Sunday, July 26, 2009

Erin Journal #1

Hola! My name is Erin and I am the newest HEAL intern to arrive on Roatan island. After delaying my departure by nearly two weeks, I finally made it to the island after two flights and a five hour lay-over in Houston. Flying over the island for the first time gave me a glimpse of a place I had heard about from so many of my friends, but have never visited. The landscape is lush with palm trees, gumbalimbo trees (aka gumbalimba), and various other flowering plants and trees. From the plane, the beaches looked sandy white and the water a crystal blue. I couldn't wait to set foot on the island! The consequences of the political instability on the mainland were manifested in the sniper policemen on top of the airport building (either to protect the island from tourists or the tourists from the island. I can't be sure) and the limited number of tourists flying to the island. The tourism industry is obviously being affected by the negative media even though the situation has not touched Roatan.

Since my arrival on Thursday (it is now Sunday), I have taken some vacation days and plan on starting in the clinic on Monday. With my two friends from college who met me on the island, we did a bunch of touristy things. We visited West End, ate at a delicious rotisserie chicken place (Creole's Rotisserie Chicken) and devoured thai peanut noodles from the Noodle Shack. I loved going to West Bay, where many of the high-end resorts are. The beaches are beautiful and the water is absolutely clear. Yesterday we went to Gumbalimba Canopy Tour and park and had an amazing time zip lining through the trees with iguanas and other wildlife around us. We saw beautiful spider monkeys and parrots and talked to the game keeper who gave us insight on what it's like to care for these exotic animals.

It was my goal to learn how to dive, so this morning I took my first diving certification class with three volunteers with Miss Peggy at Clinica Esperanza. It was the strangest thing to breath with a regulator underwater, but once I realized ample oxygen was being supplied to my lungs I became more comfortable with learning the skills. Even in the shallow bay where we learned to clear our masks of water, take off our tanks and weight belts, and recover our regulators, the sea life was beautiful. Lots of sea anemones and sea grass littered the ocean floor and little fish peeked out beneath rocks. I'm looking forward to our next dive on Tuesday!

Sandy Bay, where I am staying at the White Diamond Apartments, is a beautiful area. Many local families live here and walking along the roads offers a rare glimpse into everyday life on the island. Most tourists only see West End or West Bay and interact with Hondurans who work in tourism. I am blessed to have the opportunity to really experience both the tourist hot spots and local Honduran life. I've already discovered some local fare; my favorite so far are baleadas - thick tortillas topped with refried beans and delicious cheese that doesn't melt when heated. Any kind of meat can be added to the baleada, but I prefer the plain bean and cheese.

The weather (hot, humid, and a bit unbearable) really bothered me when I arrived, but my body is starting to acclimate to the constant sweating and overheating. I'm also getting used to the bugs and lizards that are found in the apartment. But, I don't think I can get used to the continual itch from mosquito bites. I've counted nearly 6 on my right leg alone and I fear it's only the beginning!

Thursday, July 02, 2009

Amanda Journal 1

My name is Amanda Schwartz and I just finished my first year of
medical school at Stanford. I’m originally from a suburb of New York
City and I also attended Stanford as an undergrad. I’ve studied
Chinese for most of my life but decided to begin studying Spanish in
medical school. I’m thrilled to be spending this summer as a HEAL

After two flights, one two-hour delay, and a nearly-missed connection,
I arrived on Roatan yesterday afternoon! The island is absolutely,
breathtakingly beautiful. Peggy Stranges (who runs Clinica Esperanza)
and a friend met me at the airport and drove me back to Peggy’s
apartment, where I’ll be staying for the next four weeks. On the way
home we stopped by Clinica Esperanza, where Peggy gave me a brief
overview and tour of her clinic. I must say I’m really impressed with
everything she has set up here—there is a dentist and pharmacy
on-site, and they are in the process of opening a pediatric in-patient
unit. It definitely seems like a wonderful place and one that is much
appreciated by the islanders.

Last night mostly consisted of unpacking, figuring out how to check my
e-mail, finding something to eat for dinner, and meeting the other
interns who are also here volunteering at Peggy’s clinic. Right now
there are a total of 6 of us here, but people will be rotating on and
off throughout my time here. The current interns have been great in
terms of showing me the ropes, including helping me do my first
grocery shopping (items purchased: Corn Flakes, white bread, and an
avocado!) and explaining how to negotiate for a reasonable price with
taxi cab drivers. I tried my first baleada, which is sort of like a
quesadilla but with a thicker tortilla shell. I’m looking forward to
shopping at the larger grocery store in Coxen Hole this week as
well…I’m not sure my current food supply will sustain me for too long!

