So we flew out of Puerto Cabezas into Managua last Friday and found ourselves in the civilized world once more! Everything amazed us - the cars whizzing by outside the airport, the fast food available in the airport, billboards, shopping malls, movie theaters . . . after living in the jungle for five months, we have forgotten that such things exist. When we first came to Nicaragua, Managua seemed small and run-down to us. Now, all it takes is a real mattress in our hotel room to make us feel like aristocrats. (By real, I mean about 6 in. tall with springs inside, as opposed to the cloth-covered sheets of foam we sleep on in Francia.)
In Managua we stayed in Covanic, the Adventist school that we stayed at when we first arrived five months ago. On Sunday we took a day trip to Masaya, a city a short distance south of Managua (or perhaps a sort of suburb). In the morning we visited the Masaya volcano. We drove up to a parking lot near the top. From there we could see down into the crater. The smoke rising from its depths obscured the lava I assume lay in the bottom. We walked up some stairs to a viewing station where we could see more of the area around the crater. A few hawks were wheeling around the volcano´s mouth, soaring through the smoke. Swallows swept by me, too. I wondered how they could live in the sulfur fumes.
We hiked up a hill on the other side of the volcano to get a bird´s eye view of the whole area, including a beautiful lake. Then we left for the famous Masaya market, where you can buy everything a tourist could ever want, including frog-skin purses with the frog´s head still on and highly indecent coffee mugs portraying the feminine figure. We much prefered the mugs with the ceramic cochroach in the bottom - they reminded us of what it´s like to live at home in Francia Sirpi.
Today (Monday) we headed to Costa Rica to get our visas renewed. It was a boring day - we spent most of it standing in lines. We only stayed in Costa Rica long enough to eat lunch. :) Nicaragua requires foreigners who hold tourist visas to leave the country every six months. After three days, you are free to re-enter and apply for a new visa. We didn´t want to spend three days in Costa Rica, so we just spent about an hour and came back. Nobody seemed to mind, so we assume the three day rule isn´t that important.
On the way back towards Managua from the Costan Rican border, we turned off on the San Juan del Sur road. We found an inexpensive but nice (real mattresses!) hotel with a breath-taking view of the ocean, then headed out to the beach just in time for sunset. I´ll post pìctures when possible. Just a short description for now - the beach is on a little bay and there are craggy hills on the edges for the sun to set behind. The clouds made the sky a fiery pink-red color. The waves crested on the shore in perfect little rolls. And the sand was fine and soft - extremely nice to dive onto. Also nice to wrestle your friend down onto, which we did repeatedly.
After months of work and stress, this was the perfect evening. Having worship with my friends that I love as a second family, sitting on the beach in an almost perfect world . . . how much more can I ask in life?
Tomorrow I may learn how to surf! The beaches of San Juan del Sur are famous surfing locations, and we can rent boards and get lessons. We´ll see how it goes. ;)
Monday, January 19, 2009
Friday, January 16, 2009
Bush Medicine
Some days here in Nicaragua medical care seems fairly straight-forward. We see patients at the MINSA clinic and diagnose ear infections, respiratory infections, stomach bugs, and parasites and treat them with antibiotics and antiparasitics. It´s just like a family care practice in the States, except for the parasites. :)
But some days we have emergency transports to the hospital. We turn the back of our truck into an ambulance by laying a mattress down, and we drive two hours on a dirt road, bouncing all the way because we don´t have shocks, and using the transmission to slow the truck down, because we don´t have brakes. In the States, the same distance would take perhaps half an hour, because the road would be paved. Also in the States, I would have a fully equipped ambulance so I could actually care for my patient on the way to the hospital.
On Tuesday, January 6, we took a patient to the hospital who was having convulsions of some sort. Mindy said they didn´t look like seizure convulsions to her, but they certainly looked bad, whatever they were. The young woman would start thrashing around agressively, obviously not in control of her body. Her fists were clenched so tightly her nails were digging into her palms, and she was screaming in obvious pain and terror. Her eyes looked strangely glazed over. The only thing we could do for her was hold her down to keep her from hurting herself.
