Leadership in Medicine for the Underserved/Vulnerable

First Day in Las Delicias

2012-01-30T19:44:00.000-05:00

Today was an amazing first day in the rural village of Las Delicias, not far outside the city borders of San Salvador. We had the pleasure of meeting the energetic, knowledgeable, and extremely dedicated health promoter in the community, Morena. She had us jump right in and help out with her activities in the community. We made home visits to pregnant women (there are currently 18 in the community), brushed up on our newborn exam skills, assisted with injections, and learned about all of the impressive work that they are doing in the community.

Exploring the community-

From left: Morena, Steve, Angela, Mike

Morena with one of our pregnant patients, who is due this month!

(Fingers crossed that we can be there for her during labor!!)

Some stats on the age breakdown of Las Delicias. There are about 35 births per year.

While the average life expectancy is 67 years, some of the residents seem to beat the odds, with 121 elders making it past that-- must have to do with all the great health outreach going on! :)

Morena's "Risk Map"-- green = low risk, yellow = moderate risk, red = high risk.

We saw the whole range in our visits today.

There are a number of programs dedicated to improving the health of the community of Las Delicias, including:

Vaccines for children
Pediatric weight checks and assessments for malnutrition
Vaccines and outreach to the local school
Elder outreach - flu & pneumonia vaccines, as well as a comprehensive meal program
Adolescent support group
Dengue campaigns
Animal vaccination against rabies
Pap smear campaigns

We will have the opportunity to work on a number of these projects during our time here, so keep an eye out for more updates!

¡Bienvenido a El Salvador!

2012-01-29T22:20:00.000-05:00

We made it safe and sound to El Salvador! The only hold-up was at customs, where we have to do a little more paperwork to get some of the medical supplies released, but it should be resolved soon. Shout-out to the generous donations from faculty & staff at two of our community campuses, in Midland and Flint! We couldn't have done this without you.

Upon our arrival, we were greeted by the fabulous FIMRC (Foundation for the International Medical Relief of Children) team, including Marloes, the Field Operations Manager, and Italo, transport and tourism guide extraordinaire. :)

Since we arrived over the weekend, we were fortunate to have some time to explore some local gems in the region of San Salvador (capital of El Salvador). Italo took us on the grand tour of la Ruta de las Flores, with stops in the villages of Juayúa and Concepción de Ataco, where we explored local cuisine, shimmied to cumbia music, and checked out the artisanal markets. We also had a lovely time at the cascada (waterfall) Los Chorros de la Calera, basking in the sun and cooling off in the crisp water. And we had the joy of meeting the friendly neighborhood snake of Concepción de Ataco!

Here are a few pictures from our journey:

From left (in both pics!): Angela Kuznia, Julie Celebi, Steven Moyo, Michael Moffat (all 4th year medical students)

Tomorrow, we will meet with Morena, the Community Health Coordinator and local health promoter. She is a lifelong resident of Las Delicias, the rural village where our clinic is based and where we will be conducting our health campaigns. We are excited to see what awesome community projects we can be a part of!

Until next time...

We need your help in El Salvador!

2011-12-26T21:18:00.003-05:00

Dear friends and supporters of the LMU program:

It's that time of year again-- when the Leadership in Medicine for the Underserved students travel abroad to engage in service with needy communities abroad.

The departure date for the senior class of LMU is fast approaching - we fly out on January 28th! We are gathering together needed supplies and donations for our respective sites in El Salvador and India. Wondering how you can help us within the next month?

For CASH DONATIONS, please visit:

https://www.givingto.msu.edu/gift/

1. Under “OR”, type in Leadership in Medicine for the Underserved

2. Select "Leadership in Medicine for the Underserved-Saginaw" when it comes up.

3. In the upper right hand corner, designate your desired donation amount, and click "save & continue".

4. Enter the necessary information, and click "submit donation".

If you are interested in SUPPLY DONATIONS, please see the list below for needed items in El Salvador. Contact macombe2@msu.edu or julie.celebi@gmail.com to arrange pick-up in the Flint/Saginaw area or mail items to:

Michigan State University

Flint Area Medical Educaiton

ATTN: Catherine Macomber

One Hurley Plaza

Flint, MI 48503

Thanks in advance for your support of the medically underserved!!

Project Las Delicias, Donation Request List

MEDICAL SUPPLIES DONATIONS

Childrens Gummy Vitamins

Childrens Chewable Vitamins

Prenatal Vitamins

Acetaminofen (Children and Adults)

Acetaminofen Infant Drops (Babies)

Ibuprofen Suspension (Children and Adults)

ProAir HFA Inhalation Aerosol & Canister

Asthma Inhaler: Qvar 80mcg/100mcg Inhalation Aerosol w/Canister

Asthma Inhaler: Ventolin 100mcg

Iron Supplements (Adults)

Pregnancy Tests

Glucose Strips for One Touch Ultra Mini

Glucose Strips for Prodigy Autocode

Glucose Strips for Contour

Toothpaste (clinic supply)

Antibiotics for Children Claritromicyn

Hydro Cortisone

Alchohol Wipes Childrens

Allergy meds (liquid and tablets)

Antibacterial Cream

Alcohol Wipes

Cleansing Wipes

Calcium Supplements adults

Antibiotics (please specify which ones!!),Claritromicyn

Anti-Bacterial Cream

Baby scale

Pedia- lite

Scale (digital and extra batteries)

Pediatric Nebulizer Mask/Tubes

Exam bed paper

Newborn Clothing

Tongue Depressors

Pedialyte Oral Electrolyte Maintenance Solution

Baby clothes (Newborn males)

Baby wipes

Stethoscope

Packets for Nebulizer

Mosquito Nets (Infused with DEET)

Nasil spray

Cloth Diapers (New born/infant)

Ear thermoter

Body Wash

CLINIC SUPPLIES DONATIONS

Towels

Sharpies

Whiteboard Markers

Soccer Balls (Size 5)

Needle for inflating balls

Duct Tape

Pens

Jump Ropes

Colored Pencils

Coloring books

Money for paint to repaint the clinic

Crayons

Frisbees

Baby clothes (Newborn males)

Puzzles

Books in Spanish

Dictionary En-SP/Sp-En

Combs

Projector

CAMPAIGNS DONATIONS

Dental Campaign

100 Little Toothpaste for Children

100 Children’s Toothbrushes

Or Money for Dental Campaign to buy supplies locally

Dengue Campaign

50 small Sponges

50 small bags of bleach

Or Money for the Dengue Campaign to buy supplies locally

Fluoride Campaign

Fluoride for 100 children

Q-tips for Fluoride application

Plastic cups

Gloves

Hand Washing Campaign

Big bottle of fluid soap (for instruction)

100 small bar soaps

Money for Hand Washing Campaign (supplies bought locally)

Good Foods Campaign

Money for fruit for class(es) of children.

Went to the Anthropology Museum on Wednesday

2011-02-16T00:02:00.000-05:00

We took a trip to the anthropology museum last Wednesday, as a field trip for Spanish class. It was an excellent way to learn about the culture, history, and language all at once!

Figurines

Ruins

My personal favorite

Costa Rica part II...

2011-02-09T20:15:00.004-05:00

Traditional Costa Rican dancing:
Alvaro and his family:

Waiting for the dentist at el Comeador:

Dental visits:
Group picture with Mama Rae, Camilo, the neighbor family, Matt, Claire, and the rest of the Costa Rica/Nicaragua group:

One-on-one patient education:Listening to a heart murmur:

Dr. Schnuth trying her hand at raking coffee:

Answering questions after a presentation:

Checking BP's:

