Helping vs. Hurting

“No das pescado… enseñales a pescar” – “Don’t give the people fish… teach them how to fish” – Peruvian expression

I recently read the book “When Helping Hurts” by Steve Corbett and Brian Fikkert. Many parts of the book have paused me to reflect on volunteer work I’ve done in the past, and on my actions here in Peru in the last year.

Did you know that in 2006, Americans spent 1,600,000,000 dollars on short-term missions?! Often without the volunteers’ awareness, short and long-term mission trips can cause more harm than good in developing nations. Often we have these big expectations and want to GIVE so much - but on our own terms. From my experience, #1- you always get more than you give on a short-term trip, and #2- to be effective, you really need to get a solid understanding of the culture and the community, your role and what is considered “success.”

One important distinction is relief vs. rehabilitation vs. development. Back in college, I signed up for a trip to New Orleans for a few months post hurricane-Katrina. We spent a week gutting homes in what was then a “ghost town” of a city, for persons who were older or had health conditions that prevented them from helping with the manual labor. It was an incredible experience and when the opportunity came up the following year to go back, I jumped right on board. However, the 2nd year’s situation in New Orleans was much different- there was better infrastructure and many people had returned to the city. The work had changed from gutting homes to repair and we spent a week helping rebuild a church. While we left feeling pretty good about ourselves that second trip, I often wonder if we did more harm than good. Where were the church’s community members and why weren’t they rebuilding? Why did we provide relief when we really should have been working on rehab. and/or development?

Another difficulty facing short and long-term missions lies in our individualist (vs. collectivist) culture and the need for rapid, measurable results. Corbett and Fikkert agree that “the North American need for speed undermines the slow process needed for lasting and effective long-run development.” During grad school, I went on a weeklong “alternative spring break” trip to a small desert community in Mexico. For the last decade, students from Regis University had been going to the same community once-twice per year to help build a community center. The progress was painstakingly slow. Most of the men in the community worked 2+ jobs to make ends meet and thus were unable to continue the building once we left without the manpower of the Regis group. The year I went, day 1- we played soccer with the kids and began to plan a health fair, because we were waiting on the actual building supplies to arrive. The manual cement mixing was slow and thus in one week, all that we accomplished was laying cement and getting the roof up. As volunteers, we started out feeling a bit frustrated. I was blown away by the fact that the community was that patient- every year they saw the center grow a baby step closer to completion, but not by much. But what I learned above the patience of the people was the importance of community in the process. To the locals, the groups’ coming meant so much more than construction, health fairs, and a few physical therapy home visits – to them it was all about the feast of a goat, Catholic mass, swimming in the river, playing with the kids, various meals and celebrations together, movie night, a fantastic dance party, and soccer games – community building. It’s not about the product- it’s about the process. And say Corbett and Fikkert, “development is a lifelong process, not a 2-week product.”

The book elaborated on these concepts – development/rehab. vs. relief, processes vs. projects and products, and the importance of empowering people and ensuring local collaboration/participation. Avoid paternalism and don’t do things for people that they can do for themselves. Many lessons I’ve learned here in Peru mirror some of these notions. Another - “I was still amazed to see people in this Kenyan slum who were simultaneously so spiritually strong yet so devastatingly poor.” Though across continents, I see this day in and day out in the people of Peru, too.

So now I look back on my year here in Peru and wonder, did I do more helping or hurting? One of the underlying issues is the idea that providing continuing education is a good idea, but it’s really only putting a band-aid on the “problem.” Why didn’t I focus my energy this year on changing the curriculum of the local PT schools? Is continuing education really worth it? This is something I’ve struggled with as I’ve begun thinking in the lines of public health projects, too. How do we act at the root of the problem, vs. helping the symptoms?

When I first arrived here, I began to learn about the different types of health problems faced. Based on statistics from the WHO in 2008, the number 1,2 and 4 causes of death in Peru are non-communicable diseases. In my community, I noted the poor diet, the low physical activity/opportunities for recreation, and began to see a lot of patients affected by conditions like stroke. In my first month here, I began to envision this project targeting non-communicable disease – exercise classes, educational sessions, an incentive program teaming with the local health clinic, etc.

