The Church of The Open Arms organized a brigade which went to Nicaragua from June 29 to July 8, 1999. There were 13 in our group. After last minute details and changes in our brigade, we left Dallas on schedule and arrived in Miami as planned. From there things changed a bit with an unplanned stop in Guatemala City when Managua was totally closed due to weather. However, the storms passed and we reached our Managua hotel in time for a good sleep. We stayed in La Posada de Maria la Gorda in Managua then went to Chinandega the next morning where we stayed in Hotel Cosiguina.

The plan was to divide our group in two parts with one group medical and one group construction. The construction group went to Mina El Limon where there was a women’s center to fix up. Our original plan to make minor changes was modified to allow a major overhaul. The first step was to remove the walls. The roof was propped up so it could be retained then a series of concrete blocks were used to build a new wall up to the existing eaves. Out in front of the house a trench was dug for new footings for a porch. The concrete was mixed completely by hand after choosing a spot on the ground to act as a mixing place. Pictures demonstrate clearly that the work was hard under very primitive conditions but the result was a thing of great beauty which will serve the women of Mina a long time.

Rain plagued us during this brigade. Each day the work had to be stopped some due to the rain which reminded everyone of last year’s floods. Mud was everywhere and no one stayed clean. The mud is different from the mud I have scraped so many times in Oklahoma. It is extremely gritty and sticky. A little goes a long way and seems to increase every time it is touched. The smell of the mud is also different. The corrugations on the sole of my tennis shoes became totally packed with black, fine, gritty, sticky material which smelled terrible and left tracks whenever I touched any surface. There is a Nicaraguan song by Salvador Cardenal which talks of mud up to your knees. Now I know the story behind that song line. There were floods everywhere but no new serious damage was apparent in our locale. Signs of last year’s flood are still widespread. Many bridges are still in partial repair. Work on these bridges had to be intermittent while the rains came. Detours were often flooded so waits for travel are still a major problem. Many detours are one way only, so delays are constant and must be factored into any delivery schedule. A "short trip" usually turns in to a full day of delays and frustrations. We had to go into Leon several times for supplies. That was a struggle each time it happened.

The medical group included Dr. Roberto Granera, Dr. Marcela Alonzo, Dr. Angelica Campos, RN Margie Houseman, and RN Miriam Montes. Our support staff was fabulous and included many folks from the construction group who were drafted to help us. We went to several small communities near Mina and treated large numbers of residents each day. The diseases were common with the usual sore throats and urinary tract infections. Some communities had more than their share of parasites. The places where we went are pretty remote, so in many instances we were the first in several years. Some of these people hitch a ride to another community if a doctor is visiting there, but they usually just do without. "Serious" illnesses are usually treated in central clinics if they can get there. However, even after being seen by a physician there is frequently no medicine for the treatment. We treated 1500 patients in the six communities visited this trip. The "cost" of this comes to about $10 per person treated when all of our direct expenses are included. The physician, nurse, and support staff time is not considered in that equation. The communities we visited were in the mountains around Mina El Limon.

Maritza Andino continues to b a whirlwind of activity and ideas. She is hard to read because she has a very expressive face which responds in atypical ways. She loves to joke and tell stories, but they are hard to understand because many of them relate to Spanish terms which are idiomatic to the region. When she tells a joke, she talks rapidly and totally drops her "s" sounds. My weak grasp of Spanish is inadequate to get the point. I can tell it is a joke because those who speak Spanish laugh. There has been a clear difference in the team since I was here in January.

Rodolfo Granera is a nephew of Dr. Granera who functions as a translator and general assistant. He is 17 years old and extremely intelligent. His goal is to become an architect. His contribution to the clinic was quite valuable. Even though he lives in Chinandega, there were times when he had difficulty in translation because of local idioms. There are several items which require careful explanation in a "history and physical only" diagnostic evaluation. These folks would use expressions which even he could barely interpret. I was reminded of some of my Oklahoma patients who use expressions understood only by rural Oklahomans, so my admiration for his skills increased as time went by.

On this trip we had a dentist, Dr. Angelica Campos who added another dimension to our service. She was able to see 40-50 patients each day and pull a lot of rotten teeth. Her extraction skills were great if patient satisfaction is a good yardstick. Even though we were in close proximity, no screams or groans were heard. On one occasion I had to borrow some of her tools for a procedure far removed from teeth. A young woman attorney presented with a horrible toenail which required removal. She had walked 15 miles to see me and begged me to remove it. With local anesthesia, I performed a total excision of the left great toenail. It went well but I did not want her to walk back 15 miles after the excision, so we gave her a seat on our bus and drove her to a commercial bus stop. Dr. Campos was a bit set back by my use of her tools, but it went well. The young attorney will be completely OK in a couple of weeks if she keeps her foot clean as I instructed. Dental problems have been a problem on each trip to Nicaragua, so it was good to have Dr. Campos work with us.

