It's only been five days really but I'm wiped out -- the result of the hot-sun, speaking in a second language, and navigating around a new city, hospital, and culture. I think Amy would agree with me. (She's currently scrubbed into some surgical cases.)
I delivered another baby today to a primip without an episiotomy, or laceration. Phew. There were different nurses and residents around this time and, again, they were equally skeptical and providing much commentary throughout. The poor laboring woman. One nurse told me she'd rather have an episiotomy than a vaginal laceration. I guess to each her own. I also brought in the two vacuums that Labor & Delivery donated. The residents played around with it on each other, making lots of ring marks. There are hardly any instrument-assisted deliveries done here, but maybe they'll get to see one or two before Amy and I leave.
Amy did a very cool thing today. She made two "home-visits" to home-bound patients. Santiago, our main contact person here, runs the Polus Center, a non-profit organization for social and economic development. One of his main projects has been trying disabled men find jobs. Some of these men are amputees (I'm not sure from what, possibly the war and landmines?) and some are paraplegics. Today, Amy went to see two of them on behalf of Santiago and their respective families. I'll try to egg Amy on into writing a brief entry about what that experience was like. One comment she did make to me was after seeing pictures in Santiago's photo albums of these unfortunate men on crutches trying their hardest to work on farms and in the fields. Their desire to work despite their obvious handicap contrasted the number of patients we see in the States applying for disability for pretty vague reasons.
Tonight we're headed to see a local Nicaraguan salsa band to which my R3 OB resident invited us, and then tomorrow we're off to hike and camp at a nearby volcano. Sorry no witty remarks or funny stories today -- I'm feeling pretty pooped. Hopefully the weekend will rejuvenate us and we'll upload fun pictures from our weekend. Stay tuned!
Actually, I just remembered something I wanted to mention. On my overnight call, I ended up "sleeping" on a table because there are no call rooms for residents so residents sleep wherever they can, including patient beds (when there is no patient in it, of course, although the thought did cross my mind...) There was a strike about 1.5 years ago for higher resident and physician salaries. Before the strike the residents were paid nothing, zero, nada. Since the strike they now receive about $450 US dollars a month, which is still not much. They work q4 shifts from 7am to 3pm the next day, but on the intervening days they work just from 7am to 3pm. At night the residents run the hospital and attendings are called in possibly once a month. The one thing that remains the same in the US and Nicaragua is . . . paperwork! There is a "monton" of paperwork and residents are always busy filling them out, and, of course, the interns have to do the brunt of it. Because I wrote an H&P that got a lot of laughs because of its elementary direct translation from English, I'm exempt from the paperwork. Here's an example that made the R3 resident laugh aloud.
General: La paciente esta alerta y comoda. Hace algo ruido durante los dolores pero no esta gritando... (The patient is alert and comfortable. She makes some noise during contractions but is not screaming...)
Alright, Amy's back and we're going to get ready to head out.
Cindy
viernes, 19 de enero de 2007
jueves, 18 de enero de 2007
C-section, anyone?
I've just recuperated from a busy night on call working on labor and delivery, where they average 15-25 deliveries in 24-hours. I delivered my first Nicaraguan baby, a 3400 gram porker (considered large here), to a first-time mom. When I told the resident and nurse I was *not* going to do an episiotomy (they do it on all primips), the fourth-year resident snickered back, "That's fine. Just have fun stitching up your big-ass tear..." It turned out thanks to Felipa teaching me about super-crowning and controlling the head at the perineum, the patient had only a very small 1st degree tear that needed one stitch. The nurse and med student were quite impressed. I received a "Muy elegante, Dra. Su." from nurse Carolina which helped bring down my blood pressure and heart rate, as I worried I was going to blow it and they would laugh at the ignorant and haughty American who was suturing up a large 2nd or 3rd degree tear. Phew.
