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Monday, December 30, 2013

Nicaragua Medical Mission; practicing medicine and loving every minute of it!

Stan and Barb Grogg asked us to accompany them on a second Medical Mission. Stan is the Director of Clinical Medicine at Oklahoma State University. Barb runs their Travel Medicine Clinic as well as organizing numerous mission trips during the year. (six trips per year to Nicaragua alone!) Barb is truly the most organize person I have ever met. She attends to every detail.
As you can see, Stan is one fun guy!

We spent two weeks in Uganda in March  with Stan and Barb and flew to Nicaragua in December for a week with the Groggs, medical students, doctors and others. We worked in tandem with Just Hope/DOCARE Global Outreach in Chacraseca, Nicaragua.

During the 1980's the US was deeply involved in the politics of Nicaragua. You will remember the "Contras". (Ollie North) This was a movement against the Sandinistas and grew into a war that killed over 50,000 Nicaraguans (in a country with a population of 3,000,000). The US placed an embargo and mined Nicaraguan harbors in an effort to economically destabilize the Sandinistas. In the World Court the US was found guilty and ordered to pay millions of dollars in reparation fees. Not one dime was ever paid. Nicaragua continues to be in political turmoil.

The population is now just under 6,000,000 with a per capita income in poor areas of $300 per year.  Nicaragua is the second poorest country in the hemisphere. Malnutrition is 40% nationally and 70% in poor areas. Illiteracy is 60% in poor areas and we came upon many older people who were unable to read for a vision test. 76% of the population lives in extreme poverty on less than $2/day, so few are able to buy medication or buy glasses to see.

Nicaraguans are enterprising. They have built communal businesses such as brick factories, bakeries and hardwares. Clever crafts abound, but they remain mostly subsistence farmers.

We found this display in front of one of the churches.  90% of the country is Roman Catholic, but few attend on Sundays. Holidays, on the other hand, are well attended.

Public education is free, but many families cannot afford the clothing, supplies and transportation for their children.

Health care is free as well, but our visit to the largest hospital in Leon (second largest city in Nicaragua), exhibited a third world level of care. On the other hand we were pleasantly surprised with the advanced level of care in specific areas such as dialysis, and neonatal care.
As we walked by the door of this room, a baby was being bathed immediately after birth.
As we walked by this room, we could not help, but notice the lack of cleanliness we expect in the States.  We learned to say...well, this is Nicaragua!
This grouping of doctors has a professional look. Keep in mind there is no air conditioning in the hospital. We were visiting during the coolest season. Summer must be sweltering, though there is an openness with no windows or screens for mosquitoes.  In fact the Dengue Fever room has mosquito nets over the beds to keep Dengue Fever from spreading to healthy patients. The doctors we met were dedicated to their patients as they were not getting rich as doctors in Nicaragua.
This is the Main Clinic in Chacreseca.

 The Peace House in Chacreseca.

Classroom we used to treat patients.

I can't figure out how to rotate this darling boy.
Our ride was as long as an hour and a half each day, down dirt roads to find the school or building where we were setting up a clinic for the day. Riding in the back of the pickup meant you were covered with dust when you arrived in the morning. Some of us look better covered with dust.
This is Genevieve, who is a General Practitioner in Bakersfield, CA. She is extremely knowledgeable and likable. I enjoyed the home visits with her. Osteopathic Doctors have a different approach at times, than MD's. Manipulation is part of her patient care.

Barb Grogg, on the left is a Nurse Practitioner and the Admiral in charge. Linda, in red, is an RN who works in research at Oklahoma State University.
This is Dr Jim, posing as an Optometrist. Doesn't he look professional in his scrubs and shorts?
Intake or triage is an important job. Nina is a student at Oklahoma State, learning to ask those piercing questions. Nicaraguans are a modest people and it can be difficult to get to the heart of the problem.
This was our typical lunch. As a vegetarian, I was the lucky one as beans, rice and cheese work well for me! There was no lack of food. We had hoped to lose a few pounds and....that didn't happen.
Every one worked as a team. Regina in the cap is the head of the Women's Clinic at Oklahoma State. Felicity on the left is a medical student. Terry is a psychologist. Amanda is a medical student specializing on OMM. We learned that OMM is Osteopathic Manipulation ....something. She is quite an expert and expects to return to her small town home in Wisconsin when she graduates.
An important part of the mission is teaching students. Here Genevieve is teaching Justin, a medical student about this woman's diabetes. We treated many people with diabetes, though the medication to treat the disease is difficult to obtain. Hispanics have a higher percentage of diabetics in the population than Caucasians, so it is a critical issue in Nicaragua.
 Meeting people in their homes was the most meaningful part of the mission. These patients were unable to travel to the clinic and we walked long distances and rode in the back of pickup trucks, sometimes up to an additional hour to see them. As the scribe, I recorded name, age and treatment. Surprising to see what a hard life and lack of medical care can do to one physically. One ages much faster in this environment.

 The kitchen in a large home. That is a wood burning stove on the back wall for cooking. Rarely is there a need for heat to warm the home.

This s the main area of the home. Chickens and pigs may walk through the home when we are visiting with the patient.
We had clinic one day at this home. We worked outside, which was very comfortable and productive.
 I tried to go to Picasa to rotate this picture, but it isn't working. She is so cute, you get to see her sideways.

This sweet man brought a few friends in his wagon to the clinic for treatment. Most people walked to the clinic, while others rode horses, rode in wagons or rode on a motorcycle.

Our visit to the beaches of Nicaragua was incredible. We arrived for dinner just before sunset. Those crazy medical students insisted on going for a swim, some in their clothes! The water was like bath water. What fun!

Our most meaningful home visit was to see Martell. He deserves a page of his own.


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