Mission Trip to Nicaragua
Surgical mission trips are oftentimes life changing. Witnessing and being a part of the lives of people in a third world country can change our perspective, leaving us thankful, respectful and introspective.I recently returned from an eye-opening and humbling surgical mission trip to Jinotega, Nicaragua. Although I realize that I can never put into words the gravity of my experience, coupled with the need to impact and improve the lives of the people of Jinotega, I will attempt to briefly outline my experiences.
Each morning at 0645, our surgical team made the 4 block walk to the hospital from our hotel. Jinotega is known for its beautiful mountains and foggy mists, hence the nickname “City of Mists”. As the mists evaporated around us, we passed schoolchildren dressed in immaculately pressed uniforms. All of the streets were old cobblestone, most in need of repair. Cars, mopeds and men on horseback shared the same street. We sidestepped an elderly “trash man” as he reached a gnarled arthritic hand to pick up yesterday’s trash in a never ending task to clear the streets. Horns honked seemingly at random, and we could hear locals engaged in heated discussions regarding the upcoming presidential elections. Several trucks outfitted with loud speakers jarringly cut through the cool morning atmosphere with propaganda messages in support of the incumbent president. A delicious aroma of fried dough permeated the air as everyone geared up for the morning. The residents watched us quizzically as our white clad selves made our way to the hospital.
We walk into the front doors of the hospital, weaving our way through the thick crowd of vendors intent on selling their freshly baked goods. We pass through open air hallways filled with exotic plants, a meandering dog, a sleeping visitor, a confused man with a black eye and blood stains on his shirt. The clinic is housed inside the hospital, and lawn chairs are neatly lined up to accommodate the 50+ people waiting to be seen.
Upon entering the hallway to the OR, we knocked on the door to the locker room. Every door in the hospital is kept locked. A nurse opened the door and led us into a locker room that was the size of a broom closet, accommodating only three people at most. The bathroom was adjacent to the locker room, which turned into a dressing room of sorts. The bathroom was in disrepair, and visibly dirty. The hospital did not supply toilet paper for any of the bathrooms. When I asked our interpreter about this, she told me that the hospital administrators felt strongly that staff members should supply their own hygienic needs because they had more important things to spend money on. Surprisingly, even the patients were not supplied with toilet paper or linens. If a patient had no family, they lay upon bare, ripped and unclean mattresses. I witnessed many families offering food to patients that had no family. I found myself constantly amazed at the altruistic generosity displayed by the people of Jinotega.
When we started setting up for surgery, I was impressed with the efficiency of the staff. There was little conversation. There was no confusion. Everyone understood their role, and executed each role flawlessly.
It was only when we were setting up the second case that I had to remember where I was. The backtable cover used in the previous case became the bed linens for the OR table. The Stryker saw that we just used for the previous case was wiped down with alcohol and then introduced to the scrub nurse for the next case. The bovie, suction, saw blade and k-wires used in the previous case were saved and soaked in Cidex for the next case. Even the ET tube was soaked in Cidex.
Lap pads and prep sponges were saved and laundered. The sutures used were reprocessed and were dull. Syringes were saved and cleaned. Virtually nothing was thrown away.
The turnover times averaged 2 minutes. While the current patient was being wheeled out, the next patient was right outside of the OR. If there was no visible blood or tissue on the floor, it was not mopped. The backtables were not cleaned between cases. When I started to clean the backtable, the nurse put her hand on top of mine and shook her head. I looked around for our interpreter, and she quickly explained that the staff believed that cleaning the back table was unnecessary because it was going to be covered, and the staff did not want to waste the cleaning fluid.
We saw countless machete wounds. Some of them were pediatric patients that were helping their parents in the coffee farms and did not understand how to properly handle this tool. A few were the result of fighting. The most disheartening case was of a woman who had her hand cut off by her husband because he didn’t like the way she prepared dinner that night.
