Health and Health Care

This will be a relatively brief post because, thankfully, I have been very healthy during my stay so I have not had any direct experiences with the health care system—my experience is all as on outside observer and I hope to keep it that way.  Last May, however, I suffered a bit from “intestinal distress,” but was able to take care of it by simply visiting the pharmacy.  Many drugs that are by prescription only in the US can be sold here by pharmacists (I should probably say by pharmacies, because I don’t think the people I’ve talked to were actually pharmacists) without having to see the doctor first.  I received a course of Cipro, an antibiotic; along with instructions for use and the bill was C$18—a bit over 80¢ US!  It worked well and I was able to comfortably survive the bus trip back to Managua.  After checking with my doctor at home, it is exactly what he would have prescribed.  (In fact, he did prescribe it for me to take on this trip…just in case.  That cost $5 in co-pay for the drug and I don’t know what for the office visit since the insurance took care of that.  Even though it is cheap to get here, it is still good to have it in hand since even a 25-minute bus ride to Ocotal can be agony under the wrong circumstances!)  Pharmacies, supermarkets and pulperias also carry standard over-the-counter remedies available in the US:  Tylenol, aspirin, Pepto-Bismol, etc.

This how a  typical pharmacy looks from the street, although some are even more walled-off with only a small winder to talk through.  If the resolution were better, you'd recognize products and even brands that are familiar in the US.  Note on the left that this pharmacy also has a motorcycle parked inside.

In Sabana Grande, there are no permanent doctors, but there is a health center (I think just an office location, but without equipment) that has office hours by a doctor one day per week.  I believe that every weekday there are at least some hours by a nurse of some kind (not sure if LPN, RN, or nurse practitioner).  Additionally, there are several women in the community called “brigadistas” who have some medical training and are on-call for emergencies.  I imagine the training is more akin to wilderness first aid or responders than to EMTs, and probably has a fairly strong emphasis on OB as well.  There are also some folks with a modicum of training in the pharmacy area who can dispense some remedies and advice.

Centro de Salud in Sabana Grande.  It’s located near the big Ceiba tree in triangle intersection of streets (but remember that "street" does not imply as much as does in the US), so it's more of less in the center of the community.

Here is where you can buy some medicines.  (It happens to be where William stayed 3 years ago.)  The sign on the right simply advertises that medications can be purchased here and on the left is a poster promoting immunizations.

 

Totogalpa has a small hospital and, of course, Ocotal has a somewhat larger one, and Estelí a larger one still.  There is some ambulance service since I have seen them parked at hospitals and occasionally on the highway, but most people would go by bus or, if it’s really urgent, by taxi.  The ambulances I’ve seen are smaller SUV-sized vehicles rather than the stand-up, rolling, mini-emergency rooms like in the US.  In larger places, one can find private practices in various specialties:  pediatrics, OB-GYN, GPs, dentistry, etc.  These are scattered throughout and for the most part appear to be offices in the physician’s residence, rather than a separate, dedicated office.  When office hours are posted, the often include Saturday morning in addition to weekdays.  (The one’s I’ve paid attention to have not had particular morning or afternoon off, so I don’t know when doctors here play golf.)  As is the case in the US, progressively larger cities have corresponding more extensive medical services;  and places more remote than Sabana Grande will probably have even fewer service.  (You may recall in an earlier post I mentioned one of the projects underway at the Centro Solar is a solar autoclave targeted as some of these very remote locations.)

Totogalpa hospital.  Totogalpa is probably about the smallest-sized community In which you’ll find a hospital.  It is located directly on the Pan-Am Highways, which has been true of all the hospitals I’ve seen except for Ocotal.

The hospital in Condega.  Note that the gate is closed to cars and open to pedestrians.  The expectation seems to be that people will show up on foot, rather than in a vehicle.

The Ocotal hospital.  It is located on hill near the center of town.  From the outside it doesn’t look too bad, but the med students did not give it good reviews.

The hospital in Estelí.  (This is the one next to at least 2 funeral parlors.)  The sign on the left says that “In this hospital, we don’t charge for any services to the patient.´ (Of course, it has the Spanish double negative that I still find superfluous, if we translated a bit more literally, it would be “…don’t charge for no services…”)

For a couple of weeks, 3 medical students from UC-Davis were housed in Sabana Grande while doing a practicum in the area.  According to them, this is not a good place to be if you’re sick or especially if you require surgery.  Their instructions to each other in case of dire emergency was:  1)  give Vicadin and 2) get them on a bus to Managua.  They don’t like the hygiene, they don’t’ like the equipment and they really don’t like how frequently and freely antibiotics are given out (e.g., my story from last May).  On the positive side, services at public hospitals are provided without out-of-pocket costs.  In Managua, León, Granada, etc., there are apparently also private facilities with quality and practices more akin to those in the US or Europe.

It is interesting to me to see how much herbal/folk remedies are used in the community here.  Perhaps this is in part be due to living in a community where there is a general emphasis is on a natural, sustainable lifestyle, but it appears that there are many locales throughout Nicaragua that are of a similar persuasion.  It may also stem from an indigenous/folk influence and be more prominent where indigenous culture is more prominent.  I already mentioned the herbal medicine research organization in Estelí in another post, but Ocotal has at least one store dedicated to herbal remedies and even the ordinary supermercado there carries 4 brands of fish oil, including Nature Made, a brand that I see in Platteville.

An herbal medicine/remedy store in Ocotal--Botanical Marvels..

In terms of the observed health of the people, it is hard for me to say exactly what the situation is.  The people I see and interact with are all healthy and thriving and there are quite a number of fairly old folks who are still spry enough to walk a mile or so to the highway and climb up the non-ADA-compliant bus steps.  There are many kids around who also seem very healthy.  The med students said that for the most part, they saw infections of various sorts when they visited clinics/hospitals and also quite a few dental problems (which of course they couldn’t do anything about).  They also saw a number of chronic problems, like diabetes, that were not being managed very well.  In fact, the gringos appear to have the most health problems, but mostly related to minor gastro-intestinal problems (The CELL group that was here had 7 of 12 afflicted with intestinal maladies, but nothing that was completely debilitating.).

To get some idea more globally of how the health of Nicaraguans is, I did a brief search on-line to see what the statistics say.  In terms of life-expectancy, a typical Nicaraguan can expect to live 71.9 years.  This ranks about 129 out of 220 countries listed, so about the 42 nd percentile.  For perspective, this is a longer life expectancy than Russia and about the same as Turkey, Peru, Egypt and the Philippines.  For infant mortality, Nicaragua ranks a bit lower at 133 out of 220, clustered again with the same countries.  What I can’t say is if the statistics reflect more on the state of health care system or on the state of transportation/infrastructure so people can quickly and conveniently get to medical care.