Relationships

I want to talk about some of the people, specifically non-Nicas, who I have met here.  This is my 4^th visit to Nica, and my 2^nd extended stay here.  I swear every time I come, I meet so many people who reaffirm why I keep coming back and inspire me to stay on this path  of improving health in Nica.   People like the ones I am about to talk about, and myself included, come here for a reason that is surprising to most.  Yes, Nicaragua is beautiful, physically.  It even sounds exotic to say Nicaragua, and people think you are adventurous for traveling here. However, there are plenty of other countries that are much more "USA and general-traveler friendly", accommodation-wise (AC, hot water, sewage, potable tap water, on-time transportation, less encounters with starving children and stray dogs.  So why do people keep coming back instead of checking out these easier places?  

After a little more than a week of being here, I have realized that the true purpose, for me, is  becoming less about learning medicine.  Instead it is about witnessing the true needs here, so that in the future when I am more adept to impact, I will know how.  The trip is so different from all of the others.  When I came down here with Manna Project, Inc, we were working with the poorest of the poor Nicas.  But I was living with 10 other USAmericans.  This trip I am alone.  I have “telenovela hour” with the ladies of the house: Esperanza, her mother, Yelena, and Maria. I watch Amores Verdaderos”… so good.  I eat my meals with my host family.   I get ice cream with Yelena.  I sleep in the hottest room, sharing it with mosquitos and lizards.  I wake up to the smell of gallo pinto and burning trash (bad as it sounds, I kind of like "Burning trash" smell.  I literally eat, sleep, and breath Nicaragua.  What have I learned?

Nicaragua is about relationships, love, humility, and patience.   Even though I am learning about drugs and diseases, I am learning more about how to build lasting relationships with the people I am treating.  Medicine is intimate. In order for those who you are caring for to trust you and tell you what they truly need, beyond the obvious, you must have a relationship.  That is key especially in Nicaragua.  

I have met some other people who are here to build those mutually nurishing relationships and to empower people to make culturally appropriate changes to improve their communities. 

Cheri Mauldin, Missions of Grace
In an earlier post, I talked about the lack of specific services here, such as mammograms and ultrasounds, referencing the patient with the lump in her breast.  After that experience in the clinic, I went to the 4th of July party at Eliza's house. At some point during the party, I ended up talking to a woman who I can honestly say is true a hero.  Cheri is from the states.  In 1994, Sherri and her husband moved their immediate family of 12 to a rural region of Northern Nicaragua. They lived without running water and electricity for a number of years, becoming humbled by a foreign and indigenous people.  She told me a story of how she took this gardening class before coming here thinking she could spread her Western knowledge.  Upon their arrival, she threw on her longest skirt and developed a plot of land for gardening.  She had noticed how there were no other gardens anywhere, so she thought " wow, I'm really gonna change some lives".  The Nica women just looked at her like she was crazy.  Well, her garden was planted, things grew, and then promptly, everything died.So she tried it again, this change changing her technique.  She gave her garden more attention and encouraging prayers. Same result.  Finally she did something that is surprisingly very rare of NGOs and missions to do when they come here.  She asked for help. THe women smiled, quietly forgave her :), and explained that their soil was not good for growing vegetables during that season.  and all she had to do was mix the soil with lime.  

I could write a novel on her. I hope someone will one day.  Her philosophy is one that humans should follow everyday. She believes n respecting cultures and traditions and knowledge.  Rather than showing people how to to something, she empowers them to do it their way, sometimes with a little tweeking. 

Most importantly  she believes life is about relationships.  It doesn't matter if you have it all or have nothing, as long as you have relationships with people, you have everything. 

Update: She is now a grandmother of 5. All of her family is back in the states after spending most of their lives in Nica, except for one daughter.  Sara just had her 1st child and lives with her husband in San Juan del Sur. 

Nishant, Peace Corp, Virginia

Nishant is probably one of the tallest people living in Nicaragua at the moment;) Nishant hails from Virginia, USA and is a recent graduate of William and Mary.  Next August he will be matriculating to Emory University to achieve a Masters in Public Health (whoop whoop!!) with a concentration in Global Health.  Currently, he works in the Peace Corp office in Managua.  He also has a resident card for Nica… jealous.  He knows 2 dialects of Indian and Spanish, along with English. He loves learning about the culture of Nicaragua and loves the nature in this country as well. His job is all about developing rapport.  

