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).