Louisville Medicine Volume 66, Issue 2 | Page 13

GLMS FOUNDATION MIRROR, MIRROR ON THE WALL….. Goetz Kloecker, MD T hree years ago, I was lucky to join GLMS’ medical mission trip to Nicaragua, one of the poor- est countries in our hemisphere. I wrote in this journal about my absolute astonishment at how patients and doctors coped with a desperate lack of modern medical tools. This year again, I was happy to join a gifted and big-hearted group of health care professionals to see how this country, under socialist rule, has fared. Led by Dr. Cynthia Rigby, we were warmly greeted at the women’s health clinic, known as Bertha Calderon, and were proudly shown around to a new wing of the hospital with new CT scanners and a new pathology lab. My expectations about the health care services were much more realistic than the first time around. I was glad to hear breast cancers are now tested for estrogen receptors, and oral narcotics for cancer patients are now actually available and not so strictly rationed. All through the busy corridors, handmade notice boards gave good medical advice, cheered female heroes of the revolution and thanked the ruling socialist party for the accomplishments. The waiting rooms were as packed as three years ago, while a sign on the wall announced, “Todo Servicio Medico is Gratuido,” (Every Medical Service is Free). Bertha Calderon Hospital, just as the University hospital, Manolo Morales Peralta in the capital city of Managua, are the only special- ty hospitals where patients with public “insurance” can come for their cancer care, from all over this central American country of six million. I was told this will change and more specialists will be available at the Pacific and the Caribbean coast. Currently, patients from those areas must travel one to two days to Managua either by car or horse-drawn carriage. Rounding again with the young residents on the University’s leukemia ward, where the average age of the patients was 25, I wondered where the patients older than 40 were (I was afraid they were all dead). I was amazed to hear that only two dozen residents are trained per year in the whole country to become specialists. That is for all specialties! The absolute majority of medical students will go int o general practice. Of course, why train specialists, if you do not have access to specialty tests and treatments? Even simple blood transfusions are hard to get, I learned, when seeing a young girl with severe menorrhagia and a hemoglobin of five. Nicaraguans are reluctant to donate blood - I was told - possibly worried about ill effects of the donation. Thank you again to the American Red Cross and all the generous donors that we depend on! What struck me is how expressly grateful the patient and their families at the San Francisco and AMOS clinics were: for each minute of listening, for each advice, for each reassurance, and for each sample of medicine, including the obligatory deworming pills. We met the poorest and kindest families in the slums of Managua. For many years, Louisville’s Hand In Hand Ministries has supported the education of the children of these families. Drs. Grimaldi, Rigby, Laufer, Weinstock, Brockman, Neimat, Zaid, our tech wiz Courtney Nanney and I were split into smaller groups and taken into the families’ homes, and offered the best Managuan Sunday meals. I met Adriana and her family. Adriana had just graduated top of her high school class with the help of Hand in Hand Ministries and is now planning to become an industrial engineer. Her family showed us around downtown, which is still scarred from the horrendous 1972 earthquake. This city-shattering event ended a half-century of brutal Samoza dictatorship, leading to the Socialist Sandinista takeover of government in 1979. I learned more about these events at the “Museum of the Revolution” in colonial Leon, the city of poets, where an old veteran explained the fascinating contrapuntal history, from 1930 to 1990. Over the last 12 years, three elections have not lead to any change in the ruling Socialist party, nor is any change foreseeable. The history of Nicaragua, just like Nicaragua’s health care system and the easy friendliness of Nicaraguans who welcomed our group, mirrors our own history and political involvement in Latin America. This experience should make us all take a good hard look at our health care priorities, our helpfulness towards our poor neighbor, and our gratitude for things we take for granted. A special thanks to Ed and Barbara Dunsworth, who continue with Hand in Hand Ministries and the GLMS Foundation to host us, and let us get closer to this tropical and beautiful land of vol- canoes. Dr. Kloecker is an associate Professor at the University of Louisville School of Medicine Division of Medical Oncology and Hematology. He is director of the Hematology-Medical Oncology Fellowship Program. JULY 2018 11