About Me

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Managua, Nicaragua
I'm participating in a month-long medical trip to Nicaragua, so I'd like to use this blog to document all of my experiences abroad and keep everyone at home in touch!

Thursday, June 30, 2011

Day 23

We spent the majority of the day setting up and working at a health fair in Veracruz, a small community about 20 minutes outside of Masaya. We began the morning at the hospital to pack up supplies in a government truck. Room inside was limited so the four of us and Dr. Cerrato opted to ride in the bed of the truck. Unlike the US where such actions will leave you with a hefty fine, it is perfectly legal here as long as passengers aren't sitting around the edges or allowing their limbs to hang out. It was a very hot, humid day and the air blowing on our faces felt refreshing.
We set up the clinic inside one of the wealthier homes in Veracruz with a group of nurses working for the government. Around 30 people were waiting outside as we unpacked the truck. In front of the home we set up two tables for taking blood pressure, conducting glucose and HIV tests, and giving vaccinations to children. Many of the little girls came up to us unprompted to say hi. We were there best friends until they realized they were there to get shots. We rotated duties throughout the day. We had several handouts to help us teach about preventative medicine, sanitation, and symptoms/treatment of common diseases. We started to get overwhelmed by the late morning. More people were in line for the glucose tests than we could handle at one time.
In the afternoon I helped the doctor inside with PAP smears. The majority of the women were having one done for the first time. The youngest girl we saw was 16. Part of the patient survey asked for the number of past pregnancies. She had an 18 month-old daughter. The cramped room was dark and a small lamp was set up at the foot of the table that had stirrups attached to it. It was hard for of us to imagine having a similar experience with a gynecologist. Overall it was a great day.
We started packing up around three and then headed to a late lunch. We had a delicious meal of chicken, rice with beans, plantain chips, and a mysterious green veggie with cheese. It is pouring rain and dark already here. It will be odd when I arrive in the States next week to bright and sunny skies until almost 9 PM. Hard to believe this trip is coming to an end soon! I'm not sure how I feel about it. I think part of me will be ready to get back to see families and friends as well as begin preparing for the MCAT. Another part of me would love to stay in Nica for awhile longer. Tomorrow we are headed back to the hospital.

Day 22

Yesterday afternoon we worked an eventful evening shift in the hospital. We spent most of our time in the Pediatric ER and the Internal Medicine wing. All of us enjoyed working once the sun had gone down. Dr. Jihron, one of the primary doctors in charge of the ISL students, let me follow her as she went from patient to patient explaining their health problems, the treatment they will receive, and why. Several people were in the hospital with complications due to diabetes and cirrhosis of the liver. We met a 65-year old recovering alcoholic who had come to Masaya to get fluid drained out of his stomach. Looking solely at his abdomen one could mistake him for a pregnant woman. The rest of his body, especially his arms and chest, were emaciated.
Towards the end of the night we went to pediatric unit. Even though all of the kids were there with injuries, the room remained astonishingly quiet. A few kids stand out to me in particular. One boy around ten had fallen off a horse and broke his arm. He seemed too small to have been riding such a large animal without a saddle. Although he was noticeably in pain, I didn’t see him cry or complain once. A little girl around 8 years old was brought in with a leg wound. She was playing with her friends when a worker who was riding a bike somehow accidentally hit her with his machete. As she was fighting back tears, I told her she was very brave and she gave me a big smile in return. We learned that the girl and father with her weren’t even her own. They were neighbors who had seen it happen. All of the kids were so brave and calm despite their injuries. Each day I’m here I keep thinking about how much I would love to go into a pediatric sub-specialty.

As we were leaving the hospital, a man who looked around 40 years old was receiving some kind of respiratory treatment while a policeman with an AK-47 stood next to his chair. He asked one of the other students for a glass of water. It was the first time I had seen a prisoner at the hospital. It seemed so odd to all of us at the time that he wasn’t tied down or handcuffed to anything. The admitting doctors had suggested it to the police, but he deemed it unnecessary. When we returned to the hospital Wednesday morning several more police had arrived. In the middle of the night the guarding cop had briefly fallen asleep and the prisoner was able to quietly sit up and sneak out unnoticed.

We learned later in the day he was in prison for raping a young boy. We all felt creeped out and sad about the situation. We were also angry with the cop for allowing his escape. Unlike the US where our methods of tracking people are aided by technology and cameras on every corner, we all knew how easy it would be to disappear here and never be seen again.

We spent most of Wednesday helping the nurses and doctors admit patients and take vital signs. In the afternoon we saw another vaginal birth and worked in the ER. A middle aged man in critical condition was rushed in towards the end of the day with several broken ribs, a fractured hip, a punctured lung, and possible brain damage. Dr. Jihron told us he had fallen into a latrine head first after helping clean it out. Average latrine holes here are around 35 ft deep. It was the worst condition I’ve seen anyone in. He was vomiting up blood and the doctors at Masaya tried to stabilize him before they sent him to the larger hospital in Managua with more resources. Within an hour, he was loaded once again into the small Red Cross ambulance with his weeping mother and supportive brother. We haven’t learned yet if he lived or not. I hope he did.

