"Picking Flowers" in the back 40

We had one of those ‘charming’ breakfast discussions the other day … topics that seemingly pop out of mid-air.  Oftentimes they are non-consequential … but sometimes they strike a chord in my heart.

This was one of the latter.  And of all the things to talk about at breakfast: latrines! 

This conversation started because when we were shopping for cement fence posts, Cecilia had asked the cost of the piece of molded cement that serves as the base/floor of a latrine as well as the cement structure that serves as the stool.  Apparently they were pretty inexpensive!   People would also need 2 sheets of metal lamina sheeting to serve as a roof.  The families themselves would construct posts and hang towels or sheets or use heavy plastic sheeting to serve as walls.  The families would also be responsible for digging the hole for their latrine.

 

This is the base and stool made out of cement.  This is a NICE latrine!  Lamina walls!

Many just have heavy plastic or boards, or sheets or towels which serve as walls

 

The Pastoral Teams sees a latrine project as something quite necessary in the communities.  I thought there was an NGO currently working on a latrine project because I’ve seen some really nice latrines as we have driven through the cantons.

I asked Blanca about that and her answer was – yes.  ProVida and FISDL had latrine projects.  ProVida and FISDL worked in 3 of our cantons.  But not all the families in those 3 cantons received a latrine.  They didn’t provide them to an entire community.  For example: they might have had a latrine project in Loma Alta … but possibly only 24 of the 70+ families received them. 

I’ve been to MANY of the villages.  And I have walked door to door in many of the villages.  I have seen – and used some of the available facilities in the cantons.  When lucky enough to encounter a ‘real’ latrine – it’s humbling enough.  But when one is in need and encounters a ‘home-made’ structure – or worse … none at all – well.  For those of us accustomed to some of the ‘finer’ things in life – it isn’t a pleasant situation to be in.

There apparently are still many families who literally have to go out to the ‘back 40’ to go to the bathroom. 

So I asked the Pastoral Team to write up a budget for me and here is the synopsis:

$32  total cost for the cement base and stool (this cost includes the transportation to make the purchase)

$16  total for the two sheets of metal lamina sheeting
$2    per toilet for transportation to the communities from the Pastoral House.

So for a grand total of $50 – a family can have a clean and hygienic place to go potty.

$500 would take care of 10 families …

$1000 would take care of 20 families (the whole community of La Llanes for example!!)

So I’m writing this blog to see if anyone wants to ‘adopt a toilet’

Or even on a church-wide level – would a church that has been looking for a manner in which to support the Our Sister Parish mission like to support a few hygienic toilets?

Can’t you just see your next Christmastime efforts?  We at Heartland Presbyterian used to have an “Ángel Tree” for the children of people in prison … and we had a “Mitten Tree.”  This could be the year of the “Toilet Tree”

Hmm.   Maybe not.   There is probably a better way to raise funds for this sort of project.  Someone could bring a (clean) porcelain toilet to church, set it in the foyer and make a sign to put on the raised lid:  “place your $50 donation to provide a toilet to a family who has pee in the back yard

I daresay you might have a more eloquent way in which to create your signage!

I sometimes approach these things a bit tongue in cheek – but – this is a serious question that is coming next:

Anyone (or many ones) or any churches want to take this on?   

This sure makes a statement! (Thank you water.org)

 

 

 

Fumigation

Mosquitos are an issue here… there is Dengue in the country (though not so much in Berlín – last year I think there were only 4 reported cases).

There is some education about how to lower the mosquito population – but it is very hard to actually eliminate all the 'standing water' locations in which they can breed.

Because they don’t need much.

I know I have to keep a close eye on the pila in my bathroom (the water reservoir that everyone has because water does not run every day).  When I come back from a trip to the States I frequently have to douse my pila with bleach.  And then I have to be careful for a few days with how I use that water.  My skin could burn or rash, my clothes could be ruined … but I’d rather do that than have it be a mosquito breeding ground.  There are times when I can see literally hundreds of ‘wigglers’ in my pila after being away for a couple of weeks.

I have taken pains to have a mosquito UN-friendly environment.  Long ago I screened my bathroom window as well as the window between my bedroom and the office.  And I keep my bedroom door closed at all times. 

The bathroom attached to the room next door to my bedroom shares my pila.  On that side, I have put a wooden shelf and screening over the top of the pila – secured with two heavy rocks.  This also prevents rat and lizard poo from falling into my pila.  I bet that was too much information … sorry. 

I always keep a close eye on my pila and scoop out any random ‘wigglers’ that I see.  I have mosquito netting over my bed. I find it to be a ‘necessary adornment.’ If I see a mosquito has snuck into my room … I go after it with a vengeance.  I have what looks like a tennis racket … it is ‘electrified’ by battery and serves as a portable mosquito zapper.  It’s quite effective actually.  And I confess I feel great satisfaction at the roasting of a mosquito.   

There is so much standing water in town.  I can do what I can in the spaces near me – but I have no control over my neighbors. 

There is a group of people (Civil Protection Committee) which takes it upon themselves to go door to door to fumigate.  They borrow from the town of Alegría (10 minutes up the road) a device that looks like a leaf blower on steroids.  They wear a surgical mask and bandana over their noses and mouths  but no other protection. 

Armed for bear ... or in this case ... mosquito

And they knock on your door – if you are home and want the service – they will enter your home and fumigate at no charge.  They do go door to door prior and ask for donations – we gave them $10 towards the gas for the machine.  Some people could only give a quarter – but as they said … every little bit helps to get the job done. 

They had a set date and time but they got rained out.  And we had no idea when they would reschedule. 

Turns out it was yesterday afternoon.  I thought I heard the machine next door – it is rather loud.  Then I saw a fog coming over the wall.  I warned the ladies but they didn’t believe me.  I decided to prepare  just in case what I saw was really what was happening.  I put all my toothpaste/toothbrush paraphernalia in a zip lock bag.  I also covered my electronics.  I actually put my laptop in a huge plastic bag and put it inside my wardrobe.  I put any bottles of medicines in a drawer (I don’t have much in that department).  I made sure I had no food lying around and my coffee cup was securely covered.

Sure enough, within about 10 minutes they rang the doorbell.  We needed to leave the house.  So we scooped up the Conures (parakeet type birds) … and stepped outside. 

What a smell. 

We waited about 10 minutes after they were done to go back in.  You have to wait for the fog to settle and the smell to dissipate.

Nastiness

Idalia, the conures, Blanca, Alejandro and fumigator supervisor waiting it out

Frankly, I really don’t think the home by home fumigating does much good.  Perhaps it kills a few larvae … and a few of the flying critters but when we were able to come back in again … and I opened up my bedroom to help the fog leave … I got strafed by a very pissed off mosquito.

And within 10 minutes … I had my usual gang of mosquito activity in my office.  They like to swarm behind me (between me and the back wall) and under my desk where my (sometime smelly) feet reside.  

So I turned on my fan to keep the air moving and continued on.  It took about a half hour for my office to not have a residual odor … and about 3 hours for the odor in my enclosed bedroom to totally clear out.  My headache went away after downing a couple of pure aspirin.

I really worry about the men who are doing the fumigating.  They spend HOURS in the midst of the fog with mosquito poison donated to them by the Berlín Health Clinic.  I hope they at least get free medical consultations!!

The not so cool stuff in the country ...

I recently wrote about some of the cool and beautiful things in the cantons and posted lots of photos in an album on Facebook.  Today I was reminded of some of the uglier and not so cool things. 

You have to remember that I am here in the middle of a poverty ridden country.  And the people we serve live ‘en los campos’ – in the country.  And it is POOR out there. 

Most of you who read this blog have either been here or have heard a lot about the poverty and what we are trying to do here as a mission. 

This past couple of weeks we have been strumbuntzing in the cantons.  We’ve been doing a final verification of the slow sand water filters that people received a couple of years ago.  Making sure those who are using them are using them properly … if any need repair (lots have needed this and those filters have been repaired!).  We have found lots of rusted out diffusors and lids and really gross PVC tubes (the exit point of the purified water) so we have been replacing those.  We’ve been giving cantaros (water jugs) to the families actually using their filters (information obtained from a prior visit by Ismael).  We’ve been re-educating people about using the filter daily and other basic hygiene issues.  It’s been quite a bit of work, but worth the effort when people say that their health has improved … they have less diarrhea, fewer stomach issues … and something rather cool: in two different communities, 3 different families individually said they talked to their doctor about the filtered water … asking them if it was worth it?  Or if the carbon based filter they received from another project (another NGO working with water tanks) was better.  Dr. Vladimir, the director of our Berlín health clinic, said the slow sand water filter was the best!  He highly recommended the people continue to use them!  Hooray!

Entonces … este trabajo vale la pena!  So this work is worth the effort!  But man is it hot work.  We drive out to the communities but often times a home with a filter is well off the beaten path and we cannot get the pick-up anywhere near it.  Such was a case this morning.  Well, actually, 3 homes were well off the beaten path!  We were in Tablón Centro.  There are only 15 families actually using their filters in this community.  We didn’t think it would take us too long to deliver the cantaros.  We were wrong.

This is ok.  I really don’t mind the walking.  It’s good for us!  But Pastor (that is the man’s first name… not his title) lives WAY WAY WAY WAY (and I repeat: WAY) off the road.  First we took a turn off the main road and went down the smaller road in the pick-up to their soccer field.  That is where the truck had to stay.  Knowing how far we had to go, we took all the materials with us.  Normally we scope out the filter in each home to verify its use - then go back to the truck for the goods. 

