I'm so sorry for leaving people hanging! But kudos to anyone who actually reads this, a week after our return, to find out the end to our epic tale.
Where we last left off, Libby, Alisha, and I were heading out of our Chicago hotel at about 2:30pm Monday, to catch our 4:55pm flight out of Chicago. Since we didn't have any bags, and we had already gotten our boarding passes, getting to our gate on time was no problem. We got there plenty early.
And surprise, surprise! It was futile for us to get there early. We had a few gate changes, and then at about 4:30, they informed us that our flight would be delayed by an hour. Another gate change. Another delay. Finally, we overheard some people apparently in the know who were saying that we were changing gates one final time because our first plane was broken, but they had managed to track down another one that we could use.
Alas, we finally boarded and had an uneventful flight to Detroit. About 9:30pm, eastern standard time, March 2, 2009. (Reminder, original scheduled arrival: Saturday, February 28, 11:30pm.)
Upon landing, at baggage claim, of course our bags didn't come out on the conveyor belt, since they had been there for at least a day. We went to the baggage office and told the woman there that we thought our bags may have arrived before us.
"What's the last name?"
"Egle and Floyd."
"Oh! You finally made it!"
She didn't even have to check her computer or anything. We were infamous already.
Neil, who had driven his girlfriend's car from Chicago, beat us to Michigan by several hours. His luggage was sent on to Flint, since that airport is closer to his parents' house. We later found out it arrived filthy and damaged. A nice punctuation to a fabulous trip, eh?
That is the story of our 9-hour trip that really took 55. We were compensated a grand total of $300 in voucher form, but that was technically only for agreeing to arrive 6 hours late. So, since we really arrived 46 hours late, at a rate of $50 an hour, we should be eligible for a total of abrst $2000 in vouchers, right? We'll send letters to American Airlines and let you know if they agree.
We missed our first day of our current med school rotation. That's a big deal because more than two days means you fail the rotation, and since we are so close now, it would mean a delayed graduation. So, needless to say, we weren't pleased about the delay, and neither were our preceptors. But as long as we don't get sick this month and miss more days, we should be ok.
Thus comes to an end our delightful trip. It really was quite wonderful, all said and done, and we had many adventures... and just when we thought we had had our last, God decided to throw one more surprise at us.
Stay tuned for a blog for our upcoming April trip to Malawi, Africa (assuming that we get occasional Internet access there)!
Monday, March 9, 2009
Monday, March 2, 2009
Jonathan - Mar 2 - One last aventura...
Why am I still posting to the blog? Our trip ended a few days ago. We posted our comparisons of the different cultures we've been exposed to. The end, right?
Don't I wish. As I write this, we still haven't made it home. American Airlines should be looking forward to lots of friendly emails to their customer service department, as we will be arriving, optimistically, 44 hours after our scheduled time. Although, as I sit in our Chicago hotel watching snow fall, I'm not letting myself get too helpful.
Original plan, for your reference, was leaving El Salvador at 2pm Saturday, stopping in Miami, and arriving in Detroit just before midnight Saturday night.
So, the plane to take us from San Salvador to Miami apparently had some engine problems, and it took them about three hours to get a replacement. By the time we made it to the USA, we were too late to catch our Miami to Detroit connection. Night in Miami.
The next available MI flight was via Dallas (logical, right?) the next day. Checking in for our Dallas flight, we were told that two of us hadn't been rebooked successfully, but thankfully we had arrived two hours and fifteen minutes early, which ended up being just enough time for them to get it sorted out, and to get us on the plane.
We were told we had to get our seat assignments there for our Detroit flight. They didn't tell us, though, that when we got there, we would have to deal with the fact they were overbooked by 18 people. We didn't have seats. The supervisor said he'd "try really hard to get us on the plane," though. That made us feel a lot better.
We were given the option of giving up our non-existent seats for a $300 voucher, and we would get guaranteed seats on flights to Chicago and then Detroit, arriving at midnight Sunday night. There were only a few seats left, though, and if we didn't take that option immediately, there were other people in line who were asking about it at the same time as us, and if they took it, the next available flight wouldn't arrive until Monday afternoon. Since we didn't have seats on our flight, we decided to go for the guaranteed seats via Chicago.
Since I'm in Chicago now, you've probably figured out things didn't go according to plan. But here's the scoop. Our flight to Chicago was a bit late, and they had closed one of the runways there due to fog, but we made it to the gate about 10 minutes late. Not too bad.
We went to the gate for the Detroit flight and they told us we'd board in 15 minutes. But then they announced boarding for Flint, MI. It turns out, there was a flight to Flint before ours leaving out of the same gate. No problem, they promised. It'd be a quick turnover, and we'd made it out, arriving at about 12:30am instead of 12am, and they were sorry for the inconvenience.
Flint passengers boarded. But the plane sat there. And sat there. And sat there. For two hours, they waited to get de-iced (oh how I felt for those passengers on board!). We sat at the gate, waiting for them to leave. We were finally told that our plane was on the ground, waiting to take us, but it didn't have a gate to pull it. It was next in line, though. Finally, it got assigned to a gate, and we were able to board, now about 3 hours late, getting on board about 11:30, Central Time, 12:30am Eastern Time.
I'll finish this saga later with a dramatic end later, but it's time to catch an airport shuttle!
Don't I wish. As I write this, we still haven't made it home. American Airlines should be looking forward to lots of friendly emails to their customer service department, as we will be arriving, optimistically, 44 hours after our scheduled time. Although, as I sit in our Chicago hotel watching snow fall, I'm not letting myself get too helpful.
Original plan, for your reference, was leaving El Salvador at 2pm Saturday, stopping in Miami, and arriving in Detroit just before midnight Saturday night.
So, the plane to take us from San Salvador to Miami apparently had some engine problems, and it took them about three hours to get a replacement. By the time we made it to the USA, we were too late to catch our Miami to Detroit connection. Night in Miami.
The next available MI flight was via Dallas (logical, right?) the next day. Checking in for our Dallas flight, we were told that two of us hadn't been rebooked successfully, but thankfully we had arrived two hours and fifteen minutes early, which ended up being just enough time for them to get it sorted out, and to get us on the plane.
