One Step Forward, Two Steps Backward

(This post follows the previously posted blog "Trouble with the Law", which saw Dr Robson meeting resistance at customs while attempting to bring medical supplies into the country.)

I had arranged to meet with Rob, the local FIMRC organizer, to give him the customs receipt to retrieve the medications at the airport. I was advised that Rob would be at the Las Salinas clinic on Friday afternoon and on Saturday morning. Thereafter, the FIMRC group were scheduled to close down operations for the Easter Semana Santa week. I was scheduled to work at the Roberto Clemente clinic on Friday, so I advised FIMRC that I would drive to Las Salinas later on Friday afternoon. When I arrived at the clinic, there was no sign of Rob and after waiting for half an hour, I left.  I emailed the FIMRC folks and I had hoped to hear back with a revised time to meet Rob, but I haven't heard back.  This morning (Saturday) I will drive back to the clinic and I hope Rob or someone is there.  Otherwise, I guess that means the medications will not be used. Perhaps if the medications are still at the airport when I return to Canada, I can take them back home. This feels like a step backward.
The second step backward is the lack of power and internet at the casa where we are staying. Lack of power means no ceiling fans and this means a very sticky sleep. Lack of power means flashlights and candles after 7 PM. Lack of power means no coffee in the morning. Amazing what we take for granted. 

The step forward yesterday was the work at the clinic. We saw over 10 families, most with more than 1 child, and courtesy of the portable printer, each mother was presented with treatment recommendations written in Spanish. Another copy was signed and became part of the permanent medical record for the child. On this visit, we started plotting weights on CDC growth charts.
There were no seriously ill children yesterday. The common presenting complaints were poor appetite, poor weight gain, headaches, fever, and nosebleeds.  

There were 3 children with headaches. One child had classic migraine, another child likely had migraine, and the cause in the third child was not clear to me. This last child had headaches that had routinely awakened him in the middle of the night for over a year!  When headaches wake a child, this is considered a "red flag" for a potentially serious neurological problem. His neurological exam was normal. He was only 5 years old but he cooperated well and he allowed me to visualize his discs with the ophthalmoscope and the margins were crisp, which was reassuring. In Canada, this child would justify referral to a paediatric neurologist and he would likely have a CT scan. I discussed this with Dr Flore, the clinic doctor, and if the boy does not improve, perhaps this can be arranged. I otherwise offered a variety of analgesia options for the mother to try. 
One 11-year-old boy was overweight. Overweight children are not common in Nicaragua. Most are shorter and thinner than the average Canadian child. His blood pressure was borderline. Diabetes and hypertension are apparently very common in the adult population. I explained to Mom that her son was 9 kg overweight.  I outlined an exercise program with fast walking or jogging every day in the cooler hour immediately after dawn. I made specific nutrition recommendations. I advised Mom that if he didn't loose weight his risk for diabetes and hypertension was likely high. I know the Mom took these recommendations to heart because she has adult family members with diabetes.

This first clinic day on the second trip felt like progress, and progress is good.

We didn't manage any clinic photos so another gorgeous sunrise will have to suffice.  

DISCLAIMER: This blog was originally posted on Help Nicaraguan Children. Please note, Dr Robson is not accepting donations at this time. However, he would greatly appreciate your comments and suggestions in support of his efforts.