Nicaraguan Health Care: Where Hospitals are Cemetaries

I've been trying to write about this experience for the past few months- and each time I sit and put my thoughts into it I find myself too irate to begin. The story must be told to all who will hear, and if you are reading this right now I thank you for your interest in something that rarely affects those in the first world, something that reminds us of the harsh reality of the incomprehensible lack of proper health care in the third world.

November 2008...

One of my best girlfriends here in Nicaragua, Mayerling, waltzes into the room with her own soundtrack which sounds something like a funky rhythmed snare drum. She is strikingly beautiful and her dirty humor and easy smile have filled many a night in our home with light and laughter. Today Mayerling knocks on our front door and enters the house a changed woman, the sexy swagger in her step now turned into a saddened shuffle.

“My grandma is dead.”

Mayerling’s eyes lower to the ground, her voice a flat line wavering with choked emotions.

Mayerling tells us that her grandma, who had been in perfect health at age 70, fell and broke a small bone in her hip the week before. The health center’s ambulance took her to the public hospital in Somoto where she was informed that she needed a surgery. Here healthcare is free up to a certain point, but when surgery is involved the family must contribute a certain amount. Mayerling’s family took out a $2,000 loan (the US equivalent of an entire year’s savings) and paid for the surgery, which included placing pins in her hipbone. The next day, the doctor forced her grandma to walk on her newly pinned hip and only let her rest when she began to cry in pain. The wound became so infected (IN THE HOSPITAL) that the doctor decided to re-open it, clean the pins, and put them back in. It was too late, as the infection spread to her blood and left her in a desperate life-or-death fight. Mayerling heard the doctor snidely remark to one of the nurses that he sometimes “operates on people for fun, not because they really need the operation”. Ethical.

Mayerling’s family decided they’d had enough and attempted to take her out of the hospital but the administration (backed by the doctor) refused the request and her health worsened by the hour. The doctor pulled Mayerling outside at one point and told her,

“Your grandma will not make it out of this hospital alive.”

To which Mayerling replied, “and if she doesn’t it is YOUR fault.”

He laughed. In her face.

The next morning found Mayerling’s grandma on her death bed, the infection having spread through her entire body. The family decided to move her to another hospital by force. The doctor was so angry he told them to never come back; he said if they ever tried to return to the hospital they would be removed by the police. Mayerling got her grandma on a bus headed to Esteli (the second biggest city in the country, which is about an hour by bus from Somoto).

She died in that public school bus.

She died because a doctor (who probably does not have any medical training beyond an “internship” of a year after college) faked that she needed surgery, infected her with dirty instruments, then left her to rot away unattended without an ounce of care or compassion.

Mayerling tells us now that her family wants to sue the hospital but knows that because the hospital is government-backed, there will be no way around the bureaucracy. She reports that this doctor has been denounced by multiple former patients on both radio and television, yet continues to hold his post as the head of the hospital in Somoto. They could file the paperwork, but how will they pay for a lawyer now after they just racked up a $2,000 loan? She shakes her head in disbelief, “my grandma was here one week ago. She was fine. They killed her in that hospital and I cannot do anything about it”.

In the United States, or in any developed country for that matter, this man would be put in jail without a second thought. He would be spending years there, thinking of how he wished he had not laughed in Mayerling’s face about the oncoming death of her grandma. Instead Mayerling’s grandma lies in a shallow wooden cross-marked grave in the pined cemetery in Cusmapa and the doctor resides king of his phony hospital.

The real problem stems from the following:

In Nicaragua the current government (so-called Sandinistas who have nothing to do with the actual ideals or actions of the popular revolution in the 80’s) backed by wannabe dictator current president Daniel Ortega use all of its government offices to back movement of the Sandinista (“el Frente”) party. The doctor publicly announces his diehard Sandinista beliefs all over the same radio waves thorough which his former patients denounce him. He will never lose his job because he is untouchable. He is untouchable simply because of his claimed political beliefs, it has nothing to do with the way he runs the hospital or if he kills his patients on a regular basis.

This is the so-called-Sandinistan way of making Nicaragua a BETTER place.

Ortega does not stop at exploiting public hospital administrators for his political benefit; he also uses nurses, teachers, public school administrators, police officers, and any other person who holds public office in order to make his party appear to be supported by the masses. During the current mayoral elections (in which the Sandinistas refused to let in international organizations to monitor voting procedures- leading many to believe in widespread fraud and corruption) Ortega MANDATES that all government employees protest and march in favor of his government. If an employee is unwilling to participate in Sandinista rallies, he or she loses either a large portion of his or her paycheck OR job.

My friend Kelly, a fellow Fabretto volunteer in Managua will lose her elementary school’s director next year. Soledad is a woman who’s built the school up from the ground. Spending any amount of time at the school it becomes obvious that Soledad is a true community leader. The teachers and students at this school are dedicated, happy, and learning. Yet, Soledad is not a Sandinista. She cannot remain in a leadership position under this government if there remains the potential of her denouncing the government’s actions in any manner. She will be replaced by a Sandinista party member regardless of the fact that she is a GREAT administrator and leader, regardless of the fact that she’s given her heart and soul to this school for the past 10 years. After the elections ended here in Cusmapa, the health center “let go” its’ director and a few nurses, leaving only those who participated in Sandinista rallies here in the village throughout the campaign season. They leave the 16-year-old nurse and the quacky doctor and fire competent nurses simply because of political ideals.

To top it all off, after the Sandinistas won the elections (whether fraudulent or not, it’s been decided and they now hold 86% of the mayoral seats in the country) Ortega mandated that all of the government employees AND their families in Managua (the capital city of 2.5 million) rally in 4 of the city’s central rotundas (where the main roads meet). I passed a few of the rotundas in a taxi last Thursday and was, for the first time in my two years in Nicaragua, completely frightened for the future of this country. I witnessed people waving black and red flags in a brainwashed fervor and masked teenagers holding fire throwers and lead pipes and bricks. Apparently (according to the Nuevo Diario, Nicaragua’s only remaining news source that does not support Ortega) the government is paying ex-gang members to incite chaos and to track and terrorize journalists who oppose Ortega. People are dying and wounded every day in this conflict.

And the conflict is not being raged by the losing party “los liberales”, the party that was ravaged by corruption and falsification throughout the whole electoral process. The Sandinista party incites the chaos, backed with their motto of “united Nicaragua will triumph,” singing “what we want are jobs and peace”. In the echoes of the song of peace Ortega supporters throw bricks at civilians and shout “death to the liberals!”

I am baffled.

And at times speechless.

Especially when people inform me of things like my friend Brenda told me earlier today, that Ortega is now talking of the evils of the internet. He apparently wants to block internet access because it feeds people “false information” about his government. He will intend closing down all the television channels except Canal 4, the Sandinista propaganda channel. Ortega’s blatant hatred of foreigners (especially Americans) may become public policy, blocking many of the aid programs upon which so many Nicaraguans rely for survival. The private hospital where Kelly’s friend Aleyda works is an NGO run by a Dutch couple who are already talking about the possibility of leaving the country next year and closing the hospital.

What I do not understand is how many people in this country cannot seem to make a connection between Ortega and former long-time dictator Somoza (whose lethal 60-year rule caused the revolution in the 80’s which led to the Contra War). Ortega fits into the precise definition of a dictator (autocratic control with use of absolute and oppressive rule) and his current government becomes more and more of a dictatorship every single day (a form of government in which absolute power is concentrated in a dictator or small clique- in this case his hypnotized power crazy supporters).

How long will it take the Nicaraguan people to see beyond the billboards claiming “upwards the poor of the world” to the reality of a president who cruises the streets of Managua in a Mercedes Benz SUV flashing a V-for-victory sign as he pulls out the democratic rug from underneath this country?

These Days...

These days…

Are filled with sunshine and relaxation, of afternoon hikes through pine bedded forests, of early bedtimes, of making cookies and cakes with neighbors, spending holidays enjoying the company of my Nicaraguan families, camping in forests and canyons, getting alone-time for the first time in a year, and getting to know both the dark and gold sides of being in a true relationship.

