Saturday, January 7, 2012

Nica Clinics

Four days in the field.  Three in rural villages.  One at the hospital in Rivas.  Having no medical background, I cannot really assess certain aspects of the clinics, but certainly have impressions.  Perhaps it's best to simply share from the journal that I kept while there (with some editorial license :-)

Quick Sidebar - I sit here ready now to hit the "Publish" button, having sifted through a couple of thousand photo's, picking out what I hope are the ones that best tell the story.  What an exhilarating and exhausting process.  Exhilarating in that I was able to relive so much of the trip.  Exhausting simply because of the volume of photos and amount of time it took.  Having concluded the exercise I realize I have not yet answered the question "So what are you doing there, anyway?"   Well, guess you are going to have to wait another day to find out :-)

Clinic day 1 - Woke @4 feeling pretty crummy.  Up at 5, hoping for the best.  The bus was leaving at 7:30 and by 7:15 I had been unable to eat but a few bites of breakfast and had a decision to make.  I had been quite sick for the previous two hours and couldn't imagine being in the field all day with this - whatever it was.  Worried it was "the revenge", but fearing it was last nights drink of choice (I had one shot of the local Rum), I was bummed, ashamed, worried...

Time to board the bus and I confided in Cheri how I felt and she said she felt the same.  We decided to pray, so sat down for a few minutes together.  Five minutes later we were on the bus and both felt fine!  Yeah God.
Outside the dining area at Surf Sanctuary

Loading up, on our way to the first clinic day...


Driving through rivers is a regular occurrence.  During the rainy season this would be virtually impossible (i.e. impassable)

Martita's clinic
It was a short, but bumpy, ride to the clinic site in Bario Neuvo.  We made a quick stop at Martita's clinic.  Martita has been training with the portable ultrasound and is part of the initiative to take this country wide - using Nica based nurses and doctors (sustainability!).

Meet Martita (and yes, she is always smiling)

Kind of look like I'm charge, doesn't it :-)

The day was a bit crazy at times, but generally went well.  Three stations of med students, with two doctors rotating provided clinical assessment and care. Allie and Martita worked with some of the med students as well as local nurses to provide maternity and kidney ultrasounds, the Pharma students had a pharmacy up and running in no time, and this proved to be a big hit with Cheri. Having not had pharma students in the past, this proved to be a key to keeping the pharmacy from being a bottleneck.  Sam worked with some of the local medical staff on Herbal and Homeopathic options.

From the very young to the very old they came from miles around, most on foot, some on horseback or bike. 

My day was primarily spent directing traffic.  That meant having to learn to count in Spanish, as I was regularly calling out the next number to be served. 

The teams worked so well together.  Everyone is so full of life and promise and a desire to make a difference.  One woman was told that she was pregnant with twins :-)

And how old, exactly, is this technology?

Plan made.  Time to set up...

This would be the pharmacy in a few short minutes...

Many of the dogs, and working horses and cattle look like this.  Parasites, not malnutrition...

Most of these photos are from Tolga.  Student from Turkey doing his Thesis on Imaging Systems in 3rd world/emerging countries.

MINSA (National health office), set up a dental clinic a couple of times this week.

Starting to line up.  "Triage" was done by local nurses (blood pressure, temperature, weight, etc)

Getting under way...

Finding a need and filing it...

The portable ultrasound

My sister Cheri and her son John-Mark (Johnny)

Is this what free range means? :-)

Dr Sadz (don't make me try to spell his whole last name :-)


Allie and Marwa

Team #1!  (inside joke) Ellen, Abram, Dan

In case you were wondering how we got power...

Trying to keep order when an unusual December rain storm hit (normally doesn't rain from December thru February)

Does she look like she is in her element here, or what?!

Mauldin child #1 and Managua resident, my niece, Adri's mom, AWESOME mom and amazing MOG'er - Windy :-)

Pharma students - Jennifer, Sabrina, Ashley

Windy and Adri...

Tolga and Adri - you can tell she's miserable on these clinics, huh?
Translator and future doctor, Camillo

Windy's guard, our driver, and my new friend Luis.

