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.

Bumps in the Road

I'm no native speaker and naturally, there are going to be some mix-ups. Besides that, there are some words that I want you to know about. Non-Spanish speakers, have no fear; it's not too technical.

Tonight, as I was looking through the fridge to find some dinner, Dona Dora (the host mom) called to me and said that there was some "Carne con ongo" in the fridge. I was thinking, "meat with fungus?" Maybe I misheard. "Meat with what?"

"Ongo."

Hmm. Sure enough I found meat with fungus. It was steak with mushrooms. Suddenly it all made sense. All of you readers probably saw it coming, but in the heat of the moment, I was baffled.

Another time I was talking with Dorisabel, Dona Dora's daughter, about what she does. She said she was a law student in the mornings and in the afternoons she worked in a "bufete." That's weird, I thought; why would a talented law student work in a buffet all afternoon 5 days a week? "What do you do there?" I asked in Spanish. "Do you serve food or something?," thinking that maybe she had a waitress job to make extra cash or something along those lines.

She was like "What?!"

Now I'm thinking "Uh oh big mistake. Something went wrong." "What is a 'bufete'?"

"A law firm" she said in English.

"Oooooooh." How embarrassing. How did I never learn that word beforehand? It's certainly sealed into my memory now.

Vocabulary time:
Sometimes things in English and Spanish translate really well. For instance, backpack in Spanish is mochila. Backpacker is mochilero. It makes perfect sense and it's possible to understand what someone is talking about when they start talking about all of the mochileros around town, even if you haven't heard the word mochilero before. You can piece together that it means backpackers. Theses direct, logical translations are great.

Other times, translations work, but they don't quite capture everything the original word had to offer. For instance, the "Twin Towers" becomes "Torres Gemelas." It's a direct translation and it's easy to understand, but it loses the alliteration of all those T's and W's.

And lastly, sometimes the best translations are loose translations. In English, we call those bumps in the road to slow you down "Speed bumps." Makes sense. In Spanish, or at least Nicaraguan, they call them "policia acostada." That means "police lying down." That's a much more entertaining way of looking at them.

Drug Dealers

At hospitals and even the free health centers around town, drug representatives from pharmaceuticals come by and peddle their wares. They find doctors, give a little presentation, and offer you various samples. What I find most interesting about it is that they even give samples to me, which makes me feel pretty special. I think people sometimes mistake me for a visiting physician. Here are a couple samples I got a few days ago. One is for hypertension and the other is for ulcers. Since I don't really have any need for these things and am not supposed to be writing prescriptions, I just left them with a doctor.

Escorpión King

One major difference between houses in Nicaragua and houses in the US is that here there is much less distinguishing between outdoors and indoors. Often times there are no doors. Windows are open all the time. Since people don't need heating and air conditioning is rare, there is little need to design houses to be air-tight. Insects and animalitos come and go as they please. One of the most ubiquitous critters here is the gecko lizard, which here is called the escorpión. It's pretty harmless. They are all over the house and I've found them in my bedroom and bathroom on multiple occasions. This one I took a picture of in the kitchen. They're about the same size as the blue-tailed skinks that you find in North Carolina. Supposedly these escorpiónes eat mosquitoes. They don't eat nearly enough. My first week or two here, I would hear someone knocking on the door and go answer it but find no one there. It turns out that one other feature of these geckos is that they make a tock-tock-tock sound every 10 minutes or so. Even after I knew the gecko sound, I would still sometimes be fooled into answering the door because it sounded that similar to door knocking. After a while, my ear adapted and I was able to distinguish the geckos from the knocks.
Other little critters come and go in the house. There are a bunch of bats that fly through the kitchen and dining area at night. Hummingbirds come to the gardens and fill up. Ants occasionally try building a colony right inside my doorway. I evict them, but they usually return to rebuild within a few days. Sometimes you see mice scurrying around or roaches, but they generally don't bother me. Since there aren't any precautions to keep critters out, the food is always kept locked up.

Mr. and Ms. Law School

Back on September 26, they had the election of Mr. and Ms. Law School. This is a pretty big deal at the university. Students pack the auditorium. They have a variety of rounds such as a question-answer session, dance competition, and even a swimsuit competition. Some faculty members serve as the judges. There is also lots of entertainment between contests such as guitarists, a stand-up comic named Poncho, and one faculty member played the marimba. Unfortunately, this competition lasts for several hours and I was getting a little tired, so I went home before finding out who won. The next night, they had the election of Ms. Medical School (there is no Mr. Medicine). All of the schools/departments each elect a Ms. (and sometimes a Mr.) and then there is some university-wide competition for the Mr. and Ms. UNAN-Leon. I guess this is vaguely like Homecoming King and Queen at UNC. But not really.

One additional clarification: Yes, Mr. Law School candidates do the swimsuit competition too.

Urban Cowboys

Some cowpokes at the procession for La Virgen de la Merced. This happened last month, but I'm still catching up. By the way, those are fake plastic horses, just in case you were wondering.

Playoff Baseball Guide

I thought it might be interesting to see how the teams are spelled in the local papers here:
Los Yanquis - The Yankees
Los Indios - The Indians
Los Medias Rojas - The Red Sox
Los Angelinos - The Angels
Los Cachorros - The Cubs
Los Rockies - The Rockies
Los Diamondbacks - The Diamondbacks
Los Filis - The Philies

La Catedral

La Catedral in Leon is the biggest cathedral in Central America and the second largest in Latin America. It's easily the most impressive building in downtown Leon.

