WHERE and WHY? aka, Beginning to Answer the 4 W's (Part 1 of 3ish)

Sweat beads under my heavy cotton ADAWA teeshirt, granted graciously but unceremoniously to me minutes before our meeting with the local clinic workers and community leaders. 'It may help for you to look official,' Don Ramiro explained; 'it will show the community that you're not from the government or any other organization; you're just here with us, to help us.'

I shift in my hard plastic chair and glance at Don Ramiro, waiting for his signal. The mid-morning heat is quickly becoming oppressive in this modest concrete office the local government permits the association use of, in place of Santa Lucia Lachua's subpar 'community center'- a lumpy dirt pavilion with a tin roof (and no chairs). 

I glance down at the questions I've prepared for this meeting, called by Don Ramiro on my behalf, to gather information about the community's health needs. As he gestures dramatically and makes what Tara and I can only guess are further assurances of our good intentions in the distinctive Q'eqchi' that is the native, primary, and often only language of his community members, my confidence falters. In a country brutalized by a 30-year-long civil war, where the mere suspicion of dissent was enough to endanger one's life, indigenous communities are not known for their willingness to openly and honestly complain about the government's failures. I steel myself for silence and prepare to spend the next three hours subtly prodding participants for the information I need.

Don Ramiro turns to me and breaks into a grin that illuminates his round face. "Alright, then. You can start with the questions." I smile at the thirty stern faces in front of me, some nodding in acknowledgment, some unmoving with eyes cast to the floor, and begin. "I'm interested in learning about the medical care you provide to your communities, and any struggles you may face in trying to provide it. Is anyone interested in speaking about this?"

Don Mario clears his throat. A thin, wiry man clutching a red backpack on his lap, Don Mario has been giving Don Ramiro his rapt attention, nodding throughout the lengthy introduction and jotting down notes as he listens. He raises a hand in the air, pushes a smudged pair of glasses up the bridge of his nose, and begins.

"There are 22 FCs (community health workers) working in 10 clinics, serving 34 communities. We are paid Q500 ($62.50) per month to work in the clinics. Depending on the size of the community, we have support from a doctor, nurse, or practical nurse. Some communities have a nurse every day, others only once a month. Clinics in smaller communities are open one or two days a week, or whenever someone needs care. In most clinics, FCs provide all the direct patient care. Sometimes we have enough medications to treat the conditions that are hurting our community; sometimes we don't. 

Our jobs were difficult before, but in November, the candidate we voted against won the local elections. To punish us, he stopped paying our salaries, stopped giving us money for medication, and locked all the clinics. We still see patients when they need us, and give them whatever medications we have left. We could lose our jobs if they found out, but we do it because our community needs us. We found out today that the clinics will open again, but only half of the FCs will have jobs. We'll only have 11 people to care for the 12,700 members of our community."

As Don Mario speaks, the sea of somber faces begins to awaken. Other FCs nod their heads vigorously, murmur in agreement, and interject with complaints of their own. Don Ramiro can barely keep pace with his translation as clinic workers and local leaders from 18 different rural villages echo the same anger, sense of abandonment, and concern for the communities they serve. Far from being met with silence, I am confronted with a room full of people eagerly vying for their turn to be heard.


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

While I initially signed on to collaborate with ADAWA under the auspice of supporting public health, my new role in the project is significantly more expansive. I will be working with an association comprised of 400 members of the indigenous community to coordinate projects that bring long-term, sustainable development to a highly marginalized region. The underlying, central focus of the projects we implement is to empower each community to take responsibility for its own progress, improve cooperation between the region's 34 communities (where competition for scarce resources leads to strife), and develop strong local leaders that can advocate for and advance the development of the region from within.

While informative, that explanation does little to paint a picture of what ADAWA is actually doing to accomplish our goals. It also fails to explain the context of where we operate, why the support is needed there, and how we aim to accomplish our goals. I'll address the where and why first, as both are irretrievably intertwined.

Working in health, human services, and nonprofit, marginalization is a word I have heard and used often throughout my career. Marginalization is oppression accomplished through social, political, and economic exclusion. Every nonprofit I've worked for, both in the US and Guatemala, has expressed a commitment to 'empowering the marginalized.' But beyond the rhetoric, beyond the feel-good mission statements justifying our work, what does it mean to be marginalized?

mar·gin·al·ize: to put (or keep) someone in a powerless or unimportant position within a society or group. (thank you, Merriam-webster.com!)


Americas Quarterly completed their updated Social Inclusion Index in 2013, scoring 16 Latin American countries on their progress (or lack thereof) towards social inclusion. In AQ's words,

"At its most basic, social inclusion is about opportunity: it represents the combined factors necessary for an individual to enjoy a safe, productive life as a fully integrated member of society—irrespective of race, ethnicity, gender, or sexual orientation...  including the factors that allow for a citizen to express himself or herself to demand change and a reasonably accountable government that will respond to those demands.

This touches on a wide range of factors that... encompass, of course, economic growth, social spending, reduction of poverty, access to education and other social services, and access to formal employment. Also included are measures for the respect for basic human, political and civil rights, as well as the extent to which citizens participate in civil society and the perceived responsiveness of government." 

Social inclusion is essentially the opposite of marginalization. By all accounts, Guatemala boasts one of the most marginalized populations in the Western Hemisphere. Indigenous Maya comprise well over 40% of the nation's population, but are routinely denied access (inclusion) to quality education, healthcare, and opportunities for economic advancement; they are treated as second-class citizens and largely ignored within the political process. As a result, 75% of the nation's indigenous population remains impoverished.

As expected, Guatemala (which also ranks 131 out of 187 countries on the UN's Human Development Index, comparing literacy, life expectancy, education, and overall standards of living worldwide) performed poorly on the AQ's index. Of the 16 countries surveyed, Guatemala ranked last in overall social inclusion as well as women's rights. This is no surprise in a country that boasts some of the highest levels of chronic malnutrition and government corruption, and lowest gender equality and literacy levels, in the Western hemisphere.

In order to begin to understand how nearly half a country's citizens can remain so oppressed while others advance, the region's history must be addressed. From the arrival of the conquistadors and the Spanish empire in the early 1500's, the Maya have been subjugated, brutalized, enslaved, and oppressed by one group after another. Early European settlers and later US-based companies like United Fruit Co. bought up large swaths of land for coffee and fruit plantations, creating a system of indentured servitude for most indigenous Guatemalans and cementing their place in an already racially stratified society.

A CIA-backed military coup in the 1950's sent democratically elected president Jacobo Arbenz- whose recent land reform had redistributed uncultivated, privately-owned land to the working poor- into exile, and plunged the country into a 30-year civil war. The military waged war against leftist guerrillas, mostly indigenous Guatemalans, who aimed to overthrow the military government and return to a democratic governance that would give the indigenous community equal rights and opportunities for advancement. Anyone who expressed dissent, showed an interest in their own civil rights, or participated in any sort of community organization could be labeled as a guerrilla and slaughtered at will. 200,000 died during the conflict, with hundreds of thousands more displaced. Entire villages were brutally massacred and razed to the ground as part of a governmental policy of genocide against the Maya. While peace accords were signed in 1996, the country remains deeply affected.

Despite increased awareness and advocacy for indigenous rights and a growing body of indigenous activists, the corrupt but powerful government, still backed by an elite aristocratic minority, have done a remarkable job of ensuring that entire swaths of the country remain uneducated, disempowered, and struggling to survive. The simple truth is, and always has been, that an organized, empowered indigenous community is too strong a threat to those that hold the reins of economic and political power in Guatemala.

This is what marginalizaton is, and how it happens. But what does it look like for the hundreds of thousands of Guatemalans affected by it?