After our weekend at Manuel Antonio, we started the week by meeting two new FIMRC volunteers for the week, Matt and Claire. They are 3rd year Physician’s Assistant (PA) students at NMDNJ. It made for an interesting week having someone else there with the same name. It was definitely nice to have the additional energy, knowledge and experience.
Once we were back at the clinic at Alajuelita it felt like home. It was another wonderful week of working with the doctor, the psychologist, in the pharmacy, and performing front office/check in duties. After the clinic hours were completed, Dr. Stedem gave us an enthralling presentation on snake bites. He talked about the different species of snakes in Costa Rica, the color patterns signifying dangerous species (Remember: RANA Rojo, Amarillo, Negro, Amarillo aka Red, Yellow, Black, Yellow are the POISONOUS species!), the physiology of venom and how anti-venom is made. Costa Rica is one of the worlds leading exporters of anti-venom.
Once David arrived we had our 7th Spanish lesson. It’s been very helpful to have a Costa Rican medical student as a tutor as he is able to answer questions about not only the grammar but the subject matter as well.
That evening we spent some time getting to know the new PA students. It was fascinating to learn about the program they are in, some differences between PA school and medical school, and about the different career options available to them.
Tuesday we spent the afternoon at a local coffee plantation. They welcomed us with a cup of iced coffee and a small taste of what was to come. Our tour guide was very knowledgeable and engaging. The Doka Estates was founded by the Vargas family at the foot of the Psoas Volcano and still utilizes the same building it started with over 100 years ago. They grow the highest quality Arabica beans. While coffee plants can be used for 100 years but each year the quality decreases slightly thus the Doka Estate only uses their plants for 25 years. The workers hand-pick the red coffee “cherries” and fill giant baskets. After savoring the natural sweetness of the coffee bean fresh from the plant we saw the gathering gate, the peeling machine, the drying fields, the sorting bins, the storage room and ended in the roasting room. Dr. Schnuth got to try her hand at raking the drying coffee beans; she was so great at it that our guide offered her a job. In the roasting room we got to smell some freshly roasted and ground coffee. The best part of the tour may have been the gift shop where we got all the free coffee and chocolate covered espresso beans we could handle, needless to say we all left just a little happier then when we arrived. After the coffee plantation Dr. Schnuth invited us up to her dwelling to enjoy the view and get a taste of some of the goodies Costa Rica has to offer. We got to meet the family that lives in the house next to her. During our time there, we had an impromptu lesson on Costa Rican slang as Camilo translated the ever popular You Tube video: “Gringo Pinto”.
The topic of our health presentation on Wednesday was pregnancy. Our opening skit involved our newly married couple, Angela and Mike, and a slight slip in judgment that resulted in Angela becoming pregnant. He friends told her to go to visit the doctor but she was afraid because she was a Nicaraguan immigrant. In Costa Rica the National Government (the Caja) guarantees all women, regardless of status, 7 free prenatal visits. Additionally, all deliveries are free of cost to any women. We gave additional information regarding the importance of healthy eating, not smoking, not drinking, not using illegal drugs, checking medications with your health care provider, circumcision, and the importance of breast feeding. The concluding skit involved pregnant Angela and me, as her sassy friend. As the bad influence, I tried to get her to smoke and drink to celebrate her pregnancy. But Angela knew better and since her doctor told her not to, and since she knew she needed to be responsible for the well being of herself and her baby. After the presentation we handed out patient education and then allowed ample time for questions. The women, once again, had tons of questions and Camilo fielded them like a champ. Again, many misconceptions were debunked. Hopefully the women will walk away feeling empowered knowing a little more about the wonders of pregnancy and their future babies will be healthier for it.
That evening we had a wonderful treat as we went to a traditional Costa Rican restaurant complete with traditional dancing. The restaurant was on a hill over looking San Jose. Our driver, Alvaro, who became one of our favorite people we’ve met while down here, brought his beautiful family. We got to spend some time getting to know the man behind the blue bus. Videos of the dancing soon to come.
Thursday, as a follow up from the previous week, we were lucky enough to have a real dentist accompany us to the Comeador (soup kitchen), while he checked the teeth of the children we were set on entertainment duty. There was some piggy backed line dancing, a nice series of piggy back running races, Anda! (tag), general dancing while the children on our shoulders entertained us with their wonderful singing, vuelto (spinning in circles), patty cake, and group jump rope. It was a lot of fun but we were all exhausted by the time we were done. That evening our Tica Momas had a potluck style goodbye dinner for us. They shared their food and also some of the less-then-flattering stories of our times with them, including the night I ate the plantain leaves and Angela almost got attacked by her host mom’s big black scary dog. We gave our presents to our moms and exchanged thanks and appreciation for all they had done for us. They shared some stories of previous students.
Our last day at the clinic was bitter sweet. We were joined by Dr. Linda, a retired internist from the Seattle area who had been involved in National Health Service Corps and also done some work through temp agencies. We got to pick her brain on what it was like to work for both. She spoke about being a female doctor, raising a family, what it was like to get into and work for the National Health Service corps, what working on an Indian reservation was like, and the differences between rural and urban medicine. We also got her take on the political changes in medicine and the possible direction that it’s heading. She spoke about what it was like to be in medicine during her generation vs. what it may be like for us during ours. She way very honest and very open to answering any and all questions we had. It was very informative and gave me quite a lot to think about. We shared our last lunch (which happened to be left over Arroz con Pollo with enough to feed a small army) with Dr. Stedem and Camilo. We concluded with our last Spanish lesson with David.
That evening was filled with packing and preparing for our last night in Costa Rica. We met up with the PA students, had a few tearful goodbyes with the host families and went off to enjoy our last night in San Jose with Dr. Stedem and Camilo. Good times were had by all, an excellent way to end our Costa Rican adventure.

Sunday: Food Tour

2011-02-08T15:02:00.001-05:00

Cuisine is a big part of any culture, and so this past Sunday we went on a food tour.

This was a starter we shared on our first stop. We didn't want to spoil our appetites, but sometimes food is too good to pass up.

Our second stop. Coffee is grown on the mountainside. Why does it look like a waffle iron? To collect water.

This dog was sitting close to me while I was enjoying my chocolate covered fresa, manzana, pina, y sandilla.

Our last stop was holding a large event, with both great cuisine as well as entertainment.

She sings to me as I take the photo

Uncut churro

Multiple ways of peeling mangoes

The window of what was the most fun shop in the pueblo

One of the rarer sights to see

Greased Lightbox

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Saturday: Hiking the Izalco Volcano

2011-02-08T14:40:00.000-05:00

Weekends provide an opportunity to explore the local area and familiarize ourselves with the country. This past Saturday, our destination was the Izalco Volcano at Cerro Verde.

A lake we passed on the way to the volcano

Izalco Volcano

Sukhi, Boramee, and Madonna

After about 1300 steps down into a valley, we began our trek up the volcano.

We made it to the top!

360 degree view from the top

Boramee and Madonna take in the view

Other hikers enjoying their time atop the volcano

A little bit of catch up

2011-02-08T14:15:00.003-05:00

Quick recap of the past few days...

We organized and stored the supplies we brought to El Salvador. Some of the bins needed a little cleaning.

Boramee works on creating some posters to advertise the upcoming Campana Citilogia, where we will be performing exams for breast as well as cervical cancer.

Angie discusses what she would like the posters to say.

Emily working on a poster

Madonna and Karyn working on their posters

Angela working on a poster.

Sukhi creating the large poster.

Thursday for Spanish lessons we went on a field trip to Joya de Ceren, an agricultural village that was buried underneath layers of ash due to a local volcanic eruption.

well-preserved pottery

One of our Spanish teachers explains the picture

Chocolate

We have all been having a great time thus far. It has truly been an experience that has us immersed deep in the local culture, the health problems of today, and the history of yesteryear.

2011-02-06T15:22:00.003-05:00

Super Hilo getting down and dirty with Mr. Cariaton:

The Clinic at La Promesa while Dr. Stedem explained the government program that brought the families to the area:

Angela giving the demonstration at the conclusion of the STD program and Mike showing enthusiastic support:

Children with their toothbrushes:

At the start of brushing the human mouth:

Doing physical exam for a child with strep throat:

