Monday, October 27, 2014

Vacation at the Family Support Center!

The last month at the Family Support Center has been focused on preparing the children and youth for the end of the school year exams. This has meant a lot of reading, homework help, and working on multiplication tables. School is now out for most of the FSC participants and we have a lot to look forward to during vacation.

To kick off the end of the school year, we hosted a Halloween party on Friday, October 31st. In the week leading up to the fiesta we began making kites at the FSC as a way to celebrate the festivities surrounding Day of the Dead and All Saint's Day. Throughout the holiday weekend, families throughout Central America gathered in cemeteries to honor the dead. The kites, or barriletes, are thought to carry messages up to the spirits in heaven.

Intense kite making

We also have some big plans for our little garden at the Family Support Center! The other week we all spent some time outside weeding. With hands and tools we have begun to dig out the weeds that have sprung up among our remaining onions and chard during the rainy season. We're thinking about planting another round of fast-growing radishes as well.

Weeding the chard

Post-weeding chard

Since the produce from the garden is used to supplement food costs at the Family Support Center, we plan to take full advantage of the remaining wet soil from the rainy season in order to plant and harvest even more vegetables!

We also started teaching classes in Math, English, and K'iche', so that FSC participants are able to brush up on their skills during vacation. Amy, Adam, Lily, and Emma teach math and English classes, while Santos teaches K'iche'.

Emma's math class

Emma's math class

Amy's attempt at an outdoor math class

Other fun activities that we will be continuing from last year include Olympics, water games, and hikes around the valley! Stay tuned!

Thursday, October 23, 2014

Timmy Global Health and Pop Wuj Medical Brigade: October 13-17, 2014

Text by Emma Gilbert
Photos by Jeff Leventhal

Even though I was warned about what a hectic week it would be, I don't think I could have imagined how much hard work goes into planning a Timmy Global Health brigade. Starting my first week at Pop Wuj, we talked about what we would need for the week—20 translators, 15 loaves of bread, and lots of energy! 

Day 2, Xeabaj II: Timmy Global Health volunteers and volunteer translators from Chiriquiac, Cantel.
Day 2, Xeabaj II:  Volunteer translators from the Chiriquiac scholarship group.
During the week we would visit five different communities. Some were close and familiar, such as Llanos del Pinal and then here in Xela. Others were much more remote, such as Pujujil in the Sololá department.

Day 2, Xeabaj II: Lining up for registration

Day 2, Xeabaj II: Registration Line

Day 4, Buena Vista

Day 4, Buena Vista: Pop Wuj Social Work Spanish student, Michael, helping take patient histories

Although the communities were very different from each other, the one common factor found in all was a great need for healthcare. For many, Timmy brigades are the only option for accessible and affordable health services. As a translator, I was privileged to speak with a lot of different people and I noticed that a frequent topic of conversation was how people depend on Timmy to get critical medicines for chronic illnesses such as diabetes, hypertension, and gastritis. Oftentimes, these medicines are beyond financial reach for families struggling with multiple illnesses.

Day 4, Buena Vista

Day 4, Buena Vista

Day 2, Xeabaj II:  Pharmacy
Something else that I noticed throughout the week was that patients were equally grateful for the medicine as they were for someone who would listen to their concerns. More than a few times, patients would ask me to thank the doctor for providing them with such personalized attention and care. 

Day 4, Buena Vista:  Carmen, Pop Wuj's Director of Social Projects,
completing an intake interview for chronic and referral patients.

A major takeaway for me was the social care that the Timmy brigade is capable of providing. As translators, doctors, students, and volunteers, we were working to serve the patients in a comprehensive way that would fill their physical and emotional needs. It was especially cool to see repeat patients come in and tell the doctors that their new medicines from the past brigade had been working well. Other highlights include giving a hopeful mom the news that she was pregnant, and telling a man with chronic headaches that his new glasses had arrived from Xela!
Day 5, Pop Wuj Clinic, Xela

Day 5, Pop Wuj Clinic, Xela
Overall, I am grateful to have worked with a group that recognized their responsibility to provide care to patients, regardless of nationality, economic status, or social background. This brigade saw over 400 patients and I hope that the next brigade in January will be able to do the same!  Thanks Timmy Global Health and the University of Cincinnati!

