Saturday, January 26, 2008

Becky Journal 4

So this week has been going kind of slow, since the weather has been really nasty and rainy. On Monday, I saw the most malnourished baby that I have ever seen…definitely the sickest baby I have ever seen that has not been in the NICU. A mom brought in her 12 day old for a well baby check. She said the baby was born premature, at somewhere between 32-34 weeks, and was kept in the hospital for 2 days. She went to unwrap the baby, and I hae seen a lot, and it takes a lot to shock me, but I was absolutely shocked at the sight of this baby. It was tiny, with arms and legs skinnier than a pencil. It’s skin was all shriveled up, and it’s face looked like an old person…it almost looked like a mummy. I couldn’t believe this baby was still alive. I asked the mom if there were any problems, and she replied that there weren’t and that the baby was breastfeeding just fine. We undressed the baby, and I was honestly afraid to pick up this baby and put it on the scale, because I was afraid I would hurt her if I moved her. We put her on the scale, and she weighed 1.2 kilograms. She had weighed 1.5kg at birth, meaning she had lost 18% of her birthweight, which was already really low. Andrea saw her right away, and told the mom that she needed to be admitted. At first the mother refused, but Andrea told her flat out that the baby would die if she went home and continued like this. Both Dr. Gross and Andrea agreed that the baby should be in a NICU, but since no such thing exists here, they put her in an incubator in the pediatric ward. They wanted to give her an NG tube to get nutrition, but were unable to. Apparently the baby was so tiny that when they put the tube in, the baby became apneic, due to the tiny size of her tubes. They also tried to put an IV in, but the baby was so tiny and so dehyrated that they could not put one in anywhere. Instead, they ended up trying to syringe feed her orally, which is still what they are doing, until she is hydrated enough that they can get a line in. The most shocking thing about this situation was that the mother had a two year old child as well, but still had no idea that something was drastically wrong with her baby.

On Tuesday, we had a four year old girl come in today with a cyst on her eyelid, which she had for 2 years and which scratched and irritated her eye when she blinked. They were going to try to send her to the mainland to an opthamologist, which of course would be costly, but I remembered Peggy mentioning that she had an opthamologist coming down to her clinic in March. I called Peggy, and ended up taking all of this girl’s information, along with pictures of the eye to send to the opthamologist in the states. Hopefully, it will be something he can fix, and it will save her family a very costly trip to the mainland.

As of Thursday, they still had not put an NG tube into our malnorished baby, who had now been in the hospital for 4 days. Dr. Gross brought our baby scale into the ward, since they don’t have an accurate scale on the ward. He weighed the baby on our scale, and the baby still weighed 1.2 kg, exactly the same she had been 4 days ago. We had Peggy bring over a couple of NG tubes, since they said they didn’t have any at the hospital. That afternoon, Lydia put a tube in the baby, and the baby is already looking better.

Friday was pretty slow, probably because of the rain, and so we finished clinic early and spent time with Dr. Gross. He is leaving this weekend, which is really sad, because he is an amazing doctor and I learned so much from him. We all went out to dinner at Romeos in French Harbor, which was nice for his last Friday night. Next week will just be me, Andrea, and Lydia, so hopefully things won’t be too crazy.

Wednesday, January 23, 2008

Becky Journal 3

This week was amazingly productive, and the Global Healing team has been working amazingly well together. The week started out on a sad note as we found out on Monday that the baby we had flown to San Pedro last week had died sometime over the weekend. The news came as a shock to all of us, since as of Friday we had been told that the baby had been placed on a ventilator in the NICU and was stable. We did not get any other information from the hospital in San Pedro, only that the baby had died. It was really dishearteartening, not only because we had worked so hard to help the baby, but because we all believed that this baby was through the toughest part. However, we all knew that we did all that we could have possibly done to make a difference for this baby.

On Monday, the hospital was on strike again, so we played the part of pediatric ER, taking all of the kids who were coming into the ER to be seen. It was pretty much the same as a normal clinic day, except that overall the kids were a little bit sicker. We took advantage of ending early on Monday to go through all of our supplies, inventory, clean, and make lists of needed supplies for the next people coming down. On Tuesday, things were back to normal. Wednesday was a crazy busy day. We had clinic as usual in the morning, and afterward, we had a lecture given by Dr. Dominguez, the orthopoedist. It was very interesting, and he was a great speaker. I was a little bit worried that I wouldn’t be able to understand everything since it was done in Spanish, but the lecture supplemented by power point was very clear and easy to understand. After the lecture, I went right over to Peggy’s clinic, as I had organized a screening up in the Colonia for that afternoon.

We all met at Peggy’s clinic and laded the truck with supplies, and headed up to the church. We weighed and took temperatures on all of the children, and did pressures and sugars on the adults. Then they all got a brief check-in with the doctors, and were given reference cards to come to the clinic if they needed to. I was not at Clinica Esperanza today since I was at the hospital, but apparently lots of people for La Colonia came after going to the screening. This was really encouraging, because after talking to some people in the Colonia, I have realized that many people do not know that Clinica Esperanza is free for those who can not pay. There is one family in the Colonia that I have visited with a few times, and after their screening the mother told me that she knew she should take her kids to the clinic, but she had 5 kids and did not have the money to take them. I told her it was not a problem if she was unable to pay, and her whole face lit up, and gave me a hug. She also told me that her father was sick and she would like to take him to the clinic, but that he was unable to walk down to the screening. I went with her up to the top of the Colonia to do a screening on him, and his pressure ended up being dangerously high. He was advised to go to the clinic the next and promised that he would. It was definitely a satisfying day, which was ended by a night dive in West Bay with Dr. Gross and a few of Peggy’s volunteers.