We were told we had to get our seat assignments there for our Detroit flight. They didn't tell us, though, that when we got there, we would have to deal with the fact they were overbooked by 18 people. We didn't have seats. The supervisor said he'd "try really hard to get us on the plane," though. That made us feel a lot better.
We were given the option of giving up our non-existent seats for a $300 voucher, and we would get guaranteed seats on flights to Chicago and then Detroit, arriving at midnight Sunday night. There were only a few seats left, though, and if we didn't take that option immediately, there were other people in line who were asking about it at the same time as us, and if they took it, the next available flight wouldn't arrive until Monday afternoon. Since we didn't have seats on our flight, we decided to go for the guaranteed seats via Chicago.
Since I'm in Chicago now, you've probably figured out things didn't go according to plan. But here's the scoop. Our flight to Chicago was a bit late, and they had closed one of the runways there due to fog, but we made it to the gate about 10 minutes late. Not too bad.
We went to the gate for the Detroit flight and they told us we'd board in 15 minutes. But then they announced boarding for Flint, MI. It turns out, there was a flight to Flint before ours leaving out of the same gate. No problem, they promised. It'd be a quick turnover, and we'd made it out, arriving at about 12:30am instead of 12am, and they were sorry for the inconvenience.
Flint passengers boarded. But the plane sat there. And sat there. And sat there. For two hours, they waited to get de-iced (oh how I felt for those passengers on board!). We sat at the gate, waiting for them to leave. We were finally told that our plane was on the ground, waiting to take us, but it didn't have a gate to pull it. It was next in line, though. Finally, it got assigned to a gate, and we were able to board, now about 3 hours late, getting on board about 11:30, Central Time, 12:30am Eastern Time.
I'll finish this saga later with a dramatic end later, but it's time to catch an airport shuttle!
Friday, February 27, 2009
Libby- Feb 28- A comparison of the Health care systems
Costa Rica, an introduction to the system: Last year, we learned about the nationalized healthcare system in Costa Rica, which came out of a post-war restructurization of the country that included eliminating all armed forces and putting that money into the infrastructure of the country, the education and the healthcare system. According to the WHO, Costa Rica has a better healthcare system than the US. And yet, as we worked in the community, we learned that there are still many gaps in the delivery of healthcare in Costa Rica.
One of the pros of the system is that there are chronic disease registries for everyone in the country who has conditions such as diabetes, hypertension, asthma, etc. Even for the Nicaraguan immigrant children we worked with last year, this chronic disease program is available, to provide medical care and medications related to that specific disease process. In the children's clinic, it meant our asthmatic patients had access to the inhalers and other medications they needed.
The cons were that we still saw our asthmatic patients when they had a cold or parasites because those diseases weren't covered. Even for Costa Rican citizens the healthcare was not accessible if you did not hold a job. There were other people who were excluded from healthcare services. Additionally, even for the people who had access to the healthcare system, there was a shortage of specialists and a long waiting list for certain, non-emergent surgeries, etc.
Overall, the Costa Rican system provides better access to decent healthcare for the majority of the population- a step above what the US has been able to offer its citizens as of now.
Nicaragua, an introduction to the system: When we got to Nicaragua, what we first noticed was the poverty. It was not contained to the "ring of poverty" outside the capital city. It was in the cities and certainly extended out into the rural areas, including the community that we worked in. Our community was a 30 minute drive from the closest town, and the only way there was a dusty dirt road. The healthcare system seemed to parallel the infrastructure of the country. In the biggest cities- Managua and Leon- you could find tertiary care hospitals and just about any specialist you could want. There were private and public hospitals and clinics. As far as the public system was concerned, the medications and medical supplies were distributed first to the tertiary care centers, and then portioned out to the secondary hospitals and clinics in the smaller towns, and then the remaining supplies were packaged and sent to the most distant clinics, including the one in our community. When we arrived at the public clinic, the pharmacy had almost bare shelves, with a few different types of beta blockers, statins, tylenol, antibiotics and antiparasites. One of the supplies that they desperately needed was condoms. One unique feature about the Nicaraguan system are Brigadistas, or health promoters, who are lay people from each rural community who work with the Ministry of Health to help bring clinic and national efforts to their communities (these are the people we taught first aid classes to).
One of the pros of the system is that healthcare is universally available. There are a couple of different levels, depending on what kind of a job you have, but everyone has access to some level of care. The brigadistas are a second pro of the system, as they are the hands and feet of the Ministry of Health, and make a lot of public health campaigns, such as the abate campaign, feasible.
One of the cons of the system is that the healthcare that is universally available is lacking. The doctor was only there a few days a week, which meant that it was mostly the nurse who ran the clinic. Medications were scant, so although medications are free through the nationalized system, there are not many actually available. Also, although there was a clinic in our rural town, a lot of people are unable to access the clinic during the raining season, because the clay-like dirt creates huge rivers across the roads that are impassable at times. When we taught first aid to people from these further communities, it was with the understanding that sometimes their 'first aid' efforts would be the only medical attention that people in their community would be able to access during the raining season. The lack of basic infrastructure such as paved roads and bridges was a huge barrier to access. Another huge aspect of health was the lack of waste management services in all of the country. The streets in the biggest cities and the smallest towns were always lined with garbage, because there was no where else to put it.
Overall, the Nicaraguan healthcare system and overall country structure was severly lacking in terms of population health.
El Salvador, an introduction to the system: Arriving in San Salvador after 2 weeks in Nicaragua was a bit of a shock. The streets were cleaner and many of the store signs contained English words. It looked like a city from the US. From our time here, we have learned that the system sounds a lot like the Nicaraguan system as far as the format. There are lots of specialists and tertiary care centers in the capital city, and smaller hospitals as you go a little further out, ending in rural clinics. At the government clinic closest to our rural site, there are several doctors, a handful of nurses, a dentist and a pharmacy.
The pros: Healthcare is available to everyone, free of charge, including medical and dental visits and medications. There are nurses and health promoters that work for the Ministry of Health, who have specific jobs that they have to complete each month. This includes visiting pregnant women each month for education and health checks, visiting babies every month for the first year for weight and measurements, and every 3 months after that until age 5 for the same. Vaccinating the children and older adults in the community, as needed. Providing PAP smears for women once a year, in the community. Other jobs include tending to wound care, administering TB medications, and providing health education to the community.
