HBI’s Medical Director, Dr. Robert Gehringer, just returned from a month-plus long trip all around Perú. Traveling with our colleague, Srta. Lidia Ruiz, Dr. Bob made his way through a number of trains, planes and automobiles. Check out the following brief excerpt from his travel diary:

So after a 5-6 year hiatus, I’m finally back in Iquitos in the Amazon, the world’s largest city absent road or rail access.  In this city of 400,000 it’s amazing to recognize that almost everything, from the concrete and steel I-beams to plastic waste baskets and beverage straws, all arrived by boat, generally up the Amazon from Brasil.  Stepping off the plane a wall of humidity greets you.  Last night while on the malecón sipping a cold Cusqueña after a light rain shower the relative humidity was actually 99% according to my weather app, air almost water.  With the enthusiastic support of Rosana Chumbe, the new regional decana of obstetras (midwives), we’re trying to resurrect their pandemic challenged inactive newborn resuscitation training program.

We rode into the city in a mototaxi, the first of multiple excursions.  There must be thousands in Iquitos.  Small underpowered motorcycle in front that widens to form a bench seat over the two back wheels.  They haul everything and actually are a pretty cheap and efficient way to get around.  Open air with a roof for the rain in this always warm place, weaving in and out of traffic and shooting through intersections as long as the red light had only recently turned.  I much prefer them to taxis.

Sunday evening on the malecón, the walkway along the broad Río Itaya adjacent to downtown, all was alive with activity.   Pandemic masking seems a bit more lax here than in other Peruvian cities, though quadruple anywhere in the midwest.  Families out for the evening, street food, vendors of balloons, jewelry, candy, street performers, tarot card readers, whatever.  I love the energy.  The flip side is that poverty is still omnipresent with no shortage of folks asking for a little money and looking like the need it.  Iquitos didn’t seem as creepy as in past visits: no long beckoning looks from ladies of the night, and fewer old gringos (who unfortunately look like me) hanging out to sample the local sex trade.  As the distinctive aroma of marijuana occasionally drifted by and regatón pounded away in the background, Lidia, my HBI colleague and my computer and online training expert, and I enjoyed dinner under a large table umbrella at El Mesón, a couple small lizards nervous on the adjacent wall.  Our classic food from the jungle included cecina, cured pork with a bacon taste and none of the fat.  Tacachos, balls of mashed cooked plantain with bits of crispy pork, spices, etc.  Lagarto, local cayman, like a McNugget (yes, tastes like chicken).  Chonta, ribbons of palm heart, like very long thin fettuccini.  And yuca, manioc root cut and cooked like french fries, punctuated with a delicious hotsauce of cocona, a tropical fruit.  All enjoyed with a second cold Cusqueña, the bottle sweating in the heat, as was I.  Not in Kansas, Dorothy.

Lidy always wants to practice her English and me my Spanish.  I’m in Perú, afterall.  It seems that whenever I’m with my bilingual Peruvian friends, the conversation turns to the commonality of food and the idiosyncracies of Spanish and English, so we covered both, flip-flopping languages, then indulged in shared observations of the idiosyncracies of our coworkers and today’s workshop students.

After unusually smooth travel to 9 cities, we arrived at the airport today two hours early to find that we hadn’t been notified of a schedule change and our flight had just departed.  Rebooked for late tonight, ergh, we salvaged the day with lunch at a unique restaurant floating in the middle of the Río Itaya.  More cecina and chonta plus paiche, a huge freshwater fish from the Amazon, all in a sweet maracuya sauce, with camu camu juice to quench the thirst.  It’s tough to find camu camu at the Menasha Piggly Wiggly supermarket.   So, Iquitos revisited, 2022.

Random Perú Observations . . . .

About and hour into my flight from Lima to Atlanta after a month in Perú traveling among 9 different cities to resuscitate, post-pandemic (hopefully the worst of it), the Regional College of Midwives training programs. It generally went well though predictably a few trainers have dropped out and there has definitely been some learning loss since early 2020 as they hadn’t been able gather in groups to do any workshops.  Two steps forward, one back.  My wonderful HBI colleague, Lidia Ruiz, and I hopscotched by air, bus, and car through Lima, Arequipa, Huánuco, Tumbes, Piura, Chimbote, Cusco, Cajamarca and finally Iquitos and back to Lima, covering the coastal desert, the Andes, and the Amazon.   A few random impressions along the way.In Lima, the work was mostly to reaffirm our 8th year of connection with the national College of Midwives as well as to establish new planned relationships with the national College of Nurses, the Peruvian Society of Pediatrics, the National Childrens Hospital, and the Universidad Sete Septiane with its several campuses around the country.

