Granada

            I originally didn’t think it would be possible for us to make the four-hour trip to Granada, being away from the clinic for long, and making the trip by ourselves, but we ended up working it out and I am so happy that we did. Everything went surprisingly smoothly, both going and coming. We would show up to a bus station, get on the right bus, and then were off five minutes later. The three of us have been so used to things going wrong here, that we find our selves saying “no pasa nada” multiple times a day. In Granada though, everything went flawlessly. As we entered the city, Gaby asked me where we should get off and I realized I had absolutely no idea. As many of the passengers began piling off the bus, we followed and found ourselves in the Parque Central. We then decided to head down the main street in the city and soon arrived at our hostel.

            Walking into the hostel, I immediately had déjà vu, from mom’s descriptions and our facetimes when she stayed there, Casa del Poeta immediately felt like another home to me. My mom’s friend Marcela and her family greeted me when we arrived. They were all very welcoming and friendly to me, assuring me that if I needed anything at all, to come to them. From the very first day in Granada, it felt so special to be able to explore and share my mother’s love for this gorgeous city.

            Much of our time was spent just walking around and just exploring the city. Each house and store is painted a beautiful, bright color. The doors themselves are a work of art, inviting guests to enter and explore the tropical courtyard that hid inside each building. The main street, La Calzada, is filled with bars and restaurants, where people sit out at tables in the street watching all the people passing by. Nicaraguans were selling everything on the street; souvenirs, hammocks, gum, cigarettes, cashews, balloons. While they could be a bit of a bother, you simply had to say “no” and they would walk on, looking for other potential customers.

            The food at each restaurant was delicious, and it was so much fun being able to eat out again and choose foods that reminded us of home. By far our favorite restaurant was The Garden Café, where we all got different pastas and a panini and tried a bit of each. Our other favorite restaurant was El Tercer Ojo, where we went for 2 for 1 sushi night, and discovered the best sangria in the city. It also had a cool, lounge atmosphere, with live jazz music, giant Buddha heads decorating the restaurant, and chic boutiques on either side. On our last day we discovered Kathy’s Waffle House, which tasted just like home with its chocolate chip pancakes, flavorful hash browns, and savory bacon.

            Gaby was very excited about the cigar factory, so Cat and I both went along, but we all ended up really enjoying the tour. The tour guide’s passion for the cigar-making process was contagious, and although I’m still not interested in smoking the cigars it was very cool to see how they were made. We also spent a morning painting with a local artists, different scenes of Granada and Nicaragua. What a fun way to spend a Saturday morning!

            We spent a lot of time shopping around, after six weeks without any stores it was so fun to be able to look at all the fun things for sale. We visited the Garden Café’s store which sold local artisan handmade crafts, at least once a day to browse. The art galleries were another fun place to look around in, each had a few different artists that had their own styles and way of representing both themselves and their marvelous city. Although the little carts in the Parque Central were pretty touristy, we also enjoyed looking through them a few times to see all the bright and colorful gifts that we could take back with us.

            The weekend we were there happened to be a horse festival, so we found a spot in a Tona tent, bought a beer and watched the parade. I’m not sure what my expectations were going into the parade, but the actual event was beyond anything that I could have come up with. There seemed to be very little organization, ten horses would come down the street and then we’d wait five minutes for another fifteen. While the horses were all beautiful and looking their best that day, it was clear that many of their riders had been drinking for hours. At the same time as the parade was going, people would weave in and out of the horses selling beers, hats, balloons, with little concern for the poorly controlled horses, which seemed ready to kick at any minute. The three of us sat their just taking it all in, until thunder clouds rolled in and we thought it best to head back to the hostel.

 

            Since we were spending a week away from our own clinic, we logged some hours at a local clinic. It was a great experience, working with the poorer people of the communities near Granada that were trying to manage their chronic conditions or came in with little colds or infections. The three of us all agreed that our Spanish greatly improved during this time and we learned a ton from the doctors and nurses that were running the clinic and were gracious enough to allow us to volunteer with them.

            Lucha Libros is a local bookstore where we all picked a book from, and then we all enjoyed trying out different cafés, getting an iced coffee and reading or people watching. Granada is such a lively city, attracting people from all over the world with the brightly colored buildings which themselves seem to breath life as well. I instantly fell in love with the city, and had a hard time saying goodbye (especially since I was nursing a hangover from the previous night’s festivities). As sad as it was to leave, I know that I will have to return again one day because Granada is one of the many cities that has stolen my heart.

Clinic & Brigadistas

          It’s hard to describe a typical day in Nicaragua, because every day is full of its own surprises. This is true with both our work and just our life in general. I still can’t believe how unfazed I am by things that would be absolutely crazy in the United States, like chickens running inside our clinic or almost stepping on a five-foot long snake. If I were to let all these things bother me, I would go absolutely crazy. Usually the girls and I just laugh as each new situation comes up and do our best Aussie impression, “oh Nee-ka-rae-gue.” Although, I’m often unaffected by the crazy things Nica sends our way, at times it is still a struggle for me to accept that most working days have only a very, very vague plan of what we are going to do. Even then, those plans often fall through. Most days however, we work either in the clinic or train brigadistas.

