Bad Habits

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Paraguayan skyWhy is the knowledge that something is bad for you not enough to make you stop doing it?

I’ve been thinking about this question a lot recently. When I tell Paraguayans that I’m in Paraguay to teach about health they jump right in and tell me how bad the Paraguayan diet is. Paraguayans tell me their food “has a lot of fat” or that the food “is heavy.” They tell me that there are a lot of people who are overweight, have diabetes, or have high blood pressure.

Next, Paraguayans ask if I like their traditional foods like sopa paraguaya, tortillas, and mandioca. They tell me they want to lose weight, but then put three tablespoons of sugar in the milk they are going to drink with bread. They ask, already knowing the answer, if they should eat fewer carbohydrates if they want to lose weight. They explain how they don’t exercise or eat vegetables.

I don’t know if the people I talk to know that different foods have different nutrients or that balancing calorie intake and calorie burn is the center to weight control, but it’s clear they know what they are consuming isn’t the healthiest option.

If they know it’s bad for them, why aren’t they trying to change it?

  • Is it habit?
  • Is it that they don’t know how to cook different foods?
  • Is it taste preference?
  • Is it cost?
  • Is it cultural heritage?
  • Is it a lack of information or understanding about what makes food healthy or unhealthy?
  • Is it something I’m not seeing?

In the past, I wrote about developing public health programs that encourage change by focusing on the out-of-box-experience. But, as I work in Paraguay, it’s daunting. Clearly, a lack of knowledge isn’t the only thing at work here. But what can I do other than provide information?

Where Public Health Fits Into the Health Picture

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ClimbingParaguay and Health Care

Every country has it’s own way of trying to protect its citizens’ right to health. In Paraguay, there is universal health care. This means that consults and medications are free. Well, at least that’s the idea. Most people have access to doctors and nurses trained in family medicine, but things get complicated when it comes to medications and access to specialists.

Every medical facility in Paraguay doesn’t always get all the medications it needs for its patients. (Paraguay is working to decentralize its medical system with the hope to reduce some of the bureaucracy that might be contributing to these shortages.) As for specialized care, it’s unsustainable for every health clinic to have specialist in all areas, so they are centralized regionally in hospitals and health centers.

These limitations sometimes mean individuals go without the medications or care they need. Public health has a role to play to help relieve strain on the health care system by helping people lead healthier lives in the first place.

Barriers to Medicines and Specialized Care When They Are Not Available in Local Clinics

The main barrier is access. When a local clinic doesn’t have a needed medication patients must either buy it or find a public health facility that has the medication.

For families where money is short or income is unreliable, it means individuals go without their medications—a scary thought in a land where hypertension and diabetes are leading conditions.

Traveling to another medical facility might also be out of the question. It costs money to travel—whether by bus, by dirt bike, or by car. What’s more, it takes time that individuals might not have. For those who work, they can’t be absent from their jobs. And, for those who are looking after a house, there’s food to cook, children to watch, and clothes to wash.

When patients have to travel to a regional facility for care they face the same challenges as accessing medications. It’s not uncommon for local health care providers to use their personal money and vehicles to help people see specialists. But, that is limited because it puts stress on health care providers beyond their normal work and their vehicles may not fit everyone who needs to see a specialist.

There’s no silver bullet for resolving barriers preventing people from the health care they need. But, one thing is for sure; the more we can do to help prevent illness the better off individuals will be. That’s why health education and providing individuals with advice on how to lead healthier lives makes a difference.

Hold Tight Folks, We’ve Got a Storm Coming

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Muddy road after rainIt doesn’t rain in Paraguay; it dumps buckets. We have days darkened by ominous clouds with sheets of rain. We have nights that boom with thunder and gleam with lightening. You’ll never go back to fireworks after you’ve seen a Paraguayan lightening storm light up the starless sky.

When it rains the streets become red rivers. We don’t have glass in our windows so rain beats against the shutters and drips down the wall. If you don’t have a good roof it will inevitably drip. In my current house the kitchen, bathroom, and bedrooms are in separate buildings and the only water faucet we have is outside—the downpour days are damp days. You can’t avoid water specks on your hair and shirt.

Children don’t go to school when it rains and sometimes work is cancelled. The buses run less than usual. Most people have dirt bikes, which don’t protect you from the rain. There’s too much mud to drive a car.

Because you have to close the shutters it’s dark inside. Early afternoon feels like early evening. The electricity flickers or goes out entirely, so you are trapped in the dark. You unplug everything, including the fridge, in case the power surges when it comes back. It drops 20-30 degrees Fahrenheit and wind rustles the trees. Sometimes the water stops working.

