Now what?

Wow so here I am back at Duke and getting back into things.  By no means am I settled in yet but it is truly amazing how much easier is it to get used to the luxurious life in the US and be spoiled by it.  I found myself getting upset already that my wireless internet connection is finicky when I was lucky to get internet for an hour in Nicaragua. I am back to paying 10 dollars for a meal and paying a drink what would be a meal in Nicaragua.  I haven’t spoken Spanish in a long time.  I no longer say Gracias instead of Thank you, Or “Puedo..” to ask for permission.  I haven’t gotten up and sat on our porch in the wind, talked to a parrot or a nun, picked a mango from a tree and eaten it, bartered at the market, picked through Gallo Pinto and sour tofu cheese for every meal, or heard a “Chiquita bonita” either.  And I honestly no longer feel guilty not finishing my food, eating delicacies like cereal, or taking really long, warm showers.  I miss fluttering through the hospital hoping to find Martita the crazy nurse that will make me laugh or Harold to give us advice or Veronica to answer questions. I miss making my own schedule and figuring out what to do with my time and resources.  I miss not having to be anywhere on time.  I miss walking places.  It has been really hard to come straight back to Duke (after the conference of course), so I haven’t yet processed everything.  I am just hope that as I am forced back into this culture, that I will not forget what I learned, saw, and experienced this summer- that I will not conform to the “Duke” culture.  The first night in DC I was upset because I wanted to go back to Nicaragua, where people are happy with what they have.   In DC, the very first night we heard 2 incredible presentations about how these kids built a back-up power generator for one of their many secondary projects in Tanzania (we made posters).  All of a sudden, I was thrown back into the comparison game.  I felt the pressure to be as good as or better than everyone else.  “I just want to go back to Nicaragua,” I thought.  Maybe it is because in Nicaragua, I couldn’t be compared to anyone there because I was so different.  Maybe it is because Nicaraguans don’t compare themselves to each other.  Either way, I liked it, and I want to continue that perspective here at Duke.  I also want to keep the big picture of life and of the world rather than get caught up in which library to study in. No, I can’t refuse food at a restaurant if they give us too much so that they will give it to poor Nicaraguan people.  But I can be thankful that I had so much food, volunteer to help feed the poor in the US, and not take more than I will eat at a buffet so it is not wasted.  I can’t change the country, but I can change the way I live my life.  I’m struggling to determine how to keep my perspective of the world, when my world for the next 6 months is a bubble known as Duke campus.  How do I use what I learned this summer to have an impact?   I don’t know.  But I am going to try.  I would love to use my new Spanish skills to volunteer somewhere (at church, in the hospital) so I also would remember how to speak.  I would love to set up a good equipment donation method online to create communication between donors and donees.  I am worrying that instead I am going to get caught up in my world of studying, swimming, and hanging out with friends (with some med school apps in there).  And then what did the summer accomplish?  What did I change?  Hopefully the lessons I learned will last longer than the 2 months I was there.  I hope that I left the hospital a better place than when we came- I do think so.  We cleaned the neonatal room and fixed the incubator.  I learned what I wanted to do with my life- be a doctor for sure!  I do see things differently now- I am thankful for my incredible education; I appreciate the amazing and numerous opportunities I have growing up in this country with a supportive family and friends; I see that the world as big and has a lot of problems but also a lot of people willing to help, work hard, and love everyone; I realize that most people deep down inside aren’t that different from each other- want to love, be loved, and provide for their families.  Just walking around during orientation now, I don’t assume as much as I used.  I saw a woman moving in a car of stuff by herself, and I really thought she might be going to school herself despite her age.  I see people of different races and don’t immediately stereotype them or think of them as different than me.  I heard the housekeeping workers speaking Spanish and considered joining in.  So even though I haven’t sold my car and apartment and given all my money and clothes to poor people in Nicaragua, I still feel a lasting impact from the summer.  Who knows what God’s real purpose of the summer was? I think that the most important thing now is not to try to live like a Nicaraguan here in the US as that is not possible or intelligent, but to apply the lessons of the summer to my life here- not valuing material possessions, being thankful for what you have, taking time to visit with family and friends and God too, showing respect and love and kindness to others, working hard because you should, thinking about other people over yourself (how to help other people).  It will be a long process to transition back to the fast-paced life at Duke and not miss the quality time in Nicaragua and it will take a while to process everything that happened there.  When people ask me “How was your summer?”, I honestly don’t know where to start or what to say.  “Absolutely amazing” is usually how it goes.  And it was.  I hope that I will always remember it- I know I will at least every time I eat rice and beans.

People make the world go round

We were called Nicaraguans today in the hopes that we would be convinced to stay!  Everyone has been so nice that words can’t even describe it.  This entire experience has blown my mind- words and pictures can’t describe everything I have seen, heard, learned and experienced.  I will absolutely without a doubt miss this place when I leave on Thursday.  As much as I enjoyed Costa Rica, I truly consider Diriamba, Nicaragua my home away from home.  Nicaragua has so much more culture I think that Costa Rica, which is very Americanized with more tourists and Gringos.  Here, I don’t just look twice but actually stare when I see a fellow Gringo.  No wonder everyone looks at us funny here!  We have also been much more involved in the culture here as we live and work in it as just 2 Americans in a town of Nicaraguans.  The people have welcomed us with open arms.  I am so thankful!

We now have a nurse (who’s poco loca) named Martita that yells “I love you” when I walk down the halls, runs up to us and latches arms to walk down the hallways, tells us the latest phrase she learned in English which must be from an entertainment show today’s was introducing a blind date contest, and tries to teach us bad words in English.  Last Tuesday, the adorable receptionist Veronica took Rita and I out for ice cream at the Eskimo shop across town- bought us both banana sundaes which were beyond heavenly!  She sits with us, waits patiently as I ask my millions of questions (slowly because they are in Spanish of course), answers them, gets us permission into the operating room, finds people for us, and even calls all the stores in Managua for us.   Tomorrow, we are going with the other receptionist to Jinotepe to some place but we don’t know where because we can’t understand her Spanish.  We will see.  It is the thought that counts.  The anesthesiologist even asked for our email addresses.  Harold, the technician, answers all of our questions and teaches us whenever he can.  Cheyo, the maintenance man, waved to us as we passed him on his bicycle in the street!  When we were painting the wall, another maternity nurse named Ruth came in to talk to us despite the awful paint fumes to give us advice about how to best do it- aka with a roller rather than a brush.  All of the maternity nurses now know us, smile when we walk by, and try to translate Shannon into a Spanish name.  The closest they got to was Susana. “Sh” sound is not common in Spanish, so no one can say my name.  Rita is much easier.  I tried saying “Shannon like Shaquira”- didn’t help.  The women in the laundry room that wash all of the linens (some in a machine which is quite the novelty, some by hand, and all hung out to dry) say “Buenos Dias Bonitas” we walk by.   The cleaning lady and X-ray technician smile and say hi, and the ayudantes who work in the little store “pssssed” at me today as I walked by to get my attention.  We were riding the bus home from Jinotepe one evening, and the lady sitting next to me works at the hospital and just started talking to me.  When we went around asking all the nurses for info just about the hospital and their needs, everyone was very willing to talk to us.  We have not gotten to know the doctors very well as they seem to always be running around doing something and going somewhere.  Haven’t figured that out yet either since there are not many patients.  The nuns are also always busy, especially Sor Ligia, but we haven’t seen much of them in the past week or so.  And those are just the people in the hospital!

