Harrison has been active in this project, and his description of his experience in 2016 is similar to the feedback from all our American participants.
This trip is one that I highly recommend to students and residents alike. It was a great opportunity to see how healthcare is delivered in another part of the world. Obviously, practicing medicine is very different there when compared to the United States. I think understanding these differences will effect my future practice make me a better physician. For instance, it was humbling to see how much room I have to improve on my physical exam skills. This is an area of medicine that is very important, but is often overlooked in the U.S. due to our easy access to various diagnostic testing and imaging tools. “Why spend extra time on a careful pulm exam when I can order a chest Xray. Better yet, go ahead and CT the chest!” I think experiencing medicine in Nicaragua, where X ray and CT are not readily available, forces physicians to rely on themselves to make diagnosis and treatment decisions without excessive testing. I now realize that we often use the EMR, with all of its order sets and shortcuts, as a crutch. Most students and residents have never worked without an EMR. I think it’s healthy to experience what its like to practice without it. Practicing this way for a relatively short time in a place like Nicaragua helps a training physician to develop a deeper level of confidence and competence that otherwise may take years to develop in the states.
Besides what you can gain personally from this trip, it’s also a great opportunity to contribute to the medical efforts in a developing nation. I obviously benefited by learning from them, but they mentioned multiple times that they too benefit from exchanging knowledge and ideas with us. For instance, while in country it is easy to identify common medical problems that plague the population of southern Nicaragua.
One such ailment is nephrolithiasis. I was able to put together a short poster presentation on the latest recommendations for the diagnosis and treatment of kidney stones. I obviously catered this presentation to the resources available to the clinicians in that setting. Additionally, we experimented with the utility of a simple and affordable one lead EKG system for that clinical setting. However, the bigger picture is the relationships that we are forming there and our aspirations to continue to build upon them. Personally, I feel better knowing that my role is not simply that of a visitor interested in clinical tourism. The ultimate goal of this project is to maintain continuity from one trip to the next and in doing so have a meaningful impact on healthcare delivery in the region.
Finally, the trip is just fun! There was a great balance of work and independent down time. There are plenty of hiking, surfing, tourism and cultural opportunities that I found unique to this trip. I have been on several medical missions abroad, but all of them were with larger groups. On this trip there was only Dr. Samras, his 6-year-old daughter, and myself. This small group experience allows for far greater exposure to the local culture. You are not insulated by a gaggle of other American students and clinicians. The three of us stayed in a small Airbnb in downtown San Juan Del Sur. It was truly an immersion into a different way of life. If you are looking for a rewarding travel experience with less of a chaperoned, “summer camp” feel, look no further.
