Monday, December 6, 2010

What Happens Next

I certainly did not miss the beeping. 

It’s my first night back at work after being in Nicaragua for ten days. Of all the things that stick out to me most upon my return to Ruby Memorial, I think the constant beeping takes the cake.

Something on 7East is always beeping. There is quite a variety of beeps, actually. There’s the empty IV bag beep, the downward occlusion beep, the air-in-line beep, the sequential compression device beep, the fall prevention beep, the call light beep, the bathroom beep….the list goes on and on. Some of the beeps are sharp and urgent. Some are softer, fading into the background soundtrack of the night.  All of them get annoying. All of them have to be addressed. But tonight I’m just amazed that we have so many at all. Despite all of their efforts to keep me focused on my patient assignment, my mind keeps floating away from Ruby Memorial Hospital, and back to the soft sands of Pochomil on the Pacific coast.

I'm sure you can see why. 

Regardless of where my mind is, though, my body is home. And it's back at work. Alas, I've had to turn in my photojournalist hat, pick up my stethoscope again, and return to my duties as a nurse.

There’s this post-Nicaragua sense of appreciation that descends on most of the RMU group by the end of every trip, a sense of fresh perspective. Anyone who has been on the trip before understands it well. For me, stepping back into an American hospital nearly makes my head spin, seeing hand sanitizer and elevators and medical equipment and computers and medication scanners and all of the other modern-day healthcare amenities that we simply expect to find when we walk through the door. Because this is America. And Americans have it all. 

Robin, my charge nurse, apologized tonight for assigning me six patients on my first night back. But I certainly wouldn't dare complain. Not tonight. As I wrote down my assignment, I shared with Robin that Nicaraguan nurses are sometimes responsible for 45 to 50 patients at time on a medical-surgical floor like mine. And they don’t have a computer to tell them what their patient’s orders are or which medications need to be administered. They don’t have those luxuries that I do right at my fingertips. Sometimes I can't even imagine doing my work without a computer. But they do, every day.

Around this time of the night, between three and four in the morning, I start to catch up on my charting. My thoughts usually start to catch up with me too. I think about the undergraduates who were on this trip, most of whom I had never met before last Thursday. Often times I wonder, does it really change these college kids’ lives? Or is it just one of those once-in-a-lifetime opportunities that eventually get tucked away in a box of fine memories? In a broader sense, with our ChangeALife campaign winding down in the next couple weeks, I wonder what real impact that we’ve had on the Pittsburgh community. After all the billboards get taken down and the commercials go off the air, will all of that hard work just be another phase of Robert Morris’ development as a local university? Or will it really have some sort of lasting impact?

I don't know.

I remember a conversation I had with Larkin Werner back on the beach at Montelumar Resort after we wrapped on the commercial in July. Being one of the top advertising gurus in Pittsburgh, I asked Larkin how he would define success for a campaign like this one. He responded in a way I expected. The results would take time, he said. But they would eventually be looking for success through increased admission numbers, in student surveys and community involvement. Larkin’s father, Ray, was our art director for the commercial, and he was the visionary behind the whole idea. I remember Ray telling me about a conversation with RMU’s president, Greg Dell’Omo. “I asked him what he wanted most out of a campaign of this size,” Ray told me on the flight home. “And he said, ‘This university has yet to make a real connection with the surrounding community. I want RMU to finally connect with people. The essence has to be about changing lives.’” 

Well, for President Dell’Omo and all the fine folks who work for the University, I hope we accomplished that. I hope we do see more student involvement in community service. I hope we do attract high school students who want to be a part of the ChangeALife team. I hope the campaign does all it was supposed to do. But for me, the success of this campaign will be defined a bit differently. 

For me, our success will be defined by what happens next. Success will happen when these RMU students become RMU graduates and wade out into this nation of pushovers and cynics and stand up for what’s right when the world tells them it’s wrong. For me, the success lies in DJ Smith when he doesn’t forget about that kid in Nicaragua who wants to be a doctor someday because of him. The success lies in MaryKate O'Hear when she raises her kids one day to appreciate the food on their dinner plates. The success lies in Brianne McLaughlin when she takes the time to talk to kids about working hard and taking pride in their country. The success lies in each and every RMU student who not only cherishes the college education they’re gaining, but then uses it as a tool to enrich the lives of those around them.

