Two years after Felix

Many of you may be unaware of the natural disaster that targeted the Miskito coast 2 years ago on September 4th. It is something that is still very alive and real to the families involved in lobster diving and fishing populating Northern Nicaragua. On September 4th Hurricane Felix touched down over the Cayos Miskito, leveling the fishing villages and taking many of its divers and fishermen with it.

The way the story was told to us was that the severity of the approaching storm was not revealed to the men and women working out at the Cayos. Evacuation was never mentioned. When it was apparent that a massive storm was making its way directly towards the keys, an area with little to no protection from the elements, many attempted to make their way back to shore. Of the boats that departed several were blown back to the key just as they had made progress. Others urged forward into the sea, never to be seen again. We were told that people from the keys decided to congregate at Maras, possibly due to the ring of mangroves that offered a minute amount of protection, and also due to the knowledge that the eye of the storm was to pass directly over Cayo Mikutu. Our boat captain and his crew had all passed the Hurricane at Cayo Maras, and survived. They explained how they filled their boat with people, and drove it into the mangroves, a set of brush-like trees. This was facilitated by the waves that were crashing above the tall trees, driving them into the vegetation. They tied themselves to the boat and prayed that they would make it through the lashing winds and roaring tides. Rigo, said that he was so glad that the storm hit at night, because it would have been such a horrible thing to watch all of the people that he knew and worked with be picked up and flung into the sea. He said the night was filled with screams and tears. When morning broke, the sky and ocean was calm, but all had been destroyed. Not a single house remained. The water was filled with bodies. He told me that of those most affected were the women who worked in the Keys. He estimated that at least 300 died, those who had not made it in a ship back, who feared going back in a ship, or who had stayed in the houses to weather the storm.

As we spent our week at Maras, we were often told stories of the horrible night, of the terrible morning identifying bodies. We were told that many men have dreams in the Keys of women coming up from the water, touching them, crying. People see images in the water. One man told us that while we were there that he had a dream in which a woman’s hair was wrapping around his neck, tighter and tighter, reaching up from the water. He startled awake, sitting bolt upright. Another woman who had not been there during the storm told me that she dreamed of a legless woman, climbing out of the water onto the dock, scooting her body forward with her arms, looking into the room filled with divers hanging in their hammocks. The woman said she peered straight into her eyes, and then she awoke.

I had visited the Keys about two and a half years earlier. They were bustling fishing villages at that time. Cayo Miskutu was so developed that there were churches, a military post, a hotel, many houses, and I am told, Direct TV. When we went to visit the key, there was a startling difference. The mangrove island, once lush and long, was decimated. Barren, grey trunks stuck out from the swampland that was once a green island, reputed to have a fresh water lagoon at its center. The many colorful, open-faced homes were gone. A total of 10-15 houses had been rebuilt. These stood sadly amongst the skeletons of houses past, their wooden posts forcing their heads out of the crystalline water.

We are also told that the harvest of lobster and fish has dramatically declined. Those who have been coming out to these traditional fishing lands for years believe that the high time of the keys has passed. I am honored to have had the opportunity to know these eclectic island, fishing villages, both before and after the storm.

Miskito Keyes

On Monday we set off for the Cayos Miskitos, a set of “islands” 50km off the coast. The plan was to be there over Cody’s birthday. A friend of Cody’s, Rigo, works for the prominent company Mar Azul, a lobster buyer based in Puerto Cabezas. They outfit him with a big, fast, speed boat and enough supplies for a week at the Keyes. So, we boarded the big, fast, speed boat on Monday afternoon, arriving at Cayo Whippling in just under an hour, a trip that had taken us all day when we made the journey two years earlier by sailboat. Whippling is either the most impressive or most unimpressive of the Keyes depending on your perspective. There is literally no island to this island. No land to speak of, not a mangrove to shake a stick at; only a set of 8-10 stilted, open faced, wooden houses topped off with zinc. The houses birth out of the blank horizon, standing tall like soldiers. We stopped at one of the homes to purchase the lobster that was being kept on ice there by a full bodied Miskito woman and her family, she clearly being the negotiante. I witnessed the first of many lobster tail transactions in which our shipmate Ricky would inspect each tail carefully for color, size, firmness, and damage. He wielded a short, yellow plastic ruler that was used to ensure that the lobster tails were long enough, i.e. old enough, for harvest and sale. 450 pounds of lobster later everything was loaded into white sack bags and moved into the icy belly of the boat, just in time to watch the sun fall below the horizon.

