This blog is for the friends and family of Kimberly Cook, RN who want to follow her adventures serving at Nueva Vida Clinic in Ciudad Sandino, Nicaragua. Welcome!

Monday, October 4, 2010

Un Dia en la Vida (Parte 2)

To continue 'A Day in the Life'...

When I arrive at the clinic a little after 8am, I help Danelia and Henri assess and triage patients. The pediatrician comes Mon.-Fri. from 8:30 to 10:30 am, so there are lots of sick babies and children who come in to see the pediatrician in the mornings. There are also lots of nebulizations and injections that the pediatrician orders, and I administer these. Asthma and congestion from allergies are major problems here. In Nueva Vida (the impoverished community where the clinic is located), food is oftentimes cooked over a fire inside the house, so the house becomes smoky. Additionally, there is dust in the air, a humid climate, lots of stray dogs traveling the neighborhood, and family members smoking inside the house. Overweight and obesity are also big problems in Nicaragua. Fifty percent of the population is overweight or obese. This issue is complex, but stems from a variety of factors including lack of money to buy healthy foods, lack of availability of vegetables, cultural preferences regarding food, and lack of education and value of healthful eating. Many children also have infections, especially parasitic infections due to contaminated water or lack of proper hygiene and an unhygienic environment.
After checking in and assessing patients (in the room pictured here) and administering nebulizations and injections, I am sometimes able to shadow the pediatrician. I have learned a lot from the minimal amount of time I have observed him. He speaks some English, understands the complexity of providing health care for the impoverished, and provides holistic assessment and treatment to patients and their families. I have been incredibly thankful for the time I have spent observing him, and have learned a lot. Additionally, I spoke with him today about topics for patient education. I plan to gather educational supplies, construct care plans, and begin patient education within the next couple of weeks. I will be focusing on hygiene, proper nutrition, reducing environmental triggers for asthma and allergies, and automedication (patients treating themselves with medication without consulting a doctor).

At around 11:30 or 12:00, we head back to the house for lunch. We eat lunch in the JHC (Jubilee House Community) house, which is very close to the dormitory in the same gated community. Kathleen, Mike, their three boys, and Sarah (all members of JHC) live there. Lunch consists of leftovers from dinner the night before, or if there are no leftovers, rice and beans. White rice and red beans are a staple here, and are delicious when made Nica style! We usually head back to the clinic at 1:00pm, but Leah (another long term volunteer who arrived here the same day as me) and I are beginning daily Spanish lessons tomorrow from 1-2pm with a woman who works here for JHC. We are very excited to get some formal instruction and have an hour devoted to learning Spanish each weekday!

Depending upon the day of the week, there are different physicians and specialists at the clinic. The general practice physician comes daily from 2:30 until 5:00 pm. He is a jolly, funny, knowledgeable man whom I truly enjoy observing and interacting with. The orthopedist comes Wed. and Fri. from 8:00 am to 12:00 pm. He provides wonderful care, and has been administering an experimental treatment to his arthritic patients for seven or eight years. It consists of an injection with lidocaine and a mixture of minerals that is very effective to reduce pain and inflammation when combined with diet and lifestyle modifications. The dentist comes Monday afternoons and Tuesday and Thursday for most of the day. She is a young Nicaraguan woman who looks like she is 22 but is actually about 29 years old! (I have yet to post pictures of the dental equipment available, but plan to take pictures of the dentist's room for readers who are interested :-)). The optometrist comes Friday mornings along with two optometry students. As you can imagine, Friday mornings are a very busy time with the pediatrician, orthopedist, and optometrist all available! Additionally, we have a lab tech who works every afternoon.

When I arrive at the clinic in the afternoon, I help Danelia and Henri check in and assess patients there to see the general practitioner. There are many patients with type II diabetes and many with hypertension. I have already seen a few patients with blood glucose levels in the 500’s within my 2 weeks of working at the clinic! (For those of you not familiar with the norms, this is VERY high). It is very difficult, if not impossible, for diabetics in Nueva Vida to regulate their blood glucose levels due to a lack of availability and money for glucometer supplies and insulin. Although they have monthly appointments with the physician, this is not sufficient to keep their diabetes well controlled. By the time they arrive at the clinic, many are already experiencing symptoms of diabetic ketoacidosis such as dizziness, increased respirations, vomiting and upset stomach, and increased urination and thirst. Last week, I had the opportunity to start an IV on a patient in diabetic ketoacidosis. Although it is scary stuff, it is a great learning experience for me. Although patients with chronic hypertension have monthly control appointments, blood pressure is oftentimes poorly controlled. Patients come into the clinic complaining of dizziness, headaches, and hot flashes. One woman last week had a blood pressure of 200/130!

After assisting with check-in and assessment, I shadow the general practice physician and administer injections and nebulizations as needed. I have learned a lot from the general practioner, especially pertaining to parasites, fungal infections, viral vs. bacterial infections, hypertension, and diabetes. I have seen many different types of skin lesions and infections. I have also learned a TON of medical Spanish words, although there are many more yet to be learned. It is fascinating to learn so much in a days’ work, but by the end of the day I am exhausted and ready to relax.
There is about an hour and a half between work and dinnertime to finish whatever needs to be done and to relax a little (dormitory photo to the left). I usually eat a small snack (I am famished by the time I get back to the dorm!), put on some comfy clothes, and journal for a little while, read my Bible, exercise, or just hang out. Dinnertime can never come too soon, because we are always really hungry and Kathleen makes great food! We eat dinner together in the JHC house. It is always a balanced meal with a vegetable and main dish, and sometimes another side dish. We have had a couple birthdays since I have been here (this is pretty much the only time we get dessert), and the cakes are delicious! The volunteers rotate dish duty each night – Leah and I share dish duty Tuesday and Thursday nights. I do not mind dish duty, especially since I didn’t have to make dinner! Because Kathleen will be gone for the next 3 weeks visiting the States with Daniel on college visits, I will be making dinner for everyone once a week. I am excited to be cooking for others once again!

After dinner, there is about an hour and a half to hang out before I get ready for bed. During this time, I look up Spanish words that I didn’t know during the workday, journal or read my Bible, answer emails/write blog entries, or just hang out in the dorm kitchen/common area (pictured at left) with the other volunteers. There is usually a game going on in the common area if I would like to join, but oftentimes I like to take it easy at night and spend time in my room. I cherish the alone time that I have at night.


In my next entry, I hope to write about the adaptation process as well as the challenges and joys of serving here. ¡Hasta la próxima vez! (Until next time!)

1 comment:

  1. Hey Kim! Love reading your blog haha. But really you give a great description. See you at dinner :)

    ReplyDelete