A long-overdue final post...

Happy New Year!

As you may know, I've been gone from San Jose for some 6 months now. I miss it. I miss the people, I miss the work, I miss the weather and I miss the purpose. The third year of medical school is a very different beast! Phone calls from friends in San Jose and continued involvement in the projects has helped to keep me grounded.

While the coup which occurred several weeks after my departure had little noticeable effect in San Jose, it disrupted our projects in several ways. Most significantly, due to the coup the medical school banned school-sponsored travel to the country. This prevented the year-long volunteers who were going to take my place from being able to go and also prevented the fall 2009 trip by the Rochester brigade of doctors. Even so, with huge efforts by the Honduran Shoulder to Shoulder staff and a rogue visit by a committed Rochesterian, our efforts have continued with great success. In sum, the last six months have seen:

- The flattening of a hillside to provide a place for the guest house and clinic. This has been 100% achieved by voluntary community labor. Ten people a day are donating a day of work to make this dream a reality for the community. They have self-organized and self-controlled to make this happen in an orderly and successful fashion. Impressive! We are currently fundraising for the two buildings and plan on beginning construction in the spring.

- The construction of a water tank which will be part of the San Jose Centro piped water project.

- The completion of an application cycle for the next class of middle school scholarship recipients, with 13 more students selected for this year.

- The successful completion of the 7th grade by the majority of the first scholarship recipients and their reentry into 8th grade.

- A Spanish/English literacy curriculum designed and given to the local elementary school teachers.

The fact that a coup, a travel-ban and a bad economy haven't stopped us is evidence of the self-initiative of the people of San Jose and the willingness of this organization to find new and creative ways for things to happen in the face of changing circumstances.

The journey goes on. Please continue to check in on the website for updates, and please don't hesitate to contact us/me if you ever would like more information.

To 2010 we go....

mateo

Photos galore!

As I look at my journal, I often notice that my entries start with “phewf.” And “phewf,” how busy and full these weeks have been!

What have I been busy with? Well, a little bit of everything, quite literally. What follows are a few snippets ... I’d tell more, but neither you nor I have time for the whole story!

As I mentioned previously, Kirsten and I got a few local women together to discuss the sale of their hand-made tablecloths in La Esperanza, the closest “city.” Well, as planned, on one Saturday morning, myself and 10 of San Jose’s finest lady-folk made our way to La Esperanza to do just that. One tall gringo and 10 little ladies from the mountains, now THAT was a sight to see!

Francisca, embroidering at her house in El Portillon.

The San Jose Embroiderers and I in the shop.

We met with the directors of the gift shop (a women’s cooperative) for about an hour, which gave each woman the opportunity to show them her cloths. While the shop “did not have the money,” to buy cloths up front (or probably, wisely, didn’t want to take the initial risk), the women still gained a few valuable things. First, the director gave commentary on each cloth, explaining how it and future cloths could be made more compatible for sale and/or saleable for more profit. The women listened intently to this advice. Also, 4 women who had brought cloths that somewhat met the recommendations left the cloths there on consignment. If the cloths sell in the coming months, there will be a lot of excitement…

Felix, one of two people in San Jose with an existing fish farm. So yes, the fish farms project is underway. Currently I am working with 4 different families to start a farm at each of their houses. As part of this, I’ve now given two workshops on how to make and maintain a fish farm. I think it’s fair to say that I never thought that I would be lecturing on fish farming! A highlight of the workshops was when I asked them to sketch their fish farms; I had a room of middle-aged men drawing like 5 year olds. I forget that we Americans enjoy years of art classes to learn how to draw with scale, depth and perspective. They enjoyed the exercise as much as I did.

Here are most of the mothers from the community during a meeting for a government program. Prior to taking this picture, I was in the middle of this same crowd doing a little piece of water health education. In general, I’ve been poaching any large meeting I can find and using it to teach about water quality and the need for filters. Parents’ Groups, Mother Groups and Baby Weighing Days have all been graced by the “water guy.” People are eager to see the water tests from their community and seem to enjoy my little interactive lesson. Little by little, people are learning what they need to protect the health of their families.

Here I am giving a lesson about water contamination to the group of mothers in El Mangal. I am using the water tests (which you can see in my hand and in their hands, as well) as a teaching tool. People find it very convincing to see the colors and worms that grow out of their water.

And once again, here I am at a mothers’ meeting in Guanacaste. In this shot I’m doing my Tony-winning rendition of “The story of Juan and Antonio.” It is a little skit I made up about 2 boys who would be equal, except that one’s mother uses a filter to clean the water, while the other doesn’t. Diarrhea, parasites, stomach pain and a poor growth end up plaguing one, while the other thrives. It’s a very simplified view, but by using lots of terms and outcomes that they can relate to, I think it works to make the importance of clean water much more real. As any public health person will tell you, building knowledge is one thing, yet creating a change in behavior is a whole different challenge…

As part of the education piece, I’m also continuing to distribute filters. 40 more are out so far.

The San Jose Festival was also in early April. Beyond the usual silently-consumed-with-great-great-haste eating of tomales, the day was punctuated by a forest fire! Yup, in the heart of the dry season they see it fit to set off lots of low-quality fireworks. Not surprisingly, one lit the hill in front of the church on fire.

We controlled the fire quickly-enough such that there was no big loss, but it gave me a great, fun(?) scare! Do I look like I just fought a forest fire with a bucket?

The men of “the little mountain” before heading out for a day working on our newest piped water project. I’ve been monitoring and managing this effort, which is progressing well.

Can you see the trench for the water project, going straight down the hill? (Note the difference in color compared to photos from the beginning of my time here. All green has been replaced with brown. It hasn’t rained a drop since November. When they say the “dry season,” they mean the “DRY season!”).

And then, of course, there was “Semana Santa,” or Holy Week. Here in Honduras where everyone is Catholic (at least in word), Holy Week is the biggest holiday of the year. Most people take all or most of the weak as their only vacation of the year. This photo was taken during one of the many Holy Week church services here in San Jose. The whole week was filled with relatively-silent Honduran-style celebrations…

One tradition is to walk down to the river and bathe. I made the trek with my friend Lazaro (who had TB) and a few other younger men and enjoyed a very hot day on the river. For the first time in my life I was considered to be a good swimmer and a brave rock-jumper! It pays to be the only person who grew up in a place with water.

During the wet season there is only one bridge to cross the river, and this is it. It’s affectionately called “the hammock” and is made of barbed wire and boards. Even the Hondurans were nervous to cross it! This is Lazaro, braving the (tilting) “hammock.”

And then, the night before Easter there is a late night vigil in a local house. This photo doesn’t show a lot clearly, but it gives a good feel for the candle-lit (simply because there is not electricity), small, dirt inside of the house where the vigil was held. The whole night was 5 hours of “mass,” the rosary, ….

…prayers to shrines of their patron saints (Which you can see behind Paulino and Paula, who wanted a picture with the shrines), and…

strange foods! This is “atole of corn,with roasted cacao seeds.” It’s basically a corn mush with stuff that tastes like burnt coffee beans. I tried my best to drink the whole gourd full, as they all did quite quickly, but I couldn’t quite get it down.

And finally, after a week of enjoying their customs and being welcomed into their homes, I invited everyone to my house for a great Malek tradition: decorating Easter eggs! People thought it was strange and funny, but it was a surely a hit. They made some pretty fine eggs, given I could only find watercolors and crayons as our materials…

As you can see, the women generally were more able to make a “design,” while the men were all about “the more colors the better.” Some things stretch across cultures, right?

Lorenzo and his egg.

Clara’s eggs.

And then I enjoyed a delicious Easter dinner! Not bad for being in Honduras, right?

Ooops, I put the wrong photo for my dinner. I guess this was my real Easter dinner. It was nothing much, but I ate it with great thoughts of my loved ones.

Love to all,

mateo

The legend comes to town

After 7 months getting talked-up by Mateo, Kirsten was already a living legend in San Jose before she even arrived. When she swooped in on her umbrella, though, she really confirmed her place in San Jose lore forever! OK, so the umbrella was just for the sun (as many women-of-means use in Hondu), but even without a flying entry, Kirsten did indeed live up to her legend.

A few photos can best tell the story of our wonderful, fun and full 9 days together…

It’s always interesting how having another person from “outside” makes you notice things differently. For example, the sunsets. I never have/take the time to stop and appreciate the sunsets, but while Kirsten was here, we made the most of the opportunity to stop, appreciate and have a sunset conversation.

