Vos sos loco!

This post is raw. I just got to my host family’s home after leaving the hospital for the last time. I’m ripping the bandage off just like I had to do for a few patients in the past two months. I’ll start with this week and work my way to a summary of my journey here Nicaragua.

This week was a week to see the parts of the hospital that I hadn’t experienced before. I started the week off in the Emergency Room’s Gynecology and Obstetrics area, then spent a day each in Labor and Delivery, the Intensive Care Unit for new babies and surgery again. In each of them, there was little that I could do to help so I used the week as more of an educational week. Being in the room for a delivery of a baby was a brand new and exciting experience for me, for example. I also had some great conversations with people at the hospital. I always end up talking with some fellow med students, asking them where they are in their studies, what they’re thinking about specializing in, etc. The head doctor in the infant ICU was an interesting guy who talked my ear off about all the technology that they’re lacking and all the things that I could bring back from the States for them. Although it hurts me not to be able to provide for their every need here, these are the kind of conversations I have enjoyed having because the lack of supplies and technology are a main point in my capstone project.

la foto 3 (4)

I did get to provide for one need while I was here, however. The boss of the nurses in Pediatrics, the area where I spent about a month, mentioned to me recently about the lack of chairs for mothers and family members to sit in while they stay with their children. I checked my finances and, finding chairs for a good price in the local market, sponsored the purchase of 8 of them. Today, my last day, I delivered them and was greeted with smiles and thank yous from my nurse friends in Pediatrics.

Today also included my last English class. I turned the tables on my ever-generous English students today and gave them all a small refreshment at the beginning of class along with Certificates of Participation for the class and a small gifts I put together. My Spanish-English medical dictionary will also stay in the nursing office to help them translate and sort the donated packages of medical supplies that often come printed in English. It was tough to say goodbye to my new group of middle-aged female friends but I let them know that I hoped to return one day when I had some more medical knowledge and shared my gratitude for all they had given me over the past two months.

la foto 2 (5) la foto 4 (4)

I’ll miss many things about the hospital and about Nicaragua in general. I’ll miss the vast amount of hands-on learning opportunities I had everyday; heading back to pre-med classes will probably feel like going backwards in my studies. I’ll miss teaching English and doing what doctors tell me. I’ll miss sitting and enjoying the breeze in Central Park after a long day at the hospital. I’ll miss stopping for at a pulperia (small store) to buy a fresco (homemade fruit juice) on my way home. I’ll miss the food. I’ll miss being able to walk or ride my bike anywhere I needed to go. I’ll miss the challenge of speaking Spanish everyday. I’ll miss the prices and the lack of consumerism. Most of all, I’ll miss all the friends I’ve made and the host family that has taken care of me all this time.

Looking back on my overall experience here, I can’t say that it opened my eyes about any great need. I knew there was need in the healthcare system and I wanted to find out exactly what it was. I can’t say that Nicaragua transformed my views of the world, although it definitely refreshed my ideas about injustice in the world and my desire to work towards a change. I can’t even say that my 10 and a half weeks was enough to fully immerse me in the culture. I’m still not comfortable in every situation here and my Spanish remains imperfect. But when I look back on this summer, I will be able to say that it was a defining experience in my medical career, that I was shocked by many differences between the hospital here versus those of the States, that I learned more than I ever thought possible, that I made and strengthened treasured relationships that I hope to continue, that I taught a useful skill to some nurses, that for one summer, I ate and lived and breathed like a Nicaraguan. It all adds up to an incomparable experience about which I have no regrets.

Today, as I walked out of the hospital, I looked down at the lab coat I was wearing and the stethoscope draped around my neck. I looked up at the bright blue sky and the Central American sun beating down on me. I looked around at the dusty street and then back at the green building that I had just exited for the last time (this year at least). Then I realized something: I had never taken a picture in front of the hospital that I called my place of employment for the last few months. I found someone on the other side of the street willing to indulge me. Here is the picture from my last day that looks like a picture of the first day. Yes, I was truly here at Hospital Escuela Oscar Danilo Rosales Aguillo in Leon, Nicaragua during the summer of 2014.

la foto (4)

 

 

