Riendo con los Niños

Picture of a picture too beautiful to pass up

The children here in rural Guatemala are beautiful.  Young girls dressed in traje (the traditional Mayan clothing) are womanly, elegant, and at times very proper -- sitting erect in their seats during health education class.  There is traditional dress for men here too but you're not likely to find the boys wearing it.  They wear used American clothing brought in boxes to the market, where the newest shipment gets devoured immediately upon arrival.  Minerva Market in Quetzaltenango is better than any thrift store in the States.

The children at the clinic are my teachers.  They've helped me become more confident in speaking Spanish as I've had to speak in front of groups of them many times now.  (Sometimes little children are the most honest critics.)  They correct me if I make mistakes.  They accept me and express that acceptance with a tender smile, a shy giggle, or uninhibited curiosity.  There's nothing more rewarding than ripples of laughter from my audience, allowing me to surrender into laughter as well.  Which for me, of course, is not hard to do.

Third grade class of Llano del Pinal

Every school in each community just outside the periphery of Quetzaltenango comes to the clinic for routine physical exams.  We offer this as a way for the people to become accustomed to making medical visits.  Of course, cost is prohibitive at other clinics and many families have had unfavorable experiences at the local public hospital.  Over the years, these families have come to trust Primeros Pasos.  Llano del Pinal is located at the base of Volcan Santa Maria, the "mother volcano" which birthed Volcan Santiaguito.  (In 1902 Volcan Santa Maria had an enormous eruption which covered all of Quetzaltenango in ash and formed baby Volcan Santiaguito, which is still active.)  Llano del Pinal is one of the largest communities we serve.  Their primary school alone has nearly 2,000 students.

Where the kids file in and give up their poop samples before getting measured and examined

Sizing them up before their physical exams

Since many children are malnourished, taking measurements of them is essential.  For those with 25-30% malnutrition we provide children's vitamins as a supplement.  (With eyes wide open, some children were excited about the gummy vitamins my Mom had bought and sent with Matt.  So you mean eating candy is part of good nutrition?  We repeatedly told them this was not candy.)

Below Mynor, the Children's Health Education Director settles into his new job with Primeros Pasos.  Only weeks before I came, Mynor had just begun too.  With many many years of experience in education, Mynor is a natural at this.

With their measurements, we calculate level of malnutrition

Each class is split into 2 groups: the first half sees the doctors for their physicals, while we have health class with the second half.  Then in reverse.  Mynor led the classes for the first few weeks for experience and to train us.  This coming week he goes out into the schools to give more focused talks.

The standard topics with all grades are nutrition and hygiene.  We give them a basic idea of what food they should eat and why, how to prepare the food, and how to prepare for meals (i.e. handwashing).  A majority of kids come in with gastritis, caused by amoebas, microbes, and parasites that are common in the water.  (They could use a wastewater management engineer like Simon in these here parts.)  This is why each student is given an empty cup to provide a fresh fecal sample for the day of the exam.  The fecal samples come carefully covered and tidily wrapped in a plastic bag.  The kids obediently provide their muestra and before they leave, they get their results and medicine is distributed accordingly to those infected.

Teaching nutrition to 4th graders

For the same reason, we speak about how to clean food bought at the markets on the roadside explaining that flies who had been happily tromping around on feces somewhere, make their way to our uncovered food.  And without washing this carefully before eating it AND covering the food with a clean towel/sheet, they are putting millions and millions of bad germs into their mouths and bellies.  With illustrations we drive the point home: one illustration of feces with flies hovering, another with a latrine with flies loitering, and a final illustration of a little child overcome by gastritis defecating on the roadside.  I admit that these are scare tactics and that there are other possible strategies to teach them, but how else could you best illustrate to them the severity of the situation?

To put knowledge into practice we buy bananas, clean them properly, cover them, while as a group we wash our hands thoroughly one by one before we each enjoy our delectable treat.  As I mentioned before, they each get a bar of soap and a toothbrush as parting gifts.  Poor oral health is also a problem for children here.  Kids are frequently brought in to get teeth pulled because decay is such an issue.  If they get it done on the same day as the health field trip, there is no cost.  Lucky them.

The boys demonstrating good handwashing techniques

Dental Hygiene -- our most popular topic

For me, working with the children has been fun!  And the "staff" I work with is great.  Mynor is a good humored chapin -- all smiles -- and a diligent English student, masterfully weaving in lessons from us throughout the day.  Versy a college student who is graciously giving Primeros Pasos 6 months of volunteership, is gentle and kind and too cute for her own good.  She asked me once if I knew the cartoon Scooby Doo.  And after confirming that I did, she playfully referred to herself as a guatemalan Velma.  What do you think?  (See below.)  Cather is here until June, at which time she comes back to the States and prepares for going to med school in Alabama.  We used her as the perfect example of good dental hygiene since she's got great chops.

