Tuesday August 30

Becca:

I am not a clinic nurse. Nor am I a pediatric nurse. One of the first questions I e-mailed to Becca this spring while deciding to come or not was in regards to my actual use to the clinic here. Me - an intensive care nurse, a cardiac nurse, a hospital nurse, an adult only nurse, and a just for 10 tiny short days nurse. I don’t even speak Spanish. Yes, of course. Come, come was the response I received.

My thoughts and feelings on American NGO aid to foreign communities are complex and not well resolved within my own mind. I don’t think I’m going to delve into that now, but one persistent question stays with me even now at the end of our time here: What will I do (have I done) that will effect lasting change within this community? Sure. I can take some blood pressures, and temperatures. I can check patients into the clinic, sort medical supplies and count out prescriptions. I can even provide some patient teaching through the eloquent, ever present and skilled voice of Claire (whom without I would have been useless). But when I’m gone, these skills and my willing hands are gone. This contribution is so finite and in the long run I have difficulty seeing how it will ultimately change the lives of individuals of this community. So what is my role as a white, middle-class, highly educated health care professional from the United States in the infrastructure of third world health care systems? The answer is: I still don’t know. Instead, I’ll share with you two stories from my time working here in the clinic.

At the end of last week, it came up in conversation that a 12-lead EKG machine had been donated to the clinic. Dr. Avilla, a resident Nicaraguan Doctor, was interested in learning how to place the leads and use this device in the Nueva Vida Clinic, which takes an electrical picture of the heart useful in diagnosing heart attacks and other cardiac dysfunction. I eagerly offered to look at the EKG machine to see if it was a model I would know how to use. It was, so in the afternoon with Claire as our translating guinea pig patient, I showed Dr. Avilla how and where to place the leads, connect them and then to print a subsequent reading from the machine. We practiced again with him placing the leads on the laboratory tech. He was thrilled and excited to learn, and it was a joy to teach him. I smile to think that I have left a little bit of knowledge here behind me that will be used when I’m gone.

The other story is from my time spent checking in patients to the clinic. Most of the children I saw would take one look at me and burst into tears, some did nothing short of scream should I try and actually touch them. In an effort to make my assessments less scary I would often hand my stethoscope to a child in hopes of convincing them it was more a toy than a Western instrument of torture before we started. Ignoring all I know about epidemiology and infectious disease I let my stethoscope be chewed, sucked and flung. With the older children I would place my ear pieces in their ears and let them listen to their own heart before I did. It was thrilling to watch a slow smile spread over their faces as they realized that the lub-dub, lub-dub they were hearing was coming from their own chests. One of the small girls about 8 was so excited about this she could hardly stop chattering away, a huge grin pasted across her face. Her mother smiled, nodded knowingly and said, “she’s going to be a doctor someday”. She grinned even wider. Maybe her mother was joking, but I leaned in close to her and through Claire said, “I hope you are, I think you will be a good one”. I showed her how to count her mother’s pulse; she nodded enthusiastically. The little niña followed Claire and I around for the rest of the day- clinging to my legs, reaching for my stethoscope. I told her to study hard, her community needed her. I hope she believed me, I hope her mother keeps telling her she can accomplish anything, and I hope she goes home after medical school to work. If nothing else, when she thinks she can’t accomplish something in the face of such poverty; I hope she remembers the gringa that told her she believed that she could.