The Land of Lakes and Volcanoes

Following are excerpts from a travel journal keptby the author during the MEDICOS trip to Nicaragua last summer. Three accompanying photographs on the inside back cover can also be viewed on the online edition.

June 20, 2005 - Day 1
Leaving from San Francisco was hassle-free, except for the 1:30 a.m. departure time, which was a relief considering all the medical supplies we have with us. I carried the endoscope in its briefcase through the security check and was happy not to be asked to explain what it was -although I could have offered the guy a free screening colonoscopy had he stopped me….

My first impression of Nicaragua was of the oppressive humidity, unlike any that I've experienced before. I wonder how long it will take to get used to the climate…. Dr. Sprinkle was amazing; helping the team find our way through Managua and to León, he bought some bananas and water from street vendors as we sped past them in our fully loaded minivan turned landspeeder. León is a pleasant small town from the little I've seen of it this evening. Some kids and a man begged for some money as we sat and had lunch….

The matriarch of my host family is named Paquita. Other members of the household include Paquita's daughter, Leonora, who has two cute little kids, Maria Alejandra (age 6) and Carlos Roberto (age 18 months). My room is simple and accommodating. The floor is tile and there is a shelf, small table, nightstand, chair, clock, picture of some flowers, relic of Jesus above the bed, and a fan. There is an adjoining bathroom where I anticipate taking many cool and refreshing showers during sultry afternoons.

June 21, 2005 - Day 2
Today started, literally, with the rooster's crow. Breakfast and dinner were served by Paquita and were very tasty. Although, I think I may have offended her when I questioned, or rather, worried about getting sick from the food. Paquita assured me that she has been hosting students for five years, and none of them ever got sick from eating her food…. Today was the first thunderstorm of the trip and it was simply spectacular. Booming thunder with flashes of lightning and a torrential downpour for about 30 minutes and it was gone - great stuff.

June 22, 2005 - Day 3
Clinic started today for a few people but I couldn't make it to the one I've been assigned since we arrived at the Centro de Salud (a large clinic within the city) at 8 a.m. and the ride out to the clinic I'll be working at departs at 6 a.m.

Those of us who didn't make it to our respective clinics took some time to visit another clinic called Osman Rios - it was about a 10-minute ride on a camioneta (the most convenient form of public transportation about town) from the Centro de Salud. The Osman Rios clinic is in a part of town with all dirt roads; it was peculiar how the border between the nicer and less nice part of town was so distinct. All of the animals wandering the streets, mostly dogs, were very thin and sickly looking….

Later in the afternoon I visited the big market next to the Cathedral and it is quite a colorful place. Tripe, live iguanas that have their legs bound, various kinds of tropical fruits, meats, toys, and a bit of everything else is available for purchase. Interacting with children in the town has been great so far, but a few of my colleagues have had a tough time for giving the kids money or food; doing so will lead to more attention and begging. Now they look forward to our last day here so they can give all the kids whatever money they can spare as we leave.

June 23, 2005 - Day 4
Today started at 5 a.m. since I had to be at Sutiava by 6 a.m. to meet the doctor and nurse whom I'll work with at the clinic in Goyena. The bus to Goyena leaves at 6:45 a.m. and riding out to the pueblo takes about 30 minutes - the roads are made of mud and rocks - but the trip is through some beautiful countryside with volcanoes apparent in the distance. Interrupting the serenity of the countryside is the very poor situation of the people living there. Some families live in grass huts without walls or floors. Doctora Dalila looks to be 25-27 years old and is very sweet. She spent lots of time talking to Huong and me since there was only one patient during the day and she showed patience with our Spanish skills. The patient was a young woman who came for a depo provera shot….

Dra. Dalila graduated medical school last year and is currently doing her year of service (something all newly graduated doctors do) at the clinic in Goyena. She hopes to learn English, take the USMLE, and secure a residency in the US…. The truck ride back into town from Goyena was the highlight of the day. A man riding a bicycle was literally left in the dust as the truck sped by, leaving him to pedal in a cloud of dirt. I wonder if he was riding all the way into town; it must be a long and difficult trip considering the heat and dust from the few vehicles on the road….

The food Paquita is feeding me continues to be excellent and my stomach is happy.

June 24, 2005 - Day 5
Today was quite an adventure. There were a few patients in clinic and everyone had fever and pain. The standard treatment seems to be acetaminophen, an antibiotic, and sometimes a blood smear is collected so it can be sent to the Centro de Salud to check for malaria. I do not yet understand the reasoning behind who gets a blood smear and who doesn't but I hope to soon….

