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.