The Hurricane

The people in town are aware of the hurricane, word travels fast around here because it is such a small place. The children have been sent home from school. There is unfortunately nothing to be done for protection. Mother nature will have her way. I need to not spend much time with this letter as I must get back to the plantel before the bulk of the storm hits.

There is so much that happens in a day here it is difficult to convey. I feel more sad today as I am faced with more hurtles than I counted on and I feel more alone this time because my access to the outside world is not as strong. Learning the fate of a few of the children I cared for last year also broke my heart. Many of the changes we made though were positive and still have remained in place. Most importantly the bulk of the children are well and the dirty diapers are being burned!

I think one of the other pieces that is effecting me is the overall moral of the plantel which is bad this month. The orphange is not getting paid the money they were granted by the government for education and it has put a tremendous stress on the already small funds we had. People are frustrated and tired. It is difficult to get away from the many injustices I spoke of yestarday.

There was also a tragic event yestarday which effected a few of our families. A gang attacked a bus in a near by area and killed one boy and wounded several people. They were students and workers comming up the mountain on public transportation. Crime is a reality here but usually it is not so close. Pena Blanca is a small quiet village so this is not so common here. We are not in danger on the plantel because we have security guards and no one wants to hurt the hospital as many people rely on it, there is also nothing to steal. That said I would be lying if I didn't say it hurt my moral a bit too.

I will not give up. I came here with a purpose and I intend to accomplish as much of it as possible. Jen and I have tossed around a few ideas and we will continue. We both have extreme faith. We still have a vision of establishing a descent health care team with doctors, residents, nurses, social work and hopefully mental health workers to take care of poorest people. I try to remember that in the US it was once like this and we will need to evolve in much the same way.

The rain is harder now I better go....

First Day Back to Honduras

4:00am comes early here. The rooster screams like clock work outside my window and there will be no rest for the weary.

Yesterday we drove up from the City. Our trip up the mountains would not have been complete if it had gone smooth. Through a long and convoluted story we ended up with a car which was “in good shape” which someone lent to orphanage in exchange for their truck just for the weekend. For those of you who know me know cars and I just have bad thing for each other. About ¾ of the way it started to over heat. Now imagine a car full of gringos sitting along side the road with 1 ton of luggage. Yeah you guessed it …..It would be a really bad thing. Luckily we had about 2 cups of water with some juice between us and we managed to limp it along to the entrance of the orphanage.

They finally brought to my room……and when I looked at the porch I actually started to laugh because it was just to perfect….they put a bee hive box outside my door and the whole porch was swarming with bees. I asked Jenny if this was a joke, she was laughing just as hard as I was. No, she said it’s not a joke they were told to figure out a way to get the bees out of the rooms and I guess they decided this was the way….. provide them with a home of their own! Okay so I thinking “I can do a lot but I am not going to walk up there, not gonna do it”. Jenny agreed and kindly invited me to stay with her last night until we get the whole situation straightened out.

Today I will check out the Clinic first to get a general idea of what has worked and not worked over the past year then we have planned a meeting at 2pm with the heads of each department to try and re-organize. We have a plan to improve work ethic and try to make some progress.

Jen said that the children are doing fairly well right now. Her biggest problem for the moment is a girl with epilepsy and mild mental retardation. She is having more frequent seizures and refusing to take medications.

I will try tonight to see if I can send email in town. We lost our satellite connection at the orphanage because the company was basically ripping them off. They were charging $900 dollars a month. We also have no phones because cellular company sent them a bill for $11,500 for which they refused to give a report of the calls made. Jenny and Anita spent the day yesterday in the court house filing a complaint. Some businesses here think because there are ties to America there must be money. It’s damn mess.

That said, and despite the bees and the car and the luggage I am glad to be back….I think….

The Interim Evolution of a Plan

After the leaving the plantel in Honduras it took time to readjust. My life in the states seemed extravagant and the guilt tremendous. Imagine the guilt you feel when you have ordered desert even though your full….now amplify that about ten fold. Every time I wanted to go to dinner or buy clothes I kept hearing a voice in the back of my mind whispering ..….that would be 1 box of lice cream or that would be 4 little beds or I could pay for another case of antibiotics with this money. The nightmares were relentless. After wrestling with my emotions and learning to acknowledge my anger over the severe injustice in the world it became clear to me that there was only one solution for me personally. I would dedicate the rest of my life and the skills God so generously provided me to people in need and in this moment those children need me and there are plenty of people in the poorest areas of our American cities who are suffering in much the same way.

