Adventures at la Finca and beyond

This week has been more relaxed regarding my "work schedule" but has provided some adventure nonetheless. Last weekend I spent Saturday on my own touring around San Juan. There is not much to see as it's a pretty small town (15,000 people) but I enjoyed walking up and down the beach, visiting the local English book store (I've read 4 books since I arrived here!) and sitting outside near the water to enjoy one of the local beers, La Victoria. I was reminded of how different this trip is for me, when I took a taxi back to the finca and had to negotiate the price etc. I've been traveling in style this time around, so while it felt good to be on my own visiting town, I was aware of the sense of being on my own (a gringa) in a strange town once again! Needless to say I made it back to the finca safely (I haven't totally lost my ability to travel!)..

On Saturday I also did some weeding for Federico. And by "some" weeding I mean that I lasted a few hours. Using a stick in one hand to warn any snakes or insects that might be crawling in the plants I used the other hand to pull grass up from the roots in a bed of flowers. The activity was surprisingly satisfying for someone who is not what you would call a 'green thumb' and gave me an increased appreciation for what the farm workers do every day. I was incredibly sore the next day and sunburned as well.

Sunday Federico, Alden and I set out for a hike (to what seems to be a ubiquitous site in Latin America -- a Jesus statue on top of a hill), but were turned away by a serious looking guard who told us that since the hike goes through private land, he was under order to prohibit people from hiking up. I guess the rich people of San Juan want to keep the riff raff at bay. We enjoyed our day though, walking along the beach, having lunch overlooking the ocean, and visiting the market for items to supplement our food at the farm.

The Finca continues to amaze me. I'm trying to learn about fruits and veggies here and I'm learning from Dtra. Carmen (who is trained in naturopathic medicine) about the uses of many of the plants grown on the Finca. I've had Calala (passionfruit), Zapote (a custard like, VERY sweet fruit) and of course Platanos since I've been here. There is a tree called Marango, the leaves of which are full of nutrients; Alden gathers the leaves and then goes through the process of drying them and grinding them up so they can be spread onto food. It is filled with micro nutrients, protein and other good stuff! I need to bring some back for Dad - I can see him spreading the stuff over all his food! The Malinche tree is my favorite so far; it has gorgeous orange/red flowers..

While the flowers and trees are beautiful the bugs are another story.. I swear, I've tried to be nice, but they are out of control. I am trying to keep a curious attitude about them, rather than let fear take over, but it's a constant challenge! We (and by "we" I mean Alden or Rosibel) kill a few scorpions daily. I think it must have been the movie "Clash of the Titans" that gave me nightmares about scorpions (any fellow children of the 70s remember that movie scene where Medusa's head bleeds scorpions?!) but to this day I think they are the scariest creatures on the planet! Anyway, I digress. Today we had an ant infestation after a big rain and I got bit between two of my fingers as I reached for my water bottle. I'm telling you, the pain did not last long, but it was intense, and my hand was numb for a good 15 minutes! Oh, and it BLED!!! The ants have a scissors like pincher so they literally cut you; the cut on my hand looked like a paper cut... I was a total baby about it too! But the ants and even the scorpions are not the worst of it.. As I've told some of you, I had the pleasure of coming into contact with a mite somewhere on the farm! (I blame it on Federico for "making" me do weeding).. You might have heard of "scabies"?! Well, yes, I got em! GROSS GROSS GROSS. But in Spanish scabies is called "sarna".. Doesn't that sound romantic??

Luckily, I'm living with a nurse and a doctor and I was quickly diagnosed and given the treatment: covering myself in toxic cream from head to toe before bedtime, and then washing my sheets, pillow cases, and clothes (that I'd worn x the last 3 days) in HOT HOT water... The good news is I'm feeling much less itchy and I won't be bringing any mites home to the US with me (hear that, Mike?)..

One of the things I've enjoyed most about being here in Nicaragua and on the farm is the weather. Since it is the beginning of the rainy season, we get a good rain daily; sometimes during the day, and sometimes at night. We have had stunning lightning and thunder storms as well. A few nights ago, we all sat outside on the patio and watched the sky light up for hours and then listened to the heavy rains come. Lightening bugs were also lighting up the sky between the flashes of electricity and all the while the frogs were calling. It is really a magical thing to experience.

