Voluntourism in Nicaragua

"How many people brought their own stethoscopes?"

It was an honest question, asked by the orientation instructor with the best of intentions, but it was my first heads up that there was more to this trip then meets the eye. The premise of this trip to Nicaragua was ingenious. We could renew our tourist visas in Costa Rica while living every pre-medder's dream of hands-on experience in the medical world. The organization that made this possible, Vida, had every step of the process on lock, as we flowed from one event to another with oily smooth precision. It sounded ideal, and for many people it was all that they had hoped for.

However I was never able to get over the fact that this experience was for us. The overarching goal of Vida seemed to be first about my personal fulfillment, and then the health of the communities. The aspects of patient respect and safety that have been drilled into my head in the US such as proper sanitation and HIPPA were painfully absent. Additionally, while my Spanish is far from perfect, I'm pretty sure the interpreter didn't introduce me as "an undergrad who knows the mechanics of the heart thanks to high school anatomy class and just learned how to wear a stethoscope but really, really, really wants to help and thinks she knows what healthy lungs sound like".

Everything about our trip was paved with good intentions. The initial transaction flooded everyone with satisfaction; the patient walked away with drugs and we walked away knowing that we had helped. That we had made a difference. But as the days progressed I began to notice similar patterns. We sent many people away with a 15-day supply of vitamins, or a week's worth of painkillers. It felt superficial and achingly short term. One day my translator was a young man who had just finished med school. However because he was a translator, he contributed nothing to the diagnostic process, even though he could have done the whole case without us. On the last day, we saw over 120 patients. We gave ourselves a hearty round of applause and basked in our tangible "success". But how many of those people are actually helped by a one or two day annual medical brigade when they could also go to a local health center for free?

However, despite my criticisms it was an incredible experience. I now know (more or less) how to take someone's blood pressure and that a headache is a common symptom in an adult with tonsillitis. For three days, I was fortunate enough to sit and listen to the life stories of patients. I could do that for my whole life, and I certainly hope that one day, after rigorous testing, hours of instruction and years of experience, I can pursue a career doing exactly that. But the next time I step into scrubs, with a stethoscope around my neck, I want to have the brainpower, training and confidence to know that I'm making a difference.

On our last day in clinic, we closed early, despite the fact that people were still waiting to be seen because we had run out of intake forms. "So these people will have to go home without treatment?" I asked the coordinator. "Unfortunately, yes," nodded the coordinator. But then she visibly brightened and smiled at me, "But don't worry, we will be back next year!"

Keelin Moehl