Wednesday, May 30, 2012

Happy Nicaraguan Mother´s Day

Wednesday, May 30th, 2012. Mother's Day here in Nicaragua and a big deal it is! We walk along our route to the hospital where we begin our third day here. The Dining for Women group has been here for a whopping 4days (!) and they are already super seasoned and they have the routine down pat.  It's truly impressive! -  I think that sometimes they underestimate the amount of support they offer but it is truly noticeable and obvious. It's funny how one doesn't have to speak the same language to communicate compassion and support!
I don't know how many patients we saw today, it felt like a lot and the team I was with was a well oiled machine, Ismara the RN and Cecelia the general physician - It is such an honor to work with such dedicated professionals.
One patient sticks out in my mind, (at this particular moment, many more are in the back of my mind). This patient came from quite a distance, (had to leave her house at 5 in the a.m. and arrived at 7a.m.) and as she entered the exam room I saw here make the sign of the cross. Quietly, subtly, and I realized how nervous she was and how TRUSTING she was. Again, what an honor! We ended up finding a lesion and providing her cryotherapy and she left the clinic at about 4p.m. She did well, and her grace was beautiful. A gift. And, a gift to be part of that - to be part of the team that is PINCC that could serve this woman! Happy Mothers Day! Anne Daly 

Healing Hands

There is healing in the laying on of hands;
in the letting go of fear, in asking for help,
in silence, celebration, prayer. 

(Danna Faulds, Yoga teacher and poet)

The chairs were two deep in the hallways when we arrived at the hospital for our second day of the mission.  By 11:00, we had interviewed 30 patients and were well into seeing them in the treatment rooms.  There are usually 4 treatment rooms running at one time - each one lead by one of the four medical professionals on our trip.  Pam, Ilana, Ann, and Karen.  Our mission is to teach the Nicaraguan staff and ideally graduate them to teaching their own staffs in outlying hospitals how to perform the cervical screenings and remove pre-cancerous lesions on their own. Most of the clinics don´t have the equipment needed to remove the lesions, either by freezing them (cryotherapy) or excising them with a live wire (LEEP).  Training is one issue and funding equipment to do so is another.

I again began the day doing intakes and found that I was much more comfortable with the vocabulary and questions.  The true challenge came when one of the patients told me yes, she had been abused by her husband, that he had been killed, and she had lost a son to suicide.  The previous day all answers were emphatically negative.  We paused.  I took a big breath, held her hand, and told her how sorry I was for her pain and loss, making a note for her to see the psychologist before leaving.  This woman´s story wasn´t unique - along with poverty comes violence, loss, and struggle.  We finished the interview and I handed her a sheet in Spanish that explained a little about female anatomy and the treatments we were offering that day at the clinic.  When I walked into the data entry area, I burst into tears.  I wasn´t expecting it.  I couldn´t stop crying.  But of course, eventually, I did.  Feelings here are very close to the surface, it seems.

This woman had  waited over 4 hours in the hallway to be seen.  I was able to intercept her afterward and escorted her to Jenny - the director here in Nicaragua - to set up a psyc consult for Thursday.  I pray that she shows up and gets some professional emotional support.  Her screening showed no abnormal cells.  Finalmente.  Un poco de buena suerte.  She gave me a big hug and the traditional kiss on the cheek.  I asked for another and hugged her again as we said goodbye.  Tears in both of our eyes.

In the afternoon, I adopted another new role.  Hand holder.  This role is very important and not language dependent.  Each of the DFW volunteers can share a story of connecting with one of these patients as she received a LEEP or Cryo.  Wiping away tears.  Squeezing hands.  Sharing pictures of home on their iPhone.  Talking about our kids.  Coaching the patient to find their breath and exhale...... This job of hand holder is not to be minimized.   One patient pantomimed to the volunteer that she could feel her heart in her hand, supporting her and holding her fear. Compassion crosses all barriers of language, when we are open to truly and vulnerably connecting.