We got her to the hospital, carried her in, and laid her on a bed in the emergency ward. She was still convulsing violently - three or four people had to stand next to her bed and hold her at all times to keep her from falling on the floor. A doctor came in with an injection to calm the convulsions. But all of a sudden, the girl´s mother started saying no. She refused to let the doctors touch her daughter and said that she wanted to take her to a sukia (witch doctor) instead. I was listening to this conversation in Miskito, and couldn´t understand what was happening. All I could gather was that the mother was saying something about the doctors at the hospital not speaking Miskito. Which is true - that particular hospital is staffed solely by doctors from Cuba, which is one of the things that makes it a good hospital. But in this case, it apparently contributed to the mother´s distrust of the hospital.
I tried to ask the other friends and family of the patient what was happening, in Spanish. One young man told me that the mother wanted a witch doctor, but he used the Spanish word for it, which I didn´t recognize. Suddenly the people picked up the mattress and carried it outside. not knowing what else to do, I stayed with my patient and helped. While we were carrying her, Janet told Jenny what was going on, and she told me, so I finally knew that they were taking her to a sukia.
They loaded her onto a pickup truck in the street outside the hospital. She was still screaming and convulsing, and I felt desparate to get her help - real help, not whatever dubious ¨care¨ the sukia would provide. But how to communicate? I didn´t think the mother spoke Spanish, and I couldn´t say what I wanted to in Miskito. I started trying to convince the friends and family, in broken Spanish. But I was talking to the wrong people, and I was too late. The mother had decided, out of her fear and ignorance, that her daughter would be better off with the sukia than in the hospital. The truck left before I had barely started making my case.
The next week, on January 12, I met another case that tested my limits. Sunday night around 8pm, a woman in Santa Clara walked under her house. From what I could gather, she was chasing a chicken. All the houses here are built on ¨stilts,¨ so you can get under them easily. While she was down there, a beam fell from the underside of her house and struck her. They came to our mission the next morning to ask for medical transportation.
When I got to the patient´s house in Santa Clara, she was lying on the floor moaning with pain. They showed me the places on her left side and abdomen that were hurting her, and then they rolled her over and showed me her back. She nearly screamed when they moved her. There was a lump near her spine halfway down her back, where I assume the beam had hit her. Just the gentle pressure of my hand touching there hurt her badly.
All the medical training in my head said I needed to keep the patient´s back straight, because it might be broken. In the States, that would involve strapping her to a back board, chalking her head, and packaging her in a Stokes basket for transport. Here, of course, I have none of that equipment. So I had to get creative.
In my own quaint mixture of Spanish and Miskito, I told the family her back had to be straight, and asked them to get a piece of wood. They came back with a 2 by 4. I tried to explain log rolling to them, and we got the patient on to the board without bending her spine too much. Then they put the board and patient in a hammock and carried her out to our truck.
As we drove out of town, I wrapped some rope around the patient and the board to secure her and keep her from bouncing off. Then I tried to show her family how to hold C-spine on her head to keep her neck straight. I ended up doing it myself most of the way back to Francia because they couldn´t understand.
We took the woman into Janet´s MINSA clinic. Janet started an IV, gave her diazepam to calm her down, and inserted a urinary catheter, because the patient had not been able to urinate since the accident. Mindy got some webbing from the hill, and I took the opportunity to do a better job of patient packaging. The result still looked ridiculous, but I hoped it would hold until we reached the hospital.
It did. We carried our patient into the emergency ward. I was happy that I had kept her back straight, but knew it hadn´t been straight the whole night she spent in her home. And then when the doctor arrived, he untied the ropes and pulled my board unceremoniously out from under her - no log rolling involved. Why did I even bother, I wondered.
I felt so helpless in both these incidents. I didn´t have the words to get proper care for one patient, and I didn´t have the equipment to care for the other. I did my best, and that´s all I can do, but I stuggle to accept that truth. As an American nursing student, I have a concept of the ¨right¨ way to do medicine. Unfortunately, that way doesn´t always exist here.
