My first week seeing patients in clinic just happened to merge with the first brigade that came here this year. Exciting for all of us. The brigade was great, and I believe they had students from each of the fours years from CCNM the Naturopathic School in Toronto. By lunch on the first day, and with Tony’s help I felt ready to break off from working in a massive group with Tabby to work with my own little group seeing our own patients. There was a lot of learning from everyone and it was great to have 2 other professionals as well: another Naturopathic Physician and a Medical Herbalist. It was a wonderful experience being able to work so collaboratively that if you needed a second opinion there were people around you. And to top it off I was starting to get the hang of some of my Spanish, near the end of the week Tony even left me on my own to translate for the brigadiers who were working with me. I believe he told me that I learned 5 new words that week, by this rate it should be about another 100 years or so before I’m fully conversational :). The brigade seemed to go by quite smoothly, and very quickly with long days but very inspiring with classes in the evenings and hearing everyone share their experiences and what brought them to Nicaragua and NDI.
Clinic was very busy, and between 3 consult stations, and an outside physical exam station we saw a lot of patients. Not without some exciting cases however. My most interesting and challenging case happened to be a suspected AAA (abdominal aortic aneurysm), which is serious and needs immediate referral at the best of times. When you happen to be on an island without access to a majority of emergency treatment things become a lot more challenging. What needs to happen is that the patient gets transferred to the hospital in a town 6 km away, there they will hopefully agree with the severity of the situation and take them by lancha (wooden speed boat) to Rivas, the nearest full hospital across the lake on the mainland. Not all the time spent in the clinic was as serious however, and there were lots of light moments as well. Some examples were trying to explain to patients that acupuncture really doesn’t hurt or seeing someone excited to see what just came out of their ear. During an ear lavage treatment one of the other doctors showed their patient a bug that had just come out of their ear! And now it is time I find those earplugs again…
On the weekend Raly and I went out to Charco Verde, which usually has a beach but due to how high the lake is right now has a great view of the lake, as well as tostones con queso… mmm fried deliciousness. We also did some touristy pictures en route and then finished the day with some ice cream and watching the sunset from the marina in Moyogalpa.
The end of the brigade was difficult. Tabby and her family needed to go to Managua as her young son was quite sick and had a serious ear infection which turned out to be an abscess and mastoiditis. It was good they went when they did as he was able to get great care, the whole family was together and now he is back to his healthy active self! That week I tried to help out where I was most needed either organizing the clinic again, doing office work or helping out when needed with the water project that had just arrived.
By the end of the week I felt ready to try going into clinic on my own. So I got all my things and kept my trusted Spanish-English Dictionary by my side and went to it. And it seemingly went well. I managed to see a surprising amount of patients daily, and I definitely did not rush through consults. What most challenges me is really narrowing treatment focus as often people come in with a laundry list of health problems and it is often difficult to get a lot of details on when things started and how often things recur. Another challenge is just trying to help them get healthy or stay healthy when there is limited access to clean water depending on financial status of a family (which should change once the water project is up and running) as well as in the smaller communities outside of Moyogalpa, and even in Moyogalpa, nutrition. Many people eat the basic gallo pinto – or beans and rice, along with plantain and cheese. Sometimes there is chicken or salad (cucumber, tomato and onion) as well. There is a lot of fruit so far, but it is a challenge for varied protein and balanced nutrition, especially depending again on income. It is one of the things that is most striking here, from having worked with low income families and the challenges they face keeping themselves and their families healthy back home it is a whole different level in doing that here on an island where many people work in the campo for fields of coffee, wheat or tobacco.
Being here is also an excellent lesson in focus and staying present. There are always a trillion things going on around you. Whether it is bugs, people hanging out in the doorway trying to ask you questions while you are in a consult, phones going off, pigs running past or trying to run into the clinic, horses stampeding past etc. So you really have to work at staying with your patient and being very focused on the case. For example I was doing an abdominal exam on a patient, due to construction, dust and necessary venting, the table is right under the window, which is often open. This is fine except for privacy, which I will get to in a minute, and distractions. While I was doing this exam I look up as I hear a bunch of commotion, what do I see but a rooster getting it on with a one-legged hen (insert wildly inappropriate joke here). What do you do? Here you shrug, shake your head, think good work chicken and go back to your job (anyone else here feel like they are in the Mark Wahlberg SNL sketch: hi chicken, how’s it going, say hi to your mother for me).
And back to the topic of privacy, as mentioned windows are almost always opened and doors are very rarely closed or locked. People have a tendency to burst in, and even in the hospital people will try to sneak in on other peoples consults. You might think this would be a problem and people would be horrified, but for the most part they are used to it. I will step away for a second to get a vitamin or a treatment plan for a patient and come back and they are chatting with the next patient who has come in to sit by them. If the patient you are talking to doesn’t know their age (surprisingly common and ever-changing: “yes I’m about 50 or 60 does it really matter?”) someone else will yell over to you to let you know, or tell you what meds they are on. Maybe I come from a culture with very strict views on privacy (minus what is put on the internet…) but I find this a bit strange. I will ask patients if they are ok if I listen to their lungs, I look down to grab my stethoscope and their shirt is off, in front of an open door – to the street. Which is very kind of them but a little extreme for my needs. Someone has a rash in a more delicate location, no problem they’ll show it to you. Even at the window to the clinic, little kids will line up and pop their heads in, or the older man who NDI rents the building from will lean in and chat. Every time I see him in the window I kind of hope the Mr. Rogers song will play – “won’t you be my neighbour”. He does take good care of the patients who are waiting outside by chatting with them and keeping an eye on the chairs, and when no one is in the clinic he talks to me which I am sure is a sight to see due to the fact he is almost deaf and has many missing teeth, and I usually feel almost deaf with all the commotion and my limited Spanish.