Endings and beginnings

I've been keeping this blog for almost five years now, since November, 2008.  There are almost 600 posts here about living in El Salvador, about our PazSalud health missions, about this, that, and the other thing.

Now Darren Streff is well embarked on his work as PazSalud's new In-Country Coordinator, and I am getting ready to move back north, where I'll be living with my Sisters of St. Joseph of Peace in Seattle's Capitol Hill neighborhood.  I'm going to be volunteering with PazSalud, working on updating our website and on fund development, but also joining in on our health missions.

With this new reality ahead, it seemed like time to begin a new blog for PazSalud that Darren, Kathy Garcia and I can all contribute to.  It's http://pazsaludelsalvador.blogspot.com/ and I hope you'll follow me there.

So a farewell to La Paz de Susan, which I've enjoyed keeping through these years, and a welcome to the new life, new blog, and new face of PazSalud, the El Salvador Health Mission of PeaceHealth!

A glorious moment, captured

Here's Marta, one of the two patients who came to us blind, at the moment when the bandage removed and she could see again!  What a joy and what a privilege to be the person standing next to her at that moment.  It's even more special when you know a bit of Martha's story.  Literally blind in one eye, she couldn't see out of the other because of her cataract.  She had gone to FUDEM, the Salvadoran foundation that offers relatively low-cost eye care, but you still have to pay for eye surgery there, about $150, I think I remember, and that was more money than Marta could raise.

She lives in Estanzuelas, heard about our mission the week we started surgeries, and contacted Marvin Hernandez, who asked if we could possibly add her to our full list.  Well, we'll try, I said, bring her on the bus.  But we had a full patient load for Wednesday and again on Thursday, and for both of those days she sat there for about three hours and had to go back on the returning bus.  I never saw her smile once in all that time of waiting.  She sat hunched over, not communicating much at all except through her presence.  Then on Friday she came in again, for the third day, and finally we could fit her in.  She had her surgery - a huge, dense and dark cataract came out - and on Saturday morning I got to see Marta smile.  Isn't that a beautiful sight - in all senses of the word?

Our last patient, the newspaper vendor who like Marta was blind in one eye and couldn't see out of the other, also came out seeing and smiling after his surgery, but Mitch Costin wasn't there to photograph the great moment, and my attempt isn't worth posting.  You'll have to take my word on it.

Ah yes, and we completed 53 surgeries on 49 patients - (3 patients had both pterygium and cataract surgery, and one had to come back for a 2nd surgery as it hadn't been possible to implant the lens the first time).  Since 50 is our usual maximum, and one we've never reached before because we haven't had that many patients, this was a happy week that kept our surgeons - the Pisacano father and daughter team - well occupied.  Terry Clark, our optometrist, also gave about 130 eye exams and - when needed - reading glasses to all the hospital staff who showed up (and that was most of the hospital staff).

As a gift from our PeaceHealth hospitals, we gave some cool stuff to the hospital - scissors and forceps and tweezers (German made, the Director was delighted), wound dressings, sterile towels, patient gowns, and best of all a brand new EKG machine donated to us in Eugene, and made usable in Santiago de Maria by the manual en español that Darren found with great persistence on-line, printed and bound.  We were even able to promise them the donation needed to buy a new autoclave (I hate to think how they are making do right now) through the kindness of a very special donor.

But for me, Marta's smile says it all.  That's why we were in Santiago de Maria, Usulutan, El Salvador.

Photo by Mitch Costin

One glorious week

We're close to the end of a glorious week of eye surgeries at the Hospital Nacional de Santiago de Maria.  For the first time ever, in my experience, we've had more than 50 potential patients show up (50 being the maximum our surgeons and our materials will stretch to).  Several patients were not qualified for surgery - because the risk would be too high or because there were serious complications - so our ophthalmologists completed 50 surgeries, right on the number possible.

Usually our problem has been patients who don't show up because they're afraid or uncertain about the surgery.  This time, thanks to the amazing work of Marvin Hernandez, our coordinator in Estanzuelas - where our patients live - just about everybody came.  And the problem we had to solve was lack of some of the materials needed to complete our 50 surgeries - in midweek, we had to find more Viscoelastic, a fill used during surgery, and sutures.  But with a lot of cooperation and even more driving - both Darren and Hernan, our motorist, had to travel an hour to San Miguel on Thursday - we purchased just enough to get through.

What's been most beautiful, as always, is our patients, and the delight and gratitude they express when the bandage comes off the morning after surgery and they can see more clearly.  Lots of hugging and thanking and blessing happens then - it's the very best reward for us.  Here are a few of them ready to go home with new vision:

Tomorrow we'll check the patients from Friday, pack up and take off for San Salvador.  And there are two very special patients, our very last patients, whom everyone will be waiting to see.  One, Marta Elena, wasn't on our original list, but came in for three days with the group from Estanzuelas, hoping that we might find a space for her.  And on the last day, we did.  One of her eyes was blind, the other had a cataract so dense she could see nothing: the doctors expect that tomorrow she'll see for the first time in years.  The second, Calixto, heard about our mission because he sells papers in the hospital.  No one can quite figure out how he saw to sell papers or get around, but he did.  And he came to us and asked if we could look at his eyes.  He, too, is blind in one eye and the other had the largest, blackest cataract Dr. Tony Pisacano has ever seen.  We had just enough materials left for Calixto's surgery and we will all be waiting tomorrow as he wakes up to a very new and brighter day.