I've also enjoyed my many interactions with the workers on the farm. The are an extremely friendly bunch of super hard working individuals. Today, Alden, Carmen and I walked up to the finca from the main road (about 3km) because after it rains the road is too muddy to be passable by car.. As we walked we came across many of the workers who we stopped and chatting with. The gringos that work here have a great relationship with the workers because everyone works -- Federico and Alden are not just sitting here being served-- they are working on the farm and really giving to the community.. So, its nice to see that kind of relationship develop.

As far as work goes, we have a nice routine. I usually get up between 7:30 and 8 (I'm the last one up of course) and we work until lunch and then work some between lunch and dinner. Often I'll work on things in the evening as well. There really is no set schedule. The last few days I've been working with Federico to revise an article he is writing for the journal of the Pierce County Medical Society of which he is a member, to describe he and Alden's journey to and work in Nicaragua. I created a flyer (see previous blog about computer genius) for an insert in the monthly journal that will hopefully raise interest and funds for the Community Nutrition Center. We are also discussing educational materials development for diabetes education. Once goal of the center is to educate young Brigadistas (community health volunteers) about Diabetes, so we are working on a curriculum for that. Hopefully the Brigadistas will not only be able to have more knowledge when they go into communities, but can be involved in helping Carmen lead classes at the Center. Group classes are going to be an important aspect of the Center's work, so we've also been working on coming up with a plan for class topics and finding information to support this effort. I have to constantly remind myself to relax and not be anxious to get everything done in one sitting. I'm not a particularly bossy person, but I can get annoyed when it seems like its "all talk and no action"; I am having to learn to sit back, listen, and gently help guide (but not force) the process.

Today we met a wonderful man, Mr. Gonzales. He is a community leader(known to be quite an eccentric we had heard) who runs a group called the Chronic Club (reminded me of Dr. Dre and Snoop, but I digress). The group provides support for people with chronic conditions in the community. He is also a very interesting example of someone who found out he had diabetes and with the proper education, support and insistence of his Doctor, was able to turn the course of his disease around. In Nicaragua, there are many challenges to making an impact on Diabetes, including taboo around the disease, myths (for example, if you marry someone or sleep with someone who has the disease you will 'catch' it), difficulty changing ideas about food and diets (rice, platanos, potatos, gaseosas (sodas)) that are very high in sugar etc. It will be interesting to see if and how the education and support provided by the center can change attitudes and behaviors.

I went surfing again yesterday. I was very intimidating because the water was quite rough, but with some encouragement, I got out there and was able to catch a few (baby) waves. (Sorry no pics to prove my prowess!).. I plan to work for a few more weeks here and then have the last week to relax and do my own thing.. The plan definitely includes more surfing. I'm excited to take some 1:1 lessons!

I hope everyone who reads this is well. I am having a wonderful time here and learning tons, but will look forward to seeing all of you when I return to Seattle, or at some point during the Summer!

Love,
j







Photos top to bottom:
1) Alden and Carmen walk up the road to the finca
2) Federico in the hammock
3) Rosibel at the casa
4) A bus in SJDS
5) Noelle, Bree, and Jennie (surf/beach friends!).
6) Augusto Sandino, hero of the Sandinistas; "Jamas Nos Venceron" They will Never Beat Us.

Bureaucracy and Surfing (not at the same time..)

This week Alden, Dr. Garcia and I worked hard on gathering all the information necessary to present our program plan to the government folks in Managua. In order to get the center approved, they have to have a plan (like a strategic plan), copies of Alden and Federico’s medical licenses, building plans for the center, disaster plans, photos, and many other documents. We spent many hours huddled around my computer so we could work on draft after draft of the ‘strategic’ plan.

