"Too Successful!"

The clinic is "too successful." We were swamped during the first two days with many more children than we could assess.  

Fifty-three children arrived but we were only able to assess nineteen. We saw all the acutely ill children and requested that the remaining mothers return over the next few days.

The clinic has limited hours of operation and until a few days ago, none of the team had met one another. Any lack of medical experience has been more than compensated by genuine compassion, a wonderful spirit of giving, and a "can do" attitude. Congrats to Project Woo who made this clinic possible. 

The volunteer workers come from the United States, Canada, and Spain - a true international effort.

We were not prepared for so many families. Our expectations were that the community might be slow to support the new clinic. Several weeks ago I was cautioned not to expect to be busy!!

Many of the families were disappointed not to be assessed. Good health care takes time. An important principle is not to sacrifice quality for quantity. 

With so many children, one of the biggest concerns was to identify the acutely ill children from those who were only at the clinic for a routine well child check up. Triage is the medical word that describes the process necessary to separate patients by acuity. Triage is a challenge for every health care facility and for experienced health care providers. We talked a lot about this and my sense is that we did a great job.  

The Clinic is Designed to be a "Cool" Place

Average daytime temperatures in Nicaragua on the Pacific side are in the low 30's C. So, hot!  

The clinic is designed with a variety of "cooling" features. 

The orientation of the clinic is such that the morning sun comes in through windows in the pharmacy and one of the examination rooms and the afternoon sun settles more to the front of the clinic. The veranda serves as a waiting area and is shaded with a corrugated roof that is about three meters deep.

The windows are smaller and shuttered to minimize sun but allow a breeze-way. The wind has been blustery and fierce, so with the windows open, within an hour so, there is a fine layer of red earth dust on all the surfaces.

There are tiny "port holes" about a foot above the floor to allow cooler air to enter the clinic and fenestrated bricks at ceiling level to allow the hot air to leave. 

There are ceiling fans in every room, but until the electricity is operational, these traditional tropical chilling devices only offer the illusion of coolness.

Notwithstanding all the above, the clinic was very hot on the first day, and I was a puddle from the first hour. The few times I stepped outside the wind felt great as my perspiration started to evaporate. Glad I wore a loose shirt.


  

Opening Day!

Open!!!! Loads of Gigante citizens and a cadre of Project Woo workers worked hard over the last few months to prepare the clinic for opening day on Monday February 17, 2014.

Lisa, Christian, Pili, and a local resident,
talking over procedures before the clinic opened. 

We arrived over the prior weekend, and met with Lisa Bisceglia, Volunteer Coordinator for Project Woo, who led the cadre and who arranged for the final touches before opening day. Between Project Woo and the community, the clinic is well served. Based on the enthusiasm shown around the opening, the clinic will be a terrific success.  

Dr. Mariana Jarquin, a local physician who currently works for MINSA at the Coyol clinic, was present for her twice monthly community outreach clinic in Gigante. In April, after the completion of her two years of post graduation community service, she will join the clinic as the Health Program Coordinator. 

Lynne, Sebastian, Lisa, Sarah, and Lane,
just before the first family arrived. 

Lynne Maher, an American Nurse Practitioner with tremendous local experience coordinated the clinical efforts.

Pili and Sebastian, a Spanish couple from the Canary Islands, made a big difference on opening day. Pili served as a clinical assistant and took the presenting complaint information.  Sebastian served as interpreter in the office with me. He was terrific. I might not speak Spanish well, but I knew enough to know that he did a wonderful job. Caring, patient, and precise. What a great guy.

Christian, another Project Woo volunteer, was the intake person who signed in all the mothers and children at the reception are.

Sarah, a Project Woo volunteer, who is an American EMT, worked in the clinic with me to help with the assessments.   

The first morning. Dr. Jarquin is on the right talking to Lynne. 

We were all hard at work cleaning away the construction dust at 8 AM and the first patient arrived at about 9:30. Six hours later, after a blur of children, our first day was over. I saw ten children with a variety of minor complaints and was pleased to have all the necessary medications on hand for the problems.   

The clinic door was designed by a local artisan.
The leaves of the tree will eventually honour the donors
who supplied the funding for the clinic. 

Clinic Construction

The new Gigante Community Health Clinic is well located on the main road just as you enter the village.

Families live behind and on one side of the clinic. In the photo above, the building with the corrugated iron roof is a home. This view shows the clinic from the east.

The floors and window frames are hardwood. The floor is stone. The clinic will be cooler courtesy of the high ceilings and windows that create a breeze-way.

The entrance allows access to three offices.

The photo above shows the septic system. Trenches for the field were dug in front of the building. The platform for the water tank is visible at the top of the photo. To the right is a local home.

Learning Spanish

You would think that on my fifth visit to Nicaragua that my Spanish would be pretty good. Sadly, no.

I studied the Rosetta Stone Latin America version faithfully for two hours a day for six weeks before my second visit, and that offered at least some vocabulary and pronunciation tips. I worked hard on the online course but when I arrived in Nicaragua for visit two, there was no obvious improvement in my comprehension at all. I was very disappointed.

For each visit I hired a local translator to insure I could communicate well with the mothers and this was good and bad. Good since this insured that the medical communication was satisfactory, but bad, because I didn't need to learn or practice any Spanish. So for visits two, three, and four, I coasted.

This time, we enrolled in a Spanish school in Gigante. Eveline and Anna are our teachers. After two, 2-hour sessions, I feel the potential of progress. I requested and completed homework. I've studied at least an hour or two after each class. We will have time for five classes this week before our return home. Perhaps, if I can figure out a study routine back in Calgary, by visit six, I might actually be able to talk with the mothers?

Eveline and Anna, our Spanish Professors

Eveline and Anna do not live in Gigante. Anna lives about half an hour away in the Limon area and Eveline lives about 60 minutes away in Tola. We are the only students this week. So, each day, both ladies need to travel from home to the Gigante school. Anna has a motorcycle; Eveline rides a bus and then catches a ride with Anna. For Eveline, she will travel an hour to reach the school for the two hour class and then she will return home for a total of four hours for each class. The fees are very modest. The school charges only $9 per hour. I presume the director of the school takes a portion of their earnings. Presume he takes 25%. This means Eveline works for about $3 per hour!! I am embarrassed by this and yesterday I gave each teacher a cash gift. Feliz Anos Nuevo!