If you haven’t yet read Three Shots of Rum, at least take a peek at the first few paragraphs, otherwise the lovely cleverness of this title will completely pass you by.
It was the second second day on the job. The medical team and I took a tired-out bus painted a lurid purple an hour into the hills to a Nicaraguan community in the mountain province of Jinotega named Sisle #1 (not to be confused with Sisle #2 a bit further down the road, or Sasle, the place we passed on the way) where people live in wooden shacks, cook over open flames and where chickens, dogs and small children wander freely.
We unpacked out bags in the local centro de salud and began to start attending the line of 200+ people who were cued up at the fence in front of the center. By the end of the day, we had seen probably 120 of them, and planned to return the following day to see the rest. These people are far off the beaten path, and many of them had walked several hours to get there, including a mom who had delivered a baby by C-section a few weeks prior.
The family planning situation here is interesting. Men aren’t always very cooperative when it comes to letting their women heal up after childbirth and sometimes insist on having relations as soon as a week afterwards. Mothers pop out baby after baby after baby with very little rest between. I heard Isabel, the nurse (who is the primary care provider for at least 8 of these back-woods communities, often walking 3-4 hours to take care of her patients) talking about family planning to one of the moms and was curious how that aspect of life is handled.
When I asked her about it, she invited me into an exam room where a 38 week pregnant mother was awaiting an exam. She palpated the belly and measured it, explaining what she was doing as she went along, noting the details on a chart. Then, she handed me a pair of gloves and suited up herself while instructing the mother to drop her drawers, get up on the table and assume the position. Isabel then performed a pelvic exam, explaining what she was doing. She withdrew her hand and invited me to also exam the mother, telling me what to feel for (the little head!). After meeting the mother’s eyes and asking a gentle “Puedo?” I completed my first pre-natal pelvic exam, nonchalantly stripping off my gloves when I was done like I do these all the time.
Once the mother was dressed and gone, Isabel turned to me and asked “So, what do you do? Are you a medical student? A doctor?” “Um…no. Actually, I’m a high school Spanish teacher…” She looked at me incredulously before bursting into laughter. I explained that I’ve been interested in midwifery and have been in the alternative health care world as a massage therapist for several years, so I’m not so far removed from all that as it might first appear.
Next, we examined the young mother who had walked 3 hours to see us, post C-section. I got to see what a non-stretched-out-by-birth cervix looks like and to coo at two week old baby Gabriel. The next mother must have heard that there was a rookie in the exam room and didn’t want to stick around to be a guinea pig because she was nowhere to be found when we called her. Perhaps word was spreading that a Spanish teacher was performing pelvic exams. Isabel looked at me and shrugged her shoulders. “She’ll be back. There’s nowhere else to go.”
Uff. Heavy. And yet, hilarity and tragedy are regular bedfellows in developing nations and Nicaragua is no exception. There’s acceptance of hungry children and machete wounds and intestinal worms and dictators and also willingness to laugh when something’s funny – like a high school teacher doing a pelvic exam.