Coming together as a team

     Notwithstanding an hour a day on the Rosetta Spanish software, my linguistic skills are still much too rudimentary.

   Dr. Flores, a family physician at the clinic, has English skills about as good as my Spanish skills and between us we managed a satisfactory history for my examinations.

   The saving grace was Google Translate, a feature that allows text in English to be simultaneously translated into Spanish. After listening to the history and examining the child, I typed out a brief history, exam, assessment, and plan in English and the Spanish appeared like magic. Either the nurse or Dr. Flores read the instructions to the mother and this worked very well on the first day.

   On the second day, my history and exam portions were shorter and the assessment and plan sections were longer.

   I did not bring a portable printer and this would have been a great benefit because the instructions could be written out for the mother.  All translation efforts, whether verbal or written suffer the vagaries of the skill of the translator.  I have always preferred mothers to have a written record of my recommendations.

   Literacy in Nicaragua is very good, courtesy of the Sandinista social revolution and emphasis the government placed on schools.  In the early 1980’s, within a year or two after the Sandinista forces successfully defeated the Somoza National Guard, the government held a “Literacy Crusade,” that improved the literacy from about 20% to over 50% during one year.  UNESCO recognized Nicaragua for this outstanding social achievement.  Since that time, the government has established schools in most of the accessible communities and literacy has been sustained at a higher rate than many other Central and South American countries.        

   We only saw 14 patients the second day.  I was able to intervene for a heart murmur, possible pulmonary stenosis and a strabismus.  We otherwise assessed pneumonia, otitis media, impetigo, parasitic infestation, fungal skin infection, and chronic serous otitis media with hearing loss.  Most of the children were four to six years old.

   We improved our routines today.  We moved the computer into the exam room, I wiped down the stethoscope with alcohol more often, the exam equipment was within easy reach, I brought my iPhone to use as a calculator, we stored some of the common meds in the exam room, and I arranged a brighter exam light by the table. 

   Marta, the clinic nurse and Dr. Flore worked better as a team with Louise and I.  Today both teams were better prepared for each other.  We are starting to understand how to work together more efficiently.  

   Almost all the patients are waiting when we arrive.  There are buses and the children arrive together.  The children continue to be well cared for and the mothers all seem very devoted to their families.