Important Reminder...

Here's a video I found back in the Spring.  Thank you Amanda for re-sharing it with me. Great reminder of what is really important about being human.

Last beach weekend adventure... Part 2: Coco

I left off with Todd picking us up.  So we get to Playa Coco and I introduce the Frenchies to Amanda.  Etienne politely excused himself and headed straight to the beach, board in hand.  I went with him and gave him a quick lesson.  Probably not the best teacher, but I helped out some ;) By the end of the day, he was calling himself Kelly Slater.  

Bob and Claudia showed up around lunch time to join in on the fun.  We started drinking rum and Tonas. At 4, the Frenchies left to go back to Masaya.  The 5 of us and one of the guests next door went to Leonardo's bar for more rum.

One of Leo's sons really wanted my digits.  Everyone helped run interference.  He asked me if Todd and Amanda were my parents.  I said yes, I was adopted.... I am about 10 shades darker than both of them.  Todd is toe-headed.  Amanda has blue eyes.  Bob was my adopted brother.  Haha. Still didn't get him away.  He was nice, super machismo, very buzzed. Obviously, doesn't hold a candle to Mr. Krancyants.

We returned to the beach house, all buzzing. Surfed some waves and whitewater :) and Clau made an awesome dinner.  We ate outside by candlelight, with the sounds of waves pounding on the beach.  Got eaten alive by mosquitos, and crashed hard almost immediately after dinner.

I've never had a better night of sleep. We got up early because there as a blackout and the fans turned off.   We had some coffee, and Todd, Bob and I were off into the ocean by 7:15.  The waves were huge.  I caught one really good one.  Then I got braver and went out with the men.  It took me almost an hour to get out past the break.  It was hard work with that long board. And once I got there, I realized these were a little too big for me. I mustered u some more courage, and I tried to take one in.  Bob was infront and to the left of me.  Just as I was at the peak/crest/whatever you call it, I saw his face.  I looked down. Peed myself alittle, figuratively of course. and stroked backwards super hard.  That wave would have destroyed me. haha.  Eventually,  I found a smaller one and rode that sucker all the way into shore.  It was awesome.  Amanda got pics of the end of my ride.

We had an awesome day.  I am lucky to have people like Todd, Amanda, Bob, and Clau in my life.  A nice family away from family. Great people, living the dream in a great country.  What more could you need?

Last beach weekend adventure...Part 1: SJDS

Last Friday, I met up with Ann after work and we traveled via chicken bus to San Juan del Sur.  She doesn't speak any English, so communication is only in Spanish.  Great practice!  I was planning on going to straight into Playa Coco, but decided it would be fun to hang out with her. We had no plans, no hostel reservations, no guidebook. Sans everything... After we got off the bus we walked to the one hostel I know, Casa Oro.  They were booked.  Some hippie, dredded young men from SoCal were also looking for a place to stay.  They told us to follow them.  Why not?  So they walked us to this place on the south end of town called the Surfing Donkey.  Unfortunately, his place did not have power and they were closed.  The Hippie-boys told us everyplace they had gone too was booked up.  They looked exhausted from walking around. After much deliberation, of 5 seconds, I asked "well if we stay here, can you cut the price in half?" He looked around. Looked at us. Looked at his feet, the sky. Then, "Si, si, si!! We take care of you!"  $4 a person for a private room and bathroom is hard to beat.  For the rest of the day we walked around town looking for choco-bananos...no luck.  

We watched a heated match of Volleyball. There's an organization in SJDS that gets kids involved with the sport.  They are all really good. 

Then, we heard form Etienne.  He was in Nandaime at a rodeo.  He and Ann are in a really sweet 8-20 person band, and both play the trumpet.  So he took his and played with the locals during this bull fighting, rodeo fiesta.  Montar de Toro. While, we waited for him, we grabbed a drink at one of the restaurants on the beach.  They clouds finally parted and we saw a really nice sunset and enjoyed a nice Nica dinner. 

We showed Etienne the place we were staying. He said, "Wow, nice going ladies". Oops. It really wasn't that bad. Then we went to find a bar with some live music. We ended up at the Black Whale for a reggae and rock band.  We played an endlessly horrible game of pool. Drank a couple of cocktails.  Decided SJDS was a little too much for us. And went back to the hostel.

