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!

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!

Kareoke y Juaya! (by KRF)

Feliz dia de amor y amistad! (by EDF)

Compatriots! Thanks for reading. Friday was a fun day- in the morning we participated in the a meditation and relaxion group, led by the clinic psychologist. It was me, KRF, and five ladies more or less in their 50s. I enjoyed the breathing exercises and as much of the imagery exercise as I understood (it definitely involved imagining yourself at the beach!). We also did a progressive relaxation exercise, which I am used to doing in yoga class or something where you are lying down- it was a little challenging while sitting in a chair. Again, a great stress-reliever and service for the patients here!

In the afternoon we went with two health educators to do a charla about HIV and STIs (VIH and ITS en espanol) for a group of policemen. They were, understandably, a bit embarrassed and shy at first, but really opened up as the talk went on. When we got back to the clinic, the office Valentine's Day party was in full swing. Before coming to El Salvador, KRF and I had wondered whether they celebrate V Day here- silly us!! It is a much bigger deal here than in the U.S. as far as I can tell. At the clinic there was a sort of secret santa gift exchange, lots of other small gifts, tipico treats, and hot chocolate. The day is called a day of love and friendship- nice that they emphasize friendship just as much. The kids in the family had parties at school, and card and gift exchanges too.

In the evening we went out with the family to... Galaxy Bowling!!! As this is one of my favorite activities with my American family, I was extremely excited. And boy was it fun- pizza and bowling for all. Dr. M and Dr. F both cleaned up at different times, and the girls were incredible with the way they used the bumper fences- C. could hit the fence on both sides just so and get a strike or knock the rest down for a spare. And X. got better and better as the night went on. KRF and I practiced some different bowling strategies, and overall did pretty well. It was a fun night!

Saturday was actually Valentine's Day. KRF and I unexpectedly got the chance to go to a museum of El Salvadorian art, M.A.R.T.E., and we had an awesome time. I will post some pictures a bit later. A lot of paintings about the civil war, and a great photograpy exhibit mainly of photos taken in Guatemala in the 1940s through 1970s. It was also gorgeous weather- sunny and blue sky with breezes.

How to survive on 60USD per month (by KRF)

Hello loyal blog followers. I apologize for the lapse in entries, but Em and I have been muy busy over the last week or so. On Valentine's Day we headed into the community for patient visits, and we realized that although the visits are amazing attributes of the family medicine model in El Salvador, they can take a LOT of time. In the afternoon on Thursday we only made two visits, and it took all afternoon. Why, you ask. Well, try going to a little old lady's house in the afternoon while she is watching her telenovela (soap opera - sometimes strangely enough with Korean actors dubbed over in Español) and sitting down on her couch, asking her about how she feels, and listening to her talk. And talk. And talk. Sra. X we will call her, not only told us about her hypertensive episode earlier that day, and how she was afraid she was running out of Enalopril, but she also told us all of the details leading up to the loss of her middle finger 25 years ago (factory accident), how her husband ran away with another woman a decade ago, and the depressing details of her current financial situation. After being majorly screwed over financially by both her former employer and ex-husband, this nice, sweet old lady who made us two beautiful napkin holders for souvenirs lives on approximately 60 USD/month. She can barely afford to eat and subsists on rice and beans. She has a German Shephard named Condesa (Countess). Anyway, I am particularly fond of this lady and hearing her story was, albeit lengthy, fascinating and put her entire present situation, health-wise and financially, into perspective. American doctors with 10 minutes to spend on a patient barely know the age of the patient, let alone the entire saga of their loss of an appendage. Anyway, this visit came on the heels of my reading of a NYT article entitled "You try to live in NYC on 500K/year". Well, what can I say, being here certainly puts things in perspective -- and makes me want to stop reading silly NYT articles!

