by Madison Miller

While on my trip to Managua, Nicaragua, I was introduced to an entirely new healthcare approach.  Nicaragua is a proudly socialist government with a 100 percent socialized healthcare system. To be honest, in my American mind, I thought that socialized healthcare would serve to help all of the population—I’ve heard for years how more socialized medicine is the key to eliminating the health gap in America. I was very surprised to see that the gap was just as large—if not larger—in Nicaragua as in America.  Pharmacies were on every single block, if not two to a block.  We rode buy multiple health clinics and even hospitals. One hospital was tremendous—an American hospital in the heart of Nicaragua. As we drove past these facilities, I couldn’t help but wonder why our clinical services were still so clearly needed even though their access was covered. When I signed up for this trip, I assumed we would be working in villages that were hours from Managua with very little development and very few resources, and that’s why they needed our services. It was the first time I realized that the health gap between the rich and the poor isn’t simply an American epidemic—it is absolutely worldwide. It is a problem that affects nearly everyone, and therefore I believe that it is everyone’s duty to get involved.


If I had to stress one single aspect of healthcare that is most important overall to humans, it would be education.  We absolutely need to be educating people. Yes, these people had access. Yes, these people were covered.  Yes, they were within walking distance of a clinic, a pharmacy or at least a bus stop that could finish the journey for them.  However, they were absolutely uneducated as far as their health was concerned. I saw an 18-year-old patient who was four months pregnant, yet still smoke and drank. I saw an older gentleman who was missing a leg and severely obese; he was clearly diabetic, and he had been diagnosed as such. He had even been prescribed insulin, but when we tested his blood sugar, his glucose levels were five times the normal limit. The attending physician asked why he wasn’t taking his insulin and he told the physician that the insulin was making him blind.  Had he had access to proper educational resources, he would have known that cataracts are a side effect of diabetes; it was his illness, not his treatment, that was affecting his eyesight. I think that our greatest efforts should be focused there first. Even in our clinics, we analyzed the patients’ symptoms and prescribed them treatments to send them on their way. Rarely did we get to experience educational moments with our patients because we wanted to be efficient.  Perhaps it’s time to stop putting efficiency first.  Let’s hold seminars before we open our clinics to alert people to what maintaining proper health can do for your quality of life. Let’s explain to each patient why they are feeling the symptoms they are feeling, what the root cause is and how the treatment will work to stop it. Nicaragua has a huge health disparity because they have a huge educational disparity, and I know that we have the means to fix that.


I think I learned the most about this issue in clinics; it wasn’t necessarily something that we covered in our pre-meeting but that’s because it wasn’t our issues of focus. The lack of education was something that was immediately apparent from the very first patient who sat down with us. Working in the clinics allowed me to understand just how much of a difference my simple access to information makes in my ability to take care of myself. Thanks to the Internet, I can learn a lot about my health and perhaps more than I should care to know. It has never occurred to me that that knowledge would make any sort of real difference in my quality of life, though; I thought I was simply researching symptoms on WebMD. My peers also pointed out a lot of issues relating to lack of education as well. We handed out informational pamphlets when they mentioned having a specific disease, like diabetes or dengue, but who is to say that they read it? We were there to make a real difference in the health of these people and my peers helped me to see how much more could be done even by a small group of college students far from home on winter break. Towards the end of our clinic days, we began to take certain steps.  For example, we would tell our translators to make sure they understood the importance of maintaining a sterile bathroom or covering food while it’s not being eaten to limit parasite infection. The clinics opened my eyes to an entirely new world of public service that could have been run entirely separate from our medical efforts.  Public health awareness is desperately needed in Managua.


In the future, I would love to see Medical Relief take more of an effort in teaching preventive care in the communities we served. Even better, I think that a new public health-focused group trip to Nicaragua, America, or really anywhere in the world would be a step forward in the right direction as far as solving health inequity worldwide. Get into the classrooms and teach their children.  Hold seminars in local churches. Give demonstrations on how to properly sanitize bathrooms and kitchens. Teach them how to properly dry their feet and to wear shoes so as to prevent fungal infections. They need to know why parasite treatments and vaccines are essential in their areas. I could go on and on! While I unfortunately have limited opportunities within Branch Out during these last few months of my college career, I do believe that my trip to Nicaragua has impacted my future plans as a medical care provider. I know that our current system values efficiency just like our clinics did in Nicaragua; after all, there are only so many hours in a day. However, I have it on my heart to do as much preventive education as I possibly can in my practice because I know that it is the heart of health disparity. Money is certainly a factor as well, but there are plenty of health epidemics in America—smoking or obesity, for example, that could be better maintained or even controlled by simple seminars or educational efforts on the physician’s behalf. I believe that if in the future, if I can make a real difference in at least one patient’s health patterns simply by sitting down and talking to them about what I have had the privilege of learning in my classes and elsewhere, this entire Nicaraguan experience will be 100% worth it all over again.