Sunday, July 12, 2009

Nicaragua- Woman with 20 Children

“Baldwin, Holy S%#* it’s 6:15!” screamed Mike Barretti. “Bus leaves in 15 minutes!” We had both slept through our alarms and we scrambled to get ready on Friday morning for the trek back out to the medical site in Somotillo. Mike elected to forgo the cold shower and shave in order to get some breakfast, as I chose to face the frigid water in hopes that the bus would be late and I could still snare some biscuits and coffee on the run. Dang that was cold! I exited the shower and tried to slide the door back the entire apparatus came unhinged and crashing downward. Shaving my my beard and at the sink navigating around the broken plastic/glass was a chore. The morning was indeed off to an interesting start! And as anticipated the bus was bit late, so I inhaled some eggs and beans and threw some coffee down the hatch and then boarded the bus to Somotillo. I took a moment to reflect that although we were in the second poorest country in this hemisphere (behind Haiti) the beauty of this land was worth a million. The view out to the San Cristobel volcano looked gorgeous in the morning light and many of us leaned over each other to try to get a moving photo through the bus windows (note to reader- this never results in a quality photo). During the drive I embarked upon a new book by Michael Creighton called NEXT and then sadly was told that he had passed away last year. The Harvard medical school grad wrote many novels and also was the force behind the TV show ER.

We reached the health clinic in Somotillo at 8 am and the line of patients was enormous. I tried to take a picture that captured its enormity- the crowds of a few thousand stretching down the street and around the curve. It reminded me of the start of a large marathon race. The majority of the patients were mothers with their children. Most of the fathers away in the fields working. I went over to the food stand that I had spotted yesterday run by a few ladies named Erika and Cristina and they yelled out, “Hey Andres!” Wow, they remembered. “Me falta un café (I need a coffee)”, I said. This was no STARBUCKS. The water heated up in pot over fire, a chicken ran by, and Erika’s premature little girl was crying at top volume. The instant NESCAFE coffee was not nearly as good either, but it woke me up and got me through the morning. Cristina begged me to get her baby some more vitamins, and also some cream for the rash. I saw a stash of medication that they had collected already (no doubt in barter) and began to see the way that things work around here.

My translator today was an extremely knowledgeable woman named Karen who currently lives in Managua but grew up in the United States in Los Angeles. Her English was better than many Americans I know. She had done quite a bit of medical translator work before, and with these skills we set a rapid pace of seeing patients. It was a good thing considering the line outside. In the examination room with us were Dr. Barretti, Dr. Ed Taylor (Family Practice doc), CAPT Sheehan (Nurse Practitioner in Public Health Service). We were flying. By mid-morning we had already seen about 800 patients, and the line outside still kept going and going… Most patients here in Somotillo were the same- country farmworkers and housewives – the overwhelming majority of whom had headache, gastritis, and dizziness. So much so that we were already filling out the forms by the time they presented to us. Some unique patients that I saw were a woman who had no teeth, but wanted to show me her smile anyhow ☺, a man sporting a Nautica (one of my sponsors) cap and having no idea what Nautica meant, and an 80 year old woman who had twenty children over her lifetime. At eighty years of age she told us that her youngest was 30 years old, and that only eleven of her children remained alive today. Many of them were killed in the Contra-Sandinista conflict during the 1980s she said. I had to take a moment and regard the uteral courage of this woman. Upon further questioning I found out that she has over 100 grandchildren all throughout Nicaragua. What a life force!

The crowds were so large that we ate a working lunch, having some MRE crackers and cold beef stew while answering questions about headaches, gripe (flu) and cough (toz). Early in the afternoon Karen and I went through the typical patient visit and wrote out the prescriptions for a nice mumbling young lady and thought we were through, but at the end she opens her mouth and showed us something. She had a frenulum (that piece of tissue that connects your toungue to the bottom of your mouth) that held her entire tongue down. She had extremely limited movement ability for her tongue and she was able to tell us it prevented her from rolling her R’s and speaking effectively. I thought how nice it would be to get it cut back, and ventured with the woman over to Dentistry to see if we could do some minor surgery. No more surgery room aboard the USNS COMFORT, but with some urging and serious courage on this girl’s part we decided to do it right then and there. We numbed up the underside of the tongue, and got out some sharp scissors, and Dr. Sanchez dissected away avoiding the large bleeding vessels and carefully giving this girl the ability to move her tongue around (something that we take for granted every day). Afterwards she could roll her R’s (I still can’t for some reason and am considering a frenulumectomy, but others tell me that is not the problem).

The afternoon wore on and we began to see our first patients from Honduras. CDR Ed Taylor, who is from Honduras originally, jumped up and told the room when he encountered a nice woman from his home country. She had heard of the USNS COMFORT team being close by and had crossed the border to be seen. Several more followed and many more would come over the next few days I am sure. Outside the crowds became unruly outside the pharmacy, and the pediatrics waiting areas were overflowing us adult providers agreed to see some kids as well. The pediatric bail out was fun and gave a change of pace to see some different issues- lots of scabies, diarrhea, parasites, and parents stating that their children were not eating (no appetite). Most of these children were normal weight and their mothers were the opposite. But have to put it gently. Health education and reassurance I think is ofen times the most valuable in this type of setting and population.

By the time 5pm came it had been 9 hours of seeing patients, and in all the site had seen close to 2000 patients. I must have seen close to 150 and Barretti, Taylor, and Sheehan was up there as well. As we so often joke on this mission that it is “Not about the numbers” CAPT Sheehan pushed the joke even farther as he grabbed the stacks of hundreds of patient encounter forms and flipped through them all. It was a record setting day out there today, and the most prescriptions given out by far for the entire mission thus far. Great job to the Medical Military Strike Team led by Dr. Cole!

Thoroughly spent we retreated to our hotel in Chinandega, and found one hundred of our fellow humanitarians there as well. The boats and helicopters were grounded due to bad weather and they all would be staying over crashing on our floors, or on cots if available. I joined the table with CDR Santa (UNC grad and Navy NP), Jefferson Medical Student Majit Gupta, and several others including Dr. Richard Soetens, a Dutch physician. Soetens claimed a cot in our room. I’m not sure if either of us got any sleep that night with Barretti’s drunken snore. Well, until tomorrow from Nicaragua. Buenas noches.


  1. Thanks for another great illustration of your day during this mission. Rolling the r takes time - I think it was a good six month or more of near constant Spanish immersion and loads of practice for me to get it near right.

  2. I think I'm getting addicted to reading these....again, you write very well. You allow us to experience another culture through you AND add in the little distinctive details of the people and the places that make it so interesting. (LOVED the volcano thing, although I think it might make me a little nervous). Thanks for writing!