Monday June 27th

 Its going DOWN

Monday June 27^th

Today morning is the day that either breaks everything or makes everything come into place or better-said fall into place. I woke up this morning pretty anxious about whether we had received approval or not? And what that would mean if we didn’t= more work for me=more stress for me. After going to Dr. McKay’s office and having a brief meeting she told us she did not have any idea as of yet and had not been contacted. Already I was feeling queasy about the idea of tackling all the work by myself for a while. Wouldn’t it suck if Suzie did not come then I would be really –ish out of luck. To kind of motivate us in a direction we all agreed to get the community mapped since we hadn’t been able to do it in the previous week. As we headed out it was as if the sun was taunting us and it got hotter and hotter and hotter. At one point I caught my mind wondering, “what’s the point? We wont get approved anyway” I had to remind myself that this was also a learning process and that I was getting something out of it even though I did not yet understand what this message was. As we walked around San Martin we were able to get a better sense of the community, gauge safety, receptiveness etc. Most people were curious at what we were doing as we would stop at each house and stare and try to describe them. We would then take a picture and would use this to match it to the houses. In the afternoon we headed back towards campus and then walked to Dr. McKay’s office. By then I was really hoping that she would have something for us to go off of and yes she did have something for us:  We get the Okay, MOH has approved our work. The painstaking work of compiling the survey, pilot testing, etc is worth it all and will soon bear fruit. Since the sun was setting by then we decided to finish the mapping the next day. I am definitely a lot happier now.

Church in Belize

Saturday June 25

I woke up at 7AM this morning almost bursting out of my seams with excitement. Since this Sunday Dr. Corvin is returning to the U.S. the other girls have decided to take her to San Ignacio so that she can do an iguana exhibit and a homeopathic tour of medicinal herbs and plants. They will also do some shopping and visit a local pool that we discovered when we went to San Ignacio weeks ago. I on the other hand will be going to church with the couple I met yesterday. Because we had not shared the exact time that Chris would be coming with her family to pick me up and I didn’t know if church times here were different I decided to be up extra early and wait. After getting dressed, Sunscreen-ing myself and creating my bug barrier with my handy dandy Deet I was ready to go. Within minutes Chris called for directions, which I shared over the phone with her and waited. After about 5-7 minutes they pulled up and I headed to their truck. I introduced myself again and we made small talk about what I was doing here etc. This morning they are going to St.Thomas a small village outside of Belmopan city limits where the church is located. The landscape of Belize definitely reminds me of some parts of Kenya and I do appreciate the clean air and empty spaces. Within 15-20 minutes we were approaching the church a small stone structure with no windows but so many children and a few adults. The adult to child ratio was definitely large and I wondered where all the children had come from.

            Sabbath school was good, but I definitely felt like the outsider because I was stared at a lot. I guess I do look different and I also act very differently from Belizeans here. After the church welcome we began singing a few hymns. I noticed that there was no piano and so we sang a few hymnals that the children knew. It was very interesting, the children all seemed to know each other and the older children would look after the younger. When a break was announced Chris introduced me to a woman holding a newborn. The woman was definitely the reason for the children. She had an orphanage; I think the only one here in Belmopan that she had started in the 1980’s. Chris and Rich then told me that they along with many others were in the process of building a new and bigger orphanage and that they would take me to the orphanage both the current and new one this afternoon. 

I didnt have my camera and i wish i did but the orphanage is definitely bursting at the seams. They need space. When we got to the orphanage most of the kids were in their rooms taking afternoon naps and i was able to wander around and make small talk with the cook. I will return later with a camera in hand.

It Gets Better (Friday June 24th 2011)

It gets better.....

