Final thoughts

This blog is best read from the first post to this post, so start at "Setting up the Clinic," and work your way to this final post.

On the last day, we had a closing ceremony for all the thank you’s. A dance group from near San Salvador danced for us, and at the end, Dra. Angela spoke. Through tears, she said that it was too hard for words to express the gratitude she felt for what PeaceHealth had done this week for the people of her community. She felt blessed to have worked with all of us and she learned a lot from us. Afterwards, she and I talked and she asked if I believed in Jesus. When I told her no, she said, with certainty that, one day, I will be a Christian. I took that as a compliment and gave her a hug.

Prologue

Mt Rainier from the plane as we land in Seattle

If you are thinking about doing this type of mission, and want to know what to bring, I brought my stethoscope, otoscope and ear specula for kids and adults, a urine sample cup ½ full of Hibiclens to wash the specula, a tuning fork to quickly check hearing (and act as a paper weight so the fans wouldn’t blow the paper off the desk), as well as a percussion hammer for a neuro exam. I didn’t really need anything else, except my pen, of course. A long piece of twine was handy as a clothes line.

As I type this up, several days after having returned, I’m struck by several contrasts to my usual day as a family doctor in Eugene. First, I now can’t believe what people complain to me about…3 days of a cold, funny feelings in their skin, relatively minor, self-limiting sorts of things. In our high tech world, have we lost so much touch with ourselves, that we now need the “experts” to tell us what our common sense should be able to tell us? I also walk around my neighborhood; marveling at the intact sidewalk, no wild dogs or chickens running around, no street vendors, no shops built into homes on the road, and I think why is it that I was lucky enough to have been born in a society as affluent as this. It is purely luck, and for not this luck, I could have been born in Eastern Europe, Central Africa, or El Salvador, where men in their mid 20’s are routinely killed for senseless reasons. I know this happens here too, and with that same bad luck, I could have been born in inner city Detroit, and have the same sorts of risks as the youth in El Salvador.  I just cannot take what I have here for granted anymore.

Lastly, I have to say that this is a wonderful thing that PeaceHealth does. As a part of this organization, I can say that I’m quite proud of this, and I have a better understanding of the mission of the group I have been working for these last three and half years. Even though I don’t share their Catholic beliefs, I do share the general idea of mission to help those who need the help, and I’m blessed to not only have the ability to do this wonderful work of medicine, but now to have a vehicle to deliver it to those in great need.

Respectfully submitted

Photo by Barb Bigelow 

The extraordinary people with whom I worked

Dale is a 71 year old retired pediatrician who loves teaching and whose CPAP machine noise actually entered my subconscious, leaving me dreaming about wave machines when we were roommates.

Dale doing a consultation at Sister Susan's home

Charlotte, an intense ER doc seemed to find the sickest patients and picked up the game of hearts quicker than anyone I’ve ever seen.

Leah is an ER nurse and Charlotte’s good friend. She got sick the third day there and worked on 3 cylinders the rest of the trip. Despite her illness, she persevered, and now we are all worried about her, as she is traveling alone in Honduras and Guatamala for a few days, not being able to speak Spanish. (An email to Britt a few days after we got home reassured us that she was safe in Guatamala).

Jon is a family doctor from Vancouver who has a quiet dignity about him, plus he beat me in hearts.

Dale, Charlotte, Leah and Jon (Deb is partially viewed)

Norm, a lanky pediatrician from Ketchikan, AK, who had a contagious laugh and tried to keep up with the younger women during early morning work-outs.

Barb, an administrator in Alaska, was the photo journalist. She had a keen eye and an awesome camera. She even let me play with it sometimes. We had good discussions about religion and life.

Fidel, Barb, Lyssete, Norm, and Sister Amalia

Marilee, a sister who works in hospice now. She is one of the kindest people I have ever met, and if she lived in Eugene, I would adopt her as my NW mom. This is a picture of Marilee and me with our cool headbands, which left little ink stains on our heads.

Sister Marilee and me

Silvia worked in the pharmacy. She is a kind and warm Salvadoran physician who is hoping to pass the medical boards so she can practice in the US, and maybe even in Eugene.

Moises is an ER nurse at Riverbend, who also worked in the pharmacy and interpreted. He is the first person who I’ve ever seen carry a travel humidor for cigars! He has a quiet calm sense of humor and is easily liked by all.

