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! 

Baby Shower

With Paula Alvarenga still in the hospital - the doctors are waiting as long as possible before giving her a Caesarian section to deliver her baby, who will come into the world with the elegant name Alejandro Emanuel - her family and friends decided to hold the shower anyway, on the very good theory that she's soon going to need those gifts. So I drove down to Soyapango, where following Alex's directions as well as I could didn't do much good - though when I finally called for help, I was at least in the right neighborhood and about 1/4 mile from the house. The house, which belongs to Paula's aunt, slowly filled, mostly with women (like traditional baby showers in the U.S., these are female events) including some very cute babies in frilly dresses and one brand new 3-day-old. We all ate tamales and drank hot cocoa and played silly games (which were even sillier with the mama not there), and Alex and Paula now have a good set of baby clothes and equipment to begin their parenting.

I'm a fairly shy person, and it was hard to make myself get to this event, where Alex would be the only person I knew beforehand. But Salvadorans are friendly and generous people, and they included me with a good will.

Please continue to pray for Paula's health and safe delivery - thank you!

Recycling Health

On our way to a few days in Oregon, my sister Kathy Roben and I stopped in Lacey to visit CHUMA, Catholic Health United for Medical Assistance, where we met with Mark Koenig, System Director for Providence Health International and Ray Reyes, Manager for CHUMA International (Photo, left to right: Mark, Pete, Ray and Kevin, the CHUMA stalwarts).

CHUMA is a big warehouse of donated medical supplies and equipment ranging from elastic bandages to surgical drapes to staple extractors. These supplies, mostly donated from hospitals and healthcare systems, are sorted, packed and sent out to health programs in developing countries, including El Salvador, Honduras, Haiti, Cuba and Tanzania, where they will be well used to serve patients in need.

While CHUMA normally does not receive or process medications, they have made an exception for PazSalud; they've taken in shipments of medications from the Catholic Medical Missions Board (CMMB), have prepared them in plastic tubs for our mission trips, and have delivered them to our SeaTac hotel the night before the mission group travels. They are great partners, and I was so glad to meet them and get a tour of their impressive operation.

A good week's work

Yesterday we finished the cataract surgeries - today we'll return to Hospital San Rafael just for post-op checks of yesterday's patients, and then we'll head out for a weekend of exploration in San Salvador and Suchitoto.

It's been a grand week, working with the Comasagua community and helping to create new sight. Here's a photo of three great collaborators - Hernan, our driver, tour guide, and shopping expert; Rosa, who gave us and our patients joyful and loving care; and Alex, who delighted us with his shoes and smiles. We've all had a lot of fun, and the work and fun have been inseperable as it always is at the best of times.

Men and machines

Today was grand! We finally got the flow right in the mornings, starting with the post-op review of yesterday's patients and going on to the prep and surgeries for today's. Seven patients went home, seven more received cataract surgery (we always plan for 10 surgeries each day, and often book a few more, but there are always some who forget and others who are afraid to have surgery done on their eyes).

I suited up in scrubs to watch a couple of surgeries today - one by Dr. Bob Rea, one by Dr. Tony Pisacano. Tony is using the hospital's operating microscope, which has a teaching microscope attached - this means that I got to share Tony's view, up close, of the patient's eyeball. I had thought of these surgeries as fairly simple - I suppose because they are common surgeries - but it was astonishing to watch the intricate steps and careful process required to extract the clouded lens. Down here, we don't use the sophisticated Phacoemulsifier which uses ultrasonic vibrations to break up the cataract; PazSalud and See, Intl use an older, slower and less expensive direct method. It requires great focus and complete attention to detail: it was an honor to watch two excellent surgeons giving that focus and attention to people who couldn't imagine being able to pay for cataract surgery.