Está lloviendo sapos y culebras

la foto 3 (3)When it rains, it pours in Nicaragua and we’re not talking metaphors here. The rainy season which was supposed to have started several months ago, is finally here. The drought is over and the average Nicaraguan is happy because the farmers are happy. Hopefully the price of beans will go back down soon. Beans are a staple for every meal in Nicaragua and they were approaching the price of meat, something that wasobviously hurting many families financially

including my host family. It’s interesting to see such dependence on the fickle weather here. I’m also happy about the rain, but it has certainly brought new challenges. I have to be careful that I’m not out on my bike somewhere when another sudden storm comes up and turns every street into a muddy river. As I am writing this, another monsoon is dumping its payload on my family’s tin roof.

The hospital has also brought new challenges, as always. This past week, I rotated in the Orthopedics area of the emergency room. All squeamishness (if I hadn’t already forced it out of me in the operating room my first couple weeks) would need to have left this week. While most of the patients treated in this area were complaining of pain in old injuries in the legs, arms, or back, several people a day would come in with some real trauma: freshly broken ankles, large cuts on their hands, a thick wire sticking out of their arm. I quickly learned how the doctors bandaged and put casts on patients with broken bones and how to identify fractures from X-rays sent to the emergency department’s one donated computer.

la foto 1 (4)

I also took advantage, as I usually try to do, of doctors who would come in followed by a crowd of med students to teach some literal hands-on lessons. They’d learn by watching their professor assess a patient and then they’d do the same on the next patient. I did my best to blend in with the medical student and took rapid notes as the doctors explained some important detail of anatomy or physical examinations.

 la foto 2 (4)

One time doing this, I struck up a conversation with some of the med students. They were friendly and surprisingly good at English, wanting to practice speaking with me and learn about med school in the United States. They once again rubbed it in my face that, being sixth year med students, they’re nearly doctors while I’m still 5 years away. How old are they? The same age as me. We got past this, however, and I made a couple friends. The med students never stay in one place for long, following their schedule of two-hour blocks but this time they invited me to come with them to the big Orthopedics wing on the 4th floor. I went and got to assist with supplies as they cleaned the wounds of people in the entire wing, an even more gruesome and awesome experience. The initial shock I felt in seeing the conditions in the hospital was freshened for me a little though as we made the rounds. All the rooms were open to the outside air and crowded with patients, giving little help for the comfort, privacy, or cleanliness to these people with open wounds and long recoveries to look forward to. It is good to know that this is not something that I’ve entirely gotten used to. In between tasks as we were waiting for doctors to show, the med students would pull out study materials and teach me as they reviewed together. Eventually, they invited me to their class in the morning which I gladly attended, soaking up every bit of learning that I can.

My capstone project is forming before my eyes. My English students, the heads of each of the hospitals departments, have helped me edit a short survey that I will give to them and some of their colleagues. It addresses the health issues in the hospital and community acccording to their very knowledgeable perspectives. I’ve also heard some great input from doctors concerning the lack of technology at the hospital. One doctor criticized the government’s free healthcare, saying that if they had only charged one Cordoba (equivalent to about 4 U.S. cents) to every patient that came through the doors of the hospital, no technology or supplies would ever be lacking there. I also had the chance to see the inside of a nearby private doctor’s office when I accompanied a sick friend. At the office, they do charge about $8 for a consultation and the results were obvious. This private care physician essentially had the supplies of the entire emergency room in his small office. It was also much cleaner, faster, and even air conditioned. All these experiences are coming together to give me a picture of the state of healthcare in Leon.

With only one week left at the hospital, everything seems a little surreal. I plan to make the most of it. Oh, and here are a couple long overdue photos of me teaching my English class:

 la foto (3) la foto 5 (2)

Ando con el tigre

Another week in the hospital down, 2 left to go. This week I was in the surgery area of the emergency department and it was fun although at times nerve-wracking. I think I’ve found the fastest paced area of the hospital. The surgery area sees most patients with urgent medical needs that come to the hospital as well as anyone who comes in complaining of abdominal pain. This did not stop the doctors from allowing me to be a part of helping out. I was often asked to follow with a patient to the examination room and observe or perhaps review the patient after the doctor did so. I was also present for many times in which doctors were stitching up wounds on patients, cutting the string or handing instruments to them when asked. When urgent patients arrived, I was often quickly called on to help lift a patient into a bed or push a stretcher to another area of the hospital.