Juan and Becky, Venezuela and Massachusetts

Jaun and Becky live in Granada and work for an NGO that supports small businesses in Nicaragua.  Becky received her MBA with a concentration in International Business and wants to continue work in Latin America.  They both have a deep appreciation and respect for Nicaragua and all of Latin America.  They are a power couple and they are so cute in love with each other it was gross, (in a awww kind of way).

Stephanie,  Canada

Stephanie is a 22-year-old McGill graduate. She also works for an NGO that support small businesses and another that supports the arts within education here in Nicaragua.  She has been living in Esteli since May, and she has lived and traveled all over Latin America. Relationships. Empowerment. Feminist. These are all terms that have profound meanings for her. I had the opportunity to have a great dinner with her and listen to some wise words. I couldn’t say anything because I was so impressed by her passion and beliefs.  Literally, I was speechless.

This country is great for the people.  THe natural splendor, food, and views are extras.  The people here are gracious, kind, and respectful of each other and really everyone.  Family is number 1, next to God. You'll see people at 2 and 3 in the afternoon and think, "Why aren't they working" and "Maybe this is why they are poor".  But you see them sitting in the shade with their children and friends.  Teaching each other handicrafts or enjoying a snack or a beer (not the kids...jeje). 

Steph reminded me of this story from Mexico, and I have heard derivations of it from many other Lating American cultures. But I believe we all have something to learn from it regardless form where it comes from...

An American investment banker was at the pier of a small coastal Mexican village when a small boat with just one fisherman docked.  Inside the small boat were several large yellowfin tuna. The American complimented the Mexican on the quality of his fish and asked how long it took to catch them. 

The Mexican replied, ‘only a little while.’ 

The American then asked why didn’t he stay out longer and catch more fish? 

The Mexican said he had enough to support his family’s immediate needs. 

The American then asked, ‘but what do you do with the rest of your time?’ 

The Mexican fisherman said, ‘I sleep late, fish a little, play with my children, make love with my wife, Maria, stroll into the village each evening where I sip wine, and play guitar with my amigos. I have a full and busy life.’ 

The American scoffed, ‘I am a Harvard MBA and could help you. You should spend more time fishing and with the proceeds, buy a bigger boat. With the proceeds from the bigger boat, you could buy several boats, eventually you would have a fleet of fishing boats. Instead of selling your catch to a middleman you would sell directly to the processor, eventually opening your own cannery. You would control the product, processing, and distribution. You would need to leave this small coastal fishing village and move to Mexico City, then LA and eventually New York City, where you will run your expanding enterprise.’ 

The Mexican fisherman asked, ‘But, how long will this all take?’ 

To which the American replied, ‘15 - 20 years.’

‘But what then?’ Asked the Mexican. 

The American laughed and said, ‘That’s the best part. When the time is right you would announce an IPO and sell your company stock to the public and become very rich, you would make millions!” 

“Millions - then what?” 

The American said, “Then you would retire. Move to a small coastal fishing village where you would sleep late, fish a little, play with your kids, make love with your wife, stroll to the village in the evenings where you could sip wine and play your guitar with your amigos.”

source

Que dices?

What a couple of days.  First I will talk about my first day with las doctoras.  I followed Dr. Garcia On Thursday.  At first glace, she appears to be a stern, serious woman.  When I walked over to her side of the room to reintroduce myself and let her know I would be with her that day, I jumbled all of my words up to an incomprehensible word soup.  She gracefully smiled at me, and said “Que bien!” She introduced me to each patient, and each patient was kind and gave me an appreciative smile.  Nicaraguans are a appreciate people as a whole; the position of a student of medicine is pretty much the same thing as a doctor to them, respect-wise.  A lot of pressure. 

