Winter In Nicaragua

I never thought it could get so cold in Nicaragua!

As I sit and type I am wearing two sweaters, a scarf, and I am wrapped in a blanket. And yes, I am still in Nicaragua!

It is finally team season again, so that means it’s off to Jinotega to translate for medical teams. I LOVE teams. Not only because it means I get paid (I do love being able to buy groceries!), but because I really have fun with them. It’s interesting to see people who have been coming to Nicaragua on short term trips for 6 years or more, and learn about their experiences, and it’s also fun to watch a new group member experience Nicaragua for the first time, and see their reactions to things that I have grown accustomed to (i.e. drinking pop out of a plastic bag, seeing cattle being herded down the middle of the pan—American highway, using latrines etc). Every team is different, some teams are more difficult than others, but every team is also a new experience for me. I get to see parts of Nicaragua that I’ve never seen before, and I get the chance to impact lives.

This past week (Jan 23rd -28th) I was translating for a medical team from Illinois. Saturday they had their tourist day, so we went to the Mombacho volcano to do the zip line, then to buy some pottery, and finally Narome, in Laguna de Apoyo for a late lunch.

Sunday we headed up to Jinotega in the morning, and the team started organizing the mass amounts of medications they brought into the country. I think we spent about 4 hours counting pills and labeling bags. It’s a lot of work, but being organized before the clinic days is really important!

Monday morning we were up super early and out the door by 7:30am heading out to our first clinic. I translated all week for Dr. Becky Hewitt. I had a fantastic time with her! It was my first time translating for a provider, so I was very nervous the first day. I was afraid I wouldn´t know how to say something really important, but, everything went fine! By the end of the week Becky and I had it down, and when someone came in who had an illness that we had already seen a lot, she could just said “tell them what they need to know” and I could give them diet, or home care instructions while Becky listed to hearts or lungs, or did exams. We say so many interesting cases, and I wish I could share them all with you, but Im sure I would bore you to death. So I thought I would highlight one thing that stood out each day for me.

Day one: In the afternoon we had a mother and her baby come in. Her baby boy was 17 days old, and he was just precious!!! On the patient sheet there was no name written down, so I asked what her baby´s name was, and she said he didn’t have a name yet. When I asked why she told me that she hadn’t found a name yet that she thought was really great for him. So Becky examined him, and he was completely healthy. The rash that mom was worried about was just infant acne, which we assured her would clear up soon. We prescribed some infant vitamins for him, and gave mom some vitamins too. And then I got to hold him!! When I took her to the pharmacy I told her that my husband and I really love the name Jeremy for a baby boy, and she seemed to like it too! She asked me to write it down for her, and then asked what middle name we thought went well with it! I personally like Jeremy Alexander, but I Spanish-ed it up a bit and said Jeremy Alejandro. I think she really liked the names! He was such a cute baby boy, and she was a really great, attentive mother! Im kind of excited to think that maybe I´ll go back with another group and see little baby Jeremy!!

Day two wasn’t as memorable. I woke up feeling a bit grumpy that day. I went out to bring in our first patient, and there were having trouble getting the two years olds weight. I told mom to get on the scale with her boy, and then I took him and they weighed her again ([Mom + baby] – [mom] = baby´s weight!), and it wasn´t until I took a good look at him that I realized he had a rash all over his face and hands. The rash turned out to be Scabies, which is incredibly contagious, and also incredibly itchy and painful (I had it last April). It wasn´t a great was to start of the day! The rest of the day seemed to fly by. We had a lot of chronic heart burns, another scabies case, elderly women with sores on their legs, etc. (Note: at the end of the week I took a scabies-prevention medicine, so I shouldn’t get scabies again!)

Wednesday, day 3 was the most memorable. In the early afternoon a women about 45 years old came in with her two grandchildren. Before we could even talk about what they needed she told me that he daughter was at home, and that she was very sick. She hadn´t slept in 5 days, and she was disoriented. She was also violent, and trying to run away. She asked if we could come to her home and see her. I double checked with our team leader, and once we had finished with the kids, we headed out. Becky and I went, plus Kim from the pharmacy, and Oscar, our bus driver. He is a very big man, and honestly, I was bringing him for protection. From what the mom had said about her being violent, I wasn´t sure how she would react to us coming into her house, better safe than sorry!