We operated on patients with failed suicide attempts. We were asked to re-align bones, place ex-fixes, repair nerve injuries. When we arrived on Sunday, we held clinic. We saw around 90 patients and then decided which patients were in most need of surgery. From that point, we formulated a surgical schedule based on the needs of the patients and which resources we had available. As a general rule, we did not routinely accept “add-ons” because we could not adequately plan for them.
As our surgical team left the hospital one evening, a man rushed up to the surgeon I was walking with, pulled on his sleeve and begged him to look at his daughter’s hand. I stopped and engaged in the conversation. The daughter, a 15 year old named Lucy, was suffering from a medial nerve injury as the result of a failed suicide attempt. Lucy had been active in AA for the past two years. She cut her left radial artery when she experienced a relapse and felt that her life could never be a happy one. Lucy was captivatingly beautiful; she was demure and kept her eyes to the floor when we talked to her. Our interpreter knew Lucy and filled me in on her history. Lucy had been the target of a gang initiation when she was 12. Lucy suffered from unspeakable horrors that I cannot put into words. The fact that she was enrolled in AA at the young age of 13 spoke for itself.
Our surgical schedule was full, and we didn’t have room to accommodate Lucy’s surgery. However, during our walk back to the hotel, the surgeon and I came up with a plan that was feasible. We conferred with the other surgeons and agreed to take her case on as the last case on our surgical schedule.
Lucy was wheeled into the OR, terrified and tearful. She had obvious trust issues, and was fighting the anesthesiologist with all 85 pounds of her body. I took her hand in mine, looked her in the eye and said, “Que esta a salvo”: “You are safe”. It broke my heart to see the hesitation in her young eyes, but she gripped my hand tightly and didn’t release my gaze from hers until she was completely under. I said to the local surgeon standing beside Lucy’s bed, “This girl has captured my heart. There is something about her…I can’t explain it. She is special.” Imagine my shock when the surgeon replied to me, “Yes, she is indeed special. This is my niece.”
We made rounds the next day. I didn’t expect to see Lucy; the hospital didn’t typically keep ambulatory surgical patients overnight. When I was walking through the corridor during evening rounds, I turned my head and saw Lucy perched on a wheelchair in the doorway to her ward. She exclaimed, “Mi ANGEL!” According to the ward nurse, Lucy had refused to move from the doorway in anticipation of our arrival. I immediately went to her and gave her a big hug, fearing that I was crushing her small frame. Her smile was electrifying. She was pain free. She told me that she felt ‘new' and said that she was excited about taking her upcoming exams; all the while laughing in between sentences. Lucy was simply...HAPPY.
This is the very reason I chose to go on a surgical mission trip. There is no way that I could have known that I would meet and provide care for a patient like Lucy. But her struggle, her challenges, and her courage will continue to envelop my thoughts long after the memories of my trip have floated away like the mists of Jinotega.Last edit by canesdukegirl on Oct 1, '11
About canesdukegirl, BSN
Surgical trauma nurse, charge nurse
Joined: Jul '10; Posts: 2,898; Likes: 7,176
OR nursing; from US
14 year(s) of experience in Trauma Surgery, Nursing ManagementOct 1, '11wow, canes...your article gave me chills.
your description was graphic and vivid, and could imagine/visualize everything you talked about.
isn't it funny that a traumatized girl like lucy, instinctively knew who to trust and feel safe with.
thanks for sharing such a profound, life-changing experience.
btw, do you know the infection rates in nicaragua?
leslieOct 1, '11Thanks for the sentiments, Les.
You pose a great question, and it is one that I asked myself. The lead surgeon that sponsors this trip (out of his own pocket) told me that the data collection system is unreliable. I have looked on the CDC website to try to find the answer to this question, because I am also curious. I have been unsuccessful in my query.
