Day 11: In Managua

We met this morning at 8:45 a.m., ready to start a very full day in Managua! It was already hot and the day promised to get even hotter. Thankfully, Bill's car is air conditioned! Our first stop was the Metropolitan Hospital, a private hospital, where we met with the Director of Nursing, Aura Maria. Bill left us to go to a dental appointment and we went on a tour of the facility. 

The hospital is very modern and quite large. We learned that there were only 45 beds, compared with about 200 beds in other hospitals in Managua. The impression when we entered was of a typical American hospital. It is air conditioned and very clean. Aura Maria was very proud of the Joint Commission certification on the wall (see left).  

Pediatrics Nurses Station

All of the units were similar to what we would expect in the U.S. We did see that there are more reusable supplies and equipment, rather than disposable ones that we use at home. 

Emergency Room

Newborn Nursery

We were able to see the newborn nursery, where there was only one baby who was born on Monday evening. It could have been a nursery in any American hospital. 

Spiking IV Bag in Med Room

Practice seemed to be the same as well. Nurses do not recap needles except during medication preparation, when the needles are clean.  They have sharps containers in a number of places, making them readily accessible whenever they need them. We saw isolation rooms, where there are signs on the doors and isolation gowns and masks are hung outside the doors for donning before entering the rooms. Before one leaves the room, the equipment is disposed of in a special container for that purpose.

Supply Room

The level of care is very high here. According to Aura Maria, the law requires them to treat anyone, regardless of ability to pay. Compared with the hospital we saw in Granada, there are very few patients here. We did have an opportunity to see the clinic, where there are a variety of specialists available to see patients. There were a number of people waiting to be seen in the waiting area there.

All in all, this hospital is an example of what is available here if one has sufficient financial resources. 

Christine, Susan, Aura Maria and Lily

As we drove through the city, people would come to the car to ask for money or sell something. Several times, Bill waved the young men away who came to wash the car windows for money, but they refused to leave and then wanted money from him. One young man was in a wheelchair and was pushed by another who might have been a sibling. He asked me to take his picture. He had no arms or legs. There are a huge number of people here with disabilities.

Young Man on the Road

On our way to our next appointment, we stopped at Costco/Pricesmart, where we were looking for soap for the bathrooms at Los Pipitos. One of the things we have worked very hard to do is teach the staff and children the importance of washing hands. We also had a bite to eat (the famous Costco hot dogs are actually imported here from the U.S.!).

Bill and Christine in Costco

In the afternoon, we went to the America Nicaragua Foundation (ANF) to see if there were medications or other items that could be used in the clinic. The people there were wonderful! We didn't find anything we could use, but we discussed how they obtain the donations and what kinds of items they were able to get. There is an office in the U.S. that collects items from anyone who wants to give. They never know what will come, except that they do get a list of medications that they will receive in the next shipment. They receive shipments once a month. 

ANF Staff Member

We also talked amongst ourselves about an ethical dilemma that we are dealing with. If people are sick and need medications, but cannot afford them, how can we not give them what they need?? At the same time, as nurses, we cannot prescribe medications, nor can we actually dispense them. If we know we can obtain them at no cost, how can we justify not giving them to those in need? There are a number of other ethical issues, including the issue of how we can give some children (who attend Los Pipitos school) but not their siblings or parents if they have a need? We have a supply of acetaminophen and some other first aid type medications in the clinic. If a parent needs Tylenol, can we say no? Another issue relates to the need to have parents pay something for services rather than continue to encourage a culture that expects others to provide for them. This is something Paloma has spoken about at length. She would like the parents to contribute something to the cost of medications if we were to provide them. The children would obviously have to be seen by a physician who would prescribe them. We do have the agreement with the pharmacist, who can use her monthly donation to cover the cost of the medications, but parents would be expected to pay something like 25% of the cost.

Here we are with Dean Margarita!

In the afternoon, we visited UPOLI (Universidad Politecnica de Nicaragua). We met with the Dean of the School of Nursing, who was very gracious and talked about the relationship the school has with other colleges of nursing in the U.S., including Duke University and George Mason University. We discussed Los Pipitos and our desire to have some students operate the clinic on some regular basis (monthly, quarterly, etc.) so the work we do here can be continued when we're gone. We also asked about a relationship between the Seattle University College of Nursing and UPOLI. Margarita was very interested in the project! She gave us a lot of information about how the "exchange" works with other schools, and then she indicated that, if we can develop a program that focuses on disabilities and create a proposal, we might be able to come to an agreement at some point to work together and serve Los Pipitos. 

Lily and Christine did their own thing for dinner and I went to El Garaje, the nice little restaurant owned by a Canadian couple. I felt much better about eating a salad there because the owner assured me that the vegetables are all soaked in bleach and water. I've been missing salads! 

Tomorrow, the doctors from the Health Ministry are supposed to come back and the American ambassador will be visiting Los Pipitos.