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!

Kareoke y Juaya! (by KRF)

Wednesday, February 18, 2009

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.

Monday, February 16, 2009

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!

Saturday, February 14, 2009

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)

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!

Tuesday, February 10, 2009

Mike´s Birthday (by KRF)

Happy Birthday Mike! I love you!

Sunday, February 8, 2009

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. 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!

Thursday and Friday (by EDF)

Thursdays are actually Dr. M's day of the week to go out into the community, so we were excited to spend the morning with her and see her interact with patients- when we got to the clinic, though, plans changed a bit, because it turns out it was ¨D¨day (¨d¨for Dengue). D days happen with some frequency, whenever there are a few cases of dengue fever reported in the area. Apparently there have been 3 cases reported recently. So there was a lot of organizing (and waiting around for people!)- we had many of the staff from our clinic, staff from a nearby clinic, and others from the public health office all split up into outreach teams. Basically we went from house to house and asked to inspect the large sinks that people had in back (and any other items with standing water), and we looked for mosquito larvae- my and KRF's team each saw one. We distributed handouts about the mosquito lifecycle and dengue, and gave the families packets of mosquito poison to put in the water (not drinking water). Most people seemed pretty on board with this, as they had probably had several of these visits in the past. Once we finished our area, we went and checked in on some of Dr. M's patients, and then it was back to our favorite lunch spot (traditional food, in this case, chicken breast, for $1.75).

That afternoon we went out with our public health educator, Lic. V, to a few homes. Our last visit was to a couple who own a roasted chicken restaurant on the corner of one of the streets in our area, and they were very excited to host us- we discussed many things, including whether or not I should be frightened of the volcano that we are to climb in a week or so! They kindly made coffee and served cookies (KRF and I started thinking that the job of public educator here is not too bad!).

Back home, as promised, KRF and I made baked macaroni and cheese for the family (I tried to more or less use Pop-Pop's recipe, but alas, did not add bacon, and it turned out the oven wasn't working! but we had a toaster oven, so we used that, and baked the mac and cheese in two batches). The girls said it was better than the Kraft box kind, so I call that success!


Dr. M doesn't see patients until about 8am on Fridays, and since we arrive at the clinic around 630am, the three of us went out to a nice leisurely breakfast of casamiento (our favorite!), and eggs.

For the morning, KRF and I went out into the community again with Lic. V, doing risk assessments. Lunch was with her, the psychologist, and a few of the residents- I feel like we are starting to get to know them pretty well! We are now able to make jokes a bit, I just learned that here they classify jokes as ´blanco´or ´rojo´. Lic. V says that rojo jokes are not necessarily dirty! They just have to have a double meaning apparently.

We are also getting fairly familiar with the neighborhood! We often see people in the street that we have now visited- it is quite lovely. Lic. V of course knows everyone very well at this point (she has been working at the clinic for a year and a half). In the afternoon we worked on data collection, going through the family folders- not a bad activity for a Friday afternoon.

Back at home, KRF and I attempted a jog- ugh, but good for us after all this rather fattening food. And then we got ready for a fiesta! There was a family reunion of sorts at Dr. M's aunt's house- it was a nice time- lots of cousins running around, and a traditional meal with yucca as the main entre- yum!

Later that week (by KRF)

Hello faithful blog subscribers! I see that we have two regular readers.....and I know my mom is on there as well. Feel free to post comments! On Wednesday Dra. M had an administrative meeting so EDF and I were given a free day ie we didn´t have to go into the clinic. We stayed in the house most of the AM catching up on news (500K limit for CEOs, eh Obama?) and then we ventured down the seriously steep hill into the outer world for our first walk in the neighborhood. I can see why everyone drives around. First of all, there aren´t really any sidewalks that I would venture to call generous. The cars let out plume upon plume of black exhaust right into your face and the guards standing in front of locked gates with AK-47s slung over their shoulders hardly make for a welcoming sight on a morning stroll. To top it off, we were scared to death by an attack dog that quite literally made it clear it wanted to eat both of us for lunch and was angry that a fence was preventing this from happening. The fruits of our adventure included a few postcards and some tortillas bought at a local stand. Then we headed back up the volcano to the gated community.

