Tuesday, January 11, 2011

Nilasha Journal #3

August 1, 2010: Week 3

This week was a short week in the clinic – we only worked Monday, Tuesday and Wednesday. There was a pediatric conference on Thursday and Friday, so all the pediatric clinics were closed. I suspect we had more patients in these 3 days than we normally do because of this closure. We saw over 20 patients everyday, instead of 10-12 patients. I liked being able to see more patients. It kept me in the clinic longer, and we were able to see more sick children. This was also the last week that Dr. Quinn (Kevin) was going to be with us. There is a new doctor coming in on Monday though.

Because we were able to see more patients, there was a larger variety of illnesses aside from the usual diagnoses of parasites, chickenpox, cough/cold and fever. Some of the more notable patients had cancer and hydrocephaly. I felt really bad for these kids because it seems as though they need more medical care than they were receiving here on the island. Both cases were shipped to the mainland for additional care. I really liked these children because even though they had disadvantages, they were still the happiest and least tempermental in the clinic.

Outside of the clinic, I continued teaching in the afternoons with ESL and E-learning. This was going to be the last week for ESL because there was a break in the school session. We did a thorough review of everything we had learned in the last 3-4 weeks and played a couple of games to help the material sink in. We had an awards presentation for those kids who regularly came to the classes. In E-learning, we continued with reading comprehension, vocabulary and spelling. The kids are warming up to me and the other volunteer. They look forward to our lessons and reading sessions.

I’m starting to get into the swing of things here. The weeks are passing by a lot quicker than it did my first week in Roatan. The weather is still a little erratic, but it has gotten a lot cooler. I did a couple tourist-like things like white water rafting and ziplining so far. I plan to go snorkeling more and visit more shops to buy souvenirs soon.

Nilasha Journal #2

July 25, 2010: Week 2

My second week at the hospital went a lot smoother than the first week. This was my first week being the only intern, as the previous intern left last weekend. My Spanish has been improving, and I am able to pick up on new words and phrases quicker now. I have even started making conversation with the patients and the patients’ mothers also (even though my Spanish is still a little broken – but understandable nonetheless). Since I am becoming more efficient in triaging, I am able to shadow the doctors a little more during their exams of the patients. It is interesting to see/hear the thought process of the doctors as they try to come up with a diagnosis. I was also able to follow the doctors on their rounds as they checked-up on the newborns. I learned how to fill out the charts for the newborns and how to do a physical exam on the newborns. The doctors are really helpful and nice about showing me interesting findings and deformities. There was one baby that was in the uterus too long. As a result, his skin was dry and “leathery” because the placenta dried out. After being in the clinic, seeing patients that are least a month old, it was nice to see newborns and their diagnoses. After being in this clinic, I have started considering of specializing in an area of pediatrics. I really like kids, especially the well-behaved kids. There is the occasional child that is afraid of everything and screams all the time. However, all of them are really cute and I can definitely see myself working with kids in the future.

Outside of the clinic, I am still teaching ESL classes and helping English-speaking students with their computer studies. We have moved onto reading comprehension with the English-speaking students. For the ESL classes, we have started on complete sentences and various aspects of introductions, such as names, birthdays, age, likes/dislikes and where they live. Along with working with kids in the clinic, I have discovered that I like teaching a lot. It feels good imparting knowledge to those who are hungry for it. Lastly, I am doing a little bit of research into breastfeeding. Coming to this island and seeing a lot of malnourished children, I am interested in the breastfeeding patterns of the mothers here. Along with my triaging, the Dr. Quinn and I are asking questions about breastfeeding, especially if the child doesn’t eat and/or is underweight. Hopefully with enough data and surveys, I can put together a presentation at Clinica Esperanza or give the information to the social workers at the hospital by the end of my internship.

Nilasha Journal #1

July 18, 2010: Week 1

My first week at the RVPC was a good experience, although it was not was I was expecting. While the Global Healing pediatric clinic is fairly decent, the poverty of the island is obvious looking at the rest of the hospital. Combined with the crowds and the heat, it seems as though coming to the hospital is a terrible experience for the patients and their families. There is also a shortage of doctors, so patients are coming in to wait as early as 6 a.m. to be seen 4-5 hours later. With such little funding from the government the hospital must do the best with what they have. Now I can see why donations are so important.

I really enjoy my clinic duties in the pediatric clinic. The previous intern, Natalia, was very helpful in showing me what to do and where to go. My Spanish was a little rusty coming into Roatan; however, she helped me get my foundation back. I’m becoming more and more confident everyday conversing with the patient’s mothers in Spanish. I was hoping for the clinic to be open longer everyday, rather than just ending around eleven or noon. This is one of my questions for the Global Healing directors – wouldn’t be it more effective to prolong clinic hours (possibly to 2 or 3 pm) so that we could see more patients? But, besides that, I am really enjoying my time in the clinic.

