Friday, May 15, 2009

Andrea Journal 2

I planned to write an email last night, but was stymied by a small catastrophe- the pipe leading into the toilet in our apartment snapped off as I tried to turn the water off for the evening, sending liters upon liters of clean fresh water gushing into our apartment! We ran for help and finally found Hector who is somehow related to the owners of the apartment. Hector cut the circuit to stop the water. How ironic that in a country where clean water is so hard to find, within 10 minutes, the entire apartment had flooded- the bathroom, kitchen and bedrooms were covered in an inch of water. I had raced throughout the apartment throwing everything onto chairs and beds as the water spilled out of the bathroom, so luckily nothing was ruined. In fact, to our surprise, only half an hour later, we had successfully scooped buckets of water from the floor into the shower, soaked up most of the water with bath towels, and swept it out the door. Gracias a Dios that things dry so quickly here! Hector then declared that he was going to reconnect the pipe with glue. I was doubtful and begged him to wait until morning for the pipes to be replaced. I was sure that the water would come gushing into our apartment again. "No queremos agua anoche!" (We don't want water tonight!) I insisted. Again, the irony! Haha. Per the usual, the locals always know more than the gringos- 5 minutes later, Hector turned the water on and, sure enough, the pipes held! I was amazed. "American glue," Hector said pointing at the EZ Cement label. Ha ha! Anyways, it was an exciting welcome to plumbing in Roatan, where flimsy water pipes are left exposed so that silly tourists can snap them off and flood a building in minutes. Again, the idea of me wading through pools of clear water drowning our kitchen, while surrounded by entire neighborhoods without access to a reliable source of running water is ludicrous! How did resources come to be divided SO ridiculously disproportionately?

Flooding problems aside, I have been learning so much about the public hospital here in Coxen Hole, health care on the island and medicine in general! Between the Global Healing pediatric clinic in the public hospital in Coxen Hole and Miss Peggy's private clinic in Sandy Bay, all of the residents and doctors (both volunteers and Hondurian staff) have been so wonderful and eager to teach me. I shadowed the doctors during newborn infant exams in the hospital maternity ward- the infants are so tiny and cute! I have seen dengue, malaria, parasites, rashes of all sorts, scabies, chicken pox, conjunctivitis, TB...tons of cough, cold, congestion, fever. I've listened to breath sounds and looked at chest xrays for kids with pneumonia. I held the light while a doctor scraped heaping spoonfuls of dark brown ear wax out of a patient's ear; afterwards, I got to peer inside the patient's ear to examine the tympanic membrane. Yum! I listened to hearts beating, examined pupils, looked at strep throat, oral herpes. I translated for a teenage girl during her first vaginal exam. I looked at the malaria parasite under a microscope in the hospital lab.

Coxen Hole Public Hospital-
The hospital here has an "x ray machine." The xray tech joked that the machine was a gift from Christopher Columbus because it is an ancient, massive, wrought iron structure that looks like it could be 100 years old! Nonetheless, it does take xrays (albeit without any sort of radiation protection for the techs or in the walls of the room) The hospital also has a lab and a pharmacy, so we can order blood and urine tests, write prescriptions. If the hospital runs out of a particular medicine, the patient is given a prescription to purchase the drug elsewhere on the island. "Prescriptions," by the way, are notes scribbled by the docs on the back of a scrap piece of paper torn into quarters. In any case, I tell you what capabilities the hospital HAS because the list is short.

The hospital is usually very crowded and hot. The clinics have air conditioning, so we stay cool, but the patients wait for hours and hours in the hot, smelly hallways full of sick children with myriads of contagious disease. The patients begin arriving at 7 AM and receive a number from the front desk to mark their place in line. The clinics do not open until at least 8:30 or 9AM. The hospital only sees a certain number of patients each day, so if patients arrive too late and intake has run out of numbers, they are turned away. The clinic that I work in is an additional pediatric clinic within the hospital, funded privately by Global Healing, set up to supplement the public hospital's pediatric facilities. It was founded to address the overcrowding that still persists today! We usually finish clinic by about noon, but that means that the last patients have been waiting for at least 4 hours.

