Que dices?

What a couple of days.  First I will talk about my first day with las doctoras.  I followed Dr. Garcia On Thursday.  At first glace, she appears to be a stern, serious woman.  When I walked over to her side of the room to reintroduce myself and let her know I would be with her that day, I jumbled all of my words up to an incomprehensible word soup.  She gracefully smiled at me, and said “Que bien!” She introduced me to each patient, and each patient was kind and gave me an appreciative smile.  Nicaraguans are a appreciate people as a whole; the position of a student of medicine is pretty much the same thing as a doctor to them, respect-wise.  A lot of pressure. 

During each patient exam and interview, Dra. Garcia went over the science and impact on lifestyle behind the health problem.   It was mostly diabetes and heart issues, so picking out clues from her rapid Spanish was too difficult.  Then came the drugs.  During the first year of medical school, we learned ~5% of the drugs we will end up knowing by the end of 2^nd year.  Listening to a Wikipedia page’s worth of information on each drug, in Spanish, was insane. It's hard enough in English.  Every time I started getting frustrated with myself, I had to make myself remember that I am here to learn. Furthermore,  I had to keep telling myself, I am not here to only learn Medicine, but more importantly (for now) to learn about the Nica people, culture, and the language.  Dra. Garcia was very patient with me and was able to help me through the headful of knowledge. 

Anyway, some cool things I was able to do, besides dissect Spanish on drugs and natural remedies. I learned how to perform an injection in a booty while avoiding the sciatic nerve; Differentiate pathological breathing sounds (I need more practice); I set someone up on a nebulizer; I found a pea-sized lump during a manual breast exam in the upper right quadrant of a patient’s left breast proximal to her areola. That was pretty intense.  

After we dismissed the lady with the lump, Dra. Garcia talked with me about the lack of services in Nicaragua regarding women's care and cancer screening.  Many people have never even known or thought about getting a mammogram or ultrasound or a pap smear (let alone can they afford those types of services nor are they available).  So there isn’t anything we, as a clinic, can do for her.  We tell her where she can go and hope she can get a free or greatly reduced service.  I hated sending someone away with so much uncertainty.  But that’s the way it is here.  The degree of lack of resources puts a lot of responsibility on the doctors to be empathetic as well as serve as a beacon of support and guidance.

I am hiking Mombachu tomorrow, so I need to sleep.  Cars are not allowed up and it's a pretty long and vertical road up to the top. If you miss the Jeep rides (only 4 of those a day), then you are hiking. Then there are the actual hikes once you get to the top-ish region.  And getting there will be a good bus ride experience : )