These months…

Are filled with teaching teaching teaching, learning learning learning, of reading mounds of books in the morning sunlight under my orange tree, trips around the country with my dear friend Kate and my brother Cory, heart pounding African drum festivals, beaches and lagoons and monkeys and boating and boogie boarding and adventuring, of fa-la-la Christmas choir concerts, and beach trips with Cusmapan kiddos who’d never seen the ocean, of holding monkeys and ocelots, and watching America finally make a hopeful political choice.

I have not written much these days, I am too busy with life. I go to bed every night thinking of how quickly days pass, at times wishing I could put a halt on this hourglass when I see the grains of sand slipping away before my eyes. I am happy, relatively healthy (though I’ve had a cold for the past two months), and deeply fulfilled by the simplicity of my existence here.

An Election Plea from the World Community

I write to you from the top of a mountain in northern Nicaragua where I currently live and teach music and critical thinking. I've been here nearly two years, and have seen first-hand the effects of American foreign policy in Central America. We warred with Nicaragua in the 80's and left its' people and economy crippled. Many of my students remember the Contra War because they have older brothers or sisters who lived through it or fathers who were lost forever guerrilla fighting in the mountains. One would imagine Nicaraguans to hold bitter vengeful thoughts of Americans, but that's not the case. My students do ask me daily about the war in Iraq, and one asked me yesterday afternoon "Are we at war with Venezuela?".

My students are not ignorant. This question came from a general perception we've lived up to as far as the rest of the world is concerned. We are a warring people; we meddle in the lives of others without permission. I know this to be far from true, but how can I claim it isn't so when a Spanish friend asks "How the f$*% did you elect Bush a SECOND time?! Wasn't he bad enough the first time?!" and I shake my head. It frustrates me how much our country, my country, embarrasses me. I can no longer watch Bush’s puppet act (no TV news… no loss) but imagine our wide global community having a shared laugh or two over the imbecile we’ve chosen to rule our empire for the last eight years.

When I first found out who the contenders are for the current election I laughed contentedly and thought to myself "no contest!". Now, as the time grows nearer, I am not so sure. I feel a growing wariness about the way things are shaping up, probably due to the dread I feel thinking about Bush's round one and two in office. The idea of his legacy being carried further and further into the future is almost too much to handle.

I simply cannot believe that there are people, intelligent people, who do not see through the dog and pony act of McCain and Palin. Are women who supported Hillary Clinton (a brilliant, moderate, eloquent, experienced politico) ACTUALLY considering giving their democratic vote to Palin (the rifle-bearing, book banning, radically Christian, politically inexperienced hockey mom) because we “feel she understands us”? Where do we get the remotest idea that this woman represents the American woman? Everything I’ve read about Palin consistently leads me to the conclusion that she’s being used as a pawn, a pretty one at that, to sway the evangelical and female voters of our country.

I'm not sure how to say this, because I want to scream it to the world:
"WE NEED CHANGE!!!!!"

If there's one person who can sit down and look at the facts of the last eight years without thinking, "our country has really gone down the drain", I urge that person to send a rebuttal with points covering: defense spending, health care, education, the economy, and general well-being of the American people.

For the sake of our world community, let’s open our eyes. What do we want out of our lives? Do we want to be forever behind walls, dominated by fear of the “other” attacking our “way of life”? There are ways to live beyond fear. Empathy, diplomacy, moderate policies based on fact rather than speculation, and true leadership will lead us to this place. Sticking to our rusting guns will not.

A plea from your fellow world citizens:

VOTE OBAMA!!

I’m traveling 16 hours round-trip to the Nicaraguan/American embassy and spending 20% of my monthly volunteer stipend to do it. You can too.

Coloring Between the Lines: A Raging Commentary on the Nicaraguan Education System

Education in the “developing world” frustrates beyond belief.

Imagine sending a child to public school only half-day to a school that does not have an outhouse, or books, or a science lab, or encouragement towards your child’s creative capabilities. Picture the disadvantages to women in this education system in which boys are constantly encouraged to be participative leaders and women are kept humble and quiet (*side-note: just like the Virgin Mary).

