Parties, appointments, support and cute kids!

Thursday morning started out at the Quinta again waiting for Dr. Karla to come and pick us up for the day. The plan was to check on Dayana, pick up Edwin and his mom and go with them the neurologist appointment, and go to the school to do consults.

The school was having a mother’s day celebration so we didn’t do consults…we joined the party! Red and white streamers draped across ceilings and around staircases and down the walls. Music and food and mothers with their children in every classroom. I introduced Debbie and Ryan to the special needs classroom and all my friends there. They were greeted with hugs and smiles and joy. When we walked in Dr. Karla had already joined the festivities and was striking at the piñata. I toured them around the whole school where not one room was without a party. Mother’s Day is on Monday May 30^th but since it is a national holiday and there will be no school on Monday the celebrations are today. The students were in their best clothes; dresses, high heels, collared shirts, dress shoes, sparkly bows, combed/gelled hair. The people are some of the poorest in the world…but they take pride in what they have. They wash their clothes daily and always look nice. Joy was all around and Debbie and Ryan had the chance to see some of the Latin festivities.

Dayana was still not doing well and her frail little body still functioning with machine and medicines. One of the college students from Indiana donated an inflatable pool raft and bed sheets to be given to Dayana’s mom to help her sleep. Ryan and I took turns blowing the raft up and when it was inflated Debbie, Ryan, and I brought the raft, the sheets, and some food to Dayana’s mom. She was so grateful and welcoming to our presence there in her time of suffering. Then Dr. Karla offered to pray with her and all the mothers there sleeping on that cement. They all eagerly gathered in a circle holding hands and we linked hands too. Dr. Karla started the prayer and, in true Nica form, everyone prayed their individual prayers aloud simultaneously. I closed my eyes, listened, and prayed with them. Prayers of praise and glorifying God and his power and grace. Prayers asking for healing, mercy, strength, peace, protection, blessings. Prayers of thanks. Prayers for others, for their little ones in the hospital, and for themselves. When I opened my eyes I saw that more people had come to gather and pray with us. I saw tearful eyes, and faithful hearts. We hugged with them and I could not help but feel overwhelmed by their situation.

Edwin and his mom had an appointment with the neurologist. When we arrived the clinic looked closed and I began to feel bad for Edwin’s mother who had travelled by bus all the way into town for the appointment carrying little Edwin in her arms. However, when Dr. Karla called the doctor, he said he was on his way. We waited and ate some snacks that Debbie was always prepared with. Edwin can swallow but not chew. Eating is hard and always occurs with coughing and a mess. In the States he would probably have a gastric feeding button, which is a little tube that has a closure outside of the body and goes directly into the stomach so formula/nutrition can be put directly in bypassing the mouth and avoiding the risk of choking and pneumonia caused by little bit of formula from the mouth getting in the lungs.   Here in Nicaragua, these gastric buttons are rarely done for lack of supplies in the hospitals and more so due to risk of infection. When the doctor arrived, the neurologist spoke with Edwin’s mother and Dr. Karla to get the story. Then he assessed Edwin who cried an awful cry that screamed of the little air that was passing to his lungs. He was rigid at times and not at others. He was being very stimulated so he did not appear to have a seizure while we were there. After the physical assessment of reflexes, eye movement/reactivity, and neurological function, Edwin’s mother quickly picked him up and cradled him in her arms until his cry faded to a sob then melted in to smiles. They then did a test called an electroencephalogram to measure his brain waves. Edwin sat I his mama’s lap while the neurologist attached many little electrodes on his scalp to pick up the electrical activity in his brain and light flashes try to trigger the abnormal/seizure brain activity. The test does not hurt at all. The brain waves were recorded and read from the computer. The neurologist concluded that Edwin is epileptic (has seizures) and that his brain waves are slow. He prescribed some medicines and a follow-up visit in a month.

We made sure Edwin would be able to get these medicines and then dropped them off at the bus stop to catch a ride back home. Then, Dr. Karla, Ryan, Debbie, and I  called it a day.

We went by my host family house and had lunch at 3:30pm since we hadn’t had a stopping point before then. Gallo pinto (traditional nica rice/beans dish) avocado, nica cheese, and fresh tortilla. We played with Gabriel and sat on the porch listening to the rain hitting the tin roof. It was a beautiful day. The rains softened, the smell of the wet earth set in, the breeze full of honeysuckle like flower swept in, and the frogs began to sing.

