Saturday, August 2, 2008

a walk in the woods...

Sending along a happy hello from Colombia!

Thank you for the great feedback; it is easier to write something when people enjoy it.

My spirits are great and my body is healthy. Sorry about the foot picture. In the face of everything else, a few bug bites didn’t seem too disturbing. I apologize, I’ll try to limit that kind of sharing. My feet are still healing well.

In the 3 weeks since my last entry we have held a course for the promoters, hosted two engineers that work in applied technology, and I completed a monumental community-visit trip.

Alan taught the course in essential medicines. My role was primarily as a student. I am trying to learn as much as I can about teaching in general and the more I know about what the promoters are learning; the more I am able to focus what I teach.

Applied technology is a great field. Just as I am working with a medical model to teach people in communities how to address health issues where they live, there are engineers that do the same with technology. There are a number of avenues of their work: water systems, solar power, and stove construction (to move away from open wood fire pollution in homes). As technology and sanitation lead to disease prevention, we often work in concert. I really love working with people with similar goals. It was a great visit.

I describe our recent community-visit trip as monumental, but it was really business as usual for my colleagues here. For me it was HUGE!! For the first time I traveled without a more experienced medical person. Additionally, my friend and experienced motorista, Ismael, was unavailable as he was working with the technology crew. So Ismael’s son and two advanced health promoters and I set out for an 8 day trip to visit a new river basin. We are helping four health promoters and communities in this area, but this was the first support visit.

In the week leading up to our departure we completed the bulk of the organizing: buying and planning food for meals, packing medicine, and thinking about the needs of the communities. I was feeling super-responsible and as the departure date approached, a mild, dull anxiety grew. Alan was helpful and I had plenty of time to prepare…and I suppose, to dwell a bit too much. I think the worst part was packing the medicine. I had no idea what we might encounter, medically or other-wise. Looking back at my list of things to remember is comical: scalpels, dish soap, plastic bucket, twine, sleeping pad. More than once, I put a medicine in the box and thought, “oh wow…I hope I don’t need that” “hmmm…what does that thing do?” I created an emergency kit. I threw in urinary catheters, ones that seemed elephantine compared to the pediatric tubes I am more accustomed to…I brought IV fluid, suture, adrenaline, needles and syringes, whatever I could find that seemed potentially remotely useful. I loaded up. I bet if this were a movie it would be that cool scene, when the psyche/montage music starts and the protagonist (I don’t know if I can put myself in that role or not) studies/trains/readies equipment in preparation for some sort of climax…yeah…well…it wasn’t really like that at all…picture me in a dark store-room sweating and praying I wouldn’t forget anything…absolutely dramatic.

Early Saturday morning, we set out. Despite being completely busy, Alan saw us off. We had breakfast and lunch cooked for us in containers, courtesy of Ismael’s wife. There is nothing like eating chicken and rice in a small boat in a Colombian river and wondering what the week had in store for us.

Though demanding, our week did settle into a decent routine and a comfortable rhythm. We would arrive in a community and meet with the health committee and discuss their concerns. Later in the same day, we would meet with the entire community (whoever was interested) and describe our program and try to increase their understanding of our goals and the role of their health promoter. The following day we would wake up early and start seeing patients. Sometimes this happened in a school, sometimes in the room where we had slept, wherever was available. (this photo shows an advanced promoter teaching a student...they are on my bed). The next morning we would leave for a new community and the home of a different promoter. This was usually by boat, but there was one notable two hour hike/swim through swamp. Ok, I didn’t swim, but I truly have never seen mud like that.

The hike in question came on day #3, between the first and second communities. As it was early in the trip we had lots of fuel for the motor, 5 boxes of medicine and a full compliment of food. We the option of loading up the boat, driving for an hour, then unloading everything for an hour hike, and leaving the boat and fuel on the shore. The other option was a 2 hour hike, which everyone in the community described as “pantano feo” (really, really bad walking through swamp)…that was kind of impressionable, as in general, Colombians are pretty durable travelers. As no-one in the community could convince us there was a safe place for the boat and fuel, we opted for the swamp. I was quietly completely jazzed. We found horses to help with our supplies, but needed to split up the medicine again, aiming for 2-3 boxes. We trimmed our bulk additionally by leaving clothing and food and hit the trail. I guess this would be a redo of the “medicine-choosing” scene…completely ruining the effect from the original energy-building montage. That may be why there aren’t too many movies about this work. I faired pretty well early on. Then we hit deep mud. Everyone else seemed to glide over it, while I got fairly (completely) mired. I do need to add here that I indeed chucked clothing and supplies from my pack, but I was not about to leave any books behind. My feet were falling fairly heavily and sticking into soft ground. I smiled to myself, thinking that my fear of fatigue was much less than my fear of not having good resources with me here. At one point I sank to my knee; I was done. A good friend was walking behind me and tried to pull me out. We then realized the immense and sinister spines on the logs surrounding my boot. I didn’t have a location to act as a fulcrum, I was hopeless. Humbling. I pulled my foot out of my submerged boot and stood balancing on one foot while my friend found a stick and started digging. It took about 5 minutes. I buried it pretty well, I guess. I am so thankful to be able to work with these promoters.

