Stepping into a Different World

Monday, January 3^rd, 2011

Arriving in Managua yesterday afternoon was like stepping into a different world. The warm air with the gentle breeze was a shock to me coming from the cold winter weather back in the states. We rode in a bus to the hotel. Children crowded in buses stared at us through the glass of the windows. There was trash all along the sides of the road. A cement canal filled with murky brown water ran alongside the row of houses constructed from a combination of cement and corrugated metal. Colorful trash bags flew in the wind.

The hotel, Casa San Juan, greeted us warmly with its brightly colored stucco design. After dropping off our things we got back on the bus for a  quick tour of the city. Children sitting on the side of the road wanted to wash the bus’s windows. We were told that many of them sniff rubber cement glue to not feel the extreme hunger. At a cathedral that we visited two little boys followed us around begging for money and/or food.

Today (Monday) was a day full of learning. In the morning, Sonia, the ISL leader gave us a short talk about the general health conditions in Nicaragua and a description of the most common illnesses of the area. Then the doctor, Dr. Solis, talked to us in more detail about the various diseases and their associated symptoms. He explained how to write a prescription and how to perform a physical examination on a patient. 

Tuesday, January 4^th, 2011

This morning we all wore our scrubs and packed our bags with sunscreen, hand sanitizer, and the clipboards with clinic tickets to pass out.

As we approached the community known as La Chureca, I could already start to smell the smoke rising from the mounds of trash that covered the surrounding landscape. After getting off the bus, we made our way through the dimly lit school house and down the dirt path towards the houses. Stray dogs followed us, their ribs showing on their sides as they rummaged through the trash—plastic bags and pieces of wrappers. People sitting outside of their homes waved and smiled as we walked by. The homes were constructed of a combination of plastic and metal scraps. I noticed that some homes had used the borders of kiddie pools as siding.

At the first home where we stopped, a young woman was holding an infant, alongside her other young children and an older woman washing dishes. There was also a man there that she said was her husband. We asked them the questions for the census form and then we also asked about the health of the family members, checking their teeth as needed. In the home of the family next door we found more young children. There was also a young girl of 12 who was pregnant, due in two days to give birth.

One family that particularly touched me was one that we found while checking a young man’s teeth. Sonia exclaimed, “Oh, what beautiful eyes you have.” The young man then said, “Oh you should see my kid!” His eyes lit up and he led us to his hut where his young wife stood with a tiny baby boy only born on December 17^th. Apparently, they had had twins but the baby girl had died. He gave me the baby to hold and it moved me to watch as his small hands grappled the air with hope when his future sadly would most likely not take him away from La Chureca. He was so small and malnourished. We gave his mother a ticket so that she can come to our clinic and get vitamins.

Another story that touched me was a young boy of maybe three/four years old with black stains on his face from sniffing rubber cement glue. In his hand was also a bottle of mascara that he was playing with and also sniffing (apparently for the acetone content). It was really heartbreaking to see someone so young addicted to a drug just to keep him from feeling hungry.

Along with the sad stories I also felt happy to see the cheerfulness in so many of their faces—especially the children. It was surprising to me that they were so receptive to us and seemed already very grateful that we had come. Their faces glowed when we handed them the tickets to the clinic. I am really looking forward to seeing them all in the coming days and to hopefully make an impact—to show them that someone cares.

Thursday, January 6^th, 2011

When we arrived in La Chureca this morning, the church was already set-up with our chairs and tables. At first the clinic was really slow with very few patients, so my triage group went out in search of some.

In the afternoon we saw some of the sadder cases of the trip. We first had a young woman come to us. She was very thin and appeared very sick and fragile from the moment she sat at our triage group. She told us that she just had been released from the hospital that day for bacterial pneumonia. All of her symptoms seemed to match that illness. We also discovered lice in her hair and prescribed her a prophylactic for parasites and multivitamins with iron for her anemic condition. When we listened to her lungs they sounded full of mucous—like a boiling pot of water. After she left to get her prescriptions filled at our pharmacy station, the doctor came to talk to my group. That’s when he told us that the lady was very sick with tuberculosis and AIDS. It was very shocking and so sad to see someone so young (only 22) in so much despair—in such a horribly hopeless situation.

