Nicaragua

My third country this year.  I feel so lucky.  I just spent 10 days in Nicaragua with my university to provide some healthcare for the elderly.  It's a sad thing in Nicaragua because the elderly are completely neglected in healthcare.  How to care for and treat the elderly is not even taught in the medical schools.  They focus their attention on the young and healthy.  Thus, this trip was to provide some intervention and care for these elders.

Our group included 4 students from each health profession - physician assistants, physical therapy, occupational therapy, pharmacy and dental hygiene.  You can read more about it here.  We were divided into 2 groups with 2 students from each program in different cities - Esteli & Granada.  I was assigned to Esteli and was pretty bummed out since Granada is a famous tour stop and has beautiful colonial architecture, not to mention Esteli looked pretty ghetto on the drive in with not much to offer.  Esteli turned out to be the place for me though!  It was great to be in a place with zero tourism and really experience the local life.  Turned out there was plenty to do.....

The 6 am flight and 6 hr layover in Houston finally brought us to Managua, the capital of Nicaragua.  Turned out to be one whole day of travel.  We spent the next morning in Managua touring the city and seeing the major sites.  We went to the central park and saw the Cathedral, which is still in shambles from the major earthquake back in 1972.  They are still working on repairs to this day.  Obviously they haven't gotten around to repairing the Cathedral yet.

Poets are a pretty big deal in Nica.  You may have heard of Ruben Dario, considered to be the Father of Modernism.  We studied him in undergrad Latin American Literature class so it was cool to see where he was from and even this statue in honor of him.

Next stop was the Parque Historica, home to a massive statue of Sandino, Somoza's old presidential palace and a lake that you can zip line across.  We got shot down after politely asking if we could - apparently not enough time.  We also saw the old prison where Somoza used to torture his political prisoners, including Daniel Ortega, the current President (see picture above w/ me waving).

This is the lone last remaining scryscraper of downtown Managua.  The only one surviving the earthquake.  You can see Lake Managua in the background.

After our tour of Managua we drove the bus to Esteli, a 2 and 1/2 hour ride.  Our delicious Cuban dinner was definitely worth the wait!

Wednesday morning we took a tour of the hogar (home) where we would be spending the next week working.  Here's a tour for you..... The front entrance, the courtyard, water tower between the resident's rooms, and the chapel which all resident's are required to attend.

After the grand tour, the fun began!  We started our screenings, asking each resident questions and getting their vital signs to see who was ready for dental work.  It was MADNESS.  There was no organization whatsoever and even though this was the 4th or 5th trip down to Nicaragua, this was the first time in Esteli.  Zach, the other PA, and I met with Dr. Lopez (one of the few Nicaraguan doctors who has specialized in geriatrics) to discuss our plan for the week.  I was super excited to be working with Dr. Lopez especially since I've heard what a great doctor he is.  It came to our attention there was a patient with an ulcer (bed sore) and her back so we went w/ Dr. Lopez to look at her.  Before even looking at the ulcer, he did a comprehensive physical, diagnosing 7 other things.  Imagine if he had jumped straight to the ulcer!  Those other 7 things would have been missed completely..... 

Zach and I excited to begin our work!

In addition to working w/ Dr. Lopez, we had 3 nursing students with us from Managua, specializing in emergency medicine.  At first I was a little put off because they were doing a lot that Zach and I could have done, but I learned a lot just by observing them and they even taught us some skills, like how to put an IV in - got it on my first try!  Booyah.  The patient I put it in had had a blood pressure of 40/10 earlier and was unconscious prior to the nursing students and Dr. Lopez giving her CPR.  Zach and I had taken the BP reading initially and it was a good thing the doctor came when he did.  She is currently doing much better, thankfully.

Our Spanish class started this day as well - one hour every day we worked at the hogar.  They split the class into Beginners & Intermediate/Advanzed.  I learned some practical vocabulary for practicing as a PA so I was excited about that.  Here we are practicing our physical exams on each other, in Spanish of course!

That night a few of us went and out and explored the city w/ the nursing students.  A good opportunity to practice my Spanish with the natives!

