Many of Ecuador’s health challenges stem from one chronic problem: underfunded, ineffective institutions. This includes not only the major hospitals, but also medical schools, the ministry of public health, and at the most basic level, emergency response. In the developed world, we take it for granted that when (not if) the ambulance arrives, it will be well stocked, and crewed by trained professionals. This is not the case in Ecuador. Here, the bomberos, or firefighters, are the first to respond to any emergency. They put out fires, arrive first at car accidents, perform disaster relief, respond to house calls, and much more. Where we have 911, Ecuadorians have the bomberos. Unfortunately, cuerpos de bomberos are generally poorly staffed, underpaid, and composed largely of untrained volunteers. This results in a high number of easily preventable negative outcomes.

For this reason, Timmy Global Health decided to provide a 2-day long emergency first aid course for the bomberos of Tena and Archidona. Amber Valenti, a Physician’s Assistant that specializes in remote wilderness medicine, and Molly Downey, a paramedic, taught the course. August Longino, Timmy’s Medical Brigade Coordinator, translated for the 20 Ecuadorian firemen that attended. The 16-hour class covered first aid basics like wound care, vital signs, and immobilization of broken limbs, as well as the correct procedures for dealing with emergency victims. Concepts like immobilizing the spine of unconscious trauma patients, or even the use of basic CPR were new concepts that were eagerly absorbed, and generated many questions. All students successfully passed the final evaluation, a scenario involving multiple victims with a variety of problems, from trauma to asphyxiation.

By intervening at an institutional, rather than individual level, Timmy affects a far greater number of potential patients. During a brigade, Timmy doctors treat an average of 160 patients per day, for a period of 7 days. But by spending just two days training two entire squads of bomberos, Timmy has significantly improved the quality of care for countless patients throughout the region. The class was a tremendous success, and tearful goodbyes were said as the class ended, and the instructors headed home. As Timmy becomes a more established presence here in Napo Province, we hope to provide more high-level, wide-reaching interventions like this one. Currently, Timmy Global Health is fundraising to organize another, much more intensive wilderness medicine course for other bomberos, as well as for Timmy’s community health promoters.

With a mixture of apprehension, excitement, and immense amounts of pasta, Anna, myself, and a 5 Pop Wuj volunteers ventured out to Buena Vista to cook a massive meal at the home of our favorite local midwife, Doña Ana.  There to greet us sat, stood, and meandered 55 women and children, probably equally as unsure about the hours of cooking to come.  With this spirit of unknowing excitement, we began our first venture into a new area of nutrition education – cooking demonstrations.  Joining us were a large group of women from La Victoria, one of our NutriButter communities, and the mothers in the NutriButter group in Buena Vista.

We hoped to educate about a new food, and landed on eggplant, ‘berengena’ in Spanish, as our target veggie – a food full of vitamins and nutrients, and an excellent blank slate to absorb a wide variety of flavors.  Ratatouille, a foreign dish but recognizable name (thanks, Pixar!) was simple to teach, full of easily recognizable and available vegetables, and incredibly flavorful.  As an homage to my favorite chef, we used Julia Child’s classic recipe, with a slightly modified Guatemalan twist.

We centered our education around the use of zucchini and eggplant because of their availability, relatively low price, and versatility. While slicing, dicing, salting, and stirring we brought up the other ways to cook them, and reiterated the importance of high nutrient foods in the growth of babies and children.  The experience was educational on both sides – we hoped to share nutritional information and a tasty recipe with our Guatemalan participants, and in return we were able to learn a bit more about their level of interest in continued participation in our program and overall knowledge of nutritional cooking.  Above all of the nutritional information, the jokes, smiles, and sense of community shared throughout the preparation and eating of the meal left at least this Timmy employee with a sense of accomplishment and a day-long smile.

The chopping, peeling, and preparation went incredibly smoothly – considering the potential insanity of cooking with so many people, it was a pleasant surprise.  The knife handling skills of these women was absolutely unbelievable – observing them peeling an eggplant in seconds, chopping it even faster, and throwing in an ever-growing pile of delicious veggies was a pleasure in and of itself.  The Pop Wuj volunteers spent most of their time playing with adorable babies, chasing around bossy ten year olds, and conversing with the ever-entertaining Doña Ana, adding to the general feeling of camaraderie and enjoyment.

After all was completed, food was shared among all equally and with apparent gustatory pleasure.  Babies shoved noodles and tomatoes in their faces with relish, mothers laughing beside them at the strange new vegetable that few of them had eaten before.  We left no plate untouched, scraping the bottom of both cooking pans clean so families could take home leftovers to share with the rest of their family. We left feeling with full hearts and stomachs, and have already started talking about the next cooking demonstration! 

By Maria Alatorre
IU Trip Participant

“It is so easy to incorrectly assume that because you do more, or because you have more, that you are more”, Dr. Ronny Alvarado Gamarro told us as he looked around the small room at Los Olivos Hotel. It was Monday night, a few hours after our very first day of clinic at Doña Ana’s house, where we had seen close to one hundred patients. As Dr. Ronny spoke to us about cultural competency, the room was buzzing with excitement from the day’s work.

