Esperança Foundation: Jinotega, Nicaragua – Monica Contreras-Devoy, MD

Posted by Monica Contreras-Devoy, MD (a third year OBGYN resident from Kaiser Permanente, San Francisco while on a global health elective in Jinotega, Nicaragua with Esperança Foundation).

Esperança April 2013

This was the moment I had been waiting since I was an intern.  I had heard of all the wonderful abroad opportunities’ Kaiser Residents had participated, but the site that spoke most to me was the Esperança site in Jinotega, Nicaragua.  My proctor, Dr Diane Sklar, had already participated in eight missions with the group between Nicaragua and Bolivia.  I first heard about her trips when I was an intern, and I was fortunate to have the opportunity to join the family and connections that had been previously created there, now as PGY-3.  This trip was going to introduce many exciting new changes and opportunities, as we were bringing double the medical group and equipment from previous years, we were expecting double the patients waiting for consults.

The day after we arrived to Nicaragua we walked into the hospital where over eighty consults were awaiting us in a large waiting room.  Women from all over the country had come to be seen by “la brigada” the moniker they had placed on medical groups traveling through the country.  With smiles and hope we saw women who had traveled as much as a whole day from Honduras and around Nicaragua to get to this small town of Jinotega surrounded by mountains located two hours north of Managua.  The focus of our trip was on urogynecology conditions, and we saw women who had suffered from urinary incontinence and pelvic prolapse at times for more then twenty years.  The most interesting case was of a woman who was only in her forties, but had suffered for over two decades from a complicated 5cm rectovaginal fistula likely acquired during child birth.  Confined to an abusive home in the mountains, she gained enough courage to seek medical help from the volunteers for Esperança this year.  The day we met her we were touched by her personal story and the extent of her condition.  Her stoic nature was inspiring despite the effect this problem had on her quality of life.  This story and others were added to our list of surgeries we were planning on performing over the next five days.

We had twenty seven patients we scheduled for surgeries including:  colpocleisis, vaginal hysterectomies with vaginal vault suspensions, tension free tape suspensions, exploratory laparotomies for pelvic masses, cystoscopy and finally the rectovaginal fistula repair.  Over the course of that week, more consults arrived and by the end of trip we had set a record total for consults seen at one hundred patients!

Despite bringing two attendings, Dr Sklar and Dr Kayser both from Kaiser Northern California sites, and two residents on the trip, we were unsure if we would have two surgical rooms to perform.  That did not stop the resourceful nature of our volunteers in Nicaragua.  One room was converted to two operating spaces and prior local nurses and scrub technicians from past trips had volunteered their time to help this group again which helped make the week run smoothly despite the space challenges.  A total of seventy-eight procedures were performed over those five days, and all were performed with spinal anesthesia and without complications of any kind.

The women were so grateful at all time points of their care, with little complaints even on postoperative day 1 with grins showcasing their gratitude.  Many hugs and kisses were spent during rounds as these women physically communicated their appreciation to their team of doctors and nurses.

The relationships I made with the patients were memorable but also all the new friends I had found in the volunteers and local doctors working at the hospital in Jinotega.  Their selfless hospitality made me feel welcomed as a new member of this small medical family and their personal time dedicated to showing us around and having meals with us will always be cherished.

What I gained the most from this trip was regaining the humility that had strongly veered me to the field of medicine.  The humble nature of this town, people and organization reminded me once again why I had chosen the field I was in.  I regained a sense of inner peace and was more appreciative for all the advances and technologies that I had back here at home.  My perspective on the medical field and medical system is broader and I feel it will make me a better and more patient physician for when I’m challenged by our modern tribulations.

I now understand why Dr Sklar does this every year, I couldn’t imagine not being part of similar missions in the future, not only for my sense of self but also for all the lives of women who’s quality of life can be drastically improved by hours volunteered to making their life better.  This has been one of the highlights of my residency and career thus far!