The next day Zach and I started our physcial exams on the residents at the hogar.  They were just mini exams, taking pulse, respiration & temperature; listening to the heart & lungs; checking for dehydration, edema, skin conditions; noting anything else abnormal.

After attending Spanish class and the obligatory Thursday mass, Zach and I found out that Dr. Lopez had already cleaned the ulcer and cut off the necrotic tissue.  I cannot begin to tell you how disappointed we were.  Not to mention we had not worked with him at all that day (he's a very busy man).  At that point we both were like, "Just send us home."  We really wanted to see how he cleaned the ulcer......  Good thing we stayed though.  You will see why.....

After our work for the day, the nursing students wanted to take a tour of the hospital and asked if we wanted to join them.  The hospital there was SO much different than any hospital here in America.  It seemed dirty, but it might have just been that the building was very old.  But the resources they have are very limited and all patients share a room, 6 to a room w/ no curtains.  The patient I mentioned earlier had gotten her ulcer from her stay in the hospital and there was nothing more they could do for her so that's why she was sent to the hogar.  Also, the patient I put in the IV in should have gone to the hospital in reality, but the nuns and doctor preferred to have her stay in the hogar as she would receive better care and attention, not to mention avoid developing any infections she might get from the hospital.  It's just a very different standard of care in the hospitals down there....

On the way back from the hospital we stopped to buy some legit Nica homemade "bombas," aka fireworks.  These suckers were huge.  And did I mention they were homemade?  Fortunately the dudes we bought them from offered to light them off for us.  Sweet!  It was quite the show.  We're talking like the big ones in the sky w/ bursts of colors.  Fortunately no one lost their arm.  Another interesting fact is there's no law against lighting them.  You can light them wherever you want.  In fact during the soccer game we went to, they were lighting them inside the stadium.  Crazy.

Our taxi ride back to the hotel....

Friday morning we took a tour of the cigar factory.  They hand roll the cigars right here.  I gave my free after-the-tour-cigar to Zach.  He was pretty happy about that.  The crazy thing is that the owner is Brazilian and ships all the cigars back to Brazil.  They don't sell any in Nica.  We told him he should.....

This was our day of action for Zach and me.  We took care of the patient with super low blood pressure that I mentioned earlier AND Zach got to put in an IV AND clean the ulcer!  Something we'll probably never get to do in the U.S.  Dr. Lopez coached him through everything and it was awesome to watch.  This was also the nursing students' last day so we said our goodbyes.  I'm super glad we had them on board - Norlan, Tatiana, and Jared.  Norlan helped us tons w/ our physical exams, among many other things.  Hopefully we can stay in touch.  Tatiana wants to come to the U.S. when she graduates.

 (Dr. Lopez is the yellow shirt)

That night Dr. Lopez took us to the rodeo.  There was this huge horse event going on that whole weekend and he wanted to go check it out.  Unfortunately you had to pay the entrance fee once just to get into the grounds and again for the actual rodeo.  We had the understanding that it would only go an hour longer, so we just walked around the grounds, but it ended up going much later.  Turns out we could have seen some Nicaraguans ride some bulls!  Oh well.

Saturday was also a work day.  Zach and I started our ear lavages - cleaning out impacted ear wax.  This can be a very long tedious process.  In fact, I spent and hour and a half on just one guy and still didn't finish!  It was amazing, though, to witness the difference in hearing before and after.  We cleaned out Vicente's ear and he was just amazed at how well he could hear afterwards.  He thanked us with tears in his eyes and explained how he had spent $300 at the hospital and they had hurt him doing the same thing.  He said he didn't hurt him at all and then asked if we could take a Nicaraguan back with us (referring to himself).  Tear.... I said we could if he could fit in our suitcases.  He just laughed.  The nuns were excited too and said they wouldn't have to shout at him anymore.  First we looked w/ out otoscopes and then rinsed out w/ water.  Simple as that!  Don't try it yourself though.

