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.
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.