So this is how it happened... On Saturday Cody and I were driving past this hotel and saw that they had pallets full of used clothes piled ceiling high on their cement first floor. We pulled over and started sorting through the goods. This is not an uncommon event during our days in Puerto Cabezas. There are many places that specialize in used US goods, as their quality is often superior to new Nicaraguan made products. Basically we have a theory that people are either donating clothing from the US or there are people raiding those Salvation Army drop boxes and sending these tresures here where they are then sold at the price of 15-40 cordobas, basically $.75 to 2.00. In one of these towers of musty smelling clothes I happened to find these mens swim trunks that are covered in palm trees and sailboats and Hawaiian scenes minus the hula girls...and I had to have them. So Cody generously paid the 15 cordoba price and they were mine.
So on Sunday I woke up with my outfit all picked out. I decided on the Hawaiian swim trunks, a white tank top, and some high heeled sandals. It was a ridiculous outfit just perfect for lounging out back in the hammocks. While relaxing out back our personal artisan jewlery maker showed up with handfulls of black coral and tortise shell goodies. Cody had been wanting to trade a booty of jewelry for a sander he had brought from the US. We ended up whisking our jewelry man off to his partners home to make the trade. I sifted through gobs of sparkling, handcrafted earings, necklaces, and bracelets until a pile was formed that seemed reasonable to trade for the sander. The deal was made and we were on to our next stop. We decided to see our friend Anhette who was in port picking up supplies before heading back to her coastal community of Dakura. We learned while we were visiting her that her cousin was quite ill. They had brought her the 2.5 hours by panga (speed boat) so that she could be seen at the hospital. Since we had a truck we offered to bring her. The girl was extremely weak, unable to walk, and complaining of severe lower abdominal pain...Cody lifted her frail body into his arms and carried her to the truck, while I tried to differentialy diagnose what could possibly be wrong with her. When we got to the hospital she was laid onto a stretcher and we awaited the doctor. When she showed me exactly where on her abdomen the pain was I started to become suspicious of a reproductive problem...something like an ovarian cyst, ectopic pregnancy, etc. When the doctor came in the room to evaluate her it turned out to be Aragon, the one that I am working with at the Casa Materna. He allowed me to stay as the gaggle of family members were usherd outside, leaving the patient, the doctor, the girls mother, and me. The doctor quickly ruled out digestive origins of her complaint by pushing and proding on her belly and quickly sent her to the gynecological room for an examination. Probably for the first time in this girls life (shes 19) she had a speculum inserted and a vaginal exam performed as tears streamed down her cheeks...I can say that the doctor is extremely competent but his bedside manner is lacking, and basically is a reflection of how I dont want to treat my patients. Anyhow, as he was drawing the speculum out another woman was brought into the gynecological room...and she turned out to be the lovely Ena, my favorite patient from the Casa Materna in labor, 5 centimeters dilated. I had been joking with her all week that she needed to tell the baby not to be born until I was available. She has no family or friends here in Port and I had offered to be there with her at her birth...and coincidentaly enough I was present and accounted for! She was rushed back to the delivery room while I battled for 5 minutes over whether I should leave my friends cousin and head back to the delivery room, or wait with her, and also whether Cody should bring me some clothes a little more appropriate for the delivery room than short-shorts and high heeled sandals. I decided to peek in on Ena. I jogged back to the obstetric wing of the hospital, but unsure of its location I ended up pushing my head through various doors until I caught sight of Magda the nurse from the Casa Materna. I ran after her and she ushered me into the delivery room. I swept up beside Ena, she grabbed my hand, pushed one time with all her force and with that her little baby boy slipped into the world. And thats how it happened.. that I was in the delivery room of Hospital Nuevo Amanecer in my cheesy hawaiian short-shorts and high heeled sandals holding Enas hand and leaning away from the table to avoid blood splattering on my bare toes.
p.s. the girl had PID and a urinary tract infection
Monday, July 28, 2008
Thursday, July 24, 2008
Nursing in the Third World
One week has passed since I have arrived in Port. I usually wake to sun drifting through my mosquito net, while our solar powered fan gentle blows the thousand mosquitos that have managed to penetrate the net in a circular motion from fan-to blood sucking-to side of net, then head to the bathroom for a refreshing cold bucket shower, as Cody prepares me a fabulous breakfast and we make plans for a delicous lunch of fresh caught shrimp, crab, or lobster. I then set off to the Casa Materna...
