September 2015 Working and Living in El Zapote

This "blogstyle" page will keep you updated on current issues in El Zapote. On September 5th 2015, Christina Hösel (University of Leipzig) traveled to El Zapote for a first time  Global Health project. She will spend five weeks working not only in the local "Unidad de Salud" but also in the Public Health sector.

9.10.15 It´s time to say good bye 🙁

It was my last day in the Unidad de Salud of El Zapote now and of course I had to say goodbye to everyone that I have been working with for 5 weeks. Looking back I have to say that we grew up as a team and I think you can notice that in the various photos as well. It was just a marvellous and unique experience that I don`t want to miss. I am very thankful of the way people were treating me here. Enjoy the last views of my last days in El Zapote before I publish some never seen snapshots 🙂

DSC_1412The nurse in charge, always with a smile

DSC_1414The pharmacist/man for everything in charge

DSC_1415Me in the archive and the little "pharmacy"

DSC_1416Thats how the pharmacist sees the pacients that want their medicine 🙂

DSC_1431The secretary on Friday at 3:30 p.m. Time to close for the weekend.

DSC_1435This is almost everyone of the team in El Zapote. The only person missing is the other health promoter.

I can only speak out the biggest gratitude that I`ve never had to the Unidad the Salud and everyone that has been involved in this project. I am leaving with one crying and another laughing eye like we say in Germany. It hasn`t been like I expected, it`s been much more than that and part of that were the people. I couldn`t have been in a nicer place than this one. THANK YOU USCF EL ZAPOTE!


8.10.15 Visiting the neighborhood

 This week my acitivities couldn´t be more exiting. Since I live with the director and doctor of the Unidad de Salud I got invited by one of her colleagues that is absolving her social year in the next town that you always need to pass when you want to take the dusty road to El Zapote – Garita de Palmera. Ist population is about three times as much as El Zapote but the size of the Unidad the Salud is the same like Zapote.





Me and the two promotores. Yes, three times the population and only two of them as well.



There are differences between the different Unidades though, medicaments and other medical equipment that are missing in Zapote are available in Garita; maybe because the government sends certain things because is better accessible due to the paved road or the population is bigger – for example they have a thermometer that works with infraredlight or a cuff to measure blood pressure.

Furthermore we seized the day and went out to the beach to check a patient that was suspicious of the widespread Chicungunya-Virus and we checked more water basins and pila if they have the „abate“ that I wrote about last time to protect against Dengue. The area here is a bit different and very interesting to see.


The vehicle to go on the visit DSC_1306

DSC_1315checking the water bins again

DSC_1326since many people don`t have proper education and don`t know how to read and write they sign with their unique fingerprint. You only need to help yourself it you hit problems!

DSC_1301We wanted to visit a pregant woman of 11 (!) kids, she was gone though. At least we could take a picture of a few of them 😉


7.10.15 The best way to make an impact

... and change something is to go to the schools and talk to the people that are now growing up because they are more accessible to new things and don`t have their manners for all their lives.

Since it is my last week here in El Zapote I wanted to hold another class in the same school where we´ve already been. The students knew us by now and they were more open to what I was saying and I could find more curiousity as well even though I spoke about a topic that isn`t very widespread and wellknown around here. I thought to not only start talking about healthy nutrition that probably bores young people to death-I introduced and combined the topic with two psychosomatic diseases – Anorexia and Bulimia by explaining and showing a video that put picture on the dangerous consequences of these two diseases so that they will have another medium presented. It all turned out to be another success again and I sayed good bye to a place where I think there is a lot of potential in some students.




5.10.15 Celebrating childrens day!

The health center of the Unidad the Salud not only consists of a consultory for the patients; it furthermore counts a nutrition center for kids from the ages 3 to 5 that can come here for 4 hours from Monday to Friday. Here they will receive a rich meal because they all have one problem in commom-they are low of weight. The government helps a little bit here by sending 2,5 kg of each corn starch and beans every 3 (!) months. You could imagine that you won`t get far with this little amount of food-there is always a big effort by the employed people necessary. They spent their own money that those kids will eat and feel better as they play with them as well. The results are very good as they reasonably gain weight after having been attending at the center for a while.


Since their was children`s day last week we decided to make a little party for the kids to see some happy faces. We bought little presents, the very typical piñata and of course some treats to eat – sandwiches and a cake.









02.10.15 The importance of the Dengue-campain

 Let me show you how El Salvador fights against Dengue. There has been an endemia several months ago and the health ministry tried to find easy and cheap ways to combat the spread of the mosquitos. Talking about Dengue they like to put their eggs and see their grubs grow in clear and normally clean water. Since the people in El Zapote have their kitchen and bathrooms outside it is very important to check their and other containers that contain water. You coudn`t even believe how many grubs were circulating in some of those waters. Therefore the work of a health promotor in rural towns like El Zapote is very very important. Every 2 months they check every water containers of every household if there is proof of contamination with grubs. You can literally see them swimming in those still waters. If you found something it is very important to pour all that contaminated water and clean the bowel. And don´t forget the car tyres and drinking water for the animals.