This is my neighbor’s house in the evening. Kirsten took a fondness to my neighbor’s dog, “Tigre.” Despite my not-so-subtle objection, she tried to revive his scrawny frame with a few morsels from our dinner… on several occasions. Lucky dog!

Kirsten didn’t waste any time getting to know everyone… not that she really had any choice! On the first evening she was here, church got out and she was suddenly the center of attention for a very curious assembly of some 25 people, a veritable “who’s who of San Jose.” She handled it bravely, and even remembered a few of the names. On the third day, we went to the Sunday market in Rancho Quemado (the closest “town” to me on the “big road”). At no moment during the market were there any less than 20 eyes on her! We tried getting a representative photo with a little crowd of teenagers hovering around her, but this is the best we could get.

But, you ask, what did we “do” during the week? Think “pinguinos y pies” (penguins and feet)…

First: Penguins. Prior to coming to San Jose, Kirsten translated “The Penguin Song” into Spanish, with the hope of teaching it to kids at the various San Jose schools. “The Penguin Song” is a camp-type song about how to walk like a penguin, i.e. right arm, left arm, right leg, left leg, move the head, turn in circles. It’s VERY catchy, and when sung and danced by two gringos, VERY entertaining.

So, we set up a visit to the San Jose Centro school and the Portillon school, and showed up to each with a whole program of education and fun.

We would start by reading a children’s book, Kirsten in Spanish and I in English. We were pleasantly surprised to find that ALL the kids, from Kindergarten through 6th grade, were absolutely entranced by this. After, we donated the books to the schools for the kids to read themselves.

Next, I would put on my “doctor” hat and do a little lesson about water cleanliness. I would hand out a bunch of the water sample plates from my recent research (like the ones I have posted photos of on this blog before) and ask them to tell me what colors they saw. Once I had a good list, I would hand out the clean plates, and we would discuss the difference and how you can make your water change from colorful to clean. Little by little, San Jose is becoming a community of water health experts!

And last, but surely not least, Kirsten would teach a little about penguins, and then we would do “The Penguin Song.” It was HILARIOUS! Perhaps as good as seeing the kids grin and spin like penguins, though, was the aftermath… In the following days, as we would walk around “town,” Kirsten and I started hearing, yelled in little, hidden voices, “pinguinos!” Her legend grows.

And number two: Feet. We walked a lot. Despite the very un-Rochester heat, Kirsten braved the mountains of San Jose as we did a bunch of follow-up visits for the research. Here she is, descending on the far side of Guanacaste, in an isolated region known as “La Pimienta.” We tried to make it look steep, but still it’s steeper than it looks. Ask her.

Victorina Sanchez and her 3 daughters. Kirsten and I waited at this house for Victorina to return from gathering firewood, and in the meantime, Kirsten had a great conversation with the daughters. Different people reacted very differently to Kirsten: some would ignore her and just address me, others would just stare at her and say nothing, and others (mostly the women) would be open to her attempts to start conversation.

I’m speaking for someone besides myself here, but I would say this variable reaction may have been one of the most difficult parts of the trip for her. Us Americans are, culturally, outgoing conversationalists with equal respect for men and women. To be in San Jose, where the culture is quiet and reserved and the women are oppressed, is quite the shift.

This is Felicita, Francisca, and Mariano, from left to right. Since this picture was taken, Mariano has died. Why? Putting it as gently as possible, Mariano died simply because he was poor and uneducated in a poor, uneducated and underserved community in the mountains of Honduras.

Mariano was one of three patients diagnosed with Tuberculosis (TB) by the brigade last November, along with my good friend Lacero. Lacero got proper treatment and is now entirely healthy, cured, happy and back at work. Mariano went to the hospital, where he stayed for a month while he received treatment for his TB and his lung that had collapsed as a result of the advanced TB. In December, the discharge note described him as “improving,” and instructed him to come back in a month to get the next phase of his TB treatment and to check his chest wound (from the chest tube placed to fix his collapsed lung). Unfortunately, neither Mariano nor his wife can read, and apparently the hospital staff didn’t communicate very well; so, when they left the hospital, they thought the month of TB treatment they had been given on discharge was everything they needed for him to be healed. In fact, he needed another 5-7 months of carefully observed treatment.