For once, I wish we’d take the focus off of changing the world. Honestly, the world will just keep getting worse. Sadly, that’s a given. In the meantime, though, we do have a chance to reach out and make a difference in the lives around us. We can focus on looking out for others as much as we look out for ourselves. We can try our hardest to do the right thing, even when it’s the hardest thing. 

It’s a heartbreaking realization to look into the eyes of an impoverished Nicaraguan teen, knowing full well that they would give anything to get on board that plane home to America with you. It’s even more heartbreaking to know that millions of the blessed recipients of America’s bounty have no idea what they really have. There’s something we can change right there, one life at a time. 

But it takes guts to do that. An attitude of general thankfulness is definitely not the status quo in our society today. On the contrary, we live in a country that now promotes a self-centered and materialistic approach to everything, one that leap-frogs right over the Thanksgiving holiday to get right to the commercial-driven chaos of Christmas. I’ve tried to go against it, and believe me, I’ve failed on plenty of occasions. But I want to keep trying. And I believe the rest of these RMU students want to as well.

So the potential is certainly there. What happens next remains to be seen.

The lights on 7East are coming on now. A new day will be beginning soon. Thanksgiving Day is here, but as we all know, hospitals are never closed on holidays. The doctors will start arriving before the sun peaks up with fresh orders for the nursing staff. Patients will start waking up, needing pain pills and breakfast trays and many other things. So before I conclude this final blog on this Thanksgiving morning, I want wrap all these random thoughts up with a little tradition of mine. Like many of you, I like to take a few minutes every year to jot down just some of my many blessings. Here's what's on my list this year...

I'm thankful for my job at this amazing medical facility…

...because there is not a hospital that comes close to it anywhere in Nicaragua.

I'm thankful for my beautiful mansion of a house…


...because many people have just sheet metal roof to live under and nothing else.

I’m thankful for that big front door on my house that opens wide...

…because some people just have the back end of crib. 

I’m thankful for the bottomless stores of our pantry...

...because many people are down to the bottom of their last bag of rice. 

I’m thankful for my family at home….

…and my family abroad.

I’m thankful for people in my life like this man...

…a man who has given his life to teaching in the hope that his students will use what they learn to go make a difference, one life at a time. 

And most of all, more than anything, I’m thankful to the Lord, the Father of lights and Giver of all good things, who does not forsake the hope of even the least among us. I know this to be true, for I’ve met some of these least. And of all the fascinating things I’ve seen in that endless sea of tired faces, there is one thing that surprises me most. 

They hold fast to their faith.

Like David wrote in the Psalms, they continue to call out to the God who gave them life. For some, that's the only hope that they have. But it is enough. 

"I will lift my eyes to the mountains, from where shall my help come? My help comes from the Lord, the Maker of heaven and earth."

So with that as our prayer, let each of us be thankful, for everything that we have, both today and always.

God bless you all on this Thanksgiving Day.

- Lee

Friday, November 26, 2010

A Passion for Pajamas

Do you remember your favorite pair of pajamas?

Don’t be embarrassed. It’s a fair question. Most of us had favorite PJ's. Let’s just admit it. I'll tell you about mine. My favorite pajamas were bright yellow. They had footsies and white cuffs and a really long zipper that had to be carefully zipped. And they were awesome. 

 No surprise that my grandmother called me her little banana boy.

Awe. Yeah, those were the days...

The truth is, when you’re a kid (and even if you’re not) there are few things more comforting than pulling out those favorite PJ’s from your drawer before bedtime. It’s your ticket to sweet dreams. A guaranteed good night’s sleep. Just part of being a kid in America. 

But there are millions of kids all over the world who have never had a pair of PJ’s to call their own. Actually, millions live without clothes at all. When it comes down to it, there probably aren’t any lives being lost because of a worldwide pajama shortage. But that's certainly no reason to keep a simple childhood joy to ourselves. And there are some little lives that are much happier this morning, thanks to two RMU students and their passion for PJ’s. 

Here's one of them. Meet MaryKate O’Hear. We call her MK. 