“Whether consciously or not, you come here and initially think that you are the ones who have something to contribute to the people of Guatemala”, he continued. “And you do have something to offer: your time, your resources, and your compassion. But very rarely do you think about what citizens of third-world countries have to offer you, and that’s because colonization has conditioned you to think that we have very little to offer you. As the week passes, I challenge you to remember that we are all people. Period. And because of this fact, we all have something to contribute. I also want you to think about why you decided to come on this trip. Don’t give me any logical reasons—I want you to think about what you felt that propelled you to come.”

Dr. Ronny’s talk went straight to my heart. The truth in his words stung; although I hated to admit it, I had arrived ignorantly thinking I was going to be improving their lives, and never once realized that Dr. Ronny, Wilder, Hugo, Doña Ana, Jose, and all the other Guatemalan medical personnel and patients were going to give me so much more. I didn’t arrive in Guatemala expecting anything in return, because I had foolishly thought that they were unable to give anything back to me.

While we worked at the clinics in Buena Vista, Quetzaltenango (Xela), Xeabaj, and Pujijil, Dr. Ronny’s words replayed in my mind. As one of the translators, I had the beautiful opportunity to more personally interact with the patients and the doctors. I witnessed the complicated dynamics of the doctor-patient relationship, and was able to listen as the patients described the pain in their joints, chest, eyes, stomachs, and hearts. Very quickly, one sees the similarities between all human bodies: Americans also complain about problems with gastritis and arthritis, cataracts and allergies. After embracing the physical similarities, it is only natural to see that humans are humans are humans. As Dr. Steve Leuthner told me at the Pop Wuj Clinic, “We are all people. I see myself as no better than any of my patients. At the same time, I don’t think anybody is better than me. I have just as much to contribute to them as they have to contribute to me. We’re all equal.”

This message of equality—realizing that we are all people who face the same adversities and issues but in different contexts, and that everyone has a story they want to share—was the most important lesson I learned from the people of Guatemala and everyone associated with Timmy. I had been taught this message ever since I was a little kid, but I realized that I didn’t believe it with every fiber of my being. It was a lesson I used to have to think about logically, whereas now, it’s a feeling that murmurs deep inside of me, constantly coursing through me, and it is this feeling that has brought a sense of peace to my life.

This very feeling also gave all of my experiences a magical touch: it made all moments a sacred gift, whether it was riding in the van from one location to another, tickling the children and having their musical laughter fill the room, or sharing a smile with one of the women. Once I forced myself to break all stereotypes and realize that we all have a right to life’s gifts, my world just opened and blossomed. It’s hard to describe, but I felt the people’s stories all around me. Sometimes they were so poignant and palpable, it was almost like a thick fog that just completely enveloped me. Sometimes, the stories were more distant, like when I walked down the busy, colorful streets of Xela with other Timmies—but they were always there.

When Dr. Ronny first asked us what feelings and emotions nudged us to apply to the Timmy Medical Brigade, I was hesitant to look inside myself to honestly answer the question. But I knew all along that the reason I had applied had been a selfish one: I had a growing feeling of emptiness inside of me, and I wanted the experiences of this trip to fill it with something: life, love, purpose, or excitement.  Even before the trip began, I had made the trip about me.

Every patient that left the clinic always thanked us, and sometimes even awarded us with a heartfelt hug, kiss, or handshake. But the truth is, I thank them for bestowing me with their unrestricted smiles, hugs, and welcoming. Every woman, man and child infected me with their laid-back sense of time, their love for life, and their ability to truly relish in every second of their lives. They gave me the gift of life: love, joy, and passion. Through their very existence, they taught me about friendship and hope. They graciously invited me into their life and shared their stories, and when we parted ways, we took a little bit of each other with us. This building of relationships is what literally pushes me to study and work hard to become a doctor. I yearn for that intertwining of lives and stories in my everyday life. They remind me that people are the one of the biggest reason for life’s beauty.

Timmy Global Health, I will never tire of thanking you for this experience that you have allowed me to be a part of. Please know that this experience has strengthened my desire to help others, that relationships have been formed across cultures, and that my way of thinking is now backwards. That is to say, I am constantly learning that I cannot accept what society feeds me, and instead must set out to work with others to find the truth. Thank you, thank you, thank you.

By: Anna Pollock, Medical Project Coordinator – Guatemala

Earlier in the year, I wrote a post called “Conversations with Midwives in Quetzaltenango” which detailed two focus groups conducted in January with traditional midwives working in Guatemala.  In this post, I describe the context in which many traditional midwives practice in the Guatemalan Highlands, the types of trainings they have received (or not received) in the past, and their frustration with the constant lack of supplies.  Since the focus groups, multiple conversations have ensued about the value of training on neonatal resuscitation, and ultimately we made a decision to hold a training using the Helping Babies Breathe (HBB) curriculum endorsed by the American Academy of Pediatrics.  Teaching this simple yet highly effective strategy will be a good first step in impacting neonatal mortality in Guatemala’s Western Highlands – one of the main goals of our Capacity Building Grant.  After this decision was made, karma must have been on my side because I was invited to attend two Helping Babies Breathe trainings during the month of March!