Children's Education Volunteers (Cather,US; Versy,Guate)

As luck would have it, Miriam, the director of the Women's Health Education Program EBS, asked that I accompany them on a couple visits into the communities to speak to the women about pap smears.  Eureka!  My specialty!  A specialty granted to me without having the clinical expertise.  The goal:  to introduce me to the women's groups and slowly ease me into being involved in their program.

Fourth grade class of Llano del Pinal, with Ronnie, a 4 inch parasite that was formerly in a patient

Primeros Pasos Tierra Colorada Clinic

Here in Xela, despite finding respite from hurricanes, floods, and torrential downpours, in the dry season, we are welcomed every day with dustclouds stirred up by passing cars and buses.  The earth in Palajunoj Valley, where the clinic is located, is very dry and the roads are unpaved.  Primeros Pasos Clinic is just a 15 minute chickenbus ride from El Calvario, which itself is only a 5 minute walk from our apartment. 

Primeros Pasos: Clinic serving the Palajunoj Valley

It's been 3 weeks now at the clinic.  The clinic, as stated on the website, offers medical services to rural communities on the outskirts of Quetzaltenango -- Tierra Colorada, Bella Vista, Xecaracoj, and Llanos del Pinal to name a view.  Medical services for children less than 12 years old is 5 Quetzales (the exchange is Q8  = 1USD) and includes a checkup, labwork, and medication if available in the in-clinic pharmacy.  Medical services for adults and children 12+ is Q30 with labwork an extra cost.  Though the services are by US standards very inexpensive, the cost is still sometimes a deterrent to locals receiving care as is a lack in education regarding one's health.  The latter is one barrier that the clinic is tackling.

Volcan Santa Maria Mural

The 2 main populations targetted at the clinic are women and children.  In collaboration with the primary schools in the communities, the clinic provides a free yearly (or semi-annually?) medical exam for each student, in which students attend a class about topics pertaining to their age group.  All students are eligible to receive the exam and the educational component, as well as some nice parting gifts (a bar of soap, a toothbrush, and a banana).  In addition to the in-clinic health education, the children's education group goes out the schools to speak about topics suggested by the teacher.  For example, with 6th graders, topics about self-esteem, sex, and puberty are offered.  We are simply planting the seed to facilitate future discussion by their parents and their communities.

The Waiting Room

Walk-in patients are also seen everyday -- the majority involving gastritis (amoebas, parasites, and microbes....oh my!), infections, acute pain, contraception, tooth pain, and complications with malnutrition.  Very few men come to the clinic.  Fridays here are famously known as Mezquinos day (= Wart removal day using liquid nitrogen).

Above is a photo of our outdoor "waiting room."

Inside the clinic

The clinic has 3 exam rooms, with one equipped with a gynecological exam table, a small pharmacy, a laboratory (with all the fecal samples you could ask for), a classroom, a registration room,  an administrative office, a dental clinic, and an office for the medical director (see below) which can also be used for patient exams.

With the Young'uns, "national" med students

Med students at the University of San Carlos here in Xela (the "national" med students) have clinical rotations at the clinic for 2 months at a time.  And on occasion foreign med students come and volunteer.  My first week there, there were four: Esteban (Steven), Ken, Jenny, and Jessica...all from the States, the northeast to be exact.  Jenny and Jessica have since left.

 

Here, the medical students start their education at age 18.  So you can only imagine how old these guys are in the above pic.  In spite of their age, I'm amazed at their maturity and professionalism at that age.  At least with this group.  The medical director himself is 25 years old, hence, the nickname I've coined for him: Dr. Señor Joven.

Doctor Senor Joven, the Medical Director

My professional goal here was to find an opportunity in which I could acquire more clinical skills in women's health.  Several years ago, a nurse from the U.S. built up some momentum on a cervical cancer initiative, by outfitting the clinic with a gynecological exam table, other pelvic exam and Pap smear supplies, her clinical expertise, and her time.  The program has since lost some steam, and gynecologic exams happen infrequently -- only once since I've been here.

During my first few days here, I observed the med students perform physical exams on the primary school students and assisted with "discharge" teachings.  I felt ineffective and dissatisfied with this so I spoke with the other programs about their volunteer needs and day-to-day operations -- the Children's Health Education program and the Women's Health Education program (Escalera de la Buena Salud).

Maynor, Children Education Coordinator; Addison, Assistant Director

The Women's Health Education Program is a 2 to 3 year program, in which clinic workers Miriam and Marluz go out to the communities and meet with the women to discuss various health topics.  The program follows a very structured 2-3 year curriculum divided up into modules and phases.  While this seems most aligned with what I want, the opportunity is limited since a long-term commitment is preferred as it is difficult to build rapport with these women in such a short time.  The opportunity to hold a one-time talk for the women in my specialty/expertise may be possible.  Expertise?  Where can I find one of those?  The search begins.

In the meantime, I have offered to assist with Children's Education since they are short-staffed but I continue to look for more opportunities to meet my personal interests.  The children are wonderful and I certainly get to practice my Spanish, but I'm still looking for more...

Teaching the 6th graders about puberty.

Cather, US volunteer, teaching the kids proper hand hygiene.