Saturday, August 14, 2010


Reality is something I am learning is different for everyone. As ironic as that may seem. Logic appears to be completely absent at times here, especially in regards to health beliefs. But then I have to stop myself and remember that we all start our knowledge base with what we are taught by our culture, our parents, our surroundings. The other day I was told not to shower after I had worked a long, hot day out planting seeds at a farm. I should not have been surprised by this, as I´ve been warned by other gringos of this belief, but since I am working in a well developed NGO with educated Nicaraguans, I was. Apparently hot and cold can´t mix here, so if I was to take a cold shower (realllly cold, bucket shower) while hot, I could die. Or experience a lot of pain. When I responded saying I had done so the night before, after a long days work and heat, I was given then answer that gringos must have different bodies, or that it was only because I was accustomed to it. One girl even warned me that the pain would come years later, and then I would realize that it was a bad thing to do.

Hot and cold health theories go well beyond just hot bodies and cold showers...they even go into the diet practices...such as a cold drink with a hot plate of food (bad), spiritual practicies...such as women who have just given birth not being able to go to cemetaries for 40 days because of cold spirits (that could infect their warm uterus that just gave birth)...and the list goes on.

How does one spread health knowledge and contribute to development when up against such beliefs? I try to be respectful, and remember that they have believed this their entire lives, so I am not going to change it in one conversation. But at some point I wonder if its possible to merge cultural medical practices with scientific ones, or if they just contradict each other too much. I suppose thats why its development work...little by little, very slowly, progress is made.

This is my last week or so in La Dalia, then I will have a few days of evaluations and working on my reports for school, a week for vacation here, and then I am back to the states.

I will miss my family here I know...but I can´t wait for a good meal that does not consist of rice and beans.

Wednesday, July 28, 2010


Here are some fun shots...with my host family, and with the ladies at the Casa Materna...which is where the women here go when they are far along in their pregnancy. They live there until they give birth because it is a way of insuring that they will have access to good medical care when they are in labor. The infrastructure in the country is too difficult otherwise to get a woman to the hospital once she is already in labor, so instead they come and live in the city and wait for the big day to arrive.

They have a beautiful set up at this Casa Materna, including an oven that never gets used because no one feels capable of baking. So, I went and gave a baking lesson...we made cookies, pan simple (bread) and banana bread. They big concrete looking thing in one of these photos is the oven..its an outdoor barrel oven, made with a big metal barrel, white clay and bricks...heated by firewood. Also, there is a beautiful mural painted by the last Peace Corps Volunteers in the courtyard.

Friday, July 16, 2010

my host family

When I get a chance, I will borrow a camera (I forgot the charger for and take a picture with my family. But for now, just a quick reflection.

I live with a family of 5 -- mom, dad and three kids. Erich is 14, he`s shy with me. Angelica Maria is 12, and I love her..she is learning English and wants to practice with me every night after dinner. She is quite motivated, and she tests me on my Spanish vocab as well, so its mutually convenient. Then there is Erling, who is 7, and an adorable little boy.

The family is quite modest and humble, and I am already falling in love with them. They are all beautiful, with big brown eyes, and beautiful skin...but they are also very nice, and always concerned for my well being. My host mom asked me the first day what I like to eat, and then immediately went to buy it...ALL of This is rare from what I have experienced here so far...usually I am only offered what is normal to eat, but she is very concerned with me eating what I want.

Anyways, more later, but I love them.

Tuesday, July 13, 2010

vamos a ver...

I leave for La Dalia first thing in the morning, and I am nervous, excited and a little bit worried about my ability to adapt. I do not know too much about what I will be doing..
What I know of my situation in La Dalia is that I will be working with the AMC office in the city, and going out to 5 different communities in the campo to shadow and assist with health projects. I will be living with a fairly poor family, and will be using a latrine and bucket shower. I know I will be giving charlas in the schools about health and hygiene, and I will be working with land banks in different communities to diversify their crops, recycle their water for irrigation and possibly much more. I want to think about what all I can do, but I know I should be much more focused on what I can learn. I am learning rapidly here how much I actually do not know, and how big the world really is.