We go to Jinotega twice a year. We always follow up on the patients that we operated on previously. To date, in the 7 years that we have conducted this mission trip, we have had only one post-op infection that we are aware of. Our speculation is that some of the information may be kept from us for fear that we will not return. I can't explain this rationale, but I do know that it is a concern of the local surgeons. I was informed of this by our interpreter during a discussion regarding infection rates. The surgeons and the hospital administrators will only state that 'everything is fine' when we ask about the recovery of our patients.
There were many pediatric patients that we saw with open wounds on their feet. The most heartbreaking one was a 2 year old named Sarah. She had such large, expressive eyes. You could almost imagine her recording every move we made with those beautiful brown eyes. She stepped on something that penetrated the bottom of her foot, which became infected. The infection became systemic and she was so ill that her parents hesitantly brought her to the hospital from the mountain shack where they resided. Sarah's parents lived on a coffee farm that had no running water or electricity. The whole family was frightened of us, frightened of the lights, the noise and the constant comings and goings in the ward. Sarah's mom would hide her face when we rounded. I asked our interpreter about this, and she told me that they were terrified of EVERYTHING since they lived such a simple life. When we first walked into Sarah's ward, I saw her cover both eyes with her hands and start to cry. I have never seen a 2 year old do that. She eventually got used to us, after much coaxing from our interpreter. Sarah became one of our favorites, and she welcomed the toys and stuffed animals that we put in her bed. Unfortunately, Sarah was too sick for surgery. Hopefully I will be able to find out if she healed when I return in January.Oct 1, '11Thank you for sharing this interesting and personal story. It even made me look "The City of Mist" up on a map.Oct 5, '11At a time when our country needs us the most, I don't feel going to other countries to help is prudent. If you want to help, go to the hills of Kentucky, Tennessee, or Arkansas. There are many families there that have no health insurance so they don't seek medical help.Oct 5, '11This is why I am inright now and why I completed my 400-hour clinical immersion in the PACU!! Thank you so much for sharing your story--reading it has reminded me of why I am putting myself through this and given me the energy to work on my final project today. I graduate in December; after that I want to get some experience so that I can work with a medical mission team. God bless you for what you are doing.Oct 5, '11It is also true that the domestic need is great, especially in rural areas. I just saw info online about the Red Bird Mission in Beverly, Kentucky. So many opportunities abound for volunteering as a nurse. I hate to go anywhere as a volunteer until I get some actual experience, so let's hope I get a job soon.Oct 5, '11I volunteered in Joplin, MO after tornadoes destroyed the town, including the hospital. They were desperate for medical help. We had no running water, supplies were short, & a make-shift pharmacy that had the basics. The tornadoes ripped off these patients' glasses, filled their eyes with debris, they lost their houses, & everything, including relatives. You don't have to leave our country to find people needing medical help.Oct 5, '11Merrywhiterose and canesdukegirl (and anyone else who has volunteered for any nursing/medical mission), I just wanted to ask you more about your preparation for volunteering. What level of experience do you think a nurse should have when volunteering for something like that? I've been unable to volunteer for anything because I'm in school full-time, but I'll be out soon. I suspect I won't be of much use at the beginning until I have some experience.
To that end, I'm trying to tailor my to gain relevant experience to volunteer--what do you suggest? (With the market as it is right now, I'll be lucky to find anything, but I've applied for a med-surg float pool orientation, a surgical floor, ICU, and PACU)
Thanks.Oct 5, '11wannabecnl: I JUST graduated from the RN program & didn't even have my RN license when the Joplin tornadoes hit. They were more than happy to have a graduate nurse! That was in May. Now I have my RN license & work as a charge nurse in a nursing/rehab facility until I get a better job. Here many places want you to have 1 yr. experience before they hire you. Get experience when you can!Oct 6, '11Quote from merrywhiteroseYou are so right. There are PLENTY of places right here that need our help. I also volunteer for our state medical assistance team. I am the Lead Clinical Nurse for the OR portion of our mobile hospital. We deploy during disasters here in the Southeast, and we spent a great deal of time serving the people of Waveland, MS when Katrina hit.At a time when our country needs us the most, I don't feel going to other countries to help is prudent. If you want to help, go to the hills of Kentucky, Tennessee, or Arkansas. There are many families there that have no health insurance so they don't seek medical help.
