Wednesday, March 30, 2011
It's been 11 days since we've returned from our mission to Guatemamla. So many thoughts and memories remain with me daily as I get back into my very privileged and grateful way of life. Over the course of a week we treated many families. We visited their homes (huts, shacks). We got to know them with their wonderful smiles on their faces and their deep connections to their past. So much poverty and yet so hopeful and appreciative for everything. During the week we pondered over our own issues of defining happiness. When is enough, enough??? How do these people with so little appear to have so much? They are deeply connected to each other, their communities, their history and freedom. What a gift for us to be able to be part of these beautiful lives for one week. Once again we were accompanied by amazing young people from Xavier University. These students opened their hearts and lives to spend their vacation week helping make the world a better place. They have already learned the greatest gift of all- giving of oneself completely. AND THEY ALL DID THAT SO VERY WELL. Our leaders of the trip, Rabbi Abie Ingber and Amy, make everything flow so well. But we know the hard work that it took for so many months to put this trip together and we are so very grateful to them both. To my colleagues- Lauri, Richard and Cathy- what a gift!!! Their leadership and compassion was infectious and their energy, spirit and goodness was a blessing for all!!!!!.
Within moments of arriving in Guatemala City I knew this new temporary home would reward me in so many ways. ______ , the gentleman who handled our bags upon hotel check-in, asked me where we were from. "Cincinnati, Ohio," I responded. "I was there once," he said, "I walked on the bridge to cross the river." What were the odds that my very first Guatemalan encounter, one that should have ended with a $5 bill squeezed into an outstretched palm, would take this turn? The young man had come to the United States illegally to find some work and his journey had brought him to Cincinnati. When he arrived with no money he found shelter for two nights at the Drop-Inn Shelter in Over-the-Rhine. I explained to him that for more than ten years I had run a Campus Ministry Sunday morning breakfast program at the Drop-Inn Center. How many Guatemalans had I already encountered during that decade without ever having asked for a name? The next morning before we reconnected with the rest of our Xavier team we met with a father and son, members of Guatemala's small but historic Jewish community. Mario regaled the students with his ease of historical analysis, his business acumen and his sensitivity to Mayan culture and the need for healing Guatemala after its brutal and lengthy civil war. Mario had come to my attention through a faculty colleague. I had the privilege of involvement in his daughter's wedding and Mario was a relative of her new in-laws. A casual mention of my Guatemala trip was the catalyst for this quick Central American connection.The words "Cincinnati" or "Xavier" did not come up again until I received an email about a new admission to Xavier's student body. Bernard Pastor had become known outside his Reading High School community when he was arrested for failing to produce a driver's license and subsequent immigration documents in October of 2010. In days he became a poster child for comprehensive immigration reform and the Dream Act of 2010. Together with a band of his valiant friends and supporters we successfully fought his deportation back to the country of his birth, Guatemala. Bernard, like _____ had entered the U.S. illegally in the arms of his parents who had escaped the poverty and brutality of Guatemala during its worst days. But Bernard had been three years old when he came to the U.S. In one week I had more Guatemalan memories than he could ever possibly recall, I had seen more merchants selling Mayan textiles, more street vendors selling patatas fritas, and more mothers carrying their babies on their backs wrapped in a wide swath of colorful woven cloth. While I was in the land of his birth, my home university had offered him a chance to continue to grow and develop educationally. How incredibly proud I was and how hopeful I was that he might secure the funds to accept Xavier's academic welcome. Of course the words "Cincinnati" and "Xavier" were often audible in our makeshift medical clinic in the 584 family small village high above Lake Atalan. The lake was silhouetted by three volcanoes and the view from our clinic perched on the mountain top was breathtaking. Surely the Mayan gods of sky and mountain and water had come together to create the beauty in Patanatik and its villagers. At 4300 feet above sea level the hikes up mountain paths to villagers' homes took your breath away as much as the scenery. Each patient we saw, each villager we met, each child we treated during a chicken pox outbreak in the elementary school, heard words they had never heard before - words of healing from Ohio. But on our last day, I brought our healing to a most unlikely venue. All week long our team of 12 students, two doctors, two emergency room nurses and two professional staff had done everything we could to forestall suffering and death. With each full physical exam, with each prescribed and dispensed medication, we hoped to forestall a debilitating disease, to keep a bad medical situation from deteriorating, perhaps even to cheat death on this remote mountainside. On Thursday, while being examined by one of our doctors, an adult woman received a cell phone call that her elderly father had died. She immediately left our clinic and returned to her home. As if to affirm the critical importance of the first-ever doctor she had ever seen in her village, she was back in our clinic within an hour. Her family had initiated what needed to be done; she was determined to seize this healing medical moment even in the worst of emotional circumstances. The next day Dr. Walter and I decided we should hike up to the family home and extend our condolences in the name of our medical group from Xavier University in Cincinnati, Ohio. We received permission from the local director of our operation and with only our hearts in our hands we began our climb. The steepness of the climb and the oxygen poor air made the climb quite challenging. We stopped often to catch our breath. Both of us were thinking the same thing - life and death on the same continuum.We entered the one room family home. The open casket lay on a table in the center, surrounded by large votive candles. We were introduced to each member of the grieving family. As they began to speak of their husband, father and grandfather, tears flowed easily. We stood inches from each other, our hearts beating in unison. We expressed condolences from our American medical group and shared the gift of a new relationship between Cincinnati and Patanatik. May the deeds of the righteous be a blessing forever.
