Now That He's Safe, The Healing Can Begin... Right?

We sit down on the mat, colored pencils and an unopened folder between us. He excitedly picks out his favorite colors as we chatter back and forth about his day. I open the folder to reveal a picture of a little boy wearing underpants and say casually, “ooh, look, this coloring book is about our bodies!”

And so begins the most challenging fifteen minutes of my day. He looks at me, unsure. I take an orange pencil and, unaffected, begin to color the boys toes. “I think I will color his toes and his feet orange. Do you want to color his knees with your red pencil?” He relaxes and nods and starts to sing a song about feet. He makes big, dark lines with his red pencil. 

I begin to color the boys hands and say, “I think I will color his hands orange, too. Orange is a happy color!” My mind is spinning as I try to remember all of the psychologist’s recommendations for him and the information I’ve learned in the past five years about talking to children who have been abused.

As he colors the arms red, I color the boy’s head orange and say, “Juan, there are some places that are okay for our friends to touch us. There are some places that are only for us to touch. Some parts of our body are just for ourselves.” He stops coloring and looks up at me attentively. I point to the boy’s underpants. “What is this part of his body called?” He smiles and uses a slang term for his genitals. 

As the psychologist instructed me, I correct him. “Those are his ‘pene’ and ‘testiculos.‘ Those are only for you to touch. Other children and other grown-ups should not touch you there.” He is still staring intently, listening. I continue. “If a grown-up touches those parts, you can tell them NO. Your body is for you to touch. And you can tell another grown-up. It’s okay to tell grown-ups if someone touches you.”

I color the little boy’s underpants black. 

He continues to color the other pictures in the book... The nose, the ear, the leg, the arm. We talk about anything and everything else. A few minutes later, our photographer Ray comes up to the playroom. Shortly after, Juan goes to the stairs and begins trying to unlock the gate. I tell him he needs to wait for me; to help me clean up if he wants to go downstairs. I simply don’t want him climbing down the concrete steps alone, but he becomes combative. 

He clings to the gate and tries to unlock it, hitting my hand away as I hold it shut. “Juan, please, listen: we will go downstairs in one minute. I cannot let you use the stairs alone.” He begins to cry and hit at me. The social worker, on her way upstairs, opens the gate and picks him up. He clings to her, arms around her neck, legs around her waist, and turns to glare at me. 

I want to tell her ‘No, don’t hold him like that, the psychologist said...‘ Instead I stammer that he was upset with me for not allowing him down the stairs alone. She nods and brings him downstairs. I clean up the colored pencils myself, feeling like a failure. His rejection concerns me; did I push him too far? Did I say too much? Where is the line? And how have I become the person responsible for this confusing re-education?

An hour later, we are in the playroom with two other volunteers and two other children. Juan has established an iron grip on the handlebars of the scooter Alberto is riding. The volunteer behind Alberto is gently asking Juan to let go. He doesn’t loosen his grip.

I kneel down in front of him. “Juan, Alberto is riding the bike right now. We can play on the slide, or with the big ball, or the other toys. After Alberto has a turn, you may ride it. We need to share and take turns with our friends.” He glares at me again and tightens his fists around the plastic handlebars. I calmly and firmly repeat my treatise. No response.

“Juan, I am going to move your hands off of the bike now. You may have a turn when Alberto is done.” I pry his fingers off of the bike, holding back one hand until the other one can be pried free. He lashes out at me for the second time today. I gently push his hand down and say, “We use gentle hands with our friends.” I pick him up under the arms and place him down, standing, a few feet away.

He stares at the ground. He looks so, so very sad.

I sit in front of him and put my arms around his waist as I talk to him.

“Juan, I am not angry with you. It’s okay if you are angry with me. I understand that you want to ride the bike. In a few minutes, it will be your turn.”

He looks over my shoulder, staring at the wall with hollow eyes. His eyes begin to fill with tears as he stands in front of me. 

I rub his back and say quietly, “It’s okay to cry, Juan. You can cry if you need to. I know you are sad It’s okay to be sad. I still Iove you. Would you like a hug?” He nods and climbs onto my lap. I rub his back for a few minutes as silent tears fall down his cheeks. He says nothing. I say nothing. 

Alberto gets off of the scooter. I tell Juan excitedly, “It’s your turn to ride the bike now! If you are ready to play, you can ride it. If you want to sit for a few more minutes, that’s okay too.” 

Wordlessly, he nods, climbs off of my lap, and begins riding the bike. After a few minutes, he his back to his ‘usual’ self- laughing, smiling, chattering away. 

It is significantly longer before I feel like I can breathe again.

_________________________________________________________________

Working with a child who has been recently abandoned and has a past history of sexual abuse is an indescribable challenge. Working with that child in a consistently inconsistent environment, where I can be present only a few hours each day, is an insurmountable challenge. 

Children who suffer the loss of a caregiver, whether it be through abandonment, death, or any other horrible circumstance, are absolutely devastated by that loss. Regardless of how attentive or loving that person was, they were an important pillar of that child’s life and their sudden absence is confusing; upsetting; scary. 

Many children develop attachment disorders. They begin to favor unfamiliar people over familiar ones; are indiscriminately affectionate with strangers; push away and reject their  main caregivers. There are a myriad of ways that these attachment issues express themselves, but the underlying subconscious logic is this: ‘Mommy/Daddy/Person X’ loved me and took care of me and kept me safe. And now they’re gone. Whoever is loving me and taking care of me and keeping me safe now might leave and hurt me, too.”

