Sprouts

I am a gardener. My favorite thing to do is put seeds in the ground and return each morning after, and look for sprouts. I know they won’t be coming for 5-14 days, yet I still look, expectant and waiting. It is so satisfying when one of those mornings, I see a long row of baby sprouts breaking through the crust of the soil and reaching for the sun.


I am returning to the same Salvadoran people after seeing them last April. The anticipation leading up to the trip felt like those mornings of waiting for my seedlings to emerge. After a long week and end of our final clinic day today, I have seen those long awaited sprouts.

Our last day was our most remote. Some of the families walked 2-3 hours just to be seen. (This is common in many of the communities). We were shown unbelievable hospitality and kindness by their welcome. They fed us, led tours through their mountain and shared stories of themselves and their lives. I learned to make pupusas; I was horrible at it and gave the matriarch of the community a great laugh. It was hysterical!

I did have moments this past week of feeling very small. Can we do more for these communities? Can we do more for this mother of nine? She boils 50 pounds of corn, rinses it in the river, grinds it, and then makes and sells tortillas for lunch and dinner every day. She smiles and laughs with us, present in every moment. I am so humbled by her. I feel a longing to do more for her and remind myself that we are giving love, care, and enhancing hers and her children’s’ circumstance by bringing a wellness clinic to them. We are planting SEEDS. We have growth curves, medicine, education and vitamins to provide. It may be just one area of their lives, but it is a significant one.


At every clinic, mothers ask how their child’s growth is. Because we are returning to these families, we are able to give such reassurances. We also heard reports of improvements in their childrens’ health since and because of the care we gave 6 months ago. What beautiful SPROUTS!

I am in awe of seeds. They are so small and give nothing until you put them in rich soil. They will not thrive and grow unless you return to them, care for them, and water them. So we will continue to come, we will continue to water and fertilize the seeds we’ve planted. I cannot wait to return again and see how much bigger our sprouts have gotten.

Tracie Abrams, Pediatric Nurse, Lactation Consultant

Processing

I always come away from these weeks just overloaded with thoughts and emotions.  There are thoughts of what we can do better as a team, and there are always concerns over what more could have been done to help.  That’s the way it should be…  Service work is like that…  No matter how effective a team is, there will always be more work to be done. 

However, as I reflect on the week on the morning after our final clinic for this trip, my heart is so full. 

I am filled with hope because this week we saw first-hand that this model truly works.  We saw that when we committed to a group of people, when we followed through with our plan to return to the exact same communities, we created buy in, found trust, and strengthened relationships.

I am filled with gratitude for the gift of seeing some of our friends in these communities.  So many familiar faces, from community leaders to health promoters, were there to greet us with open arms and wide smiles.  So many familiar patients were there to greet us with a high five and a fist bump.  So many mothers were there, ready to talk and to listen, and to show their appreciation for our team. 

I feel guilt as well…  more than a little bit.  This community will never know how much more they are giving me than I am giving them.  I learn so much from their dedication to their families. They are the gold standard at showing me what it is like to live in community.  They live in the moment and with contentment… I am humbled by so much that I experience here.  

And I am filled with love for another new family that has come together on this trip.  I am always amazed at how strong a bond forms between a group of people after just one week.  We arrive with little real knowledge about each other.  We spend a week serving together, sharing meals, sharing time, sharing stories, and we leave as family.

I know from past experience that as the next days and weeks pass, that these emotions are just scratching the surface.  There will be so many more feelings.  But I welcome them all.  It will not be long at all until I start to feel the pull to come back.  And true to Extra Mile’s mission, I will.

Jeff Mapp MD, MBA

Co-Founder - Extra Mile Pediatrics

A Place to Gather

Today began a little later as we headed to La Red to set up a clinic just after the service at a local church. Church service is held under an outdoor structure with several trees, greenery, and a playground for the kids to play. We began to setup clinic stations while they set up chairs, guitars, and a drum set for the service. You could already feel the energy in the area as people began to arrive, and children ran around playing and eating snacks handed out in baggies by a vendor right in the church area. The service began with the pastor, Chamba, inviting the congregation to stand, and an energetic Christian band began to play. I looked over and could not miss a young mother sitting, eyes closed, singing along to the hymn, while holding her sleeping baby. Around the church area, church goers were clapping to the beat, singing along, and feeling the music and the spirit of the gathering.


The service was made even more special by Chamba, who is clearly a respected member of the community and a humble leader of this church. Preaching barefoot and in board shorts, Chamba reminded his congregation (seamlessly, simultaneously in Spanish and English) that, while our gut reaction in life is often to feed our ego by doing what suits us, as Christians, our responsibility is to serve God by serving and loving each other. The message was simple but beautiful; down to earth, but inspiring.


As clinic started, I was blessed to have an additional helper at the pharmacy. Little Betzi made herself comfortable by my side early in the day, then moved to my lap as I counted out vitamins and various medications. As I instructed families on the providers orders, she would sit and play with the bottles and continuously interrupt Abril, our interpreter, and me. Luckily, she was happy to take on the role of official Extra Mile Pediatrics hand sanitizer, and began making rounds to offer sanitizer to the volunteers and interpreters.