The cons: There is a lot of bureaucracy in the health care arena, and I believe throughout the whole government structure. In order to be seen by the next level of care, you need to be referred. In order to be seen at the local clinic, you have to arrive at 7 in the morning (where there are often 50-100 other people), and wait all day in hopes of being seen. If you are not seen that day, you have to go back the next day. Once you see the doctor, you will have a 3-5 minute appointment and, if needed, are granted a referral to see a specialist. You have to pay to get to the city, and may have to make several trips before you get to the right specialist, or get an appointment for the treatment you need. The whole process takes a lot of time and money, and is very difficult for the people in our rural community. Another example of the bureaucracy is that the dentists are only allowed to provide one procedure per person per day. So, if a person needs two fillings, the government will provide it, but the person will need to be seen 2 different days. Similarly, there is a rule that doctors can only see one member of a household per day. So, it can't be a family trip in which everyone is seen in the same day, even if everyone is in need of medical attention. It is one way to ration the limited healthcare resources, but is often very frustrating! Hector, the local El Salvadorean doctor at our clinic tells us that when he was doing his training at the local public hospital, the two imaging tests available were the X-ray and ultrasound. If a patient needed a CT scan, he (the medical student) would escort the patient up the street to the private hospital. As a medical student, he was also the one person in charge of the ER. The 2-3 attending physicians would be taking care of the intensive care patients and the surgeries and he would be the only physician in the ER, as a medical student! He was also dissatisfied with the clinical care he was able to provide during his 'social service' year after medical school. He worked in a public clinic and was forced to see patients in 3 minutes or less.
Overall, the infrastructure of the country is much better than Nicaragua, but the health care resources are very minimal.
It is hard to know what makes a good system until you have seen some systems that have a lot of problems. The experiences this year have certainly helped me to see all the US does have going for it, such as solid infrastructure (roads, electricity, water) and access to life-saving medications and procedures when needed. Although I still think that the US needs to move towards a national health plan, the plethora of problems I have seen on this trip have helped me to realize how carefully such a plan will need to be constructed, so that the end result is an improvement of health for the country.
One of the pros of the system is that there are chronic disease registries for everyone in the country who has conditions such as diabetes, hypertension, asthma, etc. Even for the Nicaraguan immigrant children we worked with last year, this chronic disease program is available, to provide medical care and medications related to that specific disease process. In the children's clinic, it meant our asthmatic patients had access to the inhalers and other medications they needed.
The cons were that we still saw our asthmatic patients when they had a cold or parasites because those diseases weren't covered. Even for Costa Rican citizens the healthcare was not accessible if you did not hold a job. There were other people who were excluded from healthcare services. Additionally, even for the people who had access to the healthcare system, there was a shortage of specialists and a long waiting list for certain, non-emergent surgeries, etc.
Overall, the Costa Rican system provides better access to decent healthcare for the majority of the population- a step above what the US has been able to offer its citizens as of now.
Nicaragua, an introduction to the system: When we got to Nicaragua, what we first noticed was the poverty. It was not contained to the "ring of poverty" outside the capital city. It was in the cities and certainly extended out into the rural areas, including the community that we worked in. Our community was a 30 minute drive from the closest town, and the only way there was a dusty dirt road. The healthcare system seemed to parallel the infrastructure of the country. In the biggest cities- Managua and Leon- you could find tertiary care hospitals and just about any specialist you could want. There were private and public hospitals and clinics. As far as the public system was concerned, the medications and medical supplies were distributed first to the tertiary care centers, and then portioned out to the secondary hospitals and clinics in the smaller towns, and then the remaining supplies were packaged and sent to the most distant clinics, including the one in our community. When we arrived at the public clinic, the pharmacy had almost bare shelves, with a few different types of beta blockers, statins, tylenol, antibiotics and antiparasites. One of the supplies that they desperately needed was condoms. One unique feature about the Nicaraguan system are Brigadistas, or health promoters, who are lay people from each rural community who work with the Ministry of Health to help bring clinic and national efforts to their communities (these are the people we taught first aid classes to).
One of the pros of the system is that healthcare is universally available. There are a couple of different levels, depending on what kind of a job you have, but everyone has access to some level of care. The brigadistas are a second pro of the system, as they are the hands and feet of the Ministry of Health, and make a lot of public health campaigns, such as the abate campaign, feasible.
One of the cons of the system is that the healthcare that is universally available is lacking. The doctor was only there a few days a week, which meant that it was mostly the nurse who ran the clinic. Medications were scant, so although medications are free through the nationalized system, there are not many actually available. Also, although there was a clinic in our rural town, a lot of people are unable to access the clinic during the raining season, because the clay-like dirt creates huge rivers across the roads that are impassable at times. When we taught first aid to people from these further communities, it was with the understanding that sometimes their 'first aid' efforts would be the only medical attention that people in their community would be able to access during the raining season. The lack of basic infrastructure such as paved roads and bridges was a huge barrier to access. Another huge aspect of health was the lack of waste management services in all of the country. The streets in the biggest cities and the smallest towns were always lined with garbage, because there was no where else to put it.
Overall, the Nicaraguan healthcare system and overall country structure was severly lacking in terms of population health.
El Salvador, an introduction to the system: Arriving in San Salvador after 2 weeks in Nicaragua was a bit of a shock. The streets were cleaner and many of the store signs contained English words. It looked like a city from the US. From our time here, we have learned that the system sounds a lot like the Nicaraguan system as far as the format. There are lots of specialists and tertiary care centers in the capital city, and smaller hospitals as you go a little further out, ending in rural clinics. At the government clinic closest to our rural site, there are several doctors, a handful of nurses, a dentist and a pharmacy.
The pros: Healthcare is available to everyone, free of charge, including medical and dental visits and medications. There are nurses and health promoters that work for the Ministry of Health, who have specific jobs that they have to complete each month. This includes visiting pregnant women each month for education and health checks, visiting babies every month for the first year for weight and measurements, and every 3 months after that until age 5 for the same. Vaccinating the children and older adults in the community, as needed. Providing PAP smears for women once a year, in the community. Other jobs include tending to wound care, administering TB medications, and providing health education to the community.
