Saturday, April 24, 2010

The Great Vaccination Campaign Take II

Since I have officially passed the half-way point of my two years of Peace Corps service, I am now beginning to get into familiar rhythms of yearly events. This April marks the annual national vaccination campaign. You might remember my blog entry about this event last year, one of my first blogs in-site. This year, I’m participating for the second and also last time. This year I bring a different perspective and although it’s the same villages, many of the same kids, and the same nurses, I now feel a greater sense of belonging and understanding in my community.

If you didn’t read my blog last year, here’s the gist of the campaign: country-wide, all the health centers send out teams of nurses and doctors to each surrounding village for two weeks straight to vaccinate all young children against polio, DPT, DT, MMR, etc. They also administer Vitamin A and anti-parasite medicine. It’s a well-organized event that most nurses carry out with efficiency and experience that I found astounding last year. How can they remember all these kids’ names? How do they not get lost trekking around the mountains looking for that lone house with the unvaccinated child? How do they know just how to grab a screaming and kicking child to make him sit still for the shot?


An unsuspecting child waiting his turn.

This year, I’ve been taking a more active part in the campaign and as a consequence have been spit on, bitten, cried on, hugged, ran away from, and stared at by hundreds of kids as I administer anti-polio drops, Vitamin A and anti-parasite medicine. (The nurses tried to convince me that they should teach me how to inject –“It’s so easy, really!” – but I politely declined). A child who doesn´t want to take his anti-parasite pill.

When we go to a village, we set-up our vaccination central “camp” at the house of the local health volunteer. The conditions vary extremely; some of the volunteer’s houses are immaculate and you can tell the family is “well-off” (relatively speaking): they own chickens, ducks, pigs, a dog, have lots of fruit trees, multiple bedrooms in the house, and maybe even running water and electricity, or at least their very own well. Others get by with the bare minimum. They give us a few battered plastic lawn chairs held together with twine and we position ourselves under a scrawny tree nearby for shade from the hot sun. We set-up the China-donated cooler to hold the European Union-donated vaccines, organize the Canadian-donated syringes, and get out the American-donated Vitamin A drops. Thank you international community. Ready to go. Our first victims start to arrive in the arms of their mothers. Some come willingly; others have tear-stained faces which attest to the battle of wills that must have taken place at their home minutes before, ending in the child being forcefully dragged or carried to be vaccinated. “It’s just drops in your mouth!” we call encouragingly to those who seem hesitant – for most, it is (see photo below).For some unlucky ones though, they have to face THE NEEDLE. In this case, everyone present gasps in excitement and anticipation, craning their necks to get a good view. Much attention and care is taken to commenting on whether the child looks scared, whether he or she will cry, or how big the needle is compared to previous needles that those present have had plunged into their skin. The needle goes in; the child’s cry goes off like an alarm. All the mother’s present proceed to coo and stroke the child, the children in their arms with eyes as wide as saucers. The poor victim, scarred for life, sobs and glares at the nurse, its torturer.

More kids arrive – mother’s holding babies shuffle in and out of plastic chairs. The yard is full of babies and mothers, and chickens – some women breastfeeding absentmindedly, others shifting uncomfortably trying to hide behind their child, wanting to avoid a possible tetanus shot we may give them. Some women are still dripping water from their hair from their recent bucket shower. A few have had their toenails recently painted and their babies are wearing Sunday dresses. Other mothers are in worn corn and bean-stained clothes with tired looks on their faces; they have laundry waiting at home and lunch to cook. How long is this going to take anyway? No one complains though – the socialized medicine system here may be frustrating, slow, and inefficient, but these people have grown to expect these services and they will wait any amount of time to receive what little they can.

One nurse devotes herself to tabulating all the numbers. She looks up names of children in a large battered notebook from the health center records, writing in pencil the date of the vaccine. Each family here also keeps their own vaccine records – at birth the baby is given a vaccination card onto which all dates and appointments are written. Depending on the care that card receives by its owner, on vaccine day, we are handed some that are illegible, stained, ripped, and often lost. You can tell a woman is a new mother when you see a bright, white and clean vaccination card that she stores in a plastic bag. Squinting as we try and make out the writing on the older cards, “Does that say 1996 or 2006?” “Was this child born in 2005 or 2006?” (That one is often met with a blank stare by the mother with a ‘how should I know?’ look). Many children move around frequently due to their family’s migrant lifestyle – perhaps the mother lives in the U.S. and sends money back. One year the baby will be living in Managua with an aunt, the next year moving to Estelí to stay with their grandmother, and maybe, years down the road they’ll move in with an uncle in Jalapa and grow up knowing him as their father.

