NICA2012, Days 11-12: “There is a wholeness to women…”

Day 11 (Tours galore) – We had an early day, with breakfast at 7:30, and the bus leaving at 8. On the agenda for the day was visits to two hospitals and a tour of Managua.

The first stop was the La Mascota Children’s Hospital, in Managua.  It is the only children’s hospital in the country. They have 306 beds, which is still not enough.  They only air condition what is absolutely necessary, which isn’t much. We started with a history lesson from the head nurse, who was also our tour guide for the day. The nurses still wear white dresses, white shoes, white hose, and little white hats. It was like being in an old movie. We had a brief tour of the hospital – units for hematology, in and out-patient surgery, emergency, neonatology, and oncology.  All of the wings had four beds to a room. This hospital gets a decent amount of funding, and you could tell that they were proud of the hospital.  Americans would have been shocked.  Passing through one of the hallways, there was a little girl, bald as could be, with her chemo bag in her lap.  She smiled and waved at us, and went back into the chemo room later.

Intensive Care Unit

The Well-Child team also got to tour the NICU.  We had to scrub our hands and put on gowns.  The NICU had two sides – one for stable babies, and one for unstable babies.  Every single one of the stable babies had a mama in the room, which is more than can be said for most NICUs here in the US.  The babies were four to a room, and really not too interesting, since at that stage they just sleep and grow.  The unstable babies were a sadder story.  One 17 year old mother had driven her child 24 hours across the mountains in Nicaragua to come to this hospital. There was one baby born with intestines on the outside.  He had been born in a house, with a midwife, and rushed to the hospital. His survival chances were lower than a baby in the next room, also born with intestines on the outside, who had been born at the hospital.  There was another tiny, tiny baby. You could see all her ribs, and her whole body expand and collapse with every breath.  She had been born to a 16 year old mother, who’d had a hysterectomy immediately after.  The family was desperate for the child to survive.

The donations our team had brought included items like infant feeding tubes and medicine cups, and couldn’t be used in our clinic.  Marta packed them up and brought them, so we presented the donations to the assistant director of the hospital.  The director was out that day, but we had met him the week before. (He’s also part owner of the hotel we stayed in).  They were very grateful for our donations.

Unpacking donations for La Mascota!

After leaving the children’s hospital, we drove out to Masaya, to visit the general hospital there.  We didn’t really tour, just walked through.  This hospital made the children’s hospital look like a 5-star resort.  Nothing was air-conditioned, and people lined the hallways.  Curtains separated the patients, sometimes.  Since the general health team had already gotten to observe a surgery, they went to the ER while the Well-Child team went to the locker rooms to prep for surgery.

Ready to go in!

Warning: This next part may not be for anyone with a weak stomach.

The surgery in progress that we were going to watch was a hysterectomy. The OR was unadorned.  All the machines were on wheels, some blood on the floor.  The doors were propped open to allow for air flow. We stood against the walls. The patient was a 41 year old woman.  The first incision had already been made, and the smell from the blood vessels being cauterized was the worst part.  The buzz word in the US is “minimally invasive.” Surgeons make the smallest possible incision, so everything is cosmetic and easily hidden under a swimsuit.  Not the case in the Nica OR.  Her incision ran the up the center of her abdomen. Our bodies have layers, which were very visible from our viewpoint.  Skin, fat, and muscle.  When the surgeons reached her abdominal wall (all muscle), they gave it a good tug to open things up, then placed an instrument in to keep things open.  Next, they had to remove built up scar tissue from her 3 C-sections.  When the surgeons got down to her uterus, it took several minutes to tie off everything and make sure they didn’t sever her urethra.  They finally pulled the uterus and cervix out, and set it on the table for us to see.  She had a benign tumor, which was the reason for the hysterectomy, and it was really obvious – a blue-black knot on her uterus.  We oohed and ahhed and leaned in closer for a good look. 4 of us made it all the way through the surgery, and the other three had to step out at one point or another to get some air. But no one passed out!

We opted for a tour of the labor and delivery instead of watching her be sewn up.  L&D was HOT. No air at all. There was only one woman in there that day, and she was only 6cm dilated at the time.  She was 19 years old, but looked 12, even with her swollen belly.  She wasn’t hooked up to any drugs. The ward had stall-like areas with small beds for the women to stay until they were ready for delivery.  When it was time for the baby to come, they were moved down the hall.

A far cry from most delivery rooms!

After that quick tour, we put our white coats back on and met the gen health team in the ER. Since we looked so legit in our white coats, we took some group photos outside the hospital.

Serious doctor pose.

