Tuesday, June 14, 2005

Natalie Chavez Journal 3

Having Dr. Eileen, Dr. Molly, and Dr. Isabelle in the clinic this week made things much easier for everyone. There was barely enough room for each of them, including Dr. Raymond, to create there own private space to see clinics. I figured that since I was mostly taking medical histories, chief complaint, and administering survey I could just set up my own little space outside the clinic where I could have one-on-one conversations with the patients waiting to be seen. Before I used to just stand the whole time I was asking the survey questions and writing down chief complaints. After using the chairs to actually sit down with each patient, I realized that the conversations were more personal and in-depth than before we used them. This helped the patient sit down, relax, and confide in you. It was nice. I just had to keep a close eye on the chairs to make sure they did not disappear to another part of the building, since we already had a shortage of chairs. Dr. Eileen loved the idea of using the surveys to determine the nutrition of the children, their families, and figure out ways of educating them on better health in case the patient was dropping below normal growth levels. The doctors would always like to see a patient who had already taken the survey, so that they could look up their eating habits when checking their weight and growth levels. I felt like I had a really important role because the surveys were a great help for the doctors in order for them to offer good health advice to the patients and their parents. I felt like a true member of a team.

This week I saw my first bronchiolitis case, which was a 9 month old boy. He was breathing so heavily and rapidly, that I could see the skin under his ribcage cave in way under it. The baby’s brochioles were inflamed, so it was really hard for him to breathe and it was also very difficult for the doctors to do anything because the airways were too small for any muscle relaxing medication. The doctors would just have to continue giving the baby oxygen through a nebulizer and wait for the mucous build-up and all the gunk in his lungs to break apart and get out of his system. I was afraid for the boy, since I could not even breathe that fast for days at a time. I was afraid that his heart would give out pumping so much blood into his system, since his heart rate was way above normal. He was such a trooper, looking into his mothers eyes with such control and calmness as his body moved uncontrollably. That baby was of strong blood. Dr. Molly explained to the patient’s mom how she should sit the baby up and gently pat the baby’s back every half-hour to help with the mucous break-up. The baby is doing much better now that he has a runny nose and is getting rid off all the mucous he had in his system. The nasal pumps were a great help then. However before the baby started getting better the doctors had to deal with a splitting dilemma. The baby had to be under hourly supervision after clinic hours since the nurses were not very attentive to each individual patient, but instead the overall order of things and there was only physician in the hospital during the evening/night shifts. So it was either that the doctors take turns in coming in to watch over the patient during the height of his sickness or they set their boundaries and go on home. In the end the doctors did end up staying longer to watch over the boy and make sure he was getting the proper oxygen levels, but after most of the evening they decided that this was the limit of the care they could give to that particular patient. They decided to check back with him in the morning after they agreed that he was in a more stable condition and was well enough to be on his own until the next day.

I am proud to say that I have surveyed at least 120 patients throughout my stay here in Roatan. All of the information on the excel spreadsheet will go towards finding the target foods needed for patients to have a well-balanced diet, pinpoint problems, and overall helping the patients take better care of themselves. Many patients have been very curious and have asked what the survey was used for and I would say that they were a great way for us (pediatrics clinic officials) to know more about our patients, their nutritional lifestyle, their language, and location in case we decided to develop a class that would benefit them. This was all going to be used in a way to ultimately benefit the patients. They would look with me with approving eyes, in a way like they could not believe that we were going through all of this paperwork in order to help them. After taking the survey some of the patient’s mothers would say ‘thank you’ to me instead of the other way around. I feel that I should do as many as I can because I while I am here I should use my Spanish skills to reach out to as many people as I can before I have to take my skills back to California. I am glad to see that the patients are glad that I am here. When I start speaking Spanish most of the only-Spanish speaking mothers blow a sigh of relief like I have just saved them the struggle of using signals or straining their sketchy English. But most of them also look at me slightly confused because they say I look like I am half Asian, white, or even Spanish. After conversing with them in Spanish they try to persuade themselves that yes, I am Mexican. It’s surprising to me how among Americans I they can easily point me out as Hispanic/Mexican, but among my own Hispanic community I look like another ethnicity. That was interesting for me, especially since the taxi drivers got a kick out of it.