The next year was filled with emails and calls and blessings from above. I was flying back from the American Academy of Pediatrics annual convention and I met a wonderful and very kind hearted gentleman who happened to be from Kodak. He related to my stories from Honduras and had a few of his own. Since that time we have been working toward developing a medical model that will work for the rural areas of Central America. There are, as Tracy Kiderer put it, “Mountains Beyond Mountains” to struggle with and climb before we get there, but if we don’t try then it matters to no one, if we try has the potential to “matter” for many.

Over the year there were several donations to help make things possible, Kodak donated a dental cam toward the project, Post Central a film editing company, provided a high tech lap top for collecting medical records in the field, fellow physicians and nurses from Rochester donated medical supplies, clothes, medical books and computers. I contacted every organization I could and was able to purchase several boxes of medications to take back with me.

Now I sit a year later loaded up like a pack mule trotting through the airport. If you saw me you would think I was homeless. I had on a dress with a big old straw hat (right out of a bad re-run of Hee Haw) a fluorescent rain coat tied at my waste and my stethoscope slung around my neck (I really did try to fit that sucker in my bag but it just wouldn’t go). To top it off I was lugging 2 body bags, a cheap black suitcase on wheels (which suddenly only wanted to turn sideways) and there was a giant camo bag stuffed to the brim on my back….ugh! The people at the baggage check were polite and supportive of my cause. Although they tested my bags for illegal drugs but didn’t hold me up. Now security was fun….. you have to practically strip naked to go through the little detector things and you have to take lap tops and electronic devices out of your bag and place them in bins along with your clothes. So here’s me hat shoes two jackets into a bin. Then I had to unpack my entire camo bag with the 2 lap tops, video cam, extra hard drive and camera then re-pack it on the other side and because I was traveling internationally I got to do it all a second time in Miami! …….Note to self……don’t use underwear as padding material in the future. The good news……they didn’t think I had a gun this time ( I left my ottoscope at home) and so they let me pass. I’m only half way there and Lord knows what will await me at the other end….

In the End

This will likely be my last email from Honduras. I will be heading to San Pedro in the morning. I plan on staying overnight in a hotel so I can decontaminate and grab a few hours of R&R prior to departure.

Over the past few days we've been working hard to tie up loose ends. A few of them simple, like, getting the curtains up where the children sleep to keep out some of the cold night time mountain air, completing the 30 little foam beds and burning the old ones. We also needed to de-lice the kids one last time which includes convincing the teenagers that having lice is not a fashion fad so they better start using the cream I gave them 2 weeks ago or else!

Then the few loose ends not so simple....

There is a woman living here in the tragedy of her own life and still allowing it to cloud her soul with anger, bitterness and contempt. She was married at a young age and bore 7 children. Her Husband had run away early in their marriage, for a brief time which resulted in an illegitimate daughter. Over the next several years he would beat his wife with in inches of her life on multiple occasions. His cruelty did not cease with his wife. Their youngest son was a mute. He ordered his wife to lock him up in a shed behind their hut and starve him to death. She could not. She would sneak away in the darkness and slide him food when ever possible. The man became extremely frustrated that this kid wouldn’t die, he felt they were too poor to care for such "waste". He eventually gave up after 4 years and released the child. His alternative means of decreasing the grocery bill was to shoot the oldest child and fracture the skull of the middle child. Quickly cutting the bill by 2/7ths. With the death of the children and the distance it placed between himself and his wife he decided to take his illegitimate daughter into his home as a trained concubine. With fear of her life and that of her remaining children his wife never left. One day the illegitimate daughter escaped to our orphanage. She was quickly found by this barbaric man and he took her back up into the mountains. It was this event that finally freed his wife. She learned of the orphanage through the illegitimate girl and believed it could provide her and her children shelter. She left in the night with no clothes or food and the 5 remaining children. She left the illegitimate child behind. I relate this story because we have been trying to pick up the pieces for her and get her back on track. It is certainly not simple and she too has hostile behavior which I can only assume is learned. We have been running interference for her children to prevent beatings or undue harm. It's not like the US where you can just call child protective. This story is sadly not so unique here. The poverty resulting in social decline that brutally demoralize a society, a culture, a family, a child, reigns supreme here in the hills…... This, a loose end I can not tie up, will haunt me.

Behind a locked door some weeks ago I spoke of the clothes and the old blankets that I found. I did not speak of the children I found. Two children had been being kept under lock and key by their mother when she worked on the plantel during the day. No one knew. It was terrifying and tragic. The good news is they seem no worse for wear at first glance but the reality of the torment will not be evident for years to come. We have been working on this as well. Again, years of mistreatment handed down through time is not an enemy easily defeated.

