Monday, March 31, 2008

Rose Journal 3

It was fabulous having Semana Santa off from work, and I spent a lot of time on the beach. The enormous influx of vacationers that come for the week before easter is amazing. West End turned into an entirely different place and the prices at restaurants and for water taxis sky-rocketed. One of my friends from the States visited, and I showed him all over the island. I also spent lots of time snorkling and eating very, very well.

The clinic opened Monday for the first time since Semana Santa. We were fairly busy, but not to the level I had expected. I'm not sure what I was expecting (perhaps a flood of people or a swarm, like locusts?) but the week ended up being fairly normal and only a little bit busy. Monday we saw our usual array of scabies, gripe, and ear infections. Tuesday was not too much more exciting. Wednesday was an altogether different day, at least for me. I got violently ill for the first time ever while traveling and spent the entire day at home in absolute misery. I think the culprit was the hospital cafeteria lettuce that I had eaten the day before. Rebecca and Lidia did a wonderful job triaging without me, though, and apparently the day went on sin mi. Rebecca also did a presentation on fluids that day and Lidia drove all the way to French Harbor to buy nachos for the social service doctors.

Friday was Rebecca's last day in the clinic, a very sad day for Lidia and me. She was a fantastic attending and working with her every day was great. She made sure to show me points of interest, including her own ear when she contracted an ear infection. Lidia, Rebecca, and I all went out to pizza at Bella Napoli's to commemorate the occasion.

Friday also brought drama concerning my visa. It had been my understanding that visas in Honduras were good for 90 days, or at least that you were legally allowed that amount of time. however, when I had come through customs last month they only gave me 30 days. Looking at my passport I could see no indication of this time limit and decided that I might be okay without renewing it. Luckily, Lidia encouraged me to go into Immigration and talk to them, because, when we went, they informed me that if I had waited any longer I would have had to pay a 1,600 Lempira fine. Instead, I had to pay $40 to extend the visa for two more months. Lidia always keeps me out of trouble.

Saturday Alice and Howard flew in and took all the clinic folks out to dinner at the Argentinian Grill. The new attending, Dr. Sabio and his wife were also there. They seem really great and I look forward to working with them next week. Dr. Sabio is a native Spanish speaker which is absolutely essential when seeing patients in the clinic.

Saturday, March 15, 2008

Rose Journal #2

This week proved to be much busier than last week. On Monday we probably saw close to thirty patients between the two doctors. Tuesday was nearly that busy as well. I find the feeling of working in the clinic with two doctors much better than with just one as it was last week. There's much more for me to do and I don't find myself sitting around while the doctor is seeing patients. It was really great to have Rebbecca back and in the clinic. She is really an amazing new doctor and works so wonderfully with children. It's great to observe her and see how easily she gains the trust of her patients. I can tell that she truly loves being a pediatrician. She is also extremely helpful to someone like me who is interested in becoming a doctor. I ask her questions all day and she never seems to tire of answering them, despite how silly they might be.

We had a couple of noteworthy patients this week. The first was eight year old boy with a giant abscess on the top of his head, exactly the size and shape of an egg. The poor guy kind of resembled a cartoon character. I watched as Lidia and Rebbecca worked to drain it and was amazed and just a little grossed out about how much pus and liquid came out of it! The second patient of interest was a very premature baby (Rhoany Collins' baby) that was coming in for the second time to get checked-up. She weighed barely three pounds, but that was a huge improvement from the last time she was in. It was amazing to me to see a creature so small (was she really human?) and I instantly fell in love with her. Even though she was so tiny had strength in those miniature limbs, as I found out when she grabbed onto my finger. The mom seemed really receptive to all of our medical advice and I felt hopeful that the little girl would grow up to be healthy. The third patient was also a baby girl, coming in for a check-up. Everything about her was healthy, but there was another reason she came in that day. The mom had come in have stitches on the sides of both of the little girl's hands taken out. Apparently the girl had extra digits on both hands that were surgically removed after she was born. I helped Rebbecca take them out, which proved kind of difficult. The mom had waited much too long to take them out and they were buried under a thin layer of new skin. Eventually Rebbecca managed to get them out and we sent the little girl home, with only five fingers on each hand.

Next week the clinic is closed for Semana Santa and I look forward to having some time to relax on the beach. My friend Lindsay is coming down and I can't wait to show them around. I feel like I'm already getting really familiar with the island. I won't write a journal entry for next week because I won't be at the clinic at all. Hopefully it won't be too crazy what with Spring Break and the holiday. I expect taxis to be more expensive and tourists to be everywhere!

