The true voyage of discovery consists not in seeking new landscapes,

but in looking with new eyes.

Marcel Proust

Julio, our guide, arrived at 8:00 sharp for our walking tour of Leon.  After a few short blocks, he conscientiously sat us in the shade in front of a large mural that related the history of Nicaragua from its indigenous roots to the current president, Daniel Ortega. Interspersed with our history lesson, Julio encouraged members of our group to read aloud pieces of literature in English, merging sentiment and imagery with fact.  Lezli and I took turns reading A Roosevelt by Rubén Darío, which speaks directly and frankly to the bullying of Latin America by the U.S. government.

The U.S. is potent and great

When you shake there is a great temblor

that passes through the enormous vertebrae of the Andes

With eloquent grace, Julio described the U.S. support of Somoza, the evolution of the Sandanista revolution, and the new hope and unavoidable challenges ahead for his country.  Juio later shared that he had been picked up on suspicion by Somoza's army at the age of 14 and was incarcerated, for no reason, for several months.  He took us to the Martyrs and Heroes Museum where he showed us pictures of those who had died for the sake of their country including his step brother and many friends.  The photos were of children and helped us understand the depth of Julio's participation and his pride in the true story of his country.   " Nicaraguans now have freedom", he said " but they need to think, and care about each other to really change the country and make it better."  He was very careful to communicate that his issues with American policy were not a reflection of his feelings for the American people, and again thanked us, emphatically, for listening to his story and giving of our time and our hearts to help his country. 

Our next stop was the rooftop of the cathedral.  I love how rooftop tours give you a completely different perspective on a place.  Julio pointed out the ring of volcanoes that surrounds León, one of which was belching gray smoke.  Numerous times I had heard how "we're due for another major eruption", and my midwestern heart skipped a beat.  The land I come from offers me stability and support, but the earth here puffs and groans, spews fire, rumbles, shakes, and breaks.  The Masaya volcano was so active this week that the park was closed to the public.  It is always enlightening to look down on the markets, the plazas, and streets.  After a few quick photos of the bell towers and a pair of lovebirds, we were ready for a cool drink at the best hotel in town, El Convento. 

Both the the art center of the Ortiz Gurdián Foundation and the El Convento hotel are funded by BanPro which charges a minimal entry fee, much of which is donated to Mujeres con Cancer, a charity that helps low income women get treatment for breast cancer.  The art collection was superb with pieces by Picasso, Chagall, Miró, and a predominance of amazing Latin American art from Rivera to Tamayo and numerous very talented Nicaraguan artists that were new to me. It is a private collection displayed in a lovely Creole-Civil style home with a rose garden at its center. Nicaragua is a country of poets, artists, and artisans – on our way back to the hotel, we passed an elderly gentlemen that greeted Julio warmly.  He is a local poet that had been honored the night before where he received a stipend from the government to continue his work.  He was impeccably dressed in a dark suit and cane, despite the sweltering heat.  I found it interesting that in a country this poor, there is still support for the arts and their ability to bring beauty into our hearts with simple words, brush strokes, and notes.

After the tour, we stopped for lunch at the beach and then headed for Managua.  On the outskirts of the city we visited another artisan cooperative, Esperanza en Acción, which is run by the niece of a friend of Patricia.  The organization works with 25 groups of artisans (275 individuals) of which 95% are women and come from rural and economically disadvantaged areas.  Through fair trade initiatives, they offer artisans a fair wage ($1.25/hour as compared to the usual $1.00/day) and a worldwide market which they are working hard to expand in the future.  Esperanza en Acción consistently encourages artisans to improve the quality of their work and offers them low interest loans to help improve their standard of living.  Each individual sets the rate for pay back, according to their individual needs and living situation.  I'm honestly not much of a market person - always wondering what percentage of the price actually goes to the vendors and artisans.  These cooperatives are a win-win for everyone, and so much less chaotic.  I also loved having the artists signature on the piece and the peace of mind that came from knowing I was truly making a difference with my purchase. 

After a quick stop at the hotel for a much needed shower, we were off for dinner at El Tercer Ojo - Managua's only fusion restaurant which was conveniently walking distance from our hotel.  Ann from PINCC warmly accepted the invitation to join the group for our final dinner.

In true Patricia fashion, she encouraged each of us to share an insight from the trip.  Gratitude and Generosity were the common themes expressed around the sangria filled table.  We discussed how misunderstood HPV is in our country, how each donation counts, and how rewarding it has been to travel with the intention of service as opposed to pleasure.  We all agreed that the unique combination of the DFW itinerary has been perfect.  It was important to get to know each other beforehand to gel as a group and create an atmosphere of comfort and trust with each other before the intensity of the service work, and equally important to have this down time at the end. 

“I’m sending PINCC some real post it notes and binder clips”, said Marcy.  She was on the data entry team and corrected (with a smile) my previous blog entry that the office staff had access to REAL post-it notes.  They had paper clipped numbered pieces of paper to each file to identify cases that kept falling off causing confusion and slowing down the process.  “A little adhesive would have made a big difference!” She’s going to send Carol some office supplies from Atlanta for the next PINCC mission.

