Disclaimer: These are our personal thoughts and opinions; they do not represent the beliefs of the United States government or those of the Peace Corps

Tuesday, July 31, 2012

Finally

I apologize for my absence. These past few weeks have been busy, and I’ve had little time to sit down at a computer and type an update for you all. At this point, providing a detailed account of my activities would most likely be impossible, so I’ll just stick with the highlights, which will be painful enough for you all (and will probably end up sounding a bit like I’m working for the Nicaraguan Tourist Board in parts. For the record, they’d be lucky to have me.):

Irish encounters: When my poor friend came down with a nasty case of MRSA and landed herself in the hospital in Managua, I temporarily took over her duties as translator and event planner for a group of Irish university students. Every year, a group of volunteers from University College Dublin come to Madriz to spend four weeks working on various community development projects. The projects are developed and coordinated by local Nicaraguan NGOs; UCD provides funding and manpower. Due to a signed agreement between former Peace Corps Director George Baldino and the University, a volunteer stationed in Somoto works as a local consultant for project development and planning, as UCD´s in-country contact, providing translation and logistical planning services.

My friend spent several months on the front-end work, only to become sick as the plans were finally coming to fruition. Consequently, I did not have to do much other than be present when requested. While this technically qualified as “work,” my activities rarely felt like that. One weekend, I accompanied the group to Esteli. In exchange for translating for them and coordinating travel and meals during their day trip, I was able to tour a cigar factory and try one of Esteli´s best restaurants. The next weekend, I was given a similar deal for two day trip to Masaya, Granada, and the Laguna de Apoyo.  Not only did I have the pleasure of spending time with a fun group of people, I also had the opportunity to explore a bit more of Nicaragua.

Takeaways:

The process of creating a single cigar, from start to finish, takes nearly a year. Tobacco is grown and harvested, then dried in large barns. The leaves are brought to factories, where they are individually inspected and sorted based on thickness, color, smell, and aesthetic desirability. All leaves selected for use then undergo further processing before they are deveined by hand with a sharp knife and assembled into the final product. Nicaragua produces millions of hand-rolled, high-quality cigars yearly. However, nearly all of these cigars are exported to an international market. Cigar smoking hasn´t, for the most part, caught on in Nicaragua.

To anyone who is traveling to or through Esteli: I suggest you take the time to eat a meal at La Casita. Their offerings are simple, healthy, and tasty; never underestimate the amazingness of freshly baked whole grain bread with homemade fruit preserves. Or natural yogurt with ripe seasonal fruits. Or delicately spiced hot chocolate.

The city of Masaya is known for leather, ceramic decorations, ornamental plants, hammocks, and baho – a dish I believe I´ve already mentioned, and thoroughly enjoy. A bit like the Nicaraguan version of our pot roast or brisket, baho is beef, marinated and slow cooked in a giant pot lined with banana leaves with yucca, ripe plantains, peppers, tomatoes, and onions.

Many of the cities in Nicaragua that I´ve visited thus far have similar shopping and dining options and a similar look and feel. Granada, however, breaks the mold. Dignified colonial architecture; horse-drawn carriages; book stores and clothing boutiques; and restaurants offering Italian pasta dishes, hummus, fluffy pecan pancakes, spinach salads, bagels, cheesecake, gelato, and cappuccino. Unfortunately, the prices also break the mold. Granada is a wonderful place to visit as a tourist, but can be inaccessible for the average Nicaraguan (or the average Peace Corps volunteer).

If you’d like to spend a relaxing day swimming in a clean, freshwater lake, I highly suggest the Laguna de Apoyo. The lake is in what appears to be a crater, and surrounded on all sides by lush forest. There are several establishments that offer direct lake access if you are spending the night, purchasing a meal, or are willing to pay an entrance fee. I can personally recommend La Abuela, a hotel and restaurant. They have a multi-level dock with lounge chairs and porch swings, as well as an off-shore sunbathing platform and water equipment rentals. Their food, while a bit pricier, is fresh, flavorful, and healthy.

Tongue Tied and Brain Dead: A week was spent suffering through a second round of intensive language training. Actually, the four day session proved to be very useful, as many of my lingering questions regarding the grammatical structure of the language were answered. It also provided an opportunity to get to know Masatepe, as I was placed in a current trainee´s home for the duration of the training.

