Sunday, August 30, 2009

Quynh Journal #2

It has only been two weeks on the island, but I already feel my medical Spanish improving, as it’s taking me less and less time to formulate questions and record answers while triaging patients. Although triaging exposes me to the variety of illnesses from which Honduran children suffer, I have learned the most through shadowing the physicians and asking them questions. It has surprised me to find out that the patients here only have to pay around 15 lempiras (equivalent to a little less than a dollar) in order to see a doctor. Furthermore, medications only cost about 3 lempiras each, which is affordable to most patients. One particular mother came in with a child who had a high fever and chills; because the doctors suspected she had malaria, they ordered a malaria smear. The first thing the mother asked of course, was how much did it cost. I was very relieved to tell her that it cost only 30 lempiras, which was luckily inexpensive enough for her to have the lab test. Incidentally, the results were positive, which immediately influenced the doctors to prescribe Chloroquine to treat her. I am glad that the public health care system in Honduras makes it possible for many patients to be treated for their illnesses; however, I also realized that this came with a 12% sales tax, and the help of many social service and volunteer doctors.

One of the most interesting medical cases I encountered this past week was an umbilical hernia, which presents itself as a two-inch protrusion of the belly button. Although this was the first time I had witnessed anything like this, I quickly learned that they were very common in Honduras, which again reinforced the notion that the children here suffer from so many things that we do not really worry about when in the United States. And although the public hospital does offer their services at an affordable price, the problem is that they do not offer many services—thus, those who needed complicated surgeries or chemotherapy treatment needed to be referred to the Mainland for care. This of course, would involve at least a two-hour ferry ride, following a by nearly a seven hour wait to arrive to one of the main hospitals.

This past week also included my first time volunteering at the eLearning Center. There, half of the children were doing computer activities that helped them learn English, while the other half were listening to cassettes that read aloud children’s books. However, I noticed that the children were requesting the tapes to be in Spanish! It was then that I began to read to the children the stories in English, teaching them to point at the pictures that represented certain words. I think I will start with these baby steps in teaching English before moving on to more ambitious lessons, such as how to maintain a healthy diet on a daily basis.

Meanwhile, I’ve had the chance to hang out with the locals more. In addition to eating out in West End with friends, I snorkeled in the mangroves, swam in the ocean, and even had a dolphin encounter!

Quynh Journal #1

My first thought when I stepped foot on Roatan was that this island was like a tropical paradise! Everywhere, I saw palm trees and colorful flowers; in the distance was a beautiful ocean with glistening water, and although the climate was quite hot and humid, the occasional soft breeze made the heat more than tolerable. Walking down the dirt road to Miss Peggy’s apartment where I now live, however, I was struck by the harsh conditions under which Hondurans reside—run-down houses built close together in clumps, with trash lining the dusty pathways, and the strong smell of garbage prevalent in the air. I had a feeling that although the trees and the earth seemed to be in perfect harmony, the people of Honduras endured many challenges each day.

Arriving at the hospital on my first day at the clinic, I understood that one of these challenges must be long wait-times necessary to see a doctor. Up to 50 people were waiting on the three or so benches that lined the hallway leading up to the Roatan Volunteer Pediatric Clinic. Mothers and their children clustered closely together as they waited to be called in this hospital—and unlike the hospitals in the states, this one was a rather short dusty brown building that blended in with the rest of the convenient stores and small family-run businesses in Coxen Hole.

The clinic that Global Healing itself was more appealing with its soft baby blue color and the “Healthy Eating” posters lining the walls. It didn’t take me too long to learn that many children here love to drink fanta and frescos, and weren’t eating correctly. Interestingly, the kids coming who came to clinic did not suffer from obesity—instead, many were diagnosed with Failure to Thrive and poor growth. One particular child, at one year of age, was at only 6.2 kilograms! He had bulging eyes that were too large for his rather small head, and a spinal cord that seemed to protrude from his backside in several small spikes. The baby suffered from many seizures, but he came due to other illnesses as well. It was overwhelming to see how just one child presented with so many different problems.

In the four days I have spent thus far at clinic, I have learned so much about the common health problems that the kids here must deal with. The most frequent case I’ve seen is diarrhea and a loss of a appetite, caused by worms. I’ve realized that the kids here suffer from many things that we never really even think about when we’re in the states—about 90% of the kids have parasites, perhaps due to fecal matter and other contaminants often present in the water. In fact, the government mandates the administration of Mebendazol to all children every six months just because it is that prevalent. Other common illnesses include asthma, a variety of skin rashes, and of course, the fevers and coughs often found in young children.

Through conversations with the residents and the attending, I’ve also learned that in underdeveloped countries such as Honduras, the lack of medical resources is a huge problem. It’s so common in the states to order lab tests and brain scans so as to better evaluate a medical situation, but here, such options are not available—and even if they were, parents would most likely forego them due to the high cost. Therefore, I think a skill more valuable than a vast knowledge of the full treatment of various diseases, is the ability to almost improvise-- use what you have to treat illnesses you suspect present.

I’ve spent most of this first week adjusting to the island, exploring West End with its variety of restaurants and tourist shops, and enjoying the gelato and clear turquoise beaches of West Bay. Just today, I spent an entire afternoon at Gumbalimba Park to volunteer at an event Miss Peggy ran to fundraise for Clinica Esperanza. What I like about Roatan is that it’s a beautiful place with so many friendly people! However, the problems of poor health and education remain at the forefront of my mind, and in addition to working at the hospital, I plan to volunteer at the Learning Center starting next week. I’m not quite sure what to expect yet, but I hope I’ll be able to teach English to the kids and impact their lives in some small way by also providing a bit of health education.

Erin Journal #4

I can’t believe that I’m writing this journal update from the US! I returned home late last night (Saturday) and now I’m reflecting on my last week on the island.

Clinic this week was different than previous weeks because I started training the new intern, Quynh, on Tuesday. That meant that Monday was my last day to be by myself in clinica diez. It was a crazy day with nearly 15 patients. We had a very sick kid who also had difficulty breathing and needed nebulizer treatment. With the neb machine running and three doctors seeing patients, the clinic felt very crowded and noisy. The chaos made the time go by very quickly, and before I knew it, clinic was over for the day. I helped Dr. Kristen prepare for her first class for the nurses by showing her the fotocopias shop. Then we hopped on a bus that took us through La Colonia. I’m not sure what I was expecting of this poor neighborhood, but what struck me as most interesting was the location of all the houses on the hills. The houses did not look particularly stable, so I can imagine that when it rains and mudslides occur, the houses may be damaged. It was interesting to see the barrio that so many of our patients come from. After living for weeks in Sandy Bay and hanging out in West End, it is easy to forget that there are neighborhoods on the island that are as poor as La Colonia. Driving through the main street gave me a bit of perspective of why giving of time, energy, and effort to help people is so important. I hope I can return in the near future to personally impact this community.

It was nice to slowly hand over the triage and clinic duties to Quynh so that I could shadow the residents and Dr. Mario. Although being a clinic coordinator is a fun and interesting job, my true love of medicine stems from being able to witness the doctors interact with patients and turn the information given to them into a diagnosis and course of treatment. I’ve learned so much about common pediatric ailments and medications. It’s been very helpful to have constant internet access and a library of medical text books in the clinic for us to look up terminology that we are unfamiliar with. Working in the clinic has also shown me how collaborative medicine can be. Whenever there was a question or doubt of what a child had or how to treat the child, the doctors would confer together and give each other their professional opinions. I appreciate that although doctors operate alone in some situations, practicing medicine is a team effort.

On Friday, I accompanied Dr. Emily, Dr. Ahila, Dr. Kristen, and Dr. Mario to the Coxen Hole Day Care next to Yaba Ding Ding and HB Warren’s. Every couple of weeks, the Global Healing fellow and the current American physicians visit the day care to give the children physicals. The kids were super enthusiastic for our visit and couldn’t wait to be seen so they could claim stickers. I have never worked in a day care before, and I was surprised at the energy of all the children together. An hour with them truly exhausted me! The kids really took to the stethoscope; they borrowed Dr. Kristen’s stethoscope and walked around the room listening to each other’s hearts. They looked like future doctors!

In other news, I celebrated the Honduran futbol victory over Costa Rica with some of the doctors from the hospital at a local spot in Dixon Cove. After every goal, the team songs were played and everyone stood up to dance and high-five each other. It was really fun! On Friday, a bunch of Peggy’s volunteers and I went to Angelo’s in West Bay to make gelato with Juan Pablo. We made cookies and crème, ferrero rocher aka bon bon, and mango. Without a doubt, my favorite part was the taste testing!

