Waiting room outside our exam rooms

At the hospital in Leon yesterday morning. Training is going great.

View from our hotel roof last night

This was before the spectacular lightning show that we had walking home from dinner in Leon!

Parking outside the hospital in Leon

No hitching post for the horsecarts, and no parking lot for the few cars. Main transportation: feet or two-wheeled vehicles (or buses).

Team PINCC on a day off on Sunday

At a nature preserve near the beach outside Leon. A much needed break!

Some of Team PINCC right now in Leon

Lunchtime in Leon! From left: Hayley Miller, Dr. Tara Hulbert, Dr. Pratima Gupta and Emily Riggs.

Guess what this is?

A bottle of orange soda left for the occupants of this house (which is in Leon en route to the hospital)? No! But if you said "a papaya", you're right!

Desvios, Puentes y 'Policias Acostado', Oh My!

SOMEWHERE BETWEEN JALAPA AND LEON, Nicaragua -- So I found myself yesterday engaged in one of the more adrenaline-pumping, sometimes-terrifying and certainly adventurous drives I've ever performed from behind the wheel.  With a vanload of innocent people relying on me to get them to their destination safely.  (Why me?  Because I volunteered to drive when our usual Nicaraguan driver was unable to join us for the trip. We later joked that he chose not to join us because he checked on the road conditions for the portion of the trip I'm about to describe.)

 

We got out of Jalapa later than expected, which meant we'd roll into Leon -- at least a 6-hour drive -- after dark. That's never good in an underdeveloped country, especially one where pedestrians (or groups thereof), loose livestock, bicyclists, motorcyclists, trucks and dogs all occupy major highways at unpredictable times and locations, and, depending on which of these you're talking about, without warning, lights, reflectors, consideration, caution or apparent concern.

 

The first part of the trip was predictable.  Jalapa to Ocotal is a known quantity.  It's a trying, winding road with the usual asortment of men on horseback, small children playing on the shoulder and -- best of all -- a series of "puentes," narrow bridges across rushing water where the approach is partly washed away, the ability of the bridge to carry our vehicle safely is questionable and the width of the bridge is just enough to drive across.  But it was during daylight hours; in other words, no big deal.

 

We got through without incident. 

 

Then we got to the highway (loosely termed) where you turn toward Leon.  Of the options to Leon, we had been told that this was the best one in terms of road conditions.  And the presence of major commercial trucks confirmed that.  In other words, if there was a better way to go, they'd surely be going that way.

 

Very quickly, we encountered a "DESVIO" -- known in the United States as a "DETOUR".  Detours where I live consist of a sign with an arrow followed by a series of signs keeping you on the right route.  Here, however, a DESVIO simply signifies that you don't go the way you thought you'd be going.

 

If it's dark (which it was by the time we saw our first DESVIO sign), you look to the right or left for a very bumpy, lumpy dirt road down in the gully alongside the highway where your vehicle MAY be able to pass if it's not raining.  And if there's no major truck (or herd of cattle) either coming the other way or stuck. 

 

We got used to this because we encountered at least a dozen of these always interesting one-way DESVIOS.  That's right: one way.  Nobody handles the duties handled in the United States by a person with a flag and radio, signaling someone at the other end to either stop traffic or let people pass.  Here, you take your chances.  Part way through, you may encounter someone coming the other way who also has taken their chances.  There's nowhere to turn around.  There's no way to back up. 

 

Once, the pavement abruptly changed from old pavement to new in our lane (with an 8-inch change in elevation) without warning.  Coming the other way, in my lane, was a huge truck.  When we got close to each other we both stopped.  The driver of the big truck leaned out of his window and motioned for me to drive off the edge of the new pavement onto the old pavement in the oncoming lane so he could pass.  I quickly thought this through.  He couldn't do what he was asking me to do because of the kind of vehicle he was driving.  So I veered gently down to the oncoming lane.  Fortunately for all of us, nobody was there.  The big truck passed and honked his air horn in kind of a "Spanglish" thank you.  I returned the signal, got back into my own lane and continued on to the next DESVIO sign I knew must lie ahead.  I wasn't disappointed.