Now, after 30 short days, I have found pockets of peace and joy scattered amongst the rubble of a poor poverty stricken community forgotten by everyone except God. I have grown to love these children for what they are, at complete face value. I will not forget the lessons they have taught me...... the power of loss and strength, pride and community, hunger and heartbreak, need and want, desire and disappointment combined with the overwhelming ability of the human soul to find happiness in the face of a living hell. More importantly though I've learned about humility, my humility.

In time the names will be lost from recent memory, the building layout will seem foggy to my recollection and yes, I will forget about the bugs, but a piece of my heart will always be ....at home......somewhere in Honduras.....

Thank you God and all of those who have walked with me through this enchanting time.....

In the End

This will likely be my last email from Honduras. I will be heading to San Pedro in the morning. I plan on staying overnight in a hotel so I can decontaminate and grab a few hours of R&R prior to departure.

Over the past few days we've been working hard to tie up loose ends. A few of them simple, like, getting the curtains up where the children sleep to keep out some of the cold night time mountain air, completing the 30 little foam beds and burning the old ones. We also needed to de-lice the kids one last time which includes convincing the teenagers that having lice is not a fashion fad so they better start using the cream I gave them 2 weeks ago or else!

Then the few loose ends not so simple....

There is a woman living here in the tragedy of her own life and still allowing it to cloud her soul with anger, bitterness and contempt. She was married at a young age and bore 7 children. Her Husband had run away early in their marriage, for a brief time which resulted in an illegitimate daughter. Over the next several years he would beat his wife with in inches of her life on multiple occasions. His cruelty did not cease with his wife. Their youngest son was a mute. He ordered his wife to lock him up in a shed behind their hut and starve him to death. She could not. She would sneak away in the darkness and slide him food when ever possible. The man became extremely frustrated that this kid wouldn’t die, he felt they were too poor to care for such "waste". He eventually gave up after 4 years and released the child. His alternative means of decreasing the grocery bill was to shoot the oldest child and fracture the skull of the middle child. Quickly cutting the bill by 2/7ths. With the death of the children and the distance it placed between himself and his wife he decided to take his illegitimate daughter into his home as a trained concubine. With fear of her life and that of her remaining children his wife never left. One day the illegitimate daughter escaped to our orphanage. She was quickly found by this barbaric man and he took her back up into the mountains. It was this event that finally freed his wife. She learned of the orphanage through the illegitimate girl and believed it could provide her and her children shelter. She left in the night with no clothes or food and the 5 remaining children. She left the illegitimate child behind. I relate this story because we have been trying to pick up the pieces for her and get her back on track. It is certainly not simple and she too has hostile behavior which I can only assume is learned. We have been running interference for her children to prevent beatings or undue harm. It's not like the US where you can just call child protective. This story is sadly not so unique here. The poverty resulting in social decline that brutally demoralize a society, a culture, a family, a child, reigns supreme here in the hills…... This, a loose end I can not tie up, will haunt me.

Behind a locked door some weeks ago I spoke of the clothes and the old blankets that I found. I did not speak of the children I found. Two children had been being kept under lock and key by their mother when she worked on the plantel during the day. No one knew. It was terrifying and tragic. The good news is they seem no worse for wear at first glance but the reality of the torment will not be evident for years to come. We have been working on this as well. Again, years of mistreatment handed down through time is not an enemy easily defeated.

Now, after 30 short days, I have found pockets of peace and joy scattered amongst the rubble of a poor poverty stricken community forgotten by everyone except God. I have grown to love these children for what they are, at complete face value. I will not forget the lessons they have taught me...... the power of loss and strength, pride and community, hunger and heartbreak, need and want, desire and disappointment combined with the overwhelming ability of the human soul to find happiness in the face of a living hell. More importantly though I've learned about humility, my humility.

In time the names will be lost from recent memory, the building layout will seem foggy to my recollection and yes, I will forget about the bugs, but a piece of my heart will always be ....at home......somewhere in Honduras.....

Thank you God and all of those who have walked with me through this enchanting time.....

Danger Still Lurks At Every Corner

Looking back now, when I first came to Honduras I heard a great many bad stories about crime, kidnapping, corrupt government news and carjacking but truth is I didn't really think it affected me because I'm not criminal nor I do I hang out in shady areas. Well I was wrong.