Watching a young child cope with their abandonment; watching these attachment issues and symptoms begin to express themselves in some quiet and some not-so-quiet ways, and knowing the limitations of what we can do for him, is heartbreaking. Children recovering from abuse or abandonment need ONE caregiver who understands their needs and can help them to learn that the world is safe again; to learn what is “good touch” and “bad touch” and to trust that they won’t be violated or deserted again.

Though I was one of the first faces he saw when he arrived and spent the most time with him, after about a week, he began to reject hugs and attention, turn away and ignore me when I arrived. Each time, I calmly and cheerfully assured him that I was excited to play with him, when he was ready. Each time, he watched me closely from across the room for a few minute before running over for a hug. His actions say clearly- he has formed an attachment to me. The connection he feels to me is scary for him. As sad as this is, it gives me this tiny hope that I can use the connection between us to help him, somehow.

Casa Jackson is an incredible place for the children we serve. But we are not a home. We are not a mother, or a father, or a family. Our volunteers are loving and kind and affectionate, but they leave. Our nurses are diligent and dedicated, but overwhelmed. We cannot provide this child with the informed, patient caregiver he needs to begin truly recovering from the trauma he faces right now. 

In a week and a half, this little boy will be moved to an orphanage. There, he will be lacking that same consistency. In a country where foreign adoptions have been halted due to trafficking and kidnapping of babies to sell to dishonest agencies, few local families are able or willing to take these children in. There aren’t enough foster families for the “easy” kids; the cute babies; the low-needs children. There are virtually none for children who need the type of attention and support that this little boy needs.

It’s hard to maintain hope in the face of so many impossibilities. The mother of a child with special needs once explained to me, “The cruelest thing you can do to a person is to take their hope away, no matter how impossible it is. That hope might be all they have keeping them afloat. Let them have their hope. They will adjust and accept what they’re facing on their own time.”

I am usually a strict proponent of realism. Call things what they are; be honest with yourself and embrace the ugly truth in front of you, no matter how awful. 

For once, I give myself permission to hope.

A Difficult Post for a Difficult Day

In every way, sexual abuse of children is an atrocity. It’s reprehensible, unforgivable, and disgusting. It’s a vile attack on the most innocent, trusting members of any society- the ones trusting us, the “big people,” to keep them safe. 

Unfortunately, it is not uncommon. Often, the abuser is not just a trusted adult in the child’s life, but a member of their own family. The abuser manipulates the child into believing that the abuse is normal, or that it is somehow the child’s fault. The abuser takes an impressionable child, learning so much about the world around them, and robs them of any true chance to know, instinctively, what their boundaries are; what is okay and not okay. They become even more helpless.

It is something we hear of often down here. Each time, it’s like a punch to the stomach. An uncle, a brother, a father... Someone that this child, who we have come to know and love so much, trusted in that innocent, complete way that children trust; someone violated this child. Sometimes, desperate mothers sell their children to strangers for sexual acts. Several children in the program were victimized this way before the age of five years old.

Working with sick children, with disabled children, with abandoned children, with the poorest of the poor’s children... It’s all challenging. As a caregiver, and someone who is in some way temporarily responsible for some aspect of these children’s daily lives, sexual abuse is the one issue that absolutely undoes me.

I think I speak for many people when I say that, in this field, you develop a fortitude that you never thought possible. You hear and see so much that, years before, living in your home country, you would be so affected by. You would cry; you would be angry; you would feel helpless. Working on these sorts of social service projects, you become able to listen to a horrible, tragic story calmly. You don’t lose your wits; you employ them to meet the task at hand, and deal with your emotions later.

Yesterday morning, I requested some support from our psychologist to determine if one of our children at Casa may have been sexually abused prior to his arrival. The extremely sad answer was yes. Not maybe, not probably, but a very resounding yes. He was abused. He was violated. He was betrayed by one of those “big people” who should have been protecting him.

Over the course of the day, I cycled through so many emotions. I am not a crier. I spent much of the day holding back tears. I was filled with a murderous rage aimed at the family member who violated this child. I was overwhelmed trying to understand how best to help this child, and how to ensure the consistent support he needs in a very inconsistent environment. I was sick with the mental images and video that played against my will all day, imagining this sweet young child in this horrible, traumatic experience. 

I was furious with myself. I couldn’t fathom or accept my own limitations. How can it be that this is so common here; that due to poverty and almost no supervision for many children growing up more or less in the streets, this child is far from alone. How can it be that this is happening, and we are here, and we can’t do anything to stop it?

How can it be that I hold this child, and hug him, and make him smile and laugh... but I can’t protect him? How? How does one sleep at night knowing this? 

On a good day, when I am not looking into the eyes of a child that I cannot protect, I can answer those questions calmly and rationally: You cannot save every child. You cannot save even one. You can only help, in whatever way you can, to provide safety, love, food, and some shelter for this child. You can be part of the solution; you can employ the skills that you have, and trust that others will do the same. You must simply accept that you are doing something- and that is better than nothing.

Yesterday was not a good day. Today is not a good day, either. I know that in time, the fortitude I have thus far developed will grow further; my ability to hear horrible news about a child’s past and still be unshaken enough to be effective will improve. I know this. I have no doubts that I can handle this, and I will. I know I’m doing all that I can, and I recognize that there are limitations that neither I nor anyone else can overcome- as a group, or as an individual. 

I have known this for a long time. I have accepted this for a long time.

But when I look in this child’s eyes, when I see him smile and laugh, when I see him and know that right now, he trusts us to keep him safe, I can’t help but feel the weight of my own limitations; my own failure to be everywhere at once, keeping every child safe from every horrible thing that may befall them. 

