This is the continuation of my blog regarding conditions and types of treatment seen in the clinic in Nicaragua.
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.>
When I was listening to patient’s lungs during my exam, the physician in the clinic would always ask me if I heard “wheeee” sound or a “whoosh whoosh”. That was their way of distinguishing between allergies (“wheee” or wheezes) and infection (“whoosh whoosh” or consolidation). In the Nica clinic if something was not an infection it was called allergies. Now in the USA we would have to specify more, because there can be many different types of allergic responses. The main reason why the physicians did not do any further diagnostic work up was due to the fact that for one it would not change the treatment and for two in the rural clinic they did not have access nor could these patient’s afford any further diagnostics such as x-rays or more extensive blood work.
The most common kind of allergy seen was Asthma and the patient was prescribed an Albuterol inhaler, which is similar to the treatment provided in the USA. There are a lot of factors that contribute to allergies in Nica. The time I was down there was their winter and the weather can change from sun, to humid, to rain, and to cloudy in the course of several hours. Also, the amount of dust and dirt around in living areas and public areas also contribute.
3. Chronic kidney disease
One of the most emergent issues taking the lives of men and women in Nica is chronic kidney disease. In the city of Leon and surrounding areas, there is a major health crisis involving chronic kidney disease. On my first day in the clinic, a patient was leaving with dark red circles below his eyes, sullen complexion, and looked very ill. Upon questioning he was one of many that is suffering from kidney disease. Part of the issue with kidney disease is that if it progresses too far, one of the few treatments available is dialysis, which is not available to many of the patients seen in the rural clinic I worked at due to lack of funds and lack of availability to get to a clinic or medical center three times a week.
Some factors that contribute to kidney disease are lack of purified drinking water and the humidity leading to dehydration, frequent urinary and kidney infections, poor diet (lack of fruit/veggie availability, high cholesterol/fatty diet, and lack of other options), and decreased access to healthcare on a continuing basis.
Treatment provided included medication to decrease cholesterol and fats (such as a Statin), sometimes a diuretic or Lasix to decrease water weight and edema, treatment for any infections, and counseling on diet/water intake. Unfortunately for many patients with this condition, there is not much treatment available. Fortunately the clinic has recently received a donation for 3-5 dialysis machines, which would provide patients with increased access to care and the ability to continue their life in a more comfortable way. That being said, it is a band-aid, not a solution to the problem.
Many children that came into the clinic were malnourished, infected with parasites, and dehydrated. Almost all patient’s came in with ‘exams’ that included a Hematocrit and Hemoglobin and almost all the children that were seen had anemia, some that was pretty severe. The physicians acknowledged that these patients had anemia, but often there was nothing they could do outside of treating the infection or parasite the patient had and encouraging the mother to increase the nutrition of their child. It was not that the mother’s wanted their child to be malnourished or were poor parents. Often with young children who were being breast fed, the mother herself was malnourished. With children a bit older, it was due to a lack of availability of healthy food or enough food. The physicians would sometimes prescribe supplemental nutrition and electrolytes, but there was only a limited supply of these for the whole clinic, so it was often saved for the most severe cases. It was difficult to see these children that were full of life, but clearly struggling.
- Of note, some of these children and adults had iron deficiency anemia, but the clinic had no access to iron supplements, so this treatment was recommended, but unavailable to these patients. This is an example of the difficulty of obtaining donations even when they are available in a foreign country.
5. Other medical conditions
Lastly there were patients that came in with medical conditions that are common in the USA including chronic pain, high blood pressure, high cholesterol, and heart disease. These conditions were treated very similarly to our treatment protocols here… diuretics and other medications for high blood pressure, statins for cholesterol, beta blockers for heart disease, and pain medication for chronic pain. The main difference is that lifestyle factors, prevention, and alternative healthcare treatments were not available, discussed, and sometimes even known about.