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!

A Long and Winding Road

My last days in Nicaragua were spent adventuring deep into communities of the north atlantic coast. Cody was sent on a mission to inspect a small saw-mill operation in the pine wood savanna, and I eagerly accompanied him for a chance to explore and get out of the city. We boarded the sleek grey truck that virtually has no shocks left, leaving us bumping up and down the road as if we were in a truck pimped out with hydraulics in a live action hip-hop video. The road is bumpy, but our driver, Chaparo, is skilled at dodging the large craters that abound. It has been raining the past couple of days so at least the road is moist, no dust to cover us from head to toe, filling the gaps in our teeth as I have experienced in past adventures on the roads of the north atlantic coast. We wound our way through the grasslands, stopping to pee and realizing that the small yellow flowers that are populating the green fields were minuscule orchids. We head deeper and deeper into no-mans land. we pass communities from which women who have stayed at the Casa Materna live: Ena in Santa Marta, Tasba Raya, Tasba Pawni... At some point hours down the dirt highway we turn off and begin our ascent into pine, mahogany, and madrone covered hills with views of the mountains of Jinotepe in the distance. The scenery is breath taking. Eventually we weave our way up and down, over and through dark, earthy-mud to arrive at the saw mill. Now, i'm not the kind of girl that knows alot about saw mills...I leave that kind of knowledge of machines and engines to Cody...my interests are in health. What struck me the most about this saw mill and the small communities around it were how isolated they actually were. I finally understood the importance of a place like the Casa Materna. I could conjure up images of medical emergencies, sense the urgency, and palpate the despair of feeling trapped. What if someone cut their arm off on the saw mill? would they make it to the small clinic in Francia 1 hour away by vehicle in time? would they then make it to the hospital before it was too late? Just a few days prior a log (basically a tree) fell on one of the employees crushing him. A makeshift cot was made out of sheets and branches and then fashioned to the skidder (the only available vehicle) and he was then carried down to the health center, later to be transferred to the hospital. There are no emergency plans in place, and what happens if you have no access to any form of vehicle. I guess the answer was seen in my previous story of the man carrying his seizing wife on a bicycle to the medical post.

It was standing in a small community like this, drinking coconut water, and watching the women herding their many children when I really got it. I really understood how difficult it must be for a woman to a) make the choice to leave all her children, walk the 8 hours to the highway to then find a ride to Port, and then spend an indeterminate amount of time at the Casa Materna, or b)stay at home, birth her baby and pray that there are no complications. Access to healthcare is a common theme of discussion in the academic world of nursing/medicine, but we are usually talking about how to market medicine to encourage patients to engage in preventative health, or reach populations that are on the fringes of society (i.e. prostitutes, IV drug users, homeless, etc.); but in this case access to health is a strictly logistic issue. How on earth do you get to the hospital when you have a long and winding road separating you from it and no money to get there. How do you get medical care when your personal knowledge of risks, emergencies, and your own body is as limited as your access?

My last days in Nicaragua were spent in the lush tropical town of Waspam contemplating these questions. Waspam is the second largest city in the North Atlantic Coast. They have no super market, no gas station, they only sell tomatoes, onions, and cabbage in the market. What they do have is a fabulously long river that separates Nicaragua from Honduras with unknown quantities of indigenous people living along its borders. I had gotten to thinking back in Port about how we could provide better access to people, specifically women living out in these distant communities...Sonja and I had come up with a fabulous idea that has started to take more shape and became more important to me as I visited communities and sat in my hotel in Waspam listening to the rain patter outside. So the conception of our next project has taken place...it may be a pregnancy of more than nine months but it will be nourished and fed until the birth of Mairin Karna (Strong Woman) a one hour radio program on Women's Health is broadcast in Spanish, Miskito, and Mayagna throughout the North Atlantic Coast! Knowledge is power, and if we can reach the women out in the communities hopefully they will in turn be able to reach us!

