Amanda Journal 1

My name is Amanda Schwartz and I just finished my first year of
medical school at Stanford. I’m originally from a suburb of New York
City and I also attended Stanford as an undergrad. I’ve studied
Chinese for most of my life but decided to begin studying Spanish in
medical school. I’m thrilled to be spending this summer as a HEAL
intern!

After two flights, one two-hour delay, and a nearly-missed connection,
I arrived on Roatan yesterday afternoon! The island is absolutely,
breathtakingly beautiful. Peggy Stranges (who runs Clinica Esperanza)
and a friend met me at the airport and drove me back to Peggy’s
apartment, where I’ll be staying for the next four weeks. On the way
home we stopped by Clinica Esperanza, where Peggy gave me a brief
overview and tour of her clinic. I must say I’m really impressed with
everything she has set up here—there is a dentist and pharmacy
on-site, and they are in the process of opening a pediatric in-patient
unit. It definitely seems like a wonderful place and one that is much
appreciated by the islanders.

Last night mostly consisted of unpacking, figuring out how to check my
e-mail, finding something to eat for dinner, and meeting the other
interns who are also here volunteering at Peggy’s clinic. Right now
there are a total of 6 of us here, but people will be rotating on and
off throughout my time here. The current interns have been great in
terms of showing me the ropes, including helping me do my first
grocery shopping (items purchased: Corn Flakes, white bread, and an
avocado!) and explaining how to negotiate for a reasonable price with
taxi cab drivers. I tried my first baleada, which is sort of like a
quesadilla but with a thicker tortilla shell. I’m looking forward to
shopping at the larger grocery store in Coxen Hole this week as
well…I’m not sure my current food supply will sustain me for too long!

After some much-needed sleep, I met up with three other interns this
morning and took a cab to West End, which is a hub of dive shops and
small cafes/restaurants about a ten-minute drive from Sandy Bay. Two
interns had scheduled a scuba diving lesson, and myself and one other
intern decided to snorkel, so the four of us spent about three hours
out on the water. I have done some snorkeling in the past, but
nothing compares to this—we saw probably 25 different kinds of fish,
plus lots of beautiful coral. The water is very clear and calm—I can
understand completely why Roatan is such a maven for divers. Our two
scuba divers had a great time and successfully completed their first
dives—in addition to fish and coral, they saw eels as well (although
sadly no turtles, which had been their goal)! After our trip we
headed back up to Sandy Bay for lunch and managed to watch the
U.S.-Brazil soccer game on TV—things were looking up for the U.S. at
half-time but sadly Brazil won in the end.

It is really hot, although there seems to be a breeze moving in
tonight, which will be nice. I’ve been told I’ll acclimate quickly to
the heat-- I'm hopeful that is true!

Tomorrow morning I’m meeting the current HEAL intern at hospital
publico to begin my training. I’m nervous and excited to see what
tomorrow will hold. The hospital is about a ten-minute taxi drive
from my apartment—this will be my first time going somewhere on my
own—I think I will spend some time tonight brushing up on my Spanish
vocabulary! I will update soon with information on how my first week
goes. In the meantime, here is a picture taken a few minutes ago from
my balcony.

Michelle Journal 5

It is unbelievable to me how fast this internship has gone by, the new
intern, Amanda arrived safely on Saturday and is getting used to the
island. It seems strange to be leaving after finally getting used to
the hospital and figuring out how to avoid some of the frustrations it
poses. My parents are down here visiting and explaining to them how
the clinic works and what I have seen and learnedis amazing to hear
outloud. Although frustrating that mothers give thier kids antibiotic
even if not needed and babies and children are malnutritioned and
encouraged to eat soda and chips I have really learned the importance
of health education. I know that the doctors in the clinic do a
wonderful job treating these patients but is is frustrating that so
many of these sicknesses could be prevented with education and when we
tell the mothers about proper nutrition and hydration they seem
genuinely thankful to have been told. I think that maybe the schools
and community centers around the island could start doing education
programs that would be very beneficial. Working in this clinic has
been an amazing experience and really opened my eyes to the healthcare
much of the world receives which is in stark contrast to the great
albeit expensive healthcare I am lucky enough to receive. These last
few days I am soaking up as much of the sun, diving and mango I can
handle and taking lots of pictures as well as training Amanda to take
over my place.

Michelle Journal 4

This week has been surprisingly slow in the clinic but pretty exciting out of the clinic. On Tuesday I came back to my apartment to find several hundred bees in my bathroom! They lived in the wall and had snuck it through a hole in the wall! Murphy the owner in the building patched up the holes and we thought it was fixed, only to find the next day that several hundred more were in my kitchen! we found there spot and stopped it up only to have the next say several hundred come out in the bedroom! I am not sure if there are still bees but I moved downstairs into an apartment that has far less critters! Also I got my diving certification so I have been enjoying all of Roatans amazing dive sites.

In the clinic we have had far less patients than usual I am not sure if it is because of the two cruise ships this week or maybe the rain? but the hospital has been empty by eleven am everyday! It still boggles my mind how an entire hospital can be empty by noon everyday and all the doctors leave. What happens if someone gets sick in the afternoon? The patients wait for several hours early in the morning only to be told if four hours later that many of the doctors of the left. It seems like such an inefficient system and sometimes it is very frustrating. Especially because I am down here to help out and I have the time to spend more than just a few hours everyday in the clinic. However, this week I have found something to do in the afternoons. Dr Diane, had a group of friends come down for these two weeks who are close friends of Miss Valerie (who owns the HIV clinic in Coxen Hole). Scott Fried is a professional speaker about HIV and safe sex and he and a group of people came down last year and this year to build a house for a family. This year the house is for this man named Alec and his family of four children (he just recently lost a child to a heart complication from Down Syndrome). He is the nicest man and has been the biggest help in building his own house. Every time he speaks he says he is so grateful for the gift we are giving him and he makes all of us cry. The neighborhood he lives in is called La Colonia which is one of the poorest areas on the island where the houses are all perched precariously on hills. The big project for his house is to build a retaining wall to make sure that when bad weather comes the whole thing doesn't topple over. The whole thing has come together extremely fast however we were at a standstill this weekend because la colonia only gets water once every 8 days for two hours and we need water to make cement for the floor. Hopefully we will get it so we can continue the rest of the work this week. Seeing how grateful he is for this house is amazing, especially because his entire family is living in a house much much smaller than the apartment I am staying in by myself. And regardless of everything everyone in the neighborhood is happy. All of the neighbor children come out to help lug buckets of sand and gravel even though they have no shoes and some don't even have complete outfits! This experience of building this house has been amazing especially to see some of the conditions that patients in the clinic come from. I can't believe that this is my last full week in the clinic already, I hope its a little busier than last week.

Michelle Journal 3

This past week has been so busy. Alice and Howard have been a huge help organizing and sprucing up the clinic, however they have been extremely busy setting up the physicians conference which took place thursday, friday and saturday. This conference unfortunately took Dr. Mario out of the clinic, but Dr. Diane and Dr. Vicky and I managed to do just fine. This week in the clinic we had two particulary interesting cases. The first one was this extremely intelligent six year old girl came in with her grandmother who said that she has never spoken a word in her life. How could this girl be seeing a doctor for the first time at six years old and she has never spoken? With the limited resources on the island we had a hard time deciding what the best course of action was for her, so we finally decided to refer her to a recently opened rehabilitation and therapy clinic in French Harbor. That same day a mother came in with her baby who she said was having a difficult time breast feeding. It didn't even dawn on me that something else could be wrong so I finished triaging and sent her to see Dr. Vicky who immediately diagnosed this little girl as having down syndrome. This baby was almost one and a half and no one had ever told this woman that her baby had down syndrome or given her any information about it.Im not sure she left the clinic understanding exactly what she has been told.

