Once upon a time in Nicaragua

My first sign should have been the vigilante with the shotgun who opened the gates as our truck rolled through toward the mountain jungle that beckoned…
And thus, with that wonderfully pointless cliffhanger, here is my third blog.
Hello family, friends, and supervisors! I have been meaning to get around to this for some time, but, as I enjoy condensing many experiences into one narrative, I usually wait until something notable to record my blog so that way I can use it to centralize the monologue, which, admittedly, can sometimes spiral into hopeless digression. And I further felt it an opportune time to begin this blog because I did not have much of a desire to watch cock fighting on the TV with my host father, even though his riotous laughter can be quite endearing.
It is nearly the end of June and the Heston Experience is entering its second half. Usually Super Bowls that are decided in the second half are the most exciting so I am using the same logic to make the most of my experience here. Greg Bowles, our current director, is five days away from leaving; over the course of our last two overnight excursions, I have tried to pick every last fruit of wisdom out of his tree of knowledge. Fortunately, in this biblical parallel, there is no serpent and no negative consequences in soaking up what wisdom I can. In the weeks ahead, I hope to do more hiking/adventuring, as I have done with Greg, pursue my experience in other health clinics, better my Spanish, and continue to avoid the nurses on the fourth floor of the hospital. This first month, overall, has been great—both rewarding with its experiences and difficult in its obstacles. Now, as I prepare to detail its final highlights, I want to express that it has been a privilege working with such an intelligent and adroit leader and I am certainly not the first to recognize that his talents will be missed.
And now onto the Heston Experience:
I think I shall once again start off with the present moment: right now I am eating a type of dairy soup for breakfast that my family has coaxed me into trying by insisting it is allegedly “very much like yogurt.” It is definitely curdled milk. Fortunately, I do not complain about food anymore or, at least, I have gotten used to some of the stranger flavors here—I even genuinely enjoy the cheese now, who would have thought? But, then again, turtle testicle soup has yet to appear on the dinner table. So this attitude could change.
Since my last blog, work in the hospital has remained mostly the same. The EKG machine in the emergency room finally broke and the 1996 machine on the fourth floor is on the fritz—leaving the entire hospital with one EKG machine. When a patient came in with suspected atrial fibrillation (the top of his heart was not beating correctly) the doctors sent the gringo running up four sweaty flights of stairs to retrieve the EKG machine which I hurriedly brought downstairs, only after brief harassment from the staff. One of the doctors in the ER, however, has since managed to procure an even older machine that looks to be about vintage Stone Age. Just kidding, more like the 70s—so now an EKG test takes 2 minutes instead of 30 seconds. My supervisor, Dr. Lau, has solicited that I see if it would be possible to find a replacement EKG machine in the States upon my return, and I find that this would be a great way to broaden my experience, so we will see what I can do. Further, it is not just the EKGs that break down in the hospital—it is also my lab coat. Because three buttons fell off in the wash, I had to sew them back on, hence the attached photo. Mom will be so proud. Anyway, I am beginning to learn that the doctors here must have some sort of Energizer Bunny battery that keeps them powered throughout the day. I arrive usually at seven o’clock (unless Antonia has forgotten to give me breakfast or my brother is late with the taxi) and stay until three o’clock. Even this relatively small window of work, amounting to only 40 hours a week, is enough to wear me down substantially and these doctors must repeat that cycle for even more hours and longer days. Their income notwithstanding, the job is certainly not one for the faint of heart. For me, the worst aspect is the fact that a lot of health care work in the hospital is like listening to a broken record: patients come in with the same problems, which sometimes are easily preventable. A lot of the problems, therefore, seem to stem from the general lack of education among the population. From the chronic problems of diabetes, arthritis, and renal issues to sex education and pregnancy, a majority of the population suffers from a lack of proper knowledge. Pregnancy among 12 to 15-year-olds, for example, is quite common in the obstetric floor of the hospital as advocates against teen pregnancy are insufficient. Coincidentally HIV, HPV, and cervical cancer are also on the rise. Furthermore, the socio-political power wielded unilaterally by the Catholic Church in Nicaragua has pressured incumbent president Daniel Ortega on the issue of abortion and, because of the Church’s ridiculous power monopoly, Nicaragua is only one of two countries in the entire world that legally forbids abortion of any type. Even therapeutic abortion, the abortion performed only when the mother’s life is in imminent and certain danger, is prohibited. This drives abortions underground and makes the procedure much more dangerous health-wise, not to mention that the punishment for illegal abortion is immediate extradition from the country. As I have travelled far and wide in my Heston endeavors—so much so that the nurses complain that I will soon know more of Nicaragua than they do—I have encountered health patterns, such as these, which have proved to be rather universal across the board. Dengue and malaria are persistent problems in the wet season but recent appearances of the diseases have been relatively confined thanks to eradication efforts by communities and cities. In general, malaria is virtually non-existent and only appears in rare circumstances/epidemics whereas dengue is usually more frequent. Diarrhea and respiratory infections seem to be the most common acute medical problems. In the small mountain districts of Talolinga and Santa Rosa de Peñon, active efforts to educate community members has paid impressive epidemiological dividends inasmuch as the incidence for malaria, dengue, leptospirosis (a disease contracted by bathing in rivers contaminated with animal urine), and chagas has virtually been 0% so far this year. After a brief tour of the public health regional headquarters in Santa Rosa, it is my hope that I will be able to work there to