Bumps in the road

During my first semester at Emory, I attended several brief presentations by second year students who had just returned from their summer practicum work.  Literally every presentation began with, "Well, I was going to... But then this happened so I ended up..."  Therefore, I should have come to El Paso with the expectation that things would not work out as planned.  And I guess I've known that in research it's best to expect the unexpected, but that doesn't necessarily make it any easier to deal with bumps along the way.

Anyway, it turns out that I don't have the proper clearance that everyone (except for one compliance lady) thought I had in order to be at one of the hospitals here in El Paso.  The problem is that I've already done 3 observations and interviews at said hospital.  So now I'm "on hold" with them, meaning that I'll have to do the second (aka postpartum) interview with those 3 women somewhere other than the hospital.  That's fine, and I honestly only wanted maybe 2 more women from this particular hospital, but now I need to make sure that all my new paperwork and such goes through soon because it could be problematic if I try to publish my findings next year.

For those of you who have been following my blog, this is a different hospital than the one that was giving me IRB trouble a few weeks ago; ironically enough, that hospital has me cleared for everything now, but none of my enrolled women are planning to deliver there.  I think the most frustrating part about this is that I sort of called attention to my study by attending a childbirth class at this particular hospital last Monday.  The class instructor emailed someone to make sure it was okay that I attended the entire course during the month of June, and before I knew it I was getting crazy phone calls and emails from lots of people.  Maybe it's good that we figured this out now though, since it would have been an absolute disaster if we discovered after I left here that I was never authorized to do the study at that hospital.  I just hate that it's causing so many people so much frustration, and I really hope that none of the people from the institution who told me that I was all clear get in trouble.

In the meantime, I'm a little frustrated with the resident I'm supposed to be working with in Juárez.  One of the women I interviewed last Friday was due on May 21, and I emailed the resident on Tuesday to find out if she had delivered yet.  (Thank goodness HIPAA doesn't exist in Mexico yet...)  I still haven't gotten a response, so I still don't know how we're going to keep track of when women deliver at the hospitals across the border.

Actually, I still don't know how we're going to keep track of when women deliver at all.  My method on the US-side has been to text the women periodically to see how things are going.  Even still, the first woman in El Paso delivered on Thursday night and I didn't find out until Tuesday morning...and I can't interview her until sometime next week because now she's at home and really sore/exhausted.  Originally, since I was going to interview the women postpartum while they were still in the hospital, it made sense to try to interview the delivering obstetricians then.  Now I'm not quite sure how that very brief (I only asked the OBs for 5 minutes in the consent form) interview is going to fit in, as they'll probably forget the particular women by the time I can meet up with them.

Additionally, I've been working with some giant data sets that are giving me problems.  Thankfully, Hillary (everyone's favorite SAS instructor) helped me figure out how to convert the Mexican birth certificate data from characters to numbers.  I love people who go above and beyond to help me- it took us a series of 12 emails over 6 days to figure everything out, but it finally worked.  It just took forever to run my code since there were over 2.3 million entries (and something like 60 variables).  Now I have that data set cleaned and ready, but today Jill gave me another data set from the state of Texas that she wants some help with.  It's in a .BH file (which apparently stands for "black hole") and I spent almost two hours trying to open the data.  Needless to say, it didn't work, so now we're waiting to hear back from people in Houston about what to do (any advice would be greatly appreciated!)

While this stuff has been going on, I've been spending the vast majority of my time transcribing the interviews that I did on Friday in Juárez.  As I expected, it's time consuming and frustrating.  The women I interviewed all tended to mumble, and I'm not comfortable enough with Juarense Spanish to catch everything verbatim.  I've been listening to the recordings on 40% speed and repeating sections over and over, but it's still super challenging.  The interviews were all about 10 minutes shorter than the ones in English, yet have taken me about an hour longer each to transcribe.  However, it makes me grateful that I'm the person transcribing in a way, since I feel like when the women mumble and trail off at the end of their sentences a transcription company would probably just notate that it was inaudible or something.  And I've noticed that it's those sentences that are richest in terms of the data I'm collecting.

