What Does it Take for Kids in Las Delicias to Get a College Education?

Last Friday, we had to give “Charlas” to Grades 1 to 3 students of the Las Delicias Elementary School. “Charlas” are skits we volunteers give out to the community as health education lessons. Last year I gave one to mothers in the clinic, talking about the nature of amoebas and tapeworms, and I had no apprehensions. However, I wasn’t so sure this time on how to navigate a “charla” for 7-9 year olds. My cynicism lied not on the impact a health lesson might have on this age group but mostly on how to make a presentation that wasn’t too preachy, belittlingly simple, or worse, boring.

We arrived at the school kind of anxious but excited. Oddly, the moment we entered the compound, the bell rang for recess, and there was chaos. Kids started swarming out of the classrooms. The school infrastructure maybe old and drab and humble, but there was nothing old and drab and humble about the atmosphere full of kids that were extremely happy for recess time. At some point we started hearing shouts of “Gringos!” A couple kids I recognize shouted out some of our names, other unfamiliar faces expectantly came to us to exchange some “holas!” and high fives .

We were scheduled to give out our charlas after recess, so we went to the kindergarten classrooms to wait for the meantime. Some of the kids we know like Kenya tagged along and invited us to play “mica” (an equivalent of tag). A kindergarten teacher wasn’t happy of the commotion , so she motioned them to stay off the premises, iron railings separating us “Gringos” inside the kindergarten buidling from the elementary kids outside.

Kenya, always fun and silly, still continued the game albeit the physical separation. We loved her initiative (and resourcefulness) so we gladly went along. They would motion their hands in between the iron rails as far as they can to tag one of us, and shout “Mica, mica, mica, mica!” When it was time for us to do the same, they would run away, or even better, tease us, drawing their bodies in and out with a sarcastic look of “catch me if you can.” I adored this moment. Even though there was this separation of us from them, we still managed to find ways to reconnect. We still had a great time, with shared moments of teasing and silliness amidst division. I guess I liked it because this moment also reverberated to what we were experiencing culturally with each other.

The bell rang, we said our temporary goodbyes, and the kids lazily went back to their respective rooms. It’s charla time. We followed suit, walking in single file towards the main buildings. This time the grounds were eerily deserted. I noticed even more how dowdy the school infrastructure was.

Like any other public schools in El Salvador, this school housed primary, middle and high school in the same buildings. They have half-day schedules to accommodate every grade level. Two parallel buildings made of adobe house about 5-6 classrooms each, their blue and white paints peeling, the railings rusting. Separating the two buildings is an outdoor stage and a roofed gathering space. It rained the day before- skimpy showers from Agatha’s upshot- and the earth was wet and grimy. Mud and dirt made all their way to the walls, to the hallway floors, to the posts, the stage, everywhere. We waited near the stage before the teachers can motion us into their classrooms. We absorbed all we could muster from our surroundings and beyond....

“What does it take for a kid in Las Delicias to get a college education?” one of the volunteers asked, an air of cynicism enveloping around us. AK, the clinic FOM and community liaison, answered, “It takes a lot of hard work… and dedication. One has to be really motivated….. and really committed to her or his studies and……” Before he could finish his thoughts, someone summoned us, signaling that it was time to begin. But my mind did not stray away from the question. It made me uneasy. But why? Was I really curious about the answer or about the truth? In a community plagued by challenges, children are the most susceptible, and the truth could be disheartening. Many families in Las Delicias struggle day by day and education may not be a top priority… Disadvantaged children are more likely to join youth gangs and engage in violence. Moreover, many youth migrate to the urban areas and those who do lack the interest to invest in their own communities.

I thought of Kenya. I always pictured her to be successful someday. She is very smart, outgoing, ballsy, funny, and mature for a seven year old girl. The other day we joked about how we wouldn’t be surprised if she’d be a gobernadora or heading the municipio.

The challenges might be unnerving but glee is gleaming. Kids like her go on with their days like all of these do not even matter. Their cheerfulness, joy, and laughter seemingly nullifies the grim realities of their circumstances.

“Let’s go guys,” AK gestured . I took out my charla visual aids from my backpack. The Grade 1 teacher warmly invites us in. I stepped into the room, and the first thing I saw was Kenya, smiling.

Art Program for the Children of Las Delicias

What drew me into the Ambassador Program was the opportunity for volunteers like me to come up with our own initiatives that support FIMRC’s mission. It was this combination of independent, creative, and immersive service-learning experience that compelled me to commit to an unpaid summer internship. As ambassadors, we spearhead specific projects of our own that will contribute a lasting impact to our host sites, projects that incorporate our interests and passions about a particular field in preventive health or community development.

I knew I wanted to do something related to art from the get go. It was one of those things that fell right into place, almost impossible not to consider, like Jack Donaghy interning for Ted Kennedy. I have worked with kids before engaging in some form of mentoring via art, and each experience affirmed my belief on the power art and its endless possibilities.