We had 3 houses on this ‘road’ we had to walk – so we took three sets of material with us: 6 cantaros, 3 lids, 3 diffusors, and 3 exit tubes.  And we walked.  It wasn’t too far UP to the first house - only about a half kilometer.  And the next house was just a couple hundred yards from that.  Then we started the climb to Pastor’s house.  Good Lord.  Blanca, Cecilia, Ismael and I hiked.  And sweat.  And hiked some more.  And it was all UP hill, walking on a rutted and often slippery, muddy, poo-riddled ‘road.’    We finally got there and thankfully someone was home.  And also thankfully, they were indeed using their filter properly!  So we chatted for a few moments, sat in the shade of the house for a spell, gave the new parts to them and started the hike down. 

Photos do NOT do this hike justice

Pastor's home ... the pitted water jug is why we were motivated to give cantaros to our filter families

Now I’ve said before that it is absolutely beautiful in the country.  You’ve seen some photos.  You’ve seen some cool individual things … the countryside … the newly planted corn … the hills … the volcano in the distance … the myriad of flowers … the children … (go see my Facebook album for cool photos).

Well.  The mud is not so nice.  The rutted roads are not so nice as well.  The dirty faces of the children and their filthy bare flat feet with broken toe nails, fungus, cuts and callouses break your heart.  God bless them.  But to me, the children are still beautiful. 

Smells aren’t always very nice – but one ‘overlooks’ that and makes NO mention as to not offend anyone.  There is usually no realistic way to avoid the smells. 

The smells today were horrible.  There were lots of pigs where we were hiking.  Pigs have a peculiar and distinct odor.  There are no huge factory farms here, but even one or two piggies create an ‘interesting’ smell.  Of course you have their excrement mixed in the mud around people’s homes and the walking paths and roads.  And the excrement of the cattle, dogs, chickens, ducks, and whatever else is roaming the same paths people take.  Then you have the mangos and other fruits which have fallen and are rotting on the ground where you walk.  All this brings the flies. 

Piggies do roam freely all around (and often inside) homes

Rain water tank ... used for everything ... washing, cooking and yes... drinking.  But when it is filtered ... it is ok!  Even I can drink it then.  But lots of people chose not to filter.

Somehow the rainy season makes the smells more pungent.  And you always have to watch where you walk.  One house in particular was really bad.  I’m not an overly sensitive person – I can usually ‘weather’ whatever smell comes my way without showing ‘distaste’ – but walking by this one house today reminded me of the ugliness of poverty.

My friend Bob always said – you don’t just see poverty.  It invades your senses: you hear, smell and taste it. 

Walking by this house today really brought that concept home.   

Poverty stinks.  Figuratively and literally.

God's Moments ...

It seems there are lots of “God moments” in life – pieces of time that you happen to be where you are needed – and you are there not because you purposely went there – but perhaps a delay on the road made you late – but – it was a good thing you were late because you were able to give someone a lift.  Had you been on time, you would have not been able to help.  Or … on the ‘spur of the moment’ you decided to turn here rather than there …

This afternoon, it was the later … we went down to Alejandria to bring the pan dulce to be given to the folks who had been praying and had been in vigil for Elena.  Her 9^th day of death is tomorrow and the family is preparing tamales by the thousands (literally) to be given to the faithful attendees.  The Pastoral Team ladies (and their families) don’t just give the tamales to those that attend the 9^th day vigil (beginning at 8 p.m. with a mass and not ending till daybreak the next day).  They give the tamales to those who attended the first night vigil, those who attended the mass and interment.  Those who brought flowers … whoever participated received at least a dozen tamales. 

We didn’t stay long in Alejandria.  Cecilia and I had gone down with Misael and Sesi (Margarita’s children).  Margarita had spent the day with Blanca and Idalia and their families helping to make the tamales.  We dropped off the pan dulce, helped disburse tamales then packed up and left - bringing Margarita with us.  On the way back to Berlín, we made some tamale delivery stops.  We went up to Colonia El Jardín to deliver to an aunt.  We went down to Hacienda Nueva in Coyolar (both places not too far from the Pastoral House).  The road down to Hacienda Nueva is bad … very rocky.  But nothing that the truck in 4x4 mode cannot handle.  We delivered to 3 homes down there.  About 2/3 of the way down, we saw a bunch of boys – bike-riding, chatting, hanging out.  On the way back up Cecilia suggested a shortcut so we went a slightly different way back up. We ran into the boys again  They asked us to stop.  One of the boys had broken his arm.  They were hoping we would take him to town.  No doubt about it … his arm was bent between his elbow and wrist and the bone was bulging the skin.  We put him in the front seat and gave him a seat cushion to put on his lap to help cradle his arm. 

I was directed to take him to the Red Cross which is right between the high school and the Berlín Clinic.   I’m not sure why they didn’t take him to the clinic itself.  My guess is, they would not attend to him (past history).  The Red Cross folks could possibly get him to the hospital either in Santiago de María or San Miguel (they would decide).    

Had we not taken the shortcut on Cecilia’s whim, the boy would have had to walk about 2 miles …

The last thing I saw was Cecilia handing some cash to the brother who would stay with the young man.  He would have to pay the gas to cover the trip.  God bless Cecilia.