In early March, myself, along with the entire Pop Wuj Clinic staff (3 Guatemalan doctors and a nurse) and 4 local midwives, went to Panajachel at Lake Atitlan to receive the HBB training from the Babies Breath Project, a group of nurses who work at the Minneapolis Children’s Hospital.  The training was extremely beneficial – the small class size ensured a lot of individual attention that focused on proper resuscitation techniques, including water-filled mannequins that simulate breathing and an umbilical pulse to practice resuscitating. Trainers walked us through different response scenarios with increasingly serious situations.  The mood of the training was light, and even though it was done in English and translated into Spanish, everyone who participated found it to be a beneficial and informative experience.
Dr. Hurtado, an OBGYN with years of experience, told me that he really enjoyed the training and now feels much more comfortable dealing with asphyxiating babies.  He said that in Guatemalan hospitals usually the nurses deliver the babies, but sometimes he is there with just one nurse (or alone), and it can be very scary when something goes wrong.  Doña Ana, a midwife who also works closely with Timmy clinics, shared her thoughts on the training and told the following story: “I have had an Ambu bag in my clinic for a long time but I never really knew how to use it.  I could never understand why the air would always leak out the sides.  The training was really great because we got to practice enough times to perfect the technique.  When I came home on Saturday night I had 2 births – one around 11PM and another in the morning.  The second baby came out a little asphyxiated, so I got my Ambu and he came right back to life and started breathing.  Learning the C technique was invaluable for me – if only I had known earlier what I know now!”

In the far northwest of the Dominican Republic, just miles from the Haitian border and a universe away from the five star resorts and tourism that powers much of the Dominican Republic’s economy, a small, innovative agricultural cooperative is working to improve the quality of life of low-income Dominicans and Haitian migrants. For years, “Banelino” (http://www.banelino.com/es/) has utilized its hybrid economic development and social welfare model to meet the needs of thousands of the Dominican Republic’s most undeserved families.  And starting in May of 2012, Timmy will be supporting their efforts to expand access to healthcare and improve health outcomes in the agricultural communities in Monte Criste. 

Starting in May of 2012, Timmy will send five annual medical teams to support the local health outreach of Banelino, an innovative, forward thinking fair-trade banana cooperative that funds and oversees preventative health and primary care medical programming for 16 underserved Dominican Republic communities in Montecristi.  Timmy’s medical teams, along with our incredible network of student volunteers and partners throughout the US, will work to expand the capacity of Banelino’s outreach, expanding the size and scope of Banelino’s primary healthcare service provision and investing in essential public health programs designed to improve overall health outcomes in Monte Criste’s agricultural communities. These traditional communities – called “bateys” in the Dominican Republic — are some of the most traditionally impoverished areas in country.  In Monte Criste’s bateys, both low-income Dominicans and Haitian migrants – many of whom have crossed the border in search of employment — make a living working in the banana fields.  For almost two decades, Banelino has garnered an incredible reputation for socially responsible development that supports vulnerable populations, and Timmy is excited to support their efforts.   

The Timmy Global Health / Banelino partnership will mark Timmy’s return to the Dominican Republic, an incredible, beautiful, vibrant country with a mesmerizing culture, unparalleled natural beauty, and significant health care and development challenges. And it will mark Timmy’s return to a focus on the plight of the thousands of Haitian migrant workers who have sought a better life by crossing the Dominican Republic border. 

Over the course of the next few months, Timmy will be putting in place the final pieces of our DR programming.  With IUPUI, Washington University, and Colorado State already scheduled to support Banelino’s work and travel to the DR this spring and summer, our programming will be launching with many of the necessary pieces already in place.  As we move forward, we will work with Banelino to set up a comprehensive referral system for patients, as well as define our near and long term public health goals for Monte Criste’s “bateys.” The program will be supported by a fantastic team of on the ground partners, including Alyson Davidson, who is working full-time from the Dominican Republic and is a current United States Peace Corps health volunteer,and Dr. Miguel Garcia Tatis (pictured above), the head of Banelino’s health program in Monte Criste, and a Dominican physician with years of experience working to expand access to healthcare for vulnerable populations.  As we continue to develop the programming, we’ll be sure to keep you – the people who make it all possible – updated. 

By: Jess Reichard

This week, members of Timmy’s Guatemala team visited La Victoria and Buena Vista, two communities participating in the NutriButter program here in Xela.  While the act of visiting these two wonderful places is no longer new – we’ve been running monthly meetings since last July when Dr. Meg Sullivan started the program – this time, a marked difference in participation, understanding, and enjoyment was experienced by all involved.

