This blog is for the friends and family of Kimberly Cook, RN who want to follow her adventures serving at Nueva Vida Clinic in Ciudad Sandino, Nicaragua. Welcome!

Thursday, October 21, 2010

Las Montañas


As a birthday gift from the Jubilee House Community to Felicia (volunteer coordinator), Paul (volunteer), and me, we went to a cloud forest in the mountains of Nicaragua this past Saturday. There were only five of us (Felica, Paul, Leah, Coury, and me), so we were able drive the Kia. Compared to the ambulancias, the Kia is a luxury car. It is actually fairly new and nice, and we were able to jam out with the CD player and sound system. It took us about 3 hours to drive from Managua to Selva Negra, a coffee plantation and resort area with an abundance of hiking trails.

Selva Negra is located in North Central Nicaragua in the Matagalpa and Jinotega Highlands. The mountain road between Matagalpa and Jinotega is known as one of the most scenic roads in Nicaragua, and I agree. It was a breathtaking drive through mountain towns and past coffee plantations on a road that weaves through the mountains. As we climbed in altitude, the air turned ‘fresca’ (cool) and we saw more horses with carts and women carrying wide umbrellas. It is a completely different culture and environment compared to the busy, dusty, and loud streets of Managua. It was beautiful and tranquil, although life in Ciudad Sandino and the city of Managua is very rich as well. I am truly appreciating and enjoying life here. The pictures of me hiking over a creek and overlooking the mountains were taken by Leah, another volunteer.

We arrived at about 11:30am and decided to eat lunch at the Selva Negra restaurant before hiking the trails. Because we had a fixed amount of money to spend on food and had to eat lunch anyways, it seemed like the way to go. However, the food was ‘rico’ (rich/delicious) and we were all very full by the time we were done eating. The Selva Negra restaurant uses fresh ingredients, including some of their own beef and pork. I ordered café con leche (coffee and milk) for starters…since I was at a coffee plantation, I had to try their coffee! It was clean, rich, and absolutely delicious. As a table, we split the cheese and ham sampler. This included about three different types of ham and at least six different cheeses. I thought I was back in Italy! The cheese was wonderful. For the main course, Felicia and I split a farm raised bacon cheeseburger (that’s right, Dad!) and German sausages with German potatoes and Sauerkraut. During the second part of the 19th century, many Germans immigrated to the east coast of Nicaragua to develop gold mines. However, after establishing themselves in Nicaragua and noticing the perfect mountain climate for coffee cultivation in Matagalpa, many switched their interests to coffee cultivation. Therefore, German roots are present in the Matagalpa-Jinotega highlands, and Selva Negra is owned by a German family. After the meal, we were each given a fresh orange for dessert. I ate mine on the drive home after our hike, and it was one of the best oranges I have eaten in Nicaragua.

After becoming very full from the comida rica (delicious/rich food), we set off on a hike up a steep mountain trail. The cloud forest was beautiful. We saw gigantic trees with roots winding up their trunks, banana trees, coffee plants, butterflies, brightly colored flowers, gurgling mountain streams, and breathtaking mountain views. Pictured to the left is a banana pod. We hiked for about three hours total, about a third of it up the side of a mountain. I loved every minute of it. I decided that I am going back for a weekend before I leave, and I will stay in the youth hostel for a couple of nights – it costs only about $8 a night! There is also a beautiful chapel in the resort area, a banquet/dancing room, gardens, a gazebo, a pond, and varying sizes of cottages/rooms for rent.

Today is my birthday (!!!), and we are going dancing at El Bosque ('the forest') tonight. I am very excited! I have been to El Bosque two times before and it is always a blast! It is a huge covered open air bar with a large dance floor. Half of the music is played by a band and the other half is DJ. The music is a mixture of traditional Latin dance music with some modern popular Latin songs. Every once in awhile, they play a few early to mid '90s slow dance songs in English. I have improved my Latin dance skills and am usually found on the dance floor. Sometimes I dance with one of the guys in our group, but I have just as much fun dancing with a group of girls. Last weekend, Leah and I went to the market with Nila's daughter (Nila works at the clinic) and her best friend. We had so much fun shopping. We also went to a secondhand store where I bought two pairs of jean capris (I didn't bring any jeans with me and realized that I need them!) and a birthday tank top.

