Day 8- July 15, 2012
A day of rest
A picture is worth a thousand words. Here are three thousand words!
NYIT Global Health Team in El Salvador
Day 7- July 14, 2012
Seeing patients excited for our study was truly gratifying
Eighteen subjects completed today—the Chagas' study is off the ground.
This morning, after a delicious, hearty breakfast, we walked up the hill to the Perquin clinic. Dragging our black doctor bag that luckily had wheels - it contained a laptop, the consents, assents, questionnaires, gauze pads, electrocardiogram (EKG) machine, and electrodes - we were prepared to start the study.
Once at the clinic, we quickly secured a room and a refrigerator. In order to recruit patients, we hung up an amazing poster designed by Hau. Within 30 minutes, we had set up and were ready to go. We spoke to the physician in charge and she quickly announced to the patients in the waiting room that we were running a Chagas screening. Patients began to line up for testing, and seeing subjects excited for our study was truly one of the most gratifying moments of this process thus far. After seven long months of hard work, we were finally able to see the study to fruition; that in itself was one of the most satisfying moments ever!
Each student took turns drawing blood and performing the EKGs under the guidance of Dr. Passafaro. He was very patient and walked everyone through the process step-by-step. Because we both already have some experience working in hospitals, we let the first — now second— year students go first. We must say the expressions of excitement on their faces were worth a million dollars, or in this case a million pupusas! Not only were we doing something good for this community and the people of El Salvador, but the students were gaining a valuable skill and an unforgettable experience— as were we!
Looking forward to at least 282 patients more…
Jasmine Beria and Jon Giordano, D.O. 2014, NYCOM Academic Medical Scholars
Day 6- July 13, 2012
Health "charlas" with the students of Yamabal
It doesn't feel like we've only been here for five full days. We don't know if it's the long days away from the hotel, the barely noticeable, two-hour jet lag (still noticeable enough, as we are always awake before 6 a.m.), or simply something in the air, but in a weird way, this seems like the only reality we've known for a long time.
It's hard to explain, but with trips like this, where you are completely out of your element, seemingly helpless in a country where you can't easily communicate a simple phrase to anyone around you, and yet, still mesmerized by your surroundings, you tend to get caught up in everything. It will be nice to get home to New York, but I never thought I would fall in love with a culture like that of El Salvador— as much as my culture of origin in Japan.
Today was a big day for the five of us who are now second-year students—both D.O. and P.A. alike. We ran a health fair for a school in Yamabal; the fair has been over a month in the making. With the coordination of Peace Corps volunteers Alex and Elsa—Alex teaches at a local elementary school—we educated 40 fifth and sixth graders on nutrition, exercise, the lungs, the heart, and oral hygiene.
The class looked at our faces with expectant eyes. They had no clue as to what to expect from the strangers who had arrived at their school. Hau started the charla, an educational talk, by greeting the class and letting them know how happy we were to be at their school. He then ran an icebreaker. The students split up into five groups. The night before, we had each written down three facts about ourselves on a piece of paper, and today we gave one of these papers to each group. We asked the children to match the three facts with the correct global health student.
This was a great icebreaker because the students ran around to each of us, and we got a chance to interact with them. We ended this exercise by revealing our respective three facts.
We then began the nutritional education portion, just as we had on Wednesday at Los Cimientos. After the children took turns telling us what foods they liked and disliked, Sarah gave a short lecture on the vitamins and minerals found in different foods.
Many of the children were able to answer our questions; they were a bright group. We ended the nutrition portion with a short activity, where the children gave us examples of balanced meals that included fruits and vegetables, along with the normal answers of rice, chicken, tortillas and beans.
To break up our morning instructional time, I led the kids in a period of engaging and strenuous activity. As a certified personal trainer, I hoped to convince everyone that exercise was a great deal of fun. It was quite a sight to see three long lines of Salvadoran kids join medical students and doctors in repetitions of jumping jacks, push-ups, and squats together! We followed this with a game of sharks and lions, where kids ran back and forth as lions to avoid being tagged and becoming sharks, followed by a classic game of freeze tag. The result? Lots of laughing and screaming ten year-olds desperately dodging the outstretched arms of good-natured, but vastly outnumbered medical students.