Friday June 24

I woke up a lot more optimistic today. We have some sort of data to look at and I’m glad that we get to participate in the data collection process. It also feels extremely awesome to have something that we have worked on for such a while bears us some fruit. This morning after settling in at UB we began going over the activities of the previous day. We decided to go over each question and comb over each slowly. A few questions had to be changed into simpler terms because they were confusing and questions had to be moved around to help with the overall flow of the survey. We also discussed the optional questions dealing with domestic violence and I shared with the group that I actually did not feel awkward to ask those questions since by the time I had gotten to them I had already gotten into a conversation with the individuals I was interviewing and they were opening up. Roberta also mentioned that sine domestic violence was so prevalent in Belize she was surprised that majority of respondents had not indicated that it was an issue in their household. Maybe we were lucky and got the people who did not have physical abuse occurring in their house and maybe they were lying. I think to gauge a sensitive subject such as domestic violence you have to get into a very comfortable rapport with the person you are interviewing so that they can open up to you. Maybe when we actually do the survey we will have people tell us what goes on behind their closed doors in terms of domestic violence. Only time will tell.

            After combing through the questions we were happy with what we had and then headed for lunch. In the evening we headed to another local expat coffee shop PerkUp, where I had their amazing frappucino as a reward to myself for all the hard work. It was a welcomed chocolate cool relief . While I was waiting for my order to be filled I got into a conversation with a couple next to me and inquired about why they were here in Belize. Long story short they had come here to share G-d’s word. Something inside me tickled and I decided to ask, “What is your religion/denomination?” I think I was also alerted by something about them, maybe an aura? I don’t know but the answer I got back was “Seventh Day Adventist” (SDA). I almost burst out of my seat as I also told her I was an SDA. She then introduced herself and invited me to church tomorrow. After exchanging phone numbers she left and I couldn’t wait. After they left I shared bean creating the Epi-Info database with the new corrected questions. This week has definitely turned out into something very positive.

Pilot Day: Thursday June 23

Performing the Pilot

This morning we left Belmopan at 7:30am. We met at the bus station to head to Belize City. The ride was a little longer than the ride to San Ignacio since we were on a regular bus, so there was a lot of stopping and going. I was actually very excited to go to Belize City since all we have heard are the horrors of staying there. When we drove into Belize City there was more action than in Belmopan, which is the capital. More cars, more noise more people.  We got off the bus and got into a taxi that shuttled us to Cleo White polyclinic. I think it was a great suggestion to have Roberta (Mrs. Timbrell) with us because we probably would have been taken advantage of, overcharged or something worse. The short 7 minute ride drove us around the city  and I could definitely tell that Belize City may still seem to many Belizeans as the capital of Belize. Once at the Cleo White polyclinic we met with Mrs. Wade who welcomed us and introduced us to some of her staff. Once getting our bearings she showed us where we would be administering the survey, which was in the waiting room. A lot of the people just stared at us and I wondered if any of them would volunteer to help us in the process. As we gathered our bearings Mrs. Timbrell began her appeal informing the waiting patients on who we were, what we were doing and asking whether anyone would volunteer. After 2 or so minutes of no one budging and blank stares a lady raised her hand and said she would do it. I approached her introduced myself and she informed me that she also worked within the health field and had to pilot test surveys so she knew how hard it was. At the end of the survey she gave me her opinion about the questions and said she was impressed that we had questions about domestic violence since it was a big problem here in Belize. She also said that asking about cervical cancer screening was also good because it would probably raise awareness in Belize since most women were hesitant to do it.   After her volunteering slowly more patients raised their hands. I think they were more curious into what exactly we were doing. After completing about 2 surveys each we thanked the hospital staff and Mrs. Bell and headed to the bus station across the street for Trial Farm. 

The Trial Farm pilot will be more like what we will be doing because it will entail us actually going up to different houses, knocking on doors, asking for participation and then administering the survey. The drive to Trial Farm is in a completely different direction and we headed further north into Belize. After about an hour and a half on the school bus, which is the public mode of transportation, we pulled into Trial Farm a sleepy town. Once at the hospital we met with the Public Health nurse who introduced us t a Peace Corp volunteer from NY.  She agreed to take us into the community we were piloting in and wished us luck. We then split into groups and began administering the survey. The entire process was pretty amazing because I was faced with some situations where I would be administering the survey and a family member would interject and give their opinion. Since I was a welcomed guest I would listen and nod and interact and then ask the question again to the person I was initially interviewing, At the end of the survey most people were very happy that we were doing the survey in Belize and said that it was much needed especially since they felt like the government was not doing much to address health issues and concerns. On the bus ride back in the evening we were so exhausted that we did not debrief like we had planned. Instead we will debrief tomorrow when we all meet up at UB.  I now hope that the community of San Martin is receptive to us working there gathering this information and I hope to learn something out of this entire experience, which I am sure I will and I definitely cant wait. 

