Give me a V-A-C-C-I-N-E!

Hello! I’m writing today to tell you about our exciting vaccine workshop we just presented on Thursday. This is the first workshop where I’ve been left in charge of big chunks of the preparation and presentation of the material, so I’m particularly proud of it. (And now I also better appreciate the work that goes into giving a training workshop!) So now, I am pleased to present: The Birth of a Community Health Initiative.

First of all, remember in August and September when I described doing a door-to-door health census and making a map of Villa Faro to inform our newly-trained community health promoters there? Well, since then, these promoters have been visiting neighbors’ houses, checking on the sick and educating the well. We have presented workshops on potable water, HIV/STD’s, dehydration and diarrhea, respiratory illness, women’s health, and other topics. We’ve visited each promoter every other month or so to ask how visits are going and to sometimes accompany them. Overall, the Villa Faro Health Promotion program is in full swing and doing well.

But about three weeks ago it came time to think about giving the vaccine training workshop. We realized that our materials – our manual, posters, etc. – were out of date, and that we’d have to start from scratch in designing the workshop. Somehow the task of compiling a new manual fell to me, and I was left to sort through the government's public health nurse training manual, our old manual, and a medical dictionary…. all in Spanish, of course. I decided what from the public health manual was important to include and what was too technical; I updated the information in our old manual to include the new vaccines available and the new schemes in use; and I distilled the medical dictionary entries on each illness to give a basic overview of exactly what these vaccines are preventing. After I typed it up and the other two members of the team checked it, we were left with a simple, clear, 23-page manual on the importance of vaccines, how they work, special considerations, administration scheme, the preventable illnesses, and how to approach a family about vaccines and verify the children’s vaccine records. Our medical director added images, a cover page, and brought it back from the printer’s bound in shiny plastic and ready to go! Yes!


Then we decided to base our presentation on the manual, using the same topic order. We split the manual into four sections and each of us was responsible for organizing and presenting our chunk. Channeling middle school, I made a big chart showing all the vaccine information together for the presentation:
That poster earned me much admiration from the team and before I knew it I was making everyone’s posters, tracing pictures of babies, coloring with crayons, and block-printing definitions and lists. (Kids here don’t get much practice/play with construction paper, markers, rulers, and glue in school, so everyone is consistently impressed with my ability to print and color. It’s a reminder of the privilege I had even in elementary school – how sad that children miss out on that.)

The night before the presentation, I stood in front of the mirror and practiced my five-minute chunk over and over. It went something like this: Ah! I forgot the indirect object pronoun! My tongue catches on double “r” sounds! I can’t say “domiciliaria” and sound like a human! Ah! Ah! I could hardly sleep I was so nervous. In retrospect, it’s pretty funny. After years of presentations and performances, memorization and improvisation, I flip out over five minutes of common sense and spend an evening staring at my flip-flopping tongue in the mirror. Haha!

But the next day, I felt ready and excited. The day of passing out my lovely manual, showing off the beautiful posters, and doing my first chunk of group training in Spanish had arrived! My chunk was last, so I took pictures, prepared the snack, and helped with small-group activities until then.

In small groups, promoters brainstormed common reasons parents give for not vaccinating their children. These can include:

• The last vaccine made my baby sick and gave him a fever, so we’re not going again.
• All vaccines cause allergic reactions.
• Grandma and I were never vaccinated and we’re still around, so why should I vaccinate my baby?
• My baby has/had a cold/fever/spots in his mouth/diarrhea/etc.
• It’s been too long since his last vaccine, so we shouldn’t finish them.

Groups presented their ideas and we talked about ways to address these concerns, and clarified questions about contraindications to vaccines. Did you know that a baby can be vaccinated even if he is sick, is taking medicine, is recuperating, is malnourished, has allergies, or is very behind on the vaccination scheme? Many people in our workshop didn’t.

During the afternoon, promoters learned vaccination methods, practiced reading various hypothetical vaccine records and identifying missing vaccines, and enjoyed a break:

Ten minutes before our scheduled ending time, it was my turn to present. I stood up and talked about how to interact with families during a home visit about vaccines. My favorite part, where I got to do some acting, was showing that it’s better to encourage rather than criticize. For example, it’s not a good idea to say: “Look! Your child is missing vaccines! You’re a terrible mother!!” (Here, the audience graciously chuckled – score one for Kate!) Rather, it’s better to say: “OK, here is evidence of part of the scheme; let’s talk about your plan for completing it.” I also emphasized that every home visit, whether it’s just a check-in or a requested visit to assess an illness, is a chance to talk about vaccines or to check a child’s vaccination record. When I asked at the end if everyone had understood me, they all smiled in an encouraging way and said, “Yes!” Wahoo!

We thanked people for coming, packed up the jeep, and headed back to the clinic. That evening, I reflected on all the hard work I’d put in to the presentation, and thought about all the work the rest of the team had done, delivering invitations, reserving the church space, organizing activities and buying supplies, and doing the majority of the presenting, in addition to all their regular clinic duties. Truly, I am so proud to be a part of this capable and dedicated team.

