NICARAGUA: THE ALTERNATIVE UNIVERSE

Do you ever wonder if you have entered some sort of time warp? A glitch in the fabric of life as you know it and ended up in an alternative universe? I wonder that all the time.
Sure, it doesn’t help that I am in Chinandega, Nicaragua again (either the 3rd, 4th or 6th largest city the country ---apparently the 5th largest CITY option is lost somewhere in the flux capacitor!) where pretty much everything operates at a pre WWII level. I keep expecting John Boy Walton to walk down the sidewalk only his skin would be kinda brown and he wouldn’t be able to afford those cool spectacles. Jim Bob and Mary Ellen would be begging coins and food from people at the petro station instead of going to school. Ma Walton would be washing clothes by pounding them on rocks here. Grandma and Grandpa would most likely be dead. Their house would have cold but not hot running water and the electricity would go out every time it rains…which it does just about every day in September in apocalyptic proportions.
Today, it rained bloody murder which means we ran on generator all day at the hospital, there was water leaking on to a pre-op patient’s head and everyone walked home in complete darkness. The good news is that we got a candlelight dinner of ribs barbequed on a gas grill. And the beans--- as far as I can tell, Patricia the cook has had the same pot of beans on the gas stove at the back on the mission house since she started working here in 1995. I have never seen the level of beans change in this container that could easily contain a small ungulant . Not ever. Bush’s should look into her technique. It’s Biblical in nature.
And speaking of the unexplained, Miriam, an American long term missionary here, gave me a ride to the grocery tonight so I could get some deodorant and people could tolerate being in the same operating room with me in the morning. ON the way back, in the pitch blackness, she starting telling me that there is a mythological creature in Nicaraguan folklore called the chichigulpa, half man and half wolf. I start thinking Twilight Zone. Not the show, the movie. I am thinking Dan Akyroyd, loud radio, country road, absolutely no lights and no one anywhere in sight when the guy driving the car leans over and says, “You wanna see something really scary?” I start to ask myself, “Do you actually know this woman who is giving you a ride? Isn’t she just a little unusual? “ I put my hand on the door handle and consider jumping out and making a run for it. If she asks me if I wanna see something scary, I will make my break. But what if she doesn’t?What if she just BECOMES something totally from the alternative universe? I am now certain I am riding with an alien and I need to call MIB. She smiles. This scares the bejesus out of me. How can anyone in her right mind smile when there is no electricity and you are four blocks from the PanAmerican highway, home of the Frito Bandito and various other sources of potentially life threatening badness? I brace myself and wait for the inevitable…whatever that might be.

“I saw one, “ she says, almost a whisper.
“What? You saw what?”
“A chichigulpa.”
“Where is it?” I glance in the rearview mirror.. Isn’t that where they always appear?
“Not right now," she chides..” I saw a werewolf. Right here on this exact same road about two years ago.”
I sigh relief. This woman seems a little unstable to me anyway. But I also check the bushes along the side of the road. Just in case. No need to jump out of the vehicle. It could be a setup…She could be in cahoots with the chichigulpa.
“Dr. McNutt saw it too. You can ask him.”
I respond brilliantly. “Uh huh.”
I don’t actually know Dr. McNutt, but even if I did, I’ll be damned if I am going to ask a highly respected pediatric orthopedic surgeon from Atlanta if he saw a werewolf about four blocks from the Pan American highway about two years ago while riding in an ambulance with an American woman of questionable mental stability., Trust me on this one--when a woman with whom you are a perfect stranger attempts to discuss intimate details of her menopause and/or menstruation with you within 9 minutes of making your acquaintance, you are living dangerously by accepting a ride with her to the store. Go out in the hurricane force winds and walk to get your antiperspirant. Or just accept your natural god given scent and hope others will too. . It’s infinitely less frightening.


We get back to the house and I realize that this surreal life won’t be changing anytime soon. The generator has been revived now and there are a few lights. I go in the restroom and while there I notice that the bathroom deodorizer scent is literally translated, “Smell like a baby.” Why, I ask myself would anyone who has polluted the toilet air want to make it smell like not only human excrement, but also vomited partially digested milk, desitin ointment and plasticky diapers? Time warp? The only logical explanation is that when someone else in the mission house is standing desperately outside the water closet door as you exit you can say, “I know it smells bad in there, but it wasn’t me. There was a baby in there before me.” And they might actually believe it. Because, after all, you are going potty in an alternative universe.

My Moist Nicaraguan Life

It’s the monsoon season here in Nic. And it’s not raining. That means that instead of getting drenching wet from time to time, you stay at a low level of moistness pretty much constantly. There’s sweat and there’s condensation from the atmosphere on your skin which is just a few degrees above the ambient temperature. Water spilled or rained onto the ground never evaporates and your freshly washed hair stays sopping in the land without a hairdryer…not that you would you it if you could in the steam pit known as the bathroom. You welcome the lack of hot water and pray you will feel cool enough to sleep. You turn on your fan, if you can find one that survived the desperate onslaught of all the mission teams that preceded you to this house past its prime and know the noise will drown out the mosquitoes taking kamikaze dives onto your arms and neck --- And all the sounds of the neighborhood-- fireworks on the Nicaraguan Day of Independence -- or is it guns?-- and dogs responding to the pain in their ears such blasts are known to cause. At 4 AM, the whir will silence the chickens and at 6am, the bevy of parakeets that swoop into the bouganvillea tree outside the bars of the sleeping porch.

Black beans and rice are the fare for breakfast and they will be for lunch and supper,too. Sure, they taste good, but I know I will get a little tired of them. I go to the pre-op clinic, hot, not having slept well and knowing the meal plan will get a bit monotonous before the week is out. I feel just a little sorry for myself.

