Photo An Hour

I wouldn't say this was necessarily a 'typical' day here in Nicaragua. But it was a rainy Saturday that we spent all together, at home. It was our first weekend together after two months of traveling.

4:00 AM. It gets light very early here. Isla wakes up at the crack of dawn, and has started crawling in bed with us. We're currently rolling with it, since it buys us an extra hour of sleep.

5:00 AM. Stepping over last night's mess.

6:00 AM. Eating $5 worth of Cheerios.

7:00 AM. Ian-buddy, still sleeping.

8:00 AM. Play-Doh with Daddy, that ended with filming a Godzilla short.

9:00 AM. Trying to dry the laundry that got rained on on the line yesterday.

10:00 AM. Blocks and Trash Truck, always.

11:00 AM. Still not dressed, yesterday's bobby pin hanging from my hair.

12:00 PM. Lunch. They maybe ate the crackers.

1:00 PM. Dishes.

2:00 PM. Chocolate chip cookies, from scratch. It was my first attempt in Nicaragua, partially because I knew the recipe wouldn't turn out the same. We'll do some tweaking, and import some shortening.

3:00 PM. Our time out corner tends to get a lot of action in the afternoon/evening.

4:00 PM. Cookies. (While I got dinner ready?!)

5:00 PM. Dinner.

6:00 PM. Volcano experiment. Which turned out to be very emotional - apparently it reminded them of the volcano short from Inside Out.

7:00 PM. Cozy Nest.

8:00 PM. Bath.

9:00 PM. Craft.

10:00 PM. Homeland.

11:00 PM. Homeland.

12:00 PM. Pick up (just a little bit) before bed.

(I know, I know. We go to bed late.)

Busca La Cubana

Sometimes, what looks like chaos and disorder is actually the opposite.

One of the more frustrating things about learning to live and work in Nicaragua is that there isn’t much of a postal service. That sounds less dramatic than it actually is. You can’t stick a stamp on an envelope, drop it in a box and easily send a letter to a friend, or a bill to a customer. Traditional (to us) home/business postal mailbox services just don’t exist, at least, not in many of the ways that we’re used to in North America.

Around here, there aren’t even actual numbered street addresses. Because Nicaragua is still emerging out of the last few decades of war, earthquake and systemic poverty, most of the streets around the country are unnamed, or at least, don’t have official posted names. But, in a city of nearly 1.5 million people, how on earth does anyone find anything? When I first arrived, I asked myself that same question many, many times, and frequently stated it more colorfully than I would prefer to write here.

Nica addresses are basically just a list of directions. Here’s an example of a major business address, printed both in the phone book and online.

“Del restaurante Munich 3 cuadras al lago, ½ al oeste. Linda vista, Managua”.

“From the Munich restaurant, 3 blocks toward the lake (north), then ½ block west, in Linda Vista.”

And if you don’t know the Munich Restaurant…?

To us, it’s pretty unthinkable that anyone could get anywhere like that. But Nicaraguans don’t seem to have much trouble with it. It’s their system. In the absence of a functional official public system, they built their own (Also: for a great NPR story on Managua’s street addresses, click here).

I have no mailbox at my house, (which is also without a traditional, numbered street address) and yet my bills arrive at my door every month like clockwork, folded and wedged between the bars of my front gate. Why? Because the companies that send those bills want everyone’s money enough to send a person house to house, folding papers and shoving them into the cracks of people’s front doors. (I now have a piece of PVC pipe wired to the door that they can utilize as a mailbox, if they choose.) Where there wasn’t a working system, people built one that worked for them, and if you know how to use it, it definitely works much better than anything a fancy government committee could design and try to implement from the top.

The other day I needed something we had at our office in Chinandega, but I live in Managua, 3 hours away.  I called Oscar, Palmetto Medical Initiative’s Nica-based Volunteer Manager, and he said, “Ok - I’ll put it on the Interlocal (a system of city-to city minibuses).” Wait. What? Just stick it on the bus? Won’t someone steal it? How do I know which bus? How will I know where to pick it up? Oscar replied, “Just go to the bus terminal near your house, and busca la Cubana (look for the Cuban lady). She handles all the packages.”

So, while I believed that this process would likely be a waste of time (not to mention my hoped-for package), I went to the bus station (a parking lot behind the market) and walked into a seemingly chaotic maelstrom of over a thousand bustling bodies, all trying to get somewhere different, and none of them looking very “Cuban,” to my eye. But, when I asked a group of older men where la Cubana was, five pairs of mustachioed lips immediately pointed in the same direction; at the shortstack lady in a floral dress, anchored in the middle of all the craziness, armed with a clipboard and piles of rubberbanded, manila-colored packages that surrounded her on the concrete floor. Ah. La Cubana.

I walked up to her, she asked my name and what city my delivery came from, she checked my ID and then she promptly handed me my package. Done. Oscar had sent the package at noon, I got it at 3pm the same day. It cost, between Oscar and I both, a total of about three dollars. Just about any way you cut it, that’s way better than FedEx or UPS.

La Cubana doesn’t work for the postal service or a national shipping company. She doesn’t likely have any official authority to do what she does. But what she does have is a clipboard and the near-absolute trust of everyone who uses the Interlocal. They needed a system. She is the answer.

As a foreigner living in Nicaragua, I realize that we often dismiss things we don’t understand, which causes us to miss lots of valuable opportunities. If I had written off the Interlocal system, it’s not just that I wouldn’t have received my package… it’s that I wouldn’t understand and appreciate an important part of the world and people that surround me.

I’m learning that just because something looks chaotic or confusing, it doesn’t mean that there’s no order or meaning in it. Most of the time, it just means we haven’t done the work needed to open our eyes and truly see it.

"Please we go back to Nica-warbwa, now?!"

TJ and I are so impressed that our brilliant children totally understand that we live in Nicaragua now! The only thing is... they think our HOUSE is Nicaragua.

You see, when we were packing up our home in Nashville, our newly-minted three year olds naturally wondered where their beds and furniture and toys and were going. We hadn't realized that Ian and Isla would be aware that anything was changing. (Chalk that up to being new parents, or still thinking of our toddlers as babies, or magical thinking.) Not wanting to traumatize them with the disappearance of everything familiar, we told Ian and Isla that we were packing up their toys so Daddy could take them to Nicaragua. And when we all moved to Nicaragua together, they would see their toys again, and could play with them as much as they wanted. 

At the brilliant suggestion of our early-childhood-expert-friends Tobin and Rebekah, Ian and Isla helped us pack suitcases of books and toys for Nicaragua. Anytime they wondered where a toy was during our months of transition, they would remind each other, "Oh, I know! Remember? Daddy tooked our toys to Nicaragua. They flew there on an airplane."

On October 30th, 2014 we pulled out of our driveway in Nashville and headed from there to Kansas to Oklahoma back to Nashville to St. Louis to Tulsa and then on to Charleston and finally to Nicaragua. Everytime we arrived at a new place, Ian and Isla would ask if we were in Nicaragua yet.

And then one day - January 10th, 2015 - we were. We finally were in Nicaragua. Ian and Isla knew it, because we pulled into our new driveway, walked into our new home, and they were surrounded by suitcases and boxes full of familiar blankets and books and toys. "This is Nica-warbwa! We're here! Nica-warbwa! There's ants in Nica-warbwa! These ants live at Nica-warbwa, too!"

And so now when we're out and about - when we've driven around too long in 100 degree heat without air conditioning, or stayed too long at a party in the village, or shopped too long at a home improvement store, or WHEREVER - Ian and Isla will eventually burst into tears and ask if we can please go back to Nica-warbwa now. When visitors come to our house, Ian and Isla say, "Welcome to Nica-warbwa! We lub Nica-warbwa!" When we we're on the highway, and we see a car turn towards our house, they say, "He must be going to Nica-warbwa. He will lub it there."

They can find Nicaragua on a map or a globe. They just... think our house is Nicaragua. We've tried to explain that the whole place and country and culture and everything we can see is Nicaragua. But... that's too vague. It makes more sense that we told them their toys would be in Nicaragua, and here they are.

Exhibits A, B, and C.