Mission in progress

Our eye surgery mission is off to a great start.  First of all, everyone arrived (though the plane was an hour late) and our franquicia (customs permission) also arrived in good time, so we moved through the immigration and customs process reasonably quickly.

And then we were off to Alegría, a very, very long 2.5 hours from the airport - in the dark, so we couldn't see anything, and with a group who'd mostly been up and travelling since the early hours of the day.  We tumbled into the Casa de Retiros (retreat center) about 12:30 AM, and most people were up and moving again when the sun came up at 6:00 AM (not me, I turned over and went back to sleep until 8:00).

Still, it was easy to see what a great team we have - no one grumping, no one complaining about the cold water or the lack of sleep, everyone eager to get on with the mission.  It's a big group this time.  We have father and daughter ophthalmologists, Tony and Kristin Pisacano; our optometrist, Terry Clark; two scrub techs, Rosy Melara and Jennifer Woodland; two circulators, Silvia Pleitez and Sarita Angulo; interpreter Gloria Campuzano; nurse Dawn Fisher; patient coordinator Rosa Aguiar; photo-journalist and keeper of the autoclave, Mitch Costin; our beloved driver, Hernan Merino; and Darren Streff, Kathy Garcia and me.

Sunday we enjoyed lunch at an Alegría restaurant, looking out over a valley full of mist, and went to Santiago de Maria - the next town to the east, about 15 minutes away - to set up our surgery at the small National Hospital there.  As always, our first surgery was practiced on some of the machinery - here's a photo of Darren, Terry and Mitch Costin working on our slit lamp, used to calculate the power of the interocular lens:

Unfortunately, the frozen knob resisted all efforts to free it, but Terry figured out a work-around that involves raising and lowering the patients, rather than turning the knob in the machine.  A nice Salvadoran solution, that!

Today, in our first day of surgeries, we saw 11 surgery patients, which is just about unprecedented - the fruit of Marvin Hernandez' hard work in the Estanzuelas community.  Often before we've had days with four to six patients, so this felt wonderful to all of us, and our surgical team kept fully occupied.  And in the afternoon Terry, Dawn, Darren and Gloria gave eye exams and reading glasses when needed to about 75 hospital employees. 

A fine first day all round!

Ready to go

Hard to believe, but this is the last time I'm going to be responsible for one of our PazSalud missions.  I hope to be part of many more, but I'm passing the responsibility, very joyfully, to Darren Streff.  Today's the day our team arrives at the airport (at 7:45 pm) and I'm feeling like everything really is ready:

• We have our franquicia, the most important piece of paper, that allows us to bring in the medications and supplies without paying customs.  We also had an extra bit of drama - which almost seems inevitable - when we discovered at the end of our first time through the process that the group we were working with didn't have the right kind of license to support a franquicia.  Thankfully, our friends at the Archdiocese came to the rescue, and our amazing customs manager, José Manuel Gonzalez, got the papers through their second round in record time.
• We have piles of tubs, a tower of water bottles, boxes of heavy instruments, snack food, fans, wood tables made by Mitch Costin for our optometric equipment, plastic shelving, etcetera ready to be loaded on the truck in a few minutes.
• And I have washed and ironed the necessary shirts and pants, showered, packed my bag.  As soon as this is posted, I'll put the computer in its travelling bag.
• But more important than any of this, we have a great group of patients waiting for their surgeries, and a great team coming to offer them.  

May it be a week of good work, good health, new friendships and great joy!

Along the road

Usually when I drive to San Martin and beyond I’m going as fast as I can and not paying much attention to what’s around me.  Often I’m listening to podcasts and thinking about, oh any great number of things.  Today I was moved to go much more slowly and to pay attention, and because of that attention it was an amazing drive both ways.  

Driving by in my air-conditioned bubble, and there were all the people getting about their ordinary daily lives, living along the street – making bricks, taking corn to the mill, working on the drainage ditches, waiting for the bus, getting breakfast at one of the little ramshackle pupuserias, herding cattle,  carrying children and running after children, going to the fields.  

It was like driving along beside one of the Books of Hours that shows people at work in their daily lives, like driving along a Brueghel painting.  All those ordinary, holy lives being lived in plain view, all involved with the sweat of their hands and the weight of the earth.  I see them every time I drive this road, which is lots, but today, today I saw them and am humbled by them, and I know how much I am going to miss them.  And how beautiful and solid are these lives lived in deep connection with earth and water and families.  Looking from here, our lives feel transient, transparent, shadowy and concerned with shadows.