Even though many families had to wait for over 4 hours, the community at La Red was so kind and patient, and seemed to embrace the time together in what seemed to truly be a church home to them. We arrived grateful to be welcomed as visitors in their home and leaving feeling a little more like members of their extended church family.

Mary Otero, Pediatric Nurse

Patient Focused

On Day 3, we had our busiest day so far. We were able to see 93 kids at Hacienda San Diego, our highest number in a day by a long shot, and unbelievably efficient for 4 providers and 4 nurses. The pace of the day was quick, due to the large numbers of kids but also because many of the families were big.


In my position at registration, where Katherine and I follow a fairly efficient system to check in, we sometimes have lulls between families. During these few quiet moments, I was able to observe our nurses and providers with these large families, and I couldn't help but notice each of these professionals giving their full attention to the patient and parent in front of them, listening to their concerns, hearing their stories, and providing gentle care and expertise. I was particularly struck by the way our providers adapted the process to provide care in the best possible way for each family. We had a sweet mom come in with 9 children in her care. After registration, the family went to our nurse's table where the nurses checked vitals and talked a bit with the mom and each child. As the nurses were still working their way through each child's vitals, Katie, one of our providers, brought her station to the nurse's table to start seeing the kids there and allowing the mom to be present for her children seeing the nurse AND seeing the provider. While I noticed this instance specifically, it has been the rule rather than the exception. that this group is always acting and changing in the best interest of the families they see.


I'm not sure Extra Mile could have put together a better team of providers and nurses, and I am grateful to play a small role in this mission.


Elizabeth Farner, Non-medical volunteer

Lucas

I first spotted Lucas and his mom at the local government clinic where we led an education session on breastfeeding and infant care for new and expecting moms. I noticed mom was loving on her boy, who she carried in a baby carrier, giving him kisses and calmly caring for him. We learned that Lucas is 3 years old, 21 pounds, and has microcephaly, along with other conditions including epilepsy.


Today, just after lunch at Hacienda San Diego, I was pleased to see Lucas and his mom walk through the door. As I called them to the nurse's table, mom said, "I remember you!" I said (with the help of my translator), "I remember you, too! I'm so glad you came!" As I checked Lucas's vitals and asked mom what brought her in, she shared that she wasn't sure; she just wanted him checked. I believe she wanted reassurance that she was doing a good job. To say she was doing a good job would have been a vast understatement - she is doing an amazing job! Lucas is this young mom's first child, and even a seasoned mother in the best of situations would be overwhelmed and may have trouble locating specialists and services. In this community, where access to clean water is challenging, Lucas's mom has managed to connect Lucas with physical therapy weekly and regularly has appointments with the children's hospital. We were able to reassure her that her efforts - feeding her 3 year old formula and mashed foods - were positive and helpful, and the providers supported her with her concerns about Lucas' weight loss and sleep schedule. Lucas and Lucas' mom (why didn't I ask your name, ugh!), you have touched my heart.


Susan Dudley, Pediatric Nurse


Twins

Today was our 2nd clinic day at Rio Grande. We had a handful of families waiting for us when we arrived. I continued with my registration responsibilities. Elizabeth and I have a good routine- she completes the basic information on the intake form and I take the kids over for height and weight checks. We had more babies this morning- including a 3 week old newborn. Our favorite 4 year old duo from yesterday, Jeffery and Josue, came back and hung around with everyone. Some local boys also came to pump water from the river to the water basin above the outhouse. Some precarious ladder maneuvers, but they made it look easy!


After the morning, we packed up and headed to the local health clinic to visit the expecting mom’s group. Before the session, we received a tour. The clinic provides an array of medical and dental services. They are triaged red (emergency), yellow (urgent), and green (no rush) and seen accordingly. The clinic was very busy and a green assignment typically means a long wait...


We had around 20 new or expecting moms in our session. Tracie, our lactation consultant, provided breastfeeding support and guidance. The clinic includes an antepartum unit. Many moms stay there leading up to their due date. This helps ensure that they make it to the hospital for delivery versus a home birth. One of the moms there was pregnant with twins! As a twin mother, myself, I was happy to be able to share some of my knowledge, struggles, and recommendations for navigating infant twins.


Our team is great and our interpreters are amazing! I am proud to have served over 80 kids in the Rio Grande community. On to San Diego tomorrow.


Katherine Jones, non-medical volunteer

Dedication to family

Choosing to attend or participate in a mission trip can come with a variety of mixed emotions and unknowns, especially for someone like myself attending their first mission trip in the role of a medical provider.

All of the mixed emotions disappear the minute that you begin working with such incredible people. My first patient of the day on our second day of clinic was a 10 month old girl believed to have down syndrome. The mother was unsure if the diagnosis was accurate and of what it could mean for the rest of the patient’s life. We discussed the characteristics that confirmed the patient’s diagnosis and then spent time discussing common delays in development, as well as some of the potential health risks. We also discussed the massive potential for lifelong success for this child with her mother’s love and support.