My dirt lawn is textured with little craters from the rain pounding into the fine rust-colored sand. The trash that is around our lawn is carried away by the rain. Old terere and food scraps thrown out days earlier are washed down downhill.  Water pools on the cobblestoned roads and the paths turn to quicksand and streams. I’ve seen it hale nickel-sized ice chunks. The rain hammers on metal roofs and patters on ceramic ones. The mosquitos come out in flocks.

I sit in the gray dark in my room and think about the houses made of wood slabs, metal roofing, and tarps I saw at the edge of my community. I doubt the people who live there can stay dry.

Turn On the Public Health

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Palms and ParaguayMy latest quandary (excluding all the integration and assimilation challenges I face) is not whether I will have work but rather where to begin. The community clinic and school where I plan to start my work seem open to have me do everything I can do to share information about health. What’s more, my school expressed commitment to teaching life skills and sexual health, my dream topics, along with all the other PC community health focus areas (plus some, like drug prevention).

I can see the need for public health education—from five-year olds with rotting front teeth to pregnant teens. It’s exciting to transition from creating health education materials in an office far removed from those I was trying to help to working with my target audiences directly. It’s a wonderful puzzle trying to find resources and find methods to convey information in a way that each audience will find useful.

It’s not going to be easy. I still don’t know how to say everything I want to say in Spanish (or Guarani). I don’t yet have allies in the community I know will help me or know if anyone will show up to whatever activities I do plan. I’m not sure I know enough about all the topics about which I’m supposed to teach.

I’m excited all the same. I have two years to give it my best shot. I hope by the end I’ve given at least a couple of people information they can use to improve their health and that of their loved ones.

I see a lot health presentations, lectures, games, and activities in my future. Don’t worry; I’ll let you know what works for me and what doesn’t.

Why Am I in Paraguay: Peace Corps Goals

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A Paraguayan viewI know the Peace Corps and its work sounds abstract, being hard to explain is one of the many challenges of international development. Before leaving for Paraguay, many people asked what I would be doing and I couldn’t tell them. Here is my post-training attempt to define my work as a volunteer.

The Peace Corps Goals

  • To help the people of interested countries in meeting their need for trained men and women
  • To help promote a better understanding of Americans on the part of the peoples served
  • To help promote a better understanding of other peoples on the part of Americans

Cultural Exchange

The first job (and inevitable outcome of a job well done) of Peace Corps volunteer (PCV) is cultural exchange. Cultural exchange means learning about your host country’s culture and sharing about the culture of the US.

As a PCV, I’ve lived with a host family almost 3 months now and will live with one for almost 5 months when all is said and done. Living with a host family gives me the chance to learn what Paraguayan family life is like, eat tons of Paraguayan food, and ask endless questions about social events, pastimes, and beliefs. On the flip side, it also allows my host family to ask billions of questions and allows me to combat myths about the US, share my music, share American food, and offer a new perspective.

Of course, this exchange isn’t limited to my host family or the time I will live with them. Through all my interactions with community members, including people just seeing me do what I do, we are exchanging culture. Also, this blog, conversations with friends in the US, and all the stories I will tell when I get back to the States work toward the cultural exchange goals.

Health Education and Public Health

As a community health volunteer my work toward helping Paraguay develop skilled men and women involves raising awareness about health issues and working to improve health environments. The community health sector goals in Paraguay are:

Goal 1: Improve hygiene and environmental health practices

  • Dental health: I could teach why brushing your teen is important and how to brush properly. It is normal in Paraguay to see children with visible rotten teeth and for people to be missing some or many of their teeth.
  • Hand washing and parasite prevention: I may teach kids how to wash their hands correctly and parents how to recognize if their children have parasites. The main types of parasites found in Paraguay are giardia, roundworm, and hookworm.
  • Sanitation Practices (trash management and potable water): There isn’t trash collection in most places in Paraguay so most families burn or burry their trash. Water pollution can be a problem in some areas of Paraguay because of sewage management and livestock, among other things. Many people don’t think twice before throwing trash on ground.
  • Cook Stoves: Many families in Paraguay use open fires to cook. The Peace Corps has developed several wood cook stoves that when built can improve cooking efficiency, reduce the risk of burns, and reduce respiratory problems aggravated by breathing smoke.

Goal 2: Reduce the risk of non-communicable diseases (NCD)

  • Non-communicable diseases education: NCDs are diseases that can’t be passed from one person to another. Some of the most common NCDs in Paraguay are diabetes, hypertension, and obesity.  I could provide general information about these diseases and teach about nutrition and exercise as a way to control and prevent NCDs.
  • Gardens: I’m planning to have my own veggie garden, help my school have a school garden, and work with anyone who wants help making their own veggie garden. Gardens are a great opportunity to promote healthy eating and diversify the veggies available to families.

