La Uva, Nicaragua

La Uva, Nicaragua

In November, 2012, The Human Path and a local area charitable organization sent a team of 13 herbology and primitive engineering students, a few translators, organizers and logistics folks to two remote towns in the hills east of the Pacific Coast of Nicaragua: La Uva and La Novia. The trip took a total of 10 days, but due to the time it took for travel, a little less than 3 of those days were actually spent running the herbal clinic, creating a slow-sand filter and a rope pump, teaching sanitation and much more.

The rest of the time was spent traveling to and from (which included plane, bus and on foot), all the setup and tear-down, as well as a couple of fun days hanging out at the beaches around San Juan and Playa Gigante, swimming in a lagoon inside a volcano (Laguna de apoyo), rappelling, zip-lining, acro-yoga-ing, and generally decompressing a little for the whole crew after all the work they did to make this happen.

This was a very intense week with a lot of work involved. Everyone worked 12-15 hour days for the majority of the week, and we were living under fairly austere conditions. We had to constantly keep our own supply of filtered water going both for ourselves and the clinic – using our personal water filtration and containers we hiked in. We had to set up the clinic, the pharmacy, the massage and the ultrasound areas, a solar shower, our own hammocks out in the woods (lots of thorns and some very aggressive ants!), be at least somewhat aware of security issues, haul materials around and figure out ways to cut through thick, food-grade plastic barrels, cut metal, fasten metal, etc., without the use of anything beyond hand-tools that we brought in and that were readily available in Nicaragua.

Additionally, we had to teach everything that we were doing. The whole point was to teach self-sustainability rather than to walk into an area, unpack some ready-made, pre-fabricated equipment and set it up, throw some anti-biotics and steroids at the health problems and walk out leaving the local residents no better off and more dependent on a system that is in no way sustainable for them or for us.

Following is a brief overview & after-action report of all the aspects of the 3 days spent working in La Uva, setting up and running an herbal clinic, creating a slow-sand filter and a rope pump for the village well, and teaching local children.

Purpose

Before getting into the details, it’s important to iterate the vision and purpose for this trip. The goals we wanted to achieve were:

  1. To help the Nicaraguans in rural areas aware of self-sustainable possibilities for their own medicine, sanitation and clean water supply.
  2. To prove my “Herbal Medic” concept: Namely that a team of trained students who have experience and skills in primitive survival, plant medicine, off-grid engineering and functioning in a post-disaster or remote area as a team, can “rough it” under some basic hardships and physical exertion to bring this kind of self-sustainability to a community to share and build together. This is following the Special Forces (Green Beret) model that is my own background, and that I feel works very well for this type of application. Teamwork, positive attitude, skills ranging from medicine to security to survival to engineering to teaching, and some physical conditioning to put up with moving ourselves and supplies over rough terrain, working long hours and having to do a lot of general physical labor.
  3. To learn from a remote community while teaching what we can, thereby creating an extended community and valuable learning experience for both them and for us.
  4. To provide training and experience for Human Path students studying core specialties (“Pathers”) so that in a post-disaster setting here at home, or anywhere they might find themselves, they will have actually experienced real-world problems and real-world solutions, rather than just learning and practicing in classes or even scenarios.

This process involved 3 main areas: An Herbal Clinic and Herbal Education, Education for the children (hygiene, sanitation, clean water, etc.), and of course the off-grid engineering tasks of building a slow-sand filter, proper drainage and a good rope-pump for the community well (which was a hand-drawn, bucket well). For right now, I am going to focus on the herbal clinic portion, and will put in the primitive engineering and teaching portions later.

Herbal Clinic

Based on the previous years of experience in this region and input from Missions of Grace, as well as having worked in an allopathic clinic the previous year in the same district, I had some anticipation of the types of chronic health problems we would most likely encounter. Most of these health problems are directly related to culture, lifestyle and environment.

Table 1.0 below shows the health problem, most likely source as well as the approximate percentage of clinical patients who had these problems during the 3-day clinic. The total number of local residents who showed up for help at the clinic was just under 200. The total number of health issues addressed using herbal formulas was around 350, counting tinctures, salves, tooth powders, ear oil, etc. There was overlap of health issues across at least 50% of the clinic visitors (for example patients who had both kidney stones and gallbladder issues, or musculo-skeletal and GI, etc.).

