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Team Nicaragua :: Celebrating 1 Year by Paving the Way for The Future

Day6Pics-5With such a great turnout at the clinic, we had to make seats in the street.

PMI cares deeply about providing sustainable health care in the communities in which it is involved. Today we were able to take part in celebrating the 1-year anniversary of PMI’s medical clinic in El Viejo by hosting a health fair out of the clinic itself. We even shut down the street to make room for our patient waiting area! This was the first time a PMI team offered its outreach services one of their permanent clinic sites. It currently serves under the leadership of Dr. Chico, and is equipped with several exam rooms, its own pharmacy and even a laboratory.

Day6Pics-9We loved getting to serve the people of El Viejo today.Day6Pics-8PMI Nicaragua’s local staff worked right alongside our team to bring quality care to the community.

We were able to see 267 patients, making today one of the busiest days of the week. Although the hallways and rooms were a little crowded, our patients were able to receive one on one care in a more private setting. They also became more familiar with the location, people, and services where they will receive regular treatment. A few patients were return visits from previous clinic days this week, and our doctors provided follow-up care.

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Day6Pics-6Dr. Brett Bentley and fourth year medical student, Grace Twitty, review a patient’s complaints and plan the best course of action.

It is with mixed emotions that our last patient was seen today. Truthfully, there are many of us on the team who are the feeling the strain of 5 straight days in almost 100 degree weather treating over 1200 patients… but grateful. There is still a lot to pray over and process. The people we served were not the only ones blessed. Each of us appreciates the opportunity we’ve had to be a part of this team, to serve and care for the Nicaraguan people.

Day6Pics-22Our full team at the end of a full day (minus our amazing pharmacist, Jose Puentes – you were missed!)

Jim Johnson and Kristina Keilson

Team Nicaragua :: Clinic Day Four

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Thursday morning was the start of a special day for our week in Nicaragua. The first three days, we did outreach in churches within some of the poorer communities near Chinandega and El Viejo. However, today we hopped on our bus for an hour-and-a-half ride out to a church in the village of Potosi, located far from town past some of the volcanic national parks of Nicaragua. It was obvious that the people of this region were without healthcare resources, even more so than the people whom we had served prior to this day.

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We arrived at clinic, greeted by a long line of soon-to-be patients, longer than we have had in the week so far. Our patients were also sicker than the previous clinics. Children had parasite infections. People with chronic conditions such as hypertension and diabetes were poorly controlled, as they rarely had the opportunity to see a doctor or even afford their needed medications. Even providing follow-up care at our El Viejo clinic presented new challenges, as the greater distance from the permanent clinic decreases the likelihood our patients will actually go week continuous, long-term care. We got to experience first hand how little these people have in terms of the quality of their healthcare.

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Overall, our day was spectacular, tiring, and humbling – to say the least. Our new patients were grateful for our care and truly appreciated PMI’s outreach to their community. They presented to us entirely new challenges that we were able to meet head on, and we were able to close clinic knowing that we had assisted the people of Potosi on their journey towards better long-term health.

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Team Nicaragua :: Clinic Day Three

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Students can be seen going to school in matching uniform.

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Patients wait for their consult with the doctor.

Today started with a 30 min drive on our team school bus to a middle class village not far from the PMI clinic. Clinic today was held in a lovely, large church with tile floors, fans and big windows lining one wall. There were about 50 patients waiting for us when we arrived.  A slow and steady trickle brought in about 120 additional patients throughout the day. Our team received a much needed drug refill around lunchtime, which should sustain our pharmacy through the end of the week. Our whole team worked hard to ensure each patient received great care.

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Dr. Mark Humphrey and fourth year medical student, Zach Prudowsky, study an X-Ray.

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Dr. Keith Barron; fourth year medical student, Lawren Anderson; and Philip Leonard use a portable ultrasound to examine a patient.

After seeing all the patients who came to our clinic, we were able to pack up and still have a few hours of daylight left. We were treated to a surprise afternoon at the beach – a local (safe) beach. We spent about an hour there, playing in the waves, taking photos, playing volleyball and watching the sunset. There were a lot of empty restaurants lining the beach (which we learned were actually very popular on the weekends), and the thatched ceilings created a beautiful sight next to the palm trees and distant mountains. It was a picturesque end to a great day.