March 25, 2011 “Nothing is more practical than finding God, that is, than falling in a love in a quite absolute, final way. What you are in love with, what seizes your imagination will affect everything. It will decide what will get you out of bed in the mornings, what you will do with your evenings, how you spend your weekends, what you read, who you know, what breaks your heart, and what amazes you with joy and gratitude. Fall in love, stay in love, and it will decide everything.” Pedro Arrupe, SJ – Superior General of the Jesuits 1965-1983 It is a great gift to love what you do. Being a pediatrician has been that gift for me. Those feelings are affirmed in my encounters with patients in clinic, and even more so in weeks like we shared in Guatemala. We all got to see how even in a simpler life people find joy in just being alive. There is no lack of color in Guatemala. I relive those wonderful colors now as I sling the strap of my bag over my shoulder everyday. Beauty abounds as I remember the scenery, volcanoes, Lake Atitlan, the purple flower trees. But what we will remember the most are the people. Endless smiles, some toothless, but all smiling. We also got to see how hard life really can be. Living in a home with a dirt floor without access to clean water is simply wrong. To quote Paul Farmer, “Clean water and health care and school and food and tin roofs and cement floors, all of these things should constitute a set of basics that people must have as birthrights.” On our first day of visiting the homes in Patanatic I wrote in my journal, “17 houses, 9 of which no longer have their water filtration systems. No wonder the kids are still getting diarrhea. The walk to the houses was the steepest mountain I have ever climbed. This is nothing to the elderly couple – woman carrying a basket laden with something on her head. These are amazingly strong people.” Life is hard here. Each day is spent in procuring what is needed for survival. If chicken is for dinner then it has to be butchered and plucked. So far from pre-packed at Kroger’s. The medicine was fun – plenty of well children. The part of the trip that surprised me the most was how healthy the kids were in general. Having traveled in Mexico, Honduras and Haiti, I was expecting some kids with severe malnutrition, but thankfully we didn’t see it. The people have limited resources, but do an extra-ordinary job of caring for their children. The mother of the 1-month-old twins was so concerned about the little girl twin (born at 4 pounds). She was already 2 pounds above her birth weight. The mother was thinking she didn’t have enough milk to feed both twins and was considering starting the girl on formula. I’m looking at this woman with breasts the size of large cantaloupes, leaking milk as we talk. Starting formula is not necessary (expensive for the family and would need to be made with clean water – or the baby will get very sick). I am so glad to have growth curves to show the mom how well the baby is growing. Her breast milk is more than enough for both babies. It is like liquid gold. Then I marvel as she slings the boy baby on her back, attaches the girl to her front and ties them up with her colorful cloth – both babies snug next to their mom. Just incredible. You all know now how remarkable it was to see 3 cases of varicella in one week. You will NEVER see that again. My pediatric resident in clinic last week was in awe when I told her that – she has never seen one case of chicken pox. Thankfully our varicella/scarlet fever patient did great and didn’t have necrotizing fasciitis. Central America is the birthplace of liberation theology. We all witnessed in our week in Guatemala what the liberation theology concept of “preferential option for the poor” means. It means one’s words, prayers and deeds must show solidarity with, and compassion for the poor. This is what we are called to do. This is what we did in Guatemala, and what Guatemala did for us. We are all poor in our own ways; some of us in spiritual ways, some more material. We are all richer from our week in Guatemala. Mishel and Diana are two sisters we will always remember. What talent they shared with us – gifts of medical interpretation, curiosity, mad skills on the marimba. We are lucky to know them. Do you think they ever stop