Sunday, April 26, 2009

Saturday April 25, 2009 – Day 5 Clinic

Somalia is a slum. It is a collection of 750 families, living in huts made from any combination of scavenged metal, wood or canvas, in an inner city squat in San Salvador. Some families are fortunate enough to have 10 by 10 feet huts with some basic furniture and electricity stolen from the city. Others have significantly less; sometimes only a small pallet on the floor for the whole family, in less than 4 by 6 feet of space, with no electricity, windows, water, or washroom facilities.

Their story is a sad one. Some time ago, a man claiming to be the landowner came to Somalia offering to sell the families the land their huts were on for $15 USD each. Hopeful to be landowners, many managed to scrape this significant amount of money together. After paying, they discovered that the man was not the landowner at all, and that they had devastatingly lost their hard-earned money to a con artist. He fled and was never found.

Today was a very difficult day for the team, both physically and emotionally. Physically, medical, dental, pharmacy and distribution were set up outside under tarps in the few open spaces to be found in between huts; having to rely on a gas generator to power the dental clinic. At one point, ominous clouds and thunder threatened to cut the dayshort. Emotionally, the team was overcome by the extreme poverty we were witnessing, and many of us had to take a moment to pause, to collect ourselves and continue on.

We met Alex, a 34 year-old man with a bullet still lodged in his head from the civil war. He requires anti-convulsive drugs daily. We met Mercedes, a 23 year-old woman with a rare allergy to the sun. Any area of her skin exposed to the sun becomes swollen, dry, painful and split. Her face and hands have the scars from suffering this condition her entire life.

There was also Dorotea, a 46 year-old woman whose right leg never developed properly, and is significantly shortened and misshapen. When Dorotea was 14, she fell and broke her good leg; after surgery to repair it, she developed gangrene and had to have it amputated below the knee. Today we were able to treat her for parasites and an infection, and also to make her a little more comfortable in an unexpected way. The tops of her plastic crutches were extremely hard and hurt her under her arms. We were able to modify her crutches with carefully wrapped layers of bandages and gauze to provide padding. She was very happy.

But perhaps the patient we were most affected by was Maria, a 52 year-old woman who came to see the dentist. After having a tooth extracted, Maria became faint, dizzy and was shaking. At first doctors thought this was due to an untreated blood pressure problem and heat exhaustion. Upon further investigation we discovered that moments before having her tooth extracted, Maria had learned that her 10 year-old grandson had been shot in a drive-by gang shooting, and was currently at the hospital in surgery.

Today’s clinic in Somalia was the final day of the FTC Canada 2009 El Salvador project. The medical and dental teams saw a staggering 889 people today. In four trips to Central America, over a period of two years, FTC Canada has provided care for over 12, 600 people.

After a long, tiring, often emotional but always rewarding week, these numbers remind us why such trips to countries in need are so very important. And so very much appreciated.

[About the El Salvador Blog: Julie Puckrin was a member of the team to El Salvador and contributed the photos and blog entries throughout the week.]

Friday, April 24, 2009

Friday April 24, 2009 – Clinic Day 4

Today the team traveled to Remar, an orphanage which is home to 90 children, aged 18 months to 16 years old. While some of these children are orphans, many still have living parents or family members, and are living in the orphanage because they have been removed from abusive homes.

The orphanage is truly an amazing place. The intent was to create an environment that feels like a home rather than an institution. The nursery, boys’ and girls’ dormitories are all situated like cozy bedrooms; each child’s bed is crowded with stuffed animals and toys. All 90 children eat together in a large family dining room, the larger children helping the smaller ones.

The majority of the food they eat has been donated, and is prepared by the 6 adult care-givers who live with them. The children share chores like sweeping and laundry, and attend a school built especially for them.

We were greeted by a swarm of affectionate children upon our arrival, and the most common and satisfying medicine dispensed by far was hugs, cuddles and smiles.