Outside in the town, there are many others too.  Beginning with my stellar family that inspires me beyond reason.  I’ll start with of course, La Doctora, as she is kinda the boss yet never around much.  She is cute, super fit (kinda intimidating when she wears a sleeveless shirt with her high heels), and walks with attitude.  She definitely knows her stuff medically and is always working hard either in the hospital or in the pharmacy or even in the house, all day every day except for Sunday.  People sometimes give me a hard time when I say that I want to have a family and practice medicine.  Heck, this lady reared a daughter as a single mother, practiced as a pediatrician, ran her own clinic and pharmacy, cared for her mother and niece, and still has time to lift weights at the gym, put make-up on, do oatmeal facials, and watch her novellas.  Talk about a role model!  No wonder she walks around like shes important!  The daughter Eulysa, I’m convinced, should be the next Ms. Nicaragua.  She is honestly just beautiful inside and out.  She is studying international business at university, hopes to learn 4 languages and travel the world.  In her spare time, she makes her own adorable jewelry and clothing.  She is just the nicest, cutest girl ever! She is super busy herself too as she is of course very popular with her friends, but she spends every afternoon and weekend working in the pharmacy with her mother.  They are very close, share a room and everything.  She calls her mother her “everything.” The grandmother is also cute. She yawns loud enough for the entire world to hear and shuffles around the house in her slippers, so I always know where she is.  She spends most of her days either in the kitchen cooking or in the chair in the living room, watching TV, sleeping, praying, or talking to her many visitors.  Every morning and evening she cooks us breakfast and dinner to which we hear “Café esta servido!”  Every time we enter the house, we know we are home when she says “Adelante, pase adelante” with a smile.  When she was younger, she cooked 500 Nacatamales (a traditional Nicaraguan dish with rice, meat, onions, peppers, cheese cooked in a leaf) a day to earn money for the family.  Incredible!  No wonder she is always feeding us!  She likes her café con leche, her block of strange white sour crumbly cheese that looks like Tofu, and crunchy bread (pan tostada) that looks like fingers.  Despite the fact that we kept trying to return the cheese to the fridge without her noticing, we appreciated her care.  We have asked for directions to cook some of the meals, but know that gallo pinto won’t be the same without her loving preparation.  She has a brother that visits multiple times a day that we call grandpa.  He took us to his farm where he grows corn, beans, and rice last Saturday.  Via motorcycle!  So fun!  He always says hi to us- no matter what, if we are walking down the street, if he has a cigarette in his mouth, or he is watching boxing on the TV.  When I was trying to salvage a rotten mango this afternoon, he went into the yard and picked some new ones from the tree.  It was literally the best mango I have every had!   Grandma also has many friends that come visit- one of which is also the cutest little thing in the world.  She also brings us mangos, guavas, and amazing hugs!  Even in the streets, she will come over to give us a hug as she lives across the corner.  She doesn’t say much as she knows we don’t understand much but makes lots of motions, such as dancing or hugging or shivering, and great high-pitched sounds.  There is also Carla, the maid, who is a small little lady with gold teeth but a nice smile none-the-less.  She is always working tirelessly hard- from the morning until the afternoon cleaning, cooking, and washing clothers.  She made us the best lunches ever!  The envy of other students with such variety as the family insisted that we come home from the hospital for lunch. Multiple times I tried to wash my own, but if she saw me, she would come up and not take them from me- even if it meant staying an hour late at work. She would just shake her finger at me, nod her head.  She then goes home and does everything over again for her 3 children and mother.  She speaks and acts with such timidity and humility- speaking only when she must, quietly, and when spoken to.  She gives a new meaning to working hard witout complaining!  (she has been doing that since she was 9- school during the day and working at night Lastly, there is Maria Feliz.  She has been our best friend here and honestly an angel to us.  Her family lives in the US, so she knows pretty good English which has been super helpful with communication and translating the other family members.  Her mother is a sister of La Doctora, but she was reared in Nicaragua in this house by the grandmother.  She is always happy!  She also knows everyone in the town!  She is the person that you want to be around and want to walk down the street with as she yells Adios to everyone we pass.  She takes us when she goes out to buy milk; she took us the first Sunday to her family birthday party; she sits with us on the front steps to talk to passers-by; she took us to church with her and let us sit on her small group; she brought us to the park; she took us with her to her cousins wedding; she introduced us to all of her bazillions of cousins and even dieing grandmother; she even took us to the beach with her boyfriend and his sister and bought us a picnic lunch and dinner.  I just can’t appreciate her enough.  She is so kind and thoughtful- a joy to be around.  She is always making us laugh and have fun- from always wanting to dance and doing it wherever even if it’s a cell phone ring, always telling the story of us “Bailando en la calle” and then telling us to dance despite the audience or situation (including the middle of church small group), watching Indian dance videos and bellydancing, scaring me by knocking at our door and hiding, yelling “Entonces Chicas!” from somewhere in the house, prank calling people’s cell phones in the other room.  She is the only one that will sit down and the table with us to eat.  She even bought and made us Flan, the desert.  When other people ate it all, the next day she bought some more and made it just for us.  She cares for everyone- even the man that she saw on the street with cancer and now invites over everyday to talk, all of her family members that she visits and talks to so often, her boyfriend of 10 years that she calls her love and wants to marry despite his past and her family’s disapproval.  What I admire most, though, is her devout faith in God.  She leads a prayer group every Monday night for women, walks around praying for the sick every Thursday night, is always talking about praying to God and asking for wisdom and strength.  As the sick man said, “Linda persona.”  She truly is beautiful. She doesn’t care that she is overweight and even jokes about it, yet tries to eat healthy and take good care of herself.  None of the past years have met her, and if she holds true to what she says, she will probably be married within the next year, so the next years might not either.  We just lucked out!

Then there are the people in the town.  Lilliam in the gym across the street- my little 5-foot tall Spanish personal trainer that I will always remember saying “Chano, Quatro y douze, quatro y douze.” The first day, I walked in expecting to just use the equipment but instead found myself doing 3 types of leg press in her kitchen while sweating profusely much to her enjoyment, then collapsing onto my bed in pain. She gave me new exercises everyday and taught me new words in Spanish everyday.  She gave me a hard time for missing a day or skipping an exercise.  She would put on more weight or add another exercise.  She became a tough coach and friend.  Her helper, the young man with big muscles and wore the “Southlake Carrol Shirt.”  The couple from Jersey that own the internet café and are relatives of Maria that invited us to their wedding despite the fact that it was just her family members in her family house with the lawyer.  The quirky gal that owns the internet café down the street that always kicks us out when it gets late and tells us to be careful as it is dangerous.  The larger lady at the libreria that told me to hold my money carefully and gave advice about paper.  The adorable Italian father from the church that was supposed to come for lunch but forgot.  Our little friend Veronica, who is 13 years old but acts like a 30 year old, coming for church prayer group but then staying to dance with us, coming the next day and doing pilates on the TV, even walking arm-in-arm proudly with us around town during the parade.  Roberto, Maria’s 36-year-old cousin who teaches English at the town’s private school and was at first I thought super nice visiting every day and asking how our day once.  Then he began asking if we had children, husbands, or boyfriends.   I began to think otherwise when he then asked when men we liked and responded to our answer about personality with “No not like that- what type of men… like Hispanic.”  The next night he asked if he could take us out on a date.  When we stopped talking to him as much or hiding when he came over, he kinda got the hint.  All the random people we ask for help on the streets for directions or advice are always willing to help out.  The mango lady that sold cut up mangos across from Pali for 5 cords or 25 cents.  Then the real mango lady that sold full mangos 12 for 6 cords at the corner by the market.  The lady that works at the smoothie place with curly hair and patiently smiles while I think what delicacy to order.

Last week

Ok I am not writing from my huge apartment back at Duke, but I realized that I never finished up my blog from the summer.  Sorry to leave you hanging for so long.  I will just give you a quick overview of my activities last week and a half before we left to go to a 24 hours conference in Washington DC with all the students in the EWH program- Nicaragua, Honduras, and Tanzania.  Then I came back to Duke to start with freshmen orientation!  Crazy!

So Monday, we walked into the hospital and found Veronica at the desk.  She asked if we wanted to watch a surgery, so we said sure of course!  We ended up watching 2 gall bladder removal surgeries as both women at gall bladder stones.  It was crazy because the doctor removes the entire gall bladder, which is a dark maroon color, and then the helper girl cut it up to remove the stones for testing.  Inside, there are these marble-sized yellow balls.  No wonder they hurt!  The first surgery went smoothly. Then in the second one, right after the surgery slices open the women, the power goes out!  No joke!  Everything turns off (except for the monitor that we brought because it has back-up battery so we could see her stats).  But everything else went off- lights, ESU knife, anesthesia.  But no one panicked.  They just stood there and waited probably about 5 minutes for the back-up power generators kicked in.  The hospital has 2 back-up power generators run on diesel that provided for the entire hospital- one for the OR, the other for the ER.  The thing is though that someone has to go start the generators when the power goes out, so it takes a while.  Good thing that there really aren’t any machines that need immediate power like breathing machines besides the anesthesia in the OR and the anesthesiologist is there.  Then the finished up the surgery as if nothing happened!  Absurd!  They did cancel the rest of the day.   After that we wandered around the hospital checking things out and went to go talk to Harold for a while because he was back from vacation.  He was very patient with my Spanish and understand me when I spoke incorrectly (which was the entire time).  Then we couldn’t do a whole lot with equipment as there was no electricity, so we actually finished making our posters.   In the afternoon, we went to the store and bought anti-hongo paint for the neonatal ward.  That night, I was sitting out in the dining room attempting to write some things, and Maria Feliz and Julissa came out to talk.  I just was really impressed by both of them- their perspectives on life and the good sense they have.  Maria wants to wait until she has graduated and worked before getting married despite the norm there.  Julissa was telling me how her mother raised her by herself, so they are really close now.  Her mother is her “everything, her life” she said.  Wow!  What a great role model for her to have!  It was fun sitting around the table talking to Julissa about where in the world she wants to visit.  I felt like we both have the world at our fingertips and its amazing!  Tuesday, we worked on the neonatal wall!  We scraped off the mold and painted the first layer of white anti-hongo paint.  I can’t believe the mold.  So gross! In the afternoon, Veronica the receptionist took us out for ice cream at Eskimo.  She is so adorable and sweet!  She bought both Rita and I a banana sundae each (which was heavenly but so rich that we could barely finish) while we got just a single scoop of the month on a cone.  I can’t believe how nice it was!  I was truly touched.  Wednesday, we painted the second layer of anti-hongo paint in the morning and then went to the paint store to buy the sea green paint that we needed to repaint the wall to make it look like the rest of the hospital.  In the afternoon, we painted the first layer of green overtop and it looked really good but smelled really bad. We also put up or good health posters around the emergency department!  That night, we also caught the Doctora in the kitchen and had a really great conversation about healthcare.  I have been trying to figure out why there are no patients in the hospital and no funding/equipment.  She explained to us that although all the services are free at the hospital, the medicine is not.  So many of the patients that need medicine to treat their illness wouldn’t go because they can’t afford the medicine.  Also she said that many people don’t have time to be sick because they need to work in order to earn money for food to survive.  I asked about her pharmacy and private clinic, and she said that those have had very few patients lately especially because of the economic crisis (which I guess is affecting everyone even the people in Nicaragua!)  She also said that Jinotepe, while the city is smaller than Diriamba, is the capital of the province, so it has more amenities than Diriamba, such as a larger hospital. When we took a tour the last week, Rita and I were amazed!  They had literally 7 incubators in neonatal, and 10 in the maternity.  We have one right now!  I couldn’t believe the discrepancies in equipment from Jinotepe and Diriamba!  Doctora explained that the government funds the hospitals based on their size, which makes sense but creates a bad cycle for the smaller ones.  They can’t get more money to buy more equipment or treat more patients, so then they can’t ever get bigger and can’t get more money.  She also mentioned that there is a problem between the government and the religiousity/ congregation of nuns that runs the hospital.  The government got mad, and forced Luxembourg, who has helped the hospital a ton through a 5-year cooperation (donating equipment, setting up computers and internet in the office, making maps and fire escape routes) to quit helping.  The feud might also explain why they don’t have a lot of funding and then why they don’t have a lot of doctors or doctors in the afternoon as they can’t pay them enough to keep them around.  I never asked why the doctors work there in the first place then if most work at a private place in the afternoon.  My guess is that they have to work part time in public medical care, but I don’t know that for sure.  All interesting huh!  So patients will come to get care if it is something that is must be done in the hospital like having a baby, or it is fast and can be fixed without a long time in the hospital or expensive medication- such as diarrhea, fever, pneumonia.  Also I saw mostly women and children in the hospital, probably because men didn’t want to take the time off to be sick and parents just ignored their own sickness yet were more willing to take care of their children’s health. The rest of the no-patient mystery is just day by day fluctuations, as Monday the next week there were 5 C-sections so it just depends.