After some much-needed sleep, I met up with three other interns this
morning and took a cab to West End, which is a hub of dive shops and
small cafes/restaurants about a ten-minute drive from Sandy Bay. Two
interns had scheduled a scuba diving lesson, and myself and one other
intern decided to snorkel, so the four of us spent about three hours
out on the water. I have done some snorkeling in the past, but
nothing compares to this—we saw probably 25 different kinds of fish,
plus lots of beautiful coral. The water is very clear and calm—I can
understand completely why Roatan is such a maven for divers. Our two
scuba divers had a great time and successfully completed their first
dives—in addition to fish and coral, they saw eels as well (although
sadly no turtles, which had been their goal)! After our trip we
headed back up to Sandy Bay for lunch and managed to watch the
U.S.-Brazil soccer game on TV—things were looking up for the U.S. at
half-time but sadly Brazil won in the end.

It is really hot, although there seems to be a breeze moving in
tonight, which will be nice. I’ve been told I’ll acclimate quickly to
the heat-- I'm hopeful that is true!

Tomorrow morning I’m meeting the current HEAL intern at hospital
publico to begin my training. I’m nervous and excited to see what
tomorrow will hold. The hospital is about a ten-minute taxi drive
from my apartment—this will be my first time going somewhere on my
own—I think I will spend some time tonight brushing up on my Spanish
vocabulary! I will update soon with information on how my first week
goes. In the meantime, here is a picture taken a few minutes ago from
my balcony.

Michelle Journal 5

It is unbelievable to me how fast this internship has gone by, the new
intern, Amanda arrived safely on Saturday and is getting used to the
island. It seems strange to be leaving after finally getting used to
the hospital and figuring out how to avoid some of the frustrations it
poses. My parents are down here visiting and explaining to them how
the clinic works and what I have seen and learnedis amazing to hear
outloud. Although frustrating that mothers give thier kids antibiotic
even if not needed and babies and children are malnutritioned and
encouraged to eat soda and chips I have really learned the importance
of health education. I know that the doctors in the clinic do a
wonderful job treating these patients but is is frustrating that so
many of these sicknesses could be prevented with education and when we
tell the mothers about proper nutrition and hydration they seem
genuinely thankful to have been told. I think that maybe the schools
and community centers around the island could start doing education
programs that would be very beneficial. Working in this clinic has
been an amazing experience and really opened my eyes to the healthcare
much of the world receives which is in stark contrast to the great
albeit expensive healthcare I am lucky enough to receive. These last
few days I am soaking up as much of the sun, diving and mango I can
handle and taking lots of pictures as well as training Amanda to take
over my place.

Michelle Journal 4

This week has been surprisingly slow in the clinic but pretty exciting out of the clinic. On Tuesday I came back to my apartment to find several hundred bees in my bathroom! They lived in the wall and had snuck it through a hole in the wall! Murphy the owner in the building patched up the holes and we thought it was fixed, only to find the next day that several hundred more were in my kitchen! we found there spot and stopped it up only to have the next say several hundred come out in the bedroom! I am not sure if there are still bees but I moved downstairs into an apartment that has far less critters! Also I got my diving certification so I have been enjoying all of Roatans amazing dive sites.

In the clinic we have had far less patients than usual I am not sure if it is because of the two cruise ships this week or maybe the rain? but the hospital has been empty by eleven am everyday! It still boggles my mind how an entire hospital can be empty by noon everyday and all the doctors leave. What happens if someone gets sick in the afternoon? The patients wait for several hours early in the morning only to be told if four hours later that many of the doctors of the left. It seems like such an inefficient system and sometimes it is very frustrating. Especially because I am down here to help out and I have the time to spend more than just a few hours everyday in the clinic. However, this week I have found something to do in the afternoons. Dr Diane, had a group of friends come down for these two weeks who are close friends of Miss Valerie (who owns the HIV clinic in Coxen Hole). Scott Fried is a professional speaker about HIV and safe sex and he and a group of people came down last year and this year to build a house for a family. This year the house is for this man named Alec and his family of four children (he just recently lost a child to a heart complication from Down Syndrome). He is the nicest man and has been the biggest help in building his own house. Every time he speaks he says he is so grateful for the gift we are giving him and he makes all of us cry. The neighborhood he lives in is called La Colonia which is one of the poorest areas on the island where the houses are all perched precariously on hills. The big project for his house is to build a retaining wall to make sure that when bad weather comes the whole thing doesn't topple over. The whole thing has come together extremely fast however we were at a standstill this weekend because la colonia only gets water once every 8 days for two hours and we need water to make cement for the floor. Hopefully we will get it so we can continue the rest of the work this week. Seeing how grateful he is for this house is amazing, especially because his entire family is living in a house much much smaller than the apartment I am staying in by myself. And regardless of everything everyone in the neighborhood is happy. All of the neighbor children come out to help lug buckets of sand and gravel even though they have no shoes and some don't even have complete outfits! This experience of building this house has been amazing especially to see some of the conditions that patients in the clinic come from. I can't believe that this is my last full week in the clinic already, I hope its a little busier than last week.

