Monday, August 30, 2010

Day 16: Blood and Blisters

Today, the children at Los Pipitos left at 1:00 p.m., so we had a very abbreviated day at work. We saw 2 patients, one of whom looked to me like she was severely malnourished. At 30 years old, she weighed 79 pounds, and her chest was concave. She complained of a headache and a stomache ache, but we didn't see anything of importance. She said she ate well, and apparently had some sort of seizure disorder for which she takes medication. Ultimately, we decided she was having a migraine. Another patient was suffering from the same ailment that I was experiencing, with a fever and sore throat, for which we gave Tylenol.

We wanted pizza today, so we went to the Monna Lisa (note the spelling) restaurant for lunch, where we indulged ourselves and had salad, bruchetta, and pizza.  It was wonderful! It's a restaurant owned by an Italian and the chef is Italian, so how could we go wrong??? 
Monna Lisa Restaurant

It was SO hot today, we used umbrellas to shield ourselves from the sun. Christine bought an umbrella from the stationery store, but there were no more adult umbrellas, so she bought a "Beauty" umbrella in lime green! 

Christine the Beauty!

Since we had a whole afternoon to ourselves, we decided to go to a salon to treat ourselves to pedicures and waxing. Christine and I settled in for a pedicure while Lily went for the waxing. Being Lily, she was adventurous and wanted waxing in a number of places - 3 hours worth! Christine and I left with minor damage - I had a couple of bleeding toes! Lily came home with blisters from the TOO HOT wax! I guess we don't want to visit the salons again in Nicaragua!
Susan and Christine Getting Pedicures


After our heavy lunch, we decided we didn't need a big dinner, so we met for drinks at Happy Hour at the Hotel Casa San Francisco, where we played a game of Christine's making, sort of a combination of charades and pictionary. Then Christine started working on her creative letter to her husband. We had a great time, and Christine showed off her salsa dancing with Franklin, the bar tender.

Creative Christine
Christine and Franklin Salsa
We left the bar at 8:00 p.m., in time for me to catch up on the blog and
be ready to talk to my husband at 8:30. Tomorrow we'll be meeting Paloma to talk about our proposal for Los Pipitos. 

 



 
 

Sunday, August 29, 2010

Days 13-15: R & R

Just thought I should say something so nobody thinks we disappeared off the face of the earth! We took Friday off because the staff at Los Pipitos school have planning meetings on one Friday every month and the children don't attend. Timing was perfect for me! I felt a sore throat coming on, and when Christine and Lily decided to take a ferry to Ometepe Island, where they would stay for 2 nights, I decided to sit it out.

It's a good thing I did! I've been pretty sick for the past couple of days and stayed pretty much in bed, just leaving my room to go to the farmacia for cough medicine and antibiotics and to find something to eat. Today, I feel a bit better, and I think I'll be fine tomorrow. I haven't heard anything from Christine and Lily, but I'm sure they're doing well, probably having too much fun to think of checking in. I'll be back blogging tomorrow!

Friday, August 27, 2010

Day 12: The American Ambassador Visits Los Pipitos!

Wheelchair Recipient
There was a lot of hustle and bustle at the Los Pipitos school today! Not only did the doctor arrive with a nurse from the Centro de Salud, but the American Ambassador was scheduled to visit to formally present 5 donated wheelchairs to Los Pipitos children in need! Staff worked hard to make sure the school was 100% presentable, and there were a number of children who came but are not regular attendees at the school. It will be wonderful for the families because they will be able to use the wheelchairs in their homes, helping them in cases where they are no longer able to carry the children because of their size. 

Dr. Examines Child's Ear
Staff and parents are beginning to bring children into the clinic to address concerns. We were able to screen a few children and today we were able to have the Health Ministry physician confirm what we saw and prescribe medications to take care of the ear infections. There were other health problems that presented as well. One little wheelchair user had a skin irritation that appeared to be from a diaper pin rubbing in the same spot continuously. A cortisone skin preparation was provided to her. Many of the conditions are not very complex, but can grow to be problems if left unattended.
Security for the Ambassador

Greeting the Ambassador
Mr. & Mrs. Callahan, Bill, Paloma & Elvis

The arrival of the American Embassy's security staff was a clue that the Ambassador would be arriving soon. When he did arrive, he was accompanied by his wife and several others from the Embassy staff. He was very interested in the school and what is being done with so little for the children. He spoke to the children about the anniversary of the Americans with Disabilities Act in the U.S. and the Education for All Handicapped Children Act and expressed delight that he was able to visit the children of Los Pipitos on this significant anniversary celebration. 

Mr. Callahan also acknowledged the work the parents have done to help their children succeed. He stressed the importance of equal rights for everyone, including individuals with disabilities, and said he felt it was very important to see the children playing, working, and learning. The children and the parents were very responsive to the Ambassador's presentation! 
The Ambassador's Wife

Both Mr. and Mrs. Callahan had an opportunity to tour the school and see everything that was happening there. Mrs. Callahan looked at the sewing machines, where parents are taught to sew. 

We were able to describe what we are doing in the clinic and how we are working to find ways to keep it operational when we leave. Overall, the visit was very successful! Mr. and Mrs. Callahan are aware of the many challenges faced by the dedicated people running Los Pipitos in Granada, and the hard work that is done every day to help the children live a quality life.

Wheelchair Recipients and Moms
We had a long day! The heat was oppressive and the humidity made it feel like a true steam bath! Bill picked us up at 6:15 p.m. to go to dinner at Astrid's home with Penny and him. Astrid is apparently a friend of someone who knows Christine and Lily. It's a small world! 

Bill Demonstrates the Process!
Bill brought a bottle of champagne to celebrate the many wonderful achievements that he has had and the work we have done in Los Pipitos. When he asked if I would open the bottle, I had no idea that it would be in the manner he had in mind! Using a machete or sword, he showed me how to slice along the top of the bottle until the blade hit the weakest part of the bottle where the cork is. With a sure, quick, fluid motion, you sweep the blade up the bottle and the top flies off! It was very impressive!


Top: Penny, Bill, Christine - Bottom: Lily, Sophia, Astrid & Susan

Dinner was lovely. Sophia, Astrid's 10-year-old daughter was delightful and kept us entertained. When the nightly lightning storm started, we had the opportunity to watch from the upper deck of the house, where we had a great time taking silhouette photos in the light of the flashes of lightning and making shadow puppets on the wall.


Some R & R for Lily
Tomorrow, Lily and Christine are planning a trip away for a couple of nights. I don't know if I will go since I started feeling a sore throat and cold coming on today. We'll see! 

Thursday, August 26, 2010

Day 11: In Managua

We met this morning at 8:45 a.m., ready to start a very full day in Managua! It was already hot and the day promised to get even hotter. Thankfully, Bill's car is air conditioned! Our first stop was the Metropolitan Hospital, a private hospital, where we met with the Director of Nursing, Aura Maria. Bill left us to go to a dental appointment and we went on a tour of the facility. 

The hospital is very modern and quite large. We learned that there were only 45 beds, compared with about 200 beds in other hospitals in Managua. The impression when we entered was of a typical American hospital. It is air conditioned and very clean. Aura Maria was very proud of the Joint Commission certification on the wall (see left).  
Pediatrics Nurses Station

All of the units were similar to what we would expect in the U.S. We did see that there are more reusable supplies and equipment, rather than disposable ones that we use at home. 



Emergency Room







Newborn Nursery
We were able to see the newborn nursery, where there was only one baby who was born on Monday evening. It could have been a nursery in any American hospital. 


Spiking IV Bag in Med Room
Practice seemed to be the same as well. Nurses do not recap needles except during medication preparation, when the needles are clean.  They have sharps containers in a number of places, making them readily accessible whenever they need them. We saw isolation rooms, where there are signs on the doors and isolation gowns and masks are hung outside the doors for donning before entering the rooms. Before one leaves the room, the equipment is disposed of in a special container for that purpose.
Supply Room

The level of care is very high here. According to Aura Maria, the law requires them to treat anyone, regardless of ability to pay. Compared with the hospital we saw in Granada, there are very few patients here. We did have an opportunity to see the clinic, where there are a variety of specialists available to see patients. There were a number of people waiting to be seen in the waiting area there.

All in all, this hospital is an example of what is available here if one has sufficient financial resources. 
Christine, Susan, Aura Maria and Lily

As we drove through the city, people would come to the car to ask for money or sell something. Several times, Bill waved the young men away who came to wash the car windows for money, but they refused to leave and then wanted money from him. One young man was in a wheelchair and was pushed by another who might have been a sibling. He asked me to take his picture. He had no arms or legs. There are a huge number of people here with disabilities.
Young Man on the Road

On our way to our next appointment, we stopped at Costco/Pricesmart, where we were looking for soap for the bathrooms at Los Pipitos. One of the things we have worked very hard to do is teach the staff and children the importance of washing hands. We also had a bite to eat (the famous Costco hot dogs are actually imported here from the U.S.!).


Bill and Christine in Costco
In the afternoon, we went to the America Nicaragua Foundation (ANF) to see if there were medications or other items that could be used in the clinic. The people there were wonderful! We didn't find anything we could use, but we discussed how they obtain the donations and what kinds of items they were able to get. There is an office in the U.S. that collects items from anyone who wants to give. They never know what will come, except that they do get a list of medications that they will receive in the next shipment. They receive shipments once a month. 


ANF Staff Member
We also talked amongst ourselves about an ethical dilemma that we are dealing with. If people are sick and need medications, but cannot afford them, how can we not give them what they need?? At the same time, as nurses, we cannot prescribe medications, nor can we actually dispense them. If we know we can obtain them at no cost, how can we justify not giving them to those in need? There are a number of other ethical issues, including the issue of how we can give some children (who attend Los Pipitos school) but not their siblings or parents if they have a need? We have a supply of acetaminophen and some other first aid type medications in the clinic. If a parent needs Tylenol, can we say no? Another issue relates to the need to have parents pay something for services rather than continue to encourage a culture that expects others to provide for them. This is something Paloma has spoken about at length. She would like the parents to contribute something to the cost of medications if we were to provide them. The children would obviously have to be seen by a physician who would prescribe them. We do have the agreement with the pharmacist, who can use her monthly donation to cover the cost of the medications, but parents would be expected to pay something like 25% of the cost.


Here we are with Dean Margarita!
In the afternoon, we visited UPOLI (Universidad Politecnica de Nicaragua). We met with the Dean of the School of Nursing, who was very gracious and talked about the relationship the school has with other colleges of nursing in the U.S., including Duke University and George Mason University. We discussed Los Pipitos and our desire to have some students operate the clinic on some regular basis (monthly, quarterly, etc.) so the work we do here can be continued when we're gone. We also asked about a relationship between the Seattle University College of Nursing and UPOLI. Margarita was very interested in the project! She gave us a lot of information about how the "exchange" works with other schools, and then she indicated that, if we can develop a program that focuses on disabilities and create a proposal, we might be able to come to an agreement at some point to work together and serve Los Pipitos. 

Lily and Christine did their own thing for dinner and I went to El Garaje, the nice little restaurant owned by a Canadian couple. I felt much better about eating a salad there because the owner assured me that the vegetables are all soaked in bleach and water. I've been missing salads! 

Tomorrow, the doctors from the Health Ministry are supposed to come back and the American ambassador will be visiting Los Pipitos.

Wednesday, August 25, 2010

Day 10: Visit to Japanese Hospital

Today was a busy day! We started with the little boy we had worked with yesterday, who didn't want to sit in the chair we thought would be better for him. He arches his back and his head needs support, but he wouldn't sit in the only chair that has head support. Ultimately, we had to let him lie on his stomach on a mat in the grass. We don't know if his condition has worsened since his stay in the hospital, but he appears to be in pain and he won't allow his back to relax. 

Bill brought Narcy, the pharmacist, at noon. After seeing the children and understanding the need, she agreed to donate the equivalent of $100 monthly to help pay for medications! Christine and Lily had written a letter on behalf of Los Pipitos explaining the history of Los Pipitos in Granada and what medications are needed that the parents are unable to pay for.

Later, the doctors arrived from the Health Ministry! We talked with them about the needs of the children we have seen and they seemed to truly understand what we were trying to do. Christine and Lily did a great job of explaining the conditions we had seen and the benefit of having physicians see the children on a regular basis. They will be back on Thursday to continue the discussion.


Policy on Breastfeeding
ICU
Emergency Room
After lunch, we went to see the hospital in Granada that is called the Japanese Hospital. It seems that Japan provided the funding to build it. Todd, the nurse we met from Oakland, joined us for the tour. It's hard to describe what we saw! The Director of Nursing took us around and explained the various departments. Overall, it is similar to hospitals in the U.S. from that perspective. The nurses are very professional and still wear all white uniforms, white shoes, and white stockings, and they continue to wear caps. The hospital rooms open to an open atrium like all of the buildings in Granada in the style of Spanish architecture. There is air conditioning only in some of the units (i.e., labor and delivery). We were impressed by the focus on educating the new mothers. 
Pediatric Beds


As we toured the various units, it was apparent that the people are able to make do with far less than we can imagine. We didn't see a lot of disposable items. For the most part, families are with their loved ones in the hospital rooms and are expected to provide their meals.


There are no nurses' aides here, nor are there LPNs. All care is provided by registered nurses, who are paid about the equivalent of $275 per month to start. This is considered a good salary.  Remember that the cost of living is much less here than in the U.S.

The mother of this little guy gave us permission to photograph him. He was born this morning! According to the Director of Nursing, the mother had a previous baby who did not survive. 

We learned that women are not given anything for pain during childbirth - the process is totally natural. 

Christine with New Mom & Baby

The little girl to the right was born today also, and the baby's father and grandmother were there to celebrate the birth. The mom gave us permission to take the photograph.

We're with the Director of Nursing

We went back to our rooms and cleaned up before meeting for drinks and dinner at 6:00. Todd and his family met us for happy hour at the Hotel Casa San Francisco. His family is great! They have been here for 11 days on vacation and will be going home tomorrow to Oakland. We left them outside the bar as they were going to The Third Eye (an upscale restaurant) and we were going to a less expensive restaurant on the walking street. It was a bit disturbing when the young children came to our table asking for the scraps of food on our plates. While begging or panhandling is common in many countries (including the U.S.), we had a difficult time thinking of the children who were truly hungry. We did share the food.

Tomorrow we will see the Metropolitan Hospital in Managua!

Monday, August 23, 2010

Days 8 - 9: Los Pipitos

I don't know if I'm getting lazy or if I just needed a day off, but yesterday was definitely a total day OFF! I let Christine and Lily know I was skipping all activities, including the evening of dancing, and I just hung out in my room with the air conditioner running all day! I had my feet up and my ankles finally got down to where I could see the bone again (they've been totally swollen since I arrived from the heat!)! I did watch some television - La ley y el orden (Law and Order!) - with Spanish subtitles, so the day wasn't totally wasted! The only time I went out was to walk to the supermarket, which took about an hour, and I bought some snacks and cream cheese for breakfast. I wasn't able to eat dinner in the hotel because they don't serve dinner on Sundays, so Nohemy (at the reception desk) ordered Chinese food delivered for me. It was fine!

Lily and Susan at Work on Fil
Today, we met at 9:30 a.m. to walk to the Los Pipitos school. The weather was hot, as usual, and it was sunny. It's been pretty consistently in the 90's since we've been here. We decided to focus on organizing the files today, so Lily and I went to the office supply store and purchased some files, several health related posters for the walls, and some other badly needed supplies to help us get organized. We ate lunch in a cafe, where 3 guys tried to engage us in conversation. They had all been drinking beers, obviously many, and one of them spoke pretty good English. They weren't aggressive, so it was fine.

One of the projects we had at the school was to assess the children for wheelchairs. There were 5 wheelchairs donated and the ambassador is coming to Los Pipitos on Thursday to have some sort of ceremonial handing over of the wheelchairs. So, we opened the boxes and 2 of the chairs were provided to students who were in great need. This little boy is 7 years old, and he just returned to Los Pipitos today after 3 months in the hospital. His muscles are atrophied and he is unable to walk or sit well. We tried to have him sit in the chair, but he kept arching his back, making sitting impossible. Finally, we were able to have him sit on his knees in the chair and he was happy.
Child in Wheelchair

Later, he relaxed a bit and staff were able to get him to sit properly in the chair with his legs dangling. I think it will take a long time for him to loosen up. 

Christine Examines Manuelo
Another child needing a wheelchair is Manuelo. He doesn't attend the school, but is part of the Los Pipitos organization. His mother brought him in today because he had a cough. He had a lack of oxygen when he was born, so today he is 8 years old, non-verbal and suffers from gross tremors and random movements of his extremities and his head. He also has severe nystagmus. It was difficult for us to examine him because while he was in the clinic, the children were dancing to loud music right outside the door. One of the concerns at the school is overstimulation for some of these children. Manuelo was agitated and he moaned continuously. (Note: Names of children have been changed)

Painting the Bathrooms
One of the areas in which we are having some impact is in cleanliness of the school. We have been educating staff about the need for clean air for the children's healthy respiratory status. We saw that the fans were not cleaned and they blew dirt into the air, so we educated staff regarding cleaning the fans regularly to prevent breathing problems for the children. We also noted the very dirty walls in the bathrooms, and today, at the end of the day, the children were gone and staff were painting the bathrooms with glossy, washable paint. Little by little, we are making a difference!

Every Monday night, Hotel con Corazon has free salsa dance lessons, so we decided to participate tonight. We met in the bar at 6:30 p.m. and the teacher had us dancing with partners. I danced with Nancy and we were pretty well matched - both a bit clumsy! Thankfully, I didn't have the camera set up to take pictures or videos this time - I do plan on it for next week, though!

We met a nice guy and his family who are here in Nicaragua on vacation. Todd is an E.R. nurse in Oakland and his wife does something with air pollution. When we mentioned that we'll be going on a tour of the Japanese hospital tomorrow, Todd asked if he might join us, so we arranged for him to go. Tomorrow will be an interesting day! A physician is supposed to be at Los Pipitos in the morning, so Christine, Lily and I are planning to get there early to talk with her. Then Bill will be bringing a pharmacist to have lunch at Los Pipitos as a P.R. activity to encourage her to get donations of medications for the children. We'll be headed to the hospital in the afternoon. Hopefully, I will have some good pictures tomorrow!

Sunday, August 22, 2010

Day 7: Weekend Activities

Laguna de Apoyo





It being the weekend, we had a lot of ideas about what we wanted to do. Christine wanted to rent bicycles and ride to Laguna de Apoyo, the volcanic crater lake. Last night after dinner, we talked about this with Bill, and he expressed great concerns about whether I might be able to do the ride. He had great confidence in Christine's ability to do it. Well, I didn't want to say it, but he was right! Given the extreme heat and the steep slope of the road, I was also concerned about whether I could do it. Lily was also expressing some hesitation. So, in the end, Christine and Lily were able to arrange for us to catch a ride with Nancy, who was going there with her friend, Karen.
The Beach

It was a lovely spot! Nancy built a hotel there right on the crater lake and we relaxed with Coca Cola's and fried plantain chips. Christine and Lily swam in the lake with Nancy while Karen read her book and I added to my growing knowledge of Nicaragua with the Lonely Planet book on the country. Karen had bought property from Nancy here in Nicaragua a couple of years ago. She has volunteered in a number of places and last spent some time in Ecuador volunteering in a school. Her regular work is in a restaurant in Chicago. 

Lily and Friend
Karen with her Book


In the evening, we hooked up with Darryl and Amy for dinner. Amy runs an art gallery in Granada. I learned that both Nancy and Penny are wonderful artists, and Amy teaches art as well. We met at the Hotel San Francisco, across from the apartment where Christine and Lily are staying, for happy hour. While we were there, it began to rain  - torrential rain! So, we flagged down 2 taxis to go to the restaurant.

Torrential Rain from the Doorway
From the start, it was pretty comical! Nancy arrived soaked to the bone since she walked from her place without an umbrella. Amy, Christine and Lily were in the first taxi and the rest of us were in the second one. Nancy gave directions to the driver, but apparently the restaurant had moved and she didn't know where it was. We tried to contact the others through Lily's phone, but she didn't have it as we found out later. Ultimately, we returned to the Hotel San Francisco, where Nancy was able to find Darryl's number and contact him. He knew where the restaurant was, so we had to flag down another taxi to meet them there. By then, getting in and out of the taxis, we were all soaked despite the umbrellas!
Christine, Nancy and Amy

The restaurant is owned by a young Filipino guy (who does NOT speak Spanish!), and his cook didn't show up, so he had to do all the cooking by himself. There was another huge table of people, but we managed to order our meals first. Even with that advantage, though, it took nearly 2 1/2 hours to get the food! The other table left before their food was served!
Karen, Susan and Lily


After dinner, the owner came over to talk and it seems he's had a great deal of difficulty hiring good cooks. Darryl said that worker reliability is a problem here because the people are so desperate to find jobs that they say they can do anything, but they are unskilled and things don't always work out.

Amy and Darryl

I'm thinking I might take the day off tomorrow and actually start working on my class materials for fall quarter!





 

Saturday, August 21, 2010

Day 6: Los Pipitos - Open for Business!

Today for the first time, we actually began our health assessments of the children of Los Pipitos! We were challenged by the organization of the student files. This was not due to staff not trying but to our lack of familiarity with the "system." It was also quite difficult to figure out the students' names. The records were inconsistent and some names were long (usually with 2 surnames) and some only had one of the surnames. They were filed by numbers, assigned according to the order in which they signed up in Los Pipitos. We had a list of children who were in the school this particular day, but it was next to impossible to find the matching files! We ended up having to go through all of the files one by one for each name, time consuming with 50 or so files! Some of the files were for children not on the list and many of the names on the list had no files associated with them.
Christine Measures Height

We saw 5 children over about 2 1/2 hours. The problems are diverse. One uses a wheelchair and is unable to move himself. We aren't sure of his initial diagnosis, since the list we have indicates general conditions (i.e., intellectual disability, mobility disorder, etc.), but he has severe mobility problems with contractures in his upper extremities. He also is non-verbal. This young man in his teens was incontinent and staff had to contact his mother to bring another pair of pants. When she arrived, she slapped him for urinating in his clothes. This is a problem! I'm sure it is related to her embarrassment but it was difficult for us. We saw 2 children with ear infections, one more severe than the other. There is a physician whom Los Pipitos has an arrangement with for free medical care; however, as we learned, the biggest problem is that the families cannot pay for the medications, so even if they see a doctor, they cannot afford to treat their conditions! 
Christine Dancing
One child has been plagued by a parasitic infection of her intestines and was seen in a clinic in Managua where she was prescribed medication by injection over 5 days; however, after 2 injections, her mother was unable to pay for the medication and the doses were stopped. Now, the distention and discomfort is severe, but there is no way to treat her without the medication starting all over again. And, who will pay for it?? One idea is to find sponsors for the children to cover the cost of their medications. Some have long-term prescriptions but cannot afford them. The cost might be only a few cents a day.
Lily and Admirer!


Children & Staff Dancing
The children love to dance! We participated as well and they were thrilled to have us join them! Even the children in wheelchairs were able to participate at their level of ability. 


Another activity the children enjoy is computer play. The younger children use special computers that are made for them. They are very durable and have webcams built in that the children love to play with. Bill indicated that the younger children are intimidated by the regular computers and start out with these smaller, child-friendly ones. Ultimately, the children can learn skills that might help them find work some day. 
Child Friendly Computers


Children with Computers
This is definitely a wonderful learning experience for us! Some of what we are learning is disturbing. For example, one of the staff members has 2 daughters who are deaf. Apparently, there will be a "sterilization clinic" next week and she will be having them sterilized! I think Nicaragua is where the U.S. was 50 or 60 years ago! There is no way to help the people think of the ethical considerations. In their minds, children who have any disabilities will be unable to find jobs, marry, or care for themselves. They believe they are protecting them. Especially the girls are seen as vulnerable to sexual abuse and the parents are doing what they believe must be done for the girls' own good.
Computer "Class"
Later in the afternoon, Marina, a nurse who visits Los Pipitos on a fairly regular basis, came and we had an opportunity to learn more about the problems for the children. Marina has a number of projects, but most are concerned with women's health. She does pap smears of the women and some of the older girls, and her projects relate to obesity and diabetes. She isn't really at the clinic to serve the children.


Blanca, Christine, Susan, Lily, & Paloma
We had a meeting over pina coladas with Paloma and her friend, Blanca from Spain, who will be leaving to work in Ecuador for a while. We talked about what we're planning to do next week and beyond. So far, we have appointments to see the Japanese hospital in Granada, tour the large hospital in Managua, visit with staff at the central office of Los Pipitos in Managua, and meet with the dean of the School of Nursing at UPOLI. It will be a busy week!


Penny, Bill, Lily, Christine, & Susan
We ended the day with dinner at Bill and Penny's home. Penny made delicious soup and pizza! We also enjoyed apple martinis that Bill expertly mixed! By the time we left after 10:00 pm, it was pouring! The perfect end to a perfect week! This weekend we were planning to rent bicycles and go to the volcano; however, despite Christine's strong bicycle touring ability, Lily and I aren't so sure we're ready to tackle the extreme hills in the heat. We'll talk about it!