Health and Health Care

This will be a relatively brief post because, thankfully, I have been very healthy during my stay so I have not had any direct experiences with the health care system—my experience is all as on outside observer and I hope to keep it that way.  Last May, however, I suffered a bit from “intestinal distress,” but was able to take care of it by simply visiting the pharmacy.  Many drugs that are by prescription only in the US can be sold here by pharmacists (I should probably say by pharmacies, because I don’t think the people I’ve talked to were actually pharmacists) without having to see the doctor first.  I received a course of Cipro, an antibiotic; along with instructions for use and the bill was C$18—a bit over 80¢ US!  It worked well and I was able to comfortably survive the bus trip back to Managua.  After checking with my doctor at home, it is exactly what he would have prescribed.  (In fact, he did prescribe it for me to take on this trip…just in case.  That cost $5 in co-pay for the drug and I don’t know what for the office visit since the insurance took care of that.  Even though it is cheap to get here, it is still good to have it in hand since even a 25-minute bus ride to Ocotal can be agony under the wrong circumstances!)  Pharmacies, supermarkets and pulperias also carry standard over-the-counter remedies available in the US:  Tylenol, aspirin, Pepto-Bismol, etc.

This how a  typical pharmacy looks from the street, although some are even more walled-off with only a small winder to talk through.  If the resolution were better, you'd recognize products and even brands that are familiar in the US.  Note on the left that this pharmacy also has a motorcycle parked inside.

In Sabana Grande, there are no permanent doctors, but there is a health center (I think just an office location, but without equipment) that has office hours by a doctor one day per week.  I believe that every weekday there are at least some hours by a nurse of some kind (not sure if LPN, RN, or nurse practitioner).  Additionally, there are several women in the community called “brigadistas” who have some medical training and are on-call for emergencies.  I imagine the training is more akin to wilderness first aid or responders than to EMTs, and probably has a fairly strong emphasis on OB as well.  There are also some folks with a modicum of training in the pharmacy area who can dispense some remedies and advice.

Centro de Salud in Sabana Grande.  It’s located near the big Ceiba tree in triangle intersection of streets (but remember that "street" does not imply as much as does in the US), so it's more of less in the center of the community.

Here is where you can buy some medicines.  (It happens to be where William stayed 3 years ago.)  The sign on the right simply advertises that medications can be purchased here and on the left is a poster promoting immunizations.

 

Totogalpa has a small hospital and, of course, Ocotal has a somewhat larger one, and Estelí a larger one still.  There is some ambulance service since I have seen them parked at hospitals and occasionally on the highway, but most people would go by bus or, if it’s really urgent, by taxi.  The ambulances I’ve seen are smaller SUV-sized vehicles rather than the stand-up, rolling, mini-emergency rooms like in the US.  In larger places, one can find private practices in various specialties:  pediatrics, OB-GYN, GPs, dentistry, etc.  These are scattered throughout and for the most part appear to be offices in the physician’s residence, rather than a separate, dedicated office.  When office hours are posted, the often include Saturday morning in addition to weekdays.  (The one’s I’ve paid attention to have not had particular morning or afternoon off, so I don’t know when doctors here play golf.)  As is the case in the US, progressively larger cities have corresponding more extensive medical services;  and places more remote than Sabana Grande will probably have even fewer service.  (You may recall in an earlier post I mentioned one of the projects underway at the Centro Solar is a solar autoclave targeted as some of these very remote locations.)

Totogalpa hospital.  Totogalpa is probably about the smallest-sized community In which you’ll find a hospital.  It is located directly on the Pan-Am Highways, which has been true of all the hospitals I’ve seen except for Ocotal.

The hospital in Condega.  Note that the gate is closed to cars and open to pedestrians.  The expectation seems to be that people will show up on foot, rather than in a vehicle.

The Ocotal hospital.  It is located on hill near the center of town.  From the outside it doesn’t look too bad, but the med students did not give it good reviews.

