Julianna Betbeze
My name is Julianna Betbeze and I am from Saint Johns, Florida, which is right outside of Jacksonville. I am a junior majoring in International Studies and minoring in Spanish and Biology. In my spare time I enjoy cooking, reading, binge watching Netflix, playing tennis, shopping online, and running. After graduating from Alabama I plan on attending medical school and becoming a family medicine physician. I applied for the Nicaragua Clinical Experience because I want to work with Doctor’s Without Borders someday and I thought this would be a great opportunity to see firsthand the conditions that doctors work in while in lesser-developed countries. I hope to learn about the medical field and international medicine while in Nicaragua. I am also excited to be able to use my Spanish skills on the trip.
Culture in Granada, Nicaragua
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Granada is a thriving city in Nicaragua. It is filled with hotels, restaurants, and natural attractions that bring in tourists from around the world. The city is also filled with beautiful churches and rich tradition. During the two weeks we spent in Granada we saw two different celebrations. The first was a day celebrating Maria Auxiliadora and the second was Mother’s Day. Both included parades and the exploding of little “bombas” throughout the weeks leading up to the celebration. The most important thing I noticed about Nicaraguan culture was the importance they put on relationships both familial and not.
While walking the streets of Granada looking for places to eat we met some interesting people. Many of whom were not from Nicaragua. Granada has a large ex-patriot community which adds to the vibrancy of the city. We met people from Ireland, Canada, and Germany living in the city. Many of them were volunteers, but some owned homes and businesses there. The city and its native people seem to be very accepting of outside cultures and clearly benefit from the jobs and diversity that they can bring in. On our walk to the clinic, we passed by three different churches. All of which were big and beautiful. The city and country are still very focused on Christianity and specifically Catholicism. I was surprised to see that there are in fact many different denominations practicing in the city. The first Saturday we were in Granada there was a huge parade in celebration of Maria Auxiliadora. Every school had groups of children walking through the streets playing instruments, singing, and chanting in celebration. We sat outside our home to watch. It was truly a citywide event. Parents walked near the children in the crowds and our host family, that had no children in the parade, was outside watching and saying hello to friends walking past. The last Friday we were in Granada was Mother’s Day and they do it up big. Many businesses close and families spend their day together. We spoke with Angelica, who works at the Spanish School, and she said that Mother’s Day is such a big deal because many families rely on the mother for everything. So many families in Nicaragua don’t have a father figure. Because of this their Father’s Day is nothing compared to Mother’s Day. Although it’s a nationwide problem, we saw many examples of fatherless children in Granada, especially in the clinic. It is a major issue, but one that many Nicaraguans are very used to. The most important thing we noticed about Nicaraguan culture while in Granada was the importance they place on relationships. Some of the things we were able to do was because Jean built relationships with people in Granada. She stopped to talk with people who worked at the hotel and Angelica at the Spanish School on a daily basis. The owner at O’Sheys saw us a few times and he brought over free drinks and stopped to chat with us about what we were doing. Our host family was clearly very connected to community. We saw this during the parade and also at night when they would have people over to sit outside and talk. Certain food vendors have special relationships with the clinic and are able to come into the clinic and sell papas and pastelitos to the doctors, volunteers, and patients. They clearly built relationships with Mario (the clinic manager) over time to be able to do this. I saw relationship building every day in Granada. Mothers and children stopped by our host family’s home to just say a few words to Doña Carmen and introduce their children. It is truly a culture based on friendship, family, and neighbors. I wasn’t able to see nearly as much of Granada as I’d wanted to because of work and all the excursions we did outside of the city, but what I saw was wonderful and I can’t wait to return. The people were friendly and accepting of us. The most important aspects of culture that I saw were the presence of foreigners, their traditional religious beliefs, and their belief in the strength of relationships. Granada is truly a beautiful city filled with a vibrant culture and I cannot wait to go back. |
Taylor Holmes
Hey y’all! My name is Taylor Holmes, and I’m a sophomore majoring in biology and minoring in Spanish. Originally from Birmingham, Alabama, Tuscaloosa has become my new home away from home. I usually spend my days studying for the day when I’ll decide my fate taking the MCAT, but when I’m not studying, I can be found playing beach volleyball or making an online shopping bag that I’ll never buy on Anthropologie’s online site. Post graduation, I’m looking forward to spending the next 4+ years of my life in medical school so one day I’ll become a doctor. I applied to the Nicaragua Clinical Experience because it’s the perfect mix between my two majors, and I’ve always wanted to travel abroad.
Volunteering in Nicaragua |
As a student at the University of Alabama, most of my prior volunteering experience consisted of serving on UA's campus, the immediate Tuscaloosa area, or even within the state of Alabama. If someone had asked me where would be an ideal place to volunteer, I would have told them the places that I had previously volunteered locally. If they asked where would be an ideal country to volunteer in, I would be at a loss having never previously traveled out of the country, but I probably would have told them countries that I had heard of from when my friends had traveled there, such as Mexico, Honduras, or Africa. The one place I would have never told them was Nicaragua simply because I wasn't aware of the need that exists there for volunteers or the difference that a few volunteers could make. When we think of volunteering, we often think of volunteering locally in our own community. But why is that though? Primarily, we choose to volunteer locally because that is where we see the greater need in our day-to-day lives. Additionally, we choose our own community over another country so that we can see the benefits within our community and that they, in turn, might benefit us a little more. Instinctively, we don't choose countries abroad because we don't really know what kind of need exists there, and we may not be able to see a dramatic change or the benefits that emerge from our short time being there. However, these are the countries that need our volunteers the most, and we can in fact make a huge impact in their lives.
