Pico de gallo

Pico de gallo

6 jalapeño peppers

2 small white onions

3 limes

2 tablespoons salt

4 large tomatoes

*Wear gloves when cutting the jalapeno peppers.

1. Cut the end/top of the pepper

2. Cut the pepper in half (long way)

3. Remove seeds

4. Slice in quarters

5. Slice again in eighths

6. Dice into very small pieces

7. Finely chop the two small onions

8. 3 limes – cut in half and squeeze

9. Add 2 generous tablespoons of salt

10. Dice 4 large tomatoes

Mix all and eat with everything.

4/7 of the days, I woke up before 5 am.  It was challenging to travel so far each day.  I am grateful for the learning, experiencing the dirt roads and understanding first hand why someone would not want to travel to a hospital.  I am grateful for observing the women who dedicate themselves to serving the undeserved.  I learned about poverty and although I may not be able to help many people, it only takes one person to create change.  I learned about a model of care where local people are invested in their own health and have ownership.  I witness a birth without interventions.  I observed poverty and will never forget the woman who only ate an avocado or the baby who will die before 5.  I felt many things this week, but I left with hope.


Last day: a natural birth

I sat at the foot of the bed, drowsy from taking a NyQuil only an hour earlier.  I awoke from my slumber to the words, “she’s 14 years old.”  I don’t know what about those words woke me up from my deep sleep, but I got out of my pajamas, went downstairs to the clinic to witness a birth.

The girl was 14 years old, a child in my eyes.  When I was 14 years old, I had not even matured into my adult body and grown childbearing hips yet.  This child before me was laying down, pulling on the rope above her head with each contraction.  She was dressed in her traditional skirt with thick blankets on top of her and a hat.  In the room was her mother, mother in law, boyfriend, two nurses and the midwife.  The young brothers of her boyfriend ran into and out of the room.  They were excited about what was to come.  There were no medical interventions, no beep-beep-beep from the electronic fetal heart monitor.  The girl mostly laid flat on her back, getting up to pee and walk-taking two turns down the hallway.

The nurse checked her cervix and announced she was fully dilated.  In a short time, she was already crowning and the baby was on its way.  I had no words to encourage her other than, “muy bien”… which I’m not even sure she understood since she spoke the local Mayan language.  I wanted to be encouraging.

She delivered without tearing and there were no fluids.  It was the easiest birth I had ever seen.  Her uterus clamped immediately and her fundus was firm.  The nurse gave her an IM shot of pitocin post delivery.  The placenta was put into a trash bag.  She delivered in her traditional skirt too.  She was vocal once and was silenced shortly after.  In their culture, it is better to be silent to not make the baby afraid.

The baby was wrapped in blankets and given to the mother in law.  Mom was attended too, but baby did not go skin-to-skin.  I’m not sure if that is a practice in their culture, since she was wearing so many layers of clothing.  After a short time, I asked if the mom wanted to see the baby, she shook her head, and so I took the baby from the mother in law and knelled over to present baby to mom.  I only held the baby there for a short time when she shook her head again, I returned the baby to the mother in law.

It was so powerful to witness a natural birth without intervention or complication.  From transition to the birth was a hour and half.  I’m sure her age helped with the delivery but more importantly she was calm, surrounded by loved ones and supported by others.


Project Site: Tuzlaj Coza

(Wednesday): Observed an adolescent class on self esteem in Calhuitz, tamale making, language class, cultural night (local kids dancing).

(Thursday): Another early morning, I awoke at 5:30 am to drive for two hours to the project site in Tuzlaj Goya.  (Photos: switchback mountains we crossed, me and classmates in the back of the truck.)

At the clinic, I was told they ran out of ibuprofen.  The next supply would be next month.  When I have a headache, I go into my backpack and take two ibuprofen.  This community would have to wait a month for a resupply.

Today, I followed two educators into the community to observe their home visits.  Home visits are really interesting.  At Casa Maternas, they follow a cascade model of care.  They first begin by taking a census of the community or a community health assessment, identifying the risks and needs of each house.  They map out the community and then begin their interventions.  At each Casa Maternas, the focus is on reaching women and children under the age of five – in the hopes of lowering the mortality rate.  The lead educator is from Casa Maternas.  She educates 7 facilitators who each go back to their districts/neighborhood and educate their community.  Eventually, one by one, each woman in the community is educated each month on a specific topic.  This month’s topic was danger signs of pregnancy.  This model of care is something I had never seen before but is so effective in its outcome.  It only takes one person to create change.

On the home visit, the baby was weighed, measured, and their records updated.  The facilitator educated on the importance of vaccines, birth control – depo is free by the government, family planning, hygiene and the monthly topic.  The mom asked engaging questions about… (social services – a nearby town gives away food, why doesn’t Casa Maternas?  She asked are vaccines truly helpful?  Free education classes at the clinic – she would want incentive like food.)  At the end of their conversation, the mom was asked to thumb print her name with ink instead of signing to acknowledge the conversation.  I thought that was a powerful record.  Even though she is likely illiterate, she was still able to participate in the health of her children in a meaningful way.  These facilitators went to her.  They went to her house to talk about the health of her children.   I walked away feeling like this baby was healthy and the children were happy.  (Photos: baby being weighed by a portable scale, art on the wall at the families’ home, children, a donkey walking down the road carrying sticks, and chickens in the yard.)

The next family was more resistant to our visit and her baby was severely malnourished.  I would have guessed this baby was a few months old, but instead it was one year old.  The mother said she feeds the baby with formula maybe once a day.  This baby will not live to five years.




