What’s the Real Message Here?

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Not so long ago, I sat in on a twelfth grade psychology class. The topic was security and how everyone has to do their part to maintain security. After a brief lecture, the class split into groups. Each group developed and preformed a skit about one of the following topics: security in the home, security in the plaza, security in the community, security in the bus, and security in the school.

The skits were funny and covered a range of themes from helping old people on the bus (this skit poked fun at the Paraguayan buses…more on that later) to picking up trash in the town plaza.

One skit struck me more than the others, but not because of its security message. The plot: The stay at home mom had a lot to do around the house, and so she was unable to have lunch (the biggest meal in Paraguay) ready for the hour her husband came home. She had three daughters who at the beginning didn’t help her with the house chores—one was texting, one was watching TV, and one was painting her nails. One day the father came home and lunch wasn’t ready. He got angry and told the daughters they had to help their mother because he wants lunch ready when he gets home because he is hungry. After that, the daughters helped their mother and lunch was ready for the father when he got home.

I understand that the intended message of this skit was that everyone should contribute in the house. But, for me, the skit did a better job of illustrating power relationships and gender expectations.

I found it interesting that the reason the daughters had to help was because their father wanted his lunch at a specific hour. From what I’ve seen in Paraguay so far, most women’s prescribed role is taking care of their men. Women aren’t powerless here, but the last word is usually the man’s, especially when he’s the main breadwinner. I also noted that it was three daughters—this was mostly due to who was in the group developing the skit—but I think expectations for sons are different. The sons I’ve seen do help out, but few do many house chores.

For me, this little skit was a great example of how gender norms and expectations permeate through how we see everything in society. It made me wonder how a group of high school students would portray the same topic, security in the home, in the US.

Pondering Over Coffee

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FieldIt’s chilly, as in I’m not comfortable outside in my shorts. It’s before 7 am and I’m sitting in the dim kitchen drinking my daily morning coffee and eating my daily morning bread. It’s Saturday. My family started playing the polka at 6 am. Being a light sleeper, I gave up trying to snooze and brushed my teeth at 6:20 am.

The chicken that I thought was one of my best friends tries to steal my bread. The kitchen has a window without glass or a shutter and a door that stays open to the outside during the day. The cold air wafts toward me. I set my mug on my leg to warm up.

This morning, the coffee is already sweetened. That’s not always the case, but today it is. The coffee is syrupy, painfully sweet. It’s like liquid coffee-flavored hard candies.

A Paraguayan coffee recipe:

  • 2/3 – Hot water
  • Just enough to thoroughly color the water – Instant coffee or finely ground coffee
  • 1/3 – Milk
  • Many, many spoons – Sugar

Mix coffee and water. Add milk at the end of the cooking process. Add sugar before drinking.

Soaking my white bread in the coffee-flavored-sugar, milk-flavored-water I wonder why my family makes their coffee this way. In my past life, I didn’t drink coffee, but this is Paraguay.

In the shadows, I consume my coffee—reminding myself not to gulp it every time I lift my mug.  The new sun makes the trees outside shiny green.

“Oh, I get it,” I think. “I know why they use so much sugar in their coffee…it must be the cheapest ingredient, apart form water, in the mix. That’s it, they add sugar to make it taste like something.”

Somehow that realization is settling. I sip my coffee and dunk the last of my bread. I too would rather have sugar-flavored-coffee than coffee-flavored-water everyday.

2 More Myths About the US: City and Disposable Clothes

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ClothesWhen I was in college we talked a lot about globalization and how US culture is everywhere. I won’t argue that point, but I’ve come to understand that being everywhere and being understood everywhere are different things.

Myth 1: The US is only city.

The thought that the US is only city has a lot to do with movies. Most of the movies that make it to Paraguay about the US are set in a city. Actually, most of the movies I watched in the US are set in the city. I guess the city is more exciting. Being from the rural US myself, this myth was fun to dispel.

Myth 2: People in the US wear their clothes once and then throw them out.

