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!

Descent upon Paradise

Boat man: " So, where are you all from?"

CI Jane: " Oh, the $5 Taco Bar just down the street.

So there's the punch line but let me give you the set-up.
With a quick but winding trip in El Van, we arrived in the gorgeous seaside town of San Juan del Sur on Saturday morning.
After Alicia got the crick out of her neck from sleeping awkwardly en El Van, the authors of this blog went out for an athletic adventure into the town. In the true spirit of immersion Sarah got up close and personal with the streets of San Juan. We learned that if you're planning on having a mega wipeout in the streets, being with a group of 9 other nursing students and a Nurse Practitioner are the kind of people to be with. Post-emergency make-shift bandaging of her heridas (wounds) we spent our day lounging on the fine dark sand of the beach, slurpin' up baratas frescas, haggling in the small, sweaty merchant shops, and enjoying the symphony of the heavy tropical rain tormentas (and periodically being soaked by it). The scent of the epic mar pacífico saturated our senses...when the fumo from the diesel delivery trucks wasn't challenging our lungs. A beautiful day in this seaside town indeed.

Last night, after hours of exhaustive searching for hopefully not-too useless souvenirs for those back home, we all stumbled back to our rooms for a much-desired nap. Our hotel vecinos and the raucous soundtrack of the $5 Party Taco Bar across the street conspired to keep us from deep sleep. Thus we donned new skirts (and in Sarah's case, road rash) to sweat in and ventured out once more into the jovial beach-side streets for dinner and Saturday night adventures. After a short-lived attempt at Karaoke and feeding the mangy but sweet mutts of the town we braved a torrential downpour. We experienced why they call a rainstorm a tormenta for a reason.

We awning-hopped until we arrived at the infamous $5 Taco Bar. there we joined the two elderly ladies dancing in front of the live band. Our Gringa moves wowed the crowd . Among us we boasted a sassy salsa señorita and traditional Bavarian folk clogger. Both had the crowd on their feet.
We met/danced with a sailor from up north, a local high school history/geography teacher and an international lover of salsa. Additionally, CI Jane assassinated any doubts about her ability to shimmy through the night like a Latin princess. Indeed by the end of the night one might have thought we were from the $5 taco bar--we closed the place down! My carriage was long-since a pumpkin by the time we left.

This morning, after a delicious meal of huevos fritos, fresh fruit and perhaps one too many butter packets, Sarah and Alicia hit the beach with their classmates. After the beach, we had our last meal in San Juan at the $5 taco bar (some may call it home) and wandered the markets attempting to bargain with local vendors.

Although for us this was a weekend escape, we were reminded in small ways that it is a rural town where families live and work--we'll always remember the sweet little girl with her chicks on the front door step.

Back to el Centro in the morning -- more posts to come!

--Alicia y Sarah

Aqui, ya.

Yesterday I was in the supermercado trying to stock up on some basic foods (peanut butter and bread and cookies) to keep in my room when some nostalgia from home hit me HARD. The rest of the night was spent in jovial company as my roomate, DJ Jessie, C.I. Jane, and all the gals on our trip enjoyed our post-conferencia in our spacious pad. We ate dinner in and I started to read an absorbing locally-authored autobiography, and cackled about Sarah's blog post from last night. Yet, as I fell asleep...I was still imagining other places and people and things I have experienced.

Fast forward to this morning, there I was stiffly stumbling from slumbering in my fresh scrubs and clambering for cafe. The long day ahead--my clinica rotation, riding in "El Van," doing a head-to-toe for my familia and trying to organize our presentation for next week--seemed daunting and tiring before I even left the breakfast table.

Throughout the dia the tide of trepidation turned into something different. A solid and overwhelming sentiment took a hold:

TRUE. ENJOYMENT. OF. THIS. VERY. MOMENT.

Amidst the women with wriggling babies in their laps, the elderly men and women quietly awaiting their turn in the consultorio, the soft and shy smiles as we exchanged "Buen dias" and the general/genial/genuine interest in the fumbling nursing students as they struggled to decipher weight scales in kilograms and read blood pressures in a bustling waiting sala (room), I found fulfillment in that very second.

