San Juan Del Sur

Last weekend we took a trip to San Juan del Sur which is south of where I am on the Pacific coast.  It is a big surf area and they have world surf competitions there.  The actual city is in a cove and then you have to drive about 30 min (6 km)  to get to the beautiful swimming beaches.

                              Some guys playing futbol at sunset

We stayed in a hostel and met a lot of tourists from all over.  A lot of them were surfers from all over and then there were also some European travelers who were going through all of Central and South America.  Also, wealthy Nicaraguans vacation here as well.

The first night we went to a local bar and that's where we saw the doctor from the clinic we work at.  All of the bars are right along the ocean as are all of the restaurants which gives it that beach feel.  In the morning we hiked up to the Jesus statue which overlooks the cove.  It was not a long hike but it was steep.

                                           View from the beach

View from the top

We then went to playa Hermosa which is a beautiful beach!  It's very secluded so in one direction see the ocean, then you look behind you and it's nothing but trees and hills.  The waves were also huge!  I was surprised that they weren't strong waves for how large they were.  

At night we went to a reggaton bar with live music.  Overall, it was a great trip!

                              real coconut water and yes it is much better                                       than anything store bought!

Adios!

Hot springs, natural healers,and therapy oh my!

                       Morning wake up call (Howler Monkeys)

Last week we spent an afternoon at the hot springs.  Driving up, the sulfer smell got really strong.  There are quite a few hot springs around because of all of the volcanoes.  It was really beautiful with all of the trees around yet also different than I expected.  There were three hot spring pools with cement surrounding them.  The one pool was the filler which used its water to fill the other two...with the other 2 being lower than the first.  Someone from the community has been designated to clean it and maintain the pools therefore it costs a few dollars. Its really interesting because with the hotmsprinmgs and many other activities in the area they have a discounted price for those who can't afford much, then the local price, then the local foreigner price, then the foreigner price. Mmany of the locals take their showers there and there is a washing station for laundry so they don't have to use their own water.  There were a few families swimming, people sshampooing their hair, and then women doing laundry which takes about three hours for a medium size load because its all by hand.  The Nicaraguans also have a different idea of modesty than we do.  They all wore their clothes in the hot springs because bathing suits are too revealing.  Also, many wear jeans in this hot weather but with more form fitting tank tops\shirts.  However, breastfeeding in public is extremely prevalent with no cloth covering as would happen in the states.  But then when the pediatric surgeon comes in she is always wearing heels and tight fitting clothing that no US doctor would ever wear.  I am still trying to figure out cultural dress.

                                Us at the hot springs

Laundry day

 Later that day we went to see the highly respected natural healer in the community.  Nicaragua is moving mainly towards western medicine and the natural healer works with the the community doctors.  For example, if there is a non compliant patient who wants to see the natural healer instead, the doctor will talk to the healer and even give medications that the patient won't take from the doctor.  Also, she has anti parasitic medications along with natural herbs and a sauna (hand made).  Luckily, I did not need the sauna.  She uses her hands to detect energy through your body and then snaps her fingers ifsomething is "bad".  For me, she said I had two vertebrae out in my back so she gave me a really nice massage.  I also had no ovarian cysts and a great immune system.  Another friend had a bad liver and parasites.  I should mention that besides the clinic, there are so specific stores or shops, everyone sells things out of their home.  So the local barber works from home, little stores are in front of a persons house, the bakery only makes goods by request from her home, and the natural healer works out of her home.  So at the natural healers I had to use the bathroom, she had me climb over a fence where the pigs were and that's where her latrine was.  She then walked away and one of the pigs started chasing me so i had to run into the latrine!  It then lost interest but I also ran out of there!  Overall, it was a great experience and i was able to learn about natural healing!

                              Natural Healer

One really nice aspect of this community is that everyone has a role.  For example, kids with Down Syndrome don't go to a different school but instead become productive members of society and no one looks at them differently.  Every Friday, there is therapy for all of the kids in need of physical therapy or therapy for cognitive delay.  Many infants are slow to start talking and walking because their mother's never put them down long enough to start using their own strength.  Also, the concept of talking to infants is lost here therefore, many babies aren't saying any words at 2/2.5 years.  The kids I saw in therapy had different types of issues.  One girl has cerebral palsy so we performed exercises with her.  Another girl was born with myelomeningocele (spina bifida).  She has surgery and now has subsequent paralysis.  That can get better with therapy and time, she is only 3 months now.  She also has hydrocephalus which is when there is too much fluid in the brain.  She is having surgery (a shunt) to fix it.  Her mother didn't take any prenatal vitamins and so this was a product of not enough folic acid because as I said earlier, parasites love leafy greens so people can't eat them.

Hasta Pronto!

Diabetic Home Visit

                              Mi Casa

Today I performed diabetic home visits, the person who runs it is an older Nicaraguan lady.  We went from house to house checking blood glucose (sugar) levels and blood pressure as well as asking about symptoms and medication compliance.  Many blood sugars were in the 400-500 levels with normal being less than 126.  Surprisingly, no one even had symptoms.  It is also difficult to find compliance here due to their diet.  Rice, tortillas, and fruit are staple foods so when we say to cut back on these foods people then ask well then what do we eat??  And honestly, there is no good answer because its difficult to buy different foods.  Also, insulin is extremely difficult to get here so metformin is the only medication given out.  For these reasons most people have poorly controlled diabetes with many complications.

