Early Visit 2002

This trip was like no other. My associates were Judith Shook and Margie Houseman. This was the first trip for Judith and the second for Margie. We drove to Dallas to fly American through Miami. In spite of security assessments and precautions, we had no difficulty and no slowdowns. Arrival in Managua was at seven, so our first order of business was dinner. The food at La Ancla was excellent as usual. It was like coming home.
Shopping for medications at Solka is an experience to create patience. The process is all very formal. After coffee is served, discussions about today’s market prices require a lot of time and some quick thinking. There is no way to make good judgments without an adding machine, because discounts have so much to do with final prices. The list of available medications and today’s prices is delivered and studied at length. Changes are made dependent upon prices in order to get the most cost effective formulary for 1000 patients. This process requires a lot of time and patience. After obtaining the medications, we packed people in the front and baggage in the back of a pickup to travel to Leon. The air conditioned pickup is a far cry from the old bus to which we are accustomed for hauling us around.
Leon is still busy and noisy. The campus is right in the middle of town, so students swarm like thousands of tiny ants around the downtown area. The park was very hot and dry, so strolling was not as much fun as last year. There was not much down time, anyway. There were some Cortez trees in bloom, but the beautiful malinches were sparce.
Mina Limon is still hard to reach after all of these times. Even though the pickup was air conditioned, the heat, dust, and gravel road were tiring. We began clinic at 10 a.m. and broke for lunch at noon. Margie’s skills at managing patient flow are great. Judith caught on quickly, so we had almost no medication problems. The pre-printed labels make dispensing much easier. The zip lock bags are best for dispensing pills. The small bag will hold enough pills for a full cycle of antibiotics or antihistamines. We were generous with cimetidine since so many folks were having symptoms of reflux. It is not possible for me to differentiate between reflux and parasites with no laboratory tests to guide me. Juana continues to be a great source of energy and stability for this community. I did not see one adult male this clinic day. The wall (or fence) around the buildings is high, well constructed, and secure. It is solidly locked most of the time. Juana knows each person there and is a strong controller. She also has a heart of soft butter, so the young women hang around her as if to soak up some of her goodness.
Back to Managua for dinner with Leslie Penrose’s group from Tulsa. They had been to Chacaraseca to study the ciclobomba, a method of irrigation invented in Esteli and now being developed by Fundeci in many areas. The idea is to use bicycle power to lift water to a height so that it will flow by gravity to garden fields. The water is released as needed to grow healthy vegetables, fruits, and food for farm animals. By using irrigation, the land will sustain three harvests each year instead of one. Each harvest is also much richer, so total output increases dramatically. A healthy small child can power the bicycle, but a teenager or adult can produce more water per hour. One of these water systems costs about $300 to build, so modest donations may provide food for a family that is healthy and readily sustainable. In addition the green gardens and orchards reduce the ambient dust that provokes and aggravates so much bronchial and nasal illness. The dust in this area of Nicaragua has bothered me for several years. It is so fine that it goes almost unnoticed, but it moves into nasal passages and clogs the sinuses. Perhaps a saline spray or mist would assist in breathing and decreasing respiratory disease, but more orchards would improve the total environment. The ciclobomba may well create a means to accomplish this miracle for small farmers.
Saturday was exciting. The brief visit to Jinotepe in 2001 led to a return engagement with Lumen. She is an immediate past deputy to the National Assembly. Nicaragua has a unicameral legislature, so a deputy is somewhat like a combined senator/representative. She has always been interested in service to the people of less economic privilege. She had arranged for two clinics in communities near Jinotepe.
La Conquista was first with clinic beginning around 10 a.m. We worked through lunch with crackers and bottled water to sustain us. At 1 p.m. we moved our operation to Santa Teresa after seeing almost 100 patients at La Conquista. Each of these barrios is very poor. Infestation with parasites was almost 100% among the people we treated that day. The frequency of headache, neck ache, and backache was almost 100% also. The clinic at Santa Teresa was held in the living room of the mayor of the barrio. He was a helpful man who seemed deeply concerned about the folks living there. By the end of a long and exhausting day, we had dispensed medication to over 230 people (the actual count was 230, but another 20 or so came in without being signed).