Sorry that this was such a long rant.  To be honest, I really do like what I'm doing and feel like I'm exactly where I need to be right now.  I feel quite willing to work through and overcome the challenges...I just needed to share my frustrations today.

A weekend of adventures

Anne, one of my closest friends from home (although she currently lives in California), came to visit me for Memorial Day weekend! After a very long work week, I was SO excited to get to the airport on Friday afternoon to pick her up.  And at the suggestion of almost everyone I know, we rented a car for the entire weekend, making planning much less stressful (and much more possible!)

On Saturday morning, we got up early and drove out to White Sands, New Mexico, which is about an hour and a half away.  Since pictures are worth 1000 words:

The landscape is quite different than anything else I've seen in this area!  It was ridiculously hot and sunny there, but definitely worth the trip.  And the ride out there was especially beautiful!

On our way back to El Paso, we stopped in Las Cruces and Old Mesilla.  There wasn't much to do there, but it was fun to walk around and explore a new place.

On Sunday morning, we went to the Franklin Mountain State Park, which is located here in El Paso, very close to Ft. Bliss.  We hiked one of the moderate trails that was about 3 miles round trip.  We got a nice breeze on the mountain and finished before the heat became unbearable, which was nice.  The views of El Paso, Ciudad Juárez, and New Mexico were wonderful, and I also really enjoyed the desert landscape.  Here we are about halfway through the hike:

We spent Monday exploring downtown El Paso before Anne had to fly back to Pasadena.  Overall, it was an incredibly fun and relaxing weekend, full of good conversation and good food.  And it served as a much-needed change of pace for both of us, which is always nice :)

A long day in Juárez

The above picture is taken from Scenic Drive here in El Paso, which I visited on Saturday night with some wonderful friends.  What struck me (probably because Tom pointed it out) most about the view was that El Paso and Ciudad Juárez appear to be one city.  Since it was Memorial Day weekend, the Wells Fargo building in downtown El Paso used its lights to make an American flag; however, that's the only building that I can even attempt to identify here.  As one of my favorite songs, Such Great Heights, says "Everything looks perfect from far away."  In this picture, we don't see poverty, violence, racism, sexism, or any type of injustice.  We just see light in the vast darkness of the desert.

Unfortunately, up close things don't look so perfect.  Real disparities exist across the little river, many of which I've only begun to start reflecting on.

I spent literally all day on Friday in Juárez.  The morning began at 7am when I crossed the Puente de las Americas.  Since there was almost no one else out that early, I took some pictures from the bridge:

The actual border

View from the top of the bridge (El Paso is to the right, Juárez is to the left, and the Rio Grande serves as the border)

After crossing into Juárez, I sat in the Parque Chamizal to wait for Goreti (one of my many helpers) to pick me up and drive me to the hospital.  An abuelita came and sat next to me and we ended up chatting for about 30 minutes.  When I told her that I am studying public health, she immediately whipped out a binder of newspaper clippings to show me that her cousin is the director of surgery at the general hospital in Juárez.  She told me that I needed to go directly to that hospital, introduce myself, and tell him that I want to shadow him so that I can learn about transplants.  She then proceeded to write down her name and phone number, along with his.  I couldn't help but smile, especially when halfway through the conversation she asked if I was American.  Her follow-up question, after I said yes, was if I was married.  I said no, to which she responded, "Be careful, then, that people don't rob you here in Mexico."  I wasn't quite sure how to interpret that series of dialogue, but I certainly appreciated her friendliness.

I spent the majority of my day at the public hospital.  There's nothing quite like driving up to a hospital and seeing lots of people waiting outside to be attended to.  I put on my roommate's white coat (thanks, Josie!) so that I could get ushered into the prenatal clinic where I would be working.  I had to correct several people who referred to me as "Doctora", but everyone official wears a uniform in the Mexican health care system and there's no color associated with "random Master's student doing temporary research."

When I met the resident who was assigned to my study for the day, I asked him how many patients we would be expecting and how things would go.  See, the original plan was that I would observe a prenatal care visit and then do an interview with the woman.  Each interview usually takes about 30-40 minutes, so I was hoping to observe about 3 visits and then do the corresponding 3 interviews, which would have taken me until about 2ish; thus, I told Goreti to return at 2:30.  To my surprise, the resident told me that he had invited 15 women to come to the hospital for interviews.  None of the women had prenatal care appointments; they were only coming for the study.  And they were all told to arrive at 8am.  Awesome.

