Thursday January 18, 2007

Photos: Moises and his house, (from left) before his shot, the doorway, and backyard with Lake Mangua in the distance. Children from the lakefront barrio (bottom).

Managua real estate is strange. The city borders a gigantic lake surrounded by breathtaking, dormant volcanoes, but years of massive industrial pollution left the water toxic and, as a result, the lakefront remains ignored by developers and left for the most destitute. I got to visit one of these barrios today.

I was escorted by a nurse and the PDVI program director to take a blood sample from a convalescent boy, named Moises, who lives with several women and several related children in a one room shelter in one of the most poor regions of Managua. Incredibly, I was granted permission to photograph the neighborhood and inside Moises’s house. Most of the floor space was composed of various bed pieces and cushions to sleep its several occupants; the rest of the dirt floor was reserved for the family chicken and an emaciated piglet. The least-decayed bed was reserved for an elderly woman, who lay motionless during the entire visit below a swarm of black flies. Strings of ragged clothing hung inside and out, and garbage was strewn throughout the backyard, which reaked of urine. We were offered drinks, a salty Tang-like brew, which I foolishly accepted, bringing all my lectures on tropical gastrointestinal parasites flashing back. The pig continuously squealed. I was later informed that this family is not even at the lowest rung of the ladder, because the beds and walls weren’t cardboard-based and the hose in the backyard actually brought a form of running water. A visit to a second patient, who’s house resembled my own humble arrangements, clearly distinguished Managua’s middle and lower classes, however deficient the middle ground may appear by developed standards. While I was overwhelmed by Moises’s situation, the other American’s that have lived in Managua for at least several months appear jaded by its normality.

After my day at the health center talking with doctors and familiarizing myself with the patient flow I visited the mall in el Metrocenter to complete my sweep of the economic spectrum. It was the type of scene to observe over some tea. Here was Western commercialization budding its beady little eyes out of the Nicaraguan landscape, poking upward, riding the profitable hopes and quarterly projections on the city’s famous first escalator to the glass display of a Radio Shack. Earlier today the water wasn’t running at the children’s health clinic, but 100,000-gallons of it towered upward from the mall’s rotunda fountain. Misallocated water flows alongside the misallocated dollars, away from Moises and his family and into the corporate coffers. The rich get to tote status-filled shopping bags, the status quo marches on. There’s water for my tea.

Wednesday January 17, 2007

Photos: modern art, Nica door-style (left), and Hospital Infantil. Children like their hospitals brightly colored.

I visited the bedside of a young girl hospitalized with dengue fever. She had been painfully sick for five days prior, but was accompanied by her mother and well on the road to recovery and away from the road to serious complications. Since the happy ending was in sight, I can look upon the episode selfishly as a nice legitimization of all my molecular and analytical research on a disease no one in America feels.

As I toured the pediatric hospital with two young doctors, I was bestowed a respect I would never receive in the self-gratifying halls of an American medical ivory tower. The medical and skilled professional classes of Nicaragua have suffered as their economy has suffered, and doctors, as a result, frequently take two jobs. They do not receive the pay or respect in their home country that would be afforded them if they studied or worked abroad, self-perpetuating the drain on their health care system. The best, brightest, and most ambitious leave where they are most needed. This is a medical problem plaguing much of the developing world. As a result, I was only a student, but American-educated and, therefore, undeservedly afforded a certain level of authority, on peer level with experienced young doctors who treat seriously sick children daily. Another Berkeley graduate student, who has spent several months here, tells me she is treated like the boss, and often reminded she doesn’t need to ask permission for her requests. The humorous benefit of this undue authority is that the American students and faculty running the studies can actually get the doctors to heed instructions and take the appropriate patient samples and data. A foreign-educated doctor recently joined the Children’s Hospital and, because he’s foreign-educated, is causing waves by doing as he pleases.

I drank Coke from a plastic bag today. The family serving lunch was especially attached to their bottles, so a coke-to-go became a coke in a bag tied off around a drinking straw. It wasn’t the easiest thing to carry. Gallo pinto is served at every meal, and I’m already sick of it, but madura will be greatly missed when I leave. It’s similar in color, shape and texture to a banana, but sweeter, excellent fried, and a good side for just about everything. It was off the menu tonight, however, which was good, because it might not have been the best accompaniment to my housemother’s lasagna; similar to the Italian version, but more watery, and using a bitter Nicaraguan queso. I had two helpings.

Tuesday January 16, 2007

Photos: Restaurants naturally extend from family kitchens (left), and dudes like their carts brightly colored.

Running water and towels are luxuries – not necessities – and I should probably grow accustomed to washing myself with water scooped from a 50-gallon plastic garbage can and drying myself with a t-shirt. The lack of conveniences makes every street sight prime photo opportunities – fathers push sons in wheelbarrows on roads shared by rickety buses and mule-drawn carts. The sensational to me is mundane to locals and hopefully my photo-inquisitiveness won’t draw their ire. Which leads me to my happy moment of the day. When I returned from lab, the household boys, upon encouragement from their mother, escorted me around the neighborhood to provide accompaniment from ladrones as I took photos. The boys saw the commonplace as I marveled and tried to photograph, without their notice, the barefoot street soccer games and women carrying baskets on their heads.

The line between restaurants and living rooms is thin and at lunchtime a lab member lead me down an alleyway and into a family’s living room where they set up tables and dished out food. I pointed at different pots, selecting a full helping of rice, pork, and plantains (madura) to go for less than two dollars. I ate in the lab building, and chatted with Christiano in half English half Spanish about my studies, his country and mine. Fifteen minutes after meeting him I was invited to Granada with him and a friend on Saturday. It’s a warmth and openness only seen in a country where you’re not taught to prematurely fear your neighbor. Apparently though, according to Christiano, Nicaraguans are taught to prematurely hate the Costa Ricans, though he doesn’t really remember why.

A 68% literacy rate doesn’t leave much chance for bilingualism. People who know absolutely zero English include every member of my household and almost every person of the lab. Fortunately, I spent most of my first day with Matute, a young, long-haired Nicaraguan who knows enough English to run me through the serology procedures and answer most of my English-Spanish hybrid questions. Luckily, much can be communicated without words.

My biggest difficulty so far – greater than the whole language barrier thing - is finding a bathroom with running water, soap, and towels with which to wash my hands. Water and electricity are unreliable, even in the National Lab. Combined with the 85 degree heat I always feel just a little dirty.