Last year the man who is responsible for my ability to email, his name is Dago, was coming back from San Pedro at night a year ago. (I believe I have mentioned the warnings we've had about night driving in past emails.) He oddly enough heard a round of fireworks in the distance just about 30 seconds before a large truck pulled up beside him flashing them a quick look and a head gesture that suggested Dago should back off. Dago looked in his rear view mirror in time to see a car flipping off the road behind him. The truck sped off apparently chasing the car in front them, two seconds later the man from the truck stuck his hand out the window and fired a few shots at he car he was chasing causing the car to flip off the road. Dago told us that story a while ago but it stuck with us.

We needed to go to San Pedro for a follow up appointment regarding my illness. It had been a long day, a long wait and there were several errands to run. We went to the hospital to try and find the boy from the mountains. We learned from a girl that comes down from the mountain every few weeks that the boy with the mass in his groin actually did leave with his sister for San Pedro but never returned.....we couldn't find him in the hospital. Needless to say the day drug on and soon it meant placing us in the dark for the way home. "Yeah they say it's not safe but is it overblown?" "Do we really need to be that strict and careful?" We all thought the same way and there were 5 of us in the car coming back together in the dark.

Suddenly on the same tiny little dirt road Dago spoke of before, only 30 minutes from home, we saw a lot of lights in the distance. As we came closer we could see it was two large trucks stopped in the center of the road. In our attempts to be careful we were watching the road hard and luckily had spotted them quite early (about 1/3 of a mile away). We slowed down our approach in time to see them jog the trucks to cover more of the road making it impossible to pass. We came to a stop, still quite a ways back, and debated for about 30 seconds whether to wait or proceed or turn around. It hit us all at the same moment...."don't sit here that's what they want!" We simultaneously but anxiously yelled for Anita to turn around. She gunned it and did a donut right in the middle of the road, turning us 180 degrees. We sped off in the other direction as fast as that beat up dodge could go! We drove an extra 55 minutes out of the way to arrive safely back at the plantation. All a little shook but no worse for the wear.....

Progress

Small respite, big payoff! Found I had a renewed energy for continuing with our plans. I was also able to see of the accomplishments we've achieved. For instance, we fired a worker in the kitchen. She refused to do what was best for the welfare of the children. This was an act of tough love. The girl had been raised here on the plantation, but she was sort of like ....well, Typhoid Mary and it was too great a health risk to keep her on. Actually, I believe she has reached a point in her life where she needs to move on to the next step. She has a high school diploma so she's got a shot.

Other accomplishments: teaching them to cover the food to keep flies away. We had a trash pit built that they burn every night to keep the dogs from getting in the diapers (still chuckling about a comment....but, what will the dogs eat now?) Cleaned up the clinic ...except for the hidden room that was kept a secret until a few days ago (more on that later). We have hired a nurse in place of the girl in the kitchen. Arranged a new work schedule that has an adult supervising the children on each shift instead of older children. We painted most of the hospital in pastel colors...pastel not usually my scene but it's better than dreary, rotten brown. We are getting a handle on the lice and scabies. Still no shoes, floor still wet, the new beds aren't finished yet (can't get em dry) and not brushing their teeth so many of the front teeth are rotting out. Lastly, strep throat and pneumonia keep kicking our butt.

The answer to last problem is multi factorial but I'm finally making head way. I'll explain. One of my favorite past times here is playing a game called "Where's the Medicine Now". It's been like asking your child what happened to the homework! Great for after dinner entertainment, not so great for running a hospital. We have noticed that we are seeing all these children and giving them medication orders but mysteriously the children haven't been responding to our oral regimes only the Intramuscular treatments that we give directly. Well... doesn't take a brain child to figure out something didn't add up. In fact, what we found was, the medication was going nearly everywhere and anywhere except into the proper children's mouths. Each shift check we were replacing medicine, so of course we thought they were giving it. But alas, when we began to question the workers about the abnormally high consumption, we heard the following..... "the children spilled it", "we let all the children have a little taste cause they like it so much", the dogs took it", "It just disappeared in the night". We also found "medication potpourri". A mixture of medications with no names and not ordered by us, being given willy-nilly for every complaint. So I made medication administration records that did not require the ability to read and write. We are making each shift responsible for the medication via salary or product deduction for missing supplies and we're trying to educate them on the uses of various classes of medication.

I'm really not patting us on the back but acknowledging improvements, the real importance of team work, communication and persistence against all odds......because that's what I need to remember.

PS: Isadora, our child that was wheel chair bound, can cruise furniture by shuffling....I've got high hopes.