“I’ll never look at my Ob-Gyn visit in quite the same way, “ said Dani.  The trust these women put in the medical and support staff was sobering.  There was no privacy, no room for modesty.  A piece of paper toweling placed on the exam table was the only “sterile” surface between patients.  The same hospital gown was used all day.  But these women showed up because they wanted to take care of themselves so they could be around to take care of their children and grandchildren. 

Catherine also spoke to these women’s courage.  Many of them thought they had cancer and cried with relief when they heard negativo.  The Nicaraguan staff spent a lot of time repeating instructions and educating patients about the severity of recurring infections and STDs and the importance of treating their partners and using condoms to prevent recontamination.  None of these are easy concepts to understand the first few times you hear them.  The patience of the staff, the volunteers, and the patients was truly impressive.

Arlene spoke to the need to equalize resources at the local level, and pointed out that although the conditions at the hospital in León were shocking to us, it is a FREE hospital where EVERYONE can see a doctor and get a prescription filled. 

Leslie’s eyes filled with tears as she once more remembered the warm welcome she had experience when a young mother invited her into their modest dwelling right next to the pottery shop in San Juan de Oriente.  The family picture with Leslie at the center says it all.  Write about it, Leslie.  

An amazing memory. 

Amidst hugs and tears and promises to keep in touch, we finally said our good-byes.  We had challenged Prousts wisdom and succeeded in seeking new landscapes AND looking with new eyes.  Somehow we all knew we were returning to our “real life” changed on some level, yet to be determined.  Keep in touch gals!  I want to see posting on Facebook and will start looking for the photos in the very near future!

On behalf of our group, I would like to thank DFW and PINCC for making this mission possible.  I would also like to formally recognize that amazing job that Patricia Anderson did as leader of the DFW group.  With patience and grace and tenacity, she kept us on schedule and always had time to listen to our stories.  I especially appreciate her sense of adventure and willingness to jump into a horse drawn carriage for a tour in the rain, and her many connections that brought us to cooperatives and clinics where we could experience the results of non-profit and fair trade organizations, first hand. 

Hasta pronto y que todo les vaya bien.

Tina Romenesko

In a country this poor, every donation is appreciated

Friday morning.  Our last day with the medical mission.  The load was lighter than expected as a group of 19, that we were hoping would arrive from a distant village, was unfortunately not going to be able to make the trip to the clinic.  The interpreters were sent into the hallways to do patient education and do interviews accessing the level of knowledge patients had about health issues in general, and cervical cancer, specifically.  Shannon was always able to get a smile from the kids and the adults with her bright effervescent personality.  At 19, she is the youngest member of the DFW team, and by far the most energetic!  By around 12:30, we were completely done with patients and were packing up the suitcases that organize the medical supplies, getting them ready for their next stop.  Peru.  Dr. Pam and her kids, and Carol were leaving for Lima the next morning for another PINCC mission. 

The Nicaraguan staff of doctors and nurses plus Jenny had made plans to take both the PINCC group and DFW out to lunch to culminate our mission.  We sat at the same large table where we'd eaten the night before.  It was inspiring to see how the entire group had gelled.  Spanglish was heard at all levels as we connected as colleagues outside of the confines of the hospital corridors.  There were lots of snapshots and smiles and exchanging of email addresses.  Dr. Pam addressed the group and offered her thanks to each and every one of us for our important role in preventing cervical cancer through education and training medical personnel.  Five certificates of graduation were distributed amid rounds of applause and tears.  The recipients varied from Ob-Gyns, to Family Practice Physicians, to nurses, and one nurse's aid that had only completed an eighth grade level of education.  What is particulary amazing about this screening method is that it can be performed by any trained medical personnel, which makes it much more sustainable in developing countries.  We posed for our group picture in the restaurant garden, and said good-byes for another 15 minutes before finally dispersing the group.  An amazing experience that has filled all of us with a deep sense of gratitude.

That evening we met for dinner in the hotel lobby and shared, again, some of the high and low points of the trip.  I donated my headlamp to Carol - an essential piece of equipment in the VIAA process.  Because of headlamps, clinics don't need to have electricity to do screenings.  She was thrilled, exclaiming that this headlamp would go to Antonia, the nurse's aide that had just received her certification.  We were also leaving our scrubs and various pieces of clothing from running shoes to t-shirts.  "In a country this poor, every donation is appreciated,"  explained Carol. 

A few of us rounded up the evening at Via Via, just around the corner from our hotel, dancing to the rhythm of a local salsa band.  Tomorrow we head for Managua. 

Quando quiero llorar no lloro

Y a veces lloro sin querer” 

― Rubén Darío

Before heading for the hospital, Patricia and Carol worked together to assemble the group, in full scrubs, for a photo.  These two groups have melded seamlessly into one over the past 5 days.  In our group meeting, the PINCC volunteers admitted they were skeptical about the  " Dining for Women" volunteers when we came in on Sunday.  They´d already had a full week together and were very close, but the lines have completely blurred now and I can sense a gratitude that flows beautifully both ways between all of us.  Ann and Karen have even expressed an interest in joining a DFW group when they get home.  Another full circle.

