May 11, 2009

Physician's Assistant Francesca Yango Jahns examines a patient as Jamie Cistoldi Lee, Class of '99, left, translates

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By Julia Ferrante

Also in the series: 10 Years Later, Waterline Project, Spinning Cooperative, Brigade Journal

NUEVA VIDA, NICARAGUA Jim Ritter, Class of '04, walked through the door of the health clinic in Nueva Vida one morning in March and looked around in amazement.

"I helped build this," said Ritter as he stood amid the examination rooms, laboratory and dental suite. Patients dressed in their Sunday best already were lining up for their afternoon appointments.

Others on the Bucknell Brigade's 10th anniversary alumni trip to Nicaragua, March 28-April 4, remarked on various aspects of the clinic they helped create during the past decade. The first building, with a pharmacy and exam rooms, was competed in 2001. The second building, with a laboratory and dental suite, opened in 2007. The clinic was and continues to be a central focus of the Bucknell Brigade. About $40,000 in donations from Bucknell goes toward paying salaries and operating costs each year.

Living in tents
When the first brigade arrived in the resettlement community of Nueva Vida in 1999, a year after Hurricane Mitch slammed through Managua, thousands of displaced residents were living in tents consisting of black tarpaulin and wooden poles. The brigade's host agency, Jubilee House Community, was working with neighborhood leaders to identify priorities for recovery. A temporary clinic was set up. At the top of the priority list was making it permanent.

Dr. Don Stechschulte, director of Student Health Services at Bucknell, and Bonnie Poteet, an associate professor of Latin American Studies, independently identified a clinic as a top priority as well.

"The two buildings of the health clinic would not have happened without our relationship with Bucknell," said Kathleen Murdock of JHC. "That was Don Stechschulte and Bonnie Poteet's vision. The Bucknell group came and we said, 'We're committed to building a clinic.'"

Nueva Vida now is more like a small city of about 15,000 people, although the concrete homes are small and lined up side-by-side, and the roads are unpaved and full of potholes. Unemployment, always very high, is now more than 80 percent, and the urbanization of the area has brought with it urban issues, such as additional crime. Those who do have jobs make an average $900 a year or about $2.50 a day.

Beyond basic care
Since Daniel Ortega was elected for a the second stint as president in 2007, Nicaraguans have had universal free basic health care, but dentistry and other specialty care is rare, said Janice Butler, the director of Bucknell's Office of Service Learning. The clinic in Nueva Vida has two physicians, a lab technician and a counselor as well as a part-time dentist.

Those who come to the clinic are asked to pay a "bono" or small charge for an appointment or to work for a half-day, Stechschulte said. The clinic maintains records on about 15,000 patients now; many are treated and given medication for chronic illnesses such as diabetes, high blood pressure or asthma. A part-time counselor offers therapy for adults, children, couples and families.

Dispelling myths
Convincing patients to comply with treatment plans and have chronic illnesses monitored is one of the ongoing challenges at the clinic. Maintaining proper nutrition also is a challenge in an area where survival is an everyday hurdle.

Those who volunteer in the clinic must work to change a way of thinking and dispel myths about how to treat common ailments.

Jamie Cistoldi Lee, Class of '99, who with Poteet, Stechschulte, Butler and others started the Bucknell Brigade, worked in the clinic during the alumni trip. She translated for physician's assistant Francesca Yango Jahns, a friend of Blakeley Lowry of the Class of '99. Lee and Jahns saw dozens of patients during the trip, including a 6-month-old baby who had chronic diarrhea.

Jahns asked the mother, through Lee, if she had given the baby any medication. The mother said no. After repeated questions, Jahns and Lee called in a staff doctor, who asked the woman if she had given the child a common Nicaraguan remedy: milk of magnesia and antacid. The mother said she had. The remedy is thought to be effective for "cleaning out the system," but for an infant it results in rapid dehydration, Jahns later explained. She sent the baby to the hospital.

Much-needed medication
Patients at this clinic receive much-needed medications to treat infections and chronic diseases, Murdock said. Many are grateful for the care they receive and are able to recover with the aid of prescription items or over-the-counter remedies.

During the trip, brigadistas worked in the pharmacy, dolling out medicines in a steady stream, from noon until after 4 p.m. Staff and volunteers in the pharmacy write instructions in Spanish and also check off icons for various times of day for those who cannot read. If the medication should be taken in the morning, for instance, the pharmacy staff checks a rising sun symbol. If the drug should be taken at night, too, a moon icon is checked.

Anne Griffin, a nurse at Evangelical Community Hospital and wife of Associate Professor of Geography Duane Griffin, worked in the pharmacy during the alumni brigade trip. She explained to the patients in Spanish how they should take the medicine. One woman at the clinic was collecting medication for four family members, so the written instructions and symbols were especially important.

The help of volunteers on the Bucknell Brigade and from other groups who work with JHC help make the clinic a success, Murdock said.

"Bucknell has played such an important role in the work here," Murdock said. "We would never have had a clinic with doctors, a dentist, lab technician and pharmacy without the vision and commitment of the people who came down here. We have over 15,000 patients on file and we have over 300 on file with the dentist. We have given out millions of dollars in medicines, all because Bucknell Brigades started it and then kept it going."

Contact: Division of Communications