Michael Journal 4

After my four and a half weeks in Roatan, I definitely feel like the experience has changed me in several ways. It was very refreshing to get away from the hustle and bustle of college pre-med life, where one must worry about classes, MCATs, extracurriculars, research, and applications – so many balls in the air in the simultaneous premed juggle. But down in Honduras, living with Peggy and the other medical volunteers, one is reminded of what medicine is really about – putting the wellbeing of patients above all else. The greatest happiness for all is not achieved by selfish pleasures, like sleeping in or spending an afternoon on the beach – but rather by the small sacrifices doctors make on whatever level (whether it’s Dr. Karina waking up two hours early to meet a patient at the ferry to hand off medical documents to bring to the mainland, or Dr. Patrick taking time off from his job in Phoenix and paying his way down here to see patients – a true medical volunteer), and if you have to get up early on a Saturday, call in a favor, or make a special house call in order to get a patient the best care, then so be it. In this sense, life in Roatan was simple indeed.

One question I’ve gotten many times, especially in the past few days, is whether I’d return to Roatan. What exactly do people mean by this? Was it just a general inquiry on my experience for the past month, or do they want to know whether I’ll bring my tourism dollars back to Roatan? Or are they asking about medical missionaries in general? I decided that I would definitely love to come back to Roatan – either as a medical volunteer or just as a tourist looking for some cheap diving. I could see myself living down there for a few months, maybe doing some volunteer work – I just don’t know when or how that’d fit into my life.

On the other hand, it seems to me that Roatan is in pretty good hands. Of course, the quality of life there will never be as great as it is in the United States, but the island is vitalized by the tourism money the resorts bring, and on some level this money trickles down. As I was there, it did not seem like what I imagined a “third-world country” to be in my head. It reminded me a lot of Taiwan, maybe a little bit poorer, but I’d classify it as a “second-world country,” if there is such a thing. Sometimes I’d ask whether or not Roatan would be as well off as it was if it wasn’t a tourist attraction, and sadly, I think it wouldn’t be. A lot of the volunteers and donors to the island first visited as tourists, and then decided that the island needed help and began to contribute. This is great and all, but it leaves one wondering about the undiscovered poverty in the world, in countries such as the Dominican Republic or Haiti, or in central Africa. Why does it take firsthand experience – a rich tourist driving by El Swampo – before they’re willing to help? What about all those countries that don’t have tourist attractions? Who is going to help them? This makes me want to look for other opportunities to volunteer in less fortunate countries.
Being in Roatan and seeing the disparity in wealth distribution also got me thinking about social injustice in the world. Right now, the government and various organizations are waging all sorts of wars for the supposed betterment of mankind – wars for democracy, wars against terrorism, battles against abortion, against stem cell research, for gay rights, against cancer, for battered women, for orphans, against HIV/AIDS, for immigration reform, for social security reform, just to name a few. Paul Farmer’s view as presented in Mountains Beyond Mountains seems to be that every single human being on the planet deserves a healthy mind and body, regardless of his or her socioeconomic and legal status. I think few people would dispute this, and if you subscribe to this belief, then we as the world have a lot of work to do. But in the list of problems with the world today, where does this directive land? As Americans, should our responsibility to feed, clothe, and care for every kid in Somalia take precedence over our own social issues? Organizations can spend thousands of manhours marching and fundraising to raise money for cancer, a disease that takes thousands of lives each year, many of them elderly, but millions of kids die every year of malnutrition or preventable diseases. The money used for cancer research would save many more lives per dollar if it was used to build bread ovens or buy cheap vaccines. But the difference is, in the United States we all have a friend, a relative, or an acquaintance who has died from or fought cancer. That makes the suffering that much more real. And likewise – how does one put a price on life? It’s not as if people in developing countries don’t get cancer either – it’s just that you can save more lives by treating the “easier” problems first. But how many lives in Honduras are worth one life in the United States? Thinking about this just makes me all the more appreciative of living in a developed nation and being born with such opportunities.

Finally, this whole experience made me appreciate donors more. Peggy began with seeing a few patients in her downstairs apartment – a humble service to the community – but through the generosity of various donors, will open a brand new clinic built from the ground up, complete with a lab and inpatient care (all it needs is a small operating room and she could call it El Hospital Esperanza). Of course I have the most respect for Peggy and her persistence, and the doctors and nurses who supported her from beginning to end, but after seeing her come home smiling every day when another donor moved her that much closer to making her clinic a reality, it made me realize that becoming a doctor isn’t the only way to directly help people – all it takes is the right intentions and means.

Michael Journal 3

I’m very sad that the three-week milestone is already here. It’s hard for me to believe that I’ve been here for that long, just as it’s hard for me to believe that in a week and a half I’ll be back to the drudgery of university life.

My time here has been everything I expected and more. I’m getting to see so much more of Honduran culture than I’ve ever seen of any other culture when I’m traveling. I used to wonder what the appeal of traveling was to people – to me, it meant long hours on tour buses, smiling photos in front of obscure landmarks, and unfamiliar hotels. My month in Honduras has showed me what traveling is really about: taking the time to live and learn in a foreign location with different cultures, perspectives, and expectations. I’m glad that I’ve had the chance to interact with patients both in and out of the clinic and to see how they live. The population in Honduras, I’ve learned, is very courteous – a personality trait often lacking in California, where time and patience are in short supply. I’ve also had the chance to meet a lot of locals through church here, and I’ve learned that islanders are very religious people.

I’ve really enjoyed my work in the clinic. It’s really great to be able to help patients get the care they need. This week, one particularly complicated case involved rapidly spreading pneumonia – subsequent x-rays show a drastic diffusion of liquid through the lungs within a span of 3 days. I remember screening and admitting the patient, and I saw them again in the wards as I accompanied the doctors on rounds. I had to travel to Dixon Cove, about a 15 minute drive, to the Galaxy Ferry office to get them tickets, and hitchhiked back because I wasn’t able to get a taxi. I was just glad to be able to help them in their situation.

In my last two weekends here, I am determined to make the most of my time. Tomorrow, a group of 10 volunteers and American workers are going on a shark dive – that is, a dive where they feed the sharks right in front of you. The weekend after that – my last weekend – we plan on going to La Ceiba, the port city closest to Roatan. I’m excited to see other parts of Honduran culture; Roatan has a very distinctive island culture that is not completely representative of the mainland culture. I’ve also heard of a nearby island called Helena, which is a small undeveloped island of 900 people with no roads and no cars. Last week, at the Parrot Tree church, I met a group of medical workers who had built a clinic there and was serving the population there, which was essentially all the descendents of 5 slave families that had been left there a few generations ago. It sounded like a very different place, and I’m sad that I won’t have the time to visit the island before I leave.

Michael Journal 2

Last week we went hiking through a barrio in Roatan called "La Colonia", which basically means "the settlement". La Colonia was created in 1998 during Hurricane Mitch when basically all the poorest islanders living on the shores of the island had their houses destroyed by the hurricane and fled up the hills to escape the water. Once the hurricane left, the people stayed and built their houses directly on the hillside. The problem was, they didn't own any of the land they'd built their houses on; it was owned privately by a Canadian. But they're still there today.

Since it's built into the hills, and since it was built so quickly, La Colonia has basically no infrastructure. As we hiked through the villages, we were taken up narrow and really steep dirt paths completely surrounded by tall grass, completely inaccessible by car, so anything the people needed had to be carried up by hand. The water is pumped up through PVC pipes that we saw above ground, and even then, the people only get running water 3-4 times per month. And there is no sewage system - which means that the sewage from the people at the top of the hill runs through the yards of the people at the bottom of the hill, creating a huge health hazard with GI diseases. This is especially a problem when there's no clean running water to begin with. I guess that's why a lot of the kids we see at the clinic are from La Colonia.

Anyway, here's La Colonia in pictures:


Built on the hillside


The locals we talked to insist that it's safe, even in the heaviest of rains


At the very top of the hill, where there was once a cellular tower, now destroyed. Doesn't look like it's going to be rebuilt any time soon.


Some cute kids we saw, doing chores I guess.


It doesn't take much to build a church.

I finally finished Mountains Beyond Mountains by Tracy Kidder. Everybody swears by this book, and gushes about Paul Farmer and how great a visionary and model he is and how he inspires you to want to change the world, and I can see his influence as they try to open new clinics in other parts of the island too. It's really inspiring to see such inspiration in other volunteers, but I wonder if I could ever lead the lifestyle that they or Paul Farmer lead - spend a few months in the States, and then fly out to wherever poor place to raise money, build your clinic, and see patients. A lot of the doctors/nurses here spend about a quarter to a half of their time here, and there's really no good reason not to when you could be helping so many people directly. One of the other volunteers asked me whether I’d ever come back. I’d definitely like to return again, preferably as a doctor (in 8 years when I’m done with my residency, if all goes to plan) so I can be more useful. It’s kind of frustrating working with all these other volunteers who are nurses and doctors and pharmacists who are helping out so much with Global Healing or Peggy’s Esperanza Clinic, and although I know I’m helping out too, I want to be able to help out more. Also, it seems like with all the tourism and diving, Roatan has attracted enough donors and volunteers that in 8 years, there will be enough clinics to serve the population – perhaps I should consider other destinations to help out, like other Latin American countries or some African countries.