In this department, patients were brought in quickly, diagnosed, and sent out or to another area of the hospital quickly. Doctors’ notes were shorter and messier than I had ever seen in order to get to the next patient sooner. After the shift change each morning (which usually meant an hour of transferring patient information to the next set of doctors), people had accumulated outside to be seen by the 3 new doctors, meaning a perpetual backup in the AM hours. Upon returning in from teaching English class in the afternoon, the doctors had caught up and it had grown much calmer. 

IMG_4106

I was lucky to meet a group of medical students from Spain this week in the surgery department. They made me one of their own even though I am far less advanced medically than they are and not as great at Spanish either. In the more tranquil afternoons, it was interesting talking to them about Nicaragua and their comparable experiences since arriving about 2 weeks after I did. Several of them even wanted to practice their English with me which was quite advanced, about as practiced as my Spanish is. On Friday, we kept hanging out after the shift got out and I grabbed a smoothie near the city’s central park with my new amigos.

After I went to help on the retreat last weekend with my host family, I thought I would be even more tired this week. However, I decided that it would benefit me to sleep in an extra hour in the morning. I showed up at 8 every day this week which is when most of the doctors started seeing patients anyways. This extra hour made all the difference and my energy level and Spanish ability was much more functional than the previous week.

The rest of my experience in Nicaragua is fighting to become routine. I say fighting because it hasn’t succeeded yet. Waking up, showering, brushing my teeth is routine here now. Even grabbing a bolsita de mango or a cosa del horno from a street vendor for breakfast has become fairly commonplace. But then I’ll nearly get splashed on my bike as someone throws water out of their house. Or perhaps a doctor come in with a watermelon and start serving me and the other doctors as we’re seeing patients. Or perhaps I’ll wake up to the gorgeous sunrise behind a horizon silhouetted with volcanoes as I did this weekend. And then I’ll remember that Nicaragua is not the norm in my life even though I could certainly live here. One of my English students asked me if I’m excited to go home in just a couple weeks now and I answered “No.” I miss a ton of people back home but I’m not ready to stop learning and experiencing the surprises that Nicaragua brings daily.

IMG_4178

El lunes, ni las gallinas ponen huevos

The weeks are going by fast here in Leon. I’m two posts behind due to busyness over last weekend and no Internet most of the week. So here’s what happened last week:

It was an educational week for me with more of the information and observation and less of the practice. On Monday, my English student nurses took me to Managua again for the second half of the hospital care conference that I had been to with them before. I learned about CPR and pain in patients. At one point, during an interactive part of the conference, the speakers passed into the crowd to have audience members answer their questions. My Spanish has been improving more and more but in that moment, as I sat on the very last seat in my row on the middle aisle, I forgot it all. I was panicking on the inside as the speaker walked towards me with the microphone and… stopped at the person immediately in front of me. I was saved from having to answer some medical question in Spanish in front of hundreds of people. When the conference came to a close, I was given an certificate for my participation. I’m official.

IMG_4113

The rest of the week, I was moved to the Pediatrics area of the ER. The doctors were generally nice there but didn’t jump at opportunities to show me their examination techniques or let me help them. I usually ended up weighing patients, sticking thermometers in their armpits, and fetching things for the doctors. But with my notebook always at the ready, I took advantage of my time there by writing down many medications and techniques I saw used. Two real emergencies came into the pediatric area over the course of one hour on one day in the middle of the week. With one, a boy showed signs of head and neck trauma after falling off a bus. The other was a girl who had been convulsing for more than 30 minutes without responding. I helped in these cases by handing the doctors something when they asked for it and generally staying out of the way. There also happened to be another person from the US in the room observing at the time, a resident doctor from Duke, and she was able to help tell me what the doctors were doing for the patients and how it would be different in a hospital in the US. I found out that one of the major difference is that this hospital does not have a CT scanner. The closest one is an hour and a half away in Managua which is where they sent the boy with head trauma.