The other surgery today was performed on the Slit Lamp, an essential piece of equipment that had suffered an internal short circuit. After I watched the two surgeries, I saw the completely disassembled Slit Lamp, which looked to be ready for the junk pile. But Hernan Merino, who owns and drives the bus we travel in, got a list of needed tools and equipment, took it to the hardware store, and came back with the necessary bits. Then all the four men on our team, Mitch, Bob, Tony and Barry, collaborated on putting the machine back together. And the women, I have to confess, laughed at this great example of male bonding. But the slit lamp works again!

One more note from today: remember the fuss we had getting our anesthetics through customs? The customs agent was particularly exercised by the fact that we were bringing in Lidocaine. Lidocaine! he said, and showed us a packet of lidocaine that had been confiscated. Today we realized that we were running short on lidocaine and set Hernan out to buy more. With no prescription and no difficulty, he was able to buy a nice big bottle of injectable lidocaine at a local pharmacy. Surely a good thing that those customs folk were on their toes!

New sight

In the photo on the right three patients from Monday - you can tell them by their eye patches - are waiting for their post-op checkup, while two of today's patients wait to begin the process. New sight! We had seven very happy people from yesterday heading home to Comasagua, and for them the flowers were bright as they haven't been for years.

A much better day

Today, the customs office safely behind us, we began the week of cataract surgeries at Hospital San Rafael, and it was a good day, thanks in no small part to the work of Mercedes and Rosa (Rosa is making a V for Victory in honor of Mauricio Funes' election as President of El Salvador). Mercedes Arias is a community organizer for CIS (Centro de Intercambio y Solidaridad) and Rosa is a member of the Junta Directiva of Comasagua. They're both splendid organizers: a little microbus arrived at the hospital promptly at 6:30 this morning with our seven patients for today, all with their papers filled out and ready to go.

The other two photos are from the waiting room: Michelle Pisacano with four of our patients and me with one.

A quick introduction to the members of our surgical team: Dr. Tony Pisacano (from the Bronx, NY) and Dr. Bob Rea (from Indiana) are our two ophthalmologists. Mitch Costin (from the cardiac care center at Riverbend Hospital, Springfield, OR) and Dr. Silvia Pleitez (a Salvadoran, currently living in Los Angeles) assist with the surgeries. Shannon Updike, an RN from Ketchikan, is responsible for pre- and post-surgery care. Charo Sanchez, who is usually unit coordinator for the childbirth center at St. Joseph Hospital, Bellingham, is our interpreter. Barry West (whose day job involves IT in Eugene) is our photo journalist, and Michelle Pisacano, Tony's wife, has been helping with patients and supplies. Kathy Garcia, Manager of the PazSalud program, is the rock who keeps everyone steady, focused and cheerful. As always seems to be the case, it's a group of committed people who are very happy to be here, working hard, and giving the gift of their time and skills to bring new sight to those who are almost blind.

Baptism by fire

Saturday Hernan and I set off for the airport in Hernan's beautiful red coaster with an operating microscope and stand, a slit lamp (don't ask me what it does!), an autoclave (sterilizer), and boxes full of sterilized water, scrub soap, and snacks. We were on our way to pick up our crew of 8 for the coming week of cataract surgeries, and I got so preoccupied with all the preparations that I forgot to check the plane status. Folly! When we got to the airport, we soon found that the plane (normally due at 7:45 PM) had been delayed and was now scheduled for 11 PM. We settled down to wait, which is such an ongoing part of life in El Salvador, and I checked in with the airport authority police from time to time about whether and when they would let me go in to meet our passengers (and their baggage). I waved my set of franquisia papers around a lot - these allow us to import the medications we were bringing in without paying any customs duty, and I was of the opinion that it was going to make it easy to get our equipment and medications through customs. I was wrong.

The plane finally did arrive - at about 1 AM - and our group assembled at the customs line. I waved my franquisia again, and the customs agent started going through it with a fine tooth comb. He looked through the list, written in English (and already approved by the body that approves medicine imports), and wanted to know the translation for every term. Charo Sanchez from Bellingham, our interpreter for this mission, gamely went through the list as he made notes. Then he started looking up the medications on his computer. Then he told us that because we were bringing in anesthetics (the local anesthetics used to numb the eye for surgery), our import would have to be approved by the anti-narcotic division, but they were not at the airport at this hour (by now it was 2:30 AM), and furthermore the import would have to be approved by the anti-narcotics division chemist, and he only worked Monday through Friday, but maybe he would come in tomorrow to take a look at our anesthetics.