We all know what it’s like to read or listen to a story about a child being abused and be overcome by our own disgust and anger and sadness for that child. Nothing can prepare you for hearing that story about a child that you love. 

The What, the Why, and the Who

After posting a few pictures from Casa Jackson today and getting "like" after "like" after "like" after "like," I realized how many people are, on some level, interested in the wonderful little faces they're seeing and wondering what's happening in our tiny little corner of this tiny little country. I also realized how infrequently I actually discuss what it is that I'm doing, what Casa Jackson is doing, and the massive "why" behind the effort. 

Obviously, I feel like what we're doing is really important. These babies and children are just as deserving of a chance at a healthy, happy life as any other, but they and their families face massive challenges that are practically incomprehensible to most of us. So... for anyone who has looked at the smiling faces in my pictures and thought, "how cute!", it would mean so much to me if you could read on and learn about who these little faces are and why they come to us.

Casa Jackson is a center for malnourished children. Our small, 20-bed hospital is one town and a short walk over from Antigua, Guatemala. Antigua is sort of this magical Disneyland bubble of Guatemala where people can walk around safely (day or night!), drive down the street with their windows open, and basically live their lives without a very legitimate fear of being robbed, raped, or worse. 

______________________________________

M A L N U T R I T I O N

(a.k.a., the "why")

 Malnutrition is one of the gravest public health issues affecting Guatemala. The statistics speak for themselves:

• 49.8% of all Guatemalan children under the age of 5 are chronically malnourished
• 1/3 of all deaths occurring in childhood are caused by under-nutrition
• 4 out of 10 children in non-indigenous families are malnourished
• 8 out of 10 children in indigenous families are malnourished

By chronic malnutrition, I mean that these kids are not experiencing periods of difficulty getting proper food due to a bad harvest year, or their parents losing jobs. These children are growing up without receiving the calories or nutrients they need to grow properly nearly every day of their lives. 

In addition to the risk of dying from malnutrition, kids who grow up malnourished often have lower IQs and smaller bodies. They are less able to take advantage of the handful of educational or work opportunities that may come their way, if they're fortunate. They are born poor, and because they are physically and cognitively disadvantaged due to malnutrition, they stay poor.

Anyone living in an area with many Guatemalan immigrants can probably identify with the following assumption: Guatemalans are short. Not so! An incredible study followed siblings of Mayan descent that were separated. One sibling was raised in the US, the others stayed behind and grew up in Guatemala. This study showed that on average, Guatemalan children from the same family growing up in the US were 6-8 inches taller then their siblings by the time they reached adulthood. The results were similar when examining siblings who grew up in Mexico and Guatemala. The Mexico-raised siblings were still taller, despite not being in an overly developed, wealthy country.

Guatemala is not the poorest country in Latin America, yet our malnutrition rates here are nearly double that of every other country. Honduras, Nicaragua, and El Salvador are more impoverished (based on gross national income), yet Guatemala has twice as many children whose growth is permanently stunted (interrupted or stopped) due to malnutrition. This begs the very big, very legitimate question- WHY?

Basically, Guatemala is the "perfect storm" of malnutrition. The gap between the rich and poor is very large. The rich live in/near cities with big shiny shopping malls; the poor are spread throughout villages and dangerous towns across the country without decent roads, sanitation, schools, or medical clinics. There is widespread illiteracy and little access to any real education.  

Most importantly is the role the government plays- or doesn't play. Guatemala is extremely corrupt and few social programs exist to support or empower the poor or hungry. It has a horribly dark history involving a 30-year civil war, ending in the 1990's, that saw the military slaughter their own civilians. The government perpetrated a genocide against the indigenous population, who stood to gain the most should the guerillas have won and thus seemed to the government to be the guerilla's "natural allies." Simply put, for the indigenous community (hardest hit by malnutrition), the government is useless at best- criminal at worst.

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W O N D E R F U L   B A B I E S  &   F A M I L I E S

(a.k.a., the "who")

We get a lot of different types of infants and children at Casa Jackson. They come from all over Guatemala and from all different types of homes. Some have parents who love them and are trying desperately to care for them despite the horribly scant information and resources available to them. Some have parents who aren't quite as concerned with their well-being. Some have been abandoned. Some of our patients have medical and developmental issues; some have alcoholic, abusive fathers who complicate their mother's efforts to keep them healthy, safe, and fed. Each of them has a family with unique struggles that are complicating their efforts to care for their child. All of them desperately need help.

A few 'typical' stories...

Axel
(fully recovered- look at those cheeks!-the day he returned home with his mother)

Axel came to Casa Jackson at 2 months old, weighing just under 7 pounds. His mother, 23-year-old Maria, was eating coffee and tortillas three times a day, with beans, rice, or vegetables when she and her husband could afford to purchase them. She became pregnant, eating exactly the same throughout her pregnancy. Axel was born slightly early and underweight. His mother tried to breastfeed him but she was so poorly nourished that her breast milk couldn't satisfy him. She tried feeding him a variety of things (soda, locally-made corn and milk drinks, etc) to satiate him and help him grow. It didn't work.

Axel stayed with us for 2 months. During that time, our nutritionist taught his mother about her own nutrition, and how to properly breastfeed little Axel. She began to breastfeed Axel again, and with the formula feeds he received as well as her breast milk during her twice-weekly visits, he gained quickly. Axel returned home, healthy and ready to thrive in a home with two parents who now have a better understanding of their own nutrition, Axel's needs, food safety and sanitation, and how to budget their scant resources wisely to ensure that all members of the family are as nourished and healthy as possible.