The next lady we visited had an equally compelling saga, but in a way hers is a bit more acutely sad because she recently was the victim of a hit and run car accident in which her right leg was crushed. Since this woman is not employed and is not the dependent of someone who is employed, she must go to the public Ministry of Health Hospital (80% of the country uses this system) which provides resoundingly poor care. For example, Dr. M told us the story of a woman who went to the ER at the Ministry of Health for something like abdominal pain, and during the exam they found a thyroid nodule which was hard and they suspected cancer. So they made her an appointment for follow-up in TWO YEARS. Luckily this woman was insured and was able to get an appointment fast through the social security system (15% of the population - those who are employed - have access to this much better system of healthcare - Dra. M works for this system, not the Ministry of Health). Anyway, this poor woman not only has to suffer a hit and run, she is also getting poor care. Very sad. And even though we visit her because she is part of the neighborhood that we visit, we can't actually TREAT HER at the Community Clinic because she is not insured. Frustrations similar to those we find in the US - except in the US this woman wouldn't even have a Ministry of Health Hospital to go to......although I suppose she could have Medicare. Anyway.

Mas con los groupos de adultos mayores (by EDF)

Thursday morning:
So, actually, each of the 5 teams in the clinic has a group for older people- and they do a lot of fun activities! This morning we participated in one group's aerobics class. They have aerobics 3 times per week, and it is free- it was located at this park- again, pretty good turnout, with children, grandchildren, etc. welcome. After the class, one of the resident doctors gave una charla about hypertension. I really do like the way this clinic practices good public health models of care- these groups are great for physical and mental health- they provide easy access to regular exercise, and a fun social experience, and some health education thrown in. Very cool.

The rest of the morning we made house visits with Dra. M- we had some very complicated patients. One patient showed us all of his follow-up appointments that he had scheduled for the next six months- he was pretty much seeing every type of specialist you can imagine for his chronic diseases. I'm going to let KRF write about the patients we saw that afternoon- she understood a lot more of their stories than I did!

Wednesday afternoon (KRF)

Hey everyone! On Wednesday afternoon we attended a senior citizens' meeting and the focus of the day was mental exercise and music and laugh therapy (risaterapia). This group gets together once a week at the restaurant of one of the members, a rotisserie chicken joint. It was very fun, there was quite a turnout with around 20 group members present with various grandchildren brought along for the ride. Most of the group members are women but there were 3 or 4 husbands as well. First the clinic psychologist gave a talk (una charla) about the importance of mental exercise, especially as it pertains to older adults. We split up into groups of four and each group was handed a series of brain puzzles to complete, whichever group finished first with all puzzles correct won! After the puzzles we participated in the musicaterapia part of the meeting which consisted of laminated lyrics projected onto the wall of the restaurant and some tunes emitted from a laptop. Unfortunately the laptop tunes ceased working so one of the husbands sort of took over this stage of the session, turning it into his very own karaoke slash American Idol try-out. Nevertheless, it was fun. Risaterapia consisted of some videos....not everyone found them funny. The one I saw was pretty funny - it was a scene of a couple getting married at the altar and they had a lie detector machine at the altar to avoid any lying at the altar that may end in future divorce. Anyway. Enjoy the pics from this afternoon.

Powerpoint given! (by EDF)

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Hi friends!
I'm glad to see that we have some readers- yeah, family!

So, looking at our blog, we realized that we only have photos of food and our trips- fun for sure, but we have also been doing some work! On Wednesday we went to the public hospital in Sonsonate to give our first powerpoint presentation to 3rd year family medicine residents. Sonsonate is about an hour west of San Salvador, and has a hotter climate. The hospital is quite nice, and brand new- they had to build a new building because of damage from the 2001 earthquake, and this building has been open for only 4 months.

First off, we met the director of the residency program, Dr. C., then we had a meeting with the director of the hospital. Despite his busy job, he invited us to sit down and have coffee and chatted with us for at least half an hour about how wonderful family medicine is! He was so positive, and so excited to host us, that it started to feel a little surreal to both me and KRF. He was also happily blasting the radio in the background, Maroon 5 to be exact, so I had to concentrate really hard to understand what he was saying! Our faces hurt from smiling so much!

