23 years old!

Today (April 28th) is my birthday! I am 23 years old now. WooWee! Some Nica birthday traditions include…smashing an egg on the birthday girl/boy’s head, piñatas, cake from PriceSmart, small gifts, and dancing. I avoided the egg on the head and had an awesome time spending the day here in Nica, one of my favorite places.
I was surprised and blessed to receive my very first phone call this morning from Heysi’s mom wishing me a happy birthday and blessed years to come. Soon after, my host dad came into my room and gave me a big hug and sang in his rich voice a song and a prayer for me. Similarly, my host mom, little brothers and NaNa gave me birthday greetings. I decided to wear, instead of my scrubs, a dress to workJ

Dr. Karla picked me up at my house and we went to one of the schools, Rey Salomon, and the parent’s of the special needs kids threw me a surprise birthday party…complete with cake from PriceSmart, and dancing. I was so touched and surprised. I couldn’t have dreamed up a better party!...and I even got another party that afternoon that I shared with Jimmy, one of the special needs kids. Also, the director of the school made me a shirt for my birthday…it is pink, yellow, orange, flowy, and very pretty. It fit me perfectly and was another surprise and blessing. It was only 1pm and I had already had 2 pieces of cake.

Later, at an appointment with her oncologist, Heysi and her Mom gave me a homemade card and a little gift of bobby pins that they decorated with beads. I was so humbled by their thoughtfulness and love.

When I got home, my host mom said we were going out to eat for a pizza party for my birthday. We went to Pizza Hut here and it was really fun to spend time with them. The wait staff came over and sang one of the five happy birthday songs and gave us a complimentary piece of yummy chocolate cake. My host little brother, Gabriel, and gobbled it up.  Then when we got back to the house, NaNa had made me another cake. 4 cakes and 1 birthday…woowee. I could not believe the blessings I received on my birthday and really felt special. One of my top 5 birthdays no doubt!

Love,
Ayla Landry

"The trick is to grow up without getting old."

Heysi Update

Heysi ia a 16 year old girl with bone cancer that has strong faith and a struggling body. The fight has not been easy but her family have been keeping their hopes high and their faith strong. Heysi is do to be evaluated for her next cycle of chemo tomorrow, but presented with a 102-103 fever and now that plan is up in the air.

After running some tests, we discovered a urinary tract infection and had some very difficult clinical decisions to make. Any infection is a serious infection for a patient with cancer. The secondary infections are what kill patient and not the cancer itself. So we need to react with wisdom and fast. We only have $300 for Heysi. The best antibiotics cost $200 a day and she would need them for at least 7 days…we can’t do that. The okay antibiotics she already has but have to be given IV every 8 hours and we do not have someone that would be available to do that…so we can’t do that. We could hospitalize her in the public hospital to receive the antibiotics but we would need the referral from her oncologist so she would be admitted into the oncology unit, but he is not picking up the phone…so we can’t do that. We could teach a family member how to give the IV meds, but she is allergic to some antibiotics and it would be a huge risk if she were to have a reaction without a clinical person nearby…so we can’t do that. It was difficult knowing that we couldn’t provide the best for her and trying to decide what the right thing to do was very hard. But with God’s help, we finally, we decided to give her some other okay antibiotics that she has had before and make an appointment with Dr. Lumbi at his private clinic for tomorrow (which would be April 28^th) to have him review the situation and hopefully write the orders to hospitalize her so she can get the good antibiotics and a blood transfusion for her anemia.

The public hospitals are very depressing and the care there is very minimal…to say it lightly. We need to pray for Heysi that this infection leaves quickly and she gains her strength back to receive her next cycle of chemo and be able to move forward in her cancer treatment and also for wisdom and love for all those who are caring for her.

Love,

Ayla Landry

"If you do not hope, you will not find what is beyond your hope.” St. Clement of Alexandra

Happy Birthday Ivania/Host Mom!!!

Today, April 25^th, is my host mom’s birthday (her name is Ivania) and since it is the day after Easter it is still a holiday/no work. Derrick and I got her a new rocking chair for the porch since the one we have now is broken and she enjoys sitting on the porch. We are excited to give it to her. Tonight we are having a party here at the house with 30 people/family members coming over.

I think I will also try to go to the Quinta at some point today to organize the donations that Ryan brought down from my mom, but besides that I will be relaxing and spending time with my host family and Derrick. Derrick leaves tomorrow to go back to the States, so I want to make sure I get some time with him too.