Last Friday we painted the medicine cabinets in the clinic and did some spring cleaning. I created a gorgeous plaque to hang up on the wall of the clinic that read ‘Nuestra Clinica Es Su Clinica’, which kind of spun off from the whole ‘Mi casa es su casa” saying. It was a beautiful plaque, which had a light blue background, with dark pink writing and colorful hummingbirds on each side. It seemed to match with the baby blue cabinets that were freshly painted. I am not sure where we are putting it, but I am sure the patients will love it.

I had a date with the dolphins this week and it was the best snorkeling experience I ever had in my life. I would sometimes feel like I was trespassing onto their territory because they about 7 dolphins would huddle all around me making me feel like a speck in the sand, but then they would play with me and let me touch them. They are magical creatures and it’s mesmerizing to hear the sounds they make underwater. I would feel them torpedo past me as they chased on another around the ocean. They’d scare me every time they snuck next to me trying to take a peak at me, but after my sudden startle I would reach out my hand and pet their soft, humongous bodies. It was truly the experience of a lifetime.

I volunteered at Peggy’s clinic on Friday morning as well and it was unexpectedly busy. Many moms were waiting in line since 6 AM waiting to be seen. I helped translate, dispense meds, pull charts, glucose screening, and talk with most of the women about their health, their social lives, and politics of the island. They are strong-minded women. We spoke about the powerful families that control all of Roatan, Indios being the bottom of the social ladder in Roatan, the differences between the school systems in Roatan in comparison to the ones in La Ceiba, and marital problems, like this woman who ran away from her husband after years of abuse. I met a medical student named Richard who was there from Arkansas for a day to help out. He was a business major as an undergraduate and he assured me that although medical school is very hectic and overwhelming, it was constructed to help you learn and succeed, so eventually all that information will sink in. I can’t get over all of the nice people I have met here. I am unsure as to what makes the culture here so rich and the natives so kind to visitors. It’s not only the natives here that are welcoming, but other visitors coming to the island seem to have a friendly factor that ties them all together. It is very different from the often impersonal ways of people back home. Of course, there are amazing people back in California that I would not trade for the world, but here in Roatan the strengths of human nature seem to magnify.

Unfortunately I have not been able to work on all of the follow up patients as attentively as I had wanted to when I arrived. The group of opthomologists were supposed to come to Roatan today, but Dr. Raymond was unsure of the exact location of where they were going to be because the group had said that they would stop by the Sandy Bay area if they had extra time. ‘Extra time’ were the key words. Also, it was difficult to focus on follow ups when I was focused on survey data entry and analysis, nutritional research, preparing my nutritional class, and trying to settle into my environment all at once. I think this was my weakest point of my role here in Roatan. But my ultimate goal was to understand, appreciate, and help the natives of Roatan and so far I think I have progressed significantly. I loved the experience.

Sunday, June 05, 2005

Natalie Chavez Journal 2

I am finally getting used to all of the heat, although I am still getting those really small painless boils all over my tan. Dr. Raymond says that it is a post-reaction to something in the seawater, which makes sense because the skin reaction only started after coming back from a day in West Bay. The skin reaction is only temporary, so I am not too worried. I am fascinated by the different changes and reactions my body has undergone since arriving in Roatan. Other than the skin reaction I think my body is finally started to acclimate itself to its new surroundings.

Monday was a very intense day at clinic, since it was the busiest day of the week and Dr. Raymond and I were the only ones working in clinic. I think we saw about thirty to thirty-five patients that day. We finished like at 1:40pm and Dr. Raymond had to be in clinic at 2:00pm, so we quickly closed up and had a couple of balleadas for lunch. They are so delicious. I have bean and cheese burritos at home sometimes, but they taste nothing like the ones here. The cheese has more flavor here and I think they use red beans instead of pinto. The rest of the week was a steady 20 patients/day. After that Monday in clinic, I felt like I was ready for any other day of the week.

