One crazy week in Krin Krin...

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.

Appendicitis Update

We arrived in Waspam this morning and I went by the hospital here about half an hour ago to check on the patient we brought up on Wednesday with appendicitis. I asked the nurse if there were any patients from Francia with appendicitis how they were. She went around asking people and we found the patient sitting with his family in the courtyard of the hospital looking quite healthy. It was really cool since I wasn´t very hopefull about his prospects before, please keep this guy in your prayers that he will make a full recovery.

Appendicitis!

Around noon Wednesday was turning out to be a pretty normal day with Matt, Dan and I watching a couple of episodes of how I met your mother under one of the buildings to escape the heat. In the middle of our second episode Jeff walked over and asked if we wanted to help transport a patient with suspected appendicitis to the hospital in Waspam. After about a third of a second we decided, 'yes that would be a good idea and when we're we leaving?' The cooks handed us lunch in a bowl and we ran to the truck for the ride to the clinic. When we got there we found the patient waiting in a room with an IV already started by Maria. Apparently the sense of urgency ended there because we ended up waiting at the clinic for over almost an hour. During this time the Doctor and Maria tried to call an ambulance and then when that wasn't an option a debate ensued about whether to drive the patient out to the main road and wait with him until a vehicle heading to Waspam passed or to drive all the way in the deuce.

Eventually the conclusion was reached that we should drive the deuce all the way to Waspam and we loaded up the patient and rolled out. I can't imagine a ride in any vehicle over these roads would be the best idea for a patient with acute appendicitis, but being in the back of the deuce is especially punishing. We set up a small cot in the back and the driver tried to take it slow but that didn't seem to improve things very much. The shocks on the truck are very stiff for heavy loads and with not much weight in the back it’s a very bumpy ride. I was kind of expecting to have to do some kind of EMT stuff on the ride up but we really didn't have to do much of any thing. We made it to Waspam and the hospital in about 3 hours and went right to the hospital. The hospital is close to the outskirts of town and is apparently staffed by Cuban doctors and nurses.

Once we dropped the patient off the medical portion of the trip was over and we went shopping for the mission. On the way to one of the stores we stopped by the Rio Coco that separates Nicaragua from Honduras. There isn't much on the other side and there is no bridge connecting Waspam to the Honduran side. Apparently the only way to cross is by boat and it didn't look like there was any kind of border security on the other side either. Apparently the Miskito people can cross freely without a passport since they live on both sides of the river. Waspam is smaller than Puerto Cabezas and seems a little cleaner and maybe less busy.

After shopping we went to an internet café by the airport (really a grass runway with a two room terminal) and got a few emails out. After that we loaded up the deuce and got ready to head out of town. On the way out we stopped by the hospital to check on our patient and found out that he had already been to surgery but unfortunately his appendix had already burst by the time they opened him up. With the age of the patient, he was over 60 which is very old for Miskitos, and the rough ride to town I don't think the prognosis is very good. Since then I haven't heard anything but I may try to check when we head back to Waspam this Sunday for our river trip.

It was a unfortunate dichotomy to the day; on the one hand I was excited to get out to civilization, get a cold coke, by some food, and get internet but on the other it was because someone was seriously ill. Its pretty easy to get jaded here by people's medical problems, many of which are a result of their lifestyle, but this patient was sad reminder of the heath reality these people face. It hit me when I got back to Francia that this guy might die and I was excited that I had gotten a cold drink…I felt pretty guilty after I realized that.

Tikamp…otra vez

Thursday we took our rolling medical circus back to Tikamp which was the last village we visited before we left for Corn Island. It’s a fairly remote village and the people who live there seemed a little less healthy than in other villages. This may be due to the lack of a government health clinic in the village. I was with Jeff for this clinic and most of the patients we saw were women with three or four kids in tow. Again the predominant symptoms were headaches, night fevers and no appetite. For the headaches we tell them they need to drink more water, the night fevers are usually unless they have other symptoms concurrent with TB or Malaria. Most of the people complaining of fevers didn't show an elevated temp even if they claimed to be suffering from fever at that very moment. There was one pregnant mother who was expecting here baby any day and said she was planning on using the village midwife to help with the delivery. We were also able to check the fetus' heart rate using our monitor which was pretty interesting. Over all it wasn't the most interesting clinic so far but we did get home in one peace which is always a plus.

A line without trees...