According to the American Art Therapy Association the creative process involved in artistic self-expression helps develop interpersonal skills, manage behavior, increase self-esteem, personal fulfillment, empowerment, self-awareness, and achieve insight. Creating something tangible can build confidence and nurture feelings of self-worth, which comes from the creative and analytical components of the artistic process (Brinkman, 2004). By helping visually express emotions and fears that cannot be expressed through conventional means, art gives power and control over these feelings.

More importantly, the benefits on children are insurmountable. Children often have more difficulty than adults trying to put feelings into words (Brinkman, 2004). Art encourages children to express emotions, containing them to the artistic expression. For many children, art provides a sense of relief and discovery of themselves (Brinkman, 2004). In an article by Dr. Estela A. Beale, a child and adult psychiatrist and associate professor in the Department of Neuro-Oncology at the University of Texas, she has asserted that the art that children create is “a window into the less-conscious mind”. Pictures and drawings can help in elucidating a child’s perceptions and feelings about what is happening to them and explore possible alternatives to solving problems (Beale, 2004). Furthermore, it can be used with children, adolescents and even adults who are struggling with personal issues or just in search of personal growth. There are many developmental stages that children go through during their lives from scribbling at ages 2-4 to pseudo realism at ages 11-13, where the child is more critical of themselves and when they began to make decisions on their own. It is not unusual for children to go back and forth between stages (Beale, 2004).

Such literature reviews did not only bolster my confidence in art and its promise, it also provided me a framework from which to build upon a project proposal that incorporates art and a community health initiative in a resource-poor setting such as Las Delicias.

While it is now common in richer countries to focus on the development of “systems of care” for children’s health, in the developing world the concept stil represents a long-term goal given the lack of resources . Encouragingly, a better balance in biomedical, complementary and alternative care are now the goals in most developing countries like El Salvador. It has been demonstrated that some of the more low cost, low resource –intensive interventions targeting early childhood development are play, reading, art, music, and tactile simulation. In this regard, my summer project seeks to augment child health care in resource-poor settings through establishing an art program as a complementary and alternative health initiative in Las Delicias, El Salvador .

The Art Program will primarily focus on the “personal fulfillment, empowerment, and play” component of the creative process, mimicking an ambiance of an art class. The program will be open to children under the age bracket of 5 to 16. Invitations will be sent out to the children in the Las Delicias community. Art therapy sessions will be carried out every Monday, Wednesday, and Friday, and these sessions will last from 30 minutes to an hour, depending on the nature of the activity. Activities range from drawing, sketching, water-coloring, painting, mural painting, and craft making.

I'm excited about what's ahead of me in the coming weeks.

The Needs of the Community: El Salvador

Insufficient income has a serious adverse effect on the general health and vitality of the population. During the civil war in the mid-1980s, El Salvador was among the countries of the Western Hemisphere most seriously affected by malnutrition. Today, the principal causes of death remain as gastroenteritis, influenza, pneumonia, and bronchitis, caused or complicated by malnutrition, bad sanitation, and poor housing. Children are particularly vulnerable to health related issues linked to poverty including diarrhea, head lice, malnutrition, and bronchial infections.

In February, 2008, FIMRC founded a clinic in the rural Las Delicias community, located 45 minutes outside of the capital city. With a population of nearly three thousand, Las Delicias sits in a beautiful valley and is divided into six sectors. Community members, as well as patients from twelve outlying communities, receive services at the clinic, including pediatric attention, prenatal and postpartum care. FIMRC works in conjunction with the Ministry of Health, the local development association and other partners on preventative health education. The main focus of the community outreach is to prevent common problems in the area such as malnutrition, gastrointestinal illnesses and respiratory infections. A majority of the health issues are due to a lack of education, scarce resources and poor water quality.




The innovative Micro Health Insurance Program (MHIP) was also launched in FIMRC’s El Salvador clinic in June, 2008. The MHIP is the world’s first non-monetary model of health insurance that incorporates health incentives with micro health insurance. The program is a holistic approach to meet the needs of an underserved population. Through an extensive health education program, participants earn health credits to purchase health-related products that would otherwise be unattainable due to a lack of resources.

Source http://fimrc.org/home.html

About FIMRC

FIMRC is a 501(c)3, non-profit organization dedicated to improving pediatric and maternal health in the developing world through the implementation of innovative and self-sustainable health improvement programs. Through its network of outpatient clinics and partnerships, FIMRC asserts a multidimensional strategy that includes clinical services, extensive community outreach efforts and health education programs.

FIMRC is a self-sustainable organization with project related funding provided from business operations – the Global Health Volunteer Program engages approximately 700 individuals annually who volunteer their time abroad and make a contribution in exchange for the experience FIMRC provides. Over 90% of FIMRC’s revenue is derived from our volunteer program.

FIMRC was founded in 2002, is incorporated in Washington, DC and headquartered in Philadelphia, PA. The FIMRC team includes over 3,000 dedicated staff and volunteers worldwide who provide the leadership and support necessary to achieve our mission of improving access to health care for children in underserved communities.

Our Vision

A world in which all children have an equal opportunity to benefit from modern medicine.

Our Mission:

1. To provide access to medical care for the millions of underprivileged and medically underserved children around the world.
We strive to accomplish our mission through the following efforts:

2. Fundraising for the construction of pediatric clinics in areas currently lacking a reliable source for healthcare. FIMRC’s foremost goal is to establish in underserved areas a facility that can serve as a center for healthcare administration to the children in that community, and as a base for our health education programs that serve to improve basic knowledge about the normal functioning body and about common diseases endemic to the area. Prior to the construction of a clinic, FIMRC mandates that a member of our Project Development Team visit the proposed site and conduct a population survey and health assessment. Follow-up visits subsequent to project initiation are also required to ensure proper use of our resources, and ultimately to monitor the clinic’s success. As continuity of care is a priority, a charting system exists in each clinic and serves to document the care each child receives over time. FIMRC’s methodology of preserving wellness is rooted in a commitment to combining incentive programs for parents and children with access to acute care and preventive measures.

3. Directly influence the health of children by encouraging and supporting individuals and groups who desire to travel to medically underserved areas of the world. FIMRC believes that better health is best achieved by direct care to those who can least access it. FIMRC organizes trips for volunteers to our clinics on an ongoing basis in an effort to supplement the care being delivered by local professionals. Medical volunteers work together to do physicals and deliver acute care as necessary. Non-medical volunteers assist with translating, administration, and a variety of other tasks. By inspiring others to become involved in global health, FIMRC aspires to broaden the level of impact in the communities we serve. To learn more about FIMRC’s Global Health Volunteer Program, please click here.

4. Encourage future health leaders to become involved in our purpose by recognizing their achievements. We encourage students to start a FIMRC chapter and participate in local community service activities as well as visit a FIMRC clinic so that they may experience firsthand the goal of healthier children worldwide – the end result of FIMRC’s vision.

Through determination and the belief that all children deserve health, FIMRC declares itself as a major force in the delivery of healthcare worldwide – one clinic and one child at a time.

Source: www.fimrc.org

Guizo, Detroit

My interest in health issues started early when I was growing up as a child in the island province of Cebu, Philippines. My hometown of Guizo has set the stage for the constant fretfulness we faced about danger, crime, and most especially, disease and illness. Memories of a playmate getting sick from floating paper boats in a drainage channel and my brother getting sick of Dengue instilled in me a sense of pitiful, passive acceptance of our circumstance, that “there is nothing we can do but live with what we have.” When my family moved to the U.S. five years ago, our assumption that immigrating would also be a ticket to good health was proved wrong when similar apprehensions were furthered as we experienced difficulties accessing healthcare. But it was only when I considered a career as a physician and started shadowing a local family practitioner, home-visiting patients around impoverished communities in Detroit, that I became committed to actively playing a role in health disparities issues.

My experiences with Dr. Jaranilla, for one, have allowed me to map out the economic geography of Metro-Detroit, where wealth and poverty exist in such close proximities. Never have economic disparities been so defined. Driving northbound of I-75 can move me from poverty to wealth well under five minutes. Secondly, I have witnessed how these geographical inequities transcend to disparities on many levels, one of which is disparities in health . Although healthcare access is all within the reach of our patients in inner-city Detroit, I have witnessed a number of inequities that still persist. Mrs. Williams, a homebound patient with foot gangrene, has been denied physical therapy service because of a co-pay issue. Mr. Emas, a wheelchair bound veteran, has been unable to diligently keep up with his appointments at the DMC due to his disability and lack of reliable transportation. Mrs. Muraszewski has complained about the predominance of fast food chains in Detroit and the subsequent lack of access to healthy food options and produce. I have learned, firsthand, that race, socioeconomic factors, disability, and the physical environment shape health outcomes tremendously.

More importantly, it enabled me to gain, firsthand, a whole new perspective about managing disease and illness. Almost all of the patients we see in inner-city Detroit have or experience symptoms to chronic diseases- cardiovascular and diabetes. I can’t help but ponder why there is such a focus on medical treatment than upstream prevention and risk assessment in managing this pervasive problem of chronic diseases in the urban poor.

Such personal encounters resonated with my life experiences of disease and illness in Guizo. I have realized that examining health issues through a social lens is as important, or even more important, than scrutinizing them under a microscope. It was through such compounding realizations that I became interested in actively playing a role in health disparities issues both in children and in the urban poor. It was also for this reason that I became interested in public health and epidemiology. I believe that examining the role that society plays in shaping health issues better equips health professionals with a well-rounded understanding as to how disease and illness should be better addressed.

From my shadowing experiences, Stacy, a 46-yearl old woman with multiple sclerosis, stood out to me. She has a good spirit for someone with a chronic illness. One time as Dr. Jaranilla and I was about to leave her home, she uttered jokingly to me, “I look forward to the day when you will be a doctor and you will be taking care of me.” She had no idea that her words moved me immensely. Such retort, to me was very powerful and inspiring. As Dr. Jarnilla and I left her house, I remember opening the door and stepping out of the porch with a strong sense of purpose. “I sure will!” I fervently responded, more determined than I ever was for a future with a great responsibility at hand.