Thursday, August 5, 2010

Rotación at Sub-Centro de Salud Luchadores del Norte

What does a mental health professional “do” when she encounters significant poverty, medical need or trauma? The words that we rely on for our talking therapies are quite inadequate, maybe even inappropriate when faced with such suffering. What does a supervisor “offer” to those who are encountering these overwhelming situations and their accompanying emotions?

This week our Lucero second-year students are working in (and outside of) a neighborhood medical clinic. These “neighborhoods” exist in several sections of Guayaquil in response to an invitation of the government to rural and mountain people to move into the city. As president Gonzalez explained, the land is essentially free at first to those who settle there and create some kind of shelter. We saw several neighborhoods of bamboo shacks that are the first generation of such settlements with subsequent iterations becoming cinderblock dwellings of several small rooms on dirt streets without sewage. The neighborhood of Dr. Montero’s Sub-Centro de Salud Luchadores del Norte clinic is such a place. The people are poor with many families separated due to parents seeking work in other countries and children being raised by extended family or even friends.

Our students are now working this week with these families. Since Dr. Montero and his colleagues will serve these families for many years, a psychosocial history will be a very valuable asset to their work.

In addition to seeing families in clinics our students are visiting them in their cinderblock homes with the medical team. On such a visit they met a mother of not one but two young children with crippling illnesses that require her to lift and transport them. She, herself, is physically injured and the family is very poor. They spoke of their ‘needs’ and what would “help”. For this family the needs are basic: food, clothing, shelter, and some assistance with the burden of care of these children. Although there is impressive love, care and commitment, there is real suffering here.

Maslow writes that more cognitive and emotional exchanges can only follow individuals’ basic needs being met. It is not only challenging for the mental health professional to help, when words are our medium of exchange, it is challenging for a supervisor to be helpful to the student who is encountering such need. What “words” can make a difference?

In such circumstances the mental health professional has little to offer from the panoply of psychological interventions. These moments are not about doing, they are about being. The only real offering, it is hard to call it an intervention, is the connection and compassion that one human being can offer to another in distress.

Hopefully, the “turning towards” rather then “turning away”, the being with rather than leaving alone can be comforting to this woman and those of this community whom our students will meet. It is what there is for a mental health professional to offer.
Certainly such an experience of mutual helplessness will impact the professional and personal development of our MSPP students. This experience will take some significant time to metabolize, but the emotions, more than any cognition, will be with them, likely, forever.

Nick Covino

Lo mejor del Ecuador es su gente.

Al regresar a Boston luego de visitar a nuestros estudiantes en Guayaquil, guardo recuerdos muy placenteros de las experiencias adquiridas. Soy testigo de la dedicación y paciencia de nuestros estudiantes en conocer y aprender de las realidades que se viven en una cultura distinta. Por ello, les doy mi sinceros votos de aliento para que sigan adelante!

Durante mi estadía en la hermosa ciudad de Guayaquil tuve la oportunidad de asistir a una recepción organizada por la Fundación Dra. Cynthia Lucero. En este evento Marta Lucero nos entregó un Kit Anti-Depresión que me trajo valiosos recuerdos de Cynthia Lucero y su bondad para con el prójimo. Este Kit Anti-Depresión provisto de un borrador, una moneda de un centavo, un elástico, una cuerda, un chocolatito Kiss y otro simbolizando un abrazo, dice lo siguiente:

• Un borrador, para hacer desaparecer todos esos pequeños errores.
• Un centavo para que nunca estés completamente quebrado.
• Un elástico para ayudarte a estirar más allá de tus límites.
• Una cuerda para que mantengas todo junto cuando pareciera que se te escapa.
• Y un abrazo y un beso para que recuerdes que alguien se preocupa por tí.

Pues en adelante esto lo tendré en mente, y tú que lees esto, cuando tal vez estés por un momento dificil y necesitas un apoyo esto te dará ánimo.

