Final Blog - Nicaragua Echo September 2009

Since November of 2006 I have been traveling to Nicaragua with Project Health for Leon (http://projecthealthforleon.org/Site/Home-1.html ) to do echocardiograms. Each of my past seven trips have met me with new rewards and great satisfaction. Although the conditions and situations there can be very depressing there is hope that things can be improved. I have also been blessed with the opportunity to take students and hopefully change their lives as much mine has been.

The need in Nicaragua is so great and the poverty so vast that I feel I must do something. I have so much to share and I could not live with the guilt if I didn't use my resources to help where God has called me to help. I'm doing very little in the big picture but each time I am able to help one person, whether it be in Nicaragua or the United States, I at least have the satisfaction of knowing that I've done something. To witness what we have seen on these adventures and not do something to help would be a waste. I'm so thankful to be able to use my talents to do this. I'm also thankful that we have clean hospitals, good healthcare, clean streets, sidewalks without big holes, clean air, and air conditioning to say the least.

I can't say thank you enough to all of the people who helped make this trip possible through donations, equipment loans, equipment repairs, thoughts and prayers. Nicaragua is a country of great need and it will take a lot of people using a lot of resources to make even small improvements. For those of you who have kept up with my former trips and remember the garbage dump, I am happy to report that there is a new sanitary landfill now. All of the garbage is now buried when it arrives at the landfill and the conditions are much better. The people are still allowed in the landfill in the morning but at least now they are rummaging through fresh garbage.

The hospital just received a fresh coat of paint on the outside and looks great. Here's the before and after pictures:

Aside from the internet problems, a few blackouts and the long travel days, this was an excellent trip. I saw great improvements in the student's scanning skills over this ten days. There's nothing like being saturated with scan time to improve your skills.

Over the past ten days we examined around 150 patients or so. That doesn't sound like much compared to the former trips but the exams were complete studies for the most part and nearly every patient had some form of pathology. Some of the patients we saw were new patients and some were follow ups from previous surgeries. All of the 8 patients who had surgery last week were doing well when we left. They were up walking and smiling, glad to have their hearts fixed and a new chance at life.

Natalie Inge:

Well this will be my last posting for the trip. There have been so many memories and so many stories to tell about our adventure over the last ten days. We spent the last couple days finishing up with the patients and checking on eight patients that had their surgeries throughout the week. I learned to become a better scanner and more importantly a better human. I learned lessons that have become a part of who I am. I have learned that our individual skills that we process, gained either through formal education or other means must be shared to benefit others in the world that have no access to that education. We must get up really early, leave our families, plan for days, pack our clothes, and ride in a 12 passenger van with 15 passengers for two hours with no heat…..just to get a small glimpse of what most of the other parts of the world live like. We must look into the eyes of patients and tell their mothers that their young child may not see live past their next birthday. You have to bring toys and food to a village where there is not enough and the children almost pull your clothing off pulling and begging for more food and toys. While there is nothing left…just your love and hope to pass on to them. Sometimes when I go to bed at night, I see these faces in my head. Their little crying faces screaming and pulling on my clothes for just one more pair` of shoes or clothing. These faces were sad and hungry and looked abandoned. I think that these faces will always be in my mind, playing like an old 45 record player that becomes stuck on one particular note, playing the same note over and over. I learned so many things while on my trip to Nicaragua. It is very vital and important to be able to bring first class world changes of our present century in the sciences and studies in our Cardiovascular Sonography sciences programs to the ends of the earth. These are invaluable tools for Cardiac Specialty teams all the way around the world. Amiss the poverty and the devastation, sonography brings many new hopes for saving lives around the world. And as a result of these advances in Sonography, more people are getting correctly diagnosed earlier therefore allowing them to transition to the next stage of care with their Cardiologist. I know that Echo is making an impact even to those who may have no hope. We must continue to take Echo around the world to the places where it may be needed to the most. Our team was tired, hungry, some sick, but hopefully all inspired. Thanks again to everyone and the one that opens all my doors, and sometimes has to push me through.