We presented a new lesson on a rather dense topic: the cycle of malnutrition and infection in young children.  The consequences of malnutrition are manifold, and we try to focus on both the positive – ways to improve life through better and more varied nutrition – and the potential negatives, in particular risk of disease and chronic deficiencies and intellectual and physical stunting.  Despite the difficulty of the subject at hand, the mothers participated more so than ever before.  Through the use of well-timed pauses for questioning, visual aids, and memory games, we were able to both encourage active input and a large number of smiling faces.  Interest is so high that the women from both communities have requested increased classes, new ones focused specifically on cooking healthfully and with limited cost.  Next month we venture out to the house of Dona Ana, our strongest connection to the community of Buena Vista and the host of our Mobile Clinics, to cook a large lunch for more than 40 women who are interested in learning more improving their lives through increased nutrition and healthcare access.

At the end of both lessons in La Victoria and Buena Vista, we brought out a camera to take portraits of the moms and babies involved, which started a whole new session of giggling, squirming, and excitement.  After spending a significant amount of time building relationships with these women who, on the surface, have very little in common with us as American public health workers, we have been able to bridge a connection that crosses cultural, economic, and linguistic barriers.  The future holds incredible opportunity, as the improvements in communication and information intake have improved greatly in a short period of time.  We look forward to a similar sense of community building among our newest participants from Llanos de Pinal and Tierra Colorada, who have only just begun their learning and growing process with Timmy and the NutriButter program.

I had been told that trips with Timmy Global Health are “life-changing” and “so inspiring,” and I would be lying if I said that I truly believed that at first. I was worried that for some reason, maybe the experience wouldn’t touch me at all. That maybe what I had heard was wrong. That maybe the distance between Tufts University and Quetzaltenango, Guatemala would not enable me to feel what I had been told I would feel. As it turned out, I was right—I didn’t feel that my experience was “life-changing” and “so inspiring,” because those descriptions are extreme understatements for the emotions that I felt.

I was right about another thing, too: the distance between Tufts University and Quetzaltenango certainly impacted how I felt about the trip. I realized, as I flew home after my week in Guatemala, that 3,000 miles in the face of globalization is both miniscule and millions of worlds away all at once. In many ways, the differences between life in the United States and life in rural Guatemala were much exacerbated in my mind after my trip. I realized that in the United States and in other so-called developed countries, we are fortunate enough to choose and then create our own reality, the reality of our dreams. In Guatemala, on the other hand, the social, political, and economic constraints of the society have caused many of the people to be born into a reality over which they have no control. Why is it that I was born into a life with my choice of future homes and family dinners, while others are born onto the same dirt floor that they will live on for their entire lives?

At the same time that I was hit with the immensity of these differences, I was also slammed by a realization from the other direction—we are all human beings, and in that way, we are all one and the same. There were a few interactions with patients—human beings just like me—that really stood out in my mind.  The one that I recall the most and the one that I feel really typifies what I took out of my experience with Timmy occurred while I was shadowing a doctor on my first day on the medical brigade. A patient came into our room with a four-year-old daughter, and when I looked over her chart I learned that the patient was 19-years-old—the same age as I am. WHAM, there it was—the realization that she and I are at the exact same stage in our lives, but the disparities between our current positions couldn’t be more vast. I was the “fortunate American” with my life ahead of me, and she was the teenage mother. Had she been born in the United States, she could very well have been sitting in my seat rather than the examination chair. But there she was, this 19-year-old mother with her future predetermined, this young Guatemalan girl who didn’t even realize that she had the choice to dream.

After my trip with Timmy Global Health, I have many more questions about the world than I did before I went to Guatemala. However, I know two things for certain: my time with the incredible organization that is Timmy is not nearly over, and I don’t want to become one of those Americans who says, “Oh, that was a fantastic trip. I realize how fortunate I am to live in the US,” and leave it at that. Since returning from my brigade, I have begun to brainstorm about how I can use my assets to help the disempowered communities that I worked in. Understanding the importance of education in terms of achieving a sustainable outcome has made me believe that education is the key to reform, and I am hoping to start a global health education organization to begin to reduce global disparities. I have the opportunity to design my future and choose my reality—why not channel that energy into enabling others to do the same?

By: Anna Pollock

One of the main goals of the Health Capacity Building Grant in Quetzaltenango is to improve the quality of care that Guatemalan midwives working in our target communities are able to give to reduce maternal and neonatal mortality and morbidity.  We have been working with the midwives in each of the communities as well as the midwives associated with CODECOT, the Quetzaltenango midwife association, to design and give quality trainings on themes that the midwives themselves identify.  In early January we held focus groups with two different groups of midwives to learn more about the past training of our target population, the conditions in which they work, the materials with which they work, and ideas for how we can better help them moving forward.

The first meeting was at CODECOT with four of the midwives on the Council, including the president and the vice-president.  CODECOT works with the Ministry of Health to decide which trainings will be held monthly in each of the municipios of Quetzaltenango.  The midwives informed us that trainings have been conducted on themes such as women’s rights, mental health, self-esteem, and medicinal plants, but that very few medical, technical trainings had been given.  Some themes we identified in which we plan to help CODECOT design and conduct in the future include: miscarriages, labor, infant care, and high-risk birth including adolescent pregnancy.

