Travel Adventures, Nicaragua style

Little Corn Island

by Tina Romenesko

The day began at 6:00 a.m. at the dock in Pearl Lagoon, which was a block away from the Green Lodge. Anne and I had always planned to take this boat and fly to Big Corn Island for part two of our adventure, and after the long bus ride a week ago, Dr. Pam’s family, Sallie, and Reva, had also opted for a boat and a flight.  Each leg would be about one hour in length compared to 10 1/12 on the bus.  Dr. Pam’s daughter Alegra had thrown up 9 times on the 10 ½ hour bus ride and they prudently decided that this would be a much better option!  It was a beautiful sunny day - and ride was gorgeous along the inter-coastal waterway.  Parrots.  Kingbirds.  Egrets.  Cormorants.  and Miles and Miles of unspoiled Carribbean coastline.   We stopped for gas at Kukra Hill, where one ambulance-load-full of women had come from, at clinic, which gave us much more perspective on their journey.

As we had heard, Blufields was a little rough - and since we had 7 hours to wait - Anne, Reva, and I opted for breakfast at the South Atlantic Hotel, upstairs.  “It’s a good spot”, whispered an ex-pat sitting on the porch. That was all the push we needed, so in we went - and they had Wi-Fi.  :)

After recollecting ourselves with the traditional breakfast of eggs sunny side up, gallo pinto, salty cheese, and wonder bread toast, we ventured down the street, rolling our suitcases behind us on the cobblestones.  We hardly looked like tourists....  Eventually we made our way to the market - which was shabby inside and out, and filled with treasures.  I had heard that there was a stall where an old woman (la viejieta) sold herbal medicines and teas from the rainforest.  After asking 2 vendors about her, the third finally sent me in the right direction.  She was tiny, wrinkled, and a little terse, as I asked about a medicine for my sun blister.  Did I say she was tiny?  Honestly, she came up to my waist at most.  I bent down to hear her answer.  “No.  Nothing for my painful “ampolla”, but how about this tea to help you sleep - it’s also good for your riňones (kidneys)?” .  She showed us roots for men’s prostates, special seeds on necklaces for children to wear if they are ill-tempered, and rosemary tea for immunity.  I opted for the kidney potion, tilo, and gave her 5 cordobas.  “Can I take our picture?”  “Sí.”  As we posed for Reva, we both smiled in recognition of the many differences in our experiences, overtly reflected in our statues.  But we had communicated across these boundaries - and I had a new tea in my backpack, from the rainforests of Nicaragua.  My kidneys will be grateful for the inquiry, I’m sure.

We arrived at La Costeňa Airlines around noon - after spending an hour in the Parque Central.  The rain had started up again - as we settled in for a long wait.  Our plane from Blufields to Big Corn was delayed because of the aguaceros (or squalls) - and even so - we took off in a driving rain.  It's only about a 20 minute flight,  but it was obvious that we wouldn’t make the last panga (boat) for Little Corn.  Enter Twyla - the owner of the Cuban restaurant on LCI (Little Corn Island).   As we landed in the 8 seater plane, she took us under her wing, shuffling us into a crowded taxi.  “The panga drivers know the flight is late - they’ll wait for us”.  Wait for her is more like it - everybody seems to know Twyla.  She is carrying a large plastic basket filled with mint for Mojitos at the restaurant.  I REALLY like this woman!  .  When we got to the port - we were hustled onto the waiting panga - guys were grabbing our bags - backpack and poof!  We were on the boat, under a big plastic tarp and we were off.  

When it rains, the passengers hold a large tarp over their heads, in unison, like a make shift roof.  Well.  The swells were pretty amazing - and all I could see was the inside of the boat and the tarp, which I was holding onto for dear life - pressing down on my head and face.  We hit a couple of big swells and I thought my stomach might end up in my lap.  I used all my yoga tool box not to barf - during the 30 minute trip - which seemed like about 30 hours.  Twyla saw my fear - and kept reassuring me from the seat behind me.  "It's okay Tina.  Hang on - we are almost there - look out - now you can see the island!"  So sweet of her to help us.  

