Our week on the Rio Coco started last Sunday when we left Francia for Waspam. We spent Sunday buying food for our trip and spent the night at an establishment called El Piloto or The Pilot. Even though the power was out half the time it was definitely the classiest hotel in town…it even had A/C and wifi.
Monday morning we drove the deuce over to a small town on the river called Lamos where we met the boats that would take us up the river. The boats on the Rio Coco are basically 65 foot dug out canoes with out board motors and it took two of these to ferry our group and gear to our destination. Krin Krin is a pretty remote village on a river with a lot of remote villages. Besides trails through the jungle the river is the only access to the outside world for most of the villages along the Rio Coco. Krin Krin itself is about 10 hours by boat from Waspam.
Over three days we saw over 400 patients which is pretty amazing since we only had one licensed provider with us. A lot of the patients we saw had hiked in from surrounding villages to reach our clinic. The doctor that was supposed to come with us got sick right before the trip and wasn't able to come. We set up three consultation stations and Jeff floated between each one and helped with the complicated stuff. The way the rotation worked out I got to be in consultation part of the first day and all of the second and third days. It was pretty cool to be able to put all the knowledge we had gained working with Jeff and Dr. Linares to work on our own. I made a cheat sheet of all the common drugs and symptoms of disorders that helped a lot. It also helped that almost everyone had the same symptoms too. The vast majority of the people we saw had parasites that could be treated with one a couple of different medications. Parasites are so commonplace that a lot the patients wouldn't even bring up the fact that they had them. For some reason a lot the kids had ear wax issues and we spent a lot of time digging wax out of ears which made for some very unhappy children, I actually pulled a chunk of wax the size of a bean out of one kid's ear. Most of the kids had never even seen a white person before, let a lone one with strange things like stethoscopes and thermometers so we had to deal with plenty of freaked out, screaming kids. For 10 hours a day in an enclosed space screaming and crying kids starts to get to you. Sadly the majority of the women patients we saw had urinary tract infections and a lot of them also had STD symptoms. We did a lot urine tests for infection and prescribed lots of antibiotics for sexually transmitted infections. Unfortunately we had to tell a lot of the people we saw that we could help them and that they needed to visit the hospital in Waspam. One family hiked two days through the jungle after hearing that we were doing a clinic in Krin Krin. They arrived with a very sick baby only an hour before we were supposed to leave yesterday and we were able to evacuate the mother and baby to the hospital in Waspam with us.
One of the most interesting things about Krin Krin is that it is the focal center for something known as the Grisi Sickness. Grisi means crazy in the Miskito language and it can best be described as demon possession. It apparently started about 70 years ago in Krin Krin and mainly affected adolescent girls and young women. There are stories of teenage girls overpowering and killing soldiers that accompanied the government medical teams that first tried to figure out what was happening. The World Health Organization has sent teams to investigate the problem and has classified it as group psychosis that only seems to affect young women. Jeff had brought this up in our Emergency Care I class last semester but I had forgotten until Jeff reminded us about it last week. It was a little unnerving to know that this is where it all began and it might still be happening but I didn't give it much thought. The night before we left all the churches in Krin Krin got together for a farewell service for our group. We sang a lot of songs and it was a lot of fun to worship with the people we had been working with all week. At the end the pastor got up to give a short sermon and soon after he started a girl in the back fell down and started having convulsions. I wasn't close enough to see exactly what was going on but Jeff said it was definitely not a seizure. It took several people to hold her down and her movements were definitely too deliberate for someone having a seizure. The weirdest thing about it was that she was completely silent, normally someone like that would at least have to make some noise. After a few minutes several people carried her away kicking, but strangely not screaming. After the service was over we got together and prayed as a group but we never heard what happened before we left.
My week on the Rio Coco was probably the highlight of my time down here in Nicaragua. It was the epitome of why I was down here; to put my limited medical skills to use in helping these people. Up till now our clinics have been limited by time and distance from Francia, but in Krin Krin it was awesome to be able to keep the clinic open as long as possible and be able to help as many people as possible. It was saddening to know that people had to walk for hours and sometimes days through the jungle just to reach our little temporary clinic because it was the only medical assistance available anywhere near where they live. A man in Krin Krin told us that the government clinic was built but there was no doctor, no nurse, and not even any medications. There is a terrible need for medical assistance in this area which is not being supplied by the government. I hope I can come back in the feature and contribute more than I was able to on this trip.