Nadie es Rechazado

"Nadie es Rechazado."

One of the docentes (= teachers) of UPOLI said this to us one morning while giving us a tour of the community health clinic. The phrase really stuck with us during these past two weeks as we were stationed in different parts of the community’s multi-service free public clinic. The phrase explains the philosophy behind the public health care system here. “No one is rejected.”

For some patients and community habitants this idea translates to a free visit to renew a free prescription for an anti-hypertensive drug. For some it is a free prenatal visit during the third trimester of pregnancy to diagnose possible life-threatening preeclampsia. For others it is a physical or psychiatric therapy appointment, also gratis (=free). Like in the ERs of the United States we observed the community clinic’s emergency care fila (line) winding down the sidewalk outside. The concept of "nadie es rechazado" is much more complicated in real life than in ideology.

So we’ll repeat: every service they offer is free! The patients can get the examinations, consults, diagnostic tests, treatments, drugs and vaccinations without the nasty insurance company bills. The catch? Not every drug and service is so easily attained. We heard one story of a hypertensive patient who was prescribed aspirin to manage her condition. However, the pharmacy had run out of their supply. Thus the woman was told she could go purchase the medication at a nearby pharmacy. To us this illustrates that healthcare does not always function as it is intended—a reality we have seen daily in the US as well. While we are preparing to graduate and enter the nursing workforce, it will serve us well to keep in mind that no system is perfect and we must be ready to deal with low supplies, miscommunications, and unexpected barriers to our ability to care for patients. In working side by side and observing the nurses in the clinic here we have seen quite a bit of patience in confronting these issues. There is no magic “snap” of the fingers as a means to accomplish an end. Witnessing the fortitude of the enfermeras we will perhaps leave behind some sense of entitlement and expectation.

What we enjoyed about working in the clinic was the variety of nursing work in which we would participate daily. Without the benefit of having a community clinical until this point in our nursing program, we have only seen the acute patient--those seriously injured, very ill or already-diagnosed. We witnessed many sad situations of this nature in the Managua community clinica here as well, but we also saw a fierce system of prevention. Nurses and doctors are working daily to keep the well-patient from becoming acutely- ill. The work of the nurse should not lie only in the realm of the already-ill but in the wide vast area of persistent prevention.

During our experiences with our families in the barrios, an entire other side of health care and the human condition was opened to us. It is one thing to care for a patient in an isolated hospital room and tell them to eat more fruits and vegetables. It is an entirely different world to be invited into the home of a client and see a single stove top and small basket where they keep their week’s supply of food. It seems simple to advise an overweight patient to get out of the house more often and give them a pamphlet about controlling their condition via exercise. However when one actually walks through a small barrio where pandillas (gangs) run rampant and unknown eyes peer at them from behind dark windowsills you might see why powerwalking is not a local trend. To talk about nursing for a community is so different from being a nurse among a community.

A huge thank you to all of the amazing UPOLI nursing program directores, profesoras, nursing students, the community clinic nurses and staff, and our beloved promotedores and leaders at the Centro Academico de la Villa Libertad. We have learned so much in this two week experience. We wish we had at least one more week to spend. Gracias por la experiencia de clínica y de la vida mas increible (thank you for a most incredible clinical and life experience).