I know I posted an entry just the other day but after what happened today I felt like writing about it. It´s definitely healthcare related in nature, so sorry for any jargon that dosn´t make sense...and if the thought of blood makes you nauseated you might just want to disregard this post.
A 45 year old man came into the emergency department this morning with an altered level of consciousness. The Masaya bomberos (firefighters) had brought him in after someone had reported seeing the man sitting in his car and having cognitive trouble. When he got to the hospital we took his vitals, which showed a blood glucose of 421 (we had glucose sticks today!), a low blood pressure and a rapid pulse. The man could state his name but was mostly incoherent and unable to open his eyes fully.
We gathered what medical history we could from him given his state and not having any family or close friends present. He said he was diabetic (and the multiple large ulcers on both feet were probably a result of this) and had a history of alcohol use. The docs did a rectal exam which showed a back up of black tarry stool, meaning he probably had an internal bleed somewhere. IV fluids were started and then one of the doctors inserted a nasogastric tube, a large bore tube inserted through the nose into the stomach. We also had no lubrication available today so the tube was inserted using water as a lubricant, instead of something to make the passage a little easier.
The tube went into the stomach okay, but the next minute we were draining over 1000cc of blood from the tube. What probably happened is the man had esophageal varices (http://www.mayoclinic.com/health/esophageal-varices/DS00820) which ruptured when the NG tube was placed. This is something you would normally screen for by asking the patient (this person was not cognizant enough to understand the question), or performing an endoscopy or CT scan to check for varices (resources we do not have), since a rupture can be life threatening. But now the damage was done, all we could do was try to drain the rapidly accumulating amount of blood from his esophagus and replace fluid IV at the same time.
Due to the amount of blood being lost a blood tranfusion was started and another doctor was notified to insert a ballon tamponade. Essentially this is just a smaller tube which is again inserted into the esophagus (after the NG tube is removed). There is a long balloon that can be inflated once the tube is inserted that puts pressure against the esophageal wall in an attempt to stop the bleeding. The tube was inserted, but by this point the man was in unimaginable distress, coughing up blood and bits of tissue that I can only imagine were parts of tissue from the varices. Aye...que puede hacer?
During this time I got called away to help deal with other people coming into the hospital, like a young kid who had accidentally cut one of his wrists open with a machete. But when I returned to see how the man was doing he was surprisngly still alive, with IV lines wide open. But somehow it seemed like the bleeding had either stopped or slowed down significantly. The baloon tamponade had been removed and he was no longer coughing up blood, he was just curled up in a fetal position as his mother, who had shown up at some point, made sure he did not inadvertenly fall off the narrow bed without side rails as he tossed around in agony.
Before I left that day he had been transfered to a med-surg unit since he was going to need longer care then what we provide in the emergency department, but I hope he makes it through the day.
That is all, just felt like I had to vent that in some way...
Tuesday, June 23, 2009
Monday, June 22, 2009
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.
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.
Saturday, June 13, 2009
Photo 6
This is just a random street intersection in Masaya, that´s me and another student on the right crossing the road. I just liked the colors and artwork on the building. Even though there´s plenty of poverty here, many of the homes and buildings express a lot of color and vibrancy.
And this is my last post for this week, so I hope you enjoyed the photos...might have more in another week or two.
Photo 5
This is just a snap shot of part of the photo exhibit that was on the palace grounds. If you click on the image you can read some of the text in the photo. The main line translates into "...it is preferible to make me die as a rebel and to not live as a slave."
Photo 4
That is me standing infront of a giant silhoutte of Augusto Sandino, an image which has been erected on that hill where Somoza´s palace once stood. The image was designed by Ernesto Cardenal, who is a famous Nicaraguan priest, poet, activist and writer. Look him up if you want to read about an interesting character.
Photo 3
Here´s a photo of that wall in the park I described in my first post. The barrels sticking out of the cement are rifles, mostly AK-47s, that were used during the most recent civil war. The wall, and park that is is located in, were built as a symbol of rememberance for those who were killed and hope for a more peaceful future. Unfortunately, the park grounds are no longer maintained by the city government and the site has fallen into disarray...hopefully not a sign of things to be repeated.
Photo 2
Here is part of that hill top view from the former Somoza palace grounds in Managua. The body of water is the Lago de Managua. I´m posting these photos in separate posts cause that seems to be the only way they will load at all.