It looks like most rural communities within the poorest departments of Quiché and Alta Verapaz, where only 20% of indigenous children enroll in primary school (completing, on average, 2.1 years of formal education before dropping out). Communities where 50% of mothers have had their first child before the age of 17, and have lost or likely will lose at least one child to an entirely preventable and treatable illness like pneumonia or diarrhea; where chronic malnutrition rates remain high due to a lack of education and basic medical services, despite access to arable land and a favorable growing climate.

It looks like the many places far from the country's bustling capital without accessible, paved roads; without access to uncontaminated water for drinking and bathing; without educational and economic prospects. Places where elected officials can penalize a whole region for exercising their constitutional right to vote freely, and deny them the opportunity to receive basic services they desperately need.

It looks like a place where indigenous legislators make up a mere 13.9% of Congress, though they represent over half the population. A place where previous attempts at organizing and empowering locally from within have resulted in government destruction of property and the brutal murder of community leaders, leaving deep psychological scars on every member of the community.

It looks like a place where entire communities sit in wait for either the government or foreign charities to come and 'save' them, because they do not believe they are capable of advancing from within. A place where the long-awaited 'savior' NGOs run development initiatives for a year and then leave, turning responsibility and control over to community members, only to see them abandoned because, as we heard time and time again during our visit to the area, "we had no leaders here to run it."

It looks like our community:

A main road in Santa Lucia Lachua, where ADAWA is based.
(The recently paved Northern Transversal highway passes
through town but is only used for travel in/out of the region).

A mother washes her children's laundry using water from a makeshift 'well'-
a hole dug into the ground, sides reinforced with mud and plywood, that
captures rainwater and runoff from a nearby contaminated stream. This 'well'
also serves as a source of drinking water for the family.

The outhouse at Santa Lucia Lachua's only school, which serves students
from 1st through 7th grade (though many drop out before that). This basic
concrete and tin outhouse is actually more advanced than the open-air,
thatch-roof, 'hole-in-the-ground' latrines utilized by even the
comparatively well-to-do families in the community.

So About This Whole Moving Home Thing...

The sound of howler monkeys and the singing of the evangelical church next door compete until the rain begins- a steady, roaring downpour that lulls me to sleep almost instantly. I wake hours later to the same sound, content beneath the canopy of my mosquito net, and listen to Aura and Doña Juana's sing-song banter in the next room, separated from us by a plank wall that stops 5 feet below the corrugated tin roof, punctuated by the slap-slap-slap of their hands forming the first batch of the day's tortillas.

It is my third morning in Santa Lucia Lachua and I am already in love.

The past two days have been inspiring in a way that gives new meaning to the word. I am honored and humbled to work alongside a true visionary; a man who works tirelessly from morning until night, without pay, to organize and uplift not just his community but the 33 other communities that fall within ADAWA's area of influence. He is a hard worker who spent years rising hours before dawn and walking from the highlands down to the campo to put in hours of backbreaking labor in the fields, so that someday he could realize his dream of owning enough farmland to provide security for his family. 

He is a devoted father to his 10 children, all of whom have attended not just primary school but university (which is no small feat or expense in this poor, rural community located far from the department capital), and a loving abuelo to his 3 grandchildren, who will receive the same opportunity in the coming years.

In addition to being a devoted community member and family man, Don Ramiro possesses a deep insight into the challenges faced by his community and region, one of the most marginalized in a country notorious for socially and politically oppressing the indigenous community. His counsel is worth its weight in gold for Tara and I, the two young gringas who stand heads above most of ADAWA's 400 members and struggle to understand, let alone speak, the halting, guttural Q'eqchi' that is the native (only) tongue of most members. 