We visited a home near the clinic that was very modest: dirt floors, animals living alongside people, and yet a television was blasting over in the corner. Along this same theme, I've seen people biking down a dirt road and talking on a cell phone. It's an odd juxtaposition of modern luxuries set against a backdrop where I hadn't imagined such things were found….

To get back to town today, Huong and I first had to hang on to the back of a pickup truck for dear life for about 20 minutes before arriving at the main road. Then we waited, in pouring rain, for another 20 minutes for another ride back to town. A Landcruiser came by and picked us up, then we went on a wild ride through the countryside, all the while the roads became ever smaller and less like roads, before heading back to town. It was a 40-minute detour and making it much more outrageous was that our driver was learning how to drive. When the driver came to a full stop, he would slam on the brakes and toss all of us sitting in back for a loop.

June 27, 2005 - Day 8
There were lots of patients at clinic today. I did my first ever "pseudo" exam on a pregnant woman, even heard a fetal heart beat. Also, a man came to clinic with an odd lesion on his arm, it was perfectly circular in the center and surrounded by pus, maybe two by two inches in size. I really need to learn how to describe lesions better…

June 28, 2005 - Day 9
We walked to nearby villages today in search of children scheduled for vaccinations. These vaccination walks are a weekly occurrence. The villages we visited were constructed by the government following a hurricane that displaced many thousands of families. Many of the homes were made of sheet metal and garbage bags. We met one woman who said four of her children died during the hurricane. Now she has six children, all of whom appear to be under age 10, and she has been pregnant 13 times….

At best, I get a fleeting glimpse of what the lives of these people are like. I see the condition of their homes during a brief moment and see the surrounding area, but this is not nearly enough to know what it is like to live under such conditions. Really, I only have a slight idea of what the "conditions" I'm trying to describe actually are. But I have to be (or should be) appreciative for the exposure that I'm getting.

The exposure is what this trip is all about at bottom. One of my colleagues said it well the other day, "This trip is not about helping people;" other than ourselves by the experiences we gain. There can be no doubt about this, yet it doesn't devalue the trip. The lasting value of this trip comes in the form of humanity gained from just being here, observing and participating in the local way of life.

July 6, 2005 - Day 17
Half way! There are 16 days left of this adventure and I'm sure that the next two and a half weeks will be as great as the last. I woke up with a few small hives on my arm, abdomen and back so I took some benadryl before heading to the clinic in Osman Rios. For a while during the morning the benadryl made me drowsy and I had a tough time concentrating. Dra. Vargas was great as usual; she includes us in everything and takes lots of time to make sure that we understand her completely. I'm going to try to show more enthusiasm for her tomorrow. All of the doctors and nurses our team has worked with have been so welcoming and generous that I felt bad for being less than cheerful at clinic today….

We saw a lot of patients, one little 8-year-old girl had an arrhythmia that Dra. Vargas said was likely due to malnutrition. I had been listening to the girl's abdomen and decided that since she was already lying there that I would listen to her heart. Lesson learned: always listen to each patient's heart. I know I should have this down already but apparently I don't. Just goes to show how much work I need to do on my physical exam skills. I also did a few prenatal exams.

July 8, 2005 - Day 19
Dr. Barrera, a faculty member at the medical school located in León, took a few of us to the main hospital to observe in the OR. Seeing the hospital was very eye-opening since it has so little by US standards. The equipment available looked very old and the four operating rooms are shared by every surgical service. General surgery gets to use the OR two days per week. Dr. Barrera was very gracious to us and allowed us to observe a few cases.

July 11, 2005 - Day 22
Today was my first day working at the clinic in Troilo, and the first day of my last week in clinic. Dra. Bonilla is running the clinic during her year of service and is true to the rest of her colleagues in being hospitable and accommodating to our team. She hopes to get into a GI surgical residency next year in Managua. The clinic in Troilo is relatively new and overall the nicest of the three that I have seen. Much like Goyena, it is next to a school and few of the students were playing on the clinic grounds during their recess. None of the clinics have had running water or electricity.

July 13, 2005 - Day 24
We did a census count of children at the school next to the clinic. It was interesting to see the classrooms and the students staring at me. In each class only about half of the students were present. A teacher told me that students don't attend unless they have paper and pencil; it is not easy for families to buy school supplies so many students don't come to class. The teacher also said that to advance to the next grade level, students must take a literacy test - this is why the first grade level class had students ranging from 6 to 10 years of age.

July 14, 2005 - Day 25 We have finished up our work in the clinics. This evening we took all the doctors and nurses who worked with us out for drinks and food at a local restaurant as a token of our appreciation for their generosity. The time spent working with them has been an amazing experience for everyone on our team and we were all sad to say goodbye.

apomerleau@ucdavis.edu