Ken, Bob and Kent are optometrists who saw a patient every 7 minutes and gave them the gift of being able to read the bible again; the one pleasure truly wanted more than anything else.

Margaret,. I talked with her most today. She is “an associate.” She works closely with the sisters, but isn’t a nun herself. She is an attorney who works pro bono in Yakima in immigration law. She needed some emergency help in the airport with nausea, vomiting and diarrhea. Some Pepto Bismol didn’t help, but Imodium and rehydration solution brought by the airport doctor, did. We wheeled around together in Houston jumping to the front of the line.

Melissa, another ER doc, was in charge of the pharmacy. She was like the leader of the docs, and her medical expertise was critical for her position. She has been on this mission several times, so her experience and advice were much appreciated.

Kathy was in charge of all of us, and herded us amazingly well. We all felt safe under her care, and when she dropped us off at the airport this morning, we felt like chicks without our mother hen. She has been doing this for many years, and her love of the people, and of her work really shows.

Sister Susan is the other co-coordinator. She lives in Suchitoto, and is very liberal. She is very cool. I told her that she has shattered my beliefs of who nuns are. 

Sister Susan

In addition to those named, who I worked closely with, there were the women in “eyes” who I didn’t work with, but traveled with, and sat with and ate with. Lyssette, Leanne, Elba and Blanca (blood sisters from El Salvador), Sister Amalia,  Mary, Andrea Pam, Deb, and Heather were all wonderful partners. Pam was Deb’s interpreter in GYN. She is a young woman from the lab who is a skier, and hiker and was my ride home. Mary is an ICU nurse at RB, and has a great laugh. She stepped out of her element and fitted people with glasses all week, as well as Leanne who is from Bellingham. Andrea is Kathy’s daughter who was the resident expert on all things WiFi and Apple.  I think Heather was the only one who got picked up at the airport, because she is from Seattle, so we got to meet her hubby.

Lastly, there was my interpreter, Fidel. He was a riot to work with. Sometimes, after hearing the chief complaint, he would nod his head to the patient, then look to me, nodding imploringly as if to say, So, doc, what do you think of THAT!” I then had to remind him that I needed to know what was said. Not only did he interpret the words, but he also was helpful with a Latino insight into what the words actually meant.

Fidel on our hike the first day

Group Visits

On Thursday, we tried something a little different. Since so many seemed to have similar complaints, I thought this lent itself nicely to doing group visits. This is something I’ve been hankerin’ to do for the last 2 years, having read the book by Noffsinger, out of Harvard, about the Shared Medical Visit. Here is a link to his book: http://www.harvardvanguard.org/about/MOST/MOSTInnovation.asp This link tells you a bit more about how the visit runs: http://www.lifestylemedicine.org/noffsinger. Basically, it is a type of group visit where 12-15 people with various complaints are seen as a group; the doctor does individual, 1 on 1 visits with each patient aloud for the group to hear, then between patients, while the doctor finishes the note, a “behaviorist” leads a 1-2 minute discussion about something that was discussed at the visit. Patients can chirp up when appropriate to lend their story or support to the patient who is being seen, and if the patient has any private matters to discuss, there is time set aside for that too.

                After getting the OK from Kathy and Susan, Britt, the medical student, and I decided she would get vitals, while I conducted the consultations. After each consult, she gave a 1-2 minute talk about something we discussed at the consultation. We had planned about ½ dozen different talks with bullet points. After each group, Britt asked the patients for feedback. It was 100% positive, and many gave us both hugs as they left the group. It was so gratifying to be able to reach this many people more deeply than we could have with just a 5-7 minute consult.

We did 5 different groups, plus we saw another 12 patients afterwards, not in a group setting. For the day, we saw about 68 patients this way. This was a bit more than I could have seen alone, and maybe a little fewer than Britt and I combined, but it allowed us some time for each of us to “catch our breath.” We both felt that the difference was negligible, and the benefits far outweighed the mild loss of productivity. We both felt refreshed and invigorated at the end of this day. There were a few moments that shined out.

The first group session, with Fidel standing behind the patient and interpreting for me.