It seems we’ve been able to establish a bit of program and organizational credibility, as each of these potential Peruvian partners is moving forward at different stages toward a formal relationship with HBI.  The Spanish saying is “Al dicho al hecho, hay un trecho.”  Literally translated, “From said to done, there’s a trench.”  We’ll see where it goes.Fresh wonderful seafood!  It’s said that some housewives will refuse to buy a fish in the market if it isn’t still gasping.  I can’t get enough of it, from great sushi and sashimi last night in Lima, ceviche in Callao on La Punta, to mahariscos in Tumbes.  Mahariscos was new to me, cooked mashed plaintains with a variety of seafood mixed in, especially shrimp, spiked with a tasty salsa ahi (spicy).  I’m a fan.

On Sunday afternoon in Piura, the older waiter brought us two whole fish, freshly caught, and we chose between a mero and some kind of sole.  We picked mero and he then fileted half and served us ceviche and then roasted the rest of the fish for our entree, appointed like a piece of art.  Buenazo!  All this thanks to the abundance of the cold Humboldt Current flowing north along the coast.Added to 11 flights, our land travel was limited to the coast from Tumbes to Piura to Chimbote to Lima.  The first leg was an easy 6 hour daytime bus ride to Piura.  I now veto any suggestion of overnight buses, as I’ve had more than enough of those.  Piura is a fairly large city, almost always hot and sunny, la Ciudad del Sol.  In 1516 it was Spain’s first city in South America thanks to Pizarro and his band of invaders.  However, well before the Europeans imposed themselves, there were sophisticated cultures here with ruins dating to 3000 BC, contemporary with the cultures in Mesopotemia, the Nile Valley, the Yangtze Valley, and Meso America.

We stayed at the Hotel Los Portales, a classic old hotel at the corner of the Plaza de Armas, the original building constructed as a hospital in 1678, then converted to a hotel in 1912 with a “new” addition in 1943.  My corner room, overlooking the Plaza had tall windows, 15 foot ceilings, beautiful wood floors, and 8-9 foot doorways, not to mention a very comfortable bed.  The bar, Marquéz, is my favorite in all Perú.  Lovely wood paneling, old black-and-white photos, comfortable soft chairs, and barmen who were real pros.  They make a great Capitán (like a Manhattan with Pisco).  We hosted the midwife trainers there after our two days of work together.  They were a fun and baudy bunch as with the second round the laughing conversation tumbled to dildos and little bottles of aphrodisiac scents, neither in my experience.  I think it’s because the midwives spend so much time working somewhere below the waist.

The next day in a private car, Montalvo took us south for 9 hours to Chimbote.  Montalvo was a quiet 30-something guy who drove predictably but rapidly, topping out a few times at 92 mph, but at least on straight divided highway.  On the two lane roads we weaved in and out, often passing in spite of an oncoming motorcycle or mototaxi.  The unwritten rule and expectation is that the smaller vehicle will slide to the side when confronted.  Hopefully, everyone gets the memo.  The coastal desert was stark, often just sand and rocks to our left and the ocean on the right.  Further south large agribusiness farms were green and irrigated with everything from asparagus to rice to grapes and avocado trees.  The small cities and little towns along the way tended to lean to the ocean, often a fleet of small 30 to 60 foot commercial fishing boats anchored in a bay, nets and rigging at the ready.  The towns had a certain unkept sameness, so many dusty buildings, rough red brick with sentinels of rebar extending skyward from the roof in hopes of better days, another floor to be built when funds allowed.

Currently, Perú’s vaccination rate far exceeds the US and COVID prevalence is blessedly low.  Though masking is still almost universal, even outdoors, they’re beginning to lighten up.  Fist bumps to handshakes to cheek touches and hugs.  Hooray!!Happily home later today, and planning no thoughts of newborn resuscitation for a while.

Resilience.

We talk about resilience a lot in the work of HBI. It is the foundation of our efforts with the boys living in the Casa Girasoles program. It is a critical part of our advocacy and support for the families in the Ines Project.

But what does resilience mean? I learned firsthand over the past couple of weeks. My family experienced a very untimely and unexpected death, as many of you know. It has been challenging. Thank you for your thoughtful messages and kindness.

The impact of this experience – is not something that will magically go away. The healing will take time. It will take healing relationships and meaningful connections. It needs space. It needs a place to find support.

Recovery requires intentionality and purpose. This is what I am learning about resilience – it is not something that happens to a person as much as a process that unfolds with other people.

This same commitment to space and place is what makes our work with children who have experienced abandonment and homelessness communities who have lived through trauma and marginalization not something we can measure in days or weeks. We need to commit to the long-term and build deep, supportive relationships.

