Sunday, March 14, 2010

Molly Journal #7

December 13th: Week 7

On Thursday a hospital nurse came in and gave us free H1N1 vaccines. I gladly accepted because the vaccine was not ready in Oregon when I left. I suppose it is a good precaution, although it’s a little late in the season. Mario said there were only a few H1N1 cases this fall at the hospital anyway. However, I thought it was nice the hospital gave free vaccines to their workers.

It is interesting how the load of patients flows with cruise ship days. Fewer mothers bring their children in when the cruise ships are here because they need to work and try to profit off the tourism. Cruise ship days are pretty entertaining around West End as it is very obvious which confused Americans found themselves here for the day.

On our busier days I do not have time to do much other than paperwork for the charts, weighing and measuring. It is getting a little redundant and I prefer when I have a little time to shadow the doctors. Also the range of Spanish I get to use is pretty limited to repeating phrases like “put the baby here for the weight.” There is not much time or opportunity for more conversation. I am also a little disappointed by the lack of Spanish speaking in my life outside of clinic. Everyone in West End speaks English. I thought I would be speaking Spanish all the time here, but it is not the case. Even about a third of our patients speak English primarily.

My parents are visiting and over the weekend we took a catamaran to Utila. It was a 4-hour sail each way. We had great weather and I enjoyed sitting on the boat in the sun and watching Roatán disappear then the little island of Utila appear to the West. We could clearly see the silhouette of the mainland from the boat, especially the peak of Pico Bonito. Utila is a really neat island. It is small, about the size of West End to West Bay, and much less developed. It has a nice neighborhood feel and is kept very clean. Because there is only one town, the ex-pats and the locals seem more intermixed than here on Roatán. The cost of living is much lower, which attracts many young backpackers. It seemed like a nice place to live, although Roatán has better beaches.

Molly Journal #6

December 6th - Week 6

This week went by quickly as we had Monday off for the post-election
holiday. We have been busier in the clinic now with two doctors. We
are seeing 25-30 patients per day now in contrast to about 15 when it
was only Dr. Mario. Dr. Robert has settled in well here but is still
surprised by the short work day. It is always a big rush for 3 or 4
hours, and then clinic is done before noon. With two doctors, I do not
have as much time to sit in on the appointments because I am preparing
the patients as fast as they get through them. However, both doctors
are very kind to call me in to see, for example, an interesting case
of impetigo or shingles.

My dentist at home in Oregon, Dr. Bodyfelt, has agreed to donate 300
toothbrushes to the clinic! My sister will bring them in a few weeks
when she comes to visit. I am so happy we will have toothbrushes to
hand out to some of the children. Even if the supply only lasts a
month or two, it will be helpful to those 300 children.

I may have written about this before, but I keep thinking how grateful
I am to have a job on the island that keeps me connected to the real
lives of the citizens here. It is so easy for ex-pats living in West
End to never leave that “bubble,” never speak Spanish, and never
understand the poverty that the great majority of the population live

Molly Journal #5

November 29th - Week 5

Yesterday, November 29th was the Honduran presidential Election Day. Today the hospital and all government businesses were closed for the day-after-election national holiday. Today it was announced that Pepe Lobo is the next president of Honduras, which the US has agreed to recognize. The weekend went smoother than I expected. There were no disruptive demonstrations. The government mandated bars to close for the weekend and liquor sales cut off. Also, Saturday night about 7pm the power was shut off. So without alcohol or lights, the chance of the public getting riled up was low. Islanders admit there was no particularly great candidate but they are happy with Pepe as he is pro-tourism. Also good for tourism- the US has lifted it’s travel advisor to Honduras. Hopefully tourists will come because the local economy was terribly hurt by the political situation.

The new attending, Dr. Robert, arrived yesterday. He is a pediatrician from Wisconsin who has spent half of the past two years doing medical work in Peru. I am looking forward to learning from him in the clinic.

This last week I worked on some organization in the clinic. It is obvious that many people have worked there for short periods of time and created their own partial organization systems, which do not translate to the next person. Having resources is one thing, and being able to find them is another.

I have really enjoyed working closely with Dr. Mario this week. He has been wonderful at explaining to me any disease, medication, or illness I have questions about. He lets me listen in on his consultations and shows me, for example, how to look into a child’s ear and tell if it is infected. I am very much enjoying working with children and leaning about the particular issues here, as well as common health problems with children everywhere such as tonsillitis. I feel lucky to volunteer in a position where I work hands on with the patients and closely with the doctors. Most opportunities, especially back home, do not allow for this great of exposure.