Before the sunset you could see with the naked eye our destination, Cayo Maras in the distance. This key is surrounded by a ring of mangroves that can easily be spotted during day light. At night it seemed that the key eluded us. When previously we were cruising at alta velocidad, we were now inching our way through the calm, Caribbean sea. The starts blanketed the night sky, the milky way creating a hazy gape above us. A large meteor cut across our view. It seemed like the journey would never end. We cut through the water slowly, deliberately, trying to avoid the abundant reefs that fill the distance between Whippling and Maras. I could feel the tension in the group. No one was talking. I started to ask myself, should it really take this long? Why aren’t we there yet? Soon thereafter I could hear the men asking each other softly in Spanish and the in Miskito: do you see it? The entrance? GPS was pulled out, but all of the coordinates had been erased. The dark of night hung all around us…I lay on my back staring up at the sky wondering if I should have made a wish on the first star I saw that night to ensure our safe arrival. After approximately 2.5 hours one of the men shouted out in Miskito that he saw the island. He pointed forward as we all strained our eyes and failed to see it. He said the entrance it keeps moving. Then, sure enough, the outline of the mangroves grew before us. I released a huge sigh of relief. We carefully slipped through the entrance to Maras key, rounding up next to the house that would be our home for the next week. After the 450lbs of lobster tails were unloaded we strung our hammocks and slept until the break of day. The morning revealed clusters of stilted homes standing firm in the Miskito Blue sea, a color that can never be described or mimicked, surrounded by lime green mangrove swamps bathed in the early morning light.

As a side note, on our return trip it took approximately 10 minutes to pass between Maras and Whippling. Cody says we were never lost, just moving slowly to prevent any unforeseen reef-boat altercations…still seems like it took a looong time to arrive!

Centering Pregnancy Nicaragua

During one of my volunteer shifts at Clinica BIlwi I told Myra about Centering Pregnancy, a form of prenatal care that I am being trained in that is done in a group. Women with approximatley the same due date are all brought together for their prenatal care for 2 hours. The first part of the session involves weighing the women, having them take their own blood pressures and record it in their charts. This is then followed by an hour in which we discuss certain topics pertinent to pregnanct women: nutrition, breastfeeding, birth control, domestic violence, process of labor and delivery, etc. Its an amazing way to teach women about their bodies, pregnancy, and delivery. Historicaly, women who attend the group are more prepared for thier delivery when the time comes.

I had noticed that many young women were coming to Clinical Bilwi for their prenatal care. They were between 15 and 18 years old, and had alot of questions, many of them were timid about asking. I also had noticed from my expereince at the hospital that most first time moms entered labor y parto very scared, and without any knowledge of what was in store for them. After bringing up the idea of Centering Pregnancy, Myra and I decided to offer a birth preparation class to the first time moms that lived in the Barrio Revolution. We started informing the women of the class, and had a plan to hold it at one of the pateint´s houses on Saturday morning. The women expressed alot of interest in this opportunity to have their questions and doubts spoken to.

The previous year I had sewn a uterus, complete with ovaries, a baby, bag of waters, placenta, and cord, and had left it at the Casa Materna. I stopped by to borrow it for the class. Armed with the model uterus, I made my way to the barrio Revoultion to meet with Myra and our group of women. When we arrived at the house the girl who was hosting the talk wasn´t there. Myra and I sat in the shade of an old building that once was a corner store to wait. After about 20 minutes Alma arrived. We chatted about her boyfriend, what she´s been eating, and I answered questions about life in the US. It soon became apparent that our "group" was going to consist of Alma, Myra, and I. We spent an hour with her, talking to her about what to expect, how she could relax during the birth, breastfeeding, post partum birth control, etc. All the things that you want to talk to pateints about, but often don´t have alot of time for. We also explained to her the things that are routinely done in a hospital in Nicaragua: you are given an IV, you will most likely be given Pitocin, you will have an episiotomy because its your first baby, you will get a shot of oxytocin after the birth, your baby will be taken away to be weighed, measured, and dressed before you can hold him. We then answered her questions about basic biology: where does a baby come from? how does a woman get pregnant? is it true that if you breath while you are pushing the baby out that it will move back into your belly?