Mario Murga
Director of Admissions

Sunday, July 25, 2010

Our Time with the Lucero Family

Spending time with Martha and Hector Lucero was one of the high points of the trip. They are loving, generous people who were highly attentive to me. They travel as a pair, much like my own parents did. They oriented me to the city, took me to Cynthia’s Foundation that works to establish a much needed program of organ donation in the country, arranged several meals for Mario and me, including a lunch in their home. With me only speaking in English, Martha was patient and attentive as her husband translated for us. When Mario Murga came down to join us, he provided a complement to our group by his ability to speak with Martha in Spanish.

It is impossible to understand the incalculable loss that the death of a child brings to the parents. The Luceros have done remarkable work with the Foundation Dra. Cynthia Lucero whose purpose is to educate the public about the importance of Organ Donations. Hector is a true advocate; when he was introduced at a meeting of local psychologists and teachers, following a lecture that I gave, he thanked the school for its work in Cynthia’s name then asked the group to consider, “only for a minute” the importance of giving life, as his daughter did, to those who need organs, after we are finished with them. Their grief is palpable and it is concretized in the materials and the heroic pictures of Cynthia running races and growing through life that are in the several rooms that are the Foundation. I learned about her visits to the aged and of the collections of soap and shampoo that she brought with her to them. I learned of her strident feminism from a proud father and of her investment in community.

About forty people gathered on Thursday evening for some wine and shrimp at the Foundation. I met some of Cynthia’s teachers and the friends and family who make up some of the Foundation Membership. They showed a brief film about Cynthia to further introduce her to our group. Our students looked beautiful and graciously interacted with the friends and family. They offered introductions of themselves in English and Spanish. It is important for me that they come to know Cynthia and her parents. The work that we are doing in this program is a real effort to extend the tragically cut-short life and work of an inspirational young woman. They clearly got that message and I was proud of the way that they engaged the membership individually and in small groups. I was very proud of them.

Nick Covino

The Doctor

We have had a number of discussions about the role of "students' working
along with professionals in a country where we have limited language and
knowledge of customs. How much of this experience is "taking" so that
our work with Latino patients in the future will be competent and how
much is "contributing" in any way. It is a challenging subject and one
that I won't presume to have a final word; it is for our program to
continually process.

However, in meeting an Ecuadorian doctor who runs a public health clinic
where our students will be for a week, it is clear that we can be
helpful. He sees hundreds of families and he sees them over and over,
like the family doctor. On any given moment he is pediatrician,
gynecologist, pulmonologist, neurologist, and cardiologist for this
community of very poor people. This is a cinderblock neighborhood that
is an iteration ahead of the bamboo shacks that stood in the same place
a few years ago. It has no sewage and there is trash in the unpaved and
unleveled streets. It is a place that is quite similar to those in
which I worked in Jamaica, but it is overwhelming if you haven't been
exposed to it. This doctor needs us to do some histories. Since he,
like his American primary care counterparts, has only a short time to
visit with patients, it will be very helpful to hear from our students
about the living situations, family challenges and emotional issues that
his patients are experiencing.

He spent a good deal of time on the orientation visit giving us an
introduction to his work and his community's needs. The fact that he
travelled to a welcoming reception and to a lecture that I gave at the
Blue Hill College spoke to me of the value that he anticipates that we
will provide to his work in only the few days of our visit. At the risk
of seeming overly impressed with heroic figures, this is another unusual
figure; he is a man from the mountains, he can work anywhere as a public
health doctor, his office and his examining rooms are a far cry from
those of the Harvard teaching hospitals.

One is forced to ask: "Why does he work here?" One is forced to
challenge Miss Freud's concept of Altruism as merely a defense against
libidinal instincts or her father's ideas about sublimation, reaction
formation, etc. He stands as a counterpoint to personal profit. What
is there to learn from his commitment to this community? Even with only
being able to contribute some good psychosocial histories there seems to
be value to the students' presence with this man and his team.
Incidentally, we did have a good discussion about the potential that the
young people whom he observes compulsively texting: so much that they do
not eat, sleep much and become deconditioned due to inactivity might be
depressed. These are adolescents whose parents have immigrated to find
work and they are now living with neighbors, not necessarily family
members. I promised to send him some information when I can speak with
some addictions people to get their impressions.

