El Fin del Viaje

Looking out over the wing and seeing nothing but clouds and sunshine, I’m having a hard time processing the idea that I’m actually going home. Like home. I’m on my way home from Nicaragua, where I’ve been for the past two months. My mind is going, “Seriously?! Did I really do that? Because I know me, and I don’t think I’d do that.” I guess I’m still surprising myself.

I woke up at three this morning after less than two hours of sleep and made some French toast for breakfast. I think it’s pretty common near the end of a long trip to think, “This is the last time I’ll…” but I couldn’t help but laugh when I caught myself thinking, “This is the last time I’ll play ‘how many matches will it take to light the stove today?’” I ate at the kitchen table on my own, brushing those irritating little spider bugs off of it before I put my plate down. (I won’t miss those.)

Mauricio drove us to the airport in his taxi, which gave things a nice bookended feel because he drove me from the airport that first night. Just like then, it was pitch black and pouring rain. This time, though, the road was familiar (despite the disconcertingly heavy fog) and because I called shotgun, I was actually able to chat with him on the way there.  I wouldn’t say I’m fluent by any means, but hablo bastante – I can get by – and I’m really going to miss speaking it. I hope I can find a way to keep it up because feeling myself improve from simple words to actual conversations is a pretty cool feeling. That, and the better I got at conversing, the more positive my work experience became; I think the reverse is true, as well. Still, having to listen so hard to understand gets to be exhausting and while I can make myself understood in Spanish, living in English again is going to be refreshing. I miss being well-spoken!

I was up so late last night because I had to finish writing in the BaseCamp notebook, which is full of past volunteers’ personal accounts, words of advice and thank-yous. I was having trouble thinking of something to say, but it seems that the others who wrote before me were right – once you get writing, it’s actually kind of hard to stop! To sum it up, I said that it’s important to relax, explore and talk.

Somehow, John, Brett, Danielle and I were all on the same flight to Houston this morning. Brett and Danielle already had seats together; it occurred to John and me last night that we could change seats online so that we could be travel buddies, too! The flight was uneventful in general – left on time, arrived almost on time – but it was really nice to spend it with John. We talked a lot about how things will be different when we go home, and how things might have been had we done something else with this summer. John has done a lot of travelling with his family, so I think he’s used to thinking about where to go next; since the idea is new to me, it was really exciting to consider my next trip! In the past week, a lot of people have been asking me when I’m going to return to Nicaragua. My response has been that I’m not sure, but maybe when I’m a doctor. I’d really like to do more volunteer work when I have more skills and can offer more help. Recently, the idea of working in French-speaking Africa with my dad has been sprouting in the back of my mind. (Um, I think that’s news to you, Dad. You in?) I know that I’m definitely not done volunteering or travelling; if anything, this trip is just the beginning.

I learned a lot while I was here, both professionally and personally. I know I didn’t make much of a difference with my clinical work – I’m still pretty slow at IVs and I don’t know all the dilutions for all the injectable meds – but I think that in terms of health promotion, I had a positive impact. I feel good about my time here.

Things got a little tricky after we landed in Houston – John had a very tight connection that I think he may have missed, and I was “randomly selected” to have my checked bag searched. I don’t mind having my carry-on looked at in Security, but this was different. My checked bag was supposed to go straight through to Edmonton, but a Homeland Security agent took my passport and told me to sit and wait for my bag to come so that they could search it. It was a little scary because for a while, I was the only passenger in this big area with a bunch of armed agents. I really had to go to the washroom and when I asked, they had the only female agent escort me into the back, where I had to use the metal prison-style toilet in a holding cell. So that was an experience! I sat and waited on a bench for about an hour, watching almost two dozen people come through to have their checked baggage checked. Fun fact: not a single woman was chosen. When my bag hadn’t arrived after an hour, one of the agents gave me back my passport and told me to go get the Starbucks I’d been so excited for. Apparently they still had to search my bag but they’d make sure it got on the plane; now, I realize that I should have refused because I have the right to be there when they search it, but oh well. I wrote this en route to Edmonton, but thankfully everything arrived safely - including me.

Me Voy

I had initially intended to be in bed by now because Mauricio (the taxi driver) is going to pick us up at 4:00 AM. I had also intended to have blogged by now, obviously, but that hasn't happened. The past few days have been so crazy that I simply haven't had the time to sit down and reflect or write. I'm making time now, but it's probably way too late for my brain to be blogging so I can't make any promises about quality.

Today was a busy one. After spending a little bit of time in surgery and changing my 90 cordobas worth of change into usable bills, I went back to the hospital to say some goodbyes. I was sad to be leaving all of the new friends I've made in my past month at the hospital, but I have to admit that it was also really cool to realize just how many friends I have there! After saying goodbye to Ivania and Esperanza, I ran into David, Salvadora, Dina, Fatima, Dr Sandino... I'm so happy to have connected with so many staff here, and so grateful for the patience and warmth they've shown me. The same goes for the doctors and nurses at the clinic; I'm so lucky!

After saying a lot of adios-es, I did a little bit of walking around town because I'd meant to take some pictures of Jinotepe before leaving. I got a few important ones I'd been thinking of for a while, but then I got carried away and thought, "Oh, I need a photo of Palí! And the rum cake place! And the market!" Basically, I wanted to take a picture of everything that was important to me so that I don't forget it. News flash: that's impossible. This country and this community have so much to offer and there's no way I can represent it in photos. I'll just have to stick with the memories and the lessons I've learned. 

(Don't worry, I'll talk all about those lessons once I've slept a bit.)

The Good Life

First, lo siento for not blogging yesterday or Sunday. There were just so many things to say and so little time in which to choose what to talk about that I got overwhelmed and decided not to say anything at all. Now I'm regretting it because there's even more to share!

I've been struggling with my work at the clinic for a while because I feel like there's never anything productive to do. When the other volunteers who are here for an environmental conservation placement expressed similar feelings last night, it was like a light switch finally came on and I figured it out - maybe. I always knew that the pace of life here was a little different; we laugh about Nica time, for example, but it's a real thing. Ten o'clock never really means ten o'clock, "later" could be in five minutes or tomorrow, and there's no way to tell if the coffee shop is two kilometres down the road or forty-five minutes up a hill. For the first little while here, it was easy to think of Nicaraguan people as being chronically late, which made it really easy to get frustrated. Now, I'm understanding how nice it actually is.

Basically, my giant realization came to me today when I was bustling around at the clinic trying desperately to help with anything even though there was clearly nothing to be done. I poked my head into a room and found my doctor, a few nurses and another doctor just... chatting. My first impulse was to think, "Doesn't anybody have any work to do?!" but then I realized that actually, they didn't. There were no patients in the waiting room and they're so thorough with their charting between patients that there was no paperwork to do. I'd been so anxious about staying busy all this time (especially because I'm a volunteer and a lot of wonderful people supported this trip!) that I never really noticed what other people were doing; sometimes, it's nothing. The workplace is more of a slow-moving environment here, and "working" seems to mean "being at work," not "running around like a chicken with its head cut off." Nobody leaves early when there are no patients - because someone will occasionally wander in with a sore throat or a cut - but not everyone is on their feet all the time. So I finally said "Why not?" and sat down to shoot the breeze.