The hospital in Estelí.  (This is the one next to at least 2 funeral parlors.)  The sign on the left says that “In this hospital, we don’t charge for any services to the patient.´ (Of course, it has the Spanish double negative that I still find superfluous, if we translated a bit more literally, it would be “…don’t charge for no services…”)

For a couple of weeks, 3 medical students from UC-Davis were housed in Sabana Grande while doing a practicum in the area.  According to them, this is not a good place to be if you’re sick or especially if you require surgery.  Their instructions to each other in case of dire emergency was:  1)  give Vicadin and 2) get them on a bus to Managua.  They don’t like the hygiene, they don’t’ like the equipment and they really don’t like how frequently and freely antibiotics are given out (e.g., my story from last May).  On the positive side, services at public hospitals are provided without out-of-pocket costs.  In Managua, León, Granada, etc., there are apparently also private facilities with quality and practices more akin to those in the US or Europe.

It is interesting to me to see how much herbal/folk remedies are used in the community here.  Perhaps this is in part be due to living in a community where there is a general emphasis is on a natural, sustainable lifestyle, but it appears that there are many locales throughout Nicaragua that are of a similar persuasion.  It may also stem from an indigenous/folk influence and be more prominent where indigenous culture is more prominent.  I already mentioned the herbal medicine research organization in Estelí in another post, but Ocotal has at least one store dedicated to herbal remedies and even the ordinary supermercado there carries 4 brands of fish oil, including Nature Made, a brand that I see in Platteville.

An herbal medicine/remedy store in Ocotal--Botanical Marvels..

In terms of the observed health of the people, it is hard for me to say exactly what the situation is.  The people I see and interact with are all healthy and thriving and there are quite a number of fairly old folks who are still spry enough to walk a mile or so to the highway and climb up the non-ADA-compliant bus steps.  There are many kids around who also seem very healthy.  The med students said that for the most part, they saw infections of various sorts when they visited clinics/hospitals and also quite a few dental problems (which of course they couldn’t do anything about).  They also saw a number of chronic problems, like diabetes, that were not being managed very well.  In fact, the gringos appear to have the most health problems, but mostly related to minor gastro-intestinal problems (The CELL group that was here had 7 of 12 afflicted with intestinal maladies, but nothing that was completely debilitating.).

To get some idea more globally of how the health of Nicaraguans is, I did a brief search on-line to see what the statistics say.  In terms of life-expectancy, a typical Nicaraguan can expect to live 71.9 years.  This ranks about 129 out of 220 countries listed, so about the 42 nd percentile.  For perspective, this is a longer life expectancy than Russia and about the same as Turkey, Peru, Egypt and the Philippines.  For infant mortality, Nicaragua ranks a bit lower at 133 out of 220, clustered again with the same countries.  What I can’t say is if the statistics reflect more on the state of health care system or on the state of transportation/infrastructure so people can quickly and conveniently get to medical care.

Totogalpa

On the way home from another of my vagabonding trips, it occurred to me that I’m going to all these “far-away,” exotic places and that I had never been (except on the bus, of course) to the nearest city, Totogalpa.  Actually, thinking of this as an excursion is a bit of a misnomer, since I live in Totogalpa. However, I live in the municipality of Totogalpa (probably analogous to a county in the US but smaller) and there is also a city of Totogalpa.  The out-lying municipality is agrarian and is famous for tomatoes, while the city is relatively indigenous in demographic make-up.

The sign entering the municipality of Totogalpa, proclaiming that it is the leader in production of table tomatoes.  This is about 1 km south of the Solar Center.

