Look, Listen and Learn: Trekking Out West

We couldn't possibly turn down an invitation to learn about the work of our young doctor friend.  After all, we have known her since she was in the university, and she has been helping us with the Missions of Healing for 6 or 7 years.  So, on Day #2 we loaded up our backpacks with water and set off bright and early for San Pedro Puxtla.  We had directions.  We had a map.  We still got lost.  We stopped many times for directions, and thanks to a really kind guy in the street who, in the rain, sketched out a map for us in his own notebook, we eventually found our destination.

Our friend (la Doctora) is the coordinator for an ECOS (Equipo Comunitario de Salud) Familiar:  a community-based family health team.  (Usually the Salvadorans just call it an ECO.)  The creation of ECOS throughout the rural areas of El Salvador has been a key strategy within the healthcare reforms that began in 2009.  Each ECO consists of a physician coordinator and support staff such as licensed nurses, technical nurses, health promoters and a driver/pharmacy person.  La Doctora's ECO is one of the first created in the country.  It is one of two ECOS based out of the Unidad de Salud or health department clinic in San Pedro Puxtla.  Each
ECO has it's remote clinic site and is responsible for the care in a large rural zone.

To get to La Doctora's little clinic, we had to walk about 3.1 miles on a rocky road - and it was HOT!  We walked off of the main road to "go see an awesome view" on our way to visit one of the doctor's patients - a little boy who was sick, and so very thin.  Malnutrition is a major issue for families in this rural area - one of the poorest zones in El Salvador.  Along the walk we saw beautiful flowers, latrines that were not beautiful, and as promised, an awesome view.  We could actually see ships on the ocean far, far in the distance.  We could also imagine that during a storm, the path would become a muddy, slippery mess.

When we got back to the main road we had only to walk for a few minutes when a pick-up came by.  We hopped in back and had an easy ride to the clinic.  The building was given to the ECO by the local mayor.  Before it had this building, the team used homes with large yards or porches.  On certain days of the month, the team still runs clinics out of homes in some of the more remote areas.  The ECO building has no electricity, so vaccines need to be picked up each day at the Unidad.  La Doctora and her team are in the midst of planning fund-raising events to raise money to put in the electrical hook-up.

The plan for the day was to go out and check homes for mosquito larvae.  A case of chikungunya had been suspected (only 1 in 10 suspected cases is actually tested due to lack of funding), so all the homes within 100 meters had to be checked.    We were with the nurse and la Doctora, while the promoters were out checking other homes.  One home was quite fancy, with a beautiful garden and a menagerie.  Most of the homes were very basic, made of adobe or stick-and-mud construction.

Before we knew it, it was lunch time.  We ate at a neighbor's home - the woman is a very good cook and the team often pays her to make their lunch.  After lunch we visited a few more homes, and then it was time to make the long walk back to town.  Luckily we got a ride!

The work day ends at 3:00 PM, when the ECO team reports back to the Unidad.  While the health promoters live within the communities where they work (and this is KEY to their effectiveness), the doctors and nurses typically travel long distances to get to their jobs.  The scarcity of jobs has created a very inefficient system in which none of the medical professionals seem to work near to their homes, and transfers take years to complete.  Despite the hardship of traveling five hours per day on the bus, la Doctora and others like her are extremely dedicated to their patients, and to their team members.


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