Love,
Ayla Landry

“One word frees us of all the weight and pain of life: that word is love.” - Sophocles

Semana Santa

Easter here in Nicaragua is a big deal! Holy Week is like spring break so everyone travels to visit family/friends and/or goes to the beach/vacation. My host family and I went to visit my host family grandparent’s farm in the rural part of Nica in the mountains. It was a 7 hour trip: 4 hours in the car on the regular pot hole highways, then 2 hours on a dirt road/path that was even less maintained (at one point we drove through a shallow part of a river as a detour from a bridge that had broken), and then the last hour we had to go by horse. There were about 10 people/family members staying there. I slept on a table, woke up at 4am to the sound of monkeys in the trees/roosters/goats. They kept killing animals for us to feast on to celebrate Holy Week and the family together. I kept having to explain the vegetarian thing and ate A LOT of rice and beans. There were baby puppies, baby piggies, and baby horses/cows/goats and monkeys. There was no electricity. At night, with only a couple candles flickering, we had a mini church service led by my host dad who sang, played the guitar, prayed and reflected on Bible verses about Holy Week.  It was really touching and beautiful hear my host dad pray for Ryan and I and for each person there. His name is Guadalupe and he is so wise and loving. I really enjoyed spending time with him over the week. We also played cards by candlelight too. It was quite the experience and was neat to be a part of since most Nicaraguans live that way. Also, good family time!

Since we have been back in Managua I have gone to a few church services and seen a lot of Roman Catholic crowds in processions down the highways carrying big floats of Jesus carrying the cross, Virgin Mary, the tomb, and a band with trumpets at the caboose. Also, the evangelical church that is next door to my house had a 18hour service on Good Friday and into Saturday...I heard them all night long singing, clapping, preaching. Like I said Holy Week is a big deal!

For Easter day, I went to the sunrise service at the church my dad is the pastor of at 5am. Gabriel went in his Pajamas and tennis shoes and we sang happy songs and celebrated Jesus’ resurrection from the dead. Then, later that morning, Derrick (the other American staying at my host family’s house) and I also to the English church later that morningwhere we sang some of the Easter songs I am used to and enjoyed being around some of the Easter traditions from back in the States. After the service there was a banquet with lots of food and visiting. I met some new friends and had a very happy Easter.  

Love,
Ayla

“Jesus answered him, “Truly I tell you, today you will be with me in paradise” Luke 23:43/
 “Entonces Jesús le dijo: "En verdad te digo: hoy estarás conmigo en el paraíso.” San Lucas 23:43

Ryan + Ayla = the best!

Having Ryan come visit was the best. We got to play, stare at each other, laugh, hold hands, and be the affectionate in-love couple that we are and to make that even better we got to share Nicaragua’s beauty and help people together! He is such a blessing in my life and I feel like the luckiest girl in the world!

Ok, so here is what we did April 11^th-17^th:
Monday: picked him up at airport at 8pm...I was so overwhelmed with joy to be near him again. Then, we went to host family house for dinner and playing with Gabriel, my host little brother. Gabriel was super excited to see him too and greeted him with a big hug. Then we went to the Quinta to spend time with Ginny and Cecil. Then back to the host family house for the night.

Tuesday: Ryan came to work with Dr. Karla and I. We took a little girl named Julia to get an endoscopy. Ryan saw me give her the mild anesthesia injection and he had never seen me do anything like that and he was able to help by carrying her after the procedure, which was really special for him. Then, we went to one of the schools in the market/business part of town and I toured him around the school and the kids flocked to him and I was able to introduce him to many friends of mine there. We took the winners of the hand washing and hygiene presentations out to lunch and Ryan got to try a lot of Nica food. The student winners were really proud and some of them would not have had lunch that day if we hadn’t taken them out. They sang in the bus, picked on each other and did so many little things like high-schoolers in the States do. That afternoon Ryan and I went to visit Heysi. She looked REALLY good. She had energy to put on a dress, make-up, her wig, and had energy. Her mom said it is the best she has seen her in a long time. We helped her pick out a new bed by car shopping which is when you drive down the market street with your windows down and the venders come and try to sell their stuff. Fun cultural experience. That night we went out to dinner with Dr. Karla, her husband, and her two-year-old who Ryan adored. I loved being able to spend time with all of us together.

Wednesday: We went to work again with Dr. Karla at the school in Los Brasiles where there is the special needs program and the orphanage. It was the day of the Hand Washing and Hygiene Presentations and Ryan and I watched and graded them all. Both of us were impressed with their enthusiasm, creativity, and effort they put into the presentations with props, dramas, and costumes. That afternoon Dr. Karla had to leave to take a little boy to the hospital so Ryan and I rode the public bus back to Managua.

