An aspiring physician’s pilgrimage to his hometown hospital

Geoffrey Collett is a third year medical student at the Herbert Wertheim College of Medicine (HWCOM). Last summer he did a medical internship in Kenya which he chronicled in the story Eyes of Africa and shared with FIU News readers in October 2014. His latest medical training trip, this past April, took him back to his native Nicaragua.

By Geoffrey Collett

Many times I imagined myself as a physician, walking the halls of the hospital where I was born. However, this will never happen because that hospital is long gone – its small size and aging infrastructure deemed unsuitable by MINSA, Nicaragua’s health ministry. A successor, built to better serve my hometown of Boaco and nearby pueblos, did not live up to its promises and also closed its doors. But good fortune finally found its way in the form of an aid fund from the Japanese government. The third version of Hospital Jose Nieborowski (HJN) is, by far, the best health care facility the region has ever had and my opportunity to volunteer there presented itself halfway through my medical education. Although not exactly what I had imagined, the prospect of a rotation through this third incarnation of HJN would certainly be more fulfilling than one at the pseudo hospital where I came into this world 25 years ago.

HJN is located on the outskirts of Boaco, about 50 miles east of Managua, Nicaragua’s capital. Upon its completion it was designated a departmental facility, meaning it can handle the patient load of the entire department or county. I reported for duty the morning after my arrival and was impressed by the number of specialties and services the hospital offered. No longer were locals and nearby townsfolk limited to basic primary care. They could now be seen by a psychiatrist for depression, or have an emergency Caesarian in a fully sterile environment, or their eyes evaluated by an ophthalmologist – situations that previously required a trip to the capital and for many were not feasible. It brought me comfort to know patients had access to a facility that offered comprehensive care. To put it in the words of an attending physician who has worked in all three iterations of HJN: “We do not have to say ‘sorry, but no one here can do that’, nearly as much as we used to.” It is far from perfect, but also far from what it used to be.

I was promptly assigned to obstetrics and met both students working the clinic that week. We had the opportunity to chat before any patients arrived. It was their sixth year in medical school and, although labeled as students, they were essentially residents (this final stage is actually referred to as ‘intern year’). In Nicaragua, you are able to pursue a career in medicine immediately after completing secundaria (equivalent to high school) so my new supervisors were quite young. I was asked to interview and present patients as the workday began. Within a few hours the attending physician arrived and they caught her up to speed. The students also introduced me and gave a glowing (perhaps undeserved) performance review. I am glad they did so because for the remainder of the day, Dr. Fuentes kept me right by her side. I was able to participate in the delicate pelvic examinations of our patients (some of whom were admitted for delivery) and help update prenatal care plans. It was a great and busy first day at HJN.

Next up were two days in the emergency department. Within minutes of meeting my new supervisor, Dr. Varela, he made it clear I would be actively involved in patient assessment, treatment and management. My time in the ED was a whirlwind – a collection of highs and lows that both solidified my clinical skills/knowledge and made me seriously question if I had what it takes to be a quality physician. One moment I was assessing a child transferred for an emergency appendectomy, determining by examination that this was an incorrect diagnosis and having a pediatric surgeon agree with me. The next, I was failing to ask about recent trauma to a man with chest pain, not suggesting an x-ray and prolonging pain management for his rib fracture. It was rough at times, but I am proud to have contributed to the ED team and prouder to have helped each patient who walked through those doors.

My final day was a surgical observation. I was instructed to arrive bright and early to meet the team of surgeons and anesthesiologists. As I greeted them, a physician asked what my surgical specialty was back in Florida – at some point there had been a misunderstanding as to what my credentials were! It made for a good laugh when I revealed suturing was the only procedure I felt comfortable doing on my own. Until then my OR experiences were limited to observing and assisting ophthalmological procedures. And although that is the field I aspire to practice in, I hoped to find other surgeries intriguing as well. There was absolutely no disappointment as I stood in on two lumpectomies, one cholecystectomy and one appendectomy. All were quite invasive (laparoscopic methods are still a long way away from HJN) and all were successful. It is truly impressive when a surgeon operates and shares his/her knowledge simultaneously.

A large portion of my family still lives in Boaco. Seeing them, especially my grandmother, brought me a great deal of joy. Seeing the huge improvement in my hometown’s health system had a similar effect. Now my abuelita can be tended to by a variety of competent physicians and residents and so can thousands of impoverished people in the area. Having volunteered at HJN, even for such short period of time, was an absolute honor.