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Tuesday, August 6, 2013

Gracias Especiales...

First, I want to give a special thank you to my dad.  While I was stressing and freaking about passing my first year of medical school, he helped me find this opportunity and get everything in order.  He has a lot going on in his life, yet he took the time, a lot of it, to help me find one of the best experiences of my life.  He had my back all throughout M1 and I can't thank him enough.  Other med students, and fam and friends of med students, know that is hard to have a relationship with one of us.  We are moody. We are stressed. We are worn out. Our time is limited and our conversations are short.  He has shown me so much love and patience despite all of my bitchiness.  Thanks Dad!  I owe you big time... I'll invest in some land down here for your retirement :) :) :)



I also want to thank Nick, my brother for also putting up with me and supporting me this summer.  You are a great little brother, and the kitten videos were awesome. Also, thank you Anne for sending me nice emails and making me feel better when I got homesick :)

Thank you Alex for sticking this out with me.  It was a long distance with limited communication.  But you really outdid yourself and showed great dedication and support for me this summer. Also, the clinic and I thank you for your stethoscope donation. You is kind. You were terribly missed this last month and a half. Can't wait to see you I like you much :)

Maria Lehman, thank you for also helping me set up this opportunity.  As well as having patience with me and teaching me some very important things :) I really appreciate all that did and for checking in on me. See you soon hopefully!

My family at home, my mom, grandparents, aunts and uncles, you guys were so great this month.  I got at least one email from you guys almost every day while I was here.  Your support has really pushed me through some difficult times for me here. 

Bob and Claudia and Todd and Amanda... I don't know what to say.  I was pretty much the very old child of Todd and Amanda this trip.  Every weekend they let me into their home and took time to hang out and show me Playa Coco and Bar Las Vegas.  They cooked me great meals.  Bob and Claudia, you guys keep adding to your saving account of fun when you come to Charleston.  Bob is picking me up today after work, in Managua traffic so that I can have an easy departure tomorrow morning.  I had a blast with them in Managua and a blast at the beach.

Etienne and Anne and Marvin, thanks for being great mentors and great drinking and travel buddies. I learned a lot of Nica slang from you guys.  I also learned a lot of pertinent medical information from you guys.  Can't wait to go to France!

And to my host family here.  They are going through some very difficult and strenuous times.  But they continued to make sure I was fed and my clothes were cleaned. THis is a very special family, one that has been through a lot together, but stayed together. I learned a lot from them.  I hope that I can come back soon and visit.  And please keep Esperanza's mother in your prayers. She is doing better, but is still in the hospital.



Thanks for reading!!!!! And visit Nicaragua!!

Fundraising

With your help and the help of our team here, we raised $1325.  Yesterday, Mario and I ordered a ton of drugs and supplies. I have posted pics below of what has arrived.  It is a  lot of medications that were very badly needed.  We order them from a pharmacy company with the help of the ANF to get the clinic on a great deal on all of their drugs. The ANF is the American Nicaraguan Foundation, a huge NGO here. They take care of a multitude of organizations. 

To the donors, thank you so much for your generosity.  Your donations went further than I expected.  I truly am grateful!

Note: Not pictured are the 4000 aspirins my dad sent down with me.  Those have already been given to patients, like within the first couple of weeks...  Thanks Dad!








Last day with the team

Yesterday was officially my last day.  It was very weird and sad.  Time has flown by here.  I am ready to come home, but I am also already ready to come back.  One of my favorite things about working in the clinic is seeing patients again and knowing who they are.  If I could stay longer, I would more of that.  But I did the opportunity to see patients again who I saw the first week I was here.  I understood them better.  I could hear their words and understand their meaning.  Despite their pain, fever, coughs, whatever, all of the patients are gracious and kind and appreciative. I really cannot wait to come back.

I also have another like, which is kind of not a good thing.  I really like giving shots.  However, the shots I give are insulin and it's for patients whose blood sugar is over 300mg.  So... I also hate having to do it.  The first one I gave to older gentlemen and my hand was so shaky.  He was tough and patient with me. Now, I am a pro.  Well, I could probably use some guidance. I was just handed a syringe and told in Spanish what to do. I sort of watched Marvin do it once. Yay for second year of med school! Hopefully I will be able to perfect these little skills. 

