Tuesday, June 30, 2009


Isn’t it awesome when a plan comes together as a result of good leadership and teamwork?  Today we had both and were able to accomplish an incredible amount- finishing up with a morning seeing hundreds of patients in La Union, loading all of the equipment onto the flatbed trucks, transiting to the next site and offloading and setting up there.  We did all of this in about 8 hours and in 120-degree heat.  I have to give hats off to our Site Leader CDR Lefebvre, the Advance Team and all the others that worked in concert with each other to pull off a seamless and highly productive day.    

Our next workstation was at a school in a quaint little town East of La Union named Pasaquina.  If there ever was a town that in my minds eye was the quintessential Central American town as you might see in the movies or in storybooks, Pasaquina was it.   

We pulled into town around 2pm after we made it past the run in with the cows on the road a ways back, and were immediately welcomed by children running alongside the bus in their school uniforms waving and smiling.  I leaned over LT Jacobson to peer out the window at the incredible houses lining the streets, painted with bright pastel colors like pink, orange, green, and with traditional Aztec and Mayan symbols everywhere.  The roofs of the houses were all of the overlapping red curved shingles that are so typical of the Moorish/Spanish architectural influence.   We passed the town center square and main Iglesia (church) with a façade adorned with Roman columns and three gorgeous spires topped with crosses.  I snapped photos out the window of the bus, hoping some would turn out ok.  This was just too beautiful.  I turned to LTJG Sam Harris, a Navy male nurse (MURSE), sitting next to me and said, “I dig this place, it has a good energy about it.”  

Harris, who has been (attempting to) grow a mustache (Deployment Stache- Navy Tradition) said back to me “Baldwin, you taking more photos again?”  I snapped one of him and told him he’d be good on Reno 911.   Let me know what you think.   The other guy growing a deployment stache is my Canadian Murse roommate LT MacLean.  His stache is a bit more filled out.  The only time I grew a Navy mustache was during Dive School.  Our whole unit did in Panama City, Florida.  In fact my Diver ID card has a photo with a mustache. But I digress…. 

We reached the school and had to wait for a while as the security detail set up.  Out the window LT Jacobson snapped a shot of some of the kids.  They were loving the attention and started smiling and posing.  It was adorable.  When we finally got off the bus, and through the school gate, we encountered an open-air school, with classrooms connected, and a large canopy of trees above.  It was a perfect spot for a shaded medical clinic.  There were kids everywhere- running, jumping playing, whispering curiously about us Americans, and some had a large jump rope.  Before I could say “Hola” one of the little girls had placed one of the jump rope handles in my hand and the other in her friend's hand and she said “Listo!”  (ready).  We began to twirl the jump rope and the girl was jumping away.  A crowd formed and clapped to the beat.  After some minutes she took the handle away from me, the rope continued to turn, and she said “Vaya!” (go!).  I pointed at myself and she nodded yes.  Ah what the heck, here goes nothing.  

The girls swinging the rope were half as tall as me, but I got in there and jumped away with big combat boots on and half ducking so I could make it under the rope.   Did fairly well for a few minutes and then got bold and tried to throw in some dance moves and that was my downfall.  That, folks, is the story of how I came to jump rope in fatigues in the El Salvadorian town of Pasaquina.  I think that my friend and Army communication officer 1st Lt Michaela Encarnacion probably has some incriminating photos, but it was worth it.  

We offloaded our gear and setup the school area to begin seeing patients the following day.  The shade was welcomed, as this was the hottest day we had encountered yet with the heat bulb hitting the 120-degree mark.  Navy MURSE and future Reno 911 star Sam Harris chatted up the owner of a nearby food/beverage stand.  His name was Oscar and his family was there making Pupusas and serving bottled beverages called FANTA Champagne and Fresca.  Both Sam and I were dubious of these drinks, especially the “Champagne” in a soda bottle, so we decided to try.  The El Salvadorian version of FRESCA is in my humble opinion the exact same thing as Mountain Dew, and as Sam related the Champagne tasted like Ginger Ale (and did not give him a buzz whatsoever). 

The school kids got out their brooms and mops and swept the area clean.  The children were so well behaved, and everyone we had met thus far in this town of Pasaquina was extremely nice.  

By 4pm that afternoon, under the leadership of CDR Lefebvre we were set up and ready to go for the following day.   Everyone boarded the bus and most of us passed out on the drive back to the COMFORT INN.  The food at this El Salvadorian COMFORT INN was so good it didn’t make sense.  In the United States I have not been to a Choice Hotel that has had a buffet like this.   The great part was that it was open from 5:30 pm until 11pm, so many of us ate when we got back from work at 6pm and then again before bed.  Comfort food never tasted so good.  

The next day we started early at 730am and were determined to see as many as possible in the town of Pasaquina.  Our general medical team of providers was made up of myself, LT Jacobson, CDR Schwartzman, Project Hope Ann, CDR Bruno Himler from the Public Health Service, and a few doctors from El Salvador Ministry of Health that were screening for H1N1.  

We got a group shot at the beginning of the day.  Dr. Schwartzman again set a blistering pace and we all strove to keep up.   The El Salvadorian woman Krisia was once again my translator, and she did a good job of keeping the health education, diagnoses, and stories between the patients and I flowing. Dr. Himler and Ann worked nearby and we would every once and awhile consult each other with questions or interesting cases.  As with every day, there were some incredibly sad cases that we simply could not do anything about, some cases where we were able to make a profound impact, and the majority of patients that we helped leave with some education, medication, and a smile.   For lunch, Dr. Himler gave Krisia some money to go out to the central market in town and she returned with big bags of fruit for us.  