OK, we said, gritting our teeth (much toothgrinding going on), OK, keep the medications and we'll come back for them tomorrow, but let us take the rest of the things we need to have tomorrow to set up the operating room - the scrubs and patient gowns and sutures and eye patches and sterile gloves, and so on. No, he said, it's all on the one franquisia, so nothing in the whole shipment can be taken until it all has been approved.

We were a shell-shocked and completely exhausted bunch by now and it was clear that nothing was going to budge our customs agent, so we climbed wearily into Hernan's bus and went to the Hotel Novo, where a very sleepy looking night clerk let the group in at 3:30. I went back home and slept (blissfully) for four short hours.

We had managed to come away with a phone number and name to call the next day. When Charo called she talked to someone who said oh yes, no problem, everything's approved, come on down and get it. So Charo and Dra. Silvia Pleitez and I climbed on to Hernan's bus and rode down to the airport. The woman Charo had talked to said we didn't need to go to the Port Authority police to get permission to enter the Customs area - but we did. Another lengthy set of explanations, and we were back in customs, and the same customs agent was there, glumly filling out yet more forms. Can we pick the boxes up now? we said. It's going to be another 20 minutes, they said. Finally, after a half hour that felt like eternity, they had Charo sign her name on about 15 different pieces of paper, and they turned loose our equipment, and we loaded it into the bus and headed back to San Salvador.

Finally, today, we did get to the hospital, we did set up the surgery suite, we are ready for patients tomorrow - but I hope never to go through anything quite like the last 48 hours again. You can probably see the accumulated strain in the tired face of Charo, sitting on the right next to Silvia in the photo above. Behind them are the liberated boxes and duffel bags and tubes, taking up more than half of the coaster. Behind us, for this time anyway, is the customs office.

In Santa Tecla

A good, busy day, with many pieces of our coming cataract surgical mission falling into place. I went out to Hospital San Rafael in Santa Tecla, where our Comasagua patients will go for their cataract surgeries. With the help of Cristy, a staff member at CIS who translated for me, I had a good conversation with Licenciada Guardado, the head of nursing, about all the arrangements (Licenciado/a is the term of respectful address for those who've completed University degrees). I look forward in hope to the day when I can have a full and complete conversation about important matters in adequate Spanish - but I'm not there yet. A side benefit of the trip was getting to talk to Cristy - en español - on the way there and back again about her work, life and political passions.

Hospital San Rafael is the middle of a vast transformation - new surgery suites and wards have been built; an area that was a dustbowl two weeks ago has been transformed into a parking lot. The site is still full of workmen and full of polvo, dust, blowing around in the swift March winds. This is the season of dust: Salvadorans I've talked to think of March and April as the hardest months, when it gets hotter and hotter, and dustier and dustier, and there's no rain to cool things down. We've been lucky this year, catching the tail-end of the cold weather further north in the Americas, to have lots of wind and cooler than usual weather. The Salvadorans think it's cold. I think it's pretty nice. Except for the polvo.

Up the road to Comasagua

I drove up to Comasagua today to meet with Mercedes Arias, the community organizer for CIS who coordinated our medical mission. We went over the list of those who were screened for cataract surgery and planned hiring a bus to take each day's patients in to San Rafael Hospital in Santa Tecla. It's great to work in an organized community - between the CIS organizers and students and the health promoters in the Unidad de Salud clinic, we have really great connections with our patients in their smaller communities.

We walked up to the Unidad de Salud and it was wonderful to see so many familiar faces - Alex, the world's best pharmacy volunteer; Gloria, the clinic pharmacist; Mauricio, who keeps the physical plant in order; and Doctora de Larios, who opened the clinic to us and managed the referrals for patients who needed to be seen at the hospital. There were some people waiting to be seen, but nothing like our crowds. And the water is running again!

