La Ruta

Of the many (many!) things that make us happy in this world, it's safe to say that a mix of hiking, smiling babies, sunshine, and doing some good are always shoo-ins.

So you can imagine our joy when our dear Doctora Somarriba-- our jefa (boss) for the month-- told us that this month is "La Ruta" in Nicaragua?! What does this mean for us you may be wondering? Hiking, smiling babies, sunshine, and doing some good! Seriously.

For the month of March, Nicaragua has a national vaccination campaign ("La Ruta"); this is made possible through the national healthcare system (which guarantees free healthcare for all), and countless dedicated volunteers, nurses, and doctors walking door to door making
sure everyone receives their vaccinations. And among these amazing people... Us! All month, we will spend at least two days a week to "La Ruta," walking from house house in various areas of Chacraseca making sure children receive polio vaccines, vitamin A (for their vision),
deworming medication, as well as providing tetanus and pneumococcal vaccines for adults.

The days are simple: we wake up at our now standard time of 6am, eat our chef Yadira's fine desayuno (breakfast), then hop on the back of a truck to a community in the Chacraseca area. We (usually a nurse and doctor plus us Buchholzes) then start walking. We carry a small cooler with us filled with vaccines, a clipboard, and a bag full of syringes. Stacen has mastered giving shots at rapid speed (as well as giving the oral polio vaccine), and I handle the cotton swabbing, deworming pills, water, and playing with the smiling babies.

Not only does this work give us the instant gratification rush (we are deworming children and preventing blindness and polio!!), we also have been given the gift of truly getting to know the incredible warm and kind people in the communities. People welcome us into their homes, often pulling chairs out of thin air. We are thanked, offered tortillas, and --one blessed time-- lemonade with ice. These are precious things that people give us with a smile of gratitude.

We will always remember these walks because they give us such An intimate look into these peoples lives. 

Below are just of the few things we are fortunate enough to see.

On the road! Richard, one of the head nursing students at the clinic, is obviously awesome.

Unloading our supplies next to the truck

Dra. Somarriba, Richard, and Stacen start walking.

Richard vaccinated a pregnant 14-year old

Bella!

We ambushed a school and got these unsuspecting kids!

Deworming medication; moments later, she spit it out.

Niño divino! He just won me over in two seconds.

He knew my weakness for his adorableness and quickly walked me over to meet his family.

Proud grandma

Proud mama

Hola!

Stacen makes a lot of friends.

Standard welcome from families

Mama handles the shot (thanks to Dr. Estacen'so gentle hands) like a champ.

We caught this sweet little boy and his baby cousin during shower time!

Beautiful wood oven and tortilla

Walking to another home

Karen, the head nurse, plays with a very happy baby!

Unforgettable eyes

 

Buses Gone Wild: March Madness

After a busy morning of vaccinations we rushed back to the house where Nicole proceeded to take the fastest shower in recorded history, we threw some things together, and we hustled in down to the "highway" to catch our bus into León. We were headed to the beach.

Buses in Nicaragua are almost always the old bluebird school buses. Total throwback. PS: this is our highway.

The bus came surprisingly close to on time, and we even got seats! The ride was amazing! We battled dust that came from all directions. If we slowed down, it caught up with us. If we turned, it would come in. If we sped up, it came in. We quickly learned to time our breathing and eye opening with all these movements. Additionally, the bus was outfitted with a sweet sound system that was blasting the latest hot Latino hits, complete with a tv mounted over the rear view mirror that played the corresponding music video featuring mostly bikinis and cartoon characters.

We jump out in downtown León, where we are advised to hop into a nearby jerry-rigged microbus out of a pickup truck, which took us on a whirlwind tour of the city, before depositing us at yet a third bus, which we hop into, and discover we have some time until it leaves. Nicole's fruit-dar went off, and she bought some clementines at a nearby market. My carb-dar went off and I bought some scrumptious pastries from a woman selling them right on the bus. Gotta love those impromptu lunches!

Nicole in her natural habitat.

Kids pumped about the beach!

Bus trip number 3 was the least eventful, but it was nice seeing another part of the country on our way down to Poneloya Beach. Thankfully some good Samaritans told us where to get off and we ended up right in front of our hotel. Door-to-door: $1.05 per person.

Coming home wasn't nearly as romantic. We joined the throngs of day-tripping locals who were ALSO headed home from the beach, and it seemed as if we were all taking the same bus. And there were so many cars parked on the sides of the road that the bus couldn't follow it's normal route, and we detoured along some tiny dirt roads, picking people up all along the way...

Before 30 more people got on...

