Wednesday, September 15, 2010
Monday, July 19, 2010
Saturday, July 17, 2010
Tuesday, July 13, 2010
Sunday, July 11, 2010
Sunday, June 6, 2010
Tuesday, April 27, 2010
Sunday, April 25, 2010
Saturday, April 3, 2010
Today's the day, the longest day in the longest 3 months of my life, the last day in Francia, the last day before we take one more terrible deuce ride into Puerto Cabezas. It’s a wonderful feeling, it means that soon I'll have internet, flush toilets, warm showers, food other than rice and beans, and all the other comforts that come along with not living in the bush. But its also not without mix feelings that I'm leaving this place; I think I'm actually going to miss this place. Probably when I'm busy beyond belief this summer I'm going to look back at the times when I thought I was so bored and think 'why didn't I enjoy it when I had the chance?'
I'm also a bit discouraged by the immense need here that is not being met, I hope that at some point I'll have more to contribute to these people. There needs to be a concerted effort at educating the Miskitos about how to improve their health and livelihoods. Until this happens clinics and de-worming medications are only a stop-gap measure.
Saturday, March 27, 2010
Our week on the Rio Coco started last Sunday when we left Francia for Waspam. We spent Sunday buying food for our trip and spent the night at an establishment called El Piloto or The Pilot. Even though the power was out half the time it was definitely the classiest hotel in town…it even had A/C and wifi.
Monday morning we drove the deuce over to a small town on the river called Lamos where we met the boats that would take us up the river. The boats on the Rio Coco are basically 65 foot dug out canoes with out board motors and it took two of these to ferry our group and gear to our destination. Krin Krin is a pretty remote village on a river with a lot of remote villages. Besides trails through the jungle the river is the only access to the outside world for most of the villages along the Rio Coco. Krin Krin itself is about 10 hours by boat from Waspam.
Over three days we saw over 400 patients which is pretty amazing since we only had one licensed provider with us. A lot of the patients we saw had hiked in from surrounding villages to reach our clinic. The doctor that was supposed to come with us got sick right before the trip and wasn't able to come. We set up three consultation stations and Jeff floated between each one and helped with the complicated stuff. The way the rotation worked out I got to be in consultation part of the first day and all of the second and third days. It was pretty cool to be able to put all the knowledge we had gained working with Jeff and Dr. Linares to work on our own. I made a cheat sheet of all the common drugs and symptoms of disorders that helped a lot. It also helped that almost everyone had the same symptoms too. The vast majority of the people we saw had parasites that could be treated with one a couple of different medications. Parasites are so commonplace that a lot the patients wouldn't even bring up the fact that they had them. For some reason a lot the kids had ear wax issues and we spent a lot of time digging wax out of ears which made for some very unhappy children, I actually pulled a chunk of wax the size of a bean out of one kid's ear. Most of the kids had never even seen a white person before, let a lone one with strange things like stethoscopes and thermometers so we had to deal with plenty of freaked out, screaming kids. For 10 hours a day in an enclosed space screaming and crying kids starts to get to you. Sadly the majority of the women patients we saw had urinary tract infections and a lot of them also had STD symptoms. We did a lot urine tests for infection and prescribed lots of antibiotics for sexually transmitted infections. Unfortunately we had to tell a lot of the people we saw that we could help them and that they needed to visit the hospital in Waspam. One family hiked two days through the jungle after hearing that we were doing a clinic in Krin Krin. They arrived with a very sick baby only an hour before we were supposed to leave yesterday and we were able to evacuate the mother and baby to the hospital in Waspam with us.
One of the most interesting things about Krin Krin is that it is the focal center for something known as the Grisi Sickness. Grisi means crazy in the Miskito language and it can best be described as demon possession. It apparently started about 70 years ago in Krin Krin and mainly affected adolescent girls and young women. There are stories of teenage girls overpowering and killing soldiers that accompanied the government medical teams that first tried to figure out what was happening. The World Health Organization has sent teams to investigate the problem and has classified it as group psychosis that only seems to affect young women. Jeff had brought this up in our Emergency Care I class last semester but I had forgotten until Jeff reminded us about it last week. It was a little unnerving to know that this is where it all began and it might still be happening but I didn't give it much thought. The night before we left all the churches in Krin Krin got together for a farewell service for our group. We sang a lot of songs and it was a lot of fun to worship with the people we had been working with all week. At the end the pastor got up to give a short sermon and soon after he started a girl in the back fell down and started having convulsions. I wasn't close enough to see exactly what was going on but Jeff said it was definitely not a seizure. It took several people to hold her down and her movements were definitely too deliberate for someone having a seizure. The weirdest thing about it was that she was completely silent, normally someone like that would at least have to make some noise. After a few minutes several people carried her away kicking, but strangely not screaming. After the service was over we got together and prayed as a group but we never heard what happened before we left.
My week on the Rio Coco was probably the highlight of my time down here in Nicaragua. It was the epitome of why I was down here; to put my limited medical skills to use in helping these people. Up till now our clinics have been limited by time and distance from Francia, but in Krin Krin it was awesome to be able to keep the clinic open as long as possible and be able to help as many people as possible. It was saddening to know that people had to walk for hours and sometimes days through the jungle just to reach our little temporary clinic because it was the only medical assistance available anywhere near where they live. A man in Krin Krin told us that the government clinic was built but there was no doctor, no nurse, and not even any medications. There is a terrible need for medical assistance in this area which is not being supplied by the government. I hope I can come back in the feature and contribute more than I was able to on this trip.
Sunday, March 21, 2010
Thursday, March 18, 2010
Around noon Wednesday was turning out to be a pretty normal day with Matt, Dan and I watching a couple of episodes of how I met your mother under one of the buildings to escape the heat. In the middle of our second episode Jeff walked over and asked if we wanted to help transport a patient with suspected appendicitis to the hospital in Waspam. After about a third of a second we decided, 'yes that would be a good idea and when we're we leaving?' The cooks handed us lunch in a bowl and we ran to the truck for the ride to the clinic. When we got there we found the patient waiting in a room with an IV already started by Maria. Apparently the sense of urgency ended there because we ended up waiting at the clinic for over almost an hour. During this time the Doctor and Maria tried to call an ambulance and then when that wasn't an option a debate ensued about whether to drive the patient out to the main road and wait with him until a vehicle heading to Waspam passed or to drive all the way in the deuce.