Magaly

Magaly came to us for the first time in early 2010. Magaly has microcephaly (small head size, associated with cognitive and other delays) and was born with a congenital subluxation of her hips (her hipbones weren't in their sockets and she couldn't move her legs). She was a malnourished but cheerful toddler. Several volunteers fell in love with her, and raised enough money to build her family a new home to replace their dirt-floor shack as well as buy all the supplements needed to get her through her first six months after being discharged.

Magaly's father was an alcoholic who became very violent when he drank. He beat Magaly's mother, sold the home that was built piece-by-piece, and sold all the supplements that had been donated, to finance his drinking habit. Magaly returned to Casa Jackson in 2010, sicker and not quite so cheerful. 

Magaly's mother lived with her at Casa Jackson (as many of our abused mothers do) for several months while she tried to find stable employment and a safe place for her and her two other children to live. While at Casa Jackson, Magaly got the surgery she needed to reconnect her hips into their sockets, and fully recovered from her malnutrition. Although Magaly recovered from her malnutrition in a matter of months, it was a little over a year before Magaly's mother was ready and able to bring Magaly home to a safe, loving home free from the abuse and control of her estranged husband.

"Jose"

Jose came to us exactly two weeks ago today. The bomberos (firefighters) arrived one Friday morning with this little bundle in their arms. Jose was exhausted, trembling and crying for his "mama."

His "mama" had left him outside the bombero station in Chimaltenango (an incredibly poor urban area a few hours away) the night before. He had spent part of the night outside before being discovered and brought into a bombero's home to spend the remainder of the night. He had a horrible case of bronchitis and a low fever. 

Jose is one of about 10 children Casa Jackson cares for each year that are abandoned by their very desperate parents. We don't know the exact reasons that Jose was abandoned. Anyone holding and hugging him and seeing him wave his chubby little hands at new volunteers and say "hola," or watching him grin and try to clap along to 'patty-cake,' would have a hard time imagining a reason dire enough to give this sweet little boy up. As easy as it is to judge his mother for abandoning her son, the reality is that whatever circumstances lead her to leave her 18-month-old(ish) son must have been truly terrible.

Because of the stop on foreign adoptions put into place several years ago due to many legitimate cases of babies being taken forcibly from poor women to sell for adoption and other such fraudulent practices, Jose will almost certainly grow up in a foster home or in an orphanage. Adoptive families in Guatemala are few and far between and the foster care system is horribly overloaded. 

Unfortunately, we have no control over Jose's future. We can't choose his placement when he leaves us. In these heartbreaking situations, our role is this: love the heck out of these babies from the moment they arrive until the moment they leave. Jose will bear the emotional scars of his abandonment for the rest of his life; he will likely grow up without knowing what it's like to be part of a family that loves him. It hurts to hear him cry for "mama" every evening. It hurts to see him smile and laugh and know that he will never know the stability and consistency and love that children need to thrive.

So we do the only things we can. We feed him, and we love him.

______________________________________

C A S A    J A C K S O N   P R O G R A M 
(a.k.a., the "what")

In the interest of keeping this short (too late!), I won't delve into all the specifics of what we do at Casa Jackson. It involves a dedicated medical staff who sees to the kids medical and nutritional needs, a constant supply of volunteers who give love and affection and attention to each child, a coordinator who is borderline obsessed with the quality of the kids experience while in Casa Jackson, a social worker with immense patience, strength, and sensitivity, and a lot of people who support us from afar.

We provide free health screenings for any family that brings their child to our center; high-quality inpatient care to the sickest children; follow-up visits and education to their families; donations of food, clothing, and medication to our most impoverished, desperate families; a temporary home for our abused or homeless mothers and "safe haven" for abandoned children; outreach in the community to find the children and families who need help, and will hopefully be branching out into some prenatal/preventative support and education in the coming year. 

______________________________________

I am the luckiest girl in the world. Working at Casa Jackson is heartbreaking sometimes, but I am grateful every day that I have an opportunity to play such a significant role in the daily lives of these amazing children while they're in our care. These children and families, and the thousands other like them across the country, are incredible. I'm honored to get to be a teeny, tiny part of "the solution" to this massive problem that affects so many here. 

It's also amazing to me how many people are supportive of me, despite knowing the details of what I'm doing, and without really knowing me on any real personal level. Family, friends, acquaintances, and complete strangers have expressed their support since I began coming down here in January. I appreciate the support and the kind words, and humbly ask that you remain interested and supportive. Just knowing that so many people in different places are aware of what's happening here, and care about these kids that my world more or less revolves around, means so much to me.

(for pictures and bios of all of our current patients, visit www.godschild.org/casa-jackson)

November 2nd, 2011

I am sitting on a plastic chair in a small, lemon-yellow room. The sunlight fades outside and slowly, darkness falls like a blanket over me and the baby in my arms.

He lifts his head up momentarily, eyelids heavy from the combined exhaustion of spending a night in the street outside the local fire station, and his constant, anxious crying for “mama.” He creeps a tiny hand underneath the bottom of my mask, settling it underneath my chin, and drops his head back onto my chest. His other arm finds its way around my neck, in my hair, and he rubs it between his little fingers and settles into  my arms.

I rub his head, rub his back, pat his bottom and rock him gently. We sit, quiet, save for his occasional weak moans and choked murmurs of “mama.” I can’t even begin to process what this little baby must be thinking. At a year and a half old, he is old enough to know his mama. Old enough to look for her in every face that enters his room. Old enough to remember her and want her arms around him for comfort, not those of a stranger. Old enough to be scared and confused and traumatized, not just due to the physical experience of being abandoned and the loss of his familiar caregiver, but by his thoughts and confusion surrounding it all.