We had a particularly trilingual conversation about Spanish/English/French, talked about differences between Canada and Nicaragua, discussed possible names for my hair colour at length, compared health care systems and shared our favourite parts of the country. At one point, Dr Harold said, "Nicaragua is glorious! It's the good life!" and you know, he's right. Poverty is a huge issue here, health care is nothing like what we have at home and the charged political scene can make day-to-day life dangerous. Still, somehow, people here are resourceful, open and passionate. I've learned a lot in my time here, but I think that one of the most important things has been to slow down and actually experience the good life I have.

Granada, Take Two

When I started writing this blog post in my notebook, I was sitting in a gorgeous hotel courtyard in Granada that's home to a free museum all about chocolate! I sat at my table with a delicious cacao frio while a toucan whispered beside me and I almost laughed out loud at how happy I am.

It wasn't the first time I'd had that feeling today. Jose and the other volunteers are hiking Mombacho today, so I decided to tag along for the minibus ride and carry on to Granada on my own. I'm meeting them at our hostel later this evening. The last time I was here in Granada, we hardly got to experience it because we spent the morning getting drenched near Mombacho, leaving us only a couple hours here. I had been thinking about going back to Léon this weekend, but I'm really glad that I'm getting the chance to see Granada properly. Doing it all by myself has been an adventure!

There's a lot to see in Granada within a few blocks of the central square, but I decided to start with La Iglesia La Merced because of its bell tower. From the top, I had a breathtaking view of the city, the volcano, the cathedral and the enormous lake. I love the courtyard gardens in typical colonial houses, and it was really cool to see them as little green spaces among the red tile roofs. The people at the church entrance were very weloming and I asked one of them to take a photo of me at the top as proof that I was actually here! On the way up the 75 steps (it feels like way more) he told me that the church was originally built in the 1700s but that, like everything else in town, it was rebuilt several times after that because of damage from fires and pirates. After La Merced, I headed down the street to La Iglesia Xalteva and then back up to to La Casa de Santa Maria Romero, Central America's first saint. She did a lot of work with health care in Nicaragua and Costa Rica; there wasn't a lot of biographical information in the little museum, though, so I'd like to find out a little more on my own.

From the little green house, I headed northeast to La Iglesia San Francisco. The church itself doesn't look like much because it hasn't been kept up like the brilliant yellow cathedral, but the attached monastery/convent has been turned into an incredible (and incredibly free) museum. It has a historical mural, religious icons, 1500-year-old artefacts from archaeological digs and an art gallery! My favourite part - though it's hard to choose - was the wildly detailed scale model of Granada's historical center. It was pretty cool to be able to pick out the churches and the parks where I had just been walking.

Actually, it's been pretty cool to be able to pick things out in real life, too. I'm not exactly well-known for having an excellent sense of direction, so I get a rather substantial sense of pride every time I find my way to something on the first try, or come up with a better way to get there on the second. Improvised navigation isn't very difficult in colonial towns like Granada and Leon, though, because of the central park and all of the churches. When in doubt, it's easy to look up past the one- and two-story buildings and orient oneself using the church towers.

So today, I visited three churches and three museums, met two toucans and walked for about six hours. I'm glad to finally be at Hostal Mochillas, which I had Jose book us into on Thursday. It's big, colourful and full of growing things. I think we'll meet a lot of cool people here.

Jose, Brett, Danielle and Amos should be here any minute now, but Nica time being what it is, I could be waiting here a while. I imagine we'll get some showers, then do some wandering around and get some supper. Tomorrow, we're doing a boat tour on the lake - we might see monkeys!

Oh, I should mention that Brianne might actually be back in Canada now after her 24-hour journey home. It was strange to not have her in our room when I got back from placement last night, but I'll be seeing her in just over a month when she brings me our travelling necklace!

Despite not having Brianne there, I had a good time last night - John and I had dinner at Friends and then went to Diriamba for karaoke with some people he knows from the clinic there. Jose was right - Nica men take their love songs very seriously! I'd never done karaoke before, but I'd say it was a great way to start off my last weekend in the country. There are only six more sleeps until I go home!

Where Everybody Knows Your Name*

When I walk past the pulperia just north of BaseCamp, there are always a few boys hanging out in the steet who yell "¡Estefanie! Hello, ¡Estefanie!" If I go into the pulperia, the muchacho there always has a 1.5 L of Fuenta Pura water and a strawberry candy ready for me.

Further up the hill on my way to the clinic, I walk past the estación de bomberos. There are usually a few guys - and a puppy or two - who'll wave from their perches on the trucks. I see them all around town as well, though. We ran into Oscar and Chino twice on Sunday, actually, while they were out collections donations for the cuerpo de bomberos. It just occurred to me that we could see what they're up to tomorrow and hang out once more before John leaves for San Juan!

When I actually get to the clinic, there are people there I know, too. (Inorite?) I don't usually see much of Roxana and Elio outside the centro de salud, but I see Cristhian at the hospital now and then. I know most of the nurses in emerge and shock and we have a lot of fun together. The language barrier actually makes things a lot funnier most of the time! I sad to be leaving so many wonderful people behind so soon - but glad that they have Facebook so that we can keep in touch.

Still, I think what I like best is walking around and recognizing people - nurses from the hospital, patients from the clinic, students from the school. The other day, the Mother Superior from the colegio came to visit a patient at the hospital and she recognized me in emerge. Still, I think my favourite encounter so far happened today, when the lady who helps me cash my traveller's cheques waved to me in the market:)

It's way too late for full paragraphs and transition sentences, though, so I'll hit you with some point-form facts:
- Santiago is Saint James. What?!
- Brianne and I bought a beautiful necklace that Eve made and we're going to share it.
- There has been no water in the house for nine hours now.
- I saw one of the patients from Tuesday's accident in the OR today. Roxana's brother was assisting!
- Roxana dictated a referral today and let me write it! We were actually busy in the clinic and it was wonderful.

- Brianne's leaving tomorrow:(

*Cheesy, I know. Sorry.

Cake, Coffee, Creativity

Yesterday was not an especially eventful day, but the evening was busy enough that I didn't have time to blog about it. After placement, Brianne and I went to the supermarket to pick up a few edible souvenirs (I want to bring the whole store home!) and some supplies for John's birthday cake. It's his 21st today, so we'd planned to make a chocolate cake while he was at the hospital last night and hide it in our room until this evening. I was especially excited because Brianne said we could make it with a box of cake mix and a can of pop. Who knew?! Unfortunately, the oven shut off about five minutes into the baking process because the gas tank was empty. We weren't sure how long the cake mix + coke chemistry would last, so we buttered half a dozen mugs and made miniature cakes in the microwave! We had a lot of fun making them and were pretty surprised when the experiment actually turned out well.

Once everyone had had cake, I headed down to maternity with Brianne. My luck was just as good as last time - a delivery had just begun! Unlike last time, though, things were a little tense. One of the residents was on call, but by the time the baby was born, he and his supervisor had called in two other OB/GYNs. It wasn't that anything particularly dramatic was happening - rather that nothing was. The woman, who was incredibly small, just couldn't seem to push hard enough. (I'm sorry, I'm trying not to be too descriptive.) Brianne even heard the doctor mutter, "She should have had a c-section" partway through. I think that's what would have happened at home given the size of her pelvis. Still, despite the tension, the near-silent labour and the very necessary episiotomy, everyone was okay in the end.

This morning, I took one set of vitals, then spent four solid hours doing arts and crafts. (Sigh.) Roxana, Elio and I worked hard on our lactancia materna display and I have to say that it's going to be pretty sweet. While I wish I could be doing more medical work in the clinic, there are seriously days where nobody comes in after 9:30 AM. There isn't much I can do about that, so I might as well make myself useful in other ways.

