Wednesday, April 6, 2011

Blood, Pus, & Speculums

As we spend time in clinics and in our global health class, I find myself more and more interested and focused on children's and women's health. The biggest rates and statistics of death and disease in developing countries are from children under the age of 5 and from maternal complications during pregnancy and delivery. In Africa I received a lot of experience in delivering babies and some complications that arise from that. Here in Nicaragua there has been less of that and more a presence of STIs, pelvic inflammatory disease, and cervical cancer - which has a very high prevalence rate in this area.

Dr. Caldera really pushes women's health and has been trying to make it more of a norm. Despite that, many women are still very shy about mentioning any symptoms or letting us do an exam on them. It is a lot different from the hospital in Africa where there was no personal space or privacy. Whole wards of people together while we did all kinds of dressing changes and most of the nurses being male. Here, even with a personal enclosed area, a blanket covering most everything and only girls assisting Dr. Caldera, it can still be hard to convince the women to let us examine them.

Dr. Caldera is one of the kindest, most understanding doctors I've ever worked with. He takes so much extra time to teach us and to let us do procedures ourselves. Because of the wariness of the women, the few of us girls have gotten a lot of experience in gynecology this semester. Vaginal exams, pregnancy check-ups, speculums galore, and even an entire clinic of just Pap smears in one village. I know that this subject is not an interest for many, but the more I see how much the women suffer from these problems and diseases, the more I want to know more on how to help them.

Our group is set up to have 2 students on call with Dr. Caldera at all times for any medical emergencies that come up, or house calls. These trips vary a lot between actual emergencies, just visiting an old woman with a cough, and transporting maybe a kid with a broken arm to the hospital in Waspam. My most recent call, I call our gynecological emergency day. David and I are partners and were called late Sunday morning to go with Dr. Caldera to see a woman that had been bleeding excessively. We walked down to the clinic first to grab a pregnancy test, a speculum, and some other meds and vitamins that might prove useful. Then we walked our way through the village in the heat to the woman. She was visiting her mother who lived in the classic one room wooden house up on stilts. The animals hang out under the house and the family cooks on the porch. This woman was visiting from the city, Managua, which was great because she could speak Spanish well and wasn't shy about explaining everything to us.

She had been spotting blood for a couple weeks and then developed significant bleeding for the last 2 days, getting really weak and dizzy. After a lot of conversation we found out that she had had many irregularities in her menstruation before and had been on some hormone medications in past years. She had quit taking them a while back when she thought she was better, and had no menstruation at all for a while. We did a pregnancy test first to rule out any chance of a spontaneous abortion or other complication with pregnancy, and that turned up negative. So Dr. Caldera had me get out the speculum we had brought and find out if she was still actively bleeding or not. There was a lot of blood and big clots that made it difficult, but I finally found the cervix and could see constant blood leaking through. With that knowledge, Dr. Caldera was stuck in indecision on whether we should be sending her to Waspam yet from too much blood loss, or do something here in the village.

We headed back to the mission and he explained how he really didn't have much experience in this kind of case. He asked me if I knew anything about what to do from a fellow women's perspective. I told him that I had friends with irregular menstruation that had started early on with birth control pills to help regulate, but that's all I knew. So we split up at the mission and agreed to meet up in 30 minutes after consulting medical books. I checked the Where There is No Doctor book first, but in the "bleeding unrelated to pregnancy" section, all it said was to see a medical provider for help right away. So then I went to my Wilderness Medicine manual and found a great little section describing treatment of taking a months worth of contraceptive pills in one week to control bleeding. We met back up and Dr. Caldera said he had come to the same conclusion, but we had none in our clinic.

A long walk to the other side of the village took us to Janet, the MINSA nurse's house. MINSA are the government-run clinics that are in most of the villages, staffed by usually one health worker or nurse. Janet said she had some pills at her clinic, so we trekked over there to get some. In the process of all this, a man had approached us on the road, wanting us to look at his wife who supposedly had a tumor. Many times people tell us they have tumors or a "ball" somewhere in their abdomen or back that they are sure they can feel. But when we check and feel around, often we find nothing and wonder about these imaginary tumors infecting so many. This sounded similar to one of those cases so Dr. Caldera kept saying, "We have an emergency right now. We can't see her. Come to the clinic in another week when we open up again." The man was very insistent, though, and Dr. Caldera finally caved saying, "Go sit at the clinic and we will look at her next time we walk by."

That next time happened when we walked by with the contraceptive pills and saw the man with his wife sitting on the steps of our clinic. So we headed in for what we thought would be a quick exam. As the husband explained once again the problem, we realized he was actually pointing to her groin, not the abdomen. So I got some sheets and took the woman into a room to change out of her clothes and lie down on one of the beds. She was very shy so I did the exam once again and found a large abscess about the size of a softball protruding from one of the outer lips of her vagina. Ouch! It looked painful. We poked it with a catheter and drained out about half a liter of white, green smelly pus. David and Dr. Caldera could hardly stand the smell, trying to keep their heads turned away, but to me it just smelled like the hospital in Bere. We drained so much pus out of people there and so many nasty infections that you eventually just get used to the smell like it is normal.