LaTosha:
My last moments, in Leon, Nicaragua were lasting moments. The entire team, which included cardiologists, a surgical team, cardiac sonographers, and nursing staff. The night was very memorable. We had dinner on the beach. We were able to walk on the black sand and watch the sun set. I felt like that summed up the stressful but enjoyable experience. We all gathered together to relax and reflected back on the weeks. We also engaged in conversation to get to know each other. These 10 days, I will never forget, we laughed, cried, got angry with each other, and comforted each other.
We went to visited the patients in the hospital to see how they were doing. They were sitting up in chair holding there pillows that the team bought in the market. Everyone who had surgery was doing well. Although they may have been in pain, I'll never know. The women had smiles on there faces, which said they had hope. It was very moving to see, and made the trip even more worth while.
As a student, to be a part of such a life changing event truly humbled me. I am excited for the next students who have the same opportunity I had. I feel that it is impossible to come back the same way you went, not to mention all of the things you learn from other cardiac sonographers. But especially, to work hand to hand with pediatric and adult cardiologist. We do not get that experience in the clinical sites. They are excited to share the knowledge that they have with you. For me, I think that was one of the best part of the trip.

Thanks again to everyone that was involved in making this experience happen for Natalie and me.

LaTosha

Wednesday and Thursday

To witness something as profound as the poverty in Nicaragua and not share the need with others would be a crime. Today when I visited the children on our morning walk I asked them what they would like for me to bring them the next time I come. I was amazed at what they asked for. They want clothes, shirts, shorts and dresses, shoes, crayons, and they love the books we bring. That’s all they asked for! These are the simplest of needs and so easy for us to fulfill. So, the next time I come down my bags are not going to be filled with toys but with the things the children need. I guess it’s hard to find pleasure in things when the most basic needs aren’t being met.

I think Tosha and Natalie are on overload now, there’s been a lot to take in. Please remember to be thankful for everything you have!

LaTosha:

What doesn’t kill you makes you stronger. Today, was a laid back day at clinical, the last few patient received their surgery. Everyone is doing great. Thank God!!!!! I have experienced more in these 8 days than I have ever experienced in my life. I cannot explain in words what I have seen. We visited a landfill, but to give out things we collected for the people there. It was closed for the day, but we went to a nearby neighborhood that they live in. When they saw us coming they surrounded us. It was men, women and kids. I was so amazed and saddened at what I saw. The need here is great, but the help and supplies are scarce. We were swarmed by children and adults. They just wanted whatever we had to give. It was not enough. It was very heart-breaking. I think even if we had more things, it still would not be enough. So, what do you do? I do know I cannot walk away and forget about what I have seen, heard and felt. I plan to do all I can to make people back at home aware that there is more out there besides what you see. It is what you don’t see that is just as important as what you do see. I am so grateful and humbled by my experiences in Nicaragua. I know that I have learned more here than I have ever been taught in the classroom. I think that life experiences are just as important as the classroom. We need both!!!!!!


Natalie:
These last couple days have been so packed. We started our day out again at the hospital clinic. When we came to the clinic we found the entire hospital decorated with balloons, party streamers. A small drum band and processional led a celebration of the Patron Saint of Leon that day. People were carrying her statue everywhere while burning candles and incense in the HOSPITAL….. I did not feel like I was in a hospital, but more like a party. Our clinic was lighter today, not quite as many patients. We had about 7 this morning. It has been very helpful to finally see some of the congenital diseases that we read about in textbooks. It has also been a wonderful experience to have so many different experts working and thinking together through the diagnosis process of each patient. There were representations from so many different disciplines such as nursing, heart surgeons, scrub nurses, pediatric and adult sonographers, Pediatric Cardiologist, Adult Cardiologist, Nurse Anesthetists, and the list goes on. Each discipline is an important part in the entire picture.
I have learned so much about this beautiful country and myself. We went to pass out toys and clothes to some children that live near the trash dump. They were very, very poor. Words will never be able to explain the circumstances when we arrived there. I have learned so much about echo. I know I will never be the same again. I was so proud about all the things that I would be able to share with the people here in Nicaragua, not knowing how much that they would end up teaching me. I will never be the same again. I am taking back all the wonderful things I have learned here and will use them everyday wherever that may be.