Michael Journal 1

I’ve been here for a whole week, already, and still not a single Starbucks in sight! In fact, there's no sign of corporate America, except for the occasional 21st Century Real Estate sign and a Bojangles (which I’ve never heard of anyway). I must admit that this was a bit unexpected, because after reading about how Roatan was a resort island, I expected some measure of corporate America following the American tourist. However, it is really refreshing to be here in a completely foreign land, with very few recognizable symbols of America. It’s almost as if Roatan is back to the basics, building everything themselves with little reliance on American culture.

Anyway, I’ve been here for a week, and I love it here. My week here has been everything I expected and more. The community of volunteers and health workers here is amazing and has introduced me to an entire movement and purpose to provide healthcare to developing countries. Peggy and all the other volunteers here have read Mountains Beyond Mountains, which tells Paul Farmer’s story of building clinics to provide healthcare for developing nations, and they all seem to swear by the book. It’s very encouraging and inspiring to see such devoted and proactive workers who come out here and build entire clinics from the ground up out of their own will and initiative. I’ve just begun reading the book today, and I hope to finish it soon.

I’m enjoying working in the clinic as well. Monday was a very daunting day for me as Molly tried to fill me in on everything I needed to know to run the clinic, from the location of different meds to how to take a history in Spanish to showing me around Coxen Hole. At first, I was very intimidated by the two attendings in the clinic too, Dr. Rom and Dr. Karina, and I was not very confident at all – it’s very intimidating to call a patient in front of 20 other impatient mothers. However, as the week went on, I became more confident in my ability to perform the job. Although my Spanish wasn’t as good as Molly’s, I found that it was enough to communicate easily with most patients. I learned that Karina and Rom weren’t nearly as scary as my initial impression of them. I started to get the hang of giving meds to patients. And most of all, I really enjoyed being able to help the patients – I loved the feeling of walking into the hospital every morning knowing that I was going to help the dozens of sick patients I saw sitting on the benches. I’m glad I can help in very direct and meaningful ways here, as opposed to the limited role we students are allowed legally in the United States.

I’m also enjoying my time outside of the clinic. The last few days when Molly was here were spent traversing the island with the other volunteers. On Sunday, a bunch of us went to the east end of the island by car and enjoyed the white sandy beaches there. On Monday, we went to a beautiful hidden swimming hole called the Creek by boat. On Tuesday, we went hiking through some of the poorest barrios called La Colonia, which was formed when a lot of the poorest islanders living near the coast fled up the hillside in 1998 during Hurricane Mitch and squatted on the land. The houses there are built up a nearly 30-40% grade hill, and there is little infrastructure of running water or sewage, creating a huge health risk. It was mind-boggling to see how humans were forced to live under such poor conditions.

Other than that, I’ve occupied myself with swimming, snorkeling, kayaking, cooking, and reading. I’ve had a lot of time to relax, and I think this month is going to be an excellent way to end the summer.

Molly Journal 4

I’m just days away from my departure from Roatan, and I can’t believe it. Somehow, this city girl managed to adapt to the island life. I spent the last few weeks happily doing the same things each day at a very relaxing pace. I am so grateful for the opportunity to have worked in the RVPC with Dr. Charles, Karina, and Rom. They really made an effort to include me as they treated patients and I learned quite a bit in the process. I’m also thankful for the relationships I was able to form with patients and their families. This is the aspect of medicine I look forward to most. Finally, I will not forget the peaceful walks home from the gym at night where nearly each night afforded a sky with an incredible display of stars and an accompanying lightning storm.

A quick summary of my last week in clinic: The patients we saw were sicker this week, and many had very interesting histories and diagnoses. Thus, although we didn’t have too many more patients, we spent a lot longer in clinic. I also learned that the nurses had been cutting us off at around 15 patients, which is absurd because we had two doctors each day. We asked them to make the default about 25 appointments per day, which will increase when Charles returns from the United States next week.
On Friday, the second baby died in the wards since I’ve been here. Although I was not there to see it happen, both Rom and Karina were really affected by what happened. Apparently Karina showed up in emergency to admit a patient from the clinic and saw a baby that was on the ward turning blue. The resident was suctioning the baby but no one was using a bag or trying to resuscitate the infant. She ran back to our clinic, got a bag, and tried to resituate the baby herself, but it was too late. Although everyone agrees that the baby should never have died, it did have signs of multi-organ failure and its prognosis was not good. Nevertheless, it seems hard to imagine that something like that could happen under the care of trained medical personnel in a hospital.

The other baby that died weeks ago died because of some kind of misunderstanding between the mom and the doctors in Roatan. She was told to get to a public hospital in La Ceiba for an exchange transfusion for her baby who had Rh disease, but she went to a private doctor on the mainland who told her that her baby was fine and needed no treatment. By the time the mom brought her baby back to the hospital in Roatan, he was essentially dead. This was a tragedy because the baby’s prognosis was good and the treatment for Rh disease so standard.

These are the kinds of situations that make practicing medicine in a third world country seem so difficult. I have heard Karina and Rom express frustration about the lack of available diagnostic tools or even standard first/second/third line drugs for treatment. I can only imagine how difficult it must be for a doctor who knows exactly how to treat a patient to not be able to do so because the treatment options do not exist. It seems unfair and inequitable that in certain parts of the world prognoses vary for a similar condition merely because the standard of care is not available. To accept this is to accept that certain lives are less valuable than others. This cannot be. Although I am aware of the arguments regarding cost-efficient treatment of patients in the third world, I am unable to forfeit lives to keep costs down. This is a subject matter that my experience in Roatan has uncovered for me and one I hope to pursue in the future.

Molly Journal 3

I had high hopes for the number of patients we could see this week with three doctors in clinic, but with Dr. Jackie’s return to the hospital, there was a smaller patient pool for us. Things will pick up next week, however, as Charles will be gone and the Cuban pediatrician is returning to Cuba. Despite the relatively low number of patients we saw this week (range was from 8-20 each day), we did manage to see some pretty interesting cases and I was witness to my first public health miracle here on the island.

Right before I arrived in Roatan a baby was born in the Roatan Hospital with hyodrocephalus. The mother had little prenatal care and the baby was taken to the pediatric neurosurgery ward in the big hospital in Tegucigalpa days after birth. On Monday after work, one of the social services doctors (they are sort-of like residents in the US) came in with the mother who had returned to Roatan after being told her baby would need brain surgery to insert a shunt in Tegucigalpa but that she would need to find/purchase the actual shunt. We sent out e-mails to Global Healing and Karina spoke with neurosurgeons she knew from NYU to try to see if there was a way we could get a shunt donated from the US and shipped down quickly. We didn’t have to wait long, as we found out just two days later that Dr. Patrick — who spends 6 months of the year here in Roatan working with Peggy — would be coming down Saturday and had obtained a shunt for us. We will bring the shunt to the Mom on Monday (if not earlier) and she will head immediately for Tegucigalpa. The surgery is currently scheduled for Tuesday. It was incredible to be part of a team that was able to act so fast and effectively to help this woman and her baby out.

Another interesting case involved a 10 year old who Karina admitted on Friday to rule out septic arthritis. The girl had severe pain in her hip, accompanied by a positive urine test and a high temperature. She was unhappy about being admitted but the potential consequences of septic arthritis (i.e. losing hip function) necessitated the admit. I’m sure we will hear more about her case when we return to work on Monday.

This week I will also be following up with two patients who I am trying to get to Choluteca in October for free plastic surgery. One is in need of a cleft palate surgery and another needs external ear reconstruction. It will be quite an enterprise organizing this as Choluteca is two days away from Roatan and the organization providing the surgeries requires photos and HIV and TB tests from each potential patient, nonetheless, as Peggy said, it’s much easier than paying for a surgery (which these patients are unable to do) or traveling all the way to the United States to have a surgery done.

What else have I been up to? Rom, Karina, Suzanne, and I dove on Tuesday. I’m officially certified! We also discovered the licuados place across from HB Warren. The banana is amazing. I don’t recommend the Italian restaurant in West End, Karina and I ate there last night and are both feeling sick today.
In office news, after the new desk Charles purchased arrived on Monday we re-arranged the clinic and now there is a ton more room for intake. This means I no longer have to scribble notes on files on top of the printer or computer. Additionally, the air conditioner seems to have been fixed in the hospital. Apparently this is a huge issue for Global Healing and something they have been trying to make a priority for some time, although it seems to me to be less important than the fact that we don’t have running water in the clinic/some necessary meds. It is hard to be concerned about fixing the AC when you are looking for a shunt that may save a baby’s life.

Anyway, as usual, it’s hard to believe how time has flown by! I officially messed up my timing of filing my AMCAS so that my Inbox has been flooded with secondaries all week that I know I am not going to be able to keep up with (not exactly what I want/plan on doing my last week and a half here). Sadly, Charles left today for San Francisco for his board review conference and I won’t be here when he gets back. The turnover here is incredible. Hopefully I can make the most of the next week before Mike arrives and I pass everything I’ve learned on to him.