So, getting to her house was another story. When I asked the mom if she lived close by, she said “Aqui, no mas” which directly translated means “Here, no more” aka close by. I guess Nicaraguans idea of close is very different then the North American version. Because her house was 20 minutes away, and the hike was entirely uphill. We eventually went off the road and had to walk through the jungle to get to the house! Once we got there we could see that there was something seriously wrong with this woman. She is 20 years old, and they said that 10 days earlier she has become disoriented. She was so violent with the family that they had to tie her to the bed. She clearly was psychotic. She was talking about being cloned, and that the people in her house were not her family, but that she had been stolen from the sky, that they were torturing her, etc. We spoke to her mother and told her that we had to take her to the hospital. She couldn’t live the rest of her life tied to the bed, and she needed a psychiatric evaluation. After a lot of convincing, her mom finally said we could take her. So we said we would be back in an hour to pick her up, along with a family member, and we would take them to the hospital in Jinotega where she could be evaluated and medicated. By the time we got back to the clinic it had started raining, and we finished up with the rest of the patients, and then headed back to the house with a few of the men from the team, one of the clinic´s local doctor, and one nurse. We also brought some medicine along to sedate the woman, since she had been so violent before, we didn´t want to take any chances with a bus full of Gringos!! She was sedated, and then taken out of the house, and we brought her down to Jinotega, and checked her into the hospital. When she was checked in, and I got back on the bus I let out a big sigh of relief. We (hopefully) really helped that woman and her family. She will get the help she needs, and hopefully be able to live a relatively normal life if she is medicated!

Day 4 we say a 62 year old woman who didn´t know she had very advanced breast cancer. It had already spread to her lymph nodes, and Becky was worried that it could have already metastasized to her spine, because she was complaining of back pain, but without tests we had no way of knowing. It was very hard for me to have to tell someone that they have breast cancer. It was also harder because she didn´t seem to understand. She kept saying that he breast had gotten swollen before, and it was just because she had a cold, and that the doctor gave her some medicine to make it better. I explained over and over again that she had to go to the hospital in Jinotega for tests to find out if there was anything they could do, and we even had the local nurse write a referral to get her there for free, but honestly, I don´t know if she was really listening. She still left saying that there was a medicine she could take. That was a really hard one for me. I had to tell Becky that I needed to take a minute before we brought in the next patient.

Finally, day 5 was a half-day clinic, because in the afternoon we were heading back down to Managua. A woman came in with her three children, but only had a ticket for one of them (we have a one ticket, one patient rule, that is only broken in certain circumstances) so she was going to go out and wait in line so we could see her other two children. I asked her what was wrong with the other two, (her daughter had been sick and seemed anemic, and her baby boy, who has a heart murmur, has had a cough for a month) so we decided, since it was going to be such a short clinic day, to let them all see the doctor at the same time. Her baby boy who was 14 months old was listened to by our pediatrician, while mom explained that a few months ago he got sick and was admitted to the hospital, they told her that he had a heart murmur, and he had an EKG, and they suggested that she go to Managua for more tests, but they never told her how serious the murmur really was. When Tim or pediatrician listened to his heart and lungs, he said that there is a possibility that he is going into heart failure. It was really important that she get her son to the hospital, and get the documents that are necessary to take him to Managua to get the other tests that he needs. She took that very seriously, and said she would make plans to go to Managua as soon as possible.

That was my week! Friday afternoon we headed back to Managua with the team, went to the market, dropped them off at their hotel, and then finally, FINALLY headed home. I got home at 9pm, and spent a lot of time talking to David until we both fell asleep. Saturday morning I was up early again, re-packing, and at 8am Steph and I packed into the truck again to go pick up the next medical team from their hotel, and head right back up to Jinotega.

So here I am, on Sunday morning, FREEZING cold in Jinotega! We have another 4 days of clinics this week before we head back down to Managua on Friday. I miss my bed, and I miss my husband, but I know that this week we are going to see so many interesting cases, and really make a difference in people’s lives. Bonus: this Wednesday we are going to a community that has never, EVER, had a medical team come. It is going to be very rural, but very rewarding!

House update: Two weeks ago David´s brother, Chico, came out to build our dividing wall, so now we have a real bedroom with a door!! I took pictures, but I forgot my camera down in Managua. I will post the pictures next week. Also, this week David is bringing out an electrician to install our “Widow-maker” which is an electrical shower head that heats the water! I am so happy about having warm water…finally!!!

Thanks for reading, blessings!!
Julia