Thursday, November 6, 2014

VIDA Nicargua

There is nothing quite like getting hands on involvement in any field, but when it come to clinical medical work, it is an absolutely unique experience. Us OTS students spent last week (from Oct 26th-Nov 1st) in Nicaragua, learning about the culture and working in rural health clinics treating the community members with the VIDA foundation. To give some perspective, these clinics weren't established buildings or centers. We'd show up early in the morning to a primary school that was down a long dirt road into the forest, unload the supplies and treatments we had brought with us, and set up the school desks in circles of five to accommodate two to three students, an interpreter, the patient(s), and the doctor.
Our job there was helping four to five doctors process 100+ patients that came in each day with complaints ranging from runny noses to mental retardation. We would sit with each patient, or family of patients because sometimes they came in in groups up to five, and ask them pre-diagnostic questions, take their vital signs, and inquire as to why they had come to the clinic that day. With the information gathered, we would try to come up with a diagnosis and then present the case to the doctor and deliberate the possible diagnoses and treatments. Of course the doctors didn't need our help in determining what the ailment was, so it was wonderful of them to take the time to discuss with us why the diagnosis was what is was, and why it wasn't what it wasn't.
Naturally, all of the patient interaction was done in Spanish, and although we always had an interpreter on hand, I was pleasantly surprised by how much my groupmates and I were able to convey and understand without any intervention. Now of course there were regional terms that even the interpreters didn't understand and phrases that they helped deliver to clarify various points, but on the whole I was impressed by our abilities. What also greatly helped though was that all of the doctors spoke English, so the truly technical and diagnostic conversations were held in English.
            There was one case that truly stood out for me. As my partner and I discussed the symptoms with the doctor, it became clear to me that the opportunity that I had been presented to with—to do clinic work in a rural community of Nicaragua with this unique patient—was not one that would be easy to recreate. I was incredibly fortunate to have been working with such a wonderful organization and have experienced such an unusual case.
            The girl who sat before us was 16 years old. You could see she had had some growth issues and was slightly disproportionate, so at not much over five feet tall she didn't seem out of place in the company of her much younger brothers and sisters. In total, there were five members of the family who had come in to see us, and she was the oldest sibling. We interviewed her siblings first and were impressed by her nine-year-old sister's maturity in looking up medicinal plants and how to use them to treat what we diagnosed as migraines. When we arrived at the 16-year-old's interview her mother spoken entirely for her, and when she specifically was asked questions she would only shake or nod her head slightly.
            Her mother explained to us that she had had a congenital cardiomyopathy when born and therefore had to have massive heart surgery at two years old. Her mother also reported that her maturity level remained at that of a 10-year-old. In fact, the mother commented that the younger 9-year-old sister was more mature and more developed than her sister, all with the 16-year-old sitting less than two feet away. Coupled with a few other symptoms, my partner and I were quite unsure as to what the possible diagnosis could be. When the doctor came to review and give us a possible diagnosis we were pretty floored by what he said: Turner's syndrome. We had stumbled upon a young woman in rural Nicaragua with a rare genetic disorder and had been tasked with diagnosing her. That's not an experience that I though I would ever have.

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