Project Site: San Domingo

(Tuesday) From home base we traveled less than an hour to the clinic at San Domingo.  The first few patients I worked with were prenatal visits.  I practiced Leopold’s Maneuver, identifying the head of the baby, back, squishy parts and it’s general positioning – facing down, transverse, or another direction.  I used a handheld doppler machine to find the baby’s heart beat. I took vital signs and measured the fundus.  I wrote these measurements on their records.

Many hours later, the portable ultrasound machine arrived with the supervising nurse.  I am told the machines are Japanese made and the quality was impressive.  It was no bigger than your average laptop.  I watched the supervisor show the women the images of their babies and bellies.  The ultrasound confirmed the presence of the baby and the size/gestation gave concrete evidence of the potential date of the babies’ birth.

It was profound to me that these women let me touch their pregnant bodies and find the positioning of their babies.  Many of these women did not speak Spanish, but their local Mayan language.  There are 21 indigenous Mayan languages in Guatemala.  In the U.S. we do not use our hands to find the positioning of the babies, but use ultrasound machines.  It seems like a lost art.

Other women who arrived at the clinic: one had stomach pain which was ruled as a GI infection after a pregnancy test, and another was also given antibiotics for a similar ailment.  One woman arrived for her 3 month birth control, depo shot.  Another woman was dehydrated and could not afford the ORS (oral rehydration solution).  The homemade remedy for ORS is roughly – one fist of sugar, 3 pinches of salt, and one clean liter of water.  ORS is like Pedialyte for those familiar with that brand.  It is used to prevent dehydration and replace nutrients and electrolytes lost through vomiting and diarrhea in adults, children & infants.  

I was most heartbroken by some of the stories of the prenatal visits.  One pregnant woman said she had only eaten an avocado that day.  When asked if she eats other fruits and vegetables, she replied by saying she buys them when the man in the car drives by to sell them.  If I am hungry, I’ll dig through my backpack for a granola bar.  I thought about my privilege of being a vegetarian.  I chose to not eat animals and here is this woman in front of me who does not have the privilege to eat and there is nothing I can do help or change that situation.  The supervising nurse spent some time educating the woman about nutrition and the importance of eating more for the survival of her baby.

Without this clinic, these women would not receive much needed services.  They are seen in this clinic, respected, and spoken to in their native languages.  The nearest hospital is 5-6 hours (which is expensive to travel to, expensive to visit, and they would not be treated in the same manner as they are in the clinic.)


Next stop Calhuitz

(Monday – travel day) We woke up at 5:30 am to take the van 12 hours to Calhuitz – the remote mountainous region of Guatemala – our project site.  I am told the drive is long because the U.S. State Department says this is the road we need to take.  It is less than 10-20? miles to the Mexican border and there are other roads to Calhuitz but not approved by the U.S. State Department.  This is the “high road.”

We traveled for about 10 hours on paved roads in the van, then switched to pick up trucks for the remaining 2 hours on dirt roads.  About an hour into the ride, the brakes on our truck started to burn so those of us in this truck hopped out and sat in the back of the open of the other pick up truck.  We tumbled and bumped the rest of the way to our new home base for the next four days.

Photos: Sign on the wall at the project site, a random families’ home with a giant turkey and one of the wood fire burning stoves that is common in most houses.

Co-op visits

After arriving at Lake Atitlan, we took a small ferry across to our hotel for two nights.

Photos: Ferry ride, view from ferry and hotel, coffee plantation, chocolate press, textiles cooperative, art gallery, tuk-tuk’s…

I was most impressed by the textile cooperative.  A woman picks the cotton from a plant.  The cotton is bunched together and spun into a thread.  The thread is dyed in a color – by pressing the leaves of the plants (photo above)… each plant makes different colors.  After coloring, it is washed, and then put into a traditional loom to weave the strands together.  The process from start to finish is about two-three weeks to make a single scarf by hand.  The scarfs are in US prices to give the workers a fair living wage.  They said about 80% of the purchase goes to them and 20% returns back to the cooperative to support the group’s resources.

An average Guatemalan salary is $400 a year and it only takes $13 a month to pay for a student’s monthly school fees.

San Juan village

I take even faster showers here than normal. The hotel we are staying at today is an eco hotel and they run on some kind of grid system. Suds up and then you turn off the water and turn it back on when you are ready to rinse off. It’s a luxury and privilege to be able to waste water by standing in it for the whole duration of my heated shower back home.

I listened to a podcast on the way here about NYC sanitation with Alec Baldwin and it was fascinating. There are only 4 “P’s” you should put in the toilet in NYC – pee, poop, puke and paper. After those items go down the drain, they arrive at a screen to let those items through and other items go to landfill. Pee gets put through a sterilization process and back out into the deep ocean. Poop goes into an anaerobic bacteria cylinder that turns it into compost. Recycling paper gets turned into pizza boxes. 80% of NYC trash is compostable. Diapers that go into the landfill take 450 years to decompose. Singapore is the only country that takes their pee and it goes back into their water system. They go through a very strict treatment process and Singapore is one of the cleanest places in the world.

Today, we visited several artisan co-ops that support people with a fair wage. The coffee co-op goes through a rigid 4 level quality control process before the beans are packaged to the U.S. It was kind of surprisingly to hear the beans that are not very good, get packaged for local consumption in Guatemala City, only the best of the best are shipped to the U.S.

We visited the honey bee co-op, followed by textiles, coffee, herbal medicines, art and chocolate. I will post photos next week when I have stronger wifi. Tomorrow we go to our project site. I will be off line for the week, back to the US on Sunday night.