So we just finished a week of school and clinics. On Tuesday we went to Kapri which is the farthest location of all of the clinics we do. As well as being the farthest away, Kapri is also the most remote and our original plan was to take the deuce as far as it could go and then hike from there. Kapri is about 3 miles from another town called Miguel Bikan which has an ok road by Nicaraguan standards. From there the road quickly becomes merely a line through the jungle that happens to be without trees and is barely wide enough for the deuce to drive through. Since everyone rides in the back we were at the mercy of all the random branches and thorns that reached out of the jungle. My hands got pretty scraped up in the process but surprisingly we actually made it the whole way without having to hike.

I was with the doctor for that clinic and we saw a couple of interesting things; our first patient had stepped on a nail a couple of weeks before and was worried about infection. We washed the bottom of his foot with iodine and then the doctor decided that we needed to check if there was any pus in the wound. To do this he had me numb up the area with a lidocaine injection and squeeze the wound to try and express any pus that might be there. Even though the patient was warned he still jumped and struggled and I was a little worried about poking myself with a dirty needle. We eventually got him calmed down and were able to check the wound which proved to be healing nicely and not infected. Our next patient was a lot older and appeared to have some kind of chronic wasting syndrome; his cheeks were really sunken and ribs were very prominent. When he removed his shirt there was an approximately 3 inch wide raised mass just below his left shoulder which he said had been there for about 1 year. The patient also had a large weeping lesion covering most of his left ear that looked like it could have been a type of skin cancer, possibly basal cell carcinoma according to the doctor. We cleaned the patients ear and told him that he needed to try and get to Waspam to get the mass on his back looked at by a surgeon.

Most of the other patients complained of a lot of the same symptoms. Almost everyone says they have a fever even though their temperatures don't reflect it at all. A lot of people also complain about having a fever only at night also. I don't know where they get the idea that they have these symptoms since their vital signs definitely don't check out, maybe someone told them one time that they had a fever and they assume that they always have one. A lot of the time I think it comes down to ignorance about health; every other person who comes in complains of being dizzy and getting head aches but when you ask them about how much water they drink its only one or two glasses. I think they believe that all they have to do is go see the white people get a few pills and whatever they have will go away. I don't know how these people will ever improve their lives unless someone really teaches them how to be healthy, that would be a worthy mission.

3/2/10...because I can't think of a catchy title

So we've been back in Francia for almost a week and its starting to wear a little. The weather was bearable until today when it got back to the normal sweat while doing absolutely nothing temperature. We've been doing classes the last two days since Southern is here and they are using the deuce for clinics. Today was the Travel and Tropical Medicine midterm which means we are half done with that class and will probably finish it before we leave Nicaragua. Public Health is over half done and will probably be finished next Friday which is fine with me.

So far having Southern here hasn't been too bad, since there hasn't been much rain lately we've been relegated to taking bucket showers while Southern is here. I still think I use less water taking a regular shower than with the bucket but that’s ok. Not that I have a problem with the group, but its been good to have some new people around to talk to. A lot of them were really surprised when they heard we were spending a whole 3 months down here.

I helped organize a trivia night on Sunday night which involved spending three hours in a group racking our brains for all the random facts and trivia we could think of. We had 5 rounds of trivia and a single music round at the end. It was such a hit we had it again last night but unfortunately my team got clobbered on the music round and came in fourth.

Some of the people that came down with Southern were mechanics and they've been working on the old Toyota Hilux that’s been sitting around broken for the last 6 months. They finally got it running today but who knows how long it'll stay running this time; they're pretty hard on stuff down here. If you didn't know any better you might think our tool shed was in rural Kentucky by all the broken vehicles and junk lying around. There is another broken deuce that hasn't run in quite a while that apparently keeps the other one running, furthermore the grounds are also graced by a non-functioning 4-wheeler.

On Wednesday, which is generally our project day, we broke into two teams one of which went into the village and located all of the wells and pumps. In addition to their locations, they also took pictures and marked their GPS coordinates. I was in the team that stayed behind and worked on a detailed map of the mission premises. We took GPS coordinates of all the buildings and landmarks as well as the perimeter and created a rough map of the area. The purpose of all of these activities was to learn a little bit about how to conduct assessments of the needs of an area with an eye toward development projects. I think it was a pretty useful exercise although it’s a unfortunate that we won't be able to make a major difference here aside from the medical aspect since we have such a limited amount of time.

So its finally almost the weekend which means two more weeks before we head on our river trip down the Rio Coco. Next week we start doing clinics again since Southern will be gone, this also means we can go back to normal showers which will be awesome.