Minsa Survey

I spent most of the last week in Nandayuri, a comarca (rural barrio) of Masaya just above Monimbo. We went door to door doing a MINSA (Ministerio de Salud) survey to catalogue people’s health and living conditions. Nandayuri is only a short walk out of the downtown Masaya area but it feels like a different world. In contrast to brightly painted homes in downtown Masaya, the shacks of Nandayuri are plain and simple, hidden amidst seemingly unmaintained groves of mango and banana trees.

We surveyed things like the number of people per household, their occupations, type of sheltering they occupied, their method of garbage disposal, presence/absence of latrines, pets, light, running water. Most people were living 6-12 per household. This usually consisted of small distinct but connected shacks sheltering the family’s different generations, their spouses, and their kin. The people of Nandayuri were shoemakers, woodworkers, small scale farmers, bicycle repairs men, bakers and seamstresses. Many of the older generation couldn't read or write. Others, including a lawyer we met, had higher education but were simply out of a job. Many households did not have latrines, running water, or electricity but all of them had a chickens, a dog or two, or ten.

Most people received us in their warm and friendly Nicaraguan spirits. They pulled out chairs for us, made us drinks of pinolillo and gave us gifts of mangoes and jocotes (My favorite part of working in the rural areas is all the delicious fruit!). They were eager to talk and jest about their family, their lifestyle, and their problems. Sometimes people had TVs and we would get sucked into the dramatic undertakings of telenovella characters, an entertaining respite from the mid day heat.

There were also those that were not as inviting to our white coats and clipboards, greeting us with cold shoulders and skeptic eyes. One particularly obstinate 78 year old woman made sure we knew about all her qualms with the government and the public health system in Nicaragua. She angrily chastised us for conducting such surveys in vain, recalling the many doctors and brigadistas who have passed through only to make minimal or no improvements to her family’s health. Despite my efforts to distance myself from the messy politics of a developing country like Nicaragua, the association of public health and the political sphere is inevitable. Monimbo, the area of Masaya that our clinic serves, is especially known for its hotheaded Indian Sandinista community. During the revolution, with machettes, women throwing boiling water, and a few rare rifles as their only weapons, they led a memorable and successful insurrection against the well armed National Guard.

The heat has become more sweltering, but the epic tropic rain has started. I am looking forward to more greenery and less dust. I am enjoying Masaya more and more, discovering the many charms the city has to offer. Quiet backyard coffee shops with hammocks and rocking chairs, the best and panaderias and fruit stands, an uphill running trail that leads up to a Somoza era prison fortress with a view of the entire city. I am writing a lot and reading a lot of Latin American revolutionary poetry and literature-Ruben Dario, Roberto Bolanos, and my current favorite Gioconda Belli. I can't find an English translation of this online, but I love it because it reminds me why I'm here:

Uno no escoge el país donde nace;
pero ama el país donde ha nacido.

Uno no escoge el tiempo para venir al mundo;
pero debe dejar huella de su tiempo.

Nadie puede evadir su responsabilidad.

Nadie puede taparse los ojos, los oidos,
enmudecer y cortarse las manos.

Todos tenemos un deber de amor que cumplir,.
una historia que nacer
una meta que alcanzar.

No escogimos el momento para venir al mundo:
Ahora podemos hacer el mundo
en que nacerá y crecerá
la semilla que trajimos con nosotros.

-Gioconda Belli


Adios

Semana Santa

Semana Santa is hardly the holy week that its namesake translates to. During this holiday break, meant to commemorate the death of their savior, people flood to the beaches to drink, party, soak up the sun, and engage in reckless activities often at the cost of lives. Along with two other interns, Kara from Brooklyn and Karen from Canada, I chose to take my week long vacation in the less populated and Caribbean coast in hopes of a scene that was more tranquilo. In the end, we did in fact get that, but we had to go through our share of chaos and near death (by sea) to reach our paradise.

