158 today! We are finishing a bit early.

Today we are in the home town of Daniel the director of CEDEINFA We had breakfast at his parents house and will be staying tonight in the homes of his relatives.

It is pretty hot and humid again. Daniel has offered us the opportunity of a hike Up the mountain to a nice view, but some will likely pass d/t the heat. The town is named "Agua Caliente" or "hot water" for the local hot spring, which we may visit. None of us came prepared for swimming however, but some may go in their scrubs!

David Drozek, D.O.

Thursday, June 24, 8:00 AM

Today we head out for our last two brigades. We may nit have email access until Friday night.

Several are struggling with coughs, the inevitable "kiddy crud" from having sick kids cough in your face as you examine them.

We are generally refreshed from the time at the beach but need to get back into the work mode for the next two days.

We lose our Canadian docs today so our three remaining docs will rove around monitoring all the students who have now learned the routine well. They will do a history and physical, making a provisional diagnosis and treatment plan which will be then verified by the supervising doc. It has been great watching the med students blossom during this time, seeing their education take on practicality. It should give them a renewed enthusiasm for the classroom material of the second year yet awaiting them!

Thanks for sharing your loved ones with us and with the needy people of Salvador. This is a transforming experience for all of us on the team that will hopefully shape our future impressions and practice!

David Drozek, D.O.

Wednesday, June 23, 2:18 PM

Yesterday we arrived late afternoon at the beach house, which is VERY nice; pool, soccer field, lagoon, Pacific beachfront, kayaks. It began to rain after dinner, but didn't dampen the festive spirit.

This morning we awoke to a gentle rain that gave way to son and a hot, humid sea level day. The sea breeze helped temper the heat some.

we went down the beach and held a brigade sponsored by the local fisherman's association in the local grade school.

These are poor subsistence level fisherman that wade into the shallows with weighted nets that they throw like frisbees to catch small fish which are a main food source for them. One of the fisherman is also the guard / grounds keeper for the beach house owner, having a small house for his family on the property. He invited me to go fishing with him tonight in the dark. I declined but plan to go in the morning about 9:00 when the tide is right again.

The brigade was long and hot. We saw 205 patients and many more went to pharmacy to receive worm medicine.

In this community about 15% of the adults tested were positive for Chagas disease, a parasitic infection that affects the heart and the digestive tract. Two of our students are studying Chagas and have thus far been somewhat disappointed, finding only a sporadic positive case in the other villages we visited. Today, finding 12 in the 80 adults tested is very significant. We shared this information with the local physician who came to welcome us. She was unaware that the problem existed in the community to this degree.

The mayor and her staff also turned out. They took pictures with us and supplied us with water, Gatorade and soft drinks throughout the day. They also supplied the waiting patients with ice water and made us a nice lunch of rice, chicken, shrimp, tortillas and a very nice vegetable medley.

We finished the brigade shortly before 5:00. Several team members walked the couple of miles to the beach house along the water, while the rest rode the bus. Almost everyone swam either in the pool or the ocean. Many played soccer on the mini field.

Dinner was again great; scrambled eggs with peppers and onions, refried beans, bread/ rolls/ or totillas, platanos, chips, leftover hot dogs from last night, and peanut butter and jelly for those who wanted something else.

After dinner many looked tired, but currently the volume of cheerful voices is increasing as the pool lights were turned on. The hammocks are full, and some are heading for a night time stroll on the beach.

Tomorrow we enjoy the morning at the beach, then head back to San Salvador for our last two days of brigades.

David Drozek, D.O.

Monday, June 21, 1:34 PM

Our walk took us down a path of volcanic rock to a series of natural and man made waterfall used to generate electricity via a hydroelectric plant.

Everyone seems to be enjoying the cool water

David Drozek, D.O.

Monday, June 21, 9:57 AM

Slowly team members have been arising, commenting on the joy of hot showers and 1 bathroom for two or three people rather than 2 shared among 20!

After breakfast we head out on a hike through a coffee plantation to a waterfall and swimming hole! We will return to the hotel for lunch, then head for the beach. Tomorrow we have an all day brigade planned near the beach.

More later!

David Drozek, D.O.

