Tuesday, August 30, 2005

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.

Wednesday, August 24, 2005

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.

Monday, August 08, 2005

Katie Journal 4

My final journal entry. Well, you never know, maybe you'll keep getting these from me forever, it's kind of become a habit :) Anyway, here goes.

Leonel has been here a week now and is pretty much settled into the routine of things. I think he was somewhat shocked at the condition of the hospital in general, the pharmacy formulary, and the general lack of lab tests available. But, he is adapting quite well, and we spend several afternoons last week cleaning up the clinic, inventorying supplies and meds, and generally rearanging things to be a bit more organized. So, Charles came back today to a much neater, tidier (is that even a word?) clinc - hence, he couldn't find anything and went around complaining about how it was too neat and tidy. There
may be a minor war of wills between Leonel's penchant for slightly obsessive order and Charles' tendeny toward marginally controlled chaos; only time shall tell who will be the victor. In any case, they seem to hit it off well and get along quite nicely today.

Alissa arrived on Saturday and we have been doing our best to show her around so far. I think we've already mananged to hit all of our favorite restaurants, the dive shop's, the bakery, and yesterday we went snorkeling at West Bay beach again. Weather has been hot as usual, but generally cloudier with frequent thunderstorms - so we took advantage of a mostly sunny afternoon break to go to the beach.

Anyway, Alissa had her first day in clinic today and was a great help - we got the new printer set up, which is fantastic - now we can print to our heart's delight. Haven't tested the 22ppm rating, but it is certainly speedy, and we figured out how to make it print double-sided too. I haven't been able to find the Spanish version of the basic clinic survey on the computer (we just had copies, and now we have only the master), so I just retyped it quickly and now it is in a slightly different format so it fits on one letter size page instead of legal - content is identical though. Now that Alissa is here we will hopefully have time to do the surveys with almost everyone.

I am planning on working in the clinic most or all of the week until I leave on Saturday, so I can get more surveys done and talk to the parents more about my followup water questions. Leonel, Alissa, and I, and possibly some nurses who are working at Peggy's, are going to spend a few afternoons this week doing my water surveys in La Colonia, so we'll see how that goes - I'm not hoping for scientific data at this point, but it will be very interesting to see how people respond.

The internet and phone have not been working since the end of last week, and I'm not sure why. It seems that internet has been having problems all over the island recently, but I thought it would have been fixed by today. If problems continue later into the week, I'll stop by Paradise Computers and see if they can come and look at it.

I will be sad to say goodbye to Roatan, but I am also looking forward to going home in a little bit less than a week - the cumulative number of bug bites, sunburns, and possible parasites are finally catching up with me. Plus, I am really craving some Trader Joe's potstickers :)

Let me know if you all have any questions or any requests before I head home. We're also trying to put together some simple info/fact sheets will illustrations for patients to take home - stuff like scabies treatment, kid's nutrition, how to avoid parasites, etc - feel free to send other ideas you have and we'll try to get it done.

Monday, August 01, 2005

Katie Journal 3

Apologies for this being late - internet has been on the fritz here at Casa Calico the last few days.

Dr. Leonel arrived yesterday and had his first day in clinic today. I think it was a lot to get used to for him, but Raymond is helping us out this week so he was around and a very useful resource today. We all went to dinner last night with Peggy and her crowd, which currently consists of another American doc, a bunch of Scottish and Irish dental students, a group of nurses, a student helper, and her grandchild and friends - quite the motley crew. Leonel got to meet everyone, so that was good.

Last week in the clinic we ended up having lots of unexpected visitors. Monday and Tuesday, Peggy showed up with groups of her dental students to help to dental exams and recommend treatment for kids that needed it. They were really helpful and I think successfully convinced a lot of the parents to take their kids for dental work at Peggy's clinic, so that's good. However, none of them spoke any Spanish, which necessitated me translating them for them - a highly amusing endeavor as you can imagine. We did all right though, and I am now very skilled in translating such phrases as "Your child needs six extractions, five fillings, and four sealants, preferably right away", and "No Coca-Cola before bed!" Anyway, it generally went
well, and the patients always like getting free toothbrushes and toothpaste, and the extra personal attention.

Then Wednesday we had a visiting nurse from Peggy's clinic, who helped with taking patient vitals and the like so that I could have the time to get a few more surveys done. Thursday a pre-med student, also working with Peggy, stopped by to help out as well. There wasn't much for him to do, and so he wandered off to parts unknown and later told me that he talked to Dr. Sanchez in the main ward and got himself invited to watch a minor surgery. I think Peggy was concerned about how this would go over so she talked to him. Anyway, I think we are finally done with the visitors (some were actually very helpful so I shoudn't complain, it just made things that much more hectic in the clinic).

On the water survey, I am hoping to convince Leonel to go out into La Colonia with me this week or next before I leave and at least get a few surveys done to get some basic information. Also, once Alissa arrives next week, I am planning on doing a very scaled down version of my survey in the clinic, in order to get basic water infrastructure info for patients who live in communities other than La Colonia. Incidentally, I found a file on the Global Healing computer written by someone named Carrie that had all sorts of info on the water situation in the hospital and in Coxen Hole generally. Very interesting, especially since it is dated over a year ago and things seem to be exactly the same. Anyway, anyone know who this Carrie is or how I
could contact her? I would love to see who she talked to, because it sounds like she managed to find the elusive PMAIB office (the Ministry of Tourism project aimed at improving water and sanitation on the island, funded by Inter-American Development Bank) that no one here seems to know anything about now - unclear if they have disappeared from the island or if anything has been going on with the project in recent years.

We haven't had any terribly interesting cases in clinic recently, other than a whole family with sickle cell anemia and a whole family that needed TB post exposure prophylaxis. It seems that TB is one of the few diseases that the hospital really does a good job on tracking and following up with patients over the whole course of treatment. Otherwise, just a lot of the usual colds, scabies, and diarrhea - good times!

The only thing I have been having problems with is getting forms/charts/info sheets/etc photocopied. The copier upstairs in the administration are works just fine, but I'm quite sure that the woman who works there hates me, and I am only allowed to make ten copies at a time (sometimes five if she is feeling especially spiteful). Even if I bring her paper, she refuses to make more than ten copies - which for things like growth charts or surveys, lasts a very short period of time. Thus, I have been taking things to Paradise Computers and just copying what we need and paying for it myself. This isn't really a problem, I was just wondering if we have any discretionary funding that we could use in this case? The new printer will help for the
things we have on file at least. Anyway, let me know what you think. I can keep incurring the wrath of the admin woman and making ten copies a day too - it does get the job done. I admit it, I'm somewhat afraid of her - but I think if this is my biggest problem, I'm probably not doing so badly.

Anyway, I am excited to finally not be here by myself - although a lot of Peggy's crew have been staying at Casa Calico and nearby at Sea Grape intermittently, so I've had some company. I have learned how to cook a lot of things with bananas, mangoes, and pineapple, and how to make chocolate chip cookies with no chocolate chips (I didn't know such a thing was possible). And believe it or not, I have even found soy milk and tofu here. What an adventure. I finished my diving certification and am now planning all the other dives I want to go on before I leave - of course, too much to do in the next two weeks!