Day 25-26

Yesterday we worked in ER during the morning and took the afternoon off. We headed into Managua to see Transformers 3. I've seen four movies in theaters here for the price of a little more than just one ticket in the States. This morning we were up early to head to San Juan del Sur, a small beach community an hour and a half outside of Masaya. Somehow we were lucky enough to get bright blue, sunny skies even though it's the middle of the rainy season here! Each day it has been pouring for at least a few hours. It was so nice to relax, swim in the ocean, and enjoy a seafood lunch on the beach.

Tomorrow will be our last day in the hospital. I will be back in Fayetteville late Tuesday night to start summer classes at 8 AM on Wednesday. It's hard to believe my time in Nicaragua has come to an end. I will always cherish my experiences here. In the coming days, I will post my last blog entry (as well as more pictures from the end of the trip). Thank you to everyone who has been keeping up with me over the past four weeks. All of your support and kind words have meant the world to me!

Day 24

Quick update tonight- We returned to Masaya to work in the hospital today. We split up into two groups. In the morning, Chris and I spent our time in the OR and Labor and Delivery. One of the doctors taught us to take the fetal heartbeat as well as how to determine the strength of contractions and dilation. We scrubbed in an orthopedic hand surgery of a 30 year old woman who had a needle lodged into her bone from a sowing machine. It was by far the oddest x-ray we have ever seen. In the afternoon we rotated between the ER and pediatric unit where I inserted my first foley catheter, saw a young boy with dengue fever, helped drain an enlarged belly from cirrhosis due to hepatitis, and watched a doctor tell a patient's family he was on his death bed.

Tonight we are all relaxing a bit and enjoying a game of cards. Leslie just submitted her medical school applications. She is freaking out! After looking over her 13 page page primary application, I'm getting a little nervous for the future... Tomorrow morning we are working in the hospital again. We are taking the afternoon off to see a movie and eat at our favorite gelato shop for the last time!

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.

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.

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.