After draining the abscess, Dr. Caldera took a while to get out some sterile instruments and cut open the skin a little more to pack it full of bandage, leaving a hole to drain out of. I gave her a shot of ceftriaxone, a pack of antibiotics, and then sent her home. We grabbed our medical bags again and hiked back over to our first patient's house to give her the contraceptive pills, explain everything, tell her to check up with a doctor in Managua when she got home, and to see the MINSA nurse if she got worse while we were gone on the river trip. Then back to the mission to continue packing for our week out in Krin Krin on the river.

Later in the evening as it was getting dark, Mrs. Brown, who cooks for our group, walked up the hill with her daughter asking for Dr. Caldera. It sounded like a very similar medical case with her complaining of bleeding over the last couple of days. As we talked more, she explained that she hadn't had her period for 3 months previous before this bleeding started. Dr. Caldera turned to me and asked, "Sarah, I am so busy right now trying to pack and prepare your tests for next week. Can you take her down and examine her on your own?" I jumped at the chance and a few minutes later after grabbing my headlamp and scrub pants, David and I were walking back down to the clinic in the dark with the girl.

First up was a pregnancy test once again. This time it was positive! Good news. Mrs. Brown would be excited about another grandkid. But now the worry about the chance of a spontaneous abortion with the bleeding. David got me a speculum and I checked again to see if she was still actively bleeding. This time she wasn't. There wasn't near as much blood as the first woman and I couldn't see any coming out of the cervix. Good news once again. So after giving her instructions to lie down and rest a lot, and a bag of prenatal vitamins, we headed back to the mission. On the way we stopped by Mrs. Brown's house to tell her the news and tell her to make sure her daughter followed the instructions on resting from work if she wanted to keep the baby.

One day, three patients, all gynecological. Fun times :)

Monday, April 4, 2011

Dear Sonya, Liz, and Hans,

This is a letter to my 3 comrades from my time in Chad, Africa. I think of you often while down here in Nicaragua. My experiences with you in Bere have shaped so much of how I view things down here in Central America. I imagine how we would joke together at the many luxuries here that most see as hardships. Outhouses with real toilet seats on them! Rice and beans to eat every day (I know! Real beans! Not just some spit sauce). Real, large, metal-framed cots to sleep on at night that never collapse. Free email through the ham radio each week.

I am grateful for the examples the 3 of you gave in Africa and have incorporated a little bit from each of you into my life and work here. Every time I'm tempted to stand back and let someone translate to English for me, I think of Hans, and how despite his excellent French that he could already communicate with, he still spent time studying and learning Arabic and Nangjere to communicate even better with the level of the people. I remember his interest in the politics behind culture and understanding why people do what they do. So here I keep trying to engage myself in the culture with the Miskito people. Ask questions about why they do things. Repeat all the Miskito words that I can. Build relationships with the locals.

In clinics I am constantly reminded of Liz and all the medications and nursing procedures she took the time to teach me. Her commitment and love for patients was so apparent in the way she treated and cared for them. It has encouraged me to spend more time with my patients, touch them, talk to them, explain what I'm doing or giving them. Rushing babies to Waspam at night always makes me wish for Liz, my CPR buddy back in Africa.

And Sonya, I was always so amazed to watch her creative interactions with the people and especially the children. No matter the language barrier, she could always make them laugh. And such simple games with bottle caps, crayons, or rocks, she could make friends within minutes and entertain for hours. On the most recent clinic I suddenly found myself pushed out of my station with nothing to do for the rest of the day. Starting to get annoyed with the turn of events, I looked around and though, what would Sonya do?....Of course, she would entertain the children! So I grabbed the bag of balloons, made a crazy ridiculous balloon hat to wear that would have made Sonya proud, and proceeded to blow up millions of balloons for the kids. Remembering how she would get creative and find ways to include kids, soon James and I were blowing up balloons within balloons and adding little rocks to make them rattle. I tasked a group of boys with finding good smooth rocks and another group to be in charge of telling me whether a kid was being honest or not about receiving one already. Soon we had a real production and game going on that lasted all the way till dinner.

Oh my life is so much richer down here by remembering your examples! Thank you for that! With a bigger group down here, it is harder to have the same comraderie, deep love, and understanding that the 4 of us shared in Chad. But I get excited when the breakthrough does happen here and there. The last few days, our group has been hit by some kind of explosive diarrhea phase that makes me start singing about Giardia. A month or so ago, most looked at me with disgust or disdain as I would try to describe the fun moments of a true diarrheal episode. With the recent personal experiences had, however, we've had such great conversations already with no holding back. I know you guys would have no qualms about joining in on descriptions on what it is like to be peeing out of both holes, to have an "accident" when you thought it was just gas passing, and to be burping up yellow metronidazole. So good. It bonds in such a unique way :)

I hope you are all well. Sometime we will have to get together, don our scarves and turbans, and ride in the back of a truck on a bumpy dusty road, singing "Ka Kongdi."