We watched Dr. Lopez do a complete physical exam on a patient w/ kyphosis (see picture below) who also had a pretty good sized lesion on his nose.  He said it could be anything from an abscess to cancer to leprosy.  What happened next would never happen in the U.S.  As he was feeling it, some liquid came out and so Dr. Lopez proceeded to squeeze the rest out and then peel the top layer off.  Strange thing is the patient had no pain.  Like I said, just a different standard of care.  In the U.S. no doctor would touch that thing w/ a 10-foot pole until it had been biopsied.  Thought it was interesting.....

Later we invited some doctors from the community to discuss a plan for the future of the hogar.  It was amazing to me to see how many people came and the concern they had.  The plan is get some university students to come every 2 weeks to keep going what we started.  Hopefully it happens.

That night we went to the soccer championship game between Real Esteli (best team in the country) & another team from Managua.  SOOO much fun.  The scoring kept going back and forth the whole team and of course everywhere was super into it.  Real Esteli scored in seriously like the last 30 seconds to win it 3-2.  When the game was over, they wouldn't let anyone out (apparently to let the other team leave safely), but we were all getting squished and everyone was super anxious to get out.  A good cultural experience all in all.

On the walk back to the hotel afterwards, I got into a fight w/ the streets of Nica.  And unfortunately the streets won.  Bahahaha.  So I was walking in the middle of the street w/ nothing even around me and the next thing I knew I had tripped on something and was started to fall.  I thought, "I got this."  I was going to catch myself.  But then I just kept falling.  At that point I still thought I was going to recover, but the next thing I knew I was on the ground.  I was then planning on doing a volleyball roll over my shoulder, but then the momentum stopped.  I was laying flat on the ground in the middle of the street.  Bahahaha.  I so thought I was going to recover and it all happened slow motion.  Everyone in my group said the same thing.  We all laughed about it for a while after that.

Early Sunday morning we left for the Miraflor Nature Reserve for some adventure on our day off.  Turned out to be and hour and a half driving on a pretty bad dirt road.  Getting bounced around on a bus for that long is never fun.  When we finally got to our destination we had a delicious breakfast (they have the most delicious white pineapple in Nicaragua!), had a short tour of a coffee plantation, and then set off for our hike through the forest/jungle (which turned out to be a 5 mile hike).  A few of us went swimming at a waterfall and then we ended the outing with the most delicious lunch.

On the ride back, I got to sit next to our Nica tour guide, Darwin, and talk with him in Spanish the whole way back. I loved every minute of it. Not to mention he was pretty cute. He told me a lot of interesting cultural things about the region as well as some of the things he's done....pretty crazy.  For instance, he used to play in the professional baseball league for Nicaragua, he used to ride bulls and stayed on one for 80 seconds once (different type than in the U.S.), and even tried crossing the border illegally from Mexico to the U.S.  Apparently he spent 2 mos. in the mountains wandering around and eventually got caught.  He was thrown in jail for 15 days and went 8 days w/out food or water.  I told him it was miracle he was still alive and asked him if he'd ever try again.  He just laughed and said not that way.....he'd try legally the next time.  It was interesting to get a personal account of that experience though.  He's a respectable guy, but just wanted a better way of life. 

You may already be able to tell how popular the horses are around Esteli.....Darwin was telling me about different types of horse races they do through the streets of the city, basically whenever you want.  If that's how you want to celebrate your birthday, then so be it!  In one type of race they hand ducks up across the streets w/ their heads hanging down and then grease their heads so they are hard to grasp.  The person on horse with the most ducks at the end is the winner!  In the other type, they hang earrings on a string across the road and you have to throw a pencil through the hoop.  Sounds insanely tough.  If you make it through the hoop, you give it to one of the girls that are dressed up and waiting and then take her on a ride on your horse around the city.  Sounds pretty fun.  I guess you just hope the guy who successfully throws a pencil through your earrings is cute.....and taller than you!  Bahahaha.

When we got back from Esteli, there was a major party going on in the city.  Everyone was on their horse prancing through the streets.  Men and women both were decked out in their flannel shirts, boots and cowboy hats.  We walked around a bit to check it out.

And of course it wouldn't be a trip to a Spanish-speaking country w/out finding my Latin boyfriends.  I asked these cowboys to take a picture w/ me.  Don't you just love it?