Right around the same time, I became connected with a number of PT’s here and became very impacted by the lack of continuing ed opportunities and the huge thirst for knowledge. This ultimately shifted my focus for the year. I often wonder how successful a different type of program would have been. I think that ultimately the most important aspect as a volunteer abroad is to listen to – what do the people need? What do they want? What are they most likely to participate in? And how can we build on the skills and strengths that already exist? Reality is, I would be up against a large number of cultural challenges in creating the first project targeting non-communicable diseases– had I jumped right in quickly without really knowing the community, I could have hit a dead end really fast.

That being said, I know that many of my actions could have been better thought through this year. I think that 2 projects – the regular continuing education classes and the planning and execution of the international event - went well and included important cultural factors and community participation. Ultimately I saw the event build relationships and networks, community togetherness, critical thinking, hands-on skills and introspection of physical therapy practice here in Peru. While it doesn’t directly target the cause, as I mentioned in a prior post, I think continuing ed is an important piece of the puzzle.

I’ve been lucky to have 3 short-term volunteer groups of healthcare providers visiting this year. I think that in general, their experiences were well-planned and really tried to get at the sustainability potential in short-term missions. The volunteers were working with community members and people on-site who already knew the ropes, which assisted in their effectiveness. Each group participated in teaching and also had activities planned to visit sites and learn more about the healthcare system here. The opportunities to develop relationships and continued collaboration with the Peru Ministry of Health, a local university that has a PT program, CMMB, etc. were all valuable outcomes of the trips and the beginning of exciting new relationships.

However – when I reflect on my other projects this year, I don’t feel they encompassed as many of the qualities suggested by the authors. Take, for example, the survey of people with disabilities. Here in Peru there are constantly people begging for money – in the streets, at the clinic, even my neighbors and people I know well. There’s a big problem here with free handouts and I don’t think Peruvians and tourists alike realize how much they are perpetuating the process by giving the beggars money. I fear that the survey hurt more than it helped by setting people up to expect free hand-outs from the project. Also, the questions were functional, yes, but some were worded negatively toward “what can’t you do? What do you lack?” vs. the approach of “What are your assets? What do you bring to the table and how can we help develop them?” Ah yes, hindsight is 20/20.

Luckily, I’m still finishing components of the plan for “Rehabilitation con Esperanza,” so I have the opportunity to right some of these mistakes and hopefully leave a well thought out model behind. In this manner I hope to ensure participation by mobilizing the skills/resources of the community and only bringing in outside resources when local resources are insufficient. Thus, the project will ultimately act off some of the authors’ helping principles – as in my favorite Peruvian expression, instead of fishing quickly to produce mass quantities, to slowly teach people how to fish.

The Survey (Por Fin!)

If you haven’t already gathered… Peruvian culture has an interesting juxtaposition of a slow, laid-back lifestyle combined with a unique amount of regulations, red tape and official processes, stamps, logos, fingerprints, certificates… for EVERYTHING. The other day I was at a meeting where we had to stay an hour afterward to submit an official letter to approve the official note taking during the meeting. (What?!) The visa process itself is a whole other story (right, Cathleen?!) And I won’t go into the headache of preparing for an international continuing education conference. Yes, being dropped down into the Latin American culture inevitably will strengthen the patience of any individual who spends much time here. With the combination of a slower daily pace and the necessity of a mountain of official documents, everything just takes that much longer. But it’s good for my character, right?

I’m happy to say that patience with work projects is finally paying off. In November I began a project to create and apply a survey for persons with disabilities. In December the survey was complete. In February we did the pilot study. Last month we presented the survey to a disability committee at the Peru Ministry of Health to gain feedback. And, finally, over the last few weeks, we had the training and then applied the survey, with the help of a group of nursing student volunteers, in Sector Bellavista (pop. ~16,000). Not quite the timeline we had hoped for, but all things considered that’s not too bad for Peru!

resident of Sector Bellavista

The whole process has been an incredible learning experience. We had a lot of preparations – creating a manual for volunteers who will apply the tool, taking photos and making official identification for each volunteer, mapping out each section of the sector, figuring out who will go where and the codes they will use, informed consent. Copies of everything, supplies and snacks, monetary compensation for transportation, etc etc. Not to mention the two-day training of our volunteers. I am so lucky to be working with CMMB’s program coordinator for Peru, who was the driving force behind so much of this project - it definitely would not have happened without her.