Having no patients means being able to talk with the residents more, which I'm really enjoying. We laugh a lot! They're really kind and generous, too, which seems to be a trend among Nicaraguans. At the clinic, doctors, nurses and techs always seem to have candies in their pockets or purses that they share with whoever's in the room. In the past week, people have given me homemade candy, helado de coco (coconut ice cream in a bag), churros... It's really something! Today, I made sure I bought some churros when the vendor came to the clinic so that I could share them.

In the hospital this afternoon, I gave more injections and started more IVs. I know a lot of nurses in emerge now and it's strange to realize that I kind of know what I'm doing now! Most of the IV meds come in these little glass ampoules with a blue dot on them. To open them, you have to flick the dot and then just break the top off; it's best if you hold the top in a cloth when you do it to avoid any accidents. Luckily, my only vial-induced injuries have bruises under my index fingernail... until today. The cut on my finger is shallow, but the gauze around it is cumbersome enough that I had to switch to manual labour partway through the afternoon. Carlos and I moved boxes of IV bags and I hung around in x-ray waiting for a particularly inebriated patient I didn't want to leave alone. Later, Carlos had me start one more IV before I left (I'm getting better!) and then I headed home with a delicious 4-cordoba coffee from the canteen.

I'm going to need another one tomorrow morning, I think, because I really haven't been sleeping very well. Friday, Saturday and Sunday, I had crazy dreams about tiny spider bugs crawling all over me. The past few nights, I've been dreaming that patients have been in our room, waking us up and asking for help. I'm pretty sure that I've actually been sitting up in bed, thinking that there's a person there and then waking up just enough to realize that it's actually the fan. I thought ditching my mosquito net would make for better sleeps, but apparently not.

I Feel Useful!

Today was a crazy day – I wasn’t bored for a second! We started with our first morning run since Jason left on Friday. It really wasn’t the same without him, but we promised that we’d keep it up. I lucked out when I got to the clinic at eight because Dr Harold’s door was open and none of the residents had arrived yet, so I got to go in and get started with him right away. We saw a lot of patients and I got to help quite a bit! I was only weighing, measuring and vital-signing for the most part, but I didn’t mind as much today because I feel like I’m getting closer to doing more. They seem to do mostly consults at the clinic, but I think I could do one of the basic ones – like the newborn checkup or the family planning visit – on my own now. Maybe next time I’ll get to do the paperwork!

Dr. Harold does spend a lot of time filling out forms and taking notes, but we also got a few more hands-on cases today. An older man came in to have his sonda Foley changed; I’d seen it done in emerge so I was able to gather the supplies we needed. Later, a woman came in for a check-up after having a c-section earlier this month. I got to hold her baby while Elio took her blood pressure, and then Roxana let me take the stitches out! It was a slightly more involved process than when I pulled my own stitches out of my pinkie toe a few summers ago, but the basic principle was the same. I was surprised by how large the incision was, both in terms of width and length. It was vertical, too, which seems to be a trend here.

Afterward, Roxana, Elio and another resident started asking my opinion on a big display they were planning about breastfeeding. Once I figured out what they were asking, I tossed out a couple of ideas and they seemed to like them. I was a little way at the first mention of a mural because I didn’t want to spend more time and money making posters at home in the evenings, but I’m looking forward to collaborating with the others on this particular project.

When I got to the hospital after lunch, I couldn’t believe how packed it was. There asn’t a free chair in the waiting room or a free bed in observation. I poked my head into Shock and saw three people transferring a woman from a gurney to a bed. She had an obviously broken jaw, lacerations on her arms and what looked like a broken ankle. The sheet she was on was really bloody, so I imagine she had some injuries to her abdomen as well. She, as well as the guy next to her, looked like they’d been in a car accident. John mentioned later that he’d heard something about a minibus collision; apparently the guy with cuts all over his face and hair matted down with blood was actually lucky because others had died at the scene. This was the first time I’d seen actual trauma patients at the hospital and while it was interesting (Jason would have jumped right in!) I couldn’t see a way to help without being totally in the way so I carried on to Clasificación. There were a few more traumas today, though, including a 20-something man who came in shirtless, handcuffed and drenched in blood. When I accompanied a patient to Observation later, there were a few police officers speaking to one of the patients there who must have been involved.

I stayed away from those dramatic cases, but I still had an eventful day in my usual section of emerge. I generally work with Esperanza and Carlos, but today there were two familiar nurses whose names I didn’t know. Luckily, one of them (Lilian, John later informed me) had seen me working with Carlos in Shock and knew what I could do. I spent three and a half hours taking vitals, running patients to Observation, giving injections, prepping meds aaaaand starting IVs! I still won’t do one unsupervised, but Lilian watched me to six today and I only missed one! They’re still a little spilly, but I’m working on it. I feel really good about my work today.

Into The Wild

Last night, I slept in the jungle!

Brianne and I set our for El Chocoyero - El Brujo wildlife reserve just before nine yesterday morning, our bags packed with sweet bread, peanut butter and bananas. We'd read a little bit about the reserve and knew that once we got there, we'd be able to rent a tent for the evening. We were excited to see parakeets, monkeys and a waterfall!

The biggest challenge, it seemed, was getting there. We thought we'd be able to walk the 8 km from the highway, but a quick chat with Leo on Friday night (he used to do Jose's job) revealed that such a walk would be more than a little risky for a couple of gringas by themselves. We asked Jose to ask someone from the park meet us at 9:30, but he told the guy to meet us at 8:30. Luckily, he was still waiting when the World's Slowest Minibus dropped us off on the side of the highway at 10:30. We took a tuk-tuk to the park office and it became clear only a few minutes in that this was a very good idea. While we were thrilled to be seeing lush green countryside, fields of pineapples and the occasional dragonfruit plant, we also saw at least half a dozen people walking along the muddy path with machetes. We were glad to have the guide's company!

Once we arrived at the office, we had lunch (bean dip and tortillas) and started exploring the park. Chocoyero is home to a plethora of different plant and animal species, but it's most famous for its namesake, the chocoyo. There are apparently only two places in Nicaragua when you can see these brilliant green parakeets:  in Chocoyero reserve and around the craters on el Volcán Masaya. There are several hundred that live in little holes in a giant rock face next to Chocoyero waterfall, which provides drinking water for nearby communities. When we first went out hiking along the most difficult of the three trails, we couldn't see much of the birds until our guide pointed to some little green blobs; his binoculars revealed that there were in fact couples of little green birds in a lot of the holes. During the walk, he also pointed out a few other birds, a ton of butterflies, some cool lizards, a big squirrel and a toucan! Unfortunately, none of these things were willing to sit still enough or close enough to us to allow me to get a very good photo. The trees, however, were very photogenic.

We were really hoping to see monkeys while we were in the park, but we were told that they stay higher up during the winter. This didn't stop us from hearing them, though! When we went back out to the waterfall after a nice break in the camping area, we were more than a little creeped out by the distant whooping sounds of the howler monkeys. That being said, it made us feel like we were really in the jungle!

It was important to be back at the waterfall by four-thirty so that we could see the parakeets come home to roost for the evening. They arrived right on time! Again, they were too speedy for photos, but it was really neat to sit near the waterfall and watch all these bright green birds zip down to their own little birdie condominiums. Honestly, parakeets don't seem (to me) like birds that actually exist in the wild. Seeing them flying around reminded me a lot of the first time I saw a hedgehog in the wild; kind of like, "Wait, don't you live exclusively in pet shops?" Once all the birds had arrived, hidden perfectly in their little holes, it certainly sounded like a pet shop. A few hundred screeching parakeets can make a lot of noise!

