Overheard in Nicaragua

American guy: Someone told me there are an equal number of Catholics and Evangelicals in Nicaragua. Is that true?
Evangelical Nicaraguan guy: Oh no, definitely not: there are many more Catholics.
American: Why?
Evangelical Nicaraguan: Because it's easy being Catholic.

"I'm Talking to my Mom"

Note: I was able to borrow someone's camera cord and put my pictures on my computer, so this and subsequent posts will now have pictures.

This afternoon Heather and I went to an orphanage in Rivas, about 45 minutes away from San Juan. Heather's Spanish school organized the trip. Other than the driver, I was the only man in a bus of about 15 women. We brought a piñata overflowing with candy for the children. When we arrived at the orphanage, the children mobbed me as if they knew I had pilfered candy in my pockets.



Heather later theorized that the children saw very few men--all the staff members were women, as was the rest of our bus--so I was somewhat of a curiosity. The little boys especially flocked to me and tried to climb me like a tree.





Before they even knew my name, they shook my hand, gave me five, and hugged me. The moment I took my camera out of my pocket, they began to grab at it. It was a bit of a leap of faith on my part, but I let all the children around me take a picture with the camera. Interestingly, they seemed to want to take pictures with the camera rather than be in pictures. I still don't know why this was the case, but if anyone has ideas, I'd be interested to hear them.

After the mob scene and having countless runny noses wiped on my Arkansas Razorbacks T-shirt, the children proceeded to attack the piñata.



Video:



They started with the younger children, who were about four years old. After many children and minor spillage of candy, the rotation ended with a ten year-old. Then I felt a tap on my shoulder. For an instant, I let myself imagine the piñata hemorrhaging candy as I pounded it with the short wooden bat. And it was meant to be: a woman stood behind me, the bat in her outstretched hand. After ensuring that all the children had had a turn to thwack the piñata, I went to town on it. After a few swings of the bat, its insides rained down on the ground, drawing forth a wave of children.

Then we ate candy. And ate. And ate. And drank Coca Cola. After a while, I began asking children if their stomachs hurt, just to make sure no one was going to throw up. In retrospect, I think we could have bought a little less candy. During the postprandial milieu, I was able to talk with a few children. However, because they were running around, sugar-crazed, I was only able to ask most of them their names, their ages, and their favorite kind of candy. While I was picking them up and making rocket ship noises, I was able to speak to a couple of the women who work at the orphanage. I learned that most of the children actually have mothers/fathers, and that the home was mostly a place for children whose parents could not afford to care for them. There were four brothers at the home, and another group of two brothers and a sister. The sister of the group, Kimberly, gave me a drawing of her name. Right now, I can't entirely put into words how touching her gift was. I felt like I was there for such a short time, that I couldn't expect to give much to them. After her gift though, I wondered if all the hugs and explaining that my name really is Noah, like the guy in the Bible with the ark full of animals, actually meant something to the kids. Considering how they acted toward me, I wondered how many of them had had a positive male role model, if even for a short time.

I spent a little extra time with Jared, one of Kimberly's brothers and one of the youngest children in the group. I spent more time with him because he was very timid and was so silent when I asked him his name, that I wondered if he could speak. After a while of me just sitting next to him while he played with a toy telephone, he finally said very quietly that he his name was "Jared." When I asked how old he was, he put up a few fingers, then put some down, then another up. This continued until I got the idea that he didn't quite know his age, but that he'd seen other children hold up their fingers after being asked this question. Sitting silently with Jared was a relief from the screaming children and madness surrounding us. After a while, I asked him who he was talking to on his toy phone. He took his time answering, but finally said, "I'm talking to my mom." So I gave him a hug.

Overheard in Nicaragua

Brit guy 1: Wow, you have great teeth. Doesn't he have great teeth?
Brit guy 2: Hey, you do have really great teeth.
American guy: Well, yeah, compared to you guys.

Working at the Clinic in Baston – June 30, 2009

We set out for Baston (pronounced “Boston”) on what began as a gray, rainy day. Gilbert, Gretchen, (some medical students from UT Houston) and I rode in the back of a pick up truck. The parts of us not covered by ponchos were soaked by the rain. Baston is 30 minutes outside of San Juan. Much of the drive is unpaved, washed out roads. Two nurses and a doctor from the Centro de Salud accompanied us to the rural clinic. We paid the driver $40 to take us to Baston and pick us up. Though we had limited medical skills to offer, we paid for the nurses and doctor to travel to Baston’s clinic. Having to pay for transportation to get out to the rural clinics seems to be one of the greatest limitations to getting doctors out there. For this reason, I was happy that we were able to pay for them. However, since I am on a tight budget because of my wallet being stolen, I will not be able to travel to the rural clinics again.

When we arrived at the clinic, three men were hard at work building a small expansion to the clinic. The clinic was not open every day and, in fact, looked as if it was closed most days; only when health workers could get out to the community did the clinic open. Today it did, and patients were already waiting. How they knew doctors would be there that day, I did not know. The first patient I helped was an elderly man with asthma. He appeared impatient, so I began simply by talking with him and asking why he was there today. In addition, he held my elbow and occasionally clasped the sleeve of my scrub. This told me that he wanted me to stay there and listen to him, and I was happy to oblige. He said he had asthma, so I asked if I could listen to his lungs, which he said was all right. He then told me that he was having back pain, but ran out of the medication for it. I got the name of the medication and added it to those he requested from the nurses. I asked him if he was married, which he was, and suggested that his wife could massage his back to help the soreness.