I put my hand to his cheek, feel its fullness in my palm, and try to imagine what sort of horrible circumstances or tragedy must have led his mother to abandon this beautiful, sweet, perfect, loving eighteen-month-old boy outside of a fire station several hours away. We pass two afternoons like this before he’s comfortable enough to sit within arm’s reach of a volunteer or nurse and play with another child.

How Can I Describe...

What it feels like to be here, doing this; this work that I love, in a place that I love?

I can't. Every day, I gleefully pass through another unexpected moment in which I am struck with the realization that yes, this is real, and yes, this is my life now.

It's the little things. The little things that seem surreal in the most delicious, indulgent way. Listening to a friend's iPod over the speaker system at a popular restaurant so we can hear our favorite songs by one of our favorite bands from back home. Splashing around for hours in a swimming pool in a gorgeous hotel with eight friends-- in the unforgiving rainy-season downpour. Buying tortillas from a stooped-over little woman passing by my doorstep carrying a massive basket on her head. Serving drinks behind a Guatemalan bar, listening to live Guatemalan music, with Guatemalan friends. Telling a joke that garners a genuine laugh-- IN Spanish. Sitting on my roof after a long, crazy night out, staring over the tops of volcanos to the lightning storms flashing in the distance.

I strongly suspect that the magic of the moments aren't entirely attributable to Guatemala's whimsy and charm. For the first time in my life, I truly feel at peace with where I am, what I'm doing, and, for the mot part, who I am. It's amazing the ease with which you can surrender yourself entirely to each moment when you suddenly find yourself inexplicably free from the weight of your own expectations, disappointments, and past failures.

Here, I just am. I am Amy. I am happy.

Not to say that I don't have moments where I'm stressed, frustrated, anxious, down, despondent, disillusioned, or dissatisfied. I've had plenty. I'll have more.

I think I said it best in my journal entry last night:

"There are headaches and frustrations, but...


I'm happy.


It is not a constant state of mind or an emotion. It is this overarching, all-encompassing sense that finally, I am where I belong, doing what I am meant to do."



*******************************************************


My work has been keeping me incredibly busy. There are most definitely not enough hours in the day to accomplish the many things I want to accomplish each day. There are the day-to-day responsibilities of giving tours and orientations to new and prospective volunteers. Supervising and providing feedback to volunteers to ensure the kids are being safely cared for and supported by the many, MANY people we trust to come in any given week and care for them, with what I feel is woefully minimal preparation (not for long!).

There are the administrative tasks to be completed, which involve tracking down information in medical records written in my non-native language, updating several databases and writing bios and providing information about the kids for our various websites, maintaining the schedule (a complex feat in itself at times), and trying to meet the needs and requests of the staff at CJ and ANA (Casa Jackson and Nuestros Ahijados).

There are the therapeutic moments and purely indulgent playtime I try to cram into my day, between communicating the nurses' requests to the volunteers, picking up any slack due to low volunteer count (hello sweeping, mopping, and laundry in between diaper changes and paperwork), etc.

There are the countless hours I've spent so far developing and writing strategic plans for a new volunteer program structure that benefits the children more fully, and uses the volunteers more effectively. There's the plans for in-house and post-discharge therapeutic services that our director wants to provide; the plans for overhauling the 2nd and 3rd floor play spaces to be more stimulating, motivating areas where our patients can safely explore and play.

There's the sponsor-a-crib program that is in development; the plan for improving the system in place to connect patients with additional medical services and procedures they need that needs to be written (by me); the training material to teach longer-term volunteers about early childhood development, developmental stimulation, and therapeutic play. The internship program that I need to develop and have ready by October 1st when my first "official" intern arrives.

There is the added mental challenge of switching between my native language and my non-native language throughout the day; of standing amongst nurses and staff members and trying desperately to follow and understand what the hell is going on. Of trying to express myself clearly and articulately, when I don't possess the words to do so. Of having a volunteer arrive and speak ONLY Spanish, and suddenly find myself having to translate the general orientation and training into Spanish without a dictionary, google translate, or the like.

I am exhausted. I am drained. Sometimes, after particularly hectic days, I find myself forgetting Spanish by 5pm. The easy banter I sustained only hours before suddenly sounds like gibberish to me, and the thought of even listening closely and TRYING to process the words I hear is enough to make me want to run for the hills and hide out until my brain decides to return from its brief vacation.

I've still got a ways to go, for sure, but my Spanish is at least improving. I keep meaning to sign up for lessons. I have a feeling that I'll make quick progress once I do; heck, if I've gotten this far without lessons, how far and fast can I go WITH them?! Soon enough... I think another week or two of focusing on work is the best idea for now.

There's been a spate of crime recently, both violent and non-violent. Lots of rumors about who's responsible and whether or not it'll happen again. Crime, security, and the upcoming elections deserve their own post. It's an incredibly interesting experience, to be here in the lead-up to the elections. I'm learning so much about Guatemala. Most of it is, unfortunately, a little disheartening and scary. Que sera, sera.

But those things aren't what make or break Guatemala for me. Those things (some profound, some frustrating, some overwhelming) aren't what make me so inconceivably joyful. The responsibilities, and positive changes I'm making for the program, the opportunity I have to truly be involved in this program in a meaningful way... Those aren't the things that make me happy to wake up in the morning (well, happier... I'll never be a morning person).

