Thursday, October 27, 2005

Ilena Journal 1

Let me tell you the story of the Hurricane…


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

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


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End with the brilliant marketing strategy of serving food and “showing movies” (that is, they play dvds of relatively outdated American flicks on medium sized tvs that bugs continually land on in ironic places).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

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

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

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

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


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

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

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


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

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


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

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


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

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

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

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

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

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


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

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

Monday, October 10, 2005

Jessica Journal 5

Jessica vs GlobalNet, match 4

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

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

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

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

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

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

Thursday, October 06, 2005

Jessica Journal 4

Adventure to Copan

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

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

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

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

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