In the afternoons, I do ESL classes with kids aged 6-14 from La Colonia in Sandy Bay. A nice American couple who is living in Sandy Bay for the next 3 years organized the whole thing. I really enjoy working with children because I feel like I can see things from their eyes and explain things that would make sense to them. I also do an E-learning class with some kids near Ms. Peggy’s house a couple afternoons a week. As far as community health is concerned, I am trying to coordinate a survey/intervention with one of the doctors here at the clinic, Dr. Kevin. We have found that most mothers stop breastfeeding very early, or don’t breastfeed at all, thus depriving the infant of important nutrients. We would like to know when, why and what they are using instead. While this will not reduce all of the medical problems children face, it can help with malnutrition and their immune system.

Neha Journal #2

June 1, 2010: Week 2

Prescriptions, Kids, and HIV

Happy june! I can’t believe week 2 in Roatan is already over! Even on island time, time seems to go by so quickly! My days at the clinic last week were really interesting, because only Dra. Sara was here. I would finish up triage and then be able to sit with her during each of her patient consults, which was an awesome shadowing experience. It was cool to see how much of the Spanish I could understand on my own, and Dra would always stop to explain a more confusing medical term, or a complex case. I’ve learned how you can tell when a diarrhea is serious, or if its just a mother with her first baby who is worried about everything- there are so many tricks of the pediatric trade!

We have a new doctor here this week, and she is really cool, but does not speak any Spanish, so I am going to get to do some translating along with my triage-ing. It is definitely a lot of responsibility, but very exciting!

I have come to realize in these two weeks how hard it must be for these mothers to keep up with their prescriptions. For example, yesterday we saw a baby with a terrible ear infection. The medicine for the baby was available in the pharmacy, but the woman brought it back to us because she did not understand the instructions. We found that 1) the bottle was incredibly hard to open 2) she was supposed to mix the powder with water herself (she lived in an area that had no access to clean water) and 3) it was meant to be kept refrigerated for all ten days she had to give it to her baby (she had no electricity, let alone a refrigerator). Thankfully, we were able to mix in some purified water for her at the clinic...but there is no way we can follow up with her every day to make sure the baby is improving. Its really frustrating because we are doing everything we can and the mothers are doing everything they can, but there is no guarantee that the children will get all of their medicine at the appropriate times. I know that for very complex drug regimens, like TB or HIV, lucky patients can sometimes get directly observed treatment, a personal assistant who comes and checks on them every day. While we are only giving out simple treatments/prescriptions, mothers often leave with 2 or 3 (or sometimes 6!), and I wish there was a way to directly observe/help them as well.

Unfortunately, the little boy with the injured foot never returned, and its really sad because the mother did not have a phone, so there is no way to contact him. All we know is the area of the island where they live, but that is not enough to find him. I was hoping/wishing every day that he would show up, but he never did. There are two possible explanations- the mother was frustrated and gave up, or the boy's foot improved with the antibiotics, but I know the latter is just wishful thinking :(

In happier news, I found the Familia Saludables office while wandering around Coxen Hole last week, and I walked in. The women who run it were extremely welcoming, and I will be spending as many hours as I can working over there when I am not at the clinic. Familia Saludable is an HIV/AIDS support organization that runs a variety of programs. They have an infant formula program for about 90 HIV+ mothers, providing free formula to prevent mother-to-child transmission of the virus. They also have a women's support group for HIV+ women that meets once a week. These women work together on various initiatives, such as selling soap and holding a raffle, in order to raise money. I was helping out in their office, which is basically a safe space for anyone who chooses to walk in. Women will come in to get tested, to pick up free condoms, to talk or ask questions, to let their babies play with toys, or just to hang out for a little bit in the air-conditioning.

Working in the office was an awesome and eye-opening experience. Neither of the women who work there speak spanish, and their normal translator is on maternity leave, so as soon as they discovered I could speak spanish, I became their unofficial translator/communicator. Women would come in to get tested, and then end up telling me their life stories. I loved the opportunity to have these longer conversations because it is something that is a bit inappropriate while triage-ing at the clinic, and something that I definitely miss. However, much of what the women were telling me was incredibly depressing and shocking. Sexual abuse, especially child sexual abuse, is a huge issue on this island, as is domestic violence. I am not comfortable giving out the details, but I have realized that the pediatric clinic was only giving me a narrow view of what goes on in Roatan. While I am not positive that my Spanish is good enough to be counseling women about using condoms, I hope I am making sense and being effective!

I am starting my work at the kindergarten this week, and I got a bunch of Miss Peggy's volunteers to help out, so we are reorganizing and repainting the kindergarten and 1st grade classrooms, which will be a lot of fun!

Neha Journal #1

May 23, 2010: Week 1

Journal #1: Welcome to Island Life!

I arrived in Roatan last Saturday, amazed by the airport landing strip only feet away from the beach. At first, I was a bit worried, because I learned that Miss Peggy is out of the country for the month, and I thought I would not be able to make any connections without her. However, I immediately felt welcomed by the volunteer/NGO community. I met several pre-med and nursing students from Miss Peggy's Clinica Esperanza, and the previous HEAL intern, Kate, invited me over for dinner my first night, so I met many of her friends as well. Everyone was super friendly and told me all about the various projects they are involved in.