We had a number of challenges come up. For one, because the neighborhood is known to be dangerous, our volunteers wanted to go out in pairs, which extended our timeline. Second, last week the sector had an outbreak of Hemorrhagic Dengue, so some of our volunteers were recruited to go out to homes and educate/treat water instead of helping with our survey (and rightfully so!) And third, we had no screening process for volunteers and the students happened to have exams the same week, so thus we encountered some challenges with the motivation of volunteers, their aptitude in administration of the tool and the quality of data received. We had to meticulously check and double-check through each page of each survey for missing information.

Training of our volunteers

Though it was an exhausting process, especially on top of my other clinical work commitments, it was also a nice change of routine. My favorite part was the “field work” – going door to door to identify people with disabilities and administer the survey. The part of the neighborhood that sits at the base of the mountain is an area of significant poverty. It was very humbling to walk around an area where the road is sand, the homes are barely standing with roofs made of flimsy thatched straw, there are no bathrooms nor electricity and the only source of water is a bucket from a vehicle that comes by every morning. The residents of the sector did not hide their shocked surprised to have a gringa wandering around their neighborhood! (Fortunately, my only negative encounter was an angry guard dog – but I fended him off!)

It was absolutely heart-breaking to hear the responses of people surveyed- many who are illiterate, don’t have any idea how old they are, never leave the home, and have little to no access to food, caregivers or healthcare. I encountered many children who looked neglected, and a kid with Down Syndrome who neighbors said had no caregiver the majority of time – I found him standing alone in a pile of sand. Many people interviewed say that they live in fear that either they will be robbed, harmed by gang members, or that the roof will literally collapse on top of them. One report described a 100-year old woman who is blind, unable to walk, hasn’t left the home in years and only receives food twice a week from her daughter who stops by for a few minutes to drop it off. Reading through completed surveys literally brought me to tears. I can’t help but compare cases to patients I’ve had in the US who - with the same exact disability - have a much higher quality of life, simply for socioeconomic reasons. On a more positive note, the residents were really friendly and I enjoyed a new glimpse into the daily life of Peruvians.

resident of Sector Bellavista

We are not through with data entry and will have to wait awhile for all of the results, but it’s clear that we are under the estimates for the national prevalence of disability. We are missing identification of people with disabilities – though it’s not yet clear if our volunteers were mistaken in their definition of disability, have missed houses, or if the residents simply weren’t home when they came by (twice).

While our study itself may have several confounding variables from a statistical standpoint, I still know that the information we receive will be incredibly valuable from a community based rehabilitation perspective. I will soon have answers to questions like - What resources are currently available? What does the community need the most? And what types of resources would they actually use if available? I’ll be using the data to create an intervention plan and now that I’ve gotten to know more people in the sector, I’m even more excited to get to work! From this process, we will also be able to fine-tune certain areas for (hopeful) future application of the survey on a grander scale in Peru.

Someone recently pointed out that I’m receiving a glimpse into so many different levels of the system – the poorest of the poor in their homes, middle class patients coming to the clinic, all the way up to the political level though the Ministry of Health. I’m counting my many blessings here and feel so lucky to be able to be part of these types of sustainable projects!

More Thank You's!

I’m feeling extremely blessed to have so much support down here from contacts in the US. I want to thank an extremely generous anonymous donor for sending down equipment to properly fit the children of Colegio Sagrada Familia in their wheelchairs. This donor sent a variety of seats, cushions, trunk/head supports etc. so that we could make the kids more comfortable. This type of equipment is only occasionally available in Lima (and it’s not cheap!) so if it weren’t for the donations, the kids would remain in miserable postures with only pillows attempting to support them for the majority of their waking hours each day.

Before...

and After!

I felt like Santa Claus as I took each kid out of the classroom for the fitting! It was a lot of fun working with my Peruvian colleagues to select the proper set-up for each individual. It was even more incredible to see the results – the kids were visibly more comfortable, relaxed and full of joy with their new additions – and more able to interact and access their environment. It’s amazing what a few small changes can do to improve one’s quality of life. One of the kids, pictured, frequents the clinic regularly, and I’ve already seen vast improvements in his head control, trunk control and spasticity since we performed the wheelchair modifications. We even have some equipment left over which we plan to use in a new project in the neighboring community of Winchinzao over these next few months.