Well I have ventured down my own long, winding road and have arrived once again in the US. I am on the brink of beginning my official studies to become a midwife and am ecstatic for the opportunity to learn more and become more skilled. I hope that all of my beloved readers have enjoyed this leg of the journey...stay tuned for more!

Last Day at Casa Materna Bilwi

The Little Icebox that Could

One of the goals of this adventure in Nicaragua was to assist the Casa Materna in establishing a small business to help them gather funds to send laboring women to the hopsital in taxis. As far as a business plan goes, this business would seem as complex as setting up a lemonade stand. Easy...buy one refirgerator (icebox in Miskito), buy many pounds of sugar, some fresh fruits, mix them up in buckets, store in aformentioned fridge, sell to the public...voila! The only problem is that this lemonade stand is in Nicaragua...and as I have come to learn, nothing is as easy as it seems here. I know I elaborated a bit on my struggles trying to purchase the fridge before: various trips to El Gallo mas Gallo, a blue and yellow facade that has become so familiar to me I could probably arrive at it sleepwalking; my battles with the credit card machine, and my frustration with the sheer lack of customer service required to don the yellow polo shirt and blue pants of an El Gallo employee. Well, a few weeks ago I acomplished the unthinkable... I bought the fridge. I felt like a super power, or some exotic bird puffing my chest out and wagging my tail feathers with success. I mounted the blue flatbed truck that would deliver my shining white pride to the Casa Materna, all the while ensuring that the delivery boys did not lay her on her side thus destroying the cooling mechanism. I circled the machine as they laid it down on the cement floor of the Casa. She was beautiful: a classic freezer on top, fridge on bottom model...white-white, and the cool air would just pour out of the freezer when you opened her door, exposing her to the heat and humidity of Port.

The day after the purchase I did what only any right minded Nicaraguan would do. I went to buy locks to put on my fridge. Obviously you cant just give anyone access to the fridge, otherwise she would stand empty, sad, in the corner. So Cody and I headed to the Casa Materna with two hinged closures, two locks, several screws, and a drill. The first drill hole went in smooth as ice. My success was growing by the minute...soon we would have the fridge and it would be on lock down. The next two holes didnt seem to go as deeply...it was impossible to put the screw through. I poked around a bit with the drill bit and said to Cody "it seems like there´s something there...you just need to drill in a bit more" he said "are you sure you want me to drill in more" and I said "definately...go for it!". Within 4 seconds the hole was drilled and a forceful stream of Frion emerged from the hole until my poor, beuatiful fridge was sucked dry of life. I was in a panic...was it possible that just 12 hours after finally purchasing this machine that it was dead? what could I do, who could help me? This sentiment ended in a long string of disinterested repair men who have left my ice box half functioning...but better than dead. First there was the old school sandanist, fidel castro-esque hippie who came to fix my fridge. rather than patching the hole and refilling the tubes he decided to cut the line and build a new system behind it. so confident was he in his work that after quoting me an exoribtant gringo price to fix the fridge he did not charge me for the work. I returned to the casa the next morning to find the fridge hot and bothered. This repairman returned the next day with a young man that we will refer to as the "welder". He repaired the work of the first repairman...again not charging me. Then there was the chubby, metal head that took one look at the work and never came back. Lastly was the "contractor". He assured me a working fridge and an under the table situation in which he would certify the work so that I could still use the 5 year additional warranty that I had bought with the fridge which was rendered nul after piercing the tubing with the drill. It was a deal too good to be true...1000 cordobas and five days later the work was never done. After a wild goose chase the money is back in hand, but my fridge will never be her glorious, chilling, original self.

So...as of today, the fridge is working...kind of. If the freezer isnt opend for two full days everything fully freezes. The fridge will keep frozen stuff cold. The women all tell me that they like their boli more luck slush than frozen solid anyway...maybe its for the better! As far as the business side of it goes we are selling boli, and frescos, and cold water (rather than ice) to the community and the women at the Casa Materna. We have made over 500 cordobas, and have re-invested three times to purchase pounds of sugar and nancite fruits to make more fresco and boli. I guess all-in-all its working; working as well as any business could possibly work here in puerto cabezas. We have officially sent three laboring women to the hospital with money from the business. Given everything I would call it a success. As for my little icebox...I hope she keeps on chugging along...she has a strong spirit. And I blame her loss of frion not on me, or Cody, but on Nicaragua...a country in which its necessary to put a lock on a fridge.