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Team Nicaragua :: Clinic Day Two

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Good evening from Nicaragua!

The update comes from two non-medical team members, Cynthia and Kristen. We’ve enjoyed the first two days of clinic watching a bunch of separate people-parts become a beautiful PMI team!

We spent our second day in Colonia Veinte de Julio, a small community about twenty minutes outside of Chinandega. The church building was larger than yesterday’s location, which gave us the chance to set up a few more provider stations and have more room to work.   As many as 255 patients came through our doors, and each was given much-needed attention; every patient who came to the clinic for a consultation was seen, including all the volunteer translators and prayer team members. Many of the patients we saw today came with extended family—mothers, children, grand parents—all together to seek care. One doctor noticed several who complained of anxiety or nervousness, and how thankful he felt to know the prayer team was on hand to tend to needs of the soul and spirit as well.

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It was another hot day in the high 90s, but the large windows of the church let in just enough breeze to keep us going. With the heat and other challenging conditions, it would be easy for anyone to become selfish. However, it’s great to see how everyone works together to care for other team members. Although we have varying levels of Spanish-speaking ability—from knowing a handful of phrases to fluent—it is awesome to see the desire each person has to become better communicators.

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We’ve both spent a day tending the glasses station. One common request made by our patients is for reading glasses so they can read their Bibles. Earlier today, a lovely older woman wanted to be sure her new glasses “worked” to her standards. She quickly whipped her own Bible out of her purse to confirm the prescription. After only two days, we are halfway through our glasses supply, which sadly, may not last past tomorrow.

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As we head to bed to refresh for tomorrow’s clinic, our feet are tired, but our hearts are full.

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Team Nicaragua :: Blood, Sweat and Toenails

And the first day officially seeing patients is done!

Today we woke up and were at breakfast by 6:30 AM. We slurped down our coffees with papaya on the side. Our new friend and pastor on the trip, Jim Johnson, read from Thessalonians and prayed over the day to come.

We were loaded up and were on our way to Aurelio Carrasco by 7:30 AM thanks to several hombres fuertes! And mujeres, too.

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Cynthia Standley registers patients to be seen by our medical team.

We arrived at 8:00 (gracias to Luis, our driver) to the church and were greeted by several Nicaraguans ready to be seen by our team. We quickly assembled, as everyone worked hard to get the clinic up and running. We began sweating (it was HOT) as we saw our first patients – those affected by chikungunya (yes, really), heart failure, ingrown toenails, parasitic worms, cataracts, diabetes, diarrhea, headaches, arthritis, asthma, fractures, urinary tract infections, depression, and allergies. Something we have realized quickly on this trip – although we (Americans) see many differences between the countries and the people here, we really have so many similarities. As medical students, we had great oversight by our attending physicians and Family Medicine residents. Plug for USCSOM – Dr. Barron, an internist and ultrasound fellow, was able to bring a V-Scan (handheld ultrasound). Through this resource, we performed cardiac, gallbladder, and lung exams today. In a very hot clinic room. Dr. Hall humored everyone by taking the main room’s temperature at one point – 101.4. The room had a fever.

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Banjor Musa, Brady Moore and Dr. Jeff Hall carry a man through clinic.

TEAM WORK MOMENTS:

Our pharmacist, Jose, built a spacer out of a Dixie cup to pair with an inhaler for a girl having an asthma attack.

Dr. Chico, the doctor at the PMI Clinic in El Viejo, was able to coordinate an X-ray in town for a boy with a broken arm.

With the oversight and guidance of Dr. Bentley, Andrew removed an ingrown toenail.

Several people worked together to carry in Bo’s first patient of the day, a man with an old pelvic fracture.

The registration team had everyone organized all day for epic patient flow.

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Lawren Anderson assesses a patient during clinic.

All said and done, we saw 218 patients today. Guys, it’s only Monday! 60 patients received reading glasses and sunglasses. Several were able to received medications filled by the pharmacy and even more will receive follow up at the permanent clinic PMI has here in El Viejo. And hopefully every single one felt the love of Jesus!