Outside of the clinic this last week I have been working to finish my diving certifications, however since I seem to be perpetually sick with the gripe I see every day at the clinic, I am too congested to be able to dive. Hopefully I will recover enough to finish it in the next three weeks! Also on Wednesday, Andrea, another Ms. Peggy volunteer and I went up to la colonia to talk with some women about nutrition while pregnant, nutrition for their babies and the importance of breast feeding. The women seemed intrested in what we had to say but no one asked any questions or had any comments so I hope that everything was understood and that our terrible spanish accents didn't get too much in the way. I understand why they might be confused though, we are telling them the importance of eating dark leafy greens, eating protein, calicum, folic acid and iron. However, I can't even find spinach and broccoli on this island and if I do it is certaintly not cheap. For these women who live in poverty many of the rules and suggestions we were providing don't apply at all. In retrospect, I think we would have been far more helpful if we had changed our discussion to apply to the particular situations that many of these women are in.

Today, was the first time I have seen rain and it hasn't stopped for almost two hours! I am learning to enjoy Roatan more as a local than a tourist and I am loving every minute of it!

Michelle Journal 2

Two days before coming to Roatan, I was sitting at dinner with my parents discussing plans for when I graduate next year. Do I want to go to Public Health School, Physicians Assistant, or maybe a nutritionist? I had thought I never wanted to be a doctor. However, after only 3 days working in the clinic I had decided without a doubt that being a doctor was definitely something I wanted to do. It has been amazing talking to people in all steps of the doctor process about their experiences. Dr Mario, Diane and Vicky have been a great help and could not have been more enthusiastic about med school. However, it wasn't until one night when Andrea, who is going to med school in August and Dr Mario, and Dr Dennis (another Dr from the clinic) who are in their last year of residency and I were sitting on the dock watching the sunset and answering the question "why do you want to be a doctor". It was a unanimous answer, "to help people". I am down here working in a clinic, helping people and doing exactly what I want to do in ten years. What could be more convincing?

This week at the clinic has been great. Monday and Tuesday were the busiest while wed (cruise ship day) was the quietest. Also, Dr. Howard and Alice arrived this week and have big plans for the clinic. We have been reorganizing as best as possible and loading up with all the supplies they brought down. They have also been a great help teaching me about the different sicknesses as well as how to exactly take the height and weight measurements of the children. One child came in who had swallowed an entire bottle of acetaminophen (Tylenol) and then had a fever overnight so when the parents came into the ER with a fever the first thing the doctors did was give him more acetaminophen! I feel that miscommunication between patients and the doctors is unfortunately pretty common in the hospital as well as not enough communication between different areas of the hospital. If not for the mother we would have had no idea that this boy was given more acetaminophen that morning. After Dr. Diane made a call to a surprised poison control branch in Minnesota we figured out that the boy was not in danger of poisoning and in fact he tested positive for Dengue Fever. It is very difficult with many of the patients to figure out what is wrong with their children, for how long have they had it, and what medicine was given. I have had to practice a lot of Spanish in order to finally figure out how to get parents to tell me that yes they actually have been giving their child the antibiotic for the last 5 days. Although it is so rewarding, it can also be very frustrating. The next couple days will be busy with Howard and Alice preparing a physicians conference for all of the doctors on the island and Dr. Mario will also be away from the clinic a little bit more.

The island itself is amazing and I am loving the sun almost every day and have yet to get a sunburn thankfully! my task for tonight is to read my diving certification book and figure out how to get the bumble bees out of my shower!

Michelle Journal 1

Well, my first day in Honduras started out exciting because everyone was talking about the 7.1 earthquake that happened the night before I arrived. First I heard of it was on the runway in Houston when the pilot informed us that just in case we had enough gas to make it back to Texas if we can't land! I arrived safely and Andrea the previous intern was there to pick me up. The island appears OK with very minimal damage done to the infastructure although everyone was pretty shook up. The first thing that surprised me was how hot it is down here, I knew it would be hot but I wasn't at all prepared! The first day here, Andrea showed me around Sandy Bay and we went to West End and walked around a little bit. I love the island so far and everyone I have met has been extremely friendly. The first day at the hospital was amazing. I am glad that I kind of new what to expect, otherwise I would have been a little shocked by the seemingly chaotic and hot hospital. Andrea, and Dr. Mario are great at helping me get organized and get the hang of things. For the first couple of days I shadowed Dr. Mario while he did his newborn checkups. Dr. Mario is great about showing me everything he is doing and explaining to me what it means. Since I have yet to go to medschool, everything I get to see is facinating. Most of the kids coming in have respiratory infections, parasites, colds and a couple of them have chicken pox. I am practicing my medical spanish and learning new words everyday! I have one more day in the clinic with Andrea and then I take over with the new doctors who got here this morning. So far, minus the earthquake my time here has far surpassed what I was expecting!

Andrea Journal 3

Last week in the clinic we were lucky to be joined by Annie’s mom, Rosie, who came to the hospital as a “volunteer volunteer” while on vacation. Rosie was absolutely fantastic! She made the babies stop crying, gave out stickers, took heights and weights, drew pictures with the kids, rearranged the furniture in the intake room and even spoke some Spanish! I was spoiled to have so much help, and I got to spend extra time shadowing the doctors on rounds and in clinic.

Monday and Tuesday were quiet days in the hospital because of the worker’s strike. The people usually doing intake were on strike as well, so I stood at the hospital entrance and tried to point all the babies and children who came through the door towards Clinica 10. We even saw a few young adults because the other clinics were closed.

One young mother brought herself and her child in for a check up. The mom had been experiencing shortness of breath, dizziness, heart racing and palpitations in periodic episodes ever since her daughter was born 3 years ago. One of the doctors ordered a urine test for the child and a blood test for the mom. Mom and daughter returned, but the mom had not gotten her blood test done; when I asked why she had no results, mom told me she was scared of needles. The doctor told her she could get an EKG in the emergency room instead. I decided to walk her down to the emergency room to make sure the EKG got done. I had a feeling that things might not go smoothly, and did not want the scenario of the premature failure to thrive baby from last week to be repeated in another lost patient. I’m glad I escorted her, because the doctor that she spoke to in the ED curtly turned her request down saying that the EKG tech was not in the hospital that day. I sat mom down and reassured her that an EKG was completely painless and quick. I asked her to please come back tomorrow to have the test done and tried to emphasize the importance of her compliance. She promised she would return, but given her noncompliance with the blood draw orders, I could only hope to see her again. I asked her to stick her head in Clinica 10 to say hello to us tomorrow so that we would know she had come back. As she walked out the door, I was doubtful that I would see her again.

The following day, in the height of clinic, mom and daughter peaked through the door with a printed EKG! I was incredibly surprised and thrilled. The patient may have followed through with the doctor’s orders regardless of my efforts, but I had been so disappointed about the sad little baby from last week, that I considered this an uplifting success, however small. The possibility that the 10 minutes I spent walking her to the ED and convincing her to return may actually have made a difference makes me want to be able to spend just as much personal time with every patient that I see as a Global Healing intern, future medical student and doctor. Hah! Naive and blissful, but I’ll wish it anyways.

By Thursday, the hospital was back to hot, crowded and smelly normalcy. As usual, we saw a lot of cough, cold and fever. We admitted a few very sick babies to the hospital, administered nebulizer treatment to asthmatics, prescribed tons of medicines for parasites and creams for rashes. My immune system is finally failing and I have come down with the beginnings of a cold. I have been bracing myself for this to happen since I am playing with, picking up and talking to sick kids and their parents all day long. Lucky for me that Vitamin C grows wild on trees in front of my apartment!

