OSU SVOSH 2007: JEN MCNAMARA 'S JOURNAL
September 2, 2007
It's our second day in Sebaco, Nicaragua. Sebaco is a city that lies right along the main highway through Nicragua. This highway provides a means of transportation for goods to Honduras.
The hotel we're staying in is quite different from what we're used to. Sarah and I are roomies. We share a small room, barely large enough for both of our beds. There's a small table, TV and LOTS of bugs and lizards. One of the first things I saw here was an enormous cockroach in Tiffany and Kelly's room. I've never been so excited to take a shower. Despite the fact that I had to kill 3 spiders and watch 2 lizards crawl into the ceiling to do so, I finally felt somewhat clean for the first time in 2 days. It was by far the largest bug I've ever seen. We're very fortunate though to have electricity, TV and running water (which we can't drink). The hotel is very pretty. The entire city is set in the mountains, so the view is gorgeous. The food is edible, but we mostly each gallopinto- rice and beans. I also had plantains for the first time, they're not bad.
We also set up the clinic today, which was a little frustrating. We had no electricity, which is a problem for our BIOs and slit lamp. We eventually got everything set up and organized, then did a quick run-through.
September 3, 2007
At 6:30 AM, Sarah and I heard a loud knock and “Buenos dias” from Muriel. Unfortunately, Sarah and I had already been up for nearly an hour. Our room is right by the highway, as well as the common room. We hear all of the loud trucks as they pass by in the wee hours of the morning. We got dressed, ate and were off to the clinic by 7am. We realized when we arrived at the clinic site that we were short a few doctors. Chantelle and Ann Rea had accidentally been left behind. What a way to start our first day!
I spent the next 4-5 hours checking pupils, angles, doing cover teston kids and finally internals. I think Melissa and I should get an award for most pathology seen in one day. I think I've seen more patients today than I have all quarter in PVC. One of my first patients presented with an eyeturn. I did a cover test- she was exotropic. She had decreased VAs in that eye, so I thought she might have amblyopia. As it turns out, when I looked inside her eye, she had two toxo scars-one covering her macula and a second just beneath it. My next patient also had a large macular scar. It was idiopathic, possibly due to toxo cariasis. I saw a few patients with glaucoma, Retinis Pigmentosa, and lots of cataracts. It was frustrating at the time, but in retrospect I learned a lot in only one day.
Our group spent the afternoon in the dispensary. It was fun to finally use some of the Spanish I had spent 6 years learning. Most patients are very grateful. Some of the older women would give us hugs and kiss our cheeks. It was a pretty cool feeling to realize how much of an impact we have on their lives. It was a long, exhausting day but we helped a lot of people.
Back at the hotel we ate dinner and had a small birthday party for Dr. Kingsbury. The cooks in the hotel had made 2 birthday cakes for Dr. Kingsbury. After dinner we sang Happy Birthday and cut into the cakes. They were so good! It was white cake with a marshmallow-like frosting. And they were so pretty-decorated with flowers and ribbon.
On another note, a hurricane is heading towards Nicaragua. It's going to hit the Atlantic coast soon. Fortunately for us, we’re on the Pacific side, but I'm sure we'll get a lot of rain.
September 4, 2007
Day 2 at the clinic. We pulled up to the site around 7:30am again. Today there were quite a few people already lined up for exams. We piled out of the trucks, set up clinic and got to work. My group started at VAs today, which I found I really like. I saw a lot of interesting things, just by doing prelims-lots of kids with nystagmus and amblyopia. I was able to talk to a lot of people. While I understand some Spanish, I had people tell me their life stories and I had to tell them I only understood about three words they had just said. Sadly, I would smile politely, mumble whatever I could in Spanish (and hope it made sense) then continue checking VAs. It made me happy to hear two of our interpreters say they were impressed with my Spanish. I made a lot of new friends, especially with the cute little old ladies.
Dr. Frick was right, people come to see us in their Sunday best. I saw an adorable little girl wearing a pretty yellow dress and pigtails. A lot of the older women came all dressed up in dresses and their finest jewelry. They were so cute!
At lunch, I learned a lot about another one of our interpreters, Rahelio. He's from Masaya also. He described how beautiful it is there and said we definitely need to visit sometime. He became involved in interpreting through Javier-another one of our interpreters. This is the first SVOSH group that he’s been involved with. He said he absolutely loves what he does, he gets to meet so many different people and it's for such a great cause. And he's very good, Muriel even complimented him after he explained something to one of my patients saying how compassionate he was towards other people. It made him blush.
After lunch I was in doing exams (internals) again. I didn’t see as much disease as I did yesterday. Today was a day for refractive error. I saw a pregnant woman with significantly decreased vision, 20/63 OD and 20/100 OS. She was very difficult to scope. We ended up finding a couple of diopters of plus and -3.25D and -5.00D of cyl. We ended up cutting the cyl and tried to subjectively find her Rx. We checked/demo-ed the sphere, had her change the axis in the trial frame until it was clearest and changed around her cyl. After nearly an hour of trying to create glasses for her, we got a final Rx. I took her outside to check her VAs with the SRx and her vision was worse! We even tried the spherical equivalent and she was still worse. It was so sad because we had to tell her there was nothing we could do for her.
Another patient I saw had -9.00DS and -6.00DC! She already had glasses and could see pretty well with them, so we gave her a solar shield and drops for her eye irritation.
A third patient I saw was an older woman. I didn't find much of a prescription and her eyes internally were completely healthy. She had quite a bit of vision loss, especially in her right eye, but I could find no reason to explain it. I called over Dr. Frick to help me. He couldn’t find any explanation for her loss either. We called an interpreter and found out that she had had a stroke 3 years ago. The stroke was in the back of her neck and she noticed that her vision hasn't been as good since. We did a few other tests, mainly confrontations to see if she had any hemianopic defects and checked her BP. Muriel explained to me that she sees a doctor for her BP, but she can’t really afford the medicine he prescribes for her. Apparently, the doctor has been prescribing medicine for pain instead of BP meds. Muriel said some of the doctors here are pretty incompetent-they prescribe meds that patients don't need, don't prescribe meds they do need and basically steal money from their patients. Most of the time the patients have no money to begin with. My lady had slightly high BP and a big sore and swollen leg. She walked with a limp because of her leg. Muriel had one of the interpreters explain to her that her doctor was stealing her money, that the medication she's taking does not treat her problem and she should invest in very tight high-highs to help with her leg. Muriel is unbelievable when it comes to patient care. She is so kind and compassionate and she tells great stories. She’s led quite an incredible life, growing up in Martha's vineyard and now living in Masaya with her Nicaraguan husband, Omar.
Today was another exhausting day, but we saw nearly 310 patients! I felt bad because some of them had to standing the rain to wait to be examined-Hurricane Felix hit Nicaragua and it hasn’t stopped raining here since.
A lot of other people saw interesting cases today. Jill had a patient with toxo, Gail had a patient with Stargardt's, there was a lot of nystagmus, a possible retinal coloboma and a posterior synechia. We all shared our stories after dinner and learned about reverse APDs. All of our doctors are so knowledgeable and I fell like I’m learning a lot from them.
September 6, 2007
It was the usual wake up at 6am, at clinic by 7am and we finished around 5 or 5:30pm. I didn't really have any interesting cases today, but it was getting frustrating in the dispensary. People didn't like the glasses or sunglasses we were giving them, even if they were the only ones with their prescription. Afterwards, I had a headache. The only interesting thing today was I talked to Ali, one of the interpretaors, for a while. He's the minister's/preacher's son. He's 22 and learned English when he went to college. Ali wears nice clothes and has his own car- a stark contrast to what most of the people in Sebaco have. Don't get me wrong, there are a few very nice houses here, and most of the people show up to our clinic in their Sunday best, but the town also has dirt roads, most people live in shacks with dirt floors. One family even owns a pig that lives in their house with them!
Today was probably one of the most eventful days in the clinic. Hundreds of people were lined up at the church gates when the first van-full of doctors arrived. I was among the doctors in this first group. We all piled out of the van and walked through the gate on foot (we usually drove in and were dropped off directly in front of the clinic building, but here were too many people there today to try to drive through). Most people politely stepped aside and let us pass through. Judging by the number of people at the gate already at 6:45am, I knew it was going to be a long day. Sarah and I don't get much sleep at night which makes matters worse. Sarah had forgotten to use bottled water to brush her teeth one night and has felt sick for the past couple of days. And with our room being right next to the common room, we can't sleep until everyone else goes to bed. Also, Omar, who sleeps on a cot in the common room, wakes up around 3am every morning. The women who work at the hotel are up around then too, cleaning up whatever mess was left over from the night before and preparing breakfast.
Shortly after our arrival to the clinic, the second van of doctors arrived. On this second trip, the van drove through the gate which caused (or allowed) people to flood into the clinic site. Previously, Omar had stood by the gate to control the crowd, allowing only a few people to trickle in at any given time. That notion went out the window as soon as the van drove in. We were completely overwhelmed. We tried keeping people back away from the building, telling them only people with exam forms would be seen. But it was a waste of breath. As Ivy and I tried to take VAs outside, families would crowd around us, talking incessantly in Spanish and asking questions we either didn'’t know the answer to or couldn't understand. At that point, we gave up. We took down the acuity charts and attempted to go inside the church. Even that proved to be problematic. One gentleman was standing guard at the church entrance. People were fighting him to get in, especially a young woman who everyone claimed was very sick and has seizures. She would periodically lay on the ground and just shake. It was so sad. But we couldn't help her much either, we're eye doctors not general physicians. This blocked our entrance into the church as well. Eventually, we maneuvered through the crowd and got back inside. We then started doing all of the prelims indoors. Eventually, we were forced to stop seeing patients altogether until the police arrived to help control the crowd. It was crazy!! And sad too because all of these people were only hurting themselves. We saw very few patients today, only about 293, compared to the nearly 350 we had seen on each of the 3 days prior. We survived the day but we were all very weary.
When we arrived back to the hotel for dinner, we had an incredible surprise awaiting us. A DJ was set up on the front porch and a bunch of people were also on the porch waiting to welcome us. As we ate dinner, we watched through the windows of the common room as a little girl got all dolled-up in authentic (traditional) Nicaraguan attire. We watched as 3 other girls joined her. Next, after dinner, we received a speech from the Vice Mayor of Sebaco-who reminded us all of a character from The Simpsons. He said how grateful and pleased he was, in fact the whole town was, to have us visit. They were having a party tonight at the hotel in our honor. Next, we watched 3 different dance performances. The first of which was a traditional dance, performed by a guy and girl in their mid teens. The next show was probably the cutest thing I've ever seen. A little boy and girl performed two dances for us. They represent Nicaragua at different international festivals-like on in Venezuela. They were probably about 6 years old and absolutely adorable. The last performance was an Atlantic-coast dance. The two boys and two girls were probably in their early teens and boy could they move! Then, all the dancers came out to the floor and started pulling us from our seats to dance with them. It was a contest and in the end the best dancer would get a prize. I didn't dance, but instead took pictures. It was pretty humorous to see how everyone (the Americans) danced. In the end, Liana, Tiffany, Andrew and Dr. Frick won the contest. But we all received gifts. I got a mortar and pestle for crushing herbs. Some people received picture frames, liquor and pencil holders. It was all very nice.
I almost forgot, we also had a pinata! After the dances and gifts, we all ate rum cake and went outside to take a swing at the pinata. They do piñatas a little differently in Nicaragua. In the words of Liz, “Americans are way too easy on their kids.” Here the pinata is hung on a long rope which allows it to be dropped to the ground, raised to the ceiling, etc. Nearly everyone took a swing, it was hysterical to watch. Anne peaked around her blindfold, someone hit Ivy with the stick and Gail's head was too big for the blindfold. Chantelle was the one who finally broke open the gray cat. Candy poured out and everyone scurried to get some. Most of it was hard candy. Then we danced for the rest of the night. Everyone on the trip, including Larry, Javier, William, our van driver were all out on the dance floor at some point. I danced the entire night. We heard American music, Shakira and other Hispanic songs. It was so much fun! There were two young boys (one probably 7 or 8 and the second a couple years older-I think they came with the DJ) who danced with us the whole night-and we were up late! They were better dancers than us too!
September 7, 2007
I saw an older patient with end-stage glaucoma. She was completely cupped-out. Unfortunately I had to tell her that there was nothing that we could do for her to improve her vision. Even glasses won't help. We gave her about a year’s supply of Timolol, but that was about all that we could do. It was heartbreaking. Another interesting case I had involved a young girl, 17 years old. I scoped her at plano in one eye and +7.50 -2.00 x 90 in the other. I thought I had just done a poor scope. But, when I re-checked my retinoscope findings, I came up with the same results. Still really unsure of myself, I called over one of the doctors. Dr. Casper came to the rescue. He scoped the EXACT same thing I did. He told me this was the third time that I had questioned my findings and had been dead-on. He said I really need to trust myself and trust what I scope. The girl had amblyopia due to a difference in refractive error. I questioned her about patching, to see if she would be willing to do vision therapy, and she said she would. So, we are special making her glasses and shipping them to her from the US. We gave her the highest plus specs that we had (a +3.50) which were incredibly ugly so that she could start patching right away.
I was in the dispensary for the last half of the day. Let me tell you, dispensary is the WORST to have as the last rotation on the last day of clinic. We were out of nearly all of the sunglasses we had brought, and it was very difficult to find the correct prescriptions for people. We had to resort to giving people two pairs of glasses, one for distance and one for reading. We were also giving away drugs by the bagful. I later got called to help with dropping people and checking pupils. We saw quite a few patients that afternoon, even though we were ending clinic early in order to clean up. We even had a family come in that we suspected had lice. They had to be quarantined in the clinic and Andrew examined each one of them individually with gloves on. Fortunately, they were all clear of lice, but their hygiene was very poor. The kids were very dirty and the oldest daughter had large wounds on her legs that looked similar to the lesions Ivy had. We gave them all of the leftover hand sanitizer that we had, baby wipes and clothes that Liz had brought. Hopefully we did some good, although the family was not as appreciative as I would have expected to them to be. I only hope that we did not offend them in our attempts to educate them. We also had a dog problem throughout the day. A few of the stray dogs in the area kept entering the clinic building and walking around. Muriel and Ivy had to continuously shoo them back out the door. But they kept coming back!
It was sad to clean up everything and repack when clinic was over. I was sad to leave everyone. Larry was giving people rides on the bicycle carriage and we spent at least half an hour taking pictures. We gave away everything that we had left, all of the ugly sunglasses, artificial tears, everything except the prescription glasses. People would be standing at the windows, hands reaching out to us, hissing and yelling “Muchacha, muchacha, muchacha.” We had nothing left to give them.
We did have quite an eventful last night. After dinner, Jill, Gail, Liz and I walked into town (it was pitch black by 6pm here, mind you) with our interpreters, Larry, William and Javier to go to the bakery. Tiffany kindly offered me her pocketknife to carry with me along the way. This bakery was located right across the street from where our interpreters had been staying all week (there wasn't enough room for them at the Sebac-Hotel). The bakery was notorious. Gail wore Sarah's miner's flashlight on her head as we walked. That was the only light that we could see the entire way to town, besides that of the semi-trucks that were passing within what seemed like inches of us along the main highway. Once we arrived at the bakery, we were in all. There were so many delicious-looking goodies. We nearly bought out the store and only spent $6 to do so. We got just about one of everything. Lots of cookies and a special bread called pico. Pico is a croissant-like bread, filled with cheese in the middle and sugar on top. It was amazing! The flan was also delicious. They even had ham muffins. Jill got the ham muffin, which I think sounds incredibly disgusting. It was pretty funny to joke about though. We even saw the two little boys that we had been dancing with the night before. The risqué little dancer we had met at the party was now a shy little boy, hiding his head in his friend's arm. I couldn’'t believe how shy he had become! We also met up with the doctors, Andrew and Omar at the bakery. The doctors had gone to the internet cafe to look up what Ivy had. She had gotten bit by something earlier in the week and her entire leg swelled up. It became very painful for her to even walk and she spent a lot of time throughout the day icing her leg. She later was bit in the arm too and her arm started to swell. The doctors discovered the she had skeeter syndrome. She was having an allergic reaction to being bit by mosquitoes. Ivy had been bit before in the states, but had never encountered a reaction like this. I guess there's something special about Nicaraguan mosquitoes. She was given antihistamines and steroids when we got back and that seemed to help. The doctors drove back to the hotel and we walked again with our new friends (the interpreters). It was crazy to hear all of the bullfrogs and bugs as we passed by the bogs. They sound so different here. They make a really cool sound though, like a drop of water falling into a lake.
When we arrived back at the hotel, I learned that some of the other girls had gone with Ali for ice cream and a tour of the city. I really would have loved to have gone with them. They said they had a lot of fun when they got back. We shared all of our baked goods with everyone and then played card games. Tonight we played a new game. Well, it was an old game for me but a new game to everyone else. Dr. Casper called it neighbor, but it was really “Screw your neighbor.” They play a little differently then my family does, but we all still had fun. Even the interpreters stayed to play. Sarah and I showered (finally) and then had planned on staying up with everyone, especially because it was our last night. But, the power went out for the second time that week. Sarah, Jenny, Dal and I all piled into Liana and Dieu's room to hang out and talk. As we were talking about what an incredible trip we had had, we noticed something on the wall. It was a cockroach! Dieu, being the brave sole she is, took off her shoe and went to kill it. Then it started to fly!!! I couldn't believe it. I didn'’t know that cockroaches can fly! We were all screaming and somehow we all ended up on one bed. After ten minutes of attempting to kill this cockroach by flashlight, Dieu was finally successful (although we found out that the body of the dead cockroach was nowhere to be found the next day). It was getting late, no one else was up, and we had to be up by 5:30am the next day, so we all decided to go to bed. Our last night in Sebaco.
