So...about those updates

Well, it turns out it's a lot harder than I thought to keep up the blog while not in Nicaragua. So, I think I'll go ahead and sign off for the time being. I should have some more posts coming in January to let you know about plans, and I will definitely resume blogging once I'm back in Nicaragua, probably in February. Thanks for reading and don't forget to check back in a few months!

The Last Float

This was the only video I took that turned out well all the way through. Most of the others have shoddy camera work and poor lighting, so I'm leaving those out for now.

La Chica CUUN

A while back, I posted about Mr. and Miss Law School. Well, now all of the departments have elected their Miss (and in some cases Mr.), and now they're electing "La Chica CUUN," which is the basically "Girl of the University." Turns out this is a huge deal and they have a parade through downtown Leon. Each department has a float for its candidate. And there is also two floats for the beer company that sponsors the event, one of which is the first picture. The second picture is the float from social sciences, if I remember correctly. For most of the others, I took video clips so I'll try to post a few of those. If anyone knows of a free, good, easy-to-use video editing program for avi files, let me know. I'd prefer to just string the highlights together and make one decent video rather than half 5-6 half good videos. By the way, I have little idea what exactly "CUUN" stands for, and most university students don't seem to know either, but the word "universidad" is probably in there somewhere.

The Future of the Blog

Well, as some of you may know, this is my last night in Nicaragua for a few months. For those of you who didn't know, it's probably a complete surprise. I'm heading back to the US, hopefully having some medical school interviews, and then hopefully coming back to Nicaragua in February or so to continue research. So what does this mean? Well, after two months of cold showers, it'll be nice to have hot water again. On the flip side, I'll have to deal with cold weather. Secondly, the future of the blog: I have a bunch more material to post that I simply haven't gotten around to, so I'll continue posting for a while, and it'll probably be easier for me since I'll have more time. At some point, there will probably be a break, and I'll let you know when it's coming and an estimate of when the blog will be back in action.

Free Entertainment

On the ferry ride back to mainland Nicaragua, lots of local boys from Ometepe got on board of the boat. The ticket guy doesn't take your tickets until the boat is already in motion, so it's easy to walk on for a while if you want to. In what's apparently pretty common, these boys get on the boat, and then, once it starts to leave the port, they jump off into the lake. The biggest, wildest kids jump off the roof of the three story boat, which you can't see here, but it's pretty high up, trust me. Unfortunately, my camera takes about a minute per photo, so I wasn't able to get any really good pictures, mostly just splashes in the water after the fact. At any rate, here's a couple kids jumping off from the main level.

Monster Truck Rally!

Just kidding. No monster trucks. But on the way back to Leon, we stopped at a car fair in Managua to visit Edgar's sister, who works for Suzuki. Toyata had set up a huge mud course to show off its all-terrain vehicles. Edgar and I did a loop in one of the SUVs, which is blurrily pictured above. Only the professional drivers are allowed to actually drive the car, but as a passenger, you get tossed around a whole lot. Even though you only go about 5 miles per hour, you need a seatbelt so that you don't get thrown all over the inside of the car.

Tweet Tweet

Edgar and I had a few meals at a nice hotel called Villa Paraiso on Ometepe. It's on Lake Nicaragua. You eat outdoors, which is actually not uncommon in Nicaraguan restaurants where the line between indoors and outdoors often blurs. But unlike most restaurants, this one has beautiful tropical birds that come hang out in the trees ten feet away from where you're dining. I took these photos from our dinner table. Unfortunately, I don't know what sort of bird this is, but if you tell me, I'll be happy to credit you.

Update: As John pointed it, it appears to be a White-throated Magpie-Jay. That's a lot of hyphens for one bird. They seem to be quite friendly, or at least don't mind posing for photos.

Tropical Lakes

This is Edgar on the beach Playa Santo Domingo on Lake Nicaragua. It's a nice place with little rancho umbrellas in the water and on the shore. It's a very nice looking beach.