Eventually the conclusion was reached that we should drive the deuce all the way to Waspam and we loaded up the patient and rolled out. I can't imagine a ride in any vehicle over these roads would be the best idea for a patient with acute appendicitis, but being in the back of the deuce is especially punishing. We set up a small cot in the back and the driver tried to take it slow but that didn't seem to improve things very much. The shocks on the truck are very stiff for heavy loads and with not much weight in the back it’s a very bumpy ride. I was kind of expecting to have to do some kind of EMT stuff on the ride up but we really didn't have to do much of any thing. We made it to Waspam and the hospital in about 3 hours and went right to the hospital. The hospital is close to the outskirts of town and is apparently staffed by Cuban doctors and nurses.
Once we dropped the patient off the medical portion of the trip was over and we went shopping for the mission. On the way to one of the stores we stopped by the Rio Coco that separates Nicaragua from Honduras. There isn't much on the other side and there is no bridge connecting Waspam to the Honduran side. Apparently the only way to cross is by boat and it didn't look like there was any kind of border security on the other side either. Apparently the Miskito people can cross freely without a passport since they live on both sides of the river. Waspam is smaller than Puerto Cabezas and seems a little cleaner and maybe less busy.
After shopping we went to an internet café by the airport (really a grass runway with a two room terminal) and got a few emails out. After that we loaded up the deuce and got ready to head out of town. On the way out we stopped by the hospital to check on our patient and found out that he had already been to surgery but unfortunately his appendix had already burst by the time they opened him up. With the age of the patient, he was over 60 which is very old for Miskitos, and the rough ride to town I don't think the prognosis is very good. Since then I haven't heard anything but I may try to check when we head back to Waspam this Sunday for our river trip.
It was a unfortunate dichotomy to the day; on the one hand I was excited to get out to civilization, get a cold coke, by some food, and get internet but on the other it was because someone was seriously ill. Its pretty easy to get jaded here by people's medical problems, many of which are a result of their lifestyle, but this patient was sad reminder of the heath reality these people face. It hit me when I got back to Francia that this guy might die and I was excited that I had gotten a cold drink…I felt pretty guilty after I realized that.
Saturday, March 13, 2010
Thursday we took our rolling medical circus back to Tikamp which was the last village we visited before we left for Corn Island. It’s a fairly remote village and the people who live there seemed a little less healthy than in other villages. This may be due to the lack of a government health clinic in the village. I was with Jeff for this clinic and most of the patients we saw were women with three or four kids in tow. Again the predominant symptoms were headaches, night fevers and no appetite. For the headaches we tell them they need to drink more water, the night fevers are usually unless they have other symptoms concurrent with TB or Malaria. Most of the people complaining of fevers didn't show an elevated temp even if they claimed to be suffering from fever at that very moment. There was one pregnant mother who was expecting here baby any day and said she was planning on using the village midwife to help with the delivery. We were also able to check the fetus' heart rate using our monitor which was pretty interesting. Over all it wasn't the most interesting clinic so far but we did get home in one peace which is always a plus.
Friday, March 12, 2010
So we just finished a week of school and clinics. On Tuesday we went to Kapri which is the farthest location of all of the clinics we do. As well as being the farthest away, Kapri is also the most remote and our original plan was to take the deuce as far as it could go and then hike from there. Kapri is about 3 miles from another town called Miguel Bikan which has an ok road by Nicaraguan standards. From there the road quickly becomes merely a line through the jungle that happens to be without trees and is barely wide enough for the deuce to drive through. Since everyone rides in the back we were at the mercy of all the random branches and thorns that reached out of the jungle. My hands got pretty scraped up in the process but surprisingly we actually made it the whole way without having to hike.
I was with the doctor for that clinic and we saw a couple of interesting things; our first patient had stepped on a nail a couple of weeks before and was worried about infection. We washed the bottom of his foot with iodine and then the doctor decided that we needed to check if there was any pus in the wound. To do this he had me numb up the area with a lidocaine injection and squeeze the wound to try and express any pus that might be there. Even though the patient was warned he still jumped and struggled and I was a little worried about poking myself with a dirty needle. We eventually got him calmed down and were able to check the wound which proved to be healing nicely and not infected. Our next patient was a lot older and appeared to have some kind of chronic wasting syndrome; his cheeks were really sunken and ribs were very prominent. When he removed his shirt there was an approximately 3 inch wide raised mass just below his left shoulder which he said had been there for about 1 year. The patient also had a large weeping lesion covering most of his left ear that looked like it could have been a type of skin cancer, possibly basal cell carcinoma according to the doctor. We cleaned the patients ear and told him that he needed to try and get to Waspam to get the mass on his back looked at by a surgeon.
Most of the other patients complained of a lot of the same symptoms. Almost everyone says they have a fever even though their temperatures don't reflect it at all. A lot of people also complain about having a fever only at night also. I don't know where they get the idea that they have these symptoms since their vital signs definitely don't check out, maybe someone told them one time that they had a fever and they assume that they always have one. A lot of the time I think it comes down to ignorance about health; every other person who comes in complains of being dizzy and getting head aches but when you ask them about how much water they drink its only one or two glasses. I think they believe that all they have to do is go see the white people get a few pills and whatever they have will go away. I don't know how these people will ever improve their lives unless someone really teaches them how to be healthy, that would be a worthy mission.
Tuesday, March 2, 2010
So far having Southern here hasn't been too bad, since there hasn't been much rain lately we've been relegated to taking bucket showers while Southern is here. I still think I use less water taking a regular shower than with the bucket but that’s ok. Not that I have a problem with the group, but its been good to have some new people around to talk to. A lot of them were really surprised when they heard we were spending a whole 3 months down here.
