NICARAGUA, NOVEMBER 2017 – Scott Kuzma MD, Class of 2018

As I prepared for my trip, the idea of traveling to a country where I didn’t know the language, culture, or procedures I’d be performing was admittedly a little terrifying yet exciting at the same time. I felt grateful that I would be able to have a chance to help provide care to those who needed it most.

My week started at a clinic in the public hospital. The Nicaraguan residents had arranged for a select group of patients needing treatment for their foot and ankle conditions, as no specialist was available locally. When we entered the clinic, all of the patients for the whole day were lined up in the hallway waiting for us. They had arrived early in the morning and would wait as long as necessary just for the chance to be seen by us that day. The “exam room” was merely a repurposed classroom where we saw patients simultaneously on opposite sides of the room as few of the residents translated for us. Working alongside them, we evaluated, triaged, and arranged surgeries for the week. While challenging, it was rewarding at the same time seeing the patients so happy that we could help them regain function or relieve their disability.

After we wrapped up our clinic, the residents took us to our hotel but were unable to stay and relax, as they had to return to prepare the specific implants for the next day’s cases. I was surprised to learn that each implant and piece of hardware was individually selected and sterilized ahead of time instead of selected from a pan with multiple choices intra-operatively. I was just beginning to see some of the challenges that would arise.

The remainder of our time was spent in the operating rooms, at three different hospitals. Each location had its own obstacles, from limited implants at the public hospital, power outages at the children’s hospital, or absence of fluoroscopy in Jinotepe. Yet at each location, the local surgeons helped us roll with the punches and be able to provide the necessary care for our patients.

One case that stuck with me was a patient that had sustained a distal tibia and fibula fracture. Due to the difficulty in accessing care and the necessary implants, non-operative management had been attempted, but he unfortunately had developed a non-union with significant deformity. In a society so dependent on physical function, this was completely debilitating, so it was arranged that we would correct his deformity while we were there. In this hospital, there was no intra-operative x-ray, which took us out of our comfort zone. Using careful dissection and identification of anatomic landmarks we corrected the non-union, fixed the bone, and realigned his leg. Post-operative x-rays showed that we had corrected his alignment and gave the patient the best chance we could to regain his functional independence. While we won’t know if we were ultimately successful for a few months, knowing that the skills I’ve learned during residency provided such a strong foundation to provide care in new ways was very rewarding.

Reflecting on the week, I think about the disparities between Nicaragua and the United States, both in health care and life in general. Thinking of the luxuries we enjoy here and things we take for granted would be life altering there. It provided me a new perspective on my place in medicine and the world and striving to make it better for everyone. Having the privilege to go to Nicaragua as part of my residency was an invaluable experience that taught me many lessons and will enhance my future practice.