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Swapping bathing suits for scrubs and sunblock for medical supplies, Ryan Klitgaard headed off to one of South America's poorest countries for spring break this March. The Texas Tech University medical student spent a week in Nicaragua on a mission trip, setting up and working at a clinic outside the small city of Jinotega.

Patients lined up for everything from eye exams to treatment for parasitic infections and even machete wounds. Klitgaard and a group of about 30 students helped treat them. On occasional visits to a nearby hospital, he assisted maternal health doctors while doing his best to fend off stray dogs – and sometimes, chickens – wandering about inside the hospital.

Here's a look at his experience.

What woke you up in the morning?

Once the sun comes up around 4:30, every Nicaraguan is outside, going about their business. And it can get very loud, very quickly. There's a newsman that would walk around every morning with a megaphone, screaming, "LA PRENSA, LA PRENSA, LA PRENSA," which is "print" in Spanish.

A daily task that you had to do differently?

Plumbing is not as robust as it is in the United States. They use coffee machines to heat the shower water. So at the top of the spout, there was a coffee machine rigged to it. And when you turn on the water, it would slowly dribble out hot water.

A surprising sight?

For some reason in Jinotega and in the rural areas, everyone and their daughters walk around with machetes. We had two pretty significant machete injuries that we had to deal with at the clinic — one man had cut his leg, the other almost lost his fingers. Luckily we brought with us a doctor that does dermatology, who was able to clean the wounds and suture them back up.

Most memorable experience?

The mothers [I saw] there are extremely young, for the most part. A 17-year-old was having her first baby, and she had a really long and difficult labor that lasted 12 to 13 hours. When they finally got the baby out, it wasn't breathing, so the worry, the hope and the despair was palpable. The doctors and the nurses were trying to stimulate the baby's diaphragm by rubbing its back, and after several very tense seconds, they finally got the baby to start breathing. I don't cry often, but there were definitely tears. It was surreal. It was like time had stopped.


When we were talking to the patients, trying to figure out what their problem was, they did a lot of pointing. A lot of patients would point at their stomachs, indicating they had some pain there. I kept asking them about their bowel movements, and they seemed very confused. It turned out they were actually trying to say they were having trouble urinating.

Funny moment?

In Nicaragua, there are stray dogs all over the place, and there really was no way of keeping them out of the hospital. It's kind of a shock to see really, in a place that was supposed to be sterile. As you might imagine, lunch time is when we would have the most trouble — no matter what we said or did, we could not get this dog just to leave us alone. Then our translator walked by, spoke really quickly in Spanish and the dog just kind of wanders off. He told us to just say anything we know in Spanish until it goes away.


You really admire these health care workers who are able to do so much with so little. They have one fetal heartbeat monitor in the whole hospital, so they have to share it with the gynecology department, ICU and labor and delivery. And with those machines, you need lubricant, and they have so little lubricant that they are only able to put in one tiny drop before using it.

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