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!

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!

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! 

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!

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. 

Vacation pause

I haven't blogged much these last couple of weeks because I've been working hard on our PazSalud report to our donors (done, printed and mailed!) and connecting to my CSJP Sisters.  I've been blessed to be present when our Sister Cecilia Marie Gri went home to God at 98, dying as she lived with clarity, grace and the deepest faith.  I was delighted to join the community yesterday in celebrating our 7 Jubilarians, who've given a collective 395 years of ministry.  And today I head south, driving to northern California with my sister Kathy to visit cousins and have a vacation.  So I'll be back in July, and meantime here's a couple of Suchitoto photos:

From the Corpus Christi procession -

and from a celebration of art and artists at the Centro Arte para la Paz -

A dash of tropical color as I set out on a rainy Northwest June morning.

Villanueva, Tuesday

I'd love to give you some of those worth-1000-words pictures, but Í'm using Ayagualo's computer, and can't get to my photos.  Yesterday and today have been full and overflowing - we´ve seen some 650 patients so far, with lots and lots of them needing special attention or a reference into the national health care system.  Our hearts are overflowing with the stories we´ve heard and shared.  And then there´ve been a few cases of just overflowing, as some Salvadoran bacteria tangled with our gringo systems.  It´s been very hot in Villanueva, which makes the return to Ayagualo (not until 7:30 tonight) and the cooler breezes on this hilltop a great joy. 

For another view of our mission week, go to http://wwwpeacehealthorgpaz-salud.blogspot.com/ to read about the experience from the point of view of Barbara, our photo-journalist.

Noise and silence

Apologies for the blog silence...it's only because I've been in the United States - in Bellevue, Washington - since early June, so I haven't had much fresh info about El Salvador to post. Strange things have been happening there: a big constitutional crisis has heated up with the legislature passing a law to require the judges of the country's Constitutional Court to be unanimous in any decision about the constitutionality of a law (many recent votes of this five person court have been 4-1 decisions), and there's been a strong popular protest. The court, perhaps predictably, declared the law unconstitutional. You can read about it in Tim's El Salvador blog, but it's pretty hard to understand the dynamics at a distance (like someone in El Salvador trying to understand the current dynamics around the debt ceiling crisis in the United States).

Meanwhile, blessedly, my own health crisis has been resolved with great medical skill and lots of prayer. I am able to enjoy long walks for the first time in six months - what a joy! - and I will be heading back to El Salvador on July 25th, most thankfully. Perhaps I will find someone there who can help me understand the constitutional crisis.

And also, meanwhile: I've been assembling photos from the last year for our PazSalud calendar selection, and here's a favorite from the May eye surgery mission - left to right, Dr. George Sesson, our optometrist; a happy patient; Dr. Tony Pisacano, our ophthalmologist, and Dra. Silvia Pleitez, our circulator.

Hospital Bloom

Last week I drove Sandra, her grandmother and her uncle to a 6 AM appointment at Hospital Bloom, El Salvador's public pediatric hospital. In order to do that, I had to get up at 3:30 AM, meet Sandra and family at 5:00 in Ciudad Arce (they live in the municipality of San Juan Opico, but Ciudad Arce is closer to their very remote home in the hills). They were probably up even earlier to walk down long rough roads in the dark, but they were there on time, and we set off for the capital.

I'd already discovered that invariably appointments at Bloom are set for 6 AM, but I couldn't figure it out - surely the doctors didn't start their clinics that early? By 6 AM I'd found a parking place and we lined up outside the hospital, a commanding multi-story building, with a lot of other parents and children, a woman selling atole (a hot corn drink) and a clown selling balloons. The guard checked Sandra's appointment and let us in. We went down the hall, found the ophthalmology clinic, and sat down. And after quite a while we noticed that a long line was forming in front of the desk outside the clinic - ah yes, no one told us about that part of the ritual. I have to confess that we jumped the line - we really had been among the very first to enter the hospital, and it didn't seem fair to have to go to the very end. It may have helped that I was a gringa, because the secretary let us turn over Sandra's hospital card and appointment. And then we waited some more and after another time that seemed longer than it really was, the clinic secretary got us all lined up in chairs according to arrival time. An orderly procession had been created. This not-very-good photo gives some sense of the feeling of the corridor, full of mothers and some fathers, each tenderly carrying or watching over their child.