I know this is only a part of the story.  I know that people live under great stress here, the stress of not having enough money to pay for education or needed medications, the stress of having some of the little they do have extorted from them, the sheer stress of physical labor in this heat.  And yet how beautiful they are, how full of the goodness of God.

(thanks to Mitch Costin for the photos)

April miseries, April beauties

For me, "April is the cruelest month" here in El Salvador - not because of the lilacs that T.S. Eliot wrote about, but because the combination of heat, dust and the smoke from burning cane fields makes moving and breathing heavy, hard. 

April is the month before the rains start.  Everything is dry: the big trees still keep their green, but the fields and sides of the road are dust-colored.  It's the sixth month without rain.  Besides the burning cane fields (they are burned to clear away the tough out leaves and leave the juicy interior stalk to be cut and carried off for processing into cane sugar), trash is burned and spontaneous fires start on hillsides and volcano slopes.  They never seem to turn into wild fires: I suppose there must still be  deep moisture under the dry surfaces that keep them from exploding.

One of the pleasures, then, in this cruelest heat, is getting into the air-conditioned car and driving down the road to San Martin and San Salvador, encased in a bubble of cool.  And one of the great pleasures along that drive is the new face of San Bartolomé Perulapía, the town just before San Martin.  When I first moved to Suchitoto, Perulapía was no fun to drive through.  Lots of gang graffiti, signs that suggested deep quarrels between political and religious sectors.  But since a new mayor was elected in 2012, a beautiful change has come upon Perulapía.  All along the main street, house fronts have been turned into vivid, lively murals, like this one honoring San Romero of the Americas:

Or this one, where I caught the painter in the act:

And Perulapía, which once seemed dangerous and drab now invites visitors and makes a high point for my escapes from the heat of April.

Good Friday Walking

Tonight I rest tired feet after walking in both Good Friday processions.  First comes the Via Crucis, Stations of the Cross.  It's a fairly short procession in mileage, perhaps half a mile, but slow and in its Good Friday version very elaborate.  We all walk, men in the middle, women on the sides, following the statue of Jesus carrying the cross that, in turn, is carried by eight men.  The stations, beautifully decorated, come about one per block - but because I was in the middle of the procession we often stopped for one station when I was looking at the altar for the previous one.

There was a long pause at the 4th station, where Jesus meets his mother - a long pause so that the statue of Maria Dolorosa, Our Lady of Sorrows, could come up and bow before Jesus (women carry the statue of Mary).  She's followed by St. John, carried by men.  Then at the 6th station Veronica (women again) comes out to wipe the face of Jesus and, in a little magic trick, reveals his image.  They all fall in line - Mary, John, Veronica - as we complete the stations, stopping at each station for a reading, a short interpretation, and prayer.

Finally we all came into the church where Jesus, Mary, John and Veronica took their places in front of a purple curtain that hides the altar (it will be dramatically pulled away during the Easter Vigil tomorrow night):

This procession took about two hours, from 10 to noon, in very hot sun.  Water sellers were doing a brisk business - I was glad I'd remembered my water bottle.

Then after a moving Celebration of the Passion and Veneration of the Cross - and a quick supper - I returned for the Santo Entierro.  I've never gone on this procession before, but this was the year for walking.  This time the men - I hope it was a new group, but I'm not sure - were carrying a heavy wooden coffin topped by a glass case holding Jesus, dead.   For quite a while, hearing a motor noise, I assumed there was a truck of some kind doing the carrying, but when I drew closer I discovered that this was a rolling generator following along behind so the coffin - and Mary following behind - could be brilliantly lit.  We walked from the church, over several alfombras (carpets) of bark and colored salts that had been created in the afternoon to be walked over by the procession:

It turned out to be a long walk - from the church, over several alfombras, then down along the road that leads to the hospital and the graveyard (we paused and prayed at both places) and back up the hill into Suchi's El Centro, and back into the church, where Jesus came to rest.  As we were getting close to the church, I began to worry about the men carrying Jesus, who looked almost spent - but they made it.  Then the coffin was placed on a rolling base and slowly steered down the aisle.  It was almost too big to fit, and at one point there was an ominous crunch, some quick consultations, and a bit of redirection accompanied, of course, by "dé le!" - the ubiquitous Salvadoran male language for directing cars, trucks, or stuck floats. 

The procession was probably about 3 miles in total, a good walk and a slow walk, which is good for me!  As I walked, I thought how much I will miss these processions next year when I'm back in the U.S.  Politely sitting in church - much as I love creative liturgies in the U.S. - doesn't have the same body power as walking in noonday heat and evening darkness with your friends and neighbors, following Jesus.

Processing with palms and donkey

I have finally, by accident, figured out how to do Palm Sunday right here in Suchitoto.  In previous years, I've skipped the procession of palms in favor of getting an actual seat in the church, which you can only do if you're there before the palm-bearers arrive. 

This year I went to Mass Saturday night, not realizing that it would be the Sunday readings - but it was, a Palm Sunday Mass minus the palms - and plus songs and ¡Que Viva! for Monseñor Romero.  That left me free to walk down the street this morning to the Capilla la Cruz where we all gathered on the cancha (basketball court) and where I bought a puny bunch of palm leaves for a quarter.

