Bringing otologic, audiologic services to NicaraguaExpanded from the print edition

By Theodore McRackan, MD

Ted McRackan and Ilka Naumann look over a pre-operative patient’s CT with the residents.

Over the last 11 years, Mayflower Medical Outreach (MMO) has established an impressive presence providing otologic and audiologic services as well as deafness education in Jinotega, Nicaragua.  In addition, they work with and train otolaryngology residents in Lenin Fonseca Hospital in Managua. I was fortunate to join James E. Saunders, MD, and MMO on their biannual trip this spring.

Immediately upon arriving in Managua, the entire team convened in a nearby hotel. There we were introduced and immediately separated the various surgical equipment that we brought from the United States. There were three main surgical groups going to three separate parts of the country; one in Managua (our team), one Esteli, and the largest group in MMO’s homebase of Jinotega.

Along with Ilka C. Naumann, MD, and Janet Choi, I was part of the Managua team who would be working in Lenin Fonsesca, the public teaching hospital. On our first day we arrived to find the clinic waiting room full of patients whom the local attendings had identified as good otologic surgical candidates. We then worked along with the local residents to evaluate and triage the patients for surgical care. We were quite impressed with the organization of the patients, as most came with their recent audiograms and recent radiological imaging. After all the patients were seen, we made up our weekly surgical schedule.

The following days were spent in the operating room working with the local residents and attendings to treat mostly far-advanced chronic ear disease. A large part of the MMO mission is training local doctors to treat ear disease. However, we realized the large obstacle ahead as several senior residents had never placed ear tubes. Starting from this basic level we were able to teach the residents and attendings ear anatomy, how to diagnose ear pathology, and basic otologic surgical techniques.  Given this inexperience with ear surgery, the public hospital had minimal otologic surgical equipment available. Fortunately, Dr. Saunders warned us of this and we packed accordingly.

On our last day we traveled into the mountains to Jinotega to meet with the rest of the team. There we were able to see the incredible inroads that MMO had made in the region. Our first stop was the school for the deaf that MMO established to fill a huge need in the area. Without this school, there would be minimal to no resources for the deaf children in the region. We also toured the extension housing they built for children who had recently graduated from the school to aid them transitioning to the community.

Our next stop was visiting the medical side of the MMO Jinotega mission. Set up in an ophthalmology office and operating room, the MMO team is able to provide incredible care. In addition to providing excellent medical and surgical care, the audiology outreach is extraordinary. Using makeshift audiology booths, the audiology team fit and dispensed 96 hearing aids in addition to providing testing and follow-up to numerous patients.

The MMO organization has a long history in Jinotega and succeeds on all fronts of a medical mission. Due to their longstanding commitment to the country, they have established a trust with the local community that has also allowed them to work with and train local physicians. Because of the regularity of their trips, they are also able to provide excellent long-term care to their patients. In doing so, their influence extends far beyond their large biannual outreach trips and helps Nicaraguan citizens on a daily basis. I am very appreciative of the opportunity to work with the group and to the AAO-HNSF Humanitarian Efforts Committee for their support. I give this trip my highest recommendation and hope to return with the group in the near future.