After clinic we went to lunch as a group.  Mario, and the who crew really, were so nice and appreciative. It was very touching.  I have loved working with this group of people.  I hope that one day when I have my own clinic, I am lucky enough to work with people like those at Clinica Alabama. 

Marvin, Etienne, Anne, and I went to grab one last rum and coke at Cafe Isabella. It was bittersweet for me.  


I am so grateful for this experience and for meeting and working with such amazing people.  I have learned so much from being here. 








Adventures in the North: Somoto

We waited outside the pharmacy gas station for almost an hour, our heads pounding. Not so much from rum, but more from dehydration and lack of sleep. We grabbed breakfast of little corn cookies and pastries from the station and waited. Finally, someone told us it was best to go to the actual bus station, which was a 2 minute walk down the road.  Once we got there, the bus was leaving,so we jumped on. I sat next to a very nice man who offered me part of the Prensa.  La Prensa is one of Nicaragua's newspapers.  I read about the canal, a flood, Snowden, and baseball.  We talked about Nicaragua.  He asked me all about what I was doing here, if I liked it, would I come back.  I asked him about his life. He lives in Managua and owns a ferreteria, or hardware store.  He is from some town near Somoto and was going to visit family.  He sad he has never been in th canyon, and if he could he would join us.  I also talked to another guy who was an illegal immigrant in the US.  Somehow, he managed ot get from Nicaragua to California with literally nothing.  I asked him what made him decide to risk everything, and he put his little girl on his lap. He said that he was always told that if you want to make anything of yourself, you have to risk everything.  He was starting a family, and he wanted to be able to send her to a good school so she could have everything she needed when she was older. He thought the US was the land of dreams, so we went for it.  He said he struggled in California. He was homeless, could barely find work, and was treated like shit.  Finally, he met a girl in her 20's.  She was on vacation in San Diego.  They met randomly and she saw that he was a good person.  She and her family owned a restaurant in Knoxville, TN.  She said come with me and we will help you out.  Somehow she got him across the US to Tennessee and moved him in with her family.  He worked in the restaurant and when he made enough money, he came back to Nicaragua.  He also learned English and other skills that would increase his chances of being able to get a better job.  He was reunited with his daughter recently, and they were on a daddy-daughter trip to the Somoto area to visit his family. He is a great man. And whoever that family is deserves a medal of honor or something, because that is just amazing. He said he liked the South.  He was mistreated at times because of his heritage and legality, but still found the people to be kind, hospitable, and Godly.

The bus ride was great.  We had to take two to get to the Finca that we were staying at.  Eti's uncle knows a guy from Managua who owns a pretty big piece of land right on the river bed of the canyon. He was going to let us stay for free on his property. So nice. Our second bus dropped us off on the side of the Pan American highway.  We didn't really know where we were supposed to go, so we asked the driver if he knew of the finca. He did and told us to walk straight up the road.  We were in the jungle. I loved it.  The weather was cool. Sunny. Dry. Awesome. We walked and walked until we got to a little house on the side of the road.  We asked the people inside if they knew Saul. "Si! Si! Si!"  One of the men grabbed his motorcycle and zipped down the road yelled, "I'll be right back!  Have a seat on the porch!".







Saul came up with his motorcycle and greeted us.  He escorted us through the jungle for another mile.  I didn't do a lot of research for this trip, because I wanted to be surprised, and let's be honest, my spirit likes to be free. This place is my paradise. 






We get to the Finca, and I am just amazed. I took too many pictures to put on here. So visit my Flickr site and they will be up on there soon. We got a tour of the main house and our cabin, complete with mosquito nets. And we had lunch.  We messed around with some turkeys and geese. They were a bunch of a-holes... the birds.  Eti, Anne, and I got a good laugh from their quackiness :P 










Next adventure was a hike through the mountains and a swim through the canyon.  Eti brought his camera since it was waterproof, so I will add those photos later.

The hike was great.  The land here is so green and fertile.  So many fruit plants and trees. The air is fresh. just amazing.  Once we were in the canyon, the guide and his 2 sons helped through some really tough class I rapids. It was cute. We traversed rocks and rapids all day.  We got to a place in the canyon where you can jump 5 meters, 8 meters, 10 meters, or 20 meters.  I chose the 8m and Eti chose the 10m jump.  I wasn't taking any risks on my last weekend, but now that I have seen it done (by the guide's son), next time is 20m :)  The water felt amazing.  I haven't been cool really all month.  So this trek was well worth it. We spent almost 4 hours in the canyon.  Angry bats flew at our heads. Weird little fishes nipped on our toes.  



We took a canoe type boat through the last portion of the river, and hiked back to the house.  Then we decided we weren't finished with fun and rented some 4wd. Some of the paths were a little dangerous, so one of the guides came along with us.  Eti and Anne on one, and me and guide on the other. I drove it some. Up one kind of steep hill, too.  Then I handed it over to the guide.  Sometimes, it's more fun to be the passenger. 

We went to 2 lookouts and really enjoyed the views.  











Afterwards, we came back to a nice dinner of scrambled eggs, gallo pinto, nica cheese, and a tortilla. Rum and Coke, and the biggest limes I have ever seen (see below).  We were exhausted and passed out hard.  For all of us, it was one of the best nights of sleep ever.  And we needed it for the chicken bus return trip of 6 hours.  I will never forget this place, and I hope I can return soon.  Somoto is awesome. 





Etienne and Anne were great travel companions.  I will really miss them when I return and on future adventures.  They have invited me to Bordeaux France to have more. I will definitely take them up on that. Both are great people and will be great doctors.  




Adventures in the North: Esteli

5:30am came too fast on Friday.  I didn't get any sleep because I was so excited (and sad) for my last weekend. Esperanza made me a hearty breakfast of eggs and gallo pinto to help wake me up.  At 6:30 I was packed and walking out of my door.  My house is right in front of the clinic.  The line of people was incredible.  I felt a little guilty for walking right past the patients with a simple " Buenos dias" and a smile. I walked down Calle Atrevesada looking for a bus.  Nothing.  I turned left on the Masaya highway and walked down the road some more.  This is the sam route I tok when I went to the hospital, but usually I could catch a bus pretty easily.  As I was walking I heard the familiar call of " LAUCA LAUCA LAUCA!!  MANAGUA!  MASAYA! LAUCA!". An express bus was sitting on a side street cramming people on board.  I ran across the street and jumped in, thus starting my chicken bus adventure to the north.  LAUCA is what the bus people say for the bus stop in front of the University of Central America. It is fun to yell out loud. 

Within an hour and a half, after 30 stops along the side of the road, I was in Managua.  I crossed the street to wait for Etienne and Anne. Once they arrived we got a cab to the other busstop, Mercado Mayoreo, about 18 minutes away.  We bartered with the drivers and got one down to 80 cords for all three of us. When we got into the market, the bus was already leaving, so we ran to get in. It was hot. But we all had seats. I slept through the whole ride pretty much. The bus ride was about 2 hours.  It got kind of boring.  The scenery was getting prettier and prettier, but it was difficult to see through the tinted windows.  I snacked on a treat that I had bought at a bakery near my house: torta de leche. It is delicious and gluten free.  

When got into Esteli around 11 and we had no plans.  We were dropped off at a gas station/ pharmacy.  Etienne got out his guidebook and asked a thousand questions to the employees inside.  We didn't really know where we were.    Eti brought out a map and asked a random dude where we were, and he replied "You are in Esteli"....


Esteli is situated right on the Pan American highway. It is quite different from the city scene of Granada.  It is bustling, cars everywhere, very alive.  There is also a bit of a problem with drugs and prostitutes.  We saw a few of the latter. The girls looked really young. It was a bit disturbing.  But overall, Esteli is a nice town, full of Nica flavor.  It isn't really a tourist spot, so if you want to get immersed, this is the place to go. 