MK has one of those smiles that’s always on the verge of laughter. I have to tell you, throughout our week here in Nicaragua, there’s never been any doubt in anyone’s mind that this girl is having the time of her life. But for all the life-changing moments she’s lived on this trip, the one she says she’ll cherish most happened on this final morning in Nicaragua. 

The whole project started with a simple idea from MaryKate’s roommate and best friend, Amanda Musser. Amanda was watching Oprah one day and saw a feature on the non-profit organization called the Pajama Program. For ten years, this charity has been providing warm pajamas and bedtime storybooks for kids who don’t have them. Upon seeing the impact that these simple gifts had on young children, Amanda was instantly inspired and set out on a mission to collect as many sets of pajamas as she could. Working in tandem with the Bradley Center in Pittsburgh, this RMU business major was able to hand out 100 sets of pajamas and over 200 books to abused and neglected children on Christmas Eve. Her work with these children, along with her devotion to several other charitable causes, made Amanda Musser one of the stars of the RMU ChangeALife campaign. You can watch her inspiring story on our website here

When Amanda found out that her roommate MaryKate would be traveling to Nicaragua, she decided to take the Pajama Program abroad. For three weeks before our group left, Amanda and MK put the pedal to the metal with their collections, hanging signs around campus, placing collection boxes and asking for donations. They teamed up with Spanish classes at Cornell School District to write special messages for the kids in Spanish to be packaged with the pajamas. They made each high school student responsible for writing twenty personalized notes. In the end, the two RMU seniors collected 150 sets of PJs and over 600 children’s books. It took them four days to wrap them up with ribbons and pack them away in suitcases.

And today is the big day to give them all away. 

We are at the pediatric hospital in Managua this Sunday morning. Our last day in the country will be spent relaxing on the beach at Pochomil, but this was a mission we had to complete before we left for the coast. We’ve all tossed on our dirty nursing scrubs overtop our swim trunks to go into Hospital Infantil, the pediatric medical center in Managua. MK is even more excited than usual. 

“It just seemed like such a nonchalant thing when we were packaging them back home,” she tells me excitedly. “But to actually be here, to be passing them out today in the hospital….I can’t believe how excited I am.” 

We are greeted in the lobby by the head nurse. After introducing us to some of her staff, she walks us down a long sunlit hallway that leads to one of the pediatric units. Amanda leads the way, smiling as always.

Once we reach the nurse’s station, we lay the suitcases down and open them up. For the next half hour, the group dispenses the PJs to the little patients along the hallway. The first few moments are awkward, as they always are. American college students entering your room, complete strangers to you and your child, would probably unnerve you too, if you were a Nicaraguan parent. 

But when they see what the students have for their children, and those shy little faces start to widen with smiles, the international barriers don't last very long. After ten days of being immersed in the culture, most of us have rekindled a good portion of our high school Spanish vocabulary. We can speak a few sentences back and forth, but mostly, all of what needs to be said is passed along just fine in the flash of a smile or the clasp of a hand. 

Out in the hallway, Dr. Ross and Edgar open up the suitcases full of books. They are written in English, but that's all right. Most of the kids here love to learn new English words, and regardless of the language, all of them will enjoy the pictures. Dr. Ross teases Edgar at his selection of books for one of the young boys. 

"You really think a little boy wants to read about princesses, Edgar? Come on now! Give him a real book!"

There are plenty more pajamas and books to hand out, but we only have time to pass them out to this particular unit. The rest will be distributed throughout the hospital. We've also left clothes and books at the UPOLI clinic for the Christmas party they are planning for the children. All in all, the Pajama Project for Nicaragua has been a tremendous success. MK and Amanda can be proud of the work that went into that special suitcase.

So this winter, we hope you’ll think about that special feeling the next time you feel it, slipping into your PJs after a long day. It takes you back to childhood for a moment, doesn't it? Fortunately, it’s a feeling that’s very easy to share with those less fortunate, whether they live in Nicaragua or right next door. Just click here if you're interested in learning more about the Pajama Program. 

Maybe you share Amanda and MK’s passion for pajamas. Maybe your help can give a little kid like this one...

 ...a little something special to call their own.

Wednesday, November 24, 2010

The Perfect Cast Party

I never told David I was coming to visit.