Photo 1
Here´s a picture of the country flag, in case any of you geo-challenge game nerds out there always miss that one, flying in a plaza in Managua. Now let me see if I can get more to load...
Friday, June 12, 2009
Una familia de músicos, desarollo sostenible y caballos de Granada
¡Buenas! I just returned from Managua. All of the students in our group met there today for a workshop on grant writing, which looks like pretty tidious work. But the venue was interesting, our class was held in a small private room at La casa de los Mejia Godoy, a full time restaurant and local music venue.
The Mejia Godoy is a famous nicaraguan family of musicians (http://www.mejiagodoy.org/). Their reputation began with two brothers, Carlos and Luis Enrique, who made a career of performing traditional nicarguan music, in addition to writing and performing countless songs of political protest during the Somoza regime...and people have told me they lived and acted on what they sang. They also continue to be politically active, criticizing the current president, Daniel Ortega, for succumbing to the common mold of politicians by speaking in one regard and legislating in quite another. Many people here regard the music of Carlos and Luis Enrique as central to modern nicaraguan history and culture. So it was neat to see the restaurant and performance stage, decorated with musical paraphernalia and photos of various sorts.
The grant workshop we had there was very detailed oriented. As a focus of our time here with FSD, each intern is expected to at least attempt implementing a program or activity, in cooperation with our host organization, which will help improve the effectiveness and/or efficiency of that organization´s services to the local served community. Sounds easy, maybe? There´s certainly a long list of basic material goods that the hospital here could use on a daily basis, but the catch to our project is that is has to be "sustainable."
What exactly does that mean? Well, it can certainly have different definitions depending on the application. With our specific case, it means we have to develop a project that the organization has agreed that it needs and will use. The project must have a potential for lasting impact that continues in our absence and wont deflate once there is no external funding to support it.
This means we have to utilize what few resources there are here, and we must involve the community´s interest and values so that they are equally involved in the proposal, planning, and creation...and then fully capable to carry on the project into the future once the interns leave. For the instances where there is some additional funding needed to get the project up and running, FSD offers a grant program that we can apply for. However, the application is no easy task and requires that the plans for our project are written out in fine detail and have demonstrated adequate community involvement and investment.
With all of that said, you can understand the difficulty of coming up with ideas for a project in an underfunded nicaraguan public hospital. Nothin´worth doin´is easy, right? That´s what I try and tell myself at least, otherwise it´s easy to just become overwhelmed and walk away. One idea I am looking at is to try and start a peer health education program here, which is something that the hospital has expressed interest in and could possibly conform to this sutainability model. I need to wait until next week to start looking at more specific details, and if it´s not doable, then back to the drawing board. On top of trying to figure this material out, I came down with a cold over the weekend that I spent Monday and Tuesday at home trying to recover from. Then Wednesday and Thursday were pretty hectic in the emergency department...but here it is Friday and I´m still kickin´.
The past weekend was eventful at least. Our student group went to the city of Granada, which is about a 20-30 minute bus ride east of Masaya, right on the edge of the Lago de Nicaragua. We arrived in Granada late Saturday afternoon, which gave us some daylight to walk around the city. It is a very beutiful place, with lots of the colonial style architecture and buildings still maintained. There is a large central plaza and numerous cathedrals, museums, coffee shops and handicraft stores to peek in. However, in contrast to the other cities I have been to in Nicaragua, the atmosphere is quite different. There is lots of tourist activity and foreign or expatriate run stores and restaurants. Even a lot of the menus for places were in English and the prices of food and things is much more comparable to prices back in the United States, albeit less expensive. All of that just made it seem much less representative of the impoverished conditions you see elsewhere in the country.
The main reason I had gone to Granada though was to see the hípica of Granada, which is essentailly an annual celebration where the town closes down the main plaza and roads to car traffic for a horse parade. There is also lots of music and other activites going on as the mounted horses parade through town. It was led by a young boy mounted on a bull the size of a small bus (an adult man did have the reins of the bull as he walked along side the bull). The bull´s horns were painted in bright striped colors and there were lots of impressive horses on parade. It´s also the first time since being here that I have seen large livestock that looked sufficiently fed, without ribs or pelvic bones showing grossly on the skins surface.
