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!

11/4/11 La Comida

After one week in Nicaragua I can safely say that I have never eaten more beans and rice in my life. Abuelita does most of the cooking at the house and she serves this as a side for casi todas las comidas, including breakfast. The best version is Gallo Pinto which is, of course, fried. There is always some fruit juice along with the meal, today was cantaloupe, and often fried plantains. She is a great cook but there IS the rare misfire, like this hot egg soup in clear broth. Not only is hot soup on a 95 degree day not my ideal meal, but when there are two whole egg yolks floating in it I am reminded me of something from Indiana Jones that’s like laughably terrible. Had delicious seafood stew at a restaurant on the beach that afternoon!

It has not been very difficult to keep my Lenten promise since the fish here es muy delicioso. I had great pescado asado in Ometepe, made even better with a rum and coke! I hear that they served cow intestines last week at the house. Thankfully I have a built in excuse should they try that again! I stick to shrimp and fish and we have even had lobster a few nights. I definitely do not miss Taco Bell.

10/4/11 La Religión

Stella and I were feeling ambitious so we got up early and went to mass at the little iglesia Parroquia San Juan Bautista. They still use kneelers and bells at the consecration and the priest gave a VERY long homily about the resurrection of Lazarus, but it was a very interesting experience! The sign of peace was a truly involved process with everyone going to shake hands with everyone else in the church. Old people kept coming up to us and putting their hands on our shoulders, we must have looked like we needed the love! Religion is very important in Nicaragua and most people are Roman Catholic. The Church has a lot of political influence here, and, even though there is no official religion in the country, the separation of church and state has not entirely occurred.

There is a statue of Christ, El Cristo de la Misericordia, at the summit off of the beach in San Juan. It is a point of pride here and it’s the second largest statue of Christ in this hemisphere after one in Brazil (or something like that.) I decided to climb to the top today to see the view. I get up there and the gate is locked. There is a sign that says foreigners have to pay 20 cordoba ($1) to enter, but there is no guard on duty. I thought for a minute I was going to have to break in to see a statue of Jesus, which didn’t feel right, or climb all the way back down without accomplishing my goal, which didn’t feel right either. I had pretty much decided to chance it and scale the gate when a woman noticed me and came over to unlock it. Good thing because after I paid and walked in I noticed there were two large pit bulls chained just inside. Luckily the view from the top was beautiful!

9/4/11 La Isla de Ometepe

The hour long boat ride to this island in the middle of Lake Nicaragua was pretty scary. I really thought la lancha was going to capsize and I disembarked very happy to be on solid ground. Even the more stable ferry on the way back was a rocky ride. Both the ferry and la lancha let passengers off in Moyogolpa, where I hired a driver for the day so that I would not get lost and be sure to hit all the highlights of the island. The two volcanoes that give the island its name are Maderas y Concepción, the latter an active volcano that occasionally spews humo. I asked my guide if he would be afraid of an eruption, he laughed and said that he would not, but that others may. I was like hmm, I feel as though that is not an unreasonable fear.

We first came to el Charco Verde, a green pond that is connected to the Lake in the rainy season. On the walk there we saw a ton of wildlife including howler monkeys in the trees! The sand on the beaches there is black from the ash of the volcano Concepción washed down by the rains. Next we scaled what was supposed to be a short walk but ended up being a 45 minute long trek up a pretty sheer hill. Luckily the wind is so strong that it blows you into the side of the incline for security. My guide told me that to climb the volcano you have to scale the last part on your hands and knees because it is so dangerous. No thank you. The vista from the top of our climb was amazing though!

Lunch at Playa Santo Domingo and a swim in el Ojo de Agua, a beautiful natural spring, finished out the day. My guide was very nice and enthusiastic about his island. We did not speak a word of English the entire day. He asked me where I learned Spanish and if I studied abroad while at university. I said no but that I had classes in high school and a few in college and then practiced when I could. I’ll have to thank Señor Brakel if I ever see him!

