Week of March 10-18

It has been an exciting 9 days with lots to write about. We had a long Saturday going house to house giving vaccinations as well as brief preventative medicine tips to families and children. It was extremely hot, but we pushed through going to near 30 homes. The best part of this campaign is how welcoming most of the people we visit are. They all pull up enough seats for all of us to sit right away and at times offer us food and drinks. Most seem genuinely grateful for our presence.

Sunday was our free day, and as planned we went to the nearby volcano (Cerro Negro) with our homestay family in a tractor. It was a surreal experience. They attached an old rickety wagon to the back of the tractor, piled 14 people into the wagon and on the tractor and off we went. Riding through dirt/gravel roads through villages, we made our way to the volcano. Towards the end of the ride, the bench on our wagon broke, but we just rearranged our seating and kept going! 

Transportation to Cerra Negro

About an hour and half later we arrived at Cerro Negro. There, we saw many tour groups, and saw many of them astonished at our arrival and taking numerous pictures of us. We hiked the volcano and some of us volcano boarded down it. Surprisingly, most of the family was fearful of boarding down the volcano. We had a picnic lunch and then got ready to head back.

"Volcano boarding"

Back to work on Monday, the vaccination campaign is in full force with at least half of the clinic heading to the village and going house-to-house every day. This leaves the clinic very short staffed all week which is where I stayed (Juan mostly stayed as well, going on the vaccination campaign one day). On Tuesday, Juan, a local doctor, and I ran the clinic, just the three of us. We checked the patients in, evaluated them, gave any needed injections, and filled prescriptions and somehow kept pace with the patients.

House to house vaccination campaign
 
On Thursday, Juan gave a great talk to a group of high school students regarding domestic violence and abuse. He used to be a teacher and one could tell as it was very well done and he held their attention throughout. On Friday ,as we were closing up, a man walked in with a relatively large laceration on his wrist. We cleaned it up and sutured it as best we could with our supplies. The needle took extreme force to pierce the skin and sterile technique is a relative concept in a village health center (due to resources). Some gloves and clean paper under his hand were about the extent of the sterile technique. The wound closed nicely and he went home with early follow up.

Throughout our time in the clinic, we have obviously noted many issues that could be improved, but many are due to lack of resources. One issue that seems like it could easily be improved is family planning and contraception. Contraception is given with appropriate privacy and is completely free. However, a monthly trek to the clinic/pharmacy is needed for any woman on birth control and for condoms, one must go to the pharmacist and request them and may even get a brief lecture from the doctor before getting them.


Obviously, these can be large barriers to adolescents and Juan and I think there could be some simple improvements to this system. I may even try to undertake this as my project for next year. We are going to go back to the high school next week to discuss some of these issues in a focus group-type setting to assess the feelings of the adolescents and the potential for improvement.

A dust storm

Another issue of interest in the clinic was with one of Juan's patients, who was suicidal and in Juan's opinion, required hospitalization for his personal safety. This is not as easy of a proposition in the village as calling an ambulance and signing a paper. We learned that involuntary commitment in this setting is not fully possible. First, in order to get him to the hospital, the patient had to call a friend or relative to drive him there. Then once there, after the initial evaluation, inpatient treatment was recommended for three days, but the patient did not want this so he returned home. The system is a little different here, to say the least. So far, luckily, the patient is doing slightly better.

As for our life after work, village life continues to treat us well. We feel completely comfortable with our homestay family. We continue to play lots of baseball with them along with some other makeshift games,such as basketball, and volleyball. We talk and hang out right up until we go to bed every night, often sharing as much as we can about each other's cultures as possible. After work on Tuesday, Juan and I went to the city on the bus to use the Internet, planning to return on the evening bus. We underestimated the time in getting to the bus and missed it. We scrambled and got a cab to take us to the road that goes into our village, but it's a poor dirt road, so did not ask him to drive us in.

It's about 5 km from this point to our house. We began walking and soon a pickup truck came by offering us a partial ride. When he needed to turn, his friend in another truck drove by and we hopped in with him for a short portion. This left us within a 30 minute walk to the house. Our family was worried about us and sent their kids on dirt bikes to pick us up. So through the kindness of the village, we took 3 forms of transportation to cover the 5 kilometers!

We had this past weekend off, so Juan and I decided to leave the dry, hot, dusty area near Leon and headed north to the city of Matagalpa. Apparently, the express bus required reservations for seats and was full, so we had to stand, packed in ridiculously tight, for the 2.5 hour ride. On the bright side, it costs only $3. We met some German medical students working in Leon on the bus and hung out with them in Matagalpa. It is a nice town surrounded by mountains, but nothing too memorable.

View from our hike at Selva Negra

On Saturday, we hopped another bus to a eco-lodge/coffee farm called Selva Negra. This hotel was pretty amazing and we had a hot shower for the first time since leaving the US. The hotel is in a cloud forest, far enough from the road that engine noises can't be heard. There is a gorgeous lagoon where the restaurant is perched and we may have been the only non-couple there as it is a quite romantic place! We took a pretty significant hike and then relaxed and hung out with a nice Canadian couple.

Sunday, we toured the farm and coffee plantation, and took a short hike, but after much effort and following the howls, were able to spot a group of howler monkeys and proceeded to have monkey feces thrown at us. We then had to begin the journey back to Leon. We were told that there was no reservations on the way back, but this was incorrect and we ended up standing again for the journey back to Leon. We stocked up on water, I worked hard to type this blog up and we prepared for our final week in the village!