smiling? They are Guatemala. We will take away memories of each other as well. Xavier is a phenomenal place. Your formation into men and women for others will always be connected to this trip. We also were gifted with great leaders. Amy, with her bible, is a terrific organizer, great listener and remarkable problem-solver. Rabbi Abie, so at home leading us in Shabbat dinner, and paying respects with the family of the elder of Patanatic in their loss. You will always remember Cathy as you encounter ED nurses – she is so perfectly suited for her job. Bonnie has a heart for alleviating suffering of any kind – be it human or animal. They also are great teachers. As students you know more about accurate blood pressure measurement than most residents. Then there is Richard. He is one of those rare human beings that we are graced to encounter. He is a great gift to me – someone who I can talk medicine with who also understands the humanity that we see daily in our work. As students he is a teacher you will always remember. So, drink in these memories. Share the stories with your friends and family. Guatemala will go with you always. Peace, Lauri Pramuk, MD
Monday, March 28, 2011
My trip to Guatemala would be a hard thing to ever forget. It’s not just the amazing scenery, or the smiling locals, or even the fact that we are helping so many people. The thing that makes it unforgettable is the feeling that we were doing something bigger than ourselves. We gave back to a community in need but at the same time we gained so much more than we gave. This was my first service trip and now I can see why people keep coming back for more. The experiences I had are worth more than anything money can buy. Knowing that these people have a medical history now, knowing that we might have made their lives better, knowing we brought some joy to an entire community is a great feeling. The people of Guatemala made such a strong impression on me. Their sense of family and community is much stronger than anything I’m used to back home. Each person we saw had a story and a life we knew so little about but yet we could feel such a strong connection to them and their family. You knew that they deserved so much better and they had worked for everything they had. These people didn’t wait for doctors to come help them; they didn’t sit on the street and beg. They built a clinic from almost nothing. Knowing they did so much just for their children to have medical attention makes you want to do everything you can for them. Your hearts go out to each person that walks through the clinic door. They don’t feel foreign to you. They feel like neighbors or friends. How often do you feel that way about someone you’ve never met? The thing that touched me most was visiting a small village on the other side of the lake. We had three little tour guides (children from the village school) showing us around so we could inspect the water filters in people’s houses. We finished an hour earlier than any of the other groups so we had time to play with the kids at the school. Apparently play is a universal language because I didn’t know any Spanish but we still had a blast. It just hit me so hard to think that all of these kids will grow up to fill their parents shoes as being poor, underpaid hard workers who probably won’t get the chance to go to college. Some will have to quit school to help support their families. Those kids are so special and they all have great potential. If they had grown up in the U.S. half of them would go to college. The fact that they don’t have that chance killed me more than anything. And yet they were so happy. Many of the people wore smiles. Some of them laughed more than I do at home. Some people might think it’s strange that a community so poor can smile so much. Some might argue the reason they are so happy is because they don’t know anything else in the world, that ignorance is bliss. But I know there is more to it. The Guatemalans might have little money but they are richer than most people I know. They know how to enjoy life and that family is more important than anything money can buy. They have a different kind of wealth there. After only a week with them, I hope I’ve brought back a little bit of their wealth with me. It’s something we could all use a little more of.
