18/4/11 La Salida

This morning I am sad to say adios to Nicaragua. I will miss the weather (it didn’t rain once and there was rarely a cloud in the sky), the people I met, the adventure and of course the rum. I do have 4 bottles in my bag right now though, so that should last me at least until the end of the month!

My cab driver from the bus station in Managua to the airport was happy to chat about my trip and what I was going back to in the States. He is impressed with my Spanish. They say once you speak without thinking you know you are on the right track. I say I should not even do that in English, but regardless. I have progressed a lot but can’t wait to get back to my native tongue.

At my stop over in Atlanta the guy directing people at customs is trying to speak to me in broken Spanish, meanwhile I am wearing my Michigan tee shirt and Wayne State School of Medicine zip-up thinking, “am I really THAT tan?!” I say, “uhh obviously I speak English,” he goes “oh thank god.” My thoughts exactly.

17/4/11 La Adventura

Today I ash boarded down the side of an active volcano. Somehow I talked Stella into trying it with me, even though she says she prefers to stick to things that aren’t likely to kill you. Cerro Negro is a young volcano just outside of León whose last eruption was in 1999. Our guide, Franklin, assured us that the eruptions only happen every 12 years or so. Doing the math we were a little comcerned but he was confident we would have heard if anything was brewing. He was billed as bilingual but he was more like quadrilingual, fluent in English, German and studying Italian and a little French, along with his native Spanish. ¡Muy impresivo! He was great to chat with, in all languages, and kept our nerves at bay on the climb up.

Scaling the volcano was HARD! The landscape was all rock and ash and was at times pretty terrifying. The views were amazing! We took tons of pictures trying to delay the inevitable trip down the mountain, and once we got to the top we had quite an audience! The ride down was invigorating, if a touch dirtier than snowboarding. I would definitely recommend it if you are ever in the area!

16/4/11 La Ciudad Vieja

Early this morning I said goodbye to San Juan as Stella and I travelled to León, the oldest city in Nicaragua. We walked around the city all day and went to a few museums. Well I feel like I’m using the term “museum” pretty loosely here. They were more like small private courtyards that had art hung up around them at random locations. There were armed guards and confused looking people asking for donations. One was a contemporary art museum that apparently has the largest collection in Central America. I thought of how the curators in Europe and the States would cringe at the lack of climate control or security surrounding the many Picasso’s here.

We also went to a museum of myths and legends, which looked like a glorified haunted house. Since we aren’t exactly fluent in Spanish (a fact our guide chose to ignore) we only understood the gist of most of the legends. One that I feel I really misheard was a bogey-man type story designed to scare young children and teens, but the bogey-man in this case is a large chested woman who will catch you at night and suffocate you to death with her large breast. Interesting. There are some beautiful churches here though, and everything is being spruced up for Semana Santa, which is apparently like Spring Break here.

The staring and cat calls are really starting to get to us at this point, and I think Stella may actually try and fight someone soon. A month in Nica has really tested her patience. At least in San Juan the same people have seen us day in and day out for the last few weeks so they are kinda over it. We hit up a touristy spot at dinner for refuge.

15/4/11 La Clinica: Última Parte

La doctora and I talk a little about the healthcare system here in Nica. It is government run so care here is free, but like in many other countries, to get really good, and reliable, care you have to go private. The family I am staying with took their child to Managua for a tonsillectomy and all the doctors they see are there in the capital. They are relatively affluent though and obviously this is not an option for everyone. Nica is the second poorest country in the Western Hemisphere next to Haiti, and it is evident.

On my last day in clinic Dr. Rodríguez asked that we keep in touch, and that when I get back to the States I send some things back to the clinic. I had already planned on sending some hand sanitizer and other sterile materials that I was bothered by not having in El Centro. She also asked for a stethoscope, BP cuff, scrubs, and the bag I was carrying. She literally asked for the items off of my back. I get the impression they think all Americans are Donald Trump. I told her as soon as I got back to the States I would send as much as I can. She thanked me for all my help and I thanked her for putting up with my muddled Spanish. I really enjoyed my time working there. It was definitely a new experience!

14/4/11 La Piscina

The other day at the coffee shop El Gato Negro, a kind of haven for expats that looks like a hippy version of Starbucks, Stella and I met a woman from Texas who has a condo here. She spoke very little Spanish and whatever she did had such a heavy southern accent that no one could understand her anyway, so she needed a translator. We starting talking, and grateful to meet other Americans, she invited us to swim at the pool at her condo complex in the mountains overlooking San Juan. We thought this would be a nice change of pace so we took her up on the offer.

There are many luxury condos being built around the area along with the resorts and flocks of people with money can come down and pay cash for these homes. This country does not believe in credit, or mortgages. Some people from Managua have private homes in the area, which is kind of like having a house in the Hamptons. It was strange to spend the day in a place where no one speaks Spanish and they cater to you like at a country club, but leaving refreshed and not covered in sand was quite nice!

13/4/11 La Playa

The beaches here are beautiful, sparsely populated and relatively untouched by tourists. Playa Hermosa, where Survivor Nicaragua was filmed, is nearby San Juan. By nearby I mean 30 minutes of hilly and rocky terrain away. The roads to the beaches are through the mountains and are generally only accessible with four wheel drive and I can’t see how they are accessible at ALL during the rainy season. Nicaragua has few paved roads. Resorts are being built along the way to the remote beaches, and the investors apparently have to bribe the government to lay down pavers in the areas where they are building. I feel like I came at just the right time to appreciate the beaches before there are hordes of tourists!

The beaches near San Juan are some of the best in the world for surfing, which I attempted to do but pretty much only managed to paddle out and then fall off of the board. I think it still counts though! I went horseback riding on the beach at sunset. The sunsets are amazing! It is VERY windy here, which means I leave with more of the beach on me then I leave behind, but there is nothing better than laying out on a beach with no one else in sight! I could definitely get used to this.

12/4/11 La Clinica: Tercera Parte

There are three other doctors in clinic, but only two see scheduled visits during the days, and some non-emergent walk ins. If there is an emergency then one doc is pulled by the triage nurse to see the patient and las consultas must wait. There is a lot of waiting in El Centro de Salud. The ER is staffed at night and they also make house calls in the outlying areas if needed. We went to a small house down the highway from San Juan to check on a woman who was on bed rest for the last 20 weeks of her pregnancy. Yikes.

They give steroid shots for everything. Apparently there is nothing that can’t be cured by dexamethasone and amoxicillin. We lost our thermometer somehow over that last few days, so we are doing tactile temps, which are not terribly accurate. Apparently I don’t know how to use a mercury thermometer anyway so that’s no big loss. I had to weigh a baby today using a scale that looked like it was from the 1800s. I acted as a translator for a Canadian couple who brought their two year old in to have stitches removed.

I am learning a lot about the way medicine is practiced here. Nicaragua still has a very paternalistic approach to medical treatment, which is both interesting and distressing. For the doctors everything is very black and white, there is little compromise. If you don’t give your baby Tylenol when he gets a fever he WILL have a seizure, and then he WILL have seizures for the rest of his life. Well that is definitely not true but I wonder if that is the necessary approach made by the doctors here. I wish the advice about weight loss and not drinking gallons of juice and pop were heeded as freely. But such is life no matter where you are in the world!