FEBRUARY 10-14, 2014

The WVU Medical Team

February 10 is my first day of mission work in Guatemala. I am working through the San Lucas Mission in San Lucas Toliman' on Lake Atitlan', the most beautiful natural locale in the country.

The on-site volunteer director, Katie Wallyn, asked me if I would like to work for the week with a medical team from West Virginia University Medical School that is staying for a month. Sure, why not? I just left a 17-person med team in Nicaragua.

The team consists of ob-gyn Dr. Maria Merzouk, her 14 year-old son, Ben, Amani, a nurse of 30-plus years' experience, a fourth-year resident, and two third-year interns. This is Ben's second year in Guatemala. Last year he gave up a trip to Hawaii to accompany his mother in her mission work. Good kid. Margaret, another nurse who has a long history of volunteering in Guatemala in the past but is not part of the WVU team, joins us on most days.

The local Maya contact, Jesus Antonio, is a local "promotador," which means that he is trained and responsible for promoting healthcare education, distributing materials, and arranging events like this outreach clinic for a certain number of villages. He has arranged all the locations.  

Besides the difference in the sizes of the teams, there are other major differences between the Nicaragua and WVU med teams. In Nicaragua we were  in the city of Managua, so the team worked in various public hospitals in the morning, then came to the clinic to tend to the Pathway to Change children, their parents, extended families and neighbor children who all had appointment times. They also had access to public transportation to get to the clinic. The population was mostly mixed-race.

The WVU team are the five professionals, plus Ben, who does the eye chart exams and hands out appropriate eyeglasses donated by the American Lions club. And me. Dr. Maria asked me to assist her in "the farmacia." Oh, wow. Little did I know what that would look like. Take a look at the pictures. 

The second difference is that the WVU team goes out every morning to an outlying Maya pueblo rather than the people coming into town. Because the pueblo Maya are overwhelmingly rural, transportation would be a problem. The round-trip might take them all day, which means a lost day's work, many are elderly, and they probably couldn't afford the bus fare for the whole family anyway.

The daily chores of the Maya women would be another obstacle. These women are up at 4 AM to make the daily supply of tortillas, wash clothes by hand in big plastic tubs with cold water, hang them to dry, send the young children to school in the morning until 12PM, serve the main meal at lunchtime, send the older children to school around 2PM, clean the house, which has to be swept and floors mopped daily because they live surrounded by flying dirt and debris, typically will have at least one nursing child that they are toting all day and night so as to feed at any given moment, make the family's clothes, except for the father, and on and on.      

The  "clinic" is held either in someone's house or in a small two- or three-room concrete community center, if the pueblo has one. Maria thinks that this outreach of taking the clinic to the people likely comes from the fact that West VIrginia is also rural and poor, so the problems of access to medical care are well understood, and the solution is logical, as well as sensitive to the population's circumstances.

Our transport is an open flat-bed truck, so along with the Rubbermaid containers of medicines and supplies that we pick up from the local hospital every morning, and some local people we pick up along the road, it's standing room only for most. 

Sometime between 9:30 and 10AM we arrive at our location.

POP-UP CLINICS

Most pueblos sit off-road, up steep inclines, and many are deep into tall vegetation. For one pueblo we leave the truck at the edge of the road and cross on foot a three-plank bridge over a river. The bridge sways right and left and front to back, so "Don't look down" is the advice of the day because otherwise dizziness comes on quickly. We then trek up a long dirt road then down a dirt road to up another dirt road to a home. More than a mile by the time we arrive. At Panimaquip the road is up the side of a mountain with switchback turns that make everyone in the truck screech, especially since there are no guard rails.

Dirt is everywhere - roads, surrounding the houses, and in the communal areas. Some pueblos  have some stone roads or walkways, but not many. In Nueva Providencia there are four concrete-commode outhouse toilets and two flush toilets for all 384 residents to walk to and use in a central area of the community. Most pueblo homes have an outhouse in a small wooden shack. 

Housing is the typical shed of spare scrap wood and metal. A couple of pueblos have houses made of concrete block, which is a step up. They are not painted, just concrete grey in and out. Rooms have one light bulb up close to the ceiling, which makes for dim, grey light. Some bedrooms have one light between two rooms  at the top of a dividing wall that does not go to the ceiling. This lack of lighting makes examining a challenge. At times a flashlight is used.

Most patients are women and children. They wait wherever there is space inside or outside. They are seen in space available - bedrooms, hallways, the outside area in front of the house, a small room or two in a community center. The pharmacy area is usually prominently placed, but also usually cramped. Dr. Maria and I sit all day at small tables with the tubs of meds on the floor. We dole out medicines prescribed by the resident and interns and explain in Spanish how to take them.

Most ailments are chronic and repeat from pueblo to pueblo - lice, scabies, fungal skin infections, colds, coughs, upper respiratory infections, and chronic headaches,all from living in and breathing dirt and wood smoke (cooking is wood-fire) all day every day. Pregnancies, bladder infections, cavity-filled teeth down to the bone, malnutrition of mothers and children, except nursing babies, who are plump because of the high nutrition of breast milk. It is common for these families to eat only once per day, at a midday meal. The usual menu is rice, beans, and tortillas. They either have no meat, or chicken once a week. 

Occasionally there is a serious situation, such as the 78 year-old man who complains of sudden onset rectal bleeding, which after questioning, Doc Maria figures is undiagnosed cancer. He is advised to go to the clinic in town for testing, but there's no guarantee that he will because of distance, cost, and inconvenience. Without volunteer foreign medical teams most of the pueblo Maya wouldn't see a doctor or dentist from one year to the next.  