Molly Journal 2

I forgot to write this in my last journal but what has struck me most while working within the health care system here in Honduras is how eager these medical professionals are to help. Perhaps it’s just the Global Healing docs, but the rule seems to extend to others I’ve met through Peggy as well. For example, my first day I assumed that I would have to turn patients away after the nurses had already given out the maximum number of appointments for the day. However, I asked just to make sure about a particular patient, and Dr. Karina said, sure, just have them stick around. The same thing happened with Dr. Charles and another patient. When other doctors close their doors early, either Charles or Karina is happy to see these patients, to follow up on their lab results, or to prescribe medications. And they do this without a single complaint, they act as if this is their duty as a medical doctor, and I guess it is. It just makes me wonder about the way our health care system operates in the United States where doctors refuse patients regularly and patients go unseen who have “the wrong” medical coverage. It makes me think back to times when I’ve volunteered in the ER through SCOPE and an on-call orthopedic surgeon would be in the hospital seeing patients but would refuse to see a patient because he’s not on call for their doctor. Maybe the problem is elsewhere, with the insurance companies who make things difficult, like the patients who come to El Camino’s ER but have to be sent over for Kaiser if they are insured by them. Wherever the problem lies, it is completely absent in the Global Healing clinic. We see patients who don’t have appointments, even adults sometimes! This willingness to help anyone and everyone, to make sure that everyone is an equal recipient of care, is an attitude I hope to carry back to the States with me.

On Sunday Melissa, Suzanne (a nurse staying upstairs with Peggy through December), Kenfor, and I hiked up to the Carambola gardens. The plants were beautiful and the view from the top was incredible. We all went to dinner together in West End and came back early to rest up for a busy week in clinic.

This week in clinic was quite busy. Each day we saw over 20 patients. A particular patient that stands out in my mind is a young boy who was admitted because of lymphadenitis, a huge swelling below his chin. He was incredibly well-spirited but had been in to the clinic 3 times and had shown little to no improvement with various antibiotic treatments. Charles was concerned that he might have a potentially fatal disease called Ludwig’s Angina. I got to see him again on Friday when Karina allowed me to come on rounds with her. Other patients in the pediatric ward include three severely uncomfortable looking abscesses (one in a patient’s armpit, another on a nipple, and a third on a girl’s arm), a possible case of TB, and a baby with high fevers and eyes that were nearly swollen shut. That same day I also went to get Galaxy Ferry tickets for a mother to take her 16 year old son on a follow-up appointment with a nephrologists on the mainland. The only problem with Karina seeing this patient and making the referral is that she had not seen any of the diagnostic workups or reports done by previous physicians and so knew very little about the boy’s medical history. Discontinuity of care seems to be a very serious issue here.

Yesterday (Saturday) we picked up Dr. Rom, a new attending, at the airport. A whole vanload of us came to greet him and he seems youthful, enthusiastic, and very comfortable practicing medicine in a third-world setting. The clinic is going to be quite busy this week with three attendings, but we’re hoping that we can see every patient who comes to the hospital this coming week, and not turn anyone away. This means I will have to get to work a bit early to triage additional patients, but I think it will be very worthwhile and rewarding to see so many patients treated each day. Additionally, Charles leaves for San Francisco for a board review conference next weekend so for the remainder of my time here we will be back to just two docs in the clinic.

As for work outside the clinic, Charles, Karina, and I finished a rough draft of his proposal to do public health talks in local churches, high schools, day cares, and over the radio. Hopefully, we can get started on developing ideas and collecting information for these talks soon. On Thursday, we plan on going to the day care in Coxen Hole to give a short lesson on sanitation and hand washing. I also hope to finish my dive certification with Suzanne this week, as we have only 2 remaining dives.

I can’t believe another week has passed here in Roatan and that only two more remain! Life here does move slowly-island pace so to speak-but the days also seem to blend into one another, so that before you know it, it’s Sunday and another busy week in clinic is on the horizon.

Molly Journal 1

It’s hard to believe that already a week has passed since I arrived in Roatan. Last Sunday, Melissa, Karina, and Miss Peggy picked me up at the airport and drove me to Miss Peggy’s house in Sandy Bay, where I will reside for the duration of my stay here. A short while later, Karina, Melissa, and I jumped in a two-person kayak and paddled over to the resort where they took dive certification classes. They wanted to go on a last dive before Melissa left. They introduced me to the instructor, Shane, and he promised to get me started on my certification next week after I’ve settled down at the clinic.

I also met Lindsey, a second year med student, who lived upstairs with Miss Peggy and left on Tuesday to go back home. We all went down to another part of Sandy Bay for a BBQ with 9 Irish dental students who volunteer with Miss Peggy in the mornings. We baked brownies to drive over, but when showed up only four of them were even at their apartment. After a few hours they cooked up some nachos to go along with our brownies. Interesting BBQ.

On Monday I began my first day in clinic, which involved waking up very early (6:30am!). This wouldn’t be so difficult if it weren’t for the fact that it takes me forever to fall asleep here. The dogs, birds, iguanas (I had no idea that they make noise), and even the crabs that scuttle across the floor create a symphony at night that is hard to ignore. Each day this week was pretty busy in clinic, but Melissa had enough time on Monday and Tuesday to show me the ropes. It appears to me that the most difficult part of working in the clinic might be trying to read Charles’ diagnoses and treatments for data entry. I hope that I can find more time to shadow the doctors, but with all of the triaging and data entry, I find that the most I can do is pop in on Karina or Charles’ last consultation of the day. Perhaps with more practice I can find the time to listen in more, as there have been many exciting cases already in clinic.

As far as life outside the clinic goes, I helped Lindsey finish her cervical cancer survey on Monday. This involved hiking up the hills of La Colonia to ask women if they had ever had a Pap smear (most had not) or if they had ever heard of cervical cancer (many had). The survey seems a little rigged—they have changed the questions a few times to try to get the responses that they “think is correct.” One issue is that most don’t know what a cervix is. We also run into the problem that we don’t want to scare them by telling them about another form of cancer that they are not being tested for. Hopefully, when Peggy’s new clinic opens she can provide this service for the women of La Colonia.

Lindsey left Tuesday but before she left we kayaked over to Anthony’s Key to see the dolphins during their “quiet time.” I also joined a gym this week, as I found that I run out of beach after about 15 minutes and running along the twisting road with speeding taxis is a dangerous proposition. The gym was a little expensive and had only one broken treadmill, but the owners are very nice and from my hometown. I’ve been every day since.

Yesterday, Melissa left, leaving me all alone in Peggy’s downstairs apartment. Fortunately, Peggy’s home is a revolving door and I have faith that new life will enter the home within days. Before she left, we went over to Karina’s apartment in West End to cook banana chocolate chip pancakes and eggs. We also got a chance to swim in the water at Half Moon Bay which was incredibly relaxing and refreshing.

This coming week I will get started on a few public health projects. The first involves a public radio station, which first will interview Peggy, Karina, and Charles and then will air intermittent public health PSAs that we design. We are hoping that this will be a means that we can reach the population of Roatan. Additionally, Charles is in the middle of writing a proposal to Global Healing to extend his work for them into the afternoons, when he will visit local day cares, high schools, and other community centers and give talks about nutrition/sanitation/prevention of disease and such. He hopes to reach out particularly to high school students, encouraging them to practice safe sex or abstinence, as many of the moms we see in the clinic are teenagers. On Saturday, Dr. Rom will arrive. He is a water-borne diseases specialist and we will have to find a way to squish a third doctor into our tiny clinic!

Melissa Journal 1

I wish I hadn’t waited so long to start writing about my days here…now I’ve lost my first impressions. But they would have been a little foggy anyway since I was in a bit of a haze the first few days here. Less than 24 hours after my last final (medical school year 1), I found myself sitting next to Ms. Peggy in her truck getting my first “tour” of Roatan, including the store that sells the best (read: cheapest) eggs and so-called Crack Alley. I think I was most impressed by the amount of construction taking place on the island. Every turn on the road from Coxen Hole to Sandy Bay there is a new compound of homes/condos being built. I’m sure it’s doing wonders for the employment rate, but it’s a bit strange to also realize you’re in one of the poorest countries in the Western hemisphere. Peggy’s house was strangely empty when we arrived – which I don’t think has been the case since! Always full of wonderful people. But it gave me a few needed minutes to settle in.

Lots of goodbyes followed over the next few days. First Deb and Anu, the two residents who were here for 3 weeks before I arrived. Then our short-lived friend Anna from Missouri. Then Jerry. I realized that Peggy’s house is quite the revolving door of people – thankfully just as many people arrive as leave so she’s always got good company! For someone who has lived within 30 miles of San Francisco almost her whole life, this is a lifestyle I could never imagine having for myself. Not sure how she manages it so well and continues to thrive. I feel so fortunate to have the opportunity to live here at Peggy’s house – it’s really the only way to get up to some kind of speed about the state of health care on the island. For interns who are only here for 5 or 6 weeks, it’s really crucial because it can be difficult to transition projects during the 1-2 day overlap. The downside is that it can become pretty overwhelming pretty quickly – there are so many projects in different stages and Peggy always needs lots of help!