We were squished. Things were fine until a guy squished up against me started grinding heavily on my left hip. But in his defense, he was drunk, and the bus was playing some awesome Reggaeton.

After another fruit pit stop, Nicole and I pampered ourselves and took a taxi home.

Look at those papayas!

A Note on Climate Change & Deforestation

My favorite college professor once told me about the shame he would
feel when he attended international climate change talks. He would
listen to representatives from developing countries plea for help,
listing the devastating effects climate change was causing in their
countries -- now. Then, delegations from the developed world, the US
most prominently, would discuss the political complications,
scientific uncertainties, and do--nothing.

After walking all day in Chacraseca, I saw climate change. Today. Now.
We have mentioned the dust and the dry season, as well as some of the
political and economic reasons for the degradation of the land.

Here is a global map of deforestation, with Nicaragua ranking seventh
in the world in the most extreme risk of deforestation :

But the map, much like most of what we hear about climate change in
the US is large, abstract, and overwhelming.

In Chacraseca, it's tangible and understandable. But no less overwhelming.
Land practices that prioritized profits over sustainable livelihoods
have left the community with only dust. A changing climate has made
the dry and wet seasons a yearly gamble, with rain coming later and
harder, shortening the growing season of the few working fields even
further.

School playground; few trees remain in the area, most small and thin. Due to a 90% unemployment rate (particularly during the dy season), most parents have little-if any- way of providing for their family.

Typical road. The large pile of fire wood is another cause of deforestation; most households continue to cook with firewood, decreasing the vegetation stock further, and causing health issues due to the smoke inside the home. 

I now get this shame. There is always that huge divide between when
you "get it" or "understand" and truly understanding. I have know and
believed and been wanting and willing to fight the global beast of
climate change for many years. But now... I am ashamed. For what we continue to do--and not do.

First Medical Days

FYI--there are some, in my opinion, very not gross medically pictures in this post.

2 posts in one night-I'm on fire!

Nicole and I left León for good early Monday morning, and made the trek out here with the whole medical team that we had been joined up with since our arrival on Friday. We arrived at the clinic, where we rushed in to where we are staying to drop our stuff of real quick, and get our first glimpse of where we are staying for the month--La Casa de Paz ("the peace house"). It was built 15 years ago by a group of nuns, who then dedicated it to be used by the local charities and development groups that work in the area. 

Thank god for google maps

The group split up into 2 groups and Nicole and I were separated 💔😿. Nicole remained here at the clinic, I hopped into the van and continued 30 minutes down the road, to an area that had never had a medical group before! 

Standard transport

Was it a square cloud? No, the locals hose down the area in front of the clinic to keep the dust under control.

This is how it works: the medical teams come down and run big clinics where they essentially function as way of identifying what illnesses etc are out there. Anyone who needs a follow up or is actually pretty sick gets referred to the lone doctor for all 9200 of these people--Doctora Somarriba.

We set up in a municipal building, and I joined a dermatologist all morning. We saw all skin problems, and a bunch of primary care. We had a great time, she was a great teacher, and her translator, Ricardo, was amazing. Good groove going. After lunch, I joined up with a family practice doc from Colorado, and we saw a myriad of strange things all afternoon. All in all, it was a very positive experience, not just because I love doing what I was doing, but because the patients were pretty healthy. 

Classic ulnar deviation of untreated rheumatoid arthritis.

The same woman. She is 31.

Just happened to notice this. Doesn't bother her at all. Nice paint job!

This guy made my day. He was so proud of how healthy he was, he pulled out his ID to prove that he was 79. And at the end of the consultation, he said "and you know what? I smoke 5 cigarettes a day!"

A point of pride for this family...every one of them have 12!

This woman had been making tortillas, and working in very hot conditions. According to local belief, the heat can enter your ears and give you a fever. Therefore, toilet paper ear plugs.

Before heading back we did a house call on a 9 year old girl born with club feet, and had never walked in her life (although she skedaddled on her hands and left knee very quickly). We let them know that an orthopedist is coming in June, and that we can't do anything about it until then. And suddenly I found myself in a prayer circle--these are very religious people.

The atrophied legs and club feet of this girl. Note the dirty callous on her left knee from how she ambulates.

The group went back to Leon and Nicole and I met our cook, the groundskeeper, and various locals. It gets very dark and quiet here around 6:30, (except for right now as I'm writing this there is a Toyota pickup blasting Nicaraguan pop), and it definitely has taken some getting used to.

After a good nights sleep (and my first use of a mosquito net--crucial), Nicole and I found ourselves both working at the clinic here in Chacraseca. I paired up with the dermatologist and Ricardo again and we once more had a wonderful time. Additionally, it was my job to fit people with reading glasses. Talk about instant gratification!

We finally settled on a style to her preference.

This woman's growth on her eyelid prompted us to ask about styes. Which is when we found out the local treatment for styes: several vigorous rubs on the eyelid daily, with literally, the tail of a cat.

Around lunchtime Nicole and I were invited to join in the weekly meeting of the Chacraseca community leaders. What organization! We witnessed as they talked about such as issues as educating their children, access to clean water, and building a new home for a young mother whose husband is a migrant laborer in Costa Rica. We introduced ourselves and offered to assist their community in any way we can in addition to working in the clinic. It was a wonderful feeling to be welcomed into the community!

For these 2 days, Nicole worked "intake". She recorded names, birthdays, heights, weights, chief complaints, and kept that crowd in order with her Latina sass! Haha no actually they were all very well behaved. We were pretty surprised to hear a lot of them say they had been waiting since 4:30 in the morning. Nicole also discovered that many people didn't know their birthday.

Nicole's partner in crime, Janie, poses with 2 lucky guys.

At the end of clinic, Nicole met someone who made it even clearer that we had come to the right place--this man oversees water and electricity in the community, working with the Austrian International Aid Agency. He is measuring water usage...and really needed a geocoder! Nicole was elated! So they will be going around all of Chacraseca to map the locations of all the wells and current piping being used, in an effort to improve the current infrastructure. This, in addition to her clinic duties. Can't keep this girl down!

I went on a house call that afternoon and met a young husband and wife who had been in a motorcycle accident 15 days previously. Wife broke both legs, husband broke his hip. Due to issues with insurance, and simple access to healthcare, they wife has only 1 leg casted, and the husbands cast for his hip was fine, until he had a seizure and broke the cast. It was removed and another was not given. They now just lay on their beds, no books, no tv...just laying there. I helped clean up some wound the woman had, and found myself in a prayer circle yet again.

She keeps a mixture of lime and mango leaves on the wound to prevent infection.

Husband and wife, waiting to heal.

The group left for good this time, and now it's just me and Nicole out here. We are grateful to have this opportunity at this time in our lives.

Sneak peak for my next blog: vaccinations!

Where we are

Hello hello from little ole Nicaragua (about the size of Texas). I am writing in a room filled with dirt and bugs...and excellent wifi. The inconsistencies we experience in the developing world never cease to amaze me.

Standard home

We arrived in Chacraseca on Monday morning. It's a 50 sq mile patch of land beginning about 5 miles due east of Leon (don't bother googling it--it's not on the map). It is home to 9200 people, the majority of which have no education (thankfully however, almost every child goes to school). The average family survives on $1.50 a day, and unemployment here is unbelievably, 90%.

One of many very thin stray dogs that attempt to join us for every meal.

Clever machete placement

Some history: in the 1950s, American companies came into this area with the support of the abominably corrupt Somoza government (I also recommend a quick read-up on Nicaraguan history). They entirely deforested the land, and very soon what had been a tropical dry forest became 2 crops--peanuts and bananas. They pumped the land with fertilizer and insecticide, and they marketed their product in the US. When the Somoza dictatorship was overthrown in 1979, the companies withdrew from Nicaragua, leaving behind a dustbowl, and the tenant farmers that had worked the crops. The new government gave the land to the farmers, but in a cruel twist of fate, the cost to farm the land exceeds the amount the farmers have saved. So, large companies come in and pay 1/3 what they would make if they could afford to plant it themselves. The cycle of poverty continues...

A peanut field covered in 3" of dust

My patients are tenant farmers on their own land.

NYC, Philadelphia, Nica, Managua, Leon (¡Jodido!), .... Y Chacraseca

Our adventure started the day before our flight to Managua; in one flurry of a Thursday we moved out of our apartment (and New York City), drove to Philadelphia (our new city), filled a 5x10' storage space with our treasured possessions (paintings, tapestries, awesome kitchen tables, chairs, and abundant appliances), took a train back to NYC, subwayed to Greenpoint, Brooklyn, had Thai noodles with our dear amiga Barbarita (shout out for giving us a home for the night!), and.... slept.

Friday was go-time. We had our last hipster meal; our sun-drenched luncheonette gently played 1950s tunes while our pierced and flanneled waitress brought us crafted espresso beverages, and a breakfast of dates, pears, coco, and homemade granola (in soy milk, of course).  We then walked, subwayed, and bused to LaGuardia, and looked awesome while doing it.