Love, Esther

Sunday, March 27, 2011

Chatting with Elisa

Elisa is one of our translators that we take along on all our clinics. She is 41 years old and probably the least proficient in English compared to the other two. But I love her so much. The slightest joke or funny incident makes her erupt into endless giggles and laughter. Her English is getting better and better the more time she is with us. Usually she translates for the pediatric station and that is my favorite station to be at, so I think we have naturally been drawn to hanging out together as we both hold babies and laugh at the kids.

This week at clinic in Esperanza, we finished early at peds, so I asked Elisa if she wanted to walk with me to see the river. It is a beautiful flowing river that reminds me a lot of the Umpqua in Southern Oregon. So we walked out there and sat by the edge of the river chatting about life in our halted communication.

Me: Elisa, have you been to Esperanza before?
Elisa: Oh yes, yes. It is good like Santa Clara. Not too much people. Francia is too much.
M: Yeah the houses are so close together back in Francia. How is your son doing?
E: Son?
M: Your boy.
E: Oh! He lives in Waspam.
M: Do you get to see him very much?
E: Sometime I see. Sometime not so much.
M: Oh that is too bad. I'm sure you miss him. So on Tuesday and Thursday you come on clinic with us. What do you do on Monday, Wednesday, and Friday?
E: My plantation! I go work.
M: Oh you have a plantation! What do you grow?
E: I have beans, the papaya, cassava...
M: Everybody is harvesting beans right now, right?
E: Yes, but it is not so good this year.
M: From all the rain?
E: Yes too much rain.
M: So you go work each week. You know all the people that come to our clinic say that have back pain.
E: Yes everybody, everybody!
M: I think everybody in Nicaragua has back pain! They work too hard in the fields.
E: Yes, work too much. I only carry little bag back, but you know other women carry big big bag. Too much!
M: And then the women have so many babies!
E: (Laughing) Yes, yes. Sarah, how many sisters do you have?
M: I have one sister and two brothers. There are 4 of us.
E: Ah...I have 5 sisters and 3 brothers.
M: Oh! So many! There are 9 of you!
This river is so beautiful. Why doesn't Francia have one?!
E: (Laughing) Yes, Francia river is only little and brown. Not good for much people.
M: In the summer I work with kids.
E: Oh?
M: Yes, they are age 15, 16...And I take them to a river like this to have fun. We get a boat and go down the river and at night we stop to camp on the side. For one week!
E: Oh do they work?
M: The kids? No, no. It is just fun.
E: About one year before, maybe two, I don't remember well...3 boys were coming down this river in a boat. They work at plantation far away. There was rain. Lots of rain and the river here was full. Big. And the you say?
M: Oh the boat tipped?
E: Yes the boat tipped and one boy fall out. He try to swim, swim, swim but not make it and he died right down there.
M: He drowned? That is very sad.
E: Yes.

M: Elisa, I heard that the whole village of Francia had an election on Sunday?
E: Election?
M: A big meeting to decide leaders?
E: Oh yes!
M: So what did they decide? Was it all good people you like?
E: Yes good people. We vote a new judge and new leaders everywhere.
M: What does the judge do for work in the village?
E: Well, you know if a boy take something, that is not good.
M: You mean stealing?
E: Yes, yes. The people take the boy to judge and he give the boy a lot of work.
M: He makes the boy work for stealing? I like taht. It's productive! Does the judge do marriages too? Or do people here get married?
E: Some people get married. It is good to wait a while to know your husband is good before you get married.
M: Do you have a husband Elisa?
E: Yes I have husband.
M: For how long?
E: Ten months.
M: Oh, that isn't very long. Are you married?
E: No, but I would like to. I know now that he is good man.
M: Well then you should get married! And soon so I can come!
E: (Laughing) Yes, yes. Sometime.
M: Do you have a party when you get married?
E: No, not so much.
M: Oh, in the US it is a big ceremony with a pastor and many people come. They usually have lots of food and party.
So Elisa did you have a husband before this man?
E: Yes, but he bad and I not marry. He drink a lot, not good. But my boy is very good. Never ever drink and good worker.
M: Oh that is good that he didn't pick up bad habits from his dad.
E: Sarah are you married?
M: No not yet.
E: How old are you?
M: I am 23.
E: But no children?!
M: Haha! Nope, no children yet. I am still in school. It is hard in the US to have children when we go to school for many years.
E: Ah yes. It is good to wait. Do you have a boyfriend?
M: Yeah I do.
E: Yes?! But you are here! How do you have a boyfriend?
M: I actually just saw him 2 weeks ago. You know when we left to go to Corn Island? He flew on a plane from the US to Corn Island to see me.
E: Yes?! Oh that is far!
M: Yes it was very good to see him. We have been together for 2 years now.
E: Oh so long? But that is good. You need to make sure he is good man. Make sure he not drink alcohol a lot.
M: Yes, it is good to know those things.
E: And Sarah, if he is bad you come live with me.
M: (Laughing) Ok I will do that! But it is very unlikely.

