Rice GMB Nicaragua Days 1-3

Rice University Global Medical Brigades: Nicaragua Medical/Dental/Public Health

Today marked the end of the second full day of our brigade. Already the trip has opened my eyes to a different world than I have ever been exposed to before and has shown me the power we all possess to make a lasting difference once we decide to leave our little comfort bubbles.

Thursday Night:

After months of preparation and building excitement for our trip, our team of 32 Rice students landed at the airport in Managua, Nicaragua on Thursday night carrying suitcase after suitcase filled to the brim with medications and medical/dental supplies that the Rice 

community and friends and family back home so graciously helped fund. As soon as we stepped out of the airport, though it was dark, it was evident that we were no longer in Los Estados Unidos. The weather was reasonably warm with a level of humidity comparable to Houston, the urban air smelled like a mix of smog and trash, and some Nicaraguan vagrants approached us speaking in Spanish and aggressively attempted to help us carry our bags to our trucks(the GB security quickly shooed them away).

Since we arrived so late on Friday evening and because our GB compound was located a 2-3 hour drive away, we had the wonderful opportunity to stay in a hotel in Managua that was equipped with nice amenities such as warm water, A/C, a gorgeous central swimming pool, and complimentary Nicaraguan-style breakfast. We stayed in rooms in groups of 3-4 people, and I was able to room with Jodie and Saheba, two very sweet friends.

Friday:

After a nice breakfast (platanos, papas, arroz, judo, etc.) we embarked on our long 2+ hour bus venture to the GB compound located in Estelí, Nicaragua. The long bus ride was a great way for me to see some parts of the country. We traveled from Managua to our compound in Turicentro Estelí and passed through rural stretches as well a few bustling urban areas on the way there. 

In the more populated areas, the streets were full of life. Children dressed in school uniforms shared bikes with each other while husbands zipped their pregnant wives around on mopeds and groups of giggling schoolgirls crossed the streets. We stopped at a gas station for a bathroom break, and the convenience store was packed with kids around our age/ a little younger. The native people look very pretty and healthy here with a range of darker to a more golden light skin tone, big round eyes, and a variety of light and dark full heads of hair. 

Our bus also passed through more rural areas with cows on the sides of the streets and old men carrying bunches of iguanas (?) by their tails. The majority of the people in these areas were seen out and about walking on foot with children playing barefoot around their houses and in their yards.

The GB compound that we get to stay in is quite large and well maintained. The compound is run by in-country staff and everything from food, housing, site leaders, security and drivers is covered by GB. The compound contained learning areas, which I assume are for local children that they bring on to teach about physics, culture, history, mathematics, and more. The compound also contained 3 pools (1 containing water), multiple cabanas, a cafeteria, and a pharmacy area where we sorted our donated medications. 

After we arrived, we ate lunch at the cafeteria and proceed to spend several, several hours packing meds… we opened up hundreds of boxes of medications and counted out pills and tablets and wrote their dosages on them to ensure easy distribution during our clinic days.

It was amazing seeing all of our medications unloaded. It gave a more tangible feel to all the work we put into fundraisers as well as all the donations we received.

Saturday:

Today was the first of our three mobile clinic days. We visited San Gabriel, a rural area hidden amongst rolling mountains The community was located over an hour drive’s worth away from our compound. During the bus ride I was able to see many parts of the community. The poverty was very striking.

Amongst the farmland lay little makeshift wood shacks assembled from fragile looking sticks and wood pieces where it was evident full families lodged. Clothing lines were hung from tree to tree and crowded with small children’s clothes. Stray cats, dogs, and little children ran around barefoot on unpaved floors most likely harboring parasites that could eventually enter their bodies through their feet. Meanwhile mothers carried babies or balanced large bowls containing water or other items on their heads. I have never seen such living conditions in the United States. I could never imagine these large families thriving with so little. 

We set up our clinic in a cleared out community church. When we arrived we were greeted with a surprising scene. The entire little grassy/rocky area in front of the church was packed with community members consisting of mostly women and children with a few elderly men. When we filed out of the bus they stared shyly and curiously at us.

The community was very friendly and gracious towards our brigaders. They had hung up posters reading “WELCOME RICES UNIVERSITY” and even had a small children’s dance performance prepared for us all. During our meet-and-greet, the in-country staff of translators, helpers, and 2 doctors introduced themselves to us and our two American doctors (dr. Helmers and Dr. May introduced themselves to them.

After we finished with the introductions, our brigade began rolling. Our clinic consisted of multiple sections:

- Triage:

Here we took and recorded vitals signs and principal symptoms for the doctors. This involved a lot of patient interaction and Spanish speaking.

- Consultation:

This is where we could shadow both the American and Nicaraguan doctors who evaluated the patients, diagnosed them, and offered them treatments and general lifestyle advice.

- Dental:

At this station, we aided dentists in general check-ups and treatments including extractions and cavity fillings.

- Pharmacy:

Students at this station helped hand out medications and ensure that the community members received the correct written and verbal instructions regarding dosages and storage conditions.

- Charla:

Here students interacted with the several young local children while their parents were waiting for medical services. For this station, our team prepared a hygiene workshop to teach them about proper brushing and flossing, gave them fluoride treatments, and taught them about proper water sanitation.

Today I was lucky enough to work both charla (morning) and consultation (afternoon) stations.

As soon as I began the charka with Olivia H. and Shannon, a beautiful 8-year-old Nicaraguan girl with fair hair and round hazel eyes rushed towards us and gave us each individual kisses on the cheek. Soon after more and more children flocked to us tentatively with reserved but intently interested facial expressions.

The charla was a fantastic way for me to practice my Spanish. While Olivia H. took the lead on narration, I had many additional opportunities to share some of my knowledge, ask the children questions, have them demonstrate brushing/flossing and teach them a few English phrases. They were super cute and well-behaved. I helped the cutest little girl floss her little teeth though they all had huge gaps between them. Better to ingrain good habits sooner than later though! After our dental and water presentations we handed them individual ziplock bags containing a toothbrush, a roll of floss, and travel-sized toothpaste. The kids went crazy attempting to gather as many as they could from us…” Muchacha! Muchacha! Cepillo, cepillo por favor! Para papá, para hermanita en casa.. para abuelo enfermo.” I was corned off by 30 or so hands of children and parents begging for more. It was so interesting seeing all of these people begging for toothbrushes. It crushed my heart because it would never been something you would see in any community in the United States that I have lived in. As Olivia A. mentioned to me later, the children were probably all excited just to have a possession to claim as their own.

After we had gone through our prepared curriculum, we moved on to games. Though the age of the children ranged from more young to older, the older kids were amazingly patient with the younger kids. Additionally all of them were extremely respectful and inclusive towards us. Their manners were much more tame than children I have tutored  back in the states and it was evident that they had grown up with an understood culture of respect towards elders. We taught them “pato pato perro” (duck duck dog), “rojo luz, verde luz” (red light green light), y “Simon dice” (Simon says). In return they shared us some of their most popular games: “gato y paloma (sp?)” (cat and mouse), a complicated group game, as well as “quartel (sp?)”, their version of capture-the-flag requiring piles of rocks to mark sides. Though the children were not at optimum health, they had ceaseless energy and ran us all out under the beating sun. Their bright faces, giggles and teasing faces had all of us brigades on our toes after lunch up until we left for the day.

Lunch was absolutely delicious. The wonderful GB staff packed us individual boxed lunches containing rice, chicken, vegetables, and a sort of special chips, and a mixed fruit punch. It was my favorite meal thus far.

After lunch I was able to pair up with Katie P. to shadow Dr. Thaddeus May, an internal doctor from the Baylor College of Medicine. He spoke impeccable Spanish and was able to communicate directly to the community members during his consultations. I tried my best to follow along and translate general ideas to Katie.

We saw several, several patients. They just kept on coming. Many of them complained of issues affecting multiple systems. Most women complained of back and joint pain, most likely due to carrying heavy items and walking long distances every day. Children complained of headaches, eye aches, vision issues, rashes, diarrhea, and general viral infection related symptoms including sore throat, coughing, fever, and vomiting. We ensured that everyone coming through took anti-parasite medicine. For those exhibiting viral-infection-like symptoms, the doctor prescribed them multivitamins. He also prescribed a lot of Ibuprofen and Tylenol amongst others. I also had the opportunity to see patients coming in with other issues including UTIs, consistent vaginal bleeding, pain in other parts of the body, anemia, and asthma. Others saw cases of renal infection and even tuberculosis. The doctors mentioned later that some of the patients exaggerated and complained of multiple problems in order to receive extra medications to stock up for their families for future cases of illnesses. 

I have shadowed doctors back home, but the experience in Nicaragua was much different than that in the U.S. I found people here to behave in am such more respectful and thankful way to doctors. Though they could talk for a long time in response to questions about their medical history, they did not do so in a negative, pessimistic manner. They consistently smiled and laughed throughout and listened quietly while the doctors gave advice (such as diet changes, breastfeeding tips, etc.). Additionally the number of young mothers here was startling. Most of the mothers we saw were 18-20 years old with 1-3 year old children. In fact, after I told one of the kids my age, she asked me why I didn’t have a little baby. It was strange for me to see girls my age sitting across the table balancing two babies on each knee, living in such different conditions with such huge differences in burdens and roles. Picturing myself in their shoes was too difficult to fathom. 

At the end of the day, we found that our doctors and dentists were able to see a total of 280 patients from the community. It was AMAZING to see our group’s impact. Having a paper total of donation money for meds back at home evolve into actual bags of pills that these hundreds of Nicaraguan people walked home blew my mind. I still am in disbelief at the sheer numbers of people who walked up to 15 miles and waited in long lines all day under the hot sun in order to receive GB medical and dental services.