One big advantage of the hospital- The cost for a doctor's visit here including all medicines is 7 - 11 Lempiras or less than 50 cents- very cheap, even for the poor!
A Sad Case-
I held an emaciated, bony infant with floppy skin- in medicine, they call this "failure to thrive." He weighed something like 3kg at 40 days old :( He turned out to actually be a sad and frustrating patient. The docs decided to admit him to the hospital to observe feeding and try formula milk. However, the mother was clearly reluctant to admit the baby, frustrated that she had been kept in the hospital with him 2 weeks ago and was so recently discharged. I heard the next day that the mother and baby had fled the ward just hours after admission. Later, I mulled over our mistakes- it was clear that the mother cared about her baby. And with large families as the norm here in Roatan as in most of the developing world, I wouldn't be surprised if the mother had other children at home to care for. We clearly should have listened more to her concerns and perhaps come up with a compromise- Could we have treated the baby as an outpatient? Could we have given mom formula to take home, observed one feeding in the outpatient clinic and asked her to return? Would she have returned? Sadly, we are now afraid that she will be scared to come back if things get worse. The docs said that if the baby's growth does not turn around within a week, there could be dire consequences for the child. If this were Children's Hospital Boston, I know we would send a brigade from Farley 135 to the patient's house with the best bottles, formula and babysitters in the world. Sadly, though, we are a world away from Boston. For now, we have to hope that she will return when the baby needs our help.

Fun things I have done outside the clinic (because no one likes to end on a sad note)-
I have been volunteering at a nighttime sports program for kids called S.O.L., which was started by two American guys a few years ago. It is SUCH a success! The kids have a shack full of old, donated equipment- baseball mitts, soccer balls, basketballs- and they go nuts! They love soccer and baseball, so you can imagine the fun that I get to have. They are a rag-tag group of kids- half of them have shoes, they fight like you wouldn't believe, and I have yet to see a single parent show up to the court. I made up an ESL lesson and taught English on the side to some of the Spanish-speaking S.O.L. kids one night. I have also been teaching English to a guy who works at the apartment I lived in. Like most Spanish speakers here, he really wants to learn English. He brings a beginners English workbook that he borrowed from a friend, and we spend an hour or two talking in Spanglish during the afternoons. I have also been snorkeling again and can't get enough! It is AMAZING. I saw a HUGE spotted eagle ray, a SEA TURTLE, a porcupine fish, barracuda (scary ones that followed us!), tons of Doris swimming around in huge groups, beautiful coral, conches, and billions of other gorgeous fish and weird sea creatures I cant describe! My local friend took me out on his boat to fish. We didn't catch anything, but we rode right through a whole school of wild dolphins swimming right next to our boat! Incredible. And the view of the island from the water was amazing. I am tan and COVERED in bug bites. The sand flies love foreigners. I'm going to keep telling myself that the bites are from sand flies, but the resident and I joke that we have bed bugs and scabies :-)

Andrea Journal 1

ROATAN, HONDURAS- An absolutely wild place that I am still struggling to understand. A 30-mile long, skinny island off the Caribbean coast of Honduras, about 1.5 hour ferry ride from the closest mainland port, La Ceiba. It is almost nothing like I had imagined except that the beaches are gorgeous, tropical fruits and flowers grow wild everywhere, and the weather is hot! My biggest surprise has been that the few parts of the island I have seen so far are much more developed than I had expected. I have spent the last 5 days comparing everything to the Dominican villages I worked in last year, which were homogenously rural, primitive and quite impoverished. Here, there are multiple classes of people ranging from the very wealthy to the extremely poor. I think the socioeconomic stratification of the island has been exacerbated in recent years by a massive spike in tourism. Less than a decade ago, the island's economy was primarily fishing-based; what a change from now! Resort developments are springing up left and right; cruise ships, which used to be a novelty (evidenced by the fact that the Spanish speakers call them "cruise ships" because they had never seen any before and didn’t have a Spanish word for them!), stop on the island multiple times each week. I’m sure this story sounds as familiar to you as it does to me…the touristification J of a tropical island…the rapid change in economic priorities…the resulting rich-poor gap…local culture and goods replaced by plastic lawn chairs and cheap souvenirs. It feels like Roatan is in the beginning stages of this unfortunate transition, and the only people who enjoy the change are (obviously) those who are making dinero!