T.T.P.

We went to San Salvador to buy cantaros on Tuesday – the plastic (5-ish gallon) jugs that people here use to fetch water.  They are lightweight when empty – but between 40-50 pounds when full.  Usually the job of fetching water falls to the women and young girls but there are many men and boys who pitch in to do this task.  The lucky ones have horses to schlep the full jugs home – or home-made pull-carts.  The rest carry them on their shoulders/backs (the men) or on their heads (the women).  If they are lucky, they live close to their water source – be it a community water faucet that runs maybe twice a month for a few hours or a spring or an actual river.  They might have to walk 30 yards or 3 to 5 kilometers. 

Everyday tasks can take a long time and do damage to your body over time!  Say a prayer of thanks next time you turn on your faucet and you not only get water – but you can choose to make the water hot!!  And you can drink it without getting sick, too!

Anyway – I didn’t start this blog to preach at you – consider that a bonus!! Haha.

Back to the cantaros: we had hired Raúl from El Tablón to take us to San Salvador.  In the past, when we needed a large quantity of cantaros, we have gone to San Miguel.  The problem is, the pick-up truck we have only holds about 5 dozen.  And San Miguel is about an hour away – takes longer if there is no parking readily available.  We normally spend about 3 or 4 hours per trip by the time all is said and done.  And it’s about $25 worth of gas for each trip.

So when we realized that we were going to need a ton of cantaros – I suggested we call Alfredo to see if he knew of a distributor in San Salvador.  I thought it would be cheaper to pay the store to get them here.  Also thinking about the time that would be saved.   Cecilia immediately thought of the ‘little’ store from which we had purchased a lot of small bottles and containers a couple years ago for a woman’s group.  She found Roxy’s in the phone book, gave them a call, and they said they had what we needed.  They also said they were having a sale!  For every 100 you buy – you get 10 for one penny each.  Nice.  This sale ended today she said.  So we looked at each other and said – well – guess we’re going!   We quickly called our ever faithful driver (it is about 9:30 a.m. at this point) who said he could be at the house by 11:30.  Cool.  Lucky for such a last minute call!

It was 12:30 by the time he actually got here – he had been in Talpetates and had a car issue.  We did not give him grief for being late.  Life happens.  Especially in the country. 

We hopped into the cab of the big truck and off we went.  I tend to doze on long trips if I am not driving – it was not very comfortable – but – I still managed to keep up my reputation.

2 hours later we found the place.  I had only been there once – a couple of years ago – but we knew the street (and I knew the street) and we had a good idea more or less where it was.  And we found it with no problem. 

Again – I should never complain about parking.   Raúl got that monster truck into the little parking lot (a lot that has space for maybe 6 normal vehicles) without a hitch. 

They knew we were coming and had an invoice all ready for us.  And out they came.  5 cantaros tied together in bungles with plastic string (pita). 110 bundles in all!  I pulled out the camera to start taking a photo journal and very soon realized that I had left my chip in the computer after downloading the photos from the day before.  So I was camera-less.  Darn it.  I was kicking myself because the process of loading was very fun to watch.  The truck was FULL when all was loaded.  José, a friend of Raúl’s had come with us and between the two of them, they made fast work of loading and tying down.

All four of us ended up in the cab of the truck for the trip back.  It rained a little.  We had to stop a couple times to re-secure a few that seemed to be slipping from all the bouncing around.  (I say “we” but it was Raúl and José!) We made it back to Berlín by 6:15 p.m.

Then we ALL helped unload – each of us making several trips with two bundles of 5 each up to the chapel.  The chapel is now quite full.  I’m sure that God doesn’t mind.  It’s for a good cause.

The cantaros are to give the folks who are using their water filters – the project that we had a few years ago.  We’ve been re-visiting the communities and monitoring their use this past 6 months and learned that most everyone’s water jugs were either broken or just really gross.  So we decided to give each family who is actually using their filter 2 cantaros: one to capture the purified water, one to store it for use.

So what does TTP mean?  They are the initials for “To the Penny” – that was always the signal in my checkbook that I had balanced my account each month. 

At the store, when Cecilia was in line to pay – she had cash in hand.  The bill was $1,095.15.  She asked me if I had 15 cents.  I did and I gave it to the cashier. 

After we got back and the truck was unloaded – Cecilia was putting the change from the purchase back to its proper cash box.  There was change from the cantaros and change from the small snack we had bought for Raúl and José (Gatorade and pan dulce).  Then she turned to me and handed me 15 cents.  So it would be exact.

I rolled my eyes inwardly.  We’ve had this discussion before.  The Pastoral Team likes things ‘just so’ – they want accounts to be totally accurate.  They want every penny accounted for.  So knowing that I could not (and really should not) argue – I accepted my 15 cents back. 

Good stewardship of funds.  It is a GOOD thing

Raul in front of the truck

10 at a time they made it up the stairs to the chapel

Little by little the lake filled

Idalia trying to keep them from slip sliding

After a while they sort of held onto each other

Un MONTON de cantaros en la capilla!

