Sunday, July 24, 2005

Katie Journal 2

I am certainly having a lovely time on Roatan so far. Began my diving class yesterday and have done all confined dives and two of the four open waters so far, so I should finish that up this week - I have my own instructor, and it has been a fabulous experience so far.

Things at the clinic continue to be busy but under control. We have been seeing 20-25 patients (usually plus some follow-ups) each day, which means that Charles usually has to hurry towards the end of the day so he can finish in time to get to his other job. Things are running smoothly though.

Eileen left me with some educational posters that she made earlier, and so I had them laminated on colored construction paper this week and they are ready to be used in the clinic. They are about breastfeeding, dental hygiene, and general kids nutrition, and scabies treatement. Basically they are a series of 5-6 notebook page size illustrations with a little bit of writing/information. I think the idea was that the doctors could use them while doing patient consults if they think it would be useful to go over the information - such as, if the kids has scabies, go over the posters for scabies treatment and prevention. All of the posters are in Spanish too. Hopefully they will be a useful educational aid in the clinic.

I also noticed that at least one day a week, the nurses do a little mini class in the hallway, teaching the moms that are waiting about breastfeeding usually. It is a highly amusing demonstration involving many poster-sized pictures of breasts, but the moms really seem to pay attention and like it. The only problem is that they send the kids to another part of the hospital during this time, so we can't see any patients for a while because they are all off playing elsewhere.

There are two people here volunteering at Peggy's for a couple of weeks (a nurse and a pre-med student, both in their mid-20s) who would like to come and see our clinic and possibly help out a bit. I tentatively told them that would be okay with me, but I wanted to run it by you guys too. I don't know that there's really a lot for them to help with at this point, other than that they could possibly do some of the admin stuff for a bit which would free me up to do more surveys. Anyway, I was thinking maybe they could just come by towards the end of the morning and see how things run, I could show them
around a bit, but then they wouldnt' be in the way at all. Let me know what you think.

Progress on my water survey has been a bit slow this week. Monday I dropped off a bunch of copies of the survey to Peggy, because she wanted to have her students administer it in clinic this week. I went through it with her housekeeper, Irma, who also lives in La Colonia, and it seemed like she understood all the questions and everything. However, I stopped by again Tuesday to see how it was going and Rob and Ginger, the two students that were going to do it, had decided that the way it was currently designed they didn't think I would really get truthful and/or meaningful answers from people. They thought people would be too embarassed to say that they don't have soap, etc, don't always have money to buy purified water, etc. So, while they didn't have any other suggestions, the end result is that the survey is not going to be done at Peggy's at all anymore. While I agree with their criticisms completely, I don't really know how to fix the situation and get people to be more comfortable answering things honestly. Rob and Ginger seemed to think that the survey was also generally much too sophisticated for the people in La Colonia - that they wouldn't really understand the questions, and would just look to me for the answers and tell me what they thought I wanted to hear.

All of this said, I have still managed to find out a lot about the water infrastructure on the island, and specifically the water systems in La Colonia. I went to see the new purification system in Polycarpo (one of the three colonias) with Chuck, the water engineer/missionary who owns the hotel where Peggy's clinic is, which was very cool. I feel like I have a much better understanding of the water situation in general, and I have begun to keep notes and write up what I find out when I talk to people. I am hoping that when I have more time in clinic (ha ha, if that ever happens), I will ask some of the basic infrastructure questions from my survey to our patients from other parts of the island, so I at least know the basics of the water systems elsewhere - like Los Fuertes, the different barrios of Coxen Hole, Flowers Bay, Gravel Bay, etc. I think I will try the survey in our clinic and just see how it goes, whether I think people are understanding and answering honestly or not, and then reevaluate whether it is worthwhile to try to do it on a larger scale. Any thoughts you guys have on this would be appreciated as well.

Dr. Leonel arrives one week from today, next Sunday, so he will start in clinic that Monday. Dr. Charles, however, is going to be gone that entire week for his graduation, so it will just be Dr. Leonel and I in the clinic until the following week when Charles returns (and Alissa arrives as well).