On Thursday, we were finished clinic by 11, and we all went with Dr. Prado over to the daycare center, where she was going to give de-parasite medication to all of the kids, because apparently a few of them had been vomiting worms. We set up a mini-clinic at the daycare, where we first weighed all of the kids, then calculated medication for each one, and each child got medicated. It was soo different from the US, where I could not imagine what would happen if someone came in and gave all of the kids medicine without parental persmission. The kids were all so good with taking the medication, and we had fun playing with them as well. On Friday, we also went to the daycare after clinic to give the kids their second dose of medication, and got to play with them some more. Then we all went to lunch in Coxen Hole, and went shoppping for fish. Friday night, we helped Dr. Gross cook a big dinner as a send off for a big group of volunteers that had been at Peggy’s clinic. It was a great week, and very productive as well…we have already seen over 200 patients this month! Next week is my last week with Dr. Gross and Andrea, though, which is sad.

Monday, January 14, 2008

Becky Journal 2

As of this week, Dr. Gross, Dr. Lee, and the new Honduran doctor, Dr. Prado, are all working in the clinic, and things have finally come together. It was a great week this week, and it was a good thing we had so many doctors, because we were really busy. I saw a lot of interesting cases this week, and also got to help out with getting a patient to the mainland, which was amazing. Monday through Wednesday, we had about 25-30 patients each day, so I was kept busy with triage, shadowing, and doing paperwork. We had one case which was a 3 week old baby girl that had supernumery digits hanging off of each of her pinkies, which Dr. Gross removed. I also saw a few abcesses drained, as well as all of the usual cases.

On Tuesday, when Dr. Gross and Dr. Lee came back from rounds, they were talking about a baby with a lung problem whose left lung had not expanded. On Wednesday, they took an x-ray and discovered that the baby’s left lung was either collapsed, filled with fluid, or not opening for another reason. The baby was 5 days old, and although she was breathing spontaneously, her oxygen saturation was very low, so she was being bagged by the nurses. On Wednesday night they got a call that the hospital had a ventilator that they wanted to put the baby on, but they did not know how to use it. We went to the hospitial and the doctors looked at the vent, which was an ancient piece of equipment that they had never seen before, aside from the fact that it was for adults. They determined that there was no way the the vent was usable, so they continued bagging the baby overnight. The baby was only being given IV fluids and no nutrition, and was in very poor shape. Dr. Gross decided that it would be best for the baby to be sent for the mainland. After researcheing, he decided that Cieba did not have the right resources for the child, and so she would have to go farther.

On Thursday during rounds, Dr. Gross talked to Dr. Jackie and got permission to fly the baby out. Around 10, they sent me to the airport to try to arrange a flight. After 3 hectic hours at the airport, I learned that commercial planes did not allow oxygen, and so we arranged for a charter flight to fly the baby to San Pedro. By 12:30, everything was arranged, and I met Dr. Lee and the baby at the airport. Dr. Gross had driven them in her car, with the baby in a small plastic tub, and Dr. Lee ventilating the whole way. The whole experience was pretty surreal. We were rushed through screening at the airport, with Dr. Lee and I holding the tub with the baby, who was being bagged. We then were loaded into a tiny little four person plane, no bigger than the size of a small car. The mom sat up front with the pilot, and Dr. Lee and I sat in the back, with the baby in the tub on our knees. We bagged the baby for the entire hour and a half flight, with Dr. Lee constantly checking the baby’s color and feeling for chest rise. We had no pulse oximeter, and the plane was so loud that she could not hear breath sounds,s o she relied on feeling for chest rise. As soon as we landed at San Pedro airport, there was an ambulance waiting, and they met us at the door. It was very comforting to see an ambulance with 2 paramedics and a doctor, as wel as neonatal equipment, moniters, and pulse oximeters. It made me feel very confident that we were getting this baby to a higher level of care. After getting the baby loaded and giving report, the baby’s mother, who spoke no English, came up to us and said “Bless you”. It was truly amazing. We flew back to Roatan, and still made it home in time for the crab races that night. We called the hospital the next day, and the baby had been put on a vent, but had still not been diagnosed, but we were told that there was a pulmonary neonatologist as well as 3 pediatric surgeons there, so we knew that the baby was in good hands. Dr. Lee is going to call again today to see how things are going. I have helped out with manny individual patient cases since I have been here, but this was definitely the most satisfying case that I have been involved with, as the baby surely would have died if we had not gotten her transferred right away.

Then, for a climactic end to the week, when we all came in on Friday, feeling exhilirated from the day before, there were no patients around, and the workers were all on strike. The doctors did their rounds, and then we decided to do some reorganizing and inventorying in the clinic. However, then a nurse from the ER came over and asked if we could see all of their pediatric cases since they were so busy, so we became the pediatric ER for the rest of the morning. We finished up around noon, and I headed to Peggy’s clinic, as I usually do. Their waiting room was still completely full, because all of the people that would have gone to the hospital ended up there. I called Dr. Gross and Dr. Lee to tell them I would be late for snorkeling, and twenty minutes later they both showed up at Peggy’s, and helped see patients to speed things up. We got finished quickly, and spent the rest of the day relaxing on the beach. Yesterday I went with Dr. Gross, Dr. Lee, and some of Peggy’s volunteers down to the east end of the island to Paya Bay. I had been there before, but it is absolutely gorgeous. We followed that up with a dinner at the view, whicih was a perfect end to a perfectly relazxing day.