My Tandana Experience

Drs. Hugh and Ash use a portable fetal doppler to check the health of a baby.
Na takes vitals to prepare patients for seeing the doctors.

by Hugh Chapin

After confirming and re-confirming the critically high blood pressure measurement, I realized that the calm, smiling woman sitting in front of me in her traditional indigenous clothing was not aware of the severity of her situation. She only knew that she had run out of money for her medications and she might as well come see the visiting doctors since they’re here. After all, she didn’t even mention the pesky vision problems, and intense, intermittent headaches and falls until I inquired after accepting the blood pressure measurements. It harkened back to all the literature on hypertensive emergency I had studied in medical school and it was instantaneously clear that I was currently the only one cognizant of the hypertensive time bomb in front of me that could go off at any moment.

This was the beginning to one of my most memorable patient encounters during my first humanitarian medical aid mission. While living several years as an expatriate, I followed the world of humanitarian medical aid organizations with great intrigue, admiration and a feeling of purpose and was resolved to some day explore a niche for myself within that sphere when the time was right. Through a bit of serendipity I discovered the Tandana Foundation in 2011 and became intent on volunteering on one of their Health Care Volunteer Vacation (HCVV) trips and the day I had often imagined finally arrived during the HCVV of March, 2012.

Before leaving my home in New York City for a country I knew little about, I was filled with excitement and forced myself to buffer any images or expectations of what would be, with the inevitability that the reality will be vastly different from any image my mind could conjure. In essence, try not to get excited about the fast-approaching unknown. What a tall order that was!! And how wonderful the unknown turned out to be, as I continue to learn from my experience as I reflect and savor each memory.

My ‘HCVV experience’ with Tandana Foundation was just that….an experience: Personally encountering or undergoing something. A shared experience yet each person takes away their unique perspective. Here are some thoughts from my perspective on my ‘Tandana experience’.

As a young physician, the medical aspect of HCVV: providing medical care to rural, under-served communities, was my driving force to take part. Leading up to the trip I focused on what interesting cases might present, what diseases, parasites and pathologies were unique to that region, and how patient encounters would compare to what I knew from home. During the trip; however, I discovered other aspects and intricacies of the ‘HCVV experience’ apart from the medical. They were just as memorable and not quite as foreseeable. It was often unexpected moments interacting with the group that were most euphoric: a coming together….a sharing of stories…a discovery of common interests…..singing songs…a realization that someone used to work at the same hospital back home.

There was also the learning: Learning from the life experiences of others in the group and especially learning from the people of Ecuador. I suspect that each participant learned something unique from being a guest within the indigenous communities and within Ecuador itself. The cultural beliefs and customs were fascinating and educational for me from beginning to end. I could write a thesis on what I learned and experienced from their rich culture but what impressed on me most personally was the way the people in the isolated communities experienced everyday life and their attitude about it. It was certainly a life without the luxuries taken for granted in modern society which impressed me the greatest. A sort of simple living and content self-sufficiency apart from modern conveniences reminiscent of Thoreau as he took to a Life in the Woods.

Then there was the nature. I frequently think back on the sight of mountain peaks lining up as far as the eye can see as if all standing in an eternal line, the lakes hiding amongst the volcanic peaks, and my favorite by far: looking down at the world below from above the clouds. These pictures show you what it looked like, but neither photos nor words can sufficiently convey the view, the feel of the wind and clouds, and the smell and sound in the air simultaneously stimulating the senses.

Lastly, an over-arching sense from my ‘Tandana experience’ was one of coming together. Indeed, the Tandana Foundation points out the name means “to unite” in the local indigenous language of Kichua. If I had to reluctantly pick only one descriptor of my HCVV experience, it would be “unity”. The sense of unity began with the formation of one medical team out of 14 strangers with very diverse backgrounds on day one. This sense of unity continued throughout the trip as we were guests and ambassadors among many different indigenous communities.

Through no choice of my own, I was born in a country of opportunity and am fortunate to have the opportunities in medicine that I have had. During the HCVV, I enjoyed sharing some fruits of my good fortune with those that, through no choice of their own, were born into a community literally on the edge of the world; far, far away from any level one trauma center, ivy league school, or family medicine clinic.

