Disaster Strikes: Nicaragua Day Trip Part Two

---

This entry is a continuation of Part One... you should read that first.

We had just arrived at the Central Market in Granada, Nicaragua and I turned around from purchasing some bottles of pop and water to find Marilyn (my 71 year-old mother-in-law) laying on the ground. She was moaning in pain, with her right hand bleeding and her camera in two pieces on the ground. My first instinct was that someone had run into her at full speed with a bicycle, or that she'd been attacked or mugged. It just looked too severe to be the result of a simple fall.

Once I'd had a moment to process what was happening, I saw Cheryl kneeling behind her mom. I asked what happened and found out that Marilyn had simply tripped and gone flying. In trying to protect both her bad knee (due for surgery in two weeks) and her camera, she landed really badly, heavily bruising her side, bouncing her head off the cement pavers, and (worst of all) tearing the muscle of her right hand all the way around from the middle of her palm, around the outside of the hand and halfway into the back of the hand. You could see the bone. This was a major tearing of flesh, a scary "must get to the hospital immediately" kind of injury.

I left Cher with her mom and ran back to the bus to try and find our tour guide Luis. He is Nicaraguan and would be our best bet for getting help. Luis wasn't on the bus but there happened to be a police station across from the park. I ran in and found a policeman in uniform and immediately tried to tell him (in Spanglish) that we had an emergency "tengo una emergencia!" "Necissito una ambulancia!" "mi Madre esta muy infermo!" (hand motions of blood spurting out and madly pointing to the park). Honestly, I still don't know what happened in that conversation. I do believe he completely understood what I was saying but for some reason, he would not call an ambulance. This brought on the first of many moments of complete frustration and helplessness. It's one thing to be unable to order exactly what you want at a restaurant, but when you need an ambulance and are getting blank stares from the police, it's just damned scary and bewildering.

I asked him if the number for the ambulance was 911 and he shook his head, typed a long number into his cell phone, held it up for me to see and then pointed to an internet cafe down the road. I asked him to make the call and he refused. I thought about just pushing the 'send' button on his phone. I didn't understand what he was saying. In addition to the language barrier, my brain just couldn't make sense of what was happening - why wasn't he helping?? I ran back to the square where there was now a group of people gathered around. Mostly Nicaraguans, including children begging for a sip of our drinks and/or some money, seemingly oblivious to the fact that we were in the middle of our own family crisis.

When I pushed through the crowd I found Ella, terrifed and crying, and Cher, trying to be supportive while not looking at the wound. Norm (Marilyn's husband) and Charlie were also standing close by. Cher is a tough cookie and can handle any crisis - but not the sight of blood - and this was one ugly wound. Marilyn was being looked at by a really nice American man who seemed to know what he was doing in terms of assessing the injuries. This was the first of many acts of kindness by complete strangers. I asked him if he was a doctor but it turned out that he was a firefighter. Mike (a firefighter from San Diego) asked a bunch of questions and got Marilyn to sit up. He told us that when the ambulance arrived (by now Luis was on the scene and had called an Ambulance) that they needed to dress her hand, and after getting to the hospital, also needed to check her ribs and her head contusion. He also stressed that we had six hours to fix the hand. He didn't say "or else", but it was implied. We just weren't sure what "or else" meant until much later.

It's difficult to tell how much time passed before the ambulance arrived. Marilyn was in shock and pain, Cher was trying to keep it together and Ella was very upset that all these strangers were pressed in tightly around us, gawking and begging. I saw genuine concern on most of their faces so was not as disturbed as Ella was, although it was disconcerting.

The ambulance was stopped at the top of road, a good distance from where we were gathered and for some reason it was not coming any closer. Minutes passed and we weren't sure what was going on until we were told that the ambulance got rear-ended by a car and was no longer available to drive us to the hospital. Nothing seemed to be going right. It's now clear that this is how things work here. Never expect plan A or even B to work. Now it's, "of course the ambulance got in an accident, what else did we expect?"

Luis told us not to worry - he was getting a taxi to drive Marilyn to the hospital and we just needed to decide who would go with her and who would go back on the bus and rejoin the tour (which was now scheduled to leave for a boat tour on Lake Nicaragua). Meanwhile, one of the medics from the ambulance walked over and wrapped (but did not clean) Marilyn's hand wound.

At this point we thought Luis was also rejoining the tour and that we were to be left on our own to get through this situation. It seemed almost certain that we'd be stranded in Granada for the night. At this point I should add that Cheryl and I both have anxiety disorders. Her's is triggered by health related issues and mine by general stress and especially, situations where I am away from "home". Needless to say, we were feeling overwhelmed. We quickly decided to grab all of our stuff from the bus and to stay together as a family. After doing this we all piled into a waiting van. Marilyn could barely move and struggled to get into the van. Luis also jumped in, much to our surprise. When it was clear to Luis that we thought he was going to leave us, he assured us that he would stay with us and the tour could continue without him. His job was to get EVERYONE back safely. This brought us an immense sense of relief, knowing that Luis was there to help. He is truly an amazing person and I'm not sure what we would have done without him, given the further challenges ahead.

We drove a short distance (maybe 5 minutes) to a small private hospital. Everyone waited in the van while Luis and I went in. After speaking with the only attendant in sight, it was clear that something was wrong. After a couple of minutes Luis told me that the doctor was "missing". It was Easter holidays, one of the biggest celebrations of the year in a very Catholic country, and the doctor was simply gone. He wasn't answering his cell phone and no one knew where he was. I picture him slamming rum shots in a bar down the street. It seemed obvious to me that Luis was hesitating on deciding what to do next. Clearly, we needed to head to the next hospital, pronto, but Luis was seemed to be torn between waiting for the doctor and moving on. He tentatively suggested that we "could try" the public hospital. I now know why he hesitated but at the time, it seemed ludicrous that we weren't rushing there immediately.

We drove another few minutes and arrived at the public hospital. Luis spoke to the guard at the gate (I'm still not sure why the gate was closed and guarded) and we were eventually allowed through. We put Marilyn in a wheelchair and waited for Luis to speak to the two people at the admissions counter. Finally, Marilyn was asked to go into a room and Norm was permitted to join her. This was a bit tricky; of course Norm wanted to be with his wife, but neither of them spoke any Spanish (beyond "hola", "cerveza" and "gracias"). Luis kept running from the hospital room, where he was acting as interpreter, to the parking lot, where he was on his cell phone co-ordinating the tour remotely with the bus driver.

There was a pregnant woman being treated ahead of Marilyn. We don't know what she was being treated for, but she was being made the priority (I'm sure for good reason). Things were moving very slowly. It didn't seem like anything was happening. It seemed that the public hospital is not supposed to treat non-Nicaraguans, and the staff didn't really seem to know how to respond to the situation. Once again, Luis took charge. He bribed the staff at the front desk as well as the doctor and also stressed that he had a busload of gringos waiting on us so that they could get back to Costa Rica today. Eventually, Marilyn was wheeled into the x-ray room (which held an ancient x-ray machine). They took an x-ray of her hand then wheeled her back into the room and closed the door. During most of this time, we didn't really know what was going on.

After a while, Marilyn was wheeled back into the x-ray room for another x-ray (her ribs). I believe at this point she had been given some kind of pain killers and they had washed her wound with water and lightly bandaged it. It had been maybe 1 1/2 or 2 hours since we arrived at the hospital and we still weren't sure if we were going to spend the night here or not. No one was really telling us anything. Finally, the ambulance (from earlier) arrived and the driver came up to us to ask how Marilyn was doing and to apologize for getting into an accident. His concern, warmth and sincerity went a long way in soothing our frayed nerves. He didn't need to seek us out and we thought this was a really nice gesture.

Time ticked by, I went to use the washroom, which was really delapidated (as was the rest of the hospital building). There was no running water in the washroom sink. This was not a great sign in terms of overall cleanliness and sterility. I found an outdoor utility tap (for watering the grounds) and washed my hands there, splashing cold water all over my face. It helped. Cher and Ella also had to use the washroom but returned because there was no toilet paper (not sure what other people did in that situation). Luis took me around the corner to a little store where he bought us all cold drinks and a roll of toilet paper.