His fellow community members find him as indispensable as we do; his advice and mediation are sought in almost every dispute or disagreement that arises between communities (of which there are many). In the first 48 hours following our arrival, Don Ramiro had 3 meetings with a nearby community who has blocked a public path that crosses onto their land for a mere 15 feet, preventing some members of Santa Lucia Lachua from reaching their own fields further down the path. He has arranged, attended, and translated a 3-hour-long meeting with 30 local health workers for Tara and I's benefit, and spent every meal collaborating with us on future plans for this fledgling association that is truly unlike any I have encountered in my three years of exposure to Guatemala's NGO scene.

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

          When I arrived back in Antigua in September, I wasn't sure if I wanted to stay. I simply knew that I wasn't feeling happy or productive where I was (living and working back home), and that the winter was fast approaching. Antigua was the last place I had felt genuinely happy, and thus seemed like the logical place to return to in search of the feeling. I missed having not just a 'job,' but a purpose- a project to throw myself into with complete and utter abandon. I missed the exhaustion and exhilaration of attacking an insurmountable challenge. I missed my work.

I returned to a slightly different Antigua than the one I left, which is not uncommon in a small town whose fabric is unraveled and rewoven every three to six months with the ongoing exodus and arrival of old and new faces. My closest friends remained, but without a real job to anchor myself to, I felt the strain of the late nights, partying, and constant comings and goings of the people I interacted with on a  daily basis. For all my excitement to return, I found myself paralyzed with fear to jump back into the professional arena, no longer romanticizing or amnesiac about the severe emotional toll that the trauma I dealt with on a daily basis in my previous position had taken on me.

After several months of feeling lost and unhappy for various reasons and a particularly rough holiday season, I made the decision to move back to the states. I accepted that my life was heading in a different direction and that perhaps it was time to shelve the dreams I had held for so long in favor of a more 'logical' path. I enlisted the help of my boyfriend and planned a surprise visit home in January to ease my homesickness and make the announcement to my family in person. I was incredibly excited to be coming home, ecstatic that I could soon begin seeing my loved ones on a regular basis again, rather than every few months, and cease feeling like I'm missing out on so many precious moments in their lives.

A few weeks before my scheduled departure, a friend mentioned in conversation that she had begun working with an association up in Alta Verapaz. As she shared details of this new endeavor, her excitement was palpable, and after listening to her for several minutes it was easily apparent why. Knowing my background in community health, we discussed the possibility of me visiting the area and planning a nutrition workshop prior to my departure. I walked away from that conversation feeling refreshed, light, energized. I felt like myself again.

Over the course of the next few days, as we continued discussing the details of this project, I became more and more captivated by how unique and unconventional it was. I walked away from each conversation with my head spinning with ideas about how to apply my experience in pursuit of the association's goals, and began to feel that familiar pull to dive in, headfirst, and submerse myself in it.

After a genuinely heart-wrenching week of indecision, I accepted and admitted to myself and my loved ones that I simply could not pass this opportunity by. I could not leave Guatemala. For all the fear and self-doubt I have carried with me over the past several years, I still believe in myself, my abilities, and my dreams. Above all of that, I believe in Don Ramiro and I believe in the vision that he and his community share for their future.

For those that were eagerly awaiting my move home this weekend, having patiently said goodbye to me countless times and tolerated several years of long absences, I am sorry to let you down. I think most of you have already accepted my lifestyle, although I still struggle to accept that the pursuit of my dreams prevents me from partaking in the daily life of so many of my loved ones.

I have never been more excited, or more proud, to be a part of anything as I am to be a part of ADAWA. The potential that this project has is immense; the model, inspiring. There will be innumerable challenges, but I genuinely believe in the power of this community to organize, empower, and develop themselves from within, when given the support they are so earnestly seeking.

MANY more details to come over the next few weeks... I hope that with each update, you'll grow to love this project and our community as much as I do. Thanks to all who followed my last endeavor so closely, and also to my family and friends back home for continuing to love and support me from afar.

