¡Salud!  Espero que Uds. estan bien.  Estoy muy cansada ahorita.  Hice mucho calor hoy, y no viento. Ayer, el viento le ayuda el tiempo a sentir comfortable.  Pero, no lloro :)  Tenemos algunas pacientes interesantes hoy- una  jovena que tiene Bell's Palsy, un hombre que tiene cólesterol muy, muy alta- el nivel fue 702.  Recibió una receta para Pravastatina, aspirina, y una referida al cardiológo. Además, recibió educacion de viviendo saludable. No tenía obesidad- solo un poco sobrepeso, pues, la cólesterol problamente esta parte genetico.  Ayer, envíamos al hospital un hombre que tuve presion arterial alta- 160/120 al brazo derecha y 172/120  al brazo izquierdo y dolor de pecho.  Hoy, regresó a la clinica mejora. No tenía infarto o otros problemas. En hospital, hayan hecho electrocardiograma, hayan sacado sangre, y le hayan dado medicina, pero el no pudo a contar cuales medicinas o resultados ha tenido. Pues, sacamos mas sangre a cheqear la colesterol y triglycerides. Fue alta, y recetamos para Omega-3 porque no quiere a pagar de Pravastatina o otros medicamentos.  Aun cuando la clinica tiene bajos costos, no son bajo por todo.  Algunas pacientes no quieren a pagar mas para laborotorios o algunos medicamentos. No todos laborotorios o medicamentos estan gratis aqui, pues a veces se siente a poco a la sistema de la salud in Los Estados Unidos.  Algunos pacientes no dicen que nuestra clinica no es cara, pero algunos tienen ansiedad de los. Costos son importante. 

En comparación, los cargas de un pocos otros hospitales privados son eso: a dos, Ud paga 552-575 cordobas por consultación emergencia. No incluye otras necesitas. Al otro la carga es dependiente en nivel de consultación: 690- 1610 cordobas. Pues, 50 cordobas a Amos Esperanza y Salud es bien.  No se las cargas de otras clinicas. 

Continuamos a trabajar en Español. Continuamos aprendiendo. Dra Gonzales es muy bien- nos ayuda cuando la necesitamos.

En Ingles:
So- today was hot!! and interesting.  We had some patients with some pathologies- a young girl with Bell's Palsy, and a middle aged man with a cholesterol level of 702. There is not a lipidologist here, so we are starting him on pravastatin, aspirin, and sending him to the cardiologist. He is not terribly overweight, so there it probably has a genetic component.  Yesterday, we sent a man to emergently to the hospital with  hypertensive crisis: 160/120 in the right arm & 172/120 on the left.  He returned today- said that he did not have an MI- and also that they ran an EKG, some labs, and gave him some medicines, but could not remember any results or what the meds were. He was better today, so we checked his cholesterol & treated the elavation with Omega-3 Fish oil, because he did not want to pay for Pravastatin. Which leads now into the economic discussion:  although Amos is a low cost clinic, it is not low cost for all.  We have had some patients tell us how reasonable and low the costs are, but some are very concerned when they have to pay for some meds & lab services. Not everything is included in the consult cost.  It is similar to the US- cost is really important.

In comparison,   at a couple of the private hospitals, it costs any where from 552-575 cordobas (C$) ( I am using cordobas, because if I were Nicaraguan, that is what I would be paid in.) to have an emergent consultation. Another's charges depend on the level of consultation, and range from 690-1610 C$.  So, the 50 C$ at Amos is pretty low, although I am not sure what other private clinics charge.  To be fair, the MINSA hospital will see you emergently if needed without charge, but you will pay for other items, as noted before. So access to health care is still an issue here- and not only from economic issues, but also geography.  Matagalpa, Jinotega, and the eastern side of Nicaragua have the lowest access rates due to lack of clinic and provider availability. It is difficult to access health care if there are no providers near you.

In conclusion, I'll leave you with a poem written by Javier Campos, called "Return to Sender"  It reflects that although the streets have names here, they are not posted.  It is amazing how people learn how to get around.

Return to sender (Managua, Nicaragua Postal Service) I

Turn at the corner known as “gallo más gallo”
2 blocks toward the lake, and at Doña Blanquita the Belle’s house
look to the right and up a little
as toward the sky and then lower your gaze to the tree charred
in the earthquake, right there where
Don Francisco props himself up in the window to talk
with Pedro Xavier and that Gloria girl,
at the next house take just three steps,
knock on the door where there’s always a rocker,
and deliver these poems and this letter, please.
And if nobody takes them or the person whose name
is written on the envelope is no longer living,
return to where you came from.
Go slow, looking over your shoulder,
who knows if the address is right,
and perhaps someone will ask you, Mr. Mailman,
who are you looking for to these many hours in this neighborhood
in Managua?