Next, we will start training promoters in new communities to follow the path of the Villa Faro group. We are currently gathering volunteers, doing our preliminary census, and making maps, but soon the program will begin in two new communities. And I’ve already been assigned a big chunk of the next presentation, most likely on how to be a health promoter. Here we go again!

I hope everyone had a peaceful Easter. Enjoy spring, and if you see a crocus, please say hello for me!

A Whirlwind Week

Hello! After some time away from the internet, I’m back and vowing to post more regularly.

I’ve just moved back to San Pedro and am finally moved in and into full swing in the HIV unit and with the community health team. Before the move, I was working in the rural town of Santana Bani (about two and a half hours away) preparing for and then translating for a visiting short-term medical team from western North Carolina. No amount of words can describe the experience, but I’ll give it my best shot and throw in some pictures for flavor.

Part I of my work, preparing for the team, proved a bigger job than I’d anticipated. I started simply by making nametags in Spanish for the Americans: Jim became Jaime, Ray à Raymundo, Joan à Joana, etc. In the days that followed I worked with two others to plan the clinic flow through the church and school building available to us: waiting room to intake to waiting room to exam room to pharmacy to parasite station to exit. We trained community volunteers, picked up meds, strung up sheets for examination areas, made signs, scrubbed bathrooms, and had countless conversations with willing and wonderful locals on how to ensure water, electricity, and working fans and toilets. Lesson learned: Always make friends with security guards and maintenance people.

Part II began when the team arrived to provide four days of free medical care. We had an ophthalmologist, three doctors doing general medicine, one physician’s assistant, one nurse practitioner, one paramedic, two nurses, a med student, a marketing analyst, a priest, a dance teacher, and an organist. Phew. Only two or three of those spoke Spanish, so I spent most of each day jumping from room to room translating. (I snuck some picture-taking in too.)

We saw about 180 patients each day and there still wasn’t time to see everyone. Our “waiting room” in the church sanctuary was full most of the time, as families gave their medical history to a volunteer or waited to be weighed.

These three kids waited patiently all morning - when I took this picture – but by the time I was translating for them and Mom at 11:30 they could no longer curb their curiosity over tongue depressors and stethoscopes. My pictures of them then all turned out blurry with movement, though I had a great time during that session.

We did exam after exam, until some things became so common the providers turned over explanation to me. Kate, please find out what they’re eating and do The Diet Spiel… Could you please do the Diabetic Foot Care Explanation? …. I need a Scabies Cream Tutorial over here! etc. OK, so maybe they didn’t use those exact words, but pretty close! In truth, I was lucky to be with a team of experienced providers who were excited to teach me new skills and talk through their diagnostic approach with me. For every patient I helped, I was helped in return, since everyone was willing to let me take a second listen to the lungs, watch an exam, or re-palpate a lymph node. A big thanks to all our providers and patients!

On February 27th, in the middle of our clinic week, the country celebrated Independence Day, so we spent the day watching parades and hanging out with the neighborhood folks.

I inadvertently ended up part of the parade, marching and waving a flag, and got a good view of family onlookers:


Now that the hubbub is over, reflections are starting to percolate through my brain. I can’t get over the huge amount of preventable or easily treatable illness, left un-checked, that we encountered every day. I saw adult after adult with hypertension and/or diabetes, and all the heart/foot/eye/body problems that go with them. I saw child after child with iron-deficient anemia and skin/digestive tract parasites. And then facing our own limitations to help as a short-term group: It’s hard to provide the necessary follow-up care for these chronic conditions. And what does it mean to give every child anti-parasite treatment when they’ll be back playing in the contaminated dirt and water next week?

When your advice is to drink less Coke, but drinkable water costs as much or more…. When you recommend monthly doctor check-ups but the nearest free clinic is often un-manned or out of meds…. When your instructions are to stay out of the dirt, but there’s nowhere else to play…. How can you help?

Sometimes I am overwhelmed by the incredible need in this country. The short-term clinic and my work here in San Pedro provide wonderful ways to concretely help people in these communities, even when it is the service of simply being with the people. Every time a child gets an iron supplement, a parent physical therapy, or an infant a vaccine, it is an important contribution. But I can’t help but feel the pull for infrastructural change, for running water, clean streets, health education, sewage systems, etc. These are big issues in a big picture, and I don’t have the background or skills to fairly address them, but I think it´s worth thinking about.

But for now I´ll close with a lighter anecdote: On Independence Day, after a morning of watching and marching in parades, two of us settled down under a tree with books. Suddenly I heard the clanging of spoons on pots and pans and turned to see about fifteen kids in all type of dress – though most with their underwear on their heads – yelling and marching our way. They swarmed around us jumping and laughing and yelling something about chicken, celebrating Independence and a day off school in their own unique way. Pretty soon, as spoons were dropped and participants´ underwear-hats became askew, we were all in hysterics. And then just as quickly, the kids waved and went back the way they came. Interactions like that, where language isn´t necessary and everyone is having a good time, are simply some of the most enjoyable. I still smile to think of Santana Bani´s Impromptu Parade.

That´s it for now, though there´s more on the way! Happy March, and have a great weekend!

Faces of Santana Bani

....I´m on a portrait-kick.