Week 8: Field Work in Mesbilja (Part 1)

            On Monday, Rahul and I took a combi to Oxchuc to meet Elena and do another pilot test. When we arrived, Elena (the translator from ECOSUR) met us outside of her shop in Oxchuc (about an hour from San Cristóbal). We walked with Elena to meet with a family and when we arrived, Elena asked the woman (who was carrying a little baby) the questions in my survey, which took about 20 minutes. When she was done, Elena asked the woman’s husband the questions in the “attitudes and practices” section of my survey. I was happy because even though Elena conducted the survey in tseltal, it seemed to go well and she told me the woman understood the questions. After Elena had pilot tested Rahul’s qualitative questions with the same family, we walked up a hill to another home. There we met another mother with a baby who invited us to sit outside her house. Because the woman could speak Spanish, Elena conducted my survey in Spanish so that I could follow along. There were a few changes that I needed to make to make the questions more clear, but overall I think the survey went well. After almost a month of working on my quantitative survey and making countless revisions, I think I am done!

Elena pilot testing my survey

            On Tuesday, I went to ECOSUR early to meet Marco Tulio and we drove to Oxchuc to meet with Elena again. After we picked up Elena, we drove along a dirt road to Tzopilja, one of the indigenous communities where I am hoping to conduct my study. When we arrived in Tzopilja, we looked for the Comité de Salud (Health Committee) to ask permission to conduct the study, but we were told that they had gone to Oxchuc for the day. Walking around Tzopilja, I only saw women with babies on their backs (all of the men were working in the field). We found one woman who worked as a promotor de salud (health promoter) for the Oportunidades poverty alleviation program, but unfortunately she could not read or write (and we needed her to read and sign a form that we had brought with us from ECOSUR). We decided to return to Oxchuc to look for the Comité de Salud. When we arrived back in Oxchuc, we went to a government building to look for the Comité, but no luck. We decided to drive to the second indigenous community (Mesbilja) and then return to Tzopilja on the way home.

            The road to Mesbilja was much less bumpy, and when we arrived it was clear that Mesbilja was a more developed community. We parked outside the Centro de Salud and found the Comité de Salud outside the building. Elena spoke in tseltal to the men from the Comité about my project and they read the letter that I had written explaining the project and requesting permission to conduct the project. They signed the form and agreed to let us come back on Thursday to start interviewing families (yay!). After we left Mesbilja, we returned to Tzopilja. The Comité had not returned, but we found another woman who worked as an auxiliador de salud in the community. Elena explained the project to her in tseltal and she told us that we could do the project. When we return to Tzopiljá to conduct the study, we will talk to the Comité de Salud. We returned once again to Elena’s hometown of Oxchuc to see if we could find Nati, another woman who has translated for ECOSUR projects in the past. Nati (and her 9-month old baby) agreed to come with Elena and I on Thursday morning to help translate the surveys.

On Wednesday, I went back to ECOSUR to make the final revision of my survey. After Rosario had reviewed my survey one last time, I went to a copy store to make 60 copies. That night, I took a combi to Oxchuc to spend the night with Elena in her home.

Naty administering my survey

            Thursday morning Elena and I woke up at 7:00. Because indigenous communities do not follow daylight savings time (only God has the power to change time), we woke up at 6:00 Oxchuc time. We met Nati (another ECOSUR translator) and her 9-month old baby and got in a car that would take us to Mesbilja. When we arrived in Mesbilja, we were surrounded by indigenous women with babies on their backs. We started surveying families and it was really cool to see my survey in action. Elena and Nati surveyed the women and men in tseltal (many women could only speak tseltal), and I surveyed the women and men who could speak Spanish. One of the men I surveyed said that his wife could not come because she was sick. Once we had finished surveying families, Elena and I decided to go with the man to his home in order to survey the woman. We followed the man along a dirt path, which turned into a rocky slope, and eventually became a narrow steep path surrounded by brush. The trip took almost half an hour, and it was only possible to reach his house (and the majority of the houses in Mesbiljá) by foot since the path was narrow, steep, and rocky. When we finally arrived at his home (with chickens pecking the ground outside), we entered a door and met his wife. She was laying in bed, clearly in pain. Elena spoke to the women in tseltal for a while, and as the conversation progressed, the woman started crying. Elena later explained to me that the woman had had one of her kidneys removed at a hospital (she had fallen, and when she fell, one of her ribs pierced one of her kidneys). She felt very sick, and to make matters worse, her son had gotten sick and had died three weeks earlier (Elena told me that he had high blood pressure). After listening to the woman, Elena asked the woman the questions on the survey and we descended from the house. As we walked, I couldn’t help but wish that I could have done something to make the woman feel better.

The house where the woman lived (and the path to get there)

            We headed back to Oxchuc around 5:00 (tseltal time=1 hour behind) and returned to Elena’s house. Her family was so generous during my stay – her husband heated water for me in a bucket so that I could shower with hot water. They also fed me copious amounts of delicious Mexican food and coffee that Elena’s father had grown. Wednesday night, I reviewed the surveys to make sure they were complete and organized the survey packets for the following day. I was (happily) was distracted by Elena’s two little girls and their friends who came into my room and (after they saw my camera) started shouting “foto!” “foto!”. I now have lots of pictures of cute little Mexican children.

