Christopher Jaeger
Ghazala Khan
Stephanie Schley
Melissa Bayci
Sarah Willits
Alex DeMare
Alex DePorre
Laurie Bossory
Lucy Boekelheide
Sara Singer
NICARAGUA
SPRING BREAK 2012
FIMRC
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FIMRC is an acronym for the Foundation For
International Medical Relief of Children. They are a non
profit organization that uses a combination of clinics,
community outreach, and education to improve
maternal and pediatric health all over the world. We
chose to work with FIMRC because our faculty was
familiar with the organization and knew that it was
reputable and safe. They were able to accommodate
us at their Limon location during the week of our spring
break. The FIMRC staff members were all a pleasure to
work with which made organizing the trip in a short
time period feasible.
~Sara Singer
Organizing The Trip
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In selecting an alternative spring break experience for first year medical students we
wanted to select an organization that would allow students to gain a first-hand
familiarity of the diverse experiences of international health care, particularly in a
third-world country as it would provide a greater awareness for students of the need,
as well as to juxtapose to our own healthcare in America. In selecting an organization,
we wanted to keep a number of things in mind:
The organization should offer one-week experiences at a reasonable price and have
experience working with groups, in particular medical school groups.
The location should be safe.
The location should be accessible due to spring break length time constraints of
traveling.
The organization should focus on providing sustainable, high quality health care.
The organization and site should offer a medical experience on par with M1 skills.
There should be an opportunity for students to provide meaningful assistance to the
local community, such that it is not only the OUWB students benefiting but a mutual
benefit.
~Stevie Schley
Overview of our Trip
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Students were able to gain a variety of healthcare experiences including:
Working with nurses of the local health post to visit schools and go house to house to
vaccinate children as part of Nicaragua’s March vaccination campaign. As well,
children were given anti-parasite medication and vitamin A.
Checking in patients at FIMRC’s bi-weekly clinic visits by a pediatrician and observe
the pediatrician seeing patients.
Help develop and present educational health talks on microbes and trash.
Work with FIMRC’s nurse to visit the outlying communities and do blood sugar and
blood pressure checks on identified diabetics.
Assist in holding informal community meetings on diabetes and maternal health care.
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Help provide bi-weekly therapy for 2 children in the community with cerebral palsy.
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Visit the local (1 hour away) government hospital to shadow surgeons.
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Maintain the FIMRC building site and local health post through clean up and painting.
~Stevie Schley
Reflection
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Overall, I couldn’t have
asked for a trip that better
aligned with the first year
medical school experience
and skill sets. I believe that
all of the students greatly
benefited from the
learning experience in
gaining a better
appreciation for the needs
of the underserved, an
understanding of global
health care, and increased
~Stevie Schley
their cultural awareness.
Pediatrician
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On Tuesday and Thursday afternoons, FIMRC would organize
for a pediatrician from one of the nearby hospitals to come
visit their clinic. The pediatrician traveled via taxi for over an
hour to spend the afternoon with the local children and
infants. All of the volunteers were able to sit in on the
patient’s consult with the physician. For those of us who did
not speak Spanish, a FIMRC employee would translate the
conversation for us. The consults would take place in a small
room towards the back of the clinic, a room probably no
greater than 40 square feet. The room contained a small
table with a handful of supplies for the doctor and two
plastic chairs for the patients, typically a mother and child.
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~Laurie Bossory
The Pediatrician’s Office
Pediatrician
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The pediatrician often diagnosed the children through a
short conversation with the parent and a short physical exam
with minimal diagnostic equipment. For the two days we
interacted with the physician, the only diagnostic tools we
saw were his stethoscope and tongue depressors. The
physicians would write out a note and prescription for the
parent on a plain white piece of paper that had been torn
into quarters. The “pharmacy” was in a room next door that
was smaller than most walk-in closets. It contained mostly
donated meds that had been arranged on a large
bookshelf. The physician would stay until all of the mothers
and children had been seen.
~Laurie Bossory
Helping the Pediatrician
The Pharmacy
Thoughts on the Pediatrician
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We were also able to see this
same pediatrician when we
visited the OR at the hospital. As
we watched two caesarian
sections through the course of one
morning, we noticed that the
physician caring for the babies
immediately after they were born
was the same physician who
came to the clinic earlier in the
week. This made our group
reflect on the diverse
responsibilities of this one
pediatrician. It was an extremely
enlightening experience to
witness health care and routine
doctor visits in Nicaragua
compared to the United States.
~Laurie Bossory
The Waiting Room
School Visit and Microbe Presentation
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We went to a school to teach the children about microbes. This was a
relevant topic as the environment is dirty and lacking in sanitation and
knowledge of personal hygiene. Parasitic infections are especially
prevalent in children in this area.