After the exercise portion, Ryan talked about the lungs, and what they do for the body. Please understand that this was no easy task. What makes a good teacher is not how smart they are or how well they understand difficult subjects, but rather how well they are able to make difficult subjects understandable to a layperson—and in this case, by layperson I mean an elementary school student who does not speak English.
Ryan went above and beyond this challenge. Not only was he able to communicate that oxygen is all around us and explain how it helps our muscles and organs, but he was able to interact with the kids, who answered all of the questions he posed. The peak of interaction occurred when he asked the group to identify their favorite soccer team, in order to relate the oxygen requirement for elite athletes to lung health. A shouting match ensued among the children as they tried to make a decision between F.C. Barcelona and Real Madrid. I think the Barcelona fans prevailed.
The kids seemed to understand Ryan's point, and that's what we were hoping for.
Next, Michael adapted his extensive experience as an EMT into a charla on the cardiovascular system. Using analogies such as comparing blood flow to the town water supply, Michael quickly engaged the group on a level where they could understand complex ideas.
To give the children some perspective on what happens when a person develops high blood pressure, he organized a "human" blood vessel, where NYIT students and faculty served the roles of vessel walls, and children played the roles of red blood cells. NYIT members stood opposite each other an arm's length away from their neighbors– fortifying vessel walls just wide enough to let our eager red blood cells pass through two-by-two. We asked the children to repeat the trip, but this time the NYIT members bottlenecked the end of the vessel to simulate a narrowing of the arteries and an increase in blood pressure. Then, the illustrious Dr. Lardner played the role of a lifetime as arterial plaque impeding our red blood cells' clear passage through the vessel.
After the nutrition and exercise charlas the students certainly had a much better understanding of what they could do to have healthier hearts.
Finally, it was time to show the students how to properly brush their teeth. Dr. Ahmed had a model mouth with teeth and tongue— not actually hers; it was a plastic model!– that were about ten times larger than life. Dr. Ahmed and Ryan distributed toothbrushes and toothpaste to each student as gifts. We put toothpaste and a little water on the children's toothbrushes. Hau then showed the students how his mom taught him how to brush his teeth. He used the model and brushed the front, sides, top, and bottom of the teeth. He also made sure to not miss the tongue. Dr. Ahmed joined the students as they brushed their teeth. Everyone was laughing and having a great time.
Considering the challenges— we had shown up a little late, it was hotter than normal, we had to speak to them outside where the acoustics weren't very good, and most of us still can't speak Spanish without sounding funny— the day was a success. Even if we influenced just one child to change her life by making better choices, it was all worth it. As unique an experience as this likely was for them– they have probably never seen so many gringos in one place, let alone talk to them— I would wager that they were all able to take something useful home with them, and I am generally not a betting man.
The constant integration of new lessons with ones we discussed earlier in the day was central to the success of our health fair. Teaching the interconnectedness of healthy choices and their effects on all the systems of the body was our primary objective. The enthusiasm and energy these young children exhibited for nearly three hours can only be a sign that today's health fair will have a positive impact on their lives. This day showed me that even with obstacles like a language barrier, the right attitude and preparation will lead children to pay attention to your every move and learn from you.
Even if your Spanish sounds a little funny.
Dane Masuda, P.A. 2014, with Hau C. Chieng, Ryan Denley, Sarah Ng, Michael Nickas, D.O. 2015
Day 5- July 12, 2012
Mountains beyond Campos
Our group, one of three NYIT factions to disperse from our compound today, hit the trails to assist a health care promoter while he made rounds visiting six or so homes in the hot morning sun. The promoters dress in khaki short-sleeve shirts, and they all wear ID badges. Were they not already well known to the community, they would unquestionably have been invited into anyone's home because of their professional appearance and trustworthy demeanor.
Our objective was simple: to promote health. Lucio, our promoter on this day, knew certain households to harbor up to eight small children, and he was prepared to weigh and evaluate each one.
It was distressing to see how much the children hated being put on the scale. Poor kids—I couldn't bring myself to tell them that it doesn't get easier with age.
The silver lining of what they certainly viewed as an inhumane breach of the trust between child and adult was that Lucio was able to tell each mother that her children were of a normal, healthy weight, and that there were no immediate concerns.
Every mother had pamphlets to chart her children's growth curves and vaccination schedules. Lucio plotted the day's findings so each mother could view the progress of her child and have some peace of mind.
Down the road we visited a man and wife who were in their eighties. The man greeted us in a large-brimmed hat, wearing a smile, and slowly led us into the simple, open room that was his home. His wife seemed quite ill and weak as she lay half-asleep in her hammock. We were told she hadn't been able to move around for months, likely due to arthritis in her knees. Taking their vitals by flashlight in the dark room, we determined that both the man and his wife had very high blood pressure.
Lucio dispersed some pills containing vitamins and folate. We stayed to make sure the couple took them, and then left their home with a promise from the husband that he would visit the clinic in the morning. It was sad to learn that they had never had any children, and therefore had no one else to check in on them—but I suppose that was Lucio's job in this town.
Our last visit today took our group up a mountainside to visit the lone house on that particular trail. I can't even talk about the scary and steep drop-offs or the number of times I slipped or sunk into the mud because I know doing so will only upset me, but we'd heard the old abeula we were visiting was capable of making the trip without any difficulty at all.
On arrival, to my sight and to anyone else's who'd graced that mountain home today, I saw an alert woman working hard by her indoor wood-burning stove.
After I asked her permission, she allowed me to take a picture of her methodically rolling out tortillas. She was a very generous host to Dane, Sarah, and me, and happy to have us in her home. She insisted on serving us some of her food.
Obviously, it's impossible to say ‘no' to an abeula.
We ate our tortillas with beans and some cheese taken from a bowl of mountain water. It was delicious and we left nothing behind.
After assessing her normal blood pressure and asking some basic health questions, we checked her water basin—or pila—for contamination, and left her home with a smile and an embrace.
It was a relief to know that one didn't always have to help someone on the brink of serious illness to feel satisfied as a health care promoter.
Ryan Denley, D.O. 2015
Day 5- July 12, 2012
Médico promotores secure wellness for their communities
The ceiling fan in Room 11, where Dane, Ryan and I are staying, started to make a rhythmic clicking sound last night. It was occasionally interrupted by a loud grinding noise, which woke me up multiple times throughout the night. Despite that, I was up promptly by 6 a.m., ready to jog around the block with Dane as planned. We dashed through the morning air, now infused with the smell of burning stoves, tortillas and many other unidentifiable aromas that are distinct to Perquín.
Once again we squeezed into our familiar blue van after greeting our friendly driver. The view of the morning lights creeping over the top the majestic mountains never gets old, and we sat in awe driving down to Torola.
We arrived at Torola at 8 a.m. As planned, Ryan, Dane and Sarah accompanied one of Dr. Franklin Gomez's health promoters to five home visits. Dr. Lardner and Jon stayed at the Torola clinic to work with Dr. Gomez, and the rest of us headed to the San Fernando clinic where Dr. Erik Gomez was seeing patients.
When we arrived, we saw about 25-30 patients waiting outside of the clinic, mostly women, children, and a few elderly. Buenos dias, the crowd said as we walked through the clinic gate.
Dr. Gomez had just finished seeing a patient when we walked through his door. There were even more patients sitting on the blue benches inside the clinic, waiting for the nurse. Dr. Gomez introduced us to two médico promotores and suggested that we accompany them to a local school where they would be spreading the word about Chagas disease.
Dr. Ahmed, Michael, Helen—the Peace Corps volunteer that we met in Los Cimientos— and I followed médico promotor Marvin and his colleague to a local school where they spoke to a class of ninth graders about Chagas prevention. The presentation was remarkable, as it precisely tackled all the critical points about the disease. It also motivated the children to participate and ask questions. At the end of the session, Dr. Ahmed gave the students a quick lesson on the purpose of our using an EKG in our Chagas study, and also on how to obtain an EKG exam for themselves. She thanked the class for having us.
