Prison Update

So the plan was to do a weekly clinic in the prison......
Week one:
Brendon, Nestor (our driver) and I are ushered into the heart of the prison with alomost no fuss. We were able to set up in a small room in the medical block. I had a desk to consult from. Bren and Nestor had another table from which to dispense all our medcines. Steven was allowed to come and help us and he brought one of his friends who was able to help me with translation.
We saw 25 or so patients in the morning, msotly things we could treat; musculoskeletal problems, high blood pressure; fungal infections; stomach ulcers.
A few patients had worrysome symptoms that would require investigation outside of the prison. There is a system for this and I was assured it would be arranged. The prisoners assisting witht he clinic seemed less confident.
One patient had epilepsy (I was later told there are 5 men in the prison with epilepsy) The prison pharmacy has no anti-epileptic medication and nor did I.
One patient had a hernia in the scar of a previous operation. He told me he had had appendicitis. His scar however was huge and implied that he hadn't been treated untill his appendix had burst, causing a more serous problem.
One patient told me he had a type of inherited heart problem. He did indeed have an enlarged heart. I wasn't however granted access to the medical files of these patients to see what tests they had had previously.
The prison doctors (4) were very friendly. They were welcoming and seemed keen to work together, though not offering me their files which did limit what I could do.
Treating prisoners was a first for me. Part of me was interested in what crimes they had commited. On reflection I'm glad I didn't know. Not only because I would have been more scared had I known, but more that I wasn't distracted from treating these men with the respect I would try to give every patient. In the respect and value which I tried to show, I hope to have communicated something to these men who live in very hard circumstances.
I left optamistic that I was being welcomed to be a part of a medical team working in a difficult environment with limited resources. I felt I had something to contribute; in bringing some extra medicines; in running some extra clinics and on working on the best treatment plans for patients with chronic illnesses.

Week two: no-one seemed interested in letting me in to do anything. None of the doctors made it out to meet me. I spent the morning in the waiting room.
I went home disappointed; and prayed a bit more, remembering that this had seemed to be the important aspect in the beginning.


Week three: The prison governor met me to ask if I would do the clinic for the guards. I was aware that this man holds all the power in the prison, so I was keen to play ball.
The prison serves 2200 inmates and employs 500 guards. They run regular health clinics for the staff as well.
One of them seemed rather unwell, a man in his 30's having been told previously that he had diabetes, but that day seemed to me to have some sort of liver problem. He was hopefully transferred to hospital. I've not had opportunity to see what kind of care is available in the hospitals here. i can only hope he gets the treatment he needs.
This time I went home happy to have done some medicine, telling myself that even if it wasn't group I had wanted to treat, they were still sick people and that is what I'm there for.
Week four: I'm told this time by the governor that I can no longer enter the prison untill I have a letter of authority from the govenment minister who overseas the prison service. It seemed pointless to try to argue that this seemed a strange thing to bring up now, and it been required of other people I had met who also do volunteer work within the prison.
Fortunately Sandra's husband had worked previously in that government department. He may be able to get my paperwork processed more quickly.
So we shall see. Its frustrating. I'm not the first person to comment that nicaraguan infrastructure seems designed to slow or obstruct progress. I still hope that there is more good to come of this.