Return to the US

I have been home for about a week now. There are a few things that I miss about living in Guatemala, but mostly there are things that I wish we did differently here. I'm not going to pretend that I don't enjoy the hot luxurious shower, or the warm water in the kitchen sink, but the excess here is pretty shocking. Mid-December, with all of the holiday excitement, is probably one of the most difficult times to return to the country after being in a poverty-stricken place.

My friend Becca described my feeling as "materialism guilt." I'm simultaneously torn between wanting the pretty shiny things and the peppermint mochas, but I'm also acutely aware of the items that I'm buying. I had no problem gift shopping in Guatemala, Cody will certainly tell you that. But half the stuff I bought there I bought because I wanted to give the money to the vendors and artisans. I enjoyed shopping at Fair Trade stores, and buying things on the streets. But here, it's back to the Wal-Mart style shopping, that makes me a little bit sad. It's hard not to think "oh, the cost of that necklace could feed 'x' number of people..."

This isn't the first time I have gone through this before. In fact, about 6 or even 9 months ago I remember telling myself that it was time for me to get out of the country again, because I was starting to want too many new sweaters and shoes and stuff. It comes and goes, and hanging out where I do I easily can slip back into the appreciation for pretty, new things.

Have you seen those ads from non-profits that suggest that you give someone the gift of a charitable donation in their name? I have done those a couple of times for people, and this year was the first time that someone did one for me. It might seem silly to someone who so thoroughly enjoys the latest and greatest, but it actually made me really happy. Opening that email telling me that a gift had been made in my honor made me smile that sort of smile that comes from deep within. I still feel warm and fuzzy as I think back to it. My friend was right, this was something I'd enjoy much more than a new pair of earrings. There is satisfaction in knowing that someone was given something that he or she really needed, instead of something (admittedly fun) that I don't really need.

I struggle with wondering if this materialism guilt is a good thing (a realistic thing) or not. I have no doubt that some awareness of our spending habits and our wealth is important. Now comes the question of what to do about it. Maybe I'm not going to sell my diamond ring and feed the hungry, (but then again, should I...?), but I think that a conscious effort to literally share the wealth is important.

This brings me to another important lesson. I have always felt that we have an obligation to do our absolute best to make the world a better place. In Jewish tradition this principle is called Tikkun Olam (translated: repairing the world). I take this principle to mean more than just spending wisely and being responsible consumers. To me, this obligation extends to using more than financial resources, but whatever skills and knowledge we have. At this time, I am searching for a pediatric nurse practitioner job in the Boston area. I am not too far into the job hunt (I've sent out about a dozen applications), but the stress that I am starting to feel is actually not financial. I am stressed because I feel like I have a skill to be offering the world, and I have nowhere to use it. I feel like being idle with any resource, even skills, is wasteful.

After all these heavy thoughts, the question becomes what to do. Well, first and foremost, I have to find a job. But obviously it goes beyond this. I'm an advocate for responsible consumerism, including both spending wisely, and buying fair trade, local, and organic as much as possible. I'm not saying don't buy the stuff, but think about how much you need it, and when there is a choice about the source, take into consideration fair trade, organic, etc! As for materialism guilt, I'm not writing it off, nor am I going to let it take over my shopping. It's a good reminder to help you slow down and buy responsibly, but even responsible consumerism isn't going to change the world. It's going to have to take some Tikkun Olam, and careful work.

If you are interested in donating to the clinic where I was working in Guatemala, here is the link. http://www.primerospasos.org/donate.html They offer an option to donate in someone's name as a gift, and there is other information about donating. I definitely care a lot about this organization, and I think they use their money wisely, but there are plenty of places that are worthy of donations.

Goodbye Dinner with Friends at Cafe R.E.D.

I wrote about Cafe RED in a previous blog post. The owner, Willy, offered us to have our goodbye party there. Cody and I both left the clinic at the same time, so we decided to do an event together. Neither of us wanted much of a party, and we didn't want to make it into such a big deal. Willy offered that we could buy a bunch of food and cook it there for our friends. It turned out really well, and we had 6 people cooking and doing food prep! It was great to get people involved, and have a nice place to hang out all afternoon while we made dinner. My favorite kind of party! We had indonesian coconut pineapple rice, and a tofu peanut sirfry. I also made a chickpea spread for an appetizer, and we had homemade bread and some tasty cheese. It was some good eating!

