Day Eleven:

Labor and Delivery Crew: Schmizing

On our last day official day of service and education, our team went to the regional hospital outside of Managua. We had all been looking forward to this for some time. It was such an experience to see the emergency room, labor and delivery, and the operating room. Although we had expected to be saddened and alarmed by what we saw, the procedures and standards, or lack thereof, were shocking. The lack of sterilization techniques, the reuse of supplies until they are no longer operational, and the overwhelming feeling of the “wild west," coming to the hospital in Managua is light years different than coming to a hospital in suburban America.

The things we saw today will most likely stay with us for a lifetime. While I will not go into details about the individual cases, I would feel very confident that if these same people walked into an American hospital the treatment they received and the outcomes would hopefully be much different.  We witnessed an appendectomy, a mastectomy, a cesarean section, and a live birth.  Watching the live birth without a doubt left the greatest impact on us all.

Happy Birthday Nubia! We miss you.

So, as we go into our final full day in Nicaragua, we all have begun to reflect on the impact this trip has had on our lives and our futures. While we have certainly helped people in such dire need, it is also important that we incorporate what we have learned into our daily lives though meaningful changes.

Tomorrow we will be spending some time playing in Nicaragua hitting up some tourist attractions. Nicaragua is certainly a very scenic country with many natural treasures. So after seeing how underfunded the hospital network here is hopefully the Nicaraguan government will capitalize on these resources and create a more vibrant tourism economy.

Day Nine and Ten: Painting a Rainbow

Each day brings its own colours
To be chosen, mixed,
Pigments of joy,
Happy moments,
Smiles and laughter.... 

And which will you choose?
For 'Life' is choice,
We are all painters
In our own way,
All needing to create
Something of worth,
Of lasting beauty,
Marking our journey....
Footprints in the sand....

Being in medicine goes beyond putting a bandaid on a cut.  Often times, there is a reason behind the cut, and the types of people who tend to get this cut.  Though, in our case, it was often times not a cut we were bandaging.  The past two days in Los Martinez provided a broader social, political, and cultural perspective of healthcare, and, as Eva put it, the nebulous of medicine. 

"Patient"ly Waiting

Carl and Brooke. Baby Whisperers.

As mentioned previously, Los Martinez was once the heart of the trash dump that is now the community of La Chureca.  It was disheartening to find that many of the children and adults in Los Martinez had parasites.  On our house visits, we found that most individuals received their last parasite treatment six months ago, versus the one month at most found in La Chureca.  As a team, we felt great fear that after the election, La Chureca may lose the attention and help it needs.  Tonight, the topic of our reflection was sustainability.  Though we find that our group cannot provide complete sustainability for the community due to corrupt and unstable infrastructure of Nicaragua, we can educate the people of Nicaragua on how to brush their teeth, boil their water, take their medicine, and possess a healthier way of living. 

WMMR!

Today, a patient came in with a high blood pressure.  She informed her triage group that she did not find her blood pressure pills, Enapril, to be working. Thus, the woman was taking two at a time.  She said that at least one time she found the medicine to really not be working, and took six pills at once, which resulted in the fast beating of her heart. WOWZER.  The doctor and team informed her that this behavior would induce a  heart attack.  This emphasizes the necessity of educating patients on not only what the pills are for, but also how to take them and what could result from pill taking misconduct. 

Another patient came in with a glucose level of 420.  OFF THE CHARTS. This generally results in hyperglycemia, and the doctor informed the team that this patient should be in a coma.  By educating these individuals, we have the potential to achieve sustainability of their lives. 

Anthony's Triage Group.

In the past two days, we have seen a wide array of cases which have enhanced our understanding of medicine and fueled everyone´s passion for service.  Everyone has grown astronomically, and the comfort and confidence level of each individual as skyrocketed from the first clinic day.  For some of us, this trip has confirmed the chosen medical or dental path.  Others are lost in the nebulous of medicine and are trying to figure out the best way for them to pursue a medical or career dealing with healthcare...be that in law, government, or research.  There are even a few who have realized that medicine is not their path at all, but are beginning to perhaps see that some sort of international job may be best suited for them.  Many of us are still taking in everything, and trying to determine how this trip is shaping them.

Regardless, this trip has had a huge impact on us all.  Last night, all of us were given a shot giving class.  We each paired up and gave each other Vitamin B shots.  For the returners, this was a chance to build confidence and put our arsenal of knowledge to the test.  However, for most of the team, this was an opportunity to learn a new and necessary skill.  Our very own Allison Perz administered a shot to a patient today (quite successfully and professionally, I must add). 

Carl and Danny.  Limpiezas galore!

