Slow, hot day in clinic…and some hives.

Maybe it is the heat that’s caused such a slow day in clinic.  Still, we got to work today.  Denis worked diligently to make up some information for patients to read about hypertension.


I’ve been suffering from some hives since it has started to get warmer and my feet appear to be a bit swollen.  It usually takes some time to adjust to it.  This is a minor inconvenience compared to the pain and suffering of most of the world and it serves as a humbling reminder to me that at least I have the knowledge and resources to help myself, whereas this is not the case for the majority of the people in the world.




So the hot season begins.

It was very hot and there hadn’t been rain over the weekend, which normally cools things down.  Even little Crystal told me she was con sueño (sleepy).

I connected to UofSC through Adobe Connect and got to view some of their ultrasound cases.  That gave me the idea to use that for our physician continuing education classes, potentially.  I’m actually really interested in the roll of technology and informatics in global health.  I didn’t even really know that the field of informatics existed until I went to the AAFP Global Health conference.  So, if anyone has any awesome ideas, feel free to let me know!

Below is a video of one of our first patients in the Hypertension Registry in El Viejo.

Eyes of a Foreigner

Sunset in El Viejo

“Though I had lived there before, the towering skyscrapers, the limousines, the fashions, and the frenetic pace of life dazzled me as if I were seeing them for the first time.  Already, even before leaving the United States, I was beginning to perceive it with the eyes of a foreigner.” -Blood of Brothers, Stephen Kinzer

As I’ve started to think about going back to the US, I have been mentally preparing for the culture shock of returning.  Last time, after being in Nicaragua for 3 months, I remember going to the local grocery store in my neighborhood and talking to all the employees, then leaving the store empty-handed after being unable to make a decision about which of the 30 types of yogurts I should buy.

Last week, I traveled by bus the 3 hour ride north into the mountains of Sebaco to hold some training sessions at the clinic for the Hypertension Registry.  I was happy to find an excited staff who were willing to learn and try this new program.  They learned quickly and continued to show the teamwork and enthusiasm that made their clinic a success already.  It took a total of 3.5 hours train everyone and include mock runs.  I think that isn’t too much to ask as far a source time investment.

Training in Sebaco
Training the staff at Sebaco on how to do the Hypertension Registry.

During one of our breaks, my translator, Denis and I wandered accidentally though the back yard of the Baker’s house in search or coffee and pastries.  It was a fortuitous finding, however, because I got to see how they made these delicious, flaky pastries.  We enjoyed two hot cups of coffee and split two pastries for a total of less than a dollar.

On the way back to El Viejo, I rode a bus that played salsa music the whole way home.  I relaxed and watched the beautiful, varied natural Nicaraguan landscape pass by: fields of rice, peanuts, coffee, forests, and smoking volcanos.

I hoped I had done something that would have a long lasting positive influence.

Reflecting at the end of the day.

E pluribus unum / Out of many, one.

E pluribus unum: Out of many, one. In other words, there is unity in diversity. It struck me as I was reflecting on God’s word today—is this not the motto of the United States? And yet, how troubled is our nation by division because of race and religion? As an American in a foreign country right now, I have run into both fellow Americans and people from other countries and it is striking how this subject in one way or another always surfaces.

It has troubled me greatly, and I’ve often thought (and heard other people ask) in the past, “Well, why don’t we just get rid of race,” or “Why don’t we just get rid of religion?” But we cannot. It is a lifetime of stories and moments that have molded me into who I am. It is in a lifetime to come, I hope, that will continue to change me. Most people understand the complexity of what it means to truly know oneself and how that understanding changes in life. Most of us know that one’s sense of identity is determined not only by race, but by life’s experiences and culture within which we have existed. Perhaps at some point, I will explain my own sense of identity, but for now let me say this: I believe it to be true that there is a sacredness in a person’s identity that should not be violated and our identity is derived, in part, by one’s sense of ethnicity and race.

In my undergraduate years, one of my favorite classes was African American literature. In that class, I read the autobiography of Frederick Douglass and I learned about such things as the race theory. In that time, I was learning about the history of race in America and it allowed me to understand how over decades, race was used to define people. I was troubled by the idea of race because of this disturbing history and because of my own personal experiences, particularly in my childhood. My physical appearance was such that there were people who could not tell that my race was not their own and because of that, I was privy to conversations to which I did not know how to respond. They were conversations full of prejudice and ignorance against my race (or anything different from theirs), and therefore, I felt they were against me. They were comments that left a mixture of thoughts and feelings that imprinted upon me, experiences that left a stinging mark on my identity.