From December until March, all I heard about Mariano from those in town was that he had gone to the hospital and that he was now back home.

I ran into Mariano’s wife a day before Kirsten came and she asked if the brigade had a program to give food to sick people. She said she needed it for her husband who was “really skinny and wasting away.” We don’t have such a program, but I found some old (but still good) food supplements in the store room. So, while Kirsten and I were out by Mariano’s house for filter visits we stopped by to check in and see if this food help was really needed.

What we found was a man on his deathbed. His room smelled like the Mother Teresa Hospice in Ethiopia, with that unmistakable smell of a wasting-away human body. His wife said his treatment hadn’t worked, and since January he had been getting worse. Beyond that, she didn’t know anything about his condition. He had stopped swallowing solids a few days ago and she was now feeding him Coca Cola as a last resort.

I asked for the hospital discharge sheets, which she had but couldn’t read, and thereby gathered the history of miscommunication and unfinished treatment I have just told.

Kirsten and I hid our anger and grief and asked if they still wanted to try to improve his condition. They very much so did, and so we gave them the drinkable food supplements and arranged a home visit, ASAP, by the local nurse, to get the ball rolling on starting treatment once again. He died before the nurse got there.

This is the face, the story, and for us, the smell, of one of those “millions of preventable deaths” that you hear about in the news. Personally, we couldn’t quite decide which bothered us more: that Mariano had died of an easily treatable disease or that his family was so accustomed to loss and hardship that they felt their father’s death at age 49 was acceptable.

We’re going to do what we can to make sure that nobody from San Jose is ever dropped by the system like this again.

Back on the road, here was a family at another home visit, the interview nicely done in Spanish by Kirsten. Note the beautiful purple filter!

Kirsten has a way with kids. Here she is getting a rise out of Veronica and Sandra, two girls she had befriended at school and then found again at their house during a visit. Nice shades, Sandra!

And of course, we played some soccer. Well, maybe I shouldn’t say “of course,” because I had only played a few times before Kirsten’s arrival. But anyway, Kirsten befriended these little guys and then we went to play an evening soccer game at their house. (They are, from left to right, Santos, Sandra, Paulino, Marcos and Priscilla, ages 13, 9, 14, 5 and 6, respectively. Yes, seriously, those are the ages, and yes, that’s what malnutrition will do to you.) We, and they I believe, had a blast! They were adorable, loved Kirsten, enjoyed the attention and were very respectful.

In the end, I would wager to say that the soccer game was a fitting activity for our final night in San Jose. It captured well the relationships, connections and local savvy that Kirsten picked up, and the shared adventure and joy that we both experienced during her time in San Jose.

Until Kirsten comes again in May, I look forward to running into little reminders of her around San Jose as the kids yell “pinguino!” and adults rave about how “bonita” was “Christina.”

-mateo

Visitors galore!

Forgive me if I seem a bit distracted. I’m currently sitting in the airport awaiting the much-anticipated arrival of my girlfriend, Ms. Kirsten Nagel. Suffice it to say, I’m crazy-excited, and that’s not helping me recall all that has transpired in the very busy last few weeks.

So, with one eye on the immigration line (which I can conveniently see from here), let’s check out a few pictures…

This is San Jose. I found a new little hill that gives the only view up the hill, so for a bit of perspective, I thought I would share. In this photo you are looking at San Jose Centro and Guanacaste, only two of the seven communities! The “main road” to the “city” runs along the top of the ridge. The little cluster of buildings in the upper-center of the photo includes the school, store-building and community center of San Jose Centro. That’s my “home!”

These are my beans. They had been closed in this Tupperware for a few weeks, and when I opened it up to cook ‘em up, out came the plague! Well, not the plague, but there were indeed hundreds of little beetle things. I thought I had bad luck, but upon consulting my friends here, this is the norm. The beetle larvae enter when the beans are in the field, grow and eventually hatch. Eat the beans early and you have a little extra protein, eat them late, and you have to wait for the visitors to fly away!

One morning, I made the 2 hour trek down to the very bottom of San Jose, to the Rio San Juan. I didn’t know this much water existed in Honduras during this part of the dry season!

