NICA2012, Days 4-6: The Beat of a Heart…

Days 4-6 were spent holding clinics in the orphanage.  We would set up a pharmacy, run by two team members, and 4 triage “pods.” The pods consisted of 2 or 3 students, a translator, and two chairs for patients.  People lined up early in the morning to get a numbered ticket.  The translators would bring them to triage one at a time, where we would take medical history, perform a physical exam, then come up with a diagnosis and possible course of treatment.  We then would consult with one of our two doctors, and they would write a prescription.  We had Dr. Cerrato, a general physician, and Dra. Ferrayra, a pediatrician. After consultation, one of the students would take the patient to the pharmacy to fill the prescription and explain the dosage.  Sadly, my exhaustion got to me those three days, and I have very little in the way of journal entries, so I’m just going to tell stories from memory!

Day 4 (Clinic) – I was in a triage group with Evan and Emily today, with Ivan as our translator.  The three of us alternated asking questions, performing the physical, and going to the pharmacy.   We started the day off by seeing all of the orphans. One nun came to our group, with four of her children with her.  Seeing them took most of the morning. I was instantly and pleasantly surprised by the details she knew about each of the children.  Not that I think the children aren’t well taken care of, it’s that she knew when the cough had started, when it was worse, who had run a fever and when, and other details about their health.  With so many children in her care, that spoke volumes of how attentive she is! The children were very sick, and many of them had been sick since they had been brought to the orphanage, 3-4 months prior.  The first one we saw was 4 years old, but was at the growth and development level of a 2 1/2 year old.  He had followed us around during our tour the day before, and loved to hang on us.  The Sister kept telling us how worried she was about him. We treated both him and his brother, who had been dropped off by their mother a few months before. Their father was an alcoholic. One of the other boys she brought to us received two pages worth of prescriptions.

We ate lunch in the usual place, then came back for more clinic.  I must say, it was an odd feeling to walk out and go to lunch when there were a dozen people waiting outside. We had to eat, but still, an odd feeling. We spent the rest of the afternoon seeing patients. The only patient that sticks out from me from the afternoon is a 27 year old woman. She came to us complaining of lower abdominal pain. We took her history, and performed a physical exam.  We suspected a UTI, but all tests for that came up negative.  We asked all the questions and ran all the tests we could, then we were stumped.  Dr. Cerrato came over for consultation. We presented the case to him, and he decided that we needed to perform an abdominal examination.  Us three students, Dr. Cerrato, and Ivan all went to a back room with our patient.  The room had a bed, so we could have her lie down.  I felt bad for her, since she had to have the palpations performed times 4.  Those tests also gave negative results.  After she answered some more questions, which I’ll spare you the details of, the final conclusion was that she had an STI (aka STD). She was given a cocktail of antibiotics, vitamins, and instructions to use condoms and have her husband checked out at the local health center.

On top of getting to perform an abdominal examination, the woman’s case stuck out to me for two reasons: the first, she was the first woman I have ever met that had an abortion. I hope my shock didn’t show on my face when she told us that. She wasn’t the only patient with an abortion in her past, but I never got used to that. It shook me. The second reason actually happened the next day. She brought her 7 year old daughter into the clinic. The daughter was presenting the same symptoms she was, and was diagnosed with an STI as well.  There’s only one way a child contracts an STD. Though the woman denied that her husband would do such a thing, we didn’t believe her.  This case is one I’ll certainly never forget.

We held clinic until about 4:30. Dinner was at the hotel that night, and then we had a suture and shot clinic with Dr. Cerrato.  We stitched up some kitchen sponges, and gave water shots to oranges.  Pavel decided to make things a little more realistic…

He flinched and yelled at every needle stick!

and taped an orange to his arm.  We laughed so hard! Unfortunately, the orange was only able to take a couple shots before it started leaking, so we didn’t all get to stick him.

Day 5 (Clinic) – I was in a triage pod with Kevin and Katie. We had one day of experience under our belt, and things went super smooth.  We fell into a good pattern of alternating taking medical history, performing physicals, and going on the pharmacy run. Learned on Day 5:

-Kevin glazed over all questions regarding the female reproductive system.  If the answers were relevant to the symptoms, Katie or I would have to go back and ask.  Too cute!

-As much as I enjoyed flexing my Spanish muscles, my absolute favorite thing was performing the physicals.  Placing my stethoscope on a patient’s chest and hearing their heart beat was a “Wow – what an amazing God I serve” moment. Listening to hearts beat never got old, even with 5 days of clinics.

-You have to get creative with kids.  One very sick little girl never cracked a smile, even when we gave her a sticker.  We needed to look at her throat, but she wouldn’t open her mouth more than a tiny bit.  Pavel was our translator that day, and he stepped in, telling us that we just needed to know the tricks.  He said something to her, and she opened her mouth up long enough to look in.  He loudly whispered something in her ear, in Spanish, after that, and she giggled a little! I asked him what he told had told her – it was “That’s the game we call ‘Show the tongue to the gringos!'” Ha!