The cons: There is a lot of bureaucracy in the health care arena, and I believe throughout the whole government structure. In order to be seen by the next level of care, you need to be referred. In order to be seen at the local clinic, you have to arrive at 7 in the morning (where there are often 50-100 other people), and wait all day in hopes of being seen. If you are not seen that day, you have to go back the next day. Once you see the doctor, you will have a 3-5 minute appointment and, if needed, are granted a referral to see a specialist. You have to pay to get to the city, and may have to make several trips before you get to the right specialist, or get an appointment for the treatment you need. The whole process takes a lot of time and money, and is very difficult for the people in our rural community. Another example of the bureaucracy is that the dentists are only allowed to provide one procedure per person per day. So, if a person needs two fillings, the government will provide it, but the person will need to be seen 2 different days. Similarly, there is a rule that doctors can only see one member of a household per day. So, it can't be a family trip in which everyone is seen in the same day, even if everyone is in need of medical attention. It is one way to ration the limited healthcare resources, but is often very frustrating! Hector, the local El Salvadorean doctor at our clinic tells us that when he was doing his training at the local public hospital, the two imaging tests available were the X-ray and ultrasound. If a patient needed a CT scan, he (the medical student) would escort the patient up the street to the private hospital. As a medical student, he was also the one person in charge of the ER. The 2-3 attending physicians would be taking care of the intensive care patients and the surgeries and he would be the only physician in the ER, as a medical student! He was also dissatisfied with the clinical care he was able to provide during his 'social service' year after medical school. He worked in a public clinic and was forced to see patients in 3 minutes or less.
Overall, the infrastructure of the country is much better than Nicaragua, but the health care resources are very minimal.
It is hard to know what makes a good system until you have seen some systems that have a lot of problems. The experiences this year have certainly helped me to see all the US does have going for it, such as solid infrastructure (roads, electricity, water) and access to life-saving medications and procedures when needed. Although I still think that the US needs to move towards a national health plan, the plethora of problems I have seen on this trip have helped me to realize how carefully such a plan will need to be constructed, so that the end result is an improvement of health for the country.
Thursday, February 26, 2009
Libby - Feb. 27- Update from El Sal
Let's see, we had another adventure on Wednesday when we went up the mountain near the clinic to a more remote community called Las Brisas. We were told last week that the hike would take about an hour and a half, and Wednesday morning, people began to say it would take 2 or 2 and a half hours, and that the journey was unsafe, so we were talked into hiring a pick-up truck to take us up the mountain. The journey took about a half hour and provided some great views along the way.
When we arrived, we met with one of the teachers at the school. She and the other two teachers are from other communities, but stay in Las Brisas during the week with local families. 30 years ago, the children of Las Brisas had to go to school in Las Delicias, where the clinic is, and walked there and back every day.
From her, we learned that there is no running water in the community, so families were given a certain ration of water each week by the Mayor, that came in large barrels. They have had electricity for one year. The closest clinic is in Las Delicias, and the closest government clinic is even further. There is a local midwife who is also a natural healer and one of the leaders in the community. The majority of women deliver at home, and only go to the hospital if something goes wrong. The most common medical issues are respiratory infections, diarrhea (parasites) and malnutrition.
After lunch, we walked around the houses in the community and met 10 or 12 different families. We asked a lot of questions to get an idea of what public health issues exist in the community. We discovered that most families have a latrine, houses constructed of corrugated tin, bamboo branches and rope to hold it all together. Homes had dirt floors, and most of the women and children we met were not wearing shoes. The dirt is very dry and fine in the dry season, and the loose dust was up to 3 inches deep along some of the roads we walked along.
One girl we met was 7 years old and had decided that she had had enough school. When we asked her mom about it, her mom said she had tried to convince her to keep going, but the girl was set on stopping. The mom told us that she works a 'man's job,' picking coffee in the fields and doing other manual labor so that her children will have money for food and school uniforms and books, so that they can finish school and get jobs in the factories, which is much better work but often now requires at least a 9th grade education. The situation didn't seem to be that uncommon.
By the end of the day, we had thought of many ideas for how to improve upon the overall health of the community. It was very interesting to talk to Meredith afterwards about what needs she had identified in the community, and what her first steps will be in making that happen!
Yesterday we got to visit one of the two archaeological ruins that are near the clinic. The buildings are approximately 3000 years old and thought to be Mayan in origin. San Andreas was the cultural and political center, and these ruins are thought to be religious in nature, I believe.
Tuesday, February 24, 2009
Jonathan - Feb. 24 - An International Comparison
This entry won’t be filled entirely with the super cool stuff that we did this weekend. That stuff comes at the end, along with some amazing pictures, but you have to read my intellectual stuff first.
Our dean has asked us to compare the different healthcare systems we’ve experienced, and that’s what I’m going to do here(, and there will probably be a similar entry later from Libby... only a lot more insightful). It’s hard to isolate the healthcare system from the rest of society, so the comparison will be on a slightly broader scale.
So, Nicaragua, El Salvador, and Costa Rica all have their own unique needs. All tout universal healthcare, though none do it perfectly. Costa Rica seemed to do it the best, though when you decide to not have an army and to devote all your national defense budget to healthcare and education, that makes sense. Its biggest flaw, from what I saw, was their inability to reach out to illegal immigrants. Not unlike in the US, technically immigrants are allowed healthcare, but they don’t seek it because of fears of deportation. Costa Rica also has the benefit of a good infrastructure and the continual income that ecotourism brings.
Nicaragua has different issues. They don’t have many illegal immigrants, and they seem to have a decent supply of resources (which is surprising, considering that their biggest source of income is money sent to individual families by illegal immigrants in the US). Their biggest challenge is the rainy season. The clinic where we worked is isolated from basically the rest of the world for several months each year. Wanna have a baby in that situation? Or get in a car accident? Or even just get a bad case of diarrhea? A few engineers and hundreds of thousands (or perhaps millions) of dollars would fix that with the construction of tons of very stable bridges, but it just isn’t feasible. There are so many rivers that would need bridges built, and each one, we’re told, costs at least tens of thousands of dollars using local supplies and workers.
El Salvador is like a mini United States. And that’s the attitude of people here. It’s a little United States because that’s what they strive so hard for it to be, but they all want to live in the big United States. I think that El Salvador’s problems are most similar to the US’s in terms of health care. They don’t have impassable rivers during the rainy season (that I know of). They don’t have many illegal immigrants. Their problem is that they don’t have their own currency. That sounds weird, but let me explain.