Andrea Journal 2

I planned to write an email last night, but was stymied by a small catastrophe- the pipe leading into the toilet in our apartment snapped off as I tried to turn the water off for the evening, sending liters upon liters of clean fresh water gushing into our apartment! We ran for help and finally found Hector who is somehow related to the owners of the apartment. Hector cut the circuit to stop the water. How ironic that in a country where clean water is so hard to find, within 10 minutes, the entire apartment had flooded- the bathroom, kitchen and bedrooms were covered in an inch of water. I had raced throughout the apartment throwing everything onto chairs and beds as the water spilled out of the bathroom, so luckily nothing was ruined. In fact, to our surprise, only half an hour later, we had successfully scooped buckets of water from the floor into the shower, soaked up most of the water with bath towels, and swept it out the door. Gracias a Dios that things dry so quickly here! Hector then declared that he was going to reconnect the pipe with glue. I was doubtful and begged him to wait until morning for the pipes to be replaced. I was sure that the water would come gushing into our apartment again. "No queremos agua anoche!" (We don't want water tonight!) I insisted. Again, the irony! Haha. Per the usual, the locals always know more than the gringos- 5 minutes later, Hector turned the water on and, sure enough, the pipes held! I was amazed. "American glue," Hector said pointing at the EZ Cement label. Ha ha! Anyways, it was an exciting welcome to plumbing in Roatan, where flimsy water pipes are left exposed so that silly tourists can snap them off and flood a building in minutes. Again, the idea of me wading through pools of clear water drowning our kitchen, while surrounded by entire neighborhoods without access to a reliable source of running water is ludicrous! How did resources come to be divided SO ridiculously disproportionately?

Flooding problems aside, I have been learning so much about the public hospital here in Coxen Hole, health care on the island and medicine in general! Between the Global Healing pediatric clinic in the public hospital in Coxen Hole and Miss Peggy's private clinic in Sandy Bay, all of the residents and doctors (both volunteers and Hondurian staff) have been so wonderful and eager to teach me. I shadowed the doctors during newborn infant exams in the hospital maternity ward- the infants are so tiny and cute! I have seen dengue, malaria, parasites, rashes of all sorts, scabies, chicken pox, conjunctivitis, TB...tons of cough, cold, congestion, fever. I've listened to breath sounds and looked at chest xrays for kids with pneumonia. I held the light while a doctor scraped heaping spoonfuls of dark brown ear wax out of a patient's ear; afterwards, I got to peer inside the patient's ear to examine the tympanic membrane. Yum! I listened to hearts beating, examined pupils, looked at strep throat, oral herpes. I translated for a teenage girl during her first vaginal exam. I looked at the malaria parasite under a microscope in the hospital lab.

Coxen Hole Public Hospital-
The hospital here has an "x ray machine." The xray tech joked that the machine was a gift from Christopher Columbus because it is an ancient, massive, wrought iron structure that looks like it could be 100 years old! Nonetheless, it does take xrays (albeit without any sort of radiation protection for the techs or in the walls of the room) The hospital also has a lab and a pharmacy, so we can order blood and urine tests, write prescriptions. If the hospital runs out of a particular medicine, the patient is given a prescription to purchase the drug elsewhere on the island. "Prescriptions," by the way, are notes scribbled by the docs on the back of a scrap piece of paper torn into quarters. In any case, I tell you what capabilities the hospital HAS because the list is short.

The hospital is usually very crowded and hot. The clinics have air conditioning, so we stay cool, but the patients wait for hours and hours in the hot, smelly hallways full of sick children with myriads of contagious disease. The patients begin arriving at 7 AM and receive a number from the front desk to mark their place in line. The clinics do not open until at least 8:30 or 9AM. The hospital only sees a certain number of patients each day, so if patients arrive too late and intake has run out of numbers, they are turned away. The clinic that I work in is an additional pediatric clinic within the hospital, funded privately by Global Healing, set up to supplement the public hospital's pediatric facilities. It was founded to address the overcrowding that still persists today! We usually finish clinic by about noon, but that means that the last patients have been waiting for at least 4 hours.

One big advantage of the hospital- The cost for a doctor's visit here including all medicines is 7 - 11 Lempiras or less than 50 cents- very cheap, even for the poor!
A Sad Case-
I held an emaciated, bony infant with floppy skin- in medicine, they call this "failure to thrive." He weighed something like 3kg at 40 days old :( He turned out to actually be a sad and frustrating patient. The docs decided to admit him to the hospital to observe feeding and try formula milk. However, the mother was clearly reluctant to admit the baby, frustrated that she had been kept in the hospital with him 2 weeks ago and was so recently discharged. I heard the next day that the mother and baby had fled the ward just hours after admission. Later, I mulled over our mistakes- it was clear that the mother cared about her baby. And with large families as the norm here in Roatan as in most of the developing world, I wouldn't be surprised if the mother had other children at home to care for. We clearly should have listened more to her concerns and perhaps come up with a compromise- Could we have treated the baby as an outpatient? Could we have given mom formula to take home, observed one feeding in the outpatient clinic and asked her to return? Would she have returned? Sadly, we are now afraid that she will be scared to come back if things get worse. The docs said that if the baby's growth does not turn around within a week, there could be dire consequences for the child. If this were Children's Hospital Boston, I know we would send a brigade from Farley 135 to the patient's house with the best bottles, formula and babysitters in the world. Sadly, though, we are a world away from Boston. For now, we have to hope that she will return when the baby needs our help.


Fun things I have done outside the clinic (because no one likes to end on a sad note)-
I have been volunteering at a nighttime sports program for kids called S.O.L., which was started by two American guys a few years ago. It is SUCH a success! The kids have a shack full of old, donated equipment- baseball mitts, soccer balls, basketballs- and they go nuts! They love soccer and baseball, so you can imagine the fun that I get to have. They are a rag-tag group of kids- half of them have shoes, they fight like you wouldn't believe, and I have yet to see a single parent show up to the court. I made up an ESL lesson and taught English on the side to some of the Spanish-speaking S.O.L. kids one night. I have also been teaching English to a guy who works at the apartment I lived in. Like most Spanish speakers here, he really wants to learn English. He brings a beginners English workbook that he borrowed from a friend, and we spend an hour or two talking in Spanglish during the afternoons. I have also been snorkeling again and can't get enough! It is AMAZING. I saw a HUGE spotted eagle ray, a SEA TURTLE, a porcupine fish, barracuda (scary ones that followed us!), tons of Doris swimming around in huge groups, beautiful coral, conches, and billions of other gorgeous fish and weird sea creatures I cant describe! My local friend took me out on his boat to fish. We didn't catch anything, but we rode right through a whole school of wild dolphins swimming right next to our boat! Incredible. And the view of the island from the water was amazing. I am tan and COVERED in bug bites. The sand flies love foreigners. I'm going to keep telling myself that the bites are from sand flies, but the resident and I joke that we have bed bugs and scabies :-)

Andrea Journal 1

ROATAN, HONDURAS- An absolutely wild place that I am still struggling to understand. A 30-mile long, skinny island off the Caribbean coast of Honduras, about 1.5 hour ferry ride from the closest mainland port, La Ceiba. It is almost nothing like I had imagined except that the beaches are gorgeous, tropical fruits and flowers grow wild everywhere, and the weather is hot! My biggest surprise has been that the few parts of the island I have seen so far are much more developed than I had expected. I have spent the last 5 days comparing everything to the Dominican villages I worked in last year, which were homogenously rural, primitive and quite impoverished. Here, there are multiple classes of people ranging from the very wealthy to the extremely poor. I think the socioeconomic stratification of the island has been exacerbated in recent years by a massive spike in tourism. Less than a decade ago, the island's economy was primarily fishing-based; what a change from now! Resort developments are springing up left and right; cruise ships, which used to be a novelty (evidenced by the fact that the Spanish speakers call them "cruise ships" because they had never seen any before and didn’t have a Spanish word for them!), stop on the island multiple times each week. I’m sure this story sounds as familiar to you as it does to me…the touristification J of a tropical island…the rapid change in economic priorities…the resulting rich-poor gap…local culture and goods replaced by plastic lawn chairs and cheap souvenirs. It feels like Roatan is in the beginning stages of this unfortunate transition, and the only people who enjoy the change are (obviously) those who are making dinero!