The hospital day typically begins for the PINCC group with a teaching session in one of the meeting rooms, briefing the Nicaraguan doctors and nurses who take written tests, are asked to interpret photos of lesions and suggest treatment plans, and also work on bedside manner and patient etiquette with the U.S. staff.  Carol had asked me to share my son´s experience using breath (pranayama) for his spinal taps when he had cancer 20 years ago.  Ross is now 26 and cancer free.  The techniques are similar to the LaMaze technique used in childbirth and help patients focus on their breath instead of the procedure and discomfort (a.k.a. pain), breathing in through the nostrils and out through the mouth, very slowly and rhythmically.  It is also a great way to connect directly with patients and offer support.  The doctors were very open to the suggestions and appreciated Ross´s story.  I also slipped in a mudra for relaxation: Prajna Prana Kriya.  You curl the index finger into a small ring and place the index fingernail at the base of the thumb on the inside.  It is very effective for reducing anxiety and again, offers another focus that helps the patient remember to relax into the procedure instead of resisting it.

I was agained assigned to Karen´s room (yay!) and the other interpreters headed to the hallways to do patient eduation.  Everyone is getting more comfortable with our role as volunteers and finding new ways to help everyday.

By around 1:30 PM, we had seen our last patient and were given a tour of the hospital, which was very eye opening and sobering.  The hospital was built during the Samoza regime as a private hospital but is now the official teaching hospital for the university.  It does not have air conditioning, except in conference rooms, offices, and a few treatment rooms, has almost no natural sunlight (which naturally kills bacteria)  and is very difficult to clean.  There is an open area in the middle of the building where the generators are housed allowing pigeons access to the hospital corridors on a regular basis.  Patients have to bring their own linens upon admission and it isn´t unusual for two patients to share one bed.  Yes. You read that correctly.  When Carol first started coming down to Nicaragua in the 80s, they were still sharpening and re-using needles.

Our first stop was the basement where the Emergency room is located along with the Pharmacy and Pathology.  I had noticed that our patients were given their specimens to deliver on their own to Pathology with their name scotch taped onto the bottle.  A different level of quality control than we are used to in the States.  The morgue was also in the basement.  When our guide, Carmen, asked if we´d like to see it there was an emphatic No, Gracias from the group.  The "mor-gay" was not going to be a part of the DFW tour.....

Maternity was on the second floor.  We walked into a large room which 8 moms and newborns shared together in the sweltering heat.  We wished them congratulations and asked the names of the babies.  Ernesto, Gonzalo, Maria,...HILLARY.... and KEVIN!  Lesli, our infectious disease control expert, noticed a used catheter sticking halfway out of a garbage can in the middle of the room and tried to steer everyone around it.  The hospital averages 15-20 births a day, and has a small NICU with incubators, respirators, and monitoring equipment.  More serious cases are referred to the Pediatric Specialty hospital in Managua.

We visited Orthopedics, Med-Surg, Infectious Diseases..., but the most heart breaking area for me was Pediatrics, where the mothers were sitting with their sick kids in crowded rooms, with little to do and lots of time to think.  I expressed the compassion of our group to a couple of mothers wishing them good luck from our hearts to theirs and couldn´t help but imagine my time in the hospital when my own children were ill.  The hospital was a refuge for me where I felt safe and supported.  I could barely control the tears as I recognized the fear and pain in these mother´s eyes.  As we left the building, everyone expressed a renewed gratitude for the state of medical care back home.  It´s certainly not perfect, but the standard of care is completely at a different level.

After a long day - a few of us headed to the Museo de Rubén Darío.  Darío is Nicaragua´s most famous poet and he is from León!  The museum is the house where he lived for most of his childhood and is also where he died.  Doctor Sara´s husband and mother-in-law run the museum so she had encouraged me to seek him out and get a personal tour, which we did!  He proudly explained each item in the museum in great detail, from his funerary mask to his writing table.  Darío was sitting on this very curb, writing poetry, at age 6 and is credited with changing the way metaphor is used in the Spanish language.  He was influenced by Poe, Emerson, and Whitman, and spent quite a bit of his life in Spain, Paris, and New York.  We learned about his many lovers and tried translating some poetry that was preserved in the original written form. They also house a small library that is available to university students studying Spanish literature.

As we wound our way back to the hotel, Patricia shared that she had nearly dropped into a pot hole on one of  her errands.  Pot hole doesn´t accurately describe the state of the streets here.  There are huge holes in the sidewalk that come up at a moments notice, so you have to look down with every step.  AND, the drivers totally have the right of way.  If you try to cross in front of them they beep at you, impatiently.  So walking around is a full on sensory experience!

Carol had arranged dinner at an open air restaurant - where we all sat at a huge table and shared stories, old and new.  Dr. Pam´s and Dr. Ilana´s kids rain between rain drops and played games at the end of the table as we waited for dinner.  The kids have been a wonderful addition to the group.  A true breath of fresh air with all their energy and enthusiams.  Two of Carol´s friends also joined us - sisters that have been helping with the intakes in the morning to get patients into treatment rooms more efficiently.  One is a nurse and the other, a biologist.  Fascinating, dedicated women from León.

I´d like to close this blog entry with part of a poem by Rubén Darío that speaks to the emotions that each of us have experienced in our own unique ways here in Nicaragua.  Tears connect our hearts in compassionate caring and often appear when we least expect them.  Thanks for the permission, Rubén.  To tears.