-It’s ok to laugh! “Abra la boca, saque la lengua, diga ‘ahhh!'” is one of my favorite Spanish phrase sequences. However, my rhythm gets off and my pronunciation is subpar at times.  I was performing a physical of a 16 year old girl who worked as an apprentice to the nuns.  I asked her to open her mouth and say ahh, and we both just burst out laughing. She was laughing because I was so excited I had mastered that phrase, and I was laughing because I knew how silly I must look and sound! We got in a good minute of belly laughing before we continued with the physical.

-Education is key. Pavel would occasionally give long spills to the patients, then tell us what he’d said after.  Often, it was things that we would never think to share – that parasite treatment was needed every 3 months, that clean drinking water would stop digestive issues, and many other hygiene issues.

That afternoon, my roomies and I made a quick trip to the supermarket.  Don Juan, our bus driver, was sitting at the front gate when we went to leave.  He didn’t speak English, but we understood each other.  He told us it would be dangerous to go with just us girls, so he went with us.  Long story short, we were short on time and ended up running through the streets, 4 American girls in scrubs and Don Juan – what a sight we were!

We had a natural medicine seminar before dinner, which was pretty interesting.  It turns out that ginger is one of the main roots used – a mug of ginger tea with honey will cure all digestive issues, help a common cold, and help you sleep better at night!

Day 6 (Clinics) – The general health team was spending the morning touring a hospital in Masaya, so the other Well-Child chicas and I had to head up to El Crucero extra early.  Dr. Cerrato was going to the hospital with the other team, so we had Dra. Ferrayra for the day.  We got to the orphanage before the doctora, so Marta sent us to the preK room to deliver some of our donations.

Que color es eso? They all got a couple crayons of their own!
They sang a number song for us!
Hanging out with the prek class was a great start to the day!

Once Dra. Ferrayra arrived, it was back to work.  For the morning, Emily and I worked the pharmacy. Since it was just the Well-Child team, we had only two triage pods.  We had prescriptions to fill about every 20-25 minutes, but other than that just sat there.  We talked to Marta, and a few kids that would wander through.  Emily and I knew we had to take our turn in the pharmacy, but I’m grateful it was only for a half-day.  We both agreed that the pharmacy was not our cup of tea! It just moved way too slow. One of the other girls, Lindsay, is actually a pre-pharm student, so she was one of the two pharmacy people every day but this one.

They let two redheads run the pharmacy!
The Well-Child girls! (Karen, Danielle, Emily, Brittany, Natalie, me, Katie)

The general health team joined us for lunch, and shared about the surgeries they had seen that morning, a c-section and a reconstructive surgery.  It’s probably a good thing the restaurant staff didn’t speak English, because we shamelessly discussed all the gory details!

Jenna and Danielle took over the pharmacy after lunch, and I joined Seth in a triage pod. Ivan was our translator, but Seth is pretty fluent, so we didn’t use him too much. We mostly took care of a good assortment of people that afternoon.  A brother and sister who had chronic parasites.  A well-dressed older man with some arthritis.  A woman who ran her own restaurant.  I remember a couple stories from that afternoon: one sweet, bubbly little girl, who was about 5 or 6.  I was taking her vitals, and needed her temperature.  When I told her what I was about to do, her eyes got as big as saucers.  She asked me a question, and all I caught was “rectal?” Her mom, Seth, Ivan, and I just burst out laughing – we couldn’t help it! She saw the laughter and relaxed. I told her we were just going to put the thermometer in her armpit, and she was happy-smiley again.

The other story from that afternoon – a sad little boy, 5 years old.  He was basically allergic to every food he had ever eaten, as well as mosquitoes and heat.  Since he still needed nutrition, he had to eat. He just got a bloated, achey tummy after every meal.  In the US, he would have been tested for specific allergies and placed on weekly allergy shots.  In Nica, he was given Tums, vitamins, parasite treatment, and rash cream.  I was taking his vitals as well, and when I pulled the thermometer out of my pocket, he screamed, “inyección, inyección, no, no, no!” His mom and I finally convinced him that we just needed to put it under his arm, and there was no injection, just a thermometer! When we got him taken care of and sent to the pharmacy, he came back and gave Seth and I both hugs and said thank you! After his prescription was filled, his mom stayed to talk to the nuns for a few minutes.  As I was taking the medical history of our next patient, he came back over and leaned his head on my shoulder.  I pulled him into my lap, and he sat there quietly until I had to get up and go to the pharmacy.  Such a sweet little boy, but so sick!

That night, we drove back to Masaya for dinner and dancing.  We ate at Pollo Narcy’s, and then went to the Masaya market for some traditional Nica music and dancing.  A band was playing when we got there, so we all danced (even Marta and Pavel) up at the front, until the traditional dancers came on.  We watched some little dancers, then older ones, then called it a night.  Funny moment: a college-age guy came and asked Karen to dance, then talked to her for quite a while.  We teased her the rest of the trip about her “Nica boyfriend!”

Baila! Baila!
This is also the night that Nat and I got dressed at the same time, then turned around and we were wearing the same thing! We were both too stubborn to change, so we rolled with it. She did finish getting ready first though, and ran out to tell everyone I had copied her outfit 😉

This is, so far, the longest post I have ever written! I’m trying to just giver overviews, but the more I write, the more I remember.  Thanks for bearing with me! Up next: our first recreation day!



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