Goal 3: Reproductive Health:

  • Life Skills: I will work with youth to help them expand their decision-making and problem solving skills, critical and creative thinking abilities, communication and interpersonal relationship strategies, self-awareness and sense of empathy, and stress and emotional strain coping strategies.
  • Sexual and Reproductive Health: I may talk to youth about what sex is, STDs, and family planning strategies.
  • HIV/AIDS: As part of reproductive health, I could work to educate youth about what HIV is and how it is transmitted. Also, through this work I can hopefully help reduce discrimination against people who are living with HIV.

The Lindo Factor

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Ceramic figurines made in Aregua.

Ceramic figurines made in Aregua.

Lindo means pretty in Spanish. And while it means that in Paraguay too, especially when talking about people, it also carries a deeper meaning. I like to call it the “lindo factor.” Let me come clean from the outset, I love the lindo factor. Actually, it’s one of my favorite things about Paraguay.

In short, the lindo factor is the emphasis Paraguayans put on making things look nice. Lindo doesn’t just mean clean and it doesn’t mean hygienic (and in Paraguay clean and hygienic are not the same thing). The emphasis is on how things look overall.

Let me describe the lindo factor from within my American upbringing and then expand it to the Paraguayan setting. My mother has always been keen on keeping the house neat, which to her means no dirt and no dust; things are put away in their places in an organized manner; and curtains, flowers, art, and other objects are strategically placed to make things look pretty.  In this context, the emphasis is on making things perfect. All this together, gives my mom’s house a serious dose of the lindo factor.

Now, in the Paraguayan context, as much importance is put on making things pretty and neat as in my mom’s house, but there isn’t the pressure to make things perfect.  There’s a lot of sand here in Paraguay so there’s always sand on the floor. There’s dust and spiders on the ceiling beams and the walls show dirt and water marks. Things like seat covers might be stained or slightly torn and the walls or doors might have children’s writing left over from the tender years. But, you will never walk into a messy Paraguayan home. There is a table cloth on the table, the floors are swept everyday, the dirt in the lawn is swept everyday, and sometimes you’ll find a ceramic figurine outside or a painting inside.  The first 3 feet of the trees outside might be painted white for no other reason than it makes them more “lindo.” Things might be piled on a table (because there are no drawers or shelves available), but nothing is left on the floor. Everyone in the house helps keep it clean.

The lindo factor is one thing that has made living in Paraguay easier for me. I’ve always felt that the neatness of one’s living space is a reflection of the neatness of her mind.

Cows in the Street

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cows in the streetIf you can overlook the fact that everyone is not speaking English and you’re never entirely sure what is going on around you, Paraguay can seem a lot like the US, especially the rural US. However, contradictorily, you would never mistake your life in Paraguay for that in the US.

So what makes the two countries different? What makes Paraguay a developing country and the US a developed country? These are hard questions, but here are some observations about Paraguay I think illustrate some aspects of life here.

Infrastructure

  • Dirt bikes are the most common mode of personal transportation. Buses are a critical way of going farther distances or to areas where you don’t want to drive or park your dirt bike. Along with motor vehicles, you will see ox carts and horse carts on the road.
  • If it’s raining school and work may be cancelled. We are in the sub-tropics; a heavy rain will turn streets into rivers that are fast enough to carry a child away. Dirt bikes don’t have roofs to protect you from the rain.
  • On the walk from your house to the nearest supermarket, your eyes and nose may sting because people are burning trash. Most areas don’t have trash collection so some of the easiest ways to get rid of trash are to burn it or bury it.

Daily Life

  • Paraguay has it’s own soundtrack. A soundtrack that blasts from almost every house from morning to evening.  Have you every heard the Paraguayan polka?
  • Most people and houses are well kept. I don’t mean to say they are flashy, because they’re not. “Humble” and “neat” are some words that come to mind.
  • The tablecloth serves as a napkin for whipping your mouth and as a cover for the table and then a cover for food left on the table. It’s not uncommon for family members to share one or two glasses while drinking juice, soda, or beer.

Personal Interactions

  • In your community, everyone you pass acknowledges you with a greeting, nod, or smile. Most people in your community are related.
  • You don’t just do errands, but rather you have conversations with people while buying things. A lot of shopping can be done at house-front, mini general stores.
  • Children live with their parents until they marry. Siblings are likely to share beds and it’s not uncommon to have several beds in one room.

Animals

  • Dogs run free everywhere. They aren’t trained; they aren’t de-bugged; and they aren’t spayed or neutered.
  • Except in the city, there are a lot of free-range chickens.
  • You can sit at a bar in the middle of a medium-sized town and cows will wander down the street by you.