The case of the woman with hypertensive emergency had an optimum outcome, due in large part to the donations we had received for that mission. A large part of my time with her was dedicated to drawing pictures and using help of interpreters to explain her medical condition and discuss plans for after our departure (She had up until that moment absolutely no understanding of her condition. She had thought of it like a bug bite, that goes away after a few days and a few pills). We gave her a relatively new, hypertensive medication which was donated from Direct Relief International. It enabled us to quickly remove the immediate threat to her health. Experiencing the smile on her face from being free of symptoms, and her joy of understanding her condition is hard to describe. It was a moment that reminded me why I love medicine so much and why we were there. But it was just one little moment amongst so many that together gave me my ‘Tandana experience’
Dr. Hugh

Vision screening
Hugh draws blood for an H. Pylori test.


By Anna Taft (Some names have been changed to protect patients’ privacy.)

A barefoot woman in traditional Otavaleña dress wandered up to the schoolyard in Larcacunga, grey hair trailing from under her head wrap.  “What are you doing?” she asked.

“We’re offering free medical consultations,” I replied.  “Would you like to see a doctor?”

“Well, okay.  I’m healthy, but I have pain here,” she said, placing her hand on her back.  “Where are you from?”

“Very far away,” I answered in Kichwa.

“All the way from Otavalo?” she asked, eyes wide at the thought of us traveling ten kilometers from the market city.

“Even farther than Otavalo.”

“Even farther?” she asked, incredulous now.  “How is it that you came all this way to my community?”

How is it, indeed?  It’s a winding story that began ten years ago when I first came to Ecuador as a volunteer for a neighboring village.  But even given the incremental, mostly-explicable growth in that story, the question’s underlying surprise merits remembering.  It is a bizarre thing we are doing, though we often forget that in the enthusiasm and instrumental focus to our energies.  We collect volunteers, including doctors, nurses, and willing assistants with no medical experience, from the United States, bring them to the Andean highlands, and each day take them and our boxes of supplies to a different village’s school or community center to provide basic health care.  A bizarre thing, but a beautiful one.

Beginning my usual set of questions for arriving patients, I learned that her name was Maria Juana Perugachi Torres and that she could correctly state her age at 90.  Many elderly patients weren’t sure of their age, or guessed something different than the birth date on their identity card suggested, but Maria Juana was right on.  I couldn’t help grinning at her, and she responded with the most beautiful smile I could imagine.

“Open your mouth,” Katie instructed my new friend, holding out a thermometer and demonstrating with her own mouth, “under your tongue.”   She gently nudged the thermometer into Maria Juana’s mouth.  Maria Juana sat there, mouth gaping wide, waiting for Katie to finish whatever odd thing this was she was doing.  Katie motioned for her to close her mouth, using hand gestures, forcefully closing her own mouth, saying in her brand-new Spanish, “close your mouth.”  But Maria Juana didn’t understand.  Finally, a middle-aged woman who had already been through this process and was waiting her turn to see a doctor came over and taught Maria Juana how it worked.

As Katie helped her roll up a sleeve to make room for a blood pressure cuff, Maria Juana repeated, “I’m healthy!”

Guessing she might fear her sleeve was being raised for an injection, I reassured her that it was only to take her blood pressure, as if that meant anything in her world.  Next, she was asked to climb up onto a scale.  She stepped squarely up from the side, her left foot entirely covering the plastic window where her weight would be read.  Katie and the middle-aged patient managed to convince her to turn 90 degrees and then inch backwards so that her weight could be recorded, then instructed her to dismount.  What an odd set of tests, Maria Juana must have thought; she would have a story to tell when she got home. Speaking of home, her breakfast was there, waiting to be cooked and eaten.

“What time is it?” she asked, as if she were late for an important meeting.  Receiving her answer, she waited patiently for a few minutes and then asked again.  “I haven’t eaten yet,” she offered, as if to appease our quizzical looks.  Unsure of how to respond, we gave her more blank stares, and then I remembered the boiled eggs in my pocket.  I pulled them out, offered one to her, and began to peel the other one for myself.

Why was she so pleasing to me, this 90-year-old I had just met?  Was it the sly, toothless smile, the high voice blending Kichwa and Spanish, or her self-confident air, asserting quite indisputably that she was healthy?  Perhaps it was her approach toward difference.  Walking through the center of her community, she discovered strangers from a distant land there, doing inexplicable things in the name of “medical consultations.”  She wasn’t afraid or angry and neither was she clamoring for a panacea or a handout.  She was curious enough to try it out, and trusting enough to have her vitals taken, but not so enthralled that she forgot about her breakfast.  In a sense, that attitude shouldn’t be surprising; you don’t get to be 90 in her circumstances without developing a certain self-assurance in addition to an impeccable cardiovascular system.  But she had none of the complaints of loneliness or aches and pains, laments about lost joys that are the staple of some of her contemporaries.  If only all of us could approach new experiences and others with that sort of calm curiosity and confident equanimity.

