Yo No Se Mañana

And so, queridos lectores (dear readers) our amazing little adventura nicaraguense finally has ended.

From our time in and around Nica, we have seen and experienced so much more than hospital tours and medical treatments. Our kind guides have shared their food (especially gallo pinto), their history, their land and roads, los insectos (especiales las hormiguas), their homes and their lives. In a cliche and but very true manner, our lives have been altered because of the people we met.

As a fitting farewell and look ahead, we decided to post our favorite song from the trip, "Yo no semañana" for our final entry. A translated excerpt:

"I don't know tomorrow, I don't know tomorrow

What we live now is something truly beautiful.

Who could know what will happen,

tomorrow there is nothing written."

After two increíbles weeks in Nicaragua, we have safely returned to the United States to begin our final semester of nursing school.

We would like to extend thanks to UPOLI (faculty and students), Don JM (our fearless driver), CI Jane, DuSON and all other new friends and family that made our trip possible. We will be sure to carry our very special community clinical experience with us in our corazones y mentes--and maybe a little extra peso (weight) from the rice and chicken. The insight we gained will follow us from the barrio Villa Libertad into our remaining nursing school clinicals and future nursing careers.

Muchisimas gracias Nicaragua. Aunque no sabemos manana, es verdad que vamos a echarle de menos. (Thank you Nicaragua. Although we don't know what tomorrow will be, it is an absolute that we will miss you).

Un gran beso a todos,

Sarah y Alicia

Nadie es Rechazado

"Nadie es Rechazado."

One of the docentes (= teachers) of UPOLI said this to us one morning while giving us a tour of the community health clinic. The phrase really stuck with us during these past two weeks as we were stationed in different parts of the community’s multi-service free public clinic. The phrase explains the philosophy behind the public health care system here. “No one is rejected.”

For some patients and community habitants this idea translates to a free visit to renew a free prescription for an anti-hypertensive drug. For some it is a free prenatal visit during the third trimester of pregnancy to diagnose possible life-threatening preeclampsia. For others it is a physical or psychiatric therapy appointment, also gratis (=free). Like in the ERs of the United States we observed the community clinic’s emergency care fila (line) winding down the sidewalk outside. The concept of "nadie es rechazado" is much more complicated in real life than in ideology.

So we’ll repeat: every service they offer is free! The patients can get the examinations, consults, diagnostic tests, treatments, drugs and vaccinations without the nasty insurance company bills. The catch? Not every drug and service is so easily attained. We heard one story of a hypertensive patient who was prescribed aspirin to manage her condition. However, the pharmacy had run out of their supply. Thus the woman was told she could go purchase the medication at a nearby pharmacy. To us this illustrates that healthcare does not always function as it is intended—a reality we have seen daily in the US as well. While we are preparing to graduate and enter the nursing workforce, it will serve us well to keep in mind that no system is perfect and we must be ready to deal with low supplies, miscommunications, and unexpected barriers to our ability to care for patients. In working side by side and observing the nurses in the clinic here we have seen quite a bit of patience in confronting these issues. There is no magic “snap” of the fingers as a means to accomplish an end. Witnessing the fortitude of the enfermeras we will perhaps leave behind some sense of entitlement and expectation.

What we enjoyed about working in the clinic was the variety of nursing work in which we would participate daily. Without the benefit of having a community clinical until this point in our nursing program, we have only seen the acute patient--those seriously injured, very ill or already-diagnosed. We witnessed many sad situations of this nature in the Managua community clinica here as well, but we also saw a fierce system of prevention. Nurses and doctors are working daily to keep the well-patient from becoming acutely- ill. The work of the nurse should not lie only in the realm of the already-ill but in the wide vast area of persistent prevention.

During our experiences with our families in the barrios, an entire other side of health care and the human condition was opened to us. It is one thing to care for a patient in an isolated hospital room and tell them to eat more fruits and vegetables. It is an entirely different world to be invited into the home of a client and see a single stove top and small basket where they keep their week’s supply of food. It seems simple to advise an overweight patient to get out of the house more often and give them a pamphlet about controlling their condition via exercise. However when one actually walks through a small barrio where pandillas (gangs) run rampant and unknown eyes peer at them from behind dark windowsills you might see why powerwalking is not a local trend. To talk about nursing for a community is so different from being a nurse among a community.

A huge thank you to all of the amazing UPOLI nursing program directores, profesoras, nursing students, the community clinic nurses and staff, and our beloved promotedores and leaders at the Centro Academico de la Villa Libertad. We have learned so much in this two week experience. We wish we had at least one more week to spend. Gracias por la experiencia de clínica y de la vida mas increible (thank you for a most incredible clinical and life experience).

Ode to Gallo Pinto

Hola fanaticos de deportes (=sports fans) today was our second to last day working in the community clinic and with our familias in the Barrio. Only one more full day and we are sadly obliged to fly back north (if Irene nos permite).

