Medicine from the heart . . . Stephanie Muriglan

On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit:



Stephanie Muriglan, MD, a resident in the Fitchburg Family Medicine Residency program and a participant in the UMass Family Medicine Global Health Track, recently returned from her trip to Nicaragua and reflected upon what she learned. Presented as a blog, her writing addresses many types of success—from community health, to the power of reflecting upon our impact when we try to "help" another culture, to how well a team can work together. Following are two of 11 blog entries.—Hugh Silk, MD


Day 9 (Feb. 24): Vaccinations and Sex Education

We returned to the local school in El Tololar to vaccinate 12-year-olds against MMR. After receiving their vaccinations, the children were quite excited and compared arms. Following the vaccinations, we led three classrooms in reproductive education. With the older group, ages 14 to 16, we divided the males from females, and conducted a safe, private forum for them to ask questions. There are few things more beautiful in life than watching kids transform when offered new knowledge.

The girls I worked with all agreed that they have never had anyone who they could safely ask these personal questions about their bodies. I watched them become empowered, given the courage to say no to sex because they now knew the consequences of having intercourse before they are ready or without protection against pregnancy and STIs. Someone finally told them how and why to say no.

Two memorable quotes were:
"Girls get pregnant because they do not have the knowledge. We will get pregnant now only when we want to."
"There are guys who respect you and your decision and guys you send walking."

After our visit to the schools, we went into the community to speak to the people. One thing I noticed today about myself is that sometimes my naive vision needs to be shattered. Although sometimes hidden, the struggle and hard times are apparent on the faces in El Tololar. One villager recounted stories of his neighbors and friends who are dying of kidney disease and how he may eventually be affected himself, but has to work despite the risk. There is fear and stress in this difficult environment, but they make their lives, their community, as rich as possible under these difficult circumstances.


Day 11 (Feb. 26): Final Hours, Final Thoughts

Think of a pristine environment that has never seen human footprints and what an impact people have when they settle that area. Species become extinct and that landscape changes forever. Globally, we just learned that the last Bengali tiger was killed and what a sense of loss I felt knowing that those majestic creatures will never roam the earth again.

I hope that my trip to Nicaragua did not have that kind of negative impact. Did local people's perspective on their own lives change when they laid their eyes upon me and my colleagues? Did they suddenly see what they don't have because I am there? Because, [in reality], I saw the beauty of their caring community and I do not [always] have this in the States. In the end, I hope my curiosity and giving nature does not take a piece of someone's personal light, their hope.

Not only did our trip to Nicaragua create a new lens in which to view our own world, but we grew as a family. As we sat around a round dining table in Managua discussing our final "a-ha" moments and general issues we had with the trip, we realized how extraordinarily our team had performed. There were so few things we wanted to change, and how minute those details were