Last day!

Today is my last day here in Santiago. I've enjoyed my time here and it's hard to believe it's over, but I'm really ready to go home. This was a great experience but there's a lot I miss about being home, and a month was long enough. That's really all I wanted to say in this post. I may write a few more after I get home with more reflective type entries (since that was the original purpose of this blog, but I didn't do too much of it... oh well) but for now: goodbye, Guatemarla!

On Speaking Spanish and Special Occasions

I thought I'd reflect a little on the thing I've been doing every day here - speaking Spanish. I was really nervous about it beforehand, since even though I took 5 semesters of Spanish I had never used it outside of my classes and occasionally with friends. But I quickly learned to get over being nervous, and that I just had to dive into what ever I wanted to say and figure it out along the way. I'm still far from perfect but I can definitely tell I've improved. I can speak faster and native speakers have told me I speak Spanish well, which is an awesome confidence booster. I do have some tricks though... if I can tell I'm not understanding what someone is saying, I just nod thoughtfully and say, "Ah, sí, sí" and hope they weren't asking a question that needs an answer. The kind of annoying part, though, is that most people don't speak Spanish all the time, and some not at all. So I can't practice by listening to people on the street, and every time I hear people speaking tz'utujil I think they're talking about me. Well, I guess not every time, just when they same something in tz'utujil and then look at me and point. They're probably just saying, "Look! A white girl!" And it's also hard when I'm in the hospital or health center and the patient doesn't speak Spanish, since it's so much different working through a translator than actually talking to the patient. It's hard to connect, and it's showing me the true importance of communication in the medical setting. I'll really appreciate being able to talk to and completely understand my patients after this!

The other thing I wanted to talk about are the special occasions here. A few times there have been processions in the streets with music, huge crowds of people, etc. This morning was one of those times. I kept waking up to sounds of music and helicopters, and when I finally got up and went downstairs for breakfast, my host dad said there was some sort of church event outside, with "alfombras" (the Spanish word for rugs). The alfombras were strips of designs down the entire main road leading to the Catholic church, very intricate and made out of what appeared to be colored sand. Lisa had told me about a similar event during Semana Santa, and I'm really glad I got to see this. People apparently work all night making the designs, just to have it on the ground for a few hours. The music was coming from a truck with men singing and playing instruments in the back, and it drove slowly down one side of the street, while people started streaming from the church and lining up on either side of the alfombras, all holding candles. When the truck and people carrying a golden cloth canopy passed by, everyone poured into the center of the street, walking over the designs until they were a stripe of muddled colors. The road was packed at this point, and I followed the people for a while but didn't even reach the end of the procession before I headed back to my house for lunch. Kids were scooping up sand and putting it in bags, and people started sweeping it out of the street but you can still see the colors now. The helicopters I heard this morning turned out to be Americans delivering "víveres," or provisions & food, which my host dad told me after he saw them land on the soccer field. I'm not sure if they were connected to the Church event, but when they flew over the lake everyone was pointing excitedly. I just kept to the edge of the road taking it all in.

I'm not sure if I described this event in a way that you all can picture, but I wanted to attempt since I enjoyed it so much. There are some things I won't miss about Santiago (my hard bed and lumpy pillow, nothing to do after 6pm, not being able to throw toilet paper in the toilet), but experiencing the culture like I did this morning is definitely something I will miss.

Thoughts

So I don't really have a theme for this post but I figured I would update since I'm sitting at a computer and I don't have anything else to do for the rest of the day.

I did get to see the birth the other day! It was a great experience, the mom did so well, the baby boy was healthy, and all 8736 family members in the room were happy. I'm really glad that I've now seen births in two different settings here, the centro de salud and the hospitalito, to compare them to each other and the ones back home.

Today I went around on home visits with a nurse from the health center. We went to four different houses doing either prenatal or postpartum checks. Even though I couldn't understand the conversations since they were in tz'utujil, it was really interesting to see how the visits were conducted (and also to see more houses around the town... some are just one room with one bed that the whole family sleeps in!). For the most part, we'd go in and sit down, the nurse would talk to the woman and husband for a while, then she would give them information on warning signs to look out for, and then she would do a brief physical exam. I got to help a little bit taking blood pressures, and she let me listen to the babys' hearbeats and feel for the position. Sometimes here I feel a little bit like an intruder just tagging along with nurses and doctors and helping out with patients, but for the most part everyone is so welcoming, and the town as a whole is used to always having volunteers and students around. It's been a little bit hard not being part of a group or an official volunteer anywhere, since I have to just show up places and see what I can do there. That's all part of the experience I was hoping to get though. I wanted to be able to do a lot of different things while I was here, and do things that I have never done at home. I definitely think I've accomplished that so far, and hopefully I'll get in a few more new experiences in this last week.

It's weird to think I'll be home a week from today! Somewhere around the middle I started thinking a month seemed incredobly long, and June 9th felt a lifetime away. But now a week seems really short and I'm just excited for the rest of my stay here. Which hopefully does not include any more volcano eruptions, tropical storms or sinkholes.

Rain, rain, rain

It finally stopped raining today after three days straight. Yesterday it poured the entire day, and the streets were literally rivers. It was the work of Tropical Storm Agatha, and that combined with the eruption of Volcano Pacaya a few days before made for a lot of destruction in all the surrounding areas. Everything is ok in my town, but there were apparently mudlides in some of the towns across the lake, and the airport in Guatemala City is going to be closed at least for a few more days due to the large amount muddy ash all over the runways.

Yesterday I didn't leave the house at all because I didn't want to get soaked, and also because nothing would have been open. Things stop here because of rain (and not just bad rain like yesterday)... kids don't go to school, meetings are canceled, people don't go to the hospital. Here's my reflective part of this entry: it seems a bit crazy to me that people wouldn't go to the hospital because of some rain, but things are entirely different here. Transportation becomes a problem, and it's difficult to wade through rainy, muddy streets often with children in tow. On Friday I was supposed to go around on prenatal home visits with a nurse from the health center, and it was only drizzling then so I thought she still would go. I got there at the time we agreed on, waited half an hour because she was in a meeting, and then she came out and looked at me like I was crazy - of course we're not checking these pregnant women today, it's raining! It's all part of the things to get used to working in this environment.

And now a little venting: Staying inside all day didn't mean the rain didn't affect me, as the houses here aren't exactly water-tight. Yesterday morning I woke up to find water running down my wall from the corner of a window, and the posterboards that I had on the floor ready for a lesson at the schools this week were soaked. It's not a huge problem since they'll probably dry by Wednesday, and if not I can buy more for about 12 cents a sheet. But last night, when it was finally late enough that I could reasonably go to sleep (and that means 10pm... I've been going to bed so early since nothing happens at night), I picked up my pajamas only to find they were sopping wet too. Apparently water had been coming in another hole that I hadn't seen, and it conveniently soaked all the pajamas I had (I'd been wearing them all at once since my room has been so cold the past few nights). After huffing around for a few minutes I put on all the other clean, dry clothes I could find and crawled into bed, still listening to the lovely rain pound the streets outside.

But today has been better. It's warm and sunny, I could leave my house, and there's a woman in labor at the hospitalito and if she keeps progressing at the rate she has been, I'll get to see the birth! It will be interesting because I'll be able to compare this one to the one I saw in the Centro de Salud. I was in her room earlier and it seemed a lot more like the labor and delivery rooms I'm used to (at least as much as it can, being a makeshift hospital in a former backpacker's hostel in rural Guatemala)... the woman was wearing a hospital gown, there was a fetal heart rate monitor going, and she was getting pain medication. Hopefully I do get to see the rest!

One more note: I shouldn't be surprised that a tropical storm decided to hit Guatemala while I'm here. I have this handy talent of inviting rain to every important event in my life, most notably my Bat Mitzvah and high school graduation, when it practically monsooned. So this is your warning, Penn class of 2011... there's going to be a hurricane in Philadelphia on our graduation day. Sorry.

Making Plans

I'm feeling pretty proud of myself because this week I've made a lot of my own plans and am feeling pretty independent here. On Monday I went around to a lot of different locations - the health center, the hospitalito, the new hospitalito construction site, the library, the Pueblo a Pueblo office (an organization that sponsors and helps children and pregnant women). In all of those places I talked to people, some I knew already and some I just met, and made a lot of plans for the rest of the week. I've been trying to find out about a small nursing school here in Santiago, and I finally talked to a nurse at the hospitalito who attended the school and she gave me the phone number of the teacher. Everything I do here is a new experience... I had never had a phone conversation in Spanish and was a little worried I'd have a hard time understanding without being face to face. But it went well and the teacher told me to come to her center on Thursday to chat with her, and finding the place should be an adventure in itself since the only direction I have is that it is a house over the bank, but there's no sign out front and from the outside I can't see how to get up there! And then once I'm there I'll be having more of an interview type conversation, since I would like to find out what nursing education is like here.

Sometimes my plans don't always work out like I planned... earlier today, for example, I went to the health center because I thought I would be observing and helping the nurses, but it turned out I was just helping one nurse fill out charts of children's vaccinations in the different areas of Santiago. Which, like everything else, was a new experience, but it was kind of a boring one. I was still helping them out though and the nurse appreciated my help, so I felt good about it.

And sometimes my planning works out really well, like this morning when I went to a school in town and had prepared a short lesson on health. Lisa was there and she had supplied me with a picture book to use to base the lesson on, but I prepared and led it all on my own. I made copies of some of the pictures, and brought in posterboard to made simple posters with the classes. I led two classes, first reading them a story, then asking them to remember important ways to stay healthy from the story, and finally asking for help attaching the pictures to the posterboard (we had one side for "good things" and one for "bad things"). While it's hard to tell how much of an impact the lesson had on the classes, I was glad that they paid attention (for the most part) and the teachers thanked us on the way out.

I'm getting a great feeling from everything I do here, and I can't wait to see what else happens in the next two weeks.

Mornings

I wouldn't really consider myself a morning person. Whenever possible, I prefer to sleep through the morning and wake up in time for lunch. Here though, that's not the case. Every morning I'm woken up sometime between 6 & 7am by chickens, roosters, dogs, children, and construction above my room, just to name a few sounds. I don't mind it since I usually go to sleep pretty early (there's not much to do at night here because of a 10pm town curfew and pelting rain pretty much every evening) but it's just a change from what I'm used to. Plus, I feel weird on days when I sleep in until 9 and the whole family is up and already in the middle of their day. So much happens here in the morning! Today, for example: I woke up around 6:30, went to the bathroom to get ready and Aclaxito was outside my door as per usual, asking what I was doing and if I wanted to play. When I left my house the town was busy and full of activity. There are men sorting and packing avocados all over the town center, kids playing basketball, women going to the market, and of course, tuk tuks racing all over the narrow streets. It's only 10:30am and I've already observed the town for a bit, talked to a nurse in the health center and made plans to go back on Wednesday and Thursday to help out and talk to some nurses and the obstetrician, and spent time in this internet cafe responding to emails and writing this post... all before I would even think of waking up if I were home with nothing to do.

Education

The other day I went to an elementary school to deliver anti-parasite medication to the children and give a little lesson to go along with it. The medication was donated to this school by volunteers, like a lot of other things here. Another volunteer and I read and acted out a story of a girl who never washed her hands, never washed her food, didn´t wear shoes anywhere, drank water from the lake, and went to the bathroom wherever she wanted. Then, she got a parasite, and the doctor and nurse treated her and taught her all the things she can do to stay clean and healthy. This story is very pertinent to the community here... people have to boil water in order to drink it, wash the fruits and vegetables thoroughly, always use soap and water, etc. and many children get sick just like the girl in the story. In addition to being educational for the school, the experience taught me more about the town and what some important issues are. It also taught me more about education in general. We learn all the time in nursing school how important patient education is, and here I´m seeing the huge variety of patient education, not only in the hospital setting.

On a related note, I also see a lot less teaching going on in the health centers here... doctors and nurses don´t always explain what they are doing, and patients often don´t ask. There will even be misinformation, and doctors sometimes give placebos to patients telling them it´s a treatment. It´s just such a different atmosphere from what I'm used to, and I´m really glad I was able to help teach some people, even in a small way.

OB Clinical, v. 2.0

Yesterday was FANTASTIC.

In the afternoon I shadowed one of the volunteer doctors in the hospitalito and saw several patients with her. One was a teenage boy with dehydration and abdominal pain (and I heart murmur which I was able to listen to!), and the rest were pregnant women, there for regular prenatal visits. It was really interesting to be able to listen to the visits. Two of the patients needed a translator from tz'utujil to Spanish, and it was great to see the interaction between doctor and patient/family with the language barrier. I thought the doctor was great at still talking directly to the patient and making him or her feel comfortable. During the prenatal visits I got to hear everything I learned in OB clinical this year... the doctor determined how far along the woman was, which tests she had already and which she needed, if she was having any problems like headaches or blurry vision. She did some education with the women, including how to time contractions, when to come into the hospital, the importance of a support person and more. I measured fundal height with her and did Leopold's maneuvers (for non-nurses: fundal height measures how far up the uterus is to determine if the baby is growing sufficiently, and Leopold's maneuvers involves feeling the woman's abdomen to determine the position of the baby). After I left the hospitalito, I went over to the centro de salud, where there was even more obstetric excitement.

At first there was one patient in the centro, a woman who had delivered at home with a comadrona (midwife) and had extensive vaginal tears so came in to the centro for repairs. Right away the doctor and nurses had me helping out... I took her vitals (took a manual blood pressure for the first time on an actual patient, and got pretty confident with it by the end of the night), pushed an IV med, and took out her IV. Then, a patient came in with contractions, and after her water broke moved along pretty quickly. Within a few hours she was ready to deliver! The centro de salud was obviously much different from what I was used to on the maternity floor at HUP. Here they have one tiny delivery room, sterilize equipment themselves, often run out of supplies and have to send famiy members to the pharmacy to get more, don´t generally give pain meds, use newspapers on the floor to soak up blood, and in general just have the most basic necessities (they did just receive an ultrasound machine, though, and are very excited to start using it!). If a woman needs a c-section or has a complicated pregnancy, they have to send her to the hospital 2 hours away. I was so glad I got to see this delivery. One difference from what I had seen in school: the woman made almost no sounds the entire time. I could tell she was in pain from her face but she did not scream or cry out, and I'm not sure how much was the woman's personality and how much was expectations of pain tolerance in this culture. All I know is it was very different from the birth I saw at HUP with no pain medication! After the baby was born the nurse washed him in the sink and wrapped him in blankets, including a red cloth on his head which I learned is to protect the baby from the the mal de ojo, or evil eye. Throughout the evening I was also observing the interactions between the nurses/doctor and patient/family, and there was not the same level of patient education or privacy that I am used to.

While this was going on, there was also another patient who came in in labor, and the doctor determined that her baby was breech, or feet down, and the centro de salud does not have necessary equipment to deliver the baby (I got to do a vaginal exam after the doctor and feel the baby's foot. By the way, sorry if this is way too much information for those of you who are not medical or are squeamish... but I love this stuff!). So, they were ready to send her to the hospital in an ambulance, when her husband arrived and would not let her go. Apparently that is not uncommon here, and even after the staff explained that if she does not go to the hospital she and the baby could die, he still did not want her to go. In the end, they took a tuk tuk to the hospitalito, but even there they may not be able to care for her and successfully deliver her baby.

Overall, my experience at the hospitalito and centro de salud was great. It was both a refresher course in things I had learned from OB already, as well as a crash course in new skills! It helped me start to get an idea of the differences in health care between here and US, which is what I really hope to get out of this whole experience to complete my reflective practice project.

La cultura y más

I figured now would be a good time to tell a little about the culture, lifestyle, health and general atmosphere of Santiago, so that you all can better picture where I am. Some of this Lisa has told me and some I've observed walking through the town or talking with my host family.

Santiago Atitlán is one of several towns around Lake Atitlán, in the region Sololá of Guatemala. Santiago is near the edge of the lake in between three volcanoes, and it has a population of about 40,000. The people here speak a Mayan language called tz'utujil, and although many children and some adults also speak Spanish, a large portion only speak tz'utujil. Women generally dress in traditional clothing, which is long wrapped skirts of colored stripes and patterns, and short sleeved shirts usually in bright blue or purple with designs like flowers or birds around the neck. Most men wear jeans, but some wear traditional pants, which are white with dark vertical stripes and sometimes designs around the bottom, with button down or t-shirts. Women carry huge baskets or heavy bags on their heads, and men usually carry loads on their backs with a strap around their forehead. Children are usually in school until they can work, if they go at all, and here a sixth grade education is good. Some children go all the way through high school, but if they want to go to college they have to go to boarding school in Gutemala City because the schools here don´t prepare them enough. There is a health care system of little clinics in each of the towns and one hospital for all of Sololá, and in Santiago there is also also the "hospitalito" (where I'm going to shadow one of the volunteer doctors tomorrow afternoon). There are a lot of problems with the health care system and health of people in general, and it's really great so many people come to Santiago to help out. There are volunteer doctors and nurses who come for a week or months at a time, and lots of groups like church mission trips that come to do certain health related projects. The other day I met a group from the US that is coming to Santiago next Spring to do cleft lip & palate surgeries. To get back to the general atmosphere... the streets are full of many children playing and people out going to the market, working in tiendas (stores), going to church, etc. I stand out since I'm a white girl in Western clothing, but everyone is generally very friendly and says "buenos días" or "buenas tardes" (good morning or good afternoon). There are also stray dogs everywhere and in addition to the tuk tuks (the little red taxis) there are pickup trucks with wood & metal house shaped structures in the back that function as taxis - people ride standing in the back packed in with each other and fire wood and various other objects.

