Instead of relaxing on a beach or engaging in well-deserved sleep for my spring break, I participated in the University of Florida’s Second Annual Public Health Spring Break in El Salvador. The trip allows public health and anthropology students to participate in community-based work. We were divided into two teams: the field work team in El Limón, which made medical and housing assessments in Canton El Limón, one of the poorest towns in the municipality of Torola, and the epidemiological team, which assessed the current surveillance systems of the Department of Morazán. Alba Amaya-Burns, MD, MSc, CTM, a clinical associate professor in the Department of Behavior Science and Community Health at UF, created this program in 2007.

Photo courtesy of Dawn Alayon

I participated in the field work team in Canton El Limón. This community is located on an almost secluded mountainside with a steep incline, presenting accessibility problems and making travel to and from the village to the neighboring town of Torola difficult. As for the roads leading to the community, they are unpaved and very uneven, forcing the use of pick-up trucks to drive on the rough terrain. In addition, the community does not have electricity or running water. El Limón has community leaders and health promoters, and we worked closely with them to coordinate health visits in the homes. Our goals were to focus on the environment and perform health assessments, using the Ministry of Health’s health files (carpetas).

For water, each family had several containers and walked to a water source daily to refresh the supply. The same water source was used for both drinking and cleaning clothes, and due to the probable contamination, we supplied Puriaqua, a chlorination agent, to purify their water. Each family was trained on its proper usage, and we hoped that the incidence of diarrhea would decline. As for cooking, almost every family cooked on fire stoves, and the ceilings were noticeably burned from the smoke. Many families did not cook outside due to the rain during the wet season. During the interviews, families often cooked food, and the smoke was pervasive throughout the home. This can cause major health problems, including upper respiratory ailments. Food stores in the home were in danger of being contaminated due to the presence of animals in the home — I remember one home where the pig constantly kept walking through the door. In many other homes, chickens would jump on the tortilla makers or eat kernels on the ground.

The epidemiology group worked with Dr. Erick Gomez, the director of the local health clinic for the Municipality (Unidad de Salud). Located in Perquín, this local health clinic is the only one in the area. Nabih Asal, PhD, FACE, professor of epidemiology in the Department of Epidemiology and Biostatistics at UF, headed the epidemiology group, and they studied the surveillance system. Due to a lack of access to laboratories and staff, the system relies heavily on diagnosing infectious diseases by symptoms alone.

The family stories were extraordinary. While completing the carpetas, we noticed every family member suffered from some level of malnutrition, as the diets consisted mostly of tortillas made from corn. For many of the families, the hens were so malnourished that they were unable to lay eggs. In particular, we visited the home of a family who were considered outcasts. The grandmother knew she was in the early stages of dementia, and the man of the house was a 15-year-old boy. Due to his obligation to financially sustain the family, he had only a third-grade education.

On our last day in El Limón, we gave a poster to community members, who in turn expressed their appreciation for our presence and hoped that we would return the next year. We left encouraging, positive messages for the community to remember such as "Puriagua makes the water better." Our poster was left on the community leader’s home, or the "culture house," so it would be readily accessible to all the community.

I was very humbled by the experience. In order to be well-rounded public health professionals, I believe all public health students should venture outside the United States and observe other health care systems.

I would like to acknowledge the members of the group: Alba Amaya-Burns, MD, MSc, CTM, Allan Burns, PhD, Nabih Asal, PhD, Mai Asal, John Gaines, MD, Mirna Amaya, Ana Amaya, Kathryn Evans, Susan Fesperman, Dyanne Herrera, Amy Non, and Trey Perez. Each of us relied on our expertise to sustain each other during the trip, and we hope to return for Spring Break 2009.

If you are interested in learning more about the program, please feel free to contact me directly at dcalayon@hotmail.com .

By Dawn Alayon, Student Representative to the Communications Committee