A young man with a wheel barrow was waiting for us at the dock.  There are no cars on the island, so wheel barrows are used to schepp equipment to and from the hotels, as needed.  We hugged Twyla good-bye, promising to stop by her place for a mojito in the near future and headed down the path.  We wandered through farm fields, through a marsh, and trampsed alongside a couple of modest family homes, acccompanied by cows, egrets, pigs, chickens, and the ubiquitous Nica dogs.  Eventually we figured out the Little Corn Island B and B is on the OTHER side of the island!  Upon arriving we were given a much needed piňa colada and within moments had showered and were sitting down to dinner with a glass of cold white Argentinian wine.  Perfecto!  Safe and sound in our new island abode.  :)

The diving here has been phenomenal.  The reefs are some of the best I have experienced.  Period.  Purple Sea Fans in full splendor.  Colorful healthy coral.  And a wide variety of sea life.  Our dive master, Gary, is incredible - always stopping to show us huge nurse sharks, camouflouged Spanish rays, tiny drum fish, and of course the Disco Fish!  Gary is delightful in his professionalism and his vast knowledge of sea life, and he takes very good care of us!  Probably my favorite sighting was a large Hermit Crab who had taken up residence in a Conch shell.  I’d never seen a crab home of quite that magnitude.  Must be old money.....  

Diving in the morning at 9 - and then spending the rest of the day blowing off nitrogen and enjoying other aspects of the island Then back in the panga at 6:30 a.m. to head for Blufields and then the flight to Managua.  May the travel gods be with us - especially for the Managua connection!

As Anne and I were walking back from the dive shop today, we mused on the great variety of this adventure.  What a special treat.  Languages, landscapes, accomodations, people, work, rest, and activity.  From Laguna de Apoyo to the Caribbean sea - from the hard work at the clinic to a glass of white wine on the beach at dusk - its all been a grand adventure into the heart of Nicaragua.  With much gratitude.  Namaste.

I am always doing that which I can not do, in order that I may learn how to do it. - Picasso

by Tina Romenesko

As we wandered through the soggy streets toward the clinic, we were all a little sad that this is our last day.  It has been challenging, and fulfilling, and wet, and long, and filled with laughter, tears, good news, bad news, and lots of hard work.  Each of us has been challenged to do, to see, to be something that stretches our edges.  In service work, expecting the unexpected is the norm.  We only saw 30 patients today (instead of 45-50) because we needed to clean all the speculums and pack up the PINCC suitcases with equipment and supplies.  The Nicaraguan trainees also took their written tests and all agree that they have learned A LOT in the past five days.  

Today there was a cancer diagnosis, which is always a staggering reality.  This woman has four sons - the youngest is six - and she will have to go to Managua, as soon as possible, for more diagnostic tests and treatment.  She doesn’t have the money for the trip and hopes she can find help affording treatment.  Many women die because they can’t afford treatment.  Joyce and I were called in to bring her to a quiet space to process the bad news.  Joyce is our PINCC team grandmother that has spent the past two weeks walking through puddles and up and down cobblestones with her two walking sticks.  Despite having MS, Joyce has ridden on boats, walked the beach, and held many hands during our time in Pearl Lagoon.  A fierce warrior with the biggest heart I have ever known, she offered sage advice.  “Take it one step at a time.  Talk to your family - and remember its okay to ask for help.”  I held this brave woman’s hand and told her about my son that is a 21 year cancer survivor, diagnosed at age 6.  We drank apple juice, and she talked again with Dr. Sharry to ask a few more questions before taking the bus back home.