Since it’s only 5 km, I walked there along the Pan-Am Highway, and as usual was able to observe new things on the road:  a compact pick-up truck loaded with 8 caskets, a truck that was piled 3-times higher than the roof of the cab (I’m not sure how dense the load was, but the center of gravity had to be high!), someone sleeping (at least lying down) on the top of a truck cab…  Upon arrival, I learned that Totogalpa has just over 10,000 residents, about the size of Platteville.  I also noticed that it had a sidewalk along the highway and that it was relatively accessible to wheel chairs—a first for Nicaragua.  The highway passes through the east edge of town and has a few shops, an Assembly of God church, the hospital and a few housing developments.  The site of an ancient village (circa 400 A.D.) has been identified just to the northeast of town, but it has not been excavated thoroughly;  there are plans for a future museum, however. 

Entry sign on the Pan-Am Highway for Totogalpa.  Such signs on secondary roads are non-existent.

A picture of the almost-ADA-compliant sidewalk.  Really impressive for Nicaragua, however.

One thing that’s evident in Nicaragua is that if any progress is made, there must be a sign or a plaque commemorating and honoring whoever was responsible.  Here is a very nice plaque commemorating the building of the sidewalk.  In the background is a new housing development with a standard, basic design.  There are a number of these I've seen in various locales.

As all the cities I’ve visited so far, the church dominates the skyline and sits at the center of town, facing west, with a central park just across the street.  On the way to the church, one passes an intersection with a statue of Mary Magdalene, the patron saint, and a plaque declaring Totogalpa as the “City in the Nest of Bird” and announcing the annual celebration to Mary in July.  It appeared to be “the” place to be on a Saturday morning, with several dozen folks hanging around and the bicycle ice cream vendor more or less parked there.  Arriving at the mid-18th century Church of Santa Maria Magdalena, one sees that it is currently under fairly extensive restoration, as is evident from the scaffolding surrounding the bell tower.  It is interesting that this preservation is funded by the US government to the tune of about $110,000 over the past two years,  (For details, go to:  http://nicaragua.usembassy.gov/nt_1000722_afcp_totogalpa.html)  With the renovation work, it was impossible to visit the interior, but it appears that the sanctuary is still available for Sunday mass.  It

Intersection with the statue of Mary Magdalene.  There are a lot more “loafers” off to the left, along with the Igloo man.

Close-up of the statue.  Note the wire bird’s nest at the bottom to represent Totogalpa as being in the nest of the birds.

View of the front of the church.  Mornings are just not a good time to get pictures of Nicaraguan churches as the there is always back-lighting.

Close-up of the scaffolding on the church tower.  I don’t think this would pass OSHA inspection.

The park was again different that any I’ve seen before.  It was smaller than the others and more dominated by kids’ play equipment/activities:  a basketball court (but with both hoops missing), swings, climbing equipment and a library.  At the center was a statue I presume to be of Mary Magdalene.  (The statue was unmarked and appeared to have feminine features, but it also seemed to have a crown of thorns, so I’m not really sure what to make of it.)  Surrounding the park was what appeared to be a typical mix of shops, although Totogalpa appears “sleepier” that the other places I’ve visited.  However, it may just have a smaller population—cities not on the Pan-Am don’t have nice population signs like Totogalpa.

A view of some play equipment with the basketball court in the background.  The damaged backboard is directly below the street light if you look closely.

I normally don’t like the word “cute,” but I think it’s an apt description of the library.

The stature in the middle of the park—Mary Magdalene…or not.

 

In wandering down side streets, I found the secondary school (where Sabana Grande kids must go after 6 th grade), the cemetery and very impressive, though completely unmarked, religious shrine of some kind.  There was also an interesting a mural or two, something that seems very common as a means of artistic expression here.

A view of the secondary school.  It consists of several building around this central courtyard.  They obviously have some kind of satellite service (or at least did…or at least were intended to have such).

A very elaborate grave for a couple of young folks.  There are even pictures included.

The unknown shrine not far from the cemetery.  It seemed worth a picture even though it had no markings and I don’t know what it’s for.  Somebody was moved by something.

