Monday, February 28, 2011

Back in the States! Wrap-Up from Elliot

Overall, I had a great experience on my trip to Nicaragua with the Global Health Track and all members agreed. No one knew what to expect going in to this trip, but in the end, it helped us all learn and grow. We are now more prepared for our rotation next year and eventually for our careers incorporating global health.

This was the first year of the trip and there are still many kinks and room for improvement. We learned how crucially important it is to learn as much as possible about the culture and health systems before even thinking about trying to do clinical work in a foreign land. I was surprised to learn that while they obviously lack resources, in my opinion, the health care system set up in Nicaragua is far ahead of ours.

All of us with our posters (from left)
  Juan, Naomi, me, Marianne, Amber and Cristina
The trip also gave us the opportunity to begin directly planning our rotations for next year. Juan and I plan to return to El Tololar and live in the village during our month in Nicaragua. We also have a grand plan to purchase a horse to use during our month for transportation (and donate it upon our departure!)

I want to formally thank Dr. Anna Doubeni for setting up the Global Health Track and all of the details of our trip. We know the amount of stress and responsibility that you felt throughout the process. Thank you.

And to the group, it is amazing how close we became in only 12 short days. I look forward to working closely with Juan, Amber, and Christina over the next 1-2 years. And it was great meeting Naomi and Marianne, and hopefully we can stay in touch.

Thanks for reading and come back next year,


Day 13, February 25 (Friday) - Our Last Day!

This is our last day and just a travel day. Juan, Amber, Christina, and I all had a slightly later flight. After a quick swim, we crossed the street and said goodbye to Nicaragua until we return next year!

Day 12, February 24 (Thursday)

Today is the last real day of the trip. We had a later start and did some last minute souvenir shopping and packing in the early morning. We then went to a center that makes prosthetic limbs. The center only employs three people and can make around 100 prosthetics per year. Its funding is also supported by the Polus Center.

We had a last meal in Leon and took off for Managua. We stopped at a market quickly on the way and continued on to the Best Western which was right across the street from the airport. This hotel is luxury compared to the hostel! We went for a quick swim, then had a nice dinner and a debriefing session led by Juan.

Finally, we had one last card game by the pool and said goodbye to the three leaving early in the morning (Naomi, Marianne, and Dr. Doubeni).

Day 11, February 23 (Wednesday)

Today was our big day of teaching. We were well prepared, but were only planning on doing ONE presentation. When we got to the school we were informed that we would present to each grade (which meant FIVE presentations) and then two presentations at a different school!

Our ride to the school!

We all stepped up to the challenge and it seemed like our message was well received. We all presented in Spanish despite our varying abilities in the language. The younger kids really liked the posters we made and all asked us to return soon. The nurse from El Tololar also gave out Albendazole to all of the children during our visit.


After our presentations, we had a little time to relax at a nearby pool. We returned and played cards at our bar to close out the night.

Day 10, February 22 (Tuesday)

Today we had a meeting in a different health center called La Mantica. We took public transportation to get there. La Mantica is the health center that receives patients and monitors the clinic at El Tololar. In order for us to do rotations at El Tololar in the future, we need the approval of the leaders at La Mantica. That was the primary purpose of the meeting and they promptly approved our plan. The leaders then took the time to further educate us regarding the set up of the health care system in the Leon region.

After this meeting, we went on a tour of the hospital in Leon. This tour was shocking to all of us. The conditions of the hospital were extremely poor. (I could not post any pictures of the conditions as there are patients in all of the pictures, but will try to describe it.) The hospital rooms consisted of large rooms that held roughly 5-15 people at once. Obviously, there is no air conditioning nor television. When the hospital gets busy, patients often share beds. Patients are separated by specialty and further separated as either "infected" or "clean." This means that all patients with any type of infection (cellulitis, pneumonia, etc.) are all placed in one room while "clean" patients (surgical, trauma, etc.) are placed in another room. Imaging consists of only X-Ray and ultrasound.

After the hospital tour, we had lunch and had another meeting at the epidemiology center. We were given a lecture regarding a recent study on infant mortality. We also discussed the possibilities for our epidemiology project that will take place in our third year. After this meeting we returned to the hostel and spent the night finishing our teaching presentations.