We found a hostel: Hostel Chepite.  This place is for locals.  Not very touristy. No internet.  You ask for sheets. Very simple.  But it was the cleanest hostel I have seen here. Also it cost us 90 cords a person.  Pretty cheap. We walked to the center of town and all around the markets.  We had lunch in this place that looked like an old airplane hangar.  I do not recall the name, but for 70 cords it was pretty good.  we bought some cacao and Nica music instrument. All in all, it is a pretty boring town to visit for more than a day.  I think you lived there, it would be different.  The people are all super nice  We had women coming up to us making sure that we had a place to stay. We were invited over just in case. 

We had coffee in a place called Mi Cafe.  It was a little hidden gem.  Very cool inside and great coffee.



We decided we wanted to take it easy since we had a long day tomorrow in Somoto Canyon. We ate tacos for dinner, delicious. And then we met up with Stephanie from Canada.  I wrote about her in an earlier post.  She wanted to take us to her favorite bar.  We agreed and we were off.  We walked along the Pam American highway for about 7 minutes and she said "okay we are here!". Where?  I looked around and saw auto shops, a pulperia, and then I saw a beer girl.  She had a cooler of Victoria and was handing them out for free in front of the building that resembled someone's house.  We grabbed our free beers and walked inside.  And we were in someone's house. Kitchen to be exact. Continuing on we were then led through a living room.  A family was gathered around a tv spending quality time together.  We were literally in someone's house. We said our hola's and buenas's and kept going through their house.  There was a staircase in the back of the house.  Once we climbed it, we were in a bar.  Bar Rincon. 100% Nica style. We were the only cheles.  There were different groups of Nica's there as well.   Hipsters, metal kids, making out nicas, college Nicas. It was really good mix of people. It was awesome.  Stephanie was a bit of a celebrity there.  The bar tender played all of her favorite music on the YouTube and took really good care of us. Some of her friends came by and we had a blast with them.  

Obviously, we drank rum.  And obviously when you have me, who loves rum, and the French and the Canadian, we stayed out too long. Like 1230. But we had a 6am wake up. We came back to the hostel and listened to Santana ad had a few laughs.  We pissed off the rest of the hostel, which was full of Nica laborers, who got us back at 4am the next morning.  Farting, laughing, hocking loogies (not sure how to spell that word). Just a joy. Our bad, I guess.

All in all, we were pleased with our Esteli trip.  Early Saturday morning we caught our bus to Somoto... the best place on Earth. :)

Stay tuned for Part Somoto. Gotta do some stuff. 


Monday, August 5, 2013

Thank you!! and a cute pic x2

I want to thank my mother for donating money to the cause!  Thank Mom and thank you everyone else.  

This weekend was a blast. One of my top 10 favorite adventures.  I need to get ready for my last day at the clinic. So post coming later!

Again, a big hug and thank you to my mother!  This is us at Disney in 1994ish! 




Also here is a cute picture of those kids I get hang out with in the afternoons :)

Thursday, August 1, 2013

Hard times

Abuelita, the mother of Dona Espiranza, is in the hospital. Before I arrived in Nicaragua, she had a surgery done on her large intestine.  I think it was cancer, but I'm not sure.  She had been having pain in her abdomen for a few weeks so she went back in for a colonoscopy.  They found some necrotic tissue (I think), and the hospital scheduled her for surgery. Last week, she went in.  She is still not back. 

The doctors discovered something is going on with her heart. From what I dissected, I think she had blocked heart vessels, resulting in some kind of myocardial ischemia.  I'm not sure because I am having to try and understand non-technical medical slang in Nicaraguan Spanish.  The important issue here, is that she is not doing well. Dona Espiranza has been very sad.  But she is sticking to her routine with taking care of her father, house, and me as much as possible.  She takes a 1.5 hr bus in every day to visit her mother. 

She is one of the funniest, snappiest women I have ever met.  I hope that her wit and strength can pull her through this.

Please keep Abuelita and her family in your thoughts and prayers. 

Butt Worms and Final clinic days

Que Triste!