Nick Covino

Hello from President Covino

Seven days in Guayaquil. I arrived a day prior to our students to meet President Gonzalez and the Luceros and to get acquainted with the area a bit before the students came.

This is a highly organized and complex rotation. President Gonzalez is an unusual man; a real humanitarian. He looks after the students with the enthusiasm of an uncle and a master teacher. He speaks passionately about his country and the work that our students will be doing here. He and the host families waited with me until 12:30 am to greet our students when they arrived. He knew everyone by name when they arrived and made sure that they were settled and that each one had a packet of information. The introductory week was manageable and well thought out. A tour of the city, an orientation to the area services, government structure, neighborhoods and customs. Although he has done this work as an educator for many years, he engaged our group with enthusiasm, kindness and energy and he spoke of the customs and needs of the people with compassion.

On the second day we met the staff and people of the three placements that the students will be working in: a primary school, a public health clinic in a neighborhood that is being settled by squatters who were brought in from the mountains by the government to become “voters”, and a Foundation that educates street children. The latter is a school that takes all comers regardless of age and groups them into classes according to educational needs and abilities. Many of these children are without families or have been working from a very young age (grades 2 or 3) so that they have had a very spotty education. The students began their work at this Foundation on the very next day.

Johnny continued to be present and to mentor the group, giving his time in the morning to make sure that things went well and, again on the next day. Jazmyn is one of the local psychologists (a BA level professional with an additional year of professional training). She interviewed a young child with one of our students in the room and the rest of us behind a mirror. Apart from the heat and the age and condition of the play materials, these mornings looked much like internship training at the Beth Israel Hospital when I was there. If I can get back to this blog, I will write about the young boys that were seen that day by our students and Jasmyn; it was very impressive.

I am most impressed by our students. The early days are overwhelming for all of us. If you haven’t lived in another country, it is scary to be in a neighborhood with limited language skills. People on the plane cautioned each of us to “be careful” living in the city. It isn’t staying at the Hilton compound. However, in a brief meeting on the second day, we were all able to talk about the issues of safety and trust that we were experiencing. It was easy to make the leap to understand how patients, especially those whose English mirrors our level of Spanish, feel when they come to a mental health provider for care. By day two or three, however, these students were jumping rope, playing clapping (hand) games and swinging on swings with the Foundation children who were eager to engage, touch, and talk with them. This was impressive “immersion” after only a few days and starting with a good amount of apprehension. They are clearly off to a great start.

The “star” of this rotation, though, is Johnny Gonzalez who is ubiquitous, compassionate and a true educator. In short order it is unmistakable that this man has a “calling” to do this work and that it is not in any way a job. He knows the people at the clinics and they have obvious affection and respect for him. He is concerned that people get the maximum outcome from their educational experience. He left a dinner with his wife to pick up two of our adventurous students who had become stranded at a mall. He has been very attentive to me and to the Lucero family to make sure that the work that we are doing in Cynthia’s name is successful. He speaks Spanish with patience to the students and has been the translator of language and culture for me. Anything that moves this program forward is his mission. I meet a lot of people in my work, this is the “real deal” as a man who is concerned about the human race. We are fortunate to have him as our host and teacher….and did I say that he has a family and another job as president of Blue Hill College? Indefatigable as well.

Nick Covino

Wednesday, August 19, 2009

Casi en casa...

Hola todos!
¡¡¡Lo siento por mucho tiempo antes de una entrada!!! El sabado nosotros vamos a regresar a Boston, y el viaje ha sido fantastico! Durante las cinco semanas, nosotros hemos viajado a Manual Antonia, Monte Verde, Arenal y Guanacaste en Costa Rica. Las playas son muy bonitas y la gente muy amable.
Nostros hemos aprendido mucho de la lengua aqui, pero tambien hemos aprendido mucho de la cultura de Costa Rica. La comida esta muy rica y las familias estan muy unidas. Todos han hecho Costa Rica una casa segunda para nosotros.
Nosotros estamos planeando escribir mas sobre las aventuras de las estudiantes aqui, y esperamos ver todos dentro de poco!