The amount of c-sections in the hospital is hovering around 40% and the past 24-hours in the hospital were no different. Perhaps, actually, there were slightly more c-sections than normal, vaginal deliveries. I miss those! A couple of thoughts why the c-section rate is so high: 1) VBACs (vaginal births after prior c-section) at all, 2) limited use of fetal monitoring, and 3) hardly any use of instrumental delivery (no vacuums or forceps). Reason number two is mostly from my own personal observation. They have only one fetal monitor machine and use it on a limited basis. For example, yesterday there was a woman who came in at 3 cm and hadn't progressed after a few hours on pitocin. They decided to put the fetal monitor and toconometer on her and saw a 20 minute strip of tachycardia with a couple of variables (not decels). She ended up with a c-section because of that strip. In another case, a woman with preeclampsia had a somewhat flat-looking 20 minute strip (minimum variability) but otherwise was asymptomatic and having contractions. She went to section. When I asked the residents if they had the ability to have an indefinite number of fetal monitoring machines would they be inclined to use it on all patients throughout their entire labor. Their answer was yes. It seems to me that they should either use it all the time or none of the time. Otherwise, sometimes decisions to have a c-section are based on a twenty-minute snapshot fetal heart strip.
Another woman had a primary section without a trial of labor because on clinical exam (including the beloved pelvimetry exam we residents in the States get poor training on) and some "Johnson formula" they use to calculate macrosomia suggested that there was going to be cephalopelvic disproportion. The baby turned out to be 3800 grams so not meeting macrosomia by our definition (their argument is that Nicaraguans tend to be smaller than North Americans, which is true, but I've had tiny Mexican women deliver 7, 8, 9-lb babies vaginally). It would have be interesting to see if she might have been able to deliver that baby vaginally if given a chance. A last comment is that so many of the fundal heights at term measure 30-34 cm. I was pretty shocked, at first thinking oligohydramnios, IUGR, or just something bad in general. The residents argue that it's a combination of Nicaraguans being smaller people and the prevalence of malnutrition in the country. I think I agree with them on that one.
Overall, I have been impressed, though, by the residents and the way they run the hospital. For the most part, in labor and delivery anyway, they manage complications like we do. The residents are incredibly smart here, as there are only two public medical schools (one in Leon and one in Managua) and they are super-hard to get into. It is the only field where the tuition is free, making it that much more competitive. Thus, these residents are the creme de la creme. They are intelligent, hard-working, passionate, and quite amiable. Their clinical skills and knowledge base are quite immense as they are always reading textbooks and studying.
My partner in crime, Amy, is currently crawling into bed because our apartment is on a loud street and she hasn't been sleeping well. While I was on call last night, she was putting together a 56-slide powerpoint presentation for a 6:30 am meeting with an anesthesiology attending, Dr. Gomez. As expected, he was impressed, and she was doing intubations with him all morning. Good job, Amy!
So we are working hard on our elective away, getting to know the residents, attendings, and nurses, and just enjoying being in Nicaragua, where everyone we've met has been so friendly and welcoming. The hospital doesn't get too many foreign visitors (we may be the first from the U.S.) so they are all eager to ask us about life in the States and to practice their English. I'm hoping to spend the majority of my three weeks doing OB and weaseling my way into actually doing the c-sections , while Amy will be spending a few days in each department (surgery, anesthesiology, pediatrics, and OB). We're also hoping to try to head out to a rural clinic for a day or two at the end if we can.
By the way, for those not in medicine, I realize much of the blog is filled with medical jargon and I apologize. It's hard when most of our days have been in the hospital. This weekend we'll be going on a two-day camping trip to a volcano so will have more "non-medical" things to share. And hopefully lots of pictures as well! Stay posted!
Cindy
The amount of c-sections in the hospital is hovering around 40% and the past 24-hours in the hospital were no different. Perhaps, actually, there were slightly more c-sections than normal, vaginal deliveries. I miss those! A couple of thoughts why the c-section rate is so high: 1) VBACs (vaginal births after prior c-section) at all, 2) limited use of fetal monitoring, and 3) hardly any use of instrumental delivery (no vacuums or forceps). Reason number two is mostly from my own personal observation. They have only one fetal monitor machine and use it on a limited basis. For example, yesterday there was a woman who came in at 3 cm and hadn't progressed after a few hours on pitocin. They decided to put the fetal monitor and toconometer on her and saw a 20 minute strip of tachycardia with a couple of variables (not decels). She ended up with a c-section because of that strip. In another case, a woman with preeclampsia had a somewhat flat-looking 20 minute strip (minimum variability) but otherwise was asymptomatic and having contractions. She went to section. When I asked the residents if they had the ability to have an indefinite number of fetal monitoring machines would they be inclined to use it on all patients throughout their entire labor. Their answer was yes. It seems to me that they should either use it all the time or none of the time. Otherwise, sometimes decisions to have a c-section are based on a twenty-minute snapshot fetal heart strip.