help in my understanding of public health in both rural and urban areas. Thus, although the government provides limited funds to social services, it seems that the health care system is doing all it can with what it can. Making matters worse as far as funds are concerned, the United States reacted to President Ortega’s illicit political sabotage in the 2011 election by withdrawing all U.S. fiscal aid to the country. The aid, which came in as waivers, was revoked about a week ago and the president’s tirade against “American imperialism and domination in Latin American affairs” led the president to denounce the “gringo” as the “enemy.” The political fervor among the general populous, thankfully, has not yet incited much anti-gringo demonstrations or harassment thus far, so Nicaragua’s Heston interns are still safe, for the time being. The decision to withdraw the waivers, ultimately, could work against the U.S. The Nicaraguan administration, though deficient in certain aspects, has experienced a great deal of success in the war on drugs. This was Ortega’s “trump card,” so to speak, against the U.S. withdrawing aid, but, now that there is no aid, Ortega has no real motivation to continue to crack-down on drug smuggling. Maybe that is why the Nicaraguan police stopped our vehicle last night as we were returning from Santa Rosa and demanded we exit the car and show our passports while they searched the vehicle. As luck would have it, none of the gringos had their passports. Whoops. So there we stood, hands clasped behind our backs on the side of some dark road, an officer searching the car while another stood with his AK-47 before us, daring someone to break out into a run or otherwise do something stupid. In that moment, my brain asked my conscience the same question over and over: Did you know that the words “internment” and “internship” differ only in their suffixes? And so I cursed myself for trying to be humorous during the serious affair and tried not to think of what would happen if the officer smelled the mushrooms on my breath from the soup at dinner. What actually was comical was that it might have been Greg’s business card that indeed saved us from a night in the back of a Nicaraguan squad car or prison. The first officer was rather cordial, perhaps in recognition of his error, upon realizing that we were social workers volunteering in his country with less than no intent to smuggle drugs or other paraphernalia. The experience showed us that the efforts against drug smuggling are active and supposedly quite effective.
This all brings me to my first trip with Greg since my last blog post. In light of his imminent departure Greg wanted to say “adios” to all his friends in a region of Nicaragua where he worked building water systems around 10 years ago. Our first day I departed at 4:30am with Greg’s driver Moisés and we headed to pick him up at Santa Rosa where he had stayed with a delegation of high school students from Maryland. The same delegation also took a tour of the hospital two days prior when their plans took a rain-check. It was enjoyable for me as I played side-kick tour guide to my boss Dr. Lau, who the nurses refer to as “chinito”—the little Chinese man; Nicaraguan’s typically lack tact in their nicknames. The following day, I conducted yet another tour—this time solo—with a man who graduated from our prestigious 4-year-institution in 2005, his name was Andrew and he works as a Peace Corps volunteer in the field of public health in Central America. After only dinner and a short while in the hospital the following day, I can tell he is a great guy and if I ever have the chance to work with him in the future, it would be a great opportunity. Anyway, back to the trip: Moisés and I picked up Greg and then met up with a man that could be Greg’s future fellow-employee; his name was Emilio. Emilio works with an organization based out of Denver and his organization is basically a consultation-only organization in that they help with community development projects (from latrines to schools) so long as the community solicits the aid and takes an active role in the development itself. Our first stop was a little town tucked away in the foothills of two dominating mountains. The town’s name was San Nicolas—Saint Nicholas. So we stopped there for a bit so we could meet the mayor and Greg could shake hands and introduce himself. Upon learning that the man was in a meeting, however, Greg made the executive decision to leave. And thus, alas, I was that close to shaking the mayor’s hand of Santa Claus town. After this, Emilio directed Moisés to drive the truck around a vast expanse of mountain roads and dirt trails to see two schools. On the return trip, Moisés tried to speed through a slick roadway and then up a small hill, but instead mired the truck in mud. After a good half-hour of road construction from Greg, Emilio, and I, the truck was able to climb over the rocks we had placed in our makeshift road. For those of you familiar with PENNDot (Pennsylvania Department of Transportation), the rudimentary road work would have rivaled any project of theirs, AND it was done in a third of the time. Once the sun slipped below the horizon, I had been in the car for 15 hours of driving time. When we finally got to the San Francisco Hostel at 8pm that night in Estelí, we had Tip Top for dinner—an exclusively Central American fast food restaurant that my appetite has fallen in love with. At least I will not lose any weight by the time I get back. The following day we drove out to Jalapa, a small peninsula of land that juts into the side of Honduras like a thorn. In a narrow valley overshadowed by magnificent ridges of trees—pine and palm coexisting—sits the comfy town of Jalapa, with all the quiet feeling of the rural countryside. We stayed in the house of a man who has had an interesting (in a bad way) history with other gringos, mostly from the Peace Corps, yet the man, Don Enrique, accepted us with open arms—literally—and exclaimed how proud he was to be our host. That same day, the objective was to hike to a water system that had only been half-way completed thanks to a lack of funding. So after a cup of coffee at Don Enrique’s house and a second cup of coffee at the director’s house, we were off. Just kidding, we had to turn back because the host, Danielle, had forgotten his proper footwear. When he returned from the house, he threw a machete in the back of the truck and looked at me, winking, said: “Para las culebras”—for the snakes. He laughed and I let out an uneasy chuckle until Greg turned around and said: “no he’s serious; the small ones are really quite poisonous.” I think I chuckled a lot less after that.