So, MUCHAS GRACIAS to my anonymous donor! (Also, thanks Mom and Dad for hand-carrying the equipment down to Peru and getting it through customs!)

THANK YOU Holy Cross Rumson!!!

Amamos los alumnos del séptimo grado en Rumson Holy Cross!

I am thrilled to announce that the 7th graders at Holy Cross in Rumson, New Jersey raised an incredible amount of $2,700 dollars for La Esperanza’s school for children with special needs, Colegio Sagrada Familia! Their fundraiser concert last month was a huge success and I want to especially thank …

MaryJane Gallo, the students’ teacher, who has been working hard since August of 2010 to support CMMB’s work in Peru
Jeff Wilson, the singer/songwriter who volunteered his talent to make the event so successful
Holy Cross teachers Geri Ciampoli, Kyle Baldi
Class moms Debbie Bagnell, Tara Avallone, Lynn Worobel, Cathy Caruso
Paul McGuire and CMMB
And, of course, the 34 7th-graders who made it happen!

Thank you Jeff Wilson, leaders at Holy Cross and CMMB for working together to support us!

I was recently asked to comment on the support from Holy Cross for a newspaper article, and I wrote, “It's been a tremendous joy and blessing to build a relationship with the 7th graders at Holy Cross in Rumson, NJ. From the start, the students have proven to be extremely passionate about service and have a great hunger to learn about another culture. Their support via emails, letters and prayers has been a huge blessing in my work down here in Peru. They went above and beyond by coming up with the idea to have a fundraiser concert.”

I (heart) my 7th graders!

“The implications of financial support for the school are tremendous. Most of the children who attend the school have moderate to severe disabilities, and their quality of life is influenced by additional factors such as extreme poverty and abandonment. Colegio Sagrada Familia is the only opportunity for children with disabilities to receive education and free physical therapy in a community of about 40,000 people in La Esperanza, Peru. The school is a safe haven for the children by providing a roof, regular meals, bathroom facilities, and recreation opportunities, in addition to the free physical therapy and speech therapy services.”

“The community is extremely touched by the efforts of the Holy Cross students, as the funds will help clothe the children at Colegio Sagrada Familia and provide them with basic school supplies. Normally, all children in Peru wear uniforms to school, but due to lack of funding Colegio Sagrada Familia went without in past years – thanks to our supporters at Holy Cross Rumson, this year it will be different! In addition, the donations will be used to help outfit children with appropriate assistive devices such as wheelchairs and orthotics, items which they would not otherwise receive and which will have a huge impact on their quality of life. I am so grateful for the generous efforts and leadership from the Holy Cross community and hope that we can work together in the future to create a sustainable source of support and partnership with the school and community of La Esperanza.” Basically, I cannot thank you guys enough for what you have done, and I hope you’re very proud of your efforts.

This week I went out to an area called Winchinzao, which is about ten minutes from La Esperanza. The Hermanas Del Buen Soccorro (the same nuns who run the clinic and the school) have a small clothing factory business in the “red zone” of Winchinzao – this district has high problems with delinquency, violence, and poverty. The business provides mothers (victims of abuse) a safe opportunity to work, with a steady income source. So, in addition to supporting the kids at Colegio Sagrada Familia, the money will also be poured back into a nearby community of need. We selected colors (blue and white) and fabrics for the clothing. I’m not sure how long the production will take, but I’ll be sure to post photos once the kids are outfitted in their new uniforms (etc.)!

The congregation is also beginning a new project in Winchinzao to support the mothers, young children and youth of this high-risk area. They are planning a community center that will include space for about 15 children to live full-time, and plan to serve another ~75 youth with day activities promoting healthy living and respectful values. They’re also planning for services such as psychology, speech therapy, and physical therapy on-site. I will begin working with families there next month, doing physical therapy a few mornings a week, most likely with tarps, mats and blankets until they construct a roof and put in cement. Right now the space is a lot filled with sand and trash, but I look forward to seeing it transform into a great resource for the Winchinzao community.

Pilot Study!