A mural on a downtown building.  The left touts Totogalpa's location on the Ruta Sandino (a tourist-promotional route that traces places important in the life of Augusto Sandino;  somewhat like our Great River Road or Mormon Pioneer Trail designations in the US) and the right side promotes the tomato crop.  Over the door is the slogan “in the nest of the birds.”

The local campaign headquarters for the Sandinista party (FSLN).  Here in the north, I’ve only seen one building used by another party and only a handful of campaign signs.  Note the image of Che Guevara on the left.

The last item is from the guidebook, but I didn’t pursue it since I also wanted to get to Ocotal to do some errands—maybe next time.  Just north of Totogalpa is a mountain (Cerro de las Rocas) along the Rio Coco (the one that goes through Somoto Canyon).  In this mountain is the “Cueva del Duende,” or “Cave of the Leprechaun/goblin/elf.”  The north of Nicaragua is apparently full of legends relating to duendes, a race of small demonic, alien beings who are in league with the devil and wreak all kinds of havoc on good folk, but they are especially keen to snatch babies who haven’t yet been baptized.  If it’s a stand-up-and-walk cave, I might try this before leaving—if it’s a slither-on-your-stomach-like-a-snake cave, probably not!

Final note:  I already disproved my thesis in the “Bus” posting that “there’s always room for one more” as I left for Ocotal.  Only about 10 of the 25 or so waiting were able to get on the bus (and several were on the rear bumper and hanging out the front door.  However, I think that bus was very late (and hence fuller than usual) as the next bus came within 3 minutes and was relatively uncrowded.  I bet, though, if this had been on a route with only 1 or 2 buses a day, we would have somehow all fit in (or on).

Language (i.e., Spanish!)

I think I have enough observations about trials and triumphs with Spanish (more trials than triumphs!) to justify a post, however, you’ll note that there will be no pictures (spoken words are hard to photograph and don't make very interesting photos), so this may end up being a bit duller than the rest. Written Spanish here seems very similar to the Spanish I studied the past few years and is relatively straight forward.  I have little problem understanding 80+% of most things I read, even without a dictionary, and a few key definitions are usually all it takes to comprehend.  Perhaps this is because of the relatively low average level of education, so signs, notices, etc., are written very simply, but in any case, I feel pretty good whenever something is in writing.  One place where I sometimes have difficulties with written, as well as spoken, Spanish is with the many plants, animals, foods, customs, etc., that I have no knowledge of, so there are, of course, new names for all of them.

Orally, I still struggle to speak at anything like a normal speed and arrive frequently at “road blocks” where I find myself at a loss while searching vainly for either the right word or some way to work around the right word.  I do feel I’m making progress but am still far away from thinking in Spanish.  I’ve made a couple of presentations about the designs I’m working on and attendees seemed to understand everything (and politely complement my abilities).  I also work side-by-side the locals daily and am able to ask for things and give information relatively easily.  There has even been a time or two that I’ve actually said a sentence or two with some modest fluency!  I think at least part of the problem is that it’s so long since I last learned a new language that I forget the struggles that I went through at the time.  (Although a petrifying brain may also be a factor!)

Many times I sincerely regret not having at least an introduction to Spanish when I was much younger.  I think that even if not used, having a language simmering in your subconscious is a tremendous advantage.  After years of limited practice, I find German words (and even French) popping into my head (if not my mouth) frequently when the Spanish word is not immediately accessible.  In fact, when caught off-guard a few days ago, a simple thank ended up as a stuttered D(anke) followed by M(erci) before finally arriving at Gracias.  I can’t tell you how many times that I’ve had to stifle a “gesundheit” before pulling a “salud” out of the next layer down in my brain.

