International Rescue and Relief Students' training culminates in Nicaragua
“Glue the pipe together here,” he indicated with one hand, “and angle the ninety-degree elbow up, like so.” He tweaked the joint, stepped back to admire his work, and proclaimed, “That’s a finished product.”
Posed over a jumble of PVC pipes, brackets, angles, elbows, and drills, Carl Ladd resembled more of a mad scientist than an International Rescue and Relief contract instructor. The contraption at his feet seemed like a prop from some fantasy film instead of a water pump.
Ladd and the four students who assisted in assembly huddle around the pump and discuss the project—how it is both affordable and sustainable; how it connects to a filtration system to provide fresh, clean water; how it shapes the future of community development.
They joined the other four students inside who have completed the frame for a Biosand filter, the second half of the water system. Constructed from a blue 55-gallon drum and PVC pipe, the filter is also cheap and easy to build. Connected to the pump, this system can channel water from a natural source and purify it through the sand and gravel inside the drum, which contains natural microorganisms capable of consuming pathogens and, after one year of maturity, viruses too.
If this technology is shaping the future of water sustainability, then these eight International Rescue and Relief students are shaping the future of relief work. Alongside instructors Aaron and Lauren Kent, this team will spend 89 days in Nicaragua, living, learning and lending the expertise they have spent years cultivating in Union College’s unique Bachelor of Science program.
Over the course of the semester abroad, students will learn survival skills, participate in rural clinics, and volunteer with local EMS crews, all while adapting to a foreign culture and language and taking course work in Emergency Care, Global health, Travel and Tropical Medicine and Expeditionary Leadership.
“This semester in Nicaragua is the seminal experience of IRR,” said trip leader, instructor, and Union alum Aaron Kent. “Everything they have learned over the years leads to this.”
Kent has led the trip to Nicaragua five times and says each one is different. This unpredictability is often due to the varying number of students in attendance each trip. With eight students compared to the 16 from last year, this is the smallest group yet.
“There are unique challenges with so few people,” said Kent, indicating the eight students huddled over the water filter. “That is your social group. That is your family. If one loses patience with another, it has to be resolved, because we will be together nearly every day for three months.”
He assessed the group and smiled. “Social dynamics are always unpredictable.”
Until then, however, the students presented solidarity in their interactions. Juniors Zack Leyda and Josh Wahl joked about coastal survival, which they claim is less survival and more relaxation. “Sipping coconuts, getting a tan, catching some fish,” said Leyda, “it doesn’t get much better than that.”
“It’s gonna be a dream,” laughed Wahl.
“Survival is all about locating food and water,” Kent agreed, his hand straying toward the communal M&M bag. “It’s nothing but foraging. But on the coast, everything you need is right there. Food, water, shelter, it’s nice.” He paused and chuckled, “The ocean survival, however, that is the worst experience known to man.”
Kent referred to the 24 hours students spend together on a life raft in open water. “It’s nothing but rocking and seasickness,” Kent said, grimacing at the prospect.
Once the eight days of survival training are finished, students shift into the medical phase of their semester. This year, the group will be exploring a new region along the Caribbean Coast in the northwestern most part of Nicaragua. The North Atlantic Autonomous Region is one of the poorest and most undeveloped in the country. For two weeks the group will travel by boat through the dense mangrove swamps, delivering medical aid to the indigenous groups living in that territory.
Senior Joellyn Sheehy, who will graduate this year with an emphasis in pre-medicine, is eager for the opportunities and exposure this experience will present. “I want a better understanding of what development work looks like,” said Sheehy, pausing from her drill work on the biosand filter. “And I want to learn the strategies for implementing it.”
Other students express more interest in the opportunities following the medical excursion. Newlyweds Dillon and Erica Whittaker are both eager to work with the EMS crews based out of Managua and Grenada.
“The experience will be unlike anything in Nebraska,” said Erica, who recently quit her job as a paramedic for Midwest Medical. “There will be such a diverse range of patients and cases that one never sees in developed countries.”
For Dillon, this is the opportunity of a lifetime. “I’m just excited to travel,” says Whittaker. “I’ve never done anything like this.” Not only will Dillon be on foreign soil for the first time in his life, he will also be learning and practicing valuable career skills there. “I’ll get the experience I need by working with the fire crews in Managua,” he said. “That will give me an edge when I graduate.”
Getting an edge is an important aspect for IRR students. Graduates of the program are offered such a diverse range of experiences that they are able to pursue careers in many fields. One graduate is a crisis counselor for an outdoor program. Another is an investigator of accident claims for an insurance company. Still another works for ADRA. Many pursue graduate degrees and join NGO’s working in development.
Ladd, for example, has participated in, led, and been sponsored on water-based development projects in fifteen nations, including Sudan, China and Romania. It is because of his passion and experience that Union College brought him back to help prepare the students for their semester abroad.
Even though they may not build a water system in Nicaragua, Ladd believes it is important for them to learn appropriate technology for sustainable development. Their careers may depend on it.
But even greater than the technology, said Ladd, is the mentality of those implementing the technology. “I help students recognize that what most American’s view as ‘problems’ abroad are opportunities to build a relationship and lend our unique expertise.”
For more information on the IRR program check out: https://www.ucollege.edu/irr
Updates from Nicaragua
Throughout the semester, we will post updates from Joellyn Sheehy below as she sends them from Nicaragua.
The Final Countdown (April 16)
There we were: sitting in the back of a Mitsubishi Pajero, fire gear in the back, following a Toyota pick-up filled with rescue equipment and rescuers through the busy streets of Managua. Suddenly “The Final Countdown” by Europe came on the radio.
“If we were in a movie,” I told Rod [Stickle], “this is exactly the song that would be playing.” He agreed. It felt a little bit like the end of the world.
Truth be told, it didn’t turn out to be the end of the world—no sudden volcanic eruption provoked by a super earthquake. There didn’t even turn out to be anything that dramatic, but we did have a nice drive through town.
The fire station stayed on standby through Friday as another earthquake occurred ten minutes before the scheduled downgrade. As a result, the bomberos still couldn’t go home, we stayed close to the fire station, and the government decided to pay for fuel for the response vehicles. The trucks were all lined up and ready to go, and the decision was made to travel to the municipal fueling station in our response groups so as to be ready should something happen during the travel time.
The ride to the fueling station was long, in part due to traffic, but uneventful except for the grand sense of expectation. All of Managua was out on the roads and our vehicles’ sirens and flashing lights didn’t seem to impress them much. We slowly pushed our way through the traffic, people begrudgingly moving aside, and met up with the fire trucks at the municipal fueling station to refuel. Now we were all ready to go. As we drove back to the fire station I couldn’t help but feel cool, half hopeful and half dreading another, bigger earthquake.
The curious thing with disaster and medical work is the paradoxical relationship between the responder and the misfortunate. It’s not that you want anyone to get hurt or have damage come upon them, but if they do you sure want to be the one to respond. A larger, shallower earthquake would have been terrible, but if it does happen it would be preferable to have it occur while we are still in country so we can get some experience.
We made it back to the station with few developments. Except for an electric pole down, which another truck responded to, we were in the same position as when we left: waiting. There were still regular calls as well, though not very dramatic, but the earth didn't seem as though it was going to quake that night.
One thing about disasters, or the threat of one, is that they tend to elicit donations. A beer company gave us a bunch of packaged water, someone else gave money for fuel, and other contributions meant that the station could equip itself for a potential national emergency. Kique, one of the bomberos, noted that the association doesn't have funds to actually prepare for disasters, so they have to wait until one comes about to get the resources they need to respond. It's a sad common trend: we don't think about helping organizations prepare for a calamity or prevent excessive damage, we only offer a band-aid after the event.
The next day involved more waiting and some packing for our group. We were planning to spend another night in Managua and then leave the next day for Leon and the final stretch of our trip (a fun-tourist stretch). We went to Lauren’s friend’s house for dinner, and then Aaron [Kent], Zach [Leyda], and I went back to the station to sleep and be on call for the last time.
It was a quiet night, but enjoyable as we shared stories and information into the early hours of the morning. Aaron talked about mechanical advantage for rope rescue, Zach played pool, and I drank bag juice for regrettably one of the last times. During our week at the fire station our meals were catered by one of the volunteers who owns a restaurant called La Esquina del Sabor.
It was all very tasty and he was very passionate about his art, but my favorite part was the juice he made fresh for us twice a day. We had tangerine, passion fruit, Jaimaica, beet and lemon, and many others, all served in a sandwich-sized plastic bag. It’s quite common across Nicaragua to serve drinks in bags, in part because it’s so cheap, and is in fact one of the best inventions ever.
We had packed up all of our tents and extra gear, opting to sleep by the trucks for the last night. After requesting and being granted permission by multiple parties, I made myself a bed out of turnout gear (fire protection clothing) on top of one of the unused fire trucks: definitely one of the coolest places I've ever slept and surprisingly comfortable.
The next day we had breakfast and returned to the fire station to say our goodbyes. It was a sad affair because many of us had some very positive experiences and learned a lot from the bomberos, so saying goodbye wasn’t much fun. But we exchanged Facebook information and several are even considering coming to IRR’s summer program.
While I started out apprehensive and skeptical about how firefighting could be beneficial to me personally, but it has turned out to be one of the best experiences of the semester (even without a super earthquake).
