had happened.  Culturally, the housekeeper told me “yes” because that’s what she was supposed to do, but in reality, she held the reins. It is a very macho culture, and I wonder if a request from Sam would have had a different effect. (Certainly, the two male doctors who came later in the week got what they asked for right away.)  That grates at me, but what can I do about it? Nada.

As the project develops, there will be a community center built with the clinic, and then there will opportunities for the children to minister.  On this trip, their work was to learn Spanish and to be gracious guests.  Being gracious is not their natural gift (though this year has afforded many chances to practice!) and it was hard.  In the future, they should have a chance to run children’s programs during parents’ classes and to bless the kids we are there to serve.  I think they are well suited to that task, and I hope this trip doesn’t spoil that vision for them.

Guatemala, Part 3: the childrens’ perspective

You can read Part 1 or Part 2 if you missed them.

This time I asked the kids to share their own experiences of Guatemala.  So what follows is theirs. (I did help with spelling and punctuation, and SweetP dictated hers to me.)  So without further ado:

Guatemala was awesome. It was so green- I miss its greenness. When we were in Antigua we could see the volcanos.  While we were driving to Antigua, the view was beautiful. I had the best cheesecake EVER. The Finca was beautiful, It rained ALOT EVERY DAY. I thought that Lucy the cat is adorable. One night Lucy was in my bed room and she woke me up by scratching my feet. Dona Rosa and Rosita made all are [sic] food. The food was so good I loved all the food.  One day we had orange jello.  I loved the crepe place in Antigua called Luna De Miel.  (Moriah)

Guatemala was the craziest place I’ve ever been. There were people jumping into cars off the streets. It was very hot there and the bugs were really annoying.  I couldn’t have lasted for another week there—it was really hard for me.  There was lots of food I liked: black beans and homemade tortillas, rice, all the juices they had there (mango, watermelon, and jimica), and doblados.  It was very strange overall but it was still a little nice there with all the nice scenery and trees.

I liked the markets (besides the mobbing shop vendors).  I really enjoyed that the people liked owls there. Everywhere we went there were owls in the shops.  (Owen)

Guatemala was an interesting experience. The weather was very crazy. It rained every day we were at the finca. At the finca it was very interesting. In Guatemala the plumbing is really bad. You have to throw your toilet paper in the trash. Guatemala was not my very favorite place to go to. It was nice, but it wasn’t my favorite. We saw ruins while we were there. The ruins were very cool. They were very interesting. Some of the ruins were of a cathedral. At the cathedral, the angels had open skirts. Because the people who were in charge of the church didn’t like that, anything built from a later date had closed skirts. The mermaids had skirts. We were able to cuddle with an adorable kitten at the finca. Her name was Lucy. She was one of the cutest kittens ever.   (Jonah)

We went to see Takalik Abaj and found some obsidian.  I liked the standing stones and the ugly fruit.  I like the food at the finca and Lucy the cat.  The fountain in the hotel was scary because it had scars in it from a lion.  (Phoebe)

For the record, I missed the lion-scarred fountain.

Next time, I’ll try to summarize my thoughts on traveling with the whole family.

Guatemala, Part 2

 
If you missed Part 1, you can find it here.

Sam’s goal for this trip was harder than mine: he was to explore possibilities for collaborative research and to work on his Spanish.  That required him to make connections with doctors in Guatemala, for which he was dependent on our contacts here.  But the timing of our trip was determined by my work and placed us in Guatemala during the holidays, so the person he was supposed to meet in the teaching hospital in Guatemala City was out of town. Strike one.

He rallied well, though, and was game to do some home visits with us, so on Wednesday, we went down the mountain to Chiquirines and began visiting Hilda’s list of kids with hard cases.  First up: a child with an infection on his face.  (This should have been right up Sam’s alley, right?)  One of the pediatricians who had visited a month prior had given the child an antibiotic which had improved the infection, so when we saw him, he was a three year-old with fistulas on his cheeks, just under his eyes, which were draining pus.  I have never seen this before. 

Turns out Sam had never seen it before either, which always makes me feel better (though it didn’t help his confidence any).  We took a history: at birth he had had blocked tear ducts [my diagnosis, not the mother’s], and at 18 months old, he had developed an infection in one eye, which lad led to the development of the fistula.  Six months later, the same had happened to the other eye.  We don’t see this in the states, because babies here with congenitally blocked tear ducts (a relatively common condition) are referred to ophthalmology and undergo stent placement, which prevents fistula formation.   So we explained that he needed to go to ophthalmology (which the mother had never heard of) and Hilda said she would come back with the referral information.