Pretty hard to argue with that logic. So we're rolling with it.

New Kids in Town

So, these last few months, I’ve kinda been the new kid in town.

As PMI’s new Regional Director here in Managua, Nicaragua, I arrived in January with my wife, Holly, and our ever-so-cute 3-year old twins in tow. We walked off the plane, holding hands down the escalator and into our exciting new future in Nicaragua. Later that night at our new home, surrounded by twenty or so yet-unpacked duffel bags, and sitting cross-legged on the floor of our living room provisioned with pizza, popsicles and headlamps (the electricity was out for a few hours), Holly and I made a plan on how to settle into our new life.

The McCloud family on our first Sunday (ever) at a new church. For our whole life together (12 years!), Otter Creek Church has been home.

That week, we started to check off all the things on the “set-up” list. House? Check. Vehicle? Check. Grocery store? Check. Church? Check. Pre-school for the kids? Check. Everything went very smoothly and before we knew it, we had the kids suited up in cute little school uniforms, bouncing off to make some new amiguitos.

But, as many of you know, schools, in general, are germ factories. The first week of classes, no matter where you are located, is a time of meeting new friends (and their germs) and building new knowledge (and immune responses). Our kids were no exception. They woke up a few days later with a fever, and it quickly became apparent that it wasn’t just a 24-hour bug.

Alas, the one thing that we didn’t have checked off our list was a doctor. Irony alert: my job is to set up health clinics in Nicaragua (In my defense, PMI doesn’t yet have any clinics here in Managua, where the central office is located).

After polling some of our new friends from church, we settled on a pediatrician whose office was located at the nicest, well-equipped hospital around. We wiped the kids’ noses, strapped ‘em into car seats and braved Managua’s grueling traffic, arriving on-time for our appointment.

The hospital was NICE. New construction, lots of glass, marble and steel. Our doctor’s offices looked copied and pasted right out of any major US hospital or medical park. Nice waiting room, chairs, magazines, flat-screen TVs on the walls, and completely empty, save for us.

We waited almost an hour past our appointment time in that empty waiting room. When the doctor was ready for us, we entered his office, and he took all the patient intake and vitals himself - no nurses or techs. Our case was pretty open and shut; most anyone could deduce from the various colors oozing from four little nostrils that the kids had sinus infections. Two bottles of (apparently yucky-tasting) antibiotic suspension and a prescription fever reducer later, we were good to go.

All in all, we paid around $100, or $50 per child for the visit, which is at the top end of what you would pay for a pediatric visit here in Managua, and also completely inaccessible to more than 90% of the Nicaraguan public (hence, the empty waiting room).

Driving away, I reflected back on the experience. I liked the pediatrician and would definitely take the kids back to him, if needed. I also know that the big, nice hospital we visited has many other excellent doctors and facilities, and it’s absolutely the place I would take my children in an emergency. But, as someone who knows something (yet still learning a lot) about primary care in Central America, the quality of the care and experience still left me feeling like I had mostly just paid for marble and glass.

For primary health care, I realized, (and as a part of the PMI team I was pretty proud to say) I would have rather taken my kids to a PMI clinic to see one of our doctors. They would have absolutely handled our case as well or better than this more expensive doctor did. The two clinic visits are even comparable; PMI’s clinics aren’t over-the-top fancy, but they are attractive spaces, nicely appointed with clean tile floors, comfy chairs (not to mention a flat screen in the waiting room!). But then again, you’d never get to watch it, because when a patient shows up at one of our clinics, they are immediately attended to by our full staff of nurses, doctors, pharmacists and admins. We’ve got the full suite of laboratory testing and exam technology that most primary/urgent care patients need. And the current cost for a general patient consult at PMI’s Nicaraguan clinics? About $4.00 or less.

Imagine the picture; a rich Gringo electing to take his sick children to the same clinic and doctor that a Nicaraguan mother who makes less than $5 a day can afford to bring her kids to!

Palmetto Medical Initiative exists to make high-quality health care (and specifically, primary care) accessible, affordable, and sustainable for the majority of the people in the world who can’t take their sick kids to a shiny marble and glass hospital on the rich side of town. We do it by finding donors who make initial investments to establish an excellent facility, and then we are as efficient as possible in running those clinics, finding talented, well-qualified medical professionals who are more passionate about public health than their own bottom line.