At the end of the dinner we had a little moment of thanks from the clinic. They kindly made us these certificates honoring us for the work we have done at the clinic. This is Margarita (and her son), presenting them to us. Margarita is the clinic's director.

Last Day at the Clinic

Saying goodbye is tough, but the last day at the clinic was much more than that for me. Half of the day consisted of wrapping up the projects that I had been working on, and the other half of my time was filled by seeing patients.

I took pictures with my second to last patients, and they were very sweet about it being my last day. I just wish I got some action shots, but the smiles are pretty great, too. :)


Read the blog I wrote about the suero project, and you can get a sense of some of the wrapping-up we were doing. It was a busy day, but it was exciting to see how much work we had been able to accomplish. It was nice to take a moment and reflect on what was done. We were given many thank-yous, and very sweet goodbyes.

I counted up my totals, for the figures I have to report back to Hope Through Healing Hands, and I saw 293 patients with the clinic, and did formal and informal training sessions, which included 42 people. Cody and I left the clinic with materials to treat malnutrition and prevent and treat dehydration. It has been a really valuable experience, hopefully for everyone involved.

Suero Project: Making ORS with easy to obtain, locally available ingredients

Dehydration from diarrheal illnesses is one of the leading causes of death in the developing world. We have fewer diarrheal illnesses in the US (mostly due to clean water and food), but in places like Guatemala, gastrointestinal infections are very common. In order to prevent and treat dehydration for these people, oral rehydration solution (ORS), or as they say here, suero, is used. Suero isn't everyone's favorite thing to drink, but it can be life saving!

One of the things that Cody and I noticed at the clinic was that there is rarely enough suero to go around. We did the calculations, and it seemed like we were only giving out about a tenth of what we should be distributing. We often run low, despite the rather frequent pharmacy deliveries. The supply was clearly in need of some help.

Cody decided that we should try to make our own suero at the clinic. I could see that this was going to be big, so I asked him if I could help out on it, too. We looked into a few methods, and decided that it was feasible. In some parts of the world people make a very basic ORS out of sugar, salt, and clean water. This is pretty basic, and the World Health Organization (WHO) has specific guidelines about how to make an even better version. The only problem was, when we looked at the WHO recipe, it became clear that we were not going to be able to obtain a key ingredient: potassium chloride. We looked into various ways of buying it abroad, and getting it transported to the clinic with volunteers, but decided that wasn't a sustainable (or very feasible) option.

We looked into our possibilities here, and ways to get potassium into the suero. In some of my research I discovered that unrefined brown sugar actually has a lot of potassium in it. By chance, we were able to find a bag of ground panela, or piloncillo in a store. This artisanal product is not only flavorful and sweet, but also has a whole lot of vitamins and minerals in it. Cody worked closely with his friend Jonathan to come up with a recipe that would allow us to do the best we could with the ingredients we had available here.

In the end, we came up with a recipe for suero that we can make at the clinic! Through Willy's help at Cafe R.E.D. we were able to get in touch with a cooperative of local farmers, who grow panela organically. We now have a regional, organic source of panela, that we can purchase through an organization that we respect. We also got several pounds of salt and bicarbonate. All items are in containers at the clinic, and can easily be measured into liter-sized amounts of suero mix, and given to patients in little plastic bags.

And the best part is, Cody did the math, and it turns out that this recipe is 1/10 the cost of the old suero packets we were buying at the clinic! Now for the same cost, we can treat 100% of the patients who need suero, instead of just 1/10!

Cody has been working on writing up a report and presenting it to the clinic's board in both the US and Guatemala. But the reception at the clinic has been overwhelmingly positive.

Here we are showing off our supplies, about to teach people at the clinic how to mix up the batches of suero mix.

A Place of Inspiration: Cafe R.E.D.

One of the great things about being in Xela is being surrounded by so many inspired people. The city seems to collect young idealistic people looking to change the world. As cheesey as that may sound, it is great to get the chance to meet so many interesting people.