After traveling to Nicaragua and doing some research there, I've realized that countries in Central America and some countries in South America are in fact ideal places to volunteer. Volunteering in Nicaragua is particularly appealing to those traveling from the United States for many reasons. First, according to the Worldwide Association of NGOs, there are over 20 non-profit organizations in Nicaragua that accept volunteers from abroad. These 20 non-profits range from areas of fair trade to education, so you are almost guaranteed to find an organization that would interest you (Boyer). A couple of examples of non-profit organization in Nicaragua include Project Bona Fide, Casas de la Esperanza, Building New Hope, and la Esperanza Granada (Henderson). Secondly, Nicaragua is ideal place due to the particularly low crime rate that exists there. While volunteering here, we noticed that the country is relatively safe as long as you take the normal safety precautions that you would in the U.S. about protecting your belongings while in public. Thirdly, the cost of living here while you are volunteering is relatively inexpensive. Hotels range in prices, but most are less expensive that the ones found in the United States. Homestays and hostels are also another alternative mode of housing while here. The food here is also relatively affordable. While eating out frequently is obviously going to be on the expensive side, the prices here at most restaurants would be affordable during your volunteering stay. There are several different areas in Nicaragua that need volunteers. We volunteered in Granada, but the best city to volunteer in is Leon. On our flight down to Managua, there were several other groups traveling to Nicaragua in order to volunteer and serve in some of the more remote, underdeveloped areas of the country. In general, any Central American country is a good place to volunteer in as to get away from big cities like in the United States. However, Nicaragua is one of the poorest countries in Central America due to its agriculturally supported economy and therefore a good choice (Boyer). Perhaps the biggest (and only) disadvantage of volunteering here is that a pretty extensive knowledge of the Spanish language is required to communicate while volunteering. Majority of the people that you would be working with speak little to no English, so if you are not semi-fluent in the language, there is definitely a language barrier of communication that arises. The Clínica Alabama-Granada is where we volunteered our time while in Nicaragua, and it is also a very popular location for natives of Nicaragua to volunteer their time as well. Volunteer members of “Friends of Rudy (FOR) Nicaraguan Health Inc” in the United States founded this clinic in 2004. This clinic formally has two Nicaraguan doctors, administrative personnel, and volunteer personnel who give care to approximately 60-80 patients per day (“FOR Nicaraguan Health”). The volunteers here, both natives and from abroad, are truly what keep this clinic up and running. In the clinic, they even have a wall dedicated to the founding volunteers that were essential in starting the clinic. On this wall, each volunteer has their picture with their name printed on it hung in a frame and neatly organized in order to pay homage to what they accomplished. There are two consistent volunteers at the clinic and one part-time volunteer. The two full-time volunteers are Olivia and Cathy, and the part-time volunteer is a 16-year-old student named Ryder. Olivia and Cathy assume most of the administrative duties. For example, Olivia is primarily in charge of checking patients in, pulling their charts, and making sure they have a page in their chart for the visit that day. At the end of the day, she is in charge of cleaning up and making sure the clinic is organized for the next day. Cathy assumes many different responsibilities depending on where she is needed. She performs many administrative duties including scheduling the patients' next appointments and giving them directions to the lab if extra tests, blood work, or urine analysis have been ordered by the doctor during their visit. She also monitors the patients' vital signs in triage. If a patient has a high blood pressure reading, high temperature, or high glucose reading then she will send them to the pharmacy to receive treatment immediately while they wait their turn to see the doctor. She also assists the doctors with patient exams or IV drips. At the end of the day, Cathy reorganizes the charts in their appropriate file. The third volunteer, Ryder, volunteers at the clinic whenever he is not in school, so his responsibilities vary day by day. I had the opportunity to talk to Cathy and Ryder and find out why they chose to volunteer their time at the clinic and more about their volunteering experience. When I talked to Cathy, I was amazed by her answers. I asked her why she chose to dedicate so much of her time to the clinic instead of working another type of job. She told me that she just loved working there so much that she wanted to make it a priority in her life. She said that all her life she has really loved helping people, so she wanted to do whatever was necessary to dedicate her life to helping others. In return, she says that she has enjoyed getting to know the patients and building a relationship with each and every one of them that walk through the clinic's door. Additionally, she told me that her time at the clinic has been especially rewarding because she has been able to learn so much about how the clinic runs and about how medicine works. She said that when she first started working at the clinic she was scared to see blood. However, after personally observing her for two weeks, you would have never known that. She has overcome that fear and does not hesitate to jump in and help when she is needed. I also had to opportunity to find out why Ryder volunteers at the clinic. As a teenager, I was surprised to see him at the clinic as much as I did because I figured he would want to hang out with his friends or do his homework. However, Ryder has always been around the clinic since he is the younger brother of Verania, the pharmacist. His volunteering schedule is less consistent than Cathy's and Olivia's because he is a student, but his passion and dedication are just the same. When asked why he chose to dedicate his time to the clinic, his reply was because he wishes to pursue a career in the medical field and possibly become a doctor. I admire such a tenacity and willingness to volunteer your time at such a young age in order to pursue the career path of your choice, and I think it demonstrates a high level of maturity. These volunteers that work at the clinic are truly the foundation that keeps the clinic in operation every day, and without their hardworking attitudes, the clinic would not be nearly as successful as it is. Personally, as for my volunteering experience in Nicaragua, I was pleasantly surprised. The research that I had previously done claiming that Nicaragua was a good place to volunteer was true. Our host families welcomed us with open arms giving us a comfortable place to stay and a taste of true Nicaraguan food while we were volunteering there. Our time at the clinic was invaluable. We volunteered in triage, the pharmacy, assisting with some of the clerical responsibilities, and shadowing the doctors. The administrative personnel, other volunteers, doctors, and patients were thankful we were there. Olivia and Cathy made sure we knew what we were doing. The patients helped to mend the communication gap with us making small, casual conversation while we were taking their vitals. And finally, the doctors taught us an abundance of medical knowledge that we previously had not been exposed to by allowing us to sit in on their patient consultations. Overall, volunteering in Nicaragua is a phenomenal place to choose to spend your time, and I would not hesitate to go back and do it again! Works Cited Boyer, Katie. "Volunteer in Nicaragua: Bienvenidos!" Volunteer in Nicaragua. Web. 21 May 2014. "Friends of Rudy (FOR) Nicaraguan Health." Facebook. Web. 21 May 2014. Henderson, Kirsty. "Free and Cheap Volunteering Opportunities in Nicaragua." Free and Cheap Volunteering Opportunities in Nicaragua. 14 July 2009. Web. 21 May 2014. |
Jackson Knappen
Hello, my name is Jackson Knappen and I am a freshman from Overland Park, Kansas. I am double majoring in Biology and Spanish on the Pre-Med track. When I'm not in class, I enjoy running, playing tennis, doing community service, and hommocking anywhere I can find two sturdy trees near each other. I have always been interested in Orthopedic Surgery since I had knee surgery in high school, so right now my plan is to go to med school and check out orthopedics, however a lot could change. That being said, I am incredibly excited for the Nicaraguan Clinical Experience. I chose to apply for this because it is the perfect combination of everything I am interested in (Medicine, Spanish, and Service). I can't wait to see what is in store for me in Nicaragua!
The Role of Diabetes in Granada |
Many people in the United States suffer from diabetes. Old or young, skinny or overweight, many people have it, and it is a very manageable issue to live with in the US. However, in Granada Nicaragua, the role of diabetes is different. Although it is a common disease in the US, it does not seem to have the same presence that it has in Granada.