Two days this week I was also invited by a group of 6th year medical students and their teacher to go to a seminar in the medical school building adjacent to the hospital. I gladly went and, although 6th year medical students have far more knowledge of medicine than I do at this point, I was able to understand well and take notes on the topics of growth and development and seizures in pediatric patients.

English classes continue to go well. There had been several nurses who stopped coming completely due to the demands of their departments so the two classes per day were combined into one. This helps me out because it means I have an extra hour to help downstairs in emergency and don’t have to prepare for two different classes each day. I can’t understate how great these nurses are to me either. They continue to take turns bringing me a small snack every day and they’ve somehow worked out a deal to get me a free lunches from the hospital cafeteria. They always ask me how it’s going in the hospital and if I ever have any type of problem or question, I can come to them and they always work things out for me. They love to laugh and make fun of each other and me during English class and I’ve become comfortable enough to give it back just a little bit. I’ve tried to make English classes as interesting as I can for them, throwing in fun US cultural facts and dedicating every Friday to teaching nursing terms in English.

The days are long here. I still arrive at the hospital at 7am but don’t leave until between 3 and 4 when the doctors’ shift ends. In the evening I haven’t had any rest either while helping my host family prepare frantically for a retreat for the weekend. I’m also preoccupied with medical school applications, for which I’ve reached the second round and have begun writing essays in my free time. And the weather here is exhausting, the heat and dust nearly always bearing down on us. They tell me there’s a drought going on in Nicaragua making it an extra hot summer for us. I believe it. I keep finding strength though because I know my days here are limited and I want to be taking advantage of every moment.

¿Qué onda?

Another exciting week down at the hospital in Leon, Nicaragua. This week was my first one in the emergency room and my first week truly shadowing doctors (up to this point, I had simply been working with the nurses in Pediatrics). It was a completely different experience. I spent the week in the internal medicine area of the emergency department which saw patients with a variety of symptoms or diseases including stomach and chest pain, high blood pressure, diabetes, asthma attacks, alcoholism, heart disease, and fever. I met some great doctors over the course of the week and some not so great ones. I learned which ones to stick with quickly and they taught me all kinds of cool medical things this week from how to perform a physical exam on the chest and abdomen to how to check for dengue to how to take an ECG. Like the rest of the hospital, when the emergency room has an influx of patients, it becomes extremely crowded with doctors and nurses and patients and family members running into each other constantly. Supplies run out on a daily basis, especially common things like a certain size of syringe or IV bags of saline solution. But I’ve become adjusted to expect this over the past month and medical personnel that work under these conditions always come up with a solution, whether saline or not.

I think I’ll take the rest of this blog post as an opportunity to share some mental lists I’ve been developing about the culture of Nicaragua which should give some good insight into my experiences here from day one.

Nicaraguan cultural practices that fit me perfectly:

  • Laid back: Coming to Nicaragua is relaxing just because the culture here is relaxing. Even in the busy hospital, I have never seen the demands truly cause the people to work at a different pace. Everything is one day and one step at a time which is a great relief from the busyness of classes and job and perpetual hurriedness of back home.
  • Just in the Nica-time: Nothing ever happens on time in Nicaragua. If the event starts at 8, it’d be a miracle for it to get started before 8:30 and even if it didn’t start till 9, no one would blink an eye. My family only begins to mention the word “tarde” (“late”) when we were supposed to be there an hour ago and we haven’t left the house yet. This fits me perfectly since I’m always just a few minutes late for everything back home. In Nicaragua, I’m the first one there.
  • Food: Nicaraguans love food and those that can afford it eat 3 large meals a day. I love the food: beans and rice with every meal, salty cheese, lots of chicken, pork, and beef, fried plantains, yucca at times, fresh tropical fruit and juices, pastries with fruit or cheese inside. It’s all delicious. I love the food prices: my family’s shown me that it’s possible to buy a full dinner for under a dollar (26 Córdobas) and my occasional breakfast on the way to the hospital of 3 freshly sliced mangos runs me about 40 cents. I love that giving food is a sign of appreciation: the nurses that I’m teaching English to always call me skinny and provide me with a mandatory snack at the beginning of class and lunch at the end.

