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