So, for now, I will be reflecting on what I admire in this culture, and packing my bag that keeps getting tighter everytime I repack it..even though I feel like I am using stuff up.

Something I enjoy about the culture, especially in the campo here is that the people have an unwritten code of conduct regarding the stop and chat. It is normal and expected to greet practically everyone you pass by on the road. Sometimes if you are lucky you will get a goodbye or hello followed by chuckles of satisfaction at knowing an English word. But the greatest thing to me is that they have an out for the stop and chat. If you are not available or really just not interested in stopping for a uneventful conversation with an aquaintance, or really even someone you know well, you just say Adios instead of Buenas. that easy. and in the campo they say Adiooo.. and let the word just linger in the air incomplete as they pass by. What a nice cultural norm to have a way of still being friendly, and acknowledging that we do not always need to stop for someone we know. Perhaps its the small town mentality, where you see them all the time, so its easier to just keep walking.

For now, I am going to focus my attention on the things I enjoy, so that I dont spend much time worried about the things that will probably be uncomfortable.

[dear people who are commenting on my posts frequently in Chinese...though I appreciate you reading my blog, please write in English or Spanish when you comment, or stop writing comments. thank you.]

Wednesday, June 30, 2010

a day in the life

my day yesterday:

2 hr express bus to Managua from Matagalpa at 6:00am

Sat in AMC office for 2 hours waiting for a ride to the dentist

Root canal at the "rich people's" oral surgeon who charged me $300...less than my copay in the US

Back to AMC office, ran into my padre de Nica, who offered me a ride back to Matagalpa in the back of his truck

Waited 2 hours for him to return from a mysterious meeting

Loaded 6 cases of latex condoms in the back of the truck.. 43200 in total, boxes marked keep in a dry, cool environment...that my padre says are for the hombres del campo who don't like using them. Public health in the field...picked up 3 family members, and headed to the mall where they bought new clothes. +1 hour.

Then to the Nica version of a Sam's club that I'm pretty sure is owned by Walmart +40 mins

Then to Matagalpa.. 3 - 3.5 hr ride that should've taken 1.5 hours, luckily I was comfy enough to sleep.

I slept on the mini seat with cushioning and felt like I was being smuggled into another country. I'm getting better and better at sleeping anywhere when the need arises.

Arrived home at 8pm, could've been home by 4 if I would've taken the bus, but by far an exciting cultural experience.

Things I'm learning: I have no patience, though I thought I did. Probably in part because I'm used to Philadelphia, but I'm gaining more every day, which is good for me, and character building.

Public health in the field means giving up the best case practice for the overall goal sometimes...i.e. transporting condoms in an open pick up truck ...boxes which are marked "keep in a cool, dry place" ...whilst driving in 90 degree heat in the day and rain after dark.

Is Paul Farmer right that we should not settle for giving poor people just "appropriate" technology that sacrifices quality for quantity....or is that just not realistic in a place where its difficult to accomplish even the quantity part?

Things I love today: the fact that I learned how to talk in future tense. And that Nicaraguans are so patient, and understanding of my poor Spanish grammar. And that they all live together, and love each other regardless, with more patience and sacrifice than I can imagine.

I'm also grateful for the Scottish and Canadian girls down the street who gave me lasagna tonight. Thank God for Italian food when beans and rice just aren't cutting it.

Wednesday, June 23, 2010

estoy viviendo donde mucho es diferente, pero sigue siendo lo mismo

Hola amigos.

Its been a while, and there's much to tell. So far, so good considering. I've had a series of health frustrations...but, I'm still in one piece. As my AMC supervisor puts it, my body is adjusting to a whole new world of bacteria and its information overload.

Besides that, I've made so much progress with my Spanish studies, and I'm very excited to continue my studies.