Waiting for our bus

Two flights latter, we arrived in Managua, and quickly found our way to the extremely swanky Best Western--literally across the street from the airport-- and into the wonderful arms of DO Care and JustHope (the partnered organizations that made Stacen's rotation possible). There we met up with a large group of DOs, students, and many of their loving spouses. All people worth knowing, but a few stand-outs are the leaders of the group (a couple who is in their late sixties and have been to over 150 countries... Hello new life goal!), a groovy pony-tailed doc who spends his days questioning American capitalism and traveling to Peru and Costa Rica on "spiritual cleanses," an eight-time Ironman lady doc ex-engineer that pumped us up so much about what we are doing, a surfer lady-doc who had a "mid-life crisis" and decided to travel and learn Spanish (pretty damn well), and a fellow lovey couple (she's the doc). 

Swanky BW

And course ....the woman that started JustHope, a minister that has been working in Nicaragua since 1996 and just emanates love for this country. She first became involved in Central American politics by serving in an Underground Railroad for war refugees during the early 1980s, a time when many of these countries were at war and highly violent. Due to complex and painfully shameful US policies, not only did the US cause, manipulate, and extend much of the local conflict, it also denied amnesty to the fleeing refugees. So, an Underground Railroad of sorts was created to take refugees to the much more welcoming Canada. 

We encourage you all to read up on some Nicaraguan history; it will amaze you just how involved the US has been since it's independence from Spain in the mid-nineteenth century; Wikipedia gives a fabuloso short intro. (Also see: "Open Veins of Latin America" by  

Eduardo Galeano, if you really want to get fired up).

Saturday morning was spent lounging in the Best Western in the morning, filled with exploring the hotel's extensive grounds (and making friends with a goat herd!), the airport, and a local gas station. In the afternoon we headed to Leon, stopping to take some pictures at the lovely (and contaminated) Lake Managua, overlooking two  (often active) volcanoes. The road was cleaner than we had seen six years previously, thanks to a government effort for trash removal. 

BW's friendly goat herd in an abandoned area of the resort

Abandoned bungalows

But... the roads and fields were also much dustier than we remembered. Deforestation, brought on by American/foreign monoculture of bananas, peanuts, and other cash crops, surrounds us. Dust is everywhere at all times, getting in your lungs, eyes, skin, and every surface. We will get into this more in later blogs, especially about how it's affected local farmers (no more livelihood), and health.

Dust, due to deforestation

Leon is a colonial city, crumbling in parts, colorful and beautiful in others, with a pulsing heart of rebellion and pride everywhere (clearly I'm easily swayed by my Latino roots). Because of their history which, much like the rest of Nicaragua, has seen a series of corrupt rulers, dictators, and wacky government, the city has a simple and telling slogan: "Leon-- jodido!!" ("Leon-- screwed!!"). We dig this city. 

Leon panorama 

Attention-loving local

Downtown Leon

Biggest cathedral in Central America 

The afternoon in Leon on Saturday and all of Sunday were spent in a flurry of seminars (learning about local health issues, global health ethics, etc), walking around the city, getting to know our fellow travelers, learning about Nicaraguan history, and cultural activities.

 A very simple exercise that surprised both of us at its effectiveness was a family buying experience. Nicaragua, the second poorest country in the Western Hemisphere after Haiti, has most rural families living on a $1.50 a day. So, to attempt in a small way to understand this, Stacen and I each were put into a "family" (4 volunteers), given $1.50 and told to feed ourselves for a day, and have some money left over (for transportation, education, electricity, etc). 

As you can imagine, this made us abundantly aware of how little food people have access to (and how limited it is to rice/beans), and what an overwhelming task living on the equivalent of a grande drip coffee (no espresso for you!) is for a family. 

Powerful history lesson of Nicaraguan through a public mural

Politics

In the afternoon (after NACATAMALES) we met with Dr. Somarriba, to brief us on Chacraseca. She is THE local doctor that we will be working with for the next month; she cares for the 9,000 residents of the Chacraseca area. She comes every weekday, every week to care for patients. Even more humbling to any American doctor/professional is the fact that for all her work, she earns about $6,000 a year, almost $2,000 more than the average Nicaraguan. 

Nacatamales; no hallaca, but it'll do ;)

After more talks and another typical Nicaraguan dinner of rice, beans, meat, plantains, and salad, we headed to a musical extravaganza of typical dances and a truly bangin' local band. Then... Ice cream! (Truly necessary in these 90-degree plus days).

Amazing local band

This morning, bright and early, we headed off to Chacraseca for the first of the two clinic days with the visiting team; much to say, so we will leave it for the next couple of days. 

Casa de Paz, our home for the next month

¡Mucho amor a todos!