In Nicaragua, the government cannot (or chooses not, either way you look at it) afford for children to attend school full-time. Therefore, kids here go to school in shifts. Grades 1-3 and 7-8 have class from 7:30 AM till 12 PM and grades 4-6 and 9-11 attend school from 1 PM until 5:30 PM. This means that a child receiving an education here gets less than half of the class-time as a child going to public school in the United States. Beyond that, teachers are given a 10-12 page guide outlining their teaching themes for the ENTIRE school year and then thrown to the wolves (and by wolves I mean teenagers). This outline (I have personally only seen the guide for the teacher of 10^th and 11^th grade history) has suggestions like this:

Week 1 Lesson Plan:

1) World War I

a. Causes

b. Effects

c. Long-term consequences

Anyone who has ever taught or thought about teaching can look at this outline and see a major fault in the fact that, if given to a teacher in a place in which doing research is nearly impossible… the teacher is likely to use one or two sources and make up the rest, missing many important facts, or brush over the whole theme with a few sentences like “yes the Holocaust was important because a lot of people died and Hitler is now in Hell”.

Case in point: when Lauren and I taught about Hitler and Gandhi in a leadership section of our Critical Thinking class, I’d estimate that 80% of our students had never heard of EITHER of them. GHANDI. HITLER. These are high schoolers we are talking about. We’re currently working on simple math word problems and I am consistently shocked to find that many kids who will graduate high school within the next two years do not know how to do SIMPLE math (addition/subtraction/multiplication/division). The logical reasoning simply does not exist.

I will tell you why.

Picture learning everything you’ve ever been taught in school through the following method:

1) Teacher uses meager outline to create lesson plan.

2) Students do not have a book, and are lucky to have a guide for the class.

3) Teacher writes his/her ideas and notes on the board.

4) Student copies these ideas and notes.

5) Student studies these ideas and notes.

6) Student regurgitates these ideas and notes for a test/quiz.

And what happens next…

7) Student entirely forgets what they’ve learned.

8) Student does not learn to formulate their own ideas, to come to conclusions based on what they’ve learned or read… their ideas are the teacher’s ideas and their conclusions are the teacher’s conclusions.

Can you imagine graduating from high school with the type of semi-illiteracy that leaves you unable to spell simple words? I’ve seen teachers here write in Spanish substituting “b” for “v” and leaving the “h” and “s” off of multiple words. Some of these teachers graduated from COLLEGE and can still not spell. It’s culturally considered so unimportant that I often see students spell their name differently every single time they write it (that may or may not be due to the fact that the name which appears on their birth certificate is not spelled correctly either).

Here’s where the lack of creativity comes in. Children are encouraged to be “just like” all the other students – no skies painted green here. Rather than art class, they are given cartoon Bugs Bunny or Winnie the Pooh drawings and told to color between the lines. When Lauren tried to create a giant paper mache fish last year and let the kids paint it, the project turned quickly into the teachers painting one side and students painting the other- one of the teachers commenting “let’s see who does it better” then not allowing a student to paint on the “teacher” side. I may be wrong, but isn’t the whole point of education ‘trial-and-error’?! If kids are never allowed to formulate their own thoughts, images, or beliefs about the world… they will stay silent and stagnant forever.

More than that, this school in reality only functions three or possibly four days per week because at least once per week there exists a holiday (and therefore days off for teachers) such as:

Day of the Starving yet Un-Spayed Dog who Bites Neighbors but Who Cares Because He has his Rabies Vaccination

Day of the Construction Worker who only Works Drunk on Sundays Beginning at 8 PM

Day of the Cheesy Argentinean Soap Opera Watched by 5 out of 6 Million Nicaraguans Country-Wide Regardless of Age

Day of Loud Reggaeton Played at 6 AM by Neighbors Every Day of the Year

Day of Machismo (aka: Men Rule the World Since the Beginning of Time and Forevermore Day)

Obviously these holidays do not TRULY exist, but you get the idea. Although the official embassy website only posts 11 national holidays per year, I tell you without exaggeration that the NATION of SAN JOSE DE CUSMAPA celebrates more than 70 holidays per year. That’s about 20% of all existing days. If the holiday happens to fall on a weekend, we would never dream of celebrating it on a weekend, we celebrate it either the Friday or Monday that falls closest to the day of fiesta-ing. Therefore every 1/5 school days which could potentially aid children towards their future development is wasted as a “dia feriada” (free day!!).