We sat on the roof porch and enjoyed the lights of SJDS.  Then we enjoyed a concierto of Roosters from all over the town.  It was hilarious.  We laughed so hard, we were gasping for air.  This ruckus of roosters went on for 20 minutes.  Caw caw doodle do!!  1 mile away.. caw caw caw caawww.  All over the place. All of us were really tired so we retired to our room via flash light. Our room was hot. Only one window. The mattresses were less comfortable than the floor. It was bad.  We all started to drift off, when an AWFUL dog started barking outside our window.  This cascaded into every other dog in SJDS to start barking.  Then the roosters.  Then the chickens.  No sleep for the whole night. Terrible. $4 though. 

We got up at 6:30. Packed and paid. And went out in search of a breakfast.  We found Cafetin Angelica, by the market.  We all got breakfast for c$50, which is 2 bucks USD. 

Dios mio we were tired.  We walked to the beach and found some chairs and slept. SJDS beach is not the best place in the world.  It is kind of pretty.  There are better.  But it was a nice way to start the morning. We took a couple of dips.  Drank more coffee.  I convinced Frenchies that Playa Coco is better.  Etienne wanted to learn how to surf so he and Ann agreed to come with me for the day.

Todd met us at the market and we 4wd'ed it to the best place in the world. We had to tie Etienne's $10USD rented board in the most unreliable way ever. But it made it without falling off from those bumpy roads. 

Part 2 coming...

Brain worms

There is this super cool organization called Free Wheel Chairs.  And it is exactly that.  This non-profit hand-assembles wheelchairs and donates them to hospitals.  Etienne and I saw a pack of young, pregnant Nica woman being wheeled to delivery in these really creative wheel chairs. 

Source

Here is how they are made... pretty nifty!

One of the ladies who we saw on our first visit was initally diagnosed with having a stroke.  When we visited her, she was drooling and could barely communicate.  Etienne was asked to give her an eye exam, because she had hypertensive retinopathy and retinal edema (note: may have just been retinal edema, I can't remember). He looked into her right eye with his left eye, which is slightly incorrect.  It looked like he was going in for a beso :)  Her smile was priceless.  He said in a French accent, "I can't see anything".  Then went in for another look, their noses almost touching. I tried to hold in giggles so hard, I started choking. I wanted to take a picture of her face, and her daughter's face.. It was priceless.  Finally, the resident told him he needed to look with his other eye to avoid giving any besos (kisses).  Our second visit with her, we learned that after further examination, she had a worm in her brain called taenia solium, which a tapeworm you can get from pork.  This causes Neurocysticerosis.  This leads to increased intracranial pressure, which is the reason why the residents initially thought she was having a stroke. She was acting funny, because her brain was under pressure.  

The residents are incredibly smart and very good at what they do.  I feel very spoiled witht he shiny, brand new toys we have at MUSC and in the states in general.  These kids have literally barley anything to work with.  Their CT scan machine is ancient, and the images are poor quality. Yet they still manage to make correct diagnosis, based on back up from nicer hospitals in Managua.  We bitch and moan about healthcare in the states, but it could be worse.  I honestly think every health care practitioner should take some time, even if it's a week, to see and learn how health care is in other places.

The clinic has been pretty steady.  We have started to see a lot more dengue fever.  Today, I thought I have a touch of it,but med students have everything they read about or encounter in someone else.  It starts out like the flu.  You get a really temp, pain in your body, pain behind your eyes, nausea, vomiting. Then once the fever drops a weird rash.  I have something on my back and stomach but it might be surfboard burn or heat rash. Dr. Villarreal had me as her patient today and got me hooked up with a ton of meds that cover multiple bugs. I am probably just sick with something normal like a flu or sinusitis. I feel better now, and no high fever :) so no worries family...

No hemorrhagic dengue as of yet in the clinic, which is good.  There may be some cases in the hospital.  One of the attendings who I follow specializes in infectious diseases. 

I have seen many patients with gout, infectious intestinal diseases, diabetes type 2, and, breast masses, possible cervical cancer, and lots of anemia. These are all apparently very common conditions here. Many of these patients are unable to manage these diseases on their own.  This clinic does a great service.  Almost every day we catch someone with a systolic blood pressure over 200 or a blood sugar level over 300 and 400.  