What I've noticed the most so far are the cultural similarities and differences. Similarities first. The shopping culture here is very much like that in the states. People have a lot less money, but everything costs a lot less, so in some odd way, it works least in the city...except for those who purchase brand name clothes for the same price as they would in the states. LOCO. In the campo (country) where people are much poorer, my opinion is that it doesn't work out, because people do not prioritize the important things, such as diversifying their diets, buying medicine and soap..etc. Instead, they spend money on cell phone minutes, bags of chips and sodas. Often I see television sets and cell phones in houses with dirt floors where people eat beans and rice for every meal. Its so similar to what I felt when I worked with a poor population in North Philly -- very poor conditions, but satellite dishes on their rooftops.

Things I've noticed that are different are interesting, because I'm learning that not everything is what it seems -- I assume certain actions to be inherently natural, as if they are instinctual part of human nature. What I'm learning here is that assumption is far from true. For example, to point at something, people here use their lips, not their hands. To wave for someone to come over, they point their hand down and wave, not up. One thing I am most grateful for is the whole emphasis on word problems in the States -- we learn logic through paragraphs of words where we have to sort out what is important for solving the problem, what is just extra detail, and how to logically work through that. Here, they do not have such education..and its obvious. And it makes me feel really impatient. But, I'm learning more patience and how to be a much more empathetic and understanding individual.

Saturday, June 12, 2010

Mi primero semana en Nicaragua

Week one has been a good introduction to my summer. After my arrival, I hung out with the peace corps group for a training...Michele and other volunteers spent the day training new trainees (aspirantes) on food security. It was fun to meet people and spend a day seeing what Michele has been working on.

On Saturday night after the training, we went to Michele´s training town in Fatima and met his host family from his first three months here. They were quite hospitable, and his host sister was excited to take us dancing at a festival in the town nearby. It was just like a carnival in the states...cheesy rides, and fried food, and a concert with a boy band...a bunch of teenagers dancing. Good times.

We returned to Managua the next day, and arrived in Matagalpa, where I am studying Spanish for the month of June on Monday evening...just in time for the foreign bacteria in my stomach to settle in. Within a few hours I was violently ill, the onset of which conveniently happened on my way to the bathroom at a cafe...luckily it was out the top end! And, lucky for me, Michele stayed and took care of me, got me cipro, and made sure I got better before he left for his site. No pasa nada.

I´m doing great now, no health problems (knock on wood) and I´m settled in quite nicely with my host family. I´m learning Spanish quickly, though its tricky with native speakers, because they talk soooo fast! My host family is quite hospitable, and fairly wealthy I imagine...I have a toilet and shower, and they have nice tile floors. Its normal in the city, but outside of the city it is much more poor. So, this is good for me now to get aquainted with the culture and the language, and then in July, I will probably have to adjust to poorer conditions.

Today´s cultural Nicaragua, the taxis pick up as many people as can fit in the cabs, even on different trips, as long as they are all going the same direction. Logical for them, better money for them, but a strange adjustment for me. They also charge more to give you a ride home at night than during the day...perhaps its more of a risk for them to be driving at night?

More to come later...for now, I must go to the park and see the girls from my family dance in a festival!

Friday, June 4, 2010

Safe arrival

I'm safe and enjoying my morning here in Managua, on my first day of this summer adventure. Thanks to all for the encouragement and support.

I'll be heading up to my language school in Matagalpa on Monday, and then La Dalia in July for my internship.

Here's the NGO I'll be doing the internship with, in case you want to know what they are up to:

Exciting things to come!!

Saturday, May 22, 2010

the next chapter

Long time without a here's the latest news.

I've been given the opportunity to go abroad for an internship in Nicaragua this summer. I will be working in northern Nicaragua, with an organization that assists in communities with health issues. Hopefully I'll get some experience with sanitation and hygiene education, as well as working with water resource management -- perhaps digging wells, securing safe water, building latrines to protect the groundwater, etc. We shall see. I'm being told by the organization I'm going with that everything must be flexible in, we may plan for something, but that never guarantees it will come to fruition. That's obviously the case for every development project I would assume...

