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!