Monday, June 25, 2007

Natasha Journal 4

As I write this, I realize that this is my last weekend on the island – my final picture-perfect weekend in one of the most beautiful places in the world. It seems as though I just got here, yet in a week's time, my internship will come to a close. But a week is still plenty of time to learn and explore – and that is exactly what I intend to do.

Clinic was an enriching experience this week – in addition to my morning triage and screening duties, I was able to spend more time with the physicians as they rotated through the pediatric wards in the afternoons. Simply walking through the wards and seeing familiar faces – some that we had in fact referred here from our own outpatient clinic – provided me some sense of comfort, as though the children were now safe and would be constantly cared for until their departure from the hospital. Of course, it was even more rewarding when we saw a child's health improving dramatically over the course of just three days – and an empty bed the day after. Stories of success make the challenges of medicine worthwhile, I believe; without the challenges, there would be no rewarding recoveries. I also believe that it is this hope that makes the losses – like the tragic death of a convulsive febrile baby last week – just a little bit easier to bear. Medicine is not, after all, a field of magic or perfect certainties. It is, however, a reminder of the power of people helping people, and that is exactly where I want to be.

One simple but powerful observation I made this week was the effectiveness of positive reinforcement in the medical setting. I noticed that, when doctors praised mothers for their vigilance and determination in caring for their children, the same mothers were more likely to bring in lab tests the next day and obtain all necessary prescriptions from the pharmacy. When mothers were looked in the eye and thanked for their tireless efforts – waiting in long lines, taking time off from work or other pursuits, paying for medications despite an already tight budget – they would feel genuinely appreciated. The appreciation manifested itself through sincere attentiveness when our physician explained the causes and treatments for asthma. It manifested itself as a mother passing on her new knowledge to her sister and her niece, encouraging them both to come to our clinic the next day. And I find that absolutely incredible. It is about time that we appreciated the patient; because as difficult as a physician's job is, it is ultimately the patient who must be willing to take necessary steps to ensure success. If one simple “thank you” can convince a mother to provide her children a healthier home, then we have succeeded in our mission of providing sustainable patient care.

Outside of clinic, I have busy with my other pursuits – tutoring at the bilingual school, teaching English to Moises, and spending quality time with the other volunteers I've met here, especially those here in Sandy Bay. This weekend I was initially a bit disheartened when the last of the original friends I had made here left for the states – I felt very alone, all of a sudden; it struck me how easy it was to make friends here, but how difficult it was to let go of them. On the bright side, I met a whole new set of incoming medical students volunteering here in the community – thirteen of them! Indeed, the volunteer efforts on this island are best characterized by a state of constant flux, with people coming in and out as their schedule permits, but with the guarantee of finding incredible and diverse friends regardless of when one decides to come down. I hope I can keep in touch with those who have already left, as well as with those who are just arriving – a forum to reflect upon our experiences here and perhaps shape future journeys.

This next week will be my last on the island, but it is a crucial week nonetheless; the Grubers will be coming down, as well as Sarah (my replacement for the month of July), and lab technicians from the Bay Area. Hopefully with all of their help the clinic will see a host of improvements and efficiency in the coming days and months. As for me, I am simply ready to relish my final days here and do my best to pass on what I have learned to Sarah. I know that while the 'end' may be near for my internship, it is yet the beginning of better days to come.

Tuesday, June 19, 2007

Natasha Journal 3

The past week at the Global Healing clinic has finally taken on a semblance of routine, and of continuity – for these next couple of weeks, anyways. Dr. Lea Cunningham left the clinic the previous weekend and moved to West Bay, where she plans to relax and enjoy a short vacation before returning to the states. Meanwhile, Dr. Anne Tran, Dr. Leonel Toledo, Dr. Charles and I are to be a team until the end of June. This past week gave us a taste of the teamwork dynamic, and I must say, we all get along wonderfully. Both of the American doctors are highly trained yet approachable, often taking the time to explain, clarify, and illustrate to me some of the medical information behind their diagnoses and treatments of their patients. While administrative work and triage have inherent value for an intern like me, it really is the one-on-one time I get to spend with the doctors that has made all the difference. The learning experience is incredible. These doctors provide an amazing wealth of knowledge, and it is my privilege to be working so closely with them on a day-to-day basis.