Table 1.0: Some of the Most Common Health Problems and Likely Sources in the Rivas “departamento” (District) in Nicaragua

Health Problem Source Approximate % of Clinic Attendees with this Problem
Kidney Stones Water Quality (My opinion: Salt water on one side of the ecosystem, Volcanic soil
on the other side, and sugar cane fields with multiple agricultural toxicities,
leaching into the very hard ground-water in between)
30%
Chronic Biliary Colic & Cholestatis Again in my opinion, this is related to water quality and general hygiene as well,
secondary to the fact that the liver is so overtaxed in dealing with both natural
and environmental toxins in the water.
30%
Urinary Tract Infections Mostly general hygiene for the women (probably E. coli). Possible STDs for at least
some of the men. Also may be secondary to upper and lower urinary tract irritation
in the case of kidney stone formation.
25%
Gastro-Intestinal infections (bacterial, protazoal and helminthic) Hygiene and Water Quality 25%
Chronic Musculo-Skeletal Injury & Inflammation, Osteo-Arthritis, Repetitive Motion
Syndrome, etc.
Difficult and repetitive manual labor (swinging a machete with the same arm, 6-7
days a week for 30 years, or hand-washing clothes on a washboard for the same amount
of time)
25%
Upper Respiratory Infection and/or COPD Cooking indoors over a fire with no chimney 25%
Chronic Dyspepsia Probably related to the chronic biliary inflammation either secondarily or as a
pre-cursor to the same (sluggish gall).
20%
Nutritional Deficiencies, Anemia, Fatigue, Hair Loss This was generally seen in mothers who were, in my opinion, not getting enough protein
and had a diet that was lacking in many of the B vitamins as well as other micronutrients.
20%
General Cold and Flu, Malaise No specific, apparent cause, other than exposure to a pathogen and likely a weakened
immune system
15%

Herbs and Preparations

All herbs to be taken internally were prepared using alcohol tinctures (Mostly maceration, some percolation) starting in spring 2012 and continuing literally through the last day before departure to Nicaragua.

Most of the herbs used were either ethically wildcrafted from the Central Texas region or grown in my own medicinal garden. All the rest of the herbs were bought in bulk from Starwest Botanicals. A list of all the herbs and formulas is located HERE. Sorry it’s not alphabetized. I tried to take about 16 ounces of every tincture. 32 ounces of Algerita – because from experience I knew we’d use it. I made some mistakes on the amounts (ran out of a few things) and will address that at the end of this section. I used the 16-ounce, Nalgene bottles and they worked very well. All tincture formulas were mixed in the pharmacy using graduated cylinders, etc., and the final product was put in a 1 ounce, nalgene bottle for the patient.

Containers

The containers used were Nalgene, narrow-mouth, leak-proof containers. I get them from Freund Containers, and after many years of using and comparing them with other types of containers for tinctures, I use these Nalgene bottles exclusively. Although they are a little on the expensive side (around $1 each for the 1 and 2 ounce), they are well worth it. They last forever, are lightweight and I have kept tinctures in these kinds of containers for 2 years without any noticable degredation in quality.

As you can imagine, using glass containers or rubber droppers is out of the question. Breakable, heavy and the rubber part of the dropper degrades very quickly outside.

Two droppers (about as much as you can get from a normal squeeze) fills half of a narrow-mouth cap of a 1-ounce or 2-ounce, nalgene bottles. So all directions concerning the amount to take of any tincture, was based on the capful (e.g. “1/2 capful twice a day” etc.)

Education, Intake and Assessment

We saw almost 200 people in 2 1/2 days, so there was not a lot of time to spend on each individual patient, but we broke into as many small clinic stations using school desks, as allowed with the translators and bi-lingual students we had available at any given point in time (usually 2, sometimes 3 stations). I roamed around the clinical stations and helped direct SOAP questions, helped with objective measurements like BP, breath sounds, abdominal exams, temperature, etc. where appopriate, asked questions of my own, discussed the case with the student a little and then gave the final assessment/formula, or a referral in the few cases we were unable to do anything for.

Prior to their coming into the clinic, the local residents who wanted clinical attention were required to take a 30 minute class that was an introduction to herbalism and local medicinal plants. We had a wonderful, Nicaraguan, natural doctor who gave these classes and then ran her own clinical station also when she had time. She and I discussed her cases and came to formulas as well for her cases, using the herbs I brought down.

We had an ultrasound machine available with an area set up to use it, but power was limited. In the case of urinary stone symptoms (which are so common they actually have a single word they use to describe it, similar to the way we say “the flu”) – especially those cases that seemed more severe, we took ultrasounds. Apart from 1 person, the stones measured 5mm or less in all cases, and I felt very comfortable with an herbal formula to relax the ureter and help flush the stone (usually Lobelia inflata, Eupatorium pupureum and Taraxacum officinale).
A few people returned with more family members day 2 or day 3. One returned with a child who had gotten better very quickly (fever) from the formula they received the day before, but had developed a cough that they wanted herbs for as well.

Additionally, we had a massage area set up, and Suchil (my wife) worked on musculo-skeletal issues pretty much non-stop during the first 2 days.

