New City, New Home, New Work

August 30^th 2010

I had a very interesting first week of work at the Municipio de Guayaquil. I spent the majority of my week shadowing two resident psychologists who do pre and post HIV/AIDS test counseling at Hospital Jacobo y Maria Elena Ratinoff. The hospital is located in the Sureste (the southeast sector of the city).

Each morning I wake up at 6:30am, make breakfast for myself (which usually consists of café with milk, juice and cereal) while watching the morning guayaquileño news. I then pack a lunch to take to work. We leave the house around 7:15am and I am dropped off at the end of the road with my host sister Valeria at the bus stop. I jump on a city bus called Padre Solano, which takes me over a long bridge. I then take the Metrovía, which is Guayaquil’s fast track bus system, which travels north/south and only stops at select stations across the city. I take the Metrovía about five stops to El Barrio Rocafuerte, which is named after Ecuador’s first president. I then walk four blocks towards to the Municipio. After I arrive at the Municipio, I usually spend about five to ten minutes every morning debriefing with my counterpart Dr. Farhat. During these meetings, I usually take the opportunity to ask him questions and to discuss any concerns that I have.

While shadowing the two psychologists at Hospital Jacobo, my goal for the week was to sit in on multiple counseling sessions to see how the psychologists interact with their patients. On a basic level, a conserjería session is a mini charla 1) to differentiate between HIV and AIDS, 2) to highlight the vias of transmission, 3) to remind the patient that everyone is equally at risk for getting HIV and that the virus does not distinguish between race, color, social class or sexual preference, 4) to discuss ways the patient can protect him/herself and their partner against HIV, and 5) to educate that HIV is not a mortal disease and that Ecuador provides free antiretroviral medications for any Ecuadorian living with HIV/AIDS. Overall, the purpose of the HIV/AIDS conserjería is to reinforce what the patient already knows, to provide them with information they are lacking and to counteract any false information or stereotypes about HIV/AIDS. From my experience speaking with Ecuadorians, I have found that there are a lot of people who know what HIV stands for but people are still uneducated about the vias of transmission. In a conserjería the average person can tell you one via of transmission – ie: via sexual intercourse. However, there are still many people who think they will get HIV by kissing or from a mosquito. In the conserjería we reinforce the 3 vias of transmission – 1) blood (via non-sterile needle drug use or blood transfusions) 2) vertical transmission (from mother to child) and 3) sexual intercourse without protection.

Over the course of the week I enjoyed getting to know the staff at Hospital Jacobo and speaking with both resident psychologists about conserjerías. One of the downsides of this week was that there wasn’t an opportunity to sit in on many conserjerías. Over the course of 4 days, there were only two patients that came into the psych clinic with an order form a doctor for a pre-conserjería. There were some days during the week when we would not see any patients in a whole day. I was informed by Dr. Farhat that Hospital Jacobo is not very active in promoting the HIV/AIDS test. From my own observations, the number of patients coming in for conserjerías is down because doctors in the hospital are not ordering the HIV/AIDS rapid test on a regular basis. The first HIV/AIDS test ordered this past week was for a pregnant woman and the second was for a woman who was preparing for surgery. In a meeting with both Dr. Morla and Dr. Farhat, we discussed the importance of increasing promotion of the HIV/AIDS test at Hospital Jacobo and to encourage the doctors at the hospital to order more tests on a regular basis.

During training, we were constantly reminded that during these first three months of service before “Reconnect” (our 1^st Peace Corps conference), we should “take it slow” and focus on integration and less on jumping right into work. Over the course of these three months before Reconnect, we will be using CAT tools (Community Assessment Tools) to 1) assess the resources in our communities, 2) analyze needs and interests of the community, 3) find ways to address those interests and needs and 4) disseminate this information to meet the expressed need. At the end of 5 or 6 months in site, I will have the opportunity to present my findings in a report, which will help me develop a more formal and professional relationship with my counterpart organization.

Part of my frustrations from this past week stem from an American mentality that I want to be as productive as possible and to jump right into work. The key for me is to take my mentality to a lower gear. I have to remind myself to take it slow in these first three months and to focus on integration. If I can see the little things as accomplishments such as meeting with one new doctor each day, or sitting in on one conserjería per day, I will be able get more out of each day.

To say the least, I have learned a lot already in these first few days in site, most importantly how to use public transportation. I still have a long way to go but I now have a general idea about the layout of the city and how to take the bus to and from work.

On Friday of last week I met up with five other Peace Corps volunteers from my omnibus for dinner on the Malecon (waterfront). After a full week of only Spanish, it was very nice to be able to share stories with each other in English! On Sunday, I took the bus from my house in Entre Ríos (in the north) all the way to the southern part of the city to meet up at the apartment of another PCV who has been here for more than a year. We made eggs, bacon, home-made tortillas and cheese empanadas. I then took the bus all the way back to the north of the city to meet up with Michelle, Caitlin and Mike – three PCVs from my HIV/AIDS program. We went to see the movie Salt with Angelina Jolie at Mal del Sol. Overall it was a very relaxing and productive weekend. I am very thankful to have other PCVs from my omnibus here with me in my site. They are my local support system, which is a great resource to have.

Tomorrow our Peace Corps director Parmer Heacox is visiting me and my counterparts at the Municipio de Guayaquil. My program director Rebecca will also be present at the meeting in order to discuss the beginning of the partnership between the Peace Corps and the Municipio. On Thursday and Friday of this week, I will be shadowing at Fundación VIHDA, which is another organization that does pre and post conserjerías in Guayaquil. There are currently two PCVs who work with VIHDA. Hopefully I will have the opportunity to shadow the PCV who is almost done with her two years of service.

Good news! My older sister Tessa is coming to visit me for two weeks in January! I’m very excited to show her around the city and to travel with her to Cuenca and Zamora in the Southeast part of the country. Can’t wait!!