Wednesday, February 25, 2009

Chrissy Journal 2

The clinic has been busy with three doctors, the Global Healing clinic saw just fewer than 350 patients in January. In the clinic we see a lot of common problems; ear infections, respiratory infections, parasites, infected bug bites and gastroenteritis. Lots of cavities, and we went through all the toothbrushes Dr. Gary brought down. Some more unusual cases for the clinic was a young girl with alopecia areata, and a rash that Dr. Gross thought might be typhoid, because nobody in the clinic had ever seen one like it, but after looking at typhoid rash pictures he decided it was probably pitynasis Rosita.

Last week was very intense in the hospital. Wednesday night, the hospital caught fire, the hospital sent everyone home in taxis. The women’s ward burned, nobody was hurt and everyone got out fine. Dr. Mario was in Tegucigalpa, and Dr. Gross, Dr. Lindsay and I didn’t find out about it until we arrived Thursday morning. They told us some of the patients had been transferred to the private hospital, Wood Medical Center. On our way out to go to the other hospital, there was a two month old baby girl on the bench in the lobby, breathing very heavy and the doctors both agreed that the baby should be admitted.

When we arrived at the private hospital none of the kids from the hospital were there, they had all gone home in taxis at two in the morning. We talked to the director of the hospital, Dr. Wood and told her about the baby that needed to be admitted. She told us she didn’t know if she would have any beds. We took a tour of the hospital, it is cleaner than the public hospital, but seems to have about the same technology and same staff as the public hospital. When we saw the Pediatric ward, we didn’t see a single child in the beds.

We came back to the hospital and Dr. Wood said they would clean up the hospital and the baby could stay here, so they got oxygen and a nebulizer and baby laid on the wooden bench in the lobby all morning. They took and X-Ray once the electricity came back on, and noticed she has a collapsed lung. Dr. Lindsay and Dr. Gross thought that she needed to be transferred to another hospital that has a CPAP machine. Global Healing offered to cover the cost of transportation for the baby to be transferred. The mother of the baby didn’t want to go. The baby is only two months old and has already been to Tegucigalpa where she was supposed to see a pediatric cardiologist, they were there for days, and never saw him and all they did was an EKG and sent her home with no more information. Meanwhile, the baby got into a bed at the public hospital. We were waiting for the husband to come to decide whether or not they would transfer the baby. Dr. Mario was calling to try to make arrangements in Tegucigalpa.

Friday, the mother did not want transport the baby. The baby was still in the same condition, the mother thought she was doing a little better though. We were getting a little upset because it seemed like nobody cared, there was no sense of urgency, everybody just wanted to wait until tomorrow to see. The previous week a baby died, she didn’t transfer and then she was too sick to transfer out. Another doctor, Guido, came in and explained to us that if the baby transferred to Tegucigalpa that she would have to go through the emergency room in order to be admitted to ICU. The baby really could be waiting in the Emergency Room for days trying to get in, and they don’t triage, it basically comes down to you need to know someone in order to get a bed in the hospital.

At least the explanation made us understand the mother telling us that ‘if her baby is going to die she wants her do die in Roatan.’ We were all pretty downhearted when we left the hospital on Friday, and it was Dr. Gross’ last day as well. He is a great asset to the clinic, I very much enjoyed working with him.

Chrissy Journal 1

My first week in the clinic was very interesting. Elena came in on Monday to show me the ropes and Dr. Mario was the only doctor in the clinic for the week, it was a nice slow week to get started with. I think we saw fifteen patients everyday. I didn’t do much shadowing as I was getting used to everything and not too far ahead of him with patients. Most of the cases were normal things that kids get, like strep throat, colds, and respiratory infections.

Mario showed me around the hospital as well, and took me on rounds with him one morning as well. The facility is not what you would see back home but about exactly what I expected. There were 8 new mothers with their newborns all sharing one room. No running water or actual restrooms, even though patients wait for hours to see a doctor. Since it is my first clinic experience at all, I have nothing to compare it to, but I can tell they get by on much more limited resources. Of course, it’s also pretty amazing that they only pay $.50 for a doctor consult and all of their prescriptions.

