Alicia Journal 1

My first week in clinic went more smoothly than I expected. It was a little overwhelming at first- all those mothers and their babies and their rapid-fire Spanish (and the fact that they seem to talk faster when we didn’t understand what they said the first time), the crazy multitude of names (and spellings) on all the charts, Global Healing volunteers coming in and out to use the phone and computer, hospital employees looking for Dr. Charles and the attendings, Dr. Charles’ illegible handwriting- but once I got used to the way things worked, it wasn’t all that bad. I already sort of knew some local medical terminology- like “calentura” for fever- after going with Audra to Peggy’s clinic the week before to help teach the weekly class for the Community Health Promoters Project in La Colonia. The week’s topic was diarrhea and respiratory illnesses and it was a good introduction to a lot of the common complaints I would be seeing in the clinic, as well as how they are approached medically on the island. Audra is making a lot of progress on the project with the volunteers and made sure to introduce me to Dr. Raymond and Peggy while I was there.
During our days of overlap while Ilena and I were waiting for the doctors to finish with their patients so we could enter their data, Ilena we through some of the books in the clinic’s “library,” including a book on Parasites and “Pediatric Dermatology.” I am convinced I am going to get scabies. No, seriously. I even had a dream about getting back to the States with scabies. Almost all the kids that first week had them. I’m sure it also helped that Dr. Charles showed me the rather large, cartoonish drawing of scabies that he points out to mothers to scare them into taking scabies seriously and making sure they treat their kids for it. Those bugs look like no fun. Ilena finds my paranoia incredibly amusing and proceeds to diagnose every bump and bite on my body as scabies. So much intern love.

When I first got here, Audra and Ilena were both sick with some kind of cold and sinus infection combo so we spent most nights that week indoors, watching “Desperate Housewives” Season 1 DVDs I had brought with me. Then it started raining for a week straight because of Hurricane Gamma so we stayed inside most of those nights, too. After that, it had become tradition. We mixed it up with some episodes of “House, MD” and “Grey’s Anatomy” that I had on my computer. “House” is especially great when we get to see some of the tropical diseases in clinic that they mention on the show. Like leishmaniasis. Fun! And “Grey’s” is about surgical interns at a hospital in Seattle so there’s lots of quotable goodness like, “You’re interns, grunts, nobodies, bottom of the food chain. Take orders, work every second of your life until you drop and don’t complain.” Yay intern abuse!

Eileen, the new attending and my roommate, arrived my second week in clinic. I think it is her 5th time volunteering on the island and in the clinic, so random people drop by all day to come and see her. Dr. Thomas, the resident from Chicago has really been enjoying some of the differences from back home. Last week, a mom came in with her daughter who had fallen out of a tree. He sent her to have an X-ray of her shoulder and she came back a few hours later holding a sopping wet x-ray of her daughter’s broken clavicle. Dr. Thomas kind of stared at it blankly like he didn’t know what to do with it.
“It’s wet,” he said. “It must have just been developed a few minutes ago,” he said more excitedly.
“Yeah, that’s what it looks like,” I said.
“That’s crazy!” he said then proceeded to clutch the x-ray for the next few minutes, not wanting to set it down and get everything all wet with x-ray developer or whatever liquid they dunk them in. I guess sometimes it’s just the little things.

Thanksgiving Day. Although I’d usually spend it scarfing down turkey and cranberry sauce at home, today was just not a good day for West End residents looking for a traditional American Thanksgiving meal. Fosters, the one restaurant that advertised an all-day Turkey Buffet, ran out of food before 4 pm. Drs. Eileen and Thomas, Nora, Ilena and I ended up eating rotisserie chicken- which is kind of like turkey, if you squint really hard- and a few days later I found a can of cranberry sauce at Warren’s (yes!).

I’ve gotten to see parts of the island I hadn’t really expected to from my crazy cab rides back from clinic. Somehow the cab drivers have all conspired to kill me. One time Ilena and I were nearly backed into by a truck and nearly ran off the road multiple times as the driver took the turns at 60 miles an hour. Not to mention the numerous bikers and pedestrians he nearly clipped. I was pretty sure that we weren’t going to make it. For the rest of the day after miraculously making it home alive, the colors seemed a little brighter, food tasted a little better. Nothing like a near-death experience to perk your day right up. Then there was just this ridiculous driver that detoured into La Colonia on the way back during the worst of the Gamma rains. We got about halfway up the hill when the car lost traction and started sliding backwards down the clay. He started cursing and thankfully abandoned the endeavor, managing to steer us backward down the hill to safety. Now you’d think after risking my life on this La Colonia adventure, the cab driver would be courteous enough to at least take me back to Casa Calico…but no. I was promptly ejected from the cab at the West End turn-around, left to trudge back home in a bonafide tropical storm. Funnily enough, while most cabs won’t think twice about going up the perilous, death-trap road to La Colonia, they refuse to go the last few feet to Casa Calico because “the road is too bad.” Craziness.
Then there are the random intense conversations I have with the drivers. One time I talked with this guy about how the island needs to invest more in the youth to keep them from getting into trouble and having problems as adults. He wanted to start a youth rehabilitation center on the island, which I thought was an interesting idea. Then he proceeded to talk to me about the importance of having Jesus in my life for the rest of the drive. Another time the driver launched into his whole life story, about how his daughter was killed when she was 10 and his wife left him and went to the mainland soon after. It was sad. And awkward. Apparently I am the only one blessed with all these taxi cab experiences as Audra and Ilena laugh at me every time I come home with a new one.

Last week Eileen was pretty sick with some stomach virus and Dr. Charles was on vacation so it was just me and Thomas in the clinic. Of there were more patients waiting to be seen on the day with only one doctor than I had seen on any other day thus far. It was ridiculously busy, but after I’d gotten through triaging everyone and was waiting for Thomas to finish with charts I did get to enjoy a warm and fuzzy moment with a little girl whose brother was being seen. I had changed the wallpaper on the computer earlier that week to fish and I guess she must have been in earlier because even though I had the spreadsheet open and you couldn’t see the desktop, the girl ran up and pointed to the screen and said “pescados.” When I minimized the window so the fish magically appeared she grinned and exclaimed, “there they are!” (in spanish of course) She then demanded that I put up a dog. Little did I know that by complying with her I request I would spend the next 10 minutes cycling through every wallpaper image that comes with Windows XP. When those were exhausted we started flipping through a picture book. It was in English, but no matter. Instead we went to work identifying the animals, doing pretty well between the two of us until we came upon a Hippopotamus. Neither of us knew the name in Spanish, but she was pretty amused when I explained how we say it in English. Then we moved on to colors, which was an interesting exercise as she knew the names of various colors, but apparently hadn’t learned to match them up with their respective shades. It was fun though, since we’d been so busy I hadn’t been able to spend much time talking to any one child.

In more recent news, Ilena, Audra, and I started our dive classes and went out on our 3rd open water dive today. The three of us were waiting about 15-20 feet down from the surface while the instructor was working on a skill with another guy. Out of nowhere this rather large fish swims straight at us and starts rubbing against our fins and legs. This wouldn’t have been problematic until it started heading towards my face and bared it’s evil little fish fangs. Let me explain that is was no ordinary fish. Despite what modern medical science may say to the contrary, it was clear that this fish had leprosy. It’s scales were flaking off in patches and it had sickly discolored splotches all over it. We’d had just about enough of leper fish when the instructor came back down and shoo-ed him away. She later informed us that it was a Dog Snapper trying to pass a leechy parasite fish to us, but he will always be Leper Fish to me.

Ilena Journal 4

On the first solidly sunny day in a week and a half, I am genuinely coming down with a cold. Last week, I could practically feel the little kid germs crawling on my skin. Everyone came in sneezing and coughing. “If nothing else does, this will get me sick,” I kept thinking to myself. Although I tried to deny I was coming down with something over the weekend, this morning I woke up feeling gross. Though I expected today’s efforts to climb over the Insurmountable Language Barrier to be more easily rebuffed than usual today, I found that having a cold makes it a lot easier to blur the distinction between my Spanish “b”s and “v”s, which I can pretty much never do while healthy.

Along with the cold germs that seem to have taken up residence in my sinuses, making my head feel like it’s being squeezed in a vice, several new tropical friends have suddenly moved into the bathroom. We’ve now got a large (“It’s not that big,” says Audra) mini-tarantula-esque spider and some kind of small lizard that settled in the shower.
We also have a new intern. And a new attending.

With Alicia here we’ve got a triad of names bookended by “a” sounds and the beginning of some kind of joke: Audra, Alicia and Ilena walk into a bar... Alicia brought two crucial things (in addition to her lovely self): DVDs (particularly season 1 of “Desperate Housewives”) and the news that iTunes is selling current episodes of “LOST” (an incurable addiction of mine).
Stephanie discovered another hospital absurdity to add to the list: an X-ray of a pregnant woman, hanging on the wall in the labor and delivery room. As there are no ultrasound machines here, to conclusively determine the position of an unborn baby x-rays are the only resource available.

Clinic was eerily quiet the past week. Only a handful of children showed up each day, along with a tall Cuban doctor who comes in to use our internet and asks me questions (en espanol) about navigating yahoo mail. Hep A kid came back and looks much improved; where before there was a completely lifeless-looking child there is now a kid that looks healthy. I’m glad his illness has turned around. Sadly, we also made him and his mom come back, twice, as they were unable to get the lab test done yesterday and we were unable to wait for the results expected at noon this afternoon (considering we closed up shop at 10:30).

On Alicia’s first day in the clinic, everything went smoothly, despite one little girl throwing a tantrum and nearly hitting Alicia in the face. Hep A kid was finally seen and has continued to improve.

Two days later we were greeted in the morning by a hallway full of people and 30 charts. Alicia and I divided our triage duties in half, sharing access to the scale and the growth charts and trying to dodge the half-dozen random people who kept appearing and complicating an already overwhelming process. First the Cuban doctor whose been using our internet, then a nurse with two women and a newborn in tow (who claimed there were here because the baby had a fever – but it was normal when we took the temperature) who disappeared shortly afterwards, then the pharmacist, looking for a file Nora had left on the computer (which was supposedly in Spanish although we couldn’t find it) who returned later (at possibly the most inconvenient moment of all, when Alicia and I had five kids between us that we were trying to juggle) with Nora in tow, Dr. Green for a short time and finally an absolute parade of crazy mothers. One woman kept insisting that she was third in line, though I had found her chart at the bottom of the pile. Another mother showed up with her kids in tow but with no charts, asking for a doctor to read her lab results; Dr. Charles read her the riot act but saw the kids anyway and ended up sending the family to Valerie’s to get the youngest, suffering from a completely hacking cough, a third HIV test. A family of three came in and the middle child, a girl, began almost silently throwing up a stream of bright orange vomit into our wastebasket. I felt both sorry for the girl and grateful for her neatness and discretion.