Day 9, February 21 (Monday)

Today we left early to go to the health clinic at El Tololar. In the clinic this morning, we broke up into groups, shadowing the doctor, the general nurse, and the OB/Gyn nurse. This was a great experience. We saw how medicine was practiced on the front lines when tests and referrals are options of last resort. The medical staff was extremely welcoming to us and I look forward to returning to El Tololar.

El Tololar

After morning clinic, there was a meeting of the Brigadistas from the nearby communities. Brigadistas are people who are chosen by their community of usually several hundred people to represent them. At this meeting, any new preventative advice is given to the Brigadistas and the Brigadistas in turn share any medical concerns from their community.

Translation: All services in this hospital are free
While the Brigadistas are not medically trained, they are given the authority to give certain medicines for certain prescriptions. These medications are tallied and resupplied at these meetings as well. After the meeting we returned to Leon and began work on our teaching presentations on diarrhea.

Thursday, February 24, 2011

Day 8, February 20 (Sunday)

Today, after a slow start, we headed to the beach. Juan, Dr. Doubeni, and I went on a motorboat through a nature reserve of mangrove forests. We saw many interesting birds and a small crocodile. We had a few minutes on a completely secluded beach where not a single other person or development could be seen. We also visited a turtle hatchery.

We then had a nice lunch of fresh full fish and hung out on the beach staying for sunset on the ocean. We hopped in the cabs that we had arranged to head back. We quickly realized that our cab drivers were in an extreme hurry and were driving us recklessly without regard to safety in order to go quicker.

After multiple terrifying passes, we told our cab driver to slow down and he reluctantly agreed. After a street side dinner, we were all exhausted and just relaxed in the hostel at night.

Day 7, February 19 (Saturday)

Juan Carlos volcano boarding!

We had been given the weekend off during our time in Nicaragua. Most of the group signed up for a tour with Julio to go volcano boarding and visit a volcano lagoon. First, we had a short hike up the volcano. We were hiking on old lava with gorgeous vistas. Parts of the ground were smoking and extremely hot.

Once we got to the top, we hopped on the wooden boards that we had carried up and slid down it. It was similar to sledding, but obviously much longer! The speed accumulated quickly and all of us braked a little to slow ourselves down! 
We volcano boarded on this side

We hopped back in the van and promptly reached a part of the road that became very soft and the van could not pass. We got out and prepared the road with rocks and sticks for better traction.

After many attempts, we got past the difficult roadway. Upon approaching the lagoon, we got stuck again and we had to push the van to get it going again.  We made it to the gorgeous lagoon where we relaxed for a couple of hours.

Upon returning, a few of us went out for a night on the town as it was our only night to sleep in!


Day 6, February 18 (Friday)

We left Leon to head to the health center in the town of El Celse. It is a significant drive (about 1.5 hours). We had a brief stop to get some fresh smoked cheese and then continued on. We met with the director of the health center who led a tour for us. This health center has an impressive epidemiology and prevention department. They are also a 30 bed community hospital. We toured the clinic, the lab, the small OR, the OB department. The center is surprisingly similar to our community health centers.

We headed back to Leon in the early afternoon. A quick lunch break turned into a 2 hour lunch break as often happens in Nicaragua (waiting for the food). When we got back, we had a meeting about the trip and to discuss our plan to teach the basics of diarrhea to a group of school children on Wednesday. We ate at the same restaurant as last night and ended the night with a card game in the local bar.

A typical village house


Tuesday, February 22, 2011

Day 5, February 17 (Thursday)

Again, we got an early start and headed off to the Tololar Puesto, a village clinic. This clinic consists of a doctor, a nurse, a dentist, and a medical student and serves 4,500 people. We toured the clinic, which was about four rooms. The facility was obviously very basic and the pharmacy was the bare minimum. The staff was extremely welcoming to us.
A clinic room
We then split up into two groups and went on home visits.  Cristina, Amber, and I went with the nurse. We handed out Albendazole to everyone and the doctor gave quick preventative medicine advice. He instructed the villagers to wash their hands and cooking utensils well and to avoid mosquito bites as much as possible.

A home visit group

Juan, Naomi, and Marianne went with the doctor in the other direction. There, they made more traditional home visits checking on patients with chronic health problems as well as with a lady who was instrumental in beginning the health center at Tololar. We returned to Leon in the afternoon and promptly left to hop on a public bus to tour the medical school in Leon.