More Photos

The faces of birth in Puerto Cabezas

In matters of birth the outcome is generally positive. A woman labors, a baby is brought into this world and it is celebrated. In a place like Puerto Cabezas you not only have the joy and beauty of birth, but you must also contend with the reality of when birth goes wrong. I have this personal or spiritual beleive that at the moment of birth a veil lifts between the worlds of life and death...mostly the baby passes through into the world of life...but occassionaly the veil falls on the side of death and either mom or baby leave this world.





On Monday I went to the hospital to volunteer. I arrived in my freshly cleaned, line dried scrubs. I walked back to the sala de labor y parto and waited as I engaged in the usual conversation with the nurse: where are you from, are you a nurse, how many kids do you have...oh when you do have a baby it will come out blanco, blanco, blanco, etc. After about three hours with no action and no one in labor in the maternity ward I decided to visit Dr Aragon who was on call in emergency. I sat with him for about a half hour as he reviewed children all suffering from the same litney of symptoms: cough, fever, lethargy, vomiting and/or diarrhea. After about the tenth child screamed with tears streaming down their face when he asked to see their belly I felt exhausted. It was in that moment that an ambulance arrived and a stretcher was quickly guided into the emergency room. One minute later a white clad nurse peered her head through the door and yelled nervously "we need a doctor". Aragon was on call so he left the weeping children and scurried into emergeny...with myself tailing behind to see what was going on. On the stretcher was a young woman pregnant with her first baby. She looked possessed as her dark, milky eyes rotated back and forth in her head, as her thick tongue proturded from her mouth, and her black, silky hair billowed about her face. She wore a green hand sewn top and a yellow skirt that was soaked through with urine and feces. Her husband had carried her on a bicycle early in the morning to the town of Rosita, several hours away by ambulance. He thought that when she began convulsing in the morning that it was a normal progression of labor. He later began to fear for her life and placed her on the bicycle. We received her in the emergency room with full blown eclampsia, a disorder of high blood pressure that can occur in pregnacy that almost never evolves in the US which manifests as convlusions, extremely high blood pressure, and at its worst coma and death. In a disorderly fashion the nurses began grabbing the womans arms and legs to prevent her from falling of the stretcher as she seized; her blood pressure read 220/140 (normal is 120/80); the doctors started shouting orders to hang normal saline with doses of magnesium sulfate to stop the convulsions, and I started cutting the womans clothes off to prepare her for surgery. The only way to truly treat eclampsia is to deliver the baby STAT in order to save the mothers life. As I cut through her skirt that was hand altered to fit her growing belly I was swept by a tidal wave of emotion that brought tears to my eyes. how does a woman become so ill in her pregnancy and not know it? how is a disorder that is treated in the US able to manifest in to such a life threatenng state? The emergency room was tense with the severity of the situation. tubes were running into her arm carrying the magensium sulfate, a nasal cannula was held against her nose to provide oxygen, and a tongue depressor was shoved into her mouth to prevent her from biting her tongue. After three boluses of magensium sulfate her body finally quieted. Her limbs lay at her sides, her head tilted upwards, her eyes empty. She was rushed to c-section. In the morning I found out that she had survived. I counted it as a miracle, never having seen someone in such an acute obsetric emergency. Sadly, her baby did not survive.