Quando quiero llorar no lloro

Y a veces lloro sin querer” 

― Rubén Darío

"When I want to cry, I don´t cry

and sometimes without wanting to, I cry"

Felicidades a Mamá 

(Gracias a dios - I just learned how to do accents on this Spanish keyboard!)

There was definitely an energy of celebration in the air as we headed toward that hospital in the morning.  Mother´s Day in Nicaragua is a national and obligatory holiday.  Imagine that!  Only the restaurants and stores are open and everyone is shopping for mom!  As we passed the market, I saw a large table completely filled with mother´s day cakes, a yellow cake with bright white frosting and lots of red frosting roses with Felicidades a Mamá written across the top.  I bet there were 50 of them, monitored by two young boys, towels in hand, swatting at the ubiquitous flies that were trying to land on these masterpieces.  

Because of the holiday, we expected our patient load to be much smaller, in fact the entire clinic was on skeleton staff except for the PINCC group.  Carol couldn´t justify an entire day off in a 5 day training so she and Jenny had  encouraged patients to come and get their cervixes examed for mother´s day - giving themselves the gift of health.  


The PINCC translator, Sallie, was needed to translate a document for Dr. Pam, so I was upgraded to translator for Karen, the Nurse Practitioner from Spokane, in a treatment room.  We saw 6 patients with various needs and there were also 3 Nicaraguan doctors in a very small room with two fans, duct taped to the walls.  It was my first view from the other side of the table.  I felt the pressure of accuracy as I was interpreting the results of tests and treatment plans.  I dropped out of my logical / grammatical mind and into some numinous space that seems to be able to speak medical Spanish!  Karen is a wonderful teacher and briefed me between patients so I could understand the terms I was translating!  I learned so much first hand and was able to experience the conditions these doctors and nurses work in.  We are definitely not in KANSAS anymore.  Everyone is very professional, but the rat poison on the floor, use of one hospital gown for the entire day, and placing a piece of paper towel on the exam table to provide a clean surface for each new patient are just a few examples of the limited resources they are working with on a daily basis.  Our exam table didn´t even have stirrups for the woman´s feet.  She had to hold herself in the compromising position necessary for examination, sometimes placing her foot on the doctor´s knee while they performed the inspection.  More than once, I found myself leaning over a patient, coaching her to breathe, and holding her ankle at the same time to stabilize her foot on the table as she had a procedure.

We brought our donations today - which filled one entire side of the corridor.  Gloves.  Hospital gowns.  Scrubs.  Shannon is a pre-med student and also works at a clinic, so she had an entire extra suitcase filled with an amazing variety of medical supplies that she had lugged with her from South Carolina.  Each of the Nicaraguan medical staff filled a bag with medical goodies.  It was a rare treat for all of them and much appreciated.  Just about everyone in the DFW group brought something, from toothbrushes to ibuprofen and specific supplies. 

Carol had predicted that it would be a half day - due to the holiday and around noon there was only one patient still watiing to be seen for a procedure.  Carol asked her to wait while we had our private Mother´s day celebration so everyone else could go home.  Jenny had purchased flowers for each of the mother´s in our group ( a Nicaraguan tradition) and our last patient was thrilled to be the first to receive a rose while sitting in the hallway in her hospital gown with the group!  The smile on her face spoke volumes!  Jenny had also brought in a Mother´s Day Cake.  just like those we had seen in the market on the way to the hospital that morning, which we all shared.  I´m sure this was one gynecological exam this last patient will never forget! 


The DFW group headed for the beach around 2:30 PM, but I opted to stay back and write and do yoga.  So.  One of them will have to do the beach update!  I know they were able to take nice walks, had access to a lagoon perfect for swimming, and fresh seafood for dinner.  That sounds pretty good.


I shared dinner with Ann and Sallie from PINCC.  We had to make a reservation and put down 200 Córdobas because of the mother´s day rush.  We got there at 7 and the place was half empty but as we prepared to leave at 8:30, things were really getting going.  We shared a delicious margarita and as he brought out agua con gas and a big glass of ice I asked if the ice was made with agua purificado.  No - was the answer.  Hmmmm.....  My margarita was on the rocks......  Rocks are ice.......  We all said a little prayer, and drank warm seltzer water with dinner.  Carol had explained to us the first day that the water pipes and sewer pipes run side by side in Nicaragua and are open so microbes can easily pass from one pipe to the other.  That description had firmly instilled the fear of Monteczumas revenge in all of us.  We reasoned that the tequila had probably kiilled any errant bugs that might upset our intestinal tracts.  


We headed for bed as soon as we got back to the hotel.  Two mother´s days for me this year.  Monteczuma wouldn´t dare take revenge on a mother on her second mother´s day.  Right?

There is healing in the laying on of hands;
in the letting go of fear, in asking for help,
in silence, celebration, prayer. 