Today the thought recycled itself: There is no where else in the world that I am supposed to be. For these two weeks, for today, for this morning, this hour and this momentito I am exactly where I need to be.

With the intensity of our school demands, desire and commitments to family, friends, exercise and sleep I have lived under the shadow of "I should be..." What clarity and relief the recognition of "I am" has provided me today.

----

Our group is off to a concert by a former revolutionary and current poet tonight

( a sample: http://youtu.be/kkN4KWrT7Rs ). I continue my faith in the 'right now.'

Trabajando juntos

Buenas noches, ustedes! Today was another action-packed day in Managua. We started off the morning working at el "Centro" (community center), followed by a tour of a private hospital, Hospital Bautista, for the remainder of the afternoon.

One thing I have learned about blogging- it is difficult to write a long entry after a hard day of working (especially all in Spanish)! Therefore, I will follow Alicia’s lead by using a collection of bullet points.

-This morning at the “Centro de salud” I worked in the “consultorio” with a doctor where she interviewed patients, assessed and prescribed. Every patient we saw had severe hypertension so I had the opportunity to help with some nutritional education – eat your fruits and veggies, people! The doctor perfomed consultations fairly quickly – she saw over 5 patients in one hour--which in any healthcare system in the United States is pretty comparable.

-Yesterday I had the opportunity to work in the epidemiology room at the community health clinic with rapid HIV testing. A doctor, nurse, two Nicaraguan medical students and I were all present in the room. While the woman was waiting for her HIV results, several people in the waiting room entered the room to consult the nurse or doctor about treatments or when their turn would come. Strict privacy? Not a factor in healthcare here.

-Hospital Baustista: I am so lucky to have had the opportunity to see this facility. A nurse gave us a tour of the entire hospital. She was dressed head-to-toe in white including the traditional white nursing cap (“cofia”). One thing Alicia noted during the tour – the prices for the majority of the services are displayed on the wall. Not only does this serve as a reminder that the service is not “gratis.” but it is also an upfront way of displaying the costs of the service. There are no surprise bills later.

-Please note the photograph of the wheelchair from Hospital Bautista. One word: resourceful! You can see, it's trending in other parts of the world as well.

-I love when it rains here. Today was our first day without rain, and I can honestly say that I missed it. It usually rains around 3-4 in the afternoon. It always seems to rain just at the perfect time – like yesterday when we were in the homes of our families in the heat of the afternoon. The cool breeze through the front door was a sense of calm and relief I’ll never forget.

-Today, I think the shell shock from culture has let off a bit. I feel like I’m starting to understand the Nicaraguan culture more—our hotel feels a bit more like home and the UPOLI faculty and students are feeling a little more like family (YES, even after just a few days). “L,” one of our leaders, is amazing. She is patient, knowledgable about nursing and really knows the Nicaraguan community. Being placed in a busy, humid room to assist a doctor with consultationss can be exceptionally overwhelming. It was reassuring to have her by my side to explain things “mas despacio” (more slowly) in Spanish. I love working with UPOLI so far.

- I can’t believe how much I’ve learned about community health nursing in just 3 days. The combination of working in the clinic, touring healthcare facilities and working in the barrio (Villa Libertad) with our families has made epidemiology, complicance issues and barriers to access in healthcare all become real.

That’s all for tonight.

Hasta manana,

Sarah

Cerebro Lleno. Unas migas de pensamientos.

Hoy, estabamos estudiantes muy ocupadas ( = today were were very busy students). We enjoyed an action-packed morning while working/observing in the hectic community clinic. The duration of the late morning and afternoon was spent in the barrio (=neighborhood) doing two long visits with our individual families. It was a long day trying to think, talk, write, read and nurse in all-spanish.

Due to mental & physical exhaustion the authors of NicarBlogua are simply going to bullet point a collection of random thoughts.