Our talk went well, I think. We gave some background on the history of New Orleans, what the healthcare system was like pre-Katrina (the Charity Hospital system), and what happened during and after Katrina. We also talked about all the community health centers and local organizations currently involved in healthcare and rebuilding. Quite a lot of material! We also threw in a bit about family medicine in the States (including the primary care model of healthcare delivery called the 'patient-centered medical home'), and lessons we have learned from our time in El Salvador. The residents were very engaged, and asked a lot of questions- especially about the healthcare system and insurance in the U.S. We may add some slides on that for our next talk. All in all, we feel very good about how our presentation went! And all in Spanish!

Mike´s Birthday (by KRF)

Happy Birthday Mike! I love you!

Oh yeah....I forgot (KRF)

We felt a tremor on Friday night! At least everybody except EDF did (she was in the bathroom when it happened) ----the entire house moved from side to side about 2 or 3 inches for about 5 seconds!!!! My first earthquake experience. Really a serious reminder that the Earth is a moving, changing, REAL important part of this thing called LIFE.

Some more photos from our wknd

Fin de Semana (KRF)

Hola amigos! We had a jam packed fun filled weekend! On Saturday afternoon we went to the David J. Guzman Museum of Anthropology while Drs. R and M went to a parent´s meeting at the girls´school and C. had her weekly English class at the American School. The museum had four main exhibits which chronicled the history of El Salvador. The museum had lots of pottery, that was my favorite part. There was a whole exhibit on agriculture and the various staple crops of El Salvador, including coffee and indigo (añil). One of the interesting things about El Salvador that really separates it from most of the other Latin American nations is the fact that there are almost zero indigenous peoples and traditions left here. So walking around, you don´t see anyone in traditional wear the way you would in say, Peru or Guatemala. There are several reasons for this. First of all, when the Spaniards came, within 100 years there was a 90% (yes...90%) reduction in the native population due to European infectious diseases. Then, as time went on and the Spaniards established indigo and coffee as the main items for production and exportation, the traditional economy changed and many indigenous people had to leave their small towns to find work on coffee or indigo plantations. So, the migration of indigenous people away from their traditional towns towards the Spanish owned plantations led to further disintegration of the indigenous social and economic structure. Nobody really thinks about Spain so much anymore - but boy did they conquer and leave their influence way more than those Brits! My Goodness. Lots of suffering and blood and tears along the way.

On Saturday night we went to Planes del Rendero, which is basically a mountain in San Salvador. You drive (and drive and drive) to the very top of the mountain and at the top is a lookout where you can see all the lights of San Salvador. This is also THE place to eat pupusas, the most traditional food item in El Salvador. A pupusa consists of two corn or flour tortillas stuffed with either cheese, cheese and beans, or revuelto, with cheese, beans, and chicharron (pork). They are cooked on a griddle and they are very yummy. We ate at a place teeming with families and we also enjoyed the traditional hot chocolate with our pupusas. So.....so far we have eaten pupusas (revuelto was the best), casamiento which is refried beans and rice with tomatoes, onions, and spices, yucca with fresh tomato sauce, and cole slaw or curtido which is eaten pickled with practically everything. I love all of it, although both EDF and I confess to some bathroom issues late Saturday night after the pupusas.

Sunday: This was a fantastic day. We woke up early and piled in the car to go to La Libertad, which is another departamento. La Puerta de La Libertad is a beach famous in C. America for its surfing waves. The M family has a membership at a private beach club at nearby San Blas beach. It was really beautiful and luxurious, with a swimming pool, bar, and private beach. The water was super warm and the sand was volcanic and black. We played in the water with the girls and even went to a salsa lesson at the beach club. EDF ordered a gigantic lemonade with tequila and the rest of the family (the adults, me included) had our share of Golden beer (local). EDF is pretty white so she has been very careful about sunscreen but I stupidly forgot to reapply and of course I now have a fantastic burn.

So....then we met some family at a restaurant further down the beach with an amazing view of the water and we all feasted on ceviche. It was really, really good, white fish and shrimp. I had a piña colada and EDF a daiquiri. All in all a great day. The Drs. work hard all week, but they definistely know how to relax, enjoy food and family, and get rejuvenated on the weekends. Reminds me of my family in Spain. Life is too short to work all the time!