It was about 7:30 when we finally got in to see Dr. Dominguez, who checked Sandra's eyes (she has congenital cataracts), scheduled her for pre-tests and surgery, and told me the size of the interocular lens she will need. But those lenses won't be provided by Hospital Bloom, nor will the heart valve needed by Richard, a little boy we met in San Rafael Cedros. Unless the families can raise the money to buy the lenses, or heart valves, or tests that the hospital doesn't perform, or medications that the hospital pharmacy doesn't have in stock, health care gets stopped in its tracks.

This isn't the fault of the staff at Hospital Bloom or at any of the other hospitals. It happens because El Salvador is a poor country and in a poor country's health care system the extras - interocular lenses, heart valve replacements, expensive medications - just don't happen unless someone steps in to help. The children who can profit from ordinary care do well in this system - El Salvador has a good record of pre-natal care, vaccinations, and treatment of normal childhood diseases. And if the lenses or heart valves or medications can be purchased, all the surgery and hospital care and follow-up appointments are completely free. In El Salvador, the cost of health care is relatively inexpensive - doctors and nurses are not paid much at all by U.S. standards - but the cost of 1st world technology is prohibitive.

Children with costly or complicated illnesses are often, in effect, triaged out. Sandra and Richard who needs a heart valve replacement and Gema who needs medication Bloom doesn't carry are lucky to have encountered one of our PeaceHealth mission teams and found sponsors. But for too many children here and in every poor country in the world, the miracles of health care that we take for granted and see as any child's right in the United States are simply too costly and not available.

God be with you

Do you know that "goodbye" is a shortening of "God be with you"? This morning Kathy and I hugged our wonderful medical team goodbye and sent them into the airport, knowing that God was with them. By now, they're home and telling their stories to family and friends, as they remember the people and the days of our mission.

We saw 1305 of San Rafael Cedros' citizens during our five days with a total of 2185 clinic visits. A number of our patients had serious illnesses that needed referrals to the local clinic or hospital for follow-up care. I'll be keeping connected to some of those follow-ups, and to our 50 patients for the cataract surgery week in May.

We will all remember different things from the week, different faces - surely this lovely woman in pink will be well remembered by Kathy and Sister Amalia - but we know we've been blessed by the people of San Rafael. And we've been deeply blessed by getting to know each other. By the end of this intense week, the 28 of us had worked together, laughed together, shared stories, wept a little, danced, played cards, enjoyed Salvadoran food, loved the sunshine in February. It was as smooth a week as Kathy and I have experienced, and for this we're grateful both to our great team and to the super-organized local volunteers of San Rafael Cedros. May God be with all those returning home with memories of a week well spent.

San Rafael Cedros

We had a wonderful week of clinics in San Rafael Cedros, and since a photo is definitely worth a thousand words in this case, I'll let a few photos tell the story. We were in the municipal kindergarten, a small building to hold our group of 28 plus our local volunteers and the patients we were seeing, but it worked beautifully - and coming up on the bus every morning we delighted in seeing Micky and Minnie and the crew.

The first photo shows Dr. Dale Heisinger, a great pediatrician, with Jen Cowan, his interpreter, and one of the many families they saw. While many of our providers needed interpreters, Trevor Moerkerke, a 4th year medical student working under the direction of Dr. Ron Stock, used his excellent Spanish to talk with this mother. Our pharmacists dispensed medications through the elaborate framed window - Moises Lucero, an ER nurse in his day job, patiently explained dosing instructions to each person. The last photo shows Iris Alas, our local coordinator (on right) with some of the great group of local volunteers who organized our patients and kept the lines moving smoothly every day.

