Back from Sahsa!!! I apologize for the lack of entries but I’ll try to do a quick whirlwind tour of our adventures on the Atlantic coast of Nicaragua. So for those of you who don’t know about Collaborative Sahsa Health Initiative, UNAN has now committed to sending a brigade of medical students in their 6th (last) year to Rosita and Sahsa to help increase man power in the medical infrastructure in there. So after enjoying a couple days in Leon, we met at 8 AM on June 29th in front of the hospital to catch a yellow school bus for our 17.5 hour bus ride to Sahsa. Oh yea, I forgot to introduce DOCTOR Sara Faber (yes, she made us call her Dr. Faber the whole time…J/k Sara!), who we met the day before in Leon. She is one of two UNC med/peds residents “supervising” us medical students on this trip. After rolling our luggage through half of Leon, we arrived at the hospital and helped load the bus with the 12 other UNAN students (6 of whom you’ll meet later in the blog), the UNAN supervising physicians, Dr. Edgar Pena, our main project contact at CIDS. Highlight moments of packing the bus include Andrew and Jay being very helpful in loading countless bunk beds and then unloading them once it was determined that there wasn’t enough room for the students. As for the ride, we forded 3 rivers, dodged holes the size of your grannies panties (thank Jay for that comparison), seeing the amazing cloud forest greenery, crossing multiple mountain ranges. The 2 hour drive from Rosita to Sahsa can only be described as a Jackhammer roller coaster on a pitch black “road”. Highlight of the ride, after driving straight for probably around 6 hours, sphincters (yes ppl…think back to your anatomy!) were starting to show signs of failing so there was a request made for the driver to stop. He kindly did so on the side of the highway, were we ended up using the bathroom in the bushes as trucks passing by looked on….among the Sahsa crew, this is known as the ‘I want my mommy’ moment.
We arrived in Sahsa at 2 AM, where we were greeted with our dusty and empty dormitory, which was the former clinic of Sahsa. So the eight of us stared at the 3 cots, and 1 queen sized bed and wondered what we could create…the end result: Jay and Andrew under Andrew’s matrimonial mosquito net, Kristine on a cot with a mosquito net hanging from yarn we thumb tacked to the wall, Kamal on the floor with the boys, Mia and me sharing a bed in one room and April and Sara on cots in the other. It was quite the maze..the best part being when we all got into bed, exhausted and reflecting on the eventful experience of the last 20 hours…around 3:30 AM, a cow (who Andrew lovingly named Dood) mooed, sounding as if it was standing outside our window. The next morning we woke up promptly at 6:30 as we were told to be prepared for a meeting at 7. I believe Andrew described it best as he awoke to the sight of his matrimonial mosquito net, and said, “jay, look it’s so pretty.” From then on, the boys were known as Jotandres, forever inseparable! Sorry boys, had to put it in there.
The 7 o’clock meeting happened at about 3, and we soon realized that part of the territory of starting a new program was that ironing out details was our responsibility. We did manage to get our rooms organized, get our bunk beds assembled (big thanks to the boys for heavy labor), and get used to what we now joke as Nica time (if you’re brown, this is very similar to Indian standard time). A quick introduction to the players of the Sahsa game: the UNAN students: Farabundo, Juan, Scarlet, Claribel, Laura, Sharon, Dr. Mendez (UNAN’s supervising doc who will be working in Sahsa for a year), and Edgar Pena (our main contact for this project). All of them were absolutely amazing to us for the while trip. They spoke rather well in English (big plus for me especially since my Spanish is rather on the weak side), and were a big help both on the clinical experience end as well as being cultural bridges for us as we did our surveying.
It is probably impossible for me to put into one blog all of the strange/funny/insightful/crazy/rough/etc moments so I’m basically going to do topic headings and figure out how to best put it on paper later…sorry folks, I haven’t seen internet in 4 weeks, I’ve got 3 inboxes to clear too!
1) Clinic Stories
a. Meningitis patient that with bulging fontanel that couldn’t be transported to the hospital for hours
b. Countless pneumonia casesà want to hear abnormal lung sounds, this clinic is the place!
c. Pregnant woman giving birth, no pain meds, 6 UNAN med students, 4 of us, one VERY crowded room!
d. Pain of unknown origin for 5 years in abdominal/pelvic area and my first solo speculum examà the DOLOR patient
e. Ant in ear…or river water+ mud in ear…the first one Dx with no otoscope!
f. Machete wound to hand that had a 7 hr horse ride to get to the clinic…the same night as the knife fight wound victim that Jay and I got to practice suturing on…poor guy, his street rep was totally shot after Dr. Reuland put two lime green monkey peds band aids on the neck wound he wouldn’t let us suture!
2) Latrine/bucket bath adventures…there are pictures from the boy’s camera that will pretty much summarize that aspect.Thankfully, Dr. Dent promised us 2 toilet seats for next yr! Worst part : the GIANT roaches in the latrine at night...thus, bathroom buddies =P
3) Salsa Picante! My nickname and our saving grace for eating gallo pinto for breakfast, lunch and dinner for 3 weeks!
4) Surveying stories..bee stings, crazy rides, crossing rivers, blue santa claus with a bag of meds to give out, seeing kids with obvious medical conditions and trying to tell parents the importance of bringing them to the clinic, animals everywhere (5 cordobas to the person who finds a doorway WITHOUT poop!)
5) Game Nights! Bi-lingual Mafia and Charades! Some very funny pictures to come!
6) Dr. Dent and Dr. Morgan’s visit…I believe there was a vehicle malfunction, some very full rivers, and amazement at just how much help the Sahsa community needs
7) Diarrhea…CIPRO!
8) Dr. Rick Hobbs (Med/peds resident at UNC) and Dr. Reuland join the crew…and our very scary bus ride back from Puerto Cabezas
9) And more but I’m out of time…and Andrew is the only one next to me and he’s not creative at all!!
While the score was probably Sahsa 40 and us 4 halfway through the trip, we came back strong and I think all of us would say that this experience was worth all the hardships/surprises/and psychotic break laugh moments (if you know Sara Faber, she can best demonstrate a psychotic break laugh). Being in one of the most rural and forgotten places of the world really makes you re-evaluate the resources and opportunities available to you. When we got to Sahsa, we had no electricity (a week later, it started up from 7 pm to 10 and we were in awe), the water was yellow, the clinic was lacking a thermometer and quickly running out of medications. There was a line of patients every morning and there were definitely days when patients were sent home and told to return the next day…and since Sahsa ‘s clinic covers the surrounding other communities, that may mean half a days walk/horse ride/bus ride. The houses we visited during our surveys probably survived a day on what we spend on a pack of gum. One of my personal wow moments was seeing a 14 year old with a 16 month child and I followed that up with giving a Depo shot to another young teenage girl. During surveying, Andrew and I interviewed a woman in her 40’s who had 17 pregnancies, 4 spontaneous abortions, 3 children who died before the age of 5—with 3 events happening over a span of 4 months. All of us will probably post a more thorough evaluation of thoughts and events later but we all survived, when there were definitely moments we thought we wouldn’t and I think we will make better human beings and better physicians because of it.
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