Tuesday, October 21, 2014

The Sound of Music at the Family Support Center

Almost every day before snack time at the Family Support Center, five-year-old Oscar enlightens us with his multifaceted musical talents, whether it be a rendition of Justin Bieber’s “Baby” or freestyle beat-boxing. Back in Xela, one of Pop Wuj’s social work students is often found on the roof after class playing guitar and singing. This seemed like a match made in heaven and got the ball rolling for a music activity for celebrate El Día del Niño, or International Day of the Child.

Michael, on the roof of Pop Wuj
Every Thursday afternoon students from Pop Wuj visit the Family Support Center. Although there has been a lot of emphasis on homework help in the final weeks of school before exams, we’ve managed to make time for some fun as well.  Music day ended up being the perfect way to take a break from studying, for the Pop Wuj students and Family Support Center children alike.

The wonderful and talented Michael came out to Llanos del Pinal with his guitar, ready to sing with the kids and teach them a little bit about rhythm and harmony. With the help of another Pop Wuj student, Johanne, they were able to break the kids up into four different groups, each of which was responsible for a particular sound.

Johanne, writing lyrics for the kids

The Center was filled with a symphony of sound and laughter. We ended the afternoon with a lovely performance from Michael and promises to renew the music activities during vacation!

Volunteers, heading back to Xela

Friday, October 17, 2014

Education and Healthcare--Together Again in Chirijquiac!

Qué:  Reunión de becados y clínica móvil
Dónde: Chirijquiac, Cantel, 100% K’iche’ Maya
Fecha: Miércoles 8 de octubre

Scholarship Meeting and mobile clinic in Chirijquiac, Cantel , a 100% K’iche’ Maya community, on Wednesday October, 8, 2014.

Pop Wuj Medical Spanish student, Elizabeth, in triage.
The mobile clinic included two Pop Wuj MedicalSpanish students, one a first family medicine resident from Chicago and a 4th year medical student from Arkansas.  Pop Wuj’s staff doctors, Carmen Rosa and Barbara as well as staff nurse, Luby also traveled with Pop Wuj to the rural area.  Pop Wuj’s coordinator, Amy, also participated as a medical translator.

The waiting room

The clinic saw 24 patients—mostly adult women with some children and teenagers, some seniors, and some scholarship family members.  

Dr. Barbara in a pediatric consult
While patients were being seen, Carmencita, the Pop Wuj Social Work Program and Social Programs director, and Amy conducted the scholarship meeting.  We discussed the end of the school year which is fast approaching, and the extra effort that is often required for our scholarship students to pass all of their classes.  Sadly, it's common in Guatemala and in our target communities for students to fail courses throughout the year, but this is no reason to quit and give up.  Most students are able to make up work or go to “recovery classes” (similar to summer school in the U.S.).  

Scholarship meeting
Pop Wuj has maintained a scholarship program in this community for over 20 years.  Our work requires the collaboration of the scholarship students, their families, Pop Wuj staff and volunteers, as well as the padrinos and madrinas (scholarship sponsors) who support the project and their individual students year after year.  Currently we have thirteen scholarship students in this community, ranging from preschool to last year of high school.

Scholarship meeting
At the close of the scholarship meeting, we asked for volunteers to be our K’iche’-Spanish translators for a large mobile clinic that we were planning for the following week.  The mothers and some fathers who participate regularly in the scholarship meeting often travel with us and translate when we have a mobile clinic in Xeabaj, a nearly monolingual K'iche' community.  Seven of the community members volunteered to translate for us!

Pop Wuj’s social work team will return to Chirijquiac in mid November to collect and review final report cards.  All of the students are expected to be finished with classes by then and will be able to attend the meeting with their parents.  

Monday, October 13, 2014

Nutrition Mornings!

By Emma Gilbert with photos by Carmen Benitez

My day started out a little earlier than usual—around 6:30am. I had my first nutrition meeting scheduled so I needed to be at the school by 7:30. After loading the bus full of supplies and 11 people, we headed out to Buena Vista to the midwifery clinic where we would set up for nutrition. 