¡Hasta la próxima vez!

Wednesday, October 13, 2010

La Tierra (The Land/Soil)

I am finally becoming comfortable with Nica (short for Nicaragua) being my HOME for the next ten to eleven months. At first, the widespread and colossal differences between my home in Michigan and my new home here were overwhelming. I wondered, “How am I going to live here for ten months or a year? I don’t know if I’ll be able to make it!” Yet I am becoming accustomed to the things that were incredibly difficult for me at first and beginning to appreciate the depth of life and culture here.

The most difficult aspect to adapt to was the abundance of dirt. I am accustomed to relatively clean cars, clean floors, clean clothing, clean streets…the list goes on. The vehicles that the volunteers use here are NOT clean because it is impossible to keep them clean, considering the roads in Ciudad Sandino and Nueva Vida are covered in mud and dirt even if they are paved. We drive 3 old Toyota Land Cruisers (we call them ‘ambulancias’ because they used to be used as ambulances in Nica), all with mechanical transmission. The ‘youngest’ is a 2000, the middle aged is a 1998, and the Vieja (‘old woman’ in Spanish) is so old that its year is not known among the volunteers. This is the vehicle I drive – yes, I am driving an old manual transmission! – to and from the clinic every day.
I would eventually like to post a video of part of the transit to and from the clinic to give you a better idea of the intense ‘off-road’ drive through Nueva Vida. There are potholes filled with muddy water so deep that the driver has to maneuver carefully through the pothole in order to get through. This can be difficult when there are children walking in the streets, stray dogs running in front of the car, and men and women with food stands set up on the side of the road. I think that after learning to drive the manual transmission Vieja in Nueva Vida during the rainy season, I can drive almost anywhere!

Although I deep cleaned my room 2 weekends ago (as well as switch my bed to a twin size to free up more space in my room) and plan to sweep it weekly, dirt accumulates surprisingly quickly on cement floors! Additionally, my windows are screens with thin glass panes on the outside that one can close to help keep out rain when necessary. But dust still travels through the screens, adding to the accumulation. I cannot imagine what it will be like during the dry season! The entire living area in the dormitory is cement floored, so dirt accumulation is an issue throughout the dorm. We have wonderful women who clean the common area/kitchen for us once a week, which definitely helps. Additionally, I scrubbed the shower 2 weekends ago because no one knew how long it had been since it had been cleaned (which means it was at least 8 months!).It was also incredibly difficult for me to get used to having less storage space, because I love organization and a ‘pretty’ room! I brought along some easy to assemble plastic shelving units with me and was provided a small desk without any drawers. I need to use my suitcases under my bed for extra storage. I got the idea from Felicia, the volunteer coordinator, to stack two plastic Coca-Cola crates on top of each other (we have extra crates in the dorm) and top it with a hard surface (I am currently using cardboard) to function as a nightstand. It is very different from what I am accustomed to, but it is beginning to feel like home!

We are incredibly blessed to have a washing machine in the dorm, because this is a luxury in Ciudad Sandino. Here, people wash their clothing by hand and hang it to dry. I should start a collection of clothing line photos, because they are so colorful and fun! There is no reason to have a clothing dryer here because it is hot enough to hang your clothes on the line to dry. It is more difficult in the rainy season because if the clothing line is not covered, the clothing takes a long time to dry due to recurring rains. We have a clothing line inside the first floor of the dorm (all of the walls surrounding the downstairs common room are screens), but good luck getting your clothes dry on very humid or rainy days! The clothes come out smelling not quite clean. We can’t figure out if it is because of the incredibly cheap laundry detergent we have at the dorm, because we air dry our clothing in a humid climate, or a mixture of both.