It’s been quite the two weeks since we last checked in. We continued the week at the mobile clinic in La Promesa. The clinic was held in a soon to be soup kitchen for the city. They are still in the process of getting funding for electricity and running water. The clinic is situated at the side of a canyon with a breathtaking view. There are always birds that sore trough the canyon throughout the day. The mother of the house next door was always kind enough to bring us homemade goodies each morning. She made, what I believed was called “pan de pan” which is all the left over bread mixed together with milk, cinnamon and sugar and then baked. One day she brought over the Costa Rican version of Horchata, which is a sweet creamy thick rice drink.
Similar to the week before, we rotated through visiting patients with the doctor, working in the pharmacy and checking patients in. Once patients were checked in we would spend time with the children. We would color with them, read aloud or help them read, or simply spend time talking to them. Dr. Stedem spent time explaining to us that simply talking to the children makes them feel important, as they rarely get attention from anyone besides their friends or siblings. They have few, if any, role models in their lives. I’m hoping they will remember us as fondly as we remember them.
The children showed immense interest in stethoscopes. During one of my days in the front office I spent some time with a group of girls. I would help them listen to their hearts. As soon as their heard the “lub-dub” their eyes would light up like it was Christmas. It was very touching. I also got to have story time with the children, though sadly I think Donde Viven Los Monsturos (Where the Wild Things Are) is a bit out of my Spanish league. I’m at more of a Ve, Perro. Ve! (Go Dog Go) level. Though the kids, after laughing at my attempt at reading in Spanish, were more then happy to jump in and have group read aloud. Joe, our undergrad friend from Princeton, also had a read aloud session with the kids.
Working with the Doctor was always a great experience. He is a wonderful teacher and more then willing to answer any and all questions. He is also very interested in having students as actively involved as possible. He lets us ask questions during the history, do physical exams and help develop the treatment plan. He is great with the patients and they really do seem to respect him. He is also wonderful with the children. He calls them all “campeon” and “princesa”. They light up when he is around. During time with him a few of the things I saw were scabies, allergies, UTIs, URIs, gastroenteritis, colitis, IBS, psoriasis, HTN, Diabetes, strep throat, congenital heart murmur in a young child with chronic fatigue, a variety of neurologic/developmental disabilities, carpal tunnel, malnourishment and a few cases of suspected child abuse.
The doctor also made house calls during the week. One day during the clinic we went to a house of a boy who had gotten an ingrown hair that had become infected and had formed an abscess. The other was a patient who was post-op from a heart catheter.
Tuesday after the clinic we had a little taste of San Jose, the big city. Mike, Angela, Joe and I went into downtown San Jose and visited the Costa Rican Contemporary Art museum. The exhibit had a sacrificial theme featuring alters, lights, bread, blood and oil. The piece that struck me were a collection of oil barrels draped with a sea of dead roses to represent the people that had died for liquid gold. We then visited the National Library and spent some time getting to know our new friend Joe in a quaint coffee shop at the side of a lovely Parque Morazon. Dinner was at Café Mundo, which is a popular restaurant in down town San Jose. We concluded our evening at Café Morezon.
Our health presentation on Wednesday was on STDs and contraception. We began the presentation with a small skit where Angela pretended to have some STD symptoms and she went to the doctor. We hoped the women would grasp that it was ok to ask your doctor about these symptoms as they are not normal and also some exposure to questions the doctor may ask during the visit. We also added information about getting both partners treated and abstaining from sex until after the symptoms were gone. The presentation involved additional information on what STDs are, the most common, how they are transmitted, signs and symptoms and what to do if you think you have one. Then Joe and I got to perform a memorable skit on the importance of using a condom. The opening line was “Mi Amor, Hagamosolo” aka “my love, lets do it”. I’m sure I turned bright red. But the women laughed and hopefully it will give some of them some boost in confidence when it comes to condom usage. Then we concluded with a demonstration of how to use a condom correctly, handing out condoms and a small sheet of patient information on ETS’s (aka STDs) that summarized the information we had delivered. Once the presentation was over, Camilo (the right hand man of the clinic) did a phenomenal job of answering any and all questions the women had. Thank goodness Doctor Schnuth was there to contribute her professional knowledge. It was wonderful to watch the women so engaged in asking questions and I feel that a lot of misconceptions (such as whether or not you can use Vaseline as lubrication) were straightened out and hopefully the women will feel somewhat empowered after the presentation.
The following day we did a dental campaign at the mobile clinic. We went door to door getting the children of the village to come to the clinic. Then we had a presentation on the parts of the tooth, why to brush, why to floss and how to brush. Luckily Camilo’s sister is a dentist and we were able to utilize her as a great resource. She let us borrow a model of a mouth for the presentation and was able to double check our presentation for accuracy and appropriateness. We started the presentation with a skit about Angela the tooth, and Joe as Mr. Cariaton (Mr Cavity). But luckly Super Cepillarse del dientes (toothbrush) and Super Hilo (floss, aka Mike and myself) saved the day by scaring away Joe. We ended by forming a mouth with all the kids as teeth and proceeded to brush and floss them. Then Dr. Stedem showed them a cartoon and we handed out tooth brushes and toothpaste to the kids. We repeated the presentation again at the soup kitchen in Alajuelita that afternoon and ended, as usual, with playing with the kids. I’m pretty sure their favorite phrase is “corre caballo corre” (run horsey run).
On Friday, Angela’s Tica Mom (her house mother), sent enough lunch to feed a small army. We all got to partake in the traditional Costa Rican Taco which consists of corn tortillas, beans, pico de gallo, eggs, and sausage and of course a little topping of Salsa Lizano (the most amazing condiment known to man). After lunch we concluded the week with inventory and organization of the pharmacy. Our Spanish class followed. To end the week we met up with Camilo in San Jose for our last night with Joe.
Saturday we woke up early for our trip to Manuel Antonio. We spent the day relaxing on the beach and playing in the waves. It was filled with people from all walks of life and is known as the Costa Rican Mecca for alternative lifestyles. While we were on the beach we unfortunately saw a near drowning. The lifeguards of the beach ran down to pull him out of the water and laid him on the sand. They proceeded to draw a crowd of people, fan him with a towel and at some point rolled him onto a surf board for a backboard (talk about resourcefulness). The ambulance eventually followed. However, soft sand and mini-vans seem to not mix as the ambulance got stuck in the sand. Sunset soon followed and our evening was concluded with a nice game of foosball with the restaurant at the hostel.
The next day we ventured into the National Park. After walking through the jungle we came upon a nice quite beach. As we were out enjoying the waves a monkey proceeded to open our bags and steal our food. As soon as we realized we ran up to save it only to find the monkey sitting in the tree skillfully opening the package and eating it in front of us. I could have sworn he was laughing at us the whole time.
We walked back into town to enjoy the local fair and then proceeded to a different part of the national park. While there, we got to watch a family of monkeys and a family of iguanas. The waves were big, the sand was white and it was like a little tropical paradise. It was the perfect way to recharge for a busy week at the clinic.

Part 2 to come soon…Cheers, peace and love!

Photos from Uganda!

2011-02-03T04:42:00.006-05:00

Here we are with Richard, the health outreach coordinator at the FIMRC clinic in Uganda. We are outside the Bududa District Hospital, awaiting the arrival of staff from TASO (The AIDS Support Network). We were able to observe an outreach visit for AIDS patients in the area. Patients talk with a counselor, meet with a physician, and are provided with medications. The organization has been used as a model for treating AIDS throughout Uganda and other places in Africa.

Getting to know the Community

2011-02-01T22:18:00.000-05:00

Hola!

Hello again,

Today was day 2 of volunteer work in El Salvador, and what a day it has been. We started the day with Spanish lessons, and soon after that, we went with Morena to perform prenatal visits with locals.

Karyn performs a prenatal visit

Afterwards we had lunch, and we helped out around the clinic whenever it was needed.

Angela and Madonna apply a new dressing

Homemade jewelry for sale at the clinic

Reading? We can help with that too.

A child enjoying a book.

After lunch, with met with a number of community leaders. We also began work decorating for a large community event coming up in about 3 weeks. We are very excited to be working with the local community to ensure this will be a successful event!

Our neck of the woods

A Weekend in Huaraz, Peru, day 2

2011-02-01T16:08:00.007-05:00

Read the post about day 1 in Huaraz first!

Shawna rapelling down a waterfall in Huaraz

Our second day in Huaraz was mostly free for tourism. It started off as a promising day, with a bright blue sky and a great temperature. Six of us contracted with a tourist company to do 'canyoning', which I took to be repelling down cliffs. Much to my surprise, it was actually repelling down waterfalls! (They did say to bring an extra pair of clothes, as we 'may get a little wet'- we were actually all completely soaked by the end!). We descended one waterfall, and then made a descent just beside the second part of the same waterfall. It began to rain just after we finished the first descent, and since we were all getting cold at that point, we wanted to avoid more icy mountain water! It was fun though, with some definite adrenal moments, and the area was beautiful.

Emily and Steve pose with alpacas in downtown Huaraz

That afternoon we went to the home of our medical student friend, Jose, to have dinner with his parents, the anthropologist and award-winning author (his father writes in Quechua, the native Peruvian language). We had a lot of stimulating conversation with Jose's family, about literature, medicinal plants, and a pre-Incan culture called Chavin, which has ruins nearby which they say are 2nd only to Machu Picchu. Sadly, we didn't have the time to visit the ruins, but we saw many pictures which looked amazing. The Chavin temple which is nearby has many intricately carved statues with snakes, jaguars and their diety which combines features of the two. The temple is 5 stories tall, and natural tunnels funnel light down onto the main carving of the god, which is in the depths of the temple.

That night we travelled back to Trujillo on the sleeper bus, and arrived back home in time to have breakfast and go right back to the hospital!

A Weekend in Huaraz, Peru, Day 1

2011-02-01T15:46:00.006-05:00

This last weekend FIMRC organized an optional trip to the city of Huaraz, so that we could learn about traditional Peruvian medicine. We all decided to go, and were glad we did because it was an amazing experience. Huaraz is a smaller city than Trujillo, about 8 hours away and located in the Andes mountains. It's situated in a valley between two distinct mountain ranges, one snow covered and the other not.

Rural village in Huaraz where we saw traditional medicine.

On Friday night we took a sleeper bus from Trujilllo to Huaraz. These double decker VIP buses are a common sight in Peru, and are incredible. The have reclining seats, food and drinks are served, and there are movies (that may be less incredible, as the movies often play when you want to sleep). We 'slept' on the bus overnight and arrived in Huaraz in time for breakfast. We were met there by a Peruvian medical student, Jose, whose parents live in Huaraz and who had arranged our educational experience. Jose's mother is an anthropologist and his father is an author. His mother joined us and we took a rented minivan far into the valley, and then up a mountain. Our destination was a small village at the top of a mountain- it was a fairly remote Peruvian village, off the beaten path. The landscape was amazing- it was a scenic village of mud brick houses, flowers, birds and great mountain vistas.

Jose's mother talks to a local woman about medicinal plants.