Kidney Failure

Over the last few years I've heard of so many deaths due to kidney failure.  It seemed so common and I often wondered why it was such a deadly phenomenon here.  I ran across an article recently and wanted to share it here.  The credits go to:

Associated Press writer Filadelfo Aleman reported this story in Chichigalpa, Nicaragua, and Michael Weissenstein reported from Mexico City. AP writers Marcos Aleman in Bajo Lempa, El Salvador, and Romina Ruiz-Goiriena in Guatemala City contributed to this report.

The article (in part) is here below:

A mysterious epidemic is devastating the Pacific coast of Central America, killing more than 24,000 people in El Salvador and Nicaragua since 2000 and striking thousands of others with chronic kidney disease at rates unseen virtually anywhere else. Scientists say they have received reports of the phenomenon as far north as southern Mexico and as far south as Panama.

Last year it reached the point where El Salvador's health minister, Dr. Maria Isabel Rodriguez, appealed for international help, saying the epidemic was undermining health systems. "This is a disease that comes with no warning, and when they find it, it's too late,"

Many of the victims were manual laborers or worked in sugar cane fields that cover much of the coastal lowlands. Patients, local doctors and activists say they believe the culprit lurks among the agricultural chemicals workers have used for years with virtually none of the protections required in more developed countries. But a growing body of evidence supports a more complicated and counterintuitive hypothesis.

The roots of the epidemic, scientists say, appear to lie in the grueling nature of the work performed by its victims, including construction workers, miners and others who labor hour after hour without enough water in blazing temperatures, pushing their bodies through repeated bouts of extreme dehydration and heat stress for years on end. Many start as young as 10. The punishing routine appears to be a key part of some previously unknown trigger of chronic kidney disease, which is normally caused by diabetes and high-blood pressure, maladies absent in most of the patients in Central America.

In Nicaragua, the number of annual deaths from chronic kidney disease more than doubled in a decade, from 466 in 2000 to 1,047 in 2010, according to the Pan American Health Organization, a regional arm of the World Health Organization.

In El Salvador, the agency reported a similar jump, from 1,282 in 2000 to 2,181 in 2010.

Despite the growing consensus among international experts, Elsy Brizuela, a doctor who works with an El Salvadoran project to treat workers and research the epidemic, discounts the dehydration theory and insists "the common factor is exposure to herbicides and poisons."

End of article.

So here we have a major killer.  And from previous posts you have heard a little about the health care resources here - access to and limitations of.  I don't know what the solution is.  It would take the cooperation of many: big business, little business, governmental regulations in place and enforced for safety and accountability, the health care system, individual as well as company owned farming practices...

I just can't imagine changes happening any time soon.  And in the meantime, thousands are suffering and dying a painful death.

Can I have prayers for the people please?

Medical Assistance

One service that is provided by the Pastoral House is financial assistance for medicines, special medical tests and exams (CAT, X-Ray, etc.) or even a regular doctor’s consultation for those without the financial resources to handle those.

Why would folks need to pay for a medical consultation when the clinic up the street gives basic consultations for free?

Here is the reality … testimony provided by a woman and her daughter this morning:

Margarite and her mom ... I did not ask her to lift her shirt and I apologized profusely for being so intrusive of her privacy - Blanca explained that she could be helping someone in the future - perhaps her story will move people to help.

Margarite had a hernia that needed surgery.  She and her mom came to the house today asking for assistance for the post-operative medicine she needs – we helped out with that …

Margarite’s history: she had gotten a referral from the clinic here in Berlín to be seen at the little hospital in Santiago de María (25 minutes up and then down the road).  The hernia was apparently bad enough that it needed surgery.  She had that scheduled and then done. 

As she tells it: she was given too much anesthesia and woke up vomiting and with a severe headache.  Her neck had been in a hyper extended position (she demonstrated from her standing position with her chin pointed at the ceiling). 

They sent her home after the vomiting subsided.  The vomiting returned and the headache never went away.  She went to the clinic here in Berlín looking for relief.  She waited several hours to be seen and ultimately was never attended to.  So she went to a private doctor, who after a cursory look and simple questions, prescribed acetaminophen.  She was told to go back to the little pharmacy at the clinic where she was told they had none.  She had to go to the clinic in Alegría which is a 10 minute bus ride to the next town.  So she and her mom took the prescription and went.  There she was given 2 (yes … TWO) acetaminophen.

Wonderful health care provided to the folks here.

Not.

Please: for every delegation that comes down … each one of you – please consider going to Costco or Sam’s and buy the huge bottles of Acetaminophen, antihistamine and antacids (like Tums) to donate them to the Pastoral Team.  Those things are very expensive here and are weaker in strength to boot.  A big bottle could help a lot of people!

When people come to the house with headaches or aches and pains and they need basic OTC medicines – and we happen to have some here, we ‘baggy-up’ 20-30 for them. To me, it speaks volumes that people come to us for medical assistance.

