Thursday, November 6, 2014

VIDA clinic

VIDA clinic
The bus bumped along the muddy road that had extra potholes from the previous night's rain. I sat in my seat next to Emily feeling apprehensive and very unqualified for the week's activities, and maybe a little excited. It felt kind of like that first day of school where you know it is all going to work out, but the butterflies in your stomach just will not quiet down. We narrowly missed dogs dumbly staring at the large bus coming towards them quickly. The houses that sparsely dotted each side of the road were made of sheet metal and some wooden panels and some looked extremely precarious perched on mud over sheer cliffs. Nicaraguan children and their mothers stared up at us with a contrasting mixture of confusion and glee at seeing white people in their village. We rounded a corner and saw the elementary school that would act as our clinic site for the next two days. Children in uniforms, regular clothes, and a mixture of the two were playing baseball, soccer, or sitting in groups around the school. A class was in session outside the classroom to avoid the heat already rising to an unbearable degree in the early morning. We unpacked boxes full of pharmacy supplies, intake forms, clipboards, thermometers, blood pressure cuffs, and any other supplies a basic clinic requires. Each group of three students was matched with a medical interpreter and given an "office" that included five or six desks in a circle in a classroom or outside. We chose outside in hope of a little breeze. Schoolchildren immediately swarmed our cluster of desks introducing themselves in Spanglish and smiling adorable gap-toothed smiles only young children and capable of producing.
The morning passed quickly, and we had time for one more patient before lunch. Our medical interpreter disappeared to introduce himself to our next patient. A young woman carrying a baby shyly approached our group. As we introduced ourselves, the young woman explained that both herself and the baby would be patients that day. We saw many young women and their babies throughout the day, but this case was by far the most interesting one that we saw. The baby merely had a common cold, so the doctor prescribed some anti-flu medicine and acetaminophen for his fever. The young woman complained of abdominal pain around her belly button that constantly bothered her. She explained that she had a C-section four months ago to deliver her baby. As we gained more information about her condition, I had the feeling that there was really something wrong with her abdominal area. She seemed like she was in too much pain to have it be a simple problem. Sure enough, the doctor immediately asked if we could take her to a private room for an examination. I held the baby as the doctor felt the area around her belly button. Very quickly after completely the examination, the doctor explained that this woman had a hernia that could potentially be very dangerous. We each got to feel the hard, perfectly round ring surrounding her belly button. Unfortunately, the only cure for a hernia is surgery, so the doctor gave her a referral to the nearby health center.
Although the doctor was able to diagnose this woman's problem, I felt unsatisfied with the result as we only told her she had this condition requiring surgery, we were not able to offer any counseling on the matter, and simply sent her on her way hoping that she would go through with the referral and see a doctor. I voiced this concern to our medical interpreter, and he responded saying that primary health care can be somewhat unsatisfying as these doctors spend hours on end, spending little time with patients, only to give a preliminary diagnose and maybe sometimes an easy treatment. He went on to describe how vital primary health care doctors are for any healthcare system. Without these doctors, patients would have no connection between the terrifyingly complicated world of medicine and how they feel in the moment. Primary health care doctors bridge this gap. This experience working in a primary health care setting really opened my eyes to the first step in providing care to people, especially in a vulnerable population like this one in rural Nicaragua.

Kat DeRuff 

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