April 9, 2015
The University of Wyoming saw over 300 persons at their clinic in Agua Salada last week. Being Holy Week we had some concern that they might not have as many patients as they would on a normal week. But, Wyoming’s clinic is well established with developed relationships of trust. Regardless of the week, the people turn out. Laura and I visit them twice, but because they are so busy, we have little time to engage with the brigade members. Mostly we just observed the coming and goings of the residents and their interactions with the students, nurses, dentist, and doctors.
We recognized an older woman who had also come to the clinic when Wyoming was last here in November. She would be memorable to almost anyone; that soft, grandmotherly look and manner that inspires you to want to care for her. She’s trying on reading glasses. She had done the same thing at the last brigade and I recalled that she didn’t have a need for reading glasses. Perhaps her memory is a little challenged. This time as before, two or three brigade members come to assist her. I inform them that she doesn’t need reading glasses. They ask her if she has difficulty reading and she answers that she doesn’t read. “What about sewing? Can you see the material and the thread?” “Yes,” she responds, “I can sew just fine.” She’s disappointed when they explain to her, as they had at the last brigade, that wearing reading glasses for her poor distance sight would not help her, and might even hurt her. Still, she and the brigade members are having a great time, laughing and conversing. Solicitous of her, the brigade members search out ways to help her. I think that they already had.
Laura spoke with one of the brigade members, thanking him for all the good work Wyoming is doing. He asked, sincerely, if in fact they really are doing any good. It’s a jarring question. A lot of brigades either never ask it, or answer it quickly and affirmatively to avoid their personal insecurity. But the question is the beginning of discernment, the beginning of mission. Everyone wants to feel helpful. It’s another thing entirely to actually be helpful. The former is about ego. The latter is about commitment. The question itself provides the map outlining the journey from ego to commitment.
On our second visit there was a meeting with the community leaders. The clinic has never been part of the Honduran health system and therefore has only been open when the University of Wyoming is present on brigade. The situation has changed now and there is a possibility for the clinic to be operational on a daily basis. This would mean regular health care for the inhabitants of Agua Salada and the surrounding areas. The community leaders expressed gratitude and praise for the committed individuals who have been coming to their village for years. They even spoke about memorializing them by hanging their photos on the walls. Then the community leaders expressed the fear they were feeling. If the clinic becomes part of the Honduran medical system would that mean that Wyoming would stop coming? Wyoming answered the question definitively. No, they would continue to come. They would continue to provide health care. They would stand by the side of the community as they developed. This response eased the fears of all present.
Is the University of Wyoming doing any good for the community and individuals of Agua Salada? Well, they built a clinic here. They’ve provided health care for years. The community is now poised to obtain regular, ongoing health care. They are known and respected by the residents. The community wants them to continue coming. Wyoming is committed to standing by their side. But even with all of that, the question is a scary one to ask, and even more elusive to answer. Though it is so tempting to document proof of our generosity, “good” is not subject to empirical measurement. It is only and always a thing of the heart.
When Wyoming next returns to Agua Salada, I suspect we’ll see the older woman return again. She will again search the reading glasses, again be dismayed that the glasses will not help her, and again find comfort in gathering around her two or three young Americans. They’ll talk and laugh and gently lead her about, searching out ways that they might help her. Once again, the question will be asked. Once again, the answer will elude us. The question, however, is so much more important than the answer.
Holy Week
April 3, 2015
Every brigade arriving here brings particular gifts as individuals and a particular dynamic as a group. Baylor College of Medicine has been here during this Holy Week under the direction of Dr. Sandra Williams. Laura and I present ourselves to brigade groups as advocates, both for their time here as well as for their continuing relationship with Shoulder to Shoulder. We attempt to discern why they’ve come to Honduras, what they want to achieve, and what are their reactions to being in an unfamiliar world. The Baylor brigade presented a great challenge to answering those questions.
