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thank you

several people have asked if there is a way to help the health clinic here in la concha in the way of supplies. thank you for asking!!! i have investigated a little, talking with the director of la mariposa, paulette, and the director of the clinic, mercedes. as i suspected, although the lack of some of the supplies i mentioned is an irritation to the clinic staff, mercedes named what she thought were more critical needs. these mostly come in the form of transportation. it sounds like they don’t have their own truck/ambulance to transport patients who come with emergencies that can’t be treated at the clinic (i.e. pregnancies, broken bones, urgent problems etc. etc.), they have to send one from the hospital, in another town, several kilometers away, and she says that’s a problem for patients. likewise, they have a motorcycle they use to transport supplies like vaccines from the clinic to a smaller satellite clinic in the next town that doesn’t have its own stock, and it’s broken. this, she says, is also a problem, causing staff to rely on public transportation and thereby costing unnecessary time and money for the clinic. so support in the way of money to meet these needs, merecedes says, is at the top of their wish list.
paulette told me that any donations from the u.s. could be sent directly to la mariposa’s paypal account (on the mariposa’s website on the “projects” bar under “how you can help”: donations can be earmarked specifically for one project–just enter “health clinic” or something like that. although i have to say, all of the projects i’ve seen here seem well worth supporting if you’ve got the itch! in my judgment so far, i have total trust in both the integrity of la mariposa as an organization as well as their integration the community, and therefore the relevance of their projects to local needs. the pastor from texas who set up the paypal account is actually staying here right now, and in addition to trusting him i think he seems like a really cool, righteous sort of man of god 🙂 i’m serious. and finally, i want to point out that dollars here go really far! i haven’t been buying a lot, but here’s a little illustrative example: if you go out to a restaurant here, a bottle of beer is equivalent to one dollar, tops. and because unfortunately people’s labor is also “cheap” here, likewise a modest amount of dollars could go much further toward auto repair than they would in the united states.
ok, well thanks again for asking, and reading, and of course let me know if you have any questions about any of this.
otherwise, things are going well. they left me alone in the emergency room most of the morning! which sounds much more important than it really is, but it was kind of fun. i helped clean up the stitches of a man who got stabbed in the stomach. oh my god. other than that, just little things. i am only there a few hours but when i leave sometimes i feel like i’ve been there all day! like today. but really, i have spanish classes in the afternoon, so i’m not quite done. for my “conversation” class my instructor and i walked down to this ice cream place i discovered in town and got ice cream cones. such hard work! ok i guess that’s all for now.


guerrilla nursing!