The second meeting, conduced at Doña Ana’s house in Buena Vista, was an entirely different experience.  Twelve midwives came, some from as far away as the coast (2 or 3 hours); others from communities so rural that a car cannot enter, just to share their thoughts with us.  Each woman talked candidly about her individual experiences working as a midwife in her community.

I started this meeting by having all the women introduce themselves and tell us how many years they have been working as midwives and how they got started delivering babies.  The stories were incredible – mainly young, sometimes prepubescent, girls, attending their first birth out of pure necessity. The women spoke of being born into their roles as midwives, whether or not they were interested (most initially were not). The community believed it was their don, or predetermined role in life, and they were thus sought out by their respective communities to attend births even before they had experience.  For all but one of the women, this meant that they taught themselves how to deliver babies with no prior formal training.  Some mentioned that they were trained by apprenticing with an older midwife, usually a mother or grandmother, or through dreams.  In Guatemala, before you can become a midwife you must dream about it, indicating you are able to fulfill your don.  In many instances, the midwives said that what they learned in their dreams guided them when delivering their first babies.  Nearly all of the women agreed that they did not start attending formal trainings at the community Centro de Salud until they had been delivering babies for more than 10 or 20 years.

During the meeting we again talked about the monthly trainings that the midwives are currently receiving and what themes they would like to cover in the future.  The topics most frequently mentioned in regards to future trainings were the desire to learn to put in an IV and/or basic injections, and how to put in stitches so that when women have small tears after birth they do not need to go all the way to the hospital for only one or two stitches. 

After covering the questions I had prepared, the conversation strayed into other interesting experiences and obstacles to adequate care that these midwives have encountered over their collective 204 years of experience.  Many midwives agreed that it could often be difficult to convince a family of a woman’s need to go to the hospital when complications arose during birth.  One midwife, Paulina, talked of women coming to her in labor accompanied by drunk husbands.  These bolos have refused to send their wives to the hospital when it has been necessary, saying that it was the midwife’s job to deliver the baby, that they had come to her, and she was to deal with whatever complications arose.  Another midwife talked of one instance in which a woman was hemorrhaging and, at the midwife’s insistence of going to the hospital, the husband said, “no, this is just how my wife is,” and refused.  Throughout the meeting a recurring topic, and what seemed to bother the midwives most, is that although they tell their patients to make an emergency plan in case something goes wrong during birth, to save some money, find a car, etc. many families chose to ignore this advice.  At the hour of birth, these strong women were forced to make decisions, even against the family’s wishes, to save the life of the mother and the baby, as best they could, but often with little support from the husband.

When discussing how and when the midwives determine that a woman’s condition is risky enough to need to be referred to the hospital for labor, one example mentioned was when a woman has high blood pressure.  Interestingly, when asked if the midwives take blood pressures with a blood pressure cuff, they said no, that they don’t have these supplies.  Instead they rattled off the accompanying symptoms (head ache, shortness of breath) and use the presence of those as a proxy for when to send a woman to the hospital for delivery. 

These candid conversations with these groups of midwives were incredibly illuminating and shed light on the real issues midwives face working in rural Guatemala.  They will help us as we move forward in setting up a larger training (most likely on neonatal resuscitation and the first 30 minutes of life) next summer.

Just as the holidays were approaching in Guatemala, Pop Wuj and Timmy initiated a brand new group of mothers and babies into our ongoing Supplemental Nutrition, or “NutriMantequilla” Program, as it is affectionately called.  These 16 new families joined us mostly from Llanos de Pinal and Tierra Colorada, two rural, mostly Mayan communities who have received stoves in the past from Pop Wuj’s Estufas program. 

The initial meeting, held on December 9^th, found Pop Wuj filled with mothers, grandmothers, and children of all ages milling about, awaiting information about a program whose name was undoubtedly a little odd, in any language.  First Carmen Alvarado, the Social Work Coordinator (and the reason why we were able to invite so many women from these new areas), gave a general introduction to the program – not only about the daily supplement, but also our monthly meetings with lessons concerning nutrition, hygiene, infection and disease, and more.  Dr. Meg Sullivan followed, shedding light on the more detailed and potentially complicated aspects of nutritional supplements in the lives of young, developing babies.  Perhaps the most entertaining part of the entire afternoon was watching the mothers, as they were able to sample a little NutriButter themselves.  As peanut butter, let alone sugary peanut butter, isn’t a typical food in their diets, surprise marked many faces as they popped their buttery fingers into their mouths for a quick taste.

After explaining the proper daily use of NutriButter, each mother was individually interviewed to obtain demographic information, and ensure adequate understanding of NutriButter.  Each mother also signed a contract to formalize their commitment to the nutrition program – not only to give their little ones the nutritional supplement correctly, but also to attend our monthly educational meetings on relevant nutritional topics.  Finally, we measured the head circumference, height, and weight of all our future participants – instead of laughter, Pop Wuj rang with the startled cries of 20 babies forced to sit on a cold metal scale while we gathered our essential, but uncomfortable, data.  In the future, we will gather the same data once every two to three months and create individual growth charts to show the successful nutritional impact of NutriButter on physical development. 

