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!

FRIDAY:

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.

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.

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 economy...plus 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.

What are some crazy/really weird/ unusual facts about El Salvador?

And I found the following answer(s) to my question on the World Wide Web, including but not limited to:

1) There's a Ghost in El Salvador called La Siguanaba. Well there are a lot of ghosts in El Salvador.
We also have El Cipitio (la Siguanaba's son)
2) El Duende(a) (he/she falls in love with attractive people and stalks them all day and annoys them but only YOU can see him/her, nobody else.)
3) El Cadejo (there's a good one and a bad one I think, it's basically a black or a white animal that appears to you, one means you're going to be ok and one means something bad is going to happen)
4) La Careta Chillona (Old as a Carriage with squeaky wheels that makes you crazy if you hear it, it comes out late at night when people are sleeping)
5) El Griton (its a guy that comes out and YELLS really loudly like somebody is killing him. I had a cousin that said that she heard el Griton before, that it sounded like he was right outside of the house screaming)
6) La Mano Peluda (this is a myth in many other countries, not just El Salvador. If you go to sleep in a hammock, la mano peluda starts to swing you really hard until you fall and you become crazy. Something like that)

and then a few more mundane facts.....
1) There are more El Salvadorians in Houston than there are El Salvadorians in El Salvador.
2) In Nejapa there is an annual tradition of throwing fire balls at each other.

Test Run.....

Well, here is the first post of the fabulous new blog PPDs and Palm Trees, coming Live to you from a rather PPD and Palm tree-ridden place, New Orleans. This is the travel blog of MagicTeapot and her friend, MagicCarpet. We are two medical students and good friends almost finished with the long trajectory of medical school and we have chosen to spend one of our last elective months in El Salvador. We are leaving in two weeks and we don't really know our itinerary yet. Ooops. Well more on that later. This blog will include daily musings, photos, and anecdotes of our month down South. Check back in two weeks for our first entries!!!!