Wednesday, March 18, 2009

Quick update from the U.S. (EDF)

El Salvador had their national presidential election on Sunday, and the leftist candidate, Funes won!  

KRF and I had a feeling the right-wing party (ARENA) and their candidate, Avila, would win- that party has been in power for a loooong time (I think 16 or so years), and they had canvassed the entire capital city, and the countryside as well, with ads, slogans, and their colors.

Funes and the leftist party (FMLN) represent change; Funes had been compared to Obama, so I think it is exciting (though we did have many conversations with more conservative El Salvadorians, who I'm sure are disappointed).  Way to take on ARENA!

Last few days in El Salvador (EDF)

Our last few days in El Salvador were busy and memorable- we continued to go out into the community, making home visits with our team.  On our last day we went to the U.S. Embassy with Dra. M to give a presentation (in English!) about our activities in El Salvador.  We don't have any pictures of this talk with us in our suits- security was intense!  We were not allowed to wear watches or bring calculators (a calculator I am usually never without...), cell phones, etc., and we spent a lot of time at the entrance getting appropriate clearance, and going in one at a time into the screening security room.  Only slightly intimidating, goodness!  After that, though, we actually enjoyed ourselves quite a bit- we gave our presentation to 3 embassy officials and had a great, lively discussion with them about health care and medical education systems, and future exchanges between New Orleans and San Salvador.  It was a nice wrap-up of our month!

We also had our last get together with the older persons group- they threw Lic. V a baby shower, and it was a great party!  The room was decked out (as you can see from the pictures), there was a full meal, and lots of party games!  The one pictured is where we all passed around a roll of toilet paper, and each person measured out what they thought the circumference of her belly was; the winner, a man in our group, got it exactly right!  What a lovely group of people.

Santa Ana day

Our last week-photos

Spending time with the family medicine residents!

Sunday, February 22, 2009

Volcano Outing Pics

Volcano Outing (KRF)

On Wednesday we met at the rotisserie chicken shop with the Senior Citizens Group (Grupo de Adultos Mayores) to go on our full day outing to the nearby volcano. The group meets every Wednesday - last week was our risaterapia session, if you remember. So we rented a microbus (aka bus that is falling apart) and we all piled in for the 20 minute trip up the volcano to the park entrance. We were about 8 members of the group, me and EDF, Dr. M, the health educator, and the nurse.
The trip up the volcano was very dusty but when we got to the park we wre delighted! It was serene, woodsy, with a lovely little cafetin or cafe and a playground. The park is taken care of by an eco-cooperative that harvests the coffee plants on the premises and produces a small amount of organic coffee to be sold. They also take care of the park and send guides out with groups like ours. So once we were ready, we began the 30 minute or so hike up to the top of the volcano. Keep in mind this was a seniors group hike, so it wasn't exactly fast. Nonetheless, we had a great time, and we only were worried for about 5 mins re. one of the asthmatic group members. One of the men in the group carried a radio with him the whole time, so we were able to listen to cumbia music as we trekked up the volcano. At the top we ate watermelon, papaya, and oranges and we rested with a lovely view of San Salvador below. If it had been a little clearer we would have been able to see the ocean from that far up.
We descended back to the cafetin where we enjoyed a lunch of boca colorada (a local fish with a red mouth), salad, and rice. After lunch we had some of the organic local coffee and EDF and I have an informal talk to the group about the importance of community during natural disasters using Katrina as an example. I praised their community group created out of the clinic as a great model for groups in the US. Although a lot of times our sense of community is more polarized during disasters and crises, it would be great if our communities existed prior to such polarizing events. Groups like this one could easily be formed using the conext of a particular health issue (HTN, DM etc). Especially for senior citizens, these groups are incredibly important.

Sonsanate Hospital (by EDF)

So this week we went to Sonsanate Hospital (an ISSS hospital, for those with ISSS insurance) on Mon, Tues, and Fri, and these were looong days. We would leave the house at 5:25am in the dark- in fact, it was so early that each of the mornings we had to wake up the guard to get him to open the gate to let us out of our neighborhood (interesting side note- the guard is definitely armed, and at night when it is cold out he wears a black knit hood over his face with eye and mouth holes- I was like 'that's a little scary', and Dr. M said, 'he probably just has that left over from the war', which was not that reassuring to me or KRF!). Anyways, we would rendez-vous with Dr. C (chief resident), who drove me and KRF the hour or so to Sonsanate.

The first two days it was interesting to join a team at the hospital and go on rounds- on Monday I went with the Gyn/Obstetrics team and KRF went with Internal Medicine. I enjoyed Gyn/Ob so much that I stuck with that team on Tues and Fri and KRF joined me on those days. Rounds are pretty much exactly the same in El Salvador as in the States. The Gyn/Ob service was fairly busy with a nice variety of patients- pregnant women with problems early in the pregnancy (threatened abortion, bleeding, high BP, placenta previa etc), women in labor, and post-partum women, as well as those getting gyn surgery (ex laps for endometriosis, ovarian tumors).

I liked being on this team, because the attending was extremely calm and relaxed, and liked to explain pathology and plans to us. After rounding on all the women and the pre-surgery area, we would then join the pediatrician and examine all the babies- this was definitely a highlight for me. In the morning the nurses and all the women who were well enough would take their babies to one bed to go over how to clean them off and things (see the photo above)- pretty cute! After having a baby vaginally women stay at least 12 hours, and after a C-section at least 48 hours (in the US it is 24 and 48 hours).

On Monday I observed a C-section- the OR was actually fairly well-equipped, they used a bovie and things- instead of the blue plastic sterile field sheets they used green cloth sheets, which definitely absorbed all the spilt blood, but other than that, things were pretty similar. I wore scrubs, but didn't assist- just observed, and chatted with the pediatrician. It was actually pretty rough once the uterus was open and they were getting the baby out- this was a repeat C-section, which makes it harder- but they got the legs and butt out first, and it took what seemed to me a long time to get the rest of the baby out- the baby was entirely blue and limp at first- but the pediatrician calmly cleaned it off and gave respiratory support- APGAR scores were 6 and 8. When the baby was fine, I got to hold it and show it to the mother- everyone joked that I should be it's godmother.

Friday was rather more of the same, plus we gave our powerpoint to the 2nd year family medicine residents- we added a bunch of slides about the healthcare system in the US, and tried to make it more of a discussion. Overall our days at the hospital were interesting, but extremely long! In general we would get back to the house at 7 or 8pm (so 14 hours or so after leaving), because we would pick up the girls or meet up with family and go to dinner and things before going home. Friday involved a birthday party for one of the cousins who was turning 5- we ended up having some fun, but KRF and I felt gross- the party was at Pizza Hut, and the residents got Pizza Hut for lunch to go with our presentation--- turns out you can have too much of a (sort of) good thing!