To follow up, home visits were conducted after 1 week at each of the new participants’ homes, with the guidance of our local heroes, Dona Leti in Tierra Colorada, Dona Lidia in Llanos de Pinal, and Dona Luisa in Buena Vista.  In addition to checking in on the progress and continued understanding of NutriButter, we completed a second interview, asking a series of knowledge- and habit-based questions in obtain pre-program data.  With this information we will be able to better measure increased knowledge levels and changes in nutrition-related habits after attending the series of monthly nutritional talk.  Questions included knowledge of certain minerals like Iron and Calcium, feeding habits during a child’s illness, and how the family usually cleans their fruits and vegetables.  As we plan to teach lessons on these topics (and many more), these initial questions develop the baseline upon which we can measure how much of the information we share is retained by the mothers.

As we add more families and further develop this nutrition program, Pop Wuj and Timmy hope to increase not only our numbers, but even more so its effectiveness and sustainability.  As always, challenges exist, but the rewards – increased cerebral and physical development and lowered chance of disease – are undeniably worthwhile.

The Clinics

Each day our team would travel for upwards of two hours to clinic destinations, perched sometimes precariously, in buses, trucks or motorized jungle boats. Upon arrival in these small sub-100 population villages, the process became quite familiar. The buildings were constructed and arranged in concentric squares around the center of the village, which was always a soccer field. The village school was always the first perimeter of concrete buildings, with residences forming the outer perimeters. To the delight of the children in school that day, our teams would occupy their classrooms, giving them an unexpected break from classes.

The Sustainability 

To ensure that our group created a lasting impact on the communities served, this year and for the future, the U of L group teamed with Timmy Global Health, an Indianapolisbased, Ecuador-run organization that sends medical brigades every 60-120 days into identified medically underserved communities, thus ensuring continuity of care for these populations. This teaming also allows for bulk discounted purchasing of medications and supplies, as well as the opportunity for longitudinal clinical research endeavors for the U of L team.

The Cases

The populations that we served were exceedingly rural and agriculturally based. A typical patient worked long hours in the hot sun in the fields, bent over at the knees cutting crops with a machete. Chronic pain issues from overuse of joints were common and easily mitigated with ibuprofen and Tylenol. Complaints of “La Grippe,” or the flu, were commonly encountered and appeared not to be virally induced, but rather allergic complaints from the pollens and dusts stirred up
by the cutting of crops. These were easily treated with a drying agent. Chronic headaches uncovered dehydration – the average field worker was found to drink an average of only two glasses of water a day.

Most Poignant Case

Drug trafficking is an unfortunate reality in parts of the Amazon, the area of our visit being no exception. To deter detection, the traffickers will often protect the remote walking paths to their crops by stringing a trip wire across a path at knee level – anchored at one side by a tree and the other side attached to the trigger of a sawed-off shotgun trigger.
We evaluated the case of a 73-year-old woman who inadvertently triggered one of these booby traps. She self-ambulated into our clinic with wounds that were three days old. We counted 36 entry/exit wounds and our X-ray showed 24 retained buckshot pellets centered between mid-thigh and mid-calf. Incredibly, the wounds were not infected and there
was no neurovascular compromise. She was bandaged and allowed to recover on her own with a prescription for some
over-the-counter NSAIDs.

I woke up with a startle and a feeling like someone was slowly driving an ice pick into my neck. Very quickly, I realized that I had dozed off on the plane on our way to Ecuador and as part of my mileage plus privileges, in addition to seats squeezed together like sardines, I had the honor of sleeping in positions that are fit for a contortionist. Sadly, I also realized that I had already maximized my ability to sleep on a plane and we had not even taken off yet!

My thoughts quickly turned to our medical service trip to Ecuador. It occurred to me that this time, everything was different – different country, different child companion, different group on the trip, different altitude and thankfully, different insects (hopefully, none). So, I wondered, what would this trip really be like – mostly: are the social and medical issues that burden the Ecuadorian people similar to what I saw in the Dominican Republic? Are they hampered by similar prejudices and inequities or is their plight controlled by different factors? Would we be able to contribute in a meaningful way to their lives?

Upon waking on the first morning, I could barely restrain my exuberance – not a single mosquito bite to be found; in fact, not a single mosquito anywhere in the vicinity! And no roosters crowing at 3 a.m.! Unfortunately, my joy was brief and after astutely looking over at Jared and his chattering teeth, I brilliantly surmised what my body had been feeling for the last few hours – it was freezing! Well, technically about 45 degrees, but far different from the sweltering heat of my prior trips. I felt quite fortunate to be wrapped in the llama-haired blanket until I caught a quick glimpse of myself in the mirror and realized that my eyes were swollen like a raccoon and I looked like Rocky Balboa – it seems that llama hair and my body have a love/hate relationship.

We spent the next days travelling to deliver medical care by day and counting pills by night; both had their own set of challenges. I strived to develop a Zen-like approach to counting vitamins for two to three hours and I readily admit that I failed. I have been meaning to write a letter to the vitamin manufacturers begging them to simplify their packaging. The Notre Dame students and Jared developed truly brilliant techniques that might someday earn them a Nobel Prize, but I labored at a pathetic pace of about 20 vitamin removals an hour for the first night or two. I was quite relieved to actually start seeing patients so that I would no longer have to undergo this humiliation.