Elena's daughter (left) and her friends

            On Friday, Elena and I woke up at 7:00 again and got in a car that would take us to Mesbiljá. After we had finished surveying families in the morning, Elena and I went to go look for the families who had missing information (i.e. in some cases we still needed to interview a woman’s husband). The houses in Mesbilja are very far away from each other and while looking for specific families, we had to asked people who passed by where they lived. In most cases, it took almost half an hour to reach the family’s house. While walking around Mesbiljá, I couldn’t help but think about how difficult it must be for these families to access any kind of health care. The houses are very spread out, and the paths to and from many of the homes are narrow, rocky, and steep (i.e. not something a very sick person could do on their own). Most homes are at least a half hour walk from the Centro de Salud, and are even farther away from the hospital in Oxchuc or Ocosingo.

Elena administering my survey to one of the husbands

            By the end of the day on Friday, Elena and I had surveyed almost half of the families from the list of 60 families in Mesbiljá. We will need to return to Mesbiljá to finish surveying the other 30 families, and then do our field work in Tzopiljá. Until then, I am going to relax and spend time with my boyfriend who is coming to visit next week!

Week 7: Mi casa es tu casa :-)

This past week, things at ECOSUR moved very slowly. I was hoping that I would find out the communities where I would work and that I would be able to go and ask permission to conduct my study. However, Dr. Ochoa did not return from Mexico City until Wednesday, and when he reviewed my survey he told me that I needed to pilot test again with the changes that he had made. I also did not find out from Dr. Ochoa what communities I would be working in until the end of the week, and there was some confusion about who would travel with me to translate my survey into the indigenous tseltsal language (Elena, the translator, told me that ECOSUR was not going to pay her what she needed). However, I continued working on my research project. On Tuesday morning, I went to the Secretaría de Salud to meet with a woman who works in the reproductive health office. She gave me some helpful information and now my survey is based off the information that pregnant women receive about risk signs and complications during pregnancy, birth, and the postpartum period. I also had time this week to start writing the background section and the literature review for my thesis.

Near our apartment

On Wednesday, Dr. Ochoa returned from Mexico City and I gave him a final copy of my quantitative survey. I met with Dr. Ochoa, Rosario, Roberto Solís and Elena about my research project. Dr. Ochoa talked with Roberto Solís about which communities I should work in. We also discussed how I would calculate my sample size. Because part of my survey will be given to only women (a section on obstetric history, a section on knowledge of risk signs and complications, and a section for pregnant women) and another part of my study will be given to women AND men (attitudes and practices with regards to complications), it has been somewhat challenging to calculate sample size. I am also worried that since my survey is now very long (and I will only be working with one translator walking from house to house in each community), I won’t have time to survey an adequate number of people for my analysis. Hopefully it will all work out.

This week there was a giant tent set up in the main square with a concert stage in the presidential plaza. After salsa class on Wednesday night, I went to see what was going on in the tent. There were lots of ecotourism agencies from different indigenous areas of Chiapas and other states in Mexico, including Oaxaca, Veracruz and Michoacan. I also went to listen to the concert going on across the street from the tent. There was a group singing in tsotsil, one of the indigenous languages in Chiapas.

On Thursday and Friday, the logistics of my research project finally started coming together. Rosario told me that on Monday, I will go with Elena to pilot test my survey in a municipality near San Cristóbal called Oxchuc. On Tuesday, Elena and I will go to two indigenous communities (Mesbiljá and Tzopiljá) where I will ask permission to conduct my research study. ECOSUR conducted a trachoma study in these communities in 2007, and Roberto Solís has a list of the families that were randomly surveyed. Dr. Ochoa explained that it may be easier to bring this list with me on Tuesday and ask the community leaders if it would be possible to survey the same families. On Wednesday and Thursday (if the communities agree to participate), I will hopefully be able to start my field work. Because Elena will not be available to translate again until the third week in November (she is also translating for another project), I am hoping I will be able to make some progress on my field work next week.

Thursday night, Rahul and I met our friend Paco and went to a birthday party for one of the secretaries that works at ECOSUR (there is always a birthday around here!). We chatted with some of the other people from ECOSUR and after a few hours, the salsa dancing started. When I return to the states in December, I am really going to miss the festivity that is ever-present in Mexico.

Rahul waiting for Ronni to meet us at the bus stop

This past weekend, Rahul and I went with Ronni (one of the nutrition students at ECOSUR) to his hometown of Ocosingo. On Saturday morning after a night filled with salsa dancing, I woke up and Rahul and I went to the bus station to meet Ronni and his friends. It was a beautiful day and after stopping for some breakfast, we drove to Ocosingo, which was about a two-hour drive northeast through the mountains.

