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