Days 4 and 5: El Sauce

We headed out for El Sauce (pronounced “el sow-say”) early in the morning accompanied by two sixth-year medical students from UNAN named Alma and Cynthia. Along the way, we stopped at a centro de salud (health center) and a puesto de salud (health outpost) to learn about the different scope and scale of clinics in Nicaragua. Centros are often larger and better equipped, with some basic lab testing available as well as the occasional specialist. Puestos are typically more rural with little to no on-site lab testing, and require referrals to other centers for any necessary specialist care.

In El Sauce, we toured the recently constructed secondary hospital and learned about a number of community health programs run out of the hospital. The hospital had 30 inpatient beds, an operating room, emergency department, primary care, maternity care, lab services, and X-ray. A number of programs operated in the hospital, including one for ensuring healthy growth and development of children. Despite the specialized services, the hospital did not perform emergency surgeries or handle high risk OB, both of which patients had to travel 1.5-2 hours to Leon for.

We spent the afternoon in the emergency department, shadowing a pediatrician who also saw adults. The ED was initially relatively quiet, and then became very busy, as patients arrived with chief complaints ranging from syncope to fall from a horse to contractions.

The next morning, we participated in rounding on inpatients, which lasted all of an astonishing 20 minutes--this is something the U.S. health care system could learn from Nicaragua! Rounds involved attending physicians from every service at the hospital, including pediatrics, anesthesia, surgery, medicine, etc., an interesting model for incorporating a variety of medical perspectives.

At the conclusion of rounds, all the doctors met for a few minutes to discuss the impending changes brought by the ICD-10, a challenge all around the world, I then realized. We proceeded to the primary care pediatric and internal medicine clinics, where we shadowed doctors as they saw patients.

In my mind, one of the biggest lessons that Nicaraguan health care holds for the U.S. is how much more effectively they practice public health in Nicaragua. Even specialists tabulate each of their visits for the day on a special ledger with room for the chief complaint. With pediatric diarrhea, for example, they record the severity, or whether oral versus IV rehydration was given, for instance. They also record whether the patient is being seen for the first time for the complaint or in follow-up, and so on.

That evening, we returned to Leon and headed out for some work-life balance/cultural competency with our host families for salsa dancing.