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Carleton Student Faced Challenges at Nicaraguan Children's Hospital

November 12, 1998

For Carleton College senior Melissa Salzman, participation in a recent off-campus studies program turned into the experience of a lifetime. She spent 12 weeks last winter in Nicaragua, where she was awakened each morning at six by the shouts of a street vendor. While her classmates
slept in, Salzman left her host family's apartment in Managua to volunteer at the only public children's hospital in the nation's capital.

A Latin American studies major from Fairport, N.Y., Salzman was on a School for International Training (SIT) program sponsored by Carleton. She sought out the Hospital Infantil Maneul de Jesus Rivera, or La Mascota, as the site for her required independent study project. She quickly became involved in volunteer efforts there.

"It started one day when I heard someone mention a public children's hospital, so I hailed a cab and went over there," Salzman said. "Later I found one of the medical school directors who told me to show up Monday at seven with a white coat."

Beginning with medical school classes three mornings a week, along with the work load of her SIT program, Salzman became heavily involved in the
hospital's operations. After only a few weeks she was assisting in the inhalation therapy ward, and also with blood tests and stitches. "The volunteer work was something I never would have been allowed to do in the United States, but I was capable."

Two months later, after her official SIT classes ended, Salzman started work on her independent study project-examining the effects of financial policies on the health care industry. Coincidentally, just as her study began, the salaries of medical interns and residents were revoked by Nicaraguan President Arnoldo Aleman. "On average, prostitutes make more than medical students in Managua," Salzman said. "I met a student who almost dropped out to vend in the market, just because of the improbability of earning a decent salary." The students could not survive without their salaries and, with no other options, were forced to organize a protest.

Salzman joined the health care workers in a protest march. "We wore our white coats and chanted slogans, marching several miles through Managua to the National Assembly," Salzman recalled. It was extremely hot, and the assembly completely ignored the protest."

Desperate for the government's attention, the interns and residents declared a strike, leaving most hospitals staffed by only a handful of individuals. At La Mascota, Salzman was asked to assist the remaining staff: two doctors and an Italian medical student who spoke only basic Spanish. She worked a 24-hour shift, a commitment normally required every week of the striking medical students.

Due to extreme conditions, Salzman's supervisor often left her responsible for the inhalation therapy room for hours at a time, where over 50 children were waiting for a doctor.

La Mascota was short on medical gloves during Melissa's shift; "they had to be washed and reused. There was no soap or toilet paper in the public
bathrooms, and basic medications like antibiotics and cortisone were constantly running short. At one point we ran out of anesthesia," Salzman recalled. "I held down a screaming girl while her mother watched, hysterically crying."

Because of the rising costs of medical care, most children in Managua only visit the hospital in crisis situations, arriving after traveling for hours on
overcrowded city buses. Privatization in the industry has forced families to choose between food or medical care. Salzman's personal encounters with these tragedies occurred every day. "Many of the women I talked to in Managua spoke of prayer as their only recourse in case of serious illness."

The emergency visits were often unpaid for, leaving hospitals and doctors with significant financial problems. "I lived next to a family of four, ?both of the parents were pediatricians, and the mother had to wash other people's clothes in her spare time to support the family."

To complete her independent study project, Salzman wrote a 30-page paper on the taxation of aid shipments and its effect on inflation, unemployment and the health care industry. She included many of her personal stories from La Mascota, and other experiences with political organizations. "As a part of my research, I attended the national convention on public health and met the head of the health ministry," Salzman said. "The convention was only for doctors, but I asked some of the employees at the hospital if I could go, and they said yes. I was pretty surprised."

As a result of Salzman's project, SIT now suggests "structural adjustment in the health care sector" as a research topic for its Nicaragua program.

Salzman plans to return to Nicaragua as soon as possible, to see how the country's health care system has changed since her last visit. "I really learned a lot there," Salzman said. "I want to go back."

Addendum: On Monday, Nov. 16, Salzman is one of several Carleton students who will be at the Nicaraguan Embassy in Washington, D.C., to protest Nicaraguan President Arnoldo Aleman's recent refusal of humanitarian foreign aid in the wake of Hurricane Mitch's devastation. She also has organized a benefit concert to help fund hurricane relief efforts.