Imagine getting on a bus at 3:00 a.m., arriving at a big hospital by 7:00 (the time they are told to arrive) , and sitting in a sweltering hallway for 2 hours before the medical staff even arrives.  My last patient on Tuesday was seen at 3:00 p.m.  She had to catch the 4:30 bus back to her pueblo and probably hadn´t had anything to eat except for the couple of cookies I encouraged her to eat along with the glass of water that washed down her ibuprofeno. We handed out sodas and crackers.  Many volunteers shared parts of their lunch with women that had been waiting for hours.  There was no protocol except to follow your heart.  Some volunteers even brought toys and crayons for waiting children.

When we got back to the hotel, we were all exhausted, but felt good about the work we had done for DFW and PINCC, and for the connections with these very brave Nicaraguan women.

Nicaraguan dancers arrived around 6 and we were treated with 3 traditional dance performances by local young people.  They were amazing and full of celebration and  laughter - just what we needed after the long day.  We then ambled down the street to Carol´s favorite family owned restaurant for soup and postre de tres leches.  The soup was delicious, served in giant bowls with giant spoons that looked more like spoonRESTS than soup spoons.  We encoutered numerous new root vegetables and potatoes in the broth which was made with a huge variety of ingredients including sour orange.  Yum.

After dinner some of us found our way to the rooftop again and were treated with double fireworks.  Arriba (to the east) was an amazing display of lightning that traversed the sky like words written in cursive (a direct quote from Marie Cruz).  Abajo we heard the boom and crackle of  fuegos artificiales or fireworks.  I thought they might be coming from down on the beach, a preveiw for tomorrow´s national holiday.  NICARAGUAN MOTHERS DAY!

Tuesday, May 29, 2012


"We Can Fix This"

By 8:00 a.m., we were in the hotel lobby, wearing our scrubs and ready to go.  We each made a name tag that could be easily pronounced by our Nicaraguan patients.  Lezli, Catarina, Daniela, Lina... made some adjustments.  The hospital was crowded, inside and out, packed with people waiting to be seen.  We moved through the un-air conditioned hallways, heading toward the air conditioned conference room to meet the Nicaraguan doctors, nurses, and residents.  This is a teaching hospital, and some of the medical staff has worked with PINCC in the past three years, practicing to gain proficiency with these procedures to prevent cervical cancer.  

The PAP test is also done here in Nicaragua, but the wait time to get a result often makes it ineffective for patients who travel long distances to get screened or are unable to complete a follow-up exam.  The VIAA (visual inspection with acetic acid, which is white vinegar) is performed and completed in one visit making it a much more efficient screening procedure.  If abnormal cells, areas, or lesions are detected, they are immediately removed and the client is sent home.  All in one visit.

The data entry group was set up in a small room with numbered post-it notes and a big pile of charts.  Their job is to organize the charts, get one of the interpreters to do the intake and then enter the data and prepare the file for the necessary screening and possible treatment plan  

I began by shadowing Sally as she interviewed a young mother.  The questions were now clear for me, but answering them involved discerning heavy accents, deciphering the handwriting of numerous doctors and pathologists on previous tests, and then confiming all of the information, from medical history to current contact information, directly with the patient.  The patience of the 3 women I interviewed was impressive  They were so helpful, and willing to repeat place names until I was able to understand and reproduce them onto the current form.  Some patients waited for hours to be seen, in an un-airconditioned hospital corridor.  I spent most of the afternoon in conversation with these women, helping them pass the hours and sharing life stories.  

At the end of the day, I was pulled into an exam/procedue room to translate for Karen - one of the nurse practitioners.  Half the time I was holding this very scared young woman´s hand and the other half of the time I was trying to parrot procedures I didn´t really understand.  It felt a bit like channeling...  ¨words like displasia, biopsia, cepillado,  matriz, cuello uterino.... that I can barely understand in English.  I was diligent to re-check what I couldn´t understand but it was by far the most intense translation experience of my life.  We´ll see what days 2-5 bring....

