Today's the day, the longest day in the longest 3 months of my life, the last day in Francia, the last day before we take one more terrible deuce ride into Puerto Cabezas. It’s a wonderful feeling, it means that soon I'll have internet, flush toilets, warm showers, food other than rice and beans, and all the other comforts that come along with not living in the bush. But its also not without mix feelings that I'm leaving this place; I think I'm actually going to miss this place. Probably when I'm busy beyond belief this summer I'm going to look back at the times when I thought I was so bored and think 'why didn't I enjoy it when I had the chance?'
I'm also a bit discouraged by the immense need here that is not being met, I hope that at some point I'll have more to contribute to these people. There needs to be a concerted effort at educating the Miskitos about how to improve their health and livelihoods. Until this happens clinics and de-worming medications are only a stop-gap measure.
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.
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.
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.