Dagobah

This shot reminds of the planet Dagobah from Star Wars, where Yoda trains Luke in the ways of the Jedi. Yes, I did have to look up the spelling of "Dagobah." This particular photo is on Omotepe at Playa Santo Domingo

Ometepe

The highlight of the trip was visiting Ometepe, a volcanic island in the middle of the gigantic Lake Nicaragua. We took a cheap little boat to the island for about $1.60, a ride of a little over an hour. As we approached the island with its two imposing, volcanoes Concepción and Maderas, with smoky gas pouring out of their tops, I began to wonder in the back of my mind what would happen if there were a serious eruption while I was visiting. As avalanches of lava raced down to the beaches, my only option would be to swim many many miles across the worlds' only shark-infested fresh water lake, Lake Nicaragua. If I survived the sharks, would I survive the exhausting swim? Too bad I didn't go to the gym more often when I had the chance. What about all the ash, the falling rocks, the blowing sand; what if the lake starts boiling? Well, at least then I wouldn't have to worry about the sharks.
Luckily, there haven't been any eruptions from Concepción since 1957 (or 1999 or 2005 depending on which line in Wikipedia you decide to believe), and Maderas has been silent since the 13th century and is considered dormant.
It turns out that the island is huge. It is 276 km squared and has a total population of 35,000 people with schools, health services, hotels, cell phone towers, and bananas. They export a ton of plantains. A truck from El Salvador boarded our ferry on the way back home, loaded to the brim with bananas.
As for those aggressive fresh water bull sharks, I didn't see any. According to the internet, studies from the University of Nebraska show that the sharks swim into the lake via the San Juan River from the Caribbean.
The river is a major waterway and the US originally wanted to use it as the basis for a Nicaraguan Canal, but they eventually built the Panama Canal instead. As of 2006, then-president of Nicaragua, Enrique Bolaños, was still trying to get a Nicaraguan canal built. He said it would be a huge economic boost for the country, but there are some problems, such as the huge construction cost and possible environmental damage.

Pizza Hot

Here are two photos from our brief stop in Rivas. The main cathedral surrounded by a fence, which is a little less inviting, but it still looks pretty. The second picture is of the Pizza Hot delivery bike. Edgar and I ate there, and I think it made us both a little sick afterwards, but at least it tasted good. Anyway, several pizza and chicken restaurants have delivery options. It's almost always a guy on a motorcycle with a little pack on the back with the goods. The Tip Top chicken delivery guys always have these bright yellow jackets and bright yellow helmets. Safety first.

Volcán Masaya

Volcán Masaya is located near Masaya, Nicaragua. The volcano is still active, although there have been only two lava eruptions since 1600. However, it still belches out rocks and constantly perfumes the air with sulfer dioxide gas, so much so that it can be hard to breath near the top of the observation point, which is marked with a cross in the third photo. Climbing up to the observation point, I was coughing and gasping for air. I tried to take a picture across the volcano (photo 2), but there is so much gas that you can't see much. In the first photo, you can look down into the crater a little, and also see the parking lot. Notice that all the cars are parked facing away from the volcano. This is in case of an emergency so that everyone can evacuate quickly. I think that my traveling companion Edgar might have better photos of the volcano; if so, I'll try to post some of his so that you get a better idea of what it looks like.

Hey Hey We're the Monkeys

San Jorge once again. These monkeys were chained to a tree, apparently as pets or something. There were quite frisky until I started to video them, at which point they became mostly still. There are wild monkeys in Nicaragua, but unfortunately I haven't seen any yet.

Bring Your Alibis

Located in the town of San Jorge, which is a port town on Lake Nicaragua. There's plenty of room at the Hotel California...

Update

I was on a little vacation for a few days, but I'm back now and will post some entries from my trip over the next few days.

More Red Soft Drinks

Here are a couple of friends (Marlon on the left and Edgar in the center) and I enjoying some red soft drinks in sandwich bags. That's how drinks are often sold here in Leon. They pour it out of the glass bottle and into a baggie, tying it around a straw. They keep the bottle. It's a decent vessel for drinking a soft drink, but sometimes the straw sucks up the bottom of the bag and you have to free it in order to get the liquid flowing again. They also sell juices and flavored milks (chocolate and corn flavored, among others I believe) in sandwich bags.

The Little Soft Drink That Could...

This red soft drink is called Rojita. It is a popular drink in Nicaragua, and used to be owned by a Nicaraguan company. And then Pepsi bought it. This particular soda, Rojita, seems to be totally invisible on the internet. I spent a long time trying to find out more about it, but was almost completely unsuccessful, which is pretty remarkable in itself. If someone finds something, let me know. As far as taste, it is basically the equivalent of the Coca Cola drink Fanta Roja.
Last year, I discovered a similar soda situation. Inca Kola was the native soft drink of Peru (my Peruvian friend Hernan jokes "The kola of the Incas"), and then Coca Cola bought most of the company in the late 1990s since they couldn't quite rival its popularity in Peru. I linked to the Wikipedia entry on Inca Kola, which details the rise and buying out of the company (at least I find this sort of thing interesting anyway)

Residents of Sabaneta

Here are a few more residents of Sabaneta. The lady in the first picture makes pottery for a living, and you can see a jar off on the left. She was working on making some little jars when we arrived. The gentleman in the other picture was 90 years old and living alone in his little house.