We had a very sad case this past week, a follow-up from last week that Dr. Eileen was able to see while she was in clinic on Monday - an 8 month old baby with advanced AIDS and several opportunistic infections. Due to a miscommunication, the mom was told that Eileen wasn't there and so she left, but Eileen later found her at Valerie's clinic. She decided that the only way the baby was going to get the care she needed was to take her to the hospital in Ceiba, so they took the afternoon ferry, got the baby admitted, and Eileen was barely able to make it back to the island on a flight that evening so she could make her early morning flight back to the US the next day. It sounded like the doctors in Ceiba were very helpful and accomodating, and that the baby's mother was willing to take her there monthly for treatment if necessary, as ARV therapy typically isn't available for kids here on the island.

Monday, July 18, 2005

Katie Journal 1

My first week has been pretty busy, but things are going relatively well in the clinic. Agnieszka was in clinic Monday and Tuesday with me, and then it was just Dr. Charles and I the rest of the week. Since neither of us really knows exactly how things are supposed to work or where anything is, we are sort of learning together. We've had 20-25 patients each day, and with only one doctor, we usually aren't done until 1-2pm. I am doing all the record keeping on the computer, updating and
organizing the charts, calling patients, doing weight/temp measurements, etc, and then helping Charles as necessary.
This is keeping me pretty busy, so I haven't gotten to do many surveys yet - maybe 15-20 total for the week. Perhaps once I am a bit more organized I'll have time to do more, and certainly the last week when Alissa comes that will be more possible with two of us. My Spanish is okay, but definitely still leaves something to be desired - I can do the surveys okay, and direct
the patients to where they need to go and answer basic questions, but I'm sure I'm missing a lot of the nuances of what they're saying sometimes and when they start talking to me really fast I get lost really quickly.

Otherwise, the only problem I've had is trying to keep the patient flow smooth and keep the clinic calm inside, when a lot of the patients want to wait inside or come in every five minutes and ask me how long it will be. Another problem is that follow-up patients (with test results, either from earlier the same day or previous clinic days) come back in and want to be seen right away. Charles usually sees them next (they're usually pretty fast consults, writing a prescription or giving meds and instructions usually), but this tends to make the other patients who have been waiting rather irritated. And then sometimes one of the nurses or another hospital worker will come by and demand that we see a certain patient first (for reasons that are
entirely unclear to me - as far as I understand, it's usually a patient they know personally or a relative or something like that), even when their file is at the end - again, other patients get irritated. But all of this said, I think things are running relatively smoothly given that Charles and I are both new, and I'm sure things will get better as we get used to the system more.

Dr. Eileen is returning tonight and will be here for a day or two before she returns home. We are hoping that she can see a follow-up patient, an 8 month old baby with AIDS, that she treated a while ago in clinic. The baby has a severe oral thrush infection, but the meds that other doctors have given her apparently don't agree with her. Her mother said that Eileen gave her something else that worked previously, so she is coming back to clinic tomorrow to see her.

I have been to Peggy's three times so far. She now has Dr. Raymond working with her, as well as a group of Irish dental students, and several other student helpers. Plus several family members are staying with her, so she has a very full house right now. She has been very helpful with the water survey, and I think I am going to drop the final version off to her tomorrow afternoon. She thought it would be better to at least start by having her student assistants administer the survey at her clinic instead of going up into the Colonia. I feel bad that I can't help with it then since her clinic is also only open in the morning, but I think we'll see how it goes the first few times and then probably have to revise anyway. Also, it looks
like my sister may be able to come out here for a few days so she can help me with the survey as well. I also talked a lot to the owners of the hotel where Peggy's clinic is - they are from CA and just came here four months ago, and the guy is a water treatment engineer. He put in a mixed oxidant chlorination system for the well there at the hotel, and got one donated for the Colonia, so as of two months ago, one third of the Colonia has completely purified water (for drinking, cooking, bathing, everything - at least every three days). So it will be interesting to see if there is a difference in the surveys between the people who now have purified water and those that don't. Peggy thinks that the owner of Anthony's Key, who is
running for Mayor, could also be convince to pay for a purification system for the rest of the Colonia in the near future. Interestingly though, people who are part of the purified system apparently don't like it - they think it smells funny (chlorine) and makes them itch, so they are constantly complaining to the system operator to turn down the chlorine levels - the
hotel owner keeps going up there to turn the chlorine back up to safe levels. In any case, I think it will be really interesting to see what we find with the surveys.