Around 2:30, Carol brought us all together, instructing us to blow up two balloons and tie them around our ankles.  Really?  Some of us were better at inflation and others at tying, and eventually we were all set for her ice breaker.  Amidst squeals and laughter, we tried to pop each others balloons, until there were only two left standing:  Jaya and the trainee, Inez.  It was a great way to release the stress of the week and come together as a group again.  Each of member of the PINCC group shared what they had learned/loved on the trip and about Nicaragua. Sally translated for those that didn’t speak Spanish and the consensus was that it was a very valuable week of learning and listening.  Many of the Nicaraguan trainees wanted to share also - expressing their gratitude and looking forward to our return in November.  PINCC will return to Pearl Lagoon every six months to check on the trainees and continue educating them in these life saving techniques.  Each visit they are progressively moved forward until they are able to perform all of the available treatments independently.  This process usually takes about 3 years and there are always new trainees with each visit, so everyone progresses at their own pace.

The rain continued to fall as we headed our separate ways, filled with appreciation, and wiser for having experienced this amazing week together.

Creole, Mestizo, or Miskito? by Tina Romenesko

Carol opened our PINCC group meeting by exclaiming “ This is the dampest PINCC first days we have ever experienced!”  The rain here comes and goes - one minute the sun is shining and the next the sky has opened up and it is raining gatos y perros.  We were without electricity for a full clinic day and for parts of the other three days which means no fans, no air conditioning, no lights, no computer back up.  You don’t realize how much you depend on electricity until you don’t have it!  

“Because this is a first visit - we all walked in completely cold,” Carol reminded us.  We didn’t have any idea what conditions would be, how the rooms would be set up, or even how much support the clinic could offer us.  The consensus is that it has been a very good couple of first days.  The trainees are beginning at ground zero as VIAA is a completely new technique to this area - so they are brand new to the idea, as are the patients.  PINCC’s main mission is to train these doctors and nurses to replace the need for return visits, which usually takes a few years and lots of training and patience from the U.S. clinicians.  The day starts and ends with classroom time - combining study (lecture, slides, etc)  and hands-on experience.  VIAA, or Visual Inspection with Acetic Acid (or vinegar)  and immediate removal of lesions with cryo (freezing) or LEEP (electrical current) allows women to be evaluated and treated in the same day, a big advantage when patients travel long distances to be seen.  On day three, women traveled from the neighboring communities of Orinoco and Tasbapounie, spending one to two hours by panga (boat) through driving rain, to get treatment.  Most spoke predominantly Creole, a few spoke only Spanish, and we BOTH had a hard time understanding each other in interviews!!  

The support team spends a lot of time educating women in hallways and private rooms to help them understand the procedure they will be receiving, what we can evaluate, and what we cannnot do.

This part of Nicaragua was never conquered by the Spanish and therefore is unique in its ethnic and racial composition.  The population is mostly Creole, but also includes the indigenous ethnic group Miskito (nothing to do with the Spanish word “mosquito” which comes from “mosca”) as well as the ubiquitous Mestizos that are a combination of many races, colors, and creeds and speak predominantly Spanish.  This diversity makes communication challenging here on many levels.  

I begin each intake asking the patient her name, figuring out how to say it correctly, and then holding her hand as I share my name and a smile.  I emphasize that clear communication is key and that it is important for us to be sure the answers are accurate.  Smiles and gestures are always helpful, like the one that seems to be universal for vaginal births - a sweeping energy with the back of the hand, down and out of the pelvic bowl (apanavayu for you yoga nerds)!  I continue to do orientations with women that have a history of abuse and am keeping a running journal of the case histories, including only their age, ethnicity, and story.  No names.  Confidentiality is a big deal here.  Carol wants me to keep a data sheet so the director of the clinic can make a case for the need for support groups and psychological counseling for women that have been victims of rape, physical abuse, and sexual abuse.  I stress how important it is for women to support women.  “Find a good girlfriend,”  I counseled a young 20 year old mother who was feeling alone and disempowered.  “Changing your life alone is really difficult - but with the support of friends, it’s always more hopeful.”  This young woman found me as she was leaving - her VIAA was clear, and she and her one year old son gave me big hugs before they left.  “ Girlfriends,” I whispered in her ear.  She kissed me on the cheek and said she’d try.  