Today’s clinic was open to all members of the community. Sergio, a 5 year-old boy in a wheelchair, came to see the doctor with his mother. When Sergio was 5 months old, he contracted meningitis, and began having seizures. He eventually had a stroke, leaving the entire left side of his body paralyzed. His mother, a single mom who lives with Sergio’s grandmother and makes her living selling tea from their home, was able to find a wheelchair, but it is old and broken. She cannot afford Sergio’s medication. We were able to help her today with free medicine.

Later we met Joana, a 49 year-old single mother of six children. Her 72 year-old mother was recently hit by car, leaving her bedridden and in need of constant care. Joana cares for her mother and her children in a two-room house, but has lately begun to experience dizziness, fainting and angina pain. The team was very concerned with her symptoms, and FTC Canada is arranging for her to receive an ECG in San Salvador to determine whether she requires a pacemaker. This would be an expensive undertaking for the family.

Finally, 16 year-old Ernesto came to the clinic hoping to have his teeth checked by a dentist. Upon examination, Dr. Jack realized that Ernesto is literally tongue-tied; his tongue is webbed to the bottom of his mouth. This greatly hindered his ability to speak; in Canada, such a condition would be addressed at birth and never affect the child. Ernesto has had to suffer with this his entire life. In less than ten minutes, Dr. Jack was able to perform a simple procedure to correct this hinderance and completely change young Ernesto’s life. He was extremely happy to receive this unexpected but greatly appreciated gift.

Thursday April 23, 2009

The main objective of the El Salvador 2009 project is to bring medical and dental care to communities in need. There are many components necessary to support the provision of that care.

Every morning the team hauls 18 large bins of medications to the day’s site. Over the course of 5 clinic days, this traveling pharmacy will dispense 42,000 vitamins; chewable for children and tablets for adults, and almost as much medication for parasites. Doctors, nurses and paramedics have access to 67 different medications to treat their patients. The list of medications dispensed in the pharmacy has been carefully chosen to reflect the needs in the area, but is also based on the availability of these medications in the host country. It is important that any medication prescribed during these clinics, particularly ones to meet long-term needs such as blood pressure medication, can be procured locally after the team has left.

Part of providing care is providing nourishment for the body and mind. Each clinic day, a distribution centre dispenses food packages containing enough lentils and Vitameal, a highly nutritious and fortified food product, to feed an entire family. Every family that sees the medical or dental team receives a food package. Families are also given such necessities as shoes, clothing and undergarments. Small things that provide a huge amount of joy are children’s toys, especially stuffed animals and soccer balls. Many of the items we are able to dispense have been donated directly to FTC Canada to be distributed to communities in need.

Every team member has donated their time to be here.  Some have brought their own equipment along with them as well. Every team member covers the cost of their own travel and accommodation. Even so, the team requires additional, often costly support materials. Occasionaly, a clinic must be built from scratch, requiring crews to haul in items like tarps, tables, chairs and generators. Every site must have hundreds of bottles of clean, drinkable water and portable washrooms to keep the team functional.

Finally, and perhaps most importantly, there is the local support team. The Medical-Dental team from Canada is comprised of 24 people. There are an additional 26 FTC Central American employees and volunteers who are vital in our efforts to bring care to areas in need. We could not do this work without the help of local doctors, dentists, interpreters, security, administration and registration staff.

Thursday, April 23, 2009

Wednesday, April 22, 2009 – Day 3 Clinic

Unlike the isolated, impoverished rural villages of our first two clinics, Anayito is a crime-ridden, urban area. Many of the people living here were displaced by such traumatic events as civil war, earthquakes, volcanoes and natural disasters. With nowhere else to go, a community of 380 families was created, with another 90 families living nearby as squatters. They are extremely poor. Most people in Amayito make their living as garbage collectors.

Our trip during the day was safe as we had our security escort but by night this area is considered dangerous. Violent crimes – shootings and robberies – are a nightly occurrence. Gangs are prevalent, many recruiting boys as young as 10 years old.

In the centre of it all is Virginia. Now 48 years old, Virginia was adopted as a baby by a loving middle class couple. She experienced an extremely caring upbringing. When Virginia learned at age 14 that she had been adopted, she realized how lucky she was to have grown up in such a loving, safe environment, and that many children were not so fortunate. It became her goal in life to give to others the gifts that she had been given.