Although Nicas have to work very hard to keep their homes and workplaces clean, I have seen many hardworking women sweeping. They sweep inside their homes and the sidewalks outside of their homes. Doña Conchita, the woman who maintains the outside of the clinic and opens the gate for cars to enter and exit, keeps the cement entrance swept immaculately. She also sweeps the dirt ground surrounding the entrance to keep it looking nice. Nila, our incredible ‘housekeeper’ in the clinic, is constantly mopping the mud and dirt off the floors to keep them clean. The clinic always smells wonderful! Although she has arthritis in her elbows from years of cleaning, she puts in a full day of hard work. She arrives at 8am and mops, restocks supplies and sterilization tubs, prepares coffee and a snack for the employees, does clinic laundry, and cleans anything and everything. She takes an hour for lunch and a siesta which helps sustain her throughout the rest of the afternoon until 5pm, when the clinic closes. Although I have not yet become close with many Nica women, Nila strikes me as the quintessential Nica woman. She is hardworking, lighthearted, and joyful, yet carries many burdens. Nila is a widow and has many children. She works fulltime to make the money to support her family, and most nights and weekends are devoted to caring for the children and fulfilling household duties.
Something wonderful happened this morning at the clinic. I was filling out a new chart and assessing an 8 day old baby girl. Her parents had not yet chosen a name for her. Henry suggested my name, saying "Kimberly is a very good nurse, and this would be a good name for the baby girl". 'Kimberly' is my Spanish name because 'Kim' is difficult for Spanish speakers to pronounce, and Kimberly is a well-known name in Nicaragua. I laughed and told the parents, "There are many good names to choose from, for instance Sara or Juanita or other popular names. Take your time while I am filling out the chart to think about it". A couple of minutes later, the parents had finished deciding on a first and second name. Here in Nicaragua, children are given two names (nombres). They also have two last names (apellidos), the father's first last name and the mother's first last name. Guess what name the parents chose? Kimberly de los Angeles. Now I have a beautiful Nica baby girl named after me! I am pictured with her and her mother to the left.

In my next blog entry, I will continue to describe difficulties and joys I have experienced here during the adaptation process. Rest assured that I am becoming accustomed to the difficulties, and the joys are becoming more apparent with each new day!

Monday, October 4, 2010

Un Dia en la Vida (Parte 2)

To continue 'A Day in the Life'...

When I arrive at the clinic a little after 8am, I help Danelia and Henri assess and triage patients. The pediatrician comes Mon.-Fri. from 8:30 to 10:30 am, so there are lots of sick babies and children who come in to see the pediatrician in the mornings. There are also lots of nebulizations and injections that the pediatrician orders, and I administer these. Asthma and congestion from allergies are major problems here. In Nueva Vida (the impoverished community where the clinic is located), food is oftentimes cooked over a fire inside the house, so the house becomes smoky. Additionally, there is dust in the air, a humid climate, lots of stray dogs traveling the neighborhood, and family members smoking inside the house. Overweight and obesity are also big problems in Nicaragua. Fifty percent of the population is overweight or obese. This issue is complex, but stems from a variety of factors including lack of money to buy healthy foods, lack of availability of vegetables, cultural preferences regarding food, and lack of education and value of healthful eating. Many children also have infections, especially parasitic infections due to contaminated water or lack of proper hygiene and an unhygienic environment.
After checking in and assessing patients (in the room pictured here) and administering nebulizations and injections, I am sometimes able to shadow the pediatrician. I have learned a lot from the minimal amount of time I have observed him. He speaks some English, understands the complexity of providing health care for the impoverished, and provides holistic assessment and treatment to patients and their families. I have been incredibly thankful for the time I have spent observing him, and have learned a lot. Additionally, I spoke with him today about topics for patient education. I plan to gather educational supplies, construct care plans, and begin patient education within the next couple of weeks. I will be focusing on hygiene, proper nutrition, reducing environmental triggers for asthma and allergies, and automedication (patients treating themselves with medication without consulting a doctor).

At around 11:30 or 12:00, we head back to the house for lunch. We eat lunch in the JHC (Jubilee House Community) house, which is very close to the dormitory in the same gated community. Kathleen, Mike, their three boys, and Sarah (all members of JHC) live there. Lunch consists of leftovers from dinner the night before, or if there are no leftovers, rice and beans. White rice and red beans are a staple here, and are delicious when made Nica style! We usually head back to the clinic at 1:00pm, but Leah (another long term volunteer who arrived here the same day as me) and I are beginning daily Spanish lessons tomorrow from 1-2pm with a woman who works here for JHC. We are very excited to get some formal instruction and have an hour devoted to learning Spanish each weekday!