During each patient exam and interview, Dra. Garcia went over the science and impact on lifestyle behind the health problem.   It was mostly diabetes and heart issues, so picking out clues from her rapid Spanish was too difficult.  Then came the drugs.  During the first year of medical school, we learned ~5% of the drugs we will end up knowing by the end of 2^nd year.  Listening to a Wikipedia page’s worth of information on each drug, in Spanish, was insane. It's hard enough in English.  Every time I started getting frustrated with myself, I had to make myself remember that I am here to learn. Furthermore,  I had to keep telling myself, I am not here to only learn Medicine, but more importantly (for now) to learn about the Nica people, culture, and the language.  Dra. Garcia was very patient with me and was able to help me through the headful of knowledge. 

Anyway, some cool things I was able to do, besides dissect Spanish on drugs and natural remedies. I learned how to perform an injection in a booty while avoiding the sciatic nerve; Differentiate pathological breathing sounds (I need more practice); I set someone up on a nebulizer; I found a pea-sized lump during a manual breast exam in the upper right quadrant of a patient’s left breast proximal to her areola. That was pretty intense.  

After we dismissed the lady with the lump, Dra. Garcia talked with me about the lack of services in Nicaragua regarding women's care and cancer screening.  Many people have never even known or thought about getting a mammogram or ultrasound or a pap smear (let alone can they afford those types of services nor are they available).  So there isn’t anything we, as a clinic, can do for her.  We tell her where she can go and hope she can get a free or greatly reduced service.  I hated sending someone away with so much uncertainty.  But that’s the way it is here.  The degree of lack of resources puts a lot of responsibility on the doctors to be empathetic as well as serve as a beacon of support and guidance.

I am hiking Mombachu tomorrow, so I need to sleep.  Cars are not allowed up and it's a pretty long and vertical road up to the top. If you miss the Jeep rides (only 4 of those a day), then you are hiking. Then there are the actual hikes once you get to the top-ish region.  And getting there will be a good bus ride experience : )

Happy 4th Eve!

The last two days have been 2 of the most tiring days of my life.  I am only in the clinic for 5 hours a day, but we pack in at least a whole days worth of patients and work into a 4 hour time period.  Since we only have two doctors on hand, sometime the other student and I have to perform preventive measures while the patient waits.  For example, if someone has a systolic blood pressure over 155 or diastolic over 95 (healthy <120/90), they get a beta blocker under their tongue.  And if someone’s sugar is over 300, they get an insulin shot.  Over 400, someone walks them to hospital.  Diabetes is surprisingly prevalent.  Surprising because the food they eat seems so much healthier and more natural.  However, the street vendor food is not so healthy. It’s like the most delicious smelling bread doused in sugar and honey as well as yummy Nica doughnut treats.  Thank God for Celiacs, because I would come back diabetic and muy gorda.

Another thing that this clinic lacks, that I have never thought about being a helpful tool, is a scale for babies and toddlers.  Kids get scared seeing a huge scale for the first time, so they won’t stand there for long.  Babies can’t stand obviously.  So we have to weigh them with their mom and then either I or Rachel hold the baby while we weigh mom without her kid. Also, on the note of parenting, we had a 13-15 yr old breastfeeding a 2 year old in the clinic. Obviously, I know teen pregnancy is a thing, especially here, but I have never seen someone so young breastfeeding before. 

 There is a limited supply of gloves, which I think are reserved for the doctors.  We only use them when we are slammed and do all of the diabetic’s blood sugar at once. And we only wear one. Dealing with needles is scary, even if it's for a simple finger stick.  We use the One Touch system and something like this at-home finger pricker.  Our are older versions, and we don't have the option of an automatic release of the used lancet. Needless to say, we are super careful and try to take our time.

Sidenote.  I am sure Anne and my Aunt Denise can relate to this.  We have some really really old people come into clinic.  Fully functioning 95+ year olds.  Every time I do a blood pressure, I think I am going to break an arm because they are so thin!!! I could wrap the BP cuff around their arms 3 times.  One time my dad and I saw the oldest couple in the world in Mexico, but I think these Granadians have them beat.

I helped out in the pharmacy as well.  We get the Rx’s from the doctor, and put the pills in baggies.  On a piece of cardboard cut from a box that onc housed medicine, we write down the name of the drug and the directions: “Un tab, tres veces diario”.  Marvin is the pharmacist.  I am pretty sure that he hasn't gone to pharmacy school.  He volunteers his time in only air conditioned, non-Doctor area in the clinic.  He looks up interactions on the computer while listening to Bob Marley and reggaeton. He's knows quite a bit about the drugs he is prescribing.  And he’s hilarious.