As we walked back from the river together, one of the other translators came up to us and said something to Elisa in Miskito. I asked,
"Elisa, what did he say?"
"Oh he say you are my sister!"
"Yes, yes Elisa. You are my sister.

Wednesday, March 23, 2011


Finished with our survival and spring break on Little Corn Island, our group said our goodbyes to the island paradise and flew out of Big Corn to the town of Bluefields on the Atlantic coast of Nicaragua. I love flying into the little airport there in our small 12-passenger plane because it brings back memories from a mission trip I did to Bluefields in high school. When we fly in to the runway I can pick out and see the roofs of the building our group lived in and the church that we built. The airport has a long walkway out to the runway with a bright blue covering that I can remember walking down before.

We landed and hung out in the waiting room of the airport for 3 hours watching dramatic soap operas in Spanish. It is fun to make up our own commentary of what is happening on the shows. Finally our plane arrived to take us to Puerto Cabeza so we gathered our passports and belongings, and stood outside waiting to be allowed to board. We watched them gather all our big bags and start packing them into the back of the plane. Suddenly one of the airport attendants grabbed one of the large army bags, threw it onto a cart, and came booking it up the walkway towards the airport. He ran up to the security scanner and tried to fit it through in a bit of a panic. Wren recognized it as one of our bags and walked over to see what was wrong. She turned to the rest of us confused and said, "It's beeping?" We all gathered closer and could hear a definite "beep.....beep.....beep...."

A group of airport security had gathered by now and had some concerned, fearful looks as the beep started to speed up faster and faster. Beth turned to me and exclaimed, "Sarah! That's your Catchphrase game that Arthur left." We all laughed and tried to explain to the airport security men that it was just a game. They didn't understand and motioned for me to find it. So I opened the bag and dug down to the very bottom and pulled out the round little game that was beeping like crazy. They all looked relieved but then wanted me to turn it off. It turns off on it's own and has no switch to keep it off so we eventually had to get a screwdriver and take the whole back off so that I could pocket the batteries before they were satisfied that it was no longer a threat. We quickly boarded our plane and headed off into the sky, laughing to each other over the scare it gave that young attendant trying to get it to the scanner in time and being glad that it happened at this little airport in Nicaragua instead of a bomb crazy airport in the States.

Monday, February 21, 2011

Feeding the 5000...or maybe just entertaining a hundred

On our 3-day clinic expedition, I packed my scrub pockets full of balloons and stickers for the kids as usual. As a last minute thought, I threw in a few extra handfuls of balloons into my bag. Usually I only give out to kids coming through as patients to avoid the mobs. On our last clinic, though, out in the furthest village of Polo, I felt more the remoteness and little chance the children have to see much out of their village.

About halfway through the clinic, my group was taking forever on a family. Since only one person can question at a time with only one translator in our group, James and I moved on to the other 2 kids in the family. We had fun playing with them while checking them out, listening to their lungs, making a big show of breathing deep so they would imitate, looking down their throats and in their ears. Really they were a healthy bunch, but since they never have access to medical care out there, every family in their entirety were coming in to be looked at with some rather bogus symptoms or just a couple family members actually sick. All of the kids definitely needed worm medicine. We got the funniest descriptions from moms of the different sizes and colors of worms coming out in their kids' diarrhea, mouths, and noses. One mom even said her boy had moths coming out! We exchanged some dubious looks at that one.

With the current family, James and I gradually gained the kids' trust and they began to show us all their little cuts and bruises. After finding a fungal infection on the boy's foot and prescribing some Clotrimazole cream for him, I finally pulled out some stickers to keep the kids entertained while their parents were being checked. Before I knew it, the girl had run off and brought back friend after friend for stickers too. With a group of 6 girls gathered around me, I tried to talk a bit with them in limited Spanish and Miskito. Soon they were all shyly repeating "hello" and "how are you" in English as I taught them. Wanting to keep the learning going, I grabbed a balloon out of my pocket and tried to get them to say "balloon". It was fun and soon each of the girls wanted their own balloon with a face drawn on it.

You can't go very long handing out colorful balloons without kids noticing. Soon I had a crowd around me of kids, big & small, watching the production and hoping for one. It was crowding out the clinic so I grabbed my bag and sharpie and headed outside. The mob grew, and I began to wonder if this was a good idea or not. There was no way I would have enough balloons for them all. So I tried to make the best of the experience, making a show out of it by making exaggerated faces while blowing the balloons, taking the time to draw a specific face on each one, and making the older kids pronounce "balloon" before they could have one. All the parents began forming a ring behind to watch and caught on that I was drawing specific faces. So they all started guessing which kid I was drawing next from the hair style, etc. Great fun. Sometimes I'd get a dud balloon that just didn't want to expand. I'd blow and blow, until all the moms would start yelling Ai! No! She's going to blow all her air out and die!