 Even though I feel relatively comfortable communicating my ideas, there are also times when my Spanish is cause for great amusement.  I think I already wrote about the religious “salvation” of a piece of broken glass earlier.  My latest gaffe illustrates the problems with pocket-sized dictionaries.  One of my side-projects right now is installing some support struts in a couple of buildings, so I looked up the noun “support.”  The dictionary gave the word “sostén,” so I started using it for those struts as well as any other support piece on solar cookers or elsewhere.  Finally, one of the women pulled me aside and politely told me that I was actually describing a piece of women’s underwear that does, indeed, support, but it wasn’t the word for a support strut—and then we all started laughing.  Fortunately, Nicaraguans have a great sense of humor…

Aurally, however, I’m somewhat frustrated and seem to have made almost no progress with Nicaraguan.  I’m using the word “Nicaraguan” here in lieu of “Spanish” because, unlike the written language, the spoken language seems to have little resemblance to the Spanish I heard in class and on recordings.  (To my ear, anyway, Nicaraguan seems related to Spanish as Bavarian or Swiss German is related to standard German—although I don’t think it’s not quite that bad.)  Part of it, I’m convinced, is simply hearing deficit—I don’t hear nuances well and background noise is a disaster.  I’m trying to set up some lessons a couple of times a week to see if I can’t make some more progress with the local idiom before I leave.  Just today was a very illustrative example.  I was leaving for the morning to explore and my host family asked when I was going to return.  I didn’t understand at all and said so.  It was then repeated in Spanish that was completely clear and easily understood—I still don’t have a clue as to what was said the first time.  Another often-repeated example is the phrase “Que le vaya bien!” which means something like “may it go well with you.”  This is not an uncommon greeting and I hear it frequently, but there are times that I’m sure that’s what they are saying, but I’d never know from what I hear!  I think another contributing factor to my difficulties is that most folks here have a limited formal education and don’t have as many ways to rephrase the same thought, so they tend to simply repeat what they said the first time.  This often doesn’t help me much.

There are, of course, a host of slang expressions that show up in speech but are typically absent from writing and these are generally fun to learn (but I sometimes wish there were fewer!).   Also, word use can vary a bit from the Spanish I have learned.  For example, a number of food items have familiar names (empanada, tamale), but the versions here are unlike what we are familiar with.  The word for balloon that I learned was “globo,” while in Nicaragua it is “chimbomba.”  The word I learned for turkey was “pavo,” but here it is “chompipe“.  While perhaps annoying to a foreigner, these are similar to the differences between US and British English and I can cope which these fairly easily—in fact, many of these kinds of differences are very fascinating to learn.  

Before arrival, I was worried a bit by the vos form (a familiar form that is equivalent to tu).  Not only do I not know the vos conjugations, they don’t even show up in the on-line dictionary I use.  That, however, has not been as issue at all for two reasons:  1)  I don’t try to use it and 2) it’s a relatively easy form that is very regular.  My number one issue with comprehension is probably the frequent (seemingly almost universal) dropping of the letter “s.”  (There seem to be a few other consonants that soften, if not disappear, but my comprehension is such that I can’t figure out any patterns.)  Even a word I know very well, like “fiesta.” completely stumps me when it shows up in a sentence as “fieta.”  “Uno, dos, tres” becomes “uno, do, tre;” “Las Manos” (a town on the Honduran border) becomes “La Mano;”  and the here ubiquitous “adiós” (which means hello as well as goodbye—it’s the standard greeting when meeting someone on the street) becomes “adió.”  

In short, I can function reasonably well, but was hoping for a bit more progress, particularly in the comprehension of speech.  I still have about 7 more weeks, so I guess there’s still hope!  The process, though, has always been fun, even if a bit frustrating.  

So, adió for now!

Latrines!

Finally!  Here is the much-anticipated post with a review of latrines of Nicaragua (and also a few toilets).  It’s a bit hard to do in-depth critiques (like Sarah did for our Olympic Mountain trip) because I was not able to personally experience all of the latrines that I’ll be showing /discussing—one can’t just walk into someone’s yard and try out the facilities.  Also, there is a good deal of standardization, so the rating would depend more on maintenance than design.  So what follows is more of an overview of latrines by class, rather than individual ratings.  Sorry to any who were hoping for rankings of 1-5 toilet paper rolls.