We left the school sometime after 11 a.m. Our next destination was about 20 minutes away from the school; we were to see a pregnant woman for a health check up at the site. Twenty El Salvadorean minutes quickly turned into another 45-minute hike for us. We arrived at the house just before noon.
Diego, a three-year-old boy, welcomed us into the house. His 17-year-old mother is having another boy, and is eight months along in her pregnancy. Marvin took down her blood pressure and her weight. We discussed the important role that médico promotores play in securing the wellness of pregnant women and their children.
At the end of the visit, the young mother granted us permission to perform a simple physical examination on her. We palpated her stomach and identified the position of the fetus inside the womb. The fetus' head was hard, located in the lower right quadrant of her stomach. We sensed the fetus' movement, witnessed its limb moving beneath her skin. This was my first encounter with a pregnant patient; the experience was priceless and I will remember it as an important page in my medical career.
Hau Chieng, D.O. 2015
Day 4 - July 11, 2012
Incentivizing preventive care
As Dane mentioned, we all travelled to the remote town of Los Cimientos. Two hours of this trip consisted of a fairly uncomfortable ride atop the metal bar of a pickup truck, as well as an unforgettable view of the mountainous and fertile land beyond. As soon as we arrived, 30 or so women greeted us next to the town clinic.
Helen, the local Peace Corps worker, was able to organize a Pap smear clinic for us in the morning. The women in El Salvador tend to be nervous and embarrassed about the procedure—not unlike us. However, as a result, they will rarely volunteer for the test— we learned that last year, during an attempt to run a similar clinic, only a couple of women were willing to receive one.
This year, it so happened that a non-profit organization donated 25 solar lamps to the community. Helen was unsure of how she would distribute this finite and popular resource, but then she had an idea: she could offer a solar lamp to each woman who agreed to receive a Pap smear exam. And so, 25 lucky women left the clinic with both an environmentally-friendly light source as well as a helpful preventative measure for cervical cancer!
This arrangement made me appreciate the roles of the Peace Corps workers and other long-term volunteers. They are so essential to the cohesiveness of the many non-governmental organizations and outside aid that come into any given country. They have an understanding of the true needs of the community and how best to bring education, resources, and services to local people in a meaningful way.
One anecdote Helen shared with us was that several men in the community who did not understand what a Pap smear was adamantly requested to be included in the solar lamp exchange. Sadly, they had to be turned away.
As one of two female medical students on this trip, I felt fortunate to be able to see and assist with the clinic. As a first-year medical student who is considering specializing in OBGYN, I also found this to be a great opportunity to better understand the clinical experience. For example, culture in this country is such that it is inappropriate for males to perform gynecological exams on females.
When we began, the scene seemed a bit chaotic— between calling out the names of the women, making sure their assigned numbers matched the numbers that had been written on the prepared slides, working out an efficient system to perform all of these exams in a few hours, and getting used to the tiny, hot, and dusty exam room. To emphasize the conditions: our translator passed out while we were examining our third patient.
Dr. Ahmed and Dr. Lardner were great at making the procedure as painless for the women as possible. Relaje—relax—and respiro profundo—breathe deeply— were two phrases that every patient heard as they were reassured repeatedly throughout the exam.
No more details about Pap smears in this blog but suffice to say it was a successful endeavor for all.
Sarah Ng, D.O. 2015
Day 4- July 11, 2012
Engaging the community
So the funny thing about technology in a developing country is that as you tend to use it less and less, you get more and more immersed in the surrounding culture. It's been three full days here in El Salvador and my use of technology simply consists of Skyping with my wife each evening, checking my email once a day, and using my iPad to blog every few days. It's kind of cool how one's need for technology decreases on these kinds of trips—but maybe it's just me.
Anyway, today was an extremely full day. We woke up at 5:30 a.m. so that we could head over to the community of Los Cimientos, which was a three to four-hour drive – you lose track of time on these types of trips. We spent the first hour in our regular blue van, but the majority of the time, we sat in the back of a mid-size Toyota pickup truck. We had to travel up to the top of the mountain to reach the community. Even though the seating was uncomfortable for most of us, the sights never got old. We passed children playing soccer, dogs laying in the middle of the road, cows herded up the mountain, farmers taking work breaks in the shade, and beautiful, cloud-perched mountains sitting in the distance.