THE PEOPLE (who I have heard of or met so far)-
1. The “islanders” or the “locals” are the black or dark-skinned people who speak English with a crazy Creole drawl- dey sound lik dis mon! End dey very hahd da undastand at fuhst (They sound like this man! And they very hard to understand at first J). The island was originally owned by the British and I think at least some of them are the descendents of slaves who came from the Cayman islands during the first half of the 19th century. Others may be Black afro-Carib. The internet is down, so I can’t look it up! Edits to come I’m sure… Anyways, so far I have spent most of my time hanging out with islanders in the West End, one of the two most touristy areas of the island and more of a backpacker’s budget spot. It seems that work comes and goes for many of my new friends, and that their jobs largely depend on tourism- construction, waitressing; if they own a boat, they can take tourists on the water to fish or taxi. I have seen some islanders with nicer houses for island standards, and others who come from poorer neighborhoods that I gather are not quite as bad as the shanty towns.
2. The “Spaniards” are the people who immigrated from mainland Honduras after Britain gave the island to Honduras in….the mid 1900s?? These are the lighter-skinned Hispanic people who speak only Spanish. Apparently Honduras left Roatan to its own resources for many years before realizing the economic potential of the island’s coral reefs and beautiful beaches. More resources from Honduras created tourism, which created jobs, which spurred the movement of people from mainland Honduras to Roatan. Most of the Spaniards I have come in contact with drive taxis or work in the resorts. They seem to be poorer than the islanders, but it's hard to generalize. I have heard they tend to live inland in the poorer barrios and shanty towns- i.e.: La Colonia or El Swampo (yes, El Swampo = the swamp, named as such because it is apparently one huge valley of mud during the rainy season)
3. White islanders. I think there is a small group of white local island dwellers who have been here for generations. Haven’t met any yet, but I think they're here somewhere...
4. Random people who have settled here, mostly the white hippie type from the U.S. or Europe. (i.e.: Carl, a white guy with an American accent who plays volleyball with the islanders most nights despite their endless and ruthless taunting about his lack of coordination, who built his own submarine and runs submarine tours for a living. Hah!)
5. Tourists!!

OF NOTE ON THE PEOPLE- There is a lot of tension between the islanders and the Spaniards. I have been told that the islanders feel invaded and want the Spaniards to go back to the mainland. Roatan’s government, controlled by the islanders, has apparently made this sentiment clear by neglecting the Spaniard neighborhoods. La Colonia is a Spaniard shanty town that has grown from population 300 to 3,000 in less than 5 years and sits across from my apartment in Sandy Bay. The entire community did not have running water until a Texan couple (the guy happened to be the “pastor” at a crazy church service I attended on Sunday!), started an NGO 2 years ago called Living Water for Roatan. The people of La Colonia now get water for 3 hrs each week. The doctor at Miss Peggy’s Clinic in Sandy Bay says that even with such a limited water supply, the public health situation of La Colonia has been exponentially improved. Anyways, I guess the point is that it was an American couple, not the Roatanian government, who brought water up to La Colonia. Then again, the only public hospital in Roatan (which is where I work and write from today) does not have running water either. Yes! The public HOSPITAL does NOT have running WATER. It is incredible. Anyways, I'll leave the health care and hospital stories for later after I have spent more time here…

STORIES-

Snorkeling was just about the most amazing experience ever. Seriously, Nemo, Dori and all of their friends live about a 5 minute swim from my apartment. What an incredible and fascinating little world that I have never seen before!! NOW i know what people mean when they say "the reef."

I went for a swim yesterday just to get some exercise (You can't run on the beach because the wild dogs will chase and bite you. You can't run on the roads because the cars will hit you. So...I swam!). I stayed close to the beaches in the grass where there are a few fish but not nearly as many as the reef... I wasn't even swimming to see the fish, but off to my left about halfway through the swim, I saw a familiar looking black shape flop right past me- a sting ray! hah!! Exercise here is so much more entertaining than an ipod and treadmill :-)

On Saturday, I stumbled upon the birthday party of a 3 year old Sandy Bay local islander named Wendel (the second cousin of my friend). It was a giant affair for which Wendel's mom cooked mounds of food for nearly 100 kids...plus random guests like myself who happened to be passing by. There were about 8 yellow "bombas" (balloons) and 10 plastic chairs lined up along the fence of the property as I passed by on my way home. 20 mintues later, hoards of children were being dropped off the back of pick up trucks, some carrying wrapped gifts. they piled inside a tiny patio area and screened porch to sit and eat- Conch soup (spicy and amazing!), arroz con pollo (also fantastically delicious), spiral pasta with a mayo sauce and huge juicy shrimps ("shrimp salad"), the island version of enchiladas- open-faced deliciousness piled on homemade fried tortillas, soda and strawberry cupcakes from a box topped with green frosting! HAH! Local food at its finest. Of course, the seafood is plucked from the ocean just steps away straight onto the plate! And despite eating local food like this and more, I have YET to experience any sort of indigestion...

FUTURE PLANS- This evening, I plan to work with the kids of Sandy Bay in an after-school program called S.O.L., which is currently being organized by two young guys from Ireland who are here for 8 months. Outside of the clinic, it sounds like I can make myself most useful in the poor barrio of La Colonia. They need everything, including health care education and a system for trash pick-up. Perhaps I will focus on these 2 items during my month on the island.

TO CONCLUDE- Yikes! This is taking forever. There is no running water at the hospital so the bathroom is a pour-a-bucket-of-water-in-the-toilet-and-hope-it-goes-down ticket, so I can't stay here much longer if I want to avoid that! I know this update is mostly island history, background and people, but with the hospital closed for the holiday and weekend, I really have spent most of my time learning what I've written above through word of mouth. My next update will hopefully focus more on my work in the clinic and community.

Chrissy Journal 15

This week was just Dr. Mario and I in the clinic. Sabreen left last Friday, she is a really nice person to get to know and a great sounding board for me as I am wrapping up this internship and figuring out what steps I need to take to get into a medical career. Dr. Hott left Thursday, I found him to be an inspirational doctor, and hope I can be half the doctor he is. He has an amazing attitude and is overflowing with energy and great ideas. I’m so glad I had the opportunity to work with both of them.
Again, Friday was a holiday. Labor Day, April is quite the celebratory month out here.
Mario admitted a baby to phototherapy this week, not quite as high as the last baby, but jaundice, she also went home the next day, after her bilirubin levels dropped down to 11.

Swine flu has become quite the scare down here. They had a meeting on Tuesday afternoon for the doctors, which I did not attend, but they are worried about it. I think Mario is going to try to contact Dr. Howard about getting some Tamiflu for the hospital. The hospital wanted us to start filling out special paperwork for everyone that comes through with a cold. Can you imagine what that would look like from our clinic, that’s every other patient?! I think they talked them down to reporting only the cases that look like they could be the flu or pneumonia, because I never saw any special paperwork to fill out.
Yelsi gained 200 grams! She’ll come in next week for a weight check and the following week she’ll go back to San Pedro for a check up.

Dr. Hott did a presentation on pallitive care on Wednesday and even had the surgeon and the internal medicine doctor in attendance, impressive. It was a good presentation on prescribing medications and helping families of patients that are dying. I thought it was very interesting, and I think it was something new for the social service doctors. They seemed to really appreciate a list he made of how to talk to the family of a deceased patient and what to do to help them by just taking a few extra minutes.
Andrea arrived Wednesday and started in the clinic Thursday. We showed her around and got her oriented. I think she’ll do a great job and have a wonderful experience.

Chrissy Journal 14

Another relaxing week, as we had Monday and Wednesday off. Two more holidays, so the clinic was closed, although noone could tell us what the occasion was.
Yelsi came in this week!!! After being admitted in San Pedro Sula for 24 days, little three month old Yelsi came in with a diagnosis of a Patent Ductus Arteriosis. She has surgery scheduled in November, and a check up again in May. She looked much better. She is still really skinny, but she is on high calorie formula and she is going to come in for weekly weight checks and we are going to try to help them with transportation, if we can.

I single handedly successfully identified a case of chicken pox, Dr. Tami taught me how to identify them. I put them up front to try to get them in and out of the hospital, and back home. Only to see them walking around the market after we left clinic. We had a little girl come in with croup. I think it was the first time I had heard a cough like that, it was very ‘barky’. Lots of parasites this week, too.
Dr. Sabreen did a presentation over different skin diseases and problems in pediatrics. It was a lot of fun as it was set up as Jeopardy. I think everyone really enjoyed it, although Dr. Hott dominated the game. Then Dr. Hott and Dr. Sabreen did a presentation for the nurses. It was basic Emergency medicine, simple procedures, reviewing ABC’s and some advice, or tips on things to think about when patients present and how to procede. I think they really appreciated the doctors taking the time to give them an educational presentation.