After our take-no-prisoners triage efforts, Alicia and I finished early and read up on parasites, infectious diseases, pediatric dermatology and Global Healing’s advice and protocols while kids were crying and vomiting all around us. Charles had given Alicia one of the greenish yellow “oranges” they sell outside the hospital; one little boy started chattering away at us, asked for our orange and proceeded to start hiding it in his baseball cap while coming in and out of our area. He was obviously bright and completely adorable. Despite some of the craziness that occurs daily, working here has its rewards.

Ilena Journal 3

Clinic got off to a late start this week. Lucky for all of us, Leonel decided to stick around for a few days, he came into clinic to show the new attending the ropes. The way things were supposed to work out originally was that the new attending would start working in the clinic basically without knowing the hospital’s system or the hospital at all since there was no overlap between attendings. With Leonel around the transition was much smoother.

Tuesday, Dr. Stephanie, the new attending, called me out of the clinic to come see “something interesting.” With more than a little trepidation I followed her down the long corridor into another clinic where a girl of about eight was sitting with a giant, weeping ulcerated wound just above her ankle. Leishmaniasis, they said. Carried by fleas, this parasite eats away at the skin, but causes no pain. Although the girl had the cutaneous form, there are visceral and other forms of leishmaniasis that can cause deformities and other ailments. This girl’s lesion had been steadily growing for four months; tests had been done that confirmed the presence of the parasite and a secondary infection. Apparently it’s not endemic to this area, she had been bit on the mainland and brought the parasites with her (one doc mentioned that other fleas may bite her now, becoming vectors that could infect other people with the parasite).

When I returned to clinic there were a string of run-of-the-mill complaints- colds, constipation, 10 day old babies in for well visits, followed by two seven year old boys with unusual pathologies- one’s yellow eyes, upper right quadrant tenderness and inability to eat suggested Hepatitis A, a disease that, Leonel said, many American pediatricians have never seen. (After calling me in to take a look, he asked, “By the way, have you been vaccinated against Hep A?” I told him I had received the first of the two inoculations. “Oh” he said, pausing, “You may want to take a step back, then.”)

The second boy’s story came out a bit muddled: He had been tooling around with a screwdriver and either scratched his eye with it or was around his father while his father scraped paint off the walls and managed to get some of that in his eye. In any case, the eye was inflamed and Leonel was concerned he may have scratched his cornea. Charles caught that it was actually a relatively large ulcer at the top of the eye. We had to look at the eye as if it were a hologram, adjusting the kid’s head and our perspective to get the light to hit the surface of the eye at just the right angle to see the ulcer, a cloudy triangle.

We rented “Dear Frankie,” a movie about a scrappy but damaged Scottish boy and his scrappy but damaged mom, and watched it on my computer, using the speakers Leonel had bought. In the middle of the movie, Leonel got up abruptly to check something out on the floor. He said there was a frog in the apartment, that he had seen it hopping. Audra and I were surprised- how did a frog climb all those stairs? We went back to watching the movie. Afterwards, as we were cleaning up the hot chocolate mugs and putting the chairs back, I said I hoped the frog found its way back out and Leonel confessed it wasn’t a frog he had seen. “Cockroach?” I asked. He reluctantly said yes. Regardless of whether he lied for my peace of mind or because he thought I would flip out and disrupt the movie, I appreciated the gesture. Things are going to be different when he leaves.

Later this week there was a mayonnaise jar with a cancerous uterus floating inside it that is perched on the orderlies’ desk in the maternity ward. It sat above the charts for the newborns that lie side by side, waiting to be read through and signed by the attending. It looks more like a naked, twisted cassava root than a womb. Apparently, as someone randomly came in and told us in clinic, it and the woman it was once a part of are wanted in pathology. I also saw my first instance of soda in a baby’s bottle. I had been on the look-out for it since Audra had mentioned it was common practice but this was my first real sighting. There really is no question why half the children who come through the clinic have brown teeth rotting slowly in their gums.

As part of her introduction to the clinic, we took Dr. Stephanie to the “country bar” in Coxen Hole, one of Dr. Charles’ favorite haunts. A piece of cardboard taped up above the women’s toilet reads, “VORNING,” then a little space before the line, “Don’t do no dope in the toilet.” Then it said the same thing again, slightly more formally, in Spanish.
For all the tearing asunder from their rightful places that goes on in the hospital of organs, food and waste products, there was one reunion story this week. When I first came to the clinic, Leonel, in his infinite optimism, taped up the vaccination record card that Jennifer Suoza Flores had left behind. “She might come back for it someday,” he said. For weeks it sat square in the middle of my field of vision when I looked just above the computer monitor. Then finally, I go to call the next patient in for triaging and who was it but Jennifer Suoza Flores herself. If this were a made-for-tv movie, my handing back the scrap of paper would have been in slow-motion, with grandiose music in the background.

Things growing where they shouldn’t seemed to be the theme of the day: one case of hair fungus, where a young boy of seven had a huge round bald spot towards the back of the right side of his head, and of course the usual parade of worms and intestinal parasites although made more noteworthy this time by one of the mothers saying that although she hadn’t noticed anything abnormal in her kid’s stool, they had traveled north instead of south; he had been chewing on ascaris worms the night before. In addition, the past two days have featured several repeat customers. Hep A kid came back, looking healthier and the probable malaria twins returned, too, although only one of the almost identically named identical twins’ malaria smears came back positive. But malaria tests are like fishing; you keep casting your line out until you reel in the result you want.

Ilena Journal 2

Monday

The roach has been vanquished. Nurse Audra, the newest addition to the team (and also my new roommate) cornered and killed it after I saw it flying around the room. Who knew that cockroaches could actually fly? I thought they were like turkeys or ostriches- winged but only decoratively. That cockroach zooming across the room today will definitely haunt my nightmares for a long time to come.

Other than that, clinic was absolute chaos today. Children everywhere, parents suddenly appearing in the doorway demanding that their kids be seen, the odd Global Healing staffer showing up to use the printer and complain about our/the island’s/the country’s lack of resources. Two kids came in with sebarrheic dermatitis and one who potentially had diabetes insipidus, a condition where you’re constantly creating urine and are unable to control its flow. Nurse Audra, who works in obstetrics, told me about a pregnant woman who had the same condition who put out a liter of urine while trying to deliver her child and then another liter immediately after the C-section; it’s a condition that can easily lead to dehydration and other problems but can be ameliorated with medication. The kid in our clinic was thirteen and had been wetting the bed every night for the past five years. He’s definitely won the prize for oldest patient I’ve seen so far and had the most unique pathology of the day. Lucky kid.

Audra also helped manage the flow of charts between me and the doctors so that there is a more efficient and less confusing system. She reorganized the shelves and has a few more clinic improvement ideas she’ll be putting into place. I put the invaluable (yes, that was sarcasm) skills I learned while temping to use in putting file folders in the drawer in place of the stack of manila folders laying there haphazardly. Hopefully I’ll come up with some kind of systematic way of dealing with the random scraps of paper that have been accumulated and that no one seems to use.

After clinic I headed over to Miss Peggy’s clinic to learn about The Project (capital T capital P) and how I can pick up where Jess left off. Unfortunately, Matt and Miss Peggy had forgotten I was coming and Matt- who I guess was supposed to show me the ropes- was in West Bay. We decided to talk again tomorrow when Miss Peggy and her entourage come to the hospital.

On the non-business end of things, I got to go swimming for the first time in a week and then had my first shower with a continuous stream of hot water. Reena, Audra and I made a pot-luck style dinner- including the newest menu item I have in my arsenal of culinary catastrophes/experiments: eggplant with black beans and onion- then got dessert at the Argentinean restaurant with Leonel and his three friends from home who are visiting for the week.

Tuesday

Nothing super-exciting in clinic today but everything seemed to go so slowly. Part of this was due to the nearly constant stream of non-patients that came in and out, including Nurse Peggy and her crew. Nurse Peggy’s resident, Matt, briefed me on The Project that Jess was involved in and that I hope to do something with. The only trick is, the way things progress here, the turnover of the people involved and the current unavailability of internet just about everywhere on the island, there aren’t concrete dates set for Project meetings. So I volunteered to hunt down internet access and obtain information on diabetes and hypertension for the community health initiative in Flowers Bay.

Nurse Audra continued her streak of resourcefulness and ingenuity. I thought the baby scale had miraculously fixed itself when it was no longer registered 1 lb of weight when nothing was resting on it. When I announced to the room the magical self-correcting abilities of our scale, Audra told me she had calibrated it with a dial on the back. That one had stumped the docs for weeks. She even managed to make friends with someone who works in the hospital with the willingness and the resources to make a curtain for the window in the clinic’s door. Now, hopefully, people won’t keep just barging in. Like I said before- lots of optimists in this crowd.

Lack of internet is beginning to frustrate me. I have no idea what’s going on in the world beyond Roatan and have lost touch with everyone back home. My family has given me up for dead. Audra and I were talking about The State of American Politics while sitting in our newly cleaned living room today and I tried to make a point about Harriet Miers, then realized that I had no idea whether she was confirmed to the Supreme Court or where that whole issue stood. I would do a lot for steady access to CNN right now.

Tonight was Night of the Burning Basura. All throughout the island a thin glaze of smoke hung in the air from people burning leaves and other detritus that Wilma left in her wake. Apparently since it’s the first clear night since the hurricane, without wind, everyone decided it was time to start fires.

Wednesday

Three interesting things in clinic today- first some good news: gastroschisis baby went home after only five or so days in the hospital. Second, a girl with abnormal bone growth in her legs. Rodney said it may be rickets- a lack of vitamin D- or childhood rheumatoid arthritis. Third, a baby with a cough, whose mom had a cough that had lasted a year, including coughing up blood the past two weeks. On top of this, they lived with the mom’s grandfather, who had been diagnosed with tuberculosis. The docs didn’t think the baby had TB but they got the mom into the system to be monitored/treated.

The biggest news of all- Casa Calico now has internet! I’m absurdly happy about this. Here’s hoping it will last.