Thursday we are taking a break from the hospital to volunteer at one of the local health fairs to teach about preventative medicine, take vital signs and conduct glucose/urine tests. We are hoping to work another evening shift in the hospital tonight.

Tuesday, June 28, 2011

Day 20-21

We spent most of the day yesterday shadowing surgeons in the OR at the Masaya hospital. In the morning, we saw a kidney removal from a caner patient as well as a vaginal birth. The kidney tumor had metastasized beyond the physician’s pre-surgical expectation. The procedure was one of the most complex surgeries I’ve seen thus far. Watching the birth this time was just as amazing as the first one! I’ve been incredibly impressed with all of the mothers and their ability to stay calm and collected despite not having epidurals.

In the afternoon, we scrubbed in on two laparoscopic gall bladder removals. Laparoscopic procedures are only conducted about once a month in the public hospitals because the equipment is much more expensive. All patients are put into a lottery and the ones who are drawn have the option of choosing between laparoscopic or classic. The recovery time is significantly shorter than that of a classic surgery. Dr. Cerrato was able to scrub in with us on the first surgery and explain the procedure from start to finish. The amount of dexterity and precision one must have to use such small instruments is impressive.
Towards the end of the second surgery, the patient’s anesthesia began to wear off. At first she was only slight moving her stomach and fingers. As a few minutes passed by, she began flailing her limbs and started to sit up. Her eyes were wildly flashing back and forth. Instead of giving her more medication, one of the scrub techs yelled out “Tranquila, Mami” (essentially a nicer ways of saying calm down woman) and pinned her legs on the table. The four of us left the OR feeling a bit horrified. Even if I weren’t able to feel any pain, I can’t imagine going into surgery and waking up while the doctors were still finishing their final sutures. It’s not that the anesthesiologist is incompetent- Rather, the doctors didn’t want to waste any more of the limited medication on a patient whose procedure was minutes from completion.

This morning we took a break from the hospital and went to the health center in Nindiri, a 40,000-person community outside of Managua. We split up into two groups and went from house-to-house vaccinating two, four, and sixth month old babies. It continues to amaze me each day just how many children there are here. Approximately 48% of the population is under the age of 18. It seems to me that every direction I turn, I see several children and pregnant women staring back at me. In recent years the Ortega government has heavily increased their promotion of contraception and education about various public health issues. He explained to us several of the common misconceptions about disease and sanitation among the Nicaraguans living in poverty and/or rural areas. Many of the people don’t understand the importance of vaccines (some parents even believe they are bad for their children), the role of antibiotics, or the necessity of washing your body/hands.

I loved returning to the community today! Being able to walk into someones home and see where they live is a much more intimate way of providing health care. One mother particularly sticks out in my mind. During the late morning, the nurse we were traveling with led us to home behind what looked like a landfill. Several young children emerged covered in dirt from head to toe. We asked for their vaccination card and none of the children had ever been vaccinated. Their living conditions were among the poorest and unsanitary I have seen in my life. We all left today so gracious for what we have back in the States.
We ate lunch near Dr. Cerrato's childhood home and we were able to meet his Mother. She was such a sweet lady- we walked out with smiling faces and several mamons (a tropical fruit she grows in her backyard). We took a few hours off this afternoon from work. At four we are heading to the hospital to work the night shift.

Sunday, June 26, 2011

Day 19

We were supposed to have today off but last night we had asked Dr. Cerrato if we could go into the hospital early to see if anyone needed help from the night before. We arrived by seven to see a number of exhausted nurses and doctors but very few patients. One of the young females residents explained to us how hectic the night shift had been. With thousands of people celebrating and drinking in Masaya, a number of accidents and a few fights had broken out. More patients than normal were being wheeled in and out of the ER. The chaos has subsided, however, by seven.

Knowing that Sundays in the hospital are very slow, Nilda suggested we make alternate plans for the day. We decided to go out to lunch followed by a tour of the Masaya zoo. For only a .50 cent entry charge, we were able to see a wide array of animals- including pumas, monkeys, lions, parrots, and a number of others! We’ve had the evening to ourselves. As I sit here relaxing in my air conditioned hotel, I keep thinking back about all of the children I've seen brought into the world here.
As the mothers leave the public hospital with their newborns, the reality sinks into me. These children with their bright purple bodies and tiny beating hearts are no different from any American baby- yet they will grow up with nothing. Many will be raised in filth and poverty and live a life with very few opportunities. Within a few hours, most of them will go home to a house of metal scraps and a dirt floor. Flushing toilets, clean water, and food in their bellies each day will be amenities that only live within their wildest imaginations.

