Dr. K. Linnea Welton completed an off-site elective at the public hospital (Hospital Escuela Antonio Lenin Fonseca - HEALF) in Managua, Nicaragua. This hospital provides free(or nearly free) healthcare to Nicaraguan citizens and provides medical services for a large catchment area. Here is what she had to say about her trip:
Treatment of subacute fractures and chronic osteomyelitis were common cases that are not normally encountered to the same severity as at my home program. The management process of fractures, arthritis, sports-related ligamentous injuries were often done differently because of the severely limited resources, ability for patient follow-up, and surgeon knowledge. So while many of the orthopaedic disease processes I saw were fundamentally similar to those back home, the methods by which they could be managed were unique. HEALF is a 90 bed hospital and in addition to caring for the indigent and low-income population, receives referrals of difficult or complex cases from hospitals around the country outside of Managua. Common cases at HEALF are complex articular fractures, open long-bone fractures, and machete injuries to the hand. The wards are inhabited mostly by open fracture cases in various stages of treatment. Clinics occur on a daily basis and are predominantly resident driven. The Orthopaedic Department also has a designated room in the ED that sees patients on a continuous basis and is staffed by both residents and an attending during the day (and by a resident all night).