 

Of all the DESVIOS we encountered, only one was so deeply rutted that the entire undercarriage of our van scraped along the center part of the dirt road with a pronounced sort of grinding sound, punctuated by abrupt stops and more pronounced sounds.  It felt and sounded really awful.  We envisioned u-joint parts, the oil pan and other essentials being ripped from beneath us. 

 

After many more DESVIOS, we finally concluded we were through the section being worked on.  Not because there were signs indicating "End Construction Zone," but because of the lack of any more DESVIO signs.

 

But now we faced a new phenomenon.  We called them "random strips of missing pavement."

 

These were sections where, apparently, new, huge concrete culvert pipes had been installed across the road, with the opening then filled in with dirt and rocks to be paved later.  No care had been taken to ensure the level of the unpaved space was anywhere near that of the highway. So, at 80 or 100 kph (that's kilometers per hour to those who have never left the mph world), you'd come to one of these strips and struggle to slow down enough to keep the car intact as you passed over the patch.

 

We got through all of these, as well.

 

Soon we were in total darkness, but with ominous lightning occasionally flashing in the sky to our right or just ahead.  Now came the really fun part.  Apparently, in Nicaragua, the place for people in tiny villages to hang out just after dark is along the side of the road. Once in a while, they hang out by themselves.  Mostly, though, they hang out in groups ranging from 3 to 20.  The custom I was most surprised at was the one where they hang out as close to the pavement as possible, or, in many cases, on the pavement where vehicles are traveling at what we in the U.S. would describe as "freeway speeds." 

 

Sometimes, they'd be sitting or even lying down perpendicular to the pavement.  One young man remained in this position, with his body from the waist up on the road and the rest of his body on the shoulder.  As I came speeding along, just about when the limit of my high beams brought him to my attention, he did a very slow and controlled situp -- just in time.

 

One of my favorite experiences, though, involved my encounters with people on bicycles, motorbikes, horsecarts and other vehicles with no lights or reflectors whatsoever. They weren't moving along on the side of the road.  They were in the road.  In the dark. Mostly, if they were people either on foot or on bikes, they wore very dark clothing.  Sometimes, I'd catch a momentary glint of a reflector strip on the pedal of a bike.  These made me feel lucky.

 

I also felt lucky to have Carol Cruickshank, our trip director and a one-time Nicaragua resident, as my co-pilot and navigator.  From time-to-time, she would quietly alert me to a barely visible pedestrian or bicyclist.  Carol's voice is almost always perfectly calm.  Her voice remained so as the rest of the passengers sat behind me in abject terror.

 

And then, once we got to Leon and my body had more adrenaline coursing through its veins than blood, I learned about "policias acostado."  In the United States, we call these "speed bumps."  Here, they're called "sleeping policemen."  If they're really large and challenging to drive over, they're called "policias acostados con su mujer," which means they're nearly twice as high.  I'll leave it at that since this is a family blog.

 

After nearly seven hours, we rolled into Leon without incident.  In fact, there actually were no true INCIDENTS on the whole drive.  Only the constant, nagging sense that an INCIDENT -- or worse -- would happen at any second.  There are a lot of seconds in nearly 7 hours.  What if we had a flat out there in the middle of nowhere and had no way to drive to a non-existent shoulder?  What if the oil pan had truly been pulled from the bottom of the engine on that one DESVIO where the center section of the dirt road was higher than the van's clearance?  What if a child on a bike had randomly chosen the moment we were careening past to cross the road? What if, what if, what if (fill in the blank)?

 

My mind reeled as to what may have happened but -- thankfully -- didn't.  We got to the hotel safely.  The longest, toughest part of our trip was finally over. 

 

-- Larry Shushan, PINCC volunteer in Central America

Success in Jalapa, Nicaragua

JALAPA, Nicaragua -- Seven PINCC-trained medicos yesterday were certified to perform screenings and treatments on their own, which is a tremendous accomplishment, both for the trainees and for PINCC.

 

But it's an especially significant development for the women of Jalapa and the surrounding area, because now there are trained medical personnel who know how to screen for the precursors of cervical cancer and provide immediate, effective treatment.  And Jalapa's clinic now has a gynecologist assigned there -- for the first time ever -- by the Department of Nuevo Segovia (the equivalent of a state in the United States).

 

Lives were saved while we were there, and lives will be saved in the future.  "Brigades" of medical teams will now be able to visit outlying areas -- trained and equipped by PINCC -- and screen and treat women.  It's a profound experience to contribute to this kind of progress because one knows that lives will be changed for the better.

 

Jalapa is the poorest place I've ever seen.  I acknowledge that I have not been to some of the world's areas most well known for poverty.

 

That said, however, I and others on the trip were deeply affected by our experience.  If you live in the United States, even the poorest areas we see have an infrastructure that provides basics -- from toilets to running water and from electricity to protection from most public health hazards.

 

In Jalapa, life is a grind, plain and simple. At first glance, it's quaint and charming to watch people ride around on bikes and horseback, or to see people walking from place to place -- except these people are using these methods of transport for lack of any other way to get around. There are almost no private cars, and public transportation is only from town to town, not within a particular town or village.  They're unprotected in the rain.  They're in sandals in the mud. And they have no protection from the blazing sun or suffocating heat.

 

Unlike patients we saw in San Salvador, where people of limited means showed vibrancy and interacted with energy, the people in Jalapa were blank, extremely stoic and flat.  There are few smiles. 

 

Dogs are treated like, well, dogs.  Not the way dogs are treated in the U.S.   Here, they wander the streets and look skeletal and desperate.  They're shooed away; sometimes even kicked.  They wander through the clinic and scrounge for crumbs.  I didn't see any that were "pets" in the U.S. sense of the word. Black vultures circle and, frequently, descend for a meal on the side of the dirt road.

 

Some streets are paved with interlocking concrete blocks.  Many are dirt.  Some are formerly paved streets whose pavement has been destroyed by the elements, vehicles and time -- apparently never to be repaired because there are no resources available.

 

As I said in a previous blog entry: One can only focus on the positive -- that people are being helped now and in the future because of PINCC's work.  But I couldn't wait to leave Jalapa, which I'm almost ashamed to say.  At least I had the option to leave.

 

-- Larry Shushan, PINCC volunteer in Central America

 

A much different kind of day

From the urban center of San Salvador, where clinics are relatively efficient, and patients and trainees are plentiful, PINCC's team has moved on to an extremely remote location in Nicaragua -- Jalapa. This is PINCC's fourth trip here.

At this clinic, where women travel sometimes for two days on foot or by bus from even more distant villages, there are more positive screenings and the need for more treatments.

Poverty is grinding and ubiquitous. The team is affected by what we see and experience. We went from celebrating success in the big city to sitting through hours of travel to come to a place where what we see is sobering (a huge understatement) and saddening.

Women wait patiently for screening exams, some of which are the first on their lives. Children wait with a patience unseen in the United States.

Here, where waiting is frequent and almost always lengthy, children occupy themselves without complaint or fuss. They wait for hours and say it's their duty to wait for their mothers. This phenomenon is utterly different from what we see in the United States. No video games, no books, no coloring books -- just waiting patiently.

Tomorrow is a new day in Jalapa. Today we saw 25 women. Tomorrow will bring whomever and however many it brings.

-- Larry Shushan, PINCC volunteer in Central America

Team PINCC heading for Nicaragua

...and so we say goodbye to El Salvador for this trip. We're heading for Jalapa, a tiny village in Nicaragua for PINCC's 4th visit. Then it'll be on to Leon, where we're training doctors to enable them to train others and to head to outlying areas to screen and treat women for the precursors of cervical cancer.

An amazing trip so far, with more to come.

Stay tuned ...

-- Larry Shushan, PINCC volunteer