So, this means I've resigned from my job -- my last day is in less than two weeks, and I fly out the next day. Its all very exciting. I must say, with all the arrangements and such, this has been an incredibly smooth process, and every step of it has been good. I don't feel much resistance or difficulty at all, which reassures me that this is the right decision for me. Its a truly great feeling of peace, to know that I am making a major life change and I feel totally confident that it is the right choice. Especially for someone as indecisive as myself, this has been an amazing blessing for me. Oh - and I did end up getting that scholarship :)

I will do my best to update this blog with news of my latest adventures, so be sure to check back.

Sunday, April 25, 2010

pretty please

hoping for a scholarship to come through...I should find out this week. It would be incredibly helpful and release me from some obligations that need to be let go of.

say a prayer for me!

Wednesday, March 24, 2010

sex ed

I taught a sex ed class at a Catholic church last weekend. In the sanctuary. To a group of adults in a premarital class at the church...all immigrants I think, not sure. And the priest asked us to teach on contraceptives and reproductive health. We passed around condoms, and showed them what different forms of birth control were available. We told them of clinics where they could get affordable reproductive care.

They asked questions about orgasms, periods, hormones and the like...and listened comfortably, all while a statue of Jesus and Mary stood behind us at the altar.

I'm impressed with the progress this church has made. We need a church that views sex as part of life, instead of only as taboo. We need proper education and equality to be promoted in the church, if we expect people across the world to progress, especially when so many around the world still rely on the church for their guidance. We need population control, we are on our way to 10 billion people, a # so large that our Earth will have difficulties sustaining us, and wars over water, food and land are inevitable...we need people to be responsible about having children, especially when they are barely affording to feed themselves. Not to imply at all that people of any socioeconomic status have less rights than others to reproduction. But, we are no longer in the age where you have 10 kids in hopes that 5 survive, at least not in the US. Let's stop acting like we are and start being responsible with the science and medicine available to us.

Friday, March 12, 2010

why health reform matters

Last night I volunteered at the clinic I am a coordinator of in South Philadelphia, one that primarily serves Mexican immigrants. It was a good time. Besides getting to work side by side with bright and interesting students from all over Philly, I got to talk with patients and practice my Spanish.

What struck me most was how great of a relationship the doctors and nurses of this clinic have with the members of this community. The patients are treated for free, and many walk in without appointments and are unsure of how good they will be treated, weary of past experiences at other free clinics. But, they have no choice as they work in restaurants in Philly, without insurance, and barely make ends meet. Greeted with a warm smile, they are welcomed in for a thorough checkup, no strings attached. There is always detailed care given to every patient, with ample time taken and all concerns addressed.

In the regular health care world, doctors have to see patients every 7 minutes or less in order to make enough money to support their practices. Insurance companies pay only a portion of what the initial invoices list, though they make millions off of people to ensure that they are treated properly. Why is this a problem? Because doctors have to worry more about costs and time than they do about their patient's well being. They have to rush through appointments, missing important clues in patient cases, and above all, they have very little time for establishing great relationships. In my opinion, health care is a field where relationships are required for the comprehensive care of a sick person.

Why do I say all of this? Because our country is in need of change. Health insurance companies should not hold the power to the treatment of patients. Health care providers should. The doctors and nurses who I know didn't get into the field to keep insurance companies booming...they got into it to make a difference in peoples lives. Making an easy buck is the last thing the students eagerly learning in this clinic are thinking of.

Consider it: supporting health care reform

Unlearn it: that people only deserve the health care they can afford...what if you didn't have money or a job with insurance?

Friday, February 26, 2010

Engineering a future in sustainable health

I am almost at my half way point in the spring semester, and on my way to class last night, I surprised myself with motivation I would've never imagined having. I'm taking an engineering of sustainable water and sanitation resources course...a sort of glorious meshing of theory pertinent to my public health studies and frightening three-page-long math equations.