So how have I been spending my time outside the clinic? So far doing lots of planning. Dr. Patrick is here for 3 months from Arizona helping Peggy to fundraise for the new hospital she is building and to develop a few grant applications for funding of special projects. We’ve created a cervical cancer screening questionnaire that we’ll be taking to the communities of La Colonia and Diamond Rock next week. We hope to survey 100 women in each community so that we can get some idea of how many women have ever had a pap smear or who might by chance even have them somewhat regularly. Karen and I are also working on a public health education project at the daycare in Coxen Hole. We’re headed over there tomorrow afternoon with Dr. Charles to teach the staff about water purification and the kids about handwashing – fun fun! We had big plans to do some dental hygiene (complete with a self-assembled coloring book of dental superheroes) but it turns out there was a traveling medical team in there a few weeks ago delivering toothbrushes etc. However, the kids aren’t using them yet because there’s no way to label them and store them at the center–Global Healing label-maker and ziploc bags to the rescue! I hope to be able to talk with Irma soon about the La Colonia community health educators to make sure that we are up-to-date with all of our data collection and two try to find two more volunteers. And Flowers Bay HTN/DM project is on hold for the moment while Dr. Amanda spends some time thinking about how she wants to utilize her newly trained volunteers. Island pace…

OK, I hit one page and Jenn tells me that’s my duty. I’m sorry I’m not one for public posting of my writing/reflections. But hopefully some of the above was interesting/instructive for old/new interns. Next installment, perhaps I can focus on some of my thoughts about the clinic at the hospital – the new attending from New York arrives on Saturday. In closing, I feel so privileged to have the opportunity to experience a bit of life on Roatan, to see health care practiced in the true definition of an underresourced setting (and I thought community health centers in San Francisco had a rough time!), and to occasionally beat Jenn and Karen at a game of Nertz while we watch the sunset.

Jerry Journal 8

Two months now, since I first arrived; one more month left. I feel now that I am two-thirds of the way through, I am beginning to close a very profound chapter in my life. I forged so many new relationships over these two months, and a part of me feels a little sad knowing that this will be the last time I’ll see them. The past week alone had been filled with goodbyes: Grace, Tucker, Stephanie and Mary, Clint and his family, Kristin, Gary, and Peggy. And even though I’ll come back someday, who knows how this island will have changed? Each day I see new developments, buildings that weren’t there before, tourists that are now aplenty. What will a year’s time hold for all of us who have been touched by the island?

And so it goes. The act of leaving and returning is as engrained in the island as is the ebb and flow of the tide. We see it everyday, in the coming and going of familiar patients, volunteers, and in the rise and fall of available medications and ample help. Life here is one giant cycle, creating the illusion that nothing has changed, although there is change in every passing minute. The point here is that in the face of adversity we can only rely on such small steps, to be patient and wait humbly for the correct timing. It is impossible to solve any significant problem in a short amount of time; healing involves a lifestyle and perspective change, to which there is no easy resolution.

Take the case of any diabetic patient. Last week a sixty-year-old Italian diabetic, chronic smoker and alcoholic, came into Peggy’s clinic with his son and daughter for a redressing. His left foot reeked of day-old eggs, a sign of a bacterial infection. There were cracks in his foot, yellow and black from lack of care, and a gaping hole through which we were able to see the aponeurosis. His right foot had gone through three surgical amputations; all that was left were his big toe, so bloated that the bone wasn’t even connected to his foot, and two other toes, scrunched together in his shoe and sock. His foot had been pressed together medially to form a permanent crease down the sole of his foot. What was most depressing was that the man didn’t seem to care much about his condition or what was going to happen to him in the future. He didn’t want to change his smoking and drinking habits (which was expected), but he refused to take his medication as well. Even worse, his children were powerless to change him; they seemed to lurk under the tyranny of their father, softly urging him to change but with him outright refusing. Finally Peggy gave him the unvarnished lowdown: he was going to die if he continued living this way. “How long do you want to live? How long do you want your legs?” she asked. Her curtness worked; he committed to the redressing of his wounds everyday after his consultation visit in San Pedro Sula.

The problem was that he had come for the first day, and the next he had not showed up until after clinic hours. I had just come back from my work at the hospital and saw him in his car, waiting, even though the clinic was clearly empty. He had just missed Peggy, and I asked him to come back tomorrow morning. His response was a grumble (he didn’t like mornings because that meant he couldn’t drink at nights). Next morning he came, throwing a fit at Dr. Raymond for making his feet turn black. I haven’t seen him since that day.

One of the most difficult aspects of medicine is that it is so easy to treat the nice ones, the compliant and obedient patients, or the quick simple fixes. But I think what separates the best doctors from the rest is that they treat the nasty patients the same way they treat the good ones. The one unifying quality about medical practice is an unnerving belief in life and the well being of patients. It is inevitably true that most will not conform to a lifestyle required to save their lives, whether it’s to quit smoking, to exercise daily, to eat a balanced meal, and will instead lazily fall into the cycle of sickness and treatment instead of prevention and cure. But when they come back with their worsened conditions, we treat them anyway, because that is the life we have chosen, and maybe, after each visit, some part of them will open up and change in the right direction.

Jessie Journal 3

It’s muggy and hot, and I am sweaty and tired. Jenn is in front of me, and we are climbing the hills of La Colonia. This shouldn’t be this hard; I consider myself in shape. It’s gotta be the heat, I tell myself; I haven’t been drinking enough water. We stop for a moment to catch our breath, although my pride hopes that it looks like we are just taking in the view. It is a beautiful view from up here. Ironically, it is possibly one of the only places in the world where the quality of your view is inversely related to how much money you have.

There is poverty in La Colonia. And, although there are exceptions, it seems to deepen the higher up the mountain we travel. At the tops of the hills, we find small houses made of mud and sticks and tarps. The women we interview tell us that they and/or their husbands have very little consistent work. They are worried about having enough money to purchase food and they often feel like they are not able to feed their children enough. Some of them tell us that they have whole days when they do not eat. Their water situation is not good: There are exposed PVC pipes that should, theoretically, deliver water to their houses. Unfortunately, the pump from the well is not great, so they only get water once every eight days. Those people that work must rely on neighbors to gather water and, once gathered, the water is stored in open containers, which is a mosquito’s paradise and, thus, malaria’s breeding ground. And several of the very high houses don’t have water pipes, so those families must carry the water up to their houses.

Sometimes I compare the poverty I witness here to the poverty I saw in Tanzania. This is sort of a strange thought process. Usually I think, well, in Tanzania most poor villages don’t even have water pipes, so La Colonia must be better off. But then I remember that many of those villages are close to natural sources of water. In addition, many rural Tanzanians grow, raise, and hunt the majority of their food. For reasons unclear to me, very few people grow vegetables in La Colonia. Chickens abound, banana trees grow, I’m sure some people hunt and fish, but overall, it seems like many people rely on the market for their food. Thus, I think, perhaps those that still have access to the means of production of food are better off. This thought process degrades into a simplistic “my country is poorer than your country” debate. The reality is that there are people in Tanzania who are impoverished and there are people in La Colonia who are impoverished. The reasons and the resources may be different, but the results are similar: malnutrition and disease.

I think I am becoming calloused, which is something I was hoping to avoid. I notice it the most when I see the reactions of tourists who are witnessing extreme poverty for the first time. Sometimes, I am not shocked by dirty wounds or lack of water. And sometimes I am not horrified by bellies swollen with malnutrition and people dying from treatable diseases. Occasionally I try and use cultural relativism to rationalize poverty: it’s a different way of life than mine, seeing bad in this way of life is assuming my way of life is better. But, no one in the world thinks that parasites and stunted growth are ways of life. There is a middle ground between complete cultural suppression and dire poverty: clean water, enough food, basic health care, and respect are probably a good start. On a side note, it seems that these positive changes are much slower to develop than the negative changes– soda and chips are incorporated into almost every La Colonia family diet, even the poorest families own a television (although some would argue with me about the evilness of t.v.), and trash is a huge problem in the village.

In the end, I hope that my calloused thoughts come and go. I think that it is important to be occasionally overwhelmed by the effects of poverty. And, similarly, I think that feeling guilty can be useful. I also think that being productive is dependent on being able to detach oneself from such thoughts.

Such heavy thoughts. I’d like to end this journal on a more positive note, but it seems that I am stuck. Let’s try this: I have loved this experience. I have met amazing people, from the island, the mainland, and the rest of the world, who are really set on improving the world around them. They have been working at it for years and they aren’t discouraged – well, sometimes they are, but they keep going. They are practical, realistic, hard-working, fun-loving, multi-dimensional people. They have innovative ideas and are willing to peck away at problems over and over again. They aren’t saints and they aren’t failures – they are just trying to do something, anything that is pushing the world in what seems to be a better direction.

And those are my thoughts for the week. Thanks for listening folks. . . it’s been a great time here.