Thursday and beyond

Today was Reena, Rodney and Leonel’s last full day on the island. It’s going to be very quiet around here after they take off tomorrow morning. The basic plan for the day was to rent cars and travel around to the far-away parts of the island. Although the steep rental fee (we ended up paying 70 dollars each for two Jeep Wranglers, although they initially charged 85, plus gas) would have been prohibitive for a smaller group, three of Leonel’s friends from home were visiting this week and helped offset the cost. We drove past Coxen Hole, through Los Fuertes, past Jonesville and into Oak Ridge. Driving around today opened my eyes to the places where the people who come into clinic are coming from; before they were just names to me.

In Oak Ridge we traveled through the mangrove tunnels, in the slowest speedboat on the island. Pirates carved out the tunnels (although our guide didn’t think so), using them to hide from law enforcement. Before we went exploring, however, we had to get the car to start.
“Don’t worry,” Leonel said, “It did this the last time I rented it, too.” (Yes, everyone’s favorite sentimentalist knowingly rented a broken car).
It took a handful of the dozen taxi drivers waiting by the dock to push the car downhill, open the hood and bang on the parts, then push the car back up the hill and repeat the whole process. It was comical, especially when the car started (rather than the alternate ending of having to get it towed).

Two of Leonel’s friends, Nora and this girl one of Leonel’s friends had met all went to Camp Bay Beach in lieu of joining us in among the mangroves. After we piled back into the Land Rover, we took off in pursuit of them. We passed each other as they were coming back towards the main road from the beach; a storm was coming, they said, and they were advised to get to the road. Naturally, we kept going towards the beach, determined to see it quickly then be on our way. Leonel planned to keep the car running while we were there, just to make sure we weren’t stranded. There was no one else around but he got paranoid about leaving the keys in the ignition without someone standing by the car and decided to shut it off. The beach was pretty and completely deserted, but the waves were growing, the sky looked like it was about to storm any second and the water was coming far up the beach. After five or so minutes, we decided to be on our way. The car had other plans. The engine would not engage. We began to push it towards the road, periodically attempting to start it and trying not to get too worried about the situation. Luckily, after a few minutes, the car started, we all jumped in and roared off.

The next day, Hurricane Beta, our newest friendly neighborhood weather disaster, had been pummeling Nicaragua and wanted to visit Honduras but changed its mind at the last moment. Instead, it has sent its emissaries- heavy rain, high-speed winds- our way. As a result, Audra and I spent the entire day inside, reading and listening to her ipod. Leonel’s friends and Reena successfully left Roatan, Rodney and Leonel- who were supposed to take the oversized model airplanes that fly out of the airport into San Pedro Sula and El Salvador respectively- proved not as good at being gone. Rodney was told flights were taking off tomorrow but Leonel decided to stay until Thursday, eliminating my need to say anything nice about him in this journal entry.

Ilena Journal 1

Let me tell you the story of the Hurricane…

Saturday

I’ll save you all the mundane travel details. Quick recap: I slept through the first leg of the trip (the flight to San Pedro Sula- departing JFK at 3:55 am), waited around for several hours, got on two smaller planes, got to my destination. Exciting, eh?

This island is incredible; it oozes with elements of paradise- exotic plants and animals (Casa Calico has a resident parrot that wolf-whistles at girls), lush greenery everywhere (palm trees and fruit trees and mangroves, oh my!), ocean all around and small hotels tucked here and there in the middle of it all. Only problem is there is virtually no access to “modern communications equipment” here; no internet in Casa Calico (where there’s supposed to be wireless), nor in the clinic (it’s been down for a month, though not for lack of trying on Jess’ part), nor at the internet café next door (which is supposed to be for last ditch efforts to get online). No phone today either- the phone hub arbitrarily closed three hours before its advertised closing time. This is how Roatan works- small glitches accumulate and are only very slowly (if ever) addressed- an island operating at the speed of a glacier.

Sunday

There’s only one word for tonight’s events: arachnophobia. An honest-to-God, eight-legged, hairy tarantula was hanging out on the floor behind us in this open-air restaurant 700 meters off the road (down this not very well-lit nor very free of vegetation path). We were there because it’s one of two places in West End with the brilliant marketing strategy of serving food and “showing movies” (that is, they play dvds of relatively outdated American flicks on medium sized tvs that bugs continually land on in ironic places). Tonight was “Life Aquatic with Steve Zissou” which had been cloyingly absurd the first time around but was a lot more amusing this time.

Since then, Dr. Leonel the attending has found it endlessly amusing to command me to do things, prefaced by “Intern!” a la Steve Zissou. That Leonel, he’s a laugh riot, let me tell ya.

Walking through town is like walking on the moon- if the moon’s surface were made of grayish/yellow sand with water collecting in the craters and had cars slowly splashing you as they deliberately wound their way around people and ghost crabs. Ah yes, the crabs. At night these bizarre white/gray creatures hang out by the side of the road and scuttle away from people and cars that get too close, shaking their claws as if they were fists to admonish the drivers. It’s surreal; on the taxi ride home yesterday I saw them in the headlights- like this planet’s equivalent to bunnies- but the whole situation seemed too odd to be true until I risked sounding like a fool and asked about them.

If yesterday was a day of upheaval, today I set about putting down some roots. I bought groceries. Never mind the fact that I forgot several essential items- toothpaste, shampoo, soap- the fact that I have coffee and olive oil to my name suggests that I’m planning on sticking around (and that I’ll stop mooching off of everyone in sight).

I learned how to get on the internet (not as complicated as it could have been), where to buy groceries, where the closest swimming spot is and also some ideas as to where to get food (that I wouldn’t have to cook). I’m glad to be living with someone, but the inevitable judging of my habits (“All you’ve had to eat is coffee?” “Are you sure you don’t want to shower in the morning?” etc etc) I could do without. I appreciate the fact that she- like the rest of the residents (I mean that in the medical sense rather than the, well, residential one)- seems very certain of what she’s doing in life and enjoys the whole process of learning to be a doctor, in direct contrast to my squeamishness about spending so much time in school. Talking to the residents has reminded me that people in the medical profession aren’t resigned to spending 10 plus years in schooling- it’s seen more as an opportunity to learn and to be challenged. There’s one guy here who also grew up in Manhattan, went to Brown, was an English major, enrolled in an English PhD program planning to become a fiction writer and ended up becoming a doctor instead. Some of the reasons he voiced for turning away from English professor-hood are similar to the reasons I have in my head- few people care about the work you do, it doesn’t actually serve any real function and although I love reading books, the writing I produce will end up being a criticism of the criticism of the literature that I like rather than really directly engaging with the text. Anyway, it was reassuring.

Monday

It seemed appropriate that the very first thing I saw when I stepped into the clinic was a big, Manhattan-style cockroach scuttling behind the small fridge and out the door. I was a little nervous about being thrown to the wolves as it were- Jess, the intern I’m replacing, has been sick with dengue fever for a week and a half. She’s a real trooper; were I in her shoes- sick with a potentially dangerous disease, in a third world country, far from my parents- I would not have handled it with the grace and good spirits that she has. Her illness has prevented her from coming in to the clinic so I had to fend for myself. Luckily, the residents- my roommate in particular- were there to help. Things went surprisingly smoothly; despite my tendency towards getting tongue-tied when attempting to speak Spanish, I was able to get temperatures, weights and got over my fear of numbers-in-translation long enough to get birthdates, too. I learned how to read a growth chart and not to flinch when putting the same (disposable) tip into the ears of multiple children (when in America it would have been used once and thrown away).

Overall it was a busy but non-traumatic day. Although I was tentative at first about standing in a hallway crowded with young children and their mothers, all waiting expectantly for me to call their names, timidly shouting out my best understanding of nearly illegible names and trying to hide the fact that my accent is horrendous, I learned to let go of that, too. I had help from some of the mothers with voices that resounded down the long corridor and out the side door where mothers were waiting outside, too. There were a lot of kids sick with the things that kids get sick with- ear aches, colds, coughs, worms, chicken pox. Well, the things that kids get sick with here at least. One baby was going to be hospitalized but when asked to wait a few minutes for Dr. Charles, who was standing-in for Leonel, the attending physician (who was taking care of Jess), to admit her kid, she took off. Some of the other mothers said she had gone to get food. By the end of the day, she had not reappeared. The residents explained that this illustrated two facets of the prevailing mentality on the island: One, that if something like this is not taken care of today, there’s always the possibility of returning tomorrow (when the kid is sicker) and two, that the acting attending did not immediately try to admit the baby but rather saw two more patients before he went in search of her. It’s frustrating, my roommate explained, but this is just the way things are here.

The big news on the island at the moment is the impending hurricane. One resident working at another clinic wasn’t overly worried- Wilma originated as a tropical depression, was upgraded to a tropical storm and only just became a hurricane. Besides, he said, it may not even pass this way. Others are more cautious. Basically there’s nothing we can do but wait and see.

Tuesday

Another day in clinic, another giant cockroach. There was a virtual flood of people in the clinic today to match the impending hurricane waters of tomorrow. Trying to keep order in clinic was somewhat exacerbated today by the fact that the mothers learned early on that I’m a total push over and won’t kick people out if they barge in and start making demands. Leonel, the attending, is a bit of a push over as well, so I don’t feel quite as bad. And he does pay lip service to the fact that we have rules about being outside the clinic door when your name is called or risk losing your place etc etc. But exceptions are made, as they are always made.

No one is quite sure when or where the hurricane will hit, if it will hit at all. But inclement weather set in almost as soon as we returned to Casa Calico after clinic today. We decided to have a pre-hurricane party on the porch outside my room and the room adjacent. Leonel and I bought the supplies and we used Jess’ blender to make pina coladas from white rum, pineapple juice and coconut milk. It was surprisingly delicious. Parts of being here are like the better parts of being at Stanford- especially freshman year when we would all congregate together randomly. We set up our makeshift lounge just outside Leonel and Rodney’s room, with candles, mosquito coils, Leonel’s speakers, my surge protector and Rodney’s laptop. We toasted Wilma. Rodney regaled us with stories of how he earned his (self-appointed) title of BMOC- including his 15 minutes of fame on MTV’s “Boiling Points”- Leonel spoke of turning thirty and losing some of his youthful optimism. I guess that’s what’s struck me most about the people here; I was expecting to find them to be hardened in some ways, inured to the harsh realities of life- particularly health care- in the third world. What I found instead was a bunch of optimistic idealists.