I spent my afternoons at Clinica Esperanza. My original plan was to help out at the Sandy Bay orphanage, but they are going through a transitional phase and don’t need help now. They have really built an amazing facility in Sandy Bay. Miss Peggy has been an amazing resource, everything from picking me up from the ferry and showing me around to donating any extra supplies to the hospital and openly sharing her resources with the Global Healing clinic. I had the opportunity to work a few days in the pharmacy at her clinic, filling prescriptions the doctors wrote up. It’s an opportunity I’m sure I would never get to experience back home. I’m hoping to get to shadow some of the doctors at her clinic as well. It was a really great first week and I’m looking forward to learning more next week.

This week started off with Dr. Gary and Jessie joining us in the clinic. Things got a little more crowded but more interesting as well. We had a rainy week, which I think kept a lot of people from coming into the clinic, because it was a slow week. Thursday we only saw 10 patients. We saw a lot of parasite cases, ear infections, and pneumonia. I was able to shadow Dr. Gary a few times and combine our limited Spanish, he’s very nice about explaining things. I also accompanied them all on rounds to check the newborns, all healthy! I also saw the bathroom at the hospital, out of necessity. The cleaning lady escorted me to a small room with a toilet, no seat or back cover. There was water all over the floor and a big barrel of water next to it. There was a door, no way to close it properly, and no toilet paper. The only redeeming thing about it was that it did smell of bleach. It’s amazing to think of a hospital without proper running water.

I had the opportunity to take the doctors to meet Miss Peggy and see her clinic on Tuesday as well, Jessie and Mario had the opportunity to meet her and get a tour of the facility, and Dr. Gary got to see the progress. I heard they had some cases of Rota Virus come through the clinic as well. I didn’t miss any clinic days, but I got sick Wednesday, so I didn’t make it up to Miss Peggy’s Thursday or Friday.

