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 

Nursing school in Nicaragua

I visited a nursing school here in Nicaragua on Saturday and learned all about nurse education here in Nica! The university is called La Universidad Martin Lutero and is conveniently located right next door to my host family house! I met with the Director of the Nursing Department, a really nice lady named Mercedes. She toured me around the nursing school and then we talked for a good 2 hours about nursing in Nicaragua and their school. I love meeting other nurses. There is a common thread of compassion and nurturing in all of us nurses. I love encouraging, supporting, and learning about nursing around the world.  Nurses Unite!

Okay so here is part of what I learned about Nurse Education in Nica:

There are 3 different levels of nursing here:

1.      Nursing Assistant: 9mo-1yr education program (equivalent to our Clinical Technicians)

2.      General Nurse: 3 year education program (like an LVN)

3.      Licensed Nurse: 5 year education program (like an RN)

There are 4 specialties (certifications) that you can get with an extra 1 year of education

1.      Mother/Baby

2.      Critical Care

3.      Public Health

4.      Administration

There are 4 Master’s in Nursing programs for another 1-2 years of education

1.      Advanced Clinical Nurse

2.      Nurse Educator

3.      Public Health

4.      Epidemiology

Like in the States they have classroom time and then time in the hospital/clinic/community doing hands on practice. Every Nursing school has a different color of scrubs/nurse uniform that they wear to clinical. Martin Lutero’s color is light blue. The director of the nursing school coordinates with a teacher that they have hired at each of the hospitals they do clinical practice at and that teacher is involved in supervising and evaluating the students at their clinical practice. There are normally 20ish students per teacher at clinical practice for Martin Lutero which is a smallest nursing school...in the university I went to groups were of about 6-8 students.  This is an issue becuase the teacher cannot supervise all of them and students do not get quality hands on practice before they begin their nursing career when here in Nica there is an average of  40-50 patients to 1 nurse in the hospitals. The new nurses will be pulled in a million directions with too many tasks to prioritize and manage and hadn't even had good hands on practice. AHH!

Nursing Students in a Licensed Nurse Program have clinical practice in:

1.      Observing and Learning the Role of a Nurse

2.      Fundamentals of Nursing (Vitals, basic assessment, positioning, bed baths, and intro to documentation)

3.      Surgical Nursing

4.      Maternity

5.      Community Health

6.      Administration

7.      Critical Care

8.      Psychological nursing

9.      Practicing the Profession (last clinical when solidifying skills and working as a nurse)

There are 3 nursing schools in Nicaragua:

1.      UNAN: the only public university with a nursing program. It has the biggest program

2.      UPOLI: private university. Most expensive nursing program.

3.      Martin Lutero: private university. Newest nursing school. Smallest and still developing nursing program.

The University Martin Lutero started its nursing program with hopes to get authorized by the Ministry of Health (equivalent to our National Health Department) to  have the nursing that graduate have their license and be able to do clinical practice in the hospitals/public clinics. However, for the first couple years they did not have this authorization so it was really tough for the school to organize clinical practice. They now have had the authorization from MINSA for the past 2 years to prepare Licensed Nurses and have been growing and developing their program with great vision and organization.

They currently have minimal supplies in their practice lab and have not been able to give their students an opportunity to practice any hands on skills before they get to the hospital/clinic. Students pay $30/month to attend the university. The main campus is here in Managua where they have 1,000 nursing students. However, what is unique about this university is that they have 21 seed universities all over the country where they have another 1,000 students and are preparing nurses to reach the rural, low healthcare access areas!

I have this dream of setting up partnerships between US nursing universities and other nursing schools around the world to share resources, education materials, and experiences to enrich and educate nursing students about nursing around the world. The director of the nursing school loved that idea and thought it would be fruitful for both parties. I see so much potential in collaboration and relationships with nursing schools. Go Nurses!

International Nurses Day is May 12^th and the Mercedes wants me to go to the celebration with her and is planning to introduce me to the president of the Nicaraguan Nurses Association! She also wants me to be a part of the celebration at their university on May 14^th. I am so excited to have spent the day with her. What a blessing! We will see what comes of the dreams I have for supporting nurses all over the world.

Love,
Ayla Landry

“Unless we are making progress in our nursing every year, every month, every week, take my word for it, we are going back."~Florence Nightingale, 1914

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