Getting there was an arduous yet adventurous journey including an array of different transportation mediums. Chicken Bus, Micro Bus, Panga, Taxi, Boat, Mini plane. Masaya to Managua on microbus, Managua to El Rama on overnight bus that left at 9 pm and got to El Rama at 2 in the morning where we had a 3 hour layover in the middle of the night outside on a bench waiting for the first panga to leave at 5 am to go down the entire length of the Rio Escondido, get to Bluefields, take another panga to a town called C-------, miss the bus going to Pearl Lagoon because it decided to leave a half hour early, take a taxi to Pearl Lagoon, another panga to and from the village of Awas, and finally a night's rest back in Pearl Lagoon.

It is quite hard to still feel like one is in Nicaragua on the Atlantic Coast. The spoken language was English and the vibe was very west indie. It was such a stark contrast to the Spanish speaking, traditional catholic Latin American ways of the rest of the country. On the Atlantic coast, we ate Coconut Bread in place of tortillas and listened to more reggae than salsa or marimba. For an area so geographically isolated from the rest of the country, it has a unique mesh of different cultures including Mestizos, Creoles, Garifunas, and different Amerindian tribes. Most people are bilingual in English and Spanish and some people speak an additional language that is indigenous to their tribe. When conversing with locals, their heavily accented English was so difficult to understand and we had to switch to Spanish to understand what was going on. In Awas, we met one man who spoke 5 different languages- Mestizo, Creole, Suma, English and Spanish. The contras snatched him from his parents when he was sixteen and he proceeded to fight in the counter revolution of a country he barely associates with. From Pearl Lagoon, we went to a village called Oronoco. Oronoco is the home to a population of Garifuna people, a group with West African roots indigenous to areas in Belize. Karen also seems to think that it is the namesake of that Enya song that goes "sail away sail away sail away", because its actual title is "Oronoco". For years, their Garifuna language and culture was suppressed in Oronoco. Now there is a revival movement that includes teaching Garifuna in schools and reviving traditional Garifuna music and dance. The Garifuna music I experienced was the percussion and voices of a group of young men bringing the vibrant and passionate Afro-Caribbean beats of their ancestors to life. Our new friends took us to the homes of two women, one who sold us cassava bread, and the other who sold us a homemade moonshine comprised mostly of corn and sugar.
After a night in Oronoco, we headed back to Bluefields hoping to catch a ferry to the Corn Islands. What we didn’t know was that there are only ferries to the corn islands on certain days, so we had to stay in Bluefields for a night. Despite the guidebook’s warnings of Bluefields as a dangerous crack ridden city, the girls and I liked Bluefields, and its feeling of a true city. There was a central park, two story buildings (very rare in this country), and a feeling of laid back kind of hustle, but a bustle nonetheless. Something about the city’s raw Creole vivaciousness with its scene of dark and sinful pleasures, made me think of New Orleans (though I have never been, only heard). The hostel we chose, however, did embody all of the stereotypes and warnings. There was a single dark hallway with tiny rooms. Our room had no windows to the outside, but a window that overlooked the dark creepy hallway. The owner of the place was an old man who hobbled around on crutches because of an ailment that left him with a completely skinless, raw underside of one foot and the absence of one toe. My diagnosis is that some weird parasite was eating away at his flesh. Besides its “bargain value and convenient location” The Moon Nicaragua Guide failed to say that one should only go there if they intend to evoke feelings of a Caribbean version of the Shining. To avoid the hostel, we walked around the city all day and even tried our luck at a Casino, where I won just enough to buy us girls a healthy handle of Flor de Cana for the next day’s journey to Little Corn Island.
We had grand plans for the six hour boat ride from Bluefields to Little Corn. It would consist of sunshine, Caribbean ocean Breeze, rum, and deck tanning. In actuality, it was overcrowded, uncomfortable, and by the end, drenched in vomit, saltwater, and sick people laying in all of it. One crew member’s job was to hand out barf bags and collect used ones. Everyone in the inside area had their heads in their laps. Outside on the deck, people were lying down, heads overboard, as waves continually and violently crashed on them. In my corner of a bench squashed between two helplessly immobilized grown men, my stomach endlessly churned as a layer of saltwater slowly accumulated on my face, burning my eyes, and forcing them shut. After witnessing a mother throw up all over her daughter who was already lying down in her own spew, I decided to just keep my eyes closed for the rest of the ride. Together, the girls and I have come to terms with the trauma we underwent. We have acknowledged the impossibility to convey to others the dreadfulness of the experience, and can only look back and laugh at our initial preconceptions.
We finally reached Big Corn, where after all that, we had to take another 45 minute Panga ride to little Corn. And now for the happy ending. It seems almost inappropriate to talk about the rest of the trip in the same post. White sands, turquoise waters, waking up hearing the waves, eating fresh seafood and all day everyday, wearing bathing suits not clothes, coconut bread, Flor de Cana, reggae, vast beaches with no one else on them. It was pretty much that for the next 5 days...On the way back, we paid for a flight in a tiny plane that flew directly from big corn to Managua.
Freaky Warrior.

