¡Saludos! Today is Friday, June 5th. Another week has passed since posting my previous entry and there has been plenty to write about, but from the start I must apologize again for not having any original photos or video to present. I have a small digital camcorder with me that seems to be a little too much for the older computers I´ve used here. The disposible film cameras I have are yet to be developed, but that will change soon once I find a developer. In the meantime you´ll just have to settle for my half-witted descriptions starting from where I left off. This entry is a little long so I´ve divided it into three parts, don´t hesitate to read some and come back later.
PartI
Last Sunday, the four FSD students living in Masaya (including myself), and one student from Jinotepe, met up in the afternoon to walk around and get to know this small city better. We walked around the central plaza, el parque central, to the northern outskirts, crossing the highway leading to Managua, despite its fast paced traffic. Enduring the dust, fumes, and language reserved for "gringo" foreigners on a busy roadside, in addition to the countless packed school-type buses with operators yelling "¡Managua Managua Managua!," as they headed towards the capital 26km away, we soon arrived at the base of a hill with a single road leading up to our destination. The destination was the Fortaleza de Coyotepe, also known plainly as Coyotepe. After walking up the steep climb that most people chose to taxi through, we were greeted at the main gate of the fort by a Nicaraguan adult boy scout leader, who collected out $1 per person entry fee and welcomed us in to enjoy the hilltop view of Masaya below and the miles of green countryside, lakes and volcanic peaks that could be seen at varying distances for 360°.
The word coyotepe literally means "coyote hill," as there apparently used to be many coyotes here when the hill was named, although I´m not sure how many exist here currently. Being the highest point in close proximity to the city of Masaya, a fortress was built here in 1893 by the President of the time, José Santos Zelaya. The fort was then taken over in 1912 by Nicaraguan conservatives, witht he aid of U.S. Marines (representing one of the major U.S. military interventions in Nicaragua).
In the 1930´s, Anastasio Somoza (Nicaraguan dictator who came to power with the aid of U.S. intervention), converted the fortress into a political prison. Thus, while the building appears like an old military fortress from the outside, once you enter the underground detention levels you can see the harsh conditions Somoza used to detain those in opposition to his rule.
One of the younger Nicaraguan scouts walked us through the underground levels to provide information, answer questions, and guide us through teh dark unlit passages. The outter ring of the first underground level, which actually had narrow slit window openings that permitted daylight and a view of the outside, was reserved for the less threatening dissidents of Somoza, were they would be held indefinitely in cramped, unsanitary conditions with a concrete floor to sleep on. The inner circle of this level, which we entered afterwards, was reserved for the more threatening/serious dissidents or active conspirators.
This inner level permitted no views of the outside world, and little or no daylight entered, depending on the specific room. There were places for complete isolation in darkness, and other areas designated for various forms of torture and interrogation. There is also an additional lower level(s) to the prison, but reported tunnel collapses mean it is no longer accessible. Our guide said it is likely the dead, due to torture or disease, were likely disposed of below. He also said there is no reliable data to know exactly who or how many people "disappeared" in Coyotepe during Somoza´s rule.
In 1979, the last phase of the Somoza family dictatorship, Coyotepe was used as a location to mortar some of the rebel strong hold neghborhoods of Masaya below. But the Sandanistas eventually fought for and took control of the hilltop prison, freeing the remaining survivors. However, even once the Sandanistan government took control, Coyotepe was used to imprison the former captors. Reportedly, some of the same forms of torture used on the previous era inhabitants were then used on members of the ousted regime. After several years of Sandanistan use, the prison was abandoned for whatever reason and it sat vacant for years.
More recently, a Nicaraguan boy scout troop has taken responsibility for the site and they are attempting to turn it into a historical museum, which seems just. There was certainly a lot to take in internally and externally from that hilltop...sorry if you don´t like all of that history, but I think it´s pretty relevant.
Part II
Monday morning was my first taste of what I´ll be doing here primarily for teh next two months. I arrived at Hospital Humberto Alvarado, which is the only public hospital in the city. It has an employed of staff of around 400 people, and located on teh east side of Masaya, close to the Managua highway. It´s also only about three blocks from my host family, which means I can easily walk to and from the site.
I was introduced to the senior doctor at the hospital, who showed me around briefly and introduced me to the staff, who were generally pretyy friendly and conversational. At the hospital, my goal is to learn as much as possible about public healthcare in Nicaragua, using this facility and the staff here as a primary reference. I am being given the chance to work in most of the major departments at the hospital while I am here, and as my personal inclinations go, I drifted to the mergency department as my introduction to working here, where I will be for the next two weeks before moving on to other departments.
Given Nicaragua´s recent and current economic status, I really was not expecting much in the form of medical resources before coming here. From a distance, things did not appear to bad. The hospital is an old, relatively small, one story building made of brick and concrete, with numerous wings and outdoor covered hallways leading from one department to another. Some of teh departments have functioning airconditioning while the building power is on, someimtes it cuts off, and other departments are at the mercy of the weather, which is usually hot.
Once I got to work in the emergency department, I came to appreciate the little resources I am used to having in hospitals in the U.S.. Here, for example, gloves come in one or maybe two sizes on a good day, so if they are to big or to small, you have to make due. There is also a general shortage of clean linen, so we only change the bed sheets between patients if the sheets are obviously saturated with blood or other bodily fluids (a little blood is okay if you flip the sheet over, right?), and when the sheets run out we do our best to clean the bed with soap, water, and gauze, or sometimes bleach if we have it. I guess I could go on and on about the basic things we don´t have that I´ve been accustomed to in the U.S., such as clean paper towels to dry hands, needles in appropriate sizes, beds with side rails to prevent falls, more than two blood pressure cuffs for an entire department, etc., not to mention anything more technologically advanced like an MRI or CAT scan. The docs here have to rely on more mnaula methods such as palpation and auscultation to diagnose (although we do have a functioning x-ray machine at the moment!). But I should also say that the nurses and doctors here seem committed to doing the best they can with the government funding they have. One doc summed it up whe he told me on my first day there; "Aquí, aprende a trabajar con clavos." Meaning, here you need to learn to work "with nails," with difficulty, with few resources.
Part III
When I arrived in Managua in May, the swin flu had not yet been indentified within the borders of Nicaragua. As arriving passengers exited their plane in the airport, they were each screened individually in front of a thermal scanner to identify anyone with an elevated temperature. But on Tuesday of this week, a case was confirmed in Managua. Then on Wendesday a case was confirmed here in Masaya in a nearby neighborhood.
Although the outbreak here is not receiving nearly as much press as it did in the U.S. back in April/May, there is still some alarm and the government health department is taking measures to hopefully reduce the spread. For example, today in the hospital, anyone presenting with fever or respiratory symptoms was screened in an outdoor make-shift assessment center to rule out the influenza strain before they were allowed to actually enter the hospital. all of the staff, including myself, are also required to wear surgical masks (which we do have a limited supply of) and safety glasses to avoid contagion. So we´ll see how things develop. I´m not to worried about the swine flu in its current form, since most people seem to recover without to much problem, but there´s always the chance that the virus will become more virulent. Given the ease of transmission, it would cause much harm if that happened, but I think at some point you just have to aknowledge that you´re not in control and if you get sick and die, you can still be thankful for the time you did have, ¡hoka hey!
Tune in next week for "Caballeros de Granada," or "Ticky Ticky Goes Boom Boom"...´hope all is well at home, wherever home is for those reading this. And I apologize for any typos, but if I am going to post this today there´s no time to proof read.
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