Our Final Entry

September 16, 2015 | Uncategorized  |  Leave a Comment

We are back in the United States and it is full steam ahead for fall semester 2015. While our brains are filled with our to do lists for nursing classes, none of us can forget our experiences in Nicaragua. It has become a part our souls and for many, it was life altering. As we reflect on the clinical experiences in Nicaragua, we believe it will make all of us better nurses in the short and long term. In the short term, while in country we practiced numerous nursing skills. We measured blood pressures, took vital signs, listened to apical pulses, measured blood sugars, participated in prenatal visits, instructed CPR classes, did physical therapy sessions, provided education on the use of water filters and the list goes on and on. Additionally, we have all returned to the States with a keener sense of empathy and compassion for the underserved, which will make us better nurses in the long run.

We have a deeper appreciation for the unique struggles the underserved face. We saw first hand a few of the health issues burdening Nicaragua, from parasitic disease and malnutrition to limited prenatal care and diabetes. The United States, with all of our infrastructure and technology is a country that also has its share of the medically underserved. It’s safe to say that we all find ourselves feeling more empathy and compassion for this part of the population, which we can directly link to our time in Nicaragua.

Nicaragua has left a lasting impact on our lives, and we are certain that it has helped prepare us to be the best nurses we can possibly be. While many of us may not have the chance to return to Nicaragua, the people will remain a part of our very being. We are all richer for the experience and we owe it to the Nicaraguans to continue to work with the underserved in some capacity.

Observing La Pediatra

August 13, 2015 | Uncategorized  |  1 Comment

Yesterday, some members of our group had the opportunity to observe a local pediatrician during her clinic hours at FIMRC. We saw a number of patients, including children recovering from pneumonia and those suffering from parasitic infections. One toddler with impetigo came in for a follow-up appointment post hospitalization, and the physician felt she was much improved, but adjusted her dosage some and told her mother to come back in a week, or sooner if she was not improving further.

The most striking case of the day was that of a young toddler who presented with an abscess over his clavicle. The toddler’s mother stated that her son had previously had a marking over the bone, but that it had turned into a sore. As the child’s history was obtained and we heard more of what the physician was saying, it became evident that there was some sort of injury to the bone, and his mother had been given a referral to an orthopedist, which they attended, then a second referral, which they deferred in favor of a visit to the local natural healer.

We heard that the natural healer had placed some sort of solution or salve upon the marking, then covered it and told the mother that she was not allowed to remove the cover, and that only the natural healer was permitted to view the treated site. She was to bring her son back in 3 days for a followup, at which point she could see that her son’s skin was not improved, and was in fact much worse, as the site was now open and swollen. The doctor put on gloves to further access the site, which was very painful, as the boy screamed and fought the exam — very emotional for us as students knowing it was an infection that was caused by an inappropriate “natural” intervention.

The pediatrician immediately addressed the boy’s mother, giving her a short lecture, stating that if someone suggested a treatment for her child and told her that she was not allowed to look, that should not be something she should ever agree to as a mother. The doctor explained again that there was some sort of bone deformity to the clavicle and she felt it had likely been caused by some sort of injury, as it had not previously been present and as such was not a birth injury. She was very concerned at the progression of the abscess, stating that the infection could be in the bone at this point and would require significant followup care.

At the end of the visit, the physician prescribed 14 days of oral antibiotics, a topical treatment, and told the mother that she should bring her son to the health post to have the abscess thoroughly cleaned as she felt the mother was too nervous to do so properly herself. The pediatrician then spoke firmly to the mother about the need to followup with her referral to rule out a tumor once the abscess had healed.

Having the opportunity to observe a specialist providing medical care in this community was a very unique experience I appreciated greatly. It was very impressive to see the careful balance the doctor appeared to successfully walk between pushing the parents to continue to choose to seek traditional healthcare and yet not pushing them so far with guilt over past choices that she alienated them. We hope this little boy improves quickly and is able to receive his followup care with the local specialists.