It is very honorable to feel the way that you do, and I completely understand.
I work with a surgeon that goes bi-annually to Jinotega for this mission trip. He asked me to join his team many times. I had to really think about it, because I did feel just the way you feel. After the third time he asked me to go, I finally shared my feelings with him. He listened patiently, and then told me that I had very valid points.
He explained that while we have plenty of people here who need our help just as much, that the people in third world countries face a much more looming battle. There are few government sponsored programs...and not just in healthcare. There isn't even a formal sanitation program in place; the people must incinerate their trash. People don't have the freedom to voice their opinions the way we can here. Violence is a way of life in many third world countries. Law enforcement is largely non-visible. Women and children don't have many choices, and there aren't programs to help them get back on their feet.
The people live by a set of rules that we can't possibly comprehend unless we have witnessed it ourselves. I was ill prepared for the injustices I saw.
Our main focus was to TEACH the surgeons and the nurses basic skills such as sterility, infectious disease prevention, surgical techniques that have the best outcomes with the least amount of trauma to tissue, and post-operative interventions to increase healing rates. We had very little resources and few supplies; all the while dealing with a language barrier. We were forced to think 'outside the box' constantly. A friend of mine who has gone on many mission trips to many countries told me that we are "teaching the people HOW to fish". I kept that in the back of my mind at all times, and it kept me focused.
This kind of experience is very helpful to foster your creative thinking skills as a nurse. It sure did for me.Oct 6, '11Quote from wannabecnlYou don't have to have any special experience. Keep in mind that the kind of care needed in a disaster/mission setting is BASIC care. If you know how to triage, know how to treat wounds, and can organize a make-shift unit, you are golden! We have nurses from every specialty. Some of our volunteers are not even medical, but they are logistical volunteers. We need people who can build things, have knowledge regarding computers, and can organize donated supplies in a manner that is easy to work from. We need people who know how to drive forklifts and bulldozers. As long as you are able bodied and don't mind getting dirty, you are WELCOME!!!Merrywhiterose and canesdukegirl (and anyone else who has volunteered for any nursing/medical mission), I just wanted to ask you more about your preparation for volunteering. What level of experience do you think a nurse should have when volunteering for something like that? I've been unable to volunteer for anything because I'm in school full-time, but I'll be out soon. I suspect I won't be of much use at the beginning until I have some experience.
To that end, I'm trying to tailor my job search to gain relevant experience to volunteer--what do you suggest? (With the market as it is right now, I'll be lucky to find anything, but I've applied for a med-surg float pool orientation, a surgical floor, ICU, and PACU)
Don't ever think that you won't be of much use. If you want to volunteer, there are plenty of things that you can do. The best thing to do is to join a volunteer agency and learn the roles. When you feel comfortable with what you learn, you can then in turn teach others who wish to volunteer.
Kudos to you for wanting to volunteer. You will LOVE what volunteering gives back to your soul.Oct 10, '11Quote from wannabecnlThank you for bringing this up as the USA REALLY needs help from medical teams such as nursing, MD and Dentists. I am thankful for all the many people who do go overseas to help, but wish we could first "clean up our own backyard" so to strengthen the many people right at home; before venturing out and spending hundreds of thousands of dollars outside.It is also true that the domestic need is great, especially in rural areas. I just saw info online about the Red Bird Mission in Beverly, Kentucky. So many opportunities abound for volunteering as a nurse. I hate to go anywhere as a volunteer until I get some actual experience, so let's hope I get a job soon.
Again, thanks to all who are so generous with their time and helping outside USA. Hopefully, you will commit to helping USA on your next trip as there is a critical need!
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