California

The final leg of my journey this past summer (I know, these posts are a bit late) was 4 days spent with my family in a cabin in the mountains near Lake Tahoe. I got a bit of a shock upon arriving at the airport where a friend of my dad's was there to pick me up.

"When was the last time you talked with your family?"

His comment made me feel a bit uneasy, "Uhhh, 2 months or so, but we've been emailing... why?"

"Well, your mom broke her leg."

"What!?!"

"But she's ok."

"phew... OK... what happened?"


And she is OK. But it was a good shock to me at 12am after a day of traveling. It turns out my parents and brothers had decided to do a hike down to a river and camp the night a few days before I was to arrive. That was the plan at least.

The hike ended up being longer and more arduous than they had planned and in one slippery spot my mom went down and instantly felt a shooting pain in her leg. She tried to walk and was unable to. By this point my brothers had forged ahead to set up camp early and thus my dad had to tear off after them to get them to return and help. They got my mom to a comfortable spot by a creek close by and decided to spend the night and see how the leg was in the morning.

No better it turned out. They had a good 7 miles to get back to the cabin, up out of a valley, over rocky terrain. Using Patrick's hiking pack and a flat piece of wood they forged a carrier and proceeded to take 10-15 minute turns carrying my mom up out of the valley. It was slow going and they had only gone a few miles after most of the day. Just at this time though they happened to meet some rangers out doing wild life tallies who just happened to have their truck nearby on a fire road my dad wasn't aware of. Saved!

The story has gone down in family lore and the piece of wood my mom sat on for 7 hours as they hauled her out now sits on my parents mantel.




(At the cabin with my mom recovering and my brothers making faces)


When I arrived my brothers had gone back down to the river and My dad and I hiked down to join them the next day. It is one of the most beautiful spots I can think of that isn't a national park type area and I wanted to share a few photos. Note, for those of you familiar with it the countryside shown in these photos is a part of where the Western States 100 miler is run each year.




(Devil's Peak)




(Long lake - so blue!




(A big tree with my dad)




(At camp. this camp was pretty decadent for camping with a great fire pit, nice sitting stones, flat tent spots, hanging trees - the works! five stars.)




(A waterfall we descended by climbing down the first part on the side and then jumping off the second fall.)




(Matthew taking the leap! We three bros adventured down-river, jumping from rock to rock, swimming when needed, and jumping down waterfalls as often as possible. We would toss our dry sack of supplies over the edge and then head after it! Sometimes with falls of over 50ft!)




(Click on this one to get a bigger version. See if you can find Matthew in the upper right corner:) this was about the biggest one we went off.)

The trip was a capstone to a great "last summer of freedom" before coming back to start second year. which, as it is now more than half over with has for the most part been an enjoyable experience!

Guatemala

After Mexico I didn't think that going to another country in Central America would be that different, shoot, Mexico and Guatemala even share a border! But I was wrong. Words, food, buildings, countryside, customs, weather, and more were all quite different and it gave me a bit of a culture shock to be honest!

What were we doing? First off, "we" was a group of first year medical students and a number of physicians. We were on the shores of Lake Atitlán in the town of San Lucas Toliman to partner with the local mission in delivering medical care to a number of the 17 small towns located in the mountains surrounding the lake. The mission employs two health promoters who work closely with the foreign medical teams to facilitate as much follow up for patients as possible. I quickly came to see the success of the program we were assisting with rested on the shoulders of these two men, Vicente and Jesus Antonio. We would have been toast without them! For one, many of our patients spoke Katchikel (one of Guatemala's 23 indigenous languages) and thus they would have to translate from Katchikel to Spanish which we then had to translate into English as our attendings did not speak Spanish. They also knew most of the patients, could recognize many of the disease presentations, and new what resources we could recruit for patients.

But, before clinic specifics a few pics to give you a sense of where this all took place. I found the area we where in breathtakingly beautiful and the following pictures only do partial justice.

One common site that I do not have a picture of (because I would have felt weird taking one) is men walking on the side of the road bent over with a huge load of branches that have just cut up on the mountain and now have wrapped in ropes that come to a point around their forehead and are bringing into town to sell.