They use the US dollar as their national currency. Their economy is in shambles. There is a huge discrepancy between the haves and the have-nots. There are 13 families in the country who own basically everything: malls, movie theaters, coffee plantations, hotels... everything. There was a civil war here in the 80’s that was quite gruesome, and that helped things a little, but not a ton. The pre-war government formed the political party Arena, which has maintained power ever since the war, so not much has changed. The guerrilla fighters from the war formed the political party FMLN, and they haven’t been able to obtain much power, though apparently they recently made some progress in getting senate seats, and their presidential candidate stands a chance in the March election.
An Arena demonstration on the street
The resulting traffic jam
Most of the trip, we were either on a nonexistant trail, or wading through a river, or perhaps on the edge of a huge cliff. It was on the edge of one of these cliffs that I had a little scare. Those leaves on the ground were a safe place to step, right? But when I put my foot there, it turns out they weren't really resting on anything and my foot just keep going. Luckily, I had already been clinging for dear life onto a root that was traversing the wall in front of me, so no harm was done. That was a pretty typical experience for the hike. We were told that no one has ever died on this hike, and I find that fact amazing. But it must be true, since the Lonely Planet travel book sings the praises of our guide.
A picture from a calmer moment in the hike
This picture hardly does the non-existent, super-steep trail justice
I like the picture above because Libby's face reflects just how crazy it seemed to jump as our guide (in the foreground) described. He would sit on the edge, throw a rock over the edge of the cliff into the water below, and say, "Aim for there." Some times he would add particularly comforting instructions like, "Tuck your legs in," and he would leave the translation (because it's shallow and otherwise you'll break your ankle) to us. Or he might add, "Don't jump too far and hit that log," or "It's really slippery so don't slip as you're jumping." 
Suiting up to repell down a waterfall
So, I got lots of instructions and helpful hints (like the part of the rock furthest from the edge was more level, and notice that small patch of dry rock that you could step on)
And then I was off!
And wouldn't you know it? I survived!
And the only injury of the day was very very mild. The falls pictured above were the biggest jump. We jumped from about halfway down, the cliff on the right of the picture. It was the tallest jump... about 15 meters. When I landed, it almost felt like I had twisted my ankle. I think the force was just so strong as I hit the water that it stretched things out a little. After a few minutes, though, it felt better, and I was well enough for the hour-long straight uphill steep treacherous hike to the waiting pick-up truck to take us back to Italo (our FIMRC driver, who would take us back to San Salvador). 
And then our hotel room flooded (we think from a leaky toilet tank), so we had to switch rooms, and our shoes stayed extra wet for a few days. But having flooded housing made us feel at home... just like Saginaw.
I realize this post is way too long, but to briefly describe our Sunday adventures:
We went to the San Salvador Zoo, which actually was pretty good... especially for $.75
We went to the Military Museum (very pro-Arena), which featured a ginormous three-dimensional topographical map of El Salvador.
It also had more guns than I'd ever seen before, from many different eras
And lots of people around to answer questions... or enforce their funny rules (don't step past the yellow line, don't enter the green zone, don't wander behind the exhibit)... it was definitely still an active military site, not just a museum.
And back to work we went this week. Today, Alisha and Libby gave women PAP smears on this exam table (makes stirrups seem less unappealing?) while these local health workers taught breast exams and Neil and I advised the male and female elders in the community about their arthritis that is well controlled with their current medication, and the fact they get nervous sometimes, and yes, even about that fever they had two weeks ago that only lasted a day.
Our dean has asked us to compare the different healthcare systems we’ve experienced, and that’s what I’m going to do here(, and there will probably be a similar entry later from Libby... only a lot more insightful). It’s hard to isolate the healthcare system from the rest of society, so the comparison will be on a slightly broader scale.
So, Nicaragua, El Salvador, and Costa Rica all have their own unique needs. All tout universal healthcare, though none do it perfectly. Costa Rica seemed to do it the best, though when you decide to not have an army and to devote all your national defense budget to healthcare and education, that makes sense. Its biggest flaw, from what I saw, was their inability to reach out to illegal immigrants. Not unlike in the US, technically immigrants are allowed healthcare, but they don’t seek it because of fears of deportation. Costa Rica also has the benefit of a good infrastructure and the continual income that ecotourism brings.
Nicaragua has different issues. They don’t have many illegal immigrants, and they seem to have a decent supply of resources (which is surprising, considering that their biggest source of income is money sent to individual families by illegal immigrants in the US). Their biggest challenge is the rainy season. The clinic where we worked is isolated from basically the rest of the world for several months each year. Wanna have a baby in that situation? Or get in a car accident? Or even just get a bad case of diarrhea? A few engineers and hundreds of thousands (or perhaps millions) of dollars would fix that with the construction of tons of very stable bridges, but it just isn’t feasible. There are so many rivers that would need bridges built, and each one, we’re told, costs at least tens of thousands of dollars using local supplies and workers.
El Salvador is like a mini United States. And that’s the attitude of people here. It’s a little United States because that’s what they strive so hard for it to be, but they all want to live in the big United States. I think that El Salvador’s problems are most similar to the US’s in terms of health care. They don’t have impassable rivers during the rainy season (that I know of). They don’t have many illegal immigrants. Their problem is that they don’t have their own currency. That sounds weird, but let me explain.
They use the US dollar as their national currency. Their economy is in shambles. There is a huge discrepancy between the haves and the have-nots. There are 13 families in the country who own basically everything: malls, movie theaters, coffee plantations, hotels... everything. There was a civil war here in the 80’s that was quite gruesome, and that helped things a little, but not a ton. The pre-war government formed the political party Arena, which has maintained power ever since the war, so not much has changed. The guerrilla fighters from the war formed the political party FMLN, and they haven’t been able to obtain much power, though apparently they recently made some progress in getting senate seats, and their presidential candidate stands a chance in the March election.
An Arena demonstration on the street
The resulting traffic jamSo, the translation in terms of healthcare is the following: the haves get great private healthcare. The have-nots have to go to either social security type hospitals (if their job is good enough to pay into the system) which are apparently pretty decrepit, or they can go to the public hospitals and have to share a room with a dozen other people and maybe not get seen by a doctor for a day or two. For the females reading this, imagine giving birth in a room with 4 or 5 other women in labor, possibly without a curtain separating you. Pretty fancy, huh? Resources are scarce, and they’re definitely not distributed equally.