When stopped by the hang out with Ginny and Cecil on the way back to the hotel. I was having language troubles that day and kept mixing up English and Spanish in my head….it was silly and we laughed a lot. We ordered pizza delivery at the hotel  for a late dinner and spent quality time Debbie, Ryan, and I together before they left the next day.

The trip seemed so quick but packed with all the good stuff…love, God, new adventures, sharing life with loved ones, opening eyes, gaining perspective, friends, and laughter. I am so happy to have shared Nicaragua with Debbie and to work as nurses together was really special. Similarly, for Ryan to see more of my heart here and my passion to serve in the developing world was really good.

Love,

Ayla Landry

“Past the seeker as he prayed came the crippled and the beggar and the beaten. And seeing them...he cried, "Great God, how is it that a loving creator can see such things and yet do nothing about them?"...God said, "I did do something. I made you." ~Sufi Teaching

Sex and slavery in Nicaragua

That night back at the hotel, Ryan and I talked for a while in the chairs near the elevators. A non-Nicaraguan older man came out of the elevator with a prostitute. It really bothered me. How could a man play into that system of wrong? Where did she come from to learn that selling her body was the best way to make a living? Did she have a choice…or know there are other ways out there? Does the man have a wife and kids at home? Is he a sex addict/ a sexual tourist or just some rotten man? I wanted to punch him in the face!!!! Though there is consent from both the man and the woman…it is still wrong.

Here in Nicaragua the sex trade is a big issue along with slavery. People are sold for their labor in a factory or plantation, for their bodies at outrageous rates. And I am not just talking about adults…children too.

In the world right now there are more than 27 million people who are estimated to be in slavery…more than any other time in history. 80% of those are women and 50% are children!!!

60% of the human trafficking victims from the western hemisphere are exported from Nicaragua.  

A virgin here in Managua can be sold for as much as 750 dollars or as little as 2.50 dollars. Children are chained up by their own family and told to do house work and then sold to the man of the house by night. A friend of mine works for an organization called One By One: The Refuge Project and another friend works with an organization called House of Hope here in Nicaragua fighting against prostitution and human trafficking esp with children. They told me that in one week they found 3 girls under the age of 11 living as child prostitutes; one of which was six years old, sold to the pimp by her 9 year old big sister who also worked for the pimp for 3 dollars.

There are 109 declared brothels….some of which are frequently visited by public government officials.  Most of the brothels secretly hold little girls and boys. One secret brothel here in Managua for high government officials has 12 and 13 year old girls in high security…and my friends have not been able to get girls out of there yet. Many children see their parents in sexual abusive relationships, or in the act of prostitution since people live in little one room houses. Children learn about sex not as an act of love, but as a duty, a job, and a sacrifice.

Similarly, factory/plantation workers are forced to work against their will for little to no pay.  Workers and strong children are traded as a commodity and self esteem destruction, fear, hopelessness are cultivated at the workplace. Parents refuse to work and force their children to work and provide for their families. People are locked up, chained up, physically and mentally abused. Confidence, interests, education, love, and dignity are stripped away.

 Now, I do not know the story of the prostitute that walked out of that elevator nor of the man that bought her for the night. But I do know that love, dignity, confidence, self-value, family, healthy relationships, and justice are all things that we should strive to preserve in our own lives, in the lives of others and especially in those less fortunate and/or more vulnerable than ourselves. We are all citizens of the same world.

To learn more check out:

http://www.therefugeproject.com/innocents.htm  and/or

www.notforsalecampaign.org,

Love,

Ayla

“There are two primary choices in life; to accept conditions as they exist, or accept the responsibility for changing them.” ~Denis Waitley

Nurse Debbie and Nurse Ayla in Action!

Wednesday the optometrist came with us to the school/orphanage in los brasiles. When we arrived, I gave them a tour around the school and we saw all the cute kids in the classrooms and identified the sick kids needing to see Dr. Karla. The optometrist set up where Dr. Karla and I normally work so we were out in the cafeteria area doing the consults. We saw about 15 kids. 

Debbie and I started the consult by collecting/calculating the sick/hurting Nicaraguan children’s name, age, birthday, grade level in school, vital signs, chief complaint, height in cm, weight in kg, BMI, and general triage assessment. Then, we passed the patient on to Dr. Karla to decide plan of care. If we had the medicines needed, Ryan would distribute the medicines in little plastic bags from the prescription written by Dr. Karla. Debbie did an ear wash with little 10mL syringes full of salt water, I splinted a pinky finger to send a patient for X-Rays, we discovered a heart murmur and we were doing our nursing thing side-by-side!!!! The little moments of just the smiles exchanged and the care in Debbie’s eyes were fun to watch and be a part of. There was one little girl named Alba who took a real interest and played with the stethoscope and wanted to listen to her heart…maybe she will be a nurse one day too!

We ate lunch at the cafeteria at the orphanage and then went to visit some patients in their homes. Little Ismael, who  is 5 yrs old and was diagnosed with leukemia and then taken out of the hospital by his parents believing that God would cure their son, looked about the same as he did a week ago. He can stand leaning on a chair or his mama’s leg which is an improvement. However, his capillary refill was slow, his tongue was white, his eye socket was pale as well. His mama said he was eating okay and they were still giving him the iron supplements. We will continue to check on him and be a resource for his family. Edwin, is 4 yrs old and has cerebral palsy with frequent pneumonia. He was lying in his bed and despite his breathing and lungs being a lot clear/pneumonia-free was not very responsive. Dr. Karla and I have been suspecting that he has seizures…the kind that are not so much convulsions of the body but rather more subtle in the form of unresponsive stares, twitches, laughter, and rigidity. While we were visiting his eyes rolled back in his head and he became rigid, then his eyes would roll back and he would stare off in the distance. His mother says he has been really tired lately and doing that more often. We are going to bring him to a neurologist appointment tomorrow to check the little one out and see what’s going on with his brain.

The car (Charlie is it’s name) had a flat tire that Jose Luis fixed while we visited with Edwin and his sweet mother. Then we went off to get some Nica ceviche…Dr. Karla really likes it and wanted to share it with Debbie and Ryan. After the big bowl of ceviche, we went over to Dr. Karla’s house where Debbie got to meet Dr. Karla’s daughter, Lidia, and parents. She is 2 years old…super cute…and that particular evening expressing the terrible two part of herself. She was fussy but still fun to see kick her little ball around, walk, hold hands, and be indecisive. She was a cute little mess.

Love,

Ayla Landry

"Dreams are renewable. No matter what our age or condition, there are still untapped possibilities within us and new beauty waiting to be born." 

 ~Dale E. Turner

Woo wee big first day for Debbie and Ryan!

After visiting with Heysi, Dr. Karla dropped Ryan, Debbie, and I off at my host family house were we spent the evening. Gabriel ran to greet Ryan as he too had been counting down the days, hours, and minutes until his arrival. Ryan and Gabriel and I played. Debbie relaxed. It was nice to sit on the porch have some water, rest, and process the day a little. Nana, the grandmother figure/nanny at my host family house, and I made tortilla soup for dinner. When my host mom came home we all ate dinner together..the frogs and birds singing and all of us chatting around the table. Soon after the hotel taxi came and picked us up.

When we arrived at the hotel, we asked for an extra bed for their hotel room for me to sleep on and they said no problem another bed would be on the way. In the States another bed for a hotel room is a roll away bed or a little cot. Well, here in Nicaragua, it means a whole extra full sized bed…dust ruffle and all. Two women from the hotel came in moved the furniture and set the whole thing up. It had been a big first day with Dayana, the school, Heysi, cultural differences, heat, poverty, and lots all at once for Ryan and Debbie….the night’s sleep was welcomed and thoroughly enjoyed!

Love,

Ayla Landry  "

"Culture is a framework in which we communicate" ~Stephen Roberts

Heysi Update

After lunch, we went to see Heysi. Heysi is a 16 year old young woman with bone cancer that I have been helping through the care process and blessed to know. Debbie/Ryan had brought gifts for Heysi and her mother; a holding cross for Heysi to clinch in her hand and pray with, a pretty towel and fancy hand soap for Heysi’s mom, Francisca. Heysi looks good. She knew we were going to come and had her wig, make-up, and cute clothes on. Her nails were painted and she was smiling her beautiful smile.