Sometimes the discernment is easy. We meet an eighteen year old pre-med student with that deer-in-the-headlights sort of look and immediately know to give support and guide her experience. On the other side of the coin is the veteran brigade member who comes with great passion and energy. With him, we celebrate his sense of commitment and service. No one from the Baylor brigade fits either type. It is not that they present as distant or defended. On the contrary, they’ve been very engaging. But, their experience and background has well seasoned them. They are grateful to be here, and though the experience here is a new one, it is not something to either frighten or astound them.
They specialize in emergency medicine and work the emergency department in a Houston Hospital. They are familiar with tragedy and trauma. At the lunch table, they get along so well that I ask if they met with one another prior to coming to Honduras. Dr. Morrical answers me, “No, we didn’t do any team building. We just know one another because we work together.” From there the ER stories begin, punctuated with gallows humor that offers them a refuge and a sense of community. They know how to be kind to one another and how to be compassionate towards those in crisis.
They bring this with them to Honduras and the persons they see and treat. Still, there is even more reason for the aura of ease and familiarity that surrounds them. No one is from Texas, all of them imported there from other parts of the country and the world. Different backgrounds, races, and cultures have formed and honed their personal values of human dignity and respect. Theron, the Medical Resident from Arizona, and Rachel, the soon-to-be Yale Medical Resident from Maryland, are from mixed-race backgrounds. Gursaran’s gift is her Indian culture and she jokes of Western medicine and its insistence that there be a pill for every ailment. Angel is from the Dominican Republic, but wittingly comments that he is the only Domincan that spent a great portion of his life in Wisconsin (he has a weakness for cheese curds). I watch Angel giving a consult to a pregnant woman that has just had an ultrasound. His Spanish is excellent, of course, but rings with Caribbean flavor. He is poised, confident, and competent. He is accepted and accepting. They bring all of this also to Honduras and the persons they see and treat.
It is Holy Week in Honduras. Almost everything closes down and patients are not lined up at the clinic doors. They see patients, however, and they are likely seeing the patients in the greatest need. It is important work, specialized work in ultrasound screenings and emergency medicine. Still, they have some free time. They walk down to the waterfall and the river. Not a long walk, but a steep hill under tremendous heat. On vacation, the families have gathered there for picnics and fun. The brigade group must seem out of place among them. They are probably aware of how different they are. But then again, they are not here because they are the same. They are here because they are different; knowing, as many of us still have yet to learn, that diversity is not something to be feared and shunned, but rather, something to be embraced and celebrated.
They’re only here for a week, this Holy Week, and that’s too bad because any one of them, or all of them, could just as well live and work here. Their openness and respect to the diversity of human life and experience is a gift to the persons they are present to here in Honduras. Then again, it will be a gift to whomever they meet and serve wherever they may be.
Youth the World Over
March24,2015
Coming to Honduras for the first time, many things might make you feel uneasy because they are different from the environment your body and brain are accustomed to. But the consciousness of that, just what is different and why it makes you uneasy, lags behind the feeling itself. There are biological reasons for that, but suffice it to say it takes a little time for you to figure out what’s different here. One thing you’ll figure out rather quickly, however, especially if you’re over 30 years old, is that there is a superabundance of young people. Anywhere you go in public, they just seem to swarm about you. It’s pretty easy for your conscious brain to figure that out. The median age of the population here is 20.7 years and the life expectancy 74. In the US, the median age is 36.9 and the life expectancy 79.8. That’s a huge difference. Public and social life is dramatically different here because of it.