I awkwardly smiled and then nervously sat down in the exam room that I was assigned to.  Luckily, only 5 of the women showed up for the study.  Two male nursing students (age 18) were given the job of my assistants; they called the women in from the waiting room and then they sat on the other side of the small room where I did the interviews to observe my qualitative study methods.  Two of the women I interviewed asked them to leave for privacy, which was nice for me, too.  During my last interview, they were horsing around and being super annoying...basically, they were acting like 18-year-old boys.  I kept shooting them death stares until they sat down quietly; I was definitely not in the mood for babysitting.

The interviews were rough.  I don't ever recommend that anyone do five 30-minute interviews in a row without a break, especially in one's non-native language.  (Of course the first woman I interviewed was a soft-spoken mumbler, too...I sure hope my recorder can correct for that when I work on transcribing tomorrow!)  Despite many pilot interviews in both Spanish and English, I didn't realize that some of my questions would be irrelevant to this particular population, so that was kind of frustrating.  Most significantly, evidently women in this particular hospital have no concept of epidurals.  They all thought I was crazy when asking about pain medication during labor and delivery; all five women responded to my inquiries with something along the lines of "Of course it's going to hurt...that's just how it is..."

The people who attend the public hospitals in Mexico are among the country's poorest.  The women I interviewed ranged from ages 15 to 17.  They were obviously not well-educated, especially in regards to childbirth.

I felt like I had little rapport with the women; I've grown quite accustomed to chatting with the women in my study before observing their prenatal care appointment as a way to break down some of the barriers between us.  But in this case, I was sitting behind a desk and wearing a white coat when they entered the room, which obviously added another layer of difference between the participants and myself.  When I tried to ask the women how they were and other pleasantries, they were rather short.  I don't blame them; they had come to the clinic and waited just to be interviewed by me, so they likely didn't want to waste time.  (I suspect that at least one of the women came with the hopes of having an additional doctor's visit, but that didn't happen.)

I powered through the 5 interviews, made arrangements with 3 of the women to observe their next prenatal care visits in a few weeks, and then realized it wasn't even noon yet.  So I sat in the waiting room of the clinic for a little while and then sat outside of the main hospital for the rest of the time before my ride was going to pick me up.  It was hot out and I felt absolutely exhausted.  I also couldn't stop thinking about the simple disparities between the bathrooms in the prenatal care clinic and the majority of bathrooms in El Paso.  Despite it being a very large clinic, the men's room was out of service and the ladies' room only had 1 out of 2 stalls functioning.  There was no toilet paper or soap to be found, and the stall door was broken so that it didn't actually close all the way.  Good thing my travels have taught me to carry tissues and Purell everywhere I go!

After Goreti picked me up from the hospital, we went to a mall so I could buy a super cheap Mexican cell phone (it cost less than US$15 and looks like it's from the year 2000).  Hopefully now I won't need to wait for rides there anymore!  Then I went to buy a water bottle but the man working at the stand was super rude.  I hadn't been able to exchange my US dollars for pesos, as that was our next stop on the way back to the bridge.  I asked the guy if he accepted US currency and he said yes, but then when I said I only had a $20, he said he couldn't make change.  That's fair, but when Goreti offered to just buy the water bottle (it cost 7 pesos, which is like 50 cents), the guy basically asked why on earth she'd buy something for me.  She told him that we were friends and verified the cost while she took out her wallet.  He looked at me, paused, and then said it was 8 pesos.  Goreti then proceeded to tell him he's racist and a terrible example of a Mexican.  She left the water on the counter and guided me to another store, where she bought a water bottle from a nice clerk.  Goreti then proceeded to apologize profusely for his behavior.  We talked about how there are bigots everywhere, but I realized that it was the first time that someone was outwardly rude to me for seemingly no other reason than the way I looked.  It happens all the time, especially to non-whites in the US, so I guess it's good for me to experience as a reminder of my privilege.

