So I have now spent a good 4 months+ down in Nicaragua and I have yet to post a single update on anything medically related which has likely led many of you to believe that I am simply hanging out and travelling around the country! But don't you fret, I am in fact working in a medical capacity and not spending all my time on fun, games and travelling (as much as I would like to spend all my time doing that...). So generally speaking I go to the primary level hospital in El Sauce Monday-Friday. There are about 15 rooms in the 'in-patient' section with more than 30 beds. Every morning at 7, we do 'rounds' which is both similar and different from rounds back in Rochester. Of course there is always the patient presentation, but diagnostic questions are fewer and, of course, there are fewer test results to discuss. Then, at 8am out-patient consultations begin and depending on the day I may see patients with some of the general docs or evaluate patients with the surgeon or even see patients with the ob/gyn. Since October basic operations such as appendectomies, hernia repairs and tying off women's fallopian tubes have been performed in the OR in the hospital as well. So, I have had the opportunity to first assist in many operations as well.
The health system in El Sauce is such that the hospital is the nidus and then there are Puestos de Salud, or health outposts, in the larger or more distant surrounding communities. Nurses visit the Puestos daily, but a doctor visits 1-3x per week depending on the size of the community. I have had the opportunity to visit some of these Puestos which I enjoy because I have more opportunity to attend to patients myself due to the smaller nature of the Puesto and the often overwhelmingly large volume of patients that appear. Then, to add another wrinkle to the whole thing, on a monthly or bi-monthly basis there is a Fería de Salud at each Puesto. A Fería is when 3-4 general practitioners, a pharmacist, a lab-tech and small army of nurses descend upon a Puesto to attend to patients, perform PAPs, vaccinate children and educate the community about current health concerns such as leptospirosis, dengue, malaria, AIDS or any number of other concerns. I have had the opportunity to tag along with several of these Ferías as well which is always fun as there are a ton of patients (often more than 200 patients total between 830/9am and 2!) and more recently they have begun to feed the group!
So what follows are a few pics from some of my medical adventures.
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| Travelling to a Fería in the MINSA(govt health agency) vehicle - an old Land Rover. It was a tight fit, but good thing we got that Pinata there in one piece! |
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| Same trip. The older guy is a nurse and the dude in a full purple scrubs is a doctor in his 1st of 2 years of required social service to the govt - paying back his 7 years of practically free education. |
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| Coffee!!! The Puesto was up in the mountains where they grow and roast coffee. Too bad they still drink it with entirely too much sugar and not enough coffee... |
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| The pharmacy. |
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| Wait you need a place to attend to patients? Here's a table. Just ignore all the hustle and bustle about as we make lunch for 20 people... |
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| Attending! The little girl was much happier than this picture would make her seem... |
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| The view from the Puesto...not a bad place to practice medicine! |
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| In October a fellow UR med student, Patrick Millord, came down to El Sauce for about 5 weeks to enjoy the goodness that is Nicaragua. Here he is in action. |
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| Enjoying a cup of warm coffee on an already warm morning...it's still a nice way to pass some time. |
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| Post-surgery recovery room - aka hang-out/nap room for the surgical techs and even the docs themselves. Dark blue scrubs is the ob/gyn, guy at the computer is the anesthesiologist and the guy in light blue scrubs in the back is a surgical tech. |
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The OR. It gets the job done nicely and it has A/C!
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