A long-overdue final post...

Happy New Year!

As you may know, I've been gone from San Jose for some 6 months now. I miss it. I miss the people, I miss the work, I miss the weather and I miss the purpose. The third year of medical school is a very different beast! Phone calls from friends in San Jose and continued involvement in the projects has helped to keep me grounded.

While the coup which occurred several weeks after my departure had little noticeable effect in San Jose, it disrupted our projects in several ways. Most significantly, due to the coup the medical school banned school-sponsored travel to the country. This prevented the year-long volunteers who were going to take my place from being able to go and also prevented the fall 2009 trip by the Rochester brigade of doctors. Even so, with huge efforts by the Honduran Shoulder to Shoulder staff and a rogue visit by a committed Rochesterian, our efforts have continued with great success. In sum, the last six months have seen:

- The flattening of a hillside to provide a place for the guest house and clinic. This has been 100% achieved by voluntary community labor. Ten people a day are donating a day of work to make this dream a reality for the community. They have self-organized and self-controlled to make this happen in an orderly and successful fashion. Impressive! We are currently fundraising for the two buildings and plan on beginning construction in the spring.
- The construction of a water tank which will be part of the San Jose Centro piped water project.
- The completion of an application cycle for the next class of middle school scholarship recipients, with 13 more students selected for this year.
- The successful completion of the 7th grade by the majority of the first scholarship recipients and their reentry into 8th grade.
- A Spanish/English literacy curriculum designed and given to the local elementary school teachers.

The fact that a coup, a travel-ban and a bad economy haven't stopped us is evidence of the self-initiative of the people of San Jose and the willingness of this organization to find new and creative ways for things to happen in the face of changing circumstances.

The journey goes on. Please continue to check in on the website for updates, and please don't hesitate to contact us/me if you ever would like more information.

To 2010 we go....

mateo






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Photos galore!

As I look at my journal, I often notice that my entries start with “phewf.” And “phewf,” how busy and full these weeks have been!
What have I been busy with? Well, a little bit of everything, quite literally. What follows are a few snippets ... I’d tell more, but neither you nor I have time for the whole story!
As I mentioned previously, Kirsten and I got a few local women together to discuss the sale of their hand-made tablecloths in La Esperanza, the closest “city.” Well, as planned, on one Saturday morning, myself and 10 of San Jose’s finest lady-folk made our way to La Esperanza to do just that. One tall gringo and 10 little ladies from the mountains, now THAT was a sight to see!

Francisca, embroidering at her house in El Portillon.

The San Jose Embroiderers and I in the shop.
We met with the directors of the gift shop (a women’s cooperative) for about an hour, which gave each woman the opportunity to show them her cloths. While the shop “did not have the money,” to buy cloths up front (or probably, wisely, didn’t want to take the initial risk), the women still gained a few valuable things. First, the director gave commentary on each cloth, explaining how it and future cloths could be made more compatible for sale and/or saleable for more profit. The women listened intently to this advice. Also, 4 women who had brought cloths that somewhat met the recommendations left the cloths there on consignment. If the cloths sell in the coming months, there will be a lot of excitement…

Felix, one of two people in San Jose with an existing fish farm. So yes, the fish farms project is underway. Currently I am working with 4 different families to start a farm at each of their houses. As part of this, I’ve now given two workshops on how to make and maintain a fish farm. I think it’s fair to say that I never thought that I would be lecturing on fish farming! A highlight of the workshops was when I asked them to sketch their fish farms; I had a room of middle-aged men drawing like 5 year olds. I forget that we Americans enjoy years of art classes to learn how to draw with scale, depth and perspective. They enjoyed the exercise as much as I did.

Here are most of the mothers from the community during a meeting for a government program. Prior to taking this picture, I was in the middle of this same crowd doing a little piece of water health education. In general, I’ve been poaching any large meeting I can find and using it to teach about water quality and the need for filters. Parents’ Groups, Mother Groups and Baby Weighing Days have all been graced by the “water guy.” People are eager to see the water tests from their community and seem to enjoy my little interactive lesson. Little by little, people are learning what they need to protect the health of their families.

Here I am giving a lesson about water contamination to the group of mothers in El Mangal. I am using the water tests (which you can see in my hand and in their hands, as well) as a teaching tool. People find it very convincing to see the colors and worms that grow out of their water.
And once again, here I am at a mothers’ meeting in Guanacaste. In this shot I’m doing my Tony-winning rendition of “The story of Juan and Antonio.” It is a little skit I made up about 2 boys who would be equal, except that one’s mother uses a filter to clean the water, while the other doesn’t. Diarrhea, parasites, stomach pain and a poor growth end up plaguing one, while the other thrives. It’s a very simplified view, but by using lots of terms and outcomes that they can relate to, I think it works to make the importance of clean water much more real. As any public health person will tell you, building knowledge is one thing, yet creating a change in behavior is a whole different challenge…

As part of the education piece, I’m also continuing to distribute filters. 40 more are out so far.

The San Jose Festival was also in early April. Beyond the usual silently-consumed-with-great-great-haste eating of tomales, the day was punctuated by a forest fire! Yup, in the heart of the dry season they see it fit to set off lots of low-quality fireworks. Not surprisingly, one lit the hill in front of the church on fire.

We controlled the fire quickly-enough such that there was no big loss, but it gave me a great, fun(?) scare! Do I look like I just fought a forest fire with a bucket?

The men of “the little mountain” before heading out for a day working on our newest piped water project. I’ve been monitoring and managing this effort, which is progressing well.

Can you see the trench for the water project, going straight down the hill? (Note the difference in color compared to photos from the beginning of my time here. All green has been replaced with brown. It hasn’t rained a drop since November. When they say the “dry season,” they mean the “DRY season!”).

And then, of course, there was “Semana Santa,” or Holy Week. Here in Honduras where everyone is Catholic (at least in word), Holy Week is the biggest holiday of the year. Most people take all or most of the weak as their only vacation of the year. This photo was taken during one of the many Holy Week church services here in San Jose. The whole week was filled with relatively-silent Honduran-style celebrations…

One tradition is to walk down to the river and bathe. I made the trek with my friend Lazaro (who had TB) and a few other younger men and enjoyed a very hot day on the river. For the first time in my life I was considered to be a good swimmer and a brave rock-jumper! It pays to be the only person who grew up in a place with water.