A troubling percentage of women admitted to being victims of domestic violence, sexual assault, or rape.  One admitted that she will not get into another relationship because she has 4 daughters and doesn’t trust men, and based on her experience; she wants to protect their safety.

Each clinic day is dedicated to a different area, plus overflow from Pearl Lagoon and Haulover, the main pueblos in the area.  Day four included women from Kukra Hill, of which many were Spanish speakers, or Mestizos.  They seemed very relieved when we offered them the option of English or Spanish.  When the bus showed up - it was a sea of women that seemed overwhelming until we realized that half of them were here for ultrasounds and the other half for VIAA.  Whew.  

Day four I was able to introduce some mudras to the patients I counseled.  The first is trying to get a restraining order (which is very difficult here in Nicaragua) so I showed her Vajrapradama Mudra - the interlaced fingers reminding her of the support around her, both visible and invisible.  She connected with her breath, with her heart, with her children, and felt the protection of the shield of compassion - keeping her family safe during this time of transition and action.  I referred her to Dr. Effy and she will have to go to Bluefields to get the court action.  It is the most dangerous time for women - when they can see that the woman in taking action against him.  She is going to talk with her sister for additional support.  Again - the feeling of shame is so strong.  I keep reminding her that she is smart, strong, powerful, and deserves to be safe.  

The next mudra I taught was Trimurti to a woman that is having a lot of pain in her abdomen, wants to have a baby, and also has bad migraines at night from a busy mind.  I explained the importance of connecting positively with her reproductive organs, and also that belly breath is a good way to ground the thoughts and induce relaxation in the nervous system.  She seemed to understand what I was saying - I hope she will try it - which is the beauty of mudras.  They are free, can’t hurt, and can give hope.  

Tomorrow is dedicated to the Miskito women from Raitipura which is only about 10 minutes from Pearl Lagoon and will offer its own challenges in language and culture.  It will also be the day to see any local women that we were unable to see during the week and employees of the clinic.

Today is PINCC’s MPH Summer intern’s 26th birthday!  

Happy Birthday Reva Grimball!  

Can you think of a better way to spend your birthday than on the Caribbean coast of Nicaragua, sitting in a damp hallway, interviewing women about their knowledge and practices concerning cervical cancer?  PINCC’s summer intern, Reva Grimball. is doing just that!  Her summer project will be analyzing the data she collects to help PINCC inform others of the need for their services in areas just like Laguna de Perla.  

Reva has an undergrad degree from St Edwards University in Austin with a Major in Biology and a Minor in Spanish.  She just completed her first year in Berkely’s Graduate Master’s in Public Health program, with an emphasis on Infectious disease and vaccinology.  I quizzed her about the safety and efficacy of vaccines to which she replied that she is 100% pro-vaccine.  Her enthusiasm includes, whole heartedly, the new vaccine for the Human papillomavirus, or HPV, which is the cause of cervical cancer.  “ Cervical cancer can be prevented and is eradicable because it has no animal reservoir.  In Australia, the HPV vaccination is mandatory.”  She also emphasized the importance of vaccinating both young women and young men, as the virus is passed between the sexes with sexual contact.  Even though it is best to vaccinate before the onset of sexual activity, young people can be vaccinated up until the age of 26.  “We were able to eradicate smallpox with vaccines.  It’s time to do the same with HPV.”  

Reva said she was attracted to PINCC because of their ties with infectious disease (HPV) and women’s issues, as well as their emphasis on sustainable programs that focus on education and treatment.

We are all looking forward to Reva's birthday cake tonight at dinner! :)

PS:  Cake was delicious - from the PINK BAKERY.  Chelsea had tried to order the cake the day before and they informed her that it was dependent on the electricity (absolutely necessary for baking a cake) and the temperature (cakes cool slowly here!)  I am happy to report that the cake was enjoyed by all - with a nice round of Happy Birthday To YOU at Ulrich's Bar and Restaurant accompanied by a light Caribbean breeze!