Pensamientos de Alicia:

-"Guilty pleasure" was translated into spanish as "Pizza Hut." As in: "We ordered Pizza Hut for dinner on our second night in Nicaragua." Gleeful Gluttony is an synonym.

-Even while 1,200 miles away from North Carolina, I am fondly reminded of the lovely summer nights we are missing...What brings on this sharp pain of nostalgia?...The Q5 minutes terrible intense itching which flares up in the 17 bug bites on my feet and shins (garnered on my last night in Durham).

-While being held captive by a brief afternoon torrential downpour, I marvelled at how beautiful the barrio can be. The "tip-tap" of fat raindrops on our familia's tin roof sounded like a Dvojak symphony to me (google/youtube that if the link doesn't work). The smiles and waves of ninos chiquitos from their barred windows and yards warmed my heart like concentrated sunshine. Even the causeway full of basura (trash) that bordered the backyard of our families' habitaciones lookes like a colorful confetti spray on the rich dirt ravine. Forget expensive landscaping, the prettiest plant I saw today was a baby palm plant growing out of the side of an old Coca Cola bottle.

-As I sat and listened to the mother of my interviewing family talk about the gangs in her neighborhood, and fears of her house's dirt foundation being washed away in the next rainstorm my eyes were opened. Community health care is about more than building a free clinic in the middle of the barrio or keeping track of statistics of illness and death by region. It is about getting to know the stories and struggles of the people. A community health care worker must understand the difficulty of needing to walk 20 minutes to a busy community center to get a preventative or maintenance medicine when one is struggling to have their basic nutrition needs met daily.

--One of my classmates shared her observation "There is no quick fix or band aid that we can offer for the two weeks we are here."

--Despite living life without our home "necessities" of hot & running water in the house, a flushing toilet in an indoor bathroom, a linoleum floor with a concrete foundation--our hosts are still worried about us. Are the Duke nursing students comfortable? Do they have a local guide? Are they thirsty or tired? As much as we hoped to visit Nicaragua to help the population here, they are providing for us. Generosity and kindheartedness embodied.

--A thought with less importance: pineapple tastes better in Nicaragua.

--The more we learn about C.I. Jane, the more we discover a nursing and traveling superhero.

--Folks here really like gatorade! We are provided with this electrolyte-amping fluid at least twice a day, everday since we arrived.

--Why even bother to try eating a vegetarian diet here? Chicken and carne asada are the names of the game.

--Doing schoolwork and having lectures are more fun in the community Centro Academico than in the traditional classroom.

--We have so much more to learn in the next 9 days.

Buenas noches for now. More posts to come!

--Alicia

P.S. Thanks to my roomate, Jessie, for the photos!

Day TWO

Hi friends! Okay, I am going to attempt to write a more coherent entry tonight.

Today was our first day meeting UPOLI students, faculty and we met our community families. We will be working with them for the next 2 weeks. We had the opportunity to tour the “Centro de Salud de la Villa Libertad” (Community health center). This was an amazing facility. It consists of primary care completely funded by the government. Wait, repeat? It is FREE (unless the patient needs to be referred to a specialist). Unfortunately the average waiting time in the “Sala de esperanza” (waiting room) can clock up to 2 hours, but the patients have the ability to receive primary care, including psychiatric care and physical therapy, free of charge. There are 62 “barrios” (neighborhoods) surrounding this community health center. The center operates in 3 teams consisting of 2 medical doctors and one. This team is responsible for 6 barrios!.

Later we toured the Policlinica – a secondary health facility of the “Centro de Salud.” This consisted of specialists – dentists, radiologists, etc. The MOST interesting part about this place is that it’s construction was entirely funded by the Iranian government. The clinic opened just this past February and you could still smell the fresh paint on the walls (which were decorated in Iranian colors – red, white, green). The equipment was high-tech and very impressive!

We met our families today! Two Duke students will be paired with one UPOLI nursing student for the duration of our trip. We will be working with the family to assess their health care needs and help implement changes to address those needs.