B'antiox, everyone ('thank you' in Q'eqchi'). Another adventure begins :)

A Tribute to the Wonderful Mothers I Have Known, Both Near and Far

I always knew I wanted to work with children… It wasn’t until much later that I realized how much I wanted to work with mothers.

I began my career working with children from birth to age three with special needs and developmental delays. The program that hired me was designed around this fundamental idea: parents are the most important individuals in a child’s life. Involve and empower a child's parents in everything you do for the child, because they have the power to connect with and support their child in a way that no therapist or educator ever can. They are the most important person in that child’s world, and if you truly want to help that child, you must help their parents.

Throughout my four years as a therapist working with the very young patients in this program, I had the honor and the privilege of working closely with their families. While I worked with some fathers and grandparents, the majority of my work was carried out with mothers. It was a difficult job; a stressful job; a beautiful job. It required confidence and independence and a level of comfort I did not yet have in my own skills. My first year was overwhelming… But slowly, with each heart-wrenching or incredibly trying case, I grew as a therapist, a professional, and as a person.

At the beginning of my career, this level of maternal involvement terrified me. How could I to give a mother advice about how to raise a child? Certainly, I had the education and skills to make therapeutic recommendations… But how would a mother ten years older than me ever take me seriously? How would she ever believe that I truly did know enough to help her child? I wasn’t a mother. I was only 21 years old. I still lived with my own parents. How could I be an authority on anything related to parenting a child, let alone one with special needs?

Much to my surprise, these women welcomed me into their homes not reluctantly, but with eager and open arms. They put their trust and confidence in me in a way that made me feel both honored and absolutely terrified. They sought out my opinions on dealing with problem behavior; sought out my advice regarding their child’s sleep troubles; shared their sadness and frustrations with me. I grew to appreciate and love the mothers, just as I loved their children.

These women allowed me to be not just their child’s therapist, but a part of their lives. I have welled up with tears upon hearing the cry of a beautiful, feisty little girl for the first time, after knowing and loving her throughout the first two years of her life with a tracheotomy tube that rendered her silent, and I have sat in a doctor’s office and seen a mother's tears fall and heart shatter upon hearing the word “autism” for the first time. 

These mothers granted me the gift of sharing in their joys, trusted in me enough to witness their pains, and in giving me the honor of both, taught me more than they will ever know.

When I began volunteering at Casa Jackson last year, I had few opportunities to meet the children’s mothers. I fell in love with the frail babies and toddlers; spend my days hugging and holding and rocking and comforting and more or less “playing mommy” to our patients. It was easy to forget that each child had an anxious, eager mother at home that was desperately missing her child. 

And then I accepted this position. 

How to explain or describe what I feel for these women; to express my level of respect and admiration for them; to articulate exactly how much I love them...? How fiercely protective I feel over them? How my teeth clench and blood boils when I hear visitors or volunteers making assumptions or judgments that these women are doing anything less than everything they can?

These women are mothers in a country in which I find it difficult, frustrating, and sometimes terrifying to even be a woman. They are bringing tiny babies into a very uncertain, dangerous place and trying desperately to protect, nurture, and raise them as best they can given the unimaginable circumstances they face. 

Many watch their devoted husbands suffer through 16 hours of backbreaking labor six or seven days a week just to keep a dirt floor under their feet and a laminate roof above their head. 

Some watch their children starve as their husband spends all the money he earns each day on liquor. 

Many struggle to shield their children from the angry fists that often follow, without any hope of shielding themselves. 

Many know the pain of losing not just one child, but two, or even three, because they had no money to purchase the dose of antibiotics needed to stop their child’s diarrhea.

Some are raising and loving babies that were conceived when their own father, uncle, or cousin forced himself on them. 

Even the mothers who are lucky enough to have a caring husband and decent resources face challenges that most of us can’t imagine, including poor access to basic health care, emergency services, and life-saving medicines for common childhood illnesses. A child with any sort of medical or special need here is at the mercy of the free public hospitals, where the care provided is usually poor and often dangerous. 