despite (and really, in the long run, because of) the massive doses of humility it takes to get through the morning at the health clinic, i am still loving it. i am doing things i have never gotten the opportunity to do in clinicals yet. for example, i have given more people shots in the butt than i could have dreamed of back in minneapolis 🙂 which led directly to a very funny experience at school the other day, actually. i was in my spanish class, which so far have all been just me and one instructor, and we were talking about nursing in the u.s vs. here. one of the guys who works here walked by, back from an errand in town, and tossed my teacher a box of medication. she’s like, thanks! and then she looked at me and was like, wait, can you inject this for me? i said, sure, i guess, now? and she said, i’m going to teach you to be a guerrilla nurse! it was so funny, after we were done with class, we closed the classroom door, she undid her jeans, and i gave her a shot in the hip right there on the table! haaaa! and she said she barely felt it, and i was like awwww, you’re just saying that…
the clinic has offices for people with appointments, as well as a small emergency room for minor injuries. i was in the emergency room most days this week, and i got to do some pretty cool and gross things, taking out stitches, cleaning some wounds, helping a doctor rip off a man’s toenail. ouch!! the thing about the emergency room, though, is that sometimes it’s completely dead. the first day, when they told me how they don’t have a doctor for the emergency room, that the two clinic doctors have to run back and forth, i was appalled: what lack of resources! how do they do it? after this week i got to thinking that if i ran that clinic i wouldn’t staff the emergency room with a doctor, either. there’s was hardly enough work for one nurse most days this week.
like, on thursday, i spent the morning with my favorite nurse, ana, and it went like this: we cleaned a man’s wound, gave some vaccinations, folded gauze, she showed me this long series of really “romantic” messages a (married) man who works at the clinic has been sending her on her cell phone, we cleaned up some dog bites, folded some more gauze, and that was the morning. and just to illustrate the situation a little more vividly, nearly half the time there was a baby rooster walking around the emergency room. and at one point a dog walked through. that’s true!
the clinic was initially described to me as “understaffed and under-resourced,” and while my impression is that it is not so much understaffed, it is absolutely no doubt under-resourced. for example, between the admissions office, the nurses’ and doctors’ offices, and the emergency room there is 1 (that’s one) pair of scissors. so, to cut the tape while dressing a wound, one might have to stop to go down to admissions to get the scissors, or vice versa. there is one blood pressure cuff in the whole place. the gauze, cotton, etc. gets wrapped in pieces of scrap paper to be sterilized in a sterilization machine. i could go on!
anyway, that’s all i guess for today. my camera and i are in a small fight, i’ll spare you the details, but at the very least ruby and alice will be here in less than 2 weeks, and i am fully confident that they will be taking lots of photos, and hopefully the internet cooperates and we post them!
oh, and. they have spanish scrabble at school! you may know me well enough to know how truly exciting this is for me. i learned this week that just because i speak spanish like a five-year-old doesn’t mean i can’t whoop some ass at spanish scrabble! 🙂
thanks for reading, really, and hope this finds you well!

man of birds

there is this man who works at la mariposa, manuel, he’s in his thirties. he used to be a guide at one of the national parks, and here he seems to do a bunch of things like: take care of the many animals, the buildings, the land etc. he is also the one everyone goes to when they want to know what to do for their cold, or their infected toe, or something, and he’ll go into the woods out back here and collect the appropriate leaf/herb/whatever. but best of all, he acts like a guide in the few acres around here, which are super lush, hilly, full of wild life. he’ll get the attention of whoever is around to show them, for example, hey look at that iguana over there on the tree branch! last week, he pulled me aside and led me to a nearby dirt wall, pointed a flashlight into a hole, and handed it to me. baby birds inside the hole! they nest about 6 inches deep into the dirt. i got to take a walk out back with him, and he’s pointing all these things out all along the way, but even cooler, whistling the songs of all these birds out there, and they’re singing back to him, over and over again. he is so excited especially about these little birds called toleros (i never heard of them), who he says have a special dance or “game” they tend play at certain times of day (all of which he knew). he said that he worked here for a couple years, and would always sing to the toleros. then he went away for six months last year and when he came back, they were gone! he whistled for them every day. and finally, one day, one sang back. slowly, there were more and more, he says, and that now they aren’t hard to find here at the mariposa. his explanation: they’re just like us. you need to let them know you love them, because if they think you don’t love them, or care, they’ll leave. ! when i told him ruby and alice are coming, he was excited and said we’ll have to go for a longer walk…if you guys want to. and then just this morning i was talking to danilo, the patriarch in my homestay family, and asked him what he teaches at the mariposa, because i know he teaches at the school, but is not a spanish teacher. he said he only has one student at the moment; he’s teaching manuel to read. i was touched, and rather awestruck, because here’s this quite brilliant person, and…a person is so complicated. and well, life is so complicated i guess, to put it mildly.