Mercedes asked for a ride down to Santa Tecla, and on the way we talked about the earthquake of 2001, which destroyed every house and building in Comasagua. Mercedes and her husband and children lived in a tent for more than a year, until her husband managed to build a very small house, which they are still enlarging and arranging. Much of today's Comasagua, especially the public buildings - the San Mateo church, above, the Alcaldia, the Unidad de Salud, and the Casa Comunal - were built by Venezuelan soldiers. They also rebuilt some houses, but the Salvadoran government decided it was time for them to return home - before they got to Mercedes' house.

Purposes

Today Eleanor and Kathy and I made some preparations for the cataract surgery mission (co-sponsored by SEE, International) that will be our next big project in April. We wrote some thank you letters, worked on accounts, and compared notes about the Comasagua mission.

I've written a lot about our connection during the week with the people of Comasagua, who have moved each of us deeply. Each person who came on this mission will go back home with a deeper, more heart-felt experience of the realities faced by most peoples in the world. Each of our health providers, back in their super-clean clinics, with pure water available from every tap, will be remembering the difference.

I've said less about two other important purposes of this mission week. We brought together doctors, nurses, physician's assistants, pharmacy techs, interpreters and chaplains (among others) from a variety of PeaceHealth regions, and we brought them together as equals. I love it that on a PazSalud mission all the name tags have first names only (except for Eleanor and I, who have Hna - hermana, Sister - in front of our names. In this trip, Father Ken Olsen was another exception, Padre Ken). The long trips on the bus each day gave everyone time for thoughtful connection and conversation, and the evenings gave us time for fun (as can be seen in the photo above, from our dinner at Beto's: Bob Davis, Nelson Solano, Elba Rivas, James Boyle, Ken Olsen and Elizabeth Lowery gather around Alan and Joan Yordy). So one of the purposes of the missions is to connect PeaceHealth people with each other in ways that reach across the boundaries.

A second, and more important purpose, is simply to remind everyone involved, and many at home who will see the photos and hear the stories, that providing health care is a mission. I've heard many of our PeaceHealth volunteers by now talk about how this week has recharged their own sense of mission, their own dedication to the work. It comes in realizing that you have a gift of healing to give, even without the technology that supports healing in the United States, and in knowing that you give that gift through your respect and kindness, as well as through your skill.

A last day in Comasagua

We finished our Comasagua mission yesterday (Friday). Driving up in the morning, we saw an enormous crowd waiting for us at the gates of the Unidad de Salud - so many people that Dr. de Larios, the clinic director, had to call for the police to keep order. We can only see about 200 people on the last day, because we also have to pack up, organize our donations to the community, and say goodbye. On Friday, our 200 people stretched to about 270, including a large group of schoolchildren with myopia who needed glasses to be able to read. Still, sadly, there were people who could not get in.

We completed our clinic in the early afternoon, having seen more than 1700 people from Comasagua in the course of the week. We left behind us many of the remaining medications for the Unidad de Salud; we will be giving the remaining eyeglasses to local Lions' Club clinics. The Mayor of Comasagua came in at the end of our clinic time to invite us to a celebration at the Casa Comunal, where we had lunch all week. There gifts and thanks were exchanged - the Mayor gave each of us one of the beautiful images the women of Comasagua have been making with flower petals, and we gave each of the community volunteers who worked with us all week gifts of calendars, pens and the like. We ate cake and drank gaseosas and felt very sad to be saying goodbye to people whose faces had become so familiar and treasured in the course of a week's hard work together: Mercedes, who kept everything pulled together, Alex, who organized the pharmacy lines like a pro, Rosa, who knew how we could get back in touch with every surgery candidate, Lorena who wept when she told us how much she thanked us - and many more. We will miss each other.