Last week we had our pilot study for the survey of persons with disabilities. I created the survey back in December based on a combination of questions similar to those from the US-based National Health Interview Survey for Persons with Disabilities (1995) and from cultural observations/interviews. Fortunately I had a lot of help with translating and getting the correct wording down in Spanish, and we added and subtracted items according to cultural relevance. (For example, “Do you drive?” or questions about scooters/motorized wheelchairs and artificial limbs don’t quite apply here.)

The last several weeks were busy with recruiting participants and training our “Encuestadores” – a group of medical students – to apply the survey. Because the tool is brand new, the purpose of this “practice round” was to make sure the questions were ordered and worded properly – to assess participant understanding and content feedback, and also to assess the ease of use for the volunteers asking the questions. The adult survey is about 40 minutes long and the one for children (caregivers) is about 30 minutes long. I was worried that those interviewed would feel that the survey was too long, but from commentaries afterward it seemed to be fine.

The best part of the afternoon was getting to know the participants – many of whom graciously waited for hours in the heat to participate. We were looking for 15-20 participants and about 50 showed up! Needless to say, we had a large outpouring of support from the community. This is the first survey encountered in Perú that delves beyond simply identifying diagnoses to include in-depth questions about access, functional mobility and quality of life for persons with disabilities. The questions cover areas of the home environment, transportation, social activities, work history, education, social assistance, adaptive equipment, medications, functional mobility, health opinions/actions, etc. It was fun to finally see the tool in action and once we fine-tune it a bit more, we will apply it to Sector Bellavista of La Esperanza (about 17,000 potential homes) in April.

PEN-PALS!

My first pen-pal, in the 5th grade, lived in the Midwest and all she wanted to write about were igloos, Eskimos and polar bears. It was a short relationship.

I am happy to announce that I now have not one, but 30 new pen-pals! A 7th grade class in Rumson, New Jersey has graciously decided to stay in touch with me during my year in Perú! We met briefly after the school put on a banquet during our CMMB training week in August. Their letters are fantastic- they make me laugh, a few make me cry (in a good way) and they are very humbling- and I just want to give a big shout out to the
SEVENTH GRADERS AT HOLY CROSS SCHOOL!
You guys are awesome!

Thanks for being my pen-pals! ☺ You are doing a much better job than my first pen-pal. Your questions are really intelligent and thoughtful and I’m very impressed! THANK YOU for all of the kind words and support. I have started to write back to each one of you, but it could take a little while… so be patient!

MUCHISIMAS GRACIAS!!

Happy 2011! Time for some shout-outs...

I want to take a moment to thank you for tuning in – and especially those of you who have sent letters, packages, encouraging emails or facebook messages – and of course, the skype dates. Your words brighten my days and keep me going. THANK YOU so much!

Especially want to acknowledge…
My mom, dad and sister Britt
Mi Familia Peruana (no se si estan leyendo? Gracias por todo el apoyo aca en Perú!)
Aunt Michelle, Uncle Kevin, Ian and Maria Donahue
Aunt Kathy, Uncle John + Ryan Stroyls
Auntie Helen
Uncle Steve + Aunt Dottie Connolly
MaryJane Gallo and The 7th grade class at Holy Cross (Rumson)
Cathleen Daly - for her unwavering (on the ground!) support
Grandma
Grandpa
Uncle Keith, Aunt Pam and Crystal Walker
The Chapmans
Deborah Harris
Father Scott and Maria Elena Medlock
Rob Smith
Jules Johnson
Lindsay Palaima
Ashley McKee
Mary Kaye Dolan
Catherine Engibous
Michelle Saltmarsh
Keri Vonkalinowski
Layna Shorter
Susy Mercado – Thanks for the wonderful family welcome!
Regis faculty and my DPT class of 2010
My friends at Black Lion Hospital in Addis Ababa, Ethiopia - Tes Fekadu, Nigatu Abate and Mengestie Mulugeta
Fellow CMMB volunteers out there in the field! Keep up the great work!
And anyone who’s commented on the blog posts too!

Hope I didn’t forget anyone… Many thanks for all of your love, prayers and support! ☺

Numbers

I’ve been taking notes on some statistics since my arrival. 80% of the population in the district of La Esperanza are living under the classification of “extreme poverty.” Recent studies indicate that 45% of children in my district have some sort of stomach parasite, and many cases appear to be resistant to first-line drug treatment. 75% of people in La Esperanza do not have medical insurance.

