On a Mission for Better Health Care

In the small Jinotega region of Nicaragua, hundreds of rural villagers lined up outside a small temporary ambulatory clinic. Many came from miles away to wait for hours to receive medical care.

One of these villagers was a 12-year-old girl battling epilepsy. Jinotega natives, her family did not have money for medications. Every night she had epileptic seizures and would wake up the next morning not knowing where she was, and spent her days embarrassed about how poorly she was doing in school because of her condition.

However, as with many medical cases in Nicaragua, there was more to the case than met the eye. She needed glasses.

“We could not provide her medication but could help with the glasses, which really made her happy,” said Joseph Martin, a second-year medical student who participated in the university's international program in Nicaragua. “Seeing something that is so easily managed here in the states be life changing and embarrassing in Nicaragua upset me. I could not provide her medications to treat her. I learned we couldn’t save everyone. There are limitations to this profession. Her case humbled and inspired me to keep coming back to improve the quality of life.”

Treating the Underserved

For 10 days, Martin was part of a faculty-led international program directed by Patti Patterson, M.D., a professor in the Department of Pediatrics, consisting of 13 medical students, one nursing student,Dan Good, M.D., and nursing faculty members Laura Opton and Amy Moore.

The group worked 10-hour days with an interdisciplinary team of licensed professionals including physicians, physician assistants, nurses, nurse practitioners, dentists and occupational and physical therapists with the goal of providing primary care and education for an impoverished and underserved population. In two weeks, hundreds of people, many of whom battle chronic conditions and had never received medical care, traveled to outreach clinics to receive medical attention.

“The appreciation we felt was phenomenal and it reinforced the reason we were there,” Martin said. “People in the states complain because they have to wait an hour and these people waited in the heat for many hours without a complaint. Their gratitude was humbling.”

The first half of the program was dedicated to medical outreach. The professional team worked in small primary care clinics in and surrounding Jinotega, which included a stationary site, and the traveling team that visited five sites in the mountain areas.

“I saw a little of everything from hypertension, parasites, late stage infections, pregnancy, epilepsy, vision problems, an absolutely mind-boggling array of cases,” Martin said. “We learn so much as medical students and I was amazed to see how much we were able to recall on the spot to treat people. The team building was amazing.”

Educating the Under-informed

The second half of the mission was dedicated to education. The students wrote a program designed to impart basic knowledge to local health workers and midwives about ways to reduce cervical cancer and maternal mortality, the number one cause of death for women in their region.

According to the Instituto Centroamericano de Salud, Nicaragua has the highest cervical cancer rate in Central America and the second highest in Latin America. Patterson, who has traveled to the country 12 times on similar missions, said cervical cancer is almost always caused by a sexually transmitted disease. And with impoverished rural countries, like Nicaragua, where many women and health workers have no awareness of it or the early detection methods, that can lead to preventable deaths in young women.

“You have to remember these volunteers are sometimes the only health care providers in a rural village,” Patterson said. “Workers are Nicaraguan rural community representatives who become primary health educators in their respective villages. The medicine in the area is limited and the medical professionals have limited education.”

As a result of the program, medical students were introduced to ways to deliver health information to different cultures.

“The students were very careful to approach these issues with a great deal of respect,” Patterson said. “This was an opportunity for them to work across cultures, respect others beliefs and values all while trying to educate people about important health issues.”

Through the experience, medical students were able to hone their skills by diagnosing patients without certain technology. Patterson said students could not rely on things like electricity, electronics or equipment that are readily available in the U.S.

“In the U.S., a doctor would order a CT scan first,” Patterson said. “In Nicaragua, the student does not have that luxury. The students had to figure it out using their hands, ears and eyes, and yes, talk to the patient. The experience makes them better doctors. Hopefully once going through an experience like this, this will lead them to give back the rest of their lives.”

Gallery

Click here for more photos from the trip.