Most everyone there had glorious palms, interwoven with flowers and a seedhead that looks like baby corn.  My puny bunch would have looked impressive in Seattle, but here ... not so great.  It felt as if everyone in Suchitoto was there, whole families and children, like this charmer:

You might notice that she has woven and beaded bracelets on both wrists.  These must stretch back to the days of the Lenca and the Pipiles: each red bracelet is threaded through a small, smooth stone, and their purpose is to keep the baby safe and whole. 

After a few songs, the padres came down through the crowd and sprinkled us and the palms and anything else sprinklable with gallons of holy water.  No tame drops here.  The acolyte holds a huge tub of water, the padres have thickly-leaved branches, and they scoop the water up and fling it out into the crowd with a will:

In truth, in the hot sun of March, it's a joy to be drenched with holy water!  My camera was also blessed, and survived the blessing.

We were all ready to go after that, and Padre Jesus had to remind us that we were supposed to hear the Gospel for the procession first.  And then we formed into lines - as always here, and it makes my gringa heart a little crazy, the men marched in the middle after the donkey carrying the statue of Jesus, and the women marched in two lines on either side.  I'd just once like to see the lines reversed, women in the center, men on the outside.   But perhaps that's not yet an image our church can stretch to, at least not in Latino America. 

Monseñor, vives hoy

This video by Fabrizio Villegas includes powerful moments and images from Monseñor Oscar Romero's life.  I especially love that it begins with one of my favorite nuns here, tiny Sr. Benedita, touring us through Monseñor's house on the grounds of the Hospitalito (Hospital Divina Providencia, where he lived and died).  Then, about 4:07 minutes in, close to the end, there's video of Monseñor's visit to one of the many slums built along abandoned railroad tracks (because that was and is public ground, unused, and an easy place to take possession and build a shack of cardboard and tin) - perhaps the railroad tracks near the church Maria, Madre de los Pobres in the La Chacra neighborhood of San Salvador.  I'm moved by the three unidentified Sisters who accompany Monseñor, clearly Sisters who work in this slum and are showing him around.  It reminds me that communities of women religious have long been present with the poorest among us.

We celebrated Monseñor Romero's life and martyrdom today, on the eve of the day he died (since tomorrow is Palm Sunday).  I missed the main celebration - apparently the Archbishop was here in Suchitoto and it was a grand celebration, but I was on an errand of mercy in the capital, and was too late to join in - but the evening Mass was also dedicated to Monseñor on the 33rd anniversary of his death.  After communion the choir sang one of my favorite canciones (words and music by Alvar Castillo) - the chorus is:

Monseñor vives hoy
en el corazon
del pueblo que tanto te amó.
Monseñor tu verdad
nos hace marchar
a la victoria final.

Monseñor you live today
in the heart
of the people who loved you so much.
Monseñor your truth
makes us march
toward the final victory.

And at the end of the mass we all proclaimed together "Que vive Monseñor Romero!  Que vive!"  With the election of Pope Francis, with his passion for the poor, Salvadorans have hope that the canonization of Monseñor Romero will take place at last - but then the people have always known that he is San Romero de las Americas, pastor, prophet and martyr for the people he loved so much.

Doing it right

Our eye surgery mission - a week of cataract and pterygium surgeries that follows up the general medical mission - always begins with a good long list of people who qualify for surgery, according to our optometrists, and who say that yes, they want to have the surgery.  But year after year, we've seen only half the people on our list show up, in spite of info calls and transportation provided.  We have gathered that people are frightened, and that often their families discourage them from going.

Last year we asked Iris Chacon, our wonderful coordinator for San Rafael Cedros, how she thought we could do better, and she suggested that we have a meeting for everyone on the list where they could ask questions and could hear from someone who had the surgery. 

So this year, we invited everyone who qualified for surgery to come to the meeting, held last Sunday in the biggest school in Estanzuelas - and we had a great crowd!  There were probably about 75 people there, 47 of them patients on our list, to hear Lito of San Rafael Cedros talk about his successful cataract surgery, to hear Iris talk about the importance of family support, to hear Darren sum up the steps they would be going through on their surgery day and to hear Marvin remind them where to gather on the morning of the surgery.

Here's Marvin with a very old gentleman who moved right up next to him to hear everything clearly:

And then we got the questions!  Can I still sleep in a hammock?  How long does my father have to wait after hernia surgery before he has eye surgery?  Do I have to keep my head turned up to the sky for two weeks?  Is there a special diet I have to follow?  We were able to put many fears to rest!
And there were a lot of internal conversations, for example among this group of women who checked up with each other about everything that was said:

This is a town where many of the seniors have never learned to read, so it was especially important to share all the information in a meeting - and to send them home with copies that their younger family members could read.

So thank you, Iris, for steering us in the right direction.  Having a pre-meeting for the surgery patients will be part of our practice from now on!

Maria del Carmen almost mobile!