Wednesday June 22nd

^{Wednesday June 22nd}

This morning I woke up excited about being able to actually get things done. I am so relieved that Dr. Corvin is here because I feel like things will finally be pushed forward. This morning I went to UB and met with Dr. Corvin. Elizabeth and I helped Dr. Corvin complete and submit the IRB materials for USF. After maybe an hour of finalizing all the materials, Caitlin and Debby joined us and we continued to finalize everything that had to be submitted. After correcting everything we were finally ready to continue onward into making sure our survey was ready to pilot. We moved into the conference room and met with Mrs. Timbrell. Dr. Corvin informed us that we would be pilot testing the survey tomorrow. We will be meeting at 8am at the Bus stop here in Belmopan and then we will head to Belize City to the Cleopatra White clinic. This setting is not ideal because it is nothing like what we will be actually doing which is going door to door. Also at the clinic the population we get may be very different from what we are going to be encountering n a daily basis.

            To get a better idea or something closer to what we will be doing we also plan on maybe heading to San Ignacio, which is about an hour away, and possibly doing the survey somewhere near the bus station near the market. We may encounter a similar population there and also it will give us the opportunity to actually iron out the survey, see how it flows and actually see what works and what doesn’t work. Even though Dr. McKay has said going there is not a good idea I think since we are pressed on time (Elizabeth, Caitlin and Debby are leaving this next weekend) and also since we have not actually performed the study it will not hurt to pilot the study there at all.

            We also agreed that after the pilot we would have a debriefing session where we would discuss our experiences, revise the protocol, and finalize the survey if necessary. We also discussed our lack of support from UB in terms of students and the only student we have is Ruth. It would have been ideal if we had more students taking part in the study. We definitely need more UB students but we have to “roll with the punches” and push when we can. Hopefully from all this we will be able to develop the long-term objective of a program that is supported by UB and the MOH.            

            We also have to start finalizing on the community health fair on the 2^nd of July. We hope to use the help of the community health worker to help us get an event location and also gain support from the community. Dr. Corvin brought some educational pamphlets in Spanish. We will be able to at least give people information on hypertension, diabetes, BMI, CVD. The organizations that we are still very interested in including are Diabetic association, BFLA, a family and reproductive organization, Red Cross. We can also possibly include the nurses I met last night who are doing a health intervention (fingers crossed). To inform the San Martin community we plan on getting mini fliers made to pass out at the Belmopan bus station.

            After discussing all the technicalities, Dr. Corvin, Mrs. Timbrell and us went over the survey ensuring that there it was culturally appropriate for Belize. This is exciting!!! Three-quarters through the survey the rain started falling and Mrs. Timbrell had to leave to pick up her son, she seems a little more relieved that things are moving along swimmingly. I am still not sure what her role is in this entire process but any help is good help. In the afternoon Elizabeth completed the changes to the survey while we worked on other information and planned for the next day. Dr. Corvin was also able to meet Dr. McKay who has made us final survey copies for the pilot we will be doing tomorrow.

The process of the pilot also seems to take a lot of phone calls and permission. In Belize City we have to get the permission of the PH nurse (Mrs. Wade) so that we could do the survey at Cleo White polyclinic. In Trial farm we have to get the permission of the PH nurse (Mrs. Bell) for Orange Walk and Corozal. Luckily Dr.McKay seems to know all these people and was able to get on the phone and talk to each one of them allowing us to accomplish at least one part of the needs assessment process.

We are making moves!