I have pretty thoroughly settled into my duties as clinic intern by now, and as such, I am able to finish my tasks more quickly and effectively, leaving me more time to observe and shadow the physicians as they work. I also had the opportunity to accompany them at the weekly Wednesday-afternoon medical talk held in the upstairs room – Dr. Toledo gave an interesting presentation (in Spanish) on the causes, symptoms, and treatment options for common childhood disabilities on this island, complete with pictures and a PowerPoint presentation, and free Bojangles for all doctors attending (which was another important lesson for me: provide free food, and the audience will come!). I think this is an excellent way for all the doctors at the hospital – American, Cuban, and Honduran alike – to better collaborate, share their experiences and expertise, and thus optimize the quality of care they provide their patients. Plus, it's a great way for them to get to know one another and build a sense of community within the hospital – something I feel would greatly benefit all involved.

My past week has marked another important milestone of my trip – I have officially crossed the halfway point of my internship and am now heading into the final two weeks of this adventure. I know that I still have much to do and see and learn, but I cannot deny just how pleased and proud I am to have at least gotten this far, learned this much, and enjoyed myself during the three weeks I have been here. For me this trip has been different from anything I had ever experienced before, my first solo journey to a new country. It has already done wonders on my Spanish, and I look forward to whatever the final two weeks will bring. Now that Peggy and several of her volunteers have left for the States, it just serves to add more to that “solo adventurer” feeling. (Although new volunteers have also been coming in regularly; I just haven't gotten to know them very well yet). My optimism might also have to do with the fact that I have almost fully recovered from my viral illness that made last weekend miserable. The plan is to stay happy, healthy, and strong for two more weeks.

Three weeks into my internship here, I feel as though I am on the threshold between two distinct states of mind – in a transitional state somewhere between an islander and an American. Three weeks is not an incredibly long amount of time; in fact, it is hardly much time at all. But be as that may, three weeks is plenty to gain an appreciation for the way of life here– the people, their culture, their needs, and their interactions with the world beyond these waters. I feel somewhat more immersed in this culture, but the ties to home are still strong. I now feel equipped to deal with perpetual power failures, sand crabs infesting by bathroom sink, and dog urine stinking up my front porch...take it in stride, I say. During a beautiful afternoon on Anthony's Key yesterday, I discovered that, maybe if I were to stay here another two months instead of the two weeks that remain of my trip...I may never want to come back home.

Monday, June 11, 2007

Natasha Journal 2

Week two here on Roatan has been a challenging one for me, but not one without its rewards. This was my first week working as the sole intern at the Global Healing intern at the hospital, an experience marked by an increase in both responsibility and time commitment. As the number of attending physicians increased – we had four altogether, including Dr. Charles Welcome, Dr. Leonel Toledo, Dr. Lea Cunningham, and Dr. Ann Tran—so did the number of patients waiting to be seen. Whereas I had had more time to myself last week (due to sharing work with Ryanne), this week I have been regularly working in clinic until 2pm or later, triaging patients, updating the computer database, filling out the inventory forms, buying a few supplies for the office, and preparing materials for our daycare health screening project.

While working in clinic, I came to realize just how many common diagnoses, treatments, and medical terminology I have picked up in just my short while here – I no longer have any trouble deciphering the ever-famous handwritings of seasoned physicians, nor the abbreviations for upper respiratory infections (URI in English, IRA in Spanish) or acute otitis media (AOM). I have become accustomed to frequently coming across salbuterol and prednisone treatments for asthma, and a host of other treatments including albendazole, metronidazole, and acetominaphen; prior to my trip these terms would have seemed like the remote language of a medical culture far beyond my reach or comprehension, while now they continually reinforce how much I have learned. I may not yet be able to differentiate between scabies and impetigo simply by looking at the patients' symptoms and skin abrasions, but I certainly am working on it.

For three of the five work days this past week, the doctors and I committed about 2-3 hours to the daycare health screening project we are working on. This project, while vastly different from my routine clinical duties, provided insight into completely new aspects of cultural competence, childcare and development here on Roatan. For example, because we understood that many of the kids' parents at the daycare would be unable or perhaps unwilling to provide a comprehensive US-style medical history, we adapted this format to one-page questionnaires, consisting of important health issues presented in a friendly question-and-answer format. We hope that this format will encourage parents to become more involved in their children's education and health. As for the screenings themselves, we found it quite difficult to get the children to perform the tasks that were crucial to assessing their developmental progress: our requests for them to copy a circle, turn the page of a book, or stand on one foot seemed strange and somewhat intimidating to them, as they had probably never had such screenings performed on them in the past. But with the help of Linsday and Lilliana (daycare managers who we need to thank immensely for their bilingual expertise), the overall project was a success. Based on the questionnaires and the developmental screenings, we referred some of the kids to come visit us at the clinic.

