Wait, there's a medical reason to this trip...?

So I have now spent a good 4 months+ down in Nicaragua and I have yet to post a single update on anything medically related which has likely led many of you to believe that I am simply hanging out and travelling around the country!  But don't you fret, I am in fact working in a medical capacity and not spending all my time on fun, games and travelling (as much as I would like to spend all my time doing that...).  So generally speaking I go to the primary level hospital in El Sauce Monday-Friday.  There are about 15 rooms in the 'in-patient' section with more than 30 beds.  Every morning at 7, we do 'rounds' which is both similar and different from rounds back in Rochester.  Of course there is always the patient presentation, but diagnostic questions are fewer and, of course, there are fewer test results to discuss.  Then, at 8am out-patient consultations begin and depending on the day I may see patients with some of the general docs or evaluate patients with the surgeon or even see patients with the ob/gyn.  Since October basic operations such as appendectomies, hernia repairs and tying off women's fallopian tubes have been performed in the OR in the hospital as well.  So, I have had the opportunity to first assist in many operations as well.

The health system in El Sauce is such that the hospital is the nidus and then there are Puestos de Salud, or health outposts, in the larger or more distant surrounding communities.  Nurses visit the Puestos daily, but a doctor visits 1-3x per week depending on the size of the community.  I have had the opportunity to visit some of these Puestos which I enjoy because I have more opportunity to attend to patients myself due to the smaller nature of the Puesto and the often overwhelmingly large volume of patients that appear.  Then, to add another wrinkle to the whole thing, on a monthly or bi-monthly basis there is a Fería de Salud at each Puesto. A Fería is when 3-4 general practitioners, a pharmacist, a lab-tech and small army of nurses descend upon a Puesto to attend to patients, perform PAPs, vaccinate children and educate the community about current health concerns such as leptospirosis, dengue, malaria, AIDS or any number of other concerns.  I have had the opportunity to tag along with several of these Ferías as well which is always fun as there are a ton of patients (often more than 200 patients total between 830/9am and 2!) and more recently they have begun to feed the group!

So what follows are a few pics from some of my medical adventures.

Travelling to a Fería in the MINSA(govt health agency) vehicle - an old Land Rover.  It was a tight fit, but good thing we got that Pinata there in one piece!

Same trip.  The older guy is a nurse and the dude in a full purple scrubs is a doctor in his 1st of 2 years of required social service to the govt - paying back his 7 years of practically free education.

Coffee!!! The Puesto was up in the mountains where they grow and roast coffee.  Too bad they still drink it with entirely too much sugar and not enough coffee...

The pharmacy.

Wait you need a place to attend to patients?  Here's a table.  Just ignore all the hustle and bustle about as we make lunch for 20 people...

Attending!  The little girl was much happier than this picture would make her seem...

The view from the Puesto...not a bad place to practice medicine!

In October a fellow UR med student, Patrick Millord, came down to El Sauce for about 5 weeks to enjoy the goodness that is Nicaragua.  Here he is in action.

Enjoying a cup of warm coffee on an already warm morning...it's still a nice way to pass some time.

Post-surgery recovery room - aka hang-out/nap room for the surgical techs and even the docs themselves.  Dark blue scrubs is the ob/gyn, guy at the computer is the anesthesiologist and the guy in light blue scrubs in the back is a surgical tech. 

The OR.  It gets the job done nicely and it has A/C!

Adventures!

The last 3 weeks have seen some interesting adventures.  It all started with an impromptu trip down south - almost to the border with Costa Rica- to the beach La Flor where una arribada - or an arrival - of sea turtles was happening.  This was considered a small event, but there were still up to 10,000 turtles arriving on a given day!  These turtles were about 45-50kg, so relatively small by giant turtle standards but very impressive.

They also do releases!

Even if there were no turtles the beach was beautiful and the sunset was incredible!

So many turtles.  They look like rocks from afar.  Apparently during the big arrivals the beach is absolutely covered.

So that was one unexpected trip - but definitely worth the 7 hours in bus one way...
The next weekend I had plans to hang out in El Sauce but that changed with ease.  Turns out that one of the Peace Corps volunteers has a family friend that owns a house down on the Laguna de Apoyo close to Managua.  He was in the country and she was going to go visit him and invited myself and the other Peace Corps volunteer and I readily agreed.  Good choice!

La Laguna.  Breathtaking.  And that white speck on the other side - that's Granada.  Tourist hotspot for all of Nicaragua.

The group.  Turns out the friend is an OB/GYN in Wisconsin who came to Nica 30 years ago on a 4th year elective and has been coming back ever since.  Very cool guy with a ton of interesting stories.

Living up the beautiful Nica morning with some great swimming.  THis is how life SHOULD be down here!

Then this past Thursday was Día de Acción de Gracias.  I had seen and heard some turkeys roaming the streets and figured thought it would be fun to try and do something.  I had grand plans for a feast that didnt quite come to pass, but we did get to enjoy a turkey - all the way from the slaughter to the eating!

