Monday, August 25, 2008

Stephanie Journal 2

The first week, I needed a bit of transition time, but I think I am pretty comfortable with my island life now. The clinic has been very interested, especially once I got a hang of the Spanish, medical terms, and pharmaceuticals with their Spanish names. It is a bit like a routine - we get a lot of Upper Respiratory Infections (or IRAs in Spanish), flus (gripe), scabies (escabiosis), impetigo (impetigo), and dermatitis (dermatitis). It's been very interesting watching Dra Sri and Dra Prado apply their knowledge to these cases. A lot of the time, it really depends on the family and therefore the drugs prescribed can be more or less, depending on how much the doctors think that they will comply to it.

There was one interesting child with dextrocardia. Her heart was on the right side of her body, although the rest of her organs were on the right side. There's another condition called Situs Invertus when everything that is normally right is on the left and vice versa, so everything is inverted. It's extremely uncommon, therefore I was lucky to even meet a little girl with this condition! She was really adorable and friendly.

Mondays are the busiest day, so we had a ton of patients then. Apparently, they have not been paid since 2004 and have only been given some "bonuses" but the hospital still owes them a lot of money so the nurses are unhappy. On Tuesday, the nurses went on strike at the hospital so the last week was pretty slow because the nurses were not sending patients to our clinic. Now some other workers.

The kids at the orphanage are having a spelling test in 2 weeks. They need to learn how to spell Roatan, flowers, dolphin, today, boy... and other words that they know how to say, but don't know how to spell. It's really frustrating because the kids themselves get frustrated. I don't blame them - I think that they are behind in school because they were homeschooled for a long time. The other thing is that the English/Spanish transition is confusing. The kids all speak English, but they also learn Spanish in school. Therefore the keep getting their "e"s and "i"s mixed up because "i" sounds like EEEEE in spanish. It's heartbreaking because the kids want to go play and don't want to study this difficult material, but I know that it's something we need to help them with.

I visited West Bay for the first time yesterday. It is SUCH A BEAUTIFUL BEACH. The water is turquoise and the sand is white. The water is warm with some cold currents running through it which feel so good when you're snorkleing. I've never been snorkeling before so doing it in Roatan has been a new experience. There were a lot of jellyfish at West Bay, so I was pretty afraid of getting stung. I didn't exactly want to find out the hard way whether these jellyfish were the stinging kind (I have a pretty limited knowledge of marine wildlife) so I definitely avoided those when I could, sometimes kicking them away with my flipper. I got to see a sea snake (which scared the life outta me), two huge barracudas (which also scared the life out of me), beautiful parrot fish, and lots of other interesting wildlife.

I'm slowly, but surely, getting over my fear of the open water and using my Spanish!

Monday, August 18, 2008

Stephanie Journal 1

I arrived last Sunday, sleepy and jetlagged, and was thrown into the Roatan environment. I'm staying at Miss Peggy's in Sandy Bay in her downstairs apartment, right at the edge of the ocean between two docks. Everyone has been great - the volunteers from Clinica Esperanza, Mia who left yesterday, Miss Peggy, and the staff at the clinic. At first, I was very anxious in the clinic, but after 3 days with Mia, I am ready to tackle the clinic on my own. It's smaller than I had imagined, but it's been a great experience shadowing the doctors, and as I get faster at paperwork and triaging, I get more and more time to shadow and talk to the doctors. Doctora Prado is the Honduran fellow in the clinic, and she's been very helpful, especially with translations from English to Spanish. There are a lot of medicines, treatments, and illnesses that have abbreviations or names that I do not know/understand because it's in Spanish. She's been really patient with me. Dra Tiyyagura is a pediatrician from New York and she's also been great to shadow and learn from.

I had heard so much about the clinic before I got here, and even seen a lot of pictures, but when I got here it seemed very foreign. It's great to be in this environment - where volunteers like Dra Tiyyagura and myself can help a large number of people - even if it's only seeing 20-25 patients a day. Most of my patients are under the age of 5, and they're almost always accompanied by their mothers (sometimes fathers). The people have been patient with my Spanish, which has an accent and is sometimes hard to understand compared to their Spanish. For me, it's easier to understand an American speak Spanish than a Hispanic person speak Spanish, and I think that's a bit ironic.

On my time off, I've been continuing the work at the orphanage. Mia told me about the improvement that Dawn started and that she has continued. I hope that Allen and I can keep going to the orphanage to help with their schoolwork. After the orphanage, I usually go fishing on the dock or kayaking in the ocean. Although I know my priority is in the clinic, it's been nice to have time off in the late afternoons to relax because I wake up early to go to clinic again. I've kinda caught a "fishing bug" and I go almost everyday :) Catching fish and then eating your catch is pretty satisfying, even if it's only a tiny fish!

Sunday, August 10, 2008

Mia Journal 5

Sunday August 3 to Sunday August 10

Me and Hannah have had a very adventurous weekend as we were let loose on the Roatan roads by ourselves. We took Peggy's rickety truck and luckily survived the crazy taxi drivers-who love to pass cars on blind turns-the invisible potholes every couple feet, and the random people walking along the sides of the road. Yesterday we went to go solicit donations from businesses in Coxen Hole and West End for Sundae by the Sea, the silent auction that Peggy's clinic holds every year to raise funds for Clinica Esperanza. And today we picked up Stephanie and Allen - the new volunteers - at the airport. Today we were supposed to go la Colonia to distribute Kids Against Hunger food packets to the families, but Dr. Ivan - who was going to also give a presentation on dengue - was called to la Ceiba because one of his patients got dengue hemorrhagic fever. Hopefully next weekend before I leave.

