Location, location, location. Let us, dear friends, take a tour of some private health clinics in Nicaragua. Because those are the only tours I’m going on of late.
First, Estelí. Nicaragüenses will tell you that Estelí (and Matagalpa, Jinotega, Somoto, etc.) is in “the North”. By this they mean “north of the PanAmerican Highway”; they must, because it sits in the mountain range which evenly splits Nicaragua north-south. No one lives in the true north. Except mosquitos. And Misquitos. Hehehe.
Second, León. Firmly in populated Nica, along the PanAm. I guess-timate that the city center is approximately three times the size of that of Estelí. Loads of locals, expats, and tourists stay here and make it a cross between industrial Managua and touristy Granada.
I had the fortune to visit Estelí’s Adventist Clinic two days after Christmas. My first-ever urinary tract infection – which I either picked up from mediocre sex or an awful bikini wax; both are possibilities, but one is significantly more probable 😉 – had left me with a terrible tingly hurty sensation in my hoohah and a solid ache in my left kidney.
The taxi took me to this particular clinic after he and two other clients (taxis are shared, which really pisses off the Europeans) decided I was too stupid to navigate the free clinic.
Note: I feel quite certain that I would take into account the fact that someone is ill, is not from the area, doesn’t speak the language all that well, and that there are no signs on the free clinic and offer a bit more aid before I decided he is stupid. But I wonder if this is only because I’ve been in these situations.
The clinic receptionist was standing in the doorway. After not responding to my greeting, I decided she wasn’t the receptionist. And then I stood for two minutes – every single minute is a big deal in UTI Land, real talk – in front of the reception desk until the doorway lady came back and barked “Degame“. For those who don’t know, barking “degame” is the Spanish equivalent of a Waffle House waitress spitting “whaddya want?” through her gum snaps.
Every clinic visit starts the same: you embarrassingly give the receptionist way too much information, she counters with “so, you need a consultation?” and then hand-writes your name, DOB, and nationality on a piece of paper. At this point, in a private clinic, you will also need to pay for the consultation (which they insist on calling an exam), between $6 and $10. And accept your large, hand-written receipt.
You give the aforementioned piece of paper to a nurse who takes your weight, blood-pressure, pulse, and temperature (under the arm, what?). She scribbles these vitals on a second piece of paper, onto which she’s previously hand-copied your name, DOB, and nationality. She sends you back to the receptionist who will direct you to the consultation room outside of which you need to wait.
In the Adventist Clinic of Estelí, the nurse assigned to take my vitals led me to a room in which a disheveled looking man in a wrinkled, short-sleeve dress shirt and faded, high-water dress pants (no man over the age of 30 wears jeans) was sideways slumped over the bed, looking either hung-over or still drunk. She shooed him away but didn’t bother to change the linens. Thankfully I didn’t have to sit there.
After the vitals session, I was directed to pee in a cup. In a bathroom with no toilet seat, no toilet paper, and no soap. I knew right then I would probably catch MRSA and die in this clinic. Then a different lady, a lab technician I think, took my blood without wearing gloves. Jesusmaryandjosephiamgoingtogethivtoo.
I was ushered directly into the consultation room, and was followed in by the disheveled hung-over dude. His name, it turns out, is Doctor Disheveled Hung-Over Dude. He did not wash his hands in my presence, a practice that I had never fully appreciated to this point.
My exam consisted of him listening through a stethoscope to my kidneys – really? that’s a thing? – and then pounding on my stomach a few times. He then talked really really fast (people in this region don’t really respond to “slowly, please”) about symptoms and medicine. I was instructed to wait in the lobby for up to two hours for the results of my urine and blood tests.
People in Nicaragua love to sweep and mop. I don’t really think they love it, but I have no other explanation for why they “clean” floors but no other surface anywhere ever. Case in point, a woman in a ratty tee shirt and jeans was sweep-mopping the floor of the clinic. The mop didn’t pick up that used band-aid, but it did manage to sweep the larger bloody bandage into the courtyard gutter. Fuckmeishouldleavenowifiwanttoseemyfamilybeforeidie.
An hour later I was ushered back into Dr Disheveled’s room where he informed me that I did, in fact, have an infection. Duh. There was also something about the infection being in my blood, but I’m not sure if that was fact or possibility. Anyway, the sign which had clearly been drawn by the doctor’s equally drunk 10-year-old daughter about washing ones hands after using the bathroom or treating someone with dengue was distracting me from our conversation.
He wrote me a prescription for an antibiotic to which I “might be allergic based on my penicillin allergy” – Whatthefuckdidhejustsayheseriouslywantstokillme – and a urogesic for the pee pain and some aspirin. The clinic’s farmacía, located next door, didn’t have anything but the aspirin. But the other farmacía next door to it had everything and it was cheaper and they took credit cards. All in all the drugs and visit cost me about $38. I slept the rest of the day and by the evening was ready to go to the rodeo.
I ended that round of antibiotics Friday the 3rd. When I woke Wednesday the 8th, I knew my little friend was back. And so began my tour of the AMOCSA clinic in León.
I was first directed to the cashier and paid $10 to see a doctor. (There is also a public, free, hospital but the line was HELLA long.) AMOCSA was right away cleaner, but for some reason had a real shortage of light. And after the vitals session when I had to pee in a cup, there was again no seat, no paper, no soap. However, the woman who took my blood had a glove on each hand!
The doctora was super-nice and explained things slowly and well, using synonyms and once my dictionary for words I didn’t know. She also explained that Dr Disheveled had wanted me to return after three days to determine exactly what bacteria I was growing and treat it specifically – it wasn’t written, that’s just procedure. I didn’t catch that the first time around, but I bet it would have been really helpful. If only he had cared as much as she did that I understand what the f was happening.
I needed to give two hours for the lab to process the tests. For some reason their labs are super convenient, super inexpensive, and super fast. I had to pay for them before hand, which meant another tour to the cashier, but they cost $4.
I returned after breakfast and the doctor said I did in fact have an infection. ::sigh:: And I could either check myself into the hospital for two days and be connected to an IV drip of medication or I could remain an outpatient and return each day for the next five days to receive an injection.
My insurance would have covered the stay, but honestly I was worried about bloody bandages on the floor – have I already mentioned the lady mop-sweeping the floor at AMOCSA also?
The doctora wrote the prescription and directed me to the farmacía next door, also owned by the clinic, to purchase everything. To my surprise, that included the syringes, the saline solution, the medicine, Tylenol, and the IV thing to keep in my hand. Why can’t the clinic just charge me for these things? Good question.
My bonus side tour of the farmacía went like this: one lady took the prescription from me, another lady put the drugs in a bag, a third lady took my money, and a fourth lady gave me the receipt and the bag. I felt like a car on a moving assembly line.
So, now I have this magnificent piece of hardware in my hand for the next five days. And each day I take a syringe, a bottle of saline solution, a vial of antibiotics, and $1 – Why can’t I just pay for them all in advance? Good question. – to the clinic for them to shoot me full of antibiotics. This will cost me less than $50.
On Monday I have to take more urine and blood tests to see if the infection is gone. Wish me luck.