The work day ended with an hour of sharing, lead by Carol, in the hotel lobby.  I was impressed how everyone had an equal voice.  These Doctors, Pam and Ilana, are completely capable, amazing, and present.  Ana and Karen, the Nurse Practitioners are equally open, vulnerable, and interested in everyone´s commentaries.  We saw 23 patients today and performed numerous life saving procedures.  We talked about how to provide more privacy for patients.  Issues with residents.  How to deal with confusing data.  Computer glitches.  And the fact that this week numerous Nicaraguan doctors and nurses will be graduating to the role of eduacators.  

"We can fix this" , said Carol to the group.  "HPV is everywhere, but we can prevent cervical cancer with screening".  She reiterated that what we are doing is pure service.  No glamour.  Just damn hard work.  

Over dinner the lines between PINCC and DFW faded completely.  We had returned full circle to the yoga class the previous morning.  Women helping women.  Tomorrow. Day Two of the Medical Mission.

PINCC and DFW in Nicaragua - DAY ONE IN LEON

¨Where The Streets Have No Name......¨

The DFW group began the day on the rooftop of the Hotel San Francisco, connecting our hearts and minds with a gentle yoga practice overlooking the city of Granada.   It felt so good to move and breath together.  I taught the group Trimurti and Yoni mudras (hand gestures associated with the feminine body, mind, and spirit), uniting our intention of women helping women, as we headed for Leon and the beginning of our true meaning for being in Nicaragua, our medical mission with PINCC, or Prevention International.  No Cervical Cancer.

A quick stop the Masaya Market and then we off for Leon.  Our driver pointed out the Iguana hunters along the side of the highway, selling their wares to passing motorists!  Patricia wanted to know how they prepare the meat, what it tastes like, ... so I was kept busy for the entire ride translating sentences I never dreamed would need translation!  A quick roadside stop for the local specialty - quesillos - brought us to Leon around 1:30.  By 3:00 we were assembled as a Medical Mission Team, having joined with the PINCC volunteers in the lobby of our hotel.  The group is lead by Carol - a veteran nurse and midwife that has done amazing work here in Latin America and beyond.  There are two female Ob-Gyns, both from Tucson, who brought their children (ages 3-8) and husbands ( a.k.a. amazing caregivers and supporters of the PINCC mission) with them.  There are also two Nurse Practitioners and an Interpreter with the PINCC group.  They spent the previous week doing a similar training in El Salvador - so they are our experts!

We were divided into 3 groups:  Medical Staff, Interpreters, and Support /Data Entry.  There were 4 of us in the Interpreting group - my group  Sally quizzed me on the intake form, asking me to translate from my Spanish PINCC manual to English, checking that I could understand the vocabulary.  The first few questions seemd obvious.  Date.  Name.  Address.  But wait!  BTW.  They don´t use written addresses in Nicaragua.  What?  Bono was singing about a real place in the song, Where The Streets Have No Name?  And now it will be my task to figure out how to write an address in a country where that song lyric is a reality? 

Places are described in relation to a famous landmark.  East of the landmark is arriba (up - because the sun comes up in the east), and west of the landmark is abajo (down - because the sun goes down in the west).  So our hotel is two blocks up from the Concepcion Church.  Dos cuadros arriba de la Iglesia de la Concepcion.  That seems simple enough.  Yeah, right.  But not if you´re talking about Tio Jorge´s store, or where the Coca Cola plant used to be in Managua.  You have to KNOW the main landmarks to navegate FR0M them.  Ironically, the streets do display names - " But nobody pays attention to them" , says Carol with a flip of her hand. 

As I continued with my translation of the intake form, the questions became more and more personal.  Do you drink?  Smoke?  And then it jumped to some of my new vocabulary words like genital warts, condoms, and methods of family planning, touching on topics from number of sexual partners to whether they have had an AIDS test.  When we got to some of the abuse questions, my heart filled with tears as I imagined asking these personal questions and holding each patient´s personal answers.  PINCC has secured a psychologist to counsel women who would like to have a consultation - which they usually decline. This will certainly be an emotional journey for all of us, on many levels. 

We shared a simple dinner of pizza in the hotel lobby and head to bed by 9:00, eager to begin our true mission tomorrow morning at 8.