By: Drew Blackman
Prior to my trip to Managua, I had arranged for a hotel shuttle to pick me up at the airport. As I walked through customs and baggage claim, I saw numerous shuttle drivers with whiteboards emblazoned with hotel monograms and guests' names written in dry erase marker. None had my name on it. I continued through the airport and out into the muggy Nicaraguan night. Finally, I saw something familiar...my name. Written in pencil on a piece of three hole paper ripped from a spiral notebook. I followed the driver, expecting to be led to a bus, or van, or car, or something with the words "Hotel Casa Naranja" on it to reassure me we were heading in the right direction. No such luck. Just a dented, scratched 1990's era Toyota hatchback. I got in and we drove through the night, through unfamiliar boulevards with no street signs. I had studied the city map briefly before my arrival, but as we wound through dark streets past residences made of corrugated sheet metal, I was admittedly lost...and nervous. Eventually, a small lit sign read "Casa Naranja", and I had arrived at my home for the next two weeks while I would experience orthopedic surgery in the capital of the poorest nation in Central America. Hotel transportation was only the beginning of the differences between my experience in Nicaragua and what I am used to in St. Louis.
I spent the majority of my time in Managua working at Hospital Antonio Lenin Fonseca, HALF for short, which is a public hospital that serves as the major referral center for uninsured patients throughout the nation of nearly six million people. In Nicaragua, there are three tiers of healthcare: privately insured, government insured, and uninsured. The gap between three is staggering, but that between those with insurance of any kind and those without is particularly chasmal. The private insurance-only hospitals were on par with most community hospitals in America in terms of resources, facilities and capabilities. The hospitals that accepted both private and government insurance seemed to be on par with smaller American community hospitals. HALF was different. The hospital itself was outdated and the interior lacked the cleanliness one typically associates with hospitals. Patients were housed eight per room, with no air conditioning in the 100 degree heat. Patients, or their families, brought many supplies from home, including sheets and fans. Family members provided much of the nursing care that did not involve administering medications, as well.
A busy clinical schedule limited my time for sightseeing while in Nicaragua, but a surgical cancellation on Saturday and a day off on Sunday allowed me a weekend to experience the countryside. I spent an afternoon hiking on the Mombacho Volcano overlooking Lake Nicaragua. On my drive home, I was stuck for 90 minutes in traffic after I was detoured off the main highway on account of a huge street carnival that lasted well into the night. I also spent a day exploring the uncrowded, and largely undeveloped, beaches at the southern extent of the Pacific coast, eating ceviche and watching surfers prepare for the upcoming World Surfing Championships.I am grateful for the opportunity to have had this experience and grateful to those who made it possible, specifically the orthopedic department here at Washington University, Health Volunteers Overseas, and Dr Dino Aguilar in Managua.
These trips are an important tradition that can help inspire a sense of international stewardship and facilitate future overseas volunteering. I hope the relationships I formed during my two weeks in Nicaragua will help me with trips to HALF after I finish my orthopedic training.