The visit also gave me the opportunity to see many different houses.  The houses range from those with front doors, ceramic floors and a kitchen table to those with diet floors and no table.  Most houses are made of cement but there are some of wood and others of tarp.  Every home also has a latrine which is a hole dug deep into the ground used as a toilet, surrounded by tin walls.  Sometimes, homes will have an outdoor clay oven and many have a washing station for clothes.  An interesting sign off status is having these portraits superimposed onto some sort of background.  For example,  a baby in a queen sized bed, our two people with the background of a nyc apartment.  It looks slightly odd but people here love it.

                               Very nice home

 This is a well that many homes have in order to get water. They are working on purifying the water so many homes how have filtered water.  The tropical climate is perfect for parasite growth so those who don't have a filter (and even those with one) get parasites.  Here, everyone is advised to take anti parasites every 3 months, and the medication is cheap because its so common.  Many of the kids who come into the clinic are malnourished,not hungry, and have a night cough... All of which are signs of parasites.

The cows are coming!! Animals and humans share the roads around here.

Below is a latrine

Hasta luego!

La Clinica

My village


I am working with the FIMRC non profit organization (Foundation for international medical relief of children).  They have multiple locations including those in Uganda, DR, Peru, and in India.  At this specific clinic they are here full time to help give the community the medical help they need.  This includes a pediatric surgeon 2 days a week, medications too expensive to get elsewhere, any supplies, and a prenatal program.  In Nicaragua, all public healthcare is free.  Every community of around 4,000 people have a community physician, in rural communities such as the one I'm in the physician is a newly graduated medical student.  Medical school begins after high school and every new physician must do a year of service in a rural community before residency.  So basically a 22 year old with my knowledge providing all healthcare in a community with no support and the closest hospital 1.5 hours away.   They get their medical education paid for in exchange for a year of service.  Every region has a hospital that provides more services including xrays, labs,  labor and delivery and surgery with some subspecialties.  Then in Managua, the capital, they have the most technologically advanced medicine.  As I mentioned, FIMRC provides a pediatric surgeon who knows more about pediatric illnesses and has more experience than the local clinic.  Also, FIMRC and the local clinic (health post) share medications with mainly FIMRC giving meds out.  The prenatal program is awesome.  Before it started there was a high maternal mortality however it has lowered since the program began.

Today, I went on home prenatal visits.  In the community there is usually around 50 pregnant women at any time.  The prenatal visits happen once a month throughout the 9 months.  We visit their homes and talk about something different every month.  This includes symptoms, foods to avoid, getting exercise, foods to eat, and many more topics.  Then, the woman gets a handout at the end.  It's run by a Nicaraguan from the community and the women really trust her.  Here, home births are discouraged because of conditions of the home and flourishing tropical diseases.  However, because the hospital is far women are told to come to the hospital 2 weeks prior to their due date and they then sit in the hospital.  However, they need to bring their own food, sheets, and anything else they may want.  Even with these conditions, last year only 1 person delivered at home because she had no one to care for her other 5 kids and the baby died and the mom feel ill secondary to leaving the placenta in the uterus.  Also, prenatal vitamins are essential here! Many of the parasites live on green, leafy vegetables and that's where folic acid comes from thus women aren't getting them.

One more note about pregnancy in Nicaragua, most women get pregnant at an early age and also marry young and have 6\7 kids.  Pediatricians stop seeing girls after age 12\13 and tell them to see an OB/GYN because many are beginning to have kids.

Ok, until next time!

Hasta luego!

Bienvenidos a Nicaragua!

Hola! We arrived in Nicaragua Saturday night, appreciating the dry heat we were met with (much better than -25)!  There are three other medical students from my school and we were met at the airport by Omar, our trusted driver.  We drove through the capital city Managua.  I was amazed by the good conditions of roads,  much better than many Michigan roads.  The streets were also filled with people.  The homes were very similar to those in San Jose, Costa Rica,  small concrete one story houses.  We drove two hours to the town of Granada.  Granada is a cute town with dirt roads and small concrete homes.  They also have a plaza in the center with all outdoor tables and bars along the street.  At the bars there were many young people dressed very american (guys in plaid and girls in heels).  I'm assuming its the wealthy part of the country.  We went out for drinks ($1 beer) and there was a mariachi band as well.  There were also 4 boys between 8-12 years old who played until 1am then came over to the drunk people at the bar to beg for money.  We were thinking maybe they were homeless because they were out so late.

Our room in Granada, with                           gecko!

Sunday morning I woke up to a typical Nicaraguan breakfast of gallo pinto (rice and beans) , Plantains, vegetables, and cheese with salsa on top of a tortilla.  After breakfast we drove 2 more hours to Limon through the rural countryside on dirt roads.  I am amazed at how many people are out everyday.  At one point we have to drive through a herd of cows walking down the road.  Also,we passed many men in baseball uniforms and a few baseball games. That seems to be the big sport here. We eventually made it to our residence which is down a rural road,  the closest grocery store is 1.5 hours away.   

I am staying at a complex about A 5 minute walk from the Pacific Ocean and it is gorgeous!  

I am at the back of the complex which borders a rainforest so the howler monkeys wake me up in the morning!  There are also a fair share of insects.  The first night there was a scorpion-spider in my bed which made me nervous but now it just hangs out on the ceiling and I've adopted it as a resident of the room.  

We have a Nicaraguan cook at the house who cooks gallo pinto and eggs for breakfast.  That is all for today but tomorrow I will give more details of the clinic and what I am doing here!