My most recent adventure: My MSN

My latest adventure in nursing was the completion of grad school (with the exception of a little paper, my comp/thesis - but it will be finished soon!)

Last week I walked in a ceremony full of pomp and circumstance, complete with brass instruments to serenade us as we walked on stage. It was surreal, to say the least.

I have succeeded in adding more letters to my name. BSN, RN, MSN, CNS. Will those letters point me toward a new adventure? Only time will tell!

Latest on Bed Nets For Kids

What a crazy year it's been! The Bed Nets For Kids project is still going strong. In fact, as of the end of May, there have been 442 children served by the project. Almost everyone has had their in use and installed correctly at their follow up home visit. Nate created a graph to represent the findings during these visits, including cases of malaria relapse. (See graph below)

I am completely thrilled. I never would have imagined this rate of growth! We went from less than 10 kids per month to over 65 per month in less than 1 years time! I feel so fortunate that I have Papy in Goma. He is a really dynamic nurse who is running the project locally. The reports and pictures from him are really heartwarming. I don't know what the future holds for the project, but I feel great about the level of impact on childhood malaria that we've made so far. Several of my classmates (Kay, Jill and Malou) helped me write a grant for one of our classes and I hope to submit it later this summer to further support the project. At this rate of growth, it can't survive on small private donations alone!

We're soon going to work directly with HEAL Africa.org for the project's financial transactions (Bed Nets For Kids has been under the umbrella of Global Strategies all this time). Next stop, filing paperwork to become our own 501 (c) 3. At least there will be more time to manage all of this soon after I graduate. When I started grad school, I would have never thought I'd end it running an international non-profit for a project in Africa!

One of my classmates, Malou is going to be following my lead and is going to Goma, DRC this summer. I'm excited that she's chosen to follow up on the bed net project. She'll be conducting a qualitative study on their use and feelings about bed nets and about the project itself. I am really excited about her study and can't wait to learn the results! Good luck Malou!

My visit in Aug 2006 to see the Gorillas in Rwanda

Here are some videos of the Gorillas I visited in Rwanda. They were so amazing!

This first one is of a silverback eating.



This video is of several baby gorillas playing in the trees.

Visiting the CMJ Orphange in Goma July '06

The children at CMJ put on a dance to welcome us.

Kids at CMJ Orphanage dancing with me

Children in Goma

Here's a video of some kids singing the DRC national anthem for me:

Bed Nets For Kids

Update on the Bed Net Project mentioned in the letters below.....
The project has been going strong thanks to a wonderful nurse at HEAL Africa hospital named Papy. He has been responsible for making sure each eligible child recieves a bed net and has tracked them down at home to follow up with them. Not easy considering there are no street names or home addresses and not everyone has a phone! Papy has managed to visit almost every child's home one month after they leave the hospital. During these visits, he is able to provide family teaching and answer the parents questions about malaria and prevention. He also asks to see the net we gave them to see if they are using it or have had any trouble placing it. Each month he sends me beautiful reports of his findings. The great news is that almost all of the families he visited have been using their net! Compliance with bed net use has been an issue in recent malaria research, so the success of this program really is exciting!

We've been getting great feedback from the parents! Papy has also been sending me pictures with their comments. It feels so good that the project is so well recieved by them!

To keep the project going I've been focused on getting a web site up to advertise it and do some fundraising. I feel so fortunate to have gotten the domain name: bednetsforkids. So I changed the project name to Bed Nets For Kids. Dan created a beautiful web site for the project this past month. Thank you so much Dan! It provides more information on the project and ways to donate to it. Please go check it out! http://www.bednetsforkids.org

Catching Up

I have not been able to update my blog for a long time! I promise I will soon! While I was in Africa, the internet was so slow it was too hard to update everyone using this forum. So I sent out email instead. I thought I'd post some of the letters that I sent out while I was there.

June 29, 2006

It looks like it's going to be harder to communicate
than I thought. The internet is really bad here and
is only available at the hospital. Not at the home
where I'm staying. I am not going to be at the
hospital much during the week, so I don't think I can
really rely on email to communicate. Its so slow that
I wonder if it will even be able to load any pictures.
I'll try but it doesn't seem easy.

I'll do my best to keep my cell phone on and charged up. Though
there is only electricity at the house for 3 hours a
day that they run the generator. Fuel is very pricey
here so they can't run it more often.

Meals are made over an open fire and showers are only
warm when the generator is running. Water must be
treated and filtered. My hosts have a home in a compound
with a lovely rose garden and an outside shaded patio right
next to the lake. Breakfast and tea is served there everyday.
They have a huge, lovely home. I don't stay in their home,
but in a building of modest rooms on the property with
cement floors (think youth hostel). The property is
fenced and is patrolled by two armed guards at night.
The city outside the walls is very poor. Everyday is
a bussle of activity with trucks driving all over the
place. Many big name organizations are here full time
and there is a HUGE UN presence (Tanks, Etc). Today
there is a specially large amount of police in the
city because the president Kablia is here campaigning
for the up coming election. I'm at the hospital now
where he is expected to show up soon.