During the wet season there is only one bridge to cross the river, and this is it. It’s affectionately called “the hammock” and is made of barbed wire and boards. Even the Hondurans were nervous to cross it! This is Lazaro, braving the (tilting) “hammock.”

And then, the night before Easter there is a late night vigil in a local house. This photo doesn’t show a lot clearly, but it gives a good feel for the candle-lit (simply because there is not electricity), small, dirt inside of the house where the vigil was held. The whole night was 5 hours of “mass,” the rosary, ….

…prayers to shrines of their patron saints (Which you can see behind Paulino and Paula, who wanted a picture with the shrines), and…
strange foods! This is “atole of corn,with roasted cacao seeds.” It’s basically a corn mush with stuff that tastes like burnt coffee beans. I tried my best to drink the whole gourd full, as they all did quite quickly, but I couldn’t quite get it down.

And finally, after a week of enjoying their customs and being welcomed into their homes, I invited everyone to my house for a great Malek tradition: decorating Easter eggs! People thought it was strange and funny, but it was a surely a hit. They made some pretty fine eggs, given I could only find watercolors and crayons as our materials…

As you can see, the women generally were more able to make a “design,” while the men were all about “the more colors the better.” Some things stretch across cultures, right?

Lorenzo and his egg.

Clara’s eggs.

And then I enjoyed a delicious Easter dinner! Not bad for being in Honduras, right?

Ooops, I put the wrong photo for my dinner. I guess this was my real Easter dinner. It was nothing much, but I ate it with great thoughts of my loved ones.
Love to all,
mateo
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The legend comes to town

After 7 months getting talked-up by Mateo, Kirsten was already a living legend in San Jose before she even arrived. When she swooped in on her umbrella, though, she really confirmed her place in San Jose lore forever! OK, so the umbrella was just for the sun (as many women-of-means use in Hondu), but even without a flying entry, Kirsten did indeed live up to her legend.

A few photos can best tell the story of our wonderful, fun and full 9 days together…



It’s always interesting how having another person from “outside” makes you notice things differently. For example, the sunsets. I never have/take the time to stop and appreciate the sunsets, but while Kirsten was here, we made the most of the opportunity to stop, appreciate and have a sunset conversation.


This is my neighbor’s house in the evening. Kirsten took a fondness to my neighbor’s dog, “Tigre.” Despite my not-so-subtle objection, she tried to revive his scrawny frame with a few morsels from our dinner… on several occasions. Lucky dog!


Kirsten didn’t waste any time getting to know everyone… not that she really had any choice! On the first evening she was here, church got out and she was suddenly the center of attention for a very curious assembly of some 25 people, a veritable “who’s who of San Jose.” She handled it bravely, and even remembered a few of the names. On the third day, we went to the Sunday market in Rancho Quemado (the closest “town” to me on the “big road”). At no moment during the market were there any less than 20 eyes on her! We tried getting a representative photo with a little crowd of teenagers hovering around her, but this is the best we could get.

But, you ask, what did we “do” during the week? Think “pinguinos y pies” (penguins and feet)…


First: Penguins. Prior to coming to San Jose, Kirsten translated “The Penguin Song” into Spanish, with the hope of teaching it to kids at the various San Jose schools. “The Penguin Song” is a camp-type song about how to walk like a penguin, i.e. right arm, left arm, right leg, left leg, move the head, turn in circles. It’s VERY catchy, and when sung and danced by two gringos, VERY entertaining.

So, we set up a visit to the San Jose Centro school and the Portillon school, and showed up to each with a whole program of education and fun.

We would start by reading a children’s book, Kirsten in Spanish and I in English. We were pleasantly surprised to find that ALL the kids, from Kindergarten through 6th grade, were absolutely entranced by this. After, we donated the books to the schools for the kids to read themselves.

Next, I would put on my “doctor” hat and do a little lesson about water cleanliness. I would hand out a bunch of the water sample plates from my recent research (like the ones I have posted photos of on this blog before) and ask them to tell me what colors they saw. Once I had a good list, I would hand out the clean plates, and we would discuss the difference and how you can make your water change from colorful to clean. Little by little, San Jose is becoming a community of water health experts!

And last, but surely not least, Kirsten would teach a little about penguins, and then we would do “The Penguin Song.” It was HILARIOUS! Perhaps as good as seeing the kids grin and spin like penguins, though, was the aftermath… In the following days, as we would walk around “town,” Kirsten and I started hearing, yelled in little, hidden voices, “pinguinos!” Her legend grows.


And number two: Feet. We walked a lot. Despite the very un-Rochester heat, Kirsten braved the mountains of San Jose as we did a bunch of follow-up visits for the research. Here she is, descending on the far side of Guanacaste, in an isolated region known as “La Pimienta.” We tried to make it look steep, but still it’s steeper than it looks. Ask her.


Victorina Sanchez and her 3 daughters. Kirsten and I waited at this house for Victorina to return from gathering firewood, and in the meantime, Kirsten had a great conversation with the daughters. Different people reacted very differently to Kirsten: some would ignore her and just address me, others would just stare at her and say nothing, and others (mostly the women) would be open to her attempts to start conversation.

I’m speaking for someone besides myself here, but I would say this variable reaction may have been one of the most difficult parts of the trip for her. Us Americans are, culturally, outgoing conversationalists with equal respect for men and women. To be in San Jose, where the culture is quiet and reserved and the women are oppressed, is quite the shift.


This is Felicita, Francisca, and Mariano, from left to right. Since this picture was taken, Mariano has died. Why? Putting it as gently as possible, Mariano died simply because he was poor and uneducated in a poor, uneducated and underserved community in the mountains of Honduras.

Mariano was one of three patients diagnosed with Tuberculosis (TB) by the brigade last November, along with my good friend Lacero. Lacero got proper treatment and is now entirely healthy, cured, happy and back at work. Mariano went to the hospital, where he stayed for a month while he received treatment for his TB and his lung that had collapsed as a result of the advanced TB. In December, the discharge note described him as “improving,” and instructed him to come back in a month to get the next phase of his TB treatment and to check his chest wound (from the chest tube placed to fix his collapsed lung). Unfortunately, neither Mariano nor his wife can read, and apparently the hospital staff didn’t communicate very well; so, when they left the hospital, they thought the month of TB treatment they had been given on discharge was everything they needed for him to be healed. In fact, he needed another 5-7 months of carefully observed treatment.

From December until March, all I heard about Mariano from those in town was that he had gone to the hospital and that he was now back home.

I ran into Mariano’s wife a day before Kirsten came and she asked if the brigade had a program to give food to sick people. She said she needed it for her husband who was “really skinny and wasting away.” We don’t have such a program, but I found some old (but still good) food supplements in the store room. So, while Kirsten and I were out by Mariano’s house for filter visits we stopped by to check in and see if this food help was really needed.

What we found was a man on his deathbed. His room smelled like the Mother Teresa Hospice in Ethiopia, with that unmistakable smell of a wasting-away human body. His wife said his treatment hadn’t worked, and since January he had been getting worse. Beyond that, she didn’t know anything about his condition. He had stopped swallowing solids a few days ago and she was now feeding him Coca Cola as a last resort.

I asked for the hospital discharge sheets, which she had but couldn’t read, and thereby gathered the history of miscommunication and unfinished treatment I have just told.

Kirsten and I hid our anger and grief and asked if they still wanted to try to improve his condition. They very much so did, and so we gave them the drinkable food supplements and arranged a home visit, ASAP, by the local nurse, to get the ball rolling on starting treatment once again. He died before the nurse got there.

This is the face, the story, and for us, the smell, of one of those “millions of preventable deaths” that you hear about in the news. Personally, we couldn’t quite decide which bothered us more: that Mariano had died of an easily treatable disease or that his family was so accustomed to loss and hardship that they felt their father’s death at age 49 was acceptable.

We’re going to do what we can to make sure that nobody from San Jose is ever dropped by the system like this again.


Back on the road, here was a family at another home visit, the interview nicely done in Spanish by Kirsten. Note the beautiful purple filter!

Kirsten has a way with kids. Here she is getting a rise out of Veronica and Sandra, two girls she had befriended at school and then found again at their house during a visit. Nice shades, Sandra!

And of course, we played some soccer. Well, maybe I shouldn’t say “of course,” because I had only played a few times before Kirsten’s arrival. But anyway, Kirsten befriended these little guys and then we went to play an evening soccer game at their house. (They are, from left to right, Santos, Sandra, Paulino, Marcos and Priscilla, ages 13, 9, 14, 5 and 6, respectively. Yes, seriously, those are the ages, and yes, that’s what malnutrition will do to you.) We, and they I believe, had a blast! They were adorable, loved Kirsten, enjoyed the attention and were very respectful.

In the end, I would wager to say that the soccer game was a fitting activity for our final night in San Jose. It captured well the relationships, connections and local savvy that Kirsten picked up, and the shared adventure and joy that we both experienced during her time in San Jose.

Until Kirsten comes again in May, I look forward to running into little reminders of her around San Jose as the kids yell “pinguino!” and adults rave about how “bonita” was “Christina.”

-mateo

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Visitors galore!

Forgive me if I seem a bit distracted. I’m currently sitting in the airport awaiting the much-anticipated arrival of my girlfriend, Ms. Kirsten Nagel. Suffice it to say, I’m crazy-excited, and that’s not helping me recall all that has transpired in the very busy last few weeks.

So, with one eye on the immigration line (which I can conveniently see from here), let’s check out a few pictures…



This is San Jose. I found a new little hill that gives the only view up the hill, so for a bit of perspective, I thought I would share. In this photo you are looking at San Jose Centro and Guanacaste, only two of the seven communities! The “main road” to the “city” runs along the top of the ridge. The little cluster of buildings in the upper-center of the photo includes the school, store-building and community center of San Jose Centro. That’s my “home!”



These are my beans. They had been closed in this Tupperware for a few weeks, and when I opened it up to cook ‘em up, out came the plague! Well, not the plague, but there were indeed hundreds of little beetle things. I thought I had bad luck, but upon consulting my friends here, this is the norm. The beetle larvae enter when the beans are in the field, grow and eventually hatch. Eat the beans early and you have a little extra protein, eat them late, and you have to wait for the visitors to fly away!



One morning, I made the 2 hour trek down to the very bottom of San Jose, to the Rio San Juan. I didn’t know this much water existed in Honduras during this part of the dry season!



I visited the Rio San Juan to check out a potential fish farm site. Ah yes, fish farms, surprise! That’s one of my new projects, little backyard tilapia ponds. More on that as things progress… For now, here are the two men who are looking to make the fish farm, Vicente and Santos. Kirsten and I are going to visit the river once more to test out the inertia-driven pump that we’re thinking of using for the fish farm.



It’s a ghost! Nope, it’s just me, ready to jump in for a swim. I think I gave a little Honduran girl a good scare when my big white carcass popped up next to where she was standing on the bank. The speed with which she ran crying to her mother was impressive!


The water was refreshingly cool… and probably filled with all the crap (literally) from everywhere above, but hey, beggars can’t be choosers. Vicente, Santos and I all took a quick dip. It was quite lovely.



One of the traditional, hand-embroidered tablecloths that many women in San Jose make. Another new push of mine this time back is to connect these women artisans with the gift-shop in the “city.” They’ve got the products, they just need the market. Kirsten and I are hosting a meeting on March 9th to help the interested women organize themselves.



What is this? It’s a tomato farm, of course! This is Bernabe, one of the more progressive farmers in San Jose, among his tomato patch. Who said you couldn’t do anything with 2 feet of bad soil on top of pure bedrock? We are helping Bernabe try a new, piped irrigation system to water his tomatoes during the dry season. Right now, his irrigation system is a pile of jugs (plus his 6 kids).
Ah yes, the scholarships for middle school! A very good chunk of my time in the last month has been spent setting the new scholarship program into motion. After a bit of difficulty with getting the cash for the scholarships, cancelled matriculation days, overpriced housing and overwhelmed parents, all has turned out well!



