Sore throats, skin rashes, stomach aches, and headaches…

At the schools the majority of complaints that Dr. Karla and I see are sore throats, skin rashes, stomach aches, and headaches. The directors of the schools prepare a list of the sick kids in the school that we see that day and then when class is dismissed we always get some others that wander in. With all the sick kids and programs that Dr. Karla and I have been doing, we have not progressed very much with the annual physical check-ups. Little by little they will be done though.

This week have continued to teach the hygiene class at other schools and completed many clinical histories for the special needs kids. From my experience, many people do not know their family medical history (esp. not on the father’s side of the family) and some do not even know their birthdays. Dying is a part of life and receiving quality health care to prevent death when old age comes around is not as common. People don’t often know what their family members died of. They will say “died of an infection,” “died from bleeding a lot.” This is a very interesting trend and I imagine it is even more prevalent in the more rural areas. Genetics is definitely not big topic here.

We had a meeting with some of the parents and have found many specialists in the area that are willing to give a 50% discount for office visits for our patients. Having a strong referral network is important to be able to provide for whatever the needs may be for the patient.

The financial struggles the parents have are almost imaginable. More than half the population on Nicaragua lives on 1 dollar a day or less. Mothers have many children and the father often leaves the picture when the woman can no longer “serve him.” I spoke with a woman yesterday that has 7 children and the father of her most recent child beat her during the pregnancy….even in the abdomen. The woman was scared and did not want the man to leave her. But he did and left her with 7 children, the youngest one with special needs most likely due to the physical stress the mother was experiencing during the pregnancy. Marriage is a different thing here. Many times there will not be an official ceremony or even papers signed. The couple lives together and then decides they are “married.” This leaves the man without any legal financial or physical obligations and when a woman gets pregnant or old the man leaves her for someone else. The women tolerate it and the men keep doing it. This situation leaves mothers and their children very close. Siblings are close too…but not the father.

Well, for today, I am going to be helping with some consults this morning and then have some more fun this afternoon. Dr. Karla and I are going to split up. She is going to some neurologist and lung specialist appointments with some of the kids. I am going to go room shopping with Heysi’s (the 16 yr old girl with cancer that I have been writing about) sister for a new comforter, a small bedside table and room decorations. She has been receiving chemo at the hospital and will be coming home tomorrow hopefully. While she has been in the hospital, we have done a lot to her house to make it a more infection-free and happy environment. Dr. Karla’s husband has been doing most of this project and done a fabulous job! We re-did the floor, from cement/dirt to pretty tile. Painted the walls a happy green color and made solid divider between Heysi’s room and her parents. We got her a few fish to take care of and hope the paint flowers/something fun on the walls with Heysi’s help. It should be a fun day!

Love,
Ayla Landry

"Your worst days are never so bad that you're beyond the reach of God's grace. And your best days are never so good that you're beyond the need of God's grace." --Jerry Bridges

Sunshine, Mangoes, Friends, Prayers, and New Places...

The weekend was good. I spent time relaxing under the sun, went for a long run on the beach, found a sand dollar, watched some fisherman, saw Dr. Doty, and worked for a while on my computer. The fisherman had a 15minute process to catch maybe 4 fish.  It took 4 fishermen, a big net and all afternoon to catch those fish. They would throw out the net from about thigh-high water and then wait for about 7 minutes with the waves crashing on them and then with all 4 men in particular position they pulled the net to shore with the few fish in it. Pretty fun to watch a couple times.

I am eating an average of 6 mangoes every day and learned that socks and sandals (even flip flops) are acceptable. There are mangoes on the streets, on the roofs, on the trees, in a big bowl on the counter, in a pitcher of fresh juice, in between teeth, smeared on clothes, and just everywhere. They are so yummy and definitely one of the best parts of Nicaragua. Yum YumYum!!!

Seeing Dr. Doty was also a joy. I have been to Nicaragua several times with him and I admire his dedication and leadership he has given to his Nicaraguan friends/initiatives. He looked at Heysi’s X-rays and Tomography. He confirmed that there appeared to be some cancer in her pelvis and is going to send me some information about Ewing’s Sarcoma.