But some days we have emergency transports to the hospital. We turn the back of our truck into an ambulance by laying a mattress down, and we drive two hours on a dirt road, bouncing all the way because we don´t have shocks, and using the transmission to slow the truck down, because we don´t have brakes. In the States, the same distance would take perhaps half an hour, because the road would be paved. Also in the States, I would have a fully equipped ambulance so I could actually care for my patient on the way to the hospital.
On Tuesday, January 6, we took a patient to the hospital who was having convulsions of some sort. Mindy said they didn´t look like seizure convulsions to her, but they certainly looked bad, whatever they were. The young woman would start thrashing around agressively, obviously not in control of her body. Her fists were clenched so tightly her nails were digging into her palms, and she was screaming in obvious pain and terror. Her eyes looked strangely glazed over. The only thing we could do for her was hold her down to keep her from hurting herself.
We got her to the hospital, carried her in, and laid her on a bed in the emergency ward. She was still convulsing violently - three or four people had to stand next to her bed and hold her at all times to keep her from falling on the floor. A doctor came in with an injection to calm the convulsions. But all of a sudden, the girl´s mother started saying no. She refused to let the doctors touch her daughter and said that she wanted to take her to a sukia (witch doctor) instead. I was listening to this conversation in Miskito, and couldn´t understand what was happening. All I could gather was that the mother was saying something about the doctors at the hospital not speaking Miskito. Which is true - that particular hospital is staffed solely by doctors from Cuba, which is one of the things that makes it a good hospital. But in this case, it apparently contributed to the mother´s distrust of the hospital.
I tried to ask the other friends and family of the patient what was happening, in Spanish. One young man told me that the mother wanted a witch doctor, but he used the Spanish word for it, which I didn´t recognize. Suddenly the people picked up the mattress and carried it outside. not knowing what else to do, I stayed with my patient and helped. While we were carrying her, Janet told Jenny what was going on, and she told me, so I finally knew that they were taking her to a sukia.
They loaded her onto a pickup truck in the street outside the hospital. She was still screaming and convulsing, and I felt desparate to get her help - real help, not whatever dubious ¨care¨ the sukia would provide. But how to communicate? I didn´t think the mother spoke Spanish, and I couldn´t say what I wanted to in Miskito. I started trying to convince the friends and family, in broken Spanish. But I was talking to the wrong people, and I was too late. The mother had decided, out of her fear and ignorance, that her daughter would be better off with the sukia than in the hospital. The truck left before I had barely started making my case.
The next week, on January 12, I met another case that tested my limits. Sunday night around 8pm, a woman in Santa Clara walked under her house. From what I could gather, she was chasing a chicken. All the houses here are built on ¨stilts,¨ so you can get under them easily. While she was down there, a beam fell from the underside of her house and struck her. They came to our mission the next morning to ask for medical transportation.
When I got to the patient´s house in Santa Clara, she was lying on the floor moaning with pain. They showed me the places on her left side and abdomen that were hurting her, and then they rolled her over and showed me her back. She nearly screamed when they moved her. There was a lump near her spine halfway down her back, where I assume the beam had hit her. Just the gentle pressure of my hand touching there hurt her badly.
All the medical training in my head said I needed to keep the patient´s back straight, because it might be broken. In the States, that would involve strapping her to a back board, chalking her head, and packaging her in a Stokes basket for transport. Here, of course, I have none of that equipment. So I had to get creative.
In my own quaint mixture of Spanish and Miskito, I told the family her back had to be straight, and asked them to get a piece of wood. They came back with a 2 by 4. I tried to explain log rolling to them, and we got the patient on to the board without bending her spine too much. Then they put the board and patient in a hammock and carried her out to our truck.
As we drove out of town, I wrapped some rope around the patient and the board to secure her and keep her from bouncing off. Then I tried to show her family how to hold C-spine on her head to keep her neck straight. I ended up doing it myself most of the way back to Francia because they couldn´t understand.
We took the woman into Janet´s MINSA clinic. Janet started an IV, gave her diazepam to calm her down, and inserted a urinary catheter, because the patient had not been able to urinate since the accident. Mindy got some webbing from the hill, and I took the opportunity to do a better job of patient packaging. The result still looked ridiculous, but I hoped it would hold until we reached the hospital.
