Health Talents International

Nicaragua Mobile Medical Clinic
January 31-February 5, 2008

By Marie Agee

Participants: Drs. Alan Boyd, David Darrah, Charles Jarrett, and David Weed; Dentists Silvia Albizures and Jessica Romano; Nurses Eileen Weed & Stacey Mullins; Pharmacists Guthrie Hite, Kate Miller and Bill Staggs; Chaplain Pete Allinder; Translators Mark Maxey, Ruben DaVila; Dental Assistants Carlos Baltodano & Gary Tabor; Dental Instrument Scrubber & Dental Techs Mike Duncan & Hannah Allinder; Eyeglass Techs Steve Fox and Grace McIntyre; Team Leader Marie Agee.

Each of these clinics has an identity all its own. This one is notable because of two reasons: My flight was cancelled from Birmingham into Houston because of bad storms, so I wasnâÂÂt able to travel to Nicaragua until the for the first time, in the fourteen years weâÂÂve been conducting mobile medical clinics, the Ministry of Health confiscated our medicines! With the new (again) government headed by Daniel Ortega, came much more restrictive requirements for bringing pharmaceuticals into the country. Despite our most valiant efforts to comply, there was evidently one piece of information missing that they considered critical. It took until Saturday at noon before they released the medicines to us.

Even with the lack of sufficient medicines on Friday, the team forged ahead with the clinic in San Benito. Jose arranged with the preacher there to come to Rene Polanco on Saturday to pick up the medicines that people needed there that had not been available on Friday.

Saturday at Rene Polano was a very busy day. It began with Ruben DaVilla of the Spanish congregation at the Waterview Church of Christ in Richardson, Texas, leading the team and the waiting patients in a moving devotional. Although I couldnâÂÂt understand everything that Ruben said in Spanish, it was clear to me that he was preaching a first principles sermon to which the patients listened to attentively. It must have been really, really good because when he finished, they clapped for him!

Everyone was busy from morning till evening. Pediatrician Dr. David Weed treated los of scabies, including a two-month old baby whose tiny body was covered with open sores. It was so sad to see.

David also saw many, many cases of the typical things you see on a clinic like this: lice, impetigo, malnutrition, ringworm and lots of children with intestinal parasites. He also treated one case of an abscess on an ankle.

One joyous thing that happened on Saturday was that we saw little Ashley. We first met Ashley a couple of years ago when she was only 5. Having been born a hemaphrodite, she was in desperate need of surgery. Many of us struggled to find in surgeon in the U.S. who could help her, but many obstacles seemed to prevent that option. Her physician in Managua was able to arrange for a Costa Rican surgeon to come to Nicaragua and do the surgery. ItâÂÂs been several months now since the procedure, and Ashley seems in good shape. Although sheâÂÂll have to be on hormones the rest of her life, she now has a chance to live a relatively normal life. It was so wonderful to see her looking so well. It was so gratifying to see GodâÂÂs hand in her little life. All of us on the Nicaraguan medical team whoâÂÂve been so involved with praying for her and donating funds for her medical care felt rewarded in seeing the sparkle in her eyes! God is good. Her story is truly an international cooperative effort to get her the care she needed so badly.

Dermatologist Alan Boyd is very often the busiest of all the doctors because there are so many skin conditions in this hot climate. Some of the patients are patients heâÂÂs seen several times before during the many years he has been going to Nicaragua, including the woman with the nervous condition that causes her to claw at her body to the point where her body is literally polka-dotted with sores, especially her arms and legs.

Sunday we worshiped with the members of the Rene Polanco Iglesia de Cristo and had a bi-lingual service with both their new preacher, Noel Elias Aragon Reyes, and our chaplain, Pete Allinder, taking turns in the pulpit. Dr. David Weed also led a couple of songs in English. There were about one hundred people present.

After a trip to the Masaya market, we finished the day at the hotel watching the Super Bowl.

Monday our clinic was at Rene Polanco again and was even busier than Saturday! There were almost always four and often five and sometimes six people working in the pharmacy, and it was still hard to keep up! Our most efficient times were when we had a native speaker helping to give instructions to the patients. The preacher from the Aleman church heard we were having clinic and came across town to help. Since he was a Baxter Institute grad, he spoke really good English and was a great help stayed several hours. On Monday afternoon an older teenaged girl who was there with her grandmother simply came over to take his place when he had to leave. She helped us for an hour or so.