The day continues. We calculate ages, months since the last booster shot of dpt, tetanus, mmr… Pens and pencils are stuck into ponytails just as quickly to be grabbed out again, brows furrowed, erasers move erratically back and forth over the paper, shavings blown away. Cell phone calculators are whipped out to avoid confusion on birthdays. It is customary here to state your age in an approximate value, rounding up or down. Many women tell us they are 20, when after looking at the records it turns out they are 23 (it surprises them as much as us). Calculating exact ages is not too important here and something that people are not used to. I once spent three minutes trying to convince the nurse doing record keeping that no, a boy born in December 2008 was not yet two years old. She had trouble understanding that although we were in 2010, December had not yet passed.

I was often in charge of taking care of the MEF (mujeres de edad fertile) – women of child-bearing age. This means I had to look up every mother’s name who came to the vaccine post and see if she was up to date with her tetanus shots, and record new women who weren’t already on file. This was particularly difficult for me since it meant I had to spell a lot of Nicaraguan names, which are not your typical traditional Spanish names like Maria or Esperanza. It got quite frustrating. How do you say that name again? Spell it for me? What was that again? “It’s Hairy… H, A, I, R, Y,” one answered me (pronounced “Hi-ree” in Spanish). “What?!” I replied, “Are you sure??” Good thing she doesn’t speak English. Poor thing, hopefully she never moves to the states; she’d never hear the end of it. Here are just a couple of the odd names I’ve encountered down here – a mix of English and Spanish, European and make-believe: Milady (My Lady), Lubby, Mayerling, Maycol (when pronounced phonetically in Spanish sounds like Michael), Duglass (pronounced like “Dooglas” – a Spanish version of Douglas), Yelsin, Sindi, Harol, Daysi, Yessel, Jeniffer (yes, two F’s), Furry, Moni (pronounced like “money” in English), and Visitación (means “visitation” in Spanish)… Oh well, I guess I shouldn’t poke fun, my name is arguable just as funny.

On a few days, we finished vaccinating earlier than expected, and the nurses got anxious to go out and explore a bit before we went back to town. “Don’t we have to get back?” I asked, wondering if the health center director would appreciate us joyriding around in the health center vehicle conducting unofficial business. “Oh, we have all afternoon!” they’d insist, “Come on, let’s check out this coffee cooperative nearby, I’ve always wanted to go.” Okay – you’re the boss… Upon entering the large co-op, we are treated to a grand tour of the facility (one of the largest in the country). It is coffee processing season here, so we see the women sitting outside under a wooden tent structure “picking” the coffee beans, and sinewy men hauling 50 lb. sacks of finished coffee beans into large trucks, from which they will be transported to markets in China, Russia, the U.S., and Europe. We are treated to coffee samples and free promotional calendars featuring a half-naked Nica girl lounging on motorcycles (what that have to do with coffee, I’m not sure). An hour after we had entered, the nurses and I left the cooperative happy and caffeinated, each with a couple pounds of coffee under our arms. But the nurses weren´t done exploring yet! We then proceeded to visit an isolated rural vineyard and enjoyed a tour of the farm by the old man who owned it. When he saw our vehicle pull up to his cement home, we saw him jump into a shirt and some boots and rapidly dry-shave his stubble using the rearview mirror of his broken-down motorcycle in order to be presentable. I’m sure not too many people from “outside” come to buy grapes there, much less a bunch of nurses with a blonde gringa. He treated us all the grapes we could fit into our bellies. All together, we left with about 50 pounds of green, purple and black juicy grapes, at $0.75/lb. Sadly, he had no wine on hand, but promised that if we came back, he’d have a few liters set aside for us. Nice outings to finish hectic days. I guess there’s always time for coffee and grapes…
Above: nurses enjoying the grapes. Notice the sexy coffee calendar in one nurse´s hand.

This year, I feel more comfortable in these rural villages. The extreme poverty that used to scare me: children as skinny as broomsticks with faces and bodies so dirty you can’t tell their skin color, clothes so worn that they take on a transparent quality, and villages and homes so isolated I begin to doubt if they’ve ever even heard of the internet. Despite the poverty, they are often happy and generous with what little they have. I will gladly accept the mango juice they offer me, even though I know they have so little and it will probably give me parasites. I will be thankful for the dirty, roach-filled latrine that they let me use – it’s better than none at all. I will enjoy the shade of this sparse mango tree, even though I’d much prefer an electric fan. I’ve learned to be thankful for the little things, and to take time to smell the coffee roasting.
(Below: my neighbor´s baby and I. I held the poor thing down while they gave him a shot in his leg).