She did not handle the last round of chemo well and could not finish the cycle. Since chemo has been a struggle and not been effective at controlling her tumor as evident by her pain, fevers, and growth in the size of the tumor. The oncologist and orthopedic doctor agreed (yay…first time they agree on her care plan) that they should stop trying with chemo and start radiation to reduce the size of the tumor and then evaluate for best operation to do. So Heysi is at home recovering and strengthening up for radiation.

She is eating and trying to remain happy and strong in faith. I had spent time with her last week and we read about her cancer and about what things she can to take ownership of her care. She has been trying to exercise, drink liquids, eat, and stay infection free. Heysi’s mother is such a loving woman. She always wants to thank us and prepares food for us when we visit. She had a mango salsa and a cow stomach soup for us. The mangoes were really yummy.

We loved on them and shared in the blessing of being a part of each other’s lives. Heysi’s birthday is June 26^th and she mentioned that she wants a camera. Debbie, Ryan, and I got her one later in the week and I plan to give it to her this week! Giving, learning, experiencing empathy and seeing the love of mothers, love of friends, love of families, and power of prayer.

Love,

Ayla Landry

“CANCER IS SO LIMITED: It cannot cripple love; it cannot corrode faith; it cannot shatter hope; it cannot eat away peace; it cannot destroy confidence; it cannot kill friendship; it cannot shutout memories; it cannot silence courage; it cannot invade the soul; it cannot reduce eternal life; it cannot quench the spirit.” Author Unknown

Pray for Little Dayana!

The next morning we met up at the Quinta and waited for Dr. Karla to pick us up for the first day of work with Ryan and Debbie at the schools. However, I received a call from Dr. Karla that changed our plans for the day. Dayana Bello, the little 2 year old that I wrote about earlier, is still in intensive care and is in critical condition and we need to visit her and support her mother.  Dr. Karla and her husband, Jose Luis, arrived and greeted Ryan and Debbie. Then, off to the hospital we went…

                                                                                            

Dr. Karla went to the school to start consults and Ryan, Debbie and I went to the hospital to check on Dayana. She was still attached to the breathing machine, receiving strong antibiotics, and now on medicines for her heart. The Doctor did not like us in there and preferred that we get the information with the mother at 11am (which was in 15 minutes.) So after a quick visual assessment of Dayana’s frail condition, we went to see her mother. Her mother was sad in her eyes and was still spending the day and night on the cement outside the hospital with the other mothers. I went with the mother to get the report from the Doctor and he was very vague. He said they were doing all they could, and that the infectious disease doctor had changed the antibiotics a couple times, she was on meds to help support her heart function, and a couple of other things that neither the mother nor myself understood…something about a choque? Very frustrating that Dayana’s mother waits all day to hear from the doctor and he doesn’t really say anything…ugh!

So I called her lung doctor to get a more sufficient story about how Dayana is doing. He told us to call back around lunchtime since he would have  more information about her then. Okay…so we did what we could to help…we loved on the mom.  If nothing else, this mother was going to feel supported and loved through this process. Debbie gave her some food, we all hugged her and listened. I told her that Dayana was in critical condition and receiving all the help she needs. I then told her I would call her as soon as I knew more information. We hugged her again and left with heavy hearts. This was quite the first experience for Debbie and Ryan.

We then went to the school in the oriental market. The school is right in the middle of the busy, impoverished, cluttered, chaotic market…urban poverty Nica style. Debbie, Ryan and I walked around the school, and helped Dr. Karla finish a few consults…then went off to lunch.

We went to the same little eatery we always do. Big plate of traditional Nica food for 1.50 dollars. The meats of the day were cow heart, chicken with a cow tongue sauce, or fried chicken….Debbie and Ryan got the fried chicken. Spending time with Dr. Karla and Jose Luis was nice at lunch. Dr. Karla then called Dayana’s lung doctor and we got the update…Dayana’s pneumonia infection had spread all over her body and was in her blood stream. She was not responding to medicines well. Her kidney function is poor. Her blood pressure and pulse keep dropping. She seems to be having multi-organ failure….meaning not good….might die. Pray for Little Dayana and her family!

Love,

Ayla Landry

“Where there is faith, there is love;
Where there is love, there is peace;
Where there is peace, there is God;
And where there is God; there is no need.” ~Leo Tolstoy

Ryan came back and this time with his Mama!!!!