And now, life after clinic. Well, due to my busy schedule at work, I did not have much time for other pursuits, although I did meet with Moises for tutoring on Monday. Unfortunately, he has a week of school off now and I do not think he intends to come to tutoring during his vacation time – which is kind of sad, considering that I had prepared fun activities for us to do this week. But not everything can always turn out as planned, and that is probably another important lesson I have learned so far during my time here. Sometimes the spontaneous moments are the most memorable ones – like sleeping out under the stars with Mike and Sierra when the electricity went out on Thursday night, chatting about anything and everything, 'saving' my pistachio ice cream from an unfortunate end. Or singing “Lavense las manos” with the kids at daycare (a song we wrote to the tune of 'La Cucaracha' to help the kids remember to wash their hands) and the Spanish version of the 'Hokey Pokey' and being amazed at Dr. Toledo's vocal and guitar skills. It is these moments that will bring a smile to my face years from now.

And on that positive note, I'm trying my best to deal with one of the not-so-pleasant aspects of medical work with children: children and hygiene seem to be natural enemies, everywhere in the world! Whether in the States or here on Roatan, the cutest kids are those who absolutely cannot be convinced to cover their mouths and wash their hands, perpetually spreading germs as a result. For as hard as I have tried, I have not been able to escape the inevitable falling sick at the hands of children who cough on my face, put their hands in their mouths before giving me a hug, and then display the most adorable smiles I have ever seen. It is impossible to get mad at them, for children will be children; therefore it is parents and medical professionals who need to do their very best to teach them early and often the importance of cleanliness – we are the sole guardians of their (and our own) health. As for me, I am determined to deal with my fever, fatigue, and sore throat as an ongoing reminder of this very important lesson and fervently practice the techniques I preach to children and their parents in clinic.

As this second week draws to a close, I continue to reflect on what I have already learned about medicine and life in general here, and look forward to the weeks to come.

Monday, June 04, 2007

Natasha Journal 1

Last Saturday afternoon, when I landed at the Roatan airport and made my way down the rusty staircase leading from the front of the plane to the crude concrete runway below, I quickly understood that I had entered a new world. The humid air, the tropical trees and smells, the ocean and sky that extend as far as the eye can see...indeed, I had come quite a long way from California.

On the drive to Peggy's house that day, I caught my first glimpse of the social and economic stratification that I had only vaguely heard about before then: along the road to Sandy Bay, I saw several multi-million-dollar gated properties; but along the same road, the countryside was dotted with tin-roofed shacks and stray dogs. And as I got settled into my own apartment furnished with cable TV, a full kitchen, and a private bedroom w/ bath, I was told that many of the neighbors did not even have running water or an indoor toilet. While I am not a stranger to poverty in all its manifestations—my frequent trips to India have already shown me plenty—it is nevertheless disturbing to see it so closely, on such a grand scale.

Of course, there were other differences as well – but many of these would not become apparent until I had spent a bit more time here, until I had seen more of the island. There was surprisingly a “Bojangle's” in Coxen Hole, but other than that, there was no other evidence of the beloved staples of modern American life—no fast-food joints, and certainly no Starbucks. The closest equivalent to fast food I have seen is the 'balleada' – an island snack consisting of bean and sharp white cheese wrapped in a soft tortilla. While I had heard that this island was greatly shaped by tourism, a walk through Coxen Hole or La Colonia would certainly not give that impression to a newcomer, given the poor conditions of the roads, buildings, and homes. Rather, it is West End of the island that distinguishes itself as a tourist haven – expensive gourmet restaurants, resorts, and dive shops...even a Paradise Computers Internet Cafe and store...most islanders don't even have computers.

During my first week as a clinical intern at the Global Healing clinic at the Roatan Public Hospital in Coxen Hole, the term “hospital” took on a new meaning – far from the immaculate, air-conditioned facilities one gets accustomed to in the States, this hospital was simply one of the only places where islanders could come for medical help; most patients came out of desperation, not choice. The air conditioning often failed, as did the lights, and there was no running water inside the clinic. The patients lined up along the long corridor that also served as a waiting room, often for several hours, just for a chance to speak with one of the few available doctors on duty. And our clinic was one of the more popular ones in the hospital, as many islanders seemed to take comfort in the bright white “médicos americanos” sign on our door, as if an indication of superior training and knowledge, a small gift to Roatan from the 'land of plenty.'

