Tuesday, October 07, 2014

Kylie Mason Summer 2014

I’ve now been back in the United States for three weeks, and have finally been able to really work through processing and reflecting on my five weeks in Roatán. I don’t think I’ll ever forget when I first walked into the hospital and saw a child throw up onto the concrete floor while cleaning ladies attempted to mop the floor nearby. At the same time, I don’t think I’ll ever forget how kind, helpful, and hospitable everyone was when I was trying to get to where I was going to be staying; one worker at the hospital called Dr. Cerritos for me and the security guard at Clínica Esperanza insisted on carrying my suitcase when I was waiting for other volunteers to meet me when I arrived. I think that these two instances, which occurred within minutes of each other, serve as fitting examples for the general situation on the island—in many ways there is so much lacking, especially in terms of medical resources, but the islanders never seem to let this get in the way of being kind, grateful, and friendly people.
I certainly saw examples of this every day at the clinic, such as when parents would bring their kids in because they thought they had a fever, but they rarely knew the actual temperature that their kid had because they didn’t have a thermometer at home. Fortunately, most of the time the parents aired on the side of caution and the child only had a low-grade fever, but there were still instances when the child would have a high-grade fever and I would immediately have to let Dr. Cerritos know so I could give the child acetaminophen and have the child seen sooner. In general, the parents were trying to do the best thing for their child, but often didn’t have the resources to be able to provide everything, whether it was acetaminophen, multivitamins, or proper dental hygiene.

So, being able to try to fill in the gaps on what the kids needed, and what the parents wanted to provide but couldn’t, made helping these kids even more rewarding. Not only did the kids’ faces light up when we would give them a toothbrush and toothpaste, but the moms were just as happy too. Another way that we were able to try to fill in these gaps was by providing fluoride treatments that had been generously donated to the clinic. Genevieve was great about offering it to any patient who had any teeth, regardless of age, and the parents were always more than willing to have it done not only on the patient, but any other children who may have come along. Even though it didn’t take long, and doesn’t seem like much, it was rewarding to know that it made some sort of difference in the child’s dental hygiene and overall health, which they wouldn’t have had without the clinic.

Another thing that struck me was the sense of community that I often witnessed. For example, I often saw mothers reprimanding kids other than their own if the child’s own parent was busy, and there seemed to be a general acceptance and appreciation for the whole community truly raising everyone together. I think that this mentality was also at work when patients would come in while Dr. Cerritos was already seeing a patient. Often, they just needed something quick, like a prescription renewal, and the mom and patient who were in the middle of seeing Dr. Cerritos never seemed bothered to have the appointment that they had waited hours for to be interrupted. While I’m sure the moms are understanding because they realize that they could easily be in a situation when they need to see a doctor immediately, I also imagine what the reaction would be in the United States if someone’s appointment with a doctor were interrupted, never mind if it was an appointment that they had waited for since six in the morning. Needless to say, I’m not sure the reactions would be quite as patient and understanding as what I saw

As far as what I personally got out of the experience…I’m not sure where to begin. I came in hoping that my Spanish would improve, and that definitely was achieved. Although I had been pretty comfortable speaking before I got to Roatán, I hadn’t been very familiar with medical terminology, but after being in the clinic and having to ask patients what was wrong and understanding what they were saying, I definitely have a better grasp on that. Being in a pediatric clinic also made me much more comfortable working with kids than I previously was; reading and coloring with them while they were waiting to be seen ended up being one of the most rewarding parts of my time on the island. Overall, I think meeting people who are struggling to survive every day but still manage to be kind, loving people has helped to put everything in perspective for me, as cliché as that sounds. Most of the locals who I met have had a fraction of the opportunities that I’ve been fortunate enough to have, but instead of being bitter or resentful, they are grateful for what they do have, whether it’s acetaminophen from the pharmacy so they can start to treat a fever at home or a coloring page while they wait for the doctor. This experience was truly invaluable, and I know that my time in Roatán has left a permanent impression on me that will continue to be valuable as I pursue a career in medicine.