Don't get me started on women's care.  There is a very good ObGyn clinic similar to this one down the road.  They provide care for anyone who is a female. We sometimes get their overflow. These docs do everything they can to provide care.  All they can really do is look and if its looks infectious, prescribe a drug. Prenatal visits are pretty standard as is the counseling: eat well, don't drink coke, take the vitamins, don't drink alcohol, stay away from sugary sodas, and stop consuming sugar.  Coca Cola has a large presence here. Gestational diabetes is an issue.    

I have one more week left as of today, and I am very sad.  I am somewhat ready to come home.  Really just to see my family, bf, and friends.  But I am really going to miss Nica.  I already started looking at plane prices for December.  

This is a really inappropriate picture of pig's kahunas....
sorry it just had to be posted :)

Big Thank You's!

Lo siento!!! I know that I haven't updated in a while.  I've been very busy and very tired.  And the internet gets shotty with all of the rain.  I will definitely update you on last week by tomorrow night :)

But more importantly, I want to thank my Pappap and Marilyn and Keith Agin for donating money to my cause.  I really appreciate it. Mi corazón está sonriendo. 

Now we can definitely get more alcohol pads and some medicines :)

If you still want to donate, my last day of work is Monday, August 5th.  I would like to be able to go and get supplies for the clinic before or on that day.   

Help Clinica Alabama

Thank you for your support and for reading!  And look out for more updates tomorrow.  I am super tired and need to sleep :) 

Here's a pic of Pappap and me :) Love you. Abrazos!

O Nicaragua!!

In order to reward myself during the week, I have been seeking out the best coffee places in Granada (and San Juan del Sur) and going to the beach at Playa Coco :) Coffee and Beaches, bitches. 

I love coffee.  And Nicaragua has some the finest on the planet. So here are some places I have repeatedly been patronizing. I plan on going to more!  But come taste for yourself!
Warning: I know nothing about coffee growing, roasting, or brewing. But if I get time, I am going to go on a coffee finca tour so I can know what I am talking about it.  All I know is taste :)

Fitzcarraldo- Granada- 5 stars on everything. I have had every kind of coffee here. Espresso, Americano, Iced, Iced with vanilla, mmmmm. Strong, tasty coffee.  If I knew more about brewing I would write about it.  But it is good.  The staff is friendly and the atmosphere is very European. They get their beans from all over Nicaragua's coffee growing regions. 






Coffee Boutique- Granada- 4.5 stars.  I got an iced coffee here, and it was dessert. Simply delicious.  I ventured in to the cafe on a very hot day, and they served me a very refreshing drink.  This place is located right behind the Cathedral.  Not at much atmosphere as above, but still very good. 


Euro Cafe- Granada- 3.5 stars. This joint is in the Parque Centro.  This is a place to go if you need internet, a sandwich, and want to speak English with someone. Or get a blind massage. It is okay. I got an iced coffee there.  It was decent, not mixed very well.  But that may have been because I ordered it with soy milk.  They do have a really neat courtyard.  And someone there likes Calvin and Hobbes, as there are multiple books laying all around the place.  I have heard people say lots of good things. I am sure the food is good.  Due to Celiacs, I cannot eat a sandwich, but I think I should try it again.  Maybe order a salad.

El Gato Negro- San Juan del Sur- 5 stars.  They get their coffee bean from a guy who's name is Keith (?).  His coffee beans have some ratio that is ridiculously high making this bean one of the best in the country. I have no clue what I am talking about. Todd tried to explain it to me.  But what matters is that this coffee was served hot and strong. With a little pinch of sugar it was perfect. Nica families and travelers frequent this hole in the wall.  They also serve amazing superfood smoothies. 

super chill, relaxing... internet password: ireadbooks

gray's... fun

Next coffee spots:
Espressonista
Garden Cafe
Cafe de las Sonrisas
Chocolate coffee shops

Any suggestions, let me know!