I'm realizing with new appreciation each day just how fortunate I am. I’ve grown up with numerous luxuries and an almost endless number of opportunities- opportunities that the majority of people in this world only dream of. Spending time with the people of Nicaragua is allowing me to better understand the kind of doctor and person I want to become. It has also forced me to realistically look at the numerous challenges we are faced with in the 21st century. I want to be a part of the solution to providing health care to the masses! I want to care for the under-privileged. I want to make a difference, however small, in the lives of those who don’t have what I have been provided with my entire life. I want to serve those from all walks of life, including the Hispanic people, and use my Spanish skills for a purpose beyond myself.

While seeing the conditions has been upsetting and disheartening at times, I've also been given a great amount of happiness and rejuvenation from my experiences here. I can't imagine a life outside of medicine and I'm so excited to pursue these dreams when I return to the States.

Day 18

Leslie and I spent the morning in the Internal Medicine wing of the hospital taking patient vital signs. There are five rooms with five beds in each one. Several of the patients were incredibly ill. In any US hospital, the majority would have been in an ICU hooked up to a number of monitors and IVs with nurses and doctors checking on them regularly. Instead they lay there sweating profusely in the hot, cramped rooms waiting either alone or with a family member for a doctor’s arrival.

A number of the patients had irregular heart sounds, fever, and/or abnormally high/low blood pressure. One patient had a bp of 65/40, as opposed to the normal 120/80. Rather than hearing alarms go off and nurses rushing into the room, we were instructed to record the information and move onto the next patient. I arrived at the bed of a 40 year old paranoid schizophrenic with all of his limbs strapped to the table. As I approached him, he began calling out in fear that I would hurt him. We tried our best to calm him down, but he wouldn’t stop struggling against me for long enough to take the blood pressure.

We left the hospital early afternoon. Today (June 25th) marks the beginning of the 1979 Revolution led by the Sandinistas to overthrow the totalitarian President Somoza. Each year, thousands of Nicaraguan people walk the historic walk of their ancestors. The march, known as “El Repligue” by many, mimics the route that the Sandinistas walked 32 years ago from Managua to Masaya to congregate in massive forces. Throughout the day we had asked our team leader, Nilda, about pre-Revolutionary Nicaragua and the Somoza regime. She remembers seeing a young man accused of being a guerilla fighter shot in the head at gunpoint a few feet from her. Each time anyone would come by her home, her mother feared for the life of her 12 year old brother. Although he was only a boy, the family worried that his adult size would convince one of Somoza’s men that he was part of the revolutionary forces.

Nilda knew the roads home from the hospital would become too dangerous for traveling as the afternoon progressed, so we were instructed to get back to the hotel earlier than normal. The march didn’t reach Masaya until around five in the evening. The hotel sits on the main road and we could watch the celebration from out front. It was a very fun sight to see. The streets were congested with hundreds of excited Sandinistas and smiling relatives of those lost in the revolution. We saw several motorcycles and trucks filled with people waving flags and beaming with national pride. The celebrating continued until late into the night.

Friday, June 24, 2011

Day 17

Today was a much busier day than yesterday. I was up around 6:30 to enjoy a cup of coffee and plantains before heading to the hospital. Upon our arrival, Dr. Cerrato split us up into two groups of two for our morning shifts- Leslie and Michelle spent their time in the pediatric unit while Chris and I were observing and helping out in the ER. Shortly after our arrival, a 50-year old woman with a 6-inch deep laceration on her foot (as well as a broken ankle) arrived. We learned that her bathroom ceiling collapsed and a large piece of metal crashed down and sliced it open.

For the first time since my arrival in Nicaragua, my heart began racing and I felt a little anxious. Unlike the OR where the patients are sedated, this was the first time I had seen so much blood accompanied by a hysterical patient screaming out in agonizing pain. I had to force myself to keep watching and not turn my head away. After a few minutes passed I was finally able to shake my nerves so I could really pay attention and listen to Dr. Cerrato’s explanations. They thoroughly cleaned the wound and began trying to stop the bleeding. I saw one nurse wipe off a quarter size piece of bone from her shin mid-way through the process. She received well over 50 stitches (both internal and superficial) before the leg was put in a cast. Once the swelling has gone down in a few weeks, she will return for surgery.

We saw two more patients before finishing up the morning in the ER. With each passing minute, I felt much more at ease and comfortable with my surroundings. A man around 25 arrived with a muscle-deep cut along his kneecap. He explained to us through yelps of pain that he was hit with a shovel. He had many tattoos that ran along his arms and knuckles. We speculated he was a member of gang who had just lost a fight. Our last patient of the day was a young woman whose leg had accidentally been nicked by a cutting knife while working at one of the local food markets.