Such self-absorbed sentiments won’t last for long here in Chinandega, Nicaragua.

When we’re emptying out of the ambulance like wasps from a smoky nest, we see about a hundred ladies either standing in line or sitting on long benches without backs. Some are teenagers. One elderly woman is slouched in her chair and looks like she might not be able to straighten her back at all. I am here and out of my comfort zone as a general surgeon with a gynecology team.

We start to see patients, many of them accompanied by family or a worried husband. “How many children do you have senora?” I ask a spry 84 year old lady.

“Thirteen.”

I look up from the paperwork and smile at her. I am not being friendly. I am somewhere between amusement, awe and disbelief. So you were pregnant thirteen times, right?”

“No,” she shakes her head. “Sixteen.” I look at her a little more closely and she says, “Three of them died.”

I think about what it must have been like for her to have these children here in this land of rural subsistence in the 1950s. Living through the conflict with the Sandanistas. Accepting a life of poverty and hardship without complaint, because it is all she has ever known and eight decades later, probably all she ever will.

“Are you having pain?” I ask her.

“No, not much.”

“Urinary frequency?”

“A little.”

“Can you make it to the bathroom when you know you have to urinate?”

Most of the time.”

“Constipation?”

“Only sometimes.”

“Do you have any problems with your womb or ovaries?”

“No,” she says, “They took all that out thirty seven years ago.”

I want to get a little exasperated, this elderly woman playing stump the professor so boldly with me. “So,” I ask, laying my pen down on the desk, “What brings you here?”

She leans forward and whispers, “I have a ball between my legs.” My mind flashes back to some stupid party game performed after too many glasses of wine at a friend’s bridal shower. She is sitting across the desk from me, but I am nearly certain there is no ball between her legs. I saw her walk in and she was graceful--nothing like the drunken waddle of my errant cohorts and the bride-to-be I remembered from years previous. And not bent over like so many octogenarians I treat in the US.

"Maybe we should get a look at that,” says Dr.Wiist, the lead gynecologist and mission director.

He politely steps out to allow our patient some privacy while she underdresses which she does deftly for an eighty year old, standing on one leg to shuck her panties. I notice there is a sanitary pad also. She sits down at the examination table, throws her feet in the stirrups like it is no big deal and keeps her knees together until Dr. W gets back, at which time she spreads eagle…she’s a veteran. And what I see before me is proof that our senior citizen is a mistress of understatement. After thirteen kids, God love her for forgoing the melodrama. Clearly in view and flopped out for all the world to see is her entire bladder.

“Grade Four,” says Dr. W, another master of the understated.

The day goes on and we see plenty of prolapsed bladders and uteri and cervixes with early pathology. One of the ladies cries bitterly and we reassure her repeatedly that it is just a change in the cells of her cervix, It is not cancer. And if she keeps up with her PAP smears, she will probably never get cancer. She is difficult to console, but eventually we convince her that she isn’t going to die anytime soon. At least not from cervical cancer.

As we get to the last 5 patients of the day,--women who exemplify why those in the waiting area are the “patient” in the adjective form of the word-- the clock rounds to the 5. We have been here since 8 am and they have waited 9 hours to see us. And every slot for the operating room this week is filled and we won’t be back for another year. No one else is getting an operation. Fortunately, the first four patients have diagnoses that don’t need surgery or can wait for a while without difficulty. The last lady walks in and she has come from a town far away on the Honduran border. The last bus of the day back to her village has left. She is fifty eight years old, just a couple years older than Dr. W and myself, and having pain in her lower belly. She feels pressure all the time. She is uncomfortable all the time and worse when she walks or carries the water or washes the clothes in the river. Her husband wants to have sex with her and she wants to, but it hurts too much. She is the mother of twelve. They are all grown and away from home. Can we help her out?

Dr. W examines this very pleasant lady and what we see is the worse prolapsed bladder of the day with some rectal involvement. We look at each other and both wish she had been at the front of the line early in the morning. She dresses and our interpreter explains that we want to help her, but all the surgery slots are taken. She can come back a year from now and we will write her name down and give her priority. She looks at us and a tear starts to roll down her cheek and then the torrent follows. She can’t help it . She came all this way and now, we figure, she is facing the fact that she will leave disappointed and have to live with this condition for twelve additional months. And that only if she has the money for the bus to get back in 2010.

Suddenly, she starts to speak and her voice is loud. It is obvious that she is upset and beside herself. Dr. W and I look at each other. We are getting the tongue lashing of our life in Spanish, a language well suited to this cause, And one which neither of us understands very well, particularly spoken quickly and at a volume.

We look at the interpreter. Although neither of us is sure we want to know, we ask simultaneously, “What’s she saying?” We feel bad for her, but we figure we should hear her out. “Oh, it’s nothing much,” says Rosana.

“What is it?” We figure it is so foul Rosana is too embarassed to say it.

“Well, she says, thank you for coming here. She really can’t believe you would leave your own country to come here just to help her and bunch of strangers you don’t know. She appreciates even that you listened to her and gave her your time, because the government of Nicaragua won’t help her. She is too poor to pay for the surgery. But you did everything you can for her.”

Our eyes are saucers. We thought we were getting the tirade of our life, but instead, this indigent lady, far from her home and no way to get back there tonight is expressing gratitude to us--the people who won’t be doing her surgery this week.

We are humbled. We walk over and hug her and when we do, her tears spill out on my shoulder.

And that is when I realize that it is indeed monsoon season in Nicaragua. And it rarely hurts when my life gets a little more moist.