Lots of mental images!

   Departure morning.  I have some walking shoes from MEC.  Lightweight.  Breathable.  Waterproof.  Good traction.  I wore then in Haiti and last October in Nicaragua.  When I arrived back in Calgary last fall I left the shoes on my outside porch to let the winter “disinfect” the shoes.  I was very worried about bed bugs because the place we stayed in had lots.  On the day we left I retrieved the shoes from the porch and routinely put my hand in the shoe to check for whatever.  This is a practice I have done for years hiking in the bush.  I pulled out the desiccated exoskeleton remains of a one-inch scorpion!!!!  Ouch.  I must have carried that scorpion back from Nicaragua last October.  Glad he didn’t sting me.  Generally, the venom is inversely related to the size of the scorpion.

   Arrival in Nicaragua.  After everyone else on our flight had retrieved their luggage, the absence of our bags was very noticeable.  Ouch.  The luggage arrived the next day and we left in the afternoon for the clinic.

   Arrival at the Roberto Clemente Clinic.  We arrived just in time for an incredible sunset.  Wow!

   Sunday.  Their day of rest and ours too.

   Monday. The first clinic day.  The first patient was a severely handicapped five-year-old girl.  She was obviously blind, spastic quadriplegia, athetoid movements, and malnourished with tiny arms and legs and no muscle mass.  “Oh Oh,” I thought!  “What if the entire day is like this?  I hope they don’t expect Canadian doctors to cure this sort of thing.”  They didn’t.  Child had intrauterine Toxoplasmosis, diagnosed in Managua, and all the family desired was information on nutrition.  Whew!  I supplemented her oral liquid feedings with oil and carbohydrate.  Thereafter we saw a total of 18 children, almost all infants, with a variety of complaints.  Asthma, pneumonia, gastro, cystitis, otitis media, common cold, lymphadenopathy, scabies, and some well baby checks.  I picked up a hip click and the clinic can arrange an ultrasound in Rivas or Managua.  I also diagnosed probable rheumatic fever and this child and a another ill-looking child with pneumonia were the sickest children.  A lab bus arrives every Thursday to do blood tests and other lab work. 

   All in all, our first day was very positive.  The Nicaraguan health system is basic but pretty well organized.  The children were very well cared for.  Nutrition was not a major issue.  I have a sense I saw the ‘middle class’ of the community today and only a few of the really poor. 

   Tomorrow is another day.