I achieved my goal of riding in the back of a pick-up truck :-)

We arrived in the late afternoon and walked around the town of Ocosingo. On January 1, 1994, Ocosingo was occupied by the EZLN (Ejército Zapatista de Liberación Nacional). Not coincidentally, January 1, 1994 was the day when the North American Free Trade Agreement (NAFTA) came into effect. The Zapatistas wanted to call the world’s attention to protest the signing of NAFTA, which the EZLN believed would increase the inequality gap among people in Chiapas. The Zapatistas wanted the natural resources that were extracted from Chiapas to benefit the people of Chiapas in a more direct way and also desired autonomy from Mexico. When the Mexican army arrived in Ocosingo, the Zapatistas did not retreat and there was a lot of fighting. Ronni says that he remembers (as a 7-year-old boy) that everyone was afraid for their lives that day. Today, however, Ocosingo seems like a peaceful place with a small-town feel.

Driving to the ruins on Sunday in Ocosingo

On Saturday night, Rahul and I went to dinner with on of Ronni’s friends, Daniel. He is a middle-school teacher in a community outside of Ocosingo near the jungle. Later that night, we met some more of Ronni’s friends. One of them told us that we were the first gringos that he had ever talked to. On Sunday, we went to a Mayan archaeological site called Toniná with one of Ronni’s friends, Daniel. Me and Rahul rode in the back of the pick-up truck (one of my goal’s since coming to Mexico) as we drove through the beautiful landscape to the archeological site. When we arrived, we perused the small museum and then walked the path towards the ruins. It was a very hot day, but we climbed the stairs to the top of the ruins. The Mayans definitely picked a good spot – the view from the top of the ruins was incredible. After descending the steps, we got back in Daniel’s truck and drove to a nearby river, where families were picnicking and boys were swimming in the freezing water. We got some empanadas from a local food stand and walked along the river. Before heading back to San Cristóbal, we ate some food that Ronni’s mother had prepared for us. When we said goodbye, she said “mi casa es tu casa” and assured us that whenever we wanted to return to Ocosingo, we would have a place to stay :-)

Me with Ronni (right) and his friend Daniel (left) at the ruins of Toniná

Me and Rahul at the ruins of Toniná

Week 6: Always something to celebrate

Last weekend, Rahul and I rested and recovered from our first fieldwork adventure. On Saturday, we went out salsa dancing with Milton (I taught both Milton and Rahul some of the steps I have been learning in my salsa class). On Sunday, I revised my quantitative survey on the knowledge, attitudes, and practices with respect to risk signs and complications during pregnancy, birth, and the postpartum period. I also spent four hours in the Telcel Customer Service office trying to get my internet device (banda ancha) fixed. Despite being told to return to the Telcel office on Monday and Tuesday, they were unfortunately unable to fix it.

Home sweet home (our apartment is on the left right before the stairs)

On Monday, I met with Dr. Ochoa and Rosario about my research project. Dr. Ochoa suggested that I carry out my study in two indigenous communities in Los Altos, where ECOSUR conducted a trachoma study a few months ago. Next week, I will hopefully go to these communities to ask permission to do my research study. First, I need to discuss with Dr. Ochoa which communities I should choose: he suggested that I pick a variable to distinguish the two communities. I am considering working in one community that has a Centro de Salud (Health Center) close by, and one community that is far away from a Centro de Salud clinic. This variable may be correlated to the level of knowledge in the community with respect to risk signs and complications.

Map of the state of Chiapas and all of the different indigenous languages

On Tuesday, I finished revising my quantitative survey and arranged an interview with a woman who works with the Oportunidades poverty alleviation program at the Secretaría de Salud (Secretary of Health) in the capital of Chiapas, Tuxtla Gutiérrrez. I created an interview guide with the help of Enrique Eroza, which consisted of questions such as “what information do you think women need to have in order to have a healthy pregnancy”, “why do you think maternal mortality is higher in Chiapas than in other states in Mexico”, and “do you think the Oportunidades program has improved maternal health in Chiapas”. I was also hoping that the woman could help me find more specific information beneficiaries of Oportunidades receive about risk signs during pregnancy. Later in the day on Tuesday, I was told by Esmerelda’s husband that I should not travel to Tuxtla on Wednesday (as I had planned) because there was going to be a roadblock.

I love all the grafiti here...

On Wednesday, I met with Esmerelda and Elena (the translator at ECOSUR) to review my survey (again). Because many of the people in the communities where I will conduct my study only speak tseltal (different from tsotsil), Elena will need to translate my survey. After reviewing my survey (at around 1:00 p.m.), Esmerelda suggested that in factI should travel to Tuxtla Gutiérrez to meet with the woman at the Secretaría de Salud because she had heard that the road to Tuxtla was not, in fact, blocked. I quickly hopped in a cab and then got in a minibus towards Tuxtla. The ride was about an hour from San Cristóbal into the mountains, and I felt the climate change as we descended in altitude. After arriving in Tuxtla, I took a cab to the Secretaría de Salud building and found the Oportunidades office. I asked for the woman and someone directed me towards her desk. She was very helpful and gave me a health promotion book entitled “Cuaderno de la salud para madres de familia” (Health Notebook for Mothers) that had chapters explaining different health topics (including Pregnancy, Birth, and Postpartum). Unfortunately, the woman did not have any of the health promotion books I had found when we went to the Centro de Salud in Ramos Cubilete last week (with more specific information about risk signs during pregnancy/birth/postpartum), but she said that the Jurisdicción Sanitaria (Health Jurisdiction) in San Cristóbal might have this information.