I kept on, kid after kid, and really began to worry about running out with all the kids so eager to have one. I never looked into my bag, just stuck my hand in and rummaged around until feeling another balloon. Over and over I did that, praying each time, "Please God, give me another one." It went much longer than I expected until finally, the dreaded moment where all I could feel was my headlamp, knife, and other supplies at the bottom of the bag. No balloon. My spirits plummeted. Looking up, there were still 10 kids I could count who hadn't gotten anything. Reaching in my scrub pocket, I found half a sticker page and started handing those out. That was quickly gone and I was at a loss for a moment before I realized that the sticker page outline had little clouds printed on it. I started tearing those out like little stickers, feeling rather apologetic for giving such a measly gift compared to balloons, but the kids were grinning still, just happy to be included. Got down to the last cloud, looked around and spotted one last little boy, shyly standing back. I beckoned him forward and planted the last that I had on his sweaty hand. The perfect amount. There's nothing like perfection to tell you that God was a part of it in our non-perfect world.

Friday, February 18, 2011


On one of our past project days, Becky, Jeff, and I volunteered to go search out all the wells in the village here in Francia. So after breakfast we headed out into the first quadrant of the village walking on little trails between stilted houses. When we found a well, we'd ask the villagers around about it, noting anything broken, possible new well heads to be built, quality and depth of water, etc. I'd mark it in the GPS and then we'd trek off in search of another one.

It was great to have the chance to see deep into the village. The people are rather shy, sitting back in their houses waiting for us to acknowledge or greet them. Very unlike the boldness in Africa where everyone runs up to shake your hand and kids crowd around to follow everywhere. We ended up covering over 3/4 of the village by lunchtime, much more than expected. And that includes all the visits with people Becky knew. She was a student missionary here the same year I was in Africa and was getting the chance to greet some long, lost friends. One of the first wells was with a man with heart problems who actually stayed a year in the states for extensive heart surgery. He was barely able to stand up and greet us as he is constantly weak from the blood pressure problems and siezures he has. Later on we ran into Armando, one of the head elders of the church. He has taught himself English very well, so is always our translator when we talk up front. He invited us up on his porch to chat for a bit, noting that he needed some bleach for his well too. Also ran into a man who was so excited to see Becky. She helped deliver his wife's baby 3 years ago, so they dragged the chubby little boy out to see her. He promptly screamed and went running for his mom at the sight of us.

Towards lunch time, we happened across the house of a newborn baby that we'd seen a couple days earlier. The parents had brought the baby to Dr. Caldera because she was sick with fever and not breast feeding at 10 days old. He check the baby out and was concerned that she was developing some lower lung pneumonia. So seeing the baby, Becky asked if we could check her out. We climbed up on the porch and were happy to see that she looked much more hydrated but still had a fairly high fever. She was taking the antibiotics ok, so after some suggestions on how to keep her fever down, we left.

The next day, we decided to go check on her again after talking to Dr. Caldera. He was still concerned because he'd asked the parents to bring her back to the clinic right away to get checked, but they never had. So at lunch time, Becky, Jeff, and I headed back out to the house. I came prepared this time with balloons after seeing all the kids the day before. So while Becky checked out the baby, I blew up balloon after balloon and drew faces on them for all the kids in the family. This visit we were surprised to find 3 young babies on the porch and it took a bit to sort out which was the sick one. The other two were twins that belonged to a sister. Becky said the baby was doing better, fever down and breastfeeding. So we headed home feeling good that she was improving.

The weekend came and on Sunday, Brittany and I got called out on a house call with Dr. Caldera to check on an older lady with bad heart and blood pressure problems who was having trouble sleeping. Dr. Caldera is such a great teacher, explaining everything step-by-step and letting us do every part of the assessment with him. The lady, Olga, had a very irregular heartbeat and through Dr. Caldera's careful teaching we narrowed it down to the exact heart valve that was causing it. She also had too high blood pressure so we decided to get some meds at the clinic for her. Noticing that we were close to the little baby's house, I asked Dr. Caldera if he wanted to check her and he readily agreed. So I led them over to the house, but we were disappointed to find the parents and baby gone for the day. Questioning the family, we heard that the baby was not doing well. Dr. Caldera said it was very bad that they hadn't come to the clinic again and that they should come immediately once they returned. The family brought out the twins to be checked instead because both seemed to be coming down sick as well. One of them especially could barely cry and both their lungs sounded like the beginning of bronchitis. With promises to return with meds, and instructions to send the newborn with us, we headed back to the clinic.

The rest of Sunday went rather smoothly until that evening when Dr. Caldera was called to go check on the newborn who had finally been brought to the clinic. The new on-call team, Justin and Rebecca, went down with him. I was studying on the porch in a hammock when the 4-wheeler suddenly roared up and Dr. Caldera went running into his house. Soon he ran out with the news that he was taking the baby to the hospital in Waspam, and took off on the 4-wheeler again. Justin appeared soon after since there was only room for Rebecca to go. He said the baby was barely breathing when they got to her. While trying to study, I kept thinking about her, wondering how she could have taken such a bad turn since we'd seen her just 3 days before. I was also trying to imagine them driving all the way to Waspam on the little 4-wheeler since the truck was gone. It might be faster going around all the potholes, but very exposed and difficult to fit them all on and keep the IV in that little 14-day old baby.

