Sunday, September 30, 2007

Christine Journal 2

I've been working in Clinica Esperanza this past week, while Max has been in the pediatric clinic (well, most of the time - see his email for the strike update). On Monday and Tuesday, Betty, the normal pharmacist, was out of town, so a nurse and I were in there all day trying to figure out where meds were kept, etc., but we ended up finding everything eventually and got all the meds out. I've also been helping to enter patients into the new database they're making, which includes looking through old charts and just filling out online records. They go back to 2005, so there's a lot of work to do!

On Wednesday, I went in to the public hospital with Max because the clinic is closed, but I woke up with a cold, headache, and nausea, so didn't last long. I did get to go on the morning rounds with Kristen, the current pediatrician, and see her visit two newborn babies and see the rest of the hospital for the first time, which was great. I'd never seen a newborn before, so that was interesting! However, after the rounds I was feeling really sick, and the hospital staff was on strike so there were very few patients, so I got a cab and went home, sleeping for pretty much the rest of the day.

On Thursday and Friday, I was back at the clinic, and helped again in the pharmacy, this time with Betty back. The doctors have been really great about calling me in to see interesting cases, or to help them out a little bit, which has been so rewarding. I listened to a lung crackle with Dr. Charles, and then saw the patient when he came back to get the fluid in his abdomen drained - it filled a bucket that probably held a gallon or more of liquid! I also helped a doctor clean and re-wrap a patient's fingers that he had sliced pretty badly, and saw a boy who had a thyroglosal cyst.

We've still been pretty bored in the afternoons, waiting for either the tutoring to start up, or someone to give us an idea for a project, since we're ready to get going. As I said earlier, Miss Peggy is back now and has given us lots of ideas, but we still need to really sit down with her and decide what would fit our interests, time constraints, and the island's needs the best. I definitely want to make sure whatever we do is sustainable and practical for our skills and time here. It sounds like the tutoring is starting up this week (or at least SAT tutoring is), there are schools at which we could teach English or basic health, among other things. We'll definitely let you know when we decide on something.

That's about it for the week. Everything has been going really well and I think that we're in for a wonderful few months. I'm really looking forward to everything we'll be doing!

Max Journal 2

This week has involved more great learning opportunities for both me and Christine. Monday was a heavy patient load at Global Healing, so I stayed busy all morning triaging and inputting information. On Tuesday I showed up a bit earlier to the clinic, hoping to prevent getting overwhelmed by patients, and we ended up seeing only about six kids. Wednesday I arrived at the hospital to find the Preclinica closed and surprisingly few patients in the clinic. After Kristen and Charles arrived, we ascertained that the hospital workers (or some subset of them) were on strike, so we would be unable to get patient files and see patients. The strike continued until the end of the week and I am still not sure if it will be over tomorrow.

On Wednesday, Kristen gathered the social service doctors together to give a lunchtime lecture on meningitis, which went really well. While she was working on organizing that, I assisted with an American medical brigade called Hearts in Motion that was using the hospital for OB/GYN, dentist, and general internist consults. We let them use our clinic because we weren't using it, and I stayed there helping to translate and deal with patients. Probably the most interesting case that I saw this week was a woman who came to the brigade for a medical report to present to the police after being attacked. We couldn't give her a full medical report without X-rays (there was a possible fracture and radiology was closed due to the strike) and we didn't know what the form should look like, so I just wrote out a semi-official looking letting stating our findings and referred her to Woods Medical Center (on the public attorney's recommendation). I was sorry we couldn't help her more and it definitely made me realize the kind of proaction that is necessary in that sort of situation. We spoke with the woman for a while and gave her antibiotics for a possible infection of the wound site, but I couldn't leave the clinic to accompany her to find an X-ray, which I would have liked to do. Maybe that was the first opportunity I had for case management and I passed it up, but I'll try not to let that happen again.

On Thursday I returned to the clinic to find that the strike was still going on, so Kristen and Charles went to check up on kids in the day care while I did an inventory of soon-to-expire meds.

Each day after I got out of the clinic, I went to Peggy's clinic to help in the pharmacy there, and on Friday I didn't go to the hospital at all, staying at Peggy's clinic instead. Christine and I have also been working on a poster for Clinica Esperanza. It was a good week despite the strike and next week will surely be an adventure too.

This weekend Peggy and the Grubers arrived, so hopefully we will hit the ground running with a public health project before long. We have been trying to figure out where to work in the afternoons, but nothing has realized yet. This evening we will meet Howard and Alice for the first time, so I look forward to them putting us to work.I also spent a number of hours this week trying to track down a dog that bit me on the beach, but I'm not worried about it and I am getting PLENTY of medical advice!