After the second trip out to the waterfall, I'm really not sure what Brianne and I did other than talk. We enjoyed a delicious dinner of peanut butter, bananas and tortillas, which was kind of a big deal because I hadn't had peanut butter since I left home! (I've also eaten exactly one apple in the past six weeks, by the way.) Our tent had been set up for us while we were gone, but since it had no fly and it was going to rain that night, the park ranger set it up under a roof instead of in the camping area. We couldn't help but laugh when we saw it - they had even put foamies and sheets inside for us! It was quite the contrast from what we'd been expecting, but I also think it was the perfect middle ground - close to the jungle but not really in it; left to our own devices but within earshot of a park ranger. Still, we used one of my little backpack locks on the tent door because we couldn't decide if we were more scared of snakes, tigrillos, bugs or the park rangers themselves.

Still, despite chloroquine-induced dreams about being covered in bugs and the loudest rainstorm I've ever heard, we got some sleep and woke up at six, ready to go. We hiked out to the waterfall again and ate our breakfast in the company of more parakeets. We'd secretly hoped that our last two bananas would bring out some monkeys (apparently they'll mug you for your bananas!) but no dice. The trail felt even more Jungle Book-y this morning, though. Everything was especially green and shiny because of the recent rain, the path was muddy and a beautiful mist hung in the air over everything. Looking out at some parts of the forest, I really expected to see monkeys or ocelots or something crazy coming out of them. Alas, we were left with lizards and butterflies, which were still pretty special.

When we were ready to leave, we ran into a few communication difficulties and a very brief moment of panic; the road was very muddy and it seemed unlikely that a tuk-tuk would make it all the way to the office. (We realized then what the driver meant on Saturday when he asked if it was one-way or not.) After a lot of, "No entendemos...¿Otra vez?" we finally got the point across that we'd walk the eight kilometres, just not on our own. The lady kindly sent a 14-year-old muchachito with us to keep the bad guys away, and we ran into a tuk-tuk after only 45 minutes of trudging through the muck. Once up at the highway, we bought two giant pineapples and stood to wait for a minibus, marvelling at our good fortune. The weekend was such a success that when John slept through the doorbell and we had to wait outside the house in the scorching sun for two hours, we weren't even that upset. (It's amazing, actually, that we managed to kill those two hours just sitting there. I'm finally getting the hang of it!)

Brianne just booked her trip home for this Friday and while I'll be sad to see her go, I'm really glad we chose this trip for her last weekend. I think that camping in general is always a nice way to escape and remember to appreciate different things in life - amazing things like waterfalls and jungles, but also simple things like peanut butter sandwiches and friendship.

Photo is Unrelated

I don’t have any photos from placement, but since that’s what I’d like to talk about, the photos in this post have nothing to do with the words beside them.

Yesterday got off to a bit of a rough start; during our morning jog, I tripped on a particularly terrible piece of sidewalk and biffed hard, resulting in some pretty annoying road rash. This is the first time I’ve used the rubbing alcohol and Fucidin in my first aid kit for me, though, which is kind of impressive given my track record for clumsiness. (Nothing like dear Rae, though. Go read her blog after this. She’s funny.)

After the disastrous run, Jason left for Haiti and I left for the clinic. I was vitals girl again, and did a lot of weighing people. I did get to talk to one woman about eating more healthily, which was really important because her BMI was 38; she really needs to make some lifestyle changes. She said that she knew she should be eating toast instead of soft bread (what?) so I talked to her about whole wheat bread instead of sweet bread. It’s definitely interesting to see the kind of things people think about nutrition. While it can be discouraging when their ideas are myths that won’t help at all, it shows that they do care about it. She seemed ready to make a difference but just wasn’t clear on what to change.

My experience at the clinic so far has been very different from John and Brianne’s. I’m beginning to think that I simply won’t get very much hands-on experience there – with paps smears, breast exams and prenatals – for two reasons. First, the place is full of residents who want to get that hands-on experience too and second, the doctor just doesn’t seem to do them there! Brianne suggested that I see if there’s a nurse somewhere who’s doing all these exams. We’ll see.

That being said, I think my time at the clinic will still be well spent. First, I feel like I can make a bit of a difference with health education; the poster is still being read and I can throw in my two cents whenever nutrition is mentioned in a consult. In terms of a less medical experience, I’m starting to get to know the interns/residents/doctors better. One of them, Roxana, invited me to go over to her place sometime, which I think will be really cool. Elio, another resident I spend a lot of time with in the clinic, says he has a farm with fruit trees and animals that I can go see! It’s so near to have friends here – doctors, nurses, firefighters, store owners, waiters, schoolchildren… I’ve said it before, but I like feeling like I really live here.

Another clinic things I’m excited about just started yesterday. Because the patients suddenly stop coming at about 10 AM, I was looking around for something to do when I noticed that the door to Fisioterapía was open. What luck! I snuck in and met Luisa, a lady who instantly seems kind, gentle and sincere. I really enjoyed talking to her – she had no patients at the time – about the kind of work she does. She said that she usually works with babies and younger children with developmental difficulties, but we spent the better part of twenty minutes talking about a nine-year-old patient of hers with Duchenne muscular dystrophy. This woman really cares about the work she does; the one book she had that mentions Duchenne is highlighted, dog-eared and very well-read. Still, she said a few times that she’d like to know more. Since she doesn’t really have computer access or skills, I said I’d see what I could find and bring her some useful information next week. I think that working her after the clinic has died down could be really cool – we’ll each learn from each other, and hopefully a few boys with Duchenne will benefit.

That’s it for the clinic right now. I’m also really enjoying my time working in the emergency department. Carlos and Esperanza have been really great to me and I’m getting to do a lot of injections. I can mix meds and prepare IVs no problem now, and they let me give IV meds once they’ve done the canalisar part. I started one with some help last week, but I want to be doing them in my own by the time I leave. I think I’ll get there.

I wish I had time to say more, but there’s always too much to talk about! Here are some other important details:

- I’m planning to keep spending time in maternity and the OR, too.

- We got three new volunteers yesterday.

- Brianne and I are going camping today!

- My cousin Carly is getting married today. Congrats, Carly and Shaun!

When We Get Home

I've had this post in mind for a while now and I think today is a good day to post it because Jason is leaving in the morning. He was originally going to go straight to Disney World when he got back, but he's changed his plans and is going to help with relief efforts in Haiti instead. The man never stops!
Anyway, the other volunteers and I all know that we're going to be a little different when we get home; we've learned a lot and grown a lot and we've lived a lot! Mushy things aside, though (for today), there are a lot of strange things that will have changed. Since our first week here, we've been compiling a list of sorts about these things. Here's a selection:


When we get home...


We’re going to make a lot of people uncomfortable with our new ideas about personal space. (As in, "What personal space?")

We’re going to have low self-esteem because nobody will be calling us beautiful in the streets.

We’ll try to buy rum at the grocery store, and when we finally get to the liquor store, we’ll realize we thought we could buy a mickey with a toonie.

We’re going to look like weirdos while we eat our food because we’ll be absent-mindedly waving away the flies.

We’ll go into rice withdrawal.

We’ll never know which bus to take because nobody will be yelling its destination at us.