Jerry Journal 7

When she had first arrived some five years ago, I’d like to think that she wasn’t alone. Zeus and Ana, siblings, had been her guides for those first three years. She had raised them since they were young and watched them grow larger and larger by the day, and when Ana was old enough, her slick black coat and youthful eyes attracted so many males that she ended up suffering from a venereal disease. In her third year Ana died of uterine cancer, with a tumor so large that it corroded her stomach.

The very next day Coco arrived at her doorstep, the smartest and ugliest one of them all. By then she had outgrown her clinic from her downstairs bedroom to a fully stocked four room treatment center. One day when she went to visit a neighbor at his home, she had shut the backdoor gate behind her. Zeus and Coco followed, but went around the gate towards the front entrance. As it turned out, a car had hit both of them. Zeus survived.

When I arrived on the island a little more than one and a half months ago, I met Zeus and Taber—the favorite, a year-old blond with perky ears and a comic, playful demeanor. My favorite was Taber too; he was smart enough to open the screen door at least. But over the past several weeks I grew fonder of Zeus. He was not as intelligent as Taber and not as beautiful as him either, but he was simple and loyal, bold and protective, independent and humble. He had followed me whenever I would go to clinic, and would sprawl out lazily in the inn for days. At nights we would hear him outside, never heeding the yells “shut up, Zeus!” When I would read on the porch hammock, he would come up from under me, scratching his back, waiting for me to give him some attention. Zeus and Taber would always travel together, but they were obviously very different. Taber would always come home at night, for one, and we would find Zeus wandering about at random places, at random hours. Taber loved to shower himself in the sea; Zeus never did. Taber would always respond when called and Zeus, well, he only responded to the broom. I had grown to love Zeus’s mannerisms much more; he was his own and not owned; he was a loyal friend but no servant. He had personality.

So when he was lying on the ground outside the house, motionless, eyes gaping, mouth parched, we were waiting for someone to say exactly what we were thinking. She had finally said it, his companion for five, gruesome years—“he’s dead.” But when she checked his heartbeat, he suddenly gagged, choking for the air that wasn’t coming through. And while I was sitting in the back of the truck, his body wiggling in response to every bump in the road, he looked lively to me, his movements, but his eyes were glazed over like emptiness encapsulated in marble. The doctor pronounced him dead five minutes later.

This was the first time someone even mildly close to me had died. I had seen animals die before, people die before, and dissected people even, but how was that going to prepare me for a death of a friend? I had only known him for less than two months, but as I was burying him, my hands blistering over every swing of the pickaxe, every thrust of the shovel, I wondered how she was. Zeus represented all her work here, her five long years of struggle for the people on the island, and it suit him to be buried next to the site of her new hospital, still in construction. She was burying the past. But the funny thing was, I looked at her face and my own, and our expressions were the same, an emotionless smile, a face neither solemn nor apathetic. This was her third burial; her hundredth death; her thousandth loss. How many more deaths I would see? Deaths of patients? Deaths of friends? Deaths of family?

My first real medical experience, in my opinion, so far removed from physicianship that I almost failed to count this experience as my most important and memorable medical lesson. It seemed like just another day on the island, a surreal, lethargic amble of an existence, made of daily changes so continuous that the weeks meld together into one globular whole, until we have realized our time is over and how much of an impact each moment has been.

And what exactly had I learned? I’m still unsure, but as I stared deep into the dark pools of those empty eyes, I had grown a little older, a little sadder, and much more determined.

Jerry Journal 6

Last Wednesday a group of students from a boarding school in Colorado came down to Honduras as part of a senior trip for a class on globalization and anthropology. That morning I took four of them and their teacher with me to monitor infants in the Colonias. We went to each house in Pastor Obence’s partition in Policarpo, checking each infant’s current weight against a growth chart, along with recording data on birth weight, status of vaccinations, history of diarrhea and other common childhood illnesses. Along the way, we referred several kids to Peggy’s clinic, some with asthma and severe coughs, some with scabies, and a few suffering from malnutrition. It was revitalizing to see the children’s happy faces and our own to mirror theirs, in light of a backdrop of sand-dirt beds and tin roofs. Everyone was welcoming, friendly, inviting, although I’m sure our procession of six gringos and one pastor must have been intimidating. On Thursday, the students returned to the Colonias to teach hygiene to the elementary school. They brought soap, toothbrushes, and toothpaste for each of the kids and played Simon Says and a local chicken game. It was a rewarding experience for the kids as well as the students, offering each other a taste of their respective cultures.

Since my arrival on the island, I hadn’t really noticed a big disparity in between Roatán culture and American culture. At first I thought they were fairly similar; most people on the island believe in Christianity of some sort, and there was no apparent native religion or set of unified cultural beliefs present. I’ve slowly begun to recognize the large differences in life here, differences that were so painstakingly obvious but were covered by a thin veneer of Western influence. Marriage and sexuality, for example, is very third-world. I was talking to a friend of mine the other day about this topic and he told me he lost his virginity at eight years at a fifteen year-old. “Second grade!” I exclaimed. Sexuality had been made so evident, even to the prepubescent. He was telling me that it was extremely rare for a man to abstain or have few sexual encounters (his brother being one, and ridiculed often because of it), as the opportunities were endless—older women, younger girls, married women, gringos, even (the other night he had an encounter with a married thirty-one year-old gringo; he is only seventeen). He said that he practiced safe sex as much as he could, but mostly when it was visual—when he could see the pubic lice. Often he wouldn’t have access to condoms, and who knows how prevalent STDs are on the island. Most peculiarly, when I asked him about his religious beliefs, he said that he was Christian, like most islanders, and he did believe that premarital sex was a sin. However, he explained, he would be forgiven no matter how many times he committed the sin, so it was fine for him to keep on doing what he was doing.

I blame American media. I hadn’t know how much of an influence it was until coming here; our movies, our TV shows, our music videos are broadcasted all over the world, and what they see is what they think is standard American practice. They see the clearly-explicit sexual innuendos of our media and obey it. I was talking to a Russian friend earlier this morning and he said that the Russians think that all Americans are fat because of McDonalds advertising. Kenfor, who is only nine and is one of the kindest kids of his age that I’ve ever met, wishes to be a professional fighter (he loves WWE). My aforementioned friend says that he plans on getting a 6mm gun, and although he says that he doesn’t want to kill people, he has no qualms about doing it. After all, our violence-filled media substantiates gun possession as an essential tool, does it not?

On a mild tangent, I believe that third-world medical practice is different from American medicine. In America, doctors have a disincentive to treat due to the threat malpractice suits. Here, the islanders are grateful for whatever treatment we can give, whatever advice we have, and even in instances of death the family members are thankful for our service. Going from house to house, monitoring blood pressure and sugar, I realize that we are not treating Americans; we are treating the third-world, people who are in great need and always thirsty for guidance, for assistance in what little ways we can give. I don’t think we should deny them of that even in our incomplete medical knowledge. It is true that I am not a doctor, but neither was Peggy when she first treated her patients, nor everyone’s favorite doctor, Paul Farmer, when he treated the Haitians. I’m not saying we should go around treating people without the experience or chancing the communication of fallible information, but I don’t think our student status should stop us from taking an active interest in each community member’s lives, in doing more than our job description requires, and in taking calculated risks for the betterment of the people here. It is not only required of us as future doctors, but as future leaders as well. We are here for the patients, most importantly, and not to impress heads of state or influential people. I think this is an important reminder, especially in a place where it is easy to forget the baseness of the human condition and fall into the magnanimity of failures which cloud creativity for possible solutions.

Jessie Journal 2

Children are great. I mean, most people love children and those that don’t still enjoy them from a distance. And for the most part, children all over the world* run on the same principles: they smile at you if you smile at them, unless they are 18 months old, in which case, they cry; they find repetition hilariously exciting, and they think that stickers are just about the coolest things on the face of this planet. But sometimes you meet a child that just strikes you – a little boy whose frightened, huge eyes haunt you or a little girl who is just glowing with happiness, like the one I met a few days ago. She had a round face and a round belly and her hair was pulled into two little round puff balls on the top of her head. She was missing about four of her upper teeth, all from the right side and she had a make-you-feel-warm-and-fuzzy-inside smile. Plus just about the cutest high pitched giggle. And she was a spinner – I mean that figuratively and literally. She was spinning with energy and she was expressing that energy by spinning. She kept running over and giving me a huge hug, and then speaking very earnestly in her very own language. I was completely taken with her.

This story is going somewhere. See, after I triaged her, the mother requested to see Dr. Charles specifically. When he brought her in, she said, “I know you.” He looked perplexed because he did not recognize her. “I know you,” she said. “Were you working in the hospital in San Pedro Sula three years ago?” Dr. Charles nodded, “I was working as an intern there.” She proceeded to tell him that three years ago he delivered her baby (who grew up into the ridiculously happy girl I described above). Dr. Charles remembered her – it was a complicated birth (placenta previa), there was no surgeon available to operate, and no one was stepping in to help the mother who was hemorrhaging. Dr. Charles stepped in to save the day and three years later he was lucky enough to witness the difference he had made in someone’s life. Ahh. . .I just can’t wait to be a doctor.

Moving on, this has been an interesting week filled with lots of discussions and events that make me wonder what should be the role of foreign assistance from the first world (alien assistance, if you will). There are so many people who have a strong passion to help others. It’s usually stated as a desire to “help those less fortunate” or “serve the underserved (or underprivileged, or disadvantaged. . really, take your pick). But this altruistic drive seems to come from a place of arrogance. Actually, I think there is no seems about it - it does come from a place of arrogance – perhaps not intentional or malicious arrogance, but implicit in the concept of help is the belief that you know something that others don’t, and that something is superior, and I would define that as arrogant. Thus, there is a certain paradox in this world of aid: Most people wanting to help others are not arrogant, but the act of helping is arrogant.

So what then? Why am I down here? Why do I want to dedicate my life to working with underserved populations? How does my belief (or at least my desire to believe) that no one person or culture is superior to another reconcile with my interest in helping others. Usually I can gloss things over and push through them, telling myself that I am different because I want to work with underserved populations, not help; I tell myself that I am different because I recognize this inherent arrogance. But really I am just playing word games. Perhaps the answers lie in the reality that the world is shrinking (trite, I know) and first world countries need to learn from other cultures some of the more intangible things that we don’t do very well (like raising children, eating better, caring for the elderly). We also need to teach those usually more tangible things we do well (like clean water, gender equality, and, my favorite, health). A genuine give and take. And perhaps the truth is for all of us working in seemingly altruistic fields to cast off our cloaks of martyrdom and admit that we do what we do for selfish reasons: to learn and grow, to feel good about what we do, because we enjoy learning about other cultures, because we like feeling superior – whatever the reason is. After all, biology teaches us that there is no such thing as true altruism. It’s all for the betterment of the genes.

Speaking of genes, although I miss my jeans, I highly recommend not bringing any jeans down here. It’s hotter than hot. I wake up wishing that clothes were never invented (and really, it is ridiculous that we wear clothes down here). And I brought all of the wrong clothes. If you are reading this and planning to come down here, just know that whatever you are thinking of bringing you should put it aside and bring something cooler.

Well, it’s about 7:00 and the sun has just set: the sky is a warm grey with a streak of pink running through it (nature does the best color coordinating), Ray Charles is singing Georgia, and Jenn and I are going to head over to the West End for a late dinner. So, no more silly liberal school educated thoughts for me – I’m signing off. G’night, Sianora, Ciao, Buenas noches.

*my version of all over the world being the few countries, including my own, that I have spent some time in.

Jerry Journal 5

A little bit about what’s been going on in Roatán, and what I’ve been up to.

There are currently two projects with the community of Las Colonias, made up of Policarpo and Balfate. These residents are mainly Spanish-speaking Latinos from the mainland that immigrated to Roatán not too long ago after the hurricanes. They live in shacks, in mud/wood houses, and have running water only for two hours every ten days. The housekeeper for Peggy, Earma, lives there and is also one of the 8 community volunteers that we train to monitor high risk infants. We check for diarrhea, respiratory illnesses, and malnutrition, among other things. My goal is to see that they monitor the infants correctly by going with them for the first couple of times and to make sure that they go every month. The project also gathers data on these infants to use as grant material and research data. These are collected monthly and input in a database. We’ve already had two meetings, and I’m planning on going with a volunteer this Wednesday on his rounds.

The other project in Las Colonias is establishing a waste disposal system. The area does not have trash cans, so it is littered with garbage that the garbage men don't want to pick up. Our goal is to make dumpsters out of barrels with holes in them (so the residents won't use them for water storage) and situate them around a wooden fence so the dogs can't get in. We have already located about 15 spots where we need to put these 78 barrels. Our current objective is to get the materials ready by next week; a group of thirteen students from a private boarding school in Colorado is coming down, and I'm thinking of putting them to work on this project. We can use the free labor, but first we need the wood so that it can dry by the time they arrive.

Another project is one regarding hypertension and diabetes in Flowers Bay. The community volunteers there are already trained also; we just need to start monitoring. We had our last meeting yesterday about how to take blood pressure, and today we accompanied one volunteer on her rounds. The objective is to raise awareness in the area and to successfully identify and treat high-risk diabetic and hypertensive individuals.

Our newsletter was written and finished yesterday, with five articles on Global Healing activities. Also, the Global Healing president will be coming down to Roatán next week to assess healthcare needs and resource distribution.

As a pharmacist in Peggy’s clinic, I have learned all about medications and treatment. Sorting her donations, organizing her pharmacy, and working in the morning have made the highly eclectic medical vernacular much more accessible. Last week we went over all her medications and threw out/burned the expired ones. The Ministry of Health came by last Friday and closed down another pharmacy due to expired medications (as well as fining $2000). We decided not to risk holding on to expired medications. But I’m not sure what the Ministry of Health did is noble; after all, expired medications, with a possible decrease in efficacy, are better than no medication at all, right?

I'm also planning a categorizing system for triaging in her clinic. I’ve made a spreadsheet so that it will be easier for the nurses to locate the names/numbers of patients. There has been a large problem organizing the card system that we have now since some of the nurses don’t know the alphabet. Plus, this way, finding names and entering them will be much easier. I need go through over a thousand cards and teach the nurses how to use the database by Monday.

Lastly, Peggy's new hospital needs to be built. Her current clinic is only four rooms borrowed from SonRise Missionary Inn. I'm working on writing grant proposals to the Gates Foundation to get funding for the completion of the project and, hopefully, its sustainability as well. Peggy introduced me to a couple of contacts that are already working on the project; hopefully I can help them do the research they need (as they are currently living in the US) and write the proposal.

Jaime left today. We went ziplining in West Bay to see her off.

Jessie Journal 1

My first week at the clinic went surprisingly smoothly, given the regression of my communication skills to about age two. My Spanish is slowly returning – forgotten words pop up at random times and, if I am lucky, I am able to correctly match a pronoun and tense with the proper verb conjugation. I’ve discovered that the secret is to simultaneously focus and relax and to remember by not trying to remember. That and if I speak slowly, other people respond more slowly – I always think that by speaking fast, I will convince people that I am fluent in Spanish. Of course, I end up being in trouble if I actually succeed in that, because then people speak to me as if I am fluent in Spanish, which I’m not. Thus, I often end up nodding my head and smiling, and occasionally laughing for good measure without understanding a word that I heard.

The clinic is great – witnessing what public health care is like in Honduras, interacting with patients, learning about what the most common ailments are on Roatan, and having 4 enthusiastic teachers eager to share their knowledge (Dr. Charles, Dr. Jamie, Dr. Gross, and Dr. Kristen). A month is a very short time in the world of public health, so it is nice to have some projects to plug in to: tomorrow and Saturday I am helping with the Flowers Bay Health Volunteer Diabetes project. Next week, I am helping the midwife, Bernadette, with a family planning/birth control activity. In addition, I hope to help Jenn in La Colonia with some of her research – I look forward to seeing that area and meeting some if its residents. Peggy Stranges, a nurse from Ohio who has incredible energy, vision, and follow-through, continues to provide me with a wonderful education about the difficulties facing island health care and the politics that, unfortunately, permeate it.

I decided to participate in this internship primarily because I wanted to experience working/volunteering in another country (specifically in a developing nation). I have spent time in other developing countries as a student and as one of those gringos toting around a huge backpack, and I have always said (somewhat naively) that, as a doctor, I hope to work in international health. This internship gives me a chance to shed a bit of that naiveté and test such a theory out. And. . .so far so good! Becoming involved in something beyond the tourist’s eye has, already proven worlds more rewarding than studying or traveling. More than that, I have greater confidence when talking to locals and I feel more established in the community (and how quickly that happened – in less than two days the local baleada seller knew me by name and a few days after that, her daughter had me in the kitchen learning how to make baleadas). I love not living on the tourists’ path - I spend the beginning and end of my day saying good morning and good night to the same people. Rather than always feeling like an outsider observing others, my daily life occurs in conjunction with the daily lives of my neighbors, taxi drivers, patients, and store venders. So this is a good way to be in another country – I think it will be difficult to ever travel another way.

Today is Thursday May 4th, which means that I have been in Roatan for thirteen days. It’s hard to believe that I’ve been here that long and it’s hard to believe that I’ve only been here for thirteen days. Time seems to absorb itself down here. The sun rises at the same time every morning, the wind blows in the same direction every afternoon, and the dogs bark at the same things every night. Things you can count on down here: there are always people awake later than you and up earlier than you; nothing happens when you think it is going to happen; if you say hello to someone on the street, they will say hello back to you; if you are a woman, the second question your taxi driver will ask is “Are you married?”; the internet will be down at least once during the day; freshly-made tortillas taste absolutely amazing. Life on this island is great.