I visited Heysi today. She is still at the hospital but was sitting up, smiling, and eating today. Hopefully she will be able to receive her chemotherapy this week. Dr. Karla and I got her a couple little fish and she is excited to take care of them. A woman who was recently cured from her lung cancer is in the same hospital room as Heysi, but also last night a 7 yr old little girl died from cancer. I am praying that Heysi remains strong in faith, hope and perseverance. I am also praying for a smooth path for Heysi where everyone caring for her is doing their best.

Dr. Karla’s house is a rusted red color and has 3 rooms plus kitchen and living room. I loved seeing that the hand prints from when the outside of the house was painted remained on the wall in one corner of the house. I loved the personal touches of the house, its modesty, the love that obviously abides there, and the family that surrounds it. I am loving Dr. Karla more and more the more I learn about her.


Love,
Ayla Landry

"I have found the paradox that if I love until it hurts, then there is no hurt, but only more love. " ~Mother Teresa

Woo Wee!

On Tuesday, I got to teach! I love teaching! I taught the two oldest grades at the high school about washing hands and hygiene. They all listened very well and even asked questions. I had practiced in Spanish before I did the presentation to make sure I got my vocabulary and pronunciation correct, but I still mispronounced a couple words. It actually worked out becuase it made them pay attention and provided some comic relief. These students are going to be teaching the younger grades at the school about washing hands and hygiene based off the information I presented to them. Empowering the students, giving leadership opportunities, and allowing the younger kids to learn from their peers instead of a professor...all good things.

Wednesday was a sad day. I saw a puppy get run over. The lil guy was scared and bleeding, but I don't think he actually broke anything. Then, Heysi had to get another blood transfusion in the hospital and the care she is/is not receiving is frustrating me! I also learned that a little girl in a nearby town died and the family had no money to buy a casket or have a ceremony or anything. Luckily, the family is friend's with NRN and they were able to give the family some support, but still pretty sad.

Thursday, I attended to many children and school teachers with respiratory symptoms and head aches with Dr. Karla. Dry season is in full swing…the dust is everywhere and the sun is beating. I have learned the importance of asking the patient follow-up questions in the assessment process. Instead of hearing the complaint of a headache and immediately reaching for the Advil, asking the patient how much water they have had that day or in what position they sit at their desk all day is also very important. Drinking water and/or non-caffeinated/non-alcoholic fluids is so important and if I don’t ask a patient, dehydration could be overlooked. Similarly, bad posture while sitting at a desk all day long can be overlooked if you don’t ask the questions. This day also the optometrist came back to work with the special needs kids. I helped him with documentation and parts of the screening. He is a friendly man with a humble attitude. I love they way he is so willing to help.

Friday/Today, I spent the entire day organizing the medicines and supplies Dr. Karla and I have. At the NRN office, they just built us some new shelves and I was excited to unpack and organize it all. I also was able to spend time with the staff at the Qunita/NRN office. I just love meeting people. 

Love,
Ayla

"A man should look for what is and not for what he thinks should be." Albert Einstein

Back to Work...

Yesterday Dr. Karla and I finished giving the anti-parasite medicine to the kids in La Concha (AKA Pineapple Land.) We also had some very exciting meetings with the leaders there. We are going to bring water to the school/church and a pharmacy!!!!!!!!! The idea is to have a big reservoir on/in the ground that will be kept covered and then to have a pump and PVC pipe to carry the water out of the reservoir to a long cement sink that will be built. The issue will be keeping the reservoir full and clean. But...the people we met with at La Concha had some great ideas to add to our ideas. They know of a person in a nearby town that can bring water out to the school for the reservoir and a way of filtering and cleaning the water. The idea was accepted by the leaders there and now the actual planning can begin. Clean water is so important for health and it is exciting to be working with a community so ready to work/support/manage the betterment of their community!

The second idea that was also accepted was starting a pharmacy in La Concha near the school grounds. The Nicaraguan government has been supporting citizens wanting to start pharmacies in rural areas and the school has a perfect spot for one. It would hold only basic over the counter medicines and frequently prescribed medicines. We found a pharmacy in the market that sells medicines very cheap and that is willing to be the supplier to the little pharmacy in La Concha if the government gives authorization. Someone chosen by the pastor and his family would run the pharmacy. "Someone very organized, honorable, and responsible" said the pastor’s wife as we began talking more excitedly about the initiative. Dr. Karla as well as the leaders of the school and church will be keeping the pharmacy keeper accountable. The medicines could be sold for a little profit and the school and church could use the money for projects to better the school/church. This would be another great step for the community! Now that the leaders are on board we will have to ask the NRN (Nicaraguan Resource Network-the supporting organization that supports the school.) for their support and initiating funds.

Dr. Karla is really enthusiastic, wise, and brilliant both in mind and heart. I am learning from just being around her.

Love,
Ayla Landry

"Kindness in words creates confidence. Kindness in thinking creates profoundness. Kindness in giving creates love. “  Lao Tzu

Last Week

Last Monday I went back to Pineapple Land and Dr. Karla and I gave the anti-parasite teaching and medicine to the high school kids at the school there. On the way there, we got a little lost. From the highway to the dirt bumpy road and then to…we didn’t know where the next turn was. So we asked a few people and got some mixed directions but finally found it. It is a beautiful drive up, up, and up to the top of a big hill. In the states the fences are made of posts and wire but in Pineapple Land and other rural areas here in Nicaragua the fences are made of thick rows of cactus…so thick that nothing can fit through. The cactus fences are effective.  The dust up on the hill is everywhere and when we left it was all over us…in our noses, in our eyes, in our shoes and ears….all over.

Tuesday Dr. Karla and I went to the school in the market called Tabernacle Agua Viva and we did physical annual check-ups on some of the kids but, then once teachers realized we were there, the rest of our day was filled with attending to the sick kids. It was a busy morning. Then for the afternoon we went to visit Heysi. Today was her first day of chemo and we wanted to check up on her and bring her all the info about how to manage the side effects of chemo. She is depressed, weak but smiling and praying as often as she can. She had a little bit of a cold and an eye infection. We made sure she got medicine to treat both of those. Also, she was lying outside because the stuffiness of the inside of the house and the heat makes her nauseated. We are working on a plan to fix up her house to make it better for her to be in regards to both comfort and infection control. Also, Courtney (a dear friend of both Heysi and I) brought lots of gifts for Heysi…including an iPod Nano. I gave her the gifts and we listened to the tunes on the new toy. She is only 16 and is already dealing with so much…I can’t imagine.

Wednesday was a big day! Not only did we have another dentist/lab fiesta but a group of students from TCU (my alma mater) came to learn about the Nicaraguan health care system. The special needs kids from los brasiles at the Josue 1:8 school came to the dentist/lab clinic. We had the chairs for them and the teachers and Dr. Karla organized the kids while I organized the TCU group. It is always so neat to see the special needs kids meet and interact with new people. They are so loving and genuine always. Also, for them to receive a dentist appointment and get their hgb/hct taken is a great opportunity.  The TCU group was fun to have around. I definitely realized that sharing my passion for helping is one of my favorite things. The nurse at the clinic talked to the group about her experiences as a nurse and I loved seeing how proud she was to talk with them. Go Nurses! Also, they got a tour of the public children’s hospital nearby. There are a lot of differences between the care received at a public hospital here and the hospitals back in Fort Worth.  Then everyone was super hungry so we went to a Nicaraguan buffet and had good Nicaraguan food. I had some excellent conversations that were encouraging and supportive of my future as an international nurse. 

On Thursday, the same wonderful optometrist came to the school, Rey Salamon, and did evaluations on the special needs kids while Dr. Karla and I attended to the sick kids. She did the assessment and I documented, distributed the medicines she ordered, and explained how to give/take the medicines.  Then we got a call from Heysi’s mom that Heysi had strong heart palpitations that morning and they couldn’t give her the chemo. She was in the hospital again and they were running a bunch of tests to see what was wrong. Soon after, Courtney arrived at the school with her daughter to visit Heysi that afternoon. As soon as we could, we left the school and went to see Heysi in the hospital. She was said to have another kidney infection. We called the Internal Medicine Doctor who was treating her for the last kidney infection and set an appointment for 5pm that evening. Dr. Karla dropped Courtney, her daughter, Heysi, Heysi’s mom and me at the internal medicine doctor’s office to help with the appointment. Dr. Karla went to Masaya (about an hour drive away) to meet with a Doctor there and pick up some anti-convulsant medicines that are super expensive here and were going to be donated. At the clinic waiting for Heysi’s appointment, Heysi vomited a couple times and could not keep any liquids or medicines down. She had to give a urine sample to re-run the urine test and she couldn’t fit in the bathroom with her wheelchair so her mom helped her take off her diaper and do pee into the cup in the hallway to the bathroom. It was really sad and humiliating but at the same time seeing the love of her mother and the strength of Heysi was lovely. To distract Heysi  from the pain and discomfort we told her stories of Texas and played “I spy…” for at least an hour. The appointment finally arrived and he reviewed her and ordered antibiotics and other medicines to give IV since she was vomiting everything else. Then it took us about 2 hours to finally find all the medicines she needed. Taxi, after taxi…we were all squished and giggling…it was good to hear Heysi laugh.

