A bit of this and that.

Wow, that was a brutal morning...just got handed a very definitive 6-0 defeat in the weekend soccer league.  That being said it wasn't that surprising given that we were playing the perennial champions and my team is new and definitely not very organized.  It's rather interesting to listen to everyone talking about how we should play and whatnot - everyone here loves either Real Madrid or Barcelona and they like to think that by watching their teams they know how they should be playing.  Unfortunately, reality and mental desire are a bit disconnected.

I can't necessarily talk too much though - these days my knowledge of the game far exceeds my technical abilities.  What with all this cycling and running I now do my slow twitch muscles far outnumber my fast twitch - which were in need of help when I was playing regularly...oh well it's still a fun way to spend a few hours each day!

Next week will see me more in my current element with my road racing debut here in Nicaragua...a half marathon from Jinotega to San Rafael del Norte in the northern and 'fresco' part of Nica - should be an interesting time.  I am going to see more Peace Corps volunteers in one place than I ever have before, which me

Life in the hospital here in  El Sauce still goes well.  I have recently started to feel more confident attending to patients in the ED  and that has made the whole experience much more enjoyable.  My project is going well - in fact I have essentially finished with my surveys of the patients with asthma and boy was that interesting - I feel incredibly sorry for any child who has ever been nebulized here in El Sauce (and there are a lot - one of the 'normas' or edicts from MINSA the government health organization is that if a kid comes in with the suspicion of pneumonia and there are wheezes in the chest fields they get nebulized).  This generally makes mothers think their child has asthma and if a child has asthma they are forbidden from doing a TON of things - anything from bathing in the evening to playing in the river to eating ice cream or drinking a nice cold fresco.  Not a nice way to pass your childhood.  And this doesn't even touch on some of the traditional cures - anything from monkey, shark or fox oil to cures based on copious amounts of garlic or the blood of a cat.  One woman - who actually has her grandsons asthma well controlled was telling me that she would give him a little bit of a laxative so that he could get some of the phlegm in his chest out with his poop - an interesting concept.  

With this in mind my current project is making a little brochure about what asthma is and some myths and realities - including the best ways to treat the disease.  We'll see how it goes over - most people look at me like I am nuts and have no idea what I am talking about if I explain the actual physiological basis behind things - asthma and other things included.

Well, that's been a lot of words - let's see if there are any photos to share from the last several weeks...

This one is to make all you fruit lovers jealous...in a few weeks there is going to be a massive influx of ripe mangos and avocados!  Boy am I looking forward to that.  A ripe mango beats a green one with salt and chile any day...

I recently went to the port town of Corinto - the biggest port in Nica.  The goal was to eat a ton of delicious seafood and  I definitely accomplished that.  The views were quite good too...

The central park in Corinto.  There are a bunch of cruise ships that come in each day and deposit their charges to explore COrinto for the day.  Everyone was sure I was part of the cruise ship that arrived the day I arrived but it was gone by 6 and when I was walking around taking these photos the people were saying "Look at the gringo - he got left behind!"

A doctor here has a good friend there in Corinto who I called and he brought me out with the boys - or the gallera as they call themselves.  Really it's a group that can drink rum like water - incredible cantidads consumed! 

Variation on painted easter eggs?

Apparently this is how my beloved cashew grows...I had absolutely no idea!

Matagalpa y más

Wow - it's hard to believe that I have already been back in the country for over a month!  Before I know it, I will have to start thinking about scary things like med school electives and residency interviewing...but until then there is still a lot to be done and seen here in Central America.  The last few weeks have brought some fun adventures, both here in Sauce and out and about in Nicaragua.  

As the next phase in my study here in Sauce commences I have had the opportunity to track down numerous patients with asthma in order to chat with them about their disease, its maintenance and how it affects their lives.  It is quite interesting (did you know that oil derived from foxes, sharks or even monkeys will cure asthma?) it is also quite challenging as addresses as we know them in the States do not exist and no one is ever really willing to simply say "I don't know them or where they live".  So, it's time intensive but fun.

Two weekends ago I took the opportunity to visit Matagalpa, a city in the northern and more mountainous region of Nica.  As such it is both beautiful and has a wonderfully fresh climate - I was actually chilly at night!  It is known for its coffee and has a local chocolate 'factory' - 2 things that I love and don't get enough of here in the Sauce.

Nica is full of volcanoes.  This is taken maybe 30k from Sauce where I got off the bus in the middle of nowhere to wait for a bus going the other direction.  Love travelling here!

Cacao beans at the Castillo de Cacao - the chocolate factory in Matagalpa.  It is  a small outfit with a mixture of machine and hand-labor.  For example, the beans here are ground by hand, but the shell and the actual meat are separated with the help of a machine.  The chocolate is very different from what I am accustomed to - 75% cacao signifies 75% cacao and 25% sugar - nothing else!  Turns out to be quite tasty - and melted it tastes even better.

It's done by hand - from making the aluminum sleeves to putting on the colored wrappers!

Matagalpa's pretty!

Went to a coffee plantation that was amazing not just for its coffee but for its self-sustaining policies.  It's called Selva Negra and is now renowned for it's hotel and beautiful locale, but what interested me the most was how they have found a way to re-use just about everything - from egg shells of the hotel to the casings of the coffee beans.  They even generate about 50% of their own energy!  Super cool.