But my clinical experiences have been greatly positive in many other ways. For one, here I have had greater exposure and access to patients and medical care than I ever would have dreamed of in the States – and all in a week! My primary duties included taking height, weight, and temperature measurements for each scheduled patient, and keeping a record of their symptoms and treatment procedures. I also updated growth charts and the clinic patient database, and verified crucial identification information from each patient as the basis for follow-up care if needed. In addition, I spoke more Spanish in the clinic than perhaps in all my years of Spanish in school...I hope that this month will improve my fluency and pronunciation. And I had the unparalleled opportunity to work side-by-side with highly trained doctors – usually pediatric residents in their last year of training – who gave me e me a glimpse into the world of possibilities that is open to an aspiring physician, including international medicine. Dr. Leila Sabet and Dr. Darren Fiore were in clinic until Wednesday, which also happened to be Ryanne's last day. Since Thursday, it has been just me and Dr. Charles Welcome in the clinic, and he has done his best to further answer my questions about my work.

Finally, let us get to life outside the clinic—because it most certainly exists! There are so many educational, volunteer, and recreational activities that I want to participate in before I leave the island. So far, I have been tutoring math and English at the Learning Center at a nearby bilingual school, and starting next week, I will be privately tutoring English after school for a boy named Moises. Another item on my agenda: arrange and jump-start a daycare health screening program between the Global Healing clinic and a local daycare in Coxen Hole...once the new doctors come to work on Monday, I will talk to them about this plan. Other than that, I have been snorkeling, swimming, enjoying breath-taking sunset views, and reading some of my favorite books. My first week has been a wonderful educational experience, and I hope that the remaining weeks will afford me the same kind of unique learning opportunities.

Ryanne Journal 4

Today was my last day in clinic. I had to fight the urge to cry when saying goodbye to all the Global Healing doctors. Though my focus has been to facilitate patient flow, I couldn’t help but learn a ton from my experience here, and I am more excited than ever to begin medical school in July.

This last week has been the perfect ending to my time on Roatan. Saturday, a few volunteers from Clínica Esperanza and I went snuba diving (similar to scuba diving, but the air tank remains on the surface on a raft). Our guide took pictures of us, and there’s an embarrassing video of me dog paddling 10 feet underwater. Then, we went on the zip line canopy tour through Gumba Limba Gardens. Sunday, I went with a Global Healing physician and her husband, along with a couple of Peggy’s volunteers, to Barbaretta Island. We passed a group of about 12 dolphins on our way there – an absolutely amazing sight. Jade Beach was our first stop. Thousands of jade rock fragments covered the shore, and I have never seen water so clear or sand so clean. We had the entire beach to ourselves. Next was Pigeon’s Key, a bank of white sand with a few palm trees, surrounded by reef. I saw so many different types of fish and sea life while snorkeling. How am I supposed to return to the States, to a life of watching movies and going to the mall, after all this? I’m going to try my best to not think about it too much.

Well, the new Global Healing intern, Natasha, came in on Saturday, and I have been training her for the last three days. The clinic is being left in good hands, and now it’s time for me to say my final goodbyes. Goodbye cat-calling parrots, road-crossing crabs, dogs that bark but don’t bite, children without shoes, Rotisserie Chicken, Buccaneers, Eagle Ray’s, Deep Ted’s, snuba diving, zip lining, mosquitoes, sun-dried laundry, waking up at 5am, toilets that don’t flush, sniffling babies, sun burns, sandy shoes, baleadas, gripe, tos, calentura and another hundred things that I will miss about this island. I hope to see you all again some day.

Ryanne Journal 3

It’s beautification week in the clinic! New cabinets have been installed, lights have been fixed, and shelves have been tidied up. A couple of the physicians and I have been staying after nearly every day to organize medications and tidy up. The volunteers really care about the appearance of the clinic. A resident bought a tapestry to adorn an empty wall, and then she and another doctor took extra fabric from behind an examination table and are making curtains with it. I think that this extra effort really makes the difference. I am so proud to be working with people who want to go the extra mile to make the clinic better.

Ryanne Journal 2

The Global Healing clinic may not look too impressive to someone coming from North America or from Europe, but it’s important to take into account that the greatest resources are not the donated medications and equipment but the doctors who volunteer their time. I have been constantly amazed at the care shown by the GH physicians. I often question people’s motivations, but that effort is wasted when I observe the GH volunteers pour over medical texts, consulting with each other frequently, before deciding upon the optimal treatment for a given patient. Concern over certain patients even keeps one of the physicians up well past midnight. I assumed that extensively-trained physicians would be so reflexive with their diagnoses that the patient-doctor interaction would be reduced to a question and answer session, a checklist of yeses and nos, adding up to a prescription. But, I couldn’t have been more wrong. These doctors understand that medicine is about treating the person as well as the patient.