I'm still getting oriented to everything. I will be
part of a special meeting on Sat with the Early
Childhood Development coalition.
I should be starting my project soon after that.
----------------------------------------------------------

July 5, 2006

On July 4, I started making home visits to the most
vulnerable families in Goma. I have seen 8 children so
far. The full assessment and interview is taking at
least an hour per child. I'm sure it's much slower
with the interpreter and the fact that the children
are so shy......... .. I'm a strange white woman in
their home. I had a meeting with several NGO's at the
start of the week and have arranged for each to find 5
families for me to work with each day. At least one
member from the NGO and my interpreter accompanies me
to the home of each child. The NGO is responsible for
preparing the mother and then I also describe what I
am doing. Lyn (my host who runs DOCS hospital) has
arranged for a donation (from UNICEF) of a can of
powdered milk and a small bag of sugar for the
families that work with me. It's really been
wonderful to give them something in return for their
time. And they are so appreciative of it. It's
amazing how many go on so little food each week. I
have never seen poverty at this level. Walking around
the various communities of shacks, the smell is very
bad and the dust in the air chokes me and gets in my
eyes. I was so overwhelmed yesterday by the sadness
that I had a very hard time not crying till I got
home.

We are so very privileged and blessed.
---------------------------------------------------

July 7, 2006

I have been shocked by the prevalence of malaria in
the homes I visit and virtually no one has a bed net.
Malaria makes children incredibly ill and they easily
die from it. I would like to start a fund with the
local hospital where each child hospitalized with
malaria receives a bed net upon discharge. One bed
net costs $5 here(though, I wonder if I bought in bulk
if I could get a discount). Can you help me? Can you
get others motivated to help out and collect funds and
then wire it to me so I can set it up while I'm still
here?

This idea came while on text mssg with Bill this
morning when he asked about sending money to help
(Bill, perhaps you could create an account on that end
for the fund?).

It's amazing how much assistance there is available
for HIV in central Africa, but very little for
Malaria. Yet, it's one of the largest killers here.

Please help me get started. Consider it my birthday
present. :)
-------------------------------------------------------------

July 13, 2006

Wow. It's taken an hour just to get to the point
where I can compose a letter. The internet is a
nightmare here. The thing I miss most about the US is
DSL. Now lets hope this thing will send off without a
hitch. So the past few days I've been ill. Not able
to do a thing with my original project, let alone the
bed nets. Feeling better today. I took a bunch of
Cipro and extra doxycycline. I was almost convinced I had Cholera.
I called Sasha to read me the description on line from the CDC website.
If it comes back, the doctors want to check me for worms. Lovely.
No one else has been ill so I have no idea how I got sick.
I've really been careful about my food and water.

I still need to talk with the MD's here at DOCS
hospital to discover the rate of Malaria that they
treat here so we can determine how many per month.
But I stopped by a pharmacy today and got the name of
their distributor PSI. I then went to the
distributors home and spoke to him about buying in
bulk. They have nets at wholesale that last
for 5 years (the package says 21 washings in French).
The net is large enough to cover a large family bed
(about queen size). They can arrange for unlimited
distribution. The nets are cheaper in this part of
the country than in Kinshasa because this area is
considered war torn and the need is greater. I'm
going to ask Lyn about us working with the distributor
vs her. Though I imagine it will be easier if she's
in control to keep it going.

Global Strategies is an SF based company that has been
helping DOCS HEAL AFRICA for several years. They
already have a fund transfer system set up where they
tranfer funds every quarter, along with a list of
designations for each fund. They don't take any cuts.

I will have 5 days to work on paper work before I
leave here so I'll really be able to do more with the
bed nets then. Each day I'm making house calls all day
long, mostly on foot. Its been physically and
mentally challenging. The stories I hear from the
mothers of genocide, war, rape, murder, disease and
hunger is the most challenging part of the
experience. It's all so overwhelming. Almost
every day I want to cry.
-----------------------------------------------------------------

July 24, 2006

I'm actively scoring the kids and
putting data in excel to provide a prelim report
before I leave. I met with a couple of people at
UNICEF today who want me to give a project
presentation on Wed. I will likely leave this Thurs,
if not Friday. Hard to know when the border will be
closed for the election (the idea is closure for a few
days before and during the election so Rwandans don't
come in to try to vote illegally). UN tanks still
visible everywhere. More and more groups of people in
motor bikes or cars with posters all over them,
driving up and down honking continuously. Free shirts
and hats given out everywhere with candidates on them
and huge fights breaking out over people wanting them.
Very interesting to see how a campaign works in a
city without electricity. There have been thunder/
lightening storms every night this week. It took out
the internet at the hospital when lightening hit the
antenna. It's just now been fixed! :)

The bed net project is off the ground.
I'm so excited to see this come together!
--------------------------------------------------------

