Reflection on El Salvador San José Villanueva Medical Mission 2012
El Salvador is a beautiful country rich in history and traditions but most notable to me as a foreigner was the passionate people; full of life, hope and religion. As a country that not long ago was torn by civil war and government oppression, the people of El Salvador remain resilient. Throughout my encounters and interactions with patients I was amazed at their how much they have to give us, how appreciative they were for receiving what we may consider little, how resourceful the people are with what they have available. Additionally I was struck by how polite and patient the people we saw in clinic were.
We saw 1640 patients in one whirlwind week of eager faces, listening to stories, handing out medications, testing vision, fitting glasses, ultrasound exams, breast exams and pap smears. I can still visualize numerous faces smiling, crying or inspecting me inquisitively. Everyday hundreds of men, women and children stood patiently awaiting our arrival, their faces peeking around the corner of the fence at registration. Many of their faces remain etched in my memory weeks after returning home.
I recall an eighty-two year old woman dressed in an all white dress covered by a blue apron and adorned by beautiful rosary beads around her neck. She shuffled her feet slowly, hunched over, walking with the help of her daughter. Years ago she was hit by a car and never received medical care for the injury, leaving her with a large deformity in her skull to which my eyes immediately were drawn. Yet quickly my eyes were guided down to the infectious smile that overtook her face as she shook my hand. I couldn’t help but smile while I was talking with her. Given her significant anatomic deformity I prepared myself to be ready to listen to all of the symptoms she must be afflicted with, expecting to have to refer her to a specialist in San Salvador. When I asked her what I could help her with today she complained only of a minor headache. This seemed consistent with the same headache symptoms that many patients I had already seen that day were complaining of. These headaches seemed to be a combination of a tension headache and dehydration. Next to her sat her 94 year old husband who came complaining only of the same mild annoying headache and knee pain that had been present for many years. After a full history and exam the couple gave us numerous thanks and multiple hugs to show their appreciation and they left the clinic with a bag of Tylenol, vitamins and tooth brushes. This was just one example of many patients who despite their circumstance and age had little to complain about and were enthusiastic by the little we could give them.
These types of patients became the norm for most of the week in adult medicine. Just our presence in the community may have evoked curiosity or a unique opportunity to get medications that they cannot afford and may need now or in the future. Generalized complaints that were often not acute and non-specific presented one after the next. Headache, stomach ache, trouble sleeping, joint pain, lack of appetite, and chronic cough were recurrent symptoms that when read between the lines painted a vivid picture of the everyday barriers to health that are encountered. When probed deeper it often was clear that patients had a large amount of psychological stress, inability to access clean water, nothing to hold water in to drink it to stay hydrated, exposure to dust and smoke and recurrent GI infections. These were the public health issues that truly afflicted the population. Due to this most of my time was focused on education with the patients, both individually and for a day in group clinic visits. In addition, as is a key to improving population health, I was able to speak with the local health volunteers and share with them some information that they could use to educate others and bring back to their communities to improve health. These eager, young, bright women are the leaders who remain in the country who can affect real health improvements. They were excited to have more knowledge and handouts on common health topics and this felt great to know that I had something important to share that might make a real difference in their lives. Speaking with them was the most satisfying part of my time in El Salvador.
Of course in addition to generalized complaints there were also patients who needed acute medical care and it was extremely rewarding to be able to treat them. One patient that I will always remember was a 16 years old new mother carrying her 1 month old child miles in the hot sun to get a newborn exam. Upon arrival, exhausted and sweating through her shirt, she appeared worried. At first she focused on her child to assure the baby was examined and only after being asked by a clinician did she explain she was still having uterine pain one month after child birth and now began to have fevers and chills. After a gynecologic exam she was treated with antibiotics for endometritis. The next day when she returned to our clinic for a quick follow up there was a different expression across her face. She was relaxed and smiling. Her fevers had stopped and though her pain was still there she felt reassured having seen the clinician and started treatment.
“No one is too poor to give nor too rich to receive.”
This quote encompasses my experience on the Paz Salud medical mission in San Jose Villanueva, El Salvador. We come to give what we are able to and in return receive more than we imagined possible. It is an exchange of experiences, stories, knowledge, background, emotions, and expressions. Everyone benefits in extraordinary ways and the volunteers, including myself, often come away with more than they gave. Even months after the pills are packed up and the clinic is converted back into an elementary school classroom, kids will sit in their desks drinking clean filtered water and able to see the chalk board with their new glasses, laughing about the funny smiles and accents of the doctors who saw them. Meanwhile, months and even years later when an immigrant family comes to my clinic, I will remember the stories of the hardships in El Salvador and remember the smiling children’s faces. I will approach my patient with a new appreciation and understanding, for I have been lucky enough to glimpse at what many immigrant’s lives may have been like.