I then shadowed the doctor who accompanied us to the clinic, and saw various patients. The first was a pregnant woman on a prenatal visit. Her pregnancy was progressing normally, and I was able to hear her baby’s heartbeat. It was amazing! I felt tremendously thankful that she let me hear the heartbeat, and expressed my appreciation to her. We then saw a very thin, young diabetic man. He had insulin-dependent diabetes, and looked dragged down by his disease. He was only there for a renewal of his insulin prescription, but I wish we could have done more for him. Finally, I saw a man with giardia. The doctor prescribed antibiotics and sent the man on his way. This doctor was able to spend even more time with each patient than the doctor at the centro in San Juan. What is more, the patients did not seem to mind waiting to be seen.

We also helped clean and organize the office, which was quite disorganized and unsanitary. Bloody gauze sat uncovered in a trash bin.



Dirt, dust, and flies covered the floor and surfaces. Dogs and chickens wandered into the clinic at will.



The restroom was a hole in the floor in a three-walled shack behind the clinic. Next to the hole in the floor, some wayward chicken had laid an egg.

Beginning Work at the Centro de Salud

After a failed attempt to travel with Rosa Elena, a doctor in San Juan, to the rural communities, we went to the health center. Four of us shadowed a doctor named Oscar, and I took blood pressure. We saw a few children with fevers and indeterminate infections. Another child had a foreign body, possibly an insect, stuck in his ear. A small baby girl had a urinary tract infection, which Oscar diagnosed when the mother said the baby cried whenever she peed. A preteen girl had left lower quadrant pain, which Oscar thought might either be premature menses or a parasitic infection. Mothers and not fathers always accompanied their children. Three men came into the clinic, two for trauma and one with a cold. One man had sliced his fingers with a machete and had an infection, for which Oscar gave him antibiotics. The other man was a carpenter who had been hit in the head while working and had sutures that had also become infected.

Oscar seems like a great doctor and teacher. Although he speaks little English, he always explains the case to us in Spanish and allows us to ask questions. With patients, he is an adept primary care physician. His time is limited with patients, though not to the degree I imagined, but he always manages to add primary care tidbits while taking a case history. For instance, he asked the man who came in with a cold whether or not he drank alcohol and how often. He was able to this because he was less harried relative to US doctors; he spent between 15-20 minutes with each patient.

After lunch, we went to Rosa Elena’s clinic and talked with her about organizing a trip to the rural communities around San Juan to do home health screenings. She put us in touch with a family with a truck who agreed to drive us to Baston (pronounced Boston), one of the communities outside San Juan. I’m was excited about going to do this because I am curious to understand the nature of primary care without ongoing patient-doctor relationships.

Feeling at Home at Nelgin’s -- June 28, 2009

Today was the first day that I truly felt welcomed and comfortable at Nelgin’s. When I walked in the door after returning from Ometepe, she took my hand and held it gently. (Nelgin calls me “Noel” though I introduced myself as “Noé.” She said she liked that my name is Biblical.) She asked me about how I liked Ometepe and what we did, the most questions by far that she had ever asked me. Until this point, I thought she was kind of cold because she never seemed to want to know anything about me even though I asked plenty of questions about her. I genuinely enjoyed talking to her and never felt that I had to ask questions to keep the conversation going.

During dinner we talked more because I asked whose son Luis is. She told me he was her son, and that he was born in Costa Rica. She explained that they fled to Costa Rica because of the war in Nicaragua. They lived in Costa Rica for six years. This means that Luis is a Costa Rican citizen and can live, work, and travel there easily.
Nelgin also told me about where the father of her children is: he lives in San Juan del Sur, not far from her house. They fought often, and he was physically abusive, so she left him. He lives with another woman, though Nelgin did not say whether or not they are married. She often sees him around town.

In the span of a few hours, not only did I feel that Nelgin was interested in my life for the first time, but she also opened up to me about hers. Just when we finished our conversation, her daughter and Gaspar, her son in law, pulled up with the kids. They went to the beach, and I talked with Gaspar about how his day was and how I liked Ometepe. While Nelgin held Isabella, her granddaughter, I played with the baby.

The Morning Christa Left

I was quite sad after Christa left. I returned to our hotel room and tried to sleep for a little while longer, but I could not. After packing my things, I ate breakfast alone in the restaurant across from the hotel. I had the meal Christa and I always looked forward to in the morning: Nicaraguënse. It’s scrambled eggs with bell peppers and onion, gallo pinto (beans and rice), an avocado, toast, and coffee or fresh squeezed orange juice. After breakfast, I was still a little down, so I decided to take a walk on the beach. Already, little children played in the water as their parents looked on. I walked all the way to where Christa and I had spent the previous day relaxing on the beach. The tide had come in unusually high, but the sand chair she had built was still there. I did not sit in it, but on a large piece of driftwood that we had also used for seating the day before. While I was afraid it might make me sadder, being in that spot cheered me up. It was nice to remember the joy we shared together just a few hours earlier.

It is such a strange experience to be with someone so few days out of the year, such an extreme mix of good and bad; the good being spending time with her, and the bad not doing so, of course. In the last year, we have spent less than three week’s time together. At times, it is agonizing to an extent that I fear I cannot bare it. But somehow, the good, the times when we are together, are so rewarding as to outweigh the hurt. Somehow it works, even though I cannot truly imagine the extent of the good when we are apart. I try--and inevitably fail--to imagine how I will feel the next time we see each other. I cannot imagine the feeling because I can only feel it when I am with her. Though I know I will fail, I continue to try to imagine this feeling because even a flicker of it is wonderful. In this way, I do not simply hold out hope. I make my hoping an active process, something to chase, to sustain us.