In cities:

If you arrive in Nicaragua at the Sandino International Airport and visit the facilities (VERY recommended if you’ll be directly catching a bus to anywhere), you may not even detect that you’ve left the US (except that it will be 90°F and there will be no air conditioning).  The facilities there are equivalent to a modern building at home.  Managua and other cities have sewer and water systems, although water systems may have much lower pressure than is typical in the states, which makes them susceptible to contamination if there is a leak.  Managua has literally hundreds of barrios which are blessed (or cursed, depending on the barrio) with differently functioning water and sewer services.  Therefore, you may find latrines within the city right along-side sanitary sewer services or even sections with no sewer service.  I’ve not been to other larger cities yet, but I think it’s a safe bet that the poorer parts of town will consistently have poorer public services than other parts (some things appear universal).  Aside from the airport, the UNI (Universidad Nacional de Ingeniería) is the only other place in Managua where I have personal experience and their facilities are also modern.

Other “city” experiences: 

1.       Ocotal (at the restaurant with the Che Guevara manger scene).  The restaurant had a clean rest room with a flush toilet, a urinal, running water in the sink and toilet paper, but the toilet lacked a ring to sit on.  I don’t know if the women’s room was similarly equipped, but my guess would be yes.  The only other unusual aspect of this rest room was the valve on the urinal, which, in lieu of the typical flush lever or button, had a simple PVC ball valve plumbed in and you flushed by opening the valve.  Of course, this means that you have to manually shut off the water or it will continue to run forever.

2.       Estelí (at La Casita Restaurant).  A basic latrine, somewhat dark, but it was set in the beautiful gardens across the creek, so it’s a pleasant trip to get there.

3.       Condega (public restroom in park).  A pay toilet that required C$3 (about 12¢) to enter.  It was clean enough, but had no water to wash—the sign said to wash outside, but there was no water there either.  It did have an interesting nearly bathtub-size urinal.

Massive ceramic-tiled urinal in Condega.

In the country (Sabana Grande in particular):

In the country, I’d guess 99+% of the latrines are simple pits.  When they are filled, they are covered and a new latrine is dug.  So with a few exceptions, the differences between latrines lie in the “amenities” that are provided at the top.  Since the 80s or 90s, various NGOs and development agencies have put resources into latrines (the other major thrust being wells), so most houses now have at least one “standard design” latrine (although there are several “standard” designs depending on when and by whom the latrine was supplied).  For seating, there are a couple of options:  a cast concrete base and seat or a fiberglass seat and floor that sits on a flat concrete base.  Standard latrines also have vent pipes, typically of plastic, from the pit through the roof.  Regardless of seating type, the hole is always covered when not in use by either a wooden or fiber board.  At least some of the standard designs also incorporate latches and toilet paper holders, although toilet paper is generally not left in the latrine, but carried there as needed.

A photo showing the cast concrete version of the seat.  This happens to be in one of the all-steel, painted ones.  You can see gray vent pipe in the back.

This photo shows a fiberglass seat/floor covering housed in a wooden-framed structure with flat galvanized sheet metal.  The roof is regular corrugated roofing.

And some brave folks “don’t need no stinking superstructure!”  Here’s one that Sarah would really like-great view, lots of ventilation!

For the superstructure, one common design uses flat, galvanized, unpainted sheet metal supported by either a wooden or a galvanized steel frame.  Various insects and the weather tend to wreak havoc on wooden frames, so the all-metal designs seem to stand up better. (In fact, the rafters and joists holding up the roofs often need to be replaced at intervals.)  The roofs of the zinc-colored latrines are made of a standard, galvanized, corrugated roofing material (like many of the roofs on other buildings).  The other design is galvanized steel painted/coated to a light blue-green color, but the frame is plain, painted steel, which tends to rust faster.  The steel walls have some corrugations for stiffness, but are not the wavy corrugation of roofing.  The roofs for this design are made of the same coated steel as the walls.