Wednesday

Despite last night’s torrential rain, Leonel and I ventured into clinic today. Leonel had said that the last time Roatan had been pelted with heavy rain, part of the hospital’s entrance was under half a foot of water. I was expecting to wade to work but I was not expecting the blackout that received us instead. Since the other residents were given the day off, Leonel let me accompany him as he made rounds with the formidable Doctor Jackie, even though interns are no longer allowed to do this regularly. For the uninitiated- “rounds” consists of visiting the kids who have been admitted to the hospital. The room was like something out of World War II- the beds had thin pallets on iron frames and we were maneuvering by candlelight for the most part. One baby was slung in a white cotton sling that had been tied to the head and baseboards like a hammock. Doc Jackie explained that some children find it soothing. A tiny baby boy was in an incubator in the corner- Leonel explained he was born with gastroschisis, a congenital defect where his intestines were not completely contained by the abdominal wall and spilled out into his belly. Dr. Sanchez performed surgery- making a small incision, stuffing the guts back in and then pulling the skin from the sides of the wound together and sewing them closed. Although it sounds straight forward, Leonel said there is a chance that because the baby’s skin had developed around the deformity, rather than to contain the intestines in their proper place, the skin would not stretch far enough to allow the incision to be sewn closed, requiring an artificial membrane be used- a resource this hospital does not possess. So it was fortunate that Dr. Sanchez was able to squeeze the baby’s wound closed- “it’s like zipping up an over-stuffed suitcase,” Leonel said.

The hurricane, or lack thereof, is the topic of the night. We had a more mellow re-enactment of last night’s festivities- once again making pina coladas, though this time after chatting for a while we climbed on Leonel and Rodney’s bench and watched “Saved!” all together. It’s still raining, hard, but it’s off and on. Some people claim that Wilma will miss us entirely, others claim it will pass by and then double back on us. Obviously no one really has a clue. Island life goes on, albeit somewhat stifled by the fact that internet is down everywhere I wouldn’t have to pay for it, there’s not much to do and I haven’t really had a chance to get out of the house since the rain started. It’s anyone’s guess what will happen tomorrow.

Thursday

9 am. Day 2 of the hospital blackout. Leonel brought candles for the darkest half of the anteroom. I was given the flashlight, by the light of which I am sitting here writing, waiting for the docs to get back and start seeing patients. Already more people have turned up than were here yesterday but luckily the residents as well as Dr. Charles are here today. Hopefully it should be a smooth day.

The rain has stopped for the most part- now all that remains of Wilma’s gifts to the island is a raging wind that is churning the ocean waters and felling trees.

The Beeping of Unknown Origin, which was slowly sapping my will to live yesterday, continued today- I discovered it came from the surge protector on the floor in the corner. As part of her miraculous recovery, Jess came to the clinic today and shut off the surge protector, saving my sanity.

Today’s highlight was a little girl named Sheriska who was one of those irritating little kids at first that kept walking into the clinic and wandering around while her mom chased after her. But while Raymond was talking to her mom, she got less annoying and more adorable- she came over to me and Jess, played with my flashlight and started hugging our legs. That was fun. As was finishing up at the clinic at 10:15 am.

The past two days I kept asking the powers that be to please make it stop raining. I realize I should have wished for the electricity to remain on instead. Without it, we all revert back to naked, shivering animals, blindly seeking warmth and light. The lights went out again this morning, closely followed by the water. No one knows when they will be back, or why exactly they went out in the first place (beyond the obvious- hey, there’s a hurricane out there!). Although the rain stopped, the wind has been relentless, causing big waves that flooded out the streets of West End. Coxen Hole seemed to have fared better than we are faring at the moment. Here it looks like we missed a big street party and have been left to clean up the mess.

Despite finishing our clinic duties around 10:30, it wasn’t until 1:30 that we finally made it back to the blacked out Casa Calico. Island time passes excruciatingly slowly. The other night, Jess said that the past two months have taught her patience, broken her of her “Type A” drive to always do half a dozen things at once. This afternoon, we decided to get “liquados”- a fruity drink resembling a milkshake- from a place down the street called Que Tal Café. On the way, we stopped when Drs. Reena and Rodney wanted to take pictures, stopped again when Dr. Charles held up traffic to flirt with a girl in the passenger seat of a van. On top of this, no one walks in Roatan, they amble- leisurely. We finally get to Que Tal, find it closed, then turn around and go through the whole routine gain to get to a café on the other side of town. We had an extra stop to gawk at repair work on a broken water main, which the mayor of Roatan himself was overseeing. Dr. Reena warned me not to make too vocal a fuss when I vented my frustration about it all, that I would be accused of being an uptight American. I told her I had long ago accepted the fact that I am an uptight American. You can’t ask a New Yorker to move this slowly. I can’t even wait for the light to change when crossing the street at home; this is torture.

Friday

After the rain had ended and the wind died down today, West End underwent a blitzkrieg clean-up effort. Crews of men were trucked in. They swept up the kelp, wood and other ocean detritus that had coated the streets. A giant zamboni machine smoothed out the craters in the sand of the road. Someone commented that this was probably the cleanest and most well-manicured West End has ever been.

With two residents, Dr. Charles and Leonel all present, clinic went extremely quickly. The day ended with a harried 16 year-old mom with a 10 day old baby she was trying to have a doctor see. Reena commented that things are sometimes very different here than in the states; it’s almost expected that you will have your first child in your teens and there are always extremely young-looking, extremely pregnant women walking around.

Jessica Journal 5

Jessica vs GlobalNet, match 4

We are going on week 4 of being internet-less, not only at Casa Calico, but at the hospital as well. I have decided to take matters into my own hands... After unplugging everything for the millionth time, I called to harass GlobalNet again on Thursday. They have heard a lot from me, but Thursday took the cake. I completely read them the riot act over the phone—considering I’ve called at least 5 times, and they’ve now sent people out twice but with nothing to show. Supposedly the parts” for the “radio” are still on their way…the same parts that were supposed to come in two weeks ago. (I’ve begun to think that this is their standard explanation when they don’t want to spend the time to actually figure out what is wrong.) Well, it was a great accomplishment for me to be able to express my discontent on the phone, all in Spanish. It was a crowning achievement in fact. Needless to say, the guy from GlobalNet came on Friday, 7:30am (thanks to my mom for teaching me how to bust out the “I’m-not-taking-any-more-of-your-shit” in such an effective manner). Well, 45 min later he starts talking about “parts” that are supposed to come on “Monday” for the “radio.” At this point I sic Charles on him, and Charles made him swear on his LIFE that he was gonna come fix it today (Monday). This must be an island thing—because the guy didn’t show today. Perhaps because GlobalNet has NO competition they can afford to run their business this way. I called them around 10 to ask what was up…and they guy on the phone said the “parts” were coming in “this afternoon.” Ha. Anyway, this has now become a personal saga—and the internet WILL be back (probably the day before I leave, but oh well).

Other than the internet, things have been going very well in the clinic. I’ve been able to do more surveys than before, although it’s hard when trying to manage the patient flow for three doctors. Also, on Thursday and Friday I was doing some translating for Dr. Reena, because she doesn’t speak much Spanish at all. So it’s been very busy—but I prefer it that way. We
still haven’t seen many patients needing follow up care, just a astounding number of kids with a common cold or upper respiratory infection. Also, lots of skin infections, asthma and parasites. Because there are so many docs here (Dr. Leonel, Dr. Courtney, Dr. Reena and Dr. Rodney), they have been rotating between our clinic, a clinic in French Harbor and Peggy’s
clinic. Also, today Leonel just supervised the residents while they all saw patients, and that seemed to go well (Reena was also at Peggy’s).

Also, it’s become a regular “Real World: Global Healing” around here. It may have been slightly quiet when it was just me and Leonel…but now it’s practically out of control there’s so many people. Courtney and I have actually laughed ourselves to tears about the dynamics that are forming. Personality-wise, the five of us are just about as different as we could possibly be—and they might as well start filming us right now because I think this stuff would make for some seriously funny TV. It’s not that there have been any real drama or issues…but Courtney and I are hoping that something fun might turn up soon ☺. Especially since some UK pharmacist is about to join our island shortly. I would write more, but since these journals are posted and anything I write will probably come back to haunt me later, this is all I will say on this subject for now.

As for my personal project, things have been really coming along. I spent a ton of time this past week inputting diagnosis data onto a spreadsheet. Although it was fairly mind-numbingly boring, I think it will be very helpful. So far, I’ve put in info from Peggy’s clinic for about three weeks worth of September—including barrios, sex, age and diagnosis. I will also add September info from our clinic any day now, and hopefully result in a pretty good picture of the diagnoses for the month. ( I had originally wanted to include more Global Healing data, The database is set up with numbers representing each diagnosis, to make analysis easier. The database will help Dr. Raymond with his reports (which will eventually be used to get more money and support for the Bay Island Community Clinics), and also will be good starting info for the “health promoters” project that I’m helping with in La Colonia, in Sandy Bay.

As for the qualitative research I’m working on, I hope to FINALLY start the actual interviews this week. On Thursday I went to a meeting in La Colonia with community members, Peggy, Richard and two other American docs working on the project. The community members had been identified by the pastor as people who would be interested in being health promoters. The meeting seemed to go very well—the women (they all happened to be women) seemed to really like the idea, and were ready to get involved. I will hopefully be starting my interviews with them this coming Wednesday, and as they start to take some census info of their neighbors, I’ll go with them. I was supposed to do my first interview with Peggy’s housekeeper (one of the women at this meeting, and a strong female leader in the community) on Saturday, but I spent the entire weekend in bed having been infected with a serious cold by one of the kids in clinic. So I’m a little behind, but hopefully I will get a bunch done this week. I came up with the questions with Richard, and I’m very pleased with them. They focus on diarrhea, and through that topic get at some of the hygiene and food/water issues I’ve been interested in. The questions also include finding out when moms decide to take their kids to a doctor, and where they take them. So hopefully some really good stuff will come out of this.

Also on the subject of the La Colonia project—I see a lot more that can be done with it. My report is going to end up being fairly limited in scope, and while I think it will provide the health-promoter-trainers with good background cultural information, I think there is a lot more out their for future interns. Future interns could do more research—or perhaps even more valuable—help lead some of these training sessions themselves. I just think this is such a cool project that is just taking off now, and I’m sorry that I’m leaving before it really gets underway…I hope future interns will feel a similar excitement, and will want to support it as well.