Monday, June 21, 8:15 AM

This morning I awoke refreshed at 4:30, drawn out of bed by the sounds of a rural town beginning a new week, so familiar to me from my years in Honduras. The roosters, other birds and dogs were calling to one another. Heavy trucks were passing through town and buses were collecting workers to head for factories in San Salvador.

The breeze was brisk and cool refreshed by the surrounding mountains, four cones which stand as sentinels, both blessing the land with fertile soil yet casting a threat as the last eruption of Izalco is still fresh in the minds of many adults.

Hot water from the electric shower head heater was much appreciated, hot water being a luxury until this morning only a memory from the States.

None of our team is awake but me, which is too bad for them, missing the beauty of the clouds and colors roiling over the volcanic peaks. But they all enjoyed a late evening playing games, telling stories, strengthening bonds forged through common events which have forced them out of their comfort zone, challenging them to think afresh about life, and health, and poverty, and wealth.

Each year I wonder “How could a team be better?” which is of course the wrong question to ask. They are all as unique as individual children to a parent, not to be compared to their siblings but to be celebrated for their uniqueness. The pharmacy students and their preceptor add so much, especially in light of our lack of familiar medicines from the States. They have done wonders utilizing medications with foreign names, researching, finding their application, appropriately dispensing them to patients in need. Our newly graduated intern and residents have been wonderful diagnosticians and teachers, showing compassionate care to those who so need their healing touch. Dr. Godwin’s watchful eye guides the research and he shares comparisons between his native Ghana and Salvador. The students of Indian heritage comment on the similarities they observe with India. The Canadians add such fresh perspective from a system that is service oriented, as we have had many enlightening discussions concerning the stories, many of them myths, that we hear of the Canadian system in the States.

And of course the students, many whom I knew well, many whom I am learning to know well, who make these trips so worthwhile as I see them observe and learn and process their experiences, becoming better physicians, blossoming before my eyes!

It is a wonderfully unique team that will live in my memory, unrepeatable, yet representative of why these programs are so valuable to all who participate, and so fulfilling to me personally. The future of international medicine is indeed bright!

David Drozek, D.O.

Sunday, June 20, 5;33 PM

As we tell our teams at the outset, flexibility is necessary!

This morning we arose early to leave at 5:30. 10 minutes before hitting the road for our brigade we received a phone call from the local sponsor of the brigade that they were not able to set it up, so we had to cancel. We had mixed emotions; being still pretty tired, it was nice to have a day to relax a bit, but yet we mentally were ready, and felt bad for the folks who were expecting us, and in need.

So we leisurely headed on the route we were scheduled to take, stopping along the way in two artisan villages. The first was poorer but had a nice selection of things to sell. They also had a carnival in town. Ever wonder what happened to the old carnival equipment from the states that no longer passed code? We saw it in action. Don’t worry, even though the CEDEINFA staff enjoyed some rides, none of the “Gringos” partook.

The second village was an upscale tourist site that was beautiful with nice shops and restaurants; and escape for the middle class from San Salvador to a cooler location in the mountains surrounded by coffee plantations.

We finished up with a late lunch at our third village of the day, where there is a “food festival” underway. We were advised to enjoy the sights and smells, take pictures, but eat at our own peril! We are staying the night in the hotel where we ate lunch. After unloading the bus and checking in, a rain shower hit, but now is ending. We were all excited to find we had TV’s to watch the World Cup, (we can hear the buzz of the noise making crowd from every room) and wireless to allow email access.

Since the rain is stopping we are heading out to explore the village. We have been told there are double decker buses with live bands that will take us on an hour tour of the area for $3, as well as horse drawn carriage rides.

Off we go! More later!

Dave Drozek, D.O.

Sunday, June 20, 8:15 AM

Today we saw 174 patients. I am impressed with the depth our team is assesing their patients! Our preceptors are doing extensive physical exams finding some things that would have been overlooked by many who would feel it didn't matter since we couldn't treat it anyway! The students are having a great experience putting their skills into practice.

It was very HOT and humid today. Several folks were not feeling up to snuff, including me. I think it us probably dehydration for most. I had to drink four liters tonight before I began to feel better and have urine output. We were encouraging water in the afternoon, buying a second waterbottle for everyone to keep the water conveniently present. We do always have several 5 gallon bottles with us but it is inconvenient to go fill your liter bottles in the middle of clinic. We will encouarge the effort more!

