I have been feeling like I need to write something recently, but I hadn’t quite figured out a topic until one found me…we ate an early dinner tonight, and as the humidity and ants are doing a number on the lap-top I’ve been using, I took a walk down to the clinic to use a different computer and to get some studying done…

I received a great email from an old friend this week…we haven’t been in contact for years…she had been catching up by reading my blog posts…she thought that as I keep mentioning clergy in my stories that I must be doing a religious mission…that made me realize that I haven’t really described my work to everyone…I better set that straight, huh??

I also better straighten out the fact that despite photographic evidence to the contrary, I am still young on the inside. I have shaved since this photo and all is well.

I am working for the Pastoral Social for the Dioceses of Apartado in Colombia. This is the social arm of the Catholic Church dioceses which includes the area where I am living. We work exclusively in this regard. But I didn’t find them on my own. The support for the volunteers is provided by Concern America (situated in California and Chicago); which is a non-profit, non-religious, and non-governmental group. That is why the majority of our local contacts are church-related, but our work is not. Our work benefits the church as we improve the medical care in their jurisdiction and they help us with transportation, and occasional space for working and lodging. THAT is why I needed to ring the bell and wait for a priest to answer the door.

If what I am doing has an official title it would be a teacher and advocate for health promoters. The idea of educating local people to act as medical care-givers in a community far-removed from official medical services is not new. As I mentioned before, Susana is working with the same model in Guatemala and Juan is in Mexico. It has been proven effective all over the world. My colleague Alan created the program locally just over 5 years ago. The program has grown slowly, but steadily. He has his wife Julie and his close friend from Riosucio, Ismael, doing a massive amount of work concerning logistics and transportation; but he has done the majority of the medical portion single-handedly. I can’t fathom how much work it has taken. Now there are roughly 3 levels of health promoters, living in nearly 30 communities along the Atrato River and its tributaries in Northern Colombia. As I am so new to the project, the best thing I can do is learn Spanish as quickly as possible and start teaching medicine to the promoters.

Our primary goal is education. The promoters leave their homes for weeks on end to come to Riosucio to learn from us. If Alan is alone here he spends a week teaching a specific course to a specific level, but as we have 3 others physicians here presently, all the promoters have been convening here for three different courses…the last series included the gastro-intestinal system for the first level, advanced suture and trauma for the second level and eye diseases and treatment for the 3rd level. As we had a larger group in Riosucio than we could fit into our small classroom, we used the 3 separate classrooms across the river. They have adequate space, but no electricity or bathrooms...yep... Here we are crossing to the other side for morning lessons. The classrooms are the small group of buildings in the background.

Here is Alan teaching IV access. I needed two tries to find Alan´s vein, the promotors, on the other hand, did great! All the other classroom photos from the week have a pig dissection or pig suturing...I figured I would leave those out...

ummm...sorry about the tease, but this photo kept crashing the computer...I´ll send this post without it...

That was about 3 weeks ago. All the promoters will arrive back in Riosucio next Sunday, June 15th. The first level will learn the respiratory system, the second will be wowed while they absorb growth, development, immunizations, and illnesses of childhood, the most experienced group will learn neurology and auto-immune illnesses. Here is a picture of Susan at our kitchen table working on a game illustrating the life cycle of different worms.

(Alan and Julie have spent a long time fixing up their home. It is a really nice place to stay. The kitchen is in the background, the three bedrooms are along the wall on the left. On my last visit, we lived downstairs as this upstairs’ floor had burned down.)

Each course adds to the promotors´ knowledge as they go back to their village and practice. They are volunteers and are busy. They have families to care for, food to grow and harvest, and other jobs to complete. As much as I admire how much Alan has accomplished, I am completely impressed by the work and dedication of the promoters. The amount of experience with classrooms and structured learning varies. A challenge for me will be structuring a course that is practical and helpful. I have been planning this course steadily and have enjoyed coming up with games and activities to make the concepts more real, understandable, and hopefully more memorable. I am scared stiff. I think I have a knack for teaching, and I am certainly comfortable with the subject matter. The scary part centers on teaching pediatrics with my present 4 year-old Spanish vocabulary. I hope I am exaggerating. I also hope no one was wondering how that is different than me teaching pediatrics in English.

Besides structured coursework, we also complete visits to the communities. I love this even more than the teaching, primarily because it combines teaching and medicine with traveling and camping. We work hard in the communities, but for me the reward is meeting people and seeing places that I would have no opportunity to encounter other-wise.

As I mentioned, the towns are along small river valleys, accessible only by boat or by foot. In each of the communities that I have visited we have been put up in an open-walled platform with a roof. We set up our camping mattresses, our mosquito nets and we are good to go.

The large majority of the towns do not have electricity, and water for washing and other things is provided by the river. We spend these visits with the local promoter talking about town needs: water sanitation, mosquito prevention, creation of latrines, and vaccination. We also see ill people in the community. This is very different from the clinic at home. As our priority is the education of the promoter, we see all patients with the promoter. What we teach depends on the promoter’s level. With an early promoter we might work on history-taking, examination, or obtaining vital signs, while with another we might talk about the sequellae of diabetes mellitus or the specifics of treating emergent hypertension. The promoters improve steadily and it is great to watch and be a part of the progress, not only for the promoter as a person and care-giver, but for the community. It is our goal that eventually some promoters will become teachers and form the foundation of a solid, sustainable medical care system for this remote part of the world.