With our precious little time left and a flurry of last minute activities to do, we're delaying more in-depth posts until Saturday or after we return to the ol' US of A. Thus, we shall gift you with a bit of prose this rainy evening whilest we prepare for our big NicaNursing finale: la Ferria de Salud en la Villa Libertad (=the health fair in our barrio). We're very excited to talk more about health and self-empowerment via knowledge with our familias and their neighbors--we'll tell you how that goes another entry.

So for now we'll get back to our nursley duties, and do please enjoy the following poem. It expresses our deep bond with a certain dish which is found on every mesa (table) of every casa (house) on every calle (street) in every ciudad (city) of this fantastic pais (country).

The following piece is called...you guessed it...

"Gallo Pinto"

Gallo pinto everyday

gallo pinto--no matter what you say.

Gallo pinto in all of my dreams

gallo pinto--we're busting at the seams.

Gallo Pinto stuffed in your face,

gallo pinto goes right to your waist.

Mas gallo pinto por favor

porque el gallo pinto tiene muchi sabor.

Gallo pinto every morn'

No gallo pinto? You shall be forlorn!

Feel free to add some rhymey goodness with commentary!

Buenas noches amigos -- Alicia

Tiene una pelotita de qi...

A little live-motion action for our friends to enjoy...

So little time left here! Sadness!

UPDATE: Our little sick friend in the 2nd vid above is doing much better now. We saw her today playing "tag" and running all around the grounds of the clinic today. Nos de mucho alegria esta vista bonita (To see this beautiful sight made us incredibly happy).

Seguir Aprendiendo

Buenas noches a todos! Gracias a Jessie for her incredible job with the blog last night. Kudos to you, coco caballo. We leave Managua in 3 days. THREE. I can hardly believe it. I feel like I need at least one more week here. There is still so much to be done and I would love to spend more time with my family.

What made my day today: Yesterday, when Katie and I visited our family in the barrio, we helped the 7-year-old study for his test on English vowels. Today just we when arrived to el barrio, he couldn’t wait to tell us he received a 100% on his test this afternoon. He thanked us for helping him yesterday with English sounds. Obviously I congratulated him with a hug and his favorite sticker, but what he doesn't know is how much he's helping improve my Spanish and how he's impacted my experience here. I will certainly miss this family when I leave Managua.

Anywho, on to what the group did today! We got to sleep in 30 extra minutes this morning…! Instead of working in “el Centro de salud” this morning, we toured el Hospital Bertha Calderón, a hospital for the women of Nicaragua. We toured the NICU, labor and delivery units, and gynecologic cancer facilities. I think this may have sparked an interest in Labor and Delivery in a few of our classmates! Here are some awesome facts about this public hospital:

1. NO EPIDURALS IN LABOR. That's right...no epidurals, and no pain medications delivered via IV, unless they are preparing for a c-section. Only local anesthetics (ie: Lidocaine for episiotomy repair). This facility believes in LAMAZE therapies for pain control (deep breathing, support, etc.) I wish our maternity instructor could have been present for the tour--shoutout to HG!

2. An oncology facility just outside of the hospital for chemotherapy patients who have traveled from all over the country. The women are able to stay and eat here while they receive therapy. Talk about being connected with a great support group. We talked with some of the mujeres (women) at the home -- what strong people. See the photo of the woman sewing pants for her nieto! (grandson)

3. The hospital was named after a woman who worked at the hospital but was captured during the guerra (=war) of the 70s against the dictator, Somoza.

Tomorrow is our second to last day at the Centro and working with our families. We will be spending the afternoon in the towns of Granada, Masaya and Catarina. I have heard nothing but good things about these places, so I’m excited for what lies ahead tomorrow. I’ve loved every minute of working with each member of this group. The cohesion of our group is great, whether at la clinica, la playa, or adventures in El Van. I am also impressed at our progress in perfecting the art of "Spanglish" -- especially in El Van after a long day. Absolutely could not have asked for a better group- or a better CI!

Well, we’re not quite ready to get nostalgic yet, two more full days of work and play to barrel through before we even think about the trip home (or packing for it).

We'll post more tomorrow and hopefully include pics (and maybe videos, with help from Jessie) from our trip to Granada. Que tengan una buena noche, ustedes!

--Sarah

**Photo credit: Susanna, gracias chica!

Hola todos! This is Jessie taking over for the night while our favorite heroines are off furiously working on a presentation for tomorrow and recovering from cooking a delicious pasta dinner for the troops (gracias Alicia!). We may or may not have had a few slices of pan (bread) served extra tostada this evening....