Our Center of Excellence project is working to chart a path for training staff working with children living in orphanages, group homes, and residential care facilities to build resilience. Over the past year, we have partnered with the NGO Paths of Hope and Thomas Jefferson University (Philadelphia, PA, USA) and La Catolica Santa Maria Universidad (Arequipa, Perú. When we started the project – a five-year research study – I naively expected to have a curriculum planned and ready to roll out within a year. Oh my goodness, was I wrong?

Instead, we are finding that training staff in core concepts and skills is just a tiny part of helping to build a culture of resilience. Our biggest challenge is enhancing a culture, an environment, and a community to be pathways to resilience. Now, as we bring the first year of our five-year research to a close, I realize that our actual work is about connection . . . and this is not something that can be rushed or pushed into a small box.

This thing that we call resilience – is about space and place, and it is about people connecting with people. That’s profoundly healing.

Thank you for all your warm wishes and support. We are in this together.

We just got back from vacation. Our trip to Cabo San Lucas was a reverse “staycation.” We did not go anywhere – no restaurants, no trips to the beach, no excursions, just pool time, daily walks, and lots of family time. We spent our entire week in México at a rental house. It was awesome.

One of my jobs on the trip was to keep the pool floats blown up. Every time I had one float finished, it seemed like another would require more air. This went on all week.

In all my inflating of rubber floats, I recognized a pattern. The initial phase of inflation is challenging. There is a lot of resistance and pushing air into the float requires loads of energy. However, there comes the point where things ease up when the air flows with less struggle, and the impact of all my huffing and puffing becomes more visible. Then, I would reach a final phase – let’s call it the last 10% – and the process would get arduous again. I mean, really demanding. Almost to the point, I wanted to give up. However, the last 10% of the effort made the pool float work. The final bit of air made a raft my wife could float on versus sink.

I noticed something in this endeavor. Aside from the satisfaction of accomplishing something tangible, there was a pattern metaphoric for our work with HBI.

The initial stages of our efforts are challenging. There is a degree of uncertainty as to whether or not we can accomplish our goals. Then, as we settle into the project’s work or the program’s tasks, things lighten up – they get easier. Finally, there is a push – a sort of last effort – and this is often the most challenging.

For over 25 years, we have worked in Perú’s child welfare sector through critical partnerships with academic institutions, subject matter experts, hospitals, youth ambassadors, and government agencies in the country. Over many years, our focus shifted from delivering services to training and assisting many organizations working on child abandonment, homelessness, and child welfare services. This shift required a different input of energy.

This phase in our organizational development is a bit scary and exciting. We are at a new stage, and it requires a renewed effort. As we venture forward, we are focused on helping to construct the systems and structures of care that can genuinely change child welfare. Shifting our focus to systems development – Centers of Excellence – does not mean we are less attentive to the needs of the women and children we serve. No, we are even more concerned about their needs and now find ourselves wrestling with the structures that will be sustainable.

Each phase of our organizational development included many lessons and learnings. The most critical is the need to continuously involve community stakeholders and representatives in all our work. Having strong community-based partners helps shape projects and programs that meet local needs and ensures a sustainability plan. This is the last 10% of our efforts – and it is challenging. It is the phase of our work that requires constant attention and effective communication. It is the last push of energy that makes everything worth it.

Check out our 2021 Year in Review – we are super excited to share all the amazing work you helped us do! Thank you for all your continued support.

I’m a big fan of the late Irish poet and philosopher John O’Donohue.

O’Donohue writes with such depth and clarity that his work is timeless. I recently read some of his poems, and I found his words to be critical in the current world challenges.

The essence of life is beauty. Not the type of beauty that can only be found in culture or aesthetics, but the beauty found in depth. A deep understanding of complexity transforms this type of beauty. O’Donohue is quoted as saying, “If our style of looking become[s] beautiful, then beauty will become visible and shine forth for us.” This statement resonates strongly inside of me. I feel so fortunate to be called into communion with so much beauty regularly. I am blessed to be enriched by the deep beauty of an almost 30-year marriage and the immeasurable power of a healthy and happy child – but more than that, I am enriched through service and commitment.

There is nothing easy about the work we do with HBI. So much of what we do is about continuously showing up in the lives of others. It is about commitment and connection. This is true beauty.

I am back in Lima. I arrived a couple of days ago. I am joined on this trip by two important supporters of HBI’s work. This afternoon we took them out to some of the most impoverished communities in Lima to visit with families in our Ines Project. We will call one of the families, the Alvaro’s – and they live at the top of a long flight of stairs high on a hill. Their home is a mishmash of discarded wood and poured concrete – the fruits of years of saving and a multitude of informal jobs. The government deems them ineligible for assistance because they have a poured concrete floor.

