Planning to Re-plan

Many of you have noted that I have not recorded my thoughts for some time here in this blog. I have been pretty busy over the past few weeks and one of the unfortunate results of this, aside from cutting my sleep short, is failing to properly take the time to record my experiences and then broadcast them via the web. One lesson that I have grappled with, as will become apparent as you read on, is the need to expect that plans will fall apart. I have found that very few things are truly dependable, whether they be physical resources like electricity or transportation, or human resources. I think that is the, albeit frustrating theme of that past few busy weeks and part of the reason why they have been so busy, since the majority of events and actions were preceded by preparation and then scrambling to account re-prepare. There are a few stories that I'd like to share.

First, team “Bartek in Nicaragua” has recently acquired a new member. Kyle “Capitan Carlos” Oberle arrived in Managua after the weather in St. Louis delayed his flight for a day which meant that I made the 3-hour-one-way trip to Managua twice in two days. But, no matter—Kyle is here and we are working in sync now! As would be expected, his arrival was followed by a figurative sigh of relief that someone could understand my native tongue and that I could again express complex thoughts. Not to mention the fact that Kyle is an all around good travel buddy. Having him here has changed the dynamic of this trip for me in a great way. While having an individual experience, and all the frustrations and joys that go along with that, has been great, having someone here to share the work and the play with is equally rewarding. We have already accomplished a lot together and we expect to continue doing so for the next week and a half until Andrea comes and my vacation starts.

Kyle jumped right into the thick of things and we got out to the campo on his first day here. In true Nicaraguan fashion, he spent his first night in a hammock that we rigged up in my room because we returned too late at night and his family had already gone to bed. However, as mentioned before, planning and re-planning is something that I've begun to get used to.

That Friday, we ran into Victor, a local fisherman who is a good friend of a good friend of mine and who had already offered (another story of expectations which were built up and then let down) to take me fishing. So, I asked him when we could go “pescando” and he told us that tomorrow, at 1:00 pm, he would pass by my house and we could go out. Although I can't understand a single word he says (There are some people whom I can understand as if they were speaking in English, and there are some people that sound to me like they are speaking one of the other 1,500 languages on this Earth which I don't have a clue how to interpret. Victor fits into the second category.), I made sure to check and recheck that we would swing by at 1:00 the following day. Alas, the next morning, after a great run with Kyle, I returned to my house in a ball of sweat only to find that Victor had come by already looking for me. Knowing that a day of fishing was worth the stress of trying to find him, find Kyle, and get out in to the sea, I ran down to the beach only to be ridiculed by him saying that I wasn't there when he came by.

The more important part of this story is the actual experience, although the building of expectations and the failure to realize them is and has been an important lesson for me here. Once we got going, though, it was something else.

Victor is a 55 year old man that walks barefoot nearly everyday with his circa-1913 wooden cart full of his daily catch from the beach to his house. He has a pink faded LA Dodgers hat which could have been anything from blue to white when it was new. He doesn't wear a shirt and he smokes on and off the boat. Lastly, he has an infectious smile that, although I can't tell what the words emerging from it mean, speaks to me all the same. After we found him, he waded into the water and then swam out to his boat as Kyle and I stood on the beach debating whether people are healthier in Nicaragua because of the higher level of physical activity that they have in comparison to the US. Then Victor hauled the motor on his shoulder out to the ponga and placed it on the back. With a little push, we were off.

The crew consisted of me, Manuel (the brother of a good friend), Joakim, Victor, and Kyle and I. I've already described Victor. Joakim was tall, by Nicaraguan standards, and lanky. Manual was shorter had a bit of a gut, which is normal especially considering the quantities of fried food here, and a killer of a tattoo—it was a middle finger, tattooed right on his upper arm!, above a cross. The irony oozed from that right arm.

We made our way north, up the coast, seeing a view of the beaches that had been foreign to me but was truly beautiful. This coast is the most beautiful of any I've seen in my life including Thailand, New Zealand, Australia, America, Aruba, Costa Rica and St. John. Then we stopped and Joakim and Manual went diving for lobster. We were asked if we knew how and if we had equipment, but even if I did know how and had my own my equipment, I wouldn't have gone. They would use a hook on the end of a long pole to hook the lobster in the side and then drag it back to the boat in their hands. After about a half an hour, we were heading back to San Juan bay to look for fish. I have never fished when it is not for sport and while the difference is subtle, we were certainly using and treating each fish as a means to an end—namely payment—rather than an end in and of itself. It turned out that we didn't catch that many fish that day and the biggest lobster was me since I had been in too much of a rush to find Victor to put on sunblock.