Flat Tire

Shockingly, with 14 people piled into a pickup truck, driving on a terrible road, we got a flat tire. Here is our fearless leader Armando removing the old tire. Impressively, from stopping to driving again, it took only about 10 minutes or so. I guess the secret is to have four people helping change the tire, and 10 people supervising.

Hoops

There is a serious leptospirosis epidemic, but I don't want to it to seem as though everything here is panic and illness. Most people still go about doing most of their normal activities. Here are some kids shooting hoops in Malpaisillo during the evening.

Little House on the Campo

Here are some pictures of some typical houses so that you can get a better idea of what they look like.

Water Works

This is Marlon, a statistician from CIDS, giving a demonstration of how a well works. Unfortunately, this one was broken, but he got to at least practice the cranking technique. This picture was taken at the health outpost in Sabaneta. Most folks living out there use well water, although in some rural areas people just use river water if it's available. One team on the brigade was sent out to an area where a river divided part of the community. People have to wade through the river to travel from their houses to the center of the town. Many people living on that side of the river were sick.

Little note

To clarify, I'm back from Malpaisillo and Sabaneta. I went there on Saturday and Sunday, but today (Monday), I was back in the office in CIDS. As far as I know, the situation is under better control now and the medical school isn't sending any more brigades. I still have a bunch of pictures to post from the trip and I'll keep updating the blog everyday until I've posted them all.

Serpiente!

This snake was found already dead, probably killed since it's head was missing, by one of our medical brigade members as we walked to different houses out in the country. It looks like a coral snake, but none of us know for sure, and the Wikipedia entry isn't helping much. Nonetheless, this was still pretty exciting. To put this in perspective, let's use a quote from Moon's Living Abroad in Nicaragua: "There are 15 species of poisonous snakes in Nicaragua, but your chances of seeing one is extremely rare, unless you're going deep into the bush. In that case, walk softly and carry a big machete" (114).

Volcanos

Outside of Leon, there are tons of volcanos. I took these pictures on the trip to Malpaisillo and Sabaneta. The first one is San Cristobal, which is the tallest in Nicaragua. It's pretty far away in this picture. The next is Telica, and you can see the frozen lava streaked down the side. The last one is San Jacinto, which is smaller and hasn't erupted lately, as you can tell from the heavy vegetation.

Little Piggies (and a dog)

One thing that puzzled me is that some of the pigs wear these wooden V-collars around their necks.
It turns out these are to prevent them from escaping between the barbed wire fences. I'm not sure how well it works since this pig if obviously free, and most of the pigs I've seen are. Maybe pigs are only kept penned every once in a while.
Dogs in Nicaragua are almost universally emaciated, just skin and bones. They usually have some old wounds and beg whatever scraps they can find, or root through trash. This dog is fairly typical. Behind the dog, you can see little black piggie banks. In Sabaneta, pottery is about the only industry besides agriculture. A lot of folks make jars and piggie banks and fire them in kilns to solidify them. Then they're often painted or decorated and brought into town to be sold.

House visits

Here are a couple of pictures of Eveling (a medical student) and me going around to families in the Sabaneta community, spreading information and medication. Eveling did most of the work, but I helped out with distributing and explaining information sheets and dividing up the medications. We went house-to-house checking to see if anyone was ill or symptomatic. We did encounter several folks who had or had had fevers, and families that already had sent someone to the local health outpost ("puesto de salud"). The first picture is from one of the first houses we visited. The trash bags on the floor were full of medications that we distributed. We visited 17 houses, documenting everyone in living in each house and their health, as well as whether they had sick animals or not. The last picture is from one of the last families we visited. We visited houses until we ran out of medication for adults. There were some communication and planning problems afterwards and we didn't get to distribute any more in the late afternoon.

Intro to Nicaraguan Healthcare

The Nicaraguan government offers free health care to all. The sign says "Health is a right of everyone and is free. Any charge is illegal." Unfortunately, the quality of care varies quite a bit, and the best care is obtained from private clinics ,which most people can't afford. Also, medication costs usually aren't covered, so many patients have to pay for their own. Because of this outbreak, the government is distributing free prophylaxis to help stop the epidemic, as well as treatment.
Secondly, the pictured building is Pinocho Preschool in Malpaisillo. It is currently full of patients in beds since the health center across the street is full. Most of the patients have either leptospirosis or dengue, though making exact diagnoses is difficult.