Jessica Journal 4

Adventure to Copan

The highlight of this week was a trip to the Mayan ruins in Copan. Dr. Courtney, Dr. Leonel, Dr. Charles and I went on a wild adventure for the long weekend—it took a whole day to get there, and a whole day to get back, but it was well worth it. It was BEAUTIFUL. We stayed at this lovely little bed and breakfast called Casa de Café—a little out of the way, but definitely recommended. We woke up in the morning, had a lovely breakfast outside and then spent the whole day at the ruins. It’s a big place, and we enjoyed ourselves so much—especially because it is much cooler there than in Roatan, and hardly any bugs, so walking around all day wasn’t bad. There are a whole bunch of temples and statues and residential blocks, and the vegetation around the ruins themselves is also beautiful. We met up with some travelers too--one from Ecuador, and then two Australians on the trip back--which is always interesting. I would highly recommend future interns to go to Copan, although you really can only do it if there is a holiday and you have three days.

Other than our weekend excursion, there is not much exciting news to report. Courtney is very nice, and is staying in the apartment with me—very welcome company, since I hated living alone in the apartment. The clinic is much busier with three docs, and I find that I have almost no time at all to do surveys. By the way, is anything actually done with that information? I sometimes question the honesty of the answers I get from moms (I have yet to hear anyone admit that they don’t drink purified water all the time—although I have a strong feeling that this must not be true, because their kids have so many paracites!). I think that whoever does use to data will probably want to account for this somehow. Also, I’m worried that I’m
not getting enough of them done. How much of a priority should I make them?

Dr. Reena also arrived this weekend, and this coming Friday another doc named Rodney is coming. A British pharmacist will also be joining us soon. On top of all this, Nurse Peggy has a first year resident, an attending physician and another nurse with her right now (and Richard the MPH is still staying at her place too), and there are a whole bunch of midwives and midwives-in-training working at the hospital 24/7 for the next month. So it is a serious gringo party here these days. Peggie’s docs will be working on the community health project as well (setting up this “health promoter” network and training them). We have a meeting tomorrow to talk about the survey questions we are going to use in our qualitative research of health-related behaviors. Afterwards, I’m going to one of the first meetings to announce the program to interested community members in La Colonia (across the street from Peggy’s clinic). Also, the midwives have offered me the opportunity to shadow a bit—and I’m very excited about that.

Also, this week Dr. Jackie has been gone, so I’ve been able to go on rounds in the morning, which has been a good learning opportunity. So I’m very pleased, because I feel like I’m getting lots out of it.

So becides all that, and a few epic battles against the ant infestation in my apartment, that’s about it. All the cases in the clinic this week were very straight-forward. Sorry this journal is so short—more next time I promise!

Jessica Journal 3

My Experience as a Narcotraficante (and other stuff)

So, things are finally starting to happen around here! I’m very excited with what’s been going on since my last journal...well, I guess I better start at the beginning.

Early last week I went to introduce myself to Valerie, finally. She is quite a character—she took one look at me, and said “you say you want to help? Ok, let’s go!” She immediately sent me with a client of hers to assess the condition of the client’s neighbor, who the client claimed was dying of AIDS. But before I left (not even two minutes after I had met Valerie), she shoved a few day’s worth of Morphine into a plastic baggie, and told me to give it to the women if she was in a lot of pain. So great, all of a sudden not only was I qualified to assess the condition of an advanced-stage AIDS patient, but I was also a drug dealer. So I follow this client to her home in el Ticket (not far from the hospital at all).

The neighbor in question lived in a tiny, dirty, hot, smelly room in the back of a collection of shanty houses. She couldn’t stand up, but was lucid and fairly animated when she spoke. I spoke with her for about 10 min, asking all the questions I thought I should ask and writing everything down. Then her boyfriend came in, and started asking me about this itching
he’d been having all over his body, and that other people got if he shared his clothes. At this point I look around at the buckets of urine etc collected on the floor, remember that I’m sitting on the edge of the woman’s bed (the only place to sit) and realize he must have scabies (or something like it), and realize I’m getting exposed to the buggers at that exact moment. So now I’m an infested, medically-qualified drug dealer. Excellent. I tell him I wish I could help but that he should come into the hospital for some treatment, and I finish up with her. The whole scene is over in about 15 min, and I go join Leonel at Paradise Computers, where he proceeds to laugh hysterically over the randomness/absurdity of it all.

The next day I went to report back to Valerie, and Leonel and I spent a few hours talking with her about the situation of HIV/AIDS patients on the island, etc. I learned a lot from her, including the fact that I’m super naïve—I knew nothing about the sordid activities surrounding cruise ships! I thought they were family-oriented places, and after about 45 min of naïve
questions Valerie asks me, “where did you grow up? The Good Ship Lolliepop?” Well no, Marin county…but close enough. Anyway, Valerie was very informative. I feel know that I have a much better understanding of what’s going on with HIV/AIDS here on the island—although I recognize that everything I’ve heard is from Valerie alone, so it isn’t gospel.

The second time I went back to visit Valerie, I was able to translate for her (she doesn’t speak Spanish!), and we gave two young women HIV tests. We also talked to them about HIV, how it works etc and showed them how to use condoms. I found the whole situation really interesting and gratifying, and I’m very pleased that I’ve had the opportunity to be involved in the program, even if it’s only for a little bit.

Also, I’ve finally connected with Peggy. Peggy is still building her clinic, but now her clinic is associated with a bunch of others on the island, and they are calling themselves the Bay Island Community Clinics (did you know this already?). They are still in the process of filling the paperwork to be an NGO, and the docs have all come together recently to start discussing joint projects. Right now, they are trying to set up some curriculum for health education in schools. They actually may need some help finding some legit, tried-and-true curriculum to use, but I’m not sure where to start with that.

Now associated with the Bay Island Community Clinics is a guy named Dr. Richard _____. He is working with Peggy and the others to set up a residency rotation for Marshall University, in which residents will help train local “health promoters”—key community members who will bring skills and health knowledge into the communities to start to improve health behaviors and practices. I am very interested in their program, and I’m really excited that they’ve included me in what’s going on. Richard in particular has been really helpful, both with my personal project and with career ideas etc (he’s a PhD/MPH). He and I have talked extensively about the best way to make my project applicable. We decided together that we could come up with something more helpful than my original idea of a quantitative survey to identify the most common health issues in different communities. He said that his program could really use a survey that goes one step further. The idea would be to take the patient data from the Global Healing computer (by the way, has this been used for anything else so far?) and data from the diagnosis sheets from Peggy’s clinic to come up with the most common diagnoses for patients from each barrio. We will also analyze the data for most common diagnosis by gender and age group. Then, using these top diagnosis, we will talk with Peggy/docs/etc to talk about the behaviors that are affecting these diagnoses—behaviors that health promoters could potentially focus on educating people about. For example, lots of diagnoses of impetigo, scabies; inadequate bathing of kids; want to improve bathing practices. However, to best do this, we need detailed info about how people are currently washing their kids, in order for our ideas for improvement to have any sort of cultural/environmental relevance here. This is where the rest of my survey would come in: I would do qualitative research on people’s current health practices (using identified key informants).

I am very excited by this idea, and I feel supported by both Peggy and Richard. My only concern is that if I take the project in this direction, we won’t have the info for our clinic about how many people know about the clinic and where do they live and what have they heard about us etc (ie quality feedback stuff). The upside however, is that the research I do would be very helpful for future Global Healing docs: it would give docs a heads-up on the most common diagnoses, and what we know about local behavior associated with leading to these pathologies. This would give docs a better cultural grounding, so that when they give advice (like “wash kid with soap and water”) we will have a better idea of whether or not this advice is getting through, and if what the docs are recommending is even possible (ie in communities where water is only available every 4 days, will they actually be able to bath their kids everyday?).

Ok whew. That was long-winded. What do you guys think? I would love some feedback—I can try to tweak this survey project to be most appealing to everyone (including you guys). I just want to know whether this explanation makes sense to you guys, if you have any ideas/concerns/suggestions etc.

Also, Courtney joined us this Sunday. She’s a resident from Oakland, and is super nice. Reena is another Resident coming this weekend, so it’s gonna be a regular old party here!

Alright, I know there’s probably more I could fill you guys in about but I’m drawing a blank…so whatever I missed now, I let you guys know about it next week!

Jessica Journal 2

This was quite a fun week on the island! Thursday was Independence Day, so everything was closed, even at the hospital (except the emergency room, of course). Leonel and I spent the day with Dr. Charles and Francisco out at West Bay—which is easily my new favorite place in the world. Some of Francisco’s friends got us into the Mayan Princess for a few hours—the pool there is awesome, with fake waterfalls and everything. Needless to say, it was not a bad way to spend the day ;). There was also a parade Thursday morning through Coxen Hole, which was a lot of fun to watch. It was mainly middle-school and high school kids marching in costume, or as marching bands/baton twirlers etc. It seems like the whole town was there, so it
was a very festive atmosphere.

Also, Saturday night was the end of a fishing tournament here at West End, and there was a huge Carnival in the streets to celebrate. There were three different bands, and the music was great. Leonel and I danced for hours, and although I can’t hold a candle to these island girls on the dance floor (even the 6 year olds!), I had a ton of fun.

This week things were slow in the clinic, although it picked up a bit on Friday. Wednesday was the slowest, and when had only about 8 patients the whole day. Some people were saying it was due to the holiday, and Wednesday was the morning that all the school children participate in parades so moms may have been more reluctant to come into the hospital. Also, this week a Cuban pediatrician joined us at the hospital. His name is Eduardo, and the hospital has contracted him for a year, I believe. So now there’s Dr. Jackie’s clinic, our clinic and Eduardo’s clinic. This may have a more permanent effect on patient flow in our clinic, but I think I’ll get a better idea after this coming week.

Since things were slow I got a chance to look around the hospital a bit more—Leonel spent time with me talking about all the different cases in the peds ward on Wednesday. There weren’t that many kids at the time, but there was a kid who came in with blood in his urine—they were still trying to figure out exactly what was going on, and Leonel explained all the different possibilities to me. There was also a girl with an abscess behind her ear, and two kids Leonel hospitalized from the clinic because they both had high fevers for several days.

Thursday, unfortunately, the preme I wrote about last week died. The baby had been alive for 18 days and fought hard, but just didn’t make it. After talking with Francisco about it, I found out that the mom had originally come into the hospital in labor pains, and the doctors in the ER had managed to stop them. However, after she was released, she tried to get
home in the back of a pickup (I believe she lives pretty far away, but I don't know which community). On the way home, the people in the back got bumped around a bit, and one bump sent everyone flying. The mom fell and this sent her into labor again, and she ended up having the baby at home. So it seems that although the baby’s medical care could have been better--and there would have been more options to help him either on the mainland or in the states--the real reason for his death was that his mom was poor, and couldn’t get a safer ride home from the hospital. Which almost makes it more tragic, because the whole thing is so avoidable.