The same day, two other triage groups saw patients who were HIV positive—all young women. One of them laughed at me when I tried to speak to her in Spanish at the pharmacy table. I purposefully kept talking to her so that she could laugh some more.

Sunday, January 9^th, 2011

Today we visited the community, Los Martinez, for the first time. It was pretty different from La Chureca in many ways. First of all, there wasn’t trash everywhere and thus no smell of spontaneously combusting/burning trash. Secondly, some parts actually had a little road with sidewalks. The houses were made of similar materials as those in La Chureca, though some were nicer with cement and tiled floors. In addition, many of the houses had satellite dishes, TVs, and stereos. The people were better dressed and generally healthier-looking. I did not see as many malnourished children. In fact I would say I saw more people that were overweight. Basically, it was a different level of poverty than that of La Chureca.

Monday, January 10^th, 2011

The first day of clinic in Los Martinez went by smoothly despite the stifling heat. 

In the afternoon I worked at the optometry station. At first it was confusing because some older women kept coming to my table without first asking our team leader Sonia. Many wanted sunglasses. We gave out sunglasses to those that had pterygiums in their eyes, which are membranes that grow over the eye due to overexposure to sunlight. We would also recommend to these people to wash their eyes with clean water frequently and to wear a hat when outdoors. Others that came to the optometry station had presbyopia—which is an eye-muscle accommodation problem due to old age. For these people we would have them hold a bible and try to read it trying on different strengths of reading glasses. It was really great seeing how excited they got when they tried on the right pair and could read the words in front of them. One woman didn’t want to stop reading the lines of the bible—it was quite a magical moment for both of us!

Wednesday, January 12^th, 2011

The visit to the Masaya Public Hospital really opened up my eyes in many ways. It was one level, due to the common earthquakes of the region, and there were many open-air hallways and courtyards. Flies and mosquitoes buzzed around and the sheets were covered with stains and tears. Doors to the operation rooms were left open as patients lay barely covered on the operating tables.

We were then brought to the emergency room where a woman was getting several stitches put in above her eye due to a wood chopping accident. An older woman was rushed in while we were there with diabetic-related problems. She had ulcers all over her legs, including one that was quite large and open—causing her pain. Her blood pressure was found to be extremely high and she was moaning in pain. At first, being surrounded by the doctors and nurses in the emergency room it was easy to get caught up in all of the medical stuff and see only the minor details such as blood pressure readings. However, upon noticing the patient’s adult son standing by her side, holding her hand, it occurred to me that this wasn’t just a patient with diabetes—she was someone’s mother, and this was so much more than medicine or science, this was a person with emotions and a family.

Friday, January 14^th, 2011

In the airport in Managua we had our final team meeting with Sonia. We reflected on the impact we had on the communities and the impact the trip has had on ourselves. I know for myself that this was a life-changing experience. Among the many things I learned were some key aspects of bedside manner—how important it is to show compassion for the patient because they are people with feelings. Additionally, I realized that though, as a doctor, one may not be able to cure every illness, there is still reward in being able to help make a patient feel a little better—as I hope we did in the case of the young woman with AIDS and tuberculosis. Furthermore, from a cultural aspect, I saw how even though I do not share a language, culture, class, or beliefs with the people in the communities, I was still able to connect and relate to them because after all, we are all just human beings. I feel that it is important to never forget that basic fact when traveling abroad—people are people and you can always find something in common. After going on this trip my heart has expanded and made room for the people of La Chureca and Los Martinez—and there they will stay, never to be forgotten, as I hopefully continue on my journey to medicine.