Saturday, September 11, 2010

Day 27: Last Day at Los Pipitos! :(

School Children on Parade
Today was the last day at Los Pipitos. We were very sad to be leaving the children! We went to the market in the morning and bought watermelon and oranges - the kids never seem to have fruit or vegetables! On the way, we saw a huge parade of younger school children, obviously celebrating Independence Day.
Parade of School Children

Rather than only candy in the pinata, we had toys and other treats to mix with a little candy and Elvis bought a large pinata. It was only about $5.00!
Lily and the Watermelons

We wanted to finish decorating the clinic before we left, and we picked up spray paint with a plan to have the kids spray paint stencils that Rodolfo had them make yesterday. As it turned out, the job was much messier than we thought it would be and, after having one of the older children give it a try, we decided that Elvis should do the rest. 
Elvis and the Pinata

Whacking the Pinata!
The pinata party was well received! All the kids took turns with the bat and it was exciting to see how happy they were scrambling for the toys and candy tumbling to the floor! 
Another Turn at the Pinata

There was dancing and music, and even the children in wheelchairs were able to participate. When it was time for us to leave, one of the children was tearful, which was surprising because he was one of the bigger, heftier kids who you wouldn't think would be emotional. There were hugs all around and we promised to TRY to come back.

Stenciled Sea Creatures on the Clinic Wall
Wearing Gas Masks due to Sulfur Vapors
We had a tour booked to see the bat caves, which Christine missed on Monday, as did my husband, Jay. So, we met the driver at 4:00 and went back to Masaya. We were quite lucky - it DIDN'T RAIN!! We were able to see the glow of lava in the volcano crater, which we missed on Monday due to the bad weather. Unfortunately, we couldn't get it on film, so it will just be a memory in our minds. There were SO MANY BATS!! I think I'm over my fear of them!

Bats - Perfect for Halloween!

We met for drinks at happy hour and Jay and I went to the Monna Lisa Restaurant for dinner. The others went dancing.

Tomorrow will be our last day in Nicaragua. We will be packing and getting ready for our 4:00 A.M. ride to the airport Sunday morning. I hope to be in a better frame of mind at some point next week, when I can pull my thoughts together and share some reflections of our trip. The experience was one we will never forget!

A Sad Farewell to Los Pipitos Kids!

Day 26: Touring!

Today was a day off for all of us! Jay and I went on a tour to Masaya, where we visited the market for cheap souvenirs and saw the volcano. Our driver, Carlos, took us to Catarina, where we had lunch and saw the beautiful view across the Laguna de Apoyo. This is a crater lake that was created by another volcano.
Laguna de Apoyo from Catarina

While we ate, roving musicians came through the restaurant, playing a variety of interesting instruments.

From there, we actually visited the Laguna, stopping at Nancy's San Simian Resort for a cold drink.

Having a Cool Drink by the Laguna
On the way back to the hotel, we stopped at La Colonia, where we picked up some snack foods. We decided to go to El Tercer Ojo for churrasco, and we chanced upon a parade of high school girls, who were practicing for a celebration of Independence Day next week. 
High School Girls Practice for Independe

The churrasco wasn't quite like the Brazilian churrasco, carved off the sword, but it was tasty and the meat was very tender. Tomorrow will be our last day at Los Pipitos:(
Jay and Susan at El Tercer Ojo

Wednesday, September 8, 2010

Day 25: Visit to Los Pipitos Clinic Managua

Well, today we finally visited the big clinic in Managua run by Los Pipitos! What an amazing place! To begin with, the clinic is open to Los Pipitos associates. In other words, only people who are parents or friends of individuals with disabilities who have signed on to Los Pipitos as members are able to access care at the clinic. One day a week, the clinic is free for any chapter of Los Pipitos. So, on Tuesdays, if you are a member of a chapter of Los Pipitos, you can have free care. The only problem is when there is a follow-up appointment necessary, you may not be able to get a free appointment for a few weeks because the free days are booked in advance. If someone with no money needs a follow-up appointment, the parent may just give up rather than come back and have to pay for the visit. This is a problem for the children in Granada.

The clinic has an intake office where a physician does an assessment and determines if the child needs a specialist. Then, if necessary, a specialist (audiologist, physical therapist, ophthalmologist, etc.) will see the child. There are a number of people who work specifically with children with hearing deficits from the time it is noticed. Unlike in the U.S., here in Nicaragua, children do not automatically get screened for hearing loss at birth. It's up to the parents to discover when there is a problem and have the child seen. We observed a 2-month-old baby having a hearing test using probes to assess the response of the tympanic membrane to sound while the child slept.

The professionals made a point of the focus on teaching parents to work with the children at home rather than expect the child to improve with only periodic appointments with specialists. They do extensive therapy with the children, including music therapy and play therapy. We met with a young man who is responsible for the hearing aid molds who was obviously extremely hard of hearing himself. Children are fitted with hearing aids when they can benefit from them.
Hearing Aid Molds

"Light Room"
Vision Deficit Diagnostic Equipment
Children who are suspected of having visual problems are also diagnosed and provided with specialist care. There was a "light room" where children with vision problems are screened for specific problems.

Physical Therapy Room
There was a physical therapy room where therapists work with parents either individually or in groups to teach them how to provide therapy for the children at home.

In addition, there was a beautiful pool area for the children, as well as a room with a variety of play equipment for the children, including paper mache chairs made by the parents.

Paper Mache Chair
Pool Area
Funding for the clinic was raised through a telethon in 2004. All in all, the whole facility was spectacular and it gave us an idea of what might be possible for Los Pipitos Granada if we could only find the funding to support it. I suppose miracles do happen!

We returned to Granada and spent the rest of the day applying laminate to health-related posters to prepare them for hanging in the clinic. We had hoped to do ear lavages; however, although we had sterile water and the rest of the equipment to do this, we didn't have sterile basins or other sterile equipment to maintain the sterility of the solution, so we decided not to do them. Hopefully, we can refer the children who have impacted wax to physicians who can do this procedure.
Child at Los Pipitos

Tonight, my husband and I accidentally discovered a celebration of some kind in the church in the central plaza. There were fireworks and a procession out of the church with the Virgin Mary and the entire congregation following behind. At the very front was an ambulance leading the procession! We learned later it was the Prosecion de la Virgen Maria.
Prosecion de la Virgen Maria

We wanted to eat at the "Monna Lisa" restaurant; however, when we got there it was closed, so we had pizza at another pizza restaurant and braved the rain and lightning to return to the hotel. Tomorrow we will spend the day touring the area with a driver.

Day 24: Market Day!

My New Room
This morning, Jeffrey helped me move to Hotel Casa San Francisco. I was terribly sad to leave Hotel Con Corazon, especially because the staff has been so very helpful from day one until right now! As it turns out, the room is really quite nice - in many ways, nicer than Hotel Con Corazon.

We've been thinking about how we can make the clinic more child friendly. One of the ideas we had is having them do hand prints on the walls. Paloma suggested stencils that the children can spray paint. Christine went to Los Pipitos to discuss this with Rodolfo to see if he can organize that with the children today and then we can have them actually do it tomorrow. Lily and I went to the frame store to find out what happened to the 2 frames we ordered (and paid for!) that should have been delivered last Friday to Los Pipitos. It turned out that the frames were on the way to Los Pipitos when we arrived at the store! 
Clothes in the Market

In the Market
We met up at Gonper's (the stationery store) and decided to go to the market. We want to buy these really cool aprons as gifts, and that's the only place with them. AND, we found bras for $1.50 each!

Shoes in the Market
I waited all day for my husband to arrive tonight! Christine, Lily and I spent the last hour watching You Tube videos and laughing to make the time go faster.

His flight was delayed because of Tropical Storm Hermine. He was stuck in Houston and ended up an hour and 18 minutes late. I had Bill's driver, Gustavo, take me to Managua to pick him up and take us back to Granada. We didn't get back until about 10:30 p.m. Tomorrow is another day!

Monday, September 6, 2010

Day 23: Last Day at Hotel Con Corazon!

Maritza: A.M. Recepcionista Superb

Today is my last day here at Hotel Con Corazon! I will be moving to Casa San Francisco tomorrow morning for the last few days in Granada. :(  The hotel will close for several days of maintenance, so since I'm the only guest for some of those days, I have to move to another hotel. I took photos of all of the staff, and will be posting them over the next couple of days.
Nohemy: P.M. Recepcionista Superb!

I met with Paloma this morning and we discussed the accomplishments Christine, Lily and I were able to achieve during our time here. She was quite pleased with what we've done! I shared the proposal I drafted for a nurse to operate the clinic 3 days a week to make it sustainable. She thought it was well written and we talked about how we might present it to a number of people and groups to see if we can get the nurse funded. This is so needed here!

Food in the Market
Colorful Market Items
In the afternoon, Lily, John and I decided to go on a tour to the bat caves at Masaya. We stopped at two markets: one is for locals and is less expensive and the other is for tourists. We were able to pick up some souvenirs for friends and family, and took some great pictures!
In the Market: Man Carries his Wares
Sweat Shop?

The bat caves were a real hit! There was a pretty hairy climb down into the caves, and we wore hard hats to protect our heads. We had flashlights to light the way and the guide and driver were really helpful when the going was tough. There were hundreds of bats!

It was pouring rain by the time we got to the volcanoes and the caves, so we were soaked!

I have many more great photos and lots more to say, but I'm being eaten alive by mosquitoes, so I'm going to call it quits for tonight!

Friday, September 3, 2010

Day 19: Only 10 days to go!

So, where has the time gone??? Here we are with only 10 days before we head home, and it seems like the time just flew by! Today, we were in the clinic and I couldn't believe how organized everything was! We no longer have to deal with disorganized files, cleaning of walls, floors, and furniture, or lack of supplies and equipment! We get there and get right down to business - seeing the children!
Lily Examines a Child

I finished the proposal for Paloma today and we will be meeting Monday morning to discuss it. I am hoping it is acceptable to her. My next step is incorporating that into the proposal for the College of Nursing and Los Pipitos to establish a long-term partnership. Christine, Lily and I have brainstormed and come up with some wonderful ideas for where this experience can take us! One idea we have is development of a course in the Nursing Program at SU addressing nursing care of individuals with disabilities. There are a huge number of issues, including mobility, communication, cognition, and psychosocial that can be foci of nursing care. The course can include other aspects of disabilities, including legal issues and educational issues, and the clinical component can be here in the Granada Los Pipitos school. From our discussion with the Dean of UPOLI's School of Nursing, this would also give SU a unique course that she would be interested in with respect to a student exchange program. 
Little Girl Seen in the Clinic

The doctor from the Centro de Salud was supposed to come to the clinic today, but she did not come. This is one of the problems with the arrangement; whenever there is a busy clinic where she works, she will not come to the Los Pipitos clinic. There is no warning - she just doesn't show up.  

We have found most of the children very passive when we examine them. Very few are curious about what we are doing and even fewer are obviously afraid, resisting even the placement of an axillary thermometer. We have learned that several of the children have probably never been seen by a doctor in their lives. 
Christine with Child

Today it rained during the day instead of at night. We had a few days when the rain only came at night, and it was very hot during the day but at least it was dry. When it rains during the day, it's a bit cooler, but the rains are very heavy and one can almost not avoid getting wet. We decided to leave early at 3:00 p.m. so Christine and I could meet before dinner to discuss her scholarly project.

We met at the bar at Casa San Francisco for happy hour, where I had the opportunity to meet the hotel manager, Melissa, from Hartford, Connecticut. She invited us to a pot-luck at her house tomorrow evening, but Christine and Lily will be taking the 11:00 a.m. bus to Managua to go out of town for the weekend. I may go to the dinner, depending on how I feel. I'm still dealing with the remnants of a cold.
Susan with 16-year-old Los Pipitos Boy

I made a reservation to eat dinner at my hotel tonight and Christine and Lily went off on their own. Dinner was wonderful - bruchetta, fish in banana leaves, and vanilla flan! It was a bit strange because this was the 2nd time I ate dinner at Hotel con Corazon where I was the only patron!

Los Pipitos Kids
With only 10 days left, I am very ambivalent about leaving. I feel like we've been able to make a very little difference in the lives of the children at Los Pipitos, although I believe strongly that we have the potential to make a huge impact given more time. We've developed a nice rapport with the staff and the children, and we've made contacts within the health care sector that will be beneficial for our future engagement here. At the same time, I'm anxious to get back to Seattle to prepare for classes, and, frankly, I'm looking forward to being able to make my hair look decent again! It doesn't do well in the heat and humidity here in Nicaragua!

Tomorrow, Christine and Lily will go to the clinic in the morning to complete the screening of the children before they head out of town. I will start working on some preparation for fall classes, which is weighing heavily on me. Unless something exciting happens, I will not update the blog until Monday.

Wednesday, September 1, 2010

Day 18: Another Day in Paradise

We stopped at the frame store today before heading to the school, and we had a bit of a disagreement about what our priorities should be for Los Pipitos. Paloma had suggested this place and she said she wanted to frame the posters rather than hang them using tape. As it turned out, the cost was fairly high - U.S.$13.00 each! We have 8 posters, so that adds up to U.S.$104 for all of them. I very much wanted to do this and leave a clinic that is bright, cheerful, and decorated with medically oriented, child-friendly posters that would last a long time. Christine felt strongly that we should not be spending the money on posters, but on something more relevant to the needs in the school. Ultimately, I chose to donate the cost of framing 2 posters, and I will see if I can get my husband to bring laminating material when he comes next week to protect the rest of the posters. 

Lily Examines a Child
We didn't get to the school until after 11:00, and the children were dancing to very loud music and then went to lunch. I spent the morning working on the proposal for Paloma, covering the needs that we identified for a regular nurse to be in the clinic and check the children's health. I found a number of very good Internet resources that provided some sobering facts for the background section of the proposal. I should have it finished some time tomorrow.
Paloma and Chilo

In the meantime, Christine and Lily checked out several children. There are quite a number who have impacted wax in their ears, and we are considering doing some flushing of the ears. We will have to get some sterile water and hydrogen peroxide. I checked out one little boy and, when I asked his age, he said he was six years old. His height and weight were probably appropriate for an 8-year-old. We found out from Elvis that the boy is SIXTEEN years old! This could be due to malnutrition. It was quite shocking.

My Neighbor
I didn't take many photos today, but will fill in by uploading some of the ones from the past few weeks that I haven't included. They are from my neighborhood here in Granada and from the Los Pipitos school. Enjoy! 

Man in the Street
Dinner at El Tercer Ojo
Tonight we ate dinner at El Tercer Ojo (The Third Eye). The food was great, but the bill was high (at least for here!)! We made up for the fact that we had no lunch today and had big meals and dessert. Tomorrow we will buy some mercury thermometers for the clinic and try to get there early, since Dr. Guitierra will be there with her nurse.