I helped organize a trivia night on Sunday night which involved spending three hours in a group racking our brains for all the random facts and trivia we could think of. We had 5 rounds of trivia and a single music round at the end. It was such a hit we had it again last night but unfortunately my team got clobbered on the music round and came in fourth.
Some of the people that came down with Southern were mechanics and they've been working on the old Toyota Hilux that’s been sitting around broken for the last 6 months. They finally got it running today but who knows how long it'll stay running this time; they're pretty hard on stuff down here. If you didn't know any better you might think our tool shed was in rural Kentucky by all the broken vehicles and junk lying around. There is another broken deuce that hasn't run in quite a while that apparently keeps the other one running, furthermore the grounds are also graced by a non-functioning 4-wheeler.
On Wednesday, which is generally our project day, we broke into two teams one of which went into the village and located all of the wells and pumps. In addition to their locations, they also took pictures and marked their GPS coordinates. I was in the team that stayed behind and worked on a detailed map of the mission premises. We took GPS coordinates of all the buildings and landmarks as well as the perimeter and created a rough map of the area. The purpose of all of these activities was to learn a little bit about how to conduct assessments of the needs of an area with an eye toward development projects. I think it was a pretty useful exercise although it’s a unfortunate that we won't be able to make a major difference here aside from the medical aspect since we have such a limited amount of time.
So its finally almost the weekend which means two more weeks before we head on our river trip down the Rio Coco. Next week we start doing clinics again since Southern will be gone, this also means we can go back to normal showers which will be awesome.
Saturday, February 27, 2010
We've been back since early last Wednesday morning when we rolled in from Port. This time the ride wasn't quite as long as the last and we didn't break down which was a good thing. The downside was that there hasn't been very much rain here lately and the road was extremely dusty which means every thing including me was coated in a fine layer of red dust. As soon as we got in I jumped in the shower and scraped the dust off and went right to bed. Even though I got about 8 hours of sleep I was still extremely tired Wednesday; I got up to eat breakfast, went back to bed for an hour or so and slept a couple of more hours after lunch.
I have to admit that after being on the tropical paradise of Little Corn Island for the last two weeks it was kind of difficult to accept coming back here to Francia. On Monday one of our flights took us through Managua where we had a hour layover which gave us enough time to visit Subway. It was something that I'd been looking forward to for quite a while since I knew that we were probably going to stop in Managua but I'm afraid it might have done more harm than good to my mental state. To get from the regional terminal to Subway you have to pass through the air-conditioned international departure hall, past the check in desks for American and Continental with their lines of Americans heading north. I had hoped that the next time I would see that would be the day I was leaving this country but no such luck apparently. The Subway was worth it at the time but it might have not been the best idea in retrospect.
Now that we are back here in Francia we have 5 weeks to go before we head leave for good. This next week some nursing students from Southern are here which means we won't be doing any mobile clinics and we'll be doubling up on classes. I think that’s a good thing since it kind of mixes things up a little which should help.
Thursday we had a mobile clinic in Tasba Pain (pronounced pine) which was either an extremely healthy town or nobody knew we were coming. My guess is that since we don't have access to the radio station to make announcements it was probably the latter. So we only ended up seeing 7 or 8 patients for the whole day. I was in the vital station which the patients have to pass through before they see the doctor and I had fun trying to find pulses and count respirations on screaming babies. I guess I would probably be scared if some big white guy with a beard decided to squeeze my arm for a minute. Overall it wasn't a bad day since I had some time to catch up on my reading and throw the frisbee with some kids from the school.
Today is Sabbath and I think I'm about to head to church and after lunch to the river possibly. It’s the weekend which meant something back in the states but isn't much different from the week here…funny how that works.
Tuesday, February 23, 2010
The week after survival was also spent on Corn doing normal island stuff like eating, sleeping in beds and taking showers. Our group got a package deal with Dolphin Dive, one of the dive shops on the island, for 20 bucks a dive which is a major steal. So on the day after ocean survival I boarded another boat but this time by choice. It was my first scuba diving experience since diving in a sand pit in Kearney, Nebraska in October. Needless to say it was a stark difference mainly because it wasn't freezing and the underwater visibility was more than 20 feet.
On our first dive we saw a massive loggerhead sea turtle as well as some sting rays. The second dive was a lot more interesting since it was in more shallow water and we got to spend more time at depth. On this dive I got to see at ray that had about a 6 foot wing span and got to swim through some really cool coral tunnels. The final dive of the day was even shallower and we almost got to spend a full hour underwater and saw some small reef sharks which was definitely the highlight of the day.
The rest of the week the weather took a turn for the worse with some intermittent rain and really high winds. It was almost unbearable on Carlito's side of the island so we spent a lot of time over on the leeward side of the island which was also where most of the restaurants were. I spent a lot of time at this sweet bar/restaurant called Tranquilos in my off time. It turns out it was managed by a guy from Louisville and we probably doubled his clientele for the week. Since it was the main hang out spot on the island we got to meet a lot of cool people. By the time we were done with survival we were minor celebrities on the island, often being confused with Italian Survivor which was being filmed on nearby Big Corn. There weren't a whole lot of Americans on the island but we met some really cool Swedes and a girl from Australia and had a good time comparing notes about why they used a knife and fork to eat a hamburger and how big pizzas should be.
Due to the poor weather all my dives were canceled on Thursday but I got to make up for them on Friday and Saturday but none measured up to what we saw on Tuesday. Overall it was an awesome experience hanging out on a tropical island paradise but like all good things it had to come to an end yesterday when we boarded our boat from Little Corn to Big Corn and the airport. I'm pretty sad to leave it all behind but I'm also happy to be beginning the final phase of our experience down here in Nicaragua.