Progress

Small respite, big payoff! Found I had a renewed energy for continuing with our plans. I was also able to see of the accomplishments we've achieved. For instance, we fired a worker in the kitchen. She refused to do what was best for the welfare of the children. This was an act of tough love. The girl had been raised here on the plantation, but she was sort of like ....well, Typhoid Mary and it was too great a health risk to keep her on. Actually, I believe she has reached a point in her life where she needs to move on to the next step. She has a high school diploma so she's got a shot.

Other accomplishments: teaching them to cover the food to keep flies away. We had a trash pit built that they burn every night to keep the dogs from getting in the diapers (still chuckling about a comment....but, what will the dogs eat now?) Cleaned up the clinic ...except for the hidden room that was kept a secret until a few days ago (more on that later). We have hired a nurse in place of the girl in the kitchen. Arranged a new work schedule that has an adult supervising the children on each shift instead of older children. We painted most of the hospital in pastel colors...pastel not usually my scene but it's better than dreary, rotten brown. We are getting a handle on the lice and scabies. Still no shoes, floor still wet, the new beds aren't finished yet (can't get em dry) and not brushing their teeth so many of the front teeth are rotting out. Lastly, strep throat and pneumonia keep kicking our butt.

The answer to last problem is multi factorial but I'm finally making head way. I'll explain. One of my favorite past times here is playing a game called "Where's the Medicine Now". It's been like asking your child what happened to the homework! Great for after dinner entertainment, not so great for running a hospital. We have noticed that we are seeing all these children and giving them medication orders but mysteriously the children haven't been responding to our oral regimes only the Intramuscular treatments that we give directly. Well... doesn't take a brain child to figure out something didn't add up. In fact, what we found was, the medication was going nearly everywhere and anywhere except into the proper children's mouths. Each shift check we were replacing medicine, so of course we thought they were giving it. But alas, when we began to question the workers about the abnormally high consumption, we heard the following..... "the children spilled it", "we let all the children have a little taste cause they like it so much", the dogs took it", "It just disappeared in the night". We also found "medication potpourri". A mixture of medications with no names and not ordered by us, being given willy-nilly for every complaint. So I made medication administration records that did not require the ability to read and write. We are making each shift responsible for the medication via salary or product deduction for missing supplies and we're trying to educate them on the uses of various classes of medication.

I'm really not patting us on the back but acknowledging improvements, the real importance of team work, communication and persistence against all odds......because that's what I need to remember.

PS: Isadora, our child that was wheel chair bound, can cruise furniture by shuffling....I've got high hopes.

Folded

After a very long night Friday due to nausea, bugs and bad dreams from something in the medical field we call poly-pharmacy (which in English jeans too dam many drugs). Three antibiotics, an antifungal, an ant malarial and lets not forget the wormer……I feel like a sow being readied for market. Under the pressure, shamefully I folded. In every country sadly enough there are the “Haves” and “Have nots”. I am somewhere in the middle here with enough to buy things but little to buy and no resources to use what is bought making me a “Pseudo Have”. Deciding to become a temporary “Have”, I through my camo bag in my circa 1975 Hyundai (on loan) and drove to the lake where the 4 star resort hotel is located and laid down the plastic! I wanted a hot shower, warm food and a chance to lounge by the pool all day!

The hotel was really beautiful. As you drive in you first notice the grounds, a lot of it. It is isolated without competition from other monstrous hotels and knick knack shops that are the routine in most resort cities around the world. The landscape was impeccable with a combination of fantasy island meets golf course with the lake off in the distance and the grounds completed by two horses grazing about. There was a stereo typical Tike hut bar with an octagon shaped pool. Brilliantly colored flowers, all sizes and shapes, lined the walkways and the architecture was quite modern with giant angled columns finished in light mustard colored stucco. Up close the place was a bit run down. It had a faded sign out front, rust in the door frames and the halls inside were empty. Apparently it had been closed for years and only recently re-opened.

Literally the only person there, in the spirit of it all, I ordered a Pine Colada (yep took a risk on the ice thing but figured with the amount of antibiotics on board it would take a bacterium the size of a small child to grow) and laid out my towel by the pool….. sun blazing (for once no rain, as if even God new I’d had enough), a perfect light breeze and promptly burned myself to crisp tortilla! Yep in 2 hours time I had a sun burn that made me look as if I painted my self with pink nail polish. Ugh!

I stayed long enough to get cerviche and their version of filet mignon. The cerviche was excellent but I’m not really sure what part of the cow (if it was a cow) was in my filet but all in all it was pretty tasty stuff especially given my vegetarian diet of beans rice!