                In the first group, we had 16 patients, including 6 kids under 11. The first 2 women were quite depressed, and I had to spend more time with each of them. I feared that was a recipe for disaster, as it may have been “contagious” and others would have similar complaints, bogging the whole group down. This wasn’t the case, though. There was one other with severe depression at the end, and she took less time than usual because she heard what was said before. This group took almost 2 hours, so the next group, we took 12. We had more volunteers than spots and had to turn some away.

Our first group was outside. Sister Susan observes, while Britt gives a 2 minute
talk on how to work with stress.

After lunch, we took another group of 10. In this group, there was a woman who kept on helping the other patients with what they were trying to say, or what I was asking them to do. I called her “la infermera” (the nurse). When it was her turn, I called her my nurse, and she loved it.

In another group, an elderly lady, while trying to find her meds in dress pockets, pulled out Kleanex, a toilet paper roll, medicine packets and other assorted knick knacks. Everyone laughed good naturedly when she said she had a whole pharmacy in her dress.

In another group, our last of the day, 4 of the people had rotator cuff injuries. After teaching isometrics to one, they all got it, with a little reinforcement. The true beauty of group visits at work.

I have to say that Britt was awesome in her job as educator. She spoke simply and hit the major points well. When she finished, I sometimes summed up and got some accord from the group. This could not have been successful without her. At the end of the week, during debriefing, she said that the feedback she and I got after each session was the most memorable part of the entire week for her. Several said that they have never had so much time with the doctor before, and received such timely education. Good job, Britt! She is currently thinking she will be doing international medicine as a significant part of her career. She is going to be an outstanding doc, and I felt privileged to work with her.

Britt doing a mini-lecture while I watch on
in one of the groups.
Picture by Mary Frazer

After our last group, we saw a few others one on one. I saw a 48 year old who looked to be around 300 pounds, and no taller than 5 foot 3 inches. She had the usual headache and stomach pain, but when I reached across to examine her belly, she had a positive Murphy’s sign, which means possible gall bladder disease. Her pain was worse with fatty foods, so we got an ultrasound which confirmed several stones in her gall bladder. When I told her the news, she refused to go to the hospital. Charlotte came by and told her what I was telling her, about the dangers of not getting it taken care of, but she still refused to go. Sister Susan, then Father Mario all worked on her, and she finally relented. She was fearful that her 14 year old daughter would not be cared for and wouldn’t go to school, as she was sure to die in the hospital. We were finally able to convince her that this was a very rare circumstance, and she agreed to go.

Lastly, in one of the groups, there was a woman who felt like she had a ball in her throat. She ate a piece of fish and a bone lodged in her throat. She felt particularly bad because the fish was her pet! This was pretty funny and all laughed, including the patient and her husband. Since we could, I got an ultrasound to see if there was a fish bone, mostly for reassurance, and although there was no fish bone, we found a small 5 mm thyroid nodule. So, she probably had globus hystericus ( a condition where the patient feels something is in the throat, but there really isn’t anything there), plus a new thyroid nodule that will need follow up.

Specific People Who Touched Me

Examining a wrist with Fidel, my interpreter looking on, during a group session.
Photo by Barb Bigelow 

                If you are still reading this, I hope this isn’t too boring. I want to tell you about several specific patients who stand out in my mind. The pictures are only representative of the patients described, as I couldn't pull out my camera and take their pictures at the time of seeing them.

                My first day, I saw a man in his 60’s who had a “fungal infection” on his scrotum. We went to the private tarp-walled room, and when he showed me his scrotum, he had 3 or 4 raised red open sores and one that was more linear and raised, but not ulcerated. I have never seen anything like this, so I asked Dra. Angela, a local “doctor” who was in her last year of medical training, if she thought it was secondary syphilis, and she thought it was too. I gave him 2 g of Zithromax and set him up for an RPR through his regular clinic. When I got back to the retreat, I looked it up, and it looked just like the picture on Medscape of syphilis.

Dra. Angela working on a woman who really needs a biopsy.
Photo by Barb Bigelow 

                Also, on the first day, I saw one of the clinic volunteers who started crying when I asked her about depression. I started her on Elavil and I saw her several times throughout the week, looking OK. I was sorry I never had the chance to see if she was tolerating the medicine well, but when she saw me, she smiled broadly at me. I took that as a good sign.