Today we are planning on heading back to Francia which means limited communication again for most of the next 5 weeks. I'll be keeping up with the blogging but unfortunately I won't be able to update it. Please keep my group in your prayers as we try to bring health to the Miskitos and learn a little in the process.
Sunday, February 21, 2010
Sunday morning we headed back from the beach to Carlitos to finish up our reading assignments for coastal survival and to begin ocean survival. The class began with watching a video which detailed the contents of an ocean survival raft and the procedures for operating it and how to survive in it for a long period of time. This video was followed by some survival anecdotes from our teacher Mike Lowe who was a former air force survival instructor who once spent two weeks at sea in a survival raft, apparently by choice. He stressed the importance of establishing duties and a routine since the monotony and boredom of just sitting in the raft can be very mentally taxing over time.
Since it was supposed to be so mentally challenging that people might even get angry at each other it was decided that we elect a captain whose word would be law out on the boat and that every one would have responsibilities. Since the regular IRR raft is stuck somewhere between here and Honduras we hired a local to let us use his boat over night for only 20 hours instead of the regular 24. Since this boat isn't a raft all the normal raft duties like bailing water and pumping the raft had to be simulated since there was no water to bail and no raft to pump.
Before they sent us out to high seas we were all given some sea rations which consisted of 400 calorie cubes that tasted slightly like lemon but were mainly just sickly sweet. Since I hadn't had any at all that day I was super hungry and I had two and a half cubes which seemed like a good idea at the time…little did I know how fateful this decision was.
So at the appointed time we loaded up the boat and the "captain" motored out about 300 yards from the beach and sunk the anchor. Our "captain" promptly donned snorkel gear, told us he'd see us in the morning, and jumped over board. Our first order of duty was to simulate abandoning ship so we all jumped over board and then climbed back in our "raft." We had had plenty of discussion with Mike Lowe about how uncomfortable and cramped we would be on our boat and how that would a constant source of stress, but as soon as we got on it became clear that there was probably at least 2 feet of space between each person.
We had decided to rotate positions every hour so it would be fair for people who happened to have a less comfortable spot than others. About two hours in I started to feel seasick and nauseous and began to rue the hour I ate those sea rations. Its hard to describe but what tasted good at the time still makes my stomach turn; every time I burped I would be rewarded with a sickly reminder of why I should have stuck with my empty stomach. The first person to feed the fish started only about an hour and half in but luckily I never had to. My strategy was to focus on the horizon and to constantly remind myself that any untoward sensations were completely artificial.
The sun set about 6 PM and the temperature started to drop and by 7:30 it had started to rain. At first it was only a sprinkle but soon it turned into a genuine downpour. I had brought a rain jacket which I thought would protect me but it turned out to be an expensive layer of wet clothing. For the rest of the night it went from raining, to not raining, then to raining again just as soon as you had dried out from the last rain.
By sunrise I was definitely ready to get off but I still had to wait till 11 AM when we thought we were gonna get off. We had thought that the "captain" would be back at 6 AM to do some fishing off the boat but when he never showed we started to worry that they might not show up till 3 PM for the regular 24. But at 11 we saw some small dots swimming toward us that could only mean one thing…it was over! When we reached land Jeff and Linda were waiting for us with candy bars and encouragement…it was probably the best welcome I've ever had. Even though we made landfall at 11 I definitely felt like I was still on a boat for the rest of the day.
All in all it was an excellent insight into what the physical and mental reactions would be to surviving on the open ocean but I have no desire whatsoever to repeat it.
Saturday, February 13, 2010
Survival week started out with the wrong kind of meal. We had breakfast at Carlitos which consisted of too little of gallopinto (rice and beans), eggs, and coffee, in other words not enough calories to start off a week with very little to eat. We took a boat around the island to a deserted beach and unloaded all of our gear plus our water (despite it being survival we had to guarantee the water source apparently). Since it was jungle survival first we hiked right past the beach and into the jungle where we would spend the next two days roasting and ignoring the water mere yards away.
The first afternoon we focused on learning how to build a shelter and learning a little about our environment. One of the skills we had to demonstrate was opening a coconut without a knife and this was quite an operation. For those who don't know much about coconuts they usually reside 30 to 40 feet up a tree with no branches. Climbing is an option but it can be kind of nerve wracking especially in a calorie depleted state. Our next option was to build a three high and see if the guy on top could reach the coconuts, but this also proved futile. Our next attempt was to chop down a tree about the same height as the coconut tree and use it as a massive pole to knock the coconuts down. This proved to be more difficult than originally anticipated because the tree was quite heavy and required three people to operate. We ended up jerry rigging a snare at the top of the pole which we tried to wrap around the coconuts and yank them down.
We also found what looked like an orange tree and were pretty excited until we found out that they were really incredibly sour lemons. Even so I probably have eaten about 10 in the last three days. We spent Tuesday night in the jungle and Wednesday morning I definitely felt very weak and probably didn't move more than 30 feet from my tent the whole day except to get water. They had told us that we would get a bowl of rice and beans every two days during the survival week but that we were going to have to walk back to Carlitos to get it. So Wednesday evening we all marched the 30 minutes back to the beach resort to take the jungle survival test and get our meal. I had almost decided not to go since I thought the calories expended by the walk wouldn't be made up by the meager rations I was expecting to get at Carlitos but I decided to go anyways mainly to get out of the jungle. I was also wondering why we couldn't just cook the rice and beans in camp but I chalked that one up to the typical disorganized nature of these kind of operations. We got to Carlitos about 5 PM and got the test out of the way and got in the ocean to try and feel a little bit cleaner. I knew something wasn't right when Jeff let us use his shower to clean up afterward and people were getting to clean their clothes and put on new stuff. When we sat down for our rice and beans it turn out that we were actually eating fish, grilled chicken and spaghetti and that the whole rice and beans thing had really been a rumor to motivate us to seek out and try the jungle foods near our camp. Even though I loved the food I could have eaten three more plates the same size.
