It was such a cool and humbling experience to explore around with Josh and help him really capture the essence of the people we were serving. I learned lot about photography, of course, but also the people who came to clinic. Being at the front of the line I feel like the registration team often gets them in the door then doesn't know what happened to them, why they came, what they were treated for, etc.. By doing patient profiles with Josh, I was really able to get a better understanding of how helpful PMI is to these communities. The gratitude, in particular from the older generation was overwhelming. They welcomed Josh and I into their homes, they were amazed by all the gear, shared stories of their life, gave tours of their homes, waited patiently while we set up shop and then "paid" us in love and sometimes a cola or hot fresh tortillas off the fire.
Of course everyone kind of knows about the colorful and vibrant culture of Central America, but it's still a 3rd world country, a developing country. People, despite the colors and vibrance, live in what we would consider unspeakable and unthinkable living conditions. Most houses were made of homemade cement, masonry, sticks and cardboard. There was normally one community space for shower, restroom and cooking area/ kitchen.
These are all things people inside do not see. Once inside everyone is 'happy' because they know they will get to see the doctor. Outside clinic is a different story. While it was slightly frustrating, especially to me a Virgo who loves order, it was a lesson learned. The registration team all agreed some of the issues were just part of the culture and the process was new to them as well. PMI Nica was only a year old when we went. That meant, we were one of the first handfuls of group teams to have served in this country. Kinks were still being worked out. Translators were still learning when they sign up, they are there all day to help. Patients are learning, while yes it is hot, we are all out here together, you can't leave for hours and cut back in line, and finally PMI has been doing this for years, so there is a reason things are done the way they are.
Selena: Selena and her entire family:parents, aunts, uncles, cousins, all live in a compound of sorts. There is a main front door from the street. Once you enter it, there are private living quarters for the family surrounding the perimeter of the property. In the center of the property there is a kitchen area, two laundry wash stations, one toilet and two / bathing/shower spaces. Selena is 11 years old and has a one year old son. She washes clothes for a living.
We start the day with a devotion on Exodus 3, the burning bush. As Jim's children said "you can't do nothing." We drove to a small village that sat at the bottom of San Cristobal Volcano. This volcano is the highest and most active in the country. It's been erupting since the 16th century.
Clinic was a church that was a little bigger than Monday's church. This meant more stations could open up and we could see more patients. It seemed less hectic on Tuesday. There were about 100 people in line when we arrived, then people slowly came on up through out the day. Josh wanted to explore the village and try and make it to the volcano. A local translator said he would take us. We crossed a bridge just by the clinic and walk through the village, through housing and trails for less than 10 min. Then the space opens up to this massive field with San Cristobal behind it. The field is full of workers. Josh and I start setting up to take photos and ask if we can speak with the workers. A guard quickly comes over and starts talking and using his hands. He's got a machine gun strapped to his chest. Our translator tells us we can not be there, that it is private property and we can not speak with the workers. We find out that one reason may be because if they speak to us, or we photograph something we shouldn't the land owner could be inspected. The guard thought we may be sending pictures to the Agriculture Department in Managua and would get them in trouble for not being up to code for one thing or another. We don't ask questions. We say our good byes and found some other people to speak with and photograph. One man we wanted to find was a man we saw at the volcano. He had a load of sticks on his back walking through the volcano field. We found him and learned he lived around the corner from clinic and was in great health and didn't need to see the Dr. He told us he collects these branches then makes brooms to sell, for a living.
The coolest thing I witnessed at clinic on day 2 was DJ letting children listen to their heart beat for the first time. He would let them use the stethoscope and they would light up when they could hear it. We also saw a women in a literal wheel chair. A plastic chair with wheels on it. There was a family that lived across the street and they had two talking birds. There was a little boy who had a pet rat. He wanted to bring his rat into clinic with him, but I had to stand my ground with a firm NO on this one!
After clinic we were able to stop in town to shop, get ice cream and walk through the park. We all bought souvenirs, walked through a beautiful yellow church built in 1885. It was a great clinic day.
Day 2 Patient Profile:
Elizabeth Valladares. She's 89 and has 14 children and 25 grandchildren. Eight of her 14 children are alive. She and her family in similar compound like Selena. She's been in this space for 40 years and her family owns the land just outside the village where we walked to see her. She was married for 60 years and her husband died 12 years ago. She makes tortillas and sells them for a living with her daughters beans. She came to clinic for joint pain and told me she was given medicine she had never seen or heard of.
We had people sitting in chairs under a tent in the street and would bring them through the front door. It got a little hectic inside, b/c there wasn't a lot of space for people to wait to go to the next station. Triage was moving faster than the providers were, so there was several halt stations, where we had to let the flow catch up. Another issue was pharmacy. Normally there is a separate holding areas for people waiting to get their meds from pharmacy, but since space was limited they were being sent back outside and not sure of what to do. A handful of patients would take off their wrist bands, and try to give them to others, thinking they were done with them, when in fact they were not. This causes a problem, b/c the # on the wrist band and # of the form that pharmacy is filling, need to match. We don't want the wrong person getting the wrong medication! Since we are dealing with a language barrier, # on wrist band and paper work were a huge resource for us, to insure people were getting the proper medication. People not wanting to leave after clinic was also a small problem, they just wanted to sit under tent or try and get back inside.