This is part 4 in my 5 part series on healthcare in Nicaragua. I did not realize how much I had to say about the different types of conditions in Nica. Since my post started looking more like an essay than a blog post, I have broken it up into a few pieces. Sorry it is such a lengthy one, but I wanted to be sure and discuss all the main healthcare issues seen in the country.
Conditions and Types of Treatment
Now to the fun part…. what kind of conditions did I see and treat.
<Please note that I am going to be vague regarding the patient description to protect the medical information of those individuals.>
1. Infection, infection, infection
The most common illnesses that were seen in the clinic were infections of all sorts. In Nicaragua, especially rural Nicaragua, most infections are bacterial in nature vs. in the USA they tend to be viral. Patients would come in complaining of difficulty breathing, cough, runny nose, or chest heaviness and upon listening to the lungs you would hear consolidation or according to the Nica doctors a “whoosh whoosh” sound. This to them meant infection, most likely pneumonia although they never did the follow-up labs/imaging to check for sure, and the proper treatment was antibiotics, NSAIDs for pain/fever, and vitamins once the infection was over. Most of these were seen in children, but some in adults as well.
Getting ready to see patients in the clinic.
Along the theme of infection includes ones of the stomach or GI tract. Many patients come in with stomach pain, nausea/vomiting, or diarrhea (lots of diarrhea). After providing a stool sample and receiving a blood draw they would return with the results to be interpreted. More often than not patients would either have a high Eosinophil count (leaning towards allergies or parasites) and/or some type of bacterial culture in their stool (often E. Coli). While in the USA bacterial infections of the GI tract are not common, patients in Nica have the deck stacked against them.
The water supply is not purified, so many patients drink un-purified water. Also, the hygiene practices of washing hands and proper bathroom hygiene is not emphasized or even known leading to an increased chance of exposure. Lastly, the food in Nica is grown with un-purified water and washed in it as well contributing to potential exposures. Typically the treatment is an antibiotic, anti-acid (which does not necessarily protect from future infection, but it is a commonly practiced prescription to give for this diagnosis in Nicaragua), possibly a fever reducer or pain relief (Tylenol or Ibuprofen), and vitamins.
- Probiotics are not prescribed although this would be protective from future infections. The clinic does not have access to probiotics to prescribe to patients. Also, there was a lack of understanding on the physician’s part regarding healthy/normal gut flora, which could be the result of a communication barrier or lack of this information being widely accepted in Nicaragua.
- I was taking a probiotic while in Nicaragua, to help prevent parasite/bacterial colonization in my GI tract by lack of space. The idea behind it is that if I fill up all the space for bacteria to adhere with ‘good’ bacteria that is commonly found in the gut, then the ‘bad’ bacteria that causes infection has no place to hang on to. When I tried to explain that, their response was, why would you take bacteria to avoid infection.
In such a beautiful country there is unfortunately a lack of infrastructure leading to increased incidence of infection and disease.
The last and probably most common infection that was seen in the clinic includes urinary tract, kidney, and vaginal infections. I combine these together, because often women who had one had the others and most of the men that came in with urinary infections they were advancing to kidney infections. These patients most often came in with the chief complaint of “chistata”, which is a local Nicaraguan word that means urinary symptoms or pain. Again the prevalence of urinary tract infections is partially associated with poor hygiene practices (either lack of using toilet paper completely, wiping from back to front, and/or decreased bathing), lack of water intake (with the heat in Nicaragua and the humidity it is easy to become dehydrated, which increases the incidence of vaginal/urinary infections), and lack of condom use or other forms of protection as well as high risk sexual behaviors. These patients would have a UA (urinalysis) done as well as a urine culture (and vaginal discharge culture for female patients). At the visit the doctors would interpret the results of the ‘exam’ and prescribe the appropriate antibiotic based on the type of infection (Bactrim for kidney/urinary or Clindamycin for vaginal). Often for female patients they would prescribe Monostat cream for fungal infections and overgrowth. Also, patients would receive pain medication and vitamins.
Infections are a commonly diagnosed thing in clinics in Nica due to the lack of hygiene, lack of infrastructure for pure water and good food, close living quarters, and lack of sexual protection and high risk sexual behaviors. The common treatment is an antibiotic based on the type of infection (not the bacteria involved but rather the location), pain reliever/fever reducer, and vitamins for after the infection resolves. Main differences between the USA and Nica in the diagnosis and treatment of infections include:
- Less emphasis on diagnosing the specific bacteria if it does not change the treatment vs. needing to be as specific as possible due to providing the most effective treatment and decreasing physician liability for incorrect treatment.
- Decreased focus of lifestyle factors that contribute and lead to these infections partially due to lack of infrastructure to solve these issues vs. discussion of lifestyle factors with the ability to change them.
- Treatment that is focused on resolving the infection, but antiquated information on adjunctive treatments vs. encouraging probiotics and other treatments and therapies that help support the system while it is fighting off the infection.
- Antibiotic heavy prescribing vs. antibiotic light prescribing.
Overall the patients in the clinic were all very sick and needed treatment for multiple medical conditions. Other medical conditions that will be discussed in the rest of this blog post include: allergy, chronic kidney disease, anemia and other illnesses.
Doctors, future doctors, and missionaries in front of the clinic.
This is preventive health! 