Photo by Barb Bigelow 

                After the first day, my mind was numb. It boggled my mind that so many people had sub-acute problems. I finally realized that they were trying to guess what it was that they needed to say to get the medicine and although it was the wrong thing, it worked anyway. This exaggeration was not at all evident with the kids. I wonder how much had to do with the fact that they got their appointments so long in advance and they wanted something to justify the long wait.

                On the second day, one of the first patients was the 1^st grade teacher. She was around 35, very energetic, wearing stylish eye glasses, and a nice hair-do. Her skin was fair, and she exuded confidence. She had allergies, and I started her on Claritin. She saw me every day after that and made a point of telling me how much better she felt.

                There was an 82 year old gentleman who said, “My thoughts are fine, but, you know (looking down), I just have a hard time.” We realized he was having erectile dysfunction, and he spoke so loudly, even the people waiting behind him chuckled. I had to explain that we didn’t have any Viagra to give him, but he could buy it OTC. I wrote the name out for him once I figured he didn’t have any heart disease.

Photo by Barb Bigelow 

                Another patient was a 30 year old woman with chest pain for several months. It was sharp and pleuritic (hurt to breath), but her doctor wanted an EKG. We hooked her up to our 3 lead and got leads II and III, printed it out for her and told her that this little part of the EKG looked good, and I didn’t really think she needed more.

                I saw an 86 year old with DJD of the knees, carrying a machete. When asked why he needs it, he said it was for protection.

Photo by Barb Bigelow 

                There was a 70 + year old woman brought in by her grandson. She was on Coumadin and prednisone, although after a lot of questioning, it looked like she had stopped it about a week before. She also was anemic. I couldn’t get more information from the son about why she was on these meds, so I just sent her off with vitamins, like everyone else got. She then went to get glasses, and passed out. She was brought back and given IV fluids and sent to the hospital.

Photo by Barb Bigelow 

                After finishing with patients for the day, I walked out of the room to see if there were others to be seen. Only Padre Mario was standing there, chatting with some others, so I said, “Do you want to be seen?” He said that his stomach is bothering him and he is on Prilosec or Prevacid for this. Half joking, I asked if he drinks alcohol and coffee to which he replied, “3  cups of coffee per day at least, and several drinks of alcohol at night.” He also used Motrin. After telling him that he should cut down on these things, he thanked me and then, for a quid pro quo, said that he can now take my confession. I laughed, telling him that, as a Jew, I only need to confess once a year, on Yom Kippur! He thought this was grand, and gave me a hug. I said, “Vaya con dios.” One of the people next to him said, “He already GOES with god!”

Padre Mario and me

               

Father Mario impressed me as a warm caring human being. His booming voice demanded respect and those around him gave it to him. On the last day, while I was kicking a soccer ball around with some kids, a drunk man came up to me, and gave me a hug and started asking me for some medicine. Not being able to help him, I found the padre and he put his arm around this man’s shoulder and led him away.

                Briefly, we saw a man in a cowboy hat who was excited to tell me that he has been to Chicago, LA, and all over the US. He was a hoot. He called himself a cowboy.

Photo by Barb Bigelow 

                There were a couple of baby stories. One was a woman who had a 1 year old in her arms during the history part of the consult. I had to do an exam on her, and as she passed the baby to Fidel she remarked how she couldn’t believe she would be getting an exam!

Photo by Barb Bigelow 

                Another woman was breast feeding her baby. When it came time to do a belly exam, even though I was careful not to disturb her; the baby started crying in protection of mom…perhaps.

Photo by Barb Bigelow 

                The priest at our retreat home, who must have been over 75 years old, had a swollen cheek on the left side. He started Amoxicillin on his own the day prior, but wanted to have a doctor’s opinion. When looking at him, I noted a swelling at the angle of the jaw on the left. His teeth looked OK, but there still could be an infection that can be detected by tapping on each tooth. We were in the kitchen, so I asked for a butter knife to be my tapping tool. He jokingly asked me if I was using it to cut him open.

                I was seeing an 11 year old and her mom. The 11 year old girl was first, and everything she said was very animated. She basically had a cold, and when I told her not to kiss any boys, she opened her eyes wide open and said, “No, I don’t do that!” then laughed. Then, while seeing her mom, the mom’s cell phone rang. The 11 year old sprang up and grabbed the phone, looked at it and yelled, “Pappy!” She started telling him in a very excited tone all about our consultation.