Dr. Granera is still the leader of our medical group and is highly regarded by all. His clinical skills are excellent and his dedication to the poor of Chinandega is admirable. When I was in Chinandega in January, I diagnosed a young girl with hypothyroidism and started her on treatment. Dr. Granera told me she was doing very well and that he had now diagnosed another girl with the same problem. He was pleased with his ability to learn new ideas. The youngster I saw in January has grown 6 inches since I started her on replacement therapy. Her mother says she is getting smarter each day and is really thrilled with her status. During this brigade I saw several women with fairly large thyroid glands. One of them clearly had severe thyroiditis and many had full necks suggesting large glands. I doubt they use iodized salt. Practicing medicine without a laboratory is indeed a challenge.

The shortage of laboratory services was brought home to me in a very poignant way when we returned to Chinandega. Dr. Granera requested that I see his son in consultation while I was there. This young man is 17 years old and is over six feet tall. He smiles warmly and wanly when greeted. His sclerae are deep orange and his skin is yellowish brown. His urine is deep brown and forms a large foam layer when it is agitated. His stools are normal in color by history. His liver is enlarged to 3-4 fingerbreadths below the costal margin. His spleen is enlarged and tender. In his axilla are clusters of lymph nodes which are non-tender. His liver is non-tender. His appetite is good with no nausea or vomiting. The disease is certainly viral although parasites can involve the liver. The big question in my mind is hepatitis or infectious mononucleosis. There is no reason to suspect leptospirosis even though there are a few cases each month. I explained to Dr. Granera that a survey would be necessary to be sure of the diagnosis. Because of all the difficulties involved, he will be treated as if he has mononucleosis. I wish I had him in my Oklahoma City office for a few tests.

It seems every trip has a moment of quiet sadness relative to the human needs in the environment of poverty. Father Miguel referred a child to me for assistance. His mother dutifully brought him to FUNDECI for my evaluation the day of our departure. His story is simple and tragic. When he was 1½ years old he aspirated a round object which totally shut off his airway. Without oxygen he became comatose and was taken to the hospital. At first it seemed he would not live, but he gradually came out of the coma. Doctors advised his mother on several occasions that he could not live, but his mother refused to accept that verdict. Now the child is alive with severe cerebral palsy. His mother is still hoping for recovery. The child has bilaterally symmetrical hyperreflexia with pathologic reflexes in all 4 extremities. He has dysconjugate gaze but does respond to his mother’s voice and smiles---even laughs when she teases him. His pupils react to light. He can hear. But his arms are tightly spastic with early contracture in spite of the mother’s efforts to run them through a range of motion often. He is clean and neat. His mother gets down on the ground and plays with him. He clearly needs to be evaluated by a rehabilitation clinic, but there is no easy way to accomplish this. I urged her to continue to move his arms many times each day to try to maintain some flexibility. The need is great.

Along with every sorrow there is a joy. On this occasion the joy was Margie Houseman. Margie runs a free clinic in Oklahoma City where I volunteer on occasion. I was working there just two weeks before this trip. When I mentioned to Margie that I was going, she said she would like to go sometime. That evening I received notification that one of our brigadistas had to cancel her plans. Since we already had her exchangeable ticket, I called Margie and asked if she was serious and if she could make arrangements with such short notice. She made arrangements and became a fill-in brigadista. Her nursing skills are surpassed only by her people skills. She was great to work with and assumed a leadership role both medically and socially. She bonded quickly with Miriam Montes and developed some new ideas to make the clinic flow more smoothly. Unfortunately her skin made the unplanned acquaintance with the proboscis of a mosquito. The resultant dengue fever caused her to miss a few clinics but she did recover after fairly severe dehydration. Hopefully, this will not deter her from going again next year. At least she is immune to that variety of dengue.

This brigade was characterized by originality and charm. The music was wonderful. The bonds of love were enhanced by the open acceptance of diversity and new sensations. Voices were raised in praise of humanity. More than a few tears were shed for the awesome power of the human spirit. The first night there we visited three refugee camps. The first was developed around a park with a church in the center. There were many new houses of concrete blocks and adobe, each of which was identical. It was a duplex bedroom opening to a patio where there was a central kitchen. At least two families were jammed into each space. Each of these homes represented a few feet of privacy and space to sleep with shared cooking in an outside setup. None of the duplexes were as big as my bedroom and each slept 8-10 people. The brigadistas were saddened by the obvious poverty but these were the best houses we saw. There were sidewalks outlined with lava rock and flower beds with some gardens producing vegetables. The next community had a few semi-finished shacks of wood and black plastic. There was no arrangement apparent. People were living in all sorts of tents and temporary quarters. There were no sidewalks and few gardens. The next place we visited was the worst by far. People were crammed together in barns, sheds, and huts. The children had no shoes. After engorging all of these sensations, it was noted that the smiles were equal in each area. The children played with gleeful abandon with no concern for the lack of creature comforts. The people were positive in their approach to life. They asked only for a small plot to plant a garden so they could feed their family. Happiness here is clearly not related to affluence. They talk of subsistence acreage which was promised by the government after Hurricane Mitch destroyed their entire possessions. Hopefully that will be done soon. Assimilation of these powerful feelings was enhanced by a chorus of voices lifting songs of praise and glory. Of course, a few dozen renditions of "Bobby McGee" helped to distribute the load.