Sometime between 4PM and 5PM we pack up our movable clinic and head back up and/or down whatever road, bridge, or hill will take us back to the truck and back to San Lucas.

FEBRUARY 1-

Sat. Feb 1 - up at 4:30 AM to have breakfast and be ready to leave Quaker House at 5:30. Ed and Barbara are driving their friends Bill (dentist who did free work in Managua this week) and his wife Brenda (who brought me out of dehydration) and me to the airport. My flight on COPA Airlines leaves at 9:15 and is punctual and pleasant. Good food for breakfast, which is a distinct difference from US airlines that don't give you anything for breakfast even if you leave at 7AM. 

Staying for 2 nights at B&B San Nicolas. Lovely one story Spanish Colonial with a beautiful center garden all in bloom. (yes, I think about how miserable everyone back home must feel with a never-ending winter of snowstorms.) Staff are wonderfully friendly and helpful. Rossana, the day clerk, spent 13 years in the US because her father was Guatemala military and was assigned to US units in Kansas City and Arlington, VA.  We have an hour and a half conversation about Guatemala, the problems, potential solutions etc. 

Sun. Feb. 2 - Through determined research I find the Episcopal Sunday service in Antigua at what's called St. Alban's. Starts at noon because the priest is also responsible for a congregation in Guatemala City and does that service before driving to Antigua. The service is held in Convento del Concepcion'.  After being a convent it was owned by a big-time Antigua real estate mogul who left various parts of the property to each of his three wives and their respective children as he divorced them. The last wife outlived him and is now 102 years old. The building now houses a variety of offices. 

The church service space is one room and morphs from yoga to karate classes, to other community offerings before becoming a pop-up church space on Sundays. The priest, Rev. Ricardo Frohmader, hangs out in a cafe' every Wednesday from 10AM until 11:30 in case anyone wants to stop by to chat or seek guidance. The only guy in the place wearing a clerical collar. I arrange to meet him there.

Mon. Feb. 3 - I leave San Nicolas and move to a B&B in a private home. Wish I hadn't. Got great reviews on TripAdvisor, nice house, lousy room that was not shown in TA photos. A frosty air settles in between the husband-wife operators (who are not Guatemalan) and me. I stay gone most of the day. Later I decide to leave Antigua on Wednesday after meeting with Rev. Riccardo and go to San Lucas Toliman', where I'll start at the mission on Sunday.

Tues. Feb. 4  - What a day! Once again boldness pays off. As I was standing at the bank counter to change money I noticed that the woman next to me was surely an expat and a resident also because she had a bank account transaction booklet with her. So of course I introduced myslef and asked if I could buy her a coffee so I could pick her brain for a while.

Two and a half hours later(!!!) British Sylvia, who has lived in Antigua for 36 years, and I have become fast friends. And here's the magic that you can't make up - Her daughter lives in Center CIty Philadelphia  and teaches at a charter school just nine blocks from my house. I tell her that I live close to that school and have been going there monthly for Democratic ward meetings for years. We both almost fall off our chairs. Add to that the fact that she is a graduate in English Theater and I have a degree in Speech, specializing in Theater, her husband, who was successful in other businesses, got them into the restaurant business, and my former husband owned restaurants. It's becoming very Twilight Zone-ish. And she will be in Philly next week visiting her daughter. (More about Sylvia in a future Perspectives posting.)

About 20 minutes after leaving Sylvia I stop into a teeny (12 seats) restaurant for lunch. I can tell that the woman at the next table (also a lady "of a certain age") is American. (Yes, we are easily identifiable.) When she finishes her meal, she turns to me and asks if my food was good, I say yes, and the conversation is off and running. Here it comes - Thea is from Harrisburg and  has lived in Philadelphia. Retired, hates snow, and is trying to decide between Granada, Nicaragua, and Antigua for relocation. So I mention I'd been in Granada, and the people I'd met there, and my time with Donna Tabor. She has a friend there who is a friend of Donna's so she knew all about her. Then it comes out that her ex-husband owned a restaurant also, like Sylvia's and mine. What are the odds of all these connections in triplicate from three people?!

For dinner I go to a small Thai restaurant. Fellow sitting at the next table obviously American. I explained to the Guatemalan waiter that I'm headed for a mission assignment. As the fellow at the table gets into his dessert he turns to me and asks what kind of mission work. Which leads to a back-and-forth and it turns out that he too had lived in Philly. I had to call an end to the day because I just couldn't take one more encounter of the woo-woo spooky-Philly kind.

Wed. Feb 5 - I'm walking through the park on my way to meet Rev. Ricardo when I see a group of American men "of a certain age" who are clearly expat residents. When I told Rev. Ricardo about my encounter with the American Legion fellows in Granada (see previous Granada blogpost) RIcardo told me there is an AL  group in Antigua also. Of course I go right up to them and ask if that's who they are? Yup. I recount the Granada story, the chapter president knows all the fellows in Granada whose names I mention, and says he's going there next week. So I tell him to tell Carl there that Marianne from Philly says "hi" and thanks for the connection to Donna Tabor. Which is when he tells me that he's from Philly too. Seems that wherever I go I take Philly with me.

I have arranged van transport to San Lucas that is scheduled to pick me up at 12:30. At 12:40 he calls to say there is a labor demonstration that has closed the road to Panajachel, which is the drop-off point for San Lucas, and he'll be 45 minutes late. At 1:45 I call him and learn that the trip is off for today because it takes 3 1/2 to 4 1/2 hours to Pana depending on traffic, and then there's a 20 minute boat ride to San Lucas, but the boats don't leave after 5PM because the water gets too rough.

So now I have checked out of the unfriendly BnB, it's almost 2PM, I have nowhere to stay for the night, and have to make some telephone calls quickly to find a place. Keeping up their bad attitude, the owners tell me they have to leave the house now, so I will have to leave also. I quickly call back the transport driver and tell him to come get me immediately, I'm going back to San Nicolas, even though I know they don't have a room. Two minutes later I'm on the street, under a blazing sun with my bags as the owners walk away. Ugo, the driver, shows up 20 minutes later.

Back at San Nicolas my friendly day clerk, Rossana, is off for the day. So I ask the young man at the desk to call her at home. No problem. (Imagine that happening at a place in the US.) She's a sweetheart and gives me the name of another place, then tells the current clerk to tell the new place to give me the same rate as at San Nicolas, even though the new place is usually more expensive. He calls, they agree, and finally, around 3:30 I'm  at Casa Capuchinas. Ugo tells me to be ready at 8AM tomorrow for the Panajachel ride.

Dinner time. After the stress of the day and wondering if I'd have to sleep on a bench in the park, I'm looking for a nice relaxing place that I've not yet been to, and am walking the streets around the Parque Central.  Up and down, but nothing catches my attention. I spot a place that has sort of a dim, cozy vibe. Stop to read the menu at the doorway, which is open like all the doors in Central America. I'm halfway down the soups when a female voice calls my name. I look up and there at the bar is Thea from Harrisburg. What are the chances? So in I go and we continue our conversation from lunch right through dinner. 

Got only slightly lost on the way back to Capuchinas, but a helpful young woman walked me right to the corner of the street and pointed the way. Antigua is supposedly the safest city in Guatemala, but even at that, the advice from locals and expats is not to walk around alone after 9PM. So because I hadn't left the restaurant until 9:15 and my BnB was a fifteen minute walk, I was glad to be back at Capuchinas without too much of a detour.

Tomorrow to Pana then San Lucas Toliman' - I hope.

***

JANUARY 24-29, 2014

Friday, January 24 

Barbara and I are with the children in the small courtyard in front of the San Francisco clinic where the med team is doing their exams and treatments. We're talking about the children in the Pathway to Change program who do not have sponsors. 

Sponsors commit to supporting a child in many ways - $2000 per yea, which covers their private school and all  tangential costs, like uniforms, textbooks, and the Pathway Children's Center services; encouragement through letters and cards; receiving the student's report cards every marking period and communicating with the student to congratulate or commiserate on the results, and more.

Barbara tells me that when she receives a potential sponsor inquiry she responds electronically with a written profile of the child, his/her strengths and needs, personality, interests, character and the like, and a photo. 

The children are not told of the potential sponsor interest in case it doesn't come through, so they're not disappointed. Even if it does finalize they are not told that money is involved. Their understanding is that the sponsor cares about them, their education, their progress, their dreams and goals, and their family, and prays for them. The sponsor never sends gift money to the child, and the children never ask for any because it's not part of the relationship. So the support is minus any potential for financial manipulation on either side.

In a flash it occurs to me that a major piece of making a connection between child and potential sponsor is missing. What the children need to do, I tell Barbara, is make a brief video introducing themselves to potential sponsors, a video about themselves, their favorite school subjects, what they hope to become, the people who live in their home, and why they want a sponsor. With a video, that child becomes a real-life person with a voice, eye contact, mannerisms, facial expressions, and personality. If a child already has a sponsor the video can be a "thank you." 

I point out that making videos would be a wonderful new tool in the program's toolbox, beyond sponsors. It allows the children to see and hear themselves as others do, rather than their language sounding inside their heads. It will help them to develop confidence and poise in presentations. It will move them further into the world of media, which is required to become leaders in their own country, let alone outside it. It will advance their English communication skills.

And it will be fun!

Just like that Barbara understands the value of the suggestion and jumps on it. We decide to start the video process four days later, on Tuesday.

Friday night the whole med team (including me) goes to a wonderful pizzeria owned by an Argentine woman. We consumed probably 15+ pizzas and drank mucho vino, letting loose of the frantic pace of the week just ended.

Saturday, January 25

The med team (including me again) gets the big reward - a 7-hour day  at a secluded private beach on the ocean. Everybody agrees this is exactly what the doctor ordered (pun intended.) A stop for ice cream on the way home. 

Sunday, January 26

The med team leaves the Big House at 5:45AM for the airport. Dr. Dennis and I move to the Quaker House, a guesthouse of the quite plain and simple Quaker variety. Two rooms with five beds each, and a third with six beds. Bunk beds, of course. Cold-water only. A definite backpacker kind of place. But that's what you get for $10.00 per night.

Dennis and I both luck out and get rooms with nobody in them. I have an additional stroke of luck and get a teensy private bathroom. I am not complaining. Then to the grocery store for supplies because Quaker House is strictly do-it-yourself. 

 I veg out for what's left of the day.

Monday, January 27

I spend the day at Quaker House writing a video script for the children in which they will fill in the blanks with their necessary information. I also write a script for Barbara because her video will introduce the children, and a bullet-point guide for making a video because I won't be around forever.

Tuesday, January 28

Six children were invited to participate in the first information and practice video session. But some kids told their friends, so nine showed up.  Getting them to put their information into the script is a struggle because the script is in English and they have varying levels of speaking ability. Most are sort of shell-shocked by the whole process because they have no experience with making videos, have no video cams, no smartphones, or PlayStations, Xboxes, no DVD or CD players, or anything like them.