 

 

 

Two Myths About the US

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Paraguayan SkyWhen I meet people in Paraguay, I expect to tell them that my state is close to New York and Canada because they’ve never heard of it. I’m excited to be the first one to talk to them about Vermont. Coming from a rural area of the United States, I think it’s fun to dispel the image movies and TV shows create of my country. Eagerness to teach aside, there are two myths many people in Paraguay have about the US that frustrate me.

Myth 1: Everyone in the US is blond and blue-eyed.

I think one of the challenges related to this is that Paraguayans don’t always realize how big the US is. They’ve heard of New York and some of our other major cities. But, it’s hard to describe to them that the US is about 24 times the size of Paraguay (Paraguay is about the size of California). We have cities that have more inhabitants than the entire population of Paraguay

Myth 2: Everyone in the US is rich. There are no poor people in the US.  

I had an interesting conversation with one woman who thought people didn’t have to work in the United States. I think she thought we get money from the government. If I wasn’t so interested in capitalizing on the teachable moment I might have laughed. When I left the US, people were still up in arms because some saw the new health care law as a government overstep.  In Paraguay, where government handouts were part of the system for the 30-odd years leading up to Paraguayan democracy, it’s hard to convey the “pull yourself up by your bootstraps” mentality that is the American dream. Many volunteers struggle against the perception that they are here to deliver money.  Even among development organizations the idea of development as a partnership of work is not as common as it should be.

It’s not for nothing that 2 of the 3 Peace Corps goals focus on cultural exchange.

The Journey to My Site: Top 10 Thoughts

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Peace Corps training ended in a hot second. Well, it was actually raining and not too hot. IMG_0310

After taking the oath, the other new volunteers and I only had an evening and morning to say goodbye, not only to our first host families and training staff, but also to each other. The morning after swear-in, Peace Corps drove us to various bus pick-up points so we could travel to our sites. We aren’t supposed to leave our sites for the next 3 months. It’s a dramatic change, especially after having so much time in training to chat with each other about our daily challenges.

When I arrived at my site I was numb. I’d stayed up late the night before wishing other volunteers in my group good luck. I’d also gotten up early to say goodbye to my family before they left for school and work. My new host family kept asking questions—about how I was, about my trip—it was so sweet of them to care, but I wasn’t ready to think of answers. I said I was tired, that wasn’t really the case, I didn’t know what I was.

Recall how you felt the day you finished high school, the day you moved to college, the day after you got your college diploma, and the first day of your first job after college, combined all those feelings, that is what it felt like to finally move to my site.

Top 10 thoughts while traveling to my site:

  1. How on earth am I going to bring all my stuff to my site using a commuter bus? Considering that I’m living here 2 years I don’t have much stuff, but I can still hardly lift my large suitcase.
  2. When will I see the volunteers from my group again? How often will I see them? During training I saw them daily (and that was comforting).
  3. Am I ready for whatever is waiting for me at my site? I hear I’ll have down times, up times, slow times, busy times, fun times, sad times…that’s a lot of times.
  4. Am I going to accomplish anything? Will I learn the language and get to know the community? Will people work with me? Will I be creative and come up with good projects to help people improve their health?
  5. No really, what are the next 2 years going to look like? They say every volunteer’s experience is unique, so what’s mine going to look like?
  6. Am I going to get sick? I don’t want a parasite or dengue. Actually, I don’t even want to have a cold while in Paraguay.
  7. How are the rent and other money conversations going to go? Paraguayans tend to be comfortable talking money, however I feel trepidatious.
  8. What am I not anticipating that’s going to be a challenge? Sometimes the unknown is the most stressful.
  9. Am I going to make friends in my site? Two years is a long time, in-site friends would make life more enjoyable.
  10. Who will I be 3 months from now? A year from now? Two years from now? I already feel like I’m a different person than the one who left the US (and that was just 10-ish weeks ago).

Taking the Oath

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taking the oathTen weeks and a billion new emotions later, I’m officially a sworn-in Peace Corps volunteer. Time flies when you are having fun, or maybe it’s when you are working hard.

The swear-in ceremony was simple and sweet. Peace Corps staff offered advice; representatives from my group gave pump-up speeches with inside jokes; our host government shared some touching words; and the US ambassador, well, had good things to say but his Spanish wasn’t very good.

We took a lot of pictures. It was overwhelming. As exciting as the oath was, many goodbyes and new things lurked and would inevitably follow. Peace Corps has changed my understanding of excitement. In the Peace Corps excitement and being petrified are inseparable. The two emotions together are a concise summary of my first months in Paraguay.

The oath is as follows:

“I, [name], do solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the duties of the office on which I am about to enter. So help me God.”