Just as I was getting ready to get back in routine and back to work after my visitors it was time for Tabby and Tony to leave for the AANP in Arizona. Which meant that Angela and I would be on our own to hold down the fort here on the island. It was definitely busy back at work after having taken a week off. Many patients commented on my vacation, especially as most thought I had left the country rather than having had visitors come to see me. The beginning of the week was mostly making sure everything was sorted for what needed to be done while the boss’s were away.
The first week that I was back in clinic turned out to be another one of those challenging weeks that reminds me of the difficulties in working and living here. First I had quite a few cases that would have challenged me both mentally and emotionally if I were back home in Canada, but then it was complicated by the lack of access and services here on the island. Sometimes the island feels as though it is in a bubble and I get comfortable being here and used to challenges working here which means I don’t notice some of the big differences in services offered to the people here. Also because of the vitality of the people here on the island I forget that Nicaragua is the second poorest country in the Western Hemisphere. Then I will get a reminder that brings me back to the reality of the situation. It started early in the week with a case of a thyroid dysfunction complicated by epilepsy. This was a patient that has been seen both by NDI and the local health authorities. This particular patient was also from a town further away with less access and a poor family. The day I saw them they had been brought in early in the morning to the emergency room for seizures, they then continued to seize both while waiting outside of my consult room and then during the consult. Their family that had come with them knew how to calm them during the attacks, but still I couldn’t help feeling ill equipped in this situation, especially as I had no real treatment to offer them. Another challenge of working here is a constantly changing dispensary based on donations, sometimes cases come in and the appropriate treatments are not available. I offered what I could regarding the history of the case and then made sure to get them transferred as soon as I could to Rivas where they would be able to access more thorough care. The family almost chose not to go, as they could not afford the 60 cords (roughly 2 dollars) it would cost them to send a guardian for the patient.
This case was not done with me yet. On Saturday afternoon as I was playing cards with my neighbour I received a frantic phone call. It took me a while to make sense of what I was being told. It was the family, the patient had returned home and was seizing again and could not be brought to the hospital, as the family could not afford to pay for gas for the ambulance. I couldn’t believe what I was hearing. In my world the job of an ambulance is to have gas to be able to bring people to the hospital in emergencies. After many back and forth phone calls between Angela and the family I decided to go to the hospital and try to find a way to get this patient picked up. It turned out the ambulance really was out of gas. It took me a while and a few more phone calls before I convinced the on duty doctor to find someone who worked at the hospital to pay for gas and then send the ambulance for the patient.
Having to deal with this situation reminds me of what I take for granted. The challenges that people are faced with here are above and beyond anything I would encounter back home. Many here don’t have access to basic medicine or to basic services such as an ambulance with gasoline or a fully equipped emergency room. Knowing that this case was just one example of what happens here saddens me, as I think of all the other cases on the remote parts of the island who have no one to call to try to bring their loved one to a health centre or the hospital. It is a reality for the people here that sometimes what they need is just out of their reach, and so they will seek out care or help anywhere they can find it. It makes me realize why people will take a bus from the other side of the island to wait hours to see a foreign naturopathic doctor if it means they might be listened to, treated or given support to seek out the treatment they need. I appreciate the role that NDI plays here even more after experiencing first hand how people have come to rely on NDI not only for medical care but also to give them a voice to be able to access the health system here.