A day at the health post

This morning, I made my way to the bus station but Yuritza met with me on the way. The medicine we needed hadn’t arrived yet, so we would have to wait in the Centro de Salud for an hour or two before making our way to the post.

I enjoy the Centro de Salud in the early morning. It’s not intolerably hot and there isn’t a crowd of patients screaming for attention, so everyone is in a much better mood. While I was waiting for Yuritza, I sat and talked with another doctor, Antonio. As it turns out, he is familiar my host family – Sonia, Alberto, and the very gracioso Marlon. Antonio has a very interesting life story – he studied in Spain and in Switzerland through scholarships and came back to Nicaragua to practice.

It’s interesting to see Yuritza in the context of the Centro de Salud. Sometimes when we’re out at the posts, she’s so capable that I forget that she’s still not officially licensed yet, but the nurses at the health post seem dead set on pulling rank on her. Maybe because of that, it took us about two hours to get the medicines we needed.

Without a ride to the health post (all of the ambulances had left for the day), we had to wait for the next bus. Unfortunately for us, much more people take public transportation at 10am than at our normal 7am. Today I didn’t ride the bus; I rode the chicken bus. The second we boarded in Sauce, it was packed because the bus had already picked up passengers in a previous city. When the driver saw that we had a cooler and a bag full of medicines, he opened the back emergency door and tried his best to fit us in. The ride couldn’t have been any more uncomfortable. The bus was hot, humid, and personal space was nonexistent. To make things more interesting, a group of girls boarded right behind us carrying chickens, piglets, and puppies. When we hit a rough turn, I got pecked in the back.

I was so relieved when we reached the post. There were already a few women waiting with babies at the gate The cases were all simple: a baby with a cough, another two who were due for inoculations, and one or two birth control consultations. We were done rather quickly – not many people come on Monday because the doctor comes for consultations on Wednesday.

So, we went on to our next task: cleaning the post. Thepost was filthy after being neglected for about a month because of the Christmas vacation.

Our first task was the worst of all: getting rid of the wasp nests. It wasn’t nearly as dangerous as it sounds: the wasp species that had built in the post don’t attack – they’re just a nuisance. They build their nests out of the polvo that gets everywhere in the dry season. The wasps also tend to build in tight spaces – so we had to look between medical forms, in cracks, and even in the boxes of medicine. Dozens of exterminations later, we emerged victorious.

Next, we visited a nearby house to fetch some water and use the latrine – the health post’s latrine had fallen into a state of disrepair. Today was a day of firsts: I’ve never before had to cross a barbed wire fence, nor have I ever had the opportunity to use a well. Though I almost gave Yuritza a heart attack with my attempt to get through the fence, I was actually decent at using the well.

The health post workers maintain a friendly relationship with the neighbors. Upon visiting, we were offered the usual tortilla. About an hour later, the family came to visit us at the post, just to hcat.

We did some pretty standard sweeping, disinfecting, and mopping. By the time we were done, the post looked fantastic. The only thing that bothered me (as usual) was the way we had to deal with the garbage – some of it was medical waste! We emptied the trash onto the lawn and set it on fire.

I guess this brings me to a suggestion for future groups: There is definitely room for

(1) Some sort of ecological awareness program

(2) More health post awareness campaigns – especially about breast feeding. The health post officials already have a good idea of what information they want to display, but the signs often rip in the wind or get damaged when patients come to the post. Donated signs should be laminated and have large and demonstrative pictures because it seems that many people who come to the outlying health posts are illiterate.

We had one late arrival – an elderly woman who had to walk down from the mountains with her granddaughter, her grandson, and her daughter. She had flu like symptoms, so we gave her the standard medication. The grandson had a rash and, again, we gave him something relatively standard. Despite the fact that they were ill, they were both in good humor. The grandson told me that he has an uncle working in Cuba and jokingly asked me if I, as an American, hated Cubans. I did my best to give the usual explanation: that the opinions of the government don’t necessarily reflect those of the American people.

I guess this all brought me to my big revelations of the day:

Health post workers, especially the nurses, have a lot on their plates. Not only are they responsible for bringing medication to the post, writing and filling prescriptions, diagnosing, inoculating, weighing, and comforting – they also have to organize the community, maintain positive community relationships, make and maintain health post educational materials, be responsible for the upkeep of the post, and chase wandering dogs and chickens out of the post. They do all this under the constraints of a public health care system that can’t provide specialized medications and a salary that would be less than minimum wage in the United States.

Today Yuritsa told me, somewhat kiddingly, that she would never see the doctors going to the well to get water to mop the post. The nurses keep the post running!