There will always be expensive, highly trained doctors and private, amazingly equipped hospitals for those who are able to pay top dollar. I am glad for that, and I count myself lucky to be one of the people who could access such a place. But make no mistake; quality CAN be affordable. Palmetto Medical Initiative’s success in treating thousands and thousands of patients in Uganda, Burundi, and Nicaragua over the last five years demonstrates that it is possible to provide high-quality, compassionate, affordable (and yet financially sustainable!) care to people who have very few resources; the very people who never could have accessed quality health care before, and who often need it most.

The best part is that while we’ve got multiple locations where our clinic model is already breaking down barriers to health care access, we’ve got lots more clinics we plan to open in the very near future.

Hi, we’re Palmetto Medical Initiative.

We’re the new kids in town, and we’re just getting started.

30 Things We've Learned in 30 Days or Less

We love/hate this about living overseas: learning. Always. Every day feels like a extended teachable moment. Life as a roller coaster learning curve. We sometimes/often/always feel like we don't know how to do ANYTHING.

(This morning's learning opportunities: the twins are supposed to wear specific navy shorts as a part of their preschool uniform, and I don't know where to buy them. TJ has a group of doctors arriving in a few weeks, and the health department has added new layers to their clearance process. I want to buy 5 gallon bottles of water, but I don't know where to exchange the empty ones.)

It's exciting, getting to know a new people and a different part of the world. It's also draining, to be in a constant posture of learning. This past month, we've often thought, "If only this were happening a year from now. We would totally know how to navigate this." But the only way to make it to the experience and knowledge on the other side of  'a year from now' is to work our way through the not-knowing of now.

We've been in Nicaragua for exactly one month today. We don't know as much about life here as we will a year from now, but we know more than we did a month ago. In honor of 30 days in-country, here are 30 things we didn't know before we arrived (but now we do!). 

1. Our utility bills are hand-delivered to our door via motorcycle.
2. Nicaragua is home to one of the largest species of ants in the world. (Thanks a lot, PMI. You could have mentioned that in the interview process.)
3. Milk is sold in plastic bags, not cartons.
   
   
   
4. The weather is lovely (so far). Sunny, upper 80's, not humid, and breezy.
5. Nicaraguans prefer small red beans to black beans.
6. When writing a check, the number 'two hundred' MUST be written as 'doscientos' and not 'dos cientos." 
7. You can withdraw US dollars or Nicaraguan cordobas from an ATM.
8. Nicaragua is the largest country in Central America, about the same size as New York state.
9. Managua's giant yellow metal tree sculptures are based off of Gustav Klimt's 1909 work 'The Tree of Life.' (Actually, didn't even know there were giant yellow tree sculptures everywhere.)
10. If you're even a day late paying your electric bill, the power company will come out and literally cut your power line. Without mentioning it to you.
11. Didn't know our landlord hadn't been paying the electric bill before we moved in. Which is how we found out about #10 above.
12. It's free to text between the US and Nicaragua. (Technically iMessage, not text.)
13. So many trees. In our yard alone we have: mango, avocado, papaya, banana, grapefruit, lemon, lime, and palm trees. Very surreal.
14. Mountains and old volcanoes and lakes - spectacular vistas are everywhere, even in the city.
15. The tap water in Managua is considered safe to drink. We still don't drink it, but it's nice to know it's in the realm.
16. You can pay all of your bills at the bank - rent, utility bills, internet, even traffic tickets.
17. They're digging (or planning to dig?) a 2nd 'Panama Canal' through Nicaragua. 
18. Our neighborhood has cobblestone streets.
19. Our house has red clay (tile) floors. That means our feet and our kids and our beds our rugs and our furniture are always covered in red.
20. Diet Coke (or Coca Lite) is almost non-existent here. Lots of Coke and Coke Zero, though.
21. Bath night for the kids is every night, and can never be skipped. (See #19.) They are covered in dust and dirt at the end of every day. We used to do bath night maybe 2-3 times per week in the winter. This is a big adjustment, because we are all tiiiiiired at the end of the day.
22. There are swan tiles in the twins' bathroom, and I kind of like it.
23. Netflix streaming works here, and the selection is awesome. Think: every Disney and Pixar movie ever made.
24. The president of Nicaragua is Daniel Ortega.
25. The wood beam ceilings in our house are mahogany.
26. The geckos on our windows make a loud chirping sound - almost like a woodpecker. (All night long.)
27. The wind sets off our neighbor's car alarm. (All night long.)
28. How isolating and disempowering adult illiteracy can be, especially in a world that increasingly communicates via text and social media.
29. That there would be Publix-esque grocery store less than a minute from our neighborhood. Seriously, I don't even have time to shift the car into third gear before I'm in the parking lot.
30. How very at home and well-welcomed we would already feel here.

FAQ: the Nicaragüense Version

Questions. We get asked a ton of questions. Questions about having twins, and questions about living in the developing world. The thing is: we don't mind. We really enjoy talking with people about some of our favorite things in the world - our almost-always-delightful children, and a desire to live/serve outside of our comfort zones.

We're used to the questions people usually ask us in the States (FAQ: Stateside Edition post to follow!), but it's been fun getting just as many (different) questions from Nicaraguans. Below are the top 5 most common questions we're asked here.

1. ¿Qué te pareció Chinandega? A Uds. les gusta? (How do you like Chinandega?) We actually don't live in Chinandega, which is a rural area on the northern Pacific coast of Nicaragua. We live in the capital city of Managua, but our car license plate is still registered to Chinandega. It's somewhat rare to encounter expats who live in Chinandega, and Nicaraguans are ALWAYS asking us if we like it there. They usually also say something like, "How do you like Chinandega? Your little ones are going to like it so much there, they're never going to want to leave Nicaragua." In the beginning, we would explain that we live in Managua, but haven't changed the car tag. Now that we answer this question several times a day, we usually just say, "We really like Chinandega, and the children love it, too!" This question, and #2 below, are far and away the ones we are asked most often.

2. ¿Son gemelos? Quien nació primero? (Are they twins? Which one was born first?) Nicaraguan culture values children highly, and Nicaraguans especially love twins. Everyone is a little starstruck when I confirm that Ian and Isla are indeed, twins. Sometimes people are surprised when I say that Ian was born first, since Isla is a little bit taller. Sometimes I just agree that Isla was born first. They were born within the same minute, and Ian and Isla can't yet understand what I'm saying, so... Nicaraguans have never asked us if the twins are identical, which is almost always the first question we get in the States. (Yes- even though they're boy/girl twins. Unbelievably, we've had medical professionals ask us that. And, they don't even look that much alike. It's just an instinctive question Americans ask about twins.)

3. ¿Ustedes son de aquí? (Are you from here?) Holly gets asked this pretty often, perhaps due to her dark haired, dark-eyed, super-exotic Mediterranean looks (Romanian, actually)?! No one asks TJ where he's from. He pretty much looks like an Okie from (just north of) Muskogee.  We answer that we aren't from Nicaragua, but are from the United States. Nicaraguans usually want to know what part of the US, which has proven to be hard to explain. We've learned to say that we're from the state of Tennessee, which is located in the middle, between New York and Miami. We try not to say that we are "Americans", because Nicaraguans are, too! U.S. citizens and Canadians are instead referred to as North Americans (norteamericanos), even though The Google says Mexico and Central America are technically part of North America, too.

4.  ¿Como es que aprendieron espanol? (How do you already know how to speak Spanish?) The long answer is: we both enjoy learning other languages, and Spanish has been a part of our lives for a long time. We both studied Spanish in high school - Holly for 5 years, and TJ for 2. TJ improved his conversational Spanish while working landscaping in high school. Holly went on mission trips to Mexico, studied abroad in Spain, and double majored in Spanish at ACU. We were both summer interns in the Dominican Republic. We later attended language school for several months in Antigua, Guatemala before moving to the Dominican Republic. The short answer (and what we usually say) is: we lived in the Dominican Republic for a few years. Nicaraguans, some of whom are about as bad at geography as most (North)Americans, are often interested to learn that Spanish also is spoken the Dominican Republic (sort of).