The health promoters here often thank me for being here and mention my patience. To me, they are the patient ones. My Spanish still demands the listener’s full attention. They talk with me, trying to teach me about their country, their culture, their food, their language. They laugh with me and dig out my boot or correct my speech. In some ways I am a teacher here, but in many more ways, I am a student. The promoters have lives and need to be productive to support their families. Their communities are investing in their ability to learn. They attend to sick people at all hours. They are completely comfortable in a huge variety of conditions. I was walking with a community member and he shared a wonderful compliment, “your friends, the promoters, are good campesinos (people who are able and comfortable in the outdoors)”. I thought that was great, especially because doctors traditionally lean a bit toward the “less capable in the outdoors” end of things. I am making generalizations, I know.

Well, we made it to the next community and the week continued. The whole trip turned out to be a huge bonding experience (despite feeling completely lost language-wise). My three colleagues used language with each other that I couldn’t make much headway with¨..."hey…is that in my dictionary?” after a smile and a “nope”, they would describe what I missed. I have no idea when I will use this new cache of vocabulary.

Despite the difficult work, I often wondered how neat it would be to have 3 other close friends with me. When was the last time I was on an 8-day boat/camping trip? I really can’t believe this is my job.

I think I described our visits in a previous blog and I don’t want to be repetitive. We usually sleep in a community building and eat food that we bring but is cooked for us. The community buildings usually do not have cooking facilities and we are usually working and don’t have time to prepare food. The food is pretty fun for me, though I should say that the planning was a bit of a challenge. We were all hungry growing guys: 3 Colombians and myself. I am only just learning local traditions of what to eat and when. All the food had to be portable and as none of the communities have power, the food needed to tolerate ambient temperature for the entire trip. We ate lots of rice. MOUNTAINS, three meals a day. Plaintains. Oatmeal. Lentils. Beans. Sugar. Oil. Tuna. Canned meat. Eggs (though they didn’t quite survive the swamp portion)…Hmmm. Two communities up-graded the food we gave them to cook with fresh hen and freshly picked rice. We ate Olympic quantities of cheese as well. I don’t really know the science of it, but it deserves a description. (I don’t have a picture yet…) It doesn’t need to be cold (I hope), because it is normally kept on top of store counters. It is white and might almost be described as cottage cheese, but it is a solid block. Both of the French women that I live with here get completely nauseous at the sight/thought of it. We have tried to hide a small bit in lasagna, and they sense it and pick it out. It feels a bit like squeaky Styrofoam in your mouth. Yep, we devoured a huge amounts. I would get back from handing over the food and someone would inevitably ask me “what are we eating tonight?” “what is the liga (substantial food-usually meat)?”. Then I would review the food plan, followed usually a bit of silence, then a slight nod, “bien”. Pheeeww…passed another small test. Here it is really late and we are having dinner, cheese and pasta soup.

We are planning for one if not two more trips before I come home. I’ll keep you posted. We came back to Apartad√≥ this week so that I could write a grant application. I finished and sent it yesterday. I have been cooking more and more. I really like it.

I hope your summer is going well. Food and gas prices have been climbing here too. It is kind of frightening.

Thinking of you,

p.s… AND…I didn’t know where to put this…if anyone is reading this from East Greenwich High School…class of 1988…it would be great to see you at the reunion this October…


Terra said...

Hi Dr. Good! The girls and I were just looking at your blog. We LOVE seeing and reading about what life is like for you right now. You are such a blessing to the people down there and I'm sure they are VERY sad (as we were) when you leave each village.
We are doing great - we have been chosen for another baby and he/she is due in January. Which brings me to my (as well as many others) next question...are you coming back?!? I know your coming back, but are you going to be working as a pediatrician anywhere? Nights, days, it doesn't matter...we just miss you and want you back - even if only for a few months at a time! You can check out our blog if you get time:

We miss you but are so thrilled at all the good you are doing for the Columbians. They are lucky to have you!