The icing on the cake for the day was that after I walked over the bridge back to the US (which is about a 10-15 minute walk) in the insane heat, I had to wait in line for an hour and a half to get through customs.  Oh, and there's no shade in the area.  I got quite sunburned, but at least the time standing in line gave me a chance to process my day before I went to the airport to pick up Anne...but that will be the subject of my next blog post!

Getting to know the community

Happy Hump Day! It is SO hot and dry here this week.  Yesterday was the first time since I've been here that the thermometer hit triple digits, and it doesn't look like it's going to break any time soon.  That isn't surprising to me in any way, but what is surprising is how windy and dusty El Paso is.  I constantly have to hold down my skirt or dress when I'm walking around, and last night I noticed that all my shoes are covered in a considerable layer of dirt even though I've only walked on paved streets since I've been here.  It's pretty gross, especially when I can't get rid of the feeling that my throat and nose are covered in a dusty film.

Anyway, one of the major challenges I'm facing here is that I'm meeting lots of people who are involved in the non-profit/activism world in El Paso, and I kind of have an inferiority complex because I feel like my work is much less valuable than theirs.  Of course that's one of the hazards of doing full-time research, and I know that I'm exactly where I need to be.  I'm super passionate about access to quality healthcare, and it's a major issue, especially here on the border, but I'm not going to get any immediate gratification by seeing progress from my hard work.

It's interesting because when I was working as a full-time Mercy Volunteer in 2010-2011 at the Good Samaritan Clinic in Savannah, I constantly felt like I was on one of those hamster wheels, just running in circles.  I was seeing immediate results, but they all seemed somewhat inconsequential.  I successfully got free and reduced cost specialty medical care and prescription medications for many people, and the clinic provided very high-quality primary care at no cost, regardless of individuals' documentation status.  This is all good stuff, and I know that the clinic has made a huge difference in the lives of many of our patients.  But we didn't have the capacity to address why people were stuck in a cycle of vicious poverty and discrimination, nor could we do anything to advance the system so that more people had access to healthcare.  We were putting a proverbial Band-aid on an issue that was extremely complicated by state and federal policies.  And this frustrated me.  No matter how many patients I worked with one-on-one, I knew there would be a million more who weren't able to access the care they needed, and frankly, there was nothing I could do about it other than work my butt off for the people right in front of me.

Now I'm in a position to work at a level that is higher than a clinic, and I find that I miss seeing results.  I hope there's a way to strike a balance between staying in touch with the struggles that individuals face while also working towards broader changes that will affect many more people than I'll ever meet.  Maybe this is ridiculously idealistic and naive, but that potential is what is getting me out of bed every morning.

Anyway, I digress.  Since I've been in El Paso, I've had the opportunity to hang out with Border Servant Corps volunteers and Jesuit Volunteers.  I also live with a former Annunciation House volunteer, and my landlord is a former Maryknoll Lay Missioner.  They are all extremely passionate about social justice issues and have allowed me to join them in some of their ministry.  For example, I've been going to the Comité de Justicia Laboral, which is an incredible community organization that works to recover unpaid wages in El Paso.  As part of this, I also went to a teleconference on Sunday afternoon with people all around the country working for different social issues.  This is such a good way for me to get to know the community (especially men, since my research project is obviously only with women).  I'm slowly learning about the social service organizations here and about the unique issues that El Paso faces as a very poor border city.  It's making me feel more grounded, especially since I've spent a lot of time sitting in front of a computer looking at data and reading articles lately.

I had a good conversation with my friend Tom about this stuff recently, and he pointed out to me that there's a reason that professionals continue to volunteer their free time working with community organizations.  I know that he's right, and I guess I'm just yearning to feel connected both here on the border and back in Atlanta.  And I'm obviously super impatient.

Last night, a Carmelite priest named Peter came over and we chatted for several hours.  He's been living in Ciudad Juárez for 17 years with a Sister of Mercy named Betty.  They are extremely passionate about human rights and have spent the greater part of their lives around Latin America (my estimate is that Peter is about 80 years old).  Oh, and Peter's good friends with Gustavo Gutierrez...you know, no big deal.  I initially felt embarrassed to tell him that I'm working with the CDC on a study; it would have felt way cooler to say that I'm starting a revolution or something.  But then I remembered that, just like we need socially-conscious people like him in the Catholic Church, we also need socially-conscious people working for government organizations.