I visited the Rio San Juan to check out a potential fish farm site. Ah yes, fish farms, surprise! That’s one of my new projects, little backyard tilapia ponds. More on that as things progress… For now, here are the two men who are looking to make the fish farm, Vicente and Santos. Kirsten and I are going to visit the river once more to test out the inertia-driven pump that we’re thinking of using for the fish farm.

It’s a ghost! Nope, it’s just me, ready to jump in for a swim. I think I gave a little Honduran girl a good scare when my big white carcass popped up next to where she was standing on the bank. The speed with which she ran crying to her mother was impressive!

The water was refreshingly cool… and probably filled with all the crap (literally) from everywhere above, but hey, beggars can’t be choosers. Vicente, Santos and I all took a quick dip. It was quite lovely.

One of the traditional, hand-embroidered tablecloths that many women in San Jose make. Another new push of mine this time back is to connect these women artisans with the gift-shop in the “city.” They’ve got the products, they just need the market. Kirsten and I are hosting a meeting on March 9th to help the interested women organize themselves.

What is this? It’s a tomato farm, of course! This is Bernabe, one of the more progressive farmers in San Jose, among his tomato patch. Who said you couldn’t do anything with 2 feet of bad soil on top of pure bedrock? We are helping Bernabe try a new, piped irrigation system to water his tomatoes during the dry season. Right now, his irrigation system is a pile of jugs (plus his 6 kids).
Ah yes, the scholarships for middle school! A very good chunk of my time in the last month has been spent setting the new scholarship program into motion. After a bit of difficulty with getting the cash for the scholarships, cancelled matriculation days, overpriced housing and overwhelmed parents, all has turned out well!

This photo is at the house which 5 of the female students are renting. They all live 3+ hours of walking (round trip) from the school, so their scholarship includes a room and board stipend. After the rich dude in town tried to get $110 a month from them to rent a room, I used my white-dude privilege (sometimes being the gringo has its benefits) to find a more reasonable landlord with a house to rent for $30 a month. The house did lack a “cookstove” to make tortillas, so all mothers came and made one. This is the crew and the completed cookstove.

But wait, isn’t that another white dude in that picture!?! Sure is.

For the last week I had the pleasure of hosting two guests! Here are Andrea and Adam, college students from Ohio who were traveling for 2 months to all the Shoulder to Shoulder sites to check on the water filter program. While here, they helped me do a bunch of follow-up surveys for my research, pitched in with the cookstove and a slow sand filter (champion sand-washers that they are), and kept me company on long walks and chilly evenings, with good conversation and some quality ukulele playing. We had a busy, fun and productive week.

The slow sand filter that we made, at a source in Mangal.

Argentina, the younger daughter of the woman who owns the source, posing with the slow sand filter, prior to remaking the filter. On a scouting mission of the filter, we had a jolly time hitting mangos out of the tree with rocks. She was grateful of my big-boy arm, but I was equally impressed with her quite-powerful little-girl arm! And yes, I did sing her “Don’t Cry for Me Argentina,” by Madonna.

Ah yes, another big time-eater: our new piped-water project! Here I am on delivery day of all the materials for our new piped water system in a cluster of houses called “The Little Mountain.”

Love this photo. It was supposed to just be a group photo of the 11 families receiving piped water, but then two women hauling water walked by. The folks on the stack of pipes will soon never more bear the physical, nutritional and educational burden of hauling water like this. Yeah!

The beneficiaries and the facilitator.

And last, but not least, the home visits for my research follow-up: I’m visiting all homes with filters once more, and it has been a very rewarding experience. For one, everyone really likes their filter. But more importantly, a good handful of mothers, with another good busload of kids have told me, “yeah, this summer my kids don’t have any diarrhea,” “we used to think our kids just got sick with the change in season, but apparently it was the water,” and “we never even realized we were sick all the time, but now we realize what it’s like to be healthy.” VERY awesome.

I’m also offering a family photo at each house this time, and a few have requested that I join them in the photo, so…

Here I am with Paublina and (some) of her kids. The house is courtesy of the government of Germany.

And with Wilson (a scholarship recipient), Vicente, the grandmother, and Lidia.

Ok, time to meet my much-awaited guest! We (Kirsten and I) will surely have plenty more stories to tell quite soon.

Love to all,

mateo