We wrote a brief informative presentation about bacteria, viruses,
parasites, and the importance of hand washing in Spanish with the help of
a translator. We wrote a song in Spanish and sang it with the class,
demonstrated proper hand washing technique, and used glitter sprinkled on
the student’s desks to represent the spread of microbes.
It was nerve racking to be forced outside of our comfort zones; singing in
front of a class and presenting in a foreign language. Our warm reception
by the students quickly calmed our nerves and we all felt comfortable and
were able to have fun.
The students were very attentive and eager to participate. It was heart
warming to see how happy they were to see us and we all felt proud about
the important information we taught them.
~Sara Singer
The Students
Hand Washing Demonstration
Sanitation Education
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One morning a group of us went to a local school and
taught an elementary class how trash could affect their
health. First, we explained the difference between
organic and inorganic trash, and how long each takes
to decompose using posters. Then we explained how the
mosquitoes could become dirty from the trash and make
them sick. To emphasize this, we played a game where
they had pieces of paper that signified trash, and they
had to put them in the proper place before
“mosquitoes” (the group teaching) tagged them and
made them “sick” and they had to stop where they
were.
~Sarah Willits
“Basura” Presentation
Playing the “Basura Game”
game with the school children
“Charla”
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On one of the days, I went with our nurse, Jessica, and two other FIMRC
volunteers to a town called La Virgen to lead a charla (informational talk)
about diabetes. Before we left, Jessica explained to us how the lack of
information and resources affected treatment of diabetes and its adverse
effects. For example, many of the diabetics she works with have very poorly
controlled diabetes (with blood sugar readings upwards of 300), and did not
understand how they developed diabetes, nor how to control it to prevent
adverse effects. In our charla, we explained to the participants what diabetes
was, how they developed it, and how to control it. We stressed the importance
of exercise and daily monitoring of blood sugar. In addition, we addressed the
difficulty of maintaining a diabetic diet while surrounded by a culture in which
the main staples consist of rice, bread, fried plantains and juice with additional
sugar added, all of which are detrimental to a diabetic. During our charla it
was important for us to have many visual aides, such as pictures, and less words,
because the majority of the participants in the program could not read or write.
~Melissa Bayci
Blood Sugar Testing
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One afternoon, we went door-to-door to check blood sugars
of diabetic people in another town called Cukala. In
addition to their blood sugars, we recorded the patient's
age, weight, blood pressure, time of last meal and what
they ate throughout the day. It is FIMRC's hope that we can
use this data to more tightly control their diabetes. We then
counseled the patients about diabetes in the same way we
counseled the participants in the charla. We emphasized
exercise in their daily routine, and explained how to make
better choices while eating (for example, drinking Diet Coke
instead of regular Coca-Cola). We also explained to them
the importance of good foot hygiene.
~Melissa Bayci
Blood Sugar Testing
Reflection
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A few patients really stood out to me when we were checking blood sugars.
One patient that we tested has a blood sugar of 415, and we started an IV on
her to try to decrease her blood sugar. What was amazing to me is that she
claimed to be asymptomatic and was surprised that her blood sugar was so
high. It was hard for me to imagine how someone with such a high blood sugar
could feel so normal.
Another patient that we visited had a whole-leg amputation. She initially went
to the doctor because of painful ulcers on her leg that were not healing in a
timely manner. At the time of the doctor appointment, she was officially
diagnosed with diabetes (but no one knows how long she was living with it
before officially being diagnosed). During this encounter, I truly realized the
importance of education in healthcare. This patient thought she was taking a
medication to lower her blood sugar (something like Metformin), but when the
nurse looked at the pill, she discovered it was an antibiotic.
~Melissa Bayci
Reflection
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I really enjoyed counseling
patients about diabetes, and it
gave me a chance to no only
use my Spanish language to
reach out to patients, but also
allowed me to put into practice
skills that I learned in our Arts
and Practice of Medicine along
with the sciences that I learned
in our BFCP and Cardiovascular
courses. All in all, I feel that the
things I learned during diabetic
screening was very valuable
and gave me a great venue to
learn and practice medicine.
~Melissa Bayci
Vaccinations in Nicaragua
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The most profound and influential experience during the
FIMRC program was the opportunity to administer vaccines,
vitamins, and anti-parasitic medication to rural Nicaraguan
men, women, and children. Although Nicaragua is the one of
the poorest countries in the hemisphere, the Nicaraguan
Government recognizes the incredible medical, social, and
economic benefits that can result from a strong immunization
campaign. The national government, therefore, provides
free vaccination and medication services to all citizens by
using local outpost clinics to monitor and facilitate the
campaign. Local aid workers frequently visit homes and
schools to monitor individual vaccination records, administer
indicated immunizations, and answer any questions related
to the program.
~ Alex DeMare
Vaccinations and Medication
Administering Vaccines
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While most OUWB students accompanied nurses into local
primary schools for a DPT vaccination program, another student
and I had a very different experience by traveling to local
villages and homes along with two healthcare workers. We spent
the morning trekking through dense forests, scaling hills, and
crossing streams to visit some of the most remote villages and
homes. The families we encountered lived in utter poverty,
subsisting mainly on farming, and lacked many basic resources.