One of the coolest people I have met here is a Guatemala guy named Willy. He runs Cafe R.E.D., which is located about 2 blocks from my house. Cafe R.E.D. is way more than just a restaurant, it's an educational program and a source for fair trade goods and organic veggies. The walls are currently half covered in murals, and the other half in a photo exhibit trying to help young women improve their self esteem. Half the time I go to visit there's some board meeting or class going on. It's a really neat multi-functional space. They host cool events, have art shows, fair-trade/organic/crafts markets, and a whole bunch of interesting people gather there. One of the reasons I have been working with them was to get connected to a co-op of organic farmers that sells panela (unrefined sugar) in powder, which we are using for the ORS/suero project. Willy introduced me to the head of sales at Kuchub'al, and we were able to make that happen.

This is the place where I went to make pumpkin pies.
They actually posted some pictures of the final product, the Thanksgiving dinner. I didn't attend, because I headed off to Antigua with Luis, but I heard it turned out well.

Here is a link to Cafe R.E.D.'s webpage. If anyone is ever in Xela, you should check them out.

Another reason why I like Cafe R.E.D. is the fair trade store. In there, I found a documentary about a coffee farm a couple hours away called Santa Anita. The documentary talked about the events leading up to the start of this farm. The tragic past, tied with the conflict/revolution here gives meaning to what the families there are doing today.
The film is available on youtube, from this website, if anyone is interested in seeing it. After all of my project-work at the clinic, it made me realize that no matter how much I try to treat symptoms of social problems, they will always return unless we treat the source of these problems. True preventative medicine is much more about social issues and politics, helping people meet their needs, rather than prescribing vitamins and such. It's pretty thought-provoking to see what people here have lived through, and perhaps even how little has changed since the start of the conflict here decades ago.

Willy is doing a great favor for me and my friends, allowing us to come and cook on my last night in Xela. It's halfway between a restaurant and a home-made goodbye party, and I think it will be great! Plus it's a great way to support an organization I care about.

Quilt Project

One of the things that constantly impresses me here is the indigenous clothing. Women have gorgeous, intricate clothing, embroidered and woven. As much as I love the fruits and vegetables sold in the market, my favorite part is still the dress shops, where whole families go to shop for an outfit for one child, or one of the women. I have decided that I would like to take some fabric home to make a quilt.

All of the fabrics that I chose were some of the traditional weavings. Most of these fabrics are what the women here use for skirts. I have two more intricate cloths, one is actually a little girl's shirt, hand embroidered with flowers and other designs.

I am really looking forward to going home and piecing all of this together. If anyone has any quilt design ideas, let me know! :)

Implementation of the new Malnutrition Protocol at the Clinic

This morning I went into the clinic with a back-pack full of stuff. I brought in the 150 copies of the nutrition record for the charts, 150 copies of the patient info handouts, 5 laminated copies of the color-food pyramid/nutrition info sheet, the stuff to make folders, handouts for my class, and a sample of an appetite stimulant we can use. When I got to the clinic in the morning, I set out to organizing all the folders, posting the information, and making a spreadsheet to keep track of patient data.


We got busy towards the end of the day, so I was a little nervous we weren't going to have time to hold the little training session class for the clinic staff. But in the end we were able to fit it in. We held the class in the classroom space the clinic saves just for this purpose (and for office-parties).

I went over a little bit of info on why malnutrition is important to treat even when it's mild or moderate, how to treat it, what paperwork we can use to keep track of tests and stuff, distributed protocol, went over dosing of some medications, talked about what sort of educational info we should use, and how to help motivate people to get involved in such long-term treatment.


The protocol includes:
-screening for malnutrition at every visit, and prompt treatment
-education for students, volunteers, and staff
-documentation specific to the needs of malnourished kids

Treatment includes:
-monthly weight checks, and exams
-lab testing for parasitic infections and anemia, and treatment for any infection
-multivitamins
-educational plan with info about nutritional requirements, supplements, health/hygiene, etc.
Everything is kept track of in the patient's chart, and a spreadsheet at the front desk. The parents also are given a chart where they can keep track of the information themselves.

It has been really exciting to work with the clinic on this, and get input from various people. I'm looking forward to keeping track of the progress of the children at the clinic over time.

All in all it was a good day. It felt nice to finally get to do something with the work I have been doing, and I think it was all pretty well-received.