All in all it was a beautiful few hours with lots of time to ponder life and what meaning this whole experience has brought to my life. There was a surreal moment when I was standing out on the veranda overlooking the water, alone, with the sun setting, pouring a bright light across the land in front of me in stark contrast to the thick dark clouds folding in around the mountain peaks in the distance…..I felt peace and sadness simultaneously. A world so beautiful both because of its rough undeveloped crust and in spite of it. In time it too will be overdeveloped and sprawling taking on a new set of social problems and inequities. We fight one battle only to bring on a new one but that is the nature of progress. The people here don’t realize that and have a difficult time understanding the nature of our interventions, can’t help but wonder if they might actually be the wiser sometimes…..

Folded

After a very long night Friday due to nausea, bugs and bad dreams from something in the medical field we call poly-pharmacy (which in English jeans too dam many drugs). Three antibiotics, an antifungal, an ant malarial and lets not forget the wormer……I feel like a sow being readied for market. Under the pressure, shamefully I folded. In every country sadly enough there are the “Haves” and “Have nots”. I am somewhere in the middle here with enough to buy things but little to buy and no resources to use what is bought making me a “Pseudo Have”. Deciding to become a temporary “Have”, I through my camo bag in my circa 1975 Hyundai (on loan) and drove to the lake where the 4 star resort hotel is located and laid down the plastic! I wanted a hot shower, warm food and a chance to lounge by the pool all day!

The hotel was really beautiful. As you drive in you first notice the grounds, a lot of it. It is isolated without competition from other monstrous hotels and knick knack shops that are the routine in most resort cities around the world. The landscape was impeccable with a combination of fantasy island meets golf course with the lake off in the distance and the grounds completed by two horses grazing about. There was a stereo typical Tike hut bar with an octagon shaped pool. Brilliantly colored flowers, all sizes and shapes, lined the walkways and the architecture was quite modern with giant angled columns finished in light mustard colored stucco. Up close the place was a bit run down. It had a faded sign out front, rust in the door frames and the halls inside were empty. Apparently it had been closed for years and only recently re-opened.

Literally the only person there, in the spirit of it all, I ordered a Pine Colada (yep took a risk on the ice thing but figured with the amount of antibiotics on board it would take a bacterium the size of a small child to grow) and laid out my towel by the pool….. sun blazing (for once no rain, as if even God new I’d had enough), a perfect light breeze and promptly burned myself to crisp tortilla! Yep in 2 hours time I had a sun burn that made me look as if I painted my self with pink nail polish. Ugh!

I stayed long enough to get cerviche and their version of filet mignon. The cerviche was excellent but I’m not really sure what part of the cow (if it was a cow) was in my filet but all in all it was pretty tasty stuff especially given my vegetarian diet of beans rice!

All in all it was a beautiful few hours with lots of time to ponder life and what meaning this whole experience has brought to my life. There was a surreal moment when I was standing out on the veranda overlooking the water, alone, with the sun setting, pouring a bright light across the land in front of me in stark contrast to the thick dark clouds folding in around the mountain peaks in the distance…..I felt peace and sadness simultaneously. A world so beautiful both because of its rough undeveloped crust and in spite of it. In time it too will be overdeveloped and sprawling taking on a new set of social problems and inequities. We fight one battle only to bring on a new one but that is the nature of progress. The people here don’t realize that and have a difficult time understanding the nature of our interventions, can’t help but wonder if they might actually be the wiser sometimes…..

A Regular Medicine Day

Thankfully a run of the mill day! We had a little boy who cut off the tip of his finger with a saw (no plastic surge eons to argue with just good old fashion cleaning and dressing), then a drunk who fell over a bush..... face meets pavement, face looses, depression and teen pregnancy counseling. Sounds like Rochester:)

We also had a child with a psuedoseizure. Now this one is kind of interesting. A rebellious teenager who gets in a knife fight with one of the workers daughters, gets kicked off the plantation, travels 3 hours to grandma's but grandma won't have her so she returns to her mom's house (which is the back two rooms of the clinic we have been cleaning), tells her mom if she doesn't take her back she's going to kill her and oh by the way I'm not going to school either. She's 14. So why the pseudo seizure? Well the plantation owner said that the only way she could stay was if she worked on the grounds picking up garbage and she needed to apologize to all those she had threatened and attacked. So she through a fake seizure and a pretty good one at that, because she didn't want to clean. Everyone came running to get us yelling and screaming....quite dramatic. When we arrived she stopped shaking and just acted passed out. So we checked her over to be sure she wasn't really sick, she was still not responding so we got a big needle and syringe, said we would have to give her a shot to wake her up and she squinted open her eyes to see the needle and miraculously came to.