Sunday, September 07, 2014

Zoe Malot Summer 2014

After living in Roatan, Honduras for a month I found it to be beautiful, humid and hot, and full of wonderful people, many of who are suffering from extreme poverty. After settling in, we went to the hospital the following day to receive our tour of the hospital. Genevieve, the nurse practitioner volunteering in the pediatric clinic, showed us around the hospital including the incredibly small emergency room, the crowded maternity ward, the pediatric ICU, the sole room for dengue and malaria patients, and the rest of the small hospital. The malaria/dengue room was a dark room only lined with empty lawn chairs. She also introduced us to the doctors, nurses, and other hospital staff members as we started to familiarize ourselves with the hospital and the system.

The first two things that stuck out to me the most was how many people were there just waiting. The hallways were lined with benches on either side, filled with people just waiting to be seen. They wait there for hours, sometimes from 6 in the morning. I learned that thanking them for waiting for so long went a long ways, and the moms seemed to appreciate the acknowledgment.    

Since I was one of the two Global Healing interns for the clinic, on some of the days after we finished triage I would help the social worker, Ingrid, give health “charlas” to the people waiting in the hallways. I helped give informational talks on HIV/AIDS, Tuberculosis, and Malaria, all of which are prevalent on the island.

The talks were informative about symptoms, how infections and diseases are transferred, treatments, and preventative guidance. Public health and health education is underprovided on the island, so preventative health education goes a long way. 

The other most shocking sight was what was called ‘The Medical Equipment Graveyard’. This was a dumping ground in the hospital courtyard for medical equipment that was broken such as wheelchairs, gurneys, filing cabinets, infant incubators, and even cars or tires. This broken equipment just lies there deteriorating and rusting next to patients waiting in line outside.

In the next few days I assisted Dr. Chantry teach the course Helping Babies Breathe® to Genevieve and Dra. Cerrritos, which is a course for infant resuscitation designed for low-resource settings. Teaching a ‘Train the Trainers’ course is especially helpful because it has the potential to help more babies as the Trainers teach more providers, giving it the ability to spread and thus be more effective. The course is a 2-day, 12 hour course where learners practice on NeoNatalie®, a water-filled baby dummy. In the next couple of weeks we also spent a couple days teaching the course to a couple of nurses including Sarah, Jesse, Bertha and Gabriel.  It was not only a wonderful experience to learn the Helping Babies Breath course, but also to help teach it because we learned so much about the hospital, the doctors, the nurses and the culture.

During the course Jesse, one of the nurses, explained to us how hard it is to work in the hospital, and how hard it is to change procedures as a nurse. She explained, frustrated and near tears how she knows the umbilical cord shouldn’t be cut within the first minute and a half (WHO recommends 1-3 minutes after birth - 2 being optimal), but doctors continually cut it immediately after birth. Hearing her describe her struggles was heart-breaking, because she is there trying to provide the best care for the babies but disheartened because she feels she is unable to change anything. We then discussed the long list of procedures and practices that need to change in the hospital. Listening to the discussion, it was hard not to feel disheartened since it seemed that it was so hard to make changes with so many obstacles, with resources being a major one.

Concluding the discussion Dra. Cerritos told them she knows how hard it its, that it is a constant struggle, but encouraged them not to give up the fight, and hopefully Helping Babies Breathe would lead to at least one thing that could change within the hospital and on the island.

When we returned the following Monday, I was delighted to find the nurses and doctors on strike. It was great to see them stand up for what they were constantly fighting for. Jesse and Sarah were sitting outside with other hospital staff members who were hanging up signs in protest. The signs did not read “more benefits” or more pay” like many protests in the United States are for, but rather “No hay suturas para pacientes cesarean; guantes descartables” (We don’t have sutures for caesarean patients or disposable gloves) and “Tenemos mes y medio de no hacer cirugias programadas, por tener la maquina de anestecia mala” (Its been a month and a half without scheduled surgeries because the anesthesia machine is broken). They weren’t striking for themselves (even though some of the nurses hadn’t been paid in months) they were striking for the patients, so that they would have the resources and materials they needed to just even provide basic care.