*****

There is Ana, mother to Edy. Ana and her husband Erick desperately wanted children. They tried and tried and tried to conceive, but to no avail. Ana went to a doctor who diagnosed her condition and concluded her sterile. Ana and Erick were heartbroken until miraculously, Ana conceived some months later... Not just one little life, but two. 

As most women do, Ana labored in her home with the help of a midwife. Their gorgeous, healthy daughter was born first. Their beautiful, joyful son came next, but suffered without oxygen for several minutes as Ana experienced complications during labor.

Edy was admitted to Casa Jackson in October, severely malnourished but with a persistent smile stretching across his chubby cheeks. 

I remember the day I met Ana. She and Erick were visiting Edy. Erick sat cross-legged on the floor, and Ana sat next to him, leaned up against his shoulder. Their heads were close together, foreheads practically touching, as they watched little Edy sleep in his father’s arms. Ana gently rubbed his head. Erick held his infant son’s hand and raised it to his lips to kiss him every few minutes. It was one of the most beautiful displays of tenderness and familial unity I have seen in the past year.

Two weeks later, shortly before Edy was to be discharged, his twin sister, healthy save for a persistent cough that had recently worsened, passed away unexpectedly. The precious little daughter that Ana had longed and wished and prayed so long for- gone. She begged us to keep Edy at the hospital longer, terrified of what could happen if he fell ill as well. As she grieved for her daughter, she worried for her son.

During Edy’s stay, I began to notice that something was not right. He was sweet, and happy, and handsome, but his strength and coordination were not where they ought to be. He was late in reaching his milestones. He had all the markers for cerebral palsy or a similar disorder. 

In the absence of a “better person for the job,” I had to share my concerns with Ana directly. She listened intently as I stammered through an explanation of the possible results of Edy’s brief period without oxygen; normal child development and where Edy's skills fell; what this could mean for his future. I kept my words gentle. I still felt awful.

Ana had one question: “how can I help him?”

During Edy’s stay and throughout the 7 months since his discharge, I have had the incredible pleasure of working with Ana and Edy together. Ana is soft-spoken and says little, but watches her small son work hard to learn and develop with a joy and pride that is matched only by the worry that shows in her face when she talks about the fever he had for almost a month straight, and how the family recently sold every item of furniture they own, save for one bed, to purchase the antibiotics he needed to fight it.

Ana listens intently, watches even more intently, and shyly joins me in learning new techniques to help her son grow and develop. Edy’s slow but steady progress is a testament to Ana’s faithful follow-through on all of his “exercises.” 

At the end of our last visit, Ana went into the room that she shares with her son and husband and returned with two picture frames. A gift for myself and the social worker; a quiet, wordless “thank you” for coming- for caring- for simply trying to help. 

For reasons that I will never fully understand, Ana grants me, a foreigner several years younger than her who is culturally worlds apart, who speaks her language about as well as an 8-year-old girl, the trust to not only share in the joy of watching her precious son, her only surviving miracle, grow and learn, but to be an active part in it.

*****

There is Monica, mother to Jorge, who lived with us throughout her son's recuperation at Casa Jackson. In a culture where many women are raised to be meek and mild, Monica is outgoing and outspoken. She missed her two older daughters, being cared for in her absence by her own mother, but couldn't fathom leaving her infant son anywhere alone.

Monica was a wonderful presence for all of us. She was friendly with volunteers, helpful with the nurses, playful and attentive with the other patients. Monica has a sharp wit you'd more likely expect from a mother raising children in New York than in the poor village she currently lives in with her husband and three children. She kept us all laughing.

Every morning, Monica got Jorge dressed and completed his outfit with a hat. Sometimes a baseball hat, sometimes a beanie. As Monica swept and mopped each morning, she carried Jorge, little backwards baseball cap on his head, bouncing along behind her in a blanket on her back. We used to joke that he was our "little homeboy."

