ON THE COVER
Shanna Barton, MD
I
am currently a medicine-pediatrics resident. Thanks to the
partnership between Hand in Hand Ministries and the GLMS
Foundation, I got to travel to Nicaragua this past winter to
provide outpatient pediatric care to children enrolled in the
educational program. This program provides transportation
to and from a private Nicaraguan school, as well as additional
educational resources (such as textbooks and tutoring services for
math, physics and chemistry), as well as occasional meals, which are
provided at a local educational center. Each child is also assigned a
case manager to assist in overall educational needs as well as an on-
site social worker and psychologist, should they require additional
assistance. In order to remain enrolled in the program, children
must maintain a superb grade point average (most are at the top of
their class), regularly a ttend classes and be seen once yearly by the
medical team affiliated with Hand in Hand.
The medical team worked daily in a local clinic. Our medical team
consisted of two family medicine attendings, one adult hematologist/
oncologist, one pediatric hematologist/oncologist, two pediatric
residents, one child psychiatrist, one OB/gyn, a lab technician, a
biomedical engineer, a dermatologist and three neurosurgeons.
Daily, we worked in an established clinic to provide care to the
children. Primary complaints ranged from routine well exams to
abdominal pain, headaches and associated vision changes, and sore
throat, among others.
While visiting the women’s hospital and the pediatric hospital,
I was impressed with their resources and facilities. Wards were
crowded, supplies and technology were minimal, and the facili-
ties were not in great condition. But I was inspired by what these
professionals were able to accomplish with scant resources. For
instance, the women’s hospital had established a milk bank on the
property to assist babies in the NICU on site. Their lab was well
equipped, and while they were unable to test for all necessary or-
ganisms, they certainly made the best of what was available. I felt a
similar resourcefulness amongst the families and children we met.
For instance, on the day of our home visit I was paired with a child
psychiatrist, and we visited a family of three children enrolled in
the program and their parents. Hand in Hand provided 40 dollars
in total for lunch for the seven of us. While that task may have been
daunting for most, this family was actually able to feed a group of
nine (the family also invited their housekeeper and her daughter) a
full meal including chicken, rice, plantains and homemade orange
juice. They had money left over to take our group to downtown
Managua to tour the waterfront and the national palace, which had
been converted into an art gallery.
nately, in an economy like Nicaragua’s this still may not be enough;
despite your knowledge there may not be a job in which to utilize
your talents. It is in this space that I feel Hand in Hand does a
strong job. Children are funneled into a private school established
in Nicaragua, as opposed to an American school, so that they can
obtain a true Nicaraguan education. Children are encouraged from
a young age to work hard in school and attain a strong work ethic,
for wherever they go, that will be an invaluable skill.
While I only spent a week in a foreign country, I am sure that
what I’ve learned from the people I have met will have a lasting
influence on the way I practice medicine. Many Kentucky families
also fall at or below the poverty line, subsisting on the supplemental
food program and relying on public transportation. And while I can
make an argument that while children in our city have adequate
access to health care, just as in Nicaragua, they may be unable to get
to their appointments. Public transportation is, at best, moderately
reliable, and in rural areas mostly absent. Most families work two
jobs with several children at home, and thus getting one child to
the doctor becomes a full day affair. Add to that, a family who does
not speak English as their primary language who must navigate the
complexities of our health care system, which can be downright
disastrous, or merely intimidating.
I spent one week in Nicaragua with an interpreter and still felt lost
and uneasy at times during an appointment, leaning on my scant
understanding of Spanish, hand signals and body language to make
up the difference (not a reliable method). How much more difficult
in a town would my experience have been if I did not also have a
host home, traveling group and group transportation?
Based on these recent experiences, I plan to work toward changing
my outlook on my impoverished, uneducated and refugee patients.
Rather than frustration at seeing a non-English speaking patient
on the schedule, I hope to greet them with empathy and patience
as they navigate a new health care system and new country. I must
work to tailor my outpatient appointments and hospital visits to
the patient, realizing that even the most basic task for me may be a
huge obstacle for them. Such things as food, education and health
insurance are privileges I expect to have, and yet I know that does
not hold true for too many. I intend to serve as an advocate for my
patients to obtain the same privileges, while also recognizing how
blessed I am in my own situation. While I may have felt out of place
in Nicaragua, I hope that the knowledge I have gained of our own
local resources aids my current and future patients and enables me
to serve them not only as a physician, but as an educator, social
supporter and advocate.
Dr. Barton is a pediatric resident at Norton Children’s Hospital
I continually heard the same advice from the citizens. From the
coffee farmer we visited, from the clinic staff and from the owner
of a local vocational school, we understood that simply providing
money is not a solution. You must also have the tools needed to
learn how to make a living and to balance your expenses. Unfortu-
AUGUST 2017
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