On a couple days I would go to the maternity ward with Dr. Chantry to check-up on the newborns. There would be anywhere from one mom and baby to ten moms and babies in the same room. It was great to listen to. Dr. Chantry and Dra. Cerritos give anticipatory guidance to the new moms on breastfeeding and other healthy practices. The doctors would check the heartbeat and breathing of the babies; listening to the fast, strong heartbeat of such a small, fragile baby is incredible. I was amazed how fast it really was even though I already knew on book how much faster it should be than an adult heart rate.

The best part of the internship and my experience on the island was the interaction with the kids in the clinic. Although some cried and screamed because they did not want to be there, and were afraid of the thermometer in their ear or the scale, but the few that were happy to be there and would smile when I took their weight and height were wonderful. Those smiles from the month-old babies were very special.

We would see quite a wide variety of diagnosis in the clinic. To name just a few of the more common ones; we saw mild to severe cases of malnourishment, contact with resistant Tuberculosis, allergies, pre and post surgery consultations, bacterial infections, and common colds.

Overall, I had a wonderful experience that really opened my eyes to the low public health capabilities of Roatan, Honduras. So thank you to all that made the Global Healing internship possible for students like me.

Monday, July 28, 2014

Will Yokeley Summer 2014

I can’t help but feeling like the past month is an experience that will impact me for the rest of my life. Seriously, I’m incredibly thankful for the opportunity to live in and get to know Roatán. It´s like a friend that you become really close with in a short period of time and you can´t help but to just be thankful that they were a part of your life. That´s how I feel about Roatán. From my islander friends (like Kenfor shown below) to the awesome American and Canadian volunteers who work at Clínica Esperanza, I met a ton of people who were so much fun to be around. Most of the volunteers were med school, nursing or pre-med students (and some doctors and nurses too), and being around them made me even more excited to get on the path towards a career in medicine because they were all so down to earth, caring and passionate about helping others. Couldn´t have asked for a cooler group of people to work with!
My bro Kenfor
My bro Kenfor
Since I´ve gotten home, a lot of people have asked me how my experience was working in the hospital and what kind of things I was able to do there. Obviously I wasn´t giving treatments to people or diagnosing them since I´m not a doctor, but I got to be a part of every other aspect of a patient´s doctor visit. My co-intern and I were always the first people in the clinic to see patients each day, and after their long waits each morning (anywhere from 2-4 hours sometimes), we were always eager to get them into the clinic for triage just so they knew we´re doing our best to see everybody ASAP! But the attending pediatricians, Dr. Chantry from UC-Davis and Dra. Cerritos from Honduras, worked hard to see anywhere from 10-15ish patients every morning. There´s Dr. Chantry and her daughter and niece with me in the picture below.
Dr. Chantry, Zoey and Sabrina
Dr. Chantry, Zoey and Sabrina
Definitely my favorite part about volunteering at Global Healing was working with the kids everyday. Not only did I learn to tune out a crying baby, but I also got to know some pretty awesome Honduran niños! A lot of times parents would bring all of their kids to the clinic in addition to the one who was sick, and most of the time those healthy kids wanted to do something…anything. They were probably so bored of sitting around at the hospital! So Zoey, Sabrina and I would give them some paper to draw on, we would read with them sometimes and Sabrina even made a poster and taught kids about the importance of brushing their teeth (which deserves emphasis because many kids came into clinic with cavities). I especially loved having older kids come into clinic because it’s fun to talk to them and see how they’re feeling instead of immediately asking the parent. Some of the kids would be shy and just look at their parent for answers, but some of them would be pretty chatty, like Keylin who’s in these pictures.
Keylin      Keylin 2
Global Healing is really doing some great things in Roatán! There were 10-15 patients everyday who would not have gotten medical care if it weren´t for the clinic. In addition to that, sustainability is always a big question with these medical mission projects, but that is taken care of at the clinic since we have Dra. Cerritos working there throughout the year. And all the families loooveee Dra. Cerritos by the way.
I learned so much about healthcare during the month I was there, and especially healthcare in an under-served área. It really is so much different than healthcare here in the states. There is a lot of need in Roatán, as there is in much of Central and South America. Healthcare is just one aspect of the need, but healthcare is also something that effects the total well-being of an individual in ways that no other service to someone can do. Volunteering in Roatán helped me to see that first hand.
By the way, I also ended up getting a little bit of a bonus added to my trip when I found out they have little league baseball on the island! They had games every Saturday and the kids are pretty good ballplayers. I got to hang out with them a few times and they even let me pitch to them at a game, which was a lot of fun!
At the little league field
Pitching at the little league field
Being in Roatán was one of the best experiences that I´ve had. And just to wrap all this up, I´m very thankful that I had the opportunity to volunteer and learn there. Roatán definitely gave me much more than I was able to give to the island, and it will always be a special place to me. Thanks for reading my post, and if you´re interested in learning more about Global Healing then check out the link below!