Many homes have no TV, and the ones that do are often operating on illegal electric hookups because the people cannot afford electric service. So their TV watching is limited to an hour or two per night.

Another definition of poverty is extreme limitation of resources and access to them.

Wednesday, January 29

Today 20 children are scheduled to come to the Center to pick up their new pencil boxes and supplies for the start of the school year next week. (It runs February through November.) 

The task for me is to re-video six of the children from the practice session - four who need sponsors, and two who are saying "thank you."The "newbies" will complete their information scripts. Barbara and I agree that we don't want to pressure the new kids to do more than that so they don't experience videoing as a chore rather than a fun actvity which they'll want to do again.

I'm doing the videos in a small courtyard of the school. Today is especially hot and humid. For some reason, the kids from the practice session are not doing as well as the day before. Taking much longer than I expected. I'm about to start the video with the last student when I suddenly feel light-headed. Need to take a break. Splash cold water on my face and arms. Back to the student. Feeling faint. Get through the video - twice, because he didn't like the first one. Done.

Now I'm in the kitchen getting a wet towel to put around my neck. Head lowered to my knees. Barbara's friend, Brenda, who is visiting from Nova Scotia, looks at me and says, "Dehydrated." She starts pumping water into me. Three large glasses in 15 minutes. 

Yup. That's what it was. In half-an-hour I'm good as new.

Tomorrow and Friday Barbara and Ed will be away, so I'll be working on the video project from Quaker House. Will put together a list of educational uses of video for use at the Children's Center. Barbara wants to incorporate videos into as many educational and fun activities as possible and practical. 

Barbara thought I could use her old FLIP for the videos, which I tried, but it conked out after 30 seconds, so I used the iPad Mini loaned to me by Bhavisha, my surrogate daughter in Philly, to video the kids. 

Barbara thinking that the FLIP could work made me realize that it's not just the kids who get along with little to nothing. Barbara and Ed are always counting every cent, always finding ways to complete a task or provide a service or opportunity to the children in a creative and least costly way. They take nothing for granted, and have adopted the perspective of doing without because their program finances and access to equipment and the like are also limited here.

How different from our US expectations. If Barbara and Ed were in the US they could stroll into a Walmart or BestBuy or shop online or from the TV and pick up a videocam for $80 or less. A 15-year old FLIP would have been recycled years ago. 

I make a promise to myself to help them get a couple of inexpensive videocams for the Center. One can be used by the teachers, and one could be used by the students for class projects of their own design and making. 

JANUARY 20-22, 2014

Managua

The 17-person volunteer medical team from Louisville, Kentucky, arrived late in the evening on the 19th. By the time they got to their accommodation - La Casa Grande (The Big House) - here in the 38-house compound where Barbara and Ed Dunsworth live, and got to bed, it was 1AM. Some of them didn't sleep at all. But they were up and out on their way to the hospital at 6:30 AM that morning.

Among the non-medical members are Marla Cautilli, CEO of Hand in Hand Ministries (myhandinhand.org), and Pamela Carter, the Director of Development.The Pathway to Change education program that Barbara and Ed founded is part of Hand in Hand Ministries. 

Along with Barbara, the four of us have specific duties for the week in support of the medical team's work: To organize, teach, and entertain the hundreds of children who will show up during the week with their families (and sometimes neighbor children) to receive medical services.

After their morning time at various hospitals, the team gathers for lunch, which is where we meet up with them. Then it's off to a "private" clinic for the poor, where they meet with the Pathway to Change families.

The medical and dental exams and treatments are made available to all the children in the Pathway program, their siblings, parents, grandparents, extended family like aunts and cousins, and neighbor children. The entire group that a family brings along receives the services for $1.50 per total group, not per person. That small fee goes to pay for the small bus provided by Pathway to bring them to the clinic. Without this yearly volunteer visit arranged by Barbara and Ed and the Hand in Hand organization, the families might never see a doctor. If on-going care is required, Barbara and Ed facilitate that too. 

Ed and Barbara are adamant that any service that a family receives - education, house building, medical etc. - be something they contribute to, if only in the smallest way, such as the $1.50. It is their experience that this is important for several reasons: So that they don't develop an attitude of entitlement because they are poor; that they don't take services and help for granted; that they maintain personal dignity that they are able to contribute to their family's well-being; and that they appreciate the service because they have had to be part of it.

The families arrive at the clinic in a small bus carrying 20 passengers, but with more like 30 people because there are babies and small toddlers in arms. The parents register and go through the basic blood pressure, weigh-in routine, then wait for their name to be called for the doctor. The wait can be as long as three hours. They are patient.

In the meantime, the bus goes out to pick up the next group of families. Eventually we have a backlog of adults and children running in and out of the clinic, so there is a definite need for the children to have some structure to the day. The children we deal with are from toddler age to 16, so we have to be flexible and creatively engaging so as not to lose their interest.

The clinic is a small one-storey building open to a small front courtyard. There are four rusty swings for the kids. We come equipped with fat pieces of colored chalk to draw on the stone courtyard, watercolor paints that we will use in a teaching lesson about germs, glitter that we pour into their hands to resemble hand germs that they pass to each other, two plastic tubs, one with only water, and the other using soap to demonstrate which cleans the germs off better, a jump-rope, drawing paper, colored pens, crayons, a ball-tossing game, playing cards, and other activities for learning about personal hygiene. 

Jump rope with both boys and girls participating and card playing are big hits. I played cards non-stop for about three hours yesterday. I learned a new game called Stolen Casino (English name) that is fast and cut-throat. Can't wait to do it at home!