Primarily, the amount of people that have diabetes seems to be much higher in Granada than it is in the US. Almost half of the patients that walked into the clinic were diabetic, and were prescribed metformin (a medicine to control blood sugar levels), or insulin of some sort. At first I thought that the doctors in Granada simply over-diagnosed the people with diabetes, but I soon realized that about half of the population really was diabetic. Each morning in the clinic, the first thing we would check would be the glucose levels of each diabetic patient. My first time doing glucose levels I was incredibly surprised by the massive line that appeared when I called for the diabetics to line up in front of me. They all knew the drill as they wiped their finger with an alcohol wipe, waited for the prick, and anxiously looked at their glucose level. I got the opportunity to talk to some of the patients who were diabetic waiting in the clinic (Nicaraguans as a whole were incredibly receptive and easy to talk to!). I first sat down with a woman named Lillian, who had been living with diabetes for 17 years. Unfortunately, after so much time with diabetes, her kidneys had begun attacking her body. It was a bit unclear as to what she meant by that, but chances are that after so many years with diabetes, it was beginning to get more and more difficult to treat it. Because of this, her body as a whole was starting to function worse, leading her kidney function to decrease. She had been coming to the clinic for 8 years, which shows how necessary the clinic is to the city of Granada. Lillian was waiting for a new type of treatment for her kidney function along with her diabetes, but she said that there is a chance that it wouldn’t work. Unfortunately this happens commonly as no case of diabetes is the same. What may work for one person doesn’t always work for everyone. Another day, I sat down with Pastora, a middle aged woman. Pastora had been living with diabetes for 8 years and was able to keep her glucose levels incredibly well managed. When I asked her how she did it, she told me it was foolish not to keep track of it. She was taking metformin, and glipizide for her blood sugar levels, and she always took them (which is a surprising problem for many people down in Nicaragua). She also told me that she eats a lot of fruits and vegetables, with fish and salad. She eats little rice, little cheese, and no red meat. I asked her if it is hard to monitor her diet like that in Granada, and she said that it was easy with the right self-control. Overall, although diabetes is a problem down in Nicaragua, many times due to long family history and a diet rich in rice and beans, it is possible to maintain and control the disease. Many of those who had incredibly high glucose levels many times did not take their medicines, and did not watch their diet as well as Pastora and Lillian did. To ensure one’s own good health, one must make sure to follow instructions of diet, and medicine to correctly manage their diabetes. This may be easier to do in the United States solely because of the ability to buy healthier foods, and perhaps even the ability to buy medicines. |
Kara Fadanelli
My name is Kara Fadanelli, I'm a freshman at the University of Alabama on the Pre-med course track with another major in Spanish. When I'm not studying I can be found hanging out in the Gamma Phi Beta house or in my bed watching Netflix. I love walking along the river walk, Starbucks, and Disney. I have a passion for travel! This is why this trip interested me. I'm so excited to improve my Spanish fluency, while practicing for my future profession as a doctor. My dream is to become a doctor, I can then travel the world volunteering my services to countries in need.
Nutrition in Nicaragua
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One of the most enjoyable experiences while traveling abroad is having the opportunity to enjoy the local cuisine. The types of food and drinks a country consumes can be very telling of their culture. Living with a host family in Granada gave me the opportunity to try authentic Nicaraguan meals. Walking down the streets and passing by all the restaurants gave me a taste of what Nicaragua could offer.
In a country like Nicaragua that is in the process of developing, some caution should be taken while consuming food and beverages. The water is not as purified as water in the United States. As a result, drinking water from the tap could cause illness for tourists by ingesting bacteria their bodies are not used to. The same is true of fruits and vegetables. Only fruit that have a peel or skin that is taken off should be consumed. For Nicans, the tap water is safe to drink and the fruit and vegetables can be consumed as long as they are properly cleaned. On the average Nicaraguan plate you will find rice, beans, and some type of meat. Plantains, salsa, chees, and fruit are also common. Every meal I ate at my host home included rice and beans. Many foods were prepared by frying them. Breakfast is a large meal in Nicaragua and dinner is a smaller meal. The country of Nicaragua is one of the Central American countries most influenced by the United States, so there are influences in the food from our own country. One night our host family made spaghetti. The city of Granada is tourist friendly and many of the restaurants passed while walking on the street resemble restaurants found in the States. Within the country, the food eaten differs between economic classes. Families that live comfortably eat meals described above that include meat, vegetables, and fruit with their rice and beans. For families with less economic stability, their meals consist of fried foods, rice, and beans. With no refrigeration, most foods will not keep for a long time. Rice and beans are inexpensive and can be stored easily. In rural communities they grow their own fruit, but vegetables, meat and dairy products are expensive to purchase and hard to keep. Furthermore, safe drinking water is hard to find in rural areas. At the home our group visited, fresh water was five kilometers away. Due to the inability to eat balanced meals and the overconsumption of carbohydrates, which are broken down into glucose, Diabetes is a major health problem in Nicaragua. The foods eaten in Nicaragua are heavily influenced by economic factors, but the flavors experienced in Nicaraguan food can be found all over the country. |
Tyler King
My name is Tyler King and I was born and raised in Mobile, Alabama! I am currently a Junior at the University of Alabama and plan to graduate next spring with a major in Biology. I am on the pre-medical track, as well. All my life I have been very passionate about playing soccer. I began playing around the age of four and am still playing club soccer today. I actually took a scholarship my freshman year to play in South Carolina at Francis Marion University, but transferred to Alabama my sophomore year. I have yet been able to give up playing, though! This semester I have had the opportunity to start coaching the game as well, which I really love. I enjoy watching and playing pretty much any sport and just being outdoors in general! In the future, I hope to be accepted into medical school and become a physician. With this goal in mind, I applied to the Nicaragua Clinical Experience trip. After taking hours and hours of class pertaining to science and medicine, I wanted an experience that will put all of my studying to the test. I love hands on experiments and knew this opportunity does not present itself too often. I think it is great that the University offers this trip to students so that we can put ourselves in a real clinical setting where we can get a sense for what our future careers may hold. We also have the chance to help many people and ourselves during the process.
Life of a Medical Professional |
When I arrived in Nicaragua, I knew I had a great topic to study because of how different the culture was from the United States. Medical professionals in the United States are seen as some of the most highly paid jobs after their long and grueling educational process. In Nicaragua, the process and outcome for a medical professional is drastically different.
The change between the cultures for this career begins early in the educational path. In Nicaragua, students have to decide early on if they want to pursue a career in medicine. I gathered much of this information from Dr. Maria Auxiliadora and Dr. Maria Garcia in Clinica Alabama- Granada. One graduating high school, students have the option to take an early entrance exam for a public medical school in Nicaragua. If their score is good enough, they have one of two choices. They can go ahead and enter medical school or they can attend college, take a later entrance exam, and then go to medical school. However, if they decide to enter early into one of the public medical schools, the government, or Ministry of Health, will pay for the medical school education. This is a six year path, but the last two years are working in social services where the students basically pay back the government. If a student chooses to go to college first, or attend a private medical school, they will have to pay for the education themselves. Also, for a doctor to be specialized in a certain area of medicine, they have to declare that specialty before turning the age of 30 years old. Once one has become a doctor, there are still choices to be made about where to work. After speaking with a few doctors, I learned that there is a major difference between working in a clinic and in a hospital. The doctors at Clinica Alabama- Granada receive their salaries from Dr. Vargas, who runs and oversees the clinic from Alabama. However, the hospital we visited in Granada is government run. This means that the doctors there are getting paid by the government. I noticed that this led to different types of patient care. When shadowing the two doctors at Clinica Alabama- Granada, I saw that they truly cared for their patients. They began seeing patients at 7:40am and did not stop until they were all seen. Though the hours of operation officially state that the clinic closes at 11am, the doctors make sure that every patient is tended to. They also always took the time to interact with the patients and helped them understand what was wrong and the steps being taken to improve their health. The patients seemed to bring in gifts for the