We had a great experience living and interacting with people who consistently give their time and strength to helping others, including teaching us. And they’re not just in it for a short spurt. Many of these bomberos have volunteered average six or seven years. Most of them are still young, and all of them are super dedicated.
We made it to Leon, still unsure about future seismic activity, but playing the tourist instead of the rescuer. We had another quake on Sunday night, just after I’d gone to bed, but nothing since then.
The worst part of it all is that we are unlikely to go volcano boarding, a unique activity where you slide down a volcano on a board. Leon is allegedly one of only two places in the world that offers such entertainment and it's supposed to be a really good time.
Our plan was to go on Wednesday, but due to the country being on high alert, the volcano activities have been canceled during out stay. I have to admit to being a little sad for no earthquake and no volcano boarding, which seems a bit of a double whammy. Our group’s guess is that all the action is probably going to happen right as we leave, such as lava spewing out of a volcano just as our plane leaves the ground. But then at least Dillon could get it on his GoPro. If anything does happen it had better be within the next 56 hours, otherwise we will be gone from the country.
El Nino y Los Bomberos (April 11)
The whole fire station is on earthquake standby and pretty much all of the thirty some volunteers are on call.
It all began yesterday around 5:00 p.m. Dillon [Whittaker] and I were coming back with the firefighters from spraying down a model in the back of a Toyota for a TV commercial (that’s all I’ll say on that story), when we stopped off to check the structural integrity of a stage for a techno concert that night (it really has been a varied week). Meandering through the field examining the setup, we were escorted to the front stage and walked under it, checking the fixture points. As we were on our way out, suddenly the stage started wobbling. Wondering why the others were so violently shaking the scaffolding, I realized that actually the whole ground was moving due to an earthquake of about 6 something on the richter scale.
We cleared ourselves swiftly from the structure until the quaking was over. Deciding that if the stage handled an earthquake so well, it was probably okay for a DJ, we drove back to the fire station. A few buildings had apparently suffered some damage, so two groups went out to do more safety checks, while Dillon and I cleaned up and grabbed something to eat. We had gone out to a wildfire right before lunch and were then successively called to the commercial and inspection.
That evening, we planned to join the bomberos in providing emergency services for the concert. The fire truck left early and the rest of us piled into the ambulance to head to the potential rave. We joked and chatted as we drove, all squashed into the back. As we arrived at our destination, new orders came in to return to the station. The concert was cancelled because of the earthquake, and the station was going into standby in case of more.
Being a non-Spanish speaker is confusing pretty much all the time at the fire station, especially when something important is happening (a.k.a. the most important times). I can ask how you’re doing, find out your age, even understand if you tell me that your cat’s name is Bob and he thinks he’s a goldfish, but unfortunately none of this does any good when it comes to disaster response briefings. In all honesty, I’m not sure anyone knew what was going on, but we settled ourselves to playing pool while food was eaten and the issue discussed.
More people kept coming to the station and the rescue equipment was itemized as the final decisions on task force divisions were made. At the end of the evening they lined all of us up in rows and briefed us on our roles in case of an emergency. We would head out in teams depending on the call and resources needed. The Union group was partnered with the most proficient English speakers and interspersed on the ambulance, fire truck, and Selim’s Jeep, where we would work as medical back up.
Excitement was high and organization admirable. After the briefing we were all advised to get as much rest as possible, but to keep our gear close at hand to be ready to leave. Anything could happen, or nothing at all. Tired after a long day (I’d been on call the night before so had slept lightly), I headed off to my tent, placing shoes and socks by the door.
The next morning the bell went off early. It wasn’t an urgent ring, only a few sounds, and no one was rushing around or yelling. We’d passed the night calmly and it turned out that this call was only a normal water run. Sometimes the bomberos fill up people’s personal water tanks or pools in exchange for fuel money. I dozed in my tent.
Maybe an hour later (I don’t know how long it was; my clock’s screen is broken), but still early morning, the somber strains of a brass band floated over the station. My first thought was that the procession heralded a funeral, but as I poked my head out to see the source of the Godfather-esque music, I saw a small ornately dressed effigy of Jesus leading the way on a pole down the road. One week away from Good Friday and heading into Semana Santa (the Holy Week leading up to Easter), I identified the Catholic church on the opposite side of the street as the source of the procession and drifted back into a light slumber. This was the second of such processions that we’d seen in the past two weeks during the run up to Easter. When heading towards Granada, our truck was paused for some time as we waited for a pilgrimage of thatched wagons to pass by following a life size image of Jesus, wrapped in robes and crown and heralded by fireworks. Coming from a more religiously quiet background, I found such public displays of devotion and celebration both bewildering and fascinating at the same time. While still unsure what I think of it from a religious perspective, from a cultural view, they’re awesome.
When I got up, nothing much had changed from the night before. We were still on standby and even had another, smaller earthquake during our morning meeting. Not many of us felt that one, but it cemented the impression that we weren't clear yet.
El Niño fights fire
Life continued as normal on the streets of Managua. As Selim said last night after our briefing, “We’ll hope for the best and prepare for the worst.”
Preceding these latest developments, life at the fire station has been both crazy and relaxed. Interspersed with long periods of nothing and nonstop action, it’s been a good time getting to know some of the volunteers, their nicknames, losing to them at pool, and struggling to communicate through language barriers. Despite many of their nicknames not being very flattering (for example, there’s Dog, Crazy, Stick, and Suck…as in the verb), I got off easy with “el niño”—the boy (since I chopped off all my hair at the beginning of the year, it’s not too hard to figure out why I got that one).
Never having done any fire work before and not being, well, strong, I felt very incapable coming into the week. We set up tents on the Saturday night and the next day Dillon and I went out with Nelson “Chuito” and Teran to inspect a stage and practice with the water hoses. We sprayed down the driveway, trying to wield some form of technique, and then got a real call to respond to a wildfire. The hottest month of the year, April has left many vacant lots dry and prone to catch fire.
We were not the first to arrive on the scene and instead came in as back up, supporting the actions of the other teams. Dillon got some time on the hose and I worked to maneuver it across the bushes and tall grass.
Having had a gentle introduction to fire, I wasn’t on call again until Tuesday. Zach, an actual firefighter in Colorado, and I had a quiet morning, but in the afternoon we were the first on the scene a wildfire by the highway.
My respect for firefighters everywhere has skyrocketed after this week. Clothed in protective gear and helmets, but without any breathing apparatus, they charged in to tackle the fire with hoses and shovels. I tried my best to keep up, but as we moved into the heart of the field, smoke pouring out from every side, I found it more and more oppressive and confusing. I didn’t know which way to breathe or what I should be doing to help. The heat close to the fire was too much to use the shovels, so I strove just to pass around the water I brought to those on the hose and driving. Having already refilled the truck once, we soon returned to the station to get drinking water and I switched out with Ren [Kent] and Rod [Stickle].
I’m awed by the bomberos determination to proceed and their ability to breathe apparently pure smoke. Firefighting will probably not become one of my biggest hobbies in life, but coming out of this week I’ve certainly gained a healthy respect for those who do it. Dedicating time and talent to helping others, whether rescuing a girl from her 30 foot fall into a latrine or removing beehives with a truck filled with laundry detergent (both true stories. Serendipitously, they actually happened on the same day so we got to clean the hose used to retrieve the girl from the latrine with the extra laundry detergent from the bees), these bomberos have additionally gone out of the way to make us feel comfortable, have fun, and learn only a tiny portion of their great craft. It’s been a good time, and really more people should volunteer.
Hippie Heaven (April 5)
II love the idea of the hippie lifestyle.
I want to live sustainably, eat organically, hug a few trees, and frolic in waterfalls. Practically, however, I like modern convenience, I usually buy the cheapest options, and find little personal satisfaction in a tree's embrace. That being said, our stay at Finca Bona Fide (Good Faith Farm), a permaculture research farm and non-governmental organization, was very enjoyable and memorable.
Transitioning from the Atlantic coast to the Pacific part of the country, our group was led by the last leadership team of the semester, the fearless duo: Captain Redbeard [Rod Stickle] and yours truly. Our week would consist of logistical uncertainty as we visited non-governmental organizations, expanded our understanding of community development programs, and explored new territories never before visited by Union College. Our very first destination was on the island of Ometepe, which none of our instructors had visited previously.
Lauren [Kent] and I had flown to Managua early at the end of the previous week to attend a conference on non-profit organizations in Nicaragua hosted by the U.S. Embassy (experiencing a 5.5 earthquake in the process. It was about 60 km away, so we were fine), leaving Rod to negotiate with La Costeña Airways for our trip across the country.
We regrouped Sunday afternoon, stayed the night at the courtesy of one of Lauren’s friends, and then left the next morning for Ometepe, a volcanic island in the middle of lake Nicaragua. A private bus took us the first part of the way to the docks at San Jorge, where we caught a small ferry to Moyogalpa, one of many touristy spots on the island. We were trying to save money by using public buses as much as possible, so we waited around a while for the 3:45 p.m. that went past the aforementioned Good Faith Farm. We had directions, we checked in with the farm, I had even talked with a nice man who said he would ask the driver to stop at the entrance to the farm, but I still stressed out the whole two-hour drive that we were going to miss the entrance. Generally, when traveling by myself it’s not too big a deal to miss a stop/bus. You can always get another one. But the weight of responsibility for a whole load of people getting to the right place at a decent time is another story, and a lot more frightening.
In the end, the bus worked out and my fretting was for naught. We arrived at a wooden sign proclaiming the entrance to “Finca Bona Fide” and all that was left was to figure out the bewildering directions up the hill to the actual compound. It was night as we climbed the path through the woods, around large mounds of dirt, past outdoor shower stalls, and into a new world of eco-friendliness.
It was pizza night when we wandered in, dirty and sticky from traveling in the heat, and they were firing the pizza bases in the giant cob oven. Barefoot and tanned, the volunteers were a diverse group from all over the world, but each was welcoming and generous. We stayed three nights in this alternative living space, completely off the grid utilizing solar energy, a natural spring, and compost toilets, and growing the majority of its own organic food.
The volunteer coordinator showed us to our sleeping quarters, a roofed structure open to the elements on all sides with bamboo beds, thin mattresses, and mosquito netting. The group had mixed feelings about the conditions, but I think two of us liked them. Then we met with Mitch, our teacher for the next few days.
Impressions of Mitch were mixed, but I think everyone thought him to be a quintessential hippy (opinions differed mainly on if that was a good thing). No one contested, though, on whether he knew his stuff.
The first day we arose early with the other volunteers and worked on the farm until breakfast, then had class on the basics of permaculture. Probably about 15 minutes into the lesson, I became a complete convert and wished I liked plants more so that I too could go grow things and help save the world.
The farm had been started about 12 years earlier on an empty field used solely for grazing cattle. Today it flourishes with large trees and plants everywhere, giving the impression of untouched forest. Our visit was in the height of dry season, but we were still surrounded by the green leaves of plants that were never watered.
The purpose of permaculture design is to plan out your farm/garden/living space to be as sustainable, productive, and secure as possible. Because there are many risks associated with planting a single crop, permaculture calls participants to diversify their crops and intersperse them so they feed each other’s needs, making crop rotation unnecessary and petroleum-based fertilizers redundant. With multiple plants fruiting at different times, crops are planned to harvest throughout the year, as often as every month, and the leftovers are used to mulch others.
For example, once a banana tree has finished producing, it dies back. Part of our job on the first day was to hack the stalk to pieces, carefully placing the remains around other trees. Doing so fertilizes them, provides extra moisture, and saves time from cleaning up bio waste. Other aspects of the farm’s setup were also designed to promote growth, optimum nutrients, and minimize work. Shrubs in need of shade were planted near trees, and nitrogen-fixers lived alongside other plants that needed it, with fungi everywhere mulching on logs.
Grey water from the hand washing station was piped to trees that needed more moisture, and any plastic was stuffed into bottles to make tightly compacted Eco bricks, which could then be used in the walls of natural buildings. Leftover food was given to the pigs or chickens, or used in one of the many compost stations. Even human waste, or humanure, was either processed into a special kind of fertilizer for trees, or they just planted a tree over the latrine once it fills.
Meals were mainly vegetarian, except for fish at lunchtimes, and consisted of spicy greens and fancy vegetables from the garden. Breakfasts hosted homegrown fruits, and it all made you feel clean and healthy inside (well, me at least). Showers were open and free, offering a panorama of the landscape and volcano. I’m really not sure where the Wi-Fi internet access came from, though.
I was in paradise: a happy haven heralding holistic, healthful living. I could learn from each one of the volunteers all day, and pretty much did. We discussed the importance of fostering microorganism growth in soil in addition to the volunteer’s experiences and plans.
It made me question the elaborate plans I construct for myself that focus largely on personal advancement up an invisible ladder. What am I striving for? Would it not be best to concentrate on being a better person right now and helping those around me?
This was my conclusion as I absorbed everything around me and wrote down the perpetually increasing book list that was sure to expand my mind.
People Helping People
I was sad to leave the farm and its organic vegetarian cuisine, but the time had come. We headed out on Thursday for Granada, one of the main tourist centers of Nicaragua and purportedly the oldest colonial city in the continental Americas. The purpose of this week was to learn more about various types of NGOs, and we were thus moving on to interact with a micro-financing group called People Helping People (PHP).
We moved back across the island to a port, taking a larger ferry. Everyone was more comfortable this trip, and Rod and I were more confident in the directions we'd been given. After arriving back in San Jorge, we had began negotiating our trip with a bus driver when Tony, the administrator of another NGO in Managua, offered to take us straight to Granada. Bypassing a complicated bus transfer, we accepted (after determining it was safe) and were driven right to the city center of our beautiful destination.
Granada is beautiful in a far different way than our other stops so far. With colorful buildings and towering cathedrals, it boasts a much more European feel and a plentitude of street vendors (you need never search for sunglasses, they bring them right to you every five minutes). It was fun for me to hang out in a city once more and browse through cobbled streets and art exhibits.
We interacted with PHP on the Friday, meeting up in the late morning to learn more about the organization and then making the rounds to collect repayments over lunchtime. It was interesting to see in person what we’ve read so much about in development books and news stories.
At first I wasn’t too impressed with their business model, largely because they do not charge interest and thus can never expect to be a viable business. But as we learned more and walked around I began to see that they really were helping people. With a greater than 90 percent repayment record, they must be doing something right. Nowadays I often get caught up in the thought of how to precisely do development work, almost as a science, but perhaps it really is better to just go and do something. It might not be perfect at first, but at least getting started you’re learning what works and trying to make a difference.
Off to catch the bus for Managua, this next week will be interesting as we stay at the fire station and run calls with the volunteer fire fighters. We certainly get a lot of diverse experiences in this semester.
Going West (Mar. 29)
It’s pretty interesting how people can change. My mother loves to remind me of how squeamish I was about germs as a child and unwilling to travel anywhere without a flush toilet. Now, while I would prefer to have some sort of enclosed latrine, let’s be honest, a crop of bushes will do just as well. I did draw the line earlier in the semester against using the side of a medium-traffic road with little cover, but had it been nighttime, I’m sure even that would have been a different story.
The previous week we journeyed along the river Wawa to the villages of Kukalaya (“coconut water”) and Layasiksa (“black water”). We left the docks of Puerto Cabezas Monday morning for what was supposed to be a four to six-hour journey. While many boats can make it in two hours, ours was a bigger boat with more weight and consequently went much slower. Students, cooks, translators, and luggage all piled on and set off down the river.
The journey took us through a hand-dug canal and into some swampy regions. The going was pretty smooth, but the water was shallow, especially because we passed through during low tide and our boat was especially loaded down. We got stuck part of the way through the canal, but it eased up as we entered the jungle part of the swampy maze, the haunting echo of howler monkeys in the distance.
I have no idea how our drivers found their way through, and in fact they didn’t for about an hour and half when we got lost, but eventually, with the help of some nice fishermen who were only going to charge us a little bit, we arrived just after sunset.
A group of people met us at the docks of Kukalaya, which was a little unnerving at first, because all we could discern was a crowd of ominous figures on shore. It was already nightfall and they were quiet (or maybe the boat was just loud) so we only noticed them as we pulled close to the pier and scanned it with our flashlights. Everything was fine in the end; Ericka [Whittaker] and Josh [Wahl], our leaders of the week, met with some community leaders to set us up with a house to sleep in, a place for the cooks to sleep and work in, and a church to host the clinic in the morning. We got luggage ashore, set up sleep systems, and then more or less crashed after a feast of rice with beans.
Clinics, kids, and hazardous swims
The next day brought one of the largest groups of patients we had seen. Our group was only a third of the size of the previous week (there were more nursing students than IRR this year along with instructors and additional volunteers), but we saw 189 patients. Adam [Neep] and I worked together for what I think was one of my more educational clinics, involving multiple pelvic exams and three stitches (my first on a real person).
By this stage we were in a pretty good clinic routine. When we got to the church we set up the pharmacy, the women’s clinic, and triage, then settled ourselves with a translator at our respective benches. Treating mainly worms, coughs and arthritis (hard physical labor takes it toll on the joints), Adam and I took turns as leading provider to ask questions, listen to lung sounds and take blood pressures.
My favorite patients are usually the kids. Generally, people are not direly sick in the clinics, so you can smile and joke with the children. It’s hard to take vital signs of the little-little ones since they burst out crying whenever a giant white person comes towards them with a thermometer. Sometimes with a little coaxing they’re okay (either that or their parents just hold their arm down over the thermometer and let them wail). Adults can be harder to read. They often list off a hundred different problems but don’t really look sick at all. Others will only mention something in passing that seems like a big deal. Maybe they’re not really sick at all and are just coming to get medications, but we treat regardless. It could be that they don’t have a fever or pain now, but they might in the next month when there isn’t any clinic.
The next day we weren’t allowed to have clinic in the church anymore. The pastor was happy for us to use the building to see villagers, but the other church leaders didn’t think it was appropriate so we transferred to the town’s government clinic. It was a little smaller and farther away from our house, but in the end it worked better. The nurse had absconded to Puerto Cabezas for about a month, which is apparently a problem with many village medical providers (apparently they have to travel there every month for medications and supplies and sometimes just don't come back for long periods of time), so we had free reign over the facilities.
Josh and Hoover, one of the translators, had traveled to Layasiksa the previous evening, encouraging as many as possible to come to the clinic in Kukalaya the following day. We had a good mixture of people from both villages that day, and could even draw medications from the government’s supply for what we didn’t have. Aaron and I worked together with Isabel, our wonderful translator, and I gave a lot of shots in the butt (I’m just in this degree program for the glamour, really).
We cruised through that clinic, rotating groups out for lunch, and finishing in the early afternoon. Everyone was hot and sticky, so Dr. Caldera suggested we drive the boat out a little way and go swimming. There was talk about alligators and piranhas, but we didn’t see either of them, a little sadly, and had a relatively normal frolic in the sun and silty water. Hoover suggested the water probably wasn’t the cleanest, so I was persuaded to take another shower when we got back.
Our bathroom and shower huts were about 15 meters from our house and I think they were used by the community. I never did figure out whose house we stayed in or whose stuff we were using. The water well was nearby, so all our amenities were close at hand. I had an informal, silent lesson from a little girl one night about how to draw up water. I got there right before her, but figured I would let the professional have at it first. She expertly filled her little bucket while I watched and waited, taking mental notes. When it was my turn, I was a tad slow, but eventually got the job done. She watched me the whole time, which was a little unnerving, and then closed the well up and walked back ahead of me as I struggled with my full bucket. Granted, hers was maybe half the size of mine, but she was only about seven and wielded the bucket around professionally...I’ll work out when I get back.
At night the grass field between our house and the latrines would fill up with giant bullfrogs (or maybe just normal-sized, but they seemed pretty big to me) so that you’d have to be careful not to crush a frog, which was always a good time in bathroom emergencies. I was following a frog around one evening (as you do, well, at least we did. You’d be sitting on the porch and see a headlamp inching across the grass and could pretty much assume they were following a frog) when suddenly a child appeared out of the dark.
“Ninam dia (what is your name?)?” he asked me. I answered and repeated the question back, proud of myself to know what he had said. He told me his name and then asked “an mani brisma (how old are you)?”
“Cut it out kid,” I thought, “that was the only other phrase I knew! Now I've got nothing.” I gave him my age and repeated the question back, trying to think of some other Miskito word so I could add to the conversation. Well, “tutni yamni” I said, using the wrong greeting as I walked away. Oh well, I tried.
Medical excursions and language barriers
That Thursday we walked out to Layasiksa, the neighboring town about an hour away. We set up in their government clinic also, except the nurse was around and was an active member of the community. She had made a list of house calls for us to make, mainly bedridden elderly, and was preparing to go give vaccinations.
The leaders divided us into three groups and we went out with the doctors and nurse to give vaccines and pay visits. Dillon [Whittaker] and I went with Dr. Caldera and Brenna, a physician assistant from North Dakota and provider over our clinics for two weeks, to visit several older ladies. The first was a tiny woman in her eighties who had a hip-femur fracture and was never treated. She lay on the floor and winced as Caldera examined her ill-healed joint, breathing rapidly as her asthma prevented deep breaths. There wasn’t much we could do for the joint, but we gave her some medicine for the pain and asthma. She was a sweet little lady and spoke in Miskito as her granddaughter translated into Spanish. The younger woman told her we didn’t understand, but she still looked deeply into our faces as she spoke to us, making me wish that I could ask something deeper than just “how old are you?”
The other house calls were cases of joint pain, female problems, and a bad case of bed sores. We did what we could and then headed back to the clinic, where long lines of people were queuing up. Aaron [Kent] was running triage by himself (indicative of his advanced skills in Miskito) and I joined Josh as a provider group, overseen by Caldera. We’d lost most of the morning trekking around the village, but settled into our group and quickly got to work. There didn’t seem to be as many worm cases in this village, and we discussed afterwards the significance of having a very active nurse in the community.
We hiked back to Kukalaya that evening and prepared our things to leave early the next morning. This time we wanted to hit high tide, so we planned to leave around 2 a.m. An elderly lady Dr. Caldera had visited earlier passed away while we were gone, so the family held a vigil at their house. They rang a bell several times and played instruments and sang through the night so that when we got up, the community was still paying homage. It was nice to see people stand together at such a time. Elderly people in Western countries so often are left alone, as are their family when they do pass on. It was nice to see people support one another and grieve together.
Missing our target by a few minutes, we left shore at around 2:20 a.m. Leaving at night presented a few problems in and of itself (we’d gotten lost coming in during the day time, the cover of night doesn’t tend to help that process). But with Josh’s high-powered flashlight that could practically illuminate Saturn, we got through okay. We rested up the remainder of the day and Saturday, packaging medications on Sunday while half the group taught CPR at the airport.
Monday we had our last village clinic, travelling some four hours to Awastigni, on the way to Tronquera. We left early, around 5 a.m., and were tossed around on the bus before arriving at the remote town. The language skills of the villagers were a lot more heterogeneous than in some of our past clinics. The town was mainly Mayagna (which apparently shares roots with Miskito), but many also spoke Miskito, Spanish, and even English. After a little bit of concern about whether we’d be able to communicate through our Miskito/Spanish translators, everything worked out fine. We did a house visit for a 20-year old boy who had been suffering from a fever and dehydration. Ericka and I gave him an IV and after a hefty dose of acetaminophen, he looked a lot better. Word had it that he was even walking around by the time we left that afternoon.
We got back late from the clinic and slept in the next day. I traveled with Ericka, Dillon, Zach [Leyda], and Aaron that afternoon to the airport to teach first aid, and everyone else taught CPR once again at the orphanage. Wednesday was our last clinic day. This clinic was specifically for the staff at Verbo, their families, and the children at the orphanage. It was fun to chat a little more with some of the familiar faces, but a little disturbing also to treat the ladies who do our laundry for joint pain related to their work. It made me realize that we are not exempt from contributing to this cycle of degenerating health. (I'm not negating that they need jobs and should be working, the whole situation just seemed rather ironic.)
Brenna, Ren [Kent], and I left Puerto Cabezas on Thursday—Brenna to go home and Ren and I to attend a meeting in Managua before the rest of the group arrived. While I was glad to think that I would get to see my family soon and then go home, it was sad to drive away from Verbo knowing that I may never go back. I had a wonderful time and met some amazing people, but another chapter is ending that has been very educational and fun. We have three more weeks left in country and then only a few more until graduation.
I don’t mind moving on to do new things, I just wish sometimes it didn’t have to include so many goodbyes.
The Show Sure Went On (Mar. 15)
After trudging through the jungle, scuttling round a beach, and sitting on a boat for 24 hours during survival training, we were ready to kick it on Little Corn Island for a week. A total area of about 1.1 square miles, Little Corn didn't offer much variety in its destinations, but a bed and regular meals were greatly appreciated.
We sampled the restaurants' fine cuisine, took advantage of our scuba diving certifications, and read a lot, until finally spring break was at an end. The Frontier Nursing class was scheduled to join us to travel north to Tronquera and other smaller towns for to run clinics. We were also beginning a leadership practical portion of the semester. Adam and Zach [Leyda] were designated the "leaders of the week" to manage our impending travels back to Puerto Cabezas and migration north with all of the nurses.
A little sad to be leaving a holiday on the beach for camping in the jungle with sweaty days in clinics, we flew back to Bluefields and boarded another aircraft for Puerto Cabezas. Little Corn was small, and I was glad not to stay there too much longer, but clinics sounded daunting and I was nervous of the upcoming demand on my medical skills.
Our last flight was delayed so that we arrived in Puerto Cabezas right after the nursing group and rode together in the bus back to Verbo. It felt like we were returning home as we passed all the familiar spots: the hospital, the little market stalls, that place where they always sell dead sea turtle, and Verbo's beautiful compound. The staff welcomed us back with smiling faces, and the whole group chomped into pizza as we were briefed on what was to come next.
We’d leave Puerto Cabezas within a few hours, arrive in Tronquera that evening, and stay with Clint and Marilyn Hanley, founders of Wings Over Nicaragua.
Despite having already sent a separate truck ahead with supplies, luggage, two students, and a translator, the bus was crowded and stuffy. I sat in the back with Gerald, one of the translators, who chatted with me and tried, largely unsuccessfully, to teach me words in Miskito.
A somewhat modified ex-US school bus (as are apparently most of the public buses in Nicaragua), the bus bounced a lot on the well pot-holed road. As the luggage was stacked to the ceiling in the back, Brianna, a nursing major, and I tasked ourselves with preventing anything from falling on peoples' heads or out the windows (a more active role than you might guess).
Adam and Zach were well into their role of leaders that day. Unfortunately, Zach got sick and we had to make many stops along the way. But he powered through with a smile on his face—demonstrating to me one of the attributes of a good leader.
Finally, after many hours drive, we arrived at the Hanley’s and set up tents and camp. We’d have to purify our own water for the week and shower in a waterfall (some parts of my degree are almost too much to bear), getting up early in the mornings and potentially going to bed late.
After resting over Sabbath and visiting one of the Seventh-day Adventist churches, we had our first clinic in Santa Rita and saw about 60 patients. I was in triage with Marissa, a nursing major, where we essentially did intake of patients and began their clinical sheet. The day went by pretty smoothly and we even began to see a few patients ourselves as the day progressed and intake slowed.
The next day we traveled to Miguel Becon for one of our larger clinics where we saw roughly 240 patients, and then stayed the night in the school. In the morning we rode the bus part of the way and walked the rest out to Capree, a smaller and more remote village. We walked out the same day, had dinner in Miguel Becon and then drove back to Tronquera for the night, which allowed us to shower and maintain personal hygiene. Our next clinic was in the actual town of Tronquera, which was quite simple as Marilyn works there consistently. We then did two more clinics, one in Teekamp and the last in Buenos Aires.
My favorite was the final clinic, though it wasn't very long. In some of the other places we traveled, the kids and adults seemed more closed and wary of us coming in. But in Buenos Aires, it was a lot easier to connect with people. Near the end of the day I was managing triage and ended up playing with about 15 kids, just chasing bubbles. One of the girls who had been my patient earlier in the morning offered me a local pear.
I had seen them all munching on them and I knew she'd got it from the several families picnicking on the side of the hill, but should I eat it? It had very thin skin and if it sat on the grass for a while, parasites could have penetrated the outer layer.
I looked at her earnest face, knowing that it would be easy to say “no thank you” and wondering on a scale of one to rude how bad it would be to refuse. “Oh well, I'm probably infested with parasites anyway,” I thought as I took the pear, rubbed hand sanitizer on it and my hands and then bit in. It was good, and I liked this decision.
The girls giggled as I munched away, making me wonder if perhaps they'd intentionally given the wormy pear to the foreigner as a joke (I mean, it would be funny), but it tasted good enough to be worth that, too. In reality, I'll probably never know conclusively what gave me worms because the groups' water filter broke on one of early in the trip and we didn't really realize it until later. Additionally, giardia takes about 7-10 days to set in, so by the next email we should have some closure on that topic.
It's not going to be fun sporting diarrhoea on our river trip in the next few days, but as I'm sure Zach would agree, what kind of adventure would this be without some sort of gastrointestinal problem?
There ain't no real food here but some chickens (Mar. 3)
I never thought of myself as a huge outdoors person. Deep down I’ve always known I was a city girl stuck to my metropolitan conveniences, I just never really knew how much.
Our last few days at Verbo were relaxing and fun. We visited the organization’s private beach a couple of times and chatted with the most recent mission group fresh from New York City.
On Monday we took our Travel and Tropical Medicine final exam—the last written test at our collegiate experience for Adam, Dillon, Ericka, and me. We then packed and sat through leadership and survival classes until Wednesday, when we left Puerto Cabezas on the smallest commercial plan I’ve ever seen (though apparently they do get smaller).
Random laughter does not instill confidence in one’s pilot
There were fourteen seats in all, two of which belonged to the pilots seated directly in front of the first row, one to a random lady, and the rest occupied by our group. As we cruised down the runway the pilots spewed the safety messages in garbled Spanish over the intercom, forgoing visual “how to fasten your seatbelt” or “don a life-vest” reenactment. As we sped up and began to lift off the plane wobbled from side to side disconcertingly, but eventually evened out. As the plane soared higher, so did my confidence.
From the air, the sea was a perfect blue, broken only by dark reefs or the shadows of passing cloud—demonstrating the beauty of this tropical haven. We all gazed out the windows in meditative silence, at least partially because the engine noises made it challenging to speak even to the person sitting beside me—and eventually slipped into thoughts, slumber or a good book. I was halfway between dozing and musing poetically on my future when the pilots suddenly burst out laughing, startling half the plane. They said a few more words to each other and then fell silent again.
“Ok,” I thought, exchanging bemused glances with the others, “that’s cool. Just so long as they’re not crying or screaming I guess I won’t complain.” The passengers sank back into comparative silence, but now prepared for the next few bouts of apparently random and enthusiastic mirth.
We landed smoothly in Bluefields, a more predominantly Creole city in the southern autonomous region on the Atlantic coast, grabbed our gear, met our contact and scooted off to the hotel. Aaron [Kent] left to go meet Tyler [Anderson], who was coming down for ten days to replenish funds and teach classes in survival. Unfortunately, Tyler’s plane had been cancelled, requiring the drafting of a new, creative way to transporting him across the country to meet us in time.
The next day we were joined by the newly arrived Tyler and Aaron and headed out for our survival adventure. We took a half hour trip by boat to Pearl Lagoon, a picturesque coastal town I didn’t get a chance to explore. There we picked up some food, water, and “Dell,” before moving on to Cocabila (your guess at spelling it is as good as mine), another coastal town some 45 minutes further away to do our survival training.
As we emerged onto the island, we quickly moved all of our bags and supplies under the awnings of a large thatched hut to escape the oncoming rain, and then chomped away at the food Dell had prepared. Our contact in the region, Dell facilitated many of our arrangements for guides and chickens (live ones), as well as bringing sumptuous food and generally making us feel cared for.
The trek into the jungle that afternoon would take about an hour and a half, so we shed all unnecessary items and left them in the thatched hut for our return. Having dined, filled water bottles, and emptied packs as much as possible, we waited for our guides, the chickens, and breadfruit to arrive to start the hike.
As part of the whole “survival” experience, we were not taking food with us for the next two nights and three days except for four chickens and breadfruits (not to be confused with “fruit bread,” which Dell also insisted we take).
I knew we would learn to set traps and snares, but it was unlikely we would catch much in so short a time. We still needed to learn to prepare meat—hence the chickens. One of two vegetarians on the trip, this skill is not one that I had previously sought, but still considered it important to have some level of familiarity should I be in a situation to need it. I’m vegetarian because I like animals alive and don’t see a personal need to eat them, but in preparing for extreme circumstances I reasoned that this might not always be the case.
And so we set out through the little town and into the jungle with our packs, a pot, a bag of breadfruit and four chickens wriggling in tow. Split into four groups of two, each group had a chicken and Zach and I split the trip carrying “Cane.”
Some of the chickens were pretty chill with whole ordeal. “Jorge” just sat in Adam’s arms and Josh whispered to “KFC” to do his bidding. Cane, however, appeared to sense his impending doom. He squirmed periodically and had to be carried upside-down at arm’s length at times, but I tried not to make the trip so unpleasant.
The walk was muddy and muggy, with more sun exposure than I anticipated (I should have sunscreened my shoulders) and less plant identification. It was well into the afternoon when we set out, so we plugged through the hike quickly to set up camp before dark.
Half the group brought hammocks with bug nets and tarps and the rest of us set up tents on the ground. I haven’t done a whole lot of camping, particularly in the last two and a half years, so wandered around the place trying to figure out where to set my tent. Eventually I decided (with advice) and borrowed a machete to clear the grass and weeds, feeling very powerful as I did so. Never underestimate the great feeling of importance that comes with holding a machete. There wasn’t a great deal to do after setting up camp as the sun had pretty much set and the bugs were out, so we went to bed early.
The next day we had our official activities and set about to survive in the jungle. The priorities when you’re stranded anywhere are finding water and shelter. We brought water with us for at least the first few days, a local source in a hole in the ground filled with groundwater, and we also had filtration systems. So we set about building a group shelter.
If there is one thing I learned from the whole experience, it is that you should never underestimate the usefulness of a machete—even a blunt one. For whatever reason, should you find yourself lost in the jungle or on the coast, make sure to have at least a machete. You can chop small trees with them, skin fruit, dismember animals (not the most pleasant use, but in such circumstances an apparent necessity), and prep yourself some coconut water. Of course there are a thousand more uses. Remember, with great machetes come great responsibility, and great opportunity to not die in the forest.
Jungle survival was not particularly the favorite of anyone in the group. While I couldn’t say that I hated it, I was glad to be done. I learned quite a bit from the experience including how to kill and cut up a chicken in multiple ways (though I only actively participated in the plucking—still not very pleasant) and ways to improvise materials when building a shelter. Fire starting in the jungle is hard, especially in the rain, and I can run on very little water when I don’t want to use a filter or pee very often in the jungle. In addition, I discovered that surviving without technological (or other people’s expertise) is rather hard and something I’m not sure I’d be very good at. Also, sloths are rather adorable and don’t feel particularly soft. I know this because our guides found a little one and brought him over to us. Don’t worry, nobody ate him; the guides said sloth tastes bad.
We spent another night in the jungle and learned more about what to eat, what it’s like not to eat (this lesson carried on for much of the next week), how to set up snares, how to make bowls, and how to emotionally handle always having dirty hands. (I’m just kidding, I never could figure out how to deal with it.)
When we finally made it out of the jungle, everyone jumped into the ocean to clean off a little and rinse clothes. The many layers of insect repellent mixed with sweat and mud on my skin made for a pungent mess. It was nice to have some semblance of cleanliness, after which we were given our first proper meal (rice, beans, and coleslaw) since we had left (other than chicken for some, breadfruit, and fruit bread). We slept around the hut that evening and then woke early the next day to catch our boat out to Pearl Lagoon to make the next transition into coastal survival.
Even though we got up early and were prepared to leave a little after sunrise, it was a long while before we made it to our destination in the Pearl Keys. Several delays including a paper work mix up meant we had to wait a while at the navy base. As we sat by the barracks, I could see the television through the window as one of the guards was flipping channels. Seeing the Canadian flag flash across the screen and a bunch of Canadians lined up looking important with the Olympic symbols in the top right corner of the screen, I grabbed Rod’s [Stickle] attention only to see the guard had flipped the station when we looked back. A loyal Canadian distraught to be disconnected from the world the weekend of the hockey Olympic finals, Rod became a little frantic from my brief description of what I’d seen. That was the day very day of the final and he didn’t even know if Canada had made it. Spoiler alert: For those who don’t know, Canada took the gold in both men’s and women’s hockey.
We all sat glued to the screen for the rest of the half hour, willing the “flippant” guard (because he kept flipping the channels) to switch back to the Olympics. It was thought best not to ask them directly, as they did have guns and looked grumpy, so we left for coastal survival with Rod and Josh [Wall] ignorant of their great country’s athletic achievements.
That is one tough coconut
The ocean called and we answered. We skipped across the water (literally actually; we would catch air periodically) and headed over the sea, the water a mix of deep blue and turquoise. The Pearl Keys consists of numerous small islands, some sporting only a lonely coconut tree and others several hundred. Our little island neighbored the island where they film the Italian version of Survivor. We swam over to the coast twice but didn’t see anything interesting. Only about 500 meters long and 50 meters wide (both are complete guesses, but be sure that it was small), our island was also home to a large abandoned house. A caretaker lived there permanently to manage the place for the American owners who has tried to build a mansion, but were forced to stop when they discovered the house was too big for local regulations. Now it just sits largely finished and wholly unused.
If you tried to imagine a tropical paradise, you would probably think of this island—white beaches, crystal clear water, gentle breezes, deep blue skies, coconut palms. Our task: survive on the beach for three days and three nights. Fortunately, we all the coconuts you could need (and probably more than you’d want) and crustaceans for those who appreciate them.
We quickly got to work collecting coconuts, and then had a brief class in coconut-opening theory and practice (another important use for your machete). I wanted to learn without a machete, so Aaron showed me how to use a rock and gravity (throw the coconut strategically on a pointy rock). After about 45 minutes of creative prying with smaller rocks to pull back the skin (making up for my lack of arm strength) I finally got it open. This was the best-tasting coconut ever.
After waltzing back from conquering the coconut and having entered the realm of coconut master, I learned the caretaker didn’t want us to take any more coconuts because he sold them as coconut oil.
“What? How do we have survival without using the resources?”
We had already cut down a bunch of coconuts so were fine for the time being and so decided to just get on with it and see what happened. But the future looked bleak, particularly for vegetarians.
That afternoon Rod and Zach [Leyda] went out with their Hawaiian spears to find fish, and we all set up camp and separated our stuff. We had chosen 12 group items to use this survival (such as machetes, knives etc.) and a personal item each. I took my towel which cleverly doubled as a blanket. We set up a shelter of black plastic and parachute cord and a few extra tents to protect the rest of our stuff. Most of the students chose a hammock or tent as their item, so Aaron, Ren, Josh, and I were the only ones sleeping in the tent.
The first night was a bit rough. We rushed to bed prematurely as it started to rain, and the wind fluttered through the A-shaped shelter all night. The next day we redesigned the structure and its position in relation to the wind, so our little group slept warmer, but the ground still felt pretty hard.
Rod had the worst first night. Having positioned his hammock in a pristine location just over the surf at the very tip of the island, his hammock was soaked through by rain before he even got into it and he was jostled by the wind all night. You should ask him about it, I’m sure he’d love to share.
To me, the curious thing about survival in general is how easy it is to just be bored. I get tired because I’m hungry and then don’t want to do anything, but in a real situation if you have energy you want to stay busy. What also surprises me is just how little food I need to function, in comparison to how much I usually eat.
Coastal survival was met with more fishing, lobster and crab catching, water desalination and fire building (which is not my calling in life). We made friends with the caretaker and he gave us some more coconuts. Then Ren and Tyler both fell ill. They came down with a fever the last night, so we waited until the morning to head out as planned. Since they were each a little better, we headed on to Little Corn Island. So close to spring break, all we had left to do was spend 24-hours on a boat (to simulate being in a life raft) as part of ocean survival.
Compared to the jungle, the boat was easy—sort of
Our boat driver was late picking us up because one boat had broken down. So we crammed into a smaller boat for the two-hour trip out to Little Corn. The first hour or so was not bad, just lots of splashing, which soaked me despite my position near the back of the boat. We stopped shortly before the halfway point at a small Miskito village apparently in the middle of nowhere to load our luggage onto another boat. The village was a collection of some 15 buildings on stilts on a semi-island, but with hardly any land or anything else. We later discovered that this little town was an important drug trafficking stop, but everyone was very nice.
I moved to the front of the boat for the next part of the trip. “It’s more fun there,” I naively thought, remembering the fun times when the boat caught air in previous trips. That was a mistake. Lightened of the luggage, the boat could more easily catch air, it could more easily go higher, and it could definitely more easily crush your tailbone as it slammed back onto the water. For an hour we hopped through the water, soaring over waves and crashing into the troughs. After the first ten minutes of agony we finally reached a strategy. If you tensed your leg muscles at the right time as you launched from a wave, then you could sort of slowly leg sit back onto your wooden seat. Zach, sitting at the front and bearing the brunt of the pain, called out “big one” every time the boat approached a deadly wave, indicating the relative size by how frantic his voice sounded or the number of times he repeated the phrase.
The system worked well and we arrived in one piece, but not without significant mental and posterior bruising. The goal was to get out on the boat as soon as possible, and after a brief lunch we moved onto the boat that was our home for the next day.
It was mid-afternoon when we got out onto the water and the weather was calm so we floated relatively peacefully. A few felt nauseas and one threw up, but other than that we just chilled and talked.
Having passed a quiet night, the next day we were brought inland and were finally on spring break. A rough, hungry week over, we would spend the next seven days on Little Corn Island, a tourist resort with diverse and delectable cuisine.
Enjoying the flush toilets and running water not saturated with salt, I realize how much I cherish these luxuries, and how loathe I am to let them go. Moral of the story: don’t find yourself stranded on a deserted island. Just don’t.
Natural birth control (Feb. 15)
For the most part, I like children. I’m not the sort who’s always playing games or trying to ply the nearest baby from its mother’s arms, but kids are fun. You just smile at them and then you’re friends. You don’t have to worry about complicated grown-up ideas, like being sophisticated or appearing smart. I suspect one day I will probably want to have kids.
After this week, that day will probably be a very long ways away.
The previous Monday in our hospital rotations Rod [Stickle] and I decided to have a go in the labor and delivery room. There is nothing as educational as witnessing the miracle of life in action. After four hours waiting for a child to be born, our observations were over and we had to return to our classes: no miracles that day.
The miracle of life
This past Tuesday, realizing that our time in Puerto Cabezas was ticking away, I decided to join Ren [Lauren Kent, one of the instructors] in a night shift at obstetrics (OB) after dinner. It was ideal because we didn’t have class the next day until the afternoon, and this way I could be sure to see at least one birth because we would be there into the night.
Apprehensive of my decision, I set off in the taxi with Ren and the other students who would be hanging out in the ER. We got to the hospital around 7:00 p.m. and the two of us entered the OB ward where we saw an older woman pacing. She looked miserable.
After we checked out the list of recent births, we hung around and asked the nurse questions.
“Well this is awkward,” I thought. “I’m just chilling in a tiny room with a lady who has blood on her legs from her water breaking. That’s not weird...”
The worst part was the not knowing.
“Do I try to talk to her? I don't like people talking to me when I’m in pain, that’s a bad idea. Should I smile and send reassuring looks? That might seem patronizing and sympathy can be annoying when I’m in pain. Should we just ignore her and talk amongst ourselves? It seems rude to ignore her while we sit here waiting for her to have a baby...”
I settled, probably unwisely, for ignoring her and chatting with the nurse, throwing in a few sympathetic smiles for good measure and to surreptitiously assess her condition.
I’m pretty certain she didn’t care about my conduct, as she was a little busy writhing on the bed and vomiting into a bucket. The nurse adjusted her IV and periodically checked the cervix’s dilation. Having been at 8 cm when we first went in, the lady wallowed in her misery a little longer as we chatted until she was finally at the necessary 10 cm and they walked her into the delivery room. Feeling about as awkward as one can, I held the IV bag as she climbed onto a special pushing table with scary stirrups.
A 38-year old on her fourth child, the woman was pretty familiar with the routine and hardly spoke as she went through the motions. The nurse handled most of the preparations and was very nice and encouraging to me. The three of us gloved up, and the nurse coached the veteran mother in Miskito. She pushed with the contractions and rested in between until you could just distinguish a rounded, pale head matted with hair easing its way out. She pushed and struggled and the head inched until it finally popped out. The nurse felt around the neck and verified the umbilical cord wasn’t in the way, then motioned for me to get in there.
I stepped up and tried to support the head while gently pulling. I pulled a bit on the baby’s head but apparently wasn’t very good at it (for the record, our classes, from my recollection, have never taught us to pull the head). The baby was quite big, so the nurse got back in there and pulled the head. (And I mean pulled! You could see the neck elongate). Next the shoulders squeezed out. Then came the fluid.
Going over the process of childbirth in my mind, I always knew it would probably be a little weird and uncomfortable. Dealing with a human being coming out of someone’s lady parts is not quite the same as negotiating small talk about the weather, but I had never anticipated the fluid. When the shoulders popped out the baby just kind of slid into the nurse's hands and with it a tidal wave of water, mucus and blood splashed out onto the nurse and the floor. The nurse placed the baby on a towel on the mother’s stomach and Ren helped her dry the little girl, snip the cord, and then wisp it away for documentation. Feeling a little traumatized, I stood there like a stunned goat (I’m sure goats can be stunned) and tried to work out if I should be doing something useful or taking care of the fact that I had momma juice on my gloved hands and bare arms.