As for the little ones, we are concerned about our inability to keep them healthy. Their immune system is shot because of malnutrition and chronic parasites, complicated by the fact that we can't keep them warm and dry and someone keeps stealing their shoes (they sell them in town for cash). We have put up curtains, given numerous hygiene lectures, and played the role of Russian prison guard checking on the staff at each watch but the minute we turn our backs they go back to the same old routine. We can't change the building they are housed in and getting the kitchen to keep the flies off the food is purely insurmountable. We have a few cards left in our hands to play so I'll keep you posted.....

Into the Mountains

Feeling better steadily, still a little uncomfortable now and again. Am looking forward to even better days ahead.

Taking advantage of improved health, I pushed ahead and organized the trip up into the mountains for yesterday. Got up at the crack of dawn, snagged the 4 wheel drive pick up truck owned by the plantel and a couple of able bodies to help me load a few boxes of blankets into the back along with some stagnant clothes and old shoes. Given the delivery of new clothes from the Mormons last week (Wal-Mart a la cart) Jenny and I had gone through the children's clothes and collected some of the rattier things which I tossed on the truck as well. Felt a little bad giving out "triple hand me downs" but even if they used them for rags or stuffing for a bed mattress it would be more than they had before.

Now, Jenny has been feeling a little down since I became ill. She has realized that when I'm gone she will be here alone. As you can imagine it's extremely difficult to get things done solo around here. She's also concerned about her daughters education....quite frankly, there isn't any! Well, actually that's an over statement of a sad fact. They do have a school here but it is sporadic at best. Sometimes the kids go to school for only 1 or 2 hours and they send them home and the teachers have a bare minimum education themselves. For instance, Monday, Nana (Jenny's daughter) came home furious, she's 15. Apparently the teacher told her she spelled surgery wrong and the teacher made her write it 10 times in her note book the correct way. Sounds logical right? Well that's all well and fine but the teacher said it's spelled S..U..R..J..E..R..Y not s..u..r..G..e..r..y as Nana had spelled it. Given that her mom's a doctor she's probably got that one down pat wouldn't you think? but the teacher insisted she was wrong. When Nana pulled out her dictionary to disprove the teacher's allegations, the teacher stated "well that's a different kind of surgery" and moved on. All this said Jenny decided not to go to the mountains with me so she could straighten out some things at home.

I was uncomfortable going alone with only a driver but, so be it, figured it would work out in the end. Miraculously at the last minute the daughter of the plantation owner (who speaks English and had nurse training) radioed that she would like to come. Perfect! So, off we went with our blankets, clothes, wormer, vitamins and few medical supplies I through in my camo bag, just in case.

It took about an hour to climb up the winding dirt road that had huge gullies in it from the torrential rains we've been having. It was a beautiful day. I was grateful because the truck was an open bed and 40 wet wool blankets wouldn't do anyone much good ( not to mention that I had to ride in the back). As we went up in elevation the terrain changed only slightly but there were several coffee plantations and the vegetation was more stunted.

We drove through several villages each a little poorer than the one before. You might say a hut is a hut, but I have learned in fact, that is not the case. Some huts have the boards super tight and the roof is raised slightly up off of the top of the wooden walls allowing the smoke to escape from the oven ( I use the term oven generously, it is anything from an open pit fire to a slick little contraption of stone and metal sheeting that is elevated on concrete blocks and holds a wood fire). Other huts have the roof smack tight on the walls and there is no oven just a fire pit outside. A really nice hut might have separate rooms or an attached over hang that allows them to eat outside protected from the rain. Some have a shotty little outhouse. The less fortunate resort to the woods or the rivers and streams as a latrine. I also learned about bathing along the way. There are three, well four options. The fist of course is indoor plumbing. The second is interesting, as you climb the mountain there are veins of water streaming down that they can stick a pipe into and get fresh mountain water to bubble out, then using a burlap sack they make a two sided shower curtain for added privacy. The third way is just to use the toilet water ie. streams and rivers or the fourth way which is not bath at all.

Although in writing this I sound a bit flip, actually, I was really impressed with the resourcefulness they showed. They have minimum to no education and no resources. They essentially spend their entire life camping. Also worth a comment is the difference between residents of Pina Blanca and the mountain folks.....overall cleanliness was much better in the mountains. They were more poor but more proud. What they had was neat and orderly. There was less trash and above all else....they were happy. In Pina Blanca the conditions are crowded and dirty. There is no ownership and they have just enough education to make them miserable.