Playa Coco!!
I have spent the last two weekends with Todd and Amanda VanderArk. Todd and Amanda are from the Midwest and are now expats of sorts. They decided a few years ago to have a sea side resort, and after a lot of travel, they saw the beauty of the Pacific coast of Nicaragua. Right now, they are renting out a place down the road from their land, while they get everything in order to start building. Check out their website!! Sea Dream Resort!! Todd oversees construction of houses in San Juan, and Amanda gives energy massages right on the beach. They are super nice and fun, and I'm really lucky to have such great friends only a few hours away from me. 

Todd and Amanda making me a great meal

my bus to Rivas with the 

Getting to San Juan del Sur.  You can take a taxi... you can take an excursion van... or you can the chicken buses. I took an excursion van on my first trip, just to get my feet wet.  On the second trip, I took the chicken buses.  This weekend was the celebration of the Sandinista Revolution.  It's like the US's 4th of July, but on steroids.  Thousands of people travel to Managua on Friday, via chicken and Tica bus, to attend the fiestas and rallies thrown by the Ortega regime.  This left my travel window of opportunity very small. At 7:20am on Friday, I hurried through the Granada market to get to the bus stop.  The market was already alive.  Most people don't work on this day, but these market people can make a killing catching people preparing for festivities and needing a snack before going to Nicaragua.  There are no weekends for them. I weaved in and out of bike and taxis and people and carts and dogs and chaos.  In the distance I hear "Rivas!  Rivas! Rivaaaas!". I followed the call and found my chicken bus. 

As explained in an earlier post, chicken buses are old school buses from the states.  They get a total make over before getting beat up by the roads of nicaragua and the amount of people who get crammed onto them.  The drivers own their individual buses, so they all look different. Chicken buses are not the most comfortable form of travel, but they are cheap.  More importantly, this is a great way to get involved with some culture.  Instead of passing through in a rental or with a driver, you are in the mix, in the life.  It's overwhelming, but in a good and adventurous way.  Especially alone. I get on this particular bus and everything is covered in colored tape on the inside.  Most of the seats are already occupied, so I sit towards the front. I notice how all the Gringos are packed in together in the back.  I also notice how when Nicas get on the bus they fill in the unoccupied seat next to someone rather than sitting alone. Nicas love socializing and I love that they love it :) I sat next a nice man from some mall town near Granada.  He was visiting his new daughter-in-law's family in Rivas.  We ate some corn cookies together and enjoyed the bumpy, long ride.  Chicken buses stop every 5 minutes to either let someone off or let people on. There is no limit to the number of people who get on. These buses will barely make it up a hill due the weight they are carrying.  At every stop, vendors will get on the bus trying to sell foods, snacks, and drinks. A lot of activity.  

On the way to Rivas, we passed at least 100 buses carrying 1000s of people to Managua for the Revoluccion celebration.  People were hanging out windows and were even on the top of the buses waving the black and red FSLN flags.  Upon getting off the bus, I learned from the 50 cab drivers flooding the doors, that all the buses were done running.  It was 9:15am.  Somehow, luckily, I ended up on the last bus that day away from Managua.  But now I was stranded in Rivas with eager beaver cab drivers trying to get me to pay 3x as much to get to San Juan. 

buses to managua

If you know me, I hate people in my face telling me what to do.  Being the first to get off the bus, I was the first to get slammed with offers of a ride. So I sat on a bench and waited. Once everyone stopped being in my face and dispersed to the others on the bus, I found the quietest of the taxi drivers and asked for a ride.  He drove the dinkiest car I have ever seen. It almost didn't start.  He let me in the front seat, because the back passenger door was jammed.  I asked him why he wasn't in Managua partying, and he looked , at me with a look I get from half from the people I talk to when we talk about politics. He then looked at a picture of family and said "I'd rather work for them, then party for nothing". I won't get into Nicaraguan politics on this blog, but it is interesting.  People love talking about it. It's unlike the US because no one gets offended.  You can be with someone of totally different views, and politics are extreme here, and have a healthy conversation.  I love it. But if you are interested you should read about it yourself.  Nicaragua has an intense and very fresh political history that has left a country very divided... but still in a lot of ways united. 

