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