We had an excellent dinner that evening at the Hotel Casa Grande. Service was first class and the food was superb. The shrimp were tasty and abundant. The hotel was once a private home of an executive of the Somosa regime. After he fled, the house was vacant until about 5 years ago, when it was purchased and converted into a hotel. There are 4-5 floors around a beautiful courtyard. The roof "dance floor" enjoys a beautiful view of the town and surrounding area. One can only fantasize about the dance floor with swirling skirts and dashing courtiers, but similar scenes may be seen in many movies about this era. The air is cool and a fresh breeze moves through each floor.
Our day of rest began with a trip to the beach at Caseres. We were invited into a private beach house by Lumen. The setting was beautiful with elegant housing and beach facilities in the midst of lush and well planned flowers and trees. The landscaping was gorgeous and the fruit delicious. The beach was, however, rocky and the waves too fierce for enjoyable swimming. Nevertheless, we plunged into the shallow water for a few minutes. My fragile skin warmed quickly in the noontime sun, so warm memories lasted several days in spite of the brevity of exposure. Another surprise awaited us for lunch. Lumen had selected a special restaurant situated high over the oceanfront with a splendid view up and down the ocean for miles. The wind continued at a strong pace and seemed to come from all directions. Any light object was at risk for being carried away. We ate outside, so menus, table napkins, and other such items swirled and were gone.
Our original plan was to return to Managua in time for mass services at Bataola, but it was not to be. The priest who had conducted services there and who had taught the young people to play such wonderful music had died several weeks ago. There were no services being held there, and the beautiful and awe inspiring sounds of children’s voices raised in praise were gone. I was deeply saddened by the loss of this incredible man of faith whose dedication brightened each of our recent brigades. This void in our schedule was filled with pizza at our hotel and comparing notes on our experience thus far.
Monday was a new experience in many ways. There was a special request from the Ministry of Health for us to go to a woman’s prison where there were perceived serious health problems. There was a special clearance for this visit and a selection process for the women who would be treated. There were to be 50 patients only. Our schedule was to start at 10 and work until lunch that would be served in the prison mess hall. Because we had treated far more patients early in the trip, our medications were depleted, so a trip to Solka was necessary before the prison. We arrived a few minutes early and set up a clinic in the prison health center. The prison doctor was a young woman named Tania. She had a system in place that allowed smooth and un-interrupted care. Her medical records were excellent. We finished the work by mid-afternoon and were able to tour the prison.
I had promised myself that there would be no personal feelings for any of these prisoners. I would simply ascertain the medical need and provide medications with dispatch. I would not care why they were in prison nor would I care how long they would be there. I would not ask how conditions were, and I would not allow my own feelings to interfere with the simple technical act of diagnosing and treating. However, each of my antecedent fantasies were shattered and by late morning I was in deep trouble emotionally. Les Miserables and Victor Hugo moved from my deep sub-conscious to the very front of my every emotion. I could hear the voice of Javert: "The law is not mocked. You have broken the law. You are just a con!" Then the haunting, plaintive, beautifully phrased words of Jean ValJean: "I stole a loaf of bread. My sister’s children were starving, and I stole a loaf of bread to feed them." These haunting words reverberated incessantly so that each eye contact in that clinic brought tears to my eyes and gravel to my voice. I am still haunted by one woman child who helped me peel open prescription sheets and kept them from blowing away in the wind from the fan set up to cool the room. Her smile was warm and wonderful. Her eyes were bright. Finally, I broke down and asked where she was from. When she said "Esteli" I could not resist remarking that I had been there many times. She then asked me where I was from. When I said "Oklahoma" she timidly sang a few words from the song and then looked downcast as she said: "I am so sorry for the people who were killed in the horrible bombing." She then brightened and said: "I have a friend in Kentucky." Her eyes continue to haunt me.
What a waste! There must be a better way to live together. This life and the lives of those other women I treated are intermeshed among drives of society to be orderly and to survive. Most of the women in the prison were caught and convicted for selling drugs. Most of them were trying to feed their children. Since I have personally treated many people for problems related to drugs over the years, I have no sympathy for the drug traffic. On the other hand, if my children were starving ………….