We were introduced to the local healer, who explained Peruvian medical plants to us, and who was going to show us two traditional Peruvian medical ceremonies. The first was healing by Cuy (Guinea Pig), which involves rubbing the patients entire body with a live guinea pig, then killing the animal and disecting it. Any health problems found in the disected guinea pig are thought to reflect those of the patient (ie, if the guinea pig is pregnant, so is the patient- so they always use gender specific animals). The second process is healing by flowers, which is both diagnostic and curative. They take a large number of flowers, which are bought especially for the purpose, heat them up in a clay pot, and then rub the patients body in them. The pattern in which the flowers fall is also important, and the patient can't wash the flowers from their body for at least a day. The ritual also involves throwing the flowers at full force against the patient, much to our surprise. Emily volunteered for the guinea pig diagnosis and Steve underwent the flower healing- it was a fairly surprising experience for all involved, but very authentic and we are told still an important part of P eruvian culture. Many people, they say, will undergo one of these two processes before they will go to a hospital.

Undergoing the guinea pig healing ceremony.

After visiting the local healer, we continued through the valley to visit the ruins of a city which had been covered by an earthquake 30 years ago. The area was built like a memorial, with giant flower and rose gardens and monuments to the dead. It was eerie, but a beautiful place. It rained on us there, but we were interested enough to walk around and see most of the area.

Next, we went to a small mountain town with a nice central plaza and an ice cream shop. We watched them make the ice cream (more like gelatto), and then bought cones for 30 cents each. A few of us then walked over to a coffee shop. It was a really nice way to spend the day.

The Peruvian Hospital Experience

2011-02-01T15:19:00.002-05:00

A significant amount of our time in Peru has been spent in the Belen Hospital of Trujillo. A typical day in Peru has us shadowing Peruvian physicians in either pediatrics, surgery, internal medicine, or OB/GYN. We arrive at 8am and leave the hospital usually just before 12:30. So far, we've been doing two days in each service, and in groups of two students with a FIMRC staff member or Peruvian medical student to help translate.

So far we've done 7 days in the hospital, and everyone has had at least one day in each service. From my own experience, surgery and OB/GYN have been the most interesting- a sample of what I saw in each: in GYN I had a Peruvian physician who was interested in teaching and took the time to explain important information about each patient. We saw many women with pre-eclampsia, and many who had had C-sections due to high blood pressure, although the doctor said they probably were not really in pre-eclampsia at all. We saw a number of premature rupture of membranes also. In OB, I saw two natural births. An episiotomy was performed on one mother because it was her first child- it seems to be standard practice to do an episiotomy for a first time natural birth.

In surgery, I saw two C-sections, which seemed to me to be done quickly and professionally. Although I haven't seen much surgery in the US, I imagine it would be hard to tell the difference between a Peruvian and American surgeon unless you know where to look- for example, to save money on buying booties for the OR, most doctors have plastic bags wrapped around their shoes; they use every last bit of their sutures; and one doctor told me he doesn't change his gloves as often as he would like to in order to save money. The doctor told me that 50% of all births in Peru are by C-section, and the national health insurance covers the cost.

I also saw a prostetectomy, and the doctor invited us to get as close as possible to see the surgery. They made an abdominal incision and when it was time to remove the prostate, the physician had his entire hand up to his wrist inside the abdomen, he would occasionally pull out chunks of prostate. The blind feeling for the prostate was fairly surprising, but the surgery was very professional and quickly done.

Pediatrics and Internal Medicine were interesting at times- both services had patients with interesting diseases that you don't see often in the US, such as congenital CMV infection, Stevens-Johnson skin rash, spider bites with necrosis, and lots of cancer. However, these services are busy, and the floors are loud. Although I can have a conversation in Spanish on most topics without too much of a problem, I was completely lost in IM and Peds because of the background noise, the fast cadence of speech, and the fact that the doctors were often speaking to a group and not directly to me. Those services were not as educational as the surgical ones, where you get more personal attention from the physicians and there is less distraction from noise and bustle of the hospital.

Overall the hospital experience has been educational- we've seen how things are done differently, and in many cases, how similar medicine is - in Peru. The Peruvian medical students have been great about volunteering their free time to come and shadow with us, to make sure that the Peruvian medical staff knows who we are and to help translate and to keep us company.

First Volunteer Day in El Salvador

2011-01-31T23:57:00.001-05:00

Hola, we made it safely to San Salvador, El Salvador on Saturday night. Sunday we unpacked and explored the local area. Our clinic is located in Las Delicias, which is approximately 40 minutes away by bus.

This morning, we met the staff. In addition, a local nurse, Morena works with the FIMRC clinic. She is also part of the ministry of health for that area of San Salvador. She does home visits throughout the community and focuses especially on pregnant women and ensuring children are up to date with their vaccinations. Today, she took us to several homes in the community and let us practice our interviewing skills as well as vaccination administration.

We had a lecture from the local physician, Eduardo, about common diagnoses and treatment. We are excited to work with him and seeing patients. Over the course of the next 4 weeks, we will be seeing lots of children, dispensing medication, and offering basic health education. This will be an amazing 4 weeks!

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¡Comida de Peru!

2011-01-27T20:40:00.011-05:00

WARNING: The pictures to follow may cause your mouth to water, please keep una servilleta (napkin) in hand...

One of the wonderful parts of Peruvian culture is the delicious cuisine! We have been lucky enough to have the majority of our meals prepared by our host mom, Margarita, who we are trying to convince to write a cookbook! Her food is muy, muy rico!! She makes us everything from sopas con pollo (soups with chicken) to cabrito con arroz (goat with rice). Every meal is followed with a melt-in-your-mouth fruit which has included mangos and a cactus fruit called "Tuna." Outside of our casa we have tried three different ceviches so far, but there will be more to come! Our favorite thus far was at a restaurant on the beach in Huanchaca that was sprinkled with onions and perfectly flavored with lime juice. We all fell in love!

Another delicacy in Peru is Cuy (Guinea pig). A mildly fatty meat reminiscent of duck was enjoyed by our group in Lima.
Don't worry we didn't eat the ones to the left, we saw those at the Huaca Pucllana ruins.

Additionally, Causas are a popular potato dish stuffed with chicken, seafood, and chicken. We experienced a lovely Causa prepared by our very own Margarita. ¡Deliciosa!

Last but not least, many of us have tried the national cocktail, Pisco Sour, which is created with local grape brandy, fresh lime juice, sugar, and topped with frothy egg whites.

Looking forward to experiencing more culinary wonders of Peru! ¡Buen Provecho!

Happy Monday from Costa Rica

2011-01-24T22:01:00.001-05:00

Hola from Costa Rica!

After an eventful weekend of tourism, we were back to work bright and early this morning. This week we are running a mobile clinic in an underserved area of Santa Ana (a suburb of San Jose), which also happens to be the place where we live. Apparently, there was a movement a few years ago to help a group of unfortunate families in San Jose to obtain better housing. These families were given new homes in Santa Ana, which is a safer and nicer neighborhood to live in. However, this move didn’t solve all of the problems of this population, and so many of the people who live in this particular area are still very poor, unemployed, and/or sick. And, interestingly, the move makes them farther away from work opportunities in downtown San Jose and leaves their children in a district where the school is quite far away (and still not very good). We are set-up in a building which is in the process of becoming the equivalent of a soup kitchen, which is called a “comedor” here in Costa Rica. We forgot to pack a few key things, but were able to make it work for the day and we’ll bring more supplies tomorrow. I worked in the waiting room and pharmacy today, but it sounded like the patients had different health concerns than the population in Alajelita, so I’m excited to see some more variety of the medical kind. Dr. Stedem also explained that there is a large population of handicapped persons here, so I am interested to learn about the difficulties that such minority groups face in Costa Rica and the ways the health system, government, and foundations like FIMRC can help.

We parted with the Harvard students on Saturday during our weekend of adventures and were greeted by a new volunteer, Joe, a junior from Princeton, this morning. The additional volunteers were very helpful in coming up with ideas for evening and weekend adventures, and they definitely provided some great ideas and lots of energy and extra bodies for the health education programs and day-to-day activities in the clinic. I hope we were able to teach them a few things about some simple medical terms, conditions, and medicines, and that perhaps we opened their eyes to medical school programs like LMUV. I didn’t speak much with Joe today since he was in the doctor’s room with Claire, but I’m sure he’ll get the hang of things. And after Joe, I hear that we’ll be getting two more students during our last week here.

We had Spanish session #4 today and I think I am picking up on a lot more—certainly much more than last Monday! But I can tell that my brain has its limits—while I feel like I can understand WAAAYY more than a week ago, it seems that my vocabulary hasn’t improved much, or that I am now stuttering and speaking more slowly than ever. But it reminds me of learning the new “language” of anatomy in my first year of medical school. There is a time-period where you are taking everything in, then it needs to simmer in your brain, and then, finally, your mind puts everything together and you can understand and speak the language. So, hopefully all of that happens within the next week ;)

And finally, I’m sure you’re dying to hear all about our weekend adventures. On Friday we (all 7 MSU and Harvard students) drove to a resort near Jaco on the Pacific coast (about 2 hours away) and got to swim at two beaches and several pools. We went back home on Friday evening and went out dancing at a local salsa club. On Saturday morning we made the three-hour trek to La Fortuna, where we got to see a waterfall up-close, gazed at the volcano from afar, and went canopying (a.k.a. ziplining) through the jungle. The Harvard students went back to San Jose that evening, and left for Boston early on Sunday morning. We stayed the night in La Fortuna and took a public bus back to San Jose onb Sunday afternoon. It was an exhausting weekend, but the experience was well worth it.

