Thursday, May 29, 2014

Kukra Hill, Nicaragua, May 2014

By  Shana Wetzler, RN ICU/ER, Jackson Wyoming

"Welcome to Pearl Lagoon!" was the first thing that I heard stepping off the boat onto a deck full of men handing out their hands to offer assistance. All I could think of is…"where am I? This place is magical" I was a little nervous at first flying into Nicaragua, the first time since I've been out of the country in 3 years. Although, Carol, our leader, who has spent many years in this country, fluent in Spanish, yes pretty much a saint, reassured me this place was safe. That still didn't convince me and I definitely had worries coming from a small town in Wyoming.

I felt like I was walking aimlessly around the streets looking at all the greenery, palms trees, run-down buildings, brick roads and not to mention the natives staring at you with no smiles on their faces. When I offered a smile to them and said "hello" their facial expression immediately changed to a smile and offered a "hello" back.

We got to our hotel called the "Green Lodge" which was a gated little area. Professor Wesley was the first to greet us with open arms and a smile on his face.

"WELCOME TO OUR HOME. Thank you so much for coming". Bottled water was in our hands within seconds with a key to our rooms. What a welcoming gift, although I didn't realize I was dripping with sweat and cold water was heaven in my eyes. As we entered our rooms, the air-conditioning was the first to greet our tired and hot faces.

All I could think of is "This is WAY better than what I was expecting! Air conditioned rooms with beds, fresh water every morning, homemade breakfast from Wesley's wife. OK sweet, I do this for 2 weeks, no problem!" But there are definitely some things that we have taken for granted in the US such as; sunscreen to buy, internet access, consistent electricity and running water, a cold beverage with ice or fresh veggies (Carol has make it VERY clear not to drink the water here or eat fresh veggies). Mangos and pineapple on the other hand…are safe! YUM!

Sunday was our adventure day. We hopped onto a boat filled with the 15 of us from our PINCC group and a random extra engine lying on the floor of the boat. We headed out to the "Keys Islands", and within about 15min the boat stopped. Our boat driver was frantically working hard to 'fix' the broken engine. Within minutes he was asking to hand him the 'random extra engine'. Little did we know…this extra engine was not as strong as the first…so our quick boat ride ended up turning into a 2 hour boat ride to the Keys. He stopped at the first 'tiny' island because it was the closest and our crew was getting pretty anxious to get out of the boat at this point. This 'tiny' island may have had about 26 palm trees total…each one finding it battling to stay alive with the small amount of space given. The white sandy beaches and warm water calmed all our nerves the minute was stepped onto the island. Swimsuits were on and people were instantly in the water swimming. What a wonderful way to spend our first 'leisure' day in Central America.

Meanwhile…while our group was basking in the sun, eating fresh papaya and coconut, swimming…Carol, was hard at work in Kukrahill. Meeting with the hospital staff for our visit, setting up transportation for the week, making sure we were going to have lunch each day…hard at work. She greeted us back in Pearl Lagoon with a huge smile on her face saying "I have such great news". What a comforting thing to hear after spending a total of 4 hours on a boat, a few people getting seasick, and many of us with sunburns.

Instead of having to take a bus ride for 1 ½ hours, she set up a boat ride that would only take us 20 minutes. I laughed internally thinking…we just spent 4 hours on a boat, I'm sure some of the crew is not so thrilled about more boat adventures. Although, I was over excited! Not having to be on a bus for 1 ½ hours in the hot and humid weather…done and DONE! Thank you Carol!!

Each night Carol set up a spot to eat at a different restaurant. "I do this to help out the community, our business will feed their families for weeks" Carol would say. I will have to mention…this woman, Carol, whom I just met a few days ago…is one of the most positive, inspiring, organized and giving person I have ever met in my life. A smile on her face at all times and a reassuring statement to make any worried person feel at ease.

Monday, May 26

First day of clinicals in Kukrahill. We arrived on the boat to a dock in Kukrahill filled with beautiful colors painted all over. What a welcoming place! The ambulance was there to greet us and pack our large suitcases filled with equipment to the clinic. We arrived at the hospital around 8am. The waiting room was packed with women of all ages, children running around and men standing outside. I had no expectations walking into the hospital, but this was sure overwhelming. We all started scrambling to set up each exam room. Carol assigned 2 of us to each room to set up. I remember thinking as I was setting up the room…I have no idea what I'm doing! I hope I don't put something in the wrong place…I don't want to forget something…and what the heck is the VINEGAR for?!  I could see Carol and Sarah running around knowing what to do and where to go. Meanwhile, Christian, Lang and I were kind of dumbfounded. The physicians were all in the back room giving a lecture and class to the 'new trainees' about the procedures, instruments, etc.…

While the physicians are training, the rest of us volunteers and nurses from Kukrahill will interview all of the women. Questions range from; age, date of birth, medical history, history of family cancer, how many children they have, when was their last menstrual period, when they first had their menstrual period, if they have ever been abused physically or sexually, and many more questions. Once we get a nice stack of women interviewed, we will start placing the women in each exam room with one MD from PINCC with one or two trainees. The PINCC MDs will explain and instruct the cervical cancer screenings. Within a few patients, the trainees will then take over and have the MDs supervise.

It was a pretty hectic day with a lot of cervical cancer screenings being performed. Not only that, but myself and a few others felt extremely overwhelmed due to the massive amounts of 'Spanish speaking only' women here. It was a struggle because every time someone came up to the front desk to ask a question, I had no idea what they were asking. I then had to go find one of our bilingual volunteers to help me interpret. That was pretty frustrating, I sure wish I knew more Spanish!! We were expecting to start with 20 patients…that was until Carol came to us to let each of us know that there was a bus filled with 16 women from a different town who needed to be first priority to leave by 1 o'clock that day. Of course she had a smile on her face with no fear at all, how impressive. So we scrambled to get all the women seen by our lovely physicians before one o'clock that day.

At the end of each day the physicians take the trainees into the back room to for more teaching, also reviewing their day. The rest of us cleaned each room, entered patient data into the computer, cleaned up paper charts and organized for the next days to come. Whew! What a crazy day…and we all left the clinic smiling and happy to be in the sunshine. I personally was looking forward to the cool breeze on the 20 minute boat ride back to Pearl Lagoon.

There were a few things I remember Carol telling us before I came to Nicaragua:

"It may rain every single day so be prepared"

"The women here speak both English and Spanish"

"Don't bring a suitcase heavier than 25 pounds".

So far…the sun has been shining almost every day, with a few rain spouts here and there to cool things off. The women in Kukrahill mostly speak Spanish. AND my backpack only weighed 15 pounds!!

The nights here have been very relaxing. We all usually meet around 6pm to head to dinner. That gives us a few hours to cool off and separate from the group for a bit. A few nights some of us will relax on the patio looking out into the Bay and watching locals fish. Others go for walks or catch up with their children and family to hear about all of their adventures during the day.

So far this adventure has been wonderful! I came with zero expectations and…well my expectations have been exceeded. The local people here are extremely friendly; the land here is absolutely beautiful with lush greenery everywhere; the water is warm and clean to swim in; the food here is delicious-ranging from shrimp, white fish, chicken, plantains, beans, rice, and cooked veggies (mainly carrots and squash); and most of all, our group is FABULUOUS! We all get along and work together really well and to top it off, Carol is a wonderful leader. I am going to miss the crew that was here the first week, but also can't wait to meet the new crew coming next week! Thank you PINCC for letting me take this adventure to an amazing country with amazing people!!

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