Throw Them in the Trash

The most popular prescription in our medical mission was for las seguridades (reassurance). Several of our patients were frequent fliers, meaning they stopped by daily to get a bit of this particular drug. Luby* was one such patient, emotionally exhausted over worry for her son with a suspected heart condition. She thrived on reassurance and hugs, as well as the attention she received when she fainted in the presence of a large crowd one evening (she was fine).

Another frequent flier was Lourdes*, a single mom of 4 in her mid-forties whose mother lived with her as well. She had been recently diagnosed with cancer and after a medical treatment for her malignancy had been advised to temporarily avoid her former place of employment, preferably forever. It was the only job Lourdes knew, and it was terrible work: she had been a waste picker. 

Wait, what? Yes, a waste picker.

Wasteland.

In Nicaragua (as well as many other poor countries), many seek work as human recyclers in the municipal dumps, massive and unsafe expanses of trash. They collect plastic and cardboard and sell them to large corporations to reuse. It is back-breaking and dangerous work, but an honest wage could make it worth it. However, there are no rights for these types of workers; companies can change the rates they pay on a whim and the waste pickers have no recourse because they are virtually invisible to the government. Within the last 6 months, wealthy, well-known corporations have halved the amounts they pay for a kilo of recycled materials, even though their profits have not fallen. Lourdes was paid $15 per week for her labor, and she was “successful.”

We went to the dump to see for ourselves, and while we were there the students fed the waste pickers and the medical personnel attended to people who looked like they needed help. 

Serving a meal to the workers.

Dr. Alex cleaning a tough hand wound Dr. Luis had cleaned out the day before when he visited.

One of the workers thanking us on behalf of the group for our kindness.

After the meal was served, the workers went back to the piles - truck after truck piled high with trash were rolling in - and our group went out to the wasteland to deliver masks and gloves shortly after.

It was sobering.

The emotions hit me worse than the stench of so much rotting refuse: los buitres (vultures). Vultures exist to live in this type of environment, but humans do not. These poor people were being treated worse than nature’s vultures, since these birds can eat what they find here but people cannot. Ironically, they were treated this way by people who prey on and exploit others - also called vultures...

The students were also shocked at what they saw but were deliberate and empathetic as they delivered masks and gloves to the workers. Seeing my own son among the group extend his hand in friendship and provide masks and gloves to others kept the tears flowing. I was proud of them all.

One special lady caught my attention - she was called abuelita (granny). She was about 80-years-old. Notice her feet:

She had been working in the dumps nearly her whole life, and her family had followed her. She knew nothing else. She and another woman went home with shoes that day.

We were all pretty somber as we rode away, reconsidering many, many things in our own lives. I was not alone in thinking these lovely, hardworking people were treated like trash as well.

*not their real names

Hanging the Shingle

We were ready to go - our triage station was prepped, supplies were organized as best as we could, and our 3 makeshift exam rooms were all set. The patients arrived, a good mix of kids and adults, although 90% of the adults were women. Most were moms or grandmothers, and many had not seen a doctor in a good while.  

All ready to go!

I had preconceived notions about the patients we would be seeing - I had expected to see a lot of diabetes given the diet of mostly rice and beans, along with a decent amount of hypertension. Well, we didn’t see anywhere near the number anticipated of these diagnoses. While we did see a fair amount of foot injuries due to the poor footwear, the biggest complaints were abdominal pain and upper respiratory symptoms.

Everyone had abdominal pain. Pain with eating, pain without eating. Many had concomittant diarrhea. A good chunk of these also had respiratory complaints. Cough, especially at night, and some dyspnea (shortness of breath) when in the house were also frequent symptoms. To understand why, take a look:

Inside of home, baby’s pack and play in view. Note hard-packed dirt floors.

Wood-fired cooking area. Note the chicken. Location adjacent to home.

Cooking prep area - open air, no storage area including fridge.

Outhouse. Clothesline is barbed wire.

What you have to do to get water when the government doesn’t.

When you have to live in a small shack with packed-dirt floors, an outhouse near the home, and a woodfire stove blowing smoke close to your window, there WILL be problems. Nearly everyone showed signs of parasite infection; in fact, in many countries with similar living conditions, the government will provide parasite treatment to its citizens twice yearly to prevent malnourishment and anemia. Not Nicaragua. Its infrastructure is pretty infantile and even vaccination campaigns seem tepid. The dirt floors and open-air kitchens in close proximity to the outhouse, with no running water anywhere nearby, meant the transmission of parasite infections from hand to food to mouth was depressingly high. Parasite infection = abdominal pain and frequent diarrhea as well.

Water was also an issue - the Nicaraguan government turns on the water to this barrio twice per week, on Tuesdays and Saturdays. Residents would fill up as many containers as they could to use until the next time the water was turned on. However, the week we were there there was no water on Saturday, so many people were without water for both washing and drinking for days. In the last picture above, the family home we visited tried to compensate for this cruel practice by digging to find a municipal water supply pipe; luckily they found one and discovered it leaking, so they placed a basin under it to catch the water so they could at least have something to drink.

Can you imagine that? Your government only allowing your water to be turned on twice a week? And “forgetting” one of those days? Really?

In spite of these harsh living conditions, the people of this barrio were beautiful, kind and loving people doing the best they could with what they had. I wonder if I would be so generous of spirit if the tables were turned...

Baby R, the beautiful young girl of the house above.

 

Gandhi and Dr. Farmer Were Right

“The idea that some lives matter less is the root of all that’s wrong with the world.”

~ Dr. Paul Farmer

I was lucky to be invited to join this mission to assist in setting up a medical clinic; I was even luckier to be able to bring 2 of my medical residents with me. Luis and Alex, third year residents in our internal medicine residency program, came with me to help. They are amazing young physicians who will soon graduate and go on to do amazing things. Joining us were three nurses from the U.S. - Otilia, a nurse from Miami and Fr. Manny’s sister; Maribel, a nurse from Port Chester, NY; and Amanda, an ER nurse from northern New Jersey. Together we did some pretty amazing things! 

Since we arrived in Nicaragua on a weekend, the first few days were spent getting accustomed to the schedule and meeting the community. As you can see, Dr. Alex was showing the kids how qualified he was to be there:

Good thing he is not a surgeon

We also set up the area for our clinic - each person brought donated supplies to assist in the mission. This is a bigger deal than you think - the Communist government is extremely strict with what is brought into the country, presumably because they want items purchased within the country so it can profit. However, the customs process is reportedly pretty corrupt, and we were warned anything we brought in excess could be confiscated or prone to “fines” (to line the agents’ pockets). Meds were a strict no-no.

People brought donated glucometers, lancets, test strips, pulse oximeters, thermometers, blood pressure cuffs, alcohol wipes, cholesterol testing kit, gloves, bandages and other wound care supplies, and much more. I was also blessed with a donation for the mission from my boss - a Welch Allyn product with a blood pressure cuff, otoscope, ophtalmoscope all on a wall mounted system. It came in a large box and was verrry expensive, and the Foundation was uncertain if I’d be able to get it into the country. My boss also loaned me a spirometer (to check lung function) and the equipment to calibrate it was also quite large - I was expected to bring it back, and we were concerned it would be confiscated too.

I was nauseated when we landed in Nicaragua. I barely held it together through immigration, and then baggage claim. When we went through customs I wished I had kept my barf bag...but no one seemed to be paying much attention - until Father Manny got flagged. He brought his bag to the agents for inspection and was interrogated about his duffel filled with toys. We are all sure his bag served as a decoy and my giant box and massive suitcase of medical supplies went through the scanner without a peep from anyone. I grabbed them and ran. Everyone else was similarly fortunate: the Foundation got their much needed supplies and Father Manny didn’t have to relinquish the toys or pay a fine. We had done it!

It’s up!

We finished getting things organized and had a meeting with our Nicaraguan dentist (Dr. Carlos) and 2 Nicaraguan doctors (Dr. Perla and Dr. Edwin) who had volunteered to help the mission so we could get prescriptions and (hopefully) ongoing follow up for people in severe need. Dr. Edwin had even gotten a bunch of med samples from colleagues. We were ready to go!

Ready to serve!

“The best way to find yourself is to lose yourself in the service of others.”  
 ~ Mahatma Gandhi

Why Nicaragua?

I have been blessed to be a part of another mission trip, this time to Nicaragua. The high school where my husband works and my son attends, Don Bosco Preparatory High School in Ramsey, NJ, has an annual trip to this country as humanitarian missionaries. Twenty five students and a group of chaperones go to a poor barrio (neighborhood) to build homes for the poor, through the Mama Margarita Foundation. Two years ago a Nicaraguan dentist and a volunteer dentist from Miami started providing much-needed dental care; this year, the Foundation’s other dream came true - we started a medical clinic.  

Soccer field at Mama Margarita

Why Nicaragua? Good question. I’ll talk more about this in another post, but let’s start with this: Nicaragua is the second poorest nation in the Western Hemisphere, behind Haiti. The poverty is pretty unimaginable, and the difference between the wealthy and the poor borders on horrifying. However, this I found to be true: the people are truly beautiful.

The beautiful children of Mama Margarita

While Mama Margarita exists as an oratorio (a place for prayer other than a parish church), it also serves as a safe haven in a very harsh world where neighborhood children can play, be tutored, and in many cases receive the only meal they may get that day. In addition to our medical mission, I witnessed a group of high school senior boys - men, actually - bond with these kids in a way which made my heart grow at least three sizes. Our trip leader was Father Manny Gallo, and his task for our group as a whole was almost medical in nature: CPR.

• C for Community. Build a community with each other and with the people of the barrio.
• P for Prayer. Not everyone prays, but most of us ‘talk’ with our higher power or send positive thoughts to somone in need. We were to do this for each other and for others around us to build each other up.
• R for Repentance. No one is perfect. We need to acknowledge our imperfections and express sincere regret for our wrongdoings, as well as accept the imperfections of others.

Over the next few days I will share the joy and heartbreak of this amazing journey, one which changed each of us for the better and made me realize that perhaps this is the kind of CPR which can save lives.