We recently completed a medical mission to Nicaragua, and I wish to send you a report of our activities there. Some of us arrived February 17, and the last group departed on March 7. In total, there were 53 of us, the largest group we have ever taken. Although the core of the group was from the Brody School of Medicine and Vidant Medical Center, we had a significant national and international representation, with members from Florida, Idaho, New Mexico, Colorado, Oregon, Missouri, Kentucky, the District of Columbia, and Ecuador. Our group included a total of eight Brody students and four nurse practitioner students, and members of the faculty from Brody and the ECU College of Nursing. A complete list of participants is attached.
In the adult cardiology clinic, cardiologists Drs. Fritz, Khan, Bellorin, and Rose, and cardiology fellows Drs. Adusumalli, Chagarlamudi, and Kaiser saw a total of 300 patients, most with valvular or congenital heart disease. Each encounter entailed a history, physical exam, echocardiogram, and treatment decisions with a detailed discussion with each patient. The unusual pathophysiology and often striking physical findings offered many teaching and learning opportunities, not just for the students, but also for all of us who participated.
A large number of patients evaluated in the cardiology clinic, approximately 60 in number, required cardiac surgery as the best treatment for their disease. Of these, we selected a list of 10 and presented them to cardiac surgeons Drs. Koutlas and Anderson. They and their team operated on all 10 over a period of 4 ½ days, with extremely successful results. Operations included 3 aortic valve replacements, 2 secundum ASD repairs, 2 patent ductus arteriosus repairs, removal of two benign but very large cardiac tumors, and repair of a ruptured sinus of Valsalva aneurysm. The skill, expertise, and professionalism of this team, operating in conditions of limited resources, is truly remarkable.
Dr. Hannon, working with his colleague Dra. Berrios, saw 60 patients in the pediatric cardiology clinic. Many of these children had unusual and challenging problems, and the educational experience for the students was exceptional. A major challenge for the pediatric cardiologists is to find surgical programs for their patients who require this treatment. There is a fledgling program (supported in part by Project Health for Leon) in Managua which is starting to undertake this project, and other children have been sent to centers in the U.S., including Vidant.
Dr. Jeff Brumfield and his assistant DeeDee Brumfield conducted an electrophysiology clinic and performed a lead extraction in Leon, and later performed radiofrequency ablations in Managua.
Under the direction of Debra Kosko and Drs. Adams, Lehman, and Afanador (both Brody graduates), students worked with Dra. Karla Tellez in a Ministry of Health clinic in the village of Poneloya, where they saw many primary care patients. Some of the students participated in an OB/GYN rotation with Dra. Lidia Ortiz, and others attended the HIV clinic. We also provided two large general care clinics for two days, where the group examined and treated 170 patients of all ages.
Shannon Shambley again led the hospital nurse continuing education project, which has been spearheaded by Dr. Donna Lake, who was unable to join us this year. It has been very popular and has improved nursing care as observed by the hospital chief nurse and by Ms. Shambley. The Nicaraguan nurses who successfully completed the first continuing education program have since provided in-service to other nurses in the hospital.
The collaboration with UNAN School of Nursing continued this trip. Professor Kosko met with the Dean of the nursing school and two of her faculty, all of whom contributed to the nursing curriculum research conducted over the last several years. They were informed that Dr. Lake had submitted our collaborative research article to an English journal for publication and that the Spanish version of the article would be forthcoming. A discussion about further collaboration resulted in the decision that the Nicaraguan nursing faculty would like to submit an abstract of our research to the national nursing conference to be held in Managua in October 2015. Professor Kosko offered support for this effort with plans to collaborate via email and skype in preparation for the meeting.
We worked closely with Nicaraguan physicians, residents, students, and nurses, and our twelve students were organized into four groups each of which contained one nurse practitioner and two medical students. We believe that the interprofessional experience is one of the most important aspects of our mission. We had several discussion/reflection sessions at the end of the day, led by Tom Edwards, which provided structure for examination of many aspects of the experience including interprofessional and cultural competencies. We look forward to receiving and examining a post-trip survey to improve all aspects of the project.
We met with Dr. Jorge Aleman, dean of the medical school at UNAN-Leon, and discussed the continued collaboration of our schools and medical centers, and made plans for two Nicaraguan students to come to Brody/Vidant for a 6 week rotation this Spring. We also met with Dr. Ricardo Cuadra, director of the Rosales Teaching Hospital, and he outlined plans for building a new hospital, solicited our thoughts about the structure of a cardiology center there, and encouraged our continued participation in the clinical program at the Rosales Hospital.
As always, the trip was organized under the auspices of Project Health for Leon, and veteran leader Manny Suarez and his new associate Vicente Vila accompanied us and were invaluable in organizing a smooth operation and in interacting with hospital officials and the Nicaraguan bureaucracy.
It was a joy to once again see many of our former students and the many friends and associates we have gathered over the years. We believe that this is a unique educational and clinical experience for all of us, and particularly for the Brody School of Medicine. We thank all of you for your participation and those of you at home for your support.
John D. Rose, MD, FACC, FACP
Professor of Medicine
Department of Cardiovascular Science
East Carolina University Brody School of Medicine
President, Project Health for Leon