Wednesday, April 26, 2006

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.

Monday, April 17, 2006

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.

Thursday, April 13, 2006

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.