Enough complaining.

Can't complain with this view. Currently at the beach, obvs. And now able to have a leisurely contemplation of this past week, without taking into account creature comforts and illnesses.
So about Sabana Grande, our community. It is about 5 hours north of Managua, high up in the mountains near the Honduran border. This particular community has a longstanding relationship with an NGO called Grupo Fenix, which has been working with community and US partners to promote solar energy. Most houses have some solar panels - enough to power one or two light bulbs, and some homes have solar "kitchens" aka ovens. Otherwise, the kitchens have varying degrees of ventilation, which is bad for respiratory health because they burn wood for fuel. Most families have multiple generations and several species of animals living together- cats, dogs, chickens, turkeys, pigs, cows. One or two families have televisions. Nearly every family as at least one cell phone. Our cell phone carrier is Claro (there are 2 major carriers in Nicaragua it seems), and they must have realized that the best means of advertising is through the cell networks so we are bombarded by promotional texts - e.g. you can win a Toyota Hilux! Buy minutes for 50% more today!
So speaking of the chickens, the roosters are out of control up here. They start crowing around midnight and don't really stop until well into the morning. Usually it begins with a distant cock-a-doodle-do which then starts a chain reaction with all of the nearby roosters. Sarah and I have conjectured that our family's rooster is going puberty as his squawk sounds a bit off, like he can't get the cadence right.
Rural medicine is challenging. Rural medicine in a developing country like Nicaragua is really challenging. We rotated with the local docs at their main clinic in Totogalpa as well as our "local" clinic in Sabana Grande. So the local/rural clinic in the community consists of 3 exam rooms and a room that they call a pharmacy, which is stocked weekly by the doc and nurses who come a few times a week. The first day of the week that the clinic is open begins with cleaning out the dirt and critters that have accumulated over the past week (this week we had a bat, several geckos, which were actually left mostly in peace). Then the patients line up for either "consulta" or "control" visits, e.g. urgent care-ish doctor visits vs immunizations with the nurse. We (Kay and I) saw 18 in 2 hours one morning, which is what can happen when you only have to chart the patient's information, diagnosis and write out prescriptions on scraps of paper. Most people don't have their own charts, and many forget even their ID cards. Lots of diarrhea (which is more likely parasitic than not- huge mental shift), headache, backache, allergies. Our greatest inadvertent booboo was giving metronidazole vaginal tablets thinking they were oral tabs.. hey we were just learning our way around the pharmacy, and dispensing our own meds (until they ran out anyway)! Clinic trash is thrown out in a pit outside. There is no running water, no thermometer for temps and otherwise we take our own vitals.
At the Totogalpa clinic, patients are vitaled and they have paper charts. So we saw a bit more chronic disease management... and the clinic ran until it got too dark to read the chart, because there was no electricity. There is a maternity center across the way where ladies come to nest prior to delivery, at about 39 weeks. Every night they all walk over to clinic to be checked to see if anyone is in labor, because if so, the clinic doc on call stays overnight.
There is a group of engineers from Dayton University here working on a solar autoclave, who plan on staying all summer. Apparently the university has been sending students for several years, and encourage global missions- it's a Catholic university ... so lots of folks around the solar center which has become our home base. We tend to hike down in the mornings (flushing toilets with seats are a big draw!) and also meet for a delicious plate lunch accompanied by a cold glass of juice (papaya, passionfruit, orange combo). As plentiful as the mangos are in the area, somehow we don't eat a lot of them... but we do eat the gigantic avocados which have a lovely mild taste (people have talked about importing these puppies to the US as our puny avocados look and taste like pale imitations). Oh and the coffee... delish.
I am looking forward to this next week when first year med students and my psychiatry colleagues join us- the more the merrier! And on that cheery note, I shall sign off for now. Until my next wifi access...