Wednesday, July 09, 2014

Emily Carey Summer 2014

My experience on Roatan was unforgettable, but in a way I could never have imagined before I got there.  As a pre med student with a love for learning the Spanish language, I knew this trip would be an amazing experience.  When I arrived, I’ll be honest I was a little bit scared – I had no idea what to expect! Ms. Peggy picked me up from the airport and brought me to the beach house where I would be spending the next month. That night, some volunteers came over to our house to cook baleadas, a staple in the Honduran diet. Everyone was so friendly and welcoming; my fears were immediately assuaged and I knew that this would be an extraordinary month.

Naturally, I was nervous for my first day of work. When I cabbed to the hospital with Genevieve, the nurse practitioner I would work with for the month, and other volunteer doctors, my nerves were again alleviated as I quickly realized just how amazing these women were.  Genevieve showed me around the hospital and the doctors taught me about some interesting diagnoses as we worked through the patients for the morning. I headed to Clinica Esperanza in the afternoon.  There, I was translating for some of the nurses who did not speak any Spanish. My Spanish was definitely put to the test, but I loved every minute of it. Explaining instructions for birth control pills, or picking out the right glasses for a patient is not the Spanish I was used to speaking in my university classes. But I worked my way through it and I returned home excited for what the next day would bring.

            As the first week went by, I explored the island a little more and began to get used to triaging patients. I made friends with a little girl named Neli, whose brother, Junior, was at the clinic for neurological problems. I drew pictures and played with the two of them as the doctors spoke with their mom. The next time they came in they were so excited to see me, and their mom told me they wanted to learn English after meeting me. This was really moving. I loved making connections like this with the patients, and this was only the first of many.

Neli and I at the hospital

A patient and her mom sporting their new butterfly tattoos

Finally a patient that didn’t scream on the scale!

Clinica Esperanza Triage

            The kids at the clinic absolutely loved the donations that I had brought. Most were just small balls, or stickers that we would give to the patients after seeing the doctor. The little boys loved the toy cars and their faces lit up when they realized they could bring it home with them. Many times, they would offer to give it back, but when I explained it was a present, they were delighted. One day I sat and put temporary tattoos on with a patient waiting to see the doctor. We ended up putting one on her mom, her grandmother and some other patients sitting in the hallway waiting. Putting that smile on the patients’ and parent’s faces was a truly special feeling, but realizing that sometimes this might be their first and only toy was heartbreaking. So many children in the US have piles of toys, but these boys and girls barely have crayons. We take these things for granted as kids and as adults, but such a small thing can make such a big difference. These children simply learn to play with what they do have, and sharing is never questioned. I learned to truly be thankful for everything I am blessed with at home in the United States.