On Tuesday Charles, Leonel and I went out for liquados at Que Tal Café, and happened to run into a midwife who is working here on the island. Her name is Burnedette, and it sounds like she’s been here on and off for the past few years. She is currently working out of Valerie’s clinic in the mornings, and I can tell just from the few minutes that we spent with her that she is very passionate about the work she is doing here. She knows a lot about the less-than-ideal situations many pregnant women here are in, and it sounds like she is doing a lot to try and help them. She has some students coming soon, so they will try to have 24 hr care going on in the maternity ward for the next few months, I believe. I asked if I could shadow her a bit and she agreed—I’m very excited because I’ve never seen childbirth before (and I’m actually a little nervous), and I feel like I could learn a lot from her. However, I haven’t been in contact with her since Tuesday, because the clinic was closed when I went by on Friday. I’m going to check it out again on Monday, which works out well because I’ve been wanting to introduce myself to Valerie anyway. So hopefully I will get connected with them this coming week.

Also this week I’ll be starting Spanish classes and I’m really looking forward to it. Actually, it turns out that the classes are one-on-one tutoring, and the tutor comes to me at Casa Calico! I met her last week, and she seems very nice. I signed up through the Central American Spanish School, and so far I would recommend the company to future interns. My teacher responded very quickly to my email, and has been flexible (we’re going to have lessons for two hours a day, three times a week). So I’ll keep you all posted on how the lessons actually go. Leonel and I also signed up at a new gym that opened last week. It’s right next to Rick’s American Café. It’s SUPER nice, with mirrors and A/C and shiny equipment and everything. It was pretty pricey--$75 for 6 weeks—but I decided it was well worth it if I could stay remotely in shape while I’m here.

There’s not much in other news. I’m still learning a lot everyday, and meeting new people--everyone has an interesting story, too. I’ve revised my survey and I will start out tomorrow or Tuesday to start interviewing people in the different communities surrounding Coxen Hole. Leonel and I decided it would be best to start with communities close by, and expand out later if I have the time. Also, we’ve made up some ideas for posters to hang in the hallways for the moms to read while they wait. The hospital has signs hanging everywhere about breastfeeding, so we were thinking about other things that would be helpful to put up. One will be more or less about the “10 ways to a healthy childhood,” another about healthy diet
(there are signs about this already inside the clinic, but we figure another couldn’t hurt) and possibly a third about fevers (since so many kids come in with them).

Ok, well, that’s about it for now! More next week!

Jessica Journal 1

Well, one week over already! I have finally settled in now, and I’m feeling much more comfortable around the island, and in the clinic. So far, I have discovered my deep passion for liquados, the relentlessness of the heat/humidity, the great music at Black Pearl (thanks to the Honduran med student named Francisco and Dr. Leonel for that one) and even some cool hole-in-the-wall places. Just yesterday Leonel and I stumbled across a really cool botanical garden by accident. So I’m really enjoying all the stuff like that, and I’m feeling much more at ease and at home than I did the first few days.

The clinic is going well so far, although I feel like I am always busy, just with taking in patients, weighing them, marking their charts etc. When I look at the spreadsheet with all the surveys on it I’m amazed at how many everyone has done! I had time for 3 today, which is just about the max I seem to be able to fit. And that seems like that’s slim pickin’s compared to how many some of the other interns were doing daily! Perhaps it has to do with my Spanish—I find that my Spanish (like Katie was saying early in the summer) leaves something to be desired. The moms often talk so fast that I can’t really understand them, and I feel very limited by what I can say in Spanish. I’d really like to work on learning all the colloquial phrases, like “what a lovely young lady” to a little girl—or something friendly like that. I find that I enjoy the day at the clinic so much more when I’ve chatted with the moms and made the kids smile a little. I would just like to be a bit more personable than spitting out phrases like “please stand on the scale” etc etc. I’m currently looking into taking some Spanish classes in the afternoons while I’m here, so we’ll see how that goes.

On Friday we had a very busy day in clinic—it was just me and Leonel because Dr. Charles had to go to the mainland. There were lots of impatient moms yelling at me. I’m not very good at standing my ground against them yet—I actually would probably feel the same way if I had to sit on those benches for 4 hours myself! Anyway, after clinic we stayed at the hospital for quite a while to take a look at a very premature baby in the pediatric ward. It was my first time in the inpatient part of the hospital, and I definitely feel like I got something out of it. The preme we went to look at was two and a half months early! I have never seen a baby that small—its head is the size of my fist! Honestly, it was pretty sickly looking. It was born 14 days ago, and unfortunately, the baby is struggling because they don’t have the resources to feed it properly with a gastric tube, so they have to try and syringe food into its mouth—which isn’t ideal because the baby can’t really suck and swallow yet, so sometimes he aspirates the food. So it was pretty sad, and it’s just very unclear how it’s going to turn out.

Also in the pediatric ward was an eight year old boy who had swallowed a stone cross (which was sitting just at the bottom of his esophagus) and a young girl who has had several seizures. The boy had surgery and is doing alright now, but the girl has very limited options, so it seems. There is no CAT scan machine in Roatan (or MRI machine, or even the resources to do a simple strep culture!) so the girl needs to go to the mainland. Unfortunately, the public hospital in the capital doesn’t have a CAT scan either. She’d have to go to a private hospital—and it is clear that her family can’t afford to go to the mainland and stay somewhere, nonetheless go to the private hospital for an expensive test. This has gotten me thinking again about trying to set up child-specific fundraising among tourists, particularly the idea of setting up a stand in front of where the cruise ships dock. Also, I’d like to know more about how patient advocacy has been done in the past—was it only for kids that had been seen in the clinic? How did you get started with a new patient?

A few nights ago we went to have dinner with a family from Alissa’s church (this was before Alissa left and the world was still colorful ☺ ). The family was incredibly nice, and it was wonderful to be invited into their home. She and her husband speak very good English, and were so welcoming! She works for the ferry services that connects Roatan to the mainland, and he’s an artist. They were really interesting. We also watched the Agassi/Blake tennis match on their TV, which was really really exciting. I haven’t seen much tennis, but boy it was terrific. Tied until the last point of the tie-breaker! It was kinda fun to sit and watch the sports with them. They invited us back anytime, so I hope we will go again.

The only main concern I have right now is actually with my personal project. I have explored my survey idea a little with both Alissa and Leonel, but I’m struggling a little because the clinic is actually not set up like I had imagined. I had thought the clinic was free standing, and much more independent of the hospital than it actually is. Since the clinic is very much a part of the hospital, it seems to me that it is probably less visible to the community than I had imagined, and also much harder to evaluate separate from the hospital as a whole. Which has led me to question to relevancy of the original project, or at the very least the target interviewees. Nat and Jen, what do you think? I came back to one of my old ideas after seeing the girl in the pediatric ward with the seizures—would my time be better spent operationalizing the process of child-specific fundraising? Has that already been done and I’m just forgetting about it? I’m getting a little anxious that I haven’t started my project already, so I’m hoping to really begin this week. So I guess I’ll just need to think a little bit more about the best way I can contribute to this clinic.

Anyway, I guess that’s all for now!

Saludos,
jess

Alissa Journal 3

THE MISSING INTERN.

But first, I can't leave out the museum. So one day Leonel and I decided it was time to see the dolphins over at Anthony's Key Resort. We arrive in our rental Isuzu truck, happy that we could make the trip and see some dolphins jump around. The first thing I saw when we got there was the snack bar. I really wanted an ice cream but it was closed in the middle of the day. We
should've turned around right there, but we trudged onward to the information booth. "There is no dolphin show today," said the lady, she was obviously quite annoyed that we would ask such a question. For some reason, she wouldn't give us a straight answer. Were the dolphins not there? Was the show not every day? Finally, she, against her will it seemed, told us
that the dolphins were busy making babies, so there would be no show. Fine. That's nothing to be embarassed about, is it? Has anyone seen The Life Aquatic? Remember when Bill Murray was trying to get his dolphins to go and spy on another part of the ship and they didn't do anything? The guy said, "Either they can't hear us, or they don't understand us." I now can relate to such a frustration. Dang dolphins. I should've known it would end that way. Unpredictable those dolphins are.

We went to the Roatan Museum instead, eager to see the magical history of one of the Bay Islands. Leonel told me a story about how he went to some country and saw a Jade Museum, pointed out in travelling books as a "must-see." It was just about the most boring place he had ever been to. Apparently that was a better experience for him than Roatan's famous
museum. He gave it a 2 on a scale of 1-10.

There is a baby that came to the clinic last week. I don't remember her exact age, but I think she was 5 months or younger. The poor thing has a heart murmur. Leonel let me listen to her heart and lungs. Leonel and Charles suggested she go to Ceiba to get treatment, but even if she gets there, the operation she might need would cost thousands of US dollars.The
day after our clinic saw her, Dr. Jackie saw the girl and all seemed well again. I don't know how everything will work out, but I hope future interns can try to followup with her.

On Friday night, Charles and Francisco came to West End to hang out. We went to The Twisted Toucan. Everyone looks so familiar on this island. At one point Charles and Leonel went to the restroom. In less than a minute, a semi-familiar looking local lady came and started talking to me. Interns! Don't be left alone unless you enjoy being hit on. This lady's dorky friend
from Kansas came over and told me all about how his fiance dumped him and that she's not coming back, etc, etc, etc. Man, shoot me now. I was sure that my bloody eye would scare him away. Isn't this eye hemorrhage good for anything?! After Toucan closed, none of us were tired so we went to French Harbour to go watch t.v. at Francisco's. We stayed until 5am. Why? I don't know, but I've always been a fan of late night t.v. There's nothing better than watching the Magic Bullet infomercial at 3 in the morning.

On Saturday, after waking up at 1:30pm, Leonel and I went in search of yet another isolated beach. We figured we could find one before Jess arrived that afternoon. We started driving towards what we thought would take us to West Bay. We ended up near Flowers Bay, opposite West End. Then the road ended, but that, for some reason, didn't stop us. On and on we went until, at last, we found what looked like a pretty nice beach. There was one other couple on the beach, but we didn't mind. It was isolated enough. We hopped out of the truck and set up camp. For such a nice beach, there was a good amount of trash. We named it "Basura Beach." Why does everything sound better in Spanish? One of life's mysteries. Anyway, we got in the water, looked over at the other couple, and realized they were stark naked. Europeans? Maybe. Although they looked it, for Europeans, they were sure scared of us seeing them in their birthday suits. They put their clothes back on and left. Too bad. No dolphins and no naked people: two strikes. What a week. To top it off, Leonel and I learned from visiting the Roatan
Institute for Marine Sciences that it takes a little chunk of coral 50 years to grow. In ten minutes of swimming, Leonel stood up on some "rocks." According to my calculations, he destroyed about 100000000 years worth of coral.