“I thought it was a big deal to come in contact with someone else's blood. Is it a big deal? Is there always so much fluid...?”
I just stood there and watched the doctor deliver the placenta and then spend 15 minutes scraping more blood and fluid out of the mother. Determined to perform some sort of action, I walked to Ren, my hands suspended in the air signifying the gloves’ soiled state, arms violating protocols about body substance isolation, and watched them give the baby shots and take her measurements.
“Ok, I'm going to go wash the blood off my arms,” I told her after a few minutes, and she smiled as I dazedly removed the gloves and headed for the sink in the reception area. Trudging back into the delivery room, I arrived just in time to finish dressing the chubby little girl (which was no simple feat), and carry the mother’s IV pack out to the recovery bed, where her family came in to meet her. The father had been waiting earlier, but now her mother and an older daughter greeted the new addition.
“Ok, that was interesting,” I thought, “I would be happy to leave now.” We took a break to visit the other members of our group who were interacting with a visiting surgical team, and then came back to find a young girl accompanied by her mother. The girl was not happy at all and didn’t practice the stoic calm of our previous mother. This birth was her first, and she cried out loudly in pain with every contraction. When we arrived her cervix was already fully dilated, but the baby’s position was too high, so we sat and waited with the nurse and doctor. The baby's heart rate was not very high, so they carefully monitored it as the mother tried to hush her daughter through each contraction.
The painful scene continued for probably 20 minutes as we waited for the baby to drop into place. Eventually, they gave her the oxytocin and led her into the labor room to start pushing. At only 15-years old, the girl was small and her body was not very flexible for the birth. Another doctor joined the little group around her as they coached her through each contraction and lubricated the baby’s passageway. In fact, a small hoard of people came in and out of the room at various times, apparently not serving any real purpose except to hang out and offer more encouragement to push during each contraction. Several were doctors, a few nurses, but unable to understand what they were saying, I assumed they turned up in case of further complications.
After another 20 minutes of labor, I felt sympathetically drained with the girl. Having tried every other way possible, the doctor finally numbed up the girl’s undercarriage for an episiotomy: an incision to widen the exit hatch.
Incision made, the gap was a bit wider and after a few more contractions a baby boy popped out on a tidal wave of fluid. Less shell shocked by the proceedings, I helped a little more this time with giving the baby a shot and preparing him for life while the doctors cleaned the mother up. Ren convinced me to carry him out to the reception area afterwards. Despite his small size, I didn’t break him. He was even a little cute, but not enough to offset the recent memory that he had just spent the past 45 minutes actively exiting a human being.
“Ok, that was good,” I thought. “I think I’m done. Learned a lot and all of that. Let’s get some sleep.”
There was already a very pregnant lady waiting in the room. The nurse looked at me and told me I would do more to assist this next one. “Hmm...” was really all my brain thought, considering that it was then past 11 p.m. We conferred briefly with our group in the ER, who were preparing to wrap up, then returned to OB.
“We'll just hang out here until they come by and then go back with them,” suggested Ren. It sounded like a good plan. I agreed. They never came.
Being the third birth in one night, I was getting used to the drill. This girl mainly stood up and paced a little, only lying down to check the progression. We waited a little while for her and then, as with the others, moved into the delivery room. She was in great health and complied easily with all of the procedures. The nurse told me the woman was just about ready, and then directed me in checking how far along (don’t think about it too much, just know that I had gloves). This process was a little bit easier than the last and moved much more rapidly. I asked which child number this was and how old she was. Third child and she’s 23.
“What? That's my age!” I thought, recollecting my birthday the previous week and panicking that someone should have such responsibility at my age. Unlike the previous birth, this wasn’t just a teen pregnancy. Having her third child with her partner waiting outside, this woman was a completely serene and seemingly full-blown adult.
Again I tried to catch the head and pull the rest of the baby out, but I couldn’t bring myself to pull enough and so the nurse took over again. I was content to just deliver the placenta (which is likely the inspiration for many an alien movie). I helped Ren with the baby processing and carried the little boy out to his family.
“That was nice, now let’s go back,” I thought as I washed my hands and walked back to the room, before finding another expectant mother. “What? Please, no, I’m sure she can wait...” As it happened, she couldn't.
We hung out in the room for ten minutes because she looked so close. She was an older mother and paced a little bit instead of just sitting on bed. She said something to the new nurse that came in and then winced as she lay down to be checked.
I went to retrieve my gloves and by the time I returned, the doctor was already holding up another baby boy. We helped clean up a little and document the child and then finally grabbed a taxi and headed back to Verbo to get some sleep. The gate was locked, so I climbed over and headed to the house where I very gratefully cleaned myself off.
So childbirth is interesting and all of that, but this whole “miracle of life” does get a little messy.
Kids, cooking, and chaos
The next morning we didn’t have classes, so we went to Verbo’s feeding center. Built about a year ago, volunteers prepare donated food for as many as 600 children at lunch every day. It was crazy.
We arrived well before serving time and helped cut vegetables and prep food in the kitchen, which housed the largest cooking pots I have ever seen (Hansel and Gretel could have sat very comfortably in any of several). As it drew closer to lunchtime, the kids started arriving. Because we had finished our work, we went to play with them a bit.
At first there were just a few and we watched as they interacted with each other. Then we started swinging them around in circles or lifting them up in the air. Then several students started cutting kids’ hair (don’t worry, the director asked them to). Then we got mobbed.
It’s not that the kids weren’t sweet and cute, there were just so many of them, and they soon lost all inhibitions from jumping and climbing on the foreigners present. Think Lord of the Flies, except the children are attacking you because they’re happy and like you, and just want your attention and strength at the same time. After several games of Duck Duck Goose and being toppled on the grass, Rod got the idea to stand with his back against a cement pillar so no kids could jump him from behind.
I was a little apprehensive to make skin contact with any kids considering the lecture on ectoparasites I had presented the day before, but that was soon decided for me. Paranoid as I was through the whole experience, it became clear that treatment would probably be far easier in this case than prevention, as curbing their enthusiasm was nigh on impossible.
After serving lunch to around 350 people, we ate and came back to Verbo exhausted. We had class that afternoon and then punched through three more class periods the next day to finish up all of our lectures and quizzes from Travel and Tropical Medicine.
The next day, Friday, was Dillon’s birthday and was spent entirely at a clinic two hours from Puerto Cabezas. We got up early and then set up our first village clinic in a school. Dillon and I worked the pediatric section and saw mothers and children the whole day, mainly with stomach pain and colds. Curiously, I thought the kids’ station was kind of fun and not at all as depressing as I had anticipated.
As long as they’re not being born or jumping on me in droves, kids are okay.
What does the rooster say? (Feb. 5)
The answer: nobody cares. He should just say it less because he’s getting annoying. I always assumed roosters crowed at dawn and then, having fulfilled their main purpose in life, keep quiet the rest of the day—just like on children’s television programs.
What a lie! Yes, they crow in the morning when you ought to wake up, but only by sheer coincidence as they pretty much crow at any other time of the day they feel like. Morning, noon, midnight—it’s all the same to the cockerel, who is inconsiderate to everyone else.
Living with critters
It’s common to see chickens and roosters milling around houses, and pigs farther out of town. We hold classes at Aaron, Ren, Ericka, and Dillon’s house (the married couples’ abode), and animals are frequently scurrying about. A group of chicks usually peck their way through the garden during class (especially after it rains), and dogs mingle with the cow on the other side of the fence.
But aside from the plethora of geckos scurrying across the walls after dark, the most abundant creatures to plague us are mosquitoes.
I imagine I must have Dengue fever, malaria, yellow fever, onchoceriasis, and every other bug-borne parasite by now from the sheer number of bites on my legs. (Don’t worry, mom, we don't actually get yellow fever here and onchoceriasis is from another fly by fast-moving rivers. I was highlighting my point through dramatic effect.) We all take malaria pills and are moving towards more aggressive insect-repellent application regimes as the nightly attacks worsen. But the blood-sucking villains love me.
This past week in Travel and Tropical Medicine class we talked about some of the more exciting communicable diseases a person can catch from various vermin. Who knew there were so many parasites waiting to eat you?
In general biology class two years ago, we studied intestinal worms and other such parasites and I got a little freaked out. Convinced that I harbored at least one of these wretched creatures in my gut (the internet told me I probably did), I bought a litre of apple cider vinegar and drank a diluted cup periodically (the internet told me this would help).
My roommate was very understanding in this difficult period, though she did write a song about this unusual vinegar chugging habit. But eventually I got bored and decided the parasites and I could just learn to work things out, or maybe they left because of the vinegar. Either way, fresh classes about parasites brought back a flood of memories carried on a pungent wave of apple cider vinegar.
I didn’t bring any vinegar with me, but I am still surprisingly calm in this war zone that is life. Far from the urgent panic of the previous year, now I just keep an eye out for all signs and symptoms alluding in any respect to foreign organisms inhabiting my person. So far I’m fine, but they could still be dormant.
On Wednesday, we participated in our first official clinic held at the local prison. We worked from 9:00 a.m. to 6:00 p.m., seeing more than 75 patients. Working in pairs, six of us were set up in little consultation cubicles and the other two worked at the pharmacy. I found myself paired with fellow student Adam Neep, a former medic in the U.S. Navy. I was relieved to lean a little on his experience and knowledge base.
Facilitated by a translator, we recorded the names and ages of the patients and tried to pinpoint their primary complaints. This sometimes proved difficult, because many had multiple health issues. Armed with reference books, we attempted to diagnose the problem and—after discussion with the doctor—could recommend a course of treatment.
The whole process was a little frustrating at first because I felt so incompetent, but everything got easier as the day wore on. Urinary tract infections were very common, and I think most of the women we saw were diabetic with high blood pressure. Many of the men had joint problems and nerve damage from sleeping on the cold floor, and we gave out a lot of multivitamins just to boost immune systems.
There were some pretty sad cases, but it was inspiring to see Dr. Caldera’s commitment to providing quality healthcare. And the experience will be useful as we prepare to for the traveling clinics in the coming months.
One clinic down, only about another 23 to go. I'll try to work hard and learn a lot from them all, but one thing is certain: I’m going to get very good at taking blood pressures.
Meanwhile, back in the jungle (Feb. 1)
We’ve hit the two-week mark in Nicaragua, including one full week of classes at Verbo in Puerto Cabezas. The sun continues to shine, the beans and rice continues to flow and I could get very used to not always aggressively applying moisturizer (I still do sporadically, but largely as a nod to my former life as a dried prune in arid Nebraska).
The culinary adventures of a vegetarian in Puerto Cabezas have not proven very exciting, but the cooks do a great job and I get plenty. The national dish for the country is Gallo Pinto, which (contrary to what the name may imply) is rice with beans. It’s actually pretty tasty and I haven’t grown tired of having it at breakfast, lunch, or dinner, in part because it is nicely interspersed with rice and beans—a completely different dish.
We also have potatoes or yucca; salad; fried bread; and a white, hard, salty cheese. We can walk across the road and get doughnuts for 15 cordobas (about 60 cents) a piece.
The exchange rate is very favorable to the U.S. dollar—about 25 cordobas to the dollar. Food can be pretty inexpensive (doughnuts at least), but many things cost a lot in the city, such as gasoline and electricity. It appears that people in the city fall more into what I consider a middle class, but the rural areas tend to be pretty poor.
This week we began formal classes and trips to the hospital. I’ve had a bit of a cold, so wasn’t aggressively active in a medical capacity, but at least three students worked in the obstetrics room and helped deliver babies.
In an attempt to spread fewer germs, I assumed a more observatory role in the emergency room, where I took several temperatures and saw some shots and stitching. A man came in with an open gash on his upper left cheekbone. He told us he’d been slashed with a machete the night before and had gone to the police before coming in to the hospital. The wound had already stopped bleeding, so the doctor washed the wound, numbed up the site, and then cleaned it before putting in stitches. It found it interesting to follow along, having received several stitches myself a few weeks ago.
I am enjoying our classes, but they require lots of reading. We’ll finish up Global Health class this week and then be left with the rest of Travel and Tropical Medicine class. Dr. Caldera has already taught us a bit about physical examinations and we’re striving to learn medications.
It is sobering to think that we’ll actually all this knowledge in our clinics this week and after spring break. While grades generally tend to motivate me to do well in classes, being responsible for a life up the stakes a little. The doctor is very professional and does not put us in positions to cause harm to others, but we had have to learn fast.
Always ready for anything
On Sabbath, a whole group of us went to the main Miskito Adventist church. We arrived just as Sabbath School was starting so we listened to them sing in Miskito and joined in a little bit. As the children filed out for Sabbath School, Dr. Caldera was asked to lead the lesson. I’m quickly learning that it’s probably good to 1) always study your lesson, and 2) have several meaningful anecdotes on standby and the rough outline of a sermon just in case. IRR majors talk about being prepared for anything—and apparently that includes preaching.
After the hour-long lesson study, some church leaders approached Aaron, our leader, and asked him what kind of translation he wanted for his sermon. Note, they just assumed he was giving the sermon. Aaron did a great job, and demonstrated what it meant to be always ready.
Hopes and dreams
I still haven’t had many opportunities to interact with the children in the orphanage very much, so it was fun to watch a movie with some of the kids. The two girls I sat with gave me hugs afterwards. The most beautiful thing about this orphanage is that the children seem happy, but they’re mischievous and free to dream.
Last week I met two girls who were both planning on becoming doctors. At ages 15 and 17, they believed these dreams were legitimate and no one was telling them they couldn’t do it. One of the most tragic aspects of poverty is that it crushes hope and the belief that the future can get better. Dreams stem from hope, and that hope will foster success where no kind of aid ever could.
Buenas noches, mundo. Joellyn Sheehy
P.S. For those interested, the is a Facebook page called Expedicion Nicaragua 2014 that has pictures and posts from the other members of the group.
A long road to paradise (Jan. 24)
Buenos dias, amigos. It is day six in Nicaragua and we are living it up in Puerto Cabezas. After a 28-hour road trip along some rather bumpy roads (rumour has it we traveled about 300 miles, averaging less than 10 miles an hour), everyone was happy to finally arrive. We traveled pretty much nonstop and the ruggedness of the roads made it challenging to sleep, but people got pretty creative and you’d be surprised how comfy the floor of a moving vehicle can be. Perhaps some of the resting positions were not the safest choices possible, but we weren’t exactly speeding along. I was highly impressed by the skill of the drivers at navigating around potholes (as well as animals and people) and they didn’t complain about the distance or length of the trip even once (I cannot say the same for our group...).
Yesterday morning around 9:00 a.m. we arrived at El Verbo, an orphanage in Puerto Cabezas where we’ll base our operations for the next month. The compound feels like such a safe haven: our accommodations are comfortable (being the only single girl on the trip I have to have my own room), they feed us richly and there is internet in our abodes (a little to the chagrin of the program leader). Another group from Alabama has been here for almost a week doing construction and other jobs. Our groups all eat meals together and so usually end up chatting a bit. So far we have not interacted much with the children or people that live here. El Verbo is certainly a terrific organization run by Nicaraguans, but it still makes me feel funny eating western food and grouped with all the other western people speaking English. Actually it’s just a little boring. I want to practice Spanish more.
We’ve taken today and the end of yesterday pretty relaxed since everyone was tired from the long trip. Today we had a look around the city, painted a little on the nearby school, and will go back after lunch. I plan to go to the Adventist church tomorrow (hopefully it's in Spanish) and then Verbo’s church on Sunday. I've heard that the latter is a bit charismatic and it sounds like fun.
It’s still hard to believe that I’m here after waiting three and a half years in anticipation (well, I was studying as well, which passes the time). The flights were quick from Omaha to Atlanta to Managua, where we were met by Dr. Caldera (who will supervise our medical clinics), his wife, and two of his sons. Some of the medications we brought were confiscated in the airport until we could get proper paperwork, so the doctor and course leader, Aaron Kent, stayed to sort it all out. The word is today that the papers are done, but they still have to hand them in to the airport and make the trip themselves across the country, so we’ll see when they arrive.
The first item on our agenda Monday morning was to visit Habitat for Humanity in Managua. I had just finished reading one of our textbooks, Toxic Charity, which discussed how much of the way we approach “charity” and “development” is more harmful than good and causes people to become dependent on continued giving. The author advocated long-term commitments to a communities to find out real needs and capitalize on inhabitants’ capacities.
As we talked with Salim, our guide with Habitat for Humanity, he echoed everything I had just read. They’re very conscious about who they help, how they help and the long-term implications of their actions. He took us on a tour of a poorer area where they’d helped build some homes. One woman showed us around the home Habitat for Humanity had helped her built. She had since gone on to triple its size. While still a modest house, her pride and Salim’s pride for her definitely (and the very fact that she was empowered to continue the work for herself) proved to me the efficacy of their work.
Tuesday we stopped by the U.S. embassy and were briefed by many of their different departments. Lauren Kent, one of our course leaders, has a friend in the military, so he connected us with numerous key players including someone from USAID. We had a great time, but it all made for a long day as we went to a baseball game that evening with the volunteer fire department. None of us were very sure of what we were getting into before we signed up, but it turned out to be the final championship for the country (which is very keen on its "beisbol").
We worked on their emergency services team. The atmosphere was electric. I give Nicaragua an A++ for enthusiasm, as well as ability to make noise. Loads of people brought their own drums and played them before, during and after the game. I was stationed with Ericka and Dillon Whittaker, a volunteer named Enrique, and a few others down by the dugout of the home team.
The game lasted about three hours, and our early arrival (around 3:00 p.m. for a 6 p.m. game) made for a long night. Since we were there for medical support, we sat right on the edge of the field for most of the game. One of the players pulled a muscle, so Ericka (a paramedic) went to assist with him.
Dillon had just finished telling me what a long time it had been since he took EMT class when one of the firefighters indicated for one of us to come. A woman had bruised a finger, and an off-duty doctor told me nothing was broken, so I stabilized the finger as best I could.
We waited a little while after the game (in case there were fights since the home team lost), then took our only other patient to the hospital and headed back to the hotel very late. The following day we mobilized at 3:30 a.m. and left Managua at 5 a.m.
So far it has all been a very positive experience and I’m having fun. Rudy, Dr. Caldera’s youngest son, joined us on our trip and so I learn Spanish words and cultural tidbits from him, which makes for an extra good time.
Classes start on Monday, and we'll be learning about global health. I'm glad we're staying here at Verbo. It’s a happy place.