Local coordinators control
the crowd behind the front gate in El Espino -- several hundred people
were lined up on the street leading to the school.
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Day 4 -- El Espino, The Struggle |
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The people who focus on process improvement back at PeaceHealth would have been proud of us -- lots of Continuous Quality Improvement had gone on the previous night, and during the morning of our second day. The flow in and out of the Pharmacy was of particular focus -- being able to find drugs quickly and easily, sorting by type, age (pediatrics), alphabetizing by name, etc. |
| The drive into El Espino was farther than any of the other communities we visited -- roads were dirt and rough, which made it slow going in our bus. The school we worked out of this day was also more primitive and in disrepair. Once we got setup and began seeing patients, we quickly realized that the isolation and difficulties of this village showed in the people. Lots of children without shoes. As people waited in line to see the physicians, there was more desperation present -- not rudeness, just a strong desire to see the American physicians, probably something even more remote and rare for this village as compared to others. |
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After roughly an hour of work, the local Ministry of Health physicians and assistants had to leave. That left just the PazSalud volunteers and the people from the Citizens Roundtable working the doors behind, which made it more difficult on our physicians -- it was good for them to have the local physicians nearby, as many of the symptoms and diseases that were presenting themselves were foreign to those practicing in the U.S. We had also been receiving support such as beds and mattresses that were no longer available. |
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Just a couple examples of the difficult cases seen on this day: Julie saw a young woman in the Gynecological room whose uterus was literally
descended outside her body ("on the table"). Kalpna Thuraisamy saw a
46 year old woman with angina (chest pains) accompanied by high blood pressure.
These are signs of a chronic heart condition that requires long-term care, but
all she could do was give a couple weeks worth of medications and make a
referral for follow-up (that may never come). David Lynch saw an old woman
with apparent appendicitis -- again, all he could do was prescribe medication
for the infection, and hope that she gets to a hospital. We could make
referrals for people to go to the hospital, but with the knowledge that travel
is nearly impossible, and even if they made it into San Salvador to visit
Hospital Rosales, they would face the social quotas referred to in the first
article in this series.
So troubling for our care givers to struggle in this way -- is it good to give people bad news? Do the people go home worried about their fate? Is it better that they know? The problems and conditions seen here are so much worse than what these doctors typically see in the U.S. I recall Kathy Garcia mentioning that the cases seen in Lauren Herbert's Pediatric room on this day were very tough -- a theme shared throughout the week, but particularly acute on this day. Even with the struggles, a few bright moments seemed to keep people going. The last man Ken Henderson saw "hit the jackpot" and got 2 pair of glasses that will help him (reading and normal sight). Several commented about how everyone is dressed in their best clothes, even those without shoes -- the Salvadorans seem to take great pride in their clothes and appearance.
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Julie
relayed to me how meaningful she believes it is
for the women to spend time with her and Gina Chastain in the Gynecological room
-- devoted time where nothing is discussed
beyond their own personal issues. No husband, no kids, no parents, just a
complete focus on them for 20 minutes. Probably not a frequent occurrence
in their lives.
And, I took one of my best photographs on this day, of Kalpna with a young boy. Even in the midst of our struggle, the light seemed to keep shining through these volunteers. Without being overly dramatic, it was a little uneasy on this day -- the feeling of "being alone" was a bit nerve-wracking, especially for those like me who weren't familiar with the local communities or country. As it turned out, we simply kept doing our work and everything was fine. As I walked to the bus at the end of the day with Gina, we exchanged knowing glances, and remarked at what a grind it was today (and I'm just the photographer!). I guess sometimes "good" isn't always 'fun' -- it's just simple, plain hard work. |
| Upon arriving in San Salvador that evening, we were treated to a Pupusa ("poo-poo-sa") dinner with Sister Eleanor and Sister Grace. Some sort of fried tortilla with cheese or bean filling, topped off with pickled cabbage, salsa, or jalapenos. Was actually quite good after getting past the fear factor J. As I sat eating dinner consisting of a word I'd never heard before, with volunteers from Sri Lanka (Kalpna), Puerto Rico (Elizabeth Gonzalez), Italy (Sister Grace) and Spain (Charo Sanchez), I reflected on what a wonderful experience this was -- for a privileged & sheltered lily-white male from Eugene Oregon. As Louis Armstrong used to sing, what a wonderful world. |
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With such a difference between our first day and the second, wasn't sure quite what to expect from our next day in Buenas Aires. . . . . |
