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Posted by Amani Zewail, MD (a third year Ob/Gyn resident from Kaiser Permanente, San Francisco serving a global health elective in Nicaragua through Esperanca.)


Upon arrival at the airport in Managua, we were warmly greeted with a big sign and everlasting hospitality.  We stayed in Jinotega, a small town in the mountains two hours north of Managua. 

The next morning we saw over 40 patients in clinic and scheduled many of them for surgeries including exploratory laparotomies for newly diagnosed pelvic masses, hysterectomies, surgery for prolapse as well as incontinence procedures.  We wasted no time and started the surgeries on our first day. I was challenged clinically in ways I’ve never considered.  Limited by resources, we had to think about what materials were necessary so we could be as strategic as possible with the limited equipment we had.  We often found ourselves improvising throughout the procedures and our time in clinic.  Scant light, limited suture supply, minimal suction, and with basic instruments I quickly became thankful for all the materials we easily take for granted as surgeons in the U.S.  “We simply do the best we can with what we have,” Dr. Sklar, my mentor, often reminded me throughout the trip, one time when the lights and power in the operating room went out in the middle of a doing a hysterectomy. 

The patients are forever memorable.  For all the major procedures we used spinal anesthesia and out of almost 40 surgeries completed on this 10-day mission, there were no pain issues.  I can still vividly recall the smiles on their faces as they lined up in the late evening after we had finished a full day of surgery so that we could evaluate them in the clinic.  Women who traveled 6-8 hours by several bus routes were quick to wrap their arms around us and embrace us with gratitude and a warm welcome to their community.  Their smiles persisted immediately postoperative and every morning as we rounded on the patients.  I will never forget their smiles. 

Despite the language barrier and the cultural differences, I was able to form relationships with the people in the community.  The little children whose mothers worked in the clinic spent hours there and were quick to befriend us.  At any given break, I ran to play with the kids.  They taught me games and songs and seeing them day after day it was impossible to not become attached.  The local physicians ate lunch with us daily and we shared personal stories, cultural experiences, and clinical advice.  It was impossible to not notice that despite how little they have as far as monetary things they are spiritually complete.  I was envious of the sense of community and love that is disappearing in the major cities in the U.S.

One night we took a stroll around the village to learn more about the city and people of San Rafael del Norte, which is where the hospital was situated.  We walked up a hill to the town’s cathedral.  It was simple yet magnificent and we enjoyed one of their ceremonies. As I looked around the church it was striking to witness how these people are full of so much love and happiness.  They hold each others hands in church, walk in the streets late at night, children play soccer outside at all hours, all the doors to their houses are wide open all day so as to welcome neighbors, couples walk holding hands, and everyone is smiling.

On the last day of our trip everyone involved in the mission and clinic threw us a celebratory dinner.  Over 40 people attended and the room was full of warmth and appreciation both on behalf of the local physicians who worked with us, the ancillary staff, and me and the other two visiting physicians.  Being privileged to be a part of a smaller medical mission with only two other physicians, I was able to be involved first hand in leading a medical mission.  I learned that to make the most of a medical mission it is important to: 1) be flexible, 2) be willing to work with the local staff and 3) remember that you are a visitor…culturally and professionally.  I am forever thankful to Dr. Diane Sklar for being a role model and taking me under her wing as she showed me the ropes to spearhead a medical mission.  A flame has been ignited within me to be involved in more medical missions in the future as a new passion in me has surfaced.

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