It was like this all day.  Case after case, often found in a house full of barefoot children and poultry, of children with bad complications of relatively simple conditions.  Congenital herpes infection.  Ocular herpes.  Blindness from a congenital cataract.  So many things I had only read about– or, in the case of the fistulas, that I had to reason out based on my knowledge of anatomy, since I had neither encountered it before nor read it.

We also visited the pediatrics ward at the regional hospital.  There was a child with a neck mass Hilda wanted us to see; he had been waiting at the hospital for 3 days to have a biopsy.  In the states, it would have been scheduled as an outpatient surgery, but that doesn’t happen there.  So he was walking around the pediatrics ward in his pants and robe, waiting.  We saw a child with a huge abdominal mass, and another with EBV.  Sam met the residents and the head of pediatrics and arranged to come back the next day to do some teaching.

On our way back to the coffee farm after our day of home visits, we had to stop at the mall for Marco (the doctor who will run the pediatric clinic when it opens) to get his wifi connection working.  While we were there, the other doctor “just happened” to run into a childhood friend (whom he hadn’t seen for thirty years) who is a local ophthalmologist.  Marco told his friend about the child with the fistula and the child with the ocular herpes.  His friend said he would be happy to see both children without charge if Marco sent them over.  It was this moment of pure grace that gave me hope for this project, and that reminded me that relationship are really what make everything work.

Sam spent the following morning rounding with the peds residents and teaching them.  This was medical relationship-building.  The more we can contribute to the quality of care and teaching at the hospital, the better care our patients will get when they are referred there, and the more likely they are to take our cases. (I do the same dance here, with how I build goodwill at the hospital so that they will take my uninsured patients.)  Sam did this all in Spanish, which was so good for him–he knows so much Spanish but really doesn’t get a chance to practice it.  That day was Spanish boot camp.  He and Marco brainstormed about the laboratory needs and capacity available locally.

When I look back at the trip, I feel frustrated with how much time we spent trying to get “so little” done.  The efficient part of me strains against the pace of international work.  I find myself apologizing to those who sent us to Guatemala with their prayers and financial support, because it was so much money to accomplish “so little” medically.  But this is how it is.  And the relationships we built with the Guatemalans doing this work every day– Marco and Hilda and Ada and Millie– are what will endure, and encourage them to keep going despite the weight of hopelessness that pervades in a setting of poverty.

Thoughts on Guatemala, Part 1

Let’s talk about our time in Guatemala, shall we?

This trip had so many facets– my work, Sam’s work, building bridges for future work, the kids’ experience, and our experience as a family– that I haven’t really known where to start the conversation.  But I think I’ll break it up just like this, and then we’ll see how the threads come together.

My job was to teach the postpartum exam and warning signs to two tecnicas (health outreach workers) and their supervisor.  It’s work I do myself all the time, so the material was intimately familiar.  Even in Spanish.  But I was preparing to teach an unknown audience, and that was hard.  I didn’t have a sense of their knowledge level or experience, and I found myself over thinking it.  The OB resident who was finishing her time there was reassuring, “You know this.  They’re nice. Don’t stress.” But I did anyway.

So after a weekend stressing, I taught for a morning. Of course the tecnicas wanted to learn, and I wanted to teach, so we had a lot of good will in the room.  It went well.  Then we moved on to home visits, which was the best part of my work.

Each home visit takes about an hour, with transport time in between.  The project serves about 3000 families so far (with an eventual goal of 25,000 families), with almost 200 women enrolled in the prenatal piece.  Almost 100 of those have delivered since the beginning, and we visited fourteen of them (and their babies) in three days.

Home visiting is so different from working in the clinic.  Granted, my being in one place means I can see three to four people per hour at the clinic.  It is efficient.  But visiting someone means you also see their neighbors, and their home.  Homes in this part of Guatemala are concrete block, with open concrete work (often in the geometric shapes like leaves) above the windows. The windows had metal shutters and sometimes screens, but I didn’t really see the point when the eaves and decorative concrete works let bugs in anyway.  The houses had metal doors to the outside, but most of the rooms inside the houses were without doors.  Some homes had beds; a few had hammocks instead so that one room could serve as living-, dining-, and bedroom all at the same time.  Because most of the cooking seemed to be  done over wood fires, the kitchen was always a separate area, even if it was only a space outside the back door.  Soot stained many walls.  In the more affluent houses, pigs, chickens, and turkeys wandered in and out.  Dogs with exposed ribs were present whether the house had a source of protein to eat or not.