Another woman had a primary section without a trial of labor because on clinical exam (including the beloved pelvimetry exam we residents in the States get poor training on) and some "Johnson formula" they use to calculate macrosomia suggested that there was going to be cephalopelvic disproportion. The baby turned out to be 3800 grams so not meeting macrosomia by our definition (their argument is that Nicaraguans tend to be smaller than North Americans, which is true, but I've had tiny Mexican women deliver 7, 8, 9-lb babies vaginally). It would have be interesting to see if she might have been able to deliver that baby vaginally if given a chance. A last comment is that so many of the fundal heights at term measure 30-34 cm. I was pretty shocked, at first thinking oligohydramnios, IUGR, or just something bad in general. The residents argue that it's a combination of Nicaraguans being smaller people and the prevalence of malnutrition in the country. I think I agree with them on that one.
Overall, I have been impressed, though, by the residents and the way they run the hospital. For the most part, in labor and delivery anyway, they manage complications like we do. The residents are incredibly smart here, as there are only two public medical schools (one in Leon and one in Managua) and they are super-hard to get into. It is the only field where the tuition is free, making it that much more competitive. Thus, these residents are the creme de la creme. They are intelligent, hard-working, passionate, and quite amiable. Their clinical skills and knowledge base are quite immense as they are always reading textbooks and studying.
My partner in crime, Amy, is currently crawling into bed because our apartment is on a loud street and she hasn't been sleeping well. While I was on call last night, she was putting together a 56-slide powerpoint presentation for a 6:30 am meeting with an anesthesiology attending, Dr. Gomez. As expected, he was impressed, and she was doing intubations with him all morning. Good job, Amy!
So we are working hard on our elective away, getting to know the residents, attendings, and nurses, and just enjoying being in Nicaragua, where everyone we've met has been so friendly and welcoming. The hospital doesn't get too many foreign visitors (we may be the first from the U.S.) so they are all eager to ask us about life in the States and to practice their English. I'm hoping to spend the majority of my three weeks doing OB and weaseling my way into actually doing the c-sections , while Amy will be spending a few days in each department (surgery, anesthesiology, pediatrics, and OB). We're also hoping to try to head out to a rural clinic for a day or two at the end if we can.
By the way, for those not in medicine, I realize much of the blog is filled with medical jargon and I apologize. It's hard when most of our days have been in the hospital. This weekend we'll be going on a two-day camping trip to a volcano so will have more "non-medical" things to share. And hopefully lots of pictures as well! Stay posted!
Cindy
martes, 16 de enero de 2007
First Day in the Hospital
We had our first day in the hospital and spent an unfortunate amount of time shadowing. Hopefully, we'll rectify that tomorrow.
In any case, we spent the morning rounding with the high-risk OB team, where we saw cases of pre-eclampsia, preterm labor, pyelonephritis, and a sad case of a woman measuring small for dates carrying an anencephalic baby to term who likely would not survive the delivery. Afterward, I spent the rest of the day in labor and delivery, while Amy was triaging (or more like watching the OB residents triage) in the ER.
A couple of interesting things I learned today. First, an abortion of any kind is illegal in Nicaragua - even an unruptured ectopic pregnancy (for non-medical readers, an ectopic is when a pregnancy is somewhere else outside the uterus). Theoretically, according to the law, one has to wait for the woman with an ectopic pregnancy to show signs of instability (pain does not count) before proceeding. The third-year resident did tell me, though, that often many of her attendings will still go ahead with it prior to its rupture because of its obvious danger to everyone but the ignorant lawmakers. I also learned that one can deliver a baby without any of the many tools we use in the States. I'm exaggerating, of course, as I know it's possible. More, I felt sort of lame on just how much I rely on machines, intrauterine devices, etc. to perform what is a natural process. I felt embarrassed telling the third-year resident that my fancy $120 Littmann III stethoscope had never touched the belly of a pregnant woman before. "What? You can hear the baby's heartbeat without a doppler??" And, get this!, the residents use their very own hands to estimate the frequency and strength (calculating pseudo-montevideo units) of contractions and to rupture membranes. Pitocin drips are "calculated" based on the number of droplets per minute. Crazy. Tomorrow I take my first "turno" (call) and will get to experience all this firsthand. I'm actually looking forward to it, as I'll sure be learning new skills...
