Thursday, February 27, 2014

Day 1 - Orientation

Didn't sleep particularly well last night, but what else is new? At least there were no more spiders. The day started bright and early with breakfast at 7 (rice and beans, eggs and ham, fresh fruit and yogurt) and we were on the bus by 7:45. Our driver, Roberto, has been with our group in the past and must be a masochist of the highest degree to put up with a group of American students more than once.
Our first stop was UPOLI (Universidad Politecnica) where we met the professors and students we will be working with for the next week. I will be paired with Amanda, a junior and Duquesne and Alvaro is our UPOLI student. Communication should be an adventure - my Spanish is conversational but by no means fluent, Amanda speaks even less and I don't think Alvaro knows any English at all.

One of the professors, Georgiana, gave us a brief lecture on the demographics of and chief medical problems in Nicaragua (see earlier Presentation Notes). I tried taking notes in Spanish and I'm hoping the language gets more comfortable as the week progresses.

After the lecture we all piled back into the bus and drove to the barrio where we took a tour of the Centro de Salud (health center), essentially a local clinic. They can take care of outpatient procedures (immunizations) and small emergencies like rehydration, but anything major gets sent to the hospital. We met one woman at the CS whose job it was to make sterile supplies. She made her own cotton balls, folded gauze pads and sterilized everything in the autoclave. Everything is in short supply here and so it is all precious. Maybe if we treated our system in a similar fashion we would see a difference in healthcare cost.

We each got to meet our families after that - all in the same neighborhood within walking distance of one another. The Román family is as follows:

Nelson - age 70, Grandfather (diabetes)
Nelson Jr. - age 38, Son (diabetes)
Cesar - age 34, Son, (healthy)
Rosa Esmeralda - age 13, Granddaughter (asthma)

We are unsure at the moment how Rosa is related to the others - she may be the daughter of another sibling. Tomorrow we will spend a few hours with them assessing what their major health issues might be - other than the aforementioned diabetes and asthma. After the tour of Villa Libertad (the barrio) we sped back to UPOLI for lunch (rice and beans with chicken) and took a tour of an actual hospital.

Everything in the hospital was in some way related to women's health. The labor and delivery area was run like a well-oiled machine - women here until they are 5cm dilated, then to the labor room until they are crowning, deliver in a separate room and as soon as the placenta is delivered they go out in the hall on a stretcher with their baby for observation. Two hours later they are sent to the postpartum area. From what I saw there were five beds for laboring (all in the same room) and two delivery rooms, and they deliver an average of 30 babies per day. If only we had that sort of efficiency in the US.

Dinner was chicken with rice (and anything fried in that much butter is bound to taste incredible) and we had a conference on our thoughts on the day and our ultimate goals with this program. While I am excited about helping people here, I'm here more to learn - both about nursing in general and how to make better use of time and supplies. There are an infinite amount of things that need to be changed about the US healthcare system, but we can start with cost. I'd never really considered administration and policy before, but there are so many things I want to change that I just might.

One things that especially struck me today was the attitude of the patients. They all shared rooms, in close quarters, no AC so it was about 85˚f inside and apparently it's sometimes so crowded they have to share beds. And yet everyone was grateful and happy to be there. Imagine such a thing in an American hospital.

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