The moms were very hesitant to let the babies get cold, so the shutters were often closed, and the babies were all wearing multiple layers and hats.  It was above ninety and very humid; all the adults were sweating freely.  Everyone looked so tired.  The schools are on vacation in Nov-Dec, so that the older children can help with the coffee harvest, so there were lots of younger children underfoot. 

So we’d come in, Ada would introduce us to the family (usually mom, baby, mother-in-law or mom’s mom, and a sister or two with her children) and Ada would explain why we were there.  We examined mom and baby, and then the real work began: helping to correct cultural norms which are dangerous.

Cross-cultural work is hard.  The goal is to slearn what we can, share our commonalities, appreciate our differences, and only change habits or customs that are dangerous.  I do the same thing in my office all the time (and in fact, many of the custom I see are the same).  So we didn’t point out that no one needs to be wrapped in a fleece blanket when it’s 90 degrees out.  Instead, we focused on the custom of giving babies water-with-honey instead of breast milk.  Feeding babies water (with or without honey) in the first months contributes greatly to rural Guatemala’s childhood malnourishment and is a frequent cause of diarrheal illness, which is a top killer of children under 5 in the developing world.  But it is firmly ingrained (in fact, all but one of the families we visited was practicing this custom) and hard to change.

The need was overwhelming.  One mother’s experience in the hospital was so bad that when she went home and her Cesarean section wound reopened, she didn’t go back to the hospital.  Instead, it healed on its own with a large hernia, which was incarcerated when I saw her.  As we traveled, Hilda collected a mental list of kids for Sam to see when we brought him down.  Hilda, the tecnicas’ supervisor, seemed to know everyone around and certainly knew how to help them access care, which she did with skill and sensitivity, but it was often too late to prevent serious complications.   I felt comfortable signing off, as it were, on Ada’s and Hilda’s skills with their patients, and the work they were doing.

I think that’s enough for today.  Next time: Sam’s work.  Thanks for supporting us.

UNoPOO

Well, we’re back home safe with a good case of UNoPoo (you know: the constipation sensation that’s gripping the nation) but that beats the alternative, I guess.  My theory on this is that if you life in a country that has multiple endemic causes of diarrhea, you make your food more like glue to counteract it.  Anyway, moving right along…

I have about 300 photos, but 200 of them are the children’s blurry selfies (or pictures of food) that I won’t torture you with.  I am far from having anything deep to say about our experience, but it was a good trip and there are a few highlights I’ll share while my brain and body are getting accustomed to life in the States.

It is SO much easier to get to Central America from here than to Asia or Africa.  Or Europe.  Or even Vermont.

Antigua was full of young Americans and itinerant Europeans, looking for themselves.  Some were on the curbs telling Mayan horoscopes.  I wasn’t convinced they’ve found themselves yet.

Shopping is overwhelming to me, but the children loved it.  It was great math: divide all the prices in Quetzales by 7.5 in your head to see how much it is in dollars.  Speak Spanish.  Moriah, in particular, was bargaining like a pro.  For me, I just find it exhausting.  Tell me a fair price, and I’ll pay it.  If it want it.  In one of the markets, word went up the row of vendors that I was the hammock lady, and each vendor popped out at me in turn, demanding to show me their hammocks.  Asking me to name a price.  But I just didn’t fall in love with any of the hammocks I saw and escaped without buying one.  Or seven. Or any.

I have so much freedom.  For the first week, we were guests at a gorgeous coffee farm, but we had no freedom.  We were shuttled here and there; our meals were prepared for us; our laundry was done… ideal, right?  But despite the beauty, despite the ease, I felt trapped.  I really just wanted to take a walk by myself without fear, or grab an apple from the kitchen.

There is much work for us to do.  Sam was able to visit one hospital and forge a few relationships there; my training went well, and I spent three days doing home visits with post-partum moms and newborns.  The project is still developing, and we should be able to find our niche.

That’s all for today. Thanks for all your prayers and support!