Sunday, August 22, 2010

The presentation

The group left El Sauce on Saturday morning (July 17).  It was a strange feeling to be moving out of the place we had called home for almost a month.  We said teary goodbyes to Perla, the UNAN nursing preceptor who had been with us for almost two weeks.  We hugged and said goodbye to the Hotel Blanco staff, and told them we would return on Wednesday to give the presentation in their dining area.  Some members of the group jumped on a bus and headed to Granada for a couple of days.  The rest of us headed back to Leon to work on the presentation and to go volcano-boarding on Cerro Negro. We worked on the presentation Sunday, Monday, and Tuesday, and had a practice run-through with the whole group on Tuesday night. We agreed to have four presenters, and the group gave the presenters feedback on their Spanish presentation skills.  I went to bed excited and nervous for the next day's events.

The next morning was not the smoothest of mornings.  I accidentally overslept. One of the presenters woke up sick and was not able to come. I ended up taking on her portion, which I reviewed in the van on the way there. We scrambled into the van with only one laptop, and as it turned out, it was not the laptop with the presentation on it. The driver did not know we were supposed to pick up Dr. Peña.  Luckily, we figured that out before we wasted too much time.  When we picked up Dr. Peña, I informed the driver that we needed to go back to the hostel to get the other computer.  Somehow along the way he forgot that we needed to do that and we were almost all the way out of Leon by the time I realized what was going on.  Fifteen minutes later, we were finally on our way to El Sauce with all necessary people and tools in the van. Phew!

We arrived at Hotel Blanco and hour before the presentation was to begin.  We were informed that due to a city-wide power outage, there was no electricity anywhere in the town except for those places that had generators.  I thought to myself - OK, so we're going to do a presentation with no projector and no fans......uh oh.  Luckily for us, Hotel Blanco had a generator and they said that they would provide power for our presentation.  Phew! (again)

The presentation was scheduled for 10AM and much to my surprise some people actually arrived at 10.  Paola, from the health center, invited nurses and doctors from the clinic, the vector-control workers, and local  health department staff.  Our guides showed up proudly sporting their UNC garb that we gave them at the 'fiesta de despedida'.  About 20 people attended and the presentation began at 10:15. Dr. Peña opened with a brief introduction and a few words about the continuing collaboration between UNC, UNAN, and the health center in El Sauce. We presented preliminary statistics on the demographic information of the survey population, perinatal care, STI prevention methods and knowledge, diarrhea, social networks, and unintentional childhood injury.  We presented the information mainly in bullet points and tables, but we were also able to include maps of the spatial distribution of the data.  I thought the presentation went really well, and I was very proud of our group for pulling something together so quickly and for being able to competently present our findings in Spanish in front of a large group.

Attendees had the opportunity to ask questions and make comments at the end of the presentation.  The health center is collecting some of the data we collected as well, and it was interesting to talk about the differences in what they have found and what we found.  For example, we found that about 75% of women had had a Pap smear, but Paola thought that number was too low.  We promised to do further analysis to see if there are certain areas where the uptake of Pap tests is particularly low.  This information will help the health center target its outreach programs to the health issues of specific communities. The attendees were also interested in the process and software we used to create the maps of health data.  Data mapping technology would be useful for monitoring outbreaks of vector-borne diseases in the El Sauce municipality. Dr. Peña explained that it was a matter of linking GPS points to data in Excel using a specific kind of software, and he said that UNAN/CIDS would help the health center work on their mapping activities. Another attendee (a nurse) suggested that we add questions about HIV testing to the survey for next year.

We received all positive feedback and the health center staff told us that they were grateful for our work. We promised to send them a full write-up of our findings after we have a chance to thoroughly review and validate the data.

I took one last trip to the health center to take pictures of the health posters they have on many of the walls. I said my final goodbyes to Paola and Dra. Velazquez who told me that they look forward to working with the UNC-UNAN partnership in the future.
Paola and Dra. Velazquez
That's me, presenting
Elena presenting
Anisha presenting
Question and answer session
Dr. Peña - opening remarks

Tuesday, August 17, 2010

Inauguration

On the same Thursday we met with Dr. Pena we also went to the inauguration of a new hospital in El Sauce. The event was scheduled for 3PM 'Nicaragua time' (or maybe 4, depending on who you ask). As we have been told many times since starting work in Nicaragua, there is regular time and then there is Nicaragua time, which can mean that the person or thing you are waiting for may be 15 minutes to an hour late, or may just never show up. Life in Nicaragua is not about being in a hurry or constantly checking your watch; it is about taking the time to engage with others, it is about patience, and it is, in some cases, about survival.  Mothers arrive at the health clinic expecting to wait for hours for care, and we have spent enough time in Nicaragua to know not to show up at 3PM for this event.