8/4/11 La Clinica: Segunda Parte

After three days, Dr. Rodríguez seems pleased with my comprehension of the language. She tells everyone, “this is the American doctor, she doesn’t speak much but she understands a lot, true?” Then it gets really awkward when I don’t always realize she’s talking to me and don’t respond, but it’s progress! I haven’t figured out if she can’t or just won’t speak any English, but I am finally having an easier time catching on to her pronunciation. No one here pronounces their “s” so it is VERY difficult to understand when they speak quickly. “Mucha gracia” took me a second. I guess we are no better. I try to picture some nonnative speaker getting thrown into Detroit and having to figure out how long “bout a minute” is and what “boo boo” means.

By now I can pretty much conduct a prenatal visit en español on my own. Literally every woman in this town between ages 16-36 is pregnant, or has a newborn. I hope that is not ALSO something in the water. I have had ample practice writing scripts for supplementos de hierro con ácido fólico y vitaminas prenatales. “No puede tomar, fumar, ni beber café negro” rounds out the advice to the expectant mothers. I have read ultrasounds and done fetal heart rates and a few pap smears. Good thing I paid attention in my ObGyn rotation! I like these and the pediatric visits though because I know what kind of medicine to expect, so the translation is easier. It took me about 10 minutes to understand the guy who came in with a gluteal abscess, and when I did I was like oh gross!

I haven’t yet worked in la sala de emergencia. My tenuous grasp of la lengua isn’t quite at the point of surgical abdomens and traumas. I’ll save that for next week.

7/4/11 La Ciudad Pequeña

There are just under 20,000 people in SJDS. To put that in perspective, that’s about the size of the student section at a Michigan Football game. I already see the same people over and over again, which is a double edged sword since one of them is a scary clown. Most are local Nicaraguans, but a fair number are tourists and expatriates who have moved here for a taste of the simple life. The main industry of the town is tourism. There are a ton of Europeans here and most of them are in the middle of months or years long tours of South and Central America. There are beautiful homes in some areas that are generally owned by wealthy foreigners but are empty most of the year.

The town is on the Pacific Ocean and sits between two mountains. There is a small school, a church and of course our clinic. Went to watch a basketball game last night with some of the girls who work at la Iguana. For the first half I thought the players were middle school students so I was all, “ohh look how adorable and serious they are!” Then, when one came to say hello to the woman next to me at halftime, I realized that they were like 30, and that I am a REALLY bad judge of age.

I have been going to the bar every night. The rum here is amazing. I have to find out what the laws are about how much I can bring back to the States.  Oh and it’s also a great place to practice Spanish since there is no getting rid of the locals who want to chat you up. Apparently I’m a pretty good speaker, for an American. I think it’s the baseless confidence two ron y colas gives me.

Got a “Go Blue!” today at the beach while wearing Michigan shorts and yellow tank top. Love it.

6/4/11 La Clinica

I should probably explain the point of this whole visit-a-third-world-country-by-myself excursion. I came to volunteer at El Centro de Salud, the government clinic in SJDS, through a Sister City program based in Boston with the Harvard School of Public Health. Today was my first day.

I worked with doctora Katya Rodríguez and felt like a first year again; worse, a first year who doesn’t even speak the language. I could understand less than 1/3 of the dialogue between her and the patients. Also, no Spanish speaker can say my name. I think it’s the “th” diphthong that trips them up, so she keeps calling me “doctora,” a title to which I have not yet, nor will I soon, become accustomed and NEVER know to respond to. We saw only women and children, who I think make up most of the population at the clinic, at least for the scheduled visits. I think the urgent care and ER portion of el centro see more men. Perhaps it’s because of el machismo that they tend to put off routine screening more than the women, though this is not much different than back home. Care here is completely free, and as a result the necessities of a doctor’s office are lacking. The JCAHO people back in the States would have a fit over the lack of latex gloves and hand sanitizer on every door.

Kidney stones, bladder infections y otros problemas de riñón, comprise a large portion of the diagnoses; there is something about the sulfa content in the imperfectly purified water causing all this trouble. I saw a few pregnant patients at various stages of gestation, and let me tell you, taking a detailed sexual history en español for a ministry of health form es MUY difícil. One little girl walked in with a rash and, after just coming off of derm and ER, I thought, “I’ve got this.” Chicken pox. Missed that one. Haven’t seen that since I had it myself as a kid, and likely won’t see it too often if at all in residency. There are big public health campaigns to get people vaccinated against this and other common problems that in the US are routine, and there has been amazing progress in the last few years.