Also Wednesday afternoon, Michelle and her mom visited which was fun.  They inspired me too, because we showed them our room full of equipment, Michelle had some ideas for some of the equipment.  Her mom, when we showed her our room, made a comment about “how our training as engineers probably did not prepare us for this,”  which motivated me to remember why we were there.  Our first goal was the equipment and the second was these other things (even if they might be more fun to me).  So we were motivated on Thursday to return to our equipment and see what we could do.   So Thursday morning, we finished up the wall with a second layer of green paint!  And then cleaned up the room that was now very green and smelly.  We then went back to our room and asked Harold about all of our machines.  We tried a transformed on one incubator, which flashed on and then off.  When we asked Harold about it, he didn’t want us to even mess with it.  He said the others were much more important and newer and better so don’t even look at fixing that one.  Ok, we took the hint.  We tried to look at the Dopplers some more, but really didn’t get much inspiration.  We then tested the incubator that they claimed to work but was missing a sensor.  It did work perfectly!  It has a sensor to measure the air temperature, just not one to measure the baby’s skin temperature, so you would have to manually take that.  But other than that the machine worked great, so I didn’t really see the problem with using it considering the severe lack of others.  In the afternoon, we walked around the hospital, interviewing people to find anymore unused or broken machines as well as to determine what the common problems were at the hospital.  We heard from the ER nurse that diarrhea, fever, pregnant women, high blood pressure, high blood sugar, and the flu were the most common problems.  We heard from the pediatric nurse that dehydration, respiratory problems like pneumonia and asthma, diabetes, and gastro-intestinal issues from bad water are the most common problems.  The most common surgeries are C-sections, hysterectomies, gall-bladders, and hernia removals.  This was fun talking to all the different people in the hospital and all the different areas.  We made friends with the head nurse in the maternity ward, who explained to us the giant book where they write down all the births in the hospital as well as how they used to use non-disposable syringes before the year 2000.  She also pointed out to us a pulse oximeter that they use for babies that didn’t work well and a suction for babies that didn’t work.  On Friday, we determined that the pulse oximeter worked for Rita but not the nurse because the nurse had nail polish on.  We also figured out that the suction worked perfectly, but the nurses did not know how to use it because you had to keep your finger over a hole to create the pressure for the suction.  We wrote instructions, taped them on, and explained them to her.  The next week, the other nurses claimed that it didn’t work, so we then explained them again to them, and the nurses seemed satisfied.  Friday morning, we spent all morning calling different supply companies in Managua, as we were determined to find some spare parts!  We needed the heater lamp for the Olidef incubator, 4 surgery room light bulbs, and 2 light bulbs for a blood analyzer.  We thought we had some leads, but none proved fruitful except for Casa Sarria who we already had trouble with.  Another store said they could order them but they would take at least 2 weeks and about $400 for the heater lamp.  Not happening!  So we went to Managua after lunch hoping that we would start there and then see if they had any advice.  We had no idea where we were going, but some how ended up finding the store.  They had everything we needed including a man that spoke English, and all the bulbs.  Unfortunately everything was too expensive to buy all together, but we gave us a bit of a discount, so we were able to buy the heater lamp, 1 operating room bulb, and 1 blood analyzer bulb with the money we were given by EWH.  Perfect!!  We were so thrilled!!!

That weekend, we decided to spend with the family at home.  Maria Feliz took us with her boyfriend and his sister to the beautiful beach just 30 minutes away!!!  Her boyfriend drove and they bought a picnic lunch and dinner for us all on the beach.  We even got to watch the most incredible sunset with orange, pink, purple, yellow… gorgeous!  The beach was so deserted- one restaurant but no other buildings.  There were boys that lived that that raced horses down the beach and surfed in the waves.  Rita even got to ride a horse for a bit.  We went swimming, but the currents were super strong so we didn’t venture far.  Sunday, Grandpa took us on his motorcycle to his farm where he grows rice, beans, and corn!  The motorcycle was a blast!  It was interesting though because he has a helper who lives on the farm with a wife and child in a one room building made of cement, with a stove that consisted of bricks with a rock on top and spilled smoke throughout the place, with a bed that was wood with a comforter on top as the mattress, and literally 2 chairs, a soccer ball, and a radio.  It was interesting to see all the different levels of living in Nicaragua from my wealthy family to this.  It was nice to stay home and get to hang out with the family too!

Monday, we were so excited to use our spare parts!  We also heard that there were 5 C-sections and we were dying to see a birth!  So we first went in to surgery, where Doctora Fernandez was too to catch the baby when it came out.   The surgery was so fast!  All of a sudden there were 2 people instead of 1, and the mountain that used to be her stomach was flat.  It was awesome!  The baby came out, blue, and kinda gross but not too bad.  Doctora grabbed him and wiped off his face, then he started to cry.  She took him than out of the room to check him out, but he was totally fine!  Turns out the mother was 20 and this was her second C-section.  Crazy!  Glad I don’t have 2 babies at age 20!  Anyway, after that we went back to our room.  We got Harold’s help to install the heater lamp on the Olidef.  Turns out we would have done it completely wrong because it is not like a normal resister that use put into a circuit.  You have to run the current both ways, so it will get stuck and then the energy will turn into heat.  We installed it, got the nurse to check it out, and she said it worked like it used to!!!  We doubled the neonatal’s incubator capacity!!! The nurses and staff were super thankful for the incubator as well as the new wall!! They immediately cleaned it and wanted to put it to use.  They discovered though that one of the sides was supposed to be moveable but wouldn’t because it was rusted in.  We tried really hard to fix it, but just couldn’t.  Bummer!  That was not important at all but just a matter of convenience.  We then installed t the blood analyzer lamp, so the lab had a working blood analyzer.   I also had a great talk with Maria Feliz about the culture of marriage and motherhood there.  She explained how things were much worse outside the city were the people did not have as much education, which is probably like it is everywhere.  I expected her answers to be a lot worse than they were, but really it wasn’t that different than the US.  I also talked to Carla, the maid who works endlessly hard.  She began working at age 9 while going to school, yet school didn’t really change her life at all which surprised me.  I thought that everyone who had an education could have a future, but not necessarily.
Tuesday and Wednesday were our last 2 days at the hospital, which we mainly spent talking to people- nurses, doctors, staff.  We asked questions about the hospital and its needs, about their lives, about working there, about living in Nicaragua.  Wednesday we ran around taking pictures with people and then passing them out.  We also made an apple pie for our family.  In the end though, we received more gifts than we were gave I think.  Martita gave us a beautiful wood carving, Grandpa gave us an elephant candle holder, Julissa gave us hand-made necklaces that she made herself, Gilda gave us each a rose, Lilliam from the gym gave us her music to copy, Maria Feliz and her boyfriend took us out for Eskimo ice cream and a drive around town.  Everyone was absolutely incredible and I am seriously going to miss them all!  Martita and the anesthesiologist have already emailed me.  I gotta figure out how to write back in Spanish!   We were really sad to leave, but so thankful for all the wonderful people that we met!!