Life for adolescents and young adults is much more structured in the US than here. In the US, almost everyone is in school until at least 18 years of age, and a significant proportion continue with higher education. In Honduras, 60% have finished their education by the sixth grade, much fewer attend or graduate high school, and in realty almost no one goes on to higher education. In the US, young people who are not in school are generally in the work force. In Honduras, those who are in the work force are generally pretty young, but work itself is pretty scarce. Besides these two most obvious and striking differences for the socialization and personal development of youth, the countless supports for adolescents and young adults in the US are rare to non-existent here. Here, families and culture are the principle, if not the only, supports for adolescent development. Some families provide this support superbly. But many families are simply too challenged. Mothers are too young, fathers are too distant or not present at all, financial hardships are too demanding, and older siblings take on parenting roles too young. There are already too many young people, their numbers expand exponentially, and all the while the structures and supports to be a healthy, happy young person are shrinking.
Dr. Martha Kubik and the student nursing brigade from the University of Minnesota have been in Southern Intibucá this past week. Their focus, a much needed focus, is adolescent youth. Laura and I met up with them in Camasca at the High School. We were with them in the auditorium where they were seeing fifteen to twenty year olds. Dr. Kubik was very busy organizing the event, but she had a few minutes to speak with me. With a beaming smile she said to me, “Look at these kids, aren’t they wonderful. They’re just like kids in the US.” I have to admit her statement initially threw me. The difference in experience for kids in Honduras and kids in the US is stark. Honduran kids face challenges that, quite frankly in my opinion, no kid should face. But, I had the opportunity to observe the kids gathered in the auditorium and reflect on what she said. First I recognized that what she said was absolutely correct. Second, I realized that she fully appreciates the challenges for Honduran youth and was responding to them justly and with compassion.
There is a universal experience to what it means to be an adolescent. There is a biological component and its consequent expression in socialization. I watched how the kids touched one another, testing and experimenting. I watched their vivid, almost exaggerated, expressions; moved deeply it seems by life’s fullness and its affect on them. They smile widely at one another, but alone, unwatched, deep sadness can cast shadows over that brilliance. Boys tease girls almost ceaselessly. Girls feign annoyance, glaring at them disapprovingly, then turn to their girl friends with knowing pride. They are insatiably curious. All of them questioned the cards they were given by brigade members. Two simple English words, “vitals” and “screening,” were written on the cards indicating the two procedures they were to have. All of them wanted to know what the words meant. The brave ones called me or one of the interpreters over to translate. A very industrious, young man left the auditorium and returned with an English-Spanish dictionary. Unfortunately, it didn’t help. Challenge and discovery, fear and joy, love and rejection intensely fill their days. The world, their futures, are yet unexplored; terrifying demands and limitless opportunities. Whereas if I studied them carefully I could note the subtle cultural and environmental influences on their behavior, this would dishonor the primary influence of their journey. They are discovering who they are and how to be one with another.
Dr. Kubik and the University of Minnesota, after extensive research and focus groups here in Honduras, have designed an interviewing tool to use among adolescent, Honduran youth. First they are weighed, measured for height, and have their blood pressure checked. Then they sit down individually, one on one, to dialogue over a few key themes of how to be a young person. Two of the brigade members were Spanish-speaking, and three were assisted by translators. The interview speaks to nutrition, exercise, sports, socialization, relaxation, and a variety of youth health themes. It also touches upon mental health, sexuality, and drug use. The content is excellent. There is no demand that the young person converse. Some might. Most don’t. But they know that many of the things they’ve been feeling are not a mystery. It’s the normal process of life and socialization. If something is discovered in the process that gives concern for the well-being or the health of the young person, a referral is made.
When the interviews were over, I watched the brigade members coming back together with the group. They all displayed a satisfied, even joyful, expression. I asked each of them how it went. They all thought it was meaningful. They all seemed to gain a sense of fulfillment. I imagined that for many of these kids this might be the only time someone has explained some of what they are feeling. How essentially important that is! When we honor someone else’s experience, when we can reflect our common humanity, we are sharing a precious gift. Though there is so much more the kids in Honduras need, without this gift of honoring, we would simply miss the real point of it all.
Thank you Dr. Kubik and all of the Minnesota nursing students for honoring the youth of Honduras.