Outside the Secretaría de Salud in Tuxtla (notice the palm trees)

I conducted my interview with another woman from the Oportunidades program, which lasted about half an hour. Unfortunately, there was a lot of noise in the background (phones ringing, people interrupting us, etc.) and the woman spoke very softly and quickly, so I had some trouble understanding all of her answers in Spanish. I recorded the interview so hopefully I will be able to get some help with the transcription process. After I finished the interview, I left the Secretaría de Salud and went to go find a café. No luck. Tuxtla reminds me a little bit of Los Angeles: it is incredibly spread out and you can’t really walk anywhere (no offense to people from Los Angeles). Being in Tuxtla makes me very glad that I am living in San Cristóbal, where there are cafés with wi-fi and you can walk almost anywhere. I finally hopped in a cab to the bus station where I could find a minibus back to San Cristóbal. I arrived back in San Cristóbal just in time for salsa class at Zirko :-)

This is what it looks like when you drive around Chiapas

(yeah I stole this from Google images)

On Thursday, I went to ECOSUR and worked on transcribing the interview I had conducted the day before. I also started to think about my sampling methodology, and looked for other similar KAP (knowledge, attitudes, and practices) studies in Chiapas. Next week when Dr. Ochoa returns from Mexico City, I will hopefully be able to get more advice from him about my study sample and begin to move forward with my fieldwork. I am starting to get anxious about starting my fieldwork because I know that I still have a lot of work ahead of me!

Friday morning I met Milton and he accompanied me to the Jurisdicción Sanitaria in San Cristóbal. We passed a lot of people in the street marching with signs. One man handed me a flyer that explained the “Marcha por la dignidad y respeto al trabajo”. Apparently, there has been no response from government authorities to allow hundreds of people to obtain a decent workplace in Zona Norte, a public market facility that was completed more than a year ago. The people marching were opposed to the privatization of public markets and wanted the state government to respect their right to work. Milton and I passed hundreds of people walking in the street and walked into the Jurisdicción Sanitaria, and I asked where I could find health education materials with information for pregnant women about risks signs and complications during pregnancy, birth, and the postpartum period. I was directed towards a woman named Beatriz Vera, who coordinates the reproductive health department. We arranged a meeting on Tuesday, so hopefully I will be able to get some helpful information for my survey.

Milton and I took a convi back to ECOSUR and passed his high school on the way. He mentioned that when he is done with his year of Servicio Social (Social Service) at ECOSUR, he wants to try to find work as a nutritionist at the Jurisdicción Sanitaria. Sounds like it is just as hard, if not harder, for recent graduates to find work in Mexico. Later in the day at ECOSUR, we celebrated the birthday of one of the ECOSUR secretaries (Carmelita) with a cake and popcorn. I love how despite the constant rain, there is always something to celebrate here in Mexico :-)

Carmelita cutting her cake :-)

Week 5: Our First Field Work Adventure

This week was definitely an adventure: Rahul and I went to a community called Ramos Cubilte to pilot test our surveys. On Tuesday, Rahul and I woke up at 5:30 a.m.  and hopped in a taxi to ECOSUR. We met Esmerelda, Elena (the ECOSUR translator), and Milton and Ronni (the two nutrition students). After a quick breakfast, we packed the ECOSUR van with three days worth of food, sleeping bags and mats, and two boxes filled with surveys. The drive north to Simojovel (a municipality in Chiapas north of San Cristóbal) was beautiful, blanketed in green mountains and rivers. As soon as we left Simojovel, the road changed from a one-lane paved highway into a dirt road. The further we drove, the worse the road became (and the more I started bouncing around in the back seat!). Because it was raining (it’s the rainy season here in Chiapas), the dirt road turned into a mud bath and, to little surprise, the wheels of our car started spinning. We were stuck. Time to get out in the mud and push the car! After about 30 minutes of trying to dig the car out of the mud and pushing the back of the car, we still had no luck. Luckily, a jeep filled with about 20 passengers traveling between Simojovel and Ramos passed our car and stopped to help us. Finally, the back wheels started to emerge from the mud pit and with one more push, the car was free! We paid our new friends 100 pesos for their help and piled back into the car.

The first time our car got stuck

The road to Ramos Cubilete (the community where we would conduct our surveys) became worse as we drove. Finally, at 3:00 (7 hours after we left ECOSUR) we arrived in Ramos Cubilete, where there was no cell service, no internet, and only one house with a working landline. There was a small church, but only one little store that sold chips and cookies, as well as water and basic supplies. We parked our van outside the new Centro de Salud clinic and Esmerelda spoke with the doctor at the clinic and one of the community leaders to ask permission to administer our surveys. They granted us permission and we brought our things to the old Centro de Salud clinic (next to the new one), where we would spend the next two nights.

Centro de Salud (new)

Esmerelda (purple shirt) and Elena asking permission to do the surveys

Esmerelda had a list of 40 families to whom we would administer the surveys (they were the same 40 families who ECOSUR interviewed in 2004 - the last time they came to Ramos Cubilete). The names of the families were called over a loudspeaker across from the Centro de Salud (everyone in the town can hear the loudspeaker), and people started arriving to our workstation in front of the Centro de Salud. While Esmerelda and Elena administered the surveys, Milton took anthropometric measurements (height, weight, waist circumference, and a hemoglobin test for anemia) and Ronni conducted a dietary recall survey for school-aged children. Rahul and I helped Milton with the anthropometric measurements and observed the entire chaotic process. That night (after we had finished surveying 5 families), we ate tortillas and refried beans for dinner and then went to sleep on the floor of the Centro de Salud clinic.

Rahul and I helping Milton with anthropometric measurements

On Wednesday, Rahul and I woke up with the rest of the ECOSUR team at 6:30 a.m. By 8:00 a.m., families were already lining up to be surveyed. In the morning, I was able to pilot test my quantitative survey on the knowledge, attitudes and practices of women and men of reproductive age with respect to risks signs and complications during pregnancy, birth, and the postpartum period. While administering my survey, I realized that many people did not know the answers to my questions (for example, one of my questions was “can you name any problems that can appear during a preganancy/birth?”). It may be easier if I list some of the events that can occur during pregnancy/birth and the person has to decide if it is ‘normal’ (such as weight gain during pregnancy) or ‘not normal’ (such as swelling of the hands/feet). Another problem with some of my questions was that many people did not know what ‘prenatal care’ meant (for example, I asked “how many times should a pregnant woman go to the Centro de Salud for prenatal care”). I may need to change this question to “how many times should a pregnancy woman go to the Centro de Salud for a check-up during her pregnancy”. Hopefully these changes will yield more accurate and helpful results when I conduct my field work in a few weeks.

Elena surveying one of the women in her home

After I had piloted my survey a few times, I helped Esmerelda and Elena administer the other surveys. Esmerelda would hand me a household survey packet and I would read the questions to the head of a family and record their answers. The first question asked the head of the family to list the names of all of the people who lived in the home. Many families had ten children: one family had children who were 20, 18, 16, 14, 12, 10, 8, 6 and 4 (and this family lived in a 1-room house). Another woman had three children who were under the age of five. While I was filling out the survey, all of the children would crowd around me, touching my blonde hair and laughing when I mispronounced or misspelled their names. Although the majority of the families in Ramos speak ‘Chol’ (an indigenous language), most can speak and understand Spanish very well. As I filled out the survey, I was surprised by the generation gaps: many parents could not read or write, but almost all of their children over the age of 6 could read and write (and many were even learning English in school!). In addition to asking questions about how many years of schooling each person in the family had completed, I also asked about occupation: I learned that all of the men worked in the field (‘campo’), while all of the women worked at home in the kitchen. By the time we finished surveying the last family (around 10:00 p.m.), we were all exhausted. After a quick dinner of tortillas and tomatoes (and cookies), I went to sleep on the floor of one of the consultation rooms in the Centro de Salud clinic.

Me in Ramos :-)

On Thursday, we finished the last of our surveys in the morning. Some of the schoolchildren came over to practice their English with me and Rahul and ask us about life in the United States. Before we left, a man came over to ask us if we could go visit the home of a sick man to check his blood pressure. I went with Milton to the home (a 1-room house with a concrete floor) and saw a man lying on a hammock, clearly in pain. His blood pressure was normal, but he was complaining of pain in his chest and his abdomen was tender. The family said that the doctor at the Centro de Salud told them they should go to the hospital in Simojovel or Tuxtla Gutiérrez, but the family said they could not find any money to make the trip. The family thanked Milton and I for coming to their home and we left. On the walk back to the Centro de Salud, we talked about how we felt useless, and that we wished there was more that we could have done.

Some high school girls who came to talk to us 

We left Ramos Cubilete around 12:00 p.m. It started to rain, and we began to worry that our car would get stuck in the mud again. Sure enough, the back wheels of our car started to spin and we got stuck. Not 1, not 2, but 3 times! The first time we got stuck, we were lucky because another jeep carrying passengers stopped to help us. We tied a rope between the jeep and our car and the jeep pulled our car out of the mud. The second time we got stuck, however, things didn’t look good. We had accidentally backed into a hole and one of the back tires was stuck. We waited until another jeep came by and again, the passengers helped us put stones in front of the tires and push the car out. A little but up the road, our car got stuck again, but luckily our new friends helped us push the car out again. By the time our car was cleared, everyone was soaked in mud.

2nd time (on the way back) our car got stuck

Feeling triumphant, we embarked on our journey home to San Cristóbal. We arrived back at our apartment around 7:00 p.m. and washed all the mud off ourselves. After a good meal (I am not going to eat anything that comes in plastic for a while) and a nice hot shower, we passed out. Soon, we will be ready for our next field work adventure :-)

Third time is a charm!

Week 4: Finding a Research Topic...

I have officially been in Mexico for one month! The time has definitely flown by and I am starting to feel more at home every day. I really like my schedule here during the week – I wake up every day and go to ECOSUR, where I work on my research project. At 4:00 p.m., I take the ECOSUR bus back to the center of San Cristóbal and rest a little before salsa class. From 6:30 – 8:30 I go to Zirko (where salsa class is held). The first hour, we practice basic steps individually, and the second half of the class we learn new steps with a partner. I am usually exhausted by the time salsa is over, and I come home and eat dinner with Rahul. At night I do some more work before going to bed.

Last weekend, I was alone because Rahul went to a wedding in Texas. I spent a lot of time in a café with a beautiful view of the city working on my health systems paper. On Saturday night, I got pizza with Milton, one of the guys getting his nutrition license at ECOSUR. After we ate, we decided to burn off the calories and walk up the steps of the Cerrito de San Cristóbal (a church), which had a great view of the city. I swear there is a church on every other block here in San Cristóbal. Later that night, I went to a birthday party for one of the people in my salsa class. It was really fun and I met one girl who grew up in California. I am always amazed at how friendly everyone is, despite the fact that many people probably think I’m a tourist (there are backpackers walking around everywhere in San Cristóbal). I am not a tourist :-)

Cerrito de San Cristóbal

On Monday and Tuesday, I went to ECOSUR to work on my research proposal. I read a lot of articles about maternal mortality in Chiapas, which is the state with the second highest maternal mortality rate in Mexico. In Chiapas, the majority of women who die because of maternal causes speak an indigenous language and live in rural areas. Between 2004-2008, 31% of the women who died because of maternal causes in Chiapas died at home (many indigenous women prefer to give birth at home with an (untrained) midwife). The families of these women decided not to seek medical attention (for financial, social, or cultural reasons), or when they did decide to seek medical care, it was too late. In my reading, I have learned that the ability to recognize a problem is one of the factors that affects whether an individual decides seeks medical care. I am interested in learning more about the knowledge, attitudes, and practices of indigenous populations with respect to risk factors and complications during pregnancy, birth and the postpartum period. Hopefully, this study could help determine a baseline level of knowledge of risk and aid in the implementation of an intervention to increase the level of knowledge about risk factors and complications during pregnancy, birth and the postpartum period.

On Wednesday, Rahul and I presented our research proposals (in Spanish) to Dr. Ochoa, Enrique Eroza, Rosario, Roberto Solís, and the other students from our research methodology class. After we had finished presenting our projects, we received some feedback. In addition to narrowing the objectives of our studies and figuring out the research design, we are also trying to determine the feasibility of doing the research. Hopefully I will have more information next week about the feasibility of my project.

A poster relating to maternal health in one of the indigenous languages (I think this is 'tsotsil')

On Thursday, I started to work on a draft of a quantitative survey for my project at ECOSUR. Next week, Esmerelda will be going to an indigenous community to do field work for a study on childhood obesity. Hopefully, I will be able to join her and pilot my quantitative survey in the community. After coming home from ECOSUR on Thursday, I went to salsa class and then had dinner with Rahul at a vegetarian restaurant. Although lots of people here look aghast when I tell them I am vegetarian, it has actually been incredibly easy to find vegetarian food here and all of the vegetarian sandwiches I have had have been incredible (although I do have to ask every time I order if it has meat!). On Friday, I finished a draft of my quantitative survey, which I will review with Rosario and Dr. Ochoa next week before going to the field. This weekend I am going to relax and hopefully do some exploring around Chiapas. There’s still so much I have to see!

Week 3: Becoming more mexicana...

On Saturday after the Independence Day festivities had finished, Rahul and I woke up early and went to San Juan Chamula and Zinacantán, two indigenous villages about 6 miles outside of San Cristóbal. Both communities speak tzotzil, which is very different from Spanish (for example, ‘thank you’ in tzotzil’ is kolaval – very different from ‘gracias’). Our first stop in San Juan Chamula was the cemetery, where we saw graves marked with black, green, and white crosses. Our guide (César) explained that the black crosses were for adults, the green crosses were for young people, and the white crosses were for babies. While the majority of the crosses were black, there were definitely a fair number of white and green crosses in the cemetery. We walked through the small town of Chamula and our guide brought us to the town jail, where there was a man behind bars. César explained that when someone commits a wrongdoing (such as being violet after drinking), they are brought to the jail. If they are male, they are put in a cell that is open to the public and everyone can see them in the cell (the women are not publicly shamed like the men). However, the maximum sentence is only three days. If they commit another offense, they have to do a year of community service. And if they commit a third offense, they are banished from the village. Pretty good judicial system, I think :-)

San Juan Chamula

César also brought us to the church in the center of town. While it looks like a western church on the outside, it is a completely different world on the inside. Before entering the church, we were told to put our cameras away because the people there believe that taking pictures inside the church may take the sacredness away (kinda makes sense, doesn’t it?). We walked in and stepped on pine needles, which covered the church floor. There were no pews, no altar, and no confession stand. Instead, there were hundreds of people kneeling on the floor, with dozens of different colored candles in front of them. Apparently, the candles (and their color combinations), different colored soft drinks, and even a chicken (yes, there was a man with a chicken in the church) are all part of the religious experience in San Juan Chamula [it amazes me how CocaCola has found a way to infiltrate an indigenous religion]. In Zinacantán, there was also a church, but inside there were pews, an altar, and a confession stand. However, our guide explained that the cross outside was not meant to represent the crucifixion, but rather, a tree.