Happy August!

This marks the end of our third week here, and it was pretty different than the others.  At work, we finished most of the repairs that we could accomplish, meaning that we were then left figuring out what to do.  On Monday as I wrote, we (with Harold’s help) finished working on the centrifuge, only to discover that it couldn’t be fixed.  We Cheyo gave us a nebulizer that is missing the plastic piece to connect the tubes to the hole where the air comes out.  We didn’t understand what he was talking about, so we kept asking “Que falta?” to figure out what was missing.  Then I followed him up to pediatrics where he was given the tubes and a plastic connector piece that was too big for the hole.  Then he took us into his workshop where he had another old nebulizer to show us the missing piece on that one.  So asked if we could take them both and try to switch them up.  Turns out we couldn’t, so now we had 2 broken nebulizers.  Monday we cut the “too big connector” and super-glued it over the hole of one. We then gave Sor Ligia the fixed nebulizer and infusion pump complete with instructions.  When we visited Sor Ligia on Friday to ask some questions, they were still there.  For a hospital with such little equipment, I would think that they would snatch up any machines.  Doesn’t seem to be the case, and I’m not sure why.  It seems like Sor Ligia has all the power, so if she doesn’t do anything with something, it doesn’t happen.  I don’t know why she didn’t place those somewhere though to be used.  Well, now in our room we have the equipment that we are stuck on and Rob (our medical equipment teacher in Costa Rica and absolute genius at all medical equipment) tells us to throw in “El Rio” (the river): a 40-year-old ECG machine that doesn’t show anything, 40-year-old ECG/ defibrillator that also doesn’t show anything, a centrifuge that needs a new motor, 3 fetal Doppler monitors that can’t pick up and hear a fetal heartbeat, and a nebulizer with a ridiculously loud motor.  We also have the equipment that need parts that we are waiting for: Drager baby incubator that needs a 220 V-> 110 V transformer, Olidef baby incubator that needs a new heater lamp, and Vickers baby incubator that needs a temperature sensor.  We gave all the info to Casa Sarria, a medical supply store in Managua, over a week ago, and they are supposed to give us prices, and they told us they were coming Tuesday morning.

Tuesday, with our equipment kinda at a standstill and waiting for Casa Sarria, we asked to scrub into a surgery.  Rita and I have become pretty good friends with the adorable receptionist Veronica who patiently answers our questions, introduces us to people, and asks people for favors for us such as to watch a surgery.  So we got to not only enter the double doors into the operating room, but we also got to scrub into 2 surgeries that morning:  the first a sterilization procedure where they cut the Fallopian tubes which was super fast we didn’t realize it was happening, and the second a hysterectomy where they remove the uterus.  The hysterectomy was super cool as I could figure out what everything was.  The surgeon just cuts the lady open, sticks his hands in, feels around, and then pulls out this large lighter bulb that is the uterus.  The rest of the surgery is preparing the areas around it to cut it out.  The operating room was, I thought, very nice and spotlessly clean and looked very similar to one you would find in the US.  It definitely had more equipment than anywhere else in the hospital with an anesthesia machine, ECG monitor/ defibrillator, and the bedside monitor that we brought!  It made me so happy to see it being used and as the main device for the anesthesiologist in the surgery.  It was beeping the whole time though because her blood pressure was really high.  I didn’t know if he wanted the alarms or not, but he seemed to know what he was doing.  In the room, there was 1 general surgeon, 1 helper doctor who is actually general medicine doctor, a nurse helper, a helper’s helper, and 2 anesthesiologists that traded off.  The surgery run very much as it did in the US with a sterilization zone and everything: preparation, anesthesia, procedure, stitch up and wheel out The biggest difference I noticed was that they opened less autoclaved tools (just 20 instead of the 100 in the US) and opened stiches as they went rather than opening and wasting them. Oh and the surgeon was missing about 1.5 fingers on his left hand.  Inspirational that he is still a surgeon!  I enjoyed watching the surgery but had very little interest in doing it.  I think that surgery would get very repetitive and boring after a while.  Rita and I were discussing how we can understand why many engineers become surgeons because of the clear-cutness of surgery: see a problem, fix it, and see the solution; have a particular way to do things or steps to take, there is really only one way to do things.  There are actually 2 operating rooms but really only that 1 is used because they typically only have 1 surgeon working each day with average of 4 surgeries a day.  The other room had a really old anesthesia machine, which apparently works but is really old.  That afternoon, after Casa Sarria didn’t come, we decided to do a little needs finding so we interviewed a few people.  So also met this crazy nurse in the ER who wants to learn bad words in English!

Wednesday, we tried to clean the other nebulizer (that we nicknamed Grandpa because it is really old and squeaky) really well with WD-40.  Grandpa needed more than a bath- he needs a new rocking chair.  I tried and tried but couldn’t figure out why the motor was soo loud.  Meanwhile, Rita was working on the EWH paperwork and powerpoint for our conference.  She has some great pics!  We also waited around again for Casa Sarria to come.  Finally that afternoon the little salesmen came with a large engineer guy in order to get more information (which they were supposed to do for the last 2 weeks).  He came in and demanded all of this stuff and just acted generally disrespectfully towards us.  He made fun of us for going to the town’s celebration during lunch the week before- totally uncalled for.  I don’t know if it was because we are 2 young, white girls that he assumed we did not know anything or if that is normal.  Or it might be because engineers are so rare here, that he is used to being the looked to as the expert on all matters.  He made me really angry because he treated us as if we did not know anything and he knew everything.  Part of it was the language barrier, some I’m guessing is culture too, but it was frustrating.  When these guys got to the hospital, the engineer was asking about a centrifuge, and all of a sudden the lab technicians pulled out an old microcentrifuge with a rubber gasket that was broken.  We had never seen it before, and now the engineer and Sor Sonia were talking really fast about it.  They then take it away to fix it and claim to be bringing back on Friday with more info too.  What a mess!  We felt trapped since we had never seen it before and then the Sor asked for them to fix it and assuming that we would pay for it. 

Thursday morning, we were again waiting for prices then from Casa Sarria.  We decided to do some needs-finding to investigate possibilities for a secondary project.  Of course, we first went to Sor Ligia because she knows everything about the hospital.  We asked her a bunch of questions about the hospital and discovered that it is a public hospital that treats everyone for free.  It also receives all of its supplies and equipment via donations.  We asked about what equipment they need most, and it was basically everything.  She said that they have 4 ECG machines that do not have paper, so they cannot be used.  Can you imagine a hospital without a working ECG machine?  She also mentioned the fetal monitors that we tried to fix and apparently aren’t working any more so now they have none L  She also said that they need ventilators and nebulizers as these are the most commonly-used equipment there since respiratory problems are very common.  We asked Sor Ligia as well as a pediatrician at the hospital what were the most common health issues: for children, respiratory issues from bad stove ventilation in the houses and malnutrition/ intestinal worms; for adults, also respiratory issues, diabetes, hypertension, and gastric problems.  A lot seem to come from the diet which is typically rice, beans, tortillas, and white cheese which are all sold in bulk for cheap at the market.  Most of these problems I would think are very common among people that live in poverty.  We also asked Sor Ligia what we could do for a secondary project and translating a list of ideas for her.  She suggested that we paint the neonatal ward wall with anti-fungus paint because it is covered in mold.  She also thought that posters that taught good health would be a good idea.  We then asked Dr. Cano, the other pediatrician besides Dr. Fernandez who is the doc we live with but never see.  She seemed to like the idea as well and gave us a few suggestions: wash hands, brush teeth, clean feet, wear shoes, and drink clean water.  We then bought posters on Thursday and began drawing a making posters!  We also got a hold of Casa Sarria for prices.  They told us: $45 for the microcentrifuge that they stole from us, $120 for the baby warmer lamp, and $150 for the temp sensor for the incubator.  Uh oh!  We definitely do not have the money for all of this!  We feel very stuck since they have our centrifuge, so we have to pay for it.  They also are bringing the lamp tomorrow.  Yet I really would rather not deal with them anymore because they kinda trapped us, so I think they might be unfairly overcharging us.  We really just want to be helpful to the hospital, but we can’t just go around buying everything.  I’m realizing that this hospital needs money more than anything else! 