Primero Díos

Yesterday PeaceHealth President and Chief Mission Officer Alan Yordy and his wife Joan flew in to spend a few days with our Comasagua mission. This morning, because Alan has a noon telephone conference, I'm here at our Base House so I can drive him up to Comasagua after his conference finishes. Happily, this gives me time to do a little longer posting on the amazing experience of our health mission.

Primero Díos. Yesterday I logged in 14 candidates for cataract surgery during our April 20-24 surgical mission - and because Eleanor was picking up Alan and Joan at the airport, I did this on my own, with only occasional need for help from one of our interpreters. A bit of a baptism of fire, as each candidate was a senior citizen, a couple were hard of hearing, others had strong campo accents, and I had to explain the whole process of the surgery - getting to the hospital, what happens in the surgery, and the after care - in understandable Spanish. It all went well, and was quite a boost for my confidence in Spanish. At the end of each interview, I said "nos vemos 22 abril" - we'll see each other April 22nd. And each Salvador responded, "primero Díos," God first. God first, meaning that our seeing each other in April is first of all in God's hands. God first, meaning let's not get too invested in our plans and programs. God first: what a great lesson for a North American who's used to making plans and carrying them out.

When I wasn't logging in cataract patients, I was delighting in watching our PeaceHealth volunteers connect with the people of Comasagua. Their loving, respectful attention to each person is the very essence of great healthcare - and it's healthcare at its most essential, stripped of the technology and supports that all our providers are used to in the United States. The love and respect is joyfully returned, as can be seen in these photos - of Dr. Dale Heisinger being hugged by a young patient and 4th year medical student Jenny Semadeni-Malcom consulting with a family. It's hard work, long hours, lots more patients in a day than our providers are used to seeing - and everybody loves it.

We've also been blessed with great local volunteers who log in our patients, keep the lines organized, keep people moving through the process, and cook delicious lunches for us (yesterday was bean soup, rice, avocados, and glorious local fruits). Doctora de Larios, the Executive Director of the Comasagua Unidad de Salud, where our clinics are located, has completed many referencias so that patients whose health issues are beyond what we can diagnose and treat will get attention at the national hospital.

Will those who have been referred really get the attention they need? Health budgets are bare bones in this country, and poor patients often have to pay for their medications (which means that they are likely to go without). We can't do everything. Reforming the Salvadoran health system is not within our scope. We do follow up with particular cases when we learn that crucial care cannot be provided (for example, our optometrists will be taking home glasses prescriptions for several patients whose needs can't be met with our donated glasses). We do what we can. Primero Díos.

No water, much joy

We learned on Sunday that the water in Comasagua (the entire town) was going to be turned off for four days so the leaking town water tanks could be repaired. As you can imagine, this has been a challenge to everyone, but especially to Mauricio, who keeps the Unidad de Salud clinic clean. He's been hauling barrels of water from the cistern to provide essential washing and toileting for staff and volunteers - and all our PeaceHealth volunteers, used to the sparkling clean environment of a U.S. hospital, are managing without a murmur. Well, maybe a little murmur or two - but not so you'd notice. The people are patiently taking it all in stride.

I'm going to add a second post of photos only, because the photos tell the story - especially the story of the niños encantadoros, the beautiful children of El Salvador.

Setting up

Our mission group of 25 came in on Continental Airlines last night, and it took a lot of serious and lengthy discussion to get them and their 44 tubs of medication through customs. We had the bad luck to start with a Customs agent who was very bureaucratic, and for a while they threatened to lock up the medications until some unspecified time (after the end of our mission?). Then they said they'd have to look into all the tubs. They did, but the sheer overwhelming number of tubs and people meant that this was a very quick look. Finally we were on the road to San Salvador.

This morning, the group went up the winding and scenic road to Comasagua in Hernan's lovely red van (Hernan has been our driver for many mission trips). Those who wanted to joined the Comasagua community for Mass, and a special surprise: a wedding had been incorporated into the Mass. We got there early and had time to stand around and talk and compare footwear (as Melissa Doherty, Olga Orievsky and Kathy Garcia are doing in this photo) before the bride came down the aisle.