We left Basura beach just in time to meet Jess at the airport. Leonel made a lovely sign that said "Global Healing." It was about the size of a drivers license. We were both very excited to see my replacement. "Maybe that's her! She looks interny." Nope. Nope. Not her. Not that one either. Oh wait! Nope, unless Jess looks like a fifty-year old man that's not here either. When the crowd from TACA flight 431 from Houston cleared, Jess was nowhere in sight. Recap: no dolphins, no naked people, no Jess. Leonel and I had a rough week.

To top off our Saturday night, Leonel and I ate, watched the US v Mexico soccer game, showered, then sat around at our respective apartments. It was a Saturday night dud. After frantically emailing Nat and Jenn, it turned out that Jess was stuck in Houston. To quote one great Natalie Ramos, "Houston is a shitty city." Amen to that.

The new plan was that Jess was going to be coming in Sunday at 3:30. We could only hope.

Sunday morning, I went to church for an hour, then Leonel and I were off to find Palmetto Bay. I can't reiterate this enough. LEONEL IS WRONG A LOT. Haha. After a couple wrong turns, big drops, and steep hills we had no prayer of getting back up--we ran over some palm trees and nearly gave up on Palmetto Bay. We found a patch of beach and started walking, in hopes of
finding the resort. In about 5 minutes, we walked right into paradise. Oh my gosh. We had what Jimmy Buffet called "a burger in paradise." At least that's what it said on the menu. I highly doubt Jimmy was talking about Palmetto Bay Resort's burgers. We ate, laid on the beach, then decided it was time to dig ourselves out of the hole we drove ourselves into. We destroyed some more vegetation before we decided to drive on the beach through Palmetto Bay. We made it back to the road. It turns out we took the wrong road to Palmetto Bay. Ugh. Leonel.

INTERN FOUND. Yes. Jess is here. The world is right again. Jess, medications, the new computer. All is well in the RCPHI intern world. When Jess and I got back to the apartment, we unpacked the meds. Wow. More Dimetapp and Benedryl than the world has ever seen, all conveniently packaged in single doses. As soon as Leonel saw the stash, the next words out of his mouth were, "We could sedate a small army." True. It makes the mothers happy to go away with something, but I wish more could be done to get to the bigger problems at hand. The same day we got the new meds, we ran out of Scabecide.

Monday and Tuesday were spent training Jess in the clinic. With two of us, we had time to do a survey, organize meds, and Jess shadowed Leonel and Charles. We even got the new computer up and running. If only we could get the sound to work. I told Jess about the main diagnoses we see on the island: impetigo, scabies, diarrhea, IRA, asthma, and everything else that
came along. She seems to be getting the hang of things fast. I'm no longer needed here, only to translate the docs' writing.

I pride myself on my amazing healing abilities. I could be a small superheroine my eye is healing so well. It's in its yellow stage now. I only have a lighter red bloody left eye and a slightly jaundiced right eye.

I had to pay a visit to the immigration office. Those men live like kings. You should've seen the bling on this guy's wrist. He made me pay for a full month of staying on the island, when I was only 4 days over (380 lempiras). I understood the principle of it, but still didn't think 4 days should count. Oh well.

Maybe this is my last journal? Or maybe this isn't the last you'll here from me.

Alissa Journal 2

Dear RCPHI journal,

Haha. I just had to write that. The other week Leonel asked me what RCPHI stood for and I stood there, at a loss for words. I now know after looking it up on the website. I think I used to know it, now I'm sure I do. Lots has happened in a week. I'm ready to write if you're willing to read. Here we go.

I need to mention a certain taxi driver. Leonel and I affectionately call him "Star Wars Guy." Dunnnn-dun! Dun-dun-dun-Dun! Dun! He has Star Wars seat covers, which is only partly what makes me laugh. He's gotten used to our schedule and actually drives towards Casa Calico in the morning in hopes of picking us up. The first time we rode with him, all of a sudden, I heard what sounded like lasers. Hmm, I thought to myself. Star Wars Guy, instead of honking to gather colectivo riders along the road, uses a car alarm to get their attention. I believe this just drives customers away. Note to future interns: don't be afraid of the lasers.

Leonel had to stay late at the clinic today to help the nurses fix an incubator. When he returned, he said he took longer than expected because he couldn't figure out how to turn the darn thing on. Ah, Doctor Toledo. What a character. I took a taxi back alone. The driver asked a lot of personal questions about my age, if I had a boyfriend, how long I'd be on the island, and the like. I was a bit uncomfortable, but he ended up giving me the ride from Coxen Hole to West End for a discounted 20 lempiras. When I was ready to go to the beach, Leonel told me he'd be there in half an hour. I trekked alone to the beach. I set down my stuff and laid on the beach, reading, waiting for Leonel. There's a bunch of local men that sit beside a tree and watch the tourists on the beach. After a few minutes, a local guy approached me and asked if I was waiting for my boyfriend and if the seat next to me was occupied. I told him I was waiting for a friend and he said he just wanted to talk; he'd stay until my friend came. Oh how I wished Leonel would hurry up. Ray (the guy) asked me if he could take me out for lunch or dinner. Since then I won't go to the beach alone. Leonel is my buffer. Despite random guys whistling and commenting, I've never felt unsafe on the island. Just a heads up for those following me.

On to news from the clinic. There is one resident from Tegucigalpa. He's made it a ritual to come around and talk every other day. His name is Francisco. He's in his early 20's, very nice. He seems to like to come to West End to the clubs and has good suggestions about where to go to hang out on the weekends.

I've gotten a clearer idea of Valerie's clinic, Las Familias Saludables place that gives HIV/AIDS couseling as well as courses for mothers. One lady came in today from Valerie's clinic, asking if I could take a pregnant mom's blood pressure. I did, but had to go to the pre-clinica to use the enfermera's stethascope. The head nurse, I forget her name, is actually very nice and has warmed up to me. I don't even have to go to the pre-clinic to pick up the charts anymore. She brings them to me with a
smile. Everything has become familiar to me now, even names and faces of patients. I see kids and parents on the street around Coxen Hole and they wave and smile.

It is a very rare thing to see dads bring their kids to the clinic, but we've had a couple this week. It's so refreshing to see how caring and absolutely loving parents are, especially when the dads come in. I've noticed the children here are mostly well-behaved. It's different from the States. In the clinic, on the streets, around town, I never see kids throw fits or yell and scream. Another reason to love this island. The pace is slow, the people are kind, and the music is great: country music, classic soul, reggaetone, soca...it doesn't get much better.

This past week Charles and Leonel also admitted some patients. We stayed until 2 or 2:30 a few days for this.

On Friday, while Leonel was still on rounds, a lady burst into the clinic and asked me to get the doctors. Charles had just come in, so I told him about the littel girl outside, who was throwing up. She was in pretty bad shape. It surprised me how nonchalant Charles was about the whole situation. Without even raising his head, he told me to tell the mom to take the girl to the emergency room. Panicked, she didn't listen and brought the girl into the clinic. The poor girl threw up on the floor.
Charles walked out the door. I told the mother to stay calm and took them to the ER. I couldn't find the cleaning ladies so had to clean everything up.

Friday we saw more older kids. The nurses usually assign us the kids five years and younger. I was surprised to have to move the scale arrow to accomodate someone more than 50 pounds.

News of the week: Charles got a new thermometer from Peggy! Woo hoo. Well, I didn't think it was such a grand happening, but Charles did. It's easy to use. We now just have to stick the thermometer into the kids' ears for a second, versus waiting several minutes for the old, under-the-pit thermometers. Also, it helps with the kids who think that the pit thermometers are going to injure them. So that's that. New thermometer. We're all very happy.

Lately I've been having a little problem with patient flow. It's difficult to manage who knows Charles and who's just another pushy patient wanting to get a prescription written. Charles likes to take his friends and family ahead of others, which makes lots of patients a bit irritated and me confused. I can understand the frustrations of the mothers.

I met Nurse Betty. She borrowed a nebulizer for an elderly women.

Leonel and I went on another adventure. Leonel wanted to swim to some boats in another bay. It took us 35 minutes to swim there. After we tapped the boat, I looked down and realized I couldn't see the bottom of the ocean. I've never swam in that deep of water. Scary stuff. I swam extra hard back to Half Moon Bay. On the way back, I got ahead of Leonel and swam right
into a shallow reef. I was stuck for a bit. It was pretty gross, seeing that I don't really like sea creatures. I waited for Leonel to catch up then found a way out. When I saw Half Moon, I swam in towards shore and again, had to wait for Leonel. From afar, he gave me the "OK" signal and kept swimming. I thought I was in the wrong bay (I've done this before) so I followed him. After an hour and a half in the water, I asked Leonel where we were going. We missed our bay by a long shot. By the time we started swimming back, the sun had already set and we were swimming in the dark, with maybe 5 feet visibility. Leonel fell behind (yet again) and I swam right into a barracuda. I was terrified. Point of the paragraph: Leonel doesn't always know what he's doing. Haha.

We finished our scuba certification this weekend, but not before I made a little mistake on our first dive. I had just recovered from being sick, so I was worried about being congested, etc. Long story short, I forgot to equalize my mask and ended up at the bottom of the ocean with my eyes almost popping out of my head. After the dive, Leonel pointed out that my eyes looked like they were bleeding. I popped some blood vessels and now I have demon eyes. It's actually pretty cool but also very gross. I've been wearing my big, chunky glasses to clinic so I don't scare the kids. Leonel came up with a good phrase that the dive shops could put up next to a picture of my eyes: "Be Wise. Equalize."

Did I ever mention our Austrian instructor, Mike? I think I did. What I'll always remember him saying: 1) "duh bohdy system" and "duh durr-dull" (English translation: the buddy system and the turtle). He made scuba worthwhile.