Being responsible for this many kids is a challenge for me. I am an only child, so I didn't have other children in my home environment. The last time I was responsible for entertaining a toddler or elementary age child was with my son, and he's now 36 years old. He is also an only child, so no other children were in the house. My entire working life has been with and for adults. I keep reminding myself that I love change and challenge, so the Lord has given me what I say I want. I am meant to learn from them as much as they might learn something from me.

The clinic closes at 5:30PM. We pile into the bus, exhausted. But there are two home visits to make to the homes of two Pathway students on Monday evening. Since I did five home visits last week, I know what to expect. For med team members on their first time in Managua, the homes are a shock. 

After the close of the clinic on Tuesday, the med team wants to stop at a supermarket, so we go to LaColonia (The Colony), a store that carries a large number of US items. Wine seems to be a favorite purchase.

Back to Casa Grande, where we have dinner together at 6:30 each evening. The food is done by a woman who cooks for a living and it is delicious.

After dinner there is a gathering for open discussion about observations and experiences of the day, and questions and suggestions about moving forward. We finish the evening between 8:30 and 9PM. Barbara, Ed, Dr. Dennis the neurosurgeon also staying at the Dunsworth home, and I walk the half-block home. That's it for the evening.

I spend my time before bed answering and sending emails, and starting blog entries and Perspective pieces that I finish the next morning for you to find on the Website. The next two days will follow the same schedule. Saturday a "reward day" at the beach for theend of the  intense medical mission week is planned. The med team leaves on Sunday. 

Sunday I will be moving to Quaker House, the guesthouse for mission people and others coming to Managua for volunteer work. I was supposed to be there on the 21st but Quaker House changed the date. That was fine with me because the Dunsworth home has hot water in the shower. Quaker House is strictly cold water. So I'm enjoying my showers while I can.

The days are long, active and draining. I am going to bed much earlier here and am awake sometimes at  4AM. Have not seen any TV other than ten minutes of the Seattle football game since I left the States on January 7. Change is good. Except for the cold showers!

No complaints, however, when I see online the snow and frigid temperatures in Philadelphia. 

Stay warm!

What do you do if you're a 50 year-old law partner in Halifax, Nova Scotia, with a wife and four children, and want to add something new to your life? If you're Ed Dunsworth you take the advice of a friend who's done it and volunteer for a 10-day stint as a volunteer for Habitat for Humanity in Belize. When you return home you then convince your wife that you should take a three-year leave of absence from your law practice so that the whole family can relocate to Belize for a three-year commitment.

One year later you, your wife, and the three children still at home are on the ground in Belize. At the end of that commitment, the Dunsworth gang took an assignment of four years in Buenos Aires, Argentina, still with Habitat. The Dunsworths arrived in Managua eight years ago, after Buenos Aires. They work here under the auspices of Hand in Hand Ministries.org.

Their charge upon arriving was to start some kind of community outreach program, and their allotted seed money was the grand total of $500. They saw the aching need for quality education for children from poor families whose options for the future are limited  to remaining in the barrios because they are stuck in the chaotic, low quality, no-textbook schools of Managua. The Dunsworth program, Pathway to Change, started with three children. 

From that humble beginning Pathway to Change has grown to 89 children placed in four private schools, with the Pathway to Change Children's Center providing additional education and family support services, such as weekend tutoring; weekly home visits by a social worker to monitor family situations and provide guidance; monthly parent group meetings; medical and dental care. (http://myhandinhand.org/our-work/our-work-nicaragua/).

This past Wednesday I arrived in Managua and was welcomed into the Dunsworth home. I will be here until January 21, when I will move into Quaker House, a guesthouse for volunteer workers and other groups interested in Nicaragua.

Even though schools are out of session for their summer break from December until the beginning of February, contact with students and families continues throughout this period. 

Yesterday, Thursday, I made five home visits with Dona Marta, one of the Center's social workers. We walked through the dry, dusty roads of the barrios to each of the homes. I was introduced to the children and the parents. I listened as Marta carried on a gentle discussion  in Spanish, asked questions in a concerned yet non-threatening way, and offered encouragement and advice to child and parent alike. We were gone two-and-a-half hours.

While we were gone Barbara was at the Center with a student who wanted to bake a banana cake for her friend's birthday. Since the Center has a small kitchen, Barbara met her there to guide her through the process.

Next week a 17-person medical team from Louisville, Kentucky, will arrive for their annual one-week medical mission. They include doctors and their residents representing six areas of medicine, and also a dentist from a Managua clinic. This team will provide examinations and treatments to the children and their families, including extended members such as cousins, for the week. They will pay only about $1.50 per family, regardless of the number of family members, and the cost is only for the provided  transportation to get the families to the clinic.    

Barbara and I will be part of the medical week, keeping busy with some of the non-medical staff. There is a schedule of activities starting Monday. More on that as it happens in a later post.

Also staying with Barbara and Ed at this time is Dr. Dennis McDonnell, a 77-year-old  retired neurosurgeon from Wisconsin on his second trip to Managua. Last year he came for three weeks. This year he is staying for three months. Dennis provides teaching and operating room advice to Nicaraguan surgeons during procedures.

On a personal level, I can tell you that the people here who commit themselves to making positive change in third-world countries, do so with limited resources, sometimes in compromised living situations, with no help from any local or national government agency, and for not a lot of money, are a special breed. But they don't think that about themselves. Like Ed and Barbara, they never, ever envisioned themselves living the life they live, where they live it, or doing the work they do. But now that can't envision anything different.

Just like in every country, education is the way up and out. But in third-world countries poverty is the roadblock to that goal. The difference  is that in North America our poor children have better, though not perfect options for achieving potential. Our public schools are lacking, for sure, but they are not essentially useless. Our children and families have access to community agencies and federal  programs, and  there are financial aid, scholarships, and school lunches. There is none of that in Nicaragua. Only the rich are educated and fed well here.

If Barbara and Ed Dunsworth were not here there would be no Pathway to Change, no good education, no family support, no hope for a  life outside the barrios, no possibility of one day contributing in a meaningful way to one's family, community, and country.  Barbara and Ed have asked themselves the fundamental questions: Will I be part of perpetuating or ignoring poverty as it exists outside my own life, my own country? Or will I be part  of relieving it in any way that I can, anywhere that I can?

Asked and answered.
***

Please click through to these two inspiring videos:




1. Pathway to Change American volunteer, students, parent, and Barbara Dunsworth on how the program has changed their lives. http://www.youtube.com/watch?v=rQlyhINMeIs




2. Pathway to Change student  Mauro Lopez delivering a speech in English in the US about his experiences in Pathway to Change http://www.youtube.com/watch?v=7IvC_pnPNKc

About 45 minutes after sending the last post the head pain went away. No pounding, stabbing. thumping. I could see, walk, focus, and think just fine. No idea why.

At 4:30 I went for my blood test results. Evidently there was a misunderstanding on someone's part because the only test they did was for potassium level. I mentioned potassium to them and said maybe, but I wanted more. The technician said yes, mas - more. Didn't happen. One mentioned electrolytes, I said yes, I wanted that too, and blood sugar. Come back tomorrow.  I said I really needed to speak with a doctor. She said he was just seeing his last patient. Then she went to the door to look into the courtyard where he was standing. He must have heard her because he said to let me come in.

What a wonderful man! He asked me all the right questions - in Spanish, but he did have some English words, so once again with my Italian I was in a 3-language conversation. He checked my carotid arteries - fine. My heart - fine. My leg pulses - fine. My lungs - fine. My blood oxygen - very good. My pulse -slow - but having told him my dance and swimming schedule he told me what I already know on that - people who exercise regularly usually have a slow pulse. 

Then my blood pressure. I almost fell off my chair - 150 over 80!!! Never in my life! I have a history of low blood pressure - 108 to 118 over 80 now, but it has in the past been as low as 84 over 56. That technician took it three times, then asked me if I was actually dead.

He asked if I was staying in Leon for a while. No, leaving in two days. He asked what I had been doing before Leon. I told him the whole saga from the Philly airport right down to the shuttle ride on Saturday when the pain first started.

He told me not to be alarmed, that he would diagnose it as relative hypertension. That it was situational. I had been on two airplanes, in two countries, on a miserable van ride, with no food, dragging luggage, and all of it in five days. I had overloaded my system and it went haywire. He gave me a prescription for Capitrol, a hypertensive med. Ten  tablets taken one half at a time twice a day. After that, he said, he was sure I'd be done with medication and go back to my usual self, assuming that I didn't wear myself out again. It's a good thing I didn't mention that I hadn't slept more than five hours a night since September when the trip plans got really hot and heavy. 

It was great that I could just walk in and ask for any kind of blood test, which, by the way, was $6.00. My on-the-spot visit with the doctor was 40 minutes long and cost $16.00! The ten tablets were $3.00. Can you imagine an American doctor taking a walk-in patient at the end of his day and  spending 40 minutes with her? Not even on a first appointment visit. And he asked me to come back tomorrow after I will have taken two doses so he can monitor the result. What a guy!

So there you have it. I have one day left here. I'll try to see something. I doubt there will be any accidental encounters of people who refer me on to other people and they all have a story to tell, like in Granada. Which reminds me that I am four stories behind, but I dare not let that stress me. Leon's purpose for me was evidently to smack me upside the head and put the over-stimulation and deadline modes on "pause."

So for all of you who read the post prior to this one and were worried, all's well.

More as it happens.

Marianne

What's written below is a chronology of my past three days. I promised to write about the good, the bad, and the ugly of this trip. This is bad and ugly. But it's part of my experience, so in the name of full disclosure, here is the blog  post as of this moment.

It's Monday. The ride from Granada to Leon was a nightmare. Crowded van with 13 people including the drivers, air conditioning minimal so there was a lot of carbon dioxide being exhaled, I swear I smelled a faint odor of exhaust, the two hour trip was actually four  because we didn't go directly to Leon. There was pickup of passengers at two locations, then a detour to the Managua airport to drop off one person, then a stop for gas, then winding through neighborhoods before getting back on  the highway. With the exception of six peanut butter crackers,  I did not eat from breakfast at 8:30AM until 3:30. Had a headache on arrival. I figured it was from hunger.

Then the really bad stuff started. I asked for a fruit salad. They gave me an entire dinner plate of beautiful fruit. I ate about 2/3 because it was light and the headache had turned vicious. Got to my room and could barely make it to the bed the head pain was so bad. Collapsed on the bed. Awoke 2 hours later starving. Figured I needed protein. Had a chicken panini and fries. Still figuring a hunger headache. By 8:30 I was practically on my knees in pain.

Went to the front desk. They called a pharmacy which delivered 2 pain pills to  the door, free. 400 milligrams each of acetominaphen. Took one and saved the other for later. Back to bed, sitting up because putting my head down was too painful. Awoke at midnight, took the other pill, back to sitting  up, always wearing the eye mask because light made it worse. Awoke at 7AM, made it to breakfast at 7:40. Asked for more pills. This time they gave me two and said to take them both. Cereal and toast with jam.