In the clinic surveys, every single person I have asked has said that they drink only purified store-bought water, all the time, and yet a really high percentage of the kids have bacterial or parasitic intestinal infections, so I'm not really sure how to reconcile those two facts. When I have more clinic surveys done and have more time, I will go back and cross-reference
the surveys to the kid's diagnosis in the computer spreadsheet, and then we can see if there's any correlation with survey answers and the types of medical problems they are coming in with. Someone mentioned that in addition to drinking water contamination, the other way that a lot of kids get parasites is by sleeping on the dirt floor - I don't know how true that
is, and I would imagine that applies more to skin parasite, not intestinal ones, but it would be interesting to look at that more too.

Otherwise, things are going really well - the apartment is great and I've got it all stocked for cooking. Agnieszka and Ben introduced me to a lot of good restaurants and fun places in West End, but while I'm here by myself for the next two weeks, I think it makes more sense to just cook for myself as much as possible. After Eileen leaves, I am going to try to clean out
the other apartment a little bit - it is quite a mess, especially the kitchen - filled with gross food, and the fridge desperately needs to be defrosted as the door currently doesn't shut because there's so much ice. Hopefully Eileen and I can also go through all the extra supplies that are over in that apartment and take what is useful to the clinic and get rid of the rest - I get the idea a lot of it is supplies for equipment we don't even have. In the clinic itself, what do you think we should do with the old computer and the printer, both of which are completely non-functional? Arup said he has another computer ready to go, but it's unclear when that is coming, and I don't think we have another printer yet. Any thoughts on whether we should try to get rid of this stuff or just keep it around for a while?

Also, Agnieszka left me with the cell phone that she bought, which works quite well here - the number is 504-368-6590 if anyone needs to get ahold of us at some point. I will just leave it with the next doctor or with Alissa when I leave. It works on a prepaid card systems that you can refill almost anywhere, and incoming calls are free - apparently its about 30 cents/min to call from the US, so Agnieszka was having her parents call on that, it seems to be a little bit better connection than at the clinic, plus it works in West End as well. Also, it is the best way to find Raymond, Charles, Peggy, and others with local phone numbers, who are otherwise difficult to track down. Arup called when we were in clinic on Thurs, and Charles and I talked with him for about an hour - he just wanted to be filled in on everything that was going on, how Charles and I were settling in, etc. It was good to talk to him and get his perspective on how the clinic should be run, what our roles should be, etc.

The computers are both a bit tempermental but generally working fine. I have just been taking the Global Healing laptop back and forth to clinic each day, but using Jenn's laptop for my personal use. I keep saving the patient files on a jump stick because I don't quite trust the computer. Jenn's laptop works fine for email (although internet at Casa Calico has been in and out), but doesn't do much else because the hard drive is completely full and "low disk space" errors come up all the time. So I have been keeping my survey files on the other computer and on my jumpstick just to be safe. But basically, for my purposes, everything is working just fine. Agnieszka and I took a bunch of pictures in clinic last week too, so now that she is back she'll probably send some of those to you guys for the website. I'll take the GH digital camera and take more photos at some point too.

Sunday, July 03, 2005


Where do I begin? My experience in Roatan has been amazing, although much different from what I imagined. The people are incredibly kind and giving and I only wish I could do more for them. Unfortunately, due to my lack of knowing Spanish and because I am frantically trying to finish my medical school application, I cannot contribute as much to the clinic as I would have liked.