Then we went to the Unidad de Salud, the health clinic where we will be working all week, and worked and worked and worked to unpack and sort the tubs, arrange all the clinics, arrange the glasses, organize the pharmacy and bag up vitamins (a month's supply goes to everyone who comes to our clinics). We hear that water is going to be turned off - we don't know why - for the next four days, so we are working with bottled water and great barrels of cistern water for toilets. Feels like we're ready to go - and I'm ready to go to sleep.

Waiting for the mission group to arrive

I've ironed 10 shirts (one for each day of our mission group's time here) and 7 pairs of pants. I walked down to Office Depot (yes, the same one) today to get masking tape and double sided tape and batteries, little extra needs that came up as Eleanor and I reviewed the tubs full of supplies.

The supplies we keep here in big plastic covered tubs between mission groups are the obvious things - equipment for the eye exams, blood pressure cuffs and stethoscopes, rubbing alcohol, hydrogen peroxide, reading glasses and sunglasses, thermometer probe covers, signs, peak flow meters, power strips, shower curtains and clips to create privacy areas, an electric frypan and salt (used by the optician to adjust glasses fit), tongue depressors, baby wipes, vinyl gloves, rope, and more. To these we've added a large order of medical supplies, including speculums, and a large order of medications from the Archdiocesan supply house (we are able to purchase medications from them at a reduced cost because we give them away to the people). All of this will be swept up into a good-sized truck at 7 this evening, and then we will be off to the airport to welcome our 25 members of the PeaceHealth team with all their tubs of medications and equipment. And then the work of this week in Comasagua will begin!

Salvadorans share the hard times

Hard times in the United States are hard times in El Salvador for a number of reasons. First, a lot of families in El Salvador depend on their relatives in the United States to send money - this has been the country's biggest source of income. And now the jobs available to immigrants, with or without papers, have dried up. CNN had a story yesterday about the desperate situation of Latinos, many of them Salvadoran, in New Jersey. Those men aren't sending any money home, and the families here that have depended on them are hurting.

I can't begin to understand all the ways the global recession impacts a small, poor country like El Salvador. But one story in this week's La Prensa Grafica gives a clue. "Faces of Scarcity" talks about people who are postponing chemotherapy or going without post-surgery medications because Hospital Rosales, one of the country's largest hospitals, is out of stock on 85 basic drugs. The alternative is for patients to buy their own medications from a commercial pharmacy. Vitelio González found that it would cost him $600 to purchase for himself the antibiotics he has to take for two chemo sessions. His brother helped find the money for one batch, but that's all that was possible. He's hoping those sessions made him better, because there's no money for more antibiotics.

In the next day's paper the government denied that there was any scarcity.

A visit to the campo

We visited the countryside today, taking what seemed like a long journey to visit Rosita and her daughters and son in the El Paraiso area of Chalate-nango. It turned out to be only about 42 miles one way, but given that I was driving, getting used to a stick-shift again (turns out to be like riding a bicycle - you don't forget), and navigating the challenging traffic of El Salvador, it felt like a looonnng trip.

Above top, Lupita, Rosita, me, and Edith (pronounced eh DEET, more or less, and I have no idea how she spells it in Spanish), and the two beautiful girls below. Rosita has been connected with the Sisters of St. Joseph of Peace and PeaceHealth since 1989 when she came to Jesuit Refugee Services at El Despertar in San Salvador. She was 11 years old then, and had lost both legs below the knee from crude amputations - perhaps resulting from an infection or gangrene, she didn't really know why. She met Sister Eleanor at El Despertar, and was eventually fitted with prostheses which she uses like a pro today. In the years Eleanor was away from El Salvador (1993 - 2000) Rosita had her three children, but without any lasting relationship to their fathers and no way to support herself, they were mired in deep poverty. Through the help of Eleanor and friends among the Sisters of St. Joseph of Peace and at PeaceHealth, Rosita has been able to buy a small lot and have a two-room house built, very simple and campo style, but adequate space for her family; she has banana trees on the lot which yield fruit that they can eat and sell, a well, an outhouse, a small flock of chickens tended by a glorious rooster and some scrawny dogs and cats, and her daughters are going to school. It's a life that would still seem like deep poverty to any norteamericano, but for this little family it's security and a bit of hope. It was good to be there and to connect with Rosita.