My take-aways of the day:

1. COMMUNICATION BARRIER: Whoa, hello dialect! Although I took a phonetics course at UNC which helped me to recognize certain dialects, this one can be difficult. For those Spanish nerds out there, in Nicaragua, when “s” comes at the end of the word or syllable, it is sometimes pronounced as “h.”

For example: “Our beds. “

Spanish: “Nuestras camas.”

In Nicaragua: “Nuehtrah camah.”

So, maybe that doesn’t sound bad, but when hearing it at a rapid speed, and a low tone, it can get confusing.

This makes it difficult because when meeting my family today, I wanted to form an instant connection! Because I speak spanish and have studied it for so long, I hoped to better communicate with the family to get to know them. Hopefully, over the next few days, the communication issue will mejorar (get better).

2. I was blown away by UPOLI and the health centers today. The staff and faculty are friendly and accommodating. The UPOLI campus is beautiful. It’s a private school in the heart of Managua. The school is filled with open courtyards blooming with vibrant flowers and luscious fruits. The students took us on a tour and spent time explaining their school and daily routine. They made the day a lot more meaningful to us.

The healthcare system and the people that make it happen are more real to us now, and we look forward to knowing more about them.

--Sarah

Day One

Day One

After a long, but exciting day of traveling, we are finally in Managua! We arrived today around noon Nicaragua time. We were graciously greeted by 2 UPOLI faculty members who welcomed us and escorted us to our hotel. Our hotel is so different from what I thought it would be! Fabuloso though, it’s comfortable, personal and perfectly picturesque. I’m so excited to call it home for the next 2 weeks.

After dropping by the Hotel, we went to an amazing resaurant where we had our first real taste of Nicaragua. It was in-cre-ible! I will never forget the Jugo de Naranja y Zanahoria (Orange and carrot juice). One of the UPOLI faculty members, we shall call her “M” shared stories and enlightened us about Nicaraguan foods and fruits. Then we visited the Palacio de Managua and made a visit to the market to buy snacks. The Palacio was a government building built in the early 1930’s that was later turned into a museum. We took a tour and learned a great deal about Nicaraguan history, from the volcanoes to contemporary art. What a great way to be introduced to the country! We were then driven around the city where we conducted a windshield survey. We have lots to learn and experience in the next 13 days, that’s for sure. I can’t wait.--Sarah

Sarah’s first impression:

-Healthcare. When standing in line waiting for customs, CI Jane and I noticed two healthcare workers (physicians maybe?) greeting people as they passed through customs prepared to assist anyone in need. Although this was my first and only glimpse of the Nicaraguan healthcare system today, I liked what I saw so far. I’m excited to have my first real taste of the UPOLI nursing school and touring healthcare facilities tomorrow and this week.

-Colors. Every home is unique with its own color, design and personality. From bright pink homes to neon green to carolina blue (woo), every home is its own. Also, the Nicaragua landscape is so lush – from the banana trees in full bloom, to the palm trees to even the grass.

I wish I could put into words everything I took in today. Between the colors, the smells, the people, I was definitely in a state of culture shock, and I liked it. I’m absolutely exhausted and will write more later, but I’m excited about the next 12 days.

Alicia:
Obvio, I fell in love with the greenery as soon as we hit the tarmac. Other things that enchanted me immediately:

- Being surrounded by the spanish language once again. I’m hoping that the 12 day immersion will force my medical spanish to flow forth fluently.

- Meeting our hosts from UPOLI-- Doñas M y Don Jose M. We got the hook-up! Additionally, CI Jane is truly a pip and a calm traveler too. She is an Nurse Practioner who has visited about 10 countries in Central and South America. A new role model indeed.

- Spanish language TV. I just flipped from "High School Musical 2" en espanol to a man reading today’s closing numbers from the stock exchange...while wearing an eyepatch. I think Channel Ochenta is my new “good night” TV.

