Mia Journal 2

Week of Sunday, July 20th-Sunday, July 27, 2008.

Today marks the 15th day I've been on the island-almost the

halfway mark. This past week started off with the coming of

Howard and Alice Gruber. After a wonderful dinner at the

Argentine Grill with the entire Global Healing team, I went

home to rest up for my second week of work at the clinic.

That week at the hospital was distinctly different with

Howard, Alice, and Robin (nurse practitioner) there. Our

already tiny working space shrunk to the point where every 5

seconds someone was bumping into someone else. Alice spiffed

up the place, AND we got a new 19 inch flat screen computer!

Oh my goodness does that make a HUGE difference! The old

computer took FOREVER to perform ANY action and this new

computer is quick, fast, and never freezes up, saving all of

us lots of time. The air and electricity still go out quite

frequently which is a bummer; especially with a minimum of 6

people in the room rushing about creating heat. I triaged a

1.4 kg premature baby (I forgot how many weeks it was) which

was really very scary for me. I was scared she would break if

I made a mistake! We also saw a little boy with a nasty

infected lip, with swelling from his lip up to his right

eyebrow. The image of Dr. Gross cutting open and draining a

cranial abscess will forever be burned into my brain. On

Wednesday, Robin took me on a tour of the pediatric ward and

we watched the nurses clean and dress a child's fractured hand

(Robin is here to train the nurses and so she was taking

notes and telling me the differences in method as compared to

how it is done in the United States). The 7 children in there

were melancholy and a few were whimpering, but upon giving

them Global Healing teddy bears, we exited the ward leaving 7

smiles behind us.

Wednesday afternoon, we had a small conference with other

nurses and health workers from the Hospital in a separate

building across the way. Dra. Prado gave a presentation on

hypertension and Robin followed with a presentation on how to

properly administer sodium fluoride varnish to children.

Global Healing does quite a bit of community outreach in

addition to managing the pediatric clinic at the hospital;

this coming week we are planning to administer antihelminth

medication and next Saturday marks the 2nd Annual Trauma

Conference. I am really excited for the new pilot program

Howard is starting at the clinic to fight the prevalence of

dental caries. Not a day goes by that we don't see at least 5

children with horrible looking teeth. One child had a dental

abscess near the size of a ping pong ball due to lack of

dental hygiene and the consumption of chatarra! Although we

give out toothbrushes, I am skeptical as to whether the

parents really have the time or patience to force their

children to brush twice a day. I don't even want to think

about whether these kids floss. But, dental hygiene would

fall towards the bottom of my "important things to do" list if

I had to scrape around to obtain enough money to feed my

children. It was really discouraging to see mothers come into

the clinic worrying about their children's constipation and

stomach pains, say they understand they need to feed their

children fruits and vegetables instead of chips and Coke, and

then walk across the street and buy their children a soda and

some candy-a treat for putting up with a doctor's visit. I

have seen this in many underdeveloped countries and it is

frustrating and saddening because most parents can not afford

to buy fruits and vegetables for their children every day.

Something else must be done, possibly from the economic or

government sector, because doctor's can't do much else besides

tell the facts about nutrition and dental hygiene. In the

states, people have a choice to listen to what their doctors

and dentists recommend. Here, parents-especially single

mothers-don't have much choice other than to provide their

children with the food their income will allow them to buy.

Howard explained to us that this dental program is distinctly

different from other varnish administering programs that have

been recently proven successful in other Central American

countries because here in Roatan, the fluoride varnish will be

administered at the hospital by the nurses; once when the

children come in for the 12 month vaccinations, and again when

they come in at 18 months. We have posters to promote this

varnish all over the hospital and we are putting them up in

different barrios around the area. It is really neat to watch

this program develop because the kinks and other issues are

still being worked out. And, there is only supply enough for

300 children for 6 months-so there is half a year to come up

with an additional supply. Yikes. The nurses are stoked that

they are doing something unique to Central America and they

joked around about becoming famous. They are really excited

and hopeful for this program to be successfully implemented.

Friday I got to try out an audioscope for the first time!

Exciting! Dr. Laura shocked me when I was shadowing her

because she handed me the audioscope unexpectedly and said,

"Take a look at her ears. You'll see they are quite impacted

with wax." She taught me how to properly hold the audioscope

to be able to see best, and as I looked into this young girl's

ear, I saw a dark brown wall of wax. After Dr. Laura

prescribed drops of Cerum for the girl's impacted ears, she

let me look into her own ears for comparison. There was such

a stark difference between Dr. Laura's ears and the girl's

ears! Whereas the girl's ears were dark drown, Dr. Laura's

were completely clear and light and I could actually see her

tympanic membrane. I was able to check Alice's ears also, and

her tympanic membrane was in clear view as well. That was a

really cool hands on experience for me.

Another cool close-up experience I had this week was watching

an ultrasound being administered on a 6 month old baby with an

abnormal neck mass. Everyone was clustered around the

ultrasound monitor and with 4 doctors huddled around, there

was a lot of mumbling and hypothesizing and debating about

what the neck mass was or whether it was attached to anything

concerning. I watched the blood vessels in the neck open and

close like a fish does while swimming underwater, and the

consensus was open ended. All the mother could do was wait

until the child was old enough for surgery or until the neck

mass popped on its own-if it ever would.

Dr. Gross is leaving today; I am going to miss shadowing him

and translating for him. He has done so much in his life and

has been all over the world. I knew he was a crazy cool

doctor ever since he told us that he really liked chocolate

covered bees. "They have a nice little crunch," he said. I'm

definitely going to miss him in the clinic. Next week is

going to be a trip; just two doctors instead of three. But I'm

super excited as to what I will see and learn in the next

seven days!

