Saturday, June 24, 2006

Soccer and Butterflies

This afternoon was the training session for the annual blood draw for the cohort study of dengue transmission. A large group of nurses came to the health center to learn about the project and to practice drawing blood and labeling the vials. It's quite a sophisticated operation - each time they take a sample, they record the details electronically in a PDA(Palm Pilot). The whole thing is going to start in early July, and teams of nurses will go out into the community and take blood samples from all of the children who are enrolled in the study. This year, they are trying to make things easier for the nurses and they will encourage the parents to bring their children to the health center. However, those who do not come to the health center will receive a visit from the team of nurses to their houses.

As part of the training I agreed to participate as a volunteer for a role playing exercise. I thought this meant that the nurses would pretend to draw my blood and would learn
how to label the vials and enter the data in the PDA. What I didn't know was that I had actually volunteered to have my blood drawn. It went fine. They used brand new, sterile Butterfly needles (the same kind that I used my first week of medical school when I learned how to draw blood). And when the needle entered my vein I didn't feel a thing. It was actually the most painless blood draw I've ever had.

Afterwards I went to a local bar with William and Mario (the two guys who manage the database) to watch the World Cup match between Mexico and Argentina. It was a good game, and Mexico played well, but in the end they couldn't come up with a second goal, so their World Cup dreams came to an end. Argentina moved on to play Germany in what should be an excellent game.

Friday, June 23, 2006

El Cine

Went to the movies tonight and saw a German film called "Downfall" about the last days of the Third Reich. Quite sad but also interesting. It showed Hitler and his top commanders in their bunker in Berlin as the Russian forces were advancing on the city. The film was in German with Spanish subtitles.

The movie theater was brand new with stadium seating and very comfortable chairs. Plus the theater had the nicest, cleanest bathroom that I've seen since I've been in Nicaragua - that is to say, it had toilets that flushed, faucets that worked, soap in the soap dispensers, toilet paper in each stall, a clean tile floor. Really quite amazing.

On the other hand, the bathroom at the Health Center where I've been working doesn't always have running water, so after using the toilet you have to pour a bucket of water in to make it flush. And of course there's no soap. Not the best way to prevent the spread of disease.


Two days in Nicaragua. Where do I begin? I’ve lived in Mexico. I’ve traveled in Peru, and Ecuador. Compared with Nicaragua, these countries are rich. According to Wikipedia: Nicaragua has a GDP per capita of $867, placing it in 127th place amongst all the countries in the world, and placing it just behind Bolivia and Honduras as the poorest country in Latin America.

They ration the water here in Managua. In the neighborhood where I’m staying, the city water only comes out of the faucet between 7pm and 7am. To cope, people fill up large basins with water at night so that they'll have water to wash with during the day. This morning I woke at 7:20am, after the water had been turned off, so I had to use a bowl and pour water over myself from a water basin that they leave in the bathtub. Same goes for using the toilet - you get one free flush once the water has been turned off - but after that flush there won't be any water to replace the water in the tank, so after that you need to dump a bucket of water in the toilet to make it flush.

There really are no street names in Managua. I read this in the guidebook but didn't believe it until I got here and saw for myself. Instead, people give directions based on landmarks that are found in each neighborhood. People don't use the four cardinal directions, either. Instead, they say: Al Lago (North), Arriba (East), Abajo (West), y al Sur (South). For example, here’s the address of the house where I’m staying: “Barrio Campo Bruce, del Bar Los Rastros, una cuadra al sur y una cuadra arriba, frente a la casa de dos pesos. (The Campo Bruce Neighborhood, One block south of the bar “Los Rostros” and one block up, across from the house with two stories)."

Seriously, those are the directions that you would give a taxi driver and would also write on a letter if you wanted the mailman to deliver it correctly.

The house in which I'm staying is simple but they have the essentials: a refrigerator, stove, oven, microwave, TV (with cable) and a stereo covered in plastic. There’s no air conditioning. My room has a window, a double bed with a very soft mattress, a wooden dresser, a TV (with cable including HBO), and on the wall: a picture of Jesus.

Maribel lives in this one-story house with her sister Flor and her two sons: Alan (9) and William (14). Flor works at the National Laboratory at the Ministry of Health, and that is how she knows Eva Harris, the scientist at Berkeley who runs the Dengue program here in Managua.

Last night the power went out just as I was going to bed. This was problematic because the fan stopped blowing, and without fan it was HOT in my room. Then because I had trouble sleeping I woke up after 7am and had to pour myself a shower.

So far I've split my time between three different sites: The laboratory at the Ministry of Health, the Hospital Infantil Manuel de Jesus Rivera, and the Health Center Socrates Flores. In two days I've gotten a chance to meet the various doctors working on the multiple dengue projects that are all affiliated with Eva Harris at Berkeley. These include:

1) A Cohort Study of over 1000 healthy children who live in Managua. They are followed long term and are evaluated by medical staff anually to see who develop dengue and to try to better understand risk factors and dengue transmission.

2) A Clinical Study of all children referred to the Hospital Manuel de Jesus Rivera with suspected dengue. These children are treated and their information is all recorded electronically in a database. There is also a Lab Component in which the viral genomes and host antibodies are analyzed by PCR and serology and are also sent to Berkeley for further analysis.

3) A Community Health Project that sends health promoters out into the community to work on mosquito control and educate the population about how to avoid Dengue.

My involvement in this project is to help analyze data that was collected during the past year from the clinical study. Specifically, we're interested in learning how Ultrasound could better be utilized in children with Dengue.

Wednesday, June 21, 2006

Arrival in Nicaragua

Left SFO at 1:30am and arrived in Managua at 10:30am this morning after a brief layover in San Salvador. I'd say I got about 3 hours of sleep, so needless to say I'm exhausted. I was picked up at the airport and then I dropped my bags off at Flora's. Since then it's been a whirlwind tour of the Ministry of Public Health, the Children's Hospital, and the Health Clinic. Now I'm sitting in the office of the health clinic waiting for someone to get me a cell phone - then, once I have the cell phone I can go back to Flor's to take a much needed nap.

Monday, June 19, 2006

Lake Tahoe

I'm up at Lake Tahoe with my parents and grandmother, relaxing after finishing my first year of medical school. In two days I'll leave for Nicaragua. Should be an adventure.

Here's a pic of the lake that I took with my new digital camera: