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Journals from Nicaragua: Days 4-6

Day 4, by Dr. Carlo Reyes


A record day. A very good day. The morning started much like the prior two mornings, but with the added anticipation of knowing that the clinic census may double or triple:


Once the region gets word of a mission, the word-of-mouth spreads the message for miles across to other villages. It is not uncommon for people to walk for hours to visit a mission clinic with the hope for medical care that helps whatever ails them.


After two days of clinic, we have identified a trend in diagnosis, improved clinical and communication workflows in our clinic, and staffed our stations with translators and Nicaraguan doctors ready to help us see patients, serving as translators as they had not been given government approval to work in our government-sanctioned clinic in time.


Driving up the rocky dirt road path to the clinic, we saw lines of people waiting patiently for our arrival. Our fatigue has definitely set in: from the Gala preparation, transitioning to mission preparation, and the red-eye plane travel to rush to launch our clinics within 24 hours of landing, I know one thing: to achieve success today, each of us have to ignore our fatigue and push forward.

I do my usual walk-through: triage staffed. Check. Stations equipped with medical tools, vitamins, and our translators and Nica docs. Check. Pharmacy ready to dispense. Check. Patient flow non-medical staff ready. Check. And just like that, we launch.




Patient after patient, the time flows effortlessly. Rutu, our dentist, implemented her new workflow: on-the-spot dental assessments worked wonderfully as she shifted from station to station, identifying needs and educating. Working alongside young, eager, brilliant Nica doctors and watching them giving of themselves to our cause was awe-inspiring.


As Team clinical physician leader, I evaluated EVERY patient through the eyes, ears, and hands of our nurses, advance practice providers, and medical students to make sure we implemented the correct treatment plan.

Several times I called on our volunteer virtual specialists from the Bodhi Connect network, reviewing skin rashes and treatment plans

to make sure patients received the best speciality care through Telehealth consultation. I paused for a moment. What we are doing is groundbreaking stuff.



The day closes, as we drag through the final patients who have waited hours to see us. The final patient census for today: 190 souls. Number of prescriptions dispensed for the day: 250 medications, vitamins, and deworming treatments. This brought our 3-day total to 380 patients and 495 medications, vitamins, and deworming treatments dispensed. Today was a record day for me, and for Health-e-Charity.


As I did my closing walk-through of the clinic, I scanned the faces of my fellow team members: exhausted in their facial expression and posture. Some even had to fight through the dehydration from food poisoning from the past 48 hours. As I looked closer at each of them, their eyes showed something more: a sense of amazement at what we have seen, what we can do, and how we can help people here in Nicaragua. I am humbled by each and everyone on the team today.



Day 5, by Prema Ray


Cigar Production Tour


The morning after our last clinical day, a few of us visited a small cigar factory outside of Esteli, named Karen Berger. Cigars are one of Esteli’s big exports and the quality of cigars rivals cuban cigars. The cigar factory is on a tobacco plantation and is a small room with about twenty people. Each person had a specialized roll, from placing the tobacco to rolling the cigar to quality control.

The strong pungent smell of tobacco permeated the air. The dark browns of cigar leaves and tobacco remnants stained the tables and ground. In the back of the shop was a cigar workshop where we smelled and shopped for cigars. The owner showed us that cigars range from bold to light flavors. He highlighted several kinds of cigars that were wrapped in different leaves from South Africa to Nicaragua. Sliding the cigar under my nose and inhaling the earthy smells, I could smell the difference in the variety of cigars. It was quite the experience to see the culture and production behind cigars. Having the privilege of seeing cigar production gave me a better understanding of Nicaraguan culture and

a deeper understanding of the Nicaraguan people.


Coffee Tasting


Stumble out of bed, eyes half-closed. Boil water. Grind beans. Steep coffee. Press. Drink. Wake-up. This is my morning coffee routine. My incentive to get out of bed and my only way to feel ready to face the world. Although my coffee routine is the key to my existence, I take it for granted and forget the complicated process and unique history that my coffee holds.

On a mission clinical day at Pastor Ricky’s Clinic, I had the privilege of meeting Bertha, a local doctor in Esteli. Together we saw patients throughout the day. She gave me cultural insight on the medical care available in Nicaragua. She shared that her fiancé owned a coffee plantation North of Esteli and asked if our group would be interested in a tour. The following day we headed to the far northern territory of Esteli. Bordered by lush green tropics, the car swung through windy mountain roads. Grey clouds touched the mountains and subdued the oppressive heat.

The plantation was an open concrete compound that was fenced in by mountains. A small tasting room with a hipster barista was arranged for us. The Barista explained the several ways to brew the coffee, how to prepare the filter, and precisely cover the grinds with the boiling water. We tasted coffee that ranged from light fruity flavors to deep dark bold chocolate tastes.


The coffee tasting was amazing, it revealed the traditions and complexity of flavors that coffee holds.

Day 6, by Jen Weber


Today we had a meeting to discuss census, along with things that went right with the trip and things that could use some improvement. Overall, feedback was very positive. This was a great trip, with a lot of positive ramifications. Relationships were established and hopefully will continue to grow stronger over time, so the transitions for us to come to Nicaragua will be a lot easier. Bringing our own medical equipment would be nice, since we were short, but we all managed to make do and still provide quality healthcare.



After the meeting, we went to town to pick up some groceries and our driver was our neighbor. His name is John and he is from Nebraska. He is very knowledgeable on the political situation in Nicaragua and what is going on there. He did say that the president of Nicaragua lives in the neighborhood where we were renting our Airbnb. We had a great time at the market- it was fun shopping in the grocery store and seeing what options they had available and how their grocery stores were set up. We came back to the house and prepared a homemade meal. Francine is an amazing cook and it was so good to have her home cooked meals. She is such a kind person and I am so glad she was there; she was a wonderful blessing!


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