Nicaraguan-isms that it’s hard to adjust to:

  • Calling people by labels: Fatty, grandpa, whitey, Chinese (for anybody with Asian-looking eyes). These are all common nicknames for friends, strangers, or even patients at the hospital. And while it’s natural and accepted here, it’s hard for me to remove myself from the condescending nature and political-incorrectness that these names have in my mind.
  • Throwing trash in the streets: The streets of León are pretty dirty. There is a trash service in the city although very few public trashcans downtown (they only exist around the touristy parks and shopping areas). Most gutters eventually get swept clean by the residents of the houses or the businesses in front of those gutters but there are many ditches or sections of streets that never get cleaned. Even when it caused some of my family making fun of me a little for bringing trash home from dinner one time, the environmental consciousness won’t let me join nearly every Nicaraguan and just throw my trash on the ground.
  • Nicaraguans don’t read: I love to read books. Nicaraguans don’t, according to everyone who sees me reading one. It seems to me that Nicaraguans are very satisfied with entertainment in TV in their free time while for me, I try to be unplugged from electronics for at least part of the day.

A few things in Nicaragua I’ve gotten used to over time:

  • Heat: It’s really hot here. I can probably count on two hands the number of fully air-conditioned buildings in León and they’re all ones I rarely go into. Everything is open-air to allow the occasional breeze to float through. But the heat is oppressive and I blame it for causing me to get tired much earlier and need more sleep than I normally do back in Tallahassee. I’m also nearly always thirsty but I drink plenty of water and have truly gotten used to the heat on a day-to-day basis.
  • Pants: All men wear pants in Nicaragua if they’re leaving their house. Shorts are what tourists wear or what you’re supposed to wear to go swimming. Despite the heat, I’ve adjusted accordingly and have a regular rotation of my 3 pairs of jeans.
  • Hair gel: If you are a male under 45 in Nicaragua and want to be taken seriously, you better have a short haircut with plenty of gel to spike it up or slick it back or at least make it look wet. This includes every professional setting: all the male doctors at the hospital are regular gel-users. I even get self-conscious now if I show up at the hospital having forgotten to put a healthy amount in my hair.

And that’s where I’ll leave it for this week. I’m on the downhill part of my experience at the hospital now but still with 4 weeks left, I’ll have plenty of adventures to share in the next month of blog posts.

Aprovecha Marcario, esto no es diario

Great week at the hospital! It was my last week in Pediatrics and I finally felt like I was able to offer a helpful contribution to the work going on. I worked with a nurse who speaks very fast Spanish but has a hilarious personality and insists that I be involved at every step of caring for patients. She also trusts me to do the things I have already learned and brags about me to the other nurses. I had some great conversations with nurses, doctors, and patients’ parents this week and made friends with tiny patients, feeling more comfortable every day.
There’s still always something new in Nicaragua each day. One day this week, a mission team of Virginians came into the Pediatric ward to talk with patients and offer hygiene supplies, toys, and Bibles. While it certainly felt strange to see white people come into the place where I volunteer to try to make a difference in about 30 minutes, I was able to have some valuable conversations with a couple of them. One of them was a nurse who had some great questions about the hospital and how it’s different from those in the States. The room full of medical supplies that they left downstairs was definitely welcome in the hospital since it seems that we’re running out of the basics. I was able to help sort out the supplies for distribution into each area of the hospital and even translate some of the English labels on packages to assist with identifying some of the donations. Another day, I stayed late to go back into the operating room and observe a couple more surgeries.
On Friday, I was invited to go with all the bosses of the different departments of the hospital (almost all my English students) to a conference in Nicaragua’s capital Managua. I gladly accepted, knowing that any extra experiences like this would add to my knowledge of the healthcare here and contribute to my capstone project. We left from the hospital even earlier than I normally arrive in a van that we rented for the day. It was me and a bunch of women, as usual. They’re fun to be around though, always laughing a lot and insisting on buying me food (I was able to fend them off for lunch). The conference was about thrombosis a disease which I now know something about. It was held at the conference center at the Holiday Inn in Managua, one of the country’s fancier hotels. I was impressed by the staging and the food at the coffee break and couldn’t help wondering where the money came for a conference like this especially given the state of the Nicaraguan healthcare system as I’ve seen it so far and knowing that the nurses paid nothing for it. Then, for about 45 minutes, the conference turned into a glorified commercial for a particular brand of medicine used to treat thrombosis. Mystery solved.
la foto 1 (3)la foto 2 (3)