Harvard kids—good luck with starting your new semester!
Families—we’re still alive and kicking!
Classmates in Peru—hope you’re having as much fun as we are!
Everyone else—Pura Vida!!!

From Angela.

2011-01-20T21:12:00.006-05:00

The FIMRC Clinic at Alajualita: The doctors office:

Playing soccer at the soup kitchen after giving the nutrition presentation:

Mike tending to a minor injury during the game:

Hard at work preparing the presentations with the students from Harvard (next to Angela, in the upper left corner, is Jessica, then Rosmary, Denni and then Marie is next to Mike)

Hola from Costa Rica! It's been almost a week in Costa Rica already. We spent our first day here visiting the local Sunday market and then went out to celebrate Angelas birthday. There are 4 undergraduate students from Harvard that joined us this week and have been a great addition to the group. Once we were oriented to the clinic on Monday we began working with the doctor and the psychologist. We have also been able to spend time in the pharmacy and in the front office doing patient intake. We had two days of lecture on the health system of Costa Rica and the use of psychology in the clinic. We also planned and executed two health programs for a local soup kitchen. The first was a presentation to a group of women about hypertension and stroke, and the second was a presentation to the children at the soup kitchen about nutrition and exercise. Both were well recieved by the community.

We have also had three spanish lessons from a Costa Rican medical student. He created a complete book geared towards medical spanish complete with grammer lessons, patient-doctor dialogues and a medical dictionary.

Our three different homestays have been a great immersion experience since none of the families speak english. They have been very gracious in their introduction into the local fare of Costa Rica including Gallo Pinto, a taste of the fresh local produce and plently of coffee. The coffee has definitely lived up to its reputation.

We spent one afternoon in downtown San Jose visitng the various stores and the souvenir market. We also took a tour of the Museo de Oro while downtown.

Dr. Schnuth has been very welcoming and enthusiastic. She seems to know everyone here.

This weekend we plan on spending some time on the beach, visiting a live volcano and relaxing in the Costa Rican sun.

Pura vida!

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Health Care in Peru (H.I.P.)

2011-01-19T20:31:00.014-05:00

Hola!
Well we have definitely been busy and have so much to tell you. For now we decided to give you an update on one of the things we care about most- health care! Aside from all the wonderful food- more to come from Shawna on that- we have been feasting on some food for thought. You see what I did there? Here are some morsels for you digest.

H.I.P.
1) Public H.I.P. - similar to say... Oh Canada! Peru has a public health care system that provides care to the:
A) Extremely poor and Poor via "Seguro Integrad de Salud" (SIS) which is free.
B) Employees/Companies via "Es Salud" which has some minimal cost covered by employers or those that can afford.
C) Policia y Armed forces

2) Private H.I.P. - similar to say... America the beautiful!
A) For Profit
B) Non-profit

Disclaimer: I have provided some well known reference health care systems but in no way is H.I.P., Canada or the US summed up in the above quick and dirty contrasts and comparisons.

Well enough theory let's see it in practice:

Hospital Belen: We will be working here over the coming 6 weeks focusing in pediatrics, internal medicine, surgery, ob-gyn, family med and psych.

Bella Vista Health Center in Nuevo Jerusalen: The doctors, dentists and nurses are really excited to work with us and us with them. Especially as part of their TB program.

Jerusalen Health Center: We have already started working along side the doctor(a)s and nurses (enfermero(a)s) doing well child checks, psicoprophylaxis (preparation for joys and wonders of pregnancy, birth and the bliss thereafter), vaccinations and HIV screening of new mothers.

It's been three short days here in Trujillo and while the above is just a snapshot of what we have experienced we look forward to learning more about H.I.P. and bringing you more news from the proverbial front lines. Be well. Salud!

¡Hola de Perú!

2011-01-17T21:19:00.010-05:00

The Peru folks (Shawna Benard, Rachel Brim, Julie Celebi, Alisan Fathalizadeh, Erik Hemingway, Paul Johnson, Emily Jackson, and Steve Moyo) have arrived safe and sound and jumped right into the culture and excitement. A little bit on our time in Lima--

We arrived in Lima late on Saturday night and stayed in a hostel. We were fortunate to have the day to explore the city, and had an amazing full day together. We walked more than any of us have walked in a really long time- we got a great view of the coastline...
tried some Indian-Peruvian fusion cuisine at an all-vegetarian restaurant, including, much to our surpise, tofu ceviche..

visited the Huaca Pucllana ruins...

joined in some traditional folkloric dance at a major festival in the downtown square and Steve & Alisan made it on the big screen! [vid to be posted soon]

Celebrated Shawna's birthday and she was spontaneously serenaded by a local musician...

This was a fantastic nosedive into Peruvian culture, and we are so energized to begin our work here. More to come on our initial introduction to the FIMRC program --

¡Hasta pronto!

Isla Chira

2010-02-24T19:14:00.004-05:00

We began the trip to Isla Chira monday morning. A little while into the trip, we stopped by a beach for lunch.

We hopped back in the van and continued on our trip. This time, we took a boat.

Here are a couple of photos from the boat tour a few hours before we departed back for the mainland. I still find it hard to believe, but there are animals that live in places other than zoos.

Sukhi Receives a Present from Monte Verde

2010-02-24T19:07:00.000-05:00

The Road of Life

2010-02-24T19:05:00.000-05:00

We may encounter a lot of obstacles on the road of life that may lead us away from our goals. Leadership, intelligence, responsibility, and determination are just a few of the essentials needed to keep ourselves on track. Last week in Alajuelita we demonstrated just that to a group of children, as they followed the lives of four childhood friends. They each had their own goals in life, but would they make it or succomb to temptation?

The four friends:

Roberto gets tempted by the drogas:

The audience sits in stunned silence as they behold the masterpiece unfolding before their very eyes:

After the performance, children received bracelets enscribed with the tenets of the road of life.

Setting goals in life from an early age will give you the direction you need. I am biased towards this person's goal:

2010-02-20T19:41:00.002-05:00

Two weeks ago we descended from the mountains to accompany a health campaign in Trujillo´s newest barrio... La Esperanza. It is what amounts to a shanty town, an area of sand at the edge of the city where poor people began to put up makeshift housing 2 years ago. It has grown incredibly, yet still lacks running water and electricity. Water has been promised them for July of this year, but you never know. We´re on Peru time. I hope it´s soon, though, because sickness is rampant and the area is dangerous, filling the ER with gunshot wounds on the weekends (something I have seen first-hand). Here, Tyler is using his doctor skills to check out the kids that came.
It never rains in Trujillo... or so we were told! And so everyone thought. El Niño has done crazy things with the weather here and we had to put tarps on the roof to keep the rain from ruining our work. It was quite the process!
These kids are waiting for their parents to move their houses so that the bulldozer que level out the hill upon which their house resided. Imagine living on the side of a hill of sand! I was just impressed that a bulldozer had finally come to help out!
A typical street in La Esperanza.

Here´s the health campaign we helped out at..... starring Tyler and his star ;)

The Ballad of Sukhi Bains

2010-02-18T23:38:00.002-05:00

Alright, so last weekend we went to Monte Verde for some fun. One of the activities we've heard about that we "must" do was ziplining. I did not know exactly what ziplining was before coming to Costa Rica, so for the uninitiated, ziplining is basically a way of traveling from tree to tree via a series of wires strung high off the ground. The adventure starts when you strap on the harness, attach the carbiners to the zipline, and let gravity do the work as you plunge into the cool mist. Saturday morning we eagerly put on some warm clothes and took the bus to the cloud forest where the ziplines are located. It's called a cloud forest because the elevation is so high that the forest is enveloped in clouds year-round. The activity didn't go by that smoothly, however. Boramee explains:

With a smile on her face and bravery in her eyes, Sukhi was then transported to Clinica Biblica in San Jose, one of the top hospitals in Central America. Surgery was required to fix her leg. After rating her pain on the happy face scale, she was transported to the OR.

The surgery was successful. The nurses celebrated with a feast of a sandwich and mac & cheese served with a side of baby food.

The next day, other members of the team visited the Bains as she recovered. It was my birthday that day and it was a great present to see that my friend was OK.

Coming soon: Monte Verde gives Sukhi a present.

Jazmin Clinic

2010-02-18T23:08:00.000-05:00

For the past week or so we have been stationed at a clinic in a clinic in Jazmin. It's a small area that is in strong need for health care. We set up shop in an empty building and serve the patients during the first part of the day. We set up all the necessities. There's an area for registration, a doctor's office, a pharmacy, and a place for kids to play.

Parasitos & Classe de Baile

2010-02-18T22:58:00.002-05:00

There are some events from last week I haven´t posted about. First, was a parasite lecture. Problems with parasites are more prevalent here in Costa Rica than in the states. Albendazol is an amazing drug. After a lecture, we even got to see some specimens in class.

When we´re not in the clinic, we also like to have fun. One of the activities we´ve been doing is dance class. We´ve been learning salsa, merengue, cha cha cha, swing, etc. We get 4 hours of lessons each week. Is it awesome?