After cleaning the wound, one of the physicians on the case asked us if we could do the sutures. Dr. Cerrato told us a few days ago that if we are ever given the opportunity to learn hands-on just say yes. Listening to his advice, we quickly replied with the affirmative. I don’t know why the two of us were compelled to give her this answer- it’s not like our one-hour suturing practice on a sponge last week makes us even close to qualified to stitch up human flesh. She chose me to do it (I was standing closest to her). As I put the gloves on and took the needle out, my hand started to shake. I was able to some-what control it once I reminded myself to relax and breathe. The first stitch took me what seemed like forever to do but I picked up my pace with time. It was a very nerve-wracking and exciting experience. I hope I get the opportunity to do it again next week.

Our afternoon was spent observing in the Labor and Delivery Unit of Masaya, where I scrubbed in on a C-section as well as my first natural birth. The delivery area is a large room with one bed in each of its four corners. We entered nearly an hour before the baby was born and stood less than a foot away from the stirrups and the doctor. Each time the obstetrician instructed the mother-to-be to “respire profundo” (breath deeply) I noticed I would do the same as she caught her breathe and pushed through each contraction. Because epidurals are so expensive here, the public hospitals of Nicaragua do not provide any pain-killing medications. The newborn was crowning for almost 45 minutes until it was finally brought into this world.

The whole thing was incredibly powerful and moving. I was on the verge of becoming teary-eyed when the baby boy-with his almost impossibly tiny fingers, bright purple body, and cone-shaped head- was finally breathing on its own. The doctor asked one of the male students how he felt after it was over. He said he had a new-found sense of appreciation for his mother and women in general (as well as a feeling of great relief he will never have to go through the process himself). I know I was certainly experiencing similar feelings.

Thursday, June 23, 2011

Day 16

A delicious breakfast of french toast and gallo pinto was served promptly at 7:00. Instead of eating with just our medical group, we were accompanied this morning by two new ISL teams that arrived late last night. One group is comprised of seven just graduated nurses who will work in various health centers and clinics throughout the area. The other team is a group of female students here on a pediatric and women’s health service trip for two weeks. It was nice meeting some new faces. They reminded me of our group just a few weeks ago when we were the ones asking several questions about the days ahead. Our role has now been switched.

After breakfast, we caught a taxi to the hospital. The number of patients and doctors in the hospital was much smaller than normal because Nicaragua is celebrating Father’s Day today. We had the opportunity to watch a few surgeries before lunch, including a C-section and a repair of an inguinal hernia of a 60-year old female. The head of internal medicine had us take vital signs for a bit before guiding us around the hospital. She introduced us to several of the patients and talked about their symptoms and treatment. The degree of illness was varied, but we spoke with several incredibly sick patients. We met a 76-year old man complaining of severe swelling and pain in his legs. He took his sock off to show us necrosis of his foot. Two of his toes were completely black and the others were characterized by redish/yellow pockets of pus and purple lesions.
Part of the pediatric unit
Before leaving the hospital, we were introduced to the orthopedic surgeon in Masaya and scrubbed in on a femoral fracture fixation surgery. The 13-year old boy was kept awake (though hardly lucid) during the procedure that consisted of putting three metal nails at the neck of his hipbone in order to fix the injury. It was a very interesting procedure to watch. I now have a much greater understanding and appreciation for why orthopedic surgery tends to be a male dominated field- the sheer strength it takes to drill and screw nails into human bone is quite great. The surgeon was sweating profusely by the time the task was accomplished.

Given the oddly few patients at Masaya, we called it an early day around 1:30. On the way home from the hospital, our team leader suggested we could tour El Coyotepe, a fortress built on top of one of the largest hills in Masaya by Nicaraguan president Zelaya in 1893. During the dictatorial regime of the Somoza family (1937-1979) a dungeon was constructed below the fortress that served as a prison, torture chamber, and execution center for political enemies.
A guide led us along the dark, bat-infested hallways of the three-tiered under-ground dungeon. The entire tour was very creepy. We learned that up until 1983, it housed more than 800 political prisoners who lived under sub-human conditions. The US television show Ghost Hunters confirmed to the guide that there were ‘paranormal activities’ among its several torture rooms. On a much less morbid and depressing note- we were able to climb one of the little towers on top of the dungeon to see a beautiful panoramic view of Masaya, its lagoon, Lake Nicaragua, and the Mombacho volcano.

Wednesday, June 22, 2011

Day 14-15

Yesterday I wasn’t able to update my blog because the power went out at the hotel for the evening. Luckily it was back up and functioning this afternoon. Early this morning, we traveled to Nidiri, a small town on the outskirts of Masaya, to attend a regional health fair. The Ortega government sponsors these fairs in several communities throughout the country once or twice a month on average. The people of the communities come for general check-ups (most notably for blood pressure and glucose tests) and vaccines for their children. Sexual and women's health are also addressed with information about contraception, free HIV/AIDS tests, and cervical cancer screenings.