Four individuals also were given a new set of tools and skills in dentistry.  The past two days were filled with cleanings, extractions, and fillings.  One patient entered the dental clinic today without having had his teeth cleaned in three years.  His mouth was full of tartar, and it took three members of the team including the dentist forty five minutes to remove all of the tartar and clean his teeth.  Needless to say, no one on the team was hesitant to hand the patient a toothbrush and tube of toothpaste, and teach him what a toothbrush was and how to use it.  Education...so important. (Yes, mom, you are always right.)

Whether it is during reflection at the hotel or in the medical clinics, we are all growing and learning from each other and our patients.  Tomorrow we are heading to a local hospital.  After seeing the patient in La Chureca who visited us the day after being released from the hospital, we are anxiously anticipating seeing the condition of the hospital and gaining a better sense of the health care system in Nicaragua.  Our team will get to experience labor and delivery, the OR, and the ER.  I imagine there are plenty of stories that should soon follow. 

Day Eight: Good to Be Back...

 For the remainder of our time while we are here in Nicaragua, our team wil be in the community of Los Martinez.  Los Martinez is within view of La Chureca, but is certainly more developed and has a higher standard of living.  By higher standards of living, I of course mean the occasional house made out of cement blocks as opposed to metal sliding and a spattering of homes with working toilets.  We will be providing the same services to this community making sure to spend time with the young children of the community.  Today, we got to meet the community leadrs, check out where the clinic will be set up, and play with ¨los ninos.¨

The best way to find yourself is to lose yourself in the service of others.

                                     -Mahatma Gandhi

                                            



John with Enrique



Those returning were excited to see Enriquita, Raphael, Nelson, and some of the other children from Los Martinez.  Once we arrived, Enrique, now with a much deeper voice, was there to greet us and not only remembered those returning by name, but also showed some sadness when he realized there were eleven who did not return from last year (especially towards the absence of Austin and TJ).  While on the house visits, Nelson came up to one member of our team who primarily spent time in dentistry.  He approached her as ¨the dentista¨and asked for a ticket for a limpieza, which he received.  Not only did the children remember some of the English taught to them last year, but it was clear that there were great strides in education in this area through the English speaking ability of many of the children, compared to the one or two we came across last year.  Our experience today in Los Martinez was a true testament to the impact we are making in the communities we are going to.

 

Danny With Los Ninos of Los Martinez



 This evening we listented to Pastor Pavel about the history, particularly the political history, of Nicaragua.  While we have spent a lot of time talking about what we witnessed and how sad it is to see, it was very interesting to learn about what caused these problems and the larger macro issues facing Nicaragua.  The government of Nicaragua has been plagued by instability and corruption, and the people of Nicaragua have paid the price at the benefit of a select few.  



We had No Idea



We also discussed what we could do individually to help the people we have met and the larger issues of poverty worldwide.  From small acts such as bringing reusable bags to the grocery store to larger changes in lifestyle such as taking steps to reduce one´s carbon footprint or raising awareness and support for issues of poverty, etc., we all have a responsibility to help those in need especially becaue of the priviledged life we were born into.  So as we complete our time in Nicaragua, it is important to remember that all people deserve dignity and respect.                                                                



Soccer with Los Ninos.  Kristen started her own Soccer Clinic.  If any of these children end up in the World Cup, we know who to thank.

Day Seven: Tengo La Camisa Negra



I got chills...

Our previous day ended with salsa dance lessons.  Though, once "You´re the One That I Want" came on I think we were a bit skeptical of the techniques taught by our soulful dance instructor.  Regardless, it was a great workout considering the amount of food we are intaking.  On that note, our team traveled to Granada, a well known tourist city in Nicaragua, for zip-lining, large consumption of pizza, and a tour of the city.

Ready to Rock n´Roll

Our day began with a canopy tour in the rainforests of Nicaragua, surrounded by monkeys, giant furry caterpillars, and hot pink helmets.  We met up with the Nicaraguan men working at the canopy tour place, who geared us up and helped us transition into the Superchicas and Superchicos we are.  Many members of WMMR fought their fear of heights and traversed over 2,000 ft of cable 10 to over 100 ft above the forest floor. 

 

 

Kristen!

 We then went to a pizza restaurant in Granada, which was both delicious and extremely filling.  Following our meal, Sonia guided us around the city, where we visited local churches, vendors, and an icecream shop (no worries, the milk used was pasteurized).  This was a great day of "team bonding" and was a manifestation of the developments we have been making as a cohesive unit and as individuals.  This will only enhance our performance as we begin our house visits in our next community, Los Martinez.


The Boys



Local Catholic Church

Day Six: Sillybands



WMMR and ¨los ninos¨



 After two long yet fulfilling days working in the clinic, our team was able to celebrate with ¨los ninos¨of La Chureca.  While we had been utilizing all of our down time in the clinic, playing and talking with the children, it was nice to have a celebration just for the children.  There was plenty of Sillybands, lollipops, and colorbooks and crayons to go around.  But, the best thing that we could offer was the attention we gave to each child.  It was so nice to see all the children so happy and full of excitement about things that most children 5- 7 years old take for granted as make the birthday party circuit each school year. 