Hello all!
Sorry for the long period of time without blog entries! Saturdal we are going to return to Boston, and the trip has been fantastic. During the 5 weeks, we have traveled to Manual Antonia, Monteverde, Arenal and Guanacaste in Costa Rica. The beaches are very pretty and the people are kind. We have learned alot of the language here, but also we have learned alot about the culture of Costa Rica. The food is very delicious and the families are very attached to each other. Everyone has made Costa Rica a second home for us.
We are planning to write more about our adventures here, and we hope to see you all soon!

---Melissa Jenks
Latino Mental Health Program, MSPP
La Guacima, Costa Rica

Friday, July 31, 2009

Me encanta Guatemala

Hola mi familia y amigos de MSPP,
Our 17 day immersion experience in Guatemala is defiantly worth writing home about :) Thank you to Michelle Contreras, Stephanie Guila, and the clinicians and staff at Boston Clinical Consulting en Guatemala for hosting such a wonderful, memorable, and personally/ clinically enriching experience. In writing this blog I hope to share some highlights from our work, our play, as well as the excitement we all feel about the catalyzing of this important and special professional international exchange program between MSPP and the Boston Clinical Consulting group in Guatemala City.
During our 17 day immersion we had the opportunity to get to know personally and professionally the group of psychologists and staff working at Boston Clinical Consulting (“Boston”) in Guatemala City. We were welcomed with open arms. At the clinic we attended Spanish lessons as well as psycho-educational workshops presented by the clinicians, topics included: A workshop on grieving for bereaved parents/ families and Sexual Disorders (2 part). These types of psycho-educational workshops are offered weekly to other professionals and to the public in an effort to provide information and services; to de-stigmatize mental health services in the area.
At the end of the first week we visited and did one short play therapy intervention with 25-50 children at an orphanage in Chimaltenango. This orphanage is named Nuestros Pequenos Hermanos and houses over 350 orphans. It is quite a sight to behold. It is a huge pretty well self sustained campus with metal, wood, sewing, cooking/ kitchen workshops, a school, living quarters for the children as well as staff/ volunteers, football field, basketball courts, gardens, green houses, animal shed and more, all back dropped against a surreal mountain and volcano scenery. I remember walking across the field my first afternoon side by side a small boy of 9 years old. I had gone to get him from class to go to his “anger management” group that was being run by a visiting Japanese psychologist. As we crossed the field together, he asked, “So do you like my country?” I said yes, I do. It is very beautiful. He then looked at me, smiled and said, “I know!! just look at the mountains over there!”
In addition to the mountains we were also welcomed by the children to snap shots of their lives and some stories of early abandonment and resilience. We used a “paracaida” (for falling)/ parachute in our intervention, and consulted on a case with the only local psychologist for all 350+ children on how to help better support a 13 year old girl who was reported to be having significant behavioral difficulties that included stealing eggs from the chicken pen and going to the green house to make omelets for herself and a couple of other friends all of whom had recently sneaked out of the residence late one night. There is much clinical work that can be done here, however, more appropriate it seems for groups that could consider staying a considerably longer period of time then we had available on this trip.
Over the weekend we traveled to Antigua. A special and scared place. A place to relax, chat with the locals, and dance.
In the second week we continued with our Spanish classes at the clinic, visited a second orphanage, as well as made several day visits that included going to the National Psychiatric Hospital, visiting an acupuncturist/ local healer, Train museum, and the National Political Archives. At the second orphanage, El Hosicio San Jose (an place for children who are HIV positive) we again did a short play therapy intervention using drawings and a parachute. This was very successful intervention and left us all with active thoughts about how and in what form MSPP could continue to be a presence in these very special children’s lives. I look forward to sharing more on my cross cultural clinical reflections in the future at MSPP :)
We ended the trip by visiting one of the largest Mayan ruins in the world located in the Tikal National Park. This was my first time seeing a ruin and I experienced standing in awe of humanity. The jungle is certainly an energizing place. I fell in love with Guatemala.
Gracias a Zackarias, Christina, Juan y Michelle por un bien viaje!
Gracias to the MSPP community y Boston Clinical Consulting for this first opportunity to be part of such a positive and important international professional exchange.
Entonces. Calidad!!!
Simpre la paz,