The best part of my days, by far, is the moment I walk up the stairs to the second floor of Casa Jackson. I see the kids before they see me, through the colored glass square windows on the side of the stairs. I get to see the exact moment when they realize it's me and the happy grins spread across their faces. I get the hugs, the kisses, the cuddles. I'm one of the constants for them now. I'm not just another volunteer, who comes and goes in a week or two or three. I'm there. And somehow, they know it.

It's the simplest moments. It's standing in the laundry space, putting away tiny sleepers and onesies, and singing silly songs and hearing Alison giggle from her bouncy saucer behind me. It's when Estrella puts her feet up in the air during every diaper change so I'll make a phone call on her "piggy phone" (piggy toes, that is). It's the weight of Alberto's tiny, frail arms around my neck and his soft downy head under my chin. It's Magaly's giggle and clap and delight at being able to finally move around on her own. It's Alejandra's love for bubbles and the precocious little chatter that she bombards me with to get more. It's seeing Laura smile and hearing her laugh in between her dissatisfied, fussy-shrieking-mini-tantrums. It's  the quick smile and the sweet babbling that I used to get from Naomi when I leaned in very, very close to her face after a diaper change and smiled and talked to her in silly voices.

I can't know what it's like to be a mother. I can't know what profound bond comes of the experience of sharing your body with the tiny being growing inside of you.

I know only that the longer a child is at CJ, the more they become my own. My own flesh, my own blood, my own chid, my own vulnerable little soul that needs protection and nurturing. I am Mama Duck with her brood of ducklings in tow. I am directly responsible for the overall quality of their time at CJ. The medical staff will get them healthy, but it's my responsibility to keep them happy.

I don't take it lightly.

A Whole Different Ballgame

The changes in Casa Jackson, implemented since my last visit, are numerous. It seems many of the rules have become more lax, and there are now more volunteers allowed per shift. In some ways, these are great changes. Increased laxity with the rules means that the few rules there are ought to be more easily enforced and more widely followed. More volunteers per shift should equate to more hands on deck caring for the babies, and more time actively engaged with volunteers.

There also seems to be some confusion regarding what type of setting Casa Jackson truly is. The type of setting determines the rules. Some people, volunteers and management, view Casa Jackson as a hospital for severely malnourished children- hospital being a place where strict hygiene and infection control policies must apply at all times to protect the babies from further illness. Others view it as a place where babies are going to receive nutrition, love, and interaction with caring staff and volunteers.

These two views need not be mutually exclusive, but finding a "happy medium" seems to be an ongoing challenge at Casa Jackson. On one hand, relaxing the infection control policies has led to increased peer interactions amongst the babies; the babies are clearly more motivated to move and explore by each other than by any other adult. This bodes well for their development. The official abandonment of the "mask at all times" policy provides far more opportunities to model speech sounds for the babies, almost all of whom are extremely delayed in their expressive communication. With the increased laxity in these policies, the babies are certainly recovering in a far more "natural" environment.

Still, coming from a medical background, it feels wrong to give the babies here any less consideration in protecting them from infections and illnesses than they would be given in a US hospital. I'm very interested to see if there are more colds and stomach viruses going around Casa Jackson due to these policies, or if the relaxation of the rules doesn't affect the rate of kids getting sick at all. I do very much hope they aren't adversely affected, because again, it does feel like a less institutional environment for these kids to be in for several months at a time. I'm still conflicted.

Yesterday, I arrived at Casa Jackson a little early for the afternoon shift. Despite there being four volunteers signed up, there were only three of us there other than the nurses. With a full house of 19 babies, the absence of one person is definitely felt! There are a lot of walkers, crawlers, and scooters right now and it seemed like every step I took there were little hands and feet that had snuck up beneath me. While it gets a little harrowing trying to rush around and change diapers without stepping on anyone, it is wonderful to see the kids moving around and exploring as much as they're able to now.

Due to the short staffing, I stayed with Rafa through the afternoon shift, the dinner shift (a two-hour shift newly created to help the nurses during one of the busiest times of the evening), and into the evening shift. We left around 7:15pm. A six hour day may not sound very long, but with 19 babies who need to be fed, changed, fed, changed, and changed again, as well as held and rocked and entertained, and only five people (including nurses) to do it, six hours feels like sixteen hours. Sixteen wonderful, trying, heartwarming, frustrating, inspiring, fun, ear-splitting hours.

It's amazing to me how some kids are so resilient. Many kids that come into and leave Casa Jackson really do thrive. They don't seem to experience any horribly glaring residual delays, beyond the typical cultural differences that are often viewed as delays by foreigners assessing the skills of kids growing up in this culture. For those kids, Casa Jackson truly is enough.

It's the ones who aren't thriving, the ones who are sick and admitted for months on end, who can't sit up or stand despite being over two years old that worry me. The ones who are too weak to make any progress developmentally, and can't seem to make progress nutritionally either. I'm concerned about the lack of long-term follow-up for the kids. What happens to the kids who may get better medically, but whose parents can't afford to send them to school or the doctor? The kids who aren't visibly handicapped, but absolutely need support? The many, many kids who- once again- just fall through the cracks?

It seems I've given myself a new "to-do" on my list here...

Two Cute, Cuddly Little Puzzles

While every child seems to grow in leaps and bounds during their time at Casa Jackson, I can't help but be especially heartened by Alison's progress since I last saw her in April. That intense, serious stare she always sported still makes an occasional appearance, but she's so much more interactive and engaging now.

I brought Alison to the upstairs playroom with me to work with her and get a better sense of what her current skills actually are. Rafa filled me in on his biggest concerns for her: she rarely touches anything with her left hand and consistently pulls it away from any stimulus, and she doesn't seem to be making any sounds other than "puh puh puh."