An interesting thing that I learned during our session, is that women attending high school who become pregnant are kicked out of school. They are not allowed to attend classes, and once they have had a child they are not allowed to where the school uniform. This means that they are not able to return to school after they have delivered, except on weekends, or some evenings when all of the "bad girls" go. The burden of fertility is so high in a population such as the one in puerto cabezas. o sexual education is taught, young women are not offered birth control, men will not wear condoms, and if you get pregnant you are denied the opportunity to be educated.

Even though our Centering group only consisted of one woman, I think that the education will change the trajectory of her birth. I think she will be more confident to ask questions, and will also share what she has learned with other women in her community.

La Prueba es Gratis

The last time that I had been in Port I had talked to a friend of mine about what clinic she thought was the best for women’s health. She had recommended a doctor at Clinica Bilwi, a social health service, telling me that they did the most gentle exams. From what I had witnessed last summer I was eager to meet someone who practiced woman centered care. I had heard of the clinic before, as they advertise themselves on the radio as a nonjudgmental health center that serves the lesbian, gay, and transsexual community as well as sex workers. This is a bold mission in a region where homophobia and prostitution is rampant.

After arriving in Port I made the appropriate arrangements to work at the clinic: walk to the clinic with a friend, who cooks delicious Chinese food, who knows Dr. Chamorro. A quick chat with him and Ingrid who runs the HIV testing clinic and I was set for my volunteer stint. I had explained that my interest was mostly in obstetrics and gynecology. The practice dedicates a large portion of its work hours to “capturing” pregnant women and bringing them into prenatal care; but it is still a general practice, and as I would learn a variety of people walk through the door in a disordered fashion throughout the day. Interruptions are the norm…you can be working with one patient, when another walks up requesting you to remove their big toe nail, or to repair the gash in their child’s head, for example.

I showed up the next morning promptly at 730 as instructed, only to wait until 9 for the doctor to arrive. Myra is a young red headed doctor born in Puerto Cabezas to German parents, who speaks perfect Costeno Spanish. She is at Clinic Bilwi as part of her servicio social, a two year residency that all doctors are required to do, in an area of need after completing medical school and before studying a specialty. She and I worked throughout the morning and afternoon, measuring bellies, listening to fetal heart sounds with a cardiac stethoscope, and treating “sindrome vaginal” in all of the patients. A difference in the practice in Port versus in San Francisco is that when a woman complains of some type of discharge there is no way to confirm if the woman does or does not have an infection. Rather than looking at the discharge under a microscope to determine if it is normal pregnancy mucus, a yeast infection, bacterial vaginal infection, or a sexually transmitted disease, the doctors treat for all of the above. Each woman would leave with a stack of pre-cut, brown, slips of paper with a MINSA stamp on them that served for prescriptions, to carry to the pharmacy to treat their vaginal syndrome.

I left the clinic at 1230, heading home for lunch. I had planned on going to the hospital for an evening of labor and delivery, but turns out that there were other plans in my barrio…

When I arrived at the house Cody was ecstatic; he had wanted to experiment with making chocolate from scratch and today was the day. He had brought five pounds of raw cacao to our neighbors across the street that have a mill for making pinolio, a blend of corn and spices that is mixed with water that we drink for breakfast….basically the Nicaraguan version of Carnation instant breakfast, only tastier, and prepared by your neighbor. Across the street there was lots of excitement and anticipation as the cacao was roasting over the fire. The kids would poke their heads into the wooden shack that held the mill, and circle anxiously around the cacao pods. Instead of heading to the hospital, I found myself in my scrubs cracking open the hot cacao pods to reveal the dark material inside that would become chocolate. My hands became black from the work, and more than a few cacao innards made it into my mouth and not into the bowl. When all of the meat had been freed from the pods we were ready for the grand experiment. No one had attempted to make chocolate before, but as people say in Port: La prueba es gratis…It never hurts to try! The mill got powered up and its operator began feeding the cacao into its mouth; on the other end a rich, chocolate syrup spurted forth into a plastic vessel. We all smiled and cheered the mill onward, the kids became giddy. We mixed the chocolate paste with sugar and powdered milk, feeding it back through the mill once more; it exited as a perfect chocolate solution. Fingers dipped into the mixture and squeals of delight were heard as we licked our hands, spoons, bowls. The first chocolate ever made in Puerto Cabezas was a success, and I have to admit that I have been enjoying my morning hot cocoa! I don’t think that I missed anything at the hospital that night more amazing than the birth of chocolate!