Sunday, September 23, 2007

Christine Journal 1

It’s been a week now since we arrived on Roatan, and I’m loving meeting everyone and getting a sense for how things happen here. We were met at the airport by Edwin, the intern before us, and Shelli, who’s working in Miss Peggy’s clinic, and were quickly introduced to all the other people working down here. There’s a really great community feeling among all the volunteers, and I’m excited to learn from everyone who’s working with both clinics (Global Healing and Clinica Esperanza) in different ways.

After moving in to our apartment on Sunday, we were ready to start in the clinic the next morning. We arrived early to find many, many people already waiting outside to see the doctor, and have been told that they arrive around 6 am. I was immediately struck by how different the hospital is from anywhere I’ve been in the United States – no running water was the biggest surprise. I think it will be really interesting to really get to know how things work there over the next three months. Edwin taught us how to triage the patients, where we could find everything, and how to fill out forms at the end of each day. There is an American doctor and a Honduran doctor there right now, and they’ve both been really open to explaining different things to us. It should be a really great learning experience to work so close with them.

I’ve loved all the patient interaction we get as the triagers. It’s been interesting to see the different ways that the kids react to the triaging. Some think it’s fun to stand up on the scale, while some kick and scream and cry when we try to weigh them. I’m looking forward to getting to know people better as time goes on.

Max and I have realized that having two of us at the Global Healing clinic does not really achieve much more than have one of us there, so we both worked at Clinica Esperanza one day last week as well. I went in on Friday, and Alex, a volunteer, helped me learn the ropes of the pharmacy there. That’s probably where Max and I will primarily work when we’re in that clinic. It’s amazing how many donations they receive and how smoothly everything seems to run!

In terms of our public health projects, Max and I are still trying to get a feel for what’s available and needed, especially since Nurse Peggy has been out of town. I’m really looking forward to finding a few projects for the afternoons, though. It seems like there are a lot of tutoring opportunities, and I’m sure there are many other things that Nurse Peggy can tell us about when she’s back.

In our free time, we’ve been enjoying exploring Sandy Bay and other parts of the island, as well as snorkeling, cooking, and getting to know other volunteers and workers at the two clinics.

It should be a really great three months!

Max Journal 1

We started work on Monday with both of us in the clinic with Edwin. He showed us basically what he does each day, and we took turns interviewing patients. On Tuesday all three of us went to the clinic again and did essentially the same thing.

On Wednesday Edwin left for El Salvador so Christine and I both went to Global Healing to make sure we remembered how to do everything before we left each other alone in the clinic. Dr. Breslin gave me a very short tour of the hospital and I was very grateful to get a little more of the "big picture" of how the different departments there interact. I would still love a more complete tour by Dr. Charles or anyone else, but that will probably come when I need to get something done and I'll just figure it out for myself.

On Thursday I went to work in Clinica Esperanza because the pre-med volunteer there was taking a day off and I wanted to see the place. I spent the day in the pharmacy with Betty mostly doing data entry and learning how the clinic works. I assume that once I work there a few days I will be able to help measure out prescriptions and possibly translate for the nurses and doctors, which will be interesting. It was also enlightening to see how the clinic takes in large quantities of donated medications and incorporates them into their pharmacy. I noticed that the clinic there will take peoples' personally prescribed medication, which is different from Global Healing but seems to make sense. For both the Global Healing clinic and Clinica Esperanza I am slightly amazed by how they keep consistently providing quality services with what seem like inconsistent supplies of medications, equipment, and volunteers. For most of the non-profits that I've worked with in the states, "turn-over" a very sore point and constant reason for concern, but here these clinics seem to be built around an acceptance of extremely high turnover with volunteers coming and going every month, and they seem to function alright. Also, with the medical supplies that seem to come in randomly (except for the few things that the clinic buys outright), somehow prescriptions manage to get filled one way or another. It's like stability out of chaos. Very cool, and not at all easy to pull off, but I look forward to learning more how it all works.

On Friday I went to the Global Healing Clinic and Christine went to work in Clinica Esperanza. We had almost 20 patients so we stayed quite busy. I am enjoying practicing and improving my Spanish and haven't run into any insurmountable barriers, although my Spanish is definitely a long way from being as fluent as Christine's. I look forward to practicing and improving more over the next few months, and I hope that I can be effective if I am put into the position of translator. I was expecting one patient whose chart had a number of notes from previous Global Healing clinic interns, but the patient never came to the clinic. The boy had some sort of seizure/muscle spasm disorder for which a previous intern considered coordinating an expensive surgery in San Pedro Sula, but the charts say he is responding well to seizure medication. Although I never saw this patient, it reminded me of the "case manager" portion of the orientation packet.