My silent, pensive little Disney monkey has turned into a strong-willed fussbudget who very much has her own ideas about what she wants to do! Once I figure out what motivates her to really work hard, I think she'll make great progress. With an iron will like she's got, it's just a matter of convincing her that she wants to do the things I want her to do...

Regardless of where her skills fall right now, I am thrilled to see her smile and laugh so much. That one little half-smile that took a month to appear has blossomed into a toothy grin that she gives up easily. She was a little disconcerted being in the playroom upstairs, and pulled her hands away from all the toys I offered her. I decided to entice her with some good old-fashioned sensory play and we spent a good fifteen minutes taking turns slapping the giant therapy ball and making motorboat sounds (it's the simple things...). Alison imitated me readily, putting both hands on the ball, hesitating only a moment with her left before slapping it down next to her right hand and looking at me to make the silly sound.

After all the giggles, seeing that she was growing more comfortable, I decided to push her a little bit further. I sat her on top of the ball. She began to fuss and reach for my neck. I ignored the fussing, started to sing the ABC's, and began to roll her slowly back and forth, and side to side. It took a minute, but she began to enjoy this too, and wiggled her little body around whenever I stopped. I bounced her gently on it, making the same motorboat sound as before, and boy did she love that! Each time I stopped, she tried to imitate the noise and bounce herself until I continued to do it for her. As I rocked her side to side, she began to first put her left hand down, palm up, on the ball. After a few tips to the side, she began placing it palm side down. I'm feeling pretty confident that this left hand avoidance can be overcome!

Alison was none too pleased when I first laid her on her tummy over the ball, facing me, with her arms in front of her. All of the points I must have racked up in our fun just minutes before went out the window when I did that! It took a bit longer, but with more bouncing and rolling and silly noises, she enjoyed being on her belly, rolling forward and back, bouncing, and pushing up on her arms. She definitely hasn't been spending time on her stomach; her weakness and rapid fatigue are a clear testament to that. But, again, judging by her eventual acceptance and even enjoyment of it today, there's hope!

After a good lunch (during which she held her bottle by herself once I positioned her hands there and decreased my assistance from hands, to wrists, to elbows, to none), I brought her back downstairs and put her into her crib with a toy across her lap. She enjoyed exploring the toy with both hands, pushing levers and opening little doors. She continued to smile at me every time I went back into her room to change a diaper, chase a runaway toddler, or grab more diapers or wipes. She definitely has something going on, but I'm feeling good about the direction she's heading-- up.

I spoke with Rafa about another little girl, Joanntoni:

Joanntoni  has issues with her legs and feet, though no one knows what they are. Joantonni walks with her feet turned slightly inward; standing above her and holding her hands while she walked, it appeared almost as if her hips and legs were rotated slightly to face to the left rather than straight ahead. Her legs are extremely slender, but muscular, unlike the stick-thin, fragile limbs common on some of the older toddlers. She can walk with hands held, but she puts a lot of her weight onto her arms. She prefers to ring-sit and scoot around that way. Joanntoni was willing to pick her feet up individually to take a step up, but threw her torso back onto my arms to avoid putting weight on either leg individually.

She's definitely an interesting little one. Apparently she had an X-ray recently to try and determine if there were any abnormalities, but nothing showed up. I'm hoping she may be able to get in with an orthopedic specialist soon.

I also had a chance to speak in a bit more depth with Heather, the new CJ volunteer coordinator today. She echoed many of the sentiments I've had for awhile regarding the missed opportunities that exist in terms of using the volunteers to their full potential, and ensuring that the kids are getting the most benefit possible while in Casa Jackson's care. She seems eager to get more training and orientation for the volunteers, so I will be trying to put together some basics and work together to determine the best way to identify and communicate with volunteers who want to be involved in a more complex fashion than just coming, caring, cuddling (all very important, but not the whole picture!) and changing diapers. I'm excited to finally get going on this aspect of the project I've had in my head for the past six months!

Corinne and I took a lovely walk up to Cierra de la Cruz this afternoon. It's a very do-able trail of steps leading up to the top of the mountain that our apartment is on the side of; we actually can see the backroad to it from our front window. We went up the safer "tourist path" and enjoyed a beautiful view of Antigua, complete with cloud shadows, clouds blanketing the tops of the volcanos, and the stunning view of the entirety of Antigua laid out beneath us. I find myself having at least five moments each day where I can't help but feel so very lucky to be living in such a beautiful place...

Itty Bitty Amy in the Big Bad City

Around 10:00am this morning, I found myself in a cemetery, watching a potential gang member’s coffin being pulled from a hearse surrounded by a crowd of surprisingly quiet mourners. Vultures soared in circles above us, concentrated in certain parts of the visible sky. I wondered what they could be scavenging for; the grounds were covered in mausoleums and tombs of varying sizes. None appeared to be accessible without the aid of some serious power tools. 

As the mourners walked from the wide street cutting between virtual neighborhoods of mausoleums down the narrow corridor housing one of many long, tall walls of box-like tombs stacked at least ten high, the policia pulled away in their eponymous green pick-up truck. 

Over the cheerful sounding but lyrically somber music that began to play, 

Jacobo explained that police often escort fallen gang members and their loved ones from funeral home to cemetery to dissuade any rival gangs from attacking the mourners, which may include fellow gang members. He suggested we keep walking. I didn’t protest.