There is a very easy method to prevent the contamination of those worms that will develop into the mosquitoes that transmit Dengue. You just need a little bag named „abate“ – it will stop and kill the development of the worms. They are little plastic bags with special substances.



You can use the abate as well to eliminate worms. Just open the back and spread it all over the bowel. It doesn`t take a long time and doesn`t cost a lot of effort neither.

Or put one or two fish in your „pila“ and they will eat the worms. Easy methods to prevent a disease that can get very severe. Surprisingly people don`t use them adequately though – they say that they were just out of them or the kids were playing with them. Here you see again how much work has a health promoter to do and how important it is that he or she gets support from outside. The "abates" are for free – Dengue costs a lot...

DSC_1031                      And we made it! Even though it definitely is very hot. Its worth it though.

30.09.15 Informing the pregnant and old


 It was time for the next class on wednesday.I held a class about nutrition for both pregnant women and elderly people. Unfortunately only 3 of 9 invited pregnant women appeared, 2 were on time and one came 2 hours (!) late. Of the many elderly people that exist in the unidad there were only two showing up – many having excuses of that the way is too long or they just have other things to do.

What I and the complete unidad see as opinion is that the consciousness of the people how important it is to care for yourself is very very low. People may listen but don`t complete what you tell them. It costs a lot of effort to really make a difference and put an influence. I tried my best and hope that some of the people came will get stuck with my advices. After my talk was finished doctor as well did her best but people live their own lives – you can just put as much effort as you can – people need be wanting to change. Especially speaking of non communicable diseases like high blood pressure or diabetes.


28.9.15 The Unidad de Salud meets its Donation


This is me and Glenda, the doctor and director that is doing her mandatory social service to finish her studies, and Miss Ventura, the nurse that is always in a good mood and is like the soul of the Unidad.


I did`t say too much and wanted to share this wonderful experience of handing out urgent goods for someone that is really reliable on them. Everyone was really happy and we already tried out some of the things that were in the packages, for example this otoscope that usually was brought and financed by the doctor in charge.


26.9.15 Mission completed - the sending of medicine and other important goods is in our hands!!! 

After almost 3 weeks we finally could pick up the parcels of the shipment of medical equipment sent by medeor. It`s been three weeks of organizing things, talking to many public institutions to try to get rid of the horrendous costs for customs, income taxes and storing fees at the airport. Thanks to the health ministry of El Salvador we could be exempted from approximately 400 dollars for customs. It was literally a long way, but it was worth it - all these things that were sent will bring so many benefits to the Unidad the Salud and I saw already things of the packages that will have a great use and will ease everydays work for everyone as well.


Yesterday I could finally shake hands with an employee of the ministry of health where I got handed out the documents and the parcels.

Today we checked the content. Fortunately everything is sealed and undamaged and                   didn`t have to undergo various controls on its way to here in Miami or San Salvador. I`m very      looking forward to see the happy faces of the Unidad the Salud when the parcels will be              handed in on Monday.



23.9.15 So many new experiences in one day...

 Since I haven’t been out with the other health promoter it was time to do so this week. He doesn’t go on his motorcycle though. He`s got a bike because he serves the regions that are a bit more close by.


1) Visiting the newborns and pregnant women in their natural surroundings

For me it is very interesting to see how people live because it’s totally different when you can see them in their natural „habitat“. Yesterday I saw the people in the unidad and today we visited them in their homes to see how things are going. The structure of the unidad is a very good one and people work hand in hand – I think that’s what the patients see as well.




This is a very interesting story. Here you see a woman with a newborn. It`s not her child though; it`s the child of her daughter that was sent to hospital after our visit last Friday because of an infection of her episiotomia. Because the mother has a 1 ½ year old child as well and is still breastfeeding (!) she gives her breast milk to her grandchild as well. Another example of what family means here.


Since you don`t have a scale out in the field you need to improvize. Weighing the newborns is very important and you will need to find a way how to still do it. Of course, since many things in Central America are missing and you can`t carry a heavy scale on you bike, the promotor found a way how to solve this problem as well.

2) Informing the old and interested...

 In addition to that we held another chat with some of the older people that are regularly visited by the other health promoter. We talked about what is good nutrition and how important it is to maintain your wellbeing and to visit the consultation of the doctors to prevent non communicable diseases like diabetes, hypertension or elevated triglycerids in the blood. People’s mentality here is difficult sometimes. They tell you that they will do what you tell them but at the end you see that they don’t cooperate. But thats generally a problem in the world from my point of you. They were really interested though even though only half of the invited people came. But like it always is – the ones that come are exactly the right ones. In my mind it seemed that they were more interested in everything as there was a foreign person speaking and putting a lot of effort. So here you can see again how important and worth it is that a person from another country comes and visits people to try to change and improve something. Enjoy the fotos and videos of our class in the waiting area of the Unidad de Salud.