It did. We carried our patient into the emergency ward. I was happy that I had kept her back straight, but knew it hadn´t been straight the whole night she spent in her home. And then when the doctor arrived, he untied the ropes and pulled my board unceremoniously out from under her - no log rolling involved. Why did I even bother, I wondered.
I felt so helpless in both these incidents. I didn´t have the words to get proper care for one patient, and I didn´t have the equipment to care for the other. I did my best, and that´s all I can do, but I stuggle to accept that truth. As an American nursing student, I have a concept of the ¨right¨ way to do medicine. Unfortunately, that way doesn´t always exist here.
Sunday, January 4, 2009
You Know You´re a Student Missionary in Nicaragua When . . .
your Christmas tree has an angel made of a toilet paper roll on the top.
you name the tarantula in your shower Peeping Tom.
your clinic has a possum living in it.
you have to push your truck down a hill in order to start it in order to have power to pump up the tires on your four-wheeler.
you try to stay up until midnight on New Year´s Eve, but you´re too tired to stay awake because you normally go to bed at 8:30.
candlelight dinners no longer seem romantic because the candles are necessary to see your plate.
you´ve forgotten what it´s like to be able to hear your friend´s voice over the noise of the vehicle you´re riding in.
everyday conversations are conducted in three languages at once.
the chickens come in the kitchen and you get a kick out of closing the doors and chasing them till you can catch them and hold them upsidedown by their feet.
the plane flies into the airport and someone has to shoo the horses off the runway before it can land.
you have a truck engine chained to the bottom of your porch.
a chicken walks into your dorm every day to lay an egg next to your suitcase.
you take a pan off your shelf to bake a cake and cockroaches crawl out of it.
out of 7 bicycles that your group has bought, only 3 or 4 are ridable at any given moment.
you have to take an extra pin with you to put the wheel back on your four-wheeler in case it falls off while you´re riding it.
you name the tarantula in your shower Peeping Tom.
your clinic has a possum living in it.
you have to push your truck down a hill in order to start it in order to have power to pump up the tires on your four-wheeler.
you try to stay up until midnight on New Year´s Eve, but you´re too tired to stay awake because you normally go to bed at 8:30.
candlelight dinners no longer seem romantic because the candles are necessary to see your plate.
you´ve forgotten what it´s like to be able to hear your friend´s voice over the noise of the vehicle you´re riding in.
everyday conversations are conducted in three languages at once.
the chickens come in the kitchen and you get a kick out of closing the doors and chasing them till you can catch them and hold them upsidedown by their feet.
the plane flies into the airport and someone has to shoo the horses off the runway before it can land.
you have a truck engine chained to the bottom of your porch.
a chicken walks into your dorm every day to lay an egg next to your suitcase.
you take a pan off your shelf to bake a cake and cockroaches crawl out of it.
out of 7 bicycles that your group has bought, only 3 or 4 are ridable at any given moment.
you have to take an extra pin with you to put the wheel back on your four-wheeler in case it falls off while you´re riding it.
Saturday, January 3, 2009
Happy New Year
This past week was a little more restful than the rest of December. After I got home from Puerto Cabezas Friday night (actually 12:30 Saturday morning), I got to crash for a few days. Finished an excellent book (Three Cups of Tea) on Saturday afternoon. Had a headache most of Sunday. I dragged myself out to visit a few patients, but spent most of my time trying to sleep in the hammock. Then Monday I was still dead tired, so I took a nap all morning.
Boring, right? Don´t worry, it gets better.
Wednesday, New Year´s Eve, Janet came to the mission hill and handed us a letter from Esperanza. It was a request for transportation for a pregnant woman there. She had gotten into a fight a few days before and the other party had battered her pretty well. Whoever it was hit her hard in the stomach. Not a good thing to have happen to a 32 weeks and 5 days pregnant mother. She had started hemorrahging and having labor pains.
Jeremy went with Janet to Esperanza to pick the woman up on the four-wheeler (which was still running at that point). Then we took the truck into Waspam. The woman was in quite a bit of pain, probably both labor pains and pain from being beat up.