When I left each night, wrenching myself from Alberto's tearful, wailing arms, Monica winked and took him from my arms, off to some fun make-believe game or distraction, assuring me that she would take care of him. Her validation that yes, this little boy and I shared this bond and yes, he was in need of some extra love and attention during those times, meant almost as much to me as simply knowing that throughout the evenings and nights, a loving pair of arms was always there to hold him.

When the boy I've been seeing began visiting Casa Jackson, Monica didn't hold back. "He's going to be a good father someday, and by the way he looks at you, a good husband, too." I laughed and struggled to explain the differences between our cultures and upbringings that prevent me from feeling like I should, or even want, to have any of those things in the near future, let alone with someone I've only recently met. Monica waved my words aside with her hand and smirked. "I give it one year before he changes your mind. And I’m coming to the wedding." 

After a few more minutes of playful banter, I gave into her questions about why I myself couldn't imagine ever being ready for a husband or my own child. For the first time, I told a mother about my past. I wasn't the one asking the hard questions; I was answering them. I told her about the man I almost did marry; the drug addiction; the emotional and verbal abuse; the betrayal; the loss; the anxiety that still plagues me whenever I begin to care about someone.

As I spoke, I worried- what is she going to say? How can I expect her to understand, when she's faced so much in her own life? I'm just another gringa who has had it easier than her, complaining about my own 'hard lot.' When I finished telling her the whole sordid story, she let out a heavy sigh and gave me a sad smile. "They're not all like that. I promise you, they aren't. There are good men that wouldn't ever lie to you, do drugs, yell at you, or leave you like that. Jorge's father is a good, good man. I know I'm lucky. And you're going to be lucky, too. You take care of everyone here... You need someone to take care of you. And when you're ready, you will have a baby. You're already a mama inside. You can't hide it."

Monica and Jorge left last week. Jorge was scheduled for a minor surgery in one of the public hospitals. Monica kept her smile and wit flowing all morning. It wasn't until she stood at my office door to say goodbye that the tears began to fall.

"Miss, miss, thank you for everything... Thank you. I'm so scared, I'm so scared, I don't want to leave, I don't want anything to happen to my baby. He was so sick when I came here and now he's so healthy and what if I can't keep him healthy at home and he gets sick again and something happens to him and this surgery is small but it could go wrong and I'm just so scared and I don't want to lose my baby and what am I going to do without you all I don't want to say goodbye and I miss my girls and my husband but I want to stay with all of you where I know my baby is safe and healthy and thank you for everything, thank you, thank you..."

I hugged her tightly and fought back my own tears. I can't promise that Jorge won't get sick, no matter how hard she tries. I can't promise that the hospital won't commit some awful error during what would be a routine procedure in a different country. I can only promise that we will always be here.

*****

There is one mother whose story has been too painful to tell. 

Maria arrived at Casa Jackson with her husband and 10-year-old son late one Friday morning in February. Frank's father Juan carried him inside. Frank was pale, frail, and trembling. He was tall, but impossibly thin. He rested his head on his father’s shoulder for support, too weak to lift it on his own. 

Maria wrung her hands together and looked down at her lap as she and her husband recounted the story of the nightmarish 2 months that had preceded their arrival at our hospital. 

Frank had been fine; a healthy, happy boy who loved to go to school and play fútbol with his friends until he began having headaches several months prior. The doctors at one of the public hospitals had diagnosed him with hydrocephaly and placed a shunt (Frank did not have hydrocephaly). Immediately following the surgery, Frank deteriorated. He could no longer eat without vomiting; he could barely keep a few spoonfuls of chicken broth down. 

He lost weight quickly. Their once vibrant, energetic young son became sicker by the day. He came down with infections requiring expensive antibiotics that Juan worked from before sunup until 10 or 11 each night to afford. They brought him to clinic after clinic after clinic, begging someone to help him. Each doctor told them the same thing: “He’s dying. Just accept it and let him go.”