Interestingly, the rate of anemia is high here for both adults and children. Anecdotally I’ve also had an overwhelming amount of middle-aged patients with the diagnosis of osteoporosis- not surprising, I’ve also seen a large number of fractures. Facial paralysis and lower extremity amputations secondary to diabetes are also emerging as common pathologies in the clinic and hospital.

However, it’s suspected that due to financial and access/transportation barriers, many people with disabilities in my district rarely leave their homes or seek medical care. So, it’s very possible that we have no idea what is truly going on in this area in terms of the numbers. And it’s not just my neighborhood- as a whole, Perú lacks detailed information regarding persons who have disabilities.

While I’ve made several personal observations on the types of conditions I’ve encountered in various blog posts, my district of La Esperanza lacks data about the specifics. Which types of disabilities are most common? How many people are affected? What are the needs and resources desired of the persons who have disabilities? ETC!

The good news is, in about 5 months I will have a whole bunch of concrete answers to these questions! Part of my public health project includes the creation of a door-to-door survey for persons with disabilities (and their families) that will cover all 40,000+ homes in my district! It’s a “pilot” study with the potential to be applied around the country. Based on the data from the survey, I’ll be putting together a plan of action that will likely incorporate a combination of treatment and prevention-based components.

Math is definitely not my favorite subject, and I never thought I’d get this pumped about a bunch of numbers. But I’m really excited that I get to be a part of this and can’t wait until the results are in! So stay tuned for more numbers…

One Long Journey!

First of all, I stand corrected… I had 5 flights, not 4, in over 40 hours to get here… next time I will look at my ticket more closely! Fortunately I only had to lug around the 240 lbs. of baggage and carry-ons during 2 of the 4 stops. It was an exhausting journey, but during my 12 hour layover in Lima I had a chance to get some sleep so I was pretty pumped and energetic by the time I got to Trujillo. It was interesting to see the vibe of the people change over that time… each flight had less and less familiarities (language and otherwise) in the people around me. I already have a few friends in this new place including a cab driver in Lima who informed me “that I will marry a Peruvian before the year is over.” Ha.

I got to practice my Spanish on my last few flights, and also during my 8 hour layover in Mexico City, which improved my confidence. I had a window seat flying into Trujillo and it was awesome to emerge from the clouds and see this brown, barren-looking but very beautiful landscape of mountains and cliffs on the seaside. I’ve never seen anything distinctly like it. After collecting the bags once more, I was promptly greeted by this adorable, energetic nun and her brother, Luis. Everything moved quickly from there- we were shuttled into a tiny car and I learned my first “Cosita Importante” about my new life:

Peruana Cosita Importante Numero 1: Always hold tightly onto something in a moving vehicle, even if you are buckled, or you will get a giant bump on your head. Ouch.

When we arrived at my new casa, it was already dark and we literally threw all the bags at mach-10 pace through the door before congregating inside for introductions. (Apparently not good to stand outside at night in my neighborhood.) My host family consists of mi padre, Antolino, madre Maria and bebe Isabel. However, mom and baby were on vacation so it was me and Antolino to start. He is a traveling salesman from Trujillo. He is also hilarious and talks really fast. I was amazed at how much Spanish I could understand from the nuns at the beginning. However, with my new padre there was a lot of nodding and “Si’s” to who knows what those first few days! He is very talkative and sweet and I’ve already seen every photo in the casa, his extensive collection of antique Peruvian coins and bills, and his DVD collection of Peruvian music/dancing. He gets up before dawn is on the streets all day selling his goods, and sometimes travels to other regions for sales too. He is a hard worker- says he is barely scraping by, which seems evident from his simple lifestyle and sole pair of shoes which are literally falling apart into pieces. He has a huge heart and I’ve already learned a lot about the culture from him.

Adios Alaska!

I'M READY!!!
4 checked bags are going to be a pain but hopefully worth it to get some PT supplies down there. We'll see how it goes at Customs...

I have a long trip ahead, starting tomorrow night...

Anchorage-Seattle
3 hour layover
Seattle-Mexico City
8 hour layover
Mexico City-Lima
12 hour layover
Lima-Trujillo!

