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My Experience


Posted by Alexander Krassner, DO (a third year internal medicine resident from Kaiser Permanente, Oakland) serving a global health elective in Nicaragua with Greater Lawrence Family Health Center

I had the pleasure to travel to Nicaragua in January of 2012. The trip was partially funded by the Kaiser Permanente Northern California Residency Program Global Health Program.

There were 9 physicians, 1 physician assistant and one registered nurse on the trip. Most of the other physicians had been on prior global health experiences, many of them to this particular region of Nicaragua. The trip organizer, Dr. Anthony Valdini, is a faculty member at the Lawrence Family Medicine Residency Training Program in Lawrence, MA. He has been to Siuna and surrounding communities annually on global health projects for the past 8 years. Several of the physicians were either current or past family medicine residents in Lawrence, MA.

We partnered with a non-governmental organization called Bridges to Community (BTC). BTC is a non-profit whose mission is to “build a more just and sustainable world through service learning and community development by engaging volunteers to work in developing countries–building community and changing lives.” With offices in New York State, they currently offer many programs in Nicaragua exclusively with plans to spread to the Dominican Republic in the near future. Medical trips are only a subset of the work they do. They help to arrange logistics such as food, lodging, transportation and community liaisons during medical brigades.

The area of Nicaragua we traveled to was outside of the town of Siuna in the Regional Autonomous Region of the North Atlantic (RAAN) to a community called Mongallo. While there we staying with a local family, the Trujillos.

Interestingly, there has been tremendous change in both the country of Nicaragua and the area of Siuna in the preceding years. The availability of electricity on a regular basis had spawned increased usage of cellular telephones, cable and satellite television. Infrastructure is still poor. Medications and medical services are available, but too costly and/or scarce to be widely or regularly available.

Once we arrived to the community of Mongallo, we set up at our “home” clinic at a regional health outpost usually staffed by a registered nurse. We had purchased medications and brought supplies with us from the United States. With the assistance of local health leaders from each nearby community, residents were instructed to come to the clinic to be seen by a health care professional. Once the word of our arrival spread, people were coming from several hours away to be seen. Additionally, we operated “field” clinics to communities further afield. These communities tended to have less infrastructure and more acute illness, many times preventing travelling to the regional hospital in Siuna. In addition to seeing patients, we helped to educate some of the local health leaders.

We saw a wide breadth of illness in Nicaragua. Many healthy people with musculoskeletal pain, parasitosis, dehydration, anemia, malnutrition. As Nicaragua has a very high birth rate, we saw many pregnant women. We also saw some hypertension, diabetes mellitus, coronary artery disease and other chronic diseases. When appropriate we offered medication, education or procedures to the patients. Follow up was to be obtained either by the nurse at our health outpost or the regional hospital. In cases where further testing or treatment was necessary, we would write a brief letter to the regional hospital. According to the team members who were returning, there was a notable decrease in acute medical conditions and increase in chronic conditions compared with prior years.

After one and a half weeks of clinic work, we traveled back to Managua, then on to a coastal community for several days of relaxation prior to returning home. While there, in addition to relaxing, we discussed our work in Mongallo and how it could be improved in the coming years. We discussed how to make our impact more meaningful and lasting. After much discussion, we started planning a 5-year strategic plan with goals for sustained improvement. We agreed on the need for an increased presence in the community, and hope to increase the frequency of medical brigades trips to the community of Mongallo. We also worked on the creation of a “Field guide” to document all aspects of setting up our field clinics, including a pharmocopia, common and dangerous pathology, procedures, equipment and logistics.

Now that I have returned to the United States, I am already planning my next global health experience and assist/encourage other residents in their own global health projects. Additionally, I will be co-presenting a Department of Medicine Grand Rounds in the spring on my global health experience.

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