Thursday morning we transitioned to coastal survival by moving camp 100 yards down to the beach. Some of the objectives for this evolution where to catch a fish with a hook and line or a spear; both of which are a lot harder than they sound. I promptly headed out to the reef with snorkel gear and spear with every intention of coming back with a nice fish on the end of my spear. I returned to the beach very discouraged after watching my spear bounce off two or three fish. I spent the rest of the day trying to fish with a hook and line but only managing to feed a lot of bait.
I woke up Friday morning feeling extremely weak despite getting almost 10 hours of sleep. I barely ate on Thursday and used up a lot of energy on snorkeling around the reef so I was pretty out of it. It took all of my energy to walk 40 feet back from the beach to pick up almonds to get enough calories to make it through the rest of the day. I spent most of the day trying to fish some more and working on a beach shelter and a raft made from plastic bottles. Friday evening we marched back to Carlitos, this time with the knowledge that we were getting a full meal. Even though I knew I was gonna get fed, Dan, Matt and I stopped by a store on the way and I got a package of ritz cheese crackers and managed to consume just over 700 calories before I even got to Carlitos.
Saturday was a day off and we went to the small SDA church on the island in the morning and just lounged around all afternoon. Around noon on Saturday the wind really started picking up all over the island making walking around kind of difficult because of blowing sand. After dinner we went back to our beach to find a disaster area with several tents almost sideways. Some people had stayed behind and had managed to stake a lot of the tents down but it was still a pretty interesting night.
Sunday, February 7, 2010
At least I think that’s how its spelled, I've heard two other variations today though. Anyways it’s a small village about 45 minutes down the road toward Puerto Cabezas from Francia. It’s the first time that we've headed that way on any of our clinic expeditions so far and the landscape in that direction is very different from what we have around Francia. Almost as soon as you are out of Francia it becomes much more hilly and the palms and deciduous trees give way to pine forests that are very reminiscent of Colorado. In fact if I'd woken up and someone had tried to convince me I was in Nicaragua I might not have been convinced except for the humidity.
Today in Tikamp I was in registration where the patients first come and give there name, age and the reason for coming to the clinic. Since we weren't able to get on the radio to tell them we were coming, all the men were out in the fields and our patients were all women and children. It was a little frustrating trying to keep everyone in order through a translator, but registration is probably the easiest place to be in the clinic.
We didn't have lunch till about 1:30 in the afternoon because the consultations ran a little late. For the mobile clinics we pack lunch in a couple of plastic paint buckets and it usually consists of some kind of sandwiches and another random, heavily rationed item like Oreos. Usually its only enough for 1 and half sandwiches and I'm usually left wanting more. Today was no different with rice patties; leaving a meal hungry is something I'm starting to get used to.
I'm back in Francia now and I just before I started writing this I finished making notes for the public health test tomorrow. We've only had class for less than three weeks and we are already having a midterm, if that means we'll be done before we get back I'm all for it though. The quizzes so far haven't been too terrible so I think I'll finish studying in the two hours I have before the test tomorrow morning.
Today we took the mobile clinic to Esparanza. Esparanza is about the same distance away as Wisconsin and took about 30 minutes to reach in the deuce. It’s a smaller village compared to some of the other ones we've visited so far. It also sits next to the Wawa river which we visited two weekends ago. We set up both the pharmacy and examination stations in a very rickety one room school. Before Jeff told us that a girl fell through the floor during a clinic several years ago…needless to say I was less than reassured. I was assigned to the pharmacy today which meant that I, and several others, were responsible for receiving and filling the prescriptions that Dr. Linares, Jeff or Maria would write. This involved lots of pill counting, mixing of oral suspensions and asking lots and lots of questions. Our pharmacy is really four tackle box like things organized by drug type. There's a drawer of antibiotics, a drawer for cardiac meds, one for anti-parasitics and so on. Its definitely a learning experience since at first you don't really know what any of the drugs are, but its pretty easy to catch on.
Part of being in the pharmacy also means explaining what the drug is and how to take it to the patient. I've been picking up some medical Spanish along the way and I was stumbled through my instructions earning a few puzzled looks. About half the of the patients only spoke Miskito so we had use our translator Manuel with them. The patients are also asked to pay an examination fee of 10 cordoba or about 50 cents. If the don't have any money they can also give payment in kind, so we always come back from clinics with lots of coconuts and grapefruit. Today I finished giving instructions to a patient who, when I finished, promptly pulled out a single egg and offered it as payment. Although it wasn't quite worth 10 cordoba but it may have been all she had. I stuck the egg in one of the med boxes to pick up later, however since I forgot about it the intrepid egg survived the bone jarring deuce ride back to Francia intact and now may become part of a meal sometime soon.
So its Monday and now five days till we leave for the Corn Islands, internet access, the ocean, cold drinks, fairly normal food and mainly not being stuck in the jungle.
Normally, back at Union a cause for excitement…not so in Francia. At least during the week there are things that take up time in the day. Not on the weekend unfortunately, that’s the time when you really realize there is nothing to do. During the week there are clinics and classes and other random things that distract from the absolute nothingness. It’s the weekend that’s the problem…its then that it feels like it takes 10 hours to get from noon to supper time. Back at school it seemed like you would and blink and miss the weekend that’s not a problem here. I think one of the reasons for the slow pace is that we get up pretty early, 7 AM compared with 8ish back at school. That just contributes to the more hours to contemplate being away from air conditioning, cold water, warm showers, flush toilets, etc. Don't get me wrong I'm not complaining, it just doesn't seems like I should be doing more than doing a lot of sitting around. I guess I envisioned this semester as being a little more action filled. On the other hand I did try to not have any expectations about this trip so I wouldn't be disappointed…maybe present day Phil needs to take some advice from Phil from a month ago.
Tomorrow will be another day filled with absolutely nothing but Matt, Dan and I are planning hiking to the river and spending some quality time in the water…not roasting.