Having the opportunity to practice any form of medicine in a developing country is truly an enlightening experience. On the one hand I come to the Casa Materna with limited knowledge and the staff are extremely eager to teach and share not only their knowledge but their language with me. Each day I learn a new word that i get to practice with my pregnant ladies (panzonas) such as lie down (prouss) or sit down (eoos) or fish head (inska lal). There is a yound doctor from the pacific side of the country who has decided to teach me various medical practices. He has shown me how to hear a babys heartbeat with a stethescope which is no small feat on its own, but imagine that the stethescope doesnt fully fill your ears and the sounds of buzzing saws from next door mix with the drama of the telenovela being brodcast at full blast next to the clinic room, all slipping into your ears simultaneously with the doctors and nurses asking, do you hear it...now...now? I finally did...it was a miracle to hear that tiny heart (kupia) beating away! The other thing that I did for the first time was a vaginal exam to see if a woman, and then another womans cervix was dilating. for those of you reading this that are not into medicine this might seem like a strange thing...but for me it was fabulous! the docotor basically looked at me and said, have you ever done this before, and i said no, and he said, well put a glove on! That to me sums up the ease of learning in the third world...people are eager to share with me, and the reality is they dont even know who i am or if i have any credentials behind my name. this is very different from the sterile, badge on all the time hospital training i have had in the states.
But on the other hand...having just completed a year of nursing training in the US, it is too easy for me to see flaws in the nursing care. I also want to express that these nurses are extremely well trained and competent in the care that they have learned to provide...but in the US we are taught to conduct every proceudre under a shroud of sterility. How can you provide aspetic or sterile care when the floor of the clinic is concrete with dirt blossoming through cracks, when the doctors and nurses all wash their hands in the same bucket of water that sits on the table all day, and quite simply in a place where running water does not exist? The answer is that they do the best they can. But as a new nurse when i saw the nurse place the cap on a newly placed IV that she had dropped on the floor two times without cleaning it with alcohol, and when the blood trickled out the IV onto the floor and she wiped it up with a dry cotton ball with no gloves on, my little heart sank. There is still much training and learning to be done on both sides here!
On another note one of my pregnant Miskito ladies has been teaching me to crochet with the needles and yarn that were dontated to the clinic. It was so fun to see all their eyes twinkle when I brought out the bag of supplies. Now every morning when I head to the clinic I see the women sitting out front in their handcrated wooden rocking chairs, bright threads in hand, crocheting little hats and booties for thier little babies to be! Im still looking for someone who can teach us to knit!
Isabe! (Im pretty certain that one means goodbye!)
Having the opportunity to practice any form of medicine in a developing country is truly an enlightening experience. On the one hand I come to the Casa Materna with limited knowledge and the staff are extremely eager to teach and share not only their knowledge but their language with me. Each day I learn a new word that i get to practice with my pregnant ladies (panzonas) such as lie down (prouss) or sit down (eoos) or fish head (inska lal). There is a yound doctor from the pacific side of the country who has decided to teach me various medical practices. He has shown me how to hear a babys heartbeat with a stethescope which is no small feat on its own, but imagine that the stethescope doesnt fully fill your ears and the sounds of buzzing saws from next door mix with the drama of the telenovela being brodcast at full blast next to the clinic room, all slipping into your ears simultaneously with the doctors and nurses asking, do you hear it...now...now? I finally did...it was a miracle to hear that tiny heart (kupia) beating away! The other thing that I did for the first time was a vaginal exam to see if a woman, and then another womans cervix was dilating. for those of you reading this that are not into medicine this might seem like a strange thing...but for me it was fabulous! the docotor basically looked at me and said, have you ever done this before, and i said no, and he said, well put a glove on! That to me sums up the ease of learning in the third world...people are eager to share with me, and the reality is they dont even know who i am or if i have any credentials behind my name. this is very different from the sterile, badge on all the time hospital training i have had in the states.
But on the other hand...having just completed a year of nursing training in the US, it is too easy for me to see flaws in the nursing care. I also want to express that these nurses are extremely well trained and competent in the care that they have learned to provide...but in the US we are taught to conduct every proceudre under a shroud of sterility. How can you provide aspetic or sterile care when the floor of the clinic is concrete with dirt blossoming through cracks, when the doctors and nurses all wash their hands in the same bucket of water that sits on the table all day, and quite simply in a place where running water does not exist? The answer is that they do the best they can. But as a new nurse when i saw the nurse place the cap on a newly placed IV that she had dropped on the floor two times without cleaning it with alcohol, and when the blood trickled out the IV onto the floor and she wiped it up with a dry cotton ball with no gloves on, my little heart sank. There is still much training and learning to be done on both sides here!
On another note one of my pregnant Miskito ladies has been teaching me to crochet with the needles and yarn that were dontated to the clinic. It was so fun to see all their eyes twinkle when I brought out the bag of supplies. Now every morning when I head to the clinic I see the women sitting out front in their handcrated wooden rocking chairs, bright threads in hand, crocheting little hats and booties for thier little babies to be! Im still looking for someone who can teach us to knit!
Isabe! (Im pretty certain that one means goodbye!)
Friday, July 18, 2008
Leaving Managua
So...many have probably been wondering where is kari? has she arrived, has she begun to settle into life in Puerto Cabezas (which I will now refer to as Port to save some typing and use the local name of my summer home)? to answer your many questions I have finally arrived! I touched down in managua on the 5th to be swept off into a fariytale land of affluent managuites and government officials. I spent my morning by the pool, took HOT showers, and directed the house staff for my non-spanish speaking friends. by night we entertained all range of officials from the RAAN, the autonomous region of the north atlantic where port is situatited. All this was related to a proposed project of a group called Raya Ka Raya.