doctors very often so it is noted that they appreciate their work. The two doctors at the clinic also took a lot of their time to help us understand and observe what was happening to different people. On the other hand, when I visited the hospital, I saw a different type of patient-doctor interaction. It took an hour at the hospital for the director to actually place us in an area in the hospital. Once there, only the interns interacted with me, and I never got the chance to speak with a doctor. However, an intern walked me around to see a few patients. It seemed to me that many of the patients did not know exactly what their health status was and that they wished to speak with the doctor but were never able to get into contact with him. I believe this shows the difference between a "private" clinic and a government run hospital. Doctors there know they are getting paid either way so I think a lot of them lose their incentive to please the patients or make them feel comfortable. Also at government run hospitals there are droves of patients and it is hard to build a relationship with any of them. After helping around the clinic and the hospital, I also got a feel for what many of the medical professionals in Granada see every day. Most of the patients at the clinic, and many I saw at the hospital had either diabetes or hypertension. While speaking with both doctors at the clinic, they emphasized that this was the biggest problem in the area due to unhealthy lifestyles. Though Dr. Maria Garcia has now passed the age to be able to declare a specialty, she feels that her specialty would be assumed as endocrinology due to her numerous exposures to diabetes. For the patients that come to the clinic for aid, their consult and medicines are completely free. They simply pay a 50 Cordoba donation upon coming in, but the rest is supplied free of charge. Those donations are put towards paying for daily operations to run the clinic, such as electricity and water. Since this does not leave much pay for the two doctors on staff, Dr. Vargas takes care of their salaries. It has to be tough for the doctors, however, because running the clinic from Dr. Vargas' standpoint is not cheap. In fact, I was told that in Nicaragua doctors and teachers have extremely low salaries compared to other careers. They do not receive any help from the government or Ministry of Health because the government does not approve of clinics such as these. They want everyone taking part in the social healthcare at the government run clinics and hospitals. Luckily, Clinica Alabama-Granada gets medicines and supplies donated to it from Alabama and other generous people, yet it still seems to not quite be enough at times. Whereas, at the hospital, patients can receive an abundance of medicine for free because the government is supplying. However, many Nicaraguans I interacted with complained that the care at these locations is not adequate and claimed that they do not trust the doctors. I also had the opportunity to ride into a rural community located near Laguna de Apoyo for a short time. While there, I was able to see their clinic that an American couple funded. I learned that the doctors in this area deal a lot with respiratory infections in children. This is because their parents are cooking in closed areas over open fires, and it is very bad for all of their health. The American couple, Brian and Nancy, have also begun funding a process for families to try to switch over to stoves that do not produce near as much smoke to help these people. There are two doctors that work at this small clinic and they seem to be much like the two at Clinica Alabama- Granada. They take much pride in their job and for helping the community around them. One of them said that he often goes around the neighborhood to make house calls to those who cannot make it into the clinic. This type of doctor- patient interaction is surely not seen in the hospitals in Nicaragua or even in the United States. I think it is amazing how much gratitude and service the four doctors I have met that work at the clinics have. It was made pretty apparent that the United States and Nicaragua have very different paths for their medical professionals. However, once spending time with doctors from both cultures, there are similarities as well- making patient health improve. Although Nicaragua may not have the most money and supplies, they are fortunate to have some amazing doctors there that are striving to make the population of Granada a healthier environment, which will help their standard of living and economy. |
Jacqueline Visina
Hello! My name is Jacqueline Visina. I’m a rising sophomore from Oklahoma City, OK double majoring in Biochemistry and Spanish with a minor in the Blount Undergraduate Initiative.
Running is my favorite hobby. I ran track and cross country all through high school and continue to stay active with road races. I’m also passionate about my faith, reading, and sports. Finally, I’m a complete foodie! I love trying new cultural dishes, so I’m eager to explore the Nicaraguan cuisine.
I feel a strong calling to enter the medical field. My healthcare career plans consist of attending medical school and later specializing in some area of internal medicine. I hope to work in a large city and serve a wide range of people of varying socioeconomic statuses. Lastly, I hope to not only practice medicine in the United States, but also partake in medical mission work in South America.
I chose to apply for the Nicaragua Clinical Experience because I have never traveled outside the United States, and I wanted to experience a new culture. I also applied because I desired to improve my Spanish conversation skills. As a Spanish major, this was an excellent opportunity to learn the language by having complete immersion in a Spanish speaking country. Finally, I applied for this trip because I hoped to increase my medical knowledge. This study abroad experience is unparalleled because it allows undergraduate students the chance to not only see different medical conditions but also be a powerful instrument in providing baseline medical care to those in need.
Running is my favorite hobby. I ran track and cross country all through high school and continue to stay active with road races. I’m also passionate about my faith, reading, and sports. Finally, I’m a complete foodie! I love trying new cultural dishes, so I’m eager to explore the Nicaraguan cuisine.
I feel a strong calling to enter the medical field. My healthcare career plans consist of attending medical school and later specializing in some area of internal medicine. I hope to work in a large city and serve a wide range of people of varying socioeconomic statuses. Lastly, I hope to not only practice medicine in the United States, but also partake in medical mission work in South America.
I chose to apply for the Nicaragua Clinical Experience because I have never traveled outside the United States, and I wanted to experience a new culture. I also applied because I desired to improve my Spanish conversation skills. As a Spanish major, this was an excellent opportunity to learn the language by having complete immersion in a Spanish speaking country. Finally, I applied for this trip because I hoped to increase my medical knowledge. This study abroad experience is unparalleled because it allows undergraduate students the chance to not only see different medical conditions but also be a powerful instrument in providing baseline medical care to those in need.
Jordi Baraad
My name is Jordana (Jordi) Baraad, and I’m an Agoura Hills, CA native and UA freshman. I am becoming a Psychology major (change pending) with a double minor in Biology and Computer Based Honors, on the Pre-Med track. My two main passions are fitness and community service. As for the former, my first love is running, which I do solo, unofficially with friends, and as a member of the UA Honors College Running Club. When I’m not pounding the pavement, I also enjoy kickboxing, biking, dancing, and yoga. As for the latter, making a positive contribution in the community to which I am a part always helps me feel like I belong. Most of the service I’ve done since attending UA has been as a member of Circle K. I’ve worked with TOPS, Big Brothers Big Sisters, and Kiwanis International. Also, I have served as the Circle K Chairperson for Operation Smile (founding the UA chapter of this organization last semester) and the West Alabama Heart Walk. I also love listening to music, reading, designing t-shirts, watching movies and UA sports, and, of course, spending time with friends and family.
It is my dream and goal to eventually become a physician, though, as for what specialty, it is too soon to tell. The organization that first sparked my interest in medicine was Operation Smile, which donates cleft palate surgeries to children in developing countries, who could not otherwise afford the procedure. The opportunity to, as a reconstructive surgeon, help children like this, as well as others barred from a normal life by their appearance, look upon themselves without shame and have a fair chance at striving for happiness seems like a fulfilling career. However, my experiences shadowing and volunteering in a hospital setting, as well as, most recently, listening to guest speakers on primary care at Alpha Epsilon Delta meetings, have shown me that I can potentially find equal job satisfaction and do just as much good in other areas of the medical field. While Operation Smile is still an important organization to me—hence, my continued involvement—I am very interested in gaining exposure to all aspects of medical care.
It is, in large part, this desire to gain exposure to a wide range of medical procedures that spurred me to apply for the Nicaragua Clinical Experience. I am looking to observe a broader spectrum of medical issues than I have thus far been exposed to in the suburban hospital/doctor’s office setting. I am also intrigued by the opportunity of immersion in another culture—learning in and about a new country while performing good works there. Ultimately, this experience seems like the perfect opportunity to combine my commitment to volunteering with my interest in learning about different cultures and my knowledge of the Spanish language. I see this trip as one that could not only be of value to me but also as one that could allow me to be of use, and I am so excited for this opportunity.
