Brazil 2019 by Jessica Kimmes

I was fortunate to be accepted to and went on a medical mission trip to Brazil in April with the New York State Nurses Association. During our time there our group; which consisted of two other Nurse Practitioners, myself, eleven Registered Nurses, and one Medical Doctor, went to two different states to do volunteer medical work where together our group saw almost 1300 patients. We started in Manaus, a state that is in a region of the Amazon. There we partnered with the local Brazilian Nurses Association. It was wonderful because at all of our clinics we had volunteer nursing students who were translators and some local doctors who saw patients alongside our group. The nursing students were excited to hear what it was like to be a nurse and especially a nurse practitioner in the states, as they do not have a similar role to a nurse practitioner in Brazil. I was also interested to hear what it is like to do nursing in Brazil. For example, they were fascinated by the nurse practitioner role because they told us that nurses are always held to a subordinate role to doctors in Brazil, although in contrast I found it interesting because they reported that in more rural areas, nurses can prescribe for a few ailments, mostly related to STI’s or tuberculosis.

Amazon 1For our working days, with the nursing students and local doctors for two days our group split into two as we had two medical mission sites to cover each day. The first site was held at a local village, the second at a school. There we offered free primary care clinics. We had supplies that we brought with us from the states including basic antibiotics, antifungals, and antiparasitic’s. We even had an EKG machine, some diabetic medication and medication for hypertension and hypercholesteremia. Local volunteers registered the patients and we set up folding tables/chairs in classrooms to see patients.

In doing these trips and seeing the patients I do, I often know what inspired, amazed, and touched me on these missions, but what I hope for is that I am able to made a difference for someone else. I have always felt that I receive more than I give on these trips, as I am constantly inspired by the children and how resilient they are. In Manaus, we worked with local tribes who do not have access to healthcare unless they travel hours from their home village, which is often very difficult or can even be impossible. The bridge to their village is composed of planks nailed together with no guardrail besides the branches that serve as poles. On this bridge, half a story above murky water were alligators live, the children run back and forth with abandon. They paint their legs with black stripes as part of tribal tradition, but also to ward off snake bites.  They have no access to regular electricity or plumbing and by our modern world standards they are very poor. Yet despite this it is heartening to see how healthy they are. I treated the usual primary care issues, a cough here, a rash here, and more commonly parasitic infections. What I was struck most by on this trip though as well, is how well behaved the children were for exams. Whether it was because they were unused to getting them so didn’t know to protest, perhaps were thrown off by an unusual face, or just had no need, almost every child no matter their age sat still for an ear exam and even throat exams!  

For our second clinical site we traveled to the city of Recife. What struck me most was that the children there actually seemed to have more ailments. There was a higher rate ofAmazon 4 respiratory problems ranging from simple upper respiratory infections to asthma and allergies. I also saw some interesting cases, such as a uvula pillar that was so high it almost seemed abnormal. Upon further research, a similar case study was mentioned in a surgical ENT journal of a referral that was made in the states and ultimately diagnosed as within normal limits, but it was so rare that the provider had referred them and it was written up, and that patient was also from Brazil! I was also reminded that at the end of the day despite resources and access, which of course are essential in healthcare, what is even more essential is the interaction between provider and patient. I had one mother who came in with her daughter who had been diagnosed with a pineal cyst. She had an MRI report and had seen a neurologist, yet she came to our free clinic to make sure everything was ok. After going over her documents and history, I advise the mother about symptoms to watch for and monitoring with follow up. She expressed her appreciation at the explanation and how it made her feel better. It was wonderful to me because I was reminded that this is why we are nurses, and how it is in our interactions that we make the difference. It is the connections you make and the human interaction that at the end of the day, you never know what difference you might have made. I often struggle with wondering about the sustainability of ‘drop in’ clinics and free care like this, where we know sometimes our follow up is limited personally (although in our case we had local providers who were documenting and following up, many missions do not) and the resources it takes to get us there sometimes seem like maybe they could be used in more sustainable ways.

These interactions though, the unique things I saw, the interactions with the patients and the local doctors and nurses, that is where the benefit is, that is what inspires me and keeps me going back. In all things, but especially in medicine we never know the one person’s life we may change, and I think in turn how they will go on to change other’s lives. Thank you ONAAT for being a vector for change, through us nurses. I am grateful, humble, and thankful!

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Respectfully and gratefully,

 

Jessica Kimmes