Light My Fire

This preist is setting off fireworks for the festival celebrating La Virgen de La Merced, who is the patron saint of Leon. This means it's a local holiday and it's a big deal around here. The celebration takes place at the Church of La Merced and they decided to celebrate by setting off fireworks and ringing the church bell...all month long...even at 4 am...two blocks from where I'm staying. This photo is from September 24, the peak of the festival and the day procession in town. I knew that the event got going at 12 pm, so I went close to the church to get some pictures. Unbeknownst to me, they set up fireworks around the church and suddenly they started going off 30 feet away from me. It was fairly terrifying. As you can see in the from the smoke in the background in this picture, the fireworks around the church are still going off. Meanwhile, the priest and a couple helpers are setting fireworks off by lighting them while holding them in their hands. Upon ignition, the firework then shoots up out of their hands. It seemed a little dangerous to me, but I don't think anyone was hurt.
Fortunately, since September, it's been a bit quieter here in Leon, especially at night, but I still occasionally am startled by booming surprise fireworks in the middle of the day.

Raise the Roof

Here is a picture from the car on the road to Leon Viejo. I think this business builds this type of thatch roofs, which are popular for bars and restaurants.

Rocky Road

Here is a little clip from a trip to the beach. There are some very good roads in Nicaragua. The road to beach is not one of them. Note the jolting camera and mini-lakes consuming the road. I sometimes felt like I was "fording the river" in that Oregon Trail computer game that many of us played as kids. I was surprised on several occasions that water didn't seep into the side of the car through the doors when we drove through these huge puddles. Anyhow, we got to the beach without any real troubles, just a slightly wetter-than-normal car.

Baseball video!

Here is a little clip I took with my camera of the championship baseball game. Unfortunately, there is no sound. I think that at this point in the game, Leon was losing and things had calmed down a bit.

Fish and a Bicycle

Here are some photos from a trip to the beach Las Peñitas, which means "Little Stones on the beach." These are from September 22/23.
There were several dead fish lying around on the shore being chewed on by stray dogs. One dog wasn't satisfied with the dead fish and went fishing in the ocean trying to catch something a little fresher. I didn't see him find any fish, but he was at least having a good time chasing them around in a tidal pool. I tried to take a picture of him, but it was too dark to get anything decent.

Jonrón = Homerun in Spanish

On September 20th (I think), I went to the Nicaraguan Baseball Championship Game 7 between Leon and Granada. It turns out baseball is by far the most popular sport in Nicaragua. It was the most intense, over-crowed sports event I've ever been to, including a UNC-Duke basketball game. I think admission to this game cost about $1.66. They don't sell "seats." They just sell as many tickets as possible, meaning that it's completely packed. At any given moment, I was usually sharing at least a part of my seat/seating area with 1-2 other people.
I arrived an hour early, and the covered seating section (actually, it was really a standing section) was already full. People were already screaming enthusiastically and completely drowning out the loudspeaker.
One popular activity at the game was to buy these bags of drinkable water, but rather than drink them, rip a little hole in one end and then squeeze it, waving it around above your head. This is actually fairly refreshing and enjoyable. The camera men on the field with expensive equipment didn't appreciate it, but everyone else liked the break from the Nicaraguan heat. If someone doesn't have a water bag, they sometimes just throw whatever drink they do have into someone near by. By the end of it, I had been bathed in water, beer, and one sugary drink was practically poured on my head, but at least it tasted okay.
I was in the section right next to the Granada fan section. The section for Granada was lined with police officers to help keep things orderly. There is a lot of swearing, gesturing, and booing between the different fan sections. Additionally, a lot of people are drinking. After Granada scored a run or two, someone tossed a bottle at a fan, and the next thing we knew, there was an all out bottle battle between the sections. I ducked but was still hit by various liquids swirling out of the bottles. Police were eventually able to calm things down.
Unfortunately, Leon had a less than stellar game and lost 15-0 . Ouch. Some people had waited 5 hours in the stands prior to the game. They were pretty disappointed. Hopefully, next year will be more successful.

Flowery Language - kinda

Look, I do have a job! I work mostly in an epidemiology center, which is a part of Universidad Nacional Autónoma de Nicaragua (UNAN). This center is called Centro de Investigación en Demografía y Salud (CIDS). It's a very nice facility that even has air conditioning, a rarity in Nicaragua! However, like most places in Leon, it doesn't have water for about half of the day. Those hours happen to be include working hours. But we do have power! And wireless internet!

The Kissing Bug

From the Moon series, Living Abroad in Nicaragua: "The Chagas bug is a large, recognizable insect, also called the kissing bug, assassin bug, and cone-nose...The Chagas bug bites its victim (usually on the face, close to the lips), sucks its fill of blood, and, for the coup de grâce, defecates on the newly created wound...Besides the downright insult of being bitten, sucked, and pooped on, the Chagas bug's biggest menace is the disease it carries, which manifests itself in 2 percent of its victims. The first symptoms include swollen glands and a fever that appear 1-2 weeks after the bite. The disease then goes into a 5-30 year remission phase. If and when it reappears, Chagas' disease causes the lining of the heart to swell, sometimes resulting in death. Unfortunately, there is no cure for Chagas' disease" (114).

Learn something new everyday.