I was overwhelmed by the experience. I headed back to labor y parto to gather my things and walk home to clear my head. As I started down the hallway a woman was being pushed towards me in a wheelchair in full blown labor. I figured this birth had to turn out okay...so i turned around and followed her back to the room. She wore a fitted, red, v-neck shirt and a camoflouge mini skirt. There wasnt time to get her out of her cloths. We had her get onto the birth table, setting her legs in the black leg supports. I donned a glove and checked her. My fingers barely entered and grazed the babies head that was just about to emerge. The mother screamed with fear that she had had an ultrasound that showed the cord wrapped around the babies neck, and the doctor had prophesed that she would require a c-section to save the baby. I explained to her that it was okay; that we would just lift the cord off of the babies neck like pulling off a necklace. She shot me a pleading look and told me that she had seven boys and this would be her only girl...she had to live. With that she bore down and her little girls head was out. The cord was quickly lifted from around the babies neck and the rest of her body slipped into the world. Tears flooded the mothers cheeks as she heard her little girls first cry. In a moment that I will never forget, the mother grabbed my hand and said thank you. A thank you is hard to come by in this side of Nicaragua, and I will always remember it as a testament of how important it is to be caring and understanding of a patient, particularly in their most vulnerable moment, no matter where they are or in what language you are speaking.

This day in the hospital showed me the faces that birth can have...the fears that women bear, the real ife emergencies that can occur; the joy and the saddness that can ensue. It was a powerful day to say the least!

Funny, Fantastic, and Frustrating

In this blog i decided to take the opportunity to relay some of the things that have been said to me that made me laugh out loud, or that seemed really interesting to me, or situations that were down-right frustrating...yet all illustrate what day to day life in puerto cabezas is like...

fantastic...cody´s amazing connection with a man named chico down at the pier. on any given day we can drive down to the pier, pull up in front of his small, yellow painted, wooden shack and collect pounds of fresh caught monster crabs, or lobster tails. chico has also been known to hook us up with half of a red snapper or some delicious fresh conch meat! all we need to do is get the butter, cody cooks it up, and we are feasting of giant claws!

funny...Ena and i were talking about our families one day. She asked me how many sisters and brothers I had, and nodded politely as i told her i had one of each. she then asked me if i get confused when i would see my sister, mistaking someone else for her, because all white people look the same! I explained to her that i am pretty confident of who my sis is! Earlier in the year I had attended a global health conference and during one presentation the lecturer mentioned a study that was conducted in which people of a similar color are able to distinguish between people of the same color better than those of a different color....case in point!

funny...Dr. Aragon likes to ask me all kinds of questions about the United States. I think he is either trying to flex his knowledge to impress me or to dispell myths. One day he told me how people in the US dont have sex. He then said that all we do is work and so there isn´t any time for sex. He explained that this was different from latin america where everyone makes time for it. I told him it wasn´t true...its just that people in the US use more birth control than in Puerto Cabezas!

fascinating...Miskito women follow many tradtional practices related to birth, post partum, and care of the newborn.
-Several of the women at the casa materna have not participated in learning to crochet or embroider. come to find out these women have a beleif that if you crochet or sew during pregnancy that this will cause the babies cord to wrap around its neck.
-Many woman are known to use teas of commonly found herbs to stimulate labor. this is the oxy-casera that i refered to in an earlier post. They also protect themselves from wind/cold entering their body after birth. This is a common preocupation of women throughout all of latin america, yet their preventative practices are different. Women here put cotton balls in their ears and cover their head for 9 days postpartum to prevent wind from entering their body and affecting their uterus. Similar to other latin american cultures women will make tea from rosemary in a large pot and sit over it to steam the uterus and release any wind or retained placenta.
-As far as newborn care women put a red plastic band that has a large brown seed as large as the newborns fist, around the babies arm to ward of the evil eye which is known to cause diarrhea, dehydration and death. the baby is also fed 1oz of a tea of cumin or fennel 3xdaily after birth to help expell all of the meconium (babies first poop) and prevent colic. Women are also advised not to do any sewing post partum because this can prevent the babies umbilical cord from drying up and falling off.