At our 'graduation' from language school in Guatemala. Our experience at CSA was simultaneously intense and idyllic.

5. ¿Que típo de trabajo están haciendo aquí? (What brings you to Nicaragua, or what type of work are you doing here?) This is also a question that we are often asked when we are in the States. We answer that TJ works for an organization that builds medical clinics in smaller cities without good health care access. The organization makes the initial investment in the construction of the clinic, but then, through hard work, great church partnerships and small, accessible patient fees, the clinics start to quickly pay for their own operation. Each clinic is 100% run by Nicaraguan administrative staff, doctors and nurses. That's something that resonates with everyone that we talk to - that the clinics are low cost, high quality, sustainable and completely Nicaraguan (although there are some great Cuban doctors around here...).

We're continuing to settle in here, and will post again soon with the top 5 questions we get from friends and family and complete strangers in the States.

The Rest of the Story

We love staying connected through social media, but so much is happening so quickly - it's hard to capture it all in snapshots. I feel like I've been posting things out of order, or not at all. Last week was our first 'normal' week in Nicaragua - it was awesome to settle into our new rhythm of life here.

It was TJ's first week back in the office, and the twins started school. They're going to a Spanish-speaking preschool a few mornings a week, and they really love it. They haven't noticed that Spanish is different than English, which is a fun surprise! We also got a dining table, placed an order for a couch, hung curtains, and organized closets. 'House-is-feeling-more-like-home' type things. Awesome.

But also: it was a roller coaster of a week.

$4,000 mysteriously disappeared from our bank account, the twins picked up a little back-to-school virus, our car needed a major repair. Our kitchen sink clogged, our bathroom toilet overflowed. Ants ate a small hole in our roof. We got pulled over while on our way to the twins' doctor appointment, and the police wanted to impound the car. Almost all of those things happened within 24 hours, on what was supposed to be TJ's first travel day to one of PMI's medical clinics.

The end of all of those stories is: we are fine, everything is fine, it all worked out. Laura Essner (our friend and banker-extraordinaire) helped us track down the missing money, and got it restored to our account. It was an international banking mishap that we now know how to avoid!

The twins are completely well now, and never had any symptoms other than fever. We were able to go ahead and get established with a great pediatrician here, which is something we'd been meaning to do, anyway. Dr. Mora was great with Ian and Isla (Isla loooooves all things medical). He was so excited to hear we were from Tennessee - he did part of his residency in Knoxville, and fell in love with the Volunteer State.

Getting a little creative to help our feverish little ones cool off in the tropics. Packing totes fit the bill!

We were pulled over by the transit authority on our way to the doctor, but they ended up letting us go. It's a normal thing to get pulled over here - often just to check paperwork. There was a problem with the car's registration, but we were able to find the paper we needed and avoid a detour to the impound lot. On our way home from the doctor, the car had a major problem. (But it ended up being a minor repair.) Our friend, Fabricio, recommended a mechanic to us, and he did SUCH a great job. He repaired the car within a few hours, and delivered the car back to our house.

The sink, toilet, and ant issues are still... ongoing. No big deal.

We are thankful to be here. TJ absolutely loves the work he's doing with PMI. It's funny to think of TJ working in "health care administration", but the truth is... if you care about people and want to make a substantive difference in the life of a community, health care is a pretty great way to go. Being part of a team with the goal of improving access to healthcare is exciting and really challenging, and much-needed in this country (and many others).

Our family is also remembering what it's like to buckle up our seat belts (figuratively, though we try to do so literally, when possible), and be along for the ride. We are thankful for our years of life and ministry in the Dominican Republic - we learned a rhythm of celebrating the good, and trying not to dwell on the bad. That experience helps us step back and look at the big picture, and not get too caught up in the day-to-day dilemmas.

Thankful for your love and prayers. Hopeful for a more 'normal' normal first week here. We are very much enjoying getting to know the people and places of Nicaragua - we are surrounded by great beauty.

Much love,
tj&h