The day done, everything packed up and cleaned up, we headed back to the Sanctuary where the bag of missing meds was waiting for us!  It had been driven the four hours from the airport after being found.  As this bag contained about half of the supply of antibiotics, it was an important bag. Yeah God.

The days "reflections" from my journal:
People - warm, patient, kind, appreciative.
Team - Cohesive, sincere, fun, hard working.
Extended team - Selfless. Tenacious.
Village - Stereoptypes met and broken.  So poor, yet so free.

Bill's card - day 4:
Mark 14: 6-8 - "Leave her alone" said Jesus, "why are you bothering her?  She has done a beautiful thing to me.  The poor you will always have with you, and you can help them anytime you want, but you will not always have me.  She did what she could.  She poured perfume on my body beforehand to prepare for my burial."

Start with God and you will have a right view of people and circumstance.  Start with people and circumstance and you will probably have a wrong view of God.  In every action from day dreaming to conversations we need ask "Am I robbing God?"

Clinic Day 2 - My mom's birthday!  Sent a note to my wife asking her to call mom for Cheri and I.  As I sat in the dinning hall waiting for the team to wake, I was doing my devotions on this day with my headlamp on as the power was out.   My meditation was Proverbs 19:1-3, 17, 21-23.

 1 Better the poor whose walk is blameless
   than a fool whose lips are perverse.
 2 Desire without knowledge is not good—
   how much more will hasty feet miss the way!
 3 A person’s own folly leads to their ruin,
   yet their heart rages against the LORD.
17 Whoever is kind to the poor lends to the LORD,
   and he will reward them for what they have done.
21 Many are the plans in a person’s heart,
   but it is the LORD’s purpose that prevails.
 22 What a person desires is unfailing love[b];
   better to be poor than a liar.
 23 The fear of the LORD leads to life;
   then one rests content, untouched by trouble.

The house I stayed in at the Surf Sanctuary
View from the balcony of my room

Looking left from the balcony

Power was out.  I got the only shower (early bird got the worm :-) until the lack of power meant lack of pump.  Camillo figured out another way to clean up for the day :-)

Some of the other houses built by Surf Sanctuary owner Tony.

On this day we would head to a fishing village in Las Canas - on the Pacific Coast.  Our clinic would be set up in the church building on the edge of town.  Abraham and (Cheri's son) John-Mark would carry a table from one of the neighbors who happily offered it up to meet our need.  One life, perhaps two, were saved today as a woman about 8 months pregnant was just hours away from a miscarriage.  The ultrasound revealed the trouble, and she was rushed to Rivas Hospital for an emergency C-Section.

This clinic location was arranged by request, and while the team worked well together and some good stuff was done, I sensed in Cheri confirmation that her desires to go "really rural" is MOG's calling/purpose.  Seemed obvious that this village received regular help and had some access to medical care.  "Next time" I seem to see the wheels turning "we'll get those 4x4's and go where the real need is..."  This does not, by any means, diminish what was done here today, however.

Ok, so I guess it was Allie and Tim that went for the table!

Camillo recruiting for the dental clinic

Setting up the pharmacy, day 2

Dr Sagz (ER Doc) and Dr Pam (Dr Pam owns and operates a free clinic in Detroit)

Nothing is wasted.  The plastic chairs we so quickly discard are repaired - and quite elegantly I'd say.

Ultrasound clinic, day 2

Windy running the walk-thru pharmacy window :-)

Our driver Johnathan.  Not always happy about all the miles, but was very dependable.

The lack of table lead to ingenuity.  Fencing placed on top of more of those plastic chairs.

The two Nica nurses that were with us all week.

Silly faces is one of Adri's favorite games

Here's a good shot of those fences and chairs turned tables

Cheri gives and gives until she absolutely crashes late in the day.  And then she gets up and does it again. So inspiring.