9AM Saturday and I'm back in bed, still propped up. I can't think, can't focus attention, I'm not visibly shaking but my insides feel like a vibrating guitar string. Feeling weak, can't trust leaving the hotel, or even my room. Noon I ask for a grilled cheese sandwich and get two so I eat both because I'm starving again.

Back to the darkened room and propped up. 3PM I forget having eaten the sandwiches and order something else but my memory does not remember what it is. The desk clerk gives me one more 400 mg tablet. Back to bed. If I could see myself from the front I probably look like a sitting corpse because I don't move for hours in that position.

Now I figure that I must be having the first migraine of my life because it feels just like an old friend Phyllis used to describe hers. In a dark room for days, throwing up every time she sat up. Thankfully vomit is not part of my crisis.

6PM to the small restaurant, which they call a cafeteria, even though it has tables and a full bar.I know I have to eat because I can't  keep getting weaker. I order a small piece of grilled chicken (protein) and a small dish of fruit, which the server thinks is a highly strange meal. The night clerk comes over and gives me a different foil-wrapped tablet which he says is particularly for headaches. He says to take it after I eat. I ask for dinner in the room because I can't trust my balance much longer.

Food comes, I eat four bites of chicken, alternating with a piece of fruit each time. On the tablet foil written in Spanish I can make out the word for "prescription." Oh, well. What could be worse than what I've got? Take the new tablet at 6:45 and wait for relief. By 8:45 I figure it's as good as it's going to get. 10PM I approach the desk  again. The clerk doesn't wait for a request. She reaches in  the drawer and hands me two more tablets,of acetominaphen - 500 mg each this time.

Awake at midnight. Take the second  tablet. Still propped up.

Awake around 4AM. Is it my imagination or has the pain diminished to about a three inch strip running from the crown of my head to the base of my skull? Nothing to be done. Pills are gone. 

8:15 I drag out of bed and put on  the same dress I've been wearing since Saturday night. Cereal and toast with butter and jam. I think about  what I've consumed in the last seven days and two things occur to me: On Saturday my breakfast was the daily Continental type - canned juice - sugar, tea, and a huge croissant that I used jam  on as I'd been eating for four days. Then no food until the afternoon until the fruit plate - fructose and water. And there was that piece of cheesecake with cherry topping in Granada - more sugar. I hadn't had a drop of wine since the night before leaving. That was a choice because I wanted no impairment of my mind while here. But maybe my blood sugar was off kilter because I had consumed more sugar in six days than I would at home in six weeks 

The second thing that occurs to me is that because of all the fruit, which is mostly water, I may have overdosed my kidneys. The strange thing about kidneys is that in order to flush them of fluid you need to take in more fluid to get them going. Maybe all the fruit water which I got rid of often, had depleted my potassium level. That happened to me about 20 years ago and it was not pretty.

There is a medical laboratory across from the hotel and I ask if I can walk in with no prescription for blood tests. Of course, why not?
Bless these people. But I'm so out of focus that I eat breakfast and then go there for a blood test, especially sugar and potassium levels. And of course they tell me to come back six hours later because I had eaten.

So here I am, writing this at 1PM, counting the minutes until three o'clock, drinking water constantly to fill my stomach. All I want is an answer so I can stop taking pain pills and take or do whatever will make the pain stop. 

This is the first time in three days that I have been able to look at the computer. My brain has been too addled to even try. I have not been out of the hotel in three days, have seen nothing of this beautiful city before going to my mission assignment in 48 hours. Maybe tomorrow. Eternally optimistic.

More as it happens.

Marianne

What I learned today: 

Be bold, or miss out on meeting people who can make a difference.

After yesterday's trek I'm looking forward to a hot shower this morning to work out my shoulder kinks. (Darn that tote!)

There is no hot water in the shower.  I wait, letting it run for a minute, despite my aversion to running water for the sake of running it. Hot never comes. Not even tepid. I position myself against the shower wall and thrust one body part at a time under the spray because even in a hot climate mornings are cool and cold water won't make me feel better.

Done.

I learn from one of the owners that they paid the contractor $5000 to hook up a hot water system. He took the money but didn't do the work, which they found out the hard way. But in Nicaragua it's not unusual not to have hot water in the bathroom because cold showers are acceptable for the hot climate. Oh, well.

Breakfast: papaya and white pineapple (Never saw that before. Mild, sweet and delicious), a huge double croissant, juice and tea. I'm feeling human again.

To the pharmacy for sunscreen because two large containers were confiscated at the Philly airport by TSA. When I declined paying the $125 third bag fee for the tote I forgot the two containers in the tote. Definitely more than 3.5 ounces. The security scanner caught the containers. Gone. 

Pharmacy has typical Latin country division of labor - one person serves you, another takes your money, and a third bags or wraps it. All accompanied by various pieces of paper. An advantage is that you can buy just a few of certain things if that's all you need. Like BandAids.  Buy one or a box.

Decide to walk to Lake Nicaragua which sits about a mile from the start of a long wide street called La Calzada. The Calzada is a tourist hodge-podge: about as wide as Walnut St. in Philly, but with narrower sidewalks, tables everywhere, including in the street, bars, cafes, restaurants, "art" galleries (poor quality for tourists), hotels, guesthouses, noise, music, cars, motorcycles, bicycles. Your basic tourist hangout. Much quieter during the day.

It's a long, hot and humid (90 degrees) two-mile roundtrip down and back up the Calzada. About half-way back I notice a  group of men congregating at tables outside a cafe. They are speaking American English. Because there no women, they look to be  in the 55-and-up age group, and are coming individually from different directions I deduce that they must be retired American expat residents. 