Upon arrival, we quickly set up and started playing with the babies on the play mats. The classical music was an awesome touch, and Carmen Rosa explained to the large group of moms how important is for their babies to have auditory and visual stimulation.

After wrangling a few kids who were trying to break free out the front door or up the staircase, I gave a presentation on the dangers of lead poisoning with Elizabeth and Brianna, current Pop Wuj students. The moms were a little distracted with so many babies in the room, but they paid attention and seemed to understand how dangerous lead can be. 

During my research for the presentation, I was shocked to learn that some paint brands here still contain lead! Through the presentation we hoped to give the women ways to minimize the risk, for example by cleaning the walls and floors with a damp cloth.

The screaming began when the measuring and weighing started, and it was total chaos. At that point I retreated to the hall to help Elizabeth distribute the vitamins, Nutributter, and other items for the women. While we waited for the women to come through, we entertained one of the older boys, who had come along with his infant brother, by playing a variation of soccer and handball in the hallway. Even though he only knew about 10 words in Spanish, we got some laughs out of him which was pretty fun.

After we had finished distributing the vitamins and Nutributter to the women, we quickly packed up and headed home, returning to Pop Wuj around 1pm. It was a tiring morning, but one of the most fun days I’ve had on a project site!

Monday, October 6, 2014

First Impressions of the Pop Wuj Clinic

By Emma Gilbert, General Projects Coordinator

My first day at the clinic was last Tuesday, where I got to know the doctors and medical students that are working there. I was greeted by Isabel who does the initial registration of all patients. Look at that smiling face!

Isabel, the Pop Wuj Secretary

Although I have little background in medicine, I was able to help with patient intake by recording the answers for the two Guatemalan high school interns. Although they definitely (and normally do) get along without this kind of help, it was great to get to meet some of the community members that the clinic serves. I was not surprised that many of the illnesses are chronic, such as stomach issues like ulcers, or diabetes. These issues are manageable, but without the proper medications and check ups at the clinic, many of the patients would experience much worse symptoms.

After a few hours of patient intake, a 4th year med student named Esther from Tulane began her consults with patients. Admittedly, I did take a little coffee break before we started! The Guatemalan doctors really push through all consults without stopping, which is so impressive. 

When I went back down to the clinic, I sat in on the consults, along with another med student named Elizabeth, who will begin her own consults in the coming weeks. Esther’s Spanish is more advanced so there was little need for translation. It  was so fun to see how well she could communicate with everyone and I loved how the other doctors worked with her to teach, diagnosis, and treat the patients.

In the coming weeks I’ll be in the clinic more often to help Elizabeth with translation in the consults, and in a few weeks we will all be pitching in to help with the Timmy Global Health brigade that is coming down. We can't wait!

Luby, the Pop Wuj nurse, in the pharmacy

Friday, October 3, 2014

Christian's Pop Wuj Medical Program Experience, Part 4 of 4

Christian Ngo was a 4th year medical student at the State University of New York, Downstate Medical Center when he participated in the Pop Wuj Medical Spanish Program in the spring of 2014. He is now a first year internal medicine resident in Dallas at UT Southwestern. Thank you Christian for sharing your insights with the Pop Wuj blog!

Christian and Becky, sorting medications in the Pop Wuj pharmacy

Resource Management and Sustainability of NGO Clinics
Every clinic that serves the underserved must deal with resource management. However, in the hospital setting this resource management calculus occurs far away from the provider and is typically secondary in my mind when seeing and treating patients. However, working in the Pop Wuj clinic, the primacy of resource management issues became apparent. Because I participated in the elective during a peak season for medical students, the clinic was able to see twice as many patients as usual. The clinic typically receives the medications that it dispenses to its patients through Timmy Global Health approximately every 2-3 months. However, because the clinic was able to serve more patients, the supplies for the pharmacy began to run low. 

Running low on certain medications meant multiple things as someone working in the clinic. First, some patients would have to be transitioned to equivalent medications (e.g. from lisinopril to enalapril) dependent on the availability of stock in the pharmacy. In addition, we had to make decisions on how many pills to dispense to patients based upon the amount of medication left in the pharmacy. This raised issues of who should receive the full typical dispensement and who could be given fewer. In working with my panel of patients, I preferred to give the full number of pill to patients who lived very far away and were unable to return to the clinic easily. In addition, for patients who expressed that they typically purchased the medications themselves, I would usually provide a month’s supply rather than the usual two months as this indicated to me that they were more financially able to bear the burden of pay for medications themselves. I was left wondering what the best option in these situations is and I was reminded of how complicated maintaining a physician’s duty to justice and equity are in medicine today.