I was hungry too, so I gobbled up my egg and a protein bar, taking advantage of a lull in arrivals.  José Manuel, the current president of Larcacunga, approached me with his bag of pills.  “When do I take these?” he asked.

Reading the simple instruction sheet in the bag with the medication, I replied, “one with breakfast and one with dinner.”  Many patients liked to double and triple check their instructions, so I was not surprised.  I noticed his pills were for stomach problems.

“With which water?” he asked.

“Oregano,” I suggested, knowing that oregano tea was considered the best remedy for an upset stomach, “if you have it, or if not then with toronjil or cedrón or anise, any water is okay.”

“Anita!” called Joaquin, an interpreter we had hired to work with one of our doctors.  “Jim has a patient with women’s problems.”  Joaquin, indigenous himself and fluent in Kichwa as well as Spanish, cared about the patients and was sensitive to women’s modesty and reluctance to discuss female issues with him in the room.  I bounded up the steep bank to the principal’s office, which Jim was using as an examining room.  I translated for Jim as he asked a few questions, and then Molly brought in the patient’s pregnancy test results: positive, not at all what she was hoping for.  Elena was nineteen and already had one child.  Apparently, things weren’t going well with her husband and she was not excited to bear a second child.  She hadn’t even mentioned the possibility of being pregnant, until Jim asked to make sure a prescription he had in mind would be okay.

After Elena left, eyes downcast and red, I reemerged on the sunny soccer field to the sight of the kids, out to recess, running madly up and down, kicking a tiny ball.  Maria Juana was heading home with a bag of ibuprofen (she was healthy!  Just had some pain in her back).  She stopped to shake my hand, saying “yusul pagui.”  God pay you.            As we rode down in the van that afternoon, Jim related the story of one of his patients.  The diagnosis was situational depression; what she needed was someone to talk to.  She had talked to Joaquin for half an hour about her pain; her teenage adopted son had disappeared, perhaps to Colombia, and she wanted to make sure her younger daughter, also adopted, was healthy.  Joaquin had related only the basics of the story to Jim, but both had watched her attentively as she spoke.  Jim had examined the daughter, found her perfectly healthy, and told the mother she was doing a great job of caring for her.  The mother spoke to Joaquin some more, reiterating her worries, and he noted her name and her son’s to see if he could help her by contacting immigration authorities about her son.  She thanked Jim and Joaquin profusely, saying she hadn’t been able to tell anyone about her troubles before, and departed, her burdens at least a little bit lighter.

Sinking back in my seat, I felt a warmth in my eyes.  This was the kind of medicine that touched me.  I had sometimes wondered how it came to be that I, who had always been rather suspicious of medicine, was coordinating groups of volunteers and taking them out to Ecuadorian villages to practice it.  My motives, I must confess, were more about intercultural interaction and education for the volunteers than medicine, when I began the program.  I realized, though, that what bothered me was less about medicine itself and more about the power relations that are typically set up in the clinic and the bureaucratic structures that reinforce them.  Here we were, listening to patients, sharing laughs with them, trying to respond to their needs, and asking only a 50-cents-per-family contribution for the medications we provided.  Our volunteers were doing their best to learn the villagers’ languages, welcome them, play with the young ones, smile with the old ones.  And many of the patients walked away with the means to improve their health.

That night, exhausted from the responsibilities of organizing the group’s work and activities, I closed my eyes.  Maria Juana walking away from the school, trailing her wisp of grey hair, was the first vision that appeared.


Report on the Distribution of Millet

Le Rapport de Distribution de Mil

Ce rapport est le résumé de la mission de distribution du mil offert par via Tandana Foundation effectué par Housseini  dans les de Kansongho et Sal-Dimi du 27 juin  au 2 juillet 2012 .

Dans le cadre du partenariat avec les communautés de la commune Wadouba, Cercle de Bandiagara, la Fondation Tandana a apporté une aide alimentaire suite à la crise que traverse le Mali.

En assemblée il a été rentré avec les notables, les jeunes et les femmes du village pour expliquer comment faire  la distribution de mil  sur la base la liste de recencement du village.Distribution mil Houssini 048 Distribution mil Houssini 078 Distribution mil Houssini 079    Distribution mil Houssini 093

Les débats ont commencé  par la bénédiction du mali, Amérique et la fondation tandana on a aussi rappeler la criser au nord du Mali qui est la main des rebelles.