So, last Monday was a glorious day!!! Ryan, my boyfriend, came back to visit and this time his mom, Debbie, came too! I did not go to work that day because their flight came in mid-day and I met them at the airport. I took a taxi all the way across town to the airport…for the first time it took more than 5 minutes for a taxi to drive by…it took 25 minutes and I was worried I would be late to the airport. However, I arrived at the airport with 45 minutes to spare…phew!

My heart was racing again and I was so excited to see Ryan and share Nicaragua with his mom. Debbie is a nurse too. It was sure to be a special trip for us to share our nursing skills with the Nicaraguans together.  We went from the airport to their hotel in the hotel taxi. Looking out the window from taxis is always interesting…everyone always sees things differently. First impressions made from the taxi window.  Then we had a little lunch at the hotel and got settled in their room.

We went to the Quinta and visited with the missionary group from Indiana who would be leaving the next morning. We ate dinner with them and did devotionals with them. The group had become special to me since I had spent time with them and they were my age. Also, Debbie and Ryan got to meet Ginny and Cecil. Then very tired Debbie and Ryan went back to the hotel for the night and I went to my host family house. They are here in Nica safely and I am so blessed to have them in my life!

Love,

Ayla Landry

"A rock pile ceases to be a rock pile the moment a single man contemplates it, 
bearing within him the image of a cathedral."   ~Antoine De Saint-Exupery

It's Raining, It's Pouring!!!!

April 27th was the first day of the rains here in Managua. Which marks the beginning of rainy season when it rains nearly everyday, sometimes just showers and sometimes full on flash flood.

The cool winds came then the thunder, then some cheers and then people running to find shelter as the rains this year came with gusto. It poured for a good hour and a half with thunder and lighting and the whole enchilada. My host brother and I ran around the house giving each other high-fives and singing about the rains. Happy First Rain everyone!
However as it turns out that big storm was a tease and the real rains came May 11th. It has rained every day since. Welcome Rainy Season! 

Love,

Ayla Landry

"If we are facing the right direction all we have to do is keep moving." Buddhist Proverb

Funny Fact!

Here in Nicaragua there are:

• Lizards that sound like birds
• Birds that sound like monkeys
• Monkeys that sound like Dogs
• Frogs that sound like lasers in a video game

Near death experience….

So last Thursday Dr. Karla and I were taking 3 little children to lung doctor appointments with their mothers.  These little ones are all in the special needs program and have had chronic respiratory problems including pneumonia, and severe sinus infections. One of the little ones name is Edwin. He is 4 years old and has been in and out of the hospital the entire time I have been here. He has black hair, the longest eye lashes I have ever seen, a tiny body, seizures, a waist that I can reach almost all the way around with one hand, his chest looks like a basketball from all the work he does to breathe, and he has the brightest smile. Another of the little ones is a 5 yr old little boy named Patrick. He has dark blonde hair, and the same body type as Edwin, and does not focus on you with his eyes but smiles at the sound of your voice. We have been trying to get him health insurance but his mother/family legally does not exist…they are not registered with the government…so insurance is a work in progress still. The last little one is a precious girl named Dayana. She is 2 years old, has blonde hair, and was very weak, gasping for breath and in very grave condition when picked all of them up. In the car on the way to the lung doctor appointment, Dayana almost died. 

She got very pale, she was gasping wildly, tongue out and heaving to get some air until she threw up a lot of phlegm and began to cry ever so quietly. Another one of those hopeless moments where my heart ached for this mother and child and all I could do was encourage and pray. She needed to go to the ER and so off we went rushing through the crazy Nicaraguan roads to get little Dayana to the hospital as fast as we could. She began again to get very pale, nearly passed, and gasping wildly. Her mom was patting her back and holding her upright and praying nervously that her daughter be okay. Dayana’s little body needed oxygen and fast. When we arrived at the ER no one was at the admissions desk so I walked around until I found some one that would attend to her. At this point Dayana was breathing minimally with every muscle she had and very weak. Finally, they got her attached to a monitor to check the amount of oxygen in her blood and I gave her mother Dr. Karla and I’s cell phone numbers and left her for the hospital to attend to her. We got a call a just a couple hours later from Dayana’s mother very worried because Dayana was intubated (meaning a  tube was inserted into her mouth down to her lungs to get air to her lungs) after Dayana had been gasping, fainted, and stopped breathing. Dayana was now in intensive care and her mother was left outside of the hospital to wait for word from the hospital doctor. We visited first thing the next morning and learned that Dayana’s mother slept on a cement bench all night without food, or water. The love of mother is so strong, loyal and special. A friend had come and brought her clothes. The love of a good friend is so important and the wind under your wings when we are weak. Dr. Karla and I gave her some food, and money. We checked on Dayana and she was still attached to the lung machine and heart monitors and not able to breathe on her own. I am glad we had brought her to the hospital when we did and that she is now in a place to get the advanced care that she needs. We will be following Dayana and her mother through this process and praying that Dayana’s body become healed and strong soon.