            The clinic is about 200 feet from our house, which makes our morning commute very easy. It is open every Tuesday, Wednesday, and Friday, and is usually staffed by the three of us, Meg, and Milagro, a local nurse who started off as one of Meg’s first brigadistas. The number of patients varies greatly, some days we will only see four patients and other days there will be twenty-six. Most of the patients are women and children, and they’re all from the twelve neighboring villages. Gaby, Cat, and I all get the weight, temperature, blood pressure, and heart rate of each patient as they come in. We each also take turns sitting in on the consults with Meg to help with the assessment of the patient and translate her recommendations.

            The most common conditions we see in the clinic are babies with respiratory infections, children with parasites, and women with urinary tract infections. Many people that come into the clinic also appear to have chikungunya, a mosquito spread disease that causes fever, rash, and body aches. Other than give them acetaminophen and ibuprofen though, there’s not much we can do for this epidemic. We’ve also been able to share some exciting moments with patients, like being able to tell a few women they were pregnant. Gaby even was able to use the Doppler so one mom could hear her baby’s heartbeat for the first time. Some days have left me completely stumped, like one boy who came in with blisters all over his stomach that the mom said appeared after he swam in a dirty river. Although we only observed the first few weeks, Gaby, Cat, and I are now able to do the full assessment on the patients, ask them questions about their condition, and often we are able to make the correct diagnosis.

            The Brigadista program is done around the whole country, although Meg does most of the training for our area. We are currently teaching 20 women and men from the northern communities. Most of their villages are extremely remote with poor transportation to hospitals or even to smaller clinics. Through teaching them basic healthcare skills and about the most common conditions affecting their communities, they will be able to give advice for simple problems and be able to distinguish when someone needs to actually be transferred to the hospital.

            So far we have had two of the six Brigadista training days. There was a slight issue for those two days though, and only twelve people were able to show up either because of communication or transportation problems. With the students that were able to come however, we spent the time teaching things like the maternal health, parasites, and how to take vital signs. Gaby and Cat presented together over the four epidemics that have been issues in our area- malaria, dengue, chikungunya, and leptospirosis. I taught the class on how to do a baby assessment, since it’s what I did every day at my hospital in Cleveland. We have two more training days coming up this week and then a final two in December.

            It was interesting to listen to the group discussions, although we weren’t able to participate much the first training days because it took all our energy trying to understand the various accents and our complete immersion back into Spanish. After the week we just spent in Granada however, our Spanish has greatly improved and I think we will be able to participate even more this time!

            From the first two days we have observed cultural differences in classroom dynamics and also some of the material taught. I was surprised by how little people know about mental health here and that it’s considered normal for people to interrupt whenever they had a question, instead of raising their hand or waiting until the end of a presentation. While the class time was a good learning experience, the leisure time was fun to get to know the people in the class. The students were anywhere from 16 to their 60’s. After class we walked the beach with them, learned new card games, and watched movies. So far the Brigadista training has been a great experience!

Operating Room

        Surgery week was filled with many long days for us, but the opportunity to help before, during, and after the operations was well worth it. A group from the United States comes down here to Chinandega every year to do as many orthopedic surgeries as they can. Meg has been working with them for years, and we spent a whole day in our clinic when the doctors first arrived doing consults of the people in our villages to see if any where good candidates for surgery. In the end we had around six of our locals go for surgery.

            The surgeries weren’t done in the hospital, but rather a clinic in Chinandega that is only used by Americans who come down here to volunteer and the rest of the time it’s closed. There’s one room for preop, another for postop, and two tiny operating rooms. All the equipment is ancient, and I’m still amazed they continue to work. Preop is one big room filled with about ten beds where patients shower, get an IV placed, answer a set of questions, and then wait for their surgery. Each day there is a general order in which the surgeries will take place and about how long each one takes, but with walk-ins, no-shows, and surgeries taking longer than expected I’m not surprised that they don’t even try to make a schedule. Most of the patients arrived in the morning and then waited around the entire day for their surgery. A medical translator came along with the orthopedic group but she was crazy busy, so I helped whenever I could.

            Postop is similar to preop, with a room full of beds all together. I was so surprised that there was only one monitor and one oxygen tank for the entire room, so they were only used on the person most recently out of surgery. Luckily we never had two patients coming out at the same time or I don’t know what they would have done with only one monitor. After getting a few sets of vitals, the nurses would keep and eye on their patients, keep them comfortable with pain medications, and then eventually do discharge teaching.

            There is one scrub room for the two operating rooms, which are both behind glass doors. Unfortunately these doors don’t close all the way and we occasionally had a fly in the OR that we’d have to keep an eye on. Supplies were low so the surgeons and nurses had to make do with what they had. When we ran out of light covers, they began using sterile gloves instead, and then when the lights went out the surgeons and scrub techs used headlamps.

      In the beginning we had some problems getting the doctors and nurses to trust us, which is understandable because surgery can be life-threatening especially in a place with limited resources. Eventually they allowed us to do more and more when they realized that we knew what we were doing. Most nursing schools don’t get the opportunity to be in the operating room at all, but Case students spend 6 weeks there, so all of us were quite comfortable and knowledgeable in that situation. Cat and I both circulated a few cases and Gaby even scrubbed in to give the tech a break on some especially long cases.