21.09.15 - Out in the field with the health promotor!

The Unidad de Salud (and other Unidades as well) offer a special program to inform and educate the people who live in the community of El Zapote and its surroundings. They have a "promotor de la salud", in the case of El Zapote there are two health promotors that take care of the needs of the people that either can`t or don`t want to come to the health center. Maybe because they don`t have enough transportation mediums or just don't worry about their health. To maintain the people`s wellbeing anyway the promotores work hard day by day and are always in close contact to the doctor that is in charge of the Unidad. Usually they go by their own bike or motorcycle - the government doesn`t support them in gas etc - like many things here. People sacrifice themselves a lot for the wellbeing of the people - one of the very beautiful traits of character of the Salvadoranian people.

Last week I spent two days with one of the two promoters traveling through the community of El Zapote and got to know what it means to be working on the dusty roads with people that live in very basic houses where children only have one piece of underwear for example. It is a tough job and you need to be very patient and sincere with the people and you always need to have your eyes open where people might be in danger - speaking of saving the water ponds from the grubs of the flies that cause Dengue or people that leave the residues of their sold pigs in the backyard and the neighbor complains about the smell. It´s not only about health, it`s about getting in contact with the people and their problems. In my mind the job is very rewarding, but very tough at the same time. Vaccinating children is a tough job – on the one hand because working in sterile conditions is impossible and on the other hand they are crying and just don`t want to take the important two drops of the polio vaccination.


Worms like Giardia lamblia are a big problem here as the water is not good to drink and contaminated. People don`t have enough money to buy purified water though as the average income of a family in El Zapote is about 30 Dollars a month! It is easy to prevent the incidence of worms though - in risk areas you only need a tablet of Mebendazol or Albendazol once in 3 months - and that`s what we did. And where will you find a lot of people? Right, in schools! Fortunately the government pays for those tablets so we were able to give them to every student of the nearby school. It took us one whole day but we accomplished everything and we already got feedback from the parents. 🙂

Visiting pregnant people is a very important part of the job as well. Last Friday we all together went with the pharmacist, the nurse and the promoter as all have different jobs to accomplish in their homes. And if you´re tired you always will be offered a seat. 🙂

There is one special case of a woman with twins. Very poor, not even money for food. Look how happy the faces are when we brought them the ingredients to make "Atole" - a drink that consists of corn starch and other ingredients to nourish this small family.


17.09.15 - Even the schools know about us by now

It´s the second week that started when we hoped to get the package-problem sorted out. It was quite difficult to get yourself through El Salvadoranian bureaucracy. I have to admit that it is nothing better than the german one. The domains chief officer of the airport sent us to go and talk to the President of El Salvador to hopefully free ourselves from the horrendous costs of the customs that were needed to pay for the packages of pills and other missing equipment in El Zapote. Of course the president wasn`t there as there was Indepence Day yesterday and he wouldn`t have been spoken with little fish like us neither. But the other people in duty were really nice so that we could get a little insight in how everything works there. And which "tourist" gets to see the House of the President in close-up shot. 😛 After a 20 minute talking period and one glass of first class water they told us to go the ministry of health to find out if maybe they would find a reason. So we jumped back into the car (big thanks here to Glenda, my colleague and the director of the Unidad de Salud in El Zapote that especially took off work) and made our way to the people that rule the medical world in El Salvador. And finally we could see a touch of the end of our endless tunnel!! They offered us to pay for the customs and would organize the confirmation that all the things can be imported! The only thing I had to do is to donate all the things that were sent to them... Let`s see what will be happening! They told us that they would have the packages off the airport by next week. Unfortunately we will be needing to pay for income taxes and for storage at the airport as well... Without them we would have needed an additional week to organize everything though and I don`t only want to be here to see the nations institutions from inside.

And as I wasn´t lazy on Independence Day either and prepared a class for a school today. We informed students between 14 and 17 years about sexually transmitted diseases and how to prevent them. I think it went pretty well even though the class was pretty shy 😉 Al least the teacher wasn`t... See the video and fotos of our job!



The first two days in El Zapote passed by now and it's time for the first reflection.

It was quite a  temperature and humidity change but I'm starting to get used to it, real feal-Temperature of 40 degrees every day are quite unusual for a German person 😉 It's very green with a lot of fauna here though what makes this place very beautiful.

Unfortunately the donation of 55kg of medication and other useful things sponsored by medeor did not  arrive until today because of a delay in Miami.

The Unidad de salud is a very friendly place where all the workers are getting along very well, the first impression therefore is a very very good one, even though there are so many things that lack one can see from the start-the rough road that always breaks every car, the air-conditioning that doesn't work or the wrong syringes that were sent. There is a lot of work to do and I am very happy to be able to participate in this project.