THE PEOPLE (who I have heard of or met so far)-
1. The “islanders” or the “locals” are the black or dark-skinned people who speak English with a crazy Creole drawl- dey sound lik dis mon! End dey very hahd da undastand at fuhst (They sound like this man! And they very hard to understand at first J). The island was originally owned by the British and I think at least some of them are the descendents of slaves who came from the Cayman islands during the first half of the 19th century. Others may be Black afro-Carib. The internet is down, so I can’t look it up! Edits to come I’m sure… Anyways, so far I have spent most of my time hanging out with islanders in the West End, one of the two most touristy areas of the island and more of a backpacker’s budget spot. It seems that work comes and goes for many of my new friends, and that their jobs largely depend on tourism- construction, waitressing; if they own a boat, they can take tourists on the water to fish or taxi. I have seen some islanders with nicer houses for island standards, and others who come from poorer neighborhoods that I gather are not quite as bad as the shanty towns.
2. The “Spaniards” are the people who immigrated from mainland Honduras after Britain gave the island to Honduras in….the mid 1900s?? These are the lighter-skinned Hispanic people who speak only Spanish. Apparently Honduras left Roatan to its own resources for many years before realizing the economic potential of the island’s coral reefs and beautiful beaches. More resources from Honduras created tourism, which created jobs, which spurred the movement of people from mainland Honduras to Roatan. Most of the Spaniards I have come in contact with drive taxis or work in the resorts. They seem to be poorer than the islanders, but it's hard to generalize. I have heard they tend to live inland in the poorer barrios and shanty towns- i.e.: La Colonia or El Swampo (yes, El Swampo = the swamp, named as such because it is apparently one huge valley of mud during the rainy season)
3. White islanders. I think there is a small group of white local island dwellers who have been here for generations. Haven’t met any yet, but I think they're here somewhere...
4. Random people who have settled here, mostly the white hippie type from the U.S. or Europe. (i.e.: Carl, a white guy with an American accent who plays volleyball with the islanders most nights despite their endless and ruthless taunting about his lack of coordination, who built his own submarine and runs submarine tours for a living. Hah!)
5. Tourists!!

OF NOTE ON THE PEOPLE- There is a lot of tension between the islanders and the Spaniards. I have been told that the islanders feel invaded and want the Spaniards to go back to the mainland. Roatan’s government, controlled by the islanders, has apparently made this sentiment clear by neglecting the Spaniard neighborhoods. La Colonia is a Spaniard shanty town that has grown from population 300 to 3,000 in less than 5 years and sits across from my apartment in Sandy Bay. The entire community did not have running water until a Texan couple (the guy happened to be the “pastor” at a crazy church service I attended on Sunday!), started an NGO 2 years ago called Living Water for Roatan. The people of La Colonia now get water for 3 hrs each week. The doctor at Miss Peggy’s Clinic in Sandy Bay says that even with such a limited water supply, the public health situation of La Colonia has been exponentially improved. Anyways, I guess the point is that it was an American couple, not the Roatanian government, who brought water up to La Colonia. Then again, the only public hospital in Roatan (which is where I work and write from today) does not have running water either. Yes! The public HOSPITAL does NOT have running WATER. It is incredible. Anyways, I'll leave the health care and hospital stories for later after I have spent more time here…


Snorkeling was just about the most amazing experience ever. Seriously, Nemo, Dori and all of their friends live about a 5 minute swim from my apartment. What an incredible and fascinating little world that I have never seen before!! NOW i know what people mean when they say "the reef."

I went for a swim yesterday just to get some exercise (You can't run on the beach because the wild dogs will chase and bite you. You can't run on the roads because the cars will hit you. So...I swam!). I stayed close to the beaches in the grass where there are a few fish but not nearly as many as the reef... I wasn't even swimming to see the fish, but off to my left about halfway through the swim, I saw a familiar looking black shape flop right past me- a sting ray! hah!! Exercise here is so much more entertaining than an ipod and treadmill :-)

On Saturday, I stumbled upon the birthday party of a 3 year old Sandy Bay local islander named Wendel (the second cousin of my friend). It was a giant affair for which Wendel's mom cooked mounds of food for nearly 100 random guests like myself who happened to be passing by. There were about 8 yellow "bombas" (balloons) and 10 plastic chairs lined up along the fence of the property as I passed by on my way home. 20 mintues later, hoards of children were being dropped off the back of pick up trucks, some carrying wrapped gifts. they piled inside a tiny patio area and screened porch to sit and eat- Conch soup (spicy and amazing!), arroz con pollo (also fantastically delicious), spiral pasta with a mayo sauce and huge juicy shrimps ("shrimp salad"), the island version of enchiladas- open-faced deliciousness piled on homemade fried tortillas, soda and strawberry cupcakes from a box topped with green frosting! HAH! Local food at its finest. Of course, the seafood is plucked from the ocean just steps away straight onto the plate! And despite eating local food like this and more, I have YET to experience any sort of indigestion...

FUTURE PLANS- This evening, I plan to work with the kids of Sandy Bay in an after-school program called S.O.L., which is currently being organized by two young guys from Ireland who are here for 8 months. Outside of the clinic, it sounds like I can make myself most useful in the poor barrio of La Colonia. They need everything, including health care education and a system for trash pick-up. Perhaps I will focus on these 2 items during my month on the island.

