Sunday, September 25, 2005

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!

Monday, September 19, 2005

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!

Friday, September 16, 2005

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!


Wednesday, September 07, 2005

Alissa Journal 3


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.