Volcán de Masaya, proyecto

Hello everyone! Sorry it´s been a while since my last post but here it is. There will also be lots of photos to share from the past couple of weeks, but I am going to have to make a trip to Managua to get the film developed, so I hope to have some photos posted sometime next week at the latest. In the meantime I´ll just update you all on happenings here.

Walk up a Volcano
On Sunday, June 14th, another student and I went for a local hike up a nearby active volcano (I realize this sounds like a counter intuitive thing to do). The hike was very beautiful though, and the volcano is the centerpiece of a protected park, with a nice visitor center and park staff that maintain the area. We walked from the entrance to the park, right off of the Managua highway, up a long gravel road with lots of thick, green vegetation on either side to the top of the volcano. It is possible to just drive that distance or take a taxi...but walking up the volcano just made the journey seem more genuine.
As we approached the top, which took a decent amount of time and water, we could see the thick smoke rising from the crater...in addition to the giant cross that was erected at the side of the crater a couple of hundred years ago by a Spaniard who was convinced the mouth of the volcano was an entry to Hell, and given the series of eruptions the volcano has produced in its lifetime its understandable why.
Once we reached the top, we were able to peek down into the crater to see the source of all of the smoke. We could see farther down then I had imagined, hundreds of feet down a crater that was also probably several hundred feet wide (Ill try to post a picture next week). The smoke was especially thick that day because of recent rain, and the park employees adivsed not to linger too long at the top of the crater since the sulfuric smoke was not good to breathe in for much duration.
We left the rim of the active crater to hike a little bit further up the mountain to see some of the extinct craters. One of these had a thick forest growing in the bottom of it, also hundreds of feet down with steep walls on all sides, you would need lots of rope to rappel down and make it out again. But it was an interesting site to see.
With the incredible views of the extinct volcanic crater to one side, and active volcano on another, and a mountain top view of the valley below, we sat down for a rest to admire the view. There was also a park employee up there who monitors the trails, and we struck up a conversation. He told us quite a bit about the park and was curious who we were and what we thought of Nicaragua.
In his decription of the park we were in, he told us there were a series of caves on the southside of the craters that had been formed by past lava flows. He told us how during the revolution and contra war a lot of people had fled from Masaya (about 10 km east)and some surrounding small towns to live in the caves and hopefully escape some of the violence, or even to prevent their young sons from being consripted and sent to war.

Project update
I talked with my hospital supervisor (the emergency dept. nurse manager) last week about project ideas, and the idea of a peer health group for the hospital. However, her feedback (along with some of the other employees and doctors) is that they would like to focus on improving their staff education capacity. Currently, the department holds a staff training class at least once a week, but without a board, printer to make handouts, and absence of other classroom type materials, the classes are really not as effective as they should be. So right now I´m working with her to see what we can do about improving the staff training sessions.
However, after today I think I´m also ready to propose reorganizing the medicine cabinet in the emergency room. There is just one big drawer with a flip top lid where all of the medicines are kept. There has been an attempt to make labels to keep certain medicines in distinct locations...but everything becomes jumbled together pretty easily, making it hard to find what you need when you need it, and I am sure also increasing the likelihood of a medicine administration error. There was a man who came in today having severe chest pain, and while I could find most the medicines the doctor ordered without too much problem...it took a considerable amount of time to find the one ampule of morphine that was left. Another nurse had just figured we were out (its pretty common that our pharmacy just dosn´t have basic drugs on a given day), but I did find one ampule of morphine after looking everywhere it shouldn´t be. But we´ll see what the management thinks about med cabinet reorganizing.
I did feel very bad for the man having the chest pain and his wife who had brought him in. The doctors wanted to have a cradiac enzyme test performed to confirm that his pain was cardiac related...but our lab here lacked what was needed to perform the test today, and we could only refer them to a private hospital for the blood test, which would cost the family quite a bit out of pocket. The capabilities of our lab vary day by day depending on what supplies they have available. Sometimes we don´t even have what is necessary to check someone´s blood sugar. But we do what we can with what we have when we have it, but until the Nicaraguan government pours more money into their healthcare system resources will remain hard to come by.