With August coming to a close it was time to prepare for the next brigade. Which meant making sure all the paperwork was signed, sealed and delivered from MINSA. Unfortunately for me, as I found out the Friday before the brigade was to arrive, my papers were not signed nor sealed. Some changes had been made regarding the requirements for licensing documents, and my papers no longer met the requirements needed. So early Monday morning Angela and I set off to Managua to see if we could convince the powers that be that my papers are in fact legitimate and that I am a licensed Naturopathic Physician. I had spent the night before working to make sure I had all that I needed in terms of my license, my acupuncture certificate, my transcripts, any letters, copies of internet pages, copies of requirements for my licensing jurisdiction. I was sure that once I presented my case things would go smoothly. I would not be so lucky. The new requirements were to have my license notarized, in the United States or Canada, which as I was in Nicaragua posed a slight logistical problem. Also they weren’t happy that my license did not have an expiry date written on it. So it was back to the drawing board, or in my case contacting my licensing jurisdiction to ask them for documentation that states I am in good standing. Fortunately I had some great people on my side who were able to produce such documentation in record time, as we had to get back to the office before it closed at 1 pm. Angela and I got into the office just in time, only to find the people we needed taking lunch and not interested in doing much as the electricity had just gone for the entire sector of the city. This meant we would be returning the next day to see if they would accept our papers, which fortunately they did.
As I had just taken a couple days off of clinic to make sure MINSA would still let me work and as the month was about to come to a close it was time for another turno. With the brigade coming on the weekend I felt a good day would a Wednesday night, as I could come in a little later to the office to do brigade prep after a quick catnap. Wednesday was busy with longer visits and fewer patients but I felt full of energy, which would prove very important as the night went on. I was just finishing up with my last patient when there was a knock at my window beside me. Typically I try not to pay too much attention to distractions and focus on the patient in front of me, this time was much harder not to be distracted as all I heard was a man’s voice “Doctora Kyling hay un parto, vienes ahora”. For reasons I have yet to discover my name seems to end with “ing”, but the message was clear – there was about to be a birth and they wanted my help! So I finished up my patients and made it in more than enough time, excited and very, very nervous. It turns out the nurse that had worked with Michelle and I on my last turno remembered that I had never seen a birth and so she sent someone to find me when a patient went into labour.
After a rather brief rundown of what my role would be we were all ushered into the delivery room: the doctor, a nurse, the patient, their mother and myself. It was an incredible experience, one in which I gained even more respect for those who deliver babies on a daily basis (doctors, midwives, dulas) and especially for the mothers. The love this mother had for her newborn immediately following a rather uncomfortable and at times very painful birth was seen all over her face as soon as her little one was placed in her arms. I managed my role with as much calm as I could, with the doctor and nurse laughing at me only occasionally for my evident lack of experience in this particular situation. I was actually the second person to hold the newborn as I placed her on her mother’s stomach to warm and dry her. I also was in charge of moving her to take her vitals, during which there was a constant stream of “don’t drop her, don’t drop her” running through my head as I am known to be mildly klutzy. It was an unforgettable experience for me and for anyone reading this please give your mother a big hug for everything she went through to bring you here and the love that that takes.
It seems that would not be my only first for the evening. After fobbing off a few chances to practice my minor surgery skills it seemed only time to bite the bullet and give it a go. And so later in the night I got try my hand at stitching up an elbow, with the on call doctor right by my side giving me tips and pointers. Because of the location and depth of the cut the doctor had to do the first stitches and then let me take over for the outer stitches. Due to the surgical set up in the hospital how he was teaching me that night was a little different and a little more awkward for me to start. With lots of help I managed to stitch it all up and near the end the patient was looking less and less nervous about being the first Nicaraguan to be stitched up by me. After the stitching was done it was time to help the nurse with rounds, something I know is important but seems so cruel as often it is right when people are drifting happily to sleep after the last time we woke them up. Midway through I was back in the emergency room as there were some tourists that the doctor wanted me to speak to in regards to the rabies shot after one was snapped by a dog while leaving their hotel. After that it was back to rounds, helping the nurse where I could and trying not to make the littlest patients cry. Perhaps it was because of all the activity that night, or perhaps it was because I was getting used to doing turnos and sleeping when the nurse and doctor recommended it but I actually got a couple of hours of shut eye.
The rest of the week went by quickly. Some brigade prep on Thursday with Angela to make sure we had signs up advertising in the community and making sure the houses where the brigaders would be staying were ready. Friday was much calmer than I was expecting. It may have been due to a mix up in the list of patients I had written down for earlier in the week and partly due to the rain but it was really nice not having to turn a lot of people away for a consult. It was also nice to be able to tell people that soon there would be four doctors all working in the clinic to see them and their family if they could come back the next week.