The road to port was and remains completely flooded out, a rich track of thick, chocolatey, impassable mud. Wa-wa boom, a riverside town where the bus must board a water carrier is and remains so flooded rendering it impassable. so the only way to arrive was by plane...but since there was no road everyone trying to get to port was lining up to get their ride, leaving cody and i in managua until the 15th. somehow we caught the afternoon flight in a moment of clear skies during this season of pelting rain. since we touched down I have enjoyed the sound of rain on the tin rooves around us and the sloshing sound of tires on mud...that is until this afternoon when the rain finally stopped and it seemed fit to set off to the internet cafe! I imagine that when i step outside the rain will be pitter-patting once again!
So a quick update on the Casa Materna. I went straight away to the Casa to let them know that I was in town. I had previously requested that Cody drop off a letter at the casa ensuring them of my interest in the project and my intention of returning, so when I stepped into the clinic yesterday it was with great fanfare that I was welcomed! Spirits are high as we begin the initial phases of planning for our small fresco business! Today I spent the morning working at the clinic taking blood pressures and checking fetal heart rates with the new doppler. It was loads of fun! I also was able to practice some of my meager Miskito: dis daukisa? how are you feeling? latwa brisma? do you have any pain? bebe kapoliza? is the baby moving? There will be much more to report but the women and nurses are enjoying all of the lovely donations!
Wala auma! (something like come back or see you or something else entriely!)
The road to port was and remains completely flooded out, a rich track of thick, chocolatey, impassable mud. Wa-wa boom, a riverside town where the bus must board a water carrier is and remains so flooded rendering it impassable. so the only way to arrive was by plane...but since there was no road everyone trying to get to port was lining up to get their ride, leaving cody and i in managua until the 15th. somehow we caught the afternoon flight in a moment of clear skies during this season of pelting rain. since we touched down I have enjoyed the sound of rain on the tin rooves around us and the sloshing sound of tires on mud...that is until this afternoon when the rain finally stopped and it seemed fit to set off to the internet cafe! I imagine that when i step outside the rain will be pitter-patting once again!
So a quick update on the Casa Materna. I went straight away to the Casa to let them know that I was in town. I had previously requested that Cody drop off a letter at the casa ensuring them of my interest in the project and my intention of returning, so when I stepped into the clinic yesterday it was with great fanfare that I was welcomed! Spirits are high as we begin the initial phases of planning for our small fresco business! Today I spent the morning working at the clinic taking blood pressures and checking fetal heart rates with the new doppler. It was loads of fun! I also was able to practice some of my meager Miskito: dis daukisa? how are you feeling? latwa brisma? do you have any pain? bebe kapoliza? is the baby moving? There will be much more to report but the women and nurses are enjoying all of the lovely donations!
Wala auma! (something like come back or see you or something else entriely!)
Friday, July 04, 2008
Tuesday, July 01, 2008
on the road again...
This friday while fireworks are exploding all over the skies of the united states I will be making my way down to Nicaragua once again. I am filled with excitement knowing that I will be once again sitting on the porch of my friend Dona Gibbson's home discussing birth, spending my evenings swaying to soca music, eating seafood like a glutton, and launching my first international project! many of you read my previous email that outlined the project that i will be working on at the casa materna this summer. at the time of that email I had asked for your support in gathering donations of craft and medical goodies. As of today I have an immensely large bag...honestly the largest that I have ever traveled with...filled completely with your donations. i am thoroughly astounded by the generosity of all of you. so to pay homage to my benefactors, i thought i would compose a brief summary of what is packed inside of my oversized baggage:
-1 bulb syringe
-a cagilion pairs of sterile gloves + boxes of clean gloves
-a thermometer + sterile thermometer covers
-25 rulers to measure uterine fundal height
-a fetal heart monitor (thanks mor-mor...that's grandma in norwegian!)
-5 liters of ultrasound lubricant + one nifty bottle to pour it into
-3 battery chargers + rechargeable AA batteries to power the fetal dopplers and reduce waste
-a mother load of knitting and crochet needles!
-over 150 bundles of embroidery floss
-scissors and fabric markers
-yarn, yarn, yarn
-needlepoint kits + embroidery hoops
-felt for creating a felt board to be used as a teaching aid
Thank you so much to each and every one of you that decided that this project was worth supporting...for muddling through your craft bags and giving to women that will be soooo excited to use the tools that you are passing on to them. And special thanks to Eddie who has generously supported the women at the Casa Materna by ensuring that they will be able to purchase the supplies necessary for starting their small business.
Please continue to look for my posts related to the Casa Materna and my future adventures! I hope that the women and situations that have inspired me in Nicaragua will equally inspire all of you!
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