January 2003 Mission to Jinotepe, Nicaragua
prepared by Cheryl Kelley RN
This being my third year as a nurse with our Northeast VOSH missions to Nicaragua gives me somewhat of a sense of confidence from which to give you this report. Each year is different from the others. However, there are things that remain constant.
There is a core group of volunteers, both professional and nonprofessional, that create a sense of family returning each year. I feel fortunate to be associated with those family and professionals. Almost as soon as we returned, we begin to plan for the next mission. What to remember and where the pharmacy needs more and/or less the next year. It's quite a satisfying process.
Before we depart, many individuals are busy collecting donated medications from multiple sources. We consider the most commonly seen medication needs. We start with gastrointestinal, anti-inflammatory, analgesics, antibiotics and pulmonary medications.
Upon arrival in Nicaragua, personal luggage and donations sorted, we await arrival to the clinic site. Each site varies in character. This year in a school, we were in an area behind a counter that looked good initially. Only to discover the sink with running water wasn't hooked up to the drain but did have a basin of stagnant water. Once this was cleaned up the goal was to hope for a drain hookup. After discussion with many individuals, the hookup promise resulted in a large bucket to collect water. The area had a tendency to smell of sewerage late in the day, not to mention the biting insects as an added feature. We begin by setting up an area for each designated category of medications, then take an inventory for the medical staff.
The pharmacy is staffed with nurses from a variety of backgrounds. This proves to be most helpful as we draw on each other's strengths while meeting the needs of the population served. This year we have three veteran pharmacy nurses. Carol is strong in the area of mental health. Eileen's maternal and child health lactation specialty is invaluable. I come from a current adult internal medicine primary care focus and many years of home care/medical surgical varied experiences. Quickly boxes, piles of bottles and plastic bags with prescription and over-the-counter medications are put into order in preparation for dispensation. The interpreters are invaluable to us when it comes to dispensing medications to the Spanish-speaking population, as two of the three nurses can only communicate in key Spanish instructional phrases. Then there's always our pantomime or pharmacy charades that appears to greatly amuse our patients. Can you imagine the challenge to instruct the new user of a metered dose inhaler for asthma control when you don't speak the language? We can only hope for the best understanding of the medication use and beneficial response and outcome. With a written prescription in hand from their visit to the medical staff, our patient presents medication requests. We filled the prescriptions as directed within the limitations of available supplies sometimes needing to switch to a similar medication and often communicate with the doctors in person or by walkie-talkies when a challenge presented itself. The interpreters are key to keeping the line moving and the service time down with a minimal wait. Some medications present the delay of calculations and reconstitution of powder to liquid form. Then there's the unknown component of how many prescriptions each one in line has in hand for themselves or for multiple family members. The hardest part is on the last day or two when we just run out of the medication or even a substitute medication. I still find it amazing that we do run out when you see how much we start out with for stock.
This year we saw more individuals seeking medication refills to manage chronic medical diagnoses like hypertension and diabetes unlike previous years. The pharmacy team does a great job under challenging conditions with late hours. Our energy and volunteer spirit is contagiously sustaining for us when it begins to feel like work.
I'll always remember the smiles from the older women in particular when I ventured out of the pharmacy to assist in other areas as a nurse while still wearing my apron purchased in the local marketplace last year. The pockets provide great functional mobility working in the pharmacy. (I wouldn't be caught dead wearing a frilly apron at home, nor can I remember the last time I donned an apron in my own home.) I believe there are a few pictures out there of the infamous pharmacy apron.
At the end of four days working in the pharmacy we then pack all the medications for donations to the local medical facility. We also give away plastic medication bottles and pens on the last day. All you have to do is ask us for one.
What a satisfying experience and a great group of professionals and nonprofessionals to share this mission to Nicaragua. I feel so fortunate to be associated with the NEVOSH family.
8 February 2003
Cheryl Kelley RN
2012 Panama & Tennessee | 2010 Nueva Esperanza | 2009 Nueva Esperanza | 2008 Nandaime | 2007 Monimbo | 2006 Nandasmo | 2005 Catarina | 2005 Mus | 2004 Nindiri | 2003 Jinotepe | 2002 Ticuantepe | 2001 Monimbo | 2000 La Concepción | 1999 Masatepe | 1998 Niquinohomo | 1997 Lake Yohoa | 1996 Jutiapa | 1995 Omoa | 1994 Vera Paz | 1993 Coatepeque | 1993 Salama | 1992 Chimeltenango | 1991 Chichicastenango | 1990 Comayagua | 1989 San Manuel | 1988 Omoa | 1987 Santa Rosa
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