This is just a general description of some aspects of Santiago, but I'll definitely be telling more in the coming weeks!

Kids

From last night and today, one big thing I´m learning is that a lot of kids around the world are the same. My host brother, Aklaxito (pronounced Ah-clah-SHEET-oh) is four years old, and so similar to the many other four year olds I've met and worked with in the past. He likes to play, asks a lot of questions, and doesn't like to take baths. I've been playing soccer, building with blocks and doing puzzles with him pretty much all the time when we're home, and it's great because not only is he adorable but he teaches me Spanish. I'm teaching him some English too, but the only words he remembers so far are numbers through 10 and horse, and that's because he already knew those. Today I went with the family to a place by the lake and Aklaxito and my host dad went down by the water and skipped rocks. It's nice to know that even though I'm far away in this vastly different country some things are still the same.

Things to get used to here: not putting toilet paper in the toilets (because it will clog them), brushing my teeth with bottled water, and navigating a town with no street names and where all buildings look similar. And more, of course, but those are the first things that came to mind right now.

More soon!

The Beginning

Hello from Santiago! This is the first chance I´ve had to sit down and write a post since I´ve been here... it´s only been two days but I´ve seen and done so much already. I have so much I can tell, I don´t know where to start! I`m living with a host family and they´re really great. There´s the mom and dad, a sister about my age and a brother who´s four years old. He`s adorable and a lot of fun to be around. I`m getting by with my Spanish talking to the family, although I´m still not great at saying everything I want to so a lot of times I´m just nodding with a slightly confused look on my face. The sister, Emily, laughs a lot and a lot of times I think she´s laughing at my Spanish, but in a nice way. I talked to her for a long time last night about Spanish and English words (she really wants to learn English), school (she´s starting at the university in January), computers (she apparently has a Facebook!) and a lot more. Living with the host family is great. I have my own room (where I´m woken up by chickens and roosters in the morning), I can eat as many meals as I want with them, and I have a key so I can come and go when I want. I`m learning my way around Santiago a bit... as in I recognize a lot of places but never quite know where I´m going. Usually Lisa, a Penn grad student who´s been living here and set me up with everything, has been with me, but right now, for example, I left the library I was helping out at and found an internet cafe on my own! Next I´m going to take a tuk tuk (these tiny red taxis that can take you anywhere in Santiago for 3 quetzales, about 40 cents, and drive crazily and will hit you if you´re in their way) to the construction site of the new hospital where Lisa is working. Which brings me to the things I´ve done so far... this morning I was helping out at an event for children and their moms for mother´s day, before that I went to a preschool with Lisa where she read books to two of the classes. Yesterday I went to a different school, where my host brother Aklaxito goes. I´ve been meeting some of the other American volunteers and just learning a lot about the town. It´s around a lake and in between 3 volcanoes, and in 2005 there was a mudslide that killed a lot of people and damaged much of the town, including the hospital, which why they´re building a new one. About 40,000 people live in Santiago, and many are extremely poor. It´s great that there are so many people who want to help out.

This post is incredibly rambling... I don´t know how to organize my thoughts but I wanted to update you all! I´ll try to post every few days, with more of an idea of what exactly I want to say... but for now, I hope everyone´s doing well in the US and I´ll write more soon!

Post One

This is a brand new adventure. I've never lived in another country for a month, I've never used my Spanish outside of school, and I've never even kept a blog. I'm a little nervous but more excited and I can't wait to see how it all turns out.

I leave for Guatema(r)la early Wednesday morning and I'll write my first update from Santiago as soon as I have the opportunity!