Inside the church at San Juan Chamula (stole this from Google images)

On Sunday, I spent most of the day reading about Seguro Popular, a new health insurance scheme in Mexico that provides health insurance coverage for poor, rural, and indigenous people in Mexico. Unfortunately, I wasn’t feeling well on Sunday or Monday, so I just relaxed and worked on my health systems paper. On Tuesday at ECOSUR, Rahul and I had class with Roberto Solís, who does data analysis. He explained that ECOSUR uses SPSS for quantitative data analysis, so unfortunately I will have to learn how to use a new software system to analyze my data. We did a brief exercise using SPSS with Roberto, and fortunately it was not that complicated (there are buttons to click instead of codes to enter). Roberto Solís reviewed the different types of variables, including continuous (akaescala in Spanish), nominal, and ordinal. During the practice exercise, we also learned how to use SPSS to create contingency tables and do T-tests.

Wednesday was our last day of the research methodology class at ECOSUR. Dr. Enrique Eroza came to talk with Rahul and I about our initial thoughts for our research project. I have learned that maternal mortality is a huge problem among the rural indigenous populations in Chiapas, and so I am interested in doing a research project related to maternal health. I told Dr. Eroza that I was thinking about doing a project to find out the level of knowledge in the population with regards to maternal health and signs and symptoms of complications during pregnancy, birth, and post-partum. On Thursday, I met with Dr. Ochoa to talk more about my research project. He suggested that I do a KAP (knowledge, attitudes, and practices) study among pregnant women in the area of Los Altos, where maternal mortality is very high. Next week, he said he would help me set up a meeting with people from the Secretaría de Salud to talk more about the project. Next Wednesday, Rahul and I will present our research proposals to the people at ECOSUR, and then we will hopefully go to the field with Esmerelda next Thursday.

Institute of Health in San Cristóbal

On Friday, I worked more on my health systems paper and did some more research KAP studies at ECOSUR. Now that the class has ended, I have moved into an office at ECOSUR with Milton and Ronnie, the two guys doing research and getting their nutrition license. I’m on my own this weekend because Rahul left on Thursday to go to a family wedding in Texas, but I think I’ll be able to survive. I’ve been making some Mexican friends at my salsa class and at ECOSUR. I’m happy because I no longer have to dance in the gringo group or with the instructors at salsa class – I’ve advanced to the next level! Slowly but surely I am becoming more mexicana. The fireworks that go off during the day (just sound – no light), the random parades in the street, and the marimba music playing outside my apartment as I fall asleep are starting to feel normal :-)

Week 2: Viva México! Viva la Independencia!

Last weekend, Rahul and I went to go visit Rancho Nuevo, a cave system with a path winding more than ½ a mile underground. After we emerged from the cave, we walked around the coniferous forest surrounding the cave and passed lots of families picnicking. There was a small stable with a few horses and we decided to go for a horseback ride with a guide around the park (it was Rahul’s first time horseback riding!). Before leaving, we couldn’t pass up the irresistible smell of the food stands and decided to get some quesadillas. We took a combi (minibus) back to San Cristóbal and then walked up a street where the Institute of Health is located. It was a small building, but had signs on the walls reading “eat fruits and vegetables”, “exercise”, etc. We followed the same street until we arrived at the outdoor food market where we bought a few things for dinner. I also decided to add “Los Pinguinos Papa” (Mr. Popper’s Penguins) and “Los Pitufos” (The Smurfs) to my pirated DVD collection (shhh, don’t tell anyone) J

Rahul rode the black horse, I rode the blonde one :-)

On Sunday, I went for a long walk up Calle Real de Guadalupe towards the Iglesia (Church) de Guadalupe. The walk up the steps of the church was tiring, but it was worth it when I saw the view of the city. On my way down the hill, I stopped for lunch and got ‘chile relleno’ (stuffed pepper) and rice, which was incredible. My next stop was “Museo de la Medicina Maya”, a museum introducing the system of traditional medicine used by many indigenous people in the highlands of Chiapas. I watched a very interesting movie about midwives (untrained) in indigenous Mayan communities of Chiapas. The movie quoted a midwife saying, “sometimes babies don’t want to come out…then I have to talk to God and light candles so that the baby will be born quickly.” The midwife may try to speed up the birthing process by giving the pregnant women herbal tea or a raw egg. Once the baby is born, the midwife cleans the baby with an egg “to counteract the jealously of others” and cuts the umbilical cord. If the baby is a boy, the midwife cuts the cord at a length of around 20 to 25 cm so that when the boy grows up he won’t be afraid of heights and will have the strength to work. If the baby is a girl, the midwife cuts the umbilical cord at 15 cm, so that when she grows up and has a family of her own, she won’t be tired or suffer difficult births. The husband buries the placenta in the house: if the next child the family desires is a boy, the husband buries the placenta face down. Outside of the museum there was a medicinal plant garden with placards explaining the name of the plant, the medical use, and the part of the plant used. For example, the leaves and the stem of the “Sitit Vomol” (Vernomia patens) tree are used for treating diarrhea and post-partum bleeding. Very interesting indeed. I’m excited to learn more about traditional medicine in the communities I may work in.