And, last but not least, the most infuriating thing about Nicaraguan education is…

Drum roll please….

Machismo.

Yes, the macho culture here spills into all corners of society, leaving no teenage girl un-turned. Last month I had a look at our enrollment here at Fabretto and the difference between the amount of girls in 7^th and 8^th grade and the amount of girls in 9^th thru 11^th grade disturbed me greatly. Younger girls and boys post nearly equal enrollment numbers, but after 8^th grade something… though I know not what… happens at this age which causes girls to drop out of school like flies. Maybe it has something to do with the following examples:

1) Cece’s first day in English class, the teacher calls her up to the board and asks her to read a paragraph out loud while the boys in the class (seated on the same side of the room) repeat her after every sentence. The girls in the class are entirely excluded from this activity.

2) Our friend Mayerling’s experience with evangelical parents who pulled her out of school after 9^th grade because they were “convinced that if she stayed in high school she would get pregnant” (yes, that’s very logical). Mayerling wanted to return to school so badly that at age 14 she saved up her own money, working her way until she had enough to buy a school uniform and notebooks to return to school. Her mother, though supportive of Mayerling, never said a WORD to her father about the situation. Now Mayerling, at age 23, still has not finished high school and is stuck living with her crazy conservative parents in a household in which she’s not allowed to wear pants, earrings, has to go to church every night against her will, cannot go to parties or dances, and cannot have male visitors, even if they are just friends.

I think it’s perfectly possible for children to learn a wealth of knowledge about the world without access to books, a science lab, and even outhouses. I even think children can learn a lot in just five hours per day of class, with a teacher who cannot spell (when it comes down to it, that’s not THE most important thing). But a culture and country (government and catholic/evangelical supported) in which half of the population is STIFLED to the point of silence and un-education will never succeed.

And I will never respect a teacher who does not encourage children to color the sky whatever color they darn well choose to.

How do I feel nostalgic and heartsick for a place I haven't left yet?

When children's voices lifted in quiet song on a windy Sunday afternoon choke tears in my throat, and swarms of dragonflies floating through branches in my orange tree leave me longing and breathless?

Mid-afternoon sun-filtered through holes in a tiled roof, in the arms of someone I'm slowly tearing myself away from yet constantly pulled toward lances through me leaving profound holes in my heart.

A pink-dressed student rushes towards me for a twirling hug shrieking "mi Callie!", her smile writes arpeggios filled with graceful treble notes.

How can I remain open to life here while braced for heartbroken goodbyes?

Low Tide

Take a moment to think of all the times throughout your day you turn the faucet and are guaranteed clean fresh water. Water availability does not concern the blessed of humanity living in developed countries. On the other hand, in struggling countries such as Nicaragua, water constantly trickles across the thin line between life and death.

Facundo, who takes care of our house (yes, we have a “security guard” in a town of 1,500) lives in the small nearby community of el Imirez. At age 40 Facundo’s grin rings toothless and his two-room house shelters 12 people (four adults, eight children). His youngest, Larry, made the hour-hike-three-hour-bus ride to Somoto to the nearest hospital twice last year due to stomach parasites you and I in America will never worry about. The issue goes beyond lack of early childhood nutrition (which certainly exists in places like Imirez where people subsist on ground corn tortillas and rice donated by USAID projects) to much deeper and more serious issues. Lack of preventative health care and the non-existence of clean drinking water lead children like Larry down a malnourished road where survival, simple survival, matters most.

For Christmas last year, Lauren and I bought Facundo’s family a $14 water filter from a Nicaraguan run Potters for Peace business. The filter, sized to hold about four gallons of water in a clay barrel, will last their family for more than five years. Facundo’s family can now collect water from the community well and run it through the filter, secure that parasites will not seep through the filter’s silver alloy shell. He tells Lauren and I with a wide smile that the family’s water filter is the pride of their small village, that neighbors come by for a glass of clean water or just to marvel at the “miracle machine”. While this type of solution works short-term, it does not solve the long-term issue at hand.