Our medical teams ventured out to small villages 30 to 45 minutes outside of Quito to deliver medical care. The contrast between the majestic beauty of the Andes surrounding Quito and the abject poverty within the villages was stark. Most of the villages had a bombed-out look to them – buildings with no walls and just skeletons of structures; trash filling the streets and the fields where the children played. Very little running water or electricity anywhere. Cows, chickens and pigs wandering through the villages using it as their “restroom.” Of course, this description could apply to other third world countries, but the spirit of the people is what again, amazed me the most. Of the roughly two hundred patients that I saw over that five days, every single one of them was kind, respectful and dignified. Most of them smiled in the face of whatever adversity they were facing and they were happy with whatever we could do for them, which many times, was very little.

By: Kathy Morris, Programs Coordinator
Photos By: August Longino, Medical Brigade Coordinator – Tena

This October, local Indy kids learned what it means to be a child with a difficult health condition in the developing world. These kids listened to the stories of children just like them in Ecuador and Guatemala, kids who are similar in most every way except that they were born in poverty and with very limited access to healthcare.

After hearing these stories, and asking questions about what it’s like to live in a place where you have to take a canoe just to visit a free Timmy clinic, these elementary-age kids wrote special messages to send to the children of Tena. They also created a banner featuring their handprints, and the message “De nuestras manos a las tuyas,” meaning “From our hands to yours.” The banner and hand-made cards were delivered in November by Timmy staff to the children in Tena, bringing with them a message of solidarity and hope.

This fall has been a time of new beginnings here in Xela!  After months of daily rains and few hours of sun shine, the rain has finally subsided giving way to warm, clear days and a renewed optimism that can be hard to find amidst so much grey – the prime time for undertaking new projects and ramping older ones into high gear.  At Pop Wuj we have taken advantage of the new energy in the air to move two ideas into action – we have begun evaluating the Stove Project through meeting with stove recipient families and we have officially hired three Community Health Workers in our partner communities!

The Stove Project is one of Pop Wuj’s signature projects.  With the goal of reducing the health hazards for families cooking over open fires, the project aims to build improved stoves for as many families as possible in the areas surrounding Quetzaltenango.  The stoves Pop Wuj builds are both more efficient, requiring less wood, and healthier because the smoke is directed out of the house through a chimney. The project has been ongoing since the school began, nearly twenty years ago, and has helped build stoves for hundreds of families in the outskirts of Xela. Most recently, the Pop Wuj Stove Project has been focusing its energies on several communities in the Palajujnoj Valley, near the base of the Santa Maria Volcano.  Though in the past 2 years, the project has successfully competed stoves for nearly 100 families, there have been little funds left over for evaluating the effectiveness of the program.  With support from the new Capacity Building Grant, one of our new priorities is to evaluate the quality of the stoves built in the recent past to ensure they are functioning properly, and to hire a Technical Adviser to oversee all necessary reparations.

As a first step in the evaluation process, we held a meeting at Pop Wuj on the morning of October 10.  All the families in the valley who had recently received stoves were invited to come.  At the meeting we filled out a short survey with each family, asking questions about their stove to find out if there were any problems and what they were, as well as their perceptions about benefits of having an actual stove instead of cooking over an open fire.  Though the problems we encountered were few and seemingly insignificant, the benefits mentioned by families were many.

As a follow up to the meeting, we have hired Mynor, a teacher at Pop Wuj who also has significant experience and knowledge of the stoves we build, to be Technical Adviser and to oversee the follow up of the information gathered at the meeting.  We have determined three immediate needs that Mynor will be tasked with.  These include putting doors on all of the stoves that are awaiting this final stage of construction, following up with the families in San Juan who reported that their stove tops were inflating as they heated up, and finally visiting all the families who mentioned any other issue with their stove at the meeting.  By completing these steps, we can ensure all the stoves built by the Stove Project are functioning optimally and be sure that can move forward in the construction of more stoves knowing that the stoves previously constructed are all in good shape!

The second exciting event that has happened here in Guatemala is that we have officially hired 3 Community HealthWorkers who will help us to have a more permanent presence in the communities where they live and Pop Wuj and Timmy currently work.   On October 21, Maria Luisa from Buena Vista, Caterina from Xeabaj, and Anabeli from Pujujil came to Pop Wuj for the initial meeting of the Community Health Workers: to meet each other, discuss their roles in their respective communities, and their responsibilities as Community Health Workers and spokeswomen for Pop Wuj and Timmy.