We chatted online every so often over the past couple months, and if he mentioned the subject of me visiting, I would simply tell him that I hoped to see him soon. So I knew I wanted to surprise him. I just didn’t know how. When we arrived in Managua on Thursday night, I still didn’t have a plan. But a spur-of-the-moment on Monday afternoon took care of that. 

“Stop the van!” Dr. Ross yelled that day from the front seat. We were headed home from our first full day in the barrio, a bus full of worn-out workers. “Stop the van! Hey Lee, look out the window!” I looked across the street to see what Doc was yelling about. The only thing I could see were three ladies walking down the sidewalk. 

Then I recognized who it was. 

“Let’s surprise them!” I shouted up to Doc. “Can we get out here?” The crew was looking out the side of the van now, trying to see who it was we were shouting about. I was in the back seat, so I climbed over arms and legs to get to the front. 

“Who’s out there, man?” Mike asked as I passed. 

“It’s David's mom and sisters! We’ll be right back!” 

Doc and I hopped to the curb and walked around the front of the bus. We were going to try and sneak up on the girls, but David’s sister Judith was much quicker. The gig was up before we even crossed the street. 

“It’s Lee!” Judith yelled from their side of the street, pointing and waving. David’s mother Carmen and his other sister Louia looked and started to wave frantically too. By the time we dodged through Managua rush hour to reach them, they were in full celebration mode. 

We couldn’t talk for very long, but I promised that I would stop by the next day at the house to visit. The following morning, they swung the door open for me and I was once again guest of the ever-smiling Morales Espinoza family. 

I was more thankful than ever not to have a family assignment on this trip, since I ended up going back to David’s house every day that week to spend time with the family. My arrival tended to start quite a ruckus at David's house. The woman who calls herself my Nicaraguan mother ran to the door every morning as if I were a long lost son returning home from war. The girls would dash around the kitchen, fixing drinks and snacks, as David and I caught up on what we’d missed since I left in July. I learned he was getting over a rough breakup with a girl that he really liked, and we spent some time laughing over the international mysteries of the female kind. 

“She says that she does not want to go out with me anymore, but then why do I keep getting messages from her!” he would say, his head in his hands. “What does this mean?!” 

“Listen, David,” I told him. “As a friend of mine always says, cut her loose and set her free. If she comes back, it was meant to be.” David stroked his chin, nodding.

“Yes, I think I see what you mean, my friend. Ahhh, girls. They are not worth the trouble!” 

And David’s mother, though unable to speak English, would just refill our drinks and chuckle, probably assuming through motherly intuition that we were speaking of such things. 

I had brought many things with me to show David involving the ChangeALife campaign back home. The family marveled over his appearance on the front page of the Pittsburgh Post-Gazette…

…and the girls loved our billboard so much, they made David and I recreate it for them there in the front room. 

Later in the week, Carmen presented me with a present from her. It was a collection of childhood photos of her kids, mixed in with photos of my visits to their house. On the front, it said ‘bragbook’. She is quite the proud mother of her kids…

….which reminded me of my own mother, who had sent Christmas presents with me for everyone in the family. Carmen loved her new nightgown, and insisted that I bring my mother with me on my next trip. Did you hear that mom? 

Next time, I’m not allowed to leave you at the gate.

So somehow, it’s the end of the week. In some weird paradox of time, the incredibly long days that crawl by with a seemingly endless agenda have all disappeared in a flash, and just like that, it’s Friday afternoon, and thus the hardest part of all. The part where we say goodbye. 

I’ve told David and the family that this will be my last visit for a while. So when I knock on the door for the last time Friday morning, I’m taken back by what I find. 

The house is completely decked out. There are streamers strung across the ceiling, with balloons all over and a Spongebob Squarepants piñata hanging from the roof. At first glance, it would appear as if one of David’s sisters is having a birthday party. But on one wall of the home, there is a dry erase board, and today it spells out the reason for the decorations. 

 “My friend, we have a farewell fiesta today!” David says in greeting me. “My mother says you must bring all your friends here!” 

I am speechless. The day before, his mother had asked how many people were with me in my group. She had been planning this all along. I felt horrible at first, knowing this was not on our group's agenda. Friday is already a very tightly scheduled day for us, and we are already behind schedule. But I promised them we'd be there anyway. We would make it work.

After inviting them to the health fair, I run down to the clinic and find Doc in the exam room. 