Sunday, April 11, 2010

San Juan River


Although I didn’t fall in love immediately with Nicaragua, it was love at first sight with the San Juan River.

For my Holy Week vacation (the week before Easter is a national holiday here), six other Peace Corps volunteers (PCVs) and I headed down to that rugged, little known and slightly wild place known as Río San Juan (San Juan River) in the south of Nicaragua. The river starts at the enormous Lake Nicaragua (Largest Lake in Central America) and snakes along to the Atlantic coast, forming the border between Costa Rica and Nicaragua. It is one of the most isolated areas in the country and therefore, one of the most intriguing. The river was used by Aztec traders beginning in the 1200s and has since been the battleground for Spanish conquerors and pirates. During my days there, I became enamored with the river, the scenery and the people – I would transfer my site down there in a minute if I could!

However, transportation there and back is a different story. To get there, we took a tortuous 15 hour ride on a small ferry that was holding about three times as many people as it should have been. (If you’re from Southeast Alaska and are familiar with that Alaska Marine Highway System, then imagine riding on something half the size of the LeConte with the passenger load of the Columbia). We camped out, spreading out sleeping bags and hanging up hammocks outside to try and sleep during the overnight ride (see photo below). We made one brief stop on Ometepe Island, the famed hourglass shaped island with two volcanoes (one of them is currently erupting!) and dropped off/picked up passengers, as well as piles of green plantains and a tangy small fruit called jocote. Like my hometown in Southeast Alaska, most foodstuffs arrive by boat to the Rio San Juan. We arrived groggy, but excited at 6 am in San Carlos, Rio San Juan – the department capital.

From there, we visited a volunteer named Jill in her amazingly quaint town down the river. It has 1,000 people and only is accessible by water (there may be a road, but apparently it’s too beat up to want to use). We enjoyed hanging out with her and seeing the “Casa Materna” – a boarding house for pregnant village women to come live at right before they give birth to reduce complications. Jill is working on a project there to start a women’s cooperative where they sell earrings and handicrafts and have tourist information. Several tourists pass through the little town on their way to start the trip down the river. Starting a little business there would benefit the women by providing extra money to help buy nutritious food. Most of the time they subsist on rice and sometimes beans.

After bidding Jill farewell, the seven of us went to a town called El Castillo (The Castle). Positioned directly on the banks of the Devil Rapids, it is named for the Spanish fortress that overlooks the town. The fort was built between 1673 and 1675 and used primarily to attack pirates, who were forced to slow their boats as they navigated the Devil Rapids. One of Nicaragua’s dearest heroes, Rafaela Herrera, led a successful attack on a British fleet from the castle in 1762, when she was just 19 – becoming a feminist legend in the country. El Castillo is beautiful and arguably the friendliest Nicaraguan town I’ve ever been in. Tourism is just beginning in this area – most of the hostels are just a year or so old and the local charm has not been lost. If I had to pick another town in which to live in Nicaragua, this would be it.

From El Castillo, the seven of us rented two kayaks and two canoes to start the big river trip to the Atlantic Coast. We were planning to do it in three days. We rented our boats from a local guide named Miguel who is AWESOME, check out his website at www.firststepecotours.com Miguel lived in the U.S. for a while, so his English is great and he is quite a character… He showed me crocodiles at night (their eyes glow red!), made me some beans and rice, and treated me to some dark Nicaraguan rum mixed with coconut water from trees in his front yard. Try it - delicious.

Due to a variety of reasons that I will refrain from going into in this blog, mostly because of space (but trust me, it´s pretty hilarious), we didn’t up doing the entire trip all the way to the Atlantic coast. We did one day of paddling and then decided to hang out on the river the rest of our vacation. I was happy to just sit and watch the water go by from our hostel in El Castillo. It was nice to be around water again. It rained every day we were there. Rio San Juan is full of life. The rain forest, lush jungle, rivers and islands are part of the Rio San Juan Biosphere Reserve that harbors macaws, toucans, hummingbirds, parrots, great blue herons, egrets, giant river shrimp (they have huge crab-like claws and can easily weigh a few pounds), turtles, crocodiles and bull shark (!) Also, lots of mosquitoes. Unlike the mosquitoes in my site that are used to me and refrain from biting, on this trip my legs and feet were covered in red bites.

At the end of our very relaxing Holy Week trip, we took an 8-hour night bus back to Managua. I took a sleeping pill and was passed out the whole way, unpaved road and all. I’m already thinking about when I can go back to the river. I can still hear the water rushing in my head…