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."



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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...

Mi Chiquita esta Gordita!

I walked to each doorway, peeking into the rooms. Every crib held a little sleeping body, bathed in the mint-green sunlight reflected off the painted walls. Tiny limbs poked through the bars of some of them; dark fuzzy heads were visible beneath blankets in others. I scanned each room quickly, looking for familiar faces.

I strode across the small hallway, towards the rooms that always seemed to hold the babies nearest and dearest to me- Sandra included. The children with special needs always ended up in there for one reason or another. I had decided to look in that room last. I knew from speaking to Juan Pablo that Sandra was gone, as were almost all of the others.

An additional crib had been wedged into the room, crowding the small space even further, and complicating my efforts to peek inside each crib without waking anyone. I spotted Magaly, sleeping soundly in the corner crib, curled up on her side with one shoe on and one shoe off. Her shiny black hair hung straight across her face, obscuring my view of her almond-shaped eyes and petite nose. Only her tiny pink mouth peeked out.

The crib to my left held a healthy-looking girl with familiar features. I took in her large ears, beautiful eyes, button nose, rosebud mouth, and full cheeks. She looked at me, smiled, reached her arms up, and began to fuss. Could this be the same little girl I spent an entire month coaxing just one smile out of? The little girl who was so disinterested in people and toys? The little girl who was so frightfully thin and frail just two months ago?

I reached my hand between the bars and stroked her cheek.


Alison. Chica linda, tu me recuerdes?    She briefly stopped fussing and looked at my eyes before continuing her impassioned treatise for me to pick her up.

As I lifted her from her crib, I was delighted to feel the weight she's put on. Compared to her former self, she's downright chubby now. Compared to a typical American baby, she's still likely a bit underweight.

Developmentally, she has made some progress, though she continues to present with very significant delays. A fellow volunteer reported that they feel she may have autism, although I don't agree. I still feel strongly that there is an underlying issue impacting her development beyond "simply malnutrition," but autism it is not.

Alison is still a timid, cautious baby who is reluctant to touch toys and fully explore them, but she displays some promising progress in her social skills. Alison frequently made eye contact with me; she delighted in watching me pull Legos apart and made eye contact expectantly when I paused between each block as if to say, "come on! do another!"

She is aso beginning to initiate play, though only in the few activities that she seems to prefer. She showed a particular affinity for the Sesame Street Shapes board book I had donated during my last tenure as a volunteer, and loved to turn the pages and point to the pictures. When I put the book down and tried to move to different toys, she several times handed me the book, made eye contact, and fussed until I began to read it again. Her social skills are delayed, but no more than her play, motor, and cognitive skills appear to be delayed at first glance.

At such a young age (under two), given her global delays, I think it's impossible to look at her and say with any certainty that she could have autism. Is she off? A little funky? Absolutely. A lot of parents and caregivers become concerned with autism if a child isn't interacting as they should socially. If all of a child's skills are at a certain level, consistent with their general development, the delays in social functioning are likely reflective of a bigger issue, rather than the sole issue impacting them.

A very well-respected doctor with years of experience diagnosing autism in children under age three delivered a presentation at the hospital I used to work for; the most prominent marker she noted for autism at that young age was a lack of initiation of social interaction. Alison makes eye contact and engages in reciprocal interactions and, although unable to communicate verbally in any effective way, does attempt to initiate those interactions.

For those wondering how Magaly has fared since her surgery- quite well! Her mother wasn't at the center, and I'm hoping that she is safe and well considering the domestic abuse she was staying at the center to avoid in the past. Magaly's legs are certainly stronger then when I left; the muscles holding her femurs into her hips are tightening up and she isn't so loosey-goosey legs out wide all the time any longer. She can stand with assistance and loves taking slow, laborious steps when held beneath her underarms to get toys from the basket (which we did a lot of today!). She fatigues easily, but has come so far from the little girl in the giant cast that she once was. I can only imagine the freedom she must feel.

There aren't currently any children with cerebral palsy or any obvious neuromuscular issues, but I imagine there are at least one or two like Alison.  I have to admit that I spent much of my time today with her, "catching up" and bonding again. I've signed up for a few shifts over the next week to ease back into things and hopefully get a better sense of where the kids are, developmentally speaking. There are 19 kids there now- a full house! Pictures soon- I promise. :)

My visit to Casa Jackson, while a welcome one for me, was rather unexpected. Intending only to meet the new coordinator Heather and discuss joining the volunteer schedule, I had walked to Nuestros Ahijados after lunch and found myself waiting at the entrance to Nuestros Ahijados with the afternoon volunteers when Megan and Heather arrived at the gate. Heather had been mugged on her walk back from her apartment in La Candelaria, in the southern part of Antigua. She was visibly shaken and would not be going to Casa Jackson just yet. 

Megan asked if I could take the new volunteers to Casa and run them through the brief orientation. Just like that, I was walking down the dusty road that stretches from Antigua to Jocotenango, talking to a high school senior traveling with her mother who was interested in pursuing a career in physical or occpuational therapy upon graduation, describing the myriad of issues that the kids at the center often present with. It was almost like I'd never left.

I did have an opportunity to speak with Heather when she arrived, looking far less distressed, later in the afternoon. Heather mentioned that her primary interest is actually in community outreach and working directly with the families rather than just the volunteers and institutional setting. She said she saw no issue with me working on implementing some training for volunteers whenever I was ready to do so, and fully supported any community visits I may want to set up. While I thought that would be the case, it's such a relief to get the official green light from the new coordinator- and also to learn that she sees the community work as as much of a priority as I do.

Casa Jackson- game on. :)