(Our team.)




(A view from the hotel we stayed at out over lago Atitlan.)




(A morning view of the lake.)




(The lake with one of the several volcanos that ring it in view)




(An erupting volcano I saw from a morning run!)




(Morning run view of devastation from Hurricane rain damage months earlier. I usually think of water as something I enjoy drinking but this morning was all about the aftermath of its power.)




(What used to be a tranquil/small stream bed...)




(A typical street. dogs were everywhere! In fact, they were so common and considered pests that twice a year poisoned meat is put out to try and reduce their number. From my observations this had been of limited success.)




(The two main forms of transportation. Ever wonder what happens to school buses after they are retired in the US? Why, they go to Guatemala! Where they get painted fancy colors, accessorized, outfitted with sound systems and bright lights and used as general buses. For some reason the bigger a vehicle is the faster it is driven - aka the buses race around tight twisty pot-holed roads at speeds that have you predicting an accident every other moment! The man who collects the bus fare will climb out the back emergency exit while the bus is moving, traverse the roof while outside, and then pop in through the front main door! I was told many of them die or get injured doing this.

The other transportation method common is the little 3-wheeled vehicle you see above called a tuk-tuk. They are everywhere and race around honking their little horns. They function as in-town taxis and you have to continuously be on the watch to not get run over!)




(Two brothers with their wares. They tried to sell me things but soon realized i wasnt going to buy and then talked with me. I ended up seeing the man on the right all over town. his name escapes me now. each time he saw me he would excitedly shout my name and we would chat for awhile. One memorable meeting happened when I was heading back from clinic and he was going out to buy bread. I accompanied him and we talked, bought bread, and then ate it together. Nice!)




Clinic



(This pic is our team crossing a spot in the river where the hurricane floods had destroyed the former bridge. We hauled all our supplies over the two little wooden bridges you see and up another 200m to have clinic. A normal trip to clinic involved a sketchy ride in the back of a truck up steep mountain roads but our river crossing adventure topped even that!)




(Riding in one of said pick ups!)




(About to set up clinic. Kami, Gus (from the mission), and Jasen L-R).




(Inside a clinic. Patient privacy you say, what is that? We did the best we could with what we had. Needless to say no pelvic exams were performed.)

As you can see space was an issue but even though there were no walls between exam rooms and we often didn't speak their language the patients we saw did not complain. As medical teams rotate through the 17 communities there are sometimes month long stretches in which no medical personnel will come to a particular community. It made for rewarding and humbling work.

One situation that was hard for me was a Saturday we held clinic and our pediatrician diagnosed a newborn as having down syndrome. She also heard abnormal heart sounds on exam and was worried the infant's heart was not correctly formed (this is common in down syndrome babies). It fell to me to translate to the mother during our entire encounter that her child was not like most babies and that he needed to see a special doctor to check his heart. The language and cultural challenges of this case left me feeling overwhelmed. I do not know if the mother can afford to see a pediatric cardiothoracic surgeon. The Guatemalan nurses present did not seem too fazed. Many babies do not make it there. if this one was not healthy enough to survive it simply would perish.




Hike




(This is a pic from a morning hike I led some students on. We had been told that hiking into the hills/forest would get us robbed but after 10 days of only looking at the beautiful highlands I had to check them out. I took a solo hike with no valuables (in case I was accosted) and encountered no problems. So, the next morning I led a group up the same way at 6am. Looking down at the waking town as the mist lifted was awesome.)




(San Lucas Toliman, morning)


Carlos:

A fun evening activity that our group participated in was an evening soccer game in a small turf field fenced in on all sides with 4-6 players per side. Ball handling was the name of the game and I lacked in this area to say the least. The turf provided tremendous traction, so much so that one evening I rolled my ankle fairly badly. I decided to return to our hotel and see if I could find some ice.