WMMR Captain Molly

 While the time spent with the children was so special to them, and it was so clear how much they had appreciated what we had done, our team also took the day to reflect on all that we could learn from the people, both young and old, of La Chureca.  Their strong sense of community with their neighbors, their unwavering faith and hope amidst unimaginable adversity, and their resilence and perserverance are truly inspiring.  While we were able to give this community needed help and attention, they gave us something so much more special.  The people and faces who we touched throughout our four days in La Chureca will undoubtdely stay with us for the rest of our lives. 


The Pinata



Colring Books and Crayons For All

Days 4 & 5: Mucho Gusto- Clinic Days

As anyone who works in healthcare knows, you can never fully prepare for what you might see.  During our two days of clinic helping the people of La Chureca, our team has seen some cases that the majority of doctors and dentists only read about.

Triage

 From asthma to staph infections, from dental cleanings to root canals, we were constantly learning and helping patients with medicine and education.  For our clinic days, we divided our team into three triages, each with three members and one translator.  One individual was in optometry, two students ran the pharmacy, and two were in dentistry.  Our roles, however, constantly extended beyond our small stations when it came to the constant attention given to the children and people of the area. 




Children are often most susceptible to illness, and given the poor living conditions in an operational garbage dump, the children sufffered from respiratory infections from the dust and smoke, intestinal problems from malnutrition, and a variety of other ailments due to living in extreme poverty.  The most memorable case was that of a young baby who arrived two months early and was only 3 weeks old when we met him.  In the developed world, this baby would have remained in a hospital for a minuimum of 2 weeks.  Being exposed to so many potential infections and bacteria and the lack of knowledge for caring for a premature baby, the potential for serious illness is astronomical.

There was much more diversity in cases when it comes to the adults.  Diseases such as HIV, parasitic infections, asthma, and ptygerium, are serious enough if just one disease is infecting a patient.  However, these patients exhibited the symptoms for as many as all of them.  One woman, for example, weighing eighty pounds entered the clinic a day after being released from a one month long hospital visit.  After being treated for pneumonia, she entered the clinic with a multitude of symptoms and disease of which she was unaware.  Some of these include tuberculosis, lice, parasites, problems in eyesight, and the doctor suspected HIV; however, the woman refused to be tested because of the cultural stigma attached to the disease or her emotional unpreparedness in handling such news.  Not only did this woman leave with an armful of medicine, but she also left with a smile and hope in the form of new eye and sun glasses that allowed her to see the world more vividly.  That is truly an inspiration and testament to the human spirit.

This human spirit was found throughout the entirety of our two clinic days.  It is truly amazing to see the ability of the individuals of La Chureca to persevere through the disease, poverty, smoke, and constant struggle to survive in such a corrupt political and social environment.  The same survival instinct, however, both literally and figuratively blinds them from their medical situation.  Many of the patients seen believed their eye sight was perfectly adequate to function, but in actuality their eyesight would not be considered functioning in a developed nation.  The pure joy, appreciation, and sense of hope was no better depicted in the faces of these individuals when they received their much needed glasses.  While it is difficult to treat these patients given our limited means, at minimum we have given these individuals the attention and sense of dignity they have been deprived of due to their stigmatized social conditions. 
Dentistry was full of cleanings, fillings, and extractions.  Compared to last year, the condition of the teeth had changed drastically for the better.  Cleanliness of the teeth proved to be less of a problem, and it was very evident that the people of La Chureca were gradually becoming more educated in the ways of dental hygiene.  Most individuals came in need of fillings and tooth extractions due to the lack of dental care practiced in the past.  One of the greatest parts about being in dentistry is the production of tangible results after pulling a tooth causing great pain for the individual, or filling a hole in the front of an individual's  tooth, for example.  Overall, dentistry was a great success, and we were able to use even more instruments in order to produce both resin and amalgam fillings.

Being Pensive with Brad Corrigan.

Not only did we bond with the local people of Nicaragua, but we were also able to develop as a team.  Our fourth night was spent reflecting and enjoying a game of mafia.  In celebration of Mark's 21st birthday, we went to out to dinner at a local restaurant.  While dining, we were approached by a man from Colorado who coincidentally has spent much time in La Chureca.  After discussing with him for a while, we came to find out that this man was Brad Corrigan, a member of Dispatch and founder of Love Light & Melody, a non profit organization committed to fighting extreme poverty in the trash dumps of Managua, Nicaragua.  We share and embrace his same concept in conquering the social injustices of the world:

"When you walk with someone you're saying to them, 'I am with you.' We can walk in hell and not have fear."