I can't believe I only have three days left in the clinic! This past week we've been working at a really fast pace because we have Dra. Srit, Dra. Laura, and Dra. Prado here everyday. On Monday, Dra. Srit drained a scalp abscess and the scream of that young girl will forever be burned in my brain. On Tuesday she came in again and I watched Dra. Laura repack the hole. I thought the gauze would never end as she pulled it out of the gaping, bloody hole on the back of the poor girl's head. After clinic that day, we all went to the local daycare to administer antihelminth medication to the 15 or so children there. Boy was that chaotic. We had one tiny room to fit the four of us AND two or three crazy little children. We all felt like we had gone through war as we left the daycare; those kids were super energized because our team came right after they had had their nap. My little monkeys at the orphanage seemed like quiet little angels after the day care.

Wednesday started the introduction of the new patient sheet. For me, it only means asking four more questions about past medical ailments, current medication, vaccination history, and any known allergies to food or medicine. Lidia explained to me that getting this new sheet was such an accomplishment because apparently it had been vetoed multiple times. Lidia said the hospital bureaucracy does not particularly like changes in methodology. Thursday was super fun at the orphanage because the kids and I dyed Hannah's hair! We dyed her hair a burgundy, chocolate cherry color and of course as I reminded the kids to be careful about not getting dye on Hannah's face, Chenice slaps a big handprint of red on Hannah's forehead. It was a hilarious process, and the kids really enjoyed it.

I've still had several mothers come in with their chief complaint being, "no quiere comer nada nada." We had one mother come in with this complaint about her 2 year old child, and as Dra. Laura tried to convince her that she was the boss, not the child, I could see a look of doubt and confusion appear on the young mother's face. The two year old apparently walked around the town buying only junk food and candy. So Dra. Laura told the mother to stop giving her son money, to stop letting him walk out alone because of possible danger, and to just wait for the child to get hungry. "He'll eventually eat anything if he's starving," Dra. Laura said. I guess it sounded kind of harsh to the mother, because she left a bit disgruntled. Another mother came in with her daughter and as the mother started complaining that her child was not eating anythingwas answering my questions, her daughter sat there with cheese covered fingers, shoving cheetohs into her mouth. It's frustrating to keep seeing these mothers come in with the same complaint; I swear we see at least 5 a day!

Friday night I went with Peggy and the Clinica Esperanza team to rotisserie chicken (YUM) and we had to leave midway through for a medical emergency. The son of the future president of El Salvador had fish (and apparently he is allergic to fish) and did not have an epipen like was recommended to him, and so he was shipped to Peggy's clinic for treatment. Everything turned out fine but it was an exciting end to the night.
And now, me and Hannah are going to be adventurous and try and cook something delicious.

3 more days in the clinic!

Wednesday, August 06, 2008

Mia Journal 3+4

Week of Sunday, July 27 to Sunday, August 3rd

The beginning of this week has been a lot less hectic and crazy than last week. Last week started sin el doctor Gross and con una emergencia; a little girl with internal bleeding had all the doctors occupied for about 3 hours. I was grabbed and almost literally dragged to the laboratory to translate for Alice who was desperately trying to get blood for the girl. It was pretty scary trying to understand why we were being denied (ended up being a lot of bureaucratic filling out of forms) with noise and chaos surrounding the already scorching hospital. Not to mention, as I opened the door to the lab, I almost got nailed by a flying droplet of blood! After finally getting the order in for the blood, I went back to the clinic, where two children had puked all over the hallway, and I had to suck in my stomach as to keep myself from puking from the stench. I swear it was fever day because there were at least 5 children with fevers greater than 101. At least that insane day ended on a good note-the premie came in for a check up and seemed to be doing really well.

Tuesday didn't prove to be any less eventful; a baby girl in the waiting hall began to go into febrile seizures and had to be whisked away to the ER. I stood there with the mother, trying to comfort her as much as possible as she was sobbing and shaking uncontrollably. My heart absolutely broke for her.

The rest of the week was a lot milder; a lot of URIs and a lot of the popular chief complaint here on the island, "no quiere comer comida! solo dulces!" I've seen Dra. Laura get flustered multiple times this week trying to explain that antibiotics don't work for viruses, and it gets me thinking about the patient's perception of their quality of care. Here, as well as in the United States, parents feel more satisfied when they leave the doctor's with some sort of medication or injection. When I see empty handed parents leave with a quizzical unsatisfied look on their face, I wonder if they lose faith in the care their doctor's provide, or even in their doctor's education. I wonder what other implications arise, specifically and especialy in this Global Healing clinic where the patient-provider relationship is already tainted by a language barrier and a cultural distrust.

The orphanage has been wonderful times up until Wednesday. Shenice, who appears to be the sweetest girl (and super bright as well) did not take her nap and I feared for my life (exaggeration of course) as she threw the HUGEST temper tantrum I've ever seen in my ENTIRE life! We had to end the lesson early and calm her down because she stabbed the table pretty forcefully (and we weren't about to let her use that same force on somebody's eye).

A new resident came in this week- Dra. Srit Tiyyagura, a co-resident of Dra. Laura's from NYU. She came just in time for the Trauma Conference, which had a good turn-out. The conference was all in Spanish, and most of the Global Healing team could understand most of it if focusing at the utmost intensity possible. All in all, I'd say it was a success.

Sunday I spent my day at West Bay Beach again, and like always, it was superbly lovely. Tomorrow will mark my fourth week at the hospital!