Healthcare Service Learning at Clinica de Salinas, Limon Dos, Nicaragua

by Lola Rain

“I’m going to show you something better than any medicine,” said Dr. Domingo to a patient in the little Nicaraguan town of Limon Dos. During most mornings over the last two years the doctor sees more than 20 patients at the free clinic of Salinas, which serves seven of the surrounding communities. Mostly woman and children arrive by bus, taxi or walk the distance on dirt roads to see this young doctor in residency.

In Nicaragua, to repay the free medical education provided by the government, young doctors must do at minimum of one year in a rural clinic. Domingo was at the end of his second year at Clinica de Salinas. He chose to stay the second year living and working at this small eight room clinic.

I could tell immediately he was well liked by the community. Several patients came offering gifts: Tamales, fresh laid eggs, even a plump chicken – dead or alive. Domingo will be missed by his patients and the clinic staff. Recently he earned a new residency in internal medicine. In a few days the doctor will be traveling back to his home in the capitol city of Managua to begin a specialty track which will prove to be much different from the general medicine he practiced in Limon Dos.

ImageOn the morning I spent with Domingo in four short hours we saw 22 patients, ages 2 months to 80 years. Cases included everything from the sniffles and ear infections to pregnancies to heart disease and diabetes. Out of the 22 visits that morning, only one male appeared. He was in his early 20s complaining of chest pains and shortness of breath. After probing the patient with questions, and taking a listen to his heart and lungs, the doctor determined the man was experiencing stress from recent life events including a new job. Dr. Domingo went over breathing exercises with this young man. All four of us in the room (doctor, patient, a medical student and myself) practiced together. Slow breath in. Slow breath out. Repeat three times. This prescription reminded me of the many years of yoga training it took before I could grasp the three breath concept. Three breaths can change a stressful mindset and calm the body. This doctor on the Pacific coast of southern Nicaragua, 3,500 miles from my home, just confirmed that breathing techniques are valuable to almost anyone on the planet.

“They need reassurance,” Dr. Domingo said of his patients.

The medicine practiced in this remote village is similar to the US, but the methods are somewhat antiquated, like that of an old American family doctor in the mid-1900s. Some of the tools are modern – urine strips, an ultra sound machine – but the techniques performed indicated the doctor was doing the best he could with the conditions he inherited. At this free clinic, like most in the country, there is a lack of supplies and medications. The doctor made a cotton swab out of gauze and used it on the child with the aching ear. Urine samples were provided in plastic bags, not sterile cups like we are accustomed to in the US. There were no plastic gloves to protect the hands of the doctor or medical student. And the urine dip stick test was performed on top of the patient chart sitting on the doctor’s desk, then set on the edge of the desk to wait for the results.

If you were to look at these methods through the lens of most US citizens, some might be appalled by the lack of sterilization and others heart stricken on the lack of money and supplies. The truth is, however, these patients were being very well cared for by a doctor with an outstanding bedside manner. It’s obvious Dr. Domingo’s priority is the quality of care he provides to patients. A different doctor may not be able to get past the lack of medical paraphernalia. In a different clinic, half the patients may go unseen if the methods varied, slowing down the process.

Since I have not been on aid missions to places such as Africa or Haiti, I can only imagine what conditions must be like in other poverty stricken, remote regions. The ideal conditions would be having the proper resources for medical professionals to do their jobs. But what this one clinic demonstrated is a doctor who excelled by embracing his rural assignment. The result is a community and clinical staff who respected this young man who once was an outsider but now is a highly regarded physician who truly cares. The world needs more Dr. Domingos and hopefully his replacement will be able to fill his shoes.

Thank you to Casa Verde, Executive Director Amie Riley, and my fellow travelers: OHSU students Joe, Ericka, Jessica, and Karen Shimada of Clackamas Free Clinic for giving me this priceless experience in rural medicine and cultural differences.

Photo by Ericka Acuna

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