Friday morning, we finished up our first round of posters: Rita made one for washing hands and I made one for brushing teeth.  We looked up some pics and stuff of the internet.  We couldn’t decide if we should mention diet and exercise since these are part of the culture and not always change-able.  We also worked on looking up more info on parts, so we could see if there are any better options: perhaps repair rather than buy new, find cheaper prices to barter or to buy from.  We called another store, but they needed info and pics to find the part, so we will have to wait again.  We didn’t want to buy anything without making sure we were getting the best deal, and we wanted to make sure with the nuns what was most important: which is the lamp for the baby incubator.  Sor Ligia also told us on Friday that they need 4 more lamps for the OR room which are very important as well as lamps for this blood analyzer.  They have 20W bulbs when the machine needs 10W bulbs.  I am torn because I don’t want to waste the 20W bulbs but I don’t want to destroy the machine.  We told them that we have a limited budget, but yet they expect us to be able to pay for all of this stuff.  I also don’t think it is our job to decide what to buy either since they know better what is most important.  Actually luckily for us, the men from Casa Sarria came at 4pm, which meant that we were literally the only ones left in the hospital.  The nuns were gone, so we refused to buy anything without their permission.  The men then offered to wait around until a Sor returned to ask if the Sor wanted the microcentrifuge.  We were allowed to return to our house (only to worry about our predicament) and then called to come back in order to help pay.  Boy did we feel like sugar mama!  Called up to pay and then left!  But the sister offered to pay for half of it, which made me feel a lot better.  Interesting how money flows up when need be!  We said no to everything else except for the microcentrifuge since they had already fixed it.  Now we are free to make our own decisions rather than feeling pressure to buy something from someone.  I hope we can find some cheaper prices this week.  I don’t know what to do though because we as the engineers cannot just come back every year and buy all the stuff that they need- that just adds to the circle of dependence.

This weekend was also amazing of course!  We went to San Juan del Sure, which is a surfer town on the beach of the Pacific Ocean.  It was BEAUTIFUL!   The water was turquoise blue and very salty, waves great for body-surfing, and sun in the clear blue sky.  We swam for a bit with all the Duke kids, laid on the beach, and then walked out onto some rocks to the point of the bay.  We sat on this tall rock and watched the waves hit the rocks as the sun was setting- gorgeous.  Words can’t describe it.  Then as we were walking back, it started to storm: thunder, lightening, pelting rain!  Fast and strong!  We stayed at this pink hotel on the beach owned by a man from North Carolina.  He moved to San Juan 3 years ago and “has never looked back!”  We found him sleeping the next morning on a coach in the entryway with his dog.  Very chill town it is.  Sunday we looked into surfing but realized we need to plan better for that, so we just went swimming on the beach again.  We then walked/ climbed out on the rocks on the other side of the bay to this cave that we had seen from the point the previous night.  Oh my goodness!  Breathtaking!  We would climb around the rocks to this nook where the waves would crash through the rocks around a pool of water and then onto the shore at the pool, but then as they would leave, they would fall through the rocks and make an incredible sound like a rain stick.  Then some at this one point in the rocks, there was a crack so when the waves came, they would shoot up and shower the person standing there.  We eventually got to the cave, which was absolutely huge.  I just sat down and set so peaceful- secure with the cave around, listening to the waves crashing in and falling out through the rocks, looking at the turquoise blue water and the clear blue sky with yellow sun.  I can’t describe the beauty.  The whole weekend looked like it was from a motivational calendar.  We then found this cute bookstore in town to eat lunch where I had the best banana-chocolate chip muffin ever!  It was a great, chill, fun, cheap weekend! 

Now it is our last full week at work, and we want to make the best of it.  We are going to start with finding out more info about this baby warmer light, lights for the OR, and maybe about paint as well as of course making posters and talking to people!  We hope to see a C section surgery as well.  It is also my goal to determine why there are soo few patients at our hospital.  Thursday afternoon when we walked around, there were 0 babies, 0 mothers, 2 children in pediatrics, and very few adults.  Crazy!  I asked my host family daughter, and she said it was because there is a huge party in Managua for the past 2 weeks.  She said Nicaraguans like to party, so they don’t have time to be sick then. I don’t know.  I do notice how very little people work.  The hospital almost like shuts down after noon such that we seem to be the only ones working in the afternoon.  A perplexing phenomenon…

Second week… Success!

Wow we are about half way done here!!  Which makes me really sad L  I feel like we are all finally fitting in here and getting the hang of things.  This week was a really short working week because we had Monday off for the national holiday as the 30 year anniversary of the government revolution, and Friday was pretty much a half day because there was a procession here in Diriamba for San Sebastian, the town’s protective saint.  Every city (I think) has a protective saint, and one day each year they celebrate it with a festival and procession where they have a church service, raise the saint’s statue from the church, and carry it down the streets with a parade of dancers in crazy outfits, horses, and tons of people.  On Friday July 24, the 3 cities of Diriamba, Jinotepe and Dolores (which are all really close) each process to Jinotepe, where they meet for a huge party.  As the saints are carried through the streets, people walk with them, so the crowds get bigger and bigger.  There are horses dancing, boys in colorful caps with crazy hats topped with peacock feathers, sellers selling food, people walking with sashes as saints, the men carrying the saint statue on their shoulders, men and women dancing traditionally in traditional clothes with long flowing dresses.  But mostly tons of people!!  And then on the main highway from Diriamba to Jinotepe, the Pan American Highway, it looked like a massive Latin American tailgate!  People were all sitting under pop-up tents with piles of liquor and beer bottles everywhere and cooking food.  It was crazy!  Anyway, so Rita and I left early for lunch on Friday to see the procession, but then we went back to work afterwards because we didn’t want to miss the whole day.  But then no one was around and we didn’t have anything to do.  This actually was an incredible blessing because we started talking to the hospital receptionist Veronica, who is a super cute nice little lady.  She has been working there for 25 years and therefore knows everyone!  Key person to be friends with!  We sat at the entrance/exit of the hospital, so she would introduce us to everyone that passed.  We definitely met more people that afternoon than the whole past 2 weeks- doctors, nurses, helpers (ayudantes).  We also asked and received permission to watch a surgery in the OR next week.  We even got to hold a brand-new baby!  He was only minutes only but adorable!  The nurse cleaned him up, put clothes on him, and then let us hold him before bringing him to his mom.  So adorable!  I also asked Veronica bazillions of questions about the hospital, health care system in Nicaragua, and everything else I could think of.  She was so full of information.  Shocking bits include:  the average age to give birth in the hospital is 16! The normal number of children is up to 8!  There are 6 nuns that work at the hospital and also live there! There are no engineers, technicians, or mechanics at the hospital- just helpers/ ayudantes like Harold and Cheyo!

            Which brings me to our work this week.  Tuesday was an awful day but then Wednesday and Thursday more than made up for it as we were actually able to fix some things!  We planned on Tuesday to finish up with one of the fetal Doppler monitors that we had taken apart, cut and were resoldering a new connection.  Well it kept going back and forth between working (when it sounded beautiful with no noise!) and not working (in which there would be no noise).  It was working and then we taped the wires to protect them, and then it stoped and we haven’t got it working sense.  Sor Ligia also brought it a new Doppler that used to be the working one but then quit working.  We also tried to use the Carbon pieces that we bought last weekend in Jinotepe, but when we asked Harold who was the one who suggested them, he said that the ones we got were too small.  We also tried to figure out how the baby incubator worked since we reconnected the wire.  We used a multimeter to determine the voltage and current across 2 nodes that we saw to see if we could just add this lamp to the circuit.  Rita first measured 120 V but then after trying to measure voltage, it only measured 0.5 V.  After turning the multimeter to a different setting to see if the wire was open or short, it continuously said short which was wrong.  We then discovered that we blew a fuse in the multimeter trying to measure the 10 A current.  Now we have to go back that too!  Good thing we already had to go back.  Glad that we brought 2 multimeters.  So Tuesday we broke things rather than fixed them.  Oh except we did meet some friends!  When we were walking into the hospital Tuesday morning, we stopped to talk to a different receptionist was cross-stitching.  As we were standing there talking to her, these 2 other non-local looking guys in scrubs walk in.  We started talking in English J and found out that they are undergrad students from Canada working with about 15 others for a Canadian NGO.  These guys, Anthony and Brock, are shadowing a pediatrician in our hospital who speaks a bit of English, helping her catch babies, give shots and vitamins, and just learning.  I’m not going to lie- I’m a bit jealous when I heard that Anthony got to catch a baby when a patient had a C-section.  However, Wednesday was an awesome day!  Out Canadian friends came by to visit again with more people that we got to meet.  We also returned some of the working equipment that we had been storing in our room: 2 centrifuges, ear/eyes/throat lamps, and 1 Doppler (that we took apart but didn’t do anything to fix it).   We tried splicing together more Dopplers by mixing parts: body, speaker, transducer.  But then we gave it to Sor Ligia, the director, and she said she could not hear anything.  We then decided that all the transducers were the problems.  I cut and stripped 2 transducers in order to put them together as a good connection and a good head.  Rita also found a manual online for an infusion pump and figured out how to use it!  We then met up with the Canadians in Jinotepe for amazing Chinese food!  We also saw their “Base Camp”  where they live, it is soo luxurious… free internet, a garden, classes there, a guard, kitchen for cooking, and lots of other English speakers!  As nice as that might be every once in a while, I am so glad we are staying with a family in a homestay because we are getting the real Nicaragua- bucket showers, Spanish, and all!