Upon entering the front gate I saw Carlos, the man who came in the evenings to work as a guard. I asked him if he knew where I could get some ice and he said no, but that his day-job was a "curandero" or healer and that he could help me. What the heck, I decided to give it a try. He busted out a small jar of green paste and started to massage it into my ankle. We began to chat and after 15 minutes or so I got up and walked a bit and you know what, it did feel better than before! From that point on I would stop by and talk with Carlos each evening. Even though he did not have many material goods he said he was a happy man because he had enough of the basics and he had his family. I learned that he had not spent a single night at home in his own bed with his wife in several years as he does not have any days off from his guard job.

Two days before I was to leave he invited me to visit him at his home. I took him up on it and ran over the next day in the late afternoon. He was working when I arrived and there were several patients lined up to see him. He took a break to introduce me to his son and a gaggle of grandkids. Then he took me into a side shed were he showed me his art. This consisted of wood that looked like a blossoming flower. How had he shaped it I asked? Nature did, he just revealed it was his reply. And he wasn't kidding! What I was looking at was a branch of an avocado tree that had been infected with a parasitic vine that burrowed into the avocado tree to extract nutrients! Where it attached to the host tree there would grow out a nodule that was half avocado tree and half parasite vine. Carlos laborously extracted the parasite portion and was left with the most amazing looking wood shapes that he would then combine into new forms for his art. He gifted me a small one and you can see it below.




(the wood flower)




(Saying goodbye to Carlos the morning I left. I am not sure I will see him again (although I hope to) but I will not forget him.)

Mexico

Somehow traveling by plane has a way of making things seem surreal upon arrival. It's just too fast I guess. One moment I was hanging out with my family on Bainbridge Island and the next I was stepping out of an airport into a muggy afternoon in Guadalajara with people speaking Spanish all around me.

First, the who, what, when, where, and why.

Who: (see pic below)
What: A service learning project through the University of Wisconsin medical school in partnership with the University of Guadalajara in which we carried out community health and wellness projects with local partners.
When: June 20-July 25
Where: Mexico, state of Jalisco in several small rural communities
Why: Our mission in two words was “aprender serviendo” or service learning. In greater detail, we had traveled to this part of Mexico to learn how to find out what matters to a community and how to assist in achieving said goals regarding health and wellness.




(Our team. L-R Me, Dora a nursing student who worked with us, Maria - our team leader and long time nurse/university professor, Joel a fellow medical student, Melissa a fellow med student, and Alyson a Spanish and Library sciences grad student who was with us for the first week and gave several talks on accessing free online medical literature.)

My plan here is to share a bit of what happened in each community and then tell a few choice stories.




(The church in Tepatitlan, a medium sized city we stayed in for several days before starting our project. It is also the location of the University we partnered with and where Maria lives.)




(A pastoral view of Tequililla.)


Tequililla:

This was the first community we traveled to and the one we stayed the longest at. During our two weeks in Tequililla we were housed with the local health promoter, Berta, and her family, which turned out to be a definite highlight.




(Berta and 2/4 of her children with our team. L-R Me, Berta, Melissa, Joel, Jorge, and Kary)


Upon arriving in Tequililla we held a town meeting of sorts where we outlined what areas we (three medical students) had experience in, asked what projects the town was interested in, and came up with an itinerary together. Before going to Mexico we had talked with Maria and she related several ideas the community had passed on to her (as she had been working with them for over a year) but at the meeting the community seemed more interested in a different set of ideas. For example, I had put some time preparing to run a healthy cooking/nutrition series of classes but most of the people were more interested in a workshop on how to make soap. I guess I should have known that things always have a way of changing:)

So, what did we end up doing? A whole hodge-podge of things but in the end they all linked back to health and wellness somehow. One of those projects was renovating a dilapidated volleyball field and getting games going almost every evening. This single act ended up being one of the best things we participated in as the daily volleyball became a main avenue through which we came to know a great many people in the community, built trust, and ultimately increased interest and participation in the other projects. Volleyball is great because really anyone can play (you don’t have to be in the best shape) and we always had mixed teams of all ages and both sexes.




(Volleyball!)


As this was a farming community in planting season people would work all day. This meant we had to do our programming later in the evening. For example, we would show up at the volleyball field around 6:30pm and start playing. People would gather over the next hours and we would play until dark (around 8pm) at which point we would transfer to our evening event from 8pm-9/10pm.