July 24, 2006

Here's my long term vision for the bed net project: 1 year of inpatient
bed net supply. Then follow up by several nurses in
the home to survey compliance, visualize the net and a
qualitative survey of the value placed on the net.
After analysis of success of the project at this
level, I'll publish the results. Then we'll examine
expansion to out patient clinic vs. other hospitals in
the city. Compliance and value are the biggest
factors here. There is data to support that bed nets
given for free are not valued or used appropriately.
But that's why I want to start with hospitalized
children. I believe that the emotional and financial
investment that the family has made through the
hospitalization of their ill child will increase the
value of the bed net and the compliance to use it
appropriately. Perhaps after publishing data, we can
call Bill Gates up and let him know he's missing out on a
great project. :)

Speaking of great projects.... I finished all my home
visits last Sat! 62 kids! Now I'm crazy with data
analysis and putting it in to excel so I can provide a
prelim report to DOCS before I leave! I gave a
lecture to the Early Childhood Development coalition
last sat on project ideas to stimulate psychosocial
development and the crowd loved it. The immediately
went to work on new ideas for their project proposals
for the world bank. Today I met with an MD at UNICEF
who is very interested in my project. They want me
to give a project presentation on Wed.

The bed net project is now up and running. I worked with a pediatrician named Michael to write a hospital policy for the project and he translated it into French. We met with several pediatricians at DOCS today and distributed the policy to them. I also met with the pharmacists. I drew a comic with a child
getting bit by a mosquito and is then in the hospital.
In the last frame he is happily sleeping under a net.
In Swahili, there is an explanation that malaria
comes from the bite of an infected mosquito and kids
get sick enough from it that they need treatment in
the hospital. And also that they can die from it.
Then it explains that they should put their child
under the net every night to decrease the risk of
re-infection. The nurse is to give the comic to them
and give them further instructions on the bed net.
Someone is taping a copy of the comic on the package,
along with a nail and string to hang it up.

So exciting to have it all coming together so quickly!!!

I'm leaving Congo either on the 28th or the 27th,
depending on the border situation before the election.
I'll be staying at the Gorilla hotel in Kigali after
that until my flight on the 2nd. I'll be home late at
night on the 4th.
------------------------------------------------------------

July 25, 2006

I'm getting really irritated that I have so much to do
here that I have to wrap in 2 days because I have
to leave before the elections. Then I have 6
days in Rwanda with nothing planned..... and very
little to do there per reports of all who've spent
time there. I find it hard to justify spending money
to go to the animal park by myself or the mountain
gorilla park. The genocide museum and craft fair is only 1
day worth of stuff. I'd rather stay and get more done
here. Esp since the company in the house is such an
amazing collection of brilliant minds all working on
great projects. Every dinner feels like a think tank
with such amazing ideas and discussions!
----------------------------------------------------------------

July 30, 2006

Still in Africa, though I’m now out of the Congo
because of the elections. I’m in Kigali, with little to do.
Only one tv station works and only has a few
hrs of BBC world. I don’t have anything to read but my
medical journals and the kinyarwandan new testament in
my hotel room. No one to talk to in the hotel.
Especially since my French is really bad.
It’s been making me feel really shy.
But I made arrangements to go see the
mountain gorillas on Tuesday! I wresteled with the decision
but finally decided it was a once in a life time thing.
So now I’m totally excited about it!
I’ll be back home at the end of the week.
I’m so looking forward to being home again!
----------------------------------------------------------

July 31, 2006

I had a scare today..... after spending most of
my cash, I went to the bank to take more money out on
my master card and was denied. I have only have $40
after paying cash for my ape permit. There are no ATMs
and no other bank in Kigali will take cash out for you
against a card and they only accept Master card. My
hotel also only accepts master card and Ive been
ringing up quite a tab with all food charged to the
room. Scary to feel stuck. I called the card saying,
"Please don’t put me on hold, I’m calling from Africa
and don’t have much money for a long call. I will be
here another week and am counting on this card or I
will be stuck here!" The phone cut off just after I
got the confirmation that they would extend the use of
my card while I’m traveling but I wasn’t able to tell
them when Id be back. So I had lunch and am now
calming down a bit before going back to the bank to
try again.

Went to see another program today...... making
arrangements for the owner to go to Goma to teach them
about her program and what made it so successful.
Really amazing how much people have pulled together
after the genocide to build a community and help one
another. Some of her workers have scars from burns
and machete cuts. I still don’t know how to respond
when they finish telling me about their experiences.
All I can think is that I have no idea what it has
been like for them and hope I never will know.
---------------------------------------------------------------

August 1, 2006

I climbed halfway up a volcano today to see a family of
mountain gorillas! So cute! I want to take a baby
gorilla home! It was just such an incredible
experience! We were so close to them! Segorney
Weaver eat your heart out.