It is my dream and goal to eventually become a physician, though, as for what specialty, it is too soon to tell. The organization that first sparked my interest in medicine was Operation Smile, which donates cleft palate surgeries to children in developing countries, who could not otherwise afford the procedure. The opportunity to, as a reconstructive surgeon, help children like this, as well as others barred from a normal life by their appearance, look upon themselves without shame and have a fair chance at striving for happiness seems like a fulfilling career. However, my experiences shadowing and volunteering in a hospital setting, as well as, most recently, listening to guest speakers on primary care at Alpha Epsilon Delta meetings, have shown me that I can potentially find equal job satisfaction and do just as much good in other areas of the medical field. While Operation Smile is still an important organization to me—hence, my continued involvement—I am very interested in gaining exposure to all aspects of medical care.
It is, in large part, this desire to gain exposure to a wide range of medical procedures that spurred me to apply for the Nicaragua Clinical Experience. I am looking to observe a broader spectrum of medical issues than I have thus far been exposed to in the suburban hospital/doctor’s office setting. I am also intrigued by the opportunity of immersion in another culture—learning in and about a new country while performing good works there. Ultimately, this experience seems like the perfect opportunity to combine my commitment to volunteering with my interest in learning about different cultures and my knowledge of the Spanish language. I see this trip as one that could not only be of value to me but also as one that could allow me to be of use, and I am so excited for this opportunity.
Life of a Medical Professional in Nicaragua
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The daily routine of Nicaraguan physicians Dr. Maria José and Dr. Maria Villareal in the Clinica Alabama-Granada serves as a sound example of the nature of work typical for the medical professionals in this country. These two general practitioners begin their working days at the clinic at eight in the morning and attend to a steady flow patients until noon, sometimes later. Were they to work at one of Nicaragua’s hospitals, their shift would likely last until five pm from the same start time (Ruiz). For the majority of the day, they remain seated behind their desks as patients are called in, files are passed to them, and other employees enter with questions or messages. However, this routine, though fairly sedentary, is far from leisurely. The demand for high quality healthcare in Granada is so great that, virtually every morning the clinic is operational, patients line up hours before opening time in hopes of improving their chances of getting seen that day and having their medical needs met. In order to best accommodate their patients, José and Villareal keep visits brief and efficient, with just enough downtime between appointments to finish updating the previous patient’s records before the next patient is called. This economical usage of time spans the duration of the clinic’s operational hours, allowing for the treatment of, on average, over sixty patients per day, between the two physicians.
Dr. José and Villareal exemplify a typical Nicaraguan physician in that they are general practitioners. Though residency programs exist for a few specialties at Nicaraguan universities, preparation for most specialties is not available in the country (Pérez). Medical students begin their training as soon as they enter the university, with no graduate program necessary. The entire process, from start to finish, lasts four years for medical students and three years for nursing students, assuming that they do not specialize (Lopez). Students seeking to go beyond general training within the medical field often must attend schools in Cuba, Costa Rica, or Mexico to gain this additional training (Pérez). Furthermore, training for the specializations in a Nicaraguan university is not permitted for students over the age of twenty-nine (José). The specialty procedures offered for famously low prices in several Nicaraguan hospitals are typically performed by doctors or medical groups from other nations (Pérez). A case in point regarding this deficit is the complete lack of nephrologists in the nation; those in need of kidney transplants must travel elsewhere or wait for a medical mission trip (José). However, while the Clinica’s two physicians are ostensibly GP’s, the majority of their patients have a similar set of symptoms and afflictions. Despite attending to patients ranging from infancy to advanced age, the physicians’ diagnoses often bear all too much of a similarity. The majority of cases that a typical Nicaraguan medical professional addresses involve diabetes and/or hypertension, as well as severe renal infections. In fact, 60-70% of the patients these physicians see on any given day have come only for refills of the medications they currently take (Montano). These are all byproducts of the typical Nicaraguan diet, which tends to be high in sugar and fats and low in nutrients found in fresh fruits and vegetables (Montano). As a result, many of the appointments consist not of dispensing cures but of renewing prescriptions and maintaining manageable blood pressure and blood sugar levels. As for the other 30-40% of patients, Dr. José, Villareal, and other Nicaraguan physicians frequently diagnose and treat arthritis, hypothyroidism, and fungal, respiratory, and parasitic infections (José). The impressive quality of care available at the Clinica Alabama Granada, as well as in other clinics and hospitals throughout the country, is a true testament to the talent and professionalism of Nicaraguan physicians. After all, in addition to undergoing the rigorous training equivalent to that of a doctor in the states, José, Villareal, and their colleagues must compensate for the lack of resources available to them, as practitioners in the second poorest country in the Americas, after Haiti (Nicaragua 1). To have a true appreciation of the acumen Nicaraguan physicians must exhibit on a daily basis to take care of their patients, it is crucial to understand that time, space, and resources are at a premium. The examination room at the Clinica Alabama Granada is shared between two physicians, with a small section curtained off for a technician to operate the EKG machine. The clinic only offers or recommends tests when the doctor is unfamiliar with or unsure of symptoms; whenever possible, diagnoses are based solely on physicians’ familiarity and confidence with recognizing signs of common afflictions. When writing prescriptions, the doctors must be as attuned to their patients financial needs as their medical ones and make judgment calls on appropriate and necessary medications based primarily on what is the most affordable option available. Rather than expend valuable storage space keeping records of every refill on file, it is common practice to have patients carry their history on them, with prescriptions and medical advice written on the same reused slip of paper. Furthermore, unlike US pharmacies’ shelves of digitally labeled plastic bottles, the pharmacy at the Clinica Alabama Granada houses plastic bags for pills with hand-written labels crafted from slips of paper recycled from outdated files. Yet, despite what Americans might perceive as shortcomings, Villareal affirms that the Clinica Alabama Granada is, by far, the highest quality facility in which she has worked. Regardless of their differences, American and Nicaraguan physicians, alike, face a challenging preparatory path and career filled with day-to-day dilemmas. Training periods and health needs may vary, but work ethic, resourcefulness, and commitment to patient care, are universal. Works Cited José, Maria. Personal interview. 28 May 2014. Lopez, Yesenia. Personal interview. 29 May 2014. Montano, Maria Auxiliadora Villarreal. Personal interview. 22 May 2014. "Nicaragua Country Profile." BBC News. BBC, 20 Aug. 2012. Web. 27 May 2014. <http://news.bbc.co.uk/2/hi/americas/country_profiles/1225218.stm>. Pérez, Elisa. Personal interview. 20 May 2014. Ruiz. Personal interview. 29 May 2014. |
Jonathan Laurich
My name is Johnathan Laurich. I'm from Rochester, New York, but I grew up on the Gulf Coast. I'm currently a freshman with a concentration in pre-med, and I hope to become a cardiologist someday. My interests include reading classic literature, video games, listening to music, hockey, and I have a passion for Arabic, archaeology, and high fantasy books. I decided to apply for this trip primarily to provide aid to an under served area of the world, but also to pick up valuable skills and experience to provide medical care to those in the U.S. In time. I'm very excited for this trip, as it will not only prepare me for a future career, but also give me an opportunity to learn about a country I've never been and soak up a foreign culture.