Friday, I left for Costa Rica for the weekend. Tourist Visas only last 90 days and so Dereck and I went to Costa Rica to get the stamp out and the stamp back into Nicaragua so our Visas wouldn’t expire. Also, we went on an adventure through the rainforest there. The bus ride there was 9hrs and back was 9hrs too. Our Hotel was really nice and not too expensive. We saw lots of bright colored butterflies, fast lizards in various sizes, lizards that puffed out their red necks, an oversized rodent that was actually cute, an armadillo, and….I almost stepped on a 3 foot long iguana, and….we saw a Macaw! The hike was exciting and fun. San Jose was cold. The rainforest was hot. The rainforest was part of the National Park Carara. Fun trip!!! Good to recharge and refresh!

Love,
Ayla Landry

"Give us this day our daily bread."  The Lord's Prayer

Different things

While I have been here in Nicaragua I have noticed several things that are different than in the USA. Some of the differences include:

• Plain yogurt is called leche agria and described as fermented milk and you drink it or put it over your beans and rice\
• Beans and rice don't get old: but you do not eat them mixed together for lunch
• Seat belts are only required for the front seat and most vehicles don’t have them in the back seat
• Helmets are only required for the motorcycle drivers and not the passenger
• There is no Good Samaritan Law
• A car wash done by hand including vacuum costs $1.45
• You do not have to sign anything to get a copy of patient records
• Everyone gives kids candy: at the pharmacy, at school, at stoplights
• Car windows stay very clean because at every stop/intersection someone on the street cleans your windows….and you have to give them something or they pester you
• Horses, buses, cars, motorcycles, dogs all share the highways
• Red and black fence posts and flags are everywhere in support of the governing political party

·         The city buses are all school buses

·         The bus drivers are very proud of the paint job and neon lights on their bus

·         There are always people just wandering the streets

·         Gas stations are often the nicest stores

·         The more salt and butter the better on all foods

·         The cheese is not pasteurized

·         The Mangoes are the best

·         All toothpaste has fluoride in it

·         Where shoes hang from the electric wire is where drugs are sold

·         Women wear high heels everywhere

·         Laundry is done daily

·         They don’t sell flavored coffee creamer

·         There are no street signs

·         There is no such thing as an address

·         The beaches are wild and beautiful

·         If someone shows up to your house unannounced…invite them in and offer them a chair and a drink

·         Smile at everyone you see

Un dia corriendo....

After Dr. Karla and I got Heysi settled back at home all has been better. She does not have the kidney infection anymore and has gained a little bit of an appetite back along with strength and hope. She even put on a dress and her wig the other day. The plan is to start chemo on Tuesday.

So on Wednesday I went to one of the school called Josue 1:8 in an area called Los brasilles to complete clinical histories on all the special needs kids there. An optometrist came to the school to do vision screening on the special needs kids too. The optometrist is amazing because from a 10 minute meeting we had with him last week he decided that he wanted to support us and has jumped on board to help out. In the States there would be so many more procedural steps in place that would make collaboration so much harder to initiate.

Then on Thursday, Dr. Karla and I went to the school called Rey Salamon and did clinical histories and annual physical exams on some of the special needs kids there. Here in Nicaragua Downs Syndrome is diagnosed but any other disorder/condition is just called retarded and parents don't know about why their child has seizures, can’t pay attention, can't hear, can't walk, can't talk, or is different than the other kids. Most mentally and/or physically disabled people in Nicaragua are hidden and not a part of society. Some of the parents at the schools we work with are very involved with their kids and others use the school like a daycare.

While doing the clinical histories with the parents of the special needs kids I learned that most families have at least 7 people living in their home, many to not have toilets, but most have electric lights.  I also learned that nobody knows what their relatives die of, and especially not on the father's side of the family because in most families there is no father figure.  I learned that most pregnant women do not have prenatal care, and have at least 5 children. Everyone needs help buying milk for their families and they don't understand medicines when they are prescribed to them.

On Friday, I had a boring day of entering information into to computer from all the histories and check-ups that we did.  It was uneventful and boring but important.

All is well. I am learning a lot and enjoy the simplicity of life here.

Love,
Ayla Landry

"Empower yourself with love and then share it." ~Anonymous

Heavy Heart

                Yesterday was a really hard day. I woke up with a headache. Then after my rice and beans for breakfast I went over to the Quinta to work on Inventory of some supplies and wait for Dr. Karla to pick me up. Dr. Karla arrived with some bad news and we cried. 

                Remember Heysi, the 16 yr old girl with bone cancer in her femur, well a lot has happened since I last wrote about her.  She had been in the public hospital for the new fracture of her femur and was getting over a fever/infection. When the public hospital released her they said she was “infection free” and we were just waiting for her to strengthen up for the operation to put in prosthesis for her femur. So, with this good news, she went home and not but 36hrs later she had a 104 degrees fever again. Dr. Karla brought Heysi to see an Internist friend of hers and it was confirmed that Heysi had a kidney infection and that upon releasing Heysi from the public hospital they had not run a urine test. Dr. Karla and I decided that to get better for the operation scheduled in just 4 days Heysi needed to go to a private hospital.

                Off to the private hospital (Hospital Cruz Azul) we went. She had a nice spacious private room with pillows, a personal nurse, a TV, clean sheets with her medicines/care given in a timely, cleaner manner. The private hospital was nice. Not up to par with US hospitals in terms of the gadgets but they seemed pretty organized. In just a couple days on some strong antibiotics, Heysi is recovering from the kidney infection. However, the internist friend also found some bad news on a report from X-rays done back in September and the recent  X-rays done on her new fracture. The bad news is there is metastasis to her pelvis.

                This is so frustrating because traces of metastasis were noted on the X-ray report from September and no follow-up or attention was given to it all. In fact, the opposite was done….went ahead and planed for the operation went on as if the tumor was inactive! So much more too…but I won’t go into it all.

                This is sad because so much hope for Heysi’s cure and ability to walk again was in this operation/prosthesis and now that seems not to be an option.

                There is a helpless feeling of again having clinical knowledge and not having a way to implement or process all that is going on.

                But there is always Faith in a bigger plan and Motivation to serve as the best nurse I can.  Learn and give the best I can.

                So we went to talk with all the Doctors involved and ran an MRI to make sure of the metastasis and now are waiting to decide the next step which is most likely more chemo and avoiding infection until we can re-evaluate for an operation.

I’ll keep you posted, but in the mean time pray that Heysi finds her appetite, peace and keeps her faith. Also, pray for Dr. Karla to have wisdom to discern and make decisions.

               

Love,

Miss Ayla Landry

“Just because the tide is out does not mean there is any less water in the ocean.” ~Anonymous

Beauty of the Ocean!

I could not dream up a more relaxing and beautiful place than the beach I went to on Saturday. To get there we rose on the bus on the highway, then on a pretty good dirt road, then on a  not so good dirt road. Then the final 0.25 mile we walked to the location. It was a private sandy beach, a sea turtle sanctuary, and a rustic getaway. The roar of the waves and company of friends was just perfect. I played in the waves, went on a 4 mile run on the beach, ate some good food with tropical juice, laid in a hammock and listened to music, went on a mini-hike in the wilderness and peacefully stared at the waves as tide rolled in. The outing was a real treat!

Love,

Miss Ayla Landry

“Every drop in the ocean counts.” Yoko Ono

Pineapple Land

Yesterday was a great day! It started with some beans and rice and some coffee then some meetings. Dr. Karla and I are building a great referral network for the kids and setting up arrangements for discounted services at several specialists’ offices. Then we went to visit two of the schools to talk to the director’s really fast about the arrangements that we set up and get them set up for this month of March.

Then we went back to the dentist office and helped a little girl with special needs with her appointment. The mother had not bought or given the little girl the sedative to help with the appointment. Dr. Karla and I went to buy it at the pharmacy next door but they didn’t have it in liquid form only in pill. So we bought the pill and went with it. I crushed it up and diluted it in 3mL of water then calculated the dose. Then I drew up the 0.3mL and gave it to the little girl. 10minutes later she was very relaxed and the dentist had no problem.

Then Dr. Karla and I met up with Ginny the on-site head of NRN (the organization we are working with) to have lunch. Then we went off to PINEAPPLE LAND. We went in the four-wheel drive truck and went up up up a big long hill through a village called el crucero, another called San Marcus and then made it to La Concha. The entire area up there is known for its Pineapple plantations, other tropical fruits too like ganabana, and for its hydrangea flowers. The sulfur in the air blown over from the volcanoes makes the soil perfect for these things grown. The Pineapples are white and yellow…and O SO GOOD. The hydrangeas are the brightest blue. It is beautiful there. 

We went to pineapple land to visit the school that is there and set up a relationship with them. The school is great and the people we met seem really competent and enthusiastic too. However, there is no water and they only recently got electricity. This site will have its own set of challenges. I love that all the schools I am working at are so different..each with a different puzzle to solve. Well, it’s Saturday so I am off to the beach!!!!!!!!!! Adios!

Love,

Miss Ayla Landry

“Decide what to be and go be it.” Avett Brothers

Fiesta at the Dentist Office!

Today was a fun, noisy, busy, successful, and revealing day. Dr. Karla, a medical student that is visiting Nica named Matt and I brought all the special needs kids from one of the school to a clinic for dentist appointments, and hemoglobin/hematocrit tests. When we arrived at the school, the special needs children and their accompanying parent were ready to go...anticipating the opportunity in the day. Most of the kids at these schools are low-income families which means a lot more than it does in the USA. Most of them had never been to a doctor or rely on the emergency room for their medical concerns. We loaded the morning group of 33 kids and their caregivers on the bus and we were off.
             On the bus we had the caregiver fill out a form for the hemoglobin/hematocrit test and we split the group into two groups one to see the dentist first and the other to do the hemoglobin/hematocirt tests.. The we unloaded one group at a time and crossed the busy street and went into the clinic. There were not nearly enough chairs so Dr.Karla and the med student went to rent some for the day. Then Dr. Karla thought to bring a clown in to entertain while they were all waiting. The medical student bought all the kids juice. It was a Fiesta at the clinic!  Only about 10 of all 63 kids cried and most were happy to be there. It was fun, effective and I really got to know the special needs students/caregivers better.
            After the morning group was done we returned to the school had some tortilla and tamarind juice then I went back to the school with the second/afternoon group for the second fiesta. Through the exams today that we discovered some definite needs that need to be address. Dr. Karla and I certainly have work cut out for us...

Love,
Ayla Landry

“Life is a big canvas so splash all the paint on it that you can!” ~ unknown

Heysi

      Heysi is a 16 year old girl here in Nicaragua that has bone cancer in her femur (thigh bone.) Over the past few days I have been helping to take care of her with the Doctor I am working with (Dr. Karla.) Heysi was scheduled for surgery that will put in a prosthesis  of 18 inches of her femur to get rid of the tumor and weakened bone. However, she came down with flu-like symptoms and they decided to wait until she came back to health to operate. She had been on chemo and has consequently lost all her hair. Also, in preparation for the surgery they stopped her chemo regimen and she did not receive the 4^th cycle of chemo. The tumor is so bad that she cannot walk and dreams of walking again someday. 

            She finally made it out of the hospital for her flu-like symptoms and was home for a total of 24hours before terrible unbearable pain began in her upper leg and radiating all the way down to her toes. So, her mother and big sister returned to the hospital with Heysi.  The emergency room Doctor did not even look at her leg and dismissed her saying it was nothing. The only pain medicine prescribed was Tylenol.

            Dr. Karla and I recognized that this would not be an effective medicine for Heysi. So we called the oncologist and tried to set and appointment. He could not do an appointment that day. We went ahead and scheduled an appointment for the following day and spoke with the oncologist to determine what pain medicine we could give her in the meantime to help control her pain. Then, we went to the pharmacy and without even asking for credentials we bought an IV bag/bottle with 500mL normal saline, the vials of strong pain medicine recommended, IV tubing, two 22gauge needles to start the IV,  and a 5mL syringe with needle. I already had gauze, a tourniquet, medical tape, gloves, and alcohol swabs, thanks to donations from TCU nursing school. Then we went to Heysi’s house and on the dirt floor surrounded by cement walls and a tin roof I started the IV with the pain medicine for Heysi. I had to count the drops since there was not IV machine and Dr. Karla helped. The IV ran for1 hour and during that time we visited with her and her family. My friend Courtney came with us to Heysi’s house and gave her a pillow, blanket, and daily devotional book. The hope, faith and peace of this 16yr old girl are some of the strongest I have ever seen. She spoke of God, angels and blessings despite her circumstance. Once the IV was finished we took it down from where we tied it to the roof and she confirmed that she felt much better. We visited for a little bit longer and then left in a taxi with gifts of mangoes and other tropical fruits from Heysi’s mom.

            The next day, Dr. Karla and met Heysi and her Mother at her appointment with the oncologist. We had the consult and Dr. Karla helped to advocate and explain Heysi’s current condition. The oncologist took one looka and touch Heysi’s hip (where the tumor is at the top of her thigh bone) and said it looked like she had broken her bone which is common since the cancer weakens the bone. So, the oncologist sent us to the emergency room to get an X-ray to confirm a fracture and to run some blood tests to see if the previous infection was gone. Once we got to the Emergency Room of the public hospital, Dr. Karla and Heysi went in for the X-ray and I waited outside with Heysi’s Mom. While we were waiting, she shared with me her side of the story. As you can imagine, being the mother is hard when your child is suffering and you are helpless. She shared the expected feelings of helplessness, sadness, grief, and uncertainty…but she also shared her hope, faith and joy that the entire process has brought out. Finally, Dr. Karla came out and informed us that the X-Ray did confirm a fracture in the same place she had broken it before…which is a good thing in a way because if she had broken her pelvis the prosthesis wouldn’t work and we would have been back to square #1. Dr. Karla also reported that Heysi was receiving medicine for her pain and was going to be transferred to the orthopedic unit until they decide what to do about the surgery with the new fracture. Heysi’s mom went with her to the orthopedic unit and Dr. Karla and left.

            On Saturday, Courtney and I went to visit Heysi in the hospital. To give you an idea of the public hospitals here…think of the hospitals in horror movies with harsh metal beds, old run down equipment, blank faces, no pillows, nothing to make patients comfortable…only beds full of hurting people. There was 1 nurse for both the orthopedic unit and the surgery unit!!!! Heysi was depressed and was happy to have visitors. We brought her a wig with hair accessories and her sister a silly wig. She smiled and laughed with the gifts, but she was still in a lot of pain. The splint they put her leg in was too tight and cutting of her circulation so they un-wrapped the part closest to her hip to help it. However, in doing this all support was taken away to the area with the fracture and without pillows she was experiencing the terrible unbearable pain as before…and they hadn’t brought her any pain medicine. The environment was frustrating because I have the skills to fix the splint and administer the medicine but I didn’t have the resources/access to it.

            The other women in her room were just as uncomfortable and all without pillows. Courtney and I went to the nearby market to get pillows for all the women in her room. That was at least something we had the ability to do to help. When we returned the nurse was there delivering dinner and medicine to all the patients except for Heysi. When I say dinner I mean ¼ cup of rice and ½ a streamed plantain with no drink and no utensils. One of the women did not have any visitors and was particularly depressed. She said she was hungry but didn’t have the motivation to eat. I made her a spoon out of the Styrofoam cup she had and fed her all her dinner and tried to cheer her up a bit. Then, Courtney and I prayed with and for all the patients and families of that room.

            I went back with Dr. Karla to visit Heysi in the hospital and we found out that it was confirmed that she did not have the infection anymore but hasn’t been eating. With the pain and depression of the hospital she has not had an appetite and now needed to go home and eat to strengthen up for the surgery planned for the 9^th of March. Heysi wasn’t sleeping well either because she is scared to sleep in the hospital. She made it home the next day.

            The entire journey with Heysi thus far has been one of the saddest and incredible things I have been a part of. Her circumstances bring tears to my tears but her faith inspires me. I want to have faith like Heysi. All who read this please keep this young woman and all of those that are supporting her in your thoughts and prayers.

Love,

Ayla Landry

“Don’t let what you can’t do get in the way of what you can do.” ~  John Wooden