I met a 6 year old patient named Stanley who was born with a disease that causes the tendons in his wrist joints, elbow joints, and ankle joints to cringe up. Stanley has had about 3 surgeries performed already, but needs about 6 more in order to extend all of his limbs. He is constantly traveling to San Pedro Sula for physical therapy as well. Mom says that he has been improving dramatically over the past few months. She showed me pictures of how he looked before the surgery and post-surgery. She says that she is running out of money to pay for all of the surgeries and therapies, so I decided to add her into our Sign-Out sheet to see if we could offer her some financial assistance. She explained to me how difficult it is for her to have a child who is 6 years old and unable to walk yet. Her child can speak and is very intelligent, but she is afraid of the social repercussions he may face as he gets older. I had a nice day with Stanley in the clinic and after a half hour he felt so comfortable with me that he gave me a hug before he left. I was touched by his warmth and strength for his young age. Would it be fine for me to look for financial assistance for this patient for the long run? First priority of course would be for patient’s needing surgical procedures of the heart and eyes. What do you think?

We admitted two patients this week. One patient was about 9 years old who would vomit every hour. Dr. Raymond said that she had was severely dehydrated, had diarrhea and could not keep anything down (I forgot the medical term for that). They took her in to the pediatrics ward and were going to try to give her an I.V. in order to hydrate her body. The other patient that was admitted was a 7 month old little girl who had bumps on her head. When I first spoke to the mother to find out the chief complaint, she had said that it had started off as a rash and just bubbled up after a couple days. I assumed that it was just a superficial infection, but it actually ended up being more serious than that. Dr. Raymond said that the patient most likely had a couple infected cuts on the head that swelled up with pus. One of the pus-filled abscesses was right behind her ear and Dr. Raymond feared that the pus might travel into her ear and in her brain, causing meningitis. I never thought that infected wounds on the head could lead to meningitis. It would be so sad to see such a small baby end up with meningitis. Dr. Raymond wanted to show me the draining procedure he was going to perform on the patient, so I went into the pediatrics ward in an undercover mode, so that Dr. Jackie would not find out. It was a funny feeling to be doing that at my age, but Dr. Raymond really wanted me to see. He was going to drain one abscess at a time, so he decided to do the less complicated one today and the one near the ear tomorrow. He wanted to hold off because the abscess near the ear was still hard, meaning that the puss was not formed yet, so he wouldn’t really be able to drain anything. He made a cross incision on the baby’s occipital abscess and drained three large tissues full of blood and fluid. The baby was screeching and crying, while the mother tried hard to hold her baby down so that Dr. Raymond could collect the fluid and disinfect the cut. Dr. Raymond says that the reason why he did a cross and not just a single slit was that a cross would allow the wound to keep draining over the next few hours because it takes longer for a cross incision to close than a single slit incision. A few days later I saw the patient’s mom outside of the ER she came up to me to say hello and that her daughter had just had the second abscess drained out. I was glad to hear the good news and the mom seemed very grateful for the medical attention we gave her daughter. It was nice of her to share with me the progress of her daughter’s health and show gratitude towards me, although I had nothing to do with the procedure that helped her daughter get better, but maybe she did this because I spent the time talking to her on the first day when I asked for the chief complaint. It really makes a difference to the patient’s parents when I sit down and converse with them about their child’s health in general. That same day I saw a patient’s mom cleaning up her baby’s throw up while the baby was on his back and I told the mother to lay the baby on his side, so that if he throws up again he won’t choke on his vomit. The mom looked at me with open eyes, like she couldn’t believe that her baby could choke by being in that position. It was a good feeling to notice a potential health hazard and intervene by educating the parent. Education saves lives and it’s hard to see that many people lack a basic health education. It’s a challenge to try to talk to everyone about their health, but it’s a great feeling to know that I have at least taught someone an important lesson or technique in how to take better care of themselves.

