Tuesday, July 11, 2006

Blood Draw

The Pediatric Dengue Cohort Study is prospectively following a group of over 3000 children who live in Managua. Part of the study involves an annual blood draw from each of the children enrolled in the study. So all during the month of July they have set up a "blood draw factory" at the Socrates Flores Health Center. I spent yesterday observing the operation, and must say that I was quite impressed with the organization and sophistication of the endeavor.

Each of the children enrolled in the study has a photo ID card that they present upon arrival at the health center. An attendent enters the child's data into a laptop computer, and then the child's thumbprint is scanned via an electronic fingerprint reader that is connected to the computer. This allows verification of the child's identity. The child then takes a seat and when his number is called by a nurse he proceeds to one of the six blood drawing stations that have been set up in the room. After his blood is drawn, he gets a lollipop and the nurse enters his information into a Palm Pilot to confirm the success of the blood draw.

In all, over 220 children had their blood drawn yesterday. It's a huge operation, but the army of over 20 nurses kept things flowing smoothly. The majority of the children were quite stoic and endured the needle poking with minimal complaint. But every now and then a child would scream upon sight of the needle, thus putting uneasy all the children in the waiting area. Many kids I talked to were proud to tell me "No llore" (I didn't cry) or "No duele" (It doesn't hurt).

The goal of this cohort study is to study the prevalence of the Dengue Virus and Dengue Antibodies in the community. In the long term, the idea is to use this information to help create a vaccine.

Sunday, July 09, 2006


Ni la misma Granada de Espana is tan Linda y extrana como esta de aqui
- Tino Lopez Guerra (1940)

After staying out till 4am on Friday night, I woke at 11:30 Saturday morning a bit groggy, but thanks to a bucket of cold water (the tap water wasn’t running) and some gallo pinto (rice and beans), I was ready to do some exploring. In the short time I’ve been here I’ve learned that Managua is a fun place at night. It has the best movie theaters, restaurants, bars and dance clubs in the whole country. However, during the day Managua is a hot ugly city with not much to do. So after consulting with my guide book, I decided to spend Saturday afternoon in the colonial town of Granada.

I took a “Microbus” or van from Managua to Granada. The drive was about an hour including numerous stops to pick up or drop people off en route. I’ve learned that there really don’t seem to be direct buses here in Nicaragua. If there are empty seats, the bus will stop to pick up anyone who flags it down. And the ticket taker will scream the name of the buses destination to anyone standing on the side of the road in hopes of drumming up business.
But back to Granada. It really is a beautiful city. Granada is on the western end of Lake Nicaragua (more commonly known here as Lago Cocibolca), and most guidebooks say that it’s the most beautiful colonial town in Nicaragua. It was founded by Spanish settlers in the 16th century, and was the seat of power for William Walker, an American who briefly ruled Nicaragua in the mid-19th century. When he was forced to flee Granada in 1856 he burned the city to the ground, and most buildings today date from the late 1800s when the city rebuilt after the devastation left by William Walker.

Granada is not so different from colonial towns I’ve seen in other parts of Latin America (San Cristobal, Mexio; Antigua, Guatemala; Trinidad, Cuba; Cuenca, Equador). But after being in Managua for the past two weeks, Granada’s brightly painted houses with sloping tile roofs seemed like architectural paradise to me. I spent a couple hours just wandering around the cobblestone streets, visiting the many churches and taking pictures of houses that caught my attention. I went to the museum in the old convent of San Francisco. The convent dates back to the 16th century, although it was destroyed a few times by fires and earthquakes, and so the present building is only about 150 years old. Inside the museum was an interesting exhibit of pre-Columbian stone statues as well as a display of art by contemporary Nicaraguan painters.

Energetic Eva

Eva Harris first came to Nicaragua for a couple of months after graduating from college. Now, twenty years later, she runs one of the largest Dengue research programs in all of the Americas. She has a research lab in Berkeley, but she comes to Nicaragua once a month for 4-5 days to check in with her team of over 25 Nicaraguan doctors and laboratory investigators. She was in Nicaragua this past weekend, which gave me a chance to check in with her regarding my summer project. Plus, I learned that when Eva visits, everyone goes out and parties. I don’t know how she does it, because she works around the clock and never seems to sleep. Yet, on both Friday and Saturday nights Eva was the most energetic of everyone on the dance floor. The music gets into her and she can’t stop moving, even after the rest of the group was exhausted and ready for bed.

Saturday night there was a big fancy dinner in honor of Samantha the project coordinator for Eva’s studies here in Nicaragua. After over 4 years, Samantha is leaving Nicaragua to go back to the United States and eventually attend medical school. The dinner was quite moving, as many people gave praise-filled speeches about Samantha. She has been instrumental in making this program work, so her loss will definitely be felt. Part of the reason that Eva came down this weekend was to interview replacements for Samantha’s position. The three candidates came out to the bar with us on Friday night, and I believe Eva will pick one of them in the next week so the person can start working as soon as Samantha leaves at the end of July.