It turns out that the concept of 'Nicaragua time' also carries over to completing projects, such as the new hospital. The inauguration event occurred on July 16th, the official opening date for 14 hospitals and 24 Child Development Centers throughout Nicaragua. Though the hospital structure, wiring, and much of the plumbing is finished, there is still plenty of work to be done and the true opening date has slid to mid-August.  The head Epidemiologist of the El Sauce health center said that the new hospital does have an X-ray room, although they have no X-ray machine, and they have space set aside for ultrasounds and laboratory work, although they lack a sonogram machine and some key lab equipment. It has capacity for 30 beds, and is much larger than the El Sauce health center. I truly hope that this initiative brings in adequate resources and doctors to utilize this space to its full potential. You can read more about this initiative here in Spanish and here in English.

Prepared for a delayed commencement, we lazily strolled over to the event, which did not actually start until 5:30. The majority of attendees was dressed in red and black - the colors of the Sandinista National Liberation Front (FSLN) - and at times it seemed more like a political rally than a celebration. The FSLN is the current party in power, the president of which (Daniel Ortega) is said to be responsible for the initiative to open these new centers. The FSLN is named after Augusto Cesar Sandino, a national hero, who led the Nicaraguan resistance against the United States occupation of Nicaragua in the 1930s. The small child sitting in front of me wore a shirt that said "Hay hombres que tienen la Revolucion en la boca, y viven de ella...Pero hay quienes la llevan en la sangre y mueren por Ella", which roughly translates to 'There are men who have the Revolution in their mouths and live for it, but there are those who carry it in their blood, and die for it'.  Amidst cheers of 'Viva Daniel!' we watched young women dance in traditional costume and style and listened to a band play songs praising the FSLN, the revolution and Daniel Ortega. Unfortunately, we had to leave early for dinner, but we were grateful to have been invited to the celebration.

Thursday, August 5, 2010

Wrapping up our last week in El Sauce

Our last week in El Sauce involved visiting the only remaining community - San Jose.  A large village of 60+ houses, it took us two days to complete.  We felt a great sense of accomplishment as we headed home that second day. We invited the guides to attend a farewell dinner on Thursday evening and they accepted.

Thursday morning we met with Dr. Peña.  We discussed plans for a final presentation in El Sauce the following week.  There was still some data entry to be done, but we planned to finish it by Saturday, thanks to the hard work of Cathy and Jess, our two main data-entry people.  We explained that the data would still need to be reviewed for any errors, and that would have to wait until we returned to the US.  But we agreed that we would be able to present some preliminary statistics as part of the presentation.

We also discussed our intent to donate more medical supplies to El Sauce, using the money we had made selling Selva Negra coffee in the spring.  Though money was tight due to our move to El Sauce, we as a group felt very strongly about providing something tangible to the healthworkers in El Sauce.  We had already distributed some medical supplies donated by MedWorld and UNC doctors and nurses.  But we wanted to use the Selva Negra funds for an urgent need identified by the health center.  Dra. Velasquez and Paola (two of our local project stakeholders) told us that the 'Casa Materna' currently does not have a lamp for obstetric examination.  Pregnant women who live far from the health center arrive at the Casa Materna around the time of predicted delivery date, and wait to deliver there.  Also, women with pregnancy complications stay at the Casa Materna so that they can be monitored.  Casa Materna is associated with the health center but it is a separate building. Dra. Velazquez and Paola also requested that we purchase more strips for urine testing.  Blood tests are often not possible due to the lack of laboratory equipment, and so urine tests are much more commonplace. We gave Alex, the UNAN -UNC coordinator $300 to purchase these items and planned to present them to the director of medical services at the health center after the presentation.

Thursday evening was a blast. Several of the guides joined us for dinner.  The owners of Hotel Blanco surprised us by bringing in a band especially for us - they played typical Nicaraguan music as well as some cumbia and dance songs.  We sang and danced until the late late hour of 9PM, when everyone was tuckered out from the long day.  We were very grateful to the staff of Hotel Blanco for giving us such a lovely send-off.
The group at our 'cena de despedirse'



The band!