I encourage you all to check out his website to gain greater insight into the community we are working in, and the strides being made to help their condition:  Love Light & Melody 

Overall, the past two days have been extremely eye opening, and allowed us to recognize the responsibility we have to help others due to our privileged situations. The people of Nicaragua could just as easily been born into the same social and economic conditions that we were born into. Thus, we move forward with anticipation for a day with los ninos of La Chureca.

Day 3: Cats In the Cradle

Today was our first visit to La Chureca, the municipal domestic and industrial waste disposal site of Managua, Nicaragua. For those returning this year, La Chureca was a shock of a different kind. Last year, around three thousand individuals rested on an endless sea of trash. We could barely navigate through the smoke and manure surrounding us. Witnessing this sight left the entire team in silence.  The picture below can give you a bit of an idea of what we saw last year: 

This year, we found ourselves asking: “Wait, where are we again? Is this La Chureca?” The Spanish government took over and cleared out much of the trash. It seemed as if nearly 80% of the waste had been disposed of.  However, new questions arose. Where is this trash going? What will the individuals do to acquire money?  The next community we will be visiting, Los Martinez, was previously in a similar situation. However, the trash was moved to La Chureca. It seems that this may perpetuate the cycle so that a new La Chureca may come to be. Roughly fifty percent of the population in Nicaragua lives on less than one dollar a day.  The individuals in this community rely on the trash in order to sustain their families and make a dollar.  How will these individuals acquire a buck now without the availability of jobs and the loss of their old way of living? 

Thank you, Spaniards.

Regardless, the atmosphere remained hopeful. All of the individuals, both sick and healthy, possessed a similar beam of light. All were smiling and eager to talk to us, and receive much needed tickets. While on our house visits, the members of William and Mary Medical Relief divide into three groups of five, each with a translator (YES NUBIA IS BACK!) and a local guide. Going door to door, we assess the situation of the families. In La Chureca, smoke is a major problem and thus most individuals suffer from a cough. The government has been doing a better job distributing anti-parasite treatment, so parasites proved to be less of a problem. Other cases that were found include urinary tract infections, vaginal infections, and fungal infections. Dental tickets were also distributed to those needing a limpieza (cleaning), calza (filling), or an extracción (extraction). Tomorrow we will treat those individuals with tickets, as well as others in need. 

Locals

House Visits

Following the house visits, a doctor who works at the local women's jail arrived to discuss 'natural medicine' with us. We learned that the peel of lemons can be boiled in water and used as an antiseptic for animals. Moreover, the plant aloe vera (sounds familiar, huh?), has many medicinal properties. It is used for burns, itching, constipation, and to treat veracose veins. Oddly enough, it also is used for hair growth. Sonia's aunt lost her hair from an auto-immune disease, put aloe vera on her scalp, and grew gorgeous locks. Danny is trying it out so we shall its magical hair-growing capabilities first hand. The Psyllium plant is also used as a cure for those individuals who have one too many cervesas, since it clenses the liver. It is also a fat burner (psyllium diet, anyone?). I think a lot of us are thinking about starting medicinal gardens after this.

Before dinner, our group discussed the day's events and some of the social and political problems facing those in La Chureca, and Nicaragua in general. One of the major social problems here, and around the globe, is gender inequality. In Nicaragua, female dignity comes with a guy. Females are looked upon as property of the male, and condoms are frowned upon in the culture. Sonia told us about a woman who was found to have cervical cancer. She had twenty five children and was in desperate need of treatment.  However, she refused to get treatment and acknowledge her problem because of her husband. Sonia went to the husband to discuss the dire nature of his wife's problem. He refused, saying that the wife needed to stay home to take care of the kids. Sonia informed him that if she did not get treated, then she would not be there very much longer to take care of the kids. He responded by saying he would just get a new wife. Unfortunately Sonia's pleading did not work, and he pointed to the lower portion of his wife's body and responded, “Nobody touches her but me.” 2 months later, the woman died.

The lack of sex education and safe sexual practice results in the large number of women with cervical cancer, sexually transmitted diseases, and death in Nicaragua. While in La Chureca and Los Martinez, our goal is to educate the individuals to help prevent the increase in this number. There are so many intricacies with the problem of health in Nicaragua.  We have to look into these in order to best educate and try to prevent the spread and acquisition of diseases.

I remain skeptical. (Meg)

Following a spaghetti dinner, we ended our day with a suturing class. We upgraded from last year's chicken to the yellow-green sponges that proved to be feisty patients (we literally had to duck-tape them down to stay still). It is safe to say that some of us can be trusted to suture a wound much more than others (cough, Meg, cough).

John. Hard At Work.

A Pro. Fo Sho.

Spongefest 2011. Aka Suture Graduation.

Reflecting on the day's events generated a sense of excitement and nervousness in our group for our first Clinic Day.  More to come tomorrow.