The clinic is in a slight state of turmoil. When I got here there were two residents (Mollie and Isabelle), one attending (Eileen) and the Honduran fellow (Raymond), but things have dramatically changed. The residents left last week and Eileen left today. Raymond’s last day is Thursday, but only because they convinced him to stay a few days longer (his official last day was June 30th). He will be working at Miss Peggy’s clinic in the future, but is going to San Francisco July 18th-24th. Global Healing hired Charles as the new Honduran fellow, and he is supposed to start Monday- but Eileen was skeptical of this. I met Charles when he was interviewing and he seems like a nice enough guy. He is from the island but has never worked in the hospital. I think our main role in the clinic will be to help Charles and to keep things under control. With only one physician and one that has never worked there, things will be a little chaotic (they have no one coming from the states during July and August). To help I have been basically triaging patients. I call them in, take their temperature (and if they have a fever give them ibuprofen), weigh them, measure them, mark their growth chart, and enter all of their information into the database. Then when the physician is ready, I bring them in. I also have been getting supplies for the doctors. I tried administering the surveys, but without knowing Spanish this was impossible. I tried doing a few in English, but found that it was slowing things down and it was better that I focus on triaging patients and improving the patient flow.

As far as patient follow up, I have not done any. I am not sure which patients to focus on and have not heard of any specialists coming to the island. Raymond and Eileen said they went through our follow-up list and said no one was critical and most of the patients have not expressed interest in following through on their own care (they didn’t show up to the ferry, didn’t come back when they were supposed to etc.). I added a few new cases to the follow up list: two are children that need to have an audiologist review them and one is a girl that has epilepsy like symptoms. Unfortunately, they all speak Spanish and I don’t think I can help them much.

There have been a few very interesting cases on the island that have worried the doctors. A baby was born to some missionaries with a severe cleft palette and conjoined extremities (EEC or ECC syndrome). Eileen went to La Ceiba with the family and we are trying to help them find specialists in the states that can help them (but without insurance this may be tough). Also, we had a scare because one of the other missionaries that was pregnant was past due and refused to come to the hospital to deliver the baby- actually she wanted to have an underwater birth in a tub in her shack. The doctors thought that her water had been broken for over 36 hrs and were freaking out- They spent all night at her house waiting for the baby. In the end everything worked out well, the water broke for real (the first time was a false alarm) and the baby was delivered in an hour.

I’ve also learned a little about how the pediatric ward functions and I am a little appalled. Although I haven’t gone on rounds, I have peaked my head in there a few times. I can’t believe who they keep in there and who they send home. They have kids that are basically ok- with a little cellulites that they’ll keep for days, but then they’ll have really sick kids that they’ll try to send home right away. We had a little 7 month old baby presumably with AIDS in the ward, that had terrible thrush and PCP among other things and the doctors sent her home really quickly. Eileen was really upset about this and sent the mom to Valerie’s clinic and has been checking on the baby. She is now doing really well, but I have learned a lot about the politics at the hospital and am disappointed. This baby should have never had AIDS, but the mom was not detected in time. She had tried to get an HIV test done when she was pregnant but could never find the person that was suppose to give her the consultation. She didn’t find out she had HIV until 2 weeks before the baby was born, when it was too late to take AZT effectively.

Eileen has been looking into improving the screening and treatment process for people with AIDS on the island and I think it would be great if we could help with this. Apparently, no one is really responsible for the moms with AIDS and because the way they are stereotyped and treated moms don’t want to get tested. Apparently they are opening a new clinic up in October specifically for this purpose, but we’ll see if it actually happens.

I went to La Ceiba last weekend with Eileen and met this really interesting man named Pepe. He is supposedly the first Honduran conservationist. I think he works for the US consulate now on watershed stuff. He knows a lot about water law and situations and is willing to work with us on this in Roatan. He is a really kind and generous person, he took us kayaking at his river house and gave us a tour of La Ceiba. I recommend we keep in touch with this guy- especially if people have environmentally focused projects.

Other than that we have been painting, sorting supplies, and cleaning the clinic. It looks really nice now. Unfortunately the printer is very broken- we need to get a new one. It won’t even print a single page. As for the computer situation the computer and internet in clinic are working great, and Ben was able to get Jenn’s computer to work. Unfortunately the internet at Casa Calico is broken, so we can’t guarantee that it can connect to the internet (although who knows when they’ll fix the internet). Let me know if you have questions about anything.