Maria del Carmen has now had surgery on the right leg. the one she broke, and the left leg, where she tore tendons, has been freed from its cast.  In fact, she now has two visible legs, for the first time in a month, but she still can only use the left leg.  As you can imagine, after a month of having both legs elevated with minimal movement, it's going to take a while to build up the muscles in the left leg again, and she thinks it will be another month before she's allowed to put any weight on the right leg.  I picked up a walker for her to use - it will return to our PeaceHealth bodega when she no longer needs it - and hope that she'll soon be hobbling about. 

It's a long slow process!  But she is in a good situation right now, staying in her sister's house in Ilopango, in a little room that is right off the kitchen/dining area, so she's right in the middle of everything.  It's a bonus that her 94-year-old father and her stepmother are also staying there for a prolonged visit - in addition to her sister's son, daughter, son-in-law and granddaughter. 

I'd love to share a photo, but Maria del Carmen has steadfastly refused to have any photos taken during this time.  But her spirits are good: after some mourning on the day of the break, as she realized all the changes this was going to mean in her life, I haven't heard one complaint from her (well, not quite: there was a fairly passionate complaint about unresponsive nursing in the Zacatecoluca hospital).  She's clear, determined, and looking for the finger of God along this unexpected pathway.

A grand week

Our mission team loved their long, hot, busy, happy and productive week of medical and eye clinics in Estanzuelas.  We saw 1467 Estanzuelans, most for two or more clinics.  Our providers prescribed for those who needed medications - and everyone went away with vitamins and a toothbrush, at minimum.  We referred many patients for specialty treatment or diagnosis within the National Health System.  We signed up our full list for cataract or pterygium surgeries in April in the Hospital Nacional at Santiago de Maria.  More than 100 families are being invited to our capacitation session for receiving a water filter. 

But most of all, we carried away with us bright memories of faces and voices, people who touched our hearts, smiling or howling children, beautiful seniors, hardworking men and women.  

Here are a few images from the week, bright memories:

Sister Beth and interpreter Lea worked at getting just the right glasses for this patient.

Schellie was kept very busy with ear cleanings; a speech therapist, she's had expert training in ear lavage, and we used her skill to the full.

Interpreter Rita, Dr. Gulrukh and nurse Julie focused on this beautiful woman.

Dra. Jakellyne Jimenez, Director of the Estanzuelas Unidad de Salud (medical clinic) was our gracious hostess.

Marvin Hernandez (standing, center) coordinated all the local volunteers and kept everything running smoothly.  He's a superb organizer and a great leader - it was a delight to work with him.

Fatima and Wendy, two of the scholarship students who were our local volunteers, brought their intelligence and cheerfulness to every task.

Rosa and Hernan, two Salvadoran members of our team.  Rosa explains the eye surgery process to prospective patients, and Hernan drives us safely wherever we need to go.

And finally, here's the new Health Mission leadership team - Kathy Garcia and Darren Streff.  I am so happy to be turning over the work of in-country coordination to Darren, though I plan to continue to be involved.  Can't imagine better guides for this work! 

Day One of the Estanzuelas Clinics

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Our first full clinic day in Estanzuelas, and all is very well. 

Yesterday I exchanged congratulations with Marvin Hernandez, our amazing chief organizer for the Estanzuelas community.  I was relieved that we’d come through the airport arrival and the customs process with no problems and in record time.  He was relieved that all the organizational pieces – the invitations to patients, the welcome at a local school with dancers and lunch for 120, the rental of tables and chairs and canopies, the organization of volunteers for the week had gone without a hitch.

And now we’re off and running, working our way through the opening day questions and glitches (there are always a few of these).  Medics have paired up with interpreters, we’ve figured out how to write up the references for patients who need further tests or specialist care, and every clinic is full of Estanzuelans telling their stories, talking about their needs and anxieties, being fitted with new glasses and being heard with attention and respect.

Especially on Monday, it always feels like a river overflowing: local volunteers, PazSalud providers, interpreters and patients: we’re all trying to figure out the flow. By Friday we'll have everything clear - and then we have to leave!

(Photos, top to bottom: Brian checks a young patient's heart rate; Carol helps a woman choose glasses; Darren listens to a story; Lorna and Moises give patients their medications.)

Darren's back!

In 2012, Darren Streff often showed up in my blog posts as a Maryknoll Lay Missioner who was working with our PazSalud program.  Then for the past couple of months, he's been absent.  Now he's back, but under different auspices.

What's happened is a longer story than I'm going to tell, but the short version is that the Maryknoll Lay Missioner program came to the conclusion that Darren's proposed work as a coordinator for PazSalud was not a good fit with their expectations of what Lay Missioners would do.  Their expectation, as I understand it, is that Lay Missioners will work directly with a local community on a development project that can later be turned over to the local community.  I'd agree that this is not a good description of our work in PazSalud.

By the time that Maryknoll reached this conclusion, though, Darren had already spent some months working with us.  He'd come to know our program and our people in El Salvador.  He'd even come to the Northwest to meet the Sisters of St. Joseph of Peace and the PeaceHealth Board of Directors.  He loved the PazSalud program and was convinced that he was called to do this work.