Molly Journal #4

November 22nd - Week 4

I have officially been here 1 month. I am glad I have chosen to stay for 3 months, because I am just beginning to understand the island and the culture. More so, I am learning more every day about the common diagnoses in the clinic and understanding the patterns of the medicines used. There are the most frequently prescribed medicines such as Diphenhydramine, Acetaminophen, Piperazine, Mebendazol, Amoxicillin, Salbutamol etc. These all are prescribed for a wide variety of illnesses because there are really so few medications available. Nearly every kid gets the parasite medications as a general precaution. Many come in just to get multivitamins. I have had several people this week ask for a toothbrush. We don’t have any, so I am going to make it a goal to get a supply soon. Giving each child a toothbrush would help also one of the causes of malnutrition here: dental carries. Many children have rotting brown molars, making it painful for them to eat. This leads to malnutrition, which leads to greater susceptibility to illnesses. Clearly I cannot stop this downward spiral but at least giving out toothbrushes is a place to start.

Once a week or so the hospital nurses present information to the mothers waiting in the hallway outside the pediatric clinics. Last week the nurse had a large colorful chart demonstrating the benefits of vaccinations. This week she spoke about H1N1 and passed out pamphlets. The nurses are really just yelling this information to anyone willing to listen in the busy hallway, but it does seem that most mothers do pay attention. I am really impressed by this. However random the presentations are, the information does reach some people. These mothers have already taken the effort to bring their children to the doctor and are made to wait so really it is the best timing possible to convey relevant health information.

Now that I am comfortable in the intern job and the necessary Spanish vocabulary, I can spend more time learning about the diagnoses. Dr. Mario explains to me a lot of the medical vocabulary and tells me about the illnesses, symptoms, and causes. I am surprised actually that we do not see many Malaria cases. I had expected it to be more common. Also, I do not think we have had any H1N1 cases, or else they just don’t test to verify.

In news outside of clinic, we have had beautiful weather this week. I got to eat some fresh caught Tuna, Bonito and Baracuda fish with friends here. I spent Saturday at beautiful West Bay beach. I also finished my advanced diver certification this week. I feel incredibly lucky that this internship opportunity has brought me to such a gorgeous place.

Molly Journal #3

November 15th –Week 3

It has been 3 weeks now and I feel quite settled in. I have met lots of great people through scuba diving here. There have been difficult days of extended rain but then it clears up again and I am extra grateful for the sun and calm water.

I am sad that the residents left on Wednesday; I really enjoyed them and feel a bit lonely now. In clinic now Mario is the sole doctor for a few weeks. This actually works out well because now we go through patients slower, so I can get all the triaging done and have time to listen in on the consultations. Before with 3 doctors I could only just keep up getting kids ready as they went through them. This will be good to listen to Dr. Mario work with the patients and learn more from him.

I am happy that the woman with the premature infant has been returning for weight checks. She is so proud that every time he is gaining weight (yay!). It is wonderful that she listened to the doctor’s advice and is really following through. So, there is hope for this baby.

I’m feeling competent with my duties in the clinic, My Spanish is warming up and even when a mother goes off on all the problems of the child, I can follow pretty well. Unfortunately though, everyone in West End speaks English, so my Spanish practice is more limited to clinic.

Molly Journal #2

November 8th- Week 2

This week the residents and I went to Anthony’s Keys resort to swim with the dolphins. First, we were lucky enough to have Dr. Howard arrange a tour with his friend Dr. Paul of the hyperbaric chamber at the AKR clinic. They decompress hundreds of patients a year, mostly lobster and conch divers. We even got to see a rescue course do a nitrogen narcosis simulation in the tank, which was entertaining as they all started laughing and loosing motor function at 165 feet of pressure. Then the dolphin swim was a pretty incredible and fun experience; I would highly recommend it.

Dr. Howard arrived last Saturday and this week we all went to the gala fundraiser for Hospitál Roátan. We were concerned that our sundresses and flip-flops wouldn’t cut it for the formal dress code, but we didn’t come prepared for a gala. It was in a nice ballroom at the Henry Morgan resort. In true island fashion, it began about an hour and a half late. The director of the hospital, a few doctors, and the minister of health made speeches about the lack of funding from the Honduran government, the poor or lacking equipment, and the lack of medicines and supplies. Yet, they do have impressive numbers successful treatments, surgeries, and healthy babies delivered, and lives saved. The speeches though did drag on and finally we had a nice dinner. The crowd seemed to be various ex-patriots, business owners, and medical workers. I hope they raised a significant amount of money.