Over 100 hundred children from ages 5-10 were lined up to receive their vaccinations upon our arrival. We were introduced to a few of the doctors and other health care professionals scheduled to work the fair and split up into smaller groups to treat patients. Myself, as well as one other student, were in charge of administering glucose tests. Giving vaccinations would have been a new opportunity, but I was relieved I would be poking the fingers of adults (as opposed to children) all morning. Being deemed the ‘bad guy’ by all of those precious, smiling faces would have been difficult.
As the day went on, several children continually came up to our table to watch the process. Instead of making them cry, we were able to show them how the glucose test is done and explain a little bit about its results and diabetes. I made friends with an especially curious 7-yr old boy from the community named Brandon. He was an eager learner who stood by my side for well over an hour. By the time we were getting ready to leave, he actually wanted us to poke his finger! Before leaving for the hospital, we were shown how to conduct a Pap smear. We will be helping out at another regional health fair some time late next week. I really enjoyed my time there this morning. Educating about preventative medicine seems to be incredibly important here.
During lunch, we asked Dr. Cerrato several questions about the Nicaraguan health care system and its differences in comparison to the United States. In Nicaragua, all doctors are trained to be both general surgeons and primary care physicians. After medical school, each MD must work for the government for a minimum of six years in a public hospital or clinic. After those years of service, one is permitted to work in private practice. He also told us that the average doctor only makes on average around $500-700 USD per month (some of the more successful surgeons make around $1,000). We were all shocked to hear these figures. Although cost of living in NICA is less that it is in the States, these figures are still astonishingly low. The average citizen makes less than $1,500 USD p/ year.

This afternoon in the hospital we worked in the ER and sat in on two surgeries. We scrubbed in on a gall-bladder surgery of a 20-yr old female. After removing the gall bladder, the surgeons showed us the massive stone. It had the size and appearance of a large green grape. We later witnessed the removal of a golf-ball size hernia from the naval of a 50-yr old female. To my surprise, the patient was kept awake (though hardly lucid) throughout the procedure. Next we were scheduled to see a delivery, but unfortunately the baby had just been born when we walked in. On a side note- It’s especially difficult for me to understand the Spanish of some of the surgeons during these procedures because I’m not able to look at their lips and their words are muffled under their masks.
Tomorrow we are headed back to the hospital at 7 am- I’m still very much looking forward to all I will get to learn and see during the next two weeks. So far, the doctors and nurses have been very helpful. The majority of them explain to us what they are doing and why they are doing it.

Monday, June 20, 2011

Day 13

Early this morning we headed to the Masaya Community Hospital, the government subsidized hospital that serves the people of Masaya as well as surrounding areas. Over the past two weeks I’ve gotten accustomed to jumping out of bed to throw on my scrubs and tennis shoes before venturing out for the day. For the next 15 days in the hospital, we have to wear white coats over them. Looking in the mirror for the first time, I felt excited about my future career. I also felt like an imposter, completely unworthy at this point in my life to wear one.
Pulling up to work, I had a few expectations about what I would see. After serving in the impoverished areas surround Masaya and talking with a few of the students who have worked here longer than my group, I was well aware that the public hospital would not resemble a typical hospital in the United States. It is a rather small hospital for the number of people it serves and is split into three main units- the ER, OR, and Labor and Delivery. Before exiting the van, Dr. Cerrato assigned us to smaller groups for rotations. Within each unit patients fill the open space. A few curtains separate some of the sicker patients but for the most part they are laying in beds directly adjacent to one another (no more than 3 feet apart). A number of patients with IV bags sit along one bench together and there are no private rooms.
One of the other students and I were told we would go to the Labor and Delivery wing first to watch a C-section. I learned today that after a woman’s third C-section in a public hospital in Nicaragua, the obstetrician removes her ovaries. I believe this recently instated law is aimed at limiting the growth of families living in poverty who don’t have regular access to contraception. I had noticed last week that several of the older women we treated in the clinics had anywhere from 8 to 15 children on average.

In the US we are used to hospitals that are often almost unbearably chilly at time. The first thing I noticed walking into the operating room was how hot it was without AC. Next door to the operating room was a room with around 8-10 mothers who were holding their just-born babies along with a few nurses. If there are no unusual complications during the birthing process, mothers (even those who have C-sections) are sent home with their children within a few hours, as opposed to days.
Chris and I watched the doctors and nurses prep the patient from the beginning with the insertion of the catheter and epidural. Many of the sheets and aprons the doctors wore in the OR had leftover bloodstains from previous surgeries that couldn’t be washed away– this came as another large culture shock for me. Watching the entire process less than 3 feet from the surgeon was an incredible experience! I was very impressed with all of the doctors I will be working under for the next few weeks. At the first sight of the baby’s head, he pulled the child out and passed him along to the pediatrician. He proceeded to sow the mother back up within only minutes- the entire process seemed to be astonishingly fast.
I spend the rest of the day in the ER taking patient information and vital signs. A few of the other students sat in on a prostate surgery as well as a thigh-high leg amputation of a diabetic patient. On our way back to our home this afternoon, we drove to the Masaya Volcano... It was a beautiful sight to see!

