NICA2012, Day 10: “They come because you’re Americans”

Day 10 (Clinic) – This was our last day of clinics! It was also Memorial Day, we realized later. We went back to La Hoyada, and set up clinic at the Molina’s. Normally, we would sign up for triage groups and pharmacy at breakfast, but we didn’t that day. After we arrived and things settled out, Danielle, Natalie, and I were in a group together, with Ivan as our translator. Both the spots on the porch were claimed, which left the house. We knew it would be stuffy, so we talked Ivan into letting us set up in the shade outside, which gave us the prime spot! It was a beautiful, sunny day, and didn’t rain at all. (May – Dec is the rainy season in Nicaragua, so this was rare!)

Our first patient was a 22yo woman who was 31 weeks pregnant with her first child. A few days before, her child’s movement had drastically decreased. She was also complaining of swelling in her feet. We were able to assure her that the swelling was completely normal, and Natalie and I thought that decreased movement was also normal. It made sense to us – the child is running out of room (or womb!) to move, and possibly shifting into the birth canal. After consulting with Dr. Cerrato, however, we were wrong. He said that movement should continually increase until birth, so we needed to perform an abdominal inspection. We took her into the house, and Dr. Cerrato found the baby’s head and butt. Turns out, the baby had gotten turned laterally. Head down is ideal, and breech (butt down) is also somewhat normal, but the baby had turned to where his butt was on her right side, head on the left. I got to feel the baby’s head, and listen to the heartbeat! It was an absolutely “WOW” moment that is hard to put into words. We gave her pre-natal vitamins and recommended that she see her OB asap, because the baby’s position indicated possible need for a C-section.

Next we treated a baby, who was completely sacked out when his mom brought him in. We were worried he would be cranky when we woke him up, but he was very lively! He managed to lick my entire stethoscope.

As we were finishing with the baby, a moto pulled up, and they brought out a very old man, who was clearly in poor health. Dr. Cerrato wanted us to take him immediately. The man was 86, with congestive heart failure and Alzheimer’s. His daughter’s had brought him to us. He was already taking a long list of medicines, so all we could do was give him some vitamins. Dr. Cerrato explained to us that sometimes the Nica doctors don’t tell patients when things aren’t good. They give medicines, and let the patient leave, thinking the medicine will cure all. The best thing we could do for the man and his family that day was tell the truth about his prognosis. The whole thing happened in such a whirlwind that once it was over, Nat, Danielle, and I were a little dazed. Pavel began to explain to us that the people of the community viewed Americans as superheroes, people with the magic cure. This man’s family brought him simply because we were Americans, and they thought we would have some new cure the Nica doctors didn’t have. I was shocked. Thinking back to previous clinic days, however, it all made sense. We had multiple patients tell us that they had seen several doctors who couldn’t tell them what their medical issue exactly was. Every time we would talk to a patient like this, I would think, “Don’t they know? We’re just college students. Not even doctors. What makes them think we have answers?” Pavel’s explanation cleared some confusion, but I’m still a little taken aback by it all. Naturally, the next question asked: “Did we disappoint that family today, when we didn’t have a new, great cure?” The answer was no, the fact that we spent time looking at the case, and told them the truth of the prognosis, meant a lot to them.

All of this happened before lunch! After lunch, we saw fairly normal cases. An STI, a few cases of athlete’s foot, the common cold. For some reason, we seemed to have more downtime between patients today, so Danielle, Nat, and I got to just chat and get to know each other. That, on top of some great cases and getting to sit out in the sun all day, made this my favorite day of clinics!

Danielle, me, Nat. We make a good team!
Gotta have at least one silly pic! (We may have taken a few more than one though…)

Part of the ISL program is to present interesting cases to the group and doctors. After we wrapped up clinic that afternoon, Danielle, Katie, and I presented the case of the woman with the C-section from the day before.

Presenting a sad case to the group.

And Natalie and Karen presented a case they had the day before as well, a little boy with leukemia. They hadn’t diagnosed him, just gave him a check-up and some vitamins. They presented his case and course of treatment, and some leukemia facts.

Karen and Nat

We chose to eat dinner at the hotel that night, because we decided the food there was better (and faster) than most restaurants. Since dinner only took 45 mins, we found ourselves with some time to kill. We broke out the cards, borrowed some spoons from the kitchen, and played a few violent and laughter-filled rounds of spoons. Blood was drawn, but we were all still friends at the end!

Whew, day 10 done. I should have known that I’m too long-winded to put multiple days in one post and still keep things short. Up next: touring Managua and the local hospitals!


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