Today was another clinic day…this time in Wisconsin. Apparently a long time ago the University of Wisconsin helped settle a small town about 8 miles north of Francia. We had to stop for about an hour at Santa Clara for the doctor to excise an abscess that he found when we were there on Tuesday. So we didn't get to Wisconsin till about 11:00. We ate lunch and set up the pharmacy in one classroom and the examinations in another classroom…similar to last clinic. This time I was seeing patients with Jeff and we saw a lot of patients with the same complaints. Every other person here seems to have some kind of parasite so we handed out a lot those drugs. In fact before we began the clinic we lined up all the kids and handed out albendazole to them like candy. Sanitation is pretty serious problem here among the Miskito and parasites can be contracted pretty easily from contaminated water or food. When people bathe in the same stream where they dump animal waste its not surprising that these disorders are so prevalent. Most of the patients we saw today were also women and many of them presented with urinary tract infections so we also gave out a lot of bactrim. I got to give an antibiotic injection to a girl who came in with an infected cut on her knee…not really a big deal but probably the highlight of the afternoon. Now we're back on the hill and I should be reading for class tomorrow but I'm definitely too tired to do much more thinking now so I'll probably do it in the morning.
Later: A couple of hours after we got back there was a minor emergency with a woman from the village who had gotten in a fight and had a very high blood pressure. It was a patient that we had seen with the doctor last week and had complained of TIA-like symptoms. When we arrived her systolic BP was above 200 and here diastolic was something like 180, it looked like she might have been having a panic attack but it was hard to tell. When to the clinic and got some captopril, an ACE inhibitor, and atenolol which is beta blocker. By the time we got back her BP had improved and she had calmed down quite a bit, the doctor gave here a couple of day supply of both of the heart meds and we left. On the way back we hit up the one store in Francia; the owner brings back drinks from Waspan and puts them in a cooler so it’s the only place to find anything cold for probably 30 miles. We took the last two cold cokes from the cooler which was a good break from lukewarm water.
Assessing a pregnant woman in the clinic.
Today was clinic day again and this time it was Santa Clara, a town about 6 km down the road from Francia. My first impression of Santa Clara was that it was a lot cleaner and better laid out than Franca, I couldn't really put my finger on one specific thing though. We passed one very nice house by miskito standards, I asked around and I later found it belonged to the priest of the local catholic church…go figure. We set up the clinic in the local school with the pharmacy in one class room and 3 examination stations in the classroom next door. Outside we set up a triage station and vitals and a waiting area, the patients were given numbers and waited till an examination station opened up. The stations were staffed by Jeff, Dr. Linares and Maria, the doctor's wife who is also an RN. I was with Maria and we mostly saw the simpler stuff like coughs and diarrhea. Almost everyone here has some kind of parasite so we prescribed a lot of anti-parasitics like metronidazol and mebendazol for ascariasis and amebiasis. Instead of seeing one patient at a time it was more like seeing one family at a time; mom, dad and three little distended stomach kids. A lot of people complained of fever too so it seemed like we were giving acetaminophen out like candy too. I did have some time to catch a few things from the doc like how to examine the abdomen of a pregnant woman to determine if the baby was in the correct position for delivery. We also saw a man who had an odd sore just above his knee, it was soft like an abscess instead it was hard. Although the cases I saw were pretty average it was a good learning experience and helped to figure out what to know for next time. I definitely have to get some basic drugs and dosages memorized so I don't have to keep looking stuff up every five minutes.
Monday was a class day again with Public Health in the morning and Traveler's Health in the afternoon. I spent some time studying with Matt and Dan and we totally aced the quiz before lunch. It was a pretty straight forward chapter so we only spent an hour in the morning. We discovered that one of the coolest places around the compound was under the buildings where there is a breeze. So we pulled a couple of cots underneath and studied some more for the afternoon class…too bad there was no quiz though. Right when class was going to start it started to rain like crazy which definitely brought the temp down a lot…it was definitely the happiest I've been since I've left the US. Dan and I stood under the gutter drain and got totally soaked and cold but that’s ok because I haven't actually been cold in over two weeks. The rain lasted about an hour and was definitely the highlight of the week so far.
Friday night after vespers Matt, Dan, Andrew (the SM here from Southern) and I stayed up late talking. We found a crazy caravan of leaf cutter ants that were literally carrying a tree away leaf particle by leaf particle. We ended up sitting on the wall of the half finished dorm building, we had been hypothesizing about what was really out there in the jungle for a while when we heard people yelling and banging on the gate. We thought we heard people yelling "emergency" in Spanish but we just thought it was drunk people since it was the weekend. Eventually we saw lights and people getting up and walking around the buildings down in the mission. We were a little worried that people would see us up by the construction site and think we were trying to steal stuff and freak out. Anyways it turned out to be some one from the community who needed the doctor…something about a woman who had a high heart rate. Dr. Linares ended up going to check it out and we went to bed.
Saturday morning we went to the church in the village for sabbath school. The church is a simple wood building with large windows to let the breeze in when there is one. Sabbath school was kind of a chaotic affair with the Miskito class on one side and the English one on the other side. We had a hard time being heard over the very enthusiastic miskito class across from us. It seems like the church isn't very well attended unfortunately; our group probably more than doubled the population. The sermon was in Spanish and translated into English by the Miskito head elder, as with many translations it was kind of hard to follow and I read my bible a little and mainly tried to keep from sweating.
After lunch we hiked to a river about 3 miles away through the jungle. The hike was pretty muddy and had some kind of sketchy creek crossings, but we got to our destination in a little under 2 hours despite gong the wrong way for a little bit. The river was amazing…probably even more so because of where we've been for the past week. It was really awesome to escape the withering heat for a little bit but like all good things it had to come to an end. For some reason the hike back was way shorter than the one to the river and it seemed like we were back at TRAM in no time.
Jeff decided to have movie night after supper so we broke out the projector and put up a white sheet in kitchen/dining room. The feature of the evening was the latest Warren Miller production and for a couple of hours I actually forgot I was in Nicaragua…but there is that rule about good things.