Love,

Ayla Landry

“Great things are done when men and mountains meet.” William Blake

Ginny, Cecil, and the missionary groups are back!!

Ginny and Cecil are wonderful wise and loving people in my life here in Nicaragua. They have been in the States for a few weeks and came back to Nicaragua this week. They are the on-site representatives for the board of directors of the organization I have been working with called Nicaraguan Resource Network (NRN). They have been married for many many years and have been involved in Nicaragua for nearly 20+ years. They are my parent’s age and have been my American parents here in Nicaragua. We have shared ideas and vision for the medical program, prayed together, played together, eaten together, lived together, celebrated together, encouraged each other, guided me, listened to each other, and they have blessed me in so many ways. The love they show to the groups that come to Nicaragua, the love they share in their marriage, and the love they have shared with me has been and will be a gift that God will use in glorious ways. Their wisdom, humbleness, and thoughtfulness amaze me and I look up to them. God has certainly used my relationship with them to teach me much about love, justice, culture, faith, and life as a missionary. Learning the importance of relationships and all these things will be lessons that will stick with me as I move forward in all things especially in future international health programs. I am so happy that they are back and I look forward to spending time with them more over the next few weeks here in Nicaragua.

Ginny and Cecil host the missionary groups from the States that come down to support the NRN mission. This week following Ginny and Cecil’s return came a group of 20 young adults (my age) from Indiana. They have been working on building a church both physically and spiritually. It has been a fun blessing to share time with people my age here. I think I may join them for dinner tonight.

Love,

Ayla Landry

“No one has ever seen God; but if we love one another, God lives in us and his love is made complete in us.” 1 John 4:12

The Pros and Cons of the Rainy Season/Winter...

*Rainy Season is also called Winter in Nicaragua

Pros	Cons
No dust	Flooding in houses, roads, stores
Umbrellas and rain boots	Laundry doesn’t dry very well
Cooler temperatures	Humid
Green and lush flora	Only 1 month of mangoes after the rains start
Birds singing and flying around	Ants, spiders, cockroaches in the house everywhere
Rainbows	No breeze
Thunder and lightning	Muddy run down roads, run down cars=accidents and traffic
Frogs that sound like laser toys	People use the run-off rain water for cooking, washing, bathing
Falling asleep to the sound of rain on the tin roof

“Rainy Season is when you feel like whistling even with a shoe full of slush.”  ~Doug Larson 

Happy International Nurses Day!!

There have been little news clips about International Nurses Day since last Saturday and thanking nurses in Nicaragua for the work that they do. Today, May 12, is International Nurses Day and Woo Wee did we nurses celebrate! I was invited to the Nurses Day Reception by the director of the nursing school I visited and I was seated as a special guest. The Nicaraguan Nurses Association hosted the event and 1,500 Nurses from all over Nicaragua came to the event!! They all entered the convention hall that is part of a nice hotel here in Managua with big smiles and loud greetings. Some were in jeans and nice blouse, others in formal cocktail dresses, and others in the full blown nurse outfit (white shoes, white stockings, nurse’s cap, nurse’s cape.) Nursing students were working the event. The bathroom was full of women helping each other put on make-up, fix their high heels, fix their hair, and pin on the nurses caps. The event was planned to start at 9am but in true Nicaraguan style we didn’t get started until closer to 10:30am. There was a big banner at the front of the room that said “Resolving disparities by raising access and equality.” All the nurses who have been nurses for 25yrs, 30yrs and 40yrs were announced one by one and walked under an arch way white flowers (I think they were Lilies) made by the new nurses holding the flowers in an arch. Then proceeded the Nicaraguan Flag was the Nicaraguan Nurses Association flag, the nurse’s lamp, and then the board of directors of the Association. The President wore a white sash. We sang the Nicaraguan National Anthem, a pastor led a prayer, and the president of the Nica Nurses Association spoke (a speech remembering the life of Florence Nightingale and the accomplishments of Nica Nurses). We held a moment of silence for all the Nica nurses who were not able to be there and nurses around the world. Then all the 25yr, 30yr, and 40yr nurses received certificates/gifts as they walked across the stage one by one as their names were called. There were about 100 recipients and it took 2hrs and 15mins for them to walk across the stage. After that there were special awards, one of them was for the first Doctor of Nursing in Nicaragua, and another for a nurse that has been a nurse for 65 years (and is still working). Then, we sang the Nurses’ Hymn and had a nice buffet lunch…there were no rice and beans! As I was in line for lunch I heard music start playing loudly from the room and the lights went down, and flashing colored lights went on. Lunch rolled into a dance party. It was amazing…at least 500 nurses of all ages were dancing together. Salsa, meringue, cumbia, and then just some wiggling for those that didn’t know how to dance. The older women were into it and were really fun to watch. I danced too and on the dance floor ran into some nurse friends that I have met on this trip and my previous trips to Nica. It is so good to see nurses celebrating their noble profession and being recognized for their hard work. These women were proud to be nurses and I was proud to be celebrating my first International Nurses Day as a licensed nurse with all of them!