I hope to send this Sunday AM as we pack to leave town. We are getting on the bus at 5:30 and heading toward the coast. We have a half day brigade planned, then some sight seeing and a night in a hotel.

Monday we have the day off, finishing the trip to the coast and spending the day on the beach. The next day we have a brigade near the beach. Wednesday we have the morning off at the beach and head home in the afternoon.

I don't know if we will have Internet access until wedneday evening, so don't expect an update until then!

David Drozek, D.O.

Thursday, June 17, 9:40 PM

We are finishing at 6:30! 42 patients this morning and 85 this afternoon. The afternoon patients had more problems than we have seen so far; cardiomyopathy in a teen, a child with pertussis, a large goiter, angina, a couple of people with chagas, various skin problems, and lots of pregnant women.

Ready for an hour drive home, dinner and a good night's sleep

David Drozek, D.O.

Thursday, June 17, 9:46 PM

This afternoon we are in the village of Guazapa about an hour mirth of San Salvador. It is a poor rural community of humble homes. We are set up in a house that also serves as a school.

When we arrived there were few patients waiting but they continue to trickle in, about 60.

It is very hot and humid today with lots of mud from another night of heavy rain.

The team is working very well together like a well oiled machine! We are all drenched in sweat and drug down a bit by the heat and humidity but are trudging ahead!

Tomorrow we do a small brigade a couple of blocks from where we stay at Casa Bethel in a small squatter settlement along the abandoned railroad tracks. We will then have the afternoon off and attend the CEDEINFA celebration banquet in the evening. I suspect many will head to the mall in the afternoon.

David Drozek, D.O.

Wednesday, June 16, 2:22 PM

This morning we are working in a community along an abandoned railroad bed with very humble homes, many only lean tos of old sheet metal roofing.

We made some adjustments in our intake and lab process to eliminate bottlenecks. Things are flowing so well my job today is mostly walking around adjusting patient flow and taking pictures! There are always problems to solve; the EKG machine won't print, we need to refer someone to a specialist, we need trash bags, etc.

The building we are using is very hot this am, plus it is very humid after a downpour last night. We will really appreciate the swimming this afternoon.

David Drozek, D.O.

Wednesday, June 16, 10:19 AM

Three down, 9 to go! We are in high spirits! We saw 75 patients this afternoon and hit our stride! We were done before dark and had a good time of debriefing followed by socializing.

Tomorrow we work in the morning then visit a swimming pool with natural waterfalls tomorrow.

We hope to hear about our medications in customs tomorrow. We bought some meds today and ordered more for later this week in case we don't receive ours.

The food is good; always fresh fruit such as bananas, pineapple and watermelon, some familiar food like fried chicken, spaghetti , and hot dogs as well as salvadoran food like refried beans and platano bananas.

That's it for tonight!

David Drozek, D.O.

Tuesday, June 15, noon

66 patients this morning. Everything went smoothly. See the pictures!

David Drozek, D.O.

Tuesday, 9:51 AM (June 15)

Everyone is a bit quieter this am, a mixture of a short night an a bit of anxiety possibly over having to do double the work today! The first day is always tough, a bit disorganized until we establish a routine and everyone learns their role. A new place today and rotating roles leaves some unknowns. Then we do it again this afternoon.

David Drozek, D.O.

Tuesday, June 15, 9:49 AM

We could not visit the Children's hopsital as planned due to a strike! So we went to the center of town visiting several monuments, a cathedral and the market. We are having lunch at pizza hut then head to our first brigade.

David Drozek, D.O.

Tuesday, June 15, 9:46 AM

First brigade done! 119 patients!

We learned a lot. Two more brigades tomorrow.

David Drozek, D.O.

Monday, June 14, AM

I think we all had a good night’s sleep!

The World Cup is on live as we eat our breakfast this morning.

Last evening we organized for the clinic this afternoon. This morning we will start with a hospital tour, then our first brigade this afternoon. We will need to purchase a few medications, but there is plenty to get us started.

Here are our phone numbers to reach us in Salvador:

David Drozek 011-503-7223-9538
Michelle Bestic 011-503-7224-9159

Salvador Team June 2010

Sunday, June 13, PM

We are here safe and sound! Our medicines are held up in customs. We may have them Thursday. We will be purchasing some meds and using what is already there in the CEDEINFA pharmacy.

Salvador June 2010 Team