This is part 2 of my series on healthcare in Nicaragua covering a typical day in the clinic.
Typical Daily Clinic Schedule
The clinic I worked in was open from 7:30 AM to 4:30 PM. We would arrive around 7:00 AM to anywhere from 20-30 patient’s waiting in the waiting area outside. Prior to the clinic being open one of the doctors or one of the medical missionaries (myself included) would give a short devotional to the patients outside.
Nicaragua is a primarily Christian country with 40% of the population Catholic and 40% protestant. While this would typically never happen at a clinic in the US, the devotional time allowed the patients to reflect on something during their wait period prior to being seen and also they saw that the physicians in the clinic cared enough to take the time to prepare something to say and pray with them. It was a sweet moment to see all the staff members and patients together as one in prayer.
After that the clinic would open. Patients file in one by one, first going to the front desk and paying their 3 Cordoba (26 Cordoba = $1 dollar), which covered the whole medical visit including most treatment. Then they would go to the front desk where a nurse and/or medical missionary (like myself) would take their vitals and ask them basic intake questions about their current symptoms, allergies, medications, etc. Then they would either go get their blood drawn in the lab (an exam as they called it), meet with one of the doctors at their desk for a consult or lab result interpretation, or in some instances go into a treatment room and receive an ultrasound, EKG, or further examination.
Most of the patient visits involved very little examination outside of heart, lungs, vitals, and HEENT (head, eyes, ears, nose, throat). Sometimes an abdominal exam was performed. Sensitive exams (gyn exams, prostate exams, etc.) were only done on special days when outside doctors were visiting the clinic, generalists typically do not perform these exams in Nicaragua.
More on types of diseases seen and treatment administered in Part 4 of the series. After the patient discussed their symptoms with the doctor, they received a piece of paper with medications and doses on it. The patient would then head outside of the clinic over to the pharmacy window where the pharmacist or medical student or whoever was working the window that day would count out the correct number of pills and provide the patient with a bag of medications for no extra charge.
At around 12:00 PM, the clinic closed for 1 hour for lunch, kind of like doctor’s offices in the USA. All of the staff members would crowd around a tiny table in the middle of the clinic and eat and talk together. It was a nice moment in the middle of the day to slow down and check in with one another. After lunch was over, it was back to business, but typically slower in the afternoon. Around 4:00 PM we cleaned up the clinic, but did not mop or sanitize things, because they have a cleaning lady (janitor) who would pick up after everyone was gone.
The clinic saw between 70-100 patients per day of various ages, genders, and states of health.
The overall clinic operations on a day-to-day basis was similar to a small rural clinic in the USA. Some differences were that all of the staff… doctors, cleaning staff, nurses, etc would sit together around the same table and eat during lunch. No one was working during this time, checking their emails, or reading. It was refreshing to disconnect. Also, there was less emphasis placed on exams and more on what the patient had to say. It was more personal. Similar to the US, the visits were rather short, 15 minutes tops (unlike a typical patient visit with a Naturopathic physician).
3 thoughts on “Nicaragua Medical Mission – Healthcare Part 2”
Your blog is interesting and heartfelt. FYI all residents of Nicaragua are given free health care at the Salud Clinics. The problem in rural areas is getting to a Clinic. Your one mile walk is nothing compared to the distance many people walk to get healthcare.
I think you should look at some other very rural clinics in Nicaragua that I know of. There are also some Naturopatic Doctors who have clinics. Ometepe has an MD/Naturopath with a Clinic on that island that was started by a female doctor from the US. There are a lot of similarities and many differences in how a clinic operates depending on how the Clinic is documented–US NGO, Nica NGO, or both. There are several advantages to documentation as both categories for acquisition of medications and supplies.
Getting supplies into Nicaragua is a science that I learned relatively early in my career as a volunteer nurse working in a very rural clinic in the Rivas Dept. My affiliation is the Roberto Clemente Santa Ana Health Clinic http://www.nicaclinic.org, Another successful very rural clinic is in Granada Dept. http://www.comarcasapoyo.org/
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Thank you for all the information! As I am a one time missionary there all I can draw from is my very small time in the country! I do know of many other organizations that are doing great work in the country including Naturopathic Doctors International which sends ND brigades throughout the year. This post is not to reflect on the country as a whole, but rather the clinic I was a part of and the experiences and patients I served.
The walk for me was not the walk that many patients had to make on a daily basis to the clinic, but I want people to know what my experience was since it is drastically different from the states.
As I am not running or involved in a NGO it is great for me to hear what other phenomenal work is being done in the country. Thank you for sharing. The clinic I worked at was associated with Christ for the City International and while I am not involved in getting supplies into the country… They shared with me their plight while I was there.
While I am finishing up my studies I personally will not be going back there for sometime, but I will definitely look into those organizations if I go back in the future!
Thanks again! 🙂
Our biggest challenge was raising funds for medications. In a week, doctors and nurses saw over 600 patients. Midway through Friday, we had to close because we exhausted all our financial allowances for medication. If anyone has thoughts on how to obtain medications at a reduced rate, I’d love to learn about this. Thanks so much
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