The other wonderful connection today came when we went to the Archdiocesan offices so I could apply for a carnet - a card identifying me as a Sister. There, by blessed serendipity, Eleanor was able to introduce me to Monseñor Ricardo Urioste, who was Secretary and Vicar General to Archbishop Oscar Romero. He was sad that he had missed seeing Sister Andrea, whom he remembered from her work at the Calle Real refugee camp, and I was sorry too, as it would have been a joy to have witnessed their meeting. Like Oscar Romero, Monseñor Urioste has been a powerful voice for social justice in El Salvador. He is a humble, warm and friendly man, and it was a great honor to meet him.

Both Rosita and Monseñor Urioste remind me that I am living in a country filled with the memory of war, loss, holiness and hope.

Photos from Guatemala

Three photos from Guatemala: Above, a mural in the garden of the Franciscan church in Antigua shows a Mayan woman and child, Santo Hermano Pedro, Saint Francis and a Mayan man around a painted cascade that leads to the real fountain. The legend says, "Mother Earth is a gift of God for all: take care of her and share here as brothers. Below, on the left the Directora of the Clinica Maya, the indigenous medicine clinic at Clinica Maxeña, shows us the tres puntas plant, which has worked very well to bring down high blood sugar levels for diabetics. On the right - not a very good photo, but it shows all four of us, Susan, Andrea, Sheila and Beth, under the big Ceiba tree that was planted as a stick forty years ago at Sheila's Clinica Maxeña in Santo Tomas.

Clinica Maxeña

We're back in Antigua after a day's visit to Sisters of St. Joseph of Peace Associate Sheila McShane and the Clinica Maxeña (pronounced Mashenia, more or less and shown on right) which she directs in Santo Tomas la Union. Couldn't tell you in miles or kilometers, but it's a 2 1/2 hour often bumpy drive from Antigua, along a route that goes down from high-altitude Antigua, parallels the Pacific through fields of cane, and goes up again toward the Mayan highlands. Santo Tomas has about 15,000 people (I hope I'm remembering this correctly), going up to 80,000 if you count the people in the surrounding cantones for whom Santo Tomas is the political, mercantile, and health center. The population is about half Mayan, half Ladino (Spanish-identified people of mixed heritage) and Sheila says they all get along well these days, with intermarriage increasing.

The Clinica Maxeña (Maxeña is the K'iché - Mayan - word for Thomas) has been serving the people of Santo Tomas for about 40 years now. It's a mission of the Catholic Diocese of Helena, Montana. It's a big clinic, with about 25 Spanish-K'iché bilingual staffers, including a full-time MD. Sheila, an RN who lived in Guatemala in the 1970s -80s and returned two years ago, is the Clinic Director. They are funded by the Diocese, by grants, by payments from patients, and have had to cut back, like so many non-profits, as funds dried up in the economic crunch.

We had a great tour of the clinic, where we were especially intrigued by the separate clinic that grows, dries and distributes the traditional Mayan healing herbs - including one said to be very effective for diabetics, a big problem here as elsewhere in the world. We enjoyed meals with Sheila and Sisters Mary Waddell and Anna Priester, BVM, met Father Jim Hazelton, who's been living in Santo Tomas for 40 years, visited La Asuncion, a school he started which trains teachers, and stayed overnight in the comfortable visitors casita. Best of all, we enjoyed long conversations with Sheila. And then we came back on the Clinic jeep, bumping down the kilometers back to the comforts of Antigua and the Aurora Hotel. Much more to tell, and photographs to share when I return to San Salvador, but for now, I long to be walking or sleeping, anything but sitting!