That night we went to one of apparently many American style shopping malls with Dra. M and her daughters. The mall was impressive and we all enjoyed a dinner at the food court, EDF had some Pollo Ranchero nuggets from her Guatemalan days and I enjoyed some tacos. The girls had pizza. In case you all wanted to know what we ate for dinner. Which I know you did.

Wednesday, February 4, 2009

Los primeros dias (by EDF)

Hi friends! Well Monday we got into our regular work routine- everyone in the house gets up around 5am in order to leave by 6am- Dr. F goes in one car to his work, and the rest of us head to school and then the clinic. The nice thing about starting work at 7 is that we are done around 3pm!

The clinic is a little ways away and on a busy street- the clinic's purpose is to serve the immediately adjacent neighborhood with primary care. The area is then split into 5 sections, and there are 5 teams consisting of a doctor, nurse, and a health educator. Of the patients, 80% have the national healthcare insurance, 15% have health insurance through their employer, and 5% have private insurance. It sounds great in that all people are provided with some basic health care, but it is essentially a three-tier system, and people with the national insurance who, for example, are diagnosed with breast cancer, may not receive necessary surgical procedures. There are only four public, free hospitals in the entire country (one children's hospital), and OR time seems precious. There are also only 64 family medicine doctors in the country, and the clinic where we are working is the only clinic with family medicine residents. The result is that Dr. M is responsible for 602 families on her own, and sees about 40 patients in a typical day (sometimes with only 5 minutes for a patient).

KF and I started our day reading some manuals to learn more about the clinic and the healthcare system, but when another doctor and two residents were headed out to make housecalls and we were invited to join them, we jumped at the opportunity. Each household has a folder with a list of problems and a family tree (sometimes very large!), as well as forms to track about 27 risk factors, including owning pets known to carry diseases (here a lot of birds), or poor sanitation, or no access to potable water. One day a week, each of the doctors goes house to house in their area to check up on patients, and to reassess any risk factors. So far when we have gone, usually it is the grandmother who is home, or maybe the mother, as well as any young children, and most of the time we are invited in, and discuss all of the members of the household (HIPAA rules seem to apply more to the family unit!).

So that was our morning. In the afternoon we went out into the community with a health educator and a dentist- on one block we knocked on all the doors and said, ´we are going to have a toothbrushing class for the kids in about 10 minutes at house X'. We ended up with about 5 kids and several adults, and the dentist demonstrated with a model, and everyone practiced. It was a fun time!

Some major highlights for the day included:
-getting coffee (at Subway) with J.C.- he is a janitor at the clinic, very friendly- he would like to practice his English, and appointed himself as our bodyguard.
-when we went out with the doctors, they stopped for some food at a local place nearby, and KF and I were served a delicious meal called casamiento (basically rice and beans, but very flavorful and rich- as KF says, it tastes like it was cooked with lard... yum!).
-being invited into so many homes and seeing where/how people live
-playing Blokus with the family- I brought this game from the States, and everyone picked up on it really fast
-doing exercises and dancing with the girls
-watching a movie in Spanish, ´festival de chiva'

TUESDAY 2/2/08
Again, left for clinic by 6am. KF and I went through the family folders collecting data for one section of Dr. M's area. The data were so interesting that we may continue going through the rest of the folders and looking at trends (risk factors near busy streets, or closer to the river, etc). We went and visited people´s homes with the health educator in the morning.
Highlight: we had lunch with Dr. M at a local place down a few streets- we got the daily special, which involved rice, a shrimp cake type thing, a tortilla, and fresh juice, all for $1.75. Really tasty.