“Doc, we have a problem.”

“Why? What’s the matter?” he asks. 

“We have to go David’s house before we leave.” 

“What? Why? I don’t think we will have time with the health fair and all.”

“I know, but I just came from there. They have their whole place decorated for a party. For our entire group.”

“You’re kidding.” Doc scratches his head. “All right, we’ll figure something out. But we can’t stay long.” 

Thankfully, the health fair goes smoothly, followed by the piñata for the children. During the presentations, we usher David and his family into the back room to debut the ChangeALife commercial for them on Dr. Ross' laptop. They watch it in silence, all of them with huge smiles on their faces. 

To Ray, Kyle, Larkin and everyone else who made this moment happen - I'm proud to tell you that they loved it.

Outside, the students made their way through the crowd on the veranda, giving final hugs and leaving addresses, promising to return....

Before long, Dr. Ross encourages everyone to move toward the bus, but once we’re all outside the clinic, he announces a swift change in plans. There’s a party at David’s and we’re all invited, he tells the group. For just about everyone except me and Doc, this will be the first time everyone has even met David. In a terrific show of exhausted teamwork, they trudge up the street toward the house, where they are welcomed as honored guests.

Somehow, there are chairs for everyone. There are cold drinks for everyone. There are club crackers for everyone. Carmen is in her element as a mom, directing people to sit and relax and feel at home. Dr. Ross and I are blindfolded and made to dance while striking at the tiny piñata….

And of course, everyone wants to hear the trumpet that they’ve heard so much about. My commercial co-star is more than happy to oblige.

Thunder starts to roll through the air outside. But it doesn’t matter. Inside, there are Christmas gifts to be opened. 

For me, Carmen has picked out a beautiful traditional Nicaraguan camisa. David laughs at the color, but I don’t care if purple is my color or not – it’s a wonderful gift. 

Outside the rain starts to fall, just like it did on the last day of the ChangeALife shoot in July. But we are safe under the solid roof here in David’s house, and thanks to their hospitality, the only one left out in the downpour is…well…..

….poor Megabus. 

Unfortunately, we have to say our goodbyes here. 

In one last beautiful display of entertainment, David’s sister Judith twirls through a classical Latin American dance in her finest dress.

As she spins around and around, a bright red blur in the center of the room, the trip strikes me as such: a beautiful blur that ends all too soon. 

Watching Judith dance, I remember there being talk of having a cast party for everyone on the ChangeALife team back in Pittsburgh. But this is so much better. I lean over to Dr. Ross. “I don’t think we could’ve planned a better cast party if we tried.” He nods.

“You’re absolutely right. This was perfect.”

We pile into the bus a few moments later.  I take my seat in the back corner of the bus, all of us waving profusely at the Espinoza family. 

All four of them stand in the rain, crying, and watch us go.

The bus starts down the bumpy road through the barrio on its way toward the market. I put in my ear buds to distract myself from thinking too much about what just happened, and everything that happened before it. But wouldn't you know, Carrie Underwood pops up in the shuffle, singing her song Change

There’s simply no better song that could bring this whole wild ride full circle. For me and everyone else who has stepped foot in this barrio, the words of this chorus are an anthem of hope that will stay with us forever...

The smallest thing can make all the difference
Love is alive, don’t you listen to them when they say
You’re just a fool, just a fool to believe
You can change the world.

Tuesday, November 23, 2010

The Football's Friend

Who has the football? 

It's the most common question we hear from Dr. Ross while in Nicaragua. And if no one knows the answer, we're pretty much doomed.

The football is our code name for the bag that contains every important document we need in order stay afloat while abroad. Our passports, our reservations, our credit cards, our cash - it all stays in one central location and under constant supervision by at least one member of the group. So when Dr. Ross says, "Who has the football?", there had better be a quick response from someone.  

I'm happy to say that, unlike the Steelers, our RMU group has never once fumbled the football. Here is the infamous bag, being closely supervised by yours truly, at Bush International in Houston....

And this trip, the football has a friend. It's a bit more colorful than the football, packing a lot more personality than that black bag of importance. In a surge of creativity, we've nicknamed this new guy.....drum roll please....the softball. 

Everyone, say hi to the softball….

Hi Softball!