Despite these conditions, they were delighted by our visit and
quickly yielded their vaccination cards for the health care workers
to read and analyze. Throughout the morning, we visited over 50
homes and administered hundreds of vaccinations, vitamins, and
anti-parasitic tablets to men, women, and children.
~Alex DeMare
The Journey
The villages that we visited were not
accessible by car. We hiked through the
mountains, over streams, and even crawled
through barbed wire!
Reflecting on the Experience
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It wasn’t until we were
walking back to a more
civilized area that I really
started to internalize the
entire experience. My actions
had made a direct positive
impact on the local
community, and I felt
reaffirmed in my desire to
study medicine. Now being
far from the forests of
Nicaragua, I often use this
memory as a positive force
to focus and dedicate myself
during periods of fatigue or
self-doubt.
~Alex DeMare
Cerebral Palsy
 In addition to pediatric and pre/post-natal care, and disease
prevention and health education programs, the FIMRC Limon post also
organizes special classes for children with cerebral palsy. There is a
gap in the government health and education system for children with
special needs such as cerebral palsy. There are schools, which are
funded by the government and hence, free to the public, that are
specialized for children with special needs. However, there is an age
cap of 6 years on these programs. Furthermore, transportation to
these schools is a major barrier for mothers. Those kids who are too
old for these free schools but require special attention, training, and
therapy have nowhere to go. FIMRC sponsors a program that picks up
children suffering from cerebral palsy from their homes and drops
them off at a public community center, where the FIMRC nurse leads a
therapy session for them.
~Ghazala Khan
Physical Therapy
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We joined Jessica, the Limon FIMRC nurse, as she led one of these
sessions. She began by massaging the children’s joints and limbs and
we helped her as she went on to go through various exercises using
toys with different sounds as stimuli to motivate them. It was amazing
to watch as Jessica guided the kids to perform various exercises with
utmost patience and total encouragement. It was difficult to watch
the kids struggle in pain as they got harder, but these exercises are
crucial in their development and future quality of life. We learned
different exercises from Jessica and were able to work with the kids
on our own, which was a very rewarding experience. The mothers
were grateful and they listened intently as Jessica gave them advice
on how to practice with their children at home as well as more health
tips for their care.
~Ghazala Khan
Physical Therapy
OUWB students
working with
children with
Cerebral Palsy
Hospital Visit
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We had the rare opportunity to travel to the local hospital
in Rivas and observe procedures being carried out in the
surgical ward. Caesarian sections, an inguinal hernia repair,
a cyst removal, and a knee replacement were just a few of
the procedures we witnessed as guests of the hospital. It
was a wonderful experience for we got to scrub in, walk into
the surgical field, and get as close to the procedure as our
curiosity warranted. Some of us got to observe our first live
births and others took the opportunity to ask questions of
the surgeons and note the distinct differences between
American and Nicaraguan medicine. Overall, shadowing in
the surgical ward was a highlight of the trip.
~ Chris Jaeger
Ready for Surgery
Painting
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On Wednesday we all gathered back at the health clinic after
lunch. Caroline brought out the paint cans and we all partnered
up to begin painting. A few of us worked next door at the
government clinic to sand rusty poles and give them a fresh coat
of paint. Others painted the posts of the fence between the two
clinics. Other groups before us had started the job, and it
certainly made the clinic look welcoming and cheerful. A couple of
the girls worked on painting a FIMRC sign for the clinic and it
turned out beautifully. Although it may seem small compared to
the other activities we did during the week, I think at the end of
the day we all had a lot of fun and felt that we had left a lasting
mark on the clinic that will be there for years to come.
~Alex DePorre
Painting
Leisure Time
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Being from Rhode Island (the Ocean State), I grew up around the
waves. Beaches are like home to me and the beach in Nicaragua
was no different. Laying in hammocks and listening to the waves, I
felt more relaxed and at ease than I had since medical school
started in August. Everyday after working with FIMRC – hiking to
family’s homes in rural Limon or giving vaccinations at the local
schools – we headed to the beach. As brave souls like Alex DeMare
attempted surfing, I struggled to stay above the harsh and relentless
waves. Even as someone who grew up with the ocean, the rip tide
was frightening. It reminded me how powerful the ocean can be and
how helpless we can feel in it - like a child being tossed around by
the waves. For me, the leisure of Nicaragua was all in the ocean. It
made me feel like a kid again – small in the best possible way and
free. The overwhelmed and tense feelings of medical school
disappeared because on that beach, I was home.
~Lucy Boekelheide
Beach
Horseback riding on the beach
Relaxing and enjoying the view
Leisure
We enjoyed lots of
traditional Nicaraguan food
Zip Lining
Pictures