This photo is at the house which 5 of the female students are renting. They all live 3+ hours of walking (round trip) from the school, so their scholarship includes a room and board stipend. After the rich dude in town tried to get $110 a month from them to rent a room, I used my white-dude privilege (sometimes being the gringo has its benefits) to find a more reasonable landlord with a house to rent for $30 a month. The house did lack a “cookstove” to make tortillas, so all mothers came and made one. This is the crew and the completed cookstove.

But wait, isn’t that another white dude in that picture!?! Sure is.



For the last week I had the pleasure of hosting two guests! Here are Andrea and Adam, college students from Ohio who were traveling for 2 months to all the Shoulder to Shoulder sites to check on the water filter program. While here, they helped me do a bunch of follow-up surveys for my research, pitched in with the cookstove and a slow sand filter (champion sand-washers that they are), and kept me company on long walks and chilly evenings, with good conversation and some quality ukulele playing. We had a busy, fun and productive week.



The slow sand filter that we made, at a source in Mangal.




Argentina, the younger daughter of the woman who owns the source, posing with the slow sand filter, prior to remaking the filter. On a scouting mission of the filter, we had a jolly time hitting mangos out of the tree with rocks. She was grateful of my big-boy arm, but I was equally impressed with her quite-powerful little-girl arm! And yes, I did sing her “Don’t Cry for Me Argentina,” by Madonna.





Ah yes, another big time-eater: our new piped-water project! Here I am on delivery day of all the materials for our new piped water system in a cluster of houses called “The Little Mountain.”

Love this photo. It was supposed to just be a group photo of the 11 families receiving piped water, but then two women hauling water walked by. The folks on the stack of pipes will soon never more bear the physical, nutritional and educational burden of hauling water like this. Yeah!



The beneficiaries and the facilitator.

And last, but not least, the home visits for my research follow-up: I’m visiting all homes with filters once more, and it has been a very rewarding experience. For one, everyone really likes their filter. But more importantly, a good handful of mothers, with another good busload of kids have told me, “yeah, this summer my kids don’t have any diarrhea,” “we used to think our kids just got sick with the change in season, but apparently it was the water,” and “we never even realized we were sick all the time, but now we realize what it’s like to be healthy.” VERY awesome.

I’m also offering a family photo at each house this time, and a few have requested that I join them in the photo, so…



Here I am with Paublina and (some) of her kids. The house is courtesy of the government of Germany.



And with Wilson (a scholarship recipient), Vicente, the grandmother, and Lidia.

Ok, time to meet my much-awaited guest! We (Kirsten and I) will surely have plenty more stories to tell quite soon.

Love to all,

mateo
















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Back in the saddle again...

After a truly fantastic few weeks at home with family and friends, I'm back in San Jose and quickly getting back into the flow of my Honduran life. It's always a wild transition, in either direction, and this time is no exception. What's particularly strange is that there's barely anyone in San Jose right now! It's coffee-picking season, and the majority of men and boys (and some entire families) have headed to the "fincas" to harvest coffee. There is an eerie emptiness in the community.

With no further ado, and without much else to report, here are a few photos to get a flavor of my return:

Here I am at the hotel the night after arriving, participating in my ritualistic pre-arrival head-shaving. Without a shower, short hair is a LOT more pleasant!


Two adorable little girls from Portillon who hiked up for 1.5 hours to search out electricity to charge their family's cell phone. We had quite the photo-shoot. I'm getting quite the reputation as a photographer!

Their feet. This framed-up quite accidentally when I was adjustig a setting on my camera, but I found the image quite powerful. I find it striking what they hike in, and what it does to their feet and legs. That said, they are from one of the "wealthiest" families in Portillon and, here, would be considered lucky to be wearing any shoes at all. Every once in a while I need a reminder that "wealthy" here is still really poor, and that poor here is just straight-up inhumane.

... and one more, just to prove that I was actually involved in this photo process.

Wish me luck as I get back into the groove and get things moving again.
Again, thanks to all for a terrific time home. I have many fond memories to last me the next few months.
Love to all,
mateo




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Happy New Year!

In the spirit of a new year and a new change, this (long delayed) blog entry will try something a little different: Instead of two sections, everything is all mixed in, business and play, just as it is in my Honduran life!

SCHOLARSHIPS FOR CHILDREN TO ATTEND MIDDLE SCHOOL

-Scholarships have been awarded!
-In the later part of November, the Scholarship Committee at First Unitarian in Rochester did a very fine and very fast job of selecting this year’s twelve recipients (two from each school, plus two extra from the biggest school).
-On my last day in San Jose, we got all the kids and/or their parents together and announced the winners. The winners were joyous, the losers, respectfully quiet.



Here are the winners and/or their parents. People in San Jose tend to not show a lot of emotion, either positive or negative. Perhaps life has been so difficult that they need to be fairly stoic just to get through, perhaps it’s just the culture. In either case, visible emotion is rare. In giving out the scholarships, however, I saw some truly beautiful smiles of hope and joy.

This is a photo of Regina Cabrera, a winner from San Jose Centro. In Honduras, young women are generally very reserved and timid, especially around males of power (like myself). Prior to the scholarship meeting, Regina had never really looked me in the eye, instead deferring her eyes to the ground. When I announced her name, however, she stood up, walked straight to the front of the room, held her head high, smiled a big smile, looked me straight in the eye and shook my hand with great gusto as she took her certificate. It was a pretty magical moment.

PIPED WATER DISTRIBUTION PROGRAM IN PORTILLON

-DONE!
-In the weeks following the brigade, all beneficiaries of the Portillon project worked Monday, Wednesday and Saturday on finishing the project. By the first of December, they had finished. They were a true model for organization and cooperation!

In light of their great work, they were very excited that I was able to come at each stage and document the process. They are very proud of their work and wanted to show the donors! What follows are a few photos of the process…



All households came on the day of material delivery to carry the parts down to Portillon. Here is at least one person from each of the 31 recipient houses. Note the smiles!

Sorting pipes into equally-sized “carryable” bundles (each weighing more than 60 pounds).


Doug (AKA, Dr. Stockman, my mentor for the year and the director of the Honduras Project at the University of Rochester), lending a hand.

Pilar, the community-elected president of the project and a good friend of mine, standing guard over the tubes.