Starting my long trek back home tomorrow by way of
Joburg.
--------------------------------------------------------------------

August 4, 2006

Just got off the plane from South Africa. 18 hrs with
a long lay over in Dakar. Far too long. Esp with a
kid kicking me in his sleep the whole time. I’m going
via Ethiopia next time. Now in DC with a long wait
till my flight home.

 

 

  

  

  

 

 

 

  

  

 

  

  

 

Jambo!

It has been a very busy week since I arrived in Africa! It took almost 3 days to get to Goma by way of South Africa and Rwanda. The Rwandan country side is really lush and green! So many banana trees! I was told it is the banana capitol of the world! I'm looking forward to spending more time there before I fly home. Goma lies across the Congo border. I am staying with very lovely people in a beautiful home at the western edge of town on Lake Kivu.

The streets and level of poverty is very different here. So many roads are of old lava rock (from a 100 yr old eruption). There are portions of the city that were covered in lava only 4 yrs ago and people are already starting to build homes on the site. Many homes are merely shacks with a front area to sit and a place at the back to sleep. There is a lot of food grown here. But many cannot afford food from the market and rely on handout to feed their children. I have been overwhelmed by the stories and sites as I make home visits here.

I am taking a lot of pictures but am finding difficulty up-loading them. I will share them as soon as I can!

My 2004 Nursing Adventure in Managua

While it will be my first time in Africa, this adventure in the Congo is not my first time working as a nurse abroad. In 2004, I was fortunate enough to be chosen to work in Managua, Nicaragua with Dr. Karl and the International Children's Heart Foundation http://www.babyhearts.com/new/default.php?m=1
This experience helped me to realize my dream of working with children internationally. It was shortly after my return from this trip that I began the application process for grad school.
Above is an article about us in a local Managuan newspaper.

I'm in the bottom picture!


Below are the trip reports I wrote on all my Nicaraguan adventures:

Trip Report #1 I'm here!

Made it here ok!  The flight to Managua wasn't much
Longer than that to TX.  I liked the airport in
Houston better than Florida... much larger and more
Sky lights.  I was stuck between 2 huge men during the
Flight to Managua while one other nurse who checked in
Last minute ended up getting upgraded to 1st class for
Free.  I got up after the movie to take pictures of
Everyone and discovered an empty seat next to her....
Spent the rest of the flight chatting with her in a
Big comfy chair.  Too late for the salmon and wine
Dinner though (we got some weird bbq beef sandwich
That I didn't touch, in coach.)

Landed in an incredibly lush green land with many
Conical mountains and a HUGE body of water, just as
The sun was setting.  It was very hot and humid at 6
pm!  Thankfully no bags were lost as many of my
co-workers feared (last year it took them days to get
their bags!) And we went straight to our hotel across
town.

The majority that I've seen so far of Managua is poor
and many neighborhoods and markets are similar to
those in Mexico.  People riding donkey drawn carts
crossed in front of our bus as we drove by.  But on
the other side of the tracks, we were greeted by a
Toyota dealership next to a Shell station and a pizza
hut.  In this area, are many large home, gated, with
SUV's.  Our hotel was once someone’s large home with
an open courtyard and swimming pool in back.

Wonderful artwork fills the lounge and the rooms are
Incredible!  Air conditioning and hot water in each!
It's far more than I was expecting.  The surgeon
treated us to a dinner in a nearby resteraunt and no
sooner did we return than everyone jumped in the pool
and we had races and were all making silly poses for
pictures (maybe it was all the local cervesa we had at
dinner.)  This is going to be a fun group of MD's and
RN's to work with)

I'm bunking with a 23 yr old engineer getting her PhD
from Perdue.  She's hoping to developed a machine to
detect and quantify proprioception. (Didn't realize
she was younger than me till she mentioned something about
Regan being the pres when she was born!) She was here
last year but spent most of her time working on
machines in Leon.... where she has some local friends.
I may join her there on my day off next week.

Today, we went to check out the hospital (It's small
but very clean) and unpack and set up all the supplies
we'll be needing for the next two weeks.  I was the
inventory queen and quickly organized the shelves with
all our medical supplies, while practicing my Spanish
with a nurse on our team from Chile.  We have 40- 50
patients on a list, all of which the doctors ahve to
review to see who will be the best candidates for
surgery.  We'll be lucky if we can do 20 of them.

Starting work in the morning.  Only 2 surgeries
scheduled for tomorrow!  We'll see how it goes!  It's
already been very interesting!  I'm very excited for
the rest of the trip.

---------------------------------
Trip Report #2 Thunderstorms at 90 degrees

Yesterday I had a 4 mo whose father was missing his
eye and middle finger of his left hand.  The eye was
quite well healed over but the scars surrounding
tells of some sort of trauma inflicted on him.  It
made me wonder if it had something to do with all the
conflict 20 yrs ago.  He cried when I placed his hand
on his child's foot and told me he didn't think he'd
be able to touch his child.  His poor wife was leaking,
anxious to feed the baby and I had to explain to her
multiple times that he couldn't breast feed while on
the ventilator.  Next year, I'll have to remember to
grab a portable breast pump.  We did only 2 surgeries
and things went quite well.