Of the coffee plantation where they research ways to improve the soil quality  to improve the life of the coffee trees.

The chapel at Selva Negra.  Apparently a very popular wedding location.

This past weekend I hung out here in El Sauce and survived a 10.5 mile run with this  beast of a man.  He's 50+ and runs all the time and is known by everyone and their mother in El Sauce and all the surrounding communities.  Every house we passed along the way gave us a friendly and personalized salutation.  Down side is that he is hard to understand normally and when running it's even worse...

A main reason for staying in the Sauce was an invitation to a quince años - for which i received the invitation in November.   It's a big deal here and was very impressive.  It all starts out with a procession to the church, a mass and then a feast followed by dancing and copious amounts of rum.  Sure is a shame that we don't have this excuse for a party in the states!

How to keep the Gallo Pinto from packing on the pounds...

(warning, this could be considered an excuse to post pictures and nothing much of substance...)

So for those of you who know me well you know that I have a certain predisposition to excercising - whether it be trhough playing games, spending hours upon hours on the bike or just running around - really anything that gets me up and out of the chair or the house.  But here in El Sauce I have no bike(well that would serve for long-range excursions) and the culture of exercise is more or less absent. There are a few gyms for lifting weights or hitting the treadmill, but that really holds no appeal for me.  So what am I to do?  Turns out you don't need much of anything to enjoy running except for some shoes.  However, either due to the fact that I am a gringo or that I am running - I usually gets loads and loads of funny looks and cat-calls - from both girls and, strangely enough, guys.  So to avoid this, and the crazy hot temps around here, I have started running first thing in the morning.  Turns out that sunrise in Nicaragua is a beautiful thing.

Not in Nicaragua - but still got represent the team even though I wasn't on the bike!

The dirt trails- I mean roads- in El Sauce do a real number on the shoes!

Bright and shiny - mind you they now have a good coating of dust, mud and other goodies.

Even though Nicaragua may be baseball country ( I know - how disappointing!)  I have finally found where and when I can play soccer - and it turns out to be just about every afternoon.  The ball may or may not have air, and you have to run through or around the piles of horse manure - but it's fun and some of those guys are quite good!  And the sunset every evening is quite spectacular.

Looking at volcanos from the soccer field at sunset - not a bad vista...

It get's dark quickly though...

The travels should begin again soon...

Un poqutito de todo

After a lovely 2 week Christmas visit with the parents (mildly complicated by a nasty bout with Giardia...) and after getting the rest of board liscensing exams out of the way I am back in the land of lakes and volconoes.  And boy is it a good time to be here in El Sauce.  First and foremost, the climate right now is tan fresco.  Every morning there is a slight chill in the air, there is almost a constant and refreshing breeze and every evening has been incredibly pleasant.  Add to that the fiestas patronales of El Sauce, or the patron saint festival and the place is downright amazing.  I am not entirely sure about the origens of the festival, but there is a black Christ figure here in Sauce that people make pilgrimages from all over Nicaragua and even from places as far as El Salvador and Honduras.  There are street vendors that have set up shop on the main streets, constructing little stores so that you can barely ride a bike down the street, let alone drive.

But first, there was a little visitor to the hospital: the ever present drug rep!  Turns out Nicaragua isn't immune either and she was very happen to see each and every doctor and give out medications to anyone who was in the vicinity or had a question.   Quite interesting.  Also gave me an excuse to play with my new camera...

I have arrived back in El Sauce amidst a sea of gringos.  There are several students from SUNY Gennesseo as well as a group from Rochester involved with a program called 4 walls or here, cuatro paredes.  This is a cool project that was begun about 5 years through the joint efforts of a Rochesterian and a peace corps volunteer.  What they do is raise money to help families who live in plastic houses or possibly worse build four brick walls of an improved house with the added goal of moving the wood burning cooking surface out of the living space.  They have projects going on throughout the year but send down brigades every so often to help build and experience Sauce.  If you're interested you can see more here.

Beautiful day to build.

The 4 walls group.  Enjoying some cold Toñas and typical fritanga food.

As I mentioned, the fiestas patronales are in full swing and there are goodies for sale in all the streets.  Some of the things that seem to be quite popular are these brightly colored sugar creations.  I didn't try any of these, but there are loads of other, less ornate and very tasty offerings!

A big part of the festival are the cabellitos or the little ferris wheels and spinning saucer rides.  Turns out that on one of the ferris wheels the individual cars also spin around.  Nothing like spending a good 50 cents to thoroughly scare and enjoy yourself!

 Each night during the weekend, there is a rodeo.  Apparently the bulls are the best of Friday and Saturday night, but when we went on Sunday night they were ok.  They would buck around for a few seconds but then seemed to realize it wasn't worth their time.  But it was still cool and my first rodeo ever!

On the Friday of the first weekend there is a procession of the peregrinos or the pilgrims who come in ox-drawn cart from all over to Sauce.  There were probably upwards of 20 or 25 carts and there was a speech by the pastor, the mayor and then each and every pilgrim received a plaque.  Pretty interesting.  The best part is that for the next week, the carts, the oxen and their drivers were camped out in any open and shady space that they could find.  There were people sleeping any and everywhere!

Lots more adventures to come I hope, with the accompanying pictures to document it all.  Stay tuned!

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!