He took right to El Gato Negro and wished me luck on my Nica adventures and with med school.  I enjoyed a cup of coffee and a book while I waited for Todd to get done with work.  On the way to Playa Coco, we stopped at the local market to pick up some fruits and veggies, and the largest mango I have ever seen.

mango with carrot and my cell phone

Driving to their house is an off-roading adventure through villages and jungles. In the rainy season, it is beautiful. Also, there is a fair amount of wildlife and farmlife on these roads. You will also find the following obstacles: flooded out bridges, wash outs, huge ditches, an occasional non-moving ox, and chickens.    

During my time at Playa Coco, I got in the most important R's in life: Rest and relaxation and rum.  They took me to what the call the Corner Bar, otherwise known as Bar Las Vegas, in Ostional, a small town south of Coco. Leonardo owns the bar, and he with his entire family live and work on the small plot of land.  Leonardo's bar is unlike any other I have ever been to.  It's a treasure.  Leonardo is also a treasure and has coined his expression "O Nicaragua!".  You have 3ish choices at Corner Bar.  You have Tona, the Nicaraguan national beer, or Rum.  You can have the rum with coke or with refresco.  I choose the coke.  He brings you out a bottle of coke and then shows you a small bottle of rum and the big one.  We ordered the small one.  So you drink your coke bottle down some and then pour in the rum.  Thumb in the hole, flip bottle over and mix, enjoy. The best rum and coke -aka Nica Libre- in the world. 

Leo and one of his granddaughters

I spent most of my time relaxing and talking with Todd and Amanda.  We tried to go see some sea turtles, but they were being shy.  We also tried to go on a hike to find a waterfall with Willian, their house cleaner, but workers were building a bridge, so the road to Collado was closed.  Collado is small village without running water or electricity.  Willian walks 2 hours to and from their house to clean it almost every day.  He and his newlywed wife are pregnant with their irst child.  I was really looking forward to seeing where they live and learning about life without the "necessities".  We decided to try again next weekend (I can't stay away from the beach). I did have the opportunity to witness the most amazing sunsets and fall asleep to the sounds and vibrations from huge waves crashing ~300 yds from my head. Todd and Amanda get to live this everyday!! What a life... This is the wild west, life on the frontier, or more appropriately, frontera :) It seems like the simple life, but it is hard work.  I have a lot of respect for a couple who can shed their American luxuries and survive together in a jungle, and start a business at the same time.  True love and Truly inspiring. 

I wanted to take her home so bad

More beach pics will come.  Plus check more out on Flickr... I swear I will update it. Tonight... or tomorrow!! Next weekend, Bob and Claudia and I are all going out there to celebrate life and friends! Seriously, I may run away here. 

The bus rides back were quite the experience.  I had a lay over in Rivas for almost 2 hours. Rivas on a Sunday was interesting. I really had to put my mentality of "do as the Nicas" to the test. Sundays are big drinking days here. There are two bars right in the bus stop area.  You have your passive drunks, you have your fighting drunks, and you have your flamboyant drunks.  I don't know if the latter is typical of Rivas, but I was warned of them.  These guys will come up to you and look at you or talk to you.  For most people, like anywhere you can ignore then and they go away.  But these louder guys, once they lock on, there is no getting away.  I was targeted by one old man with a huge walking stick.  He yelled "Puta!!" at me and said some other things.  Instead of ignoring him, I followed some Nica advice, and asked how he was, if he needed anything. "Puta!!"  Okay. fine. Now I will ignore you.  He treated some other people the same way, and I watched how they handled him.  I was pretty dead on with how to handle the poor man.  He was poor, lonely, drunk, and probably a little foggy in the head.  I didn't let myself take it personally, or go off on him.  So whenever he would come back I did the same as the other Nicas did. He yelled Puta! at an old woman and she bought him a pastel/ pan dulce and told him to shut up. I did not buy him a food, but asked him to please shut up and I was not interested. He then sat down next to me and stared at me for about 35 minutes. I kept my temper at bay trying to have the patience as the other Nica women and looked blankly ahead. Finally, a nice HUGE Nicaraguan kid came and sat in between us. This guy could have been an NFL linebacker he was so big and built.  He is a very nice kid. He asked me where I was going and told me when the next bus would be.  He sat with me for an hour to blockade me from Mr. Stick, and also helped me onto the chicken bus.