TO CONCLUDE- Yikes! This is taking forever. There is no running water at the hospital so the bathroom is a pour-a-bucket-of-water-in-the-toilet-and-hope-it-goes-down ticket, so I can't stay here much longer if I want to avoid that! I know this update is mostly island history, background and people, but with the hospital closed for the holiday and weekend, I really have spent most of my time learning what I've written above through word of mouth. My next update will hopefully focus more on my work in the clinic and community.

Chrissy Journal 15

This week was just Dr. Mario and I in the clinic. Sabreen left last Friday, she is a really nice person to get to know and a great sounding board for me as I am wrapping up this internship and figuring out what steps I need to take to get into a medical career. Dr. Hott left Thursday, I found him to be an inspirational doctor, and hope I can be half the doctor he is. He has an amazing attitude and is overflowing with energy and great ideas. I’m so glad I had the opportunity to work with both of them.
Again, Friday was a holiday. Labor Day, April is quite the celebratory month out here.
Mario admitted a baby to phototherapy this week, not quite as high as the last baby, but jaundice, she also went home the next day, after her bilirubin levels dropped down to 11.

Swine flu has become quite the scare down here. They had a meeting on Tuesday afternoon for the doctors, which I did not attend, but they are worried about it. I think Mario is going to try to contact Dr. Howard about getting some Tamiflu for the hospital. The hospital wanted us to start filling out special paperwork for everyone that comes through with a cold. Can you imagine what that would look like from our clinic, that’s every other patient?! I think they talked them down to reporting only the cases that look like they could be the flu or pneumonia, because I never saw any special paperwork to fill out.
Yelsi gained 200 grams! She’ll come in next week for a weight check and the following week she’ll go back to San Pedro for a check up.

Dr. Hott did a presentation on pallitive care on Wednesday and even had the surgeon and the internal medicine doctor in attendance, impressive. It was a good presentation on prescribing medications and helping families of patients that are dying. I thought it was very interesting, and I think it was something new for the social service doctors. They seemed to really appreciate a list he made of how to talk to the family of a deceased patient and what to do to help them by just taking a few extra minutes.
Andrea arrived Wednesday and started in the clinic Thursday. We showed her around and got her oriented. I think she’ll do a great job and have a wonderful experience.

Chrissy Journal 14

Another relaxing week, as we had Monday and Wednesday off. Two more holidays, so the clinic was closed, although noone could tell us what the occasion was.
Yelsi came in this week!!! After being admitted in San Pedro Sula for 24 days, little three month old Yelsi came in with a diagnosis of a Patent Ductus Arteriosis. She has surgery scheduled in November, and a check up again in May. She looked much better. She is still really skinny, but she is on high calorie formula and she is going to come in for weekly weight checks and we are going to try to help them with transportation, if we can.

I single handedly successfully identified a case of chicken pox, Dr. Tami taught me how to identify them. I put them up front to try to get them in and out of the hospital, and back home. Only to see them walking around the market after we left clinic. We had a little girl come in with croup. I think it was the first time I had heard a cough like that, it was very ‘barky’. Lots of parasites this week, too.
Dr. Sabreen did a presentation over different skin diseases and problems in pediatrics. It was a lot of fun as it was set up as Jeopardy. I think everyone really enjoyed it, although Dr. Hott dominated the game. Then Dr. Hott and Dr. Sabreen did a presentation for the nurses. It was basic Emergency medicine, simple procedures, reviewing ABC’s and some advice, or tips on things to think about when patients present and how to procede. I think they really appreciated the doctors taking the time to give them an educational presentation.

Chrissy Journal 13

The clinic was really busy the other days, probably because of not being able to get into the doctors the last week.
We had one six day old baby come into the clinic Tuesday with high bilirubin levels and we had to admit her and put her in phototherapy. Her parents were very bright and her father went home and did all sorts of research on jaundice on the internet. After two days she went home. Her bilirubins spiked again over the weekend, but they kept putting her out into the sun and they came back down and she is doing good, now she’d getting a suntan.
Dr. Hott did a presentation on CPR, he had videos in Spanish. I didn’t get as much out of it, but I think the social service doctors did, so that’s what matters.
We did see two kids with malaria this week, and the let us see their blood smears in the lab. Other than that, lots of the ‘usual’, colds, scabies, ear infections, and parasites.

Chrissy Journal 12

This week was a holiday week in Central America, Semana Santa, or Holy Week. The hospital had already said that Thursday and Friday would be holidays and the clinic wouldn’t be open, but when we showed up on Monday, the government had declared the whole week a holiday. We were already here and there were a few patients wanting to be seen so we saw them. Mario had arrived really early and had the newborn exams done by the time Sabreen and I arrived. We just saw a few colds, pink eye, and tonsillitis.