Saturday, March 08, 2008

Rose Journal 1

So here concludes my first week. I was excited to quickly find out that my position here is not just observing but that I am able to interact with the patients and do my share. I don't think I knew quite what I was getting into when I signed up for this program so I am happily surprised to see how much I am actually able to do and learn here. All this week the only doctor has been Dr. Lydia which has given me a nice slow start to get used to doing triage. Maybe, too slow at times as right now I am taking a spare minute at the clinic to write this journal entry! I have settled into the job quite easily and feel fully ready for next week when Rebbecca gets back and the number of patients coming into our office is sure to double.

This week there was a strike Monday through Wednesday. Basically the only people still working were all the doctors and nurses as it was the secretaries, maids, etc. that were striking. I got the lovely experience of trying to triage people and keep track of their data without charts. The hardest part about it was probably making sure that the patients that needed to be seen got into the office as there was really no way of keeping track of it. You just had to stick your head out the door and say "next" (in Spanish of course). Our number of patients those three days was very low because no one wanted to come to the hospital when there was a strike going on. I think on Tuesday we only had two, total, one of whom was "no contesta". It was sad to see how little people were getting care because of the strike and it is my hope that the people who didn't come here went to Clinica Esperanza.

I've learned a few cool things this week. Lydia taught me how to hook up a kid to a nebulizer (easy but I'd never done it before) and showed me about the importance of having accurate growth charts. I see newborns almost every day, most of them healthy, which always makes me smile. I'm also getting the hang of deciphering patient's symptoms in Spanish. They usually all have similar symptoms and I've learned the words gripe and calentura. I'm also getting the hang of all the abbreviations in Spanish. For example, a urinary tract infection (UTI) is an IVU and an upper respiratory infection (URI) is an IRU.

I also had the opportunity to go to the local daycare with Lydia and assist with check-ups there. The kids were not too excited to interrupt their play time to get measured, weighed, and... well you know fully examined... but Lydia has a certain charisma with children and the check-ups went well. While Lydia was doing certain parts of the examinations she closed the door for privacy and I had a chance to interact with the kids and watch the women that work there do their best to keep the rowdy ones under control. It was actually amazing to watch them preside over the children, handling every dispute with a few quick words.

This weekend I plan to explore the island a bit more and hopefully visit my friend in Punta Gorda. I am finishing up this journal entry back at Peggy's house and over the course of the night a storm blew in. The waves splash right up to the stairs of her house and the wind is deafening. All the laundry was blown off the line and into the storm. I sit in awe, watching the waves and the amazing power that they possess.

Becky Journal 7

We just finished another crazy week, and next week the clinic will only have half as many people working there, as TJ and the Grubers are going home this weekend. On Monday, we had a record 38 patients in the morning, which just added to thecraziness, as we were starting the ultrasound course. The course has been a huge success, and the ultrasound technician and radiologist have been able to provide many free and needed ultrasouds to the people here, in addition to teaching the doctors how to use the ultrasound machine. The baby with dehydration was sent home on Wednesday, at 1.6kg, so she finally gained some weight. She looked so much better too…I took a picture of her a few days before she left the hospital and compared it to the picture we had of the first day she came in, and you can’t even tell it’s the same baby…pretty incredible. The patient load the rest of the week has been pretty moderate, and since we have four doctors working, we always seem to get through all of the patients quickly.

On Wednesday we all went out to dinner and then went out on the dock and watched the entire lunar eclipse, which was absolutely spectacular in a place where there is little light pollution. Thursday after clinic, Dr. Patrick and I went to a meeting with a man named Clinton Everett, who used to be the governor of Cayos Cochinos and is still very important there. We discussed the prospect of setting up a clinic there that would be staffed by a physician once a month, just for about a weekend or so every month. There is a desperate need for medical care on the islands, and it seems like something we may realistically be able to provide. We are arranging for a trip out there next weekend, so we can go and talk to the Patronados of the island and truly assess what would be needed.

Friday was not too busy in clinic, but a very sick 2 year child came into the ER, and I am still unsure of what will happen with her. This child presented to the ER in respiratory distress, which had started about 2 days ago, and they could not figure out what was wrong with her. They thought it may have been an obstruction in the upper airway, but there was really no way to figure it out. They started her on all kinds of treatments and antibiotics, but after the whole morning she had still not improved at all. The scariest part is that if her body tires out, which is not unlikely, then she will have to be intubated, and there is no question that the public hospital is a bad place to be if you have to be intubated. They have the supplies for intubation, but as I have seen before, they have no vents, and so intubated patients have to be bagged by hand the entire time, and who knows how long that would be for. I really hope she starts to turn around and improve soon.

Next week the new Global Healing intern comes as well, and I will start orienting her. There is talk of karaoke tonight with Lydia, the other Global Healing docs, and some other doctors from the hospital, which could definitely be a good time. I have been here for over three and a half months now, which means I am more than halfway through my stay here. It is really hard to believe, and it’s scary to think that in three and a half more months im going to be in med school…crazy. Anyway, power is out again (it’s been a regular thing lately) so I need to go before the computer battery dies, and hopefully internet will be back soon so I can email this out.