A Lifetime a Day Keeps the Doctor Away

What a day!! Throughout this week, it feels like I've been through a couple of life times and it's only Wednesday. There has been so much growth, and learning that could not have been accomplished anywhere else. Today I was on triage (the nursing portion where you take everyone's vital signs and learn about their past medical history). This is something that I have done quite consistently in my nursing clinicals, but doing it in spanish is a whole different story. It can be quite difficult to try to learn about a patient, when you feel incompetent in the way you are communicating. This has made me not only stronger in my spanish by using the small vocabulary I have, but has allowed me to strengthen my non-verbal communication and my willingness to reach out when I need help. I worked with an amazing team this morning for the busiest triage morning we'd had thus far, and we were able to get through it like a well-oiled machine, because we were all willing to use each other. I was able to pull over Stephanie or Ricky when I needed help with spanish, and Ricky was able to delegate some of his nursing tasks to me if he was going to help take a history. We became so efficient that Dr. Lauri had to come out and remind us, that she could only see so many patients in one day!
The best part of this morning was also another integral part of the team: Esmerelda. She is the school nurse that is at the school all year round. This morning I helped teach her how to read a growth curve, and triage a patient, while Stephanie and KK helped her learn how to do a hemoglobin a1c test. She was able to pick everything up so quickly and with so much passion. She joked with the patients and made them feel comfortable in a way that you no one else could, because she was a community member and they trusted her. That is the best part of this trip. The care given to these patients does not end with us, but starts in a new way with a magnificent light like Esmerelda. 
After we triaged a billion patients with the best team, we had a bit of downtime and I was able to meet one of the sweetest little boys who was waiting before going in to Dr. Lauri. He had awhile to wait and so I grabbed a tube of bubbles and started blowing them right outside the door. He was pretty shy, and I didn't speak much, but this tube of bubbles brought us so close together. He would giggle each time I popped one, or chased one maniacly. He kept giggling and chasing these bubbles with me for 2 hours, and it was this moment that we shared that reminded me non-verbal communication can speak volumes, because just from my goofy running, and overexaggerated popping he knew that I cared about him, and he was the focus of all my attention. At the end of Triage KK pulled me aside and told me that even if I didn't sepak spanish I still had a way of connecting with these patients, and that lifted me up farther than anything else. As someone who is so confident at using communication as my strength in english to make people comfortable, taking that strength away leaves me in my most vulnerable state, yet it helps me see the vulnerability of the patient reflecting back on me and allowing us to meet somewhere in the middle, open to learn from each other. 
At lunch we went to a little preschool called Escualita Feliz (the happy school), this was a preschool which was a sort of precursor for the school we were currently at (Ciudad de la Esperanza). The little pre-school was right next to the dump, and you could see the trash from the front steps. As we climbed the steps to the little school, we turned and saw two little kids and a baby that we triaged that morning that lived under a tarp next to the dump. This was a heartbreaking experience for so many of us, especially those that had gotten to know them this morning. It's easy to do our medical duties in the morning, and forget about where these people end up. These beaming, giggling kids lived under a tarp. In reflection later that night, we talked about how there is no point in feeling sorry for them, because they are happy, they have the talent of finding beauty in small things, like health and family, where as they should feel sorry for us for needing so much to feel grateful. Within that little school you could feel that same happiness, and passion to do the best for these kids. It had the same artwork on the walls like any other preschool, yet the teacher was the same age as me (20 years old). She explained how not only do they teach these kids numbers, or letters but they teach them how to be a good person. They took in a new student this year, a 12 year old girl that I triaged at the clinic today. She had a port wine stain on her face that caused her to have seizures. She had never gone to school before escualita feliz welcomed her with open arms. In this small community there was no one else that looked like her, so Dr. Lauri in her appointment made sure to google pictures of other people with port wine stains and validate that she is NOT alone. She is normal, and did not come out of any curse on the family. I hope this changed the way she looked at herself.
After we visited the school we walked down and witnessed in small groups the people that were scavenging in the dump to sell things and feed their families. Seeing this situation made me really validate that environmental justice is social justice. This community lives with this giant mountain of trash where they make their living everyday. What happens when it keeps expanding, getting bigger? There are aspects of the community that already living in the trash, if trash continues to pile up then it will consume the community. This will have even more detrimental health effects on this community.  
In the afternoon I was in the pediatrics room with Dr. Lauri. What a privilege to watch this woman work. She is a running faucet of information, and tries her best to make every kid that walks in feel comfortable. She whistles in their ears and pretends there's parrots when she checks them, or has a little stuffed dog stethoscope to win over those cautious toddlers, everything she does has meaning. Since this was my second time in the peds room I felt so comfortable. I liked sitting with the family, or coloring with the kids during the appointment so that it felt like we were in a circle. It wasn't an Us vs. Them scenario it was just an Us. Most of the problems that we see in the peds room are involved with access to clean water. If they drink directly from the tap or the river the kids continually get sick with parasites, and some of this can lead to mortality. We are in a unique position because we are able to partner with this amazing company called ecofiltro which has established a filter material made out of saw dust, colloidal silver and clay. By subsidising ecofiltro for this community we are able to offer not only a treatment, but a cure. Clean water is life giving, and life sustaining. It is so powerful to be able to guide this bright light of a community to continue to sustain their shine. I'm already getting made fun of for this long and detailed post, but what can I say, this community has impacted me in ways I can't imagine, and I'm only just starting to put it into words.

Kateri Dir-Munoz


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