Today Amy told me, "Boy, you sure get ogled at." as many calls of "Ooh, chinita, chinita!" finally surfaced as expected while walking on the streets (and even during a funeral march, if you can imagine that!) In one particularly funny incident, I was inside a store asking for directions and Amy was striking up a conversation with the guard outside that went something like this:
Guard: Is she (meaning me) Japanese?
Amy: No, she's Chinese.
Guard: Oh, are you Chinese, too? (To his credit -- sort of -- Amy had on dark sunglasses and a large hat.)
Amy: No, I'm American.
Guard: Oh, why are you friends then?
And he was being completely serious. Bizarre. The other day, our driver Julio also asked me out of the blue: "So does your father own a Chinese restaurant?" Random. Oh well, maybe I'm just a target for seemingly ridiculous questions, as I've had some patients in Santa Rosa ask me if I'm Mexican. Hmmm... Anyway, I'm off to relax a bit before learning to use my stethoscope on parts of the body other than the heart and lungs tomorrow. Wish me luck!
Cindy
In any case, we spent the morning rounding with the high-risk OB team, where we saw cases of pre-eclampsia, preterm labor, pyelonephritis, and a sad case of a woman measuring small for dates carrying an anencephalic baby to term who likely would not survive the delivery. Afterward, I spent the rest of the day in labor and delivery, while Amy was triaging (or more like watching the OB residents triage) in the ER.
A couple of interesting things I learned today. First, an abortion of any kind is illegal in Nicaragua - even an unruptured ectopic pregnancy (for non-medical readers, an ectopic is when a pregnancy is somewhere else outside the uterus). Theoretically, according to the law, one has to wait for the woman with an ectopic pregnancy to show signs of instability (pain does not count) before proceeding. The third-year resident did tell me, though, that often many of her attendings will still go ahead with it prior to its rupture because of its obvious danger to everyone but the ignorant lawmakers. I also learned that one can deliver a baby without any of the many tools we use in the States. I'm exaggerating, of course, as I know it's possible. More, I felt sort of lame on just how much I rely on machines, intrauterine devices, etc. to perform what is a natural process. I felt embarrassed telling the third-year resident that my fancy $120 Littmann III stethoscope had never touched the belly of a pregnant woman before. "What? You can hear the baby's heartbeat without a doppler??" And, get this!, the residents use their very own hands to estimate the frequency and strength (calculating pseudo-montevideo units) of contractions and to rupture membranes. Pitocin drips are "calculated" based on the number of droplets per minute. Crazy. Tomorrow I take my first "turno" (call) and will get to experience all this firsthand. I'm actually looking forward to it, as I'll sure be learning new skills...
Today Amy told me, "Boy, you sure get ogled at." as many calls of "Ooh, chinita, chinita!" finally surfaced as expected while walking on the streets (and even during a funeral march, if you can imagine that!) In one particularly funny incident, I was inside a store asking for directions and Amy was striking up a conversation with the guard outside that went something like this:
Guard: Is she (meaning me) Japanese?
Amy: No, she's Chinese.
Guard: Oh, are you Chinese, too? (To his credit -- sort of -- Amy had on dark sunglasses and a large hat.)
Amy: No, I'm American.
Guard: Oh, why are you friends then?
And he was being completely serious. Bizarre. The other day, our driver Julio also asked me out of the blue: "So does your father own a Chinese restaurant?" Random. Oh well, maybe I'm just a target for seemingly ridiculous questions, as I've had some patients in Santa Rosa ask me if I'm Mexican. Hmmm... Anyway, I'm off to relax a bit before learning to use my stethoscope on parts of the body other than the heart and lungs tomorrow. Wish me luck!
Cindy
lunes, 15 de enero de 2007
Amy's Debut Blog Entry
***Amy writes:***
We awoke today well rested after a full day of traveling and decided to check out the town of Leon in slightly cooler early morning temperatures.
We made our way to the bank where apparently there is only one outdoor ATM where people wait hours to get money. A polite lady with an adorable 9 month-old told us people start lining up an hour and half before the bank opens to stand in line. Wow!! We nixed that idea and went straight for Nicaraguan comida tipico.