The majority of last week was devoted to preparing and planning (and then, of course, re-preparing and re-planning) for this past Saturday, the final phase of the three-pronged pilot project in Papaturro. We went on Monday to finalize the hygiene education phase, phase two of three, since when we went on the previous Thursday, the community simply didn't show up. The meeting went well and we spent the better part of the afternoon collecting water samples from every home in Papaturro to test how well the filters are working. That made 60 samples which Kyle and I had to analyze that night after a day of teaching, walking, and collecting. We were tired, but determined. At around midnight, we finished with the sample preparation, placed the resulting petri dishes in the incubator and went to bed. On Tuesday, around 11:00 am, the power went out, which meant the incubator turned off, which meant that the samples were not at the prescribed 35 degrees Celsius. The power outage lasted about 3 hours and while we were able to get some help from a hotel in town with a generator, there was about 2 hours when our samples were cooling.

Collection, analysis, excitement to see results, power outage, adjustment to new changing conditions.

That Thursday, Kyle, my “sister” Nadiezdha (it's a Russian name), and I went to Rivas, the closest city, to pick up supplies for the fecal collection which would occur in two days. When returned in time to go to Papaturro to drop off the collection cups, but when we got back to town, it was raining and my ride had fallen through, so we decided to make the delivery on Friday—when it would be “no problema” to use the Centro de Salud's truck. I made plans to meet with someone at 10:00 on Friday morning because we were going to leave at 8:00 and the trip should have only taken about an hour or an hour and a half at most.

The next morning, I showed up at the Centro de Salud and waited. Then the driver came, but told me that he needed to drive to Rivas and that should wait for the other driver. After waiting another 45 minutes, he arrived and we left. I was frustrated and felt rushed and the fact that the guy sitting next to me was relaxed—”tranquilo”—only made me more tense. The most important thing, though was that the materials got delivered. The lack of ability to follow through with thorough plans means that there is often a quick reevaluation of what is important and what isn't and I knew that those materials (collection cups to be distributed to the community members) needed to get to Papaturro or there would be nothing for the laboratorians who were coming the next day to analyze with their microscopes. So the collection cups got to Papaturro and I made my meeting late.

The next day, the big day, “Feces Saturday”, began late. We got to Papaturro by 9:30 am and—GLORY!—there were townspeople waiting with full collection cups—SHIT!—to be analyzed. This put a smile on my face since simple assembling the community had been a difficult task in the past. You have to celebrate the little successes. We set up the mobile lab the the lab techs, itching for some samples to look at, began looking at the samples. Results began streaming out: E. histolytica, Giardia duodenalis, Ascaris lumbricoides. We were rolling! In about an hour an a half we had cataloged and analyzed the 58 samples but that only represented half of the population of Papaturro which meant either 1) constipation had swept the town and thwarted our plans to collect poop from everyone in the town or 2) people didn't care enough to go through the process of collecting a sample and bringing it to school. I was went with possibility number 2 and so, after the two doctors came and began their consultations with the community members who had returned to see their results and receive the medication that was need to treat, I hopped in truck with two Brigadistas, the Nicaraguan term for local health worker, and we went to some of the homes that were far from the school to see what was going on. While we fell short of my hope of gathering the entire rest of the town, we did pick up one woman and we learned that, understandibly so, expecting the entire population of the town of Papaturro—or any other town for that matter—to poop on command was unreasonable.

When all was said an done, we had collected 59 samples and given about 50 medication sets to family leaders. We had a great time and we accomplished something which could quite possibly save the town from at least the agony of diarrheal disease and the cost of it and at most possibly a death or two of a small child. This was public health in it's purest preventative form.

You plan actions and processes, but not emotions. Perhaps my planning in the future will need to include frustration, anger, uncertainty, flexibility, inventiveness, reaction to change, and the subsequent joys from small accomplishments.

(The two pictures are from Saturday, “Fecal Saturday”. The first is the lineup of facel samples waiting to be analyzed. The second is Chepe, one of the three laboratorians, at his microscope.)