On Wednesday we traveled to Rivas (one hour away) for an appointment with a director at the local MINSA office (MINSA = Ministerio de Salud, or Ministry of Health). There are different levels of MINSA offices, just like we have county and state health departments in the U.S. The Rivas MINSA office is a non-descript looking building in the middle of town. We were ushered into a small room where the 3 of us sat around a table while the director - a chubby man who seems to wear a permanent scowl on his face - looked over our paperwork, without saying a word to us for nearly 5 MINUTES! I swear, I almost started making faces at Alden and Carmen, but I thought better of it. Finally, he spoke, and he was mostly pleased with our work! He gave us some feedback and a few suggestions and we were off, ready to make some corrections and bring our plan to MINSA in Managua! One thing about the visit that I found especially funny was that during the visit, I had to use the bathroom, so I was directed to a dirty, cramped room with a toilet in it. When I went to the sink (outside the bathroom, in the hallway) to wash my hands (like a good PT and public health student) I realized there was no WATER! Here was this dude scowling at us who had the power to deny our plan for a center delivering health services and he worked in a building without running water… At least it wasn’t a clinic I suppose. On a serious note, Nicaragua is a resource poor country, so this experience was not totally surprising. But, I had to smile at the situation anyway.

I’ve really enjoyed working with Alden and Carmen. The 3 of us work well together. Alden is just learning Spanish, so I am a big help to her since Carmen does not speak any English. We all have different skills and strengths. I find myself using a lot of my communication skills learned in PBL during this process. I'm also finding that I am a good editor; something I hadn't recognized in myself before.
Carmen went to deliver our plan to Managua today. Now, Alden and I are going to start working on preparation for meetings with community leaders and creation of clinic documents and educational materials.

On Thursday I got to enjoy some of the surf that San Juan del Sur is known for. A few days ago, Alden introduced me to Jessica, an American girl who has been living here for a few months teaching at a women’s surf camp. She has some time off and is staying here at the Finca with her family, who just came to visit for a few weeks from the Lake Tahoe area. We went to a beach called Remanzo, a short drive from SJDS, with her Mom, sister, and a friend. I hadn’t been surfing since 2 years ago when I was in Panama. Boy, is surfing hard work. Jessica helped me and her friend Noel and gave us lots of good reminders and tips. But over the course of 2 hours, I only was able to stand up twice! It is a ton of work to paddle out through waves crashing over you, just to try unsuccessfully to catch a wave! It was super fun just to be out there in the water, to get some sun and meet some new people though!... And the experience made me want to take some real lessons, where I can learn more about the dynamics of the waves (like that, Mike?) because besides the physicality of the sport, it is all about being able to read what the water is doing.

Photos:
Top; Remanzo
Bottom;
Alden, Federico, and Carmen at dinner
Me (not) catching a wave
Truck with surfboards

Nicaragua - San Juan Del Sur and Gettin' to Work

On Sunday, Federico and Alden took me to see "town"; San Juan Del Sur. SJDS is about a 15 minute drive from the Finca. We had a yummy lunch at a beach side restaurant and then walked along the water and through town. It is very noticeably hotter and more humid in SJ then at the Finca. We also visited the newly built center, which is being called "Centro de Nutricion Comunitario" (Center of Community Nutrition). The intent is to have a niche population of Diabetics and those at risk for diabetes (not a small group in this community!) and to provide basic consultation services as well as group education classes. As well, the Center will serve the employees of Finca Las Nubes (FLN) with basic health needs and education.

On Monday I had the pleasure of meeting Dr. Rufina Carmen Garcia (Carmen) who is a Nicaraguan trained doctor that was just hired by Federico and Alden to be the main Dr. at the center. She is wonderful -- very knowledgeable, friendly, community-oriented, and patient (especially with my Spanish!). Most of Monday, Alden, Carmen and I worked on the center's strategic plan; including goals and objectives. They have already done quite a bit of work on this but I was able to help out. It was fun to use what I've learned in school without a deadline looming over my head!! Shockingly, Alden and Carmen were totally impressed with my computer skills! (I know what many of you are thinking!). All I did was work on some formatting, play around with shading and bulleting and they think I'm a genius! I couldn't help but imagine how hard Mike would have been laughing had he been in the room.

It gets dark here around 7 pm so it has been strange to change my cycle a bit; I'm going to bed early and trying to get up early (around 7:30am). It's sort of like I'm camping.

