Looking back, moving forward...

Over the weekend, my host family visited their home-town, Calzada, for lunch. Near the plaza (as in all Spanish settlements) stands the Catholic church. In the background the famous Morro de Calzada is seen—one can hike up this touristic attraction.

Francis, my host family, their granddaughter, grandmother, and daughter, Janet, with her baby boy.

…and their ruso-americana daughter.

Luana, a granddaughter of my host family, started to talk just as I arrived in the family and mastered my name quickly (likely because she loves grapes, ‘uvas’--Luba).

Wrapping up…or rather packing up:

Wondering how to best conclude my internship postings, I decided to revisit my prior postings, journal entries, and notes from books that I have read to provide an overview of my journey during the past four months. From a few recurring topics, I have chosen to describe how I have gone about experiencing community and defining medical missions/health development (neither of which started or will end within the duration of my internship). Reflecting overall, I conclude by sharing my anticipations for the immediate future. It has been a pleasure to thus contemplate my time in Latin America and I am hopeful that sharing in my expedition has been a constructive experience for you.

The church hosted a picnic to raise money for a radio station. One chef prepared ‘una entrada de sandia,’ a watermelon entre with beet-colored mashed potatoes and avocado.

One church member readies to enjoy her ‘causa rellena,’ a stuffed mashed potato roll.

A layered Jello cake is sold.

In the evening, I settled on my mosquito net-covered bed to prepare an overview of my four months in Latin America.

Experiencing community:

Upon beginning my internship, my concept of community with clinicians and my host families was functionally based. I thought I was going to do volunteer work and would for this reason find a space of acceptance and appreciation amongst the surrounding people. I found this to be somewhat true during the first week or two, when I was introduced as "the gringa dental student from the US, volunteering at the clinic for two months." However, when the daily and weekly tasks of my service were no longer novel and I had been introduced to many, it seemed necessary to go beyond my role and function as a volunteer to belong or be amidst for an extended period of time. Finding that my pale skin and blue eyes would prompt any passerby to reaffirm the racial boundaries that seemingly kept me from connecting with my surroundings, I found it useful to observe, during a church worship song, how identical our basic human needs were, those of relationship (to a self, a higher being, and each other) regardless of ethnicity. On this basis, as well as becoming a recorder teacher, I found it easier to interact and connect with locals such that when weekly brigades from the States came, I felt more at ease alongside the locals. Passing through Argentina in my transition from Honduras to Peru, I reconsidered what it means to be an immigrant and to belong to a culture in a sectored heterogeneous society (mixed salad not melting pot). Trying to frame myself within a specific race, socio-economic status, and set of beliefs seemed unnaturally forceful to me. Rejecting one cultural heritage for another felt too reductive to define my complexly integrated legacy. Despite my inability (or unwillingness) to identify with a social group or culture, in each location that I visited, I was comforted by and grateful for the undemanding and unconditional membership within a host family. Here, the basic stability of home life was provided,  no matter what social interactions went on (or lacked) outside of the house. Even so, I felt the difference between being a host daughter and recalling what it means to be a daughter. Experiencing a variety of worship styles, my idea of fellowship has also diversified. Consistent reminders of cultural and racial differences have persisted and leave me suggesting that serving one's neighbor need not take place abroad and may be more effectively done at home. Nonetheless, my resistance to upholding clear cultural boundaries insists, with the observation that supporting these divides usually involves hints of mutual exclusivity and condescension or even contempt or disdain for the 'outie.' I find disparagement of lower classes especially tragic; how can anyone who has any ounce of human warmth be so cold and ignorant towards people who have so much need or poverty (relational and material)?...Perhaps this is our own poverty...and we don't even know it--in fact we think we are rich and have no want. But we know not that we are poor, blind, and naked, needing to receive an offered remedy if we would only acknowledge our need for it. During the past four months, I have passively and actively interacted with many diverse people. I have enjoyed experiencing a connective resonance while working in a team whose members share similar passions and motivations; I hope to be fortunate to belong to many such groups in my future as a health care professional. My practical definition of community has shifted from function, an outward motion of doing, to existence, a receiving motion of being. I hope the relational connections that I have formed remain in my memory as an important part of my experience and that I continue interacting within a diverse community as I return to the States. I will conclude my overview of experiencing community with a quote from one of my journal entries: "What did I do for four months, after all? Most simply and truly said, I lived and existed in a different place where people live and exist just as anywhere else."