Virginia has run the community center in Anayito for 12 years. She works to provide families in the area with a safe, loving environment where they can receive food and education. She feeds 150 children lunch, three times a week and strives to empower them with knowledge. Her efforts to create a compassionate oasis in the midst of such a violent area are immediately felt upon entering the center, where our medical-dental team set up today’s clinic.

While Virgina’s community center provides respite during the day, families often fear for their safety in their homes at night. Our doctors met many patients suffering from a high level of anxiety.

As Dr. Tony aptly said, there is no medicine we can give that will take that anxiety away. What the team could do though was share a moment of empathy, provide comfort, a hug, and a smile, to let the people of this community know that they are not alone.

Wednesday, April 22, 2009

Tuesday, April 21, 2009 – Day 2 Clinic

This morning the team made the two-hour journey to San Juan Buena Vista. One of the first patients we saw was an 83 year-old woman who had lived there her entire life; she remarked that this was the first time doctors had ever come to the community. She was very grateful.

San Juan Buena Vista is an interesting case. The village is fortunate enough to be relatively close to a new medical clinic, recently built through donated funds. Unfortunately, there was not enough money to staff the clinic, and so it is not operational.

An invaluable component of FTC Canada’s projects is the dental clinic. An average family of 10 in rural El Salvador collectively earns about $80 USD per month. A visit to the dentist for one person for a simple cleaning costs around $40. Understandably, many of the patients we saw today had never been to a dentist.

With so little access to dental care, extractions are a large part of what our team does. Dr. Mark commented that he performed around 40 extractions today, as compared to his practice in Canada, where he performs perhaps one extraction per week. Some patients had to have as many as 8 teeth pulled in one sitting.

But what is so impressive about what FTC Canada’s dental teams are able to accomplish on these projects is not how many teeth they remove, but how many they are able to restore! One 19 year-old man visited us very upset. He had broken off the lower third of one of his teeth, and naturally assumed it would have to be pulled. He was very anxious about losing a tooth. Dr. Jack was able to not only save the tooth, but also to cosmetically alter it to look as though it had never been broken, allowing the young man to keep his beautiful smile. He was simply ecstatic.

Our dental team arrives at every site an hour before the rest of the group, in order to set up the large amount of equipment necessary to provide such care. Even with extra time taken to accomodate such extensive build-up and tear-down of equipment, there is often more demand than our dental team can meet. Patients are often reluctantly turned away as it begins to get dark, and it becomes unsafe for us to continue. Today, our dental team was able to see every single patient.

Our medical team were also able to see every single patient. Some particularly interesting cases included Rosa, a four year-old girl with such a bad heart murmur, she is only the size of a two year-old. FTC Canada was pleased to be able to arrange for her to travel to San Salvador to receive an echocardiogram, which will determine what further treatment she requires.

We also saw Rosalina, an 11 year-old girl who has had a large piece of pencil lead lodged in her forehead for 3 years. It is innocuous, but she loves soccer, and the lead makes it hurts to hit the ball with her head. Dr. Elizabeth once again scrubbed up and removed the lead, helping Rosalina to continue her soccer career pain-free.

Perhaps the case that most affected the team today though was that of Marcos and Roberto. Marcos is an 87 year-old woman who walked several hours to come to the clinic today. She hoped a doctor would be able to come to her home to see her son, Roberto, who has cerebral palsy and was unable to make such a journey. Dr. Paul happily obliged with a house call.

Roberto is not Marcos birth son. When he was only two days old, his birth mother, seeing his disability, did not want him. With no family of her own, Marcos happily took him in. Roberto is now 43 years old and although she is so poor and can often only afford to feed him tortillas and salt, it is a testament to Marcos’ loving care that Roberto has thrived. Dr. Paul treated both Marcos and Roberto for parasites, fevers and colds.

Monday, April 20, 2009 – Day 1 Clinic

At 7:30am this morning, the team wound their way up a mountain via a steep, narrow dirt road towards El Cedro, a small community clinging to the side of a cliff. El Cedro is home to approximately 800 families, each of which typically consists of 10 to 12 people. One of the first patients the medical staff met was a young woman who had 15 children.