Monday June 20 and June 21

These two days have been sort of a blur. We have continued to work on the necessary paperwork and are finishing up on our study tool. Debby and I have also started and continued to work on the consent form to be read out loud to study subjects before the administration of the survey. We will have to find a way to shorten the survey but as of right now I am unsure how we will accomplish this. On Tuesday Dr. Corvin came into the country and we are all hoping that having her along will help to push the entire MOH approval process forward. I think we are all starting to get a little frustrated since it seems like no-one knows what is going on and no one knows who to talk to or when we can get a definitive answer. I am starting to worry a little that we may not have any data to collect but the entire process of completing the questions and developing our background information on the relevance of why we are in Belize doing this needs assessment is still very educational. We are also now seeing how the process of MOH approval in a different country may take much longer than anticipated.

On Tuesday evening we went to eat dinner with Dr. Corvin at the Bull Frog and we also discussed the possibility that if we were unable to perform the surveys we could do a focus group with the health care providers in San martin, Mayopan and Salvapan. I have started looking for some survey’s we can use and any other information that we can use to get us along in that direction. I think it would be very interesting to look at their challenges and also it would be pretty amazing to talk to one of the many Cuban doctors who are stationed here in Belize. From this information we could gauge what they perceive are the gaps and also help present our findings to the Belizean government so that they can bridge the gaps that health care providers are faced with on a daily basis.

Placencia- Saturday June 18th -Sunday June 19th 2011

PLaCenCIa

We left for Placencia this morning at 9am. Given that the roads are not horrible in Belize I was thinking that we would bet to Placencia in 2 hours. Boy was I wrong. It took us over 3 hours with a stop somewhere in the middle. The drive was beautiful in that dewy, green rainforesty kind of way.

After making a detour halfway to Dandriga to catch the bus to Placencia. This stop was somewhere in the middle of sugarcane fields and in the distance the sky had turned a darker shade of gray. After waiting 20 minutes a new bus to Placencia pulled up blasting a remix of the Commodores "Nightshift"

 Little did we know that this would become the theme song of the weekend. After a few more grueling hours of hot damp air and sitting in a vibrating uncomfortable chair we approached Placencia. The sun then started shining again as if to welcome us to paradise. All around we could smell the the salt from the Caribbean sea and I just couldn't wait to take my shoes off and recline on a beach chair. After another slow hour or driving through Placencia the bus stopped in from of Lydia's Guesthouse and we debarked.

After meeting Lydia, we walked up the stairs into our rooms in the dorm room to find that we were the only ones in the entire establishment, a relief because we would not have to share the bathrooms with anyone else. Within minutes we all realized that we were famished and decoded to look for place to eat. Our answer was Tipsy Tuna a local establishment on the beach.

If you ever do visit the Tipsy Tuna I highly recommend the "Big A** Burritos" which come with your choice of meat. As the name implies it really is big and you get your money's worth. After eating and taking in the scenery of the bar and the beach surrounding us we decided to relax on the beach and spent the entire evening relaxing, walking around the island and chit-chatting with the locals.

As the evening drew closer we sat at the bar as a new crowd of travelers, expats and Belizean's came out to listen to the live band that played a mix of contemporary music, reggae and punta-rock. After mixing with others we ended up staying at the Tispy Tuna until 2am talking with other Americans and the owners about Belizean culture, politics and a wide range of topics.

SuNDaY

We woke up at 10am and packed our bags to head back to Belmopan. After paying our fees at Lydias we walked back to the Tipsy Tuna and had lunch while hanging on the beach and using the internet to catch up on homework and send emails. The owners were sad to see us go and informed us that we could catch a water taxi to Independence at 4pm instead of leaving from Placencia at 3pm. We opted for the 4pm departure since it would allow us to see another city in Belize that we had never been to. As we walked away from our weekend adventure I could not help but be grateful that I had had the opportunity to see a new place and also experience a more relaxed and laid back part of Belizean culture. After being escorted to the water Taxi depot by a worker of the Tipsy Tuna we sat on the boat and rode away into Independence to catch the express bus back to Belmopan. Once on the bus, which is alot more comfortable than the regular buses and also is equipped with A.C. we all dozed off and by 7:30pm arrived into Belmopan to start our week doing our research.