Riding Dirty - or something like that

Here is a picture of our team of med students getting ready to go, and then piling into the back of a pickup truck for the ride. Cars are scarce, so we had to fit 14 people into the truck. It was a little tight. I'm a rookie at riding in the back of pickups, so I was clinging for dear life to whatever little thing I could find to hold on to. Most of the other folks were a bit more relaxed. The roads out in the country are terrible, but that's probably a good thing because it forces the truck to go more slowly. The paved roads have tons of potholes. If they're not paved, they have tons of little ravines, dips, holes, moguls, and other obstacles. I think riding in the back with so many people is like white water rafting. You just hang on through all of the dips, bumps and turns, and hope you don't fall out. The only difference is that you stay dry...except when it starts to pour on you. This happened on the way back to Malpaisillo from Sabaneta, where we went around house-to-house distributing leptospirosis prophalaxis and searching for people who were already presenting symptoms. It was a dark, rainy, bumpy ride at the end of a long day, but I was with some really cool med students. We were all completely soaked, but found the whole situation pretty funny. The whole time I was thinking, "I can't wait to blog about this!"

Flyers and Paper

Here is a picture of the information sheet we've been handing out to raise awareness of symptoms and what precautions are recommended. Leptospirosis is treatable if it is caught early; if someone has already had symptoms for several days, it is often fatal. One other complicating factor is that due to the heavy rains, there has also an increase in Dengue Fever incidences (transmitted by mosquitoes), which has very similar symptoms, but is a virus, so it requires different treatment.
The other picture is a photo of today's newspaper. The headline is "It's already an epidemic." I have a ton of pictures from today to post, but I'm really tired now, so I'll gradually post them through the week and fill in with stories.

La Ministra de Salud

At the end of the day, the Health Minister of Nicaragua, Dra. Maritza Cuan, came and visited us. She gave a little pep talk and instructions. Afterwards, we went back to Leon to sleep, but plan on waking up and leaving by 6:30 am tomorrow to go and visit more affected communities in the area.

Ambulance

We walked around most of the time, but we heard of one patient who was very sick, so we got in this pickup truck and picked him up from his house. We took him to the community health center, and an ambulance too him to Leon. All of the people pictured here are the medical students.

Field Trip

Here is a picture of the bus that we rode in. Most buses in Nicaragua, and probably most of Latin America, are old buses from the US and Europe that were discarded because they were old. This was a former "activity bus," the kind that you'd take on field trips in the US. Amazingly, I think all of the windows worked okay and there wasn't the notorious "bad window" that always got stuck. There was, however, in the back of the bus, a little hole in the floor and you could see the ground. Also of note is that the bus is driven with the main door wide open all the time. I asked one of the med students if it was only for ventilation since it seemed a little dangerous. She said yes, but they close the door if the police come by since they get a bit upset about it.
Enough about the bus already. In the background is a picture of the health center in Malpaisillo. This little community is one area of the outbreak. This is located in "el campo", or the countryside. Almost all of the roads are dirt and most people have some chickens and a pig or two on their property. I joined a group of med students and we went around to houses handing out information sheets, looking for sick people, and explaining what precautionary measures need to be taken. The other picture is of us discussing final procedures before beginning to visit the homes.

The Debriefing

First, I was called last night and told that there was a meeting to discuss the outbreaks of leptospirosis. I went to this meeting at the epidemiology center, and then went on to several other meetings at the hospital, joining up with a bunch of 6th year med students who are helping care for the ill and spread awareness and precautions. The purpose of these debriefings was to formulate a plan to deal with this outbreak. As people walked in, they exchanged handshakes, sat down in these little desks, took out their notebooks and began paying attention as the leaders went over the plan of attack. I couldn't help thinking about how much it reminded me of movies like Star Wars and Independence Day when all of the fighter pilots go to their final debriefing before attacking the bad guys. As accompaniment music, I even had the heroic-sounding Fox NFL theme song stuck in my head. On a more serious note, the med students and organizers are quite admirable for giving up their weekend to work hard on this urgent health project.
In this picture Dr. Peña, dean of the medical school, is giving some directions for how the relief effort will be organized.