A couple hours later Rebecca walked in teary-eyed with the words, "she died halfway there" and then walked out. Justin and I took a few minutes to say "that's too bad" and "they should have brought her in earlier." Then we looked at each other and Justin said, "are we really un-feeling people?" After seeing Rebecca's anguish, our quick "wish it would have turned out better" seemed short and not enough. We've both already seen so much death, though, during our times in Africa that this just seemed like another one. Justin said that as soon as he saw the baby, he had no hope that it would make it to Waspam. We talked for awhile about how to balance expecting and being ok with death while also believing in the power of God to heal. We finally came to the simple conclusion that we would at least wish and pray to feel the same that God would feel over the death of that baby. I think God feels anguish over the suffering that happened and the loss the family will feel, but also joy and excitement over the knowledge that death isn't the end of this story.

Wednesday, February 16, 2011


Celebrated with banana bread, a candle, & friends.

Saw over 100 patients in the village of Miguel Biken on Tuesday.

Worked Men's/General Pathology with Dr. Peterson & saw the results of lives full of hard labor and surgery cases to refer to Waspam.

Cut and popped some kind of parasite and larva out of Alex's foot.

Pitched tents around the clinic for the night.

Saw a huge scorpion on Jeremy's pack.

Got to call on the satellite phone for a few minutes for my birthday!

Woke up early on Wednesday to grab our backpacks & meds and hike 2 hours through the jungle to the village of Kapri.

Mud, mud, and more mud.

Set up clinic in Kapri in the little catholic church.

Worked Women's with Dr. Caldera and saw many pregnant women and STIs.

Made ramen noodles for dinner over a fire outside.

Pitched a tent for the night with a circle of curious onlookers.

Listened to crazy massive pig fights all night.


Packed up in the morning, left personal stuff at the church and carried all the meds & clinic supplies to the village of Polo like porters in a line through the jungle.

More mud including some massive 3 ft deep holes with slick little logs to tiptoe across on.

Clinic all day in Polo, seeing practically every person in the villaage, family by family.

Thought we'd have to turn patients away to leave in time, but decided to just stick it out & chance hiking out in the dark.

Worked pediatrics with German med-student David, treating tons of worms, parasites, sinus infections, bronchitis, and UTIs.

Flew through tons of Albendazole, Mebendazole, Metronidazole, Amoxy, Doxy, and Cotrimoxazole.

Saw first case of intense Leishmaniasis, also known as Mtn. Leprosy, on a 14 yr-old girl.

Gave out every balloon & sticker I had with me to the crowds of kids.

Finally packed up to leave and hoofed it back to Kapri through all the mud pits again.

Grabbed our backpacks and after an intense pouring of rain, headed out on the long jungle trek back, slogging through the trails.

Darkness came and we got to hike by the light of the moon and stars, listening to the jungle come alive at night.

Arrived in Miguel Biken and finally met up with the truck for the long drive back to Francia Sirpi, our village.

Truck's headlights were fairly nonexistent so a couple guys had to ride on the hood, shining their headlamps on the road.

Listened to Tyler's farm stories and all the guys' battle wound stories all the way back.

Finally home with a big meal Mrs. Brown had prepared for us!

What an expedition!

Monday, February 7, 2011


If you were told there was a major bus accident with many injuries and had 30 seconds to grab whatever you needed, what would you grab? And that includes not knowing how far away it is or how long you will be gone.

Today we went to the Adventist church here in Francia Sirpi. I think we tripled the amount of people there. Everything was spoken in Spanish and Miskito, so David sat behind us during the sermon to translate into English. After church we walked back up to the mission to eat lunch. Some were still down at the church when word came in that there was a large bus accident down the road a ways with many people hurt including some church members returning to Francia.

So I was sitting on the porch when Ryan ran up and asked if I wanted to go.

“Go where?” I asked, having not heard anything.

“There's an emergency. Go grab your water and jump in the truck.”

So I ran up to our cabin, pulled on some scrub pants, and quickly grabbed anything around me that looked stethoscope, a few granola bars, sunscreen, headlamp, and jacket in case we stayed after dark. I ran out to fill up my water bottle but we ran out of water after only filling it halfway. I jumped into the back of the truck along with the 3 other students, the SM girl here, our leader Jeff, Dr. Peterson, and a German nurse doing a rotation for medical school out here. We took off and I heard the news that they thought a bus on its way to Francia had rolled. Everyone was speculating on how many injuries that could mean, how to respond, who to leave at the site while transporting patients, etc. I just sat down in the back and got comfortable for as possible for a long ride on the bumpy road, remembering all the miscommunication that usually happened with emergencies in Africa.

We drove through the village on our way out and stopped to talk to the church members about the accident. Within a few minutes, the German nurse, David, started mumbling excitedly in German and finally in English, “Why aren't we going?! Why are they wasting time talking!” As the trip continued, he was continually fidgeting and exclaiming, “How far is it? Are we ever going to get there?!