This trip was not totally medical. As mentioned earlier in Mina El Limon there is a women’s center named "La Casa de La Mujer" where I held clinic in January. At that time it was noted that the house needed some minor repairs which would be nice to do. Doors and windows needed replacement so I volunteered our church to do the work. Much to my surprise the project had changed a bit. The walls should also be replaced. There should be a better porch. Our intrepid crew went to work alongside the women of the village. A new structure began to emerge after arduous and back breaking labor. Ditches had to be gouged from the dirt along the front by the painful process of using a pick for loosening then a shovel for removing the dirt. Concrete was mixed by hand on the ground and the walls began to rise. Jim Osterlund was an indomitable leader who worked incessantly with a smile on his face. His contribution to the project was nothing short of phenomenal. Each of the brigadistas contributed in a major way to solidarity and harmonious effort by calling upon unique facets of their personna. It is hard to be fair and acknowledge any because they were each an integral part of the team. And what a team it was! When it came time to leave, it was apparent that part of us reached across the miles in a bond eternal, part of each of us remained behind to keep the solidarity intact.

However, let me indulge my memory with a few short notes. Each person is more but each person brings a bit of individual character to the unified whole. If I miss in my assessment, I accept full responsibility.

My admiration and wonder for Kathy McCallie continues to increase as I see her leadership exerted among this group of novitiates. Her dedication to the mission and to the people of Nicaragua pulls the individual member together in harmony and cohesiveness. Her mission among humanity is extended one more notch, and her love of God grows and shines through her accomplishments. She is a treasure.

In her quiet way Michelle McFarland grew and created an aura of love of people and strength of solidarity. A few quiet words from her calmed the voice of uncertainty. She remained open and charming throughout the tour.

And what about Kim McKee! As a last minute addition, she barely made the passport clearance to allow her to go with us. Her contribution was magnificent. The beauty and clarity of her voice lifted in song will remain in my memory forever. Her competitive fires ignited a passion for beauty and harmony among us all.

Christy Sinsara continues so full of life and innate joy that songs literally explode from her heart. Her desire to learn and be a part of life charmed the people around her and became a matrix for full strength of purpose. Her ability to make music and beauty will remain as a pleasant memory for years to come.

The enchantment of the music of Peggy Johnson continues to improve the aural beauty of any environment. Who would believe that such grand sounds could emanate from a borrowed guitar with very soft strings over a soundboard peeling apart? I’m sure Kris Kristofferson would be imminently proud of "Bobby McGee" sung over and over by these troubadours.

For pure drive, initiative, and unbundled joy, Laura Choate made a contribution like no other. Her ability to crank out the work continues to amaze and befuddle the crew. If she ever tires, it is invisible to those around her. If her spirit droops, she will allow no one to notice. I’m sure the headwaiter at Cosiguina will always remember her.

Strength of character and purpose is a good way to describe Pam Lowery. She is also willing to do anything to further the team mission. However, in conjunction with the strength she also has a beautiful smile and a lovely twinkle in her eyes as she goes about assigned tasks. She reliably and invariably accomplished what was necessary and important.

Palmira Campos can light up any room with the warmth and friendliness of her beautiful smile and her "let’s do it" attitude. She could cheer up the crew and encourage them to even greater productivity. Enthusiasm is an understated word around Palmira. What charm and what joy!

Helen Anthony was quiet and wise in her comments. A warm smile and bright eyes demonstrated her feeling of love for the people to whom we are so indebted--- the poor people of Nicaragua. Her ability to right the troubled ship was also very valuable during the long days as she maintained a sense of purpose and equanimity.

Trish Forsyth remained eager and full of life as she was touched by the challenges of the people whom we met. She asked questions often in an effort to grasp more fully the dynamics under which we were operating. Her zest for living added another dimension to our incredible team.

More should be said about each participant in this brigade, but much of the power and light of our group does not lend itself to words. The anxieties related to uncertainties made way for warm feelings for the people we met. People who have so little yet gave so much to each of us. The bond forged here will go on far beyond the reading of these words.

On the plane between Miami and Dallas I was sitting alone. In this solitude words from an old Frankie Laine song came tumbling into my sadness: