Sunday, June 22, 2008

What the #%$@ AM I doing in Nicaragua? ........Part I

I got an email last week from a friend that I haven’t talked with in a while. I told her that I was down here in Nicaragua and planned to be here until the end of the year. Her response?

Hey Jones! What the #%$@ are you doing in Nicaragua?!

“Excellent question”, I thought. “Excellent question”.

The medical clinic in La Chureca (if La Chureca doesn’t ring a bell for you, check out the Blog entry from January) has been in operation for just under five year, and although it was originally constructed and funded by a charitable organization from Belgium, it is now operating through a group of physicians from Austin, Texas. The staff currently consists of two doctors, a nurse, and a pharmacist, with a dentist and an OB on the way (all Nicaraguan). The structure itself is simple but adequate, with a couple of exam rooms, a small office, and a separate small room that functions as a pharmacy. The porch in front acts as the waiting area and is relatively full most every morning from 9 to 11 AM.

Who are the patients and why are they coming? Well, the patients are the people of La Chureca, and the clinic is a “free” resource for the community. As for WHY they are coming, I think it would be comparable to the average Primary Care Physician’s office in the US. Due to the environmental factors associated with living in smoke and garbage, skin conditions and respiratory ailments abound in the community. There is also the occasional “trauma” associated with “machete fighting”, the burns or lacerations that result from walking through smoldering garbage without shoes, and a few AIDS patients that call La Chureca their home. The most common ailment though? La Gripa…the word that seems to refer to your general cold and flu symptoms. So after waiting on the porch for a few minutes and then having a short “consulta” with one of the docs, the average patient gets a shot or nebulization from the nurse (along with vital signs, etc.) and then walks out of the pharmacy with a small bag of antibiotics in hand.
In addition to the daily operation I just described, the clinic also acts as a “base of operations” for numerous other programs in the area. There is a child-sponsorship program, there are weekly health talks, and there are English classes taught several days per week. Want to have a “de-worming-drive” for the area (yea, parasites are quite popular as well)? Care to vaccinate the entire community? Have a medical “brigade” from the US that wants to set up shop for a day or two? Everything flows through this clinic. In fact, the clinic really isn’t even called a “clinic” but rather the “Casa Base De La Salud”……..or Base of Health.

Perhaps the obvious question then is………“what in the world does a gringo paramedic from Denver do in the medical clinic of La Chureca”? Well, the answer to THAT question would depend on the day. The good news is that I’m realizing more and more that the clinic really doesn’t NEED my help. They are functioning quite well on their own, and seem to be on a continual path of improvement. When I AM there though, I basically just fit in where I can. Sometimes I act as a nurse. I administer various medications through injections or nebulized breathing treatments. I clean and treat wounds. Sometimes I act as the “nurses AID” by weighing patients, taking temperatures and vital signs, etc. Sometimes I act as the janitor. I sweep the floor. I clean and organize the exam room. I try to keep the place tidy. And sometimes I help out in the pharmacy with the monumental task of taking pills from the BIG bottle and moving them to the SMALL bottles. Brilliant……I know…..brilliant. Beyond that, I chat with the folks coming through, hang out with the staff, and run the occasional errand.
And that’s pretty much my life at the clinic. In the earlier part of the year, I was spending as many as five days per week over there. I’m currently down to one. And as for the other days of the week? ………………to be continued.

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