Christine and I decided that we will work most effectively if we each have a large chunk of time at each clinic, so for the next month and a half I will work in the Global Healing clinic each morning and Christine will work in Clinica Esperanza each morning except Wednesday (when they're closed), and then we will trade places. I think this will provide the most continuity for each clinic and will allow us to get to know each place well.

In the afternoons we have mostly been getting to know the area and swimming a lot. Because Peggy has been out of town, I feel like our "public health project" questions haven't been getting very straight answers. I know it is up to us to arrange something, so we will keep asking around and exploring possibilities, but it may take a little while for us to find a project even though I think we both would like something to keep us busy in the afternoons. It seems that Edwin was playing/coaching basketball with Dr. Raymond's team in the afternoons, but we got rained out while he was here and now I don't know where the courts are and I'm honestly not much of a basketball player. Shelli (the long-term volunteer living in Peggy's downstairs apartment) has mentioned several times a tutoring project she is starting up, but I don't know when that will come to fruition. Also Peggy mentioned via email the possibility of us teaching a health class, but she's not here now and I haven't heard anything about it from anyone else. We will keep asking around and I hope that by the end of the week we'll have a better idea of how we can contribute to the health of the island with our afternoons. For the time being we are learning a lot about how things work here and enjoying some fabulous snorkeling (swam amongst a pod of ~30 dolphins this morning, including at least 4 babies!).

The White Diamond Luxury Apartment is very luxurious and probably the nicest place I'll live in the next decade. It's a little more than Christine and I were expecting to pay, but the landlord is nice and we'll just have to have a lot of guests. The clinic seems to be in generally good shape and I am looking forward to meeting the Gruber's and Nurse Peggy soon.

Tonight we are having several volunteers over for dinner, so we've got some cooking to do, but if I left out any pertinent information or used a completely inappropriate format for this email journal entry, please let me know and I'll change it. I imagine that in the future I will present more case studies and reports on my projects outside of the clinic, but for the time being I'm still just getting my bearings.

Sunday, September 09, 2007

Edwin Journal 2

The week started out with a little scare, as Hurricane Felix was making its way to Honduras. On Monday morning I woke up to the sound of hammering as locals were boarding up their windows as they headed for higher ground. Businesses were closed, and as I'll mention later, the clinic was shut down for the first half of the week. By this time, there still wasn't any certainty whether the hurricane would actually make landfall on Roatan, but folks here were not taking any chances. In fact, thousands of locals and tourists decided to evacuate the island and head to the mainland. Perhaps some saw this as a free trip to visit family and friends, although they'd eventually have to foot the bill coming back on the ferry. As things turned out, the mainland of Honduras actually got the worst of the hurricane while Roatan only saw a minimal amount of rain with hardly any wind. Despite the rain, conditions were good enough for us to play board games out on Peggy's deck overlooking the Caribbean as the storm passed. Compared to some of the horror stories I've heard about past hurricanes tearing off roofs and demolishing docks, it looks as though we dodged a pretty significant bullet.

Although the sky was clear with no sight of the forthcoming storm, Dr. Kristen and I came to clinic on Monday only to be given the news that our clinic would be closed until Wednesday. It came as a surprise and a disappointment to us both, especially since Dr. Kristen was eager to start her first day in the hospital. Nevertheless, we managed to quickly triage and give OTC treatments to folks who were patient enough to wait for the news of our closure, though we weren't able to see them as thoroughly as we would've liked. The only good that came out of the clinic's closure was that Dr. Kristen and I were able to spend a little more time seeing and examining newborn babies in the neonatal ward. I got to help Dr. Kristen out by filling out each baby's height, weight, head circumference, method of delivery, APGAR scores, and vaccinations taken up to that point on the exam forms. I really enjoyed interacting with newborns and their mothers, and so hopefully I'll get the chance to do more of that next week.

