Thursday, March 29, 2007

Central American Road Trip 2007

10 days, 5 people, 3 buses, 2 rental cars, 3 countries, lots of granola bars. . .

Tomorrow (Friday, March 30th), Hilary, Brandy, Claire, Tracy and I are embarking on our epic road trip throuh Central America. Next week is Semana Santa (the week before Easter) and all of Nicaragua is on vacation. That means, we don't have to run our programs. So we figured we might as well see all of Central America. We leave at 5 am.

Friday: San Salvador
Saturday- Monday: Guatemala (Xela, Lake Atitlan, Mayan ruins, Lago de Izabal, etc.)
Tuesday: San Salvador
Wednesday-Sunday: Honduras (Tegucigalpa, Copan, Pultapanzak, Grasias, Naciones Unidos Park)

We'll be doing lots of hiking, ruin-exploring, sleeping in hostels, backpacking, market-shopping, and lake swimming...

wish us luck
y nos vemos pronto

Monday, March 26, 2007

Scrubbing in

Today I assisted in my first surgery. Seriously.

My alarm went off at 5:30 am- the same time the roosters in our backyard start crowing and the blood orange sun starts creeping over the horizon. I rolled out of bed, threw on the most professional-appearing attire I have in Nica (a collared shirt, some khakis and my new coconut shell earrings I bought at the market yesterday), made some coffee, ate some gallo pinto and headed off to Hospital Infantil Mascot (one of two free children’s hospitals in Managua).

In order to get to the hospital, I had to catch two different public buses, not an easy task during the mornings when Nicaraguan children are rushing to school and adults are off to work. This morning, like every morning at 6:30 am in Managua, the public buses (old US school buses) were jam-packed… to the point that four or five men were literally hanging out the back, holding on tight to the open doors. I waited for thirty minutes before a bus arrived that didn’t have more than 100 people smashed into the seats and aisles. After two bus rides and forty minutes of standing sandwiched between a pregnant woman and a man holding a bag of rice, I arrived at the Children’s Hospital.

Dr. Mendez, a Nicaraugan pediatric surgeon (who works with our child sponsorship program), greeted me when I entered Hospital Mascota with a kiss on the cheek (the typical greeting in Central America). The hospital, nice by Nicaraguan standards and free to its patients (thanks to tax dollars), was teaming with babies and children and mothers- all waiting to be seen by a physician. Walking to the surgical ward I passed a baby with hydrocephaly, a young girl holding her bloody hand in a cloth, and several crying children holding on tightly to their mothers’ dresses. Dr. Mendez pointed out a three-year-old boy with big brown eyes who was about to have an abdominal surgery… that I got to watch.

Scrubbing into surgery was awesome. Decked out in green scrubs (booties, hat, mask and all), I followed the doctor’s lead as he showed me how to properly wash my hands before surgery; soap up to the elbow, scrub scrub scrub, rinse, repeat.

The little boy on the operating table had a perforated bowel and had already undergone a colostomy, in which part of the large intestine was brought into the wall of the abdomen. As a result, this child literally had part of his intestines outside his tiny belly. The doctor’s job was to repair the bowel, and put the large intestine back inside the boy’s body. For two and a half hours I stood next to the doctor, amazed at his confident and fluid sewing techniques. Stitch here, cut here, cauterize here, sew-up the large intestine- no big deal. It was incredible. And the best part? I got to help out with the stitches- the doc said, “Asi no te aburres” (so you don’t get bored), and handed me the needle. Seriously.

After the successful surgery I watched as the doctor told the parents of the little boy that everything went well. Upon hearing the good news the mother began to weep as did the father. Both are farmers in the mountains of northern Nicaragua, and hardly make enough money to feed their children nevertheless pay for this expensive surgery. They had driven nine hours in the back of a chicken bus with their three-year-old who had a torn bowel (the result of a serious oxen cart accident) because they couldn’t afford the hospitals closer to home. And now their son was going to be okay. They were so grateful to the doctor- the mother (between weeps) even hugged me as she said gracias over and over. Mid-hug the doc looked at me and winked, whispering “el mejor parte del dia,” which means “the best part of my day.”

Friday, March 23, 2007

Best Hospital in Central America?

This is what the Nicaraguan guidebooks say about a hospital I visited last week with a group of medical students from the US (who were here for a week volunteering through Manna Project)…

“Hospital Metropolitano: The best hospital in Central America. This world class facility boasts the finest medical equipment available, Central America’s most advanced surgical center, and is known internationally for its state-of-the-art healthcare.”

As an eager, med-school-bound, health enthusiast, this kind of description gets my blood going. Basically, I couldn’t wait to see this supposedly incredible hospital- I was so excited that a hospital as advanced as this even existed in a third world country.

So you can imagine my surprise when we discovered that this world-class hospital (despite the fancy machines and expensive equipment) was for all intents and purposes, empty. There were hardly any patients in the hospital- it’s too expensive for most Nicaraguans, 50% of whom live below the poverty line. The white, clean walls of the hospital, decorated with fine Nicaraguan art, stood alone in the deserted hallways. Hotel- like patient rooms, with blue walls and large windows looking over a beautiful garden down below sat silent and vacant. Even the surgical unit, with its state-of-the-art sterilization machines, was unoccupied when we walked through for our tour. Oh, and the most common surgery in this “world-class” hospital? Boob jobs.

