Here I am, once again playing catch up. September has flown by and I now find that the calendar is almost through October. September was a month to start fresh, beginning with a new fitness routine with my co-worker Tony as well as changing the system we use in the clinic for organizing patients. Tony and I started running during the last brigade and have managed to keep a fairly regular schedule since then. We have only cancelled our morning runs a few times, mostly due to weather or off island travel. At first we stirred up enough interest that some people asked to join us, most notably my neighbors. Unfortunately my excitement in having a local running group was short lived as no one has actually came with us in the mornings and thus far have only talked of doing so. I still have hope that one day we will convince others to join us, other than a couple of kids and their dog who were curious when we ran past them. The little boy without shoes even beat us to the end of the path.
Clinic has stayed steady throughout the month. After some discussions with my co-workers in Los Angeles it was decided we needed to change the system of how we see patients back to “first come first serve”. This was hard for me as there are often many people who arrive later in the day and whom I have to send away, asking them to come back another day to try their luck again. As I mentioned in my last post there has been a lot more patients coming to the clinic from the other side of the island and from the more remote communities. Angela and her mom have been seeing patients arrive as early as 5 or 6 in the morning to wait to be put on the list to be seen. It still surprises me that people make this much of an effort to come to the clinic, and I cannot imagine having to do this anytime I needed to see a doctor as this is the same system that is used by the other health centers here.
Independence day for Nicaragua fell mid-month, which meant another few days where day-to-day work is interrupted and the hospital would be closed. In the hospital I still use an sort of appointment system (citas), so I decided to work at the hospital the day before Independence Day as I felt it was better that the doctor show up and not the patients than the other way around. For a half day during a holiday I was kept quite busy, especially as I was called in to assist the on call doctor a few times during the morning. It was while working with the other doctor that I had one of my most challenging days this year. It started with a birth just as I arrived at work. I was excited to be able to assist as I felt a little more comfortable this time around, however this would not be in any way the same as my first experience in the delivery room. This time the mother was having quite a difficult labor and from the look on the doctor’s face I was sure that there might be an emergency boat trip to Rivas that morning. Fortunately a healthy baby girl was born to a very happy and relieved mother. Shortly after the birth I received another knock on my door, requesting I return to the emergency room to help the doctor once more. Not sure what to expect I found myself in the other surgery/ delivery room with a patient who would not have such a happy morning. My role was to prepare the medicine tray with sterile gloves and supplies, and then to hold a headlamp so that the doctor could see to do their work. When I asked what was happening I was told that the patient has lost her pregnancy earlier that morning and had been bleeding quite heavily. The nurse returned shortly to help the doctor to make sure the patient would not have an infection and to hold the light for him, and all I could do was hold the mother’s hand as she lay alone in a stark surgical room after her miscarriage. I had no words that I could think of to say to her, and I had a feeling that even if my Spanish were better I still might not have words to say. It was the hardest thing for me to leave that room, as she stayed there alone, resting after all she had been through. I pulled myself together to finish seeing my patients, and then I retreated for a little coffee and chocolate to help me process the feelings that I could not articulate.
The next day, which was Independence Day, I had off. In the morning I joined Ashley and the family at the park to see the school awards and the marching bands. In the afternoon I met up with Tabby, Angela and a bunch of the family for a day of swimming at the beach in Santo Domingo. For having lived here for 9 months and having driven past Santo Domingo many times it was actually my first time to the beach there. As we are now well into rainy season there was very little beach to speak of but the water was cool and inviting and we spent most of the afternoon splashing about with the kids and having little diving or swimming competitions.
September marked my ninth month being here, which also meant it was time for me to renew my visa. I was hoping to avoid another trip to the border and so decided to try my luck at the immigration offices in Rivas. It turned out to be a much smoother experience than most of the others I had, even if I had to make the 6 am journey to Rivas two weeks in a row. By the end of the month I was all set to stay another three months, whether or not the island is ready to keep me that long. It was important for me to get my visa settled mid month as not only did I want to avoid any fines but also I was expecting another visitor at the beginning of October.
The end of the month brought some clinic excitement as well. While Tabby was in Managua dealing with more paperwork, she managed to locate a medical supply store. This was great news to me as we running exceptionally low on Pap supplies, and after all the generous donations to our DIOSA program I was worried about how we could continue to offer exams to the women on the island. I had been hearing from many women that they were being turned away from the local health centers as they too were out of the supplies needed to be able to do the exam. Fortunately, with the discovery of this store, we would not be in that situation and so with the help of many who donated to DIOSA recently, we restocked our supplies and even purchased a new light for the exam room. I cannot express how excited and happy I am with this new light. The light we had been using before was quite literally a desk lamp that took a fair bit of balancing and luck to be able to position it well while doing an exam if you were working alone. We are now back on track to reach DIOSA’s goal of improving the experience women receive during their Pap exam and increasing the number of eligible women who actually have the exam done.