I have also been visiting Carita Feliz a lot.  I am helping the 4^th grade class.  They are a crazy bunch of kids.  Miguel has become a favorite of mine. And 2 other little girls, Maria and Audelis.  They are great dancers. What am I saying, I can;t pick favorites.  I love this class. I tried to take pics today, but Miguel kept taking my camera to take pictures of his mouth.  I am supposed to be helping in pre-school too on some days, but I can't stay away these cuties!

Miguel and Kenner(?). They dont sit still.

Tomorrow, Rachel and I will switch with the French MD’s, and I’ll get the chance to have no clue what’s going on with the Docs.  Rachel is a 4th year med student in England, and she is fluent in Nica Spanish. Then later in the afternoon, I’m taking the Express Micro-bus to Managua to hang out with Bob and Claudia and celebrate Amerrrrka.  Happy 4^th!! 

Here's videos taken by Miguel and David!  They are in the process of learning a new traditional dance. Here are Youtube links for a little beter quality: Video 1  Video 2

Carita Feliz, Sex Ed, Bicycle Rights, y Cafe del Tiempo

Carita Feliz is a school that goes from primer to 8th grade on the weekdays, and on the weekends, they offer practical knowledge and skills classes for older adolescents and young adults. The classroom is like an old school house in the way that everyone is together.  They have separated teachers for different grades and subjects, but everyone is in the same place pretty much.    A lot of people in one place, trying to learn different things.  Needless to say, the teachers are really good at what they do.  Here is an article on Peder Kolind, the guy who started it all.  It's in Spanish, but try and translate it!  It is very inspiring!

Sex Ed... Yesterday, I bounced around classes and age groups, and one of the classes was very interesting. I was with a group of 9 year olds, when I entered into something completely foreign to me. They were given a Sex Ed presentation.  This wasn't anywhere close to the vagueness of a US lesson.  This presentation was straightforward, honest, and not sugar-coated.  Latin America has more problems with STIs and pregnancy within a much younger population than in the US.  This discussion was great, because it opens up discussion at an age where pregnancy and STIs are more common than you would think.  These pages from Advocates for Youth  has some good facts (*a wee bit outdated). Same with this WHO factsheet  that compares all countries (*also a bit outdated).  I am starting to see potential for some good research here :)

mi bicicleta

Bicycle Rights? Nope. I rode by bike all morning and rode it to Carita Feliz.  I ended up in a class on Turismo with other young adults who want to learn skills to work in food and bev and tourism.  It was more a Spanish comprehension class for me.  Anyway, there are no rules for cyclists or for drivers when it comes to watching out for bicyclists.  No one pays attention to stop signs, uses blinkers, looks to see if anyone is coming. So you keep your eyes open and head up and hope for the best while on a bike.  Despite the craziness, drivers here are pretty good at last minute reactions and horns. No close calls yet :)

Free time... I explored Granada for the rest of the day. I bought a chip for my phone, ate another great Dona-prepared lunch, and went back out to get lost. 

Main Square 

I was walking down to the lake and it started raining hard.  I'll have to try that again when it's drier or bring a raincoat. Granada is pretty safe town.  Super chill.  You can always find someone taking a nap or relaxing on a bench.  No rush here. If anyone bothers you, just give the Nica Finger, which is a wave of your index like saying no no no. What is interesting is that I keep seeing Americans, Canadians, and Europeans.  No one will really make eye contact with each other, because most of the people who travel to rustic countries like Nicaragua are trying to get away from their world.  I found some really cool places to eat that will be visited tomorrow.  I had coffee at a really neat place in the center of town called Fitzcarraldo.  They serve coffee that is in the Specialty Coffee Association of America.  

 Then I came back and hung out with my house family.  Dona Espinoza had her son and his family over.  Their youngest son, who is 9, speaks near fluent English. Very impressive. Now I am resting, and I will spend my evening learning some medical Spanish so I am not a total dumbass on Monday.

Lastly, here's the bird

I can't spell his name... but it starts with an S... I call him Shh