The other arm of this is that there is an excess of doctors who all want jobs in the private hospitals because they pay well, but since those are so hard to come by, they only go to people who are trained abroad. That means that doctors who train in El Salvador often leave to the US or Cuba or Costa Rica or wherever else so that they can get specialty training elsewhere. And once you leave El Salvador... can you imagine having the opportunity for a LEGAL job in the US and passing it up?
After contemplating all this, it makes the US sound pretty nice, huh? But we’ve run into some Australians on vacation while we’ve been here, and one of them put it pretty simply to me: “America! Such a developed nation, and yet it doesn’t provide healthcare to all its citizens?!? What are they thinking?”
What’s the number these days? The last I heard was 40 million US citizens without insurance, but that was before the recession. We don’t have a rainy season. We don’t have a shortage of supplies like these other countries do. What’s our excuse? Or the much better question, how do we start to change?
It reminds me of a house visit we did today in the community. A poor girl who is three years old, went her entire third year of life without gaining a single pound. That’s not supposed to happen. Parasites, malnutrition, and who knows what else have been plaguing this girl for a long time. The house visit was depressing: trash everywhere, no organization to the house, food left out uncovered, no clean dishes, kids with dirty hands, chickens all over the place (including in the house), huge barrels filled with water that looked like mosquito-larvae-olympics, visible parasites swimming in the sink, no running water today... Where do you start with that? What do you tell them to do first? The first twelve things you suggest to them probably will have little impact because there are the 38 other things remaining that need to be changed, so how do you get enough of them changed before they give up because it’s not making a difference?
The other arm of this is that there is an excess of doctors who all want jobs in the private hospitals because they pay well, but since those are so hard to come by, they only go to people who are trained abroad. That means that doctors who train in El Salvador often leave to the US or Cuba or Costa Rica or wherever else so that they can get specialty training elsewhere. And once you leave El Salvador... can you imagine having the opportunity for a LEGAL job in the US and passing it up?
After contemplating all this, it makes the US sound pretty nice, huh? But we’ve run into some Australians on vacation while we’ve been here, and one of them put it pretty simply to me: “America! Such a developed nation, and yet it doesn’t provide healthcare to all its citizens?!? What are they thinking?”
What’s the number these days? The last I heard was 40 million US citizens without insurance, but that was before the recession. We don’t have a rainy season. We don’t have a shortage of supplies like these other countries do. What’s our excuse? Or the much better question, how do we start to change?
It reminds me of a house visit we did today in the community. A poor girl who is three years old, went her entire third year of life without gaining a single pound. That’s not supposed to happen. Parasites, malnutrition, and who knows what else have been plaguing this girl for a long time. The house visit was depressing: trash everywhere, no organization to the house, food left out uncovered, no clean dishes, kids with dirty hands, chickens all over the place (including in the house), huge barrels filled with water that looked like mosquito-larvae-olympics, visible parasites swimming in the sink, no running water today... Where do you start with that? What do you tell them to do first? The first twelve things you suggest to them probably will have little impact because there are the 38 other things remaining that need to be changed, so how do you get enough of them changed before they give up because it’s not making a difference?
Anyways, that’s my suave transition into the more lighthearted portion of the post: what we’ve been doing. This weekend, Libby and I had quite an adventure. We went to Tacuba (tacuba, ahuachapan, el Salvador if you’re google mapping it) for a “waterfall hike” on Saturday. We were warned ahead of time that it was only for the “strongest FIMRC volunteer,” and we definitely found out why.
Most of the trip, we were either on a nonexistant trail, or wading through a river, or perhaps on the edge of a huge cliff. It was on the edge of one of these cliffs that I had a little scare. Those leaves on the ground were a safe place to step, right? But when I put my foot there, it turns out they weren't really resting on anything and my foot just keep going. Luckily, I had already been clinging for dear life onto a root that was traversing the wall in front of me, so no harm was done. That was a pretty typical experience for the hike. We were told that no one has ever died on this hike, and I find that fact amazing. But it must be true, since the Lonely Planet travel book sings the praises of our guide.
A picture from a calmer moment in the hike
This picture hardly does the non-existent, super-steep trail justiceBut what did this life-endangering trail lead to? A pretty view? A calm picnic lunch? Well, not exactly. You see, we were going to be jumping off of water falls. That's what this hike was all about. Apparently that's what our guide does every day. He takes tourists out (or goes by himself, if there's no one around) and hikes from waterfall to waterfall and jumps in from insanely high heights.
I like the picture above because Libby's face reflects just how crazy it seemed to jump as our guide (in the foreground) described. He would sit on the edge, throw a rock over the edge of the cliff into the water below, and say, "Aim for there." Some times he would add particularly comforting instructions like, "Tuck your legs in," and he would leave the translation (because it's shallow and otherwise you'll break your ankle) to us. Or he might add, "Don't jump too far and hit that log," or "It's really slippery so don't slip as you're jumping."
He knew what he was doing, though. The first jump was a fairly benign 5 or 8 meters or so, and it was nice and deep, not too many obstacles. So, he used it and the second jump to determine who was capable of making the more difficult jumps. The two girls in the group (Libby and another gringa) were not allowed to do the most challenging jump, and instead, they repelled down.
Suiting up to repell down a waterfallThat reminds me, though. One of the cool features of the hike is that for the 5 hikers, we had four guides. They carried all of the repelling equipment (harnesses, ropes, etc.), lunch (sandwiches for all), as well as the hikers' backpacks, so that we could occasionally have access to our stuff (cameras, bug spray, etc.) between jumps. It was very convenient. But since we didn't always have our stuff, we didn't get pictures of everything, but we got some good ones.
The jump pictured below was pretty challenging. The target was kind of narrow (don't hit the log by jumping too far, make sure you jump over the rocky cliff below). The rock from which I jumped sloped downward probably about 25 degrees. And I was the last one to go, so everyone's wet butts had sat on the rock, decreasing whatever traction I may have had to begin with.
So, I got lots of instructions and helpful hints (like the part of the rock furthest from the edge was more level, and notice that small patch of dry rock that you could step on)
And then I was off!
And wouldn't you know it? I survived!