We went from there to lunch. All I remember from this lunch was the yummy tostones and the owner’s 30 day old baby that I got to hold.  Pretty great lunch, if you ask me!

After lunch, we headed back to the hotel to change clothes and take a nap, then we loaded up the bus for a tour of Managua.  We started at the national theater, which is one of the few buildings that survived the 1972 earthquake.

El teatro!

Then walked to the park so we could see the amphitheater that was built for the pope’s last visit.

For the Pope!

And we also walked over to see the old cathedral.  It’s survived the earthquake too, but has lots of structural damage.  In that same square was the president’s house (which the current president doesn’t use) and a national museum.

Greetings from Managua!

Then we drove up to a lagoon that had an amazing view of Managua.

A hazy view of the mountains.
Group shot!

There was an awesome looking zipline over the lagoon, but Danielle, Evans, and I were the only ones that really wanted to do it, so we passed.  From there we drove to the new cathedral, which is completely concrete. It wasn’t terribly attractive from the outside, but it was beautiful on the inside.  Marta knew the priest, so we talked with him for a few minutes.  We also took advantage of the steps outside to get some good jumping shots with all the girls!

Inside the cathedral.
Spidey style!

After our tour, we ate dinner out for the last time.  From my journal: “We talked about flights home tonight at dinner…It’s sad to think about. I’m ready and not ready all at once; this is the longest I’ve ever been with a team, and I’ve grown attached!”

Day 12 (Fiesta!) – “There is a wholeness to women that brings the tragedy and comfort of life together in a glorious unity”

May 30 is Mother’s Day in Nicaragua, so we got to go back to La Hoyada to have a fiesta.  At breakfast, Marta had us practice saying “Feliz Dia de Las Madres!” so we could say it for all the mamas and abuelas at the party.  We took cakes, a pinata, hygiene products, games, and prizes.  We set up at the Molina’s house, where lots of kids and mamas were waiting when we arrived.  It was fun to return to the familiar faces – people who had been patients in the previous days but were friends that day. We started with the pinata, and the kids had to dance to be able to take a swing at it. Some of the girls had stuffed the pinata with candy the night before, and we couldn’t wait to see it break.


Once it broke, we gave out cake, then played musical chairs with the older kids and hot potato with the little kids.  Several of us had brought stickers and coloring books as donations, so we gave those out as prizes.

Hot potato!

They had some traditional Nica dances prepared for us, first two little ones who shuffled around, then two girls about 10, who danced beautifully!

The little ones!
The older girls!

After they danced, we cranked the music and joined in the dancing.  We taught them the train, then did a tunnel, and some circles, a tunnel, and finally a freeze-dancing game.  Sweat was dripping from everyone, and we probably danced for two hours. Even the mamas and papas and abuelas danced!

And more dancing!!

Once the music was on, it didn’t matter that we didn’t speak the same language. (We didn’t take any translators other than Marta and Pavel that day). Even with sweating like crazy, it was so much fun to let go, dancing, laughing, and celebrating mamas.  Everyone seemed to have a good time, and even the most depressed of people managed to crack a smile.  It was hard to say goodbye to the sweet people of the La Hoyada community. Sylvia Molina told us all we were welcome back anytime!

For lunch, we went to a small farm of a sweet abuelita in the community who wanted to cook for us.  She and her daughters had prepared a wonderful meal, probably one of the best we ate in Nica.  Marta asked if we liked the food, and I jokingly commented that yes, it was great, and she (the abuelita) could come back to the states to cook for me.  Before I knew it, Marta translated what I said! The abuelita came over to sit next to me, and she asked my name and said she was ready to go whenever I was!

My Nica abuelita!

We went briefly to the Managua market that afternoon.  The beggars and shopkeepers were much very aggressive there, and we didn’t stay too long. Once we got back to the hotel, we had several hours to kill.  We walked to La Union, the Central American Wal-Mart, for snacks and drinks.  We attracted the usual honks and whistles (all for Seth and Evans, of course).  We ate dinner at the hotel, then had dance lessons.  Marta brought in the teacher, who spoke no English, then left us! We just had to follow for the most part, but caught “suave” and “rapido” multiple times! It was similar to Zumba, but with wayy more hip-shaking.  Once again, we sweated so much! And laughed. Everyone was good at it though.  The lesson was 1 1/2 hours long, and we did some partner dancing, merengue and salsa, at the end.  It was so much fun! Sadly, I only remember a few of the moves.  That night, we pushed Nat and Katie’s beds together, and everyone came in our room to talk and play cards.  Good team bonding time before our last full day in Nica 🙂


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