The mother was so dedicated to her daughter that she was prepared to complete stretches, exercises, and attend multiple follow up appointments with local specialists that would involve much planning on her part.

The thing that stands out the most to me about this country is how inspiring these families can be. One parent is willing to walk two hours carrying her toddler in order to be seen at our clinic, while other families sacrifice so much to provide much needed long term care to their child despite the cost. The people of El Salvador invest a big part of themselves in their community and in their family, both immediate and extended.


Dustin Bogan, Physician Assistant

Getting Comfortable Serving

Our first full day began with our translators arriving in time for breakfast with us. The translators are a group of young people from various backgrounds (there is a female lawyer, a veterinarian, students, and graphic designers). They work full or part-time as translators for various mission groups. After our mock set up of clinic last night, the actual set up today went smoothly and quickly. We were set up under a roofed area next to a soccer field. Do to a meeting at the local school the initial flow of patients was slow which allowed all team members to get comfortable in their roles.

As a provider I saw a variety of ages, problems, and concerns. We saw families with 2 to 3 children; some children were brought in by their aunts or grandmothers. If the child had been seen previously by and Extra Mile Pediatrics team, we were able to review the record of their previous visit, and note how they responded to treatment, and their changes on the growth chart.

The flow of patients allowed ample time for providers to review nutrition, symptomatic care for various illnesses, and skin and dental care. The entire team of volunteers and translators worked well together, and families were very appreciative of care received.

-Jill York, Nurse Practitioner

It's so good to be back!

I get to spend a week in this beautiful country surrounded by an amazing team and such incredibly loving people twice each year. This past April, just 6 months ago, I helped set up a clinic in Rio Grande under a huge tree where the community members often meet. I was a stranger to them and was there to provide medical care in a place where many of the children had never seen a nurse or doctor for a check-up. I can’t imagine the fear, anxiety and discomfort they must’ve felt when they showed up that morning. But, if those feeling were there, they hid them well. We were greeted with smiles and hugs. Our team let the families know that we would be returning to check-up on their children in 6 short months. And they trusted us to do just that...


So, here we are, just as promised. We came ready and geared up with another incredible team of 12 (that swells to more than 20 once you add translators, community leaders and so on)! Our bins were fully stocked with supplies, medications and enough vitamins for every child! But more importantly, our team came ready to provide love and great care to every person we see!


Overall, we saw 60 patients throughout our first clinic day. At least a quarter of them were known patients of ours. It was such an amazing feeling to greet a family and immediately be remembered and given a hug...they trusted us and we followed through. The hugs were so genuine, filled with love. My Spanish is very limited, which doesn’t matter at all! We had “conversations” without speaking a full sentence. I am handed a beautiful baby to hold while their mom takes a minute to fan herself. I know that when my children were infants, I never would’ve handed them over to someone I just met. But, I think that speaks volumes about the relationships we have already established in just 6 months. We are trusted friends with families whom we may have only seen 2 times in our lives! I am certain that when our first-time families see these interactions, they are immediately comforted and their anxiety fades.


I know from my previous medical missions, that I will get home and it’s only a matter of time before I feel the tugging to be back and see my friends. That amount of time seems to get shorter with each trip. I crave the unexplained, undeserved love that I have been blessed with, and I get through it knowing that we, as an organization, already have the dates set. Just six short months until I get to return, and when I do, it’ll be like I was never gone!

Kimball Mapp, Pediatric Nurse

Co-Founder, Extra Mile Pediatrics

We’ll be waiting for you…

I took so many amazing memories away from Extra Mile’s last mission trip to El Salvador in April, that it’s hard to pick any one to write about.  But there is a specific interaction that stands out, and seems very relevant now as we are just one week away from returning to the same communities we served in April.

We were wrapping up our final day of clinic for the week in a small community called La Presa.  In many ways this community best demonstrates what it is we are doing.. and why we’re doing it.  It is such a warm and clearly close-knit community.  The people there are so incredibly gracious and hospitable.  It is also a very physically remote location.  It sits well off the beaten path, in somewhat hilly, rocky terrain.  There is a road that can be used to access the small church we convert into our pop-up clinic, but that may be overstating it.  You would need a pretty well-equipped 4 wheel drive utility vehicle and some dry conditions to make the trek.  Our team has chosen to drive to the front of the community and hike in for clinic.

During that walk you can’t help but feel the barriers to care that the people of this community face.  With just the circumstances described above, it’s easy to understand why families would not be able to seek regular health care…  let alone the kind of healthcare that we want to focus on…  growth, nutrition, chronic condition management, etc.

At the end of a really great day spent seeing patients in La Presa, we gathered in the church to thank the community leaders who had worked so hard to make us feel welcome and to make the day a success.  I made a few remarks and ended with “…and we can’t wait to get back to see you in six months.”

To which the pastor responded, with a big grin on his face, “we’ll be waiting for you.”

Jeff Mapp MD, MBA

Co-Founder, Extra Mile Pediatrics