All in all, 38 hours...ugh. Prayers for a safe journey / bags making it / not getting robbed are very much appreciated :)

A little nervous, especially for finding my housing, and overcoming the initial Spanish language shock. But otherwise really excited! 

Fundraising Results!

First of all, MUCHAS GRACIAS to all of you who have supported me through the last several weeks- financially, through equipment donations, Spanish tutoring, or in any other way. I cannot begin to express my gratitude to the enormous outpouring from my family, friends and parishioners at St. Pat’s.

There’s been so much enthusiasm that a number of individuals have approached me inquiring about sending down short-term volunteers to where I will be working during my year of service. I am not sure about the feasibility of this idea yet, but will update on this in the future!

The fundraising efforts were a huge success. At one weekend of masses, St. Patrick’s Parish contributed $3188 in cash/checks alone! The online donations surpassed my goal of 8,000 at $8,750, thus bringing the total to $11,938.00!!!

I’d specifically like to thank the incredibly gracious gift of one anonymous donor, who has pledged a very large amount to help make this trip possible → I would not have felt financially able to commit to one year without your initiative, I’m very humbled and touched by your contribution, and promise that I won’t let you down!

The equipment donations have also been extremely successful. I’d specifically like to thank:
Eric and Lisa Reimer
Robert McClune, Robin Wahto and UAA Allied Health
Grace who connected me with Michael Friend / Access Alaska
Tom Bruce
Anonymous donor of pediatric equipment
Sports Authority
Alec Kay / United Physical Therapy
Boyd Esplin and Heather Brown / Chugach Physical Therapy
Linda Rose Weppner, Esther Petrie and Providence Hospital

And, the many anonymous donors who left items in my collection box!

Also, my excellent Spanish tutor:
Cecilia Plascencia

I am still blown away by how supportive my community has been with this endeavor. The monetary donations will help tremendously with the aims of improving the access, education and quality of healthcare in the community. The physical donations will provide a solid foundation for fostering evidence-based PT care in the La Esperanza area.

Lists.. lists.. and more lists!

I’m a list person (this may be an under-statement…), and the last few weeks have been especially full of lists as I get close to departure date. Unfortunately my to-do-before-Peru list seems to just keep growing larger by the day! It’s definitely a lot more work than I expected to get ready for living abroad for one year.
The vaccinations alone are daunting:

-Yellow Fever
-Hepatitis A series
-Hepatitis B series
-Typhoid
-Meningitis
-Polio
-Rabies

Fortunately a recent trip to Africa made this easy and I only had to get one additional vaccine.

I also discover how expensive one year’s worth of medications, just-in-case prescriptions like antibiotics, anti-malaria pills, and over the counter drugs can be. While I’ll be living in a large city it sounds like over-the-counter meds are particularly hard to find, so I stocked up on those. Add in a year’s supply of daily contacts (argh..) and my carry-on is already full!

A trip to REI and some online shopping helped with some other basic items:
-Steri-pen (makes water safe to drink)
-water tablets
-mosquito net
-motion sickness bands for long bus rides
-bug-repellant sleep sack
-waterproof shoes
-water repellant pants
-long underwear (while hot in the summer, most buildings are un-heated year-round)
-camping towel
-mace
-outlet adaptors, convertor
-clothesline
-hidden passport pouch
-locks
-first aid kit
-slash-proof bags (Magellans.com)

I had fun raiding the dollar store for kid toys/games that can be used in therapy… UNO, cards, foam letter, balls, bubbles, crayons/markers, coloring books, etc.

The most time consuming part of my preparations have been in getting documents ready. All passports, photo IDs, licenses, diplomas, immunization records, etc. are recommended to be carried as notarized copies in case originals are lost/stolen.
I’ve also been working on bringing down electronic copies of physical therapy resources I can use, such as:
-patient education materials (in Spanish)
-home exercise program pictures/instructions (in Spanish)
-commonly used outcome tools (in Spanish)
-research articles
-intake/eval forms (in Spanish)

It’s been very time consuming to try and locate all of these materials in Spanish, but I think it will be worthwhile to have some of these things ready in advance.