I had such a great time in Roatan! It’s so strange to be back to reality after weeks in paradise. I’m grateful for the opportunity to experience the island and give of my time to the clinic. I plan on returning to Roatan at some point in the future. Until then, adios!

Nos vemos,

Wednesday, August 12, 2009

Erin Journal #3

In 5 days, I return to the states. In some ways, my time on the island has flown by, as I’ve acclimated to the hot, humid weather, the frequent power outages, and laid-back island attitude. In other ways, the time has passed slowly as I have tried to take advantage of all Roatan has to offer. I really cannot believe how much I have learned and grown since I have been here. Before I came, I was terribly afraid of all sorts of bugs; now, a gecko on the wall is no big deal and creepy, crawly insects have become part of the experience. My rusty Spanish has improved substantially, and I have learned many medical words. I have learned to be more adventurous with food and have ever dared to eat the hospital cafeteria food. (Just imagine what the cafeteria food must be like here if people in the US even avoid eating hospital food!)

I think the most important lesson I will take away from this place is the realization that one person really can make a difference, whether it be in healthcare, education, or policy. The idea of philanthropy is widespread on this island, and although I’m sure I’ve talked about this before, it still amazes me that people like Miss Peggy and the owners of Bay Islands Beach Resort can touch so many lives on the island. A bunch of us went to the Tequila Downs Crab Races again this past Thursday, which is a fundraising event for the e-Learning Center. We raised $472, which is enough to put one child through one year of the educational program. It was so great to see so many people giving back to a community that isn’t their own. I guess crab races are pretty popular as a fundraising event, as there was another one that we went to in West Bay that raised money for families affected by HIV on the island.

This past week in clinic really flew by. We were lucky to have Dr. Howard with us the whole week as he prepared for the third annual Trauma Conference. On Friday, he took me to visit with a newborn in the pediatric ward. She was born full-term but low weight for gestational age; she looked very tiny and fragile. We examined her fully, finding that she had cleft lip and palate, a heart murmur, and an enlarged liver. As I have never really listened to hearts before, I wasn’t sure what to listen for when I held a stethoscope up to her chest. Dr. Howard said I would hear a shuffling sound after the first heart sound; thank goodness he told me, otherwise I wouldn’t have been able to tell what I was listening to! This baby was interesting because during the entire exam, she didn’t cry or flinch at all. She was unresponsive and lethargic. After returning to the clinic, we looked up chromosomal trisomies that could cause severe cleft lip and palate and found that many of the children don’t survive their childhood. I really hope this child does.
Dr. Howard taught me a good lesson on pediatrics this week. Patient care relies on trust between the patient and doctor and in the case of peds, also between the doctor and parent. With adults, trust can be established with some form of body language or kind words. With kids, it’s a bit harder. Dr. Howard told me to think about people as if they have an imaginary box around them; this is their space and others must be invited to invade their space. He discovered that peds patients respond much better to him (as in they don’t cry or squirm around) when the kids cross the imaginary line (between your space and theirs) themselves. The way to do this is to offer them a sticker or tongue depressor, but hold it on your side; this way, the child reaches over into your space and unconsciously invites you to enter theirs. I never thought to think about patient-physician trust and communication in this way, but it makes a lot of sense. I’m really going to try to do this with kids next week and see if they trust me more when I let them cross that imaginary line first.

Saturday I attended the Trauma Conference, which I thought was a success! Accomplished speakers were lined up the whole day to give lectures on pediatric trauma, advanced life support, abdominal injuries, and burns. Although the lectures were all in highly technical Spanish, I was able to understand a bit of it. I made a list of all the words I heard and saw on slides that I didn’t know; it’s a very long list! I especially enjoyed Dr. Janice’s talk on H1N1, not only because it was given in English, but also because it added to my knowledge of the pandemic. I had no idea that swine flu may present with diarrhea, which is a symptom not commonly seen in regular flu. It’s scary that swine flu only responds to a few medications, and those medications are in short supply around the world. The physicians at the conference joked that Roatan would be one of the last places to get the drugs; the sad fact is that it’s probably the truth.