At the Tololar clinic
The medical school was surprisingly very similar to a medical school in the US with the exception of air conditioning :) We ended the day with a meeting with the director of the Department of Psychology where we learned about education as well as psychology in the community. We had an early dinner at a local restaurant that was one of our best meals in Nicaragua with a price tag of about $2. We ended our night at a local bar playing cards and watching the locals do karoake!

Day 4, February 16 (Wednesday)

We left early to go to the hospital for another meeting with the Director of  Community  Practice. He explained the Nicaraguan system of medical education to us year by year, then he explained the Nicaraguan health system. We ended up with a small break between meetings and we had a Nicaraguan lunch and explored some cathedrals.  (I also got an excellent haircut for $2.00!)

In the afternoon, we had a meeting at CIDS, the epidemiology center where we learned about some of the programs and projects that they have to offer. All was extremely educational. We met up with the rotarians for a fancy dinner with two Nicaraguan medical student who plan to do two rotations at UMass in the spring. This dinner ran on Nicaraguan time as it took about three hours and we promptly went to bed after returning to our hostel.

Day 3, February 15 (Tuesday)

Today we headed to the small30-family village of Porvenir. It's about 12 kilometers from Leon, but takes about 40 minutes due to the poor condition of the road and it is a completely different world. Despite being so close to Leon, it is complete village life in this community. We visited the school first. 

We are also traveling with a group from various rotary clubs in the US who are attemping to best donate money to this village. They plan to donate funds for daily breakfast at this school. Dr. Mick Godkin, the director of International Medical Education at UMass Medical School is also with this group  While the details of this plan were being discussed, we had an intense soccer (futbol) game with the children.

Moving on, we visited the local webmaster (yesthere is a webmaster) He is obviously more well off than others in the village. We discussed how to best use the donated computers in the classroom with him. This ended our short visit to Portovenir. We had a nice lunch break at the beach and then went to visit a small wheelchair factory.

There are 8 employees and the wheelchairs are made with local parts. The wheels resemble bicycle wheels in order to allow better travel on dirt roads. The program is largely financed by the Polus Center in Massachusetts. We then headed back to our hostel for some some intense salsa lessons led by Juan-Carlos!

Wednesday, February 16, 2011

Day 2, February 14 (Monday)

A smoking volcano!

I woke up early and explored the city for a little with Juan-Carlos. The city has a nice central square, several markets, and constant energy. We then had a brief meeting of mainly introductions with some of the faculty of the local medical school. We will have many more in-depth meetings with them in the coming days.

After this meeting, we had a team-building exercise let by Juan-Carlos. We then went on a historical tour of Leon where we learned about the two civil wars led by our guide, Julio, who was directly involved in both of them. We had a nice dinner and some relaxation time at the hostel to close out the evening.

Day 1, February 13 (Sunday)

We left Boston bright and early at 6 am, meaning we all had to get to Logan Airport around 4 am. There were two different flights going down, but all travel went without a hitch and the seven of us met up in Managua airport in the early afternoon.

We quickly hopped on a van to our new home for the next two weeks, a hostel in Leon, Nicaragua. The hostel is basic, but will do us just fine. We got acclimated, went out to dinner at a nearby restaurant together and went to bed early.

Tuesday, February 15, 2011

Welcome to My Blog!

This is Elliot Schaeffer, PGY-1 of the UMass Fitchburg Family Medicine Residency program. I am blogging about the Global Health Track's trip to Nicaragua this year.

We just finished an engrossing two weeks of lectures on global health topics in Worcester before we left. The purpose of our trip is not clinical, but to learn about the health systems of Nicaragua, establish connections, and to find a health topic of need in the community and present it to them. 

I guess I will introduce our group before beginning. First there is Dr. Anna Doubeni. She is our fearless leader and the creator of the Global Health Track. Dr. Juan-Carlos Ramos-Ayes is a Behavioral Health fellow. He recently came to the US from Puerto Rico and speaks fluent Spanish.

Dr. Christina Mota, PGY-1 and Dr. Amber Wiekamp, PGY-1 are Family Health Center interns in the UMass Worcester Family Medicine Residency.  Marianne Dominguez is a recent college graduate who is very likely to apply for PA school in the near future. Naomi Lawrence-Reid is a UMass Medical School student who is going into a Pediatric residency next year (still awaiting her Match results.)