Chrissy Journal 13

The clinic was really busy the other days, probably because of not being able to get into the doctors the last week.
We had one six day old baby come into the clinic Tuesday with high bilirubin levels and we had to admit her and put her in phototherapy. Her parents were very bright and her father went home and did all sorts of research on jaundice on the internet. After two days she went home. Her bilirubins spiked again over the weekend, but they kept putting her out into the sun and they came back down and she is doing good, now she’d getting a suntan.
Dr. Hott did a presentation on CPR, he had videos in Spanish. I didn’t get as much out of it, but I think the social service doctors did, so that’s what matters.
We did see two kids with malaria this week, and the let us see their blood smears in the lab. Other than that, lots of the ‘usual’, colds, scabies, ear infections, and parasites.

Chrissy Journal 12

This week was a holiday week in Central America, Semana Santa, or Holy Week. The hospital had already said that Thursday and Friday would be holidays and the clinic wouldn’t be open, but when we showed up on Monday, the government had declared the whole week a holiday. We were already here and there were a few patients wanting to be seen so we saw them. Mario had arrived really early and had the newborn exams done by the time Sabreen and I arrived. We just saw a few colds, pink eye, and tonsillitis.

Chrissy Journal 11

Ostin gained a pound!
It was Dr. Tami’s last week, and I will miss her, she was a really excellent teacher. She taught me how to do the newborn exams and supervised while I did them on my own on Thursday and Friday. Dr. Sabreen also arrived Wednesday afternoon and started in the clinic on Thursday. We won’t have any residents this month.
Dr. Dennys did a presentation on drowning, in preparation of the holy week, and anticipation of possible problems with the tourist influx on the beaches.
It was a usual week, other than that. Colds, faringitis, tonsillitis, eczema, just a little bit of everything. The best part was definitely learning how to do the newborn exams!

Chrissy Journal 10

I talked with Baby Yelsi’s mom multiple times through the weekend to make sure she got admitted and would get the echo. She got the echo on Wednesday and still hadn’t seen the cardiologist, and they wanted to keep her longer, but Yelsi is doing well. I asked her to make sure that she bring copies of all the test results and everything when she returns to the island and come by our clinic to let us know how all is going.

First thing Monday morning I passed a baby boy, and I asked if he was a ten day check, so that I would get him through first and the mother said that he was a three month old. Ostin, ended up coming to our clinic from Miss Peggy’s clinic. He was 8 pounds at three months, and had brochiolitis and a failure to thrive. His mother died when he was two weeks old, so his aunt is caring for him. We decided we didn’t want to admit Ostin to the hospital, so Tami taught Dilsia, the aunt, to increase his caloric intake with more formula, and just treat the cold with supportive care. She then asked her to follow up in three days. He came back and Tami gave him an inhaler but he seemed to be doing okay, and we asked her to come in at least once a week to check his weight and make sure he was growing.

It was Dr. Preetha’s last week in the clinic. Dr. Tami did a presentation on back pain. She presented a case and went through the differential and it was a case of Tuberculosis. It was really interesting.

In addition, we could have used some permethrin this week. Lots of scabies, I was starting to itch just seeing all the kids with scabies. And all we can give them is Scabicide, which one of the doctors told me just treats the itching and doesn’t really kill the scabies. Other than that we had lots of faringitis and a possible Tuberculosis case that we had to send to La Ceiba to get tested.

Chrissy Journal 9

Again, the clinic was full this week. Although it was nice as Dr. Tami sat right next to me, so I got to see a lot of cases and eavesdrop on the consults, it was very interesting. Of course, we saw lots of colds. We had quite a few scabies cases and Tami taught me how to identify some of the signs of varicella, we had two cases this week.
We had one four month old baby who has come in four times in the last month with diarrhea, this week he had blood in his stool, so Tami treated him for parasites and he finally got better!

We had a girl that came in with a spot on her neck that was growing and Dr. Howard showed us the excellent resource we have of sending pictures to a dermatologist in the states for a consult. He came back with the the same results as Andrew, Mario and Howard, but then narrowed it down to a fungus. It is a nice resource, as we see many skin problems here.
Dr. Preetha she did a presentation on Ascaris and empiric treatment on Wednesday, that was really interesting.
On Friday, Tami and Preetha were pulled into 3 cesarean deliveries and when Preetha went to check on one of the kids, she was stopped in the emergency room for advice on how to treat a 3 month old baby girl in congestive heart failure. Andrew and Tami went to see her and treated her with Lasix and decided she needed to go to the mainland to see a pediatric cardiologist. They decided that she was stable enough that she could take the ferry and busses, and Global Healing would have to fund the trip as the mother could not afford it. Dr. Dennys made a lot of phone calls to make sure that we could get the baby admitted into the hospital and seen by the cardiologist once she arrived in San Pedro Sula. It seemed that everything would work out. The mother couldn’t get clothes and everything she needed on Friday afternoon, so she went Saturday morning and Tami and I went with her on the ferry, she seemed to be stable enough to make it to San Pedro when we parted in La Ceiba.
It was Dr. Andrew’s last week, too, but he left his cell phone number at home on the wall, to call for consults. Dr. Howard departed this week as well. It was great getting to know him a little better and I am really looking forward to all of his advice for getting into the medical field.

In addition, I also set up a way to copy the typed charting and tape it onto the hospitals required charting, which eliminates the task of typing it all up and then handwriting exactly the same information onto the hospital chart. Now I just copy it into a Word document, adjust some of the columns, print it, and tape it onto the hospital form. The Statistics department, said they think it’s fine, so I have saved myself a lot of time and hand cramping, I’m very happy with it. Only wish I had done it sooner.

Chrissy Journal 8

The nurses were promised a raise, so Monday we were in the clinic again, I thought we would be busier, but we saw about 25 kids. Dr. Howard came down for a week and a half. He is busy arranging and meeting with people. Dr. Hott is still in the ER, and still enjoying it, he sees much different things than we do. He has made some nice improvements to the ER, by improvising a handwashing station. He also did a meeting with them about HAZMAT. He’s pretty cool.

Wednesday, another resident arrived, Dr. Tamy, the clinic was pretty crowded with five doctors and an intern, but we made the space work and were able to see lots of patients. Not to many interesting cases, lots of upper respiratory infections and scabies. It seemed like every chart said ‘cough and cold’ as the chief complaint, and if it didn’t, they would say they did as soon as you asked. Friday looke like the nebulizer special, as we had three kids in one corner all on nebulizers at the same time.

Dr. Mario and Dr. Howard were pretty busy arranging meeting and had a great meeting about setting up a tooth varnish program through the vaccination clinic, getting it set up across Roatan, and using it as a model to have it set up across Honduras. It sounds like Mario should be spearheading the project, and I think he’s excited about it. It was a good week, with a good team.

Chrissy Journal 7

Dr. Andrew, Dr. Preetha and Dr. Hott arrived over the weekend. Dr. Andrew is the attending, Dr. Preetha is the resident and Dr. Hott is an ER doctor who is going to be working with the ER here in the hospital. Dr. Stephanie is going to go over to Ms. Peggy’s clinic, but she came in this Monday morning to make sure all was going well. There was a little boy who had been mauled by three dogs, and Dr. Dennys was going to operate, so Stephanie went to that. It was quite an experience when his heart rate fell to 33 and the doctor looked up, then reached over and turned the monitor off. He turned it back on and his heart rate was ok.

We arrived Monday morning to find the gate to the hospital closed and no patients inside. Apparently, the nurses were on strike. I’m not sure exactly why, because they didn’t get a promised raise or because they want a raise. So, they wouldn’t let us see patients, it was especially disappointing to patients that were coming from far away places like Oak Ridge, that had to get up early and pay a lot to get here and then they couldn’t see a doctor, unless they went to the ER.