I wouldn’t be smiling if I was taking off for an hour and a half hike with that much weight on my shoulder (don’t be deceived by the size of the bundle, there is steel pipe slipped inside the PVC!), but hey, I’m not getting water at my house, either!

On each day of digging trenches, each household was responsible for digging 6 “work units” of 8 meters in length and 2 feet in depth. Usually, three people from the same household work together on their household’s part, one to break the stones with a pick-axe, one to scoop out the loose dirt with a shovel, and one to follow up with a little pick thing to do touch up. Here is the family of Bersabarino working on their segment.

Finished trench, snaking across the hills.

Trench surfing!

Trenches dug, it was time to lay and attach all the 4km of piping. They worked as a unit, a few people laying the pipe, one cleaning the end, one sanding the end, one holding the PVC cement, one applying the cement, etc.

A crowd gathers as the last joint of the day is placed.

Water! The workers rest at the end of the day, as the newly-connected spigot brings water to the house. You’re looking at several hours less of hauling water every day, which means several hours more for the women and children to parent, play, study, learn and grow and several hundred more desperately-needed calories that aren’t burnt needlessly. It’s a beautiful thing!

PIPED WATER DISTRUBTION PROGRAM IN “LA MONTANITA” ("THE LITTLE MOUNTAIN")
-With Portillon wrapped up, it’s on to the next one! After checking out plans and confirming distances with some death-defying walking (this new project is in a CRAZY steep location!), we have decided to fund a project in “The Little Mountain.”
-This small project, spearheaded by a group of highly self-motivated folks in one of the more distant parts of San Jose, will serve 6 houses.

VIP LATRINE PROJECT
-Apolinar, community volunteer and foreman of the project, has finished about 20 of the 28 funded latrines.

IMPROVED COOKSTOVE (FOGON) PROJECT
-Manuel, foreman for the cookstoves, had completed 3 of 7 workshops before my departure and ought to have completed the rest by now.
This is Cirilia, one of the elder people in the community of Guanacaste, admiring her new cookstove. Note the soot-covered walls, evidence of her prior open fire pit that she previously used to cook.

Tomas and his family with their improved cookstove (and, if you look carefully on the left, their filter!).

AGRICULTURE
- When discussing community needs during the brigade, a need for cheaper fertilizer was very clearly articulated. After researching current practices, we found that a community agricultural cooperative (BRHIS) already exists and sells cheap fertilizer by buying when it is cheap (around harvest), storing it, and selling it when it is expensive at the market (during planting time). This reduces the cost by about 20 percent!

-Rather than create a new organization, we decided to support this self-run, self-sustaining cooperative. All BRHIS needed to provide cheap fertilizer to everyone who wanted it was more capital. We decided we could provide that capital (around $2000). I drew up a contract for the “loan,” made sure the cooperative understood the terms, and watched as the first person benefitted from the cooperative’s expanded resources!

The two “directors of the cooperative.” The one in the white is Manuel, a man I work with a lot because he is very involved in all aspects of the community. Note the “Rugrats” t-shirt on the other director!

Isiais, committing to buy his fertilizer under the new program.

POTTERS FOR PEACE FILTERS
More on this later, but for now….

This is why the filters are needed! These are Petri dishes in which 5ml of drinking water from different houses have been plated and grown. If the water is clean, it will look like the plate in the upper left. Two houses of the 125+ houses I visited had clean water like this. The rest looked something like the other three: Red dots are bacteria of unknown origin (earth, plants, fecal matter) and unknown health significance (without further testing to further classify). As such, we don’t know if the red-covered plate in the upper right is dangerous or not (but it surely ain’t clean!). Blue dots are bacteria from fecal matter, which are the most dangerous in terms of causing such gastrointestinal illness as diarrhea and stomach pain. The bottom left plate was typical for San Jose. This level of contamination puts it in the “high risk” category for causing gastrointestinal illness, especially in children. The water grown on the plate on the bottom right is, as my mentor likes to say, “chewy with poop.”

All the water samples looked clear, so unless you understand germ theory (a far cry for most people with a second grade education), you would never know your water was dirty. My greatest trial, and my greatest joy, was trying to teach the people in my community that their water is dangerously dirty, and that a filter could remedy that problem…

About half the plates also grew parasites. Look closely on the left side, a little over midway up, and you’ll see little maggot-like worms. These repulsively gross little parasites crawled around and gave everyone a good fright. I wasn’t happy the water was contaminated with these, since people are drinking this water, but it sure did prove to be a very convincing tool in educating how clear water can be contaminated!

This is what happens when kids drink water that is contaminated with poop and parasites: Look past the cute baby and the older boy in their one nice set of clothes which they put on for the picture and find the naked little boy inside the house (yes, you are looking at a house, in fact, a home to 6)… See his big, distended belly? That’s what a belly looks like when it is full of worms. See his skinny little legs? That’s what malnutrition looks like. This is what happens when you don’t get enough to eat… and then your worms eat for themselves some of the food that you do get… and then you crap out a bunch of your nutrients in your diarrhea… and then you still have to work like a dog to carry water and firewood to the house. This is unjust, and this is why I get so excited by the power of filters, piped water, and improved cookstoves.

SLOW SAND WATER FILTERS
Before leaving, I had the joy of directing and helping Santos, a friend and neighbor who wanted lots of clean water, build a slow sand filter.

Santos washes the loose dirt off of the sand before using it to fill the filter. The filter is the big blue barrel in the back, next to his house. His daughters watch.
The jolly white giant and Santos pose with our newly-completed slow sand filter. Here comes clean water!

OK, that’s all, folks. I hope you’ve enjoyed this (lengthy) recap of my last few weeks in Honduras. I’ll be here state-side until mid-January, so feel free to give me a call if you want to hear more (585-698-6077), or to just catch up!

Love to all,

Mateo
PS. "Gifts of Health: The San Jose Partners Alternative Gift Shop" was a huge success! Thank you and thank you again to all who gave a gift through Gifts of Health. Your donations will be wisely and worthingly spent. Thank you!
PPS. Great news! Lacero, my good friend who was diagnosed with tuberculosis during the brigade, is doing VERY well. It has been an incredible change as he has begun to improve while on medication. His face has gone from cachectic, empty and shallow, to full, bright and visibly alive. His energy and liveliness have made a similarly remarkable turn-around. The future looks bright for Lacero. Medicine, applied appropriately, is amazing.