That is what we are doing in a nut-shell. I am so proud to be doing this. It seems completely worth-while. I realize that my 2 months of work here pales compared to the years and even decades of experience of my 3 current colleagues. It feels strange even to sound like I am doing anything more than just starting to help out. I am humbled.

Thinking of you…hoping all is well...
bg

I made it!!!

Hello!

This is WAY overdue…my apologies…we just got back from a 8-day trip working with some of the health promoters in their communities. I will write about my work and the trip in the next few days…the note below is something I began writing ages ago, but never sent. I am pushed for time tonight to finish this and get to the computer with internet access before it closes. Please excuse any mistakes…AND...the line is super slow here...so I am not sure I can include any photos...

It is Wednesday night; May 21…we have been in Riosucio for 5-6 days. Our trip from Apartadó was blissfully uneventful. Despite waiting for a few hours for our boat to leave, nothing unanticipated happened: nothing broke down; we didn’t run out of fuel, the crossing of the Gulf of Urabá to the Rio Atrato was as calm as it has ever been.

It feels great to be back in Riosucio. Its energy and people make it unique. I am now staying in the home of Alan and Julie, both colleagues in this project. I lived with them during my last visit here. John and Susan are here working as well; they are visiting from Mexico and Guatemala (during their vacation). I have mentioned them earlier, and I am glad there are here. We are sharing a 3 bedroom apartment. Gregory, the 2 year old, has many friends in town that play on the partially enclosed (completely safe) balcony. Despite what sounds like a crowded situation, living is easy; I enjoy my days and the company.

Realizing that I have only just returned and knowing that my views will change and undoubtedly become more accurate, I wanted to describe Riosucio as I am seeing it again with fresh eyes.

Riosucio has a pulse all its own. Currently it is raining and after 9 o’clock. Without straining I can hear the rain falling on our tin roof, a group of men smacking dominoes on the playing table across the street, the amplified speakers playing vallanato music a few houses away. This morning different speakers began playing religious music before 5 a.m. Then when I was drinking coffee on our balcony at 6:45ish a large man walked down the street verbally berating the owner of the early morning music. The ironic part is that it happens every morning.

People live very closely here, not just in location. 11,000 people living next to a river which frequently floods. There is a cell-phone tower and fairly consistent electricity, but water is a commodity. The river is used by the majority for bathing, washing laundry, using the bathroom, and even drinking. This photo doesn´t quite do it justice, but here you go. The closet-looking things on the rafts (balsas) in the photo are used for privacy for the toilet, there is also a woman washing something on the balsa nearest the camera.

It is more accurate to say drinking water is a commodity. The seasons are just changing, we are moving from the dry summer to the rainy fall/winter. It does rain daily and the river is slowly rising. Right now, there is 1-2 blocks of solid ground/mud next to the river, and the remainder of the depth of the town is under water.

People are anticipating that what is left will be submerged in the next few weeks. The walkways to reach homes and to go shopping are planks balanced above the water. Before the angry gentlemen walked under the balcony this morning, I saw a woman, with her hair in curlers, wrapped in a towel, with her recently-cleaned laundry and dishes in her arms walking on planks from the river back to her home.

Before I forget, I wanted to write a quick blurb on traveling to poorer countries. I am certainly not an expert, but every time I get re-acquainted with living outside the U.S., I forget the interesting subtle differences that soon become normal and lose their interest. On a resourceful level, it is true, clean water does dictate so much of our habits here. We buy our drinking water in 12 liter hard plastic jugs and fill our pitchers and glasses directly from that. We have gutters on the roof which drain rain water into a 2000 liter tank. This tank has alum in it which acts as a water clarifier (settles out the large impurities and dirt). We use this for cooking, washing dishes, and bathing. Any water that we cook with needs to be boiled as well (there are other animals that use our roof too). So it works great for coffee, tea, pasta etc. If we use the rain water for washing dishes, then we add bleach to it first. Finally bathing…to save water, we stand in a large plastic bin. We have a small bucket filled with rain water and we repeatedly dip a small bowl in the water to get wet, then to soap up and eventually to rinse. The soapy water that we stand in is then brought upstairs in buckets and used to flush the toilet (pour the water into the front bowl). I don’t want to go much further along this line…but there are a few notables…toilet seats are a rarity…more cracks and crevasses to keep clean, I guess… ...go on...I know, but when I thought of that phrase, it made me laugh, so I kept it in…The other interesting thing is that nothing non-human goes in the toilet. There are small trash cans for everything else. I guess they are much kinder to their sewer plumbing than we are at home.

I sleep under mosquito netting every night. It keeps the mosquitoes and biting bugs away, and hopefully keeps me healthy. On a neat note, when here in Riosucio, we no longer have to do laundry by hand...though it isn´t quite what you´d expect...here is a photo of me wrestling with my laundry...

Alright…I am going to run to the computer place…I hope this finds you happy and healthy…I think of home often, but all is well…

bg