Obviously.

Even in Spanish class, we get down. Sorry for the bad dancing, guys. We were taught to make faces when we do turns. I assure you I am king of the dance floor now(or maybe not). But for this video, you may want to cover your eyes.

diabetes among Latinos

2010-02-15T20:57:00.007-05:00

Hi all! Emily here again. I just got back from the Imlay City Migrant Clinic, where today we talked a lot about diabetes among Latinos in the United States. The director of the clinic told me that 1 in 10 Latinos in the United States has diabetes! Today I brought some bilingual literature to pass out to our migrant worker patients about this extremely serious disease.

Something I love about the Imlay clinic is that in addition to having bilingual staff and Spanish-language health literature, there are more Latino staffmembers than non-Latinos working here. Cultural understanding is so important to providing quality care to our migrant worker patients. Dr. Carter, seated in the photograph below, is the sole physician at the Imlay Clinic. She is a gringa like myself and has never lived in Latin America, but she speaks a whole lot of Spanish just having learned it from her patients. I have learned plenty of vocab from her as well!

Standing behind Dr. Carter in this photo are Esther and Kay, the office translator and one of our nurses respectively. Everybody here is so kind--I feel very lucky to work with them.

The worst part about working at a migrant clinic is not being able to afford to treat the patients as we know they should be. We had a woman tonight who needs $75 compression stockings and a sleep study and CPAP machine, and she can't afford any of those. Someone else needed physical therapy for tendinitis, but she can't afford that either. How lucky those of us are who have health insurance, and how sad and unfair for the people who do not!

A Weekend in Costa Rica

2010-02-15T20:29:00.000-05:00

We went to a couple of volcanoes over the weekend. Lots of fun. Videos coming soon, including some dancing action.

Sometimes, natural beauty can be ruined by tourism.

Other times, natural beauty is left untouched.

We saw a few animals...

...and acted like animals ourselves.

Don't forget the plants and waterfalls.

Even the cows too.

El Salvador

2010-02-14T14:55:00.005-05:00

What a great week! This week we did a first aid charla, a dental health charla, door to door vaccinations, and post-partum visits. The events were all well received and very fun to organize.

To wrap up the week, we were invited to a local festival of patron saints in the community. It was a fair with a ferris wheel and everything. We wore sashes and were the prize givers for the winners of a unique event involving fast horses, a very large chopstick, and a fishing line. It was nice to see another side of the community and to participate in the celebration.

We look forward to another exciting week here in El Salvador!

Brandee, Donna, Emily, Nisha, Shawna, and Shirley

Up in the Mountains- Peru

2010-02-14T14:07:00.005-05:00

Judith and the crew of Peruvian medical students sift through stacks of medical charts. We are doing a retrospective study on malnutrition, looking at the age, height, and weight of children less than 5 years old.

As Dr. Schnuth commented to me, the clouds are low! Or, depending on your perspective, you could say that we´re just really high up! Many days we could see the clouds hanging in the valleys much lower than where we are now at the top!!! There´s no experience similar to walking through a cloud, as it spits rain in your face ;)

Here is another family we interviewed from La Florida. You can see the adobe house in the background. And the layers of clothing are necessary, as it´s equally cold inside as outside.... especially when in the clouds and at night! Brrrrrrr.......

On a beautifully sunny day this is a normal scene.... impresionante!

Sometimes we had to hide from the rain. Even with umbrellas the wind could easily soak you from the side, especially as you ascend the mountains up serious inclines! We would just camp out and chat until the floodgates again closed :)

Greetings from Costa Rica

2010-02-10T18:43:00.003-05:00

Hey, everybody. Alan, Boramee, Josh, Sara, and Sukhi here. It's been a while since our last update, so I'll share a few more things than I originally planned. Here we go...

Saturday we arrived in San Jose, CR. The area is much more developed than Limon, Nicaragua, where we were previously. The city is much bigger than say, Lansing, Michigan, and it has all the amenities of a big city, like good public transit, city tours, plenty of restaurants, etc.

We are each staying with host families in nearby Santa Ana. The hospitality of the people here is incredible and living with a family has been a great way to immerse ourselves in the culture here.

On Sunday, along with my host mom, we toured around the city, using a "train" that goes around the city.

There were lots of beautiful churches...

...and beautiful parks.

But perhaps the most exciting thing was that Sunday was also the day of the Costa Rican general elections. The air was filled with the sounds of car horns and people everywhere were proud to display their political affiliations.

Even kids were into it.

Many people were crowded around the central part of the city, supporting their favorite candidate.

And if you didn't support their candidate, expect a little talk.

By the way, Laura won. She is the first female president in Costa Rica's history.

Monday, we arrived at the clinic.

Tuesday, we worked in the clinic and attended Spanish class in San Jose. Here, we receive 4 hours of Spanish class each week.

Today at clinic we prepared for our first charla, which we will give tomorrow. It's going to be great. More in our next update.

Also in the next update, Dr. Schnuth introduces us to the clinic.

Adios!

Clinic in La Promesa

2010-02-10T16:07:00.007-05:00

La Promesa is a town close to Alajuelita (where the FIMRC clinic is) that FIMRC goes to every couple of months to offer care. We learned from Dr. Stedhem and Dajan that La Promesa is a little town in which the government had put housing developments in, and relocated people who needed housing from other parts of Costa Rica. It reminded me a bit of Habitat for Humanity from back in the States.

So we arrived at the clinic, only to find that it had been closed up. I really admire the Costa Rican FIMRC staff for being so adaptable, since they were immediately able to find a house in construction on the corner that worked pretty perfectly as a makeshift clinic. So we set up an examining table, pharmacy, psychology area, and waiting room. Now what to do? No patients! So we went door to door, and to the market, asking the residents if they had children who had not seen a doctor recently or needed medical care. Surprisingly, we only went to about a dozen houses, but here word travels fast, and by the afternoon, we already were booked for the next few days! Here are some pics of our clinic in La Promesa and of the children from the area that came for medical care, or simply to play:

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Hola from El Salvador!

2010-02-07T20:45:00.008-05:00

We have been in sunny El Salvador for 1 week now and it has been wonderful!

We live in beautiful San Salvador, and our clinic is in Las Delicias a rural community about a 45 minute drive away. Each morning it's similar to waking up in Costa Rica and traveling everyday to Nicaragua because the guest house in San Salvador is in a very well-to-do area while the community the clinic serves is full of homes with dirt floors and an inconsistent supply of water.

Last week we had a very full week, we gave many vaccinations, we did well-baby exams, we did a pap smear campaign for the entire community, we started taking a census going house to house, and we saw patients in the clinic. Each day we walked miles and miles up volcanoes... literally. We are really grateful to be here as the need is great. So far so good! See you next week!

*Brandee, Chanisha, Donna, Emily, Shawna, and Shirley*

Last Days in Nicaragua

2010-02-05T22:18:00.000-05:00

I'm typing this up as I eat my last dinner in Nicaragua. Hard to believe 3 weeks have already passed and tomorrow we're going to pack up our belongings and take a bus down to Costa Rica.

Our stay hasn't been short on interesting people. We had the pleasure of meeting one of them yesterday, a local natural medicine practitioner.

We even had her take a look at us for the full immersive experience. It was very interesting, to say the least.

Today was bittersweet.We said goodbye to the great people at the Roberto Clemente clinic, where we did most of our work.

We visited the place next door and saw that the water tower frame has been completed.

We also dropped off our donations to various clinics.

Patient charts at Guastcoto

Patient charts organized using a donated cabinet in Las Salinas.

We then took our last Spanish class in Nicaragua. We must have gone through at least a couple year's worth of high school Spanish right there. I learned way more than translations to gun show ticket jokes and how to cool slang to make me the hippest guy on the block, really.

To end the day, we spent more time on the beach. Costa Rica students coming to Nicaragua, make sure to visit the pink beach. Also make time for the hotsprings.

We've all had an incredible time in Nicaragua. I mean it. The memories we made here are unforgettable. We met amazing people. We visited patients in their homes, saw them in the clinic, and even saw some incredible surgeries. We were there in the community working with the people and making a real difference. This is why the LMUV program is so special.

Costa Rica, here we come.

homestays

2010-02-05T14:19:00.002-05:00

A few days ago I was in the van carpooling with the Health Delivery, Inc. staff to the migrant clinic in Imlay City, and I overheard one of the WIC staffmembers talking about a patient who had 11 children and had recently gotten married. "Eleven children is a lot of children to have with no husband" I said. "Don't you know Emily, nobody gets married any more!" the staffmember told me, sounding a little annoyed at my judgmental comment. I felt ashamed of myself. The truth is, I was definitely judging this woman. "Who is paying to raise 11 children?" I had been wondering. Not really wondering--I was feeling put upon as a taxpayer, that almost certainly this single mother living in Saginaw, receiving health care at a free clinic, was not taking financial responsibility for her nearly dozen children. It is tough not to feel less than sympathetic for some of our patients. And that is sad--both for me and for them. I really try not to judge people, but I do it anyway, almost every day.