Friday, Saturday, and Sunday, I had some romantic, candlelit dinners with Leonel. This thought cracks me up. We manage to find all the good place to propose or celebrate an anniversary. At one restuarant, lights down low, MC Hammer came on, followed by Ganster's Paradise. Haha. Good stuff. Probably ruined the mood for some people, but made a great time for me and Leonel. Speaking of eating, we had some bad food at the West End diver restaurant. The only redeeming quality of the place was that they let us watch soccer on the t.v. Ah, t.v. What I wouldn't give for some SNL and Simpsons.

Some Sundays we play soccer in Gravel Bay with some local guys and Raymond and Charles. This Sunday Leonel and I rented a truck and went to the east side of the island. We were in search of an isolated beach. Instead, we found an isolated resort, swam, and had some dinner. We'll have the truck all week, so we'll be picking up Jess up on Saturday with it.

Jess will be bringing a new computer along with her. More good news!

Sad news: I have no new books to read. Dr. Toledo has made it a new requirement to read Lonesome Dove. Just kidding. Interns, bring lots of book. You don't want to end up spending your afternoons on the beach reading Stephen King or Mary Higgins Clark (those books are made for boring plane rides, right Katie?).

At Casa Calico, I've got some friendly new neighbors, a pregnant wife who speaks no English, and her husband, who speaks English and a little Spanish. They seem to like to peer in my windows and wave.

It's been a busy week. Leonel and I can't have two computers working on the wireless at the same time. Leonel steals all the bandwidth and I end up waiting 10 minutes for one page to load.

That's it for now.

Alissa Journal 1

I’ll begin with the beginning. I arrived on the island on August 6th, a Saturday. Katie emailed me beforehand and arranged for us to meet at the airport. The flight over wasn’t bad at all; I slept the entire flight. I had some problems in LAX and at Roatan, due to bringing the printer along with me. Thankfully, it arrived with the rest of the baggage and I plopped everything on a cart and went in search of Katie (whom I had never met, didn’t know what she looked like, etc.). I made a lame attempt to Facebook Katie, but she cleverly put a long-distance picture of herself online.

I waited for about an hour at the entrance of the airport. I didn’t feel lost, but I suppose I looked it. The first thing I noticed was the weather. I said, “Wow, Katie, it’s really hot here. The humidity!” She smiled and replied, “Alissa, it’s overcast and pretty cool today.” Ha. The second easiest thing to recognize: the taxi drivers. Katie knew her way around Coxen Hole and West End, so she haggled a bit in Spanish as I stood there doing absolutely nothing. I tried to imagine what I’d do when she left.

My first day in clinic came as a bit of a shock: we saw 20 kids in the few hours that the clinic was opened. Again, to my surprise, Katie assured me that it was a slow day, and things went smoother than normal. Though I had read about the diverse population on the island, I still found it strange to hear kids of all colors—light, brown, and black-skinned—all comfortably speaking Spanish.

There are many common diagnoses on the island. Although I’ve come to be familiar with them, these problems are ones that before I had only seen in textbooks. Here they were, alive before my eyes, manifesting themselves in children. In broken Spanish I converse with the mothers about their kid’s chief complaint. Paraistes, infections, asthma, upper respiratory infections, all of them are interrelated and commonplace for the barrios. It shouldn’t have to be like this anywhere in the world. There are so many people here who need help. After walking into the hospital for the first time, it dawned on me that I was actually in Roatan. The pre-clinic, the patients waiting in long lines, the benches in the hallways—I never knew health care could be so different.

I haven’t seen much of public health on the island, but it is sorely needed. Most diagnoses can only be temporarily solved with a quick clinical treatment, but more needs to be done. I’m glad I’m here. I have nothing but respect for the workers in the hospital and for the doctors who are here to help.

Two young nurses, Kelly and Carly, stayed in Casa Calico next door to Leonel. They worked in Peggy’s clinic, but are also working on starting a clinic on the other side of the island. They’ve already established their non-profit in the states and are planning to manage and start the clinic here while simultaneously getting their Masters over at UCSD to be Nurse Practitioners. Admirable. I’m sure we’ll see and hear more from them.

I love the kids here. Today, the second day of clinic, was a little better than the first. Things are relatively easy with Katie here. She’s showing me the ropes. I’ve developed a better understanding of how things are supposed to work and thus have had more time to play with the kids, talk to them, and administer some of the water surveys. One of the questions on the survey asks how old the mother is. Most of them are my age or younger. This freaked me out at first, but I’ve recovered since then. I’ve had to get used to little differences like that. This definitely isn’t Stanford.

The two Global Healing doctors here in the clinic are Dr. Charles Welcome (from Roatan) and Dr. Leonel Toledo (from Philadelphia). Leonel lives in Casa Calico. Kelly, Carly, Katie, and Al (another working with Peggy) are all leaving within the week, so I anticipate Leonel and I will be spending lots of time together. He doesn’t know how to cook and I don’t like living alone, so I think we’ll do a lot of sitting around, eating, and staring at each other (or the wall, whichever’s more interesting at the moment).

Today clinic went very well. As Leonel, Katie, and I walked into the hospital I saw two white guys with white collared shirts and slacks; I knew they must be Mormon missionaries. I now know where church is. Yay.

I’ve discovered that the crayons, coloring books, and stickers are a great way to keep the kids from screaming all the time. It’s amazing how little these kids need to be happy. Since Katie is here, too, we’ve had time to spend individually with the kids. I’m starting to remember my Spanish and am picking up lots of medical Spanish as well. We finished clinic early then went to La Colonia, a community where Katie wanted to test out her water survey. The little villages were set against the lush, green hillsides. It was beautiful, and we even got caught in a nice tropical storm. Meeting all of the people here just makes me want to live more simply. Well, not so simply that I don’t have purified, running water all the time, but you know what I mean. Leonel and Katie gathered some useful information from the three communities. Funny instance: we met a little girl in La Colonia who had perfect English. She was from Arizona. What a small world we live in.

The days in the clinic move fast. I’ve learned so much in such a short period of time. Today turned into a long day. We had a 12-day old baby come in, covered in nodules and rashes. Poor thing. The diagnoses was “pustulitis.” At least it wasn’t scabies (?).

Katie left. Leonel and I rode with her to the airport. We snapped one picture, and she was gone. Leonel and I stared at each other for a while. This is going to be an interesting month. We went to French Harbor and did some grocery shopping at Eldon’s. I found chicken breasts and beef; this made me unbelievably happy.

I am sad without Katie (I miss you, Katie!). I’ve never lived alone. The apartment here is rather large, but more comfortable than I thought it’d be. There are three beds and one me. I’m glad Leonel’s around to keep me company.

The most unpredictable thing here, by far, is the internet. When it works, it’s fast and reliable. When it’s down, it’s down for the count. I’m supposed to be editing the yearbook at night, but that hasn’t been happening. Whatever email and little things I need to check here I do at the clinic while the doctors are on rounds. I brought my own laptop, so altogether, there are three laptops in the apartment. The clinic laptop is consistent and gets a good internet connection. My laptop is slow. The other laptop is really low on memory and actually crashed on Leonel. I managed to give it a temporary fix, but I don’t know how long that’ll last. As soon as I fixed the first problem, then the mouse quit working. Things need to be erased from the hard drive, but it’s hard to erase when I don’t know what anything is. Who’s laptop is that anyway? For the next intern, be prepared for technical difficulties all the time. Leonel’s not a big help here, but he’ll give you moral support while you’re trying to fix it.

If there were three things I’d recommend bringing to Roatan, it’d be traveler’s checks, bug spray, and lots of music. I brought the bug spray but left my money on my desk in California. Apparently it’s easy to withdraw money from here, but you have to deal with the extra transaction fees and exchange fees…it’s a hassle. On a similar note: be sure to tell your bank (and remind them) that you’ll be traveling out of the country. Bank of America thought someone had stolen my card (though I told them I’d be traveling) so they put a hold on my account. Thank goodness for the clinic phone with an Oakland phone number! As for the music, Leonel and I had to go to a local music store and get some CDs. I came out with Bob Marley and some soca mix. I only have two other CDs burned on my laptop, so the music is pretty slim-pickings. Bring your own.

Leonel and I have had all too many instances where taxi drivers want to overcharge us. There should be a fixed rate, but with the price of gas rising all the time, we get different opinions. The price from West End to Coxen Hole fluctuates from 25-40 lempiras.

Leonel and I kayaked from West End all the way to West Bay. Some said it couldn’t be done. We lived the dream. I felt like my arms were going to fall off. We came in against the wind, but right as the sun set. It was perfect. Nearly every day is a perfect sunset here on the island.

Clinic is running smoothly. Charles and Leonel are great doctors. We all get along great. Last weekend we spent Friday night at a little bar in French Harbor, listening to country music and watching big, fat, old guys play dominoes and drink beer. It was a grand time. Charles loves country and is sure to sing lots of George Jones for all to hear. I don’t mind; I love country music, too. In the afternoons after clinic, Leonel and I take afternoon naps then head to the beach. We snorkel and swim, lie on the beach and read, watch the sunset, then eat dinner. We live pretty lazy afternoons.

Saturday and Sunday we started our scuba certification course. We had to sit through “academics” and watch lame videos that were made in the eighties. I laughed through most of the five videos. Then we had to do homework and take quizzes. Who knew you had to do so much work?! For the last module, the key points were: “Hey, scuba diving is fun. Why? Because 1) You meet new people, 2) You go new places, and 3) You do new things!!!” Haha, that made me laugh, too. Leonel and I are diving with Coconut Tree Divers, where the instructors are all foreigners with accents and (I’ve decided) don’t own any shirts. Despite that, we have an excellent instructor from Austria (who sounds like McBain from the Simpsons). The underwater world is beautiful. It’s worth taking all of those quizzes and the final exam.

Today in clinic Leonel diagnosed two kids with ascaris. Apparently all of the moms he talked to kept mentioning they’ve been seeing worms in their kid’s vomit or stool. It’s now Tuesday of my third week here and Leonel and I are both sick. Maybe we caught something from the kids, maybe we have decompression sickness from scuba diving. We’ve both been feverish, having nausea, and sore muscles. He’s been taking a lot of ibuprofen and motrin, so he’s drugged up all the time and his sickness comes in waves. I, on the other hand, am not used to taking a pill every time I feel sick, so I’ve been feeling a general, steady sickness throughout the day. I’m also congested and my throat hurts. Charles thinks it’s viral pharyngitis. Today after clinic I was so tired, I ate a sandwich and slept for four hours. I had some crazy, whacked-out dreams. Leonel says that usually accompanies a fever. Since the internet isn’t working, I’m going to send this out tomorrow morning. The next blog won’t be so long, as it will only cover half a week.