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A few photos...

Phewf! My legs are tired!

In the last four and a half weeks I’ve been busy, busy, busy, visiting and interviewing 118 houses in San Jose. That’s every house San Jose Centro, Guanacaste and El Horno. If have you been to San Jose or have read much of this blog, you’ll know that represents a veritable mountain of hiking, like ten hours “on the road” every day… and it’s been great!

I could spin a few yarns about all the amazing people I’ve met or all the frustrations and successes of conducting research that I have encountered, but in the interest of time (mine and yours), this entry will just be a few pictures. Consider a journey of self-portraits. Once I get back stateside, with this preliminary phase of my research behind me, I promise more words!


A tranquil Sunday afternoon on my porch, making the map of the community so that I can find all these houses again the next time. Note my new sombrero... pretty handsome!


This is the face that says "eek, I´ve been lost for an hour now in the midday sun and I would really like to find my trail again!" Note the shirt soaked with sweat. This was on the way to map a new water project that we are considering funding.


Every night you´ll find me here, in the mini-lab in my bedroom running tests on the water from each house I visitted that day. My room smells like bacteria/poop from all the stuff that grows in the water tests. Yuck... both for me and also for the people that have to drink the water.


A few kids enjoying the gringo show. This was when I was checking in on the water project in Portillon... which is now completely done!!!


After a day of seeing only houses made from sticks and mud, this is the biggest smile I could muster in front of this home to 7. I was waiting for the owner, who was down below in the field.


In my kitchen taking a big bite of the "dough" for my birthday tomales. We spent 8 hours making 110 of them, and boy were they delicious!! We shared them with everyone after church.


A sign! ... there must have been a gringo here! Maybe I'll buy one of these filters so that I can have this clean water I've been hearing about....

And last but no least, be sure to check out our newest addition to the this website "Gifts of Health: The San Jose Partners Alternative Gift Shop." The site is an avenue to donate one of our interventions in the name of someone, and in turn receive a gift card you can give them. Take a look! http://www.sanjosepartners.org/whatyoucando/page27/page27.html

Love to all,

mateo

PS. If anyone is interested, here is the abstract of my research proposal:

"Multiple studies have demonstrated that various point-of-use water treatment methods can reduce diarrheal disease burden in resource-poor communities. The health benefits of such interventions are greater in trials in which a higher percentage of households properly utilize the water treatment method. Despite this reality, there remains a paucity of research comparing the relative ability of different implementation schemes to affect compliance and disease reduction. With this theoretical basis in mind, this study proposes to pilot a household water treatment intervention in the community of San Jose, Honduras, in order to 1) test its ability to reduce diarrheal incidence, and 2) determine if an implementation protocol with community health worker follow-up yields better compliance and outcomes compared to an implementation program with no follow-up. 100 households will be randomly assigned to one of three groups: intervention, intervention plus follow-up, or control, in which participants will continue with their customary water handling practices. A pre-intervention survey will assess baseline household characteristics, water access, source, treatment and handling, hygiene practices, sanitation facilities and diarrheal prevalence. Interviews at three months and six months will assess compliance, satisfaction, and diarrheal prevalence. Water from the point of consumption will be sampled at each visit to verify microbiological efficacy. Ultimately, the results of this study will provide valuable information about how to best implement further water treatment interventions, both in San Jose and elsewhere."
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A Day in the Life

A Day in the Life is more than just a great Beatles song, it's also a (hopefully) interesting look into the life of Mateo. So, with no further ado, come with me as I recap yesterday, Sunday, the 11th of Noviembre….

I wake up at 6:30am and eat oatmeal, which is lovely. It is a crisp morning.

From 7:30am to 8:00am I walk to the next community over, called “Guanacaste.” It is the day when all the moms with kids under 2 years old come to one house to have their babies weighed. As part of my research we a looking for changes in growth patterns secondary to decreased diarrheal disease burden, as a result of cleaner water provided by the filters. To figure this out, I’m teaching the community health volunteers to use an “infantometer” to measure the babies. This is a device in which you sandwich the little guys lengthwise, thereby getting a “height” (it is also a tool, incidentally, that I had quite a good time making from local materials). Anyway, I spent the morning teaching the health worker and weighing and measuring 27 little dudes and dudettes.

I would say the baby-weighing was fun, which it was in many ways, but that wouldn’t be truly fair, because it was also really, really sad. I actually found myself tearing up at one point (which I quickly repressed with my well-trained lacrimal-control abilities, because I am a manly man… and everyone would think I was crazy if they saw me crying). Why was I crying? Well, a kid would come over to the table to get measured, I would look at him and think, “that’s a cute 6 month old,” then we would get his name and birth date and the kid would be a year old. A YEAR old. Over half the kids we measured were more than three standard deviations below the mean for height and weight for their age. THREE standard deviations. That means they are so malnourished that they are growing more poorly than 95% of the kids in the world.. As if it isn’t bad enough this helpless little kid is so freaking malnourished that he’ll never grow to his full potential, physically or intellectually, I then lay him on the infantometer and see the distinctive lesions of scabies in the creases of his ankles. Great, so this kid it being screwed for life AND he itches all the time from an easily preventable and treatable infection? Yeah, that’s fair. It’s somewhat satisfying to know that I’m here doing what I can to give this kid a chance, but it still breaks my heart to see such needless suffering.

Anyway, I get back home at 12;30pm and there are three people waiting for me on my porch, each with a different project they want to discuss. I arrange a date for GPS-mapping a water project with an adorable, incredibly strong, 65 year old woman, get out cookstove parts for one guy, grab latrine parts for another, and finally get to throw some pasta on by 1:00pm.

1:30 to 2:00 I “read” my water tests from the day before, which means I count the number of bacteria on each Petri dish that has been treated with water from a house. There are A LOT of fecally-derived bacteria in each dish. As my mentor would say, “the water is chewy with poop.”