I showed the new doctors the hospital and they saw the newborns, then I took Dr. Andrew and Dr. Preetha over to Ms. Peggy’s to help. Dr. Hott stayed in the ER. Tuesday the clinic was open and we had quite a few patients. Then Wednesday the nurses were on strike again, they were all outside the hospital protesting. One of the Social Service Doctors, gave a presentation over lunch on Hyperglycemic Shock, so we all sat in on that. It was a nice conversation between the doctors and a nice opportunity to get all of them together, many of the doctors, and all the social service doctors came.

Chrissy Journal 6

This week was busy. The other two doctors/clinics that see patients were gone and so we were getting a lot of patients. It wasn’t too much, though, just busy. The cases were about the same as what we usually see.

There was one boy who came in that had been on the ward the week before for a broken arm. Dr. Jackie was giving him a little ibuprofen for the pain and thought that the reason his blood pressure was so high was because he was anxious, and so they put him on blood pressure medication. He came into the clinic and Dr. Stephanie took him off of it, and his blood pressure is doing fine now. Dr. Aditi heard a few heart murmurs, so she filled out the referral to mainland hospitals, then we found out that Ms. Peggy will have someone doing Echos in a couple weeks. We need to figure out a way to have better communication on the resources she has. She is an amazing asset to healthcare on the island.

Dr. Stephanie and Dr. Aditi stopped going on rounds in the morning, because they felt that Dr. Jackie and Dr. Lemos were patronizing them, and they couldn’t see eye to eye with the medicine they were practicing here.

Chrissy Journal 5

Dr. Stephanie and Dr. Aditi arrived last weekend, and will be in the clinic for two weeks. Dr. Dennys, one of the social service doctors came in to help as Dr. Mario had to go to Tegucigalpa.

Dr. Stephanie had been here before, so she got adjusted fairly quickly, and they were on rounds and seeing newborns right away. There were a lot of kids in the ward, so clinic got started a little late. Dr. Dennys saw a kid with an abscess on his head and tried to drain it with a syringe, but it didn’t work out very well and he tried to squeeze out the pus and that didn’t get enough out so the poor child had to be admitted to the hospital, so the surgeon could use some anesthetic and lacerate it. He did fine. We had a boy come in with malaria p. falciparum, he actually didn’t even look or act as sick as one would expect. There was another boy that came in with a head lesion that was a parasitic infection. It looked like an abscess on his scalp, but there was a worm living in it. The surgeon came in for a consult and they set up an appointment for the surgeon to remove the worm the next day. Other than that, there were lots of scabies cases this week, in addition to the intestinal parasites and respiratory problems.

Dr. Stephanie did an ultrasound course at Ms. Peggy’s clinic with Dr. Laleh. I somehow was coerced into being the model for all the ultrasounds, but it was very interesting. A couple of doctors from Anthony’s Key were there and all the doctors Clinica Esperanza and a few nurses too. I think they are using the ultrasound machine more already.

There was one baby on the ward that Stephanie and Aditi were worried about and the hospital discharged with a distended abdomen, and abnormal hematocrit and platelet counts. Aditi talked to Sarah, another social service doctor that was in peds, and they arranged to have the mother come by our clinic after she was discharged so we could take her to Ms. Peggy’s. She ended up getting discharged an hour earlier than we expected and she left. We tracked her name down from the chart and that she lived in Sandy Bay, so we had people asking around for her. Somebody foung her and she came into Ms. Peggy’s the next day. Dr. Laleh did an ultrasound and found free fluid around the liver. The clinic bought her a ferry ticket and gave her money to take the baby to the mainland. She ended up going to the hospital in La Ceiba because she had family there, I don’t know what the diagnosis is.

Chrissy Journal 4

Week 5

This week started out pretty busy on Monday we saw 19 patients, whereas we usually only see 15 with one doctor and then got really slow to no patients on Friday. We can only assume the island was healthy. The most interesting case to me was a baby girl that Dr. Gross had seen a few weeks earlier in the newborn exam and thought she had Down’s Syndrome. She came in this week for her ten day check up and had lost weight, she only weighed 5.5 pounds, littlest baby I’ve ever held. Dr. Mario suggested that she take some high calorie protein formula too.

Since the clinic slowed down, I spent some time cleaning and dusting and organizing before Dr. Stephanie and Dr. Aditi arrive next week. Dr. Mario made arrangements for one of the social service doctors, Dr. Dennis, to come into the clinic next week as well, since he will be in Tegucigalpa taking tests next week.

One of the doctors gave a presentation over lunch on Monday, I think, but I didn’t realize it until after it happened, so I wasn’t there.

I did ask Dr. Mario about Miss Valerie, but he hasn’t heard of her, so I will have to ask around some more.

Chrissy 3

This was Dr. Jessie’s last week in the clinic. The baby is still not breathing normally, and the mother has lost any trust she had in Dr. Jessie. They painted the hospital really nice, most likely in an effort to placate the problems of this hospital and delay building the ‘new’ hospital that has been promised for so many years.

The clinic was steady all week. The most interesting case was a 20 month old with Icthyosis. Dr. Jessie nor I had seen it before, but Dr. Mario knew what it was instantly and said he had seen other cases of it in Tegucigalpa. Keith, a friend of Dr. Gary’s, came into the clinic a few days and took pictures of the kids and moms and he brought a little printer and gave everyone pictures, everyone really enjoyed that.

I had family visiting all week, so I didn’t make it to Peggy’s clinic at all. I did hear that there is an American woman here in Coxen Hole working with people living with HIV and AIDS. Miss Valerie, is what I heard her name is, so I might try to touch base with her and see what she has going on.

Chrissy Journal 2

The clinic has been busy with three doctors, the Global Healing clinic saw just fewer than 350 patients in January. In the clinic we see a lot of common problems; ear infections, respiratory infections, parasites, infected bug bites and gastroenteritis. Lots of cavities, and we went through all the toothbrushes Dr. Gary brought down. Some more unusual cases for the clinic was a young girl with alopecia areata, and a rash that Dr. Gross thought might be typhoid, because nobody in the clinic had ever seen one like it, but after looking at typhoid rash pictures he decided it was probably pitynasis Rosita.

Last week was very intense in the hospital. Wednesday night, the hospital caught fire, the hospital sent everyone home in taxis. The women’s ward burned, nobody was hurt and everyone got out fine. Dr. Mario was in Tegucigalpa, and Dr. Gross, Dr. Lindsay and I didn’t find out about it until we arrived Thursday morning. They told us some of the patients had been transferred to the private hospital, Wood Medical Center. On our way out to go to the other hospital, there was a two month old baby girl on the bench in the lobby, breathing very heavy and the doctors both agreed that the baby should be admitted.

When we arrived at the private hospital none of the kids from the hospital were there, they had all gone home in taxis at two in the morning. We talked to the director of the hospital, Dr. Wood and told her about the baby that needed to be admitted. She told us she didn’t know if she would have any beds. We took a tour of the hospital, it is cleaner than the public hospital, but seems to have about the same technology and same staff as the public hospital. When we saw the Pediatric ward, we didn’t see a single child in the beds.

We came back to the hospital and Dr. Wood said they would clean up the hospital and the baby could stay here, so they got oxygen and a nebulizer and baby laid on the wooden bench in the lobby all morning. They took and X-Ray once the electricity came back on, and noticed she has a collapsed lung. Dr. Lindsay and Dr. Gross thought that she needed to be transferred to another hospital that has a CPAP machine. Global Healing offered to cover the cost of transportation for the baby to be transferred. The mother of the baby didn’t want to go. The baby is only two months old and has already been to Tegucigalpa where she was supposed to see a pediatric cardiologist, they were there for days, and never saw him and all they did was an EKG and sent her home with no more information. Meanwhile, the baby got into a bed at the public hospital. We were waiting for the husband to come to decide whether or not they would transfer the baby. Dr. Mario was calling to try to make arrangements in Tegucigalpa.