Shortly after, as noted at the beginning of the blog, a man with a red shirt, ragged jeans, and a shotgun opened the gate as we rolled on toward the mountain. Greg said that I should flick him off to see what happened. I preferred not to be shot at, though, so I refrained. During our hike through the jungle, Danielle went first followed by a group of 3 others and then Greg, Moisés, and me. Along the way, I learned of the manifold dangers of the jungle: a tree called “Ya te veo”—now I see you—that causes painful allergic swelling lasting up to a week just by touching the bark, the buried landmines left over from the years of civil war in the 80s, and, as always, the droves of mosquitos and other bugs. When we finally arrived at the water system, it seemed well-designed but Don Enrique grumbled that not only was the pressure-break box not built high enough, but that it was also stealing water from a nearby water system that provides water to another community. After spending way too much time looking at a cement box in the middle of a stream, we climbed back down. During the descent we saw a sloth and, given that I was lagging behind the rest of the group sniffing an odiferous leaf, they decided to nickname me “the sloth.” The leaf was from an orange tree and they said that even the leaves smelled like oranges. So, with the leaf glued to my nostrils I sniffed it all the way down the mountain and decided, based upon my highly sophisticated sense of smell, that it smelled more like Fruit Loops. When we returned to Danielle’s house, we had another shot of coffee (literally served in a shot glass) with cookies and finally returned to Don Enrique’s for the evening where we had a very-filling dinner with cake for father’s day and, of course, yet another cup of coffee. Because coffee is a main export of the country, I imagine that the Nicaraguan’s find pride in sharing their own home-grown brew. My mother, however, is a dental hygienist and would probably not take too kindly to an addiction to coffee so I will be sure to cut the habit promptly. The following day, at 6 in the morning we hiked up another mountain to view the water system Don Enrique had been in charge of constructing over 10 years ago. Not only is the Don a 76-year-old campesino man, he is also a great grandfather already, and, quite embarrassingly, he beat all of us up the mountain. With a heartfelt goodbye, we left Jalapa that afternoon for the 5 hour ride to León where work awaited me the following day.
Work that day was busy, to say the least. Every time I walked into the ER, another doctor had me running upstairs to test blood samples, which I did 16 times, take a blood pressure, review an EKG or help put a catheter in (which they, for whatever reason, feel that I need to learn). Needless to say, work always has something new to throw at me. And my thighs got a fine workout.
The last two days Phellix accompanied the Three Musketeers making us the Fantastic Four as we braved another adventure out to Talolinga and Santa Rosa de Peñon. While there, we visited the rural clinic in Talolinga, where I was originally set to work, and the headquarters of Public Health in Santa Rosa, as previously mentioned. The hike to Talolinga was, as per usual, muddy and frustrating but well-worth the trip. The people of the mountain were amicable and the children stared open-mouthed at the pale gringo. While there we saw one of the oldest and largest trees in the community and visited the farming cooperative that Proyecto Gettysburg-León (PGL) has helped fund. That afternoon, we went to meet Emilio again and we drove through a beautiful reserve known as Mira Flor until we arrived at the small school where a community gathering was slated to take place. Moisés, Phellix, and I went adventuring while poor Greg languished in what turned into a community filibuster. Before departing, we ate at a completely empty but rather upscale Colombian restaurant. Greg later informed us that it was probably empty because a Colombian spy had been caught passing on military secrets. Thank goodness they were not trading cooking secrets, that would have been a catastrophe.
Today, Friday, I woke up and dressed in my best attire, shaved my beard, and combed my hair because I had a hot date with a camera waiting for me at the hospital. Greg arrived around 11 o’clock and, after asking for the permission of the patients, snapped several photos of me actually doing work. Now I can finally prove that I am not just spending all my time going on hikes and adventures.
In other random news, a scrawny, quite hairless chicken happened to wander into the house today and Phellix, with his excellent trapping skills, scooped up the little thing and tossed it in a bucket to give to my host mom as a gift. I thought it was a joke, but, to my surprise, she was genuinely excited about her small gift.
And, from this corner of the world, I think that is all there is to report. It is about 10:04pm local time and I have never been more excited to go sleep on my straw-stuffed mattress.
Thanks for reading!
Christopher Joseph Dellana

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