JUNE 10, 2013 - Clinic Day One in Laguna de Perla, Nicaragua

PINCC Blog post by Tina Romenesko

The torrential rains during the night had left us without power, but the gas stove was humming as I entered the cozy kitchen of the Green Lodge.  Arlene and Wesley, our hosts,  were busy serving breakfast to the PINCC volunteers, six at a time.  Coffee, scrambled eggs with tomato and pepper, gallo pinto (of course), bread, guayaba jelly, and some of the most delicious pineapple I have ever tasted.  We were all done, and fully coffeed,  by 7:00 sharp and headed for the Clinic, where the patients were already lining the soggy and overcrowded hallways.  Some volunteers began setting up rooms while others began the interview process.  Fifty numbers had been distributed to patients, which meant we had a very full day ahead.  Many of them had come by panga (boat) from neighboring communities and represented at least 3 different ethnic groups that comprise the Pearl Lagoon region.  We weren’t sure if the interviews would be done in Spanish or English.  The people in this area speak both languages, as well as many ethnic dialects.  Our intake forms were in Spanish, but most of the interviews today were in a combination of the two.  It took me awhile to get the gist of the accent - in English.  I asked them to be patient with me as I tried to listen and spell their names and towns over the rattle of the continuing rain on the roof.  Most of us were standing in puddles or underneath roof leaks, but everyone pursued and communicated the important facts surrounding each woman’s reproductive health issues.  

We have brought Cytotechnician, Dr. Fatima Figueroa from Leon with us, which allows clinicians to perform a PAP test if the clinician feels that the view of the cervix is inadequate or incomplete.  This option gives patients the most accurate result, if there is any questionable tissue in the viewable area.  It usually takes weeks to receive PAP results - and follow through can be formidable as slides are often read off site, or even sent out of the region.  The problem today is the lack of electricity.  The microscope lights won’t be illuminating any slides until we have power.  Fatima and Sara, a medical student and pathology intern, stained 16 slides today, and hope to examine them tomorrow, but time will tell.  The power outage originated in El Rama - the regional capital - so it is imposiible to guess when we’ll be sending emails, enjoying air conditioning, or even powering microscopes.  If you see this BLOG ENTRY, we are back in business.  

I am always impressed by the volunteers willingness to do ANYTHING - and I mean ANYTHING.  No job is too menial when the team is in need.  Today I found myself doing interviews, educating clients in the hallway, donning rubber kitchen gloves and assisting Becca and Sallie in sterilizing instruments, and eventually was called upon to follow-up with clients that had been victims of abuse.  It is estimated that around 25% of women with HPV - the cause of cervical cancer - have been sexually abused before the age of 16.  The incidence of HPV rises with the age of onset of sexual activity, numbers of partners, and also the amount of stress the women endure throughout their lives.  For these reasons, our intakes include very personal and important questions that can raise difficult emotions and memories.  My role was simply to inquire, listen, and offer support and safety for them, however they needed it.  It is an honor to hold these women’s stories in confidentiality and with deep compassion.  

Seven hours later, when we break for lunch, we have seen 45 patients, performed a handful of cryos, and scheduled about half a dozen LEEPs for the end of the week when we HOPE to have power to perform them.  We have also given many women the good news that there were no abnormal cells in their cervix!  So many women came to the clinic with the C word, front and center.  They leave relieved, better educated, and empowered to improve their sexual health practices - physically and emotionally.  

PS:  Just got power!  Blog going UP!!!

Meet  Jenny – from Laguna de Perlas (blogger entry from Sallie Weissinger)

We got to Laguna de Perlas, a first-time trip for PINCC, Saturday evening shortly after sundown.  The last third of the 13-hour bus ride (note:  Sallie had come from Leon) was on unpaved roads.  At times the bus driver would come to a turn in the road, looking up to see which direction had more electrical wires going its way, and choose the route with the greater number of wires.  We let out a sigh of relief when we arrived at 7 pm.  It had been a long day, but we were here, gracias a Dios.

