León, Nicaragua: Epicenter for Ingenuity and Growth

The Heston Experience: Nicaragua 2012. What does it mean? What is the take home message—the bottom line of the experience? Uh, hm, well this is awkward, but I have no idea. It is rather like the kid who forgets the day of his presentation in class until his teacher kindly reminds him with a pedagogically deserved F. Fortunately, there are over 50 days still left to find out. That said, this is my first Heston blog post of summer 2012! I am already excited and there is not anything even written yet.
To think the past six days almost started off catastrophically is quite humorous: Nicaragua’s interns almost did not make it to Nicaragua. I was the last poor soul on the plane from Pittsburgh to Miami (after a marathon sprint through the terminal at 6am) and Phellix almost went to the wrong airport in New York. We found each other in Miami, however, and arrived in Nicaragua Wednesday afternoon. After almost a week of being here, it is still only May and I already feel kind of Nicaraguan—minus the fact that my German heritage still assures that I return to the house every evening with a fine shade of lobster if I forget to wear my Indiana Jones hat, which just about screams gringo or American. The first couple days here were a “dipping the toes in the water” experience in that Phellix and I followed the director, Gregorio Bowles (or Gingorio Bowles) around like a pair of faithful dogs learning the crash course that would be the cornerstone of our experience: Nicaragua 101. Among the tips: do not shake hands when they are offered by drunken men on the street, they will death grip you and never let go and avoid Managua. It is the wet season here but that has usually meant heavy rain in the afternoons and humidly unbearable mornings, which usually begin when it’s still dark around 4 or simply whenever the neighborhood roosters want it to. After visiting Gregorio’s school-construction project and climbing Cerro Negro, one of the most active volcanos, to see Phellix snow-board down it, it was already Monday and time for my first day of work.
My dad, who works in land development, has told me before that if I ever had any desire to enter a construction zone all I would have to do is wear a suit, a hardhat, and carry a briefcase. When we first tried to enter the hospital before my first day—dressed like tourists—we were denied the expedited entrance but when I showed up for my first day with my lab coat, scrubs, and stethoscope around my neck, I suddenly had access to any part of the hospital that I wanted and, even better, fellow staff members and patients alike called me doctor. This has been both a blessing and a curse—while I certainly enjoy masquerading as a doctor and walking really fast through hallways of people pretending that I am important, I am simultaneously expected to perform the tasks that attend such a position. When patients approach me in the streets of León to inquire further about their clinical prognosis or about their condition and medication, as happened yesterday, I see that walking around town with my doctor uniform is a status symbol that I have undeservedly taken upon myself.
While this is only the end of the first week, the deficiencies of hospital care here have already become apparent. The only fully-functional echocardiogram that the hospital owns is on the fourth floor of the hospital and is the product of 1996 Hewlett Packard technology—the company that makes printers. In hospitals in the United States, there is an ECG machine readily available for every patient in clinical care. The persistent cockroach infestation, the mystery of the murdered women found in a medical supply closet four months ago, and the lack of government-provided funds creates an interesting environment beneath which the hospital operates on a daily basis. The staff are clearly well-trained, albeit overworked. They are innovators in this regard, however, in that they seem not to mind shortages of resources or personnel. Cleanliness and sanity seems to play a background role—all patients are fit with the same nasal cannula on the one respirator in the entire emergency department, the bed-sheets, often splashed with blood or stained with urine, are changed only at the end of a 6-hour shift or when a patient dies and for privacy are covered in the same sheet (as happened this afternoon).
The cold precision with which the emergency room staff operates is undoubtedly a tendency borne of necessity. Sometimes doctors do not even sleep—which seems to be a nearly universal healthcare pattern. As this is only the first week, however, I cannot make judgments or suggestions as such prognoses would be naïve, I therefore offer first-hand observations.
Phellix is a good man. After knowing him for just a week, I cannot believe we did not become friends sooner. On the 5th night of being here, we went out to a restaurant across the street from my host family’s house “El Capote” and over the course of the evening and a drink or two, we really found that it was not just the Heston program itself that had brought us together, but our commonalities in other facets of life. The conversation we had that night was, to employ a doubtlessly overused cliché, a once in lifetime. He is an honest, genuine, and morally driven individual and I am so pleased that I have the opportunity and privilege to work and live alongside him this whole summer.
I am excited to be here and while I certainly miss my friends, the English language, and pools, I am living the dream and I have the esteemed Mr. Jim Heston to thank for providing what promises to be a transformative experience.
Alright, hopefully that little shout-out will get me some more funds! Just kidding. He will just get the best handshake of his life when I get back.

Until the next time,
~Christopher Dellana

P.S. SHOUT OUT TO ELLE RUPERT! Today the municipality of León instituted austerity measures on cow products (milk, meat, and leather) because of local shortages and it had Public Goods Game written all over it. Okay, maybe not really since it’s not really non-rival, but I was thinking about it!

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