I couldn’t believe it. We’d just spent the entire morning working at a free clinic in the Managua City Dump. The tiny clinic (hardly impressive, but quite functional) is a three-room building with two exam rooms, a scale, two shelves and a cabinet for donated medicine (the only medicine). It was jam-packed earlier that day with men, women and children, both young and old. The medical brigade volunteering there did the best they could with the clinic’s limited resources; there was no lab for testing, only a very limited supply of donated medication and no fancy equipment for X-rays or ultrasounds. The three doctors shared one otoscope and one blood pressure cuff (that the medical students happened to bring from the States). Patients waited outside the clinic in lines to be seen. Although hectic and busy and small, the clinic was operational- but because of a lack of resources and supplies, the patients did not (could not) receive complete care. Words can’t describe how hard it is to tell the mother of an extremely sick baby that ‘sorry, we don’t have the right medication for your child. And we don't even know what your baby has because we have no way of doing any tests… maybe come back in a week.’

The morning I’d spent in the chaotic clinic in the Dump contrasted so greatly with the emptiness of this big, expensive hospital. I felt like I’d been in two different worlds. The juxtaposition of the two health care facilities still makes my head spin. Why put so much energy and money into a big, fancy hospital that nobody can afford? Especially when there’s so much potential to impact the severe poverty and disease elsewhere in Nicaragua…

Friday, March 09, 2007

Sandías y Swinging

Two weeks ago we hauled fifty tiny kids and their mothers from La Chureca (the Managua City Dump) to our community center for a day-long, health-centered event. The children, all part of our Child Sponsorship Program, were dressed in their finest, having been freshly scrubbed and bathed by their mothers. The little boys had their hair parted and most of the girls wore sweet, frilly, lace dresses- presents given to them on their birthdays as part of the Child Sponsorship Program. Upon hugging the kids as they exited the shuttle from La Chureca, I smelled the subtle, inevitable stench of rotting trash and smoke that clung to their tiny bodies- a heartbreaking reminder of the homes these children were coming from: the City Dump.

For the next 4 hours, we played with the kids on the playground; running on the soccer field and spinning on tire swings and giggling and swinging and dirtying up their clean outfits, all while their mothers listened to a health lecture given by a local nurse. The nurse spoke about the importance of nutrition in children’s lives and how it is essential to proper development. After the lecture, we served the kids and their moms fresh watermelon, bananas and oranges- delicacies that the families in La Chureca rarely get to savor.

The aim of this event was to (1) bring the mothers and their children out of the Dump, even if for a few hours, (2) give the kids time to play without breathing in the toxic smoke of burning trash, (3) educate the mothers regarding their children’s nutrition, (4) build friendships with the children and their mothers, and (5) take pictures of the kids to send to their sponsors as a monthly update. The day was a huge success and after a good four hours, the kids (and we, the Manna volunteers) were completely exhausted. Two-year-old Jorge even fell asleep on my lap while we were swinging together. I laughed as we swung back and forth because the sight of this little boy fast asleep in my arms was just too cute to handle. I noticed that his yellow collared shirt was buttoned up all the way and still tucked into his pants... but his once-combed hair was now full of grass (we did somersaults down the hill) and both he and I were covered- head to toe- in dirt after a full day of racing and jumping and dancing in the dusty Nica park. Yes we'll give the kids vitamins, oatmeal, medication, pediatrician visits, birthday presents and love, but we make no promises to keep them clean after a day of playing with Manna Project volunteers.

Jorge and I getting some watermelon.

Some of the mothers during the health talk.

">Dan and I pushing Saleska and Arlen on the swings.

Katy (see earlier posts) looking happy and healthy.

Wednesday, March 07, 2007

algunas photos

At La Chureca

At Carol's 15th birthday party (she's on our soccer team).

Arecelly, her daughter, Myra y yo at the birthday party.

Justin, my good friend Sandra's 3-year-old son.

The Machete

As part of our weekly drama class in El Farito, we often have the kids act out various daily activities such as “brushing teeth,” or “washing dishes.” Many times, this game takes on the form of Charades: the kid picks a piece of paper out of a hat, then acts out whatever’s on the paper while the rest of the class guess what the activity is.

The other day, Elba, an 11-year-old girl (a mischievous beauty, with long, curly brown hair and this great smile) picked out a piece of paper from the hat. She giggles to herself- shy at first to act in front of her peers- but with a little encouragement from Andie (who’s leading the class), she proceeds to act out her activity. Elba bends down close to the ground, and begins to make broad sweeping motions with her right hand. She continues like this for the next few minutes- and honestly, I have no clue what she’s doing… but the other kids do. Immediately, Jose Antonio yells out “una jardinera!” which means, “gardener!” And then it dawns on me- Elba’s cutting the grass. Here in Nicaragua, there aren’t any lawn mowers. People cut the grass with machetes- they bend down low and make broad sweeping motions with the machete, cutting the grass in the process. Elba nods her head “yes!” and sits down, content with her performance.

This drama class was a perfect “welcome back” from my month-long journey back to the USA for medical school interviews. I was instantly reminded that I was no longer in my North American world of MTV and fancy technology. It’s good to be home in Nicaragua, with oxen-drawn carts, grass-cutting machetes and all.

Acting out una iglesia (a church) in drama class.