We worked hard all day, and each night returned to the Santisima Trinidad Casa de Retiro, a retreat center (not retirement!) overlooking Lake Ilopango, where we enjoyed excellent and traditional Salvadoran food, followed by cribbage, bananagrams, dancing, and a good night's sleep. Today we're at the luxurious Hotel Novo in San Salvador, and I've been listening to our team talking about how important this week has been for them, and how it has recharged them for the work they'll soon be returning to. And that is the idea.

Ready

It's only Tuesday, the PazSalud volunteers don't arrive until late Saturday evening, and I am in a most uncharacteristic state of having almost everything ready. Our franquisia, customs permission, is in hand and copied. Snacks and soft drinks and coffee and water are sitting in our bodega (storeroom). I've met with our local volunteers and with the women who'll be cooking our lunches, I've talked to the retreat house where we'll be staying the first six nights and the hotel where we'll spend the weekend. I've checked in with the San Rafael Cedros health clinic and with the police and with the Mayor's office.

My to-do list, impressive last week, just has a couple of things left for each day this week. I still do have to print some forms, iron shirts, pack my bag.

I was so delighted to be this close to ready that I celebrated this afternoon with a cooking orgy - made a bean soup with roasted vegetables, roasted red pepper salsa, and a ginger/garlic/honey tea I've been brewing to keep my throat and lungs happy. The house smells amazing. And I'm ready for a week of the best hard work in the best company possible.

One rough day

I put Kathy Garcia on the plane this morning after what has to have been just about her worst day ever in El Salvador. It began with digestive upset & stomach cramps, which left her drinking Gator-Aid and eating toast for the day. Then, when she was lying down in the afternoon, she heard a scrabbling, and looked up to see a couple of rats running along one of the ceiling beams. The usual furor ensued: Kathy yelped, the rats fled, we moved her into a different bedroom. This was a little discouraging for us, as we hadn't seen rats for months and were happily convinced that they'd gone to live elsewhere.

This would have been more than enough, but then at 8 PM our neighbor started up the disco music at top volume, playing until after midnight. Not unreasonable on a Friday night, and usually I would just curl up with year one of The West Wing, which Korla has kindly loaned me - but Kathy and I had to get up at 3 AM to get her to the plane on time. We each got perhaps two hours sleep, but luckily there's no one on the roads at 3 AM, and after dropping her off I dozed for a couple of hours in the airport parking lot, in a blissful quiet interrupted only by the squacking of the grackles that live there.

At about this time, Kathy should be reaching home in Oregon, very, very tired and very, very glad to see her husband and daughter and quiet bed. I hope tomorrow will be perfect enough to make up for Friday.

Felicidades, Moises

Friday, November 26th was a big day for graduations here with several Institutos holding graduations. An Instituto is the equivalent of a high school in the United States, and graduates receive a bachilerato, a coveted degree that is required for entering the police or the army and for most civil service jobs. A bachilerato is also necessary for those wanting to go to the university, of course.

I went to the Instituto Los Almendros, about 20 minutes west of Suchitoto on the road to Aguilares, to see Moises graduate. About 8 years ago, PazSalud's medical clinic was held at the La Mora clinic, and Moises, then about 11, was examined and found to have serious heart valve deficiencies. The doctor who examined him sent replacement heart valves to the Bloom Children's Hospital in San Salvador, where Moises got life-saving surgery. Since then Moises' PeaceHealth doctor has provided the medication he needs to take every day, something that his family would not be able to afford.

So PeaceHealth has a stake in this young man's graduation, and he looked great and was very happy (though you might not be able to tell that from the photo - all Salvadorans tend to adopt a poker face when a camera is pointed at them, and I forgot to go through my "say queso" routine). In the top photo, Moises' mother Reina - who is, I'm sure, the real reason this young man is living and graduating - stands with her son and the fellow student he escorted. In the bottom photo, Moises stands with his family at home - with the blue and white balloons (the national colors) and a huge congratulations sign. Felicidades, Moises, que su futuro sea luminoso - Congratuations, Moises, may your future be bright!