That about sums things up from my end. I do have photos from my first week here which I am trying to download onto this blog page, but with these slow connections I am not sure if it is going to work since an earlier attempt failed. But Ill try again tomorrow is I can´t make it work tonight, otherwise you´ll have to settle once again for text only.
Good night all...peace be with you.
The Mejia Godoy is a famous nicaraguan family of musicians (http://www.mejiagodoy.org/). Their reputation began with two brothers, Carlos and Luis Enrique, who made a career of performing traditional nicarguan music, in addition to writing and performing countless songs of political protest during the Somoza regime...and people have told me they lived and acted on what they sang. They also continue to be politically active, criticizing the current president, Daniel Ortega, for succumbing to the common mold of politicians by speaking in one regard and legislating in quite another. Many people here regard the music of Carlos and Luis Enrique as central to modern nicaraguan history and culture. So it was neat to see the restaurant and performance stage, decorated with musical paraphernalia and photos of various sorts.
The grant workshop we had there was very detailed oriented. As a focus of our time here with FSD, each intern is expected to at least attempt implementing a program or activity, in cooperation with our host organization, which will help improve the effectiveness and/or efficiency of that organization´s services to the local served community. Sounds easy, maybe? There´s certainly a long list of basic material goods that the hospital here could use on a daily basis, but the catch to our project is that is has to be "sustainable."
What exactly does that mean? Well, it can certainly have different definitions depending on the application. With our specific case, it means we have to develop a project that the organization has agreed that it needs and will use. The project must have a potential for lasting impact that continues in our absence and wont deflate once there is no external funding to support it.
This means we have to utilize what few resources there are here, and we must involve the community´s interest and values so that they are equally involved in the proposal, planning, and creation...and then fully capable to carry on the project into the future once the interns leave. For the instances where there is some additional funding needed to get the project up and running, FSD offers a grant program that we can apply for. However, the application is no easy task and requires that the plans for our project are written out in fine detail and have demonstrated adequate community involvement and investment.
With all of that said, you can understand the difficulty of coming up with ideas for a project in an underfunded nicaraguan public hospital. Nothin´worth doin´is easy, right? That´s what I try and tell myself at least, otherwise it´s easy to just become overwhelmed and walk away. One idea I am looking at is to try and start a peer health education program here, which is something that the hospital has expressed interest in and could possibly conform to this sutainability model. I need to wait until next week to start looking at more specific details, and if it´s not doable, then back to the drawing board. On top of trying to figure this material out, I came down with a cold over the weekend that I spent Monday and Tuesday at home trying to recover from. Then Wednesday and Thursday were pretty hectic in the emergency department...but here it is Friday and I´m still kickin´.
The past weekend was eventful at least. Our student group went to the city of Granada, which is about a 20-30 minute bus ride east of Masaya, right on the edge of the Lago de Nicaragua. We arrived in Granada late Saturday afternoon, which gave us some daylight to walk around the city. It is a very beutiful place, with lots of the colonial style architecture and buildings still maintained. There is a large central plaza and numerous cathedrals, museums, coffee shops and handicraft stores to peek in. However, in contrast to the other cities I have been to in Nicaragua, the atmosphere is quite different. There is lots of tourist activity and foreign or expatriate run stores and restaurants. Even a lot of the menus for places were in English and the prices of food and things is much more comparable to prices back in the United States, albeit less expensive. All of that just made it seem much less representative of the impoverished conditions you see elsewhere in the country.
The main reason I had gone to Granada though was to see the hípica of Granada, which is essentailly an annual celebration where the town closes down the main plaza and roads to car traffic for a horse parade. There is also lots of music and other activites going on as the mounted horses parade through town. It was led by a young boy mounted on a bull the size of a small bus (an adult man did have the reins of the bull as he walked along side the bull). The bull´s horns were painted in bright striped colors and there were lots of impressive horses on parade. It´s also the first time since being here that I have seen large livestock that looked sufficiently fed, without ribs or pelvic bones showing grossly on the skins surface.
That about sums things up from my end. I do have photos from my first week here which I am trying to download onto this blog page, but with these slow connections I am not sure if it is going to work since an earlier attempt failed. But Ill try again tomorrow is I can´t make it work tonight, otherwise you´ll have to settle once again for text only.
Good night all...peace be with you.
Friday, June 5, 2009
Cárceles políticas, un hospital con una falta de fondo y la gripe porcina
¡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.
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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