Healthcare Access |
In Nicaragua, two of the most common ailments are diabetes and high blood pressure. These conditions are fairly easy to regulate in countries such as the United States, where insulin and various heart medications are widely available. However, in Nicaragua, these items are in short supply due to a very high demand. This is one of many examples of the flaws in the Nicaraguan health care system. Although there are several establishments that offer affordable care to citizens, the people of Granada are often reluctant to seek care. This is mainly due to their hardiness and reluctance. A number of the patients in the clinic had well advanced symptoms of their respective illnesses, indicating that they either felt no need to visit a medical professional or were unwilling to do so. Despite free health care for vital services, the hospitals of Nicaragua are often the last resort. The clinic receives roughly 50 patients a day, split between two doctors. The sick often take to the clinics before the government operated hospitals, as they find the staff to be short and generally uncourteous. The wait at both the clinics and the hospitals is several hours long in stuffy waiting rooms, usually longer at the clinics. However, the infirm of Granada continue to prefer the clinics, as the staff are open, welcoming, and more attentive to their work.
Apart from mere choice, many of our patients come from miles around, mostly from the rural communities outside of Granada. Some come from the islands on Lake Nicaragua, and need to cross via boats that traverse the bull shark infested waters in order to reach the mainland. As previously stated, healthcare is fairly affordable for the average Nicaraguan. However, to visit the doctor means a day away from work, from housework, and from other responsibilities. This explains why we would often see entire families in the clinic, as a day off for each member of the household could be devastating to that family’s stability. To summarize, health care in Nicaragua is accessible to all citizens, rich or poor; but accessing it is tedious and generally inefficient. However, I can say with certainty that the volunteers of the Clinica Alabama Granada provide high quality care to a high daily volume of patients. |
Anthony (AJ) James
My name is Anthony James, although you’ll more often than not hear others refer to me simply as “A.J.” I am from (was raised) Columbus, Georgia, but was born and still have many roots and connections in Brooklyn, New York. I am double majoring in microbiology and Spanish, and also concurrently earning my M.S. in Biological Sciences. Above all, the arts are my greatest (and often most forsaken) passion. I enjoy singing (mainly gospel and R&B), dancing, and acting. At a very close second, my heart beats for activism and organizing. I am a bit of a radical worker rights, LGBTQ+, and race (particularly black) activist and organizer. On a different note, I also enjoy studying the creepy-crawlies like bacteria and viruses. I currently am on the pre-med track and aspire to one day practice emergency medicine. I chose to participate in the Nicaraguan Clinical Experience because the struggle to secure decent healthcare on a working-poor salary is one with which I am all too familiar, and I find it empowering to see how this situation is handled on a more global level.
Healthcare Access in Nicaragua
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The thing that makes the Clínica Alabama-Granada such a unique entity is definitely its accessibility to the lower-income families of Nicaragua—patients pay the equivalent of 2 U.S. dollars for their consults with the physicians in addition to all of their prescriptions filled in the clinic pharmacy. Furthermore, surprising to U.S. culture, house calls are a viable alternative to a trip to a clinic or hospital for Nicaraguans with the average house call costing around $40. However, what is lacking for the country of Nicaragua are medical specialists, especially those who deal with difficult chronic illnesses such as Parkinson’s Disease and HIV/AIDS.
These patients, especially in the case of illness involving neuronal (brain) function, often try to seek care in the United States, but quickly discover that they simply do not have enough money to cover the costs of the trip and care. However, in general, the healthcare in Nicaragua—from the outside looking in—is of decent quality and costs much less than what services would cost in the U.S. and in Europe. Yet, contrastingly, a first-hand account of a public hospital in Nicaragua, in which patients sat packed shoulder to shoulder waiting for doctors who seemed very much more preoccupied with small talk than patient care, brings to question the level of patient care that exists in the country in regards to physician compensation. (The theory goes that higher physician salaries in the U.S. give physicians more incentive to maintain a high level of healthcare services.) Undoubtedly, because the wealth of the country is concentrated in a few cities, the best healthcare can be accessed in Managua, the capital. Interestingly enough, most public hospitals in Nicaragua will not charge a patient for emergency services, but the patient must still pay for any medication needed. But, conclusively, as noted in a Nicaragua Guide, “Describing health care in Nicaragua is like describing the weather in the United States; it depends where you are talking about” (http://www.nicaragua-guide.com). Overall it seems that healthcare services in Nicaragua are fairly accessible—the larger question is the question of quality of care. |
Alex DeCubellis
My name is Alex DeCubellis, and I am a freshman from Cumming, GA. I am majoring in Biology and am on the pre-med track. My hobbies include watching and playing sports, country music, fishing, and just hanging out with my friends. My career goal is to either be a doctor or chiropractor in a small town. I chose to apply for the Nicaragua Clinical Experience because I have always wanted to travel abroad, and this trip gives me the opportunity to work on my Spanish as well. It also gives me a great opportunity to help others that are desperately in need of medical care!
My Personal Experience in Nicaragua
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Upon arriving in Nicaragua, I was beyond excited for the activities in the clinic and interesting excursions we would be going on. Although I was honestly a little scared to be in a place so different from home, the people in Nicaragua, the rest of the group, and Jean made me feel right at home. I was extremely blessed to have such a nice host family as well. Señora Mercedes never missed a meal with my roommate, A.J., and me. She was very talkative, always tried to make us feel at home, and made great food. Whoever gets to stay at her house next year will be very lucky! I must also point out that I was very lucky to have A.J. as a roommate not only since he was a great translator but also because he was a lot of fun to be around and helped me when I became sick.
Besides my awesome group and host family, there were a lot of great people working in the clinic as well. The two doctors present were a wealth of knowledge, the pharmacy was a great time filled with Spanish music, and triage was the most rewarding. I enjoyed triage the most because it gave me the opportunity to actually communicate with patients, check their weights, blood pressures, glucose levels, and pulses. While these are only basic medical procedures, it was so rewarding to not only feel like a real doctor but to also be helping people that were in serious need. It was amazing to see how welcoming the patients were and how patient they were when the language barrier was a little difficult to overcome. Sadly on Friday, I was eating lunch when I had a very severe allergic reaction. My throat felt like it completely closed, I could barely swallow any water, and it became very difficult to breathe. Thankfully, A.J. thought to give me Benadryl which probably saved me from even worse happening. Also, Señora Mercedes called a doctor right away who was a throat surgeon, and he arrived at her house in less than twenty minutes. It would be very hard to find this kind of treatment in the United States! The doctor was very helpful and gave me a full examination for only forty U.S. dollars. He wrote me a prescription for medicine to take as well which also turned out to be very cheap compared to the United States. The point I am trying to make is that if you are sick in Nicaragua there are plenty of doctors and good people around to take care of you! I hadn’t felt well all week running low-grade fevers on and off, but I just attributed it to being in a new environment. After my allergic reaction, I knew there was something more serious going on, though. After calling both of my parents, we all decided that it was probably best that I return home since I was feeling too tired to really be at the best of my ability for the clinic. Jean was very helpful in arranging a driver to take me to the airport in Managua and making sure I was alright throughout the whole process. Saturday morning I was taken to the airport to return home and was able to make it from Houston to Birmingham with ease. While it seems very intimidating to fly into and out of the country, it’s really not that bad once you do it for the first time. Upon arriving home, I went to a doctor to see what was wrong with me. After running a few tests, the doctor determined I had mono and strep throat at the same time. While it was very saddening that I had to miss the second week of the trip, it was at least comforting to know what was wrong with me. The doctor also said that this is probably what caused my “reaction” at lunch since both mono and strep place a lot of strain on the throat. It was very difficult to have to return home because I was really having a blast working in the clinic and seeing the beautiful landscape in Nicaragua. My Spanish was also off the charts better after only a week in Nicaragua than it was before I came. Hearing others speak the language and actually understanding everything they were saying became much easier as the week progressed. All in all, I am thankful for the great people I met during the trip and the cultural experiences I was exposed to. I would definitely recommend this trip to anyone that is lucky enough to go on it. |
Rachel Honan
My name is Rachel Honan. I’m from Birmingham, Alabama, and I graduated from Mountain Brook High School in 2012. I am currently a sophomore at the University of Alabama, majoring in biochemistry and minoring in biology and Spanish. My family means more to me than anything else in the world, and I love getting to catch up and spend time with them when I go home. I hope to apply to medical school next spring and become a general care physician, either focusing on internal medicine or pediatrics. I love the patient-focused, hands-on part of medicine, and I hope that I can make a difference in people’s lives by helping them through any pain they might go through and getting them back to the best health they can be in. I chose to apply for the Nicaraguan Clinical Experience, because I would like to learn about how healthcare is implemented in other parts of the world. Also, I have wanted to study abroad, but, because I am such a home-body, a whole semester would have been too long for me. I hope to come back from Nicaragua with many new experiences under my belt, including becoming more fluent in Spanish and being able to interact with the Nicaraguans and understanding their various situations.