Okay, so clearly I'm writing this to convince myself of what I'm saying here.  If anyone has thoughts, I'd love to hear them!  And if you've read this far, thank you!  I know this is an obnoxiously long post, but it's really helpful for me to externally process some of what is going on in my mind these days!

Woes of public transportation

I feel like I should write an apology letter to SEPTA and MBTA for all of the times I complained about them: their price, their cleanliness, their timeliness.  Moving to Atlanta without a car was a rude awakening; MARTA has left me stranded for long periods of time more than a few times.  And now that I'm in El Paso, I've already been stranded by the Sun Metro twice.  There's probably a reason that the MARTA and Sun Metro are about 1/4 the price of SEPTA and the MBTA.

Yesterday morning I had a prenatal care visit to observe and interview to conduct exactly 2.1 miles from my office.  I left a few minutes early to catch a bus that would get me to the 9:30 appointment by 9:08.  The bus was supposed to come at 8:54, and I waited at the stop from 8:50 to 9:00.  When it didn't come, I power-walked up the one ridiculous hill I've encountered here (not including the mountains, of course) to arrive at the appointment at exactly 9:30.  It was already over 90 degrees out, and I was drenched in sweat and my feet were bleeding from my new flats that aren't meant to be worn as running shoes.  The woman I was meeting there was super nice, and the observation and interview went really well, so at least it worked out.  I just don't quite know what to do; that was the second time in 8 days that the bus didn't come, causing me to nearly miss an appointment.  I love not having a car, but I'm starting to think that after I graduate next May I might have to get one unless I move to NYC or DC or a city that's known for having reliable public transit.

The other bummer about not having a car here is that public transportation doesn't go to many of the tourist attractions.  I guess I should use that term lightly; what I really mean is that public transportation doesn't go to any of the hiking trails here.  The only other "attractions" in El Paso are the museums that are across the street from my office building that I've yet to check out.  And there's a zoo here, but you couldn't pay me all the money in the world to walk around outside in crazy heat to look at animals.  Whenever I ask the women in my study about what to do in El Paso (which is a really good way to break the ice while we sit in the doctor's waiting room together), they laugh and tell me that this is the most boring city on earth.  I've heard there are some cool things to do in New Mexico, like go to White Sands.  And I still need to do a better border tour.  Hopefully this summer I can keep myself entertained on weekends by wandering around downtown and exploring new churches (and by making friends with cars?!), but if anyone has suggestions, please let me know!

Today was pretty exhausting.  I transcribed all morning and then entered hospital-level data about c-sections and VBACs for the state of Texas into an Excel spreadsheet all afternoon.  I hate when people publish public data in locked PDFs that don't allow copy/paste!  But at least now I'm in a good place to start some quantitative data analysis next week.

Collaboration: Challenges and Opportunities

One thing I've really enjoyed about my project so far is how many people I've been able to talk to about it.  Over the past few weeks, I've talked to people interested in maternal health outcomes in Massachusetts, California, and a bunch of places in between.  They have taken time out of their days to tell me what they're doing and then listened patiently as I've attempted to summarize what I'm doing this summer.  Every phone call has ended with their suggestions: other people to talk to, articles to read, websites to go to, research questions to consider.

One especially cool group of people I talked to was at the Baby Cafe here in El Paso.  It's a lactation support center that's run through Texas Tech, and happens to be in a building that I walk by on my way to and from work.  One of the women I interviewed last week mentioned that she had gone there in preparation for breastfeeding after her baby is born in a few weeks, and she suggested that I just stop in and hang out there for a bit.  So that's what I did on Tuesday afternoon.  The women who work there could not have been any nicer; they told me all about what they do, gave me a bag of resources that I can share with the women in my study, and then let me hang out on the super comfortable couches to listen to the types of things women come in for.  One of the women that volunteers there actually teaches childbirth classes (in English and Spanish) at one of the hospitals I'm using for my study, and she invited me to sit in on a few.  Next week, her topic just happens to be method of delivery, induction, and anesthesia...which conveniently enough are my three main themes for in-depth interviews.  So cool :)