It was in coming to know Jesus that I came to have love of myself and others in a way that I had never experienced before. I was finally able to love and accept myself. Now my identity was revealed in Christ’s love and I could see all others in this light as well (although I struggle daily). I was now free from the judgment of others and judgment was left to God. My faith allowed me to see one out of many; I could see that we were all children of God. I also found it fascinating to follow the idea of e pluribus unum (out of many, one) regarding the Trinity (Father, Son, & Holy Spirit). How fascinating it is that in Hebrew there is such a word for this; it is the plural form of the word for God (Elohim) used throughout the Bible.

We are not all Christian and we are not all of the same race or ethnicity, but we are all people. As a country, we are diverse, but we are one. Rather than separate me, my faith helped me to become one with those who are different from me. And faith healed the wounds of the past. Now, as always, it is important that we question who we are, how we got here, and what we will become. We must know our identities as individuals, because as individuals, we come together to form our nation.

E pluribus unum: Out of many, one.

I was the patient this time.

Sunset in El Viejo
Sunrise in El Viejo

IMG_6313I’d had fever, muscle pain, headache, abdominal pain, and…well let’s just say I spent a lot of time in the bathroom.  I thought that maybe it was a virus, but when the fever and the pain continued to worsen, I finally decided to treat myself with some azithromycin.  It seemed that within 30 minutes, my fever was subsiding.  I had said about ten prayers before that and had started to wonder if I had come down with something worse like malaria. Even with the medicine, I woke up about every two hours and had a fitful sleep.  My hips hurt anteriorly over my ASIS bilaterally and I could not get comfortable.

The next day, I went to work, which so conveniently happened to be a clinic and got some labwork done.  It felt strange to be the patient.  I had thought about all my patients while I was in bed and it made me realize that I don’t often know what it feels like to be sick and to feel bad.  I felt like it was good to know, even though I didn’t like being sick.  The labwork showed that I was dehydrated despite my best efforts.  I made it through, though, and got better each day, especially with the support of everyone at the clinic.  I got the most delicious bowl of chicken soup that was made for me, too, because they were trying to help me feel better.

The rest of the week has gone well and we are ready to start seeing patients next week and enrolling them in the registry!

Tomorrow I go to Managua for ultrasound teaching and training, but I’ll be back on Saturday. I’m riding on the express bus up to Managua which takes about 2 hours and then the training is held at Project HOPE.


Rainy Season in Nicaragua

During the rainy season in Nicaragua, it is common to have relatively sudden, brief periods of heavy rain.  Little streams are created in the streets, carrying debris and swirling into connecting streams from other streets.  It’s just a fact of life here so if you know the rain is coming, you just make plans to stay where you are for as long as the rain comes down, or else risk getting completely drenched.

With the rain comes a refreshing breeze usually, which breaks the heat of the day and it gives us a break from the bright sun as the clouds cover the sky.  I like the rain; it is one of my favorite parts of the day.

Today Denis and I got the Hypertension Registry agreement signed by the pharmacist and physician so we are on our way to getting truly started with enrolling patients, however one last step we need to complete is review of some educational materials regarding hypertension and treatment and also obtaining the medications we need to dispense to our patients.

Is there any place hotter than El Viejo?

Okay, so maybe I’m not acclimated.  It isn’t as hot here now in the rainy season as it was in Jan-March, but it is still formidable.  If I don’t have a fan to move the air, then I am rendered pretty useless.  Even with a fan, I feel like I’m working at about 3/4 speed as compared to my air-conditioned speed.  But in a way, this puts me right in line with the slower pace of life and I don’t mind that.

The brigade of 35 excited volunteers is now gone and I have one week in clinic under my belt.  The brigade was good and we saw around 1,000 patients for the week, visiting surrounding areas of El Viejo.  Actually, two volunteers remain and they are pharmacy students who are helping me at the clinic.    We’ve reflected on the week of the brigade.  It is always a time where our lives are enriched by getting to know others and in our encounters with another culture and its people.  IMG_5952

It is hard for me to put into words the feeling that I get from working with such wonderful people.  I think this is why blogging isn’t my ideal “thing” because I want to sit and really perfect exactly what I’m trying to say, but then I’ll never write anything.  Let’s just say that my feeling is a mixture of humility, awe, and joyfulness.

There’s some type of holiday going on that is prompting people to throw fireworks in the streets over the last two weeks.  I’ve heard it is a Catholic holiday of some sort.  I’ve finally gotten to the point where I don’t jump or expect to hear a scream after the loud POP! that occurs, sometimes in rapid succession.  I’ve even heard it as early as 4:30AM.  I’m hoping there are no similar holidays after this one any time soon.


I don’t go hungry in Nicaragua.  There are people making sure I get solid meals for breakfast and lunch.  However, I know this isn’t the case for many Nicaraguans.  Sometimes, especially out in the very rural communities, fruit and vegetables can be sparse or expensive and as a result, constipation can occur.  Here I am teaching a mom how to do a bowel lift.  She was delighted to have the ability to help her son beyond just giving him a medication.  I hope it helps!  His sister in the background was very curious, too!