We made it back to Hotel Los Volcanes by sundown, just in time to cool off in the pool, throw some footballs, and hit around a volleyball. We ended with a delicious Nicaraguan dinner topped off with flan and some awesome life stories.

Thanks for following along. Get yourself on a PMI trip.

¡Hasta Mañana!

Lawren Anderson & Grace Twitty

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Team Nicaragua :: Many Hands Make Light Work

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With the team finally assembled after hours of travel, we set out from Managua to the city of Chinandega where we will be staying for the remainder of the week. After about three hours on a packed bus, we arrived at our hotel – Hotel Los Volcanes – so named for the beautiful volcanoes silhouetting the horizon. After quickly unpacking our suitcases and supplies for the week we set off toward the center of town. It was another 30 minutes or so by bus to El Viejo to meet the yellow clinic on the corner that the locals have come to know for its exceptional quality and care.

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We then began working on loading the endless amount of supplies from the clinic’s storage that we would be using in makeshift clinics in outlying areas throughout the week. With so many helping the huge amount of work seemed quite manageable, leaving us with plenty of time to explore one of downtown El Viejo’s most famous landmarks – a centuries old basilica. We then headed back to the hotel where we made our way to our hotel rooms, but there was still work to be done. The team went to work organizing the thousands of pills and thousands of dollars of medical supplies that we had gathered to be used to provide care for the locals. A long awaited dinner, new friends, and shared stories made for a good ending to a long first day.

Tomorrow the real work begins.

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Team Nicaragua :: The Team Has Arrived!

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PMI’s February Nicaragua team has made it to Nicaragua and everyone is excited (even these guys)!

After a day of travel, the team arrived to Managua, Nicaragua and sat down for our first meal together at 10:30pm. Once full on pizza, we went around the room and introduced ourselves for the first time… all 40 of us! Tomorrow we are off to Chinanadega, which will be our home base for the rest of the week. Stay tuned for lots more to come!

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MKMC Community Health Promoters

Several of the CHPs wait for the World AIDS Day procession through Masindi Town to begin. MKMC was the only health centre represented at the district event held on December 1st.

Fortuitous events often induce moments of insight and creativity. A chance conversation with my colleague, Jimmy, did just that. We were discussing literature I had inadvertently stumbled upon concerning health centre advisory boards comprised of community members with the purpose of providing guidance on the health needs of the community. The further we discussed this idea, the more fervently committed we became as this concept afforded a unique avenue for community empowerment and self-advocacy. By the time we reached the hospital, the outline of our nascent Community Health Promoter (CHP) program had been conceived.

With this program, we hope to expand the scope of public health at MKMC to reach those populations which may be overlooked or marginalized within the community. After researching best practices for similar types of programs, namely community health workers (CHWs), we determined that the success of our project would hinge upon community investment, empowerment, and self-efficacy at each step.

Specifically, the three main goals of the program are to:

  • Increase the number of and improve the efficacy of MKMC public health education outreaches by training nontraditional health volunteers to provide quality public health education services targeting sectors of the population not typically focused on or currently receiving health education.
  • Promote health services offered by MKMC in order to improve awareness within the community leading to an increase in the number of patients seeking services. This will be done by maintaining a bridge/feedback loop between the needs of the community and the services provided by MKMC.
  • Provide a system of monitoring and mentoring to assist CHPs to become effective educators, develop critical thinking skills, become valued members of the community, and assist the community to voice and advocate for their health concerns.

Although we are still in the initial stages of program implementation, we have a total of nine core volunteers within the Central Division of Masindi representing the diversity of the community including: a boda driver, a market vendor, a person with disabilities, and a school teacher, among several others.

The selection process for identifying CHPs was based on research indicating that individuals are more likely to accept information from a peer. By training individuals with diverse backgrounds, we are attempting to reach a wider part of the community with public health education. The majority of these individuals were selected by the leaders of their sectors to represent them and their health needs based on the criteria of being passionate about working with and assisting the community to advocate for its own health needs as well as being dedicated to working as an unpaid volunteer. This last criterion was particularly important. The concept of volunteerism, while embedded within the American psyche and a tacit prerequisite for everything from college to Peace Corps to medical school, is practically unfathomable in Uganda.