The bus ride was long.  A young woman from Norway sat next to me.  She and friends were giants.  We had great conversations about travel and our views on life.  She is visiting Nicaragua for the first time with some friends from work.  They started in Panama and have worked there way to here in 3 weeks.  They have 5 days left before their holiday is over, so they are spending it relaxing in the quiet and colorful streets of Granada.

Nota Final: Someone once gave me great travel advice: "Do as the people do. Be smart. Have respect. Most importantly, be humble."  Nicaragua and her people are amazing.  And every day that I am here, I see more and more of the beauty. 

Here is a fun video of some cows in the road!!

Rounding and Oh my God...

I arrived to the clinic really early on both Monday and Tuesday.  By 5:30am, my room had turned into a sweat lodge.  Dona Espiranza prepared for me a typical Nicaraguan breakfast of an egg sunnyside-up on fried ham, gallo pinto, a tortilla,  papaya, mango, and a banana. Coffee with an overload of sugar. And cold glass of sugar with some pitaya juice.  Really healthy:) but so delicious.  I reluctantly put on my scrub pants, and walked outside into the surface of the sun. The clinic was even hotter. As much as I wanted to take the one fan on the intake side of the clinic, I positioned it to circulate air to the whole area to get some flow towards the patients.  Everyone was sweating.  I think Mondays are big blood sugar days.  We tested almost all 60 patients. 

Around 9:30am, Mario shared with the French baby-MDs and me that we were heading to Hospital Amistad in the afternoon!  My stomach dropped.  Spanish is hard enough to just comprehend when you aren't fluent. But now I am leaving the comfort of the clinic to have to survive the wrath of tired doctors and overworked nurses whose last thing they want to do is deal with a Gringa. I am was also very excited about stepping into the unknown.  Boy, were we all in for it. 

Front of the hospital.
source

Mario drove us over to the hospital and introduced us to the head of nurses. Then he left. Jefa took us to the cafeteria, which was more like a street taco stand in the parking lot.  She left. After a couple of enchiladas with gallo pinto and a cup of water covered with a baggy to deter the flies, we went to look for her. We had no idea what we were doing. Once we found her, she pawned us off to the Sub-Director of the hospital.  His office was a closet shared with 3 other people.  It smelled of cigarette smoke and heat... Very straightforward, fast speaking, and left little time for questions.  He is a busy man.  He told us to go to Emergency. Then took a phone call.  I'll just say we did a lot of figuring shit out that day. All part of the experience :) 

Emergency.  Emergency was more like a triage in a place of war or refugee camp.  People were herded onto benches outside in the heat, and their cases were ranked by some degree of seriousness. The floor, as one would call it in the States, is just a room. Some areas are separated, but most of it is open and cramped and hot.  We found 3 doctors to shadow.  I got lucky.  Etienne and Anne were with docs who could care less about having them around. It was probably a long day for them though.  And I'm not happy when I am stressed and hot, so I can't imagine them being any different. Plus, no one told any of the hospital "floors" that we were coming.  I had a pretty nice doctor.  He took me back to radiology. Showed me some X-rays of broken bones.  He also showed me how to set a broken arm on a 2 year old without waking him up. We had another patient who had fallen off a ladder and sliced his hand open.  The doctor explained to me the many of accidents they see are work-related, usually involving machetes, ladders, or machinery.  

I couldn't believe the ER. It was filthy. Soap and betadine were stored in old, used Aplina water bottles.  Used gauze was stuffed in the corners and needle caps were laying on the floor.  I saw one person wash their hands the 45 minutes I was in there. People hooked up to IVs were sharing hospital beds. They were slammed. About 80 to 100 patients were waiting outside to be seen by the 3 doctors, and it was already 2. Etienne and Anne couldn't handle it anymore, so they talked me into leaving to go and check out other areas. We figured that we would have more luck with the docs in Internal Medicine.

During our retreat from emergency, we all started to really see this hospital.  The hospital reminds me more of a huge high school in the states.  The hallways are covered sidewalks outside.  The waiting rooms are benches on these sidewalks.  