So Darren had to make a choice between PeaceHealth and the Maryknoll community who were his friends and his primary support system for his first year in El Salvador.  The Maryknoll Lay Missioners wisely ask a Missioner who is considering leaving to enter into a formal process of discernment, and Darren entered into that process wholeheartedly, praying through the Ignatian Spiritual Exercises with the help of a Maryknoll spiritual director.

He has been in that process for most of the month of January, and on February 4th finally told his Maryknoll Lay Missioner group that he would no longer be a Lay Missioner, but would continue to be their friend and would continue to carry the Maryknoll spirit in his work with us.

We in PazSalud and at PeaceHealth are sorry that Darren had to make this choice, but we are glad he chose to come work with PazSalud.  It's wonderful to have his positive spirit, his joyful energy, and his great commitment to the people of El Salvador working for us again.  We missed you, Darren, and it's great to have you back!

Maria del Carmen in the hospital

On Tuesday I took Maria del Carmen to the National Hospital in Cojutepeque, where she had an appointment with the orthopedic surgeon.  I know the Cojutepeque hospital from our eye surgery week there in 2011 - it's a beautiful hospital, recently built after the 2001 earthquake damaged the earlier site and well run.

We got there at 9 am and were met by Maria del Carmen's sister, Ana Maria Melendez, who has worked at the hospital for 32 years.  She brought a wheelchair and an orderly who huffed and puffed and barely managed to lift Maria del Carmen from the car to the wheelchair - my respect increased for Alcides and Darren, who have both carried her greater distances without breaking a sweat.

The orthopedic surgeon was supposed to be seeing patients at 10.  He arrived at 1 PM, after getting out of surgery.  In those three hours, we got to know some of the other patients and practiced our patience, an essential act in El Salvador.  He looked at Maria del Carmen's X-rays and agreed that her leg needed surgery and pinning, but said that he did not have the equipment for that in the Cojutepeque hospital.

I said that I would be glad to purchase the pin or other equipment needed, and was surprised to hear his answer: the Ministry of Health no longer allowed families or friends to purchase materials needed for surgery, and this rule was being strictly enforced.  I didn't know whether to cheer or weep - it's truly an act of justice that all patients in the national health system are being treated equally, that those who can find some money don't get to jump the line.  But I had so hoped to help Maria del Carmen get her surgery early!

That was not to be.  The surgeon said he would admit her to the Cojutepeque hospital where all the preliminary tests would be made.  Then she'd be transferred by ambulance to the hospital in San Vicente or Usulutan, where she'd have the surgery, and be transferred back to Cojutepeque for rehab.  It did occur to me that it might be more efficient and more effective to move the pins to Cojutepeque!  There was no clear date when the surgery would be done, though I'm hoping that having a sister in the system will help insure that Maria del Carmen doesn't have to spend any more time than necessary in Cojutepeque.

We then took her through a couple of stations for tests - chest X-Ray, blood tests - and up to the surgery ward, to a room with eight beds, where I left her.  We've talked the last two days - all her tests came out well, but she hasn't yet heard anything about when or where she'll go for surgery.  May it come soon.

Maria del Carmen's very bad day

On Tuesday I was shopping in San Salvador when I got the word that Maria del Carmen had fallen and had a broken leg.  Could I come and pick her up in San Martin?   When I got there, I learned that she'd gone for a peaceful walk down a dirt road and something - a hole hidden by the drifting sand?  a hidden rock? - tripped her, so that she fell badly.  

Her friends got her into my car and I took her to the little National Hospital in Suchitoto where a Doctora looked her over and said that yes, the right leg was clearly broken and it looked as if the tendons had been pulled on the left leg.  But the X-Ray wasn't available at that hour, and the best she could do was to put a protective covering over the broken leg and to suggest we take her to San Salvador or Cojutepeque.

I was due in to the airport to pick up my friend Judy Stoloff, arriving at 9 pm for a vacation in El Salvador, so Peggy O'Neill most kindly took over, driving Maria del Carmen to the Diagnostic Hospital in San Salvador, where she got x-rays and a light cast on the left leg with the pulled tendons.  Surgery or casting of the broken right leg would have to wait until she could get seen at one of the national hospitals.

Peggy got back to Suchitoto with Maria del Carmen a few minutes after I arrived with Judy, and as he'd done throughout the evening, Alcides, a strong and gentle friend, came to carry her to her bed. 

The next day Alcides came again to carry her into the car and we drove into San Salvador for a second opinion from Dr. Cabezas, a good friend of Sister Eleanor's and mine, on whether surgery was really necessary.  He recommended that she spend the next few days with both legs elevated and that she then get her right leg surgically pinned.  He kindly and thoughtfully explained the whole procedure to her, and she said yes, she would do that.