And the only injury of the day was very very mild. The falls pictured above were the biggest jump. We jumped from about halfway down, the cliff on the right of the picture. It was the tallest jump... about 15 meters. When I landed, it almost felt like I had twisted my ankle. I think the force was just so strong as I hit the water that it stretched things out a little. After a few minutes, though, it felt better, and I was well enough for the hour-long straight uphill steep treacherous hike to the waiting pick-up truck to take us back to Italo (our FIMRC driver, who would take us back to San Salvador).
Libby and I both enjoyed the hike. We definitely had our moments of sheer terror, but it was good to overcome them, and we survived. Libby was probably the smarter of the two of us, since she skipped a few jumps she wasn't comfortable with. She still jumped a few pretty big ones, and she got to enjoy smaller jumps and natural water slides formed out of rocks. It was an awesome experience.
At the end, though, our shoes were absolutely soaked and filthy. So, we had a little cleaning to do.
And then our hotel room flooded (we think from a leaky toilet tank), so we had to switch rooms, and our shoes stayed extra wet for a few days. But having flooded housing made us feel at home... just like Saginaw.
I realize this post is way too long, but to briefly describe our Sunday adventures:
We went to the San Salvador Zoo, which actually was pretty good... especially for $.75 
We went to the Military Museum (very pro-Arena), which featured a ginormous three-dimensional topographical map of El Salvador.
It also had more guns than I'd ever seen before, from many different eras
And lots of people around to answer questions... or enforce their funny rules (don't step past the yellow line, don't enter the green zone, don't wander behind the exhibit)... it was definitely still an active military site, not just a museum. 
And back to work we went this week. Today, Alisha and Libby gave women PAP smears on this exam table (makes stirrups seem less unappealing?) while these local health workers taught breast exams and Neil and I advised the male and female elders in the community about their arthritis that is well controlled with their current medication, and the fact they get nervous sometimes, and yes, even about that fever they had two weeks ago that only lasted a day.We tried going to Mayan ruins that are located near the clinic today, but we arrived at 3:30, and since they closed at 4:00, they obviously couldn't let us in. (how weird!) But we might try again later this week, so stay posted for more pictures, and also keep an eye out for Libby's wisdom regarding a four-country comparison.
Friday, February 20, 2009
Libby -Feb 20 (Happy Birthday Kevin!)- Update from El Salvador
Greetings from El Salvador! We are staying in a beautiful hotel in the nicest part of San Salvador. It is hard to convey just how amazingly rich and fancy this place is! We can walk to a supermarket about 4 blocks away, which is adjoined to an American-style mall and a BMW dealership. The restaurant at the end of our block is so fancy that a number of the people who frequent it have their own body guards that stand outside the restaurant as they dine. The supermarket has an international selection of food unlike any I've ever seen! All four of us have experienced culture shock, and I think we will have some kind of reverse reverse-culture shock when we all return to Saginaw, because we will be returning to a more widespread economic depression than is present here in the city.
The picture below is from the dining area where we are served breakfast every morning.
Let's see, we started our time here with a hike on Sunday up a volcano: Volcan Izalco. It is on the left part of the picture below . . . notice how steep it looks, even from a distance!
We started on the peak next to it. So, we went down the other hill, up the volcano, and then back to where we started again. It took us 30 minutes just to hike down the initial portion of the trail, because it was so long and steep.
This is a picture from that first part of the hike, which was all under a canopy of huge trees. Occasionally a cloud would come and engulf us. We were pretty high up!
It took us another few hours to summit the volcano, after stumbling over a combination of huge boulders and loose gravel. There were a bunch of police officers acting as guides, as well as non-police guides, but they didn't exactly help. Every once in a while they would talk to us, though.
Looking back, we could see the mountain we had just descended.
And the volcano top up ahead. Alisha's goal was just to make it through the hike alive, and she succeeded! :)
It was incredible because as we neared the top, we saw steam escaping from the side of the volcano, and the ground was actually hot when we touched it!
A view of the crater, and more steam vents!
We made it out alive!!!
So, the next few days we actually had trouble walking around much, because our legs were so sore, but it is so satisfying to have made it to the top!
Monday we started our actual work, in a rural community outside of San Salvador called Las Delicias. Compared to the people we worked with in Nicaragua, the people here have fairly good access to a clinic, hospital, and emergency transport when necessary. Even still, access to medical attention is not easy. On Thursday we had a 4 year old at the clinic who was wheezing and having trouble getting much air into her lungs. She needed a breathing treatment, and her mother needed to return to work, so I accompanied the doctor of the clinic on the journey 'up the street,' to the house with the nebulizer machine. After about 10 minutes of walking up the hill, we reached the mother's work and I was handed the sleeping, sick 4 year old child to carry the rest of the way up the mountain. It took us another 20 minutes ( it felt a lot longer!) to reach the top of the hill! I was exhausted, and my arms were shaking from exhaustion, but it helped me realize that even though this community is close to the city and the clinic is 'just down the hill,' that there is still very limited access to medical care in the community.
The FIMRC coordinator here, Meredith, works with a nurse in the community from the Ministry of Health (MINSA), on public health campaigns, vaccinations, home visits and a micro-health insurance program. As part of that work, we got to help weigh and measure local children, to report to the ministry of health (a task that must be completed monthly for every child under age 5). There are several different stages of malnutrition, and thankfully we only saw a handful of kids in the first stage, but it was still disheartening because we didn't have anything we could do for the families. One mother told us that all she feeds her daughter is beans and tortillas. She didn't think that fruits or vegetables would help the child put on any weight. We were able to talk to her a little about nutrition, but for other families, the problem is that they can't afford to feed all of their children.
One of our first days in the community, we were invited to learn how to make traditional corn tortillas in a local family's home. The woman in the picture below showed us how to carefully form the freshly made masa into flattened rounds. She also meticulously taught Alisha and I how to cut tomatoes and onions for salsa, without the use of a cutting board . . . the guys had to wait a long time for lunch, but it was delicious! Fresh made tortillas with cheese, homemade salsa and avocado!
Wednesday after clinic we stopped at a local fruit market. We bought 10 mangos for a dollar, as well as a pineapple, watermelon, limes, green mangos, and avocadoes (for Jonathan) . . . it was heavenly! 