It's really starting to hit me. Ann is sad too, even though she has another month here.  The thought of not being here forever is a sad one.  She has fallen in love with Nicaragua and claims to be back once she is a real doctor and can do more.  Honestly, I haven't met one person who has traveled here who hasn't fallen in love.  Note: There is a difference between being a traveler and being a tourist.  For everyone I know who has "lived" in the culture, experienced the culture, experienced the people, not one has said Meh, it's okay.  This is a country to have to get into to really see and feel it.  I am grateful for yet another opportunity to do just that.  I hope in my lifetime, I can inspire more people to come down and learn from this great country with her great people.


the crew minus a few
Mario, Dra Villarreal, me, Olivia, Marvin
Ann, Etienne, and Catty
This clinic has been a lot of fun.  Now that we are all friends and understand each other, we have been having a blast.  

I met Dr. Rudy Vargas, finally!  He came in from Alabama with the head of ANF and some family.  They had suitcase of medical supplies for the clinic and for the hospital.   ANF is a pharmaceutical distributor that donates meds and supplies to the clinic.  They also sell drugs to the clinic at a greatly reduced price.  Once we were all introduced, he led us in a prayer to bless the clinic and its patients and those who serve. Dr. Vargas is a jolly man.  Very nice and warm.  My house mom told me that he actually grew up on the same street as the clinic.  Dr. Vargas is a man with a lot of passion for helping others.  

I felt my first goiter.  Gout=Bocio in Spanish. Tiredeo= Thyroid.  I did not know those words when Dra. V told me to feel the patient's neck.  I thought I was feeling for lymph nodes. Oops. But I did end up finding the right thing, even though her thyroid was very obviously enlarged. 

I also helped a child who had an allergic reaction to penicillin.  She was experiencing impetigo all over her skin.  Impetigo is usually caused by the Staphylococcus aureus bacteria. The skin infection/ reaction is itchy and sore.  It is contagious.  According to Dra. V, since penicillin has the S. aureus bacteria as part of its formula, the immune system of this little girl reacted poorly.  She had the crusty form of impetigo, and she was severely irritated by their itchiness. 

Butt worms. Oxiouros. Pajuellas. Pin Worm in english. Gross.  One way to know if you have this butt worm is to literally put a piece of tape on your anus, go to sleep, and check the tape in the morning for eggs. Disgusting. But true. And sometimes, the most reliable source of information you can get. Also if you or your partner is suffering from butt worms, it is a good idea to have both parties take the recommended dosage of medication.  These banditos can exit one butt and enter into your sleeping partner. Pretty sick. 

These worms make your booty very itchy and a person is always moving around, restless, irritated. Little kids will scratch their butts. So in some places of Latin America, if you say "Parece que tiene pajuellas", that can mean a "That person is restless". 

Yeah, so we had some of that.  Imagine being explained that in Spanish and trying to understand.  A lot of acting and hand gestures went into play between that patient and Dra. V trying to explain all this to each other and more so to me... It was hilarious. 

On Monday, Mario and I are going to go spend all of that cash you guys donated on some very important things! I will post some pics. 

Weekend plans:  I will be MIA for 3 days.  Tomorrow I take chicken buses to Managua to meet up with Etienne and Ann. Then together we head north to Esteli and Somoto Canyon, near Honduras. And that is our itinerary.  See you on Sunday night!


Burns and Kidneys

In the hospital, I have seen everything from gruesome injuries to interesting, yet terrifying infections (see Brain worm entry).   Etienne and I saw two armed guards standing outside of the room.  This guys were huge and were sporting some pretty serious guns.  (Note: I am not one who is well versed in guns, but  it looked like an AK47, but was an not an AR15).  We walk into the room and see 6 guys in different beds.  The closet has his ankle cuffed to the bed. The second is laying down and is in some pain. The others are similar.  MRSA is a big problem in these hospitals.  Just as in any hospital, really. We were presented a patient who had MRSA on his elbow.  It looked like his whole elbow was being chewed off.  The man in the ankle cuff was horribly burned.  He had a 1st thru 3rd degree burns that covered 25% of his body.  His neck and shoulder were the worst.  He was in prison when some other prisoner came at him with a very large container of boiling water. The water spilled all down his chest and entire back and splashed his face. The plastic surgeon came in to determine the damage.  She first had to clean the burn.  This guys is tough.  He had to stand up while she harshly rubbed soapy water and some other cleaning agent over and over his burns.  Skin was flaking off and blood started pouring from his neck area.  He grimaced, but did not scream, did not slap the surgeon in the face, and did not throw up.  It was painful to just watch. I don't know what he did, if anything, to deserve that.  But he took that cleaning like a boss. 