Lastly, I’ve been trying to get my hands on as many books as possible. Here’s my reading list:
-Half the Sky by Kristof and WuDunn – great read for anyone! Excellent book*
-Where there is no doctor (Donde no hay doctor)
-501 Spanish Verbs
-Lonely Planet- Peru
-1001 Pitfalls in Spanish
-Culture smart: Peru
-Physical Therapy for Children
-Women’s Health in Physical Therapy
-Essentials of Global Community Health

If you have any recommendations for other resources please let me know!

Living SIMPLY!

I think that one of the most challenging yet rewarding aspects of the next year will be in living simply. On a very modest (by American standards) stipend of monthly money for food, I will by no means be “roughing it” but will definitely have to carefully plan what I buy, particularly if I intend to visit some of the other areas including desired trips to Ecuador, Lake Titicaca or Machu Picchu.

Since my return from one month in Africa this spring, I’ve been more and more disgusted with how much waste and excess are present in America. It’s hard to watch reality shows, overhear some people’s ideas of “problems,” or watch people dish out $400 on a Prada bag. Dollar amounts are now translated into miscellaneous quantities… The cost of one month’s rent, one year’s food, etc. in Addis Ababa. The cost of a custom-molded orthotic that changes the ability to walk in a patient who has hemiplegia. The cost of a bus fare to make the trek to the fistula hospital for a woman whose life is threatened during labor/delivery. The trip changed the way I view things, sometimes overwhelmingly, and I found the transition back into American culture significantly harder than the initial culture shock when I first arrived.

I am definitely not trying to say that I am a good model of living simply; I definitely get caught up my own life and drama frequently. As middle to upper class Americans, we are really fortunate to have such an incredibly high quality of life. This should not necessarily constitute guilt every time we do something fun or beyond our basic survival needs, and I’m constantly reminding myself to stop making comparisons to my experiences in Africa and to instead give thanks for my many blessings.

So what would YOU really miss if you were going abroad for a year?

While I consider myself pretty low-maintenance compared to many people I know, I imagine it will nonetheless be a drastic lifestyle change. I don’t watch TV regularly (aside from the occasional LOST or -(guilty pleasure)- Grey’s Anatomy). I don’t particularly enjoy shopping for clothes, and get a rare bi-yearly pedicure if I’m lucky. Not the biggest fan of talking on the phone or text messaging either. I think that the parts of my daily routine that I will miss the most will revolve around using a gym or the outdoors for exercise/running/swimming laps and the possible lack of internet. Of course, I’ll also really miss the food. Specifically, my comfort foods- mac ‘n cheese being one of them. For those of you who know me well, you know to stay away when I’m hungry or haven’t exercised in awhile, so it could get ugly as I’m adjusting! I’ll make a post later on the common cuisine of this area. I know that some forms of gyms exist in Trujillo but I’m not sure if I will have the time, transportation, or money to experience them. (The bigger cities in Peru have a very stark contrast between the facilities available to the upper and lower class.) Plus, I truly want to experience daily life through the eyes of the people I will be serving, which will mean making many sacrifices.

While I will definitely miss these aspects of my current life, I also think I’ll really savor and embrace living more simply in a new culture, which I anticipate to be strongly based on family values and spending time together. This doesn’t mean I won’t occasionally fantasize about giant cheeseburgers, Wifi or elliptical machines!

Introduccion

Thanks for checking out my blog! I’m so excited to begin this new chapter of my life and hope that you will share this site with friends and periodically return for updates.

As I prepared for graduation this spring - immediately following my return from a month of work in Africa, I couldn’t help but feel a disconnect from American culture and the notion that I am meant to begin my work as a new physical therapist in another country. I didn’t quite understand why, but I knew that I was being called to do something different than my peers with the start of my career. One evening I stumbled across the CMMB website and had the eerie yet calming feeling that somehow I needed to contact them immediately. I toyed with the idea of taking other jobs but ultimately I had a nagging feeling that it was now or never for working abroad. I am very blessed to be in a position where I can afford to do this!

And, sitting here a few months later, I’m sending in my Visa application and preparing for my October departure! I can’t help but feel pretty under-qualified for the job – I have no experience in public health programs and my Spanish is pretty scary – but at the same time, what I can offer will be better than this community receiving nothing. My experiences in Africa reminded me that I am so lucky to have an excellent educational background, and that language and cultural differences can be bridged easily with the appropriate attitude. I know I will gain so much personally and professionally from this experience and can’t wait to dive right on in!