Dawn Journal 4

15 July – 20 July

I can't believe this is my last entry! Time has flown by—especially because this past week has been rather eventful.

On Tuesday, I got really violently ill and spent the night throwing up everything –including water that I tried to drink. Peggy said that this same sickness had hit a bunch of volunteers a little while ago and that it usually took a few days to recover from. It was pretty awful but I managed to make it into clinic the next day to show Mia around. We spent the next few days getting Mia oriented and by Friday, she was completely in charge and running the show herself.

On Friday, because Mia had triaging under control, I got to shadow the three doctors on their rounds in the ward. It was great to be able to see the rest of the hospital, albeit a bit depressing. All of the equipment (even beds and curtains) seemed to have a thick layer of grime and rust on them. The pediatric ward had cribs that reminded me of rusted prison bars. The patients were upbeat though – I saw mothers with their newborns, a three year old with fractured fingers, a 9 month old with a severe burn on his face, and a 4 year old with a history of seizures.

Mia has also been volunteering at the orphanage with me, and the children seem to really like her. We continue to help them with their schoolwork and reading practice and I've noticed that the children have come to accept their study time as routine. When I first started working with them, there was no defined schedule and they were quick to resist any attempts towards work. Now, they come right down from their nap at 2 and are ready to start working with us. In my opinion, routines are definitely something children need.

Tomorrow I'll start work at La Clinica Esperanza – the clinic that Peggy runs. It'll be interesting to be able to compare the two environments and systems in which things are run. I'm looking forward to the experience.

Anyhow, I've really enjoyed my time here in Roatan and have learned loads. I'm confident that I want to enter the field of medicine (especially pediatrics) and have strengthened my desire to work in international health. Best of luck to Mia (you'll do great!) and the rest of the volunteers.

Dawn Journal 3

8 July – 14 July 2008

For the past 3 working days, Dr Gross, Dr. Laura, and I have been working at the hospital without Dr. Prado, who went away to a medical conference in Tegucigalpa. There were a few requests from patients that the three of us weren't quite sure how to handle, mostly because we didn't know how the hospital system worked. One poor woman who had arrived at 6am was made to visit three or four different departments, wait for hours, and finally told that there was no medication available for what her baby was sick with (rotavirus). I'd guess that she was probably there for about 6 hours total. Over my time here, I've discovered that it's a bit frustrating to work within a system that has such poor communication and organizational skills. I've also noticed this lack of organization within the patient files. For instance, there's no permanent record of past histories and medicines administered. Whatever happens to be in the patients file (a literal manila file folder) is it. I think a defined system would greatly improve efficiency and quality.

Along with triaging patients, I've been learning loads both from shadowing Dr. Gross and Dr. Laura and from other volunteers. Today for instance, I got to listen to a child's chest that was sick with pneumonia. I happened to know what to do because yesterday, another volunteer had taught me what to listen for, where to press the stethoscope, and how to interpret what I heard. It was really exciting to put that knowledge to work in clinical practice. In addition, Dr. Gross often has me translate for him, and is great at explaining different tests to me. Today he did a full examination of a child that was born at 27 weeks – very prematurely. He explained the various stages of child development and about the different tests that one might to do look for certain milestones. In the middle of the examination, both Dr. Laura and Dr. Prado popped in to take a look. It was great to hear them bouncing ideas off of each other and consulting. Each have varied specialties of knowledge and I appreciate their willingness to be flexible with their diagnoses.

The new Global Healing volunteer, Mia, arrived on Sunday. Peggy and I picked her up from the airport along with another volunteer named Sean. I'll start her orientation on Wednesday so she can get three good days in at the hospital before she's on her own. The new doctors are certainly looking forward to meeting her and I think it'll be a great transition. I can't believe it's my last week working for the hospital! I'll be on the island for a couple more weeks, volunteering with Peggy's clinic, but it definitely seems that time has flown by far faster than expected.

Dawn Journal 2

The new doctors, Dr. Gross & Dr. Papa. (abrv) have arrived to work in the clinic. Because there are now 3 doctors in the clinic, today was extremely busy – we took in around 32 patients. The waiting hall was absolutely crammed with people—whenever I opened the door to call in another patient to triage, a blast of warm, wet air would hit me in the face. About midway through the day, the power went out for around half an hour, leaving the 4 of us to operate in semi-darkness. In sum though, a very successful day. The new doctors are extremely nice and knowledgeable. They have also brought with them some extra medicines and vitamins, which are much appreciated.

As time has passed, I've gotten much better at refining my triage skills and also at administering fever medications. I'm also able to understand patients requests and explanations much better. Dr. Gross has even asked me to translate for him a few times, which makes me feel my communication skills have improved to some degree. Dra. Prado has also been great at explaining the various diseases and medications that I have questions about. I've been keeping a running tab of the various questions that have come up and am in the midst of creating a cheat-sheet for future interns' reference.

My work at the orphanage has also been coming along nicely. My job is to teach the house's four first graders how to read in Spanish, which has proved to be a daunting task. It's hard to explain why "me" sounds differently in English and Spanish and the children are easily frustrated. I've mostly been concentrating on getting them to sound out letters and figure out consonant combinations. In the end though, I feel like progress is being made. They're slowly improving and are great to play with afterwards.

Lastly, I've found great friendship in a few of the other volunteers here on the island. They are interning in Miss Peggy's clinic, which is across the street from where I live. It's definitely nice to spend time with people, especially those who have great medical stories to tell. We've had a few cooking and traveling adventures together, which has made my off-time very worthwhile.