So we bought a bedside commode and returned to Suchitoto (Alcides helping again) where Maria del Carmen has now spent two days in bed with her legs elevated - distracting herself as best she can with books, radio and DVDs.  Val Liveoak, a Quaker with the Alternatives to Violence Project, who's also living at the house this month, has helped with nursing - we've all taken turns, and Maria del Carmen does as much as she possibly can for herself.  She has a date with the orthopedic surgeon at the Cojutepeque National Hospital (the main hospital for our department) on Tuesday, and we'll hope for an early surgery date.

It's such a shocking thing, to go with one fall from being capable and strong and in control to not being able to walk at all.  I have been so struck with Maria del Carmen's spiritual strength which is seeing her through this physical trauma; she is peaceful and cheerful where she could so easily be anxious, fretful.  I am glad that Val and Judy and I have all been able to be there for her and have shared the practical nursing. 

I think, too, how very differently a fall like this would be treated in our U.S. system - X-Rays and casts and surgery would be instantly available, even in a small town, even for people without financial resources, wheelchairs and walkers or crutches too, I think - though perhaps that's optimistic.  Having to wait a week to see an orthopedic surgeon is hard to imagine.  But that is normal here - it would have taken even longer to get seen at the main orthopedic hospital in San Salvador, Hospital Zacamil. 

Here there's not enough of anything - equipment, doctors, medications, hospital beds - and while the rich can get whatever they need, most Salvadorans have to wait and hope that there will still be care at the end of their waiting.  May Maria del Carmen finally receive the care she needs.

A Circle of Wise Women

Last week, while Sister Eleanor Gilmore (founder of PazSalud) and Kathy Garcia were both here in El Salvador, we called together some of the people who've been our partners on our health missions to gather their ideas on how we can stretch and improve our collaboration with the people of El Salvador.  It's probably not entirely a coincidence that they are all women, though we've also had some amazing men working with us.  Here we are at lunch after the serious discussions: on the bottom row, left to right, Dora Alicia Alas (also known as Iris), a CIS organizer and our coordinator in San Rafael Cedros; me; Kathy; and Dina Dubon, a social worker with Caritas El Salvador and our coordinator in San Juan Opico.  Top row, Leslie Schuld, Director of CIS (Centro de Intercambio y Solidaridad); Rosy Melara, from Hospital San Rafael, who volunteers as our surgery nurse; Rosa Aguiar, of the Alcaldia de Comasagua, who volunteers in our Eyes clinic; and Sister Eleanor.

We talked about the possibility of working with a circuit of municipalities instead of going to a different one each year; we talked about how we can incorporate workshops and perhaps clinics from Salvadoran specialists on subjects like family planning or diabetes prevention and nutrition into our offerings.  We looked at stressing the importance of getting a pap smear in our women's clinic, and the necessity for followup on positives.  We talked about how to break through the fears that keep many seniors from getting the cataract surgery that they're qualified for.  We talked about cooperating more closely with the local government health clinic, the Unidad de Salud.  We talked about how our water filter program can begin to educate the whole community on the importance of clean water.

We came away from this circle of wise women with great ideas for the future, especially for the ways we can partner with Salvadoran organizations to have a long-term positive effect on the health of the communities we work with.  Gracias for the wisdom!

Eleanor's photo journal

Eleanor has visited a great round of friends over the last few days, and I've had the honor to assist with car and camera.  The best way to tell this story is to show it!  We visited Rosita and her three children, Geovany, Lupita and Edith in El Paraiso, Chalatenango:

We had lunch with Dr. Jorge Cabezas, his wife Betty, and their triplets - Dr. Cabezas is a physiatrist (hope I spelled that right) who designs rehab programs; during Eleanor's time with Jesuit Refugee Services toward the end of the Salvadoran Civil War, he helped many of her patients.  Here they are, 24 years later -

Later that day, we visited with Dra. Daysi Ramirez, her husband, Dr. Fredy and their totally enchanting 18-month-old daughter, Ana Valentina:

Then Eleanor caught up with the scholarly pursuits of Walther Jorge Martinez and Alex Hernandez, two PazSalud scholarship students who'd been outstanding volunteers in our clinics:

 And she went on to a happy reunion in Mr. Donut - always a favorite connecting place - with Lolo Guardado, who has long been helping groups of artesans to sell their work -

And with Hernan Merino, the motorista who keeps us all safe and very happy during many mission trips:

Even here in Suchitoto, Eleanor has had some wonderful days with Peggy O'Neill, and yesterday Moises Alcides Garcia came by.  This 20-year-old is about to graduate from a 2 1/2 year Tecnico program in graphic design in the Universidad Andres Bello, and he brought his portfolio to show us the work he's done.  Eleanor was remembering eight years ago, when a frail 12-year-old Moises needed two new heart valves and PeaceHealth's Roland Trenouth made sure the replacement valves were purchased so Moises could have his surgery in Hospital Bloom.  What great changes in the life and prospects of Moises Alcides!

It's been a grand time, full of memories and hope.  Thanks, Eleanor, for sharing this time with me, and for all the many years you have joyfully shared with the people of El Salvador. 

