Back Pain – Fact or Fiction Video

This is an interesting video regarding facts and fiction of back pain and how it affects patient care and outcomes…

It is about 15 minutes long, but worth the watch. Chronic pain is an issue for many Americans, especially back pain. This video gets at the Naturopathic doctors’ goal to identify and treat the root cause and do no harm. The professor looks at pain from a different lens.

My name is Emma Petshow and I am a 4th year naturopathic medical student at the National University of Natural Medicine in Portland, OR. For more about myself, check out my bio. This blog is intended for information about preventive health and lifestyle improvement. The information contained on this blog is not to be used as medical advice. For specific medical advice you should consult your physician.

Nicaragua Medical Mission – Healthcare Part 5

This is the last installment of my blog series on healthcare in Nicaragua. So far we have gone over…

  1. Clinical logistics and medical training in Nicaragua
  2. Daily operations of the clinic that I served at
  3. Spanish language, barriers, and roles that I held in the clinic
  4. Commonly diagnosed and treated conditions in the clinic

Translator, Doctor, Acupuncture student, Naturopathic medical student, Nicaraguan medical student – working together

This post will discuss where I think Naturopathic medicine, preventive medicine, and public health could be incorporated into the clinic I served at in Nicaragua. I have many ideas, but to organize them in someway, I am going to discuss them within the framework of the 6 principles of Naturopathic Medicine. There are many other ideas that I would have included to this list, but these were some of my first thoughts!

The Healing Power of Nature

Part of Naturopathic medicine involves identifying and removing obstacles to patients cure, which allows their body to recover and heal naturally. A great example of how this can be implemented is with chronic kidney disease. Now once started, kidney failure cannot be completely reversed, but the progression can be slowed if obstacles to health are identified and removed. This includes…

  • Diet! Many local Nicaraguans have a diet high in fat from poor cuts of pork. Education regarding types of foods to consume and avoid as well as encouragement to consume less fat and salt and more fruits and veggies would help slow the progression of disease. Also, resources on where to find these foods in their community or a local clinic garden could be ways to provide patients with these foods if they are not available for them to purchase.

While super tasty… not the healthiest most balanced meal I had in Nica

Identify and Treat the Cause(s)

Most doctors, including the doctors in the rural clinic I served in, in Nicaragua, strive to identify and treat the root cause of disease. In fact, I had several discussions with the doctors in the clinic about how treating the symptoms will make patients feel better more quickly, but they often do not help improve patient outcomes overall and can lead to the patient being more sick than they started. This thinking can continue to be applied in a multitude of situations.

First do no Harm

Almost all healthcare providers have this incorporated into their oath in some form, because we want to heal our patients and improve their health not cause more harm or injury. While many patients in Nica suffer from infections and while the majority are caused by bacteria, we know in the US from experience the dangers of over-prescribing antibiotics especially the incorrect antibiotic (can we say increased antibiotic resistance among other issues).

  • Increased diagnostic testing and more encouraged follow-up would help prevent over treatment with antibiotics and correct antibiotic therapy. While this must be managed with the clinic’s resources and the patients ability to get to the clinic, if it prevents a patient from coming down with an illness that is antibiotic resistant, prevents them from being prescribed antibiotics when not needed, and keeps their gut flora from being completely depleted (which encourages more ‘bad’ bugs to colonize) then the investment would potential lead to decreased return visits for the same condition.

**Antibiotics are greatly needed in these rural areas to combat actual bacterial caused infections. I am just suggesting improved diagnostics to make sure the right one is selected.**


Medications are amazing, but only utilizing medicine when there are more treatment options available is why I have this unimpressed look

Doctor as Teacher

Naturopathic doctors emphasize the importance of being teachers to their patients to try to help them understand and learn more about their body and state of health to ultimately be able to take more control of their personal health situation. An obvious place to integrate this technique is with female patients (men as well, but I will focus on females in this example) dealing with urinary and vaginal infections.

  • Many female patients that we treated did not have much knowledge of their female anatomy, partially due to cultural situations that make it taboo to discuss. That being said, they would benefit from a basic description of their anatomy, bathroom hygiene techniques (wiping from front to back to avoid infectious exposure), and steps they can take to protect themselves during sex (condom use, identify high risk sexual practices, hygiene, etc).

Let me teach you things… excited face!

Knowledge is power and the more empowered patients can be regarding their health, the more likely they will implement plans to live healthier lives. Even if it seems small and silly, it could be a factor that improves their health and quality of life.

Treat the Whole Person

Sometimes going to the doctor feels like a trip to the car mechanic. Which part hurts or which part is broken, fix that part, and then you are good to go until the next part starts to malfunction. As a Naturopathic doctor, we focus on the person as a whole and truly believe that the body is interconnected. We aim to provide care that works together and is cohesive. This could manifest in the clinic in Nicaragua in several ways. In the treatment of chronic pain, which many patients come into the clinic complaining of….

  • Treatment options include licensed massage therapists, manipulation/chiropractic care, acupuncture, and physical therapy exercises/stretching. All four of these options do not necessarily require a lot of expensive equipment. The training/techniques for some could be taught to local Nicaraguan doctors. All of these methods have successfully treated chronic pain and injuries in different ways. This can be used in lieu of or adjunctive to the current pain medication regimen that is prescribed.

A treatment room that could be easily used for multiple forms of physical medicine


The crux of this blog and the goal of most doctors is to help patients achieve a state of health and stay there, preventing further injury/illness. This could be applied with the multitude of children that have anemia.

  • Patients and their families could be supplied with supplemental nutrition, which could help prevent children to become anemic. This could and should be implemented when the mother is pregnant with her child. Also, if it is an issue of iron deficiency (which was more common with adult anemic females), iron supplements could be obtained via donation to help prevent worsening anemia or prevent anemia completely thus improving health overall.

Other Naturopathic/Alternative Treatment Modalities

Besides applying some Naturopathic principles to treatment other modalities can be used as well. Here are some ideas for how these can be implemented:


Plants can be an affordable form of medicine

  • Supplementation: already used in the clinic with multivitamins and calcium, but more could be implemented including iron, folic acid, and probiotics. The issue here is donations would be required to implement.
  • Hydrotherapy: using hot and cold water to treat a variety of conditions including detoxification, chronic pain, decreased stomach motility, and respiratory/nasal congestion. The benefit of this is low-cost and not much equipment required.
  • Physical medicine such as chiropractic care, acupuncture, physical therapy, or massage. You would need to have individuals in the clinic who are certified/trained in these modalities to implement.
  • Nutrition/Diet: education to patients, access to purified water or techniques to purify water, and community clinic garden to encourage consumption of fruits/veggies.
  • Stress Reduction Techniques (meditation, yoga, etc.): provide patients with tools to decrease stress, which will then decrease disease and improve health. Very easy to implement with low-cost to the clinic.

In Summary…

While all of these ideas and options to help support patients and increase their chance at health are viable options to many clinics in the US, the infrastructure of the country, public health policies, limitations on donations and outside aid, and the education and culture of the people are all factors that limit the incorporation of these practices. I will discuss more of the infrastructure and culture that I experienced while being in Nicaragua in further posts after the current election is held.

With all the good work that the clinic I served at and many other NGOs and rural clinics in the country are doing, I hope over time they can begin to incorporate more ideas that encourage long-term, overall health for all.


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My name is Emma Petshow and I am a 4th year naturopathic medical student at the National University of Natural Medicine in Portland, OR. For more about myself, check out my bio. This blog is intended for information about preventive health and lifestyle improvement. The information contained on this blog is not to be used as medical advice. For specific medical advice you should consult your physician.