From the beginning of the trip, the softball has been guarded almost as closely as the football, perhaps at the same ratio at which the Secret Service protects the Vice-President in comparison to the Commander-In-Chief. 

We put our Olympic goalie in charge of its security when we passed through Houston... you can see, she took her job very seriously. 

Before we entered Central America, though, we made an executive decision to double security…

We didn't want anyone messing with the valuable contents of the softball. So by now, you're probably wondering, What's in this bag that would require such close supervision? 

Allow me to show you…

350 pairs of reading glasses. All of them donated. All of them en route to needy people in Nicaragua.  

Okay, so a few pairs were used to play around with...

...but you get the picture.

The story behind the softball started back in Pittsburgh several months ago. Dr. Ross had been invited to the annual Roberto Clemente Museum fundraiser, an event organized by Duane Reider, our incredible photographer for the ChangeALife campaign. Let's all say hola to Duane...

 Hola Duane!

Anyway, after speaking to the crowd at Duane's museum about RMU's program in Nicaragua, Dr. Ross and one of our nursing students, Nicole Spellman, were approached by a woman named Susan Henault, the Pittsburgh director for a charitable organization called Mission Vision. This non-profit provides prescription reading glasses for inner city youths who have trouble reading due to poor vision. 

Mrs. Henault had a big idea. She wanted to provide us with eyeglasses for our next trip. Lots of eyeglasses. All Dr. Ross would need to do was provide two students to receive training on how to perform eye screenings. Twin sisters, Dana and Nicole Spellman, both senior nursing students at RMU, immediately volunteered. And so, when we departed for Managua last week, our football had a friend.

In the Matalgalpa, Dana and Nicole went right to work screening kids, which allowed them to determine what strength of eye correction they would need in order to read without strain.

In the process, they taught the simple screening method to fellow nursing students, both from RMU and our sister university, UPOLI. For the Spellmans, the visual impact of Mission Vision here in Nicaragua was immediately crystal clear. During one of our many bus rides around the country, they shared their reactions with me. “At first, a lot of the people we screen don't realize that we are giving them the glasses, not just letting them try them out.” Nicole tells me. “When it hits them that they can take them home to keep, their faces just light up.” Her sister Dana nods. “It's so exciting to see the kids reading the letters. They just grin and want their pictures taken with their new glasses on. I'm so thankful we're able to do this.”

I’m also personally thankful for Mission Vision. Because of this organization, I am able to fulfill a promise to a dear friend of mine, named Alvero. Let's say hey to Alvero...

Hey Alvero!

I first met this man last November while in Nicaragua as a student with my class. He was the father in the family assigned to me and my teammate Ashlee. Here we are all together in the barrio last November.

Throughout that week of working with his family, it became clear to Ashlee and me that Alvero was stuck in a pretty desperate situation. After losing his electrical shop to financial failure, he was forced to move his family into the barrio where they struggled to find enough money to feed their four children. Alvero also had issues with his eyesight, having a very lazy left eye. A pair of eyeglasses would not fix this issue, but they would make it easier for him to continue his freelance electrical work. Ashlee and I did find him a pair before we left, but when I returned to shoot the RMU commercial in July, Alvero brought sad news. His glasses had been broken when he was chased home by a gang soon after we left. He was back to square one. 

So I promised him we’d figure something out. And today, I'm happy to tell you that Alvero walked to the clinic with me to be properly screened for his vision. He walked home with a new pair of glasses, and a spare pair, just in case. He's just one of the nearly 200 people in Nicaragua who are seeing much better tonight, thanks to the wonderful work of the Spelllman twins and Mission Vision.

To learn more about how you can change a life like this little guy through Mission Vision, please click here.

You'll be glad you did.  

Monday, November 22, 2010

Once More Into the Breach

We’re late. Again.

Dr. Ross makes it a common joke in the van, the fact that we are always running on “Nicaragua time." This means we’re chronically late for everything, usually by at least an hour. For Americans who are used to getting where they need to be exactly when they need to be there, this can quickly grow frustrating. Flexibility is the name of the game in developing countries. Today, it’s the visit to UPOLI that holds us up. There’s a lecture for us this Monday morning that gives us a general synopsis of the current state of Nicaraguan healthcare. It’s interesting, but time-consuming nonetheless. 