gettin serious about water

the family with whom I am staying here is wonderful. there are the “elders” (a little younger than my mom and dad, incidentally), danilo and rosa, who live in one house about the size of the first floor of my house in minneapolis, with several small bedrooms. in the same yard, just meters away, is another house, a little smaller, where their oldest daughter, mayela, lives with her husband and two sons, ages 10 and 3. their youngest daughter, Karen, is a med student who goes to school in Managua and comes home almost every weekend, and nearby live their other two sons, their wives and kids, who are around almost everyday. then there are friends, neighbors, all kinds of other folks who pass through, which all led me to be a little confused for the first several days about who was who, who lives where, and i’m so sorry but what was their name again? the folks at la mariposa have indicated to me that my family is really well respected and well known in the community, and I have hardly talked to anyone who doesn’t know them, or at least who they are, including staff at the clinic.
danilo and rosa are both retired teachers, danilo high school and rosa elementary school, and danilo still works casually at the mariposa as an instructor. mayela travels (about an hour) every day to and from Managua where she works at a Spanish language school, and the other sons work in some sort of sales, and as a veterinarian, respectively. I say all this because I think it says a lot about the way of life in this community to note that in not one of the homes of this extended family, who for the most part have “middle class” jobs and a relatively comfortable quality of life, is there running water.
here’s how it works where I am living: there is a huge concrete basin, maybe 12x4x4 feet, mostly covered, that catches rain water. to get water for washing dishes, doing laundry, bathing, etc., they (well, me too now) fill a bucket from the basin and bring it to the kitchen, or the now laundry sink, or the large bucket in the shower, as many times as needed to get the task at hand done. the laundry and kitchen sinks drain into big buckets for “gray water” that is used for watering plants in the yard. they also have a huge tank, maybe 10 feet tall? it has a filter, and it gathers rain water as well, filters it, and that water is for drinking, cooking, brushing teeth, that sort of thing. finally, the bathroom is a latrine, an outhouse.
what happens when the water gets low? they hope for rain. last night, when I saw danilo after it had started raining, he was smiling, talking about how happy he was now that it was raining, not unlike a farmer who’s lived through his share of droughts. because the rainy season has started here, the basin and tank have been mostly full; I’ve never seen it below a foot or so deep. but in the dry season, which just ended within the last month, if it’s gone it’s gone. it sounds like the option is to buy water that gets trucked into town.
for all these reasons, guests at the la mariposa, where there is some running water, are encouraged to be very mindful of their water use, and to try to use the latrines here rather than the flush toilets, the outdoor shower that collects rainwater rather than indoor showers. but it’s not just because of the cost of water: yesterday, the director of la mariposa was saying that the underground water supply in Nicaragua is due to run out in ten years. predictably, I suppose, one contributing factor they mentioned is the disproportionate use of water by developments attracting tourists and their demand for pools, showers, lush vegetation, etc. what a double bind, because tourism is apparently the number one money making industry in Nicaragua.
for me, it’s been really good to have this opportunity to become more aware of how much water I use in a day, and have a better practical sense of how precious it is. wouldn’t it be wonderful if this little personal realization of mine could do a damn thing to address the hard reality of water as a scarce worldwide resource? i wish this little ramble about water had a more hopeful or purposeful end, but for now, for better or worse, that’s it.