Luckily Facundo’s family lives in a community with a well. Others are not so fortunate. In Aguas Calientes (where Osvaldo’s grandmother lives), about 3 hours further down the mountain, habitants must carry their family’s water supply in plastic barrels from the local river. More than backbreaking work, my heart breaks each time I see a small barefoot child weighed down lugging a fifty-pound container of water back to her family’s one-room adobe home, instead of playing or attending kindergarten… knowing full well that the water may make her family sick.

In Cusmapa, water’s non-availability writes an entirely different story. The majority of households here own a 5-foot-wide by 4-foot-deep “pila” or cement storage tank for water. The city gives water once per week; it trickles through rusty faucets to fill these meager holding containers. If the week’s water supply runs dry, the house’s inhabitants must survive without water until further notice. The pila’s faucet provides the house’s only plumbing. Families use pila water for bathing, washing dishes, washing clothes, washing the floor, drinking, and cooking. Though I’ve heard rumor that water received from the town of Cusmapa is technically filtered and safe for drinking, it comes from the closest river at the bottom of the mountain. I’ve splashed around in that river and consciously not dunked my head. Yet thousands of people in the area DRINK water pumped directly up the mountain from that river. Not for want, but for absolute necessity.

I began writing this with a nag in the back of my mind, whining about our own house’s lack of water for the past 18 days (though Cece and I have only been back in Cusmapa for 10 days)… but thinking about it more thoroughly I realize that at no point during this time have we been TRULY without water. We have access to drinking water, water for the dump-flush method of toilet flushing, and water for cleaning dishes. It’s a minor inconvenience to someone like me, who lives in Nicaragua with the support and resources provided by a larger organization. I do not fend for myself here by any means. I am not forced to send my 11-year-old sister out every morning at dawn to stagger up the mountain loaded down with barrels of river water.

Every day I live here I learn more about conservation and the importance of not taking what we consider to be basic life essentials for granted.

Next time you brush your teeth, gulp down a glass of cold tap water without a thought of the repercussions, flush a toilet, or take a hot shower, think of the action on a deeper level. Consider how blessed you are to live in a place with access to these resources, do not take them for granted. Take what actions you can to ensure that others do not live to survive, rather live to thrive.

Airports

I sit with Doña Helena and her cheery 5-year-old daughter from Managua to Atlanta. Helena, a native Nicaraguan tells me of her 20 years of life as an immigrant in Tennessee and her Mexican husband who works construction. She’s stressed about his current lack of work, and speaks of the US economy in its downward spiral towards crisis. Helena explains the division between Hispanics and whites in her town, choosing her words carefully. Her daughter, a native US citizen, only speaks a few words of English. The bubbly little one informs me that she can fly airplanes, and gives me a sly corner-of-the-mouth grin as she points to groups of people in the advertisements of Sky Magazine. “These aren’t my friends” she states, referring to an ad of white bikini-clad models sitting on a floating dock. I'd venture that "irony" is not on her short list of English vocabulary words.

Focused in tunnel vision in a brisk clip along a moving walkway, travelers move in herds through the Atlanta airport. I walk for twenty minutes, sauntering down the corridor and they pass me like water over a boulder. I don’t make eye contact with a single person. The sterile fluorescent lit air feels fabricated and stifling. A stars-and-stripes banner welcomes me to the glory of the United States of America and I am shooed through customs without a second glance.

My second flight finds me with Ron, a 50-some-year-old electrical engineer who talks of the six years he spent during his twenties teaching English in Thailand, Taiwan, China, and Japan. He believes in the importance of young people getting out in the world and the understanding of other cultures. I am warmed by his encouragement.

Everyone here whines about gas prices and debates continuously about the upcoming election.

I want a turkey sandwich but can’t stomach paying $7 for a few slabs of bread.

I will see my mom and Cece in four hours!!