In other news, I finished my last training dive today! We went to Overheat Reef out past Anthony’s Key towards West End. We followed the reef around to a wall of coral and swam along with the current. There was a ton of bright blue fish that swam in schools all around us. I really wish I knew the names of some of these fish because really all I can tell people about my dive is that I saw a blue fish, some black fishes, and fish with stripes. Our divemaster Shane pointed out fire coral, which looked like a large brownish red coral bush with white tips. It was interesting to try to interpret his shaking finger and subsequent touching of his arm to mean stay away from the coral. I guess this is where sign language would come in handy to communicate!

This afternoon, we’re heading to West Bay for beach time and Angelo’s gelato. We’ll probably do dinner at Banarama and then stay for the fire dance show. I’ve heard it’s really amazing with little kids flinging fire around.

Until next week,

Tuesday, August 04, 2009

Erin Journal #2

It’s my second Sunday on the island and time is really flying by. Last week was my first time in clinic and I was really surprised by what I found. Firstly, the hospital is bare with wooden benches for waiting rooms, limited air conditioning, and floors that never seem to be clean. The wards are small- up to 5 or 6 beds in each of the men’s and women’s health and pediatric wards. Labor and delivery (labor y parto) is a bit more impressive with a nice, air-conditioned birthing suite. Thankfully, the recovery room for newborns and their mothers is also air-conditioned. Secondly, the machines are somewhat ancient. The two engineering students from University of Michigan tell us about machines that are from the 80s and early 90s that the hospital depends on. What’s amazing is that the hospital runs quite effectively for having such limited resources.

Mondays are the busiest days and I was greeted by a group of people in the hospital lobby and in the hallway leading to the two pediatric clinics (one being the Global Healing clinic) and the immunization clinic. We saw about 10 patients that day, which was an unusually small number. The mass hysteria about swine flu discouraged people from going to the hospital; the day was a bit slow because of it. It was interesting to try to work through my elementary medical Spanish to explain to patients that I was going to measure their height and weight and take their temperature. I’m sure by the time I leave I’ll be a pro, but for now I have to really study my Spanish medical vocabulary!

It’s amazing to shadow the American and Honduran physician during the purely Spanish visits. Although I have shadowed doctors during bilingual Spanish visits before, I find it very enlightening to deliver healthcare in a country that speaks a language that is not my native tongue. There are nuances to the language and culture that only someone who is from the country or region might know. An example is the tendency to show affection or concern by touching the patient on the arm or the shoulder. In the US, the extent of showing concern would be a pat on the hand or sitting close by the patient. The invisible box that Americans put around themselves is not a concept that really exists in this country. It makes me think that the people on this island have created a more united community, although I am beginning to see some signs of a cultural divide among the native islanders and Honduran mainlanders.

In my effort to be more cognizant of the different cultural groups on the island, I’ve noticed that the native islanders generally like to be spoken to in English and are offended if you speak to them purely in Spanish. Roatan was once a British colony with English as its primary language. Once the Honduran mainlanders started to move to the island, the children began to be taught both languages. The transition to Spanish was fairly recent and some islanders don’t speak Spanish at all. I’ve heard many a side comment from mainlanders about the need for natives to learn Spanish because Honduras is a Spanish-speaking country. Now that I know this prejudice exists, I’m beginning to see it everywhere. I’ve also noticed that there are a lot of foreign ex-patriots on the island that are here for philanthropic reasons. The owners of Bay Islands Resort not only run a tourist and dive company but also dedicate time and money to improving education on the island with their E-learning centers. Miss Peggy has devoted her time on the island to open Clinica Esperanza, a clinic in Sandy Bay that has helped so many people. This island is full of people who are trying to do good in this world and it’s inspiring to be here.

So far, I’m thoroughly enjoying island life. The weather is hot, but lately it’s been raining and has cooled the earth substantially. I went for my first dive today! Three of Miss Peggy’s volunteers and I dove off of Bay Islands Resort to Spooky Channel for a 30 foot and 40 foot dive. It was amazing to see lots of brightly colored fish, conch, and sea urchins! Diving is a zen-like activity where you are very aware of your breathing and surroundings. Shane, our diver instructor, tested us on our skills. I really dislike taking my mask off underwater and clearing the water out of it. There’s something about being blind down there that really freaks me out. Otherwise, the island is beautiful and I’m already getting sad about leaving this place in two weeks. For now, I’m just trying to enjoy the beautiful weather and delicious mangoes.