Undertaking Managua
J. Brandon Watson, DO, MPH
I
n medical missions, it is not simply what one
does, but why one does it. In an age where
travel to the developing world can be made
in less than a day, the question arises, “Why are
so many people continuing to live their lives
without basic essentials such as clean water,
education and durable shelter?” The mission
of Hand in Hand ministries is “to build strong
communities by engaging individuals and families in transformational life experiences.”
Hand in Hand directs around 30
international trips a year to Belize and
Nicaragua. The annual medical trip to
Managua, Nicaragua is the only one of
its kind. Hand in Hand’s primary goal in
Managua is to educate its children and
to construct quality homes for its residents. This was my first experience with
providing medical care internationally.
Why did I decide to be a part of this outreach program? - Simply, to provide an
element of assistance and comfort to those
less fortunate than I, by whatever means
possible. My impact, albeit a small one,
allowed me to simultaneously gain insight
into the needs of the community and to
learn how I could contribute in the future.
With a population of approximately 1.8 million and 2.1 million
in the greater metropolitan area, Managua, the capital of Nicaragua
is the second largest city in Central America after Guatemala City.
Managua is referred to as the “land of lakes and volcanos,” located
on the southwestern shore of Lake Managua and near the Masaya
Volcano National Park. South of the city is the 3,000 square mile
Lake Nicaragua, the largest lake in Central America. Because it
was once part of the Pacific Ocean, it is the only place in the world
where freshwater sharks, swordfish, and sea horses live.
Currently, Nicaragua is grappling with stubborn obstacles after
a recent civil war and natural calamities; it’s one of the poorest
countries in the Western Hemisphere, second only to Haiti. Sixty
percent of its population resides in urban areas with an average life
expectancy of 74 years. The infant mortality is 24 per 1000 live births
with a premature infant mortality rate of 12 per 1000 live births.
Nicaragua has a maternal mortality rate of 100 per 100,000 and a
rapidly increasing adolescent birth rate, currently estimated to be 109
per 1000 persons between 15-19 years of age. The minimal average
income is $1,300 annually with only 11 of 100 individuals having
access to the internet. Finally, while 93 percent of its children enroll
in primary school, only 48 percent are estimated to complete it.
The local news stations, WAVE3, WHAS, and WLKY covered
our departure from the Louisville International Airport. Also, Delta
Airlines was gracious enough to wave our additional bag fees for
our eighteen 50 pound bags of medical supplies. On arrival in Managua, we were introduced to Edward and Barbara Dunsworth, the
couple who lead the effort of Hand in Hand full time in Managua
and have been doing so for the past eight years. They are truly some
of the most selfless and positive people I have ever encountered.
Quartered in a striking rented property, Casa Grande, we enjoyed
the surrounding gardens, the agreeable
staff, plus three delicious meals a day.
Mornings in Managua involved visiting the public medical facilities of the
area. We learned common pathologies
of the region, and how the staff, severely
lacking in resources, was able to manage
and care for their patients. We assessed
their needs and how best to distribute
our supplies. All the physicians and staff
we encountered were compassionate and
glad to guide us through their approach,
grateful for what aid we provided.
In the afternoons, we applied what
we had learned of the region’s ailments,
using our own skills to attend the patients
of the San Francisco de Asis Clinic. The days were demanding but
organized with approximately 400 patients seen in five days. We
had two excursions, one to Masaya Volcano and the other to the
Pacific Coast. Our mission group all agreed, before and after these
excursions, that after a demanding work week, this time was vital
and much desired.
A clear understanding of the goal of medical missions should
be part of the planning from the beginning, and a team should
consist of members with mutual respect, a common philosophy,
and great communication. The partnership between the Greater
Louisville Medical Society Foundation and Hand in Hand ministries
truly meets these requirements in order to provide essential care to
the impoverished people of Managua. I am grateful I was able to
play a small part in the lives of so many people in need. Enthused
and energized as I am, I now plan to continue as one of the team’s
physicians with Hand in Hand in Managua. LM
Note: James Brandon Watson, DO, MPH, practices internal medicine
and pediatrics as a third year resident at the University of Louisville
Hospital.
August 2014
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