The CHPs participate in a mapping exercise to identify resources and causes of health problems within their community. The CHPs will repeat this activity with their respective sector of the community to identify its particular health needs.

So far we have trained our CHPs to identify community needs as they relate to health. Using, these tools our CHPS did community needs assessments within their respective sectors. A follow-up meeting provided the opportunity for the CHPs to bring together all of the data they collected and to identify similarities among the health needs of the various community sectors. This information will form the content for a more in-depth training of the CHPs at a later date. Once CHPs are trained on these community-selected topics, we will set a monitoring and evaluation plan in place whereby CHPs will be observed quarterly and receive ongoing support and mentoring to help improve their facilitation and content knowledge. Additionally, we will identify ways to integrate the CHPs more fully within the services offered at the health centre and not just within the community.

The CHPs perform an original drama illustrating the importance of being tested for HIV and using condoms at World AIDS Day.

I continue to be amazed by the passion and dedication of our CHPs despite having to counter Ugandan culture with the act of volunteerism as well as the challenges often faced by the development of a new program. Jimmy and I, as well as the rest of the staff at MKMC, are excited to see how the program continues to grow and expand beyond its infancy.

Lynda Krisowaty

MKMC, Peace Corps Volunteer

My Journey through Medical School :: Bina Sunday Alex

Happy New Year to everyone and greetings to the PMI Family across the world!

This time last year, I was working at Masindi-Kitara Medical Center (MKMC) and was told I had received a scholarship from PMI to return to medical school! My dream has always been to become a doctor, so I began preparing for my transition from work back to being a student. This was a big challenge for me as I was used to earning my own money, and I was not dependent on the scholarship for my keep. However, my friends and PMI staff encouraged me to go for it, so I did!

Next month I will be completing my first year at the university without missing any class because of tuition and other finances. PMI has helped me achieve this, and has made this journey possible. I cannot fail to appreciate the extended hands of those who contribute to PMI. The changes you make across the globe are felt in our hearts.

Below you’ll see a photo of one of my assignments this semester. I met with a lady who thought she was 10 months pregnant. After examination and counseling, we convinced her to come into the hospital where she was diagnosed with liver disease. Had we not been there, she would not have gotten the help she so desperately needed. Even though I’m not working at MKMC right now, the effects of your support are being felt in my life, in my patient’s village and throughout Uganda.

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Thank you for working with me through last year and may the new begin with blessings!

Bina Sunday Alex

Student Doctor at KIU

 

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Patient Highlight :: Jennifer’s Second Chance at Life

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With all the drama of a teenage sitcom, Jennifer eloped from school at the age of 17 to marry the man she loved. She moved from her birth place in Northern Uganda to Masindi, where her husband secured a job with a sugar cane factory.

All seemed well with the couple for their first two years of marriage until Jennifer was due to have her first child. When her time came, a neighbor rushed her to Masindi-Kitara Medical Center (MKMC) where she gave birth to a bouncing baby boy. After four days, she was discharged in good health.

The living conditions were not ideal back at home. Her health deteriorated and she was rushed back to MKMC. The 19 year old mother learned she had developed sepsis after her c-section and was rushed back into surgery. To the surprise of the MKMC team, Jennifer’s husband abandoned her while she was in surgery.

It is customary in Uganda for the family members to provide bedside care, food, and other essential items to a patient when admitted to the hospital. When Jennifer realized that her husband was not going to be providing that care, MKMC’s staff stepped in to complete the family duties and care for her new son. The team was able to provide support the young mother so desperately needed during this time.

Efforts were made to reach Jennifer’s family hundreds of kilometers away, and her mother eventually made it to the clinic to begin caring for her daughter. All efforts to reach Jennifer’s husband, however, proved futile.

MKMC was able to care for Jennifer during one of the most trying months of her life. She has been given a second chance at life and is now back home with her family in Northern Uganda. Sadly, Jennifer’s story does not stand alone. Many women in Uganda are faced with similar trials as wives and mothers. We count it a blessing to meet these women where they are, provide care when they need it most, and ensure that their emotional trials aren’t worsened by physical ones.

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