GMT Nicaragua Shadowing Experience

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As I watched the airport shuttle carry the rest of the GMT Nicaragua participants towards the airport, I was not exactly sure what I had gotten myself into. The GMT staff was gracious enough to organize an extended stay and observation experience for me in the Masaya Hospital. All of a sudden I found myself to be the sole gringo, and was hit with a mixture of nervousness and excitement. Soon, Dr. Chavez and I were on a public bus from Managua to Masaya. There would be no more chartered buses and very little speaking of English; it was time to be immersed.....

Dr. Chavez, AKA the Rock, arranged for me to stay with a family a few blocks from his house. After a brief introduction with the family, I moved my things in to their spare room and was more or less on my own. I would only speak English twice in the next ten days. My host family turned out to be some of the friendliest people I have ever met. From the get-go they were nothing but welcoming to me. Each day I had three hot meals prepared for me and each night was filled with fun activities. They took me to play soccer with the locals, tour the Masaya volcano, explore their finca (a ranch where they grew all sorts of produce I had never heard of, and raised some pigs), and even to the beach for a weekend. On top of all that they were hilarious and had the cutest little girl I have ever seen! I still get to chat with them about once a week via Facebook. I could not have asked for a better arrangement.

The Monday following the end of the official GMT trip, I began my observation in the hospital. Masaya Hospital is full of compassionate doctors, but is severely underfunded, especially in comparison to hospitals in the United States. In keeping with the theme of immersion, I was placed in the emergency room. The ER is a small room with three beds, a resident emergenciólogo (ER doctor), an assisting nurse, and all the necessary equipment. The ER also was one of the only rooms in the hospital with air conditioning, which anyone who has been to Central America would agree is a huge luxury! Despite the limited resources and small size of the ER, the doctors, in all their resourcefulness, managed to treat each case that they were confronted with.
So to recap, I am the only gringo amidst a bunch of strangers in the fastest paced area of the hospital, where everything is conducted in Spanish (which is spoken at ludicrous speed!) Needless to say, it was a pretty overwhelming first day! The transition was eased due to the doctors all being completely willing to let me observe their activities, and the fact that they were thrilled to meet an American fellow. By the end of the 2nd day, I had acclimated to the atmosphere of the ER, and had become friends with the doctors and nurses. Each Nicaraguan I interacted with shared the traits of being laid back, calm, friendly, and more-often-than-not hilarious. One afternoon Dr. Garay, the ER doctor, treated me to leche agria, translated "sour milk", which is exactly what it sounds like. Despite my fiercest efforts, I was not able to down much of the stuff, but he got a good laugh out of watching me try. A lot of laughs were shared with my new friends in the down time between cases in the ER.
Soon I was permitted to assist them with EKG's, vitals, and minor procedures such as stitches. The cases I saw in Masaya Hospital often reflected the culture and conditions of the area. There was no shortage of machete wounds, construction accidents, and other similar stitch-laden treatments. Many of the malnourished in the area came in suffering from anemia (a side-effect of vitamin deficiency), which is prevalent in the area. Some of the more interesting cases included cut-off fingers, seizures, severed tendons, and what can only be described as the "zit from hell".
The most intriguing case award, however, goes to the pastilla del amor (love pill), so named because of its widespread usage in suicides by heartbroken lovers. The pill is actually a pesticide, phosphine, used in the production of beans. Ingesting even a single phosphine tablet will cause a gruesome death. Luckily for the man who was rushed into the ER, he had only inhaled some fumes from the container, and was brought in about twenty minutes later. He suffered a loss of lung function, and a cardiopulmonary bypass was used to manually pump the lungs. This process along with several IV's which counteracted the drug's mechanism of action allowed us to eventually restore his lung function and save his life. For nearly the entire duration of the treatment I was given the job of holding him down as he fought to remove the various uncomfortable but necessary apparatus. It was a very intense few hours, and the man fought so hard with me that I woke the next day feeling sore.
The week spent in the Masaya Hospital was one of the most educational, eye-opening, and enjoyable experiences I have ever had. The doctors explained each process to me so that I was constantly learning not only from observation but from explanation. I was able to meet many new people with interesting stories, witness procedures I had never seen and have a blast at the same time. On top of the wealth of new medical knowledge I received, my Spanish speaking abilities were also put into full use, and my cultural awareness increased. If you are someone who loves medicine, adventure, being pushed to the limit, and having a load of new interesting stories to share then this experience is highly recommended.
All of this would not have been possible without the hard work of the GMT staff, which went above and beyond in order to organize my stay. I had the phone numbers of at least three translators, three doctors, Dennia and Edgar (the trip coordinators) and even a photographer who accompanied us for several GMT clinic days. Each of these individuals made themselves available night and day to ensure my safety and comfort. I would like to end by extending my gratitude to Dr. Wil, Dr. Chavez, and Dra. Karen, who work tirelessly to give each GMT participant a world-class experience.

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My favorite patient memory was a home visit we took in Granada. The woman was very old, almost blind, and lived on her own. She welcomed us into her home and was very giving about information regarding her personal and family life. This opportunity allowed me to see first hand the kind of health care that is available to these people and made me fully appreciate everything GMT does and stands for. Here the doctor taught us about not only the health of the patient, but also about the way of life of many Nicaraguan individuals. It was truly incredible.- Heather Berman, Junior, University of Florida