Today was Sunday and it was basically a day off for the group. I spent most of the morning reading for class tomorrow. After lunch, which is almost a chore in this heat because any kind of warm food instantly makes you sweat buckets, Matt, Dan and I broke out one of the cots under a shade tree and watched the latest Terminator movie. There was supposed to be some work to do on making a room for the new pastor in the old library near the clinic but the guy who was going to supervise that project never showed up. All in all it was an extremely slow day and looking at the next two weeks it seems like its going to be two months.
This Thursday some of us got to go the clinic in Francia and help out. In the morning I was with Dr. Linares in the exam room helping out. He showed me lots of physical exam techniques that are essential here in the absence of advanced imaging equipment and lab tests. One technique I found especially interesting was a way to measure the size of the liver by percussion. You begin percussing on the rib cage just above the liver and as you move down the sound changes when you reach the liver. By knowing when the sound changes you can estimate the liver's size. We saw twelve patients before lunch; one woman was exhibiting malaria symptoms, a boy had likely pneumonia, and a 3 month old had a hyperchromatic dermatosis in the diaper area. There was a girl with a congenital eye defect called strabismus where one of here pupils was higher than the other. Apparently it is a common problem among the Miskito. Dr. Linares let me do some of the physical exams and interview the patients in my limited Spanish. Some of the patients only spoke Miskito so we had to rely on the aid of a translator for some of the day. After lunch we went back to the clinic but nobody showed up so we sat around in the lobby read text books in the intense heat.
This morning before class Matt, Dan and I went with the doctor to do some house calls in Francia. We visited one boy who had had surgery to repair a broken elbow several months ago. Unfortunately by the time the surgery was performed there had been too much scar tissue and he would never regain full range of motion in that arm. We also talked to a lady who described having stroke symptoms including temporary loss of vision and weakness in one arm. Dr. Linares did some stroke tests but decided that she had likely had a transient ischemic attack or a mini-stroke. While at this woman's house we also looked at 3 year old girl who was complaining of stomach pain and not eating well. During her examination the doctor found a green stick fracture in the radius of her right arm. A green stick fracture, which is common among children, is when only the outer segment of the bone is broken. He told the mother of the girl to meet us back at the clinic right away so we could splint it. When we got there he told us that one of us could do the splinting and since I had already gotten to give someone a shot in the butt Matt got this job. The doctor ran through all the procedures of measuring the splint material, getting it wet and forming it to the girl's arm. After about 15 minutes we had a very grateful mother and daughter and a satisfied medical team.
Today was also a class day with Public Health in the morning and Travel and Tropical Medicine in the afternoon. So after getting done with the splinting we raced back to the compound and barely made it in time for class. The lectures mainly covered the reading which was pretty basic and introductory. I'm not a big fan of lectures back at Union, but I am now adamantly opposed to them in this climate. It is almost impossible to focus on anything other than keeping as still as possible. In the middle of Travel Med we had to switch sides of the porch to follow the breeze. Jeff mainly covers what is in the reading and the quizzes haven't been to difficult yet so I think it won't be that bad.
Here are a few pictures of what Francia looks like on the walk from the mission hill to the clinic:
Dan just talked to Jeff about community outreach stuff and he gave an interesting insight about Miskito culture. Several of us are interested in taking time to go into the community and helping out. The Miskito culture, however, is very community based; most of the livestock are community owned and aren't fenced. This community mindset leads to a situation where help offered to particular member of the community would be viewed negatively. Since everything is owned by everyone help to one person can make other people wonder why they haven't been helped. Also since everyone has ownership of the community if one member receives free help its considered stealing from the community. Why stealing? Because it takes away an opportunity of a job for other members of the community to have. The only way to do something that would help the people and be viewed in a positive way would be if it was project that they Miskito couldn't accomplish on their own.
So our challenge is to find projects that we can work on that are culturally acceptable to the Miskito. A few of us are planning on talking with the doctor to figure out if there are any infrastructure needs that we can contribute too while we are here. My hope is that our impact won't be confined to TRAM.
So it appears to be official, 150 bags of concrete arrived last night from Puerto Cabezas and it looks like Jeff has every intention of starting work on the second floor of the dorm/classroom building this week if not today. Once again I'm fearful of the work on this dorm building will eclipse the work that this trip was intended to accomplish; medical clinics and gaining useful experience and skills. If I was a missionary who paid money to come here, I would be perfectly happy with doing whatever was asked of me to further the mission here. However, I am not a missionary, I paid to come here as a student taking a certain amount of credit hours and getting an education out of the deal not to do manual labor.
So far we have a schedule of when class were supposed to begin, last Tuesday to be exact.
Update: I wrote the above this morning when I was frustrated by seeing the 150 bags of concrete sitting on the back of the deuce. Today the girls went to the clinic while the menfolk unloaded the 15,000 pounds of concrete from the truck, apparently gender equality has its limits. After that we worked a little on squaring lumber for the building site and moving them closer to the construction site. Its amazing how a task which would probably take 30 minutes in the states can take 2 hours because of the horrendous heat here. Its literally 10 minutes working in the sun and 10 minutes recovering in the shade. Its funny because after several hours in the sun you get really tired and think you've worked really hard so when meal time comes around your body tricks you into thinking you need more food. For lunch today I got way too much food, apparently I hadn't worked as hard as I thought I had.
Today we also asked Jeff to set up a meeting tonight with the group to bring us all up to speed on what was going on. Some of us made up a list of questions that covered our concerns over what had happened so far. In the meeting Jeff gave us all syllabi for the classes so that took care of the concern about classes, he also cleared things up about the building project. The word is that we are going to be working on it every Wednesday which was originally meant to be a project day anyways. Right now we are trying to work it out so that some of us can do development projects in the community instead of working on the dorm building.
Over all it was a positive thing that maybe should have happened several days ago. I am very thankful that it happened today and that it went much smoother than I had feared it would.