So- we are enjoying our time in El Salvador! And more adventures lie ahead... Tomorrow, Jonathan and I will be taking an exciting, high-flying hike that we're sure to have stories about. Sunday, we'll have a little fiesta at the hotel, and next week, we've got tons of work awaiting us in Las Delicias.
The picture below is from the dining area where we are served breakfast every morning.
Let's see, we started our time here with a hike on Sunday up a volcano: Volcan Izalco. It is on the left part of the picture below . . . notice how steep it looks, even from a distance!
We started on the peak next to it. So, we went down the other hill, up the volcano, and then back to where we started again. It took us 30 minutes just to hike down the initial portion of the trail, because it was so long and steep.
This is a picture from that first part of the hike, which was all under a canopy of huge trees. Occasionally a cloud would come and engulf us. We were pretty high up!
It took us another few hours to summit the volcano, after stumbling over a combination of huge boulders and loose gravel. There were a bunch of police officers acting as guides, as well as non-police guides, but they didn't exactly help. Every once in a while they would talk to us, though.
Looking back, we could see the mountain we had just descended.
And the volcano top up ahead. Alisha's goal was just to make it through the hike alive, and she succeeded! :)
It was incredible because as we neared the top, we saw steam escaping from the side of the volcano, and the ground was actually hot when we touched it!
A view of the crater, and more steam vents!
We made it out alive!!!
So, the next few days we actually had trouble walking around much, because our legs were so sore, but it is so satisfying to have made it to the top!
Monday we started our actual work, in a rural community outside of San Salvador called Las Delicias. Compared to the people we worked with in Nicaragua, the people here have fairly good access to a clinic, hospital, and emergency transport when necessary. Even still, access to medical attention is not easy. On Thursday we had a 4 year old at the clinic who was wheezing and having trouble getting much air into her lungs. She needed a breathing treatment, and her mother needed to return to work, so I accompanied the doctor of the clinic on the journey 'up the street,' to the house with the nebulizer machine. After about 10 minutes of walking up the hill, we reached the mother's work and I was handed the sleeping, sick 4 year old child to carry the rest of the way up the mountain. It took us another 20 minutes ( it felt a lot longer!) to reach the top of the hill! I was exhausted, and my arms were shaking from exhaustion, but it helped me realize that even though this community is close to the city and the clinic is 'just down the hill,' that there is still very limited access to medical care in the community.
The FIMRC coordinator here, Meredith, works with a nurse in the community from the Ministry of Health (MINSA), on public health campaigns, vaccinations, home visits and a micro-health insurance program. As part of that work, we got to help weigh and measure local children, to report to the ministry of health (a task that must be completed monthly for every child under age 5). There are several different stages of malnutrition, and thankfully we only saw a handful of kids in the first stage, but it was still disheartening because we didn't have anything we could do for the families. One mother told us that all she feeds her daughter is beans and tortillas. She didn't think that fruits or vegetables would help the child put on any weight. We were able to talk to her a little about nutrition, but for other families, the problem is that they can't afford to feed all of their children.
One of our first days in the community, we were invited to learn how to make traditional corn tortillas in a local family's home. The woman in the picture below showed us how to carefully form the freshly made masa into flattened rounds. She also meticulously taught Alisha and I how to cut tomatoes and onions for salsa, without the use of a cutting board . . . the guys had to wait a long time for lunch, but it was delicious! Fresh made tortillas with cheese, homemade salsa and avocado!
Wednesday after clinic we stopped at a local fruit market. We bought 10 mangos for a dollar, as well as a pineapple, watermelon, limes, green mangos, and avocadoes (for Jonathan) . . . it was heavenly! 
So- we are enjoying our time in El Salvador! And more adventures lie ahead... Tomorrow, Jonathan and I will be taking an exciting, high-flying hike that we're sure to have stories about. Sunday, we'll have a little fiesta at the hotel, and next week, we've got tons of work awaiting us in Las Delicias.
Saturday, February 14, 2009
Jonathan - Feb 14 - Change of Scenery
This will be a brief post, but I wanted to let everyone know that we've arrived safely in San Salvador. We left Managua, Nicaragua bright and early (actually, it was definitely still dark when we left in the wee hours of the morning) and took a 12-hour bus ride up to El Salvador. It was pretty cool that our bus and the bus of our classmates who were making the opposite journey just happened to stop at the same bus stop at the Nicaragua-Honduras border at the same time, so we got to see them for a brief moment. They seemed to be doing quite well.
We've been here now for a grand total of about 3 hours, and we've already had tons of culture shock. We went from the middle of nowhere to a big city. From a hotel where we occasionally didn't have any water to one where we can take hot showers. From a place where there are tiny little stores in people's houses to one where there are huge supermarkets. There's even wireless internet at our hotel!
So, blog posts may be more timely. (Pictures probably will not be any more frequent, since the computer that we brought (one we're borrowing from MSU) doesn't have a functional USB drive, so we have to borrow Alisha's computer in order to post pics.)
We're planning a volcano hike tomorrow, since Ometepe's hiking didn't work out. And then we start back to work on Monday.
OH! One fun thing I wanted to mention. Among other celebrations for Neil's birthday yesterday, we went to this super fancy mall in Managua last night where they had a movie theater. We watched a movie (He's Just Not Into You, or something) in the VIP room. Very nice... lazy-boy style chairs that recline practically to flat. People who come to wait on you. Very nice... OK. Will post more some time when I have a full tummy.
We've been here now for a grand total of about 3 hours, and we've already had tons of culture shock. We went from the middle of nowhere to a big city. From a hotel where we occasionally didn't have any water to one where we can take hot showers. From a place where there are tiny little stores in people's houses to one where there are huge supermarkets. There's even wireless internet at our hotel!
So, blog posts may be more timely. (Pictures probably will not be any more frequent, since the computer that we brought (one we're borrowing from MSU) doesn't have a functional USB drive, so we have to borrow Alisha's computer in order to post pics.)
We're planning a volcano hike tomorrow, since Ometepe's hiking didn't work out. And then we start back to work on Monday.
OH! One fun thing I wanted to mention. Among other celebrations for Neil's birthday yesterday, we went to this super fancy mall in Managua last night where they had a movie theater. We watched a movie (He's Just Not Into You, or something) in the VIP room. Very nice... lazy-boy style chairs that recline practically to flat. People who come to wait on you. Very nice... OK. Will post more some time when I have a full tummy.
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