lost keys, resourceful nurses and an umbrella

i’m supposed to wait for the director of nursing every morning to tell me where to go, or who to go with. so yesterday morning, friday, i was waiting for him outside his office when he got there, and he started digging for his keys in his bag. and kept digging for his keys. he’s like, i lost them i think! so he goes off, i assume to get another set from the main office. but i was wrong. he went to see if they were in there, but he has the only set of keys for the whole nursing department. uh-oh!
but, he very adeptly pries open the window to his office and reaches his arm very awkwardly all the way around to open his office door. hooray! unfortunately, his keys aren’t in the office either, and he’s still locked out of the single refrigerated room where they keep all the vaccines, and the lobby is already full of people, at least half of whom are probably waiting for vaccinations. how many nurses does it take to break into a frosty vaccine room? in this case, two. they got some tweezers, pried the metal that holds the small window panes in place to that room, and again, the director successfully got his arm in the window well enough to reach the door knob from the inside.
problems seemed to be more or less solved after that, except that once we were in there and i was helping him arrange the vaccines for the day, he whispered to me that it’s not that he forgot the keys at home or something, he has no idea where they are. uh, good thing it’s friday? the drama wasn’t quite over yet, though. about two hours later i was with two of the nurses as they were doing a prenatal exam on a woman about 37 weeks pregnant, i.e. about ready to pop! they’re doing their thing, i’m watching and helping with little things, it’s all very interesting. one nurse (veronica) discerns the fetal position, reaches for the little hand-held doppler ultrasound that should be in the drawer, so she can check the baby’s heartbeat. it’s not there, so she asks the other nurse (darlin) to run and get the doppler from the closet where it should be stored, and she hurries off. do you see where this is going?
darlin comes back in a huff, and announces very sarcastically that “el senorito” forgot his keys, “que felicidades!” were they pissed! but she had this little wooden instrument with her, it looked almost like a short flute with a really wide lip, and she handed it to veronica, who placed it where she had estimated the fetal heart should be, and put her ear up to the other end, moved it around a little, and smiled. darlin took her turn, nodded, and then they let me listen. loud and clear, the baby’s heart was beating right into that little wooden thing. beautiful! then darlin took over and started counting the beats per minute with her cell phone timer, and that was a wrap.
but it’s not quite over: a few minutes into the next appointment, the director aka “el senorito” (no accents on this, but you know what i mean) comes in smiling with the doppler. the nurses are like, you found the keys?! and the director’s like, no, i got an umbrella, reached it around and pried the closet door open! we all laughed, and that, ladies and gentlemen, is the story of a day with lost keys at the centro de salud in la concha.

i wish i had more time to write!
i started at the health center tuesday and it is so interesting. so far i’ve mostly just been observing, helping out with little things, and i did get to give a shot today. (!) it’s clear the communication between the staff and the director–who set up my volunteer placement–has been more or less nonexistent, but luckily for the most part the nurses have been awesome, so friendly and fun, and way more patient than most nurses i’ve met in clinicals at school! moreover, even if they were all jerks the whole time, it is so interesting to be there it would still be a good experience!
so the first day, the director basically left me at an office door and ran off. the nurse answered the door, was nice, introduced herself, and was like come on, motioned me behind a curtain in the room. where there was a woman laid out and literally about to get a pap smear. hello! no gradual intro, i guess. afterward i asked her, so are you a doctor? and she laughed and said no, we nurses do everything here! i learned the next day that they also all insert IUDs, who knows what else?
but what’s really fascinating to me so far is that the clinic is public, and services are free. and most of the visits i’ve sat in on have been pregnant women getting checked out, women seeking (free) birth control, and moms taking their babies in for (free) vaccinations. i saw on the news last night a story reporting that nicaragua’s infant mortality rate has gone down to the 2nd lowest in central america in the last several years, since implementing some of these programs.
once a week, each of the nurses takes a turn doing home visits in the community. i am really hoping to be able to tag along. i feel so lucky to be here!

a good internet connection at last! pictures at last, a few.
–the view walking back from the clinic in town, those are volcanoes in the distance!
–monkeys! i think half the pictures i’ve taken are of the monkeys. i mean, what would you do? part of the “eco-hotel” schtick here is rescuing and sometimes releasing monkeys, birds, iguanas, dogs, etc. they say the monkeys are too tamed to safely release into the wild. that’s what i would say, too.
–the patio here at school
–and the front gate. so pretty!
things are good. it is mother’s day here, lots of parties, food, drink, music, it’s really fun. they had a party here with the staff and the students, lots of dancing, cake and punch with a little rum. it was super fun. we played musical chairs! i don’t know why. i haven’t played that in so long, but it was really fun and i laughed so hard, it was great. ruby and alice i was wishing you were here but i’m sure there will be other celebrations when you are here.
i hope this finds everyone well!