These other events were variable and consisted of:

- Salsa dance classes (Joel and Melissa are great dancers and no one knew how to dance salsa there – they all dance Banda instead and later taught us a bit of it!)
- Yoga classes (Melissa and I had experience in this)
- A basic bike maintenance class (I had worked in a shop for 6 years and Joel knew some as well)
- A more traditional health talk (which then prompted several personal visits as family members of individuals too sick to attend wanted us to visit their loved ones at home)
- An artisan soap-making workshop combined with a game to teach how infections spread and a demonstration of the most missed spots during hand washing
- Star gazing via telescopes we had brought
- Volleyball and soccer tournaments




(Preparing for the telescope workshop that night by spying on people working and cows. The telescopes invert the image and the kids got a huge kick out of seeing all the cows "upside down":)


The soccer tournament was particularly exciting. The day it was planned for dawned gray and it soon began to rain. We arrived at the field at the appointed hour and found a few kids already gathered. When we inquired if they still wanted to play the answer was a resounding, “Si como no, no somos de azucar!” or, “Yes, of course, we’re not made of sugar!” And so it was on. The rain continued and by the final match the dirt field had become a mud pit. Joel and I felt like ungainly giants almost unable to change direction on the slick surface. Much of the community came out to watch from a covered area and after the game Joel had the idea, after everyone else had cleared off the field, to run and slide on his stomach. We did it at the same time and right after all the other kids ran back on to the field and started sliding as well. We did a mass group slide for the cameras and came off the field laughing and smiling. It was a special moment; you could almost feel the excitement and happiness emanating from those involved.

(Post trip note: Alejandro, one of Berta’s sons who helped us on many projects and refereed the soccer tournament, informed us over facebook that the community has continued to hold soccer and volleyball tournaments after we left – awesome!)




(After the soccer tournement:)


While walking around the community during the day we noticed that there seemed to be a lot of people smoking. Could we do anything in this regard? I thought back to training I had received during my Americorps year on how to develop a smoking cessation plan and based on that I worked with Berta to develop a “Quit Plan” that she could use help her fellow community members who wanted to stop smoking. The plan attacks smoking as both a chemical addiction and a social addiction. For the chemical part we discussed the proper use of nicotine patches and I researched where to get them and the price. But even without the patches having a plan can help and thus we spent most of our time on the social addiction.

One starts by designating a quit date several weeks in the future and making sure everyone knows about it. Then, it is important to break the link between smoking and daily events. For example, if you smoke a cigarette with coffee every morning, for the next 3-4 weeks before your quit date you will have to drink your coffee and then wait for 15-20 minutes before smoking your cigarette (outside). Doing this with the other “linked smoking events” in your day will make quitting easier as you won’t be constantly thinking about cigarettes as you go through your daily activities. However, assuming you won’t have any desire to smoke is not reasonable and thus one also must prepare several emergency strategies such as taking 5 deep breaths, chewing on gum, etc. to deal with strong cravings.

Before leaving Tequililla I pretended I was a patient to help familiarize Berta with the material and also ran one cessation session for two co-workers who wanted to quit smoking. Their quit date was August 8th and I hope they had success. This was a project that had potential to be of real use long after we are gone and I am hopeful it will be so.

Switching topics, a few pics of one of my favorite things – food:)




(The kitchen with us at breakfast, my favorite room in the house:) There was always much laughter, great food and good conversation when we gathered there.)




(Joel grinding up corn kernels for later use in making handmade tortillas. The food overall was spectacular. I like Mexican food in the states but down there is the real deal! Nothing like a taco with handmade tortilla, special local sausage, avacado and freshly prepared salsa - yum!)




(A typical, yet amazing, breakfast. This was one was made on a wood-burning stove. Sweet-potato, gorditas (a thick patty of tortilla dough with beans or cheese inside, avacado, and cheese. We finished things off with mangos (not pictured))

As we spent the most time in Tequililla it proved the most rewarding for me as we really got to know people in the community. Our second week there we had lunch invitations at a different house every day!