I am far less blog savvy then my companeras, so I'm going to do a quick summary of the day and let the photos do the talking. This morning was spent at the Centro de Salud giving heaps of vacunas (vaccines) to the bebes and providing breastfeeding education to the new moms when possible. Following this, we headed back out to the barrio per our usual routine to visit with the familias. After spending 3 days away, I was surprised and SO heart-happy by how comfortable and familiar it felt to hug our madre hello, and to sit and chat on her patio. Her pooch, nino, even felt so at ease with us that he barely fussed when we arrived and even chose our chairs to curl up under. We were able to progress beyond the physical ailments, and move into the emotional aspects of life - something that is undoubtedly important, but often pushed aside when the environmental and physical concerns alone overwhelm you. Best spanglish moment of the day? Attempting to translate the idea of "empty nest syndrome"...it may have involved some well developed charades skills (perhaps my new favorite game?) and lots of quizzical looks from the recipients of the explanation. At any rate, its time for sleep, enjoy the photos! Buenos noches!

C.I. Jane Speaks

Tonight's blog is dedicated to the Clinical Instructora of our dreams: C.I. Jane!

Giving a presentation with a trusty translator to help spread her genius in other languages.

Check this!

Making friends en la comunidad...

Mentoring future nurses...

And tutoring (or being schooled) by the youth of Nicagua. Nuestra heroina! (Our hero!)

Tonight, we decided that we were quite tired of writing from our own perspective--que aburrida! So, we decided to ask the most interesting person in our group for her thoughts...who might that be, you ask? C.I. Jane claro que si!

Today she gave a "charla" or presentation about Sudden Infant Death Syndrome (SIDS) to the UPOLI faculty, students and ourselves. FYI--Jane is a BALLER in research on this topic. She humbly boasts a doctoral degree from UCLA in pediatric nursing with a focus in immunology and neurobiology of the young infant. Dare we impress you further by telling you that she DID THE ENTIRE SPEECH IN SPANISH? Well, almost all of it. It's hard to translate how ammonia is a byproduct of protein breakdown in the liver...especially when you don't know the word for ammonia.

As students we've noted how difficult it is to translate our blooming nursing knowledge into espanol. Given that, it's hard to imagine how difficult is it to translate and communicate a plethora of knowledge into a second language. We decided to find out and interview her tonight, post-charla.

NicarBlogua: Would you say you know about as much as one can possibly know regarding SIDS?

C.I. Jane: ::pauses thoughtfully:: ...Yeah, pretty close. I've certainly read everything there is to read about SIDS. I mean I don't understand it all...

NicarBlogua: Tell us more about your research y las ratas que matas (=the rats who participate in your important studies to understand SIDS).

C.I. Jane::hearty laugh:: I don't know what to say. Well, it started as an accident. My disseration was in immunology. So I needed a place where I could do more 'bench' research. So I got a fellowship at NIEHS (National Institute of Environmental Health Sciences). And everything they did [utilized] animal models so that's how I learned [how to work with animal models]. With something like SIDS...you obviously can't research on humans, you can only look at humans who have already died.

NicarBlogua: More about the rats?

C.I.Jane:...I think the most important thing about rats is that they are AMAZING mothers. They take such good care of their babies!

NicarBlogua: You pre-translated the presentation and worked with a formal translator from UPOLI. How much more difficult was it to translate the intricacies and fine points of a disease that is so mysterious in its origin?

C.I. Jane: It was VERY difficult...difficult to talk about it and yet keep it as simple as possible so that I didn't lose anybody. I really only talked about a small part of my research. I had to go into the infection model and that was hard to translate! But it really helped to have to write it in English, translate it to Spanish and have the English version open during my presentation too. And I couldn't have done it without the translator.

NicarBlogua: How did it feel to be up there with 24 pairs of eyes staring at you?

C.I. Jane: Normal! ::laughs:: I always have 24 pairs of eyes staring at me. Spanish eyes were okay, too. I had my security blanket, my English version of the presentation and the translator. Had I not had the translator, I would have been TERRIFIED.

NicarBlogua: Do you think you could teach your research rats to respond to Spanish commands? Or at least how to order gallo pinto en the lab cafeteria?

C.I. Jane: Certainamente. They don't respond to English commands, but okay.

NicarBlogua: How did you think of the metaphor for the parasympathetic system/sympathetic system? Really folks it was genius no matter in what language you explain it.

C.I. Jane: I wish I had. Someone else mentioned it when I was learning the parasympathetic and sympathetic nervous system. It made sense to me, so I stole it. Genius can always recognize genius. You know when you're trying to figure something out and the light suddenly comes on, he was describing the car brakes and I was like...I GET IT!

NicarBlogua: Any closing remarks about the presentation?

C.I. Jane: I was very excited and relieved that it went well. And, we had a really good day today. We had two really great presentations today [referring to the charla given by two of our groupmembers about adult depression].

NicarBlogua: We think you did a great job and we learned a ton about SIDS... en espanol!!! Gracias y buen trabajo!