By yesterday afternoon we had finished the door frame, a project that should have taken less than 2 hours in colder climates. Instead in the oppressive heat any simple task takes inordinately longer than it should. Upon finishing we decided to hang the door but quickly realized that we had neglected to take the dimensions of the door into account when we built the frame, but we decided to postpone that problem to the next day. Today was supposed to be a clinic day until we found that the paint from yesterday hadn't dried yet. So in the morning we headed back to finish up the door by widening the frame at the sides to take care of the massive gaps that had been there before. After finishing this task we hung the door again but realized that now the door was too big. This problem was quickly rectified by the acquisition of a planer with which we made the door small enough to fit in the frame.
Even though the clinic wasn't open Dr. Linares, the mission doctor here, asked us if we wanted to come and observe him check a abscess he had drained yesterday. A Miskito man from the village had stabbed himself with a thorn and gotten it infected. The doctor had drained it yesterday and now wanted to repack the wound. We met the man at the mission and walked back with him to the clinic. He spoke Spanish as well as Miskito and I got to practice my Spanish a little. I'm pretty happy that I can carry on a limited conversation and not have to translate things in my head when I hear them. What I've heard from the doctor is that most of the younger generation are bilingual however older people are more likely to only speak Miskito.
On the way to the clinic it started to rain which was unusual because its actually the dry season. Of course the rain was greatly appreciated because it drove the bugs away and dropped the temperature significantly. At the clinic we helped Dr. Linares gather the supplies for the procedure and prep the drugs. Before he started looking at the wound, the doctor let me give the patient an antibiotic injection in his rear. Here they save needles by using the same needle to fill the syringe as to do the injection. I found that this dulls the needle; when I gave the injection the needle didn't break the skin right away. For a second it looked like the needle was going to bend so I had to give it a little more persuasion. Needless to say the patient wasn't too excited by the experience. Finally I got a small taste of what we are supposed to be doing this semester and it was definitely the highlight of my day. After the injection we watched the doctor clean and repack the wound and we sent the man on his way with some acetaminophen and an appointment for tomorrow for the same procedure. After that we finished up the door and headed back for an early end to the day and a shower before sundown both very awesome.
I think I'm getting adjusted to the living conditions here at TRAM but I still catch myself wishing I had this or that convenience. For example today I found myself wishing for a lighted bathroom with a stink free, flushing toilet. The current situation, which has recently improved with the addition of a roof, is two outhouses that a trip to requires a highly tolerant olfactory system. At night several dozen cockroaches prefer to reside just under the seat and threaten to attack whoever dares visit the pot after hours. Some among our group have actually chosen to forgo the number two for fear of encounters with the insects that reside in the outhouse.
Our living situation is a bit more civilized with all of the guys, save one married dude, living in a dorm in bunks and under mosquito nets. Most of the main buildings are connected by raised walkways with the central kitchen/eating building which also serves a place to charge electronics while the generator is running; it is where I am typing this now, in fact. The meals are cooked by several ladies from the village and have been pretty good so far; this evening we had beans, leftover bean patties, and fried plantains. After supper people hang out in the eating area because there's light and a place to sit.
Over all its not the Best Western, but it is going to be home for the next three weeks before we head to Corn Island.
So we've been doing the work thing for the last two days here at Tosba Raya Adventist Mission and I'm not sure there is a much of a direction. I was talking to the doctor last night and he had no idea what we were here to do. Due to miscommunication, I'm afraid the staff here assume that we just showed up to help them with whatever needed to be done around the mission. Granted, we have been working on getting the Clinic in Francia open, but there are way more of us than there is work to do. So a lot of us have been attending to the "list" that the folks here have of stuff that has to be done. I'm not against helping the mission I just hope that they can understand that we are here as students who have a program to fulfill; in other words we aren't student missionaries who are just here to work on random projects. The clinic is ready to be opened after a lot of painting and organizing, as well as an awesome door frame built by Matt, Dan and I. Tomorrow we hope to begin clinics but I'm not really sure what is going to happen. Unfortunately there hasn't been much casting of vision as to what is going to happen so we have been kind of living from day to day. I keep telling myself to, pardon the cliché, go with the flow and not expect anything. However it does concern me that we don't have any idea of how the classes are going to proceed; I really don't want to have a bunch of 10 hour class days because we wasted too much time in the beginning.
My one fear comes from an unfinished building just up the hill from the mission house. It was intended to be our dorm and classrooms for this semester but now its only a hulk of a first floor. I've heard that Jeff has every intention of finishing it this semester with the use of our labor. This would be a major disappointment as I came down here to do medical work and learn as much as possible in that vane. I did not pay a $5600 program fee on top of tuition to finish a building that Union paid to have finished by the time I got here.
Saturday morning I was rudely awoken by the blazing sun shining through my holey mosquito net. After about 9 AM the temperature rises significantly and it makes it impossible to do any kind of sleeping whatsoever. So I got up and headed to the shower which, due to water conservation, is quite limited in length. Its basically a get wet, get soapy, rinse and get out. After showers and breakfast I headed with a group to the local SDA church for the service which was in Miskito. During the service the head elder randomly asked us if we wanted to do a special music so we went up front and sang which was very appreciated. The sermon was given by a guy from Tennessee who is down here for a month doing construction and was translated into Miskito by the elder. The rest of the day after lunch was spent lounging around in the oppressive heat and trying to stay cool.
Since I've arrived here in Francia I've gleaned a little understanding about the status quo. It seems that there are two missions almost within sight of each other. One is run by an organization called Tasba Raya Adventist Mission which was started by Southern in the 70's; the other is called Cross to Crown Ministries. TRAM was closed down during the civil war when the missionaries had to escape across the border into Honduras, it reopened in 1997. Cross to Crown is run by a guy called Halversen who operates a radio station broadcasting in Miskito. From what I've heard there is a significant amount of animosity between the two missions for reasons I'm not quire sure about. Halvorsen's son is an SM at TRAM and I think one of his unspoken jobs is to mend the fences between the two missions. Its amazing how people who have the same objective can be so opposed to each other.