We’ll have a hard time responding to the correct pronunciation of our names; “gringa,” “chelita” and “Estefanie” are much more effective.

We’ll say things like, “I’ll meet you at four and if I’m not there, wait at my house,” only to remember that we have these things called phones that make planning a lot easier.

We'll be ready for bed at nine pm, but we won't be able to sleep while the sun's still up.

We'll go to the pharmacy with no money, expecting to get medicine for free.

We'll drive people on campus crazy with our newly-acquired ability to saunter.

We'll burn ourselves a few times before remembering that in Canada, you can actually get hot water out of the hot water tap.

We’ll walk around with enormous wads of cash because we’ve forgotten about the existence of debit cards.

We'll (hopefully) have no trouble losing the weight we've (I've) gained because in Canada, sweet bread creations aren't nearly as cheap, available or delicious.

We'll really miss this place.

Today...

I saw somebody be born!

I watched a hysterectomy, too, which was also really cool.

Putting the experience into words is difficult, and rambling on about the twelve boring hours in between the two events would just take away from how amazing they were, so I won't bother with a long post today. Maybe tomorrow I'll do something blogworthy.

But still. Somebody was born and I saw it!

Patients is a Virtue

Yesterday, I was feeling a little down because Brianne got to witness the miracle of life and I spent my afternoon buying vegetables, but I'm feeling a little bit better about that now.

Before I shopped, though, and before Brianne watched the delivery, we taught our last batch of students at the school. We did the first few lessons together and I did the last one on my own so she could go wait for a baby. The last class was a great way to end the teaching experience - they were an attentive, energetic, intelligent group of grade sixes who really engaged in the lessons. Jose's sister was among them, too! Afterward, I met with the director and Mother Superior for a few thank-yous. Jose kindly took a few photos, but Brianne took my favourite one of the day: here's me with just a few of my 700 new friends.

I spent the afternoon and evening doing the homework my doctor at the clinic assigned me: make a salad, some handouts and a presentation to complement the poster I made last week. It was a lot of work and I had to spend some of my hard-raised money on ingredients and supplies, but it actually over really well this morning! I made a bunch of handouts (by hand, PS) outlining the principles of eating heart-healthy and gave at least two dozen patients a scoop of greek salad. (Thanks for the suggestion, Mumbly!) The best part was when one patient looked at her handout and said to the woman beside her, "Oh, that's bad?" I think that our subsequent discussion about margarine could change her diet even a little bit, which is really all I can ask for.

I decided last week that I'd go to the clinic in the mornings instead of the afternoon, which was definitely a good choice. There were patients today! Between the clinic and the hospital - where a wonderful nurse named Carlos has taken it upon himself to teach me anything I want to learn - I worked with at least half a dozen pregnant women and one lady whose little girl was born last week. While there were a lot of frustrating moments today, one highlight was holding that teeny, tiny, six-day old bundle of warmth. That was pretty great.

There were other consults that were less heartwarming, though. Our first expecting mother is 15 years old and five months pregnant; her mother, who was there today, only figured this out yesterday. I couldn't understand everything that was said, but her tears, the look on her mother's face and the doctor's head-shaking were clear enough. I was really grateful that when we went to go get her a vaccine, the tech administering it took the time to ask her how she was and see if she'd talked to anyone.

Some of the questions on the pregnancy form kind of took me off guard. The usual questions like "number of pregnancies" were there, but there were also sections for the number of children who had died, and whether this had happened before or after seven days of age. Under that section were questions about the patient's house - running water? dirt floor? toilet? The form was just yet another reminder that even though the places we hang around in Jinotepe are a little run-down, there's a whole other world on the edges of town. I'm beginning to think that I won't ever stop being surprised by the stark divide here.

This was especially evident with the patient who came in after the first. Her consult went very well: she's 25, this pregnancy (her fourth) was planned and she came in even though she's only six weeks along.The surprise came when she had to sign a form at the end of the consult and she simply said she couldn't because she didn't know how to write.

I hate to be so sombre today because most of the consults and things I saw in the hospital went very smoothly, but I have to mention one of the girls I saw this afternoon. I was in the shock room (the rest of emerge closes at three), which has a gynaecology suite attached to it. Once in a while, the OB/GYN would motion for me to come watch, if only to have another person in the room. One girl, who couldn't have been more than seventeen, had miscarried. Then, more than ever, I wished I had enough Spanish to do more than stand beside her and rub her shoulder while her partner just stood there with his hands in his pockets, staring at her blood on the floor.

So the communication frustration continues. Because I can speak much more than I can understand, following instructions is kind of hard. I recognize a lot of words but don't always understand their relationship to one another. Today, for example, Dr. Harold said something about determining gestational age without the date of the last menstrual period or an ultrasound. Unfortunately, I looked like an idiot for a while because I didn't know if he was asking me to tell him how, asking if I knew how, or offering to explain. As it turns out, he was going to give me the name of a rule to look up, which I didn't understand until he waved me over to his desk.

That in itself is a much greater challenge than it should be. People often say that body language is universal, but they're wrong. (Sorry.) In Nicaragua, people don't indicate nearby objects by pointing or, when their hands are busy, nodding their heads toward said object. Instead, they purse their lips in its general direction. You may be able to imagine how confusing this can be when, say, you ask a doctor where something is and he basically blows a kiss to some place just past your ear.

The other body language issue is even more confusing, especially in the hospital. I don't always immediately understand that someone wants me to follow them, so they motion with their hand. That's cool and all, but the Nica gesture for "come here" looks more like "bye-bye" or even "shoo!" As a result, I spend a lot of time on one side of recently closed doors, wondering if I was supposed to go through them.

It's pretty frustrating - standing around like a stupid deer caught in headlights, asking patients to wait just one more minute as I try to take their pressure again, pathetically saying "Lo siento, no entiendo" all the time - but I'm here to learn and I might as well learn to be patient with myself while I'm at it.

Where Two or Three Are Gathered

During my crazy cab ride home from the airport over five weeks ago, Jose said that most people here are Catholic and that there was a really cool church outside of Jinotepe where the mass was really energetic and the priests danced. The idea appealed to me immediately - why not? - but we hadn't really gotten a chance to go until this weekend. I'm so glad we did!

Jose's dad pulled up in a red pickup at five to ten yesterday morning and we jumped in the back. Brianne and I had been worrying about what to wear - her only pants are jeans and I don't even have pants here - but we shouldn't have. While Jose's mom was well made up and wearing a shiny gold blouse, everyone was wearing jeans.

It sounds silly, but even the journey to church was an experience! The road we were planning to take was closed, so we took a very roundabout route through the jungle on a dirt road. I'm really going to miss riding in the back of pickup trucks, to be honest. There's something about speeding down that crazy road with half a dozen people we picked up on the way and getting hit in the face with tropical plants that makes me feel... free.

Once we got to the church - basically a giant outdoor picnic shelter - the mass was already in full swing. There were at least a hundred people dancing and singing to marimba and guitar music. As soon as we hopped out of the truck, Jose's mom took us by the hands and dragged us into the mob, where she jumped, sang, shouted, translated and danced. It was wild! We were right beside a group of youth in grey polos who were eager to show us their dance moves.

After at least 15 minutes, of marimba fiesta, we pulled pup some of the plastic patio chairs and listened as  one of the priests started things off by announcing some birthdays. A particularly cute altar server - the littles one - even got to stand up shyly in front of everyone as they clapped for him. This was followed by congratulatory applause for Jose's parents' wedding anniversary, as well as a shout-out to Brianne, John and me.

We were given a bulletin to follow along with, so the mass wasn't too foreign for the sitting-down part. there were a reading that seemed vaguely familiar, and one I knew about Jesus walking on water. The sermon/homily, however, wasn't quite like anything I've seen before, either in Catholic churches or United ones. The priest who spoke spoke with so much energy! Jose and his mom translated for John and Brianne, but I understood a lot even though I didn't have a Nica interpreter in my ear. A lot of it was about fear and love - but there was a lot of laughter, too! The father said that people without fear are "Loco. Loco! LOCO!" and something about a girl needing to use butter to get her shorts on. (Not a girl there. An imaginary one. There was a lesson involved.) He sang a made-up song and danced, too. At one point, he had the group chanting "Last hour! Last hour! Last hour!" to wake us up and encourage us to keep listening until the end. I was all, ears, though - it was so cool!

I'll admit that I was getting a little tired by the time communion rolled around, especially because Jose and I had to wait it out. (I'm not Catholic and his son was born out of wedlock.) Still, I enjoyed the time I spent waiting in the sun, listening to the upbeat communion music while children played all over the place. It really made me think of "Where two or three are gathered in my name, I am there." That picnic shelter at the end of the muddy road with the electric guitars and families in flip-flops had one of the most meaningful services I've ever been to. My moment of reflection didn't last long, though, because afterwards, the party started in earnest.

The Nicaraguans' innate dancing ability has been cause for frustration and wonder for some time now, but the mystery has finally been solved: they learn at church. Toddlers, teenagers, seniors - everybody danced! Hip-shaking and all! A couple of songs in, the priests descended into what could almost be described as a mosh pit to have their own moments in the spotlight. The energy was just really incredible: smiles all around, super catchy hymns and killer dance moves. All of the hymns had actions that we picked up quickly from the people around us; because some of them involved hugging, rib-poking and trying to stomp on peoples' feet, I felt a sense of community preeeeetty quickly. I think that if church were like this at home, a lot more people would go!

This is the Minibus

I don't have anything too exciting to report from today, but I've been meaning to tell you all about transportation here for a while. Therefore, I give you: the minibus.

The minibus is the most common form of public transportation here in Nicaragua. You may not believe it after reading this post, but they’re surprisingly efficient! Here’s how they work:

The first step in any minibus journey is picking the bus. When you round the corner to the bus station, people will start trying to pick it for you: “Masayamasayamasayaaaa!” “Rivas! Rivas! Rivas!” “Diriambadiriambadiriambaaaa!” “CatarinaMasatepeCatarinaMasatepe!” The men – and a lot of boys – yell in your general direction as if you came to the bus station with no particular goal in mind, ready to jump on the bus whose representative has the most convincing screech.

Anyway, you ignore them and walk past the school buses toward the fifteen-passenger vans. You’re hoping for a shiny silver one with a high ceiling and your destination city printed neatly on the front, but more often than not there’s an empty space where you think your bus should be. You sigh because now you have to pay attention to the people yelling destinations. Somehow, they know this as soon as you do and start speaking directly to you, more urgently than before but thankfully not yelling: “Rivas?” they say. (Or Masatepe, or Diriamba, or Managua.) When you’ve only just started to nod, there’s a wave and a whistle; suddenly, your minibus has been summoned from the gravel lot and pulls right up in front of you, ready to go.

Ha. If you’re lucky, it’s one of the shiny ones, but that’s unlikely. Many of the minibuses – except the Managua ones – are roughly 25 years old and consist of more rust than they do anything else. The upholstery is holey, of course, the bumpers hang off, most have speedometers that died long ago and there are things growing in the window sills. Still, if you’re the first ones there, you get to pick your seats. (Like I said before, pick the back seat so that you don’t have to share sweat with strangers.) Once inside, you can settle into the heavy, stale heat to wait.

And wait.

In Canada, buses run on schedules. In Nicaragua, buses run based on how much money the driver is going to make out of the trip. This means that while it’s exciting to get there first and pick the best seat, it’s also frustrating because the bus doesn’t leave until it’s full.

Let’s talk about “full.” First, fill the bus so that there is one person on every seat. (Oh wait, did you try to put on a seat belt? How quaint. There are none.) Some buses have an extra seat that folds out into the little aisle while others have rickety wooden stools that they set down for unfortunate latecomers. Once every seat is taken, it's time to get creative! There are two people required to run a minibus: one to drive and one to take money, hang out the door yelling, and play human Tetris. This second person will poke, prod and push you until you're squished up against a person you've never met in a position you never thought was possible. Don't believe me? When this photo was taken, I was sitting backwards on a little bench with my knees between someone else's; John was sitting on my lap.

So once you think the Tetris is finally done (just wait), the minibus will pull out and you may think to yourself, "This bus is going to fall apart before we get to the highway." It may sound that way, but so far this hasn't happened to us! Once the bus is properly filled up, the ride itself is rather uneventful, generally because people are too squished together to actually move. Once in a while, the bus will pull over and there will be an almost imperceptible collective groan as people wonder - and Jason yells - "How?! How do you think you're going to fit any more people on this bus?!" Still, that door man has skills and he'll make it happen.

Partway through the sticky, stinky, sweaty journey, said door guy will ask for everybody's money, which is a challenge in some cases because when you're crammed into such a small place, it can be difficult to get to your pocket. Still, it's at this moment that taking the minibus becomes worth it: it's hard to say no to paying two dollars for a two-hour trip!

Dilemmas

Today - like yesterday and the day before - was a full day. I think it's safe to assume from here on in that my day was busy unless I say otherwise!

Today was also a day of dilemmas, the first of which came up when we left the grade ten classroom this morning and Brianne said, "You rocked that!" Because she has bronchitis (Jason is sick, too) and wasn't feeling well enough to do much, I taught most of the lesson on my own. It was a challenge that we were a little worried about because teaching high school has a lot to do with being confident and funny, which is a tall order if you don't really speak the language. Luckily, not speaking Spanish perfectly was humorous enough in itself that they actually seemed engaged! I'm really proud of us for taking on this challenge. The dilemma, of course, is "But what if I want to teach?" I've been struggling with the choice between education and medicine for years now, and just when I was really sure that medicine was without a doubt the next step in my life, I rediscover teaching. Being with the students - the cute Blob Tag ones and the older ones, too - is so energizing and fulfilling!

That being said, being in the hospital is pretty wild, too. I love all things medicine; hence the dilemma. Today, I took more blood pressures (I still suck at that), gave a bunch of IM injections, set up some IVs, passed someone gauze as she cleaned out a gaping thoracic incision, gave some IV meds, helped put on a cast... Oh, and started an IV! I'm kind of sad that I won't be back in the hospital until Tuesday because I want to keep practicing. I met a lot of doctors and nurses today who were willing to teach me and let me try things, so I'm really excited about that. In some ways, that also helps soothe the dilemma because I know that there are a lot of opportunities for doctors to teach, too.