Using my Spanish every day was a fun experience for me. I’m by no means fluent, and I’ve always been a little behind in my speaking skills because I was so afraid to make a mistake. Listening always came easy to me, and writing I could simply look up what I wasn’t sure of. But this trip finally made me realize that making a mistake while you’re speaking to a native is okay. They will always understand what you mean and appreciate that you are trying. Leaving Roatan I feel more confident in my Spanish skills. I loved learning Spanish from patients. If I couldn’t understand a word he or she was using, I would ask for an explanation. This way, we both worked out the meaning of the word, occasionally through a few laughs, and I could add a new vocabulary word to my list. I also loved it when patients would ask me about English words. It was fun to teach and it was great to see the patients’ desire to learn.

Although of course more upsetting, young patients who came in with rare, severe cases were the most interesting. Working with young children and babies allowed me to see various medical problems that are so easily preventable in the United States. Sometimes we’d see little things, like a little girl with a marble up her nose, or a fever and a cold. However, the babies born septic, the boy with a rare genetic disease, or the child with spina bifida, are the patients I’ll always remember. Many of these cases could have been prevented in the US, simply due to more sterile conditions or availability of resources and proper care. Sometimes I was also saddened to see parents’ serious lack of education. This lack of basic medical knowledge meant many children were missing out on proper care because their parents did not understand when it was necessary to see a doctor. This is definitely something that can be prevented with a more intense education program put into place for expecting mothers.

            Roatan is an interesting place. Because of the diving tourism, there are parts of the island that are well established, with resorts and shops. The rest of the island lives in poverty, however, and it creates an interesting dynamic. Volunteers are well respected on the island and the locals really appreciate the “gringos” helping out. It is quite surprising though how isolated and unaware the tourists are of the poverty plaguing the island. It seems if more of the diving tourists understood the conditions of the hospital perhaps they could help in some way. Of course, the tourism itself is helping the island, but it is terribly unfair how severely separated the island is. Perhaps if tourists were more aware of the conditions in the communities and the lacking healthcare system, word of mouth would allow more Americans and Canadians to travel and volunteer their in some way.  Roatan is a beautiful, vibrant place but I’m not sure visitors truly understand the hardship and impoverishment that exists throughout the island.

I feel very blessed to have had such an amazing opportunity to meet and work with such truly amazing people. The Hondurans living and working on Roatan are some of the kindest, most genuine people I’ve ever met. The nurses and doctors are incredibly talented and passionate, and I am not sure they get enough credit for it. My last day of work, some of the nurses and doctors were sad to see me go. I’d made a connection with these people and I’ll never forget them. In fact, I hope to return to Roatan as soon as I can, maybe next time with an M.D. next to my name.

Sunday, January 05, 2014

Amanda Journal #5

all the small things

I’ve been here for three months. It’s been a big three months. But today I want to think about all the small things. These are the simple, important, amazing things that together have made this experience so big for me.

Organizing patient files and learning the importance ofdecent, legible handwriting. It really is important to the time to write a person's name and their history so that the next person who touches the file can understand what happened... I know it's kind of a long-standing joke that people who work in healthcare have really bad handwriting, but seriously folks, decent handwriting really goes a long way.

Handwashing. I spent a day teaching all the kids (and their parents) who came through the clinic how to properly wash their hands and the importance of handwashing. These big bottles of hand sanitizer were purchased through a very generous donation and distributed throughout the hospital. The hospital staff was so grateful – There are few places in the hospital to wash your hands and the running water doesn’t always work. This donation was so important to the hospital!

in the pediatric ward

in the maternity ward

in the dengue clinic

Weighing and measuring with accuracy. This is one of those things that I do over and over and over again all day at the hospital. Weigh and measure kiddos. But these numbers are what help the docs determine if kids are healthy, if something is not right, how much medication to prescribe… height, weight, temperature, head circumference, these are important numbers that have to be accurate.

Cleaning supplies. These were another donation that has made a big deal. When I got here we were running out a of this. Thanks to this donation, we have not had to spend money (that is not so easy to obtain) to purchase more cleaning supplies, and there will still be some here to use for a few months after I leave.

All the little touches. A cover for the baby scale. A bookshelf to hold books and informational pamphlets for families to read while they wait to see the doctor (and, as I’ve said before, they wait hours and hours). These are the things that seem small, but a lot of work and love and kindness of friends and strangers went into making them available for this clinic.