Our destination was a small three building school which encompassed all ages. The orphanage tries to reach this destination 2 times a year to administer wormer and vitamin A. We were eagerly greeted by about 15 kids all less than six years old, and 2 school teachers. We quickly realized there was no water for the kid's to take the meds and we had no containers to put them in to take home....oops! Luckily I had duct tape! We had the kids line up along the truck each with a little piece of paper from their school note book into which we folded the medicine they would need to take over the next three days and we duct taped it shut (now,... we all know of 102 ways! to use duct tape).

As we were giving out the medicine I began noticing all of the rashes, boils and odors of illness the children had. I began to worry because I brought a few extra meds but not a ton. My mission was blankets and wormer not mobile clinic. I just couldn't ignore all these things, or could I? Soon many of the residents of the area got wind we were here and flocked to the truck. One of the teachers was instrumental in quickly making a list of the neediest families. We gave them the blankets first. At the same time I started using what little supplies I had brought to treat the kids first and then the adults. My camo back pack contained alcohol, bandages, a few scalpels some ointments, pain meds and antibiotics. One by one I treated them until the last little girl, with diarrhea so bad it was caked on her legs had approached the truck. She needed medicine for amoebic dysentery which I didn't have. So we through her on the back of the truck and headed for her house. It was a well kept little hut just off the road. Her mother was apprehensive as we explained her child's needs and our lack of supplies. We wanted to take her with us but she wanted no part of that. We tried everything and offered to pay for their way back home which was her main concern, but still no. Not knowing what else to do we gave her some instructions on hydration and left promising that if she would come with the workers to Pina Blanca in the morning we would find a way to get her home. It was unsettling. Death is always an option for these little ones.

After that ordeal we started through "town" the kids all running behind the truck. We trudged up long trails to little huts here and there that were off the beaten path to deliver jackets and the remaining few blankets.

One particular hut we were urged into. As you walked in the door it reeked of rotten flesh. In the corner lay a man all of about 4 feet tall and wasted. He was feverish but cognizant. His mother was anxious and rapidly telling his story. They spoke of boil that started about a year ago the size of grape. They were seen in San Pedro at the free hospital. He was given a script for medicine and a follow-up appointment. Neither of which they could afford and so he went untreated. The woman explained that they scrape for food (which was obvious by her stature)and although she felt horrible they had had no other choice. Her husband had been ill (we soon discovered he'd had a stroke)and wasn't able to work in the field so they were basically starving. Honestly, I dreaded pulling back the sheets to see what lay beneath, but there was no one else, so I did. The boy had a growth (a tumor of some sort), not a boil, that was about the size of my hand and inch thick extending from his groin. It was pus covered and rotten. The sickening feeling of helpless overwhelmed me. Unfortunately it would not be the last before nightfall. Obviously we didn't have what this guy needed but we did have cash. So we gave them some cash and arranged to get both he and his sister to San Pedro to the hospital for palliative treatment. When I left I was fearful they may use the money for food instead but at least they now had options which they had been lacking most.

On to a few more homes and then we were brought to a building in the center of town. In this building was an old woman with weathered skin and urgency in her voice. She wanted us to see her husband. We gladly agreed and she rushed out back to get him. As came through the door my heart sunk yet again. He too had weathered skin and moved slowly under the weight of arthritis. His belly distended as if were 8 months pregnant and his eyes a dull burning yellow. He smiled as if I were a long lost granddaughter and reached for my hand, trembling. I had been down this road before...in Bolivia my colleague and I were presented with the same situation...a man with end stage liver failure of one form or another. I remember my colleague being sort of cold when he told this man's family he was dying. It bothered me and I questioned why at that time but now realize that there is switch inside of you that trips when the load is too heavy to bear and you become disconnected. My switch was tripping....I tried desperately not to let it happen. Anita, the plantation owner's daughter saw that it was a difficult moment for me and she distracted us briefly by ushering out some of the children who had gathered. In the States end of life issue happen all the time, I've been trained in handling them and am about as comfortable with it as one can be. But in the states you can easily say "we've run all the tests, tried all the best medications and this is where things stand", but here I've tried nothing and not performed a single test. What if I'm wrong? He'd been to San Pedro already months back and they sent him out with water pills and no explanation. Compounding my anxiety, I had to have the conversation through a translator. As the conversation started, he seemed to already know from the tone of my voice and the way he was feeling what I was about to say. As I told him there was no medicine that could help him he interrupted with a smile and said "yes there is, it comes in the form of small squares of ground, that will cure everything" then he chuckled and we prayed aloud together in Spanish with his wife looking on....

PS: The little girl with diarrhea made it to the orphanage this morning:)