So I approach them ("Bold as brass", as the nuns of my youth would say), introduce myself, and ask if they will allow me to pick their brains for a few minutes about why Nicaragua, why Granada etc.  Turns out they are the Granada chapter of the American Legion. Polo shirts declaring such, complete with AL emblem.

They are about to start a meeting but answers to my questions start flying from all sides. Why Nicaragua? The low cost of living, fairly stable government, and of course, the people. Why Granada? Authentic colonial city, livable, and the people. Why not Costa Rica or Panama, both more developed? Most of them had lived in those places and left. Some of the fellows have been in Central America for almost 20 years, when it was rough-and-ready, and not yet trendy.

When the fellow next to me hears that I'm in Central America to do mission work he immediately pulls out pen and paper and tells me I have to contact Donna Tabor, an American former Peace Corps worker who is a mover and shaker in all things community outreach in Granada. Gives me her name and number. 

Boldness pays off.

By this point I have been with them for a good fifteen minutes and realize I have delayed their  meeting, so I thank them and leave.

Later I call Donna. She is friendly and agrees to meet me on Friday.

Life is chances and choices. Be bold and choose to take the chance or not. I always remember the words of Will Rogers, the American social commentator: Go out on a limb. That's where the fruit is.

So  far today has been a fruitful one.

Beginning the three-month journey to Central America - Nicaragua, Guatemala,  Belize - in that order. Temperature 5 degrees F in Philadelphia at 6:15 AM when I leave my house. I'm in six layers of clothing that I plan to shed along the way through Miami to Managua. 

At the Philly airport - first glitch. I had three bags - one with educational supplies for my assignment  in Managua; one for my own 3-month clothing supply; and one with my heavier clothes for the  Guatemala  assignment  on a coffee plantation. I paid $60 online for my own bag and the school supplies, and thought I'd carry the farm bag  (about 20 pounds of  gigundo tote, ) and an oversized purse (about 10 pounds). But the weight proved too heavy so I decided to check the tote at the airport. $125 for a third bag!!! No way.

A struggle to walk because I had to carry the tote in my arms with the purse hanging on one shoulder. Walked about a quarter mile and found an abandoned luggage cart -Yay! - but couldn't take it past security. Collapsed into a chair at the gate.

Arrived Miami with only enough time to grab a fruit cup and head from C Concourse to D Concourse in the new, huge international terminal, still hauling the bags. Nobody told me it was a 2 mile hike! One mile into it  I approached a USAIR employee to ask for a ride in one of their golf carts, but not his job. When I told  him where I was going and why, he took the tote out of my arms and walked me to the gate, said "God bless you and your work," and walked away. God bless him.

Miami was unusually cold at 56  degrees, and planes are cold, so I took off only one layer there.

It's now 1PM, I'm starving. Had the fruit, and two peanut butter crackers since breakfast at 5:30 AM.  Flight passes quickly, landing is soon, and I'm still wearing four layers too many. Into the plane bathroom, elbows banging the walls as I contort myself into a pretzel trying to shed the layers.

2:15PM. We land on time in Managua to a temperature of 93 degrees and high tropical humidity. Quickly through Customs. See my driver for the trip to Granada holding a sign with the hotel name. Leave the dreaded  luggage, which is now four heavy pieces, with him. Now looking for Ed Dunworth of Hand in Hand Ministries who will take the school supplies and plantation tote with him while I go to Granada. 

Finally on the road with Angel, the driver. A one  hour trip. His minimal English, my minimal Spanish, and some Italian  thrown in. A good ride. 

Granada is the oldest completely authentic Spanish colonial town in Nicaragua, and the second oldest in Central America. A major draw for tourism and expats.

At the B&B the people are wonderful, I have a headache from hunger, but I drop onto the bed,  and fall asleep at 4PM.

Awake at 6PM and am ready to eat the towels. Need a casual, close place. Owner suggests a local kiosk eatery in the Parque Central, the town center about six blocks away. Hotel clerk is finishing his shift and heading that way so he takes me right to it. I ask about a typical Nicaraguan dish. He suggests vigoron, and leaves me to it. Vigoron -   a cabbage salad known as curtido (chopped cabbage, tomatoes, onions, and chili pepper marinated in vinegar and salt), boiled yuca, and chicharrones (fried pork with skin, or just the fried skin) wrapped in banana leaf. Often eaten without silverware. Vigoron is said to have been created by a past kiosk owner around 1950 in the same park. Nicaraguans love it. OK, not a favorite, but belly-growling hunger cannot be fussy. I'm thankful to have food.

Chance encounter with two expat busines owners, one Irish, one Dutch. Both lived in other Central American countries previously. Came to Granada and never left. Get a converesation going about why Nicaragua (the people), doing business here, the political situation (former Sandinista rebel leader against the Somoza dictatorship is the current president for the second time after being pushed out for reelction after the first time by Western countries. They like him.) 

Gerry, the Irishman, bought a Colonial house four years ago and turned it into a guest house. (Great reviews on TripAdvisor. I checked later.) Offers to show it to me. I figure it might be the only time  I get inside one. An amazing place. Colonial houses don't look like much from the outside, but the interiors can be jaw-dropping.  Built around a small pool in the middle room after a large entry, open to the sky. I had seen some on HouseHunters International. Turns out one of those featured places sits a few feet off the main square. I recognized it immediately.

Walk back to the hotel and send a "thank you" heavenward for clean sheets, a bed, and air conditioning.

Following posts will be briefer, but today was packed with action that I wanted to share.