As a psychology undergrad student at Drexel, a very strong engineering school, I have years of ridicule under my belt for going to a technical school to earn a liberal arts degree. Never did I have an interest in even taking a peek at what engineers learned, nor would I have had the courage. Not to downplay the hard work that is put into earning a Bachelors of Science in Psychology...I definitely did my share of work. Drexel actually has quite a decent program. But I successfully avoided all things engineer related during my time there.

Now, here I am, a few years later, a bit more brave and curious, and I decided to take this ESE course at the masters level. At UPenn no less. My auto response is oh my goodness what was I thinking. But last night, having 3 pages of math written out for homework, none of which actually arrived at a correct answer, and on the brink of another snow storm, I still did not even hesitate to go to this class. I looked at the topics for the lecture on the syllabus, and was so excited to learn what they were teaching that my motivation completely overshadowed my dread of more hours of math and driving home late in a snowstorm.

Needless to say it was worth showing up to class. I've been learning about gravitational factors in water catchment, velocity and flow of water sources, calculation of head loss and diameters for the selection of proper piping for a safe water system, finding hydraulic grade lines, and how all of this has a real world impact on the health of the people I wish to serve. Who would have ever imagined I would be the most eager student in an all engineers course? I really hope this knowledge I gain will compliment my work in public health, and keep me up to speed on the necessary technical aspects of this field.

A thought to preface a future blogpost: we discussed which should be priority when only one option is feasible...providing a community with access to sufficient amounts of fairly clean water (which may still have some contaminants) and emphasizing hygiene methods for prevention (i.e. hand washing) or providing a completely pure water source, even if it does not yield enough water to meet the needs for high hygienic standards. Which do you think is more effective in public health prevention?

Consider it:
giving a completely different discipline a bit of your find how it can compliment your knowledge and broaden your capabilities and creativity in your field.

Unlearn it: mentally disposing of all the math in your head once you are out of freshman level undergrad because you "will not need it" in your field (trust me, not the best approach...)

Monday, February 22, 2010

birthday wishes

looking forward to good health and lots of learning, love and growth in my 25th year.


Saturday, February 13, 2010

Cafe Harvest

One of my favorite experiences while I was in Nicaragua was touring a coffee farm, picking the berries with the workers and learning all about the process of prepping coffee for sale. I learned the entire process, from the tree all the way to your cup. I think that Mike's blog sums it up best, so with permission...I'm sending you there, because I couldn't do a better job at explaining. He's got some great photos too.

Cafe Journey, from the tree to the cup

I really enjoyed learning about it, and it gave me insight into the inequality of what we value. A coffee harvester in Nicaragua may make $10 on a good, 8 hour day. He or she usually does not have steady work outside of the coffee harvest season, meaning that $10 a day for four months has to sustain them for an entire year. Unfortunately, it seems many Nicaraguans do not have the education to know how to properly budget, so that money does not end up lasting them an entire year, which contributes to their extreme poverty. What struck me the most was reflecting on coffee culture there versus in the US. There, it is their livelihood, and people wait and rely on coffee to ensure they will have money to feed their children. Here it is to some what keeps them moving, but it is the livelihood of very few. Few who are paid well, even Starbuck's employees get health benefits if they are part time, and I'm sure no one makes under $7 an hour. So, we as the coffee drinkers spend on average $4 a cup for this delicious product, and then we throw out the paper and plastic is packaged in and forget all about it. In Nicaragua, they are paid about $1 per 5 gallon bucket of coffee they pick. When I picked, Mike and I shared a basket and in over an hour we only picked half of a bucket. Granted, we are not skilled at this sort of thing, but it was still a timely process. Then, the farmer who does all the work of fermenting, washing, depulping and prepping the coffee still does not make anything in comparison to the coffee shops who sell it.

Perhaps we as the consumer value the coffee we are drinking, and are willing to pay fairly for what it is worth. But the companies who are paying for the product to serve are not sharing the profit fairly. It does not make sense to me that one of the most profitable markets in the US would still leave those producing the product in poverty. I'm no economist, but I'd venture to say that we are not acknowledging the true cost of coffee. Someone always has to pay, like I learned in Economics back in high school, there's no such thing as a free lunch.