            Thursday, we finished splicing the Doppler and it worked!!!  We also finished the instructions for the bedside monitor with color-coded plug-ins and everything.  We showed it to both Cheyo and Sor Ligia, and they both said it was good!!!  We are still stuck on the Defib and EKG machines.  We also asked Harold about the carbon for the centrifuge, and he said we are missing a metal plate.  Ugh!   Thursday night we stayed up and watched the Mexico- Costa Rica soccer game with my host girl.  It was great to talk to her!  I also found the scoop about the feud between Costa Rica and Nicaragua as she as rooting for Mexico over her Latin American country.  Friday morning, we finished translating and presented the Infusion Pump to Sor Ligia- complete with 3 sets of instructions including alarms.  But she didn’t want it yet.  Lots of people were cleaning out a closet near ours which was full of donated medical supplies.  Everything is donated!  Yet there are whole closets full of supplies and more equipment keeps popping up.  On Friday, Sor Ligia wheeled in another baby incubator, just to tell us that we needed to buy a new sensor.  There are many things that they show us just to get us to buy a certain part.  That got Rita and I frustrated because our purpose here was not necessarily to buy them what they want considering that is not a long-term solution.  Also, Rita and I were noticing how very few people will talk to us.  We try to say hi to the doctors and/or nurses, but they kept running away.  I don’t know if there is a cultural stigma between mechanics and doctors that prevents forming relationships.  Also, for the fact that all of the equipment and supplies are donated, they are very particular about their equipment.  Even if something is slightly off, they will not accept it and say it is broken.  When we return with equipment that is fixed, the people are not that excited and barely say thank you.  It is rather strange.  I’m thinking that it is a culture thing in that everyone just has their own jobs, and everyone does there job as expected.  People don’t say thank you very much at all.  So I guess that we are expected to fix the equipment and that is that.  But we were excited about our victories this week and the relationships that we are forming.  We hope this coming week to further those especially in order to figure out what to do for our secondary project. 

            We also formed some great relationships with the family this week.  We watched the end of the Mexico vs. Costa Rica soccer game with the daughter Eulisa    and got to talk to her a bunch.  We also are beginning to communicate better with the grandmother, and she taught me how to cook some things tonight.  I also started going to this gym across the street run by this tiny little lady in her house.  I asked to join, and then she started telling me what to do- 5 min warm-up on the bike in her kitchen, then 4 sets of 12 of all the weight exercises from squats to leg curls, leg extensions, lunges, to leg press where I was literally lying in the middle of her kitchen. She just kept taking me to more and more. She kept laughing too because I was so sweaty and bright red.  It was soo hard!  I was not expected it at all from the 5 ft Nicaraguan lady! It was fun though, and she is honestly endearing. 

            This weekend we traveled after the festival to Masaya and Granada on Saturday.  Masaya is a city with a huge, huge market full of tons of souvenir-type gifts, and because of that it was all white tourists there.  There were also kids walking around making things out of grass to sell and even these kids acting as missionaries who would come up and talk to you and then return to shove a Bible in your hand and  then return to ask for money for food.  It was very interesting.  Then Granada, which is now very touristy as many ex-pats from the US and Europe come to retire or vacation there.  It is a very old colonial town on the beach of Lake Managua, so it is beautiful! There are tons of huge churches!  We saw 2 weddings just walking around Saturday night.  It was so strange to see so many Gringos, hear English, and eat American food (we had the best burgers Saturday night).  I’m definitely going to have big time culture shock going back to Durham if this was a shock for me!  It definitely was still Nicaragua though as we had kids that came up to us in the middle of dinner begging for food, kids break dancing in the streets for money that were amazing, men juggling fire for money.  I think this would be a great place for next year to take Spanish classes as it is still Nicaragua so the students could learn Nicaraguan Spanish rather than Costa Rican and visit Nicaraguan hospitals, yet it is still more Americanized than our towns for culture customization.  Just a thought.  I loved Costa Rica but it is so different from here.  Nicaragua definitely has more culture I think.  That night we also stayed literally in a giant room with 10 bunk beds in the back of a restaurant on the main strip with an outhouse.  It was super cheap and fun but very hot and rather odd.  On Sunday, we kayaked through the 265 islands in the lake, which was beautiful and super fun!  We walked along the beach on the way there, which was nice but pretty dirty and deserted.  It was strange.  The kayaking was fun though, and we got a great deal.  Most of the people who own businesses in Granada can speak both English and Spanish as most are from Nicaragua, but lived in the states (typically Texas or California) for some time and then returned.  Interesting!

            This Monday was a kinda frustrating day at the hospital.  It was very slow day and pretty empty. We asked around for information about Casa Saria, a company that we are buying parts from, but no one was around for help.  At the end of the day, we called and the manager told us that he is sending out an engineer to get more information.  When I told him that we were engineers and knew what we needed, he did not accept that answer.  Pretty frustrating just because we don’t have unlimited funds or unlimited money, but we told him we were leaving soon and that we might not buy anything if it was too expensive.  He still wanted to send the engineer out, so we will see.  We also had to wait for Harold to return to ask about replacing the carbon in the centrifuge.  We made the pieces that we needed from aluminum foil according to Cheyo, but then when Harold came, he said you couldn’t use foil but needed real metal.  He then made the piece and properly installed the carbon.  When we tried it, it still didn’t work because the motor was been worn down so its curved.  Ugh so after 2 trips to Jinotepe to buy carbon, we couldn’t actually fix it.  We did ask Harold about his education, and he said that he studied electricity in school and just knows other stuff from his experience.  He knows what he is talking about, while I think Cheyo is more of a handyman.  Harold is currently on vacation until the end of the week, but he said that he normally works 8 to 3.  We are discovering that Nicaraguans don’t like to work and take a lot of vacation!  There is apparently a 20-day party here in Diriamba where there is no work and people come from all over- all cities in Nicaragua, US, Costa Rica, etc.  Crazy!  And each city has a festival like this but different dates so everyone can go to them all.  Our host family was telling us about this and that Nicaraguans like to party! 

            We also returned a centrifuge that was working but missing tubes.  We saw the other centrifuges that we returned last week just sitting on a table unused.  We also are still holding onto the infusion pump that we wrote instructions too because Sor Ligia doesn’t want it yet.  The hospital is rather strange.  The emergency respiratory clinic was closed today, and there were very few patients.  For example, there were only 2 children in the pediatric wing with broken arms.  Veronica said that the hospital was free and they didn’t refuse service to anyone, but our Canadian friends said that it is semi-private and that they have refused to treat some people.  I haven’t figure it out yet.  I honestly thought that there would be people lining the hallways, but it is instead hardly full.  There are many people waiting in the emergency department and the clinic across the street, so maybe those are the free parts and the others are not.  We also glued on a piece to fix a nebulizer today by cutting up a different connector.  Hopefully it will work tomorrow.  We are planning to walk around to each department and ask if they have any broken equipment or any needs or wants. We need some new projects because what we have left are at a standstill.  Anyway, we will see what this week brings.

First week

We finished our first week at San Jose Hospital and our first weekend trip in Nicaragua to Ometepe! Both were challenges and incredible experiences! So I will begin with our work at Dirimba in the hospital. I wrote last after the first two days, so I need to fill you in on the last 3. We still have our little yellow room and lots of broken medical equipment waiting there to be fixed. Rita and I were really looking forward to Michelle coming to visit us on Wednesday afternoon to bring us our cell phone as we hoped she could answer some questions or give us some guidance on what to do. She ended up having bus trouble, so she literally just flew in and out. She said that she was worried we would not have enough to do at our little hospital. Oh boy was she wrong! She did give us great insight because we thought that most all of our machines were donated by EWH because they have a little EWH sticker on them. It turns out that that sticker just means that the machine was inventoried by EWH, not donated by. This made me feel a lot better that we were not giving the hospital bad machines- only 1 was donated. As Rita and I work in our little yellow room, Sor Ligia, the director of the hospital, will come by every now and then to bring us more broken equipment!! At least we don’t have the problem of needing to find it. The one working technician Cheyo also stops in to bring us more. Rita and I also take lots of walks around the hospital- first of course to get a break, second in the hopes of meeting people, and third to see more of the hospital. Well on Wednesday, when we were taking one of our walks, the receptionist at the front gate told us to go speak with Sor Sonia in the officina. We go up there and turns out that there is a representative from Casa Sarria, a medical supply company in Managua, that could help us get spare parts! Perfect timing! We had just written a list of the parts we need: liquid Carbon for a centrifuge (the tech Harold helped us figure that one out when we popped in from vacation the first day), lamp for the new baby incubator, transformer for a German Drager incubator, and hopefully some information about the Doppler fetal heart monitors. We just asked for prices as we have a limited budget, but hopefully we can get something that will help. The next day though, Sor Ligia brought the old baby incubator lamp with a cut cord for our reference. Hmmm… we soldered it together, but now don’t know how to connect it to the machine without the manual. They only have 1 working baby incubator and 1 phototherapy machine in the neonatal unit, so getting this to work might be a big help. And now, we have 5 fetal heart monitors that don’t work- 2 with too much noise, too hard to hear, can’t find a heart beat, and one that seems to work with a new battery. Our goal is to piece together them all to get at least 1 one more working well. I would say most of the cases in the hospitals are births, so these also are often used. The representative then came back again on Thursday to get more information about the machines. His boss spoke English, so I spoke to him on the phone. I think because we were talking in English, I assumed that we would be able to communicate, but we could not, particially because there was a baby crying in the background. But also I could not understand his questions, and he could not understand my answers. Anyway, I think we got what we needed, but I am now do not take any communication for granted. Hopefully we will get the information in the beginning of this week.