As we began to do introductions, I learned some amazing facts about our new Community Health Workers – facts which only reinforced my belief that they will contribute whole-heartedly in their new endeavors as Community Health Workers.  All three of the women have completed formal studies in nursing.  Maria Luisa, beyond being a spokeswoman for health in Buena Vista has already accompanied patients to Coban (on the East side of Guatemala) to receive surgeries with Partner for Surgery, and plans to take another group of 10 patients for surgery in Los Encuentros next week.  Both Caterina and Anabeli were scholarship recipients from Pop Wuj; with the help of the Scholarship Program they were able to complete their studies in nursing and are now in a place where they can give back to Pop Wuj and their communities based on the education they have received.  Seeing the way that Pop Wuj’s programs have come full circle with these two young women was very inspiring and indicative of the changes that can be made with the correct investments in human capital and infrastructure.

In order to ensure that all of the Community Health Workers have the same level of knowledge, shortly we will be beginning a series of 6 trainings covering topics ranging from Appropriate Use of Medicines to Infectious Diseases to Hygiene and Sanitation.  In the meantime, all three Community Health Workers helped out with the Timmy Brigade that came to Guatemala in late October, reinforcing the partnership between Timmy and Pop Wuj.

Although it initially started as a project focused largely on bringing the benefits of primary education to children in the rural Niger Delta, Timmy’s work with the Bebor Model Nursery and Primary School has increasingly turned in the direction of providing sustainable public health interventions that will benefit the hundreds of kids enrolled at our two campuses in Bane and Bodo, Rivers State, Nigeria.  We recently learned that the final component of a larger water and sanitation phase of our work, toilets for the school in Bane, has now been mostly completed.  The photo below shows the shell of the building that will ultimately house boys, girls and teachers’ toilets at the school in Bane. The three black tanks in the right of the picture are what stores water pumped up by a borehole (generously funded by our partners, Stepping Stones Nigeria) from an underground aquifer.

The boreholes, now operational at both schools, serve three main functions.  First, they provide a source of cleaner and safer drinking water for the students and the teachers at both schools.  Second, in both locations, we have installed water taps near the schools that local villagers can freely access to provide themselves with cleaner and safer drinking water.  Third, the boreholes provide the water that enables (in the case of Bodo) or will enable (in the case of Bane) the toilets to flush and the students to wash their hands.

Both schools are located is an oil-producing region where spills have negatively affected water quality and the overall health or local residents.  As noted in a recent report by the United Nations Environment Program (Environmental Assessment of Ogoniland, p. 165), “An oily sheen is ever present on the water surface of the creeks around Ogoniland.  This same water is used by local communities for fishing, bathing and in some cases for drinking.”  After installing the first borehole at the school in Bodo, Timmy funded a study comparing the quality of drinking water from three different sources (a stream used for drinking, the school’s previous well and the new borehole) across eight chemical and five microbiological parameters.  The borehole water was found to have the lowest heterotrophic bacterial count.  E. coli was detected in the stream water and fecal coliform bacteria were detected in both the stream and well water but not in the borehole water.  Beyond the obvious public health benefits, the community water taps at each school will also disproportionately benefit women as they are the ones who are overwhelmingly charged with fetching water in the Niger Delta and will thus benefit the most from this more readily accessible new source of freely available water.

While the provision of cleaner drinking water is increasingly appreciated, the health benefits of providing basic sanitation facilities often go unnoticed.  The Economist news magazine editorialized in 2008 that “Politicians and celebrities are often enamored of ‘clean water’ – but less keen on posing next to the latrines that must be built to keep water that way.”  While the work that Timmy does in the Niger Delta is not glamorous, it is essential.

In addition to its health benefits, the construction of functioning toilets at both schools also plays a critical role in terms of their basic educational mission.  According to UNICEF, “Safe water and adequate sanitation are as important to quality education as pencils, books and teachers.”  In particular, UNICEF notes that “Safe water and adequate sanitation are crucial for girls to take their rightful place in the classroom. Without these basic necessities, girls will continue to be absent…. While affecting all school-aged children, inadequate sanitation facilities hit girls hardest, pushing many out of the classroom for lack of privacy and dignity.”  Although a large majority of school age children around the world not in school are girls, our student enrollment at Bebor is nearly 53% female.

And the next stop after the construction of the toilets is completed?  Our hope is that we can continue improving the overall health of the school populations through public health screenings and interventions for the students in Bodo.  Assuming that pilot project works, we will extend it to the school in Bane in the future.  Both the health interventions and the improved water and sanitation facilities will go a long way toward helping the incredible teachers and staff at Bodo continue to build healthy futures in the Niger Delta.

By: Kathy Morris, Programs Coordinator

Timmy is growing, our international impact is expanding, and our number of student chapters is increasing. Even more impressive than all this growth, however, is the deepening of impact that is taking place across university campuses here in the US and at our project sites in the developing world. And it’s not just our staff championing these efforts. While Timmy staff members initiate programs geared towards malnutrition, training community health workers, and expanding to new locations, our students by no means stand idly at the sidelines. Instead, they are initiating their own unique efforts geared toward deepening their impact in the international communities we serve.

One of Timmy’s newest college chapters, the University of Southern Florida, is a key example of a dedicated chapter full of students who aren’t satisfied to fulfill the minimum requirements. They wanted to know from the start that their brand new Timmy chapter was making a significant impact. They wanted to go deeper.