El Trabajo Comienza!

Alas, after two weeks of cultural immersion and orientation, I have started my work at the Centro de Salud Monimbo. For my first week in the clinic, I did a different rotation each day getting to know the different staff and programs. There is a staff of 12 doctors, around the same number of nurses, an epidemiologist, and 3 women who run the lab. A large portion of the clinic’s patients are referred to the lab by the doctors they see to get tests for pregnancy, stds, different parasites, dengue, tuberculosis, and aids. In the morning, the tiny one room lab floods with people carrying their excrement samples in match boxes and plastic bags and others who are waiting to get their blood tests. Due the scarcity of materials, these blood tests consist of using capillary tubes instead of needles to transfer blood into a small glass test tubes. There are only three women who work in the lab and every day they process all kinds of tests manually for every patient who needs it. For preparing the blood samples, these brave women use their own mouths to siphon samples that potentially contain deadly diseases!
One of the programs offered by the clinic is called “Trabajo de Terreno” and provides basic health services and education to communities in rural areas surrounding Masaya that do not have the funds or means to access traditional health clinics and hospitals. For two days of my first week, I traveled with a team of doctors and nurses to different areas to discover completely impoverished communities. I met many families with several children and children’s children living under rudimentary tin shacks. Right now, the Trabajo de Terreno program is focused on decreasing mortality rates of the H1N1 flu virus, as it has been very high in recent months in Nicaragua. Pregnant women are the most susceptible, so we have been going from village to village, door to door, looking for pregnant women to vaccinate. Even after finding those who were pregnant and instructing them to come to a nearby house, where stationed doctors and nurses were giving the vaccines for free, there was a lack of attendance and we had to hunt down many women and give them the shot at their house. I can already see that these visits mean more than just administering vaccinations. Simply having contact with health professionals who are positive and encouraging reminds people about their health and to make better choices. For example, we encountered one pregnant woman who was very sick. She had seen a doctor in the recent past, but had failed to follow up with any appointments for her or for the routine vaccinations of her child. We encouraged her to come in and bring her kid and also explained to the husband the importance of these future appointments. The visits to these communities are about more than disease control, they are about disease prevention through outreach, encouragement, and education.
The lack of resources is made up for by the presence of so much hard work and so much heart. The clinic is open every day so that those that work during the week could access services on the weekend. All of the doctors here are very young because here in Nicaragua you do not need an undergraduate degree before going to medical school. Their enthusiasm, energy, and optimism are really quite inspiring.
My host family is awesome. They are artisan shoemakers who sell their work in both the local artisan market and the larger local Mercado. My room is on the top floor and has a balcony overlooking the top of the San Geronimo church. Last week was Semana Santa, work was off, so I went to the Carribean coast with two other interns from Managua. So many crazy adventures, but I must save that for another post!
adios