Michelle Journal 3

This past week has been so busy. Alice and Howard have been a huge help organizing and sprucing up the clinic, however they have been extremely busy setting up the physicians conference which took place thursday, friday and saturday. This conference unfortunately took Dr. Mario out of the clinic, but Dr. Diane and Dr. Vicky and I managed to do just fine. This week in the clinic we had two particulary interesting cases. The first one was this extremely intelligent six year old girl came in with her grandmother who said that she has never spoken a word in her life. How could this girl be seeing a doctor for the first time at six years old and she has never spoken? With the limited resources on the island we had a hard time deciding what the best course of action was for her, so we finally decided to refer her to a recently opened rehabilitation and therapy clinic in French Harbor. That same day a mother came in with her baby who she said was having a difficult time breast feeding. It didn't even dawn on me that something else could be wrong so I finished triaging and sent her to see Dr. Vicky who immediately diagnosed this little girl as having down syndrome. This baby was almost one and a half and no one had ever told this woman that her baby had down syndrome or given her any information about it.Im not sure she left the clinic understanding exactly what she has been told.

Outside of the clinic this last week I have been working to finish my diving certifications, however since I seem to be perpetually sick with the gripe I see every day at the clinic, I am too congested to be able to dive. Hopefully I will recover enough to finish it in the next three weeks! Also on Wednesday, Andrea, another Ms. Peggy volunteer and I went up to la colonia to talk with some women about nutrition while pregnant, nutrition for their babies and the importance of breast feeding. The women seemed intrested in what we had to say but no one asked any questions or had any comments so I hope that everything was understood and that our terrible spanish accents didn't get too much in the way. I understand why they might be confused though, we are telling them the importance of eating dark leafy greens, eating protein, calicum, folic acid and iron. However, I can't even find spinach and broccoli on this island and if I do it is certaintly not cheap. For these women who live in poverty many of the rules and suggestions we were providing don't apply at all. In retrospect, I think we would have been far more helpful if we had changed our discussion to apply to the particular situations that many of these women are in.

Today, was the first time I have seen rain and it hasn't stopped for almost two hours! I am learning to enjoy Roatan more as a local than a tourist and I am loving every minute of it!

Michelle Journal 2

Two days before coming to Roatan, I was sitting at dinner with my parents discussing plans for when I graduate next year. Do I want to go to Public Health School, Physicians Assistant, or maybe a nutritionist? I had thought I never wanted to be a doctor. However, after only 3 days working in the clinic I had decided without a doubt that being a doctor was definitely something I wanted to do. It has been amazing talking to people in all steps of the doctor process about their experiences. Dr Mario, Diane and Vicky have been a great help and could not have been more enthusiastic about med school. However, it wasn't until one night when Andrea, who is going to med school in August and Dr Mario, and Dr Dennis (another Dr from the clinic) who are in their last year of residency and I were sitting on the dock watching the sunset and answering the question "why do you want to be a doctor". It was a unanimous answer, "to help people". I am down here working in a clinic, helping people and doing exactly what I want to do in ten years. What could be more convincing?

This week at the clinic has been great. Monday and Tuesday were the busiest while wed (cruise ship day) was the quietest. Also, Dr. Howard and Alice arrived this week and have big plans for the clinic. We have been reorganizing as best as possible and loading up with all the supplies they brought down. They have also been a great help teaching me about the different sicknesses as well as how to exactly take the height and weight measurements of the children. One child came in who had swallowed an entire bottle of acetaminophen (Tylenol) and then had a fever overnight so when the parents came into the ER with a fever the first thing the doctors did was give him more acetaminophen! I feel that miscommunication between patients and the doctors is unfortunately pretty common in the hospital as well as not enough communication between different areas of the hospital. If not for the mother we would have had no idea that this boy was given more acetaminophen that morning. After Dr. Diane made a call to a surprised poison control branch in Minnesota we figured out that the boy was not in danger of poisoning and in fact he tested positive for Dengue Fever. It is very difficult with many of the patients to figure out what is wrong with their children, for how long have they had it, and what medicine was given. I have had to practice a lot of Spanish in order to finally figure out how to get parents to tell me that yes they actually have been giving their child the antibiotic for the last 5 days. Although it is so rewarding, it can also be very frustrating. The next couple days will be busy with Howard and Alice preparing a physicians conference for all of the doctors on the island and Dr. Mario will also be away from the clinic a little bit more.

