by Daniel Gildea

This winter, I went on a medical relief trip to two different impoverished communities in Nicaragua. We stayed in a hotel in Managua, the capital, which was great, though we could not drink the water and used bottled water for brushing our teeth due to parasites. The first community we went to was called Barrio Tangara. I expected to see extreme poverty, but it was hard to be fully prepared for it: trash littered the dirt streets, malnourished stray dogs were very common, and nearly every house was made out of non-permanent sheet metal. Latrines were used instead of flush toilets, which were a luxury. The people of the community were very warm and inviting, and we met many of them during our community survey, which focused on information about the health situation in the community. For the next few days, we set up and worked in a medical clinic, trying to address the community’s health issues. Patterns of illness soon emerged, many of them rooted in a combination of poverty and a lack of information, which often go hand in hand. For example, we often diagnosed intestinal parasites, which could reach their human hosts both through water and food. Often people with parasites, many of whom were children, lived in homes with a coverless latrine. Flies would enter the latrine, pick up parasites, and later land on food, depositing them there to be eaten. It was clear that health education was crucial, and we gave out information on a variety of topics, from parasites to diabetes to mosquito-borne illnesses like dengue fever and chikungunya. Tonsillitis was another common ailment, as was asthma, which was often caused by the dirt floors of the houses: the air inside usually has a dusty feel, and breathing it in causes lung issues. Before we left, we had a community day with the children, which was a great experience. The language barrier was difficult to overcome, but I soon learned how important gestures and smiles are as forms of communication. I also learned how well sports can bring people together, even when only the most basic sentences can be used to communicate. We brought a soccer ball, and just by simply asking “futbol?” and counting off teams, we soon had a great game going.

The second community we visited was called La Chureca, which means “the city dump.” We had learned more about this community beforehand; it had formed around Managua’s dump and the people made their living by scavenging from it. In 2013, a Spanish charity donated a large sum of money to the community, installing concrete houses and roads, as well as a recycling plant. Despite more secure shelter and looking economically better off than the first community, it had many of the same issues, including stray dogs and trash. The health situation there was no better than the first community, and arguably was worse. In La Chureca, we followed the same plan as in Barrio Tangara, which included house visits for a health census, clinic days, and ending with a community day. We saw many of the same diseases, including diabetes, high blood pressure, and various infections. Again, poverty and lack of health information seemed to be at the root of many illnesses. We saw one man who had an extremely high blood sugar reading of over 500mg/dl, and didn’t even know he had diabetes! Unfortunately, as a clinic, we lacked many necessary drugs and had to refer some of the very sick people, as well as people with severe chronic illness, to specialists, though luckily in Nicaragua health care is free for all. Most often, we prescribed antibiotics, antiparasitics, cough medication, and pain relievers like Ibuprofen. The translators we worked with were a huge help for communicating with both the patients and the two Nicaraguan doctors our team worked with. The doctors were extremely helpful and really wanted us to learn, both in the clinic and in our seminars, which included suturing and pharmacy, among others. In talking to our trip leaders, translators, and other people I met during the trip, I was also able to learn a little about the political situation in Nicaragua, as well as its culture and history. It is an amazing country, and I hope to be able to return before too long.

Before our team left for Nicaragua, we spent time each week of the semester talking about the communities and the health issues that we would see. During this time, I learned a lot about the issue of disease in poor communities. This knowledge was reinforced by the 48 page disease and pharmacology manual given to us for the trip, so before going into the communities I had a good theoretical idea of the social justice issue of illness and its interplay with poverty. However, nothing could match the actual experience of seeing the communities firsthand. Over the course of the trip, I learned a ton of information about the practice of medicine and a wide variety of medical techniques and diseases. Just as importantly, however, I learned as much as I could about what living in an impoverished community is like, and how much opportunity, including not only economic mobility but also simple access to food, clean water, and healthcare, is stripped away by extreme poverty. After taking a great sociology class last year, I became much more interested in issues of international inequity, especially from a healthcare perspective, and this trip reinforced my desire to make what difference I can. I’ve been a premed student since coming to William & Mary, and I intend to continue on that path. I liked so much about the trip, though, that I’ve been strongly considering spending time volunteering with Doctors without Borders in the future, which would allow me to make far more of a difference in communities such as these than I can now, with only minimal training. I will definitely carry this experience with me, and it has certainly informed my view of the world, and more importantly, my place in it.