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NICA: Before Clinic




This past February I took my second Palmetto Medical Initiative trip to Nicaragua. I have been to Central America several times before this trip so I kind of had an idea on what to expect and I knew it would be much different than my Uganda PMI trip. Like last year, I was pleased to have a buddy come along, this year Nick Pavia joined me. The company he works for supports and works closely with PMI and he was due for a trip. The neat thing about these trips is, each quarter the dynamic is different, based on who goes. In Uganda, we had a large OT/PT team. On this Nica trip, there wasn't even a OT/PT station at clinic. There were a lot of younger folks on this trip and the trip overall was half the size of our group for Africa.

We were in Chinandega and El Viejo. This area is notorious for being the hottest part of the country, which I believe. It was much hotter than Africa, at any given point during the day. Uganda was a dry heat and Nica was not! We are talking 90 at 7:30 am and lets go ahead and throw in humidity.

Saturday:
I left from RDU and flew to Managua. We waited for everyone to arrive and stayed the night in Managua. We had people coming from all over the country: California, Texas, Oklahoma, North Carolina & South Carolina. I got in around 8:30 from Miami. While I don't love the Miami airport in general, their international wing is pretty great people watching. It was a little over 3 hours from Florida to Nica.

I was lucky enough to be sitting beside a very nice German man. His name was Schwirtlich Guizther. He is in his 70s and was traveling to Nica for a cycling trip. He's apart of a league in Germany and anyone can sign up for this trip. He was meeting 18 other Germans, whom he did not know. He lives south of Frankfurt and has two sons. He and his wife love to travel but she isn't a cyclist. Mrs. Guizther made him a "meat and cheese baguette" with fruit for his flight over. He didn't eat it before he came to Miami, so he got caught at customs. Dogs were sniffing all of his carry on stuff. They took his sammie and directed him to the food court! Before we landed we were filling out customs forms and he borrowed my pen and asked if I could help him fill out the docs. When we were done, he dug down in his bag and told me he had a little present for me, all the way from Germany. It was a thank you for helping him with his documents and speaking with him during our trip. The gift; a mini flash light that dubs as a key chain!

Side note: You can bring food on for your flight but it needs to be consumed before you go through customs in your arrival country. 




By 9:30pm we are in route to our hotel. Hotel Hex was much nicer than we all expected. We had a quick group meeting with the PMI Regional Director for Nicaragua, TJ McCloud while eating pizza and then off to bed we went. My roomie for the week was Kristina. She was great, I couldn't have asked for a better person to spend the week with.  At Hotel Hex, we were lucky enough to be on the end, which meant a bigger room. However that came with a price, the night club beside us was open and went on until wee hours of the am.

Sunday:
We load up on the bus after breaky (hot dogs, eggs, fruit, rice and dry toast) and drive three hours from Managua to Chineandega. There were few lights and stop signs. Both might as well have not been present, as most didn't work and no one used the ones that did. We stopped at gas station about half way there and were thankful there was toilet paper. The group stocked up on snacks and water and talked to the locals that were hanging out in the gas station parking lot. There was a building for the store, but there was also a tent just outside the front doors of the gas station store where they were selling snacks, drinks, blankets, hats, small toys and cleaning products.


Hotel Hex
Thomas Bus was the bus of choice
Side note: Iguanas were for sale along side the road.

Our hotel for the week was Hotel Los Volcanes. It was incredibly clean and much nicer than I expected. We had the same roomie, which was fine by me! We unloaded all our stuff in a large room then hopped back on the bus and headed to the Rosti Pollo for lunch. This was such a treat. In Uganda, there was no where for us to eat out. All meals were prepared by the hotel. This place was nice: AC, tile floors, clean bathrooms with toilet paper, wait staff, and a large menu. Nick and I decided (ok, I decided) that we would order different things and share. We also had fresh juice, soda and water!

Already, one major difference was apparent in this trip from Africa... Freedom. We had freedom in Nica. Safety was not nearly as much of an issue as in Uganda. Our mode of transportation was a big yellow Thomas bus. With a driver and no guard and no guns. We got to explore the towns we visited, walk around the parks, eat out, shop with local vendors and overall see more of the towns.