The SM girl, Brittany, and I kept responding with, “It's ok. There is no rushing it, and there's no reason to be worried so much about it until we get there and see the situation.” In my mind I was already wondering if maybe it was just a car or truck instead of a big bus coming all the way out to the village. Brittany started getting very concerned that there was only one other person along besides her that spoke Spanish well. I kept trying to reassure her too that we would be fine with our basic Spanish and hand gestures. Anyway, it turned into a long bumpy ride where I felt like I was constantly saying, “relax, we'll figure it out when we get there.” Looking back on it now, I wonder where I became so laid back. I can certainly have my times of wanting to have everything planned out and analyzed. And how can I say, “don't worry” when I'm a huge worrier at times. I think it's something to do with the “overseas mode” coming back to me. Letting things slide along as they come, not getting anxious about things we don't even know.

About a half hour down the road we stopped a moto driver heading the other direction. He surprisingly told us that he hadn't seen anything on the road on the way in. No accident, no large amounts of people, no bus. So we decided to head back to the village until hearing more. David immediately got anxious again, poor guy, so worried that we might just be leaving people out there to die. But we couldn't just drive out blindly, wandering around with not even a confirmed report. They had probably already all been transported to the hospital in Waspam if it had happened. As Brittany and I agreed on that and about waiting back at the village, he looked at us like we were ogres or something. I wonder if I'm too calloused already from past experiences. I returned to the mission without much of a later thought on what might have happened, knowing we might never know. All the students were sitting around in their scrubs, prepared for patients when we arrived and there was a bit of a collective disappointment when they heard the news. No, we aren't crazy EMTs always wanting people to be hurt, we just want to be there when it happens so that we can help!

Sunday, February 6, 2011


This post is coming from my own hands on the internet. Exciting to be on for a little bit. We are at Clint & Marilyn's house a couple hours from our village. Clint is a pilot out here and they have quite the nice house and compound out here. Can't write much, but we are able to get some emails out through the ham radio now in Francia so I will keep trying to send a few blogs. Mobile clinics have been great and this next week we will be doing an epic 3-day trip doing clinics at 3 different villages. So driving to Miguel Beacon on Tuesday, walking to Kapri on Wednesday, walking to Polo on Thursday, and then walking/driving back to Francia that night if possible.

Hope you all are well and happy :) I've been sick with something for 2 weeks now which just lately has been diagnosed by the doctor as either strep throat, mono, or some other virus. Not fun. My tonsils are so covered in white right now, they look like 2 cotton balls in the back of my throat.

Love you all,

Saturday, February 5, 2011

The Tarantula/Cockroach Dance

With the tropical weather, I've been pushing myself to drink massive amounts of water. But with that comes many trips to the outhouse...including at night. I have learned to be prepared for those nighttime jaunts both physically and mentally. As the air cools considerably in the evening, apparently all the tarantulas are attracted to the warm little outhouse sitting out there in the field.

So when the need is too great to ignore, I creak out of my cot, grab my trusty headlamp and slide my way precariously on the mud trail to the outhouse. First comes the outside inspection where I walk around the building and check for potential intrudors. Usually there's a big hairy tarantula or two hanging out on the walls. I mentally file away their locations and expected amount of time they would take to reach an entry point. Then I slowly open the door and start scanning from the top down because having a tarantula jump down on me is more disturbing than one along the ground in reach to step on if needed. Last time I arrived at the outhouse, I found 6 furry bodies with 12 beady eyes flashing back at me.The problem is that they don't conveniently congregate in one spot. While staking out their own private real estate, it makes four directions for me to monitor.

The other creature I keep an eye out for are the cockroaches. It might be disgusting to mention, but there are hundreds of cockroaches hanging out in all the glory down the hole. But when few humans are frequenting the building and nighttime arises, the bravest of the cockroaches come scurrying out of the hole to explore the surroundings.

Thus begins the dance. It is quite a workout to be squatting up over the hole, constantly turning my head to check on all the tarantulas who freeze in the light, and then be jumping my feet up and down to dodge the myriad of cockroaches going crazy as the light shines on them trying to run back to the hole. It's like practicing Capoiera, the Brazilian fight dance that Jeremy is teaching us. I guess the positive part of the experience is the extent to which it exhausts me to go back to bed.

Tuesday, February 1, 2011

DAY 4 - January 21, 2011

In Nicaragua for the 4th day and it feels so great to be hearing the generator running in the background at the mission. My mind has been constantly comparing this place to the other places I've been, especially Haiti and Africa. Justin and I were just discussing today as we walked through the village, how the standard of living here seems much better than where we've seen in Africa despite being the lowest in Central America. Almost every house has a tin roof, they have pumps on the top of wells, and so many animals running around. All the houses are built up on stilts to keep away from bugs, although right now I'm sitting in the dark writing with my headlamp on, and there isn't a single bug flying in my eyes! Sonya, Liz, and Hans – you know what I'm talking about. Working night shifts at the hospital in Africa, and being attacked by all the bugs attracted to our lights as we gave out medications. And I mean bugs up the nose, in the ears, down the scrub shirt, and in the morning we'd clear an entire layer of dead bugs off the desks in the wards. Here in Nicaragua the air is so clear at night!