In the afternoon, we went with a psychologist and a health educator to visit two patients that needed follow-up, counseling, and a longer visit. KF and I are to go on our own to visit one of them again on Thursday, but we are a little worried because we couldn´t understand her at all (due to slurring of speech), and she didn´t seem able to understand us either! Goodness. On our way home with Dr. M, we stopped at a super-mercado- it was a lot of fun to look at the snacks available, and we got some ingredients to make American-style macaroni and cheese the next day.

Shortly after we got home, we had a bit of an emergency- Ginger (the dog) ate a plastic piece in the street, had respiratory compromise, and almost died! Dr.M and Dr.F rushed her to the vet, and, I am happy to say, she is doing just fine.

Sunday, February 1, 2009

Arrival (by KF)

We arrived without a problem to the most amazing host family ever, complete with the two most well behaved, cutest girls imaginable, C. and X., and their parents, Drs. M and F. Oh yeah, and a 4 month old puppy ( I think I can use the dog´s real name) Ginger. The family lives right next to a huge volcano in the middle of the capital, San Salvador. El Salvador is roughly the size of Massachusetts, and consists of 14 distinct departamentos, which are like really small states. Most people live in Sal Salvador. The M family lives on a big hill which overlooks the entire city.

The city so far reminds me of other LA countries I have visited, maybe a little less crowded and actually cleaner. There are tons of American chain stores like KFC and Pizza Hut, and even my fave Subway. The downside is that there is no way to walk around by foot because there is no pedestrian friendly walkway, at least not around where we are staying. So you have to drive everywhere. The first thing we did yesterday was get lunch at a nice restaurant near the house. We ate mixed grill with chorizo, chicken, steak and pork, and a delicious beef soup that was my favorite part of the meal. There was also a salad bar with some beets, rice with cilantro, and then some mayonnaise covered stuff that I stayed away from esp. after my Xmas food poisoning episode. After lunch Dr. M took us to an affluent part of town where the US Embassy is located (HUGE building -- what are they DOING in there) and we went to a park called Parque Madre Selva (Park Jungle Mother) where there are playgrounds, quiet shady walkways, and lots of families strolling about. There were also the requisite lovers on a few benches. After the park we had the pleasure of meeting Dr. M´s parents who live in a lovely home with a beautiful indoor courtyard with a lemon tree and a guayaba tree. Everyone is so nice and gracious and friendly. EDF even had her nails painted by X. on our way out the door! And our Spanish is improving by the minute, of course.

EDF and I collapsed into bed at 9 PM or so and this morning we piled in the jeep with the family to spend the day in Suchitoto, a lovely old colonial town about 45 km north of San Salvador. The town has a lovely plaza with a church built in 1500. The original church and wooden capillas, or small side chapels, are still standing. We enjoyed an icee outside the church and walked around in the bright tropical sun until we were about to pass out from the heat. We also made some purchases, EDF a much needed sun visor that is a little dorky but very protective, and K bought a necklace and a very trendy leather bracelet. We like to support the local everything seems to cost 2 USD. After walking about the town we headed to Lake Suchitlan, a man made lake. We took a boat out on the lake and cruised around for a while before heading back to town for lunch. EDF took a turn at the helm of the boat whuch surprised everyone, who knew she had such skills. Lunch was at a restaurant overlooking the lake with a very inviting swimming pool. On the way home we looked at more of the fronts of homes in Suchitoto, some of which still have bullet holes in them from the Civil War. Suchitoto was in the middle of the violence (more on the war later) and the hospital was in ruins. Dr. M´s husband Dr. F was actually born in Suchitoto, and Dr. M did a year of required medicine internship in the town as well, so they both know it well. Dr. F still has a few aunts in town, but we didn´t meet them on this visit. All in all, it has been a packed weekend and we are gearing up for our first day of work tomorrow, we will be accompanying Dr. M to clinic as well as doing community visits with the clinic health educator.