I did about 60 surveys this week in clinic. I learned a lot about the population here in Roatan. Most of the patient’s diet consists of flour tortillas, beans, fried chicken, and rice. They eat a lot starchy food, but little or no vegetables or fruit. Grapes and apples are the most expensive produce in the patient’s communities. Most patients that are Indio/Caribbean don’t speak another language besides Spanish. Some patients feed their babies after the age of 15 months. I spoke to Dr. Eileen about this when she arrived on Saturday and she said that as long as the mother has strictly been feeding her baby with breast milk for the first 6 months of life, it’s okay to be feeding them breast-milk until about two years old, but that after the baby turns 6 months mom should start feeding baby formula, along with other nutritious food in order to increase their iron intake. I was really surprised to see 14 month old babies, with a full set of teeth, still drinking breast milk. In California, babies are usually weaned off breast milk before the age of 1 year, so I was really surprised to see these larger kids still lying on mommy’s lap. Being here in Roatan has definitely opened my eyes to different traditions and ways of thinking.

I know it is sad, but I just realized that I have heard of 5 deaths during my time here. The first death was of the premature baby that died in the Roatan Hospital. Last Friday two adults drowned in a septic tank down the street from the Roatan Hospital in Coxen Hole, after attempting to save a life a child that fell in. A firefighter of the area almost drowned himself while trying to save the lives of the drowning adults. Then last night there was a shoot out in Sandy Bay between a local Honduran and tourist police officers. I happened at around 10pm in an area where the police officers had put up a blockade for random checks, like they do occasionally. I heard that the Honduran (who owned a hotel in Sandy Bay) was driving by the blockade unwilling to stop and so the police officers shot at his car when they saw that he was not stopping. The man was pissed off that they shot at his car and later returned to the scene of the police shooting and shot the police officer dead, so then another neighboring police officer shot the Honduran several times and killed him. The dead police officer had part of his skull blown off with his brain on the streets and the Honduran was left at the scene of the crime until the next morning, when a pickup truck came to take him to the ER in Coxen Hole to do an autopsy for governmental records. I was going to take a taxi to French Harbor that morning when I heard about the incident, so I decided to walk up to the scene of the crime before catching a taxi, and just as I was walking up the path down came the pick up truck with two police officers on both sides of the dead body. The Honduran body had his hands lifted up and cringed inward. I had never seen a dead body so close in my life. It was frightening and upsetting. It could all have been avoided if the police officer would just have let the car go and not have shot at it. By letting the Honduran ride off would not have cost him a thing. It was all very unnecessary. From talking to the local I got the sense that the police officers have not interpersonal skills because they don’t talk to the Roatan citizens with respect and that everything is in military mode. They act more like they are at war with the citizens because of their defensive nature instead of protecting the public like most cops in the U.S. do. My fear here has always been of something tragic happening outside of West End and me not having anyone to turn to for help because most of the police here are corrupt. Of course it is not true of all cops, but it does not help to constantly hear bad stories about the police from the locals themselves. It reminds me of my first week here when I saw an injured man making a documentary of himself to release to the government and general public to show how the police abuse of their own people. This man was mistaken for a robber and was stabbed multiple times by the police, causing him to go to the emergency room to repair his internal organs and get stitched up. When I looked at the man I noticed that his stitches were only a couple days old, so I wasn’t exactly feeling the most secure. I know that I must always think smart and not put myself in stupid situations where I set myself up for a potential disaster, so I feel fine about my current situation.
Overall this week was full of eye-openers.

Raymond showed me his adult clinic this week and it was one of the nicest clinics I have seen here in Roatan. The walls are a brightly colored baby-blue color, with nice tile floors, and a glass case filled with medications and other tools. I have also had the opportunity to know Francisco Reyes, the Honduran resident, very well. I realize that although these doctors are very committed to their practice, they always make time to just go out, relax, and just be human. They create such a nice balance for themselves. I learn a lot from their practice and their lifestyles. It’s really nice to get to know different physicians, their different practices, and techniques, and just pick and choose what things I would like to incorporate into my own life and practice. ☺