And everything else seems to compare that way with Africa looking more extreme in every aspect. We went to the market in Puerto Cabeza to buy food and hardly got a few side looks. No mobs of kids touching us or people laughing at every word. There is an abundance of all types of food here. The outhouses have a cement block with a toilet seat on it to sit on. I actually miss the holes in the ground in Africa because it seems more sanitary than sitting on the nasty seat. So I've been climbing up on top and squatting over the hole. Haha! I never thought I'd miss that from Africa.

But I do wonder about this desire I have for things to be hard like in Tchad. Maybe because that experience pushed me so much in every way, making me grow in ways I didn't even know I could. And now I'm wishing for that again. I want experiences to happen even if it's hard. I'm sure it will come and then I'll be wondering what I was wishing for! The first few days here have just been so lax and laid back. I should probably cherish them. And I'm sure I'll be finding experiences unique to Nicaragua like the 3 tarantulas we've chased out of the girl's cabin already!

Friday, January 21, 2011


We have been riding the bus nonstop since 3:30 yesterday until around 5 this evening when we made it to Puerto Cabeza. Still have another 4-8 hrs to Francia tonight depending on how bad the roads are. It was a fairly nice ride on the bus in my opinion. We only had a flat tire once during the night and otherwise have just stopped for some food stops.

I was thinking about this last Christmas break when I went shopping with Arthur and my step-dad a few days before Christmas. We were leaving the mall and got stuck in the hoards of people also leaving. We sat for probably an hour hardly moving until we finally made it out of the mall parking lot. I can remember feeling frustrated, not believing that it could take so long just to get out of a parking lot. Thinking back on that now, I wonder how I can feel so differently on time. We spent 4 hours in Managua just waiting for our bus to arrive. When a friend came to me worried, asking if I'd heard anything on why it was so late, I just smiled and said, "We just wait. It's what we do here." Then we just spent the last 26 hours riding on a bus that hardly passed 20 mph because of the constant holes to bounce through with dust billowing inside like a Saharan dust storm. But despite the cruciatingly slow pace, I really didn't care. I guess it's the differences in expectations. Here I don't expect to go anywhere at a fast pace and there aren't really any deadlines to meet. In the States I expect to be places in the time I've allotted in my schedule. People are expecting me to be timely and punctual. Oh how great it would be to not have that time push back at home. To feel free to travel at whatever pace feels comfortable and even stop along the way to hang out and talk with friends. I wonder if it would make us more apt to help out that person on the side of the road or take more time in communication to actually understand the other person and their needs if we didn't feel pushed to just say what we need to say and get on with the day.

Right now most of the group is sitting by the bus just hanging out. We already ate dinner and bought dinner for the next week so I don't really know what we're waiting for instead of just leaving for Francia, but no one seems to care. We'll get there.....some time. And right now in the moment, it's great to just sit and laugh together.

Wednesday, January 19, 2011

Nous sommes arrives.....or llegado....

We have arrived in Managua, Nicaragua! (and there is internet at the hotel!) Every time I open my mouth to speak, French comes out instead of Spanish. It's like being in a foreign country brings out the foreign language, but not necessarily the one that fits. I say "avec" instead of "con", "oui" instead of "si", "et" instead of "y", "ici" instead of "aqui"...and it's those little words that mess up my sentences. We stayed the night at a very nice hotel across the street from the airport and are planning to pack up the bus and leave at 11am after exchanging some money. Should be an epic 30 hour trip across the country. So long! But it will be great to see the entire stretch of the country from west to east, Managua to Puerto Cabeza and then north and inland into Francia Sirpi. Can't wait!

Monday, January 17, 2011

Off to Nicaragua

Back to dirty water, poisonous snakes, and rice in abundance.

Back to smiling brown faces, stumbling through different languages, and stickers for the kids.

Back to sweaty scrubs, dirty wounds, and handing out medications.

Back to malaria, parasites, and fever.

Might sound a bit uncomfortable or intimidating, but it is like music to my ears. It is like going home. Tuesday evening I will step foot into Nicaragua for the next three months with my 16 other companions. It is my final semester before graduating in May with the classes Emergency Care II, Global/Public Health, Relief Infrastructure Practicum, Travel & Tropical Medicine, Jungle/Coastal/Ocean Survival, and International Relief & Mass Care. The fun is that these aren't the classic "sit in a desk and listen to a lecture" kind of classes. We get to get our hand's dirty building wellheads and other community projects around the villages. We get to don scrubs and hike out with supplies to do medical outreach clinics. We get to sit in a little boat for 24 hours anchored out in the ocean, enjoying the misery of surviving together.

As with any trip overseas, I don't know what is going to happen and if we will do what we've been planning on. But I do know that I will enjoy it immensely and be challenged immensely. And I hope that I will also grow immensely closer to God.

Updates on this blog will happen whenever possible when we travel through towns with internet. Otherwise, I will see you all the end of April!