Takeaways:

I finally learned about “vos” (informal or familiar “you”). “Vos” was never covered in my past Spanish classes, despite it being regularly used in certain parts of the Spanish-speaking world. Thus, it remained a relatively elusive concept until now. It’s still easier and often more appropriate to use the formal “you” (usted), but I would like to start practicing with “vos” so that I can eventually incorporate it comfortably into my speaking.

Also, I now have a firmer grasp on the proper construction and use of the subjunctive. You cannot believe how handy this is; with one grammatical structure I can give suggestions (or make demands); complain about present or past circumstances; voice opinions, regrets, and desires; form hypotheses; and make excuses!

I am grateful to Peace Corps for their decision to place me with my particular host family during my training. My temporary home in Masatepe in many ways could be seen by an outsider as “better.” The house itself was more than twice the size; the bedroom large and well-lit. The amenities were numerous: multiple bathrooms, at least a dozen televisions and an extensive cable package, Wi-Fi, a washing machine, a microwave, and a pool. But this home, though beautiful, is hardly representative of how the majority of Nicaraguans (and Peace Corps volunteers) live. I also cannot emphasize enough how crucial it was for me to have such an open, loving, and available family during my training. My host family was always around, willing to share their experiences and knowledge of their country. They were patient with me as I stumbled through conversations, correcting my mistakes and teaching me new vocabulary. They taught me about typical Nicaraguan foods, how to manage without water, and how to hand wash my clothing. The family I lived with in Masatepe, while friendly, was rarely home. There was a small team of employees who did all of the cooking and cleaning. In short, the thought of trying to transition from this home in Masatepe to my current living situation is, to me, terrifying. I think I would have been wholly unprepared to deal with my volunteer reality – I was unprepared enough as it was!

While Northern Nicaragua knows how to make a mean rosquilla and rosquete, every other type of bread, biscuit, or pastry product is better down south. Oh pan dulce de Carazo, how I miss thee!

Rabies and Revolution: The week I returned to site began with visits to some of the more inaccessible communities in my municipality, vaccinating dogs against rabies. It ended with a long weekend of little activity, due to the country’s celebration of the Sandinista Revolution.

Takeaways:

Outside of the controlled environment of a veterinary office, vaccinating dogs can be a frightening experience. Owners are often forced to tie their furry companion’s head to the nearest tree or post to prevent the doctor or some other bystander from being bitten as a member of the medical team (none of which are trained in veterinary practice) jabs a large needle into its thigh.

Nicaragua’s Ministry of Health is pretty serious about preventing rabies. Doctors are told to relay the message to all dog owners that a failure to have their pet vaccinated regularly and/or failure to provide proof of vaccination will result in the removal of their pet’s head (in order to test for rabies, a sample of brain tissue is needed).

If you find yourself wanting to celebrate the Sandanista revolution with your fellow Nicaraguans on July 19, Managua is the place to do it. There are parades, dances, music, and an appearance by the president. You can even get there and back for free, courtesy of the Nicaraguan government, provided that you don’t mind spending up to half of your day smashed and sweating inside an old school bus with your fellow countrymen.

Programmatic Panic and Gardening, A New Hope: At any given time, the staff at my health center are feverishly working to complete the month’s required activities for half a dozen different programs, initiatives, and strategies. Within a single visit to a community last week, I visited children under 6 and their mothers, and patients with mental and/or physical disabilities. I gave presentations about chagas disease to elementary school children and a group of adults gathered together by the local community health promoter. I even visited several houses within the community to assess environmental cleanliness and to provide bleach and larvacide for their water supplies. Talk about multi-tasking!

Later in the week, I worked with a nearby volunteer from the agricultural sector to start the development of a small vegetable garden for my casa materna. I dreamed up this project after realizing that the women staying in the casa materna are only guaranteed beans, oil, sugar, and some type of carbohydrate (rice, pasta, oatmeal, or tortilla) – hardly satisfying the full nutritional needs of a pregnant woman and her fetus. One previous attempt had been made last month to get this project off the ground. I won’t go into the details regarding how spectacular of a failure this attempt was; I will only say that it made me realize how little I know about agriculture and gardening. This time around, we were properly prepared and managed to take a big step forward by building a “banco” – a raised bed for planters. With luck, the next step (filling the planters and planting the seeds) will be completed by the end of this coming week. Wish me luck!

Takeaways:

I really need to learn how to use a machete properly.

Phew! I think we’re finally caught up. Thanks for sticking it out!