Now we are faced with a group of women who are sequestered from society. The cost to society for this effort at stabilization remains high. Is there a way to change the expense to prevention rather than punishment? Could we invest in education and improve the stabilization process? The current approach has done nothing to reduce the sale or consumption of illicit drugs among the poor. I am left with no answers. Only questions and tears strain at my emotions. The ghost of Jean Valjean has morphed into the fantasma of Kerelys and has drawn another stripe across my heart.
Tuesday we were off to Esteli and Pueblo Nuevo. This small community is on the border of Honduras and was once famous for the Contra killings of the early 1980’s. The land is dry, the crops are poor, and the air is full of the powdery dust. A cobblestone road led from the main highway to Pueblo Nuevo. We then drove though the dry, dusty town into the countryside where we treated 223 patients in what was left of the day. Families would come in with the story that they all had parasites and sore throats. After a quick glance at huge, swollen, and purulent tonsils, we handed them the magic strawberry flavored anti-parasite liquid and some amoxicillin. Many of them had urinary tract symptoms presumably related to the severe shortage of potable water. Margie and Judith had by now become a formidable team, and Jose Antonio (Dr Arce) was fast and decisive. The clinic went smoothly. Octavio and Bayardo wrote the patient’s name on a prescription sheet and kept the time between patients to a few seconds. Hector assured that the patients understood the directions. We were told that we would see 50 patients and have plenty of medicine. That quickly proved to be an inaccurate projection. Where the patients came from is still a mystery to me. But they came! By skipping lunch we finished the day in time for dinner at El Mesero in Esteli. The food was outstanding and caloric content more than made up for what we skipped at noon.
Wednesday was our last day of work. Because of the severe deficiency of souvenirs to carry back to Oklahoma and California, we simply must do more shopping. We extracted a promise from Octavio that we would terminate the clinic by 1 p.m. at the very latest. We had again run out of medicine but we were lucky to be able to purchase enough to treat 100 people from a pharmacy in Esteli. Once again we were promised a maximum of fifty people. This time the 50 became 160 by official count (there are always a lot of people who manage to get past the screeners and must be treated, so the actual number of prescriptions written is higher). San Pedro is a small community on the outskirts of Esteli. The people were charming and cheerful, but small children came alone many times. There would be a family of five led by a little girl of 12 years. The pecking order was clear, and the smaller siblings did not seem to object to the bossing by the older sister. Some came with parents, but many came alone. One little girl of 12 came back five times with another child. Finally, she presented alone for her own symptoms and her own dose of parasite medication. This day was sad, because Octavio did not clarify either the cutoff time or the amount of medicine available. We were forced to turn away about 20 people at the end of our medication supply. We were totally out of parasite medicine and pain medicine (acetaminophen and ibuprofen). Without those drugs, we were unable to do anything sensible, so we closed it down and returned to Managua. I felt badly about not having the medications but could do no more. My energies were depleted, my body racked with pain, and my emotions were crying for relief. It was time to buy a rocking chair.
That night in summation Carolina, Octavio, Judith, Margie, and I went over some of the projects of Manos Juntas. We established plans for a return brigade in June and for the scholarship students. We discussed plans for other potential projects. I hope we can establish continuity clinics in Rivas. I have a dream to complete the clinic in Mina Limon, and Octavio will calculate a cost for that.
On this brigade I had one doctor working with me each day. Jose Antonio Arce has helped many times in the past. He is skillful, dedicated, and easily fits into our schedule. Tonia is the prison doctor and is dedicated to excellence. Ramona assisted in Leon. She is experienced and smooth in her patient management. With this assistance we were able to treat over 900 people in this one week. It was the first time working with Hector and Bayardo. Jose Antonio helped me in Jinotepe, Pueblo Nuevo, and San Pedro. Hopefully, this summer we will go to Rivas and work in those communities.
It is impossible to relate all of my feelings regarding this brigade, but I feel as if the time with Judith and Margie was a life highlight. My ability to function in this environment is possible only by and with their wonderful contribution. How lucky and blessed I have been to know such fine examples of human love!
 

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