The day began much the same as yesterday - already 80˚ by 7am, a filling and tasty breakfast and on the road by 7:30. OUr first stop was UPOLI, where we waited.
A note here on 'Nica time'. Like the more well known 'Indian standard time' or the French 'normalement', times are relative. An appintment set for noon might be kept by 12:45. This has lead to the existence of our trip catchphrase "tenemos prisa, vamos a esperar" (hurry up, we are going to wait). At the same time, people will wait all day in the scorching heat for a chance to see the doctor, and not once complain.
After we obtained the UPOLI students we split into two groups - one went to the academic center to do geriatric assessments and mine went to the Centro de Salud. For a few hours we did rotations through the emergency department, the vaccine center and the OB/GYN office. This was the first time Amanda, Alvaro and I had worked together without a more proficient translator than myself and it took a little work. Eventually we got into a system where I could translate between the two of them and Alvaro could fill in the words I didn't know or used incorrectly. I'm not sure if it would have been any easier if he knew any English, but he said he wished he did, which is a start. He helped me work on my vocab list and seemed interested in learning.
In the ER I took vitals (no fancy equipment here - BP cuff, watch and glass thermometer only, in addition to my bright orange stethoscope) while Alvaro took a brief health history. Amanda's first patient had venous insufficiency so she followed him to the procedure room while I stayed in intake. Admittedly, not having to actively translate made communication a lot easier and we were able to work together fairly efficiently. A number of people were there for injections (for pain, contraception or antibiotics) and I was able to do one. The preferred method here is intragluteal, which I've never done before, but I had a good teacher. The woman's leg didn't immediately go numb, so I took that as a good sign.
We got to watch PAP smears being performed in the OB/GYN clinic, another new experience for me. I unfortunately missed the skills lab we had before the trip, so I had never even practiced on a model before. The nurse in the office did the first exam and let Amanda do the second. We should go back in a few days and I want to try doing one then.
After meeting back up with the rest of the group and a quick lunch at UPOLI (fish this time) we went to the Children's Hospital for another tour. This served as yet another reminder of why I should not do pediatrics. The first ICU we went in had a number of acutely ill patients, including one with Tetrology of Fallot (a congenital heart defect that consists of four malformations that occur together) who was struggling to breathe even with a non-rebreather mask. I've never seen a human being that grey before. There was a boy in the back of the room with lupus who was so excited when we waved at him that it made me wonder how much contact he gets with other people.
The second ICU, more of a step-down ICU, had kids with more long term issues. There was a boy in an induced coma so he could heal from a car accident. He had a nurse who seemed dedicated to him and was clearly repositioned frequently; something, I might add, I have rarely seen in the states. There were a few kids with pneumonia, two with Guillain-Barré (rather exciting for me as we just learned about it in class and I was able to teach the English-speaking doctor the word 'demyelination') and one little girl with a pleural effusion. She was the one who really got to me - about two years old and she had wrist restraints to keep her from pulling on her nasal cannula; and she was just sitting up in bed and wailing for her mother. Since I wouldn't be able to work very well if I was crying all the time, I'm thinking peds is not for me.
As far as function was concerned the hospital was impressive - a huge cancer wing that did both in and outpatient chemo, a dialysis center and many others. I find it interesting that in the second poorest country in the Western hemisphere, free healthcare is considered a right, not a privilege.
Dinner was also fish, and as always, it was fantastic. Mary Beth, a Duquesne graduate accompanying us while on leave from Doctors Without Borders, made the point that part of the reason all the food has tasted so good is because it is all much more fresh than what we get in the states. The chicken we ate yesterday was probably killed that day, and never had any preservatives pumped into it. One thing after another is making me wonder why, with all the money we have, we do not live as well (in some ways) as people here.