'El Parto'

Medicinal Plant Garden

On Monday, we talked about designing health surveys during our research methodology class at ECOSUR. Surveys can be self-administered (where the person independently fills out the survey) or through an interview. Usually at ECOSUR, surveys are done through interview. The interviewer should speak the same language and come from the same region as the person being interviewed and should ideally be of a similar socio-economic status. Esmerelda showed us an example of an ECOSUR household survey. The survey consisted of questions about demographics, how many years of schooling each person in the family had completed, as well as their occupation. Other close-ended questions included, “do you have health insurance?” and “what do you do when you get sick?”. There was also a section in which the interviewer was supposed to ask whether any persons in the household had experienced any symptoms in a list provided (the list included folkloric conditions, such as “pérdida de alma” = loss of soul). The survey also included a section for the interviewer to fill out that could give an indication about the family’s socioeconomic status, such as the type of floor/walls in the house, the types of animals belonging to the family, how often the family ate meat, whether the family had electricity, water, a refrigerator, a radio, a TV, and/or a latrine in the house.

This week I decided to try out a salsa class that was recommended to me by Katy and Linda who went last year. The class is held every day from 6 p.m. – 8 p.m. I was a little nervous the first time I went to the class, but it turned out to be super fun and I have learned a lot in the 3 classes I went to this week!

Preparing for Independence Day

Tuesday during class we talked about indicators for the evaluation of health services (such as the number of hospital beds per 100,000 people). Dr. Ochoa also gave a brief presentation outlining the health system in Mexico. In the public sector, there are various health insurance schemes. IMSS covers roughly 50% of the population and is financed by the employer, the employee, and the government. ISSTE is like IMSS, but only for government workers (such as Dr. Ochoa – he automatically gets money deducted from his paycheck for ISSTE, even though he also chooses to pay for private health insurance). There is also SEDENA (for the military) and PEMEX (for workers in the Mexican Petroleum Company). For the “poblacion abierta” (the poor, rural, and indigenous populations), there is the Secretaría de Salud (SSA) that exists in every state and gives health services to the population without health insurance, as well as IMSS-Oportunidades (*not the same as the federal Oportunidades program) that offers services to rural, indigenous populations. Each health insurance scheme has its own facilities and health personnel. Seguro Popular is a relatively new insurance scheme that was created for the poor populations without health insurance and offers a packet of interventions through the Secretaria de Salud and IMSS-Oportunidades. There are also private health insurance schemes for those who can afford it. So, as you can see, the Mexican health system seems to be almost as complicated as the US health system!

The view from my walk up to Iglesida de Guadalupe

Wednesday and Thursday we reviewed qualitative research methods with Dr. Enrique Eroza, a medical anthropologist. He reviewed how to conduct in-depth interviews and focus groups. We also watched a very well-made and captivating movie titled “The Constant Gardener” (I recommend it to everyone reading this) about medical experimentation in Africa. On Wednesday after class, we passed people in the main square celebrating the acquisition of Chiapas into Mexico (187 years ago J). The square in front of the cathedral was filled with food stands selling churros, pizza, cotton candy and people sitting in the plastic chairs eating with their friends and family. That night, we had dinner with two other people in our class and went to a surprise birthday celebration for Esmerelda’s husband, Uriel. At midnight, we all waited outside Esmerelda and Uriel’s house and when the clock struck 12:00, a band started playing in the patio until Uriel emerged from his house. The band continued playing and the party ensued J It was a lot of fun, but we were all very tired during our class on Thursday!

Rahul and the piñata

On Thursday after class, Dr. Ochoa and Rosario invited us to their house for an Independence Day celebration. Their 3-year-old daughter, Ceci, greeted us wearing a pink dress that made her look like a Disney princess and we also met the family’s parrot, cats, and dog. We ate a very yummy late lunch/early dinner and then went outside for the piñata! Ceci and the other two children were very excited and did a much better job of hitting the piñata than Rahul and I J The party ended with a birthday cake for Uriel, Dr. Ochoa (his birthday is coming up), and, of course, Mexico! We stayed at Dr. Ochoa’s house for a while chatting and then at 9:00, we walked to the main square for “El Grito” (the shout). The streets were packed with people whose faces were painted with red, green, and white (the flag’s colors) and there were two giant stages set up in the main square. At 10:45, ‘El Grito’ commenced and everyone was shouting “Viva Mexico! Viva la Independencia!” Fireworks exploded in the sky and the Mariachi band began to play on the stage. Rahul and I met up with Paco, another person who works at ECOSUR, and we celebrated 201 years of Mexican Independence with Paco and his friends J

Rosario and her daughter, Ceci

It’s amazing how easily Rahul and I are accepted here. Despite the somewhat strained US-Mexico relations, I never feel judged here and everyone we have met has been kind and welcoming to us. There is a wonderful sense of community and constant celebration of life among friends, family, and even strangers. It’s something that I think the US could learn from J

Dr. Ochoa (right), Ceci, and Uriel