After a relaxing Sunday on the gorgeous West Bay Beach, I came to the Roatan Hospital to start work on Monday. The hospital was just as I had pictured it- I spent my fall semester in Costa Rica and visited several public hospitals there. It was very crowded, with at least fifty people waiting in line to get their assigned to a clinic. I found out that most patients line up around 6-7 AM, and that the hospital, or at least the pediatrics ward, stops taking new patients by around 9 AM. The mentality seems to be come early, or its not worth coming at all. Kate took me on a quick tour of the hospital, we picked up the day's expedientes (or patient files), and entered Clinica #10, the Global Healing clinic. Its interesting because I had not realized that Global Healing was completely incorporated into the hospital, and is one of the three pediatric clinics to send patients to.

We immediately jumped into work, and began triage. It was to pick up the basics, like filling out the form and asking the standard questions. After two patients where I shadowed, Kate let me try one on my own. At first, I was a bit too cautious with my Spanish, limiting myself to only very robotic questions. I was also baffled by the stethoscope for a while, and found out I had been putting it on in the wrong direction for most of my life. I learned that a baby's heart beats incredibly fast, and that most babies are not a fan of having a cold hard piece of metal on their chests, and that crying children do not usually want their weight measured.

But overall, its been great- the description of the internship was totally accurate. Once Kate left after two days, I really was "directing' the clinic. I come in every morning and set up, begin triage, and wait for the doctora(s) to come. Last week, we had three doctoras here, so they were taking in patients as fast as I finished triage. This week, it is just me and Dr. Sara Sadrzadeh, so I get to sit in for a lot of the patient consults. I've learned a ton about what diseases are common here in children, such as scabies and impetigo, and how to tell a dangerous diarrhea from just a typical rotavirus. I also had the chance to follow the doctoras as they did rounds, doing chequeos for all of the newborn babies, which was a new and interesting experience, both talking to the new moms and learning about all of the possible things that can go wrong in baby development (there are so many, its incredible how many of us turn out okay!) It was really fun to have the three doctoras around and see their different styles of care, and also just to talk to them about their experiences with medical school. Shadowing Dr. Sara has been very interesting as well, and she always takes time to explain to me what she is thinking, and will discuss the case with me in as much depth as I want after the patient has left.

For the first few days, I was not sure how the payment system worked. All of these mothers and children were leaving our clinic with two to three prescriptions- but how were they paying for the drugs? Then, I learned about the many facets of the honduran insurance system. From my understanding, for employed persons there is a seguro social in which they pay a percentage of their income in order to have access to all seguro hospitals. Unfortunately, there is no exclusive seguro hospital on the island, but the Roatan Hospital is sort of the replacement. As a public hospital, all patients have to pay a small fee to be seen (25 lempiras, I believe), and then everything else is free. The emergency room is completely free as well, and since all of the clinicas close by 1 PM, it is where a lot of patients end up going. The system is far from perfect though, because the budget for the hospital can't cover everything. While the pharmacy has seemed well-stocked so far, I can see it easily running out of things.

The one case that has struck me so far was a little boy who came in on Friday. His foot had been run over by a car several months ago, and he spent six months in a hospital in La Cieba (on the mainland) getting plastic surgery. Unfortunately, the surgery had not been a complete success, and the boy came in to our clinic with an incredibly infected foot. We gave him antibiotics for the infection, but he also needed to get back to La Cieba to get a consult. His mom did not have the money for the ferry, so Dr. Sara filled out a form that would give the mother and son permission to take the ferry for free. This form had to be authorized, but the centro refused, saying the boy should just see the orthopedic surgeon in the Roatan Hospital. This didn't make any sense, since the boy needed to see a plastic surgeon, not an orthopedic one. The woman came back to relay the news, but the doctoras had already left, and I was closing up the clinic. I called Dr. Sara, but in order to get the woman onto the ferry, she had to fill out another form, which had to wait until Monday (the hospital in La Cieba would be closed all weekend). I asked the woman to come back on Monday, but I could see her frustration. While I promised we could help her, she has yet to come back. I know the antibiotics eliminated the emergency situation, and the boy should be somewhat okay, but I really hope she comes back, and I will do my best to follow up with this case. Bureaucracy is so frustrating!

The only thing that has been bothering me so far is how much free time I have! Its a silly complaint, but I guess I've always been a bit of a work-aholic, so the idea of finishing up at the clinic before lunch time feels wrong to me. Finding work to do in the afternoons has proved more difficult than I intended, since Miss Peggy is not here for guidance, and the clinica esperanza already has too many volunteers. Schools are about to start their summer breaks, so they do not really need any help with tutoring or anything. But I am excited to start a project this afternoon where I will be helping a local school redecorate/paint/organize its kindergarten classroom! I am also searching for other opportunities, and found a very cool organization called Familia Saludable that I am trying to contact.