We do have a small health fund that used to be supported by the sales of Blanca’s Bags – but because we only sell them to visiting delegations, those proceeds are very minimal.   With the quantity of people who come to the house in need of medical financial aid, those funds dwindle down rapidly.

I wish we had a dollar tree.  Better yet … a 20 dollar tree.   

Words

I had to laugh this morning.  I went down to get a cup of coffee and Idalia and Blanca were at the pila washing clothes.  Idalia said something that I didn’t quite catch … there are still (and always will be I suspect) many words I don’t know.  So when she said what she said and I didn’t understand I asked her what that one word was.  She repeated it for me.  Rather loudly she said: ‘doliente’   

I laughed out loud – not at her or the word – but it is so common, when someone doesn’t understand a language, when we talk to foreigners to try to help them understand what we are saying, we speak LOUDLY.  Not more slowly with more simple language.  But LOUDLY. 

So I joked with Idalia and thanked her for yelling the word to me so I would understand it better.  We both laughed then and continued the conversation about this word … exaggerating our loudness and having a lovely bit of camaraderie. 

She explained what it meant and why she was feeling that way.  Poor thing. 

“Doliente” basically means ‘sore’.

She was gathering firewood (for cooking) like most people in the cantons have to do.  This is one of her tasks for her family – probably because she is very STRONG. 

She apparently had an extra heavy load yesterday and she strained herself when she loaded them on her head and then again when she dumped them to the ground at her home.  Her side hurts her badly she said.

Así es la vida … la gente siempre doliente por su trabajo diario …

Such is life … people are always sore because of their daily work …

Hippocratic Oath?

I wish I had the words to describe the health care conditions here.  And I don’t know the half of it I’m sure.  I hear things from people we know and from the Pastoral Team themselves.  And I’ve had a couple of first hand experiences.  I want to tell you about one.

Two nights ago, two women came to the door needing help.  This is not an unusual thing.  Folks know that if they need help, we will do our best to do so and if we can’t help, we try to steer them in the direction of someone who can …

So these two women did not want help for themselves.  Instead, they told us the story of their neighbor: an old man who is quite sick. He has cirrhosis of the liver.  His niece – his only family from the sounds of it – does not want anything to do with him.  She lives right next to the man but apparently does not look after him.  So the neighbor ladies have been feeding him breakfast and supper and checking in on him on a regular basis. 

These women had become very concerned about his condition they so had taken him to a local doctor for a checkup.  This local doctor looked him over and she gave him a referral to be admitted to the hospital in Santiago de Maria.  The doctor said that at the hospital, they could ‘drain’ the fluid buildup in his stomach and potentially save his life.   By the time they were done taking him to the doctor and then back home so they could look for transportation, it was late. They couldn’t find anyone to take him to the hospital and since they knew about us and knew we had a vehicle, they came here and asked if we would take him.  

Cecilia and I talked and we decided we needed to do this for them.  So we all piled into the truck and headed down to where he lives just below the cemetery which is not too far away.  It took about 15 minutes for them to convince him to go – he didn’t want to – but eventually they all came out – several people supporting the man as they made their way down the roughly 50 yards of the uneven path leading from his home to the truck.  It took a couple of men to help him into the front seat of the truck.  He was obviously bloated and in pain.  His left hand and fingers were inflated like a balloon.  His stomach was obviously bloated as well and his calves were like rocks.  He could barely move.

And I’m not saying this to be rude, but he smelled horrible.  Now mind you – I dearly love the people I work with who live in the country.  Many of whom often do not smell very good – but we hug them and take no notice because of our love for them.  But this man smelled sick.  It was not a lack of personal hygiene care – although I’m sure that is minimal (and I say that feeling badly for him, not as a criticism) – but he smelled very ill.  I don’t have words to describe it. 

Unfortunately, it started to rain shortly after we took off so we had to close the windows.  Thankfully within about 15 minutes the rain stopped on the other side of the mountain.

So we got to the Santiago de Maria hospital about 6:30 p.m. and I could at least drive in to the parking lot so he could be closer to the entrance.  The women were able to get a wheelchair for him and as they were struggling to get the man out of the truck, a young man came out to help.  Turns out he was the relative of another patient waiting to be seen.  So they took him in and Cecilia and I drove out to park in the street and wait.  Only ‘family’ are allowed in - and at that, only one or two of them.  The women were not family, but they had his personal information so could be with him as his guardians. 

Cecilia and I waited outside for about an hour and a half.  Cecilia talked to the guards to convince them to let her in to get an update – to see how close he was to being admitted.  She found out that there was only one family left ahead of him.  So she came back out and we waited a bit more.  About a half hour later, all three of them came out: the two women holding up the sick man.  The doctor on duty would NOT admit him!  In spite of the referral and the obvious bloating – they would not admit him.  As one of the women muttered under her breath “it’s better to just die at home.”

What an incredibly sad thing to say.  But she got no argument from her friend or Cecilia. 