Otra vez, Eleanor in El Salvador

The past week has been filled with joyous reunions, only slightly interrupted by the serious work of getting the paperwork ready for our doctors' permits and our customs clearance.

One joyous reunion has followed another since Sister Eleanor Gilmore walked off the plane last Saturday.  Eleanor's long history in El Salvador goes back to time during the civil war in the 1980s, when she worked with the Archdiocese of San Salvador and with Jesuit Refugee Service, was twice picked up for questioning by suspicious authorities, and helped people coming in from the campo, including a few guerillas, get some much-needed health care.

Eleanor left El Salvador after the signing of the peace accords in 1992, but the people had found a place in her heart, and she returned in 2000 to begin the El Salvador Health Mission of PeaceHealth and the Sisters of St. Joseph of Peace.  She and Kathy Garcia developed the PazSalud mission over the next nine years as Eleanor continued making friends.

She's stayed away for four years and a few surgeries, but this week she's back at last for a good visit with those friends.  We began the celebrations on Sunday with Mass in the Crypt of the Cathedral, where Monseñor Romero is buried, followed by a festival dinner at Estela and Susy Garcia's home, with almost all the Garcia family in attendance.  Here's Susy and Estela with Estela's mother and Eleanor- it was a glorious afternoon and wonderful Sopa de Gallina India, la abuela having provided the gallina. 

It's been like that all week - we've connected with many, many friends, and each connection has been a delight.  I get to share in the memories and in the joy that Eleanor's presence - in El Salvador again! - brings to her and to the many, many folk who know and love her.

Eleanor and I were both saddened that Sister Noreen Linane died while we were so far away.  Eleanor says she was ready and completely at peace - it's good to know that, and no surprise.  Noreen was a tiny woman full of life and energy who loved gardening and sewing and creating the most beautiful flower arrangements.  I first got to know her when, as a novice, I was told to shadow her in her work at Jubilee Women's Center, transitional housing for homeless women in Seattle.  As I quickly found out, Noreen's shadow had to move fast and listen hard to the wonderful stream of Irish talk that moved with her - I was exhausted by the day's end, and enchanted.  She's continued to be one of the hearts of our community at St. Mary-on-the-Lake, and while she's gone through many serious health crises, she always before has emerged full of energy, ready to move fast, to talk fast and to create beauty.  We will miss her so much.

Oh the permissions?  I hope all is well....it's always an area of headache and worry until that moment when the customs people wave goodbye to us, and that's still a little more than a month away. 

El Último de Doña Licha

My friend Martha's mother died the day after Christmas, after several months of increasingly painful suffering.  I think her given name was Maria Louisa, but I knew her as Doña Licha - people here in Suchitoto called her Niña Licha, but I haven't yet managed to get comfortable with addressing a woman of my own age, more or less, as a niña, child.  I used to meet Doña Licha in better days when she was on the way to market, and we'd stop and exchange hugs.  Martha sometimes brought me tamales her mother had made.  And one day, when our medical mission team was visiting Suchitoto, as we do on each mission, Doña Licha came to our house to have her ulcerated leg treated by Dr. Jon Dykstra, a specialist in wound care.  Here they are, Doña Licha in blue on the left:

Jon bandaged her leg and gave her some medication for it: the bandage didn't last long, because it was itchy, but the medicated cream was great - soon I was seeing her again on the way to market, and this lasted for several months until she began to suffer from pain in her hips, back, legs and soon everywhere.

The customs of death are very beautiful among Catholic families here.  The funeral mass and burial almost always take place the day after the death.  Then for eight days the house is transformed into a shrine with flowers and santos and a photo or two, and friends and neighbors and family come by each night to recite the rosary and sing - or just to stand by and be present.  On the 9th day, this season of intense mourning closes with a memorial Mass, and then everyone gathers for El Último, the last night of mourning, and some stay with the family all through that night to the next morning.

I was able to join in on one Rosario after I returned from Guatemala and the small house was crammed so full of people that you would not imagine it could hold any more.  When Maria del Carmen and I returned for El Último, there were people sitting in rows of chairs in the street outside the house and more people inside.  Martha and her sister Orbelina invited us to come in through the side door which usually leads to a yard full of chickens and ducks and dogs and a green parrot.  All the animals were elsewhere (I wonder who does the duck-sitting?), the yard was swept and neat, and huge, really HUGE iron bowls of tortillas were waiting.  Martha and Orbe and a few friends had worked all morning to make an unimaginable number of tamales, the traditional food served in El Último, and soon we were sitting with tamales and cookies and coffee or hot chocolate.  Meanwhile, in the main sala of the house, the singing and prayers continued, as they were to do all through the night.

What a rich religious tradition this is!  The rosary is beautifully at the center of these nine days of prayer and mourning, and all around the edges of that murmur of ongoing prayer people share memories and condolences, connect with the family, remember Doña Licha.  For over a week the family is held and upheld, even as they work so hard to prepare everything.   It may be a relief to come to that 10th day when the house can slowly come back to normal - but as Martha said to me, it will also be very lonely.