The entrance to the clinic.

The San Lucas Association crew.

Giving several more talks about oral infection and hygiene in schools.

…and my hands after twelve such ‘chalk talks.’

To schools in the city, my tooth model accompanied me.

Defining medical missions/health development:

A few of the foremost of my intentions in seeking an opportunity to intern with dental/medical missions in Latin America were to learn how medicine blends with missions, how (dental) health care needs were addressed in other countries, and how any one specific health organization functions. Underlying these conceptual goals, I simply wanted to lend my hands to improve health; that is, I wanted to do something to resolve the health needs I assumed would exist. Thus, my initial definition of medical missions emphasized works, echoing and emulating the evangelical phrase, "what would Jesus do?" Seeing the incompleteness of a treatment for individuals with many ailments, I still consoled myself that 'truth' or 'good' was worth doing in any amount or to any extent. Noticing the seemingly futile cycles of medical care (involving treatment of symptoms and recurrent ailment) and the insufficiency of mass material donations in alleviating material poverty, I began to wonder about appropriate relative placing of clinicians to the roles of public/community health workers in addressing problems of poverty and disease. Participating in several brigades, I sought to gauge the effectiveness and differentiate between techniques of health projects emphasizing either treatment or education, one of which often targets symptoms while the other questions root causes of disease. Observing nutritional industrialization in villages (manifesting itself through wrapper-polluted roads/streams and oral/bodily health problems) I hoped that those working for both ecological and physical health improvement would turn their attention to the origin and progression instead of the manifestation of ecological and physical disorders. Working with the community health development director in Peru's San Lucas clinic, I was taken by surprise during my first week in a village; I was expecting to do something for the village's health development, but it seemed that the only things we were doing included talking, eating rice, and waiting for the rain to pause. The sustainable community-initiated development that we were encouraging, to me, was a new form of "doing" missions or health development. The lack of doing things suggested that being a part of a community's development is more effective in the long run. In the two months that I have worked alongside these Peruvian development projects, I feel as if I have only gotten a glimpse of the arduous and lengthy process that lasting development entails, involving educating, motivating, guiding, and repeating these steps indefinitely, until the community is empowered to identify and meet its own needs. The clinic's cleft lip/palate program caused me to question my initial inference about 'good' or 'truth' being justified in itself. The complex preparation before and extensive (speech, psychological, etc) therapy after the surgery diminished the value of a brigade-based plastic restoration on its own. It seems that financial/medical resources and the genuine desire to be helpful must be wisely channeled so that 'good' is not done poorly or incompletely. Partnering with the city school system and the local dental university in the San Lucas clinic-initiated oral health project, I have realized that my oral infection and hygiene workshops/lessons would do little for the children were it not for the commitment of the university to examine each student's mouth and offer treatment as well as the classroom initiatives that include oral hygiene practice as part of the daily rubric. Crossing paths with a Peruvian medical brigade group that visits remote villages, while I continued participating in community development efforts, I questioned the effectiveness of treatment-emphasized health care for regions generally isolated from these services. Yes, it might be effective to treat diarrhea with a parasiticide, but is it not more effective (in the long run, that is) to equip the people to prevent infection through teaching simple methods of boiling water and adequately disposing of waste? So it would seem; however it appears that the medical and political spheres have convinced themselves and the affected populations that self-empowerment is inferior to a box of tablets, making enduring and sound community development more difficult. In these four months, I feel that I have only gotten a taste of what sustainable medical missions and/or health development means. Two themes that have continually emerged include addressing the root causes of disease instead of its manifestations and being a part of long lasting development instead of doing what seems most logical and ideal. These repeated themes seem basic, almost intuitive, but are also complex. I will quote Wendell Berry to try to illustrate this irony: "All things are connected; the context of everything is everything else" (Agriculture from the Roots Up, 2004). Berry calls those seeking to resolve agricultural problems to look at the local water instead of balance sheets. Likewise in health development, little progress is made towards improvement by tallying the number of infections or even handing out chemical "cures." It is necessary to do something basic (not technologically or chemically advanced): go study the affected region--all of its complex interactions of people and place--and fully explore and understand the progression of events that results in what we call disease. Taking the "from the roots up" approach, one is well-equipped to work to achieve lasting health. My hope is to continue learning about and participating in health development efforts that have shown to promise sustainable effectiveness to cure (or rather assure continual prevention) of disease.