The line-up of latrines at my house, showing examples of both “standard” designs.  Houses frequently have more than one latrine in service, just like houses in the US often have more than one bathroom.  The codes on the door (of the green one) indicate information about the particular project that built the latrine.  This particular one was built in 2005.

Where houses are relatively close, there will be numerous latrines grouped together.  Here again are examples of both standard designs.

It is also possible to find some latrines with non-standard, home-made structures.  Some are very basic and others a bit more sophisticated.  The doors can vary widely from a simple curtain to a finished wooden door.  And occasionally one finds some interesting twist or modification that seems to be relatively unusual.

This is the latrine at the house where I stayed in May.  It is probably the most primitive I’ve seen here, but it does have the standard, cast concrete base/seat.  The door is simply a cloth.  One difficulty for me was that I can’t even walk in without bending over quite a bit.  The height at the peak is about 1.5 m.

Here’s an example of another non-standard latrine—this is the proverbial brick ****house!  In spite of being of such a durable material, the roof seems to be ad-libbed from scrap material and the masonry job isn’t the neatest.

Here’s another one that I’ve only seen one example of—a double-seater.  I’m not sure if there is a partition inside and two doors or just one space since the view shown is what is visible from the road.

Here is an example of a standard design, but the vault is elevated so you must go up steps to the latrine.  This is one solution to splash-back (see more on this below).

There are also a few more “exotic” types of latrines, the ones that I’m aware of all having been introduced by Grupo Fenix.  These try to put the waste products to better use by either composting or bio-gas generation.  The three examples are:

1.       The Clivus composting toilet (at the Centro Solar).  Emily and William lived in a dorm at college that had this type of toilet integrated into their suite.  The pictures include a description of the process (if you can read the Spanish!).

Here is the reading material while using Clivus.  It explains operation and maintenance, but Googling should get you an explanation in English if you’re interested.

The inside view of Clivus showing both adult and child seats.  The floor is decoratively tiled with broken pieces.

This is the Clivus composting latrine at the Centro Solar.  It is adobe with plaster and a tiled room.  A wash stand (but without running water) is at the side.

2.       A bio-digester toilet for producing cooking gas for the restaurant.  This is a brick structure with hinged doors, running water and electricity.  It appears very much like a standard bathroom plumbed with running water, but the water pressure is considerably less.  There are also a few restrictions on use/maintenance to maintain the proper environment for the bacteria.

This is the new, bio-digesting latrine at the restaurant.  It is a legitimate 2-person facility of brick with tile roof.  The running water comes from the adjacent tank, which is filled by a solar-powered electric pump.  The bio-digester tank is buried behind.

The interior of the bio-digesting toilet is quite similar to a standard US bathroom.

One thing that is considerably different that a standard bathroom is that uses are asked to record their “activities” since this is also a part of on-going research.

3.       A new, composting latrine that is not yet completed (at the Montaña Solar).  The base (it is raised so there is no pit—you need to climb stairs to enter) is concrete and the roof galvanized steel, but most of the structure is of natural building materials.  The raised position allows compost to be removed more easily, plus avoids one of the “highlights” of the rainy season:  “splash-back” (Apparently with enough rain, pits can fill up making the latrine an even more exciting experience!).

Living with only a pit toilet has not turned out to be a hardship at all.  In the rainy season it could certainly be a bit unpleasant, but at least the temperature here is always such that the old jokes about “tin toilets in the Yukon” never apply.  The major negative is having to go in the middle of the night:  getting shoes on and traipsing across the yard can quickly become a drag.  However, when kept clean, they don’t really seem too much different than a flush-toilet-equipped facility.  Perhaps after my travels with Susan I’ll be able to add some additional data points to this report.