A Day at the Doctor

For the 14 months that we've been in Nicaragua, today was the first day that we had to go to the doctor. We've had the occasional food poisoning, but up until now we've both been pretty healthy. Having heard horror stories about the local health center in town, we always dreaded the day when we would have to see the inside of those brick walls. But when Davie woke up last night with a fever, vomiting, and a bad headache, we conceded that that day had finally come.

So it was that we trudged two blocks through town this morning to the health center, a small single-story brick building surrounded by a chain-link fence. As miserable as Davie felt, I was actually the tiniest bit glad for the chance to find out what the health care system in rural Nicaragua really looks like. But I tried to be in solidarity with Davie's misery while also taking mental notes on everything I saw.

By the time we got there at 9 a.m., the courtyard was already filled with around 30 people, waiting on hard wooden benches to see a doctor. I didn't recognize many of the people, and lots of them wore the worn faces, missing teeth, and pencil skirts of campesinos who live even further afield than San Nicolas. Many of these sick people, it seemed to me, had probably walked miles and miles through the hills to arrive at this clinic.

We were confused about whether we should just plop down on the benches or if we had to check in, and since there were no signs, we asked a man whose face bore the scars of a serious burn. He directed us to a cluttered office, full of manila file folders. While we waited there, a nurse sorted through about a hundred of those folders. Then she finally looked up and said, “Yes?” “He's sick,” I explained succinctly, pointing at Davie. She asked what Davie's name was and wrote it down on a piece of scrap paper, and that was it. There were no medical history forms to fill in; apparently, all they needed was Davie's name.

We went to sit down on the benches outside in the courtyard. There were maybe three doctors and five nurses attending to all these people, running around from room to room. Some of them wore scrubs, but some of them just wore a kind of medical-looking shirt with jeans.

We probably would have waited a couple of hours to be seen if Davie hadn't had a sudden urge to throw up. The only toilets in the health center, we quickly discovered, were locked and reserved for employees. So instead, we dashed outside and Davie leaned over the grass on the side of the road. He didn't actually end up vomiting, but he must have looked so awful to all the other patients and doctors that they took pity on him and called him in to see the doctor next.

The doctor was a young, casual-seeming man. He took Davie's temperature and blood pressure and listened to his symptoms. Then he sent Davie in to get a blood test and a urine sample. From what I've heard, this is fairly standard procedure when you go to a public doctor in Nicaragua; most doctors want to see a blood test right off the bat. Since the latrines smelled awful, Davie hid out in a nearby old latrine, now filled with trash, to give his urine sample.

After that, the blood test lady told us to go find a nurse who would stick an IV in Davie to rehydrate him. I was surprised by the number of needles everyone was sticking in Davie, but he handled it well. After she finally found his vein and hooked him up to the IV, the nurse led us into a small room with three beds. There was an older woman from a nearby community on one bed and a mother and baby with a mini cast on her wrist on another bed. Davie took up residence on the third bed and lay down on the plastic mattress without a sheet. The nurse told us to come find her when 500 milliliters of liquid had dripped into Davie's veins.

But when the IV had reached 500 milliliters, the nurse was nowhere to be found. I searched all over the clinic for her, and finally found her in the reception office, acting as a secretary of course. Later, I saw the same nurse functioning as a janitor, taking out the trash. Anyway, she turned off the IV drip without explaining what she was doing and disappeared again.

Things proceeded in this same manor for the next couple of hours, with Davie curled up in a miserable ball on the plastic mattress and me hunting down nurses and doctors to make sure they hadn't forgotten us. But in the end, it actually worked out. We walked past the doctor's office several times, hoping he would see us, and before long, he did. He called us into his office and told us that the test results indicated that Davie's infection was probably bacterial, not Dengue, which is what we were worried about. He helpfully wrote down some antidotes on more pieces of scrap paper, scheduled a check-up test, and sent us on our way.

As we were stepping out of his office, I had a feeling that we were forgetting something. “Do we need to pay?” I asked. The doctor shook his head and laughed at me like I was crazy. “No, no,” he said. “Of course you don't pay!”

It's true that this rural public clinic was not nearly as sterile as any American clinic. The nurses didn't smooth-talk you as they stuck needles in your veins, and they didn't role out a sheet of crinkly new paper for every patient to sit on the examining table. Patients sat out in the open air with no jazzy elevator music or inspirational posters, and there were random cardboard boxes of discarded needles plainly visible in the check-up rooms. But we did, in the end, receive solid medical advice from a certified doctor, and even as foreigners we didn't have to pay a cent. The success of this public clinic is still up in the air, but the next time, I don't think we'll dread going there quite as much.