Visiting the asylum for the last time with Francis, we entertained the residents with recorder concerts.

Last week, this gentleman told me that he tries to read but doesn’t usually get too far before things start to ‘float apart.’

This señor cares for the baby just as last week.

Several ladies work at the German exercise table with puzzles and muscle stimulators.

Some recorder songs put residents into deep thought or tears, others cause them to clap along.

The asylum nurse, guides residents to her office for the daily blood-pressure check.

This señor sleeps in the same corner just as last week.

Francis solicits a smile from a resident.

Daniel helps his mom peel potatoes for lunch.

Mostly sitting, mostly waiting…

After we played all of the songs that I had notes for and there was still desire to hear more of the recorder, I tried to jot down notes for songs I knew.

Chicks, chickens, and geese roam the yard of the asylum.

Francis teaches Daniel a German song/game about a knight on a horse, falling into the mud.

Daniel is eager to ring the lunch bell.

Integrating and moving forward:

Perhaps because I left wintery Virginia for regions with two seasons characterized by dryness rather than warmth, I haven't fully been able to 'mark the passing times' with changes in season (as I have known them to flow). This has resulted in a perceived paused existence during the past four months. In a way, it has truly been so, as I have stepped out of my usual surroundings and routines into a new context. At any rate, life, as I have come to know it and as it has transformed me in these four months, is coming to a close. The 'resume button' will soon be activated and I will return to my home context. It is no use denying that I am not returning as I had left; neither should I expect to find my home context just as I had left it. I have become accustomed to hand-washing clothes, taking cold showers, eating rice daily, and walking as a mode of transportation. I have experienced different ways of worship, family, and work. I have pondered the varieties of health work, implicating my career goals as a dental health care professional. No doubt, I will move forward in accordance with these influences. It is neither needful nor valuable that I project various aspects of the future, but I hope I will continue seeking that which is prepared for me, and that I keep from operating under a flawed vision of my Father's grace and mercy, awaiting and asking for a rock when He is ready to give me bread...if only I would receive it. In closing of the 'Latin America internship' chapter of my life, I'll offer some literary influences from my journey that haven't been mentioned prior.

Excerts from Sir Gibbie, by George MacDonald...

Whatever is capable of aspiring, must be troubled that it may wake and aspire—then troubled still, that it may hold fast, be itself, and aspire still. (Ch 10)

For he that loves has, as no one else has. It is the divine possession. (Ch 22)

When life begins to speculate upon itself, I suspect it has begun to die.  (Ch 23)

...the time for speaking comes rarely, the time for being never departs. (Ch 48)

...to the true heart every doubt is a door.(Ch 49)

And a quote from Wendell Berry...

Imagination, amply living in a place, brings what we want and what we have ever closer to being the same. (American Imagination and the Civil War, 2007)

It must be rice-harvesting time.

Rioja, Moyobamba’s neighboring city is also part of the river valley.

After roughly 36 hours of travel, starting this afternoon, I will return to my family, home, tea-cup, bike, flute, and the endless list of objects that, coming together, make up the indescribable experience of home. I look forward to graduation weekend at EMU, spending time with family, and revisiting the church in which I grew. Assisting my parents to renovate and move into their new home and participating in my friend's wedding, I will settle Richmond in preparation for dental school, where I hope to continue the journeys of learning and serving alongside that I have begun in Gracias, Honduras and Moyobamba, Peru. Although I hope our paths will cross again in another context, I thank you for thus far accompanying me en route.