The island itself is amazing and I am loving the sun almost every day and have yet to get a sunburn thankfully! my task for tonight is to read my diving certification book and figure out how to get the bumble bees out of my shower!

Michelle Journal 1

Well, my first day in Honduras started out exciting because everyone was talking about the 7.1 earthquake that happened the night before I arrived. First I heard of it was on the runway in Houston when the pilot informed us that just in case we had enough gas to make it back to Texas if we can't land! I arrived safely and Andrea the previous intern was there to pick me up. The island appears OK with very minimal damage done to the infastructure although everyone was pretty shook up. The first thing that surprised me was how hot it is down here, I knew it would be hot but I wasn't at all prepared! The first day here, Andrea showed me around Sandy Bay and we went to West End and walked around a little bit. I love the island so far and everyone I have met has been extremely friendly. The first day at the hospital was amazing. I am glad that I kind of new what to expect, otherwise I would have been a little shocked by the seemingly chaotic and hot hospital. Andrea, and Dr. Mario are great at helping me get organized and get the hang of things. For the first couple of days I shadowed Dr. Mario while he did his newborn checkups. Dr. Mario is great about showing me everything he is doing and explaining to me what it means. Since I have yet to go to medschool, everything I get to see is facinating. Most of the kids coming in have respiratory infections, parasites, colds and a couple of them have chicken pox. I am practicing my medical spanish and learning new words everyday! I have one more day in the clinic with Andrea and then I take over with the new doctors who got here this morning. So far, minus the earthquake my time here has far surpassed what I was expecting!

Andrea Journal 3

Last week in the clinic we were lucky to be joined by Annie’s mom, Rosie, who came to the hospital as a “volunteer volunteer” while on vacation. Rosie was absolutely fantastic! She made the babies stop crying, gave out stickers, took heights and weights, drew pictures with the kids, rearranged the furniture in the intake room and even spoke some Spanish! I was spoiled to have so much help, and I got to spend extra time shadowing the doctors on rounds and in clinic.

Monday and Tuesday were quiet days in the hospital because of the worker’s strike. The people usually doing intake were on strike as well, so I stood at the hospital entrance and tried to point all the babies and children who came through the door towards Clinica 10. We even saw a few young adults because the other clinics were closed.

One young mother brought herself and her child in for a check up. The mom had been experiencing shortness of breath, dizziness, heart racing and palpitations in periodic episodes ever since her daughter was born 3 years ago. One of the doctors ordered a urine test for the child and a blood test for the mom. Mom and daughter returned, but the mom had not gotten her blood test done; when I asked why she had no results, mom told me she was scared of needles. The doctor told her she could get an EKG in the emergency room instead. I decided to walk her down to the emergency room to make sure the EKG got done. I had a feeling that things might not go smoothly, and did not want the scenario of the premature failure to thrive baby from last week to be repeated in another lost patient. I’m glad I escorted her, because the doctor that she spoke to in the ED curtly turned her request down saying that the EKG tech was not in the hospital that day. I sat mom down and reassured her that an EKG was completely painless and quick. I asked her to please come back tomorrow to have the test done and tried to emphasize the importance of her compliance. She promised she would return, but given her noncompliance with the blood draw orders, I could only hope to see her again. I asked her to stick her head in Clinica 10 to say hello to us tomorrow so that we would know she had come back. As she walked out the door, I was doubtful that I would see her again.

The following day, in the height of clinic, mom and daughter peaked through the door with a printed EKG! I was incredibly surprised and thrilled. The patient may have followed through with the doctor’s orders regardless of my efforts, but I had been so disappointed about the sad little baby from last week, that I considered this an uplifting success, however small. The possibility that the 10 minutes I spent walking her to the ED and convincing her to return may actually have made a difference makes me want to be able to spend just as much personal time with every patient that I see as a Global Healing intern, future medical student and doctor. Hah! Naive and blissful, but I’ll wish it anyways.

By Thursday, the hospital was back to hot, crowded and smelly normalcy. As usual, we saw a lot of cough, cold and fever. We admitted a few very sick babies to the hospital, administered nebulizer treatment to asthmatics, prescribed tons of medicines for parasites and creams for rashes. My immune system is finally failing and I have come down with the beginnings of a cold. I have been bracing myself for this to happen since I am playing with, picking up and talking to sick kids and their parents all day long. Lucky for me that Vitamin C grows wild on trees in front of my apartment!