Another Day

9/9/09

Imagine if you can, being told that you have a heart condition and need surgery immediately or you will die. Imagine again, hearing the same thing but having no possibility for the surgery. Although we are able to help some people here, there are still so many they we are not able to help. The hardest part of coming here is being present when the doctors inform the patients who can’t have surgery. Many of the patients we have seen are in need of heart transplants and have absolutely no possibility of having that in Nicaragua. There is no possibility for bringing the back to the United States either because there is already a waiting list for patients in the U.S. . The hardest thing I ever had to witness was our doctors telling a twenty two year old that her heart was too bad to have surgery and that she would likely die very soon. I think of my own daughter and I can hardly bear it. We are so fortunate in the U.S. to have access to the health care that we do. You can’t even imagine how different things are here.

The internet is really slow here so it is very difficult to post our blogs and upload the pictures. We may have to upload our pictures when we get home. Adrienne was able to upload some of the pictures on Facebook so contact her Facebook page if you want to see them (Adrienne Barnhardt). It has been a very busy week and a wonderful learning experience for all. I lost count of all the patients we scanned but it was a lot. So far six surgeries have been successfully performed and two more are scheduled for tomorrow. We will do post op scans on the patients tomorrow but so far all is going very well.

We are learning to live without a lot of things but are looking forward to the conveniences of home. The internet has been down since Friday in all of León and we have experienced several blackouts. Thankfully our compact equipment will run on batteries so we were able to continue scanning even in the blackouts.

Wendy

From: Natalie Inge

How can I pack all my experiences of the last two days into one blog entry. Those who know me know that it is never a short story, so I will give it a try. The places God takes us in our lifetime are never by chance or mistake. You learn about yourself through others. You also learn the importance of your individual gifts and feel a greater calling and duty to share them with the world not just for your own benefit. We scanned more patients and collected data on their particular conditions. We met beautiful people with hopes and dreams as big as their hearts. We brought back 12 patients that were candidates for surgery. Meanwhile the team of surgeons and their staff arrived. We spent time cleaning the ICU and trying desperately to remove the infestation of cockroaches. We bleached the entire room including the equipment, walls, and stretchers. The hospital is extremely dirty and poorly maintained. The surgical team reviewed the cases and chose 8 patients for surgery this week. It was very difficult to turn people away, some cried and some quietly left. The people were so thankful and gracious. Being here is not only a pleasure but a necessity. We all have a duty to share our gifts with those whose government has forgotten them.
In the late evening we visited the Cathedral that is over 1500 years old. It is the largest cathedral in Central America. Faith is a very important part of the culture here. The cathedral was so beautiful with paintings of the life of Jesus. We also walked through the large plaza where families played, danced, cooked on the street while visiting with friends.
We also visited the orphanage today to take the toys. A dear sweet friend made beautiful dolls that the little girls loved. They were wonderful. We passed out cars to the little boys. They were beautiful children that were so happy to see us. We were so touched by the children there. We met another surgical team at the orphanage.
Through the brokenness here we are finding so many things to be happy about. We are learning about new pathology and new ways to treat patients. I have learned more ways to not only treat patients with not only my hands but also with my heart. Thanks again to the many people that help get us here. You are a blessing.

From: LaTosha Malloy

The last couple of days, I have seen more pathology than I have seen in all my clinical sites. Some of the things I have seen are things you only see in the text books. I mean unbelievable things such as left atrium that are not able to fit on the screen in young adults. I have had 1 on 1 teaching from pediatric cardiologist and adult cardiologist. My confidence in my scanning ability has improved tremendously. I feel it is great because when you are in a room with 5 to 10 people at a time, no time to be timid. My highlight of the day was providing hope to someone who otherwise would not have hope. All though every candidate for surgery may not be chosen at least some will receive help. It was so touching when a family member of a patient was helping me in spite of her family member diagnosis. It made me realize in spite of circumstance that the people here are very gracious and caring. It made me want to do more for my own community. I know everyone is not called to go on medical mission trips but everyone can support the people who do go in many ways.