Final Thoughts
I am extremely grateful for the opportunity to participate in a rotation with the Pop Wuj clinic. Not only was I able to get a glimpse of what it is like to practice in the developing world but I also met a number of fantastic colleagues from all over the world who are also interested in global health. In addition, I was able to hone my proficiency in Spanish, a skill that I am sure will be useful going forward in my career.

Looking back on my experience in Xela, I realize how the global and the local are extremely interrelated. What makes global health experiences different is that constraints on resources and cultural factors make the issues we face here in the United States even more pressing when treating patients in the developing world. As I enter residency, I am very appreciative of how this experience will make me much more cognizant of the difference between what I believe my patients understand and what they actually understand. In addition, my weeks in Xela have brought up deeper questions about how to best engage male patients in health care and what the commonalities are across developing countries and how these commonalities can be utilized as leverage to improve health outcomes.

My deepest thanks go to Drs. Pascal Imperato and Denise Bruno, without whose guidance and support this project would not have been possible. In addition, I would like to thank the Alumni Fund of the College of Medicine whose generous contributions make life-changing experiences like these projects possible for students. Finally, I would like to thank Ms. Lois Hahn, whose kindness and tireless work for the students in this elective are unparalleled.

Christian's Pop Wuj Medical Program Experience, Part 3 of 4

Christian Ngo was a 4th year medical student at the State University of New York, Downstate Medical Center when he participated in the Pop Wuj Medical Spanish Program in the spring of 2014. He is now a first year internal medicine resident in Dallas at UT Southwestern.  Thank you Christian for sharing your insights with the Pop Wuj blog!

The Gendered Experience of Health
As I mentioned earlier, machismo culture is very prevalent throughout Guatemala. This culture of machismo affected the way in which both men and women interacted with the health care system. A majority of the visitors to the clinic were women and children. Many of these women were well aware of the chronic conditions that they had – GERD, amebiasis, diabetes, hypertension, and hyperlipidemia. A majority of these women had come to the clinic because they had either run out of the medications that had been prescribed to them previously or they had a minor acute illness for which they wanted to be seen by a doctor.

This was in stark contrast to the few men who I treated in the clinic. They would typically come in after several days of chest pain or a severe acute change in their health status. A good number of the men who presented to the clinic were in hypertensive urgency or had serum glucose levels in the unreadable range by finger stick glucometer. In my short time with the clinic, the majority of the cases which had to be referred directly to the hospital were men.

In reflecting on why this happened, I realized that this was not far off from my own experiences with health care in the United States. In my outpatient rotations, many of the men whom I treated only presented after strong coaxing from their spouses or after they had had a frightening symptom. On the other hand, women were more likely to present for routine care. It is clear that there need to be efforts to improve the way health care professionals engage men in the maintenance of their health both at a local and at a global level.

Another interesting aspect of working in Xela was the intersectionality of gender, language, and age. For many of the geriatric female patients who came from outlying areas of Xela, Spanish was a second or third language. These patients spoke only Mam, K’iche’, or other Mayan language. In these situations, husbands or sons would typically act as translators for the patients as there were no translators who worked at the clinic.[1]  This represented another significant barrier to treatment and left me wondering if the patient fully understood what was being explained to them.

In addition to barriers in spoken language, I also encountered a high rate of illiteracy, particularly amongst older women and women who we saw on mobile clinics. This presented problems when dispensing medications and giving instructions on how to take medications. In these situations, I would indicate the ways to take the medication and how many to take pictographically. In addition, I would be sure to ask if there was someone in the patient’s home who was literate and able to help them with their medications. However, when I first started at the clinic, I did not know to ask if the patient was able to read. It was only after another student mentioned that one of his patients was illiterate did I make this a standard part of my patient encounter. This experience has made me wonder how well our patients in the United States understand how to take their medications and if literacy might be an issue that we as medical providers are unaware of.