Once we got up to the town, the women in our group found the clinic and assisted local women by giving free Pap smears. The men decided to spend the morning hiking the road of the mountainside.
Please don't underestimate my statement when I say parts of the hike were steeper than I have ever encountered. For those of you who run on a treadmill, the incline of the hike was somewhere between 30 and 40 degrees – most treadmills max out at 15.
It was a fruitful hike though. About halfway up, we stopped and asked a local woman if we could pick some of her green mangos from her tree. She said yes and gave us a stick to reach the higher-up mangos. We were able to knock about five or six down. The thing about these mangos is that the first bite is indescribably tart and tough. Once you get past that, the inside is juicy and good. It just takes some effort to get past that first bite.
After reaching the home of a local family, meeting up with the women from the clinic, and eating a meal of spaghetti and refried beans, we headed to the local school to lecture the 8th and 9th graders on the benefits of a balanced meal and proper nutrition. Because each class period breaks for recess/lunch, we spent a brief amount of time playing soccer with the boys. This was the highlight of my day. I met Julio, Freddie, Luthero, and Esteban — they were students between the ages of 8 and 14 who played on my team. However, as good as they were — much better than anyone I knew when I was their age — I have to give the game MVP award to Dr. Passafaro, who made multiple saves as goalie.
Afterwards, we made our way inside one of the classrooms to give our lectures on nutrition. With the help of translators, we began with an activity for the students in each group. They listed the foods that they like and dislike. Many of their meals consisted of a carbohydrate, like rice, with an animal protein, like chicken. Once we reviewed their lists, we delivered a short talk with a visual aid on how to balance their meals, emphasizing the benefits of some of the major vitamins and minerals and how children could get these benefits by adding more fruits or vegetables to their daily diets. We ended with a follow-up activity, asking each of them to come up with an example of a meal they would like, that would be better-balanced than what they normally eat. The students were engaged. The time went better than expected.
Then, with the sight of heavy rain and lightning in the distance, ponchos at the ready, we packed into the back of the truck, flew back down the mountain, piled into the van and trekked our way back to Perquin Lenca. You know it was a good day when everyone is sleeping on the way back, and it's only 7 p.m....
Dane Masuda, P.A. 2014
Day 3 - July 10, 2012
Hunting for "chinche"
Today the group traveled to the clinic in Torola. Half of the group stayed in the clinic and half went out with a health promoter. The health promoter's job is to teach the community, provide wellness visits to people's homes, and other various tasks. Dr. Ahmed, a Peace Corps volunteer named Jess, and the two of us joined the health promoter.
We started the trip by squeezing ourselves into the ambulance, which was nothing like those back in the United States. While Hau, Dr. Ahmed, the health promoter, and two patients were in the back of the ambulance, Jess, the driver, and Mike squeezed into the front of the ambulance. The ride was about five minutes, and then we hopped out and started walking to our first house. Before entering any home or taking any pictures, we always asked permission. Jess was invaluable since she was our interpreter.
The first home had a mother with her little boy. The health promoter spoke with the mother about how she and her family were doing. He then went into the house to check for reduviid bugs— the ones that carry Chagas disease. Luckily, he found none.
We stopped at a second home. There, we met another mother and her little girl, who was three years and nine months old. The health promoter spoke with them about the child's health. We weighed the little girl, and found her to be slightly underweight.
We then made our way to the third house. This time there was an older woman there. She was very friendly and actually gave us bananas to eat. She told us that she had two daughters in the states: one in Texas and the other in Virginia.
After these home visits, we had two options for returning to the clinic — the long way that had fewer steep hills, or the much steeper five-minute way. We chose the quicker route, but we ended up taking forty-five minutes to get back to the clinic anyway. We walked up a mountain along a muddy trail with rocking popping out everywhere. It was a slippery walk. In fact, some of us experienced that the hard way — by falling on our bottoms. The walk was well worth it. The scenery and experience were amazing.