Nutrition in Nicaragua |
The food in Nicaragua is very different than I expected. Although the vast majority of patients we saw in the clinic had diabetes and had outrageous blood sugars, not once were we served dessert. However, most of the food is deeply fried and extremely salty, so those may be contributing factors.
The average monthly income for a Nicaraguan family amounts to only $90. That means that most families live off of less than $2 a day. For this reason, the Nicaraguans either buy things in bulk or grow their own crops. In our host family’s back yard, they had a papaya tree and grew their own tomatoes so as to not have to pay for fruits and vegetables at the market. However, it is important to note that the Nicaraguan economy is based solely on agriculture, so the people must export their best products and are left to eat lower quality fruits and lots of corn. In fact, many of their drinks are based on corn. Our host family made us one called “chicha” that was pink and very sweet and had leftover corn kernels on the bottom. Any given meal consists largely of rice and beans, because the starch helps to keep the Nicaraguans full. Rice and beans are also cheap, although in the past few years, the price of a liter of beans has gone from 8 Cordobas to 15 Cordobas to 18 Cordobas (“Cost” 1). This has caused strain on many families as the price continues to increase. For breakfast nearly every morning, our host mother prepared us a fried rice and bean mixture called “gallo pinto.” This plate is considered a national symbol and is consumed almost daily (“Traditional” 1). It was a little hard to digest at 7:00 in the morning, but it did keep us full until lunch. Another famous Nicaraguan dish is “nacatamal.” It consists of corn dough, animal lard, pork meat, potato slices, rice, and vegetables rolled up into a burrito wrapped in plantain leaves. The Nicaraguans often eat nacatamal on special occasions (“Nicaragua” 1), but more than once, we heard the doctors recommend that their patients avoid eating it at all costs. One of the nights, we were fortunate enough to attend a cooking class that specialized in traditional Nicaraguan cuisine. In the class, we made four dishes: Indio Viejo, gallo pinto, emparadas de maduro, and ensalada criolla. The Indio Viejo is another common dish, although it seemed more like a mushy soup to me. We also made a dish derived from Creole origins with lots of spices and vegetables, because a significant part of the Nicaraguan culture is taken from the Creoles (“Orientation” 1). Also, we used “maduros” which are platanos that are fried, and they have a very distinct, sweet taste. Our host family grew platanos in their backyard, which are basically smaller, sweeter baby bananas. We had them almost every morning with our gallo pinto. Finally, even when eating, there is a class distinction between men and women. Women eat an earlier, smaller meal, while the men are served extravagant large meals, such as a whole chicken or pig. Although I was not able to experience this in my host family because we did not have any men in the house, other students frequently commented on the inferiority felt by women even around the dinner table. Works Cited "Traditional Food." ViaNica.com: Explore Nicaragua Online. N.p., n.d. Web. 20 May 2014. "Nicaragua: Cuisine and Recipes." Whats4Eats RSS. N.p., n.d. Web. 20 May 2014. "Cost and Commitment." La Esperanza Granada Volunteer in Granada Nicaragua. N.p., n.d. Web. 22 May 2014. "Orientation: Creoles of Nicaragua." Countries and Their Cultures. N.p., 2014. Web. 22 May 2014. |
Kaitlin Newell
My name is Kaitlyn Newell, and I was born in the mile high city of Denver, Colorado. I came to the University of Alabama on scholarship, and am planning on graduating in May 2015. I am majoring in Psychology and minoring in Biology, with the hope of attending PA school in the coming years. I hope to take a year or two off of school to work and travel before applying to graduate school. My interests include singing, playing piano, doing yoga, and reading. I have also come to love Netflix documentaries. I have known my whole life that I wanted to go into medicine and travel to underserved communities. I found that the Nicaragua Clinical Experience would help me on my journey to both of those things! Not to mention, I am so excited to get to know everyone on the trip!
Diabetes in Nicaragua
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Every other Thursday during the spring semester, the students traveling to Nicaragua were prepped on what was to be expected in our time at the Clínica Alabama Granada. Up front, we were made aware that Diabetes Mellitus is one of the largest problems facing the general population of Nicaragua. Type 2 Diabetes, often correlated with obesity and the more dominant form in Latin America, occurs when there is not enough insulin produced by the pancreas to break down glucose. With time, this leads to fatigue, kidney disease (also problematic in Nicaragua), and amputation. Over the course of two weeks, we had the opportunity to interact with patients, doctors, and the staff at the clinic to understand on a deeper level why diabetes is plaguing the people of this country.