Presa de Barajas

This was our second stop and we only stayed in Presa for about 4 days (Presa means “reservoir” in English). Our first night there we were invited to the Quinceñera of a relative of the people we stayed with (a “Quinceñera” is the huge 15-year-old birthday bash that marks when a girl transfers to being a young woman) . They were frying a great number of items in hot oil (tortillas, chicken, nopales (cactus)) and more) and even though it was 11pm and we were pretty full we had to eat so as not to insult. From there we were asked to participate in karaoke and we all three gave our best shot at a Linkin Park song which must have sounded pretty bad but was, I think, a goodwill gesture that earned us some community points:)

That night we were shown to our lodging, a formerly nice house that had not been lived in for the past 10 years. Our first evening the power shorted out (and while trying to fix it the family who owned it almost caught the box on fire before giving up!), then the water stopped flowing to everywhere except the shower head, and during the night I heard scratching in a cupboard and opened it to find three mice staring at me with a look of, “what are you doing here, this is our house now.” All that being said it provided a roof over our heads (albeit leaky) and we made due without too many problems; we just had to get creative, use our headlamps, and take freezing showers:)

So what did we work on in Presa? Four days wasn’t much time, but like Tequililla we held a meeting, came up with a plan, and by running around 3 activities per day we were able to fit in quite a bit! The citizens of Presa were very eager to participate as much as possible. Many of the activities were the same (salsa, health talk, yoga, volleyball, soap making) but there were a few differences.

One of these was turning the peanut chicken cooking idea into a community event. We did this and incorporated local vegetables such as keleite (a local green-leafed vegetable much like spinach). The reception here was mixed, some liked it a lot, others (including many kids) not so much. Compared to the food that is typically eaten our meal had way more vegetables, way less salt, and a completely new flavor so I couldn’t have expected it to be a taste-bud success:) Many of the adults though were interested by the fact that it would be a good meal for those with diabetes or those looking to prevent it.




(Part of our cook-off team for making peanut chicken.)



Las Jicamas


This was our final community and we only spent 3 days here (and no nights as it was so rural and remote that Maria was of the opinion we would be bitten by snakes or scorpions and die and therefore wouldn’t let us stay).

Our main project was to turn a messy storeroom into a library. This had been identified as a project the community was interested in by a UW group that had traveled to the site the previous January. The room designated for the library already had a great number of books but no one had been able to get shelves, organize, paint the room etc. We enlisted the help of numerous local kids and over the course of several days we, well, you’ll just have to see what happened below!




(The building on the left was a former school storeroom (inside view below) that was designated for remaking as a library.)




(Inside the room.)




(After!)




(Melissa had the great of idea of doing a tree mural where the leaves were handprints from kids from the community!)


The area around Las Jicamas has many nopales (a special kind of cactus that provides both a vegetable and a fruit). One can eat the new paddles (boiled and cut up in a salad with tomato, cilantro and onion, or grilled whole) or the fruit that gives rise to the flower. The fruit itself is quite juicy (almost watermelon texture) but with a unique (and delicious!) flavor all it’s own. There are quite a few seeds but they are easy to eat and swallow. Extracting the fruit can be tricky though as it is encased in a thick outer covering full of small spines that are almost impossible to remove from ones skin.




(A nopale or cactus. This plant provides a great deal of food. The new pads are cleaned of spines cooked and eaten and the little ovals you see are the fruit which are called "tunas".)




(Preparing the tuna. First you have to rub it in the grass to remove the many hair-like spines, next cut off the ends and then slice it vertically to remove the fruit.) Then enjoy!