We arrived back at the Torola clinic at 1 p.m.; there, we regrouped with Ryan, Dane and Sarah, who had been shadowing Dr. Gomez for the past four hours. They quickly shared with us some of the cases that they had seen, and we told them a little bit about our hunt for chinche— reduviid bugs — at the houses that we visited. We headed back to Perkin Lenca, just in time of lunch.
After lunch, our group sat down outside the common area of the cabin to plan for tomorrow's health fair.
Michael Nickas and Hau Chieng, D.O. 2015
Day 3- July 10, 2012
Ridding the burden of disease
Only a single ornery roster joined me on my run up the hill this morning. A mixture of heat and the vertical climb to the edge of town likely tempted the local dogs to hit the snooze button a few more times. There were not many locals awake at that early hour except for a few extremely hard workers who were filling street holes and repairing a support wall that had been damaged by heavy rain. By the time I made it to the edge of town, I was happy to see the community beginning to wake and was excited that I would be spending my day getting to know them better.
Sarah, Dane, and I first walked into Dr. Franklin Gomez’s office at around 8:30 a.m., but he had certainly already been seeing patients for over an hour. He was kind enough to let us observe him as he serviced the men, women, and children who passed through the revolving door that was his consultation room. The woman who sat in his chair was a twenty-something wincing in pain as the doctor palpated her right lower back. Thanks to Sarah’s prowess in translating, we deduced that the woman was suffering from an advanced urinary tract infection (UTI) and possibly a kidney stone. She was sent on her way with an antibiotic and orders to get further testing at the larger Perquin Clinic. The Torola Clinic, albeit ready and able to serve many needs of its community, cannot perform most of the tests or provide the specialists that many patients ultimately need.
In the span of fifteen patients, we paid witness to a sixteen-year-old discovering she was pregnant for the first time, a woman who lost her pregnancy while recovering from toxoplasmosis — a rare disease in the United States, but more common in Central America, a five-day-old baby boy who was extremely good-tempered despite his abdominal hernia, a slew of complicated and uncomplicated upper respiratory infections in children—a major concern in this region, and an elderly man with multiple chronic illnesses driving him into frailty.
Our time with Dr. Gomez was the first exposure any of our eager group members had with patients since we arrived in this great country. A few interesting points were made glaringly clear in the wake of this remarkable experience:
1) The patient population seeking the care of a family practitioner in El Salvador can be diverse and tests the breadth of the physician’s knowledge daily; however, the overwhelming majority of patients seen are young women with young children.
2) Epidemiologic data is not determined through conjecture, but by the diligent efforts of healthcare promoters who care to, above all else, better the state of their neighbors’ health. Dr. Gomez’s clinic walls are covered with posters tracking diseases in the region because he wants to be a part of ridding the burden of these diseases.
3) It is not for the context of this entry to debate how well or poorly the free health care system in El Salvador is working for its people, but after today’s experience, I feel comfortable saying this:
I saw fifteen patients today and if they all had to pay for their services, I might not have seen fourteen of them.
Ryan Denley, D.O. 2015
Day 3- July 10, 2012
The El Salvadorian Superior Council of Public Health approved our study!
Hola to everyone following the Center for Global Health (CGH) in El Salvador!
Our first few days in El Salvador have been wonderful. The mountainous landscape that we can see from our compound (the Lenka) is absolutely breathtaking.
Yesterday, the entire group was given a tour of the three clinic sites (Perquin, Torola, and San Fernando) where we will be 1) conducting the Chagas study and 2) seeing patients with the Salvadorian physicians. The three clinics are visited by patients from the district of Morazán, as well as the country of Honduras — because of the proximity to the Honduras/El Salvador border and lack of clinics in that area of Honduras.
Following our tours of the clinic, we returned to the Lenka for a delicious dinner and a demonstration of the EKG machines to be used in the Chagas study.
Today, we started our day early and broke into two groups. One group headed out to Torola to follow a health care promoter (un promotore) into the community, while we joined Drs. Passafaro and Lardner in a trip to the Perquin clinic for a meeting with the three Salvadorian physicians who run the local clinics: Drs. Fuentes, Gomez, and Gomez. We were also elated to learn the news that the El Salvadorian Superior Council of Public Health had approved our study! We had a terrific meeting as we presented the details of the study to the physicians and worked out some scheduling logistics.