Sunday, June 19, 2011

Day 12

We were able to sleep in until a little after 8 on Sunday before driving an hour and a half West to Bochito Beach, the closest beach on the Pacific from Masaya. We arrived around 10:30 and spent time reading and relaxing in the sun before a lunch of traditional Nicaraguan food (with a few extra fish dishes) on the water. To my pleasant surprise, the water wasn’t very cold so we all decided to splash around in the waves for a few hours like we were kids again. Overall, it was a great day. I got a bit of a sunburn despite applying sunscreen various times throughout the day. We headed back to Masaya for dinner as well as an introduction seminar taught by Dr. Cerrato about our rotations in the Masaya Community Hospital tomorrow. We’ll spend time rotating between the ER, OR, and the Labor and Delivery wing. I’m very much looking forward to it- hopefully I’ll have some good stories to tell everyone about tomorrow evening.

Saturday, June 18, 2011

Day 11

Today was our last day serving in San Juan de Oriente as well as my last day working in a clinical setting. We were up early for a tasty breakfast of French toast, rice with beans, and an assortment of tropical fruits before heading to the clinic. We treated a variety of patients. In comparison to the previous days, Leslie and I met with an abnormally high number of children with asthma. Other common ailments included arthritis pain, ear infections, hypertension, diabetes, UTIs, and a wide array of skin rashes. We shut the clinic down early again (around 3) because of the noise coming from the fair going on outside of the church.
We drove ten minutes down the road to the lagoon again. Instead of just enjoying the view for a few minutes, we were able to swim for an hour or so. We were all very appreciative for the opportunity to cool off and relax a little! Tonight we will go out to dinner as a group and tomorrow (Sunday) we have the morning off. Dr. Cerrato is taking all of us to the beach and in the afternoon we will have seminars introducing us to second part of the trip. From this point forward, we will be working in the Masaya Community Hospital, the main hospital that serves the people of Masaya as well as the under-served communities that surround it like La Concha and San Juan.
While I’m very excited about starting our work in the hospital, I’m also leaving the clinics with a bit of sadness. I’ve loved serving these communities and I will miss them! By visiting their homes and walking their streets, I feel like I’ve gotten to know the people on a more personal level than I will be able to in the hospital. The amount of first hand experience I’ve had in the clinics thus far has far exceeded my expectations. My knowledge of medical Spanish has been expanded greatly because I’ve been encouraged constantly to directly communicate with the patients about their health issues. Once we start working in the hospital, I think our direct line of communication and liberty we have with the patients will decrease. I’m quite confident, though, that our opportunities to serve and learn will be vast (just different) while working under the surgeons and other physicians in Masaya.

A few things are for sure- Each day I’ve left the clinics with a great amount of satisfaction and excitement about what we are doing and what I want to do with my life. I’m learning more and more about myself, the world around me, and the kind of doctor and person I strive to be. I’m so happy and thankful I've chosen medicine as my life and career path.

Friday, June 17, 2011

Day 10

This morning we opened the clinic in San Juan de Oriente. We arrived around 7:30 to set up the pharmacy and medical equipment in the relatively small Christian church before treating patients. Just like in La Concha, there was a long line of people already patiently waiting for our arrival. Fungal infections, UTIs, and allergies were the most common reasons for seeking help from us today.
Each day, I’d like to write about at least one particular family or person that had an impact on me. Today, that person was a 50 year-old woman who came to Leslie and me seeking treatment for an allergic reaction she had been experiencing for the past year on her leg. She wore long socks with closed toe shoes and described the area as a painful itch. After completing her health history and conducting a general physical exam, we asked her to take off her shoes in order to examine the area. Expecting to see a small amount of inflammation or redness that is characteristic of a typical allergic reaction, we were both shocked to see that the entire area from right below her knee to her ankle had turned a deep purple color. Right above her shin, there was a quarter size open wound partially covered by a blackish red scab.

Today was the first day this woman had sought professional medical help for the problem. For over a year, she had fought through the pain of the severe staph infection, hoping her body would heal itself. When Dr. Cerrato arrived, he told us we needed to tell her to go to the hospital or a health center immediately to seek a stronger antibiotic than what we had available to give to her. In the mean time, we were able to prescribe the strongest antibiotic we have in our clinic as well as a painkiller. I’ve been reminded several times in the past week I’ve taken my health and the resources I have available to me for granted. Today was certainly no exception. The majority of us never think twice about our easy access to healthcare professionals or medication.