One day this week I got to follow Dr. Nicole and Dr. Rachel on rounds in the maternity ward. There were no deliveries in progress, but I was shocked by the delivery room with its black mold ceiling, lack of sheets on beds, and total lack of privacy. I watched as Dr. Rachel performed a newborn exam and kindly explained to me everything she was looking for on this healthy baby. Sadly, earlier this week we saw a much less healthy baby. A young mother brought in her one month old 1500-gram baby. Dr. Nicole did not believe I weighed correctly because a baby that small would surely be living in the hospital on all sorts of monitors in the US. The baby’s chart did not say how premature the infant was, but the mother said she was able to take him home the same day. Dr. Nicole encouraged her to feed they baby as much as possible and return for weight checks twice a week. This is just one example of a problem that gets let go because of lack of money, space, or resources to conduct proper treatment. A was also surprised to find out, as Dr. Howard told us, the average age of a 1st time mother on Roátan is 14 years old!

One afternoon the doctors did check ups on a few sick kids at the day care in Coxen Hole. They had a difficult time, as there were no records or parents to give health history. We questioned how helpful this was, but realistically some of these kids may otherwise never see a doctor.

Another sad story this week was a woman who brought in a 3 month old with swollen rock hard cervical lymph nodes. She told us that she was in fact not the mother because the mother had died during the birth and this woman was simply given the baby, I’m not sure that she was even related. She was totally unprepared financially for a child but was doing the best she could. The doctors decided to admit the baby to the hospital for care and testing to determine the problem to rule out TB or cancer. The next day we went and bought a can of formula for the woman. She clearly didn’t have much, so we thought at least this would help feed the boy for a few weeks. She was grateful.

This weekend hurricane Ida was projected to hit Roátan, but thankfully it changed course and we had a beautiful sunny weekend. We celebrated Nicole’s birthday and rented a pick up truck and drove to the East end of the island. The one road across the island goes high into the hills and along the ridge the ocean is visible off the North and the South sides. Beautiful views. We went to Camp Bay (a 30 mile drive that took 1.5 hours!). We spent they day there, the only ones on a beautiful expansive beach.

Molly Journal #1

November 1st- Week 1

I’ve been here for 1 week! It already went by quickly. I arrived last Sunday and Dr. Mario picked me up from the airport. I had been so excited looking out the window of the airplane to the blue waters and the mountainous green island below. Excited and nervous. I was finally beginning this experience I’d been looking forward to and planning for months. Up until about a week before I left I wasn’t even sure if or would be able to go because of the current Honduran political mess. But good thing Global Healing decided it was okay, because after a week here I can see that what goes on in Tegucigalpa effects Roátan no more than causing a decline in tourism. Life here is peaceful. Locals I’ve asked say “that is over there in Honduras, but this is Roátan.”

There are currently 2 3rd year pediatric residents from Stanford hospital here, Rachel and Nicole as well as Rachel’s boyfriend Robby. I am living in West End at Julie’s apartments with them as was decided would be best for extra safety precautions in this unusual time. I am very glad to be staying near them as they brought me along out to meals and showed me around West End. Monday was a holiday, although no one could identify what holiday, so the hospital was closed. It was nice to have a few days to settle in to my (bright pink) apartment and get oriented. The weather has been fantastic so far; apparently I just missed a big storm. I have been enjoying the beautiful beach of Half Moon Bay right outside my building. We also made a trip to West Bay, the nicest beach on the island with sparkling turquoise waters and a clean white sand beach. I am impressed by the lack of high-rise mega resorts that have taken over so many beautiful beach destinations.

My first day in clinic was a little overwhelming. I was surprised at how small and run down the public hospital was. We—the obvious American medical crew—walked into the extremely crowded lobby and waded through the waiting people toward clinica 10. There are no appointments, they simply arrive around 6:30 am, get a number, and wait. Robby had been helping out doing the intern job since there wasn’t one for a few weeks. I learned how retrieve the charts from the nurses and dig through the scattered medical records to find the child’s name or birth date. Once the forms are ready, we called in the kids and mothers, yelling their names the best I could pronounce into the crowded hallway. I learned to weigh the child or baby, measure height, take temperature, and plot growth charts. My Spanish was quite wary the first day because I was nervous. Then at the end of the day we record each patient, diagnosis and treatment in a file for the month.

Over the rest of the week I got a hang of the duties and improved my own system of accomplishing them. I am amazed at the number of children who have parasites here. Supposedly 90%! The doctors prescribe medicines for parasites to nearly every child as a routine, because it can be assumed that they have one. We also see a lot of asthma, upper respiratory infections, bronchiolitis, skin infections, and even a boy with Dengue Fever. Many mothers bring their children in for a common cold and are very unsatisfied when the doctor says that prescribing an antibiotic will not help them. They want to walk away with some treatment for their child or they feel the trip was not worth it.

Overall my first week has gone great. I went on 2 beautiful dives, found a great yoga studio, and even celebrated Halloween last night!