First Day of Clinic

For those of you who haven’t followed our blog on previous trips I would like to take a little time to explain what we are doing in León, Nicaragua and our purpose here. I am Wendy Barnhardt and for the past three years I have been traveling to León to perform echocardiograms on patients in the hospital here along with Chris Bauman from St. Louis and Ruben Centeno from Chapel Hill. We are the echocardiographers for Project Health León . We are here with Drs. John Paar, Jack Rose, Dave Hannon, also Manny and Nancy Suarez, Donna Lou and Asma (can't remeber all the last names but will have them tomorrow). Please visit http://www.projecthealthforleon.org/ for more information on this incredible organization and stories of the patients who have received help.

Today has been a great beginning for this awesome trip. There is a true connection between all the members of the team and everyone’s talents have served some purpose during our day today. The day did not go without incidence but we truly saw the good in people through the actions that were taken. We had a slight problem with the compact ultrasound unit that belongs to the clinic here and couldn’t get it to work first thing this morning. We were able to use our resources and connections to problem solve and fix the ultrasound machine over the phone. Thank you Bob Kaylor and Dennis McGargle from GE for promptly responding to a desperate cry for help in the middle of the day and talking us through the complicated surgical procedure we had to perform on the machine. Through the generous donations of Bob and Dennis’ time and the equipment loan from Mark McPeak from Philips Ultrasound we were able to perform about 24 echoes today.

For those of you who helped to fund the trip for Forsyth Tech students I would like to send a special thank you. Natalie and Tosha were a little overwhelmed by everything to start with today but they have learned more than you can imagine in just one day. Both students were able to scan most of the patients and worked one on one with the doctors examining the patients. They saw multiple pathologies for the first time in real life and of course, a lot of rheumatic heart disease. I think that now the initial shock has passed they will be even more impressive tomorrow.

My daughter, Adrienne accompanied us on this trip as well and is getting a big dose of the health care world. Although she had no previous experience in healthcare she has fit right in and jumped in with both feet to help care for these patients. She’s been getting the inside scoop from medical students and residents about the life in medicine as well. What a way to find out if this is the field you want to study!

Natalie and Tosha have some things to say now. Please be sure to keep checking for new posts over the next 8 days.

Natalie Inge:

Our first day in Nicaragua has been a true adventure. We have tested our minds, bodies, and hearts to go beyond our boundaries and leave our comfort zones. After two long delays from Miami, long lines through customs, and one very long bus ride, we finally arrived safely to our hotel here in Leon. Through the famine and brokenness , I have found the people of Nicaragua to be very endearing and gracious. We spent most of our day today at the Hospital seeing patients. Many of these patients traveled many hours by foot , bus, or both, just to be seen. We scanned patients from one year of age up to around 40 years old. Many of the patients do not have access to quality healthcare or the medications they need to control or prevent their diseases from progressing. Many of the patients also waited patiently for hours to be seen. Our team gave out toys and candy to the children. The children were so happy to get even the smallest gifts or toy. We also visited the local market to buy some of the wonderful fresh fruits.
It is hard to put into words what we have experienced just on our first day here. Some of the patients that we have scanned will have surgery next week while others will return later so that they can follow up on their progress. Although there is a sense on poverty and disease here, I have found the people to have a strong sense of family and humbleness. They are so thankful and gracious for our help. Today it really hit me that we are really making a difference while here in Nicaragua. These people are in desperate need of quality healthcare. When you look into the eyes of the people here you know that you are called to make a difference here in the lives of these endearing people. We are so thankful for the people that have helped to make this trip possible. All the times, monies and talents of so many people are helping to change lives here in Nicaragua. Thanks again..God bless….



LaTosha:

Thanks everyone who supported me being here, I am very grateful. I have learned a lot by being here for just a short amount of time. My experience has been more than I can explain but it has been life changing. I am simple minded. This has taken me out of my box. This experience has taught me more about myself than I could possibly imagine. It has been very overwhelming. I cry all the time, not so much because I am sad but in spite of the living condition the people here are so appreciative for everything you do for them. That alone is worth the time and effort. I look forward to getting up every day and having a purpose for my life. I hope in return that I can give enough of myself like the citizens here have given me.