Elena Journal

My three and a half weeks in Roatan were amazing, and I feel incredibly fortunate to have had this opportunity. While I really enjoyed working at the clinic, volunteering around the island, and having fun in my free time, I think that the most valuable aspect of my experience was having the chance to meet and speak with many different people. Between volunteers, locals, nurses and doctors, I was able to meet people with different and valuable perspectives all united under the cause of helping the island.
The first person I met on the island was Peggy Stranges, the nurse I would stay with. Stepping off the plane, I completely missed the man holding my name sign and walked straight towards Peggy, recognizing her friendly face from pictures on her clinic’s website. I’m incredibly thankful to have been connected with such a gracious host. In my weeks on the island, Peggy opened her house to me and served as a useful source of information and advice. Some of my fondest memories with Peggy are the two of us sitting at her dining table talking about how she started her private clinic from the very table at which I was sitting. Peggy left to see her family in Ohio for two of the less than four weeks that I was there, so I tried to soak up as much of her wisdom and advice as I could in the time that I was with her.
With Peggy at the airport I met Becky and Jacob, the two volunteers that I would end up spending my first two weeks with. Both volunteers are currently in med school, and one of them (Becky) had spent seven months of the previous year volunteering on the island. Becky proved to be an invaluable resource, as she knew the island well and had spent two of those months volunteering in the global healing clinic. From the airport, we hopped in the truck and headed into Coxen Hole so that I could catch my first glimpse of the public hospital where I’d be spending my mornings.
Coxen Hole itself is similar to how I pictured it, only with more stray dogs. I don’t think that I could have even imagined the hospital without seeing it for myself (even with the helpful maps that Stephanie drew for me:) ). I was instantly struck by how different it was from what we would allow to be called a hospital in the United States. The door is a wide, open frame, and in many places the ground is concrete. Between the two receptionist type desks stood a long line of people waiting around to be seen. The majority of the people in the hospital seemed to be from the mainland, but there were also islanders intermixed. When we turned the corner to look at the actual clinics, we could see that the line of patients went all the way down to the end of the hall. We peaked into a few of the clinics, and it was pretty clear that the hospital is operating on next to no resources. We walked down to the Global Healing clinic in the hospital, and Becky was able to orient me a little bit to what I would be doing.
After taking my first day easy, I was ready to start experiencing all that the island had to offer. I woke up bright and early with Jacob to start our first day of scuba school. Peggy had already made the arrangements with Bay Island Beach Resort, so it was incredibly easy to get started. Over the month I went to scuba school on weekends and days that Peggy’s clinic got out early. Roatan has beautiful coral, and it was an amazing experience to swim around with the fish 60 feet below the surface. In my short time I was able to see a turtle, an eagle ray, a moray eel, a grouper and a bunch of crabs. With each dive I felt that I was entering a new world, and was amazed at how its inhabitants barely noticed my intrusion.
My time at the Global Healing clinic was great, but the first few days were sort of challenging. Because there was no intern before me, and all of the doctors were relatively new, we were all sort of feeling our way out together. Mario, the Honduran doctor, had been at Global Healing for about a month, while the two American doctors, Erin and Sarah, had been there for a week. My biggest challenge in the beginning was figuring out exactly what I was supposed to be doing. Before I got there, the three doctors took on all of the tasks of the intern, so it was a hard to separate out what my responsibilities were. Becky was very helpful with this, and even two weeks in I would come to her with questions about how things were when she was an intern.
Erin and Sarah are both from Illinois, and my favorite memories from the clinic were working with them. This is partly because they used me as a translator, but mainly because they were caring doctors and thorough teachers. Translating allowed me to become comfortable with the patients pretty quickly, and was incredibly rewarding, especially when easing the minds of first time mothers. But it was the lessons that I picked up from the doctors that gave me deeper insight into medicine in impoverished areas. When they arrived in the mornings they would take me to see the new born babies, making sure to explain the different tests they would do in their newborn health checks. My first glimpse at the struggles involved with providing health care on the island came after one of our morning health checks. The American doctors found a heart palpitation in a newborn boy. They wanted to proceed as they would in the states with follow up tests and possibly even surgery. When they consulted the other doctors in the hospital, the doctors said that it wouldn’t be possible to take these measures. The baby was asymptomatic, so the hospital could not justify using the scarce resources on him even though they had the medical knowledge, skill and technology. We understood the reasoning, but it didn’t make it any easier to send a baby home that might become symptomatic when it was too late. After that, I began to realize that one of the ways medical care is possible with such limited resources is through rationing, and that preventative medicine was one of the first things to be sacrificed.
The hardship of this sacrifice became abundantly clear when a week later we admitted a patient – the only patient we admitted during my stay. A mom brought in her son of about 8 years with a bad foot infection. Doctor Mario broke the news to the mother that her child would be admitted, and I watched her face turn from hopeful to worried to almost frantic. Later that day I would retell the story to a doctor from Peggy’s clinic and ask him why her reaction was so strong. “On the island, you don’t get admitted to the hospital to get better…” he told me. The next day I talked to the American doctors about it and they said that the infection had probably spread to the bone, and that if it had the foot would need to be amputated before it spread further. Coming from a country where those receiving care are often over-doctored, it was strange to see the other extreme, where doctoring often comes too little, too late. In the case of the boy, it was through no fault of the hospital that he was brought in so late. Yet I cannot help but wonder if the mother would have been more likely to bring him earlier in a system with better preventative care.
Working at the clinic wasn’t all teary-eyed moms and tough lessons; it was usually fun and always valuable. My favorite patients were the ones who came with brothers and sisters. Often one child would be ill, and the whole pack would come in for a check up. I had so much fun watching them peek through our keyhole, spin around on our chairs and hang on their mothers. I would say that the most common issues were malnutrition and parasites. Being able to dispense advice and multivitamins to mothers might seem pretty small, but I know that it is a big step towards keeping the kids healthy.
Clinic often got out early – sometimes as early at 11:00 a.m. Usually to keep myself busy in the afternoons, I volunteered where I could around the island. A couple of times after clinic I followed Erin and Sarah back to their West End apartment. We talked a lot about their experiences on the island and in their residency programs, as well as Sarah’s experiences volunteering in Haiti. Mainly we just enjoyed the nice weather and beaches of West End. Most afternoons I would take a taxi back into Sandy Bay, walk up the hill towards La Clinica Esperanza and lend a hand to Peggy’s volunteers. Volunteering in Peggy’s clinic gave me a more holistic view of providing health, as every aspect was contained in the five or so rooms of the clinic. By the time I would arrive in the afternoon all of the triage would be done, and the volunteers would either fill prescriptions in the pharmacy or shadow doctors in the exam rooms.