Nicaragua 2013: What a difference a day makes

And we thought yesterday was amazing! Today's clinics were in La Brena - a community of 1200, where we will be spending two days. We've been graciously given the use of the local evangelical church; so it was key to string up ropes, etc - and we were so much better organized today!!!
We were able to set up private areas for the 3 MINSA nurses (HIV testing, immunications and Paps - in this community the incidence of cervical cancer is high, and takeup is low), our 3 triage areas, and the space for two consultations rooms for Dr Vega and Dr Brooks. I got to do something I've always been fascinated by - triage!!! I would introduce myself as a "good paediatric doctor", an "okay triage nurse", but not an "adult doctora" - dealt with many issues myself, but referred the adults who had more complex needs and need for ongoing follow up to Dr Vega. Saw many babies and children! Dr Vega tells us that the care of children 0-4 has been a real priority for this government - and it shows. The vast majority of them are immunized, and growing well. Many, because of a diet low in meat and green vegetables, are iron deficient. As this can affect development and contribute to recurrent infections in children, it was an honour to be able to provide these children with at least a month of iron treatment!! More is needed. Saw some children with complex medical histories - a babe with repaired myelomenigocele, hydrocephalous and a shunt, a child with surgically repaired bowel obstruction (and a colostomy for 18 months, that was reversed successfully). From what I saw yesterday and today - the hospital care for these children is quite good - if they can get there. These communities do have a local doctor and nurse (Dr Vega cares for over 5000 people) - but often can't afford the medications needed.

Dr Vega was saying that one of her biggest concerns is the care of pregnant women - too many have complicated pregnancies, and the infant and mother mortality rate is far too high. As an example, today we saw a young woman with diabetes type1 on insulin, who is 15 weeks pregnant. It was an honour to provide her with a glucometer, and strips for glucose testing, and teach her how to use it (no problem - she caught on beautifully). Keeping her sugar normal this pregnancy will mean having a baby who hopefully avoids all the complications of the infant of a diabetic mother.

Toyin the pharmacist is busily preparing and instructing folks about all kinds of medications. He has excellent helpers - Kate, Janna and Maggie have all been learning and helping him. Dr Vega has worked side by side with us - reviewing the medications available here in Nicaragua (ie what is useful and what is NOT!!), and I get the sense she is truly enjoying being able to provide her people with medications they normally couldn't afford.

I can't say enough about the quality of our translators. We have Colin, the Director here at the orphanage (who has many other jobs) helping us at the begining and end of each day. He clearly has positive relationships with the local folks and the MINSA professionals.