Lest you all think I've gone soft and am living in the lap of luxury, I must inform you that today we had an ant infestation, and I saw 3 scorpions!! Apparently the scorpions are not deadly but it's still a bit unnerving! I am obsessed with making sure the bed is clean of all creepy crawlers and then making sure my mosquitero (mosquito net) is super tight around the bed before I am able to sleep! Some nights it is hard to fall asleep even with a powerful fan, since the doors have to be shut to keep the insects out, which makes it a bit hot.

Today we continued work on the strategic plan, which has to be ready by week's end to present to MINSA (the Ministry of Health) in Rivas for approval and then go on to Managua. We also met with a former colleague of Carmen's, Dr. Beyo who works with the Clinca Comunical in SJDS. She reviewed our plan and discussed the proposed activities of the center.

Our routine is to work until lunch, have a little siesta and then work again until dinner. It's a quite relaxed yet productive way to work (are you listening US of A??!!). Alden is encouraging me to go surfing soon. I have been invited to go by an American girl who lives in SJDS and teaches at a womens surf camp. She is currently staying on the Finca with her family. So, I hope to do that sometime soon!!!

Ok, off to bed. It's after my bedtime (8pm). :)

To learn more about the Finca: http://fincalasnubes.com/

Love, Jennie

Fotos:
Church in SJDS, SJDS beach, Inside the Centro, Federico standing next to Centro building

Nicaragua - Finca Las Nubes

I decided to spend 4 weeks in Nicaragua this Summer, helping two American public health practitioners on a project here. I will be staying at Finca Las Nubes, an organic farm just inland from the Pacific coast town of San Juan del Sur. My hosts are Dr. Federico Cruz-Uribe and his lovely wife, Alden, who is a nurse practitioner. Federico and Alden moved to Nicaragua last year to live on the farm and decided to build a small health center to serve the finca employees (about 80) and their families. The clinic is in the process of being built and are in the process of hiring staff.

I will be helping with whatever start up tasks I can assist with, as well as helping Alden to do some community research related to Diabetes. We will be meeting with members of MINSA (the National Health ministry) as well as community organization leaders, and community members to find out about local attitudes, beliefs, and knowledge on the topic of Diabetes, which is a growing problem in Latin America. We will also be planning some prevention interventions. I am excited to meet the newly hired Dr. who we will have a meeting with tomorrow.

I arrived Friday and my hosts have been incredibly kind and generous. I am staying in a room in their large and beautiful house, where I have my own bathroom and a patio overlooking the Pacific Ocean. It is stunning here- we are at about 1,500 ft. elevation, with an amazing view, and as I type this I am listening to the sounds of frogs, howler monkeys, and various insects and creatures! I have been trying to do some background research (which I didn't have time for at the end of the quarter!) on Nicaragua's health status, the health care system, and the issue of Diabetes. But so far, no real work has started and my hosts have treated me to wonderful food (mostly fresh from the grounds) and lots of relaxation.

The Finca has 4 houses on it, each with its own garden. The houses are rented out by a very selective process (usually people who want to come and learn and work). So many fruits and veggies are grown here it is hard to name them all. Federico and Alden are learning all about farming as they go, and their knowledge so far is really quite impressive! They are very committed to sustainable farming. The guy who runs the whole place is named Chris. I have yet to meet him but he is an aging hippie from San Francisco who sounds very interesting! Federico gave me the tour today and I also went on a compost run with Marcelino, one of the farm workers (and a big surfer I'm told-- hope he takes me for a lesson!!).

Last night after dinner I enjoyed the sight of lightening storms in the skies and listened to the sounds of monkeys, frogs, and various insects.. I'm trying to make friends with the insects that share my room with me. I am oh so slightly squeamish about them. It's like that book Goodnight Moon.. Me: "Good night spiders, good night preying mantis, good night beetles and mosquitoes.. You stay in your part of the room and I'll sleep over here on my bed and we'll all get along just fine...".. Ha Ha.

Here are some photos of the Finca. More to follow!







Pictures, top to bottom: "Our" house, Casa Liliana; Pool at Casa; Sunset over the Pacific; View of part of Finca from the patio; My room.