“Poco a poco.” It means “little by little” and it’s a short Spanish phrase that I was introduced to on a cultural immersion trip to El Salvador three years ago. As I heard stories about the country’s civil war, I couldn’t help but notice how many people used this phrase. It was often used to refer to their belief that the war would end, and gradually things would get better. As I reflected, I realized how much this tiny phrase reminds me of my own beliefs and values. In fact, not only does it serve as a motto for many Salavadorans, “poco a poco” has become my own personal life motto. As I prepared for my second trip to Central America, I imagined this phrase would apply to many people and situations in Guatemala as well. As I sit and reflect on my recent trip to Guatemala, I am overwhelmed with happy memories and life changing experiences. It amazes me how my life has changed three different times, each from a service trip in another country. El Salvador and Jamaica both changed my perspective on a lot of things, but they can’t compare to how I have changed from Guatemala. My trip to Guatemala taught me the power of medicine, and it confirmed my desire to become a physician. I came home with so much new knowledge and a renewed feeling of empowerment to make a difference. The most powerful part of my experience came in the clinic. I have never seen such extraordinary examples of patience and gratitude. Each visitor to the clinic waited up to several hours to see a physician. Many of us got a bit restless as we felt sympathetic that they were waiting so long, but it didn’t take long for us to realize that the wait was the last of their worries. This was the opportunity of a lifetime for many of them, and not one patient showed a bit of concern or stress about waiting. They took the time to talk with their neighbors and laugh as they watched the children play in the clinic. As they saw the doctors, we were overwhelmed with feelings of gratitude from each patient. I think that we all heard the word “gracias” more than any other word the entire trip. These feelings of gratitude alone changed me. It made me realize what it truly is to be thankful, and how to express my feelings of gratitude to others. It made me appreciate my life and blessings so much more. Mostly, it made me appreciate the people and country of Guatemala. I am overwhelmed by how much beauty I encountered in each individual. They taught me the power of a smile, and that a smile is a universal form of communication that says enough. Working in the clinic helped me realize that the ultimate service I can provide to others in the future is through the practice of medicine. The prayer station was extremely powerful. I am Roman Catholic, but I have lost some of my religion as I came to school and found many reasons to put school work before attending Church. This trip brought me back to my faith and my belief in God. It encouraged me to make time to attend mass and remember to make God a part of my everyday life like the people in Guatemala. There was a particular instance that changed it all for me. A very old man, who had shingles, came to the prayer station where I was sitting. He asked to say his own prayer so I sat with him and listened. I couldn’t understand much until he put his arms in the air, started saying gracias repeatedly, and tears and sobs came from his body. They were tears of happiness and of gratitude, and this moment alone was the most powerful prayer I have ever experienced. It made me realize my belief in the goodness of humanity and how prayer and hope in God can change our world. My dream is to become a pediatrician, and if this dream comes true, I will owe it to the children of Guatemala and to a teacher I found in the trip, Dr. Lauri Pramuk. I have loved kids my entire life and have found so much love for working with kids as a swim team coach and a nanny. The happiness and innocence I see in children reminds me of the good things in our world. Interactions with children are an escape from all the violence, hatred, and jealousy that exists in the world. The children in Guatemala are some of the happiest kids I have seen despite their circumstances. They are filled with so much innocence and joy, and they have no idea that things might be a little better for kids in other parts of the world. Dr. Pramuk inspired me as she treated each child with love and patience. I see the act of working with children is an art, and it is something she has certainly perfected. I know that I will take much of what I learned from her with me in the future, and I hope to be as great as a doctor as her some day. I truly believe that my future holds many more mission trips to other countries as a pediatrician. I come home from this trip with many memories and many new friendships. This trip brought me peace, hope, and beauty. It opened my eyes to a new part of the world, and it paved the way for a future I believe possible. When I need an escape from the madness of school and graduation, I close my eyes and put myself back on the steps outside the clinic. Surrounded by mountains, a lake, and volcanoes, I have never felt so small and part of something so much bigger than myself. It is my place of solitude and my reminder of being united with “one world”. Right now, my trip to Guatemala is the biggest example of how “poco a poco” will play out in the world, for many reasons. I believe it really applies to the clinic that is opening. It has been a gradual process, and our group began something great that will continue to develop for the future. Little by little, this clinic will make a difference and become something crucial for the people in the village. Small steps are what the country needs, and I believe that our presence made this process possible and realistic. Also, little by little, each one of us can be inspired to make a difference. One of my favorite quotes is by Mother Theresa, and it says, “There are no great things. There are small things with great love”. If each one of us continues to take small steps out of love towards making a difference in the world, we can inspire others to do the same. We are all capable of change and we are instruments of hope to the people we encounter and serve. We must never forget the people we have met in Guatemala and the life lessons that we bring back with us. Guatemala has changed me in many ways, and the trip will continue to be a part of my daily life. Little by little, this new revolution of service and compassion for others will spread, and we each have a chance to play a key role. Gradual change is realistic, and "poco a poco" can inspire others to join in the movement.