Maria and Juan couldn’t let it go. They couldn’t give up on their child; they wouldn’t. As his infections spread and worsened, they ate one meal a day- sometimes less- and Frank’s father began to sell the family’s possessions, one piece at a time. The tables and chairs. The appliances. The kitchen cabinets. Their once full home (Juan was a carpenter who took pride in his beautiful craftsmanship and had lovingly made a number of pieces of furniture for his small family) grew emptier by the week. Despite the antibiotics, Frank remained ill. And still, there was no help.

When Maria finished telling me her story, she took a deep breath, looked up at the ceiling, and then turned her eyes to me. Chin trembling, she begged me: “Please help my son. I have only him and his sister. I can’t lose my baby.”

I told Frank’s parents that he could stay in Casa Jackson, that we would do everything in our power to help him. We wouldn’t give up on Frank. His mother cried and hugged me and offered to do our washing, our cooking, our cleaning; anything at all to repay us. I told her that while she was with us, her job was simply to be with her son. Maria and Juan couldn’t seem to believe that there was no debt to be repaid, whether financial or otherwise.

Frank was in Casa Jackson for only three days. He suffered a series of seizures and needed to be rushed to an emergency room, where they refused to feed him or give him medicine because “he was going to die, anyways.”

His parents held onto their hope. We held onto ours. It was a heart-wrenching week. We tried so hard to find a solution; to find some way to help. We watched Maria and Juan as they watched their son fight for his life. 

No one knew what the outcome would be; no one knew what his chances were. We tried. We all tried. It was not to be.

Frank was sitting in a neurologist’s office in Guatemala City with his father, waiting for a last-minute consult pulled together through sheer determination and a tremendous amount of teamwork, when Frank began struggling to breathe. He whispered to his father that he wanted to go home. He wanted to hug his mother. They rushed home.

Frank passed away an hour later, surrounded by his mother, father, sister, grandparents, aunts, uncles, and cousins. His father invited us to the home to pay our respects that afternoon.

When we arrived, Frank’s family embraced us and cried as if we had known each other our entire lives, and not just that one short yet very long week. His father tearfully embraced us, thanked us, and recounted Frank’s last minutes as we, the team that could not save him, struggled to retain our composure. His grandmother, her head up to my mid-chest, wrapped her arms around me and repeated over and over through her tears, “Amy, my grandson... my grandson...”

Maria pulled me into her arms and sobbed without abandon. "My baby, my baby, my baby, my baby. He’s gone. Oh Amy, Amy, Amy... Amy, my son is gone." She clung to me as if I were still her last hope, as if Frank was living still, somehow, in the hope that I stubbornly held onto, after much of the team had accepted that yes, perhaps Frank was going to die, that made me so determined to push and fight for answers and a chance until the very last moment.

I held Maria and whispered my “sorries” through both of our tears. Sorry for her loss; sorry for my failure. Sorry that I watched a wonderful, dedicated mother lose a child that didn’t need to die; that would probably have survived had his family had the money to afford the costly but necessary private medical care; sorry that no one shared his parents hope sooner.

To hold a mother while she cries for the child she has just lost (a child you were entrusted with but unable to save), is to hold an immeasurable pain and grief in your helpless arms. It changes you. I just can’t explain how.

*****

These are only a few of the mothers I have come to know and love in this past year; mothers who have granted me the unspeakable honor of sharing their joy and their grief. I can think of few things in this life that I hold more sacred than their acceptance, their confidence, their trust. Some I know well; some I meet only in passing. I am overcome with love and respect for them all.

To the mothers near and far who have accepted me, trusted me, and allowed me to be part of their children's lives... to the mothers who have taught me more about life and myself than I could have ever taught them about their children's development... to the mothers suffering in a thousand unthinkable ways, who remain determined and strong... and of course to my own mother, thousands of miles away-

Thank you.

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.