frustrating...trying to start even the smallest business in puerto cabezas! since my arrival i have been planning on starting a small business to sell frescos, ice, and boly at the casa materna to gain more funds for them and help provide money for transportation of the pregnant ladies/new moms. Everything moves in slow motion here...you make a plan to go look at fridges and it ends up taking a week before it happens. then you find out that the store is waiting for a new shipment that must be hauled through the mud and crater like pot holes of the "road" from managua, so you want to wait to see what they will bring before you commit. the shipment of course will be in at 4pm that same day...but one week later it finally arrives. then when you finally try to make the purchase the credit card machine line is down. it will be fixed by 4pm. its fixed 4 days later. then they arent sure how to use the credit card machine...then they learn...then you find out that they don´t take master card. then you use your debit card...but a block has been put on it...then you have to go to the internet cafe and use skype to unblock the card, and after four attempts (because the connection gets lost) you finally get it unblocked. then you realize it has been 3 weeks and 9 hours and you still havent got the fridge...but you are close, closer than ever before!

now we will see how long it will take to make the frescos and sell them. my goal is to sell just one bag of fresco before my little plane takes me back to managua then once again to san francisco! All frustration aside, if it was as easy to run errands and accomplish goals here it wouldnt be puerto cabezas...it would be the states and it would lose all of its charm and tranquility!

Oxy-casera

After last Sunday´s experience I made two decisions: 1) to return to the pile of used clothes to search out some scrubs, and 2) to return to hospital Nuevo Amanecer Bilwi to work in the labor and delivery department in the evenings. I was successful and found two pairs of lavender scrub pants, both of which were worn out in the crotch that I later repaired on the sewing machine at the Casa Materna, and one green and one blue scrub top. I excitedly donned my mismatched outfit, feeling quite professional and ready for any action that the hospital might show me. My first day at the hospital Cody dropped me out front of the locked chain link fence that encircles the teal blue painted hospital. My scrubs were the lock to the door as the watchman ushered me through. I walked through the maze of open aired halls, peeking my head into the various rooms filled with 4, 5, 6, or 8 beds in which whole famiies languised with their sick loved ones. I kept walking until I found the aluminum framed glass doors of the Labor y Parto wing, the only part of the hospital aside from the surgery suite that is air conditioned. Just inside the door I met Julia, who has been an obstetric nurse for a hundred years at Nuevo Amanecer. Within two hours my first scrub clad birth took place, as a slight twenty something year old woman pushed her third baby out into the world. The birth was fast and the contractions fierce...later I came to find out that the girl had been drinking a birth promoting tea that many women in the community are known to consume. It is compared to the hormone Oxytocin, a synthetic version of which is given in the labor room to stimulate birth, both concoctions are known to increase the strenght and frequency of contractions. At the hospital the tea is refered to as oxy-casera...casera means homemade! After the birth I quickly scooped up the baby and did all the basic Puerto Cabezas nursing practices including Vitamin K injection, Antibiotic eye cream, weight, temperature, and measurments of head, thorax, and length. A very exciting day at wrok indeed!

Even more exciting was my next day at the hoispital. I worked with nurse Clara who is reknowned in the community for her years of service to birthing women. She trains the new resident doctors and is often called on at home by poor Miskito families that don´t have the money to reach the hospital. She told me stories of being called to homes when a girl had been convulsing for two hours, due to bad spirits per the family, but due to eclampsia for those who beleive in western medicine; of breech babies with their legs dangeling out of their mothers, and babies so big that it took all her strenght to pull them out; and lastly of her baby that she adopted when a young mother abandoned her child in the labor and delivery wing thirteen years earlier. When I arrived to the hospital one of my patients, Luciana, from the Casa Materna was dilated to five centemeters and pacing in the Labor y Parto room. Swipe from your mind any image of a high tech labor ward, and replace it with concrete floors often covered in blood spatters as the cleaning crew has yet to clean up the remnants of the previous birth, imagine two cots in one room with a curtain as a door rather than a private room with sweeping panoramic views of the san francisco bay, and then picture the birthing room as a concrete floored operating suite with three brithing tables from the 1950s with leg supports, but no foot supports, lined up side by side in the event that three women are in labor all at the same time...its a bare bones kind of birthing center if you get my drift. Although the birthing room lacks certain comforts there is something about its simplicity that seems to traslate to the births that I have seen. Granted, I´ve only seen three births in that room, none of the women had any pain medication, because its not an option, but the women were so elegant and graceful in their birthing. No moaning, no crying, no hours of pushing. There would simply arrive a moment when the women would climb up onto the birthing table, ask for their dilation to be checked, be at 10cms, and pushing their babies out 5 minutes later. Quite striking! Well, back to Lucianas birth...the obstetric nurse Clara was checking Luciana and said that she was 9cms. She told me to glove up, that I was going to attend to the birth. I told her "uh-uh, I don´t know how to do that"...then she said "there´s only one way to learn" and thats how I ended up catching my first baby! She had me check the neck to see if there was a cord and then pull down and then up on the babies head (with alot of force which was unexpected!) and then grab under the babies arms as I pulled him from his mother and laid him on her belly! It was totaly exhilirating! Its wonderful to be in a place like Puerto Cabezas where I have the opportunity and freedom to learn in this hands on way.