That's right, I bought my turkey alive!  And it looks pretty big...

...turns out it's pretty much all fluff.  Here's the process in a nutshell.  Cut off head -> allow to bleed out> dip in boiling water in order to make de-pluming easier>clean>stuff>cook>enjoy.  This was the woman from whom I bought the turkey and who then showed/taught me how to prepare the bird.

Stuff that little bird!  It didn't want to sit in the traditional manner so we made do with a lot of string to keep things closed.

All trussed up.

Ovens are almost non-existent here so we made do - cook over coals with plantain leaves to help keep the heat in.  Cooking an American style turkey Nica style.  What a mix!

The "oven"

After about 4 hours we decided "That's enough!" and went for it.  Turns out it was a good choice.

It wasn't a feast, but the turkey was good, the stuffing tremendous and the apple crisp cooked in a solar oven quite tasty.  Turkey Day Nica style = a Success!

Honduras: Parte 2

Ok, so where was I?  As far as I remember I had put photos up from Copan Ruinas.  From there I started to make my way south.  First to Santa Rosa de Copan --> Gracias -->La Esperanza.  (in case you want to see it on a map)  In Lonely Plant guidebook parlance it's known as the Lenca trail because it traverses the lands where the native Lenca people lived.  It's a mountainous region where coffee, tabacco and incredible sights are super numerous.

Flor de Copan cigar factory.  I don't smoke but it was pretty darn cool and now I also have 3 cigars to eventually share with someone.  They do everything from fermenting and drying the leaves to rolling and then even build the boxes on site.  And they make cigars for dozens of different brands - all in the same place.  Made me wonder a bit about what distinguishes one brand from another...

In Gracias - want something pickled?

Also in Gracias, but I am not really sure from whom they would need protection or who would be crazy enough to bring an army through the region.  Legend has it that the name Gracias came from one of the conquistadors who was travelling through the country and reached the relatively flat area around Gracias and said "Gracias a Dios that we have reached flat land" - in old school Spanish of course - and the name stuck.  And Gracias isnt really the flat either...

I liked this quote alot.  And he must have done something right as he served as both President of El Salvador and later as PRes of Honduras.

These bus/vans can tackle any sort of terrain!

The road from Gracias to La Esperanza is beautiful!  Get ready for a bunch of vistas...

Still the main highway between Gracias and Esperanza - the quality is a little lower though...

La Esperanza - the city at highest altitude in Honduras and as such it was downright chilly - definitely could have used some more clothing although I brought all the warm stuff I had - which is really that much given the crazy heat in El Sauce.

In La Esperanza I met up with the San Jose Partners brigade from Rochester.  Check out their site for loads of information and even a blog from a med student who spent a year working down there.  In brief, it is a project through the Department of Family Medicine at Rochester and a group of docs and residents go down for 2 weeks every 6 months to this small village in the mountains of Honduras.  IT is a beautiful but very poor region and the goal of the project is to help lift the people out of poverty by improving aspects of their health.  To this end they run a clinic(a small part of the project in reality) and have projects of water filters, improved cook stoves, better latrines and are starting projects in fish farming and experimenting with different vegetables.  There is also a scholarship program for students and a small business loan project as well.  After 8 years, the project is quite well established and the people truly trust and believe in the project.  So much so that people in the surrounding communities are clamoring to be involved.  So hopefully, things will keep going in the right direction!  I only spent a week with the project but hopefully I can return next year as an official member of the brigade (1-2 medical students also travel with the brigade each time)

This is where we eat.

THe school and guy's dorm.  If you can't tell it is steeeeeeep around here.

THe new government built health clinic, with some students, residents and translators.  The clinic was provided by the government and it's nice,  but doesn't actually have anything but rooms inside.

We attracted a group of kids everywhere we went.  My favorite part of this pic is the little guy without clothes, but with shoes.  All the others have clothes but no shoes!

The sunsets were incredible!

More brigade members.

Not a bad place to work.  I was amazed daily by the scope of roadwork going on in a place where the roads truly are straight up and down.  I am super surprised no truck of other heavy machinery hasn't slipped off the road and off into the jungle below!

As in Nica, smiling in pictures is not allowed but after a lot of coaxing this was the best result I could get.

The improved cookstove - it gets smoke out of the house and with a smaller opening than normal retains more heat - thus using less firewood.  And it looks really nice.

Giving a quick lesson on cookstoves and latrines.

The group that went to visit the outlying community that would like to participate in the groups projects.  It's only 4.25 miles but the hike lasts over 3.5 hours...I'll let you imagine the mountains that make that happen!

After leaving the brigade I headed to Lago de Yojoa for some scenery and good microbrews ( yay stouts!) and then headed on back into Nica.  After 2.5 weeks I received a lot of "you've reappeared!".  But it's good to be back and now to do a bit of work and travel a bit through Nicaragua.  After 2 weeks in Honduras I have seen more of the country than I have in 2.5 months here in Nica!  It's time to change that...