the 1 less traveled by

When I read that the nearest hospital would be 2 1/2 hours from where we would be living in San Juan del Sur, Nicaragua, I felt a tinge of unsettling fear. Being a mother of 2 young kids, I’m fully aware that a serious injury could happen at any moment.

This fear got even more real after we moved and I discovered that the way most of the houses with ocean views are built here in San Juan del Sur are with very beautiful, but unsafe patios. I practically have a heart attack each time I find myself in one of these homes with my kids. Rope railing are great for an unobstructed view, but I just can’t see the beauty through the images one of my children plummeting to their death.

It took 7 1/2 months before we got a personal look at the free medical system in Nicaragua. On my son, Titus’s, 1st birthday my daughter, Azalea, reached up into a snow cone machine and cut what looked like the tip of her finger off. There was so much blood! We found the piece of finger and put it on ice (but not directly, as a retired firefighter party guest advised us) and rushed to the clinic in town. Knowing this would be a Spanish-only situation, we brought my friend’s Nicaraguan husband who knew where the hospitals were and could speak both languages. We were told at the clinic in town that we could wait 30 minutes, but they would probably send us to the closest “city” Rivas, so we opted to just head there. We parked and our friend carried Azalea through the front door and straight to the back demanding that she be seen. Only two people were allowed in the hospital with Azalea, so my husband had to wait outside in the waiting area. The doctors looked at the piece of finger and determined that there was no bone in it and it was only the pad that she had cut off. They asked if we’d rather they sew it or bandage it. I don’t have a medical background, so why they were asking me was puzzling. We decided that with her screams of pain and intense fear, it was best to only clean it and wrap it. As her finger healed, I was so happy that this was the decision that we had made. She had cut a pretty large circle off the pad of her finger. To stitch it, the skin would have had to pucker and the healing would not have looked as even. We left the hospital in Rivas after about 20 minutes with no bill to pay. Azalea decided she wanted to go back to the birthday party where we had left all of our friends and Titus with my parents. She was such a brave girl and recovered quickly enough to even have a turn at the piñata.

Exactly 2 years later on Titus’ 3rd birthday we had a tropical storm that was connected to Hurricane Nate whip through Nicaragua. Our internet went out with the high winds and we decided to head over to the resort, Surf Ranch, down the street to see if they had internet. They use the same provider as we do, so if their’s was still up, then it was something having to do with our home system and not the company. As soon as we pulled out of our property we found a downed tree blocking the road. With little to do that day, my husband decided to go get our machete and saw to try to unblock the road. It was raining outside, so the kids and I made fun in the car while Daddy worked on the tree. (pic) Once a large piece was cut free we tied it to the car to drag it away from the road. There was one small final branch in the way, and Kharron used the machete to slice through it. Easier than expected, the machete glided right through the branch and slipped out of Kharron’s wet hand. Unluckily, it bounced off the dirt road and ricocheted back, hitting the knuckle of his thumb. I heard him shout, “I cut my thumb! I cut my thumb!” As he walked towards the car clutching his wrist. I could see drops of blood rolling off his hand. There was a small white sliver of a bone resting on top of his open knuckle wound. We have a river that wraps around our neighborhood, so when there is a lot of rain it gets high enough where we cannot leave until it goes down. Usually this is just for an hour, but in the middle of this tropical storm, it might be days until the rained stopped. Knowing we were stuck, uncharacteristically calmly went to the back of our SUV and retrieved a medical kit my mom had left us after Azalea’s finger incident. I rolled the kit out, assessing my options, and went for the gauze and medical tape, wrapping as tightly, but gently as I could.

It was 30 hours before we made it to the Rivas hospital. We had no translator this time, but hoped our years of being in the country would get us through even the medical terminology. Immediately the doctors started talking about admitting Kharron into the hospital for 3 days. The Rivas hospital is dirty and full of cats in the outside corridors. It is not someplace one wants to sleep even for 1 night, forget about 3. We started looking at other options and called Vivian Pellas, the private hospital in Managua. They would not be able to see Kharron until the next day, so we decided if the doctor was just going to do a local anesthetic, then we’d stay and have it cleaned and stitched in Rivas. If they wanted to put him under and do something more severe then we’d wait the day and go to the better hospital. The doctor ensured that he would do a local and just clean and suture it and Kharron would only have to spend one night. We agreed and I left the hospital to run home and get our own sheets, a pillow, and a change of clothes for Kharron. When I got back an hour later they told me he was still in surgery. I waited outside the door for over an hour. Finally they wheel him out in a chair with a huge bandage over his thumb. He told me that they put him under and he thought they put “clavitos” or “little nails” in it. We asked the nurse wheeling him, but couldn’t get a straight answer. Kharron started to get pretty serious about not wanting to spend the night. We asked for a prescription for the antibiotics they were going to give him and to sign him out. Reluctantly they handed over the paperwork, but refused to give us a prescription.

Two days later we headed to Managua for an appointment with a joint specialist. He unwrapped Kharron’s finger for the first time since his surgery and we could immediately see that it was infected. He took x-rays and noted the fracture. He performed surgery right away. Removing some of the infected skin, cutting further down to find the tendon and reattach it (that’s right, the first surgeon never attached it), and removed one of the 3 pins. We left the next day on a two week trip back to California. Kharron spent every morning re-wrapping it and making sure that the sore stayed dry.  A few days after we returned to Nicaragua we went back to the doctor to get the pins taken out. We had a good laugh during this appointment as the doctor not only told us about another Gringo patient of his from San Juan del Sur, but actually showed us pictures from her arm surgery. The doctor-patient confidentiality is slightly more relaxed in Nicaragua!

Kharron saw a new physical therapist in town a few days after getting the pins removed. He still cannot bend it, but we are told that this is normal and fingers heal slow. He now has a Frankenstein finger and is forever changed by Nicaragua and Hurricane Nate.

When you hear a country offers free public healthcare, before getting getting too excited, it is important to understand what level of care is provided. In my daughter’s case, the incident was mild enough that using the national health system was sufficient and I was appreciative that even as a foreigner we were seen and cared for completely free of charge. On the reverse side I was severely disappointed by my husband’s care. After the first surgery and waking up surprised to have pins in his thumb we heard lots of stories about how that hospital is known for cutting off fingers and experimental surgeries. I feel sad for a majority of the locals who have no other choice but to use the public healthcare. How hopeless they must feel at times when receiving improper care at a dirty hospital. I quote the surgeon at Vivian Pellas who said while looking through our pictures from the Rivas hospital, “It is a shame. Cleanliness doesn’t cost anything.” One of the bacteria Kharron had was something you can only get from hospitals. Now that is sad.