I realize now that we don't have all the supplies we
need (though we have an impressive amount!) Things
like IV solutions. We have like 5 bags of .5 liter
dextrose and some normal saline but not much.  We have
very little morphine and no Benedryl. Fentanyl is just
too short acting to keep a child sedated for long and
Versed can often drop their blood pressure.  Benedryl
is the bedtime warm milk of choice at home and works
great on antsy kids who need to sleep right after
surgery and not dance around because of the irritating
ventilator tube and their empty belly.  I'm tempted to
bring in my oral gel caps of Benedryl and aspirate the
med out with a needle.

The local nurses and doctors are great. It's
challenging explaining things in my broken Spanish and
everyone speaks very fast here.  Charades goes a long
way.  More challenging was using the machinery.  Or
the lack there of.  Not having many IV pumps, I was
trying to figure out how to drip in IV fluid at a
very small rate.... totally forgot how to, since it's
not something I've done calculations for since my
first semester of nursing school.  One of their
doctors thought 20 gtts per cc was the conversion
factor so I went with it.  Cardiac kids really cant
handle too much fluid, especially right after surgery
till their kidneys function better, so not overloading
them is important. The cardiac monitors are over 20
years old and the screen on mine would fade in and out
and I had difficulty zeroing the transducers on my
pressure lines.  Then the arterial pressure would read
far lower than the kids cuff pressure so I didn't know
which to believe.... does he need more dopamine?
Albumin?  or can we leave him alone?  All day I mostly
said "Funtcion?"Ãsta no funtcion." "Sabe que como usar
esto?

Today was my 1st day off.  I've found the Metro Centro
Mercado after a day of running around the city
sightseeing.  There's DSL here in the mall but it's
pricey.  Mike you'll be please to know that all the
machines in this place use Mozilla.  My hotel has dial
up but it works quite randomly and the pages load very
very slowly (I played 6 games of solitaire waiting for
one) and I eventually gave up.  I think I'll just have
to come back here in the future.

Mango trees abound!  They are all over the city,
lining the streets and in everyone's yard.  And more
importantly, in the courtyard of my hotel, next to a
giant avocado tree, and hanging over the pool.  Each
time we hear one drop, everyone scrambles to find it.
I found a great use for my swim goggles searching for
treasures at the bottom of the pool!

Poo report: not good, but not water.  Perhaps I should
have washed off those pool mangos before cutting in to
them.

Sight-seeing was interesting.  I rode around this
morning with our shuttle driver while he ran errands
for the hospital (picking up food and ice, ect around
town.)  I figured I'd get to see more of the real city
this way.  Lots of horse drawn carts and venders along
the streets, many shacks put together in any manner to
create a structure, and several palm filled parks were
homeless have strung hammocks and created shade out of
black garbage bags. (Hammocks are very cheap here!
Put in your orders now!) Kids play soccer in the grass
on the median between very busy streets.  Turn-a-bouts
are everywhere and giant ones seem to separate
districts from each other, each with a large sculpture
or fountain in the center.

This afternoon, I took a taxi to the lakeside and saw
some old ruins nearby.  There is a beautiful church
which was partially destroyed in an earthquake, making
it too unstable to go inside.  There are several
government buildings in the same square.  My taxi
driver asked me if I knew much of Nicaragua and when I
told him it was my first time he drove me to a few
different places, including the park, nacional, which
once was a volcano, with a small crater lake, where
people go boating.  There's a great view from the top,
where I could see all of Managua.  An amazing rainbow
came out and the thunderstorm started...... it's hot.
80-90 degrees and raining.  A lot more of this to
come, I'm sure.

Tomorrow promises to be difficult.  We have a very
complicated case planned.  Wish me luck!

--------------------------------
Trip Report 3: Al hospital Mascota

Things are going really well down here.  So far no
serious problems with any of the kids, despite the
lack of a lot of equipment, supplies, blood testing
capability and medications, they're doing quite well.
It's really interesting. Even with all that back home
we still have so many issues with pain, recurrent
pulmonary effusions and secondary infections.  I have
to assume the patient needs this or that based on the
monitors (if they're working) and my assessment but I
can't confirm it with a test.  The local nurses do all
the charting and most of the tasks while I've been
taking more of a directive role, telling them what and
how to do various things for the patients.  Especially
since I often interpret for one of our doctors,
ordering things like antibiotics or lasix.
So all the parents think I'm a doctor too; even when I
correct them, they call me doctora.   My Spanish is
getting better... but I still misconjugate half of
what I say, and it's far more difficult when working
at night. There've been a few times when  was too tired
or too hypoglycemic and just couldn't get the words
out at all to more specifically answer a nurse.  But
I'm at the level where the local staff is including me
in their jokes and teasing me a lot as well.  One
doctor was giving a nurse a bunch of orders for
treatments and medications and ended it with Spanish
lessons for me as well.  They tease me for my
piercing, I tease them that they are jealous of it and
crave one for their tongue . They tease me that I'm an
old maid.  So many of them have families very young.
They suggested that I shack up with a Nicaraguan man.

Most of them are very good and really want to learn all the things I do.
Challenging trying to teach with my little Spanish,
but it helps that they are so eager to learn.

My patient's father with the one eye, turns out he is
Sandinista.  He told us, initially, he was a soldier
for the contras but was kidnapped by the Sandinistas
and then escaped to Honduras.  When he came back, the
Sando´s were in control of the Gov´t, so he became a
solder for them and get married.  Then he stepped on a
mine left behind by the contras and it blew half his
face off.  And soon later, he had accidentally shot
off
his finger.  He had some plastic surgery but his wife
left him anyway because of his face.  He's not been
able to get any work since because of his face.  He
found an indigenous woman to be his current wife (she
speaks very little Spanish) and now has this one son,
who's heart we fixed.  But He seems to have a lot of
neurological stuff going on. His cry is very cat-like,
which usually isn't good. We suspect some sort of
cranial venous malformation.  But we have no CAT scans
to confirm it.  The other day this man told us he sold
his watch to buy more food for his wife so she can
keep up her breast milk.  So we've been giving him our
leftovers from dinner.  But I feel like I have to
sneak it to him because I don't know the status of all
the patients and sometimes the nurses look at us funny
for doing so.

There are so many poor everywhere.  It's overwhelming.
I do so much to help the kids and families inside the
hospital and then refuse the begging kids outside.

At the hospital, while working during the day, threes
a little old lady who cooks for us..... usually some
rice with chicken or fish and something else and
posters. And at night the driver stops at TipTop,
similar to KFC, whether we want it or not. I think
the ministry of health must have made some kind of
deal with them, because every place our driver has
stopped so far for stuff, or even for gas, he doesn't
pay, he hands over a letter from the ministry.
Otherwise, the hotel serves us breakfast and dinner.
But there are a lot of resteraunts nearby were we
sometimes go as well, as a group.... and invariably
one of the doctors will pick up the tab then.

A few of us went out dancing after dinner one night
and I was introduced to the local rum.  We had a lot
of fun, though we were the only one's on the dance floor.
But I have to work night shifts over the weekend so
I'll be missing out on more of that.

Everyone went Salsa dancing last night (not me, I
worked) and this time there was a live band and one of
the nurses apparently got up an played the maracas
with the band.  They're all going out again tonight.  Latin
doctors are crazy. They're willing to go out raving no matter
what time they have to be up early in the morning for surgery.

I'm going to the out door market tomorrow before work
at night. There's a huge mercado near the hospital,
with all sorts of food, clothing, arts and crafts.
But now, off to sleep, hoping I can ignore the
tropical birds singing outside my window

--------------------------------
Trip Report #4 : Afuera de Managua

Sleep deprived nurse checking in here.  (Email seems
to be working better here so I was able to access my
address book and include more of you in this report.)
Lo siento.

After a week of 13 hour shifts cada dia with the
exception of last Tuesday, and very little sleep in
between, I am quite exhausted!  All the patients have
continued to do well.

2 nights ago I had a rather challenging experience of
working only with a nurse from Chile (who is great but
is used to a different style of practice than me) and
the local doctora (also great but not very experienced
with post op heart kids) and both of them speak only
Spanish.  Our team wanted the doctora to get more
experience.  We had a very critical child who's
pressures during surgery were so unstable that se
couldn't tolerate having her sternum closed at the end
of the operation.  (I'm used to these types of
patients at home, but they can make one nervous, even
in an ICU with all the machinery, supplies and Labs
available.) So there I was... explaining my
assessments of the kid throughout the night to the doctora and
suggesting various actions to take.  A few times the
surgeon would call me to check in.  It was quite a
test of how much knowledge I really did have... in
both managing cardiac patients and Spanish.  But we
worked well together and by the end of the night the
child had stabilized more, the doctora was asking my
opinion on other children as well, and I didn't have
to use my dictionary as much.

I'm constantly surprised that the more sophisticated
one gets with words (especially with medical terms)
the more the word is likely to be the same in Spanish
as in English, but pronounced differently, especially
each vowel, throwing in a rolled "r" here and lisp
there and maybe adding an "o" at the end.

The more sophisticated my sentences get, the more
frustrated I am that I don't know all the rules of
conjugation I want to know and haven't learned much
about past and future tenses.  More often than I like,
I have to use the present verb and say "pasado."  They
get it, are very forgiving, and have complemented me
on my Spanish and pronunciation... but..... it's been
frustrating working in an environment where sometimes
things have to happen quickly and not having the time
to fully interpret what I want to say in my mind and
the sentence that comes out is understandable but is
grammatically incorrect.  (Though so is much of my
English at this point.... I don't know if it's all the
exposure to the Spanish or the sleep deprivation)

We have 8 more surgeries planned before this Friday
and then we're planning to have a party for all the
kids and their families.  The last few patients
shouldn't be very complicated so that very few, if
any,patients will be left in the ICU when our team leaves.
One surgeon from Chile is staying behind a week to
take care of the kids still hospitalized.

Today, when I got off work at 8am, I had planned to
take a bus to Leon, a city south of Managua, with much
recent history surrounding the Contra War.  It’s also
a
fun little college town, apparently.  My room mate
Jody
left last night to meet up with some friends of hers
there.  But today she phoned and told me the bus took
3 hours with all the stops and road construction.  I
nixed the idea of 6 hrs on a bus and instead went to
Masaya and Granada with my coworkers who had arranged
a ride.

6 of us were crammed into a car not much larger than
my old Geo Metro and drove off 35 min away to Masaya.
The land outside of Managua is so amazingly lush!
Hills and valleys, occasional active volcanoes,
lagoons and lakes.  Masaya is famous among tourists for it's
old open air market.  I found some turtles swimming in
the fountain and parakeets and watched them for a bit
while others shopped.  Bargaining is not as active
here as I've seen in Jerusalem open air markets, but it is
expected, and sometimes, the merchant will even
suggest a lower price.  Once, I paid the initial price
of an item but told her I thought it was lower and
when I started walking away, the woman got my
attention and gave me more change.  Unintentional
bargaining.

Granada is really gorgeous.  There's a nice Hostel
there where Pam (a nurse from NZ) spent a few weeks
last year. Granada has a lot of Colonial history,
apparent in all the buildings, especially those
surrounding the Plaza Central.  It also has ruins of a
huge old hospital, which we all got out and took
pictures of.

Despues, we went to the Lago De Granada which has
fresh water sharks (Lake Nicaragua does as well) and
the water is clean for swimming and fishing (unlike
Lake Managua, which is contaminated.) There are many
small islands in the lake, with beautiful vegetation,
which are the subject of many paintings in the market
place.

Pam said she thought we might be going to some place
along the lake, she remembered from last year, called
"pollo lago" and we couldn't stop laughing at her
chicken lake..... (She knows very little Spanish and
any she does try in her very thick Kiwi accent is hard
to understand, so we tease her a lot.) When we got out
of the car to the edge of the water, sure enough,
there were a few chickens pecking the ground.  More
teasing ensued. But on the way back, we happened to
notice a road sign which said "Apoyo de Lago."

We met some guys net fishing in the water (not too
sure by the way they looked at us, but I don’t think
they were the fresh water sharks I read about.) And
nearby at a cafe, there were 2 large pet Monkeys (***I
WIN!!!***), both on leash and one in the tree eating a
mango and sometimes getting down to pet the dog that
was hanging out there.  So Cute!! I wonder how I can
get a live monkey through customs for a pet.  Maybe I
can keep it in my room in SF and hide it from my room
mates. I'll just have to feed it Mangos form time to
time and it can pet Artimis´cat. :)

We had to get back early for the few with us who have
to work tonight.  But it was wonderful to have a
chance to get out of Managua for a bit and see more of
the beautiful country-side

Still working out details for next weeks travels with
Pam and Chloe (after we're finished working at
Mascota).  Pam is talking about Guatemala. We'll see
how cheap the flights are.......

---------------------------------
Trip Report #5: Finito!

It's been a long week.  Very long, with 3 operations
each day and 13 hr shifts day after day.  Getting
dinner at night has felt like a process of at least
2-3 hrs weather I ate out with the rest of the group
or at the hotel. Throw Email on top of that and I
would never manage to get into bed till around
midnight.  I started off working a few day shifts and
switched to night shifts over the weekend, just in
time to miss out on all the Salsa Club madness and
venturing to the Pacific with the group, and then
switched back to day shift again, unable to really
manage to allow my body to sleep well during the night
and not feel tired all day. I'm sure I'll appreciate
my regular work schedule much more after this...... as
with a lot of things.  The more tired I was, the less
I've been trying to speak Spanish, lazily asking our
bilingual respiratory therapist to act as interpreter.
Though I understood what was said to me, the effort to
translate into Spanish in my brain before answering
was great.  I'd start to reply in English and would
get ¨No Sarita, en Espanol."

It's so strange now to not get into my scrubs and
leave for Mascota.  Yesterday we only worked a half
day to get as many children ready to leave the ICU as
possible and finish up any other details.  Out of 20
children, all were successful cardiac repairs, one had
a chylothorax (leakage of lymph which sometimes can
happen with surgery), which they went back in to
repair (hopefully they did.... it's always so hard to
know where the leak is, exactly.) Only one little baby
was left on the ventilator, extremely septic; possible
from the pneumonia she had previous to surgery.
Though it was risky to do her cardiac surgery with
pneumonia, without the surgery she would have only had
a few weeks to live.  She looked like a little bird
and I called her mia pajarita.  I worked so hard on
her, especially yesterday morning, giving her all new
lines and IV´s, making up Dopamine and 5% Albumin,
just in case, and making up new concentrations of IV
fluids and teaching the local staff how to (they just
don't have enough variety available to them and mia
pajarita needed a higher level of dextrose, till she
was well enough to be fed.) On Thursday the local
newspaper came to write a story on our trip and
photographed me with mia pajarita.  We left an iStat
machine for them to use for a week to help manage her
care.  It calculates Arterial blood gas and
electrolytes in the blood. I spent some time showing
all the local doctors how to use it.

In the afternoon, the foundation set up a party at the
hospital for all the children.  Children who had
already gone home, those in the ward and even a few
well enough from the ICU came.  There was a clown DJ
and a piñata.  He made the kids play dancing games to
the music and then did the same with some of the moms
and then us.  It was great to see these kids, some of
them less than a week out of open heart surgery,
dancing around and whacking at the piñata.  I'm
always amazed at the resilience of children.  We
took lots of pictures with the kids and the parents
hugged and kissed us and tearfully thanked us
individually.  I was choking back tears myself.  I've
never felt like I've made as much of a difference with
my work as I have here.

In the Friday morning paper, along with the article of
our trip, there was a report of 3 children in another
hospital who were badly burned this week, one was hit
by lightening!  As we packed up supplies at Mascota,
we put together a care package for these other
children, of IV bags, central line kits, tubing,
dressing and IV antibiotics and Fentanyl for them. A
few of us drove over there to deliver it and the
hospital director couldn't believe these Americans
showing up out of the blue with much needed supplies.

We went back to the hotel to rest up and change for
one last shebang.  We went to a great resteraunt with
a huge tree in the middle and a grass roof all around.
Great food and lots of Flor De Cañya! There was a live
band who did several US oldies covers with a salsa
beat.  A part from actually salsa dancing, I found
most people dance as though ready to play bongos.
Elbows out and arms up, somewhere between the waist
and chest, hand either open or in a fist and swishing
up and down opposite of one's hip position at the
time.

Moving the hips side to side is key and one can do so
while either marching or sliding feet (with the right
shoes.) This move works well to any tempo.... even to
a salsa rendition of "Stand by Me."  The head surgeon
voted me best dancer of this mission.  Though I think
I've got nothing on the Latin doctors.  And after
seeing how some of those children danced at the party,
I'm convinced, if it's not genetic, the training
starts sometime before walking.  I'd like to report
that we closed down the place, but at 1:40 am, the
place was still going strong.  I've found locals here
really love to sing and dance, and aren't shy about
it.

The majority of the group left early this morning,
save one surgeon who is staying behind to follow the
few kids left in the hospital.  Chloe, Pam and I are
officially on vacation and are headed to Granada
today,Tipitapa hot springs tomorrow and Ometeppe there after
(the island in the middle of Lake Nicaragua.) We
canned more grandiose ideas after discussing effort,
time and budget.  But Nicaragua really has a lot to
explore, so I'm quite excited about our decision.

-----------------------------------
Last Trip Report: Granada-Ometepe and home

Our first day after our work stint, Pam, Chloe and I
went to Granada for a night.   There were crazy
cannons firing off constantly for the city's
anniversary, making all the birds and the gringos
jump.  We stayed in a luxury hotel with a pool and
swim up bar and met up with some Irish girls Pam knew.
At night, we went out to dinner at an Argentinean
place..... lots of amazing Malbec wine!  It was
pricey, but really good.  I had an interesting
conversation with the owner about Argentina and their
view of Americans.  Chloe and I went to bed early....
I was pretty sick initially and needed rest.  But Pam
stayed up all night with her friends and came in
around 6.

Chloe and I walked all around town, went to the
waterside, saw goats and did laundry while waiting for
her to wake up so we could check out.  Then thought
we'd follow these Dublin girls to the Pacific.

It was and hour and a half taxi ride to San Juan Del
Sur for only $35. We landed at this amazing beach at
sunset to discover we had missed the water taxi to the
eco resort (I think they call it that to attract
hippies) where we were meeting up with the rest.
Haled a taxi last minute and wound up on this crazy
dirt road (which really required a 4 wheel drive to
use)to take us to this very remote beach further north.
Outside were all these blinky lights flying
around..... fireflies? or something like that? I've
never seen them before. It looked like glitter in the
trees.

We finally made it and discovered there was no
more rooms available but there were bunks in this open
barn.  So we doused ourselves in deet and took to our
bunks.... the mattress was falling through the
supportive slats and insects crawled on me and buzzed
passed my ear all night.

Early in the morning, the light from the sun woke me,
along with the loud call of the male Congos in the
trees above us.  Got up to walk out onto the beach in
the early light with Chloe and found out it wasn't even 6 am
yet. Chloe and I sat on the beach and read and swam
till I got stung by a jelly fish (not badly) then
walked around to another campground and a much larger beach.