We discovered this cool cafe that served gallo pinto (rice and beans) with fried plantains- all for about $1.50. For dessert we bought a bag if fresh fruit in the central square for $0.33. What a deal!! After a delicious meal, we went to the Basilica de la Asuncion - originally built in 1610- and then rebuilt in 1748 after a fire. It is supposedly the largest cathedral in all of Central America. We climbed about six stories and were rewarded with a fantastic view of Leon.
After a little exploring, we met up with Dr. Morales, the head of anesthesia at the hospital and apparently our liason to the residency program. The hospital is huge- four stories holding about 600 beds. They seem pretty flexible about what we can do there in terms of our area of concentration and were suprisingly quick to ask us when we want to take call.
(Amy is off to a shower after a full-day of sweating like a pig -- Sorry, Dan, if I've tainted images of your wife for you...)
*** Cindy continues: ***
So when asked about call by Dr. Morales, the conversation basically went like this:
Amy: I'd love to take call every third night. I feel underworked at our hospital.
Cindy: I agree. I think maybe we should just take call every other night actually.
Amy: Oh yeah, good idea.
Ok, if you believe that dialogue, well, obviously you are a stranger / internet stalker reading this blog.
Basically, we delicately told him we'd be willing to work as hard as they want during the week but that we'd like the weekends to explore their beautiful, precious, __________ (add another superlative you can think of) country. It looks like we may end up taking "turnos" (7 am - 3 pm shifts) Mondays and Thursdays. Are we crazy? Well, we figured we'll keep track of post-call hours and get extra money when we get back to Santa Rosa... ha ha. We'll be taking calls together so should be a fun time. The plan is to start off in obstetrics and then switch to pediatrics.
The hospital is pretty shocking in the sense that everything, including the facility and the equipment, appears old (or at least older than what we're used to, even at Sutter). We took a tour through all departments: surgery, ICU, NICU, peds, OB, emergency, etc. We even got a chance to watch a c-section. I was getting excited and thinking, "Cool, we can do this!" when she started making a long vertical incision, and then I suddenly didn't know what was going on. One remarkable thing I took away in just the two hours we spent getting to know the hospital and its staff (including residents) was how much waste we consume in the States. For example, during the c-section, all the gowns and drapes were made of cloth so as to be able to recycle them. I remember so many times in the OR in the States materials getting thrown out because some tiny non-sterile corner of an unfortunate med student (usually me) touched it. Needless to say, as we start working in the hospital more the differences will become more glaring. Hopefully, the intent of quality of patient care will be the same, though. We''ll let you know.
Alright, the sun has set and we can now leave our apartment without drenching our T-shirts so we're off to grab a bite to eat.
Amy and Cindy
**********
Some pictures:
Views of Leon from atop the Basilica de La Asuncion: (the white building in the first picture on the left is the hospital de Universidad Nacional Autonima de Nicaragua, where we will be working!)
Our apartment (the second floor with the balcony):
We awoke today well rested after a full day of traveling and decided to check out the town of Leon in slightly cooler early morning temperatures.
We made our way to the bank where apparently there is only one outdoor ATM where people wait hours to get money. A polite lady with an adorable 9 month-old told us people start lining up an hour and half before the bank opens to stand in line. Wow!! We nixed that idea and went straight for Nicaraguan comida tipico.
We discovered this cool cafe that served gallo pinto (rice and beans) with fried plantains- all for about $1.50. For dessert we bought a bag if fresh fruit in the central square for $0.33. What a deal!! After a delicious meal, we went to the Basilica de la Asuncion - originally built in 1610- and then rebuilt in 1748 after a fire. It is supposedly the largest cathedral in all of Central America. We climbed about six stories and were rewarded with a fantastic view of Leon.
After a little exploring, we met up with Dr. Morales, the head of anesthesia at the hospital and apparently our liason to the residency program. The hospital is huge- four stories holding about 600 beds. They seem pretty flexible about what we can do there in terms of our area of concentration and were suprisingly quick to ask us when we want to take call.
(Amy is off to a shower after a full-day of sweating like a pig -- Sorry, Dan, if I've tainted images of your wife for you...)
