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