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Background Information about Nicaragua: • Largest country in Central America. • Population: 6 Million • Language: Spanish History / Overview of Healthcare System: • Originally a colony of Spain, but gained independence in 1821. • Independence was followed by decades of internal turmoil with the Nicaraguan Revolution

finally ending in 1979 with the socialistic Sandinistas emerging victorious. • The newly forming government implemented a multi-tiered socialized healthcare system

that allows universal access to care to citizens at no cost. • A series of local health clinics serve as primary care checkpoints where patients are triaged

& treated and can be referred to better equipped medical centers in the cities.

Introduction

• Improve on our Spanish language skills • Learn the fundamentals of navigating a universal health care system in a developing country • Improve basic history taking and physical exam skills • Understanding the barriers that individuals of a lower socioeconomic status encounter each

day through a cultural immersion experience. • Literature Review of Teen Pregnancy Interventions implemented in Nicaragua

Objectives

• Attended individualized Spanish language lessons 4 hours daily. • Shadowed physicians in the federal medical center Hospital Escuela Oscar Danilo Rosales

Argüello (HOEDRA) in the emergency department, pediatrics, internal medicine. • Rounded with physicians and medical students in the wards. • Attended medical school lecture and seminars. • Commuted to satellite village of El Tololar to assist the physician in the local Puesto de

Salud. • Interviewed and Examined patients. • Home visits throughout village to provide vaccinations and consults. • Presented daily “Charlas” to increase health awareness on various topics. • Travelled within community to gather demographic information on each household

for the Ministry of Health Census. • Performed literature review on current teen pregnancy interventions in Nicaragua. • Interviewed local NGOs to gather more information about current interventions

implemented in Nicaragua.

Our Experiences in León: Future Directions: • Contributed to an ongoing research study aimed at identifying root causes behind

Nicaragua’s disproportionately high rate of teen pregnancy • We are in the early stages of developing an exchange program between UMMS and UNAN

Leon Medical School where students would: • Attend 2 hours of Spanish Language Class every morning. • Attend 2 hours of Semiología or Tropical Disease Seminars every morning after

which students will spend 4 hours in the hospital practicing skills learned that day. • Students will be paired with Spanish speaking medical student for mutual peer-

based language learning as well as a chance to develop international professional relationships.

Acknowledgements:

Photo of Map of Nicaragua: https://visionnicaragua.files.wordpress.com/2009/04/map-of-nicaragua-with-bethel.jpg Photo of Augusto Sandino: http://www.dadychery.org/wp-content/uploads/2012/05/Sandino_1927-e1338244802354.gif https://visionnicaragua.files.wordpress.com/2009/04/map-of-nicaragua-with-bethel.jpg

References:

University of Massachusetts Medical School: Dr. Michael Chin, Dr. Ann Moormann, Dr. Olga Valdman Universidad Nacional Autónoma de Nicaragua Leon: Lic. Brunilda Paragon, Dr. Estella Urrutia, Dr. Carlos Ortiz, Dean Jorge Aleman University of California Los Angeles: Rafaela Rodriguez

Charles J. Nessralla and Jonathan Q. Quang University of Massachusetts Medical School and Universidad Nacional Autónoma de Nicaragua

Understanding Healthcare in Nicaragua