When the conference was over, we visited one of the malls in Managua for lunch. In the mall, I found a lot of US restaurant chains that I missed and the much higher US food prices that I certainly did not. But it was interesting to see briefly a very Americanized part of Nicaragua, a far cry from the lone supermarket in Leon.
The home life has been just as busy. The pastor that I live with decided that it would be a good idea to have a church service every day for 20 days leading up to a big retreat the church is having at the end of July. I have mixed feelings about the decision but it has really been fun hanging out with the youth of the church who are some of my closest friends here (I should explain that nobody really ages out of youth groups here and many youth are well into their 20s). The organization that my host friend works for has two college interns here from the States so I’ve enjoyed spending time with and helping them out in the afternoons and evening at the hospital. This past Tuesday, I took pictures of a concert they helped put on in Leon’s central park. And Wednesday, I helped my friend get ready for a surprise party for one of the interns whose birthday it was. Birthday parties aren’t a simple affair here either: pinata, huge cake, ice cream, music, a trillion balloons a streamers strung up everywhere. I kind of wish I had saved my May birthday until the summer this year.

 IMG_4077 IMG_4073

It seems like I’ve shared a lot but there are so many details of my experience in Nicaragua this summer that I’m passing over for lack of time. I’m already preparing myself for another hot and busy week in which I’m sure to learn a whole bunch more about Nicaragua, third world medicine, and myself. I’m about halfway through my experience at the hospital, which is a unbelieveable fact that has only served to remind me again to take advantage of every moment I have here in my second home.

Pura vida!

Last week, after a couple under my belt, I had finally gotten settled in at the hospital. Things were going smoothly, even boring at times. I was confident in doing everything asked of me in Pediatrics, teaching English was becoming routine, and I was making friends with other students and workers at the hospital. Some days were even somewhat boring, especially in the context of my exciting day in the operating room from the last post I made. Nicaragua always does have something new to teach me though, whether I’m looking for it or not. It could be a new word in Spanish, new responsibilities in preparing medications for patients, or another new food that the nurses offer me. I always have my notebook in hand to jot down Spanish medical terms to define later, noteworthy conversations with a doctor or the parent of a patient, and things I learn about the unique Nicaraguan healthcare system.

But just when I was getting accustomed to it, the hospital made me sick. It was just a small stomach virus, nothing debilitating and something that plenty of foreigners get a piece of just by stepping foot in Nicaragua. I was lucky I had made it this far without anything worse, especially in such a crowded hospital. Several of the Nicaraguan nurses who I teach also got sick last week. So, at their encouragement and the hospital’s approval, I took a few days off and quickly planned a trip to Costa Rica.

It’s only one country away and doesn’t look too far on a map but my destination of San Ramon turned out to be a 13 hour taxi-to-microbus-to-bus-to-taxi-to-bus-to-taxi affair. I’ll spare my readers the breath-taking details of travelling there and back. Aside from my well-hidden nervousness in going it alone and some communication hiccups with the bus company, the trip was wonderful. San Ramon was where I ended up because I had friends there, one a volunteer for the summer and others on a short-term mission trip for the week. While sight-seeing a little bit with these amigos, it was impossible not to compare what I had been experiencing in Nicaragua with what I saw in Costa Rica. Several major notes I made was the price difference (much higher in Costa Rica, at least for daily things like food and transportation) and the tourism influence in Costa Rica (many bilingual or English signs, US restaurant chains, fancy resorts). I also made a potentially valuable and serendipitous contact on the busride back to Nicaragua: another senior pre-med student from the states who’s interning at a hospital in Nicaragua! She’s only a couple hours away from Leon (where I am) and so I may be scheming up another trip in the near future, this time to add some diversity to my Nicaragua healthcare research.

I picked up where I left off at the hospital this week, my visit to the land of the ticos leaving me rested and mostly free of my stomach issues. As usual, the hospital and my host family are presenting me with full and often unpredictable days that end with me collapsing in bed. And I’ll give in to the bed’s calls tonight and save this week’s details for my next blog installment.

la foto (2)