We recognized the bananas, apples, lychee, and mangos, but one piece of fruit was there that none of us recognized- a soft Zapote.  I dug into it with my spoon and unearthed some mushy red stuff and sucked out a large smooth seed.  Krisia screamed to me “Don’t eat that!”   I’m not sure why.  I ended up spitting out the red stuff as well.   Couldn’t stomach it.  (Please don’t tell Krisia or Dr. Himler).  

Comparing and contrasting patients from the various sites we have been, I must say that the patients in Pasaquina are the most healthy yet, and have the best chance of being seen by a local medical clinic.  I attribute this to the small town atmosphere; the way people take care of each other and town leadership.  The Mayor himself passed through the site today, and when finished drove to remote areas outside town to spread the word of our presence.  He returned with dozens of these folks (many of them with Cowboy hats) and stayed until every single one of them had been seen and then drove them back to their homes.  Now that is caring for your people.  The name for cowboy in Spanish is “vaquero” derived from the word for cow “vaca.”  The sombreros (hats) of some of these cowboys here in El Salvador were amazing.   Studded with jewels, rocks, family emblems, etc.  

One of the cowboys let me try his sombrero on and I felt like an El Salvadorian for a brief moment.  Krisia asked me what cowboys are like in the United States.  I explained that the term described the men from the Wild West and was also used today as a descriptor in reference to a person who lives their life not always in accordance with the rules.  I think she understood.   That evening the movie “Space Cowboys” with Clint Eastwood was on TV at the hotel, which I found ironic and timely.   

Towards the end of the day we got word that we indeed HAD seen ALL of the adult patients in the town of Pasaquina and were close to the mark of 500 patients seen.  In an attempt to make that mark some began soliciting patients to be seen and some of the military guards with their M-16s were evaluated for “dolor de espalda” (back pain) and treated with some Vitamin M (Motrin).  By all means, they deserve it!  After standing outside in the blistering heat all day, I got them some water too. 

I just wonder if they passed through the lines to get a bracelet as the others had (given that these were the people they were guarding).  One of the guards I think had a crush on LT Jacobson.  He kept going back to see her again and again.   

Have you ever drunk wine out of a box before?  I know many of us are familiar with Franzia.  But, what about water out of a bag?  That is the way they do it down here in El Salvador.  The water comes in a clear plastic bag, they tear off the corner, and suck.   The tap water is not potable, so it is imperative for the people to consume clean water, and they have realized that bagged water is a much easier, and cost effective means than bottled water.  

The production costs, and trash volume are considerably less.  This makes the cost of such bagged water much less.  At the end of the day I was craving some ice cold bagged water, and for 15 cents I got myself one.  Snapped a photo first.  Check it out.  Doubles as an ice cold compress for head and neck as well.  Novel idea.  I actually recommended to my patients with knee and other joint pain to first use frozen bagged water to ice their injuries and then drink it.    

The following day was our final day ashore and we gave it one last final push to the finish led by Dr. Schwartzman.  Before we headed out and back to the ship I stopped into one of the corner stores run by a family from Pasaquina.  I wanted to get one last glimpse of this friendly town.  Inside I met five generations of a family names Reyes, including the youngest who was sporting a T-shirt saying “I love Mom”.  

The second eldest had fought in the El Salvadorian Civil War and spent his entire life otherwise in Pasaquina.  I shot the bolado with him for awhile in Spanish, about their new President Funes, about the stability of their the town, the Coup in Honduras, and about their family.  I even went so far as to inquire whether they could use a doctor like myself down here in this town.  Si, claro!  (Yes, for sure!).  “Quien sabe”, (who knows!), I told him. I might be back before I know it.  And the Reyes family will be the first to visit when I do.   Hasta luego Pasaquina.   


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  2. Hi, So you know the name of the fruit and wanted to brain tease us?? was it really that gross? according to this ..... http://www.you tube.com/watch?tv.=ACXCX19k3dA
    it is delicious, maybe you had an over ripe one?
    Anyway, just a coincidence ....I saw that guy you are talking about from Reno 911 in the last 2 movies I saw, "I Love You, Man and 17 Again.....Thomas Lennon, a funny actor, he made the movies "worth it". You should see them.
    Reading your blogs took me back when I have to do a rural PHN over 30 years ago in my native country , the Philippines. It hasn't changed much with regards to the encounters with the people, it doesn't matter if they are in Asia or Central America, people are basically the same , then and now. Very gracious in their simplicity and gratitude, the reason I enjoy and love what I do as I'm sure you do too.

  3. Another movie you should see " MEMENTO" where that guy from Reno 911 has a part per IMDB, saw the movie and it was excellent!

  4. Hey, Doc!

    I wonder if "Champagne" is a brand name - the Spanish for "bubbling wine from the Champagne region of France" is "champana" (tilde over the 'n').

    Nice to meet you via @MailOurMilitary on Twitter, but...geeze! You're serving our country in the military, you're an Ironman triathlete, humanitarian, eloquent writer (and you probably like puppies, too)...didja have to set the bar QUITE that high for us mortals? ;0)


    All the best,
    Leland Stone