Countdown

I'm doing my usual countdown to the arrival of a mission team: yesterday's meeting with the local volunteers; customs documents in hand; boxes of equipment and supplies assembled; snacks and water ready for the truck; shirts and pants ironed and packed. In half an hour Hernan will arrive with the truck, and we'll be on our way to the airport to meet our team.

In this case, it's two different groups coming together - 7 people from the Bellingham Lions Club, led by Ken and Janet Henderson and 7 people from a PeaceHealth organizational development group, led by Angie Wolle. Kathy Garcia's on the team to organize us and her daughter Andrea will be translating. Tomorrow we all head to San Juan Opico for Mass (for those who want to attend) and to Carmen Aviles' campo home for what is sure to be an amazingly delicious meal, and then we set up the eye clinics. Monday and Tuesday our optometrists will be giving eye exams to people we had to skip last February, and we'll be fitting them with glasses. Meanwhile, there'll be demonstrations of the Sawyer water filter and the ecocina smokeless cookstove, presentations from our PeaceHealth doctors, a tour of the local health clinic, dentist checks for kids, and donations of vitamins, toothbrushes, toothpaste, lotion and body wash. We come bearing gifts!

After Tuesday our group heads in two different directions - the Lions for meetings in San Salvador followed by a trip to Copan, Honduras, and the PeaceHealth group to Suchitoto, where we'll meet with Sister Peggy. I hope to be able to blog as the week unfolds, but that will depend on the timing of everything. It's going to be an amazing week!

Old and new friends

This week I haven't blogged much because Kathy and Victor Garcia have been visiting. Kathy's our PazSalud program manager and Victor, her husband, came down to help us in the process of looking for a newer car (the PazSalud '96 4Runner, a magnificent workhorse, is getting old enough that we began to worry about having to make major repairs). We found the car we wanted, but the owner decided he didn't want to sell, alas.

Meanwhile, we've been able to introduce Victor to many of our friends and helpers here - he met Sister Margaret Jane, of course, and Sister Bernadita, also a native of Honduras, at Hospital Divina Providencia (she is the tiny one in the photo). We took him to visit with Leslie Schuld at CIS, and with Dina Dubon at the Archdiocesis of San Salvador, and we had a splendid lunch with Hernan Merino , our indispensable motorist (Victor is on the left in the photo). Hernan was delighted to meet Victor in person, as they've often talked on the phone. Sister Peggy O'Neill gave us a special tour of the new skateboard park and the soon-to-be-opened museum of Suchitoto life and history at the Centro Arte para la Paz

Meanwhile, Victor was feeling bad because we didn't find a car to buy, so he and Hernan put their heads together and took the 4Runner to a shop Hernan knows where our dim headlights were replaced by much brighter lights, a huge improvement for night drives to Suchitoto. The 4Runner's engine has now been inspected in detail by all the experts and pronounced perfect. The 4Runner no longer has even a single squeak (Victor plus WD-40). Why, I wonder, did we even think about replacing it?

Meanwhile, he and Kathy and I have gone through our enormous collection of supplies and medications to organize things for our November, February and May missions and to figure out what we'll need to bring down here. And Kathy and I have proofread our 2011 calendar, which is going to be glorious. And we've eaten well, talked lots, and enjoyed a relatively cool week with lots of rain showers at all odd times of the day and night.

Ready!

Today, after a bit of nail-biting, I acquired the final piece of official paper, the franquisia that allows us to import the medications for our week of clinics without paying customs duty. The storeroom in the house is full, and the boxes have expanded into the two adjacent rooms. I've ironed ten shirts. Time for the group to come!

They're due in tomorrow evening at 8:30 and we'll be there with the permission from the Junta Vigilancia, the franquisia, Hernan's spotless red coaster, and a big truck for baggage and the plastic bins that carry the medications and equipment. Once through customs and loaded up, we'll all be off to Las Brisas del Carmelo, the beautiful retreat house in Santa Tecla that will be our home for the week. And on Sunday we'll show up in San Juan Opico, ready to set up clinics and begin our week with the people of Opico.

