There's a new kid in town...

This past Saturday, Jim and I were once again able to help at the monthly medical clinic that is held in a rural area outside of Jinotepe. There were 40 people who were seen in a five hour period...pretty good for this doctor as he tends to spend quite a bit of time with each patient. He's a wonderful man who actually works for Minsa, which is the government-run health organization, and does this clinic on his own time. He had originally offered to do these clinics for free, but in order to keep things straight with the government, the missionaries who sponsor this clinic, pay him 500 cords for approximately a 5 hour day. And for those of you who are interested, that equates to slightly more than $26...exactly what he gets paid by Minsa for a full day's work.

Roger and Rhonda Euceda are the m's who make this clinic happen and they have worked hard in this community for the past year to build the trust necessary to support such an effort. They are involved in working with five schools in the area, helping the students with school supplies, socks, shoes and they even built a new "kitchen" (a covered outdoor area) at one of the schools that had been forced to abandon its lunch program due to the lack of a place to cook over an open fire during the rainy season. The medical clinic has been a natural spinoff from their other efforts and it has been very successful...people receive treatment who normally would not - due to lack of means of transportation into town or to lack of funds. I wrote a little about this in May's newsletter.

Jim and I really enjoy helping with this outreach and we were starting to "settle in" to our roles as pharmacists...don't mention that part to our local pharmacists, please. Usually, the people are very quiet when they come to the clinic and if they speak with one another, it's in a hushed tone...very un-Nica like, in my opinion. But that morning, there was a lot of chatter and hand-waving going on. Finally, thanks to Roger, Rhonda and Susanna, we found out that there was going to be a visitor to the clinic that morning.

Apparently, the government had decided that the clinic was perhaps a bit too successful, so they sent out a Minsa representative on Saturday to have a meeting with those patients who had come to see our doctor. It seems as though the Ministry of Health has come to the conclusion that there is enough need in the community to warrant opening their own clinic which would see patients two days a week. Because this will be a gov't. clinic, there will be no charge for seeing the doctor or for prescriptions.

Now, wouldn't you think that the people would be ecstatic over such news? Instead of a clinic where they sometimes have to sit and wait for hours to see the doctor and then are asked to pay a nominal amount for their prescriptions, they are now going to have an opportunity to go see a doctor 2x a week and at no charge. Wouldn't you expect cheering and rejoicing? Didn't happen. Skepticism would be a far better term to describe the prevalent attitude that morning. It would appear that the community is well-versed with government programs.

From what we were told, Minsa will come in to a community, set up a bare bones clinic (which I thought we had) and then will decide it's not worth the effort or cost to run it and will pull out, leaving the community in the same situation in which they started. They typically put a 3rd year med student in as the diagnosing doctor and are supposed to have a qualified physician alongside, but evidently, that doesn't always happen. They set up these clinics in existing buildings, like schools or vacated World Vision buildings (such as the one our clinic is held in) and so they deal with a makeshift environment as does our doctor. It is said their equipment is old and much of it not working properly...my thought was at least they had equipment. We take an old bathroom scale, a stethoscope, a blood pressure cuff and a thermometer...but it seems to serve its purpose, and somehow, in this setting, close does count.

The rep explained that they have trouble with theft of their equipment and their supplies in these rural communities and was told the crowd (the majority of whom were women and children) that they would be responsible for making sure that no one broke in to the building and stole their supplies. The rep also asked if any of them had a secure place in their homes where they could lock up the medicines. Evidently, the guy didn't bother to look to the left or right of the road he had to travel to get out there...tin, black plastic and salvaged boards are far from secure - even I could have answered that question. But I didn't need to...the crowd was bold in answering and the answer was a unified no. No one wanted to be accountable to the government for what was sure to become missing meds. Who could blame them?

He again stressed that it would be their responsibility to see that the clinic remain untouched by theft. Right...women and children who walk up to an hour to come to that facility are going to be held responsible for its security...only a government representative could come up with a statement like that...no need to share that with our local government representatives, either...or if you do, qualify it with the distinction in governments.

To top it off, it seems that the Minsa-run clinics carry only the most basic of meds...like the most common antibiotics, parasite medicine and sometimes, analgesics. I thought our supplies were limited but evidently not. In addition to those items, we also are stocked with various types of medications, including antibiotics, anti-fungals, eye drops, cough and cold meds, antihistamines, antacids and what we take so much for granted...vitamins. Those are the things these people need. So the way it sounds right now, according to the talk that morning, the Minsa clinic will be short-lived...although the Minsa rep. did talk with Roger about Roger and Rhonda "partnering" with Minsa and supplying them with meds...Roger didn't commit.

After the Minsa rep finished talking to the crowd, they all returned to their seats, inside and out and the frenzied chatter continued. There are so many times I wish I had a video camera...I would have loved to have been able to capture some of the facial expressions we saw that morning...the Nicas are such expressive people! Grimacing, head-shaking, eye-rolling and expressions I don't even know how to describe!

We visited among ourselves and wondered what this would mean in regards to "our" clinic...were we through there? Were we being "run out" in a very politically correct manner? Up to this point, any type of evangelistic outreach has not been approached. And I don't know if it was because there was a chance that might be our last clinic there or if he would have done it otherwise, but I happened to look over to a bench where an older woman was sitting and crying quietly. Roger sat down next to her, took her hands in his, talked with her for awhile and then, placing his hand on her shoulder, he began praying over her. I didn't know what business was going on in that moment, but I knew it was of the Lord and so I silently joined in from the pharmacy area and just prayed that God would work in those few moments. That act of kindness from Roger seemed to bring down any remaining barriers between the residents and the gringos.

Almost without exception, as people would get their prescriptions, they would tell Roger and Rhonda that they didn't want them to quit coming and that they would rather come only once a month and know that they were going to get good care with good medicines than what they anticipate Minsa is going to provide. They shook our hands, thanked us for coming, hugged us, bowed to us, etc. They knew the future of the clinic was in jeopardy and they wanted each of us to know that it was not by their choice. It was such a touching morning.

Roger and Rhonda have been contacted by several other nearby rural communities and asked to do a similar monthly clinic in their areas. They've not been able to do so due to their involvement and commitment to this community along with a lack of additional necessary supplies, so who knows what God has planned for this operation. We just know that we've been requested to keep the first Saturday of each month open to join Roger and Rhonda and go wherever the Lord leads...we're game!