Juan, not his real name, is enrolled in the Ines Project. At 12 years old, he has a constellation of congenital, developmental, and physical challenges. Juan’s brother, who lived with similar challenges and was also enrolled in the Ines Project, recently died from complications associated with his condition.

Juan lives in a wheelchair, and the concrete floor is a true blessing for the family. Whenever Juan has a medical appointment – which is often – Sra. Alvaro must carry him on her back down and back-up the long flight of stairs. She performs this activity many times a week. She does it with such love and dedication. She is the pure embodiment of beauty.

While visiting the Alvaro family, I took a picture. In the photo, Señora Alvaro is looking over her dear son with the eyes of love. The depth of her gaze speaks volumes. This is true beauty.

The poet John O’Donohue would be able to memorialize the moment in more eloquent prose. I will end this post with his rich teachings – wow, talk about beautiful.

 

“May the nourishment of the earth be yours,

may the clarity of light be yours,

may the fluency of the ocean be yours,

may the protection of the ancestors be yours.”

— John O’Donohue.

I bet you’ve heard some version of the Loren Eiseley short story about the old man and the starfish on the beach. You know the one . . . okay, in case you don’t, let me start with an adaptation of the story –

Once upon a time, an old man used to go to the beach every morning. He had a habit of walking on the sand every day. One morning, he walked along the shore after a big storm had passed and found the beach littered with starfish in vast directions. So many starfish, it was almost overwhelming. 

Off in the distance, he noticed a boy walking along and pausing every so often to bend down and pick up an object and throw it into the water. As the boy got closer and the man called out and inquired what the boy was doing. “Hi, good morning! Can I ask, what are you doing?,” the old man said.

As the story goes, the boy paused, looked up, and replied, “Throwing starfish into the ocean. The tide has washed them up onto the beach, and they can’t return to the water on their own,” the child replied. “He went on to say – “when the sun gets high, they will die unless I throw them back into the water.”

The old man replied to the child with astonishment, “But there must be tens of thousands of starfish. You won’t be able to make much of a difference.”

To this statement, the boy bent down, picked up yet another starfish, and threw it as far as he could into the ocean. Then he turned, smiled, and as he walked away, said, “It made a difference to that one!”

Great story, right? I just don’t know. I felt an urge to push back on the story for the longest time. To say we can’t settle for such low expectations. We need to do more. We need to help more. I still feel that way. Then something happens to remind me – to nudge me back. Yesterday I had two such experiences.

While out on my morning run, I passed a young man sitting in a guard shack in a wealthy neighborhood. He and I made brief eye contact through our masked-covered faces. He looked despondent. I’m not sure why, but I stopped running and went over to talk with him. He was from Venezuela. He came to Perú to find a better life. He told me about the challenges and struggles he faced every day. He talked about the feelings of humiliation in not knowing where his next meal would come from. He confided that every job he could find wanted to pay him only a portion of what they pay Peruvian laborers. He told me of his dream to start a business with his father one day. His story really hit me. While I was talking to this young man about the same time, I was aware that a dear friend was with his dying father thousands of miles away, back in Portland. It suddenly struck me when one life ends, another begins. I ran back to the hotel and grabbed some money. I went back to the young man and said I wanted to make an investment in his business. I told him about my dear friend’s father and that the investment was in honor of his life. He cried. We both did.

Later that day, while returning on a bike ride with the boys from the Casa Girasoles, we passed a young man walking on the side of the road. He caught my attention, if for nothing else because he looked too young to be by himself walking with a backpack and dirty clothes. Once we got the boys back to the house, I asked the director of the Girasoles program to ride around with me to check on the young man. He was not a day over 14. He told us he had walked from Lima. The director felt he was on drugs. I told him I thought the young man was having a psychotic break. In any event, he wanted nothing to do with us. I asked if we could at least buy him some food and water. He reluctantly said yes, but cautiously stayed a reasonable distance away from us. Once we got him some food and a big water bottle, he said he needed to leave and walked away. Back at the Casa Girasoles, we called the Peruvian equivalent of child protective services. The officer told us they would send the police to check on the young man – but he said there was little they could do if he was on drugs or had a mental illness. I asked the director if there was anything we could do. He said it was really hard, but the answer was no. He said that the police would likely pick up the boy and immediately call us [the Casa Girasoles] and ask if we could take in the young man. He went on to say that without a unique facility or qualified staff, it is tough to bring a young person with mental health and substance use challenges into the home. He told me the system just wasn’t prepared to handle the needs of such children. I felt devastated.

This is hard work. I am reminded every day, there are no simple solutions. I am, however, also reminded that it does not mean we shouldn’t try to help. We are trying to make a difference in the lives of the children we are called to serve – and build the models and framework that will one day prevent child abandonment and fractured families. Sometimes I just need to remind myself that we need to do both simultaneously.