How can we, the privileged handful of MSU students who choose to come live in this extremely underserved community of Saginaw, MI, learn to relate to our patients? How can we bridge the gap between our wealthy, educated, socially high-status selves and our poor, uneducated, low-status patients?

The photos I posted are samples of what much of Saginaw looks like, especially the areas east of the river and around the hospital, where many of our patients live. We would never live there. We were in particular warned not to look for housing east of the river when we moved out here. So physically as soon as we arrive there is already a divide between "us" and "them."

When we travel abroad, we always stay with host families. The hope is that by living with people from the communities we are joining we will learn about how they live--their struggles, their language, their ideas of how life is and should be. Why don't we do that in the underserved communities back here in the United States? I do not understand how a woman who chooses to have eleven children with no income and no education and no second parent to help her...I do not understand how she thinks, but I should. How can we bridge this divide?

Greetings from Peru!

2010-02-04T12:37:00.004-05:00

Greetings from Peru!

From left to right: Stefi (our peruvian medical student volunteer), Sarah (MSU medical student), Rosa (the clinic´s obstetrician), Judy (FIMRC Peru coordinator), Cristian (the clinic´s doctor) and Tyler (MSU medical student. This was taken in Paraiso, a very rural village at about 9,000 feet altitude.

Sarah, Tyler and Rosa in front of the Pregnant Woman Radar. Some women have to walk two hours while in labor to recieve medical care at this clinic. One of the priorities of the Peruvian Ministry of Health is to improve maternal morbidity, so this is how they track who is pregnant in the different villages.

This was a very sweet mother and her five children that we met while doing a survey in La Florida. This town is about a 20 minute walk from where we are stationed in Agallpampa. The survey is being done to assess the different medical and educational needs of the population so that we can create a mobile medical clinic.

Some of our friends in Agallpampa. These children meet us at our door each morning to see if we will be teaching english classes. They are vicious tag players, too.

This is a view outside of the place we are staying in Agallpampa. This building is the Posta de Salud, a clinic that acts as a referral point for many of the surrounding, smaller clinics.

The Past Couple of Days

2010-02-03T22:11:00.001-05:00

Yesterday...

We presented another set of first aid talks, this time about dehydration, hyperthermia, and heat stroke, as well cuts, wounds, burns, and blisters. Annies were out in full force, as the audience reviewed material from the first set of talks.

We donated money towards the building of a water tower for the local clinic. In the afternoon we even got to help build it.

Today:

We delivered more charlas, this time at a day care center. Kids learned about making healthy food choices and brushing their teeth.

They also participated in a little exercise.

After all that, it was drawing time, followed by pinata time. Sometimes I miss being a kid.

Isla Chira (Chira Island)

2010-02-03T20:00:00.000-05:00

ISLA CHIRA, COSTA RICA
Our 3 day Excursion to an Indigenous Community [Pop. 3,500]

Our Accommodations on the Island

Setting up clinic for the day

Check-In Station

Bubbles were a big hit in the waiting room

Exam Room

Pharmacy

Setting up Medicines

Dispensing Meds (with a smile, of course)

Patient Education - Wash Your Hands! Brush Your Teeth!