There are so many things that I want to say about birth at hospital Nuevo Amanecer...but I´m still putting words to my thoughts...right now there is a lot of blood, dirty floors, stoic mothers, legs agape, arms akimbo on the birthing table, and then there´s me drying off the babies, bringing them to their mothers, and feeling so much hope and very low expectations all at the same time. I think that as I spend my evenings at the hospital my feelings will become more articulate....right now I´m still riding the wave of having caught my first babe!

The Casa Materna

Sonja, the nursing director, and Burse Magda at the Casa Materna with the new doppler



Luciana, Jessenia, and Hazel at the Casa Materna listening to Ena tell her birth story.



Ena and her new baby with a hat that I crocheted...Ena taught me how to make the hat!

Cheesy 1970s Hawaiian Swim Shorts

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

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!)

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!)

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!

 

The End of a Saga...or just a new Beginning?

To my long lost fans that haven't heard from me in several weeks (or is it months now?)...I have returned! I have spent the last month being coddled by my dear friends in Denver (namely my fabulous caretakers Kristen and Matt!), spoiled in Florida by my wonderful family while spotting manatees and dolphins in the intercostal areas, and cuddled in Ohio while lounging in Nicaraguan hammocks and exploring beautiful Appalachian caves with Cody. So whats on the itinerary next for this avid traveler and lover of adventure? Well, I have just arrived in San Francisco where I will begin my course of study in nursing/midwifery in two weeks. I have started setting my roots in the Haight where I am living on the third floor of a classic California Victorian, in a room whose floor to ceiling bay window looks out into the sky and close by bald cypress trees. Just a stones throw from golden gate park and the UCSF campus I am able to explore the little nooks and crannies of the city, the way I would enjoy a new frontier in Latin America. So, now that I am back in the U.S.ofA. i can say that life should be a journey for all of us...that each turn in the road should be savored, whether the other side presents us with a steep hill or a lush flat pasture...its the discovery and steps that move us onward that give us life!

Now back in my mother country I am able to look back over the last several months of my life and comment upon it. If I were to sum up my experiences in a quick sentence explaining what I gained/learned/felt I can easily say that this trip taught me what it was like to be a woman in the world. So what does that mean, you ask, knowing that I am already a woman and have spent thirty years as one? From midwifery clinic, to woman's center, to impoverished nicaraguan women, miskito ladies, quechua mothers, young women on buses, my own interactions within the latin american medical realm...all of them acted as my teachers. I have a deeper understanding of how the majority of women in the world subsistence live, i understand how they are demeaned in healthcare settings, I have seen them empowered by midwives, I have seen them subjugated by men, I have seen them in their daily roles achieving domestic feats that I could not hope to realize myself! I feel a deeper empathy and understanding for what a woman truly experiences in varied environments. To come full circle, it has always been my clients that have served as my most potent teachers, and the women that I worked closely with in Latin America, as patients and friends, that have again taught me. With this refreshed view on a woman's world and appreciation for my many teachers, who transcend the role of classic student-teacher, I feel ready to delve deeper into the medical community and realize my own role as a competent provider for the many faces of woman and their families. This is the end of my big sabbatical trip...but the journey never stops, the wheels keep rolling forward. Next stop: University of San Francisco...mexico...burma...??

