Medical Notes from Nicaraguan Villages, by COEMT

Here are some insights that I gained from a recent week-long medical mission trip to Nicaragua. We treated hundreds of men, women, and children living in remote villages for general medical complaints.  I envision these conditions as being similar to what many of us would see in TEOTWAWKI.

Living conditions:
Mostly, the men in these villages are subsistence farmers, picking coffee beans, or something similar.  The women stay at home and take care of the children, grandparents, and animals – chickens and pigs.  Their average income is very low, in the 10’s of dollars per month.

Their houses are really shacks made with available materials.  They were about as big as a two-car garage, some quite a bit smaller.  Many are composed of corrugated steel sheets, plastic sheeting, and some planks.  Some have adobe walls, but few are all adobe.  With many people in a small space, they are very crowded.  One family I interviewed had 11 people in the home, probably in 3 rooms.
Their cooking is done entirely over a wood stove, many indoors without chimneys.  Smoke inhalation is a constant for everyone in the house. 
Their diet consists mostly of rice and beans to eat with coffee, soda and juice to drink.  There is literally no money left after they buy wood for cooking and their food.  There was even a sad story of how a pot of beans on the stove must be guarded against theft.

Primary medical complaints:
1)       Headaches, Dizziness – from dehydration.  They know the water has parasites, so they mostly drink coffee and sodas or juices which all dehydrate at some level.
2)       Burning eyes, sore throat, coughing – from smoke inhalation all day long
3)       Muscle aches – from lots of hard manual labor, walking everywhere, carrying children all day, plus dehydration
4)       Gastritis, Heartburn, Abdominal Pain – from intestinal parasites gotten from drinking surface water and eating beans daily, and lots of coffee.
5)       Tooth Decay, Abscesses, Rotten Teeth – from not brushing/flossing and drinking mostly sodas and coffee every day.
6)       Infections requiring antibiotics – of almost every conceivable type.

NOTE:  I’m a licensed EMT.  The below lessons are intended as educational material and do not constitute medical advice inasmuch as they may be outside of the scope of my practice or coming from instructors, experience, or reading.  The lessons are, however, within the scope of my many years of life, caring for myself and my family members.  And, in case you’re wondering, I was working under the direction of a Physician’s Assistant and an Nurse Practitioner.  I also mention several brand-name OTC products below.  I only use them because most people will recognize them a lot better than the chemical name of the medicine.  Please use your own good judgment on what is best for you and yours.

Lessons taken for TEOTWAWKI scenarios
1)        Have a way to obtain pure water without fire.  Bleach or Pool Shock (calcium hypochlorite)  work well and go a very long way.  At 1 tsp to treat 10 gallons of water, a gallon of bleach can treat up to 7,680 gallons, or enough water for a family of 4 for over 5 years, at a gallon per person per day.  (This is from a government web site.  Please do your own research.) 
If I could have handed out a quart of bleach to each family, it would change their lives.  Unfortunately, they cannot afford it on their low incomes.  And they can’t afford the wood to both cook food and boil water.

2)       Drink lots of clean water.  Most of us aren’t used to heavy physical labor all day, every day.  Drink as much as you want.  While working, you may sweat more, but you’ll stay cooler. 
Most of the folks I saw were dehydrated.  In one case, I had a sickly-looking pregnant woman drink as much clean water as she wanted.  About 20 minutes later, she looked way, way better, and said she felt better too.  Wish I could have given her a 55 gallon drum to take home.

3)       Avoid smoke inhalation.  This is so obvious as to sound stupid, but the Nicaraguans didn’t even think about the problems they cause themselves.  To avoid smoke, cook with fire outside, on a wood or gas stove with chimney inside, or without fire.  Gas, of course, doesn’t create smoke when burned, so has better OPSEC, but residual carbon monoxide is even more dangerous than outright smoke.  Solar ovens and solar-powered electric stoves/ovens are good choices as well.
The only remedy I could give those folks was to recommend they get themselves and their children outside and away from the smoke as much as possible, and to open their windows and doors – if their homes even have them.

4)       Muscle aches are a given when doing the daily activities that will be required in TEOTWAWKI.  Chopping, lifting, carrying, picking, bending over and so on take a toll on muscles.  A couple more pain reducing strategies include taking stretch breaks and learning to use the other side of your body.  Switch the tools to your other, non-dominate hand.  It’s uncomfortable learning a different way to do things, but you’ll be able to work longer and more comfortably.  Start practicing now when you don’t need it to get comfortable with it when you really need it. 
I recommended this to my patients.  I can only hope they will follow through with switching hands/arms/sides every so often.  I also wish I had been able to give out tubes of Ben Gay to everyone I saw.  It’s not a cure, but it sure feels good when you’re sore.  Advil/Ibuprofen will work, but it has some fairly serious intestinal side effects – mostly upset stomach and constipation – not good for those folks.  Aspirin and Tylenol (acetaminophen) will also work, but equally isn’t great for long-term use.

5)       Get a few pairs of really comfortable, sturdy work and walking shoes.  Break them in now so you won’t suffer when you need them. 
The only people I saw with good boots were the men who worked in the fields.  Many of the women wore flipflops – because that’s the only pair of shoes they owned.  And they walked on rocky roads and paths all the time!  Not good for many reasons.

6)       Have a lot of intestinal meds available.  The list of intestinal problems is long:  Diarrhea, constipation, gas, heartburn, vomiting, etc.  The effects are pretty simple:  pain, discomfort, and disability.  And it’s difficult to work when your belly hurts.  Example meds to have on hand:  heartburn – Tums or Rolaids; diarrhea – Imodium; constipation – stool softener and enema bag; vomiting – Pepto-Bismol; gas – BeanO or Tums.  I recommend having a few treatments of each type for each person in your party.

I gave these meds out to dozens of my patients for temporary relief, along with antiparasitics as a long-term solution.  You shouldn’t need antiparasitics if you are careful about purified water.  If not, you’ll need them, plus a bunch of other meds for the diseases that also come with contaminated water:  typhoid and dysentery among others.

7)       Brush and floss your teeth every day.  Brush your tongue.  Use an antiseptic mouthwash (Listerine).  Have a dental hygienist in your group.  Do everything you can to keep your teeth, tongue and mouth clean.  This is such a simple thing, but without dental care easily available, it can get out of hand quickly and the solutions aren’t good.
Many of the people we treated needed more than a few teeth to be pulled.  Some patients as young as 12 years old.  In some cases, our dentist didn’t even pull all of the teeth he could have because of the risks to the patient with no longer-term or follow-up care. 

8)       If you’re going to get antibiotics at the pet store, get a bunch of education too.  Our pharmacy was extremely well-stocked.  We had about every antibiotic you could name:  Amoxicillin, Doxycycline, Erythromycin, Penicillin, and so on.  This was a new area to me, except from personal experience.  It’s a very complex topic incorporating microbiology, pharmacology, and lots of other “ologies”.  The big thing I learned is that antibiotics are specialized also.  One antibiotic will work for one thing but not touch another.  Going to the pet store and stocking up on FishMox in the belief that it’s a cure all is false hope and could cause someone to die.

Learn as much as you can about what you’re buying/getting.  If you go down this path, you’re in deep water.  The fancy medical words are indications, contraindications, effects, side effects, route, dosage and so on.  The English words are what you take it for, when you don’t take it, what it does that you want, what it does that you might not want, how you take it, how much and so on. 
My own story is that one stepson had an infection that required three different antibiotics prescriptions before he was cured.  The first antibiotic didn’t do anything.  He got hives from the second one.  The third one finally worked.

One comment:  Antibiotics are only useful for bacterial infections like pneumonia. They do nothing for viral infections like the common cold or flu.  Unfortunately, it’s very difficult to tell the difference between the two, even for doctors.  The only reason a doctor should give out antibiotics for a cold is if there is a real risk of pneumonia.  The current superbug scare we have is due at least in part to overprescription of antibiotics.  The germs that are left are resistant, as well as having mutated, rendering the current antibiotics harmless to them.

9)       Bactine and PhisoHex are a fantastic combination for superficial wounds.  While in country, a couple of teammates came to me for small wound treatment.  I had an AHA moment with Bactine.  It’s terrific in two ways:  topical pain reliever and antiseptic.  Topical (on the skin) pain relief is rare in the OTC med world, but super useful because I wanted to scrub the wounds to get rid of any dirt.  The antiseptic property is also nice to have.  Phisohex is another wonderful thing because it’s an antiseptic soap that doesn’t sting when you wash/scrub with it.  NOTE:  this is not a pain-free solution.  It hurts less.
I simply applied Bactine, waited for a while, then scrubbed with Phisohex and a few sterile gauze pads.  Then I reapplied Bactine for more pain relief.  In two cases (a big toe and forearm) I applied a Band-Aid for protection.  The other, I didn’t (head wound).

10)    Hand Sanitizer is wonderful  in a pinch, but doesn’t replace washing.  Being raised before the current germ phobia developed, I’ve never been big on hand sanitizer.  Of course, I used it in the Ambulance and Emergency department.  But I used it regularly while I was working in Nicaragua, treating dozens of people each day.  I have no idea what they might have been carrying, but I’m sure I’m not immune to it.  It’s a quick and easy dose of insurance when you’re in a hurry.  Washing with soap and water is even better. That said, I want to point out that keeping a house spotlessly sanitized and trying to keep the family in an antiseptic bubble is not good for  long-term health.  Reason being:  Our bodies develop immunity to germs through exposure to those very germs!  If you want to have the most robust immune system, go get dirty with a bunch of people!  Yes, you might get sick, but you’ll be immune when you recover, at least for a time.  This is exactly how vaccines work – exposing you to the specific germs you want immunity to.

Final note for SurvivalBlog readers:  all medical training is valuable, although difficult and time-consuming.  I started down the EMT/Paramedic path when I started seriously prepping last year.  The more I learn the more interesting and useful it is.  As one EMT I talked to said, “You never know when you’ll need it.”

JWR Adds: The SODIS method for water sterilization is ideal for impoverished regions, since the plastic bottles can be obtained free at almost any dump. If you are careful handling them, the bottles can be useful for several years.

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