As far as personal experiences are concerned, I can only say that I’ve had the most diverse ones, and most fulfilling during this trip. The interaction with patients and their dilemma was unprecedented for me, but crucial as I immerse myself into the world of medicine. I encourage those who can participate in this project to go assured that you will gain lifelong experiences. I saw a man washing his brother’s foot, for he could not do it himself; I saw a wife who had been in the hospital for 4 months with her husband, because she vowed to stay with him until the end, for the end indeed seemed near for him; I witnessed a mother whose faith in God kept her strong and with a peaceful countenance amidst her son’s cancer treatment which had already led to a leg amputation; I witnessed how a doctor’s skills and adamant desire to save one’s life from the claws of violence could indeed save him by removing large hematomas from his brain.

My impression of the hospital: the hospital is much in need of resources, even though the receiving hall is well kept, the patient rooms need a fresh coat of paint, sturdier beds, and fresh linens. Most of the time, the relatives of the patient bring the bed sheets and towels. The hospital is overcrowded with frustrated waiting relatives y pacientes desesperados (despaired patients). Dr. Salgado comments, “Hay muchos esperando cirugia (there is a large waiting list for surgeries)” as if the list were endless and for the families of the patients there is nothing left to do but wait. We are told that Nicaragua has approximately 12 neurosurgeons, 8 of them are currently in El Hospital Lenin Fonseca which means that from all over the country people are referred most likely to Lenin because it is a hospital that specializes in surgeries, especially neurosurgery.
Five-year-old Stephanie needs a 2nd operation to remove remnants of a tumor in her cerebellum. Her mother is Giselle, a young woman who clings to her faith to give her the fortaleza to endure. Stephanie, at a time, attended school before the symptoms began… headache, nausea, and loss of equilibrium, along with loss of spatial differentiation. “Se topaba con los objetos (she would walk into objects).”
Karla is the mother of beautiful little 5-year-old Lizette. Lizette, who was born with spina bifida, already had her operation. It fazes me that her mother who had health insurance from her work was not given proper prenatal care. Lizette is hospitalized currently because of an improper installation of the valve to drain her hydrocephalia. Little beautiful Lizette with her perfect lashes cannot walk without her crutches and an orthodontic apparatus strapped to both legs to keep them rigid. I am told that she has no sensation from the waist down.
Little Juan Carlos has a tiny tumor in his cerebellum. We will be attending his surgery tomorrow morning. His mother is a 68-year-old woman who adopted him when he was 3 months old from a woman who gave away all 6 of her children. Something about little Juan breaks my heart… there is a sadness in his expression, as if one has already lived his life and now expects nothing after many broken promises—at his 10 years, there are no mannerisms about him that are child-like. “Es muy callado (he is very quiet)” says his mother and I can tell that his adopted family loves and cares for him very much. I found out that although many of the services are free, it is the relatives of the patients who must buy the razor blades to shave the scalp, cottonoides, IV needles, vasos de agua oxygenada (oxygenated water), and pints of donated blood from the Red Cross.

Today I saw my first neurosurgery. Dr. Salgado, the chief neurosurgeon, supervised the removal of a small tumor from the cerebellum of little 10-year-old Juan Carlos. We scrubbed up and witnessed the finesse with which the 2 attending residents conducted the surgery. What happened next was probably one of the most shocking things I had ever experienced; during the surgery, the power went out. This happened three more times. The whole room would go black from 30 seconds to less than 5 seconds, the surgeons would cuss under their breath, and then the room would flare back to life and the surgeons would get on with the task. This was their everyday existence. An average of 2 surgeries were performed daily (not including the number of trauma-related operations that got wheeled into the ER). On one hand, it was “free healthcare” but the patients had to buy a number of supplies in preparation for the surgery, a contradiction of the concept. The reality of the situation is frustrating and heart-breaking.

A patient tells me that the situation is the same in all the hospitals— the poor service, the overwhelmed doctors, lack of funds and aid from the government. She tells that a while ago the physicians were on strike for 5 months because of their poor salary. The government does not yield and the doctors go back to the operation table because their patients were dying. The patient weeps in front of me and my own helplessness cripples my heart. I learned that patients have to go outside the hospital for tomography imaging because the machine in the hospital had broken down 3 months ago and the hospital claims it does not have the funds to repair it.

Doctora Carolina Cantarero is a resident neurosurgeon at El Hospital Lenin Fonseca. Today she spent some time with us… Carolina tells us that daily Lenin receives an average of 8-9 trauma-related surgeries (not including the 2 scheduled neurosurgeries for the day) and that there is some 2000 surgeries pending. The constant flow of information nearly overwhelms me… “las materias van acabando y la gente es pobre—la especialidad es cara—es dificil mantener las cosas mantenidos y el gobierno tiene los ojos cerrados (the supplies are dwindling and the people are poor—specialization is expensive, it’s hard to maintain the equipment and the government turns a blind eye). Ayudamos como podemos sin ayuda del gobierno (We help any way we can without the government’s help). Lo hacemos porque sino, nadie los hace (We do this because if we don’t, no one else will).” I am told that neurosurgeons earn a salary of approximately $400/ month.

Nicaragua. I do not know what the rest of the country must look like but living in Managua for the week had led me to believe that the situation is the same all over the country—there is a dire need for social and economic reform.  It fazes me that there are no zip codes, no streets signs… we were told that after the 1972 earthquake there has not been much progress. People go about giving directions using some landmark… a police station, the distance from a particular plaza… we see graffiti on the wall, “Di no a la privatizacion de la agua.” Electricity is already privatized. Tito constantly befriended and chatted with the taxi drivers, and they all usually warm up to the subject of politics or religion. Nicaragua is such a poor country... 2nd only to Haiti I am told, with a devastating unemployment rate... and politics, politics, politics... I could go on in a silent rage. Doctors going on strike for 5 months and then returning to work because patients were dying... the government concedes nothing. Current outs in the middle of the surgeries, over 2000 surgeries waitlisted, deplorable conditions, not enough sheets for hospital beds, no hand soaps in the bathrooms (I kept stealing them from our hotel rooms and taking it to the hospitals), a broken down CT scan machine... and overworked humanitarian doctors, resigned patients and their families... But in a place were so much was found lacking, I found such a life... lives made bearable through faith and from faith a richness and strength of spirit… and I understood their different kind of wealth… Nicaragua is beloved by its citizens but everyone tells us “es lindo, pero es pobre (it’s beautiful but it’s poor)” with a grave and resigned tone. I think of the lush greenness of Granada, of the gentle thunderstorms at night, of the lack of smiles on the faces of children, and about feeling guilty when I could return to the comforts of a 5-star hotel every night and giving up a prayer of gratitude when I could sink down into soft clean sheets…