And why Laguna de Perlas, a place our coordinator Carol Cruickshank calls the most remote place PINCC has ever gone, including Africa?  It's because Jenny Williams, PINCC's Leon connection with the Ministry of Health, was born and raised in Laguna.  It has been her long-standing hope to bring more health resources to her region.

Jenny was one of ten children – five boys, five girls – born in “Pearl Lagoon” on the northern Atlantic coast of Nicaragua, where the Atlantic and the Caribbean merge.  Laguna de Perlas was part of a British protectorate, and the people, of mixed indigenous and African heritage, speak English and  Creole, as well as Spanish; the town seems more Jamaican than Nicaraguan, and we're in culture shock, trying to remember to say “good morning”  and “thank you” in lieu of “buenos dias”  and “gracias.”

When asked why she became a nurse, Jenny offers two main reasons- her father and mother.  When Jenny was 14, her father died at age 50 of pancreatic cancer without adequate medical care.  Her mother had to raise the 10 children on her own; Jenny doesn't know how she managed it, although she recalls several aunts in Panama helping out.  There was no family planning in those days, and her mother ended up raising many more children than she would have chosen to have.  Jenny talked movingly of a miscarriage her mother had.  Oarsmen rowed her mother, bleeding and wrapped in sheets, in a canoe to the clinic in Bluefields for 18 hours, hoping in vain to get help.

Jenny went to a school in her village run by Moravian evangelists, but for high school had to go to another town where she lived with family members.  For three years she pursued nursing training in a town called Bilwaskarma, near the Honduran border.  To complete her degree she went to Managua for mandatory public health and psychiatry courses, a move that ultimately led her to her work in Leon, where she has remained since 1975.  Had employment opportunities been available in Laguna de Perlas, however, she would have chosen to go home to work.  Following her nursing program, Jenny worked as an assistant surgical nurse and then as chief of nursing at a Leon health center.   In 1991 she returned to nursing school for two additional years to become a licensed nurse, una enfermera licenciada.  With that milestone under her nursing belt, she went the administrator route and is currently Leon's Coordinator of Women's Health for the Ministry of Health.  

Jenny's interest in the medical field is matched by several of her family members:  her older sister also became a nurse, and her nephew Dr. Wesley is a pediatrician here in Laguna and sub-director of the clinic where PINCC will spend the week working.  (Dr. Wesley's father, Jenny's brother Wesley, is a trained high school teacher and runs the lodge where we are staying.)  And Jenny's children?  Her older daughter is a lawyer, and her younger daughter has just finished her medical training to be a gynecologist.

Busy, capable, big-hearted Jenny is married to a lawyer in Leon, who shares her with an expanding family of Nicaraguan women whose lives she can alter in a way that wasn't possible in her mother's time.  Brava!

BLOGGING ENTRY - TWO.  Our time in Laguna de Apoyo was magical.  Yesterday we decided to hike the Mombacho Volcano tour - an active, but presently dormant - volcano.  Yeah.  We wondered what the heck that could mean too.  The volcano hasn’t erupted for hundreds of years, but is still steaming.  On our hike around one of the craters, we were able to experience a fumerola - an opening in the earth that shoots up sulphur infused steam!  As I turned around the guide teased me, “ Pareces aun mas joven ahora”  - or you look even younger now!  I said - I’m going back!  Fountain of youth or fumerola de la juventud?  Sounds good to me!  

Our guide, Belinda, is 23 years old and has attended the University of Leon with a major in Tourism.  She attended the public university, which is free, and is a delightful young woman with an infectious laugh and light heart.  Anne, Belinda, and I immediately connected, speaking mostly Spanish with some English peppered in when necessary, and have talked about everything from Catholicism to the role of the U.S. in Nicaraguan history to language (her boyfriend is German so she is also learning his language!) and points beyond - plus a great tour of the crater around the volcano.  We rode up the steep paved (like with pavers) road on an enormous double decker truck that felt too large and too top heavy for the roadway, but we made it, up and down without incident!  The views of Lake Nicaragua, the Isletas, and Laguna de Apoyo were amazing and helped orient me to my surroundings.  Bromeliads, orchids, butterflies.  The forest is called “ un bosque enano” or a dwarf forest as the trees are low, green, THICK and filled with vegetation.  Over 35 plant species may live on ONE TREE!  Compact greenness at every turn.

We shared a traditional lunch in Granada at a darling garden patio  restaurant.  Belinda tried to get Anne and I to try the Chicharrones (fried pig ears) but we opted for just a sampling of her Vigoron - a very typical dish with yucca, cabbage slaw and, of course, fried pig ears!  As we said goodby to Belinda, we expressed our gratitude for her willingness to share on so many levels.  Back in Managua, we met up wtih Sara, a lovely medical student from Iowa whose energy and grace will be a wonderful compliment to the PINCC team.

As the bus from Leon arrived with last week’s volunteers, Sara, Anne, and I were practicing Sun Salutations and doing Mudras on the patio in front of our hotel.  :)  The long ride, a supposed 8 hour trek across Nicaragua, headed for Laguna de Perla on the Caribbean Coast. would be an opportunity for us all to connect, reconnect, and rest.  Carol noted that this group contains more returning volunteers than any other trip she has organized.  As I found my seat at the back of the bus, I met Sharry and her daughter, Chelsea.  Sharry is an Ob/Gyn from Chippewa Falls, Wisconsin!  It seems that the Midwest is well represented on this mission.

The trip passed quickly for the first 5 ½ hours - sharing stories and pre-ordered gallo pinto (Nicaraguan rice and beans),  At Ramas the road turns to dirt - a formidable task for our air conditioned micro bus, but the amazing scenery offered a much needed and appreciated distraction.  Houses on stilts, seemingly constructed from 2 X 4s, peace lillies growing like wild flowers along the road, birds of all shapes, sizes,and colors......  I put on my headphones and enjoyed the scenery with Counting Crows as the soundtrack.  However, as the sky turned to night and we were still unsure of our trajectory, everyone settled in for the longggggggggg run.  We turned into Pearl Lagoon around 7 PM, after having spent 4 ½ hours on the dirt road and covering a mere 50 km. of distance.  Dirty and hungry we headed out for a quick dinner (not!) and some more camaraderie and team building, Carol style.  

Our team consists of:  Four clinicians - Dr. Pam (and her family), Dr. Sharry, Anne and Jaya.  Four interpreters:  Sally, Patricia, Sue, and myself.  Support:  Joyce, Chelsea, Becca, and Priya.  Pathology student:  Sara  and of course our fearless leader, Carol.  

MORNING ENTRY - JUNE 7, 2013.  I just watched the sun rise over Laguna de Apoyo, accompanied by the cartoon like warble of the Urupendula birds nesting above me and the Congo monkeys howling all around me.  Pretty spectacular.  When I booked the night for Ann and I at the Apoyo Restort and Spa - it looked pretty nice - was within our price range - and that was that.  I could have never imagined that I would be sitting on the porch, front and center to a rare  natural phenomenon.  

The Urupendula is a native Nicaraguan bird that each year creates long (like 3 foot long) pendulous nests from the fronds of bananas.  A task that takes about a month.  The flock that have nested in the large Guanacaste tree in front of our villa have created over 30 nests and are continuing construction from morning to night - both inside and out.  These large dark feathered birds have long brightly colored beaks and bright yellow tails.  Both sexes build the nest, climbing in from the top to construct and to sleep at night now and eventually to lay their eggs.  The call is like something I have never heard before.  Cartoon-like.  To make the sound, they must turn upside down, on a tree branch, and flip back up, like an ancient indigenous instrument or a child’s toy.  It’s the motion that makes the noise, and it is loud!  