(Danna Faulds, Yoga teacher and poet)

The chairs were two deep in the hallways when we arrived at the hospital for our second day of the mission.  By 11:00, we had interviewed 30 patients and were well into seeing them in the treatment rooms.  There are usually 4 treatment rooms running at one time - each one lead by one of the four medical professionals on our trip.  Pam, Ilana, Ann, and Karen.  Our mission is to teach the Nicaraguan staff and ideally graduate them to teaching their own staffs in outlying hospitals how to perform the cervical screenings and remove pre-cancerous lesions on their own. Most of the clinics don´t have the equipment needed to remove the lesions, either by freezing them (cryotherapy) or excising them with a live wire (LEEP).  Training is one issue and funding equipment to do so is another.

I again began the day doing intakes and found that I was much more comfortable with the vocabulary and questions.  The true challenge came when one of the patients told me yes, she had been abused by her husband, that he had been killed, and she had lost a son to suicide.  The previous day all answers were emphatically negative.  We paused.  I took a big breath, held her hand, and told her how sorry I was for her pain and loss, making a note for her to see the psychologist before leaving.  This woman´s story wasn´t unique - along with poverty comes violence, loss, and struggle.  We finished the interview and I handed her a sheet in Spanish that explained a little about female anatomy and the treatments we were offering that day at the clinic.  When I walked into the data entry area, I burst into tears.  I wasn´t expecting it.  I couldn´t stop crying.  But of course, eventually, I did.  Feelings here are very close to the surface, it seems.

This woman had  waited over 4 hours in the hallway to be seen.  I was able to intercept her afterward and escorted her to Jenny - the director here in Nicaragua - to set up a psyc consult for Thursday.  I pray that she shows up and gets some professional emotional support.  Her screening showed no abnormal cells.  Finalmente.  Un poco de buena suerte.  She gave me a big hug and the traditional kiss on the cheek.  I asked for another and hugged her again as we said goodbye.  Tears in both of our eyes.

In the afternoon, I adopted another new role.  Hand holder.  This role is very important and not language dependent.  Each of the DFW volunteers can share a story of connecting with one of these patients as she received a LEEP or Cryo.  Wiping away tears.  Squeezing hands.  Sharing pictures of home on their iPhone.  Talking about our kids.  Coaching the patient to find their breath and exhale...... This job of hand holder is not to be minimized.   One patient pantomimed to the volunteer that she could feel her heart in her hand, supporting her and holding her fear. Compassion crosses all barriers of language, when we are open to truly and vulnerably connecting.

Imagine getting on a bus at 3:00 a.m., arriving at a big hospital by 7:00 (the time they are told to arrive) , and sitting in a sweltering hallway for 2 hours before the medical staff even arrives.  My last patient on Tuesday was seen at 3:00 p.m.  She had to catch the 4:30 bus back to her pueblo and probably hadn´t had anything to eat except for the couple of cookies I encouraged her to eat along with the glass of water that washed down her ibuprofeno. We handed out sodas and crackers.  Many volunteers shared parts of their lunch with women that had been waiting for hours.  There was no protocol except to follow your heart.  Some volunteers even brought toys and crayons for waiting children.


When we got back to the hotel, we were all exhausted, but felt good about the work we had done for DFW and PINCC, and for the connections with these very brave Nicaraguan women.

Nicaraguan dancers arrived around 6 and we were treated with 3 traditional dance performances by local young people.  They were amazing and full of celebration and  laughter - just what we needed after the long day.  We then ambled down the street to Carol´s favorite family owned restaurant for soup and postre de tres leches.  The soup was delicious, served in giant bowls with giant spoons that looked more like spoonRESTS than soup spoons.  We encoutered numerous new root vegetables and potatoes in the broth which was made with a huge variety of ingredients including sour orange.  Yum.

After dinner some of us found our way to the rooftop again and were treated with double fireworks.  Arriba (to the east) was an amazing display of lightning that traversed the sky like words written in cursive (a direct quote from Marie Cruz).  Abajo we heard the boom and crackle of  fuegos artificiales or fireworks.  I thought they might be coming from down on the beach, a preveiw for tomorrow´s national holiday.  NICARAGUAN MOTHERS DAY!

"We Can Fix This"

By 8:00 a.m., we were in the hotel lobby, wearing our scrubs and ready to go.  We each made a name tag that could be easily pronounced by our Nicaraguan patients.  Lezli, Catarina, Daniela, Lina... made some adjustments.  The hospital was crowded, inside and out, packed with people waiting to be seen.  We moved through the un-air conditioned hallways, heading toward the air conditioned conference room to meet the Nicaraguan doctors, nurses, and residents.  This is a teaching hospital, and some of the medical staff has worked with PINCC in the past three years, practicing to gain proficiency with these procedures to prevent cervical cancer.  

The PAP test is also done here in Nicaragua, but the wait time to get a result often makes it ineffective for patients who travel long distances to get screened or are unable to complete a follow-up exam.  The VIAA (visual inspection with acetic acid, which is white vinegar) is performed and completed in one visit making it a much more efficient screening procedure.  If abnormal cells, areas, or lesions are detected, they are immediately removed and the client is sent home.  All in one visit.

The data entry group was set up in a small room with numbered post-it notes and a big pile of charts.  Their job is to organize the charts, get one of the interpreters to do the intake and then enter the data and prepare the file for the necessary screening and possible treatment plan.  

