An Eye-Opening Tour of Health Facilities in Nicaragua
Medical Delegation 2004
Eight second-year physician assistant students, an instructor, two physicians, a hospital administrator, and a medical school applicant made up a medical delegation to León, Nicaragua in July. This was PML’s second medical delegation in recent years. PML hopes to expand their involvement in health care in León as more Minnesota medical people become involved.
The delegation’s goal was to identify needs within the medical system in León, and start the process of forming relationships with groups in Minnesota. Although relationships are a primary goal, the needs in León and surrounding communities are great. Nicaragua is the second poorest country in the western hemisphere with no signs of economic relief in sight. The hospital where the delegation spent most of its time, Hospital Escuela Oscar Danilo Rosales Arguello (HEODRA), is a teaching hospital that receives referrals from all over Nicaragua. With its 420-bed capacity, HEODRA currently operates on the same budget as it did in 1969, with only 200 beds. Much of the equipment in the hospital is broken and obsolete. Emphasis at HEODRA is placed on serving the most vulnerable populations.
The PA students split up to research the needs in different areas of the hospital. Needs were everywhere. In labor and delivery there was one working fetal monitor, but no paper. The obstetrical residents were monitoring labor with nothing but a stethoscope. Clean rags were used in place of gauze in the delivery room where pillowcases doubled for leg covers. When there were two deliveries at the same time, the two babies shared the one working warming table.
The emergency room had no EKG machine, no defibrillator, no pulse oximeter, and no quick blood-sugar testing machine. Use of all such equipment is standard in U.S. clinics. Antiseptic solution was poured from an old gallon jug over wounds. Dr. Mario Orozco Berrios, pediatric faculty in the emergency room, reported diarrhea with sepsis as a major cause of death among the children brought in to the hospital. Indeed, about half the cases brought into the pediatric emergency room that morning had diarrhea. The doctors reported that the onset of sepsis in these children is escalated by widespread malnutrition.
In orthopedics, diabetic amputations are common. Everywhere we turned we heard about complications from diabetes. The limited resources for monitoring and treating diabetes, coupled with poverty and poor diet made diabetes a major problem.
Outside of the hospital, in the health centers, we encountered a well-organized health care system. But again, resources were the issue. The health centers do not receive enough medications to treat their diabetic or hypertensive patients for the entire month, leaving it up to the patient to find a way to purchase the remainder of their medications. Buying medicines is difficult when there is not enough money to feed the family. One health center reported that 95% of their prenatal patients are anemic. Another told us that they have only enough resources to give each pregnant woman eight iron tablets per month. In rural areas, those too ill to walk or in labor are transported in a hammock carried on poles between two men. Their journey to the health center can be three hours down steep mountain paths.
The PML medical delegation is now charged with the task of looking for resources and long-term relationships to help the people of León and the surrounding area receive better health care. When we left for Nicaragua in early July, each member of the delegation carried two suitcases full of medical supplies. Some of the students are hoping to return for elective medical rotations. All delegates will be talking about their experiences and looking for ways to build long-term relationships and to identify resources for León.
“I will never forget my experience, the relationships I have made and the memories … I will cherish this for the rest of my life.” – Tammy Stang, Augsburg PA student
“The trip was priceless on so many levels but nothing more so than the relationships formed. I’ve never met people as warm and kind as Nicaraguans.” – Tara Rick, Augsburg PA student
We walked for three hours one day to the small village of Talolinga and spent the night there. The next day we walked back to the town where the bus was. As we approached the town, exhausted and eager for cold sodas, we passed a group of young women, probably teenagers, carrying twenty-nine foot rolls of tin roofing on their heads. They were going to build new houses and had to carry in the building materials on foot. So much for my pride in a three-hour country hike!” – George Moore, Augsburg PA student