*** Cindy continues: ***
So when asked about call by Dr. Morales, the conversation basically went like this:
Amy: I'd love to take call every third night. I feel underworked at our hospital.
Cindy: I agree. I think maybe we should just take call every other night actually.
Amy: Oh yeah, good idea.
Ok, if you believe that dialogue, well, obviously you are a stranger / internet stalker reading this blog.
Basically, we delicately told him we'd be willing to work as hard as they want during the week but that we'd like the weekends to explore their beautiful, precious, __________ (add another superlative you can think of) country. It looks like we may end up taking "turnos" (7 am - 3 pm shifts) Mondays and Thursdays. Are we crazy? Well, we figured we'll keep track of post-call hours and get extra money when we get back to Santa Rosa... ha ha. We'll be taking calls together so should be a fun time. The plan is to start off in obstetrics and then switch to pediatrics.
The hospital is pretty shocking in the sense that everything, including the facility and the equipment, appears old (or at least older than what we're used to, even at Sutter). We took a tour through all departments: surgery, ICU, NICU, peds, OB, emergency, etc. We even got a chance to watch a c-section. I was getting excited and thinking, "Cool, we can do this!" when she started making a long vertical incision, and then I suddenly didn't know what was going on. One remarkable thing I took away in just the two hours we spent getting to know the hospital and its staff (including residents) was how much waste we consume in the States. For example, during the c-section, all the gowns and drapes were made of cloth so as to be able to recycle them. I remember so many times in the OR in the States materials getting thrown out because some tiny non-sterile corner of an unfortunate med student (usually me) touched it. Needless to say, as we start working in the hospital more the differences will become more glaring. Hopefully, the intent of quality of patient care will be the same, though. We''ll let you know.
Alright, the sun has set and we can now leave our apartment without drenching our T-shirts so we're off to grab a bite to eat.
Amy and Cindy
**********
Some pictures:
Views of Leon from atop the Basilica de La Asuncion: (the white building in the first picture on the left is the hospital de Universidad Nacional Autonima de Nicaragua, where we will be working!)
Our apartment (the second floor with the balcony):
domingo, 14 de enero de 2007
From Santa Rosa, CA to Leon, Nicaragua
After last-minute packing and shopping runs, Amy and I left on Saturday night to catch a red-eye flight to Miami on our way to Nicaragua for our 4-week elective. Thanks to previous renowned bomb-carrying passengers, not only did we do the usual removal of jackets, belts, and shoes, but also I had to toss my beloved 8 0z tube of Neutrogena face wash. Amy's husband, Dan, had asked me in the car on the way to the airport what my one must-have comfort item was. After some thought I named that tube of face wash. Sigh. Feeling dejected and the sprouting of an opportunistic pimple, I also realized that we had entered the wrong gate when Amy asked which direction we were headed. So we exited and walked halfway to the next terminal, only to realize that, in fact, we had entered the right gate. (My terrible sense of direction never ceases to amaze me.) So back we went. We had a deja-vu moment, including the scrutinizing of my ziploc bag of bottled items (now minus the face wash) by the exact same security guard.
At the Miami airport we experienced the nosy intrusions and innocent assumptions of other travellers. We started debating whether Kaiser clinics truly provide better efficiency and patient-directed care. As we were concluding that in fact Kaiser patients had equally long wait times and difficulties seeing one's own doctor, an eavesdropping older woman sitting next to us decided to chime in: "Well, I've been a Kaiser patient for over twenty years and I always get to see my doctor!" Later on, just prior to boarding the plane, an overzealous provost (at an American university located just outside of Managua) gave us his name, e-mail, office number, home phone number, cellphone number, the name of his mother, her phone number should we not be able to reach him, etc., in case we were to get sick and in need of a doctor. We thanked him and chuckled to ourselves. Boy, were we glad we were traveling with our personal favorite doctor...
Fourteen hours after our departure from Santa Rosa, we made a wobbly, squeaky-wheeled landing into Managua. We smiled big smiles upon seeing the bright blue sunny sky and, more importantly, a man holding a sign: "Cyndy and Amy". Relief. As I told Amy, it's always good to feel accounted for. We hopped in a car with our driver and history teacher, Julio, to the colonial and academic city of Leon. Apparently, Leon had been the first capital of Nicaragua but then got caught up in a sibling rivalry type fight with Granada. The result was the naming of Managua as the capital, since it was located between the two cities. We also learned that while Nicaragua is the second poorest country in the Western Hemisphere (second to Haiti), it is actually the safest country in Central America.