Photo by Barb Bigelow 

                The other funny thing about this girl was that she couldn’t understand me. My Spanish is not great, but her mom and Fidel got it, and she would look at me like I was talking Japanese, saying she doesn’t understand English, even though I was TRYING to speak Spanish. I thought she may have hearing problems, so I asked her if she used earphones to listen to music. She told me that her neighbors played it loud enough that she doesn’t need her own. Not only that, but sometimes when her favorite songs come on, she dances!

Photo by Barb Bigelow

                There was a 19 year old girl wearing a nice 2 piece top of light and dark green. Her face was long and slender, almost Asian in appearance. She was tired and I asked her if she slept well. She told me she slept about 3-4 hours per day. She repaired shoes picking them up early in the morning, and finishing them by the afternoon. She then picks up another batch of shoes that she returns late at night. She works 18-19 hours per day, and she has to do this to support the family. I later saw her mom, telling her that if her daughter kept this up, she would fall apart. She understood, and said she would try to change this. Later in the day, I saw her in the court yard, happily playing with the little kids. Watching her, I couldn’t help but think that she was still a kid, shouldering much of the financial responsibility for the family. That day, for just a few hours, she was allowed to be a kid again.

Recurring Medical Themes

Recurring themes of the medical consultations

                There were several recurring themes to their complaints. One was that they were fatigued, going on from a few months to many years. There was not anything specific most could tell me, except when they felt this way in the past, and were started on vitamins, they felt better. Everyone got vitamins. After the first day, I didn’t try to explore this complaint further. If I heard this, I’d tell them that they were getting vitamins, and they were happy. It seemed like they felt they had to justify their need for vitamins, so they said they were tired. We later found a way around this when we did group visits, and we told them at the start that all would get them, no matter what. During these groups, fatigue was not usually mentioned. Hmmm.

Photo by Barb Bigelow 

                The second complaint was headache. This was always explored. ¾ of the time, they would sweep their hand across the forehead and touch the top of the head when asked where it was. The rest presented with temple headaches with a few which sounded like migraines. About 10 or so told me that they were numb on the left side of the face, always the left, for some reason. I could never figure this one out. Sensation was intact and they were not tender. If they were sore in the trapezius (upper back), I would ask about stressors at home, and often, if they weren’t sore too. A few of them had significant stress and almost all of those couldn’t sleep. Everyone with this complaint at least got Tylenol or Motrin, and this made them very happy, even if it was only 2 weeks supply.

Photo by Barb Bigelow 

                Occasionally, when the stress discussion turned to tears, we discussed depression and if that was the case, I would try to get them up to 75 mg of Elavil, hoping they would tolerate it. I would then give emphatic instructions to either follow up with their doctor if possible, or at least go to the drug store and continue the medicine for 6 months, since a prescription wasn’t needed. I would make sure they had some support and if they didn’t, I’d call in the big guns…Sister Susan.

Sister Susan.
Photo by Barb Bigelow 

She’d make sure they were cared for. I got the impression that this was the first time a doctor had ever asked them about their emotional well-being.

Photo by Barb Bigelow 

                Another common complaint was “ardor en mi estomago” or buring in the belly. This was the code word for wanting Zantac. Once I ascertained that there was no GI bleed, they got what they wanted.

Photo by Barb Bigelow 

                A more difficult one was “malorina” or burning with urination. This would be intermittent, lasting from 2 months to 3 years or so. They ALWAYS, or nearly always, said that they would drink plenty of water, and the urine test would be normal. I don’t know what they were looking for with this one, and they all said that the urine was clear yellow- not the dark yellow of under hydration.  I just told them to drink more clean water, or sometimes, if appropriate, looking for vaginitis, sent them for a pelvic exam.

Photo by Barb Bigelow 

                The last common complaint was joint pain for 2 months to several years. If over 50, DJD was usually the cause, and younger patients had various different causes, just like at home. No carpal tunnel syndrome was found, though I looked for it. A few rotator cuff strains, tennis elbow (from wringing the clothes dry) and patella femoral syndromes were found.