I am so thankful for the small things.

Wednesday, October 30, 2013

Amanda Journal #4

go with the flow

A piece of advice that is often given to travelers is to learn to be very flexible. Often things don't happen on time. Or they don't happen at all. Or they happen in a round-about way that doesn't seem to make any sense and takes a lot more time and maybe doesn't produce the results or arrive at the destination you were looking for but you just have to go with the flow.

While living in Brazil, I learned that when people want things to be done at a specific time (for example, a business meeting), they request that it be done on "American time" (as in, like a person from the United States would do it). It was not uncommon for both students and professors to show up half an hour late (or more... or not at all) to classes. When someone says they'll be there soon, usually that means within the next hour or two, not the next five minutes. Sometimes the bus doesn't show up. Sometimes the metro is broken down. Sometimes there is a strike or a holiday so everything is closed for three days (or more).

It's good to learn to go with the flow, to be able to adapt and figure things out when things don't go exactly as planned.  The idea that "time is money" is pretty deeply ingrained in our culture, and don't get me wrong, I like to have my schedule just as much as any other gringo (you should see my day planner from college... yikes!), but traveling has definitely helped me learn that a schedule can't rule my day or my life.

But how does that translate to healthcare?

In both clinics that I am working in here on the island, appointments are not scheduled at a specific time. You can set up an appointment for a specific day, but you still have to make sure you arrive early enough that your "spot" isn't taken. Dra. Cerritos hands out little tiny signed slips of paper with a date written on it. Patients/parents come back on that day and turn in that little slip of paper to the receptionist, who then gives them an even smaller piece of a paper with a number written on it. That represents their place in line to see the doctor. The doctors only see a certain number of patients every day (Dra. Cerritos sees 15) so if you are not here early enough, you don't get to see the doctor. I have talked to parents who have come as early as 6 in the morning to ensure that they are seen by the doctor. I don't start triage until 8:30. Dra. Cerritos doesn't usually arrive in the clinic until around 10:30 (She works in maternity in the morning with the new mommas), and sometimes it is even later than that. So families are waiting in the heat for literally hours to see the doctor.

I can't tell you how many times a morning parents peek their head in the clinic to ask, will the doctor be seeing patients today? What time does the doctor show up? And I cringe because I have to answer, "Well... usually she's here around 10:30, but sometimes she gets here as early as 8:30 or 9..." More than once, emergencies have come up in the maternity ward and she has had to rush off. In these cases, I have to work up the courage to step out into the little waiting area and tell the parents who have been waiting for hours in the heat with their hot, sick, crying kiddos that the doctor will not be able to see you today. I am so sorry.

The inconsistencies are really tough, and this goes beyond the scheduling. One day, the electricity went out. I was reading babies' weights with a flashlight. And with the electricity, we lost our air conditioning (Global Healing has provided an air conditioner that we get to use inside the clinic). So instead of stepping into a refreshing clinic, families stepped into a hot, dark room with a sweaty volunteer (me) to measure their kiddos. Another day, a different lock had been used to lock the clinic, so I spent all morning looking for the key and started triage late. The first week I was here, we ran out of paper towels so I had to use gauze to wipe down the clinic at the end of the day (PS thank you ALL for those donations.....I have never been so excited for disinfecting wipes). One morning I spent half an hour chasing a tarantula out of the clinic. Yesterday, I showed up at the hospital to find out that the specialized doctors had gone on strike after not receiving their pay. All of Dra. Cerritos' patients were turned away by the receptionist, which shouldn't have happened -- She is part of the hospital staff, but her salary from the pediatric clinic is paid for by Global Healing.

I've said it before, but to my foreign eyes all of this can feel a bit chaotic. It is good to see some of these inconsistencies alleviated by Global Healing. Today, thanks to the consistent paycheck from them, we will be able to see 15 patients while the other pediatric doctors do not.  As far as all the other surprises, I guess I'll just keep going with the flow.