Nicaragua Trip Report
October 22-November 10, 2006I would like to start by thanking HVO/OREF and Orthopaedics Overseas for their generosity. I was thefortunate recipient of the OO-OREF Traveling Fellowship, which covered my travel expenses and permitted me to make this trip. I would also like to thank Dr. Dino Aguilar and his family for their kind and generous hospitality, continual guidance, education and companionship. They were truly a family to me. They opened their home to me, continually helped me with my Spanish skills, educated me on the history and reality of Nicaragua today, and became very good friends. Dr. Aguilar is a remarkable individual and physician, he is truly dedicated to the improvement of the medical system in Nicaragua, in spite of the enormous obstacles that seem ever present, and at times insurmountable.
I was in Managua during a very interesting political time. National elections were held during my second week there, and to the surprise of much of the Nicaraguan population and the international community, Daniel Ortega was again elected President. Without spending many pages recounting the tumultuous history of Nicaragua (and the legacy of American intervention in many forms since 1855) the lesson from this recent election is clear: Nicaragua is a nation with a struggling economy and a people who want change. The high external debt and internal debt have inhibited growth. Around 75% of the population lives on less than $2 a day, unemployment and underemployment are close to 50%, and income inequality is very pronounced.
There were, of course, concerns in the international community and among the people of Nicaragua that the election results would lead to violence. Fortunately, the elections (the most highly internationally observed election in history), were without evidence of corruption and were peaceful.
I spent three weeks in Managua. During the first week I was taken to the 2 large public hospitals (Hospital Lenin Fonseca and Hospital Roberto Calderon) which handle most of the trauma and referrals for difficult cases for the entire country. At these hospitals I participated in ward rounds, education conferences, and discussion of cases. In addition, at Lenin Fonseca, I assisted on several trauma cases, which made it very clear, very quickly the disparities between the United States medical sysem and that of Nicaragua. We placed a Kuntscher rod (which I had only seen in pictures) in the treatment of femur fractures and used a dynamic hip screw in the treatment of a hip fracture, without the assistance of flouroscopy. I spent several days in the ER/cast clinic working with residents. I then spent 2 days at the hospital Militar (the military hospital), helping a physician there with several pediatric cases, which were ‘bread and butter’ cases here (forearm fractures that needed reduction and fixation, supracondylar humerus fractures, proximal femoral osteotomy, club foot release) but seemed the presented many challenges due to lack of implants, equipment and flouroscopy. For example, as the patients/families must buy their own hardware for any procedure, you tend to have to make-do with what they buy (as there is no exchange policy), which may include plate modification and trimming of the screws. If you are lucky, the drill will work and you will get a quick spot view on fluoroscopy.
The remainder of my time (2 weeks) was spent at Hospital Materno Infantil Velez Paiz, the national obstetric and pediatric hospital. I split my time between clinics and the OR. I found that the residents were very motivated and knowledgeable, their greatest challenge being getting their hands on up-to-date textbooks and periodicals. I very much enjoyed my time at this hospital, and felt that the time spent in clinic with the residents and the OR with the residents was very valuable for both parites. I worked primarily with Dr. Ramos, who was very welcoming and excited to have me there. I hope that I have made the initial steps towards an on-going relationship with the staff and residents at this hospital.
At the University of Utah, where I did my fellowship in Pediatric Orthopaedics, we are hoping to involve the residents in volunteerism and international medicine during their training. In fact, one month during the 4th year of training has been set aside for such a rotation. Therefore, my participation at the Managua site was also intended to evaluate this site for future resident rotations.
I think a rotation in Managua would be a superb educational opportunity for residents in training. My concerns would be related to the language. While Dr. Aguilar and his family speak excellent English, I did not find this to be the case with the residents and other attendings. I speak some Spanish and this was indispensable for our communication. If the visiting resident spoke no Spanish, from my experience, Dr. Aguilar is the only option for a host/mentor. If the resident has Spanish skills, there may be other on-site host/mentor possibilities, but apparently Dr. Aguilar has taken this responsibility in the case of almost all HVO volunteers that have gone to Managua. I think the Hospital Lenin Fonseca, the Hospital Roberto Calderon, The Hospital Militar and Hospital Infantil Velez Paiz are all possibilites for quality rotation experiences. I think the ideal would be to pair the US resident with a Nicaraguan resident for the rotation, allowing them to really experience the on-call and day-to day life of the Nicaraguan residency
I feel that this experience was a personally and professionally enriching experience. As I said before, I hope this visit was only the beginning of my involvement with OO and in Nicaragua. As I develop my career I hope to return to continue to work with the staff in Managua and be able to teach more.
Nicaragua is a beautiful country with beautiful, gracious, intelligent, charming, hospitable people. I felt very safe and ‘looked-after’ during my trip. While this experience will certainly be a culture shock in many ways to most Americans, I think it would be an invaluable personal and professional experience to any resident or volunteer. The most astounding aspect of my experience is how much and how well they do with so few resources. Fortunately, there is no lack of motivation, ability or dedication. This is a credit to the industrious, generous, caring natures of the residents and faculty.
Theresa A. Hennessey, MD
tahennessey@hotmail.com
(801)536-3599
Nicaragua Trip Report