However, this week has also been kind of challenging.  The IRB at one of the hospitals where the obstetricians I'm working with have privileges is being kind of difficult, which is a little stressful right now because the woman I'm going to interview in a half hour could potentially deliver there any day now.  I could always nix the idea of interviewing the women in the hospital and instead interview them at home, but that will be way more complicated.  And then I'd have to find a way to talk to the obstetricians elsewhere in a timely enough manner that they can tell me a little bit about the particular patient's labor and delivery.

The other challenge has been working binationally.  I was in Juarez again yesterday and the doctor we were supposed to meet with was on vacation (which he didn't mention last week, when we told him we'd be back this Wednesday).  We met with another woman instead who suggested that the project become theirs.  I didn't really follow what she was talking about, but when I got back in the car I learned that she was insinuating that they could remove Emory and the CDC from the project and make it a collaboration between that particular hospital and the university I've been working with in Juarez.  But I would be in charge of training nursing and medical interns on how to do qualitative methods.  That wouldn't actually bother me, but the woman I'm working with in Juarez was very unhappy.  So now we're only going to use two hospitals on the Mexican side of the border.  Granted, they are the two hospitals geographically closest to the bridge that I use, so it'll probably be more convenient in the long run.

I think it's going to take me a while to get used to how the hospitals work in Juarez.  I'm still waiting for the list of potential patients from one of the hospitals, and when I mentioned that yesterday, the woman I was with literally said, "Put on a white jacket, show up at the hospital on Monday, and wait until someone gets you the patients you need."  Something about that just doesn't sit well with me; I like having appointments scheduled with the people I need to talk to.  If only the resident I'm working with there would respond to my emails...

At least it's cool to be working with a lot of people who are 100% binational, bicultural, and bilingual.  I have a lot to learn about how to maneuver on both sides of this border, and all of the people I've met are super patient and understanding with the silly gringa graduate student.

Casa Puente

I was going to wait to write more about where I'm living until I took some pictures, but today was such a perfect one to talk about to explain my life in El Paso.

When I went downstairs this morning, there was a random guy sitting at the kitchen table.  No one else in the house is ever up at 6:15am, so I don't find it strange to shower downstairs next to the kitchen and then walk back upstairs in my towel (there are two bathrooms next to my bedroom, but the water pressure isn't as good as the downstairs bathrooms).  Needless to say, I was super confused.  Anyway, when I got out of the bathroom a few minutes later, another random guy yelled "Boo!" until he realized that we hadn't met yet.  I awkwardly walked back upstairs to get dressed, and then I ended up eating breakfast with those two guys and one other.  It turns out that Casa Puente is listed on warmshowers.org, which is a hospitality website for touring cyclists.  The guys were all really cool- they're all traveling across the country on their bikes and were just spending the night in El Paso.  We talked about their experiences in very rural America over the past few weeks while drinking our coffee- it was such a nice way to begin my Monday morning!

Then, today after work, I decided to make a big pot of pasta with veggies before going for a run.  Two of the other people that live here, Katy and Eric, joined me for dinner; they added homemade garlic bread, Greek yogurt popsicles, and beer to the meal.  We sat around the kitchen table for well over an hour chatting and then moved outside to the front porch.  They've been in El Paso for a few years now and shared some of their experiences and recommendations with me.  Katy and I continued our plática while Eric played "washers" with our next door neighbor in our front yard.  Two of the other people that live next door came over to watch, and our landlord, West, joined in the game as well.  We stayed outside until darkness fell and then moved the conversation into the landing inside our front door.  Needless to say, the run never happened.  But I am SO into living in a neighborhood where every family speaks Spanish and people are super friendly.  And I'm loving the generosity and hospitality that I've found here.  I already feel like I'm part of a community, even though I haven't spent a full week here yet. :)

As a side note, I transcribed interview #2 today! And interview #3 is set up for Thursday morning! Woo!