Most families in the area are farmers, the primary crop being coffee. The average family of 10 people collectively earn around $80 USD per month.

The nearest medical services to El Cedro are more than two hours away by bus, so there was understandably great excitement for FTC Canada’s visit. Several of the children were dressed in their finest to see the medical staff, and many were receiving their first ever check-up.

The 2009 El Salvador project is fortunate to have 12 medical personnel; doctors, nurses and paramedics. While almost every patient expressed much gratitude for the clinic, some patients were more profoundly affected by the team’s visit.

13 year-old Erica has slowly been losing her hearing for over a year. It has become so debilitating that she has failed her school year. Dr. Tony examined her ears but was unable to see any sign of damage, leading him to suspect neurological damage. The only way to diagnose this would be for Erica to travel to San Salvador and undergo expensive testing. FTC Canada was very pleased to be able to arrange to pay for her to receive that testing.

Juan Antonio suffered from a benign lipoma, essentially a large collection of fat on his ribcage about the size of a tangerine. He was unable to afford to have the growth removed. Dr. Elizabeth and the team quickly scrubbed up to perform minor surgery and successfully removed the growth, much to Juan Antonio’s relief.

35 year-old Evelio was walking home at night when thieves attempted to rob him. He fought back but during the fight he was unfortunately shot in the foot. He was lucky that the bullet passed through cleanly, but a month later, his wound still hadn’t healed. Paramedic Christine was able to treat him with much-needed antibiotics and a fresh dressing.

With over 600 patients seen this day, the FTC Canada 2009 El Salvador Project is off to a great start. All the team’s members are eager to continue in this spirit and see even more patients tomorrow.

Sunday, April 19, 2009

Sunday April 19, 2009

Today was the first real opportunity for new and experienced team members to get acquainted and begin planning for the first of five clinics that will start bright and early at 7:30 tomorrow morning.

Each day, the FTC Canada medical-dental team will bus to a different village and set up a project site. Project sites may be set up in a local school or even an open field. Facilities with roofs and electricity may be available, or the team may have to set up under tarps and bring in gas-powered generators to run the dental equipment.

Locations are selected during a scouting trip months in advance and are based on a variety of criteria, not the least of which is a communities need. Each clinic has several components, all working in tandem: patient registration, medical care, dental care, a pharmacy, and a distribution centre which dispenses food and supplies such as clothing, shoes, toys and undergarments.

The needs at each clinic are different, and every country and even every individual site within a country provides unique challenges and learning opportunities for the teams. This requires a lot of flexibility, and often creativity. One of the great strengths of the teams is their ability to constantly evolve to meet the needs of their patients, and the willingness to always seek solutions and opportunities to hone their process to deliver better, more efficient care.

The entire 2009 El Salvador Medical-Dental Team is eager to officially kick off the project’s first clinic, early tomorrow morning!

Saturday April 18, 2009

Months of preparation culminated in a sleepy but excited 6:30am gathering at Toronto’s Pearson International Airport this morning. All 24 members of FTC Canada's 2009 El Salvador Medical-Dental Mission assembled, bags loaded with supplies and donations, eager to embark on a week-long journey to bring primary medical and dental care to needy families in five rural El Salvador villages.

FTC Canada President, Ken Dick and Medical Team Advisor Dr. Tony Brown and the FTC crew seamlessly orchestrated the day’s travel; we arrived safely in the country’s capital, San Salvador, to an enthusiastic welcome. There is a feeling of great excitement for this particular trip. This is the first time an FTC medical-dental team has come to El Salvador in over 10 years. Hopes for the care we can provide here are high.

The team arrived at our hotel by 2:00 pm local time, and quickly began the tedious task of pre-packing thousands of children’s chewable vitamins into individually bagged doses. In addition to any prescribed medications they may require, each patient visiting the clinic will receive 30 days worth of vitamins. All of the supplies must be prepped before heading out into the villages.

There are both new and familiar faces on this year’s team. Sunday will provide an opportunity for all the team members to meet each other and receive orientation as we prepare for the week of clinics ahead.