After being in the clinic, patients went to the pharmacy with their SOAP notes & formula, and turned it in there. Students mixed formulas, created labels with both the correct Spanish instructions as well as a pictographic version that was shown to us by the local MINSA (Ministry of Health) health care worker (sort of the equivalent of a Nurse Practitioner here), who was with us (and who was a wonderful help in many ways).

During the consultation, students also told patients about the fact that these were natural remedies and plant medicine and that there were factors causing the illnesses (in so many cases) that were related to the bad water and poor hygiene around the water areas.

My goal in this was not to “convert” everyone to the concept of self-sustainable medicine through the use of herbs in 3 days. Rather it was to assess and help as many people as possible, giving them a chance to use tinctures or salves and see for themselves how plant medicine works. That is the first step in learning about herbs. Use them on yourself and then when they work, there is a connection that has started. That connection is strengthened every time a person uses an herb to help their body heal. After that connection grows strong enough, people want to know more. They want to learn, at which point it is possible to teach them much more successfully than just standing in front of them and claiming that herbs do this or that.

Herbal Clinic: Lessons Learned

  1. We ran out of 1 ounce bottles (we took 300) and had to clean out some empty 2 ounce bottles to supply the tinctures we needed to supply.
  2. We could have easily used twice as much of the relaxing expectorant formula.
  3. We needed some good nutritive-type herbs, like alfalfa, red clover, nettles leaf etc. Incidentally I brought nettles root which I was able to offer for a couple of cases of BPH, but totally forgot to bring the leaf.
  4. We needed more pain and inflammation type herbs to blend. Salix spp., Spirea, etc., would have been useful. I had one such formula, but only had about 4 ounces of it and ran out the first day. Fortunately I had a lot of sprain/strain salve with topical analgesics in it, as most of the pain was musculo-skeletal.
  5. There were several complaints of frontal-lobe type headaches (tired, sore eyes and headache).
  6. More nervine formula (ran out and still had people who needed this one).
  7. We need to incorporate more herbal clinic & pharmacy practice in the Level 1 Herbal Medic class (actually we already have changed that, but all of the students on this trip took the older version of the class w/o the clinical scenario at the end, and all the additional case studies, clinic walkthroughs, etc., that are part of the program now).
  8. More of every tincture. We ran out of almost all tinctures by the end, but were able to substitute and send everyone home with what they needed, aside from nervine and relaxing expectorant.
  9. We needed a primary and an alternate herbal medic to focus on any sick members of the team. Several students got the start of some type or another of a GI illness. Those that were on top of it and started taking Algerita as soon as they felt anything out of the ordinary, never got sick. One student got very sick, and I should have given him an intense, anti-bacterial formula, but was too distracted by the needs of the clinic to actually be able to focus on what was wrong with him like I should have.

Herbal Clinic: Where to go from here?

This trip was a beta test (or even an alpha test) of the concept of The Herbal Medic, and as such, it was a huge success so far. However, there is a lot of feedback pending. Specifically regarding the efficacy of the herbal medicine and the local perception of herbal medicine because of it. I had to run the clinic like an allopathic clinic because it was a huge number of people, very long days, and very little time to spend on the finer and more important aspects (sometimes) of holistic care. Instead of using pruning shears, we went in with chainsaws. We hit the biggest health concern – the water, and we gave herbal formulas to a huge amount of people.

We have a person on the ground who will be able to give us feedback and let us know as word comes back to us. I know we helped some people, but I would like to know we helped nearly everyone. However, I had to be careful with some dosages and err on the side of caution. So did my formulas and amounts work across the board for every case of urolithiasis? UTIs? URIs? Only the feedback over the next few months will tell me this.

All in all the community aspect of this was huge. We pulled our two groups together and got to experience growth for everyone on many levels. The community leaders were very happy. They have clean water and a working pump. They (hopefully) have some or maybe many people who are more confident now about the effectiveness of herbal medicine, so that it makes it much easier next time to start talking about the local medicinal plants and how to use those.
I will probably be traveling back down, to the opposite coast, in a few months.

Our goal as a school and through the new non-profit (Herbal Medics) is to continue annual trips for 1st year pathers (those who haven’t been on a trip like this yet), as well as begin to form a more advanced, smaller team of herbalists, scouts, engineers and hunter-gatherers for more advanced and difficult locations. I want us to cook our own food (rather than hauling in food for them to cook for us like we did this time) and teach food preservation and guerrila gardening, vermiculture, BSFL, raised beds (the soil is pretty bad for gardening in many places), and much more. They don’t grow their own food, and I think that would help them immensely. For instance, smoking their own meat would allow them to get a lot more protein in their diet on a regular basis.

There are many more things to go through, but this is a small sample of the types of concepts and ideas we will be kicking around among the leadership team over the next few months as we line up the 2013 schedule on which I would like to have at least 2 total school trips to Nica in one area or another. On top of that we have places much closer to home to do the same thing… such as the Colonias on the border.