Thursday: Ryan and I went to a beach called Los Cardones and spent the day there. The beach has a turtle sanctuary and saw baby turtles get released to the sea. We went horseback-riding on the beach at sunset, stayed in a little beach bungalow, relax in a hammock and walk along the beach under the moonlight... It was super romantic!

Friday/Saturday: We went to Granada which is a historic old colonial town with a lot of Spanish influence. We rode around the town in a horse-drawn-carriage, took a boat ride tour of the islands in Lake Nicaragua, danced in a gazebo in the city park. On our way out of town we went to the Mombacho Volcano and hiked around the old crater, and saw really pretty look-outs. Saturday night we had dinner with my host family and played with Gabriel and went to a concert for the church my host dad preaches at.

Sunday: We went to church at the English church I have been going to with all the international missionaries and embassy workers in the congregation. The songs we really good and we held hands during the service and got to pray together. Then Ryan had to go back to the States. It was an awesome week but leaving the airport was really hard because I love him want to be near him always. However….He liked it so much that he wants to share it with his mom and come back. He is coming back the last week of May with his mom, who is a nurse like me! I can’t wait to see them both and share Nicaragua with them.

Love,
Ayla

“If I would have told myself a year ago that I was going to be in Nicaragua visiting my girlfriend that lives there….I would have laughed and not believed it.” ~Ryan Thomas..."Life is full of surprises and often that is the best part." ~ Ayla Landry

waiting, waiting...

Monday started with some playing. I was dropped off school Rey Salamon to wait for an appointment in the afternoon while Dr. Karla went to the school in the rural area. I got to play! I spent time loving on the kids at the school and I did P.E. class with them and talked for a while with them. Then I went with Rodolfo and his mom to get electromyography at the private hospital. There was waiting waiting waiting for the appointment. Rodolfo and I played in the curtain, with paper, with whatever we could find. But after the first hour went by we were running out of things to play with and energy. Then the nurse came ad said it would be another 45 minutes…which turned into an hour and a half. We went to get lunch and came back and still had time to wait. Then we finally had our appointment!

Then, at 8pm….Ryan, my boyfriend, came to Nicaragua for the first time. It was surreal to see him not on the computer. We were talking and playing and didn’t go to sleep until 2am. I cannot wait to show him around the country and to meet the Nicaraguan people…especially Dr. Karla!!!!!!!!!!!!!!!!!!!!!!

Love,
Ayla Landry

“The servants heart holds the truest wisdom.”

busy busy busy!!!!

Last week was super busy! Lots of special cases came up requiring extra attention and constantly changing Dr.Karla and I’s schedule. Heysi is at her happy home recovering for her next chemotherapy; Isamuel was diagnosed with leukemia; Rodolfo has muscular dystrophy that is progressing rapidly; Edwin is finally out of the hospital! In a ddition to keeping up with those cases, we had several specialist appointments scheduled for last week and our normal work of seeing the sick kids and teaching about health at the schools.

Busy weeks are good. I get to practice my prioritizing skills, organization skills, and communication a lot more and Dr. Karla and I’s teamwork becomes very evident. Oh and I forgot, there were a few accidental wounds to attend to…a gash on a knee down to the bone from falling on a volcano, a broken arm that turned out just to be dislocated, and a choking incident.

This weekend I spent time with my host family. We went to visit my host mom’s aunt and cousins Saturday morning anf then my little cousin had her 12 year old birthday party at our house that night. Music, piñata, 12 year old awkwardness/self-consciousness, cake, family, friends, pizza and the cousin’s slept over! The party started at 4pm and guests didn’t leave until after 10pm. I met a lot of sweet people and a little 8 yr old girl got attached to me and followed me around and asked question after question giggling in between each one. I gave her lots of hugs and danced with her and let her come into my room and play with my stephoscope.

It was a good week and now here comes another one….

Love,
Ayla Landry

“ After six days Jesus took Peter, James and John with him and led them up a high mountain, where they were all alone. There he was transfigured before them. His clothes became dazzling white, whiter than anyone in the world could bleach them. And there appeared before them Elijah and Moses, who were talking with Jesus." Mark 9:2-4

Happy 2nd Birthday Lidia!

