Hanging the Shingle

We were ready to go - our triage station was prepped, supplies were organized as best as we could, and our 3 makeshift exam rooms were all set. The patients arrived, a good mix of kids and adults, although 90% of the adults were women. Most were moms or grandmothers, and many had not seen a doctor in a good while.  

All ready to go!

I had preconceived notions about the patients we would be seeing - I had expected to see a lot of diabetes given the diet of mostly rice and beans, along with a decent amount of hypertension. Well, we didn’t see anywhere near the number anticipated of these diagnoses. While we did see a fair amount of foot injuries due to the poor footwear, the biggest complaints were abdominal pain and upper respiratory symptoms.

Everyone had abdominal pain. Pain with eating, pain without eating. Many had concomittant diarrhea. A good chunk of these also had respiratory complaints. Cough, especially at night, and some dyspnea (shortness of breath) when in the house were also frequent symptoms. To understand why, take a look:

Inside of home, baby’s pack and play in view. Note hard-packed dirt floors.

Wood-fired cooking area. Note the chicken. Location adjacent to home.

Cooking prep area - open air, no storage area including fridge.

Outhouse. Clothesline is barbed wire.

What you have to do to get water when the government doesn’t.

When you have to live in a small shack with packed-dirt floors, an outhouse near the home, and a woodfire stove blowing smoke close to your window, there WILL be problems. Nearly everyone showed signs of parasite infection; in fact, in many countries with similar living conditions, the government will provide parasite treatment to its citizens twice yearly to prevent malnourishment and anemia. Not Nicaragua. Its infrastructure is pretty infantile and even vaccination campaigns seem tepid. The dirt floors and open-air kitchens in close proximity to the outhouse, with no running water anywhere nearby, meant the transmission of parasite infections from hand to food to mouth was depressingly high. Parasite infection = abdominal pain and frequent diarrhea as well.

Water was also an issue - the Nicaraguan government turns on the water to this barrio twice per week, on Tuesdays and Saturdays. Residents would fill up as many containers as they could to use until the next time the water was turned on. However, the week we were there there was no water on Saturday, so many people were without water for both washing and drinking for days. In the last picture above, the family home we visited tried to compensate for this cruel practice by digging to find a municipal water supply pipe; luckily they found one and discovered it leaking, so they placed a basin under it to catch the water so they could at least have something to drink.

Can you imagine that? Your government only allowing your water to be turned on twice a week? And “forgetting” one of those days? Really?

In spite of these harsh living conditions, the people of this barrio were beautiful, kind and loving people doing the best they could with what they had. I wonder if I would be so generous of spirit if the tables were turned...

Baby R, the beautiful young girl of the house above.