I began by shadowing Sally as she interviewed a young mother.  The questions were now clear for me, but answering them involved discerning heavy accents, deciphering the handwriting of numerous doctors and pathologists on previous tests, and then confiming all of the information, from medical history to current contact information, directly with the patient.  The patience of the 3 women I interviewed was impressive.  They were so helpful, and willing to repeat place names until I was able to understand and reproduce them onto the current form.  Some patients waited for hours to be seen, in an un-airconditioned hospital corridor.  I spent most of the afternoon in conversation with these women, helping them pass the hours and sharing life stories.  

At the end of the day, I was pulled into an exam/procedue room to translate for Karen - one of the nurse practitioners.  Half the time I was holding this very scared young woman´s hand and the other half of the time I was trying to parrot procedures I didn´t really understand.  It felt a bit like channeling...  ¨words like displasia, biopsia, cepillado,  matriz, cuello uterino.... that I can barely understand in English.  I was diligent to re-check what I couldn´t understand but it was by far the most intense translation experience of my life.  We´ll see what days 2-5 bring....

The work day ended with an hour of sharing in the hotel lobby.  I was impressed how everyone had an equal voice.  These Doctors, Pam and Ilana, are completely capable, amazing, and present.  Ana and Karen, the Nurse Practitioners are equally open, vulnerable, and interested in everyone´s commentaries.  We saw 23 patients today and performed numerous life saving procedures.  We talked about how to provide more privacy for patients.  Issues with residents.  How to deal with confusing data.  Computer glitches.  And the fact that this week numerous Nicaraguan doctors and nurses will be graduating to the role of eduacators.  

"We can fix this" , said Carol to the group.  "HPV is everywhere, but we can prevent cervical cancer with screening".  She reiterated that what we are doing is pure service.  No glamour.  Just damn hard work.  

Over dinner the lines between PINCC and DFW faded completely.  We had returned full circle to the yoga class the previous morning.  Women helping women.  Tomorrow. Day Two of the Medical Mission.

¨Where The Streets Have No Name......¨

We began the day on the rooftop of the Hotel San Francisco, connecting our DFW hearts and minds with a gentle yoga practice overlooking the city of Granada.   It felt so good to move and breath together.  I taught the group Trimurti and Yoni mudras (hand gestures associated with the feminine body, mind, and spirit), uniting our intention of women helping women, as we headed for Leon and the beginning of our true meaning for being in Nicaragua, our medical mission with PINCC, or Prevention International.  No Cervical Cancer.

A quick stop the Masaya Market and then we off for Leon.  Our driver pointed out the Iguana hunters along the side of the highway, selling their wares to passing motorists!  Patricia wanted to know how they prepare the meat, what it tastes like, ... so I was kept busy for the entire ride translating sentences I never dreamed would need translation!  A quick roadside stop for the local specialty - quesillos - brought us to Leon around 1:30.  By 3:00 we were assembled as a Medical Mission Team, having joined with the PINCC volunteers in the lobby of our hotel.  The group is lead by Carol - a veteran nurse and midwife that has done amazing work here in Latin America and beyond.  There are two female Ob-Gyns, both from Tucson, who brought their children (ages 3-8) and husbands ( a.k.a. amazing caregivers and supporters of the PINCC mission) with them.  There are also two Nurse Practitioners and an Interpreter with the PINCC group.  They spent the previous week doing a similar training in El Salvador - so they are our experts!

We were divided into 3 groups:  Medical Staff, Interpreters, and Support /Data Entry.  There were 4 of us in the Interpreting group - my group.  Sally quizzed me on the intake form, asking me to translate from my Spanish PINCC manual to English, checking that I could understand the vocabulary.  The first few questions seemd obvious.  Date.  Name.  Address.  But wait!  BTW.  They don´t use written addresses in Nicaragua.  What?  Bono was singing about a real place in the song, Where The Streets Have No Name?  And now it will be my task to figure out how to write an address in a country where that song lyric is a reality?

Places are described in relation to a famous landmark.  East of the landmark is arriba (up - because the sun comes up in the east), and west of the landmark is abajo (down - because the sun goes down in the west).  So our hotel is two blocks up from the Concepcion Church.  Dos cuadros arriba de la Iglesia de la Concepcion.  That seems simple enough.  Yeah, right.  But not if you´re talking about Tio Jorge´s store, or where the Coca Cola plant used to be in Managua.  You have to KNOW the main landmarks to navegate FR0M them.  Ironically, the streets do display names - " But nobody pays attention to them" , says Carol with a flip of her hand.

As I continued with my translation of the intake form, the questions became more and more personal.  Do you drink?  Smoke?  And then it jumped to some of my new vocabulary words like genital warts, condoms, and methods of family planning, touching on topics from number of sexual partners to whether they have had an AIDS test.  When we got to some of the abuse questions, my heart filled with tears as I imagined asking these personal questions and holding each patient´s personal answers.  PINCC has secured a psychologist to counsel women who would like to have a consultation - which they usually decline. This will certainly be an emotional journey for all of us, on many levels.

We shared a simple dinner of pizza in the hotel lobby and head to bed by 9:00, eager to begin our true mission tomorrow morning at 8.  