April 1^st was Dr. Karla’s Daughter’s birthday. She turned 2! On Saturday I went to her party at their house and had a really great time. Karla had decorated their house with lots of balloons and there were many tables in the yard with light pink table cloths. Ginny and Cecil (the NRN Directors here in Nicaragua) picked me up and we went on the twisty, dirt, bumpy, road to her house. The party was perfect. It started with visiting and meeting many of Dr. Karla’s extended family members and then a prayer and some worship songs. Lidia had to change outfits 3 times during the party because she got really messy. She had flowers in her hair and couldn’t decide what she thought about all the people at her house. There were about 25 guests, mostly family and some friends, 15 under the age of 8. She had an Angelina Ballerina mouse piñata that was pretty in pink. The cake looked like a wedding cake with 2 layers…and so delicious. The party was simple and fun…Nicaraguan style.
As I have spent more and more time with Dr. Karla, I have grown to admire her and like her more and more. She has a loving light about her. She is personable and dynamic. She is a smart doctor that knows her stuff and knows when to seek help. She is open-minded and sincere with everyone she meets. She can play guitar and sing. She runs to her daughter’s side the moment she hears the slightest cry. She brings her husband a cold drink when he has been sitting in the car waiting for us for long while and even sometimes for no reason at all. She is full of ideas and humble. She doesn’t hesitate to say thank you and express her gratitude or joy. She never acts rushed in conversation even when we have 1,000,000 things to do. She gives of her time and talents generously. She values every person. She remembers not to pack too many things in to the schedule and complicate life when it is not necessary. She greets her husband with a kiss and then plays “tea time” in the backseat of the car. She is wise and honest. She loves God and shows it every day with her actions. Dr. Karla has become a dear friend and colleague that I have learned a lot from about life and clinical matters. The organization Nicaraguan Resource Network couldn’t have found a better Doctor to have hired!

Love,
Ayla Landry

“A true leader is a servant of all.”

Terrible Thursday...Part 3

When I arrived Dr. Karla filled me in. Before giving Heysi her third dose of chemo for this cycle, she became very pale, and was gasping for breath. They debated intubating her but instead gave her some medicine and oxygen. It got worse from there:

1. She now had a 103 degree fever and was vomiting and still pale.
2. We also realized that the oxygen that they gave her was not working...there was nothing flowing through the tube! 
3. I noticed that her IV was supposed to be changed 5+ hours ago and it was red, warm to the touch and blood was infiltrating the tube about 5 inches!
4. Heysi's mother told us that she had not seen the oncologist in 15 days! Somehow in these 15 days, the oncologist decided that Heysi was okay to have chemo.
5. He had not run any urine tests that she could remember despite the fact that Heysi was initially admitted with a kidney infection.
6. Heysi looked the weakest I have yet to see her. She quietly told her mother that she needed to go to the bathroom and her mother got the bedpan from under the bed and moved it under Heysi to urinate. The entire process was very painful for Heysi since her hip/tumor site had to move to have the bedpan under her.
7. There is no toilet paper in the restrooms in the hospital.
8. I asked the residents who were about to pass into the room to wait until after she was done urinating just a moment to give her a little privacy/dignity. They without saying anything turned away from the room and chatted in the hall for a moment. I told them she was done and they could pass into the room, but instead they continued to chat and then LEFT without looking at Heysi or any of the other women in her room.
9. I asked Dr. Karla why they would just leave like that and she said..."Ayla, that is what it is like here. That was the patient's only chance to see a doctor today and they don't care if they skip a room or not."
10. Then, the cleaning lady came to mop the floor of Heysi's room/hall with chemicals that were making even me nauseated. Ammonia and apple. Heysi, like most patients on chemo would, immediately started vomiting again.
11. We tried to tell the nurse of the IV needing to be changed and the oxygen not working and she was in the middle of preparing the medicines for her 60 patients that she didn't care either.
12. We then went to the social work office to tell them of her IV and oxygen and they said it was not their problem and that we needed to speak with the Medical Director of the hospital.
13. There was a long lone outside the Medical Director's office and he was not there. Luckily, Dr. Karla knew one of the Doctor's working there and told him of the situation and he will hopefully look into it.
14. Heysi's mom is tired and crying more and more frequently
15. The family members/friends, if patients are lucky enough to have them, are really the ones that know what is going on with the patients. They are doing the positioning of the patient, feeding, advocating, and doing assessments (not clinical ones...but still asking questions to rate/evaluate how patient is doing.)
16. The doctor's rarely talk to the patient, the patient's family and the nurses...they work pretty independently and do not look at much more than the patient's chart to see how the patient is doing....remember only the nurse and doctor write in the chart, so it doesn't reflect what’s really going on either
17. If a family member is to ask for something or offer information to a doctor such as "my daughter has vomited 10 times in the past hour" the doctor doesn't listen and instead is annoyed. The family member and patient are then labeled as problematic.
18. The longer a patient stays in the hospital the worse the patient's care becomes...Heysi has been in the hospital for 17 days.
19. Dr. Karla told me how "many patient's in the hospital die of dehydration (from not changing IVs) and hospital born infection."
20. There is even less medical care at night and on the weekends.
21. Dr. Karla also told me how "There are also many medication errors, neglect and no accountability."
22. I learned that they do not require teaching medical ethics in the medical schools here.