Depending upon the day of the week, there are different physicians and specialists at the clinic. The general practice physician comes daily from 2:30 until 5:00 pm. He is a jolly, funny, knowledgeable man whom I truly enjoy observing and interacting with. The orthopedist comes Wed. and Fri. from 8:00 am to 12:00 pm. He provides wonderful care, and has been administering an experimental treatment to his arthritic patients for seven or eight years. It consists of an injection with lidocaine and a mixture of minerals that is very effective to reduce pain and inflammation when combined with diet and lifestyle modifications. The dentist comes Monday afternoons and Tuesday and Thursday for most of the day. She is a young Nicaraguan woman who looks like she is 22 but is actually about 29 years old! (I have yet to post pictures of the dental equipment available, but plan to take pictures of the dentist's room for readers who are interested :-)). The optometrist comes Friday mornings along with two optometry students. As you can imagine, Friday mornings are a very busy time with the pediatrician, orthopedist, and optometrist all available! Additionally, we have a lab tech who works every afternoon.

When I arrive at the clinic in the afternoon, I help Danelia and Henri check in and assess patients there to see the general practitioner. There are many patients with type II diabetes and many with hypertension. I have already seen a few patients with blood glucose levels in the 500’s within my 2 weeks of working at the clinic! (For those of you not familiar with the norms, this is VERY high). It is very difficult, if not impossible, for diabetics in Nueva Vida to regulate their blood glucose levels due to a lack of availability and money for glucometer supplies and insulin. Although they have monthly appointments with the physician, this is not sufficient to keep their diabetes well controlled. By the time they arrive at the clinic, many are already experiencing symptoms of diabetic ketoacidosis such as dizziness, increased respirations, vomiting and upset stomach, and increased urination and thirst. Last week, I had the opportunity to start an IV on a patient in diabetic ketoacidosis. Although it is scary stuff, it is a great learning experience for me. Although patients with chronic hypertension have monthly control appointments, blood pressure is oftentimes poorly controlled. Patients come into the clinic complaining of dizziness, headaches, and hot flashes. One woman last week had a blood pressure of 200/130!

After assisting with check-in and assessment, I shadow the general practice physician and administer injections and nebulizations as needed. I have learned a lot from the general practioner, especially pertaining to parasites, fungal infections, viral vs. bacterial infections, hypertension, and diabetes. I have seen many different types of skin lesions and infections. I have also learned a TON of medical Spanish words, although there are many more yet to be learned. It is fascinating to learn so much in a days’ work, but by the end of the day I am exhausted and ready to relax.
There is about an hour and a half between work and dinnertime to finish whatever needs to be done and to relax a little (dormitory photo to the left). I usually eat a small snack (I am famished by the time I get back to the dorm!), put on some comfy clothes, and journal for a little while, read my Bible, exercise, or just hang out. Dinnertime can never come too soon, because we are always really hungry and Kathleen makes great food! We eat dinner together in the JHC house. It is always a balanced meal with a vegetable and main dish, and sometimes another side dish. We have had a couple birthdays since I have been here (this is pretty much the only time we get dessert), and the cakes are delicious! The volunteers rotate dish duty each night – Leah and I share dish duty Tuesday and Thursday nights. I do not mind dish duty, especially since I didn’t have to make dinner! Because Kathleen will be gone for the next 3 weeks visiting the States with Daniel on college visits, I will be making dinner for everyone once a week. I am excited to be cooking for others once again!

After dinner, there is about an hour and a half to hang out before I get ready for bed. During this time, I look up Spanish words that I didn’t know during the workday, journal or read my Bible, answer emails/write blog entries, or just hang out in the dorm kitchen/common area (pictured at left) with the other volunteers. There is usually a game going on in the common area if I would like to join, but oftentimes I like to take it easy at night and spend time in my room. I cherish the alone time that I have at night.


In my next entry, I hope to write about the adaptation process as well as the challenges and joys of serving here. ¡Hasta la próxima vez! (Until next time!)