The day's second dilemma is going to be an ongoing thing, I think. My placement is technically Santiago Hospital in general, so I can be anywhere I'd like to be. The lab was interesting for a while, but I'd prefer to work with patients so I probably won't go back there unless there's nothing to do. Surprisingly enough, this happens quite often! There are an absurd number of holidays around here this time of the year, which means that the hospital isn't always operating at full capacity. A lot of people left early today because Monday is Health Professionals Day and there was some kind of party this afternoon. In other parts of the hospital - like maternity, where Brianne and I hung out this morning - there was simply nothing going on. So the dilemma is: Where do I go? Maternity and shock can sometimes involve a lot of waiting around, and I feel bad for sitting when there could be someone I could help in another part of the hospital. When I leave to look for something to do, though, I feel bad for abandoning whoever I was working with - they might need me later! This happened today: when the injections and IV area of emerge had no patients, Brianne and I wandered into Maternity. I got back after lunch and Epseranza (the nurse from the injections area) said, "There you are! I was looking for you this morning!" It kind of feels like a lose-lose sometimes - I can feel bad for sitting around when there's nothing to do, or I can feel bad for leaving to find something to do.

The last dilemma of the day isn't really mine, but it fit nicely into this post's theme. Jason is leaving next Friday and he's counting-down-the-days excited. John is booked on the same flight as I am in three weeks and Brianne - crazy girl - has no return flight yet. I'm definitely going to stay here for the next three weeks, but the other two are trying to decide if they're going to do a little travelling before leaving the country. Things are kind of up in the air now: Brianne might leave next Friday, too, or leave later. John might go travelling with Brianne and then come back and work more, or work while Brianne travels, travel while I work and then fly out with me. It's all very complicated!

Oh well. We're all here for at least another week! We're planning to take it easy this week and stay (mostly) in town because Jason has a big cookout planned for the firefighters tomorrow so we said we'd help out. Inès is preparing a homemade marinade for the chicken skewers as we speak, and we have a lot of corn to shuck this evening! Masaya market is also on the agenda for the weekend, but we're all pretty exhausted.

Fun facts from today: I got a package in the mail! My darling mother sent me two pairs of gorgeous scrubs. I love them but I'm sad to say that either she underestimated the size of my butt or I underestimated the effect of all this Nica food! Brianne gets to wear the pants for the next few weeks, then, while I try to cut down on the sweet bread. I'm told that the blue top brings out my eyes, though; this isn't news because one of the most common comments I get from Nicaraguans is "Your eyes are blue." I don't mind that much - I prefer it to "You don't look twenty!" which is the other popular one. (I get it. I look seventeen but really, I'm twenty. Promise.)

I don't mind the weather - I've got scarves and caps and sweaters

Today was hot.

You might be thinking, "Duh, you're in a tropical country in the summertime" but you'd be wrong. It isn't actually summertime here, which would make sense if we were south of the Equator - which we aren't. For some reason, in Nicaragua, winter goes from May-ish to October-ish and summer is everything in between. There's no fall or spring, either; this made my weather worksheets really complicated in Spanish class because they were written somewhere that has four seasons. In any case, winter time in Nicaragua is technically the rainy season, which is why it's worth mentioning that today was hot!

Family and friends at home have been asking about the weather lately and I've been having a hard time saying much about it because nobody seems interested in measuring the weather here. While I've checked online a few times - apparently tomorrow's RealFeel is supposed to be 42C - some of the weather sites actually try to pass off Managua's weather as Jinotepe's. Still, I think I checked the weather here more often during the year than I do now. Here’s a screen shot of Managua’s weather in March when it was -40 in Edmonton. Checking this was an excellent way to remember that there was a light at the end of the tunnel of winter!

Now, I usually just ignore the numbers because the weather is generally pretty consistent anyway: brilliant sun in the morning, clouds or sun in the afternoon, pouring rain all night. Sometimes the rain isn't done by the time we get up and throws a wrench in our plans to run, but it isn't usually too inconvenient. John says the rain drives him crazy and I understand why, but I don't mind it because there are still very few cloudy days. It's rainy or it's sunny and there isn't much in between.

So today, the sun was especially shiny and the palm trees were especially green and I was especially grateful to be here. I put sunscreen on first thing in the morning, then again at lunch, then again before our run (as usual) and sweat all day long. While I’m looking forward to a day when I don’t have to put slimy sunscreen and bug spray on as soon as I get start my day, it’s still pretty great to walk down the street in all that sunshine, even at seven in the morning. Here’s a fun photo of how freckly I am now despite all that slime.

I’ll spare you the details of everything I did today, just this once. There will be more pictures in the Week 5 album soon, though!

Keeping Busy

Today was another early day, but there's something about doing five hours of work by noon that's really rewarding! We did our first two lesson together and I worked on my poster between them. This weekend, I discovered that Brianne vomits surprisingly quietly; today, I discovered another talent. She's an excellent heart-shape cutter-outer! I finished up my poster in the hour-long break before the second set of lessons and I'm actually pretty proud of it. As soon as I put it up at the clinic, four or five people started reading it right away - probably because they were bored, but still. They read it! The residents said it was good, too, and didn't seem to find any mistakes glaring enough to mention. The doctor wasn't there today because he had a meeting, but the residents said I could stay with them. One of them, who seems a bit older than the others, is really willing to explain things to me and lets me practice a lot. I wish I could remember his name! Today, he had me weighing and measuring, and taking vital signs. I got all three of the BPs I did. I know it's not a complicated task, but it was a huge relief to finally hear that thud in the stethoscope.

Speaking of the stethoscope, that thing is a conversation starter! The clinic is pretty slow in the afternoons (I'll go in the mornings after this week) so we were just chatting about medicine and Canada when one of the residents said to another, "Did you see her Littmann?" So thanks, Dad - the hospital and firefighters are really grateful for your donated stethoscopes, but they're extra pumped that they're Littmanns! I understand why, given that the equipment in the clinic and hospital is pretty limited. In Harold's office - which two residents were sharing today - there's a desk, a table, a sink, a file cabinet and four plastic patio chairs. He has a stapler, too, as well as a blood pressure cuff, a box of tongue depressors and a stethoscope. None of the doctors here have computers and none of us have seen one of those lights that's used to look in eyes, noses and throats. (Can someone please tell me what that's called?) In fact, when one girl came in today with tonsillitis, we had to ask her to stand in front of the window so that we could see better. All that being said, I have to say that I'm impressed with the way the doctors in the clinic interact with their patients. They don't seem hurried (Ah, Nica time...) and they take exceptional notes. Seriously, one day I'll take a photo of their paperwork for you. It's outstanding!

In other news, John asked me yesterday how I'd been passing the time over the last three weeks. He and Brianne have been in their clinic because they're thinking of leaving before the end of August and wanted to start getting hours in right away just in case. I got the feeling that he thought I'd been twiddling my thumbs, drinking jugo de piña and watching CSI... In case any of you had similar images of my afternoons, allow me to clarify. I've been going to the lab for a few hours here and there, and I spent some time in emerge but I've mostly been Jason's personal assistant! He's been working close to sixty hours a week training firefighters, teaching CPR, training emergency medical responders, teaching sports medicine, planning the Masaya rescue, making a one-year plan for the fire department, talking to various mayors and coordinating a department-wide mock earthquake drill. For CPR courses at the university and high school, I mostly helped take photos and acted as a victim. I'm not sure how it happened, but I also became his IT person for communications with headquarters in Florida, among other things. In the past ten days or so, I've been translating things like the EMR exam questions and the certificates I made up for the firefighter/EMR graduation, which was this evening. It was really cool to see the firefighting recruits get up to get the certificates I made and know that we really did play a part in their training. I've actually gotten to know some of them, too. So while I wasn't officially in a placement, I promise I haven't been on vacation!