FYI: Burn percentages are measured in the Rule of 9's.  So your arm is a 9, leg is 9, so on. You add up all the part and percentages of those parts that are burned.  Here is a picture:
source
The other guy was having trouble moving his legs, arms and hands.  He had weakness in his muscles, due to super low potassium.  The docs were still trying to figure out the cause behind his low potassium.  One of the other men was in there for end stage renal disease which was causing pretty serious pleural effusion.  the attending physician recommended that he go on dialysis, but his family refused it.  I'm not sure what will happen to him, like if he will go home or if the hospital will offer palliative care.  Or why his family refused it.  Many patients have to travel a long way to get to the hospital.  Treatments, like dialysis, are necessary a few times a week or more.  I can understand how difficult a trek like that could be. 

Oh yeah, and we saw our ulcer patient. He was in a wheelchair, outside enjoying the sun, and accompanied by his sweet mother. Hope.

I am finished for now with shadowing in the Nicaraguan public hospital system.  I have learned many things from being here, and here are some important notions:  1)The resiliency of the human spirit is unbelievable  2) State-of-the-art medical institutions and universities aren't always necessary for training great doctors and nurses. These doctors and nurses work under a lot of pressure in hot hospitals that are in pretty bad conditions and with little resources. They don't have their iPads on hand to google search symptoms and medications. They have to know their stuff. I have a lot of respect for how the have chosen to live their lives.  Especially the ones who could have stayed in the states or Europe but chose to come back to their homes. 3) We have it really good in the US, especially in terms of health care, so quit your bitching and be more appreciative :)  

Thank you my Noni and Ray!!

Noni and Ray have graciously donated to Clinica Alabama and I want to thank you both so much.  I love you and I miss you.  I can't wait to see you soon!

Abrazos!





Tuesday, July 30, 2013

Rest day

I couldn't stay in the hospital today for risk of getting sicker or more importantly  getting someone else sick.  I do not actually think I have Dengue, but I have stopped taking ibuprofen just in case.  Ibuprofen thins blood and lead to hemorrhagic dengue. I had a high fever last night, got chills, and woke up in my comforter.  There's a first. I have none of the symptoms, I just know them, so I think I have Dengue... Just pain in my  muscles and joints and behind my eyes and in my sinuses and a fever. and med-studentitis

Therefore, upon 20 minutes of research, I have self-diagnosed myself (as of now) with Surfer's Sinusitis. 

I took some pretty big spills into some big waves on Sunday afternoon.  In fact, I got stuck in the totally wrong place for 3 waves.  I had water coming out of my nose all day.  

Or maybe I have the flu. Thank you Future Dr. Kranc for helping me out this morning and last night. 

Dr. V prescribed me Amoxicilin, Acetaminophen, and Ambroxol. So that should cover whatever I have going on.

I will now rest, but I'll keep everyone updated.  Dona Espiranza is also taking good care of me. She just brought me some lemonade concoction that she said will make me feel better. So sweet. If I feel better by 2, I will head to Carita Feliz.  :) 

Here's a picture of Etienne taking a spill.  You can barely see his board in that wave :)



Early am post.

The other day I went to some churches around Granada.  Iglesia La Merced has a huge bell tower that you can climb up to and get some great views of Granada.  Here are some pics. 

























Here's the back of a residential area.  This is a tributary that floods into Lake Nicaragua during the rainy season.




And these here are mamones.  They are delicious and very weird. They grow in bundles in trees.




You are supposed to crack them open with your teeth or fingernail.  The texture is like a peeled grape. 



Then you pop it in your mouth and suck all the fruit meat off of it. 



Then you spit out the seeds in the middle. 


There is another variation of this fruit.  It is even weirder but much more yummy.  I'll post about that when I find some again. Have a great day!