Outside Waspam, we got stopped by a roadblock - the Yatama, one of Nicaragua´s political parties. No idea why they were blocking the road - that´s just something people do around here. Janet told them to get out of the way, so they did. :)
We got the pregnant lady to the hospital. I went in with her, but Jeremy went to go get gas. The doctor examined her in the labor and delivery room and said she was 7 centimeters dilated already. The doctor said the baby was still alive, but she wasn´t sure it would survive because it was so premature. They gave the mother a bed and wanted her to lie down and wait. But when she was about to get into bed, she decided it would be a better idea to go back to the labor and delivery room. :) She laid down and five minutes later the baby popped out.
It was my third time helping with a birth, and as usual I felt like I got in the way more than anything. Every birth is amazing to watch, and in this one I felt especially worried about the baby because it was so premature and so small - 3.25 pounds! He was a fighter, tho - started screaming right away, and pretty loud.
About two minutes after the birth, Jeremy walked in. He looked at the baby and said, ¨Well, that was fast.¨ :) The baby had been born about 10 minutes after we reached the hospital. If that roadblock hadn´t been cleared for us, we could have been delivering the baby in the back of the truck! Thank God we got to the hospital in time....
So that was my amazing New Year´s Eve. That night I stayed up till midnight listening to music and playing games, and the next day we took a day trip to Esperanza to swim in the beautiful Wawa River. We also took a dugout canoe up the river a little way - we put 6 people in it and then tried to paddle it up stream in a spot where the current was just a little too strong - and we shipped a bunch of water all at once and the boat sunk out from under us. It was hilarious.
Probably not the way you spent the New Year´s holiday. Nicaragua is always different. :)
Boring, right? Don´t worry, it gets better.
Wednesday, New Year´s Eve, Janet came to the mission hill and handed us a letter from Esperanza. It was a request for transportation for a pregnant woman there. She had gotten into a fight a few days before and the other party had battered her pretty well. Whoever it was hit her hard in the stomach. Not a good thing to have happen to a 32 weeks and 5 days pregnant mother. She had started hemorrahging and having labor pains.
Jeremy went with Janet to Esperanza to pick the woman up on the four-wheeler (which was still running at that point). Then we took the truck into Waspam. The woman was in quite a bit of pain, probably both labor pains and pain from being beat up.
Outside Waspam, we got stopped by a roadblock - the Yatama, one of Nicaragua´s political parties. No idea why they were blocking the road - that´s just something people do around here. Janet told them to get out of the way, so they did. :)
We got the pregnant lady to the hospital. I went in with her, but Jeremy went to go get gas. The doctor examined her in the labor and delivery room and said she was 7 centimeters dilated already. The doctor said the baby was still alive, but she wasn´t sure it would survive because it was so premature. They gave the mother a bed and wanted her to lie down and wait. But when she was about to get into bed, she decided it would be a better idea to go back to the labor and delivery room. :) She laid down and five minutes later the baby popped out.
It was my third time helping with a birth, and as usual I felt like I got in the way more than anything. Every birth is amazing to watch, and in this one I felt especially worried about the baby because it was so premature and so small - 3.25 pounds! He was a fighter, tho - started screaming right away, and pretty loud.
About two minutes after the birth, Jeremy walked in. He looked at the baby and said, ¨Well, that was fast.¨ :) The baby had been born about 10 minutes after we reached the hospital. If that roadblock hadn´t been cleared for us, we could have been delivering the baby in the back of the truck! Thank God we got to the hospital in time....
So that was my amazing New Year´s Eve. That night I stayed up till midnight listening to music and playing games, and the next day we took a day trip to Esperanza to swim in the beautiful Wawa River. We also took a dugout canoe up the river a little way - we put 6 people in it and then tried to paddle it up stream in a spot where the current was just a little too strong - and we shipped a bunch of water all at once and the boat sunk out from under us. It was hilarious.
Probably not the way you spent the New Year´s holiday. Nicaragua is always different. :)
Subscribe to:
Posts (Atom)