My question of disbelief: what kind of doctor would not admit such a sick man?  He even had a doctor’s referral!

As Cecilia said: “Such is health care in our country”

And the next day when Blanca was here and after telling her what happened the night before.  She literally said the same exact thing. 

This is such a different world than from where I come from.  And unfortunately – throughout the entire world there are LOTS of other countries who experience the same lack of care or worse.  

What a travesty.

More on Benigno

We were all sitting around the breakfast table this morning.  Most of us tired – not of us not sleeping well because we are worried about Benigno’s family (see previous blog).

 We were talking about this this morning – and how could it be that he could have been so sick and no one knew.  Because I did find out that no one knew!

 Apparently he felt a great pain in his abdomen (solar plexus area) early evening on Wednesday the 20^th.  His house is way down the road from the ‘center’ of town.  (We’re talking 20 families in this community).  He made his way up to his sister’s house and couldn’t go any further.  They called a friend and waited for transportation to get him to the hospital in Santiago de Maria and that come quite late.  He was given something for the pain, but they only did simple exams. 

 The sad reality here is if you have no financial resource, that’s all you get: a basic exam. For example: an older woman came out of her exam with one of the doctors of the Newton Medical Delegation last March and was quite emotional.  She said that this was the first time she was ever actually touched by a doctor.  In all her years – her exams have been words only:  “How are you?  You have a pain where?  Ah … take this prescription to the pharmacy and buy …” 

Ok.  That is over-simplifying the exam I’m sure.  I hope.  And I have hopes that not all public servant doctors are like this, but I have heard it over and over from several people: that without financial resources, that is pretty much all you get.  Period.

So there are many people who don’t bother to go to the doctor for every little ache or pain.  They ride it out.  They ignore it.  They live with it.  Because in reality, what could you do about it?  If you have cancer, or lung disease, or kidney disease or whatever – you can’t afford the medicines.  You can’t afford the operation.  So why bother to know. 

After the internment yesterday we were talking to some of the family and we were told that they were told that ex-rays showed his lungs were basically ‘dead’ and non-functioning.  He ended up in a larger hospital in San Miguel and died there.  The family might never know what was wrong with him.  But it is possible he was riddled with cancer and never knew it. 

May 13th 2011 - Jesus

Rest in peace in the loving arms of God your father. 

We just received a phone call that Jesus died.  Not 15 minutes after I posted the story of our visit with her.

We're sad. 

We'll be driving out there again tomorrow morning.  God must have known we needed to be there because a meeting we had scheduled in the morning got cancelled.

Please send up prayers for the family.

Cancer

Jesus (in the back-ground) and Blanca two weeks ago.

Today we received a phone call from a family in Rio los Bueyes. We always visit this family when we go down there for their annual Celebration of the Martyrs. In fact, we were there just a couple of weeks ago. (See Alisha’s blog – link to the right!).


We knew that Jesus, the mother/grandmother has cancer. She has had good days and bad. When we visited a couple of weeks ago, I could see she was weak and she only stayed out on the patio with us about 20 minutes. She then had retired to her room to lie down.

So the phone call today was from her daughter Eulalia. Mom is doing very badly she said. She is not sleeping, she is not able to eat or drink and she is vomiting blood. (Sorry for the graphic image). And she was asking for ‘those from the Pastoral House’ –

We decided we needed to go see her. It is what the Pastoral Team does. They visit the sick and try to give comfort.

Normally it is over an hour’s drive to Rio los Bueyes but we learned of a shortcut and now it only takes about 55 minutes.

When we got there, she was in bed so we went in to sit with her. She recognized and acknowledged us and spoke briefly. Blanca asked about her pain. She said ‘not too much, but I am nauseous and I can hardly sleep.’

She is so thin. Her stomach is quite bloated though. She is weak and even as we were there, she was groaning the soft groans of nausea. And several times she had to spit into a rag, or TP. And indeed, she was spitting blood.

She was very hot. It is very hot in the valleys and her room is cinderblock with one window. For some reason, the door was shut – but Cecilia propped it open for air flow. Of which there was very little.

Eulalia was using a large folded towel to fan her mother. Resting her arms every so often.

We talked for a while. I myself was praying for peace and comfort for all of them and freedom from pain and nausea for Jesús. At this point, the only freedom will come from death.



We only stayed about a half hour. Before we left, Eulalia had one of the children climb a tree and fetch some oranges for us to take back to Berlin. Even in grief and suffering, people are compelled to share!

All the way back to Berlin I could not stop thinking of her. And about how Jesús is being loved by her family – especially her daughter. I was thinking about how hard it must be for the family (they live in a multi family compound so there are lots of children that also need tending).

Death is a fact of life here – I know that – I have grieved with many families in my short time here. Suffering is a fact of life here.
Pain is a fact of life here.

People suffer but they take it in stride. I’m not saying people are ‘content’ with their lot in life – but death, suffering and pain do not necessarily incapacitate people.