And now some adventures/stories:

1. Under the Rock

On one of the open days we had in Tequililla I decided I was going to hike to the farthest off huge hill/small mountain I could see from the farm and climb it. I reckoned it would take about an hour to an hour and a half to make it up and the same back. No one wanted to go with me so I set off by myself with a nalgene of water, my camera and two bananas. For some reason the hill didn’t seem to be getting any closer for the longest time but after 2.5 hours I finally made it to the top. There were probably going to think I had been killed by narco-traffikers as my faulty time/distance estimate meant I would be getting back about 2 hours after I had told them (and they did end up thinking I had gotten lost/abducted or been killed even though we were in a safe area of the country. But, that isn’t the point of this story.) Once on top I had a strong urge to defacate and figured I would just pry up a rock, go under that, and no one would ever know. I found a suitable candidate and after lifting it up I was about sink down into battle position when I spotted some movement. Looking closer I saw it was a scorpion! It was small, about an inch long, but I had heard the smallest ones are the most poisoness – yikes! I got a stick and played with him some; his sting reaction was super fast! I threw a grub in at him and bam! A quick sting and the grub thrashed around for 15 seconds or so before remaining still. Eventually I reckoned I should leave the poor guy alone but it was my first scorpion and I was just so excited!


(My scorpion friend!)


2. Mad Cows


On the way back from playing with the scorpion I had to pass through a field of cows that had given me some dirty looks on the way out. This time they were on the other side of a fence but the fence was open at one spot a ways ahead of me so they could cross back over if they wanted. As I started to pass the herd several large ones took notice and began to moo vigorously. Soon the other 30 or so cows took note and began to moo and follow me. Now, they were still on the other side of the fence at this point but they would be able to cross over in about 100 feet when we reached the opening and this was not something I wanted to be around for. I picked up the pace and started fast walking. The cows increased their pace and matched me, coming closer to the fence and bellowing. Now I was getting worried, what was going on with these cows? There was no one else in sight. I stopped to see what they would do and they stopped too (where I took the pic you can see below). We were still a bit off from the opening and my plan was to sprint past and if they spilled onto my side and chased me I would try and hop the 4 foot barbwire fence and land on their original side. With this in mind I took off – and so did the cows! They were running right behind me on the other side of the fence and bellowing! For whatever reason they did not cross at the opening and we ran another quarter mile or so this way before their pasture ended and I escaped. Whew!




(The herd right after their initial bluff charge staring at me after I had stopped.



3. The Beach


I have already introduced you to Joel who is a fellow second year medical student (one of three of us on the trip). It turned out that one of Joel's uncles had moved to Mexico permanently 12 years ago. Joel had not seen him since he left Wisconsin but we were only a 5 hour bus ride from his house on the coast and he informed us he would be happy to have us come visit!




(Inside his canal-side house.)


Besides free lodging Joel's uncle graciously provided us with all the food we could eat. As his uncle happened to be a chef back in Wisconsin this turned out to be a mouth-watering experience twice per day.




(A seafood paella he prepared for us our first afternoon there!)




(One of the beaches we visited. This one had great waves for boogie boarding, which we did for hours on end.)




(Sunset at the beach. For the last rays we swam 100 feet offshore and bobbed up and down as the sun sank. The ocean seemed to be on fire.)




(Another shot)



4. The Burn


This story reaches back to the time we spent with Berta and her family. After trying so much good food they had prepared for us we decided to share something we know of. I used the same peanut-chicken recipe I cooked for my Ecuadorian host family and once again had to prepare the peanut sauce from scratch (peanut butter, milk, oil and chiles) as one cannot buy pre-made peanut sauce in Mexico.

Everything was going to plan and I decided to go to the bathroom quick before we served the meal. About two minutes after getting out of the bathroom I started to feel a burn that spread up inside my urethra (where the pee comes out in guys) that intensified quickly. What was going on? Did I have a rapid onset STI? I couldn’t think of anything that would have put me at risk… but the burning, it kept getting worse and worse. I tried to go to the bathroom again to see if I could “pee out” the problem but it only increased the pain. What was going on?! Then it hit me. The chiles! I had not washed my hands after splitting the chiles open (by hand in fact as I was in a hurry); I somehow must have self-contaminated myself and it had traveled up my urethra!

The meal turned out to be a hit but needless to say my enjoyment of it was tempered by the penile burning I was experiencing and that lasted a good 30-40 minutes.

Lesson. Be careful when mixing chiles and the use of bathrooms.

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So that’s all for now. I hope to have to my Guatemala experience out soon but in the meantime I’d love to hear from all of you!