Friday, the mother did not want transport the baby. The baby was still in the same condition, the mother thought she was doing a little better though. We were getting a little upset because it seemed like nobody cared, there was no sense of urgency, everybody just wanted to wait until tomorrow to see. The previous week a baby died, she didn’t transfer and then she was too sick to transfer out. Another doctor, Guido, came in and explained to us that if the baby transferred to Tegucigalpa that she would have to go through the emergency room in order to be admitted to ICU. The baby really could be waiting in the Emergency Room for days trying to get in, and they don’t triage, it basically comes down to you need to know someone in order to get a bed in the hospital.

At least the explanation made us understand the mother telling us that ‘if her baby is going to die she wants her do die in Roatan.’ We were all pretty downhearted when we left the hospital on Friday, and it was Dr. Gross’ last day as well. He is a great asset to the clinic, I very much enjoyed working with him.

Chrissy Journal 1

My first week in the clinic was very interesting. Elena came in on Monday to show me the ropes and Dr. Mario was the only doctor in the clinic for the week, it was a nice slow week to get started with. I think we saw fifteen patients everyday. I didn’t do much shadowing as I was getting used to everything and not too far ahead of him with patients. Most of the cases were normal things that kids get, like strep throat, colds, and respiratory infections.

Mario showed me around the hospital as well, and took me on rounds with him one morning as well. The facility is not what you would see back home but about exactly what I expected. There were 8 new mothers with their newborns all sharing one room. No running water or actual restrooms, even though patients wait for hours to see a doctor. Since it is my first clinic experience at all, I have nothing to compare it to, but I can tell they get by on much more limited resources. Of course, it’s also pretty amazing that they only pay $.50 for a doctor consult and all of their prescriptions.

I spent my afternoons at Clinica Esperanza. My original plan was to help out at the Sandy Bay orphanage, but they are going through a transitional phase and don’t need help now. They have really built an amazing facility in Sandy Bay. Miss Peggy has been an amazing resource, everything from picking me up from the ferry and showing me around to donating any extra supplies to the hospital and openly sharing her resources with the Global Healing clinic. I had the opportunity to work a few days in the pharmacy at her clinic, filling prescriptions the doctors wrote up. It’s an opportunity I’m sure I would never get to experience back home. I’m hoping to get to shadow some of the doctors at her clinic as well. It was a really great first week and I’m looking forward to learning more next week.

This week started off with Dr. Gary and Jessie joining us in the clinic. Things got a little more crowded but more interesting as well. We had a rainy week, which I think kept a lot of people from coming into the clinic, because it was a slow week. Thursday we only saw 10 patients. We saw a lot of parasite cases, ear infections, and pneumonia. I was able to shadow Dr. Gary a few times and combine our limited Spanish, he’s very nice about explaining things. I also accompanied them all on rounds to check the newborns, all healthy! I also saw the bathroom at the hospital, out of necessity. The cleaning lady escorted me to a small room with a toilet, no seat or back cover. There was water all over the floor and a big barrel of water next to it. There was a door, no way to close it properly, and no toilet paper. The only redeeming thing about it was that it did smell of bleach. It’s amazing to think of a hospital without proper running water.

I had the opportunity to take the doctors to meet Miss Peggy and see her clinic on Tuesday as well, Jessie and Mario had the opportunity to meet her and get a tour of the facility, and Dr. Gary got to see the progress. I heard they had some cases of Rota Virus come through the clinic as well. I didn’t miss any clinic days, but I got sick Wednesday, so I didn’t make it up to Miss Peggy’s Thursday or Friday.

Elena Journal

My three and a half weeks in Roatan were amazing, and I feel incredibly fortunate to have had this opportunity. While I really enjoyed working at the clinic, volunteering around the island, and having fun in my free time, I think that the most valuable aspect of my experience was having the chance to meet and speak with many different people. Between volunteers, locals, nurses and doctors, I was able to meet people with different and valuable perspectives all united under the cause of helping the island.
The first person I met on the island was Peggy Stranges, the nurse I would stay with. Stepping off the plane, I completely missed the man holding my name sign and walked straight towards Peggy, recognizing her friendly face from pictures on her clinic’s website. I’m incredibly thankful to have been connected with such a gracious host. In my weeks on the island, Peggy opened her house to me and served as a useful source of information and advice. Some of my fondest memories with Peggy are the two of us sitting at her dining table talking about how she started her private clinic from the very table at which I was sitting. Peggy left to see her family in Ohio for two of the less than four weeks that I was there, so I tried to soak up as much of her wisdom and advice as I could in the time that I was with her.
With Peggy at the airport I met Becky and Jacob, the two volunteers that I would end up spending my first two weeks with. Both volunteers are currently in med school, and one of them (Becky) had spent seven months of the previous year volunteering on the island. Becky proved to be an invaluable resource, as she knew the island well and had spent two of those months volunteering in the global healing clinic. From the airport, we hopped in the truck and headed into Coxen Hole so that I could catch my first glimpse of the public hospital where I’d be spending my mornings.
Coxen Hole itself is similar to how I pictured it, only with more stray dogs. I don’t think that I could have even imagined the hospital without seeing it for myself (even with the helpful maps that Stephanie drew for me:) ). I was instantly struck by how different it was from what we would allow to be called a hospital in the United States. The door is a wide, open frame, and in many places the ground is concrete. Between the two receptionist type desks stood a long line of people waiting around to be seen. The majority of the people in the hospital seemed to be from the mainland, but there were also islanders intermixed. When we turned the corner to look at the actual clinics, we could see that the line of patients went all the way down to the end of the hall. We peaked into a few of the clinics, and it was pretty clear that the hospital is operating on next to no resources. We walked down to the Global Healing clinic in the hospital, and Becky was able to orient me a little bit to what I would be doing.
After taking my first day easy, I was ready to start experiencing all that the island had to offer. I woke up bright and early with Jacob to start our first day of scuba school. Peggy had already made the arrangements with Bay Island Beach Resort, so it was incredibly easy to get started. Over the month I went to scuba school on weekends and days that Peggy’s clinic got out early. Roatan has beautiful coral, and it was an amazing experience to swim around with the fish 60 feet below the surface. In my short time I was able to see a turtle, an eagle ray, a moray eel, a grouper and a bunch of crabs. With each dive I felt that I was entering a new world, and was amazed at how its inhabitants barely noticed my intrusion.
My time at the Global Healing clinic was great, but the first few days were sort of challenging. Because there was no intern before me, and all of the doctors were relatively new, we were all sort of feeling our way out together. Mario, the Honduran doctor, had been at Global Healing for about a month, while the two American doctors, Erin and Sarah, had been there for a week. My biggest challenge in the beginning was figuring out exactly what I was supposed to be doing. Before I got there, the three doctors took on all of the tasks of the intern, so it was a hard to separate out what my responsibilities were. Becky was very helpful with this, and even two weeks in I would come to her with questions about how things were when she was an intern.
Erin and Sarah are both from Illinois, and my favorite memories from the clinic were working with them. This is partly because they used me as a translator, but mainly because they were caring doctors and thorough teachers. Translating allowed me to become comfortable with the patients pretty quickly, and was incredibly rewarding, especially when easing the minds of first time mothers. But it was the lessons that I picked up from the doctors that gave me deeper insight into medicine in impoverished areas. When they arrived in the mornings they would take me to see the new born babies, making sure to explain the different tests they would do in their newborn health checks. My first glimpse at the struggles involved with providing health care on the island came after one of our morning health checks. The American doctors found a heart palpitation in a newborn boy. They wanted to proceed as they would in the states with follow up tests and possibly even surgery. When they consulted the other doctors in the hospital, the doctors said that it wouldn’t be possible to take these measures. The baby was asymptomatic, so the hospital could not justify using the scarce resources on him even though they had the medical knowledge, skill and technology. We understood the reasoning, but it didn’t make it any easier to send a baby home that might become symptomatic when it was too late. After that, I began to realize that one of the ways medical care is possible with such limited resources is through rationing, and that preventative medicine was one of the first things to be sacrificed.
The hardship of this sacrifice became abundantly clear when a week later we admitted a patient – the only patient we admitted during my stay. A mom brought in her son of about 8 years with a bad foot infection. Doctor Mario broke the news to the mother that her child would be admitted, and I watched her face turn from hopeful to worried to almost frantic. Later that day I would retell the story to a doctor from Peggy’s clinic and ask him why her reaction was so strong. “On the island, you don’t get admitted to the hospital to get better…” he told me. The next day I talked to the American doctors about it and they said that the infection had probably spread to the bone, and that if it had the foot would need to be amputated before it spread further. Coming from a country where those receiving care are often over-doctored, it was strange to see the other extreme, where doctoring often comes too little, too late. In the case of the boy, it was through no fault of the hospital that he was brought in so late. Yet I cannot help but wonder if the mother would have been more likely to bring him earlier in a system with better preventative care.
Working at the clinic wasn’t all teary-eyed moms and tough lessons; it was usually fun and always valuable. My favorite patients were the ones who came with brothers and sisters. Often one child would be ill, and the whole pack would come in for a check up. I had so much fun watching them peek through our keyhole, spin around on our chairs and hang on their mothers. I would say that the most common issues were malnutrition and parasites. Being able to dispense advice and multivitamins to mothers might seem pretty small, but I know that it is a big step towards keeping the kids healthy.
Clinic often got out early – sometimes as early at 11:00 a.m. Usually to keep myself busy in the afternoons, I volunteered where I could around the island. A couple of times after clinic I followed Erin and Sarah back to their West End apartment. We talked a lot about their experiences on the island and in their residency programs, as well as Sarah’s experiences volunteering in Haiti. Mainly we just enjoyed the nice weather and beaches of West End. Most afternoons I would take a taxi back into Sandy Bay, walk up the hill towards La Clinica Esperanza and lend a hand to Peggy’s volunteers. Volunteering in Peggy’s clinic gave me a more holistic view of providing health, as every aspect was contained in the five or so rooms of the clinic. By the time I would arrive in the afternoon all of the triage would be done, and the volunteers would either fill prescriptions in the pharmacy or shadow doctors in the exam rooms.