One of the developers of the property, Gail from Kalamazoo Michigan, says this phenomenon is a once in a life time experience.  The nests are usually scattered throughout the rainforest and these naturally shy birds tend to cease all activity when a human meanders by.  But here they are - front and center - almost within arms reach - an amazing backdrop for my evening glass of Pinot Grigio and my morning cup of coffee.  I am a lucky girl.

Ann and I met up in Houston, flew to Managua, arrived at Casa San Juan without incident.  Always a plus when traveling to Latin America.  Our driver, Edgar, arrived at 9:00 sharp and drove us to my preferred destination of Laguna de Apoyo.  I had seen the crater lake the previous year from the mirador de Catarina (lookout) and knew I needed to plunge my body into its waters.  Our resort is undergoing an amazing transformation.  The 140 villas are perched on the verdant green crater that surrounds the lake, with a pool, restaurant, spa, and even an obstacle course.  

Many of the units are in poor condition, but the new manager, Gerardo from the Netherlands, has a plan to get this place in tip top shape by January.  There are 40 owners and it is a condo/hotel set up where owners can only spend ⅓ of the year in their unit.  Our villa is amazing.  Nicely appointed, large, very traditional in decor, and remember the view?  We are the ONLY guests in this off season.  They kept calling me “ Mrs. Tina “ :)  .  I’m thinking yoga retreat in the spring of 2014?  Put it on the calendar.

We meandered down to the lake and both had a lovely swim in these sacred waters.  As I slid my body into the warm, crystal clear fluid energy of the lagoon, I released old ways of being and limiting beliefs, opening to the unlimited potential locked in my heart and soul, waiting to be released.  Soon we will be immersed in the sea of service work and our community of volunteers.  Both Anne and I are filled with gratitude for this opportunity for some personal reflection before the service work that awaits us in Laguna de Perla.  

Today we have booked a tour to Mombacho, an active volcano and national park area about 45 minutes from here.  Then back to Managua to connect with the group tomorrow morning at 7:45 a.m.  The journey has begun - and what a wonderful first step.

REVIEW OF THE BOOK - CITY OF THE BEASTS by Isabel Allende.  

Final Project for the Thursday Morning Book Club 

Milwaukee School of Math and Science

Milwaukee, WI

Mr. Ross Romenesko's awesome advanced Sixth Grade Readers.

Alex Cold is anything BUT excited at the prospect of traveling to the Amazon with Kate, his badly behaved grandmother, but off he goes as part of the International Geographic Team in search of the Beasts, otherwise known as the Yeti.  His mother is dying of cancer, he’s angry, doesn’t care for adventure, and is hopelessly in love with Cecilia Burns, who doesn’t even know he exists.  Along the journey, Alex learns a lot about himself, the world, magic, spirits, Indians, good guys and bad guys, and even eats Anaconda before it is all over.  His cohort for much of the journey is a courageous 12-year old named Nadia, whose father, César Santos is the expedition’s guide.  Nadia, and Alex, soon realize that they will have a unique role on the trip as they battle science, greed, and the dangers of the rainforest to save the Beasts and the Indians from extinction.  

If you like magic potions, dreams, and adventures, this is a great book for you to read.  The author, Isabel Allende, is well known for her adult fiction that focuses on Magical Realism - a style that inserts magic into what would otherwise be “ normal “ situations - stretching the readers sense of reality into new realms where totem animals, talismans, and giant talking sloths are an everyday experience.  

Some parts of the book are reminiscent of the Harry Potter series, but I think it would make a better animated movie.  One of my favorite parts of the book, is when Alex realizes that he can turn into his totem animal, the Jaguar, at will.  The book also speaks directly to the concept of Giving and Receiving, which is an important aspect of how we should treat the rainforest.  If we only take, it will soon be used up and disappear, along with the Beasts and their history, magic, and wisdom.  

A fun read that stretches the imagination.

Tina Romenesko

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"