Photo by Barb Bigelow 

                In general, obesity was not common, like in the US. They were generally fairly slender, at times a bit stout, and I only saw 2 or 3 who were over 200 pounds. One of these ended up having cholecystitis, and was sent to the hospital. More on her later. They walked a lot, most likely because they didn’t have cars. It was hard when the poverty level was set at $2 per day and about half were at or below that level. Gas was $4.35 / gallon, so things weren’t necessarily cheap there. Despite this level of poverty, they came to the clinic wearing their best clothes, and many of the women under 40 even wore a little eye make-up. Just like everyone, they appreciated it when I shook their hand, made eye contact and read their name aloud to them.

The typical day

                Finally, Monday morning came, a day I had been anticipating for over a year when I had signed up for the mission. I quickly got into a rhythm, waking up at 5 am, and out of the room in 10 minutes. I did laps around the retreat, which sat on a bluff, overlooking a verdant valley to the west and the town and more hills to the east. It was dark at first, but by 6 am, the orange and blue of sunrise started appearing. We had runners, fast walkers, and those who strolled by this time.

Sunrise during my morning walk

After breakfast, served at 6:30, we were on the bus by 7:15, and at the clinic by 7:45.

A typical breakfast
Photo by Mary Frazer

We started each day in the pharmacy to go over what the stocks looked like. Melissa, the other ER doc was in charge of the pharmacy, and she was awesome at keeping everything organized. 2-3 times a day, she would venture out and let us all know what was out of stock, or when the daily shipment arrived with new stock. Since she was a doctor also, she was able to freely substitute a drug that was available for that which was not, based on the diagnosis and what we wrote for. The pharmacy rocked all day to Melissa’s iPod.

                The logistics of the clinic were interesting. The patients signed up months in advance and arrived early.

Waiting in line to register for the day, at the back of the church
Photo by Barb Bigelow

When we got there, there were already 15-20 people in chairs in front of the offices. They checked in and stated who they wanted to see. Usually they went to General Medicine (or Peds) and Eyes, but sometimes, it was just medicine. I suspect there were times when it was only eyes, but I didn’t ever see those. Sometimes GYN was requested for PAPs or vaginitis or bleeding.

Line up of chairs in front of the eye clinic from the courtyard. The clinics were on the
left, and the church was on the right.
Photo by Barb Bigelow

A magic marker line was placed on top of the piece of paper they carried with them: blue for medicine, red for gyn, green for peds and black for eyes. When I saw the patient, they handed me the paper in various states of folding or rolling, with their name, age and city they lived in at the top. The next section was diagnosis, then instructions, then prescriptions. In the instructions section, I would put down non-drug things to do, like stretch, or sleep hygiene. These would be reinforced at the pharmacy. In the Rx (Receta) section, I only wrote down the name of the drug, and it was dispensed the maximum amount we could give, which was usually 2 weeks. Occasionally, I would write out a full set of instructions when it was not clear. I would then use a blue marker to cross off that they were seen, so they couldn’t recycle and see someone else, and send them on to their next station. Ultimately, they ended up at the pharmacy, where they all got vitamins, tooth brushes and tooth paste.

My view of the "on deck" patients, while Fidel gets the history

The Medicine consultation room. The tarps came down and the tables where I'm
standing were replaced by a real exam table.
Photo by Mary Frazer

For the actual consultation, I would have the patient sitting across from me, and Fidel sat next to them. I would ask, in Spanish, why they were being seen, and they would launch into their story. After the usual back and forth, I would do a problem-oriented exam, write on the paper, and send them on. About 80% of the time, they invoked God in their parting greeting to me, like “May God bless you.” They would shake my hand with both hands, or give me a little hug at times, then tootle off.

A couple of trees in the "waiting room" which was really the courtyard. Sometimes
chairs were all filled, and when you walk out of the room for a bathroom break,
everyone is looking at you. It was fun to say, "Buenos dias" to them, and they
all said it back, in unison!
Photo by Barb Bigelow

Setting up the Clinic

The church on the grounds where we worked in San Jose Villanueva

Thoughts of a Family Doctor

Paz Salud, El Salvador

February 2012

I’m on the plane now, coming home from the Paz Salud medical mission in El Salvador. We worked out of an elementary school/church in the city of San Jose Villanueva. This is a city with about 15,000 people.

                We arrived in San Salvador on 2/4/12, Saturday night.  It was a typical night in El Salvador…hot and muggy. Quite the shock compared to the climate in the Pacific Northwest. We made it through the airport without difficulty.

Sunday, our first full day

On Sunday, after waking at the beautiful  retreat house. Fidel, my translator, and I went on a walk out of the compound. Fidel is a receiving clerk at Riverbend Hospital, from Mexico, and is a great guy. I came to appreciate his insights into people more and more as the week went on. He and I went outside of the retreat where we stayed, and crossed the main road and wandered into the countryside, or “campo.” There were dogs, and chickens roaming around and the road was alternately paved and rutted gravel. After passing  a home with 2 parrots in a cage, we looked back into the lush hills, and there was a middle aged man RUNNING on a trail, coming down onto the road we were on. When he reached us, Fidel struck up a conversation with him and he walked with us quite a ways. He was a security guard at a funeral home, only working when there was business. He told us there was a river at the end of the hill we were on, and he wanted to show it to us. When we got to the bottom of the hill, there WAS a river that ran over the road. Now it was only a few inches deep on the road, but I imagine it being impassible in the rainy season. He also told us that he was a farmer most of the time, and the land he farms on is leased to him for $8 per year. He produces enough to feed his family, and in good years, he can sell some of the produce for a few extra dollars.

The river at the end of the road.

After Breakfast, we boarded our “Tourist” bus, which was air conditioned and very comfy. 20 minutes later, we arrived at the school/church. 

A view of the very top of the church from outside the walls

Mass started at 10 and those who wanted to go, stayed while the rest of us went on a little self guided walking tour of the city. We found a cemetery that was jam-packed with graves just outside of town that was extraordinary by US standards. There were many tombs on top of the dirt, and even small mausoleums. Most of the graves were decorated with plastic colorful flowers. 

Photo by Barb Bigelow 

There were a couple of young men who were quietly hanging out, sitting on one of the tombs, facing the grave of his brother and grandmother. His brother was only 21 when he was shot in the back of his head  a year and a half years ago. He and his friend were just spending time with him. Very touching.

After services, it was time to change the school into a clinic. To set up the general medicine room, all we needed to do was move the chairs and tables to one side, set up 5 consultation stations, each made of 2 student desks and 4 chairs. We had a nurse’s area, the teacher’s desk, with all the ear irrigation equipment, urine dip bags, and AccuCheck machine and BP cuffs. We also had to enclose a corner of the room with tarps hanging from the ceiling with ropes to make a private consultation room. Charlotte, one of the ER docs from Riverbend, had an ultrasound machine donated (loaned actually) which was used in this room, which also had the exam table used by all of us. Miraculously, a local radiologist was with us the entire week and did all the exams we needed. He did vaginal ultrasounds, found several gall stones, looked at kidneys, even did vascular studies. This was incredibly useful, especially since there were several who had these studies ordered by their doctor, but couldn’t afford the $30 for the study. We were able to do it for free. 

View of the outside of the "clinic" from across the courtyard

Setting up the pharmacy was quite the chore. We had to set up several shelves, label them and then take the medications from the bins and stock the shelves. There were some new shelves that had to be put together, so of course, it was a moment for competition. Britt, the 4^th year medical student and some other women versus me and a few local men. We started out fast, but soon realized that we had the legs in backwards and had to dismantle it. By the time it was taken apart, the ladies were nearly done with theirs. Score one for the ladies.

Unloading the truck, showing off my physique.
Photo by Barb Bigelow 

The Pharmacy, with Moises

The pharmacy staff: Melissa, Moises and Sylvia
Picture by Mary Frazer

Meanwhile, the “eye people” were sorting through all the sun glasses, readers and glasses, putting them in neat rows in boxes. Others were pre-bagging 30 day supplies of vitamins in the break room.

Bob doing an eye exam on Andrea
Photo by Mary Frazer

                By 6, we were ready to return to the retreat for dinner. Meal times were, in general, awesome. Breakfast always had bananas or papaya, granola and bread, plus some other main dish, like beans, pancakes or local dishes whose name I couldn’t ever remember, but were generally tasty and filling. I had to bring my own tea (Tazo Awake) from home. Lunch was served on the long patio of Padre Mario’s house. We had long tables that sat at least 30. We ate in shifts. Always rice and some fruit, along with soup, chicken or beef. There was always plenty for seconds and the 4 women who cooked and served us were so sweet.

Yum

Finally, dinner was some typical local food. Pupuses, tamales and even some little crunchy anchovies…eyes and all. I didn’t eat those.