Breakfast, devotion, SHOWERS!!, then a 1 hour bus ride to Mateare ( ma-ti-ar’-ee) a very poor semi-rural town of about 30,000. Our clinics will be in this town for the next 3 days; a different church each day, then on to Brasilla for the last day (about 8 miles away).
All our travel is in the “Barbie Bus”. The color of the bus makes any explanation unnecessary.
It takes only a short time to load up and unload with everyone helping. Then it’s about a 40 minute ride to the clinic site for today.
Most of the homes we see are concrete block and tin with concrete or tile floors; some are dirt, however. There are various activities as we go through the barrio to the church where we will set up the clinic;
some folks are cooking over an open fire, others are washing clothes in a concrete sink in the yard. There are also some families working together to twist thread into long cords suitable for weaving hammocks or fishing nets.
As we pass a very small pulperia (a convenience store) operated from a home, a truck is parked out front and a man is delivering stock while 2 armed guards stand in the street…watching. Would someone really try to rob them in broad daylight for some cokes and chips? Maybe.
One of the focuses of Open Eyes ministry in Leon is the National Police. Terry Dupont offers regular leadership training for them as well as health care when he can put together a group to do so. Consequently, he has access to the police at many levels, a great relationship and many opportunities to share Christ with them.
Another block and we pull up at the church. It’s a concrete block building with iron bars on the windows and a tin roof. There is a raised platform at the front of the church at the opposite end from the door, and another door on the side. There are fluorescent lights and a few fans mounted on the walls.
While on the subject, this is for the electricians and handymen among you. Outdoor, open, electrical panels are common. Sometimes there is conduit, but mostly not, not even romex, just 2 of the same color 14 or 16 gauge wire running to a switch or outlet. I’ve never seen a wire nut in Nicaragua, just electrical tape. I saw an air conditioner hard wired to an electrical panel with 14-gauge wire in a hotel. I also saw a fluorescent light hanging from a utility pole with a wire attached to each end with duct tape. I once asked someone about building codes, but they didn’t know what I was talking about.
There is a plumbing fixture sold there referred to as a “widow maker”. It’s a showerhead with a heating element in it. There is a switch on top of the unit to turn it on, and 10 or 12 feet of lamp wire terminated with a 2-prong plug. 10 or 12 feet is plenty long enough to reach the bathroom outlet. No one there has ever heard of a ground fault interrupt circuit.
The church had been swept out and mopped. There was string running the length of the small sanctuary and hung from it with clothespins, were sheets of many different designs and colors. More string ran the other direction with more sheets hung there to construct dividers making 5 examination rooms. In each room was a table, a fan and 3 or 4 chairs.
About chairs: The national chair of Nicaragua (if there were such a thing) would be the white plastic patio chair – it’s ubiquitous. Everyone has them – poor, rich, businesses, churches, and restaurants. When I asked one of the missionaries when he felt like he had truly become Nicaraguan, he said it was when he purchased 15 plastic patio chairs. One other thing may be handy to know: they will hold a 250 lb. man standing in the seat. I know this for a fact. I weigh 252.
The doctors stock their rooms with antibacterial cleaner, latex gloves, stethoscopes and all the other scary looking stuff doctors always have around. I found out immediately that Nicaraguan children are exactly like US children when it comes to “injectcion” (a shot); they run away crying.
People begin to gather at a home across the street from the church where a triage center has been set up to screen our patients. Blood pressure and temperature are recorded on the pieces of paper the patients have with them as well as names and ages.
The church has, in the past week, distributed 250 “vouchers” for people to be seen at the clinic. Half go to members, the other half to non-members. The voucher will serve as admission, the doctors will record complaints and write prescriptions, and then the pharmacy will fill the prescription from this piece of paper.
Health care in Nicaragua has improved and is still improving, but not as fast as some other social services like food and water delivery and sanitary systems. Many rural areas have no health care services whatsoever, even for emergencies. In cities, there are some free clinics available and some may be able to get in to see a doctor. However, a prescription may cost a week’s wages to fill, if the medicine is even available.
A poor water supply and lack of a sanitation system in rural areas is responsible for much of the disease and sickness prevalent there. Not to mention that wound care is nearly impossible when most people work in the dirt one way or another. Poor diet, harsh conditions and backbreaking work also contribute to the health problems of people in these areas.
We all notice that many of the little girls are in frilly dresses and shiny shoes, the boys in navy pants and hite shirts. It is obvious that this is a special occasion for many here and they have dressed appropriately.
Manuel, a local pastor talks to people as they wait to get in. He is engaging, animated, even entertaining as he presents the gospel in a winsome way. He will be there all day as people come and go, and many receive the Lord when he gives the invitation.
