Nicaragua Day 6

We ended our week the way we started: back in the clinic. This was a day for follow-up on the patients treated on Monday: removing stitches, checking healing, and a few more mole removals thrown in for grins.


In the morning, I went over to the school with Kristin (who had been spending a lot of time with the community outreach), Steve (medical-student-to-be), and our translator/guide, David, to meet with one of the sisters and visit a few homes of children La Merced would like to sponsor for school. (Shameless plug: $100 covers a year of tuition and uniforms for a child. Email Tina Perrotta at tina@la-merced.org).


The first home was one of a long row of shacks bordering the main thoroughfare and sewer runoff in Managua. The mother met us outside to lead us through a short, narrow path of fence on one side and corrugated metal on the other. Seriously narrow. Anyone beyond medium build would have had to sidle their way through. The one son who needs to be sponsored was at work. Morning school is for the younger kids, while the older kids are out working. Then, in the afternoon, the older kids attend classes. Her youngest son met us in his underwear, roaring exuberantly. Playing lion, perhaps? The narrow path led to a small courtyard with a cooking area to the side under an overhang.


The home was neat and tidy. Water was everywhere from the morning cleaning, but as half the home is exposed to the elements, the floors were drying rapidly. Adjacent to the cooking area was the main living area, with a curtain partioning off the sleeping area. The mother's graciousness openness is testimony to the adage, money isn't everything.


The next family we visited was currently living with a grandmother who ran a small market in the front of her home.


She's anxious to have her home back to herself, so the family is under quite a bit of pressure to find other living arrangements. Her daughter, husband, and four children had moved in with her when her husband was laid off.



He's been able to find part time work at a pizzeria, but has to rely mostly on tips. Out of that has to come costs for public transportation to work (it isn't close), and food, as he often isn't welcome to eat at home. The couple's two young sons are currently at home, and the daughters are both at school at the local parish.


After our visits, we returned to the school to meet the daughters and visit with some of the other children before returning to the clinic. One of the girls had been a patient on Monday, with a particularly painful keloid on her foot. While her mother waited outside for her, I had stepped in to let her hold onto me during the procedure. It was great to see her again, and I was pleased she remembered me. Unfortunately, she had disregarded the doctor's orders to rest her foot and keep it dry by going to the school dance. No stitches out for her!


Back at the clinic....


... good progress was being made on the patient load. They had a rhythm with patients rotating in and out of the two beds in the makeshift OR.



One patient returned who had had a cyst removed from her foot. On Monday, while she was pointing it out, our screener noticed she wasn't using her right hand. She asked to see her arm, and was shocked to see what looked to be a gaping hole with phenomenal scarring.



About 20+ years ago, while the U.S. was embroiled in hearings over the Iran-Contra affair, she was crossing a river with her two-month old baby, attempting to flee from conflict that had erupted in her community. A bullet ripped into her forearm, the one holding the baby. It traveled up her arm and exited out at the elbow. The baby fell into the river and drowned. Both time and poor surgical work had impaired the nerves in her arm, putting her hand into a permanent claw position. While only her cyst was able to be removed on this trip, La Merced is planning to discuss her case with experts here in the States and hopefully be able to do more for her on a return trip.


At the end of the day, the government administrator of the clinic spoke for a few minutes, expressing appreciation on behalf of the people we had been able to help. Her daughter had made little wooden ornaments which she presented to each of us with a thank you inscribed on the back. It was a small gesture, but it garnered a huge outpouring of emotion from the La Merced team.