Jerry Journal 4

On Wednesday, I went out to the mayor’s office to discuss public health matters on the island with Nora and Miss Peggy. As a politician, he was flawless. We got very little accomplished; throughout the meeting, I was squirming in the leather-bound sofa hoping that someone would get to the point. Politics is a terrible game to play for those who are dissatisfied with the status quo. I had passed out in boredom somewhere in the middle of the meeting, as I had realized the futility of discussing the importance of well-managed health care to a businessman, but as we exited the municipal building, I begun to think of this experience not as a failure, but as a lesson in perseverance and preparation.

Of course, there’s always the problem of whether or not we should go to the government for help. Being a gringo, I have no idea what the system is like down here, but a native doctor, who had worked for the municipality during his social service years, said that going to the government means that we would be government-owned, that they would have full control on our (the people’s) operations and management of the health care system. I heard that several months ago the mayor had cut the already-dwindling hospital budget in half, to a mere $500 a month (we don’t even have a defibrillator on the island!), while the police gets $1800 monthly for food only.

When we were done with meeting the mayor, Peggy seemed disgusted over his remark of her alleged partisanship. The previous mayor had provided Peggy with funding for Dr. Raymond’s salary. How temporal and situational political deals are, I thought. Now that the Liberals are out of power, donations alone pay for Raymond’s salary—and Peggy still owes him.

There is no other limiting factor to the establishment of the Peggy’s new clinic, complete with a birthing center, lab equipment, a community meeting room, a kitchen, an office for Raymond, and several treatment rooms, than that of money. I had decided to help Peggy with getting that so her clinic can be built. We have all the logistics ready—the floor plans for the clinic are complete, the construction workers are hired, the materials are waiting to be shipped. In addition to working on the waste disposal and infant monitoring project in Las Colonias, the diabetic and hypertensive education project in Flowers Bay, in working on RCPHI’s sustainability and communicability, in Peggy’s clinic as a pharmacy technician/janitor, as a personal secretary, day planner, and computer technician for Peggy’s life, I have started to write grant proposals and marketing/advertising schemes to help with the filling the $55,000 hole we need to insure adequate health provision on Roatan.

Jerry Journal 3

On Monday, I started work in clinic after the weeklong holiday. I feel now that I have familiarized myself enough with island to have more time to enjoy and observe the finer aspects of life here. In clinic this week, there were a variety of new diseases that I hadn’t yet encountered. There were two cases of falciparum malaria, and, although we see malaria all the time in the clinic, it is usually vivax malaria. We also saw a patient with a bot fly in his head. The parasite bore a hole into the child’s head, and was lodged in his head. We couldn’t take it out by pulling it out, since part of the fly would still be left in, so we used Vaseline to try to suffocate it, hoping it would crawl out on its own. After waiting for about an hour (while seeing other patients), the fly hadn’t come out yet, so we sent him home for his parents to tend.

Last Saturday, our new Global Healing intern, Jessie Duvall, came in. There was some miscommunication as to when her flight was, but we got it all sorted out since our contact at the airport, Banjo, called us when she arrived. Jessie is in between her undergraduate education at Wesleyan and medical school at either the University of Washington or Boston College. She is a pleasure to have, especially since her always cheerful demeanor puts a smile on everyone’s face whenever she’s around.

Coming back from the long holiday, there was a lot of clinic work to be done. This week was spent organizing Peggy’s clinic, and also making an inventory of the RVPC to garner what medications, equipment, and other miscellaneous items we need. However, we had a bunch of donations throughout the week; Jamie (our resident) brought her suitcase of medications for clinic use. I took inventory of the clinic and gathered some of the other needed items from Peggy. Peggy has been getting boxes and boxes of donations (that I sort), so she was more than happy to give some much-needed meds and supplies (ie multivitamins, ibuprofen, and Keflex) to the RVPC. Jessie also brought her bag of donations today, which I updated on the inventory list. Hopefully, the inventory list will be helpful in keeping track of what books and equipment we have so that nothing gets stolen in the future, and will allow future residents and attendings to gauge what medications are most needed by the clinic.

I had my first real taste of island food today—iguana. Dr. Charles, Jessie, and I went to lunch at Las Rocas in Coxen Hole after work. I wanted to try some of the island delicacy, and Dr. Charles was more than eager to let me. After he made some remarks about iguana fetuses while I was eating iguana eggs, I discovered that iguana tastes exactly like chicken, but contains a lot more bones. Anyway, my introduction into Honduran culture was a mildly tasty one. What makes anthropology interesting is that people can be so vastly different in what they value but at the same time agree on fundamental similarities. And even something as basic as food preference makes such a big difference in not only understanding a culture, but in appreciating it.

There is a tremendous collective effort on behalf of multiple people from a variety of disciplines to help with the socioeconomic situation on the island. From the medical workers, like Peggy and Dr. Charles, to members of other industries, such as engineers, construction workers, and businessmen, to blue-collar workers at the airports, gas stations, and in taxis, all these men and women are deeply interconnected to help the island grow medically.

Jerry Journal 2

This past week was Semana Santa, a Latin American holiday more widely celebrated than Christmas that honors the week of Good Friday and Easter. Consequently, Dr. Charles informed me that the clinic would be closed this week. However, on Monday Dr. Charles received a message from the hospital that the clinic would be open Tuesday, and immediately informed me and the new resident, Jamie, of the situation. But, all in all, this week has been relatively relaxing, especially with Wednesday, Thursday, and Friday off in addition to the weekend.

On Sunday I met Peggy Stranges, the public health guru of the island and landlord of the house I’m staying at. What surprised me most about being in her company was the number of people she is connected with. Whenever she drives down West End, Sandy Bay, West Bay, Flowers Bay, etc., people always stop to greet her. What also surprised me about Peggy was the level of Spanish she knew—she told me that even with working on the island for five years, her Spanish had not improved all that much. This actually gave me tremendous hope for myself, as I had previously thought that language would be my greatest barrier, but I realized language competence is not as important if people know you really care about them. That is Peggy’s drive, exhibited ever so subtly and grounded by her incredible sense of humanity, giving her so much strength in her work. It seems that because people see her deep desire to care for others, miracles happen—funding appears at the most crucial moment, donations flood in out of nowhere, help comes unexpectedly. Peggy is more concerned with how she can help people at the moment, seemingly disregarding logistics at first, a characteristic that I admire.

These past few days I have been getting to know Peggy and Kenfor and enjoying the vacation I have by reading and writing. Peggy recommended a book to me, Mountains Beyond Mountains by Tracy Kidder, a story of Dr. Paul Farmer and his work in Haiti. In the novel, Farmer exhibits the same sort of passion that Peggy does, more or less, in his struggle to equalize the world. Peggy said the book changed her life, and little by little I am also beginning to realize the urgency of my life, that each day I am idle in action the poor are getting poorer and the sick sicker. Sometimes I feel helpless in the general hopelessness of the situation, but both Peggy’s and Farmer’s work has given me much inspiration in becoming more proactive with the opportunities I’ve been given. After all, I am lucky enough to have been born in a caring environment, and the least I can do is to give back to the world and try to normalize the grace that has been bestowed on me.

My family has never been wealthy, so I once held the notion that we were a part of the poor, that the rich were exhibiting their evils upon us. But how humbling it is to live here! I am ashamed to miss the comforts of home, that when I turn on the lights in the evening a flock of winged ants would not hover over me, that I would not wake up each morning to the ululation of rooster croons and dog barks, that I have a dryer to dry my clothes!

Each day I meander on the island my heart goes out to the community, in realizing the complexity of medicine. Medicine is not simply the mere science of physiological regeneration; medicine is everything, from the sciences to the social sciences to the humanities—all disciplines are ultimately concerned with healing the world, reconstructing a Utopia on earth. The interdisciplinary science of medicine is what makes medicine so exciting and difficult at the same time. Here, corrupt politicians stifle the economy and effective health care, discouraging entrepreneurial startups to compete with the wealthy and eliminating a cost-effective means to transport medications to health care providers, which results in a vicious cycle of impoverishment and debilitation for the islanders. The educational system provides only a sixth grade education to most of the locals, and English, the language essential for higher educational pursuits, is not taught in the schools even though a third of the population speaks it. Combine low-quality education with cultural differences among the black slave descents and the Hispanic immigrants—we have a difficult means for providing health care appropriate to the Hondurans, as we are lacking in trained professionals that are familiar with the sociology of the island. There is a great need for public health specialists to continue to work in this place. And I, for one, know already that being here will forever change my perspective on medicine, on public health, on humanity.

Jerry Journal 1

I arrived in Roatán this past Saturday and took a taxi to my apartment in West End. My room charged me an expensive $25/night, and was much too big for me, as there was a kitchen, a bathroom and two bedrooms (three beds for only myself). After living there for five days, I moved to a house owned by Peggy Stranges in Sandy Bay, where the area is not as filled with tourists and I can have more of an interaction with the community. Peggy Stranges is an Ohioan who has lived and worked here for the past five years, opening her own clinic in the area and serving the community through various other public health projects. She’s currently visiting family back in the States, and will be returning tomorrow. I look forward to meeting her, as I have heard very good things about her.