Outbreak

Over the last month and a half, Nicaragua has been hit with three different disasters. In early September, Hurricane Felix hit the Atlantic coastal region very hard. That was followed by 47 days of rain in some areas of Nicaragua, which caused significant damage, leading President Daniel Ortega to declar a state of emergency earlier this week. The third disaster, is that because of these rains, there have now been several outbreaks of leptospirosis, which you can read about in either of the two major newspapers (La Prensa, El Nuevo Diario). These outbreaks are very close to Leon and the hospital here is already full.
I have joined the emergency crew to go out into the affected neighborhoods and do preventative education. The following posts will explain that in a little more detail.

The Multi-Use Growth Chart

Warning: This is a post about babies!

Sometimes at the clinic, babies need to get weighed to make sure they are growing at a good rate. Naturally, this is a 4 person task. One to put the baby on the scale and move the weights around, and 3 to watch the baby be cute. Here is one example: First, a large baby boy was placed into the scale and he noticed that the doctor was moving the weights, so he started slapping them, probably trying to help. Some med students began dangling the baby's growth chart in front of him to try to distract him so that the doctor could adjust the weights. The baby was amused for about 0.3 seconds, and then resumed beating the weights. Next, students gave the baby his growth chart, optimistically hoping that he'd try to read it and gauge his progress, or perhaps more likely, that he'd be distracted chewing on it long enough for the doctor to measure his weight. Instead, the baby took the growth chart and began using it as a tool to beat the weights on the scale more effectively. The growth chart had to be confiscated, but the little boy was eventually wowed long enough by some shiny jewelry to be weighed. Bling-bling!

Powerless Clinic

Welcome to the health center in Sutiava (also spelled Sutiaba; "b" and "v" are the almost the same in Spanish), a neighborhood in Leon. The clinic opens every morning at 7 AM. It usually loses power by 7:15 or 7:30, but lately we've had power until 8:00 or even 8:15 AM once! There also is no water until about 3 PM in the afternoon or later, at which point, the clinic is already closed. The lack of power and water have been widespread problems in Nicaragua due to rising energy costs and lack of electrical power capacity since January (some people say since Feb, May, last year, 5 years ago, or forever...not sure who is right). Doctors and med students do what they can given the conditions. They have solar-powered calculators that work pretty well next to the windows. I think that the lab at the health center has its own generator. When it rains (happens a lot now since it's the rainy season), it sometimes gets too dark despite the abundance of windows, so the doctors and med students work by candlelight. Public healthcare here in Nicaragua is free, although medications are not. The clinic tries to give out samples if they have medications, but they often are undersupplied.
I've spent most of my time in pediatrics learning with the medical students. They're a friendly and helpful group. Most of the patients are little itty-bitty babies and toddlers. Whenever we get a baby that's like 5 or 10 days old, I'm always thinking to myself, "Wow, I've lived in Nicaragua longer than this kid!"

Wines, Fine Wines, and Statistics

Here are some samples from the books I've been reading:

"My books are water; those of the great geniuses are wine - everybody drinks water." - Mark Twain
Both fine wines and biostatistics are characterized by complexities and subtleties that are truly appreciated only by the relatively few people who devote the time to master them. To these readers, we extend our apologies; this book was not written for you. Rather, it was written for a much larger group of readers: those who thirst for a basic understanding of statistics, but who do not aspire to appreciate the nuances." - How to Report Statistics in Medicine, by Lang and Secic page xi


"Case-control studies are the "house red" on the research design wine list: more modest and a little riskier than the other selections, but much less expensive and sometimes surprisingly good" (111) - Designing Clinical Research, Second Edition, Hulley et al

As for the books themselves, I'd say firm they're intense, with a mix of earthy pages, dark inks, and a natural arboreal aroma. Pages turn supple and elegant before the firming up on the finish. Read now through 2011. By then they might have new editions. 88 Points. I think there is an unspoken rule of only one wine analogy per epidemiology book, but I'll let you know if I find more.

Marketing Your Product

If you're ever feeling down, or just want to feel like the most popular person in the world, then you need to go to the market. I think there are four here in Leon. As soon as you get close to it, people immediately start asking what you're looking for. "¿Qué buscas chele?" "¿Qué buscas amor?" People grab your arm and try to direct you into their store. Or convince you that you're looking for shoes or whatever they might be selling. This particular market in near the Iglesia San Jan. It's a good time.

10-23-07 Small Update: As you may notice, the market is curiously shaped like a train station. There used to be trains here in Nicaragua until the 1990s, when they were sold off.