1. Ultrasound utility
In November and December 2017 we used the Philips Lumify curved and linear ultrasound probes in a variety of clinical applications in a two large regional hospitals (Jinotega and Rivas) and also in small clinics in the community. The feedback from the physicians was unanimously positive. The following list shows specific clinical situations where the ultrasound influenced the medical decision making which improved diagnostic accuracy and improved overall patient care:
Assisted in diagnosis with trauma pain when fluorescein angiography was not available
Useful in patients with corneal opacification
Used to verify patency and adequate perfusion of distal arteries when the exam reveal a cold extremity without palpable pulses
Used to evaluate new-onset pneumothorax
Portability enabled quick access for critically ill patients unlike the standard hospital ultrasound that required much more time for transport to the ICU
Used to diagnosed an arterial clot in the foot that was causing gangrenous toes
Useful in FAST exams to evaluate for intra-abdominal bleeding
Used to diagnose mitral valve prolapse in a young woman with tachycardia
Used to evaluate pulmonary effusions on bedside rounds
Used to evaluate lung consolidations
Portability enables significantly faster and more frequent evaluation compared to the large standard unit in the Radiology department
Used in intracranial ultrasound in neonates
Used in prenatal monitoring exams
Used to evaluate for heart failure
Used to diagnose a superficial cyst
Portability was essential for home visits in the community
Battery powered functionality is useful as consistent power is unreliable
“With the ultrasound I now know the foot is perfused and I don't need to call the surgeon.”
— ICU physician in Rivas providence
2. Education for all participants
In the spring of 2017 the American participants gave multiple lectures on various medical topics to the students, residents, and attending physicians at the large hospital in Jinotega.
Pediatric pulmonary diseases
Albumin levels and predicting mortality after hip surgery
The Nicaraguan physicians gave lectures to the American participants on diseases that are more common in Jinotega and other less-developed areas compared to the United States.
Venomous snakes found in the areas around Jinotega
Pesticide toxicities in the local farms
3. Successful experience for the American participants
Harrison has been active in this project, and his description of his experience in 2016 is similar to the feedback from all our American participants.
This trip is one that I highly recommend to students and residents alike. It was a great opportunity to see how healthcare is delivered in another part of the world. Obviously, practicing medicine is very different there when compared to the United States. I think understanding these differences will effect my future practice make me a better physician. For instance, it was humbling to see how much room I have to improve on my physical exam skills. This is an area of medicine that is very important, but is often overlooked in the U.S. due to our easy access to various diagnostic testing and imaging tools. “Why spend extra time on a careful pulm exam when I can order a chest Xray. Better yet, go ahead and CT the chest!” I think experiencing medicine in Nicaragua, where X ray and CT are not readily available, forces physicians to rely on themselves to make diagnosis and treatment decisions without excessive testing. I now realize that we often use the EMR, with all of its order sets and shortcuts, as a crutch. Most students and residents have never worked without an EMR. I think it’s healthy to experience what its
like to practice without it. Practicing this way for a relatively short time in a place like Nicaragua helps a training physician to develop a deeper level of confidence and competence that otherwise may take years to develop in the states.
Besides what you can gain personally from this trip, it’s also a great opportunity to contribute to the medical efforts in a developing nation. I obviously benefited by learning from them, but they mentioned multiple times that they too benefit from exchanging knowledge and ideas with us. For instance, while in country it is easy to identify common medical problems that plague the population of southern Nicaragua.
One such ailment is nephrolithiasis. I was able to put together a short poster presentation on the latest recommendations for the diagnosis and treatment of kidney stones. I obviously catered this presentation to the resources available to the clinicians in that setting. Additionally, we experimented with the utility of a simple and affordable one lead EKG system for that clinical setting. However, the bigger picture is the relationships that we are forming there and our aspirations to continue to build upon them. Personally, I feel better knowing that my role is not simply that of a visitor interested in clinical tourism. The ultimate goal of this project is to maintain continuity from one trip to the next and in doing so have a meaningful impact on healthcare delivery in the region.
Finally, the trip is just fun! There was a great balance of work and independent down time. There are plenty of hiking, surfing, tourism and cultural opportunities that I found unique to this trip. I have been on several medical missions abroad, but all of them were with larger groups. On this trip there was only Dr. Samras, his 6-year- old
daughter, and myself. This small group experience allows for far greater exposure to the local culture. You are not insulated by a gaggle of other American students and clinicians. The three of us stayed in a small Airbnb in downtown San Juan Del Sur. It was truly an immersion into a different way of life. If you are looking for a rewarding travel experience with less of a chaperoned, “summer camp” feel, look no further.