Chrissy Journal 11

Ostin gained a pound!
It was Dr. Tami’s last week, and I will miss her, she was a really excellent teacher. She taught me how to do the newborn exams and supervised while I did them on my own on Thursday and Friday. Dr. Sabreen also arrived Wednesday afternoon and started in the clinic on Thursday. We won’t have any residents this month.
Dr. Dennys did a presentation on drowning, in preparation of the holy week, and anticipation of possible problems with the tourist influx on the beaches.
It was a usual week, other than that. Colds, faringitis, tonsillitis, eczema, just a little bit of everything. The best part was definitely learning how to do the newborn exams!

Chrissy Journal 10

I talked with Baby Yelsi’s mom multiple times through the weekend to make sure she got admitted and would get the echo. She got the echo on Wednesday and still hadn’t seen the cardiologist, and they wanted to keep her longer, but Yelsi is doing well. I asked her to make sure that she bring copies of all the test results and everything when she returns to the island and come by our clinic to let us know how all is going.

First thing Monday morning I passed a baby boy, and I asked if he was a ten day check, so that I would get him through first and the mother said that he was a three month old. Ostin, ended up coming to our clinic from Miss Peggy’s clinic. He was 8 pounds at three months, and had brochiolitis and a failure to thrive. His mother died when he was two weeks old, so his aunt is caring for him. We decided we didn’t want to admit Ostin to the hospital, so Tami taught Dilsia, the aunt, to increase his caloric intake with more formula, and just treat the cold with supportive care. She then asked her to follow up in three days. He came back and Tami gave him an inhaler but he seemed to be doing okay, and we asked her to come in at least once a week to check his weight and make sure he was growing.

It was Dr. Preetha’s last week in the clinic. Dr. Tami did a presentation on back pain. She presented a case and went through the differential and it was a case of Tuberculosis. It was really interesting.

In addition, we could have used some permethrin this week. Lots of scabies, I was starting to itch just seeing all the kids with scabies. And all we can give them is Scabicide, which one of the doctors told me just treats the itching and doesn’t really kill the scabies. Other than that we had lots of faringitis and a possible Tuberculosis case that we had to send to La Ceiba to get tested.

Chrissy Journal 9

Again, the clinic was full this week. Although it was nice as Dr. Tami sat right next to me, so I got to see a lot of cases and eavesdrop on the consults, it was very interesting. Of course, we saw lots of colds. We had quite a few scabies cases and Tami taught me how to identify some of the signs of varicella, we had two cases this week.
We had one four month old baby who has come in four times in the last month with diarrhea, this week he had blood in his stool, so Tami treated him for parasites and he finally got better!

We had a girl that came in with a spot on her neck that was growing and Dr. Howard showed us the excellent resource we have of sending pictures to a dermatologist in the states for a consult. He came back with the the same results as Andrew, Mario and Howard, but then narrowed it down to a fungus. It is a nice resource, as we see many skin problems here.
Dr. Preetha she did a presentation on Ascaris and empiric treatment on Wednesday, that was really interesting.
On Friday, Tami and Preetha were pulled into 3 cesarean deliveries and when Preetha went to check on one of the kids, she was stopped in the emergency room for advice on how to treat a 3 month old baby girl in congestive heart failure. Andrew and Tami went to see her and treated her with Lasix and decided she needed to go to the mainland to see a pediatric cardiologist. They decided that she was stable enough that she could take the ferry and busses, and Global Healing would have to fund the trip as the mother could not afford it. Dr. Dennys made a lot of phone calls to make sure that we could get the baby admitted into the hospital and seen by the cardiologist once she arrived in San Pedro Sula. It seemed that everything would work out. The mother couldn’t get clothes and everything she needed on Friday afternoon, so she went Saturday morning and Tami and I went with her on the ferry, she seemed to be stable enough to make it to San Pedro when we parted in La Ceiba.
It was Dr. Andrew’s last week, too, but he left his cell phone number at home on the wall, to call for consults. Dr. Howard departed this week as well. It was great getting to know him a little better and I am really looking forward to all of his advice for getting into the medical field.

In addition, I also set up a way to copy the typed charting and tape it onto the hospitals required charting, which eliminates the task of typing it all up and then handwriting exactly the same information onto the hospital chart. Now I just copy it into a Word document, adjust some of the columns, print it, and tape it onto the hospital form. The Statistics department, said they think it’s fine, so I have saved myself a lot of time and hand cramping, I’m very happy with it. Only wish I had done it sooner.