As the pharmacy is getting set up, the doctors arranging their exam rooms and the translators taking their place, an evangelism team is assessing the neighborhood and talking to the pastor of the church about the community and how they might talk to as many folks as possible. He gives them the location of a school and information about the principal, so David James, Brian Hardin, Kim Hay, Jeff Strange and Oscar (one of the translators) take off in a truck headed for the local school with a bag full of candy, prizes and tracts.
65% of the population of Nicaragua is under age 25 and elementary and high school education is mandatory and free. In the larger cities like Managua, Leon and Granada, most kids finish high school, but it is vastly different in rural areas. Most do not finish and a substantial number do not attend at all because they are needed to work at home, or do not have the resources for the minimal supplies that are required.
At the end of our first day of the clinic, Susan Strange hired a young man (10 years old, maybe) to pick up all the trash on the floors in the exam areas, the pharmacy and the waiting areas. She paid him 15 cordobas for his work and he happily left. Later, his mother returned to tell us that she had taken him out of school that very day because he didn’t have the money to buy the supplies he needed. The price of the supplies; 12 Cordoba’s. He was going back to school tomorrow she said.
Last January, Forest Park Community Church began communicating with an organization called King Benevolent Fund in Bristol, Virginia and another in Louisville called Supplies Overseas. These groups collect and redistribute donated overstock, obsolete or out of date drugs, supplies and medical equipment to humanitarian organizations for use in medical clinics overseas.
We supplied documentation about the church, the mission we were doing, where we were going, what group we would be working with, who would be responsible, medical license numbers and how we were coordinating the transportation of medicines into the country. After months of sending information to them as well as to the Ministry of Health in Nicaragua, we were approved to receive a donation of medicines. When our turn came, Cindy Lewis spent several hours online ordering the drugs we would need. She also helped us select supplies and drugs we would need from Supplies Overseas on a couple of different occasions.
In the end, we took with us over 1000 lbs of drugs and supplies with an estimate retail value of $200,000. What we did not use at the clinics we left for future medical teams as well as a dental ministry that is operated by Open Eyes Ministries.
One of the worst health care problems in Nicaragua is the lack of availability of medicines. Even simple cheap and effective drugs for parasites are hard to find and expensive. Insurance is nearly non-existent and outside Managua there are no hospitals. Clinics are rare and any doctor is out of the ordinary. Christian and other benevolent organizations are the main source of health care in all rural areas at this time.
Once we began seeing patients, the pace did not slow until lunchtime. Mothers would arrive with 3 to 5 kids in tow. Our Doctors examined each one with care and concern. Knowing that we could only treat them for a short period of time, the doctors would council patients on diet or exercise to help control diabetes or other ailments that could not be treated long-term with medication.
Sometimes, patients would bring in prescriptions they had received from a clinic months before, but could not afford to fill. As often as not, we were able to find the medicine they needed.
In one case Cindy Lewis saw a man who had had surgery on his eyes. His doctor gave him a prescription and was told that if he did not use the prescribed eye drops, his vision would quickly begin to deteriorate and he would loose his sight. She knew we did not have that particular medicine because she helped inventory all the drugs for the clinic, nevertheless, she walked to a table in the pharmacy and immediately put her hand on the exact medicine he needed.
Sometimes the doctors would refer their patients to Amanda Fife, a Physical Therapist, who could show a few exercises or suggest changes in a repetitive motion task that could help to relieve chronic pain due to repeated bending, stretching or lifting actions.
Our doctors performed a few minor surgeries in the clinic, a couple of cysts were removed, a few severe burns treated, etc.
One little girl was brought in who had not been to school for over a year because she could not hear. Her family was yelling to her to be heard. Upon examination, the doctors found her ear was impacted with wax and after more than an hour of work, she was hearing again. The next morning, her father met us to say she had gone back to school that morning and that he thanked God for her hearing being returned.
An elderly woman, age 82, was brought into the clinic by her relatives. Her breathing was shallow and fast, she was emaciated and had the look to this untrained eye as one that did not have long to live. This was confirmed upon examination by the doctor. She had Pneumonia. The doctors hooked up an IV and began a breathing treatment.
While she was resting, her family told us she did not know Christ as her savior. Soon a pastor and translator were talking to her, crying as she accepted the Lord. The entire family was in the clinic rejoicing in her salvation even as they were told her condition was critical.