Today I fell in love with Lake Nicaragua

Manuel, our guide, and the lovely Flavia met us at 8:00 for our kayaking excursion on Lake Nicaragua.  The double kayaks offered us a stable entry into the second largest fresh water lake in Latin America.  We began our journey exploring the calm estuaries of the Peninsula de Asese.  Surrounded by water lilies and mangroves, we wove in and out and around small islands that are most likely the result of volcanic activity from 10,000 years ago.  Now they are teaming with wildlife.  My personal favorite sighting was two martin pescadores or kingfishers!  Bigger and brighter than the northamerican variety, they filled the air with their cackling chorus, swooping and diving.  I seem to see them everywhere.  Such dramatic birds.  We also saw numerous egrets, tons of cormorants, a large black bird with a bright yellow tail that builds large pendulous nests, lots of dragonflies or libelulas (one of my most favorite Spanish words) and even a bright blue morpho butterfly made an appearance. 

We eventually headed out toward our destination - about two hours away - the island of Zapongo.  Our French hosts, Maruo and Rosalin, are creating a completely eco-friendly island paradise and we were fortunate enough to be their guests for the afternoon.  Roslin's constant companion was an adorable capuchin monkey named Cashew.  Over a delicious lunch consisting completely of local veggies and fish, they told us their dream of building a sustainable and community / culture friendly eden.  They are in the process of building rooms, complete with bathrooms and patios, that look out over incredible vistas.  Everyone employed on the island belongs to the same family and lives on a nearby island.  Our hosts employ only local people to build, and buy all their food locally - as a way of winning the respect and trust of their indigenous neighbors.  Its working so well that they now host classes for primary students and illiterate adults on Thursdays, employing a retired teacher to hold the classes.  " Sometimes we have 60 students on the island - learning to read and write", shared Rosalin.  The Ministry of Education recently heard about their project and donated books.  The entire enterprise is inspiring on so many levels.  We encouraged them to share their dream in their advertising - we had NO idea when we booked the tour that this was a sustainable, grassroots eco-kayak tour.  What great luck.  Their daughter Flavia books all the trips and studied eco-tourism in Australia.  Perfecto.

We said a big thank you to Mombacho Volcano - the island's backdrop which was unusually and gratefully in clear view all afternoon.  On the boat ride back to Granada, we exchanged more stories and hugs.  Look for a Yogatina Adventure on Isla Zapongo in 2013!  They even have a great terraza that will easily fit 8 or 10 yoga mats!  Amazing.

As we found our way back to Hotel San Francisco, the afternoon rainstorm hit.  We opted for a horsedrawn carriage ride and tour of this beautiful colonial town to round out our day.  We saw a wedding, a funeral, climbed the cathedral tour for great views of the city - and the surrounding countryside - and ended up at a Mother's Day celebration on the Calle Calzada - the walking street.  Otro dia increible en Nicaragua. 

Tomorrow we head for the Masaya Mercado and then to Leon by 3 to begin our training with PINCC.  We are feeling more and more comfortable in our Nicaraguan environment and ready to formally begin our medical mission work. 

LOST IN TRANSLATION 

Okay.  We're heading for Jubilee House - part of the Center for Development in Central America - and there some confusion going on in the front seat.  I hear jubilado which means " retired" and I'm wondering if we might be somewhat off target when we arrive, after numerous twists and turns, at the old folks home!  Hardly the fair trade, conscious community we were hoping for.  I point out the false cognate and after a rather circuitous conversation it is confirmed that Jubilee is NOT Jubilado.  We are instructed to head for the green gate and are back on track.  Ahhhh words.  I love them and all their nuances and confusion and what's important is that we are here and looking forward to connecting with a DFW project from 2006 .  Live and in person.  Zona Franca Masili. This sewing cooperative is associated with the Jubilee House - a conscious community committed to grass roots projects that facilitate positive change and support for this very poor, rural Nicaraugan community known ironically as Nueva Vida.  This area was created by the government in 1998 after Hurricane Mitch flooded out many lives and communities along the shores of Lake Managua, and was promptly abandoned by that same government.  When Mike - the director of Jubilee House started quoting the Prime Directive from Star Trek - I knew we were in good hands.  The commitment to support and never interfere with the native culture is impressive and obvious from the get go.  Education.  Health care for everyone.  Fair trade cooperatives based on true cooperation on all levels of being - and an amazing composting toilet which I experienced first hand - as an example of appropriate technology - doesn't even scratch the surface of what this group is accomplishing. 

So - back to the Sewing Cooperative - our main reason for circuitously arriving.  Words can't describe the emotion in our fearless leader Patricia Anderson's heart, when she realized the experience of connecting directly with Ruth, one of the original 60 women that started this cooperative.  Completely displaced and forced to work in so called fair trade SWEAT SHOPS, these women hoped for something more.  A place to work, and create, and support their families in a healthy environment that allowed them time to take care of their families AND earn a living.  " It is an honor to stand here with you - arm in arm - and see my donation makinhg a difference.  Woman to Woman."  said Patricia - to which Ruth replied " Many hands make light work."  So inclusive.  So important. So simple and yet so complex to get to this point of completing the circle.

The rest of the day was equally amazing, beginning with a grand tour of Managua by our excellent guide, emphasizing the merging of Sandino and Dario - of revolution and metaphor - a powerful brew that has created the motto we see everywhere.  Seguimos Cambiando.  We continue changing.  Isn't that true for all of us, when we pause to acknowledge it?

Volcanoes, por todas partes.  Side trips to Roberto Clemente baseball stadium (Nicaragua's national passtime, too!) and a side trip to San Juan del Oriente to visit a casa cermica, full of family pride and beautiful pottery.  The day ended in Catarina - peering into the crater lake at sunset and counting our blessings.  There's so much more to say.  Around our delicious candlelit dinner, made only more incredible by the power outage that signaled our arrival in Granada, Patricia asked each of us to share our " magic moment" of the day.  I was duly impressed by the depth and breadth of the stories shared by this very special group of women - looking forward to sharing right back when we get to our Leon.  I encouraged each participant to write - so look for more blog posts in the near future - from a variety of sources! 

Day two tomorrow - are you kidding me?  We're kayaking the isletas in Lake Nicaragua.  Hopefully I'll figure out how to post photos by then!

The journey of a thousand miles begins with a single step.  (Lau Tzu)  

Headed for Nicaragua TODAY - for a medical mission - my first!  The opportunity is part of the Dining for Women program - thanks to Jill Haas for inviting me to be a part of the Milwaukee chapter.  For more info, see their website at:  www.diningforwomen.org  I will have the opportunity to visit numerous projects funded by this group - including a completely independent women's sewing cooperative in Managua.  

Our mission is cervical cancer screenings with PINCC - Prevention International - No more Cervical Cancer.  Its the 4th trip for this group to Nicaragua - so our 9 DFW volunteers will help fill in wherever needed for our 5 days at a regional hospital in León Nicaragua.  Scrubs are packed along with a large duffel bag filled with sterile gloves (thanks Lisa Swartzmiller) and hospital gowns and more scrubs (thanks again, Jill Haas) !  Just a carry on and a back pack for me.  

Stay tuned for more updates.  Hasta pronto.  Tina 

Spring Equinox 2012 - Chichen Itza

On March 20 of this important year of 2012, I had the opportunity to participate in the Mayan Celebration of the Equinox at Chichen itza, in the state of Yucatan, Mexico.  We did a fair bit of research about the celebration and how it relates to the Mayan calendar which enhanced the experience and helped us plan.  

 Our first stop was the Grutas de Balankanche, about 6 km from Chichen.  These caves were only discovered in 1959, filled with Mayan artifacts, which are still in place.  It's a large cave - about 1/2 mile deep - and a 15 minute hike inside the earth. There are numerous large caves and cenotes (underground pools) and in the largest chamber stands the "Arbol de Ceiba" referred to as the sacred tree inside the earth.  It was formed when a stalactite and stalagmite merged to form an auspicious column and altar.  It's at least 30 feet tall and 8 feet around with a secondary pillar on one side.  This tree of life is surrounded by pottery relics with the image of Tlaloc - the god of rain (and dripping rainwater, I guess).  The space holds the energy of unity - of above and below uniting in one.  Another reminder that separateness is an illusion and unity is truth. 

As we emerged from the cave, we saw a bright bright blue MOT MOT - the official bluebird of happiness, Mexican style.  I think it was definitely a good omen.

 We then continued to on to the ruins, about a 2 hour drive from our hut at Maya Tulum.   It was estimated that 7000 people were at the ruins for the celebration which can be experienced for a four day window around the Spring Equinox.  Needless to say, it was quite the scene.  Lots of vendors, but we made our way through to the ball court and continued on to the cenote sagrada.  The Mayans used this sacred underground pool for human sacrifice and in the early 20 th century it was dredged and many bones as well as loads of gold and precious stones were removed from the site.  We sat for a few moments of meditation, honoring those who have given and taken lives in the search for knowing Dios.  Around 4:00, we headed for the main pyramid to watch the descent of the feathered serpent, Kulkulkan.  The sun struck the first step, casting a shadow along the diagonal rise of the pyramid.  About every 5 minutes, another step joins in the journey until 35 minutes later, the shadow of the body descends the final step and joins the stone serpent head at the base of the pyramid, completing the image.  

 Every type of person was present - Japanese, Aussies, Americans, Mexicans - young and old.  Some people were praying - others were chanting - some were barely paying attention and others were completely immersed in the experience.  For me, I was moved by the multitude of peoples that were drawn together in a shared spiritual experience, each bringing their own expectations, hopes, dreams, and fun to the day.  No alcohol is allowed on the sacred site - so although I expect many were "altered", there were no beerstands or mariachi bands.  One guy - a gringo - found his way to the top and held the crowds cheering for about 10 minutes before the policia climbed up after him and probably charged him a large fine!  The only other two active participants, besides Kulkulkan - were a large iguana that traversed the pyramid sides, and a swooping vulture that gave a fine aerial show for the crowd.  As the serpent's body and head united, the crowd began to disperse.  There was no grand moment, just a simple recognition of time passing and the completion of the seasonal event of balancing dark and light.  

 Such an honor to be in Mayan country during this important year of 2012.  The end of the world?  The Mayans clarify that it is more about a change of consciousness toward the energy of love and compassion.  That all sounds good to me.

Sarah and I doing Kaleswara Mudra at Chichen Itza.  

The ruins hold the energy of the heart chakra.