Love,

Ayla Landry

"So never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself."  ~Florence Nightingale

A lesson in cultural sensitive care

Today, Dr. Karla, our new assistant Patricia, and I went to the school in La Concha. It is the most rural school that we work in. The school and much of the community does not have running water or clean bathrooms. We attended to many coughs and tummy aches, and then followed-up on the case of Julia who had been having convulsions and bleeding from her ears, nose, and mouth.

Julia’s lab work had confirmed gastritis and that seemed to be gone along with the bleeding from her mouth. However, the neurologist said after testing that her convulsions were not from her epilepsy but in fact pseudo-crisis from some psychological trauma.

When Dr. Karla began talking about this to the school director, she did not talk about how psychological trauma can cuase changes in your brain if it is not coped with well and how a psychologist could help find and treat the cause of the convulsions. Instead, the conversation was about how Julia is possessed by demons. We didn’t talk about what could have been happening in her life around the time she started having convulsions except for that fact that she had been playing Wikki board with friends and the devil must have captured her. To help her, they talked about finding a Pastor to cast out her demons. Dr. Karla has a Pastor in mind that is also a Psychologist.

Similarly, a little boy named Ismael was diagnosed with leukemia the week before Easter. His parents then, after Ismael received a complete blood transfusion and one dose of chemotherapy, took Ismael out of the hospital and stopped all medical treatment saying that God was going to cure their child. When Dr. Karla and I went to check on the boy for the first time since he had left the hospital after Easter, Ismael had his color back, was talking, and could move his legs….relatively better. However, this was interpreted as a miracle of God healing the boy. Not once was the possibility of this change being due to his replenished blood and one dose of chemo that if not cured would come back like before. We rejoiced with the family and prayed with them about the miracle that God had preformed. We will diligently check on this child, pray with the family, and be there as a trusted person to call if things start to go wrong or get miraculously better.

Additionally, there is a young girl named Guadalupe who has Tuberculosis whose parents decided to stop treatment and let God heal their child. Well, if you do not know, Tuberculosis (TB) is an extremely infectious disease that eats the lungs and can be fatal/dangerous to populations if not treated properly. The public threat of this case made managing cultural sensitivity and clinical care more difficult and urgent. However, again we did not force the mother to start the treatment again or argue with her about the necessity of medical treatment. We simply scheduled more appointments with lung/throat doctors for her to be able to follow-up and re-assess her daughter’s condition. (after visiting with these specialists the mother decided to begin treating the TB again)

 In all of these situations, I listened, and watched and resisted the urge to discuss the scientific/clinical view of the situation that I was thinking. I was evaluating my automatic reactions to these beliefs/care plans and learning how to respect their beliefs and culture while still attending to their clinical needs. Who am I to contradict their beliefs when quality of life, trust, faith, hope, family unity and peace were all variables? Trust, understanding the mental and spiritual aspect of patients, an open-mind, faith, and love are all critical parts of any patient/caregiver relationship.