We closed up the clinic early (around 3) because today marked the first day of the ceramics fair the city is hosting this weekend. We were able to walk around and see more of the exquisite pieces displayed on tables along the city’s main road. Several of the families expressed their gratitude for our arrival and offered us good prices for their handcrafted pieces. Tonight we are traveling into Managua to eat together at a Mexican restaurant. We are all quite interested in tasting Nicaragua’s interpretation of Mexican food!
Tasting one of the local sweets in San Juan de Oriente (pretty much a frito with sugar instead of salt)

Thursday, June 16, 2011

Day 9

Bright and early this morning we headed toward San Juan de Oriente, a small community outside of Masaya where we will set up our next clinic. Just like La Concha, poverty in San Juan is endemic. The communities themselves, however, are very different. Although the people in La Concha are poor, their production and sale of fruits leaves them with a relatively steady income. The people of San Juan do not have such fertile land. Rather, the majority must depend on the sale of ceramics and other unique crafts. I have never experienced poverty like this.
Upon arriving at one of the local Christian churches in San Juan, we were introduced to the pastor and a few of his local followers. We split up into groups of two and were led by them throughout the community to conduct health/sanitation surveys and invite the sick to our clinic. Not a single home of the several I visited had electricity, a flushing toilet, or running water. Many of the homes had eight to twelve people living in them and were never more than one or maybe two rooms (one of which served as a work room for the ceramic pieces). Some of the houses were partially made from cement, but the majority were crafted from metal scraps with a dirt floor.

As we walked the streets of San Juan, one of the other students and I noticed several small children playing soccer. We split off from our group when we weren’t needed to talk with them. They immediately welcomed us into their game with smiling faces and asked us a plethora of questions as to what we were doing in their community. A little girl standing on the sidelines with her small dog waived to me, so I decided I should let the boys have their fun and went over to her. Within minutes, a few of her brothers and sisters came up beside me. Her twelve-year old brother, realizing we were on some sort of mission trip, asked me if we were Christians. After responding with yes, his face lit up and he reached for the small wooden cross he carried in his pocket. He begged me to meet his mother, a woman of Christ.
The little girl grabbed my hand, so I followed them down the street. Their mother, a woman who looked entirely too small and fragile to have given birth to the children, appeared before me and welcomed me with open arms into the home. They excitedly took me to the back of the house where I saw nestled in the corner a dog with a tiny littler of six or seven newborn puppies. They showed me how they make the pottery and the mother offered to give one to me. Despite the uncertainty of whether they would eat that night, they were all full of hope, joy, and generosity! I left the family with an odd mixture of great happiness and sadness. I don’t know why this particular family touched me so deeply, but they did. I later returned to the home to buy a small piece of pottery that I will treasure from this point forward.
After finishing our work in San Juan in the mid afternoon, Dr. Cerrato took us to Apoyo lagoon where we saw a breathtakingly beautiful view of the water. Afterward, we went on a flat bottom boat tour of Lake Nicaragua, the largest body of water in the country. Listening to my Lala’s advice, I double-checked that there were enough life jackets for everyone onboard. We saw a small island with a group of monkeys. They came up close to the boat and we were able to feed them mangos and bananas. Tomorrow we will open the clinic in San Juan at 7 am!

Wednesday, June 15, 2011

Day 8

I was up by seven thirty to enjoy a hot cup of coffee and rice with beans before venturing to La Concha for our last time. I was under the impression that we would spend the day playing with some of the local children and speaking with a few of the families we treated earlier in the week. Within minutes, the entire clinic was filled with the chatter and laughter of 45 2nd-4th graders from the community.

We spent the morning playing a variety of games with the kids, including their version of pin the tail on the donkey (pin the nose on the clown). We proceed to teach them the rules of tag and musical chairs and set up several games in front of the clinic. I loved each and every minute of the day! Their excitement and energy were contagious. Understanding their Spanish at times was difficult because of their rapid speech. Towards the end of the morning, we brought out a pinata for all the kids to enjoy and sent them home with a soda and a small toy (ranging from stickers to coloring books). They were all so grateful and gave us many hugs before leaving. They left me with a smiling heart.
Before heading back to Masaya, we enjoyed a delicious lunch in the community!
In the late afternoon, we attended a suturing and injections class taught by Dr. Cerrato. He used oranges to mimic human flesh for the injections practical and sponges for the suturing. We were taught how to do a few basic stitches as well as how to give injections in the arm and buttocks. Leslie and I talked to a few of the students on one of the other ISL trips that have been here longer than us. During their rounds in the hospital, two of the four of them have had the opportunity to suture and all of them gave injections at one point or another. Before leaving for Nica, a number of people joked with me about how much more liberty I will have in the hospitals here versus ones in the US. It sounds like that statement will hold true. Knowing that the next time we suture it could possibly be on a live human, we decided it would be to our advantage to pay extra attention to the demonstrations!

We headed into Managua for dinner and a movie. We saw "Que paso Ayer? Dos" (The Hangover Part Two) for only $2.75. It was a different experience seeing the wealthier parts of this area. Standing in line at the movie theater, you would never know that communities like La Concha were just 30 minutes away. Tomorrow we are going to the next community we will be serving, San Juan de Oriente. I've enjoyed a few days "break" but am very much looking forward to being back in a clinical setting!

Tuesday, June 14, 2011

Day 7

We took a break from working in the clinics today in order to rest a bit and enjoy some sightseeing near the colonial city of Granada. We were up by 7:30 for a breakfast of traditional pancakes with, of course, rice and beans! We loaded up the van and headed to Mombacho for a nine-part canopy tour. Some of the students were even gutsy enough to zipline upside down. The guides were wonderful and the view from above was certainly a beautiful sight to see. Best part of it was, it was only $14 USD.
After we finished up our canopy adventure, we participated in a brief tour of one of the nearby coffee plantations (free samples included). Coffee has been a key part of Nicaragua’s national economic development process since the mid-1800s. It is among the nation’s primary sources of foreign exchange and provides the economic backbone for thousands of rural communities throughout the country. The United States has been a major importer of Nicaraguan coffee for several years.
Next, we ventured to Granada, one of the first European cities in mainland America. Founded in 1524 by Francisco Hernández de Córdoba, it was not only the settlement of the conquest, but also a city registered in official records of the Crown of Aragon and the Kingdom of Castile in Spain. The architecture in Granda is completely different from anything else I've seen in Nicaragua thus far. It was a lively city with many bright colored building and churches. We ate at an Italian restaurant for lunch in the central park area. It was my first meal in a week without rice or beans. We finished up our recreation day with a trip to one of the markets in Masaya. We saw a number of crafts ranging from beautifully intricate and unique home decor to a rather odd collection of baskets made from dead turkeys.
This evening, I learned that tomorrow we have our last visit to the community of La Concha to spend time with some of the local families and educate them about health and medicine. In the morning, we have a number of games (including a pinata) we will play with some of the children we have treated in the clinic over the past week. I'm really looking forward to interacting with the families outside of a hospital/clinic setting. We will have our first suturing and injections class tomorrow night. I know Thursday will be a great day in San Juan de Oriete, the next community we will be serving.

Monday, June 13, 2011

Day 6

Today was our last day serving in the clinic in La Concha. Leslie and I got to work together again and in total the eight of us saw and treated close to 40 patients! I’m gaining more confidence with the patients and with my medical Spanish. Like the previous two days, we arrived around eight to see a long line of people already waiting for arrival. We were much busier today (Monday) and didn’t close until almost five this evening. We treated patients with many of the same health problems as yesterday, such as UTIs, ear infections, skin rashes, fungal infections, parasites, and arthritis.

In the morning we talked with a 55-year old patient who expressed her concern to us about frequent dizziness, fainting, dry mouth, and other traditional indicators of diabetes. We decided to take a sample of blood and the results were disheartening. Her blood-glucose level was four times that of an average adult. After confirming the diagnosis with Dr. Cerrato, we had to explain to her the result of the test and how her life needed to change from his point forward. Her positive demeanor quickly dissolved into sadness and desperation. There were so many things I wanted to tell her, but I couldn’t formulate the right words. I didn’t feel qualified to do this job in English (much less in Spanish). As she left the clinic with tears in her eyes, I realized she will likely never get the opportunity for treatment or further education about the disease.

I left for lunch feeling defeated. I’m grateful for the opportunity to be here and help the people of La Concha, but these experiences are leaving me with the realization that we are only applying a tiny band-aid to a gaping wound. What do the people do when we aren’t here? In a few weeks time, the effect we have had will quickly be washed away. Even in the very best cases, we can only prescribe enough medication to last for 20 or maybe 30 days. The most frustrating part of the problem is most of the public health issues are completely preventable and treatable. Those that come to us with more serious problems are recommended to seek help at their local hospital, but the reality sinks into all of us- the majority of the people in this community, and many more like it, don’t have the resources to do so.

One a much more positive note, there were a number of people that particularly touched me today. We treated a 15-year old girl for a skin fungus. After taking her health history and conducting a physical, she started to make small talk with us while we waited for the doctor to finish up with one of the other groups. She proceeded to tell us she wanted to become a doctor too. Although she has been raised in an impoverished community where most people (especially women) don’t go to school past her age, she elaborated to us what she wants to specialize in one day. As we walked to pick up her prescriptions, she smiled and thanked us for coming to her country. I hope she will have the opportunities to make her dream come true.

Tomorrow we are going into the city of Granda for some sightseeing and relaxation. I believe we will get to go on a tour of a volcano as well. Wednesday we will travel
to the next community we will be serving, San Juan del Oriente. Hopefully my next entry will be accompanied by more pictures. But for now, I'll leave everyone with another delicious Nicaraguan dish!