There are NO resources to help this family. No hospice care. No hospital that they could afford to take her to help her manage the pain and nausea.

They have each other. And they love each other. And they do what they can to soothe the suffering.

God bless these folks. And all people suffering illness and those who care for them – resources or no.

Wendy

This morning there was a bit of joy for us here in Berlin. I received a call from our friend Jorge T. in San Miguel. A while back we had asked him where we might be able to buy a wheelchair for a child here in Berlin – we were hoping he knew of a place in San Miguel so we wouldn’t have to go all the way to San Salvador. He said that his Rotary Club could probably get a chair. And they did! Rotary Club Siramá based out of San Miguel collaborated with Rotary Club Choluteca in Honduras to obtain a chair for us! (www.clubrotariosiramasanmiguel.org)

So Jorge called to set up a time that they could come to Berlin to deliver it. They wanted to go to the community and visit the little girl personally. So we found a time we could all go. It happened to be yesterday – Mother’s Day here in El Salvador.

Ursulo and Jorge from Rotary Club Siramá arrived about 10:15 in a smallish car. We all knew it probably could not make it on the roads in a canton so we loaded the wheelchair in the Pastoral House pick up truck and I drove us down to El Recreo.

I wasn’t entirely sure where Wendy lived in El Recreo – but I was told that we would be met on the main road by the cut off to their house. And sure enough, grandpa Alcides was there waiting for us!

He hopped in the back of the truck and pointed the way. I had never been on this road before – it was a bit rutted with some tight curves, a bit narrow in spots and well off the beaten path. We finally made it. I parked on the street but was soon told to move the truck into the yard because something needed to get by. I thought another truck, but it was an ox cart full of wood.

I went in to greet Grandma Marta and Wendy who were in the house. Wendy was finishing her meal of beans. The men unloaded the chair. We spoke for a while with Alcides and soon Marta carried Wendy out and set her in the chair. We all commented and expressed appreciation of the chair. And Jorge and Ursulo asked questions about Wendy’s condition.

It was all incomprehensible to me so I later asked Jorge to explain in English (he is bilingual). He said “the congenital defect of the girl in her back is named myelomeningocele. She went to surgery when she was one day old. Later she went back to the Operating Room and the neurosurgeon set a valve in her head to regulate the cerebrospinal fluid.”

Marta lifted up Wendy’s shirt so we could see where she had surgery. They must have grafted the area with the skin from her thigh. You can see in one of the photos a large patch.

I googled the condition to learn more. Skip the next 3 paragraphs if you are a little squeamish. It isn’t horribly graphic – mostly sad.

From the MedlinePlus website (A service of the U.S. National Library of Medicine NIH National Institutes of Health): Myelomeningocele is the most common type of spina bifida. It is a neural tube defect in which the bones of the spine do not completely form, resulting in an incomplete spinal canal. This causes the spinal cord and meninges (the tissues covering the spinal cord) to stick out of the child's back. Other congenital disorders or birth defects may also be present in a child with myelomeningocele. Hydrocephalus may affect as many as 90% of children with myelomeningocele. Other disorders of the spinal cord or musculoskeletal system may be seen, including syringomyelia and hip dislocation.

The cause of myelomeningocele is unknown. However, low levels of folic acid in a woman's body before and during early pregnancy is thought to play a part in this type of birth defect. The vitamin folic acid (or folate) is important for brain and spinal cord development.

Additionally:
Children who also have hydrocephalus may need a ventricular peritoneal shunt placed. This will help drain the extra fluid. This procedure is done in the operating room under general anesthesia. It takes about 1 1/2 hours. The child's hair behind the ear is shaved off. A surgical cut in the shape of a horseshoe (U-shape) is made behind the ear. Another small surgical cut is made in the child's belly. A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain. Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity. Sometimes, it goes to the chest area. The doctor may make a small cut in the neck to help position the catheter. A valve (fluid pump) is placed underneath the skin behind the ear. The valve is attached to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure.

Wendy does have Hydrocephalus. I could see the tube along the side of her neck and it’s origin on her scalp.

God bless that child!

As we were sitting and talking with Wendy and her grandfather, small talk mostly, Martha came out with bowls of beans for each of us. And then came out with heaping plates of tortillas. And then she came out with huge glasses of lemonade (which gave me no ill effects thank you very much!!)

This is another example of the generosity and hospitality of the folks who have so very little. I learned that this family does not own the home they live in … they are the caretakers of the property. Which means they at least don’t have to pay rent. But the only work the grandfather has is farming. And that does not provide much ‘income’ – especially when there is a bad harvest like the last two years.

I was very happy that Rotary Club helped this family! What a blessing!

And we will keep an eye on them. And I know their partner church in Iowa will also. They already have and I know they will continue!

Wendy in her new chair

Jorge, Alcides, Ursulo, Marta and Wendy

Jorge, Wendy and Grandma Marta

Ursulo, Alcides, Jorge, Wendy

An old wheel chair - they lead a rough life

Jorge and Wendy