Un Día Muy Ocupado

This morning, I taught health lessons to two elementary classes entirely in Spanish, talked to a group of high school students about HIV/AIDS, played Blob Tag, took a handful of vital signs, gave half a dozen intramuscular injections, helped prepare IVs, drew up various meds, helped get a catheter ready and caught blood samples - all before lunch! The health classes with the younger children went really well. Marguí came with us to translate if we needed her, but we hardly did. As soon as we walked into the classroom full of eager grade ones, I knew I was ready. I didn't realize how much I missed my grade ones at the elementary school at home, so it was so nice to finally be teaching and interacting with such wonderful little people agian. In Spanish, to boot!

Our high school presentation was sandwiched between two elementary ones. We were already nervous when we walked into the grade eight room and found out that there was no projector after all; things got worse when the director strode in wearing a white habit and a stern look. She was only there for the first few seconds, though, so we were scared for nothing. While we didn't leave the high school presentation feeling as pumped as we were after the first, it still went well. We're going to try to spice it up a little bit before we do the grade seven class on Thursday.

At the hospital afterward, I lucked out in emerge with a nurse who was really willing to teach me, hence all the things I got to do before lunch. After lunch (spaghetti, if you were curious) I headed up to the centro de salud. I've practically been buzzing with excitement over the health centre for the past few days, to be honest. Brianne and John have been giving pap smears, breast exams and injections at the clinic in Diriamba, so I've really been looking forward to getting that kind of clinical experience. The other reason I've been muy emotionada about starting there is the doctor, Harold. I heard wonderful things about him from Meagan, and he was so patient with me when we met a month ago despite the fact that I could hardly string words together.

He didn't disappoint. There were a few residents or interns with him today, so he was definitely in teaching mode and I learned a few things while I was there. I tried to take the first patient's blood pressure, but he was speaking to her while another doctor/student/resident listened to her breathing, so I couldn't hear myself think with the stethoscope in, never mind a pulse! It's frustrating because I understand how to do it but I just can't get enough practice because there aren't enough cuffs for me to take one away for a few minutes and try on a doctor or a volunteer. Even if there is an available cuff, the quality is an issue - the one I used in emerge this morning was so worn that the velcro gave way as soon as the pressure reached about 120. I'll just have to keep trying, I suppose, and hope that the patients don't get too fed up with me fumbling around. I also learned how to weigh and measure patients and perform a breast exam.

The clinic was pretty much empty by about 2:30, which was a little disappointing because I was hoping for a solid day of work. Harold was having individual meetings with all of his students, so I sat with them on the bench and chatted while they waited for their turns. As I marvelled at the realization that I was actually chatting in Spanish, a couple of the firefighters came in. I was so proud of myself for being able to talk to them about their graduation (it's tomorrow) and the celebratory cookout we're helping with on Saturday.

Anyway, I left the clinic soon after that because there were no patients there and I needed to get started on my presentation about healthy eating, heart disease and obesity. It's really hard to find stats about such things in Nicaragua, but my own observation would suggest that more than half of adult women here are overweight and that almost all of them carry that extra weight around their middles, which is a bad sign when it comes to heart disease risk. I have to say that I understand, though - if I could eat things like this delicious fried donut concoction every day, I'd have weight around my middle, too!

Tomorrow, we're teaching four more classes in the morning. Because of a miscommunication with the scheduling, we're doing two before nine and then two later in the morning, which makes it difficult to go to the hospital before lunch. Brianne promised she'd be at the hospital by nine-thirty, so I'm going to do the second set of lessons on my own. That way, I get to finish my poster during the break and spend twice as much time with elementary school children! Fun fact: Brianne's a lifeguard, and after seeing me with the grade ones this morning, she suggested that I do the rest of the lifeguard training (I did my Bronze Cross once upon a time) because teaching swimming lessons is yet another way to combine health and education! I think it could be a lot of fun.

New Leaf

August is off to a great start.

I woke up with a little trepidation today because all of the issues we’ve been having with food, money, punctuality and communication in the house finally came to a pretty emotional culminating point yesterday; I was worried that sorting out the administrative problems might come at the expense of our friendships with José, Marguí and Inès, but we had a great chat today and things are going to be just fine. There was a lot of tension in the house and in my shoulders that has completely dissolved. (This photo seems unrelated but it's not - the anklets are to remind me that I've turned over a new leaf and the Birkenstock tan is proof that I really live here.)

This morning, the sun was shining on our walk to el Colegio San José, where we talked to Señor Henry about the health lessons Brianne and I are going to be doing. We want to talk about disease prevention – including STIs – as well as nutrition and exercise. The fact that it’s a very Catholic school where we aren’t allowed to mention condoms or contraception at all is a huge challenge, but we’re ready for it. We were only planning to start with the basic STI-free version for elementary students this week, so we were a little worried when Señor Henry said we could start with both elementary and secondary students – tomorrow. At seven in the morning! We were about ready to balk and ask to do it next week instead, but Jason gave us a ten-second pep talk and convinced us to just go for it.

We had originally intended to go to our respective clinics this afternoon, but we realized that if we did, we simply wouldn’t have enough time to prepare quality 30-minute presentations in Spanish with props and activities for students aged five to fifteen. While I’m kind of sad that I didn’t get to start at the clinic today, I’m glad we decided to stay. This project is a chance to really have a positive impact on a lot of peoples’ health, so I want to do it right. After our initial research, we headed up to Café Aroma y Sabor with our notebooks and dictionaries to hammer out the English text. The delicious oreoccino we split the work a little easier, but it was still pretty difficult to write out two half-hour lessons knowing that we’d have to translate every word later on anyway. We spent most of the afternoon and evening researching, writing and translating. José is checking it over now and then all that’s left is the practising. I’m really nervous and I know that we’re going to make mistakes. I hope that the students still get something out of it, though. We’ll get better as we go!

We took a break to go get food with José, who does all the grocery shopping for the house. Because we’re going to miss out on our hot breakfast at eight tomorrow morning, we bought cereal and yogurt to eat before leaving for school. Standing in Palí looking at the cereal selection, I couldn’t help but think of the times years ago when my brother and I would do the same thing, deliberating agonizingly slowly over our choice of “junk food cereal” to enjoy on Saturday mornings. I’ve learned a lot since those days of Saturday afternoon sugar crashes, though, so we opted for some kind of crunchy granola-raisin thing despite the obvious appeal of Trix and chocolate pop things. (I realize that this paragraph was all about cereal. If you hadn’t eaten cereal for this long, you might treasure such a choice too!) This photo is of the incredible cereal selection at La Unión in León.

Upon leaving Palí, we went adventuring through the supermarket, which only solidified my decision to start buying all my snacks and Sunday meals from street vendors. Everything looks delicious, and it’s the perfect way to really experience the culture while saving money. I’ll have photos and names with which to make you jealous soon enough.

Tomorrow, the real fun beings: teaching from seven to nine-thirty, hospital from ten to noon and clinic from one to whenever nobody’s left! I’m still not sure what I’m going to do while I’m in the hospital – I know the lab but it gets lonely and boring; I like emerge but John wants to be there too; I’m interested in maternity but I don’t know how to go about getting involved there. This week, I’ll only be there for about two hours a day anyway, but we’ll be done the early morning lessons by next Tuesday and I’ll be able to watch surgeries at seven instead. In any case, it’ll take a while before I figure where I can find the best balance of learning and helping – I’m sure I’ll jump around a bit.

After everything that’s happened in the past month, I feel like I’m really, truly settled. I’ve turned some kind of corner and I have so much hope for the next four weeks!