Thursday, July 5, 2012

Chagas Disease: Or, How I Learned to Stop Worrying and Love the Chaos


At the beginning of every aspiring Peace Corps volunteer´s training, there is a period of time in which the staff provide an overwhelming amount of information about life in service, rules and regulations, the host country, and potentially relevant health concerns such as injuries and illnesses. This orientation may leave the volunteer-to-be confused, distressed, and/or exhausted; inevitably, the majority of the information will not be absorbed at this time and must be relearned later.

My introduction to Chagas was in the volunteer medical handbook, distributed during this orientation period. I vaguely remember experiencing a moment of horror as I skimmed the two page description of the disease, but I was too generally overwhelmed at the time to dwell on it. I paid much more attention the second time around, when I read article about Chagas in our volunteer newsletter.

Chagas has been endemic throughout Latin America for more than 100 years. It affects 10 to 12 million people and kills more than 15,000 each year. There is a substantial body of knowledge on the life cycle of the parasite (Trypanosoma cruzi) and vector (insects of the family Triatoma); we know how to identify and treat the disease, as well as how to prevent (or at the very least, control) it.

So…why had I never heard of Chagas before coming to Nicaragua?

Because Chagas is a disease of the poor. It rarely is found in so-called “first world” or “developed countries.” Celebrities and politicians do not become champions of Chagas elimination. Pharmaceutical companies do not invest significant resources in developing new treatment methods or vaccines.

Chagas is also a silent disease. The initial phase in which symptoms (fever and chills, loss of appetite, headache, tiredness, and painless swelling of the site of entry) may present only lasts 30 to 60 days. After this acute phase, the infected individual spends years living asymptomatically, while the parasite causes extensive damage to the circulatory system, digestive system, and nervous system.

Anyway, back to the newsletter.

The article outlined a Chagas prevention campaign that focused on community-wide bug hunts. Primary school students are given basic information about Chagas disease, and are taught how to identify and collect the insects that transmit the parasite. Collected insects are brought to the local health centers, where they are tested for the presence of the parasite. In this way, health professionals can identify and treat infected community members, and prioritize communities for activities such as health education and fumigation.

Chagas frightened me, and the campaign sounded like an interesting activity, so I decided to implement it in my community. I wrote up extensive plans, spoke with my health director to organize activities, and spoke with the local school delegate to receive permission to work in the schools. I scheduled trainings for the community health workers and presentations in the local schools. I hounded MINSA and SILAIS for materials to use, and developed my presentation. Finally, after several weeks of preparation, I was ready.

And then reality set in. Programmed trips out to the community were canceled at the last moment.  Community health workers did not show up to scheduled trainings. Schools were closed for teachers’ meetings, local holidays, or other reasons that I have yet to discover. After a month, I had accomplished very little and was left feeling extremely frustrated and cynical. How was I ever going to get this campaign off the ground? Why couldn’t anything work out as planned? Was I doomed to failure in all of my work efforts?

So I took a step back. I talked with other volunteers, and I did a lot of thinking. Finally, I let go of my anger and impatience. I made a new, more realistic plan and managed to implement it with relative success in a three week period. The future of this project suddenly looks a little bit brighter, although I don’t think it will ever match what I had originally envisioned.

I’m okay with that.

Lessons learned:

1. Don’t try to go it alone. The chances for success and sustainability improve greatly when your counterparts are involved and invested from start to finish.

2. Counterparts unwilling or uninterested in collaborating with you? Try to figure out why. It may be that you haven’t identified the right people for the project. However, you may also come to find that the project itself isn’t right for the community. Your ideas of what is good and necessary may not match those of your community, and ultimately your community’s opinion will determine the success of the project.

3. Flexibility is key. So is creativity. Have a plan B. and a plan C.

4. Make sure that any plan (whether it be A, B, or C) is realistic. Don’t try to do everything at once, or set goals that are impossible to obtain. It can sometimes be helpful to do a small “test run” to get a better idea of your plan’s feasibility and chances for success before expending a lot of time, energy, and resources.

5. Learn from your mistakes, and accept that there are some things that you simply cannot predict or control.

At this point I feel it necessary to confess that I have not completely stopped worrying. I still have my moments of pessimism and frustration, and I am not sure if I will every be able to fully embrace chaos and just go with the flow. But I’m getting better, paso por paso.

Words of the Week: Fracaso – failure. Éxito – success.