Dr. Rodríguez asks me where I am in my training, a question that I always think means to insinuate something about my lack of clinical acumen, and I tell her that I have finished medical school and await graduation in May. I say I am going to be una pediatra (which is easier than figuring out how to explain Med-Peds en español.) She seems pleased and says she will see me tomorrow.

No lives saved yet, but stay tuned.

5/4/11 La Casa Salvadora

My alarm clock is roosters. Real ones. Not like the techo farm animal alarm on my last phone. They wake up before sunrise, which is 530 AM down here where they don’t observe daylight savings time.  It works out fine actually because I can’t figure out how to change the time zone on my iPhone and my ability to remember that it is on EDT every morning is much less reliable.

Today was uneventful; just explored the town a bit, so I’ll talk about the house where I stay. I STILL haven’t figured out how many people actually live in la casa Salvadora. There are at least three children and three adult women, a husband and plus or minus one other brother, and I am NOT sure where they all sleep since as far as I can tell there are only two other bedrooms and a den in this place. Salva, her sister and their mother, also named Salvadora, run the house. The children’s parents are...well I’m not actually sure who their parents are to be honest or if they are even related. I asked Andy, the young boy, how many people live here and he said even HE didn’t know! (Though some of that may have gotten a little lost in translation.)

For now I know that Salva’s sister does the cooking for us and that they own a restaurant on the beach that is supposed to be pretty good. I told her that I can’t eat meat hasta la Pascua. Luckily I’m in a Catholic country so she didn’t look at me like a freak, and served up a plate of arroz y frijoles without question.

After my walk yesterday I came home and met Stella, a Harvard Medical student staying in the room next door. She filled me in on the water situation, the clinics and some other useful info about staying here, like that the power gets shut off by the government every day from 7 AM until early afternoon. Awesome.

Ahora vamos a la cantina. Apparently at “la Iguana” ladies drink free four nights a week. ¡Qué bueno!

4/4/11 La Llegada

I land in Managua, the capital city of Nicaragua, around noon. The drive from the airport to the small village where I will be staying, San Juan del Sur, is a 3 hour trip.

My driver, Marcos, was a very pleasant man who is often hired by visitors to this village. We stopped almost immediately for some rehydration with coconut water, straight from the fruit of course, and were, shortly thereafter, delayed by a herd of cattle crossing the highway.

The soundtrack to our journey was a CD of what sounded like old polyphonic ringtone versions of classics like “Red, Red Wine,” the “Mission Impossible Theme Song,” and Britney Spears’ “Hit Me Baby One More Time.” We chatted about a variety of subjects along the way, while narrowly avoiding at least two dozen auto accidents. We covered the helmet laws in Nicaragua, and most people’s choice to completely ignore them, the tourist spots where foreigners frequent, the volcanoes in the area and the local agriculture, among others.

The car ride is making me realize that my Spanish isn’t as horrible as I was worried it would be, but I still have a LONG way to go. We stop for pastries and to fill the gas tank at a Texaco station.

Marcos recommends a local fast food joint in the neighboring town of Rivas, with the best fried chicken you will find here. I say I’ll have to try it, though I won’t be able to since giving up meat for Lent! Not too worried though, for peces y mariscos (fish and shrimp) apparently there is no place better than San Juan del Sur!

I arrive in SJDS at about 15:00 local time and to la casa de Doña Salvadora, a cute little green house also next to a Texaco station. I am greeted by her sister, two small children and a chihuahua puppy and shown to my room.

It’s VERY hot here. It is the end of the summer and the rainy winter season will begin in a few weeks. Everything now is very dry. There is no AC, but I have my own room and private bath, even though the water has to be turned on by hand at the tank outside before it can be used!

A lizard just crawled across my wall.

¡Me voy a andar ahora! ¡Hasta luego!