Church starts at 2, two buildings down from me, and I head down for the “celebration.” I enjoy church for the community it provides, and also for the time for reflection, but in terms of delivered content, I can’t say I get much out of it… Why? Well, nobody can really read, which makes everything somewhat unintelligible to the gringo who needs his Spanish read with pauses in the right places! Anyway, Church was a hoot this week. We’re talking a great-horned-owl size hoot. Why? The music. There is this guy who recently got a guitar. Apparently, he doesn’t know how to tune it. Also, as he told me, he “just learned by himself.” This turns out to mean that he made up his own chords, which he plays in whatever sequence he chooses, in a rhythm not in time with the song. It’s hard to convey the sound that occurs during a “hymn,” but I would relate it most closely to a nursery with lots of hungry babies. It is full of joy and praise, but, for someone used to an organ and trained singers, it is also very, very entertaining.

Church goes till 4 and then I walk 30 minutes up to “town” to get water test supplies from a freezer where they are stored. I chat with people along the way; learning about how Felipe snuck across the border to work in a Chinese restaurant in Virginia and how everyone is really happy that Barack Obama took the cake. (Maybe that’s why I like it here, because everyone loves Obama!)

I buy 3 “baleadas” (flour tortilla, refriend beans, salty cheese and butter) from an outside, questionably-sanitary foodstand on the way back down. Back home, I eat, wash the stacks of dishes that have been piling up in the busy preceding days, enter some data from my research, call the lady-friend, and turn in around 10pm. It was just another Honduras day!

Love to all,

mateo
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A quick post-brigade update

I’m on the run to catch a bus, so this won’t be copious, but thought I should squeeze out a quick little something for all of you....

1. Business:


The brigade from the Department of Family Medicine at UR was here for the last two weeks, so there is something new to report for almost every project! Since there is so much to report, I’ll leave most of the explaining to the upcoming brigade report, where it can be more fairly represented. In the meantime, here’s a short list of highlights:

- The next phase of the Water Project in Portillon was begun. 6.5 kilometers of pipe and materials were bought and carried down to the community by foot.


- The scholarship applications where finished, during a meeting with all the parents of sixth graders.

- Dr. Lindsay and I gave and instructed teachers from area schools in the use of a new curriculum kit on measurements.

- 3 microfinance applicants were interviewed and 2 received a loan.

- I met with Honduras-based microfinance orgnaziation “Adelante Foundation” and made first steps towards a partnership working together in San Jose.

- A parternship between the brigade and the community’s agricultural coop was begun, so that more people can take advantage of low-cost fertilizer.

- More latrines and cookstoves were built.

- Health education was provided through skits at schools, discussions at latrine building days, women’s meetings and conversations in the clinic.

- And a whole lot more... but that hopefully that gives you an idea!

2. Blog

Right, so like I said above, the big story of the last two weeks can be spelled B-R-I-G-A-D-E-! Fourteen physicians, nurses, physician’s assistants and medical students from the University of Rochester (plus one from Colorado) descended upon San Jose and turned by tranquil little hamlet into a bustling gringo metropolis. I loved having them there. It was a productively fun time. AND, perhaps more importantly, we had a phenomenal cook who prepared three hot meals a day. THAT was really incredible! It was my goal to gain weight. I'm not sure I succeeded (a stomach virus got in my way), but I’m pretty sure I didn’t lose any. What a success!

Aside from all the brigade wonderfulness (again, wait for the upcoming brigade trip report, which will be posted on this site, for brigade details. a pile of pictures will also be available shortly, through this site.), a few other recent developments deserve note in this short update.

First, as I mentioned to some of you while home, one of my good friends here, Lacero, had been sick for quite a while before I came home. We tried to go to the local health center twice in the first two weeks I was back, but both times the doctor wasn’t there. So, I asked him to come on the first morning of the brigade to get checked out, and as I suspected, Dr. Lindsay was very concerned that he had advanced tuberculosis (Tb). Over the coming days, we helped him get to the hospital for testing, though which we confirmed the diagnosis of active Tb.

I was agry, scared and sad. Angry at the local health center: They saw him TWO times with clear signs of Tb and never did the testing. The just gave him a vitamin shot, both times. Scared for his health: Tb should be easily treatable, but after 4 months of active disease and signs of involvement outside the lungs, it’s very frightening. Sad that my friend has to suffer like this: Tb is easily preventable, easily diagnosed and relatively easily treated, but because he is poor, without access to healthcare, it has progressed to a dangerous level. Disease of poverty are not fair. That's why I’m here.

With the help of the brigade, Lacero has started treatment and I’m feeling very hopeful for his full recovery.

Secondly, and lastly, for that matter, I’m all amped up to start my research project this Monday! Monday to Friday over the next 4 weeks, I’ll be visiting every one of the 112 houses in San Jose and Guanacaste, doing a baseline interview, weighing and measuring the babies, taking a water sample, and trying to convince them that they want a Potters for Peace Ceramic Water Filter. On Saturdays I’ll be doing the filter distribution workshops. On Sundays I’ll be attending to all the other projects that are still going on. It’s going to crazy-busy, crazy-fun and hopefully quite successful.

That’s all I have time for now, but I hope this little taste is enough to tide you over till the next...

Know that I love and miss you all every day,

Mateo
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Back in Hondu

SCHOLARSHIPS FOR CHILDREN TO ATTEND MIDDLE SCHOOL
- Visited all 5 schools, met with sixth grade teachers and students, gave each their respective part of the application, and instructed them how to fill them out.
- All sixth grade students and their parents will come to a meeting in San Jose Centro on 10/27 at 1pm. They will meet members of the brigade, hear about the requirements of the scholarship program and fill out the parent part of the application. This will be the final part of the application process.

CURRICULUM MODULES FOR LOCAL ELEMENTARY SCHOOLS
- Teachers from all 5 schools will talk at their meeting this Friday and decide the best day for the seminar about the new curricula. Teachers from El Horno will be attending this time!

PIPED WATER DISTRIBUTION PROGRAM IN PORTILLON
- These guys are good! In five days, they cleaned, laid, connected and buried all the tubing from source to distribution tank.
- Distribution tank is overflowing with water from the three springs.
- This week they are digging the trenches for the distribution lines to the homes, in hopes the brigade will fund the next portion.
- All 31 families that will benefit showed up for a day of communal labor yesterday, preparing the road so the brigade buses can get down.