Thursday morning during one of our walks, we ran into Cheyo, the technician who is also a general maintenance guy from equipment to gardening to electrical power to water supply, and convinced him to show us around the hospital. We had already kinda wandered around considering it is not the big, but it was nice to have an official tour. Now we won’t feel self-conscious or intruding when we walk around. The hospital includes a wing each for pediatrics, maternity/ neonatal, respiratory emergencies, other emergencies, women, men, and then clinics. There were 5 clinic rooms, each with one doctor of all different specialties. Most doctors work in this public hospital in the morning from 7 to noon and then work elsewhere privately in the afternoon. There is also a working X-ray machine, with a really nice technician who was telling us about his ventilation problems as he develops the film in a closet about 1 meter by 1 meter. There are also operating rooms that we did not see however. Oh and admissions (where all the files are), kitchen, and laundry where the clothes are washed in machines and hung out to dry in the wind. The technicians have a tiny little office up above the laundry room. Rita went to ask Cheyo a question one time and found him up there rocking in his chair listening to music. We have also seen him working in the garden and actually working on a suction machine once too. He says he’s been working here 25 years. He does know what he is doing, but has a lot of responsibilities and isn’t too focused on the equipment. Harold is the head technician though and definitely knows his stuff. When he has come in to visit us in our little yellow room and we ask a question, he’ll tell us “Oh you need to check that with the multimeter” or whatever we need. I’m not sure when he comes back though from vacation. He did mention and I noticed in their workroom, that they do not have many tools. We brought 2 tool kits, a soldering iron, and 2 multimeters, which might be more than everything they have. Also, I have mentioned the best part of the tour! So we walked around to all the different parts, and Cheyo pointed out the medical equipment, which consisted of: a few nebulizers in the respiratory wing, lots of dangerously insecure oxygen tanks with breathing tubes, lots of IV bags hanging from a nail stuck into the wall, the previously mentioned X-ray machine, the previously mentioned baby incubator and phototherapy lights, 2 working centrifuges, 2 autoclaves, 3 fridges, and some poorly functioning ear/nose lights. We seriously have more equipment in our little yellow room than the rest of the hospital combined!!!! Granted we did not go into the OR or clinic rooms, which I assume have more.

This weekend I got the change to talk to the other students about their hospitals, and it is super interesting how different everyone’s are. Julie and Yujing in Managua have a really nice hospital with tons of equipment and a very knowledgeable staff; Benny and Jared in Rivas have a nice hospital with a good maintenance crew that know what they are doing but don’t seem to work too hard; Calvin and Will in Jinotepe have a smaller hospital but a great crew; Ali, Sharon, and Jane in Chinendaga are working at 2 hospitals: one that is really well-run but has a small budget and very little equipment, the other has tons of equipment but poor management and is really dirty. A lot of the other students are struggling to figure out their purpose in hospitals that have very competent technicians and maintenance crew- another set of hands, the attention and motivation to help, and a small budget to buy parts. Calvin and Will said that when the told the staff that they had some money to spend, the maintenance staff was so excited they held a meeting to decide what to buy and then drove them to the store in the hospital car! Our hospital seems to be so different where we are the technicians, and they are seriously giving their problems to us. We have a ECG machine and a defibrillator both from the 1970’s!

Thursday, we also worked on the opthamology machines (ear/throat lights). They had two sets and lots of extra heads that they claimed did not work. Rita and I discovered that if you take the lights out just a bit from the head, they work! One did need a new light that we replaced and taped in order to fit. We then wrote a note on the machine with instructions for if they stop working again to try that and brought one to the emergency area and one to the clinic. Exciting! Our first victory!

Friday we worked on reconstructing a working fetal Doppler with a speaker from this one, a transducer from that one, and the circuitry from another. We’ll see if its better when we test it this week. Our major project was removing a noisy connection and trying to resolder things together. It will be a long shot but really exciting if it works! We then left early to go to Jinotepe to buy liquid Carbon from the market there (and got to see Will and Calvin). We will see what this week brings. It is a short week though because Monday was a national holiday as the 30 year anniversary of the current government’s revolution to come to power, and Friday/Saturday is apparently a festival from Diriamba to Jinotepe to celebrate our city’s saints. This weekend was interesting because there were Sandinistan flags, parades, and celebrations everywhere we went and the whole weekend (a girl on our bus ride was even wearing a FLSN bracelet!), yet every person I talked to did not like the Sandinistan government. I saw FSLN signs everywhere, wall paintings with their slogan “Vamous por mas victories!” in all the cities, buses flying flags all along the road to Rivas on Saturday morning, and even lots of police in the streets. Interesting! I’m just really thankful that we were able to travel safely.

Oh and this weekend was awesome! I really just liked seeing everyone again, hearing how their week was about their work, cities, homes, families. We went to Ometepe, which is an island in Lake Managua (which is HUGE!! it looks like an ocean but is fresh water) with at least 2 volcanoes and a lagoon. Most of the group went up on Saturday and climbed one smaller volcano on Saturday to a lake on top which was a 8 hour hike! Rita and I went to a wedding of a relative of our host family on Saturday, which was interesting as it was very intimate- just the family with a lawyer in a house, which made it kinda awkward for us but still cool to see and fun as the couple was very happy that we came. So we came up on Sunday, and then met up with Julie, Yujing, and Will in a super cool hotel that they found on the beach and went swimming a bit. I was very happy! Yujing and I tried to swim to this island which looked really close but didn’t get any close the more we swam with huge waves, so we decided to use common sense and go back. Rita, Yujing, Jared, and I then stayed up that night for a while talking about life and lying on the beack looking at the stars, which was really, really enjoyable! Monday, all of us Dukies went to Punta Jesus Maria (via riding in the back of a pick-up truck) which is where all the winds around the volcano meet so the waves were coming from all directions. It was absolutely beautiful to turn around and see the volcano in the background with dark ominous clouds of a coming store and the water in all directions! Incredible! We swam out for a while, and then all of a sudden we realized we were really far out- must have been a current, and had a far way to swim. Luckily, we all made it back and caught the ferry home to San Jorge, taxis/buses/bikes to Rivas, and then home. Amazing weekend!

Second Day

So Rita and I finished our first two days at the hospital!!! Wow it is hard! A big challenge is of course the language barrier. We can communicate in Spanish, but it is not easy or very comprehensive. Our biggest problem I think is not finding people we can talk to, are willing to talk, and are helpful. We met with the director of the hospital, Sor Ligia (a nun because the hospital is run by nuns), on the first day. She gave us an old room in the back hallway that was full of unused beds and nursing supplies. A lady working at the hospital brought us a plastic table and chairs. They people started bringing in broken medical equipment. Left and right! No instructions, no manuals, no explanations, no conversations or discussions! Rita and I kept thinking that we were going to meet some of the technicians or mechanics or anyone, but rather they just brought the equipment and left. One technicians, named Cheyo, brought us a lot, and we tried to talk to him. I guess he didn’t want to talk because he would just keep leaving. Around lunch time, Rita and I decided to walk around. We ran into Cheyo with another man, named Harold, who turns out is the head technician on the hospital. He knew Maura and Pia, the EWH girls who worked there last year and even had a picture of them! He was super nice, but of course he is on vacation right now. Apparently all the other technicians besides Cheyo are on vacation until next Monday at least! Yikes! Rita and I talked with Harold a bit, who then brought us more broken medical equipment. So now, we have a little room with 4 centrifuges, a defibrillator and ECG monitor, a IV fluid pump, ear/nose/throat light set, 2 sets of phototherapy lights, a baby incubator, a Doppler ultrasound, and the bedside monitor that we brought (temperature, Oxygen saturation, pulse rate, blood pressure). Hmmm and we heard some people don’t find the broken equipment until the end of the month. Rita and I were hoping to just meet people and perhaps start an inventory today. I guess they expect us to start repairing today. We started taking apart a centrifuge while we waited to meet people because they brought us that first. Well needless-to-say, since we never met anyone, we took it apart but didn’t find a problem. Hmm, well we should have checked on our own to see if it worked. We then plugged it in and it worked. We asked Cheyo about it, and he didn’t know. We then tested another one and found that it did not work. We took it apart but could only determine that the motor was broken. Discouraged we decided to go should Sor Ligia the bedside monitor that we brought. So she asked us to demonstrate for her how to use it and then asked for the manual. Hmph too bad we don’t have one. Very embarrassed, we then told her that we would find out the answers to her many questions, write a manual, and then bring it back. I felt really bad that we didn’t have everything ready for her. I understand now though why she doesn’t accept anything and everything because literally 7/12 pieces of equipment in our room were donated by EWH. I was at first really discouraged that everything that was broken was donated by us. I didn’t know if it was because the equipment we brought was poor quality or that they brought it to us since we are from EWH. Then as Rita and I were meandering around the hospital, we realized that really all the equipment that we saw in the hospital was in our room. There were some really nice new pieces of equipment in the neonatal unit, but only one was working. The other was missing some lights. We also saw some working centrifuges in the laboratory. That is all we saw! However, there is also some operating rooms, X-ray room, and ER respiratory room that we did not see. I assume there is more equipment (hopefully working) in there. The rest of the hospital contained rooms with just beds and bedside tables with some patients. It has been an interesting past few days- frustrating and challenging absolutely. It seems like they expect us to be able to fix everything. Interesting too that they did not ask us any questions- only if we had a specialty or just general! We would like to talk to some more people and find out more information about the hospital, what it needs, and about the equipment, but we haven’t found many people willing to talk to us- maybe its language or culture. I don’t know. We did have a patient come talk to us today though who knew English and works as a dentist in Arkansas! She was sooo nice. She apparently has a brother-in-law who works at the hospital and another that works in Jinotepe and knows English. She called him on her cell phone right there and gave me the phone to talk. I didn’t really know what to say, but he will be a good contact in case we get really stuck. He works for a non-profit organization installing water filters around Nicaragua- really nice and neat man it sounded like. Good connections! So Rita and I are making progress! We were also super excited today because we think we fixed a couple of pieces of equipment! We put in a new battery in the Doppler ultrasound, and it works better than before. We tried to ask around if it was good enough but didn’t get much feedback. We also investigated the ear/nose/throat light machine thing. Only 3 of the heads worked, but when we took apart the others, we found that the light bulbs worked. We then put them back in the head and they worked! No idea why! We may not be able to rewire the defibrillador but we can definitely take apart and rebuild things! We are just taking things one step at a time and trying to build relationships here. Hopefully Harold will come back and we can talk to him, we can get Cheyo to warm up to us, and maybe meet some nurses or others tomorrow. Besides that, we need to find some info on the machines perhaps online and work on writing a manual for our monitor. A lot of work to be done- good thing we are here for a month!