We can't wait to start the work in the clinics later this week and to continue to learn more about the health care system and culture here in El Salvador. Tomorrow we are off to los Cimientos where the women on our team will be performing Pap smears in a local clinic and the men will be running educational programming at a local school.
Hope everything is great back in the states!
Jon Giordano and Jasmine Beria, D.O. 2014, NYCOM Academic Medical Scholars
Day 2- July 9, 2012
They were eager to educate us as well…
I didn't get a good night of sleep last night, but I wasn't as tired as expected. I tumbled around on the bed for a good 30 minutes before the rooster went off around 5 a.m. It bought back many memories of growing up in the rural region of Viet Nam. Dane's alarm quickly brought me back to the present, and the excitement of the day ahead got me out of bed at 6:30 a.m. Dane, Ryan and I decided to jog around the area before showering and getting down to the cafeteria for breakfast. The run was refreshing.
Today's breakfast was amazing. We had scrambled eggs, cooked with green pepper, onion, and tomatoes, and coffee, which is grown and processed locally. We also had pancakes, along with the most delicious freshly-squeezed orange juice.
The ten of us then made our way to a van parked just outside of Perquin Lenca at roughly 8 a.m. We drove to the Perquin clinic just a mile uphill from where we are staying. We met the medical director of the region of Morazán, and introduced our mission and ourselves. We also demonstrated how to obtain an EKG (electrocardiogram) using the equipment that we brought with us to El Salvador. The doctor, as well as the rest of the medical personnel at the clinic, was incredibly hospitable. They all showed a great deal of interest in our study to investigate a possible screening procedure for detecting Chagas disease. They were eager to educate us as well, and provided us with additional information that they have gathered through many years of practicing and dealing with the disease in their patients. We had a tour of the clinic, where we visited the vaccination room, the medical and psychological consulting rooms, the pharmacy, and an emergency delivery room. The patients, sitting outside of the clinic and awaiting care, were mainly female— mostly younger women with children. The children who were hanging out outside the clinic were shy at first, but later they showed no hesitation in waving to us and greeting us. We exchanged friendly "hola's" and smiles as we headed back to the van for a trip to the next two clinics at San Fernando and Torola.
Hau C. Chieng, D.O. 2015
Day 1- July 8, 2012
I’ve travelled all my life, but…
I've travelled all my life. I have gotten used to 12-hour flights from Chicago to Narita twice a year, but today's trip was rough. It started out at JFK at 7:30 in the morning. For someone who has been on summer break this past month, that was difficult in itself. The five-hour flight was spent uncomfortably watching TV show reruns and trying to get to sleep, in spite of the long stretches of turbulence going on every couple of hours. Once we landed, as we were walking from the gate to our luggage, past customs, I was pleasantly surprised at how comfortable — temperature-wise— the city was. I then realized that we had not even walked outside yet, and as soon as we did, I immediately started sweating from every uncomfortable area on the surface of my body. Luckily we only had to wait about 15 minutes before our air-conditioned bus arrived and we were on our way.
The next four to five hours were the most difficult. What made it difficult for me was that our bus driver seemed to be driving our 20-person bus with the mindset that he was driving a small two-person sports car. All the roads we travelled were two lanes, so almost every time he attempted to pass someone, I felt like we barely squeezed back into our own lane before an oncoming car/semi-truck/motorcycle flew by us. I spent the last two hours of the trip forcing myself to look out the side window, to keep from developing an ulcer.
After two gas stops and a short break that consisted of a semi-awkward attempt at ordering fried chicken at Pollo Campestro, we finally got to Perquin Lenca after dark — which was actually only 7:30. The resort owner, Ron, showed us our beautiful electricity and Wi-Fi-enabled rooms and fed us some form of do-it-yourself burritos. We spent the rest of the night was walking around trying to maximize the Wi-Fi signal or laying around in the hammocks. It was a good end to a long, stressful day.
Dane Masuda, P.A. 2014