I wanted to scream/cry/hide/protest/eat an entire chocolate cake/vomit all at the same time. I cannot even explain the rage and helplessness I felt that day. There was so much that could have been done better for Heysi and all of the patients in the hospital. It bothered me that instead of talking about the neglect and awful care of Heysi's case, Dr. Karla explained the situation in general statements that referenced the entire public hospital system. Heysi was not just having a bad day at the hospital. She was experiencing the norm for the public hospital system. We are going to try to get Heysi out of the public system as soon as we can. She could die not because her disease but due to the injustice of the public health care system. I cannot write anymore about this right now, it is making me upset and I am crying again.

Please pray for the many people I have mentioned in the Terrible Thursday posts.

Love,

Ayla Landry

"God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” ~The Serenity Prayer

Terrible Thursday...Part 2

Soon after talking to the Director of the school Rey Salamon about Eduardo, we got ready to accompany a 4 year old patient and his family to see a neurologist. But in our taxi ride to the neurologist clinic to meet them, we received a phone call from Heysi's mom. She was crying and frantic telling us that Heysi was very pale and having trouble breathing. 

For those of you who do not already know, Heysi  is a 16 year old girl with cancer in her thigh bone. Her road has been more than challenging. Dr. Karla and I decided to split up. Dr. Karla went to the hospital to see Heysi and I stayed to take note and advocate at the neurologist appointment.

The little 4 year old boy, Isamuel,  started complaining of his ankles hurting  a few months ago, and the his knees, and then one day about week ago he couldn't walk anymore. The mother said he has lost a lot of weight and is very worried about what is happening with her son. He is weak all over and can hardly move his arms and neck too. The mother has already visited an orthopedic doctor and taken him a hospital to be reviewed. The problem is she still does not know what is wrong and every doctor is ordering different tests. No one has explained anything to the mother only ordered more test. This neurologist is going to review the patient for half price and is also very good about including the family in his treatment plans.

We waited for only 30 minutes and then went into his office for the appointment. After talking with the mother and father, and a physical exam, the neurologist decided that the problem did not appear to be neurological. He said that Isamuel's reflexes are great, but there is a mass that is either his liver enlarged or a tumor.  The neurologist narrowed down the tests of the other doctor's to one plan of action and then sent us on our way.

The mother expressed how worried she is and talked about how she never saw this coming. Isamuel just sat there motionless without any expression. I could imagine how lively he must have been and how much it must hurt to be lost in the uncertainty of not knowing why her only child could not walk/move.

They then drove back home without a definite answer but with direction and support. Dr. Karla and I are arranging for the tests to be done outside of the public system and will support this family as much as we can.

After saying good-bye to Isamuel and his family, I hopped in a taxi to meet Dr. Karla and Heysi at the hospital....and as if the day wasn't depressing/hard enough already, this is where Part 3 of Terrible Thursday begins...

Terrible Thursday...Part 1

Last Thursday had the potential to be a really fun day and turned into one of the most frustrating, sad, and difficult days. It started with going to the school Rey Salamon and doing consults for the sick kids that day. We saw one little boy named Eduardo. He is 6 years old and has a serious/fatal heart murmur. One of the valves in his heart and/or narrowing of one of his main arteries. His heart is huge due to the extra effort it has to make with each beat to pump  suffiecient blood out. However, without some investigation and surgery the little boy will die. This was obviously alarming and so Dr. Karla and I talked to the Director of the school to see if we could talk to the little boy's mom when she came to pick him up. The Director of the school said that the mother is aware that Eduardo has a heart problem and does not care if he is dead or alive. One time when Eduardo turned blue at school and was complaining of chest pain, The Director had to take him to the hospital. When she got to the hospital she called the mom to come and give consent for treatment...and she said she wasn't going to come.


This is neglect, and Dr. Karla and I told the Director of the school to talk to the mom to tell her: Dr. Karla has done a medical evaluation and ordered some testing to look into how to fix Eduardo's fatal heart murmur and that if she neglects to take action to take care of her son then we will get the equivalent of CPS involved.


I am praying wildly for this little boy and his mother. It beaks my heart that such a happy, loveable, little boy does not have the love of his mother. I wanted to cry and scream at her....but the day had to go on and we left that school to...Part 2 of "Terrible Thursday" to come.