Tuesday morning (08/12/15) we had the chance to work with a group of children called “Los Pipitos.” Those “Niños” have different forms of conditions that result in developmental problems, such as Cerebral Palsy and Down’s Syndrome, and are in need of either physical therapy or occupational therapy. During our experience with that group, we did developmental assessments, physical therapy exercises, speech therapy, and fun activities that help with their issues; such as hopscotch, coloring, puzzles. Working with those kids gave us the opportunity to help them, as well as learn how to work with a variety of complications and improve our assessment skills. Speaking for the group, this was a touching and emotional experience for all of us, as the conditions of the kids had either been worsening or staying consistent over time according to their previous assessment charts.

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Elian is a child with Down Syndrome who attends Los Pipitos. One of the facilitators told me that at the beginning of the program, Elian had barely any education, but he has made great strides in the few months he has been attending the center. Thanks to his time at Los Pipitos, Elian can now count up to 15, identify some colors, write some letters, and it is apparent that he loves coming to the clinic and learning. During out time together, we read books and played hopscotch number games, which he loved. Every time he got an answer right, he would beam with pride. As we worked on coloring, Elian showed me the picture he had painted all by himself. When I asked him who it was, he pointed excitedly to his Mickey Mouse backpack, and exclaimed, “Mickey!”. During our adventures coloring, he concentrated carefully as he succeeded in staying in the lines and choosing the colors he felt were appropriate. It was heartwarming to see the love of learning that he exuded throughout our lesson. The smile and wave he gave us as we dropped him off at home dispelled any doubts we may have had before working with Los Pipitos. This is a program worth working with, especially in a country where handicapped children are so underserved by the public sector.

It has been a wonderful experience for us as future nurses, as well as human beings and the knowledge obtained through these experiences will be engraved in our hearts and minds for as long as we live.

Sports Day

August 13, 2015 | Uncategorized  |  Leave a Comment

On our first work day we split up into several different groups and ventured out into the community. Three of us visited a local school and taught the importance of exercise to about sixty 3rd, 4th and 5th graders. This community has one PE teacher for six schools so getting to each school during the week can prove challenging. We taught several new games such as Simon Says, Sharks and Minnows and relay races. Upon arrival all of the children were so excited to see us and we were greeted with tons of hugs. The school field was a multi-purpose area–lots of dirt, little grass, a baseball diamond and some horse and cart traffic through the middle. Some children did not have shoes and although the PE teacher had no more equipment than a few cones, it did not stop us from having an amazing time. Kids are kids wherever you travel and it is important to remember that. After 2 hours of running around, the kids were sent back to school and we spent the rest of the afternoon working in the clinic.

Los Pepitos

August 8, 2015 | Uncategorized  |  1 Comment

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Friday morning a group of us spent several hours at Los Pepitos, a facility for children with special needs. Every few days the kids can come and work with health professionals and volunteers to do physical therapy, and further their education. Yesterday morning we had the privilege to work with two precious boys with Down Syndrome, Pedro and Elian. We primarily worked with them on learning colors, numbers, and letters of the alphabet while also practicing writing and pronunciation. There was also a flat footed boy named Brian who was the sweetest boy with the biggest smile. We played ball, hop scotch, and follow the leader while emphasizing walking on his tippy toes and heels to further his flexibility and improve his ability to walk.

Finally, we all had the opportunity to love on a beautiful 12 year old girl named Maria, who has cerebral palsy and weighs no more than 30 pounds. Her family has kept her on a strict diet of milk her entire life, and is therefore extremely malnourished. Her health status is further compromised, not only because of the family’s inability to care for her properly, but because her value in the family is diminished. We massaged her body to promote circulation, and did a variety of exercises to further promote range of motion and flexibility for her frail body. She has the biggest brown eyes and Anthony, one of the volunteers, claims her ability to track with her eyes (follow us) was the strongest he had seen to date.

We all walked away both inspired and touched, with a deep love for these beautiful children for whom we had the privilege of caring for.