Quand j’ai parlé que je suis là au nom dela Fondation et de votre Yalièma pour la ditribution de mIL, l’Assemblée ma repondue avec des beaux sourirs et des applaudissements jusqu’à une minute. Apres la joie de la population, la fondation demande aussi de manger le mil durant les deux mois de soudires avec la joie et avoir le courage de cultiver.

Apès la distribution de mil chacun à exprimer que si c’était pas la fondation ils n’allaient pas cultiver parce que ils n’ont pas le mil dans le grenier ni l’argent pour acheter le mil, la population à beaucoup rémercié la fondation tandana

D’autre disaient que la fondation est leur deixième dieu , ils sont sur le point de donner auvoir de la vie

les femmes ont beaucoup chanter sur le bien fait de la fondation,elles disaient que la fondation aillent de très loin ,et donne beaucoup de relation comme elle veux,comme elle a sauvé la vie des milliers de personnes.

En fin j’ai quitté au village avec la joie de la popûlation et des bénédictions.

Report on the Distribution of Millet

This report is the summary of the mission of distribution of millet offered by The Tandana Foundation, made by Houseyni in Kansongho and Sal-Dimi from June 27 – Jul 2, 2012.

In its partnership with the communities of the commune of Wadouba, Circle of Bandiagara, the Tandana Foundation provided a food relief following the crisis which has traversed Mali.Distribution mil Houssini 092

In the assembly, he entered with the nobles, the young men, and the women to explain how to distribute the millet based on the census taken of each village.

The discussion began with blessings for Mali, America, and the Tandana Foundation, and the crisis in the north of Mali, which is in the hands of rebels, was remembered.

When I told them that I was there in the name of the Foundation and of your Yalema for the distribution of the millet, the Assembly responded with big smiles and applause that lasted a full minute.  After the joy of the people, I told them the Foundation also asked them to eat the millet during the two most difficult months and to have the joy and courage to cultivate their fields.

Distribution mil Houssini 087After the distribution of the millet, each person expressed that if it were not for the Foundation, they wouldn’t have cultivated their fields, because they don’t have any millet in their granaries nor money to buy millet.  The people greatly thanked The Tandana Foundation.

Others said that the foundation is their second god, that they were on the part of saying goodbye to life.  The women sung a lot about this good deed of the foundation.  They said, may the foundation go very far and give many relations as it wishes, as it has saved the lives of thousands of people.

Finally, I left the village with the joy of the people and their blessings.

Housseyni PamateckDistribution mil Houssini 081

Tandana’s New Blog

So we are just getting this blog off the ground.  We hope that this will be a place for volunteer alumni, community members, staff, and donors to share stories of their experiences working and traveling with the Tandana Foundation.  There will be more to come as we learn to navigate this vast blogging world!

We hope for this blog to become a conversation of many voices and perspectives, and when possible, several languages.  As we are encouraging dialogue and reflection by many people, the views expressed here will not all necessarily represent the views of The Tandana Foundation.  But the existence of this kind of conversation itself embodies our principles, and we hope you will enjoy it.

Donc, nous ne faisons que commencer ce blog. Nous espérons que ce sera un lieu pour les anciens volontaires, les villageois, les travailleurs, et les donateurs pour partager des histoires de leurs expériences de travail et de voyager avec la Fondation Tandana. Il y aura plus à venir aussitot que nous apprenons à naviguer dans ce vaste monde des blogs!

Nous espérons que ce blog devienne une conversation à plusieurs voix et des points de vue, et si possible, quelques langues. Comme nous encourageons le dialogue et la réflexion par de nombreuses personnes, les points de vue exprimés ici ne représentent pas tous nécessairement les vues de la Fondation Tandana. Mais l’existence de ce genre de conversation elle-même incarne nos principes, et nous espérons que vous l’apprécierez.

Así que se acaba de empezar este blog. Esperamos que este sea un lugar para antiguos voluntarios, miembros de las comunidades, trabajadores, y donadores para compartir historias de sus experiencias de trabajo y viajes con la Fundación Tandaña. Habrá más en el futuro a medida que aprendemos a navegar por este gran mundo de los blogs!

Esperamos que este blog sea una conversación de muchas voces y perspectivas, y cuando sea posible, varios idiomas. Como estamos fomentando el diálogo y la reflexión por parte de muchas personas, los puntos de vista expresados ​​aquí no representan necesariamente todos los puntos de vista de la Fundación Tandaña. Pero la existencia de este tipo de conversación en sí encarna nuestros principios, y esperamos que sea de su agrado.