In May we made our move from Houston to Midland (in West Texas) for my Physician Assistant Program at Texas Tech University Health Sciences Center. The PA field, while rapidly growing, is also a very competitive field, so I was grateful to be accepted into the TTUHSC Master’s Program. We immediately jumped into a 16-credit Summer semester, and it was a whirlwind of graduate-level pharmacology, anatomy, physiology, and clinical laboratory studies.
I submitted an application to the Office of Global Health to join the medical team in Jinotega, Nicaragua, and I found myself fortunate to have been selected, but also to be the first PA student to attend a Global Health trip with TTUHSC. The following months included numerous meetings, conference calls, modules, and presentations to educate us, build cultural competency, and to provide us with realistic expectations.
Nicaragua is the largest country in Central America and the second poorest nation in the Western hemisphere after Haiti. Jinotega is located in the northern highlands of Nicaragua and is the main producer of the nation’s coffee. The majority of the population is underemployed, if not unemployed. As a result, approximately fifty percent of the population lives below the poverty line.
As a result of the poverty of Nicaragua, the people face a number of daily challenges – challenges that are often made conveniences for Americans. We often take such conveniences for granted. The people of Jinotega are unable to afford healthy, balanced diets, and often lack access to clean water; there was little access to quality healthcare and medications, and they have a low literacy rate. The daily diet generally consists of rice and beans and few vegetables for most. Fruit and meat are more expensive, and are often excluded as daily staples. We were fortunate to have access to clean water and appetizing, healthy meals at the mission. Specifically regarding healthcare, I noted that continual care is a rare privilege. Also, there is little accountability for lab tests, and patients receive their lab results up to a year later, if ever. Despite these challenges, one of the profound strengths I noted was the community-based culture. There are a great number of multi-generational households; parents and grandparents are actively involved in raising and caring for their children, and serve as active members within their communities. In these (significant and important) ways, Nicaragua remains to be culturally-rich, with strong family bonds and relationships within their communities.
TTUHSC works with a local missionary, located in downtown Jinotega. Misión Para Cristo, a Christian-based missionary, was established in 1998 and hosts approximately five teams each year. The fees that we paid contributed to medications for the clinic, our room and board, translators, and meals.
A typical day (for me) started at 5:30 AM. I woke up, dressed, packed up my medical supplies, and made myself a peanut butter and jelly sandwich for lunch. At 6 AM we all sat down for breakfast, and started to load up the bus at 6:30 AM. Some days it took us forty-five minutes to arrive at to our clinical site, other days it took a couple hours, depending on which village we were visiting that day. On the bus we shared stories with each other and played games (one of our favorites was Heads Up) to pass the time. We would often pull up to our clinical site, and there would be a line of people around the building waiting for us. We would unload the bus, set up tents, organize medications within the pharmacy, all to essentially set up our own clinic. We had 8 “tuanis” (AKA awesome) practitioners, myself included, and a rocking team of nurses to collect vitals and perform labs/tests, and everyone worked until there were no remaining patients standing at the gates. We started packing away our supplies around 5:30 or 6 and would get back to the mission around 8 PM. We would eat dinner, shower, and then start prepping for the next day. Some nights we worked on educational resources for community healthcare workers, some nights we restocked medications and supplies, and still other nights we were learning material for the following clinic day. I often retired to my cot around 1 AM. Then I would review my Spanish before falling asleep.
The TTUHSC team represented a number of various fields within medicine – speech pathology, occupational therapy, physical therapy, nursing, nurse practitioner students, medical students, and me, a Physician Assistant student. We had no idea that within 4 short days we were collectively going to treat 1,084 patients and educate over 70 community healthcare workers. It was one of my greatest joys thus far working within the medical field – working seamlessly and cohesively within a multidisciplinary team. It was a rare opportunity to work as part of a medical team that offered pure support, positivity, assistance, and humility. As my friend Kenneth said, “If we are able to come together and work together in this kind of environment…the question is why can’t we replicate this when we come back? What is preventing us from doing this same thing when we get back to our individual places?” The answer is nothing. We can work cohesively in our hospitals and clinics, and that was the most important learning experience of my didactic year.