Also, as a side note here in Nicaragua, there are lizards that sound like birds, birds that sound like monkeys and monkeys that sound like dogs. And Nicaraguans are the hardest working people that I have ever encountered.

Love,

Ayla Landry

“Assumptions in foreign countries are a bad thing.”

Happy Mother's Day!

Today is Mother's Day in the USA. Nicaraguan Mothers Day is May 30th. I am going to celebrate twice.


Thank you Mothers for all that you do! You all are very special people!


Love,
Ayla Landry


If you have a mom, there is nowhere you are likely to go where a prayer has not already been.  ~Robert Brault

We Have A New Assistant!

 This past week was a relatively easy week. On Monday it was Labor Day here so I did not have work. I stayed home translating and spending time with my host family. Tuesday and Wednesday Dr. Karla and I went to the schools and did consults in the morning and then tended to some special cases in the afternoons. There are a lot of things to be praying for. Thursday I had an online meeting in the morning and ended up just staying at my house and working on some administrative things that Dr. Karla and I have been falling behind on.

Then Friday was a great day! Our assistant started working and I oriented her at the Quinta about her position. Her name is Carla Patricia (I call her Patricia to avoid confusion with Karla vs. Carla) and she a Nicaraguan. She is 23 years old too and is excited to be helping the project…plus she is super organized and good at the computer!

It is important that the project of providing healthcare to the 1,800 Nicaraguan kids in the NRN (Nicaraguan Resource Network) schools is sustainable and as manageable as possible. Having an assistant and soon a Nicaraguan nurse will really set up Dr. Karla to have the basic stable support that she needs to develop the project and manage all the work that is involved….not to mention have some great ladies to share in the joys and sadness of the work. Sustainability is important in any project hoping to have a long term presence and impact. The addition of Patricia and soon a nurse will make providing healthcare to these children sustainable and impactful.  I am really excited about the assistant and the growth that the project has had in just the few months that I have been here.  I can only imagine all the wonderful blessings and work that is going to happen as the project continues to develop more and more.

Love,

Ayla Landry

“We grow great by dreams. All big men are dreamers. They see things in the soft haze of a spring day or in the red fire of a long winter's evening. Some of us let these great dreams die, but others nourish and protect them; nurse them through bad days till they bring them to the sunshine and light which comes always to those who sincerely hope that their dreams will come true.” - Woodrow Wilson

Different Things

Things I have noticed to be  bit different:

• Doctors and nurses are not taught about ethics of their work with patients
• In the country of Nica, there are 3.6 nurses to every 10,000 people
• No toilet paper in public hospital bathrooms
• Patients cannot look at their own medical chart
• Children and adults juggle fire in the intersections of major streets for money
• Beggers touch, knock your car at intersections
• Once it starts raining, there isn’t a day without rain for nearly 6 months
• Stop lights can go from Red to Yellow to Green too
• Futbol/soccer is a big deal…everybody has their team. Madrid/Barcelona/Manchester…
• No one knows their birthday
• There is no right way to spell your name…Jason, Geison, Yeson may all be the same person
• A  water bottle costs 50 cents
• Medications are not locked in hospital…not even the morphine, epinephrine, atropine
• A glove=a tourniquet
• If there are air bubbles in the IV line….no problem
• IV sites are covered with opaque tape so you cannot see the IV site
• Intramuscular injections may bubble for 3 minutes, change 2 different colors when you mix the dilute and crystallized if you do not give it within 30 seconds
• Sterile materials are wrapped in newspaper
• Nurses work 24 hour shifts with only 1 day off before they work again
• There is no call light in the hospitals except for executive rooms at private hospital
• A nurse makes $4,200 a year
• There is no “hi, my name is _____ and I am going to be your doctor/nurse.”
• It’s okay if goat wanders into your house
• Chickens/roosters are often on the roof of your house
• Ants, cockroaches, lil spiders, the occasional bird, and neighbors dog are just another part of your house…especially if it’s raining
• Coffee and coca-cola are like water
• Nobody at the schools check to see if the students have had all their vaccinations
• A sharps container for needles in the hospital is a milk container that has a big hole in it and sits on the floor or on the counter labeled with a marker
• Prayer is often a simultaneous event with everyone who is around the table/in the circle/in the church praying at the same time
• Labor Day is May 1^st
 Love,

Ayla Landry

"Differences challenge assumptions." Anne Wilson Schaef