[1] Pop Wuj provides translators during mobile clinics in the more isolated, rural areas, however not in the Xela clinic where the patient population speaks Spanish.

Thursday, October 2, 2014

Christian's Pop Wuj Medical Program Experience, Part 2 of 4

Christian Ngo was a 4th year medical student at the State University of New York, Downstate Medical Center when he participated in the Pop Wuj Medical Spanish Program in the spring of 2014. He is now a first year internal medicine resident in Dallas at UT Southwestern.  Thank you Christian for sharing your insights with the Pop Wuj blog!

Framing My Experience
One of the first things that struck me when I arrived in Guatemala was how similar it was to the Philippines. I have been to the Philippines many times and been involved in a global health project there as well. The social structure of the two countries was extremely similar. The strong family structures that I saw in Guatemala were the same ones that I remembered from the Philippines. There was also a strong culture of machismo amongst both the indigenous and non-indigenous populations. This machismo had several interesting implications which I will discuss later. Furthermore, the socioeconomic situation of Guatemala is very similar to that of the Philippines insofar as a large proportion of the population works as international laborers and support their families in Guatemala through money remittances. Rapid development and its effect on the environmental health of the population was also another theme from the Philippines that I saw echoed in my experiences in Guatemala. In particular, the export of old discarded machinery from the developed world to Guatemala was very prevalent.

The similarities between Guatemala and the Philippines raised the question in my mind of whether this development experience was one shared amongst all developing countries or whether these similarities arose from the common experience of Spanish colonialism – or perhaps colonialism in general. Certainly, I can see the strong influence of Spanish culture in the development of machismo within both of these countries. However, I feel like my rotation in Guatemala raised more questions about the ways in which these systems and circumstances which are intricately intertwined with the health status of the population arose and what social and political forces have created such similar environments.

In the Clinic
Having worked in the developing world before, I am acutely aware of the imbalance between what is gained by a student from an abroad experience and what is gained by the community. Providing appropriate care is extremely dependent on an intimate knowledge of not only the endemic pathology within an area but also the cultural context and social norms that allow for patients to feel comfortable enough to engage the provider as a partner in their care. This problem is only exacerbated in situations where there is a language barrier between the patient and the provider. These barriers to optimal care arise not only in the international setting but when practicing locally where physicians are being asked to take care of an increasingly linguistically and culturally diverse population.

The Pop Wuj program addresses these problems by providing both targeted language instruction and a series of lectures on cultural issues that commonly arise in the clinic. In doing so, I believe that both students and patients had a better experience once they met in the clinic.

Christian with Pop Wuj staff doctors, Dr. Carmen Rosa and Dr. Sammy
As a student in the mobile and main clinic, I performed three different main tasks. The first of these was to triage patients. I would take patients vitals and identify what the main reason for coming to the clinic was. In addition to vitals, if I believed a patient needed a point-of-care laboratory drawn (e.g. urinalysis or finger stick blood glucose), I would also obtain these tests so that the results would be available to the teams working in the clinic rooms.

The second main task was performing clinic encounters with patients who had been previously triaged. In teams of two students, I would review patient’s charts, interview patients, perform physical exams and develop a plan to be presented to the Guatemalan physician. After presenting the patient, the Guatemalan physician would review my plan and offer any changes she thought to be necessary. Then, we would see the patient together and I would explain the plan to the patient, instruct the patient on referrals, and provide any lifestyle counseling that was necessary.

The third main task in the clinic was working in the pharmacy. This involved mixing solutions and counting pills to be distributed to patients. In addition, when giving the medications to the patients, I would explain the manner in which the medication was to be taken and any side effects and alarm signs that are associated with the prescriptions.

In addition to the roles that I took on at clinics, I also participated in an educational session at one of the nutrition screenings. Students rotated between doing growth checks and providing the educational talk on that day. I, along with a few other students, spoke with the mothers attending the screening about family planning methods, the availability of both barrier contraception and hormonal contraception at various health clinics including our own, and the benefits of birth spacing.

Christian's Pop Wuj Medical Program Experience, Part 1 of 4

Christian Ngo was a 4th year medical student at the State University of New York, Downstate Medical Center when he participated in the Pop Wuj Medical Spanish Program in the spring of 2014. He is now a first year internal medicine resident in Dallas at UT Southwestern.  Thank you Christian for sharing your insights with the Pop Wuj blog!

Contextualizing the Pop Wuj Clinic
I traveled to Quetzaltenango, Guatemala and participated in the medical program of Pop Wuj clinic for six weeks. Guatemala has a population of approximately 15 million people. The population of Guatemala is extremely diverse with 25 different ethnic subgroups typically recognized as comprising the native Guatemalan population. Twenty-two of these ethnic subgroups are considered to be culturally Mayan. The other ethnic subgroups are the Garifuna, a population along the Caribbean coast of Guatemala descended from West African and Central African groups, the Xinka, a non-Mayan indigenous Guatemalan group, and the mestizo, descendants of the Spanish and Mayan people. Quetzaltenango is the second largest city in Guatemala with a population of approximately 225,000. The population is largely indigenous with the most common linguistic minorities being Mam and K’iche’. The city is situated in the highlands of Guatemala with an elevation of greater than 7,000 feet above sea level. This high elevation significantly affects the kinds of vectors that are able to survive in the area and, as such, certain diseases which are traditionally thought to be endemic to Central America -- dengue fever and malaria being two prime examples -- are quite rare in Quetzaltenango.

Pop Wuj was founded as a teachers cooperative which taught Spanish as a second language. The proceeds from the school are reinvested into several community projects focused on improving the social situations of the local communities around the school. The development projects associated with the school include a safe stove project, a scholarship program, a family support center which provides child care and educational support for children of single, working mothers in Llanos del Pinal, and the clinic in which I worked. The Pop Wuj clinic permanent staff consists of two local Guatemalan physicians and a nurse. The main physical location of the clinic is in Xela. The clinic here has three examination rooms and sees approximately 25 patients three mornings per week. In addition, the clinic is stocked with medications provided by Timmy Global Health. The clinic occurs at this location two days per week. Once weekly, the staff holds a mobile clinic. These mobile clinics are located in more rural areas of Guatemala between half an hour and two hours from the main clinic site. The mobile clinics are typically run out of a family’s home and the resources available at these mobile clinic sites vary greatly, in particular private spaces in which to perform physical exams. Medications and supplies for the mobile clinic are brought with the clinic staff.

In addition to these three clinic days, the medical staff also have one day of the week devoted to a nutrition program. As a part of this program, the staff visits three different sites each month and measures the heights and weights of children between the ages of 6 and 24 months. Children who fall into moderate malnutrition category are provided with Nutributter nutritional supplementation and children in the severe malnutrition category are given Plumpy Nut nutritional supplementation. During these nutrition and development screenings, the clinic also offers educational sessions to the mothers in attendance. The topics of these sessions range from family planning and approaching spouses regarding birth spacing, to hygiene, to incorporating discipline into child rearing.

Wednesday, October 1, 2014

Staff Meeting at the Family Support Center

It’s been a busy few weeks at the Family Support Center, formerly la Guardería. The school year ends on October 15th and all of the children are working hard to finish homework and study for exams. Last Friday, Pop Wuj headed out to Llano del Pinal to meet with the staff at the Family Support Center and discuss each child – all 40 of them. The main focus of the meeting was to determine if any of the children were at risk of failing their current grade, thereby being forced to repeat the year or go to recuperación during school vacation.

Starting the staff meeting

After a long meeting, we were able to pinpoint which children were struggling and in what areas. Math proved to be the subject that caused the most trouble among students of all ages. Multiplication tables, in particular, are a challenge for a lot of students.

Knowing this, the staff and volunteers plan to be at the Center in full force, devoting individual attention to the students who need it most. We are also working on finding fun ways to teach and learn multiplication tables once and for all through various games and strategies!

Discussing the needs of individual students

While the next two weeks will be a lot of work for everyone, the end of the school year signals the arrival of vacaciones and a long break from the daily school routine. The Family Support Center will be open all day throughout summer vacation, so many fun and educational activities are being planned for the next two months.

As the rainy season slowly fades away, we hope to involve the students in a ton of outdoor activities such as gardening, recycling, soccer tournaments, and hikes! We certainly have a lot to look forward to at the Family Support Center.