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Debbie Michaels, Rabbi Aaron Rubinstein, Tresha Mandel

Dr. Amy Hertz

(or 3 Little Piggies Came to Clinic)

I have been asked to write tonight’s blog from the provider point of view. I was hoping another provider (there are 6 of us in all) wanted to take to the keyboard, but somehow I am here instead. I thought about what I would write for most of the return ride from the small community of Santa Lucia, the site of today’s clinic. If I were a great writer, I don’t think I would have gone into medicine, and as I have said in the past, my choice of words is not fancy, but I think I can get my point across. I thought about doing this as a disjointed, bullet point style of blog, as I have so many thoughts racing through my mind that it may be easier just to list and write. But I will try to stick to the themed paragraphs and my 11th grade English teacher may be smiling somewhere.

This is my third visit to Nicaragua, and my second mission trip. The beauty of the landscape never gets old or tiring to look at. We went so far up into the mountains, that at some point we were in the clouds. The lushness of the banana trees and coffee bushes never grew old to see. However this year there is a coffee blight/fungus that is causing great damage to the extensive coffee crops and they expect there to be much lost. We have been told to stock up on our coffee this year, as next year there will be less and it will be much more expensive. We had a 90 minute ride up the magnificent mountain terrain and I don’t know how Oscar, our amazing bus driver does it. There is no such thing as a street sign, or a street name and one dirt road looks an awful lot like the next dirt road. After about an hour, Oscar slows the bus down to a stop, and off to the right was a nice wide dirt road with a gentle incline. Off to the left was an extremely narrow, muddy, straight up to the sky road (if you could call it that). Iris, one of our very quiet, soft spoken team members points off to the right and says in an ever so soft voice, “that way looks much better.” And with that, Oscar heads up the treacherous road to the sky.

A bit later we pull up to this nice flat area (flat is really nice when offloading the bus…) just in front of a school. This being the very first day of school of the new school year here in Nicaragua, there was a handful of kids in their new school uniforms hanging around the front of the school. Our leaders Joy and Tresha got out of the bus and had a long discussion with the local person in charge about this location vs the other location that had been chosen and cleaned. There was no way we were getting into the school and then had to head another couple hundred yards up the road. Of course the patients who had lined up to be seen had to walk up the road as well. We arrived to a home, and basically were using the empty horse stalls to set up clinic and that is where we saw patients. The family, mom and dad and their 5 children live in a small one room area that looked no more than 8 feet X 12 feet. And there were kittens and chickens inside as well. I actually sat in the sun all day and did not have the simple luxury of a roof over my head. There were guards in army fatigues around the area, and I think when they saw we were not a threat, they left. There were chickens and doggies running around. There were three adorable piglets running around as well. And the roosters strutting around were quite a sight. Unloading and loading the bus was a schlep up and down a gentle slope, but the tricky part was navigating the horse caca. We have learned many words for poop this trip, our favorite being “nya nya.” The neighbor’s “latrine” was cleaned just for us. Joanne and I braved a trip up to it before we got started. There in a rotting wood outhouse was a “toilet” that consists only of a bowl over a hole leading to the ground 3 feet below. Stand in wetness, straddle the bowl, do the “dirty potty squat” and pray you don’t miss. Oh yea, DON’T BREATHE!!!! Walking back to the clinic, we passed their only means of cooking…the clay oven outside the house. A chicken ran out of it. Thankfully for that bird, the fire was out!!

So we set up and got to work. It didn’t matter that the discrepancy in locations put us almost an hour late in getting started. People came from all over. They once again lined up in the hot sun and waited. And waited patiently and quietly. Even the babies and kids waited, and waited. And we saw them all. Today 220 patients.

I want to tell you about some of the complaints and some of the people. Many of the complaints are very similar to those we see in our daily jobs. Aches and pains, headaches, burning sensation in the stomach, and multiple complaints of burning with urination. Every backache is perceived as a kidney problem. And there is a common complaint of dizziness in the adults. But when we look around at the living conditions, what you and I think of as common complaints really are a result of the living conditions of the locals here in these communities. There is no running water, thus you can imagine what it must take to stay clean. They collect some water in a bucket every day or so, and it must be boiled to use. Clothes and people are washed often in a local stream. The toilet facilities are but a hole in the ground. Please try to imagine the difficulties of potty training a child, or someone who may need a little more time to do his business as we say. Fires are burning inside the homes throughout the day, so itchy,irritated eyes is a real issue. And aches and complaints…..These people walk up and down rugged terrain all the day, in shoes that offer no support. (picture the cheap vinyl or plastic flats from payless). I asked a man who complained of backaches where he slept, did he have a mattress, or maybe hay or straw? He told me that every night he unrolls a blanket over some slats of wood and sleeps on that. Every one in his house does. It’s no wonder that he has a backache. I would too!! And dizziness comes from smoke, dehydration, hypertension and hard work in living conditions that we cannot even begin to imagine. And to the child who has mouth sores from a virus and I wanted to teach about giving him a popsicle or something cold to drink, that is not even an option because there is no refrigerator in the home.

And did I mention that there is no electricity? So as the sun goes down so do the people. No wonder that they are up and out at the crack of dawn, as the roosters crow. And I think the one who left the biggest impression on me was the woman who was pregnant with another child. I asked her where this child would be born and where had her others been born and she told me that only one was born in the clinic. The others were born at home. No one came. She delivered the baby there by herself.

So I started to look at some everyday luxuries from a different perspective.... When a toilet overflows, or here in Jinotega where I have to throw my toilet tissue in the trashcan next to the toilet, I am thankful that I have a toilet, and I can breathe when I use it. And I can sit on it without a problem. And although this year in the orphanage we have hot showers, I would gladly settle for the cold showers that I took last year, because I am thankful for running, clean water. And as much as I don’t like the dimness of much of the orphanage, because electricity is so expensive, I am so thankful that we have electricity, and some light bulbs to brighten a dark room. And when I lay my head down on the pillow on my bunk bed tonight, I am really thankful that I have a mattress, and a blanket, and some clean pajamas to help me sleep better. And when I wake up in the morning, my back won’t be hurting as I start to do it all over again.

But perhaps the highlight of the day came when those 3 little piglets ran down the hill into our area and all throughout the “clinic” bringing smiles to everyone around.

Maybe we are making a small difference in some people’s lives. All of us are here and coming together for the same reason. But as much as we may touch our patients’ lives, I do believe that all of us on this Tikkun Olam Nicaragua mission trip will be affected much more by those patients and locals we have seen over the past few days. It is about survival here and just getting to the next day is a blessing.

Thanks to all of you who make this a possibility from our families and friends, to our supporters near and far. A special thank you to Landau Uniforms for providing us with our styling team scrub tops this year. And keep on reading as our adventure has only just begun.

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