Clinic & Brigadistas

          It’s hard to describe a typical day in Nicaragua, because every day is full of its own surprises. This is true with both our work and just our life in general. I still can’t believe how unfazed I am by things that would be absolutely crazy in the United States, like chickens running inside our clinic or almost stepping on a five-foot long snake. If I were to let all these things bother me, I would go absolutely crazy. Usually the girls and I just laugh as each new situation comes up and do our best Aussie impression, “oh Nee-ka-rae-gue.” Although, I’m often unaffected by the crazy things Nica sends our way, at times it is still a struggle for me to accept that most working days have only a very, very vague plan of what we are going to do. Even then, those plans often fall through. Most days however, we work either in the clinic or train brigadistas.

            The clinic is about 200 feet from our house, which makes our morning commute very easy. It is open every Tuesday, Wednesday, and Friday, and is usually staffed by the three of us, Meg, and Milagro, a local nurse who started off as one of Meg’s first brigadistas. The number of patients varies greatly, some days we will only see four patients and other days there will be twenty-six. Most of the patients are women and children, and they’re all from the twelve neighboring villages. Gaby, Cat, and I all get the weight, temperature, blood pressure, and heart rate of each patient as they come in. We each also take turns sitting in on the consults with Meg to help with the assessment of the patient and translate her recommendations.

            The most common conditions we see in the clinic are babies with respiratory infections, children with parasites, and women with urinary tract infections. Many people that come into the clinic also appear to have chikungunya, a mosquito spread disease that causes fever, rash, and body aches. Other than give them acetaminophen and ibuprofen though, there’s not much we can do for this epidemic. We’ve also been able to share some exciting moments with patients, like being able to tell a few women they were pregnant. Gaby even was able to use the Doppler so one mom could hear her baby’s heartbeat for the first time. Some days have left me completely stumped, like one boy who came in with blisters all over his stomach that the mom said appeared after he swam in a dirty river. Although we only observed the first few weeks, Gaby, Cat, and I are now able to do the full assessment on the patients, ask them questions about their condition, and often we are able to make the correct diagnosis.

            The Brigadista program is done around the whole country, although Meg does most of the training for our area. We are currently teaching 20 women and men from the northern communities. Most of their villages are extremely remote with poor transportation to hospitals or even to smaller clinics. Through teaching them basic healthcare skills and about the most common conditions affecting their communities, they will be able to give advice for simple problems and be able to distinguish when someone needs to actually be transferred to the hospital.

            So far we have had two of the six Brigadista training days. There was a slight issue for those two days though, and only twelve people were able to show up either because of communication or transportation problems. With the students that were able to come however, we spent the time teaching things like the maternal health, parasites, and how to take vital signs. Gaby and Cat presented together over the four epidemics that have been issues in our area- malaria, dengue, chikungunya, and leptospirosis. I taught the class on how to do a baby assessment, since it’s what I did every day at my hospital in Cleveland. We have two more training days coming up this week and then a final two in December.

            It was interesting to listen to the group discussions, although we weren’t able to participate much the first training days because it took all our energy trying to understand the various accents and our complete immersion back into Spanish. After the week we just spent in Granada however, our Spanish has greatly improved and I think we will be able to participate even more this time!

            From the first two days we have observed cultural differences in classroom dynamics and also some of the material taught. I was surprised by how little people know about mental health here and that it’s considered normal for people to interrupt whenever they had a question, instead of raising their hand or waiting until the end of a presentation. While the class time was a good learning experience, the leisure time was fun to get to know the people in the class. The students were anywhere from 16 to their 60’s. After class we walked the beach with them, learned new card games, and watched movies. So far the Brigadista training has been a great experience!