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Today was an eye opening day for our group. We spent the morning in the Rivas Hospital observing in the OR. The differences between the facilities and healthcare here and in the U.S. were pretty apparent. The hospital is one floor and open to the outside environment. The only closed areas we a served was the OR, Labor and Delivery, and Radiology. While walking through the hospital, patients were in the walkways walking or sitting and waiting with their family. Walking by the rooms it was shocking to see that each room had five or six beds in them and not nearly enough nurses to provide the care we are accustomed to at home. Isolation rooms were left with open doors and no extra precautions were taken for them. While going through the pediatric unit, there were no extra beds for parents so many of them were curled up in the cribs with their children to comfort them. It was surprising to learn too that all linens for beds, clothes for patients, and any other amenities had to be brought from home. We even saw a bed with a bed net over it held up by sticks. The family can clean their family members linens and clothes in the outside laundry facility. Food is provided by the hospital but is expensive so many patients have their families bring the food in for them. Any blood work done is handed to the family members to take it to the lab.
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During our time in the operating room, we saw a lot of things similar to home but also learned there were a lot of differences. We witnessed 2 C-sections, Orthopedic surgery, tubes being tied, and an appendix removal. At home a patients modesty is always respected but here it seemed as though they did not pay as much attention to it as all patients were extremely exposed and not offered much privacy. There is also no sense of HIPPA. We learned that general anesthesia is not commonly administered here so many procedures are performed with a spinal block meaning the patient is awake but cannot feel anything. During C-sections and vaginal deliveries fathers are not permitted in the room. Surgeries are only done between 0800 and 1100. If there is an emergency, a surgeon will be called in for it.

It was interesting to see how records are kept in the hospital. There are no computers. Everything is hand written. For the OR, there is a huge record book that every surgery is entered into. All the patient records are handwritten and kept on the unit they are in. Patients had no ID bands and no monitors.

All in all this was an experience we will never forget. The most amazing part about this experience is witnessing what they do with limited resources compared to what we have in the U.S.

Today our group went to the government clinic next to the FIRMC center to see how Nicaraguan nurses function in the country. Let me say, nurses run the show down here! There was no doctor on site, but the nurses worked independently and sufficiently. I had the experience of shadowing Maritza. The clinic was a walk-in situation, so women and children were coming in and out all morning…. along with chickens, dogs, and other animals that felt like perusing through the clinic. Our first visit was with a woman who had just had two breasts removed from her axillary region. One was healing well, but the other had become incredibly infected and dehisced. Maritza directed another nurse in cleaning the would with a homeopathic medicinal solution that they grow in the back of the clinic described to me as vanilla water. Maritza said the wound was improving, and she was instructed to return the next day for the same procedure.

Our next encounter was with a girl 11 years old. She was a chronic asthmatic having an exacerbation. We brought her into the back room, where we gave her a nebulizer treatment. Usually, with a nebulizer treatment the apparatus is hooked up to tubing that goes in the nostrils, but the clinic did not have sufficient supplies, so the child was instructed to just hold it under her nose and breathe it in… which is difficult to do when the child has problems breathing in the first place!

The next client was bringing her new baby in to the clinic for the first time. The baby was eight days old, completely covered with an outfit, hat, and fleece blanket. The baby was sweating, and the nurse had to repeatedly tell the woman to stop covering her baby up so much. It is custom for Nicaraguan mothers to cover up their babies in excess. The baby, like many others under the age of 4, wore a red bracelet with two stones the size of marbles. This practice is said to ward off the “heat of others” which we took to mean any sickness that other people might transmit to the baby (but it seems like a major choking hazard to me).

Our last patient was a 17 year old pregnant woman coming in for her first ultrasound. We brought her in to the back room and hooked up the portable ultra sound machine. The machine stopped working when there was a power surge, and Martiza expressed her annoyance that the clinic doesn’t have a surge-protected extension cord. After she was able to reboot the system, we were able to do the ultrasound and found out that the baby is a girl, and that the mother is 23 weeks along. All in all, it was a very eye-opening day, and the experience gave me a lot of respect for the way Nicaraguan nurses run their clinics and take care of their communities.

-Alyssa Ball

Day 1- From the Team

August 6, 2015 | Uncategorized  |  1 Comment

Day 1 in the Clinic: Sorted through thousands of dollars worth of donations that we brought into Nicaragua. Unfortunately, we were not able to get EVERYTHING into the country, as things got confiscated at customs. Today we prepared posters and activities for the healthcare workers and locals on the importance of clean water, exercising, healthy eating, etc. We worked in over 95 degree weather, with no AC for 8 hours. Here is to hoping that our bodies can survive the long hours working in the heat! Tomorrow we officially begin our mission to work in El Límon to serve the pediatric, maternal, and elderly population.

Thank you for all of your love and support. We look forward to keeping you updated!

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