Then I was taking a picture of this guy's horse so he said, "Take a picture with me!"  He asked where we were from and when I said Oregon he got all excited since he was from Seattle.  The term "from" was used loosely in this case as he was really from Esteli and living in Seattle.  A lot of people came home just for this annual horse event.

Monday morning was dedicated to educating the caregivers at the hogar as well as any health professionals from the community who wanted to attend.  Each of us (PAs, PTs, OTs, Pharmacy, Dental Hygiene) spent 20 minutes teaching and afterwards having the caregivers practice what we taught them.  It was a bit challenging explaining how to take blood pressure, pulse and respiration all in Spanish, but I'd say I did a pretty good job.  I taught half and then translated for Zach while he taught the other half.  Don't laugh at my scrubs - yes, they taper at the bottom.



It was my lucky day! I got to mix the antibiotic and give it IV to the patient w/ the ulcer, PLUS then clean the ulcer. I would post a picture, but it would probably gross you out. Let's just say the gauze kept getting stuck on the bone (vertebrae) and I had to clean up under the edges. I loved it. I felt extrememly bad for the patient though. She was on hardly any pain meds and every time I touched the ulcer to clean it, she would flinch. It continues to improve though.


Zach and I continued our PE's (physical exams) and ear lavages.  I will never forget Rosa, a cute little old lady that kept repeating our instructions w/out actually doing them.  Zach sure had a hard time trying to listen to her lungs because she kept talking.  Haha!  We saw some more patients w/ Dr. Lopez and he brought one of his medical students with him.  It was amazing.  This student is in his third year and Zach and I have had less than one year of education.  We had WAY better skills than he did though.  Just sayin'.......

On the walk home I discovered a delicious bakery and then we went to dinner later as a group.  Here's some of the typical Nica food............ gallo pinto, white pineapple, goat cheese, avocado, platanos maduros, tostones, etc.  SO GOOD!

Tuesday was our last day at the hogar. We did our regular morning intervention and then had our fiesta that afternoon, which consisted of bowling, breaking a pinata, and eating a delicious torta (cake).

Our last night in Esteli, Zach and I conviced everyone to go out for some dancing at the local discoteque to break out our dance moves and check out the local night life.  Everyone reluctantly admitted they were glad they went afterwards.  Ha!  Don't worry, there's NO connection to Twilight.  And no, we did not dance at the table.  We got out on the dance floor baby, this was just a warm up!

Wednesday morning we went back to the hogar one last time to say our official goodbyes.....so sad.  I definitely had my favorites that I'm going to miss - Vicente, Franciso, Teodoro, Felicita, Carlota (100 yrs. old, super sharp, always so happy) and Enrique (I loved his smile.  He would always smile back when I smiled at him.  He talked to me on the last day too when I said goodbye for the last time.  Brings tears to my eyes.  Earlier in the week, I was asking him some questions but he would only ever nod his head.  The nun passed by and said she thinks he knows how to talk, but he chooses not to.  Thus it was very significant when he finally said something to me.  I took a photo w/ him and then he said something about always remembering him.  You bet I will!)

Afterwards we took the bus to Masaya and went to the insanely much open air mercado.  Last stop shop for gifts.  And boy are they ever hard bargainers!  That is probably my absolute favorite part about visiting other countries - bargaining.  I have so much fun w/ it.  I've been called the best bargainer ever before by a Mexican and thought be from Argentina by a Peruvian.  My strategy is to joke around, get them to laugh with me, and see how low I can get, which is usually pretty low if I do say so myself.  But I could hardly get any reaction from these Nicaraguans.....bummer.  We went the Granada crew here at the mercado and then all went to dinner together on the way back to Managua for our flight the next day.

Here's some random pictures of Esteli.  There were tons of murals painted all over the city and I made it my project to take a photo of as many as I could, but there were just to many so I gave up....





These old school buses were the main transportation in Nica.  They make them all fancy by painting them and equipping w/ a roof rack, both for material AND people!  Also, known as chicken buses

As you've probably already noticed, there are no pictures of the elders we worked with.  We are not allowed to post any photos of them unfortunately.  Too bad, cause I wanted to showed you all my favorites!