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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!

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.

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