Some of the unique presentations that I was able to witness included advanced varicella zoster (chicken pox), which is rare to see at advanced stages in the U.S., as well as Chikungunya, a virus transmitted through mosquitoes that results in fever, a blotchy rash, severe joint pain, and conjunctivitis.
Our team also offered some educational opportunities to more than seventy community healthcare workers. They discussed various topics which included wound care, first aid, dysphagia (swallowing issues), hand-washing, dental care, CPR, nutrition, and breast exams. This learning opportunity was vital as these healthcare workers can now utilize their knowledge within their communities.
For our free day in Jinotega, we overlooked the active Masaya Volcano, visited the inner-city market, and took a zipline tour before our return to the capital, Managua. During our stay in Jinotega, we also climbed the 800 meters to Peña de la Cruz. The legend from the 1700s claims that people from the town of Jinotega watched each year as the nearby mountain grew. As it towered over them, they feared that the mountain would destroy the city, and thus, a priest carried a cross up to the mountain in hopes that it might stunt it’s growth. A service was held atop the mountain to make the land holy, and, according to the people of Jinotega, the mountain stopped growing.
I learned so very much on this trip, about myself, about other healthcare workers, and about advocacy for the PA profession. I met some incredible people that are going to make amazing contributions to medicine, and I’m cheering for every single one of them. I learned so much from our translators, from their uplifting, positive attitudes and how it important their jobs were not simply to bridge our languages, but also build trust between the patient and practitioner. I learned so much from the faculty and staff through their support and encouragement. I learned of the impact that a healthcare team can have with a shared goal. I learned how important it is to listen to the patient – really listen, and I learned how to look beyond the condition or disease and really see the person. Most importantly, I learned that I was bigger than any single event. My grades were minute events that didn’t quite translate to treating people. When a person was sitting in front of me, it didn’t matter how good my grades were. What mattered was my knowledge, my compassion, my empathy, and my ability to share that with my patient. I also discovered that language had little to do with the essence of communication. I crushed a soda can and bonded with kids over a game of fútbol. I noticed when a young girl walked into the Women’s Health Clinic and sat rigid and uncomfortable in the waiting room. I relished in the smile and laughter from a patient that felt relief after I told her I could help her. Those subtle non-verbals helped me understand my patient and comfort them; and ultimately, paying attention to those details made me a better healthcare provider.
Additionally, an important facet to note – we were simply people helping other people. After moments of working in the clinic, it was clear how capable my patients were. Many of them were running family businesses, while caring for several children. Some of them were well-informed of the conditions that ailed them – they simply needed continual care. So often I feel that poverty is marketed to us as helpless, dependent, incapable…and that is not the case. I originally went down to Nicaragua as a reminder of my love for people and medicine. I received so much more than I gave. It was not only a medical learning experience for me, but a lesson in humility, and I was grateful for the opportunity. This entire experience reinforced Hippocrates’ statement, “Wherever the art of medicine is loved, there is also a love of humanity.” Happy Reading!
Recommendations for visiting Jinotega:
- Drink only bottled beverages and stay hydrated.
- The rule: You can eat anything that you can peel, otherwise no street food.
- Learn basic phrases.
- Travel in groups of 3 or more.
- Download the Viber app for your phone – free talk, text, and video messaging to your loved ones.
- “Le podría sacar una foto a usted?” Ask people if you can take their picture (out of respect). I found most people to be comfortable with it, while others preferred not to have their picture taken.
For more information about Misión Para Cristo.
NOTE: All photos were taken with permission of the subject. All blog posts, articles, and photographs are the intellectual and creative property of Melissa J. Koziol. Thank you for reading!