Alex journal 4

This past month in Roatan has come and gone so quickly I can hardly believe I will be leaving in three days! I feel like I’ve only started to settle in to my surroundings here, and now I have to start packing again. The truth is that a month is really not long enough to make a difference, particularly since it takes you long to establish relationships and find your niche. Nevertheless, the connections I have made here in Roatan are good for networking, especially since I hope to work in Global Health during my career. I hope I get the opportunity to come down and volunteer again in the future, perhaps while in medical school or residency so I can have a more active role in seeing patients rather than just triaging. Not that triaging patients and interpreting has not been a huge help, because it has, I just want to be able to experience everything from the perspective of a physician.

I also wanted to talk about the opportunities to do research here at the RVPC. Before coming down to Roatan, I learned that the population of the island is very diverse. In addition to the Hondurans immigrants from the mainland, Roatan has a mix of ethnic groups quite unique to the island, such as the Garifuna, whom are descendants of escaped African slaves, and the Miskito population. One thread that connects all these groups, I found, is their belief in complementary alternative medicines, also known as “remedios caseros” (home remedies) or “bush medicine”. My research project while here was to see how many of our clinic patients also prescribed to these other treatment modalities.

What I found was that nearly everyone on the island believes in non-western treatments to a certain extent. For example, teas made of manzanilla (chamomile), eucalypto (eucalyptus), romero (rosemary), or anise were said to aid with digestion and help relieve stomach problems. Many of the locals with abscesses would come in with a leaf from a specific plant covering their abscess with the belief that the plant’s enzymes would help it mature and draw out the puss. While I found that many of these alternative treatments might have some scientific validity, given that many of our modern day medicines were discovered via their uses in ethno medicine, there were others that I thought were overwhelmingly based on superstition. For example, nearly every newborn we saw in the clinic wore a red beaded bracelet that was to protect them from the evil eye. When I asked the mother’s whether they believed in curses, the evil eye, and whether the bracelet really worked, some said yes confidently, but many said they weren’t sure and that they just prescribed to the practice out of tradition or because some relative had told them to.

While I may not have had the time to do a full-blown research study, I learned a lot about the alternative medicine beliefs held by people in Roatan. For example, despite being quite popular amongst the people visiting the clinic, most said they still had confidence in the abilities of the doctors and that they used alternative medicines mostly as a complement to western medicine.

Overall, my experience here in Roatan has been great! I’ve learned a lot about tropical medicine, infectious diseases, and the challenges of practicing medicine in a resource poor environment. I only have one more day left in the Global Healing clinic (there is a nurse’s strike on Monday, a common occurrence here in Roatan) so I’m looking forward to my last day shadowing the doctors and interacting with the patients. Cheers!

Alex Journal 3

I can’t believe my third week in Roatan is coming to a close! When I first arrived a month felt like such a long time, but I now realize that a month isn’t nearly long enough to really make any lasting improvements in the quality of life of the people on the island.
This past week was a little more hectic in the clinic with the arrival of the two new pediatric residents, Dr. Sydney Leibel and Dr. Sandra Lawrynowicz. Given that I spent much of Tuesday and Wednesday orienting the residents to the workings of the clinic, showing them around Coxen Hole, and doing quite a lot of interpreting, I really saw how important the intern’s job is in preserving the quality and continuity of care for patients that visit our clinic.


While there were numerous interesting patients in the clinic this week, one in particular stands out to me because it shows how difficult it can be for people on the island to get the healthcare they need. This patient was a spunky young boy of about 4 years old who more than anything wanted me to take a picture of him J. He had been diagnosed with a seizure disorder several years earlier and had been sent to La Ceiba to see a neurologist who after several tests prescribed the boy Phenobarbital. Unfortunately, in August of this year the mother ran out of the medication and had visited the Global Healing clinic to refill the prescription. Doctora Prado gave the mother a month’s supply of Phenobarbital as well as a referral to see the neurologist in Ceiba to properly manage the boy’s seizure condition throughout childhood and adolescence.

However, as is often the case with many of our patients, the mother was back in the clinic a month later asking again for another refill prescription. Now, if you are at all familiar with anti-epileptics you know that these medications are pretty nasty, and few physicians other than neurologists feel comfortable prescribing them, particularly third year pediatric residents. Therefore, I sat down with the mother and asked her why she had not gone to La Ceiba to see the neurologist as Doctora Prado had instructed? She told me that she had gone to see the neurologist and they had already done all the tests. At this, I was confused, which is when I realized that the mother was referring to the original appointment the boy had with the neurologist over a year ago. The poor woman had not understood that the referral was for a follow-up. I gently explained to the mother that her sons seizure disorder was complex in that just as he might outgrow his clothes, it is also possible that he can outgrow his medication dose, or the type of medication he would need to take. I explained that he would probably need yearly follow-ups with his neurologist until the problem was resolved. It might even be the case that he wouldn’t need to take the medication at all!

At this news, the mother became quiet and worried. This was probably the first time anyone had really explained to her the reality of her son’s problem, and the importance of properly managing his anti-epileptics. After all was said and done, we asked the women if she was going to be able to take her son to La Ceiba, to which she shrugged her shoulders. As is the case with many of our patients at the clinic, she could not afford a trip to La Ceiba but was too ashamed and proud to admit it. Thankfully, we were able to offer the women and her son free transport to and from La Ceiba. The mother and her son left the clinic completely grateful for all the education and help we had offered them. “Que Dios le bendiga” she said, which means “May God bless you”.

My interactions with this family showed me the importance of patient education. It is so important to make sure that your patient understands their problems, why they have them, how to avoid them, and how to treat them. All this mother knew was that the Phenobarbital helped her son, but she hadn’t the slightest idea that poorly managed seizure disorders could result in developmental delay, or how anti-epileptics affect cognition. While all this information may have surprised her, and even scared her a little, I am confident she left our clinic with an increased understanding of her son’s problem, and perhaps with increased confidence in her ability to help him.