Monday, April 1, 2013

Week of March 17: Final Reflections

For my last day, I went to CIDS, the epidemiology center and inputed all of our mapping data to start making a map of El Tololar. Although I didn't have too many points, it still helped get the project going and hopefully it will continue into the future.

My residency and global health track is coming to a close. I have overall had a great experience with the global health track. I've now traveling to Nicaragua three times with the program. The community of El Tololar is an amazing place. By the end of my time there, I fully felt like part of the community and am forever grateful to my host family. They welcomed me into their home and lives without even expecting any compensation (I did pay them an appropriate amount).

It's so refreshing how they just hang out and enjoy each other's company every single night. Kelly, my fiance, and I will come back to visit them at some point within the next couple of years. I am similarly grateful for the clinic staff and Doctora Urrutia. Their hard work clearly improves the lives of the people in the village and their patience with (at times) clueless foreigners was greatly appreciated.

Although my global health track is ending, I still have many global experiences to come. After I graduate, Kelly and I are going to get married, then take off for the better part of the year to travel around the world. Then, we will go somewhere in Central America, likely back to Nicaragua, although maybe a different part of the country, to volunteer for a year (Kelly is in public health). There likely will be a blog for our future travels as well, although it will likely be written mostly by Kelly. Stay tuned..

Monday, March 18, 2013

Week of March 10-16

Clinic group on my last day at the clinic

On Sunday, we left Leon early to return to El Tololar to go to Cerro Negro with my host family. I did this with them last year and they were very excited to return. This time we took a pickup truck with about 15 people standing in the back. Up on the volcano, it was some of the strongest wind I've ever experienced. It nearly blew us off the mountain and blew my glasses right off my face and off a cliff. Luckily I brought a back-up pair (and they were not very expensive).

Heading to Cerro Negro (volcano boarding)

For my final week, I worked in the hospital in Leon, but commuted from my host family's house in El Tololar (over an hour each way with walking, a bus, and a taxi). The first day was difficult as would be expected when trying to organize anything in Nicaragua through the Internet, but I eventually got to the pediatric emergency department where I worked for three days.

 There I saw a few patients and similar to America, most cases belonged in a primary care office rather than an emergency room. Although most cases were not dissimilar to the US, the system was much different. Patients would come discuss their case with the doctor in a large consultation room with numerous people doing the same right next to them (HIPAA has not made it to Nicaragua yet).

The group at Cerro Negro

Often, the patient would be discharged after the exam by the doctor, but if further work up was needed, the patient would go to the lab/X-Ray themselves, wait in the waiting room for results and then bring them back to the doctor when ready. This is how the majority of cases worked, but if a patient was unstable or very uncomfortable there was an area within the consulting room for them to stay.

I switched to the emergency department surgical area: orthopedics and general surgery for my last two days. Neither were all that different from the US except that advanced imaging is not an option (i.e. MRI/CT scan.) However, I did hear about some critically ill patients being transported to Managua 1.5 hours away to get a CT scan. Most services were completely free for patients and all they ask for is a name. However, some procedures require the patient to pay an extra fee.

For example, a laparoscopic cholecysectomy (gall bladder removal) requires an extra fee of about $60, while the open procedure is completely covered. Another observation that I noticed is the different approach to the doctor-patient relationship. It is very paternalistic towards the doctor with minimal cordiality and a patient would never question the doctor. The experience in the hospital was difficult because it was such a short period that I couldn't be helpful to the doctors and I struggled to understand the full speed Spanish when I was shadowing.

One of our games my last night in the village

For my last night in the village, my host family hosted a dinner for all of the nearby friends/family (and Stephanie). We played all sorts of games including sac jumping, tug of war, some other made up games, and of course volleyball. I am deeply grateful for all that they have done for me and have had an unbelievable experience living with them for now a total of 7 weeks (this year and last year). Although my program is over, I will come back to visit them at some point in the next couple of years. I invited them all to my wedding, but something tells me they won't be able to come.

Group shot of all the men on my last night in the village

For my final weekend, I returned to the mountainous eco-lodge of Selva Negra with Monica and Stephanie. As it is just as beautiful and relaxing as last year, I'd advise anyone coming to the area to visit this oasis. We hiked all day today, listening to howler monkeys and eating relaxing meals by the lagoon. I only have a few more days here, and will write one last entry.

View of some of the mountains around Selva Negra

Tuesday, March 12, 2013

Week Two: March 4-9

It's been another good week living in the village of El Tololar and working at the local clinic. Still playing volleyball with my host family every night. Stephanie and Monica arrived, but Monica stayed in Leon this week for Spanish school. Stephanie came to the village and started working in the clinic. She is living with a different woman, about a 40 minute walk away, but did stay over my house one night. She is blogging as well, so see her PGY-2 blog, too (I guess we'll be competing!)

At work, I went house to house working on the census and using the GPS machine to mark every house to start making the map of the community two days of the week. We had some intense clinic days where we had some tough cases; there was a woman with Rheumatoid Arthritis that was becoming debilitating and all we could offer her was diclofenac (a strong motrin). We also saw another older man with hearing loss likely due to aging for whom we were unable to offer anything.

On Friday a group of 12 Germans aged 14-16 came along with two professors to build solar panels and make general improvements to the clinic. The students did a dance to welcome them along with large tropical fruit dishes that were donated from the community.

Over the weekend, we went to Surfing Turtle Lodge, a small island/peninsula just off the coast of Nicaragua. The only people on the island are the 20 or so at the hostel. Otherwise, there is miles of deserted beach. We played some beach volleyball and had a nice beach bonfire to end the night. Tomorrow, we are off to return to Cerro Negro with my host family. Next week, I'll be working in the hospital, so there won't be as much overlap with Stephanie's experiences.

Wednesday, March 6, 2013

Week One: Back in Nicaragua

I'm back in Nicaragua for the last time with UMass. This year, I am doing some clinical work in the clinic as last year along with a small public health project, and end with a week of a clinical rotation in the emergency department in the hospital in Leon. I will start the rotation on my own (although I will see the interns for a couple of days) and then meet up with Stephanie and Monica (two of our second year residents who are coming to El Tololar to do their clinical rotations.

The health center
I have returned to the same family in the village of El Tololar that I was with last year. They welcomed me back with open arms. Little has changed in the village since I left. The family still lives all together in the same house. Almost every night most of their neighbors and friends come over to hang out and play various sports. They have been playing a lot more volleyball and are now much better than me at it. It is far more difficult for me this year as although I have improved at Spanish I am still not fluent and do not have Juan-Carlos here to help me.
Earlier in the week, I met with the interns for the end of their trip. We went to CIDS together, the epidimology center where they taught us how to use their GPS machines and mapping software. My project will be to help enter census and health data from El Tololar into their system and utilizing the GPS, will create a map which will be extremely useful in the future. This is a daunting project and I will only be able to barely get it started before my time is up. However, hopefully, this project can be continued by future global health residents.

The doctor taking census information

Once the interns left, I spent the rest of the week in the village. Doctora Urrutia was behind on her reports and thus I did all of the clinic visits on Wednesday. Thursday, Doctora Urrutia and I went out house to house updating the census and entering each house in the GPS. On Friday, I helped in the clinic again. Over the weekend, I took off to the beach, just 30 minutes from Leon and feels like a whole different world. Steph and Monica come later today.

The beach!