Source

There really is no indoor area.  The rooms have windows without glass.  They kept cool-ish by fans and open air.  No AC, except for in the ICU and OR.  Stray dogs and cats were going in and out of hospital rooms. Flies and mosquitos outnumber the patients.  There is a very faint scent of vomit that flutters around as well. 

We went to ICU, Internal Medicine, Surgery, and OB/GYN.   Etienne did most of the talking. While both he and Anne are fluent, he's took the lead and received most of the looks while we were there. No one knew why were there, nor knew what to do with us.  Most of them ignored us with look of annoyance.  We later figured out that everything happens in the morning.  There was one doctor per unit around, and he or she was doing paperwork. The ICU doctor and the OB nurse were the nicest and did their best to fill us in on the doings of their wards.  We were urged to come back in the morning.  I left feeling miserably confused and defeated. So did my French counterparts.  Anne was so turned off by the experience she wrote off going back again. 

On Tuesday all 3 of us stayed in the clinic. We explained to Mario what happened.  Etienne and I asked if it would be okay to go in the mornings. Sure!!  I saw some cool stuff in the clinic on Tuesday but I'll save that for another day. 

This morning I hopped on a chicken bus heading to Managua and jumped off 10 minutes later at the entrance to the hospital.  Etinne and I met out front and bravely walked upstairs to meet El Jefe. He told us to go down to Internal and find the residents and they were rounding at 9.  Then he looked at Etienne and said "You cannot wear this".  Etienne was wearing surfer shorts, flip flops, and a t-shirt.  He brought scrubs with him.  But no white coat for this Frenchman. 

In the residents' lounge, we heard all about the typical cases they saw. TB. Pneumonia. AIDS. Dengue. Ulcers. Strokes.  Then we started rounds. At first it was pretty typical.  Then we entered the ICU. Only 6 beds, and no dividers. There was a kid who drank pesticides and was in a coma. Two elderly women with extremely bad cases of pneumonia and emphysema.  A man who had a stroke leading to him being in a level 3 coma.  A man with unmanaged diabetes who had both legs amputated, suffering from AIDS, and pneumonia. And I'm not sure about the last one. It was difficult to be in a room surrounded by audible suffering and pain.  Flies were zipping around everywhere.  It was hard.

We rounded some more, and we saw and examined some more stroke patients. It's amazing the different symptoms and levels of extreme a stroke can cause. After about 2 hours of seeing and learning, we hit the big daddy.  

My life will never be the same after seeing this.  A man in his 20's fell from a ladder and shattered his spine, leaving him paralyzed from the waist down.  While on bedrest, whoever was caring for him did not move him enough.  He developed a bedsore within 2 hours, and soon after, the ulcer turned necrotic.  When the resident turned him over, I expected to see the usual bed sore you would find in geriatrics.  Not so.  It was like my second block in anatomy lab when we dissected the lower back and buttocks region of our cadavers, except this was a living, breathing, talking young man in some real pain. The medical team had to dig out all of the necrotic tissue to reach unharmed tissue.  His wound, I don't even know what to call it, went covered the entire width of his back and went from L3/L4 to S1/S2 as well as to the top part of the coccyx.  You can look of the dermatome guy for reference.  It was so deep that we could see muscle tissue of the back and glutes and parts of his sacrum and coccyx.  Adipose tissue, muscle, arteries, bone.  All of this was contained with a tiny strip of gauze. There was no sterile field prepared while we watched the residents clean it. Flies were landing on it. This poor man had diminished sensation, but he could still feel this gaping hole in his lower back. Etienne and I were almost sick to our stomachs.  His mother had tears streaming down her face.  She knows the high probability of infection. As well of the high probability of losing her son.

It's terrible to see things like this.  You want to judge. You say things like, this would never happen in ____, why don't they do this procedure, why are they using this and not this?  But we have to remember that when we study in 3rd world countries, we are going to see things we won't ever see in our bubbles.  We study in top notch universities of top notch hospitals. The public hospitals here are doing the best they can for the very sick, the very hurt, and the very poor.  I am humbled at how resourceful these doctors and nurses need to be.  

Etienne and I talked Anne into coming with us at lunch today (somehow we got our appetite back).  I think we are going to learn quite a bit about medicine in the 3rd world at Hospital Amistad, as well as a lot about ourselves.