Meals

It's called the Beach of Birds (Playa de Pajaros) -- Our Launch Point from the Mainland to the Island of Chira (Isla Chira) via Boat

~~~Good-bye CHIRA!~~~

Pictures from Soup Kitchen Presentation on Personal Goals

2010-02-03T19:14:00.013-05:00

"Yo quiero ser..." (I want to be...)

Melissa as a marine biologist, complete with fins made by Dayan.

Angela the "monja"!

Karyn as a carpenter - the paper saw won't cut through much!

Madonna helps the kids write their personal goals on "estrellas"

Colleen, a dancer, and Melissa, a marine biologist, strike a pose!

Angela as an "astronauta". The kids are describing what an astronaut does in their career.

Madonna poses as a police officer, while the children tell us what a police officer does and how to become one.

Weekend Update

2010-02-01T08:33:00.002-05:00

We went a few days without an entry. Here is the update for the past few days.

Wednesday: We went from house to house doing nutritional assessments and administering vaccinations. We gained a better idea of the living conditions around Las Salinas, the area served by a public clinic.

Thursday: We delivered our 2nd part of a refresher first aid course. This time, we covered CPR.

We even made our own CPR dummy, as Josh explains.

Friday: We started the day viewing surgeries in Rivas. First I saw above-knee diabetic leg amputation. Then I took a tour around the hospital. It's a public hospital and Sukhi mentioned the large difference in between public hospitals and private hospitals. Private hospitals are much more well equipped, but don't have nearly the patient load of the public hospitals. Public hospitals are free and are seemingly always full. After the tour I saw a woman give birth. It began vaginally, but became a C-section when the baby's heart rate dropped and the woman grew tired of pushing. Thankfully, the baby was ok. It's a boy!

Then, we took a trip to the island of Ometepe for some hot volcanic hiking action.

Statue in Rivas:

We arrive in Ometepe, in time for full moon beach photos.

Saturday: We hike up to the mountain and get plenty muddy on the way up. Ask Boramee how the way down went (hint: there's even more mud involved)

Sunday: We leave back for Limon, prepared for another week of awesomeness.

slathering on the sunscreen here in balmy Michigan

2010-01-27T00:34:00.005-05:00

Hi all! Emily here. I am the only LMUVer who stayed here in Michigan, and let me tell you about all the tanning and sightseeing I am doing in this lovely weather. Um, none. But I am having a wonderful hodge-podge of a time working outpatient family medicine Mondays and Wednesdays at the Imlay City migrant clinic and Tuesdays and Fridays at the Shiawassee clinic in Owosso. Thursdays I work with a psychiatrist, Dr. Lenhart, at the Bay City county jail, the Cathedral House free clinic, and Bay Arenac Behavioral health. Dr. Lenhart seems to have the patience of Job, and I have seen so much just after one day. Almost all of his patients' mental health issues--depression, anxiety, bipolar disorder, and schizophrenia--are complicated by substance abuse, domestic abuse, emotional abuse, violent crime, or any combination of the aforementioned. On Sunday evening Dr. Lenhart invited me to the Mustard Seed, a homeless shelter run through Catholic Worker House that takes in women and children. The Catholic Worker House runs charitable offices across the country, and coincidentally my mother and sister have been volunteering as ESL tutors for years with a CWH charity out in California. Last Saturday I worked in the ER at Covenant with Dr. Wagner, and I saw a patient with toxic shock syndrome and a patient with pseudotumor cerebri. Since my patient population of interest is Latino immigrants, my favorite site so far is the Imlay Migrant clinic. And though I am not eating mangoes and touring rain forests, I bet I am learning almost as much new medical vocabulary in Spanish as my classmates abroad. For example, "comezon" means "itchy" in Mexican Spanish, and "flujo vaginal" means vaginal discharge (sorry to all the non-medical people reading this but it's handy to know how to say that). Anyway I am off to bed so I can be ready to head up to Imlay tomorrow. Les deseo muy buenas noches a todos!

First Aid Training

2010-01-26T23:17:00.000-05:00

Short and sweet post. 3 videos + bonus footage.

Thursday, we have first aid session #2: CPR.

The Peruvian Schedule

2010-01-25T14:11:00.004-05:00

I just realized that I´ve posted many pictures, but without explaining what it is that I do here in Peru. Honestly, it´s a question we´ve been asking ourselves down here for a the past week or so & it´s always a work in progress. But for the moment, it has taken the following form:

Mornings: Hospital Belén

Monday- Pediatrics
Tuesday- Internal Medicine
Wednesday- Surgery
Thursday- Pediatrics
Friday- Obstetrics

Afternoons: Hospital Regional

Every day- Emergency

Life will be extremely different in the mountains, once I arrive with Tyler in Agallpampa. We will be working on a research study, which will be published in a medical science journal here. And I would imagine it will all shift again when we come back from Agallpampa, as there will be 2 of us! Peru will keep you posted! At least this gives an idea :)

Sending hugs from the South!!!!

Peruvian Hospitals

2010-01-25T13:36:00.007-05:00

My emergency room suturing! This 18 year old guy was assaulted in order to rob his motorcycle, and in the process he found himself stabbede 5 times in the back and once over the liver. As they need hands in the ER, I do a lot of suturing! Sunday night was a war zone!!!

This señor had a traffic accident (I´m not sure exactly what, as no one seemed to understand well). He entered the ER with gray matter hanging out, a shatter cranium, a broken patella, shattered right lower leg, and internal hemorrhage (undetermined at the time with the bare essentials of diagnostic apparatus at their alcance). He kept desatting down into the low 70s and I´m not sure he will survive. Honestly, I´m not sure how anyone survives the traffic down here... it´s chaotic and whatever rules there are, they aren´t followed to my knowledge!!

Dr. Juan is a family doc of 10 years who is just now going back for his residency in pediatrics. I spend as much time by his side as I can, as he has the most love for these children out of everyone I´ve met thus far! Plus, he loves to teach ;)

Half of my host family... they´re amazing!!!!!! I´m just missing my host mom, Diana (the FIMRC director here in Trujillo) & her baby, Mònica (the other sister), and their husbands.... we have quite the houseful!

Random chicken head in the road... I thought someone might appreciate that!! ;)

Here´s Janina, a 21 year old girl about to have her first baby! She´d been 1cm dilated for the past week, was having 2 contractions every 10 minutes, but wasn´t progressing. We spent 2 hours talking while we started the induction with oxytocin and when I went by later that night she still hadn´t dilated!! My guess is they did a cesarian, but unfortunately no one seems to know & I may never find out! She was amazing!!

Here`s the neurosurgery team after just having put in 2 CSF drains (including 2 peruvian medical students)! There`s nothing like watching someone drill through another`s head.....

Here`s a little girl with hydrocephalus. She`s been in inpatient peds for over 3 months as her mom put together money to return for her. In the parents` absence, the hospital put out requests on the radio for help taking care of her, so the community is currently providing her with diapers and food. Hospitals down here have to stock of supplies. People that need treatment must first get a family member to go buy their supplies. In the ER that can waste previous time.

CT of the girl with hydrocephalus. I´ve seen many of these images in my week here. It would be interesting to find out why the incidence is so high here.

Finally, another mom caring for her child with hydrocephalus.

Estamos feliz como un lombriz. We are as happy as clams!

2010-01-25T09:12:00.006-05:00

Every morning we wake up to the bright Costa Rican sun shining in. After a filling Costa Rican desayuno (breakfast) of usually pinto gallo (rice and beans), an egg, toast, some sort of fruit (usually pineapple/mangos/papayas), Alvaro (FIMRC chauffer) picks us up at our respective houses and drives us to the clinic in Alajuelita.

The waiting room is already filled with women and their children by the time we arrive. Time only allows for about 15 patients to be seen. Dr. Stedhem, who is finishing up his training in palliative care here in Costa Rica, sees the patients from about 9-1. He writes out a plan of care and prescriptions. Usually there is 1 or 2 students in the room working with him, and he translates for us when necessary, and lets us perform a selective physical.

The prescriptions he writes out are then passed out to the student in the back who is working pharmacy. Whoever is working pharmacy writes out directions for taking the meds, and measures out medications/counts out the pills for the patient. The pharmacy student then takes the meds out the waiting room and speaks to the patient, and makes sure they have no further questions.

The other 2 or 3 students are either busy with the psychotherapist, Tatiana, or are in the waiting room, triaging patients and taking their vitals. All in all, the day goes by in the blink of an eye. Afterwards, we eat lunch together, sharing what our Mama Ticas (Costa Rican moms) have packed for us. All is well in Costa Rica...Estamos feliz como un lombriz....

The Weekend

2010-01-24T23:02:00.004-05:00

This weekend we took the time to relax and tour around the city of Granada.

At the outskirts of the city, the volcano Mumbacho can be seen looming in the background. In the city itself, there is a heavy Spanish influence. Granada is a land of colorful buildings,

cathedrals,

and of course so much more that simply can't be translated into pictures.

We also took a boat tour around the small islands in the area, which were created from chunks of rock thrown from Mumbacho. The islands are mostly occupied by vacation homes, but there was one island in particular that was inhabited by monkeys.

We spent today at Laguna de Apoyo, a volcanic lake that offers a sharp contrast to the hustle and bustle of nearby Granada.

Week 1 has been amazing, and after a weekend like this, we are recharged and ready for more.

Week 1 Costa Rica

2010-01-23T23:35:00.005-05:00

Melissa and Colleen dispensing donated medications and educating patients on their proper use.

Ingenuity in the face of Scarcity...Creativity Counts

2010-01-23T23:27:00.005-05:00

I believe it was Einstein who said that imagination is more important than knowledge. Never before have I ever felt this to be truer. Dajan is an artistic genius. We met him our first day at the FIMRC clinic, and he greeted us with open arms and great enthusiasm. He is the clinic assistant, and with his charming gregariousness, I can definitely understand the reason why the patients love him so. And we learned to love him too. Without him, we could not have constructed the skit that we did on Wednesday. The theme we decided on was "Personal Goals." We cut out paper stars out of the construction paper that we brought, as well as costumes. The gist was that the children at the soup kitchen in Alajuelita were to write down their dreams for the future on these stars. We also did the same, and acted out the part of different professions, including a ballerina, veterinarian, marine biologist, and carpenter, and more.

We were prepared to do the skit in front of 60 kids, however, when we arrived, we discovered it was free ice cream day, and so over 100 kids were eagerly awaiting. However, with the help of Dajan and Dr. Stedem, we pulled it off without a hitch. We did an enormous amount with very little supplies. And the kids seemed very happy with their stars.

Week 1 in Costa Rica

2010-01-23T23:19:00.005-05:00

We arrived with our luggage and medical supplies and had no problems settling into our home stays. Monday was our first day at the FIMRC clinic. We worked with the Psychologist, Tatiana, Dr.Stedem in his patient office, in the front waiting room with Clinic Assistant Dayan, and running the pharmacy for the clinic. The staff are amazing and are an integral part of the local community.

Yesterday's Health Fair

2010-01-23T03:17:00.004-05:00

It's been a busy past couple of days for all of us.

Yesterday, we presented another water filtration charla, at a 3rd clinic.

After the presentation, we headed back to the Roberto Clemente clinic for the health fair. By this time, the new baseball field adjacent to the clinic had been clinc, and many of the children were already playing a game.

The Baltimore Orioles donated jerseys and caps.

There was also a pinata that was put up for later in the day.

Then there was a cultural dance performance.

Now, time for our health fair charlas. There was a very packed house. Josh and I started with a smoker's lung demonstration.

Boramee talked about healthy food choices.

Sara and Sukhi discussed healthy tooth brushing habits.

Josh and I also brought out the beer goggles we made and let the children participate in a game of catch. Will they catch the balloon?

No. They're beer goggles. No matter how good you are a baseball, alcohol will always mess you up.

Later, the pinata was put to good use.

We all celebrated by going to the beach, jumping for joy, and having a great meal.

(Tanya, one of the FIMRC workers, is a both physician and a ballerina)

Images of Peru

2010-01-22T22:23:00.008-05:00

The reality of Peru is so different and yet so similar to our own in many ways. This little girl above has an astrocytoma. I watched them put in 2 cranial drains to relieve the intracranial pressure. Now we wait and see if she wakes up.
This 8 year old has been in the hospital for over a month waiting for her burns to heal....
Here´s the new coordinator, Judith! She´s from Oregon and one of the most dynamic people I´ve ever met! Everything is changing and we´re taking it one step at a time, rolling with the changes and doing a lot of laughing in the process :)
(A little boy took this picture for us in the hospital Belén)
Street music in Trujillo.... it´s all in the family!
AND.... you can´t forget the typical dishes of the region!!!! On my first full day in the hospital, the pediatrician invited me to a birthday party for one of his friends, who was turning 79. Not only did it turn out to be a fancy feast with all of the traditional dishes (from papas a la hauncaina to pato and cabrito), but there was 5 hours of talking, laughing, singing, and dancing! I haven´t felt so accepted so quickly in a long time.

Preparing for Tomorrow's Fair

2010-01-20T21:36:00.006-05:00

Today we delivered the water filter presentation to another clinic. In addition, we prepared for tomorrow's health fair for the local community.

We created educational materials including fruits,

beer goggles, and more.

We even stuffed a pinata.

We searched hard for the hole for the candy, but in the end we created one ourselves in the backs of their heads.

After some preparation, it was time for Spanish classes again. The instructors gave us some carambola...

...and we gave them instructions on how to play blackjack. Sound like a good tradeoff to me.

Tonight we continue preparation for the health fair. This is going to be an amazing event.

Este es bidon. Este es filtro de barro...

2010-01-19T21:44:00.008-05:00

Today was our first visit to a public clinic, and there was a marked difference compared to the private clinic we were in yesterday. It's free to the public, but there are less resources to go around.

At the back of the clinic was a small garden used to grow herbal remedies.

We are happy to report that the incinerator built last year was in full use.

Today we also put the finishing touches on our charla, a short lecture we made about using a water filtration system. Contaminated water is a problem to many people here, and the implementation of water filtration systems can lead to a large impact. We spent much of the time creating a script and memorizing it.

Some of us had less to read. Some of us had more.

So, how did it go?

The nurse putting in the first liters of agua into her new filter:

Now let's celebrate with some awesome mood lighting:

The first day of clinic

2010-01-19T09:31:00.009-05:00

Yesterday we went to our first day of clinic.

We were able to participate in their care...

We prepared for a talk tomorrow about water filtration. Afterwards, we had a great lunch...

We came back to the clinic for Spanish lessons. Sara even taught the instructor a few things about Michigan.

Some Pictures from Nicaragua

2010-01-18T08:58:00.005-05:00

Pictures from our first full day in Nicaragua.

We're Delayed in Atlanta

2010-01-16T19:03:00.010-05:00

Alan, Josh, Sukhi, and Sara here.

Thanks to some piping problems, we've been delayed in rainy Atlanta.

The Blog is Up!

2009-09-13T23:42:00.000-04:00

It's up and running! This is going to be a great year.