Every day during triage, patients that required a blood sugar level reading were placed in a separate line. The measurement of blood sugar is a common way to aid in the diagnoses and assessment of diabetes. According to the doctors at the clinic, healthy blood glucose should range between 80 and 130. Patients that arrive with a blood sugar of 350 or above are to be immediately addressed by a physician, either in the clinic or at the hospital, in order to receive emergent care. At the end of our first day, we were discussing with the group that more often than not, a patient would have a blood sugar level in the 200s, which while not extremely high, is still dangerous. The following day, we decided to ask the doctors the suspected percentage of their patients with diabetes. The answer was shocking at over 80%. To understand why diabetes is so rampant in Nicaragua, and Latin America in general, it is important to realize that it is becoming increasingly more related to poverty. According to the International Diabetes Federation, “middle and low income countries have more people under the age of 60 with Diabetes compared to the world average… with four out of five people with diabetes [living] in countries classified by the World bank as low and middle income” (“Diabetes”). According to the IDF, low and middle-income countries have a higher prevalence of diabetes in the under 60 population due to less healthcare expenditure on diabetes prevention and management (“Diabetes”). It should be noted that while hundreds of millions of Americans battle diabetes, there is a higher percentage of those with first diagnoses over the age of 60 due to greater healthcare expenditures on diabetes prevention. While working in the clinic one day, Dr. Maria and I had the opportunity to discuss with a patient the average cost of food. She expressed concern, because she was typically able to purchase cheese for twenty Cordoba, but recently, the price had shot up to over 60. In the United States, this would correlate from a rise from roughly 80 cents, to over $2.00. According to UNICEF, the average price of food in Nicaragua has risen by 45%, causing a typical plate of food to cost roughly $2.50 USD (“Life”). For the people of Nicaragua, this is devastating, as the average citizen lives on less than $2.00 per day, making it the second poorest country in the Western Hemisphere (“Life”). While not directly evident, the connection between diabetes and poverty relates to the fact that families must be fed above all else. Many mothers do not have the luxury to worry about the nutrient content of the food, as long as the bellies of their children are full, and they can grow and survive. Coca-Cola, as well as many fried or packaged foods, has a huge place in the markets of Managua and Granada, due to their ability to be preserved. A large majority of the population is without access to electricity or clean water, resulting in the dependence on sodas and fried foods that last in the sweltering heat. With daily temperatures almost constantly above 90 degrees, the population is also largely inactive, according the doctors at the Clínica Alabama Granada. The clinic, in a way, is a refuge for the thousands of people that make up Granada, as more than 40% of Nicaraguans are without access to health care (“Life”). The high percentage of patients with diabetes corresponds to the fact the clinic mostly serves low-income individuals. It functions by charging patients the equivalent of $2 in order to receive full consultation by a doctor, and all available medications. For those with diabetes, this means life saving access to drugs such as Metformin. Diabetes must be continually monitored, as patients are required to keep monthly records of their blood sugar levels. In the US, patients are often required to keep daily records, but this is simply not possible for the citizens of Nicaragua. Diabetes is an international problem that will require greater resources devoted to health care and health education. However, it is nearly impossible to tell a family that they should only feed their children nutrient dense foods, as many are lucky to be able to provide food at all. Works Cited “Diabetes in Low-Middle-And-High-Income Countries.” International Diabetes Federation. International Diabetes Federation. Web. 6 June 2014. “Life in Nicaragua.” Unidos Nicaragua. Unidos Nicaragua. 2014. Web. 6 June 2014. |
Lauren Nolan
My name is Lauren Nolan and I am a sophomore from McKinney, Texas. I’m double majoring in Spanish and anthropology with a concentration in biological anthropology. I also have a minor in biology. I enjoy traveling and have a profound interest for understanding how cultural differences influence medical care and health outcomes in the United States and other countries. After I graduate from the University of Alabama I plan on becoming a Physician’s Assistant. I applied for the Nicaragua Clinical Experience because it is an incredible opportunity, which not only allows us to volunteer in a medical capacity but also to learn a variety of skills in a practical setting.
Nicaragua Home Life |
Nicaraguan home life varies very much depending on where people live and what socioeconomic level they belong to but the one constant that home life revolves around no matter what is family. The family unit is the basis for the home and it is what most people in Nicaragua organize their lives and homes around. Despite differences in wealth or location multiple generations may live in one home and work in different capacities to make the home functional.
In more urban areas, like Granada where we stayed, families tend to live in two generational homes with the parents and children at home. In these more urban areas these families can live in these homes because they are of a higher socioeconomic level, the parents tend to have a university education and hold well paying jobs. The children are in school and are expected to finish out their education while their parents support them at home. It is common for the father to work and the mother to stay home. Some of the more wealthy families will employ help within their home if they have sufficient income. They also can afford to avoid public medical care and can pay for better and more private medical care. While living with a host family I discussed healthcare options extensively family and discovered that people with enough money even sought care in the United States if it was necessary. The parent, usually the father, tends to work in areas like business and sometimes higher education. The homes that they lived in, at least in Granada, had been in the family for generations. Meal times are very important to the families, dinner is typically the most important meal where everyone is expected to be home and together. Breakfast and lunch are less important because not everyone’s schedule’s line up but dinner is later in the day when everyone is home and the time after dinner is usually reserved to be spent together talking or watching television. Home life in rural areas can be quite different, while it still revolves around the family the homes people live in are much different. People in rural areas tend to work in agriculture, those that are fortunate make a living from it but many just practice subsistence agriculture. Oftentimes, the entire family participates in agricultural activities to some degree. The children will work alongside the rest of the family, as a result many children do not continue on school past basic education. It can be very difficult to get a good secondary education if you are from a rural are just because you may be needed at home. The homes that people live in in the rural areas are more rudimentary than in urban areas. They can be made of very basic materials that are not very weatherproof and may only have one or just a few small rooms. When we visited Clinica de Apoyo, rural health clinic, they explained one of the problems with living this way was that people are cooking with open fires. According to them, it is traditional and convenient to cook with open fires near the home however this obviously produces a lot of smoke and in turn causes a lot of respiratory infections which they treat at their clinic. They are currently working to help solve this problem by teaching people to cook with small brick ovens that produce little smoke. There are other challenges that come with living in these rural areas such as not being near any large cities that have hospitals or places of employment and having no reliable mode of transportation to get to those cities. These families often face difficult decisions when a family member falls ill because they have to spend hard earned money to transport them to a hospital far away. It also becomes difficult to seek employment that may pay more in the city because they cannot afford to get there and back home. Multiple generations and extended family members may live in one home and it may take all of them to keep the home running. Many families take care of the older members of their family when they can no longer live on their own or take of themselves. This can also add to the load of the family. Despite the differences in home life the Nicaraguan people encounter based on their socioeconomic situation or location it is clear that family is the uniting factor in the home. People organize and build their lives around their families no matter what their situation in life. After spending just two weeks in Nicaragua it became apparent to all of us that people value family as one of the most important things in their lives. Wealth and other things came secondary to their families. It was amazing to see that even in some of the more difficult conditions families were really sticking together and helping to take care of each other. I don’t think in the United States we could say that about ourselves sometimes. |
Brandon Sinanan
Brandon Sinanan is a sophomore from St. Louis, Missouri. He is currently pursuing a degree in Mathematics with a concentration in Statistics and a minor in Spanish at the University of Alabama.
Being somewhat experienced in overseas travel, Brandon enjoys exploring new cultures and environments. He supports the anti-slavery organization International Justice Mission on the UA campus and enjoys participating with the campus ministry Bama Cru where he plays violin in the worship band. As a pre-medical student, Brandon is considering medical school as the next step in his academic career.
Brandon expects that the Nicaragua Clinical Experience will help him develop proficiency in speaking Spanish and provide a unique glimpse into medical work while lending a hand to the clinic in Granada.
Being somewhat experienced in overseas travel, Brandon enjoys exploring new cultures and environments. He supports the anti-slavery organization International Justice Mission on the UA campus and enjoys participating with the campus ministry Bama Cru where he plays violin in the worship band. As a pre-medical student, Brandon is considering medical school as the next step in his academic career.
Brandon expects that the Nicaragua Clinical Experience will help him develop proficiency in speaking Spanish and provide a unique glimpse into medical work while lending a hand to the clinic in Granada.