The dentists were just swamped most of the time. Silvia and Jessica worked non-stop all three days and were always the last ones to finish. Gary Tabor and Carlos Baltodano were a big help to them in both gathering supplies ahead of time and working as a dental techs during clinic. College student Hannah Allinder spent a good bit of time helping in the dental clinic as well, along with Mike Duncan, an HTI board member, who was a most efficient instrument scrubber!

The day ended with a tired, yet very satisfied medical and dental team having dinner at Hotel Montserrat and sharing reflections from the week. During this time, Jose Garcia made a plaintive plea that despite the difficulties with the government, we continue to come and help them. He said they needed our help now more than ever before.

The final patient count over the three days of clinic was 1,086. In direct contrast to our day of travel to Nicaragua, on our way home the sky was clear. We praise God for once again giving us a great clinic and safe travel.

[color=red]Following is Dr. Charles JarrettâÂÂs account of his experience during our week in Managua. Read on.[/color]

Dr. Charles JarrettâÂÂs Medical Perspective on the Nicaragua clinic:

All the patients I saw seemed to have what would be considered routine complaints. However, to these people, with their limited resources, all their complaints are serious and there is usually very little that they, as a whole, can do about it. I often wondered why a simple question about the patient's complaint resulted in a long dissertation from the patient to the translator. This year I asked about that issue and discussed it with my translator, Ruben, who is a native Mexican. His take on this was that this is a Latino problem, especially among the impoverished, who restate their multiple problems many times to be sure that all problems are considered.

Since I have been there nine times, I have recognized a pattern of very common problems among the people. Headache is a frequent complaint and seems to stem from two main sources. The first and most frequent problem comes from sinus congestion caused by the heat, humidity and dust. Secondly, muscular tension in the back of the neck and upper shoulder areas from the types of activities that must be carried out in order to survive that day and have possible food for the next day for themselves and their family. Many activities are done the way my grandfather had to do them when I was a pre-teen.

Arthritis is an extremely frequent complaint which relates to degenerative arthritis which is common to the human family in all societies. Another cause of their "arthritis" is actually varicose veins resulting from the nature of their type of work and being on their feet all the time trying to make a living. Foot pain is often a result of the poor quality of footwear available to these people because of the lack of income to afford good quality shoes. Arthritic complaints also extend into the low back where I find frequent muscle spasms, again related to the nature of the manner in which work must be carried out.

Poor sleep is another frequent complaint which relates to many other problems such as the heat, muscle tension, worry, etc.

Besides these external complaints, there are the usual metabolic problems common to all humanity. Both diabetes mellitus and hyperlipidemia (high cholesterol) are common complaints and diagnoses. The medications are available with which to treat these problems but access to them financially is the most frequent problem expressed. Also, the diet of this population of people is not such that it can be significantly altered to help control blood sugar and cholesterol. As you know, the diet consists primarily of starchy foods such as rice, potatoes, plantains and beans. Some get meats, such as chicken and pork.

Hypertension is also frequently encountered but not checked with the regularity with which it can be checked in our country. Good medicines for treatment of hypertension are available in Nicaragua but financial status prohibits access to them for so many of the people.

Many women also complain of urinary problems and go to some of the government sponsored health clinics to get urine tests. Many will bring the result of the urinalysis and/or urine culture from the clinic, along with a prescription for a medicine with which to treat the infected urine, but they have remained untreated. When I ask why the patient did not get the medicines to treat this problem, I get only one response, "no denaro" (no money). Another very frequent problem is parasites and the medicine for them is very costly. Hence, this problem remains mostly untreated.

The most unusual thing I saw was a gunshot wound that had occurred seven years ago and has been chronically draining since that time. I gave him treatment for it, but I suspect he will need some minor surgical intervention and/or long term antibiotic treatment geared specifically to the organism causing his chronic infection. I discussed his case with Dr. Darrah, and we came up with a treatment plan based upon our available therapy. I also remembered something that the older doctors at our hospital told me about doing for chronic open wound infections. I had him place diluted vinegar solution on the area three times daily using "wet to dry" pads. At least this is inexpensive and something to which he should have access.

These problems which I have outlined are very common in many places, but especially in Nicaragua. These people have no means to do anything about it until someone comes, such as Christians from Health Talents International, to evaluate their physical needs and supply medications to them free of charge. So many of these people take the time to say "Thanks" in such a variety of ways. Though I do not speak Spanish, I know when the people are saying, "Thank you." Each seems to say it with a smile upon departing our time together.

Yours in Christ,

Charles Jarrett, MD
February 8, 2008