Lastly...I want to here from all of you. Please feel free to keep connected with email, but if in San Francisco, let me know! My new information is: 707 Shrader St, San Francisco, CA, 94117, and my new phone number is 415-350-8832 (beginning 6/15).

May your journeys surprise you!
xoxo, kari

A World without Lawn Mowers

Here in Cochabamba, Bolivia the weather is hot, the mountains dry, and many a medicinal plant flowering. I originally had decided to visit Cochabamba way back in the day when I was writing for my Fulbright grant. I had discovered a man named Carlos Prado, a fifth generation herbalist, who runs a small school for traditional Andean medicine with an herbal medicine clinic named Kuska Incari which translates to ¨together to live better¨in Quechua. Since my arrival in Cochabamba my days have been steeped in herbal medicines and mates (that´s south american for tea!). In the morning I usually walk to the enormous market covering many city blocks in search of my morning tea. Here you can find men and women who have set up carts with various glass jars filled with fresh herbs such as chamomile, uña de gato, cornsilk, cedar, or anis infusing in water...you can walk up and say Ï need something for my kidneys or my liver¨and they will mix up a concoction for you, tossing in a bit of fresh honey. From there I usually catch the ¨U¨ a colorfully decorated bluebird short-bus that roares through the cities streets, cutting lanes of traffic, blaring its horn at any opportunity to arrive at the Cochabamba Botanic Gardens. With Carlos I have been assisting in mounting a new garden of Foreign medicinal plants and clearing the original medicinal plant section to contain only Bolivian Natives. From there we usually go to Carlos´s home/clinic/school to see a patient, prepare medicines, or eat lunch with the family. His home is exactly how I imagened it to be: caving in ceiling, clinic room designated by a hanging sheet that sections of the ¨healing space¨from the living area, two rooms full of hundreds of jars of dried plants, five gallon buckets brimming with tinctures, and a patio cluttered with mismatched jars/pots full of medicinal plants. It is in this home that Carlos reads coca leaves to diagnose the origin of a person´s illness, where he burns copal to induce healing, and where he ladels out his medicines into platic bottles to pass on to his patients.

When working with healers in traditional cultures the most magical moments are when their philosophies are shared with you, teachings that often butt up against the western paradigm in which we have been bred. These moments challenge us, giving us the opportunity to completely disregard the information, or more interestingly instigate us to chip away at the boundries that close in our minds. When we choose to ¨chip¨we open the door to a diffent world that appears magical because it often defies our normal beleifs and perceptions.

Two examples:
1)We went out into the mountains seeking native medicinal plants to transplant into the Botanic Gardens. We stopped on the way to eat whole fried fish from the Lagoon, soft-salty cheese, and boiled beans. Knowing my interest in plants used in gynecological matters Carlos was discussing a large native grass species that we were going to dig up. He says to me that according to some women the plant is useful as a contraceptive. My interest peaked, I asked him if its a plant that´s used for short term effects or longterm/complete infertility, as many plants used in this fashion are catagorized this way. He looks at me and says, thats such a westernized thing to say! First, in Andean beleif system the concept of time is very different, so to use the term absolute doesnt fit into his description of the plant or how it would function. Second, the plant is medicine, so it can be used in various ways depending on how the plant synergizes with the person and the plants specific state of growth. A large plant may have a longer effect than a short plant; if its growing at higher altitude versus lower this can influence its effects; if the woman is young vs. old, fat vs. thin, never had a child or already has a litter, etc.

2)I hear Carlos speak about almost every plant with the reference ¨its the famous avocado seed, the famous andean sage, the famous passiflora...¨ Each plant is revered and honored as medicine. When sitting in on a class of university students one of them dared to asked: what is that plant used for, and his response was almost open jawed as he said, obviosly its medicine, its all medicine! the catagorization of uses often constricts the plants abilities, confining it so that it cant do its work.