Norm eventually came out of the room and asked me to come in and help translate what the doctor was saying. They were in the process of stitching up Marilyn's hand. I wasn't sure if they applied any anaesthetic as she groaned in agony with every stitch. I thought it was very odd that they were only putting in a few stitches, each about an inch apart. This was all that was holding her hand together???? We weren't stuffing a turkey here; I couldn't see how this could work, but I lacked the ability to discuss medical procedures in Spanish.

I only undertsood about 10%!o(MISSING)f what the doctor was saying and Luis was still off somewhere. We were being given critical information, and once again, I was very frustrated with my lack of Spanish language skills. What I did understand was that the hand needed to be cleaned every day for 10 days and that Marilyn had to be very careful not to bend the hand or do anything that would open the wound. Whatever else the doctor said, I will never know. He left and that was it. The nurse finished the stitching, wrapped the hand up and moved on to a woman with a nose bleed (the pregnant woman was still in the room, hooked up to an i.v.). I tried to ask the nurse to write down what the doctor said, so that Luis could read it later for us, "Puede escribe todo que el doctor me decir?". Blank stares. Either she didn't understand me or she didn't want to write it down. Again, I have no idea.

Marilyn's blood was all over the floor and I was very concerned that she would slip on it when she got off the bed to get into the wheelchair. The room (and entire hospital) was poorly equipped. I did not see a single papertowel or box of tissues (I already mentioned no running water in the bathroom and no toilet paper). There was a dirty bedsheet crumpled up on the bed beside Marilyn but I was afraid to use it on the floor in case they had other plans for it (who knows).

I interrupted the nurse because I had a feeling the wound was not cleaned properly. She pointed at a plastic jug of water and assured me that the wound was cleaned with water. I tried to ask if they had used an anti-septic and she shook her head and once again assured me that the wound was cleaned with water; this was not nearly as comforting as it was intended to be. Later on, Luis told us that the hospital simply did not have even basic medical supplies and that the staff did the best they could under the circumstances. I do believe that they did. In a country as poor as Nicaragua, they are left to do what they can with what little they have available. This gave us all a great appreciation for the healthcare system in Canada (and in Costa Rica, for that matter). It also inspired Cher and I to seek out an opportunity to make a donation to a local health care initiative for Nicaraguans living in our part of Costa Rica that do not have health coverage (or money) here. So good things do come from the bad.

It was time to leave. Luis said the bus was waiting for us at the end of the road. It was great to know we would be getting back to our house tonight, although we still had another 6 or 7 hours or driving ahead of us. Luis asked for Marilyn's purse (a large bag). Without knowing why, we simply trusted him with the bag and he dissapeared into the x-ray room. He came out about 5 minutes later with the x-rays stuffed into Marilyn's purse - the staff are not supposed to let the x-rays leave the hospital. Looking back on it now, the staff were extremely friendly and helpful. I believe the "payments" to staff and the doctor amounted to about $270. Once again, I don't know what we would have done with Luis' help and understanding of how to make things happen.

We helped Marilyn walk down the road to the bus. It was slow going and she was still in a lot of pain. The x-ray showed no broken ribs but every step was agony. We boarded the bus, thanked everyone for waiting for us, and headed out of town (with a short stop at a farmacia to get prespcriptions filled). A couple of hours later and we were at the Costa Rican border. Luis bribed the border guards and our family were permited to stay on the bus without having to line up at customs. The customs officer came on board and checked our passports and photos and we soon were on our way again.

The last 2 hours of the ride home was in a small shuttle van. Every bump in the road was extremely painful for Marilyn but we finally made it home a little after midnight. I immediately called our local Costa Rican doctor, Dr. Andrea and she (surprisingly) answered her cell. She was very concerned about the injuries and offered to come over in the morning.



TO BE CONTINUED (sorry, it's a looong story!)

---

Photos

Central Park, Granada
The family arriving for a quick 20 minute walk around the park...

x-rays
Marilyn being wheeled out to the x-ray room.

Luis
Luis, our tour guide and guardian angel.
I would hug him if I saw him on the street. What a great guy.

Public Hospital, Granada
A look inside one of the hospital wards.