Consider it:
buying only fair trade coffee products

Unlearn it: that the coffee you are consuming has no consequences to those on the other side of the planet.

Friday, January 29, 2010

what's in the water?

Sorry its been a long break between posts. I have had so many observations in public health this month that I can't wait to share.

My adventures in Panama and Nicaragua were quite enjoyable. I was able to travel a great deal, and to spend time at Michele's site in the mountains of Jinotega. I learned how to milk a cow, make cheese, produce coffee from tree to cup, and to surf. Michele and I went surfing on one of our last days and we were both able to stand up on our boards a couple of times, which we were quite proud of. I have so many fun and wonderful experiences to share. The interaction with the children was one of my favorite parts...but that is for another blog post.

As for now, I'm quite reflective on why my energy and interest has been consumed with learning about safe water management. Up until this trip, I understood the importance of water from a spoiled American's perspective, with most of my passion based on what I have learned in text books and class. I've traveled a bit, I know not to use the tap water and what the consequences are when you forget and rinse your toothbrush in the tap water. Or so I'd thought.

The last few days of my trip, I started having spells of stomach sickness (to put it nicely), and figured it would go away on its own. Now, 3 weeks later, I believe I may have a visitor who has made a cozy home in my intestines. Naturally, as a public health student specializing in safe water and sanitation, it irks me to think that I was not careful enough with my water consumption. How could a parasite or any form of contamination enter my body?

Then, I reflected on what I ate, drank and was exposed to, and I realized how extremely difficult it is to avoid exposure to protozoa and other pathogens when the water of a community is not safe. The only things I can come up with were coffee in a local's home (which I assumed was boiled) and juice at a restaurant (who uses bottled water, but perhaps the ice cubes were from the tap???) Imagine what it must be like for those who live with such conditions. I'm sure their bodies adapt and for many, immunity builds and they are not always this sick. I know you can build tolerance to certain bacteria, which is why that's what I thought this was (as Michele did not get sick and has been there 8 months now). But I tested negative for a bacterial infection, and was given antibiotics just to be safe...which do not seem to be working.

I'm not certain of the immunity one can build for parasites. Perhaps its more of an adaptation to the lifestyle of constant exposure, where you always have symptoms. There is only so much any digestive system can tolerate before its too much and unfortunately, survival of the fittest often dictates the outcome. Most of the time, children are the ones in a community who suffer the most, with severe illness and death. I now understand why so many children -- between 1.5 & 2 million a year -- die from diarrhea related illness. When someone spoiled, like myself, who is educated on the consequences of dehydration, and who has access to a flush toilet and adequate safe water and sanitation...and warm showers for that matter...has difficulty staying well with this, one can only imagine how a child in an underdeveloped context, with parents who are not educated on the consequences of dehydration, can so easily die.

The bittersweet part about this experience for me is that even though I am miserable, and shamefully have been throwing myself a pity party, I now have first hand experience on why it is soooo incredibly important to teach people about safe water, and to bring it to as many as possible. A great life truth really, that I had to get ill myself in order to really see what I'm investing in this education for. And for now, I have self diagnosed with having Giardia, which is a parasite with quite a few unpleasant symptoms, all of which I have. Nothing has shown up in my lab results yet though, and I've been told by several (including doctors) that Giardia seems to be one of the most difficult to diagnose, as it easily sneaks by undetected in labs. Many are warning me of the long road ahead on the path to feeling better...which I am refusing to believe. Perhaps they'll find something and treat it. Perhaps there really is nothing there, and I'm just a hypochondriac who is self diagnosing.

Or perhaps I'll get tough and tolerant in the meantime.

Consider it: being grateful for clean, safe water that is easily accessible.

Unlearn it:
that nice solid, healthy looking poop is what everyone in the world must see everyday, because you do. Or for that matter, that some people ever see it or get that satisfaction.