In the largest cemetery in Guatemala City, no one is buried underground. Anyone able to afford a space can house their remains, for eternity, in a variety of accommodations spanning from the very humble to the most ornate and pretentious imaginable. Some were larger than the homes I’d seen in small villages. 

The average Guatemalan may opt to be put into one of the humble boxes, structured and quite similar in appearance to the post office boxes lining the wall of every post office in the US. Family members decorate the doors, filling what can only be described as a window box at the front with flowers, plants, crosses, and the like.

Wealthy families and ex-politicos alike, however, purchase a plot and build their ‘dream tomb.’ Every style of architecture can be detected throughout the cemetery. Greco-Roman pillars abound, as do the elaborate stone sculptures (generally religious in nature) so popular and prolific in Guatemala. Some are merely influenced by the colonial style found in nearby cathedrals; some appear to be complete mimicry. Some boast a more modern, contemporary face, with glass doors and asymmetrical lines. The wealthiest family in the city, owners of the largest cement business, built an Egyptian-style tomb, complete with stone Sphinxes atop it.

Visible from one side of the cemetery is the massive landfill beneath, the largest in Guatemala City. We stood and took it all in from between two smaller ‘homes.’ Hundreds of vultures circled high above it, and hundreds more rested on the treetops below us. Yellow trucks formed lines both in and out, dropping off refuse from every corner of the city. 

Just barely visible were the tiny ant-like bodies rushing to each load deposited. Hundreds of families make their living off of the landfill, desperate vultures of another kind, scavenging for anything that could be re-sold for some meager income. Some children are even sold by their parents to work in one of the many landfills in the country, prized for their small size. Some children never leave.

Not long after, I stood peering down into the cavernous opening of the Congress building as a soft-but-rapidly-speaking aide provided an overview of the day-to-day activity in the building as well as some of it’s history. I quickly abandoned trying to understand him, asking Jacobo during pauses for a succinct translation instead. 

As a group of schoolchildren sporting matching red jackets filed in around us, he explained that members of the public are able to sit in on active sessions, but as silent observers only. While the logic behind that rule is obvious, I couldn’t help but be amused at the irony; citizens as silent observers in Congress, citizens as silent observers in hundreds of years of exclusion at best, oppression and genocide at worst. 

As we walked and drove around the city, Jacobo patiently answered my constant barrage of questions regarding safety, society, the military, politics, and of course- the upcoming elections. Among the things I learned today:

-Zona 9 and 10 were once considered quite safe, and are where most Guatemalans work and study. In recent years, crime has skyrocketed. The zonas are no longer considered safe as thieves target middle-class Guatemalans on their way to and from work, looking for cell phones, laptops, and other electronics.

-Sandra Torres, who divorced current president Alvaro Colom in order to run for president in September’s elections, has not yet been authorized by Congress to run. She is considered the most powerful politician in the country (more than Colom himself) and obviously knows it- she has already plastered the country with her picture and campaign slogan.

-Bus drivers who do not pay extortion money to gangs each month must have a death wish. There are often one to two shootings per day on the public buses in Guatemala, either while stopped or in transit, with equal brutality against passengers and drivers. 

-The two gangs most active in the city are the Salvatrucha (Mara Salvatrucha 13, or MS-13) and Calle 18. Between 7 and 10 years ago, they reached an agreement where members would not attack each other in certain places- funerals and jails being two of those place.  The agreement was broken several years ago and there was a slaughter of gang members at the prison; heads were severed and used as soccer balls. Needless to say, the truce has yet to be recovered.

-The military still holds an enormous amount of power in Guatemala today, despite being removed from executive office at the end of the civil war in the mid-1990’s. Speaking out against them in the press or any official forum is not only difficult, but can be dangerous as well.

Despite all of this, and despite the sometimes crumbling, sometimes dreary appearance of the city, there are things to celebrate. The former post office, still used in some capacity as such, now houses hundreds of dance and music classes offered for free to children found begging for money in the street. Instruments are provided for free, and the children put on performances and may even play in the program’s orchestra.

We visited an art gallery hidden away atop one of the many entrances to a shopping center. Walking through the center, we passed a number of hair and beauty salons either run by or catering to the gay/transvestite population, which Jacobo reports is very adept at staying out of sight due to societal pressure. The gallery housed a photography exhibit that chronicled street art/installations created by Alejandro Paz, entitled “Obras Publicas.” Some were thought-provoking, some puzzling. 

Jacobo was a wonderful guide, and we covered many of the historic sites in Zona 1 over the course of the day. I noticed only two other groups of tourists in the city, unusual for a colonial capital with such rich history. Jacobo was also kind enough to drive me past La Limonada, the largest slum in Guatemala City, and through zonas 9 and 10. While it was clear that the city is very different from Antigua, we stayed out of the most dangerous zonas. At no point did I fear for my safety or worry that I was in danger. 

Another talking point for Guatemala City- their central market has some incredible street food! Jacobo and I ate chiles rellenos (my first since arriving!) and dobladas. Chiles rellenos are chilies that have been stuffed with beef and deep fried. Ours were served topped with guacamole and a mild red salsa. Dobladas are tortillas filled with meat and cabbage, then deep-fried and covered with guacamole, salsa, and chopped onions and purple cabbage. I loved both of them, and washed them down with a licuado mixto (mixed fruit smoothie) from a plastic baggie with a straw sticking out. 

We saw so many things today; I could easily fill up another three pages describing my experiences today! I'm so grateful to Jacobo for bringing me into the city (and safely back out of it!); while I understand that the places we didn't go today are vastly different from the places that we did, I still feel less intimidated by big, bad Guatemala City...