One gentleman who complained of pain in his knee offered to bring x-rays of his surgery to help determine what might be done to relieve the pain. After looking at the x-ray, it was apparent why he was complaining. He had 8 screws in his leg along with a plate, all of which looked like a 3-year old carpenter had installed it. He was fortunate to have saved his leg from whatever accident had damaged it, but nothing short of surgery would relieve the pain he now had and the chances of that are nil.
The Sandinista movement put great emphasis on healthcare reforms for the country, which was fairly effective in a limited way. Instead of 3 separate agencies controlling different aspects of healthcare in the country, it was all combined into the Ministry of Health, which did in fact streamline the delivery of services. However, it also narrowed the delivery of services and concentrated almost 80% of all healthcare dollars in Managua, leaving precious little for the rest of the country after corruption and political favors took its share.
Meanwhile, the evangelism team arrived at the school, met with the principle, who is a Christian, and gained permission to talk to each of the classes, grades 1 through high school. In each classroom, they might play a game. sing a song, or talk about sports and do a few basketball tricks. In any case, the gospel was shared in a way appropriate to the age group and everyone was given a chance to respond.
Amazingly, or maybe not, teens in Nicaragua seems much like teens in the US. The guys want to act cool and aloof and the girls coy and flirty with the boys. Even so, there is an almost palpable hunger for hope in this country and the response to the gospel was great with most wanting to make a commitment to Christ this day and over 275 souls were added to the kingdom.
30% of the population of Nicaragua is teenagers. Illicit drugs are not much of a problem here because of the poverty. However, the most popular abused substance is glue. Huffing is a problem among youth in Managua and you can find treatment centers dedicated to this activity at about the same ratio you will find drug abuse clinics in the US.
By far the biggest problem among the young people of Nicaragua is teenage pregnancy. Half the country’s youth initiate sexual activity before 18 years of age and 15 percent before age 15. The teenage pregnancy rate is 25 percent - one of the highest in Latin America. The government has initiated several programs to combat the problem, but again the bulk of the problem has been left to be addressed by humanitarian organizations and Christian missions.
On successive days, everyone on the team will participate in evangelism, leaving others to man the clinic. They will visit other schools and simply walk the streets of the community looking for opportunities to share the Lord. A group of foreigners walking by your house does draw attention and Nicaraguan people are engaging, friendly and hospitable.
At one house, a pastor, Rex Brace learns that a couple living together with children is not married. When he asks why, he learns that the woman has no birth certificate and therefore cannot be married. As a pastor, he offer to marry them, they accept and a wedding takes place in the yard with our team members and the neighbors as witnesses. One of our translators draws up a certificate. Some of our group take pictures and make a commitment to bring prints back at a later date. The next day, on our way out of town, Rex drops off a Spanish language copy of “the Purpose Driven Life” to help give them a new vision for living as married people.
As if to remind us of the never-ending task here, the couple next door refuse the same offer of marriage because the “husband” claims he does not love his “wife”, he simply won her and has no desire to be married to her.
As opportunities arise to serve, a few of our missionaries head out to visit the family of the pastor of the church in which we are working and take along some medications and supplies. Once they arrive, they treat the pastor’s mother who has diabetes and a severe infection in her foot. She had not even intended to request medical attention, but was praising God that they had come to help her grandson.
Cultural traditions die hard and this is a patriarchal society. Many men take liberties here that are destructive; even criminal, yet are never prosecuted or even acknowledged for fear of being ostracized from tightly knit family groups that depend on each other for survival in many cases.
Since the early 90’s and the fall of the Sandinistas, Christian missionaries have flooded into the country and are having an impact through the love of Christ in many ways; changing the hearts and minds of people, even changing the notion of what a man should act like.
Last year on a mission trip, I was to give a short testimony in a seminar for men on raising boys. The teaching never got started, however, because the rest of the time was taken up with men wanting to know how to show affection to their sons. They had never been shown physical affection by their fathers and somehow had the idea that it was wrong to do so, but the bible had convinced them that strong Christian men were grown from loving Christian fathers and they wanted to know how to do this.
Since 1991 the religious affiliations of the people of Nicaragua has shown dramatic shifts; from 96% Roman Catholic down to 80%, and a corresponding rise in the percentage of residents describing themselves as evangelical Christians. Some projections predict a decline to 70% by the mid 2000’s. The Assemblies of God and other Pentecostal religions are primarily responsible for this shift, especially among the urban poor and rural families, though other mainline denominations have benefited as well. Because Nicaragua’s Roman Catholic affiliation is more cultural than religious, this shift is more a result of new religious conviction than actual conversion.
In spite of 100 degree heat and seeing 275 patients a day, as each day progresses, we are faster with the prescriptions, more accurate with the diagnoses and better with the language.
Too soon our days run out, just as we think we have this stuff down.