Chips and onions were brought to the table when we sat down



Following lunch we continued our trek to El Viejo and arrived at the clinic site for tour. The clinic Doc, Dr. Chico showed us around and we meet some staff. We learned how the treat patients, saw forms they fill out, looked around in the pharmacy and had the opportunity to ask any questions. Dr. Chico, a general surgeon, talked to us about the lack of medical attention in the country and lack of knowledge about and how to get health care. He was very passionate about is work and thankful to PMI for what they were doing to improve his community.

The space was a lot smaller than the Uganda clinic. El Viejo clinic was open sure/ space, there was a water fall and it was smack dab in the middle of town. Just outside the front door were dozens of people walking around. There was a barber shop, watch repair and jewelry store, street vendors, corner markets and homes. We were told this is where clinic day 5 would be, at clinic!
















From clinic we walked to the city center to hang in a park and see the colonial- era church, The Immaculate Cocentpion of El Viejo. It was built in the 17th century.  In 1995 the church was elevated to the status of national religious sanctuary. In 2006 Pope John Paul II declared it a basilica. I learned that in order for a church to hold the sacred name of basilica, The Pope must deem it so.

The church was in the middle of the center center. There was a nice park and people hanging out everywhere. We could see a bustling market just down the street.










While walking around the park, we saw a group of boys sitting in front a statue. We walked up to them, and started talking to them. I asked if I could snap their picture, they shook their heads yes but would not stand up or take their hands from behind their backs. They were laughing and you could tell they were hiding something. They were hiding something alright, dead pigeons! They had shot down pigeons with their sling shots and were hiding them behind their back. Most of the kids we saw, boy or girl, had sling shots as toys. 






From here we head back to the hotel to get room assignments and get ready for dinner.  Kristina and I lucked out, we got the biggest room in the hotel! Dinner was steak, rice, veggies and salad. The beef in Nica is uhhhmazing. Apparently they are known for their beef. It was some of the best I've had. 

Like in Uganda, I was the Team Leader for Registration.  Each evening after dinner, we would have a Team Leader meeting. At this time, we would discuss the next day location, tips to making it better than the day before, suggestions, and just talk out the day with the other leaders. This was a great way to see how the other stations preformed. Once clinic is set up and running, you really only have time and space to focus on your station. 

Shout outs at dinner also allow for people to talk about highs and lows of the day. This is probably my favorite part. Since I am non-medical, I really enjoy hearing about the medical side of the day. There are usually some pretty incredible stories. We are all exhausted by this point of the day, but it's nice to hear different perspectives on how the day went.

After our meeting, we all lend a helping hand to the Pharm team, as they had thousands of pills and hundreds of boxes to open/sort though along with wound care products, triage needs, etc. It all had to be sorted and put in the correct containers/ bins before we left on Monday morning. 




Another part of the day I enjoy is the devotion time. It's short and sweet, but meaningful. Jim Johnson of Sunnybrook Church in Stillwater Oklahoma was the pastor on the trip and he lead daily devotions and prayer. I really enjoyed Jim and his approach to faith. While I don't agree with everything he believes, I believe in a lot of it. I can tell you at the end of each night and the end of the week, I really thought about where I stand with the big man upstairs and what it means to be a believer. Jim is very approachable. He's firm in his belief but open to talk about yours. He's welcoming and has a warm disposition. He choose a story from the bible, gave us the bible reference, but then always gave a personal story, to make his point of that bible reference and to help us understand it. He wasn't judgmental,  he was curious. I felt as if he truly wanted to get to know each and every one of us. It was such a pleasure to have met him and the team he brought along. He helped guide us through this trip in a very unexpected way but in a way I think we all grew to appreciate. 

Sunday we talked about how to be careful and be safe. These are the two most important things on the trip. If anything happens to us, we can not do our job, what we came to do. Jim talked to us about not using these people for experiences for ourselves, which he admitted was a hard one. We want to feel better about us. About what we do. Our culture has created a vision where we need to show people how great we are. Basically he told us to keep our pride in check. This trip wasn't for us, it wasn't about us. While it may change us and we hope it does, this trip is for the people of Nica.

We are tuckered out and in bed by 11. Next stop, Aurelio Carrasco. 









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