Last day in Nicaragua

Have not been able to blog for a few days due to difficulties with the internet, I will try to catch up. So we have been out several days in Nicaragua to the med sites. The primary complaint remains to be concern about possible parasites, low weight and “kidney pain”.

I have had some interesting cases, one child who had an impressive murmur whose mom mentioned it in the history as a secondary finding, he had been seen by local cardiologist but no follow up recommended. After consulting with one of the Navy doctors it was determined that he had possible VSD, I recommended he return on a day when we would have a cardiologist and the capability to do an echo. I was thrilled to find out that he did return, our photo journalist was with me the day I saw him and she let me know that he came back to the med site as recommended on a day when she happened to be there.

I have hopefully helped some children get glasses, we have optometry on site and luckily they have been super accommodating when it comes to fitting these kids in. ON one particular day I know that the optometrist (one guy with the help of tech’s) saw over 100 patients, truly impressive. Each time I presented a case for a child I felt could truly benefit from a thorough eye exam and possible corrective lenses he agreed with a smile. Some of the schools these children attend do not have water and certainly do not have the luxury of air conditioning, yet they do the best with what they have. If I can be instrumental in helping them being able to see better which in turn will help to improve their abilities in school and potential for learning which may in the long term improve their quality of life, this is an opportunity that can’t be missed.

The way that these sites work is that a patient is registered to see just one service due to the high number of patients seen in one day they generally are not permitted to pass from one service to the next. However, there is a great deal of collaboration between the services and whenever possible a child would be referred to return the following day and given a bracelet to indicate that he/she did not have to wait in line again, people waited in lines for hours. In some cases if the condition was severe and/or the family lived at such a great distance various services would fit the child in, this was a window of opportunity for these patients to get medical care they so desperately needed. I saw a child with horribly decaying teeth, I’m no dentist but he clearly had dental caries, my concern was that in a short period of time he would have an abscess and the infection would soon enter the bone. Dental saw him that same day, unfortunately I was so busy I was no able to follow up to see what the outcome was.

There is a common theme each day/each med site, which is education,education, education... regarding the importance of remaining hydrated, proper nutrition, getting vitamins from natural sources, and education regarding appropriate height/weight for children.

I have had to prescribe albuterol to a small child, he really needed a spacer as well. Forgive me if I mentioned this in a past bog... but I will tell you again. We were able to create a spacer with an empty water bottle, tape and some gauze... it has been pretty cool learning from the experienced providers and learning to work with what you have. So I sent this mom and her child home with a spacer made of an old water bottle and some albuterol and she was so grateful.

One of the things I was really looking forward to on this trip was being able to help a population of people who truly needed help and I feel I have done that, they are appreciative of even the smallest bit of assistance. This community seems to live by the idea that it “takes a village to raise a child”, in many instances the child was brought in by a neighbor, a friend, extended family member. The children would wander in the waiting area from person to person and everybody seemed to know each other. I saw people who were at the med sites from open to close, all in search of medical care and some also seemed to be there for the social aspect of such a gathering. It was an opportunity to be provided with clean, cold drinking water and a slightly cooler environment, as we did have large fans.

I have such great respect for those people who have been on the ship for months and will remain on the ship for months after I am back home. Now that we have been here for a week I feel I have adjusted to the schedule, and to life on ship and I could (and would love to) stay on ship for the duration of the mission-scheduled to finish in Haiti and be back in the US by early september. The one thing that it difficult, lets just say impossible, to adjust to is the food... I am entertained by the creativity of those who have been on ship for months with regards to the methods they have developed to be able to create an edible meal from what is served. I have heard a grown man giggle with delight while licking up the last bit of ice cream he was lucky enough to get, apparently they had soft serve ice cream early on in the mission but it ran out very early so when there was a small amount available it was like finding a pot of gold at the end of a rainbow.

I have heard people excited about the “smell of lettuce”, lettuce is another scarce resource around here, on most nights salad is actually chopped cabbage with various salad bar like toppings, including hard boiled eggs- we are in close quarters, as a public service a beg people not eat eat the combo of cabbage and hard boiled eggs!!! Fresh fruit is also worth standing on line for, the line forms quickly and the fruit goes fast. Lets talk about milk, we do not have fresh milk on board so they use this milk-ish substance that is kept cool in the one of those rotating slushy machines, the consistency varies daily, some days it comes out in chunks, other days you can actually convince yourself it is milk and ok to drink. I drink it in my coffee (another necessity when waking at 4am) daily and I have survived thus far.

This continues to be an amazing learning experience, it has been such a rewarding experience to work with/collaborate with such knowledgeable practitioners. One thing that I have realized is that working in the conditions we are in, the heat, humidity, lack of resources, tremendous number of patients being seen, morale is always up. Our team is smiling on the way out in the morning and still smiling on the way home, we all may be exhausted but the reward from these patients is so much greater than the sacrifice. I truly do not feel as if I have sacrificed anything to be here, I feel honored and lucky to have this opportunity and I only hope what I am learning here will stay with me throughout the years. It is an exercise in being able to work with in the means available to me as a practitioner and within resources available to the patients. I saw a patient who had an appendectomy 5 years ago and was coming in for follow up because they were not able to make it back to the doctor for follow up after surgery, this just gives you an idea of the limited access to care in some of these communities. I have learned a tremendous amount in such a short period of time. We will be leaving sometime in the next 24 hours for Guatemala, I am sad to leave this beautiful country but looking forward to the next stop. If I have positively impacted just a handful of the hundreds of patients seen, I did what I came to do. It has been an even exchange though, I have taught them about medicine and they have taught me a little more about humanity.