Not sure I mentioned Johnny (John-Mark) until this post.  Johnny will graduate HS this spring.  He worked as an interpreter and was indespensible for his knowledge of how to organize and execute a clinic day.  I was so impressed with Johnny, as I could see the God has truly marked him to do great things for the Kingdom.  Though he hopes to knock pads on the football field for a few years yet, and perhaps bang the drums in a band for a spell as well :-)

We finished the day with a brief ocean swim and watched the sunset from the beach.  Hard to top that!

Oh, but I do want to mention lunch.  Each day the locals provide lunch, but today they were very excited in that someone had donated Coca-Cola for us to drink.  Additionally, the local fisherman donated some fresh catch.  So a fillet on top of our rice-n-beans, some salad, and a Coke. Yummy!

The beer of choice (1 of 2 :-) in Nicaragua

Bill Card, Day 5 - Psalm 89:14-16
14 Righteousness and justice are the foundation of your throne;
   love and faithfulness go before you.
15 Blessed are those who have learned to acclaim you,
   who walk in the light of your presence, LORD.
16 They rejoice in your name all day long;
   they celebrate your righteousness.

Joy is spelled "Jesus, Others, and then Self".  A change in attitude comes from a changed heart.  To be Christ like, is to be an alien in a country not your own.  An ambassador to the world looking in expectation for our real home in heaven.  Who will be watching you today?

Clinic Day 4 (day 3 was at the Rivas Hospital, will cover that in a separate post)

We arrived in Astillero and were delighted to find that all of the set-up work had been done by the locals. This is an important aspect.  Engaging with the locals such that they are part of the process vs. just receiving from "the gringo doctors".  This is why the women preparing lunch was also so important, an opportunity to be included in the process.  Men would often "work security", though (thankfully) that often meant nothing more than chasing away the roaming dog (or cat, or chicken or pig... :-)

Anyway, the clinic site was a school house and each room was set up for a different purpose - from the main clinic, to a dental office (staffed by Nica nurses and doctors), the ultrasound, pharmacy, etc.  It all worked very well.

Camillo, who is in dental school, was given an opportunity to work in the dental office for a period of time and was stoked when he returned, telling how he had the opportunity to assist in a wisdom tooth extraction.

In Nicaragua, schooling often ends after the 3rd grade, the 5th for some if you can travel to a larger village.  For middle and high school, you need to move to one of the larger cities.  This means finding a relative or someone to house you.  Camillo and Sade, working for us as translators, are two such cases.  Sade was in college for two years (where she learned to read, write and speak English), but lost her mother to cancer last year and had to drop out.  Just this week I got a note from her that she has found a job in Managua and is very excited to be back on a positive path.

An experience driving a bus through a river :-)

Luxury transportation, Surf Sanctuary style

Heading out for the last clinic day, meant we would not be returning to Surf Sanctuary either.  Parting shot...

Clinic site, day 4

Pharmacy for day 4

Checking us out...

Apparently Ellen didn't like the drink of choice (goats milk and coffee I believe - I didn't have the guts to try it :-)

I'm thinkin' the ice cream bike made a killin' on this day...

Suchil providing a soft tissue massage

She also worked with some of the local nurses in the basics of massage
I never did hear why this little boy had these hairless spots...

Purified water and a refillable bottle.  A critical part of the process for us...

Leaving the clinic, we headed for San Juan Del Sur where we'd spend the night and have our fun day the following day.  This is a shot of the hostel half of us stayed in

A look inside.  The door in the back corner was my room :-)
This is my niece Sarah and her husband Baldo's hostel.  Half of us stayed with them.

Dinner!  Everything heated over clay pots - very cool, very tasty

"the girls"

Bill Card Day 6 - John 15:5-8

5 “I am the vine; you are the branches. If you remain in me and I in you, you will bear much fruit; apart from me you can do nothing. 6 If you do not remain in me, you are like a branch that is thrown away and withers; such branches are picked up, thrown into the fire and burned. 7 If you remain in me and my words remain in you, ask whatever you wish, and it will be done for you. 8 This is to my Father’s glory, that you bear much fruit, showing yourselves to be my disciples.

If Christianity was a crime, could you be convicted?  Bearing fruit is not optional but expected of the one who remains in Christ.

Press on friends.

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