The remaining three days of clinic went smoothly, with many of the same cases I have come to recognize right away—impetigo, skin rashes, and viral infections to name a few. Dr. Welcome is temporarily on assignment elsewhere on the island, so filling in for him is Dr. Delia, a Cuba-trained doctor completing a social service rotation here on the island. Herself a Honduran, Dr. Delia described to us the tension between Honduras-trained and Cuba-trained doctors. For instance, Cuba-trained doctors on rotation are given two separate stipends, one from their medical school and the other from the Honduran government, while Honduras-trained doctors are given just one. She also told us that there are often problems with hospitals that choose not to recognize medical practicing licenses from Cuba. Dr. Kristen, on the other hand, is a Harvard-trained doctor originally from Boston and now practicing in Washington DC. She took time to explain to me the different tracks in third- and fourth-year medical school and some of her personal experiences in her chosen track. In my time here I have found it so fascinating not only observing the doctor-patient interaction, but seeing how such broad and different experiences can bring doctors together in an organization such as this. I hope to learn more from Dr. Kristen and Dr. Delia in my last couple of days here.

Sunday, September 02, 2007

Edwin Journal 1

The past two weeks have gone by incredibly fast--so fast that it's taken me until today to finish writing my first journal entry (sorry for the delay!). I've got a lot to recap so I'll try my best to stay organized and on point.. first, after a day-plus of connections and layovers, I arrived on August 20th at the Aeropuerto Roatan, where I was greeted by Vanessa, Dr. Welcome and Dr. Rhee. They showed me around Coxen Hole and took me to where I'll be staying for the next 4 weeks, in the White Diamond apartments in Sandy Bay. My arrival also marked the arrival of Hurricane Dean, which wasn't nearly as bad as it could have been. Fortunately, we only caught a piece of it.

There was question as to whether conditions would be good enough to have clinic the following day, but the sky cleared up nicely so Vanessa and I ended up going. Training went fast and smoothly, and I even got to triage a few patients on my own and ether their data on the first day. Over the course of the week, I began to see trends of the more common illnesses brought to the clinic. Viral infections, parasites, and impetigo are seen on practically a daily basis, with cases of lice, scabies and dengue fever also seen from time to time. Because we aren't supplied with the more advanced, technological resources found in the states, Drs Rhee and Welcome often have to rely on blood, stool and urine tests to pinpoint the illness and prescribe medication accordingly. However, seeing as how parents are often either unable or unwilling to bring in their children for follow-ups (whether for personal or financial reasons, ie., living far away, inability to afford another roundtrip cab fare to Coxen Hole, etc), we do our best to treat patients in their first visit, while also stressing the importance of returning to the clinic if their condition persists or worsens.

Although I have worked with children as well as interpreted in clinics in the past, I have never had the exposure to pediatrics that I am now fortunate to have. A number of cases come to mind that I know I wouldn't normally see in an adult clinic. One day, a nine-year-old girl came in with complaint of itchiness on her scalp. Her mother would scratch the top of her head, and the girl's scalp would turn white and flaky. When Dr. Rhee was examining her, the girl quickly reached up and picked some lice off the top of her head. Dr. Rhee joked how sometimes kids can be so cooperative that they do all the work for you. Other times, as I quickly learned, this is far from being the case. Taking ear temperatures can sometimes be an experience in itself, but I've gotten better at it by distracting kids with toys and stickers. I also had to help a mother hold down her screaming six-year-old daughter while Dr. Rhee looked in her ears for a possible infection.

I have also picked up on a couple of things that I didn't expect to see in clinic. One patient needed an x-ray read, so Dr. Rhee showed me the A-I method of examining chest x-rays. Another girl (we get boys in clinic too, but strangely the more memorable cases have been with girls) had an abscess on the sole of her foot, and with the help of Dr. Lidia Prado we were able to open up the abscess, drain out the liquid and fill the cavity with gauze to prevent infection. Of course, with cases such as this we ask that they return in a couple of days for a follow up, but as I mentioned above, we are sure to provide them with enough dressing and antibiotic to get them by.

Since my arrival there has been a lot of movement to and from the island, by volunteers from both Peggy's Clinic and Global Healing. David and Igor finished their time in Hospital Miss Peggy and have since returned to Edmonton and Nashville, respectively. On the Global Healing end, Dr. Rhee returned to New York yesterday, where he will continue his residency and begin apply for fellowships after his board exams in October. We've also had two recent arrivals--Shelly Heil, who will be helping Peggy with computer networking and data back-up, and Global Healing's newest attending, Dr. Kristen Breslin from Washington DC. She will be starting tomorrow with Dr. Welcome, and we may even be graced by the presence of Dr. Prado. Looks like a busy weeks ahead.. unless, of course, Felix says otherwise.

Other highlights:

crab races, constant (aka daily) power outages, getting devoured by mosquitoes on my very first day, helping out at the afterschool sports facility, nightly dinners in West End, playing basketball against the local high school team, and diving certification!!!