This is the first trip that I have made to the Roberto Clemente Clinic in late September and October.  I can now understand why the ex-pats who live in the area choose October as the month they go back to the USA for their vacation.

My first visit to the Clinic was in June, 2005 and it rained a lot then causing the roads to be deeply groved in mud and the rivers impassable on two different days.  However, during that trip it didn’t rain many days in a row and eventually the mud dried a little and the rivers subsided enough to cross with a four wheel drive vehicle.

The rains during this trip were daily for weeks and constant for many days in a row.  Needless to say such weather (tiempo) makes it very difficult, if not impossible for the patients and the Clinic staff to reach the Clinic.  However, such excessive lluvia brings more unusual patients to the Clinic.  This past month a baby was delivered in the Clinic because the parents were not able to travel to the Rivas Hospital.  More trauma patients have been seen for machete accidents due to the machete slipping from the intended point of contact. Fortunately, all three clinicians, Dr. Julio Flores, and nurses Carlos Pena and Martha Miranda are skilled technicians for trauma repairs.  It never ceases to amaze me how well these three clinicians execute wound closure, and restoration of function for the patient without wound infections.  Example from this trip:  An older gentleman came in from the muddy field with a deep machete wound to the top of his foot; there was tendon involvement.  After a somewhat lengthy repair with struggles of breaking suture materials, the gentleman left the Clinic with his toe function intact, bandaged with appropriate gauzes, an ace bandage and an orthopedic boot that was a bit too short for his foot.   When he returned for a dressing change some days later, he toes were moving, his wound was intact and healing nicely.  And yes, he had to walk with his orthopedic boot in the mud that was pervasive everywhere.  At the next Clinic visit, some sutures were removed and Dr. Flores gave him an exercise program to strengthen and stretch his foot and toes.

Over the past three years, I have tried to make my bi-annual volunteer Clinic visits at different months so that I gain more knowledge about the weather and how it affects Clinic operation and challenges that the weather creates for patients and staff.  This year was similar to my first Clinic experience but the conditions were magnified by 50%.  I will vividly remember this trip and the roads between Tola and the Clinic.  And I will also remember that if I choose September and October as my working vacation months again, I will make sure that I am not in a hurry to visit other areas and allow two days to get to the airport in Managua.  This trip I was lucky and left in one of the two day breaks in the rain.  Traveling to Nicaragua and working at the Roberto Clemente Santa Ana Health Clinic is worth every minute of effort and challenge.  Try it sometime, although I wouldn’t recommend October as the chosen month.

Margie Fincham, RN, MSN