Now that I have been in Nicaragua for a month and have found a place to live I no longer have any excuse not to start my “blogging career”. It has been a busy month, even though I have a hard time believing it has already been a month. In some ways it still feels like I just got here and in other ways it feels it feels like I have been here forever. I am still honored and humbled that I was accepted by NDI as the 2011-2012 Volunteer Naturopathic Physician, and am excited to be able to learn and experience work in Global Health Care in my first year as a licensed naturopathic physician. The colleagues I am working with are unbelievably inspiring people who fully believe in this cause. The two people I most closely work with are Dr. Tabatha Parker Guzman, one of the founders of NDI and its’ Executive Director, and Tony Trujillo the operations manager for NDI and in all honesty the jack-of-all trades here.
My journey to the island of Ometepe began with a day of flights, all of which were on time or early on arrival, which was a feat in and of itself. I stayed with Tabatha and her family for the first 2 weeks. It was the nicest and most welcoming introduction to Nicaragua that I could have asked for. The first day was spent getting settled with Tabby and Tony showing me around Moyogalpa and us looking at possible houses for me to rent. The next few days I spent getting acclimatized to the island and the weather at the office in Los Angeles (a much different L.A. than that which comes to mind for most) and spending time with Tabby and her family. On the weekend I was invited to join them at Ojo del Agua, a lovely little swimming hole, as well as at Anaconda – a place near the beach that Nestor (her husband) is working on developing.
By Monday I was ready to start my training, and since the island no longer offers Spanish classes formally it was decided full immersion would be the best way for me to learn. I started the day with a hospital tour and then worked the rest of the day with one of the doctors in their emergency room, in full Spanish! I am still amazed by the conditions these health care workers make do with. The emergency room consists of a desk, 2-3 chairs, an examining table, a sink with no soap, a cart with their supplies of limited gloves, suturing equipment, 2L water bottles filled with clean water, betadyne and another antiseptic. And that is all. The access to emergency health care on the island is limited to this and as such anything that requires more care is immediately assessed and the patient is then transferred by lancha across the lake to the hospital in Rivas, or if they are fortunate, to Managua where if they have the ability (ie. money) they can be admitted to the private hospital there.
The rest of the week I spent shadowing the doctors of the hospital, often splitting my time between consults at one end of the hospital with Dr. Guillen, known as El Maestro, and in the emergency room with Dra. Arcia or whoever had their turno that evening. Each doctor must do a turno – which is when they work a full 24 hours and stay on call at the hospital for emergencies at night. Working in the hospital was definitely exciting. While I was there I spent most of my time sitting in with consults, and as the week went on the Doctors would ask patients to tell me their stories and show me their labs, a good way to learn terminology and the basic treatments for common conditions. Everyone tried to include me, including on my second day offering me to stitch up the forehead of a little boy who was being held down by his father during this procedure. I declined, and did my best not to look faint when they were tugging rather firmly on the skin as I washed off the blood and cut the sutures. Also as I was (and am) still working on my Spanish sometimes when people would knock on the emergency room door and they would explain their situation to me I was often skeptical that I fully understood. This was the case when 2 women told me that the calm little boy they had brought had stuck corn up his nose. I was pretty sure I misunderstood and did my best to relate word for word what they said to Dra. Arcia in case I was completely off the mark, but it turned out I wasn’t as the little boy really did have dried corn stuck up his nose.
I also met Raly this first week, another Canadian doing research for her thesis from U of T and working with Oxfam Quebec, who would become my first official roommate. Or more accurately allow me to crash her house. By Sunday evening and with Nestor’s help I had moved my bags over to Raly’s guestroom and she very kindly let me stay with her for the next 2 weeks. It was fabulous, Raly has an amazing view of the Volcan Concepcion from her backyard, is a great cook (I would offer to do the dishes so I wasn’t just the worlds biggest mooch), likes good music and is all around a ton of fun. Also she would quite often spoil me by giving me rides to work as I had yet to try out the 6 km ride on my bicycle. We would pass by lots of traffic- busses, other scooters, horses, cows, some cars, bikes and primarily motorcycles. It is not uncommon to see 3 people and some boxes on one motorbike. Also one morning I was awoken to the sounds of Ometepe lawn care – cutting the lawn with the use of a machete. It amazes me how often you see machetes – whether it be on sale at the store or hanging off the handlebar of a bike.
The next week was more training in the hospital where I learned about the chronic clubs – meetings where patients with certain chronic conditions (such as hypertension, diabetes, asthma, arthritis, and epilepsy) come for check-ins and to receive their medication, if it is currently available on the island. I also learned about how the laboratory services of the hospital work – being that the lab techs are very well trained but have no access to any services that require elaborate equipment or reagents that require specific storage. For blood tests they can do routine analysis and certain ‘quimicos’ such as triglycerides, cholesterol, uric acid etc. For stool and urine they determine infection based on dipstick analysis and what they can observe under a microscope. I was blown away.
My second week I also was able to see the another side of the public health system here in Nicaragua, when NDI brought a patient and his family to an appointment at the children’s hospital in Managua for a booked EEG and to see neurologists for increased seizures. It was a heartbreaking experience as this family is one of the poorer families and it took a lot to get them there and to me it seemed that they were not given the respect they deserved. We ended up being turned away from the EEG (which was booked in August) as the patient was very visibly upset. It was recommended that we return after 3 nights of him not having slept so he would be calmer and sleep through the exam. I do not follow the logic in this, especially as this boy has epilepsy and autism, and could just imagine the state he would be in with 3 nights of not sleeping and finding himself in a giant machine. So this 5-hour trip to Managua didn’t end up changing much in terms of his treatment, but as a learning experience of how things work sometimes it was eye-opening.
Later in the week I joined Tabby and her family to celebrate her dad’s birthday – he was visiting from the States. It was held at Anaconda with a very special barbeque of something I can barely pronounce let alone spell, but I believe is a combination of a goat and a sheep. On the weekend I was also invited to join Raly, Laura and Gary, who are another couple of expats here on the island that have started a restaurant (The Cornerhouse, where you can find some green veggies and a break from gallo pinto on repeat, plus your coffee fix) and their friends from England at Ojo del Agua and then to Balgue for dinner.
The next week was calmer. I spent much of it in Los Angeles at the NDI clinic working on inventory and getting ready for the upcoming brigade from CCNM, the naturopathic school in Toronto. By the weekend I had decided on a house in Moyogalpa and had moved, with some help from Tony for moving my stuff and from Raly for helping me shop and set up my new little home. Little would be a bit of a misnomer however because I am living like a Queen. My house is super cute and very spacious, I even have a king bed! And it is all very colourfully decorated by its previous owner which gives it a warm and welcoming feel, and is always great for conversation (who knew you could find neon green and orange ceramic sea animals for your walls).