Love - Terra, Tea & Briar

Bkay said...

Hello Doc!
Kaleb was so excited to see a picture of you! You always make us smile as you explain your trials there, and do so with a smile yourself! You are an amazing example to us all. We are glad to hear you are well. Keep up the good work. We look forward to seeing you when you get back...will you be at Primary's?
Love, The Saunders

Trish said...

Hi Dr Good!! It was so good to find your blog. I knew you were out there somewhere, but I just stumbled across it today. You look good and it is good to hear of your adventures. It takes me back to my days in Ecuador. That is an amazing part of the world. You are doing such a good thing down there and I am sure the people love you there just like we do here. They are not going to let you leave!!
The kids and I are doing great just loving life in Midway. We miss you and hope to stay in contact with you. We have a private blog, but if you would like to see if just e-mail me at and I will be happy to invite you.
Stay healthy and watch out for those biting flies. That was not so pretty.

Allison said...

Good one, and a good reminder that everyone needs a friend to pull their boot out of the mud every now and then!

Bangel_mc said...

Dr. Good, We miss you. Kids are slowly improving. The sleeping is not. The Baby is getting strong, but not walking yet. My son is using somemore words and so is my daughter. I looks like you are having the time of your life, what a journey. I hope to hear from you,
It has some pics of the kids.
The Adams

Bangel_mc said...
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Dad Mom and the 3 E's said...

Hey Dr. Good. It's fun to see you are enjoying what you are doing. We miss you a lot and hope to come back to a practice where we can see you. The kids are growing like weeds and belive it or not, we aren't calling the doctor every week! Maybe we have figured it out, or maybe Easton is an easier baby, anyway our blog is if you get a chance.

Bakers4 said...

Dr. Good,
We are so glad to hear your spirits are high, your feet well, but dirty and success with the educaters, I truly think it is amazing what your doing for the people.
I liked the photo of your feet, I think we need to be more aware of such things. It sounds like your friends and you made some good jokes with it too.
What do the educators do while your team is away? do they have their own Clinic's or do the travel to different villages? Do they work together to educate the newer practioners? Does your team leave medical supplies and aid behind? What is the most commom ailment, or does it just depend on age, habitat, habits.....
We are doing Great! Ezra is eating like a horse, off all his medications, Dr. Pfeffer says we can probably be off CPAP next spring. He is crawling all over, he has such good tone and strength, he is even cruising furniture! He is starting to sign and just loves to get around. It has been a while, in our house, to have a youngster getting into toilets, and cupboards etc... Its so nice to see him doing so well He has his next Echo in September, at Primary's. Will you be back by then?
Your always in our prayers, keep your spirits up and your feet clean :)


Karin S. said...

Hey Dr. Good! I was so excited to find your blog. It was great reading about all your adventures. All I kept thinking about was how much we take for granted. We are soooo spoiled. I think it is awesome what you are doing. Definately keep us all updated on how things are going.
Jeffrey is doing well. Been up at Primary's lot's. Nothing too dramatic. Lot's of tests and Dr. visits. Looking at another surgery in the next couple months.Sad, but neccesary. We took Keira in to see if she was having reflux, but everything looked great. WHEW! I know you were worried about that. We miss you and are so grateful for everything. Going to the doctor isn't the same. Hurry back! Take care of yourself and be safe!

Cole Family said...

Hi Dr. Good.....we've been checking out your blog and are amazed with it....trent has loved seeing the post where you took all the pictures of the bugs....he also likes the one of your feet, he said it could be a bot fly and may have laid eggs in your feet, hopfully not though!!... we miss you as our doctor and hope you will come back doing a great thing....take care, vanessa, trent, & scarlett

Liz said...

Hey there Dr. Good, it's the Friel Family. I see you haven't been on for a while, but when you do I can't wait to see all the good work your doing. Your an awesome doctor. I showed Logan some of the pictures and his comments were so cute and innocent. I find your experience truly amazing. Take care!

Jessica said...

brian, I think its time you update this blog of yours!! and come see your favorite medical assistants at FFP!!


Cassie Plant said...

It’s great to see what you doing for other communities.Im glad to read more about your mission for education. "What lies behind us and what lies before us are tiny matters compared to what lies within us" -Emerson.You will have many patients following your return. Cassie and Jaeden Plant