Our apartment is fabulous. Water runs on Mondays, Wednesdays, and Fridays, and the bathroom is just a short 100-yard walk away. Just kidding, Mom! The apartment is actually located on the top floor of the office building of our main contact person, Santiago. Currently, he remains a "Charlie"to us (hint: TV show) as we have only communicated via e-mail and phone. Anyhow, we have two separate bedrooms (each with air-conditioning), a large kitchen, a spacious bathroom with shower, internet, and a night-time security guard named Jorge. We are in "downtown"Leon and right next to a comtemporary art museum. Everything we need is walkable. This includes banks, supermarkets, restaurants, cafes, bakeries, a movie theater, and, oh yeah, the hospital. Yes, the real reason why we're here. :P We had ourselves a delicious dinner of broiled corvina, french fries, rice, salad, and cold Victoria beer (the Nicaragua brand). The weather is quite summery, probably in the 80s, with a refreshing breeze. We're wearing shorts, t-shirts, sunglasses, and sandals. Life is pretty good right now.
Tomorrow we meet Santiago (I'll let you know if he looks like Bill Murray) and Dr. Morales to figure out where we can help out the most in the hospital. We'll be here from January 14 to February 9 and will try our best to keep this blog updated and include photos. So keep on checking and send a comment if you'd like. We'd love to hear from you!
Cindy
At the Miami airport we experienced the nosy intrusions and innocent assumptions of other travellers. We started debating whether Kaiser clinics truly provide better efficiency and patient-directed care. As we were concluding that in fact Kaiser patients had equally long wait times and difficulties seeing one's own doctor, an eavesdropping older woman sitting next to us decided to chime in: "Well, I've been a Kaiser patient for over twenty years and I always get to see my doctor!" Later on, just prior to boarding the plane, an overzealous provost (at an American university located just outside of Managua) gave us his name, e-mail, office number, home phone number, cellphone number, the name of his mother, her phone number should we not be able to reach him, etc., in case we were to get sick and in need of a doctor. We thanked him and chuckled to ourselves. Boy, were we glad we were traveling with our personal favorite doctor...
Fourteen hours after our departure from Santa Rosa, we made a wobbly, squeaky-wheeled landing into Managua. We smiled big smiles upon seeing the bright blue sunny sky and, more importantly, a man holding a sign: "Cyndy and Amy". Relief. As I told Amy, it's always good to feel accounted for. We hopped in a car with our driver and history teacher, Julio, to the colonial and academic city of Leon. Apparently, Leon had been the first capital of Nicaragua but then got caught up in a sibling rivalry type fight with Granada. The result was the naming of Managua as the capital, since it was located between the two cities. We also learned that while Nicaragua is the second poorest country in the Western Hemisphere (second to Haiti), it is actually the safest country in Central America.
Our apartment is fabulous. Water runs on Mondays, Wednesdays, and Fridays, and the bathroom is just a short 100-yard walk away. Just kidding, Mom! The apartment is actually located on the top floor of the office building of our main contact person, Santiago. Currently, he remains a "Charlie"to us (hint: TV show) as we have only communicated via e-mail and phone. Anyhow, we have two separate bedrooms (each with air-conditioning), a large kitchen, a spacious bathroom with shower, internet, and a night-time security guard named Jorge. We are in "downtown"Leon and right next to a comtemporary art museum. Everything we need is walkable. This includes banks, supermarkets, restaurants, cafes, bakeries, a movie theater, and, oh yeah, the hospital. Yes, the real reason why we're here. :P We had ourselves a delicious dinner of broiled corvina, french fries, rice, salad, and cold Victoria beer (the Nicaragua brand). The weather is quite summery, probably in the 80s, with a refreshing breeze. We're wearing shorts, t-shirts, sunglasses, and sandals. Life is pretty good right now.
Tomorrow we meet Santiago (I'll let you know if he looks like Bill Murray) and Dr. Morales to figure out where we can help out the most in the hospital. We'll be here from January 14 to February 9 and will try our best to keep this blog updated and include photos. So keep on checking and send a comment if you'd like. We'd love to hear from you!
Cindy
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