VIP LATRINE PROJECT
- The first latrine will be built on 10/20 at the house of Maria Sanchez, in San Jose.
- 1-2 recipients from each of the communities will come to learn from the man himself, "El Doctor Douglas".
- Following this, construction in other communities will begin.
- Recipients are aware they must do 2 days of communal labor before receiving their roofing sheets and have been out in force the last 2 days working on several community projects.

IMPROVED COOKSTOVE (FOGON) PROJECT
- El Doctor and Apolinar will give the first workshop on 10/24 at the school kitchen in Guanacaste. All recipients from Guanacaste will be in attendance. The community will provide all local materials.
- El Doctor will also experiment with a new stove design at the Guanacaste school.
- Recipients are aware they must do 1 day of community labor before receiving their chimney cap.
- Materials for both latrines and cookstoves will be here by the end of the week.

CENSUS
- The idea was discussed at the community meeting. The community thinks this it's a great idea, but volunteers weren't quickly forthcoming. So far, three people have volunteered to participate. There will be meeting about this at 1pm on 10/21.

AGRICULTURE
- Community members are very interested in the prospects of help in avoiding large swings in the market price of fertilizer. They like the idea of the brigade buying fertilizer when it is cheaper, storing it until needed but more expensive, and then selling it at cost to community members.
- I expect a large turnout at the Agriculture meeting at 8am on 10/21.

MIDWIVES AND MADRE GUIAS
- Will meet with Elia and Dr. Lindsay at 8am on 10/22

MICROFINANCE
- All applicants have been notified about the status of the loan (17 declined, possibly 3 accepted). Microfinance committee, you owe me an ice-cream Sunday when I get home for breaking such bad news to so many desperately needy people!
- All applicants were told of new loan terms and encouraged to attend the microfinance meeting on 10/23 at 1pm. I expect a large turnout.

POTTERS FOR PEACE FILTERS
- Elia is on board to provide the community health worker follow-up starting in December.
- I will begin visiting every house in San Jose and Guanacaste, starting November 2nd, to take a baseline survey, weigh children under 2, take a water sample and "sell" the filter.
- A workshop and filter distribution day will occur on every Saturday of November.
- We currently have 50 filters in San Jose and are still waiting for 50 more.

BLOGS AWAY….

Wow, before writing that "business" part I was trying to figure out how the last week and a half went by so quickly… now I know!

So yes, I'm back and busier than ever. It was a crash landing, once again, with language difficulties, lots of rain, a perpetually drunk foreman and the unavoidable "culture shock." But all's good now!

My Spanish is back with a bang. I actually understood several jokes today, which is a big step.

It rained pretty steadily for the first 5 days I was here. In the last 5 days there has been very little rain and lots of sun… everyone keeps telling me "here comes the summer." It won't rain a drop from the beginning of November until April.

Here I am on my porch chatting with a neighbor and Manual (The brigade's community point-man and also perhaps the fastest speaker on earth). Note the rain.

Concerning the drunk foreman… The culture around alcohol in rural Honduras is complicated and unhealthy. To curb the drinking problem, the government decided to make the state where I live "dry," ie, no one can legally buy or sell alcohol. So, of course, cheap, high-proof alcohol gets smuggled in and a culture of "all or nothing" is born. Apolinar, my neighbor, good friend and our latrine foreman was drunk for my entire first week in San Jose. Prior to this, I had only seen him drink once before. No one ever could, or would, explain to me why he went on this sudden binge, except to say "when he drinks, he usually goes for while." Figuring out how to act, and not act, and what to say, and not say, was quite a cultural challenge. Fortunately, he decided to stop drinking on the morning of our big meeting, for which he was needed, and was able to participate despite his clear withdrawal. Since then he's been his normal, wonderful self, as if nothing happened. I'm glad to have my neighbor back.

Speaking of the meeting, we had another big (80 people) community meeting one week after my return. It was a huge success! In addition to organizing all the projects listed above, we made some great strides in terms of sustainably organizing the community.

We evaluated and modified our current methods of communication: The phone/foot tree we designed last time reached about half the people, a solid result. The signs I walk around and hang up reached the other half of the people and were something that people wanted to see continue. At my suggestion, they designed a system for the communities to distribute and hang them themselves in the future.

Also, in order to satisfy their work requirements with the projects, and to help Manuel prepare for the brigade, each community chose a day this week to come and do community labor. The last two days Mangal and Portillon have come, bringing 15 and 33 people respectively! It has been an incredible show of community solidarity.

To the great amusement of everyone at the meeting, I took this panoramic while Manuel was facilitating the discussion. I love this photo. This is what it's all about. These are the people it's all about. They are here, they are involved and they're ready to make it happen.

And in case you don't believe that I'm actually doing any of what I say, here's an action shot from the meeting.

As a final note, since returning, one of the biggest changes has been how the kids respond to me. As I mentioned before, standing at a distance and staring used to be the norm. I don't know if it was the photos I brought back for a few of them or if time has quelled the weirdness of the Gringo, but suddenly I'm the coolest thing this side of the Rio Negro. Greeting me warmly, talking to me, and generally being fun is the new norm. Also, whereas literally one child wanted a picture before, now they can't get enough photos. Quite a reversal. My favorite, though, is when I'm walking on some random path and suddenly I hear a little voice yelling "Mateo!" in that distinctive way that only Honduran schoolchild can. It's been a fun change.

Here's one of my new-found friends. Definitely note that he is ridiculously cute (and I have no idea why he decided to pose that!), but also note a few statements about life in San Jose: The stick is firewood for the volunteer mothers to use while cooking the government-provided lunch, likely his best meal of the day. The plastic bag contains all his school supplies: A notebook and a few pencils. He is barefoot. You can't see his teeth, but trust me, you wouldn't want to. Would you want you child learning like this?

With no further ado, let me sign off with a few other photos…

In my kitchen with my 4 year old neighbor, Wilson. He and his brother (the photographer) offered me a very warm welcome back.
Did I mention there was a huge tarantula in my kitchen? Well, there was. Here's how he measured up against my machete…. that puts him at about 4 inches in diameter!

I already miss you all and look forward to Christmas-time reunions,

-mateo

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What is Matt Up To?!
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