Tardiness, however, works to my advantage this morning. It allows for an unforeseen reunion with a good friend of mine and many others. As I walk out to the bus for the ride to the barrio, his familiar face pops out from behind his white van. It’s our faithful UPOLI driver, Don Pedro!

I begin relaying the half dozen messages that I've been instructed to pass along to him by my classmates from my last trip. He asks about the RMU nursing students, particular Megan, who rode in the front seat with Don Pedro last year. For ten days, the two of them had attempted to cross the language barrier by coming up with some sort of code language. Don Pedro still knows all their catch phrases.

Finally we are under way toward our adopted neighborhood, the Anexo Villa Libertad barrio. The van stops outside the clinic and after brief instructions, we head out on foot. The streets of the barrio are already well baked by the sun when we begin our hike. We are going to be working in an area of the barrio that I haven't been in before. After walking a few blocks from the clinic, we have to cut off the dirt road onto a path to reach our family's homes.

The path takes us along the edge of a small ravine, overgrown with weeds and filed with the ever-present stench of rotting garbage. It's a dirty area, but there's a silver lining to be found in the abundance of foliage that blocks the sun's harsh rays. 

When the students arrive at their families' homes, there is that general sense of first-day apprehension. Some are better at hiding it than others, but every nursing student knows that feeling. You're about to enter someone else's life. You're on the verge of inviting yourself into a stranger's privacy. It's your job, yes, but it's also a privilege. From time to time, it makes all of us antsy. Today's nervousness is particularly acute, considering our patients today don't speak our language and their lives play out in tiny houses smaller than our bedrooms at home. Just looking around can easily leave you feeling overwhelmed in a foreign world...

But knowing all this, each one of them bravely stretches out their hands with a greeting and press once more into the breach. They have a job to do.

The students had the opportunities to meet their families on Friday before we left for the mountains, but it was only for a brief introduction. Today they will be spending the morning in their families' home doing assessments, conducting interviews, and providing as much education as they can. Fortunately for the nine undergraduates on this trip, we also have the added resource of six DNP students from the RMU doctorate program. On a typical trip, Dr. Ross is needed in a dozen places at once to answer questions, but this time, with these DNP students, his job is a little easier. All of them have clinical experience already, so they are able to team up with the undergrads and assess families together.

So everyone has their family assignment for the week. Everyone except me, that is. 

I'm not really functioning as a nurse this time around. For my fourth trip, the RMU ChangeALife team has tasked me with my dream job. This time, I get to be a photojournalist. My primary task is the creation of this blog you're reading. So as the students begin to delve into their family assessments, I wander from house to house with my camera, listening and watching, sometimes jotting down notes to remember later. 

In some homes, there are babies with very young mothers. In others, there are environmental hazards. As always, there are problems just about everywhere for us to address. But regardless of their issues, all of the families react the same way to our arrival. Always to my amazement, instead of hiding away suspiciously in the shadows, they take the students by the hand and lead them into their yards. They pull what furniture they have out from their dwelling so that we may all sit. They usher us into their homes in a fashion that is sadly lost on our American culture, in ways that we frankly don't deserve.

One elderly gentleman, a grandfather, catches my attention. He not only welcomes these complete strangers into his home, but also insists on cutting up oranges for his new guests. We are all too touched by his generosity to refuse them. These oranges are from his own food supply, which is already scant to begin with. His hands, worn with age, are as beautifully crafted as the ripe fruit in his hands. In an attempt to thank him for his generosity, I ask him to pose for my camera. The old man grins and stands perfectly still for me, his hands open and welcoming. 

It's the sweetest orange I've ever tasted.

I have a bit of a unique perspective, being an alumnus of this experience, and I have to smile as it all begins again for a fresh group of students. They don't quite know it yet, but for these college kids, the change is already happening.  Right under their noses, little pieces of their hearts are being stolen away by the looks of children who spy on us from the gates of small shacks. 

It probably won't hit the students for a while yet. It may not be until the end of the week, or maybe not until they return home to their own families for Thanksgiving holiday. Or perhaps it won't happen until years down the road.  But sooner or later, they are going to look back on these first few moments on that hot Monday morning they spent in Managua. And that's when they will realize something special...

...that they were in love with the people from the start.