Adios y Hola

So I just got the airport 2 hours earlier and there is free wireless!!!  Yeah it is so nice to use my own computer!   Yes, so it is a transition weekend- leaving Costa Rica and coming into Nicaragua.  I am actually really sad to leave my family here and the country too.  My family was a mom and her two daughters, one in university and one who was 10 years old and adorable!  She gave me a “I love you” card when I left 🙂  I really liked the family and house.  It was small compared to others where the whole extended family lived together (another had 18 people!)  which was really fun because then we really got to know the family and practice our espanol as well!  The country of Costa Rica is wonderful too!  SOOOOO beautiful.  San Jose is in a valley, so everywhere you look there are these bright, colorful houses against the green landscape.  Gorgeous!  The people are generally friendly too.  The food was also good- lots of pineapple, mango, and papaya.  Me gusta!  We definitely lived in the capital city, which was a pretty big city and similar to other American cities in terms of lots of young people, very international, pretty dirty, crowded, lively.  It was interesting living and studying here in this city and then travelling to the smaller towns on the weekends.  I’m not going to lie, I don’t think I’m a city girl.  The weekend trips were amazing!  I loved doing all these fun activities outdoors!  Last weekend we went to La Fortuna and Volan Arenal.  About 8 of us did the same hike up the crater lake!  I think that was my favorite thing too!  Some of us swam all the way across which was so eerie because in the middle, you can’t see anything!  We were literally swimming in a cloud!

In terms of culture, I was surprised here when talking to the family by the large amount of infidelity among the men that has left many families as solely female and many very young single mothers.  Most of our host families did not have fathers, especially among young people and the generation right above us.  Similarly with that, PDA is not frowned upon in public places such as the mall or bus stops.  Family is also super important to them as most extended families still live together or close by.  My host family all lived on the same street, even the divorced father and his parents.  The children don’t leave the house until marriage, so even when going to university, they live at home.  Our host girl lived at home and went to university only 3 days a week.  I do like how important family is and the respect of elders.  I wonder if this will be similar or different in Nicaragua. I am going to a small town of about 33,000 people which I sincerely look forward to just as a difference from here.

Classes here have been good but I’m not sure how useful.  Spanish definitely, medical instruments, we will see!  I have learned so much Spanish- 3 different tenses and sooo much vocabulary.  I hope that I will be able to at least get my point across within conversations.  I am by no means comfortable, but I am sure that next month I will be practice all that I have learned and hopefully won’t have to think so much. Our lab consisted mostly of taking apart medical equipment that we brought, which was very interesting but perhaps not super educational. I am so worried that when we show up at the hospital next week, we won’t have a clue what we are doing.   I am without a doubt much better prepared than when I left, so that is really all I can ask for!  I really look forward to hopefully giving back and helping people though!  I think this last month I gained a lot more than I gave, so I hope this month I will be able to give more.

The hospitals that we visited here in Costa Rica were really nice.  They were very equipped in terms of medical equipment with X-rays, ECGs, ORs, ERs.  We went to one hospital in San Ramon and another in Tirialba.  All of the staff that we met (mostly technicians, mechanics) were very knowledge and took great pride in their hospital.  The one in San Ramon even had a butterfly garden and made their own compost! The staff gave us tours of the hospital and even explained the medical system in Costa Rica as it is mostly public and government controlled under the social security system.  I am glad that we visited though so we could see what some hospitals looked like in different countries.  It will be interesting how different Nicaragua is from this too.

The other students on this trip have been absolutely amazing!  Everyone is so incredible- interesting, intelligent and so caring!  I am really going to miss them, having so many people to talk to and travel with.  I hope that everyone in Nicaragua can travel together on the weekends.  I’m really going to miss everyone in Honduras though and I worry about their safety.  It is going to be hard to go from having 26 other students around to just Rita and I, but I hope that it will give us more opportunity to interact with the community then instead of each other.  I look forward to Diriamba and seeing another place, another culture, another family, and another hospital.  I’ll write soon!  Hopefully others will join on and we can hear from them too!

Aqui!

Hi!  So I’m finally getting settled in and figuring everything out, which will honestly take a month in itself but oh well.  It has been super fun getting to know the other students that we are with- I think they are like 27 of us: 3 from a school in London but 1 in from Brazil and another from France, 1 from Denmark, and lots of kids from around the US (Michigan, Vanderbilt, Clemson, Milwaukee, UVA, Hopkins and of course Duke).  Its really great.  I’m living with 3 other girls in my home stay:  Ali lives in a room by herself and Julie, Jane, and I live in one room together in bunk beds.  Our host family is wonderful!  It is a mother named Rocio who works to keep the kids behaving on the school buses, Daniella who is in her first year at university studying advertising (and knows some English), and Mari who is 10 years old and very shy.  They are wonderful!  We have been trying to speak Spanish, but seeing as I don’t know hardly any, it has been super difficult.  Rocio, my house mom, said that we are only allowed to speak English in the house until Monday and then no more even amongst ourselves.  Yikes! I’m kinda glad though because then I will have to learn it.  I definitely am picking things up fast because I have to.  I feel bad though that we can’t talk to them more and ask questions, but it is hard for me to speak Spanish and them to speak English.  I’m hoping that will improve though because they seem to be very interesting people.

We started Spanish classes today, and I am in the beginner class.  It was actually really fun because there are a bunch of us that don’t know anything, so we understood a word, we all cried “Ohhhh” in unison.  Our teacher may or may not know English, but she won’t speak any either way. She acts words out like charades as we all try to guess what it means.  Just learning some common phrases has helped though.  We do have some people that have great Spanish skills though, so that helps when we are going around and trying to find food or someplace.  I really cannot communicate yet without someone else who knows more Spanish, but I hope to be able to do this by the end.  We also have had 2 classes on medical equipment which luckily are very similar to the BME 154 class I took at Duke.  Our labs are pretty crazy/fun though- very hands on!   We have our own tool kit and tools that we are use to actually do hands on stuff. I learned how to solder and desolder today!  And without burning anything up!  It was pretty frustrating though as the irons kept breaking and I did not have a clue as to what I was doing but I’m learning.

We are going water-water rafting tomorrow, and I am very excited!  Supposedly, Costa Rica has some of the best rafting in the world!  We are going to take pictures, and I will definitely post them once we get them.  Well it is off to bed for me, but I will add more soon!

We are almost there!!

Hey all,

So we are about to leave for our big journey in just a couple of days.   ” We” includes 8 undergraduate students from Duke University (7 engineers and 1 biology major) as well as 20 other college students from around the world.  We are going about to embark on our Engineering World Health Summer Institute project in Central America.  We will spend a month in San Josel, Costa Rica where we will take 2 classes, one on Spanish and the other on medical instrument repair training.  The second month we will spend in another country in Central America (Duke students are in Nicaragua, others in Honduras) working in the local hospitals.  We are waiting to determine what our communities need before we set any hard goals or tasks, but we are planning on repairing broken medical equipment, setting up new equipment, and working with the hospital staff esp technicians.  We don’t really know what else but we will see when we get there!

Well I guess I should go work on packing.  Its kinda difficult to know what we will need but luckily past students have been a big help.  All I have to say now is that we are super excited  (and a little nervous too)!