I don't know how much opportunity I'll have to post photos or comments during this week, but they surely will appear when time and internet connection allow. This is, among many other things, a most wonderful way to begin Lent, in joyful service to the people of God. May it be a time filled with blessings for all.

Tramites update

I am delighted to say that Kathy Garcia and all our doctors pulled things together very quickly after the Junta Vigilancia de la Profesión Médica told us they wouldn't authorize our medical mission unless all the doctors' documents had an Apostille from their state. Licenses and Curriculum Vitae were re-notarized and sent to Kathy; Kathy took the Oregon documents to Salem for their apostille, and Andrea Nenzel drove the Washington documents from Bellevue to Olympia. Both sets were sent via Federal Express to our friends at CIS (Centro de Intercambio y Solidaridad) on Friday - because FedEx doesn't deliver to Suchitoto. I'll be lurking at the CIS offices Monday to get the precious apostilles and take them over to the . And at last, we should be properly approved!

Meanwhile work toward the February mission moves into high gear this coming week. There's a mountain of shopping to be done, meetings with our volunteers, complicated transportation issues to work out...a lot, but it all seems do-able and delightful. In two weeks we will have the clinics set up and organized, ready for Monday, Feb. 15th, when we open our doors to the people of San Juan Opico.

Tramites

The rhythms of a delightful week of family and sightseeing and visiting were interrupted by word from the Junta Vigilancia de la Profesión Médica. I had given the Junta - the group charged with approving all doctors in the country, whether visitors or residents - notarized licenses and curriculum vitae for all our doctors in mid-December. Now in mid-January, they announced that all the documents lacked an apostille, and that without this they would not approve our medical mission.

For those of you who've never had to get one, an apostille is an official document of the state - in this case Washington or Oregon - which certifies that the notary who notarized the licences and CVs is indeed a legitimate notary. It can be obtained quickly, while you wait, but the offices are in the state capitals, Olympia and Salem, and the licences and CVs would have to be gathered again and notarized again. The requirement for an apostille has been on the Junta's list of requirements for some time, but it's never been enforced before. But here we were with new leadership of the Junta Vigilanicia, and they intend to enforce every requirement. And it wasn't at all clear that we would have time to get the apostilles before our group arrived.

In a fairly frantic day in San Salvador, Dina Duvon and I pled our case at length to the Doctora in charge of our application. We had brought mission groups down here for nine years without ever getting an apostille, we said, and there had been no problem. The people of San Juan Opico were waiting for their chance to get a free consulta, we said. The apostille wouldn't give them any additional guarantees, we said, since the licenses are already instruments of the state and the notary has affirmed that they were presented by the person named in the license. But it didn't do any good. We would have to get apostilles. In phone calls back and forth to Kathy Garcia and other PeaceHealth staff, we figured we might be able to get it done, barely, if everyone hustled their documents over to a notary again and hustled them to Kathy again, and she drove them to the state office and sent them to me by rapid express. Dina and I wrote a letter to the Junta, asking that they allow the mission to go forward even if the apostilled documents can't be presented to the Junta - which meets once a week - first. And we asked the Archbishop of San Salvador to write a letter of support, which he most kindly did.

And that's where it stands. Kathy is hustling and I'm continuing with the organizing here, and we're pretty sure we will have everything together before our mission group arrives, but we'd ask for the good wishes and prayers of anyone reading this. As I've thought this over, I understand that the Junta Vigilancia wants to make sure that any group of doctors that comes here is really legitimate, that they fear, and reasonably so, that the people of El Salvador will get a raw deal from unlicensed doctors or out-of-date medicines. I wish they had been more open to compromise, and perhaps after the new leaders have been in office a little longer they will not be so intransigent.

But most of all, I desire the outcome that will be good for everyone: our group approved and providing health care to people in San Juan Opico who have little access to care. If it takes an apostille, we'll provide an apostille.