I met and worked with Dr. Charles (my supervisor and one of the doctors for the Roatan Hospital Pediatric Clinic) on Monday. He is a pleasant fellow, very easy to talk to and amiable. I have enjoyed the daily Spanish lessons I get from working with the patients here, and I'm sure Dr. Charles gets a good laugh at my attempts to communicate. From the past week I've seen my fair share of the sniffles, scabies, and all sorts of colds, coughs, and fevers. However, seeing those patients get better is the best part of my day, so it's easy to fight off the heat and mosquitoes in order to see that I'm making a difference in someone's life each day I wake up.

Each day I wake up at around 7, spending a couple minutes in the morning conversing with the locals. My Spanish is at best rudimentary (yay AP Spanish!), but hopefully the next few weeks will be better as I am learning more and more everyday. What surprised me most was how accommodating the Hondurans are, and even though my Spanish is poor they still smile and patiently work through my fragmented sentences. I also enjoy talking to the cab drivers that take me to work every morning and to the local restaurant workers that feed me whenever I don't feel like cooking. Anyway, I arrive at Coxen Hole at around 8, and for about the next four hours I triage patients, do inventories, give medicines, fill out paperwork, watch Dr. Charles in action. In the afternoons I plan to teach community volunteers on how to treat infant diarrhea and prevent diabetes, but I haven’t begun that work yet. Hopefully when Peggy arrives we can spend more time talking about the goals for these public help projects.

The other day I spent some time in the afternoon helping to carry logs to Peggy’s housekeeper’s home. The houses here are very substandard, built with wood from the local forests on dirt floors. It's sad to see the environmental damage done and their poor living conditions, but I know it takes more than one person to transform their way of life. Even so, I believe what I'm doing there is worthwhile, however futile it may seem.

However, I feel as though that paternalistic view is misleading; there are plenty of qualities about this island that I admire. Thursday I met a local boy named Kenfor, who visits Peggy’s house consistently. He is very much like an islander, communal and free-spirited, qualities that I feel are difficult to find back at home. I almost envy his life here, where there is little social or academic pressure, where days seem slow and life feels alive, and there are hardly the worries unique to the caffeine-addicted US. Even in such poverty Kenfor is just as happy (if not more) than the children back home.

One person that I especially appreciate is Jenn, keeping me company while I’m here. Unbeknowst to her, I am truly thankful for all that she’s done—assimilating to island culture would not have been as easy, and with my embryonic Spanish and sense of direction I most certainly would have been lost. She updates me on everything from clinic history to good restaurants to go to. I feel that she has been instrumental in keeping the program on track and also in making my stay here more enjoyable.

In the future I hope that I will be able to learn more about the culture here and talk to the locals more regularly. I feel that there is definitely a language barrier between me and patients, as although I can understand most of the information needed for triage, I have trouble understanding anything outside of medical terminology. I feel that there is also a phenotypic barrier; I look too much like a tourist (I doubt there are very many Chinese living in Roatan), so this contributes to the locals marking me as a foreigner. These will be difficult obstacles to overcome, but I am confident that in the next three months I will be able to learn how to interact with the Hondurans normally.

Natalie Chavez Journal 2

On Thursday morning I had my nutritional class for moms and kids in El Swampo. Both Lynn (Valerie’s intern) and I thought it would be great if we could outreach to their community in a more effective way if we have it in their community instead of making them meet us in a different location. The community’s response to my workshop was great! A total of 25 moms and kids signed in for the workshop, but we had many spectators along the sides of the concrete that were curious at what I exactly I was presenting. I had more fun with this the second time around. I though nutrition was very important, specifically to those infected with HIV/AIDS, because they must have strong bodies in order to more effectively combat illnesses, since HIV/AIDS weakens their immune system making them more susceptible to diseases and more likely to be sick longer than someone not infected with HIV/AIDS. Everyone enjoyed the workshop, asked questions, shared descriptions of their typical daily meals, and afterwards enjoyed some “Christmas” I made for them. “Christmas” was a type of desert the islanders ate that consisted of mixed fruit with condensed milk drizzled over it. It was delicious.
I had just found out an hour before my workshop that today a mom died of AIDS in the public hospital. I had met the mother’s children at Valerie’s clinic earlier that week because they liked to come over and play and learn how to write with Lynn. It got really personal when no one knew what would happen to these children because their other family members refused to take them in. One aunt even told the mother while she was in the hospital that she would take responsibility for her kids after she died. I am unsure if it was a decision strictly out of lack of resources or space. I couldn’t believe that these kids were going to be abandoned and forgotten because of an unfortunate tragedy. I became more aware of the lack of supporting husbands. Not only in this situation, but I have come across many others. Valerie, Lynn, and Kimbal discussed possible solutions in their office because these kids were very special to Valerie. I am not sure what the outcome will be, but I hope these kids are well taken care of.
I took the opportunity to travel to Ceiba with Lynn, Kimbal and a Canadian friend named Julio on my very last weekend here on the island. It seemed more like an industrialized city with malls, outdoor markets, and larger communities. It was much different than Roatan, but I think it was just as beautiful. I felt safe there during the nighttime in certain areas, but that is the same for many other places. We went to the Garifuna festival in Carozel. During the day we received a lot of curious faces because we definitely stood out amongst many darker skinned Garifuna. I had never been in a situation like that before because in California the population is so densely diverse that I fit into the blend of colors, unless my fashion is extremely outrageous. The Garifuna style and culture is so vibrant and lively. They had music playing through large oversized speakers filling up the streets with ranchera, hip hop, reggeton, cumbias, and many other kinds of music. There was a huge soccer match going on in their community soccer field and was packed with families watching. It was a cool new experience.
I have had so many community members, doctors, and other volunteers ask me if this was going to be my last time in Roatan. I think this will be my last time here for the time being since I would like to explore other parts of Central America and other Latin countries. I enjoyed and learned so much from my experiences here.

Natalie Chavez Journal 1

It feels great to be back! It was refreshing to see familiar faces once again and sparking conversations with Charles, Jeff, Ms. Lily, taxi cab drivers, patient’s mothers, and other islanders that remembered me from spring of last year. When I first saw Charles he said, “Weren’t you the intern who was here during my interview?”. He is now the new GH native doctor in the pediatrics clinic and a wonderful doctor. He has a different approach and style towards medicine and the children from Dr. Raymond, but he seems to really enjoy his profession. I met the new GH doctors from the U.S. as well. Both Dr. Ellen and Dr. Cynthia are from Pittsburg Medical School and have been nice company. I also met Nurse Audra later on during the week when she showed up to our clinic and she’s been pretty busy teaching classes on a variety of different topics all over the island. I thought it was awesome! I noticed a lot of change since the last time I was here in Roatan. The temperature was drastically different in that it was much cooler in comparison to the scorching 90 degree weather from the spring, there was an increase in hotel construction, a new clinic in Diamond Stone created by nurses Kellie and Carlie who were here last spring, and my old friends were no longer working in the Roatan Hospital in Coxen Hole. Now there was minimal chat with the lady working in the cafeteria because she isn’t Margarita. One great change was the organization I saw in the pediatrics clinic. We had designated areas where medical charts were to be kept depending on their current status (waiting to be screened, waiting to be seen, finished), the desk area was all cleared up, the A/C in the clinic was finally working (THANK GOD!!!!), and the medications/supplies were neatly organized. This, as well as now having 3 doctors on board, made the days in clinic go by much faster (at first). As the week rolled along I enjoyed speaking to the mothers as I tried to figure out what was wrong with their children, weighing the children, taking their temperature, measuring their height, and plotting their information on the growth charts I brought to see if they were growing normally. I loved and missed this sort of direct interaction. The mothers were always very appreciative, as well as most of the children, although this time I learned how to handle really nervous, scared, and angry children that did not want to get their measurements taken. Lots of new experiences. At first the days went by really quickly, sometimes we would be finished by 10:30am, but by the end of last week I had taken up a new role: Spanish interpreter. I had done some interpreting before in the spring, but the doctors had always known enough Spanish to get them by, occasionally asking me what a couple words meant or explaining the use of medications to parents. This time though it seemed as if I was running in full speed, trying to get all of the kids screened, since no child was to be seen without getting screened, trying to administer a couple surveys, interpreting for Dr. Ellen and Dr. Cynthia for most of their patients from start to finish (except during examination), and later having to enter in all of the patient data of the day. I had never experienced so much responsibilities in a short matter of time, but I have always known myself to be at my best when I am under pressure, so I felt that I had to be creative in my technique so as to not stay a whole lot longer after we were done. Although I get super busy in clinic, this is the first time I had ever felt so needed, so indispensable. It’s a great feeling of purpose. In the U.S. the question always lingers in my mind, “How can I make myself a better candidate for medical school, how can I make myself indispensable/one-of-a-kind?”, and now I feel as if I have come real close to that answer. What I love about this island is that it has the balance of beauty, poverty, and isolation to force me to take a different perspective on life. It forces me to think about the lives of the underserved and think up new ways to help, instead of easily dismissing the homeless in the U.S. by assuming he can easily find and obtain the necessary resources. I feel that the island will have a wonderful affect on me on helping me critically think about my choice in career, my life, and my values. I hope that my services and humanity will have a positive affect on the island in return.