The person who asked me about this heard it from someone who visited the US. I think the root of the confusion might have been that it seemed like people wore their clothes only once because people in the US tend to have more clothes than Paraguayans. In Paraguay most people I’ve known have a handful (more or less) of each clothing item. It’s common and fine to wear the same shirt (or outfit) multiple times a week as long as it’s clean. To ensure they always have clean clothes, many Paraguayans do laundry several times a week.

Meat

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CowI cannot describe the Paraguayan love for meat

So strong and not selective

 

It’s not romantic, but matter-of-fact

Nawing, slurping, cutting, chopping, slicing, pounding, breading, frying, grinding

It is not the cut that matters

 

Cow for the weekdays and pig for the weekends

Pork fatty bits seasoned and laced with cornmeal

Blood sausage or breaded and fried stomach slices

 

Bones with fat in a runny broth

Little bits in cheesy rice

Slices that are somewhat nice

 

Meat, carne, so’o, pork, chancho

Meat is king in Paraguay

(Chicken does not count as meat)

 

Slaughtering is a group affair

Kids know how to remove pig hair

The men slice and the women cook

 

It’s not exciting and it’s not passionate

The source of our food is very clear

This here pork came from over there

 

Paraguayans love their meat

It’s not secret but loudly announced

Meat desire.

 

A Day in the Life

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Serving in the PC is an emotion roller-coaster. Here is an example of my feelings and thoughts during a typical weekday. Palm trees

5:30 am – Tired: I wish my family wasn’t so loud getting ready for work and school.

6:00 am – Screw it: I’m not that tired, so I might as well get up. I have to pee anyway.

6:15 am – Yay: The morning is cool and the sky is gorgeous.

6:16 am – Pumped: I’m so productive when I start the day this early.

7:00 am – Reflective: Well, this coffee with bread is actually pretty good considering I didn’t like either before coming to Paraguay.

7:15 am – Relieved: Writing it all down in a journal makes it easier. I don’t know when I’ll be able to talk to someone about it anyway.

7:30 am – Excited: I’ll get to work early today. It’s going to be a good day.

8:00 am – Cared for: The people at the health post are awesome.

12:00 pm – Starving: I’m starving and really need to pee. How do Paraguayans drink so much terere and never need to use the bathroom?

12:30 pm – Reluctant: Just eat it. I should be thankful someone made me lunch…

1:00 pm – This sucks: It’s sort of hot and now I don’t know what I want to do or what I should do.

1:30 pm – Bored: Fine, fine, I’ll study Guarani…maybe I’ll read instead.

3:00 pm – Escape: I got to get out of here. It’s clearly time for a walk, run, or trip to the grocery store.

4:00 pm – Missing people: Is anyone in the states online? What are my g-mates doing?

4:15 pm – Grr: Of course no one is online; it’s still during the work hours.

5:00 pm – Satisfied: Most of my Paraguayan family is home. We are drinking terere, and I actually know what they are talking about (mostly)!

5:45 pm – Frustrated: I’m never going to learn Guarani. Why did my host brother have to ask me a question in Guarani so fast?

6:00 pm – Hungry but it’s okay: I don’t think we are having dinner for a while still. But, I feel so integrated and connected sitting here drinking terere.

7:00 pm – Greasy: Tortillas, so good at first, so bad later.

7:30 pm – Indecisive: Do I want to watch TV with my family, work on my novel, study, read, or plan charlas? …Is there another option?

8:00 pm – Calm: Watching this soccer game is engaging enough, and they are calling the game in just Spanish so that’s nice.

8:30 pm – Awkward: Everyone in my Paraguayan family is falling asleep and the TV is in their room. Looks like I should go to my room.

8:45 pm – Not tired: Now what?

9:30 pm – Doubtful: I think I’ve been productive today. I feel like I’m not doing enough.

10:00 pm – Defensive: Stop putting yourself down, you’re doing just what you should be doing.

10:01 pm – Sleepy: On that note, let’s go to bed shall we?

10:30 pm – Awake: Why am I still awake?

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.