And now to bid you all adeu, I wanted to share the famous anti-diarrhea formula that we prepared yesterday:
1.5 cups peeled, washed, shredded avocado seed
1.5 cups burnt to a crisp, dry, white rice
1 peel of a pomegranit chopped
1 handful cinnamon bark broken into small pieces
Add all ingredients into 3 liters of boiling water. Steep 15-30 minutes, strain. Dosage is 1-2 Tbsp. To make a tincture add 1.5 liters water and 1.5 liters grain alcohol. Dosage is 15-30 drops.

This one´s for my mama!

Coming to this area of the world it is hard to deny the power of the earth. It is evident in the snowcapped peaks seen in the distance, the evergreen hills towering at 12,000 ft, and the roaring waters flowing through Andean valleys. When I sent my mother a message letting her know that I was heading down to the Inka empire of Machu Picchu she told me that I was living her dream. So, as a tribute to her and all the Mamas out there including the Pachamama I dedicate this edition of my blog once again from a land where women carry their babies tightly wrapped to their bodies in brilliantly woven tapestries.

The Pachamama is considered the feminine power of the mother earth as ascribed by the Inkas. It is a force so grand that the people populating the Quechua regions of Peru live an existence that is inseperable from her. They follow various practices that honor her, and on a day-to-day level it is obvious how she is appreciated.

1) Living Buildings
On the large scale Machu Picchu is impressive due to its complicated location deep in the Andes atop a leveled green mountaintop. One asks over and over how people lived up there, and how on earth they carried goods so far. But what is almost more impressive, in my eyes, are the architectural details that incorporate the earth into the citys dwellings. Unlike many cities where the earth has been cleared, lifted, and destroyed to accomodate its settlers, Macchu Picchu is a work of natural art. Throughout the ruins you can behold rocks that have been so delicately carved that they may have six or three sides and yet fit togehter in a linked pattern to produce walls. The most stunning buildings are built from enormous boulders that were jutting up from the earth then and exist still. Many boulders form the base of temples which are topped with smoothed stones to produce a vision that is unmatched. Not only had the Inkas chosen ares of great natural beauty to live, but their habitations are alive with the place, not seperate; an honoring of the Pachamama. The Inka decendants today still live in homes cast from mud bricks, surrounded by immense gardens and terraced agricultural plots.

2) Agricultural Advancements
The Inkas also show their appreciation for the Pachamama in their agricultural processes that are mostly based in terraced plots. In areas that appear harsh the Inkan decendants have been able to manipulate the earth to produce a wide array of agricultural successes. The potato, which origantes from the Andean mountains, boasts more than 300 differing varieties from sweet, starchy, small, large, colorful, to a dried variety that is produced by freezing and then expressing water by stomping. Having traveled a variety of times to Mexico, I thought I knew corn...I had NO idea of the diversity of corn until walking into a market in Cuzco, Peru; at least 50 countable forms and colors...the Peruvians have done a virtual evolutionary miracle with corn hybridization! The markets in Peru are unlike anything I have ever seen and I owe this fact to the honoring of the earth and manipulation of her soils and fruits to produce the rainbow available in the market place: corn, potato, camote, peppers, aji, garlic, greens, mushrooms, algeas, membrillos, pomegranits, and a majority of produce that I can only dream of remebering the names!

3)Herbal Medicine
Alongside the ventas full of fruits and vegetables in a Peruvian market you will also see the largest variety of fresh herbal medicines that I have EVER seen in a market in Latin America. I spend hours talking to women like Justicia in the markets that share their remedies and herbs with me. The beauty of this environment is that many plants that are common in the herbal pharmacopea can be located here alongside the Andean plants that are new to me: Marshmallow, valerian, horsetail, nettles; Muña, coca leaf, hierba de cancer, etc. Herbal medcine is alive here, and I attribute that to the reverance for the earth/Pachamama.

Next stop La Paz, Bolivia!