- The afternoon rain storm. I was surely sweating out every water soluble vitamin in my tissues at the museum until a lively rain and breeze jumped out of the sky to welcome us. Brillante!

- The supermarket, La Union. We stopped off to stock up on some basic groceries to keep in our hotel. One of my favorite activities--no matter what region I am in--is grocery shopping! What’s on sale? Which is the best bite for your buck (or Cordoba, as is the currency in Nicaragua)? Which cereal has the most fiber content?! I found soy milk powder to accompany my morning cereal. Just add water!
Tomorrow, we make more friends as we travel to UPOLI for our first glimpse at Nursing school, Nicaraguense Style.

Now we are about to fall into our respective camas (= beds) but cheers to safe flights, new friends, and fresh gallo pinto.
Buenas noches Nicaragua!
Sara y Alicia

Photos from day one

Preparacion

We take off in approximately 16 hours! There is definitely some packing denial going on here...thus a new blog entry.

If you are like us, you probably don't know very much about Nicaragua to start. Additionally, if you are like Sarah and I, you know that final exam week was the perfect opportunity to spend study time learning about Nicaragua. Here are some fruits of our “studying” labor from last week:

Thought National Geo would be a solid and general place to start.

http://travel.nationalgeographic.com/travel/countries/nicaragua-facts/

And for our fellow community nursing nerds out there:

http://www.who.int/countries/nic/en/ (Prof. KM would be proud of us!).

Okay, okay, so now that exams are over and we are flying out of North Carolina in about 16 hours IT. IS. TIME. TO PACK. Our modified packing list, gathered from various recommendations:

-Bug spray (High DEET %)
-deodorant, towellettes

-sunscreen
-gifts for people/new friends we meet
- stethoscopes
-Duke ID badge
-comfortable shoes
-Bug spray

Did I mention bug spray? Just a small DEET-ail (sorry, but that’s just “pun”ny).

To get myself in the spirit to really “hacer la maleta” (= pack), here is a helpful packing blog post from a former Nicaraguan traveler :
NicaraguaPACK!

Okay, back to pack. We’ll update once we are on the ground in Managua! Can’t wait to see what this beautiful little country is all about and share our impressions with you all.
-Alicia y Sarah

Nicaragua Bound

Buenos dias. We are Sarah and Alicia, two nursing students at Duke University. We are about to embark on our first international nursing experience. We are so entusiasmadas that we decided to write about it and share it with you.

THE SET-UP: For the completion of our Community Health Clinical hours (time spent in "the field") we, Duke University School of Nursing students have the opportunity to travel to Managua, Nicaragua. The trip is self-funded, but organized through our Office of Global and Community Health Initiatives . 10 ABSN students (Accelerated Bachelors of Nursing) are heading down there in less than a week!!We will be paired with nursing students from UPOLI, work with them in community health clinics, do home and family visits and soak up community nursing from an international perspective for nearly two weeks.

Are you ready Nicaragua? Porque vamos muy pronto (because here we come!)

Now, allow us to introduce you to the nursing nerd authors (don't know how to say that in Espanol) who will be sharing their adventuras with you.

Both Sarah and Alicia have undergraduate bachelor degrees in Spanish and are participating in a medical Spanish class during their time at Duke. Aside from geeking out about future tense Spanish verbs they both love country music, Harry Potter, and lima beans with ketchup.

A few words from each brand new blogger:

Bueno! Soy Alicia y estoy muy entusiasmada para visitar a Nicaragua para ver enfermeria de la comunidad en agosto! I've never been to Nicaragua before but I can't imagine a better trip than this one! 10 nursing school students. 10 nursing nerds with no idea of what we're getting ourselves into...nor what to pack.

Hi there! Sarah here. I am also thrilled for our upcoming trip to Managua and working with the UPOLI students and faculty. I am ready to experience Nicaragua with open eyes, open ears, an open heart and ready to take in all that the country has to offer with nine amazing classmates at my side. Ready, set, immerse.

So, join us here as we fly south and immerse ourselves as student nurses for two weeks in Nicaragua!